Morning Headlines 2/9/21

Six Health Information Exchange Organizations Across the U.S. Form New Consortium

CRISP, CORHIO, CyncHealth, Health Current, IHIE, and Manifest MedEx band together to form the Consortium for State and Regional Interoperability.

Nuance Announces Acquisition of Saykara

Nuance acquires AI-powered mobile voice assistant and automated charting software vendor Saykara.

Ettain Group Acquires INT Technologies, a Technology Staffing & Consulting Company

Talent solutions company Ettain Group acquires INT Technologies, a veteran-owned staffing and consulting company that serves a variety of industries including healthcare.

Curbside Consult with Dr. Jayne 2/8/21

It’s been a pretty crazy week in the clinical trenches, with COVID cases ticking up in my area. I’m approaching my one-year COVIDversary, memorializing one year since the day I saw my first COVID case, which happened to be one of the first five in my city.

I laugh a little thinking about it, since of course it presented itself at the urgent care as so many other health conditions do. It wasn’t some diagnostic mystery at a tertiary medical center, or an academic puzzle for someone like House. It was a household contact of someone suspected to be infected, who presented to our office saying she had a fever and couldn’t smell dirty diapers. My physician assistant and I spent the next several weeks wondering if we were going to die. Little did we know that the day would come when we would be seeing 15 to 20 known positive patients a day, with essentially the same level of employer-provided personal protective equipment we had prior to the pandemic (although many of us are supplying our own N95s).

Urgent care centers are healthcare’s front door for many patients who might not have a primary physician or who can’t see theirs during hours that are convenient. Even before COVID, our practice was seeing significant growth, having expanded from five locations to more than 20 in the five years I had worked there.

In November, I was having heated phone calls with our governor’s office about their vaccine plan that left non-hospital-owned urgent cares out in the cold. They were incredulous that urgent care offices treat COVID patients. “When did that start?” they asked. That would be March 14, when COVID-19 first crossed our state lines. The staffer seriously thought that all COVID patients were being seen in the emergency department, which doesn’t give me great confidence in our state understanding how healthcare is delivered to its residents. They also didn’t fully grasp that my practice performs almost 10% of the state’s COVID testing and diagnoses sometimes 500 new COVID cases a day. Seeing more than half a million patients a year, damn straight we’re on the front lines, so how about sending us some vaccine?

As I reflect back on the last year, it’s been a wild ride. At the beginning of COVID, we had to temporarily close several of our locations due to low volumes. I was furloughed without pay, something I never expected to happen as a physician. Once we started offering testing, though, it was off to the races, with volumes going crazy. I’ve mentioned before that in my clinical world I’m just a worker bee, an hourly physician with no leadership responsibility. However, due to my experience and as a consultant, I’m constantly analyzing the actions of my employers against what I might do or recommend that my clients do in a similar situation.

Some of the things they’ve done have been good. Retention bonuses for our clinical support staff helped boost morale and prevent turnover, particularly when patient volumes were high. However, they never did anything to bolster physician morale. When we brought it up, we were told that we should be glad to have jobs since one of the local health systems had completed a significant physician layoff. That never makes one feel good.

Neither does learning that your employer accepted millions of dollars in Paycheck Protection Program funds despite a clinical rebound that had us seeing more patients than we have ever seen in organization’s existence. It’s particularly special when you read about the PPP amount on the front page of the local paper right after seeing an email from your boss that everyone needs to tighten their belts because of the finances. They weren’t following any communications playbook that I would recommend as a consultant, that’s for sure.

The “acting poor” strategy also didn’t play very well when they announced that we were opening additional locations even though we couldn’t fully staff the existing ones. As a part-timer with other sources of income, I had the luxury of being able to push any negative reaction to the back of my mind, but I watched some of my full-time colleagues begin to look for employment elsewhere. Burnout is real and 12-hour shifts are rough, especially when they routinely stretch to 13 or 14 because you’re never allowed to say no to patients who are streaming in the door. I watched several of my favorite physician assistants leave for jobs with eight-hour shifts at local hospitals and have to say I was a bit envious.

I suspected something major might be up several months ago when they hired a new member of the C-suite, but didn’t announce his presence to the physicians. I met him walking through my patient care area after he had been on the job for a couple of weeks. I was underwhelmed by his demeanor and the fact that he was oblivious to my full patient board and the 40+ patients on the parking lot wait list and wanted to stand there and chat. I was even more underwhelmed a week later when his announcement email finally arrived, not from the CEO or COO, but from himself. At that point, I decided to start looking for other clinical opportunities, even though I knew that part-time physician spots basically don’t exist in my community and I’m only in this one because I’ve been here so long.

Toward the end of an already busy clinical week, we received an invitation to an all-hands meeting a couple of hours from when the email was sent. That’s never a good sign. Most of our staff meetings are at 6 a.m. so people can get to their shifts on time. During this quickie Zoom call, we learned that our previously physician-owned practice had gone the way of so many before us in being acquired.

I can’t say I’m surprised knowing the personalities involved, but it explains so much about how they’ve been managing the finances and some of the other decisions that have been made over the last several months. I’m sure it was all targeted towards making the balance sheet look as healthy as possible.

I’ve seen many versions of this movie before and I’ve never seen an ending that works out well for all parties. Inevitably, the investors want their money back and then some, and that money has to come from somewhere. I’m at a point in my career where the plot has to be pretty compelling for me to stay until the end and I’m not sure this fits the bill. I’ve done some research on the investors and I’m not impressed by their healthcare experience. Having participated in due diligence exercises with other organizations looking for outside funding, what I could find on them left me with quite a few questions and not as many answers as I would like.

Most people don’t realize that when physicians leave a clinical position, it’s not like quitting other jobs. It’s not unusual for physicians to be required to give a 90- or 120-day notice so that patients aren’t left in the lurch. Sometimes non-continuity practices like mine will accept less notice, but that’s not the case with my employer, who actually lengthened the notice period for some recent hires. There are some other things that were announced in addition to the investors, and frankly I’m not sure I want to be around when those proverbial bombs begin to drop.

I’ve been thinking about leaving for a while, and this might just be the push I need. When the handwriting on the wall wasn’t done with Sharpie but rather with red spray paint, it’s likely time to dust off the resignation letter. It’s an unsettling feeling since I’ve only resigned from two long-term jobs in my career, but I trust my gut, even in the middle of a global pandemic and without another clinical gig on the horizon. Time for my next leap into the unknown.

What’s your best job quitting story? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Building Evidence-Based Care Plans That Drive Better Outcomes

Building Evidence-Based Care Plans That Drive Better Outcomes
By Nan Hou, PhD, RN

Nan Hou is managing editor of Zynx Health, part of the Hearst Health Network, of Los Angeles, CA.

Evidence-based care plans play an essential role in guiding interdisciplinary care teams toward the most effective steps likely to yield high-quality care and the best patient outcomes.

For hospital-based interdisciplinary teams in particular, care plans offer several important benefits — including ensuring continuity of care across nursing shifts, promoting interdisciplinary collaboration across clinical and operational teams, improving patient engagement, and helping meet documentation requirements from payers and regulators.

However, too often, evidence-based guidelines either go ignored or take too long to implement. While estimates vary, the most frequently cited figure holds that it takes about 17 years for new knowledge generated by randomized controlled trials to be incorporated into practice. Even then, application is highly uneven, according to the 2001 U.S. Institutes of Medicine’s landmark report “Crossing the Quality Chasm.”

To promote greater adherence to evidence requires getting the right information to the right person at the right time in the workflow. For many hospital-based patients, this process begins with a care plan created by an interdisciplinary team that includes key information such as diagnosis and goals and is updated as the patient progresses. When developed by experienced care team and based on the best available evidence, care plans enable hospitals to standardize care, improve outcomes, and maximize performance.

One useful model for evaluating care plans is the Agency for Healthcare Research & Quality’s “Clinical Decision Support 5 Rights” framework. The model states that providers can achieve clinical decision-supported improvements in desired healthcare outcomes by communicating the following five “rights”:

1. The right information: evidence-based, suitable to guide action, pertinent to the circumstance.
2. To the right person: considering all members of the care team, including clinicians, patients, and their caretakers.
3. In the right intervention format: such as an alert, order set, or reference information to answer a clinical question.
4. Through the right channel: for example, a clinical information system such as an EHR or a more general channel, such as the internet or a mobile device.
5. At the right time in workflow: for example, at time of decision, action or need

Creating evidence-based practices

One of the foremost goals of evidence-based practice is to create standardized care that is supported by data and facts, reducing unnecessary variation in care. According to a report originally published in the BMJ, there are four key steps for creating evidence-based practices:

• Formulate a clear clinical question from a patient’s problem.
• Search the literature for relevant clinical articles.
• Evaluate the evidence for its validity and usefulness.
• Implement useful findings in clinical practice.

By following evidence, treatment is based on research and knowledge rather than tradition or intuition. Providers must weigh the value of evidence-based interventions, which requires critical thinking and an evaluation of the quality of the research and its conclusions. Instead of relying on their own personal beliefs, it is essential that providers select evidence that is centered on what is best for the patient.

Elements of a strong care plan

A well-designed care plan focuses on the whole person, taking into account both clinical factors and social determinants of health, such as economic security, and access to food, shelter, and transportation. While the plan must include interventions to treat the current medical issues, it must also help caregivers anticipate and manage the risk of future complications, including after discharge.

Further, it is essential that care plans foster a team-based, collaborative approach that reaches across disciplines in a variety of roles, including pharmacists, social workers, dieticians, behavioral health specialists, physical therapists, and occupational therapists.

To create care plans for individual patients, interdisciplinary teams use measurements from the latest clinical summaries, physician notes, and other electronic health record (EHR) data, in addition to information gathered directly from patients. For more common conditions such as heart failure, care team members often consult templates that identify the steps patients must take to achieve certain health goals, manage comorbid conditions, and avoid complications.

The importance of current evidence

Evidence, of course, plays a critical role in the development of care plans, but staying current with the best and latest evidence-based practices is a substantial challenge for any practicing clinician. For example, a study published in the Journal of the Medical Library Association estimated the volume of medical literature potentially relevant to a primary care physician published in a single month, and found that a physician trained in medical epidemiology would need 628 hours to evaluate all the articles.

To overcome this limitation, many hospitals rely on regularly updated content libraries that are built on the best available evidence, national guidelines, and performance measures. These content libraries include medical conditions and procedures, summaries of studies, and links to evidence in support of care recommendations. Armed with a source of reliable evidence-based content that can be easily incorporated into care plans, care team members can be confident that the plans they formulate are consistent with the most current and credible standards of care.

While virtually all healthcare stakeholders agree that using evidence-based care plans supports better patient outcomes, putting evidence into practice is often easier said than done. However, by leveraging pre-populated, evidence-based content libraries, hospitals can reduce much of the heavy lifting, empowering their interdisciplinary staff to develop care plans that facilitate communication and collaboration, ease care transitions, and ultimately drive superior patient care and outcomes.

HIStalk Interviews Erik Littlejohn, CEO, CloudWave

Erik Littlejohn is president and CEO of CloudWave of Marlborough, MA.

Tell me about yourself and the company.

I joined CloudWave in 2013 out of a desire to be part of a team that served a terrific market, had great potential, and allowed me to continue my career in healthcare IT. One of the things that attracted me to CloudWave is that most of the people there had devoted their careers in and around various aspects of healthcare. 

I was fortunate to join it at a pivotal point in its transformation. I initially led our technology services organization that focused on the resale of on-premise technology solutions, storage servers, et cetera. I got to interact with a ton of customers and serve a ton of customers. Then over the next eight years, we continued our transformation from being a legacy reseller of those solutions to a multi-cloud services, edge, private public cloud that solved numerous challenges faced by hospitals. We are building and continuing to build something special, and we cherish the relationships that we have had with customers going back many, many years.

What does the mix of on-premises infrastructure and cloud computing look like for the typical hospital, and how is that changing?

When I joined the company in 2013, 70% of our proposals were on-prem integration types of deals and 30% were cloud-based, whether that was full hosting or disaster recovery. As we sit here today eight or so years later, it has flipped and completely inverted. I would say that 65 to 70% of our proposals and solutions are cloud-based and the remainder are on-prem, or what we now call edge solutions.

Cerner was becoming more active in hosting its own systems back then as I recall, while Epic and Meditech weren’t doing much of that. What is different now?

Cerner continues with its model and there are no on-prem Cerner solutions. All of that is hosted, and they have been successful at doing that. Epic and Meditech have been similar, in that organizations like CloudWave have provided private cloud hosting operations or solutions. Meditech has certified a number of providers like ourselves to be able to do those, and we go through certifications or testing on an annual or biannual basis. Like everyone else, Meditech has wanted to associate themselves with a public cloud offering, and about a year and a half ago, they launched a partnership with Google. Cerner has launched a partnership with AWS and Epic has certified its platform to run on Azure or AWS as well. Everyone made their claim to a partnership. We are doing the same things and trying to evolve our solutions to be not only private cloud, but to take advantage of public clouds and their evolution.

What are the practical results of hospitals moving some of their data center operations to cloud providers?

Some of it becomes a preference based on financial models, whether it helps them to have an operational expense versus a capital expense, for example. A lot of organizations prefer CapEx, so the cloud may not fit that model very well. However, clouds, public or private, offer a lot of other benefits. Think about hospitals trying to maintain talent and the number of skills that you need for various software vendors, and keeping abreast of those certifications. Complex security challenges are daunting for organizations today, and it has been tough to keep up, particularly if you are a community hospital, with all the ransomware threats coming out of any number of countries these days. Then maintaining all of that talent over time. Healthcare certainly has been slow to adopt cloud solutions over the years, but they are becoming comfortable that that cloud can help them solve some of those challenges.

How has cloud deployment helped hospitals prevent ransomware attacks and recover from them?

First and foremost, it’s ensuring that you have the basics done of clean backups, that you have recover points that you can go to when – not if – someone is impacted by a ransomware or security event. Ensuring that there are multiple copies and multiple restore points and options you can go to so that you know you have a safe recovery point, and trusting in an air gap type of solution. We have multiple sets of data or backups available for customers, and that gets pretty expensive and complex for any organization to manage by themselves. That’s another reason that working with cloud providers makes a lot of sense for hospitals.

Why do attempts to restore from backups fail so often?

We test ours on an annual basis for our customers. That in and of itself is a huge difference. You think your backups are fine and you see that all the saves were occurring, but until you actually restore that and try to run the system, you just don’t know what you have or you don’t have. We feel like doing that annual test is critically important, and it’s a big reason that a lot of customers want to do that and choose a recovery service or a backup service with us. Otherwise, they probably wouldn’t do it on their own.

It becomes a good tool for the organization to rally around. They have this recovery test over the span of a week, they get clinicians involved, and they get people to pressure test it and figure out where the kinks might reside or find issues that need to be fixed. Figuring out what didn’t go well is as important as anything else in a test so that we can make sure they have a clean, restorable backup that they can rely upon.

What do hospitals typically need to do to prepare for moving to the cloud?

The funny thing about being a cloud service provider is that your service is only as good as the end user’s perception. Looking at connectivity and service providers in the local area is important, ensuring that you have multiple paths and redundancy in case a provider has an outage, that you have the capability to fail over and have adequate bandwidth when there’s some sort of outage with Verizon or AT&T, et cetera. First and foremost, you need to make sure that’s solid and that you have redundancy. You also need to make you have adequate Active Directory permissions and user access.

It isn’t just flipping a switch and saying, “I’m going to go into the cloud tomorrow.” We spend one to two weeks assessing the readiness of our customers and remediating any issues that may exist. That holds true with any cloud service provider. You need to be thoughtful about assessing anything in the environment that may impact an end user’s ability to use the system successfully, and make sure it’s not going to be slow, that it doesn’t time out, or that you don’t encounter authentication type of issues, because that creates a downstream headache for everyone.

How do you see the company’s business and strategy changing with its recent acquisition by a private equity firm?

We are excited about the Abry Partners investment. They have a great reputation and a ton of experience in our industry. We felt like they would help position us for future growth and enhance our capabilities, grow our team, and provide meaningful strategic input or guidance. Just as importantly, we just liked their team. There is a sense of familiarity, a lack of ego, and a near-perfect alignment about the potential of our business. We couldn’t ask for a better partner, and we know that they are willing and able to invest in capabilities that we need going forward, whether that’s acquisitions or building our organic capabilities.

What were the most useful lessons you learned from being a West Point graduate and an Army officer?

One of the things that I always talk about with the team is explaining why. That may seem counterintuitive if you’re thinking about the military and you think of people just being told to take the hill, salute smartly, and go do it. But in the military, we always concerned ourselves with the commander’s intent. I had to understand what was going on to the left and the right of me, why I needed to take that hill, and how that fed it into a larger objective. It is important as leaders to always provide that context and the “why” to our teams and the people we work with. Because if you just ask a question without context, they may not give you the right answer, or they may not meet the ultimate objective that you are trying to get to.

What will the company’s emphasis be over the next few years?

We will expand our use and footprint of public cloud and make that more accessible and user friendly to our end customers. That’s an important part of our growth in the next three to five years. We will continue to diversify our capabilities and provide more services than we do today beyond hosting and recovery and backup, providing other things like service desk and security services and expanding those. We will also diversify our customer mix. We have been pretty focused on the Meditech space up to this point, or hospitals running Meditech, but we think that nearly all of our solutions translate nicely to hospitals running other EHRs. We are having some success in Cerner hospitals and Epic hospitals, and we are anxious to do that and to serve a wider mix of customers.

Do you have any final thoughts?

CloudWave will continue to be a customer-first business. Our relationships with our customers have always been at the center of what we do, and we are going to continue investing and expanding in those relationships in various ways. We can be a great partner with customers that are looking to transform their operations through the adoption of cloud. We see the whole industry being at an inflection point and more aggressively adopting cloud, and we are in a great position to do that based on our experience. We look forward to helping customers in that journey.

Morning Headlines 2/8/21

Two Triangle biotech companies raise cash

Duke University spinout Clinetic, whose software monitors EHR activity to identify patients for clinical trials or to suggest next steps in their care, raises $6.4 million in equity.

More than 36,000 UPMC patients’ data potentially accessed in security breach

University of Pittsburgh Medical Center notifies patients of a security breach at vendor Charles J. Hilton & Associates that may have exposed their medical records.

Infinitus emerges from stealth with $21.4M for ‘voice RPA’ aimed at healthcare companies

“Voice robotic process automation” vendor Infinitus comes out of stealth mode with a $21 million Series A funding round.

Hackers post detailed patient medical records from two hospitals to the dark web

Hackers post patient information from Leon Medical Centers (FL) and Nocona General Hospital (TX) on the dark web.

Monday Morning Update 2/8/21

Top News

Duke University spinout Clinetic, whose software monitors EHR activity to identify patients for clinical trials or to suggest next step sin their care, raises $6.4 million in equity.

CEO Thomas Kaminski was previously SVP of corporate strategy for LabCorp, board chair Allan Kirk, MD, PhD is surgeon-in-chief of Duke University Health System, and board member Rob Califf, MD is former FDA commissioner.

Founder Erich Huang, MD, PhD is Duke Health’s chief data officer and directs its health data science center and data science accelerator.

Reader Comments

From Frumious Bandersnatch: “Re: your HIStalk mug from 2014. I love it! So sorry I missed that HIMSS since it would have been worth the trip. I realized today that I have been following you for many years now – glad you’re still here.” HIMSS conferences blur together, but I have the advantage of being able to refer back to my super-detailed HIStalk write-ups to remember what happened way back then. Memorable events of HIMSS14 (daily details here, here, here, here, and here) include:

• The opening reception was hard to find in the bowels of the Hyatt Regency across the street, signs were wrong, bar lines were long even with drink tickets, and racket in the airplane hangar-like space was deafening.
• Hillary Clinton said nothing interesting in her keynote, which cost HIMSS $200K-plus.
• This was our first year hiring Party on the Moon as the HIStalkapalooza band. They turned it into a dance that brought even wall-hugging IT nerds onto the floor.
• I enjoy irony, so I assigned Lorre to accept HIStalk’s Industry Pioneer Award from Sunquest CEO Richard Atkin, who had recently fired her after her 16-year executive career there. You might enjoy Lorre’s description of how that felt and what she thought of HIMSS14.
• This was our first time exhibiting, where we tried to be upbeat about the tiny, remote space that my $6,000 bought us and its uneasy adjacency to the back-of-hall bathrooms. Still, we had a lot of visitors and celebrity booth-greeters disproportionate to our cemetery plot sized booth.
• Not only was I cranky about lugging mugs around that few folks wanted, I also spent too much on having two designs of lanyard pins made, which were “limited edition” in that: (a) I never did them again; and (b) demand for them was truly limited. I dread running across a box of these in a closet somewhere, although I think I tossed them.

From Carl SPACkler: “Re: SPACS. Good for the industry or no?” It’s hard to say, but a ton of health IT SPACs are out there and they are required by law to spend their money on acquisitions within several months, which means that many of them will end up with subpar, overly expensive dance partners that had little reason to become publicly traded and that will fail to attract ongoing investment afterward. It feels to me like everybody is desperate to get a deal done before the bubble bursts. Having your long-term vendor or employer go public is like having your significant other join a cult. It could be a rough ride for hastily acquired companies that needed more time to prepare for their financial close-ups.

HIStalk Announcements and Requests

I will urge the significant number of folks who haven’t completed a living will and medical power of attorney to do it right now, then store the papers somewhere they can be easily located in a moment of need. You don’t need to spend money or hire a lawyer if that’s a barrier – you can download free, state-specific forms that you can complete in maybe five minutes and then you are set for life (or death). There’s no reason to put family members through the anguish of what you would want when it’s so easy to just tell them.

New poll to your right or here: What part of your medical record would you be most angry at having disclosed publicly? Some folks will indignantly say they need an “all of the above” option, but that’s not the point – it’s what single part of your chart is most sensitive to you. I guess mine would be credit card information since that’s the only item that would inconvenience me — the rest simply identifies me as boringly mortal like everybody else, should strangers actually care.

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

“Voice robotic process automation” vendor Infinitus comes out of stealth mode with a $21 million Series A funding round. The company’s technology asks machine-generated questions in phone calls, such as for public health outreach and insurer inquiries, then tailors further questions based on responses. Most of the folks involved come from Google or Rakuten, but the standout for me is operations guy Brad Holden, who earned a Carnegie Mellon degree in mechanical and biomedical engineering; enlisted in the US Marines as a platoon commander in Operation Enduring Freedom in Helmand, Afghanistan, where his platoon cleared routes of insurgents and IEDs; and then came home to earn a Harvard MBA.

People

Patient engagement platform vendor PatientBond hires Justin Dearborn (ICM Partners) as CEO. He replaces Anurag Juneja, PhD, who will continue as president.

COVID-19

CDC’s vaccination stats: 41 million doses administered of 59 million distributed (69%). COVID-19 tests, cases, and hospitalizations are continuing their sharp trend downward, but deaths haven’t followed yet and are running more than 3,000 per day. COVID-19 cases in nursing homes are dropping off as vaccine rollout continues.

The more contagious B117 coronavirus variant is spreading in the US exactly as predicted, with cases doubling every 10 days on its way to becoming the dominant strain by March. Its spread makes the dialing back of mitigation measures by several states, such as expanding in-restaurant dining, appear unwise. It also increases the importance of getting people vaccinated quickly.

Johnson & Johnson requests FDA’s Emergency Use Authorization for its COVID-19 vaccine, although FDA’s advisory panel doesn’t meet to review its clinical data until February 26. Former FDA Commissioner Scott Gottlieb, MD says he expects J&J’s vaccine, which requires just a single shot, to be distributed through pharmacies because it does not require special storage other than normal refrigeration, while Pfizer’s vaccine will probably be limited to big distribution centers because it requires ultra-cold freezers.

Experts remind that while some of the available coronavirus vaccines have higher efficacy rates than others, all of them are 100% effective at keeping recipients from becoming seriously ill or dying.

The Multi-State Partnership for Prevention accuses CDC of misrepresenting Deloitte’s employees as their own during a demonstration of MSPP’s PrepMod vaccination software. CDC then gave Deloitte a $44 million, no-bid contract to develop a system that ended up working up much like PrepMod. The owner and only principal of the for-profit affiliate of MSPP that developed PrepMod has filed a cease and desist notice, pending a lawsuit, claiming that Deloitte stole her intellectual property and then tried to hire her to help it copy its functionality. Ten states are using the Deloitte VAMS system, which was free to them, while 28 have bought PrepMod. Another developer of vaccine information systems confirms that his company and his competitors were asked to participate in meetings with CDC and Deloitte, but then were shut out of bidding when Deloitte was contracted directly.

The White House invokes the Defense Production Act to manufacture 61 million at-home or point-of-care coronavirus tests by summer. It will also use DPA to increase the manufacturing of surgical gloves and two components that are used in Pfizer’s vaccine packaging.

Boulder Medical Center (CO) cancels the COVID-19 vaccination appointment of a 72-year-old cancer survivor because of an unpaid $244 hospital balance.

CDC confirms that US flu activity is basically zero, easing fears of a “twindemic.”

Other

Hackers post patient information from Leon Medical Centers (FL) and Nocona General Hospital (TX) on the dark web.

Henry Ford Health System researchers find that the IPhone 12’s charging magnets can disrupt implanted cardiac defibrillators, leading Apple to issue a warning that users should keep the products 6 inches away from medical devices at all times at 12 inches away when the devices are charging.

Olivia Adams, a 28-year-old software developer who is on maternity leave from Athenahealth, develops a COVID-19 vaccination sign-up website for those residents of Massachusetts who are 75 and older. She coded a site that scrapes information from a bunch of individual sites and displays available appointments in a central location. She said it was challenging because nobody asked the developers of the individual sites to make them interoperable.

Sponsor Updates

• Clinical Architecture publishes a new case study, “The Joint Commission Experience with Symedical.”
• Nuance has been recognized for the fourth consecutive year as the highest-rated vendor in Opus Research’s “Decision Maker’s Guide to Enterprise Intelligent Assistants.”
• Nordic, for the third year in a row, is the only firm with a rating higher than 90 across seven or more “Best in KLAS” categories.
• Premier encourages nonprofit community programs that provide healthcare to underserved populations to apply for its $100,000 Monroe E. Trout Premier Cares Award by March 9.
• Pure Storage announces the new FlashBlade for Azure Stack Hub integration that delivers unified fast file and object capabilities for hybrid-cloud architectures.
• Spirion announces that The Tolly Group, an independent testing lab, has benchmarked its effectiveness in discovering personal, sensitive, and regulated data at 98.5% accuracy.

Blog Posts

• 3 Strategies for Doing More with Less in CDI (Nuance)
• Innovate4Outcomes: How to Improve Patient Outcomes (OptimizeRx)
• Rising to the Challenge: VOAGBR’s Story of Strength (Netsmart)
• How to Communicate COVID-19 Vaccine Distribution with Your Patients (PatientBond)
• Resolutions for the Rest of This New Year (PatientKeeper)
• How PatientIQ integrates their patient-reported outcomes platform in just 13 days (Redox)
• Email Appointment Reminder Templates That Will Help Your Patient Engagement (Relatient)
• Defining a comprehensive data strategy to shape the health care of tomorrow (Cerner)
• 2021 Will Be the Year Telemedicine Loses the “Tele” (SOC Telemed)
• Maintain Compliance with HIPAA Privacy and Security Rules in a Remote Work Environment (Sphere)
• Your Quickstart Guide to HIPAA Compliance (Spirion)
• Supporting Veterans’ health with specialized, interactive health education (Krames)
• #Dedicated to Securing the Actionable Intelligence Frontline Workers Need (Surescripts)
• You Can’t Just Say: “Tomorrow, we’re going to be a High Reliability Organization” (TransformativeMed)
• Secure Messaging App Connect Loved Ones, Provides Peace of Mind for NICU Parents (Vocera)
• 3 Keyword Types to Include in Your PT Clinic Website (Plus Examples) (WebPT)
• Thanks to Our Customers, Well Health Earns 2021 Best in KLAS Patient Outreach (Well Health)

Contacts

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

Weekender 2/5/21

Weekly News Recap

• Netsmart acquires GPM.
• Nordic acquires Bails & Associates.
• HIMSS confirms that HIMSS21 remains on track pending further COVID-19 developments, but with a virtual component added.
• Zyter acquires Casenet.
• KLAS announces Best in KLAS winners.
• Sharecare acquires Doc.ai.

Best Reader Comments

A “dead” language (a proprietary one at that!) put food on my table and a roof over my head for 31 years until I was laid off in 2014. Alhough that effectively ended my coding career, I was able to apply all of the software life cycle best practices to become a Product Analyst in which I design the look, feel, and flow, and have a team of ‘modern’ developers do the magic. (Marshall)

I couldn’t agree more with Dr.Van Vert, but as a patient, I often feel woefully ill equipped to create an informed advance care plan. Besides revive or DNR, yes or no to breathing machine / feeding tube? There may be other decisions to be made, such as pacemaker, surgery, antibiotics for repeated UTI. What about relatives who disagree and fight my wishes? What about if my AD is not avail at time of crisis? IMHO, there is still much work to be done to educate patients and family members so that the conversations, once normalized, can be meaningful. (Kathy Kastner)

Ultimately though, this cannot simply be about end-of-life. You need to open the doors to patient priorities and issues throughout the entire healthcare system. We’ve got one big initiative called person-centered care. When you ask the patient upfront what they expect from the care episode, this sends that message. (Brian Too)

So, if I get this right, you were shown an internal error message as an end user (patient). One that should have gone to the user who selected the document in the first place or someone who could actually do something about the error. To say this is a poor user experience is putting it mildly. (AnInteropGuy)

I work for a CRM vendor and so I have that lens on as I read your story. What I see is that the actual test went just fine, it was your entire experience around the clinical event that caused you frustration. Imagine if through a series of coordinated text, emails, calls, chats you were guided exactly where to go, and were given the results in the appropriate context? Yes, there were some physical plant issues (CRM can’t help with dust bunnies), but aside from that, it was all communication. As one health system leader said recently, “the contact center is the new waiting room,” If your health system had a Digital Front Door, you would have had a better experience. (Brendan Ward)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. T from Texas, who asked for a ring light so her students can see her better while she is teaching virtually from home. She reports, “My wonderful students and I would like to thank you for your generous contribution. Teaching virtually has been a great challenge. With the light ring, my students have been able to see me much better on camera.I really, truly appreciate everything that you have done for us.”

A science futurist website questions whether the DNA information of 18 million people that is stored by Ancestry.com is safe in the hands of its private equity owner, Blackstone, which has pledged to find new ways to “package and sell data” as a revenue stream. A finance professor says, “[Blackstone] owns healthcare companies. They own insurance companies. They own retail companies. So they can identify spending behavior, health care expenses, actual health outcomes for individuals.” The article also questions how genetic information will be protected when 23andMe goes public via a SPAC that is owned by Virgin’s Richard Branson.

In the UK, a COVID-19 conspiracy theorist is banned from hospitals – except for emergencies and scheduled appointments – after filming empty hospital hallways to prove that the British government is lying about the pandemic.

A man who made money on last week’s wild ride of GameStop stock spends his profits on gifts for patients at Children’s Hospital of Richmond, where his son receives treatment for neurofibromatosis. John Theobald explains, “If a kid that’s stuck at the Children’s Hospital wants unicorn curtains, I’m going to get them unicorn curtains, as opposed to a slush fund.” Another investor, a 20-year-old student who made $30,000 in profit, donated Nintendo Switch games and consoles to his local children’s hospital.

Mother Jones finds that online nurse groups, including that of the ANA, are filled with COVID-19 vaccine disinformation. Nurses who post that they have been vaccinated are being attacked, threatened, and accused of harming their unborn children. 

A 10-year-old boy and his mom’s friend head out after Monday’s snowstorm to clear the snow off cars of employees at Westerly Hospital (RI) so they could get home to their families faster.

In Canada, International Space Station astronaut and primary care physician David Saint-Jacques, PhD, MD returns to the medical front lines to work on the COVID-positive unit of McGill University Health Centre, where he completed his residency. He says, “In the space between the people who have no symptoms and the people who die from them, there are people who will get through it, but who get very sick, who really go through hell, on oxygen, pumped full of drugs, in the hospital, with an impact on their families. Now is not the time to let our guard down, even though we’ve all had enough.”

In Case You Missed It

• News 2/5/21
• EPtalk by Dr. Jayne 2/4/21
• Readers Write: We Need a More Patient-Centric Approach to End-of-Life Decision-Making
• HIStalk Interviews Scott Finfer, CEO, Emerge
• News 2/3/21
• Curbside Consult with Dr. Jayne 2/1/21
• Monday Morning Update 2/1/21
• Katie the Intern 1/29/21

Get Involved

• Sponsor
• Report a news item or rumor (anonymous or not)
• Sign up for email updates
• Connect on LinkedIn
• Contact Mr. H

Morning Headlines 2/5/21

Flywheel Secures $15M in Series B Funding

Medical research data management platform data vendor Flywheel raises $15 million in a Series B funding round.

Change Healthcare (CHNG) Beats Q3 Earnings Estimates

Change Healthcare announces Q3 results: revenue down 3%, adjusted EPS $0.34 versus $0.33, beating earnings estimates but falling short on revenue.

23andMe to go public at $3.5 billion with Sir Richard Branson’s SPAC

Consumer genetic testing company 23andMe will go public in merging with a Richard Branson-run SPAC in a deal that values the company at $3.5 billion.

News 2/5/21

Top News

Netsmart acquires GPM, which offers a community-based long-term and post-acute care mobile EHR and care coordination platform.

Reader Comments

From Curious Jorge: “Re: reader survey. I appreciate the offer of a $50 gift card for completing your reader survey! However, you have awesomely enhanced my IT and informatics experience for years, so I should be sending you a gift card and a huge thank you! Please donate the card to your favorite charity.” CJ is a physician informaticist who completed my reader survey and was randomly drawn as a gift card winner. Their gracious deferral of the prize allowed me to fully fund – with matching money from my Anonymous Vendor Executive and other sources — the Donors Choose teacher grant request of Ms. R in Sebastian, FL, who asked for a library of 30 take-home math and science books for her second-grade class. She sent a note saying, “Your kindness and generosity is warmly welcomed and greatly appreciated! It has been one of the most unusual and interesting school years I’ve had, so your donation to our project is an absolute bright spot that we really needed. The future scientists of the world will be so happy!”

From Journo June: “Re: journalist. Do you consider what you do as being one?” Not for most of what I do. I’ve explained to Katie the Intern that I see those who write health IT stuff as falling into three camps: (a) journalists interview actual sources and follow established technical and ethical standards to create original news, which I do when the situation warrants; (b) writers have a level of health IT education and leadership experience that gives their news callouts and opinions credibility; and (c) typists paraphrase the writing of others without even understanding it themselves, adding zero value except to give bored readers a redundant copy of useless material to waste time on. My example of the latter is those lame “best hamburgers in all 50 states” articles in which a junior nobody uses Yelp and Google to crib public comments and photos in dutifully cranking out worthless clickbait. Finding health IT typists would not be an onerous challenge.

From Code Slinger: “Re: programming. Should I be ashamed to admit that most of my health IT programming years involved dead languages like RPG and COBOL?” Absolutely not. Those are just the paintbrushes that your employer made you use. Unless you coded to someone else’s spec only, you are still an artist who understands logical thinking, user behavior, the use of brilliant algorithms to address real-life uncertainty, and how to visualize an alternate universe inside your head and turn it into reality. Programmers might have rolled their eyes at my self-taught, kludgy coding back in the day, but I made those bits and bytes howl in giving life to the software figments of my imagination. The most valuable skill isn’t knowing how you make the computer do what you want, but rather defining what you want it to do.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Ettain Health, offering healthcare IT talent and consulting solutions. Services include IT strategy, vendor selection, pre-implementation planning, system design and build, training, activation and go-live support, help desk, and system optimization, as well as IT outsourcing and application management. Additionally, in response to COVID-19, Ettain Health delivers customized on-site and remote support services including vaccination rollout assistance to provide scheduling and registration through any EHR, training, project management, help desk, and portal support. Ettain Health is a division of talent solutions company Ettain Group, which has 21 US locations and annual revenue of $500 million, deep experience in Epic, Cerner, Meditech (including Expanse consulting certification), and other EHRs. It has a 25-year history of delivering talent solutions, employs more than 400 full-time health IT consultants, and has completed more than 500 EHR implementation projects. Thanks to Ettain Health for supporting HIStalk.

Listening: new from Lucero, country-tinged, heartfelt jangle rock from Memphis that kind of reminds me of Deer Tick because of the singer’s gravelly voice. Despite some 1980s influence, I wouldn’t call it either retro or trendy, just a distinctly American blend from a hard-working, middle-aged band that has been plugging away for 20+ years. I’m not a fan of country, but this is OK since they don’t wear silly cowboy hats and they aren’t bro-country working class posers who add exactly one pedal steel lick to a soulless, corporately written bubblegum pop song so they don’t have to compete on the actual pop charts. People who don’t roll their eyes at musicians wearing cowboy hats indoors must also think that AC/DC’s 65-year-old Angus Young spends his days in a uniforms-required prep school.

HIMSS14 will always be the “Year of Those Darned Mugs” for me because I overbought the giveaways and we kept moving heavy cases of them from one place to another in trying to entice people to take them. I was interviewing CloudWave President Erik Littlejohn today and he said, “You won’t remember this, but maybe seven years ago at HIMSS you had all those mugs to move …” and I knew exactly where he was going with that story. Three guys from our exhibit hall booth neighbor Park Place International volunteered to help Lorre haul in three heavy boxes full of mugs from her car that was parked in an OCCC garage that seemed like a mile away. Not only did they lug them in on their shoulders, they did it wearing their all-black booth finery under the punishing Florida sun. Erik was one of them. Above is the Darned Mug that sits on my desk, and all memories about it are bad except for those guys from Park Place (now CloudWave). Meanwhile, while we’re looking back, do you see any familiar reveler faces in the HIStalkpalooza 2014 video?

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

Nordic acquires Bails & Associates, which provides ERP consulting with specialization in Infor.

Patient experience platform vendor NexHealth acquires digital forms company Enlive. NexHealth’s EHR-integrated offerings include online scheduling, patient communications, telehealth, and virtual waiting rooms.

New Zealand-based cancer screening software vendor Volpara Health acquires CRA Health, a Boston-based Mass General spinoff that offers EHR-integrated breast cancer risk assessment and recommendations, for $18 million.

Change Healthcare announces Q3 results: revenue down 3%, adjusted EPS $0.34 versus $0.33, beating earnings estimates but falling short on revenue. The company’s $13 billion acquisition by Optum is expected to close in the second half of 2021.

Medical research data management platform data vendor Flywheel raises $15 million in a Series B funding round. I’m fascinated that CEO Jim Olson’s education involves math and religion, and companies he has run include online gambling, supportive medical care, a family of youth ministries, and career exploration for young adults.

Consumer genetic testing company 23andMe will go public in merging with a Richard Branson-run SPAC in a deal that values the company at $3.5 billion.

Sales

• Community Health Network (IN) chooses Jvion’s prescriptive AI to identity ACO members who are risk of deteriorating due to pandemic-deferred care.

People

Carevive hires Bruno Lempernesse (Medidata) as CEO. He replaces founder Madelyn Herzfeld, RN, who moves to board vice chair.

Quil hires Kim McEwen, MA (Livongo) as VP of client delivery and Ashley Stevens (Imprivata, above) as VP of provider sales.

Announcements and Implementations

Mayo Clinic will work with Spok to enhance its Spok Go communications platform, including critical test results reporting, family and patient engagement, task management, and medical device integration.

Relatient announces a patient self-scheduling tool for COVID-19 vaccine appointments.

LexisNexis Health Care develops a streamlined onboarding process for Epic’s MyChart, which uses the company’s Instant Verify and Instant ID Q&A for identity validation, to expedite vaccination appointment scheduling. 

Israel-based CLEW Medical earns FDA’s 510(k) clearance for its hemodynamic instability prediction solution for ICU patients.

Saudi Arabia’s health minister reviews the progress of the Epic implementation at King Fahd Medical Center, noting that the implementation was completed on schedule despite COVID-related challenges. 

KLAS’s non-US Best in KLAS report finds that telehealth has been massively expanded globally during COVID-19, but patients would also like to see consolidated patient portals, provider communication, and self-scheduling. Top ranked in the acute care EHR category are:

• InterSystems TrakCare (Asia / Oceania)
• Epic (Canada)
• Epic (Europe)
• MV Soul (Latin America)
• Cerner (Middle East / Africa)

A KLAS Arch Collaborative report on large-practice ambulatory clinician EHR training finds that Epic and NextGen Healthcare lead on training quality; Epic, Meditech, and NextGen have the highest satisfaction with EHR personalization; and Athenahealth, Cerner, and Epic are strong at identifying users who need extra help. Most organizations say the EHR supports patient-centered care, with that list topped by Meditech Expanse, Epic, and NextGen. 

COVID-19

CDC reports that 33.9 million of the 56 million COVID-19 vaccine doses that have been distributed have been administered (61%).

A new Census Bureau survey finds that only 51% of unvaccinated Americans will “definitely get” COVID-19 vaccine. Herd immunity is not guaranteed when 24% of people say they probably or definitely won’t take the shot, not even counting those who want it but may not end up getting it.

Physicians who have been performing fast-result COVID-19 testing in their practices are eliminating that service since insurers sometimes pay them less than half of the test’s cost. Federal law requires insurers to cover the cost so that testing is free to patients, but does not define how reimbursement is calculated and doctors are prohibited from billing the difference to patients.

Newly elected Missouri state representative and medical clinic operator Patrica Derges is indicted on 20 counts for selling patients fake stem cell treatments after claiming on local TV that they cure COVID-19. She is licensed as an assistant physician, having graduated from a Caribbean medical school without being chosen for a residency.

Other

AMIA opens a CEO search a year after the resignation of Doug Fridsma, MD, PhD. EVP/COO Karen Greenwood has been serving as interim.

A reader says this story has Weird News Andy written all over it. A man falls asleep listening to music on his AirPods, then wakes up with a dry throat and just one AirPod. An emergency endoscopy turns up the second one, which he had swallowed. 

Sponsor Updates

• CHIME names Capsule CEO Hemant Goel a Healthcare Hero for outstanding service during the COVID-19 pandemic.
• Kyruus announces significant core business momentum in 2020 as it accelerates expansion into the payer market.
• Everbridge announces that the State of West Virginia has administered nearly 100% of first-round doses using the company’s Vaccine Distribution software to schedule COVID-19 vaccinations.
• The Race to Value Podcast features The HCI Group Chief Digital Officer Ed Marx.
• Medicomp Systems CMO Jay Anders will present at Health Datapalooza February 18.
• NextGate receives the United Kingdom National Cyber Security Centre’s Cyber Essentials certification.

Bog Posts

• Chief nurse and critical care nurse practitioner discusses HHS Public Readiness and Emergency Preparedness (PREP) Act (Wolters Kluwer Health)
• Stolen Patient Records a Hot Commodity on the Dark Web (Capsule)
• Digital Wayfinding: More Than Just a Hospital Roadmap (Everbridge)
• Chipping Away at Avoidable Days: How Even Small Improvements in Patient Length of Stay Add Up (Central Logic)
• Answers to 8 Frequently Asked Questions About COVID-19 Vaccines (First Databank)
• Experts Explain Why People with Diabetes Should Get the COVID-19 Vaccine (Glytec)
• What is Telemedicine Going to Look Like in 2021? (Optimum Healthcare IT)
• Infographic: The Impact of Alarm and Alert Fatigue (Halo Health)
• Why Data-Driven Healthcare is the Best Defense Against COVID-19 (Health Catalyst)
• Make Every Pregnant Patient Feel Like You Make House Calls (Healthwise)
• Enterprise Imaging: Organizational Challenges and Lessons Learned (Impact Advisors)
• Moving Forward (Imprivata)
• How Personalization Can Improve the Patient Payment Experience (InstaMed)
• Meeting the Hype in 2021: Machine Learning in Healthcare (InterSystems)
• Making bank or bankrolling waste: Why surgical schedules need healthy dictionaries (Intelligent Medical Objects)
• What’s in store for clinical AI under the new administration? (Jvion)
• Eight Best Practices for COVID-19 Vaccine Scheduling Online: Insights from Our Health System Customers (Kyruus)
• Situation Management Gives Hospitals the Power to Thrive Under Pressure (LiveProcess)
• Price Transparency Rule Now in Effect: What You Need to Know (Medhost)

Contacts

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

EPtalk by Dr. Jayne 2/4/21

I’m not sure what to make of the recent communications from HIMSS regarding HIMSS21. They are eager to confirm that the event will proceed and to tell us the next milestone where they plan to tell us more about it, but I personally would rather have information at hand than the promise of information down the road. It’s clear that the exhibit hall will be much reduced and the sessions will be a mix of in-person and digital, but beyond that, I’m not sure what we know. The reality is that HIMSS is about making money and they’re going to structure their communications in the way that they think will be most profitable.

What I do know is that August in Las Vegas is deathly hot, and the things that many of us have been doing to avoid COVID — such as having social events outside — may or may not be tenable there at that time of year. The average high for the week of August 9-13 is 103 F, with a low of 80 F. Even in a “dry heat,” it’s not my favorite way to travel back and forth from the hotel to the conference center. I’d like to stay at one of the connected conference hotels, but the charges are prohibitively high for those of us who are paying our own way for the privilege of attending a conference where we have no idea what to expect.

We also have no idea what vaccination status will look like as we move towards August, since vaccination administration is still rather messy across the US. Based on anecdotal reports, many of the would-be HIMSS attendees from US health systems may be vaccinated, since many of those health systems seem to have had plenty of vaccine for non-patient-facing workers under the premise that everyone supports the patient journey. My friends who are part of independent practices and federally qualified health centers are still struggling to find vaccine, and the process has become more challenging now that states have prioritized the elderly.

I honestly don’t have a bead on what vaccination processes look like elsewhere in the world except for the UK and Australia, where friends keep me posted on what they are experiencing. They have employed different strategies than the US or each other, so it remains to be seen who will ultimately be judged by history as having the best approach. Certain countries and alliances have bought up enough vaccine supply to more than vaccinate their own populations, and it’s not yet clear what will happen to any surplus in the end. The goal is of course to vaccinate people quickly, but there are still plenty of barriers worldwide.

Being a clinical informaticist in the midst of a global pandemic has its challenges, since many of us are armchair quarterbacking the charts and graphs we see and trying to determine whether they’re accurately illustrating the facts or are in danger of looking like someone changed the data with a Sharpie. A neighboring state just got caught cooking the books on their COVID positivity numbers — they decided to exclude test results that have been performed by any other methodology than PCR. Many of the large urgent cares are using rapid molecular testing like the Abbott ID Now devices in use at the White House, and those numbers are going unrepresented. Also not included in the totals are other rapid tests, such as antigen tests. We use both of the latter in my practice probably 80% of the time, only sending PCRs when required, so failing to include all the data seems like a no-no.

The state health director tried to explain it away by saying that there’s enough “saturation of PCR tests in the market to be representative,” and although I understand what he’s trying to say, it just seems like it would be better to use all the data, especially since the state requires practices to report it. Why would you want to not use data that you have? Those are the kinds of decisions that lead people to question the truthfulness of public health officials and that give rise to conspiracy theories. There have been enough irregularities with data and reporting throughout this pandemic that future academics can teach full semester classes on what went wrong.

February 3 marked National Women Physicians Day, which occurs on that date to honor the birthday of Elizabeth Blackwell, who in 1849 became the first woman to achieve a medical degree in the United States. I spent the day caring for patients, some of whom were particularly cavalier about spreading COVID to their friends and family members, which is always frustrating. I didn’t even realize it was today until I got home and was curled up with my laptop, surfing the internet while waiting for my face to stop hurting from wearing an N95 mask for 12 hours. It typically takes about three hours for the mask marks to go away and a couple more for the headache to improve if I don’t take ibuprofen or drink a martini. I’m surely in a place I never expected to be when I started my medical career.

I was proud to be part of the first majority female class at my medical school, and to be part of an all-woman residency class well known for shaking things up in the world of graduate medical education. As the first physician in my family, I didn’t really appreciate what that meant until the day I took my mother to visit the gross anatomy lab. It was there I learned, as we stood there holding a human heart, that she might have liked to have been a physician, but when she was in college women were steered towards career paths in teaching and nursing. I was surprised that she hadn’t mentioned it while I was pre-med and applying to medical school, but maybe there was something in the genes that kept me going even when training got rough.

Here’s to all the women physicians that came before us, breaking barriers, putting up with enormous amounts of harassment, and paving the way for us to be where we are today. Your courage and dedication will never be forgotten.

Email Dr. Jayne.

Morning Headlines 2/4/21

Alma Announces $28 Million Series B to Bring its Mental Health Network Nationwide

Mental health practice management vendor Alma raises $28 million in a Series B round led by Insight Partners.

Philadelphia operating room software startup raises $4.3M, hires MapQuest co-founder

Surgical process optimization software vendor ORtelligence raises $4.3 million.

Netsmart Acquires GPM to Enhance Provider Digitization and Mobile Workflows

Netsmart acquires long-term post-acute care health IT vendor GPM.

Nordic Acquires Bails & Associates

Nordic acquires multi-vertical ERP consulting firm Bails & Associates for an undisclosed sum.

NexHealth Acquires Enlive to Bring Integrated Paperless Forms to Healthcare Practices & Developers

Patient engagement and EHR integration software vendor NexHealth acquires digital forms company Enlive.

Readers Write: We Need a More Patient-Centric Approach to End-of-Life Decision-Making

We Need a More Patient-Centric Approach to End-of-Life Decision-Making
By Ryan Van Wert, MD

Ryan Van Wert, MD is co-founder and CEO of Vynca of Palo Alto, CA and clinical assistant professor of medicine, division of pulmonary and critical care medicine, at Stanford University.

As a physician with a background in critical care, I have seen scores of patients with serious or life-limiting illnesses such as advanced cancers and dementia receive aggressive treatment in intensive care units, treatments that many of them would not have wanted. I have had heartbreaking experiences where I have put a patient on life support, and then days later, found out that a family member or loved one had uncovered an advance care planning (ACP) document indicating that this care did not align with the patient’s wishes. Far too often, I have witnessed situations in which extreme, invasive measures are taken because the dying patient’s wishes are unknown simply because they never had the important conversations about end-of-life care with their physicians and loved ones.

Today, in the midst of the COVID-19 crisis, these tragedies are unfolding in emergency rooms across the country at an alarming rate. As we enter the darkest days of the pandemic, ACP has been brought to the forefront as a necessity for patients of all ages, not just those in the more mature stages of life. Clinical resources are again being stretched to the limit, and patients are at risk of receiving critical care interventions, such as being placed on ventilators, that may not align with their personal preferences.

In addition to causing significant grief for the patient’s loved ones, this is putting great strain on the physicians who are responsible for caring for them. We need a better system to help individuals, their loved ones, and clinicians navigate the complex process of making choices for future care, along with the programs and tools to ensure they are honored.

We Must Normalize the Discussions Around End-of-Life Care

Most Americans do not want to die on a ventilator in the intensive care unit at the end of life. Most of us would prefer to receive whole-person care that is focused on comfort and well-being. However, if we do not clarify these preferences, we will receive every life-saving medical treatment and intervention possible.

We need to start normalizing discussions around future care preferences that reflect our values, choices, and goals, no matter how uncomfortable these conversations might be. We must be able to ask ourselves, what is really important to me? How do I want to live my final days? Holding these critical conversations with our loved ones, caregivers, and providers enables us to think through our preferences for future medical treatment and allows us to make important healthcare choices before we become ill or incapacitated.

That is not to say that ACP is an easy process. The conversations are inherently emotional and require bravery and compassion. Providers should be supported with the education, tools, and a standardized approach to help them guide these conversations so that their patients feel empowered. A more patient-centric approach to ACP is essential for ensuring quality of care and aligning healthcare utilization with care preferences when patients near the end of their lives.

While both patients and physicians may recognize the importance of ACP, there still lacks a standard method to engage in these conversations and make this vital information available when it is needed. Research shows that 84% of individuals who are 65 and older have not been asked by their physician to have an ACP conversation, and there is a 37% medical error rate in end-of-life care plans. In the past, even when patients have taken the time to record their wishes, in many cases the documents have been inaccurate or inaccessible across the care continuum. When physicians were asked about the confidence of locating an existing advance care plan within the EHR, only 31% of physicians strongly agreed.

Why Healthcare Organizations Must Make ACP a Priority

It is clear that hospitals and health systems need to integrate ACP conversations and digitized documentation into their standard of care, without exception. However, many healthcare organizations are continuing to struggle to implement and scale high-quality ACP, despite the fact that ACP CPT reimbursement codes 99497 and 99498 are already in place for both in-person and telehealth ACP consults. By implementing and scaling ACP, healthcare organizations can:

• Improve the patient experience. Standardized ACP enhances engagement with patients in these conversations and reflects personal goals and values, enabling organizations to provide more personalized, patient-centric care. According to The Journal of General Internal Medicine, 93% of hospitalized patients with an ACP rated their experience five stars compared to 65% without one in place.
• Provide the highest quality care. ACP reduces unwanted, unnecessary healthcare interventions at end-of-life and prevents medical errors, so patients are receiving the best care possible.
• Reduce provider burnout. Very few providers have ACP conversations with their patients, as they are not comfortable or prepared to guide these difficult discussions, resulting in limited documentation available to providers. This leads to providers having to conduct unwanted, invasive interventions, all the while knowing that these patients might be better served with palliative and hospice services versus being hooked up to a ventilator in the ICU.
• Drive success in value-based arrangements. With ACP increasingly becoming a quality measure in value-based care programs, standardized ACP drives potential success in value-based arrangements, such as BCPI Advanced and the upcoming Radiation Oncology Model.

Realizing the Benefits of a Digitized ACP Approach

To achieve the benefits of ACP, healthcare organizations need to implement a streamlined approach that normalizes ACP conversations by providing education and standardizing a system-wide program. ACP education and documents must be digitally available within the patient portal, as this enables individuals to access ACP details, review them with loved ones and make changes when needed, truly putting the patient in control of their future care.

A single source of truth for all ACP documents ensures that they are always available in the clinical workflow and eliminates confusion. It also allows clinicians to view accurate patient information, which guarantees that all future care preferences are accurate, actionable, and in one reliable place within the EHR. Unlike a paper-based approach, digitized ACP enables reporting to provide clinicians with critical business intelligence for realizing ACP utilization, success, and value.

Healthcare organizations have the opportunity to help normalize ACP, prioritize resources, and truly solve for the demand and overload we are seeing at hospitals today. By empowering everyone involved with the necessary resources and tools, you have the opportunity to make an immediate impact, delivering higher quality care at the end-of-life and, as such, ensuring for a truly patient-centric experience.

HIStalk Interviews Scott Finfer, CEO, Emerge

Scott Finfer is co-founder, CEO, and board chair of Emerge of Dallas, TX.

Tell me about yourself and the company.

I’m CEO of Emerge. We offer a solution set that can overlay on top of EHRs. The strength of our company is our people, a unique group that has come together.

How common is it for EHRs to offer a search function and how is it used?

Search can mean different things to different people. In the world of Emerge, when we talk about search and when we talk about what our mission is, it is searching not only the data that exists inside of the EHR that is discrete and accessible, but also information that isn’t necessarily searchable by the EHR unless they are using optical character recognition and natural language processing to use scanned and free text information.

But more importantly, when we talk about search, we stay patient centric. If I search for information about a patient and I’m at an ambulatory facility, in an ideal world, I should be able to have their records available to me if I need to treat that patient inside of the acute world. We’ve made our life’s mission to figure out how that search is not just about searching in records that exist — that’s the easy part — but searching for all the possibilities of where we can bring this information together on a master patient index to have one patient file that can theoretically travel with the patient wherever they go.

Does it make clinicians more efficient or allow them to find the most important information more easily?

I got stuck in healthcare. I’ll be honest about that. I didn’t realize how incredibly difficult the space was. I came out of IT services. Before that, I was doing real estate. I’ve made tons of money doing everything I’ve ever done, but I’ve spent tons of money over the past 10 years to build this business up, because healthcare is way harder than we expected.

But the good thing is that we now have the ability to understand what the problems are. We can document and have engineering problems versus, wow, it’s just not going to work. That’s a big difference. You can say, is it solvable? Well, maybe. Everything is potentially solvable. But what’s better than solvable is that it’s an engineering problem. If we do this, this and this, this allows for this to work.

That’s where we are at this stage of development. The people in the country now – patients, administrators, forward thinkers, caregivers, providers –everybody keeps struggling with these friction points that exist that are self-made. One of the big friction points is that, what is the center of importance in healthcare? I would argue with you that it is often missed, because providers are the center of healthcare. The patient is the center of healthcare. This isn’t against any particular EHR, it’s against every EHR that provides acute services at a bare minimum. Why are the systems developed around hospital beds as opposed to patients? The whole thing is designed for something different than staying focused to patient care.

We have the problem now to fix all these silos. Then it’s compounded by the fact that,  who is the best source? Is it one source or multiple sources? All these things are playing friction. The one thing that has never been delivered, regardless of what belief system you’re of — and I’m a no belief system here, I’m neutral, I just want to help healthcare — is that getting my record in and out and moved around and shared has been a disaster.

One of the reasons is because, most of the time, that’s a manual exercise that happens in the back office. People don’t think about this or don’t know this, but when there’s an official records request, it’s a money-losing proposition for the facility to have to go back through and figure out what the record is. Our technology, because it breaks everything down and starts with the patient at the center, says, I always have to keep it. Wherever it came from, I should break it down and bring it to the patient. That should always be the focus of whatever I’m doing for my flows of information.

When we encounter a situation where a health system is on multiple EHRs, we can come in and they don’t have to make any more investments. We can overlay on top of those systems and not only make them communicate with each other, but we can start to automate and provide smart services. Like, push a button and here’s your health record, because we can define what it is. I can get it for you. That’s what we have with ChartGo. With the push of a button, you’ve got the health record.

If it’s that easy to grab control of the health record with so much more granularity, now we can go to the big health system. We’re talking about big health system in California, and they want Northern California and Southern California to communicate with each other. But even more important than that, they want their patients, when they are traveling on holiday, to have easy access to their records and to share if needed wherever they are. That’s now possible because it’s being patient centric.

Is it difficult to access the information so you can create the overlay?

No. The most difficult thing in working with these facilities is the facilities themselves wanting to work with you. There’s this fear with some organizations about what is going on with the cloud. As you look at a lot of healthcare systems, it’s heavy steel. Man, it’s big money up front. For me, that’s fine. You don’t even have to change what you’re doing, but for pennies on the dollar, I can automatically make you 100% digital in the cloud. Your data, your control. Tell me where you want me to send it. That has never happened before. It has always been under the control of whoever sold you the operating system. We can help change operating systems, make them work better.

We’ve got a wonderful partnership going with a couple of EHRs right now, Athenahealth and Allscripts. Their senior leadership says out loud – which I’ve never heard someone say — we’re not the only thing. We’re part of the infrastructure. We’re part of the ecosystem. I said to myself, wow, they get it. There’s not going to be one — it’s not going to work. It’s got to be able to work together. Part of working together is knowing that some people might be great EHRs and some people might be great this or great that, but at the end of the day, what is needed is glue to make them work nicely together. Forward-thinking people, and there’s a lot of them, recognize that this is an ecosystem play. That’s where we are headed.

We know how to operate in any ecosystem because we speak all languages. Doesn’t matter which EHR, doesn’t matter the versioning, doesn’t matter the age of the technology. Our guys are utilizing state of the art technology and there’s no lift on the back end. I come to you and I say, let me solve your problem for you. The facility says, what’s it going to cost? Nothing. OK, and what kind of resources do I need to provide for you to do that? None. They look at it and they go, it’s not possible.

After surviving being told that for 10 years, we now have successful investment bank software company. The most important part about it is that we did it with our own money, and now it’s making enough money to stand on its own two feet with no venture capital in the deal. We did it to solve healthcare problem because my co-founder, who is a doctor – cardiologist William C. Daniel, MD, MBA — is a humble enough guy to understand that when you’re treating patients as a cardiologist, there’s plumbers and there’s electricians. I love this guy. I’ve known him since I’m 13 years old. I wouldn’t have gotten into this business if it wasn’t for him.

What he said to me was, I’m killing people. I said, what? I’ve never heard a doctor say that before to me. He said, I’m 100% killing people. I know I am. I just can’t prove it. I’m seeing people in my office who are coming to see me because I’m a plumber. I don’t know electricity all the way through the detail. There’s stuff going on that if the EHR record was scrubbed, I would know that this guy needs to see an electrician, and I would get them to the electrician. That’s how this whole idea came up.

ONC pushed EHR vendors years ago to make it easier for users to export patient data from one EHR that could be imported into a different EHR, making switching easier. Has that gotten any better?

There’s no lift. Zero. We literally have converted over 100 different brands of EHR into the systems of our trade partners. They are left with non-usable data most of the time coming out of whatever EHR they’re coming from. Athenahealth is a partner of ours and one of our prime relationships. When Athena signs up a new customer, Athena brings us to meet the customer, because the customer can literally have everything waiting for them inside of Athena. They have access to not only to their old data, they have access to 300% more of their old data. 

But that’s not even the big kicker.They didn’t have to do anything. They turn on Athena’s state of the art system in the cloud, and it’s set up and ready to run. All of a sudden, both the old information and the new information through Athena are able to merge together as they see new patients through Emerge on a go-forward basis. They are always getting the full context view. If we need to add on other feeds from other EHRs, HIE, or API to allow somebody else to pump in a third-party data from a payer, all those things are now possible. That’s what we are building with Allscripts and Athena.

What does it take to sign new partners?

I don’t think you have to sign on new partners. I had a wonderful client and mentor in Oklahoma named John Harvey. He told me that he took a chance on us. He brought us up to the Oklahoma Heart Hospital early on, even before we really had a product. That’s the truth. We thought we had a product, but we didn’t realize what a problem there was in the space. John brought us up there and we were doing great stuff. We were going after every EHR back then. We were going to try and integrate with everybody. 

John said, if you boil the ocean, you’re going to die. You had better pick one and try and make it work. Then if you can make it work in one, you can make it work in all of them. 

That’s exactly what we did. Now we are in four of them — Epic, Cerner, Allscripts, and Athena. When I say having to get a partnership, I’d love to do a partnership with Epic if they want to do one with me. I can save millions of dollars in conversions for anybody switching to Epic. To bring their database from their old system to the new system will cost them $25,000. I mean, this is the digital age, so I have a digital solution. A lot of people are beginning to embrace it, and things are going to change rapidly. But the most important thing is that it works, it’s patient centric, and it’s following how medicine is supposed to work.

What is the direction of the company going forward?

We see ourselves following the same footprint that we started 10 years ago. A lot of companies set out to solve problems, and then they bring the solution to market. They say to the doctors, nurses, providers, staff, administrators, or the quality people –if you would only use my tool how I designed it, it would work for you. There’s a problem with using my tool as I designed it to work for you, and that is workflow. Part of our strategy has always been to make sure that we are directly in the workflow, but not in the way.

We have done that now with over 100 installs. You could literally take our install list and pick anybody on it and ask for a referral and they’ll give you one, a good one. Everybody’s happy. We have this massive retention rate because we’re in the workflow. That is key for where I see ourselves as we move forward.

Our roadmap for the past 10 years was written by my customers. With my subscription model, somebody says to me, I wish I could track proteins on these pregnant women that are coming in from all these facilities. We say, we can help you with that, and we do that for them. Then we turn around to any other OB-GYN who has a subscription with us and we give them that same functionality if they want it. Our subscription gets stronger and stronger, and what we are doing gets stronger and stronger.

We are much much more than search at this point. That’s a small underpinning of what the company is really doing. One of our strengths is the downtime viewer. If your EHR goes down, you can log in through our portal and have a digital version of everything available through our search tools, to be able to search the record while you’re in downtime. We have population health tools that don’t require an SQL search. You don’t need to spend millions of dollars to have a consultant come do this. Tell us what you want. I want to find all the patients that have not had a colonoscopy in the past 10 years and that do not have an appointment scheduled. Give me that list. Oh my God, 10,000 people that should be getting this procedure done. That’s 10,000 times whatever the cost of a colonoscopy is, $1,000, massive revenue from the existing population. And if they don’t do that, the cost of care is going to go up.

We are getting proactive, making sure that we’re hitting large target parts of the marketplace all at the same time. We have a way to find them. More importantly, we have a reverse delivery message available. If you miss something on coding and the only place where it’s appropriate to code like that is between the patient and the doctor at the point of care, it has to be done at that point. I’m inside the EHR and I have dashboards to use it in their workflow. If there is something that that doctor needs to code, adjust, or to change because the customer can now be paid for the work that the doctor’s already done, it’s a very efficient way to put it in the workflow. It can even get caught before the doctor does it, because we’re using our automated tools for the chart prepping process. We can chart for up an entire facility with a push of a button.

I don’t know exactly where it will be 10 years from now, but we’re going to do the same thing that we’re doing, which is, show us the problem, give us your requirements, let us solve it, and help us make our subscription stronger with each new member.

Morning Headlines 2/3/21

Zyter Acquires Care Management Technology Leader Casenet, LLC

Zyter acquires population health software vendor Casenet from Centene, which had acquired the company in 2012.

HIMSS Confirms that HIMSS21 Remains On Track

HIMSS announces in an exhibitor communication that HIMSS21 remains on track for August 9-13 in Las Vegas as a “completely reimagined hybrid event” that includes an online component.

HealthTensor Raises $5 Million to Augment Medical Diagnosis with AI

AI-powered medical decision-making software startup HealthTensor raises $5 million in a seed round led by Calibrate Ventures, TenOneTen Ventures, and Susa Ventures.

News 2/3/21

Top News

HIMSS confirms that HIMSS21 remains on schedule for August 9-13 in Las Vegas, but announces that it will also include a virtual component.

HIMSS will determine later — based on vaccination rates, infection rates, and federal guidelines – whether it will need to cancel in-person activities in Las Vegas.

The next HIMSS21 update will be published on February 19, which will include announcement of the date on which registration will open.

Reader Comments

From Just_a_CIO: “Re: HIMSS and CHIME. Getting a divorce, as quietly announced a while ago but in a more formal letter from CHIME this week. This likely further dooms HIMSS to the boat show only role and maybe gives CHIME a chance to get back to its roots with a more educational / peer-to-peer event. Vendors will always play a role since someone needs to pay to put these things on, but it seems CHIME has a better shot at striking the right balance as a smaller, more focused conference. What do you think?” CHIME confirms that it won’t be participating in HIMSS21, as the organizations “have decided to explore different directions in how we serve and grow our memberships.” CHIME will offer broadcast events in April and June and presumably others to follow, and had already announced that the Fall Forum in October will also offer a hybrid model. Here are my random thoughts as the reader requested:

• Certainly CHIME is better scaled to survive on the proceeds of running a smaller conference, although it was beginning to show signs of HIMSS-like dollar sign eyes. It’s a good time to refocus.
• Nearly all member organizations walk an ethical tightrope in deciding how hard to milk the willingness of sellers to pay for exposure to buyers in the “ladies drink free” model. Perhaps it’s a bit cleaner for CHIME since vendors can’t be members.
• I often question why hospital executives can’t perform their job duties without heading off to luxury resorts for networking and education. I’ve only ever worked in healthcare, so I don’t know if it’s common for C-level executives in other industries to rely on ideas from peers in other companies, to expect their vendors to educate them, or to wander back and forth between customer and vendor jobs.
• I’ve always been uncomfortable with cocooning CIOs off in their own track at the HIMSS conference. All events should be open to all attendees except for those that require extra payment (well, I don’t really like those either, but I digress). Exhibitors need to come to terms with the idea that most of the people who visit booths don’t have titles that suggest decision-maker, yet they have every right to be welcomed and in fact often actually do have influence beyond their job titles.
• I’m not really fooling myself that I yearn for a quieter, more educational conference even though I don’t go to the parties. Boat show or not, you’ll usually find me in the exhibit hall, where the collective energy, fun, noise, and elbows-flying capitalism is more interesting than most of the educational sessions, which often end up being run by the same vendors anyway.
• Now that I’ve said a lot without really saying anything, I’ll ask CHIME members, HIMSS members, vendors, and whoever cares – what do you like or not like about CHIME’s break from the HIMSS conference?

From Masshopper: “Re: VPay. Have heard that Optum is acquiring the company, adding to its healthcare payments and clearinghouse capabilities that it gained with the purchase of Change Healthcare last month.” I haven’t heard anything.

From Toothpick It: “Re: Olive’s new PR. What exactly is ‘AI cybernetics?’” I don’t think the term “cybernetics” is used much these days, but it involves feedback loops, which one could argue that in the absence of connections to physical devices like an artificial pancreas or something, simply means computer programming or scripting. Olive’s latest announcement says its product is being used by 675 US hospitals to deliver $100 million in efficiencies (that’s around $150,000 per hospital). It tripled headcount to 550 “Olivians” in the past year and will double it again in 2021 in a distributed work model it calls “The Grid.” You have to think that some science fiction nerds are involved.

Webinars

February 24 (Wednesday) 1 ET. “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management.” Sponsor: Phynd Technologies. Presenters: Tom White, founder and CEO, Phynd Technologies; Adam Cherrington, research director, KLAS Research. Health systems can derive great business value and competitive advantage by centrally managing their provider data. A clear roadmap and management solution can solve problems with fragmented data, workflows, and patient experiences and support operational efficiency and delivery of a remarkable patient experience. The presenters will describe common pitfalls in managing enterprise information and digital strategy in silos, how to align stakeholders to maximize the value of digital initiatives, and how leading health systems are using best-of-breed strategies to evolve provider data management.

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

Acquisitions, Funding, Business, and Stock

Private equity firm Abry Partners acquires healthcare cloud and managed services vendor CloudWave through a majority investment.

Hillrom purchases EarlySense’s contact-free, continuous-monitoring technology for $30 million. EarlySense CEO Matt Johnson says the company will now focus on its remote monitoring technology for the post-acute market. Hillrom announced several weeks ago that it will acquire Bardy Diagnostics for $375 million.

Zyter acquires population health software vendor Casenet from Centene, which had acquired the company in 2012.

Healthcare Growth Partners lists the transactions it closed in 2020. On the sell side: Firstsource acquired Patient Matters, Coronis Health acquired PMG, Intraprise Health acquired HIPAA One, Intelerad acquired Digisonics, Provation acquired EPreop, and EverCommerce acquired AlertMD. On the buy side, Ontellus acquired Intertel, Symplr acquired Wolters Kluser ComplyTrack, and Symplr acquired The Patient Safety Company.

Sales

• In England, Manchester University NHS Foundation Trust signs a $170 million, 15-year contract with Siemens Healthineers for the planning, installation, and maintenance of 222 pieces of imaging equipment.
• MedStar Health and Intermountain Healthcare sign legacy PACS replacement contracts with Visage Imaging, which will deploy its product via Google Cloud. 

People

Premier CEO Susan DeVore will retire effective May 1, 2021. She will be replaced by President Mike Alkire.

Praveen Chopra (George Washington University Medical Faculty Associates) joins Gundersen Health System (WI) as CIO.

Announcements and Implementations

Jackson Memorial Hospital (FL) implements Everbridge’s COVID-19 Shield: Vaccine Distribution software.

Divurgent develops a virtual patient support solution to help healthcare facilities handle call volumes related to COVID-19 vaccination scheduling.

Visage Imaging parent Pro Medicus Limited earns FDA clearance for its first AI algorithm, which assesses breast density from mammography studies.

Healthcare Triangle and CareTech Solutions partner to offer Meditech customers their cloud-based disaster recovery / backup solutions and secure hosting, respectively.

Allscripts-owned Veradigm signs a three-year deal giving ConnectiveRx exclusive rights to deliver electronic prescription coupons on Allscripts EHRs and Veradigm’s e-prescribing network.

COVID-19

The federal government says it will start delivering vaccine directly to 6,500 chain pharmacy stores starting next week to provide more vaccination sites. Walgreens, CVS, and Rite Aid are among the 21 chains involved.

Beaumont Health System (MI) temporarily shuts down its COVID-19 vaccine scheduling system after a user finds and shares an Epic loophole that allowed 2,700 ineligible patients to schedule appointments that were ultimately cancelled.

MIT Technology Review covers the many shortcomings of CDC’s $44 million VAMS vaccine management system — built by Deloitte under a no-bid contact — that South Carolina’s health department head “says has become a cuss word.” Nearly all states are passing on the free system and either building their own or paying for commercial systems, and people who are trying to use it to sign up for shots are so frequently unsuccessful that vaccine doses are going unused. The authors note that while it might seem questionable that Deloitte was given the no-bid contract despite a history of similar failures, CGI Federal has earned $5.6 billion in federal IT work since being fired for the Healthcare.gov debacle.

North Carolina upgrades its CVMS vaccine management system that one county health director says is a bigger problem than vaccine shortages. Clinics have found that it takes eight hours of data entry to record each one-hour administration of 200 vaccine doses, and that any data entry errors must be corrected at the state level.

Some California county and local health officials question the decision last week by Governor Gavin Newsom to turn COVID-19 vaccination over to Blue Shield of California, which was given an emergency, no-bid contract. Those officials note that Blue Shield has no history with a similarly sized project, the organization is a Newsom political donor, and it has minimal relationships with underserved communities. Blue Shield’s bar for success is low given that county efforts that have resulted in confusing appointment systems, shifting vaccine eligibility rules, long lines, and faulty data collection that has left the state unable to say exactly how many doses have been administered. Kaiser Permanente will run its own program for 9 million members and assist Blue Shield, but says slow vaccine shipments mean that at the current rate of vaccine deliveries, it will take four years to give just its own members their first doses.

Studies of Russia’s Sputnik COVID-19 vaccine find that it is 92% effective, with zero severe cases or deaths in the active group. Phase III results suggest that most of that effectiveness may occur after the first dose, with researchers now investigating a single-dose regimen. Mexico has already signed a contract for Sputnik and is expected to issue emergency use authorization almost immediately. The Russian government says that going through the US regulatory process isn’t a priority.

Four hundred Cerner employees will help administer COVID-19 vaccines at company headquarters later this week as part of the Operation Safe coalition in North Kansas City, MO. The coalition, which includes local hospitals and governments, hopes to vaccinate up to 4,500 people every other week.

Nine top New York health officials have quit as Governor Andrew Cuomo addresses vaccination delays by taking control away from state and local public health officials and giving it to large health systems in declaring that he doesn’t trust government scientific experts. Those workers say Cuomo blindsided them with policy decisions and ignored their plans that had required years of preparation, instead relying on long-time advisors, consultants, and a lobbyist from Northwell Health to make decisions. A former New York City health official and epidemiologist says the government lost control of vaccination pacing early by giving most of its doses to hospitals, which they say lack the skills, experience, and perspective to manage a public health initiative.

Meanwhile, Governor Cuomo says he may reopen indoor restaurant dining on Valentine’s Day even though per-capita case counts are 64% higher than when he halted indoor dining in December. The New York Times says that the graphs he used to illustrate a recent drop in test positivity rates are misleadingly optimistic in several ways.

In England, World War II veteran Captain Sir Tom Moore, who raised dozens of millions of dollars for NHS last year by walking through his garden to observe his 100th birthday, dies of COVID-19.

Other

The New York Times finds that major health systems are declining to bill Medicaid for treatment of auto accident injuries and are instead placing liens on the accident settlements of patients for the full, undiscounted list prices of services rendered. Medicaid would have paid $2,500 for one patient’s treatment, but the hospital used a lien to go after $13,000. Hospitals are asking patients to sign waivers agreeing to not bill insurance, telling them their insurer shouldn’t have to pay for an accident someone else caused, failing to mention that signing means the patient themselves will pay the full price out of any settlement they receive. HFMA, in an apparent “if it’s not illegal it must be ethical” view, says it is reasonable for hospitals to seek payment from whoever will pay the most.

Best in KLAS

KLAS announces “Best in KLAS Software & Services 2021,” which includes a change in which products in niche categories are awarded full “Best in KLAS” distinction rather than the previous “Category Leader.” Some of the winners are:

• Epic, Galen Healthcare Solutions, and The Chartis Group are named as notable performers.
• IBM Watson Health Merge PACS is named most-improved software product, while Athenahealth’s AthenaPractice EMR is tagged as most-improved physician practice product.
• The top three highest-ranked software suites are Epic, Meditech Expanse, and Cerner.
• Epic, Athenahealth, and NextGen Healthcare take the top three spots among physician practice vendors.
• The top three IT services firms are Galen Healthcare, Prominence, and S&P Consultants.
• Chartis Group, Accenture, and Guidehouse earned the top three spots in healthcare management consulting.

Some of the individual category winners:

Inpatient Clinical Care

• Large-hospital acute care EMR: Epic
• Small-hospital acute care EMR: Meditech Expanse.
• Clinical decision support (care plans and order sets): Zynx Health.
• Interoperability platform: InterSystems HealthShare

Ambulatory and Post-Acute Care

• Large-practice ambulatory EMR: Epic
• Medium-sized practice ambulatory EMR: NextGen Healthcare
• Large-practice practice management: Epic
• Medium-sized practice management: NextGen Healthcare
• Small practice ambulatory PM/EHR: Kareo
• Ambulatory specialty EHR: PCC (pediatrics)
• Ambulatory care RCM services: R1 RCM
• Behavioral health: Cerner
• Claims and clearinghouse: Waystar
• Small home health EHR: Meditech
• Large home health EHR: MatrixCare
• Long-term care: PointClickCare
• Patient intake management: Phreesia

Financial, Revenue Cycle, and HIM

• Business decision support: Strata Decision Technology
• Charge master management: Vitalware by Health Catalyst
• Claims management: Quadax
• Clinical documentation improvement: ChartWise
• Computer-assisted coding: Dolbey Fusion
• ERP: Workday
  AI/data science solutions: Epic
• Business intelligence and analytics: Dimensional Insight
• Large-hospital patient accounting and management: Epic
• Small-hospital patient accounting and management: Meditech Expanse
• Patient financial engagement: Patientco
• Quality management: Nuance Quality Solutions
• Robotic process automation: Databound
• Nurse and staff scheduling: Schedule360
• Physician scheduling: QGenda
• Front-end speech recognition: Nuance Dragon Medical One
• Talent management: Workday
• Time and attendance: API Healthcare

Value-Based Care

• CRM: Salesforce
• Digital rounding: GetWellNetwork
• Interactive patient systems: PCare
• Patient outreach: Well Health
• Patient portal: Epic MyChart
• Population health management: Innovaccer
• Remote patient monitoring: Health Recovery Solutions
• Videoconferencing: Microsoft Teams
• Virtual care, non-EHR: Caregility

Security and Privacy

• Access management: Identity Automation
• Clinical communications: Telmediq by PerfectServe
• Security and privacy consulting: Impact Advisors
• Security and privacy managed services: CynergisTek

Services and Consulting

• Application hosting: Epic
• Clinical optimization: Chartis Group
• Eligibility enrollment: Change Healthcare
• Financial improvement consulting: Chartis Group
• Go-live support: Engage
• Healthcare management consulting: Chartis Group
• Health IT advisory: Huntzinger Management Group
• Large implementation leadership: Engage
• Small implementation leadership: S&P Consultants
• Staffing: Galen Healthcare
• Outsourced coding; AGS Health
• Revenue cycle optimization: Softek
• Revenue cycle outsourcing: Ensemble Health Partners
• Transcription services: AQuity
• Value-based care consulting: ECG Management Consulting
• Value-based care managed services: Arcadia

Sponsor Updates

• Diana Nole, EVP and GM of Nuance’s Healthcare division, joins the Exactech Board of Directors.
• Harris Healthcare migrates its Harris Flex EHR to the InterSystems Iris for Health data platform.
• Healthcare Triangle offers customers its cloud-based disaster recovery and backup services along with Meditech-certified secure production hosting of EHR and enterprise applications from CareTech Solutions.
• TMC names Alcatel-Lucent Enterprise’s Rainbow cloud-based communication platform a 2021 Remote Work Pioneer.
• Artifact Health publishes a case study, “OU Health standardizes physician query workflow and achieves positive results.”
• Change Healthcare publishes a new e-book, “Poised to Transform: AI in the Revenue Cycle – a Signature Research Study.”
• The Chartis Group promotes Ben Perry to principal in its Strategy Practice.
• Engage and Navin Haffty announce they have aligned sales forces to improve the client experience.
• Swiss Re will leverage Diameter Health’s Fusion data-refinement technology to improve the speed and quality of their life insurance underwriting.

Blog Posts

• Driving Positive Outcomes with Virtual Care (AdvancedMD)
• Great Partner Management – The Keys to the Kingdom (Ascom)
• Leaning into Telemedicine: 5 Ways to Enable More Effective Virtual Visits (CereCore)
• Top 4 Tips for Transitioning to a New EHR (ChartLogic)
• Healthcare 2021: Regulatory trends to watch (EClinicalWorks)
• CEO’s Corner: It’s not a Debate, Healthcare is Broken (Emerge)

Contacts

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

HIMSS Confirms that HIMSS21 Remains On Track

HIMSS announced in an exhibitor communication this morning that HIMSS21 remains on track for August 9-13 in Las Vegas. It will be a “completely reimagined hybrid event” that includes an online component.

HIMSS says registration timing is comparable with previous years, 11,000 HIMSS20 registrants can transfer their registration to HIMS21, and 10,000 hotel room dates have been reserved. It has received 700 session proposals, also comparable with past years.

Exhibitor count is at 400, about two-thirds the usual number in a comparable timeframe.

HIMSS says it will set a go/no go date for the in-person component closer to the conference date when the impact of vaccination rates, infection rates, and government health recommendations will be clearer.

HIMSS will provide its next HIMSS21 update on February 19, when the registration opening date will be announced.

HIMSS22 remains on schedule for March 2022 in Orlando.

Morning Headlines 2/2/21

CloudWave Acquired by Abry Partners

Private equity firm Abry Partners makes a majority investment in healthcare cloud and managed services vendor CloudWave.

Hillrom Announces Acquisition Of Contact-Free Continuous Monitoring Technology From EarlySense

Hillrom purchases contact-free, continuous-monitoring technology from EarlySense for $30 million.

Beaumont shuts down scheduling vulnerability that allowed people to ‘cut in line’ for vaccinations

Beaumont Health System (MI) temporarily shuts down its COVID-19 vaccine scheduling system after discovering a user had found and shared a loophole in the Epic system that allowed 2,700 ineligible patients to schedule appointments.