News 11/4/20

Top News

Teladoc Health completes its $18.5 billion acquisition of Livongo.

TDOC shares have dropped since the acquisition was completed, valuing the company at $28 billion.

Reader Comments

From Ossified Institution: “Re: HIMSS21. Keynote speaker ideas? HIMSS20 would have been President Trump, Chris Christie, Terry McAuliffe, and Alex Rodriguez.” Here’s who I would most like to see, looking for that combination of selfless health-related experience plus the requisite celebrity appeal to make attendees feel important:

• Amy Abernethy, MD, PhD, FDA
• Jose Andres, World Central Kitchen
• Richard Carmona, MD, MPH, physician, nurse, University of Arizona medical school professor, and 17th Surgeon General of the United States
• Paul Farmer, MD, PhD, humanitarian
• Anthony Fauci, MD, NIAID
• Bill Gates, Gates Foundation
• Scott Gottlieb, MD, former FDA commissioner
• Jen Gunter, MD, physician
• Mona Hanna-Attisha, MD, MPH, physician
• Siddhartha Mukherjee, MD, physician and author
• Devi Shetty, MBBS, Narayana Health
• Laurent Duvernay-Tardif, MD, NFL player and physician

Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the “network door” they can open. This network infrastructure-oriented webinar will address overcoming the challenges of architecting a network to provide security, management, and monitoring for IoT, devices, and users using ALE’s Digital Age Networking blueprint, a single service platform for hospital networks. Digital Age Networking includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will describe enabling COVID-19 quarantine management, contact tracing, locating equipment and people, and ensuring the security of patients and more.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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

Acquisitions, Funding, Business, and Stock

Meditech reports Q3 results: revenue down 5.3%, EPS $0.82 versus $2.44. Product revenue decreased 29.9% due to pandemic-related implementation delays, but service revenue increased 6.3% as more customers went live.

People

Sentara Healthcare hires Tim Skeen (Anthem) as SVP/CIO.

Data privacy and security company FairWarning names Lisa Counsell, RN (Soar Vision Group) VP of healthcare sales.

Saad Chaudhry (Gartner) joins Luminis Health as CIO.

Announcements and Implementations

Naval Hospital Camp Pendleton (CA) goes live on Cerner as part of the DoD’s MHS Genesis program.

Cape Cod Healthcare (MA) implements Epic.

Hackensack Meridian Health deploys provider search and scheduling software from Kyruus.

In Australia, the first five hospitals go live on NSW Health Care’s implementation of Sectra radiology imaging.

Seton Medical Center (CA) rolls out CPSI’s Evident EHR.

Novarad offers a free, AI-powered COVID-19 diagnosis tool for CT scans.

COVID-19

North and South Dakota lead the world in the daily number of new COVID-19 cases per million population at 1,457 and 1,309, respectively. Europe remains in a nearly vertical case count increase, having moved from 50,000 per day in early October to nearly 250,000 now. Experts say uncontrolled US spread will likely peak in mid-January, with daily deaths exceeding 1,000 for a sustained period.

A study finds that Quidel’s widely used quick COVID-19 test performs poorly in detecting infection in people who don’t have symptoms, detecting only 32% of the cases that were flagged by the less-timely PCR test. Quidel’s test earned FDA’s emergency use authorization for diagnosis people with symptoms, but the federal government has encouraged its use as a mass screening tool. Experts warn that no tests can accurately predict whether someone is actively infectious in being contagious to others.

Hospitals, especially rural and small facilities, are scrambling to get nursing staff as pandemic burnout is causing resignations and sending those over 50 into retirement. The answer, as always, is paying sign-on bonuses and hiring traveling nurses in competing for the limited supply of licensed personnel.

Other

In North Carolina, the local news covers Sentara Albemarle Medical Center’s use of the “Sepsis Sniffer,” an algorithm developed by Mayo Clinic several years ago that looks for signs of impending sepsis using 4,000 patient data points found in real time within the EHR. Medical and Surgical ICU Director Daniel Mulcrone, MD says the predictive technology has been especially helpful in monitoring COVID-19 patients.

Sponsor Updates

• Surescripts honors 10 healthcare leaders with its White Coat Award for e-prescription accuracy.
• Arcadia’s MSSP ACO customers averaged $5.9 million in shared savings in 2019.
• Cerner unveils the Cerner Charitable Foundation focusing on home, health, and heroes.
• Health Catalyst will participate in the Credit Suisse Virtual Healthcare Conference November 12.

Blog Posts

• 4 Major Considerations for Healthcare Data Conversion (314e)
• Protecting Your Practice from Growing Telehealth Cybersecurity Threats (Part 1) (AdvancedMD)
• #RSNA20 – Entering a new era, in exactly one month (Agfa HealthCare)
• HEDIS Transitions of Care Measure: How CarePort Can Help Health Plans (CarePort)
• Civic Duty (Change Healthcare)
• What to do as Ryuk ransomware hits healthcare & manufacturing (CI Security)
• 6 Things Health Systems Need in Medication Access Technology (CoverMyMeds)
• Looking Back at Our First Virtual National Conference #eCWNC20 (EClinicalWorks)

Contacts

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

Morning Headlines 11/3/20

Health-tech startup Remedy lays off 82 employees

App-based house call and telemedicine company Remedy lays off 82 employees, many of whom were hired during the summer peak of COVID-19 patients.

WELL Health Acquires DoctorCare – the Market Leader for ‘Billing as a Service’ for Canadian Doctors

Well Health Technologies forms a new business unit, the Well Billing and Backoffice Group, through its acquisition of Toronto-based DoctorCare for $13.6 million.

Federal Health IT Strategic Plan Supports Patient Access to Their Own Health Information

HHS publishes the final 2020-2025 Federal Health IT Strategic Plan, which outlines federal health IT goals and objectives with an emphasis on giving patients easy access to their digital health information.

Curbside Consult with Dr. Jayne 11/2/20

I have to admit that being a blogger is a challenge sometimes. Although often the ideas for my columns come to mind easily after working in the clinical or IT trenches, some days are a struggle.

Today was one of the latter. I sat for a good hour without a solid idea in my head. I think a big piece of today’s writer’s block was the sheer stress I’m facing in the upcoming week. The clinical world has been completely out of control, with a good number of our providers down for the count with COVID or caring for close family members who have COVID.

Leadership is begging us to come in on our days off, which is a hard sell when you’ve barely been away from the clinic after your last shift. You also know that if you go in, you’’ll be crushed. So many patients who need to be seen that they are lined up before staff even arrives at the office. One of my receptionists had to park more than half a mile away, which led to a late clock-in and a fair amount of drama getting the situation remedied. Staff has to park in the lots of neighboring businesses and now has the worry of being towed to add to the stress of the day and concern about potentially becoming infected with COVID.

When you’re running with absurd patient volumes, any glitch in the technology becomes nearly catastrophic. At one of our sites, the Citrix client disappeared from multiple PCs. This led to a storm of calls to the help desk and frantic attempts to gain access to the system, all while the front desk was bringing patients in and filling the exam rooms. Trying to execute downtime procedures when you’re also trying to work with the help desk and get yourself up and running is nearly impossible. Trying to perform data entry from paper at the end of the day after you’ve seen 80 patients is just too much to ask.

Patient expectations are high and patience is low, for certain. We’re seeing over 2,000 patients a day and it’s taxing our radiology systems, with images slow to load. When you’re trying to diagnose COVID from chest x-rays because you don’t have enough rapid test kits, that’s a recipe for frustration.

The increasing hacking events directed at healthcare institutions aren’t reassuring. We’re getting daily reminders to avoid using email on work computers to reduce the risk of phishing. Employees who have been caught charging their phones via USB cables to the PCs have been disciplined. Websites have been locked down to the point where you can’t even access major pharmaceutical company information, which is always fun when you’re trying to find a package insert because you’re looking for the details needed to answer a patient’s questions.

Then there’s the thread of physical altercations. Although I haven’t had any at my worksites when I’ve been present, we did have an incident with an anti-masker patient who was ridiculing staff and other patients. He became physically agitated and had to be escorted out of the office. Businesses in our city are starting to board up in preparation for anticipated civil unrest, which is something we never planned for. Although we haven’t received a clinical bulletin on treating patients who have been exposed to pepper spray or other chemical irritants, you can bet that many of us have read up on it.

At least with my experiences in my own clinical office, I’m well prepared to meet the needs of my healthcare IT clients. Most of them are worried about the same issues, but with the hacking concerns magnified as the clients become larger in size. There are so many staff out of the office (both clinical and from a technology standpoint) that no one wants to implement any new solutions or features because they don’t want to stress already burdened caregivers or run implementation teams ragged. It sounds good to hit the pause button, until you realize that some organizations have received grant money or other awards that have strings attached, such as deadlines.

I spent a good chunk of the weekend re-engineering an implementation plan to make all the training virtual and asynchronous, including recording some of the training videos myself. Fortunately, the client has someone who can do some edits and cleanup. Although I can train with the best of them, my moviemaking skills are nearly nonexistent.

With the numbers coming off the Johns Hopkins COVID website this week, everyone is understandably worried about where the next few weeks will take us. Patients are continuing to travel and resume normal activities, and some are going overboard trying to stock up on experiences in advance of potential lockdowns. Mental health services are at a premium and those patients frequently find themselves in the urgent care setting because their primary physicians aren’t able to see them on a timeline that the patient finds acceptable.

I treat panic attacks and anxiety all the time, but there’s a special kind of anxiety that shifts to the clinician when you’re trying to help a patient cope with the fact that she has to have an outpatient hysterectomy because the hospital has put a freeze on “elective” cases that require an overnight stay. We certainly didn’t train for a world where any of what we’ve been experiencing over the last few months would be OK.

Third parties are feeding off the desperation of providers to do something other than practice medicine face to face. I was approached by a telehealth company that wanted to offer me $10 per visit and touted the ability of their platform to let me see 10-12 patients an hour. That, dear readers, is absurd. And the frightening thing is the number of physicians they’ve already signed up. I’m sure the patients don’t know that physicians are going to try to run on those volumes, or that they’re not going to get the level of care they deserve since they’re paying many multiples of that amount for the service. One colleague was offered $10 an hour to supervise a nurse practitioner. Certainly our licenses are worth more than that, but the employer thought it was more than fair. My colleague took a page from Nancy Reagan and just said no.

Then there’s the elephant in the room, which is, what will happen after Tuesday? Patients are girding for everything from “life as usual, since COVID will be gone” to full-scale civil unrest. I saw a patient last week who had been having chest heaviness that got worse as the day progressed but was better first thing in the morning. The culprit – he was wearing body armor around the house, “preparing.” You should have seen the look on my scribe’s face when I pulled that little detail out of the patient. Toilet tissue is once again flying off the shelves, although I was excited to finally score some bleach at the grocery store.

Whatever happens as a result of the elections in the US on Tuesday, my fondest hope is that people will remain calm, work through their emotions, and not lose their cool. I hope we rise to the occasion, regardless of the outcomes and the personalities involved. We all need a break.

How is your organization preparing for election day chaos? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/2/20

SOC Telemed Closes Business Combination and Will Begin Trading on the Nasdaq Stock Exchange

SOC Telemed completes its merger with the Healthcare Merger Corp. SPAC and will begin trading on the Nasdaq on Monday.

No End in Sight to UVM Health Network Slowdown Caused by Cyberattack

Systems at University of Vermont Health Network remain down following a cyberattack Wednesday.

Vocera Announces Third Quarter 2020 Financial Results

Vocera announces Q3 results: revenue up 6%, adjusted EPS $0.31 versus $0.23, beating Wall Street expectations for both.

Monday Morning Update 11/2/20

Top News

SOC Telemed completes its merger with the Healthcare Merger Corp. SPAC and will begin trading on the Nasdaq on Monday.  

HIStalk Announcements and Requests

A substantial number of poll respondents have had, as patients, experience with a scribe. JO says that most high-functioning teams have someone taking meeting notes and use of scribes should be similar, while JT observes that scribes need to learn to be almost invisible to avoid intruding on the encounter.

New poll to your right or here: Which is the most common way you’ve obtained prescription medications in the past year? Cary Breese said in our interview that chain drugstores force you to walk through shelves full of high-margin merchandise to get to the prescription counter, but that immediately triggered a question – if those drugstores are encouraging impulse sales, why do they have a drive-through window? Similarly, why do gas stations allow customers to pay at the pump without even entering the store where all the high-margin SKUs are piled high? Why does Walmart seem happy about advance ordering and store pickup on a few thousand grocery items when their store is full of other stuff you can’t impulsively buy from the curb? What does that portend for providers who may be giving up an upselling opportunity in offering virtual visits?

Welcome to new HIStalk Platinum Sponsor Well Health. The Santa Barbara, CA-based company’s intelligent communications hub is the only two-way digital health solution that engages patients throughout their entire care experience. It enables conversations among patients and their providers through secure, multilingual messaging in the patient’s preferred communications channel: texting, email, telephone, and/or live chat. It facilitates more than 1 billion messages for 31 million patients annually with an EHR-integrated solution that is top rated by KLAS, G2, and Capterra. It reduces provider stress and errors by unifying and automating disjointed communications across healthcare organizations, increasing patient visits and loyalty. Use cases include COVID-19 patient communication, telehealth, appointment automation, care management, patient outreach, payment management, patient reviews and surveys,  and population health. Thanks to Well Health for supporting HIStalk.

I found a really good Well Health video on YouTube that shows examples of COVID-19 communication best practices. The app looks cool, especially the auto translate option for languages other than English.

Thanks to Katie the Intern for bravely writing her first HIStalk piece even though she knows basically nothing about healthcare IT yet. I’m looking to arrange some experiences for her if you want to help out (contact Katie):

• I would like her to  interview someone who has a big-picture view of health IT, like maybe a health system CIO, CMIO, or informaticist. Self-studying enough to ask good questions will help her learn.
• She needs to see the dynamic between vendor marketing / PR and journalism, so it would help her to talk to one of those marketing and PR veterans about what they do. This wouldn’t necessarily have to be a published interview.
• I would like her to talk to a couple of folks who are in their 20s who are working in the industry and had to learn quickly.

Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the “network door” they can open. This network infrastructure-oriented webinar will address overcoming the challenges of architecting a network to provide security, management, and monitoring for IoT, devices, and users using ALE’s Digital Age Networking blueprint, a single service platform for hospital networks. Digital Age Networking includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will describe enabling COVID-19 quarantine management, contact tracing, locating equipment and people, and ensuring the security of patients and more.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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

Here’s the recording of last week’s Bright.md webinar titled ““How Presbyterian Healthcare Services Is Preparing for a Post-Pandemic Future Using Digital Care Tools,” featuring PHS SVP/Chief Innovation Officer Ries Robinson, MD as interviewed by Bright.md co-founder CEO Ray Costantini, MD. This is our first webinar that was presented as a video conversation and I have to say that I enjoyed it a lot.

Acquisitions, Funding, Business, and Stock

From the Allscripts earnings call:

• The company sold EPSi for 18.5 times trailing adjusted EBIDTA and CarePort for 21 times trailing adjusted EBITDA, which it says was above the average growth rate and margin for Allscripts but wasn’t being reflected in its valuation, so the decision was made to sell those businesses.
• Allscripts says Veradigm is an example of it “finding adjacencies to grow.”
• CEO Paul Black reiterated that “the market has not rewarded us for smart M&A transactions,” which included enhancing and then selling Netsmart and CarePort.

Vocera announces Q3 results: revenue up 6%, adjusted EPS $0.31 versus $0.23, beating Wall Street expectations for both. 

Sales

• Seattle Indian Health Board will implement order sets and care plans from Zynx Health.

Announcements and Implementations

Arcadia launches Vista, a web-based enterprise business intelligence product for value-based care.

KLAS finds that healthcare users of the videoconferencing platform Zoom are reasonably satisfied, mostly because they were able to implement it quickly during COVID and it connects reliably with high-quality video with minimal IT support, but Zoom falls short for video visits when integration with EHRs and medical devices are needed. A CMIO respondent suggests that the company create a product that is specific for telemedicine that the patient could launch by clicking a link sent to them by the provider.

COVID-19

England reintroduces a national lockdown as new infections and hospital admissions surpassed worst-case expectations, closing pubs, restaurants, and retail stores until December 2 as is already the case in Scotland, Wales, and Northern Ireland.

President Trump repeats his unproven accusation that hospitals and doctors falsely claim that patients die of COVID-19 to earn an extra $2,000 at a campaign rally, leading to a sharp reaction from AMA President Susan Bailey, MD, who called the President’s statement “malicious, outrageous, and completely misguided.” 

White House Coronavirus Task Force member Scott Atlas, MD appears on the RT network to say that COVID-19 is under control and that it’s lockdowns rather than the virus that that are killing people. He then has to apologize for appearing on RT, claiming he was unaware that it’s a Kremlin-backed propaganda outlet.

Other

Systems at University of Vermont Health Network remain down following a cyberattack Wednesday.

Sponsor Updates

• Santa Rosa Consulting team members raise over $2,000 for breast cancer research during a virtual walkathon.
• Change Healthcare will participate in a virtual fireside chat during the Credit Suisse Healthcare Conference November 11.
• Health Catalyst announces a partnership with the Middle East Healthcare Company to service six Saudi German Hospitals in Saudi Arabia.
• OpenText announces that Enfuse On Air 2020, a security conference focused on the prevention, detection, and investigation of threats, will be held virtually November 10-December 1.
• PMD releases a new video, “This is PMD – Life After Bootcamp.”
• Premier awards Call to Freedom, a nonprofit focused on navigating a healthy path for victims of human trafficking, its annual Premier Cares Award and $100,000.
• Pure Storage enhances its Pure Partner Program to provide partners with increased incentives, marketing, support, and training solutions.
• Spirion launches a Global Alliance Partner Program to provide a structured program for collaborative partner engagement and solution development.
• T-System, a CorroHealth company, launches the App Showcase.
• Medidata, TriNetX, and Datavant partner to enable seamless integration of real-world data in clinical development.

Blog Posts

• Essential IT Considerations as Mergers & Acquisition Activities Heat Up (Pivot Point Consulting, A Vaco Company)
• COVID-19 Hastens America’s Reckoning with Rural Healthcare (Medsphere)
• Healthcare Triangle’s Keys to a Successful Application Support Services Transition (Healthcare Triangle)
• Real View: Testing a partnership under the pressures of a pandemic (Nuance)
• Why you need to start preparing now for the COVID-19 vaccine (OmniSys)
• Health Literacy: Why it Matters and How to do it Right (OptimizeRx)
• Care Transitions and Addiction Recovery: Avoiding Data Gaps and Communication Silos (Netsmart)
• How to find your broken EHR windows (Nordic)
• Essential IT Considerations as Mergers & Acquisitions Activities Heat Up (Pivot Point Consulting)
• 10-Point Checklist: Deploying Shared Devices for Nurses (PerfectServe)
• Are Providers Ready for a Third Wave of COVID-19? (Premier)
• Health Tech Investment in the Third Wave (Redox)
• The Swiss Cheese Model of patient safety errors: Closing the holes with message accountability (Spok)
• Why Getting a Flu Shot Matters Even More This Year (Surescripts)
• Breast Cancer Screening: How to Close the Referral Loop (SymphonyRM)

Contacts

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

Katie the Intern 10/30/20

Hi, HIStalk readers! My name is Katie and I am excited to be interning under Mr. H. He suggested my first entry be an introductory column about myself, my studies, and my interests in healthcare IT. 

To start, I’m a recent graduate with two part-time jobs and two side “gigs,” including this internship. I work a lot and my schedule is busy, but whose isn’t these days? I work in media communications, PR, and write for a local paper. Outside of work, I write and record music, read a lot, ride horses, and write. That just about sums me up. 

I graduated in May from a prestigious journalism school with a BA in journalism and media. I say “prestigious” because that is how it was described to me when I applied to the school, and it is one of the top-rated journalism schools in the United States. I call myself a “Covid Grad” as I lost the last three months of my collegiate career to the current pandemic. Obviously, this is not half the loss that many have faced during this time, but I do mourn the experiences and the connections I might have made had my time not been cut short.

I’ve often joked that graduating during a pandemic should be listed on my resume. Losing your last three months of college, obtaining a degree, not having graduation, moving back in with your family, and stepping into a globally crumbling economy should be listed as an acquired skill set. Anyone out there hiring? 

My studies focused on multimedia news. I have experience with photography, print, broadcast journalism, animation, interviewing, multimedia design, and writing. I am proud of the school I come from and very proud to have my degree.

I had hoped to work in breaking news reporting for a local paper. I still hope to one day do this, but as the industry changes to concise and fast-paced delivery, I know I have to expand my portfolio. I enjoy writing breaking news, interviewing, taking photos, producing videos, and getting information out in a timely manner. I believe that getting concise, factual, and interesting news and stories to the community is extremely important. 

I recently spoke with a reporter for a local paper that I have wanted to write for for some time. He is a sports reporter and is now only covering Covid news. This was an eye-opener for me about the state of the news industry and the state of the world. I remember teachers assuring myself and other students, “There will always be a need for news.” I believed them and I still do, but I am quickly learning that a need for news does not promise a need for true, journalistic storytelling. So here I am jumping into an industry I know very little about! 

To be fully transparent, I know next to nothing about healthcare IT. I even had to Google what IT meant and how that related to healthcare news and what Mr. H does. I have had an interest in healthcare since early college because I have a family member who is affected by healthcare legislation. My interest stems from a curiosity as to how healthcare impacts my sick family member and her caretakers. Information technology was not among those interests, but when Mr. H described to me the possibility of learning more about the field, I decided to give it a try. So thank you for your willingness to let me learn about your industry and what makes it tick. 

I hope to learn many skills during this internship, both from Mr. H and from this audience. I expect to learn how Mr. H aggregates sources and communicates with readers about those sources. I expect to further my journalistic skills such as concise writing, compelling interviewing, interesting and important storytelling, and more. I want to learn how sources report on what healthcare IT is doing and how media concentrate efforts in publishing that information as quickly and accurately as possible. I feel I will learn a lot from interviewing professionals in the healthcare IT field and from interviewing HIStalk readers.

I desire to learn as much as possible about healthcare IT itself. Information technology is a concise name for a robust industry. I hope to learn what IT is, what it involves, and how it impacts healthcare. I want to understand who develops healthcare IT and what pushes those developments forward. I want to learn how healthcare legislation is impacted by the IT industry. I want to learn how professionals in the field predict what IT will do next. I want to understand how the stock market is impacted by healthcare IT. The jargon in health care, information technology, and in Mr. H’s posts will also install a learning curve for me. I’ve been researching and learning acronyms that Mr. H and readers use. If I can get over that hump, I think I’ll be good to go. 

I believe that the more I learn about this field and what Mr. H does, the more I will want to expand that newfound knowledge. I fully expect the list of what I hope to learn to grow. I will be writing a weekly column about what I learn and researching healthcare information technology as much as I can. I will also be doing interviews with readers and sponsors. I would love to hear from healthcare IT marketing and PR workers who could describe to me what they do.

For now, I am excited (and thankful) to be able to step into your industry and to learn what it does. I am appreciative of your patience and willingness to teach me and to interact with me, and I look forward to diving into this internship more and more.

Thank you for reading. I do hope I’m even half as entertaining as Mr. H.

Best,
Katie the Intern

Email me or connect with me on Twitter!

Weekender 10/30/20

Weekly News Recap

• HHS/ONC extend the dates for Cures Act compliance.
• Several US hospitals report cyberattacks as the federal government warns that Russian hackers are targeting 400 of them for ransomware, with payment demands of $10 million and more.
• Allscripts and Cerner report quarterly results, with both beating earnings expectations but falling short on revenue.
• HHS releases a final rule that requires insurers to report their negotiated provider rates and patient out-of-pocket costs for 500 shoppable services.
• Blank check company Health Assurance Acquisition Corp., formed by departing executives and backers of Livongo, prepares for an IPO of up to $500 million.
• The VA goes live on Cerner at its first site.

Best Reader Comments

Cerner put on a pretty good Cerner Health Conference given the limits of a virtual platform. The puppy and kitty cams were a nice touch. Exhibits were pretty boring — not sure how to replicate the real-time repartee even with vendors whose services you don’t need. The Cerner solutions center was a better experience and the ability to have a scheduled 15 min Zoom session with a solutions expert was much better than clustering around and fighting your way to the front to ask a 30 sec question at the in person event. Some of the most interesting workshops had a cap on attendance and they didn’t seem to record those sessions for later viewing which was unfortunate. Overall, they’ve done the best job that I’ve seen of a virtual conference. (CernerSuperUser)

Regarding the lab interface being down and no one noticing: I think every internal business user should have the expectation that their internal IT department will monitor functioning of business critical interfaces and similar processes like file transfers and ingestion. If you had outsourced operation of your IT to a vendor, you’d certainly cover things like that in a Service Level Agreement and you’d make plenty of noise if the vendor didn’t meet the SLA. If I was a lab internal customer, I’d ask the IT department 1) Is the interface between the EHR and the lab system monitored by tools for both up/down status and throughput? What are the performance thresholds for throughput that are considered acceptable? 2) Who is in IT is responsible for receiving the alerts from the monitoring tools? 3) What is your requirement for how quickly your people respond to an alert indicating a serious system or interface down condition? 15 minutes? 4) What do you consider prime hours for the lab-EHR interface? 7 x 24 including holidays, or something less than that? (Vendor Mgmt Guy)

Concerning hospitals and HIEs not allowing individual providers access to information in their systems … would this not constitute a form of information blocking? (Bill Marshall)

The training that Dr. Jayne describes would be to the level that I would be comfortable with the scribe process. That level of training is not what I see in the field today. Third party vendors who hire med school applicants, pay them $8-10 and hour, while charging $30-50 with a ‘training’ package of working with another scribe for a couple weeks — quickly weaned to a couple clinicians. Virtual scribing is even more problematic in my mind — communication is tough enough when you can see the patient and clinician — think about all the connection issues between the phone, the computer, the security of access, etc. Plus, in a clinical environment you can control who is in the ‘room’ with you. However, how do you do that when the scribe is sitting at their kitchen table while the family is making breakfast? And remember, these kids aren’t making enough to have an office they can secure themselves in. (AnInteropGuy)

In the early days (i.e March) patients had similar Dx codes to Sepsis – as that appeared to what was happening as well Covid Dx codes. I would hope that by now we’d know the difference of dying WITH Covid verses OF Covid. My guess someone from the Commercial Carriers would be able to chime in on this. Either way, I suspect some claims are stretched, but the vast majority are coded correctly. Also… if you are looking for conformational bias…. you can find it. (Silence Dogwood)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. P in Minneapolis, who asked for math tools for her class of Pre K-2 students. She reported in March, “Thank you so much for the hands on tools we received! Students have enjoyed learning how to use them. They have been really helpful to all students because they are hands on tools. Research shows the best way to learn is by doing something and repetition. You’ve made that possible. Students can create graphs, solve algebraic problems with the balance and use the hundreds place value mats combined with our blocks to build numbers. The mini clocks have been a hit! We are appreciative of your donation.”

Flint, MI pediatrician Mona Hanna-Attisha, MD, MPH donates her American Public Health Association 2020 Fries Prize of $60,000 to fund a pediatric public health fellowship. She found from analyzing Epic patient records that Flint’s water supply had high levels of lead due to a water supply change, triggering state and federal emergencies. 

Teens as young as 16 are working as volunteers in Czech Republic hospitals that have had 15,000 workers, including 3,000 doctors, sidelined by COVID in the country of 10 million. Czech Republic’s infection in rate is among the highest of major countries, six times higher than that of the US.

The mother of a 14-year-old who receives brain cancer treatment from the National Institutes of Health emails staff to see if Dr. Anthony Fauci could drop by for a selfie. Fauci said no because of social distancing, but offered to FaceTime with Benjamin Ciment, who asked him if he was relaxing (no, but hanging there, Fauci said), laughingly confirmed that NIH has a painting of him on the wall that Benjamin had seen, and asked Benjamin if his hair was dyed. Benjamin said the hair color is due to his chemotherapy treatments, to which Fauci said, “Is it really? That’s one of the positive things of the medicine —  it looks kind of cool.”

In Case You Missed It

• News 10/30/20
• EPtalk by Dr. Jayne 10/29/20
• HIStalk Interviews Cary Breese, CEO, NowRx
• News 10/28/20
• Curbside Consult with Dr. Jayne 10/26/20
• HIStalk Interviews Paul Ricci, CEO, SOC Telemed
• Monday Morning Update 10/26/20

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 10/30/20

HHS Extends Compliance Dates for Information Blocking and Health IT Certification Requirements in 21st Century Cures Act Final Rule

HHS and ONC extend compliance dates for the Cures Act information blocking provisions to April 5, 2021, while 2015 Edition health IT certification criteria updates and standard API functionality deadlines are moved out to December 31, 2022.

Allscripts Announces Third Quarter 2020 Results

Allscripts reports Q3 results: revenue down 9.6%, adjusted EPS $0.20 versus $0.17, beating earnings expectations but falling short on revenue.

KēlaHealth Raises $12.9M in Combined Seed and Series A Financing Round to Deliver AI-Powered, Clinician-Centered Solutions That Improve Surgical Care

Surgery analytics vendor KelaHealth raises $12.9 million in combined seed and Series A financing.

Cyberattack causes ‘significant’ UVM Health Network technology outage

The University of Vermont Health Network begins recovering from a cyberattack that has impacted its seven hospitals, most notably University of Vermont Medical Center.

News 10/30/20

Top News

HHS and ONC extend compliance dates for the Cures Act information blocking provisions to April 5, 2021, while 2015 Edition health IT certification criteria updates and standard API functionality deadlines are moved out to December 31, 2022.

HIStalk Announcements and Requests

My least-favorite term lately is “patient leakage,” which elicits two unsavory visuals: (a) bodily fluids dribbling uncontrollably from health system customers, and (b) millionaire health system executives dragging patients by the scruffs of their necks back to the facilities that they hoped to avoid.

Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the network door they can open. This webinar will address meeting the challenges of security, management, and monitoring using ALE’s Digital Age Networking, a single service platform for the network infrastructure that includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will be described, including COVID-19 quarantine management, locating equipment and people, and ensuring the security of patients.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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

Acquisitions, Funding, Business, and Stock

Allscripts reports Q3 results: revenue down 9.6%, adjusted EPS $0.20 versus $0.17, beating earnings expectations but falling short on revenue.

Cerner reports Q3 results: revenue down 4%, adjusted EPS $0.72 versus $0.62, beating Wall Street expectations for earnings but falling short on revenue. From the earnings call:

• EVP/CFO Marc Naughton will leave the company in 2021 after 29 years.
• An analyst noted that two recent high-level hires came from Leidos, suggesting an interest in getting more federal business, which Cerner hinted is the case. It was mentioned later in the call that Cerner is looking at “adjacencies” to its DoD and VA business, such as Indian Health Service, and “looking at ways that we can use data proactively with different branches of the government.”
• President Don Trigg says the next focus in its relationship with Amazon Web Services will be CareAware, also noting that Amazon’s PillPack pharmacy will play into pharmacy trends.
• Cerner had 22,000 people register for this month’s virtual Cerner Health Conference, with an advantage of the virtual format being able to see which sessions attendees choose and compare that to company focus and investment. Cerner mentioned interest in real-time workforce management, hospital operations, and consumer focus.
• Data opportunities include release-of-information for life insurance, legal, and workmen’s comp; the Learning Health Network; and clinical trials identification and enrollment for non-academic medical centers.
• Cerner will consider making acquisitions, but will also focus on repurchasing shares and paying dividends.

Surgery analytics vendor KelaHealth raises $12.9 million in combined seed and Series A financing. The company says its software improves surgical quality while preventing complications. It was formed by a group of Duke-affiliated surgeon-scientists, including founder and CEO Bora Chang, MD.

Fitness and sleep monitoring membership company Whoop raises $100 million in a Series E funding round that values the company at $1.2 billion. The $30 per month membership includes a simple monitoring strap (heart rate, sleep, and respiratory rate) and access to its analytics and community.

Sales

• Digital therapeutics vendor Voluntis will use the interoperability platform of Redox to offer providers actionable, EHR-integrated insights on how patients experience treatment at home.
• Greater Baltimore Medical Center (MD) will deploy app-based way-finding, appointment reminders, Epic MyChart integration, and mobile bill pay from Phunware.
• Alliance Health (NC) will implement ZeOmega’s CareIntel for population health management.

People

Marshall Health (WV) promotes Shannon Browning, RPh, MD to the newly created position of CMIO.

Greenway Health hires Michael Blackman, MD, MBA (Allscripts) as chief medical officer.

Long-time friend of HIStalk David B. Dillehunt is retiring as VP/CIO from FirstHealth of the Carolinas in Pinehurst, NC at the end of the year. He sent me a nice note about HIStalk that would be vain of me to post (but I appreciate it anyway), and he also mentioned that FirstHealth will do its own VP/CIO search without using a recruiter, so interested folks can apply on its website. An email search finds that Dave and I first exchanged messages in early 2006, so we go back a ways.

Announcements and Implementations

Optum’s annual health executive AI survey finds that 59% of them expect to see a payback period on investments in under three years and 95% think that hiring AI-experienced employees is a priority. The top three use cases identified are wearables monitoring, accelerating research, and assigning billing codes.

Ellkay launches its Women in HIT recognition interview series program, noting that while all of its own departments have more women than men, tech companies in general have just 25% women. Nominations are accepted online.

Epic says in an increasingly common press release that 190 health systems will go live this fall.

Tampa General Hospital says its use of GE’s command center has eliminated $40 million worth of inefficiencies, including decreasing length of stay and ED diversion that equate to 30 additional beds.

Government and Politics

HHS releases its final Transparency in Coverage rule that requires health insurers to disclose their negotiated rates and patient out-of-pocket costs for 500 shoppable services for plan years that begin on or after January 1, 2023. They will also be required to show historical payments from and payments to out-of-network providers as well as negotiated prices for prescription drugs.

Aetna pays $1 million to settle three HIPAA breaches in 2017, one related to an online document display and the other two involving mailing envelope disclosures.

COVID-19

White House advisor Jared Kushner said in a recorded interview in April that President Trump was “getting the country back from doctors” in developing a strategy to push states to reopen for his political benefit, after which the White House would then blame state governors for any resulting coronavirus spread.

Politico reports that HHS spokesperson Michael Caputo, who is on medical leave, privately pitched its $300 million, pre-election  “defeat despair” coronavirus ad campaign as “Helping the President will Help the Country.” HHS declines to say whether the ad campaign will ever run, is accused by House Oversight leaders of not providing documents they requested, and said that HHS Secretary Alex Azar was not aware of Caputo’s direct involvement. The $300 million cost was taken from CDC’s budget.

Atlanta magazine examines the botched rollout of Georgia’s coronavirus dashboard that left public health officials, local governments, businesses, and residents uncertain about how to comply with the governor’s push to reopen or to evaluate his wisdom in doing so. He assigned the dashboard’s development to to the state’s budget office instead of its public health department, where it was then outsourced to private contractor SAS. The state’s epidemiologists took the black eye for its lack of reliability and confusing presentation. National public health experts say it is unusual to let a third party contractor publish unvetted data to a state health department’s website. A much-Tweeted gaffe was a chart that appeared at first glance to show a steady decrease in case counts, but the X-axis case counts were sorted from greatest to least instead of by date.

Chicago’s NPR station looks at the lack of a central agency to coordinate COVID-19 patient transfers, with one small hospital that mostly treats low-income people of color being told by several hospitals that they had no available ICU beds despite having reported them empty to a state database. Some hospitals told the smaller one directly that they wouldn’t take a transfer if the patient had certain public-funded health insurance. The hospital was also rejected by the 3,000-bed field hospital that was built inside McCormick Place, which was mostly empty. The station notes that no state agency or public health official can force a hospital to accept a transfer and they have no incentive to cooperate with each other.

Science says that October was good for remdesivir manufacturer Gilead Sciences, which got an early look at WHO’s Solidarity trial results – which showed that remdesivir doesn’t decrease mortality or recovery time – before it signed a billion-dollar EU distribution deal and earned FDA’s approval even though FDA did not have its information reviewed as usual by its panel of outside experts. Gilead says it won’t renegotiate its $2,400 price following the Solidarity study’s disappointing findings about efficacy. Gilead got a look at the Solidarity study results on September 23, which FDA didn’t see until October 10 prior to its full approval on October 22. Gilead has sold $873 million worth of remdisivir (Veklury) so far this year.

Other

The FBI warns that Russian ransomware hackers are targeting US health systems and have taken down four of them so far. A cybersecurity expert says that hackers are demanding more than $10 million per target and discussing plans to infect 400 hospitals and clinics. Another analyst reports that 59 US providers have been impacted so far in 2020, disrupting care in 510 facilities. St. Lawrence Health System (NY) went on diversion and back to paper documentation in three hospitals Tuesday following a ransomware attack, while University of Vermont Health Network reported a system-wide outage Thursday. Sky Lakes Medical Center (OR) also reported a ransomware attack Tuesday and remains down. The Cybersecurity & Infrastructure Security Agency has issued an advisory describing how Trickbot-deployed Ryuk ransomware works and offers the usual broad mitigation suggestions, most of them not easily implemented quickly (although applying US updates, reviewing RDP ports, auditing user accounts with administrative privileges, backing up systems and storing the copies offline, and auto-updating antivirus software should be done regularly anyway).

I’m intrigued by posed skeleton displays in yards for Halloween. This Zoom call one best represents 2020, although I also like the cleverly topical ones in which an evil skeleton flings lurid coronavirus balls at others who are desperately fleeing while wearing masks.

Sponsor Updates

• Healthwise volunteers help the Idaho Food Bank deliver food to seniors.
• Experity makes its Virtual User Experience sessions available online.
• Saykara President and Chief Medical Officer Graham Hughes, MD authors a Medical Economics article titled “Can AI Rescue Physicians from their EHR Woes?”
• Fortified Health Security publishes a new white paper, “Using Zoom for Telehealth Visits: How to Maintain an Acceptable Risk Profile.”
• Aspioneer includes Goliath Technologies CEO and chairman Thomas Charlton on its list of revolutionary CEOs of 2020.
• Healthcare Triangle publishes a new case study, “Standardization Across Surgical Areas for ASC to HOPD Conversion at Great Falls Clinic Hospital.”
• IDG Connect profiles Imprivata CTO Wes Wright.
• FeaturedCustomers ranks LiveProcess as a Rising Star in its “Fall 2020 Customer Success Report.”
• Meditech recognizes the role of virtual care during Canadian Patient Safety Week.
• NextGate publishes a new case study, “UHIN Leverages Leading Patient Identification Platform to Drive Quality and Coordination of Care, Support COVID-19 Response.”

Blog Posts

• Insulin Titration Software Combined with CGM Enables Patients with Diabetes to Improve Time in Range (Glytec)
• Three Key Considerations for 2021 Healthcare IT Planning (Healthcare Triangle)
• How to Improve Nurse Efficiency in Acute Settings (Halo Health)
• Jefferson Health: Remote Patient Monitoring Boosts Outreach, Outcomes (Dina)
• The Chief Information Officer and Chief Digital Officer Conundrum (The HCI Group)
• Planning for Community Connect (Optimum Healthcare IT)
• Not All Managed Services Providers are Created Equal (HCTec)
• Healthcare Relief Funding: Five Steps to Maximize COVID-19 Dollars (Health Catalyst)
• Digital Health Improves Health Equity (Impact Advisors)
• The Case for Prioritizing Revenue Cycle Optimization (Ingenious Med)
• The haunting of health IT: Ten ICD-10-CM codes for Halloween (Intelligent Medical Objects)
• Health Systems, COVID-19 and the Redefined Healthcare Landscape in 2021 and Beyond (Loyale Healthcare)
• A Commitment to Healthcare Software Development Quality (Medhost)
• 5 perspectives on COVID-19 from Meditech customers and partners (Meditech)
• Organization and Management for the Busy PT Private Practice Owner (MWTherapy)

Contacts

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

EPtalk by Dr. Jayne 10/29/20

Hospitals and health systems are going on the offensive against COVID. One example is this two-page ad in the Tulsa World that illustrates hospitalizations within Saint Francis Health System.

Hospitals in my metropolitan area are approaching maximum capacity, having taken numerous transfers from rural hospitals that quickly became overwhelmed as cases surged. Our flagship tertiary care hospital has put limits on elective operative cases, not only to preserve bed capacity, but also to try to mitigate the load on care delivery staff who are anticipating a rocky winter.

One of my ICU nurse colleagues has been working with COVID patients since the beginning, spending several months in a vacant college dorm to reduce the risk that she would take the virus home to her high-risk household. In the ultimate show of compassion, another nurse from a “regular” unit offered to trade places for a few weeks so that my friend could have a break. It’s people like these that drew many of us to healthcare, those who truly set the example of service. But it’s a sad commentary on where we are right now and the concerns around what is to come. We had two more resignations at my practice this week and I fear more are to come.

ONC released a data brief this week looking at the state of interoperability among major US cities. The report looked at variation in interoperability within 15 cities, which are represented by combined statistical areas. They looked specifically at four key areas of interoperability – to find, send, receive, and integrate electronic health information with sources outside their health system. Data on HIE participation was also included.

Not surprisingly, small / independent hospitals performed the worst, with system-owned hospitals reporting higher rates of engagement across all domains. I practice in one of the areas that was surveyed and can attest to our paltry performance. The hospitals refuse to share information with independent facilities, and most of the time, my best source of information at the point of care involves the patient handing their phone to me so I can flip through their MyChart account.

The state HIE isn’t much help either since they won’t let individual physicians participate. Physicians only get access if they’re part of an organization that is sharing data. There are plenty of us that are independent, locum tenens, or contract physicians who care for patients outside the walls of a hospital or across multiple rural facilities, and it would be useful to have access to the data when those patients cross our threshold. That’s how the state’s prescription drug monitoring program works – it’s funded by tax dollars and each provider has their own login. Not sure why the HIE needs to be different.

My office recently suffered the devastating loss of a staff member, who passed away at the practice during the work day. It’s been an incredibly difficult time for everyone. The office has been closed and we just re-opened Wednesday. Based on the experience, I have a new item to add to our contingency plans for such a situation. If you have shared PC workstations, I highly recommend having someone log in to the PC that was last in use by the staffer in question and make sure that their login screen isn’t going to pop up for the next person to see. It never occurred to me that it might be an issue until I walked past a staff member who was staring catatonically at a login screen with her departed co-worker’s name, waiting for her password. The whole situation has been traumatic. This was another hurt that the team didn’t need on our first day without her.

Especially in a pandemic, there’s a lot of focus on the clinical workers at hospitals, along with those who perform essential functions such as food service, housekeeping, and facilities engineering. You don’t hear much about the unsung IT heroes, although they’re just as critical where taking care of patients is concerned.

One of my physician friends reached out to me recently about what she perceived as an IT disaster and I had to agree with her assessment. The hospital has had some significant delays in the return of pathology results over the last few months, due to layoffs and backlogged specimens. She’s been waiting for several sets of patient results to return and checking the system daily because she knows it’s a big deal for her patients. The lab director had told her to be patient, but I understand her reluctance to do so when she was waiting for information that could change her patients’ lives.

Late Sunday evening, she received a large volume of pathology results to review, some of which had been finalized and released by the lab more than five days previously. Apparently one of the interfaces had gone down and the results had been available but just sat there queueing until someone finally noticed an issue and pushed them through after restarting the interface. Her hospital recently outsourced quite a few of its IT functions and she couldn’t help but wonder if the changeover had anything to do with the failure, so called for my thoughts. My impression is that of a multi-level failure, first with the interface itself, then with the monitoring systems, then with a lack of notification to the responsible providers explaining the situation.

She had several dozen sets of results to address, but in a system her size, there may have been hundreds if not thousands of patients who were impacted. I know she felt terrible about the delays and was trying to figure out how to find time in a busy Monday office schedule to call notify all the patients. The reality is that on the other side of each one of those pathology results sits a woman who has likely been worrying about the outcome of her biopsy and that failure of the system added additional burden that she probably didn’t need right now.

It’s important for those of us in the healthcare informatics world to realize how critical our work truly is, and for the leadership that manages our departments to make sure we have the resources to do the work properly. My heart goes out to all the patients who had their results delayed and especially to those who received news that likely changed their lives.

Has your hospital cut resources for infrastructure reporting and monitoring? How does it notify patients and clinicians of similar situations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/29/20

Outcome Health may have found a merger partner

Outcome Health, which offers pharma-backed advertising software for waiting and exam rooms, is reportedly in talks to merge with competitor PatientPoint in a deal that could value the combined company at $600 million.

Mayo Clinic, Google launch AI initiative for radiation therapy

Mayo Clinic and Google Health partner to develop algorithms that will improve the treatment of patients undergoing radiation therapy for head and neck cancers.

Cerner Reports Third Quarter 2020 Results in Line with Company Expectations

Cerner meets Q3 revenue and beats earnings expectations; and announces the impending departure of EVP and CFO Marc Naughton.

HIStalk Interviews Cary Breese, CEO, NowRx

Cary Breese is co-founder and CEO NowRx of Mountain View, CA.

Tell me about yourself and the company.

I’ve done a few startups in my life, insurance and database. I’ve always had an automation focus, using technology to automate things in legacy industries.

I started NowRx in 2016 with an idea of making the pharmacy experience better. The real question that always intrigued us when we thought of the idea was, how do you make it profitable? That’s where the technology comes into play. We believe that if you can focus and optimize all the operations, software, robotics, and logistics, you can create a profitable model that’s a full replacement for a Walgreens and CVS experience. That has been the goal, and we think we have created it. We have since expanded from the Bay Area into Orange County, south of LA, and Phoenix, Arizona.

How do you think chain drugstores have failed to meet consumer needs?

The dirty little secret in the retail pharmacy world — and I think there’s enough evidence there – is that they want consumers to continue to come into their stores. That has been their model for decades. That creates a disincentive with where consumers are moving. They are looking for more and more convenience. I can get a car to come pick me up in two minutes and take me wherever I want. I can get my groceries delivered. I can get my lunch delivered. But the retail pharmacies don’t like that model. They want to have you come into a store for an in-store pickup.

They keep the pharmacy operation itself in the back of the store. They fill 15,000 square feet of space with all other products under the sun, and that’s where the majority of their profits come from. There’s a misaligned incentive. It has been exacerbated even more during COVID, where customers and patients are realizing there’s got to be a better way than going to stand in line for essentially a commodity product at a crowded store and risk exposure to COVID.

We work with some hospitals as well. Since we’re delivering prescriptions all day long anyway, we deliver right to patients on the day of the discharge.They get all their outpatient medication delivered to their room before they go home. We can reduce readmissions and hospitalizations. We think we’ve moved the needle on medication adherence and better patient outcomes through better prescription management. People are less inclined to not take their medications because they didn’t go to the pharmacy, they were too busy, they didn’t have time. Maybe they lack access to transportation. Maybe they just forgot. We resolve all of those issues right out of the gate. Plus we have some patient analytics that we’re layering on top of that as well to do pharmacy-based interventions to target chronically ill patients and try to make a more convenient and more reliable refill and just medication-adherence procedures.

Walgreens and CVS deliver through third-party services, and mail order pharmacies, including Amazon’s PillPack, deliver to the patient’s door. Why is it an improvement to have a physical, licensed pharmacy doing its own delivery?

Mail delivery pharmacy has been around for decades. We’re not too interested in that space. We think that works well for certain patients. Chronic meds are not urgent, and the 90-day fill can be a convenience.

But if you notice, mail delivery has been around for 20 years, as in Express Scripts and Caremark, but it hasn’t made a huge dent in retail pharmacy. Retail pharmacy is still the preferred model for many customers, particularly for medications that don’t necessarily fit a mail order delivery, like antibiotics that you need today, pain medications, or when your doctor changes the medication dosage and you need to get it refilled. All of those needs exist today and are a big pain point for customers. We believe that the right model is neither retail, which requires a patient to come into a store, or mail delivery. We see there’s a optimal model in between those two that picks the best of both worlds.

We use DEA-licensed pharmacy facilities. We call them micro fulfillment facilities. They are like the operation of the pharmacy inside Walgreens or CVS, but just the pharmacy part in the back. We take that out and put in a warehouse. We put it local to customers in their communities, within 10 or 15 miles of any patient that we serve. We do all the same things that a full-service pharmacy would do. We have pharmacist consultations over the phone, text, or video chat. We have technicians. We have our own inventory in those micro fulfillment centers. Everything is delivered right to the patient same day.

For a patient, they get the same-day service they would get from a regular pharmacy. We can do all the chronic meds and refills that a normal mail order pharmacy would do as well. We can do all of that and bring it right to your house, free of charge. You just pay your normal co-pay.

Inside the pharmacy, we take the best out of the mail-order pharmacies — the technology, the automation, the robotics, and all of that streamlined software. We built our own pharmacy management systems. We’ve been awarded the White Coat Award by Surescripts as one of the most accurate pharmacy management systems in the industry. Through that automation and our logistics, we believe that we can build a better solution for patients, taking the best of the other two models that are available.

How is chain drug store technology inadequate and how have you improved it?

I’d like to say that there’s more to fixing retail pharmacy than just adding delivery. That’s one of the problems we see, which is adding a third-party delivery service. You mentioned using Instacart or some other third-party delivery company. It doesn’t really fix the bottlenecks that are inside retail pharmacy, which we think are the key.

You have someone counting out pills, typically manually in a CVS or Walgreens. You also typically have a fairly antiquated software system that gets errors from insurance companies. Patients usually have to stand on line. There’s someone behind the counter on the phone waiting for 20 minutes to talk to the insurance company about how to resolve the claim. You can manage all of that with software.

Our software also connects with physician offices electronically. We have two-way communication. We get electronic prescriptions in, but we can also coordinate refill orders going back out. We also coordinate with the insurance companies. Then we have our own logistics.

Fixing those bottlenecks can make this a much more efficient process. The mail order pharmacies are  super high volume. They have far less labor costs per prescription because they’ve been able to automate. You don’t see that kind of automation in a CVS or Walgreens, so they don’t have enough money to spend on good customer service. They’re spending it all on all those manual processes and bottlenecks. That’s how we think we can fix the industry.

I assume that you would like NowRx to be valued as a technology company, but even with a closed-door pharmacy in individual communities, you still have to get a state license and hire pharmacists. How can you scale given the limitation of opening up individual, almost neighborhood-level pharmacies?

The key is the “almost.” It’s almost neighborhood-level, but it’s actually quite a much smaller footprint than a CVS or Walgreens that are, let’s face it, just about every two or three miles. I think Walgreens claims to be within five miles of every man, woman, and child in the US. 

We have far, far lower footprints than that. We have about one-twentieth of the required footprint compared to a CVS or Walgreens. We cover a much bigger territory per one of our micro fulfillment centers. A 15-mile radius is about 10 or 12 times the radius of a typical CVS, which only draws about a mile and a half or two mile radius. Each of our locations is a third the size. We don’t need 15,000 square feet of retail space, we need about 5,000 square feet. We don’t pay as much per square foot. We pay about a third the cost per square foot because we’re in commercial space, not retail.

Add that all up — about one-twentieth the number of locations and each one is one-third the size and one-third the price – and you’re getting pretty close to 1% of the fixed overhead that the big guys play. That’s additional savings for us that drops rates to the bottom line.

I assume that the chains stuff their stores between the front door and the prescription counter with all those products because the margin on them is high. Can you make enough money from just selling prescriptions?

They do have more margin on those products. A typical CVS makes about 60% of their profit from the front of the store, but they’re paying a big cost for that. The fixed overhead is very costly in the retail setting to have all of that product. That’s why they want people in the store. That’s why their whole model is there. They have that retail space. It’s an upsell model. They want the impulse buys. They put the pharmacy in back to try to attract customers.

We sell a list of about 250 non-prescription related items. It’s much easier for me to warehouse that product. I don’t need fancy retail shelving. I can just stack it in my warehouse. We get the customer the same convenience they would have by having additional add-on items like vitamins, probiotics, cough remedies, or pain remedies, whatever they would need to add on to their pharmacies. We don’t add so many products like back-to-school supplies or beauty aids, or I even saw tennis balls at my local CVS. We don’t go down that path. But vitamins, pain relievers, cough remedies, and things like that, we do offer today. It is a higher profit margin business, and it’s very easy for us to keep in the warehouse and add into a bag that’s heading out for delivery.

Telehealth has a last-mile problem where the online visit still requires a trip to the drugstore or lab. Can that be improved?

I couldn’t agree with you more. We’ve always been big believers in telehealth. The stat I like to use is that 70% of physician appointments result in or involve a prescription medication. You are exactly right — it’s kind of ridiculous to expect a patient to have an online meeting with their physician and then be expected to get out of their pajamas and go down to CVS. We think we’re a critical component to the telehealth movement, which will is going more and more mainstream now because of COVID. We are really excited about that.

In fact, we have some additional technology offerings that are going to dovetail right in with the telehealth platform, including feedback to physicians in a portal that gives them real-time updates on the prescriptions and if they have been delivered. Did they hit the insurance plan, or does it hit a prior authorization? Do we need to do an alternate prescription? We coordinate with that physician. Then you start to have a powerful combination of collaboration between the physician, patient, and pharmacy to drive better care.

I think of all these third-party delivery services driving around to individual houses bringing groceries, takeout food, and prescriptions. An individual business, like a restaurant, might work with several of those services. There seems to be a lot of inefficiency in making multiple trips to the same front doors. Could there be a point where someone creates a Post Office-like network that does white-label delivery from any company that wants to hire them as a courier?

It’s theoretically possible, but pharmacy is so complex. There are regulatory concerns. There are patient privacy concerns.

We always felt like from the very beginning – and we’ve been even more strong in our beliefs as we’ve moved along the last few years — that the best way for this industry to provide this kind of customer experience where you’re fully remote and everything is delivered is to own the delivery stack yourself. You have your own employees of the pharmacy that are the drivers. We can background check them. We can drug test them. We check their driving. They’re branded NowRx. They wear the NowRx shirts. They are in branded cars.

The patients get a level of comfort seeing the drivers pull up. Many of these patients that are on recurring medications see the same driver month-in and month-out. They’re on the same routes. There’s no privacy issues as far as coordinating refills and who owns the patient file that you would run into with a third-party delivery service. We handle narcotics, so we deliver all kinds of medications, including Schedule II narcotics. That’s very difficult to do if you’re a third-party delivery company and trying to make that work. We’ve always come down on the side of, let’s make the best customer experience that we possibly can, make it as seamless as possible, and make it as a complete of a service as we can. To do that, you’ve got to own your own drivers.

Chain drugstores have tried multiple concepts to get more sales per square foot out of their physical footprint, sometimes launching their own services and sometimes contracting them out, such as with urgent care and lab access centers. How will that play out over the next few years?

Our original hypothesis about this space is right. The big chains are going to keep doubling down and try to make a retail model work. They have too much invested in all that retail space.

You look at the recent announcement about a month ago. Walgreens acquired a company called VillageMD, which adds clinic services inside the retail stores. Exactly what you’re saying. That confirms my hypothesis that they are going to continue to double down. They are adding reasons to bring customers into a store, and customers are looking for fewer reasons to go into the store, so there’s a misalignment there. 

In four or five years, you’re going to continue to see displacement of customers out of the retail, traditional brick-and-mortar model into these other modes. At some point, there is going to be a significant disruption. You touched on Amazon earlier — they might be a trigger point if they try to make a move. Right now, they’re doing mail order, but at some point, they’re going to try to move to a two-day delivery for pharmacy or maybe even a one-day delivery. That will put so much heat on the retail pharmacies that they will have to have a real heart-to-heart meeting with themselves to figure out how they can change their model to survive. 

Frankly, I don’t think the existing retail model will survive more than four or five years. I think consumers are going to pull away from the retail model. They want free, same-day and even same-hour delivery, and that’s where we’re going to end up.

Morning Headlines 10/28/20

Human API raises $20 million to standardize health records with AI

Health data standardization and sharing startup Human API raises $20 million in a Series C round that brings its total raised to $36.6 million.

Harris acquires UK-based maternity ward software provider K2 Medical Systems

Harris acquires UK-based maternity ward software vendor K2 Medical Systems.

Fitbit CEO reveals the company’s plan to conquer fitness wearables and telemedicine

Fitbit co-founder and CEO James Park hints at the wearables company’s telemedicine plans, saying that adding a virtual visit benefit could be key to bolstering its subscription service.

3 St. Lawrence County hospitals hit by ransomware

St. Lawrence Health System (NY) diverts some ambulances to Gouverneur Hospital as it recovers from a ransomware attack on three of its hospitals early Tuesday morning.

News 10/28/20

Top News

Blank-check company Health Assurance Acquisition Corp. prepares for an IPO of up to $500 million.

The SPAC is sponsored by General Catalyst and is backed by former Livongo executives who didn’t make the jump to its acquirer Teladoc, including former chairman Glen Tullman and former president Jennifer Schneider, MD; as well as Thomas Jefferson University and Jefferson Health CEO Stephen Klasko, MD, DuPage Medical Group Board Director Anita Pramoda, and several General Catalyst executives.

HAAC is looking for companies that are involved in health assurance, have high growth potential in expanding addressable markets, and are led by mission-driven CEOs who are committed to responsible innovation. Its SEC filings state, “We know that health assurance companies can generate both positive clinical outcomes and outsized shareholder returns because our team built the first one—Livongo Health, Inc.”

It further defines the companies it will consider: “Health assurance companies deliver modern consumer health experiences while decreasing the overall healthcare GDP and are rooted in partnership with existing care providers. In a world built on health assurance, care is continuous, proactive, personalized, and available everywhere. Health assurance companies will be rewarded based on patient outcomes, enabling free-market economics to perform their important role in creating best-in-class solutions.“ It predicts that the digital health sector will eventually command more dollars and time than the physical sector.

HAAC’s chairman and CEO will be Hemant Taneja, a 45-year-old General Catalyst partner and Livongo lead investor who has written books about AI-based innovation and healthcare innovation. His Livongo shares are worth more than $2 billion.

Reader Comments

From Bubonic Relationship: “Re: Teladoc. I’ve never seen so many top execs bail when their company was acquired, especially one as new as Livongo.” The departing Livongo senior suits could spend their days making snow angels in the Teladoc-provided cash avalanche, but instead they’re off on a new venture to create another company to take public. I’m also surprised that Teladoc didn’t make the acquisition contingent on the whole management team signing up for a year of transition while the new owners figure out how their $18.5 billion acquisition works. Still, it’s inevitable that an acquired company’s leadership team won’t last long after the deal is done, even though they are the ones who created the value for which the acquirer paid a big premium, and Teladoc is keeping enough folks to keep the lights on.

HIStalk Announcements and Requests

Katie, freshly graduated from college with a journalism degree, started working as a paid HIStalk intern this week, earning her the sobriquet “Katie the Intern.” She and I are figuring how to ease her into the industry and put her to productive use given some limitations: (a) neither of us has internship experience; (b) I work alone and am not accustomed to explaining what I do or how I do it; and (c) we’ll be communicating remotely. I’ve given her some assignments to introduce herself in an upcoming HIStalk post, write a weekly column about what she’s learning, and review other health IT sites to see how they approach industry news. She’s also reviewing the comments of readers who suggested what I should have her do. You’ll hear from her shortly, but in the mean time, contact her if you would like to tell her about your job and how HIStalk fits into it because she has no idea. 

Webinars

October 28 (Wednesday) noon ET: “How to Build a Data-Driven Organization.” Sponsor: Newfire Global Partners. Presenters: Chris Donovan, CEO and founder, Adaptive Product Consulting; Harvard Pan, CTO, Diameter Health; Jason Sroka, chief analytics officer, SmartSense by Digi; Jaya Plmanabhan, data scientist and senior advisor, Newfire Global Partners; Nicole Hale, head of marketing services, Newfire Global Partners. The panel of data experts will discuss the opportunities that data can unlock and the challenges involved with becoming a data-driven organization. Attendees will learn why having a data strategy is important; how to collect, manage, and share data with internal and external audiences; and how to combat internal resistance to create a data-driven culture.

October 29 (Thursday) 1 ET. “How Presbyterian Healthcare Services Is Preparing for a Post-Pandemic Future Using Digital Care Tools.” Sponsor: Bright.md. Presenters: Ries Robinson, MD, SVP/chief innovation officer, Presbyterian Healthcare Services; Ray Costantini, MD, MBA, co-founder and CEO, Bright.md. Presbyterian Healthcare Services changed the way New Mexico patients access healthcare with its pres.today digital front door, which has given patients easy access to care during a global crisis. The health system’s digital care strategy goes beyond simply offering virtual visits and instead makes every episode of care — regardless of where it is delivered — better by streamlining clinical workflows and by directing patients to the most appropriate venue of care. The presenters will describe how Presbyterian has continued to meet patient needs during the pandemic, how it is deploying digital tools to tackle the combined COVID-19 and flu seasons, and how the health system is innovating care delivery to prepare for a post-pandemic future.

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the network door they can open. This webinar will address meeting the challenges of security, management, and monitoring using ALE’s Digital Age Networking, a single service platform for the network infrastructure that includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will be described, including COVID-19 quarantine management, locating equipment and people, and ensuring the security of patients.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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

Acquisitions, Funding, Business, and Stock

Harris acquires UK-based  maternity ward software vendor K2 Medical Systems.

Lux Capital’s newly formed SPAC, Lux Health Tech Acquisition, launches a $300 million IPO in hopes of eventually merging with or acquiring a health IT company. CEO and Director Josh DeFonzo comes from the Robotics & Digital Solutions division of Johnson & Johnson.

Intermountain Healthcare and Sanford Health will merge, with the combined organization having 89,000 employees, 70 hospitals, 435 clinics, and 1.1 million insurance customers.

Sales

• NCH Healthcare System (FL) will implement EVideon’s Patient Smart Room technology across its two hospitals.
• Baptist Health (KY) selects provider online search and appointment-scheduling software from Kyruus.
• Virginia Health Information chooses Collective Medical to provide hospital ADT notifications to a patient’s provider as required CMS starting May 1, 2021.

People

James Lawson (Verge Health) joins Sectyr as CEO.

Announcements and Implementations

Freeman Health System (MO) develops a text-based messaging app to update family members on a patient’s surgical status.

WellSpan Health implements Epic at several facilities that were previously part of Summit Health. The two health systems merged in late 2018.

Baptist Health (FL) deploys LifeLink’s chatbot software to expedite ED-to-PCP referrals and COVID-related care.

Population health management vendor Arcadia becomes a reseller of PatientPing’s real-time care notification technology.

A new KLAS report on health system AI purchases finds that that they are seeking specific solutions rather than concentrating on a single AI vendor, with the expected results taking longer than they expected. Jvion has a large client base but declining client satisfaction; Epic Cognitive Computing is growing fast, especially with readmission and sepsis prediction, but organizations need to drive outcomes on their own; and Cerner’s HealtheDataLab is early in its life cycle, with few live sites and little consideration in the market. Among products that allow customers to develop their own models, KenSci has high client satisfaction, DataRobot’s customers express concern about lack of completeness and the company’s lack of healthcare expertise; and Health Catalyst has weak customer satisfaction as its product is slowly maturing. Big tech firm offerings are seen as average, with Microsoft’s healthcare expertise and partnerships taking it to the top of the list, as Google and Amazon are perceived as light on healthcare knowledge and IBM Watson Health is seen as over-promising, under-delivering, and offering low value.

COVID-19

In California, San Francisco and Alameda counties sever ties with Google’s sister company Verily seven months after the state signed a multi-million dollar contract with the company to expand COVID-19 testing sites. They are concerned about racial disparities because Verily requires people to sign up using a Gmail account, uses confusing two-factor authentication, and asks health questions whose answers could be exposed to Google or third parties. A community health center CEO who shut down the Verily-run program after just six days summarized, “From where we sit, this is an old story. Corporations that are not really invested in the community come helicoptering in, bearing gifts, but what they’re taking away [user data] is much more valuable.” 

A New York Times opinion piece written by the director of the Institute for Health Metrics and Evaluation says that most of the useful COVID-19 data that the federal government collects isn’t being made available to public health researchers. This includes county- and city-level counts of cases, hospitalizations, and deaths as well as implementation dates of mandates for testing, distancing, and mask-wearing. It notes that the Times had to sue CDC under the Freedom of Information Act to get a case breakout by race and ethnicity, which revealed major societal implications. HHS also doesn’t release individual hospital data; break out hospitalization totals by age or sex; or indicate how many hospitals reported data on a given day. Unanswered questions that the data could answer include whether transmission is moving to younger people, whether death rates improved because of better treatment, and how local mandates have affected cases and admissions.

HHS data shows that only 60% of hospitals are fully complying with its COVID-19 reporting requirements, potentially exposing them to being banned from billing Medicare and Medicaid.

Other

Fitbit co-founder and CEO James Park hints at the wearables company’s telemedicine plans, saying that adding a virtual visit benefit could be key to bolstering its subscription service. The company was acquired by Google last year for $2.1 billion.

In Finland, hackers who breached a national psychotherapy provider are emailing individual patients and threatening to disclose their personal information publicly unless they send a bitcoin payment. The organization fired its CEO Monday after discovering that he failed to disclose two breaches going back to November 2018 and did not act quickly to fix identified security vulnerabilities.

Sponsor Updates

• Startup.info profiles Saykara founder and CEO Harjinder Sandhu.
• Clinical Architecture releases a new podcast, “A FHIRside Chat.”
• Kettering Health Network expands its use of Nuance’s Dragon Medical One physician documentation software with the addition of emergency department guidance.
• Surescripts VP and CISO Judy Hatchett joins the EHNAC Commission.
• Ingenious Med publishes a white paper titled “Rising to the Challenge: How Leading Healthcare Organizations are Thriving in an Evolving Revenue Environment.”
• Unified Communications Today features Alcatel-Lucent Enterprise’s efforts to transform healthcare during the pandemic.
• Change Healthcare releases a new podcast, “Capital Connection: 2020 Year-End Outlook.”
• Clinical Computer Systems, developer of the Obix Perinatal Data System, will exhibit at the virtual AWHONN Convention November 1-4.
• InterSystems adds Adaptive Analytics to its IRIS for Health data aggregation and app development platform.
• Allscripts recognizes Healthfinch’s prescription renewal delegation engine Charlie as its App of the Month for October.
• Virginia Health Information adds Collective Medical’s ADT-based care coordination and notification capabilities to its HIE services.

Blog Posts

• The Role of EMPI Services in Data Conversation for Health Information (314e)
• CMS audits have restarted: how skilled nursing facilities can prepare (Ability Network)
• A Prescription for America’s Drug Pricing Problem? (RxRevu)
• The Benefits of E-Prescribing for High-Risk Patients During COVID-19 (AdvancedMD)
• Population Health: Identify and Resolve Gaps in Care (Bluetree)
• Preparing your EHR for 2021 Evaluation and Management Coding Changes (CereCore)
• Cerner and VA Achieve Historic Milestone for Veteran Health Care (Cerner)
• Looking Back at the History of Pharmacies (CoverMyMeds)
• Using Analytics to Get a Pulse on the Health of Your Emergency Department (Dimensional Insight)
• Jefferson Health Answers 3 Questions About Remote Patient Monitoring (Dina)
• Know the Issues on Your NC20 ‘Ballot’! (EClinicalWorks)

Contacts

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

Morning Headlines 10/27/20

Lux Health Tech Acquisition Corp. Announces Launch of $300 Million Initial Public Offering

Newly formed blank-check company Lux Health Tech Acquisition launches a $300 million IPO in hopes of eventually merging with or acquiring a health IT company.

Unlike many employers, Athenahealth hiring

Athenahealth plans to hire 100 employees at its office in Belfast, Maine to fulfill positions in analytics, customer support, medical coding, and operations.

Health Assurance Acquisition Corp. Announces Filing of S-1

Backed by former Livongo executives, blank-check company Health Assurance Acquisition prepares for an IPO.

Curbside Consult with Dr. Jayne 10/26/20

Mr. H posted a poll yesterday looking to better understand when patients / readers have most recently encountered a scribe and in what context. Having spent the better part of more than a decade working with scribes in various different capacities, I thought I would chime in with my experiences.

I had my first encounter with the idea of scribes in 2006 when I was working on my first large-scale EHR go-live. We had a couple of physicians in our medical group who were not technology savvy by any stretch of the imagination. One of them had never used a home computer, even for email, Internet surfing, or the occasional game of solitaire. We began her implementation with some basic computer usage, working on tasks such as turning on a laptop and getting the hang of using a mouse by playing solitaire. Over the course of multiple weekly visits, we tried to work with her on being able to do basic EHR tasks, such as prescribing medications and reviewing patient history elements.

Even though she was willing to try, given the volumes in her clinic and the complexity of her patients, it became clear that she wasn’t going to be able to continue to practice the way she wanted to while trying to use the EHR. We were able to convince our administration to consider allowing us to train one of her medical assistants as a scribe.

The next step was to try to find a scribe training curriculum. I found one online that had been created by a medical student and included plenty of content on medical terminology and how to act in the exam room. Since this was a seasoned medical assistant, she already knew the latter, but she wasn’t that keen on sitting through a bunch of PowerPoint slides about terminology.

We ended up doing some modified on-the-job training, where we pulled several dozen notes from the physician’s files and used them to role-play mock encounters, with one trainee acting as the patient and the other supporting the medical assistant as the scribe. We also had to do simulated patient care scenarios with the physician to teach her how to communicate with the scribe, such as how to describe her examination findings and how to ask the scribe to find EHR information and show her any lab results that she could act on during the visit.

Even though we thought it would be a short-term arrangement since the physician’s retirement was always a topic of conversation, it continued for nearly a decade. Patients were happy since they already knew her long-time medical assistant, although we had to make sure that we backfilled her role as a medical assistant so she wasn’t trying to do two jobs at the same time. It’s clear that having a scribe extended the physician’s ability to stay in practice while still meeting all of the medical group’s benchmarks.

Fast-forward to today, where I’m in an organization with its own in-house scribe training program that is extremely rigorous. Our scribes are first hired as medical techs, where they are put through an extensive classroom program followed by a rigid schedule of on-the-job training where they are required to demonstrate mastery of a subset of procedures and skills before moving to the next level. After more than a dozen supervised 12-hour shifts, they are required to work independently for six months before they can apply to be scribes.

Once they make the cut, it’s back to the classroom for more medical terminology training and additional work with the EHR, followed by a written test. If they pass, they begin to practice in-person scribing, followed by several shifts with the company’s founder and other senior physicians. Some don’t make it through, but those who do know that they are gaining invaluable experience since nearly all of them are pre-med students. The company makes them commit to at least a year of work before they’re hired, which most of them are happy to do as they use the time to work on med school applications and attend interviews.

I love having a scribe and it’s rough when I work a shift without one. You get so used to having everything you say automatically added to the orders or the note that sometimes when you are flying solo, you forget to order things. It takes time for the brain to adapt back to doing things yourself. Fortunately my staff is patient as they ask me whether I was planning to include discharge instructions for a patient or ask whether I’ve reviewed labs that have been added to one patient’s chart while I was seeing another.

Quite a few of our scribes began medical school this fall, so we are knee-deep in training the next class. Given the volumes we’re seeing with our recent COVID surge, they’re certainly getting an education.

I’m not sure what I think about virtual scribes, even though the idea is clearly a hot topic. I definitely think that patients need to be informed of the presence of a virtual scribe and to be given the chance to opt out, much as they might when a human scribe is present in person. In reality, I’ve only had a couple of patients opt out of having someone else in the room. Most of the time they are thrilled that I can focus on them rather than the EHR, and the encounters go much quicker because the documentation is done in real time. However, the virtual model has limitations in being unable to truly interact with the scribe or to use the scribe’s laptop in real time to show patients their lab trends or copies of their imaging studies.

I would be  interested to hear from anyone who is using a virtual scribe model. In what clinical situation have you implemented virtual scribes? How accepting have your patients been? What are the challenges? Any unexpected successes? If you had it to do over again, would you do anything differently?

Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Paul Ricci, CEO, SOC Telemed

Paul Ricci is interim chairman and CEO of SOC Telemed of Reston, VA.

Tell me about yourself and the company.

I’ve been the chairman and CEO of SOC for about six months. Before that, I was the chairman and CEO of Nuance for about two decades. What brought me to SOC was the opportunity to accelerate the participation of the company in the exciting area of telemedicine and virtual care.

Telehealth usage skyrocketed, then tapered back off. What is driving its adoption?

COVID was an accelerant to a trend that was already underway, which was to take advantage of the efficiencies that virtual care and telemedicine offer for ensuring that we are matching patients with the best available healthcare that they can receive, independent of geographic proximity. We are focused on that in the acute setting, but it applies more broadly than that in the ambulatory, post-acute, and home settings as well.

What are the technology implications?

We serve the acute telemedicine market, so the consultations are taking place under high-acuity situations, such as a stroke victim in the emergency room or an emergency psychiatric visit. These tend to be high-acuity events. There needs to be a telemedicine specialist available with high predictability and with the requisite skills necessary to manage the consultation and provide quality care. In the case of a stroke victim in neurology, you would need to have a stroke neurologist specialist available.

The technology that is required to do that efficiently must rapidly access an appropriate specialist who is licensed in the state, privileged at the particular hospital, and with the requisite skills. That specialist has to be made available within a few minutes, with a high degree of confidence. The software and operational requirements to do that are quite demanding. It’s not really about the video link. The video link is the enabling transport mechanism for information. But it’s really about the software that fractionalizes and makes physicians available efficiently under these high-stress conditions.

Is it easier to address licensure issues since you serve specific clients in their specific locations?

You do have to address the problem of the appropriate licenses and privileging before the service goes live. But that is a significant challenge, and doing it 50 states compounds that problem. Building this kind of business at national scale is a complex operational task. That’s part of the value that we deliver to the hospitals we serve.

We’re starting to see telehealth services differentiate themselves, some offering clinical expertise and others just a platform, while some focus on remote monitoring or ongoing behavioral services versus low-urgency, episodic encounters. Are health systems offering new services through your services or are they augmenting what they were already doing?

There will be a heterogeneity of outcomes to the question you’re asking. Some hospitals will want significant coverage from a telemedicine solution, perhaps in entirely covering particular shifts or times. Other hospitals will want simply peak load support augmentation in addition to the existing resources they have, which might be their own resources or a third-party physician network. That mixture will evolve over time for a variety of reasons having to do with unpredicted scarcity, retirements, and peak demands that might occur because of prevailing illnesses. 

For us, we have built our business to be fluid with respect to that. Our software platform is agnostic to the source of the physicians, whether it’s our telespecialists, the hospital’s telespecialists, or the telespecialists they have contracted from someone else. Our platform is agnostic to that and meant to optimize under those heterogeneous circumstances.

How does the telepsychiatry service work with health system emergency departments?

Emergency rooms and hospital systems become backed up with patients who require psychiatric attention. There are strict protocols about how that has to be managed, and the capabilities and expertise necessary may not be available in the emergency room and may not be available through local staffing support. The backlogs within some facilities can become quite long, more than 24 hours, for example. Using telespecialists, we can help that facility significantly reduce their backlog, which is beneficial to the patient and beneficial to the facility as well.

What expectations have investors built into the high valuation of telehealth companies?

The market is anticipating that telemedicine is going to play a more significant role and that virtual care generally is going to play a more significant role in the delivery of healthcare services. As we look ahead five, 10, or 20 years, I think that is directionally correct. These companies, including ours, are being evaluated as having a significant growth opportunities within that growing market opportunity for the virtual provisioning of healthcare services, which has a number of benefits. It eliminates geographical inefficiencies and geographical restrictions. It allows optimizing the provisioning of very expensive scarce resources. It enables more data and analytics behind the delivery of the service, which over time will help to optimize service.

Can you describe the benefit of going public via a special purpose acquisition company or SPAC as SOC Telemed is doing versus the traditional IPO?

A SPAC is the merger of an operating organization, in this case SOC, into an investment company, in this case Healthcare Merger Corporation. By merging, the operating company SOC effectively ultimately goes public. That final event occurs, in our case, in a few days.

The advantages of doing that were twofold. One, the Healthcare Merger Corporation came with leadership with deep skills in the healthcare field. In particular, the CEO of Healthcare Merger Corporation, Steve Shulman, has a long history in the healthcare industry and is going to become the chairman of SOC.

It also brought a second benefit, which was that in a relatively short period of time — we announced the merger in July and will be consummating the transaction at the end of October — it allows access to capital, and SOC needed access to capital to prosecute the growth opportunities that are available for it in the market. Management expertise and capital for growth are really the advantages.

What lessons did you learn in your long career with Nuance?

There were lots of lessons over 18 years of Nuance. But the ones that in the end mattered the most were that if you have a big vision, stay focused on that vision and the mission of what that vision entails, assemble a great team, and pursue it with urgency and speed, you can get a great deal done. That’s really the story of Nuance.

We didn’t know when we started all the various avenues that would become available to us, but we worked incredibly hard. We took nothing for granted. We had a team that worked with a great deal of solidarity. We had an expansive vision about the ways in which speech and natural language could change the ways people engaged with information systems. All of that came together. We had a little luck along the way, of course, and in doing it, we affected some significant changes and built a great company with terrific associates.

Where do you see the SOC Telemed moving in the next few years?

SOC will be the leading provider of acute telemedicine services. The prediction that as much as 20 or 30% of acute healthcare can be done through virtual care and telemedicine is probably reasonable. Therefore, it’s an expansive opportunity.

The company will continue to build deep expertise in its existing specialties of neurology, psychiatry, and critical care, but it will grow and it expand into other specialties as well. It will increase the technological content of its solution, perhaps through the incorporation of more predictive analytics, incorporation of some AI capabilities, more sophisticated workflow, and integration into other aspects of clinical technology systems. All of that will continue to evolve over the next five years. SOC Telemed will be a leader and a visionary in doing that for acute settings.

Do you have any final thoughts?

The virtualization of healthcare is going to represent a significant opportunity for making healthcare more efficient and improving the quality of outcomes. SOC is proud to be a part of that because it will be a significant move toward the increased digitalization of healthcare.