Readers Write: AI and ML – Help Change the Course of the Pandemic and Make Money

AI and ML – Help Change the Course of the Pandemic and Make Money
By Jeremy Harper

Jeremy Harper, MBI is an independent consultant.

Twenty million people in the USA and 75 million people worldwide have tested positive for COVID-19. Public health estimates that six times more people have had the disease and are not aware. A vaccine will slow the rate of growth, but no one is expecting it to eradicate the virus as it mutates and adapts.

Even as we hit a year since the infections began, we know very little about the long-term consequences and impact for those who have had COVID-19. We are looking at how those impacts are different for people who have asymptomatic, symptomatic, or hospitalization issues. The problem is that research study after study has been released on small populations that are seen at local health systems. That information has been better than not sharing at all, but the small populations of patients at local sites have led us down directions that wasted time, effort, and energy.

The National COVID Cohort Collaborative (N3C) is the largest central data repository in the history of the NIH targeted to a single disease. It has over 400,000 records of patients who have been positively identified as being afflicted with COVID-19 out of 2.5 million patients total. Each week as they onboard additional academic medical centers, the patient population grows. This large initiative is supported by academic centers around the nation, bringing together some of the best healthcare minds to identify solutions.

A large national dataset of people who have had COVID-19, which we call a disease cohort, is required because it gives us the opportunity to pool data to create groups of people to reveal patterns and help people cope with long-term consequences of having the disease. This dataset, however, isn’t only useful for NIH-funded research. This dataset will also be transformational for health systems. Models can be quickly built and deployed to predict the business needs we are experiencing, and will experience, at health systems over the next years. Models that may not have captured intellectual property with this freely available resource, but cannot be implemented within the standard health system without experts to explain and deliver specific actions to take from the information and models that are built.

There is so much that we don’t know as we move forward in the healthcare domain with COVID-19, but we have opportunities to make a difference. We are moving beyond the local environments that only leverage standard Structured Query Language (SQL) to a future with large data lakes. Without such pooled data, we may take a decade to understand the extent of the problem and be able to ask questions across health systems to understand the issues. This centralization will allow us to research and implement within months instead of years after the initial data collection.

Even with the multiple vaccines, this disease state isn’t finished. People who have been immunized with the vaccine can still get the disease, though at lower rates. The natural evolution of the disease has been impacted by the changes we have made to our societies and interventions in which we have engaged. We may never fully understand or be able to model with accuracy where we would have been without what has been needed to control the impact, but we do have fantastic natural experiments to compare variables. We know so little today and we must test and implement interventions that have been held back.

Let’s take some examples from the problems that people face after having COVID-19, the three most commonly known long-term impact areas in the lungs, brain, and heart. These are problems that are waiting for ambitious business solutions. 

LUNG: You may know at a local health system how many people have experienced lung scarring, but you won’t have a large enough population to predict the interventions that will be required over the upcoming years. This population is large and diverse enough to have concrete predictions for what will be required.

BRAIN: We have no idea how the widely reported COVID brain impacts will play out, but it’s certainly going to require new interventions. Working with health systems in conjunction with the N3C may help us tease apart genetic, environmental, or disease specific areas that are vital for patient intervention. By being on the forefront for identification of those afflicted, we will be able to package and deliver opportunities to help individuals. Influenza and pneumonia vaccinations have been tied to lower risk of Alzheimer’s Dementia. There is a very real risk that we will see higher prevalence in the future, and monitoring and helping health systems will impact lives

HEART: We have entire hospitals dedicated to this vital organ. We know that myocarditis, which is an inflammation of the heart muscle, is occurring frequently in COVID-19 patients. This has the danger of leading to heart failure in the future. Patients will need to be flagged to be monitored for this going forward. Health systems will need to potentially reach out and notify patients that they need to be vetted for early symptoms of heart failure. As this grows and progresses, health systems will need to pivot to be able to handle the underlying disease states in their patient populations.

The healthcare industry is experiencing disruption as a result of these external forces that is unprecedented. Any time an industry experiences this level of disruption, it provides opportunities for improvement and adoption of third-party solutions. We have the ability to create many metrics, create many perspectives, and work through many issues. The N3C gives us many opportunities to connect and collaborate across organizations. While the N3C will not be appropriate to answer every question, it can answer many urgent scientific and operational questions through its different data access levels.

Examples of the types of questions that can be difficult to tackle include those that look for discrete answers, such as whether someone is asymptomatic or not. There are swaths of people who have been positive without any symptoms. While we can identify the primary cause of some hospital stays, we don’t have a consistent answer over whether someone came into the hospital because of COVID-19 or if they came because of another reason and happened to test positive. There is currently no universal standard to track the new vaccinations and which brand of vaccination may have been administered.

Than N3C has a higher potential for business to partner with research in an agile rapid manner than do most research infrastructures. The N3C team is a team of distributed participants, allowing for communication with the team in real time, while at the same time retaining full opportunity to query the data. The N3C team is also able to work dynamically upon normalizing and rationalizing what is being found within the database. Data can be created and archived in a single location for future analysis, and analysis within a team could provide a new way of communication for your business.

A combination of cloud computing, open data, and hosting ensures that your business can utilize the N3C Data Enclave. This cloud-based platform has taken research from an expensive system that we each need to implement into an inexpensive solution that we can all access. This is the new technology that has replaced outdated and slow research & development (R&D) methods.

It is the time to make it available for your business and your team. The solution ensures the business will eliminate the traditional costs and time associated with large, expensive research facilities. It allows business to do what it does best: rapidly innovate and leverage data to deploy solutions at facilities around the nation.

If you are interested in learning more, onboard to N3C or email me at owlhealthworks@gmail.com.

HIStalk Interviews Diana Nole, EVP/GM, Nuance Healthcare

Diana Nole, MBA is EVP/GM of the healthcare division of Nuance Communications of Burlington, MA.

Tell me about yourself and the company.

I run the healthcare division for Nuance. I joined the company in May, but I have known Nuance for about 15 years, which was right around the time when I started my work within healthcare, always being around technology and companies that were transforming their portfolio. This is a great opportunity. Nuance is well regarded in terms of being respected by customers. They have a large installed base, wonderful partnerships with everybody that’s in the ecosystem such as the EHRs and Microsoft, and a lot of great growth opportunities. While I wasn’t looking, it was an intriguing opportunity and time to come to the company.

Where would you place ambient clinical intelligence in your personal version of the hype cycle?

We are in the earlier stages of how it will be used within healthcare. It is focused right now on the particular area of physician burnout and patient experience.

The elements of the documentation burden that is placed on the physician is causing them to feel overwhelmed. They are not being able to produce the type of experience they want with patients, but patients are also feeling disengaged. This is a solution that is going to evolve from not just being the element to fix or to support better clinical documentation, but to expose opportunities that we haven’t appreciated or realized. 

For example, wouldn’t it be helpful to have the complete diarized elements of the conversation between patient and physician for other people that are supporting the patient in their treatment plan, perhaps family members? My specific example is that my aging parents go to the doctor. It’s not always clear what the doctor has asked them to do when they get back home. As a family member, wouldn’t that be great?

We are in the very early stages of how we see the uses and the use cases of this. The technology needs to continue to mature when you think about ambient and conversational AI versus more structured use of voice recognition.

Does a model exist in other industries that healthcare will follow, where software extracts discrete data elements from a conversation between a professional and their client?

Nuance used to be directly involved with conversational AI that took place in an automobile. It had to distinguish between conversations that were going on in a car and the aspects of what should be done with that communication. We have leveraged that a lot within our own organization. We are starting to see other interesting use cases. We also participate in law enforcement, where we can capture the conversation that’s going on and understand where that might be applicable.

How do you see that diarized speech of basically the full transcription of the patient encounter being used?

We are intrigued to see where that area evolves. As I mentioned, there’s definitely a use case where the patient may want to be able to provide that to other people who are of interest. There has always been a bit of a worry about whether that will open up even more concern about what is said and whether that will tamper the conversation and constrict it. There are elements of compliance and concerns about what gets said.

It’s not necessarily the direct clinical elements of the conversation, but maybe more of the conversation that is not directly related to the medical outcome for the patient or the treatment planning. There will be people who will be concerned that, “If I didn’t say this, will it come back to haunt me?” but I believe that we are at a point where the benefits can outweigh those risks.

The industry at large is being more open minded. In our first use cases since the product became commercially available 10 months ago, there is definitely an appreciation, even by the physician, that this is beneficial for them as well. They can’t always remember everything that is communicated, so if they aren’t transcribing or doing something in the course of the actual patient visit, could they have missed something? It is beneficial even for their own purposes to remind them of what was discussed and said. Those users have said that it is helping them to improve the quality of the documentation that’s provided.

We are going to see where it evolves, but I’m definitely pleased that people on both sides, patient and physicians, seem to be open minded about the benefits of the full diarization of the conversation.

What are customers doing with Dragon Ambient EXperience, or DAX?

They have fully deployed it. We have evolution of the maturity levels in particular specialties. Orthopedics is probably the most advanced, but they are fully deploying it.

What’s been interesting in the COVID era is that they also have been deploying it, in many cases, in a telehealth environment in addition to an office environment. Some of them use the mobile app, while some of them actually use the office device that we have. They have typically rolled it out to anywhere between 15 to 25 doctors. They see the process and change management that is associated with it, which is very limited in terms of burden to them. They are up and running right away.

Then we are already into the elements expansion and going into maybe more orthopedics in a particular location, going to the entire department, or they’ll go into the other specialties as we’ve been maturing them. It is an element that continues to include a quality review process as part of that, as that helps the ongoing algorithm in AI and the neural nets that … I can’t describe it to a deep degree, but all of that is continuing to be fed back and making the process more and more accurate. So it’s gone quite well.

What preliminary results have clients seen with regard to physician burnout?

We do data analytics around turnaround times and patient satisfaction. Before DAX, roughly 72% of physicians were feeling burnout and fatigue. After DAX, that was reduced to around 17%. We get quotes that just the thought of taking DAX away is stressful or would make them want to quit.

We are definitely seeing reduction on the physician burnout side and the benefits we offer, but patients are also describing more engagement from the physician. They feel more attended to and feel that they are being listened to. We have also seen patient wait times down, maybe about 10 minutes, which is almost 50% reduction in wait time, so it’s also an element of either being able to have the opportunity to see more patients if a physician wants to do that or to utilizing the time to feel less overwhelmed from an administrative perspective. Early feedback has been quite positive.

I assume the patient’s perception is due to the clinician paying attention and looking at them instead of typing while they are talking.

That’s exactly right. It is an element of feeling like I was listened to — you weren’t distracted. There was feedback that almost all patients are saying that the physician spent less time focusing on the computer. Very high percentages, 90%, said their visits felt more like a personable conversation. The patient elements are also very satisfactory for the physician.

Technology can now make talking to a machine seem like talking to a human, and people are comfortable interacting with virtual assistants in ways that can border on the scary. Does that capability provide new healthcare use cases?

There are a few different cases, so you are exactly right. One of the exciting things that I learned when I was going through my interview process was the opportunity within Nuance to focus on intelligent engagement, as they referred to it. We use that a lot on our enterprise side, but we recently have launched it under the umbrella of patient engagement solutions within healthcare. We have some early wins in terms of customers that we will be announcing soon.

We are focused on exactly that. Customers have reached out, in particular COVID providers, and said, “We are completely overwhelmed with calls coming in with patients wanting to understand their options. ‘Can you just remind me what am I supposed to be doing? If come into the office, where am I supposed to go?’” These basic things potentially restrict a patient from following up for treatment and getting things done if they can’t find easy access to the information that they’re looking for. We are excited to be taking this technology from the enterprise side and doing more with it in intelligent engagement.

People are also thinking about how to use DAX, the ambient clinical intelligence solution, for example, an inpatient hospital room. You could have more interaction and diarize that with multiple providers within a patient room, where the patient could interact with it. They are also asking if it could be viewed as being an ambient opportunity for check-in, where you don’t need so much human-to-human contact and could check in via the ambient device in a particular check-in room.

I don’t know how many of these things will immediately stick, but it’s interesting that people are thinking about where else it can be applied.

Speech recognition is now ubiquitous, accurate, cloud-based, and accepted by consumers. How does that support using it new ways?

We’ve talked about speech, particularly on the healthcare side with the physicians. We’ve also been working on solutions for other parts of the care teams, such as nurses. In many cases, nurses provide the same kinds of things, but in different ways and in a different structure. We have talked about the patients and the intelligent engagement. It’s an element of the environment. What is the setting? DAX has initially been rolled out as an office visit type of setting, where there is a tremendous amount of clinical documentation burden. But obviously the interest would be how to do more of that in the hospital inpatient setting or in other types of clinical settings. People have also asked if it will be more interactive in areas such as mental health.

It will evolve. I don’t want to get over our skis a little too much here, because there certainly is a lot that goes in just with the initial use cases. But certainly as you said, people are now saying, OK, it’s not just hype. It really does work and it is going to evolve. There are opportunities to deploy it into these various use cases, which I’m excited about. Especially in a COVID year, to see the ongoing investment in evolution of has been motivating for me and certainly for our team.

Do you have to evangelize the idea of developers building software with speech recognition as the primary input mechanism instead of just bolting it to keyboard-centric applications?

There is enough evolution that has occurred on the consumer-oriented side that you have to do less. People believe that it’s there, it can happen, and it can work. There is an element of skepticism of how well it can work in a clinical documentation setting where you have to be highly accurate. Not pretty highly, but highly accurate. You’re going to use this not just for coding and reimbursement, but for the treatment of the patient. There is this element of prove it out, prove it out in all of the specialties, and prove it out beyond the structured specialties that we have initially focused on.

People ask, how well does it work in family medicine practice, where you do have such random things that you might be seeing the doctor for? I fell this weekend when I was skateboarding and broke my ankle. How does that relate to all of my past history, and how is it going to interact with all of the various elements of what the doctor needs to think about when they are prescribing treatment or patient outcomes? There is a belief that it will get there, but there is also a bit of skepticism on remembering how difficult it is for some of these use cases with particular specialties, and every patient situation is quite different.

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

The heavy focus is on reducing physician burnout from the specific element of clinical documentation. But then as your comments and questions have mentioned, what can you do in the course of hearing something from a conversation? What could you actually do?

For example, three to five years out, could you have the computer help the physician with reminders in the course of that conversation with the patient? Like surfacing things that it may hear that you need to be reminded of. Such as, remember for this patient in their medical history they had XYZ. And coming from a company that I just left in Wolters Kluwer, there’s a new topic in UpToDate that would be applicable for this particular conversation, would you like to look at it?

The elements of how broadly you can take the conversational AI and incorporate it with the information that’s residing either in clinical decision support tools or in the course of the actual medical record for the patient will be intriguing. Then, how you can continue to be better and better at structuring the clinical documentation so you can do more data analytics and predictive analytics and tie it into things that go as far as into the world of life sciences initiatives. It does start to open up the creative ideas of what could happen and what could be out there in the future.

Do you have any final thoughts?

Even during the challenging time that we’ve had with the pandemic, I’m optimistic about what I have seen occur during this time from our customers. They have been able to adapt to this change and take on new technologies, such as those associated with telehealth and beyond. We are going to come out of this a stronger industry.

Optum Acquires Change Healthcare for $13 Billion

UnitedHealth Group-owned Optum will acquire Change Healthcare and combine it with its OptumInsight software and analytics business, the companies announced this morning.

Change Healthcare President and CEO Neal de Crescenzo will serve as CEO of OptumInsight.

The acquisition price is $25.75 in cash, a 40% premium over Tuesday’s closing price of Change Healthcare shares. That represents $8 billion plus the assumption of $5 billion in Change Healthcare debt.

OptumInsight generates about $9 billion per year in annual revenue of UnitedHealth Group’s $225 billion, but is its highest-margin segment at around 20%. Change Healthcare’s annual revenue is $3 billion.

Morning Headlines 1/6/21

Cedar Gate Technologies Acquires Enli Health Intelligence

Value-based care performance management company Cedar Gate Technologies acquires population health IT vendor Enli Health Intelligence.

New Resources to Help Health IT Developers Understand ONC Cures Act Final Rule Requirements

ONC publishes Cures Act developer resources, including a summary of compliance dates and an API resource guide.

BerryDunn Expands Healthcare Industry Offerings with VantagePoint Merger

Healthcare compliance, consulting, and credentialing firm VantagePoint Healthcare Advisors merges with assurance, tax, and consulting firm BerryDunn.

Hinge Health has raised $310M Series D at a $3B valuation

Hinge Health, a telemedicine company specializing in chronic back and joint pain, raises $310 million in a Series D funding round.

News 1/6/21

Top News

Value-based care performance management company Cedar Gate Technologies acquires population health IT vendor Enli Health Intelligence.

Enli earned “Best in KLAS” designation for population health management in 2017, 2018, and 2020.

Enli’s roots go back to 2001 as Kryptiq, which then worked with Providence Health & Services to commercialize the latter’s CareManager starting in 2016. Kryptiq acquired CareManager in 2012 and was then itself acquired by Surescripts the same year, and Surescripts spun off Kryptiq in 2015 as Enli.

Kryptiq was founded by Luis Machuca (Enli CEO), Jeff Sponaugle (CTO of Surescripts), and Murali Karamchedu (Enli CTO).

Reader Comments

From Peony Picker: “Re: Haven. Why do you think it failed?” We don’t know much about the company’s mission, priorities, and plans, but  here’s my armchair quarterback opinion:

• The idea that Haven’s three big bureaucracy owners would join hands and fix healthcare was naïve from the start. Companies that size can’t change the impenetrable fortress of healthcare by halfheartedly forming a company that was barely bigger than their bathroom supply expense task force. Politics and conflicting objectives make just about every joint venture a failure.
• Amazon was the only one of the three participants that knows anything about healthcare beyond what it costs and had little incentive to share its knowledge instead of creating new business lines, as it is doing now with PillPack. I would bet that most of whatever commercially viable “learnings” can be plucked from the ashes of Haven will end up as Amazon products.
• It took 14 months for the company to even choose a name for itself and it never made it clear exactly what it was doing. Haven basically disappeared immediately without displaying any anger, joy, or boldness, basically launching itself like wheezing legacy business that was just trying to hang on under journeyman leadership.
• Atul Gawande is big-picture influential, but was probably not necessarily the best person to lead this kind of business, not to mention that we don’t know what kind of marching orders and resources he was being given by his many bosses.
• The three owner companies have employees scattered all over the place, and other than maybe Seattle in the case of Amazon, they weren’t going to scare big health systems very much by threatening to take their business elsewhere. Those health systems have spent fortunes building their brands, and while their self-developed reputation may not always be matched by their outcomes, their employees wouldn’t be thrilled to be excluded from the gleaming skyscrapers downtown and instead turfed off to lesser-known but better and/or cheaper hospitals.
• Health systems hold nearly all of the useful personal and aggregated health data and don’t share it freely with competitors, making it easy to starve out an outsider whose business model is based on analytics.
• All big companies hate paying high healthcare costs and getting poor outcomes in return, but none of them have had any success whatsoever in disrupting the status quo. The idea that employers hold power over the healthcare system has been repeatedly proven to be untrue.
• Employers want to reduce healthcare costs to the maximum extent possible without driving away their most valuable employees. That tension varies by company, region, and overall benefit design. It would be easy for companies to either reduce their healthcare costs to zero (by not offering any healthcare benefits) or to spend a lot to make recruitment and retention easier, but anything in between is hard to tailor to meet those competing company objectives.

From Rants On Fire: “Re: grammar. It’s like wearing masks — you do it for others.” Actually, it’s like masks in that correct use benefits both parties. Many in the anti-mask cohort are perceived rightly or wrongly as lacking intellectual ability, possessing little empathy for others whom they could protect with the tiniest of efforts, and choosing a puzzling platform to convince themselves of their illusory autonomy. Taking the extra time to communicate clearly within the broadest rules of the road is the same — you look smarter, it shows that you value your own message, and it demonstrates that you’ve found meaningful ways to display your rugged individualism beyond exhibiting sloppiness and defying anyone to criticize you for it. Most of us are knowledge workers in which rewards seldom accrue to those who appear lazy, ill-informed, or selfish.

Webinars

January 13 (Wednesday) 2 ET. “The One Communication Strategy Clinicians Need Now.” Sponsor: PerfectServe. Presenters: Clay Callison, MD, CMIO, University of Tennessee Medical Center; Nicholas E. Perkins, DO, MS, hospitalist and physician informaticist, Prisma Health. Healthcare organizations are leveraging their current investments and reducing their vendor footprint, so there’s no room for clutter in healthcare communication. The presenters will describe the one communication strategy that clinicians and organizations need today, how to improve patient experience and protect revenue, and how to drive the communication efficiency of clinical teams.

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

Acquisitions, Funding, Business, and Stock

Haven, which launched in 2018 with the goal of improving healthcare costs and outcomes for employers, notifies its 57 employees that it will shut down by the end of February. The joint venture among Amazon, JPMorgan, and Berkshire Hathaway started losing executives in 2019 with the departure of COO Jack Stoddard, followed by high-profile CEO Atul Gawande, MD last May, Head of Measurement Dana Safran in July, and CTO Serkan Kutan in September. Analysts believe the company’s efforts to improve care access, insurance benefits, and prescription prices were stymied by separate, employee-focused projects that were being conducted by its founding members.

Population health technology company Color raises $167 million in a Series D funding round led by General Catalyst, bringing its total financing to $278 million.

France-based Volta Medical, which has released AI-powered arrhythmia management software and is working on software to improve the first-procedure accuracy of ablation surgery for atrial fibrillation, raises $28 million. President and co-founder Julien Seitz is an interventional cardiologist at Saint Joseph Hospital in Marseille.

Healthcare compliance, consulting, and credentialing firm VantagePoint Healthcare Advisors merges with assurance, tax, and consulting firm BerryDunn.

Sales

• State of Franklin Healthcare Associates (TN), Syracuse Orthopedic Specialists (NY), and Hudson Headwaters Health Network (NY) choose Emerge’s health data integration and aggregation software and services.
• Adena Health System (OH) will implement Epic through a Community Connect partnership with Ohio State University Wexner Medical Center.
• Withings will use Redox’s API to connect its Med Pro Care remote patient monitoring devices with EHRs.

People

Sam Hanna, PhD, MBA joins Divurgent as EVP of innovation and consulting / chief strategy officer.

Direct Recruiters promotes Mitchell Herman to partner.

Ken Levitan, who served as CIO of Einstein Healthcare Network for 10 years through 2015 and is now EVP/CAO, is named as its interim president and CEO.

Industry long-timer Jay Deady (Jvion) joins claims cost and payment optimization solutions vendor Zelis Healthcare as president. He rejoins fellow Eclipsys alumnus Andy Eckert, who is CEO.

Announcements and Implementations

Arcadia announces GA of solutions to help providers with COVID-19 vaccine programs, including patient-focused resources for education, targeted outreach, engagement, stratification, and dose tracking; plus reporting and analytics.

The University of Vermont Health Network pushes back the second and third phases of its Epic implementation, citing the need to focus its resources on COVID-19 response efforts and continuing recovery from an October ransomware attack.

West Virginia OrthoNeuro implements Emerge’s ChartGenie to convert data to its new Athenahealth EHR and archive legacy data.

Ochsner Health (LA) goes live on Vynca’s advanced care planning software, giving physicians access to Louisiana Physician Orders for Scope of Treatment forms from within Epic.

Retia Medical uses the Device Driver Interface development strategy from Capsule Technologies to connect its Argos Cardiac Monitor to other systems.

Independent urgent care provider FastMed goes live on EvoHealth’s zero-footprint PACS in its 100 locations.

Government and Politics

ONC publishes Cures Act developer resources, including a summary of compliance dates and an API resource guide.

A Nature paper by health privacy expert Deven McGraw, JD, MPH and Boston Children’s Hospital’s Kenneth Mandl, MD, MPH says that US privacy and security protections are not sufficient to fuel a learning health system, making these points:

• Non-traditional health data is used widely for commercial purposes without regulation.
• Social determinants of health information could be improperly used by companies, such as to avoid high-cost areas and populations.
• Health data protections need to include penalties for uses that harm people or populations.
• HIPAA coverage is based on which organizations hold patient data rather than the data type itself, and much of the health-related information that is being collected (such as by apps) falls outside of HIPAA.
• Regulatory authority shifts from HHS OCR to the Federal Trade Commission as data flows from covered entities through APIs to consumer apps. FTC’s authority does not extend to non-profit organizations and insurers and FTC’s protections and enforcement mechanisms are not comprehensive to healthcare.
• The public is realizing that HIPAA offers them little protection, such as allowing covered entities to sell their de-identified data that can be readily re-identified.
• Big tech companies are getting involved in healthcare who have behaved questionably in their data collection and consumer tracking.
• It isn’t adequate to provide consumers with a notice of how their data will be used as a condition of using an app or service. The notices are hard to understand, seldom read, sometimes changed without notice, and require consumers to consent to just about any use of their information that companies might come up with in the future. It also puts the privacy burden on the consumer. 
• GDPR and state privacy laws, such as the California Consumer Privacy Act, continue to rely on consent and haven’t limited how businesses collect and use personal data.
• De-identified patient data can be re-identified and no penalties exist for doing so.
  HIPAA focuses more on what covered entities can do with data rather than which information they collect in the first place and for what purpose, which might be something that should be spelled out, and companies could be prohibited from collecting and selling patient information except for uses that consumers might expect and that would benefit them.
• Companies that collect, use, or disclose both identifiable and de-identified patient data should establish independent data ethics review boards.
• Stronger protections are needed for discrimination so that marginalized populations will be confident that they can allow their data to be collected for healthcare learning purposes.

COVID-19

Monday saw another record day of COVID-19 hospital inpatients at 128,210.

CDC’s data tracker says that 15.4 million coronavirus vaccine doses have been distributed and 4.6 million administered, both falling far short of projections. The states with the lowest percentage of people injected are Michigan, Arizona, Kansas, Mississippi, Alabama, and Georgia.

FDA declines to adjust its approved COVID-19 vaccination regimen to speed up rollout by stretching the interval between doses, giving lower doses, or mixing and matching products, warning that such use has not been studied for effectiveness and may place the public at risk. FDA also warns that studies didn’t continue following participants who failed to get the second shot  in the designated time, so assessment of one-shot effectiveness is not possible without additional studies.

Meanwhile, a just-published analysis (not a preprint) in Annals of Internal Medicine finds that the best use of the limited supply of vaccines would be to vaccinate more people initially — using most of the available initial supply and production for the first three weeks instead of holding back half for second doses as is being done today —  then holding more vaccine for follow-up injections.

Los Angeles County orders ambulance crews to not transport patients with low survival odds and to conserve oxygen for the most critical patients. Ambulances are waiting up to eight hours before they’re allowed to take their patients into the ED.

New UK research finds that family members who are under 17 are more likely to bring coronavirus into the household than adults and those aged 12-16 are seven times as likely as adults to be the household’s first case. Data consistently indicates that coronavirus transmission is lower when schools are closed.

COVID frontline primary care doctors who aren’t affiliated with hospitals have no access to COVID-19 vaccine, with most of those surveyed saying they don’t even know where they will get the vaccine. Most states seemed to have forgotten that not all doctors work for hospitals, whose highest priority is vaccinating their own employees and those doctors who generate the most revenue.

UCHealth (CO) uses Conversa Health’s automated vaccine monitoring software as part of its employee vaccination program. Data collected from a wearable two days before and seven days after vaccination will be analyzed to help researchers better understand the vaccine’s effects, particularly on high-risk patients and long-term care residents.

States that were somehow caught off guard by the release of COVID-19 vaccines and don’t have online appointment systems for signups are instead using free party RSVP sites such as Eventbrite and SignUpGenius. Others are using sign-up sites that are crashing under heavy volumes and some are simply telling people to join long lines and hope that the shots don’t run out.

Other

ED residents are finding few available jobs upon completion of their programs, as COVID-lowered ED volumes caused hospitals to stop recruiting ED doctors. More than half of US ED doctors work for investor-owned staffing companies that have been more aggressive in cutting back staffing. Some of the residents are doubling down on emergency medicine by signing up for low-paying fellowships.

Private equity-owned medical practices — many of them in dermatology, gastroenterology, and obstetrics — are requiring patients to sign binding arbitration agreements to prevent them from filing medical malpractice lawsuits.

Sponsor Updates

• ReMedi Healthcare Solutions publishes a white paper titled “Increase Go-Live Efficiency with a Virtual Model.”
• Audacious Inquiry customer Texas Health Services Authority receives ONC’s STAR HIE Program Award.
• Change Healthcare announces the successful introduction of its first cloud-based medical tools for radiologists and other specialties.

Blog Posts

• How 3 CEOs Successfully Navigated 2020 (Get-to-Market Health)
• Secure Healthcare IT Offshore Services to Meet Domestic Standards (314e)
• Making sense of the new No Pay RAP (Ability Network)
• COVID-19 Exposes Need for Interoperability & Integration in Healthcare (Part 2) (AdvancedMD)
• AdventHealth – One Unified System. One Team. One Holistic View. (Agfa HealthCare)
• Is Your Patient Engagement Strategy Ready for the COVID-19 Vaccine? (Arcadia)
• Condition Coding Management: Maximize Reimbursement Through Accurate Coding Practices (Bluetree)
• 2020 MIPS Relief for Extreme and Uncontrollable Circumstances (Ingenious Med)
• Exploring Post-Acute Authorization (CarePort Health)
• Healthcare Triangle’s Keys to a Successful Application Support Services Transition (Healthcare Triangle)
• 2021 Health IT Predictions: Fasten Your Seatbelts for Dramatic Transformation (CereCore)
• Access Centers and Patient Orchestration: What Health Systems Need to Know (CentralLogic)
• A word of thanks to front-line health workers (Cerner)
• Enterprise Imaging: Getting Organized and Collecting Data (Impact Advisors)
• How Increased Interoperability in Eprescribing Can Elevate Patient Safety (ChartLogic)
• Telehealth Prescribing is Low – Decision Support Can Help (CoverMyMeds)
• Optimum Healthcare IT Top 5 Blog Posts of 2020 (Optimum Healthcare IT)
• Optimization Shouldn’t Be Confined to the EHR (Divurgent)
• Thirlby Clinic: Using Telehealth and CCM for Better Disease Management (EClinicalWorks)
• Advancing digital health solutions beyond the pandemic (Meditech)
• Stop Digging, Start Climbing: How to Increase Revenue Without Cutting, Cutting, Cutting (EnsoCare)

Contacts

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

Morning Headlines 1/5/21

Haven, the Amazon-Berkshire-JPMorgan venture to disrupt health care, is disbanding after 3 years

Boston-based Haven, which launched in 2018 with the goal of improving healthcare costs and outcomes for employers, notifies its 57 employees that it will shut down by the end of February.

Color announces $167 million in Series D financing to help build public health infrastructure across the U.S.

Population health technology company Color raises $167 million in a Series D funding round led by General Catalyst, bringing its total financing to $278 million.

Allscripts Closes Previously Announced Sale of CarePort Health Business

Allscripts wraps up its sale of care coordination business CarePort Health to WellSky for $1.35 billion.

Curbside Consult with Dr. Jayne 1/4/21

The new year is upon us, and other than hearing quite a few more fireworks and gunshots at the appointed hour, my celebration wasn’t terribly different from years past.

As someone who has worked big-city emergency departments on New Year’s Eve, it seems like a holiday that is ripe for trouble if you decide to go out, so I kept with tradition by celebrating at home. During the day, I binge-watched “Bridgerton” on Netflix, sparing anyone else from a tour through 19th century London. As the evening unfolded, it was time for “The Mandalorian” with the rest of the household. I feel like I’m finally caught up with the rest of the sci fi-loving community now, and can move into 2021 with a full appreciation of Baby Yoda.

I took January 1 off, then returned to the clinical trenches for a full day of adventure. Our region is going through a prolonged peak for COVID cases, and we’re perpetually running our locations with a skeleton crew in part due to illness. More than 50% of our physicians, NPs, and PAs have been infected with COVID, so I count myself fortunate to have avoided it and am thankful to the folks who have been helping me source additional PPE beyond what my employer has been able to provide.

Another segment of our staff has left the healthcare labor market entirely, deciding that perhaps dealing with COVID isn’t part of their ongoing career paths. We have a lot of staff that are from dual healthcare worker households, and if the cost of childcare is a factor, it makes a lot of economic as well as health-related sense.

Our state is still woefully behind in vaccinating healthcare workers. Our organization received a limited number of doses that were shared from a local hospital. The state still doesn’t understand that urgent cares are also on the front lines of the COVID fight.

It was great to see people starting to receive vaccine and beginning to feel a little bit of hope that we may be truly rounding the corner on our battle against COVID-19. Many of the individuals who have had COVID recently deferred vaccines so that those who have not yet been infected could go to the front of the line. We still need several hundred doses to finish the first round of vaccines, plus enough to perform Round Two. I never thought that a group as big as ours, which performs over half a million patient visits a year, would be overlooked. Hopefully, we’ll get more doses soon because we still have plenty of unprotected Tier 1a healthcare workers among our ranks.

Judging from some national Facebook groups I belong to, the vaccine distribution plans in many other states are poor as well, but I would rank us in the bottom 10% for having our act together. I learned today that our state department of health violated CDC prioritization guidelines and vaccinated its non-clinical office workers, even those who can work from home. I also learned that the department has no plans to hold hospitals accountable for going outside the guidelines, which many are. With that kind of leadership, it’s no wonder that they’re not able to meet the needs of the actual patient-facing healthcare workers.

The other adventure of returning to work in 2021 was the debut of the new CMS Evaluation & Management coding guidelines. As a consultant, I did some behind the scenes work for a couple of medical groups creating educational curricula for their physicians and teaching classes to help them get ready. We’ve been working on it for several months and most of the physicians felt confident going into the new year. As a physician, my practice waited until the eleventh hour to reveal their plan and it was pretty underwhelming. They’re so worried about the coding that they’re going to let Certified Professional Coders assign the codes.

They sent us a two-page document on December 29 letting us know of a few new EHR screens we needed to be aware of. They also sent instructions about documenting free-text information to bolster our “medical decision making” discussion in an area of the chart where we don’t usually put it. Because many of us write that information in patient-facing language in the patient plan for “cover yourself” purposes, we now have to put it in two places, which seems like a pain.

I asked for clarification and was told it was for consistency for the coders to know where to look. I’d think it’s cheaper to tell the coders to look in two places rather than have the providers do double work, but I’m just a worker bee in this scenario. Given the labor cost of the coders and the sparseness of some of my colleagues’ documentation, I give this approach no more than 90 days before they decide to retool it.

Even though the new coding rules are supposed to simplify documentation for the History and Physical portion of the note, my practice didn’t change expectations for those areas, still asking us to document Review of Systems and Exam elements that are beyond what is needed for the kind of problem-focused visits that occur at an urgent care. They make sense for some of our more complex patients, where we may be co-managing chronic conditions because the patients can’t get in to see their regular care teams, but I refuse to do them when the visits are straightforward. You can bet I didn’t document a multi-point Review of Systems on the guy who came in with the 6 cm scalp laceration after having fallen into a door while tripping on his son’s skateboard.

I’m curious what other organizations have been doing to prepare their physicians for the transition, and how well they’re handling it. It will be interesting to see if groups are seeing revenue dips due to lack of documentation or whether they actually see a little bump because they’re not being nitpicked on data elements that physicians may feel aren’t meaningful. Many physicians may also choose to code their visits based on time, which may result in an increase in code levels.

It will be at least 30 days before we can see trends, and possibly longer depending on patient volumes. Traditionally January is a slow time of the year for patient visits because no one has met their deductibles. We’ll have to see if 2021 holds true for this and how long that depression lasts. Of course, it will be confounded by the pandemic, so it may be hard to tell.

How did your organization handle the rollout of new E&M coding rules, and how is it going? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 1/4/21

Intrado Acquires Asparia

Multi-vertical technology services business Intrado acquires patient intake and engagement software vendor Asparia.

Maricopa County Vaccine Operations ‘Dramatically Slowed’ By Arizona System Glitches

Maricopa County, AZ blames vaccine rollout delays on the state’s vaccine management system, which it says didn’t email people to schedule their vaccination appointments, sent them to sites outside the county, has no text messaging option, locked people out who tried to use their Cox email address, and failed to show certain locations.

Firstsource Solutions Acquires PatientMatters

India-based business process management company Firstsource Solutions acquires Florida-based RCM vendor PatientMatters for $13 million, and will combine it with its MedAssist brand.

Monday Morning Update 1/4/21

Top News

Hospitals were required to publicly post their negotiation insurer rates and list of shoppable services on January 1, so I checked websites of the country’s five largest health systems.

Issues: (a) the lists aren’t necessarily easy to find; (b) they involve huge downloads; and (c) they aren’t really worth much to consumers who don’t have a choice or who wouldn’t understand what they are looking at.

It’s still a federal requirement, though, so here’s what I found:

• Cleveland Clinic – has posted its list in downloadable format.
• Mayo Clinic – no list found.
• Cedars-Sinai Medical Center –no list found.
• New York-Presbyterian Hospital – has posted its list in downloadable format, at least for Hudson Valley Hospital.
• Massachusetts General Hospital – has posted its list in downloadable format.

Reader Comments

From Ragged Glory: “Re: LRGHealthcare. Something is fishy about the bankrupt system saying it is spending 9% of annual revenue on Cerner. I suspect that’s posturing for the public and for the bankruptcy court. The system’s annual report suggests that Cerner costs are less than 1% of reported gross revenue and 2% of net revenue. Clearly they are using creative math to pressure Cerner to lower the costs and trying to blame others for their own decision-making, perhaps also hoping the bankruptcy judge will make Cerner lower their fees.” I agree that the number seems suspicious. The health system’s interim budget, as filed with the bankruptcy court, projects $11 million in income for January 2021 and a Cerner expense of $131,000, which is just over 1% of the total (and a much smaller percentage of its revenue for the salad days of 2019). The health system blames its financial woes on incompetent prior leadership that made bad strategic decisions and piled up debt, so either they were tardy in parting ways with underperforming executives or they’re just trying to protect their own future employability.

From Talk Talk: “Re: interviews. I would like to see more provider interviews.” So would I, but it’s tough to find interesting folks who can spare the time and who have their employer’s permission to be quoted. In their absence, I interview CEOs, mostly those of Platinum-level sponsors since I like to learn more about them, but sometimes CEOs of other companies provided that their LinkedIn interests me enough to want to spend the time with them. I look for deep industry experience, a sense of humor, and non-healthcare accomplishments, with bonus points for weird former jobs, military service, or notable volunteer work. My interviews mostly cover non-company topics, so interviewees need to be interesting on their own beyond their job title.

HIStalk Announcements and Requests

The most recent medical encounter reported by poll respondents was usually an in-person visit, during which the physician most often wore a white coat, while most video visit doctors wore street clothes. Folks who haven’t worked in hospitals would be surprised at the clinician caste couture, where rules that may or may not be spelled out explicitly dictate the style and length of lab coat, the presence of reference materials and tools in the brimming pockets of residents and their absence in those of attendings, and in many cases of a medical inferiority complex, the prominent draping of a stethoscope that hasn’t been used in decades over a crisply pressed white coat, often brandished by doctors whose specialty is non-clinical or whose education was extraterritorial.

New poll to your right or here: How is your health now compared to a year ago?

I’m feeling the loss, maybe in a good way, of a post-New Year’s Day without having the HIMSS conference suddenly looming. Monday would usually commence the Super Bowl-like madhouse that reaches its crescendo with the opening keynote, but I don’t know what to expect this year. I’m not even feeling inspired to do the HISsies awards.

Thanks to the following companies for supporting HIStalk. Click a logo for more information.

A generous donation from reader Natalie, with matching funds from my Anonymous Vendor Executive and other sources applied, fully funded these Donors Choose teacher grant requests:

• An IPad for use as a document camera for remote learning for Ms. Y’s middle school class in Chula Vista, CA.
• Electronic content and headsets for the advanced placement psychology class of Ms. B in Davenport, IA.
• Hands-on math and letters materials for the pre-school class of Ms. R in Seabrook, NJ.
• Math manipulatives for Ms. W’s elementary school class in Lindon, UT.

Welcome to new HIStalk Platinum Sponsor Divurgent. The Virginia Beach, VA-based company has for 13 years helped its clients improve operational effectiveness, financial performance, and customer experience by using data-infused, flexible, and scalable solutions that demonstrate and quantify value. Specific offerings include implementation and support, technology and infrastructure, data engagement and process improvement, IT security and strategy, and customer management. The company is privately owned and self-funded, which allows it to make the best decisions for clients rather than shareholders. The company received A grades in all customer experience pillars  in KLAS’s 2020 report on implementation leadership and 100% “would buy again.” It was also recently named as #3 on Modern Healthcare’s “Best Places to Work in Healthcare” for 2020. Thanks to Divurgent for supporting HIStalk. 

Listening: Metallica rocking “Enter Sandman” in front of 1.6 million concertgoers live in Moscow in 1991 as the Soviet Union was sagging with its last breath into history’s ash heap, with Red Army soldiers in uniform among the endless throngs of people who were cheering four thoroughly American headbangers whose miles-long view to the horizon was nothing but moshing Soviets.

Webinars

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

Acquisitions, Funding, Business, and Stock

Shares in the Global X Telemedicine and Digital Health ETF (EDOC) rose 4.1% in the past month versus the Nasdaq’s 4.4% gain and the S&P 500’s 2.6% increase. EDOC is up 23.7% since its July 30 inception.

People

Renee Broadbent, MBA (Wolf & Company) joins Soho Health as VP of IT.

Abingdon-Jefferson Health promotes interim president / COO and former CIO Alison Ferren, MBA to the permanent role.

COVID-19

US COVID-19 deaths are approaching 350,000 as the case count passes 20 million, both representing around 25% of the global total. Hospitals reported housing a record 125,544 COVID-19 inpatients on Sunday, even with seven states failing to report any data at all and another seven states not reporting hospitalizations.

IHME predicts 567,000 US COVID-19 deaths by April 1, with hospital bed demand peaking on January 16 at 185,000.

CDC reports indicate that poorly planned and executed logistics are hampering COVID-19 vaccination as they did distribution of PPE and tests, with just 12.4 million doses distributed and only 2.8 million of those administered even though the December vaccine release was expected for months and the easiest-to-reach populations—captive nursing home residents and hospital workers – are going first. Reaching herd immunity will take 10 years at that rate. The logjam also raises the question of whether hospitals have the urgency, efficiency, and excess capacity to lead vaccination efforts.

The UK will allow “mix and match” use of two different COVID-19 vaccines for the two-shot regimen if someone’s first injection is not known or the product isn’t available, a practice that has not been studied and that is therefore of unknown effectiveness. A US vaccine expert says that British officials have abandoned science and “are just trying to guess their way out of a mess.”

Eighty percent of the COVID-19 antibody doses that the federal government sent to hospitals are sitting on the shelf, as some hospitals decline their allotments and others are too busy to offer the outpatient treatments. Experts feared that after President Trump was given the drug and touted it that demand would far outstrip supply, but effectiveness data is nearly non-existent and many doctors question its value.

A London infectious disease modeler warns of the exponential risk of mutated coronavirus strains that are more infectious. A typical city in Europe would see COVID-19 deaths rise from 129 per month to 193 if the fatality rate were to jump 50%, but that same 50% increase in transmissibility would cause 978 deaths. It would be much worse in the US unless the B117 variant turns out to be rare here, making increased mitigation measures and rapid vaccination as critical as they are unlikely.

In England, Royal London Hospital warns that it can no longer provide high-standard critical care, as it is overwhelmed by COVID-19 patients and ambulances line up outside with more. Meanwhile, the city’s St. Thomas’s Hospital is surrounded by maskless New Year’s Eve revelers chanting “COVID is a hoax.”

State and local jails and prisons are closing and transferring inmates elsewhere as COVID-19 leaves too few healthy guards to staff them, with experts warning that transferring residents increases outbreaks, as does overcrowding. Nearly 100,000 correctional officers have tested positive for COVID-19 and 170 have died.

Officials of the Parker, Colorado Republican party post the names and home addresses of local public health employees in its “Revolt Against Shutdowns” efforts, warning the employees that “patriots are going to show you the error of your ways” and “we’ll see how strong they are at their homes.”

The West Virginia National Guard, which was running a vaccination clinic at a county health department, injects 42 people with antibody treatment instead of Moderna’s vaccine.

Maricopa County, AZ blames vaccine rollout delays on the state’s vaccine management system, which it says didn’t email people to schedule their vaccination appointments, sent them to sites outside the county, has no text messaging option, locked people out who tried to use their Cox email address, and failed to show certain locations. The state says its system works but had an interoperability problem with the county’s pre-screening tool and the statewide system, also noting that Banner Health and Honor Health decided to use their own systems instead of the state system.

An employee of Kaiser Permanente San Jose Medical Center who wore an inflatable costume on Christmas to cheer up patients is believed to have created an outbreak in which 43 ED employees have tested positive.

Other

Another bit of Internet history goes away, as Adobe disables any remaining installations of its long-retired, always-updating Flash browser plug-in.

I dunno, HIMSS – these don’t sound like “open-source initiatives” to me.

Sponsor Updates

Blog Posts

• ERP End-to-End Testing in the Virtual World (Impact Advisors)
• Want to Improve Rural Care? Start with High-Speed Internet. (Medsphere)
• 5 things hospitals need to know about managing COVID-19 vaccines (Wolters Kluwer)

Contacts

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

Katie the Intern 1/1/21

Happy Holidays, HIStalk! I hope you had a great Christmas and are set to have a happy and safe New Year. This column offered a wide range of topics that I found really informational and interesting, so I’ll touch on a few of them and go more in-depth on some in the next column. Hope you enjoy! 

This time around, I spoke with Rodrigo Martinez, MD, a practicing otolaryngologist who describes himself as being “familiar with the gaps between many of the good ideas and technologies that are employed and why they often fail when implemented into the clinical environment.” I thought this would be an excellent intersection to discuss healthcare IT, as Dr. Martinez has experience in medicine, EHR strategy and consulting, and software implementation. 

Dr. Martinez serves as the chief clinical officer at TransformativeMed, a company that builds software for specialty-specific data visualization that embeds inside an EHR. TransformativeMed has worked inside Cerner and is moving into Epic in early 2021. Dr. Martinez’s start as a physician gave him an insight into the importance of incorporating physician-based ideas into EHR implementation to solve macro-level issues. 

“I have had an interest in how you take all of these different technologies and how you bring them into a clinical workflow,” he said. “In parallel, as you have more and more technologies that are consumer-focused, how do you create processes and workflows that stitch all of these different capabilities together?”

To create a workflow to start this process, a provider needs to have an EHR in place that can begin this implementation of different technologies. I realized I have not really asked past interviewees about that process, so Dr. Martinez spoke to this topic and how it has changed over time. 

A decade ago, a provider would start with an overhaul of processes and select an EHR that could best support them, Dr. Martinez said. The push for the use of these electronic healthcare records by government began in 2009, and rewards were given to those companies that selected EHRs that met Meaningful Use criteria. 

“What that did was create an enormous rush to implement electronic health records,” Dr. Martinez said. “That’s why you have seen, over the last 10 years, such a dramatic increase in the adoption– or at the very least, implementation — of electronic health records.”

Today, EHR concerns center on how a facility can maintain the best access to data. Access to data and the use of EHRs to manage that task are incredibly important because of CMS incentives and repercussions. In sheer numbers, an estimated 97% of hospitals nationwide used EHR data in 2017, compared to 87% in 2015. This jump in usage means that health systems can no longer afford to use just any EHR, but need a system that can manage data from multiple sources. 

“You’re seeing health systems go after a single EHR system in an attempt to try to maintain the cleanest flow of data,” Dr. Martinez said. “Once a patient starts to move in and out of one system or another, you lose the ability to quickly and cleanly access and move data, or you’re forcing the end-users, the physician or the nurse, to jump into and out of different systems.” 

Though so many clinics and providers have EHRs in place, Dr. Martinez said many of these EHRs are not well adapted and do not provide the benefit that vendors originally promised. This is where his intersection of ideas comes into play, and where TransformativeMed embeds solutions that improve clinical collaboration across inpatient care teams. 

Closing the gap between what an EHR can do and what an EHR does for a provider group is an important task to Dr. Martinez. Some of the tools that his company creates has begun to do just that. The specialty-specific views of data, called the Core Clinical Workflows, allows a provider to gather specific patient and specialty information without sorting through the clutter of multiple specialties. 

“Usually, the EHRs are set up with fairly generic-looking displays of data,” Dr. Martinez said. “We have pre-optimized or curated ways of looking at the information so that there is less hunting around for information, so you’re increasing the workflow efficiency.”

This data is available on desktop and mobile devices, as well as in app form for some specific decision-support tools. The software also allows for easier patient handoff and task management. This fingertip access supplies an easier and faster process for providers who are focusing on patient health decisions. 

The app that Dr. Martinez specifically spoke about was the Core Diabetes App, a tool for inpatient diabetes management. The backbone of a clinical support tool is reliant upon information about a patient’s state in an illness (in this case, diabetes). This app focuses on a single disease state, Dr. Martinez said, and combines all of a patient’s data in real time for up-to-date information that can impact decisions around care.

“The software is reading all of the vital signs and the glucose and blood pressures and a bunch of other elements, and it combines all of that information and it presents it in a very easily digestible and actionable format,” Dr. Martinez said. “The end user can standardize those protocols and can scale them across the entire health system. That is a huge step in driving evidence-based care for diabetes.”

If a clinician is able to see all of the combined information in real time, they are better able to make a decision about care. Providers are always able to act on the most recent evidence and information. This app is targeted at monitoring and managing diabetes, but what about other diseases?

Dr. Martinez said that many diseases can be monitored in similar fashion to diabetes, watching and managing those high and low levels and keeping a patient within them. For example, alcohol withdrawal, the regulation and management of blood thinners, and even pain management are all illnesses that could be managed or monitored through a similar system. It comes down to working with individual health systems on what they need to monitor the most.

“There are a number of things and we have really been exploring what are some of the other conditions that hospitals and health systems are prioritizing,” Dr. Martinez said. “Then, by partnering with them, we co-develop these different capabilities.”

Dr. Martinez and I also covered the idea of AI powered assistants and their application, which I believe I will focus on for the next column.

I am enjoying learning about the tech side of integration in these manners, and I’d love to write and research more about them for future columns. So that is it for this one!

Happy New Year! I cannot be the only one to say that I am excited to send 2020 off with a bang!

Katie The Intern

Email me or connect with me on Twitter.

Morning Headlines 12/31/20

Telehealth: The Right Care, at the Right Time, via the Right Medium

UCLA Health describes in a NEJM Catalyst article how providers should developing triage processes that recognize telehealth’s benefits and limitations.

Stanford Medicine mistakenly vaccinated non-clinical affiliates over weekend

Stanford Medicine, fresh off protests by medical residents that its COVID-19 vaccination priority algorithm excluded them, deals with its second vaccine controversy in a week when rumors of “excess” doses caused non-clinical employees to line up at vaccination stations, where staff decided to give shots to anyone who was wearing a Stanford badge in ignoring the policy that only frontline workers in high-acuity settings should be injected.

PointClickCare Technologies Announces Closing of Collective Medical Acquisition

The long-term and post-acute care technology vendor completes its acquisition of Collective Medical, which offers a real-time care notification, activation, and collaboration platform.

Morning Headlines 12/30/20

Health-Costs Transparency Rule for Hospitals Upheld on Appeal

A federal court rejects AHA’s appeal, forcing hospitals to post their payer-specific negotiated charges on their websites starting Friday.

Judge signs off on Concord Hospital’s acquisition of LRGHealthcare

The bankrupt two-hospital, 162-bed system says it was paying $342,000 per month – 9% of its total revenue – to run Cerner.

Y. Michele Kang joins Washington Spirit ownership group

The founder and CEO of health and human services software vendor Cognosante buys a stake in the professional women’s soccer team.

News 12/30/20

Top News

A federal appeals court upholds hospital price transparency rules that will go into effect Friday.

The court rejected a lawsuit that was brought by the American Hospital Association to keep hospital-insurer negotiated rates secret.

Hospitals must post their standard charges on a public-facing website, both as a machine-readable file of all hospital charges and a consumer-friendly display of 300 “shoppable services.” Both must include the discounted cash price, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

HHS says it will monitor and enforce the requirements starting Friday, and non-compliant hospitals can be issued a warning notice, required to develop a corrective action plan, or have a civil monetary penalty imposed.

Webinars

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

Sales

• Syracuse Orthopedic Associates chooses Emerge’s platform to create dashboards using structured and scanned data from its Allscripts TouchWorks EHR.

People

Kaleb Huhl, MBA (Curaspan) joins Olio as VP of sales.

HIMSS hires Julius Bogdan, MBA, MGM (SCL Health) as VP/GM of analytics for North America.

Government and Politics

The Defense Health Agency awards Cherokee Nation Operational Solutions a one-year, $42 million contract to support DoD’s MHS Genesis rollout of Cerner.

COVID-19

US hospitals reported 124,696 COVID-19 inpatients on Tuesday, another record high.

CDC reports that 2.1 million Americans have received their first of two COVID-19 vaccine shots, far short of Operation Warp Speed’s goal of 20 million vaccinated citizens by December 31. California was allocated 1.7 million doses, of which it has received 438,000 and administered just 70,000. HHS Secretary Alex Azar said in October that 100 million doses would be available by December 31, but the actual number is at 11.5 million. States have received minimal money and help from the federal government to address the “last mile” of getting injections into arms, and some state health departments see their role as making sure hospitals and clinics get vaccine doses and figure out on their own how to get them administered. HHS disputed the vaccination numbers in a tweet storm Tuesday following exasperated tweets from Ashish Jha, MD, MPH, dean of Brown School of Public Health, saying that data reporting is lagging and that it will ship 20 million first doses by Friday and hold another 20 million for the second round of injections.

Hospitals in England report record hospitalizations even with aggressive mitigation measures in place, as a more contagious coronavirus variant has also pushed case counts to record levels. The first known US case of the mutated virus was discovered Tuesday in Colorado.

Russia admits that 186,000 of its citizens have died of COVID-19, triple the number that has been officially reported, based on excessive death counts. The country has been criticized for counting only deaths in which an autopsy confirms that the virus was the main cause. The new estimate places Russia behind only the US (335,000) and Brazil (192,000) in coronavirus deaths.

TSA screened 1.3 million air travelers on Sunday, the highest count since the pandemic began and the sixth day in the past 10 that traveler volume exceeded 1 million.

Five LA-area hospitals declare internal disasters, including implementing patient diversion, due to overloaded patient room oxygen pipes that are pumping the high volumes – up to 10 times the normal flow – that COVID-19 patients require.

The Atlantic interviews 30 experts about how the pandemic’s second year could play out in 2021:

• Understaffed public health departments will need to get people vaccinated despite low budgets, lack of a national strategy, and rampant disinformation that may increase the significant percentage of vaccine-hesitant people even more.
• The uneven deployment of vaccines due to states that are working from their own priority rules and resource availability could delay herd immunity and introduce risk in traveling between areas with high and low immunity levels.
• The vaccine’s impact could be blunted if states relax mitigation measures or if those people who have been vaccinated mistakenly believe those practices no longer apply to them.
• The questions of how long immunity lasts and whether the vaccine will protect against mutated strains will begin to be answered, but could trigger another cycle of urgent vaccine development and deployment.
• A weakened healthcare system and its depleted clinician ranks will be difficult to restore to normal levels given the years of study that are required and the US’s anti-immigration policies, making it even harder for aging people, those with chronic diseases, those with mental health needs, and a new population of COVID long-haulers to find care.
• The country will need to learn from its mistakes in many ways — including preparing for the next pandemic, funding public health, and addressing social determinants that go beyond vaccine availability –- in a divisive environment where consensus is unattainable on even identifying the problems, much less their potential solutions.

Advocate Aurora Health throws out 500 doses of COVID-19 vaccine after an employee removes it from the pharmacy refrigerator to get something else, then forgets to put it back within the allowed 12-hour post-refrigeration window. Meanwhile, eight home care workers in Germany are given entire vials of five vaccine doses as a single shot due to human error.

Other

Concord Hospital (NH) will acquire bankrupt two-hospital LRGHealthcare (NH) for $30 million. LRGHealthcare blames its financial woes on excessive investment in inpatient services as demand was shifting to outpatient as well as its “massively expensive” EHR, on which it was spending 9% of total organizational revenue each year to run its two hospitals that have a combined 162 licensed beds. The Concord paper reports that LRGH runs Cerner, paying $342,000 per month as its 75% share in a services agreement with Speare Memorial Hospital. Concord Hospital also runs Cerner.

Michele Kang, MPPM, founder and CEO of health and human services software vendor Cognosante, buys a stake in the Washington Spirit professional women’s soccer team.

Contacts

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

Morning Headlines 12/29/20

Health startup seeks to bring COVID-19 vaccine tracking to Apple Wallet

Los Angeles County chooses Healthvana to allow people to present proof of COVID-19 vaccination as stored in Apple Wallet and to receive reminders when their second shot is due.

Home DNA test unicorn 23andMe raises nearly $85M

The company was laying off employees a year ago in citing declining consumer demand.

‘Toxic Individualism’: Pandemic Politics Driving Health Care Workers From Small Towns

Healthcare workers are moving away from their rural communities after being harassed by their neighbors for providing public health advice, challenging rural hospitals that were already struggling to fill clinical positions during the pandemic.

Curbside Consult with Dr. Jayne 12/28/20

I’m in the middle of a blissful stretch of days away from in-person patient care. The days are still full, though, as I try to wrap up a bunch of year-end projects for clients.

I also spent several hours finishing up some Maintenance of Certification and Continuing Education requirements so that I can remain board certified moving forward. Several of the major boards have given people relief from completing their usual requirements this year, which is much appreciated since those of us still seeing patients have been a little busy dealing with the pandemic.

The last couple of weeks have also brought some unexpected changes that have shaken things up in my consulting practice. I’m having to completely re-engineer my plans for 2021 as I seem to suddenly have a lot of open time on my calendar. I can always backfill the time with telehealth visits, but I am really starting to miss being part of the large-scale health IT projects that I worked on when I was in more of a traditional CMIO role. My remaining clients could certainly benefit from full-time clinical informatics attention, but no one has the budget to make it a reality.

There are so many non-COVID initiatives that healthcare organizations could be working on right now. Even with the uncertainties of COVID, there are plenty of diseases that need prevention or early detection. Colorectal cancer is one of those, and JAMA highlighted it this week in a piece about in-home screening tests. Even pre-COVID, colonoscopy as a means of cancer screening presented a lot of barriers – cost, transportation issues, and the dreaded (but not really that bad) prep. At-home kits, while not quite the same level as the gold standard colonoscopy, can help close those gaps in care.

While health plans and other organizations are sending kits to patients who are due for screening, there are plenty of people of screening age who aren’t plugged in with a primary care physician who are falling through a second gap since they’re not an anyone’s database to be detected as needing the test. Some of these are patients who use urgent care centers as their primary source of care, since they either don’t have a primary care physician or don’t think they need one. Given the shortage of primary care physicians in my community, no one is reaching out to these individuals to try to bring them to care. The average wait for a new appointment for a patient who actually wants to see a primary physician is close to three months.

The JAMA piece also highlighted some interesting food for thought facts. One is that colonoscopies and stool tests haven’t been compared in a randomized trial. There is one ongoing to compare the two, with 50,000 veterans randomized to receive either a single colonoscopy versus annual home testing for 10 years. The endpoint is deaths related to colon cancer, and results are due in 2028. Another element that requires thought is the fact that discussing the pros and cons of different colorectal cancer screening tests takes more physician time than actually performing a colonoscopy. Guess which service pays better for the physician? It definitely helps us understand yet another reason why patients are pushed towards colonoscopy as a first-choice test.

I do respect the attitude taken by UnitedHealth, which has an educational campaign that includes an online video. Their main message is that the best test is the one you will actually get done. It sounds simple, but unfortunately there’s a lot of over-thinking in healthcare and sometimes providers miss the obvious due to competing priorities, lack of time, lack of understanding, or all of the above. UnitedHealth is also doing outreach direct to its Medicare members, which will hopefully spur some important conversations between patients and their care teams.

Kaiser Permanente Northern California is another organization that has gone direct to patient, in this case, mailing test kits directly to patients who are eligible for screening. They were able to more than double their rate of screening among members. The piece notes that sending kits isn’t enough, though. There needs to be a wraparound campaign to support patients — including text, email, and phone reminders — to ensure completion. Education is key – people are still squeamish about handling a stool sample at home and mailing it back. We need to figure out how to normalize this experience, even if it takes celebrities showing off their stool kits in an effort to encourage average people to complete screening.

Technology can certainly play a role in this, whether it’s chatbot systems to remind patients to do their tests, apps that gamify medical screenings, or database analysis to determine which patients are most likely to do the test with minimal intervention versus those who need a human nudge. The National Cancer Institute projects a potential excess of 4,500 colon cancer deaths in the coming decade due to pandemic-related delays in diagnosis and treatment. Hopefully, we can harness technology to think outside the primary care box and engage these patients in multiple ways. Otherwise, we’ll see patients presenting with more advanced cancers down the road, which will lead to increased treatment costs as well as disability and death.

Unfortunately, many healthcare organizations are just trying to get by one day at a time as we approach what will perhaps be the highest peak of COVID cases and deaths during the month of January. By necessity, they’re taking the short view and aren’t thinking about consequences we won’t see for five or 10 years. However, even as uncertain as things are today, I want to challenge them that they can’t afford to not think about the longer term. Not to mention that with all the darkness and despair that surrounds healthcare on a daily basis right now, it would be nice to have some wins to celebrate with health outcomes where we can actually make a difference for our loved ones and our communities. COVID is going to be with us for the foreseeable future, but colorectal cancer and other life-altering diseases will continue to impact patients long after COVID is under control.

Is your organization doing preventive outreach initiatives or focusing on non-COVID health conditions? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 12/28/20

EverCommerce Acquires Updox, Industry Leader in Virtual Care and Communications Solutions

Service sector business software vendor EverCommerce acquires Updox, which offers healthcare solutions for faxing, electronic forms, video chat, and secure messaging.

Sumner Regional Medical Center experiencing outage issues as result of Nashville explosion

The Gallatin, TN hospital goes back to paper records when network outages caused by the Nashville RV explosion disrupt its EHR access.

Frieden honored for his lifelong work helping people with disabilities

Lex Frieden, MA, professor of health informatics at UTHealth School of Biomedical Informatics, was named the 2020 Katie Beckett Award recipient for his lifelong work advancing the rights of people with disabilities.

Monday Morning Update 12/28/20

Top News

Service sector business software vendor EverCommerce acquires Updox, which offers healthcare solutions for faxing, electronic forms, video chat, and secure messaging.

Updox had raised $16.7 million in debt financing and in a May 2017 Series B round.

Other EverCommerce healthcare brands include AlertMD (charge capture and messaging), CollaborateMD (medical practice billing software), AllMeds (EHR/PM), and ISalus (EHR).

HIStalk Announcements and Requests

Most poll respondents are anxious to be vaccinated against COVID-19 at their first opportunity.

New poll to your right or here, inspired by Dr. Jayne’s comments: What was the physician wearing as their outermost layer during your most recent visit?

I didn’t post a Christmas day edition of Weekender where I provide a Donors Choose update, so here ‘tis. Readers funded the teacher grant request of Ms. V in New Mexico, who asked for a library of 18 books for her elementary school class. She reported in July, “A couple of the photos I posted are of the last day I was with my students this school year. They had earned a reading celebration and we turned our classroom into a huge reading fort (and they got to wear their pajamas). We read ALL day! Thank you so much giving my students wonderful books! They will be enjoyed by 100’s of students for years to come!”

Speaking of Donors Choose, reader Vicki’s generous contribution, when amplified by matching funds including those provided by my Anonymous Vendor Executive, fully paid for these teacher projects:

• A second monitor for online teaching of Ms. S’s elementary school class in Los Angeles, CA.
• Robotics and coding learning tools for Mrs. P’s K-5 girls’ coding program in New Orleans, LA.
• Headphones for the remote learners of Ms. S’s elementary school class in Irving, TX.
• Distance learning materials for Ms. S’s second grade class in Henderson, NV.

Meanwhile, for one more Donors Choose uplift in a thankfully ending year that could use it, here’s what Ms. S had to say upon hearing last week that HIStalk readers had funded her project with matching funds from my Anonymous Vendor Executive and San Diego Gas & Electric.

Lorre stayed busy pre-holiday, bringing three new sponsors on board on Wednesday 12/23 alone in what is normally a glacially slow time of year. Her thesis is that companies are anxious to get their 2021 marketing plans going, especially with the delay in the traditionally early HIMSS conference. Contact her if you have 2020 marketing budget that needs to be quickly rehomed in return for a full year of benefits.

Webinars

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

Sales

• Cerner announces four new rural hospital clients of CommunityWorks.

People

Arkansas Children’s Hospital promotes interim SVP/CIO Erin Parker, MBA to the permanent role.

UTHealth School of Biomedical Informatics Professor Lex Frieden, MA is named the 2020 Katie Beckett award recipient for his lifelong work in disability advocacy, which includes playing key roles in development and passage of the Americans with Disabilities Act of 1990.

COVID-19

The COVID Tracking Project warns that COVID-19 tests, cases, and deaths will be underreported through the second week of January, when everybody gets back to normal work schedules. The only reliable daily stats will be hospitalizations, which are reported without interruption since hospitals don’t close for holidays. That number stood Saturday at 117,344, down slightly from Friday. One out of every 1,000 Americans has now died of COVID-19.

IHME’s latest COVID-19 model projects that US deaths will reach 567,000 by April 1 or 731,000 if states ease their mitigation mandates, estimating that planned vaccination timelines will save 33,000 lives. US deaths are at 332,000.

COVID-overwhelmed hospitals in Los Angeles County, CA are running out of oxygen and other supplies and their ambulance-arrived patients are waiting curbside for up to eight hours before being brought into overcrowded EDs. Southern California’s ICU capacity is at 0%, with peak, post-holiday travel hospital demand still likely a month away. 

Huntington Hospital (CA) alerts patients and families that it may begin rationing care in allocating scarce ventilators, ICU beds, and clinical staff to patients who are more likely to survive, as directed by a team that includes doctors, a community member, and a bioethicist. The hospital reminds the public that those resources are shared by patients with all medical needs, not just COVID-19.

Florida’s Department of Corrections removes daily prison-level COVID-19 case counts and testing numbers from its public dashboard right after two big outbreaks that involved more than 400 inmates. The department says it changed the dashboard because the information it contained was cumulative from the beginning of the pandemic and therefore was not helpful in monitoring new information, but didn’t explain why prison-level reporting was eliminated.

New York hospitals apologize for their vaccination teams giving COVID-19 vaccine to anyone who joined the line instead of limiting doses those workers who were on the high-priority list as was planned, eliciting protests from employees who observed that the queue included people who have been working from home and doctors who falsely claimed that they perform COVID-related procedures. According to one doctor, ”Clearly, we’re ready to mow each other down for it.”

The suddenly worrisome new coronavirus variants are likely already circulating in the US, going undetected since this country is #43 in the world’s percentage of cases that are analyzed genetically. The strain was discovered in Britain, which has sequenced 160,000 samples versus 51,000 here, and appears to be more contagious, including in children. Japan has barred entry to all foreigners through the end of January after the variant was discovered travelers from Britain.

The Washington Post describes conditions in a $31 million field hospital that was created in the former headquarters of a bank in Rhode Island. Most of the nurses are working under short-term agency contracts, IVs are delivered by gravity drip instead of electronic pumps, EHRs are not available, and patients summon help by ringing a bedside metal bell instead of pressing a call button. The hospital is run by Care New England Health System, whose nearby Kent Hospital is reporting that ED patients are waiting 2-3 days for a bed.

AstraZeneca’s COVID-19 vaccine may earn UK approval this week as the company says that new data shows its product, like those of Pfizer and Moderna, is 95% effective. Initial trial results were clouded by underdosing of some patients due to a University of Oxford mistake in analyzing the strength of a vaccine batch. Epidemiologists question what the new data could be given that the trials are completed and no new signups are likely when competing vaccines are available instead of a test dose that has a 50% chance of being a placebo.

Other

Sumner Regional Medical Center (TN) goes back to paper when the Nashville RV explosion on Christmas morning caused connectivity disruption.

A Connecticut OB-GYN practice pays $2 million to settle malpractice charges brought by a woman whose daughter was born with cystic fibrosis even though the practice told her that her genetic tests – including one for CF – were normal. The physician found that the test had never been ordered, which the plaintiff’s attorney believes was due to the difficulty involved in accessing lab results through the practice’s new EHR. 

England’s Northern Lincolnshire and Goole Hospitals creatively used their Vocera devices to make calls to Santa on behalf of their young ED patients on Christmas day, which were answered and followed with presents dispatched.

Contacts

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