EPtalk by Dr. Jayne 4/16/20

HIMSS could learn a lesson from the American Academy of Family Physicians, which is offering a “worry-free registration” guarantee for its annual conference that is scheduled for October 2020 in Chicago. Attendees can cancel their registrations at any time, for any reason, up to the day before the meeting and will receive a full refund. Bookings prior to April 30 can also receive an additional $100 discount in honor of National Doctors Day. AAFP’s hotel policy is deposit-free and rooms can be canceled within 72 hours of the meeting without penalty. Cancelations within the 72-hour window will incur a one-night charge. It’s unclear if the world will be ready for major conferences by that point, but at least they’ve come up with a good solution to try to make a go of it.

There has been a lot of chatter in the virtual physician lounge around plans for testing and contact tracing in preparation for the end of stay-at-home orders. Excitement about the point-of-care ID Now COVID-19 test from Abbott Labs has been building, as many practices already own the machines that are needed to run them. The company has shipped 560,000 test cartridges across the US, but I haven’t heard of anyone in my area receiving them despite having placed orders as soon as the company started taking them. An article says that the majority have been sent to “outbreak hotspots,” with a request for customers to prioritize testing for frontline healthcare workers and first responders. They are manufacturing 50,000 tests per day and plan to increase the capacity to two million tests per month by June.

Rapid testing is key to strategies for reopening the US economy, along with robust contact tracing. Even though San Francisco is located in a tech hotbed, they are going somewhat back to basics with their approach to contact tracing. They’re putting together a task force to interview patients and trace their interactions, building their team from 40 people to as many as 150. They are engaging researchers, medical students, and staff from the University of California, San Francisco.

Even though major parts of the process will be manual, the group will use online and phone-based tracking tools to follow up with exposed persons and assess them for symptoms. The team will also seek permission to review phone location data for additional tracking.

Where other countries are mandating use of state-developed apps to track movements and trace contacts, many people in the US would fight any mandatory sharing of data, despite the fact that they willingly give it up every day to random apps that sell their data and aren’t trying to keep people from dying.

Testing and contact tracing efforts are going to be expensive and will further stress an already burdened healthcare system. Nearly every facility has a story of salary cuts and hiring freezes along with layoffs and furloughs. Hospitals are still struggling, even those who are not yet in the midst of the surge. They’re paying inordinate amounts for personal protective equipment and still can’t get enough of what they need to function under anything but crisis standards of care.

Next time you read an article about COVID response, look at the pictures. Are the clinicians wearing consistent PPE, or is it a hodgepodge of gear, some brought from home? Do people have head coverings, masks, gowns, and face shields? Do they have masks that fit? Are all clinicians protected, or just those performing the highest risk procedures?

It saddens me to know that I had better PPE when I played the Quipstar game show in Medicomp’s HIMSS booth than some of my colleagues now have. Once we reach the point where healthcare workers have enough PPE that they can use in the way it was designed, not in a way that is modified for scarcity, then we’ll know that we are moving in the right direction.

Greenway health did a great job with their recent blog helping practices understand how the CARES Act may impact them. I’m on a number of vendor email lists and Greenway consistently sharesg relevant information without being too salesy. This particular piece included brief descriptions of the different types of loans and funds available to practices. It may help a practice who don’t know their options for weathering this storm.

If you’re on the team maintains your facility’s charge master or load contracts, make sure you’re keeping up with all the changes CMS is throwing your way. Today’s update was an increase in the payment Medicare is making for certain high-volume coronavirus lab tests. This payment of $100 covers “COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more efficient means of combating the spread of the virus.” High-throughput systems are defined as those that can process more than 200 specimens in a day. Medicare will also be paying new specimen collection fees for homebound patients and those who can’t travel, like nursing home patients.

Road warriors of the US, rejoice. DoubleTree by Hilton has released the official bake-at-home recipe for their signature chocolate chip cookies. As a consultant who has opted to drive an extra hour each day from my hotel to the client site so that (a) I didn’t have to stay somewhere sketchy, and (b) I could have these cookies waiting for me, I am thrilled. I haven’t made them yet, but I am intrigued by the inclusion of lemon juice in the recipe. Apparently more than 30 million cookies are baked every year, and the cookie was the first food to be baked in orbit on the International Space Station a few months ago. It took two full hours for the cookie to bake in microgravity, although the experiment log documented the smell of cookies at 75 minutes. The official DoubleTree statement says, “A warm chocolate chip cookie can’t solve everything, but it can bring a moment of comfort and happiness.”

I bake an inordinate amount of cookies every year with my dad, so I couldn’t agree more. (The picture above is just a fraction of our 2019 effort). My local market is finally back in stock with flour, so these are on the schedule for the weekend.

Email Dr. Jayne.

Morning Headlines 4/16/20

GE Healthcare and Microsoft are bringing a COVID-19 patient monitoring tool to health systems

GE Healthcare and Microsoft retool software originally intended to debut at HIMSS into monitoring software for COVID-19 patients in ICUs.

Meadville hospital’s computer system not yet fully restored after malware attack

Meadville Medical Center (PA) expects to have all of its IT systems back up and running three weeks after a ransomware attack took everything offline.

Alphabet’s health company defends decision to require a Google account to use its coronavirus screening site

Following in Apple’s footsteps, Verily assures senators that its COVID-19 screening website for California residents adheres to data protection standards, and adds that it has no plans to open up the full platform to non-Google account holders.

Morning Headlines 4/15/20

Epic and University Hospital of New Jersey Partner to Lead Statewide Surge Response

Epic donates software and services to the temporary hospital set up in the Meadowlands Exposition Center by University Hospital (NJ).

Mayo Clinic develops COVID-19 tracking tool for staff

Mayo Clinic (MN) develops a tool using EHR data that alerts staff if they come into contact with a COVID-19 patient.

W2O acquires social media analytics platform Symplur

Marketing firm W20 acquires Symplur, a healthcare-specific social media tracking platform that it used to create a coronavirus media tracking tool for the California Life Sciences Association.

News 4/15/20

Top News

The FCC opens the application window for its $200 million COVID-19 telehealth cost reimbursement program.

Applications are completed on an eight-page fillable PDF form that is then emailed to the FCC.

Non-profit healthcare provider sites that treat patients, schools, health departments, rural clinics, and skilled nursing facilities are eligible to have their expenses reimbursed for telecommunications and connected devices.

Awards are expected to be under $1 million per applicant, with the money being assigned on a rolling basis until the $200 million has been committed.

Reader Comments

From Just Laid Off by Allscripts: “Re: the US healthcare system. We like to believe that the public needs are best served when the organizations that provide the needs are run like businesses. Now we’re seeing the downside. While all healthcare organizations across the globe will struggle with the need to care for so many sick people, it seems beyond dysfunctional that hospitals might close or have to layoff healthcare workers because of not doing elective surgeries.” We also have the problem that most Americans couldn’t afford to pay modest healthcare bills even before the pandemic took income and health insurance away from millions of them. I’ve seen estimates that health insurance premiums will rise 40% or more next year, which takes us further down the death spiral of unaffordable premiums, unaffordable deductibles and co-pays, and health systems that expect to be paid richly for providing sometimes questionably necessary services. On the other hand, it wouldn’t surprise me if Americans get healthier over the short term as we reduce our contact with profit-maximizing providers and thus the dangers of overprescribing, overtreatment, elective surgery, and medical errors (the uptick in poor outcomes post-pandemic will be conveniently blamed on deferred maintenance). What we want or need as patients is incidental to whatever makes the cash registers ring. I would like to think that we as patients – which is everybody, not just all at the same time — will demand better, but most of us don’t have a lot of lobbyists and politicians in our pockets.

From Curves Flattened: “Re: COVID-19. Being sequestered accomplished the goal of flattening the curve. Well done!” My joy is restrained by the fact that “flattening the curve” is not the same as “reducing the area under the curve.” Drastic societal efforts so far were intended only to extend the timeframe over which people get infected and require hospital care. Your odds of being taken out by COVID-19 in the long term haven’t changed, other than maybe you get the chance to die unconscious on a ventilator instead of while gasping for air without one. We have no proven treatments and no vaccine. Meanwhile, our globally underperforming healthcare system isn’t the immediate problem – it’s that our world-leading logistics failed us in being unable to source and distribute COVID-19 tests, ventilators, and personal protective equipment.

From Tommy Hawk: “Re: webinars. I suggest that vendors, at least for the near term, allow webinar registration using non-corporate email addresses. This would allow those of us who are newly unemployed to continue our education and maybe our employment.” I agree, although for broader reasons. We make recordings of the webinars that we produce freely viewable on YouTube (I think we were the first to do this). We discourage webinar sponsors from requiring more than the absolute minimum of signup information since studies have shown a huge drop-off in registrants if you bug people to list their employer, job title, telephone number, buying timeline, etc. in ensuring a nagging contact afterward. I haven’t seen many webinars whose content would help a competitor, and I haven’t seen many companies whose competitive intelligence strategy consists of watching webinars. It reminds me of the old HIMSS conference days, when a few paranoid and mostly crappy companies posted sentries around their booth perimeter to shoo away non-providers who might be seeking out the nuclear secrets that were hidden inside.

From Seagull Soaring: “Re: HIStalk. My communication is a simple thanks and gratitude for all of your hard work on HIStalk. I read your site nearly every day and it makes me better at my job. You provide a great service. Thank you.” I’m gratified at the several recent messages like this one that came out of nowhere. Thank you for those who sent them. 

From Michael Raymer: “Re: ventilators. Your original post led to finding our first large private donor. We will return the first ventilators to clinical use this week, three weeks after the initial idea. Thanks for your help! We need help continuing to identify ventilators. We have acquired almost 50 in one week.” Health IT long-timer Mike is the co-founder of the non-profit Co-Vents, which is refurbishing retired ventilators for clinical use to meet the short-term need.

HIStalk Announcements and Requests

I’ve received some thoughtful answers from consultants about how their work is changing, as requested by a consultant reader who is struggling. Add yours to be included in my writeup later this week.

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.  

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

Acquisitions, Funding, Business, and Stock

Life sciences data and managed services vendor IntegriChain acquires the life sciences division of Cumberland, which provides managed services, advisory services, and systems integration for life sciences contracts, pricing, and revenue management.

Marketing firm W20 acquires Symplur, a healthcare-specific social media tracking platform. W20 recently used the system to create a coronavirus media tracking tool for the California Life Sciences Association.

Sales

• Highmark Health, Allegheny Health Network, and Gateway Health will implement Aunt Bertha, which connects people to social services that can help with food, housing, and transportation.

People

Care team collaboration platform vendor Andor Health hires industry long-timer Raj Toleti, MS (Allscripts) as CEO and board chair.

Announcements and Implementations

Henry Schein Medical offers providers free 90-day use of VisualDx, which enhances telemedicine visits with shared images and documents. 

QliqSoft adds patient and engagement content from Wolters Kluwer to its clinical collaboration and patient communication solutions.

ClaraPrice offers a service to help hospitals manage the ongoing reporting and payback of advance Medicare payments via the CARES Act.

Epic announces in a second recent (and rare) press release that it has donated software and services to the temporary hospital that has been created in Meadowlands Exposition Center by University Hospital (NJ). Epic says its implementation took three days, with the first patient being admitted on the fourth day. The newly named Secaucus Federal Medical Station has beds for 250 non-COVID patients.

COVID-19

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that US employees may return to work as early as May, but employers should be prepared to offer onsite screening to detect infected but symptom-free workers. He says the rapid test platform of Cepheid is fast and requires less invasive swabbing, with other companies introducing similar machines. Gottlieb says that employers who can’t perform onsite testing should offer take-home tests or refer their employees to a local pharmacy or government program. He also recommends that employees who test positive continue being paid so they don’t have to choose between doing the right thing versus feeding their families.

James Wright, MD, medical director at the private equity-owned Virginia nursing home that has seen 45 COVID-19 deaths among its residents so far, says that American society has chosen to warehouse its senior citizens in underfunded facilities that can’t afford adequate staffing and that are forced by economics to offer non-private rooms that don’t have access to the outdoors. His facility lost much of its staff as the outbreak began since most of them work multiple jobs and were ordered by their other employers to stop working there to avoid spreading the infection among facilities. More than 50% of the facility’s residents who tested positive have died. Wright concludes that “this will not be the last untreated virus to decimate our elders” and that “a publicly funded nursing home is a virus’s dream.”

A Harvard professor of epidemiology says that we don’t have enough data to determine who in the population might have developed coronavirus immunity. He speculates that most COVID-19 patients develop some degree of immune response, but its strength and duration is probably variable, and creating herd immunity requires a large percentage of people whose immunity is long lasting. The US’s low testing rate makes analysis impossible, but results from better-responding countries suggest that herd immunity isn’t significant. The bottom line is that scientists can’t predict immunity until widespread testing for both infection and antibodies is performed. In the absence of immunity, the only hope is a vaccine.

Preliminary evidence suggests that COVID-19 causes clotting events that can lead to thromboembolism, deep vein thrombosis, ischemic stroke, and possibly even cardiomyopathy. That may also explain why those patients go downhill so quickly from what seems like normal COVID-19 pneumonia. The presence of abnormal coagulation has been found to be predictive of pneumonia outcomes in COVID-19 patients, which could lead to recommendations that those patients be anticoagulated. 

Analysis of the inpatient data of 1,000 hospitals by Allscripts subsidiary CarePort Health finds that COVID-19 mortality rates are about 10% overall, but 40% for those over age 85. A new finding from the analysis is that chronic kidney disease seem to increase death risk dramatically. More than half of patients who were hospitalized are under 65, while risk-adjusted death rates for men are 1.3 times that of women, both conclusions matching those of the CDC.

Beaumont Health launches what it says is the country’s largest coronavirus serology testing program, where it hopes to test volunteers from its 38,000 employees to measure the incidence of antibody formation among people who had no COVID-19 symptoms. The health system will use the data in its return-to-work process and to identify possible donors for convalescent serum treatment. SVP/CIO Hans Keil, MBA, MA says the antibody test, which is not yet approved by the FDA, has been validated on 1,000 volunteers.

New York City increases its COVID-19 death count by 3,700 after including presumable coronavirus-related deaths that could not be confirmed because no tests were available. The city now reports more than 10,000 deaths.

Privacy and Security

Hartford Hospital (CT) announces that information about 2,400 patients was exposed in a February phishing attack in which hackers gained access to the email accounts of two employees. Several other healthcare organizations have reported similar attacks in recent months.

Other

Sales of the stripped down Raspberry Pi computer, which starts at $35, set records as people teach themselves new skills at home and groups use them to create ventilator prototypes using hardware store components.

Doctors on the front lines of coronavirus are seeing their pay cut even as they are asked to risk infection, often without adequate PPE. This includes those whose compensation includes a significant component that is based on RVUs whose volume has been reduced with COVID-19 focus:

• A California ED doctor who was forced to buy her own N95 masks on Craigslist will see her pay cut by at least 25%.
• A New York ED doctor took a 10% pay cut and is expecting more.
• The income of some specialists has dropped by 80% due to lack of procedures.
• An urgent care company cut all salaries by 10% and confiscated all untaken PTO.
• New York doctors are being asked to take unpaid positions at COVID-19 hotspot hospitals owned by NYC Health + Hospitals, while the organization is recruiting temporary nurses $10,000 per week plus travel expenses. 
• Envision Healthcare will cut the pay of its doctors who work in areas that have lower patient volumes.
• Alteon Health backed off some of its announced cuts after ProPublica reported its plans, but is still moving salaried doctors to hourly and then reducing their schedules.
• Atrius Health is withholding pay for doctors and nurses or cutting it by 20%.

In England, 99-year-old World War II veteran Captain Tom Moore, who hoped to raise $1,300 for the NHS’s coronavirus efforts by accepting donations for each 82-foot lap he completes around his garden using his walker, says he won’t stop even as donations have topped $3 million.

Rio de Janeiro illuminates the Christ the Redeemer statue in medical gear on Easter Sunday to honor medical workers around the world who are battling coronavirus. Meanwhile, Brazil’s president, Jair Bolsonaro, maintains that coronavirus is “a measly cold,” asserts that it’s a media hoax intended to erode his political support, and says the virus is leaving Brazil on its own accord.

Sponsor Updates

• Phynd will ingrate provider credentialing and privileges data from Symplr into Phynd 360, which allows organizations to publish provider  data and deploy consumer provider search tools.
• TransformativeMed lists several health systems that are taking advantage of free use of its Cerner-integrated Core COVID-19 App for patient monitoring and data submission to health departments and the White House Coronavirus Task Force, among them UPMC, MedStar Health, UW Medicine, and Virginia Commonwealth University Health System.
• Use of the EClinicalWorks Healow telemedicine app exceeds 1.5 million daily minutes amid the COVID-19 pandemic.
• Montefiore St. Luke’s Cornwall Hospital (NY) and UPMC Western Maryland choose AHIMA’s compliant template library within Artifact Health’s mobile physician query platform.
• Nuance names Avaya a top growth partner and, for the third consecutive year, its top producing channel partner.
• Datica releases the latest edition of its 4×4 Health podcast, “ONC Final Rules on Information Blocking – Part 3.”
• Mental Health Center of Denver implements CareSignal’s COVID-19 Companion text messaging app.
• The Columbus business paper features the remote working strategies of CoverMyMeds.
• Diameter Health publishes a multi-part series on new ONC, CMS regulations.

Blog Posts

• 3 Aspects of Epic Implementation that Could be Impacted by COVID-19 (314e)
• CMS Telehealth Billing Correction (AdvancedMD)
• Supporting EMS Readiness for COVID-19 with Avaya Spaces (Avaya)
• Epic Best Practices: Phoenix (Bluetree)
• COVID-19 National Response Portal: Join the Hospital System Data Sharing Initiative (CereCore)
• How Payers Can Leverage Claims & ADT Data (Collective Medical)
• Leadership During the COVID-19 Pandemic: Dan Charney, President & CEO at DRI Shares Thoughts (Direct Recruiters)
• How Artificial Intelligent is Helping Fight COVID-19 (Dimensional Insight)

Contacts

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

Morning Headlines 4/14/20

FCC’s COVID-19 Telehealth Program Application Portal Opens on Monday

The FCC begins accepting applications for its $200 million COVID-19 Telehealth Program, which will help eligible providers purchase infrastructure, services, and devices needed to offer telemedicine during the pandemic.

Apple Responds to Senators Questioning Privacy of Covid-19 Tools

Apple responds to privacy concerns related to its COVID-19 screening app and website, stressing that the tools don’t collect user data, and that they are not bound by HIPAA guidelines.

Rapid roll-out of telehealth services in Iowa: ‘We’re just going crazy with it,’ one doctor says

Health systems in Iowa see telemedicine utilization rates skyrocket as reimbursement restrictions are lifted in light of COVID-19, prompting many to hope that virtual care will become part of their new normal after the pandemic has passed.

Mobilizing AI for Health to fight against COVID-19

As part of its AI for Health project, Microsoft will donate $20 million to advance the use of AI in the fight against COVID-19, particularly in the areas of data and insights, hospital resource allocation, treatment and diagnostics, research, and information dissemination.

Curbside Consult with Dr. Jayne 4/13/20

Despite my clinical employer’s failure to get on board with telehealth, many organizations are embracing it. The American Medical Association released a Telehealth Playbook last week. It has a lot of good information for people who might not be sure how to approach the process. It’s a bit lengthy at 128 pages, but don’t let that dissuade you, because the last 40 or so pages are worksheets.

The AMA did a good job gathering information from people who have figured this out in the past, when they weren’t in a rush as people are now. Situations are a little different when you are trying to ramp something up quickly or are using solutions that are unproven, though. Your mileage may vary to some degree, depending on how nimble your organization is and what your tolerance is for just getting something live without achieving perfection.

Not all organizations have done well with trying to manage patients remotely or making sure that the needs of patients with chronic issues are met. I have heard from multiple friends and neighbors who have visits scheduled during the next two weeks (while our state is still under a stay-at-home order) and they have received zero communication from their physicians on whether the visits will happen or how they might be executed. I’m sure some of them might be waiting to see how things unfold since they seem to change from day to day, but especially given the availability of patient portals and texting solutions to communicate with patients, it’s surprising that the practices are running silent.

There’s also an error component as practices shift visits. I have already had one pharmacy error when my primary physician canceled my annual visit. They usually send a year’s worth of refills to Express Scripts when I appear in person. This time they sent an order for a 90-day supply to tide me over until I have a visit, and Express Scripts promptly misprocessed it and sent me 30 pills. Four phone calls later, I still don’t have what I need. Fortunately I’m a bit of a pharmacy hoarder and always stay a month ahead on my refills, and it’s not something that will cause grave harm if I miss it for a few days, but I’m sure patients in those situations are experiencing similar confusion and delay.

The AMA playbook divides the process of implementing telehealth into 12 steps, with the first six being planning. Those steps typically include needs analysis, building a team, defining success, evaluating vendors, gaining buy-in, and contracting. In many organizations, these steps can take 12-18 months, and practices are now trying to do it in a matter of weeks (if not days). The playbook includes a concise “Warmup” section that talks about telehealth and provides some basic definitions, helping people understand synchronous versus asynchronous technologies and how they might benefit organizations. It glosses over some of the barriers to telehealth, though, listing them but not really explaining how much of a showstopper they can be for organizations.

Licensure issues are big, especially for organizations that are on state borders and see patients from multiple states. Although there has been some relaxation of interstate licensure during the COVID crisis, some states have their own regulations around it, where others are a bit more of a free-for-all. Even the big telehealth companies have handled temporary licensure waivers differently. One is requiring physicians to opt in to see patients in states where they are not licensed, while another is just assuming that its providers want to see patients from all states where there are waivers. Some of the waivers are already expiring, causing dramatic shifts in how many patient visits are available for physicians to staff.

Privacy and security issues are also paramount, especially given the recent federal relaxation in the level of security needed for billable visits. Providers can use commercial platforms that weren’t specifically designed for patient care, which may increase access, but also increase the risk of exploitation. Another concern is whether telehealth visits can deliver the same level of care as in-person visits with the same outcomes. Having worked for a telehealth organization that has a strong quality program, and where the antibiotic metrics are higher quality than those I saw in my brick and mortar practice, I have to say it’s more about the organization and its culture than it is about the delivery platform.

Funding a telehealth program is also a big issue. The playbook puts it squarely back on the practice to figure out, although it does define a few examples. Organizations will have to work with their payers to understand how visits might be covered and how they might impact other aspects or practice, including Accountable Care Organization cost and quality attribution. The document makes it clear that practices that go down this road will need to have dedicated resources to stay up to date on the constantly shifting landscape with payers, rules, and regulations.

Several of the steps they identify are being largely skipped over as organizations race to get telehealth solutions live. Some of them include getting feedback from staff on pain points and figuring out how different telehealth solutions might solve those issues, along with evaluating the organization’s readiness for telehealth solutions. It’s clear that whether organizations are ready or not, here it comes, so that definitely shifts the dynamic. Budgeting and identification of funding sources are also being skipped as organizations view telehealth as a way to try to preserve care delivery (and financial margins) versus just closing to patient traffic in the face of an outbreak.

Other pieces that are being skipped over include gaining stakeholder buy-in and identifying success metrics. From a vendor analysis perspective, it seems like many organizations are trying to go with solutions that might be already integrated with their EHR or otherwise using commercial solutions. There are multiple third parties that are offering no-risk or low-cost agreements for 90 days during the crisis, so that’s a good thing for practices who might just want a quick solution without significant commitment.

It’s a risk for vendors to take this approach, but if they have a solid offering and treat their clients well, it’s a great way to prove their capabilities. The contracting piece of the document made some great points about ensuring that clients understand who is going to have access to their patients’ data and ensuring scalability.

Steps 7-12 fall into the “Game Time” portion of the document. Some of these steps — like workflow design, prepping the team, and partnering with the patient — are being done in a matter of days in real life. Many of my colleagues are embracing telehealth. It will be difficult to convince them that they need to return to face-to-face visits for many of the issues they are treating. Patients are also happy with the convenience factor, so I don’t see it going away any time soon.

I’d be interested to hear from people who have rapidly executed a telehealth strategy. What worked and what didn’t? Are patients accepting it? Have you had claims come back and are there issues, or are you still waiting for the other shoe to drop? What would you warn someone who is farther back in the process? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/13/20

Apple and Google partner on COVID-19 contact tracing technology

Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

Bankruptcy judge OKs sale of St. Vincent hospital to Patrick Soon-Shiong

A federal judge approves the $135 million sale of St. Vincent Medical Center (CA) to health IT, life sciences, and publishing mogul Patrick Soon-Shiong, MD who plans to turn it into a COVID-19 research facility.

Doctors at UCLA, UCSF create registry to study coronavirus effects on pregnancy

Researchers at UCLA Health and UC San Francisco launch the PRIORITY study and national data registry to better understand the effects of COVID-19 on pregnant and post-partum women.

Monday Morning Update 4/13/20

Top News

Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

The companies will release APIs next month that create interoperability between Android and IOS devices using apps from public health authorities. Following afterward will be the release of the full contact tracing platform.

The use scenario is this:

1. User One carries their phone any time they’ are in public. They leave the app running.
2. User One is assigned an anonymous, frequently changed identifier beacon.
3. User One has close contact with User Two, who is also carrying their phone and running the app.
4. User One tests for COVID-19. They manually enter their result into an app provided by a public health authority.
5. User One gives their phone permission to upload a 14-day history of the identifier beacons with which they have had close proximity.
6. User Two’s phone regularly downloads a list of identifier beacons from contacts who have tested positive.
7. User Two’s phone alerts them that they have been exposed to someone who tested positive and tells them what they should do.

Obvious weak points of cellphone-based contact tracing:

• Adoption in other countries that have tried this voluntary approach has been low (Apple and Google did not acknowledge that this technology wasn’t their original idea).
• The app must be left running and the user must carry their phone everywhere.
• The users must have smart phones; those with flip phones or no phones cannot participate.
• Each person who tests positive must remember to enter their result.
• Both contacts must be running the app. That means, given likely low adoption, that the odds of detecting a given exposure are tiny.
• Bluetooth can detect proximity, but not the chances of exposure. It could record a contact anyone in nearby car or everyone behind doors in a hospital hallway.
• People who don’t trust big companies like Apple and Google (especially the latter, given that its primary business model is using or selling user data), or who detest the concept of mass surveillance regardless of benefit, will likely opt out.
• Public health systems must participate.
• The US still lags in testing and results from some labs are delayed due to backlogs.

Reader Comments

From Code Jockey: “Re: Epic consulting. Demand for my skills has evaporated as health systems have suspended EHR projects and cancelled contracting engagements. Given the 95% reduction in air carrier routes through September, there’s no way to get to their sites even if they need contractors. I’m now unemployed and trying to get a $17 per hour job at an Amazon warehouse. I’m wondering what people like me are doing – taking a break, shifting to other industries, or working remotely? What will consulting look like when this is all over, the former Monday to Thursday travel or 100% remote work? You also have Epic continuing to elbow into the contracting space. I wonder how the many staffing firms that have lined their pockets on the backs of contractors will be affected by the absence of engagements?” I offered to create a short survey for consultants to anonymously share how the pandemic has changed their work. Your thoughts might relieve some anxiety for people who are cooped up with little work available short term.

From Financial Cannula Insertion: “Re: HIMSS20 hotels. Marriott Orlando Village is not refunding guests because they claim they were contractually guaranteed full payment by HIMSS. They’re keeping my ‘deposit’ of the full four nights that I prepaid. Here’s the email I received from the hotel GM.” The hotel says that HIMSS told it on multiple occasions that the conference would not be cancelled and asked that the hotel not release or resell any booked rooms. The hotel add that since the US had no travel advisories in place at the time the conference was cancelled (two days before FCI’s scheduled arrival), the cancellation was a HIMSS business decision that does not relieve it of honoring its vendor contracts. The GM says HIMSS signed a contract with all the Orlando hotels guaranteeing the attendee’s full payment. It’s interesting that HIMSS can legally guarantee payment terms on behalf of the actual customer, presumably by the online reservation terms specified by OnPeak since HIMSS doesn’t handle room bookings directly.

From Spumoni: “Re: HIMSS. I’m struggling with a path forward, as exhibitors seemed to be saying in your survey. Will travel return? Do I really want to sit shoulder-to-shoulder in sessions? Was the conference a boondoggle all along that was self-aggrandized by vendors along with their own importance? Meanwhile, I’m being bludgeoned by the pivot to online content delivery and life in the glow of Webex on a laptop.” It’s hard to predict the pent-up, post-isolation demand for big conferences in the potential absence of a coronavirus vaccine. People were always returning home sick even in past years, as my post-HIMSS18 poll found that 50% of respondents came home with a cold, flu-like symptoms, stomach problems, fatigue, headaches, or muscle aches. Beyond that is the economic question — is the considerable cost of attending and exhibiting worth it, especially given a year off to contemplate the value received? Or will it go back to exhibitors who mostly show up for fear they will look bad competitively if they don’t? Or will the conference irrecoverably lose critical mass with the near-certainty of fewer attendees, a sparser exhibit hall, and attendees who have grown comfortable conducting all aspects of their work remotely?

From Allscripts Sunset: “Re: Allscripts. Appears that it just hit five straight quarters without selling a Sunrise new logo deal.” Unverified.

From Allscripts Cuts: “Re: Allscripts. Word is that the board gave Black and Poulton six months in early March to cut $100 million per year in expenses. There was an expectation of laying off 1,000 to 1,500 people, but they likely used COVID to cut pay and travel to get layoffs into the 500-600 range. That will work only until full salaries return and travel picks back up.” Unverified.

HIStalk Announcements and Requests

Most poll respondents have no personal experience with COVID-19, and thankfully few report the death of a family member, friend, or co-worker.

New poll to your right or here, for hospital employees: which is true of your EHR maintenance fees as the pandemic cuts revenue? Click the poll’s Comments link after voting to explain.

Listening: Bachelor Girl, which I discovered while creating another playlist for my young friend (it includes Dua Lipa, James Bay, Florrie, Sia, and Hazel English). Bachelor Girl is an Australian duo that has been around for nearly 30 years, and what caught my attention was 1999’s “Lucky Me,” a cynical take on success that sounds more Nashville than Melbourne (it’s amazing that the lyric way back then says, “I’ve got so many friends on the internet, I could never be alone.” I’m also thrilling to the new album of the amazing Public Enemy and the best voice in rap, Chuck D, who raises goose bumps on 2007’s “Harder Than You Think.”

A third-hand acquaintance (well educated, upper class, long list of health conditions) is experiencing cough, fever, and fatigue and was reluctantly sent home by his employer. Some of his co-workers – who as essential workers spend their work days in close office contact — have since tested positive for COVID-19. He has dawdled in sending in his own test samples and continues to convene multi-generational family and neighborhood gatherings and takes regular, unmasked trips to grocery and hardware stores. Bill Gates was right in describing STDs – it would be easy to stop communicable disease outbreaks if those who practice bad behaviors suffered the consequences immediately instead of later or didn’t harm others in the process of doing something stupid.

Health-Related Technologies That the Pandemic Has Made (Or Will Make) Mainstream

1. Telehealth and its integration with EHRs.
2. 3D printing of medical supplies.
3. Chatbots that can help keep the worried well out of the ED (instead of the previous model of hoping to bring them in as paying customers).
4. Remote patient monitoring and clinician backup.
5. Videoconferencing and team collaboration platforms.
6. Patient engagement for monitoring patients who are recovering at home or who can be discharged to lower-acuity settings.
7. Patient check-in and waiting room avoidance.
8. Public health reporting and data aggregation.
9. Online education.
10. Predictive models for hospital resource needs, patient outcomes, and pandemic spread.
11. Virtual conferences.
12. Clinician collaboration platforms for sharing best practices and crowdsourcing treatment options.
13. Robotics for contact-free hospital room deliveries.
14. Rapid online publication of research findings.
15. Syndromic surveillance.
16. Virtual mental health services.
17. Medical equipment clearinghouses.
18. Contact tracing.
19. Virtual programs for home exercise, rehabilitation, and wellness.
20. Imaging AI for detecting specific conditions.
21. Analytics and predictive modeling.
22. Supercomputer-powered rapid drug and vaccine research.
23. Wearables and mobile devices for the rapid assembly of clinical study cohorts and collection of study data.
24. Platforms to connect people with social services.
25. Voice assistants, such as Alexa and Siri, that have been enhanced with tools to answer specific health questions or to allow summoning help.
26. Apps for relaxation and mindfulness for people who are quarantined and anxious.
27. Ordering and delivery apps for food, supplies, and prescriptions.
28. Platforms for matching clinicians and volunteers with hospitals in need.
29. Internet-connected digital thermometers for outbreak detection.

Got more to add?

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.

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

People

MaineHealth SVP/CIO Marcy Dunn died last Monday. She was 65.

Announcements and Implementations

OmniSys offers all pharmacists — who can now administer COVID-19 tests as authorized last week by HHS — free online training that describes how to order tests, apply for a state license, perform the nasal swab, bill payers, submit positive cases, and share the results with the patient’s other care providers. The company has also enhanced its cloud-based retail pharmacy EHR with tools for documentation, reimbursement, and care plan communication.

Experian Health offers a free, regularly updated list of COVID-19 and telehealth payer polity alerts for hospitals, medical groups, and pharmacies, describing 1,140 changes in medical coverage policy changes.

COVID-19

New York City reports that only 18,500 of its hospital beds are being used versus the 140,000 that experts feared would be required during the pandemic’s peak resource demand that happened this weekend. Hospitals are seeing declining ICU bed occupancy, hospitalizations stand at under 19,000, and the 2,800-bed emergency hospital that was created at Javits Center is treating just 300 patients. Officials credit residents of New York and nearby states for slowing the tide by staying home. Statistical experts say their surge projection models were likely thrown off by unreliable data from China and shorter than expected ICU stays. Meanwhile, physicians worry that the big drop-off in patients who normally seek hospital care for heart problems and strokes may indicate that they are fearful of going to the ED and are just suffering at home instead, possibly to their long-term detriment.

Mayo Clinic says that a COVID-triggered freeze on elective surgeries will trigger a $3 billion loss this year, forcing it to implement pay cuts and furloughs for salaried employees, freeze hiring, lay off contract employees, and stop some construction.

Politico reports that Democratic lawmakers have written to White House Senior Advisor Jared Kushner to express concerns about the patient privacy implications of his rumored discussions with technology companies to collect COVID-19 public health surveillance data. A White House task force wants to develop a national coronavirus surveillance system that would provide a real-time view into hospital ED visits and bed capacity using “multiple private sector databases,” raising fears of a Patriot Act type encroachment on privacy. A government spokesperson says that neither Kushner nor the White House are aware of such a project, but Politico uncovered a memo written by three companies – Collective Medical, PatientPing, and Juvare – that Politico says was in response to an administration request on the feasibility of quickly gaining visibility into how many patients are seeking hospital care.

The federal government’s distribution of the first $30 billion in emergency hospital grants raises the ire of some hospitals because payments are based on the volume of past Medicare billing amounts, not their coronavirus burden. Hospitals in lightly hit states, some of which continued to perform rofitable elective procedures, are being given 25 times the amount of money per COVID-19 case as those in New York. The formula also provides payments to providers who aren’t on the front lines, such as podiatrists and ophthalmologists. HHS said the goal was to get the money out quickly and it will focus the next round on providers who were most impacted by coronavirus.

More evidence that New York City is unintentionally undercounting COVID-19 deaths – FDNY reports that cardiac arrest calls and DOAs have risen six-fold over the same period last year, which probably means that people who die of COVID are being counted instead as cardiac deaths. Italy saw the same six-fold increase in deaths, far more than the official COVID death counts.

A single long-term care facility in Virginia has recorded 40 deaths that are linked to COVID-19, with the medical director blaming lack of staff and equipment, low funding, and trying to isolate positive cases when people have lived in the same room for years. The facility is owned by private equity firm Tryko Partners, which operates 3,000 skilled nursing beds.

The US federal government is using daily, e-mailed hospital worksheets to visualize bed capacity, but Germany has a live map.

Florida is underreporting COVID-19 deaths because the state health department has decided to count only deceased state residents, omitting snowbirds and tourists who die in Florida.

United Airlines and basketball player Steph Curry honor the 20 USCF clinicians who volunteered to serve on the front lines of New York City hospitals.

Other

The 3,000-bed temporary hospital that was created in Chicago’s McCormick Place convention center will use Epic in a partnership that involves Epic, Rush University Medical Center, and the City of Chicago. Chicago’s Department of Health reached out to Epic early in the planning.

This seems HIMSS20 related and perhaps could be instructional to HIMSS. Burning Man Project cancels its annual Black Rock City gathering for 2020 due to coronavirus and will instead run a virtual version that it says “will likely be messy and awkward with mistakes.” It asks ticket-holders to consider donating part of their full refund to the project so it can continue to support its key programs, noting that “things are looking a little grim” in trying to run year-round programs when 90% of the project’s annual income comes from Black Rock City. Tthe group has already undertaken layoffs and pay cuts. Burning Man also observes that rolling over this year’s ticket sales as a credit for next year’s event is not practical because that simply “punts the financial challenges to a future date.” The group had cancellation insurance, but it doesn’t cover pandemics. The CEO recorded a personal, heartfelt message to explain the situation, an approach of unscripted humility and openness that stands in contrast to the HIMSS “strictly business” approach that makes it feel more like an us-versus-them vendor than a non-profit that wears its lofty societal aspirations on its suit sleeve. I’m not sure how many HIMSS members and exhibitors feel a personal attachment or loyalty to the organization or its goals as its global ambitions and expansion strategy has made it impossible to define a typical member.

Sponsor Updates

• MDLive reports visits and user registrations increase to all-time highs with virtual healthcare as first-line defense in fight against pandemic.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, launches the “Clinical Concepts in Obstetrics” podcast.

Blog Posts

• The Downstream Impact of COVID-19: Building a Strategy with Telehealth and Chronic Care Management (Lightbeam Health Solutions)
• Using LiveProcess for COVID-19 Response: Real World Tips from Our Customers (LiveProcess)
• Healthcare organizations implement remote testing in light of COVID-19 (Meditech)
• Remote Healthcare Work: Best Practices amid COVID-19 (Health Catalyst)
• Leveraging Virtual Care Amid COVID-19 (Netsmart)
• Building a Healthcare Data Strategy with Big Rocks (Omni-HealthData)
• Social Distancing and the Power of Patient Engagement (PCare)
• Automation can help track active coverage during the COVID-19 chaos (Experian Health)
• 12 tips to manage a remote contact center in healthcare (Spok)
• Backfilling for clinical team members redeployed to the front lines (Nordic)
• Tips for Educating & Communicating with Patients During the COVID-19 Pandemic (PatientBond)
• Pivot Point Perspective: 6 Strategies to Accelerate EHR Build Outs for Drive-Thru Clinics (Pivot Point Consulting)
• Enabling Workforce Continuity – It’s Time to Rethink Identity (SailPoint)
• How to Improve Physician EHR Adoption During an Implementation: Part 2 (Santa Rosa Consulting)
• 6 ways to maintain your well-being during a pandemic (StayWell)
• Healthcare’s catastrophic revenue gap is here. Accelerate recovery now. (SymphonyRM)
• Cloud-hosted communications for makeshift care areas. (Voalte)
• COVID-19: 6 Simple Tactics for Safer, More Efficient Communication (Vocera)
• How to Deliver, Document, and Bill for Different Types of Remote Rehab Therapy (WebPT)

Contacts

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

Weekender 4/10/20

Weekly News Recap

• The COVID-19 global tracking website that was put together in a few hours by a first-year Johns Hopkins graduate student is drawing one billion page views per day.
• Allscripts lays off staff and cuts costs.
• HIMSS revises its “no exhibitor refunds”policy for HIMSS20 and offers a 25% credit that can be applied to the next two annual conferences.
• Despite an ongoing lack of COVID-19 testing nationally, hospitals aren’t using the available capacity of independent labs because they don’t have EHR ordering and results interfaces.
• Duke’s Margolis Center for Health Policy, along with two former FDA commissioners and former National Coordinator Farzad Mostashari, MD, proposes a national COVID-19 surveillance system.
• AMA publishes a physician guide for implementing virtual visits.
• FCC publishes details of its $200 million COVID-19 Telehealth Program.

Best Reader Comments

Health systems are giving themselves gold stars for upping their stats on virtual visits, which I can’t help but find to be a tad disingenuous. Using the example from the Epic post, one organization had only 200 televisits during ALL of last year and are now counting 12,000 in just one week! Wow, except I’m not really feeling the celebration here. This success happened only because health systems were finally forced into telling their patients about the option that was probably there all along (it certainly was for Epic users). (Telehealth Princess)

The reason people didn’t do telemedicine before is because it wasn’t reimbursed at the same rates, or at all, in many cases. In addition to the obvious public safety advantages of video visits right now, insurers and CMS have agreed to broadly reimburse these services. On top of that, the government is also throwing money at hospitals to purchase telemedicine technology. The comparison to Napster is interesting. Healthcare does have a similar pricing and delivery problem that the music industry had. I wonder if some facilities will go the way of Tower Records in the coming future. So far “online doctor” services that attempt to bypass traditional payment models haven’t been particularly successful. We’ll see if that changes. (Elizabeth H. H. Holmes)

It sounds like Allscripts did a graduated pay cut. Meaning if two people are in the same role and the first employee makes more than the second, the first employee took a larger pay cut. Is that true? Doesn’t that punish harder working or more experienced or more talented employees assuming those people would be the one Allscripts would have originally given raises? (IANAL)

There will be titanic shifts across the whole economy that will reverberate for the rest of the year or even longer. Lots of docs are laid off already — the surgicenters are closed and many may not reopen.The disruption has only started. For many younger medical professionals who have never experienced a shrinking economy, the experience it will come as a shock that “MD” or “RN” does not means monotonically increasing wealth and well being. For anyone who remembers the 1990s, it is just a reminder of what we already knew. (Richard Irvin Cook)

In our county, a single for-profit health system owns the hospital and all urgent cares in the county. Last week, my wife had all of the symptoms of COVID-19 and she began to decline. I took her to the ED, and the note said that she was suspected of having COVID-19. The interesting part is they didn’t test her for COVID — their protocol was not to test anybody unless a positive test would change the treatment course. Instead of a single test, the did a CXR, metabolic panel, and a Chem 7. The Medicare reimbursement rate for a CDC COVID test is around $35.91, while my wife’s visit rang up $4,000. From a revenue perspective, it seems far more lucrative to not test for COVID-19. (Jim Bresee)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. S in New York, who asked for a VersaTiles math practice set. She said a few weeks ago, “The impact that these math VersaTiles have had on my children is immeasurable. It has allowed me to target weaknesses in individual students and help them understand the concept to mastery. The children are so focused on the task and so interested in the activities that the success rate has been through the roof. This has allowed those children who struggle, to move on to the next concept as they have now built that foundation. They have proven to be equally engaging and successful for those students who need to be challenged to do more. We will be forever blessed with your love and support.”

In Mexico, a man in a grocery store throws hot coffee on a nurse who was wearing scrubs as he shouts, “You’re going to infect us all.” Another nurse had an egg thrown at her as she waited for a ride, while residents of one small town threatened to burn their local hospital down if it treats any COVID-19 patients.

A South Carolina ED nurse isolates herself by sleeping in a RV in her back yard that was provided by RVs 4 MDs, which helps healthcare workers find a place to stay during the pandemic.

A hospital in Thailand fits newborns with face shields to protect them from coughing or sneezing that could contain coronavirus.

Pharma bro and Turing Pharmaceuticals profiteer Martin Shkreli offers to apply his drug development expertise to search for COVID-19 treatments in return for a three-month furlough from his seven-year securities fraud sentence.

Intensivist Julie John, MD makes a goodbye video for her children after coming down with severe COVID-19 symptoms at home and declining to call 911 because she didn’t want the presence of paramedics or the possibly being intubated to frighten her young children. She is recovering in quarantine, but even after 14 days the infection still leaves the 38-year-old doctor her feeling like she’s a 90-year-old woman with emphysema.

In Case You Missed It

• News 4/10/20
• EPtalk by Dr. Jayne 4/9/20
• News 4/8/20
• Curbside Consult with Dr. Jayne 4/6/20
• Readers Write: Strained but Secure
• Monday Morning Update 4/6/20

Get Involved

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

Morning Headlines 4/10/20

Behind the Johns Hopkins University coronavirus dashboard

The Johns Hopkins University and Medicine COVID-19 case-tracking site draws over 1 billion page views each day for its near-real time display of data from WHO, CDC, and other authorities.

The Nation’s Largest Convention Center Being Converted into a COVID-19 Alternative Care Facility in Chicago, To Be Equipped with Epic Health Records Software

The Chicago Department of Public Health will work with Rush University Medical Center to set up a temporary hospital within McCormick Place Convention Center that will use the medical center’s Epic system.

LabCorp and Ciox Health Enter Collaboration to Create Comprehensive Patient Data Registry

LabCorp and HIM vendor Ciox Health will develop a COVID-19 patient data registry for clinical researchers using de-identified lab testing data and data culled from EHRs.

News 4/10/20

Top News

Nature magazine describes the spur-of-the-moment decision by a Johns Hopkins University first-year PhD candidate to create a global COVID-19 tracking dashboard for fellow researchers. He developed the site in a handful of hours.

The Johns Hopkins University and Medicine COVID-19 case tracking site is drawing over one billion page views each day for its near-real time display of data from WHO, CDC, and other authorities. 

Developer Ensheng Dong (second from left in the photo above) is a first-year graduate student in civil and systems engineering with a focus on disease epidemiology. He also holds MS degrees in statistics and geography. He used his experience building a geospatial mapping tool to track measles hotspots to create the coronavirus display.

Dong’s thesis advisor, who help create the dashboard, has told him that this year isn’t normal and that he should “prepare for a really boring second to fifth years.”

Reader Comments

From Down In Flames: “Re: Allscripts. Big layoffs this week.” Here’s some of what I’ve heard from the folks who emailed me. None of this is confirmed, just what they told me:

• The company laid off 5% of employees across the board (some say it was more than that, perhaps 10%).
• Salaries of high-earning employees were cut for six months: $100-150K (15%), $151-225K (20%), $226-325K (25%), more than $325K (30%).
• Merit and promotion raises have been deferred until 2021.
• All contractors have been dismissed.
• An austerity travel ban that has been in place since early January is now being blamed on COVID-19.
• Bonuses that were accrued in 2019 will be paid “sometime soon.”
• Clients aren’t paying their bills due to lack of profitable elective surgeries.

From Allscripts Employee: “Re: Allscripts layoffs. Playing Titanic deck musical chairs continues, as even teams that are hitting goals are hit with reorgs every nine months that seem to be solely to allow executives to justify their existence. The C-suite will blame everything on COVID-19 instead of their many poor business decisions over the years (Practice Fusion, Avenel). They didn’t even warn employees, many of whom would have gladly left and found other jobs given the chance.” 

From PE Watcher: “Re: Allscripts. Paul Black is out of runway. The low share price has private equity circling to buy it cheap, then sell off the parts of the business like Veradigm that might attract a cash buyer.” MDRX shares are at $6.69, down 30% in the past 12 months and down 29% since Paul Black took over as CEO in December 2012 (versus the Nasdaq’s loss of 1% and gain of 162%, respectively). The company’s market cap is just over $1 billion.

From Exhibit Hall of Shame: “Re: HIMSS. Making a slight pivot.” An email from Hal Wolf that was forwarded to me says:

• Exhibitors will be credited 25% of their total HIMSS20 payments, to be spread over HIMSS21 and HIMSS22 (15% and 10%, respectively).
• Startup and University Row exhibitors will be credited their full payment, spread equally between the two future conferences.
• Paid exhibitor and client booth badges can be used at HIMSS21.
• Payments for optional events — such as the Universal Studio outing, awards gala, and CIO Forum — will be credited against optional events at HIMSS21.
• Some hotels are giving refunds, some aren’t, and HIMSS is puzzled why some of them are telling people to contact HIMSS when it’s the hotel’s decision and cancellation policy that determines if refunds are offered.
• HIMSS has cancelled employee raises and bonuses for this year.
• HIMSS notes on its updated FAQ that it is considering changing its hotel deposit requirement through OnPeak to just one night.

From Accounts Prayable: “Re: HIMSS20. Another outrage — we just received an invoice for ads in the Show Daily handouts, poorly named in this case since they were not actually handed out.”

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Announcements and Implementations

NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center in Manhattan.

Experian Health offers free access to a list of payer policy alerts related to COVID-19 and telehealth to help providers avoid payment delays.

Blessing Health System (IL) implements CareSignal’s COVID Companion educational text-messaging program for patients.

Hyland Healthcare develops an enterprise version of its PACSgear server software for imaging capture and exchange.

EMPI vendor Verato offers Telehealth Identity Bridge, which links a patient’s EHR and telehealth visits to give clinicians a full clinical history. The company offers health systems and health plans free use through the end of the year.

Government and Politics

President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project. She takes over from James Byrne, who was fired in February for purportedly clashing with members of the leadership team. Powers is a US Air Force Academy graduate, holds masters degrees in military leadership and organizational management, and is a retired Air Force colonel and cyber communications officer. 

CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner. The San Diego-based health IT company previously sued the VA to protest its no-bid selection of Cerner and then sued Cerner for patent violations.

VA Secretary Robert Wilkie assures Congress that parts of the VA’s shift to Cerner remain on schedule, including development of the VA-DOD Joint Health Care Exchange and other interfaces, infrastructure upgrades, clinical workflow design, and integrated testing. The transition to Cerner’s scheduling system will be delayed.

COVID-19

A National Academies of Sciences, Engineering and Medicine report that was commissioned by the White House warns that no evidence exists to suggest that coronavirus spread will mimic flu by tapering off in the summer, noting that coronavirus is running rampant in countries that already have high heat and humidity. The authors conclude that the potential absence of seasonality, along with global lack of immunity to coronavirus, make it unwise to count on those factors in developing strategies.

HHS tells a House panel that the federal government’s supply of personal protective equipment is depleted and states will receive no more. The federal government has distributed 11.7 million N95 masks versus the 3.5 billion the administration had said were needed, while just under 8,000 ventilators were sent out. HHS employees say the allocation was based on population, not state requests, which has led to shortages that required states to lend equipment to each other.

The federal government asks its health officials to track COVID-19 deaths by race after several states report that disproportionately high percentages of African Americans are dying. Every one of St. Louis’s 12 COVID-19 deaths were African Americans, although the significance of that finding will require looking at the presence of chronic disease and social determinants of health.

A Black Book survey finds that nursing homes are underreporting COVID-19 cases because of lack of technology, heavy use of agency and per-diem workers, and lack of ability for long-term care providers to find out which other facilities have cared for COVID-19 patients. Hospitals are discharging COVID-19 patients into long-term and subacute care without having test results and 96% of nursing home respondents say that they no longer believe that their facility is the best place for housing elderly, susceptible people.

Executives at Detroit Medical Center’s Sinai-Grace Hospital (MI) send ED nurses home after they refuse to work because of understaffing. Two nurses were covering 26 patients, 10 of whom were on ventilators, and seven night shift nurses are covering up to 100 patients versus the proper staffing of 21 nurses per shift . After ordering the nurses off campus, the hospital held day shift nurses over to cover for them, extending their shift to 24 hours.

Nearly 100 residents of a California nursing home that has been hard it by COVID-19 are evacuated after employees fail to show up for work for the second straight day. Officials say that 34 residents and 16 employees have tested positive for coronavirus.

Experts warn that US COVID-19 testing remains constrained and is not growing rapidly even as the number of cases skyrockets, leaving the only option as continued mass social distancing rather than identifying and quarantining those who are infected. A Nature review finds that universities that offer certified COVID-19 testing are not operating at full capacity because of lack of contracts between providers, incompatible EHRs, the FDA’s requirement that labs hold a CLIA certificate, and a lack of federal leadership. A director of UC Berkeley’s genomics institute offered hospitals a free alternative to the state health department tests – which had a backlog of 57,000 – but explains, “I show up in a magic ship with 20,000 free kits and CLIA and everything, and the major hospitals say, go away, we cannot interface with you.” Sutter Health turned down at least one academic provider of COVID-19 tests because no electronic interface exists and it wants to expand its own testing capacity. Boston Medical Center agreed to use tests from Boston University School of Medicine only after a bioinformatics graduate student wrote a script to connect orders and results to its EHR.

With numerous protective measures still in place, the City of Wuhan, China reopens to outbound travel after a nearly three-month lockdown to prevent the spread of COVID-19.

Amazon Web Services will partner with the Yale School of Public Health to offer 30 hours of online training to people interested in becoming volunteer health workers. The course will teach them how to work at drive-through COVID-19 testing sites, support homebound patients over the phone, and record vital signs in pop-up triage facilities.

University of California, Irvine designs and creates 5,000 3D-printed face masks for UCI Medical Center.  Their low cost allows them to be discarded between patients as requested by clinicians.

Other

UC San Diego Health physicians pilot an internally developed machine learning algorithm that enables radiologists to better screen for pneumonia on chest X-rays, which can also turn up potential COVID-19 cases.

UW Medicine launches the DoD-funded HIPPOCRATIC app-based research project, which will use health and wellness data from 25,000 volunteers to inform the development of predictive analytics ahead of future outbreaks. Researchers also hope to better understand the feasibility of using a smartphone-based screening tool instead of drive-through screening and testing sites.

American Association of Nurse Practitioners cancels its annual conference in New Orleans, offering full refunds to registrants and exhibitors. AANP is cancelling all the hotel rooms in its block (it does not use OnPeak or other housing service) and will not charge the one-night deposit.

“If you want to recruit fake doctors, we’re ready. We can help hand you stuff.” Past and present TV doctors come together to thank healthcare workers on World Health Day.

Sponsor Updates

• Microsoft publishes a case study titled “SyTrue offers AI-based healthcare solution at no charge to public health organizations to help them fight COVID-19.”
• The Tampa Bay Business Journal honors Greenway Health SVP Karen Mulroe as one of its 2020 Top Corporate Counsel honorees.
• Healthcare Growth Partners publishes “Health IT March 2020 Insights.”
• Esse Health expands its use of CareSignal software to include a COVID-19 text-messaging program for patients.
• PMD announces record adoption of its telemedicine platform in March.
• Collective Medical’s product offerings meet new CMS ADT notifications conditions of participation.

Blog Posts

• Keeping clinicians and patients safe through remote ventilator visibility (Capsule)
• The Journey to Empowering Patients via Apple Health (Engage)
• Flattening the Curve with Telehealth (EClinicalWorks)
• We’re all in this together, now and forever (Hyland)
• Imprivata GroundControl: Enabling secure virtual visits during hospital lockdowns (Imprivata)
• Clinical terminology in a time of uncertainty (Intelligent Medical Objects)
• What Consumer Search Behavior is Telling Us About Coronavirus & Implications for Access to Care (Kyruus)
• COVID-19: Enlisting the EMR in the fight (Optimum Healthcare IT)
• Leveraging MEDITECH’s EHR During the COVID-19 Pandemic (Meditech)
• Cross-Functional Teams of PMD: It Takes an Orchestra! (PMD)

Contacts

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

EPtalk by Dr. Jayne 4/9/20

I’ve been reading tons of scientific papers this week, trying to keep up with recent research on COVID-19 while alternating other things I have put off, such as finishing my tax return. I know the deadline has been pushed, but I’m expecting a refund this year so wanted to get things moving.

I enjoyed coming across this decidedly non-COVID article discussing the “Association between lottery prize size and self-reported health habits in Swedish lottery players.” That’s a decidedly niche research set, for sure. In case you’re curious, the question they were seeking to answer was this: “Is unearned wealth from lottery winnings associated with more healthy habits and better overall health?” Looking at over 3,300 individuals up to 22 years after their lottery win, they found no statistically significant differences in long-term health behaviors.

I also took some time for personal healthy behaviors, such as continuing to binge watch “Poldark” and also watching the first two episodes of the new season of “Call the Midwife.” I enjoy its gritty portrayal of nurses in London during the 1950s and 1960s. Although it makes me grateful for the medical technology we have today, it also makes me wonder how things would be if we had a similar national focus on neighborhood-based care, including home outreach. If there’s any good to come out of this pandemic, perhaps it’s a re-evaluation of how we deliver care around the world.

Speaking of remote care options, one of the things I wanted to see at HIMSS was the GlobalMed Transportable Exam Backpack. I was impressed by their exam cameras last year. They have integrated those plus a few more tricks into this bag, including EKG and ultrasound. Apparently its predecessor was a ruggedized briefcase that was used in various capacities, including treating Secret Service agents detailed abroad and enabling communication with physicians in the US. The images obtained with their cameras are better than what I sometimes see with my own eyes in the office, which makes me wonder about using solutions like theirs to augment in-office workflows as well as those in remote locales.

April 12-18 is STD Awareness Week, and a recent writeup made me wonder whether social distancing will have much of an impact on sexually transmitted diseases. I live in one of the US cities with the highest rates of STDs, so a reduction in illness would certainly be welcomed. The article notes that the event used to be the full month of April, but even with the condensed timeframe, the goals are the same — raising awareness, providing education, encouraging testing, and reducing stigma, fear, and discrimination. Stay healthy, folks!

When patients test positive for sexually transmitted diseases, public health agencies have to perform contact tracing. That kind of work has come into the spotlight with COVID-19. I’m hoping some of those technologies can be later adapted for routine use. A group of innovators from MIT and other organizations has created a solution that not only helps with tracking, but also helps maintain privacy for individuals who allow it to use their location tracking data. Patients’ memories aren’t always reliable over time and other countries have made great use of location data, not only for contact tracing, but to enable a return to a more normal level of human interactions.

I was glad to see CMS applying its Extreme and Uncontrollable Circumstances policy for clinicians who aren’t able to submit their Merit-based Incentive Payment System (MIPS) data by the recently extended April 30 deadline. The policy will be automatically applied to those who don’t submit – clinicians will be flagged and receive a neutral payment adjustment for the 2021 MIPS payment year. For those organizations who started data submission but aren’t able to complete it, a separate non-automatic application can also be completed.

For those of you who spend most of the winter checking this graphic from week to week, I think we can safely say goodbye to flu season. Many of my coworkers would give anything to go back to even a bad flu season rather than what we’re dealing with now.

It’s a safe bet that most medical school graduates from the Class of 2020 will receive their diplomas in the mail. My alma mater canceled its commencement exercises weeks ago, even before the first states started going on lockdown. They realized that people were already making travel arrangements and wanted to send a message for folks to stay home. It’s the first time the university has ever cancelled commencement, even with world wars and other conflicts.

They sent out an alumni blast today asking us to send messages to the newest graduates as they carry their brand new MDs into a world that none of us envisioned. Here’s to all the new physicians, nurses, therapists, and other healthcare providers heading into this brave new world. My virtual hat is off to you.

From HIT Girl: “Re: specialists. I am not a clinician, so this might be a doofus question, but how easy or difficult is it for a specialist to work as a generalist? Doctors and nurses are getting sick, getting exhausted, and visibly suffering moral distress. Can specialists be rotated in to take over and let people take some time off to regenerate (or recuperate, if sick)?” This is the approach many healthcare systems are taking, although they are trying to find synergies in what kinds of resources can do which kinds of work. For many subspecialists, such as cardiology and gastroenterology, their underlying training is in internal medicine and they have a lot of knowledge that can be brought to bear in the hospital setting. They might not do as well in the outpatient setting, where we see a broader spectrum of chronic care than what they are used to encountering.

Many physicians are taking online refresher courses to get up to speed before they’re redeployed to other clinical areas. My experience, in delivering urgent care and primary care at the World Scout Jamboree, is that a lot depends on the individual clinician and their training. The subspecialty surgeon with whom I worked had a terrible time treating basic primary care issues such as strep throat, and his continued frustration with the EHR added to his inflexibility and unwillingness to learn. Conversely, the pediatric rheumatologist slid right into adult-ish medicine without blinking and even made a couple of great saves.

Bottom line: your mileage may vary when redeploying physicians. There are some procedures I haven’t done in decades and wouldn’t have any business attempting them regardless of how many videos I watch.

Thank you to all the readers who sent me words of encouragement in response to my recent underemployment. I’m trying to pick up telehealth visits where I can, although the big surge seems to have passed in those as companies have onboarded new physicians in droves.

Several wrote with their own physician stories that could form an administrative hall of shame. One busy primary care doc who expertly transitioned to telehealth saw her schedule reallocated to her partners who weren’t as busy. Others were told to use vacation time to make up for closed clinic hours even though they were willing to see patients virtually. Another office is requiring all the providers to come to the office to deliver telehealth services, citing HIPAA and “place of service issues” as the reason providers can’t operate from their homes. The common theme was poor communication – major changes in how physicians operate probably shouldn’t be delivered via impersonal group text messages.

I appreciate each of your stories about your personal “new normal.” Please keep them coming.

Email Dr. Jayne.

Morning Headlines 4/9/20

Pamela Powers tapped to perform duties as VA’s No.2

President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project.

Epic Partners with New York Hospitals for COVID-19 Patients Treated at Manhattan’s Javits Center

NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center.

CliniComp International Gets $429M DHA IDIQ to Help Manage Clinical IT Systems

CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner.

Morning Headlines 4/8/20

Former FDA Leaders, Health Experts Urge Action Now to Contain COVID-19 in Future

Duke’s Margolis Center for Health Policy proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options.

Tyto Care Raises $50M to Expand Its Telehealth Exam and Diagnosis Offering Globally

Telemedicine and related device company Tyto Care raises $50 million in an oversubscribed funding round.

CyberMDX raises $20 million to protect connected medical devices with AI

New York City-based startup CyberMDX will use $20 million in new funding to scale its healthcare cybersecurity capabilities and hire an additional 30 employees.

News 4/8/20

Top News

Duke’s Margolis Center for Health Policy – along with former FDA Commissioners Mark McClellan, MD, PhD (the center’s director) and Scott Gottlieb, MD, former National Coordinator Farzad Mostashari, MD, and other participants – proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options. Recommendations:

• Roll out rapid diagnostic testing everywhere and for every person with COVID-19 symptoms, allowing quick identification of those infected and of those at high risk (such as healthcare workers), and conduct random tests to detect small outbreaks.
• Use the test-and-trace results to feed a national syndromic surveillance system that transparently reports outbreaks.
• Conduct widespread serologic testing to identify immunity markers and to supporting making decisions about sending people who are immune back to work.
• Require providers that receive federal coronavirus grant money to actively participate in the surveillance and response system.
• Encourage standards-based lab results reporting (CDC, CMS, and ONC).
• Incorporate ADT notices into the surveillance system for COVID-19 detection and for correlation to clinical observations, admissions, and transfers to ICU (CDC).
• Publish daily summaries from the surveillance system at the metro area level.
• Improve the use of technology to manage case-based isolation.
• Develop a common platform to query data from hospital EHRs, HIEs, and CommonWell and Carequality (CDC, ASTHO, ONC, and OCR).
• Help health systems and insurers manage patients who have tested positive (CDC).
• Publish best practices and case management models to maximize the ability to treat new cases at home or in local isolation facilities (CDC).
• Pay providers based on case outcomes (CMS and CDC).
• Lead and fund projects to answer questions about asymptomatic spread, the impact of more refined physical distancing measures, the ability predict and influence case severity, and the role of children in transmission (CDC).

Reader Comments

From Anointed Two: “Re: HIMSS20 hotels. I can almost understand Marriott keeping one night’s deposit, but keeping the entire prepaid amount is inexcusable greed. I hope that we vendors remember how HIMSS and OnPeak did nothing to negotiate on our behalf when it comes to HIMSS21.” The hotel rather coldly told this reader this: “The agreement that the hotel entered with HIMSS was an advance payment of each attendee regardless of circumstances. The hotel will be retaining these prepayments.” The HIMSS rationale for requiring exhibitors to book hotels through OnPeak is that the convention center allocates exhibit hall space based on hotel rooms booked. I can confidently predict going forward that convention centers will have all the space any exhibitor could ever want given the dying conference business, not to mention that the HIMSS track record should be adequate to convince the convention center to not stiff it on space. All that aside, I don’t think the hotel policies have caused many gripes in the past, so unless another HIMSS conference is cancelled inside the no-refund window, it’s probably all moot anyway, although I would refuse on principle to book any Orlando hotel for HIMSS22 that screwed me for HIMSS20.

HIStalk Announcements and Requests

I tweaked my current poll about personal COVID-19 experience to include “presumed positive” in addition to “tested positive” (since testing availability is still a train wreck). It’s still not perfect but the best I can do without creating a multi-page survey that nobody would complete, but you can always add more descriptive comments after voting.

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Acquisitions, Funding, Business, and Stock

Hospital operator Quorum Health files Chapter 11 bankruptcy as part of a pre-packaged plan to reduce debt. The company says its 23 hospitals and Quorum Health Resources subsidiary will continue to operate normally.

Companies that inserted mandatory arbitration terms in their business and employment agreements to avoid class-action lawsuits (Epic was the US Supreme Court test case for employers) are subverting the process they created after being overwhelmed with mass arbitration claims. Big companies – which assumed that people wouldn’t bother filing claims — are now refusing to pay the arbitration costs that they themselves specified. One law firm filed 6,000 arbitration claims on behalf of independently contracted delivery drivers for DoorDash, which balked at paying the $9 million in arbitration fees and then rewrote its terms to require using a particular arbitrator whose rates were lower. An unsympathetic federal judge ordered the company to pay the fees, saying, “Your law firm and all the defense law firms have tried for 30 years to keep plaintiffs out of court. And so finally someone says, ‘OK, we’ll take you to arbitration,’ and suddenly it’s not in your interest any more. Now you’re wiggling around, trying to find some way to squirm out of your agreement. There is a lot of poetic justice here.”

People

Clinical AI vendor Jvion hires industry long-timer Jay Deady (Recondo) as CEO.

Chris Aulbach, MS (Cognizant) joins CipherHealth as chief product officer.

Announcements and Implementations

The American Medical Association publishes a  128-page physician guide for implementing virtual visits, which includes a section on evaluating related technologies.

Santa Barbara Cottage Hospital (CA) goes live on PeriGen’s PeriWatch Vigilance automated maternal-fetal early warning system. Part of that system is a centralized acuity management tool that facilitates remote monitoring of laboring patients anywhere, providing flexibility for COVID-19 staffing.

HCA Healthcare and Google Health create the COVID-19 National Response Portal to allow hospitals to share pandemic metrics.

Audacious Inquiry launches the Situation Awareness for Novel Epidemic Response (SANER) Project, which is working on a specification to allow hospitals to send situational awareness reports to public health authorities.

Epic almost never issues press releases, but pushed out this one touting its telehealth capabilities. It calls itself “the nation’s largest electronic health records company,” which it certainly isn’t in terms of company headcount or revenue compared to Cerner, but perhaps is that among companies whose only business is selling EHRs. Novant Health went from 200 video visits per year to 12,000 per week, while NYU Langone Medical Center is conducting 6,500 virtual visits per day, more than 70% of its total. Another Epic update says the company’s EHR now includes two COVID-19 related patient registries to track known or suspected cases.

COVID-19

Former FDA Commissioner Scott Gottlieb, MD tells CNBC that someone needs to take ownership of the surveillance and isolation program to get it in place by August, along with developing 1-2 drugs that can help treat COVID-19 patients with even modest success, to avoid having the economy stall at 80% of pre-coronavirus levels. He expects schools to reopen in the fall, but with added vigilance to detect local outbreaks, and reiterates that development of a vaccine is the ultimate solution at least 18 months down the road.

National COVID-19 hospitalization numbers are trending down, as the curve-flattening seems to have worked in reducing demand for ICU beds and ventilators. Deaths are still increasing in New York as a lagging indicator (731 on Monday), but are expected to be lower than initial projections for both New York and the US.

Amazon launches a hospital-only section of its Prime service for selling face shields, masks, thermometers, ventilators, exam gloves, and sanitizer. The company will verify the qualifications of potential buyers and will waive its commissions on purchases.

Educational non-profit EDX and Harvard launch an free online course on ventilator use, hoping to help those clinicians who are reassigned to the ICU.

The New York Times explains why official coronavirus death counts are probably far below the actual numbers:

• Coroners don’t have the tests they need to detect coronavirus.
• Early cases in February and early March were likely listed as being due to pneumonia or influenza.
• The system of filling out death certificates and the responsibility for doing so is inconsistent.
• Also inconsistent is the reporting of deaths in which coronavirus is proven or suspected to be present, but not necessarily provable as the single cause of death.

HCA Healthcare-owned West Hills Hospital and Medical Center (CA) suspends a nurse for asking Facebook friends to donate personal protective equipment that her employer wasn’t providing. The hospital says she mentioned in a private chat group that her unit was treating COVID-19 patients only and those statements violated HIPAA and the hospital’s social media policy. She’s in quarantine after being exposed to the virus. An ED nurse at the same hospital said that he was also suspended after mentioning that he was working in a COVID-19 unit. Some healthcare workers are filing whisteblower lawsuits after being fired for issuing social media pleas for PPE.

ICU nurses at Newark Beth Israel Medical Center (NJ) were so desperate for gowns and masks that they raised money on GoFundMe to equip themselves via Ebay purchases. Hospitals executives then suspended Olga Matievskaya, RN, BSN, the nurse who organized the campaign, for distributing unauthorized PPE.

HHS OIG’s survey of 323 hospitals from late March lists their coronavirus-related concerns. President Trump dismissed the report in Monday’s coronavirus briefing, saying “it’s wrong” and scolding the inspector general on Twitter for not talking to “admirals, generals, VP, and others in charge” before publishing the hospital survey results. Hospitals report:

• They are experiencing severe shortages of testing supplies and waiting seven or more days for results, limiting their ability to monitor the health of patients and staff.
• Shortages of PPE are widespread, federal and state help is uncertain, and some vendors are price gouging.
• Hospitals aren’t always able to meet staffing needs due to a people shortage, also worrying that exposure fears and burnout may contribute to short staffing.
• Post-acute care facilities won’t accept hospital discharges until the patient tests negative for COVID-19, tying up acute care beds.
• Hospitals are running out of IV poles, medical gases, linens, toilet paper, food, thermometers, disinfectants, and cleaning supplies.
• They are worried about ventilator shortages that may force them to choose which patients get them.
• Costs are increasing as revenues decrease with elimination of elective procedures, quickly depleting cash reserves.
• Guidance from federal, state, and local authorities is ever-changing and inconsistent, and public misinformation is causing patients to show up unnecessarily.

This is well outside my area of expertise, but a New Jersey hospital needs PPE and asked me to forward contact information for anyone who has access to it. Email me and I’ll forward the information.

Cerner sent these hospital recommendations for dealing with COVID-19 patient surge, from St. Joseph’s Healthcare System (NJ) VP/CIO Linda Reed, MSN, MBA:

• Review and implement the EHR vendor’s COVID-19 updates and packages.
• Review telehealth documentation and education.
• Prepare to develop lab interfaces for state surveillance.
• Create daily dashboard reporting.
• Review the IT requirements for opening surge beds in non-traditional areas.
• Implement the new COVID-19 diagnosis and billing codes.
• Prepare to support additional work-from-home technology needs.
• Review government reporting requirements.
• Use remote support tools to support desktops to limit trips to hospital units.
• Prepare for updating EHR access to accommodate clinicians who are reassigned.
• Use remote patient visualization technology to limit room entry.

Other

A Florida business paper covers Orlando Health’s replacement of Allscripts Sunrise with Epic. Orlando’s other big health system AdventHealth, is also implementing Epic, replacing Cerner.

A Baltimore TV station covers the use by Lifebridge Health and Johns Hopkins of technology from Emocha to keep in touch with self-quarantined clinicians. It offers symptom reporting, asynchronous video check-ins to verify thermometer readings, and two-way messaging.

Verizon cancels making onsite Internet connectivity service calls for homes and businesses, with some users reporting they were given a date of November to regain connectivity.

Miss England 2019, Bhasha Mukherjee, MBBS, shelves her overseas humanitarian work and returns to the UK to work at NHS’s Pilgrim Hospital. She explains, “When you are doing all this humanitarian work abroad, you’re still expected to put the crown on, get ready, look pretty. I wanted to come back home. I wanted to come and go straight to work.”

Sponsor Updates

• AGS Health spotlights employee Adelaide Rose’s mask-making efforts for hospitals in New Jersey.
• Medsphere’s ChartLogic division adds integrated telehealth to its ambulatory EHR that allows patients to launch video rooms from its patient portal for a virtual evaluation.
• Baxter Regional (AR) expands its use of EClinicalWorks technology to include virtual visit capabilities.
• Access releases COVID-19 Rapid Response EForms, which allows hospitals to offer contactless registration by sending patients an online screening form and then pre-registration documents to complete and sign remotely.
• Diameter Health partners with insurance technology company Clareto to improve underwriting and claims adjudication with data-cleansing technology.
• Experity updates its travel screening questionnaire to help urgent care providers identify new cases of COVID-19.
• Healthwise launches a Coronavirus Resource Center.
• Datica releases a new podcast, “ONC Final Rules on Information Blocking – Part 2.”
• CareSignal and Americares bring a new COVID-19 text messaging program to the uninsured.
• Clinical Architecture joins the COVID-19 Interoperability Alliance.

Blog Posts

• Leveraging Business Intelligent for COVID-19 Screening (314e)
• How are you coping? We love success stories. (AdvancedMD)
• Keeping Veterans and Responders Connected During a Crisis (Avaya)
• Social Distancing, Flattening the Curve, & Raising the Bar (Bright.md)
• What is Zoom Bombing? Immediate Steps to Protect Your End Users (Burwood Group)
• The Critical Role of Interoperability During COVID-19 (CarePort)
• Mentoring in the Tech Industry is Rewarding but Requires Time and Soul Searching (CentralLogic)
• How HIE is Playing a Role in Navigating the Coronavirus Outbreak (ChartLogic)
• Expanded Telemedicine Regulations: Documentation Requirements Overview (CereCore)
• NAS Strategies Across the Nation (Collective Medical)
• Expanding How CoverMyMeds Helps Patients Access Their Medications (CoverMyMeds)
• How Analytics can Help Hospitals Better Manage Their ICUs (Dimensional Insight)

Contacts

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

Morning Headlines 4/7/20

VA pauses work on EHR during coronavirus

Following in the DoD’s footsteps, the VA decides to delay its Cerner EHR project as clinical teams focus on COVID-19 patients.

Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020

An HHS OIG survey of 323 hospitals finds their biggest challenges in preparing for and treating COVID-19 patients are associated with testing and treatment, and protecting staff.

Alliance of Va. hospitals launches dashboard tracking the status of medical needs

The Virginia Hospital & Healthcare Association develops a dashboard to help hospitals across the state visualize the number of COVID-19 hospitalizations, facility capacities, and data on PPE and medical supply inventories.

HHS Announces Upcoming Funding Action to Provide $186 Million for COVID-19 Response

The CDC will offer select state and local health departments $186 million to build out or improve on testing and surveillance capabilities, and predictive analytics.

Curbside Consult with Dr. Jayne 4/6/20

I was awakened this morning by a call from my clinical employer. Usually those early morning calls are along the lines of someone being sick and asking if I can cover a shift, or it’s one of my partners asking follow-up questions on a patient visit from the night before.

This morning’s call was absolutely surreal. They were notifying me that they’re taking me off the schedule for the rest of the month.

It would have been one thing had they just laid it out cleanly and said it was a low census issue. Instead, the person calling (who probably hadn’t discussed the word track with HR) went on and on about needing to have physicians “give up their shifts” because of other providers who have student loans to pay or whose spouses have been laid off from their jobs. I suppose they assume that physicians of a certain age don’t have student loans or other critical deb, and whatever other assumptions they made about my finances made me less needy of work than others.

I was frankly shocked that they would approach it in the way that they did. It is certainly not something I would handle with an early morning phone call.

A quick check of the “under revision” schedule shows that the majority of shifts being moved around were indeed those belonging to physicians, while keeping the physician assistants and nurse practitioners working. As it is in so many things, it appears to be about the money, because it certainly doesn’t look like it’s about having the most experienced clinicians available to treat patients who might have complex presentations. And it’s definitely not about presenting such a drastic change in a way that might be palatable to those affected.

They went on to babble about needing me to provide coverage “when the surge comes, whenever that is” as if we’re supposed to just pick up extra shifts at their beck and call. Mind you, this is an organization that declined my offer to help them stand up a telehealth program at the beginning of the COVID crisis. Where other similar clinics are using technology to deliver care and allay patient concerns in a way that makes patients (and staff) feel safe, we’ve entrenched and have watched the world pass us by.

I’m certainly not alone, as plenty of hospitals and practices have furloughed physicians in various subspecialties due to lack of demand. My ophthalmologist friends have been largely benched since they spent the majority of their time performing surgeries that are now classified as elective.

As someone who is used to manning the front door of the healthcare system, I didn’t think it would be me. It certainly doesn’t scream job security to know that when the going gets tough, decisions aren’t going to be made on quality of care, patient satisfaction scores, or the ability to treat patients quickly and thoroughly (since I’m an A+ performer in those areas).

Needless to say, I’ll be doubling down on the informatics work and telehealth visits for a while. Frankly, I wish they would have just pink-slipped me, because I’ve definitely lost that loving feeling.

Email Dr. Jayne.