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News 5/20/20

May 19, 2020 News 6 Comments

Top News

Microsoft announces Cloud for Healthcare, its first industry-specific cloud offering.

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The platform provides capabilities to deploy virtual visits, assessment chatbots, remote monitoring, referral management, patient engagement tools, and intelligent outreach.

The new Booking app in Teams allows providers to schedule, manage, and conduct virtual visits from inside Teams.

Microsoft is offering a six-month free trial of Cloud for Healthcare.


Reader Comments

From Nutter Round: “Re: Epic. I’m interested in how the company is responding to Wisconsin’s overturning of stay-at-home recommendations. Will it penalize employees who take advantage of the ‘right’ to congregate in bars?” I will invite Epic folk to weigh in, although I can’t imagine that the company is mounting an operation to surveil the after-work activities of its employees.

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From Remote No More: “Re: returning employees to in-office work. I work in the IT department of a healthcare provider in a large city. I’d like to hear how other provider IT departments are planning for such a return. No sense in planning this in a silo.” Good question, thanks. I’ve created a quick response form for provider IT department folks to anonymously describe their policies and practices for bringing remote workers back to the office. HIStalk crowdsourcing is of high value to readers who are looking for ideas, so please take a moment to respond. I’m sure we would all be interested in general hospital policies about bringing at-home workers back to the office as well.

From Long-Time Reader: “Re: not HIT related. A piece of the GI snare broke off during removal of a polyp from my duodenum. My lawyer’s GI expert says standard protocol does not requiring examining the snare afterward to see if it broke since the assumption is that the patient will just pass it anyway.” This was not an anonymous submission and therefore represents a real request for help, so GI clinicians are welcome to comment.

From Media Horror: “Re: MedTech Breakthrough Awards. Seems like yet another shady healthcare racket.” The company is suspiciously protective of its privacy given that it claims to be a marketing intelligence organization even though it seems only to dispense awards. Its minimal online presence hides everything important: physical address, executive names, telephone number, and award judging methodology. It masks its website’s domain registrar and lists no employees on LinkedIn other than the “photo not supplied” and generically named managing director James Johnson. It seems to offer no products or services beyond handing out awards. I can’t say that it’s a health IT racket, but I can say that it at least bears a strong physical resemblance to others I’ve seen that typically involve offshore companies.


HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Narrative Shift. The Herbster, WI-based company crafts written and visual narratives for companies who understand the value of generating excitement and curiosity about their products and services with prospective customers. A powerful narrative builds the brand effectively, gets the attention of prospects, and establishes stickiness with current customers. The company has 23 years of healthcare experience and thus does not require customers to educate its team or to develop their own marketing and sales deliverables. Narrative Shift is especially interested in working with new and founder-led ventures. As the company concludes, “We’ve seen too much crappy marketing and design developed for health technology companies,” motivating it to take on the mission of delivering attractive, witty, creative, and effective messaging. Thanks to Narrative Shift for supporting HIStalk.


Webinars

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


Acquisitions, Funding, Business, and Stock

Cerner joins the Fortune 500 largest US companies by annual revenue, coming in at #498. 

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PE Hub reports that Francisco Partners is looking for a buyer for medical practice scheduling platform vendor QGenda. FP made its growth investment in June 2016. The Atlanta-based company reportedly has EBITDA of $25 million on revenue of $75 million.

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Omada Health, which offers a chronic disease management platform primarily to employers, acquires digital physical therapy solution vendor Physera for a rumored $30 million. Physera has raised $10.8 million, most of it in a March 2019 Series A funding round.


Sales

  • Collective Medical is providing the technology that Cigna uses to quickly identify and manage its customers who visit an ED with symptoms of possible COVID-19 infection.

People

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Experity hires Kim Commito (WellSky) as SVP of product management.


COVID-19

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A JAMA Network editorial says that the federal government could be collecting COVID-related patient data in real time using existing EHRs and HIEs rather than emailed worksheets and anonymous digital thermometer reports, but it would first need to overcome issues such as opt-in requirements, willingness of hospitals to participate given the possible alienation of their profitable patients, and lack of a national identifier. The authors recommend creating a national health IT infrastructure that would allow real-time, patient-level data collection as has been done in other countries (including using cell phone-based location data), but with its use limited to public health emergencies.

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The geospatial expert who developed Florida Department of Health’s COVID-19 dashboard that was touted as the gold standard by the White House says she was fired after refusing to “manually change data to drum up support for the plan to reopen.” Rebekah Jones was offered a settlement to resign after disagreeing with her bosses. They had ordered her remove a column containing the date in which patients said they first experienced symptoms since some of those occurred weeks before the state officially admitted that residents had been infected. Florida’s government has declined to provide race and ethnicity case details and won’t give scientists the underlying data that the site uses to allow them to perform their own analyses, while a graph published by the Georgia Department of Health that showed a continuous case decline was found to have been sorted in descending rather than chronological order.

President Trump tells reporters that he is taking the unproven malaria drug hydroxychloroquine to prevent coronavirus infection. Asked about the medical evidence that supports his decision, he replied, “Here’s my evidence: I get a lot of calls about it.” FDA softened its previous advice immediately after the president’s statement, moving from a position that consumers should not take the drug outside the hospital setting to advising that it’s up to them and their doctor to decide.

Fluid physics researchers determine that six-foot physical distancing is adequate as long as wind speed is zero, but saliva droplets can travel up to 20 feet in even a light breeze.

Moderna reports that the coronavirus vaccine it is developing has raised antibodies in the eight patients who are receiving it, with levels comparable to those seen in recovered COVID-19 patients. Experts warn that many drug trials look good in early phases but fail quickly afterward.

A preliminary, small study in South Korea finds that recovering COVID-19 patients do not spread infection, as the virus they shed is dead. The government will therefore allow patients who have been discharged from isolation to return to work or school without obtaining a final negative test.

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COVID Exit Strategy maps the readiness of states to reopen safely based on the White House-issued gating strategy of disease spread, hospital capacity, and testing capacity.

Utah, North Dakota, and South Dakota have rolled out contact tracing apps without much success in generating participation rates of under 2%. Utah’s Healthy Together app has resulted in zero instances in which contracts were traced.

A health reform professor says she was wrong in calling for the federal government to require that private insurance pay for COVID-19 testing. Reasons: a huge number of people need to be tested, many of them retested repeatedly; providers can set whatever price they want with the cost ranging from $50 to $1,000 per test; it doesn’t help people who don’t have insurance; and insurers will need to reduce test access or raise premiums to cover the cost. She says a better approach is a testing and vaccination fund, overseen by the federal government, to provide free diagnostic and antibody tests for anyone who needs them to return to work or classes. That group could also negotiate pricing for a vaccine if and when one is developed.


Sponsor Updates

  • MassChallenge features CareSignal in its new video, “Innovation in the Age of COVID-19.”
  • Meditech AVPs Janet Desroche and Cathy Turner, RN speak with ANIA President Cheryl Parker, PhD, RN about the company’s response to the COVID-19 outbreak.
  • Experian launches an interactive US map showing populations most susceptible to developing severe cases of COVID-19.
  • MedTech Breakthrough names Kyruus Provider Match for Consumers as its “Best Patient Registration & Scheduling Solution.”
  • Vocera Vina is named “Best Overall MHealth Solution” in the MedTech Breakthrough Awards.”
  • Clinical Architecture releases the latest edition of its Informonster Podcast, “A History and Analysis of ICD-10.”
  • ConnectiveRx will participate in a virtual job fair May 27 from 8:30-10 a.m.

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 5/18/20

May 17, 2020 News 1 Comment

Top News

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Cerner will begin moving employees back on campus Monday, starting with 10% of its workforce and aiming for no more than 50%.

Employees will be encouraged to wear masks, fitness centers and cafeterias will be closed, elevators will be limited to two passengers, and staircases will be designated as one way.

The company says positions in its consulting and client support areas may remain virtual permanently.


Reader Comments

From Allscripts Insider: “Re: Allscripts layoffs. About 60 people on Monday, several of whom I know.” Unverified, but reported by several folks.


HIStalk Announcements and Requests

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Few poll respondents have been tested for COVID-19, although a significant percentage tried but couldn’t get access to a test. Maybe I should ask about antibody testing now that those are more widely available.

New poll to your right or here: How do you expect your family’s financial security to look on January 1, 2022 compared to the same day in 2020?


Webinars

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


Acquisitions, Funding, Business, and Stock

In Asia, health tech giant Ping An Healthcare, whose market cap is $15 billion, removes Wang Tao as chairman, executive director, and CEO.


Announcements and Implementations

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Banner Health launches chatbot-powered “virtual waiting rooms” from LifeLink to collect patient check-in information before all telehealth and in-person office visits.

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Microsoft and UnitedHealth Group offer their self-developed ProtectWell coronavirus symptom screening app, which they will use for their own employees, to all US companies at no charge.


COVID-19

Few of the 1,200 LifeBridge Health employees who have been tested for COVID-19 antibodies are positive, suggesting that most of its employees do not have immunity.

In England, BBC looks at the healthcare technologies that have changed in response to COVID-19:

  • One hospital developed a “call for help” app for ICU workers who need assistance and who otherwise would need to leave a patient’s room and use another set of PPE, with the app featuring large fonts for viewing through visors and sensitive buttons that respond to double-gloved fingers.
  • Expanded staffing of the NHS’s 111 national non-emergency medical help line.
  • Creation of machine learning models that predict demand for ICU beds and ventilators, now being extended to estimate length of stay.
  • Rapid rollout of video consults, with 88% of GP practices in Wales offering them within a month, after which their use was extended to hospitals, mental health services, and nursing homes.

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Former National Coordinator David Blumenthal, MD, MPP and his brother, Senator Richard Blumenthal, JD (D-CT) warn that COVID-19 contact tracing – whether by app or by human contact tracers – is intrusive by definition, as identifying contacts requires reviewing social media posts, text messages, credit card statements, and other personal records. They say that while the notification system that Apple and Google are rolling out limits contains privacy-preserving technologies, the US is overdue for a federal consumer privacy law. Senator Blumenthal and several other Democratic senators and representatives introduced on Thursday the Public Health Emergency Privacy Act, which would require individuals to opt in, require that data that is collected for pandemic efforts be deleted afterward, and prohibit using the data for purposes outside of public health.

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FDA orders the shutdown of a broadly supported Seattle COVID-19 population testing program pending federal government review. Seattle Coronavirus Assessment Network ran afoul of FDA by telling participants the result of their tests, which places the program within the realm of diagnostic – rather than surveillance – testing, requiring a different FDA group to review the safety and accuracy of its at-home collection kits. A predecessor program that identified the first US cases of COVID-19 infection using patient swabs from a previous flu study was ordered closed by federal and state officials because the researchers did not have patient consent for the new use of their samples and their lab was not certified for diagnostic testing.

New York City Mayor Bill de Blasio chooses Health and Hospitals to run the city’s COVID-19 contact tracing program instead of the Health Department, which has extensive experience in doing the same work for tuberculosis and HIV. Health and Hospitals CEO, Mitchell Katz, MD had previously urged the mayor to avoid mitigation measures, arguing that most people recover and will then contribute to herd immunity. Katz’s predecessor says, “Just because they both have ‘health’ in the name doesn’t mean they’re in the same business … this is a job for the Health Department.”

Former FDA Commissioner Scott Gottlieb, MD notes that the pandemic has slowed dramatically in the US after a long plateau, a trend that could be boosted by seasonality as summer sets in. Cases are declining or flat in most states, but a handful have an expanding case count and relaxation of mitigation steps will cause growth. He also notes that 40% of states don’t report COVID-related hospitalization, so the national count is incomplete.


Sponsor Updates

  • Health Catalyst appoints Mark Templeton (DigitalOcean) to its board.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Clinical Concepts in Obstetrics podcast, “Team Skills.”
  • Spirion raises over $9,000 for local restaurant workers impacted by COVID-19 closures through its This One is On Us restaurant relief program.
  • StayWell publishes a new infographic, “Content marketing strategies to recharge from COVID-19.”
  • Surescripts publishes a new report, “Pharmacist Perspectives on the Specialty Fulfillment Process.”
  • TriNetX adds the Brazil-based Techtrials integrated, real-world dataset to its global health research network.
  • Vocera publishes a new CNO Perspective, “Nurses Have Stepped Up. Now It’s Time to Support Them as We Move Forward.”

Blog Posts


Contacts

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

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News 5/15/20

May 14, 2020 News 9 Comments

Top News

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

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


HIStalk Announcements and Requests

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Welcome to new HIStalk Gold Sponsor Pure Storage. The Mountain View, CA-based, NYSE-traded company gives technologists their time back. Pure delivers a modern data experience that empowers organizations to run their operations as a true, automated, storage-as-a-service model seamlessly across multiple clouds. One of the fastest-growing enterprise IT companies in history, Pure helps customers put data to use while reducing the complexity and expense of managing the infrastructure behind it. Healthcare organizations enjoy always-available EHR information with always-on encryption and quality of service, with no performance impact and no tuning required. Virtual desktop infrastructure applications are accelerated with <1 ms latency and 99.9999% FlashArray availability. With a certified customer satisfaction score in the top one percent of B2B companies, Pure’s ever-expanding list of customers — which includes Atlantic Health System, Carilion Clinic, and Intermountain Healthcare – are among the happiest in the world. Thanks to Pure Storage for supporting HIStalk


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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


Sales

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

People

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

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

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

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


Announcements and Implementations

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

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

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

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

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


Government and Politics

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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


Other

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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News 5/13/20

May 12, 2020 News No Comments

Top News

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The American Medical Association publishes privacy advocacy principles that address the reluctance of some patients to share information with their physicians over fears that data brokers and technology companies will misuse it. The AMA is targeting third parties that gain access to patient information, but that are not covered entities that are bound by HIPAA. Some of its points:

  • People should be told before their data is collected how it will be accessed, used, disclosed, or processed, along with the purpose that is involved and any secondary use by others.
  • They should be able to opt out of having their data sold or shared.
  • They need to be able to protect and share information at a granular level instead of at the document level.
  • They should be able to direct a provider to delete their data throughout its ecosystem, including when an entity closes or is acquired.
  • People should be able to download their information in machine-readable form.
  • A patient’s data should be used to train algorithms only when the patient has opted in.
  • Medical records apps should allow users to add annotations to their copy of the record.
  • Notices of privacy practices should be written at an elementary school reading level and avoid ambiguous terms such as “we may share this data with our partners to improve quality.”
  • Entities should make their de-identification processes publicly available.
  • FTC should be empowered to define unfair data processing practices, minimum privacy and security standards, and minimum data elements for specific purposes. It should also be given authority to establish fines that are based on level of disregard or knowing conduct.

Reader Comments

From Amazon Primate: “Re: Atul Gawande. Surely he is getting fired and not just stepping back from Haven.” I was puzzled when the three sprawling corporations chose the high-profile Gawande because of his lack of experience running a big company and his insistence on keeping his day jobs as an author and surgeon, so Haven seemed more like an ivory tower Boston think tank than a hard-charging startup (the company is a non-profit, after all). The real question is, what expectations do Haven’s joint venture owners – Amazon, Berkshire Hathaway, and JPMorgan Chase – have for the company now that it has paddled along seemingly aimlessly for two years? Everybody (except Optum) wanted it to be a disruptor in prescriptions, primary care, analytics, and insurance, but its announced purpose was simply to lower healthcare costs for those three companies alone, not to barge belligerently into the swanky country club of healthcare’s good old boys to benefit society. I would be wary of any company that can’t even pick a name for itself in its 14 months. Haven’s chances would probably have been better if it was Amazon alone running the show, although Amazon’s PillPack hasn’t exactly kicked a dent in the healthcare universe.


HIStalk Announcements and Requests

I’m probably the only Gmail user who didn’t already know this, but I discovered today that an email that has been routed to the Social or Promotions category tabs can be dragged and dropped onto the Primary tab. This is good for me since I usually mass delete everything that isn’t in the Primary tab, but sometimes I want to use an email from there as a reminder (like some site having a sale).


Webinars

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


Acquisitions, Funding, Business, and Stock

In the Netherlands, Gilde Buy Out Partners will acquire medical software vendor Corilus from its private equity owner.


Sales

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  • In the Netherlands, Franciscus Gasthuis & Vlietland goes live on contact-free continuous monitoring from EarlySense, whose system tracks 100 data points per minute using a sensor placed under the patient’s mattress. A wall-mounted display outside the patient’s room, plus the lack of sensors and wires that require adjustment, minimizes caregiver contact with isolated patients.
  • Guam Hospital Authority chooses Medsphere’s CareVue EHR. I believe it will replace Cantata Health’s Optimum system.
  • Connecticut Children’s Medical will implement Keriton Kare’s breast milk management system.
  • Baystate Health (MA) integrates HCPro’s clinical document improvement physician query templates in Artifact Health’s mobile platform. 

Announcements and Implementations

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A new KLAS report looks at how inpatient EHR vendors are using AI. Epic is the only vendor with a significant number of live sites, with over 100 customers using its Cognitive Computing Platform for predicting readmissions, patient risk, mortality, ED, at-home fall risk, sepsis, hospital-acquired disease and patient deterioration. Epic’s customers choose its platform to avoid bringing in another vendor and report that it is easy to deploy its machine learning models. Customers who are accustomed to Epic’s out-of-the-box model report slightly lower satisfaction, often because they haven’t addressed the operational challenge of acting on its recommendations. Cerner has a handful of customers live on HealtheDataLab, which is a self-development toolkit rather than a package of pre-built models.

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Yale New Haven Health System goes live on Capsule’s Ventilated Patient Surveillance workstation to monitor COVID-19 patients. The enhancement to Capsule’s Remote Surveillance application – which YNHHS uses for its InSight Tele-ICU program – monitors streaming data from ventilator and escalates events to clinicians. The hospital’s temporary ICU rooms don’t always have hall windows, so the workstation allows monitoring medical devices in the absence of direct visibility. Capsule is offering clients free licenses for at least six months.


COVID-19

In the UK, NHS and researchers analyze the de-identified records of 17.4 million adults using the OpenSAFELY analytics platform. They found that COVID-19 patients are more likely to die if they are of Asian or black ethnic origin, poor, male, or have uncontrolled diabetes or severe asthma. The study notes that the higher mortality rate of people who are not white and who live in deprived areas cannot be attributed to co-morbidity, validating policies that protect the highest-risk residents. The OpenSAFELY team developed the platform in five weeks with no funding, running its analysis within the platform of EHR vendor TPP’s SystmOne.

Seniors who are worried about the reported poor outcomes and long-term consequences of being placed on a ventilator are adding “no intubation” statements to their advance directives. Experts admit that ventilator survival rates are low, but add that study methodologies have been inconsistent, some hospitals in other countries were overwhelmed and that likely made deaths more likely, and healthy adults fare better than those who have debilitating chronic conditions, making the intubation decision for a given individual less clear.

New York City hires Salesforce to create its contact tracing program, which includes a call center, CRM system, and a case management system to augment the work of 2,500 contact tracers.

Stanford University psychiatry professor Keith Humphreys, PhD says that public health experts are overly optimistic in thinking that the US can match the contract tracing success of other countries. He says US residents aren’t deferential to government authority, they closely guard information about where they live and work, and they probably won’t stay home for 14 days just because a health worker asks them to. He urges officials to consider what will happen if people refuse to be tested or defy orders to isolate, predicting that we’ll end up with a Swedish coronavirus policy (voluntary measures only) not because we chose it, but because we couldn’t agree on an alternative.

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Researchers find that a symptom checking app that is being used by 2.5 million people in the US, UK, and Sweden can determine with 80% accuracy whether a user has COVID-19 based on just their age, sex, and presence or absence of four symptoms: loss of taste or smell, persistent cough, fatigue, and loss of appetite. COVID Symptom Study found that the loss of taste and smell was the strongest predictor and was rarely wrong, having been reported by two-thirds of the 15,000 app users who eventually tested positive.

Wuhan, China discovers six new cases of COVID-19, and as a result, will test every one of the city’s 11 million residents over a 10-day period. The US has administered 9 million tests in total with 25,000 new cases per day and a world-leading 80,000 deaths. We have more new cases per million residents per day at 76 as a real-time measure of infection spread, with Russia, the UK, and Sweden trailing not far behind.

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Mercy Health Hackley Campus fires Justin Howe, RN 10 days after he spoke to a newspaper about the hospital’s failure to provide PPE and its ban on employees bringing in their own masks. The hospital claims that Howe, who is president of the nurse’s union local, violated HIPAA by accessing medical records inappropriately.


Other

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The Indianapolis business paper profiles startup Olio, whose mobile app is used by nursing homes to alert hospitals that a patient they have transferred there needs assessment or treatment, potentially avoiding an automatic trip to the ED.

Beth Israel Deaconess Medical Center describes how its clinicians were overwhelmed by its move to telehealth visits because tasks that were previously performed by medical assistants before the physician entered the exam room — measuring vital signs, documenting the chief complaint, reconciling medications, and managing prescription renewals – became the physician’s job. BIDMC created a pre-visit survey via OpenNotes that patients were invited to complete via a patient portal message, with their entries then being saved in the EHR for pre-visit review or copying and pasting into the note.

I don’t think I’ve ever heard of the Future of Health conference, but if you have and you care, it will go virtual for the September 23-25 event at a registration cost of $995 for providers (free for those who are willing to sit through six virtual company pitch sessions, which I’m guessing is all of the provider attendees). Maybe demand is unmet for the chance to stare at a monitor and webcam all day, or to hang out in a virtual exhibit hall.

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Weird News Andy urges readers to spare the rod. In Israel, a construction worker who felt OK after he fell from a second-floor walkway realizes from the reaction of bystanders that a metal rod had penetrated his head. Surgeons removed the rod and were surprised to find afterward that the man seems to be fine, with no damage to his speech or ability to walk.


Sponsor Updates

  • Datica releases a new episode of its 4×4 Health podcast, “Working in Healthcare: Vasanth Kainkaryam.”
  • Black Book Market Researchers publishes the third installment of its survey series gauging consumer attitudes towards seeking medical care during the pandemic.
  • ConnectiveRx SVP of Business Development John Herley wins PM360’s Elite Sales MVP Award.

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 5/11/20

May 10, 2020 News 6 Comments

Top News

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From the Allscripts earnings call, following a Q1 report in which the company fell short of analyst expectations for both revenue and earnings:

  • The company’s 22 Virtual HIMSS sessions drew 900 registrants.
  • Virtual visits conducted with FollowMyHealth’s telehealth platform went from no demand to 70,000 visits in April.
  • The virtual visit platform is licensed on a per-provider, per-month model, with President Rick Poulton explaining that patients are seen by their own hospital-provided doctor instead of “whoever happens to be hanging out on a couch that day.”
  • 500 researchers have applied for access to its Veradigm COVID-19 research database.
  • Its CarePort care transition system has tracked the care of 22,000 COVID-19 patients across settings, with early findings indicating that 10% of middle-aged hospitalized patients who are diagnosed with COVID-19 die .
  • Allscripts estimates that the pandemic impacted its Q1 revenues by $7-10 million, from both lower volumes and delayed purchase decisions, and otherwise the company would have met its revenue guidance.
  • Memorial Sloan Kettering Cancer Center is among the health systems that have extended their inpatient system agreements at a total value of $100 million.
  • The company eliminated $75 million in annualized costs via layoffs in late March through April.
  • Allscripts is reviewing its product lines to see if any non-core businesses should be sold.
  • The company doesn’t expect to spend capital on acquisitions any time soon.

MDRX shares closed up 9% Friday, returning the company’s market cap to just over $1 billion. They are down 38% in the past year versus the Nasdaq’s 14% gain.


Reader Comments

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From CPAhole: “Re: contracts. I’m interested in how companies and providers will change their agreements after this pandemic. The typical force majeure clause just doesn’t cut it here.” I’ll run a survey for vendors and customers to describe any changes they’ll make to agreements going forward to address issues that the pandemic has exposed  — like providers being unable to pay their bills, vendors being unable to perform on-site services, or companies protecting themselves in pre-acquisition due diligence. The rarely invoked, usually boilerplated force majeure T&C will undergo new scrutiny and legal tests as pandemic-driven economic issues force vendors and customers into uncharted territory, like HIMSS citing that clause in refusing to issue HIMSS20 exhibitor refunds.


HIStalk Announcements and Requests

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The idea of using tech-powered contact tracing to control the coronavirus takes a hit from last week’s poll. Two-thirds of readers (who are heavily involved in healthcare and technology) say they won’t use the Apple-Google app right away, echoing the likelihood that the US won’t see anywhere near the 60% adoption that is required for effectiveness.

New poll to your right or here: Have you been tested for active COVID-19 infection?

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

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Listening: Michael Kiwanuka, the British singer-songwriter who provides the haunting opening theme to “Big Little Lies,” which we’re watching on Prime Video. It’s the perfect spacey, mysterious intro to a show set on and around the beaches of Monterey, CA. It’s just as connected to the series as the use of Cecelia Krull’s “My Life Is Going On” on “Money Heist.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Atul Gawande, MD, MPH will resign as CEO of Haven Healthcare and move to a less-operational role as chairman, insiders report. The Amazon – Berkshire – JPMorgan company, which has had minimal healthcare impact since its splashy debut in January 2018, is searching for a new CEO as Gawande’s interests refocus on coronavirus policy and advocacy work. Haven COO Jack Stoddard resigned last year after nine months on the job and was not replaced.

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Livongo reports Q1 results: revenue up 115%, EPS -$0.06 vs. -$0.79, beating Wall Street expectations for both. The company said in the earnings call that it has been selected by the Government Employee Health Association that provides medical and dental plans to 2 million employees. LVGO shares are up 42% versus the Nasdaq’s 11% rise since the company’s July 2019 IPO, valuing it a $5 billion. Executive Chairman Glen Tullman owns shares worth $344 million, while CFO Lee Shapiro’s holdings are worth $302 million.


Sales

  • Willis-Knighton Health System (LA) chooses CloudWave’s OpSus Healthcare Cloud for hosting its Meditech Expanse system that is being implemented. 

People

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Nordic promotes John Manzuk to SVP of managed services delivery.


COVID-19

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A New York Times report finds that virus-wary Americans had already slowed their spending, traveling, and dining out before lockdown orders were issued, raising the strong possibility that state re-openings won’t restore the pre-pandemic economy as businesses and potential customers remain unconvinced that it’s safe to conduct person-to-person business.

FDA Commissioner Stephen Hahn, MD, NIAID Director Anthony Fauci, MD, and CDC Director Robert Redfield, MD are self-quarantining for 14 days after being exposed to Vice-President Pence’s spokesperson Katie Miller, who has tested positive for COVID-19.

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The Department of Justice charges Henry Gindt II with selling stolen COVID-19 test kits directly to patients for up to $200 through his YouHealth website, then failing to provide the test results. Gindt’s LinkedIn says he was a co-founder of President Trump’s Office of American Innovation, where he says, “Key wins included combining the electronic medical records (EMRs) of Department of Defense and VA employees and soldiers.”

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A researcher identifies what he says is a flaw in India’s government-mandated COVID-19 contact tracing app – which uses both GPS and Bluetooth — that allows him to identify the location of all infected users. The government requires all employees and military members to use Aarogya Setu, as well as people who live in containment zones and those who are returning from other countries. The app presents a chatbot-powered symptom checker and travel history questionnaire and health authorities track answers in a database and contact those who might be infected.

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NYC Health + Hospitals investigates ED nurse Lillian Udell, who recorded her co-workers talking about shortages of PPE. The health system says she violated HIPAA even though no patients were shown. Another nurse whose PPE pleas on “60 Minutes” earned the praise of the hospital’s president said of Udell’s case, “I feel like a lot of hospitals are using HIPAA almost under the guise of patient protection and safety, and privacy safety. But really it becomes more apparent to me, at least, that HIPAA is kind of being used to gag people. We’re all experiencing the most difficult working conditions we’ve ever faced. And everybody who is speaking out is doing so to advocate for patients, ultimately. It looks like hospital administrations tend to run to HIPAA for their protection, not so much patient protection.”


Other

Kaiser Health News notes that at least half of the top 10 recipients of HHS’s emergency provider funding have either paid criminal penalties or settled billing fraud charges in the past. Florida Cancer Specialists & Research Institute, which hasn’t started paying its recently imposed $100 million federal penalty for anti-competitive practices, got $67 million in federal bailout money. Experts observe the irony of health systems being paid at rates that are based on their Medicare billing when they were also accused with falsely inflating their Medicare bills through fraud and abuse. Other health systems that are in the top 10 that have paid to settle fraud charges are Dignity Health, Cleveland Clinic, Memorial Hermann, and Mass General.

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A display company in Colombia offers small hospitals an $85 cardboard patient bed that, if the occupant dies, converts to a casket.


Sponsor Updates

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  • PatientKeeper supports healthcare workers at Portsmouth Regional Hospital.
  • MDLive reports significant growth of its behavioral health business as its virtual therapy service provides safe, timely access to care during the pandemic.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new edition of its Critical Care Obstetrics podcast, “Sepsis Simplified.”
  • RxVIP Concierge offers CareSignal’s COVID Companion text-messaging app through its new “Stand Up to COVID19” patient initiative.
  • Relatient joins the Cerner App Gallery with mobile-first self-scheduling and waitlist solutions.
  • T-System offers DrFirst’s telemedicine software to its urgent care and emergency department customers.

Blog Posts


Contacts

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

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News 5/8/20

May 7, 2020 News No Comments

Top News

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Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.09 vs. $0.16, missing Wall Street expectations for both.

MDRX shares dropped 6% in after-hours trading immediately following the announcement after closing up 6.5% on the day. The company’s market capitalization is $952 million.


HIStalk Announcements and Requests

I fixed HIStalk’s mobile layout, also adding an option to place an icon on your device’s home screen to enable one-click access.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Shares of embedded communications technology vendor Twilio, which Epic recently chose to power its telehealth offering, rose 25% Wednesday after  the company reported a Q1 revenue increase of 57% to $365 million. The company also raised Q2 revenue guidance by another 35%. Twilio is valued at $22 billion.

The US Court of Appeals upholds a district court’s dismissal of a class action lawsuit against EClinicalWorks in which the estates of two deceased patients claimed that errors in ECW’s system displayed incomplete or inaccurate patient data to providers. The appeals court says the plaintiffs lacked standing to sue because they provided no proof that anyone was harmed.

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CVS Health announces Q1 results: revenue up 8%, EPS $1.91 vs. $1.63, beating analyst expectations for both. The retailer saw a 600% jump in telemedicine visits through its MinuteClinics, part of an overall spike in its digital services that helped the essential business realize first-quarter sales of $67 billion.


Sales

  • Perry Community Hospital will use remote cardiac and respiratory monitoring software from Coala Life to launch a remote monitoring program for its patients in rural Tennessee.

Announcements and Implementations

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CarePort Health releases an interoperability solution that meets CMS’s Conditions of Participation requirement that hospitals send ADT notifications to primary care physicians and post-acute care providers.

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Premier adds perinatal quality analytics to its QualityAdvisor improvement software.

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LogMeIn releases a healthcare edition of its GoToMeeting videoconferencing platform that meets HIPAA requirements by offering a Business Associate Agreement, with a cost of $16 per user per month for unlimited sessions and minutes.

Intelligent Medical Objects releases an open source standardized terminology package for COVID-19 that allows aggregating and sharing patient problems, procedures, and labs information.


People

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Experity names Callan Young (Anaplan) SVP of marketing.

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Wil Lukens (CenTrak) joins Critical Alert as VP of sales.

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Wolters Kluwer Health hires Frank Jackson (Prognos Health) as VP/GM of its Health Language business.


Government and Politics

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HHS awards $583 million to 1,400 federally-funded health centers to help them expand COVID-19 testing.

HHS publishes a list of the 142,000 healthcare providers that received money from the $50 billion HRSA Provider Relief Fund, in which money was paid based on their Medicare net patient revenue. The median payment was $9,600, the average $142,000. The top 10 recipients are:

  1. Dignity Health ($180 million)
  2. Cleveland Clinic ($103 miliion)
  3. Stanford Health Care $(102 million)
  4. Memorial Hermann Health System ($92 million)
  5. NYU Langone Health ($92 million)
  6. County of Los Angeles ($81 million)
  7. HMH Hospitals $(77 million)
  8. Florida Cancer Specialists and Research Institute ($67 million)
  9. Memorial Hospital for Cancer and Allied Diseases ($64 million)
  10. Massachusetts General Hospital ($58 million)

HHS OIG creates freely available statistical tools for analyzing prescription claims data to identify patients who are at risk of opioid misuse or overdose.


COVID-19

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The White House rejects CDC’s recommendations — which it commissioned — on when and how state and local officials should allow business owners, restaurants, schools, and churches to reopen. “Guidance for Implementing the Opening Up America Again Framework” was supposed to have been published Friday, but the public health agency’s scientists were told it “would never see the light of day.” The White House repeated in a Wednesday briefing that states are responsible for their own COVID-19 response.

A Premier survey finds that hospitals will need to expand their COVID-19 testing capacity by more than 200% to even partially resume full services. The hospitals say they are constrained by lack of testing reagents (41%) and swabs (40%). Most hospitals hope to screen employees for coronavirus symptoms before resuming non-emergency procedures, but just 32% say they have enough COVID-19 tests for frontline workers, so most will limit testing to those employees who exhibit symptoms.

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Government officials in the UK consider rolling out “immunity passports” to qualifying individuals as part of forthcoming plans to ease the country’s lockdown. The digital certificate would incorporate facial biometrics and antibody test results into an app that employees could use to gain entry into their workplaces.

NIH launches a study to determine whether the low number of reported cases in children is due to natural immunity or infection without symptoms.

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The US — unlike Italy, Spain and China —has not seen a significant decrease in daily new cases following the infection’s peak, which occurred here on April 26, causing former FDA Commissioner Scott Gottlieb, MD to warn that the virus could continue as a “slow burn of infection across the country … we still have a lot of infection.”

Axios reports that some White House officials believe that COVID-19 death counts are being inflated because hospitals get paid more for treating coronavirus patients. Other insiders believe the actual number is lower because presumptive cases are not being verified by autopsy, also noting that data reporting standards are not uniform.

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An MIT Technology Review article says epidemiologists and public health experts struggle to draw population-level conclusions from COVID-19 testing results, as each state sets its own standards for data collection and reporting. Some states still accept provider reporting via fax and Excel. The results of at-home tests won’t necessarily be reported to the state at all, and those tests have varying accuracy. The authors recommend using CDC’s FHIR-based tool to report directly from EHRs and non-profit Logica has developed an open source interoperability platform for health system COVID-19 reporting. Experts say that it would be ideal if the federal government took the lead on public health data efforts, but that isn’t likely to happen.

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Johns Hopkins University updates its COVID Control study app, in which volunteers submit their temperatures and any symptoms daily to detect outbreaks.

In England, Imperial College epidemiologist Neil Ferguson — whose group’s prediction of massive numbers of COVID-19 deaths in the absence of mitigation strategies led the UK and US governments to implement drastic measures — quits his UK government advisory role after a newspaper reports that he broke the stay-at-home rules he advocated by allowing his girlfriend to visit him. Complicating the issue is that both Ferguson (called “Professor Lockdown” there) and his girlfriend are married to other people, each of them have children at home, Ferguson has tested positive for coronavirus, and the woman says her husband is showing symptoms.


Other

Germany-based hospital and dialysis center operator Fresenius is hit with a ransomware attack. US and UK government cybersecurity centers warned Tuesday that state-sponsored hacking teams are targeting organizations that are involved in COVID-19 response.

A JAMIA-published study looks at how Mayo Clinic’s move from Cerner to Epic affected its patient satisfaction scores, concluding that the scores dropped significantly and didn’t return to previous levels for 9-15 months. Areas most affected were access, wait time, and receiving information about delays. Satisfaction dropped before go-live, which the authors hypothesize was due to schedulers using two systems and implementing new processes as well as pulling team members offline for training.

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In England, anonymous artist Banksy creates a painting for Southampton General Hospital depicting a child replacing his superhero dolls with one of a nurse.

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Good tweet.


Sponsor Updates

  • Goliath Technologies releases a new video, “How to Reduce Barriers to Clinician Satisfaction with Cerner.”
  • Wolters Kluwer Health launches a Rapid Onboarding module in Lippincott Procedures to help hospitals prepare nurses for COVID-19 care.
  • Impact Advisors hires James McHugh (Guidehouse) as managing director.
  • Intelligent Medical Objects releases a new e-book, “Leveraging the EHR for effective clinical workflows.”
  • InterSystems releases a new PulseCast podcast, “Don Woodlock: Capturing Cleaner Data Across the Care Continuum.”
  • Spok supports and honors nurses during Nurses Week.
  • The local paper profiles the Western PA Home & Community Task Force’s use of CarePort Health’s Guide technology, which helps connect hospitals with best-fit, post-acute care facilities for their patients.

Blog Posts


Contacts

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

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News 5/6/20

May 5, 2020 News 3 Comments

Top News

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Change Healthcare acquires ERx Network for $213 million.

The pharmacy claims and e-prescribing network reports $67 million in annual revenue.


Reader Comments

From Staying At Home Marketer: “Re: HIMSS conference. We learned this year that many people can work entirely from home, including doctors doing telemedicine. This could be the year that we learn the same about physically attending the HIMSS conference.” That could be the case. Vendors are (or will be) looking for new ways to reach prospects that go beyond the exhibit hall and its associated cost, and the exhibit hall is what powers not only the conference, but HIMSS itself. The conference will probably remain a big deal for those vendors who continue to participate even with its reduced critical mass, but others (especially those with shallower pockets) have a chance to even the playing field now that we’ve skipped a HIMSS conference and nobody is traveling. I’m hearing from companies that are interested in sponsoring HIStalk that I didn’t expect, although I’m losing some financially concerned ones as I assumed would happen. It will be interesting to see which companies benefit from adversity-forced strategic moves that go beyond trying to hunker down waiting for the old normal to come back.

From Opening Up: “Re: contact tracing. Technology could lead us out of this crisis.” Hardly, at least in terms of information technology in this country. We don’t have the discipline (and maybe rightfully so) to hide in our caves in hopes that someone will develop a vaccine or effective treatment. However, we trailed the world with our lackadaisical, “it will never happen here” approach to the virus while it was still potentially containable, so now the infection rate is out of control to stay, we’re a long way from herd immunity if there even such a thing with this bug, and you can’t contact-trace the entire country’s movements even with an app. Still, we need to use whatever tools we have available. I think we’re at a point, right or wrong, where we’re so anxious to get back to normal that we are willing to accept the inevitable casualties that will result (assuming it is someone else or their family, of course). It’s a good time to not be old, poor, or sick as we accept herd thinning as the acceptable price of avoiding an economic Stone Age. I’m struggling to find the right answer, or maybe struggling with the knowledge that any choice will kill people.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Infor. Infor Healthcare connects the business of healthcare with the mission of healthcare. Its healthcare operations platform elevates ERP to a strategic resource, enhancing delivery across the care continuum by delivering clinically connected capabilities that improve cost, quality, and outcomes. By bringing together supply chain management, finance, human resources, time and attendance, asset management, location-based intelligence, interoperability, and analytics, Infor gives healthcare organizations an industry-specific alternative to traditional enterprise resource planning (ERP) software. Thanks to Infor for supporting HIStalk.

HIStalk had some flaky moments on Monday during a denial-of-service attack that tied me up from Sunday morning until Monday night. I’m still doing some mostly unrelated cleanup that I discovered while figuring out the problem. One of those involves issues with the HIStalk display on mobile devices, which remains a work in progress since the original development company has abandoned the product I was using.

I caught up unexpectedly with Justen Deal (now Justen Burdette), who readers may remember as the 20-something Kaiser Permanente IT employee who in 2006 warned the organization about the uncertain of costs and stability of Epic, which was replacing a $440 million custom-written IBM system. Epic seems to have turned out fine at KP, so for the “everybody lived happily after” ending, Justen is living in Hawaii as CEO of mobile wireless provider Mobi.


Webinars

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


Acquisitions, Funding, Business, and Stock

Kaufman Hall acquires the Connected Analytics business of Change Healthcare for $55 million. The business generates $65 million per year.

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In Australia, clinical intelligence vendor Pacific Knowledge Systems will acquire Pavilion Health, which offers cloud-based coding and auditing tools.

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CPSI announces Q1 results: revenue up 1%, EPS $0.28 vs. $0.24, beating Wall Street expectations for both.  


Sales

  • Orthopedic telemedicine provider OrthoLive chooses Ellkay to bring the EHR information of its patients into its telehealth app.
  • Cooper University Health Care (NJ) chooses Accruent’s Connective healthcare technology management and Medical Device Security Analyzer as it brings its outsourced HTM program in-house. 
  • UK-based medical chat, telemedicine, and appointment scheduling app vendor Babylon Health — whose NHS rollout as the tech platform for GP at Hand created a company valuation of $2 billion — gains its first US client in Mount Sinai Health Partners Provider Network (NY).

People

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Impact Advisors hires James McHugh, MBA (Navigant) as managing director.


Announcements and Implementations

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CareMesh offers state and local public health departments free use of its National Provider Directory.

A Black Book survey names Allscripts as the top-rated inpatient EHR vendor in community hospitals.

Nebraska Health Information Initiative goes live with a COVID-19 cases and results dashboard, powered by NextGate’s EMPI, InterSystems HealthShare, and KPI Ninja Universe.

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Epic says that 3,000 patients of Community Health Network (IN) have used its MyChart COVID-19 symptom checker.


COVID-19

A COVID-19 model from Johns Hopkins Bloomberg School of Public Health predicts 3,000 US deaths per day and 200,000 new cases per day by June, but the school says those numbers are for a preliminary, FEMA-commissioned analysis rather than a final forecast. Hopkins adds, however, that the death count will rise significantly as governors reopen states despite meeting none of the federal criteria for doing so, such as a declining case count. Those numbers would represent an increase in daily deaths of 71% and an increase in daily new cases of 700%.

FDA says it will tighten its minimal requirements for companies to sell COVID-19 antibody tests, noting that the rush was on in mid-March to get some idea of population spread, but now the tests are being used to make individual decisions. FDA says companies are selling fraudulent tests, claiming their tests are FDA approved or authorized when they are not, and are marketing their tests inappropriately for at-home use. FDA will now require companies to submit their emergency use authorization requests, along with validation data, within 10 business days, and has also issued specificity and sensitivity thresholds for test developers.

Pfizer launches human trials of four variations of its COVID-19 vaccine, with the company saying that a successful candidate could be given clearance for emergency use or accelerated approval in the fall. Pfizer, like Moderna, is basing its vaccine on messenger RNA, a method that has never been used to develop an approved vaccine. More than 100 vaccines are being developed and 20 are expected to reach human trials this year. Initial tests involve patient safety.

Preliminary contact tracing studies suggest that most coronavirus transmission occurs by close, prolonged contact with someone who is experiencing symptoms. The highest risk factors were household contact, transportation, and dining, with family gatherings and church services giving high infection rates and those over age 60 at higher risk. Children are often infected, but do not seem to be driving outbreaks. The virus seems to spread best in cramped, poorly ventilated areas, such as homes, nursing homes, restaurants, and public transportation.

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A survey finds that two-thirds of Americans don’t believe that reported COVID-19 death counts are accurate. Forty percent of Republicans think the death count has been overstated, while 63% of Democrats believe the actual death count is higher than the official number. Overall trust in federal government has dropped to 38% and more than half of those surveyed are worried that schools won’t reopen in the fall and that food shortages will develop in the next month.  

WHO warns that government reopenings don’t change the fact that coronavirus is still a global health emergency, as case counts are rising rapidly in poorly prepared Africa and South America.

Axios notes that COVID-19 has placed most clinical drug trials on hold, especially those that involve hospitals, and pharma startups face uncertain timelines, a need for more venture funding, and a requirement to conduct studies in multiple locations to avoid having a study halted due to a local outbreak. 

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Johns Hopkins Bloomberg School of Public Health’s Center for Health Security recommends healthcare system changes that will be needed to address the pandemic, saying that the changes will cost billions but “certainly cost less than the trillions now being spent because our public health and healthcare system was not prepared or equipped for this pandemic.” Among them:

  • The federal government should create an information sharing system to allow states and hospitals to work together to obtain PPE and medical supplies and improve its medical supply chain tracking and coordination. .
  • Congress should create legislation to increase domestic production of PPE.
  • Hospitals should buy more reusable devices in their respirator purchases, such as elastomeric face masks and PAPRs.
  • Hospitals should not resume full services until ED visits, ICU census, ventilator use, and PPE use either plateau or return to pre-COVID levels.
  • Hospitals should give every admitted patient a rapid COVID test to detect asymptomatic carriers.
  • HHS should track hospital financial losses and establish short-term bridge funding for hospitals that are in danger of imminent collapse, while CMS should provide financial incentives for those that achieve specific goals for preparedness and infection prevention.
  • Regulatory limits of professional licensure, certification, and scope of practice should be relaxed, including extending cross-state licensure beyond the compact-signing states.
  • Barriers to conducting telephone or video encounters should be removed – state and federal regulations, HIPAA, and reimbursement that is lower than for in-person visits.
  • Congress should use its emergency regulatory authority to authorize clinicians to work at top of license.
  • Healthcare organizations should consider offering hazard pay to employees who are involved in direct COVID patient care and offer mental health counseling to all employees.
  • Congress should make sure that all COVID-related costs are covered under the CARES Act, should require companies to provide 10 days of sick leave for all employees, and develop a plan to give Americans access to affordable healthcare insurance.
  • Healthcare facilities should make significant investments in telemedicine, payers should pay them at the same rate as for in-person visits, and HHS and professional societies should publish guidance and best practices.
  • EHRs should be searchable by public health personnel to aid situational awareness.
  • The US needs to review hospital surge capacity given the existence of market forces that have driven down staffed bed levels.

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MIT scientists develop STOPCovid, a one-hour, $10, minimal handling COVID-19 diagnostic test that offers 97% sensitivity and 100% specificity, requires no special instrumentation, and appears to work well with saliva samples. The FDA has not yet reviewed the test, but the project invites COVID researchers to request a starter kit, hoping to expand test-trace-isolate measures that are required to re-open society.

Sources say President Trump is shutting down the coronavirus task force, sending its responsibilities to FEMA. The frequency and length of the group’s meeting have already been reduced.


Sponsor Updates

  • A Dimensional Insight survey finds that EHR analytics tools deliver lower user satisfaction than both analytics-specific platforms and in-house solutions, with more than one-third of users reporting slow queries and inadequately robust capabilities.
  • Nordic posts a podcast titled “Rise in telehealth sessions alone won’t create great patient experiences.”
  • AdvancedMD publishes a new e-book, “Telehealth: The Ultimate Guide to Maximizing Revenue, Keeping More of What You’re Paid, and Thriving Through Thick and Thin.”
  • Dimensional Insight publishes a new report, “How Satisfied are Healthcare Organizations with EHR Analytics?”

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 5/4/20

May 3, 2020 News 2 Comments

Top News

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A Duke University-convened expert group lists short-term actions that can be taken to improve interoperability and data exchange for containing COVID-19. It recommends that:

  • Commercial labs and point-of-care test manufacturers should record patient demographics along with COVID-19 samples and add the information to their reports to enable contract tracing, and CMS should use payment adjustments to give them incentive to do so. This information would include patient name, date of birth, gender, race/ethnicity, contact information (address and/or telephone number), and the identifier that was used in collecting the sample (such as medical record number). This capability could be brought online quickly by using the existing clinical query function of CommonWell, claims clearinghouses, or other information service providers.
  • State and local health officials should define a minimum data set for COVID-19 containment as part of participating in clinical data exchanges. Limited public health resources precludes developing API-driven data feeds, so existing intermediaries should be used instead, such as Health Gorilla or the PULSE system that is supported by the Sequoia Project and Audacious Inquiry. 
  • Federal, state, and local officials should enhance their use of the National Syndromic Surveillance Program.

Reader Comments

From Marshall: “Re: Greenway Health. A rumored RIF of up to 10% of their workforce Thursday.” Unverified, but reported by several readers.

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From Dill Fighter: “Re: Apple-Google contact tracing. I will address some misconceptions. The proposal mirrors the CDC in triggering notification only if you have spent at least 15 minutes within six feet of someone who is infected, so just walking by or checking out in a store won’t count. People won’t need to enable them since it will be built into the OS. Users don’t necessarily need to enter their own positive results – providers could enter them in a HIPAA-complaint way, such as entering only the Bluetooth ID of the phone.” My responses, adding to my initial comments:

  • I missed the minimum time of contact specification, which according to Apple, requires 5-30 minutes of contact (the exact threshold must be defined by the public authority, which is responsible for analyzing the data). I assume that contact must be constant rather than cumulative.
  • Apple and Google acknowledge that the six-foot range is a best guess based on Bluetooth signal strength and how the phone is being held. It will be thrown off if the phone is stored in a purse or backpack.
  • Phone users don’t need to download the app, but they need to opt in when it is installed via an OS update. They can opt out or uninstall the app later, which may well happen if the app eats up battery power in the background.
  • The user needs to manually install a second app that will be developed by their local public health authority (how that authority does that development isn’t clear). That authority sets the distancing rule and manages the entry of positive results, and without their app, the Apple-Google one does nothing. Apple and Google are suggesting that a future release of their app will eliminate the requirement of installing a public health app, although I haven’t seen a description of how that will work.
  • It’s the user’s job to enter their own positive result using the public health service’s app. I haven’t seen any suggestion that the app will support providers doing it for them.
  • Singapore saw barely more than single-digit adoption of its national contact tracing app. The country’s director of digital services, which developed the TraceTogether app, warns that they use it only to support manual contact tracing and it’s naive to see it as a replacement. He adds that “you cannot ‘big data’ your way out of a ‘no data’ situation,” such as the Washington state choir in which 45 of 60 members were infected despite distancing appropriately, likely because their singing projected respiratory particles further, and phone-based contact tracing would have missed that.

From HIMSSanity Cured: “Re: HIMSS. I don’t know about anyone else, but my consumption of HIMSS products and services is, and always has been, zero other than attending the conference.” Same here – I have no touch points with HIMSS other than the conference. I don’t read its publications, watch its webinars, attend its other events or local chapter meetings, pay for its certifications, follow its twitterati, view its endless ads, or participate in its plea for vendor-enriching government handouts (excuse me, “advocacy.”) I don’t say this as some kind of vindictive reaction to HIMSS policies and actions – I just don’t need anything that HIMSS offers and I don’t even think about the organization until it’s time to sign up for the conference (or not, as the case increasingly may be). They are just another vendor who I might contact in the unlikely event that I need something they offer. That’s just my opinion as a member, although even as a member I can’t say I’m thrilled at a lot of what HIMSS undertakes that seems more appropriate for a vendor than a member organization.

From Audioslave: “Re: podcast. Here’s a good one on public health.” I don’t listen to podcasts or watch videos that could have been presented as written articles instead. I know people have fun screwing around with their microphones and recorded video calls instead of writing, but they’re wasting my time to save theirs. I’ve done a zillion interviews and can say with confidence that skimming one in 45 seconds and reading the interesting parts more carefully is a lot more efficient than listening to a 30-minute conversation, especially when the questioner’s vanity prattling eats up an unreasonably high percentage of total run time. 


HIStalk Announcements and Requests

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A surprisingly large number of poll respondents have experienced some form of virtual visit since the pandemic broke out 100 years ago in mid-March, with video visits leading the pack. A couple of folks said that the video interface failed and the fallback was a phone call, while one also questioned the how good of replacement those visits can be when they offer only conversation and observation without the clinician being able to use a stethoscope or hands-on techniques.

New poll to your right or here: Will you use the COVID-19 contact tracing app from Apple and Google as soon as it becomes available?

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I wonder if masks could be made from a clear but comfortable fabric so we don’t all wander around in public looking like bank robbers in Westerns? If not, here’s my Plan B: custom-printed masks where buyers can insert a headshot so that the outside of the mask looks like what is underneath (hello, CVS and Walgreens photo departments). We “Arrested Development” fans will be celebrating Cinco de Cuatro on Monday, so I confess that I was inspired by George Michael’s muscle shirt.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Meditech reports Q1 results: revenue up 24%, EPS –$0.69 vs. $0.97, swinging from a quarter-over-quarter profit of $36 million to a loss of $26 million due to COVID-related stock losses and a decline in product bookings. Product revenue rose 77% and service revenue was up 3% in a quarter that was good for the company in the health IT market, but not so good in the stock market.

Spok reports Q1 results: revenue down 11%, EPS –$0.24 vs. $.04.


Government and Politics

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President Trump nominates a replacement for the HHS principal deputy inspector general who interviewed hospitals about their COVID-19 concerns and reported their experience with shortages of coronavirus-related supplies and diagnostic tests. The President accused HHS career official Christi Grimm, MPA, who started working for OIG in 1999, of being politically motivated. The President has nominated as her replacement Jason Weida, JD, an assistant US attorney in Boston. 


COVID-19

CMS issues another round of COVID-19 regulatory waivers that include:

  • Physical therapists, occupational therapists, and speech language pathologists can provide Medicare telehealth services.
  • Hospitals can bill Medicare for services that are provided remotely by hospital-based practitioners.
  • Evaluation and management services can be delivered to Medicare patients via telephone.
  • Behavioral health and patient education services can be provided by telephone and will be paid at the same rate as for office and outpatient visits.
  • Medicare will pay for COVID-19 tests that are ordered by any healthcare professional, not just a physician, who is authorized by state law.
  • Pharmacies can operate pharmacist-staffed drive-through testing sites if they are enrolled by Medicare as a laboratory.
  • Hospitals will be paid separately for performing COVID-19 testing as the only service to a particular patient.
  • Medicare and Medicaid will pay for certain FDA-authorized serology tests.
  • Hospitals can increase COVID-19 beds without reducing their payments for indirect medical education, while inpatient psychiatric and rehabilitation hospitals can admit more patients without reducing their teaching payments.
  • Hospitals will be paid at OPPS rates for outpatient services such as wound care, drug administration, and behavioral health that are delivered in temporary expansion locations, such as parking lot tents, converted hotels, and patient homes.
  • Long-term acute-care hospitals will be paid at higher Medicare payment rates for accepting acute-care hospital patients.
  • Nurse practitioners, clinical nurse specialists, and physician assistants can order home health services, establish and review plans of care for home health patients, an certify and re-certify patients for home health services.
  • Physical and occupational therapists can delegate outpatient maintenance services to assistants.
  • Applications for new ACOs will not be accepted until 2021, but those whose participation is expiring this year can extend for another year.

Analysis of TriNetX’s global health research network finds that patients aged 30 to 50 make up 26% of all strokes among patients who tested COVID-positive, versus the typical rate of 11% in non-infected patients in that age group.

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The US is betting big ($483 million) that a coronavirus vaccine can be developed by messenger RNA drug company Moderna, which has never brought a product to market, hasn’t had any of its nine vaccine candidates approved by the FDA, and has never had a product reach the third phase of clinical trials. Even the company’s former chief science officer / R&D president is shocked by the huge amount of funding the government is providing. Nature magazine criticized the company for having failed to publish a single peer-reviewed paper about products it was touting to investors, likening it to Theranos. Moderna’s market cap has risen to $16 billion.

FDA gives Gilead emergency use authorization to distribute remdesivir for severely ill COVID-19 patients, also allowing five-day use for non-intubated patients instead of the usual 10 days, which will extend the drug’s supply. Gilead is donating its entire inventory of the drug, 1.5 million vials, to the federal government, which will oversee its distribution.

New research indicates that blood pressure drugs in the ACE inhibitor category, contrary to early concerns, do not affect coronavirus infection or outcomes.

A New York City nursing home admits that 98 residents of the 705-bed facility have died from presumed coronavirus infection.

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A Brigham & Women’s ED doctor warns that it’s not reasonable to compare deaths from COVID-19 versus influenza – COVID-19 deaths count only patients who tested positive or met specific diagnostic criteria, while flu deaths are estimated using a model that adjusts for assumed vast underreporting (I admit that I did not know this). Example: CDC estimate 2018-29 US flu deaths at 26,000 to 53,000 even though just 7,200 deaths were confirmed. Applying that same underreporting assumption to COVID-19 suggests that it could have already killed 600,000 people in America (versus the official count of 68,000), and even then we are early into a pandemic that may or may not weaken in the summer.

Former FDA Commissioner Scott Gottlieb says that we may hit 100,000 US deaths from COVID-19 by June and that cases are still rising in 20 states, indicating that mitigation steps didn’t work as well as expected.

Meanwhile, the number of confirmed cases seems to have hit a stubborn plateau, leading to the possibility that a “second wave” won’t happen in the winter because the first one won’t actually have ended by then, especially with relaxed mitigation measures that the virus has waited out (late May is likely the new March as the April mitigation indiscretions kick in as active infections and hospitalizations). Seasonality remains the best (but uncertain) hope for a summer break. Curve-flattening was successful only in extending the time period in which the same number of people get infected, are hospitalized, and die, but otherwise the virus is still out there just like before.

China’s state media creates a video that makes fun of the US’s coronavirus response. Meanwhile, a Department of Homeland Security report says China intentionally hid the extent of the pandemic so it could hoard drugs and supplies, as evidenced by unusual import and export numbers.


Other

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Epic launches Epic Health Research Network, a public-facing site in which Epic’s customers can post their observational findings about COVID-19 or any other topical issues in health and public health.

UK Prime Minister Boris Johnson and his fiancé give their newborn son the middle name of Nicholas in honor of two doctors by that name who treated Johnson for COVID-19 last month.


Sponsor Updates

  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “Indications for Intubation.”
  • OpenText’s information management solutions are now available as fully managed services on AWS.

Blog Posts


Contacts

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

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News 5/1/20

April 30, 2020 News 7 Comments

Top News

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Health data and software company Arcadia acquires assets of the Massachusetts EHealth Collaborative, including technology and customer accounts.

MAeHC President and CEO Micky Tripathi, MPP, PhD will join Arcadia as  chief alliance officer while continuing his roles with Argonaut, Sequoia, CommonWell, HL7, HL7 FHIR Foundation, and CARIN Alliance.


Reader Comments

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From VCU Observer: “Re: VCU Health’s rip-and-replace of Cerner with Epic on May 1. At least one board member says the project hasn’t been approved nor the implementation costs outlined. The expenditure, rumored to be hundreds of millions of dollars more than Cerner’s upgrade bid, doesn’t make sense at this time.” Unverified. VCU announced a mid-2021 go-live when they chose Epic in December, which seems challenging given limits on travel and in-hospital presence for the all-important initial planning and on-the-ground design meetings.

From PPP Shooter: “Re: paycheck protection plan loans. The Small Business Administration has clarified that publicly traded companies, as well as the portfolio companies of private equity funds, are prohibited from receiving PPP loans and must pay them back by May 7 if they received them. Hundreds of publicly traded companies received these loans and the PE firm clarification may cause problems for the health IT world.” SEC filings indicate that 220 public companies need to return $870 million that they received before the rule was changed, with more that are likely still be disclosed since SBA has refused to release a list of the companies that received money. Publicly traded health IT company Castlight Health received the maximum loan of $10 million, but says it will return it.

From Pickle Bickering: “Re: contract tracing by smartphone app. Is it worth the privacy intrusion?” Apple and Google are doing exactly what big tech companies always do when barging into healthcare with minimal knowledge — they are thinking that a cool app can fix everything. App-based contact tracing is doomed to fail, in my opinion, and not just because of privacy issues:

  • Not all Americans own smart phones and carry them at all times. Children, for example, appear to be significant spreaders and will become more so when schools and daycares reopen, but few of them will be carrying a contact-tracing app on a phone.
  • Many people won’t use tracking apps because they don’t know they exist, don’t derive any personal benefit from their use, or refuse to be tracked regardless of privacy assurances. There is no way that Americans will accept an opt-out model in which they default to being users and also no way that a significant percentage will otherwise opt in.
  • These apps have never worked in a country where their use was voluntary, nor rolled out late in a country whose initial COVID-19 response was as indecisive as ours.
  • Accuracy is questionable. The six-foot range will flag contacts between cars, on opposite sides of plastic shields in stores, and where physical protection is in place and makes virus spread unlikely. I’m not confident that a record of whom I’ve passed within six feet of is all that useful in controlling coronavirus spread.
  • Users are expected to manually enter their positive COVID-19 test result for the benefit of others who will then be notified. Then, unlike in other countries, it’s up to those people who get the “you’ve been exposed” warnings to take action since they are not identifiable.
  • Contact tracing requires having a strong system of 14-day quarantine in place, such as providing private living space and checking up on self-monitoring. We can already guess that many nursing home residents, mass transportation riders, homeless people, prisoners, and laborers who live in employer-provided dormitories are infected, but any isolation is voluntary and limited by their resources.
  • The bottom line: this sort of contract tracing works only if at least two-thirds of Americans use the app and we roll out widespread COVID-19 testing to identify those who are infected but symptom-free to catch potential spreaders early. Even then our society, as it returns to being mobile, will make it nearly impossible to address the potentially hundreds of people that someone could pass near in the days or weeks before they receive a positive test result.

From Looking For Answers: “Re: Clarify Health Solutions. Laid off 70 employees, about 40% of its workforce, on March 19. KKR gave it a bridge loan instead of agreeing to a Schedule C. I’ve seen nothing online, but a former colleague who used to work there told me.” Unverified. I don’t think I’ve ever heard of this particular analytics vendor, which has raised $63 million, almost all of that in a September 2018 Series B round by KKR. The company announced a couple of COVID-19 apps less than a week after this rumored layoff. 


Webinars

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


Acquisitions, Funding, Business, and Stock

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Mayo Clinic (MN) will invest in Current Health and work with the company to develop COVID-19 predictive and remote monitoring technologies.

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From the Cerner earnings call:

  • Chairman and CEO Brent Shafer says he is pleased with the productivity and performance of its 27,000 employees after the majority of them moved to working from a virtual environment.
  • The company expects the VA and DoD to revise their timelines due to COVID-19 and Cerner has factored that into its guidance.
  • Cerner expects a slight drop in next-quarter bookings, but says clients are generally moving ahead and it won’t be a lot different than usual, especially since unlike the 2008 market crash, health systems were doing fine financially before coronavirus and stimulus money will help get them back on their feet.
  • President Don Trigg says the federal government’s role of top regulator and payor will expand due to COVID-19 and health system consolidation will accelerate and extend into ambulatory practice.
  • Clients are starting to ask about getting into the queue for services that will be in high demand.

Sales

  • Penn State Health selects RCM software and services from R1 RCM.

Announcements and Implementations

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A new KLAS report on US hospital EHR market share finds that Meditech Expanse is drawing new interest from customers outside its usual small-hospital base, with a new 400+ bed health system sale in 2019 giving the market a chance to see how Expanse scales. Meditech won about half the decisions made by its legacy customers in 2019, and half of its losses came from product standardization and provider M&A. Cerner saw its first-ever decrease in market share after losing four big clients in 2019, with its losses most often due to customers who standardized on Epic and those who were frustrated with Cerner’s revenue cycle management solution. Epic has grown to cover 40% of US acute care beds, with its new wins split between new decisions and standardization and acquisitions. Allscripts continues to steadily lose market share, with 2019 losses of customers of Sunrise (eight), Paragon (16), and Horizon (seven). Small, standalone hospitals were left with few choices after Athenahealth exited the inpatient market, with Cerner CommunityWorks and Meditech Expanse coming closest to meeting their needs.

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Epic will embed telehealth into its EHR using Twilio Programmable Video, which is also used by Kaiser Permanente,  MDLive, Doctor On Demand, and several health systems. Investment firms are already warning companies like Teladoc that their reach into academic medical centers may be constrained with the availability of an Epic-embedded virtual visit platform that is staffed by a hospital’s own clinicians.

Critical access hospital Macon Community Hospital (TN) goes live on Cerner in a go-live that Cerner managed remotely.

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Allegheny Health Network’s Saint Vincent Hospital (PA) implements virtual ICU software and support from Mercy Virtual.

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Greenway Health announces GA of GRS Express, a suite of expedited RCM services to help practices maintain cash flow.

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EPSi announces GA of COVID-19 Planning Analytics to help providers anticipate ICU capacity, financial burdens, and the impact of resuming elective procedures.

QliqSoft will incorporate the Suki voice-enabled digital clinical assistant in its telemedicine platform to create medical notes and perform tasks such as EHR information retrieval.

Reliance EHealth Collaborative is developing COVID-19 use cases via data management, analytics, and reporting from IMAT Solutions.


Government and Politics

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HHS awards $20 million to six organizations to help them expand telemedicine access.


COVID-19

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Conflicting studies on the use of remdesivir came out Wednesday following several incidents in which leaked information found its way to mainstream media headlines. Preliminary results from a government-run trial showed patient time to improvement was 11 days versus 15 days for placebo, which meets the NIH study’s endpoint, but the drug did not provide a statistically significant improvement in survival rate. Almost simultaneously, results of a peer-reviewed study performed in China showed no benefit from using remdesivir. Experts say the benefit isn’t necessarily how well remdesivir works, but a reminder that the virus has vulnerabilities that can be exploited incrementally to improve outcomes even in the in the absence of a blockbuster drug, as was the case with HIV/AIDS.

NIH announces a $1.5 billion challenge for rapid deployment of coronavirus diagnostic tests.

A Kaiser Health News article observes that hospital information that is stored in proprietary, siloed EHRs cannot support hospitals sharing their COVID-19 treatment experience. Experts say everybody knew from the early days of the $36 billion Meaningful Use program that hospitals were seeking systems to optimize billing, not public health. Health Catalyst CTO Dale Sanders was quoted in the article as saying that CDC should have developed a coronavirus data collection plan, with standardized terminology, that would have allowed hospitals with non-interoperable EHRs to look at the big picture (Health Catalyst is a member of the COVID-19 Healthcare Coalition that is trying to assemble information for real-time support). Public health systems are also often unable to accept electronically submitted information, requiring hospitals to complete manual forms that can take up to 30 minutes to complete and often even then with missing information.

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Most of the tent hospitals that were expensively built to provide services to an expected crush of COVID-19 patients are scheduled for closure, having seen few patients:

  • New York is shutting down two tent hospitals that didn’t see a single coronavirus patient, having spent $350 million in federal taxpayer money to plan and build temporary facilities. The only field hospital that saw patients, at Javits Center, will close Friday after treating 1,000 patients in the 4,000-bed facility.
  • Chicago’s pared-back, $64 million, 500-bed hospital at McCormick Place has treated only 12 patients.
  • Detroit’s 1,000-bed convention center hospital has seen just 36 patients and is scheduled for closure.
  • Philadelphia will close its 200-bed temporary hospital in two weeks. It has never had more than six patients at a time.
  • New Jersey’s four field hospitals totalling 1,000 beds have treated 346 patients.
  • The temporary hospital that was set up in the New Orleans convention center is averaging 100 coronavirus patients.
  • The Navy’s 1,000-bed USNS Comfort will leave Manhattan this week to return to its home port of Norfolk, having treated just 182 patients.

The Atlantic says Georgia’s rush to reopen businesses is an experiment “to find out just how many individuals need to lose their job or their life for a state to work through a plague” given that Georgia is moving forward despite meeting none of the accepted testing and infection success benchmarks. On the other hand, the article fails to note that the same number of people are likely to die either way, just over longer periods, unless we complete a technological Hail Mary in the form of a vaccine, effective treatment, or a sound containment containment strategy.


Privacy and Security

The New York Times says Europe’s world-leading GDPR privacy rules are falling short of expectations because of small national data protection budgets, lack of enforcement, and tech company pushback. The only tech company to have been penalized is Google, which paid a relatively paltry $54 million versus the law’s maximum of 4% of global revenue. Public experience with GDPR has been mostly negative as web users are forced to click through countless pop-up consent windows.


Other

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Regions Hospital (MN) works with Medtronic to develop software that allows providers to remotely monitor and adjust ventilators. Regions providers say the software, which went from concept to implementation in just 10 days, has cut down on in-room visits to COVID-19 patients by 50%, and helps conserve PPE. Several other hospitals are also piloting the technology.

Experts say it’s not the imagination of Zoom users that the videoconferencing app leaves them anxious, unable to think clearly, and tired — the app’s bandwitdh-conserving degradation of video quality leaves the brains of users to fill in the image’s gaps, especially in trying to analyze poorly rendered or out-of-sync facial expressions. Telephone calls, oddly enough, offer a more natural feeling of presence and engagement.


Sponsor Updates

  • Elsevier adds resources for biomedical and scientific researchers to its free Coronavirus Research Hub.
  • The Chartis Group publishes a new paper, “After the Surge: Five Health System Imperatives in the Age of COVID-19.”
  • InstaMed releases the 10th edition of its “Trends in Healthcare Payments Annual Report.”
  • InterSystems makes available the latest version of its HealthShare suite of connected health solutions, including capabilities to support final federal interoperability rules.
  • Engage announces feature updates for its Wait Times app.
  • Impact Advisors publishes a white paper titled “COVID19 Federal Stimulus Package – Impact on Providers.”
  • HBI Solutions names Jackie Porter, BSN, RNC-E (Syapse) client success director.
  • Meditech highlights the successful utilization of its virtual visit functionality at Citizens Memorial Hospital (MO), Grand View Hospital (PA), Avera Health (SD), and Mount Nittany (PA).

Blog Posts


Contacts

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

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News 4/29/20

April 28, 2020 News 9 Comments

Top News

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VA OIG evaluates the VA’s now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center (WA) that was scheduled for March 28, 2020, observing:

  • The VA assumed that access to care would drop 30% for 12-24 months after go-live based on the Department of Defense’s Cerner experience. However, planned mitigation actions were not completed due to the VA‘s lack of guidance and budget constraints for adding employees, expanding clinical space, expanding clinic hours, and extending appointment times.
  • The VA could not alleviate potential backlogs by referring patients to community providers because the hospital is already falling short of VA standards in that area, with a backlog of 21,000 open consults and an average wait time of 56 days. Employees were asked to work 8-10 extra hours per week to manually copy and paste information from one system to another to process the consults.
  • VA and Cerner concluded in July 2019 that some EHR capabilities would be missing by the March go-live, including requesting online prescription refills via MyHealtheVet, which presented a patient safety risk. The VA decided to turn off access to prescription refills in Cerner’s HealtheLife patient portal because it did not meet VA standards.
  • Hospital staff would have needed to enact 84 mitigations for the 62 systems that were at moderate to high risk of being unavailable.

Reader Comments

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From AnotherDave: ”Re: Scanadu. Too bad it fizzled now that there’s a run on pulse oximeters. I pulled my First Edition from its paperweight duties and it still works. I bought it for $149 in the early bird Indiegogo deal in 2013, finally received it in February 2015, and the company’s business plan fell apart in May 2017 when its investigational study was shut down. With the right investment and re-branding, it would be a Handy COVID-19 Screener.” I never quite saw the appeal of the Scanadu gadget, maybe because the Tricorder references got old fast, it didn’t do a whole lot, and early digital health fanboys were practically mounting it in lustful consummation of their naiveté-fueled enthusiasm. The company said FDA required it to brick the device because it was part of a Scripps study that had ended. Crowd-funders got nothing and weren’t happy about it. Founder and CEO Walter De Brouwer went on to launch Doc.ai, which allows researchers to conduct medical studies via the smartphone of participants. Meanwhile, Scanadu renamed itself as Inui Health in late 2018, launched an FDA-approved app for in-home urinalysis, and then pretty much went nowhere.

From Mo Money: “Re: stock market. Good time to invest in health IT companies?” I don’t buy or recommend health IT stocks because that seems like a conflict of interest, but I’ll instead offer my long-held opinions about investing in general:

  • No investment performs better in the long term than stocks, and long-term investing is where you accumulate net worth (which is the only personal financial metric that matters – it’s what you own that counts, not what you make).
  • Markets have always eventually roared back after an emotion-driven downturn. The first time that doesn’t happen will be the end of American society, in which case your mattress full of cash won’t buy you anything important anyway.
  • You have to buy dispassionately and stay in the market regardless of the ups and downs, which are just bumps in the road. Discipline pays.
  • Define your specific goals (“getting rich” doesn’t count). It’s always a balance between reward and risk, and your tolerance and timelines for the former drive the required degree of the latter.
  • The time value of money is powerful. The investment decisions you make in your 20s and 30s, even with small amounts of money involved, will far outweigh the decisions you make in your 50s and 60s.
  • Don’t look at your portfolio value more than one per quarter, rebalance holdings to meet your chosen model, and don’t change your plan just because it’s up or down. Especially if you, like me, would feel anxiety or depressive remorse in having lost money (I swear I was the only person who was buying high and selling low during the dot-com boom).
  • Buy mutual funds, index funds, or an investment company’s trading model. The odds that you will out-earn experts with your consummate stock-picking skills are minimal. Take a look at how well health IT stocks have performed against the Nasdaq index or S&P 500 in the long term before you get excited about applying your industry knowledge to stock picking.
  • Don’t be influenced by people who brag about their investing home runs since it’s their batting average that matters (it’s more “Moneyball” getting on base frequently than striking out consistently while waiting to send the next shot over the fence).  
  • Buying IPO shares means someone who knows a whole lot more about the company than you is anxious to unload.
  • Don’t overload on your own employer’s shares in your 401(k). Not only are you are overexposed from a portfolio standpoint, any employer stumbles will probably bite you doubly hard as both an investor and an employee. 
  • Stocks are worth what the market thinks they are worth, which may not track well to intrinsic valuation or reasonable expectations. No amount of stock-picking analysis will change that, and those who believe differently are efficiently separated from their money over the long haul. No formula, no matter how elaborately conceived, can take human foibles into account, and stock price is set by greed, fear, and hopes of finding a greater fool.

HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Spirion. The St. Petersburg, FL-based company has since 2006 offered accurate data discovery and classification solutions that give customers in several industries unparalleled data privacy, security, and regulatory compliance. Spirion’s platform gives healthcare organizations full visibility into their structured and unstructured data, both network- and cloud-based, to allow designing protection and monitoring without human effort or error. Spirion for Healthcare is a PHI management and data loss prevention tool that focuses exclusively on data at rest, which represents 100% of large breaches. Its rules-driven, sensitivity-tunable AnyFind technology uses contextual search discovery to find data sources such as payment card industry (PCI) data, PHI, and personally identifiable information no matter where it exists, while Sensitive Data Engine allows creating data deeper definitions to locate proprietary and unique organizational information. The company offers data security teams free 60-day use of Sensitive Data Manager during the COVID-19 crisis, also extending to stay-home employees free use of a Data Discovery Agent to identify the existence sensitive personal information on their computers. Thanks to Spirion for supporting HIStalk.

I found this Spirion explainer video on YouTube.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Cerner reports Q1 results: revenue up 2%,adjusted EPS $0.71 vs. $0.61, beating earnings expectation but falling short on revenue. The company expects the biggest COVID-19 financial hit to occur in Q2, after which project and sales activity will improve if pandemic-related restrictive measures are relaxed. 

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UnitedHealth Group’s Optum division is reportedly negotiating a $470 million acquisition of AbleTo, which offers virtual visits for behavioral care with its network of therapists and coaches. The company, which targets payers and employers, had previously raised $47 million through a Series D round, with Optum Ventures being one of its most recent investors. 


Sales

  • OU Medicine (OK) chooses Artifact Health’s mobile physician query platform to drive complete and comprehensive patient chart information.

People

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Nicklaus Children’s Health System (FL) hires David Seo, MD (University of Miami Health System) as VP/CIO.

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Nephrologist Burton “Bud” Rose, MD, who created the industry-standard UpToDate computerized medical reference in his basement in 1992, died of COVID-19 last week at 77.


Announcements and Implementations

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A new KLAS report on ambulatory revenue cycle management services finds high customer satisfaction with Athenahealth, R1 RCM, and Bolder Healthcare, while EMDs, CareCloud, and Greenway Health experienced a significant drop in satisfaction over the past year. Six of the eight reviewed firms were acquired in the past few years, some with positive results (Allscripts, Athenahealth, Bolder, and R1) and one showing a significant decline in satisfaction (EMD’s 2019 acquisition of Aprima, with 80% of the latter’s former clients expressing dissatisfaction since). KLAS concludes that third-party players are gaining traction and raising the customer satisfaction bar as disruptive new entrants.

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Another KLAS report suggests how health IT vendors should conduct business during COVID-19:

  • Sell the customer what they need to become successful (prescriptive sales) instead of allowing them to pick and chose products and services themselves.
  • Pass on sales that are not a good fit to avoid future reputation damage.
  • Have account managers proactively reach out to customers to help them understand the company’s vision and the product’s impact.
  • Empower lower-level employees to solve customer problems.
  • Create contingency plans to avoid support disruptions that could be caused by COVID-19 impact on offshore support resources.
  • Drive adoption through training.
  • Use internal expertise to guide customers instead of just giving them data or new reports.

Oneview Cloud for COVID-19 is being used for virtual care and virtual visitation in the coronavirus units of four New York City teaching hospitals.

A TransUnion Healthcare analysis of 500 hospitals finds that visit volume declined 32-60% in March.

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GuideWell launches COVID-19 Health Innovation Collaborative, which seeks solutions that address the categories of COVID-19 self testing, virtual in-home care, protection of clinical staff, reduction of social isolation, and home delivery of food and supplies to at-risk populations. The application deadline is May 8.


COVID-19

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Overall fatality rates compared to pre-pandemic numbers suggest that coronavirus-related deaths are up to 60% higher than official counts. New York City averages 6,000 deaths from mid-March to late April, but had 27,000 in the same period this year versus the 17,000 deaths that were officially attributed to confirmed or probable coronavirus.

Sixty Mayo Clinic physician volunteers are helping manage New York City’s COVID-19 ventilator patients remotely using an audiovisual connection and access to New York-Presbyterian’s Epic system. The doctors note that COVID-19 is like prolonged respiratory failure with unusual twists, such as blood clots and kidney failure.

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EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families, with 40 of the 415 who were tested in a drive-through program showing antibodies that indicate previous or current infection. Of the 15 who showed a possible active infection, only one had symptoms. The company hopes the testing will give employees peace of mind and help it transition back to on-premises work.

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Vice-President Pence was allowed to violate Mayo Clinic’s campus mask-wearing requirements during his visit there Tuesday, even as he met with employees and a patient who all wore them. Senior White House officials have never been shown wearing masks in public or in photo opportunities. Mayo said they told Pence’s team about the policy and referred further questions to them.

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Quest Diagnostics announces availability of a $119 COVID-19 antibody test via its QuestDirect service that does not require a prescription, although purchasers must visit a Quest draw station to provide a blood sample. Public health officials again warn that nobody knows what the presence of coronavirus antibodies means with regard to immunity.

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that the US must create a COVID-19 vaccine because the country that does so will inoculate its own citizens first to restore its economy and gain global influence.

A New York Times report says that China’s factories have reopened, but job losses, reduced wages, and people staying home to avoid infection have left its economy sputtering from low consumer spending.


Other

Patients complain that they are being unexpectedly charged for virtual visits despite political proclamations and insurer announcements of waived co-pays and deductibles for COVID-related services, mostly because of the fragmented health system. Among the issues:

  • Some doctors and insurers are charging patients upfront for the full cost of the virtual visit even when it is covered by insurance because insurers aren’t paying and the cash-strapped practices are anxious to collect revenue immediately.
  • 100 million people get their insurance from employers that are self-insured and the big insurers don’t control the telemedicine benefits in that case.
  • Insurers have waived patient charges only for in-network doctors.
  • Some practices are charging for routine telephone calls now that Medicare and insurers are paying for virtual visits in all forms.

A New York Times article warns that parents are postponing well-child checkups for fear of COVID-19, leading to concerns that reduced immunization will cause outbreaks of measles and whooping cough. Pediatric EHR vendor PCC found from the records of 1,000 independent pediatricians that MMR vaccinations are down 50%, diphtheria and whooping cough 42%, and HPV 73%.

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Physician and author Sid Mukherjee, MD writes in The New Yorker that the US healthcare system caused several issues in our coronavirus response:

  • US medical infrastructure fell apart in failing to inventory adequate supplies of PPE and a Strategic National Stockpile that saw its role as supplementing, rather than meeting, state and local public health emergency needs.
  • Testing failed because of the CDC’s distribution of faulty COVID-19 tests, the FDA’s requirement that only CDC tests be used (instead of the WHO tests that the rest of the world uses), and CDC’s distribution of tests only to military, state, and public health labs that perform a tiny fraction of all testing. The author notes that South Korea has so many test kits that it is exporting them to the US, which they did by quickly identifying potential vendors, certifying their products, and turning their factories loose to meet demand.
  • FDA’s process for validating diagnostic tests that had been developed by other labs was inefficient, with criticism then causing it to overshoot in allowing 90 companies to sell antibody tests even though FDA has reviewed only four. 
  • The value of distributing real-time, anecdotal treatment findings via social media and preprints was obvious though imperfect.
  • Vital drugs fell in short supply because their low profit margins left manufacturers complacent and some of them are made in single factories that were disrupted, such as by Hurricane Maria in Puerto Rico.
  • The “market-driven, efficiency-obsessed culture of hospital administration” caused leaders to fail to account for “organizational survival time” in the absence of a functional supply chain and the time required to recover from such disruption afterward.
  • The difficulty of searching for information in EHRs and the time required to obtain institutional approval to do it left researchers flying blind. The author says that EHRs “actively obstruct patient care” and are bound by proprietary interests and privacy rules from delivering their potential as a searchable national repository of real-time, de-identified patient data that could be used as a “storm-forecasting system” for research and treatment dissemination.

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In colorful COVID-19 political news, Grants, NM Mayor Martin “Modey” Hicks (D) defies state law in allowing gun stores and golf courses to reopen, concluding, “We’re not doing it no more” and that “that business, by God, is essential to that individual.” Governor Michelle Lujan Grisham says she may file a cease-and-desist order since it is “like opening up a public pool and having a pee section.” The mayor has ordered businesses to call 911 if the governor’s “Gestapo” shows up over a “little bug.“ He then told reporters he was heading off for a round of golf, and finding the course closed, fired the city manager.


Sponsor Updates

  • Audacious Inquiry will work with HL7 International to develop an HL7 FHIR implementation guide as part of their work with the SANER project.
  • CRN gives Avaya a five-star rating in its annual Partner Program Guide.
  • Black Book’s latest survey finds that Evident’s Thrive EHR has earned top client ratings in small hospital EHR user satisfaction for the tenth consecutive year.
  • Murray County Medical Center (MN) and TCare implement CareSignal’s COVID-19 Companion text messaging app.
  • Wolters Kluwer launches virtual conferences to support medical societies amid COVID-19 meeting cancellations.
  • CereCore congratulates its Epic team on helping HCA Healthcare expand its telehealth capabilities.

Blog Posts


Contacts

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Monday Morning Update 4/27/20

April 26, 2020 News 11 Comments

Top News

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Epic CEO Judy Faulkner discusses possible post-coronavirus healthcare changes in a Business Insider interview:

  • Some hospitals and medical practices will file bankruptcy, as she notes that Epic customers have reported revenue declines of up to 55%.
  • Mergers, acquisitions, and layoffs are likely, especially as small providers are purchased by large health systems that have greater financial reserves.
  • Video visits and at-home monitoring are here to stay.
  • Public health surveillance and the associated standardized data requirements will be a focus.

Meanwhile, Epic offers customers COVID-related applications with no charge for licenses, implementation, and support during the pandemic:

  • Bugsy Infection Control for infection tracing.
  • MyChart Bedside for communicating with isolated patients.
  • Remote Monitoring.
  • Secure Chat.
  • Transfer Center.
  • Willow Inventory for tracking PPE.
  • Rover for handheld nurse charting.
  • Nurse Triage.
  • MyChart, with no per-patient cost for new sign-ups.

HIStalk Announcements and Requests

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Poll respondents didn’t express a lot of positive thoughts about HIMSS, with transparency, value, and humility being the attributes they chose least often. I’m guessing that much of the ill will was caused by vendors and registrants who lost money from HIMSS20 refund decisions, but I also speculate that significant dissatisfaction and resentment has existed for years but has been masked by high HIMSS conference attendance numbers, which may have not been accompanied by any particular love or respect for HIMSS as an organization versus as an unavoidable vendor that runs the industry’s de facto gathering. Some respondents provided their own negative terms instead of choosing from the positive ones I listed. I doubt that any of us could come up with easy fixes, even if HIMSS were to agree that its past missteps require correction.

New poll to your right or here: Which types of virtual visit have you had since mid-March?

Listening: new from Delanila, moody, sultry alt pop fronted by composer Danielle Eva Schwob with the topical title of “It’s Been A While Since I Went Outside.” She filmed the official video (“visual poem”) herself in a COVID-emptied Manhattan. Her entire catalog under this name is just four singles, but all are magnificent and immediately addictive. I’m also enjoying the new, posthumously released single from Chicago rapper Juice WRLD, whose lyrics in “Righteous” (“taking medicine to fix all the damage”) foretold his drug overdose death in December 2019 at 21 years of age at Midway International Airport, when he downed of handfuls of pills to hide them from federal agents who were searching the private jet on which he was traveling (successfully, as it turned out) for the drugs and guns that were on board. Lastly, if you’re looking for a song that will burrow into your brain like toxoplasmosis, try “The Other Girl,” which sounds like Taylor Swift but is actually country pop singer Kelsea Ballerini with singer-songwriter Halsey (the latter’s first musical posting in 2012 was a parody of a Swift song, so there you go). 


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

Vocera announces Q1 results: revenue up 15%, adjusted EPS –$0.14 vs. –$0.17, beating Wall Street expectations for both. 

Amazon surveys its sellers about their health plans, creating speculation that it will offer health coverage.


Sales

  • Tift Regional Medical Center (GA) goes live on LiveProcess Emergency Manager to power its virtual command center.
  • Commonwealth of Massachusetts will offer free virtual visits to uninsured state residents who have COVID-19 symptoms or have been identified through contract tracing, powered by virtual care provider Doctor On Demand.

People

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Eric Rose, MD (Intelligent Medical Objects) joins the VA’s Office of Health Informatics as chief terminologist.

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New Jersey Innovation Institute hires Jennifer D’Angelo (Bergen New Bridge Medical Center) as VP/GM of healthcare.


Announcements and Implementations

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In Australia, Queensland Health cancels its laboratory information system replacement contract with Sunquest after two years and having spent $24 million of the $43 million original contract award. It will instead upgrade its Auslab system that Sunquest was intended to replace.

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Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments. 

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Waystar launches an analytics and business intelligence module ahead of schedule to support the coronavirus-driven decisions healthcare organizations are making.


COVID-19

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Researchers study the 14 available coronavirus antibody tests on which the hopes of reopening the US economy rest. Only three of the 14 tests — many of which are manufactured in China — delivered consistently reliable results, and none were perfect. All but one test sometimes gave false positive results (which could lead someone to think they are immune when they are not), the tests performed better when the patient had been infected for longer periods, and none of the tests have been approved or studied by the FDA. Meanwhile, an urgent care center near me is pitching COVID-19 testing for $40 cash plus the cost of the video visit, the latter of which is covered my many insurance plans for coronavirus screening. The unstated important point of all this is that (a) we have zero evidence that even correctly resulted seropositivity means that someone is immune, and (b) even if they are immune, we don’t know for how long. We could kill people by sending them back to work or causing them to throw coronavirus caution to the winds by assuming that past exposure indicates immunity. What we don’t know about this virus is nearly everything, except that it spreads and kills people with ruthless efficiency.

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A Stanford seroprevalence study – which was was already being widely questioned for recruiting self-selected users via Facebook and going straight to a press release with no peer review — takes another hit when BuzzFeed News finds that the physician wife of the lead author recruited participants via a wealthy school’s listserv, skewing the demographics of participants. The preprint article estimated that up to 81,000 people are infected in Santa Clara County versus the officially reported 956, which would indicate a much lower death rate than previously believed. Another author is maverick Stanford researcher John Ioannidis, MD, DSc, of which an expert concludes may be “so attached to being the iconoclast that defies conventional wisdom that he’s unintentionally doing horrible science.” He and another of the paper’s authors had previously questioned in a Wall Street Journal op-ed piece and in several Fox News appearances whether the threat of COVID-19 is overblown.

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Facebook is offering users a coronavirus symptom survey that was created by Carnegie Mellon University, with results from 1 million users per week being sent directly to CMU for predicting disease spread and county-by-county impact. The first set of results will be published Monday. The map above indicates percentage of people with symptoms in each county (the redder, the worse), but I noticed that the symptom map allows showing percentage of people with symptoms by hospital referral region, which is useful in hospital planning (Rapid City, SD is about to get hammered).

US nursing homes have seen more than 10,000 deaths related to COVID-19, and nine of them that experienced coronavirus outbreaks that triggered “immediate jeopardy” federal citations were found to have significant problems meeting basic health standards – lack of PPE, failure to enforce physical distancing of residents, inadequate staffing, and failing to recognize and react to coronavirus symptoms. Routine federal inspection of nursing homes was stopped on March 20. They complain that federal help has been non-existent as hospitals received all the focus. More than half of reported COVID-19 deaths in some states were nursing home residents.

The Economist warns that governments are borrowing money at a level not seen since the end of World War II despite a dramatic drop in taxes collected, piling up coronavirus-related debt from issuing stimulus money and relief checks for people and businesses. The authors conclude that such spending is sensible in trying to forestall further economic slump — especially in the lower-risk US as the world’s reserve currency and with low interest rates — but working down the 1945 debt all over the world required high taxes on capital, the benefit of inflation, and a baby boom that was accompanied by higher levels of education. The authors also expect that the public — especially senior citizens who vote against politicians who attempt to limit entitlement spending — will demand higher levels of healthcare spending.

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Former CMS Acting Administrator and United States of Care founder Andy Slavitt lists his takeaways after talking nearly non-stop to to scientists from all over the world:

  • Making effective, breathable, and even fashionable masks available at low or no charge to the entire US population could protect us (at worst) or eradicate the virus (at best) due to the power of exponential math of the infection rate. Masks, rather than a vaccine or therapy, may be the silver bullet.
  • We will solve the shortages of tests, ventilators, and hospital beds.
  • Individual immune response rather than the strain of the virus may drive COVID-19 outcomes.
  • Creating an effective vaccine by 2021, proving that it is safe, and then manufacturing and distributing it to the entire globe involves many challenges.
  • Even in the absence of a vaccine, COVID-19 could be managed as a chronic disease.
  • A vaccine may only be partially effective or may offer partial inoculation, in which case it could still be used in healthcare workers and high risk people.
  • We need to produce so much PPE that a glut is created, taking profiteers out of the picture.

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VA officials reverse their previous insistence that it is providing adequate PPE even as employees stated otherwise. VA Executive in Charge Richard Stone, MD says FEMA ordered the VA’s vendors to redirect its shipment of 5 million masks to FEMA for restocking the emergency stockpile, forcing the VA to limit employees who work directly with COVID-19 patients to one mask per day, while other employees who delivered food and medications to COVID wards received only one mask per week, with orders to staple the straps if they broke. The VA says that 1,900 of its own employees are sick with COVID-19 compared to the 6,300 infected veterans it has treated. The VA did not have enough tests for its employees until recent weeks, but its absenteeism rate is still tracking below the normal average at 4% as poorly equipped employees keep showing up for work.

White House officials are discussing plans to replace HHS Secretary Alex Azar, sources say, following widespread criticism of the federal government’s early response to the pandemic and misstatements to the White House about Azar’s reported demotion of HHS vaccine expert Rick Bright, PhD. 


Other

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Something triggered a memory of XG Health Solutions, the Geisinger analytics and consulting spinoff that was splashily introduced in 2015 without much buzz since, The company apparently closed its doors last summer (shutting down instead of selling out for even a “better than nothing” price is a key indicator of spectacular failure). I attended their HIMSS15 launch and concluded:

From the hallway conversations I heard and my own opinions, here are the positives: Geisinger has developed a lot of expertise and content that’s less ivory tower than most big academic medical centers, they put some thought into involving the patient in the use of their apps, and the SaaS-based subscription means new best practices can be put into place quickly. Negatives: the company has significant venture capital ownership (they aren’t Geisinger, in other words), you might suspect that Geisinger applied soft pressure to the newly named EHR vendor partners to get on board with uncertain future commitments, and so far they’re a company that hasn’t done much to dent the market other than to do Geisinger stuff and make announcements. Success in commercializing hospital software is elusive, and while Version 1.0 is easy, it’s Version 2.0 that gets ugly with upgrades, design decisions, and testing. The first non-Geisinger betas will be important. 

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Best tweet of the weekend, although “other” would have been a lot more sarcastically effective and epidemiologically accurate than “only.”


Sponsor Updates

  • Impact Advisors publishes a white paper titled “The Future of EHR Implementation Post-COVID.”
  • Experian Health’s MyHealthDirect scheduling solution is now available in the Epic App Orchard.
  • Health Catalyst makes COVID-19 insights derived from its Touchstone platform of 80 million de-identified patient records available to customers, hospitals, public health authorities, governments, and biopharma working on treatments.
  • NextGate publishes a new white paper, “Why Patient Identity Management Tools are Critical for COVID-19 Surveillance.”
  • KLAS includes Nordic solutions in its latest report, “COVID-19 Technology and Services Solutions Guide.”
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “Team Skills Simulation Training.”
  • PerfectServe congratulates customer Prisma Health on FDA approval of its VESper ventilator expansion device.
  • Experity will host a virtual job fair May 2 from 9am-noon CT.
  • Patient engagement vendor Relatient joins the Epic App Orchard.
  • ROI Healthcare Solutions announces comprehensive EDI optimization offerings for Info users.
  • Summit Healthcare publishes the “Galway Clinic Success Story: Solving Complex Interoperability Needs with the Latest in Integration Technology.”
  • In Europe, Synteract leverages the TriNetX platform and COVID-19 Rapid Response Network to find and enroll patients for coronavirus clinical trials.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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News 4/24/20

April 23, 2020 News 2 Comments

Top News

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Banner Health will pay $8.9 million to settle claims from its 2016 data breach. An Arizona federal judge approved the settlement, which was reached in early December, on Tuesday.

Each patient who is covered by the class action will receive $500, while the plaintiffs’ attorneys will earn $2.9 million.

Cyberattackers breached Banner’s credit card payment system that is used in its food outlets, then extended their attack to other systems, exposing the information of 3.7 million patients and health plan members.


Reader Comments

From COVID Thoughts: “Re: traveling contractors. How will hospitals address vendors and consultants coming on site post-COVID? If widespread testing is not available, will they permit traveling contractors in their hospital and office buildings?” I’ll open the floor to what, at this point, will be speculation at best. I assume that whatever precautions hospitals will take with patient visitors – temperature checks, limits on numbers, etc. – will be applied to business visitors, but I wouldn’t expect getting them into the building will be a high priority. They could require meeting at locations other than buildings where patient care is provided.

From Disengage: “Re: chatbots. Those should keep people out of the ED even after the pandemic is controlled.” Don’t count on it. The customers of those chatbots are health systems who make a lot of money from ED patients in normal times, where the ED helps keeps heads in beds. The sudden interest in doing the opposite — keeping people away from the ED who don’t need to be there — could well be temporary. Health systems are happy to have full EDs as long as someone is paying, and I expect them to deploy their post-pandemic chatbots accordingly. You don’t run a successfully restaurant by testing prospective diners to verify that they are actually hungry.


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

  • Cerner expands its VA contract with Vecna Technologies to include greater EHR systems integration and go-live support at Mann-Grandstaff VA Medical Center (WA).
  • TCARE, which offers a family caregiver support program, will use CareSignal’s COVID-19 programs (linking to local public health resources and information, a self-monitoring text system, and staff support) for its 20 million members.
  • The VA expands its contract with CirrusMD for the text-based VA Health Chat, in which VA employees provide medical advice, manage prescription refills, and schedule appointments.

Announcements and Implementations

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Cleveland Clinic and SAS share predictive modeling code on GitHub that can help hospitals better prepare for COVID-19-related supply chain, capacity, medical device, and financial scenarios.

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The Dallas VA implements cloud-based COVID-19 monitoring, surveillance, and tracking solutions custom-developed by CliniComp across 42 sites.

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The Regenstrief Institute partners with the Indiana Health Information Exchange, Indiana University School of Medicine, and several state-based agencies to develop a COVID-19 tracking and response dashboard using data from the state’s health systems and labs.

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A KLAS report on technical services providers finds that Galen Healthcare and 314e have the broadest range of clients, J2 Interactive and Navin, Haffty & Associates  are most consistent in client satisfaction, and those four vendors offer the best balance of prce and performance. Client scores from Atos, which grew in the US by acquisition, place it at the bottom. Prominence earned top scores for quality of staff and its deep Epic expertise.

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Epic reports that hundreds of hospitals are using its machine learning predictive model to alert clinicians of patients whose conditions are worsening. COVID-19 modules are being validated and used. 


Government and Politics

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HHS updates providers on the distribution and timing of CARES Act Funds, stressing that payments will be made weekly beginning Friday. High-impact areas such as New York will be allocated $10 billion.

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EHR vendor KPMD pays $1.7 million to settle charges that Southwest Regional Medical Center (OH) falsely attested to state and federal governments that its ED met the requirements for EHR incentive payments even as the hospital was shutting down. KPMD’s contract called for the hospital to send the company its government incentive payments. KPMD’s CEO Krishna Surapeneni later bought the hospital in September 2013 and closed it one year later.

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CMS, ONC, and the HHS Office of the Inspector General announce they will delay enforcing compliance with final interoperability rules so that healthcare stakeholders can focus on COVID-19-related operations.

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FedScoop profiles HHS Protect, health data visualization technology used by the White House’s Coronavirus Task Force that comprises 187 datasets from federal agencies, state governments, healthcare facilities, academia, and industry partners. The dataset, developed and managed by the HHS Office of the CIO, gives 200 users access to COVID-19 case count sources; hospital capacity, utilization, inventory, and supply data; government and industry supply chain data; lab testing data; and data from community-based testing sites.


COVID-19

Scientists determine that coronavirus was spreading undetected in the US by early February and the first known death occurred February 6, as international and domestic travelers then spread the infection. New York City had 600 people with unidentified infections in mid-February and confirmed its first COVID-19 case on March 1, but the city may have had more than 10,000 cases by then.

NIH Director Francis Collins, MD, PhD cites research that found that 44% of coronavirus transmissions occur before the infected person develops symptoms, which will make contact tracing harder. Those studies suggest that people can spread the infection for 2-3 days before they become ill themselves, which then requires tracking down and quarantining 90% of their close contacts who by then have been exposed.

A Health Affairs blog post warns that US maps that show few COVID-19 cases outside of metro areas are misleading, concluding that “the virus is everywhere” based on hospital referral regions where people travel across county and state lines to seek hospital care. Case rates are increasing in all of those regions. The authors recommend that the referral region information be considered by states that are loosening their distancing requirements.

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A Kaiser Family Foundation poll finds that:

  • 51% of Americans think the worst is yet to come with coronavirus, down 23 percentage points from three weeks ago.
  • 80% say shelter-in-place is worth it to protect people and limit spread.
  • The majority of respondents say they can continue physical distancing and shelter-in-place for more than another month.
  • Two-thirds of people support phone-based contact tracing after they were told that it could allow schools and business to reopen.
  • Twice as many people would be willing to download a contract tracing app if the data was managed by local or state health departments or the CDC instead of a technology company.
  • 38% worry that companies will sell data from contact tracing apps, while 33% think the federal government will use the data for purposes that go beyond tracking coronavirus spread.Two-thirds say they would not feel safer if phone-based contact tracing were in place.

Partners HealthCare (MA) turns its internal employee communications app into a COVID-19 messaging tool, giving its 78,000 staff members daily updates on testing protocols and stay-at-home policies.

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Johns Hopkins University hosts a free public course titled “Understanding the COVID-19 Pandemic: Insights from the Experts.”

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Researchers find that ambulatory practice visits dropped 60% overall starting in mid-March, a reduction that has not been fully offset by the upswing in telehealth visits.

A study finds that of 318 coronavirus outbreaks (three or more cases) in China, only a single outbreak happened outdoors and that outbreak involved just two cases. The study did not take note of the fact that most of the outbreaks occurred during winter when people would have been mostly indoors anyway, but the results may still encourage states to allow churches, restaurants, and gym classes to reopen with a recommendation to use outdoor spaces. The study also found that home contacts were involved in 80% of outbreaks and most of those involved 3-5 cases. A significant percentage involved public transportation.

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Facebook removes its “pseudoscience” user interest category — which tagged 78 million people — after a website discovered the targeting option when its reporter was served an ad for a radiation-blocking hat. Consumer Reports found that despite Facebook’s declared crackdown on false pandemic content, the magazine was able to buy ads claiming that social distancing doesn’t work and that drinking bleach preserves health.

Drugmaker Jaguar Health — whose only product is the diarrhea medication Mytesi that is approved for use in HIV/AIDS patients who are being treated with antiretroviral drugs — raised the price from $11 to $37 per tablet in early April, right after asking FDA to allow its use for COVID-19 patients being treated with remdisivir. The FDA denied the request. The company says it is going broke fast because insurers won’t pay for Mytesi, which is made from tree sap.


Privacy and Security

Hackers expose the stolen logon credentials of 25,000 users from WHO, NIH, CDC, and the Gates Foundation. WHO says only 457 credentials of the original 6,835 remain active. A white-hat hacker who gained access to WHO’s system using the stolen data says that nearly 50 accounts use “password” as their password, while others use the user’s name or “changeme.” White supremacist groups that have targeted hospitals and medical workers published the stolen credentials to their members almost immediately.


Other

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USCF’s Atul Butte tweets that patients can send their Apple Health-stored ECGs to their providers using Epic’s MyChart patient portal.

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Hospitals that hope to avoid Joint Commission penalties by throwing away medical supplies with a close expiration date are now scrambling to obtain PPE.

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This is pretty great.


Sponsor Updates

  • CareSignal and Texas Health Aetna launch a free, text-based COVID-19 education messaging service.
  • Ellkay releases a video in celebration of Medical Professionals Week 2020.
  • The Big Unlock Podcast features Wolters Kluwer Health VP and General Manager of Clinical Surveillance Karen Kobelski.
  • Hyland Healthcare and HIMSS Media publish 2020 Connected Care and the State of Interoperability in Healthcare study results.
  • Imprivata expands its collaboration with Microsoft to offer new digital identity innovations.
  • InterSystems announces that RxMx has built its new Chameleon platform on InterSystems IRIS for Health, powering a new COVID-19 testing and monitoring solution for employers.
  • Glytec customers AdventHealth and CHI Franciscan will lead the “Computer-Guided Insulin Dosing” session at the 2020 Diabetes Technology Society Virtual Hospital Diabetes Meeting April 24 at noon ET.
  • The local business paper profiles the rapid uptake in adoption of the Healow telemedicine app from EClinicalWorks.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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News 4/22/20

April 21, 2020 News 2 Comments

Top News

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The VA and DoD jointly launch a health information exchange that will allow clinicians to access patient records that are stored in the EHRs of community partners and health systems.

The HIE will connect to CommonWell later this year.

Both organizations were already able to access information from their own community health partners, but the HIE allow all providers to see data from all community partners.

Most of the 215 partners that are participating in the exchange can both send and receive patient data, although some allow only one-way sharing.


Reader Comments

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From Burned by TriZetto: “Re: TriZetto. We installed EClinicalWorks at our practice last year and chose TriZetto from the three revenue cycle vendors ECW offered us. ECW just announced that they are abandoning the company and their integration because of a massive security breach at TriZetto.” Cognizant, which acquired TriZetto for $2.7 billion in cash in 2014, was hit this past weekend by Maze ransomware. ECW has blocked all integration to TriZetto’s clearinghouse and patient statements. The Maze malware not only encrypts computers, it exfiltrates company data to the servers of the attackers, who then demand payment with the threat of publishing the data online. The publicly traded Cognizant, which reports annual revenue of $17 billion, warns in a new SEC filing that the attack could negatively affect its financial results. Meanwhile, Cognizant continues to offer end-to-end security solutions, including threat and vulnerability management and cyber threat defense.


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

Analytics vendor Komodo Health lays off 23 employees, representing 9% of its headcount, three months after it raised $50 million in a funding round. The company collects the de-identified data from 15 million patient encounters each day to follow patient journeys and analyze outcomes.


People

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Microsoft hires Tom McGuinness (GE Healthcare) as corporate VP of global healthcare.


Announcements and Implementations

Google announces GA of the Google Cloud Healthcare API. The company also highlights its tools for supporting COVID-19 efforts, including Google Meet for virtual care, G Suite for sharing information, a newly launched Rapid Response Virtual Agent for patient interaction, Google Maps Platform for giving directors to patients, and researcher credits for Google Cloud

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Nuance launches Dragon Ambient Experience (DAX), which creates clinical notes from the physician-patient conversation in either physical or virtual visits.

Surescripts reports that e-prescribing represented 80% of all prescriptions in 2019, while use of real-time benefit checking and electronic prior authorizations increased significantly.

Lark Health offers its text-based stress and anxiety coaching service to health plans and employers at no charge through July 1.

Redox announces a rapid deployment model that allows telehealth software developers to bring their solutions live with EHR integration in two weeks.

Premier enhances its solutions for COVID-19, including COVID-specific alerts for clinical surveillance, an early warning system for patient volumes, surge prediction, supply use prediction, COVID-19 clinical guidance, intervention effectiveness monitoring, and best practices deployment.

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PCare will deliver provider-prescribed patient guidance and education from Quil on its interactive patient system and digital rounding solution, with COVID-19 Care Journey being among the first offerings.


COVID-19

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CMS announces that hospitals that are located in areas that have low coronavirus outbreak risk can restart providing non-emergent, non-COVID-19 services. CMS advises hospitals to monitor COVID-19 trends in their area; prioritize by patient need; ensure that providers, staff, and patients wear facemasks at all times; screen staff and patients for symptoms before they enter the facility; and limit volumes so that six-foot distancing can be practiced in areas such as waiting rooms.

Baystate Health executive Andrew Artenstein, MD describes in a NEJM letter the health system’s drama-filled effort to obtain face masks and N95 respirators at five times the normal price from a broker who had a connection in China. The hospital team traveled to an industrial warehouse to meet two trucks that had been marked as food service vehicles to avoid being detained. FBI agents arrived demanded proof that the supplies were not bound for black market resale. The agents were satisfied, but the health system then had to use its political contacts to keep the shipment from being seized by the Department of Homeland Security.

Providers who accept CARES Act relief funds are barred by mandatory acceptance terms in which they pledge to not balance-bill COVID-19 patients for out-of-network charges.

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FDA authorizes use of LabCorp’s home self-test for COVID-19, in which a collection kit of nasal swabs and saline is used by the patient to take their own sample, which is then mailed to LabCorp for processing.

Former FDA Commissioner Scott Gottlieb, MD warns that most available serology tests have not been reviewed by the FDA and their quality varies, with some tests potentially being wrong half the time when they tell patients they have coronavirus antibodies. The tests are useful for public health studies, but not worth much for making decisions about individuals.

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Influential technology investor Mary Meeker looks at the influence of coronavirus, with these healthcare-related observations:

  • COVID-19 research is being published at 20 times the rate of prior infectious diseases at the same stage.
  • Clinical research is rapidly mobilizing, with 500 clinical trials underway with 5 million participants.
  • The pandemic has exposed healthcare flaws that may be the call to arms to rethink a system that consumes 8% of GDP, $1.2 trillion in 2019 federal spending, and 28% of the federal budget.
  • Primary care hasn’t changed much since 1918’s Spanish Flu outbreak, as patients still visit the office (possibly infecting others), the doctor diagnoses based on outward symptoms, the patient is sent home to watch and wait, and the patient either gets better or goes to the ED.
  • A lack of connected data, despite decades of EHR investment, have left federal and state healthcare officials using spreadsheets to track hospital utilization and capacity. Prediction models have varied wildly based on the use of assumptions. Providers are too overwhelmed with  workload and high volumes of data to deliver the benefits of digitization.
  • Innovation will be driven around telehealth, connected devices for monitoring, rapid point-of-care testing, connecting the “dark pools” of EHR data using interoperability and APIs, using automation to improve data capture quality, and applying AI to EHR data to drive insights to providers at the right time.

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Several healthcare companies create COVID-19 Research Database, a secure repository of de-identified, patient-level, longitudinal datasets from claims and EHRs. Researchers will be able to evaluate drug effectiveness, identify demographic and pre-existing condition risk factors, and predict the public health impact of quarantines.


Sponsor Updates

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  • Bluetree employees across the country make 609 masks for nine organizations in eight states.
  • Avaya CEO and President Jim Chirico discusses on Fox Business how the company is donating video services to businesses during the pandemic.
  • Clinical Architecture releases a new edition of its Informonster Podcast, “Three Takeaways from the COVID-19 Pandemic and the Importance of Managing Data Quality.”
  • Dina wins the 2020 Transition of Care Challenge, sponsored by the New Orleans Business Alliance and Tulane Health System.

Blog Posts


Contacts

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

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Curbside Consult with Dr. Jayne 4/20/20

April 20, 2020 News 1 Comment

Lots of conversation in the virtual physician lounge on when we will know when it is safe to start to resume “routine” patient care again.

Most of the employed physicians I know have taken salary cuts, and many of my independent peers are holding any physician payments while they try to cover expenses and staff salaries. Practices are running with a skeleton crew, and I’d estimate about half the practices are offering some kind of telemedicine services. (More telemedicine with primary care or non-procedural based subspecialties, less with those that relied on office or hospital-based procedures for their income.)

I know of a handful of physicians that have totally hung up their white coats. They were either close to retirement and are just “done with it,” so to speak, or their employers offered them some kind of buyout to ease the payroll.

A couple of us have been talking about last week’s New York Times piece on how we can safely move away from lockdown and stay-at-home conditions. We’re starting to see other countries that previously looked like they had a good handle on the pandemic who are starting to re-impose controls based on a resurgence of cases, which is unnerving. My state hasn’t hit its projected peak just yet, and without a robust testing strategy, it’s not even clear when we’ll know that we’re peaking. Too many patients are dying at home or in situations where they haven’t been tested.

The NYT piece quotes milestones laid out in an American Enterprise Institute report, which was authored by a group whose expertise many of us trust. One of the key points for moving forward is that “local hospitals are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care, and the capacity exists in the state to test all people with COVID-19 symptoms, along with state capacity to conduct the active monitoring of all confirmed cases and their contacts.”

We’re a long way from that were I am. Healthcare workers don’t always have N95 masks, and those who do are being asked to wear them in a way that hasn’t been shown to be effective. Some care sites such as urgent cares aren’t offering any kind of decontamination or reprocessing – employees are just expected to rotate whatever masks they have (many of which were obtained from hardware stores or family members) until they disintegrate. Local hospitals are trying to figure out reprocessing, but it’s unclear how much the precious masks can take.

An ICU nurse friend of mine posted on Facebook how thrilled they were to get hand sanitizer from a local distillery. The post was accompanied by a photo of a colleague wearing a woodworking respirator. This is in a premier hospital in an affluent suburb of a major metropolitan area, not a safety-net facility or a place without resources.

It doesn’t feel to those of us on the clinical side like we’re even remotely ready to start talking about implementing societal changes that would place a larger burden on healthcare organizations. I applaud the companies like Battelle that are innovating (their mask reprocessing strategy is pretty cool, and the Pentagon is sinking big money into additional units for deployment across the country) but for goodness sake, healthcare workers are wearing trash bags for protection. Trash bags! In the year 2020, in the United States of America. To be honest, did any of us really see that coming? Did we ever think we’d practice in a situation where that was acceptable?

I’m furloughed from my clinical gig, but I still read the email updates. Their strategy when they run out of barrier gowns is to use cloth patient gowns and launder them since all sites have a washer. Let’s see, they’re cloth, they’re not moisture-proof, and then people are going to be at risk handling them for the laundry process. Sounds like a great plan. I think I’d rather have the trash bag, to be honest. They’ve had to remove the glove dispensers from patient rooms because the gloves were being stolen. It’s surreal.

I know many of our readers work for healthcare organizations and you already know these things. If you haven’t seen them with your own eyes, you’ve probably heard about them on command center calls or during supply chain management huddles or in any number of ways in which your world is being impacted by this pandemic. Healthcare organizations are burning through money without hopes of their coffers being replenished for some time, especially since some of them depend on non-emergent services for up to 80% of their budgets.

Families are in the same situation, burning through any emergency funds they had saved, unsure when they’ll be back to work. People are having to make tough choices, and the answers aren’t as cut and dried as any of us would like them to be.

At least in my area some of the safety nets are back up and running. School-based meal pick-up services had been halted after some worker infections, and one of the major food banks had closed temporarily while they figured out a sustainable strategy for continuing to help people.

One of the local community health centers is opening additional drive-through testing sites. I’m not sure how they got their hands on so many tests, but since their community is being disproportionately impacted by the pandemic, I’m glad they have them. At the same time, they’re working very diligently to try to make sure their patients have needed medications and chronic care services, to make sure they don’t just stay COVID-free, but also protect their health as much as possible.

It seems like a lifetime ago we were debating how much money hospitals were spending on massive EHR projects or whether they would ever see their return on investment. I hope all those organizations are pushing the limits of whatever features and functions they can to make the caregivers’ lives easier. I hope the executives are rolling up their sleeves and helping on the front lines and that they’re supporting the staff who feel uncertain or frankly afraid. It’s going to be a long time before we get to any semblance of “normal” and people need all the support they can get.

With that in mind, and in order to support your stress-baking habits, I offer up the Taste of Home Giant Buckeye Cookie. The inhabitants of Casa Jayne give it a “10 out of 10, would eat it again.” I would strongly recommend the ice cream to go along with. We didn’t have it, and it would have been lovely. Even if your local grocer is out of flour, you can probably score the cake mix it calls for.

What has your favorite stress baking recipe been? Leave a comment or email me.

Email Dr. Jayne.

How the Pandemic is Changing Consulting Work (Survey Results)

April 20, 2020 News 9 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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