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News 3/27/20

March 26, 2020 News 4 Comments

Top News

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


HIStalk Announcements and Requests

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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


People

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


Announcements and Implementations

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


Government and Politics

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

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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


Other

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Cleveland Whiskey pivots to producing hand sanitizer for Cleveland Clinic.

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

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 3/26/20

March 26, 2020 Dr. Jayne 1 Comment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 3/26/20

March 25, 2020 Headlines No Comments

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

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

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

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

Inbox Health Raises $3.5 Million in New Venture Funding

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

Morning Headlines 3/25/20

March 24, 2020 Headlines No Comments

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

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

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

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

HTD Health Acquires CareVoice, an Advance Care Planning Platform

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

News 3/25/20

March 24, 2020 News 3 Comments

Top News

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


Reader Comments

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

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

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

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

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

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


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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

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


Announcements and Implementations

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

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

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


COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

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


Privacy and Security

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


Other

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Morning Headlines 3/24/20

March 23, 2020 Headlines No Comments

Amazon will deliver and pick up at-home test kits provided by new coronavirus program in Seattle

With help from Amazon Care and local health systems, the Seattle Coronavirus Assessment Network launches to deliver and pick up at-home COVID-19 testing kits in Seattle’s King County.

Thoma Bravo shuts down Imprivata process as covid-19 fears fuel market volatility

Thoma Bravo calls off its potentially $2 billion sale of digital healthcare identity company Imprivata.

Go inside the nerve center of a Western Washington hospital system dealing with coronavirus

CHI Franciscan relies on a mission control center to monitor capacity, supplies, and staffing for COVID-19 patients across its eight hospitals.

Telehealth Startups Pause At-Home COVID-19 Testing After FDA Tightens Guidelines

Several telemedicine companies halt their roll outs of at home COVID-19 testing kits after the FDA stresses that it has not authorized any testing kits for at-home use.

As some local businesses close, Jacksonville healthcare company hires hundreds

The HCI Group will hire for between 500 and 600 jobs in the coming weeks as it ramps up efforts to help hospitals with their health IT and managed services needs during the pandemic.

Curbside Consult with Dr. Jayne 3/23/20

March 23, 2020 Dr. Jayne 2 Comments

Another crazy week in the trenches, and the “organizational behavior” consultant part of me wishes I could get some of my clients to listen to reality and take solid advice. Everyone is completely stressed, and justifiably so, but we need to figure out how to get through this.

This morning, I had a very painful conversation with a client who asked me to update him on what other similar organizations are doing with their outpatient clinics. Are they closing, running modified hours, consolidating by patient needs, etc. I put together a careful analysis with summaries and walked through them.

The client proceeded to yell at me and explain why each option wouldn’t work for their organization. I tried to gently remind him that his “ask” was for me to answer the question of “what are similar organizations doing in this situation” as opposed to “how should we handle this?” Because frankly, if he had asked the latter question, I’d have been likely to tell him it’s time to just pack it up and go home, because their lack of understanding of this pandemic and failure to follow CDC and OSHA guidance is putting their staff and patients at risk.

The bright spot of the week was a patient who asked me how I was doing as a person and how my family was holding up with me being on the front lines. He was sincere and caring. It was a welcome change from having to deal with the previous patient, who was self-absorbed and flatly refused to quarantine himself “because it’s boring and I can’t stand it any more” despite his fever of 102 and symptoms that were consistent with COVID.

Like just about every healthcare worker in the US at this point, I’ve been exposed to multiple positive patients, and without the recommended gold-standard N95 mask. Still, I can control the environment in the office and can wash my hands immediately after every single interaction, which is a lot better than what happens when you make a furtive trip to the grocery store. Plenty of people are still picking up items, looking at them, and putting them back, which is less than ideal during a pandemic. Our local grocer installed handwashing stations outside the front door, but I’d give myself even odds of being infected at work versus by the general public.

Our non-clinical staff members are having the hardest time with the situation. They are not trained for it and really didn’t know what they were getting into compared to the clinical workers. They’re constantly on edge, and one of them was crying in the break room during my last shift. Talking to physician colleagues across the country, they’re seeing the same thing.

We’re all supposed to act tough and not afraid, but as people, we want to validate our staff’s concerns and let them know that we share some of the same feelings. Unfortunately, some administrators across the country see such empathy as akin to “feeding into fear mongering.” I have two friends who received verbal counseling about the conversations they had with staff because they didn’t toe the corporate sunshine and lollipops line. When the CDC is telling healthcare workers to tie a bandana on their face if they don’t have appropriate personal protective equipment, we’re well past the sunshine zone.

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Friday, March 20 was Match Day for fourth-year medical students across the country, many of whom have had their classes canceled and rotations ended for the rest of the year. Graduations have been canceled as well. Instead of learning their fate in an auditorium with friends, they learned it online. Good luck to each and every one of them. I remember what that day was like and can’t imagine how surreal it must feel to the class of 2020.

Speaking of surreal, I urge all organizations to go through any automated or pre-scheduled communications and make sure they make sense given the current situation. When the schools are closed and parents receive a notice about the 7 a.m. ACT prep session, that’s not a confidence builder.

Similarly, when vendors send out tone-deaf emails about patient loyalty or market share to health systems that have publicly announced that they will run out hospital beds within 10 days, that’s not a winning marketing strategy.

I’ve received several emails from HIMSS that are utterly devoid of acknowledgement of the present situation. Given that HIMSS might not survive after the loss of revenue from HIMSS20, I would urge them to not aggravate people. Their constant blasts about Virtual HIMSS are bordering on the absurd for people who are knee deep managing issues at their hospitals and health systems as the new normal.

On the flip side, I received a call from my bank, which is checking in with their small business banking customers to see if they can help with anything. The business they were calling about is my side hustle that I’m cultivating for retirement, so it’s not a major source of income. Still, it was a nice gesture.

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Last week, on March 18, CMS announced that all elective surgeries and non-essential medical, surgical, and dental procedures should be delayed during the COVID outbreak. This is not only to preserve hospital capacity (some of those elective patients have poor outcomes and wind up in the ICU), but also to conserve personal protective equipment. Many outpatient offices have canceled well visits unless they include vaccinations.

My primary physician and ophthalmologist canceled all their annual visits and offered refills for the next six months, so thank you. Unfortunately, some major players in the healthcare industry are behaving badly and refusing to follow this directive. You know who you are, and shame on you. Please get with the program, I’m betting you’ll wish later you had all those masks and gowns back. If you’re organization is still doing elective procedures, this piece from a Seattle vascular surgeon is a great read.

I’m keeping this brief so I can go back to the telehealth front lines. I haven’t been able to exercise my newly granted ability to see patients in states where I don’t have a license since there are so many patients to be seen in my home state. To all of you on the in-person front lines, stay safe, stay sane, and just keep putting one foot in front of the other.

Email Dr. Jayne.

HIStalk Interviews Patrice Wolfe, CEO, AGS Health

March 23, 2020 Interviews No Comments

Patrice Wolfe, MBA is CEO of AGS Health of Newark, NJ.

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Tell me about yourself and the company.

I’ve been in the healthcare industry for over 25 years, with the majority of that in the HCIT space, including revenue cycle management. RCM is an exciting and growing field, and if you do it right, you’re improving the financial health of provider organizations, which frees them up to redeploy resources that can be focused on patient care.

AGS Health is a revenue cycle outsourcing company that provides A/R management, coding, and analytics services to major health systems and physician practices, as well as to billing and EMR vendors. In 2019, we managed over $35 billion in A/R and coded over 25 million charts. We have 6,200 employees in the US and India, which is pretty amazing for a company that was founded in 2011.

What is the business environment of RCM and how has it changed over the years?

It has changed a lot. Given the penetration of EMRs and associated technologies, a lot of the manual effort that was needed to validate patient eligibility, submit claims, post payments, and reconcile remittances is now automated. In the past, the vast majority of A/R was payer-related, which just isn’t the case today. High deductibles are here to stay and providers are struggling to capture every dollar. 

The basic mission of RCM hasn’t changed – to optimize the speed, accuracy, and efficiency with which revenue is maximized and collected.

The revenue cycle is very complex. Too much so. Different departments frequently handle different parts of the cycle, which means there may be no real coordinated strategy for RCM. There are a few things I find promising, though. The industry is trying to bring as much as possible up to the front of the revenue cycle, such as advanced eligibility verification and patient liability estimation prior to the patient showing up for care. It’s a lot easier to collect a payment when you’ve told the patient in advance what they will owe.

Robotic process automation, or RPA, is eliminating low-value work from the rev cycle and driving greater efficiency. I think we eliminated about 80 FTEs of low-value work last year just using RPA, and our teams are doing more rewarding work as a result. A lot more can be done on this front.

Areas like coding used to be focused on maximizing the completeness and accuracy of clinical information for billing purposes.  Today, we’re seeing new and innovative uses for this data, which include risk-based analysis, provider scorecards, benchmarking, and analytics.

RCM is highly influenced by payer policies. I sit on the board of a large payer, so I see the challenges on that side of the equation also. There are a few friction points that I think are problematic for both parties. First, claim denials have been rising, which creates a lot of work for providers and vendors like us. Second, prior authorizations are labor intensive and remain stubbornly manual. We have a lot of work to do as an industry to resolve these issues.

What effects on health system RCM do you expect to see from coronavirus-related economic slowdown?

We are seeing the impact of COVID-19 in many areas right now. This is so hard for the provider community. In the last week, providers are canceling all elective procedures. That has an immediate impact on revenue, not to mention access to care. Some payers are shutting down call centers and stating that claims payment may be delayed. We use the call centers on behalf of our customers to resolve payment denials and delays, verify eligibility, and check on claim status. Limiting our ability to do that impacts revenue, not to mention the resultant lag in overall claims payment.

Providers are experiencing workforce shortages due to staff illness, inability to work from home, or reprioritization of work tasks. This is going to get worse. We are trying to help as much as we can from a staff augmentation perspective.

The administration approved some Section 1135 waivers to improve access to care, such as wider use of telemedicine, and allowing Critical Access Hospitals to have more than 25 beds. That’s great, but it’s confusing to both providers and payers as to how to operationalize these changes and ensure accurate reimbursement. I fear this is going to be a big mess.

Also, while new coding changes have been approved for COVID-19, it will take a while for provider systems to be updated with these coding updates, which translates into increased coding denials.

What are the benefits and challenges involved with managing a highly educated, technically savvy global workforce of six thousand people?

You forgot millennial. The vast majority of our team in India is under 30 years old, which is really interesting. I get asked for a lot of selfies when I’m there.

Regarding the benefits, as you mentioned, our entire team in India is college educated. They are open-minded, comfortable with change, and very ambitious. I do monthly live chats with our various locations and I hold quarterly focus groups when I’m in India. I get many questions about career progression and company strategy. These are people who can see themselves as leaders and problem solvers, which is exactly what we need in such a high-growth company.

In addition, almost 50% of our overall workforce is women, which is exciting for me.

The challenges of a large, global workforce really are around communication, training, and career paths. We are high growth, so things are changing all the time. That means I have to over-communicate on many topics and via many different methods, as do the other leaders.

We hired over 2,000 people in 2019, so grounding them in our business is critical. We have an incredible hiring and training infrastructure that can adapt rapidly as we add new clinical specialties and customer types.

I mention career paths because, as I said earlier, we have a lot of young, ambitious people who want to grow within AGS Health. We promote through the ranks as a regular practice. In addition, several people from our India team have relocated to the US to serve in customer-facing roles with amazing success. It’s been a win-win and we plan on expanding this program.

What I’ve come to realize is that, while revenue cycle outsourcing sometimes leads to job loss in the local community, we’re frequently doing RCM work that has been put to the side in hopes that someone in the organization will get to it eventually. For example, we do a lot of small-balance collections, maybe accounts of less than $1,000 or even less than $200. It makes financial sense to hand those to us because our labor costs are so much lower. These activities generate real cash for the organization that otherwise might have been written off. There are other examples like this around credit balance resolution and denial management.

Another challenge we’ve faced in the US is the labor shortage in both rural and urban areas, where things like clinical coding expertise may be hard to find or highly competitive. Even with computer-assisted coding tools, trained coders are still a critical part of the RCM process. In this part of our work, we are supplementing the teams our customers already have in place.

Readers Write: EHR Vendor Priorities for Successful Innovation and Marketplace Development

March 23, 2020 Readers Write 3 Comments

EHR Vendor Priorities for Successful Innovation and Marketplace Development
By Seth Joseph

Seth Joseph, MBA is founder and managing director of Summit Health of Lincoln, RI.

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With the release of the final interoperability and information blocking rules, one of the goals of the Office of the National Coordinator for Health IT is to establish an ecosystem of innovation. They mandate that electronic health records (EHR) vendors open up their APIs and effectively serve as the foundation — the platform — for marketplace development. 

But when it comes developing an EHR-based marketplace for innovation, there are a host of challenges under the ONC’s latest guidance,  from the short timeframe in which they are being asked to develop these marketplaces to a lack of experience in network development (i.e., growing sustainable, platform-based businesses). 

With these challenges in mind, what can EHR vendors be doing now to ensure they are in the best position to develop a successful marketplace for innovation?

Establish sound (neutral) governance structures and processes

EHR vendors must carefully think through and give plenty of consideration to developing governance rules, standardizing the rules of engagement for platform development and the governance processes first, then creating documentation around it. Accounting for these fundamentals at the beginning will ensure that there’s a repeatable, scalable process when onboarding new developers to the platform. 

For example, which developers are allowed on the EHR vendor’s platform and marketplace? How do they become certified? How can EHRs ensure that developers abide by all state and federal regulations regarding health data exchange and privacy and security, such as HIPAA?

There are also issues such as those that Amazon is facing in having to determine exactly if/what proprietary data can be used to compete with third-party app developers for the platform. What is allowed and how should the rules and regulations be managed?

The importance of having a strong governance process and operating guidelines becomes clear when considering the issue Apple faced in 2019 related to its app store search results. According to a New York Times analysis of six years of App Store user searches, Apple’s own apps ranked first in the results for at least 700 search terms in the store. That isn’t exactly a vote of confidence for third-party IOS app developers, or the kind of attention Apple wants on its marketplace.

While all of this due diligence will require legal, technical, and business development work, it’s a necessity, as marketplaces will not scale and networks cannot grow effectively without it.

Invest in support resources

Third-party developers will vary in their technical, business, and organizational maturity. From implementation support and technical resources to data management and standardization support, EHR vendors should invest in the necessary resources to ensure that marketplace vendors clearly understand the rules of the road and also are set up to do as well as possible. 

Third-party developer success leads to marketplace success. While EHR vendors may not believe that marketplace success is important to their success in the short term, they would be wise to consider why Airbnb is among the most highly valued lodging businesses. It’s not because it runs a better hotel than Hilton or Marriott (it doesn’t), but because it allows hosts and renters to connect and transact on its platform.

Expectations and investment

Turning a software business into a platform business can be exciting and promising, but it’s important to temper expectations. For instance, while 2018 revenue from Salesforce.com’s third-party developer platform was the business’s highest growth area (41% annual growth rate), that only represents 20% of the organization’s revenue overall. That took over a decade to reach since Salesforce.com’s developer marketplace has been in existence since 2007.

It’s especially important for executives who are managing the marketplace to set realistic expectations internally regarding likely marketplace growth over the next 3-5-year period, then determine how much and what kinds of investments will be required to support that. 

Bring in an unbiased, experienced marketplace manager

There are many reasons why EHR vendors are not in a great position to be managing platform-based marketplaces on their own, but all map back to their inexperience in network development.

For example, under the new rules, EHR vendors will have to respond to developer requests for access within 10 business days. How will those companies manage this process in appropriately screening for privacy, security, and technical concerns while also determining how to address developers who might compete with new functionality that the company itself is planning? How will the EHR vendor think about quality management, in terms of the impact of varying levels of developer and application quality and what that means to the EHR’s brand with its customers? 

Growing a marketplace also requires redundant instances of technology and managing multiple integrations and different types of partner relationships at once. EHR vendors are inexperienced in and ill-equipped in these areas.

Given these challenges, EHR vendors should strongly consider outsourcing the management of their EHR marketplace to an entity that has the right experience and knowledge of standing up and supporting third-party developer marketplaces.

In fact, an effective marketplace manager that works with multiple EHR vendors should be able to deliver increasing value to each one of them by standardizing processes, refining implementation approaches, and managing multiple developer relationships. This is similar to the value they deliver to third-party developers by allowing them to connect once and gain access to multiple EHRs.

For EHR vendors, the innovation train is pulling up to their platform. While conditions might not be ideal since time is scarce and marketplace development in healthcare is still in its infancy, now is the time for EHR vendors to prepare and ensure that when that train reaches its destination, there is a solid foundation from which to grow as a marketplace innovator.

Readers Write: Prognostication Is A Fool’s Errand

March 23, 2020 Readers Write 1 Comment

Prognostication Is A Fool’s Errand
By Jeremy Harper

Jeremy Harper, MBI is chief research information officer of Regenstrief Institute of Indianapolis, IN. The views and opinions expressed in this article are his personally and are not necessarily representative of current or former employers.

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Regardless of how COVID-19 progresses, we have scenarios ranging from (a) everyone is going to die as the stock market goes to zero, to (b) we will be back and running at full steam in a matter of months. I’m optimistic that we will go back to work and keep moving, but less optimistic that we will successfully lower the curve enough to make a significant difference.

However, there will be permanent repercussions of the choices we’ve made so far, things we as employers haven’t had time to adapt to.

Employers need to prepare for the social impact of employees who have suddenly been moved to remote work arrangements en masse. Many employers have had people working remotely for a week and a half at this stage, and states are rolling out more stringent quarantines.

Below I attempt to predict the impact of remote work arrangements for our organizations.

One-Month Quarantine

People

If we have remote work for a month, I anticipate that most will re-integrate into their work routines with relish. Having children out of school also helps. It’s hard to be a full-time caregiver and a full-time employee. Even with dedicated efforts at sharing, it’s hard to balance the workload. People may enjoy the time off, but much like a vacation, they will return to the office and be glad for the peace of a single job.

Prepare your remote work policy, though, because people will be pointing to the last month to explain that if can be done for every one of their jobs.

Organization

Workflows haven’t changed. They might be re-envisioned online, but they have been optimized for in-person, office setups.

If you don’t see an end in sight, start preparing your IT to support wikis, group teleconferences, Slack etc. Optimization of the remote work arrangement is worth the expense.

In general, the organization just needs to grudgingly get through this time period.

Two-Month Quarantine

People

Employers must prepare for a mass outpouring of employees who point to their productivity over the past two months as justification for them to be remote for significant portions of their schedule. “What happens if I am only in the office Tuesday and Wednesday every week, or Thursday and Friday?” will be a common refrain. We still like the in-person interaction, just not every day.

Organization

We will start to see workflows shift and adapt towards an assumption of remote work and effort.

Some people will take vacations while maintaining their digital presence to avoid using vacation time. Vacation could look like visiting family and friends who they never have time to see in person. It might be the dream trip to Hawaii, although during a global quarantine, it probably won’t be to other countries.

Three-Month or More Quarantine

People

Employees will have adapted to a remote work arrangement, they are searching for alternative employment, or the government stipends will be sufficient for them to stay home. Not everyone can handle remote work arrangements. People will start moving to their dream locations, as in,  “I’ve always wanted to live in another state.”

Organization

We as employers have started to change our office policies to meet the need of this new normal. This is no longer waiving policies, it is rewriting them.

We will start to see employees migrating. They won’t all be in a single time zone. We will no longer have the ability to call them in person. They will want to have accommodations for their new time zone and their working later or earlier.

New collaboration tools that were mentioned in Month 1 become a necessity. You might have new opportunities to bring in global talent since if everyone is remote, you no longer need everyone to be based locally. Alternative arrangements for office buildings that are sitting closed will be considered and leases will be dropped.

Upcoming Societal Changes We Need to Discuss as a Community

The requirement for strong telemedicine arrangements outside COVID.

The obesity epidemic is not likely to be helped by quarantine.

Regulatory barriers.

Data analytics, collaboration, and productivity.

Morning Headlines 3/23/20

March 22, 2020 Headlines No Comments

CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS will grant exceptions for reporting requirements and data-submission extensions for healthcare providers participating in Medicare quality reporting programs.

Boris Johnson met with healthtech startups Babylon and Thriva to discuss scaling up coronavirus testing

The UK government enlists the help of healthcare and consumer technology companies to address the coronavirus pandemic.

Pence’s medical licensing comment stirs confusion

Vice President Pence’s statement about waiving state licensure limitations on telehealth doctors has created confusion, since only states can waive those restrictions, few have done so, and the federal government’s legal authority to preempt states is not clear.

Negative for ‘Coronavirus,’ positive for COVID-19: Stanford Medicine reformats reports after confusion

Stanford Health redesigns lab reports in its MyHealth portal after several students complained that their reports indicated testing negative for coronavirus, only to be notified soon afterward that they were positive for COVID-19.

Monday Morning Update 3/23/20

March 22, 2020 News 7 Comments

Top News

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The UK government enlists the help of healthcare and consumer technology companies to address the coronavirus pandemic.

Companies in attendance at a high-level meeting include Babylon (symptom checking chatbot) and Thriva (at-home blood tests).

Startups that have reported surges in demand for their products there include Nye (secure doctor-patient message via telephone and video), Patchwork (matching doctors with available hospital work shifts), and Pando (WhatsApp-like teamwork and collaboration).


Reader Comments

From Mark: “Re: University of Arkansas Medical Sciences. Has a web page set up specifically for their employees on quarantine. Their concern was that their staff who test positive (and they test everyone daily!) and are quarantined, will need food, meds, and goods delivered to their houses while in quarantine. Any employee can use this. So if you are working long hours and don’t have time to shop for groceries, for example, you can visit the site and make a request. Great way to support their staff in this time of need. Kudos!” We are hopefully coming to the realization that lockdowns aside, the only way some of us will survive is if our caregivers and their families make their own sacrifices to remain on the job. We’re woefully short on ventilators, but even those aren’t worth much if we don’t have experts to run them. We have to figure out how to keep hospital employees healthy, get them back to work after exposure, and support them in ways that go beyond paying them on time.

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From Freeman Victim: “Re: HIMSS20 cancellation. Freeman is not refunding anything except booth disassembly. They are billing us for furniture rental through March 11 and we received an invoice today for handling the return of our booth, which was on top of the exorbitant shipping we had already paid. The original invoices didn’t spell out the policy for HIMSS cancellation, yet new ones include a policy of charging vendors full fees for services that were nod delivered. I know cancellation hurt them, but they could do a better job sharing that instead of squeezing exhibitors for every last penny in charging for services they didn’t actually deliver. I would encourage HIMSS to crack down on this, because if the event cancellation itself doesn’t cause exhibitors to question its overall value, Freeman’s handling of it will.” I assume that every cancelled conference is creating a mass of frustration and outright anger at the costs that won’t be refunded, whether simply billed anyway (Freeman) or rolled over as an unwanted credit for future services (HIMSS). It may be a tough sell for companies to sign up for HIMSS, Freeman, OnPeak, etc. all over again for next year, assuming there is a next year. The monetization of every conference moment and physical attribute has always seemed wildly excessive to me, so perhaps conferences — like other aspects of our economy and personal lives — will change positively following an unwelcome but necessary recalibration.


HIStalk Announcements and Requests

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The health system employers of respondents to last week’s poll are responding to expected overwhelming demand by reducing non-COVID-19 services and making physical changes to their facilities. Those who are delaying system implementations and upgrades are matched by those who are looking for new technologies to improve their services, with use of health IT consulting not changing. Readers also say they are ramping up telehealth capabilities and searching for workforce management tools.

New poll to your right or here: Which leaders are doing a good job in responding to the COVID-19 outbreak?

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Readers asked about Providence St. Joseph Health making MacGyver-like provider face shields from components foraged from local craft and office supply stores (the need to do so, while shameful, is out of scope for this mention). Providence has published instructions for creating face shields and a video showing volunteers how to sew face masks from Providence-supplied kits.

I’m being overwhelmed with companies that want me to mention their COVID-19 related technology rollouts. I will do so if: (a) the offering is free, seems broadly useful, and has limited strings attached; and (b) it can work for everybody and not just existing users of other company products. Enhancing an existing product is of interest only to current customers, and in that case, you don’t need me to notify them on your behalf.

Listening: new from Nada Surf, one of my favorite bands of all time. They’ve been playing alternative music together as an intact unit since 1990, with an easily identifiable sound that still stays fresh with each new album. I remembered the band while creating (“curating,” as the cool kids say) a multi-hour Spotify playlist for a friend who is social distancing all alone, but is preparing for a long drive to join family. She’s younger with accordingly different musical tastes and in need of something upbeat, so I chose for her Anderson .Paak, Arlissa, Birdy, Cassie, Shakira, Hinder, Leona Lewis, Radiator Hospital, Tennis, Vargas & Lagola, Alexandra Stone, and a few of my own unrelated favorites she’s never heard such as The Hives, Juliette & The Licks, and The Tragically Hip. Her playlist sits in Spotify adjacent to my unfinished work titled “HIMSS20.”


Webinars

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

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

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


Announcements and Implementations

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TransformativeMed offers Seattle-area hospitals free use of its COVID-19 / Core Work Manager. The product is already being used at UW Medicine, which says the application “is critical for our tracking of suspected and confirmed cases.” The Cerner-integrated app allows clinicians to track and segments lab tests and results, monitor symptom checklists, and submit information to the state health department.

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Experity offers urgent care clinics free use of its COVID-19 Check-in Triage app, which sends questions to scheduled patients via two-way messaging and then tells them how to proceed with their visit. Experity launched a year ago in merging Clockwise.MD, DocuTAP, and Practice Velocity.

Epic continues to update its “Managing Coronavirus Disease (COVID-19) with Epic” paper, which provides guidance on reporting capacity management, reporting nurse data and patient throughput, managing COVID-19 patients at an outpatient pharmacy, creating a training plan, and reporting on the outbreak for managers and leadership.


COVID-19

A reader comment spurred me to ponder whether the country’s haphazard public health reporting makes optimal use of data housed in the Epic and Cerner systems, which cover much of our bed capacity. It doesn’t matter when, where, or how COVID-19 testing was performed on individual patients – those systems track suspected and confirmed cases, they store the demographic and clinical information of patients, and they record the progression and outcome. Individual health systems are surely monitoring this information, but I don’t know if it’s being aggregated for review at the state and national level. We’re missing one significant denominator – the number of asymptomatic or previously infected people who didn’t seek medical attention from hospitals – but the trove of information otherwise is massive and complete.

Early CDC data analysis finds that COVID-19 hits younger people harder in the US than was seen in China and Italy. They also worry that a long incubation period means that seemingly healthy people are walking around spreading the virus before they know they are infected.

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Aunt Bertha creates FindHelp.org, which allows community members to search for and connect with personally vetted social programs such as financial assistance, food, and emergency services. Hospitals can add the information to their community resource sites. The Aunt Bertha team added 700 programs in four days and is adding hundreds each day. I interviewed founder and CEO Erine Gray a few months ago and the work they do is impressive even in normal times.

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A Kaiser Health News data analysis finds that half of the counties in the US have no ICU beds, also noting that ICU beds per older resident vary widely. Experts note that hospitals with ICU beds cluster in high-income areas where patients have private health insurance. More positively, those rural counties are often located near larger cities– if you need an ICU bed, you care more about availability and distance than whether it’s in your county or someone else’s.

Cerner updates its COVID-19 response to include mandatory employee work from home through April 30 where possible, institution of an emergency pandemic time off policy, stopping all international and non-critical travel, and a 14-day quarantine at home for employees who have traveled to a high-risk location or have been in contact with someone who has.

Vice-President Pence’s statement about waiving state licensure limitations on telehealth doctors has created confusion, Politico reports, since only states can waive those restrictions, few have done so, and the federal government’s legal authority to preempt states is not clear. The Federation of State Medical Boards maintains a list of states that have waived licensure requirements in response to COVID-19, either for in-person encounters or for telemedicine. It’s still not legal for a doctor to conduct a virtual visit for a patient who is sitting in a state where the doctor isn’t licensed unless that state has waived its requirements. It would be so much easier if licensing was based on the doctor’s state rather than the patient’s.

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Teledentistry provider SmileDirectClub, which sells plastic teeth aligners, will open its 3D printing facility for creating COVID-19 supplies, such as face shields and respirator valves. The company, whose 3D printing capacity is among the country’s largest in producing 20 million mouth molds per year on 49 HP Jet Fusion 3D printers, asks medical supply companies that need help and are willing to provide STL 3D printing files to get in touch.

Italy reports that nearly 800 people died and 6,500 new cases were reported Friday, with 5,000 deaths so far. Spain had 1,400 deaths and 3,800 new cases as its case growth tracks to exceed that of Italy. Doctors in hospitals in Spain are sedating patients over 65 and then removing their ventilators to free them up for younger patients. Meanwhile, CDC continues to report US cases only Monday through Friday.

New York-Presbyterian Hospital reports having 558 COVID-19 inpatients as of Sunday morning, 20% of them in ICU and many more likely bound for there.

Health departments in New York City and Lost Angeles advise doctors to skip testing people with mild respiratory infections for coronavirus unless the results would change the clinical management of those patients. The recommendation acknowledges a strategy that is shifting from containment to slowing the transmission.

In another change in how COVID-19 is viewed, scientists call for quick development of a serological test to determine whether someone has been exposed to coronavirus and has developed some level of immunity as a result. That information will help drive public health decisions since if people can develop immunity after exposure (nobody knows that yet), they could return to work, including to healthcare jobs.

Former FDA Commissioner Scott Gottlieb, MD says this about the COVID-19 current state:

  • The best hope of having a therapy available by summer is antibodies. As such, bulk manufacturing should be ramped in parallel just in case something is found to work, allowing rapid rollout.
  • Efforts should be focused on widespread testing (such as point-of-care testing in physician offices) and serology to help understand coronavirus epidemiology.
  • We need as a nation to define the COVID-19 endpoint and develop a plan to get there rather than taking haphazard actions without federal leadership.
  • The US is seeing much higher numbers of young people having confirmed cases, with 56% of New York City’s being under age 50.

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FDA gives emergency authorization for molecular diagnostics firm Cehpeid to start shipping a 45-minute coronavirus test that will run on its 23,000 GeneXpert systems, of which 5,000 are in the US and are capable of running hospital tests 24×7.

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An ED doctor shares her hack for using a single ventilator to support up to four patients. She warns that such use is off-label, but also notes that anything goes in a disaster.

Just a note of who to believe on Twitter: people with expertise in data visualization, statistics, journalism, or medical practice still aren’t epidemiologists. Understanding COVID-19 from a public health perspective requires specific expertise. Choose your experts wisely and avoid the armchair kind. I also note that many non-healthcare tech folks are rushing out apps that do little to help with the coronavirus response – we have ample supplies of imitative symptom checkers and tracking maps, so please channel your talents into creating something more useful.


Privacy and Security

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I got a press release from telemedicine technology and services vendor Banyan Medical Systems about a free hospital COVID-19 offering, but note to the company: Bitdefender says your website is ironically infected with a virus of a different kind (a cryxos trojan).


Other

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Stanford Health redesigns lab reports in its MyHealth portal after several students complained that their reports indicated a negative coronavirus test result, only to be notified soon afterward that they were positive for COVID-19. Stanford explains that the first results listed are for normal seasonal coronavirus, but the COVID-19 test takes longer and positive results then trigger a phone call from a nurse instead of immediate release of results to the portal. One of the students who was fooled is the daughter of UCLA Director of Clinical Informatics and pediatrician Paul Fu, MD, MPH, who is self-quarantining after experiencing COVID-19 symptoms. He says other health systems are reporting similar problems with patient communication, adding, “One of the things that we focus on when we put information out through patient portals is to empower our patients to become partners with us in delivering healthcare. The other thing is to help them understand what the data means, and that how we present the data is clear and unambiguous.” Paul isn’t happy that his COVID-19 exposure probably came from his daughter since Stanford didn’t cancel its Family Weekend on February 27-28 and then abruptly sent students home without self-quarantine instructions since testing wasn’t available.

Idiots with too much free time on their hands are “Zoombombing” public Zoom meeting in then blasting pornography to participants. The default Zoom setting is that any participant can share their screen. The company urges hosts of large public meetings to change the default so that only they can share their screen. It also recommends that private meetings be set to invitation-only with a password required. Users also suggest disabling “Join Before Host,” enabling “Co-Host” to allow others to moderate, disabling “File Transfer,” and disabling “Allow Removed Participants to Rejoin.”

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NYC Health’s guide to sex and COVID-19 suggests not having sex with anyone outside your household, noting that “you are your safest sex partner” in advocating video dating, sexting, and chat rooms. It also helpfully notes that shared keyboards and screens should be disinfected after their use for those purposes.


Sponsor Updates

  • Bluefield Regional Medical Center (WV) uses Live Process software to notify managers of updated COVID-19 communication and guidance documentation.
  • Meditech announces event changes for March and April.
  • Spok appoints Christine Cournoyer (N-of-One) to its board.
  • CompuGroup Medical sets up a dedicated website and phone line for providers to request six months of free CGM ELVI Telemedicine.
  • Experity publishes “E/M Coding for the 2019 Novel Coronavirus (COVID-19).”
  • Relatient names John Glaser to its board.
  • Vizient awards a group purchasing contract to CI Security for managed detection and response cybersecurity services.
  • ROI Healthcare Solutions creates a virtual booth after the cancellation of several conferences.
  • Impact Advisors posts a white paper titled “Keeping Your EHR Implementation  On Track Amid COVID-19.”
  • StayWell creates a COVID-19 resource hub for patients, members, and communities.
  • The Dallas Business Journal features T-System’s efforts to offer providers COVID-19 documentation resources.
  • Voalte parent company Hillrom donates $5.5 million in medical devices for critical and intensive care to 25 hospitals fighting COVID-19.
  • PerfectServe offers clients free COVID-19 automated patient and family outreach software and free services to implement best practices.
  • Wolters Kluwer Epidemiologist Mackenzie Weise appears on a special PBS “NewsNight Conversations: Coronavirus.”
  • Zynx Health publishes new COVID-19 order sets and care plans.

Blog Posts


Contacts

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Weekender 3/20/20

March 20, 2020 Weekender No Comments

weekender 


Weekly News Recap

  • Hospitals ask the federal government for a $100 billion bailout to offset their costs of diagnosing and treating COVID-19.
  • COVID-19 predictions and recommended federal government actions dominated the news.
  • HHS announces that it will allow physicians to practice across state lines, although individual states must waive their own requirements.
  • HHS OCR relaxes its requirements on the use of consumer video technologies such as Skype and FaceTime for offering telehealth services.
  • Telemedicine companies struggle with a high volume of demand that strains their infrastructure and provider availability.
  • WebMD acquires StayWell.
  • Epic cancels its XGM conference.
  • Cerner asks all employees who are able to work from home to do so.

Best Reader Comments

We are a hospital with numerous clinics making about $350 million per year in gross revenue with an average profit margin of 1.3% over the last 10 years. Our best estimate is that we will lose $10 million per month that this continues. That doesn’t even take into account our cash reserves that keep us afloat, which are being decimated in the market. We absolutely will see hospitals go bankrupt and/or be acquired this year without a bailout. (Bobby Bailout)

[COVID-19 testing data]. Epic has released functionality (COVID-19 Pulse Dashboard) that will aggregate de-identified data across their organizations. Considering they boast that their organizations cover half the US population, I would think they should be able to get some good aggregated data soon. Hopefully they do a good job of collecting the right metrics and cooperating with research institutions to help bring out some of this data. I hope Cerner is also looking to or already is doing something similar considering they also have a large share of US population. (AC)

I will think twice before ever booking our hotel rooms through OnPeak again. If we would have booked through the hotel directly, we would have been able to cancel with no fees. If you book with OnPeak/HIMSS, you lose your shirt. For what? A small room discount? Live and learn. (Jennifer)

On the practice side, most places have a little door barricade set up. People get a symptom check in the barricade one by one before they get in the waiting room area. People are told to call for instructions before approaching the clinic. On the hospital side, most of the clinical folks I’ve talked to have been told not to talk about internal details with the public. (What)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. P in California, who asked for robotics programming blocks for her kindergarten class. She reports, “The Cubelet blocks were exactly what I needed to connect computer science principles to solving real world problems. Our first experiment with the Cubelets was a simple challenge, to connect the blocks so their robot would move around the table and then stop. The kids were so excited to work together, every member of the group was trying different combinations and excitedly chiming in suggestions. I listened to these five year olds problem solve and collaborate and thought, ‘Wow. These are exactly the 21st Century skills that they need to be practicing.’ Thank you so much for giving us these high interest, durable robot blocks. You’ve made my class very happy, and given me a tool I will be using frequently in the future.”

Carnival offers the federal government use of some of its cruise ships as temporary healthcare facilities for non-coronavirus patients in major coastal cities, potentially freeing up hospital beds for treating COVID-19.

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China exonerates a Wuhan doctor it had reprimanded for warning about the coronavirus outbreak in an almost unheard-of admission by the Communist Party that it made a mistake. The party apologized to the family of Dr. Li Wenliang, who died of COVID-19. The government’s treatment of the doctor stirred uncommon public anger, with complaints that it was hiding outbreaks, punishing journalists, and valuing its own image over public safety. Several citizen journalists and critics were arrested and some disappeared after sharing information online about the outbreak. Insiders also claim that Wuhan’s claim of zero new cases is untrue because the local government suspended testing and discharged quarantined, symptomatic patients early to make President Xi Jinping look good during his scheduled visit there.

Italy presses 10,000 final-year medical school students into COVID-19 service, waiving the final exams normally required to put them on the front lines nine months early.

A California private practice doctor offers appointment-only drive-up coronavirus testing outside his office, with cash prices starting at $200. He has performed 40 tests, received eight results, and identified one positive patient. Mask shortages have forced him to buy from Craigslist scalpers.

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Ten conferences that have been cancelled at the Orlando’s Orange County Convention Center have hit the area with a $363 million economic impact. HIMSS is mentioned as working by mid-February to arrange on-site medical services to convince exhibitors not to pull out. The local paper intercepted emails from HIMSS in which it expressed dissatisfaction with the Visit Orlando convention bureau, which it said was not supporting the conference by agreeing to distributing attendee health information at local hotels. The photo above was taken on Wednesday, March 4, the day before HIMSS20 was cancelled.

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Fox’s “The Resident” TV drama, which is filmed in Atlanta, donates masks, gowns, and other supplies to Grady Hospital. “Grey’s Anatomy” and “Station 19” have donated masks and gloves to a Los Angeles fire station.


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Morning Headlines 3/20/20

March 19, 2020 Headlines 2 Comments

Hospitals ask for $100 billion coronavirus bailout

The American Hospital Association, American Medical Association, and American Nurses Association ask the federal government for $100 billion to offset COVID-19 diagnosis and treatment.

Ransomware Gangs to Stop Attacking Health Orgs During Pandemic

Several ransomware hacker groups say they will refrain from attacking healthcare organizations during the pandemic.

Surge in patients overwhelms telehealth services amid coronavirus pandemic

Telehealth services are being overwhelmed with a surge in patients that is stressing their technology and their supply of physicians.

Local medical tech startup shuts down operations

Medical credentialing-as-a-service startup MedSpoke closes, citing recent changes to its client base.

News 3/20/20

March 19, 2020 News 7 Comments

Top News

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The American Hospital Association, American Medical Association, and American Nurses Association jump on the federal government bailout train by asking for $100 billion to offset COVID-19 diagnosis and treatment.

Hospitals say they will lose revenue from delaying elective procedures and will spend more on training, supplies, and employee childcare.

The letter to Congress didn’t mention that insurers, including the federal government in the form of Medicare and Medicaid, will pay hospitals and doctors for providing care to COVID-19 patients.


HIStalk Announcements and Requests

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I’ve added a “comments” link to the bottom of every HIStalk post, a much-requested feature that allows reading or adding comments without scrolling back up.

Unrelated, outside of social distancing: need something interesting to eat with your canned soup? I made what I will modestly call “good” baguettes that were easy (no kneading), quick, and required just flour, water, salt, and yeast. They passed Mrs. H’s test of being crusty on the outside and soft (but not spongy) in the inside. You might as well have something homey while at home and make it smell good besides.


Webinars

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

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

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


Sales

  • Nebraska Health Information Initiative selects NextGate’s enterprise master patient index.
  • The Cardiovascular Center of Puerto Rico and the Caribbean will implement Medsphere’s CareVue EHR.
  • Topeka, KS-based HIE Konza will use Diameter Health’s data normalization and enhancement software to deliver de-duplicated CCDs to its members.

People

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MDLive names Chairman Charles Jones CEO, Christopher Shirley (Catasys) CFO, and Andy Copilevitz (Walgreens) COO.

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University of Washington Medicine pathology professor Stephen Schwartz, MD, PhD died Wednesday of COVID-19.


Announcements and Implementations

Children’s Hospital of The King’s Daughters (VA) implements analytics and data management software from Dimensional Insight.

Cobre Valley Regional Medical Center (AZ) rolls out Meditech Expanse, with consulting help from Engage.

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Health Catalyst will make available COVID-19 patient and staff tracking, public health surveillance, and staff augmentation support capabilities.

Jump Technologies makes its inventory management software available to hospitals for free for a limited time.

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Dina offers COVID-19 rapid response tools, including self-assessment of quarantined patients, remote monitoring of discharged and isolated patients and healthcare workers, patient self-assessment, and checking the health of staff members daily with text-based remote screening questions. 

Blue Shield of California offers its network hospitals a customizable COVID-19 Screener and Emergency Response Assistant for consumers. Mobile device or hospital website users answer questions whose answers direct them to the most appropriate medical setting. Blue Shield is covering the cost of implementation, which takes 48 hours, and three months of updates. The tool was developed by Gyant, which offers digital front door and patient engagement technology.

Allscripts announces its COVID-19 response, which includes a fast-tracked telehealth implementation plan for FollowMy Health, rollout of an EHR-agnostic automated triage tool, and employee travel restrictions.

Registry reporting vendor Iron Bridge offers free access to system to allow hospitals and labs to report COVID-19 cases to the CDC faster.

Verge Health offers free access to its Compliance Rounding solution that helps hospitals complete the COVID-19 CMS Infection Prevention Worksheet and CDC Hospital Preparedness Assessment

CompuGroup Medical offers free provider use of CGM ELVI Telemedicine, which allows them to collect patient information, share information, and provide care from anywhere.


Government and Politics

HHS will allow physicians to practice across state lines in an effort to prevent staffing shortages during the COVID-19 pandemic.

HHS asks for $21 million in additional 2020 funding for ONC to “support the emergency expansion of a patient lookup system to aid patients and COVID-19 medical response” via an online database.


COVID-19

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Former FDA Commissioner Scott Gottlieb, MD provides thoughts on COVID-19:

  • Therapeutic response involves three efforts: developing a vaccine (which he thinks will take two years), trying existing antivirals, and developing an antibody that can be given as a monthly injection to protect frontline healthcare workers and high-risk people.
  • He expects the epidemic to peak in late April and early May, with hopes that it will have run its course by July and will leave enough people who have recovered from it to create herd immunity. His biggest fear is that it will come roaring back in September and cause another epidemic that will last all winter.
  • Point-of-care diagnostics similar to the flu swab are needed to allow doctors to quickly quarantine people who are infected instead of waiting 24-48 hours (he says that test can be developed within three months). Then roll out widespread surveillance testing to see how the virus is circulating. He says the nation’s posture is not sustainable unless such surveillance can be put in place while waiting for a vaccine to be developed.

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Former National Coordinator and Aledade founder and CEO Farzad Mostashari, MD – who has strong syndromic surveillance experience — identifies issues with COVID-19 data collection and analysis, likening the current state of testing to giving a haphazard set of people a new drug, collecting information sloppily, and then trying to use that information to determine whether it works:

  • The public health value of counting positive tests is minimal without understand each individual’s condition, their source of exposure, and how they compare to those whose tests are negative.
  • The preliminary data that is being reported to the CDC is frequently missing hospitalization status, ICU admission status, death, and age. CDC does not know the denominator of how many people have been tested.
  • Labs should be required to submit aggregate information on every test they perform, not just those with positive results.
  • Sentinel testing needs to be performed.
  • A serosurvey is needed, where a random sample of households in a large city is tested and surveyed to understand the fatality and infection rates.
  • ED visits for cough, fever, and flu-like symptoms need to be studied to determine how many are COVID-19 related.

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Bill Gates address coronavirus in a Reddit “Ask Me Anything,” where he observes about COVID-19:

  • US testing is disorganized. The federal government needs to provide a questionnaire website for consumers that prioritizes the testing, such as making sure that healthcare workers and the elderly are tested first. 
  • Labs that perform COVID-19 testing need to be connected to a national tracking system.
  • Gates and his researchers feel that the Imperial College models are too negative given that China’s shutdown reduced case numbers that showed little rebound. The Imperial College models were based on influenza.
  • He expects treatments for COVID-19 to be available before a vaccine, which would keep people out of ICUs and off ventilators. The Gates Foundation is funding research on bringing all industry capabilities into play.
  • The Foundation is working on a plan to send test kits to people at their homes to try to offset the US’s disorganized testing.
  • He expects individuals to be assigned digital certificates to show that they have recovered, or when a vaccination is available, that they have received it.

Mitre urges the federal government to take immediate action to halt the short doubling time of new COVID-19 cases in the US:

  • Close all schools.
  • Give businesses incentives for allowing working from home.
  • Shut down all places of social gathering, including restaurants, bars, theaters, concerts, and sporting events.
  • Provide home food supplies to everyone who needs them.
  • Seal the US borders to all forms of traffic and transport.

Cerner temporarily closes its Realization campus after an employee tests presumptively positive for COVID-19.  The company had already announced a work-from-home policy for most employees.

National medical group Mednax comes under fire for telling clinicians that if they require a two-week quarantine following coronavirus exposure, they must use their sick leave or PTO.

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First Affiliated Hospital of Zhejiang University and Alibaba Health publish a 60-page, detailed COVID-19 prevention and treatment handbook that accumulates information gained from China’s outbreak.

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Healthcare workers at Providence St. Joseph Health in Washington fashion face shields out of supplies from craft stores and Home Depot, including marine-grade vinyl, industrial tape, foam, and elastic. The health system is evaluating the quality of material used for surgical tray liners in case they need to repurpose them for masks.

YMCAs in Memphis, TN convert into childcare facilities for healthcare workers and first responders.

US funeral homes are asking families to scale back or postpone funeral services, limit attendees, and conduct services virtually to comply with federal guidelines that limit gatherings of more than 10 people. The funeral homes are also increasing worker protection since nobody knows now long the coronavirus can live on the tissue of the deceased.

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Pulizter-winning cartoonist Mike Luckovich of The Atlanta Journal-Constitution posted this work.


Privacy and Security

Government officials in Massachusetts warn the public, particularly seniors, of COVID-19 testing scams: “Testing can only be ordered by a treating physician. We have heard about teams in white coats going door-to-door offering virus testing. This is NOT a valid offer. What they are really interested in is robbing the elderly or stealing their identity. And we have heard reports of callers pretending to be a nurse offering test results once they get a credit card number. These kinds of calls are also not for real.”

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Several ransomware hacker groups say they will refrain from attacking healthcare organizations during the pandemic.


Other

Telehealth services are being overwhelmed with a surge in patients that is stressing their technology and their supply of physicians. Cleveland Clinic reports a fifteen-fold increase in telehealth visits and is doing phone consults and recorded video visits to try to keep up. University of Pennsylvania has increased telehealth staffing from six to 60, but is running days behind, while Jefferson Health is receiving 20 times the number of virtual visits and is scrambling to enlist more doctors.

ProPublica looks at the role medical conferences have played in spreading COVID-19.

The New York Times calls the Zoom videoconferencing service “where we work, go to school, and party these days.” People are convening virtual birthday parties and cannabis hangouts, teens are referring to themselves as “Zoomers,” college students are using it for blind dates, it’s being used for virtual college graduations, and experts worry that it will turn into a Facebook-like cesspool of live online mass shootings and child porn that will force the company to moderate content. Zoom’s soaring share price values the company at $29 billion.


Sponsor Updates

  • Kyruus incorporates Gyant’s chat-based virtual assistant into its patient-provider routing and scheduling software.
  • Intelligent Medical Objects will release free COVID-19 terminology content and value sets to customers on March 26.
  • Omni-HealthData adds enhanced social determinants of health data to its health information management software.

Blog Posts


Contacts

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Readers Write: COVID-19: You Aren’t Ready

March 19, 2020 Readers Write No Comments

COVID-19: You Aren’t Ready
By Jeremy Harper

Jeremy Harper, MBI is chief research information officer of Regenstrief Institute of Indianapolis, IN. The views and opinions expressed in this article are his personally and are not necessarily representative of current or former employers.

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Chief research information officer means that I design systems to connect clinicians, research, and IT for a living. I’m paid to think outside the box. 

I’ve been tracking coronavirus since mid-January. I want to acknowledge as I write this that as of March 19, 2020 we have about 10,000 individuals in the US who have been identified with this disease. We are not at a crises today, but we might be in a week. About 3,000 new cases were identified yesterday.

Our health systems are built upon a tower of electronic assumptions for patient care, triage, and scheduling. If you review the CDC pandemic preparation documentation, we are focused on minimization of the event in lowering the curve. I’m calling on the IT and informatics Industry to look beyond minimization to what happens if we fail. We are not ready.

A crises of this magnitude brings us back to a simpler time, one that requires a massive streamlining. We’re seeing vendors begin to release capabilities for streamlined remote visits, but we need to be prepared internally for our health system operations.

We can’t just focus on how our back office connects remotely, because if the worst happens, our health administration will be ignored in favor of saving lives. We’re going to be rushing to convert swaths of our hospital beds to ICU beds like Italy has done, or creating new hospitals like China did. We are going to see all those beautiful individual rooms that have been built at hospitals over the past 30 years doubled up. 

This will be a new health system in a matter of days, and we have not designed our systems to deal with this. As an executive consultant, I’ve participated in pandemic preparedness and emergency drills in numerous health systems. We are suddenly faced with a situation that has the potential to dwarf the worst-case scenarios we have envisioned.

Almost every report that you have spent years building will suddenly become useless. They will be repurposed for decisions they weren’t intended to support. AI/ML won’t solve this one for you, because this is something new, something that will break every model we have worked to build.

Think about your automated systems to alert clinicians to close charts. If people are dying in the hallways, it doesn’t matter. Closing charts, filling in discrete fields (this one kills me as a researcher — we need discrete data desperately to identify best practices), and most clinical decision support suddenly go out the window.

I’ll take a personal example of what we’re about to face on the clinical and administrative front. My father had an esophagectomy about five months ago. They caught the cancer early. He was asymptomatic, aside from a cancer that was going to kill him. His 10-hour “elective” surgery might not be taking place or might be delayed right now as health systems gear up for COVID-19. He has had strictures (throat closing off) since the surgery. He has already been informed that they might cancel his next appointment (where they put him under and stretch his throat) depending on patient load due to COVID-19.

If we see mass cancellations of these an other “elective” process items, then we’re going to need better reports that prioritize patient rescheduling that is based on acuity rather than who gets on the phone and connects first, or who knows how to manipulate the scheduling system the best. This isn’t Ebola, where simple screening questions and changing our triage process will cut it.

What you can do now:

  • Start building reports to support your providers in triage to get the right people to the front of the line.
  • Identify how we’re going to support a world where we might ask the public to donate CPAP/BIPAPs to keep people breathing through the disease.
  • Stop assuming that you are dealing with a “business as usual, just remote” situation, and use this time to prepare for a world where the EMR is low on the priority list.
  • Work with researchers to identify the data we need to get treatment recommendations out to the world quickly.
  • Use your time and expertise to help groups in need.
  • Figure out your best practices and start telling people about the changes you are making.

I have a full-time job. I do executive consulting on the side. I have a beautiful three-year-old and a wife I love. I know how hard it is to find more time during an “all hands on deck” situation. We are all in this together. Let’s be ready.

Health System Frontline Reports and Tips – Coronavirus Response

March 19, 2020 News No Comments

A large Midwest health system with a medical school:

Optional daily huddle from noon to 1 p.m. Monday thru Friday. We are all working remotely and can’t walk to desks to have a conversation, but have new challenges. A dedicated time to discuss any concerns has helped many times.

Continuity of command structure. Statistics show that as much as 30% absence rates could be realized. We have been asked to document our command structure at least three levels deep.


A Boston health system:

A patient does not exist in Epic until they have a visit or a bed. With new tents being added, lobbies being bedded, and new ICU beds being planned, Epic builders and managers, physicians, and leadership are working overtime getting it all built.

The command center has been fully operational for nearly two weeks.

Telemedicine visits were built and rolled out in record time, hundreds and hundreds of them Monday.

I am not sure anyone outside of the Epic world understands how much work this takes,  but it has all come together safely with the hope of improving the health of well-being of our providers and patients. I’m sure Epic was busy themselves supporting us and all the other hospitals (and my Epic contact was working at home, btw).

Keep on keeping on. Endless time at home nowadays to work, work, work.


Small, rural health system in the Pacific Northwest:

Agility matters. Stay hyper-informed about what is going on locally and nationally. Literally try to guess what is going to happen next and keep planning for worst-case scenarios, which so far have been proven to be the case every time.

Keep it simple. A quickly deployed 60-70% solution is better than nothing at all. Suboptimal is the new normal.

Focus on telehealth. Our system has a limited number of providers who cover wide geographic areas. The fact that some of them are either infected or self-quarantined means we have to figure out how to get them to be able to have access to patients from wherever they’re located.

Expect and plan for a big support overhead with telehealth and work from home from all levels of IT. Set expectations on support levels, be transparent in how you’re prioritizing support, and be evangelical about focusing on providers and patients.

Expect all of your technology partners to be fairly overwhelmed. If you are looking for hardware, you are going to have to be creative in your sourcing. Don’t be too proud to reinstall decommissioned hardware or to move things around between environments to the most critical areas such as networking or desktop provisioning/support. Also, look to the cloud.

Stay engaged with your clinical and operational leadership. Force your way into any and all planning and response meetings, ask for a seat on all incident response teams, and continually give risk assessments and rational resource constraints.

Dust off your disaster plans and business continuity plans. They can be a great guide for remote workforce management. Keep your CISO and compliance officer close at hand. Don’t do anything stupid in your rush to facilitate what your clinical and operations leadership needs to accomplish.


We have been a user of Webex for years. Didn’t realize we had a limit of 200 users until we started doing town halls for staff. Have asked Cisco to expand to 1,000 users, which should be enough.


North Carolina health system spanning urban and rural areas:

Big investment in telehealth capability – network upgrades, training Investments in telework for non-essential personnel. Dashboards to track cases in house, pending tests, supply projections, vent availability.


Bay Area system:

It’s a strange mix of prepared process and optimistic feeling. We’re doing everything right – ramping up work from home, limiting visitor access, etc. But there’s still a general business-as-usual vibe from everyone that feels almost a little surreal for me. I get that it’s a lot better than blind panic, but it still makes me wonder how well everyone is going to mentally adjust in a few days when it gets really bad. Still, I’m happy to be somewhere that started taking precautions very early.

This is not the time to be particular about work from home. Everyone who can should, with as little “proving” and red tape as possible. Just do it! Maybe people will be less productive — there’s a pandemic on, that’s what happens. For essentials who need to be in, try to at least spread out the load so the density is lessened.

Make sure you know what your reporting looks like when you exceed bed capacity NOW, instead of learning as it happens. Be prepared for helpdesk to be a pinch poin, and try to find ways to lessen their burden by socializing fixes to common problems.


National hospital system:

This past weekend, we conducted an IT checkout process for 300+ employees to ensure staff who we are sending home were well prepared. Lots of them were familiar with email access, but less so with a soft phone Avaya routing of their desktop phone to their computer (avoids using a second port off your switch when forwarding phones directly) and various other IT tips. This avoided a flood of calls to the IT help desk, letting us take calls from our hospitals as normal.

From a cleaning perspective, we are just now purchasing relatively inexpensive dry hydrogen peroxide cleaning devices that can clean airborne and surface viruses and other contaminants. This should allow us to have increased safety in rooms vacated by patients positive with the virus.


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Reader Comments

  • Gonepostal: re: "Politico also reports that two senators have introduced legislation that would make the post office’s address mat...
  • Epic Dev: I think that your assessment of Epic's COVID response is focused on the wrong choice. Sure, we employees have the choice...
  • Bolognavirus: The statement made was that Epic is breaking the law. The answer clarified that it isn’t....
  • detroitvseverybody: As a member of an organization, it helps to conceptualize your options into three categories: exit, voice or loyalty[1]....
  • Deetelecare: It reminds me of the post-deregulation period in the airline business, 1980s into the 1990s, when airlines fetched this ...

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