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EPtalk by Dr. Jayne 4/2/20

April 2, 2020 Dr. Jayne 7 Comments

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Monday was Doctors’ Day. I had pretty much forgotten until I looked in my non-work email account and saw this greeting from Cerner. Specifically, it was from their Jamboree Team that supported us at the World Scout Jamboree last summer in West Virginia. It was a nice reminder of better times, when I was able to watch 40,000 people from around the world work together and get to know each other.

Our current situation is a reminder of just how global we really are. Since that Cerner team is used to supporting an international clientele, I wonder if any of them will be deployed to support the Cerner Millennium implementation at London’s 4,000-bed Nightingale Hospital?

This is going to be a rough year (or two) for doctors. I’m glad to see that professional organizations are stepping up. Whether it’s statements about the rights of healthcare providers to wear their own personal protective equipment if their employers cannot provide it or extensions for continuing education requirements, it’s appreciated. I have several friends in private practice who have taken out personal lines of credit to try to pay their staff members and who are forgoing their own salaries indefinitely. I suspect this might be the death knell for many independent practices, depending on how solvent they were prior to the crisis.

Vice President Mike Pence sent a letter to hospital administrators this week requesting that they report data in connection with coronavirus testing along with data on bed capacity. The data is to be reported in a de-identified fashion to ensure patient privacy. In a nod to 1990, all data is to be reported based on a spreadsheet, which is due every day at 5 p.m. ET for the period ending the previous midnight. Hospitals will be submitting this critical data to a FEMA email address. Since everyone likes a redundant process, hospitals must also report daily data to the National Healthcare Safety Network’s COVID-19 module, which went live March 27.

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Unbelievable, but in cybersecurity news, hackers have targeted the World Health Organization in the midst of this crisis. Tactics include creating a fake website that poses as a WHO email login portal to try to obtain passwords. Hackers had previously tried to spoof the WHO in an attempt to get money and private details from unsuspecting users. I hope what goes around comes around for these scoundrels.

A great piece in Kaiser Health News last week illustrates what it’s really like to be in an ambulatory setting and trying to confront COVID-19. This mimics what I’m hearing across the country. Although some organizations have stopped routine visits, others are forging ahead at full speed. Practices that can are pushing telehealth, but safety net organizations and others that are unable to limit in-person visits are having to rapidly redesign processes.

There are challenges in making sure exam rooms are clean in between patients. My own practice had to do an air handling study to figure out how long it would take to circulate the air out of our largest exam rooms should a high-risk patient be treated in them.

Many practices are doing “at the door” screening and triage, which often takes the form of a clipboard. Others are turning to novel solutions using chatbots and algorithm-based screeners.

Although adaptations are being made for telehealth payments, the article notes that some states are slow to get to speed with transitioning their Medicaid programs to a new payment model. It also notes the phenomenon of patients who “misrepresented their COVID-19 risks in order to get past screening.” We’re experiencing that in our environment as well, with patients desperate to be seen. Unfortunately, we have little to offer those we genuinely suspect of having the illness since care is largely supportive. Patients have latched onto media coverage of unapproved drugs and are requesting them. I’d love to be able to put a sign on the door that says simply, “No, you cannot have a Z-pack.”

From Other Duties as Assigned: “Re: from the front lines. I spent two shifts this week as a screener for all employees, clinicians, patients, family, and vendors. I’m usually a tech guy. It was a bit harrowing. In my state, we are hard pressed to maintain our PPE supplies and are repurposing surgical units to COVID. Our revenue will drop by 40% if this continues up the curve.” The writer wanted to remain anonymous, which is not difficult since this scenario is playing out at hospitals across the country. Kudos for stepping out of your comfort zone and giving it your all. Fighting this pandemic is definitely a team sport, whether you are supporting interfaces or enforcing the use of hand sanitizer at the door.

Lots of companies are throwing out cool COVID-related dashboards, showing various things such as hospital bed capacity (Definitive Healthcare) and effectiveness at social distancing (Unacast). Some of them are pretty fascinating, but it’s easy to go down the rabbit hole of interesting data and fail to do actual work. I’m limiting my COVID-related web surfing in an effort to actually remain productive.

I’m normally not a huge fan of Eric Topol, but I did enjoy his recent piece on how the “US Betrays Healthcare Workers in Coronavirus Disaster.” I think “betrayal” is the word that many healthcare workers are feeling right now, whether you’re a physician, nurse, therapist, tech, dietary worker, housekeeper, facilities engineer, security staffer, transporter, phlebotomist, or just about any role in the healthcare ecosystem. Many of us have spent our careers in service to others, but are having difficulty coping with the fact that when the going gets tough, our employers abandon us with salary cuts and furloughs. Their ultra-lean “just in time” inventories have left millions of workers without the basic protections of a safe workplace as defined by the Occupational Safety and Health Administration.

My clinical employer is still working hard to get us PPE, but it’s an uphill battle. A shipment of 500 gowns doesn’t do much for an organization that executes over 1,500 patient visits a day. We still don’t have company-supplied N95 masks, but we do have lab goggles for everyone. I’m eternally grateful to friends and family that dug through their basements or hit stores that were rumored to have legitimate masks, because I’m now covered with a set of masks I can rotate as I work. We’ll see how they hold up since they’re supposed to be single use and I’ll be wearing them up to 14 hours a day, but at least I have them, and the generosity of my support system allowed me to provide a few to colleagues as well.

Tonight’s dinner table conversation included such topics as “remember when we used to go out to eat” and “who wants to call the elders to make sure they’re actually at home,” along with something from a college math class that I’m sure I knew once upon a time. I’ve mostly adapted from my lack of travel, although the occasional tiny bottle of hotel shampoo brightens my mood. I have thousands of dollars in airline credits just waiting until the skies are safe again, so I’m making my post-2020 bucket list.

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A friend sent me this photo, allegedly from a restaurant in Ohio. I’m not sure what all is going on with this concoction, but I do want to experience it in the future. If you know where I can find it, leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/2/20

April 1, 2020 Headlines No Comments

MHS Genesis deployment suspended amid COVID-19 pandemic

The DoD presses pause on its roll out of MHS Genesis to better enable its care teams to focus on treating COVID-19 patients.

Exclusive: HCA subsidiary lays off dozens of contractors

Health IT consulting firm CereCore lays off dozens of employees contracted to work for parent company HCA Healthcare.

Microsoft helps Swedish Health Services develop COVID-19 app to track hospital resources

Microsoft and Swedish Health Services (WA) develop an app to help staff track COVID-19 patients, and hospital capacity and supplies.

eConsult solution company AristaMD secures $18 million in Series B funding

AristaMD will use $18 million in new funding to further develop and scale use of its e-consult and referral software for primary care physicians.

Morning Headlines 4/1/20

March 31, 2020 Headlines No Comments

Cerner Millennium EHR to be used at London’s 4000-bed temporary hospital

London’s 4,000-bed Nightingale Hospital, a COVID-19 emergency treatment facility created inside a convention center, will run Cerner Millennium.

Calling all COVID-19 Health IT Projects

ONC updates its Interoperability Proving Ground, making it easier to find projects already underway that are using health IT to address the pandemic.

Olive Raises $51M to Accelerate its AI Workforce for Healthcare

Healthcare workflow automation company Olive raises $51 million in a funding round led by General Catalyst.

News 4/1/20

March 31, 2020 News 6 Comments

Top News

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CMS issues coronavirus waivers and rules:

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

Reader Comments

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


Webinars

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

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


Announcements and Implementations

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


Government and Politics

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


COVID-19

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

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

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

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

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

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

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


Other

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

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

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

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Morning Headlines 3/31/20

March 30, 2020 Headlines No Comments

Trump Administration Engages America’s Hospitals in Unprecedented Data Sharing

To better allocate federal resources to areas in need, CMS asks hospitals to share COVID-19 testing data with HHS, and bed capacity and supply data with the CDC.

Supply chain companies to launch healthcare industry exchange

Supply chain tech company Resilinc will work with Stanford Health and Premier to launch a Web-based supply exchange that will match hospitals in need of COVID-19 equipment with manufacturers and donors.

New COVID-19 Preparedness App Fills Interoperability Gaps For Surge Preparedness

Epic and OCHIN develop an app for the Washington State Health Care Authority that enables healthcare workers, volunteers, and patients to perform COVID-19 screenings and find local emergency care.

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

CMS expands telemedicine coverage to 80 additional services and will now reimburse physicians for virtual visits at the same rate as in-person visits.

Curbside Consult with Dr. Jayne 3/30/20

March 30, 2020 Dr. Jayne 2 Comments

I’m still getting tone-deaf emails from HIMSS touting the value of Virtual HIMSS. They are also pitching a white paper that I can download to “understand in real time how your patients experience every interaction along the continuum of care; make patient feedback quick, meaningful, and actionable; and protect and improve your market share.” Honestly, with what is coming, I don’t think health systems are worried about protecting their market share. They are either knee-deep in COVID-19 or trying to prepare for it.

The hospitals in my area are busy giving very carefully worded interviews to the press about their stock of personal protective equipment. They usually go like this: “As of today, March 29, we have enough.” Reports from friends who work at those facilities are pretty bleak and we’re not even in a hot zone.

I also heard report that HIMSS isn’t wasting any time invoicing corporate members for their annual renewals, which has to sting for vendors who recently ponied up a good chunk of change to exhibit at a conference that didn’t happen.

I tend to skewer many different parts of the industry, so I don’t want to miss the opportunity to highlight physicians who are behaving badly. States are coping with a burst of prescriptions for drugs that are being used to combat coronavirus, often being written by physicians for themselves or their families. In response, states are requiring physicians to include a diagnosis code on every prescription for the suspect drugs, one of which is azithromycin.

Although including a diagnosis code on prescriptions is a best practice for medication safety, the reality is that many physicians don’t do this unless their EHR is set to require it. Those physicians just going about their business treating strep throat in penicillin-allergic patients are getting pharmacy callbacks, which clogs up the system. Some organizations have flipped the switch to require a diagnosis code for all prescriptions, which is making everyone unhappy.

Bottom line, folks: prescribing unproven drugs for your family in a situation like this one is unethical. If you are doing it, shame on you.

On the positive side, AMIA has announced that its Clinical Informatics Conference scheduled for May 19-21 will now be virtual. The CIC is a must-attend conference for many clinical informaticists who are in the trenches with hospitals and health systems versus being in academic settings. In addition to occurring on its scheduled dates, organizers will share the content with registrants using a learning platform. The CIC has grown tremendously since its inception, roughly doubling in size every two years. I wish AMIA the best in trying to make this new format happen.

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Recently my clinical practice has hit a lull as we wait for the surge of coronavirus patients to hit. I’ve gone from delivering medically focused care to delivering care with a more psychological focus. A good number of patients in both my in-person and telehealth practices just want advice and aren’t able to get it from their primary physicians, or don’t have primary physicians to reach out to.

I’m also giving a fair amount of public health advice both in my practice and on various Facebook groups and community forums. Medical misinformation abounds these days, and people are coping with requests to stay at home with some unhealthy behaviors.

Our local high school had to recently close its athletic fields because one of the club football teams called a practice despite a stay-at-home order being in place. Parents drove their middle school children to participate in contact football, which baffles me. Other people are getting together in groups to have social distance tailgating parties, where the six feet of social distancing is just an illusion. Another group of moms got together and backed their minivans up facing each other, then crawled into the back end and drank Starbucks. People are asking me what I think about these practices, and sometimes I struggle to find the right response.

We live in the most connected time in human history. The technology to bring people together while they are apart is amazing. Most of us in the US have ready access to free video calling, conference calls, unlimited long distance, and more. However, people are struggling to feel “close” to people unless they are within a certain physical proximity. Have we lost the ability to have relationships with people unless we are literally face-to-face with them?

Some of my best friends live across the country and around the world, but I can “talk” to them within moments through texting or online messaging. They are literally at my fingertips through the magic of the cell phone. For those people who psychologically must have face-to-face contact, I’m recommending they do it with a single friend and from a distance, rather than mimicking one of the group distancing solutions I’m seeing.

People who are getting together in these groups are missing part of the point about healthcare providers wanting or needing them to stay home. When you’re on the road, you put yourself at risk for accidents, which puts first responders at risk, and possibly healthcare providers. It also puts you at risk – you can give the virus to them, and they can give it to you, since many of us don’t have adequate personal protective equipment.

It’s one thing to go out to get essentials. It’s another thing to go meet up with friends because you’re bored. I strongly encourage people to rethink what they’re doing, especially if they’re under a stay-at-home or shelter-in-place order.

For those of you who might be struggling with this, I have some tips to share from retired NASA astronaut Scott Kelly. As someone who spent her formative years wanting to be an astronaut (specifically, the first doctor in space, but I didn’t quite hit the mark), I have tremendous respect for those who journey to the ultimate frontier. As he says in the piece, “Flying in space is probably the only job you absolutely cannot quit.” Some highlights from his recommendations: follow a schedule, but pace yourself; go outside (safely and prudently); find a hobby; keep a journal; listen to experts; and take time to connect.

As an anonymous blogger, the last one is important to me. I correspond frequently with a few regular readers, and it’s good to have kindred spirits. If you’re not sure who to reach out to, check on a neighbor, reach out to an elderly person in your religious organization, or consider reaching out to someone from work who you typically see in passing but don’t get to talk to regularly. We can all make new connections as well as our existing ones, and you might just find yourself brightening someone’s day in this challenging time.

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Those of you who have been reading my work for a while know I’m an avid baker, and one of my favorite prescriptions is for pastry therapy. I didn’t write myself a script for a Z-pack to fight coronavirus, but I did treat myself to a new cast iron skillet complete with Rosie the Riveter. She reminds me that we can do this, and like our parents and grandparents during major world upheavals, it’s going to take all of us to get this done. Thank you to my friends at Lodge for keeping the foundry going and the online orders shipping.

To the rest of you, I leave you with tonight’s pastry therapy offering: the Chocolate Chip Skillet Cookie. I promise it bakes up much better in the 10-inch Rosie the Riveter skillet than it ever did in my trusty 12-inch one. Bon appetit!

Email Dr. Jayne.

HIStalk Interviews Ed Marx, Chief Digital Officer, The HCI Group

March 30, 2020 Interviews 4 Comments

Ed Marx, MS is chief digital officer of The HCI Group of Jacksonville, FL.

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Tell me about yourself and your job.

I started my health career at age 16 as a janitor in a healthcare facility. Since that day, I knew my purpose in life was in healthcare. I didn’t know how it would manifest itself. Certainly not as a chief digital officer for a major global organization.

What does a chief digital officer do?

My objective is twofold. One is to make sure that we as an organization digitally transform ourselves. I always say that you have to eat your own dog food. If we are going to consult or sell or whatever to customers around the world, we had better be able to use ourselves as the number one use case.

Second is to take those same learnings and teach people how to leverage technology in order to see digital transformation in whatever their specific objectives are. It runs the gamut. 

What is digital? I can give you the formal definition as I see it, but really it’s a natural evolution of technology, but centered around experience. Helping organizations achieve that and to continue their evolution to enable the organization’s objectives.

What organizations are doing digital transformation well in healthcare?

I give credit to everyone who is doing anything, because at least they are moving the needle. I’m going to answer your question specifically with a couple of the obvious ones, but in addition to that, a lot of small hospital systems are doing good things.

We always highlight the bigger ones that have more resources. Certainly you talk about the Mayo Clinic and Cleveland Clinic. They have done a lot for a long time to continue that evolution, and now revolution, of technology enablement. Those are a couple of organizations that are doing a really nice job.

The impetus of the situation that we are in today is only going to help everyone accelerate that journey. That journey has been slow, especially compared to other industries. But we have an opportunity to catch up and see the fruition of all of that technology can do to enable superior clinical care.

Are health systems looking at new entrants like Walmart, Amazon, and Walgreens that have created new consumer experiences and just throwing up their hands and say they can’t match them, or are they choosing specific aspects they can implement?

We have new entrants because those companies are looking to continue to grow their margin. They look at the percentage of GDP that healthcare makes up and think it’s an area that they should focus on.

But a second reason, which maybe never should have happened, is that few of us were leveraging digital transformation and changing the whole experience. You’ve seen that in other industries. People get upset when you compare healthcare to other industries and I know healthcare is different, but from a technology point of view, you saw disintermediation of multiple industries by new entrants who said, we’re going to be more about the experience. We’re going to use automation and “digital,” quote unquote. We can do it at a lower cost point. Those sorts of things.

Whether it’s big tech or it’s retail, they are seeing the same thing. Not only is there a huge opportunity in terms of what the spend is, but in healthcare, we haven’t done it necessarily the best way because we weren’t forced to. Now we have globalism, consumerism, and retail giants who are all focused about the experience of big tech. That’s why we’ve seen this happen.

We need to learn quickly. What is the secret sauce that a retail giant might bring in terms of the experience? That’s really it. I keep using the word “experience,” but it’s really a focus on the experience. Then enabling all the technologies that they are using on a day-to-day basis to make their life easier. That’s what we need to learn. 

In some cases, we need to partner and we should partner. Sometimes it’s better to partner and do good things in the world than to sit back and watch your business be disintermediated.

Sometimes it’s better to be second in learning from the mistakes made by whoever got there first. Will we see organizations leapfrogging that first generation of consumerism?

That is happening with some forward-thinking hospitals and health systems. They are taking the time to analyze what’s going on in retail, how they created those new, enhanced experiences, and taking some of those learnings. We’re seeing that now. I’ve heard of many health systems that are working on their basic patient portal, and you know those aren’t about the experience. It’s a good start, but again, years behind what other industries have been doing.

Some forward-thinking hospitals and healthcare systems are keeping that as the foundational base because of all the integration it has. They they are building layers on top of it that get all about the experience. So I do think you can …  I don’t know if it’s actually leapfrogging, but at least keeping pace.

The leapfrogging might happen in partnerships. It will be hard for a healthcare organization to compete with the capital and innovation mindsets that some of these outside entrants bring, whether it’s retail or big tech. I would see it very challenging for a healthcare organization, especially an average healthcare organization, to bring together the mindshare and the capability to leapfrog, but I think you could leapfrog if you selected a good partner.

How will the coronavirus pandemic and the economic shock that accompanies it affect healthcare’s digital transformation?

I’m thinking two or three things, and I’ve thought quite a bit about this in the last several days. One is that it’s going to be the pure acceleration of everything we’ve been trying to do, the whole virtual care continuum. I came from a leading organization and 1% of our outpatient visits were virtual, with a goal of getting to 50% in four years. I haven’t checked back, but I bet they are pretty close to 50% now. 

Part of that stack, too, is healthcare at home. This was another thing that I put out there, that 25% of inpatient visits will be at home in the next four years. I get the feeling we’re going to get there much quicker.

Those are two examples. I think those are permanent. I don’t think that after this, we’re going back.

Another is a new way of work. I’ve been a big proponent of working from home as a way of work for 10 years. We’re not going to go back. There is no reason, ever, to travel to go use a computer. I’m sure some companies and hospitals will disappoint me, but those days are gone. That will do tremendous things for healthcare in terms of taking out costs.

These concepts of virtual care and a new way of work will come together to change everything. Why would you ever want to go and sit in a waiting room? Those two changes are going to be permanent.

How will the possible new emphasis on public health change the health IT discussion with regard to interoperability, analytics, and aggregating patient data?

I’m less optimistic on that one. I hope this brings our country together to be more serious and more intentional on public health. It took this crisis, this terrible situation, to make it happen. You bring all these smart people together and the resources that everyone has with public-private and we can do amazing things. We should have done it a long time ago.

I’m hoping that this is a catalyst that changes our public health for good. That we become a more healthy country, that people take wellness more seriously and more personally, and that our country is able to be predictive and preventative at the same time so that nothing like this could ever occur again.

Do you have any final thoughts?

I hope that my fellow CIOs and chief digital officers continue to lead the trajectory that we are on. I’ve always been critical of myself and my peers in terms of why we lag behind other industries. Now, because we’ve been given clarity, focus, and budget, I’m hearing from a lot of my colleagues about all the awesome things they are setting into motion now. May it always continue. May we take that leadership mantle and not tarnish it, but brighten it for the good of our patients and the communities that we serve.

Morning Headlines 3/30/20

March 29, 2020 Headlines No Comments

Apple announces COVID-19 website and app in partnership with CDC and the White House

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

Bright.md Raises $8 Million Series C Round to Bring Critical, Asynchronous Virtual Care to Health Care Systems and Their Patients

Bright.md raises $8 million in a Series C funding round, increasing its total to $20.5 million.

Conference Cancelled

Medical Users Software Exchange cancels its 2020 MUSE Inspire Conference that was scheduled for May 26-29 at Maryland’s Gaylord National Resort & Conference Center.

COVID-19 Community Based Testing Guide

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

Monday Morning Update 3/30/20

March 29, 2020 News 2 Comments

Top News

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


Reader Comments

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

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

HIStalk Announcements and Requests

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

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

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

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


Webinars

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

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


Acquisitions, Funding, Business, and Stock

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


People

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


Announcements and Implementations

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

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

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

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

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

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


Government and Politics

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Other

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

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

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

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

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

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Sobering tweets.

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


Sponsor Updates

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

Blog Posts


Contacts

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

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HIMSS20 Exhibitor Plans for HIMSS21

March 28, 2020 News 3 Comments

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

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

Below are excerpted comments from respondents.


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


They should have refunded at least booth cost.


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


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


Weekender 3/27/20

March 27, 2020 Weekender No Comments

weekender 


Weekly News Recap

  • UC San Diego Health publishes a description of Epic enhancements it created to address COVID-19, including tools for screening, ordering, secure messaging, and support for video visits.
  • Scripps Research launches a wearables study that hopes to identify viral illnesses more quickly.
  • Several organizations form the COVID-19 Healthcare Coalition, a data-driven effort to address coronavirus challenges.
  • CMS offers exceptions and extensions for MIPS and MSSP.
  • HIMSS announces that it will not offer refunds or credits to exhibitors and sponsors of the cancelled HIMSS20.
  • The HCI Group begins hiring up to 600 people to staff its COVID-19 telephone triage service for hospitals.
  • Thoma Bravo calls off discussions related to selling Imprivata for up to $2 billion, citing market volatility.
  • UK Prime Minister Boris Johnson meets with technology and healthcare startups to ask them for help in addressing coronavirus.

Best Reader Comments

New York hospital bed shortage? For over 40 years, the State of NY and many other states have beaten hospitals up via a payment system that pushed / punished them to close beds. (FLPoggio)

It’s always been understood that HIMSS was a vehicle for vendors to interact with prospects and clients. But they have aligned their focus on leveraging all HIMSS community members to realize the greatest revenue they can, and by way of their recent investments, they have continued to focus on media, conferences, and other marketing ventures, combined with their lucrative lobbying business. I believe that it is time for “reset” for HIMSS and even CHIME, which I was also a member of and also I’ve allowed my membership to lapse. The vendors provide the greatest percentage of revenue to HIMSS and they need to demand more. I believe this year provides vendors to determine if they are getting value out of HIMSS and I suggest they collaborate or work in a unified manner to make HIMSS serve them better. HIMSS needs you more than you need them. (HIMSS Insider)

I’m on a copious number of healthcare groups on Linkedin and it’s almost sickening how everyone is trying to get brand recognition from the crisis. Some have real things to offer, like a free year’s licensing to virtual visit module, but most seemed to be forced to use the crisis as a way of saying “we get it” and/or “we get it, and btw, think of us when you buy.” I understand. If I were a software exec at a virtual VP meeting, I would feel pressure to tell the marketing folks to come up with a C19 message and get it out there. Not so fast, though – everyone else is doing the same and you will look like a C19 make-money pile-on. (Dave S.)

One message I’d really like to get out is that a lot of us in healthcare, even administrative, do not have time for 30-60 minute webinars. So many people are working from home right now and have all the time in the world, so they aren’t realizing that many of us actually have LESS free time because we’re trying to navigate healthcare rules which are changing at least once daily. Please please please use your time to put together fact sheets with important information we can use, and make them as brief and to the point as possible. (A-M)


Watercooler Talk Tidbits

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Readers funded the Donors Choose project of Ms. B in Arizona, who asked for programmable robots for her gifted middle school class. She reports, “My students are being helped by the Ozobot coding robots because they have to use collaboration in tandem with critical thinking skills. The most exciting thing about the product is that they can code the robot to go on any path they can imagine. There is a lot of trial and error but it provides the students the opportunity to fail forward. The cool thing about this technology is it is accessible to all of my students, especially my girls. No one was intimidated by the idea of coding, instead they opened up the boxes and got down to work!”

Phelps Health (MO) asks Missouri University of Science and Technology to help address an expected shortage of caregiver masks and face shields. The few students remaining on campus set up a 3D printer farm that can run 24 hours per day. Students on the design team who worked since fall on now-cancelled design competition entries say they are energized to be performing positive, meaningful work.

Another shortage in New York: foster dogs, as applications from stay-at-home workers surge 10-fold. Rescue organizations are happy for the fostering help, but worry that joblessness will increase the number of pets that are surrendered.

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The FBI kills a Missouri extremist in a shoot-out that followed a sting operation in which the man hoped to buy a vehicle packed with explosives and use it to bomb a local hospital for treating patients with COVID-19, which he believed to be a Jewish plot.

A Kentucky hospital lays off 300 employees, 25% of its workforce, due to declines in non-COVID-19 business.

Airbnb hosts are evicting traveling healthcare workers in fearing they will bring the coronavirus into their homes. One Las Vegas landlord demanded that her ED nurse tenant vacate the premises within 24 hours as a “choice I’m making to protect myself,” then threatened to seize all of her belongings if she refused to leave. Healthcare workers in India, England, and Japan have reported being harassed and threatened, while hospitals in Australia warn nurses not to wear their scrubs in public after some were spat on or refused entry into stores.

A hospital nurse quits due to lack of personal protective equipment, warning that other frontline workers may resign after watching friends being put on ventilators or dying and then realizing they could be exposing their own families. Meanwhile, a Tennessee doctor says the state health department suggested using diapers and swimming goggles if PPE isn’t available.

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A California ICU doctor who treats COVID-19 patients moves into a tent in his garage to prevent exposing his family to coronavirus, urging everybody to stay home as he “voluntarily became homeless to protect my family.” 

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Time to dust off those orthopedist jokes. Hospital police officers arrest UConn Health orthopedic surgeon Cory Edgar, MD, PhD after he intentionally coughed on two other employers and was observed disregarding space and safety concerns. I note with wonderment that he holds both a bachelor’s and a master’s in molecular and cell biology.

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Bicycle companies rush to offer a replacement bicycle to an ICU doctor in England whose $2,000 Ribble bicycle was stolen from a locked area while he was treating COVID-19 patients. Dan Harvey says he will donate the bike to charity after the crisis ends and will put bike companies in touch with other staff members who don’t have transportation.

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An unidentified man thanks staff at Morristown Medical Center (NJ) for his wife’s treatment by holding a sign up to the ED’s back window. Nurses took a photo, but don’t know the identity of the man or his wife.


In Case You Missed It


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Morning Headlines 3/27/20

March 26, 2020 Headlines No Comments

Diligent Robotics announces $10M series A

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

Alphabet’s Verily ramps up drive-through coronavirus testing with 1,000 Google volunteers

Verily automates scheduling for its recently expanded drive-up COVID-19 testing sites, part of its Web-based screening and testing project launched in California earlier this month.

New York State COVID-19 Technology SWAT Team

New York State seeks IT volunteers for COVID-19 technology SWAT teams, specifically looking for expertise in product management, development, hardware deployment, and data science.

An Epic donation: Local tech giant transforms former headquarters into daycare for COVID-19 frontline workers

Epic partners with a local childcare provider to convert the use of its former headquarters in Madison, WI to childcare space for UW Health employees.

News 3/27/20

March 26, 2020 News 4 Comments

Top News

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


HIStalk Announcements and Requests

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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


People

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


Announcements and Implementations

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


Government and Politics

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

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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


Other

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Cleveland Whiskey pivots to producing hand sanitizer for Cleveland Clinic.

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

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 3/26/20

March 26, 2020 Dr. Jayne 1 Comment

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A great piece appeared in Forbes this week about why doctors don’t perform well when they’re afraid. I would extrapolate that to, “humans don’t perform well when they are afraid.” They especially don’t perform well when they are afraid and they are receiving mixed messages from the World Health Organization, the Centers from Disease Control, and their own hospitals or employers.

People are sending me copies of documents from their employers that show policies that are directly divergent from WHO and CDC recommendations. Especially for people who have devoted their careers to scientific inquiry and the application of research to the point of care, this understandably doesn’t go over well.

The author notes that feeling under threat creates an attentional bias, where physicians’ thoughts are more focused on the threat than on caring for the patient. Lack of personal safety also reduces cognitive flexibility, which impairs problem solving and decision making. She also notes that being worried keeps us from learning from our experiences and our mistakes.

The reality is that workers are already becoming exhausted and we haven’t even scratched the surface of what’s to come in the US. Organizations are at a loss as to how to best support their workforce. One of the physicians in the article states, “I think the system is failing us. There’s so much talk of wellness and we are given more modules on wellness. The reality is this is just giving me more work. So how about you take those funds and redirect them?”

The funny thing about the article was when it rendered on my screen, an ad for St. George’s University School of Medicine appeared alongside it. I’ve been to St. George’s – it’s in Grenada and it’s a lovely place, with the anatomy lab only steps from the beach. It also has the distinction of having had the United States Marine Corps rescue its students during the 1983 invasion.

I wonder how many people who previously wanted careers in health care will still want them after all this. It’s not just the clinical teams who are being beaten up, but everyone on the front lines, from dietary to engineering to custodial to IT and so on. The physicians I’ve spoken with that are the most distressed are those who have administrative teams that are working from home since they are non-essential. That’s shocking to me, especially compared to facilities with administrators who are rolling up their sleeves and getting in there.

A friend of mine from high school lives in Taiwan. We were chatting the other night about what life looks like for them. When we spoke on February 2, his city was on partial lockdown, with schools closed through the end of the month. At this point, he reports that since the majority of new cases are coming from foreign travelers, they have shut down the airports for the next two weeks.

He notes several other differences: “We’ve got temperature and sanitizing stations everywhere. We set rations early for medical supplies, tied to nationwide health cards so people don’t get more than they’re allotted per week. Home quarantine is digitally tracked with phone and wristband – if people aren’t where they’re supposed to be, the police show up.” There’s no way that would fly in the US, but it’s an interesting view of how other countries are handling this challenge.

He sent me this piece from NBC News that explains it based on the fact that “Taiwan put lessons it learned from the 2003 SARS outbreak to good use, and this time its government and people were prepared.” Taiwan’s actions:

  • Aggressive testing and contact tracing, with swift isolation of infected patients.
  • Temperature monitors were already in place at airports to look for passengers with fever.
  • Individuals with positive contacts but who test negative are tested repeatedly to determine if they become positive.
  • Masks were rationed, but were given to lay people, which helped people feel safe and avoided panic behaviors.
  • Soldiers were sent to staff mask factories, increasing production.
  • TV and radio stations broadcast hourly public service announcements on hygiene.

Can you even imagine that in the US, where we’re still hearing in some channels that this is all a hoax?

There are other good strategies in the article, including parents monitoring children’s temperature at home and not sending them to school when febrile, which I know is not always the case in the US. We often see parents who load their children with ibuprofen and acetaminophen and send them to school sick because they can’t take off work. Once the children are sent home from school, they come to urgent care.

There’s also a plug for Taiwan’s nearly universal healthcare system, which “lets everyone not be afraid to go to the hospital. If you suspect you have coronavirus, you won’t have to worry that you can’t afford the hospital visit to get tested… you can get a free test, and if you’re forced to be isolated, during the 14 days, we pay for your food, lodging, and medical care. So no one would avoid seeing the doctor because they can’t pay for healthcare.” That’s a different world, indeed.

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I was able to do some actual informatics work this week, as I helped a couple of organizations set up their COVID response plans, including messaging campaigns and drive-through screenings. There are plenty of companies standing up solutions specific to the current crisis and I’ve heard some comments dismissing them as capitalizing on the emergency. Still, some vendors are offering some pretty cool solutions for free and I was happy to take advantage of a couple of them this week (as were my clients).

Smaller companies can be a lot more nimble. I watched a patient outreach solution go up in less than 12 hours and a drive-through screening management system go up in less than two days. It’s been fun to watch innovation at work.

I finally left the house, though, when I received the call that a colleague had an N95 mask for me. I felt like a transplant patient must feel when they get the page that an organ might be on its way. My hopes were dampened a bit after I heard the story of where it came from – it’s likely to be a counterfeit. Once it makes it out of the quarantine area in my house, I’ll check out its particulars and see if it’s the real deal. A good friend of mine might also have one in his basement, which I’ll definitely take advantage of if this one looks sketchy.

There are a lot of scams out there, “friend of a friend” kind of situations where people promise to get a high volume (and high dollar) order through when traditional supply chains have failed. Even hospitals are not immune to the scams.

Stay safe out there, and stay sane. It’s going to be a long, bumpy ride.

Email Dr. Jayne.

Morning Headlines 3/26/20

March 25, 2020 Headlines No Comments

Scripps Research launches DETECT study, leveraging wearable data to flag viral illnesses

The Scripps Research Translational Institute kicks off an app-based study that will use health data from wearables to more quickly pinpoint the onset of viral illnesses like the flu and coronavirus.

Rapid Response to COVID-19: Health Informatics Support for Outbreak Management in an Academic Health System

UC San Diego Health providers and researchers outline the ways in which the EHR is essential to supporting a health system’s management of the COVID-19 outbreak.

Inbox Health Raises $3.5 Million in New Venture Funding

Patient billing company Inbox Health raises $3.5 million in a funding round led by Healthy Ventures.

Morning Headlines 3/25/20

March 24, 2020 Headlines No Comments

COVID-19 Healthcare Coalition Forms to Support the U.S. Healthcare System and Help Protect U.S. Populations

Consulting firm Mitre and several companies form the COVID-19 Healthcare Coalition, a data-driven effort to study community mitigation efforts, identifying people who have been exposed and need testing; and helping health systems manage staff, space, and supply chains.

HHS Awards $100 Million to Health Centers for COVID-19 Response

HHS allocates $100 million to help nearly 1,400 health centers across the country acquire medical supplies, support screening and testing needs, and expand telemedicine capabilities.

HTD Health Acquires CareVoice, an Advance Care Planning Platform

Health IT software development company HTD Health acquires digital advance care planning vendor CareVoice.

News 3/25/20

March 24, 2020 News 3 Comments

Top News

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


Reader Comments

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

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

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

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

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

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


Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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


Acquisitions, Funding, Business, and Stock

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

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


Announcements and Implementations

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

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

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Privacy and Security

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


Other

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

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

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


Sponsor Updates

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

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Reader Comments

  • David Lareau: The concepts in the graph database need to be mapped to the relevant vocabularies and code sets for the different domain...
  • Joe Magid: If you've not had a chance to watch Rachel Maddow on MSNBC, she had a pretty steady stream of video tales from the trenc...
  • nirvous: Sure, graph databases are hip. But how does reformulating a proprietary clinical vocabulary as a graph database solve th...
  • Brody Brodock (Adapttest): While I do agree that the current EHR schemas are not the best at categorization or enabling clinical decision making, I...
  • Frank Poggio: Re: The old ways of building EHRs to support tracking of transactions for billing will not suffice... If I have hear...

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