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Weekender 8/21/20

August 21, 2020 Weekender Comments Off

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Weekly News Recap

HHS denies a Wall Street Journal report that says COVID-19 hospital data reporting will revert back to CDC’s control using a new system.
Bankrupt smart pill developer Proteus Digital Health sells its assets to Japan-based pharmaceutical company Otsuka for $15 million.
Clinical communications vendor Vocera acquires EASE Applications, which offers messaging tools to connect family members and a patient’s care team.
Health IT vendor TeleTracking refuses to answer the Senate Health Committee’s questions about its $10.2 million contract to develop a HHS COVID-19 hospitalization reporting database.
HHS CIO Jose Arrieta resigns unexpectedly after 16 months on the job

Best Reader Comments

Spoke with an MD yesterday, they’re doing pot over the phone now. Great job, telehealth, you really saved the world this time. Meanwhile, back at the facility, kidney patients are bearing a COVID burden on top of the mortality rate associated with dialysis. Point: mobile works, big brick things with windows that don’t open don’t. Disclaimer: I’m talking about patient healthcare, not funding a better grasp on a sinking anchor. (richie)

I would rather some dumb startup provide access to marijuana cards, Rogaine, birth control, contact lenses, etc. than have to wait in line behind those people in the doctor’s office. Those are mostly just doctor employment programs anyway, which they don’t need. (IANAL)

Here’s how your insurance company thinks about [telemedicine]. You know that nurse line that they run where you can call in and ask questions? What if the people on that line could write prescriptions, order and interpret labs, etc.? What percentage of doctor’s office visits could they cover? Rough guess would be 1/3 of your typical PCP visits. How much less could the total cost be for that office visit? Maybe it is 60 percent of the in-person cost, more in high rent areas or areas with limited physician supply. When an insurance company is required to spend 80 percent of revenue on claims and they optimistically have a margin of 5 percent, it is a no brainer for them to try as hard as possible to make their telehealth solution work for their consumers. I agree it doesn’t make sense for traditional fee-for-service health systems to be using telehealth. Instead, it is something that cuts the traditional health system out of the relationship because they are too expensive or their service is too bad. Which makes the idea of health systems buying telehealth services sound strange to analysts. Why would health systems want to fund their competitors unless they have no hope of putting the telehealth cat back in the bag? (Bogon)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. P in Texas, who asked for programmable Ladybugs for her kindergarten class. She reported in February, “These little robots are the STAR of our classroom right now. I wish that I could send you a video of the children using the ladybug robot and coding remote. The shrieks and laughter were amazing. When I sent the videos and photos to the parents, they were thrilled, as well. I can tell how meaningful it is to these parents that their children learn more and accomplish more than they were able to at their age. It is really sweet. The first time I showed the children how to use it, they thought it was pretty cool. The first time each child got to program in a code and watch the ladybug travel over the mat, THEY WENT WILD!!! It was the perfect example of how seeing something happen can be a learning experience, but actually doing something is the best way to learn. Thank you for providing this opportunity for my littles.”

Google launches a six-month certificate program that will prepare students for high-paying technical jobs, such as data analyst, project manager, UX designer, and IT support specialist. The company says that college is too expensive for many Americans and a diploma shouldn’t be required for economic security. Google will treat the career certificates equivalent to a four-year degree in its own hiring, will fund 100,000 scholarships to the program, and will offer apprenticeships and job search services.

An Alaska doctor is indicted for $9 million in Medicaid fraud for requiring his addiction patients to undergo a urine test that he sent to a lab he owns in Tennessee, for which he billed $3,000 to $8,000 each. A cash-paying patient filed a complaint with the state’s medical board. The doctor is posting rambling videos to YouTube proclaiming his innocence in referring to himself in the third person. Bonus footage minimizes COVID-19 and the “mind control” involved in mandating mask wearing, says his tests are expensive but nothing compared to what Medicare pays for a COVID-19 admission that “in most cases, is not even as bad as a cold,” and his persecution under the Obama administration for donating money to Republicans.

Missouri’s medical board revokes the license of a 70-year-old doctor who amputated a patient’s toe on the porch of his office, a machine shed that does not have running water. He says, “Everything was absolutely perfectly sterile, out in the bright sunshine and fresh air.” His practice’s website is full of bizarre conspiracy theories, along with his offer of video counseling ($50 per 15 minutes) for marital difficulties and unruly children, also offering student tutoring at the same rate. Googling turns up previous charges for narcotics distribution.

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Weekender 8/14/20

August 14, 2020 Weekender Comments Off

Weekly News Recap

MDLive announces plans to go public early next year.
Health Catalyst announces its acquisition of Vitalware for $120 million.
Epic reverses its mandatory return to campus policy, approving working from home through at least the end of the year.
Waystar will acquire ESolutions, valuing the company at $1.3 billion.
Craneware raises $100 million for acquisitions.
Providence Services Group acquires Navin Haffty.
VA OIG recommends that the VA work on increasing its use of VA Direct and improve oversight of its VHIE community coordinators.

Best Reader Comments

The most surprising aspect of the Teladoc-Livongo deal is how investors and healthcare analysts don’t seem to understand the telehealth market. The walk-in or urgent care telehealth visit has a razor thin margin for telehealth companies. Almost 100% of the $50 fee charged to consumers goes to pay the physician labor or pay for the ads. The market is national, so any telehealth agenecy can join if they are willing to spend the ad dollars or offer slightly cheaper visits for a brief period as telehealth is uniquely price shoppable. On the other hand, your average physician is used to being protected from national competition by having a very local, captive market and they have many options when it comes to keeping their income above say 120 grand a year. Plus consumers prefer in person visits if the cost and convenience are the same, so providers always can fall back to that. It is very hard to reduce provider labor cost. So the telehealth agency gets squeezed between a price sensitive consumer, a provider who demands the bulk of the revenue from consumer, and the cost of ads which are raised by investors repeatedly dumping their money into new telehealth companies driving up demand on the ads displayed when people search video doctor. So every telehealth company that has lasted more than a few years has some strategy that gets them out of the urgent care market. (detroitvseverybody)

[Teladoc acquiring Livongo for $18.5 billion] reminds me of the post-deregulation period in the airline business, 1980s into the 1990s, when airlines fetched this kind of insane money from all over. I was there for that and it didn’t end well. (Deetelecare)

Providence Services Group now owns two MEDITECH focused service organizations while Providence is in process of migrating multiple MEDITECH hospitals to Epic. Plus, Providence is large Epic client. So basically MEDITECH helps fund a large Epic client since NHA and Engage are two of its partners. (Chris Hill)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. G in Ohio, who asked for white boards for her high school class in urban Cleveland. She reported in late February, “I cannot express how much these white boards have helped my students in class. We use them every day in order for them to practice different concepts in class. These white boards allow for my students to have immediate feedback in class and work through concepts even faster. They have taken pride in their work and have grown so much since having these white boards available in class. Thank you so much for allowing my students the opportunity to use these white boards every day in class.”

A COVID-19 hospital in India lists its challenges: relatives keep barging in rooms to bring isolated patients meals, air conditioners don’t work in the sweltering heat and humidity, new patients are housed with those known to be infected, families sit curbside with the bodies of family members waiting for funeral home pickup, and armed guards protect the hospital administrator.

An Alabama neurosurgeon crashes his $200,000 sports care while doing 138 miles per hour in a 45 zone, killing his 24-year-old medical school passenger. He’s charged with manslaughter. Police say the doctor was intoxicated and suffered only minor injuries.

Chicago chose a politically connected company to develop a temporary 2,750-bed COVID-19 hospital in the McCormick Place convention center at a cost of $66 million, passing on another company that offered to do the work without fees. Federal taxpayers will foot 75% of the bill for the hospital, which saw just 38 patients. Wielding influence in the selection was the private company that oversees Navy Pier, which is run by political allies of former mayor Richard Daley.

A medical practice in England discovers why patients aren’t answering its phone calls – a phone system error caused its Caller ID to show the name of a massage parlor.

Can’t wait for Las Vegas at HIMSS21? MGM hotels is offering “Viva Las Office,” a work-from-Vegas package that includes discounted flights, rooms in the Bellagio or Aria hotels, and a personal concierge. Big cheeses can blow their company’s cash with “The Executive” package, which includes a luxe suite, $75 food and beverage credit, a discount on JSX semi-private jet travel, a day’s cabana rental, a poolside massage, and a mask and hand sanitizer. Plus you can study COVID-19 in person since 95% of new Nevada cases originated in the city, comping visitors from all over the country with yet another situation that happens in Vegas but doesn’t stay there.

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Weekender 8/7/20

August 7, 2020 Weekender 1 Comment

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Weekly News Recap

Private equity firm Blackstone acquires 75% of Ancestry for $4.7 billion, which includes the DNA information of 18 million people.
Teladoc reaches an agreement to acquire Livongo for $18.5 billion, digital health’s biggest deal ever.
Epic announces plans to return employees to campus by September 21.
Siemens Healthineers will acquire oncology technology vendor Varian Medical Systems, which includes several software products, for $16.4 billion.
Virginia will become the first state to use the Covidwise exposure notification app from Apple and Google.
CDC Director Robert Redfield, MD tells a House coronavirus committee that CDC was not involved in HHS’s decision to replace its COVID-19 hospitalization data system to a contractor-developed HHS system.
Allscripts notes in its earnings call that the US Department of State’s 450 clinicians will use its TouchWorks and FollowMyHealth systems in its role as a subcontractor.

Best Reader Comments

[On Epic’s mandatory return to campus] Most egregious, for a company that beat into me from day 1 that I must make clear recommendations supported by data, they have no data. They released multiple products during the pandemic while working from home. Support ticket closure rates are up 10% in some applications. They have no metric for productivity, but are willing to die on the hill of “magical, spontaneous hallway conversations.” They’ve failed to create a culture that can exist outside of their physical workspaces; I was part of the very first inter-office chat pilot at Epic – Skype in 2017 – and had to fight tooth-and-nail for its roll-out. Even during non-pandemic times, I primarily called into my on-campus meetings because getting there would’ve taken 15 minutes. This is an abject failure of leadership from Judy, Carl, and the rest of the executive team. (Ex-Epic)

Bill Gates used to say that early on in the life of Microsoft, he used to eyeball how many cars were in the parking lot when he left (which often used to be late in the evening/night) to get a sense of how hard his people were working. He later admitted that it was a rather naive and inaccurate way of measuring productivity. And that was 40 odd years ago! Well, Bill G and Microsoft grew up! Seems like Judy and Epic haven’t. (Ghost_Of_Andromeda)

[On Teladoc’s acquisition of Livongo] Mr. Tullman and Mr. Shapiro poised to cash out (again). As has been proven with Allscripts and now here, it’s easier to raise money for a startup than it is to actually run a company. (It’s All Good)

[On Teladoc’s acquisition of Livongo] No quarterly profit ever and an 18.5 billion price tag… Is there that much waste reduction in the US healthcare non-system to account for such strange valuation? (Eddie T. Head)

Siemens acquires Varian. Ggreat news for Varian shareholders. Sad to see another technology company move to non-US ownership. Will be interesting to see how things shake out when Siemens decides to “integrate” the business. (Robowriter)

Watercooler Talk Tidbits

Readers funded the Donor’s Choose teacher grant request of Ms. S in Philadelphia, who asked for carpet and bean bag chairs to create a reading center for her after-school kindergarten program. She reported in February, “When my students first saw the new rug and bean bags in the library area, they asked me, how did we get that in our class? Can we keep it? I answered them how Donors Choose helped us get a funder to donate what we needed. They were surprised that a stranger gave us money . They were super excited and wanted to lay down on the rug to read. We follow D.E.A.R. (drop everything and read) in our schedule. With the new cozy area, the students are more interested in literature. The students enjoy sitting in bean bags, or laying down on the rug to read. They go and pick a book of their choice and start reading enthusiastically. We also use the rug to play different games, practice the numbers and the alphabet. Sometimes, the students just lay down on the carpet to relax. When they are having a bad day, they sit in bean bags and distract their mind. It helps students to calm them down and rejoin the class group when ready. Having a cozy and safe library area has been a life-changing experience for them.”

Maria Fareri Children’s Hospital (NY) designates eight-year-old Jorden Hutchins as an ambassador to the hospital after he survives a COVID-19 infection with Multi-System Inflammatory Syndrome in Children, which involved being placed on a heart-lung machine, undergoing heart surgery, and having multiple strokes and kidney failure.

Here’s a tech tip I learned for editing a web address or any other text on the IPhone or IPad. Hold down the on-screen keyboard’s space bar until it turns gray, which turns the keyboard into a trackpad for precise cursor positioning.

A furloughed urology nurse in Virginia sews cloth masks and 3D-prints 800 face shields for local teachers.

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Volunteers for the non-profit Telehealth Access for Seniors are providing devices, instructions, and free tech support to seniors and low-income communities to support telehealth and digital connectivity with family and friends. Lia Rubel from Vermont (above) has collected 50 devices and raised $800 to help with the mental health of self-quarantined seniors. The organization overall has collected 1,500 used devices, $63,000 in donations, and has 315 volunteers in 26 states. The organization seeks IPhone 4 and above and second-generation or newer IPads, for which it provides data erasing instructions. Their GoFundMe has raised $29,000 so far. The founders are Yale undergrads Aakshi Agarwal, Hanna Verma, and Siddharth Jain along with high school junior Arjun Verma. Agarwal is double-majoring in molecular biology and political science, hoping to purse a law degree and then work in healthcare policy. She also co-founded a college admissions consulting service.

A nurse in an explosion-damaged hospital in Beirut runs to the NICU with a colleague to remove five newborns, captured by a press photographer who said that among the rubble and bodies, “The nurse looked like she possessed a hidden force that gave her self-control and the ability to save those children.”

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Weekender 7/31/20

July 31, 2020 Weekender 1 Comment

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Weekly News Recap

HIMSS pushes out its 2021 conference from March to August in Las Vegas.
Allscripts will sell its EPSi business to Strata Decision Technology for $365 million.
New investment in WellSky values the company at $3 billion.
Irregularities are found in HHS’s $10 million contract with TeleTracking for a COVID-19 hospitalization tracking database.
The COVID Tracking Project says that COVID-19 hospitalization data is now unreliable, partly because of HHS’s abrupt switch to a new system and accompanying data element changes.
Private equity investments in Edifecs value the company at $1.8 billion.
A surgery journal retracts an article in which the authors created fake social media accounts to search for photos or comments by surgery residents that they deemed unprofessional.

Best Reader Comments

I couldn’t care less about what my PCP or NP is doing with their family and friends in their off time. What’s considered “professional” and “unprofessional” is a social construct and is consistently changing over time based on patriarchal or even outdated viewpoints. To this day people still consider minority hairstyles as “unprofessional.” I’m glad they retracted this ridiculous journal article. (Brooke)

Very frustrated and disappointed with HIMSS. I am a small single attender and have attempted to reach them for a refund, as a refund would be of financial help. They won’t answer a phone nor reply to email. As Mr. Wonderful would say, “You are dead to me.” (Bigdog)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. K in California, who asked for headphones for her middle school special education class. She reported in February, “Your generosity towards my students have made a huge impact on their learning. Being a special education teacher, I teach students with a wide range of abilities. In order to differentiate instruction and meet their individual needs, I use various forms of technology in the classroom. In my language arts class, I rely on computers for their reading intervention program and audio books. The online intervention program is individualized to work on deficits each child still has. The headphones allows my middle school students to work on phonics and reading comprehension skills at their own level and pace. These headphones are exactly what my students need to progress as successful learners.”

Organizers of the influential CES technology conference, which draws 175,000 attendees to Las Vegas each year, announce that the January 2021 event will be virtual only.

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The Arizona Diamondback fill the empty seats for its home opener with teddy bears representing Phoenix Children’s Hospital.

Former pro football player Myron Rolle says it’s not yet safe for the NFL to resume play. His credentials exceed just being a retired 33-year-old player – he holds an MD degree from Florida State University College of Medicine, earned a master’s degree in medical anthropology as a Rhodes scholar, and is a neurosurgery resident at Mass General.

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ED physician Candice Myhre, MD plays the winning hand in the #MedBikini protest by posting a photo of herself saving a boating accident victim while wearing a pink bikini.

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Weekender 7/24/20

July 24, 2020 Weekender Comments Off

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Weekly News Recap

Symplr’s owner considers selling the company at a valuation of up to $2 billion.
Publicly traded HCA Healthcare books a $1 billion Q2 profit, boosted by $822 million in federal CARES act stimulus money.
Cerner announces CommunityWorks Foundations, a fixed-fee, quickly implementable version of Millennium for Critical Access Hospitals.
HHS activates a new COVID-19 hospitalization data website that replaces the one that was previously operated by the CDC.
WellSky’s private equity owner decides not to sell the company and instead will bring in an additional investor.
Researchers ward that sloppy health system implementation of screening for social determinants of health could cause patient harm.

Best Reader Comments

Interesting that in late 2019 CPSI commented that Cerner was competing less aggressively in their market. Then mid-2020, Cerner comes out with a streamlined install for that market. (PeanutGallery)

Opposition to a national identifier is deeply rooted in the American psyche. It might be easier to amend the constitution to eliminate the electoral college than to get a national ID. To be technically feasible a national ID would need to be provided at birth and be (unlike SSN) unique and immutable. Countries in Europe have had systems for this for many years and they work well. In Sweden the “personnummer” is assigned at birth and used everywhere. (Richard Irvin Cook)

It could also be a federated national ID. Each state has an unique ID and identity database. If you are receiving care in X state, your provider queries X state system for matching info based on your ID. Recognizing your ID is from a separate state, your state queries the other states database through a federal broker. The feds don’t see the data, just the ID and a random sample of enough of the query to make sure everybody is following the rules. Data updates are propagated only to those states that have queried for the ID before. If you don’t leave your state, the feds never see your ID or any query info for you. System is bootstrapped based on voting/drivers Id cards. Verification and resolution of identity info takes place at the resident’s state level. Federal block grants conditional on the performance of the states identity system. Health providers keep their own records clean as they are already supposed to. (Boondogle)

The interoperability problem is as Kevin identified, but a significant part of that is also the fact that the solutions do not interpret the data the same way; by schema, domain, structure, dictionary, enumeration, workflow, etc. So in handing your thumb drive over to them, they have no way to bring that data into their system. Unless, it is the same system, configured the same way, with the same dictionaries, and, and, and… (Brody Brodock)

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. W in Texas, who asked for hands-on learning activities for her pre-kindergarten class. She reported in late February, “I cannot begin to express how grateful we are to have received these items. These resources have made small groups a blast. The interaction between the students and the various activities are very useful. We are able to provide differentiated activities for them. The reactions was priceless as we opened the box. The new materials even improved some behavior issues. We had a brief lesson on how to take care of our items and how to properly use them.“

NBC News profiles the “recharge rooms” of Mount Sinai Health System (NY), which give stressed employees a place to relax in a simulated beach or forest. The doctor who came up with the idea provides advice on doing the same thing at home – designate a no-phone sanctuary space, add some artificial plants and aromatherapy diffusers, use noise-cancelling headphones if living in close or noisy quarters, and reserve the bed for sleeping only.

COVID unit Nurses at 198-bed Virtua Marlton Hospital (NJ) are summoned to a Zoom work meeting, where they are surprised to be treated to a personal concert from country star Tim McGraw as part of Spotify’s “The Drop In” series.

A former sales rep for drug maker Novartis AG who turned whistleblower against his employer for bribing doctors to prescribe its products will get $109 million as his share of the company’s $678 million settlement.

A suppose this supports the “less is more” theory. A nurse in Russia who reported to work in a coronavirus unit wearing only underwear beneath her see-through PPE because it was too hot gets a job as a TV weather presenter on top of a previously signed sportswear modeling contract. She says she still wants to be a doctor.

Employees of Stony Brook Southampton Hospital (NY) who are looking for storage space in an old dialysis unit storeroom are startled to find a “King Tut’s tomb” of more than 100 works of art that had been donated by some of the world’s most renowned abstract expressionist artists in the 1950s through the 1980s. The lithographs, drawings, and wood block sculptures – many by artists who lived and worked in the Hamptons back when it was cheap — could fetch up to $1 million to benefit the hospital and the local history museum. A frequent donor was Willem de Kooning, who spent a lot of time in the hospital as a patient in the 1970s due to various alcohol-fueled mishaps, including falling down stairs and passing out in a snow bank.

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Weekender 7/17/20

July 17, 2020 Weekender Comments Off

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Weekly News Recap

Congressional Democrats criticize HHS for issuing a no-bid, $10.2 million contract in April for developing a hospital bed and supply tracking database to TeleTracking Technologies, the Pittsburgh-based hospital equipment and bed tracking vendor.
Cerner and Epic delay their return to campus.
Athenahealth renames its Centricity product line to AthenaIDX.
University of California Health uses de-identified patient data from its Epic system to create a database for COVID-19 treatment research.
Fax machines are part of a broken data system that is impeding US coronavirus response.
Amazon will conduct a health center pilot with primary care service provider Crossover Health.
A KLAS report on pediatric practice ambulatory EHRs names PCC as the clear leader.

Best Reader Comments

At Epic, we used to spend 6-8 months documenting current-state workflows and gathering current-state documentation so that the customer could translate into their own system. Again, customers pushed back (well, probably mostly executives who were on the hook for cutting checks) on the amount of time we spent on the early phases of the implementation where little “visible” results were being made. The implementation methodology continued evolving and cutting out more of the customization steps in favor of more expedited and less expensive installs. This gets the system live faster, but with less customization. There are cons to this, but there are actually many pros to this as well. (HITPM)

Being familiar with some of the events and people that encouraged Epic to become the Marine Drill Sergeant, it wasn’t really how Epic wanted to do things, it was initially customer demand (Kaiser made some strong suggestions, and one Kaiser executive in specific had some….issues) and then some pretty drastic personnel mismanagement in response to the 2007-2008 economy. (Guy M. Fay)

[On Athenahealth renaming the former GE Healthcare Centricity products to AthenaIDX] I’m sure the programmers GE laid off really appreciate that homage. (IDXreturns!)

[On HHS changing hospital COVID resource reporting databases] Is this even the problem space that this company is in, with only 15 or 20 positions open how are they able to take this project on? Awarding a 10 million dollar no bid project in April, 75 days ago, and turning it on with 2 days notice is plain and simply not going to work. I don’t even believe it is intended to work. I do believe there is a desire to further politicize data to obfuscate the current state of the epidemic. (AnInteropGuy)

I personally buy “The One Minute Manager” by Ken Blanchard for all of my new managers. The book offers simply and practical advice for managers. The initial version was published in 1982. (Shaun Priest)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. C in Kentucky, who asked for LEGOs to help her fourth graders develop science, math, and engineering skills. She reported in February, “Thank you so much for your amazing donation to our classroom. The LEGOs have been and will continue to be utilized in so many ways in our daily instruction. Obviously most of my kiddos love playing with LEGOs so these have allowed me to include a fun and engaging morning “tub” or center to our stations. I have used them and will continue to use them to help students have a better understanding of fractions. We are able to count the circles on the tops and create equivalent fractions. We can also use the pieces to add and subtract fractions as well as see why it is important to have like denominators when adding and subtracting fractions. I have also allowed students to get creative and use them to build things.”

Residents of a nursing home in England that is closed to visitors entertain themselves by recreating classic album covers from The Clash, David Bowie, and other musicians. Here’s a cultural teaching point, from me after reading a Twitter comment that surely the residents have never heard of The Clash – “London Calling” was released more than 40 years ago in 1979 and lead guitarist Mick Jones is now 65, so let’s not picture today’s nursing home residents hepping to Cab Calloway.

A 29-year-old mental health counselor in New York City whose household income is $22,500 describes the stress involved with owing nearly $300,000 in student loans as she continues her studies to earn a PhD.

Two New York doctors rig app-powered cellular walkie talkies targeted to kids to allow families to speak to isolated patients any time they want without exposing employees who would otherwise be setting up video chats. The app allows multiple people to contact the patient through the single device they have. The hospital developed a disposable casing so the devices can be reused. The devices cost $50 plus $10 per month for cellular service, and for kids, they include real-time GPS tracking, geofencing, playback of missed messages, and voice commands.

In Virginia, a physician assistant is fired after a black patient who suffers from anxiety and PTSD asked her about a Confederate flag he saw on her wall during a virtual visit, after which she adjusted her camera, told the patient he was seeing things that weren’t there and was paranoid, and doubled his sedative dose.

In England, Queen Elizabeth II knights Captain Sir Tom Moore, aka World War II veteran Captain Tom, who at 100 years of age hoped to raise $1,000 for NHS by walking laps around his garden in return for the health system saving his life and ended up generating $40 million in donations. Captain Tom holds two Guinness World Records – one for fundraising and another for being the oldest person to chart a #1 song in the UK for “You’ll Never Walk Alone,” performed with singer Michael Ball and the NHS Voices of Care Choir.

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Weekender 7/10/20

July 11, 2020 Weekender Comments Off

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Weekly News Recap

Health Catalyst will acquire Healthfinch for $40 million in shares and cash.
A Health Affairs blog post calls for ONC to start measuring the impact of the interoperability requirements of the 21st Century Cures Act.
VA seeks robotic process automation to import patient documents from external providers into VistA and Cerner.
Walgreens will spend $1 billion over the next five years to open VillageMD primary care clinics in up to 700 of its stores.
Informatics pioneer Octo Barnett, MD dies at 89.

Best Reader Comments

The new interoperability regulations that were promulgated in March are like any other regulations, they are only as good as the enforcement actions that will be taken. Thus, while it is fine to have a wish list of those things ONC should track, more importantly is simply enforcing the regs as they stand. Of course, putting on my cynic hat, I see this article from academics as a lead up to a research grant from ONC to support an academic endeavor to measure these metrics. (John)

Those proposed metrics are a bit confusing to me. Measuring things that aren’t in the rule as a way of implicitly adding the things we all wish were actually in the rule (but aren’t) doesn’t seem right. (Brendan)

The main barrier to telehealth is financial. I work for providers who are using telehealth extensively for med refills and wellness visits, and it has been working well. They and their patients want to continue using it, but the insurers continue to waffle on payment policies and suggest that they will only pay for online visits during the pandemic. Of course practices are preparing to bring patients back in whenever possible under those conditions. (Amanda B)

I work in mental health and much of what we do can be delivered quite well by telehealth and often by phone for patients without the ability or devices to do telehealth. The vast majority of our patients do not want to come into the office and the vast majority of our clinicians do not want to sit in a small poorly ventilated office where there is a risk of COVID transmission. However, our organization is strongly encouraging us to see more patients in person because the rates for phone calls are less than telehealth or face-to-face and because the insurers are already jerking us around on reimbursement with the likelihood of additional payment-related travails from insurers and CMS down the road. (RightOn)

Unfortunately, your assessment of telemedicine is spot on. Absent a significant change in healthcare and healthcare delivery in this country, profits ($) will continue to drive behavior, despite the fact that we have the worst outcomes on a number of measures of health and healthcare in the world (including our management, or lack thereof, of COVID-19. (Michael J. McCoy, MD)

Dr. Jayne, I am so embarrassed and ashamed of our healthcare system as I read what you are experiencing in the trenches. We are about four months into this Coronavirus pandemic. I was a little more forgiving (but not much) in March since supposedly this virus caught us off guard. But now? Really? After working in healthcare since the 1970s, I have no words anymore. Just tears. (JT)

Two ways to do something, the right way and again. Allscripts has showed a willingness to take the second option as a standard practice. So, until that stops, they will lose customers. Remember the business model is to buy startups and then promise to integrate them, while not requiring them to integrate. (AnInteropGuy)

Watercooler Talk Tidbits

Army veteran Richard Rose III of Port Clinton, OH died July 4 of COVID-19 at 37, with his previous Facebook posts in which he disdained wearing masks and checked in at crowded bars and parties now forming his obituary. He said just before he died that he probably caught the virus at the party on the upper right. Meanwhile a 30-year-old man who intentionally exposed himself to the virus by attending a COVID-19 infection party dies of it, telling his hospital nurse, “I think I made a mistake. I thought this was a hoax.”

A Vice article describes how biomedical technicians are buying non-working, 20-year-old ventilators on Ebay, then using a handmade dongle to program around manufacturer protections so they can fix them. They can then sell the repaired device to US hospitals to meet COVID-19 demand. Newer models validate the identity of the repair tech to make sure they’ve paid the manufacturers’ $10,000 to $15,000 fee that allows them to bypass the anti-repair technology, so the market is in older machines that don’t have that protection. Ventilator manufacturers say their machines are complex and they need to limit who can work on them, while hospitals say it’s their own liability if their highly trained technicians make a mistake, which has apparently never resulted in a manufacturer lawsuit. Hospitals also note that manufacturers wouldn’t sent techs onsite in the early days of COVID, so they were stuck with machines they needed that were awaiting repair.

A Nebraska ED nurse renders aid at a two-car accident that she encountered on her way to her daughter’s wedding.

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Weekender 7/3/20

July 3, 2020 Weekender Comments Off

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Weekly News Recap

WellSky’s private equity owner considers selling the company at a valuation of up to $3 billion.
Epic will delay the return of employees to campus by month following a local uptick in COVID-19 cases, but says it is impossible to maintain its culture when employees are working from home.
UCSF pays ransomware hackers $1.14 million to regain access to its medical school servers.
A cybersecurity firm reviews Internet traffic of six Fortune 500 healthcare companies and finds significant security exposure and hacks in progress.
Telehealth visit counts have steadily declined since their mid-April peak, dropping from 14% of all visits to less than 8% as the availability of in-person visits returned.
Smartphone urinalysis company Healthy.io acquires competitor Inui Health, formerly known as Scanadu, for $9 million.

Best Reader Comments

CMS continues to blast out information like nothing else is going on in the world. Can you spell TONE DEAF???? (JT)

As to definitions, we use these. Telemedicine is doctor to doctor consults, e.g. suspected stroke patient at rural hospital. Telehealth is doctor to patient, omni-channel, asynchronous and synchronous. Virtualcare / health is telehealth combined with remote patient monitoring. (John)

Often the more important distinction is telehealth / medicine vs. virtual care. The former generally implies synchronous communication to replace an in office visit (whether via video, voice, or real-time chat). While the latter brings in asynchronous communication via chat with different care providers, data from connected devices (scales, blood pressure, SpO2, EKG, spirometers) and find a way to present it to the care team and integrate into the EHR that makes care more efficient. (Greg Chittim)

I’ve been using virtual health as the umbrella term that includes (1) telehealth (which involves any modality- video, phone, messaging) between a provider and a patient; (2) eConsult, which is any modality between two providers; and (3) autonomous health, which is any modality between a computer and a patient. My gut is that we will get to a new baseline of 20-30% of telehealth visits assuming reimbursement continues to be at least close to parity in a FFS system. And for healthcare systems in a capitated model, we may see much more. (Lyle Berkowitz)

I am afraid you are too correct in your assessment of the veracity of some state data. We can look at the assertions and testimony of Rebekah Jones, the Florida state chief data scientist who describes the manipulation of data as an example. There are other states that appear to be in similar states of data invalidity for political purposes. This is on top of the problems with data quality that are just inherent to EHR information. I am not sure how to see these trends and infection byproducts in a single EHR, unless that is a combinatorial EHR (acute, ambulatory, ED, etc.) or through a data aggregator. If our testing was both active and historical (covid markers) then we could tag patients then watch their subsequent treatments, Dx, and Rx — maybe through case reporting? But again, if you take that route then you have to trust the health departments to not be influenced by politics. (Brody Brodock)

Watercooler Talk Tidbits

The Alabama Board of Nursing investigates a complaint brought against a nurse who shouted “Heil Hitler” to the Mobile, AL city council meeting and then threatened its members as they approved a mandatory mask-wearing ordinance. A councilman replied nonchalantly, “Good gracious alive. Heil Hitler?”

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A newly graduated nurse who had just left her wedding with her new husband “went into nurse mode” when she stopped to render aid at the scene of an auto accident while still wearing her gown.

An unnamed female CEO of a Detroit health IT company pays $3.5 million in cash for a Sarasota, FL condo.

Twitter and JPMorgan Chase will remove the common programming terms “master,” “slave,” and “blacklist” from their source code following complaints from black engineers. Twitter will also replace “grandfathered” and “dummy value.”

In England, a five-year-old boy who just learned to walk on prosthetic legs following amputation raises $1.5 million so far (versus his goal of $600) in a 10K walking challenge for Evelina London Children’s Hospital, which saved his life as an abused, weeks-old baby. He was inspired and congratulated by 100-year-old World War II veteran Captain Tom, who raised $40 million for NHS charities by walking 100 laps around his garden.

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Weekender 6/26/20

June 26, 2020 Weekender Comments Off

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Weekly News Recap

Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions.
Public health officials in Austin, TX blame COVID-19 case counts that vary wildly by day on labs that are sending test results by fax.
The American Hospital Association loses its bid to stop the federal government from requiring hospitals and insurers to publish their negotiated prices, but will appeal.
Massachusetts eHealth Collaborative shuts down after 15 years.
CMS begins publishing a monthly Medicare COVID-19 Data Snapshot.
CMS announces the creation of CMS’s Office of Burden Reduction and Health Informatics.
Russian President Vladimir Putin calls for the healthcare system there to roll out out digital systems and to use artificial intelligence.

Best Reader Comments

While in theory I like the idea of requiring hospitals and insurers to publish their prices, I’m somewhat skeptical of the actual benefit this may provide to patients. To the majority of patients in this country who are insured by a commercial payor or CMS, unless the anticipated out of pocket costs are also provided, I suspect the published price itself will be ineffective in driving patients to lower cost alternatives … with health system monopolies and the ubiquity of employer-provided health insurance, patients simply don’t have much of a choice either where they get their care or who their insurance provider is, which will only cause prices to continue to rise. (Dr. Gonzo)

Administrator Verma’s heart seems to be in the right place and the tweets carry a lot of bite. But I am skeptical that asking current health systems players to take on the role of addressing social and economic factors of their patients is going to work. Those who know the system know very well that American health system has had its knee on the neck of racial minorities and economically disadvantaged for a long time. You don’t get to be a part of $4,000,000,000,000 annual industry without shattering a few million middle class dreams. (SeismicShift)

I would question how many companies are as worried now about how to “strategically reallocate those unused marketing dollars” but rather how to use those funds to meet a demanding payroll and to stay afloat until the markets are open and the economy levels out. (Just Wondering)

Healthcare is but one symptom of a system ripe for correction. What can we say about the richest nation in world history with currently 48 million of us lacking nutritious food on a regular basis, including 16.2 million children? USA needs to look long and hard at its fantasy that we all are existing on a level field. (Kevin Hepler)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Mr. H in Georgia, who asked for a robotic center for his school’s media center. He reported in February, “Thank you for your generous donation. It has truly exposed boys and girls in a variety of grade levels to how coding can be a fun learning experience. We have built the robots, practiced building block languages, and have even implemented different movements with the Kamigami Robots. An activity the students always look forward to in the program is playing tag with the robots. Each student has to use the coding language to try and disable the other robot in a specific time session. I am working to continue to create authentic and innovative activities that will promote their knowledge of computer science. The smiles on the students’ faces would not have been possible without your support.”

Dermatologist and YouTube star “Dr. Pimple Popper” Sandra Lee, MD unsuccessfully tries to hide her social media tracks after insulting nurses everywhere.

In Russia, a nurse whose hospital employer reprimanded her for showing up for work in a see-through PPE gown with a sports bra and short underneath because she was getting overheated lands a modeling contract.

Columbia University ED doctors describe how to tame your email inbox using crisis resource management techniques:

Have one person summarize multiple status reports into a single email that is sent at the same time each day and with the same subject, format, and section headings.
Include the titles of everybody who is sent a group email or is added to thread.
If a recipient is being included just as an FYI for one message in a thread, use BCC so they don’t get future group messages.
Don’t just make broad requests for help – assign tasks to specific individuals with timelines and expectations on reporting back. Otherwise “email is commonly abused as a tool for putting work on somebody else’s desk without having to confirm that they can take it on.”
Add action requests to the subject line in brackets “[respond EOD].”
Ask why you are being added to an existing email chain and what expectations are involved.
Use the SBAR concept (situation, background, assessment, recommendation) to make communications concise.
Encourage people to speak frankly.

The former CEO of Union General Hospital (GA) and one of its doctors are sentenced to federal prison for their roles in scheme in which the doctor prescribed the CEO 15,000 doses of opioids in return for being paid for additional hospital work and being placed on its board.

A Colorado anesthesiologist gives up his medical license and serves 30 days in jail after turning off all the patient monitors in a hospital’s recovery room with a rant about how the noise creates alarm fatigue for nurses, then choking a nurse who told him to leave the machines alone.

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Weekender 6/19/20

June 19, 2020 Weekender 1 Comment

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Weekly News Recap

Health Care Service Corporation, the country’s fifth-largest insurer, will create a Payer Platform to connect its health plans to Epic-using health systems.
Epic cancels UGM 2020.
Proteus Digital Health, once valued at $1.5 billion, files Chapter 11 bankruptcy.
Walmart acquires the technology assets of online pharmacy CareZone for a rumored $200 million.
Surgisphere, the tiny company whose questionably sourced aggregated EHR data was responsible for two major research article retractions, appears to have shut down.
Milliman acquires Wisconsin-based employee health monitoring technology vendor Healthio.

Best Reader Comments

I can’t help but wonder how this will affect minor telephone calls with doctors. In the past, I would occasionally call a doctor on the phone to check in on a test result or ask about a medicine and so on. These were relatively quick, focused calls for which there was no charge. But going forward, if telehealth becomes an accepted modality for paid services, what’s to stop a doctor from billing me for each of those calls? (Ben)

If you want providers to do something, you have to pay for it. I’ve got some nice cushy corporate insurance, so I can get my PCP to throw in a couple of freebie phone calls after he’s price gouged me on a few visits. If I had an ACA exchange plan, I doubt I’d get the same level of customer service. I’d rather the billing for telehealth and chat services gets formalized so that the people on government or skimpy plans can push for and get it. Otherwise it’s just going to be a perk for good employer plans, which means it won’t affect anything. (IANAL)

I am appreciative that CMS has relaxed some of the constraints for telehealth services billing during the pandemic but those rules were inane restrictions to begin with. Why should a patient ever have been precluded from getting telehealth at home, simply because they don’t live in a designated rural area? (ValueBasedSkeptic)

As to the hype around value-based payments, we’ve lived through this before with different names and slightly different variants. Improving quality sounds great, but we still can’t define or measure quality well, even for very clear-cut conditions. We’ve spent untold money and efforts on quality measures with lots of content from CMS, NQF and others. Yet for some specialties, there are few if any viable measures. Whether it’s framed as improving population health or some other positive sounding initiative, the main goal has always been shifting costs onto the backs of providers. (ValueBasedSkeptic)

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. H in North Carolina, who asked for game buzzers and wobble cushions for her fifth-grade ADHD students. She reported in February, “My students come in every day begging to use the wobble cushions, as well as wanting to know if we will be playing a game with the buzzers. We will continue using these resources daily in our classroom until the end of the school year. I know my future students will be just as excited next year using the wobble cushions and game buzzers.”

Federal authorities arrest a Chinese citizen at LAX as he attempts to board a flight to China, charging him with obtaining a UCSF post-doctoral fellowship position so he could record lab layout details that could be replicated in China. The man, who turned out to be a major in the People’s Liberation Army, admitted that he had been stealing information in his year of employment there. His laptop contained UCSF study information and he had wiped his WeChat phone messages right before arriving at the airport. He is charged so far only with visa fraud.

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Four ICU nurses sue Landmark Hospital (GA), claiming that the hospital ordered them to perform COVID-19 test swabbing incorrectly to ensure that the tests would come back negative.

NASA’s next Mars rover, scheduled for launch on July 20, will bear a plate that honors those who are on the COVID-19 front lines.

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Weekender 6/12/20

June 12, 2020 Weekender 1 Comment

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Weekly News Recap

A new investment in workforce management software vendor QGenda values the company at $1 billion.
Conversa, PatientPing, Wellsheet, and Kyruus announce significant new funding.
Only three states have committed to using COVID-19 contact tracing apps from Apple and Google.
GAO says the VA is doing a good job of getting clinicians involved in its Cerner implementation, but suggests choosing broader representation at its local workshops.

Best Reader Comments

If the medical record is not reconciled, then the source system is part of the problem. However, I have yet to see a system that has entanglement of the data that has been exchanged. Meaning that if Clinic A provides a referral for a preliminary diagnosis and the specialty adjusts the diagnosis and adds a new diagnosis, is the provider notified? That is the goal of 360x, but how many have implemented it — Cerner, Epic ? (Brody Brodock)

Once there are only a few EMR vendors left, then you can start telling your customers that they can’t do the thing in a way that prevents interoperability. The government could mandate that the EMR companies provide interoperability, but it either won’t work or will drive certain EMRs out of business. The situation is FUBAR in that respect. The problem is that healthcare delivery and organizations just aren’t that standardized and process oriented. They’ve never been exposed to the sort of environment that produces that. What we need isn’t a technology standard, it’s a process standard. As an example, accountants use GAAP so that they can calculate the revenues, losses, etc. for their company. When someone tells me their GAAP deferred revenue, I know what they mean and how they calculated it. When someone tells me that a patient has an active medication in their chart, I don’t have a good idea about what that means. (IANAL)

Due to my own illness that I’ve been dealing with for a decade plus, during the COVID surge, I’ve had five telehealth visits, one with PCP, others with specialists. Each started right on time, each accomplished what was needed effectively and efficiently. I dread the thought that there may be a retrenchment of telehealth and I’m forced back to in-person visits. I will resist. (John)

I’ve been in healthcare tech for over 30 years, sat on the HIMSS board, and been a member until 2016 when I came to the decision that HIMSS only cares about three things, money, promoting its own agenda, and removing alternate opinions from the dialogue. Until its membership and that of the vendor community wakes up and understands that those simple truths about what motivates HIMSS or its current leadership, nothing will change. I agree with HIStalk that HIMSS more than likely cannot afford to refund the money it collected without digging deep into the leadership’s compensation and its political machine lobbying Capitol HSill. It is my belief that its time to abandon HIMSS and allow it to either make it as a for-profit organization, which is what it really is verse it hiding under the veil of a non-profit, which it hasn’t been for decades. The educational aspects of HIMSS can be easily replaced by regional groups who can provide localized and national educational content by collaboration and by working with vendors who in lots of instances will pick up the costs. The vendors can form their own association with dues and hold an annual conference that they own, manage, and set the time and place. This would reduce costs all the way around facilitate greater transparency. (HIMSS Insider)

I’m pretty comfortable with a hospital firing a nurse who openly wishes for the death of people she doesn’t like. She is not able to fulfill her job functions. Not only did they do the right thing in firing her, if I were them, I’d also go back and do detailed reviews of all patient cases that she handled to look for irregularities or disparities in the care (“care”) she provided to people — before someone recognizes her as having been on a care team responsible for them or for a family member and starts asking questions about a bad outcome. (HIT Girl)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Mr. H in California, who asked for a computerized scientific calculator for his high school class. He reported in mid-February, “Because of your donations, my students will be able to learn about how an advanced graphing calculator works and get experience using this technology that will be an important aspect of their future math classes. Our school does not have the resources to provide all teachers with class sets of graphing calculators, but with this project, I can begin to teach students about how to use this advanced technology and provide exposure to it they will remember in their future math classes. In order to support future students in STEM subjects, students need to be familiar and have experience using technology and your donations have made that possible in my classroom.”

Creation and operation of a 1,000-bed COVID-19 field hospital in the New Orleans convention center cost $192 million, three-fourths of that provided by federal taxpayers. Occupancy peaked in early April with 108 patients and officials kept extending the contract even as patient count dwindled. Nurses who had nothing to do were paid $243 per hour with a guaranteed 98-hour workweek with time-and-a-half for overtime. The bored staffers volunteered to leave, but were told that it was a government contract and to keep showing up to sit around.

Healthcare staffing provider TeamHealth fires ED doctor Steve Huffman, MD, who is also an Ohio state senator, who asked during a public hearing on racism, “Could it just be that African Americans or the colored population do not wash their hands as well as other groups?” He defends his question as relevant to public health, and while admitting that he worded his question awkwardly, says “colored population” seems to be interchangeable with “people of color.”

Michigan’s Medicaid medical director is reprimanded and fined after admitting that he did not use the state’s prescription drug monitoring program system when prescribing opioids in his private practice.

UF Health Jacksonville suspends a 72-year-old doctor following complaints that he groped female patients, stashed money in their underwear, and undertook his examination of a 70-something woman’s neck mole by kissing it.

NBC News finds that Facebook’s feel-good TV ads that featured members of its Groups expressing support for healthcare and other frontline workers was faked, with none of the feature postings coming from actual Groups. Facebook admits that it mocked up the posts using stock photos and its own employees posing as group members, which it says was due to privacy concerns. The non-fake “Cheers For the Frontline!” group, unlike its happy TV counterpart, is struggling with spammers and trolls.

Doctors remove a mobile phone charging cable from the urethra of a man who told them, unaware of the anatomical impossibility of his declaration, that he swallowed it. Trust me that you do not want to watch the doctor’s Facebook-posted video of the removal procedure.

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Weekender 6/5/20

June 5, 2020 Weekender 2 Comments

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Weekly News Recap

Amwell files IPO documents.
Two major medical journals retract influential coronavirus-related articles that analyzed encounter data from Surgisphere, a tiny company whose capabilities and transparency were questioned by experts who found flaws in the articles.
R1 acquires Cerner’s RevWorks RCM outsourcing business for $30 million.
Private equity firm Rubicon Technology Partners takes a majority position in patient access center platform vendor Central Logic.
Change Healthcare acquires retail pharmacy technology vendor PDX for $208 million.
Virtual diabetes clinic vendor Onduo names former National Coordinator Vindell Washington, MD, MHCM as interim CEO.
Tested hospital EHRs failed to flag potentially harmful medication ordering problems one-third of the time.

Best Reader Comments

[Dr. Jayne] wrote that “a unique patient identifier would help and would bring us into line with many other developed nations.” I think this is a notion that is still up for debate. In fact, the first session of the day spoke to what an identifier gets you and its limitations. Yes, other nations have patient identifiers, but these nations are also single-payer (national health systems). So it’s a bit apples and oranges. (Catherine Schulten)

The new CEO and outside investors have had Cerner on a track to shed low margin business units, such as RevWorks. The Cerner revenue cycle software solutions all remain, an organization just can’t outsource their rev cycle staff and leadership to Cerner RevWorks anymore. They can still do that with companies such as R1 and other RCM organizations. (Dodele)

If the WHO is only feeling mildly petulant, they could simply charge the US for continued access to the ICD an amount comparable to the totality of what we were paying as members. That way WHO efforts will remain financially supported in coping with the pandemic and they won’t have to be bothered with dealing with chaotic input, conspiracy theories, etc. from the US leadership. (WHO fan)

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. W in Texas, who asked for microscopes for her third grade class. She reported in February, “With the gift of handheld microscopes, my students were able to dig deeper into understanding how soil is created and the difference between soils from multiple regions. When they actually saw the tiniest of sand crystals that are broken down from larger rocks and bits of leaves and decaying animals of the humus layer, they experienced for themselves the learning that is required of them by the state. When students are involved with their own learning, they take ownership of that knowledge which gets ingrained deeper with that experience than just the surface. It also gave them a glimpse into what scientists really do when conducting science experiments. It is for this reason I believe they need first hand experiences with first class tools. Your donation has helped put these tools into their hands. Without a doubt, you have aided in inspiring future scientists to dream big. Thank you.”

Amazon-owned Whole Foods fires an employee who was keeping a running online count of COVID-19 cases in the company’s stores. Katie Doan was dismissed for “time theft,” which she says involved a 45-minute panic attack. Her list shows 340 workers who have tested positive and four who have died.

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Workers are finishing transformation of the long-shuttered, 4,500-bed Cook County Hospital in Chicago into hotels and medical offices. The developer says the building is 550 feet long but only 80 feet wide, which he says is “like a 50-story building on its side.” The renovation is part of a $1 billion project that includes apartment construction.

Northwest Mississippi Regional Medical Center fires a nurse whose Facebook rant against protesters concluded with, “It is time we take this country back from you animals so be very careful about what your next step is because it can lead to 6 feet under! Trump is fixing to put your asses in jail or a grave. I hope it is the latter of the 2.” Most shocking is that she didn’t use the two key strategies for people who confidently espouse a position but then regret it when public reaction hits their personal bottom line: (a) claim that their account was hacked; or (b) compose a suddenly literate, thoughtful post about why their original comments were misunderstood and don’t define their consistently saint-like behavior. On the other hand, I’m not sure I’m comfortable with the “cancel culture” of firing someone for comments they make off the clock and unrelated to their jobs purely out of employer embarrassment (I say that as someone who was nearly fired from my hospital job for honestly and anonymously reporting vendor cluelessness in my early HIStalk days).

A Florida celebrity plastic surgeon self-styled as “Dr. Miami” offers drive-through Botox treatments. He says the mobile facial injections make perfect sense in pandemic times, but his website makes it clear patients will need to come inside for his $13,000 Brazilian Buttlift, his $10,000 breast augmentation, and $7,500 nose job. It would be interesting to compare his career to whatever he told Washington University in St. Louis School of Medicine to convince them to give him an incoming class spot. Most of his celebrity patients are D-list stars of sleazy reality shows, he wrote a kids’ book titled “My Beautiful Mommy” that pushed elective plastic surgery, and he took heat for a song and video he commissioned titled “Jewcan Sam (A Nose Job Love Story)” that promised Jewish high school boys the chance at romance if they “get their nose circumcised.”

ESPN will award Quebec-based Kim Clavel, RN with the Pat Tillman Award for Service. She took a leave from her nursing job last year to pursue a pro boxing career, after which she won the NABF flyweight championship. She is now working as a night-shift nurse at retirement and elder care centers.

A mother and daughter who graduated from different medical schools this year are matched to residency programs at LSU Health. This is apparently the first time that a parent and child graduated medical school in the same year and then were chosen for residency at the same site. The Ghana-born mother – who is also a RN and family nurse practitioner — also holds three master’s degrees in nursing, health administration, and leadership.

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Weekender 5/29/20

May 29, 2020 Weekender Comments Off

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Weekly News Recap

Bright.md, Orbita, Oncology Analytics, MDMetrix, and Higi announce new funding rounds.
Healthcare associations take a huge revenue hit as their conferences move to virtual.
China’s expansion of its COVID-19 contact tracing app with new functions raises privacy concerns.
ONC funds The Sequoia Project to continue as the Recognized Coordinating Entity for TEFCA for a second year.
The National Institutes of Health issues an RFI on digital health solutions that can help it build a central data hub for COVID-19 researchers.
Central Logic is reportedly nearing a $100 million-plus acquisition.
Kaiser Permanente EVP/CIO Dick Daniels announces his retirement.

Best Reader Comments

KLAS: Is it me or does it seem odd to rank vendors based on such small sample sizes? n = 6 is not exactly a big sample when considering there are ‘000s of hospitals in the USA to award top spot. I suppose at least they front up to the fact by publishing sample sizes as opposed to most obtuse and ropey awards out there. (Plucky Brit)

As one of the couple dozen companies sending a petition to HIMSS, I’ll just say that some large companies (some very large) who were originally signatories to the petition have dropped out, possibly when they saw their logos on the letter. Regardless, HIMSS should continue to be made aware just how unhappy the industry is about their actions. (Ed Chung)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Texas, who asked for programmable robots and board games for her kindergarten and first grade technology classes. She reports, “Having Kinderbot and Botley have allowed them to have first hand experience with block coding. They immediately wanted to get to know them by name and play with them. Their colorful appearance was visually engaging and the child friendly buttons made it easy to use. This allowed them to be more actively engage in learning and feel successful as they completed an assignment. Again, we greatly appreciate your donation! It has opened my students’ desires to learn more about coding, and it has allowed them to feel successful and more willing to challenge themselves. Thank you!”

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Novant Health is running 10 test flights of drones each day, using the 11-foot aircraft to deliver PPE to one of its hospitals in exploring the option for future health crises.

A Texas doctor recommends that residents change their face masks for summer, choosing lighter masks “much like men in North Texas change their cowboy hats in style during the summer.”

A Texas woman is arrested for threatening an Ecuador-born medical resident (who has been treating COVID patients) and her husband with a hammer in Houston, where she ran after them on the street screaming, “You Mexicans, get out of my f—ing country.” Her family, many members of which are Latino, say she was drawn to extremist political beliefs and possibly experienced mental decline after losing her job as a nuclear medicine technologist and medical sales specialist. Her resume says she is “HIPPA certified.”

London doctors are using Microsoft’s HoloLens 2 mixed reality headsets with Remote Assist 365 software to conduct virtual rounds on COVID-19 patients, reducing PPE usage by sending in just one doctor whose encounter can be broadcast to other team members who are away from the bedside. The system also displays diagnostic images and lab results.

A Las Vegas couple is charged with $13 million in Medicaid fraud after posting social media photos of their private jet, piles of newly delivered Tiffany boxes, an Aston Martin, and a Bora Bora vacation. The wife started a fake home health company, cross-checked obituaries against North Carolina’s Medicaid eligibility tool, and then back-billed those accounts for fictitious charges. The husband’s Instagram is full of biblical quotes about honesty and hard work.

Three boys in Bolivia are discharged from a week-long hospital stay after they provoked a black widow spider to bite them in hopes of gaining Spiderman-like powers.

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Weekender 5/22/20

May 22, 2020 Weekender Comments Off

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Weekly News Recap

Optum acquires post-acute care management company NaviHealth.
Amwell raises a $194 million Series C funding round.
Microsoft announces Cloud for Healthcare.
Omada acquires Physera for a rumored $30 million.
Cerner joins the Fortune 500.
Cerner begins bringing its employees back to campus.

Best Reader Comments

Optum are the healthcare Borg. Now they add Navihealth’s service and technological distinctiveness to their own. Resistance is futile. (Lazlo Hollyfeld)

If you look at all the ‘successful’ vendors, ALL of them (Epic, Cerner, Meditech, CPSI) started in HIT and built a business solely around HIT. Seems to me there is significant message there. (FLPoggio)

What I am curious about is how all those Epic-ites will react when the stay stay at home order goes away how much pressure will there be to not return to the office. And if Epic goes the route that many Silicon Valley companies seem to be (remote working can work), what happens to the billion dollar edifices in Verona? (HISJunkie)

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

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Mr. M in California, who asked for codable Legos. He reported in February, “We have been having so much fun with our basic Lego set, and this expansion set will make our Coding club even better! I think students really love to build and code because it builds their confidence. They are able to experience the pride of creating something from scratch and tell their family and friends about it. We have only been able to scratch the surface with this expansion set, but the projects that are included in it will allow my students to continue in our club next year!”

New York’s requirement that recovered, hospitalized COVID-19 patients can’t be transferred back into nursing homes until they test negative is causing hospital backups, as PCR tests can show positive results – most likely from measuring dead virus – for up to several weeks after the patient recovers and is likely not infectious.

A UK bus operator takes just two weeks to roll out an app-powered service in which hospital staff can request free transportation to and from work. The app allows workers to book a seat in advance, with the bus company then using their pick-up and drop-off information to choose the most efficient routing.

Florida spent $283 million in a no-bid deal to create temporary COVID-19 hospitals that were never used, with a politically connected bidder signing a deal to operate a 200-bed hospital for $42 million per month. That construction contractor has no hospital experience, but has developed emergency shelters and previously won a $789 million contract to build a wall on the US-Mexico border.

Lloyd Falk, a 100-year-old World War II veteran, is cheered by employees of Henrico Doctors’ Hospital as he is discharged following a 58-day stay for COVID-19. His wife of 74 years died from COVID-19 a few weeks before.

The UK funds a brilliantly creative trial to see if “bio-protection” dogs – which can detect some forms of cancer and malaria from smell alone – can sniff out COVID-19 as an early warning measure or for screening travelers. NHS will collect odor samples from infected patients and train six dogs being provided by the Medical Detection Dogs charity for 6-8 weeks, and then launch a three-month trial.

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Weekender 5/15/20

May 15, 2020 Weekender 1 Comment

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Weekly News Recap

Cerner moves its October health conference to an online format.
Epic is working with an unnamed group on a COVID-19 “immunity passport.”
AMA publishes privacy principles for companies that aren’t HIPAA covered entities, such as technology firms.
Quarterly reports from Livongo and Health Catalyst beat Wall Street expectations for revenue and earnings.
Akron Children’s Hospital creates the country’s first endowed chair in telehealth and appoints its CMIO to the role.
Researchers find that an app’s four-question COVID-19 questionnaire can determine with 80% accuracy if the user is infected.
KLAS says that more than 100 Epic customers are using its AI-powered model, making it the only inpatient EHR vendor to have a significant number of sites live on AI.

Best Reader Comments

Epic/COVID-19: If Epic has really done rigorous analysis on 100 million patients and 30 drugs, don’t they owe it to the public health experts (and to public at large) to publish that information? … Same goes for the deterioration index mentioned in the conversation. If this index has really been successful in providing early alerts to front line clinicians at over 100 health systems (and has discriminated meaningfully between COVID-19 induced crash and other underlying cause of crash) and has been a factor in reducing COVID-19 related mortality (or even in reducing hospital stay or ventilator use etc.) then that’s a huge success and breakthrough! Why not publish those results and performance of the index? Why not publish it so that other non-Epic hospitals can also use it and save lives? (Corona_Verona)

Direct Trust is doing good work, but it is mostly around how to get the next generation out and building standards for the solutions to use. Who uses, how they interpreted, and what they exchange via those standards will dictate how effective their efforts will be. Carequality is an interesting concept, but if you don’t solve the underlying interoperability failures, then you are back to the same problem. I know several EHRs are trying to get together and do formative testing between themselves, but it is slow going and has been recently hobbled. We know with certainty that certification testing is not sufficient to solve this problem Here is a challenge for you. Can you exchange your top 100 problems, allergies, medications, procedures, labs, results at 100% accuracy with the top three ambulatory, acute, and SNF solutions? Can you then create a longitudinal record for the top 10 most common conditions with and without co-morbidities — and exchange that with 100% accuracy? (Brody Brodock)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a ubiquitously overused excuse for inaction and unwarranted “privacy” protection. And it is definitely a favorite blocking tactic of hospital administrators, especially witless ones. I have been told at my bank and grocery store that rule or policy was for preventing a potential HIPAA violation. Just for giggles, I generally ask the earnest clerk/cashier: “Who is the covered entity in question?” or “Which of the 18 protected health information identifiers are being exposed?” When they admit they don’t know what I am talking about, I explain that they obviously do not understand the HIPAA law. (Wadiego)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Washington, who asked for math manipulatives for her kindergarten class. She reported in February, “My students are aware that generous and thoughtful folks have donated these manipulatives in order to enhance their math skills. I am so happy to know that my current and future students will all benefit and become better mathematicians because of your generosity. We are currently working on composing and decomposing numbers, and the number windows came in so handy. Critical thinking is happening. With the rockets, students had to basically find the numeral, the appropriate ten frame, the tally, and the array that represent the same number. Seeing how the students persevere and seeing their smile brings me so much joy.”

A Cambridge, MA pub that reopened as a COVID-19 antibody testing site in partnership with the owner’s physician brother lasted four days before the city shut it down over zoning issues. According to the vice mayor, “I felt that it was a little bit odd and quite honestly concerning to see a restaurant pivot from serving food to being a phlebotomy site.”

FDA provides guidance for disinfecting refrigerated trucks that temporarily held human bodies so that they can again carry food.

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A doctor treating a COVID-19 patient at Advocate Christ Medical Center (IL) leaves the man’s sister a voicemail but fails to hang up afterward, with the doctor’s phone then continuing to capture her telling co-workers, “Look, he’s going to die. It’s just a matter of time. For the safety of everybody that’s involved, we should not do chest compressions on him.” The man died 10 days later, after which his sister expressed concerns that he didn’t receive all the care he could have.

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An Emmy-winning camera operator records parts of his two-week COVID-19 hospital stay on his phone, hoping to leave his family a record of what he feared would be his final days. He is recovering at home and says he hopes his videos will encourage people to maintain physical distancing and wear masks. His wife’s mother had died from COVID-19 two weeks before his admission in mid-March.

A woman in labor whose husband rushed her to a Louisville hospital only to find the doors locked gives birth on the sidewalk, with a 911 dispatcher walking her husband through the delivery. He couldn’t find anything to tie off the umbilical cord, so he used one of the COVID-19 masks that his grandmother had knitted for the family. The couple’s new son is fine.

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Weekender 5/8/20

May 8, 2020 Weekender Comments Off

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Weekly News Recap

Allscripts reports Q1 results that miss Wall Street expectations for both revenue and earnings.
CVS Health beats Q1 expectations and reports a 600% increase in telemedicine visits in its MinuteClinic business.
Change Healthcare acquires ERx Network, sells its Connected Analytics business.
Johns Hopkins recommendations for addressing COVID-19 include making EHRs searchable by public health officials, creating a platform for hospitals to share PPE and medical supply availability, and improving healthcare supply chain tracking and coordination.
Duke University’s interoperability recommendations for containing COVID-19 include collecting and reporting patient demographics with samples, defining a minimum data set, and expanding the use of the National Syndromic Surveillance Program.
CMS issue waivers to pay full rates for telephone-based encounters.
Epic launches a public website where customers can post their observational findings about COVID-19 or other health and public health issues.

Best Reader Comments

My former employer (an EHR company) had onsite primary care clinics for all employees that were also set up as somewhat of a showcase of how to “EHR” well. All the exam rooms had two armchairs facing a large monitor that the physician’s laptop was connected to. After the exam the doc would move the conversation over to those chairs to write up the note and finish the visit, making the act of writing the note more of a collaborative experience. As a patient, it felt a lot better than the doc plugging away on a laptop on their little stool while the patient sits on butcher’s paper. (EHRing well)

There’s actually a FHIR-based replacement to CCOW called FHIRCast that’s been in the development / connectathon testing stage for about two years. (Not sure if it’s in production anywhere yet.) There’s actually a track focused on testing it and playing with it during the May 13-15 connectathon too. I’m sure you’d be welcome to show up and dabble! (Lloyd McKenzie)

Re: remdesivir study. Statistical significance means less than 5% probability the result is due to chance, but you have to specify the one thing you’re measuring in advance. They didn’t do that—instead changed from mortality to recovery time. This sort of thing raises the question of how many more slices of the apple they would have taken until something passed the test. (Robert D. Lafsky, MD)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. F in Michigan, who requested Osmo learning sets for her first grade class. She reported in early February, “My students absolutely love Osmo. While they believe that they are playing, they are learning so much! My students are using Osmo Coding Awbie and Osmo Detective Agency both cooperatively and independently. They look forward to Friday afternoons, which is when we have technology time to explore and learn. Prior to the funding of this project, I only had two sets of these games. By donating to my project, my students now have the choice to work on their own or with a buddy to feed strawberries to Awbie as they code a path for him or solve the mystery in Paris. My students are so excited to explore with Osmo!”

Intermountain Healthcare cancels its agreement to send COVID-19 capacity data to data monitoring vendor Banjo following reports that the company’s CEO was a white supremacist as a teen and served as the getaway driver in a KKK synagogue shooting. The company has received $100 million in funding to develop police surveillance tools, with the state of Utah being a big customer until it cancelled after Damien Patton’s history surfaced. He says he was a homeless high school dropout who was taken in by skinhead and white supremacy groups.

The Ascension Seton nurse whose sign for co-workers explained why he was staying so long in the room of a COVID-19 patient provides this explanation:

I just feel like I was doing, as a nurse, what I’ve been taught. That’s what you do. I work at Seton and we have a policy that no one ever dies alone. It doesn’t matter, any circumstance. COVID makes it more difficult, but no one dies alone. Someone’s going to be there in your room with you.

A Harvard Medical School professor says that pathogen-fueled anti-immigration sentiment isn’t new, as early US immigration laws were created out of fear of disease, especially cholera. A New York City mob, led by wealthy landowners, stormed the city’s 1,000-bed New York Marine Hospital, called Quarantine, in 1858 and burned it down, returning the next night to use battering rams to level what remained. Many of Quarantine’s patients were new immigrants who had arrived by ships on which health inspectors found at least one person who was suspected of having an infectious disease, which then forced all of the ship’s occupants into lockdown.

Food service vendor Aramark opens makeshift grocery stores in several New Orleans hospitals so that healthcare workers don’t have to go shopping for essential and hard-to-find groceries after work.

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Weekender 5/1/20

May 1, 2020 Weekender 1 Comment

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Weekly News Recap

Arcadia acquires the assets of the Massachusetts EHealth Collaborative.
A KLAS inpatient EHR bed win-loss report for 2019 shows big gains for Epic and Meditech, big losses for Allscripts and Cerner.
Epic announces plans to add integrated telehealth to its product.
VA OIG finds that the VA had not adequately planned its now-postponed first go-live, specifically in the areas of staffing, patient access given an expected 30% drop in provider productivity for 12-24 months, and missing functionality such as e-prescribing.
Cerner’s Q1 beats earnings expectations, but falls short on revenue.
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.
Facebook’s coronavirus symptom survey is sending results from 1 million users per week to Carnegie Mellon University for predicting disease spread and county-by-county impact.

Best Reader Comments

People badmouth VistA, but many MDs we worked with used it at a VA and say they prefer it to Epic or Cerner systems. I assumed Millennium couldn’t be enhanced and customized to address AL existing military-specific capabilities in Stage 1. But not having basic e-prescribing capabilities (refills) that meet safety standards in 2020 in a multi-billion dollar EHR is alarming and a show stopper IMO given VA’s target population. Likely execs on top of food chain @ Cerner and VA OK’d plan to go-live without refills without deep understanding of potential harm and disruption for millions of vets (many depend on lifetime of meds for chronic pain, injuries and illnesses) and their families. (Ann Farrell)

People like the VA system because it doesn’t have the same data capture and billing systems as those serving commercial insurers. It also doesn’t have the same central oversight of the local orgs that a big health system does. That’s one reason why vets from different areas have such different experiences and opinions of the VA. I agree though that this particular screw up was probably caused by the exec team being told to go live without any real incentive to make sure everything works. (IANAL)

Not knowing all the key ways it spreads or just how fatal it is if contracted. Because we don’t have the denominators, which are key to knowing any of the rates. Exacerbated because the only people approved for COVID testing have to have symptoms, so no total population stats are known. New data is coming in on the head counts of those with antibodies who never reported sick, which provides hope this isn’t as bad as we are led to believe and that the death rate is greatly lower across the population than modeled. And the urgency is bolstered by CDC’s original instructions on coding U07.1 as being the underlying cause for any death when present (or suspected if no testing done) with co-morbidities and end stage conditions. NY is getting excoriated because they forced nursing homes to take hospital discharges of patients with COVID, which resulted in double digit deaths in those locations, because they are filled with the at risk elderly. And it also adds to the death count numbers that probably would not have occurred. These types of factors inflate the actual COVID death rate, but even then, it is coming in quite low (most stats now are showing actual death percentage under 2% and most don’t even achieve 1% of everyone who gets it.) (Icon O. Klast)

Among the things that have changed with the emergence of COVID-19 is the number of Epic generated press releases. Have there been more this year than all of previously recorded time? (AnotherDave)

If MDs want to improve the ratio of physicians to administrators, maybe they should pressure their colleagues to open more US medical schools. (Commenter)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. O in Kentucky, who ask for hands-on practice tools for class IPads. She reported in early February, “My students have already benefited so much from this addition of resources. As we learn to use our Osmos, we are finding even more ways to use them for teaching and learning than we even knew were capable. They work amazingly with some older IPads that we had on hand. We were able to resurrect this technology and give it a new purpose. I have also been able to share them with other teachers in the school to check out and use so that all students at my school have access to this resource. Students are excited to do math, reading, writing, engineering, coding, problem solving, and so much more.”

The Milwaukee paper describes how Epic’s 200 culinary team employees, freed up from providing up to 7,000 meals per day to employees who are mostly working off campus, are serving food pantries, long-term care facilities, frontline healthcare workers, and at-risk groups in the Madison area. The company also donated 47,000 pounds of food to food pantries and long-term care facilities between mid-March and mid-April. Epic is also offering curbside grocery pickup for its employees, which allowed a local produce company to bring its laid-off staff back to work.

In England, an NHS anesthesiologist creates a flashcard app that allows mask-wearing clinicians to communicate with COVID-19 patients using predefined on-screen text and voice messages. Rachael Grimaldi, BM developed Cardmedic in 36 hours while on maternity leave. The free app is being used by NHS trusts and by hospitals in 50 countries and is being expanded to include 30 languages, sign language, illustrations, and downloadable PDFs.

Doctors in Germany organize a protest called Blanke Bedenken (“naked concerns”) in which they pose nude in pictures to illustrate how lack of PPE puts their lives at risk. One doctor posed with a sign that reads, “I learned to sew wounds. Why do I now need to know how to sew masks?”

The New York Post profiles NYU Langone Hospital Brooklyn maintenance mechanic Hans Arrieta, who maintains the hospital’s ventilation and water systems. He has self-isolated by sending his family to live with relatives.

Kansas City Chiefs right guard and Super Bowl ring-wearer Laurent Duvernay-Tardif, MD makes Sports Illustrated’s daily cover for answering the call of Quebec’s health ministry for medical and nursing students to help give caregivers relief. He hasn’t completed a residency yet, so his assignment is to administer medications to patients in a long-term care facility. He observes, “I realize that I’m privileged. I didn’t lose my job. I don’t have three kids at home and a Zoom meeting and home school to teach. I know a bunch of my friends are going through difficult times; many are physicians who I met in medical school. I have friends who are working in emergency rooms. One does triage and tests patients for COVID-19. Those people are on the front line, and they’re giving everything to protect us.”

Children’s Memorial Hermann pediatric plastic surgeon Phuong “P. Danger” Nguyen, MD writes and performs a public service announcement featuring the song “Stay at Home.” It’s a project of Help the Doctor, an all-surgeon band.

In England, police in a small village seek to give some “words of advice” to someone who is walking around town wearing a 17th century plague doctor outfit. Some residents were frightened, some were amused, and one was pragmatic: “If it’s not illegal and he can’t wear it now, when could he?” Plague doctors wore the black outfits for home visits during the Black Death, with the beak-like mask that was thought to filter the disease leading to the disparaging doctor term “quack.”

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Going to ask again about HealWell - they are on an acquisition tear and seem to be very AI-focused. Has…

If HIMSS incorporated as a for profit it would have had to register with a Secretary of State in Illinois.…

What I wondered, after reading this? Could a single physician want to shift back and forth, dynamically, between workflows with…

I read about that last week and it was really one of the most evil-on-a-personal-level things I've seen in a…

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