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Morning Headlines 6/12/20

June 11, 2020 Headlines No Comments

Wellsheet Raises Series A Funding for Healthcare Workflow Platform to Reduce Time in the EHR and Physician Burnout

Provider workflow optimization company Wellsheet raises $3.8 million in a Series A funding round.

Leading Virtual Care Platform Conversa Health Raises $12 Million as COVID-19 Accelerates the Need for Digital Health

Automated virtual care vendor Conversa Health raises $12 million in a Series B funding round.

Apple and Google’s ambitious COVID-19 contact-tracing tech can help contain the pandemic if used widely. But so far only 3 states have agreed — and none has started to use it.

Just three states – Alabama, North Dakota, and South Carolina – will use contact tracing software from Apple and Google, while 17 have said they won’t use any apps and 19 remain undecided.

News 6/12/20

June 11, 2020 News 2 Comments

Top News

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Silicon Valley investment firm Iconiq makes a “significant” investment in healthcare workforce management software vendor QGenda that values the company at just over $1 billion.

Francisco Partners, which considered selling the company in May, will remain Atlanta-based QGenda’s majority owner.


Reader Comments

From Going Live: “Re: EHR go-lives. Are they still happening? What measures are being taken to protect those involved?” The only go-lives I’ve heard about in the past couple of months were done remotely, but perhaps others have been involved in the traditional version and can report. I would be surprised if hospitals that were preparing for COVID overrun and banning patient visitors were simultaneously undertaking a go-live that involved on-site help.

From Confused: “Re: [vendor name omitted.] Announced new funding, but this news is 16 months old, according to former employees.” I reached out to the company, which says it held the announcement “to peg it to exciting company milestones and product capability rollouts.” I’m not listing their name since this could be commonly accepted practice for all I know and there’s no reason to call them out if so. I didn’t find any of the usual investment sources that listed the actual funding date — they all used the recent announcement date instead. Maybe the biggest takeaway here is that while it is impressive that companies are announcing new funding during a pandemic and its associated economic downturn, the funding itself may have occurred before all that happened or when its competitive situation was different than now.

From Doctor Doctor: “Re: COVID-19. I’ve seen a lot of dumb opinions and advice from doctors quoted on news sites and social media.” As have I. People erroneously think that all doctors from every practice setting are science-based, apolitical, free of commerce-related bias, current in their knowledge, and just as qualified as epidemiologists, virologists, and public health experts to speak authoritatively on COVID-19’s transmission, mitigation strategies, and treatment.


HIStalk Announcements and Requests

Somehow I missed that John Glaser left Cerner back in November 2019, according to his LinkedIn. He’s on the board of health IT-related organizations Press Ganey, EHealth Initiative, InTouch Health, American Telemedicine Association, PatientPing, Relatient, and Scottsdale Institute, also serving as a senior advisor to Brighton Park Capital.


Webinars

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.


Acquisitions, Funding, Business, and Stock

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Provider search and scheduling software vendor Kyruus raises $30 million in a venture round from Francisco Partners, bringing its total funding to $155 million.

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Wellsheet raises $3.8 million in a Series A funding round. The New Jersey-based startup has developed software that uses predictive analytics to optimize provider workflows.

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Genetic clinical decision support company ActX secures a patent pertaining to cloud-based storage and real-time distribution of biological information.

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Automated virtual care vendor Conversa Health raises $12 million in a Series B funding round.


Sales

  • Health and Social Care Northern Ireland signs a $351 million contract with Epic for implementation across five trusts and its ambulance service.

People

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Optum promotes former Center for Medicare and Medicaid Innovation director Patrick Conway, MD to CEO of its Care Solutions group.

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Virtual care technology vendor Conversa Health promotes Murray Brozinsky to CEO.

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Kevin Lynch (Netgain) joins Datica as CEO. Co-founder and former CEO Jeremy Pierotti takes on the role of president.


Announcements and Implementations

Goliath Technologies helps Maimonides Medical Center (NY) anticipate, troubleshoot, and resolve Citrix slowdown issues.

Nuance Dragon Medical One voice assistant users can now access UpToDate clinical content from Wolters Kluwer Health.

Novant Health (NC) implements iQueue for Operating Rooms from LeanTaas to help its surgical facilities ramp back up to pre-COVID-19 capacities.

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Health Catalyst will launch a quality reporting product that combines its Data Operating System with measures, visualizations, and workflows from Able Health, which it acquired earlier this year.


Government and Politics

The VA gives Cerner a $99 million task order for sustainment support of hardware and software associated with its $10 billion EHR modernization project.


COVID-19

Regeneron begins the first clinical trials of antibodies for COVID-19 treatment, which if successful, could be cleared for emergency use by fall assuming production can be ramped up.

Researchers identify 12 malware-distributing Android apps that were disguised to look like COVID-19 contact tracing apps issued by the governments of Brazil, Italy, Russia, Singapore, and other countries.

Business Insider reports that just three states – Alabama, North Dakota, and South Carolina – will use contact tracing apps from Apple and Google. Seventeen states have said they won’t use contact-tracing apps at all, while 19 remain undecided.

None of the 140 customers of a Missouri hair salon whose hair was cut by two stylists who worked for eight days despite having active, symptomatic COVID-19 infection have become infected. Health department officials credit the salon’s insistence on mask-wearing by both customers and employees, its wider spacing of chairs, and its staggered appointment times to reduce group waiting. The stylists have been released from isolation. Experts are increasingly convinced that wearing masks could significantly reduce the spread of COVID-19.

Mount Sinai (NY) uses a grant from Microsoft’s AI for Health program to develop an informatics center dedicated to COVID-19 research.

The Department of Justice charges the president of a biotechnology company with submitting $69 million in fraudulent COVID-19 and allergy testing claims to mislead investors. Arrayit’s Mark Schena, PhD allegedly paid kickbacks to doctors for ordering allergy testing regardless of medical need, used the revenue to misrepresent the company’s prospects to investors, then jumped on the COVID-19 bandwagon with diagnostic tests whose accuracy was questionable.


Privacy and Security

StayWell secures the portal it hosts for the State of Kentucky’s health and wellness incentive program after discovering two data breaches that exposed employee email addresses, passwords, and biometric screening and health assessment data. The breach also resulted in fraudulent gift card redemptions.


Other

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Bloomberg Businessweek describes the negative effects of private equity firms buying dermatology practices, 10% of which are now owned by PE firms:

  • The PE formula of drastically cutting costs and flipping the business for a profit in 3-5 years with a 20-30% annualized return makes it difficult to serve both patients and investors effectively.
  • Corporate-owned medical practices are illegal in many states, but lawyers get around that by creating a management company that buys a practice’s non-clinical accesses and bills its doctors for its services, which is supposed to keep medical decisions separate from profit-seeking ones even though PE firms admit that they insert themselves into the clinical side of the practice.
  • Doctors in solo practice can sell out for $7-12 million, with some of that paid in equity. Patients are not notified of the practice’s new owner.
  • Some of the acquiring firms pay cash bonuses to offices that hit daily and monthly financial goals, encouraging them to perform as many procedures as possible. In some cases, medical assistants earned their bonuses by falsifying documentation and doctors were told to falsely claim that they were supervising PAs.
  • PE firms push dermatologists to perform more high-profit procedures such as cosmetic surgery, laser treatments, and Mohs surgeries, the latter of which are sometimes performed by traveling labs that are flown in or that work from temporary parking lot clinics.
  • PE firms buy labs and hire their own pathologists to keep revenue in-house, which is legally allowed under Stark laws only for dermatology and a few other specialties.
  • Doctors are pushed to see more patients and sometimes are forced to use inferior medical supplies and equipment. One dermatologist says their employer insisted that surgery patients be sent home with open wounds so they would be forced to return the next day for suturing, which allowed the practice to bill them a second time.
  • 25% of the dermatologists with the highest biopsy rate work for private equity-backed groups who encourage diagnosing “Pre- pre- pre-cancer” to get patients to have skin blotches removed.
  • A dermatologist says that the debt-saddled chains are struggling to find their expected buyers since “there’s a limit to how much money you can make when you’re sticking knives into human skin for profit.” As a result, the PE firms are moving into specialties that perform more invasive procedures, such as urology.

Sponsor Updates

  • Banner Health (AZ) expands its use of Spok’s Care Connect communication software.
  • Health Catalyst will partner with life sciences company Sprim to use real-world evidence to inform clinical trials for liver disease.
  • Gartner includes Imat Solutions in its “US Healthcare Payer CIOs Boost Medicare Advantage Star Ratings Using Engagement Hubs and Insights” report.
  • The “HIT Like a Girl” podcast will feature Intelligent Medical Objects CEO Ann Barnes on June 10.
  • NextGate’s identity-matching EMPI solution is now available in the Microsoft Azure Marketplace.
  • Arcadia makes available a COVID-19 Recovery Toolkit to help its customers resume normal operations.
  • Wolters Kluwer Health helps to develop and virtually host the American Diabetes Association’s 80th Scientific Sessions June
  • Providers from five health systems will present their experience with implementing Glytec’s EGlycemic Management System during the 2020 Diabetes Technology Society Virtual Hospital Poster Session. 12-16.
  • PCare adds on-demand movies and television shows from Tubi to its COVID-19 Tablet Configuration Solution.
  • Optimum Healthcare IT posts a case study titled “ Virtual Epic Go-Live at Valley Children’s Healthcare.”

Blog Posts


Contacts

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EPtalk by Dr. Jayne 6/11/20

June 11, 2020 Dr. Jayne 2 Comments

CMS Administrator Seema Verma blogged for Health Affairs last week, sharing a discussion of CMS payment model flexibilities that stem from COVID-19.

The healthcare system in the US was broken to begin with and the pandemic has pushed many organizations past their breaking points. Many of my physician colleagues have retired, closed their practices, or been downsized by their employers in the name of cost savings. Hospitals and health systems have laid off countless employees from everywhere in the process. Very few job classifications have been spared, and I suspect we’ll see a number of CEO, COO, and CFO heads start rolling before long.

Although it was a well-written read, I was disappointed that it mostly rehashed the changes that have been ongoing for the last several years in attempting to transition us from a fee-for-service to a fee-for-value model. She mentions the concept of providers taking financial risk as “the cornerstone of value-based care,” but over the last few months, most providers have figured out that financial risk is the cornerstone of all of fee-for-service as well. Plenty of providers and hospitals who counted on a certain number of procedures or encounters have been hobbled, if not sent to bankruptcy. It’s not clear if they would have been better off under value-based care arrangements since they don’t fit every specialty and situation. Verma notes that such arrangements “provide stable, predictable revenue,” but that doesn’t really apply to urgent and emergent care situations or unpredictable needs for things like cancer surgeries.

She goes on to talk about flexibilities CMS is adding, but a quick look at the summary table shows that many of the changes are extensions of existing models or delays to the start of upcoming or changing models. A handful of models have changes to their financial methodologies. Verma also mentions flexibilities with telehealth, which I hope become permanent. Nearly every patient I’ve spoken with has been happy with their telehealth visits and not having to experience the hassle of visiting an office.

Congress is paying attention to telehealth, with a bill recently introduced that would require HHS to study how telehealth has been used during the pandemic and to deliver a report back to legislators within one year after the emergency ends. The bill is HR 7078, the Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020.

I didn’t have time to dig deeply into the federal register since I’m in the middle of a couple of big projects, but I’d be interested to see how they define telehealth and how data points would be gathered. Many physicians I know haven’t been using proper billing codes while they deliver telehealth, instead performing what is essentially a free visit in the name of ensuring patients are cared for. Some of the major telehealth vendors don’t use standardized billing codes, especially if they offer a direct-to-consumer option. The bill would require analysis of the types of telehealth platforms used as well as the locations where care was delivered (hospital, physician office, health clinic, private home, etc.) I wonder how they would classify the RV flying down the highway, which was my patient’s location the other night.

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ONC announces its all-virtual Tech Forum for August 10-11, 2020. Sessions will include a mix of keynotes, panel discussions, and breakout sessions. The full agenda isn’t available, but I registered anyway. How can you not like a conference that gives you more than an hour for lunch plus two 30-minute breaks and you can do it all from the comfort of your own home? Get your fuzzy bunny slippers ready and I’ll see you there.

News of the weird: A surgery professor in California leverages telehealth and maggots to treat a patient’s wound, saving his limb and likely his life. David Armstrong, DPM, PHD is co-director of the limb salvage program at the University of Southern California Keck School of Medicine. The maggots in question, which he refers to as “nature’s microsurgeons” are larvae from the common green bottle fly. The patient had experienced tissue death after a surgical procedure, but also had diabetes and recurrent pneumonia and was high risk for an emergency department visit due to COVID-19; the necrotic tissue in his arm placed him at high risk for sepsis. Armstrong shipped a package of larvae to the patient then instructed a home care nurse via video on how to apply the larvae and dress the arm. Two days later, they used a telehealth encounter for a dressing change. After another course of treatment, the necrotic tissue was reduced from 46% to less than 1%.

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I worked with the best scribe this week. He was geeking out on ICD-10. With the nice weather and lifting of stay-at-home orders, we’ve been seeing plenty of orthopedic injuries and trauma. At the end of the day when reviewing and signing my notes, I was glad to be surprised by entries that went well beyond the usual sprains, strains, and lacerations:

  • W29.3XXA Contact (accidental) with hedge-trimmer (powered).
  • Y92.832 Beach as the place of occurrence of the external cause.
  • Y93.G2 Activity, grilling and smoking food.
  • Y92.828 Other wilderness area as the place of occurrence of the external cause.

My recent shifts haven’t been much to smile about, so I was glad for the distraction. Needless to say, I rewarded him handsomely via our on-demand bonus system. He’s leaving soon for medical school, so he’ll definitely need the extra dollars.

Although emergency physicians aren’t expressly there to deliver preventive care, I’d like to offer some guidance based on my recent experiences. First, if you’re going to be using an electric hedge trimmer, may I suggest not “rushing to beat the heat of the day” and also wearing a pair of sturdy work gloves. Second, if you’re going to engage in a beach barbecue, follow the instructions on the charcoal lighter fluid and don’t squirt it on the coals beneath the already-cooking food. Third, if you’re going to use the hunting knife you just sharpened to open the cheese and sausage packages on your picnic table, please wear shoes. That’s a wrap on today’s safety moment, folks.

What’s your favorite summertime ICD-10 code? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/11/20

June 10, 2020 Headlines No Comments

Kyruus Secures $30 Million Investment from Francisco Partners

Provider search and scheduling software vendor Kyruus raises $30 million in funding from Francisco Partners.

Cerner Gets Potential $99M VA Software, Hardware Sustainment Task Order

The VA gives Cerner a $99 million task order for sustainment support of hardware and software associated with its EHR modernization project.

Cue Health Closes $100 Million Series C Financing to Support Launch of Rapid Molecular Testing Platform

App-based testing company Cue Health will use $100 million in new financing to expand its San Diego headquarters and further develop and commercialize its portable COVID-19 testing kit.

QGenda Announces Strategic Growth Investment From ICONIQ Capital

Iconiq Capital invests in Atlanta-based healthcare workforce technology company QGenda. 

Readers Write: An Interoperability Data Challenge — Out and Back Demonstrating Reflection

June 10, 2020 Readers Write 10 Comments

An Interoperability Data Challenge — Out and Back Demonstrating Reflection
By Brody Brodock

Brody Brodock is a principal with AdaptTTest Consulting of Raleigh, NC.

I want to offer up a challenge that will express the current state of interoperability within regional systems. The challenge involves the top N most frequently used values within domains, exchanged via C-CDA within your community of practice, reconciled and incorporated, then returned to the sender, where the originating sender then reconciles and incorporates the returned items.

This should be a simple task that any certified EHR can accomplish with 100% accuracy. However, if you get better than 80% success in the first part of the exercise, I will be greatly surprised. If you can successfully exchange above 50% on the second round, I will be impressed. I would even argue that two systems from the same vendor will be challenged.

We should keep this to the required domains: medications, problems, and medication allergies. Other domains should be left out to reduce complexity. This gets messy really quickly.

You will need to gather from your system:

  • Problems. Problem text, problem code, problem code set, status, date added, date updated, and onset date.
  • Allergies. Allergy category, allergy severity, reaction, reaction severity, allergy dates with specificity, status, and the codes for allergy and allergy reaction.
  • Medications. This might get trickier as some systems load meds into different table sets depending on the order type (prescription or order). But essentially you need the medication name, medication code, status, date of entry, order expiration date, dose, dose form, frequency, SIG, PRN, and DAW.

Once you gather these extracts, (you might need to limit the period), you should slice and dice the data to tell you what the most frequently used (MFU) items are. You don’t generally need to associate the metadata to other data elements. Knowing that the top medication allergy is penicillin is sufficient, the top reaction might be hives — they don’t need to be associated in this round.

HIPAA note: watch out for names in the SIG, and purge any “zzz” names you come across.

Now that you have your list, take the top 10 from each and add them to your new patient. Then another set of patients that reflect the metadata objects: status, dates, reactions, severity, PRN, DAW, etc. If you have the ability to add free text med allergies, then submit a patient safety defect report to your vendor, but send the free text allergy anyway. Try “pentillacillian” with “anti fylaktic” — yes, I have seen that.

Medications should be a mix of your top 10 prescriptions, plus your next 10 with your top SIG, plus the next top 10 with all of your statuses. Add a couple that are tapered dose, vaccines with multiple dosages, and multiple formulations (albuterol syrup, pill, and rescue inhaler) all active.

Your CDS/DUR systems are supposed to alert for for all of these domains. Once you reconcile and incorporate these items into your system, pick a couple of items like penicillin with anaphylaxis and attempt to prescribe that. You should get an alert. A significant battery of CDS/DUR tests should be done with this data.

Now that you have built up the patients, have your development team automate them so they can be duplicated on demand. If you don’t have an automation team, ask your vendor for their scripts. These tests should be part of your standard operational and production qualification tests — OQ/PQ.

Now send these patients via a summary of care or a transfer of care (try both — they should be different) to your geographic neighbors. Whichever systems from which you receive transfers, referrals, and notes. They will be ambulatory, acute, ED, SNF, and specialty facilities. But more importantly, they will be different systems, or at least different configurations of like systems.

Take these C-CDAs and send them through your Direct HISP, email, or sneaker net (HIPAA rules apply and these must be fake patients). You can name them “MedicationTest-xxx” where xxx is an alpha counting scheme: aaa is the first, aab the second, all the way to zzz being patient 676. If you can create patients with numbers in them, I would be surprised, but go ahead and try one of those patients too. “Patient 0” shouldn’t be possible, so it will probably blow up on the receiving end.

The receiving facility should then bring in the C-CDA and perform reconciliation of the listed domains. Problems, medication allergies, and medications should now be in this patient’s record.

The expected result is 100% accuracy in the exchange. No conversions, no substitutions, no increased or decreased specificity, no “go fish” in presenting the user with a series of options to reconcile. These are the most frequently used, so there should be no problem.

Your actual results will not be even close to 100%. You will have allergies that switch category, reactions that aren’t recognized, medication APIs that are switched to brands, problems that are either more specific or less specific than the incoming problem, dates that will increase specificity from year or null to DD/MM/YYY:Time, and multiple formulations that will be considered duplicates (three albuterol formulations).

Now without further modification, the receiving facility should create the same type of C-CDA and return it to the originating facility. A full round trip. The record that is returned will look like a completely different patient than the one that you sent out. Statuses and dates will be converted to something else and your medication intolerance will suddenly become a medication allergy. All sorts of fun here.

This is why healthcare interoperability singlehandedly enables the fax industry.

This is the first part of a long and complex set of tests, a simple out and back. Yet the exchange will demonstrate how badly the industry needs to get its data house in order. The results will not change just because you were using different technology. If you are using FHIR to write data back into your solution, you are going to have the same problems.

Morning Headlines 6/10/20

June 9, 2020 Headlines No Comments

PatientPing Secures $60 Million in Series C Funding to Continue Expansion of National Electronic Notifications Network

PatientPing raises $60 million in a Series C funding round, increasing its total to more than $100 million.

Babylon Health admits GP app suffered a data breach

London-based Babylon Health fixes a software error that allowed several users to view the archived telemedicine sessions of other patients.

Kristin Myers, MPH, Appointed Executive Vice President, Chief Information Officer, and Dean for Information Technology

Mount Sinai Health System (NY) promotes Kristin Myers, MPH to EVP/CIO and dean for IT.

News 6/10/20

June 9, 2020 News 5 Comments

Top News

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PatientPing raises $60 million in a Series C funding round, increasing its total to more than $100 million.


Reader Comments

From X-Treem Geek: “Re: Duke–UNC anti-trust lawsuit brought by physicians. Looks like they will soon face a new lawsuit for faculty.” Duke University and University of North Carolina paid $54.5 million in mid-2019 to settle a class action lawsuit in which academic physicians found evidence of a decades-long “no poach” agreement in which the schools agreed to avoid recruiting each other’s doctors to keep salaries in check. The new case seeks damages for non-medical faculty members who were not part of the original lawsuit.


HIStalk Announcements and Requests

Cerner tells me that tiny analytics vendor Surgisphere – which is under fire for its use of EHR data of unknown provenance to publish error-filled, now-retracted COVID-19 research studies – is not a Health Facts customer. Surgisphere has declined to disclose how it obtained a massive database of de-identified patient encounters from hospital EHRs, and many large health systems say they’ve never provided such data to the company. Meanwhile a non-profit in Africa that was using a Surgisphere-provided COVID-19 Severity Scoring Tool powered by the same database rescinds its recommendation of the software.

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

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Webinars

June 10 (Wednesday) 1 ET. “COVID-19: preparing your OR for elective surgeries.” Sponsor: Intelligent Medical Objects. Presenters: Janice Kelly, MS, RN, president, AORN Syntegrity Inc.; David Bocanegra, RN, nurse informaticist, IMO. The presenters will cover the steps and guidelines that are needed for hospitals to resume performing elective surgeries and how healthcare information technology can optimize efficiencies and financial outcomes for the return of the OR.

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.


Acquisitions, Funding, Business, and Stock

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Business Insider profiles Doxy.me, which saw the user count for its browser-based telehealth platform jump from 80,000 in January to 700,000 now. The company is run from the house of the CEO, Medical University of South Carolina Assistant Professor Brandon Welch, MS, PhD, whose doctorate is in biomedical informatics. Headcount has increased from 15 full-time employees to more than 50. The company says it isn’t interested in the pitches it is suddenly getting from venture capital firms that have until now characterized telehealth platforms as a commodity. Welch, who says the company’s main competitor is Zoom, concludes, “The only thing providers care about is a way to connect with their patients. They don’t need all the other crap that other telemedicine solutions are providing. We just keep it simple and made it easy to sign up.” Doxy.me’s basic product is free, with paid upgrades available for expanded functionality and institutional use.

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Banyan Medical Systems offers its virtual care and telemedicine platform with no upfront costs to eligible hospitals that are waiting for funding from FCC’s COVID-19 Telehealth Program. I did a double take at the company’s information page that says funding expires on June 31, 2020, a day that will live in infamy for not actually existing.


Sales

  • Poplar Bluff Regional Medical Center (MO) will implement Pulsara’s telehealth and communication platform.
  • Rady Children’s Hospital – San Diego chooses Syft’s Synergy for supply chain management.
  • FDA will use HealthVerity’s privacy-protected data exchange for performing COVID-19 research on real-world datasets.
  • North Carolina’s HHS will use a COVID-19 version of the OpenBeds Critical Resource Tracker to track treatment and equipment resources across the state. The existing OpenBeds platform was developed to allow states to pool their behavioral health resources. OpenBeds is owned by Appriss Health, which is best known for its state prescription drug monitoring program systems.

People

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Mount Sinai Health System (NY) promotes Kristin Myers, MPH to EVP/CIO and dean for IT.


Announcements and Implementations

A Black Book survey finds that 93% of hospitals and large physician practices have seen financial IT system shortcomings exposed during the pandemic. Most CFOs say they will not reduce or defer financial system spending as they look to IT to improve revenue capture and to provide analytics and forecasting support.

Nemours Children’s Health System (FL) saw its telehealth visit count jump from 800 in April 2019 to 30,000 in April 2020, where it uses InterSystems technology to exchange information between its EHR and the its CareConnect virtual system for scheduling appointments.

OptimizeRx says that a partnership with an unnamed organization will expand the reach of its specialty medication platform to 300 health systems that use Cerner and Epic.


Government and Politics

Insurers, hospitals, and unions are pushing Congress to spend $100 billion to pay the COBRA insurance payments of 27 million laid-off workers who would basically get their health insurance for free. They are also supporting expanded ACA subsidies and Medicaid, but expect the COBRA bill to gain the widest support in Congress since it bypasses ACA-related politics.


COVID-19

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WHO makes a questionable statement that people who are free of COVID-19 symptoms don’t spread the infection, failing to differentiate between “asymptomatic” (infected patients who never experience symptoms) from “pre-symptomatic” (those who are infected but don’t exhibit symptoms until days later). WHO based its conclusion on a tiny review of contact tracing in China, whose findings are not in agreement with four rigorous studies that used actual data instead of people who simply speculate that their infections came from someone with symptoms. The resulting mass media clickbait interpretation makes the definitive statement that people won’t become infected if they avoid those with obvious symptoms, which could affect mitigation strategies such as encouraging social distancing and wearing masks. UPDATE: WHO clarifies that 6-41% of people who are infected don’t have symptoms but can still spread it, with 40% of infections coming from those symptom-free people. WHO says it regrets calling such spread “very rare.” Bottom line: nothing new has been learned and WHO takes a black eye for allowing scientists to confuse the public with poorly worded or researched comments, although they are at least allowing scientists to speak without bureaucratic filters. WHO also said in its correction that nobody should assume that its employees who are speaking at press conferences are speaking on behalf of WHO, which is truly bizarre.

Experts warn that temperature screening of employees and customers provides false reassurance given New York data showing that 70% of people admitted to the hospital for COVID-19 did not have a fever.

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Getting people back to work in high-rise office buildings that house thousands of workers creates a new problem with social distancing – limiting the number of people who are allowed in an elevator simultaneously while avoiding having them log-jammed in close proximity in the lobby.

HHS will run out of its free supply of remdesivir by the end of this month as Gilead tries to ramp up production of the antiviral, whose modest benefit to hospitalized COVID-19 patients was enough to convince HHS to distribute it to some hospitals.


Other

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Mozilla names the OpenMRS EHR as one of three open source winners of a $50,000 grant from its COVID-19 Solutions Fund. The award will be used to create the OpenMRS Public Health Response system that will include data collection tools, reports, and interfaces with public health systems.

Tuesday saw mixed messages from CMS Administrator Seema Verma on telehealth. She told STAT that “it would not be a good thing to force our beneficiaries to go back to in-person visits,” but then hinted that CMS needs to look at whether it should pay the same rates as in-person visits. She then said in an announcement encouraging the reopening of healthcare facilities that “while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care.” I’m wondering if those who jubilantly predicted that the telehealth genie could not be put back in the bottle may have overestimated, as it seems clear that many providers and patients prefer in-office care; practices are more efficient (and therefore more profitable) when their providers are flitting between multiple exam rooms simultaneously, using non-physician helpers optimally, and perhaps upselling other services; kludgy solutions like Zoom and Skype offer an underwhelming, make-do experience; and the couple of months of virtual-only visits may not have been adequate to permanently change habits. All it would take is a pullback in CMS’s emergency payment and licensure policies to fill the waiting rooms again.

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In India, a state government investigates the case of an 80-year-old hospital patient whose family could pay only part of his bill. The hospital, worried about collecting the balance owed, refused to discharged the man and instead tied him to the bed.


Sponsor Updates

  • CompuGroup Medical sponsors recognition of Teachers of the Year in its US headquarters in Phoenix. The company provides CGM ELVI for telehealth, which allows teachers and students to connect virtually for counseling and speech therapy sessions.
  • Artifact Health engineering VP Jake Lieman describes the company’s experience in integrating its mobile physician query platform with Cerner using Cerner’s APIs.
  • Impact Advisors is named to CRN’s 2020 Solution Provider 500 list for the sixth consecutive year.
  • Clinical data exchange capabilities from InterSystems helps Nemours Children’s Health System scale its CareConnect telemedicine service.
  • XpresSpa will use AdvancedMD’s practice management and EHR software at its new XpresCheck COVID-19 screening and testing facilities in US airports.
  • CompuGroup Medical recognizes Teachers of the Year in Phoenix, the home of its US headquarters.
  • Elsevier Clinical Solutions adds Portuguese-language content to its COVID-19 Healthcare Hub.
  • Ellkay supports the Alpine Learning Group’s virtual Go the Distance for Autism Ride as a platinum sponsor.

Blog Posts


Contacts

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

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Morning Headlines 6/9/20

June 8, 2020 Headlines No Comments

Siemens Healthineers and Geisinger Announce Value Partnership to Drive Digital Healthcare

Geisinger (PA) signs a 10-year contract with Siemens for its digital health offerings, diagnostic imaging equipment, and on-site staff support.

VA, Bristol Myers Squibb Foundation deliver cancer care to Veterans via teleoncology

The VA will use a $4.5 million grant from the Bristol Myers Squibb Foundation to offer veterans expanded access to cancer care via telemedicine.

ChristianaCare develops telehealth Employee COVID-19 Symptom Monitoring and Testing Program for businesses and employers

ChristianaCare (DE) develops a COVID-19 symptom-monitoring, testing, and virtual care app for employers.

Curbside Consult with Dr. Jayne 6/8/20

June 8, 2020 Dr. Jayne 1 Comment

Most of the journal articles that come across my desk during the last couple of months have understandably been about the novel coronavirus or its downstream effects. Since there have been a flurry of retractions of articles recently, I was glad to see this study that took me back to my healthcare IT roots.

One of the main reasons my first practice implemented an EHR was to increase safety – reduce handwriting errors, reduce medication errors through the addition of allergy and interaction checking, reduce errors due to missing or incomplete data, and more. Although we did see some initial improvements, it quickly became apparent that EHRs could be the source of safety issues we didn’t even dream of in the paper world.

The study, published in JAMA Network Open, looks at trends in EHR safety performance in the US from 2009 to 2018. The authors drew data from a case series using over 8,600 hospital-year observations from adult hospitals that used the National Quality Forum Health IT Safety Measure, which is a computerized physician order entry (CPOE) and EHR safety test administered by the Leapfrog Group. The authors found that mean scores on the overall test increased from 53.9% in 2009 to 65.6% in 2018. However, they noted “considerable variation in test performance by hospital and by EHR vendor” going on to voice concerns that “serious safety vulnerabilities persist in these operational EHRs.”

Digging into the methodology, the Health IT Safety Measure test uses simulated medication orders that have been previously proven to either injury or kill patients. They are entered into the system under study to determine how well it can identify potentially harmful medication error events.

Looking deeper at the measures, it was interesting to see the difference between the various levels of clinical decision support: Basic Clinical Decision Support (CDS) scores increased from a mean of 69.8% to 85.6% where Advanced Clinical Decision Support scores increased from a mean of 29.6% to 46.1%. Basic CDS functions include drug-allergy, drug-route, drug-drug, drug/one-time dose, and therapeutic duplication contraindications. Advanced CDS functions include drug-laboratory, drug-daily-dose, drug-age, drug-diagnosis, and corollary orders contraindications. Researchers looked at whether the EHR’s CPOE system correctly generated an alert, warning or stop (soft or hard) after entry of an order that may cause an adverse drug event.

The Health IT Safety Measure test is included in the Leapfrog Group’s annual hospital survey and is performed by a hospital staffer. Detailed demographic data is provided for test patients, including diagnoses, laboratory results, and more. These test patients are loaded into the EHR so that they function the same as actual patients. (Hopefully this is all being done in a copy of the production environment, but the study didn’t mention the specifics.)

Once the patients are created, a clinician is supposed to enter test medication orders for those patients and record how the EHR reacts to the orders, including whether it generates alerts, and if it does, which kind. Hospital staffers are then responsible for entering this data into the tool. The tool includes protections against the hospital trying to game the system, such as control orders that aren’t expected to generate alerts. The process is also timed and must be completed in under six hours.

As I read the study, I kept waiting for the juicy part where we would learn the details about which of the “hospitals using some EHR vendors had significantly higher test scores.” The authors used self-reported data and reported each vendor with more than 100 observations as a single vendor, although it grouped all vendors with fewer than 100 observations as “other.” Unfortunately, “vendor names were anonymized per our data use agreement.” Although the vendors all had overall scores that were in the same ballpark (ranging from 53% to 67%) the minimum/maximum score data literally ranged from zero to 100%.

The closest statement I could find to anything that might indicate how real-world vendors performed was this: “In our results, the most popular vendor, vendor A, did have the highest mean safety scores, but there was variability among Vendor A’s implementations, and the second-most popular vendor had among the lowest safety scores, with many smaller EHR vendors in the top 5 in overall safety performance. Additionally, while we found significant variation in safety performance across vendors, there was also heterogeneity within vendors, suggesting that both technology and organizational safety culture and processes are important contributors to high performance.”

As someone who has spent many thousands of hours doing consulting work in the area of organizational change, that last statement hit the nail on the proverbial head. I’ve been in plenty of hospitals and offices where safety features have been disabled or modified, and for reasons including alert fatigue and the cumbersome workflows needed to override alerts, as well as organizational culture. It would be interesting to see whether the top-performing installations were using the vendor’s EHR out of the box or in a modified fashion, and what the CPOE build actually looked like.

The authors note several limitations, including the fact that the data set only includes hospitals that completed the Leapfrog survey, which may not be representative of all US hospitals. Although it was out of scope of this study, I would be interested to see how ambulatory EHRs would fare in such an analysis. In my experience some ambulatory systems can be even less uniform, as IT teams are pressed to perform whatever customizations or configurations are requested by the physicians who sign their paychecks. I’ve seen organizations that allow physicians to turn off all medication alerts, and others who require physicians to slog through a mind-numbing parade of low-quality alerts throughout the day, and everything in between.

Regardless, the study was thought-provoking, and I hope it generates thought for additional opportunities designed to assess EHR safety and measure vendor progress towards a more optimized EHRs in the future. It will be interesting to see what the data looks like in another five years or 10, and whether individual institutions improve in their performance. I would be interested to hear observations from any hospital IT staffers or clinicians who have been involved in performing this test, including whether you feel your scores are representative of the organization’s safety culture.

What do you think about EHR safety data? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/8/20

June 7, 2020 Headlines No Comments

Electronic Health Records: Ongoing Stakeholder Involvement Needed in the Department of Veterans Affairs’ Modernization Effort

A GAO review finds that the VA has implemented effective configuration decision-making in its Cerner implementation by holding national workshops and creating 18 EHR councils, but needs to improve representation at local workshops.

NorthShore provides real time genomic decision support to 10,000 patients using the ActX Service

NorthShore University HealthSystem completes a precision medicine program in which genetic data is loaded into ActX’s genomic service, then used within Epic to alert medication-ordering clinicians of potential genetics-related side effects, efficacy, or dosing considerations.

Hospitals could struggle — and more will go bankrupt — until they get patients back in the door

Many hospital operators say the pandemic-induced surge of telemedicine visits over the last several months won’t be enough to keep them from bankruptcy or from consolidating with neighboring health systems.

Monday Morning Update 6/8/20

June 7, 2020 News 5 Comments

Top News

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A GAO review finds that the VA has implemented effective configuration decision-making in its Cerner implementation by holding national workshops and creating 18 EHR councils, but needs to improve representation at local workshops.

The report also notes that while the VA and DoD both user Cerner, coordination is needed to allow sharing of information and tasks, such as VA’s requirement to maintain durable orders for life-sustaining treatment across patient encounters that is not supported by the DoD’s Cerner configuration.


Reader Comments

From Quinn Martin: “Re: rebranding. Why so hostile to the marketing folks?” That was Dr. Jayne, but I agree with her conclusion. Rebranding is admirable, but publicly pontificating about it and the process that went into it is not. Companies for some reason feel the need to yammer on in press releases about the naively aspirational big-picture ideas that led them to choose a particular website color or logo style (probably just to stroke the marketing people who dreamed it up) and the whole world just rolls its eyes. Just do it and let your audience react without trying to forcibly steer them to pre-conclude how wonderful it all is. My experience is that even though non-marketing company executives grudgingly go along with the process, they aren’t simultaneously committing to implement corporate change as part of the pig-lipsticking process, so it’s usually fluff anyway. Show, don’t tell.

From Creole Mustard: “Re: HIMSS. Pledges to stand against racial inequality.” I will provide a pro bono communication plan for this effort – publicly report how many people of color are on the HIMSS board and executive team, then ask vendor and provider organizations to do the same. I’ll recycle my advice from above – show, don’t tell.

From Didn’t Attend: “Re: HIMSS. Do you agree with Dr. Jayne’s assessment of HIMSS as greedy because they aren’t giving HIMSS20 refunds?” Not exactly. HIMSS was always about profit, highly paid executives, behaving like a vendor, and profitably commingling providers and vendors in a boat show environment that had little to do with patients or actual health. However, it clearly met a market need, as evidenced by its ever-increasing headcount and revenue. My take: I don’t think HIMSS is financially capable of providing HIMSS20 refunds even if it were inclined to do so, especially given the uncertainty of the conference industry in general, from which HIMSS generates $43 million of its $95 million in revenue. Imagine sitting around the HIMSS conference room table trying to plan HIMSS21 amidst the choking dust that remains from the implosion of HIMSS20. Where HIMSS needs to step up is in transparency and honesty instead of brandishing its force majeure clause in the faces of the members and exhibitors who express concerns – those members are really all it has left at this point. HIMSS20 was scheduled for just three months ago, so maybe they are still crafting strategy and exploring options, but I think the wounds are festering rather than healing. Now is the time to win us all back over. Other cancelled conferences seem to be doing a better job of managing the fallout, and while it’s probably unfair to compare leadership styles, I think former CEO Steve Lieber would have taken positive control of the narrative instead of creating a communications void that its critics are happy to fill.


HIStalk Announcements and Requests

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More than 80% of poll respondents prefer to work from home at least one day per week.

New poll to your right or here: Would you trust medical research findings that are based on analyzing the EHR data of hundreds of hospitals?

I celebrated the anniversary of the heroics of D-Day, now 76 years in the rear-view mirror, by reading “A Train Near Madgeburg,” a previously untold story of how Americans (mostly teenagers) of the 743rd Tank Battalion, which was one of three tank battalions that landed in the first wave on Omaha Beach, became the world’s first witnesses to the horrors of the Holocaust in April 1945. They rolled into Germany, and purely by serendipity, found and liberated a train full of 2,500 starving concentration camp prisoners who were minutes away from being exterminated to hide evidence of crimes against humanity to the the tune of millions of deaths. The author, a high school teacher, told the stories of those boys of long ago and those mostly women and children they saved, bringing them together in reunions at his school to provide their first-hand accounts. I was uncomfortable with the similarity of those 1933-1945 events to today’s headlines, but I was moved by the actions of one battle-fatigued, eight-man M5 light tank crew who, deep into Nazi Germany and surrounded by mostly hostile locals, were left alone overnight in their single light tank to guard the train’s occupants, who they assured were “under the protection of the United States Army.” Few books capture both the worst and best aspects of humanity like this one and the lessons it contains are worth careful study.


Webinars

June 10 (Wednesday) 1 ET. “COVID-19: preparing your OR for elective surgeries.” Sponsor: Intelligent Medical Objects. Presenters: Janice Kelly, MS, RN, president, AORN Syntegrity Inc.; David Bocanegra, RN, nurse informaticist, IMO. The presenters will cover the steps and guidelines that are needed for hospitals to resume performing elective surgeries and how healthcare information technology can optimize efficiencies and financial outcomes for the return of the OR.

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.


Acquisitions, Funding, Business, and Stock

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NorthShore University HealthSystem completes a precision medicine program in which genetic data is loaded into ActX’s genomic service, then is used within Epic to alert medication ordering clinicians of potential genetics-related side effects, efficacy, or dosing considerations. Long-timers know ActX founder and CEO Andy Ury, MD, whose leadership history includes Physician Micro Systems and Practice Partner. In an unrelated note, whose “let’s just make up words” idea led to the grammatical abomination of “NorthShore” and “HealthSystem?” The CEO blabbered on in 2008 about how the former Evanston Northwestern Healthcare had “outgrown its name,” the “NorthShore” part communicates the all-important “prestige,” and the “brand equation” needed to include “University,” all of which were guaranteed to ensure “ushering in a new era.” I’m guessing the locals just call it “North Shore” anyway are are either indifferent to or annoyed by the impersonal “system” in the name.


Announcements and Implementations

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Scripps Mercy Hospital San Diego is using Dexcom’s continuous glucose monitoring system for managing inpatient diabetics, including those with COVID-19 who would otherwise require finger sticks.


COVID-19

The government of Delhi, India files charges against a private hospital that failed to report its COVID-19 test results using the government’s mandatory reporting app. The chief minister also issued a warning to hospitals that he says are turning away COVID-19 patients to free up beds to sell on the black market.

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US combined deaths for pneumonia, influenza, and COVID-19 as a percentage of the total continue to taper off sharply, on track to return to pre-COVID levels. Total US coronavirus deaths are at 111,000, with the projection that has been most accurate over time predicting 190,000 deaths by September 1.

CMS acknowledges the wide discrepancy between its just-published data on COVID-19 cases in Virginia nursing homes with data from the state’s Department of Health. CMS reports that one nursing home has had 90 residents die of COVID-19 when in fact it has had zero deaths in zero confirmed cases. CMS also reports only nursing home information, while the state includes assisted living centers in its totals. The industry’s trade group says CDC’s slow approval of new accounts explains the 29 facilities that did not report at all. Virginia has refused to provided totals for specific nursing homes since the state defines corporations as “persons” whose confidential information cannot be published.


Sponsor Updates

  • Pivot Point Consulting Managing Partner Rachel Marano joins Vaco’s latest Free Yourself podcast, “Flexing to the Curve in Healthcare IT.”
  • PerfectServe recognizes customer St. Elizabeth Healthcare as its 2020 Healthcare Champion.
  • The Late Late Show host James Corden will keynote Pure Storage’s Pure//Accelerate Digital event on June 10.
  • Santa Rosa Consulting publishes a new case study featuring Berkshire Health Systems.
  • Spirion welcomes new board members T.E.N. CEO Marci McCarthy and Fannie Mae Deputy General Counsel Jennifer Mailander.

Blog Posts


Contacts

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

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Weekender 6/5/20

June 5, 2020 Weekender 2 Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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


In Case You Missed It


Get Involved


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Morning Headlines 6/5/20

June 4, 2020 Headlines No Comments

Amwell confidentially files for IPO amid surging demand for remote health care

Telemedicine company Amwell files for an IPO that may take place in September.

Surgisphere: governments and WHO changed Covid-19 policy based on suspect data from tiny US company

An investigation finds that governments have changed their COVID-19 policies using apparently flawed research findings from virtually unknown US analytics vendor Surgisphere.

New U.S. Data Rules Aim at Clearing Up Jumbled Virus Picture

HHS issues new guidance to standardize the reporting of COVID-19 testing data, requiring facilities to submit data on race, gender, and zip code, among other details, by August 1.

Intermountain Healthcare Names Ryan Smith as New VP and Chief Information Officer

Ryan Smith, MBA (Health Catalyst) will become Intermountain Healthcare’s VP/CIO upon the retirement of Marc Probst, MBA, later this month.

HHS Provides an Additional $250 Million to Help U.S. Health Care Systems Respond to COVID-19

HHS provides health systems an additional $250 million to help them expand virtual care and telemedicine services, train staff, procure PPE, and coordinate COVID-19 responses.

News 6/5/20

June 4, 2020 News No Comments

Top News

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Governments around the world have changed their COVID-19 policies using apparently flawed research findings from virtually unknown US analytics vendor Surgisphere, whose handful of employees includes a science fiction writer and an adult entertainer.

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Lancet has retracted the paper and NEJM has begun the retraction process for hydroxychloroquine-related articles that were based on suspicious data from the company, which is led by founder, CEO, and former vascular surgeon Sapan Desai, MD, PhD.

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Surgisphere, which does not identify any scientific advisory board that oversees its work, recently pivoted from publishing medical textbooks. It claims to have created a real-time database of 240 million anonymized patient encounters from 1,200 healthcare organizations in 45 countries, It says the information is provided by “our hospital customers,” although the company declines to name them and no hospitals have come forward as being among those data-providing customers.

Desai says the company has 11 employees. He says it uses AI/ML to perform the data analysis, further explaining, “The labor intensive task required for exporting the data from an electronic health records, converting it into the format required by our data dictionary, and fully de-identifying the data is done by the healthcare partner.”

I found a 2015 paper with Desai as the lead author that used Cerner Health Facts as its data source, so I’m wondering if that’s what Surgisphere uses. I’ve asked Cerner to confirm and am waiting to hear back. I have confirmed that the source is not Epic Cosmos.

As an HIStalk reader says, “This is a major setback for science and the credibility of medical expertise.” I would add that it may also call into question how researchers use aggregated EHR data to draw clinical conclusions when they may not fully understand the semantics and sourcing of that data, especially when most of us know how messy and maddeningly inconsistent EHR data can be even within a single health system, with the potential of AI/ML to introduce further errors while trying to clean it up.


Webinars

June 10 (Wednesday) 1 ET. “COVID-19: preparing your OR for elective surgeries.” Sponsor: Intelligent Medical Objects. Presenters: Janice Kelly, MS, RN, president, AORN Syntegrity Inc.; David Bocanegra, RN, nurse informaticist, IMO. The presenters will cover the steps and guidelines that are needed for hospitals to resume performing elective surgeries and how healthcare information technology can optimize efficiencies and financial outcomes for the return of the OR.

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.


Acquisitions, Funding, Business, and Stock

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RCM company R1’s shares jumped over 9% on the news that it will acquire Cerner’s RevWorks business in a transaction valued at $30 million. As part of the deal, Cerner will offer R1’s software and services to customers and prospects. In an April 2019 earnings call, company reps said RevWorks had grown stagnant, contributing $200 million in annual revenue. Cerner had been using its RevWorks offerings “to more tightly align the client to Cerner” for additional sales of its software and services.


Sales

  • Cumberland River Hospital (TN) selects RCM software and services from TruBridge, and EHR technology from CPSI sister company Evident.
  • CHI Texas Health Network selects Innovaccer’s FHIR Data Activation Platform to help it better manage utilization, care workflows, and patient outreach.

People

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Moffitt Cancer Center promotes interim CIO Elizabeth Lindsay-Wood, MBA to the permanent VP/CIO position.

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MDLive names Cynthia Zelis, MD (University Hospitals) as chief medical officer.

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Intermountain Healthcare hires Ryan Smith, MBA (Health Catalyst) as VP/CIO. He replaces Marc Probst, MBA, who will retire.

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AI-powered physician assistant developer Saykara hires Joy Efron (Glytec) as VP of marketing.


Announcements and Implementations

Change Healthcare announces GA of Connected Consumer Health, which includes provider search, appointment scheduling, patient intake, messaging, and billing.

Healthfully adds NextGate’s enterprise master patient index to its white-labeled personal health and wellness record.

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Banner Health will use video technology to conduct rounding on patients with COVID-19, repurposing patient room TVs with videoconferencing via virtual care technology from VeeMed and Intel.

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Beauregard Health System (LA) implements SOC’s Telemed IQ software for critical care, inpatient neurology, emergency neurology, psychiatry, and cardiology.


Government and Politics

Congressional sources say the VA probably won’t restart its Cerner rollout until the fall because of COVID-19 demands.

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A GAO review finds that the “Mar-a-Lago group” of three influential associates of President Trump meddled in the VA’s decision-making as private citizens, including influencing its selection of Cerner, but GAO says it was outside the scope of its investigation to determine whether the group constituted a formal advisory committee whose membership and role carry legal ramifications. Mostly it seems the three — none of whom have any government or military experience — wasted the VA’s time in demanding to become involved, pitching themselves and their associates for various projects, and asking newbie questions using the mandate from the president that left VA officials uncertain about how much effort to spend dealing with them.

HHS provides health systems an additional $250 million to help them expand virtual care and telemedicine services, train staff, procure PPE, and coordinate COVID-19 responses.


COVID-19

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HHS issues new COVID-19 testing data requirements that it hopes will give it better understanding of the outbreak. Laboratories must report de-identified COVID-19 testing results to the CDC in one of three ways: (a) through local health departments via HL7 or CSV; (b) by a centralized platform such as AIMS whose information is then routed to CDC; or (c) via an HIE. Required data elements include patient demographics (age, race, ethnicity, sex, ZIP code, and county of residence); provider name and NPI; and date ordered and collected. The same information must be provided for home-based tests. HHS asks (but does not require) that the patient’s name, address, phone number, and date of birth be collected and reported. Also recommended but not mandatory is that the lab results include the test result, unique patient identifier, LOINC-coded test ordered, device identifier, and accession number.  HHS wants to start receiving the new data elements as soon as possible, but no later than August 1.

Morgan Stanley’s COVID-19 model shows a slowly expanding epidemic in the US, with cases and/or hospitalizations rising in Arkansas, Arizona, North Carolina, Washington, Utah, and Texas, leading to its concerns that the US will experience an earlier second wave than other Western nations and will carry a big infection burden into fall as reintroducing mitigation strategies afterward may not be feasible.

Sweden’s top epidemiologist admits that the country’s controversial strategy of avoiding lockdowns to allow mounting a sustained COVID019 response has not been successful, as its 43 deaths per 100,000 population ranks among the worst globally and the country’s economy is slumping anyway.

Premier asks HHS to make 24 temporary, COVID-related regulatory waivers permanent, primarily those involving telehealth. They include allowing non-rural providers to provide services, expanding the types of practitioners, allowing audio-only visits, and expanding telehealth to occupational and behavioral health services. Premier also recommends changing EMTALA to allow pre-admission screening, allowing nurse practitioners and physician assistants to perform routine medical tasks, and eliminating the rule that requires Medicare patients to undergo a three-day inpatient hospital stay before they can be admitted to a skilled nursing facility.

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Fitbit secures Emergency Use Authorization from the FDA for its new Fitbit Flow ventilator. The wearables company developed the device with help from the Mass General Brigham Center for COVID Innovation and emergency physicians at Oregon Health & Science University.

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A study published in the New England Journal of Medicine finds that hydroxychloroquine did not prevent people who had been exposed to COVID-19 from developing the disease.


Other

A Cleveland Clinic analysis of EHR data finds that while behavioral health ED visits dropped by 28% with the implementation of stay-at-home orders, suicide-related encounters decreased by 60%. The authors don’t know whether the drop-off was due to people not seeking mental health care, using behavioral telehealth services as an alternative, or experiencing fewer suicidal thoughts while isolated. The authors will correlate these findings with actual suicide rates once those are published.


Sponsor Updates

  • Wolters Kluwer Health’s customer support teams for UpToDate, Ovid, and Lippincott each win a NorthFace ScoreBoard Award from the Customer Relationship Management Institute.
  • Microsoft awards Billings Clinic (MT) and Health Catalyst a joint 2020 Health Innovation Award.
  • Health Data Movers publishes a new case study, “COVID-19 Rapid Response.”
  • Dina will sponsor the June 18 virtual demo day of Home Health Care News, where it will showcase its COVID-19 employee health screening and reporting tools.
  • Hyland donates $10,000 to The Foundation of FirstHealth’s COVID-19 Response Fund.
  • KLAS recognizes Impact Advisors with top marks in its Clinical Optimization Services 2020 report.
  • Nordic releases a new edition of its HIT Breakdown podcast, “Automating submission of data to registries.”
  • CentralLogic publishes a new case study, “Arizona Surge Line: A unique collaborative response to the COVID-19 pandemic and beyond.”
  • Bright.md announces that its Smart Exam virtual care technology is now available in Epic’s App Orchard.
  • Health Data Movers announces new account managers.
  • Health Catalyst will participate virtually in the William Blair Annual Growth Stock Conference on June 10 and the Goldman Sachs Annual Global Healthcare Conference on June 11.

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EPtalk by Dr. Jayne 6/4/20

June 4, 2020 Dr. Jayne 3 Comments

I attended the ONC working session on patient identification and matching on Monday. It was scheduled as a seven-hour Adobe Connect meeting, and for me, getting the most out of it in this format was challenging.

The only agenda available had been sent more than a week prior, along with my registration confirmation. It had two, three-hour blocks with the broad titles of “Challenges around Patient Identification and Matching – Boots on the Ground” and “Exploring Potential Solutions.” Under those blocks they had a list of individuals and their organizations, without a lot of detail around what they would be presenting.

According to the welcome, each presenter was supposed to have about eight minutes to speak. I tried to make my own time-boxed agenda, but it quickly was off by more than 10 minutes, so I gave up.

The first three sessions were largely review for anyone who has been dealing with this problem. Although the speakers were good, I wasn’t sure I wanted to commit a full day to gambling that I’d hear something I didn’t already know. It would have been good if the agenda included the theme of what each presenter was going to discuss so we could tune in and out in a way that made sense for us.

One of the best (or worst, depending on how you look at it) parts of some of the presentations was the inclusion of examples of how things have gone wrong due to poor matching. It’s terrible from the patient perspective, but it is useful to provide concrete examples to try to engage stakeholders who may not think matching is a priority issue.

I continue to see organizations create their own matching nightmares by deliberately creating duplicate charts for patients depending on their payment status. I worked with one client who had separate charts when the payer was employee health versus when they were using insurance or cash pay. I understand their concern about having the employer have access to sensitive medical information, but if you have an employee health department that has to certify an employee’s readiness / safety for work, shouldn’t they have all the pieces of the puzzle? I worked with another practice that had separate charts for work comp versus insurance visits for a patient, simply because they didn’t understand how to use their practice management system to set up different payers on a patient and toggle from visit to visit.

Overall, the speakers did a great job of keeping within their time block, often running shorter than anticipated. Frank Opelka from the American College of Surgeons talked about silos in surgical care. The number of tax IDs that touch a patient during a major surgery could be more than 20. That’s pretty unbelievable,  but of course is believable in healthcare.

I really enjoyed hearing from Congressman Bill Foster of Illinois, who was a co-author of legislation last year that attempted to remove the ban on activities in support of a national patient identifier. I didn’t know much about him before today, but I was impressed by his background as a businessperson and also a scientist. He worked as a high-energy physicist at the Fermi National Accelerator Lab and was part of the team that discovered the top quark. For science nerds, that’s pretty cool.

I also enjoyed Henry Wei’s explanation of “circles of trust” that evoked Robert DeNiro in “Meet the Parents.” Another great quote was David Speights from Appriss Health, who notes that regarding matching, “We’re trying to science the heck out of this.”

The bottom line for the day: Improved patient matching is a critical need, and a unique patient identifier would help and would  bring us into line with many other developed nations. A lot of smart people are working on this, but many barriers remain.

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We are all knee-deep in COVID-19 projects, dealing with furloughs and working outside our usual norms. but CMS continues its churn with various rulemaking and other activities. On May 11 they issued the FY 2021 Inpatient Prospective Payment System (IPPS) for Acute Care Hospitals and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule. That’s a lot of abbreviations right there within a single rule, but I guess calling it the IPPSAPCLCHPPSPR would be a bit much.

The proposed rule includes minimum 90-day reporting period in CY 2022; maintenance of the Electronic Prescribing Objective’s Query of Prescription Drug Monitoring Program measure as optional for five bonus points in CY 2021; renaming the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure to the Support Electronic Referral Loops by Receiving and Reconciling Health Information measure; and increasing the number or quarters of electronic clinical quality measure data reporting. Comments can be submitted through 5 p.m. ET on July 10.

Speaking of COVID-19, Quest Diagnostics has received Emergency Use Authorization (EUA) approval for its self-collected COVID-19 test last week. They hope to have half a million kits available by the end of this month. Other vendors already have similar tests available, but providers aren’t falling all over themselves ordering the tests for their patients. There are serious concerns about the self-swabbing ability of patients and with the ordering and management of the tests.

Go Mississippi: The Mississippi Hospital Association is launching a state-wide health information exchange in partnership with several regional hospitals and health systems. Initial capabilities will include admission and emergency department visit notifications, along with post-acute care transfer updates. Later phases will include clinical document exchange and referral management.

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HIMSS is at it again, spending its efforts on frivolous activities such as “rebranding” rather than figuring out how to earn back trust among members and show attendees who are still smarting from financial losses. Last week they launched new branding for their regional chapters.

I really dislike it when organizations discuss their branding strategy. Branding, when done right, should be invisible to the consumer. I dislike it even more when the branding strategy is explained in buzzwords. “Our HIMSS brand architecture has been designed to do two things. First, to maximize clarity across our brand spectrum for both internal and external audiences. And second, to enable us to realize our full brand value, both now and in the future.”

I’m pretty sure most of us already recognize the HIMSS brand by its exorbitant fees and punitive housing and refund policies. Great job, marketing folks.

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Happy 17th birthday to HIStalk this week. Being part of this industry has been a wild ride at times and I’m glad to have shared the journey with the HIStalk team and all our readers.

Email Dr. Jayne.

Readers Write: Hospital Vital Signs: The EHR Doesn’t Know Everything

June 4, 2020 Readers Write 2 Comments

Hospital Vital Signs: The EHR Doesn’t Know Everything
By Keith Boone

Keith “Motorcycle Guy” Boone is informatics adept and SANER Project leader for Audacious Inquiry of Baltimore, MD.

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In the fight against COVID-19, it is imperative to understand and monitor the vital signs of our healthcare system – the hospitals and health systems that are playing a critical role –  to ensure that we can provide patients with unfettered care as this global pandemic plays out.

To this end, numerous agencies at the local, state, and federal levels are attempting to monitor the pulse, EKG, respiration rate, and chemical balance of hospitals across the country for a better assessment of whether the hospitals we rely on to keep people safe are themselves up to the task. This information is needed to rapidly identify the hospitals that need supportive care as they face COVID-19 head to head.

Today’s data collection efforts are focused on extracting data from the EHR, which focuses on data elements such as bed numbers and bed types, ventilator use, and death rates. While this is a great place to start, the EHR is just one critical information system within a hospital.

Similar to how the body has many flows — or as these were once explained, humors — a hospital also has a network of systems that manage its overall wellbeing and operations.

  • Asset tracking solutions monitor the physical inventory in a facility, and asset management systems can both pinpoint the location of a ventilator or anesthesia system and report its present operational status.
  • Bed management solutions help a hospital streamline patient flow, ensuring that patients are getting into beds as fast as possible. They identify if beds that need cleaning are being turned around quickly and whether patients are being discharged efficiently.
  • ICU and central monitoring solutions keep track of patient telemetry inside the ICU, bringing signals from the monitors and medical devices at the patient’s bedside to the central nursing station, possibly long before the information is available in the EHR.
  • Inventory management solutions keep track of consumable medical supplies – simple service parts such as ventilator tubing,  medicines, lab test reagents, personal protective equipment, and the cleaning and disinfectant supplies that a hospital goes through faster than your most germophobic relative.
  • Workforce management solutions track the flow of staff and are often linked with identity management solutions that grant privileges, identify credentials, and monitor access points.
  • Some hospitals have command centers into which many essential data elements flow. These have compelling visual displays, dashboards, and teams of staff who manage hospital capacity, but they are rare outside of larger academic medical centers, and even the most advanced command centers may not be able to readily share data outside their own system. 

The list goes on and on. These systems collectively determine the pulse or heart rate of a hospital.

While a hospital’s EHR system may be considered the brain of an organization by many who think about hospital information systems – and that’s probably not a bad analogy – a critical failure in any one of these other systems can be debilitating to hospital operations. Though EHRs may be the highest level as the most business-critical decision-making element of a hospital, they cannot track all the functions of an organization that are essential for efficient and prolonged patient surge operations.

To truly understand the health of a hospital and its level of readiness for taking in a surge of critically ill patients requires tracking more than just what is going on in its brain. In our analogy, the heart, the lungs, and liver represent a hospital’s staff, supplies, and equipment. All of these are tracked by other systems.

Some of these systems connect to the EHR, and extracting data via the EHR rather than from the system directly is possible. However, in these instances, speed and clarity may be sacrificed for simplicity. The originating systems often know something well before it is shared with the EHR, just as your stomach responds to food without your brain having to decide how to handle it. Some of these data sources may have no direct connection to the EHR at all, yet their importance to the overall vitality of the system remains undiminished.

As we experience our 100-year pandemic event, the healthcare industry is learning that it didn’t think of everything that hospital leaders might need to know considering equipment or critical supply or staffing shortages. The magnitude of this response has drawn national attention to the critical infrastructure deficiencies in our healthcare, public health capacity, and surveillance systems.

But a silver lining in this endeavor is the rapid progress that is being made by passionate and committed individuals and organizations coming together to solve these complex data sharing and interoperability challenges. HL7 International is doing a tremendous job supporting their members by enabling the secure and rapid transfer of information about hospital bed capacity and availability of critical resources during public health emergencies. From May 13-15, they held a virtual connectathon to demonstrate projects in development. It is promising to see such rapid progress being made through data standardization using FHIR-based APIs.

As an industry, we need to support standards across the many information systems inside a hospital. We need to expose the critical vital signs these systems have to hospital leaders so they can work with public health and emergency response agencies to ensure that appropriate measures are being taken to address this pandemic. While we don’t yet have a consistent approach to sharing data from disparate sources within the healthcare system, it can be achieved.

Morning Headlines 6/4/20

June 3, 2020 Headlines 2 Comments

R1 Announces Agreement to Acquire Cerner RevWorks

RCM company R1 will acquire Cerner’s RevWorks RCM outsourcing business in a transaction valued at $30 million.

VA Likely Can’t Debut EHR Until the Fall

Politico reports that congressional sources say the VA likely won’t relaunch roll outs of its new Cerner system until the fall, giving it more time to focus on caring for COVID-19 patients.

Change Healthcare Inc. Reports Fourth Quarter and Full Year Fiscal 2020 Financial Results

Change Healthcare reports Q4 results: revenue up by 1%, adjusted EPS $0.42 vs. $0.37 beating both revenue and earnings expectations.

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  • IANAL: Your employer/insurance wants to decrease your use of healthcare so that they don't pay as much. Sending you advertising...
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