Morning Headlines 3/4/21

Amazon Care’s health provider has quietly filed paperwork to operate in 17 more states

Care Medical, which powers the Amazon Care virtual and house-call clinic offered to Amazon employees in Seattle, has filed paperwork to operate in 17 additional states.

One Medical’s Coronavirus Vaccine Practices Spark Congressional Investigation

The House Select Subcommittee on the Coronavirus Crisis launches an investigation into One Medical’s COVID-19 vaccination practices after NPR uncovers that it provided vaccines to ineligible patients, including some with ties to company leadership.

Post-Cyberattack, Universal Health Services Faces $67M in Losses

Universal Health Services estimates September’s cyberattack has caused $67 million in losses, according to its latest earnings report.

DispatchHealth Raises $200 Million in Series D Financing to Build Largest System of In-Home Medical Care

App-based house call company DispatchHealth raises $200 million in a Series D round of funding that brings its total raised to $417 million.

Morning Headlines 3/3/21

Health Gorilla raises $15 million to build secure APIs for medical records

Healthcare API developer Health Gorilla raises $15 million in a Series B round of funding it plans to use for market expansion and product development.

Why drug prescriptions should include diagnoses

HHS OIG Principal Deputy Inspector General Christi Grimm, MPA and HHS OIG Chief Medical Officer Julie Taitsman, MD, JD say that prescriptions should be required to include the condition for which the drug is being prescribed.

Hill-Rom accused of wrongfully pulling plug on $375 million deal

Hill-Rom cancels its plan to acquire ambulatory ECG monitoring vendor Bardy Diagnostics for $375 million, citing potentially unexpected reductions in Medicare reimbursements for patient-monitoring devices.

Preventative Wellness Startup Reperio Health Nets $6 Million in Seed Funding to Expand Proactive Health Monitoring

Reperio Health raises $6 million in seed funding to advance the rollout of its kits for employer-provided, at-home wellness screenings.

News 3/3/21

Top News

HHS OIG Principal Deputy Inspector General Christi Grimm, MPA and HHS OIG Chief Medical Officer Julie Taitsman, MD, JD say that prescriptions should be required to include the condition for which the drug is being prescribed.

They say in a Stat opinion piece that including the reason the drug is being prescribed would help Medicare detect off-label use that is not payable, such as prescribing hydroxychloroquine for COVID-19.

The authors believe that including the diagnosis would also help people organize the meds of their family members and would make it easier for pharmacists to identify safety issues. They note that privacy concerns are minimal since pharmacists are bound by HIPAA.

Cures Act standards already require EHRs to be able to send and receive the reason for the prescription.

HHS OIG previously made the same recommend in 2011, when it was endorsed by the American Pharmacists Association.

Reader Comments

From Carry On: “Re: my new CIO job. Thanks for mentioning it. I have been an avid HIStalk reader for many years and it is required reading for my team.” I’m always surprised when someone says that they read what I write, given that I just fill an empty screen with whatever interests me without considering the invisible presence of bystanders. An industry legend seemed puzzled years ago when I expressed skepticism about how many CIOs read HIStalk (since I have no way of knowing), after which that person said every CIO they know reads it. Regardless, I’m happy to have anyone who keeps coming back.

Webinars

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

Acquisitions, Funding, Business, and Stock

Mayo Clinic-backed maternal and fetal remote patient monitoring company Marani Health raises $3.7 million.

Blueprint Health Merger will raise $200 million through its IPO, according to SEC filings. Led by former Thomson Reuters CEO Richard Harrington and former Virgin Pulse CEO Rajiv Kumar, MD the blank-check company plans to pursue digital healthcare deals.

Health IT vendor MTBC renames itself CareCloud, the EHR vendor it acquired last year for $36 million.

DeliverHealth Solutions completes its acquisition of Nuance’s transcription services business and EScription technology, first announced last November. Nuance holds a minority share in the Madison, WI-based company.

Hill-Rom cancels its plan to acquire ambulatory ECG monitoring vendor Bardy Diagnostics for $375 million, citing potentially unexpected reductions in Medicare reimbursements for patient-monitoring devices. Bardy has filed a lawsuit in an effort to force the acquisition.

Truvian Sciences raises a $105 million Series C round of financing. The company, which counts former Livongo Chairman Glen Tullman among its investors, is developing an automated, bench-top device that can perform multiple blood tests. Truvian President and CEO Jeff Hawkins has stressed that the company’s goals are far less “extravagant” than those of its pseudo-predecessor, Theranos.

Reperio Health raises $6 million in seed funding to advance the rollout of its kits for employer-provided, at-home wellness screenings. The co-founders came from contact lens prescription service Sightbox, which Johnson & Johnson acquired in mid-2017 and then shut down two years later.

Sales

• Apervita embeds Diameter Health’s data optimization and interoperability capabilities within its care collaboration software.
• The government of Scotland chooses Genesis Automation for hospital inventory tracking.

People

Philips hires Shez Partovi, MD (Amazon Web Services) as chief innovation and strategy officer and a member of the company’s executive committee. He held executive informatics roles at Dignity Health from 2011-2018 and helped launch the biomedical informatics program at Arizona State University. He replaces Jeroen Tas, who is leaving the company to spend more time coaching digital businesses.

Divurgent hires Adam Tallinger (Impact Advisors) as VP of provider services.

Optum names Maia Laing (HHS) VP of product.

Industry long-timer Drex DeFord, MSHI, MPA (Drexio) joins CrowdStrike as executive healthcare strategist.

Keith Lynn (Virtustream) joins ChartSpan as CTO.

Announcements and Implementations

Northern Inyo Healthcare District (CA) will implement Cerner Millenium through the CommunityWorks program.

Sharp HealthCare is using Experian Health’s Patient Schedule to allow patients to self-schedule COVID-19 vaccinations.

Highmark Health and Verily will develop digital solutions for chronic care management in a six-year collaboration that includes Verily-owned wellness app vendor Onduo, whose CEO is former National Coordinator Vindell Washington, MD, MS.

Diameter Health develops a HL7 C-CDA Online Search Tool for the Consolidated Clinical Document Architecture and its Companion Guide.

Community Hospital (CO) goes live on Meditech Expanse.

Gatorade introduces its first wearable, a “sweat patch” and IOS-only app that measures sweat loss during exercise to recommend the volume of sports drink to consume as a replacement (guess which one?) Single-use patches costs $12.50 each, which would seem to limit the potential customer base.

Period tracking app vendor Clue earns FDA clearance for its “digital birth control,” which statistically models a woman’s self-reported period onset to predict days where they are more likely to become pregnant. The company claims that the app is 92% effective with typical use, although it recently removed a similar feature from its period tracking app because it was found to be unreliable for avoiding pregnancy. The company’s user access agreement had better be airtight to prevent disastrous payouts from the inevitable lawsuits that claim unwanted pregnancy in demanding the net present value of the resulting lifetime cost.

Senior living community operator Asbury Communities renames its Frederick, MD-based IT outsourcing and consulting group to ThriveWell Tech.

Government and Politics

CMS hires Liz Fowler (Commonwealth Fund) to lead its Center for Medicare and Medicaid Innovation.

Naval Medical Center San Diego goes live on Cerner in the fourth wave of the DoD’s MHS Genesis rollouts.

COVID-19

President Biden says that the US will have enough doses of COVID-19 vaccine to give every adult American their shots by the end of May, cutting two months off the previously announced timeline.

Merck will help competitor Johnson & Johnson manufacture the latter’s COVID-19 vaccine in a deal brokered by the White House to ramp up supplies. Merck, which manufactures and sells several other vaccines, halted Phase 1 clinical trials of its own COVID-19 vaccine on January 25  when the product failed to elicit adequate antibody response.

Novavax expects FDA to issue Emergency Use Authorization for its COVID-19 vaccine as early as May. Novavax, which has a contract to supply 100 million doses to the US, was forced to delay the start of its Phase 3 trials twice due to manufacturing holdups, possibly giving it a too-late start in the race and raising the potential that patients will go off-study to get a known vaccine rather than a possible placebo.

Microsoft admits that problems with its COVID-19 vaccine appointment scheduling system have caused frustration for several states and their residents, with errors, web page crashes, and inability to complete appointments. The timing is not great given that the company’s recent rollout of Microsoft Cloud for Healthcare.

Researchers find that high employee turnover at nursing homes may have contributed to their large number of COVID-19 deaths, as their infection control practices may not have been adequate. The average nursing home experienced a 128% one-year turnover rate, while some exceeded 300%. Owners of nursing homes, many of them for-profit companies and private equity firms, say Medicaid doesn’t pay them enough to ensure adequate staffing, while observers note that any increase in federal payments should be earmarked to make sure they don’t end up in the pockets of those owners.

Colleges that spent big money on symptom-based COVID-19 screening technologies such as temperature scanners, self-reporting app passports, location tracking, and heart rate monitors have seen few results because the technologies can’t detect pre-symptomatic carriers, they are often inaccurate, and they aren’t always used consistently. Most of the schools, some of them eminent medical research centers, aren’t studying the effectiveness and outcomes of their use of the technologies.

The founder and CEO of Zocdoc explains why vaccination self-scheduling is harder than it looks:

• Walled garden practice management systems weren’t designed to connect to patient-facing scheduling systems.
• Sign-up screens collect too much information upfront before showing any available appointments, and if none are available, the user is required to start over to try again.
• Too little time was available to develop scalable, integrated systems.

Other

Nursing informatics students: AMIA is offering a travel stipend for poster presenters at this fall’s annual symposium in San Diego, with submissions due March 10. That’s bringing back my fond memories of HIMSS in San Diego, where I enjoyed the opening reception on the patio overlooking the bay, Old Town for Mexican food, and Balboa Park for walking in the sun. They still haven’t expanded the civic center, so San Diego will remain a HIMSS orphan along with New Orleans, Atlanta, and Dallas (I’m excluding Chicago since HIMSS is like a jilted lover who wants desperately to patch things up despite its two-for-two whiffs).

Madison Magazine profiles Carebot Health, launched by Healthfinch co-founder Jonathan Baran and former Healthfinch sales director Tyler Marklein last March. The startup is focused on helping providers use its automated software to manage COVID-19 vaccinations. Health Catalyst acquired Healthfinch in July for $40 million.

In a reverse telemedicine (or perhaps a telejudicial) session, California’s medical board investigates a plastic surgeon after he reports to his Zoom traffic court hearing while wearing scrubs in front of a patient who was on the operating table. A Superior Court commissioner ends the proceeds — eloquently, I would say — in explaining, “Unless I’m mistaken, I’m seeing a defendant that’s in the middle of an operating room appearing to be actively engaged in providing services to a patient … I do not feel comfortable for the welfare of a patient if you’re in the process of operating.”

Sponsor Updates

• Meditech announces that 61 hospitals went live on Expanse in 2020.
• Cerner Chief Human Resources Officer Tracy Platt joins the Kansas City Chamber of Commerce board.
• Deloitte will offer CareSignal’s Deviceless Remote Patient Monitoring to its healthcare clients.
• ChartSpan announces its partnership with I2I Population Health.
• The local news covers the new $240 million CoverMyMeds headquarters, set to open sometime this summer.
• Staffing Industry Analysts includes Ettain Group CEO Trent Beekman on its “Staffing 100” list.
• Elsevier Clinical Solutions adds additional resources to its COVID-19 Healthcare Hub, including a COVID-19 Vaccine Toolkit and ICU Nurses Refresher Toolkit.
• Wolters Kluwer Health introduces Lippincott Clinical Context, a suite of digital learning tools intended to help medical schools as they incorporate digital and remote instruction into their curriculum.

Blog Posts

• Bring efficiency and visibility to COVID vaccine distribution (Ability Network)
• Survey Results: Are We Returning to Normal? (Access)
• Data Security Best-practices for Remote Workers in 2021 (AdvancedMD)
• ECR2021 – Explore the Enterprise Imaging Journey (Agfa HealthCare)
• Leveraging Your EMR Investment: 3 Lessons Learned from an Epic Telehealth Video (Twilio) Install (Bluetree)
• Here’s What Has to Change for Women to Thrive in STEM (CarePort)
• How to Close Gaps in Care and Gather Quality Data During and After the Pandemic (CareSignal)
• Intelligent Transport: Because Faster is Better for Patients and Providers (CentralLogic)
• Easily Identify Eligible Medicare Beneficiaries for Annual Wellness Visits (ChartSpan)
• Data Quality Matters (Clinical Architecture)
• What’s Next in Healthcare Innovation 2021? (Dimensional Insight)
• What’s FHIR and How Will it Drive Healthcare Interoperability? (EClinicalWorks)
• Patient perspectives on the state of patient access (Experian Health)
• Closing the healthcare cybersecurity gap (Cerner)

Contacts

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

Morning Headlines 3/2/21

MTBC Announces Name Change to CareCloud, Inc., Doubles Down on Innovation & Growth

Ambulatory health IT vendor MTBC will change its name to CareCloud, which it acquired in January of last year.

Top Health Industry Leaders Launch Historic Coalition to Modernize California’s Health Information Systems

Fourteen healthcare organizations come together to form Connecting for Better Health, a California-based coalition in support of state efforts to create a unified HIE.

Babylon Expands its US-Based C-Suite Team to Lead Ambitious Growth Plans

UK-based virtual care company Babylon Health names Steve Davis (Expedia) CTO, Stacy Saal (Amazon) COO, and Paul-Henri Ferrand (Brex) chief business officer.

Curbside Consult with Dr. Jayne 3/1/21

My calendar made me smile today with an appointment reminder that had 2020 been a normal year, I would be in Las Vegas attending HIMSS21 and drinking martinis with all of my healthcare IT friends. Alas, it was not meant to be. Instead, I’m ever-present in my home office digesting a constant stream of email, press releases, and journal articles.

The theme of the week seems to be telehealth, with different companies in the news. MDLive, which was thought to be setting up for an IPO, was instead acquired by Cigna’s Evernorth subsidiary. At the same time, Mercy and Humana teamed up to expand access to telehealth services for Humana Medicare Advantage members. The latter agreement is particularly interesting because it specifically called out a value-based care component of the relationship. Once the US healthcare system begins to fully process the burden of COVID-related care, I suspect there will be a greater drive towards value-based care.

Due to the fragmented testing strategies across the country, many patients are receiving high-cost testing at urgent care centers that require a physician visit to justify the testing. A better strategy would have been to enable public health-based testing, where patients could have been tested under standing orders from local public health authorities, reducing the overall burden on the system. The nation has been walking a tightrope, balancing the need to ensure access to testing with the potential for out-of-control testing costs.

I see this in my urgent care practice, which is one of the organizations requiring a provider visit prior to testing. Patients are seen and examined, then the most appropriate test is determined, ordered, and obtained. Over the last few weeks, we’ve seen a shift in testing behavior. Previously, the majority of our tests were done on symptomatic or exposed patients, with rare testing for travel. Now we’re seeing a boom in pre-travel testing, and doing that kind of testing in an urgent care setting is a significant waste of resources. We are also seeing people just coming in to be tested weekly because they can, and because they don’t have any financial skin in the game. They’re going about their lives unmasked and practicing unsafe behaviors and the rest of us are picking up the tab.

Out of necessity, we don’t want to create barriers to testing, and as a physician, I totally get that. Recent executive orders and subsequent guidance from federal agencies make it clear that patients must be tested with no cost sharing or utilization management oversight. As someone watching the costs mount, especially in states that didn’t bother to prioritize low-cost testing options, it’s anxiety-provoking.

Fast-forward then to a new world where payers are going to be looking to make up for all of those expenditures. Premiums are certainly going to rise, and they’re going to crack down on payments for other services. I predict that use of low-cost telehealth services will be pushed to the forefront. That’s good for patients who are technology-savvy and value the convenience. It’s not so good for patients who don’t have access to technology or aren’t skilled with it, or for whom an in-person visit would be better. Telehealth may become an additional layer of triage that helps control which patients receive more expensive in-person services, and this is most certain to happen if payment parity for telehealth services does not continue.

Practicing in a telehealth environment doesn’t come naturally to physicians, and few schools taught telehealth skills prior to the pandemic. I enjoyed reading a recent article in the American Family Physician journal which explained how to do high-quality management of musculoskeletal issues through a telehealth encounter. That’s the kind of practical retraining that many physicians are going to need if they’re going to be expected to practice in that world. They shouldn’t be expected to just figure it out on their own, as most have had to do.

But if they are going to be held to the same value-based care metrics and standards that they are held to in the brick-and-mortar world, they’re also going to need adequate telehealth infrastructure to deliver it. This means being able to coordinate visits with ancillary providers such as registered dieticians or certified diabetic educators and being able to leverage high-quality remote patient monitoring services. Although these are great concepts, we’re not remotely close to delivering that level of care to most of the US.

I’ll be watching the recent telehealth acquisitions, agreements, and expansions closely to see who is hitting the mark and who starts drifting off course. Many organizations will be forced to migrate from make-do virtual visit platforms to robust telehealth solutions that integrate with the EHR. Physician groups will have to determine how they figure telehealth into evolving physician compensation strategies. Much like groups might pay physicians less when they stop taking overnight call, will they pay physicians less if they elect not to come into the office? Will they create different kinds of practice-share arrangements for teams of virtual and in-person physicians to partner together? Will telehealth be part of a continuum of care, or will it continue to be a bit siloed?

I’ll also be watching lab and other ancillary businesses. Will the big lab vendors start performing COVID testing in person, so that a patient could receive a telehealth-driven order for testing and go to a lab patient service center to have it collected, just like they might go for a blood draw or a urine culture? Or will local public health agencies step up to fill that void, especially since those states that had mass testing centers are starting to close them down? Will we see COVID testing booths on street corners like you might see in other countries? The devil will be in the details as far as how we try to contain costs and deliver the medical services that provide the most value to our patients without breaking the bank.

Looking in your crystal ball, what do you think are the next steps for telehealth in the US and around the world? Will we see massive shifts in utilization? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/1/21

As Demand for Virtual Health Care Surges, Evernorth Announces Acquisition of Long-Term Partner, MDLive

Cigna’s Evernorth health services business will acquire telehealth vendor MDLive.

Marani Health (Formerly Odonata Health) Raises $3.7M; Appoints Health Care Veteran Jodi Hubler to the Board

Mayo Clinic-backed maternal and fetal remote patient monitoring company Marani Health raises $3.7 million.

Health Catalyst Reports Fourth Quarter and Year End 2020 Results

Health Catalyst reports Q4 results: revenue up 22%, EPS –$0.16 versus -$0.21, beating estimates for both.

Digital healthcare SPAC Blueprint Health Merger files for a $200 million IPO

Led by former Thomson Reuters and Virgin Pulse CEOs, Blueprint Health Merger’s SEC filings indicate it plans to raise $200 million in an IPO.

Monday Morning Update 3/1/21

Top News

Cigna’s Evernorth health services business will acquire telehealth vendor MDLive, the company announced Friday. Terms were not disclosed.

MDLive had raised $200 million and was reportedly valued at $1 billion early last fall, when it was considering an IPO.

Reader Comments

From Umbrella Beverage: “Re: Twilio. Was down Friday, affecting the ability of multi-factor authentication vendors (Entrust, Duo, Imprivata) to send out second-factor push or SMS notifications to phones, thus the ability of those users to access any services. Have the Russians figured out that Twilio is the center of the SMS universe?” Twilio’s incident log shows Friday downtime with “cross-platform API erors involving multiple products” that was resolved at just after noon Eastern on Friday. I’ll take this as an opportunity to provide some background on Twilio. The company offers APIs for sending and receiving phone calls and text messages, such as those for two-factor authentication, and Epic uses Twilio Programmable Video for its native telehealth offering. Twilio is huge, with 4,500 employees,  over $1 billion in annual revenue, and a $61 billion market cap. TWLO shares are like riding a rocket, up 240% in the past year versus the Dow’s 20% rise. Had you invested $10,000 on April 20, 2020 when the company’s deal with Epic was announced, you would be holding well over $36,000 in shares today. The co-founder and CEO is a multi-billionaire, of course.

HIStalk Announcements and Requests

One might quibble with the clinical and business operations of hospitals, but don’t doubt their ability to market themselves, although their owned medical practices don’t register to poll respondents any higher than independent ones (probably because they don’t always make their ownership obvious). 

New poll to your right or here: How does your employer’s company culture compare today to a year ago? Define “company culture” however you like, but in general, think of the company’s social fabric – what it encourages or discourages, how it relates to employees and customers, how well its goals align with those of employees, and how its beliefs and leadership practices are likely to make it successful for the long term. Vote, then click the “comments” link to explain whether you saw changes during the pandemic.

March 1 isn’t spring, but with the changes in weather and COVID-19 trajectory, it feels that way, especially now that baseball spring training games have started. It was one year ago Friday that HIMSS20 was cancelled, an early warning that 2020 was going to be eventful in all the wrong ways. Parts of the country that were almost cold enough to store Pfizer’s COVID-19 vaccine on the back porch last week have swung to daytime highs that are nearly 100 degrees warmer. I get the feeling that the US economy is about to rebound vigorously, although national debt, lingering and structural unemployment, political divisiveness, and income inequality are sobering long-term issues that could have major geopolitical ramifications.

I started subscribing in 2017 to a little-known app called Texture, which was like the Netflix of magazines. Apple bought the company a few months later, subscriptions automatically lapsed while Apple retooled their acquisition, and I lost interest and didn’t sign up under the newly christened Apple News+. I discovered this weekend that Mrs. HIStalk had subscribed on her own, mostly to read The Atlantic, and I Googled to find that her $9.95 per month subscription can be shared by up to six family members under Apple’s Family Sharing (which also includes Apple’s music, TV, games, and ICloud storage subscriptions – am I the only person who didn’t know about this?) I’m back in, and minor quibbles aside about lost features (easy back-issue searching, such as for Consumer Reports), it’s better now. Included are a bunch of expensive national newspapers, like the Los Angeles Times and San Francisco Chronicle; the Wall Street Journal (!!); Business Insider; PCMag; National Geographic; Consumer Reports; and 300 magazines with a nice mix of travel, food, sports, and vacuous celebrity updates. Like Texture before it, you can follow specific publications or topics, but it also brings up articles it thinks you’ll like based on your perusal habits, giving you an endlessly scrolling page of reading material that beats the heck out of killing time on Facebook looking at feta pasta recipes and faked prank videos.

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst reports Q4 results: revenue up 22%, EPS –$0.16 versus -$0.21, beating estimates for both. HCAT shares are up 69% in the past 12 months versus the Nasdaq’s 54% gain, valuing the company at $2.1 billion.

From the Allscripts earnings call:

• Paul Black chose the perhaps unfortunate term of “infectious enthusiasm” to describe the company’s success in 2020.
• The company will continue to encourage on-premise clients to move to its Azure-powered hosting services.
• The Veradigm EHR and linked claims data-selling business was discussed at some length, with the company noting that while most of its data comes from the ambulatory EHRs of customers, that’s the most important to drug companies since that’s where most prescribing happens.
• CEO Paul Black reiterated that it sold EPSi and CarePort Health in Q4 because those businesses “were not receiving the appropriate valuation under Allscripts ownership.”
• Black says he does not see the just-formed Truveta organization, which includes big Allscripts client Northwell, as affecting its Veradigm business.
• President and CFO Rick Poulton says that the company’s “extensive data rights” from its ambulatory EHR customers give Veradigm an advantage over competitors who are chasing that “in vogue” business model.
• Allscripts expects the fragmented US EHR market to consolidate and the company expects to be a net winner in system replacement, while “outside the US is still a lot of greenfield.”
• Black said, in response to an analyst’s question, that client feedback on Sunrise 20.0 has been “universally positive,” but declined to specifically answer another question about the number of Sunrise clients.

Humana will offer its Medicare Advantage customers who are patients of Mercy access to the health system’s Mercy Virtual telehealth service. Also included in the agreement is a value-based care component, where Humana will pay Mercy based on outcomes instead of fee-for-service.

TriNetX appoints four new members to its board following October’s acquisition of a majority stake in October 2020, including former Pfizer Chairman and CEO Ian Read as chair.

COVID-19

FDA issues its Emergency Use Authorization to the COVID-19 vaccine of Johnson & Johnson’s Janssen subsidiary, a single-shot product that requires simple refrigeration instead of the two-shot, freezer-stored vaccines from Pfizer and Moderna. The boost in vaccine supply to 20 million doses per week, along with the new vaccine’s simple storage requirements, could add up to 25% to US vaccination capacity almost immediately. Mostly missed by the press – the first two vaccines were tested before coronavirus variants surfaced, so their efficacy against them is unknown, but the J&J vaccine were tested later and was proven to be effective against those variants (suggesting that the other two vaccines probably are also effective).

CDC reports that 73 million doses of COVID-19 vaccine have been administered out of 96 million distributed (76%), with 19% of the adult US population having received at least one dose. The pace could soon reach 3 million doses per day.

A KFF poll finds that the percentage of Americans who plan to wait and see before being vaccinated has dropped from 39% in December to 22% now. The 15% who say they won’t get it under any circumstances remains unchanged. Groups with the highest resistance to being vaccinated are Republicans and rural residents, while 25% of non-healthcare essential workers and 14% of healthcare workers fall into the “wait and see” category.

The state of California declines to renew its coronavirus mobile testing contract with Alphabet-owned Verily, which the federal and state government touted last year as a high tech approach to help Americans find COVID-19 testing. The state says the program, which cost $63 million and was operated entirely by subcontractors, didn’t serve poor areas of the state. Optum/UHG-owned OptumServe is now operating state vaccine clinics, but one county had already cancelled its contract with OptumServe, saying that its testing clinics were poorly run, performed only a few dozen tests in each 12-hour session, spent a lot of money sending negative tests results by FedEx next-day delivery instead of electronically, and were staffed by employees who were “coughing violently” and not wearing PPE.

Other

A two-year study finds that Medicare’s PAMA decision support requirement for ordering expensive advanced imaging exams – as implemented with Change Healthcare / National Decision Support Company CareSelect – improved ordering appropriateness. The authors note the limitations of their study – inappropriate use could have been reduced by other simultaneous changes, users can game CDS by choosing an invalid ordering reason, and the lack of pre-CDS implementation data – but their next step will be to have experts determine order appropriateness by reviewing EHR and imaging data.

A few Epic employees told the Madison paper that the company has told employees to stop holding discussion groups related to diversity, equity, and inclusion on company time and has eliminated a training session on identifying white privilege. The article notes that Epic, with $2.9 billion in annual revenue and 10,000 employees, is unusual for not having a chief diversity officer or other executive to manage equity and inclusion and instead created a a diversity council made up of five employees who still work in their full-time jobs.

A Florida pediatrician who was arrested on child pornography charges asks the court to let him conduct telehealth visits. He initially told investigators that he thought he was downloading photos of older girls, but finally agreed with a detective’s observation that a pediatrician should be able to recognize pre-pubescent children.

Sponsor Updates

• Meditech launches a Telemetry Appropriateness Toolkit in its Expanse EHR.
• PatientPing publishes a new case study, “How Kintegra Health is improving transitions of care and succeeding in value-based care programs through real-time ADT notifications.”
• PeriGen’s innovative perinatal technology supports the US Surgeon General’s call to action to improve maternal health.
• The Ethisphere Institute recognizes Premier as “One of the World’s Most Ethical Companies” for the 14th year in a row.
• Pure Storage announces fourth quarter and full year fiscal 2021 financial results.
• Sectra publishes a new e-book, “The radiologist’s handbook for future excellence 2021: Key technologies to amplify success.”
• Krames publishes a new infographic, “Easy telehealth tips to drive positive patient experience.”
• Vocera releases a new podcast, “The Burden and Joy of Caregiving During the Pandemic.”

Blog Posts

• How healthcare workers can overcome increased levels of stress and burnout (Nuance)
• Let your physician builders build (or architects architect) (Nordic)
• What You Need to Know: 2021 Patient Financial Responsibility Trends (PatientBond)
• Why CBO Billers and Coders Need a Charge Aggregation Tool (PatientKeeper)
• Coordinating COVID-19 Vaccination: 3 Essential Elements (PerfectServe)
• MIPS 2021 – What’s New? (PMD)
• Does Your Claim Scrubber Meet Your HCC Coding Needs? (RCx Rules)
• 5 Reasons Why You Need to Prioritize Prescription Price Transparency (RxRevu)
• 7 Lessons in Communication From a TeleNeurology Practice (SOC Telemed)
• How to master rollout of a secure messaging app (Spok)
• New Prior Authorization Rule Puts Patients Over Paperwork (Surescripts)
• How price transparency can help you drive revenue (Waystar)
• The Art of Getting Acquired: How to Prepare Your PT Clinic for Sale (WebPT)
• Well Community Outreach Enables Clinics to Secure More Medicaid Revenue (Well Health)

Contacts

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

Weekender 2/26/21

Weekly News Recap

• Allscripts and Teladoc Health release quarterly results.
• Healthcare Bluebook acquires the quality division of Quantros.
• Innovaccer raises $105 million at an implied valuation of $1.5 billion.
• Redox announces a $45 million Series D funding round.
• Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.
• IBM is rumored to be looking at selling IBM Watson Health.

Best Reader Comments

When resource limited, and dealing with existing systems and a legacy of choices, “apps are dead” can sound a little blasé and soundbite-y. Now add in organizational politics, budgeting, and available skill sets. The choices get more complicated. Absent those factors though, there’s a lot to like about “apps are dead”. You get a single code base that supports all devices. Support lines tend to be simpler too. But sometimes? An old app can do a better job than the new replacement! (Brian Too)

I think the green passport idea is great. It might allow the free market to push the vaccine-hesitant to get on board when businesses and airlines start advertising special privileges for passport holders. The problem in the US, though, is that we can’t seem to get a nationwide IT system for anything unless it involves the IRS. (Bob)

We should challenge developers (I am one) to think critically. Also, bugs aren’t exclusive to coding errors. (RobLS)

Watercooler Talk Tidbits

Two Vanderbilt University Medical Center physicians publish “From Two Doctors,” a newsletter that highlights the pandemic’s unsung heroes. Assistant Professor of Clinical Medicine Michelle Izmaylov, MD is a published author of fantasy fiction books and medical essays, while Thea Swenson, MD is a medical resident who formerly worked in health IT startup marketing and product development. Both are first-generation Americans, from Russia and Vietnam, respectively. 

A technology reporter whose broken collarbone left him with his arm in a sling for six weeks describes how accessibility technology helps people with disabilities. Topping his personal experience list is AI-based transcription for typing on all devices, which taught him that voice typing on his phone is three times faster than finger typing. He likes the dictation and voice control technology of Google Docs best. Runner-up accessibility winners are biometric authentication, password manager apps, and finger swipe typing.

PCP versus demanding customer: In Australia, D-list reality show celebrity Yvie Jones complains in a profanity-filled Instagram post that she saw her doctor about a lump on her neck and while there, he suggested that she see a dietician. She declared that she has been “weight-shamed by my doctors for years” and said that she and many others “would rather die than be spoken so poorly to” by doctors who “never focus on what we’re there for.” She has previously posted recaps, sometimes with photos, of her other medical issues, including case of hives following a cat allergy, peri-menopause, iron deficiency, abdominal cramping, a back problem, depression, and weight loss surgery.

NHS England urges people to ignore the medical advice of celebrity huckster Gwyneth Paltrow, who claims that her COVID-19 infection and the resulting long COVID were successfully treated with her expensive, Goop-branded nutritional products. If faux COVID cures aren’t your thing, the college-uneducated GP will be happy to sell you – hopefully delivered in an unlabeled package – an $80 candle that smells like her vagina.

In Case You Missed It

• News 2/26/21
• EPtalk by Dr. Jayne 2/25/21
• HIStalk Interviews Michele Perry, CEO, Relatient
• News 2/24/21
• Curbside Consult with Dr. Jayne 2/22/21
• HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health
• Monday Morning Update 2/22/21

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 2/26/21

Allscripts Announces Fourth Quarter 2020 Results and Outlook For 2021

Allscripts reports Q4 results: revenue down 7%, adjusted EPS $0.29 versus $0.17, beating earnings estimates but falling short on revenue.

Healthcare Bluebook Now Owns Largest Healthcare Quality-Cost Database in the U.S.

Healthcare Bluebook acquires the quality division of Quantros.

USDA Invests $42 Million in Distance Learning and Telemedicine Infrastructure to Improve Education and Health Outcomes

The USDA will invest $42 million in 86 projects through its Distance Learning and Telemedicine program to help rural residents gain better access to healthcare and education.

Medisafe Secures $30M in Series C Funding to Build Future Model of Patient Support

Digital prescription support vendor Medisafe raises $30 million in a Series C funding round, increasing its total to $52 million.

Teladoc Health Reports Fourth-Quarter and Full-Year 2020 Results

Teladoc Health reports Q4 results: revenue up 151%, EPS –$3.07 versus –$0.26, beating revenue expectations but falling short on earnings that were affected by acquisition and share payout costs from its $18.5 billion acquisition of Livongo in October 2020.

News 2/26/21

Top News

Population health management technology vendor Innovaccer raises $105 million in a Series D funding round, increasing its total to $225 million and valuing the company at $1.3 billion.

The company’s co-founders are Abhinav Shashank (CEO), Sandeep Gupta (COO), and Kanav Hasija (chief customer officer).

Reader Comments

From Inquiring Minds Wanna Know: “Re: Olive Health. No HCIT firm in recent years has gotten more favorable press. Not Catalyst, Zocdoc, or any of 10 other ‘show ponies’ trotted out by leading healthcare PE outfits like Francisco Partners or Vista Equity. Is it enormous budget or a new healthcare PR firm?” The company has wrapped what seems like mundane technology in a thick layer of trendy buzzwords and Silicon Valley brashness for a business whose first funding round (of $450 million total through a Series F) was a Series A in 2013. I’m surprised that the company hasn’t arranged a quick IPO or SPAC merger to take advantage of a frothy stock market, but until that happens, the only folks who can pore over its financials are the investors who have driven its valuation to $1.5 billion. I will say this, having had many HIStalk sponsors over the years whose renewed PR efforts were followed shortly after by being favorably acquired: it’s worth the effort to get a company’s message – whether pointless buzz or meaty news — out to gain and retain the attention of prospects and investors, especially the latter when those SPACs are desperately looking for acquisitions. I am uncomfortable with companies and people that promote themselves shamelessly, but I begrudgingly acknowledge that it’s hard to be successful if nobody has heard of you. Any press, good or bad, is better than no press.

From RTW: “Re: COVID-19. The biggest need is to reopen travel and offices, agreed?” No. The biggest need is to reopen schools, whose closing was scantily supported by evidence in the first place. The economy, our future economic prospects, and the mental health of citizens will suffer as long as parents are forced to stay home with their kids who are receiving an inferior online education and missing important social services and developmental opportunities with effects that won’t be obvious for years. Some parents would rather keep their kids at home, which is fine, but most would welcome that aspect of returning to semi-normal rather than expanding restaurant and bar capacity and allowing bigger sports crowds. Much has changed and been learned in the pandemic’s first year.

From Google Clusters: “Re: Google Care Studio. Recall that Epic stopped working with Google Cloud a year ago over privacy concerns.” Epic announced in January 2020 that it was calling off further integration with Google Cloud and instead would focus on Amazon Web Services and Microsoft Azure because of customer interest. Google was at that time facing privacy criticism from its deal with Ascension to develop EHR search and aggregation tools in a project that was named Care Studio this week, but I don’t recall that Epic specifically mentioned privacy concerns in its decision. Cerner also passed on Google despite a rumored incentive in the tens of millions of dollars, going with AWS instead.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Experian Health. The company collaborates with more than 3,400 hospitals and 7,300 other healthcare organizations representing 500,000-plus providers — almost 60% of the market — to provide data-driven platforms to empower its clients to make smarter business decisions, boast a better bottom line, and foster stronger patient relationships. Its industry-leading solutions include revenue cycle management, identity management, patient engagement, and care management. Thanks to Experian Health for supporting HIStalk.

Webinars

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

Here’s the recording of Wednesday’s webinar, “Maximizing the Value of Digital Initiatives with Enterprise Provider Data Management,” sponsored by Phynd.

Acquisitions, Funding, Business, and Stock

Allscripts reports Q4 results: revenue down 7%, adjusted EPS $0.29 versus $0.17, beating earnings estimates but falling short on revenue.

Healthcare Bluebook acquires the quality division of Quantros.

Redox raises $45 million in a Series D funding round, increasing its total to $95 million.

Digital prescription support vendor Medisafe raises $30 million in a Series C funding round, increasing its total to $52 million.

Teladoc Health reports Q4 results: revenue up 151%, EPS –$3.07 versus –$0.26, beating revenue expectations but falling short on earnings that were affected by acquisition and share payout costs from its $18.5 billion acquisition of Livongo in October 2020. Teladoc said in the earnings call that it provided 10.5 million virtual visits for the year and brought on 15 million new paid members. Share price dropped 14% Thursday, valuing the company at $32 billion. TDOC shares are up 123% in the past 12 months versus the Nasdaq’s 42% gain.

EHR prescription messaging platform vendor OptimizeRx reports Q4 results: revenue up 123%, adjusted EPS $0.20 versus $0.07, beating Wall Street expectations for both. OPRX shares have risen 420% in the past 12 months versus the Nasdaq’s 42% gain, valuing the company at $930 million.

People

Kate Barimani (The Advisory Board Company) joins analytics vendor Covera Health as VP of provider partnerships.

Industry long-timer Brian Graves (Hospital IQ) joins Optum as VP of provider solution sales.

Workforce management platform vendor IntelyCare hires David Burke, MBA (QPID Health) as CFO.

Montgomery County Memorial Hospital (IA) promotes Ron Kloewer, MHA to CEO. He was CIO for 28 years before being promoted to COO in November 2020 and tapped to replace the retiring CEO next month.

Announcements and Implementations

HIMSS announces that its membership has grown by 20,000 in the past six months to 100,000.

InterSystems releases an enhancement to its TrakCare health information system that will allow UK sites to schedule COVID-19 vaccinations.

Microsoft’s April update for Microsoft Cloud for Healthcare – when was released in the fall – will include a patient self-scheduling solution for Microsoft Dynamics 365, the ability to schedule and launch Microsoft Teams virtual visits from within Epic, home health and remote patient monitoring features for Dynamics 365 and Teams, and additional Azure API for FHIR capabilities for Microsoft Cloud for Healthcare tools.

Government and Politics

A Georgia man is sentenced to six months in federal prison for falsely claiming that his former girlfriend – a hospital nurse – violated HIPAA by emailing pictures of trauma patients outside the hospital.

COVID-19

CDC reports that 66 million of 89 million COVID-19 vaccines distributed have been administered (75%). About 6% of Americans have been given both doses.

A physician-epidemiologist says that COVID-19 shaved just five days off average US life expectancy in 2020, not the one-year number that CDC published last week. Public experts use life expectancy projections that assume no change from one year to another, which have been shown to distort the impact of events that affect mortality for only a brief part of the average lifetime, such as pandemics and wars. In other words, losing a full year of life expectancy would require the same number of pandemic deaths every year for the rest of someone’s life, when in fact life expectancy will almost certainly rebound to that of previous years once the pandemic is over.

FDA’s vaccine advisory committee finds that J&J’s COVID-19 vaccine offers high efficacy across all demographics, based on the company’s study data. The J&J vaccine will likely earn FDA’s emergency use authorization in the next few days. All major vaccines (J&J, Pfizer, Moderna, Novavax, and Sputnik) offer 100% protection against death or hospitalization (hat tip on that to @EricTopol), so take whatever one you can get.

US nursing home deaths from COVID-19 have fallen by 65% in the past two months as 4.5 million residents and employees have received at least one dose of the vaccine. The drop-off is even more pronounced than of the population in general.

Washington State Department of Health cuts off COVID-19 vaccine shipments to publicly traded concierge medicine provider One Medical after complaints that it provided doses to its own executives and customers who were not eligible under local guidelines. The company also offers the vaccine to all of its employees regardless of their risk factors or exposure. Doctors report that young patients with no health issues were able to sign up for a trial membership and then book a vaccination appointment even though health workers were being waitlisted, with the company responding that upgrading its systems to screen appointments was too hard and that it won’t question someone’s declaration that they are eligible.

The Ad Council looks at COVID-19 messaging for its upcoming pro-vaccination campaign, saying that positive messages (acknowledging hesitancy concerns, vaccination as a pathway to regaining human connection, protecting family, and acknowledging personal choice) will work better than negative messages (fear tactics, referring to “the right thing to do,” overpromising, and emphasizing “back to normal” that most people won’t experience). Most interesting to me is the level of trust people place in various messengers.

Other

ECRI’s health IT patient safety workgroup publishes a white paper on reducing alert fatigue. One of its recommendations is a standard set of metrics for monitoring and optimization:

• How many alerts fired and who received them? This would be reported as the number of alerts per 100 orders or per encounter, broken out by department, specialty, and the type of user who received the alert.
• Did the alert fire appropriately?
• What did the alert recipient do? That includes think time, rates of acceptance or override, override reasons, and clinician comments.
• What impact did the alert have on recipients?

A Cleveland TV station profiles Peggy and Bill Schneck, who met as 17-year-old service workers at Cleveland Clinic in 1975 and were married four years later. He studied IT and is a Cleveland Clinic systems analyst, while she became an RN and is now a nursing informatics instructor.

Sponsor Updates

• Everbridge VP of Global Account Management & Customer Success MJ McCarthy wins a 2021 Stevie Award in the category of Worldwide Sales Executive of the Year.
• Meditech publishes a new success story, “Med Center Health’s vaccination process supports high volume and eliminates waste.”

Blog Posts

• Insulin Dosing Software Explained (Glytec)
• Improving Healthcare Communication: Where to Start (Halo Health)
• The CDO Influence in Patient Experience (The HCI Group)
• How to Build a Healthcare Data Quality Coalition to Optimize Decision Making (Health Catalyst)
• Use Patient Education to Spread the Word About COVID-19 Vaccines (Healthwise)
• COVID-19 Testing Strategies: 10 Lessons from Colleges (Healthcare IT Leaders)
• Meet the First Optimum Career Path Training Class (Optimum Healthcare IT)
• Technology and transformation at Marshfield Clinic Health System, a conversation with CIO Jeri Koester (Infor)
• How Can Interoperability Solutions Help Health Plans Streamline Care, Cut Costs? (InterSystems)
• In My Opinion: Understanding the clinician’s needs with Brad Naeymi (Intelligent Medical Objects)
• Revenue Cycle Practices – Part One: The Importance and Effect of Contract Maintenance (Medhost)
• ERP System Cutovers: Preparation Considerations (Impact Advisors)
• Using a vaccine workflow in the fight against COVID-19 (Meditech)
• Top 3 Predictions for the First Virtual IHE Connectathon (Capsule)

Contacts

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

EPtalk by Dr. Jayne 2/25/21

Today’s web-based entertainment was courtesy of Nuance and its Dragon Ambient eXperience product. I’ve been keeping an eye on it since seeing it at HIMSS19.

Their demo at the time involved an orthopedic visit, which tends to be a lot more straightforward than most of the visits we have in primary care. I was hoping they would show a truly complicated visit and how the system could handle it. It was encouraging the host said they would be doing an “unscripted” demo based on attendee input through a Zoom poll with randomly generated options.

However, it quickly turned into the same old orthopedic visit that they typically show. They asked the audience to have input via poll on past medical history elements, but many of what we were given to choose from were just standard conditions like hypertension or an ACL repair.

I have yet to see a demo where the system can manage the real-world things we see in practice. Where is the history of “heart surgery” where the patient has no idea what was done or what the underlying diagnosis might have been? What about the problems that were more complex than injuring your ankle while walking your dog Lucky, which was the demo they actually showed? They showed the voice recognition streaming during the demo, and there were a number of elements where it wasn’t capturing exactly, so I was curious to see what the process would be to resolve those.

The command “Hey, Dragon, show me the x-ray” brought up an x-ray example with no patient identifiers, which failed my realism test. The physician also interpreted the x-ray before examining the patient, which is a no-no for many of us. The physician used a fair number of medical words, but didn’t really explain to the patient what those meant, including the anatomical names for the affected areas.

I wasn’t impressed by their simulated assessment and plan, which didn’t entirely follow the standard of care in that the patient was given a scheduled controlled substance for her ankle sprain, which most of us wouldn’t do until the patient failed other pain management strategies such as anti-inflammatories or acetaminophen, neither of which she said she had taken.

I know I tend to be critical since I’m a practicing physician, but it’s all part of credibility. It’s hard to find the messaging to be credible when they missed the clinical mark. Was it intentional, or did they not find it important to be clinically credible? Interestingly during the interview, the clinician ordered tramadol, but when the host reviewed the medication orders, the canned display on the back wall showed Tylenol, which maybe was an indicator that it was a little more unscripted than they planned. The final note did mention both Tylenol and tramadol, however.

They cut away to videos from physicians, including family physicians and orthopedic physicians, but they didn’t really show what this would look like in family medicine. I asked a pointed question via the Q&A chat about how the system would manage vague elements like I mentioned above. Not surprisingly, it was skipped. They did mention that they have a four-hour service level agreement for note turnaround, although they noted it can be shorter in the real world. As a physician who likes to have my notes done when I walk out of the room, that would take some getting used to. They did demonstrate how the system could filter out the conversational parts of the visit in order to create a concise note, which is promising. Still, I’d love to see how it handles a complex primary care visit.

Today’s patient-side entertainment was courtesy of my local hospital, which continued to underwhelm. I’m living the nightmare shared by a number of female healthcare providers who received the early rounds of the COVID-19 vaccines. Since it’s been two months, and statistics do what statistics do, one-sixth of us over a certain age have been due for an annual mammogram since receiving their vaccines. Both of the current vaccines tend to cause swollen lymph nodes, usually in the neck or underarm, and sometimes those nodes turn up on a mammogram. It’s a widespread enough issue that mammography centers are adding questions to their intake forms asking about vaccine status and which arm was used for the administration. The Society of Breast Imaging sees this as a big enough issue that it has recommended women delay screening mammograms until at least 4-6 weeks after receiving their last vaccination. However, for those of us who were due for screening prior to the recommendation, we are now chasing down rogue lymph nodes that could be due to the vaccine or to something more sinister, such as breast cancer or lymphoma.

I had a difficult enough time scheduling my follow-up ultrasound due to my clinical schedule and the limited appointment slots. Today’s actual appointment could have served as a case study of what not to do from a technology, operational, and clinical standpoint.

It started with patients reporting 15 minutes before their appointments as instructed, only to find that they had a single registrar who was taking names and instructing people to be seated until called. The problem: six patients and five chairs in a waiting room that had been stripped of furniture for social distancing. Patients were slowly called to the desk, where they were forced to fill out the usual clinical history form (completely from scratch, once again not pre-populated from the Epic system as it could have been) standing there in front of the registrar. This delayed additional check-ins and I’m sure was frustrating to patients.

Despite arriving early, I wasn’t called back until 10 minutes after my appointment time, where I was taken to a changing room that fed a sub-waiting room with an additional four patients (although there were five chairs, but this time we got to sit around with each other in flimsy gowns). Plus, instead of watching HGTV in the main waiting room, we were treated to a screen displaying a version of the imaging center’s tracking board, showing all the patients and their appointments and how backlogged they were. Although the names were truncated like we were flying standby, it felt like an invasion of privacy since we could see all the procedures scheduled for the day. There was a Windows popup on the screen that looked like an error or alert message, and although I couldn’t see the details, I wondered if we were really supposed to be seeing it.

After finally reaching the exam room, I was treated to a brusque sonographer who acted like I hadn’t followed appropriate prep instructions (despite having received none). I felt like reminding her that even though she does this a dozen times a day, each patient was enduring the harrowing experience of wondering if they have cancer or not, so they don’t need her attitude. It was clear she was having trouble getting the images she wanted, but she finally went to review them with the radiologist while leaving me draped on the table.

When the radiologist came in, she started spouting medical terminology and I’m hoping it was because somewhere my chart was flagged as a physician because as a “regular” patient I would have had no idea what she was talking about. I guess I’m also more sensitive to the patient’s comfort than she was, because I rarely have conversations with patients while they are draped and lying on the table. At a minimum, it would have been nice to sit up and have a conversation at eye level.

I don’t think I have unreasonably high expectations. They have been shaped by the way I was trained and how I’ve seen medicine practiced for the last two decades. But it seems they’ve substantially diverged from the post-COVID reality of healthcare in my city. Patient advocacy and patient empowerment are supposed to be major factors influencing how healthcare organizations operate, but apparently for some they’re little more than buzzwords.

The perfect cap on the day was when the sonographer walked me back to the changing room, where she told me to “enjoy the rest of your day.” As I looked at the faces of the other women in the sub-waiting room, knowing that their lives might be changed dramatically today, it didn’t seem like what patients might want to hear, especially knowing that some of them would go home to sit and wait for results. Perhaps “take care and thank you for choosing us as your healthcare team” might have been a better option.

Have you experienced a decline in patient services in the COVID era? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 2/25/21

High-End Medical Provider Let Ineligible People Skip COVID-19 Vaccine Line

One Medical comes under fire after leaked internal documents show that the membership-based primary care company has let ineligible patients – some with ties to company leadership – receive COVID-19 vaccinations before other, higher-risk groups.

Redox Market Momentum Leads to $45M in Series D Raise Led by Adams Street Partners

Healthcare API developer Redox raises $45 million in a Series D round that brings its total funding to $95 million.

Ontario Systems Continues Growth

Revenue recovery software vendor Ontario Systems acquires Pairity, which offers AI-based solutions for accounts receivable management.

Innovaccer Raises Series D at $1.3 Billion Valuation, Launches Innovaccer Health Cloud to Power the Future of Health

Innovaccer confirms a rumored funding round led by Tiger Global Management, bringing its total raised to $225 million.

HIStalk Interviews Michele Perry, CEO, Relatient

Michele Perry, MBA is CEO of Relatient of Franklin, TN.

Tell me about yourself and the company.

Relatient is the 2020 KLAS category leader in patient outreach and communication. The company is located right outside of Nashville, TN. We got our start with appointment reminders back in 2014. Since then, we have built an entire patient engagement platform to help medical offices manage all the major touchpoints in the outpatient journey. Our goal is to end phone tag in healthcare.

I’ve been Relatient’s CEO since 2017. We have been growing a lot and we are excited about where we are headed as a company and the work we are doing alongside the health systems, hospitals, and medical offices we serve to improve the patient experience.

How are providers using technology to manage COVID-19 vaccinations?

Medical providers are really grabbing hold of technology right now to solve the daily operational issues related to getting the COVID-19 vaccine distributed on a mass scale.

The first thing we started hearing from health systems like Med Center Health in Kentucky and Warren Clinic in Oklahoma was that they wanted to shoot for zero wasted doses. When they came to us with those conversations, they were most concerned about patient no-shows, because the first vaccine was Pfizer’s and the whole freezer situation meant that once a vial was thawed, mixed, and ready to use, it couldn’t be set aside for another day. A patient no-show could mean doses in the trash, and no one wanted that. After they set up their vaccine departments or clinics and locations, we configured some specific vaccine reminders to help get patients to both the initial appointment and the one following it 21 days later.

Health systems learned really fast that getting the vaccine schedule filled was a huge task. It takes a lot of people to work through lists of patients who qualify and get them booked. We had used our patient self-scheduling module for some customers earlier in the pandemic that wanted to let patients self-schedule for testing. We turned this on for customers who asked for help with vaccine scheduling and then made it available for new customers, too, turning it on very quickly un-integrated for immediate scheduling.

Some other things we’re seeing providers do include the use of messaging tools to send mass communication to their patients and their staff, like when a new phase of vaccinations opens up or a new vaccine clinic. We’ve seen them use short links to maps and directions in case patients are new to their organizations and utilize text messaging for one-to-one patient conversations so they can field questions and make schedule changes without the back and forth of playing phone tag with patients.

Why do patients fail to show up for their appointments and what are the best practices to reduce the no-show rate?

It’s interesting, because we are far enough into a world where appointment reminders are the norm that patients have come to rely on them to remember and plan for their appointments. Healthcare has come a long way in this, but COVID-19 introduced a new layer of complexities to patient schedules and the load of responsibilities patients are carrying. They’ve got kids at home all the time, they’re trying to work from home, they may no longer be close to the doctor’s office during the day because of this. We have heard from a lot of healthcare leaders over the past year that patients who were afraid to come in early on added to no-shows. It kind of all comes down to keeping communication open and clear so patients know that you are open and you’re a safe place to receive care. If something changes, do they have a telehealth option that can replace the in-person appointment?

The other key piece or best practice is the combination of communication methods and the ability for a patient to respond to a reminder. We’re patients ourselves and we get reminders from our own medical providers that either don’t ask for our confirmation or response or only allow a confirmation. If a patient has to call your office to cancel an appointment, they’re likely to hit the phone tree or get put on hold and hang up. This is where a lot of patient no-shows still come from, and there are well-established practices to avoid this.

Patients want self-scheduling and virtual waitlists more than just about any other technology. Has the pandemic affected adoption?

Definitely, and for a few reasons. Part of the increase in adoption has been resource constraints. Medical offices had to furlough employees, like many other industries. When they started to recover from that, they got hit with COVID-19 cases of their own and often found themselves short-staffed. The need for self-schedule and waitlists that can backfill last-minute cancelations is growing as there are fewer resources to do these things manually.

Additionally, Accenture recently reported that two-thirds of patients said they are likely to switch providers who don’t meet their expectations for handling COVID-19, and we know that patient access is a piece of these expectations. More than 30% of patient appointments are scheduled after normal clinic hours.

As I mentioned earlier, managing vaccine and testing schedules has also been a big burden to medical practices. Solutions that can lighten this burden and empower patients to self-select are win-win.

Can medical practices compete with the consumer-facing technology that is offered by urgent care centers, health systems, and chain drugstores?

Absolutely. Medical practices have the potential to offer the most personalized care if they can keep up with the innovation of larger organizations. They can do this with a cohesive digital strategy that works alongside and enhances their portal strategy. When solutions aimed at expanding access and convenience — like self-scheduling, two-way patient-practice conversations, and registration — are only available to portal users, a significant portion of a provider’s patient base never experiences those benefits.

Which health IT sectors will be the winners and losers in the next few years as COVID-19 becomes better controlled?

This is the winning question, right? COVID-19 won’t be a crisis forever, but some of the things we’ve learned during this time will stick around long term and we’re better for it.

Telehealth is one that is here to stay, but it won’t stay at the levels medical providers have used over the past year. Providers are now operating hybrid care models, where patient care is delivered in-person and via telehealth, so they need tools and workflows to help support this model of care delivery. I expect telehealth vendors to continue refining and expanding their technology as medical providers lean away from general video conference platforms that filled the immediate need early on.

The health IT sectors that help answer the question, “How do we get patients the right care, in the right place, at the right time” will be the winners. Interoperability will be a must as care becomes more dispersed, and digital communication tools and patient messaging will be crucial to helping patients navigate the journey.

You kind of hit on this already when you asked about consumer-facing technologies, but it’s key because patients are consumers, and these are the tools and kinds of access they’re looking for. My point is those technology sectors that require a lot of the patient — apps to download, portals to log into, additional accounts to create, and passwords to remember – will find less and less room over the next few years.

Morning Headlines 2/24/21

Our Care Studio pilot is expanding to more clinicians

Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.

Enforcement Discretion Regarding Online or Web-Based Scheduling Applications for the Scheduling of Individual Appointments for COVID-19 Vaccination during the COVID-19 Nationwide Public Health Emergency

The HHS Office for Civil Rights won’t penalize certain potential HIPAA violators for their use of COVID-19 vaccine scheduling tools during the nationwide public health emergency.

DirectTrust Announces Implementation Guide for Event Notifications via the Direct Standard

DirectTrust publishes an implementation guide for sending ADT event notifications via the Direct Standard.

News 2/24/21

Top News

Google Health expands the pilot of its EHR search and data presentation tool, which it has named Care Studio.

The system provides a centralized view and search capability of patient information that is stored one or more EHRs.

Ascension was the pilot site, for which Google earned the attention of Congress a year ago for how the company intends to use and protect patient information. Google has made assurances that it does not own patient data, doesn’t sell it, and won’t use it for advertising purposes.

Clinicians from unnamed sites in Nashville, TN and Jacksonville, FL will use an early release of Care Studio and provide feedback about its usability, usefulness, and workflow integration.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor RCxRules. The Burlington, VT-based company, founded in 2010, helps healthcare organizations succeed with both value-based care and fee-for-service billing models. Its unique, predictive rules engine ensures compliance with healthcare’s complex regulatory and reimbursement rules. Integrating with leading EMRs and PM systems, RCxRules software addresses issues before they affect revenue, delivering claims with the most accurate financial and HCC data — every time, guaranteed. Thanks to RCxRules for supporting HIStalk.

Listening: a grab bag of obscure 1960s psychedelia, which is mostly new to me. The naively optimistic flower children who formed forgotten bands 50-plus years ago are now dying off without fanfare. Little-known groups I’ve discovered: The Fallen Angels, Kaleidoscope, and The Peanut Butter Conspiracy (in addition to one of my all-time favorites and not obscure at all The Love). I am contemplating a foray into collecting LPs and 45s for the first time since I suspect a lot of this trippy vinyl is moldering in basement junk boxes and deserves better. It is sweetly sad to think of someone’s great-grandma passing away in her 80s without her family knowing that, if only for a few weeks, she was a sun-drenched Renaissance faire goddess with flowers in her hair, whose heartfelt, unskilled folkie crooning soundtracked the personal summer of love for thousands or millions of people who are struggling, as she did, to reconcile the sunny days of youthful exuberance and seeming immortality with the realization that the clock is running out. “Legacy” is an uncomfortable topic for me since I envy artists whose work will continue to be discovered and appreciated by new generations.

I ran across the best acronym-based group name ever, the Paediatric International Patient Safety and Quality Community, aka PIPSQC (“pipsqueak.”)

Odd grammatical quirk, almost entirely heard in 20-somethings: pointlessly expanding “thank you” to “thank you so much.”

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

Tech-enabled insurance startup Oscar Health plans to raise over $1 billion through its IPO, scheduled to take place next week. Like competitor Clover Health, the Alphabet-backed company has yet to show a profit, despite having raised $1.6 billion since launching in 2012. Analysts, however, are quick to predict a $6.7 billion valuation.

Precision medicine technology vendor Tempus will collaborate with Texas Oncology-owned Precision Health Informatics to advance clinical research and personalize patient care. Both are for-profit companies.

Sales

• Jackson Hospital and Clinic (AL) will implement CPSI subsidiary TruBridge’s RCM software and services.
• Mercy Iowa City selects Spok Go clinical communications software.

Announcements and Implementations

Southeast Health (AL) implements Epic.

RxRevu develops SwiftMx, giving providers access to medical price transparency and coverage information via EHRs from vendors like Cerner.

General Leonard Wood Army Community Hospital (MO) employees prepare to go live on Cerner as part of the DoD’s MHS Genesis Cerner roll out.

CommonSpirit Health uses VeeMed’s tele-ICU physician services across its Dignity Health and Catholic Health hospitals.

Jupiter Medical Center implements Artifact Health’s mobile app for physician queries.

A new KLAS report looks at the EHR experience of medium to large home health agencies, finding that MatrixCare Home Health leads the market, while Epic Dorothy follows closely as used mostly by health system-owned agencies. Homecare Homebase is widely used, but receives the lowest rating for quality of support. WellSky’s customers report lower satisfaction as the company grows and acquires, while users of Netsmart’s acquired products (Homecare Advisor and Homecare) say development has slowed as the company focuses on its MyUnity Enterprise platform.

DirectTrust publishes an implementation guide for sending ADT event notifications via the Direct Standard.

Government and Politics

TeleICU provider RemoteICU sues HHS for not allowing US-licensed physicians who live outside the US to bill Medicare for telehealth services.

In Canada, New Brunswick’s auditor general says that the province’s EHR rollout failed, where $21 million was spent on a system that fewer than half its physicians are using and that does not integrate with hospital systems. The New Brunswick Medical Society partnered with private company Accreon to create Velante to sell the software, then kept pumping money into the failing program and adding switchover subsidies until the exclusive deal ended in 2019. Velante is closing and the software vendor, Intrahealth Canada, will take over support.

COVID-19

J&J says it will ship 20 million doses of its single-shot vaccine in the US by the end of March if it receives FDA’s emergency use authorization, earlier than expected.

Other

HIMSS said early this month that it would provide more information on HIMSS21 on February 19. I didn’t see any specific announcement, but the FAQ now says that registration will open in early March. HIMSS will also run an extra-cost, single-day “CIO Summit” that will be followed by a “curated CIO experience” now that CHIME has pulled out. Exhibitor count is at 410 versus 1,300 at HIMSS19.

St. Margaret’s Health-Spring Valley (IL) reverts to paper-based processes after its IT team discovers a data breach, forcing it to shut down all of its Web-based systems.

An AMA article touts the use of Xcertia app development guidelines — developed by AMA, HIMSS, and other groups — even though the Xcertia project was shut down in August 2020. HIMSS said at the time that the effort would continue with oversight by a HIMSS work group.

Sponsor Updates

• AdvancedMD shares the product enhancements that will be made available during its Winter 2021 Release.
• Black Book Market Research includes Impact Advisors among the top-rated RCM services and optimization consultants.
• Cone Health (NC) expands its use of PatientPing’s real-time event notification software to include community providers.
• PeriGen affirms that its technology supports the US Surgeon General’s call to action to improve management of maternal health.  
• CereCore relocates its Nashville headquarters to, in the near future, better accommodate its workforce and partners.
• Cerner releases a new podcast, “How diverse, community-based hospitals are a lifeline to saving clinical research.”
• The Chartis Group publishes a new brief, “Partner with Purpose: How to Build a Winning Playbook to Guide Health System Partnership Strategy.”
• Columbus CEO includes CoverMyMeds Senior Manager of Employee Engagement Lachandra Baker in its Future 50 initiative.
• Wolters Kluwer Health highlights the top four challenges facing CMS Administrator nominee Chiquita Brooks-LaSure.
• Quil becomes a HealthShare Exchange MarketStreet partner.
• Medical Marketing & Media includes OptimizeRx SVP and Principal of Agency Channels Angelo Campano to its “40 Under 40” list.

Blog Posts

• How Healthcare Leaders are Leveraging Patient Engagement Software to Distribute COVID-19 Vaccines (AdvancedMD)
• What if? (Ascom)
• ECR 2021 – Explore the on-line opportunities (Agfa HealthCare)
• The Shift to Home Health Care – and Setting Your Organization Up for Success (CarePort)
• Epic Testing: Tips for Taking Testing Virtual (CereCore)
• Understanding Social Determinants of Health and Their Integration with EHRs (ChartLogic)
• Engaging hard-to-reach patients (EClinicalWorks)
• 5 Reasons Why You Need to Prioritize Prescription Price Transparency (RxRevu)

Contacts

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Morning Headlines 2/23/21

Alphabet-backed Oscar Health eyes as much as $6.7 billion IPO valuation

Tech-enabled insurance startup Oscar Health hopes to raise over $1 billion through its IPO early next month.

St. Margaret’s Health – Spring Valley breached by cyber security attack

St. Margaret’s Health-Spring Valley (IL) reverts to paper-based processes after its IT team discovered a data breach over the weekend and shut down all of its Web-based systems.

Conversion Labs Begins Trading Under New Company Name, LifeMD, and Ticker Symbol, LFMD

Conversion Labs rebrands to LifeMD to reflect its transition to direct-to-consumer telemedicine and online prescription delivery.

Curbside Consult with Dr. Jayne 2/22/21

I’m not sure if I’ve ever met Nordic Chief Medical Officer Craig Joseph, MD in person, but he’s definitely on my list of “people I’d like to have a cocktail with” at some point. His Twitter posts @CraigJoseph always have interesting tidbits, such as a recent white paper from ECRI’s Partnership for Health IT Patient Safety. He notes, “Lots of smart people with clinical and EHR vendor chops outline specific actions to consider.”

I checked out the paper, titled “Optimizing Health IT for Safe Integration of Behavioral Health and Primary Care.” It resonated with me because this is an issue I’ve had to deal with for years – navigating the intersection of those two disciplines while trying to coordinate care while maintaining privacy. Many organizations, including some of my current clients, choose to keep primary care and behavioral health records siloed. This results in fragmentation of care and lack of understanding around whole-person factors that drive both physical and mental health.

It lays out clear reasons why primary care and behavioral health need to be integrated:

• 80% of behavioral health patients will visit a primary care provider (PCP) at least annually.
• 50% of behavioral health disorders are treated in primary care settings.
• 48% of appointments for psychotropic medications are with non-psychiatrist PCPs.
• 67% of people with behavioral health disorders don’t get behavioral health treatment.
• 30-50% of patients referred from PCPs to outpatient behavioral health don’t keep their first appointment.
• Two-thirds of PCPs report being unable to access outpatient behavioral healthcare for their patients.

Additional barriers for mental healthcare access include provider shortages, health plan barriers, and coverage issues. In my major metropolitan area, we recently opened a dedicated mental health emergency department unit that is staffed full time by specialist providers. The community accepted it readily because we know we don’t do the best job for patients needing non-medical services who present to other care venues, such as the emergency department or urgent care facilities.

Even for health systems or provider-side organizations that want to try to integrate the behavioral health and primary care realms, EHRs aren’t always supportive. Psychiatry notes, therapy notes, and documentation from social workers are often kept under separate access where the primary medical team can’t see them. Especially when we’re dealing with medical conditions that can have significant behavioral components, it would be useful to be able to see all the information about the patient. The white paper does a nice job explaining different levels of integration, from “coordinated” care to that which is “co-located” to fully “integrated” care. Right now, many primary care practices are struggling to deliver even minimally coordinated care.

One of the major participants in the creation of the paper was the HIMSS Electronic Health Record Association (EHRA). I have some experience with EHRA from a past life and know many of the members of the project’s working group to be knowledgeable individuals with a deep understanding of EHRs and care delivery. EHRA has a code of conduct for EHR and health IT developers that addresses the need for collaboration described in the paper.

However, working as someone outside of an EHR vendor, I’ve found it nearly impossible to access the materials that we relied on when I was on the vendor side. This forces those of us who work on homegrown or in-house systems to re-invent the wheel trying to determine best practice as we develop our technology. Since this is a partnership with ECRI and this paper exists, I take that as positive signs. Still, non-commercial developers are going to have to do a lot of figuring out on their own unless there are maneuvers to standardize at the federal or payer levels.

The paper talks about standardizing screening and documentation tools so that data is consistent across an enterprise. Although this would be good, many patients may receive their care across multiple organizations. I cared for a patient the other day who receives medical care primarily through a county health clinic because she doesn’t have health insurance, but receives a telehealth benefit from her employer, so she’s using that for urgent care services and psychotherapy. She came to our urgent care because she needed stitches and we have an affordable self-pay program. Given the vast differences in the systems used by those entities coupled with the relative immaturity of our state’s HIE, there’s no way there will be coordination any time soon.

There are also legal barriers to sharing of data under both HIPAA and 42 CFR Part 2, especially around sensitive health information. Many organizations find these restrictions daunting and either don’t have the wherewithal or the manpower to try to tackle them, especially while simultaneously coping with a pandemic and the generalized dysfunction of healthcare delivery in the US. Patients also struggle to understand the protections and restrictions and become frustrated when we try to explain why we have to ask the patient to summarize their care because we can’t access the information that we need without recreating the proverbial wheel.

The document has some great appendices, including a literature review and tables of evidence used during its creation. The summaries of EHR challenges and existing workarounds were fascinating case studies in dysfunction: lack of integration between the EHR and tablet devices used for patient-completed screeners and surveys; copy and paste to add the same note to the PCP and behavioral health EHRs; printing and scanning of medication lists from the behavioral health EHR to the medical one; and more. My favorite is “Reliance on patient or clinical recall for inaccessible clinical information – providers describe this as ‘flying blind.’”

Due to my employer’s lack of integration with our state HIE or nearby health systems, I’ve been flying blind for the last six years, except for when patients use their phones to access MyChart and then hand them over. That’s been useful in a number of medical situations, but I have to admit I’ve never seen psychiatry notes or therapy notes in any of those encounters, and I usually can’t see a full medication list history to know what’s been tried in the past — only current medications are typically displayed.

The paper also contains pages of recommendation tables, some of which push back on ONC, CMS, and other agencies to provide easily accessible standards for developers to use when creating documentation. It also calls on ONC to drive adoption and implementation guidance for APIs to improve integration. There is also a bid for the federal government to incentivize patient care organizations to implement standardized tools. There’s a great swim-lane diagram of an ideal IT-enabled workflow for safe integration. It will be interesting to look back at this paper in a couple of years and see how far we’ve come or whether we’re still living in the land of siloed documentation.

Has your organization done work to support integration of primary care and behavioral health? Leave a comment or email me.

Email Dr. Jayne.