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EPtalk by Dr. Jayne 10/1/20

October 1, 2020 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 10/1/20

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For those of you still playing along with the Medicare Promoting Interoperability Program, October 3 is the last day to begin the required 90-day EHR reporting period. This applies to eligible hospitals who want to try to avoid getting a negative payment adjustment (aka penalty) down the road.

It’s hard for some organizations to even care about the CMS programs any more. They are trying to keep their doors open on a month-to-month basis, and the idea of future penalties isn’t on the radar when they’re juggling staffing issues and figuring out how to protect their employees.

Another deadline approaching is that for submitting comments on the 2021 Proposed Rule for the Quality Payment Program. That comment period closes October 5 at 5 p.m. ET and comments may be submitted through regulations.gov.

COVID and the related lockdowns, shutdowns, and limitations to healthcare delivery are having negative impacts on patients in other ways. The Morbidity and Mortality Weekly Report from September 11 presents the results of a survey done in June looking at patients whose routine care was delayed. The survey estimates that 41% of US adults have delayed or avoided care, including 12% who reported having avoided urgent care.

A close friend of mine is going through some stress following a delay of care. When she was finally able to get in for her annual GYN exam, there were some abnormal findings, and now she’s beating herself up about whether they would have been found earlier had she gone in April as originally scheduled. I reminded her that in her age group she’s not even recommended to have an annual pap test, which means that her physician performed it “early” per the guidelines rather than “late” due to COVID. It’s hard for most laypeople to wrap their minds around how guidelines are constructed, especially when they’re worried whether they have cancer. At least her care team is running full tilt now, so hopefully she’ll have the answers she needs very soon.

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ONC announces the awardees for the STAR HIE (Strengthening Technical Advancement and Readiness of Public Health Agencies via Health Information Exchange) program. The goal was to support state and local public health agencies, as they use health information exchange services to respond to public health emergencies such as natural disasters and pandemics. Five HIEs were each awarded two-year cooperative agreements: Georgia Health Information Network, Health Current (AZ), HealthShare Exchange of Southeastern Pennsylvania, Kansas Health Information Network, and Texas Health Services Authority.

I enjoyed this article in Nature looking at how researchers are using virtual assistants to diagnose coronavirus infections along with dementia, depression, and more. Vocalis Health, a start-up with offices in Israel and the US, modified an app that was being used to detect worsening chronic obstructive pulmonary disease in an effort to detect COVID-19. They asked patients who had tested positive to use a research app to record their voices, with the recordings processed through machine learning to try to identify a COVID voiceprint. The article goes on to cover the history of voice analysis with neurodegenerative conditions such as Parkinson’s disease as well as how it can be used for behavioral health conditions like mania, where voice features can be telling. I ran the article past my favorite voice expert who thought it was “very fascinating,” although I’m personally curious about how it handles patients speaking different languages with different dialects and regional accents.

Greenway Health is getting into the telehealth game with a solution slated to be available in October. It claims to “deliver quality care from remote locations without interrupting established workflows” and they’ve got a video on the website from their chief product and technology officer, but I’d find it a lot more credible if they had a physician announcing it. The rest of the information requires you to provide your information, so I took a pass.

My state chapter of the American Academy of Family Physicians reached out to me on behalf of the state department of health as they try to plan for administration of a COVID-19 vaccine. The documentation is extensive, including a participation agreement and a multi-page provider profile that requires details down to the brand, model, and type of storage unit that will be used for housing COVID-19 vaccine prior to administration. Based on our already unstaffable volumes, I can’t see my practice agreeing to be an administration site, but you never know.

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I registered for the all-virtual Lenovo TechWorld conference today, to be held at the end of October. Based on my interests, it suggested a couple of sessions for me. I’m not sure where the “liquid cooling innovation” one might have come from, but it does sound pretty cool (pun intended). Unlike an in-person conference, it’s easy for the day-to-day to get in the way of virtual conferences, so we’ll see if I make it to any of the sessions.

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I’m mostly interested in seeing how the virtual conferences run and what platforms they use, as well as how they engage (or don’t engage) attendees. The Optum Forum had some glitches this morning, with participants having to log out and back in as well as reload their browsers to continue. Sessions that may have been missed are posted for on demand viewing through October 30, however.

I’ve been dealing with some non-work issues lately, so I’ve been much more likely to answer phone calls from unknown numbers. I had the ultimate bad cold call the other day. I answered the phone as I always do, “Hi, it’s Dr. HIStalk” and the caller says, “Jayne, this is Dave.” “Sorry, Dave who?” “You know, Dave, from XX company. We met at the YY conference a couple of months ago (insert name of conference that I most certainly didn’t attend, because you know, COVID) and you said to call you in a couple of months.”

“I’m sorry, what is this about?” “I wanted to follow up on your cybersecurity needs.” When I began to explain that I don’t have any cybersecurity needs, he literally hung up on me. Definitely not a best practice for the sales playbook, and needless to say, his number is now blocked. I’ll also be making sure that all my hospital and healthcare friends who might actually have pressing cybersecurity needs know what bozos the company has hired so that they’re not inclined to give them their business.

What’s the worst cold call you’ve received? Leave a comment or email me.

Email Dr. Jayne.

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Morning Headlines 10/1/20

September 30, 2020 Headlines Comments Off on Morning Headlines 10/1/20

CORHIO and Health Current Join Forces and Announce Intent to Form New Regional Organization

Colorado-based CORHIO and Arizona-based Health Current announce plans to merge, potentially creating the largest HIE in the Western United States.

Private equity firm’s healthcare SPAC SCP & CO Healthcare Acquisition files for a $200 million IPO

Blank-check company SCP & CO Healthcare Acquisition files for an IPO of up to $200 million.

Nebraska Medicine to resume appointments, procedures after battling cyberattack

Nebraska Medicine resumes all appointments, procedures, and surgeries after making “significant progress” in recovering from a cyberattack on September 20.

HHS Announces Funding for Health Information Exchanges to Support Public Health Agencies – STAR HIE Program Funds Five Organizations to Improve Interoperability of Health Data

GaHIN, Health Current, HealthShare Exchange, KHIN, and Texas Health Services Authority will receive a combined $2.5 million from the HHS STAR HIE Program to better support public health agencies in their response to emergencies like COVID-19.

Apple Accused of Delaying Masimo Legal Fight to Gain Watch Sales

Masimo contends in a court filing that Apple is trying to delay a legal fight over allegedly stolen blood-oxygen monitoring technology in its latest Apple Watch so that it can gain more market share.

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Readers Write: Technology Augmented by Behavioral Science Theory Leads to Improved Health

September 30, 2020 Readers Write 1 Comment

Technology Augmented by Behavioral Science Theory Leads to Improved Health
By Rhea Sheth

Rhea Sheth is a clinical and marketing intern at Carium and an undergraduate student at the University of California, Berkeley studying integrative human biology.

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Behavioral science is the study of human behavior. It asks the question: why do we act the way that we do? The simplicity of this question masks a complex science that underlies it.

Understanding human behavior has many invaluable applications in our society. If we can better understand human behavior, we can shape our policies in a way that will better engage individuals or present public health information in a way that will lead to an increased compliance rate.

The intersection of behavioral science and technology is an area of huge opportunity. With the rise of technology, there has also been a rise in the number of opportunities to move healthcare away from a fee-for-service model and instead move towards a value-based approach. The incorporation of behavioral science theory into mobile health platforms can help facilitate the movement towards more patient-centric care and improved health outcomes.

Research-backed behavior change techniques should be intentionally incorporated in digital health platforms to help individuals manage chronic disease. Influencing behavior change in chronically-ill patients is a crucial public health intervention. According to the CDC, 6 in 10 adults in the US have a chronic disease and 4 in 10 adults in the US have two or more chronic diseases.

Smartphone apps are a convenient, cost-effective way to provide behavioral interventions at the appropriate times. In addition, they help reduce healthcare disparities by increasing reach to populations who were previously unreachable due to demographic, socioeconomic, and geographic barriers.

Behavior change techniques can be woven into virtual healthcare tools to help users identify and manage negative behaviors that may be contributing to worsened health outcomes. Self-monitoring is one of the techniques that enable this type of positive behavior change and has been found to lead to reduced hospitalization and readmission rates.

In the context of healthcare, this includes tracking metrics indicative of health-related behaviors such as calories eaten, weight change, and blood pressure levels, often collected through devices such as wearables and fitness trackers. Through digital health platforms, users can track their desired metrics in which they can also see short-term and long-term trends in their health data. This data can be shared with care teams and providers can then keep track of their patients’ health metrics through remote patient monitoring (RPM).

According to the American Heart Association, through RPM, providers can obtain a more holistic view of the patient’s health through data, gain insight into a patient’s adherence to treatment, and develop a deeper patient-provider relationship. RPM can also help reduce healthcare costs by enabling timely health interventions before a patient’s health deteriorates to the point of requiring a costly procedure.

Before the rise of mobile health, self-monitoring was done primarily through paper journal methods, where participants would manually record entries such as calories eaten, blood pressure readings, and blood sugar levels. With recent advances in mobile technology, there are opportunities for more convenient, real-time self-monitoring. Rather than having to carry around a bulky paper journal, individuals can simply enter their data into a mobile device and see their short- and long-term trends.

For an individual with diabetes, taking a daily measurement of blood sugar can help increase awareness about their positive or potentially harmful behaviors. Seeing a huge spike in blood sugar one morning can cause the individual to, first of all, be aware that there is a change in their health, and then reflect on what actions could have caused that. They might remember that they ate three fudge sundaes last night and did not go on their daily walk. The question is, are they now likely to change their behavior?

Here’s where behavioral science comes in again. The act of self-monitoring has increased the probability of behavior change by making the individual aware that there is a change in their health. However, the act of self-monitoring does not guarantee that someone will change their behavior. The next day, the individual may have a craving for ice cream and engage in harmful behavior again.

While they may be aware now that eating ice cream is affecting their blood sugar in such a drastic manner, there may be other underlying factors that cause the individual to perpetuate a negative behavior. It may be that the individual does not understand the consequences of having high blood sugar because they haven’t received information regarding its risks. It may be that they are lonely and feel like no one cares about their health because they do not have frequent access to a healthcare professional. Or, it may be that the individual has a goal of reducing blood sugar but does not know how to achieve that goal and thus becomes demotivated.

To help mitigate the risk of perpetuated negative actions, mHealth apps can integrate different behavior change techniques with self-monitoring to enhance user engagement and increase the probability of behavior change, such as secure messaging and educational materials. Secure messaging is one way for providers and patients to interact and strengthen their relationship, and learning materials such as diabetes-self management education also help improve health outcomes.

Studies show that self-monitoring is more effective in improving health outcomes when used in conjunction with other behavior change techniques in this manner. Self-monitoring was also found to lead to reduced hospitalization and readmission rates.

Making sure technology caters to the complexity of a human being is imperative. Behavior change techniques help us do that. There is no one-size-fits-all solution for behavior change, but intentionally designing technology based on research-backed behavior change techniques has been shown to improve health outcomes. In this way, we make movement away from episodic transactional healthcare and instead towards mutually beneficial, patient-centered, and holistic healthcare.

Much like having a trainer at the gym can motivate people to reach their fitness goals and feel stronger, more confident, and successful, having a digital health platform with specific behavior techniques such as self-monitoring, health coaching, prompts / reminders to take medication, and motivational messages can help patients achieve their health goals.

Readers Write: Remember the Opioid Crisis?

September 30, 2020 Readers Write 1 Comment

Remember the Opioid Crisis?
By  Peter J. Plantes, MD

Peter J. Plantes, MD is physician executive with HC1 of Indianapolis, IN.

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The last few years have ushered in significant progress on the opioid crisis containment front. Acknowledging decades-long misinformation shortfalls, negligence, and improper prescribing patterns, the healthcare industry took important steps on national and state levels to get out in front of devastating statistics.

A March 2020 report suggested the needle was finally pointing in the right direction. The Centers for Disease Control and Prevention (CDC) reported a 13.5% decrease in opioid overdose deaths from 2017 to 2018.

Unfortunately, that report was quickly overshadowed by the global pandemic that brought the nation to its knees. Opioid misuse, like many other critical healthcare priorities, took a back seat to COVID-19. The fallout is notable. A recent analysis points to a spike in opioid overdose cases by 18% since the start of the pandemic.

It’s not just overdose rates that have many across the industry concerned about the current state of the opioid epidemic. Public health officials also report a surge in relapse rates due to limited access to treatment.

The reality is that 2020 has delivered a perfect storm of factors that are contributing to a problematic front for opioid misuse, including mass unemployment and the isolation created by stay-at-home orders that interrupted existing care plans and contributed to an increase in mental health issues. In addition, studies reveal that opioid prescription rates for procedures such as hip and knee replacements continue to rise. Prescription rule changes aimed at helping patients during the pandemic may also have had negative effects by opening the door to increased fraud and “doctor shopping.”

Amid alarming trends, today’s providers face a complicated front at the intersection of increased addiction and appropriate opioid prescribing. Within what is now a highly regulated framework, healthcare organizations must ensure that they are optimizing patient safety by following prescribing guidelines and adhering to ongoing monitoring processes to detect misuse.

This is especially true for patients covered under a population management program of health insurance (ACOs, Medicare Advantage, and HMOs.) Neglecting this opioid substance abuse patient population can result in poor financial performance as well as regulatory scrutiny. NCQA issued additional opioid abuse management measures that are required to be reported as part of HEDIS 2020 standards. These will encourage both:

  • Timely “Follow-up After High-Intensity Care for Substance Use Disorder” (FUI), and
  • Sustaining “Pharmacotherapy for Opioid Use Disorder” (POD) patients.

In late 2020 and heading into 2021, there is much at stake with the opioid crisis. Healthcare organizations should reprioritize efforts now and increase their engagement to get the opioid trajectory moving in the right direction. It will not be easy, as accessing the right data and complying with guidance remains complex for the average resource-strapped provider.

At a minimum, healthcare organizations need to address the problem by:

  1. Taking into account the public health emergency declared by HHS Secretary Alex Azar. This move on January 31, 2020 subsequently lead to the March 18, 2020 clarification from the US Department of Justice Drug Enforcement Agency (DEA) that healthcare professionals can now prescribe a controlled substance to a patient using telehealth technology.
  2. Improving leadership through opioid stewardship committees. The Joint Commission mandated that all healthcare facilities implement leadership teams and performance improvement processes in 2018 to address safe opioid prescribing. Opioid stewardship committees can advance best practices by identifying existing gaps and implementing processes that meet best-practice guidelines that include risk assessment, using state implemented Prescription Drug Monitoring Program (PDMP) data, laboratory testing, and patient education. 
  3. Conducting optimal patient risk assessments, monitoring, and education. Comprehensive risk assessments seek answers to the following questions: 1) Was a patient assessed for potential risk of misuse prior to a procedure or prescription? 2) Did the provider and patient have an open and honest discussion about whether opioids were the right choice? 3) Did a patient receive monitoring during follow-up care to ensure appropriate use of opioids? 4) Was a patient counseled on proper procedures for disposing unused opioids? These risk assessment standards should especially be part of telehealth-based opioid prescribing.
  4. Accessing the right data in the most efficient way possible. Access to PDMP data is a critical first step, but it doesn’t always provide the full picture, especially in cases where patients are doctor-shopping across state lines. Healthcare organizations can extend the value of this data by combining it with dispensing records from multiple states and intelligent drug consistency assessment via laboratory testing to support precision prescribing.

Smart prescribing and oversight of opioid risk is more important than ever, as is equipping providers with easy access to the right patient data for monitoring. Technology that efficiently brings together the right data and delivers it in an actionable way to providers is improving this outlook. Technology that does not hinder the doctor-patient encounter is especially important for effective delivery of safe opioid prescribing practices. The technology must assist the physician in rapidly and completely engaging all required regulatory expectations without creating an administrative bottleneck in the daily practice setting.

Readers Write: Debunking Price Transparency Myths to Enable True Progress

September 30, 2020 Readers Write Comments Off on Readers Write: Debunking Price Transparency Myths to Enable True Progress

Debunking Price Transparency Myths to Enable True Progress
By Kyle Raffaniello

Kyle Raffaniello, MSHA is CEO of Sapphire Digital of Lyndhurst, NJ.

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For years now, the US has had the highest healthcare costs in the world. While high medical costs are nothing new, these costs, in combination with the financial impact of the COVID-19 pandemic, could turn healthcare from unaffordable to unattainable for many Americans. Now more than ever, we must kick the nation’s price transparency conversations into overdrive to increase industry competition and lower the cost of care.

Increasing price transparency in healthcare is not a new goal by any means. The term has been used for years to not much avail, but has gained headlines in recent months because the Trump administration is making it a health policy focus and has announced multiple rules aimed at increasing transparency. However, confusion and uncertainty still linger around what transparency truly means for healthcare and whether it really works.

The truth is that it’s the foundation to making healthcare more affordable for Americans. Unfortunately, several common transparency myths muddy the waters for all:

Myth #1: Transparency Doesn’t Work

Transparency not only works, it is essential to lowering healthcare prices in our country and saving money for consumers and employers. For example, a hospital in Kentucky recently heard about the success Kentucky Employee Health Plan (KEHP) was having helping members find cost-effective facilities for their care when they used digital shopping solutions. Now the hospital wants to lower its prices and be more competitive in order to keep local business, as consumers had been going to get procedures done at more cost-effective facilities. Market forces will compel high-cost facilities to lower their prices to compete.

Myth #2: Cost Equates to Quality

An age-old adage, cost equating to quality, is simply not true when it comes to healthcare. Through the use of the right digital shopping tools, consumers can compare cost options and quality to find and select low-cost facilities that have high marks on quality, equating to high-value care. It’s time we all understand that quality doesn’t need to be compromised for cost or vice versa – this isn’t an either-or scenario.

Myth #3: Industry Stakeholders Don’t Want to Support Transparency

A common misconception is that not everyone in healthcare supports transparency because it’s not in their best interest. The truth is that most industry stakeholders do support transparency — they simply have differing views on how to achieve it. We must accept that different parts of the industry have different viewpoints when it comes to strategy and focus on the ways we can come together to achieve the common goal.

A recent survey found that nearly half (47%) of Americans age 18-64 surveyed are more concerned about the cost of healthcare now than they were before COVID-19. That same percentage of people also said they plan to change how they access care as part of our “new normal.” It’s clear that consumers want to shop for care and the market wants to increase transparency. In order to align stakeholders and ignite change in healthcare, companies in the transparency space must educate consumers about the right tools, support, and information to compare care options and engage the consumer in actively shopping for that care.

When we talk about the right information, this goes well beyond publishing a list of prices for procedures online, as these lists are not true to what patients will pay out of pocket. True transparency involves digital shopping platforms that can present consumers with a look at how much they will individually owe based on their insurance provider and individual health plan. Additionally, the listing of prices does not provide insight into the quality of care at a particular hospital or medical facility.

Digital tools will include the important qualitative information consumers can’t get elsewhere to ensure they’re not only choosing low-cost care, but high-quality care as well. Offering incentives to help consumers go beyond their research and actively shop for their procedures is important, too. Some digital shopping tools offer cash rewards, as a share of the savings, for consumers who choose high-value care.

Everyone needs and deserves access to low-cost, high-quality care, and we need to work together as an industry to make that happen. Through raising awareness of these tools, more consumers will become empowered and incentivized to use them, ultimately making more informed and confident decisions about their care. Additionally, there will be healthy competition among hospitals and medical facilities in the industry, driving down costs for the entire healthcare ecosystem.

The need for robust transparency that presents an easy healthcare shopping and comparison experience for consumers has never been more important following the impacts from COVID-19. As facilities reopen and begin rescheduling appointments, we must put the pedal to the metal and bring true transparency to the healthcare industry. Transparency is no longer an option, but a necessity for the livelihood of the industry and the consumers who power it.

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HIStalk Interviews Brent Lang, CEO, Vocera

September 30, 2020 Interviews Comments Off on HIStalk Interviews Brent Lang, CEO, Vocera

Brent Lang, MBA is chairman and CEO of Vocera of San Jose, CA.

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Tell me about yourself and the company.

I’ve been with Vocera for 19 years. I was brought in by the founders, initially as the VP of marketing back when it was just a few guys in a dark lab trying to figure out if they could make our product work. My wife used to tease me that I was the VP of business, as opposed to the VP of marketing, since I was trying to figure out our go-to-market strategy, our pricing strategy, and our target customer.

The company was not originally created as a healthcare-focused company. The founder’s vision was to enable wearable communication across multiple markets. One of my first jobs as a VP of marketing was to go out and interview a bunch of potential customers about the idea of wearable, hands-free communication. We started talking to some hospitals and nurses were so excited. I remember one hospital nurse saying to me, “You’re going to change the way nursing is practiced around the world.” At that time, I had no idea what she was talking about because I had not come from a healthcare background. I was more of a technologist, having made my way through Silicon Valley tech companies with an interest in technology and business strategy.

I fell in love with the impact that technology could have on hospitals and healthcare workflows. I was an industrial engineer back in school and never really thought about too much how I would use that until I started thinking about the role that communication can have on improving workflow and operations within a healthcare setting. I tell people all the time, just learn what you can, because you never know what knowledge you’re going to pick up along the way that will be relevant to you at some point in your future career, even though it may not seem particularly relevant at that particular moment in time.

Cell phones, apps, and phone-based texting were not around when the company was started. How have they changed the appeal or the marketing of healthcare-specific communications?

People forget that we created the company before Siri, Alexa, and the IPhone. Vocera revolutionized the idea of communication using voice as a user interface and thinking about mobility. We built the original Vocera badge because there weren’t any other appropriate devices. The closest ting might have been a Palm III, Palm V, or later, the Treo. Hands-free is critical in a hospital, so we built the device mainly because there was nothing else that would work. We have learned over the years just how essential the hands-free capability is.

We have embraced a range of different devices. Our strategy is very much about being device of choice, and our software platform supports iPhones, Android devices, tablets, and desktop interfaces. But we find that the closer a clinician is to direct frontline care, the more important it is to have that hands-free capability, and it’s even more relevant during COVID. But what has been important for us was to figure out ways to bring in those other modes of communication that you mentioned — text messaging, alerting, alarming, and other forms of media — into the platform and into the devices that we support.

The new Smart Badge recognizes a “wake word” to make everything hands-free. How important is that to clinicians?

We introduced the wake word earlier this year. You can say “OK, Vocera” to wake up the Smart Badge and allow you to issue a voice command, such as, “call the nurse for room 101” or “call a respiratory therapist.” You don’t have to have any interaction with a button on the badge at all. In this era where people are wearing personal protective equipment, or PPE, a lot of people are excited about the wake word functionality, because they are able to wear their Smart Badge underneath their gowns and maintain an entirely hands-free environment.

Could you integrate your system with inexpensive consumer voice assistants that could be placed in patient rooms, which would allow patients and nurses a simple, hands-free way to communicate, either along with or instead of a call system?

This is actually an area that we are really excited about. We are building a Vocera skill for Alexa that will allow you to put an Alexa device, like an Amazon Echo, in the patient’s room and enable the patient to issue voice commands. Those messages are then routed to the appropriate caregiver. We can leverage our software platform and routing intelligence so that we know who to notify if the patient asks for a blanket, but if the patient says that they are in pain, it can go directly to their nurse to take immediate action. 

It’s really combining, as you said, the consumer devices that are becoming so available and the prevalence of using voice as a user interface and speech recognition as a user interface, combined with the intelligence and routing capabilities of our software, and then the connectivity that we have out to the employees of the hospital. We’ve shipped over a million Vocera badges out into the marketplace. There are hundreds of thousands of people using them every day. That gives you an instant connection to nurses, transport techs, housekeepers, and food services. A patient can get immediate access to all those people, rather than it just being a hardwired connection back to the nurse station, where someone then has to figure out how to deal with that patient’s request. We are seeing a convergence of technologies that people have become used to and comfortable with in their personal lives and in their homes, merging with hospital-specific workflows and hospital-specific solutions that leverage the sophistication that we can build within software.

How has COVID affected the use of your products and the trajectory of the company?

The pandemic has raised the awareness for our company, our solutions, and the value proposition of what we offer, in particular, the hands-free capability. Every time a care team member removes or replaces their PPE, there’s a risk of contamination. Minimizing the number of times PPE is removed reduces the risk of infection and helps preserve these valuable resources. Whether that’s in a triage tent, an ICU room, or an isolation room, the hands-free capability of our solution has been really valuable, because it can be worn underneath the personal protective equipment.

We have seen the product being used in temporary tents being set up to triage patients. We’ve seen the Vocera badge being used connected to the bedrail, to allow patients to reach care team members and for nurses to do virtual rounding, where they can call a patient’s room instead of going in and out for a quick conversation, which keeps them safer and reduces the amount of PPE used. It allows them to reach out to family members. It has been exciting to see the role that that communication can play.

For our employees, our connection to our mission has never been stronger. Our mission is to improve the lives of caregivers, patients, and family members. While the pandemic has been tragic in many regards, it has been inspiring for the employees. Our level of employee engagement is higher than it has ever been because we have been part of the solution. It has been inspiring for employees to feel like they are doing something that is having a direct impact on patients, caregivers, and family members.

What sales and marketing changes have you made given travel limitations and the cancellation of HIMSS20?

We were one of the first companies to drop out of HIMSS when we saw the pandemic rising. Maybe it was the benefit of being out here on the West Coast and seeing what was happening in Washington. But we very quickly started transforming the company to being virtually oriented in our sales, services, and marketing efforts.

Just to give you an example, within 30 days of this all coming about, about 90% of our professional services had been transitioned to remote work using Zoom or other virtual technologies. Our sales team quickly embraced reaching out and working with customers on a virtual basis. Our marketing team did a really good job of creating new use cases and case studies talking about COVID-specific workflows and how the product could be utilized in these environments. We used it as an opportunity to support our customers. We issued several thousand free, temporary license keys for our software to customers who needed to increase their capacity to respond to COVID surge situations.

I’ve been incredibly proud of the response by the company and by the employees to support our customers and do the right thing during these really challenging times.

How do you position your offerings in rounding, patient experience, pre-arrival, and patient monitoring software within the framework of enterprise communications?

Our vision is around enabling the real-time health system across the care continuum. That is more than just voice communication. It is more than just communication broadly. It is all about eliminating the friction points in a patient’s journey and making sure that the right data is delivered to the right person, on the right device, at the right time, with the right level of urgency.

Take as an example our recent acquisition of Ease, which is a patient and family communication application. It enables caregivers to give updates to family members when a loved one is in the hospital for surgery, COVID, or other situations that prevent family members from visiting them. This speaks to our desire to expand to enable this real-time health system.

The company has its roots in the Star Trek communicator kind of mindset, but our software platform is much broader than that now. We have had to evolve as the industry’s has evolved. In the old days, a lot of actions in a hospital were triggered by a nurse walking into a patient’s room and noticing a change in their condition. The workflow started by the nurse needing to reach out to get the appropriate help. More and more today, patient monitors, physiologic monitors, smart beds, and the electronic health record are becoming expert systems. They can, in many cases, notice a change in the patient status quicker than the nurse who is walking into the room. The event that needs to be triggered from that, and the people who need to be activated as a result of that change in patient status, can be coming from lots of different sources beyond just the initial human interaction with the patient.

As a company, we focus on evolving what we do to be able to incorporate all this data coming from these expert systems, route it through our workflow engine, and more importantly, prioritize it and triage it so that we aren’t creating cognitive overload or cognitive burden on the clinician, so that they’re receiving just the most critical information. and know the most important activity to act on next.

You are at a blurred line between what you’ve traditionally done and new technologies that are gaining in popularity, such as chatbots, artificial intelligence-powered population health management, asynchronous text-based provider chatting, and patient-reported outcomes, all of which are usually offered by a standalone startup company. Do you see Vocera getting more involved in either these specific technologies or with those companies that offer them?

You’re absolutely right. Hospitals tell us all the time that they are looking to consolidate the number of vendors that they are working with. They are looking to build platforms that are unified and fully integrated.

We try to create as much of an open platform as we can. We want to be interoperable with data from a range of different systems. Whether it’s a piece of technology that we develop ourselves, creating an interoperability relationship or some sort of partnership, or a potential acquisition — those are all ways of building up a platform that is easy to use and is delivering the right information to the caregiver.

I love to see the innovation that is occurring in the space, because the more information and the more data that gets generated, the more of an opportunity there is for us to analyze that data, route that information, and provide better patient context. When a call or message comes in, it’s not just an interruption, it’s actually patient context-aware events that provide the caregiver with situational awareness that allows them to decide what the next action is.

Our strategy is to say that we are going to do a lot of this ourselves, but we’re also going to create open APIs and open standards that allow us to bring data in from other organizations. One of my favorite examples is sepsis alert technologies, those sophisticated algorithms that can  predict when a particular patient might be headed towards sepsis. The challenge with those is that often that the algorithm can identify the patient who is at risk, but it may not do a good job of notifying somebody who can take action. In that case, we do a simple integration with them, they send us that alert, and we route that to the appropriate caregiver. They can take action much more quickly than if we were just waiting for the clinician to go log into the electronic health record or some other expert system that has identified that the patient is at risk.

Do you have any final thoughts?

Technology vendors have an important role to play in transforming healthcare, whether it’s providing improved safety for clinicians and for patients, reducing the cognitive burden, our doing a better job of protecting our frontline caregivers. Technology must be part of the answer to bridge the gap between where we are and where we need to go. Vocera is really excited to have an opportunity to participate in that.

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Morning Headlines 9/30/20

September 29, 2020 Headlines Comments Off on Morning Headlines 9/30/20

HHS Launching Initiative to Track Physician Use and Burdens of Health IT

HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.

As insurers move this week to stop waiving telehealth copays, patients may have to pay more for virtual care

UnitedHealthcare and Anthem will end their virtual visit benefit Thursday, after which patients will once again pay co-pays, co-insurance, and deductibles for virtual visits that are not related to COVID-19.

JLL Partners strikes deal to buy Thoma Bravo’s MedeAnalytics

PE Hub reports that private equity firm JLL Partners will purchase MedeAnalytics from Thoma Bravo, which acquired it in 2015.

Comments Off on Morning Headlines 9/30/20

News 9/30/20

September 29, 2020 News 1 Comment

Top News

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Universal Health Services begins recovering from a Sunday morning malware attack that locked computer and phone systems at 250 facilities, forcing some to close departments and divert patients.

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An anonymous staffer reported seeing the phrase “shadow universe” on computer screens as the breach commenced, leading cybersecurity experts to assume that Ryuk ransomware was involved.


HIStalk Announcements and Requests

I had to switch concierge doctors after mine closed his practice to take a drug industry job. Allow me to correct my own convenient but incorrect use of the term “concierge doctor,” which mine was not. A concierge practice still bills your insurance company and/or you personally — you are just snootily buying your way around the velvet rope at a cost of thousands of dollars per year. What I have is “direct primary care,” where you pay an average of $75 per month for anytime access to your family practice doctor via call or text, unlimited office visits or telehealth sessions, wellness exams, physicals, health maintenance, minor in-office treatments and surgical procedures, and often at-cost labs and prescriptions right in the office. Savings on routine lab work alone – paying the heavily discounted doctor’s cash price instead of your insurance’s deductible — can cover much of the entire year’s cost. I feel like a VIP when I have a minor, obvious health issue (pinkeye and a swollen toe being the most recent examples), I text a photo to my doctor on a weekend or holiday, and almost immediately I have a prescription waiting to pick up at the drugstore, with follow-up available if I need it. I keep my regular insurance, with the few hundred dollars per year DPC cost a modest luxury that lets me avoid the usual poor customer service. I expect quite a few physicians fail at DPC due to inadequate business skills (especially marketing), but otherwise small panel size, lack of insurer meddling, and freedom from bureaucracy makes it a great model for both doctor and patient when done right. Plus doctors can choose which patients they want to work with.


Webinars

September 30 (Wednesday) 11 ET. “The Hidden Threat: New Research on Security Vulnerabilities and Privacy Gaps in Healthcare Apps.” Sponsors: Verimatrix, NowSecure. Presenters: Neal Michie, MEng, director of product management, Verimatrix; Brian Lawrence, direction of solution engineering, NowSecure. The presenters will present research on the security risk profile of 1,000 healthcare apps in managing patient privacy, how they compare to those in other industries, and where the biggest vulnerabilities lie. Attendees will learn how to make their healthcare apps more secure in managing protected health information.

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


Acquisitions, Funding, Business, and Stock

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Defunct personal health record vendor Medlio notifies users that cancer reference lab NeoGenomics Laboratories has acquired some of its assets, but will sunset the patient-facing mobile app and health records download service. Medlio co-founder Lori Mehen took a full-time product manager job with NeoGenomics Laboratories early this year.


Sales

  • Henry Mayo Newhall Hospital (CA) will implement Ensocare’s Transition and Choice automated referral software.
  • The US Air Force selects NeuroFlow’s behavioral health integration technology, beginning with deployment to a division of Space Force.
  • Provider communications platform vendor Updox will integrate its systems with inpatient EHRs using technology from Redox.
  • CareSignal will white-label a conversational AI chatbot from QliqSoft to automate the traditional call center model of remote patient monitoring.

People

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The Chartis Group promotes Roger Ray, MD to chief physician executive.

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Mount Sinai technology commercialization spin-off Rx.Health names Richard Strobridge (Nextbridge Health) CEO.


Announcements and Implementations

LifeBridge Health implements Artifact Health’s mobile physician query software at Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center in Maryland.

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West Tennessee Healthcare deploys Cedar’s patient engagement, messaging, and billing platform.

EMpower Emergency Physicians (AZ) and Integrated Care Physicians (FL) adopt RCM software and services from R1 RCM.

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A new KLAS report on  oncology software finds Elekta as the leader in both medical and radiation oncology software, with Varian (slated for acquisition by Siemens Healthineers for $16 billion) coming in second. EHR vendors Cerner and Epic have seen significant adoption of their medical oncology software, but with functionality gaps and click-heavy, multiple ways to complete tasks that hurt usability and training. Medical oncology EHR vendor Flatiron Health, acquired by drug maker Roche for $2 billion in April 2018, placed in the middle of the pack with strong product design and support expertise that is dragged down by poor communication around enhancement requests, upgrades, and delayed support response. Varian leads in the tiny field of radiation therapy treatment planning, as more than half of Philips Pinnacle treatment planning software customers say they’re switching to a different vendor (presumably Varian) due to lack of development effort and failure to keep promises.

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Best Buy-owned GreatCall releases the Lively Flip smartphone for seniors, which builds on the previous Jitterbug phone in adding Alexa voice services, a bigger screen and keyboard, a dedicated button for calling an urgent care provider, and 24/7 access to its telehealth service. The phone costs $100 plus a $35 activation fee, while monthly plans run $20 to $35 not counting unlimited text and talk, which adds $20. Best Buy acquired Great Call for $800 million in August 2018.


Government and Politics

HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.

Premera Blue Cross will pay the HHS Office for Civil Rights $6.85 million to settle potential HIPAA violations stemming from a 2015 data breach that affected 10.4 million members. An OCR investigation found the Pacific Northwest payer failed to implement risk management and audit controls and failed to conduct an enterprise-wide risk analysis.


COVID-19

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Health systems are creating “one-stop shop” clinics for patients who have survived COVID but who are experiencing ongoing problems such as lung or heart damage, neurological issues, fatigue, and anxiety. The director of the Center for Post-COVID Care at Mount Sinai says that if even if less than 10% of infected patients experience long-term symptoms, that means 500,000 Americans will require medical care of unknown duration. He says half of the clinic’s patients have test results that show damage, while the other half have symptoms but inconclusive test results.

The White House will send 150 million Abbott BinaxNOW rapid coronavirus tests, purchased for $750 million, to states and other jurisdictions by the end of the year, with several million going out this week to be used for vulnerable populations such as nursing homes. The tests use a shallow nostril swab, require no special equipment, and give results in 15 minutes, so they can be used in medical practices and pharmacies. However, they are approved for use only in symptomatic people, must be administered within the first seven days of symptoms, and cannot be self-administered at home. Experts praised the news, but say 150 million tests is a drop in the bucket given their likely use and they still don’t solve the problem of assessing true prevalence. Public health officials also question how the results of the tests will be reported, particularly if administered outside the health system such as in schools.

The federal government has sent rapid COVID-19 test machines to 14,000 nursing homes since last month, but they come with a catch. The nursing homes must agree to test each employee and resident weekly and pay for their own supplies at $32 per test, meaning that even small facilities could be on the hook for thousands of dollars each week. They also report that manufacturer BD is back-ordered on testing supplies. Health departments haven’t figured out how to collect data from nursing home tests. Some facilities that have become frustrated by the cost and availability challenges of the BD tests are using state labs, but they don’t get results back for several days.


Other

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@Cascadia is right – the VaccineFinder website operated by Boston Children’s Hospital, CDC, Harvard Medical School, and HealthMap shows no locations offering flu vaccine anywhere, which I can personally contradict since I got my flu shot yesterday. At least some other vaccine searches seem to work, although the location list seems incomplete when it says no Walgreens in Chicago offers Tdap or shingles vaccine.

UnitedHealthcare and Anthem will end their virtual visit benefit Thursday, after which patients will once again pay co-pays, co-insurance, and deductibles for virtual visits that are not related to COVID-19. Nobody knows how much patients will have to pay or how the cost of a telehealth visit compares to the co-pay for an office visit. Other insurers that had planned to end expanded telehealth coverage on September 30 have extended the program until the end of the year.

A Spok survey of 600 healthcare professionals finds an inability to communicate effectively, remote workers, and lack of or insufficient devices have been the biggest communication problems during COVID-19. H

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Amazon announces a palm vein scanner that will let customers of in-person shops check out with a wave of the hand, which hopefully will reinvigorate the healthcare interest in that biometric technology that made perfect sense a few years ago to positively identify patients in a non-threatening way compared to fingerprints and retinal scans. HT Systems (PatientSecure, now owned by Imprivata) and Fujitsu (PalmSecure) were the healthcare players in palm vein scanning 10 years ago and I was a fan of the idea.

Not related to health IT, but fascinating and fun to watch, is this UK paramedic’s test of a 1,000-horsepower jet suit made by Gravity Industries for air ambulance response in the mountains of Cumbria. I pondered how much a private equity-owned ambulance or air flight service would charge for that trip in the US.


Sponsor Updates

  • Kyruus will host ATLAS, its Annual Thought Leadership on Access Symposium, virtually October 20-22.
  • CarePort Health wins the 2020 Tech Cares Award from TrustRadius.
  • CareSignal develops AI-powered predictive models to help providers and payers keep patients engaged with digital health programs.
  • Datica achieves top marks for interoperability solutions from Chilmark Research.
  • Everbridge announces that, in addition to Anthony Fauci, MD and Sanjay Gupta, MD, a former World Head of State will speak at its COVID-19 R2R: The Road to Recovery virtual leadership summit October 14-15.
  • Audacious Inquiry founder and CEO Chris Brandt joins University of Maryland St. Joseph Medical Center’s Board of Operations.
  • Arcadia publishes a new case study, “CareMount ACO Uses Arcadia Analytics to Build a Narrow SNF Network and Reduce ALOS by 4 Days.”
  • MassChallenge features “A Look at How OSF Health Care Teamed with Startup CareSignal to Help Their COVID-19 Response.”
  • Ellkay sponsors the BCBS 2020 Virtual Summit through October 2.
  • Experity opens registration for its half-day Virtual User Experience October 15.
  • Black Book Market Research publishes, “Top Healthcare Human Resources Outsourcing Solutions Vendors.”

Blog Posts


Contacts

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

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Morning Headlines 9/29/20

September 28, 2020 Headlines Comments Off on Morning Headlines 9/29/20

Healthcare giant UHS hit by ransomware attack, sources say

Universal Health Services experiences a ransomware attack that has locked computer and phone systems at several facilities across the country.

Startup Hims Nears a Deal to Go Public Via Oaktree SPAC

Online health and wellness company Hims prepares to go public through a merger with Oaktree Acquisition Corp., which is raising $75 million to help fund the deal.

CloudMD Acquires Majority Interest in Innovative U.S. Based Provider of Cloud Based Practice Management and Electronic Health Records with US$4.9M in Sales

Canadian health IT vendor CloudMD will acquire a majority stake in Lynchburg, VA-based EHR, practice management, and RCM vendor Benchmark Systems from AntWorks for $4.4 million.

Comments Off on Morning Headlines 9/29/20

Curbside Consult with Dr. Jayne 9/28/20

September 28, 2020 Dr. Jayne 1 Comment

Just when you can’t think 2020 can get any weirder, here comes the story of a copperhead snake that made an appearance during a patient’s televisit.

Every week it seems like there’s something more bizarre going on than there was in the previous week, and that’s really saying something when you’re in the 39th week of the year.

I’ve had another couple of surreal clinical shifts, to the point where I can’t even talk about them. Some of the issues are just medically complex and are nearly impossible to blind for HIPAA purposes. Others have been so traumatic for the care team that I don’t want to relive them in any way, shape, or form.

In that context, I was glad to have a low-key informatics weekend. I spent a good part of it being on call for an upgrade, playing the role of the “IT person who just happens to be a physician.” They wanted someone to be on call to do additional testing of any clinical issues that cropped up during the upgrade, as well as to test any hotfixes that had to be done on the fly.

Fortunately, my client is a solid organization that understands the value of a well-planned upgrade. They’ve been tweaking and enhancing their test scripts over the years to the point where they are super solid. We only had one small issue that turned up early Saturday morning, and fortunately, it was with a new feature that we just turned off while waiting to troubleshoot with the vendor on Monday morning. It was certainly different from the white-knuckled adventures that I had with my IT team in my early days as a CMIO.

The rest of the weekend was spent on various consulting projects. One was to help a startup company with their messaging, which I always find to be fun work. Sometimes the smart folks behind a great tech idea don’t fully understand how to translate their solution into the language their target audience is looking for. I did some proofing for a redesigned web site and editing of a potential case study. The most fun part of the messaging work was working with a couple of sales reps to help them hone the delivery of their pitches. Sometimes being able to correctly pronounce medical words is the difference between building credibility and being shown the door, so I hope I made a difference in how those individuals will be able to convey their message going forward.

Another project involved designing order sets for a mid-sized medical group, which has spent a lot of time trying to do the work without much success. The physicians struggle to agree on anything, and the IT team is trying to distill hundreds of different physician-specific order sets down to something manageable. The project was originated by the quality department, who was tired of trying to promote various quality interventions when physicians would just refuse to use the global set and use their own instead.

Essentially, I had to export all the order sets and compare them by specialty and by location, identifying the commonalities and analyzing data about their use. The physicians had agreed to get on board with a data-driven approach. When I’m done, we’ll have a real understanding of which order sets are used and which parts of order sets are manually altered. They actually allocated ample time to mine the data and achieve physician buy-in, so I’m fairly confident the project will be successful when it goes live in a couple of months.

I also started working on a new medico-legal project, which was at times exciting, but overall made me sad. If there’s anyone in a healthcare IT organization who believes they can take actions within an EHR and not get caught, they really should think twice. Sifting through hundreds of pages of audit trails isn’t what I enjoy doing on a beautiful fall day, but it’s important to my client to understand the havoc that their employee created. I’ve identified the impacted patients (which fortunately isn’t that extensive of a list) and the next step is to audit the individual charts to see whether the employee modified any of the data, and if so, what they modified. I also need to see what kinds of data was specifically visible and whether any of it falls into the sensitive category.

Stories like this are a good reminder for organizations to check their security settings and to make sure employees only have the minimum access necessary to complete their work. It’s not just “a HIPAA thing,” but it’s a major integrity issue when you have to notify patients that someone was caught snooping through their charts.

I’m getting things caught up and organized since I’ll be out of office for part of next week, this time taking a much-needed mental health break. From a clinical standpoint, I know there are a lot of us that have hit the breaking point and I can tell I’m approaching mine if I’m not already there. It’s time for three days in the desert to sort things out while trying not to think of COVID (although I’m sure it will be front of mind on the flights there and also on the way home).

My favorite desert escape is closed through at least 2021, so we’ll have to see whether VRBO can deliver. Regardless of the accommodations, I’m looking forward to lots of sun and fresh air with no mosquitoes or ticks involved. My traveling companion already sent a list of the cocktail supplies she’ll be bringing with her, so it’s looking to be a good getaway even if we have to shake our own martinis since we’re physicians who will be self-isolating. I’ve packed three good books to get me across the time zones and back with some reading material in the middle. One is serious, one is a book club pick, and one is the pure unadulterated madness that only comes from Carl Hiaasen.

What strategies have you used to refresh and recharge during 2020? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Blake Marggraff, CEO, CareSignal

September 28, 2020 Interviews 1 Comment

Blake Margraff is CEO of CareSignal of St. Louis, MO.

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Tell me about yourself and the company.

I co-founded the company CareSignal, which was previously called Epharmix, and I serve as CEO. CareSignal is a simple enough concept. We create device-less remote patient monitoring solutions to help support risk-bearing providers, payers, and the patients or members they serve, with a primary focus on chronic condition long-term management and support.

What led you five years ago — as a 22-year-old coming out of pre-med — to form a company in an industry that is notoriously hard for newcomers to crack?

There’s a pragmatic answer and a philosophical answer. The pragmatic answer is that I saw an opportunity to do one of my favorite things, which is to orthogonally combine technology – which, to your point, a lot of people have thought would work by itself and hasn’t — with evidence. The basis of our company is evidence first, sales second.

Philosophically, though, if I could spend my time doing anything, I want to be able to look back in one month, one year, 10 years, 50 years, and be proud of the impact it had and the scale of that impact. I think healthcare, and specifically health technology, is the best one-two punch out there.

Some wellness technology companies offer solutions that, if they work at all, won’t deliver ROI for years, when the cost savings of improving chronic conditions will finally pay off for some other employer or insurer. How do you approach a prospect who questions return on investment?

These are two really important concepts. The credibility of the argument, fundamentally, always involves return on investment. That credibility comes in the form of defensible impact clinically and then financially, but also the time horizon of that impact. Getting a person to stop smoking is a good thing, but financially it might not actually be a good thing for one, five, or 10 years.

To the people who have abused the concept of evidence-based or clinically validated outcomes — and you can bleep this in the written version — but frankly, f*** them. They are treading on one of the most elegant and powerful parts of medicine, which is the concept that you can advance the standard of care by thoughtfully conducting high-impact research and iterating on innovation in the process.

In terms of CareSignal, we announced recently that we now take risk on any contract we sign. We are confident that we can engage through all the patients, drive clinical outcomes, and return financial benefit to our partners with the time horizon of less than a year, and generally within six months. That touches on all the points that you mentioned. It’s not enough just to do it — you have to do it in a way that is financially compelling to your partner.

What portion of patients show a willingness to interact honestly with automated messages about a concerning condition, but would not have taken the initiative to reach out directly to their provider?

You are hitting on selection bias, and maybe touching on the transtheoretical model of behavior change as well. It is true that some healthcare innovations can only help people who want to be helped. That’s always true to an extent, but I fundamentally reject that as a barrier to bending the cost curve, or even engaging the vast majority of patients who need to be engaged and supported.

The argument that I provide is a simple one. When providers, meaning physicians primarily, want to effect change, they leverage this power of the prescription. There is still an element of healthcare that is relationship driven, stemming from the strong relationships that many providers still have with their patient populations. The best technology sits at that intersection of clinical and relationship.

Does the political concept of campaigning only to the undecideds make sense in population health management in focusing resources on patients who are most likely to benefit from health messaging?

I don’t have deep background, so I’m almost wary of speaking to that and I would just be pontificating on it. I will say that looking at chronic conditions, there’s kind of an ironic behavior trend that we see across our patient population and partners. Patients who are doing just fine wind up disengaging faster than patients who are experiencing adverse outcomes or adverse symptomatology. The heart failure patient who hasn’t had pedal edema or nocturnal dyspnea for months, maybe even years, is going to be much less inclined to stay engaged and to provide clinically helpful, actionable patient-reported outcomes. Whereas the one who’s struggling is going to do so more.

A well-designed system will support people who are doing just fine for the long term, but will then allow the benefit to be had by the people who decompensate or get worse, whenever that happens, and that could happen a month or a year down the road.

Does the interaction between care managers and patients in your system populate other systems, such as EHRs?

Absolutely. CareSignal can operate as a standalone system. That’s important because a lot of groups need to operationalize and prove any new partnership or investment. We integrate with Redox and have a whole lot of respect for Niko, Luke, and the team. They can integrate with any EHRs that they touch.

Providers might react to a patient’s response to automated messages by either assuming that they are fine or that they need to come in for an office visit. What other kinds of communication do you see?

Our system is white-labeled, so from the perspective of our partners and patients, it is always their system. It’s essentially a warm line that is always ready. For patients who are in that rising risk bucket with barely-controlled chronic conditions that could go south at any moment, having a direct line to the care management team that you already know is powerful.

How is your system being used differently in the pandemic?

It’s just being used more. I’m grateful for the new opportunity from a business perspective, but the whole team and I have been pretty humbled to see that it’s doing what we always thought it could do in virtual health. Telehealth is table stakes and is increasingly quite present and quite high quality, but providers especially are emphasizing the need to defend relationships and grow revenue, and sometimes the reverse depending on their financial position. It’s the long-term engagement, ideally long-term, clinically actionable engagement, that seems to speak to them as we all go through this frustrating process.

What advice would you offer to people like you who didn’t come up through the health IT ranks or who may be disappointed by its bureaucracy and long purchasing cycles?

There’s a great mental model of Chesterton’s Fence. A couple of guys come across a fence in a field. One says, “Let’s tear this down. This is stupid. This is pointless.” The other guy says, “That’s fine. You can do that, but at least first tell me why it was built.”

That’s how I approach a lot of the conversations. It can seem like there’s too little of one type of thing and there is too much of another thing that seems unnecessary. You have to understand why it was put there in the first place if you’re going to effect sustainable change that will benefit all of the stakeholders. I guess that has  brought me to the conclusion that everybody in this space deserves a huge amount of respect, if only for their patience and often their iterative investment in a pretty weird industry over the past decades.

What is good and bad about how investors may take a company in a different direction that it originally planned?

Founders have to remember that investment is a means to an end. Folks who want to raise money so that they can raise money … most investors will not invest in that type of founder or business. More positively, I can cite investors such HealthX, UnityPoint, OSF, and others that are deep in healthcare, as well as many more that are immediately adjacent to health IT. They are run by operators and industry incumbents. It’s too complex of an industry for me to think that I can come in and figure everything out. The best investors not only provide good direction, but help you learn faster.

You started your entrepreneurial journey at a young age. What do you hope to accomplish?

Impact. Help as many people as possible live better lives and live longer lives. It comes back to the beginning. That’s what keeps me so motivated, even in a sometimes slow-moving industry, to keep pushing.

Morning Headlines 9/28/20

September 27, 2020 Headlines Comments Off on Morning Headlines 9/28/20

Allegheny Health Network, Innovation Works Announce New Startup Accelerator Focused on Health Care Technologies and Life Sciences

Allegheny Health Network (PA) and a Pittsburgh investor create AlphaLab Health, an innovation hub that will provide seed funding to companies that are involved in diagnostics, therapeutics, medical devices, and health IT.

‘Big ripple effect’: Cybersecurity issue causes problems across Neb. Med network

Nebraska Medicine officials say normal operations should soon resume across its Epic network, shared by several other hospitals across the state, as it works to recover from last week’s cyberattack.

CloudMD Signs Definitive Agreement to Acquire Snapclarity Inc., an Enterprise Mental Health Platform, Expanding Telehealth Offering to Include Mental Wellness

Canadian health IT vendor CloudMD will acquire mental health assessment and care coordination vendor Snapclarity for $2.5 million.

Comments Off on Morning Headlines 9/28/20

Monday Morning Update 9/28/20

September 27, 2020 News 2 Comments

Top News

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Allegheny Health Network (PA) and a Pittsburgh investor create AlphaLab Health, an innovation hub that will provide seed funding to companies that are involved in diagnostics, therapeutics, medical devices, and health IT.

The hub will be housed in the former Suburban General Hospital in Pittsburgh’s Bellevue community, which Allegheny Health Network has mostly closed since acquiring it in 1994, leaving only an urgent care center and outpatient clinics.

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A predecessor organization to Allegheny Health Network was AHERF, which went from running just Allegheny General Hospital to Pennsylvania’s largest health system, which include acquisitions of Medical College of Pennsylvania and Hahnemann Medical College and their hospitals. AHERF filed bankruptcy in June 1998 in what was then the largest non-profit healthcare system failure with $1.3 billion in debt. West Penn Hospital  was merged with the Pittsburgh assets of AHERF to form West Penn Allegheny Health system, which struggled to compete with UPMC and eventually sold itself to insurer Highmark, which was anxious to strike a deal since its relationship with UPMC was deteriorating. Highmark Health remains AHN’s parent. AHERF’s Philadelphia-area hospitals were bought out of bankruptcy by Tenet in becoming that area’s first for-profit hospital chain.


Reader Comments

From CIO: “Re: HIStalk. Just wanted to let you know that I still make my team read HIStalk and occasionally quiz them to make sure they do.” Thanks. Similarly, a CEO recently told me that a new investor made him promise to read HIStalk daily. I appreciate that even if I can’t really comprehend it since my view of HIStalk is an empty screen that I fill in solitude each day with whatever interests me.


HIStalk Announcements and Requests

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Vendor experience with virtual conference exhibit halls hasn’t been good. Commenters note that the volume of leads is good but the quality is not, while low engagement leaves reps starting alone at a Zoom screen for hours.

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New poll to your right or here: How has your job changed since the pandemic began? Click the poll’s comments link after responding to explain further with your anonymous thoughts.

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Welcome to new HIStalk Platinum Sponsor Newfire Global Partners. The Boston-based company partners with healthcare businesses globally to make innovation happen, such as in developing custom digital health solutions, speeding up the drug development cycle, and de-risking growth without compromising interoperability and security to turn the new normal into a durable, competitive advantage. Nearly 90% of the company’s 350 employees hold advanced degrees, working from offices in the US, Ukraine, Croatia, Singapore, and Hong Kong to offer services in advisory (assessments and due diligence, strategic marketing, interim operating roles); talent (blended teams, dedicated teams, specialized expertise); and AI-powered software development management. Healthcare-specific offerings include FHIR integration, data science and analytics, provider and patient adoption, and interoperability. Chairman and CEO Stephen Hau, MS is an industry long-timer who founded PatientKeeper and co-founded Shareable Ink. Thanks to Newfire Global Partners for supporting HIStalk.


Webinars

September 30 (Wednesday) 11 ET. “The Hidden Threat: New Research on Security Vulnerabilities and Privacy Gaps in Healthcare Apps.” Sponsors: Verimatrix, NowSecure. Presenters: Neal Michie, MEng, director of product management, Verimatrix; Brian Lawrence, direction of solution engineering, NowSecure. The presenters will present research on the security risk profile of 1,000 healthcare apps in managing patient privacy, how they compare to those in other industries, and where the biggest vulnerabilities lie. Attendees will learn how to make their healthcare apps more secure in managing protected health information.

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


People

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Ori Lotan, MD (Universal Health Services) will join MultiCare (WA) as VP / chief health information officer. 

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Central Logic hires Maija Costello, MBA (Accenture) as VP of people and culture; Samantha Endres, MBA, CPA (West Acadamic Publishing) as CFO; and Robert Zdon (RAZR) as chief marketing officer.


Government and Politics

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UT Southwestern Medical Center Assistant Professor of Radiology Lorraine De Blanche, MD pleads guilty to intentionally misleading federal agents who questioned her in a telemedicine fraud investigation that occurred while she was employed as a radiology professor at University of Arkansas. She admitted that she prescribed durable medical equipment and compounded prescription drugs without talking to the patients involved. She faces five years in prison and will pay $213,000 in telemedicine proceeds and fines. 


COVID-19

HHS takes $300 million from CDC’s budget to run a “defeat despair” advertising blitz that features celebrities and administration officials discussing the pandemic and the White House’s response to it, with airings to begin before Election Day. Interviews have already been recorded with Dennis Quaid (who has publicly praised the administration’s COVID-19 response) and CeCe Winans (who was chosen for improving messaging with black viewers). HHS spokesperson Michael Caputo said before he took medical leave that President Trump demanded personally that he create the campaign, which he says will draw ire from Democrats and “their conjugal media and the leftist scientists that are working for the government” because he’ll be running $250 million worth of taxpayer-funded ads.

A White House aide demands that FDA justify its toughened standards for a COVID-19 vaccine on the same day that the President branded the changes as a “political move.” FDA planned to release the guidance last week, but is instead working on its explanation of extending safety studies to two months after the second injection, which makes a pre-Election Day vaccine release unlikely.

Minnesota stops a door-to-door coronavirus survey after public health workers were intimidated by people who shouted ethnic and racial slurs, followed the workers, videotaped them, and threatened to call police. The mayor of one small town says it is reasonable that residents become concerned when they see a car with California plates.

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Just about all infectious disease experts warn that it will be a gloomy US winter as people move back indoors, schools and business return to some degree of normal with increasing contact, and people gather for holidays. The predicted post-Labor Day case jump is already happening. IHME projects 372,000 US COVID-19 deaths by January 1, with daily deaths increasing from today’s 780 to 3,000 (or 6,600 if mandates are eased) and ICU bed demand rising from 8,400 to 31,000. California’s HHS secretary warned Friday afternoon that he expects COVID-19 hospitalizations to double by late October.

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ProPublica reports how the CEO of a telemedicine vendor, who was also an ex-convict, convinced two South Texas elected officials to promote local government use of his telemedicine services during the pandemic and to urge other leaders to buy his unapproved COVID-19 tests.


Other

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USA Today lists several new consumer gadgets devices can serve – now or down the road — as a dedicated Zoom devices, including Amazon’s Echo Show 10 for $250, a webcam plugged into a Fire TV Cube that can be displayed on large-screen TVs, and Facebook Portal TV. Benefits include freeing up hands and computer screens for taking notes and untethering webcam placement. The Echo Show 10 even auto-frames the user with pan and zoom. It will also connect with Amazon Chime pay-per-use service for business calls and meetings. Amazon sells the Alexa-powered Facebook Portal TV for $149. I suspect remote work and videoconferencing is here to stay, so the modest investment to make it better and easier seems worth it.


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Get HIStalk updates.
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Weekender 9/25/20

September 25, 2020 Weekender Comments Off on Weekender 9/25/20

weekender 


Weekly News Recap

  • CMS is reportedly preparing to notify the 76% of US hospitals that aren’t submitting daily COVID-19 reports to HHS’s new reporting system that their Medicare payments may be halted.
  • A business associate of Community Health Systems will pay $2.3 million to settle charges that it failed to secure its systems even after the FBI warned it that hackers had penetrated them.
  • FDA launches the Digital Health Center of Excellence that will advise it on digital health policies and regulatory approaches.
  • Microsoft launches Cloud for Healthcare.
  • A KLAS Arch Collaborative survey finds that EHRs are not a significant cause of nurse burnout.
  • The Carlyle Group acquires a majority stake in global health research network TriNetX.
  • Healthcare robotic process automation vendor Olive raises $106 million.
  • Informatics pioneer Bill Stead, MD announces that he will retire from Vanderbilt University Medical Center’s senior leadership team after a 29-year career.

Best Reader Comments

A person’s birth sex matters in lab results and medications. How they feel does not and could get them misdiagnosed or possibly killed if I am asked to send how they identify in PID:8. If HL7 wants to add an additional field for delivering how a patient feels about their gender identity, Interface Engineers will deliver it, as we do with all fields. (Don’t Blame The Interfaces)

You aren’t wrong about birth mattering in some situations, but also important to keep in mind that deliberate mis-gendering or dismissiveness of patient gender identity can present a lot of harm to a patient. (Alex)

Congratulations to Dr. Stead. I had the pleasure – as many – at McKesson to work with him on the CPOE system. A gentleman and obvious scholar who was practical is his approach to many of the problems faced by physicians and informatics folks at the time. Dr. Stead, may the sun shine on your face and wind be at your back always. (Mark P)

Your employer / insurer wants to decrease your use of healthcare so that they don’t pay as much. Sending you advertising for healthcare (services) typically increases utilization. Care coordination is expensive in itself and often actually drives up utilization. The majority of Americans at this point are putting off some healthcare issue. Get them into a care management program and suddenly you’re paying for the issue they neglected for the last five years in order to make rent. Pay close attention to their issue and now you catch all the stuff that needs more medical attention. In conclusion, the answer to the question “Why don’t they X?” Is because X doesn’t make them money. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Michigan, who asked for two interactive learning tablets for her elementary school class. She reported in mid-March, “The PBS Kids tablet is a wonderful edition to our classroom. The already installed games really excite our students and help them in the areas of literacy and math. The students are also able to explore with music, art, audible stories and more. They honestly know more about the tablet than I do through exploring. We use the tablet during choice time and also during individual learning time. This tablet really helps the students to have fun, develop technology skills and learn all in one. We could not have gotten this obviously without all of you generous donors. Thank you for caring about our classroom.”

The Los Angeles Chargers team doctor punctures the lung of starting quarterback Tyrod Taylor while administering an injection into his cracked ribs just before kickoff, sending him to the hospital with breathing problems.

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Time names Johns Hopkins University engineering professor Lauren Gardner, MSE, PhD as one its 100 most influential people in the world. She led the team that developed the COVID-19 Dashboard in late January in working with first-year PhD student Ensheng Dong, MS while COVID-19 was still contained to China. Her Hopkins role is as associate professor, which seems a bit light for someone who has changed the world. 

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A Virginia TV station profiles Nigerian-born otolaryngologist Samkon Gado, MD, who played football for Liberty University, spent six years as an NFL running back, went to medical school and residency, and is now back in Virginia working in an ENT practice with his former college roommate and football teammate. His dream was medical school, not pro football, so he hoped for a four-year NFL career to pay for medical school. He finished his residency caring for COVID-19 patients in St. Louis.

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Friends and family of a former World War II Army nurse celebrate her 100th birthday with drive-by greetings. Georgia-born Virginia George says of her post-war move to Binghamton, NY, “I came here over 70 years ago and I haven’t been warm since.”


In Case You Missed It


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Comments Off on Weekender 9/25/20

Morning Headlines 9/25/20

September 24, 2020 Headlines Comments Off on Morning Headlines 9/25/20

Trump Administration Plans Crackdown On Hospitals Failing To Report COVID-19 Data

Internal government documents suggest that CMS will threaten to stop paying the 76% of US hospitals that aren’t sending COVID data daily and will also add new reporting requirements for influenza.

The Dark Overlord Member Receives 5 Years Prison Term in the U.S.

The extradited UK national is also ordered to pay $1.5 million in restitution for stealing and selling information from businesses, including hospitals.

HHS Announces Health IT Awardees Focused on Data Sharing to Support Clinical Care, Research, and Improved Outcomes

HHS and ONC award $2.7 million to four health IT acceleration projects.

Comments Off on Morning Headlines 9/25/20

News 9/25/20

September 24, 2020 News 2 Comments

Top News

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CMS will threaten next week to terminate the Medicare participation of the 76% of US hospitals that aren’t submitting daily COVID information to the new HHS Protect system, according to an NPR review of internal documents.

The pending update will allow hospitals to submit PPE and ventilator data weekly instead of multiple times per week, but it will also add several new data elements that are related to influenza patients.

HHS previously justified the need for the abrupt system switchover from the CDC’s system in July by saying that the 85% of hospitals that were reporting voluntarily was inadequate and that the White House Coronavirus Task Force requires 100% participation. Since then, only 24% of hospitals are complying with the new mandatory data submission requirements.


HIStalk Announcements and Requests

I wanted to schedule a checkup from a former provider and remembered that I have an associated Epic MyChart account that has been dormant for several years. I logged back in and it was impressive, especially compared to my experience with an academic medical center’s MyChart deployment a few years back in which I concluded that their mediocrity spanned both technical and clinical domains. This provider’s version contained useful health reminders, strong security (such as two-factor authentication), easy appointment scheduling, provider messaging, complete medical records, and the ability to update my own medication and health issues lists subject to provider confirmation. It even let me know of a study I could participate in. I would have given it a perfect score other than my submitted insurance information has yet to be verified by the provider’s office after several weeks, so I still don’t know what to expect when I show up waving my card.


Webinars

September 30 (Wednesday) 11 ET. “The Hidden Threat: New Research on Security Vulnerabilities and Privacy Gaps in Healthcare Apps.” Sponsors: Verimatrix, NowSecure. Presenters: Neal Michie, MEng, director of product management, Verimatrix; Brian Lawrence, direction of solution engineering, NowSecure. The presenters will present research on the security risk profile of 1,000 healthcare apps in managing patient privacy, how they compare to those in other industries, and where the biggest vulnerabilities lie. Attendees will learn how to make their healthcare apps more secure in managing protected health information.

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


Acquisitions, Funding, Business, and Stock

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KKR acquires 1-800 Contacts – which has branched beyond COVID-boosted lens sales with technology that allows consumers to perform at-home eye exams and to scan their glasses to generate prescription details — in a deal worth $3 billion.


People

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Nuvance Health promotes interim SVP/CIO Geoff Hook, MBA to the permanent role.


Announcements and Implementations

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NYC Health + Hospitals launches a telehealth solution for non-urgent needs, powered by NYC-based Bluestream Health.

Change Healthcare expands its pharmacy claims billing solution to include COVID-19 tests, which pharmacists can order, administer, and bill under recent HHS rules.

CareSignal offers an at-risk pricing option for its Device-less Remote Patient Monitoring, allowing providers and payers who are paid under value-based contracts to maximize their return on investment.

Redox announces new integrations with Salesforce Health Cloud and MuleSoft.

NantHealth releases APIs that will allow provider and revenue cycle organizations to connect to payers via the NaviNet Open Platform.


Government and Politics

HHS and ONC award $2.7 million to four health IT acceleration projects:

  • CRISP, which will work on using FHIR for participating in the American College of Cardiology’s disease registries.
  • MedStar Health Research Institute, which will demonstrate using bulk FHIR data extraction for research.
  • Children’s Hospital Corporation, which will develop tools to allow researchers to annotate data extracted by bulk FHIR for analytics, de-identification, and cohort assignment.
  • Missouri Department of Mental Health’s developmental disabilities division, which will implement the integration of standardized data to advance person-centered planning, outcomes, and value-based payment models.

COVID-19

A fourth coronavirus vaccine candidate begins Phase 3 clinical trials as Janssen starts testing of its single-dose regimen with up to 60,000 volunteers.

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The presidents of the National Academy of Sciences and National Academy of Medicine issue a statement insisting that pandemic policymaking, especially that involving vaccines, “must be informed by the best available evidence without it being distorted, concealed, or otherwise deliberately miscommunicated.” They add that they find that “the politicization of science, particularly the overriding of evidence and advice from public health officials and derision of government scientists, to be alarming.” 

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Helsinki’s airport deploys two coronavirus-sniffing dogs in a pilot program for voluntary passenger testing. Travelers wipe their skin, deposit the wipe in a sample, and the dogs then smell it to detect coronavirus with near-100% accuracy within 10 seconds.

California expands its home address confidentiality program that was designed for victims of violence and abuse to include public health workers, following the resignation of a dozen workers after they were harassed at home or received death threats after enforcing masking and stay-at-home orders.

Missouri Governor Mike Parson, who shunned mask-wearing in saying that most people can figure out how to stay safe without government intervention, tests positive for COVID-19, along with his wife. The state reported its highest-ever COVID-19 death total of 83 on Wednesday, although the state attributes the high number to delayed reporting of death certificates.

President Trump says in a press conference that the White House “may or may not” approve FDA’s just-announced higher standards COVID-19 vaccines, saying that the change is politically motivated and that he “has tremendous trust in these massive companies” that are developing the vaccines. The White House’s authority to override FDA decisions is not clear. White House advisor Scott Atlas, MD said in the same press conference that CDC Director Robert Redfield, MD “misstated something” in reporting that CDC blood sampling indicates that 90% of Americans are still susceptible to infection in the absence of antibodies, saying that T cells and exposure to related viruses “make the antibodies a small fraction of the people who have immunity.”

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Google Maps will add a COVID overlay that displays the seven-day confirmed COVID-19 case count per 100,000 people for each state, county, and some cities.

New York Governor Andrew Cuomo announces that the state will perform its own review of coronavirus vaccines that have been approved by FDA, saying that President Trump’s criticism of FDA’s more rigorous standards as a “political move” has led him to determine that “we can no longer trust the federal government.” The state would have little say in the matter other than determining its own rollout plan.


Other

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A US federal court sentences an extradited UK citizen who is a member of The Dark Overlord hacking group to five years in prison. Nathan Wyatt will also pay $1.5 million in restitution for stealing the data of several companies since 2016, several of them hospitals, and threatening to sell their data unless they paid a Bitcoin ransom. Among his big scores is the sale of 9.3 million patient records that he obtained by breaching an unnamed health insurer.

Specialty EHR vendor Net Health moves to a permanent Work From Anywhere model, which it says will improve recruiting, increase retention, and reduce costs. It hopes to encourage community building with virtual team meetings, CEO emails, one-on-one video meetings that include pets and kids, virtual field trips and happy hours, and development of affinity groups.

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As noted by @Cascadia: the care plan that Amazon is piloting for its Seattle-area employees posts a job opening for a healthcare-experienced Business Development Manager – Network Strategy, with responsibilities that include defining an executing a strategy for acquiring and managing provider networks; creating the highest-quality, lowest-cost referral network; and driving customer adoption via insurance company partnerships. Amazon Care, whose pilot started in September 2019, offers employees text chat with clinicians, video visits, nurse visits in the home or office, and courier delivery of medications.


Contacts

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

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EPtalk by Dr. Jayne 9/24/20

September 24, 2020 Dr. Jayne Comments Off on EPtalk by Dr. Jayne 9/24/20

An article published last week demonstrates the ability for health systems to save money though implementation of clinical decision support (CDS) tools within their EHRs. One major outcome was the ability of CDS tools to help reduce waste by reducing unnecessary laboratory tests and antibiotic prescriptions. Researchers also noted issues with CDS systems, including maintenance costs and malfunctions that could have an adverse impact on bending the cost curve.

The authors “could not draw a sound correlation between vendor-purchased or home-grown systems’ costs to their economic benefit,” however. I would go further to state the need to look at the middle choice in that continuum as well: the heavily-customized vendor system, which sometimes is closer to homegrown than not.

Further studies are needed, and one of the elements that should be included is the impact of alerts on clinicians and the time they spend managing those alerts. They also need to assess the impact on extensive computerized physician order entry (CPOE) order sets that may add orders to a patient’s record when those orders aren’t entirely necessary. There’s always a balance between the technology, the needs of the patient, the needs of the care team, and the bottom line. A well-configured EHR can make your day go well, but a poorly-managed one will be your worst enemy.

On days that I see numbers of patients that would have been considered impossible before COVID, I’m truly grateful that my organization has stripped the EHR down to only the bare essentials that are needed to document quickly, without any extraneous content. The downside to that approach is that sometimes I find myself in a situation where I wish I had a fighter jet, but I’m piloting a Stearman. I’d love to see the vendors that are bragging about their ability to create documentation through voice recognition and artificial intelligence spend a day in my well-worn shoes. I’m sure what they see would be shocking, but we can’t solve problems that we don’t understand.

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The US Food and Drug Administration is launching a Digital Health Center of Excellence within the Center for Devices and Radiological Health. Digital health technology within its purview includes mobile health services, wearables being used as medical devices, Software as a Medical Device (SaMD), and technologies used to study medical products. The FDA plans to create a network of digital health experts and to get technology to patients faster by providing technological advice, coordinating work being done across the FDA, advancing best practices, and reimagining the oversight of digital health devices.

I almost missed this one in my overflowing inbox, but apparently a new national system is being developed to track administration of the COVD-19 vaccine. Millions of people who are used to walking into a retail clinic or their local Costco and walking out with an influenza vaccine are going to be surprised by the complexity of the new coronavirus vaccine. Patients must receive two doses and the products are not interchangeable between manufacturers.

Public health officials are justifiably concerned that this new system will bypass existing state immunization registries, while watchdogs are concerned about its $16 million cost. Consulting giant Deloitte has been engaged to develop the Vaccine Administration Management System, which will use underlying Salesforce technology. It’s apparently been piloted in four states over the summer, but details are scant on what data fields are required or when states will be able to obtain access to test versions.

We’re all familiar with the COVID-related hospitalization data debacle from earlier this year, and it looks like we’re teeing up another not-so-successful deployment. Without appropriate user acceptance testing or the involvement of actual stakeholders in the field, software projects usually fail. I’ve seen this enough as a clinical informaticist and it baffles me that in such a critical moment we’re making so many systemic mistakes. Not surprisingly, patient matching is a concern in this effort. Who’s wishing we had a national patient identifier now?

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I’m practicing in a community in a surge situation, where we have been featured on several “worst places for COVID” lists. It’s not an enviable position. I’m continually challenged by patients who are wearing what are essentially “non-masks” rather than accepting one of the medical masks that we offer at the front desk. Today I saw a family for COVID testing and every single one of them was wearing a bandana. When offered medical masks by my staff, the parent declined, stating that they were only wearing the bandanas to humor our request for masks, and they refuse to wear a medical mask because they cause lung disease. Unfortunately, we’re not allowed to deny service to non-maskers.

Trying to educate around those beliefs is a losing battle, and since they were there for COVID testing, I certainly didn’t want to spend a minute longer in the room than I had to. If masks are deadly, how are any operating room nurses or surgeons still standing? Why haven’t the attorneys come calling? Kudos to Dove for its “Courage is Beautiful” video that shows what we really look like under our masks. Even though many people across the US have moved back to their normal lives, our lives (and our faces) will never be the same again.

Just when you think you’ve reached the pit of despair, you’re sometimes surprised. When a pediatric patient started crying about having a COVID test, my scribe offered to show her how it was done, and literally took off his mask and swabbed himself right there. Her eyes were wide and so were mine, and the patient went along after seeing how easy it was. I’ve never seen someone perform a nasopharyngeal swab on himself, let alone do it blind, so I was impressed. We did, of course, have a conversation about how he probably shouldn’t do that again since he was unmasked and the patient / family had no way of knowing that he recently recovered from COVID and is considered noninfectious at the moment, but it was a touching gesture.

For those of you in the clinical trenches, what has been your wildest moment during COVID? Leave a comment or email me.

Email Dr. Jayne.

Comments Off on EPtalk by Dr. Jayne 9/24/20

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