News 12/11/20

Top News

Amazon announces HealthLake, an API-driven, HIPAA-eligible, petabyte-scale AWS Cloud service for storing, transforming, querying, and analyzing health data.

It supports ingestion of FHIR-formatted data and provides natural language processing of unstructured data for querying and searching.

Early adopters include Cerner, Orion Health, and Konica Minolta.

Amazon estimates that a large hospital that stores 1 TB of patient data, runs 13,500 FHIR queries per hour, and applies NLP to 5 million characters of text would incur charges of $500 per month.

Reader Comments

From John Barleycorn: “Re: ActionOI. Vizient bought the workforce productivity benchmarking tool from IBM Watson Health a few months ago and has now cut off access to consulting firms. Just about every process improvement consulting firm – Huron, Deloitte, Accenture, Kaufman, etc. – used either ActionOI or Premier’s benchmarking package. I’m guessing that Vizient doesn’t want third-party firms profiting from their benchmarking and would rather sell the tool directly to hospitals.” Unverified. IBM Watson Health acquired Truven Health Analytics for $2.6 billion in April 2016, then in May 2020 announced a “partnership” in which it turfed ActionOI, CareDiscovery, and Market Expert to Vizient to offer clients a transition path to Vizient Operational Data Base.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor ReMedi Health Solutions. The Houston-based, clinically-driven healthcare IT advisory firm is committed to improving the future of healthcare. It provides EHR solutions that support enhanced patient care, efficient clinical workflows, and improved financial and operational performance for healthcare providers. The company believes in leading with empathy. Its deep knowledge of healthcare systems, workflows, and technology has helped it improve physician buy-in, patient care, and engagement significantly. ReMedi assists its clients with all aspects of EHR, from system selection and data migration to go-live, and provides valuable insights into trends and changes emerging from new regulations and industry best practices. The company was founded in 2017 by Texas native and physician informaticist Sonny Hyare, MD. Thanks to ReMedi Health Solutions for supporting HIStalk.

Unrelated to anything except maybe in a COVID Christmas stretch, but perhaps you need a current and future Zoom break. Mrs. HIStalk came running in with catalog that had come in the mail for her, gleefully describing how I would love it (the address label started with “For the master bathroom of:”) Thus began my two-hour, sophomorically giggling immersion into the warped world of Shinesty, which is what could result if writers for “The Onion” bought a manufacturer of bizarre Christmas pajamas, semi-profane underwear, and wild party suits. I’ve yet to decide whether I require “Weekend in Boca” Hammer pants or a Jesus-adorned “Santa is Fake News” sweater, but meanwhile, the catalog has earned a permanent spot within impulsive reach.

Listening: new from Toronto-based U.S. Girls, throwback, experimental pop with some disco thrown in by what is really just a single performer with some backers. Bands have usually ended up being ephemeral, fluid gatherings, so I guess I’m OK with one-off collaborations even as I wonder how the resulting musical diaspora can string together financially successful careers.

Webinars

December 15 (Tuesday) 1 ET. “Highlights from the 2021 CPT Code Set Update.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, senior director of global clinical services, IMO; Shelly Jude, RHIA, RHIT, mapping manager, IMO. Top coding professionals will highlight the most important changes to the Current Procedural Terminology code set that take effect on January 1, including crucial additions, deletions, and revisions; how to communicate Official Coding Guidelines changes to the healthcare team; and a description of the impact that the code set update could have on practice.

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

Acquisitions, Funding, Business, and Stock

Baxter International has reportedly offered to acquire medication management technology vendor Omnicell for more than $5 billion. OMCL share price jumped on the news, up 44% in the past year versus the Nasdaq’s 46% increase.

Consumer telehealth vendor Ro acquires Richmond-based Workpath, which offers an API-powered platform for dispatching workers to provide in-home blood draws and nurse visits.

Capacity management, access management, and analytics software vendor LeanTaaS raises $130 million in a Series D funding round, increasing its total to $250 million. CEO Mohan Giridharadas, MS, MBA founded the company in 2010 after 18 years at McKinsey & Company.

CitiusTech acquires healthcare management firm FluidEdge Consulting. 

Sales

• Hi-Bridge HIE chooses NextGen Health Data hub as its HIE platform.

People

Novant Health promotes Angela Yochem, MS to EVP / chief transformation and digital officer, expanding her CDO/CTO role to include transformation and growth initiatives.

Announcements and Implementations

HIMSS launches its Office of Scientific Research, which will offer digital health vendors help with creating evidence of the effectiveness of their products and to share best practices.

Google announces Health Studies, a clinical trials recruitment app for Android devices. The first study involves COVID-19 related respiratory illnesses and is being conducted by Harvard Medical School and Boston Children’s Hospital.

Credit card services company Alliance Data donates $2 million to Nationwide Children’s Hospital (OH) for development of a database to support its community children’s program, allowing the hospital to track infant mortality, kindergarten readiness, high school graduation, teen pregnancy, obesity, suicide, preventive health, and child mortality.

CPSI will offer its customers a COVID-19 Vaccination Assistant chatbot that was developed by QliqSoft, hoping to automate education and follow-up to overcome vaccine hesitancy. 

Phynd announces Epic App Orchard availability of Provider Data Connect, which allows Epic users to enroll providers and keep their data synchronized with Phynd Provider Data Management.

Banner Health is using Cerner integration with Xealth to allow providers to order digital content and services from a single location in Millennium.

A KLAS report on outsourced coding finds high client satisfaction with Himagine and AGS Health, while internal changes and expansion have caused a 40-point drop in customer satisfaction for NThrive.

Runnymede Healthcare Centre goes live with Meditech Expanse following an eight-month implementation involving its relationship with Humber River Hospital, North America’s first fully digital hospital.

Scanwell Health, which sells direct-to-consumer home lab tests, lists its urinary tract infection kit for sale on Amazon. Consumers pay $15 for three tests (with free Prime shipping), read the test strip on the company’s app, then get same-day prescriptions via a $25 telehealth visit that is provided by Lemonaid Health. The urine test detects leukocytes and nitrites. The company is working with Lemonaid on a home blood test for COVID-19 antibodies.

Atropos Health launches itself with a “digital physician consult service” that mines EHR information for real-world evidence from similar patients to provide recommendations. The product uses Green Button technology that was developed at Stanford Medicine to form its Clinical Informatics Consult service.

Government and Politics

HHS OCR publishes draft changes to HIPAA, including:

• Patients would be allowed to take notes, photos, and videos of their records when inspecting them in person.
• The time for a covered entity to respond to a patient’s request for their records would be shortened from 30 days to 15, with the possibility of one 15-day extension.
• Patients could request a covered entity to send an electronic copy of their information to third parties.
• Covered entities would not be allowed to charge patients for viewing their information in person or online, but could charge patients their cost to make and mail paper copies. Copies made for third parties could be charged only to cover the labor involved.
• Covered entities would not be allowed to require patients to comply with unreasonable identity verification measures, such as requiring their records requests to be notarized, making them prove their identity in person when it could be done electronically, or requiring patients to use the covered entity’s online portal.
• Healthcare operations would be expanded to include care coordination and case management by health plans, at both the individual and population level.
• Covered entities would not need to decide which information is minimum necessary when the request comes from a provider or health plan for care coordination and case management.
• Covered entities would be allowed to disclose PHI to social services and community agencies for care coordination and case management.
• Permissible disclosure would be expanded in cases of substance abuse, serious mental illness, and emergencies. 
• Providers would not be required to get a patient’s signed acknowledgment that they received a Notice of Privacy Practices.

COVID-19

Wednesday’s state data showed another record day, with 210,000 new cases, 106,688 COVID-19 patients in hospital beds, and the highest-ever single day death count of 3,054.

China’s civil aviation authority recommends that airline flight attendants avoid COVID-19 exposure in onboard restrooms by wearing diapers.

Florida state police raided the home of fired former state COVID-19 data scientist Rebekah Jones at gunpoint this week in investigating what the Department of Health says was unauthorized use of an emergency group text system, but Ars Technica finds that the system is not secured, uses a single username and password for all users, discloses those login credentials in a publicly searchable manual on DOH’s website, and will broadcast any message that is sent to a specific email address that is also listed in the manual.

Other

University of Vermont Health Network says its weeks-long, malware-caused downtime will cost it at least $63 million in lost revenue and additional expense.

The federal government’s cybersecurity agency advises users of GE Healthcare’s radiology equipment to change the widely published default password to protect their systems and networks from hackers, scoring the vulnerability at 9.8 on a scale of 10. A security firm also recommends restricting the Internet support ports to listen-only mode.

The Washington Post’s review of Amazon’s Halo Band concludes that not only is it “the most invasive tech we’ve ever tested” in using nude photos and microphone voice analysis to assess health status, it also “makes the absolute least use of it” in doing a better job sending data to Amazon than helping users get healthy. The paper warns that Amazon’s intention for the “half-baked product” is to capture user health information for training its algorithms to eventually disrupt medicine.

Plastic surgeons report an uptake in their Botox and cosmetic surgery business that could either be from pent-up demand, the perceived benefit of recovering unseen at home, or a “Zoom boom” in which housebound employees don’t like the way their webcam accents their chin, jaw, and neck on Zoom calls.

Sponsor Updates

• Healthcare Tech Outlook recognizes Lumeon as a Top 10 Surgery Solution Provider for its pathway engine that uses EHR data to personalize the care experience.  
• Wolters Kluwer Health integrates Tabula Rasa Healthcare’s DoseMeRx with its Sentri7 Antimicrobial Stewardship solution.
• Meditech offers Expanse customers High Availability Snapshot to give them immediate access to patient data during unexpected downtimes.
• Saykara wins a Stratus Award for Kara, its AI-powered voice assistant that automates clinical charting.

Blog Posts

• COVID-19 Vaccine Distribution: The Next Hurdle for Hospitals (Everbridge)
• How Glytec’s EGMS Unlocks Quality Improvements in Glycemic Management (Glytec)
• COVID-19 is Exacerbating Challenges in Clinical Communication (Halo Health)
• Accelerating Healthcare Evolution: Cross-Industry Lessons (The HCI Group)
• As hiring freezes thaw, IT managers scurry to fill critical positions before year-end (HCTec)
• Shifting to Virtual Care in the COVID-19 Era: Analytics for Financial Success and an Optimized Patient Experience (Health Catalyst)
• How Does Telehealth Change the Provision of Care? (Optimum Healthcare IT)
• Measuring and Improving Patient Self-Efficacy and Informed Choice (Healthwise)
• Imprivata was in the news yesterday morning. Didn’t notice? Good. (Imprivata)
• Interoperability and COVID-19 in 2020 and Beyond (Infor)
• 5 Cybersecurity Threats to Healthcare During COVID-19 (InstaMed)
• Bed Visibility Proves Value at Two Levels: Q&A with Charley Larsen and Luke Smith (Central Logic)
• More than ever, we need powerful technology partnerships in healthcare (InterSystems)
• Creativity and caring: The secret sauce for a successful marketing team (Intelligent Medical Objects)
• For Legacy Healthcare Providers, The Retail Threat Keeps Getting Bigger (Loyale Healthcare)
• Building better virtual care experiences with the Epic App Orchard (Lumeon)
• Hackathon 2020 Drives Systemic Innovation at Medhost (Medhost)
• Managing a crisis with COVID-19 drive-thru testing at Lawrence General Hospital (Meditech)
• 6 Patient Engagement Tips to Utilize in the New Year (MWTherapy)
• Why patient identification is crucial for detecting adverse drug events (NextGate)

Contacts

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

EPtalk by Dr. Jayne 12/10/20

As COVID-19 ravages large swaths of the US, CMS continues to push a strategy to enhance hospital capacity that is somewhat slow to start. It allows ambulatory surgery centers to provide inpatient care when needed. However, the problem is that most clinical staff at ambulatory surgery centers aren’t used to ongoing management of very sick patients. Just because there are more beds doesn’t mean there are more people to staff them. Our area has a surplus of beds but limited staff, which makes for some interesting spinning of hospital capacity rates.

The strategy also allows certain patients who would normally be admitted to the hospital to be cared for in their homes. Although many academic centers are gearing up programs to make this a reality with high-quality coordinated care following the CMS guidelines, some organizations are forcing greater at-home care by just discharging patients as early as possible even though they may not meet conventional discharge criteria. It will be interesting to see how this impacts readmission rates down the road. Analytics gurus, start your engines.

With all the clinical shifts I worked in November, I missed out on a telehealth-related bill introduced in Congress that would penalize states that aren’t part of the Interstate Medical Licensure Compact. I’m fully supportive of anything that makes it easier for us to practice across state lines. I live fairly close to a state border and can have a telehealth visit with some patients while they are at work in my state, but it becomes illegal if they start their visit from their home across the river. HR 8723 would give states three years to join the Compact or risk not receiving funding from the Bureau of Health Workforce, which rolls up under the Department of Health and Human Services. State licensing boards would also be blocked from some federal grants if they don’t have a “public awareness campaign to encourage specialty physicians to practice telemedicine.”

The Interstate Medical Licensure Compact was launched in 2017 by the Federation of State Medical Boards and now has its own governing board. Its goal is to create a more streamlined process for physicians to gain licensure in other states. Currently 25 states plus Guam are live with five more states scattered throughout the process.

When I started practicing telehealth, my mentor encouraged me to apply for multiple state licenses. I quickly found the process to be arduous and expensive just for the applications, with some states requiring bizarre documentation such as high school transcripts that are largely irrelevant to the competency of a physician who has been in practice longer than some high schoolers have been alive. Once the licenses are approved, there is then annual maintenance of those licenses, and the risk/benefit equation quickly tipped to the former.

I’m deep in the final stages of a product launch this week, and this is the first one I’ve done in a totally remote environment. I’m used to working in a command center with everyone under one roof for rapid troubleshooting and hotfixes, which just isn’t realistic given the current pandemic conditions. Nearly all the resources are working from home, which has created some interesting situations, including a toddler attending one of our final checkpoint calls. The organization is doing a great job trying to foster togetherness and support the team during this high-stress situation, including sending gift cards for take-out and delivery meals.

Although I miss the feeling of togetherness and the satisfaction of working as a team, it’s just one more element of the new normal that many of us will be working in for the foreseeable future. I’m also glad for some time away from patient care so that I can refresh and recharge. Of all the go-lives I’ve supported, no one has ever tried to get me to look at a Ziploc bag full of their stool sample, which happened to me three times during my last few days of patient care.

Nearly 100% of the chatter in the virtual physician lounge this week surrounds whether the Pfizer COVID vaccine will be approved on Thursday and how quickly organizations can start administering it. The lack of a national vaccine strategy has created vast disparities across states with regards to how it will be administered to frontline healthcare workers. Over the last couple of weeks, our area’s major health systems have announced their plans for employee vaccination and public health organizations have started to talk about their plans for vaccinating high-risk patient populations. However, it didn’t seem like there was any plan for vaccinating frontline healthcare workers at non-hospital entities.

After getting an unsatisfactory update from my employer, I felt like I was on my own and connected with a group of independent physicians who are in the same situation. They’ve been making phone calls to various county and state agencies along with hospitals and health systems for weeks, and each entity seems to point fingers at someone else who “should have been responsible” for including us in the planning. Just talking to the physicians in the group, our respective organizations deliver over 500,000 patient visits each year and represent close to 3,000 COVID tests each day. It doesn’t begin to reflect the amount of care delivered by independent physicians across our city, let alone the state.

My contribution to the effort has been reaching out to state and local professional societies and elected officials. Although many of the individuals we have collectively contacted are sympathetic, none of them are willing or able to take the burden from us and carry it forward. This has been such a long, hard slog and the emotional impact of knowing that physicians who don’t even care for known COVID positive patients will be vaccinated but we won’t, just because of who we work for, is enough to push us over the edge.

The best comment of the day came from the physician advocacy rep at my state professional academy: “It is truly unfortunate that something so important is so difficult to achieve.” It’s not like we haven’t had months to plan this, or in the worst-case scenario, could have just copied from the “smart kid” state next to us that seems to have a fully formed plan.

How is your state or community handling vaccines for non-hospital frontline healthcare workers? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/10/20

UVM Heath Network cyberattack fixes expected to exceed $63M

University of Vermont Health Network officials says the ransomware attack that occurred on October 28 has so far cost the organization $63 million in lost revenue and incurred expenses.

Baxter in $5 billion bid for Omnicell

Medical device manufacturer Baxter has reportedly approached medication management software vendor Omnicell with an acquisition offer of $5 billion.

GE puts default password in radiology devices, leaving healthcare networks exposed

The US Cyber Security and Infrastructure Security Agency issues an advisory urging GE Healthcare customers to request that the company change default passwords in certain radiology devices so they are no longer susceptible to hackers.

Advancing health research with Google Health Studies

Google launches a Health Studies app, giving Android users the opportunity to participate in research such the initial respiratory illness study conducted by Harvard Medical School and Boston Children’s Hospital.

Elsevier acquires Shadow Health, a leading provider of best-in-class healthcare simulations

Elsevier acquires Shadow Health, a developer of virtual simulation software for nursing and healthcare education.

Morning Headlines 12/9/20

Story Health Launches Virtual Specialty Care to Empower Patient-Clinician Relationship

Verily co-founder Tom Stanis launches digital care coordination and engagement company Story Health with $4 million in seed funding.

Cerner and Elligo to Make Clinical Trials Accessible for Health Systems of All Sizes

Cerner invests in Elligo Health Research and will use its technology to offer clinical trial opportunities to providers and patients.

AWS Announces Amazon HealthLake

Amazon Web Services launches HealthLake, a HIPAA-compliant data aggregation, normalization, and analytics service for healthcare and life sciences organizations.

In the Latest COVID-19 Surge, Health Record Exchanges Through Care Everywhere Reach 221 Million in a Month

Epic’s Care Everywhere reached 221 million health record exchanges in October 2020, up 40% from the same period a year ago.

News 12/9/20

Top News

Canada-based long-term and post-acute care software vendor PointClickCare will acquire care transition notification startup Collective Medical for $650 million.

The companies have been partners for a little over a year.

The deal marks PointClickCare’s third acquisition in two years. It acquired Co-Pilot analytics from Consonus Healthcare in May and LTC EHR vendor QuickMar last year.

Salt Lake City-based Collective Medical, whose product is used in 20% of US hospitals, was valued at $170 million in its most recent funding round in 2017.

I interviewed Collective Medical CEO Chris Klomp a few months ago.

HIStalk Announcements and Requests

Today I learned about the “Texas sharpshooter fallacy,” in which an armchair expert mistakes a random clustering of data points as being indicative of a trend. The title refers to someone who shoots a bunch of random bullets at a blank wall, then paints a target around the tightest grouping to claim expert marksmanship. As with the cherry-picking sharpshooter, data similarities are stressed and exceptions are ignored. The most recent offenses involve COVID-19 and the election.  

Webinars

December 15 (Tuesday) 1 ET. “Highlights from the 2021 CPT Code Set Update.” Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, senior director of global clinical services, IMO; Shelly Jude, RHIA, RHIT, mapping manager, IMO. Top coding professionals will highlight the most important changes to the Current Procedural Terminology code set that take effect on January 1, including crucial additions, deletions, and revisions; how to communicate Official Coding Guidelines changes to the healthcare team; and a description of the impact that the code set update could have on practice.

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

Acquisitions, Funding, Business, and Stock

Talkspace considers putting itself up for sale, leading analysts to speculate that an acquisition could value the online therapy app startup at $1 billion. It has raised $107 million since launching in 2012, and made its first acquisition — a couples therapy app — last year.

Verily co-founder Tom Stanis launches Story Health with $4 million in seed funding. The startup has developed software to enhance patient care between office visits, including virtual programs and analytics.

Cerner invests in Elligo Health Research and will use its technology to offer clinical trial opportunities to providers and patients. Allscripts has offered Elligo’s services since 2017. The company was awarded an FDA grant in October 2019 to work on real-world data harmonization for 21st Century Cures Act data sharing use cases.

I listened to the business overview by UnitedHealth Group CEO Dave Wichman at the company’s virtual investor conference, assuming that the strategy of a company that has a $330 billion market cap, that expects $277 billion in 2021 revenue, and that has penetrated every aspect of healthcare and insurance is worth hearing. Clearly UHG is targeting every profitable aspect of healthcare in a way that will turn the hospital industry on its ear and is leading the charge with its high-growth Optum business. UHG  says it has 3.6 million customers covered by some degree of value-based care in 44 states and is pushing hard to move surgeries from expensive hospitals to ambulatory surgery centers. Points:

• Nearly every aspect of UHG’s strategy involves consumer technology, data, and AI, all of which it expects to lower costs, provide a better experience for patients and physicians, and expand affordable access. Wichman says that no country’s health system was strong enough to respond to COVID, but technology, information, and systems are now capable of showing how healthcare can evolve.
• An individual’s entire health history will live in the cloud, will be constantly updated by real-time systems, and will be backed by an AI-powered care team that will offer both virtual and face-to-face services in which evidence-based medicine will guide next-best-action and care plans.
• Everything will be on demand, such as flu meds stored in a remotely controlled lockbox, home IVs, and virtual help for stress.
• Doctors will be paid in real time for following science, while patients will be rewarded for their healthy behaviors.
• The company’s growth pillar 1 is to reinvent healthcare delivery via high-performing local medical practices that are paid for value-based care and backed by national support such as a digital clinical home, virtual primary care, analytics-supported telemedicine visits with your own doctor, house calls for seniors, home infusions, retail pharmacy, and digital pharmacy powered by analytics.
• Growth pillar 2 is pharmacy services, especially specialty pharmacy and direct-to-consumer offerings. The company has introduced daily dose packaging (similar to Amazon PillPack), home infusion, the Optum Store, digital pharmacy, and the opening of 60 retail dispensing sites.
• Growth pillar 3 is consumer-centered benefits, with wider choices and digital therapeutics and coaching for diabetes (again seemingly aiming at Telehealth’s Livongo business).
• Growth pillar 4 involves insights — digital scheduling, health record scaling, development of proprietary telemedicine, and use of AI in practice. The company has invested in 30 startups, most of them related to technology.
• Growth pillar 5 is health fin tech, such as digital payment and authentication for rewarding consumers and high-performing clinicians.

Sales

• Hampton Regional Medical Center (SC) will use consulting services from Engage for its Meditech Expanse implementation.
• Thriving Mind South Florida selects Netsmart’s CareManager population health software.

People

Eagle Telemedicine promotes Jason Povio to president and COO.

Richmond University Medical Center (NY) names Tom Pagano (Johnson County Community College) VP of IT and support services.

Johns Hopkins Health System names interim Sibley Memorial Hospital President and COO Hasan Zia, MD, MBA to the permanent role. He is an informaticist who served as Sibley’s CMIO from 2011 to 2015 and led its Epic implementation.

Announcements and Implementations

Epic’s Care Everywhere reached 221 million health record exchanges in October 2020, up 40% from the same period a year ago.

A Black Book survey names The HCI Group as the top rated health IT consulting firm for system-wide technology, innovation, and organizational digitalization strategy.

Avera Health goes live with Meditech’s Google Cloud-powered High Availability SnapShot to give clinicians access to patient data via a web browser during unexpected downtime.

COVID-19

In the UK, a 90-year-old grandmother gets the first shot of Pfizer’s COVID-19 vaccine. In the US, Pfizer’s vaccine cleared FDA’s safety and efficacy review on Tuesday, and if the company’s data is accepted in Thursday’s advisory committee review, the first doses could be administered by this weekend.

Monday continued the trend of every day setting new US COVID-19 records, with 180,000 new cases, 102,000 Americans in the hospital, and 2,204 seven-day average deaths.

HHS publishes COVID-19 hospital capacity data at the facility level on a weekly basis dating back to August 1. Previous data sets were compiled by state. A group of data journalists, data scientists, and healthcare system researchers who have reviewed the data have put together a FAQ.

California Governor Gavin Newsom announces that CA Notify — an app-based, COVID-19 exposure-tracking tool — will launch statewide later this week. The app was developed using technology from Google and Apple and was piloted at the University of California. Several regions across California have imposed stay-at-home orders through the holidays in an effort to alleviate virus spread. The state reached a single-day record of 34,000 new cases on Monday.

Meanwhile, a New York Times review notes that US consumers and state governments have shown little interest in using the Google-Apple COVID-19 smartphone exposure notification app that California is launching statewide. Only 13 states have developed their mandatory public health add-on to the app (it has since been made optional) and most of those states are seeing single-digit percentages of residents using them. Experts also note that people are loading the app to receive warnings of their exposure to infected others, but then refuse to allow the app to notify their fellow users when they themselves test positive.

COVID-19 vaccines have not been tested to see if they prevent transmission of coronavirus, meaning that people who have been vaccinated still need to wear masks because they could still be contagious. Nobody knows whether enough antibodies will circulate to the nasal mucosa to prevent its growth there, which is why some respiratory virus vaccines work better as nasal sprays. 

Pfizer board member and former FDA Commissioner Scott Gottlieb, MD says in a USA Today interview that:

• The hardest 4-6 weeks of the pandemic are ahead of us, with COVID019 hospitalizations expected to peak in mid-January at up to 175,000 and 50,000 in the ICU.
• US deaths will reach 400,000 by the end of January during the infection’s final surge, with the situation improving in February and March as the virus will “largely collapse” and its major spread will end.
• Flu rates will likely drop sharply because the mitigation steps for COVID-19 are more effective in flu.
• Vaccine distribution will seem slow to people who are anxiously awaiting it, but supplies will be adequate by March to make it available to most people.
• Gottlieb urges the US to “get as many shots in arms as possible” in using available supplies immediately instead of holding the required second doses for January, when the virus will begin to decline.
• The vaccine will be effective if 50% of people get it instead of the previously accepted 70-80%, especially if follow-up studies find that it prevents viral spread.
• The summer’s big spread was surprising to experts, who didn’t predict that Southerners would congregate indoors under air conditioning or that the Sturgis motorcycle rally would be allowed to proceed and spread virus all over the Midwest.
• The federal government didn’t take an active role in the production of monoclonal antibodies, so supplies will be rationed and not widely available in the foreseeable future, a lesson that should be learned for future health issues.

The CDC’s text messaging system that COVID-19 vaccine recipients can voluntarily use to report side effects — which was developed by Oracle and HHS as part of Operation Warp Speed — contains security vulnerabilities, experts say. Anyone who gets the QR code that is contained in the patient immunization kit – such as when it is discarded — can file false reports to the V-safe system that would need to be evaluated. The federal government issued a $2.3 million contract to an IT company to process the incoming reports.

Experts warn that otherwise careful workplaces are exposing their employees by allowing them to socialize and eat together in break rooms, as happened in Mayo Clinic.

More than half of surveyed Fire Department of New York union members say they will not get a COVID-19 vaccine if the department offers one, even though their jobs make them 15 times more likely to be infected.

Florida state police raid the Tallahassee home of Rebekah Jones, a former state data scientist who was fired in May for insubordination following what she says was her refusal to manipulate data to make Florida’s COVID-19 dashboard data look more favorable for reopening as Governor Ron DeSantis was urging. The state’s health department says someone using the Comcast IP address of Jones logged in to its emergency messaging system on November 10 to send messages that were critical of the state’s response. Ten armed FDLE agents entered her home and, according to Jones, pointed pistols at her husband and two children before seizing her computer equipment.  The incident was recorded on her home’s security camera. The state FDLE says that Jones refused to open the door and that weapons were not pointed at anyone.

Other

Greater Baltimore Medical Center deals with a ransomware attack that forced it to take down several of its IT systems on Sunday. Reports suggest the ransom note came through a fax machine (!!), demanded a response within three days, and provided contact information using the Dark Web.

Sponsor Updates

• Access releases a new Access Points Podcast, “Blending in with a New Team.”
• IDC MarketScape includes Arcadia in the Leader category in population health analytics in its “US Population Health Analytics 2020 Vendor Assessment.”
• OptimizeRx integrates Komodo Health’s Healthcare Map with its digital health savings and educational content software to enhance clinical decision-making at the point of care.
• CareSignal develops AI to improve patient engagement.
• New England Venture Capital Association names Kyruus the winner of its 2020 Powerhouse Healthcare Company Award.
• Cerner releases a new podcast, “The value of preparing for innovation.”
• Team members from The Chartis Group share “Lessons from the Pandemic.”
• Clinical Architecture releases a new Informonster Podcast, “The Impact of Logica and How the Healthcare IT Industry Can Come Together, Part 1.”
• Dimensional Insight publishes a new white paper, “Staying Ahead of COVID-19 with a Data-Driven Response.”
• Ellkay exhibits at the virtual Node.Health Digital Medicine Conference through December 11.
• Black Book gives several HIStalk sponsors top consulting rankings, including Bluetree (Epic implementations), Hayes (RCM optimization, hospitals), Impact Advisors (enterprise resource planning), and The Chartis Group (value-based care transformation and strategy, hospitals).

Blog Posts

• Physician Burnout (314e)
• Mobile readiness is a must-have for scheduling software (Ability Network)
• 3 Things That Might Be Preventing Your Patients From Using Telemedicine (AdvancedMD)
• Clinica Universidad de Los Andes, Chile: Transition Project to Enterprise Imaging (Agfa HealthCare)
• The 21st Century Cures Act: Updated Deadlines and Considerations for Payers (Bluetree)
• The Cleveland Clinic: Leveraging CarePort to Achieve BPCI – A Success (CarePort)
• Moving Patients In, Out, & Around the Health System: How Central Logic is Transforming Care Transitions (Central Logic)
• Why Parents Love Working at CoverMyMeds (CoverMyMeds)
• Connecting to the Home? Put People Front and Center (Dina)
• Kiosk, HEDIS, and More: Welcoming Patients to the Medical Landscape (EClinicalWorks)
• 5 Forces for the Future: Accurate and actionable data across care settings becomes the currency of the new health ecosystem (Wolters Kluwer Health)

Contacts

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

Morning Headlines 12/8/20

PointClickCare is buying a Kleiner Perkins-backed startup for $650 million in the latest sign that health-tech is heating up

Long-term and post-acute care software vendor PointClickCare will acquire care notification startup Collective Medical for $650 million.

COVID-19 is Complex, as is COVID-19 Open Data

HHS publishes COVID-19 hospital data at the facility level on a weekly basis dating back to August 1.

CA Notify app to offer COVID-19 exposure notification

California Governor Gavin Newsom announces that CA Notify, an app-based, COVID-19 exposure-tracking tool built on Google and Apple technology, will launch statewide later this week.

Talkspace Working With Advisers on Possible Sale

Talkspace considers putting itself up for sale, leading analysts to speculate that an acquisition could value the online therapy app startup at $1 billion.

Readers Write: Technology: An Essential Element of Holistic Revenue Integrity Strategies for Future Sustainability

Technology: An Essential Element of Holistic Revenue Integrity Strategies for Future Sustainability
By Vasilios Nassiopoulos

Vasilios Nassiopoulos is vice-president of platform strategy and innovation with Hayes of Wellesley, MA.

Healthcare organizations are facing a perfect storm of financial challenges. US hospitals and health systems entered 2020 with razor-thin operational margins that were exacerbated by substantial and ongoing losses related to COVID-19.

Amid a dramatic drop in healthcare spending during the first quarter of 2020, financial executives found themselves with limited means for countering ongoing pandemic-related impacts, touching everything from supply chain costs to lost billing opportunities and compliance issues. Notably, the industry acknowledges that federal incentives related to the COVID-19 pandemic will not provide enough relief to surmount the far-reaching financial impact.

The heightened role of technology, especially as it relates to use of analytics to inform operational decision-making, proved a key differentiator for keeping many balance sheets in the black and stabilizing the bottom line. In contrast, manual efforts to audit claims and understand potential revenue cycle liabilities and bottlenecks left many organizations reacting to issues late, opening the door for cash flow problems that quickly spiraled out of control.

The advantages of using advanced technological frameworks to inform sound revenue integrity strategies should not be lost on today’s C-suite in their quest to a sustainable, profitable outlook. If healthcare organizations do not act now to proactively capitalize on all appropriate reimbursement opportunities as well as avoid future penalties from audits, the future stability of hospitals in communities across the nations is uncertain.

Progressive revenue integrity strategies bring together all billing and compliance functions in a collaborative way to address billing issues before claims leave an organization as well as via ongoing process improvement. Optimal programs consider:

• People, through cross-functional steering committees.
• Processes, by combining the strengths of both retrospective and prospective auditing.
• Metrics, through established performance-based goals.

Sound revenue integrity processes rely on technology-enabled workflows to speed identification of risks, perform targeted audits, identify and address root causes, and monitor the impact of process improvement tactics. When the right combination of automation, analytics, and artificial intelligence (AI) exist, billing and compliance teams can overcome the barriers of manual auditing processes to gain visibility into patterns and issues, which in turn inform process improvement and corrective action tactics.

Technology can be a game-changer when it comes to minimizing financial risk, improving revenue retention, and often identifying dollars that might otherwise be left on the table. Foundationally, data-driven infrastructures should be designed to promote shared monitoring and auditing processes between members of a revenue integrity team.

A framework of automation should support both continuous and proactive auditing (prospective) of claims before they are submitted and immediate and ongoing monitoring of delayed or denied claims (retrospective). Analytics tools can extract key charge and payment data to provide instant visibility into all prospective and retrospective data sources, eliminating the manual preparation time that often bogs down revenue integrity strategies.

Prospective auditing of claims for proper coding and clinical documentation minimizes denials by ensuring accurate, compliant submissions. Automation that supports ongoing monitoring and analytics can be a critical enabler of these processes in terms of staying abreast of updates and changes across payer reimbursement policies. They can also better enable risk-based auditing practices that prioritize an organization’s greatest risk areas.

For example, telehealth reimbursement has become an important driver of revenue over the past year, as healthcare organizations find ways to safely support care continuity. Advanced solutions that automatically release new ICD-10 codes and telehealth guidance streamline the ability of billing teams to operationalize changes and support ongoing monitoring.

When supported by automation and analytics, retrospective auditing speeds root cause analysis, ensuring rapid implementation of an optimal corrective action strategy to promote submission of clean claims. Analytics can be used to automatically generate key metrics around identified risk areas, allowing revenue integrity teams to benchmark against peers.

Use of advanced AI tools such as natural language processing can further elevate the strategies to improve management of a healthcare organization’s overall financial performance. These solutions can be used to track case mix index, elective surgery trends, and average lag days from denial resubmission to adjudication. Revenue integrity teams can analyze year-over-year and year-to-date trends for Medicare and commercial payers, detecting data anomalies and outliers that barriers to revenue integrity.

Use of AI can deliver a depth of understanding of denial attributes over large volumes of historical data that is typically a non-starter with manual processes. These systems learn from trends over time and can then, in turn, automatically apply identifiers or changes to future claims submitted to various payers. For example, denials related to medical necessity account to almost 10% of total denials. Identifying the root case and applying the necessary edits or process changes will prevent similar denials.

The value proposition of advanced tools, especially when integrated into a single platform, has increased over the past year as healthcare organizations try to maximize reimbursements to counter revenue shortfalls and rapidly changing regulations associated with COVID-19.

Curbside Consult with Dr. Jayne 12/7/20

My adventures as “just another physician” continued this weekend as our urgent care suffered a crippling EHR downtime.

My location had all of its staffed rooms full, several patients checking in, and a waiting room queue of nearly 20 patients when the EHR began to sputter. At first, it was only certain parts of the system that weren’t working properly, but they were some of the most critical – assessment and plan and medication orders. This of course created havoc in the discharge process. Because the EHR was merely sputtering, we were hopeful that it was a momentary glitch, so we kept trying to execute our workflows.

Eventually the EHR started spitting back truly unwelcome error messages, such as “server disconnect” that progressed to the hated “no servers available.” The dysfunction then spread to the practice management side of the house, with check-in and check-out grinding to a halt. For the staff members who had kept kept their systems up rather than trying to reboot, they at least had access to the tracking board to see what patients were physically in the exam rooms. For those of us who had tried to “turn it off and back on again,” the system was dead in the water and we were unable to access Citrix. (My staff often wonders how or why I even know anything about Citrix, and I must say I owe it all to one engineer who decided to take a young clinical informaticist under his wing.)

As expected, the IT emergency phone line was jammed, leading staff to call other locations to see if the outage was just our problem or everyone’s. We were all in the same unfortunate position, but when asked about instituting downtime procedures, the IT team told us to hold because they were already contacting the vendor. This led to wasted time and frustrated patients as we were trying to discharge patients so that we would have open exam rooms to use for those milling at the check-in desk in a non-distanced fashion.

I asked for a paper prescription pad to expedite discharges, but there was some confusion about where it lived and whether it was in the regular narcotics cabinet, the back stock narcotics cabinet, or the administrative office. One clinical tech started phoning prescriptions to the pharmacies and documenting them on Post-it notes while we waited for our site leadership to get their act together.

We were 15 minutes into this veritable goat rodeo with no update from our leadership when I directed the team to go ahead and pull out the downtime binders so we could start moving patients forward again rather than spinning our wheels over what we should be doing next. It took nearly 10 minutes to pull the binders, and then staff had to read the instructions to try to figure out what to do. There was some disagreement from our site leader about whether we should start the process, which added yet another delay.

Fortunately one of my clinical techs took the initiative to run from room to room and collect names and dates of birth for each patient, which we wrote on Post-it notes that were then attached to two old-school clipboards propped up at the physician work station. The list of physically present patients didn’t fully match the list of patients on the remaining tracking board screens, so we decided to make the clipboards the source of truth. Everyone updated the Post-its with as many facts as they could remember about the patients, and we queried our laboratory devices to provide duplicate results for anyone who had testing recently performed.

That provided enough facts to cobble together the information needed to discharge several patients, although we still had some confusion at the check-out desk as far as collecting payments. I was just happy to have exam rooms in which to install the remaining patients that hadn’t gone back out to their cars to wait, as they had been treated to a bit of a show as staff ran around trying to figure out what to do.

Nearly 30 minutes into the event, which felt like an eternity, we still didn’t have an update from leadership. Having come from a big health system where we lived and died by the strength of our downtime plan, I found that surreal. All the other IT systems were up, so there was no reason they couldn’t be sending email or text updates to each site or to the physicians since they already have groups set up for bulk notifications.

I continued to see patients, Post-it by Post-it, until the clipboards began to clear. Eventually, the system came back up, but not in its entirety. Restoration came in the reverse order of it going down, with medications, assessment, and plan lagging behind. The only way we knew the system was improving was by constant trial and error as opposed to an “all clear” notice from the practice.

Since our downtime policy requires manual entry of all data into the system rather than entry of critical or longitudinal data and scanning of the paper downtime forms for non-critical data, the staff immediately became even more stressed, wondering how they would catch up with a continuing flow of patients coming in the door. All told, it took us almost two hours to fully recover and get everything caught back up.

I don’t know whether this was a vendor failure, a hosting failure, an infrastructure failure, or what. but it’s clear that if there was a fail-over system for downtime, it didn’t work correctly. It’s also clear that we don’t practice our downtime protocols enough, or educate on them enough during training. Of the eight staff working at my site, only two of us have ever been through a downtime, and the others were generally unfamiliar with what needed to happen. Since I don’t play any role in the organization other than as a physician, I’m going to keep my thoughts to myself, but make sure my IT clients are better prepared than what I just worked through.

Experiences like these should be rare, and although they cannot be prevented, they can certainly be mitigated in a way that was better than what happened to us. It’s a good reminder of how critical it is to continue good IT practices, even in a pandemic. The patient experience was certainly less than optimal during the episode, and I hope there wasn’t any compromise in care.

When is the last time your organization practiced its downtime routine? Has anyone tested their backups lately? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/7/20

CommonHealth, a Free Mobile App for Patients to Share Health Data – including COVID Test and Vaccine Status – Connects to 230 US Health Systems

The non-profit Commons Project has connected its CommonHealth app to 230 health systems, allowing the majority of Americans who use Android devices to use Apple Health-like functionality to obtain their health records from connected providers.

City of Chicago Launches New Data Analytics Tool in Fight Against COVID-19

The Chicago Department of Public Health and Rush University Medical Center launch a COVID-19 tracking hub to which all 28 area hospitals have agreed to contribute lab test results, CCDA information from Epic-using sites, and capacity information.

GBMC Health Care experiences information technology systems outage

Greater Baltimore Medical Center experiences a network disruption that has taken down several of its IT systems.

Monday Morning Update 12/7/20

Top News

The non-profit Commons Project has connected its CommonHealth app to 230 health systems, allowing the majority of Americans who use Android devices to use Apple Health-like functionality to obtain their health records from connected providers.

The Commons Project says it will integrate with 110 more health systems this month and has already connected to LabCorp.

The app’s developers were UCSF, Cornell Tech, and Sage Bionetworks.

The Commons Project also offers a COVID risk questionnaire and the CommonPass passport-like app to prove COVID-19 testing and vaccination status.

Reader Comments

From Unplanned Demise: “Re: NTT Data. The company previously bought the Meditech hosting business of Dell (formerly Perot and JJWild), which has 100 hosted customers. It is down to about 40 customers, and I think most of us have received contract termination letters that blame the pandemic and its economic impact. I suspect that the reality is that NTT Data is anxious to get out of the Meditech business and go after larger, better-funded health systems and the pandemic gives them a convenient excuse.” Unverified. NTT Data is publicly traded, and if its Meditech hosting business really has dropped off that sharply, then they probably are doing the right thing from a business perspective to redirect energy to seek growth elsewhere. The only reason companies stick around in situations like this is if they don’t want to disappoint customers who might buy something else. The corporate Pacmanning (thanks to the reader from whom I stole that term) looks like this: Perot Systems acquired Meditech-focused services organization JJWild for $89 million in 2007, Dell acquired Perot in 2009 for $3.9 billion, and NTT Data bought Perot from Dell in 2016 for $3.1 billion. Paging Vince Ciotti: I don’t know what happened to the original J. J. Wild (senior and junior — the former founded the company in 1956 and the latter took over in 1975) or what business JJWild was in back in the 1950s.

HIStalk Announcements and Requests

HIMSS, CHIME, and AMIA are the membership organizations to which poll respondents most commonly belong, although #1 among the options is “none of the above.” I gather from the CHIME count that I have more provider IT C-level executives as readers than I assumed, but I might need to reach out more to nurse informaticists to “unlock readership” (making fun yet again of the aspirational yet stupid business phrase “unlock revenue.”) 

New poll to your right or here: What grade would you give your preferred local hospital on being patient-friendly, trustworthy, and effective? I was thinking about this after hearing from a friend who said they received marvelous care during their heart surgery, but they learned to wave a cheery, roving hospitalist away from their door several times per day since every one of her 15-second “hey, how are you doing?” greetings was, in his previous visit, recorded as another out-of-network professional encounter that ended up totaling thousands of dollars that insurance wouldn’t cover. I can understand community-based doctors billing the patient for in-hospital care, but permanently assigned hospitalists cranking out their own bills for their private equity-owned employer seems to stretch the definition of  hospital (is it just a clean hotel with bad food that, like a Mexican beach, fails to discourage persistent peddlers who keep casting a shadow over you while you’re trying to snooze in the sand?)

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

Reader Bill sent me a Donors Choose gift card, which with matching funds from my Anonymous Vendor Executive and other sources, fully funded these teacher requests:

• Digital resources for online learning for Ms. S’s elementary school class in Sacaton, AZ.
• Two monitors for online teaching for Mr. B’s high school class in Melvindale, MI.
• Online and hands-on math supplies for Ms. F’s elementary school class in Stonewall, OK.
• A math fluency kit for Ms. E’s elementary school class in Madison, FL.
• A library of books and science and math activity kits for Ms. R’s middle school class in Mobile, AL.

Webinars

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine & Digital Health exchange-traded fund rose 7.3% in the past month, about the same as the Nasdaq and S&P 500 indices.

Former VA Secretary David Shulkin, MD and health IT consulting firm Healthium announce a joint venture to enable health IT innovation between United Arab Emirates and Israel. The organization will connect companies with US counterparts for partnerships, with particular interest in AI, behavioral care, COVID-19 response, interoperability, digital health, EHR support, population health, analytics, and telehealth.

A. G. Breitenstein, MPH, JD — who founded analytics company Humedica and sold it to UnitedHealth Group for an unreported amount in 2013 — launches Folx Health, which will offer telehealth-prescribed, cash-only “queer and trans healthcare delivered on our terms” hormone therapy, STI testing, and meds for HIV prophylaxis and erectile dysfunction.

People

Tenet Healthcare hires J. Roger Davis (Revint Solutions) as president and CEO of its Conifer Health Solutions business.

John Hallock (Livongo) joins Crossover Health as SVP of corporate communications.

Jeff Fuller, MBA (UNC Health) joins CipherHealth as VP of data and analytics.

Announcements and Implementations

Vanderbilt Health adds an End of Life Care Plan feature to Epic, which prompts its MyChart users to download a generic advance directive, customize it as needed, sign it in front of witnesses or a notary, and then upload it. Care teams will also be prompted by Epic to ask inpatients and outpatients if they have completed their documents so they can either steer them to MyChart or help them scan and upload.

COVID-19

The US saw 225,000 new COVID-19 cases on Friday and 101,000 infected Americans were occupying hospital beds, both all-time highs that are increasing. The South’s seven-day case average has exceeded that of the Midwest for the first time in months as cooler weather pushes south. The seven-day average death count rose to a record 2,123 per day and is moving sharply upward due to Thanksgiving travel and gatherings. COVID-19 was the leading cause of death in the US last week as the total death toll reached 281,000.

The COVID Tracking Project says that the operations and capacity data that hospitals are reporting to the federal government’s HHS Protect / TeleTracking system has stabilized and now mostly matches state-reported information once data definition differences and reporting lag times are considered. It says that states aren’t consistent in their reporting – some report hospitalizations of only confirmed COVID-19 cases while others include suspected cases, some report numbers without defining what they mean, and others use non-standard definitions.

NIH says that a new name and billing codes should be assigned to treat “COVID long-haulers” who experience a syndrome of breathing, heart, fatigue, and brain fog problems long after they have “recovered” from their initial infection. In a stark example of the issue, the topic was examined in an NIH meeting in which four patients were scheduled to speak, but two of them couldn’t participate because they were hospitalized. Johns Hopkins says that more than half of its COVID-recovered patients experience some degree of cognitive impairment in the first three months.

CDC will issue paper vaccination cards to remind people which COVID-19 vaccine they have received and when their next dose is due. An Operation Warp Speed display shows that each vaccination kit will include the vaccine, a face shield, a mask, alcohol preps, a syringe, an instruction sheet, and the vaccination card.

CDC analysis finds that, adjusted for age, Hispanic and black Americans  are dying at nearly three times the rate of whites. American Indians and Alaska Natives die at 2.6 times the rate of whites.

The Chicago Department of Public Health and Rush University Medical Center launch a COVID-19 tracking hub to which all 28 area hospitals have agreed to contribute lab test results, CCDA information from Epic-using sites, and capacity information. The system will provide management dashboards to hospital and civic leaders as well as information for researchers. They hope to secure a federal grant to enhance reporting and to develop a COVID-19 immunization registry.

Other

Sanford Health and Intermountain Healthcare cancel their proposed merger a week after Sanford Health fired its CEO for emailing employees to declare that he would not be wearing a mask because he believed himself immune from COVID-19 after recovering from it.

Epic describes how its user experience designers created a new look for MyChart, including displaying health history as a news feed, providing easy jumps to most-used actions, highlighting announcements, and offering week-to-week pregnancy updates. My only previous experience with MyChart was an obviously incompetent implementation by a hospital whose mediocrity was evident in every aspect, but a recent visit with a physician who works for a much better health system showed MyChart’s full power in a clean, intuitive layout – I could schedule and reschedule appointments, view a health calendar with reminders, review my doctor’s bio and send them a message, complete a pre-visit questionnaire, handle billing and payments, and review the full notes of my visit afterward (the health system has rolled out OpenNotes). I also gave approval to match me with clinical studies and was invited to participate in one, while the Share Everywhere option lets me give access to anyone I choose with a custom-generated access code. I don’t know if this is the new version, but it’s pretty cool and highly useful regardless.

Sponsor Updates

• Ellkay makes its Expert Exchange Series of 30-minute discussions featuring high-profit health system IT executives available online.
• Southern Illinois Healthcare begins validating automated testing scripts for the acute/inpatient setting as part of its continued Test Automation as a Service work with Santa Rosa Consulting.
• CareSignal CEO Blake Marggraff provides a video overview of the company’s deviceless remote patient monitoring to the Innovation Challenge Virtual Showcase.
• Zynx Health updates and expands its free-of-charge COVID-19 clinical decision support.

Blog Posts

• Densitas AI platform automates breast density, image quality, and breast cancer risk assessment (Nuance)
• Covid, virtual trials, and a rapidly evolving supply chain (OpenText)
• In Case You Missed It: Outcomes-Based Care for Justice-Involved Individuals (Netsmart)
• Miles to Go Before I Sleep: Reimagining Patient Engagement (PCare)
• Lazy Data – What Your Organization Can Learn from Steve Martin & Kevin Costner (Pivot Point Consulting)
• Ransomware’s Impact on Healthcare (PMD)
• COVID-19 Vaccine Information: 3 Things to Know (QliqSoft)
• Q4 2020 Product Updates: Preparing for the Future (Redox)
• How New Decision Support Tools Enable Informed Prescribing at the Point of Care (RxRevu)
• How to Choose a TeleNeurology Partner: Five Critical Areas to Consider (SOC Telemed)
• The Ultimate CCPA Compliance Checklist (Spirion)
• Clinical diagnostics: Why today’s critical test result processes are broken (Spok)
• Surescripts Commends CMS on Decision to Proceed with EPCS Mandate Without Delay (Surescripts)
• You Can’t Just Say: “Tomorrow, we’re going to be a High Reliability Organization” (TransformativeMed)
• Leveraging a propensity-to-pay solution to drive collections (Waystar)
• 8 Reasons You Should Attend Ascend 2021 (WebPT)
• Help patients make sense of complicated health information when the stakes are high (Well Health)

Contacts

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

Katie the Intern 12/4/20

Howdy, HIStalk readers! I hope you all had a fantastic Thanksgiving and are looking forward to Christmas and the rest of the holiday season. As always, thanks for reading my columns and I greatly appreciate every comment and email (I’m behind on those replies, but thank you!)

This column will cover a great interview I had with Nick Wanner, MPAS, PA, a physician assistant who serves as a clinical advisor for a healthcare vertical team at Avtex. Our discussion surrounding telehealth and its advances was eye-opening to how fast telehealth has moved forward. Nick has been practicing medicine for three years, but he said his clinic used telehealth relatively often even before the outbreak of COVID. He worked on a project to bring telehealth into his practice early on in his career.

“I had a capstone project for our PA program,” Nick said. “My focus was on bringing a telehealth program into a bigger organization.”

The program aimed to bring telemedicine to a primary care facility and eventually into a specialty care program. In early 2017, Nick was put on a design team for formulating a telemedicine program at work and helping install the formal telemedicine program. By 2018, phone visits were a regular occurrence at the clinic.

As a consumer of medical care myself, I found this interesting, as I had never really heard of seeing a doctor online or over the phone before COVID. It’s highly possible this is because I’ve always been healthy and also have no issues going into doctors appointments. Still, I found it fascinating that telehealth was on the market way before COVID.

I asked Nick about his experience with telehealth before the pandemic, how often he used it with patients, how usable it was, and how much experience he had with it. Outside of his experience with designing a telemedicine program, Nick said that the clinic he works at was already leaning towards virtual and online video visits before the pandemic. His clinic had plans to push for more telehealth usage beginning in 2020.

“Video was on the docket for us as a group this year,” Nick said. “We basically had the infrastructure ready, we knew what video service we were going to use, and we had all the marketing. So it just got pushed forward.”

Nick said that before COVID, the average telehealth appointment was for college students who were away from home or people who wanted to stay home and use a virtual visit. He said telehealth was limited in use, but since COVID, it’s become more common.

“Since COVID has come around, [telehealth] has been more of a mainstay at our practice,” Nick said. “We’re kind of advocating between 30-35% of our visits as telemedicine, both video and phone.”

When I first heard 30-35%, I’ll admit I thought that was low for COVID’s impact on the necessity of telehealth. Nick clarified that year to date through November, his group has completed over 500,000 video visits alone, assuming closer to 750,000 for a more up-to-date number. He used the words “rocket ship takeoff” to describe the trend.

We all could have guessed that telehealth would be heavily used during COVID as safety has become such a large part of slowing the spread. But what are the other benefits of telehealth? And where is it falling short?

Nick said that as far as the benefits of telehealth, the major pros are lower costs and more transparency for phone and video visits, patient satisfaction in relation to being able to talk to a doctor long distance, reduced overhead for providers and fewer staffing issues, and the general overall comfort that this trend won’t go away.

“Once people buy into this, we’re seeing that people keep coming back to it,” Nick said. “We’re seeing a huge portion of patients that really are enjoying these visits.”

As far as the cons, Nick said that one of the biggest is “managing that fine line between convenience and ease of access at appropriate clinical quality.” Clinicians and providers have voiced this concern often, Nick said, along with a lack of physical touch for examinations and hands-on care.

“There’s nothing that can replace that,” Nick said. “I think that is part of the art of medicine.”

Nick also said that just because telehealth aids in lessening the amount of in-person care initially, it can still lead to physical, in-person follow-up appointments and hospital visits. Nick said that it is important to teach patients how to appropriately use telemedicine and only when physical care is not an absolute need.

“We don’t want to miss those big, bad wolves out there just at the expense of convenience,” Nick said.

I found the pros and cons useful to hear from a provider, but I also wanted to know where providers need it to go from here to continue its growth and its ability to treat people with high quality care.

Nick focused on the need for a software / telehealth system that provides high quality and ease of access to both patient and provider. He said having a system that could allow patients to upload their own numbers and pictures without going through texts and messages would help.

“I think that if there’s a group that came on that provided a really great experience for both the patient and the clinician, and that could integrate information from an electronic health record … I think would be a really awesome thing for a lot of clinical providers,” Nick said.

Overall, Nick said that having options for patients that are safe and quality-driven but still promote revenue for the health system is where telehealth needs to go. He said that, so far, he has seen this as a trend and hopes that it continues to develop with those needs in mind.

That’s it for today’s column! I enjoyed talking with Nick and learning about the provider side telehealth. Next week I am hoping to speak with someone about how cancer trials and telehealth have overlapped throughout COVID. Until then, have a great week!

Katie The Intern

TLDR; Katie interviewed a PA who discussed to pros and cons of the rise of telehealth. Pros include access and lower costs, while cons include a lack of physical examination capabilities. He also said that healthcare needs to continue to grow with a focus of providing quality care that also promotes revenue.

Email me or connect with me on Twitter.

Weekender 12/4/20

Weekly News Recap

• Healthcare process automation vendor Olive acquires prior authorization platform provider Verata Health.
• McKesson launches Ontada, an oncology technology and data business.
• Imprivata acquires FairWarning.
• The former GM of Uber Health launches home care provider MedArrive.
• ONC, HL7, and other groups launch Project US@, which hopes to publish a healthcare standard for representing patient addresses.
• Salesforce acquires Slack for $28 billion.
• HealthStream acquires Change Healthcare’s capacity management business, including its Ansos staff scheduling system, for $67.5 million.
• A Stat review finds that health systems are using AI to create patient COVID-19 risk scores despite a lack of evidence of real-world correlation or assurance that the training of those systems was adequately broad.
• University of Vermont Health Network restores full access to Epic after nearly a month of malware-caused downtime.
• Informatics pioneer Reed Gardner, PhD dies.

Best Reader Comments

I’m reluctant to be too critical of such pronouncements because they come from a desire to improve service delivery. The energy and enthusiasm this displays is worth protecting. But honestly, if there’s one thing we do know: All too often, healthcare does NOT “have to” deliver a great customer service experience. If it did, then we’d see that achieved routinely. The fact that we talk about a need is telling. (Brian Too)

Re: Olive. Not seeing it, what am I missing? They seem to have found a nice niche, but they are not what I would call revolutionary, and I don’t think their execution is anything to write home about. $1.5B valuation? Seems like this is a case of Silicon Valley easy money mania meets healthcare. (WestCoastCFO)

In spite of AMA lobbying, regulatory changes in the early 2000s allowed pharmacists to give flu shots. Costs fell, accessibility went up, public health improved, and doctors wallets weren’t quite as fat as they could be. Maybe half of flu shots still occur when people happen to be in the doctor’s office for another reason, but for the most part the doctor “establishment” has been cut out of making money on flu shots. Telemedicine cuts out your local doctor from making money on all those non-procedural, episodic office visits. Brian Too is right that your local doc is not going to do telemedicine unless it is convenient for her and the billable rates make sense. (IANAL)

Like most other people in this country, my health insurance is offered by my employer, who provides three plans for me to choose from. For the most affordable of these, if someone in my family develops some sort of serious condition, our PCP will have to be the gatekeeper before getting a referral to a specialist (likely first, one within the same organization, and MAYBE a second opinion from another group with providers known to be strong in that specialty). There’s a lot of talk about the “consumerism” of healthcare, but the idea that most people have the financial resources to just pick up and go to whatever provider of whatever service they like is blatantly false, in my opinion. (Employee)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Florida, who asked for two Chromebooks for her second grade class. She reports, “The minute we arrive in our classrooms, the children are directed to the computers to finish their IReady minutes. IReady is a math/reading program that when used properly has a huge correlation to the SAT and FSA exams the students take at the end of the year. I always find it amazing how they cannot wait to get on and never complain about getting it done. This is because the program is child friendly and offers rewards, games, and other incentives to increase student performance.”

In England, town councils are hiring an analytics software company to study the personal finances, school absences, and living arrangements of residents to identify those at risk for COVID-19. Privacy experts worry that the information could be used to predict which residents are likely to break isolation rules, also noting that the system can analyze issues such as unfaithful and unsafe sex, emotional health, dangerous pets, anger management issues, and financial struggles.

Geisinger produces a 30-minute documentary called “Five Days in May – Inside the Fight Against COVID-19.”

Cleveland Clinic and other businesses will provide affordable Internet service to residents of the Fairfax neighborhood of Cleveland, which is America’s worst-connected large city. The EmpowerCLE wireless internet service provider has installed equipment on the roofs of two main buildings of Cleveland Clinic’s campus to boost coverage.

Reuters reports that North Korean hackers are posing as recruiters on LinkedIn and offering jobs to employees of COVID-19 vaccine maker AstraZeneca, after which they email them job descriptions that contain malware that gives them access to the employee’s computer.

Former professional soccer player and Olympian Rachel Buehler Van Hollebeke, MD is working as a first-year family medicine resident at Scripps Mercy Hospital.

In Case You Missed It

• News 12/4/20
• EPtalk by Dr. Jayne 12/3/20
• HIStalk Interviews Robbie Hughes, CEO, Lumeon
• News 12/2/20
• Curbside Consult with Dr. Jayne 11/30/20
• Monday Morning Update 11/30/20
• Katie the Intern 11/27/20

Get Involved

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Morning Headlines 12/4/20

Olive Acquires Verata Health to Accelerate Artificial Intelligence Technology For Healthcare Providers and Payers

AI solutions vendor Olive acquires Verata Health, which offers an AI-powered prior authorization solution.

McKesson Launches Ontada, an Oncology Technology and Insights Business Dedicated to Help Advance Cancer Research and Care

McKesson launches Ontada, which will sell drug companies real-world patient data from its IKnowMed oncology EHR and Clear Value Plus cancer pathways system.

Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients

CMS will continue to pay for certain telehealth services after the pandemic’s end, most notably those for nursing home residents in rural areas.

Prepare for medical visits with help from Google and AHRQ

Google builds an evidenced-based tool leveraging AHRQ’s expertise to help patients prepare a visit plan when using the company’s search tool to find providers.

News 12/4/20

Top News

AI solutions vendor Olive acquires Verata Health, which offers an AI-powered prior authorization solution.

Verata’s 60 employees will join the 400-plus headcount of Olive.

Reader Comments

From Motion Detector: “Re: CHIME. What the heck was Russ Branzell doing pitching Imprivata’s acquisition of FairWarning as the ‘real answer’ for healthcare security?” CHIME and HIMSS usually manage to keep a public straight face while pleasuring their vendor underwriters privately, so it’s jarring to see Russ’s laudatory quote in the press release’s second paragraph. Privacy and security vendors who, unlike their competitor Imprivata, didn’t earn CHIME’s endorsement as the market’s “real answer” have reason to take umbrage. I guess richly compensated membership organization CEOs have been forced, in the absence of conference revenue, to brandish their “will work for food” signs more forcefully. The third paragraph was another questionably appropriate quote from a KLAS VP, but at least his cheerleading was masked as a general market observation instead of genuflecting to specific companies.

HIStalk Announcements and Requests

I’m curious how the government and COVID-19 vaccine vendors will track the performance and side effects of the available products after their administration, especially since vaccine administration records will be scattered all over the place. Hospital folks, care to elaborate what you’re planning in terms of recording vaccine administration (your own or as reported by the patient or other providers) that can be tied later to outcomes? It would be helpful to know how many of those folks end up with COVID-19 despite being vaccinated or experience other problems. I expect it will be helpful in encouraging folks to get vaccinated early on to be able to quickly report that few significant issues with it have surfaced.

I’m getting sick of the overused term “unlock revenue,” but I’ll accept the word “wantrepreneur,” which describes those self-promoters whose vast business insight never seems to materialize into an actual successful business.

Webinars

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

Acquisitions, Funding, Business, and Stock

McKesson launches Ontada, which will (as I’m inferring from its PR puffery) sell drug companies real-world patient data from its IKnowMed oncology EHR and Clear Value Plus cancer pathways system. The company unwisely lets the marketing VP laboriously explain the company’s brand and contorted name development (O means having no beginning or end, ON is derived from oncology even though the O was already used, and TADA is an anagram for data – I guess they ruled out NODATA). Your body, like mine, is surely luxuriating in that “every part of our visual identity was chosen to make people feel at ease, confident, hopeful, and energized.”

Imprivata acquires threat detection platform vendor FairWarning.

Home care provider MedArrive announces its launch with a $4.5 million seed funding round. The company will attempt to bridge the virtual care gap by partnering with health systems to send virtually physician-supervised EMTs and paramedics into patient homes to draw blood, administer vaccinations or medications, and perform urgent care services. Co-founder and CEO Dan Trigub previously led healthcare operations for Uber and Lyft.

Virginia’s VCU Health System lays off 635 employees as it outsources revenue cycle management, although 90% of the workers have been hired by the outsourcer, Ensemble Health Partners. VCU Health says the decision wasn’t triggered by a 2019 investigative report in which it was found to be using aggressive collection methods against patients, including seizing their homes and paychecks.

Sales

• Campbell University and Wayne HealthCare choose Emerge’s ChartGenie service to convert their existing existing EHR data to Athenahealth and to provide ongoing access to those systems afterward.
• Health and wellness concierge monitoring vendor MonitorMe chooses Cumberland to optimize its Athenahealth platform.
• Lake of the Woods District Hospital chooses Vocera’s intelligent communications solutions that include its Smartbadge and Vina smartphone app.

People

Halo Health hires Julia Goebel (Benefitexpress) as VP of marketing.

Anthony Belthrop (PeopleFluent) joins MDLive as CISO.

Experity hires Brian Wilson, MBA (Ascentis) as chief customer officer.

Announcements and Implementations

Meditech announces a Google Cloud-hosted platform that includes Expanse Now, High Availability SnapShot, and Virtual Care.

First Databank updates its COVID-19 Medical Supply Guide with 1,300 test kits, PPE, and disinfectants. The guide is provided to health systems at no charge.

Google announces its Healthcare Interoperability Readiness Program, which includes an implementation plan for FHIR API development, Google Apigee API management, the Google Cloud Healthcare API, and interoperability resources.

Government and Politics

CMS will continue to pay for certain telehealth services after the pandemic’s end, most notably those for nursing home residents in rural areas. CMS notes, however, that Medicare does not have the authority to pay for telehealth services outside of rural areas or to patients in their homes.

COVID-19

Wednesday’s COVID Tracking Project report finds another record-setting day, with 196,000 new US cases reported and over 100,000 people hospitalized with COVID-19. Daily deaths rose to 2,733, just shy of the all-time record set on May 7 and exceeding the body count on December 7, 1941 while falling just short of the toll of September 11, 2001.

The White House coronavirus task force warns that the post-Thanksgiving COVID-19 spread will overwhelm hospitals, compromising care for all patients. It also urges public health officials in states that don’t have mandatory mask policies to bypass their elected leaders and warn residents directly that they should avoid indoor spaces where people aren’t wearing masks.

Los Angeles Mayor Eric Garcetti says the city will run out of hospital beds in the next three weeks, urging residents to “cancel everything.”

CDC Director Robert Redfield, MD says that today’s COVID-19 death count of 274,000 will rise to 450,000 by February if Americans keep refusing to wear masks. He also expressed disappointment that New York closed its schools again given that few clusters of infection have been traced to schools.

The American Ambulance System says the US 911 system is stretched and “likely to break” in its request for relief funds from HHS.

IBM’s cybersecurity operation warns that unknown hackers are launching malware attacks on the “cold chain” of refrigerated vaccine distribution, urging those who are involved in shipping, storing, refrigerating, and delivering COVID-19 vaccines to beef up their security. Many of the attempts involve emails impersonating an executive of a China-based biomedical firm whose contract attachment steals user credentials.

CDC recommends that Americans who ignore its advice to avoid travel get tested for coronavirus 1-3 days before departing and again 3-5 days after returning, the first time CDC has recommended testing for domestic travelers. CDC also recommends that travelers quarantine themselves for 7-10 days (depending on whether they are tested with a negative result) instead of their previously recommended 14-day quarantine period.

The mayor of Austin, TX becomes the latest public official to be caught ignoring their own dire warnings about travel, masks, and restaurants. Steve Adler broadcast his stay-home plea from Cabo San Lucas, Mexico, where he had just arrived via private jet for a vacation following his daughter’s 20-guest, mask-free wedding ceremony in Austin, where a 10-person group limit was in effect. Once caught, he followed the political playbook in expressing profound remorse at his rare lapse in judgment and insisting that now that he has seen the COVID light, he wouldn’t do it today. Denver’s mayor recorded a similar “don’t travel” pre-Thanksgiving warning, then immediately caught a plane to Mississippi for some family time.

Other

Mental health EHR/PM vendor NTreatment exposes patient information in failing to secure its Microsoft Azure cloud storage with a password. Grammar joke: perhaps the company will NTreat its customers for forgiveness.

Sponsor Updates

• The local paper profiles Sansum Clinic’s use of Well Health’s patient engagement and messaging software.
• OptimizeRx enhances its digital health and communications platform with AI for more precise patient support.
• Concierge telemedicine company MonitorMe selects Cumberland Consulting Group to optimize its Athenahealth software.
• First Databank updates its COVID-19 Medical Supply Guide with more than 1,300 products to help in the fight against the pandemic.
• Fortified Health Security Director of Cybersecurity Operations Preston Duren discusses healthcare IoT on “Between Two Servers.”
• Healthcare Triangle becomes a partner in Google Cloud’s Healthcare Interoperability Readiness Program.
• Healthwise wins six Digital Health Awards in the Health Information Resource Center Fall 2020 competition.
• InterSystems publishes a new white paper, “AI in Healthcare: Early Stage with Steady March to Maturity.”
• Jvion shares predictions on trends driving clinical AI adoption in 2021.
• Kyruus wins the Powerhouse Healthcare Company of the Year award from the New England Venture Capital Association.
• Lumeon releases a new video, “Current Challenges Facing Patient Access Departments.”

Blog Posts

• Healthcare Financial Transformation: Five Leading Strategies (Health Catalyst)
• Fighting the Pandemic with the COVID-19 Vaccine (Healthwise)
• Managed Services by the Numbers (Imprivata)
• COVID-19 vaccinations: Now is the time for healthcare IT to step up (Nordic)
• Healthcare M&A and the Effects from COVID-19 (Optimum Healthcare IT)
• Innovation among disruption (Infor)
• 3 Ways Data Reduces Physician Burnout and Enhances Revenue Amid the Pandemic (Ingenious Med)
• While Hospital Margins Shrink, Leaders Search for More Sustainable Operating Models (Loyale Healthcare)
• Compliance with Screening Policies for Intimate Partner Violence (Medhost)

Contacts

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

EPtalk by Dr. Jayne 12/3/20

I’ve received quite a bit of feedback and comments on my recent Curbside Consult that addressed ongoing usability issues in EHRs. Some of the comments came with questions, so I thought I’d answer them here because the answers raise other interesting items for discussion.

The first question was around why my organization controls access to the vendor’s documentation and/or why I cannot access it because I’m a physician informaticist.

In my clinical practice, I am not a physician informaticist. I’m a frontline ER/urgent care provider, just like the other 100-odd providers who are employed by my organization. I play the role that the majority of physicians and healthcare providers in the US also play – we are simply gears in the machine. It has been made abundantly clear that our collective role is to see patients, follow organizational directives, and not ask a lot of questions. This is not unique to my organization, but also applies to many emergency physicians around the country, a good portion of whom are employed by third-party companies and not the hospitals or facilities they serve.

Back in the days before COVID, I made a couple of suggestions about the EHR – implementation of features that I know must exist because they were required for 2015 CCHIT Certification and this is a Certified EHR – and was told that it was not my concern and that leadership needed to focus on operations and not chasing down issues with the EHR. They apparently don’t see the links between happy users and productivity or good workflows and patient safety. Like many other mid-sized organizations, they do not see value in paying a physician good money to perform non-clinical work. Our EHR is maintained by a paramedic who is “into computers” with occasional input from the chief medical officer. I see this mindset all across the US, including at a major academic institution where I was on faculty.

Many institutions still do not see value in clinical informatics. This lack of understanding is the primary reason I became a consultant. Don’t think you need a CMIO? Fine, hire me for an engagement and I’ll convince you why you need one more than ever. To those who work at hospitals and health systems that place value in clinical informatics leadership, be thankful. It isn’t like that everywhere. Culturally, my organization would rather curl up and die than bring in a consultant that might tell them they’re not perfect, because they think they are the best and most tremendous care delivery organization on the planet and say it regularly in pep talk emails to the staff. Hyperbole is alive and well there, as is penny pinching.

Another question addressed why I won’t name an EHR when I talk about its flaws.

As a consultant who has seen the good, bad, ugly, and downright horrific, I am reluctant to throw a vendor under the proverbial bus for the sins of its clients. I used to do subcontract consulting work for a major EHR vendor. They would send me out independently to troubled clients. My only responsibility was to figure out what the issues were and craft recommendations that would help get the clients to a happier and more productive place.

Invariably, shadowing one or two patient visits would reveal a poorly-configured EHR that didn’t take advantage of the vendor’s latest features. Some clients were so far behind on upgrades they were no longer able to receive support, but they were unprepared to even consider an upgrade for various reasons. Operational and leadership pathologies contributed to never being able to optimize the EHR. I’d love to be able to get a demo-grade copy of our EHR to know how good or bad it isn’t, but until I know it’s the EHR’s fault and not that of my myopic leadership, I’m not going to blame the vendor. If I had unfettered access to a general release copy of the EHR that I knew had not been butchered or gutted by a client, I would be more than happy to name and shame.

I enjoyed David Butler’s comment about “God came in and created Intelligent Medical Objects.” IMO is one of my favorite add-ons for EHRs that don’t already have it. My current EHR as implemented does not leverage IMO. There is some kind of mapping among ICD-10 and SNOMED and ICD-9 (which we still have to use for certain work comp cases), but it’s mediocre at best.

I also enjoyed the comment from AnInteropGuy talking about systems that still ask if someone has had overseas travel, since that’s currently a somewhat moot point. I recently had to take a family member for dental care and assisted them in filling out their COVID pre-screening. Question #1 was, “Have you recently traveled to China or traveled on a cruise ship?” I kid you not. Those questions are so March 2020 and indicate a vendor who can’t be bothered to stay current or a client who refuses to upgrade.

Thanks to all who commented or reached out by email to either Mr. H or me. I enjoy hearing from readers and being able to understand where you’re coming from.

Many of my physician colleagues are taking all kinds of unproven supplements — including aspirin, melatonin, zinc, and vitamin D — in an effort to either stave off COVID or reduce its severity should they become infected. To be honest, healthcare providers in my area are dropping like flies. I strongly suspect lack of appropriate PPE. Some nurses have been wearing the same N-95 masks since February because their hospitals say their role doesn’t demand anything more than a surgical mask even for COVID-positive patients, and even the best-provisioned of us may get one new mask a week despite the fact that the new CDC recommendation says masks should be discarded after five “donning” cycles, which equals one day if you eat lunch and hydrate a couple of times during your shift.

A few of my more fringe colleagues are also taking prescription drugs like ivermectin (which will also keep them free of heartworms and cat scabies) because there are a couple of papers that say it might be a good idea. I’m personally on board with a new study that links consumption of chili peppers to better midlife survival.

The research was presented at the virtual American Heart Association 2020 Scientific Sessions. It concludes that higher intake of any type of chili pepper was associated with fewer deaths from all causes (including cardiovascular disease and cancer) during a seven- to 19-year follow-up in middle-aged adults. As any good student of the middle school science fair can attest, correlation does not equal causation, but at this point as a physician looking down the barrel of a rampant and seemingly unstoppable pandemic that many in the US still believe is a hoax, I’ll take any positive thoughts I can get.

Having spent time pursuing my studies deep in the heart of Texas, I became a fan of the chili pepper. Since then, I’ve been on enough camping trips to know that a splash of hot sauce can help overcome many a bad meal. As an added bonus, daily consumption will also tell you if you still have your sense of taste and smell and whether you need to take your “essential worker” self for a COVID test, since many of us are exposed regularly but never tested.

What’s your COVID prevention regimen? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/3/20

Imprivata Acquires FairWarning to Expand Digital Identity Platform

Digital health security vendor Imprivata acquires FairWarning, a data privacy and insider threat detection company based in Clearwater, FL.

DuvaSawko Completes Strategic Merger with abeo

RCM outsourcing business DuvaSawko merges with Abeo Management, which offers outsourced RCM and practice management services to anesthesia practices.

Startup Virta Health Valued at $1 Billion In Fundraise

Diabetes-focused remote patient monitoring startup Virta Health raises $65 million in a Series D funding round that brings its total raised to $231 million and valuation to $1.1 billion.

HIStalk Interviews Robbie Hughes, CEO, Lumeon

Robbie Hughes, MEng is founder and CEO of Lumeon of Boston, MA.

Tell me about yourself and the company.

I’m an aerospace engineer. I’ve been a computer geek all my life. I was particularly interested in the problem of the computerization of industries versus the digitization of industries. That led me when I was still a student into the law, accountancy, and healthcare. All of those industries were activity-based in their reimbursement forms, and all I saw was using computers as expensive typewriters rather than the way I’d been brought up to use them.

Characterize me as a computer geek who was naive enough to think I could get rid of variability in healthcare delivery and stubborn enough to stick at it for now 15 years. But the thing that interests me, and the thing that got me into this in the first place, was, how do you deliver a common standard of care across a network? That’s the variability problem I’ve been going after all this time.

Lumeon is an agility layer that sits on top of the EHR. It helps providers personalize and operationalize a common standard of care across the enterprise. The people who buy that tend to be interested in doing something different, innovating around an operating model, innovating around a new way of delivering care. That lends itself in particular to risk-bearing entities who want to principally use automation to cut out costs and transform care. That’s a lens that we bring to it.

We started in Europe. We moved over to the US, and obviously there’s a huge amount of difference between those two environments. But there’s also a huge amount that is similar, so we’ve been lucky to be able to isolate a lot of what’s common between the two and bring it from one environment to another in a relatively interesting and different way.

Are providers interested in standardizing care when their patient population is a mix of fee-for-service and value-based care?

Absolutely yes, but we need to be really careful about the language. What we don’t do is standardized care. What we do do is standardize decision-making that results in the personalization of care. So the problem as I see it is not how to do the same thing to every patient, it’s how to apply a common standard or apply the same decisions in the same way to every patient. That results in the appropriate application of the right care to the right patient, which in a fee-for-service construct, very happily is usually reimbursed.

The effect we tend to see is not only in elimination of waste — which is good in both environments — but also an increase in throughput, which tends to increase reimbursement and revenue as well. We’re in the slightly strange position of being able to drive up revenue in a fee-for-service environment as well as cut costs in both the capitated or risk-sharing environment.

That’s the core of what we do. It’s basically ensuring that every case, every patient gets the right care, and because the fee-for-service model reimburses the right activities, generally speaking, you will find the reimbursement goes up.

Is it hard to get enough information from the EHR to allow you to provide the best recommendations for all patients?

It’s very difficult. The way we do it is what we think is a little bit easier. I’ve been doing this long enough to know that you don’t try to eat the whole elephant in one go. When we started out, we would go off and do 100-site enterprise deployments that would take two or three years to roll out. Whilst that was, let’s call it educational, I wouldn’t describe it necessarily as fun.

The approach we’ve taken instead is to try to think about what is a digestible version of that problem that can be applied quickly and that can deliver value quickly for the customer, so that you never actually need to solve the problem of, what is the entire universe of care for every patient and every possibility? I don’t believe today that’s a tractable problem. Instead, what we tend to focus on is identify processes where there are gaps or discontinuities or grit in the machine, if you like. Then, how do you apply automation to that to deliver that lift, that personalization, but also that control and predictability to ensure that you are operating at peak performance?

You’ll know that the typical areas that you’ll find this will be around care transitions. For example, that will be around surgery and obviously in population health, where you’re trying to get large populations to do specific things, but each one of those things need to be specific to the individual. Those are the kinds of areas that we tend to specialize and see the most benefit.

Analytics-powered population health was mostly an aspirational legacy software vendor’s overused marketing term a handful of years ago. Has the definition or the expectation around PHM changed?

This was one of the really curious things to me when I came to the US a few years back. I looked at population health management as a category, and I thought, that’s interesting. That should be the application of the appropriate care to the individual at population scale. That’s what we do.

But the reality of the market seemed to be somewhat limited to meeting your quality measure obligations, and most specifically, looking at population health as an analytics and insight problem rather than an action problem. Population health management as a noun rather than a verb.

For us, the analytics are interesting. They tell you where to point the machine, but the problem we’re interested in is, how do you actually operationalize that? How do you solve that last-mile problem so you can drive the engagement, drive the personalization? Anyone can do the analytics with enough horsepower, but actually driving real change in a health system so that you are appropriately intervening with the appropriate patients with the appropriate care at the appropriate time — that’s a hard and interesting problem. That’s the thing that gets us up every morning.

The pandemic has possibly set us back, where we’ve moved to video visits that may be disconnected from the the patient’s usual providers and interrupting their normal health maintenance activities. Has care coordination suffered, or has the pandemic done us a favor to show us what we need to change?

Telehealth is probably the most interesting version of this care coordination problem. Health systems have lurched towards swapping face-to-face visits with video visits, which is a fine and a reasonable thing to do. But what nobody’s really thought about, or at least nobody that I can see has really thought about, is the governance around this.

When is it appropriate to have a telehealth visit that is provided virtually rather than a visit that’s done face-to-face? When is it safe to do so? What are the benefits? What is the standard of care that might be reasonably considered in a remote or in a face-to-face environment, how are they different, and what do you need to do differently?

For me, the orchestration of virtual care and the safety netting of it through the use of a combination of remote patient monitoring, screening, or any number of the other myriad interventions that exist for us today is the ultimate care coordination problem. It isn’t just now a problem of, “this patient is due for their flu shot” or “this patient is overdue for their colonoscopy.” This is now a problem of, for this patient and their presentation, that the next thing that they need to do is share this information, because it’s missing in their medical record. That will then tell us whether they can have the bit after that in this form or the other, et cetera, et cetera.

This orchestration of the fragments of care delivery is going to get dialed up to 11 if we are serious about using… I’m going to use the term virtual care, because I believe that’s different from telehealth in a meaningful way. I think that’s what the consumer wants. The consumer wants something that looks like every other industry, but there is a safety and a governance aspect to the application of these types of interventions in our industry that has not yet been, shall we say, road tested in any meaningful way.

I’ll bet there’s going to be a ton of lawsuits, not just in the US, but globally, next year from patients who have been misdiagnosed, mistreated, or forgotten about because of this very problem. When the dust settles from all of COVID, I think this is going to be one of the more interesting problems for the industry to address.

Much of the value in a visit is simply asking the patient how they are doing and using their answer to guide the next steps. Are we overlooking the value of allowing the individual to electronically document and contribute their own sense of wellbeing, activity level, or concerns?

One of the overlooked aspects of automation is that it should, if done well, enable hyper-personalization. For me, automation is not, at least not in our industry, about doing the same thing for every patient. It’s about looking at the marginal cost of every single activity and trying to reduce that to zero so that you can implement as many different activities as you possibly can to build up the most robust picture and then use that to drive the appropriate intervention.

In your example, I would advocate that the face-to-face consultation could be augmented by tele-triage in advance, whether asynchronously or synchronously, to determine the best use of the face-to-face time that that physician or clinician will have with the patient. It’s a perfectly reasonable thing to do. But in the case that it’s not face-to-face, you could apply the same model, but you can also look at other things.

If the consultation is face-to-face, for example, perhaps the patient has a sweaty palm, and as they’re leaving the consultation, they shake the hand of the physician and say, “Oh, just one more thing, Doctor.” That’s a classic pattern that, in a face-to-face environment, a physician would tend to leverage to gain better insight. But in a remote consultation, they can see that the paint is peeling off the walls, that they don’t have a chair to sit on, that they have 13 cats on the sofa, and there are people shouting in the background. You can build up a picture of the patient that is — I don’t want to say more complete or less complete, but suddenly different. The cues and signals that you look for in these environments are going to be different.

Again, not to say that either of these is right or wrong, but the important thing to realize is the expectation and the baseline that we set for care delivery in the “old normal” is completely different to what we might anticipate in the “new normal,” and we need to adjust. We need to design our interventions appropriately, and we need to recognize that the patterns, cues, behaviors, checklists, or whatever that we had previously are no longer going to be as useful. That’s a huge, huge opportunity if it’s embraced.

Again, this is kind of why I got into this. The trick is, how do you bring it together? How do you orchestrate it with precision? Because there is such a thing as the objectively right care for a given patient. It’s just that in this industry we tend to apply a lot more subjectivity to that than perhaps I think we should.

Will hospitals and practices whose capacity is once again being challenged by the pandemic respond by using those technologies that were rushed into service in the spring – such as telehealth and contact-free check-in – or will we see another wave of innovation?

We first need to come to a common understanding about what the core problem that we’re solving, and I don’t know that the industry has necessarily done that yet. People have applied the solution at hand to the symptoms that they see, but there is another level of optimization that needs to take place to create the sustainability and to create from scalability of even those same solutions and those same interventions before we get to another round of innovation. There’s a lot that can and will be done, but we have a lot to fix on the ground first. I’m not convinced necessarily that there is a universal view in the industry about what “good” looks like.

I would say that there’s the reimbursement problem which needs to be addressed one way or another, and obviously that’s going to drive a lot of behavior. Consumer expectations are being set. I think there’s going to be a lot of conflicting opinions around the level of reimbursement anticipated because the standard of care will be different. I think that’s an entirely reasonable debate, but I would advocate for much more freedom in terms of how people think about reimbursement, particularly around service lines and particular outcomes.

A lot of simplification can happen that will create innovation. I see a lot of complexity being introduced in order to manage some of the risks and bridge to value transition. Whereas if you look to other industries like the cosmetic surgery industry, it’s well published that cosmetic surgery and the cosmetics industry more broadly has been publishing a fixed price for a long time. Costs have been driven down there in an environment that is broadly similar to many other surgical interventions in healthcare. If we can get to a place where there is predictable pricing for predictable care, that will unleash a huge amount of innovation, and we will see a lot of adoption of all kinds of both operating models and technology potentially to support them. But everything begins and ends with money, so I would advocate for that kind of approach. I think if we do that, we will see the kind of movement we all want to see.

What changes do you expect to see with the company over the next three to five years?

The core emphasis of the company is on the US market. The core things that matter to us are around being aligned with our customers. I got into this because we have a very firm belief that it is possible to both take costs out of care and to improve the quality of care being delivered, however you define quality. Every time we’ve done this, the quality comes alongside cost reduction. I’ve yet to see a single example, over my many years of doing this, where the cost has increased and the quality has gone up. It has always been that the cost has gone down and quality has gone up.

That’s our North Star. The one thing we do, the one thing that drives us, is, how do we improve the quality and the consistency of what our customers deliver? Nothing else matters, really. If we do that, then our customers will speak for us. If our customers speak for us, then we will have commercial success, and we will create the flywheel that everyone wants.

But the healthcare industry is not one single, homogenous market. It is extremely diverse, extremely amorphous in payment model, operating model, structure, patient population, et cetera. It would be naive to suggest that one approach will work for each different environment. The customer intimacy that comes from the analysis we do, from the deployment work we do, from that strive for quality, is what makes us different and is what allows us to adjust for that. But I wouldn’t necessarily say that it’s a straight line path to success.

Anyone who gets into this industry who is trying to do anything, let alone any of the problems we’ve decided to solve for, is going to be in it for the long haul. But it’s nothing more than singular focus on that one thing, driving for quality and taking out waste. I think if we continue to do that in the way that we’re doing, we’ll all be successful, no matter what happens in the broader market.

Do you have any final thoughts?

It’s a fascinating time to be in this industry, and it’s a privilege to be able to work with some of the people we do. If I was to go back and give my 23-year-old self some advice, it would be to pick an easier problem to solve than trying to get rid of the biggest problem in the biggest industry in a country 3,000 miles away from where you’re based. But it is an absolute privilege to be able to do what I do, and if it didn’t work, I wouldn’t still be doing it. I’m grateful for the opportunity to talk to you and hope to be doing it for many years more.