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EPtalk by Dr. Jayne 3/19/20

March 19, 2020 Dr. Jayne No Comments

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I was back in the clinical trenches today. At least in the urgent care world, it was eerily calm at times, although we did see some big rushes at the beginning of the day. People are getting the message to stay home, although some ventured out.

I want to offer some advice for those of you who need to seek medical care. First, this is not a time to take the family. If you need someone to drive you, great, but have them wait outside and not enter the facility. I saw two families today with multiple children in tow, but multiple parents. It would have been better if the second parent, who didn’t participate in the visit at all, remained in the car with the siblings.

Second, look out for your healthcare workers. If you see that something has gone wrong with their personal protective equipment, say something. Although I’m sure the worker in the picture above knows that their forearms are exposed, therefore defeating the point of a gown, maybe they would have done something different if a patient or co-worker had said something.

Third, please do not question why your provider is wearing a mask. We have our reasons, and some are personal health issues. We might also be protecting you from our cough or sneezing since it’s also allergy season. We are healthcare providers and you need to trust us to make decisions for our health and yours. I have had colleagues at other facilities that have been told they can’t wear masks because they’re “panic-inducing” for patients.

Many of your healthcare workers are terrified. If they wear the one crummy mask they have access to and have been wearing every day for a week, give them a break. Maybe they’re just scared because physicians in our area have already been infected.

Last, please think before you complain about wait times. You never know when the team is tied up transferring a critical patient to the hospital or doing another critical task, like starting the autoclave so we can get more instruments sterilized. For those patients who are coming in apologizing for being sick, it’s OK and you don’t need to apologize. That’s what we’re here for.

I was excited to hear announcements that licensure requirements for telehealth are going to be relaxed. The reality, though, is that it is on a state-by-state basis, and not all the states are playing along. I can see patients in Florida and North Carolina as well as the states where I have licenses, but we’re a long way from letting available physicians flex to cover the areas with the most need.

Most of the telehealth visits I’ve done in my off hours have been for routine things. Patients either don’t want to risk going to a physician’s office or the offices are overwhelmed and not keeping up with phone volumes. I handled some medication refills along with sinus infections, urinary tract infections, and pinkeye. These are routine things in primary care and I’m glad to be part of the solution as clinics struggle to cope with their new normal.

CMS has also relaxed telehealth rules for Medicare and Medicaid as far as which visits providers can bill. Medicaid is still subject to state regulation, so that might take time, just as with the state license issue. New federal policies also let clinicians use technology beyond established telehealth platforms, such as Apple’s FaceTime, Facebook Messenger, Google Hangouts, Microsoft Skype, and more .

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Speaking of virtual care, I practiced some virtual self-care this week as my cello instructor moved my lessons online. I had to run a cable from my laptop to the router to make it work and we experienced some distortion of the sound when I was too close to the microphone, but it worked out well. I only started playing last summer, so I smiled when I saw this article about two young cellists who played a socially distant concert on the porch of their elderly neighbor. The article mentions that their repertoire included Suzuki Book 1 and Book 2. I’m just finishing the latter, so perhaps it’s time for a concert.

From Cultural Afficionado: “Re: Google Arts & Culture. I was led there by an article about virtual tours of museums around the world for folks who are self-quarantining (is that a proper verb?) While looking over the rest of the site, I found a ‘Spotlight on Shoes’ section that included this story, ‘Amazing Shoes of Turin.’ Enjoy, and thanks for your contributions to HIStalk!” I’ve been enjoying all kinds of virtual adventures as I force myself to take frequent breaks away from scientific articles and other reports about COVID-19. My favorite video is the one of the penguins at the Shedd Aquarium in Chicago, who were allowed to roam the building after it closed to visitors. We need a little levity in times like these, and penguins always get the job done.

From Homeward Bound: “Re: telecommuting. I work for a health plan with about 2,000 employees. The organization had very little telecommuting before this outbreak. This crisis has forced a huge amount of scrambling to get hardware to people who need it, and more importantly, get management to figure out how to manage people they don’t see on a daily basis. It will be very bumpy for the time that everyone is working remotely. Work will get done, but not as much as usual. It will be interesting to see whether the old-school leadership tries to put the genie back in the bottle once we don’t all have to be remote. The lack of telecommuting has been a real negative for recruiting for a long time.” I hope managers are keeping an eye on productivity because they might be surprised. Of course it varies from employee to employee, but some of us get much more done in a non face-to-face situation. I’m sure others have trouble focusing or maintaining the self-discipline needed to work remotely. Lack of childcare is another factor in this situation compared to other work from home efforts, so if productivity dips, I hope they don’t judge too harshly.

It’s time to announce the results of my virtual Shoe-A-Palooza and Sock-It-To-Me competitions. A single champion dominated in both categories — Dr. Nick van Terheyden. In his submission, he notes: “My Scottish Leather Ghillie Brogues. Not for the whole show, but for my now-cancelled Whisky Tasting at the NextGate booth on Tuesday.”

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There’s a potential 18-month trajectory for the COVID-19 crisis, so let’s hope we get to see that ensemble at HIMSS21.

Email Dr. Jayne.

Morning Headlines 3/19/20

March 18, 2020 Headlines No Comments

RubiconMD Raises Another $18M to Connect Primary Care Physicians to Specialists

E-consult software vendor RubiconMD raises $18 million in a Series C funding round led by Deerfield Management.

Trump administration will allow doctors to practice across state lines to address pandemic

HHS will allow physicians to practice across state lines in an effort to prevent staffing shortages during the COVID-19 pandemic.

A new app would say if you’ve crossed paths with someone who is infected

MIT and Harvard researchers develop an open-source app that tracks the movements of users and alerts them if they come near someone who has self-reported testing positive for the coronavirus.

HIStalk Interviews Jeffrey Wessler, MD, CEO, Heartbeat Health

March 18, 2020 Interviews No Comments

Jeffrey Wessler, MD, MPH is a practicing cardiologist, assistant clinical professor of medicine at Columbia University Irving Medical Center, and founder and CEO of Heartbeat Health of New York, NY.

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Tell me about yourself and the company.

I’m a cardiologist by training. I started Heartbeat Health three years ago with goal of bringing a virtual care model to cardiovascular disease. Virtual care has evolved from telemedicine only as a platform, then urgent care chatbots, then some of the singular disease verticals such as diabetes. Now with Heartbeat Health, we have a chance to take on some serious disease processes, such as cardiovascular disease.

Little of a cardiology practice’s work is preventative, right?

That’s right. The majority of cardiovascular care happens after patients get sick. They get referred into the system after they have had a heart attack, uncontrolled blood pressure, or resistant symptoms. That made sense 20 years ago, when we really did need to focus our resources on treating those who had advanced disease.

But we’ve gotten pretty good at that as a field now. The advanced treatments are amazing and they work really well. The next phase, and where the ball is now, is now to keep people out of that advanced disease, emphasizing early disease management and prevention. That is the huge missing component with the care system.

Standalone healthcare apps tend to move the overall needle very little, so you have integrated your platform with your cardiology practice that provides the hands-on component. How do you see the company scaling?

What makes cardiology different than, say, weight loss management or exercise management is that these are really sick patients who need physical care. It’s this hybrid model of virtual when you can, digital when you can, but then get patients to the right care at the right time when they need it. 

By that, I mean the physical care environment for diagnostic testing, in-person evaluation, and hospitalization if needed. Being able to navigate between those two settings is really not done in the market right now. That’s our sweet spot — how to get people to the right place when they need it and everything else managed via the app.

You are offering services to employers and individuals. From the individual’s perspective, how would that work for someone who doesn’t live in New York City?

The best way to think of the New York office is as the test kitchen or the R&D lab for our clinical experience. But across the country, you would download the app, go through the risk assessment and data collection phase, undergo a tele-visit to speak with the doc and discuss the specific results — what the risk factors are, what they mean, and what the necessary next steps are. Then we would get you to a Heartbeat preferred partner who can do a stress test or arrhythmia monitoring as needed, then get that information back into the app for ongoing management.

The physical care happens very successfully in cardiology across the country. It’s just that too often, the wrong patients are getting to those doctors. By that, I mean not necessarily the right time or the right level of patient getting to the right specialist. That’s where we step in and say, it doesn’t matter where you are — California, Nebraska, Florida – the key step that we do is getting your data, interpreting it, organizing it, and then telling you and showing you where to go.

Do cardiology practices see Heartbeat Health as a competitor or a potential partner?

As a cardiologist, I’ve given a lot of thought to this. My goal is to become a partner for the highest quality cardiologists across the country. I have incredible respect and admiration for the level of work that’s being done. I want to make their practice habits better, faster, and easier, to trim some of the inefficiencies and administrative burden of what happens when you get the wrong patient and have to figure out parts of the care model that you’re not necessarily best at. Let’s focus you to get exactly who you want to be as a cardiologist and get you to do your best care. In that sense, I think Heartbeat really is a friend and a partner rather than taking business from them. We’re helping to augment their practices.

Will you integrate wearables, EKG, and monitoring solutions?

We are leaning heavily into the wearables and the device landscape. This is such an exciting part of the field right now. We have all of these consumer devices — the Apple Watch, AliveCor, Omron blood pressure cuffs – and cardiologists don’t really know what to do with that information yet. There are now hundreds of thousands of patients with Apple EKGs who are asking, what does this information mean?

This plays a role in how we find the high-risk individuals based on those wearables, identify what that information means for their care pathway, and determine when it’s relevant. This is a layer of service that is being provided on top of the devices to cut out some of the unnecessary data, focus on the relevant and important ones, and then use it to help people and help patients get into the right care.

Atrial fibrillation is probably the highest profile cardiac condition now that consumer devices like the Apple Watch and AliveCor issue warnings to users. How do you manage those newly worried consumers?

This is a very hot topic right now. You are wise to be identifying it as a real issue. The first answer is, we don’t know yet what to do with asymptomatic patients who are being diagnosed with AFib because of an Apple Watch or an AliveCor. All of the guidelines for stroke prevention and heart rate and rhythm control have been done in patients in whom we know that the atrial fibrillation is causing problems. That is mainly symptomatic patients, those with elevated stroke risk due to age or comorbid conditions, high blood pressure, diabetes, and prior strokes. These patients are fundamentally different than an otherwise healthy person who is being diagnosed with AFib through a screening device.

This group needs to studied rigorously, and Apple is working on that. They just launched their first important study, the Heartline study, which is focused on older adults wearing Apple watches and what to do with those who are diagnosed with AFib.

But our best guess of what to do with the younger population is to take the arrhythmia or the AFib that is diagnosed by the Apple Watch and use it to focus on modifiable risk factor controls. Make sure blood pressure stays controlled, make sure cholesterol stays controlled, make sure these patients are exercising and eating well so they don’t develop diabetes. In that sense, use AFib more or less like a elevated risk factor that gives us indication of a higher risk of cardiovascular events or heart disease, but one that we can work hard on reducing if we can control everything else that’s modifiable.

Health apps often fail to change user behavior and are abandoned quickly once the novelty wears off. Do you have an advantage in having self-selected people with cardiology concerns, or do you need to use psychology to keep them interested?

I am a huge skeptic of behavior change apps. I think they have proven time and time again that they can work for very short periods of time, but have no sustained, long-term results.

My hypothesis, and where Heartbeat stands in this challenging landscape, is that it is important to establish a care environment. In particular, a patient-doctor relationship, in which an expert in the field with clinical experience can discuss one-on-one with a patient – face-to-face in our case — what your specific risk factors are, what they mean, why they affect the heart, and based on thousands of patients before you, what happens if left uncontrolled.

The tele-visit sets the stage for downstream adherence, engagement, and going to follow-up appointments and diagnostics. It’s a relationship-based intervention, not dissimilar to coaching, but we think of it as clinical coaching. Patients are more likely to do something and to follow through into care when the doctor explains the importance or the relevance of this condition rather than just an app popping up and saying that it’s time to stand up, go for a run, and eat well.

How does the model work from an insurance perspective?

By being an enterprise-based business model where the self-insured employer or the payer is sponsoring this as a benefit, we refer to people within that network. The advantage of that is that we can focus on finding providers that are doing high-quality care. For us, that means following evidence based-guidelines. Not using the diagnostics that will net them the most fee-for-service money, but the ones that are appropriate based on conditions and risk factors. In doing so, this is the classic value-based play to the payer. We can improve outcomes at a reduced cost, and therefore by starting with Heartbeat, we can guarantee a value-based process, lower events at lower costs.

Will be be a challenge to accumulate enough outcomes evidence to get employers to have confidence that their cost of offering the service will be offset by benefits?

Wellness interventions are in a rocky territory right now. Most people are getting wise to the fact that they don’t really provide clinical benefit. We take that head on by saying, if you want to provide clinical benefit, go after the people that you can demonstrate clinical outcomes on.

Our first layer is to identify those high-risk patients. This is the hot-spotting concept. It has come under fire a little bit lately because the data is not necessarily bearing out what everyone thought would be the case. But for cardiovascular disease, if you take high-risk people and those with comorbid conditions and elevated cardiovascular risk if not early disease, those are 100% the people who are leaving to the cost centers of these healthcare employers and payers with heart attacks, arrhythmias, heart failures, hypertensive crises, and ED visits for chest pain. These are very predictable numbers. If you can get ahead of it and get these patients early care, we can predictably reduce those episodes. That comes with really tremendous cost savings.

Do you have any final thoughts?

The landscape of digital health is changing. We have landed at a place where wellness and digital solutions are coming under fire. The disease-specific ones are starting to work, mostly in the diabetes prevention space, but we are left with this next era of digital management, which is, what do we do when patients actually get sick and need, quote, “traditional healthcare?”

This is the area that I’m incredibly excited about and that Heartbeat Health is taking on. When patients move from digital-only solutions into the traditional care system as they’re getting sicker, how can we get in there and try to halt the disease progression process, provide some online app-based and virtual touches to early care and early progressive management so that we can prevent these outcomes? This will be the next decade of digital healthcare, using it to manage those patients who need it the most.

Morning Headlines 3/18/20

March 17, 2020 Headlines No Comments

Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency

HHS OCR will not assess penalties on providers who use non-compliant communication technologies to provide telehealth services during the COVID-19 public health emergency.

As Coronavirus Spreads, a Telemedicine Company Raises $60M

AmWell raises $60 million in equity, according to a recent SEC filing.

Medicare Telemedicine Health Care Provider Fact Sheet

CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic.

LOINC Prerelease Terms

LOINC publishes codes for COVID-19 lab testing.

News 3/18/20

March 17, 2020 News 1 Comment

Top News

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HHS OCR won’t assess penalties on providers who use non-HIPAA compliant communication technologies to provide telehealth services during the COVID-19 public health emergency. This relaxation of rules applies to all healthcare services, not just those that are related to COVID-19.

Providers can use any form of personal audio or video communication, such as FaceTime, Facebook Messenger, Google Hangouts, and Skype.

Telehealth services may not be delivered via public-facing apps like Facebook Live, Twitch, and TikTok.


Reader Comments

From Convener: “Re: conference bridges. Is anyone reporting that they are giving busy signals?” The free services like the one I use – which make money by charging AT&T using a “last mile” telecommunications loophole that AT&T hates passionately – have complained that AT&T has blocked their customers from using the conferencing services following an FCC rule change. I haven’t heard anything otherwise. The demands placed on videoconferencing services for online meetings and education must be incredible, leading to rampant (but unfounded so far) speculation that they will “break the Internet,” along with heavy use of streaming video and audio by folks newly assigned to work from home. Microsoft Teams went offline for several hours on Europe’s first work-from-home day.


HIStalk Announcements and Requests

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Poll respondents said they want to see more COVID-19 news and reports from the field on HIStalk. I’ll tread lightly in covering just the most important items.

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I’ll add the COVID-19 items as a separate section and continue soliciting reports from the field, as on my open survey. It would be great to get provider entries that could benefit a lot of patients and healthcare workers.

I was thinking as I saw photos of under-40 folks packing bars, concerts, and beaches that perhaps they are frustratingly uninformed or irresponsible, but then I went to the dark side and pictured them convening  “boomer remover” gatherings to exploit their lower coronavirus mortality risk to extract revenge on their elders for mismanaging their economic or environmental futures. I bet Stephen King is working on that novel as we speak.


Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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


Acquisitions, Funding, Business, and Stock

I’m studiously avoiding watching the stock market, especially when it comes to my 401(k), but here’s how some publicly traded health IT-related stocks have performed over the past month, compared to the big market indices (at Tuesday morning’s market pre-open):

  1. Teladoc (up 4%)
  2. Premier (up 3%)
  3. NantHealth (down 18%)
  4. Vocera (down 18%)
  5. Cerner (down 21%)
  6. Livongo (down 26%)
  7. McKesson (down 28%)
  8. Nasdaq composite (down 29%)
  9. S&P 500 (down 29%)
  10. Dow Jones Industrial Average (down 31%) 
  11. CPSI (down 32%)
  12. Nuance (down 35%)
  13. Inovalon (down 35%)
  14. Allscripts (down 41%)
  15. Health Catalyst (down 43%)
  16. Castlight Health (down 44%)
  17. Change Healthcare (down 45%)
  18. NextGen Healthcare (down 53%)
  19. Evolent Health (down 68%)

An investor’s New York Times opinion piece predicts big problems for companies that piled up debt when borrowing was cheap, with the pandemic-demolished sectors of auto, hospitality, and transportation being the worst offenders. The author also says that companies that have been taken private by private equity firms carry debt averaging six times their earnings, leading to “zombie” companies that don’t generate enough profit to pay even the interest alone.  


Announcements and Implementations

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LOINC publishes codes for COVID-19 lab testing.

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OptimizeRx launches a free consumer text message alert program that delivers CDC-issued COVID-19 information to any SMS-enabled device. Text VIRUS to 55150.

Collective Medical offers free use of its ADT-based collaboration network through the end of 2020 to help with COVID-19 response. Healthcare organizations can go live on its lightweight solution in less than one week without cost or obligation for the rest of the year. It offers frontline providers quick identification of high-risk patients.

Asparia develops a COVID-19 tool for Epic App Orchard that contains three elements: a chatbot appointment scheduler, a patient questionnaire that alerts staff of possible infection risk, and enhanced appointment reminders that can extend character limits to allow including enhanced education and instruction. The app won’t be listed on App Orchard for several weeks, but can be requested through Epic or Asparia.

T-System will provide free influenza and COVID-19 T Sheets to providers that include point-of-care documentation, diagnosis, and treatment tools that incorporate the latest CDC guidelines. Templates are available for ED, pediatric ED, and urgent care.

Bluetree publishes a COVID-19 resource page that includes ideas for leading remote projects, developing reporting functionality, and clinical decision support build workflow.

Healthwise creates a Coronavirus Resource Center of consumer-friendly educational information and care instructions that are free to all.

Meditech offers Expanse Ambulatory customers use of its Scheduled Virtual Visits functionality for six months at no charge.

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The White House’s Office of Science and Technology Policy joins Microsoft, Chan Zuckerberg Initiative, and other groups to create a COVID-19 open research dataset of scholarly literature. The groups have issued a challenge for AI experts to develop text and data mining techniques to help scientists answer high-priority COVID-19 questions.


Government and Politics

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CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic. Medicare can pay for office, hospital and other visits via telehealth, unlike previously when those visits were covered only for patients in rural areas. Payment will be the same as for in-person visits.

Hackers attack HHS’s computer network in what insiders say was an attempt to undermine the government’s response to the coronavirus pandemic. It appears to have been a distributed denial of service attacked that was quickly stopped.


COVID-19 News

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England’s Imperial College COVID-19 response team self-publishes a paper whose impact is reverberating around the US and UK, with the White House getting an early look a week ago that may have influenced its 180-degree turnaround in how the pandemic is viewed and managed. The team describes two strategies for the two countries: mitigation (flattening the curve to reduce peak healthcare system demand) and suppression (reversing growth and case numbers in an indefinite program will awaiting development of a vaccine). Summary points:

  • Mitigation, such as home isolation of suspected cases and social distancing of high-risk people – is not preferred. It could reduce peak healthcare demand by two-thirds and cut deaths in half, but would still result in hundreds of thousands of deaths and overwhelmed hospitals, particularly in terms of ICU beds.
  • Suppression, as was practiced in China, requires social distancing of the entire population, home isolation of cases, and household quarantines, possibly supplemented with closing all schools. The practice would need to continue until a vaccine can be developed and produced in adequate quantity to treat the entire population, which could take 18 months or more. A compromise may be to regionally relax and tighten social distancing based on public surveillance case numbers.
  • In the absence of any action, the computer model suggests that peak US deaths will occur in June, 81% of the population will be infected, and 2.2 million people will die (not counting those whose deaths from other causes are related to overwhelmed hospitals). ICU bed capacity will be exhausted by the second week of April and demand will peak at 30 times the available number of ICU beds.
  • A strong surge is likely again in the fall, so action now is urgent.

The government of Spain temporarily nationalizes all of the country’s hospitals and private health providers.

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A hospital in northern Italy whose supplier ran out of oxygen mask valves uses 3D printing to create its own. The original is on the left, the 3D printed version is on the right.

A Premier survey of 179 skilled nursing / assisted living facilities finds that two-thirds of them can’t get personal protective equipment such as masks and face shields. Distributors have addressed shortages by allowing customers to buy quantities consistent with their historic usage to prevent hoarding, but many senior living facilities have never needed any until now and thus can’t get any.

Positive news:

  • Scientists across the world are anecdotally reporting preliminary, sporadic success in treating COVID-19 with old drugs that were developed for something else. That’s a common story in pharma, and while individual patient impact may be limited, such treatment carries minimal risk and – like the HIV/AIDS fight in the 1980s and cancer today – provides encouragement that progress can be made even in the absence of guaranteed prevention or a complete cure.
  • Regeneron says it plans to start widespread testing of an antibody treatment by summer. Former FDA Commissioner Scott Gottlieb, MD urges a “Manhattan-style project” to accelerate the rollout of this and similar antivirals that could be first used to protect healthcare workers and high-risk people.
  • China and South Korea are reporting greatly diminished numbers of new cases, although their success is attributed to widespread testing and social limitation that was not done in the US.
  • High-throughput testing systems are coming online in the US, with the new rate-limiting item being the supply chain for reagents and swabs.
  • The US Army’s advanced medical technology group publishes a pre-solicitation notice for developing COVID-19 testing technology, studying repurposed drugs that could offer effective treatment, creating AI models that can track spread, and implementing patient monitoring technologies.
  • Scott Gottlieb concludes, “We’ll remember spring of 2020 as a very hard time. It’ll change the way we do things, but it will end either by nature or at hand of our technology. We’ll get through this together.”

Other

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I ran across the COVID-19 online screening tool of Medical City Healthcare (TX), which offers a slick questionnaire powered by Zipnosis. I intentionally answered just enough questions positively to make my diagnosis uncertain, after which it offered one-click access to a free online virtual visit for screening. Medical City Virtual Care offers visits for minor conditions such as pink eye, lower back pain, diarrhea, and yeast infection for $45. I saw it from the consumer’s point of view and was impressed.

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Nashville-based Center for Medical Interoperability was awarded a $3 million grant from the CDC last year to extract EHR information from hospitals that would allow CDC to monitor the inventory and demand for personal protective equipment, but hospitals haven’t been willing participants. According to Melanie Thomas, CIO of pilot site Nashville General Hospital, “It’s difficult and scary sometimes to share data and equipment, especially with your competitors, because you want to have the advantage.” She says it’s easier for her taxpayer-funded hospital to share information because they don’t have the money to stockpile masks and gowns anyway. CDC has added $600,000 to the project’s funding and is hoping for an accelerated go-live schedule starting in May, with participation optional.

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Cerner announces the actions it is taking in response to COVID-19, including creation of a client update web page:

  • Employees who jobs allow them to work from home are asked to do so from March 16-30, with extensions possible.
  • Offices will remain open for employees who need to be physically present, but social distancing strategies will be implemented.
  • No non-critical and international travel is allowed.
  • Employees who are returning from high-risk locations or cruises are required to work from home for two weeks.
  • Critical travel will continue for clients who want Cerner people on site, but higher-risk employees (over 60, immunocompromised, those with chronic conditions, and those exposed to high-risk others) have been asked to avoid travel.
  • A COVID-19 update has been pushed to Millennium clients, while Soarian clients already have strong communicable disease screening tools.
  • Ready-to-use, staffed telehealth services will be offered to clients via Amwell.

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The local paper profiles Sentara Healthcare professional development specialist Heike Nicks, MSN, RN, who worked with IT and nursing employees to automate the process of screening newborns for inherited disease, including sending blood samples to the state lab and getting results back within five days. She got the idea from a commercial product, but Sentara ended up enhancing its EHR to collect the needed information and to process secure messages.

Newport, OR’s police department urges residents to stop calling 911 when they run out of toilet paper. The department added a lengthy, humorous list of alternatives.


Sponsor Updates

  • Integration technology vendor Summit Healthcare partners with data management vendor BridgeHead Software to offer healthcare data extraction and consolidation services.
  • The Jacksonville Business Journal profiles The HCI Group’s hiring and expansion plans.
  • KLAS recognizes Imprivata as one of the 2019 “Revenue Cycle Unicorns” in its latest performance report.
  • Omni-HealthData parent company Information Builders embraces FHIR to harness and harmonize data across healthcare systems.
  • OptimizeRx offers a free interactive text message alert program that delivers COVID-19 information issued by the CDC.
  • Netsmart postpones its Connections 2020 event originally scheduled for March 29-April 1 in Denver.
  • Avaya offers complimentary work-from-anywhere contact center solutions to help address COVID-19 challenges.
  • CompuGroup Medical offers its CGM ELVI Telemedicine service for free to medical providers.

Blog Posts


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Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Morning Headlines 3/17/20

March 16, 2020 Headlines No Comments

Alphabet’s Verily launches a limited coronavirus screening website

Verily pilots a COVID-19 resource, screening, and testing website for Google account holders in the San Francisco Bay Area who agree to sharing some of their data with the company.

Cyber-Attack Hits U.S. Health Agency Amid Covid-19 Outbreak

HHS recovers from a Sunday cyberattack in which its servers were overloaded with hits over the course of several hours.

Tempus Announces $100 Million in Series G Financing

Cancer-focused precision medicine company Tempus will use a $100 million investment to expand into new consumer markets and offerings for diabetes, depression, and cardiology.

Telemedicine companies are struggling to serve ‘extreme volumes’ of patients as coronavirus calls surge

Patients face virtual care delays as telemedicine companies experience IT glitches and staffing shortages due to COVID-19-related visits.

With launch of COVID-19 data hub, the White House issues a ‘call to action’ for AI researchers

The federal government releases the COVID-19 Open Research Dataset, a machine-readable collection of constantly updated scientific literature that health officials hope AI researchers will use to uncover new insights into COVID-19’s incubation, treatment, symptoms, and prevention.

What Are Your Health System’s Coronavirus Reports and Tips?

March 16, 2020 News No Comments

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The US healthcare system is reacting to the coronavirus threat. For those who work in health systems, what have you learned, what IT advice can you share, and what are you seeing from the front lines?

Curbside Consult with Dr. Jayne 3/16/20

March 16, 2020 Dr. Jayne 3 Comments

Mr. H recently published a reader comment that asked for more COVID-19 news that isn’t necessarily healthcare IT specific. While he waits for responses to his poll about the issue, I’m going to go with the leading response and share some reports from the field.

The American Medical Association recently published “A physician’s guide to COVID-19” that I will use it as the framework for some comments. Before I begin, please note that the comments below are not necessarily my own. Some have been culled from my personal Facebook feed, text messages, and chats with friends. All are presented anonymously. They are the words or thoughts of the individual physicians, nurses, medics, techs, and frontline folks and in no way reflect the opinions of their employers. Readers, please excuse my digression from the usual, because what we are experiencing right now is anything but usual.

Communicate your COVID-19 updates and details about your preparedness plan with both staff and patients.

  • OMG, the president of our medical group just went on TV and bragged about our testing capabilities at the same time an email went out to the staff that said that we were not telling the public we could test. #cluster
  • TV reporter knew more about hospital plan than MDs did.
  • Admin is more focused on updating the EHR (which they did without telling us, then had to roll it back, then updated again without so much as an email). Makes us feel unstable and vulnerable and we don’t need that right now.

Take measures to keep “Persons Under Investigation” (PUI) and others with suspected COVID-19 symptoms separate from the rest of your patients.

  • We are a walk-in facility and we don’t know whether a person is high risk until they’re at the front desk with the receptionist. They are taken to the first available exam room and the door is marked with a Post-it to let people know they’re high risk. The medical assistant and physician who see the patient put their initials on the Post-it so that no one else inadvertently walks in. Anyone else think this crazy low tech? What if the sticky falls off?
  • Our office canceled all well visits and are seeing sick only. They have to call and be triaged by RN or provider. They wait in their cars and we text them when they can come in.
  • It’s still flu season. Who has symptoms that DON’T look like coronavirus?

The CDC recommends specific measures to minimize the spread of infection that include: proper use of PPE, including eye protection.

  • LOL! We haven’t reliably had masks in clinic since February. Admin seems to think that outpatient departments don’t see sick people. No gowns and no face shields, either. Other hospitals have drive-through testing clinics with nurses in full PPE reaching through car windows. We’re swabbing patients in our street clothes. No showers at work and nowhere to change. Most of us are stripping in our garages before going straight to a hot shower at home. I haven’t seen an N-95 mask since residency.
  • Why do nurses in China have three layers of protective gear but I can’t get a disposable gown?

Misinformation about COVID-19 is being shared across social medial and other platforms at alarming speed. Physicians have a duty to correct dangerous and misleading myths that could harm patients’ health. Read the biggest misconceptions.

  • I continue to encounter people who think this is all media hype or a political tool. Do they really think that millions of people in Italy give a damn if this makes Trump or anyone else look bad?
  • OMG. If I see one more post about “quarantine babies” nine months from now, I want to scream. As an OB/GYN, does anyone remember Zika Virus? We don’t know what this virus will do to a developing fetus. Use protection, people!

I worked today, and it was a rough one. Although patient volumes were (thankfully) down by about one-third, nearly every visit involved an in-depth discussion about risk factors for coronavirus infection. I had to counsel multiple patients that they should not go visit their grandparents or other elders, even if feeling well. Probably half of them seemed to take my advice, the other half plan to do it anyway.

People were still asking if they should take spring break trips, despite footage of the crushes of travelers at O’Hare and DFW airports all over the news. Friends texted from Colorado, miffed that the ski resorts were closed. I mentioned that hospitals there are communicating with physicians that they are past containment in the state, moving to a strategy of mitigation, where only hospitalized patients would be tested. It will just be assumed that symptomatic patients have it and need to be quarantined and managed at home if they are well enough. Patients are upset that elective procedures have been canceled, and apparently Sunday at the urgent care is the place they have chosen to try to get their issues addressed.

We’re still in early days with this pandemic in the US and the stress levels I’m seeing are off the charts. People are using humor to try to get through, but as a veteran of a Level 1 trauma ED, I can tell it’s a mask for some who are really scared. I’m in a lower acuity setting now, but I can’t imagine what this is going to look like over the next 30 days.

Workers in non-healthcare environments are also stressed, including supermarket employees and restaurant workers. Parents don’t know what they’re going to do for childcare when schools close. People living paycheck to paycheck don’t have the means to stock up on supplies. Han Solo would definitely have a bad feeling about this one. I’m sure we’ll all find our new normal, but it’s going to take some time.

I had intended to judge the results of the non-HIMSS shoe and sock contests tonight, but after I came home, worked through my well-planned decontamination routine, and then discovered my hot shower would be hampered by a broken shower head that was akin to standing under a garden hose, I was just done. I have plenty to be grateful for – I’m not working the intensive care unit, I’m not working a big-city trauma service, and at least part of the time I can work from home. I have plenty of non-perishable food and I know how to recognize good leaves and bad leaves in case I need to operate without toilet paper. My sense of humor is still intact, or at least I hope so.

What has changed in your life in a post-COVID world? Leave a comment or email me.

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Email Dr. Jayne.

HIStalk Interviews Jay Desai, CEO, PatientPing

March 16, 2020 Interviews No Comments

Jay Desai, MBA is co-founder and CEO of PatientPing of Boston, MA.

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Tell me about yourself and the company.

I’m CEO and co-founder of PatientPing. Prior to starting this company, I worked at Medicare at the Innovation Center and helped support many of the value-based care initiatives there – ACOs, bundled payments, and a number of the new payment models.

I started this company in September 2013. PatientPing is a care coordination platform. We have a number of products. Our flagship product, Pings, delivers real-time event notification when patients have admissions, discharges, and transfers at emergency rooms, hospitals, skilled nursing facilities, home health agencies, and a number of other sites of care.

How widely are ADT notifications being used?

It has really matured as an industry and as a problem that is being solved across the country. For several types of organizations, ADT notifications are becoming a critical part of their infrastructure to do their work. Accountable care organizations, in particular, those that serve Medicare and Medicaid patients that have frequent visits to the emergency room or the hospital. On the Medicare side, skilled nursing facilities, home health agencies, and other post-acute care providers. I don’t know if I could say explicitly the majority, but a large number of ACOs are using event notifications to do their care coordination activities.

A lot of the opportunities for medical management, improvement of quality, and cost savings tends to be when patients are repeat visitors to the emergency room. That’s an opportunity to prevent a subsequent ED visit by engaging them in after-hours primary care, urgent care, and things like that. At least informing them that that’s available to them to avoid a future visit.

Then on the post-acute care side, there are opportunities to reduce skilled nursing length of stay and have patients treated in home care as opposed to skilled nursing. Those are cost savings opportunities in lower-acuity settings for patients to get the same amount of recovery or hopefully the same speed to recovery. Those alerts are important to be able to trigger those workflows that drive the care coordination that ultimately drives the outcomes.

That’s on the ACO side. More broadly than that, health plans are using notifications. Primary care groups often are doing it for their transition of care activities. Hospitals are using it for their readmission reduction activities. Bundled payment organizations are using it for some of their initiatives. But I think we’re seeing the most widespread adoption among ACOs.

How has your solution avoided being bogged down in the competitive, technical, and cost issues that have hampered interoperability in general?

The need was apparent to me seven or eight years ago. ACOs that we were supporting were very keen to know when their patients went to different providers. I wouldn’t say that it was widespread, commonly accepted, or appreciated that hospitals didn’t feel that it was competitive information that they were sharing, say, with a competitor hospital that had a value-based care program.

Say you’re a big health system within a region. Your patient goes to your #1 competitor within the region. Then that competitor has patients that come to your hospital. In the early days of trying to build this organization, it wasn’t the easiest conversation to convince both of them to share ADT feeds, even though it is just ADT feeds and it’s a pretty lightweight set of information. That kind of notification is already happening, often between hospitals and primary care providers. But it wasn’t that easy.

It has gotten easier over time, where people say, I’m OK with sharing ADT because I need to receive that information, recognizing that I probably need to give it up if I’m going to receive it. We’ve had this conversation with thousands of hospitals many, many, many times over the years. The industry has evolved to the place where there’s more comfort doing it.

Some groups in many parts of the country still aren’t that excited or comfortable with notifying the community PCP, their competitors’ PCPs, or value-based care organizations that they have one of their patients. But it’s a lot more common and folks are more willing to do it.

You had a limited rollout the last time we spoke three years ago. Now that you have established the network and created trust, will you wrap more services around that same connectivity that you use for Pings?

The business has matured quite a bit. We have ADT feeds from over 1,000 hospitals across the country of a denominator of 4,000 to 5,000. We have about 4,000 to 5,000 post-acute care providers that are providing us their ADTs, skilled nursing and home health. That’s the senders of ADT.

We have close to 1,000 provider organizations receiving electronic notifications. That includes ACOs, health plans, Federally Qualified Health Centers, and post-acute providers that have an interest in knowing when the patients go to those 1,000 hospitals and 4,000 to 5,000 post-acute providers. They represent over 10 million patients. The business has scaled quite a bit. We have encounters that are being tracked by providers across the country, at sites across the country. It’s kind of neat to see the network grow.

We think about the future as this. ADT is a really great data source. Every ADT is an opportunity to help a patient who is having an emergency room visit, is being hospitalized or discharged, or is being transitioned to a skilled nursing facility. Every one of those encounters is an opportunity to wrap around products and services to ensure that the care transition is happening more safely and smoothly.

As an example, a patient shows up in the ER. We may know that they have had several other ED visits, they may have had prior utilization of a skilled nursing facility, they’re currently on VNA, or they have an affiliation with an ACO care program. The care coordinator at the hospital or the emergency room is left with the decision of how to best support that transition of care. We think that with the historical context we have on that patient, some of the knowledge we know about their whereabouts, can support that care manager’s decision on what to do next. That could be supporting a care transition and linking that patient into the care program that is most beneficial to them. That could come through a range of products and services.

We are excited to be able to continue to make sure that every one of those admits and discharges and the subsequent care they receive is high quality and safe.

What are hospitals required to do with notifications under the new CMS rule?

The CMS rule contains a number of provisions. The one that we’re focused on is the conditions of participation for electronic notification. They are requiring all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. They are very specific in terms of what is considered the patient’s established care team. They are also very specific about the information that must be included in that notification.

One key provision is a six-month implementation timeline. Hospitals need to have a system to provide these notifications by September 9, 2020.

How would they meet the requirements without using PatientPing?

Hospitals will have two categories of notification recipients. One is the patient-identified practitioner. A patient comes to the hospital and says, “My doctor is Dr. Desai.” The hospital has the burden to send the notification to that particular provider. That typically happens through EHR workflows. The EHR will have an active directory where they can look up the email address or other provider contact information and then send the notification through.

That often happens at discharge through the transition of care document, the CCD. There are established workflows to send ADT alerts to the patient’s designated provider. Companies like ours don’t necessarily help with that. EHRs typically do a pretty good job with sending those notifications directly, as identified by the patient.

This rule includes a second category, recipients who have a need to receive the notifications for the purpose of treatment care coordination and quality improvement. They narrow it even further to say entities affiliated with the patient’s primary care practitioner as well as post-acute service providers and suppliers with whom the patient has an established care relationship. Entities affiliated with the patient’s primary care providers will include groups like their primary care practice. Their affiliated accountable care organization that is a function of their primary care relationship. It may include groups like their Federally Qualified Health Centers or the independent physician association that their primary care provider is a part of.

Hospitals will need the capability to deliver notifications to those groups. That is different than just sending a notification to the patient’s designated doctor. It’s more driven by a roster or a panel. If I’m the ACO, I may have a roster of patients and I want to watch the ADT notifications that are being rendered. I then want to do a match between those two and then send a notification.

To do that, a hospital probably will benefit from having essentially a router of those ADTs that can compare the list of patients against those ADT messages that are to be generated. They may need more than one router. They may send their data to their HIE that delivers data locally within their region. They may send their data to a national network like ours that provides notifications outside of their state. Or they may have their router point the data to wherever it needs to go. But there are a number of stakeholders that may be out there in the communities surrounding the hospital that have an interest in knowing when the patient shows up at that hospital, and they have a valid reason to do that.

This will be particularly relevant for some of the larger academic medical centers that are referral sites for many patients across the country. Cleveland Clinic, Mayo Clinic, and Hospital for Special Surgery receive patients from all over the country. There may be providers out there in the community who have an interest in knowing that the patient is presenting at that particular hospital. Service providers can help route that notification through to the various endpoints where it needs to go.

Do you have any final thoughts?

The CMS and ONC operability rules are totally groundbreaking. I’m excited about what they will do for patient care. CMS and ONC had a lot of hard decisions to make, and I’m impressed by their commitment to supporting patient care, care coordination, and quality improvement. Many hospitals have been thinking about this and putting solutions in place.

We think this will create a broader national framework under which this information is going to flow. We’re excited about that. We’re excited to support it and be part of the solution. Obviously we won’t be the only solution. We’re excited to be part of this solution and we think that there’s going to be a lot of good things that happen for patient care as a result.

We’ve been committed to this mission for a very long time. ACOs, provider groups, and health systems are doing a lot of really hard work to try to support patient care. Data is often at the center of that strategy, or is at least part of the strategy. Being able to facilitate these care transitions with more real-time data sharing across all the different places that patients might go will do a lot to support care. I’m excited to be part of the solution and the momentum that will come with it.

Morning Headlines 3/16/20

March 15, 2020 Headlines No Comments

New CPT code announced to report novel coronavirus test

The American Medical Association creates a CPT 2021 code for the SARS-CoV-2 novel coronavirus, which will allow tracking of cases.

WebMD Acquires the StayWell Company

WebMD Health acquires Merck subsidiary The StayWell Company, which offers employee well-being, patient education, and patient engagement platforms.

Hartford HealthCare will bring 700 jobs to downtown Hartford and build new venture studio in $24 million renovation of office complex

Hartford Healthcare (CT) will spend $14 million to develop a new access center that will coordinate care and schedule appointments for patients across its 400 locations, pilot a telehealth urgent care clinic, and house an incubator space for healthcare startups. 

Epic Systems cancels spring XGM conference that draws thousands

Epic cancels its Experts Group Meeting (XGM) 2020, which was expected to draw 9,000 attendees to Epic’s Verona, WI campus April 27 – May 8.

Cerner employees to work remotely

Cerner tells employees who can do so to work remotely until March 30, adding that its offices will remain open with social-distancing policies to employees whose work requires them to be on site.

Monday Morning Update 3/16/20

March 15, 2020 News 27 Comments

Top News

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The American Medical Association creates a CPT 2021 code for the SARS-CoV-2 novel coronavirus, which will allow tracking of cases. The code is available for immediate use.

AMA has also published “A Physician’s Guide to COVID-19.”

CDC and AMA have published a video interview with a highly cited physician who heads a hospital’s anesthesia and ICU departments in northern Italy. The interview calls out the death rate they have seen in Italy, which is minimal for younger people, but jumps to 8% for those aged 60-69, 34% for those 70-79, 44% for 80-89, and a likely statistical aberration of just 9.3% for those patients over 90. The doctor’s takeaway message is to increase ICU and ventilator beds now.


Reader Comments

From Beyond the Pale: “Re: Epic’s announcement to employees. Here’s the full text. Epic’s failure to invest appropriately in collaboration tools and its reliance on physical proximity positions them poorly to work from home. I worked several years for Epic in a leadership role, where I ardently defended them, but this is disappointing to see.” The email says those employees who can report to work on campus should do so. If that isn’t possible, then work from home is allowed for the two weeks starting Monday, March 16, but customer issues, project readiness meetings, or internal meetings may require coming to campus. The message seems mixed – you can work from home if you can’t come to campus, but you might have to come to campus anyway.

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From Joyous Boys: “Re: COVID-19. I would like to see you include more news about it that isn’t necessarily health IT specific.” Jenn told me she thinks it is a bit tone-deaf to stay in our non-COVID lane when we are pretty good at extracting truly insightful or newsworthy items. My counterpoint is that even though we stay on top of COVID-19 news that we could summarize efficiently, that kind of information is amply available elsewhere. I will let readers decide what if any changes are needed with a poll. HIStalk readership is high lately, so it’s good for me to understand what people are looking for. But as my life’s motto explains, I’m not looking for extra work.

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From Top Gun: “Re: HIMSS20. HIMSS was to let us know in 14 days about hotel and registration refunds. My team made reservations through the HIMSS site, so I didn’t do anything while I waited to hear. Since then, HIMSS updated its FAQ to say – without notifying anyone – that it’s up to individual hotels whether to offer refunds. Now that we’ve waited, hotels won’t refund anyone, and registration has rolled over to HIMSS21. What if we can’t go or won’t have as many attendees? I want my money back. I already swallowed flight costs for several people, and now I have to swallow hotel and registration as well? Anyone else mentioned this? I’m considering protesting the charges on my credit card.” Above are the original and current versions of that FAQ. I don’t quite get the “14 working days” (why 2.8 weeks?), but HIMSS said in the original item that “an advisement will be sent” and the replacement wording says only that HIMSS won’t object if the hotel wants to refund your payment and the hotel should be called as soon as possible. You could protest the charges (hint: say “billing error”) and the charge will probably be reversed, but that will last only until the credit card folks contact OnPeak, which will claim it did everything correctly and get the charge reinstated. If you didn’t have travel insurance that covers cancellation, you may be out of luck, even if you’re contemplating suing since there’s probably a force majeure clause hiding somewhere. At least non-exhibitor attendees had a theoretical but heavily discouraged option to book lodging on their own – the HIMSS exhibitor contract requires them to pay for two OnPeak rooms per 100 square feet of booth space.


HIStalk Announcements and Requests

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It’s a bit surprising that one-third of poll respondents – presumably healthcare people — are making no effort to avoid crowds and unnecessary travel, but I’ll generously assume that early voters from a week ago – or about a year in COVID-19 news – have since changed their practices to those of the majority. Or perhaps low-risk people, those who are blessed with youth and vigorous immune systems, don’t understand that such restrictions are intended to prevent them from inadvertently killing Grandpa or Grandma by introducing them to their microorganism tenants. 

I can’t even comprehend that I should be fresh off a return from a HIMSS20 trip right about now. The conference was cancelled just 10 days ago as I write this, but it seems like it’s been a couple of months. Meanwhile, interest in our webinars has picked up as an alternative to the HIMSS that never was, so ask Lorre nicely and she will extend her previously offered webinar discount.

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New poll to your right or here, for health system employees: what strategies have changed with COVID-19?

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We ran a mention last week from the local paper that United Community & Family Services (CT) was moving to Epic from Greenway Health’s Prime Suite, which the paper said was necessary because Prime Suite is being discontinued. That article was incorrect, as Greenway very kindly let me know – Greenway is still investing in the development of Prime Suite and has no plans to discontinue it. Prime Suite had 48 software releases in 2019 and last year saw the introduction of Prime Suite Reporting 2019 and Prime Suite v18.00.01.00. Thanks to Greenway for just alerting me nicely instead of going nuclear with indignation for assuming the local reporting to be accurate.

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I ran accidentally across a HIStalkapalooza video that recalled happier times when industry folks danced the night away, complete with fleeting thoughts that maybe I should do a scaled-back version at HIMSS21, assuming we emerge on the other side of COVID-19 and will need cheering up. Year-by-year highlights:

  • 2008, Orlando. A reception for 200 attendees in what was then the Peabody Hotel, with some outstanding food in an upscale setting. I was worried that nobody would want to attend, and figuring I should offer some kind of stage presentation, I quickly threw together the first HISsies voting to fill time.
  • 2009, Chicago. Trump Tower failed us a bit in being so expensive that we had to limit attendance, food cost was ridiculous so we could offer only a few passed snacks, and they neglected to provide a decent stage and sound system and thus few attendees could see or hear Jonathan Bush present the HISsies. But the view was fantastic and the attendees were fun.
  • 2010, Atlanta. We took over Max Lager’s pub, a bagpiper played outside, Judy Faulkner wore the “No Pie for Me” sash that I ordered to celebrate Neal Patterson’s pie-in-the-face HISsies win, Ross Martin did his “Meaningful Yoose Rap” live, and JB turned his allotted five minutes to present the HISsies into a long, crazy stage show on a day when ATHN shares had tanked.
  • 2011, Orlando. I first used the term “HIStalkapalooza” that year at BB King’s. JB did the awards again and we had a blues band.
  • 2012, Las Vegas. This is still my favorite because ESD sponsored the event and Brittanie Begeman was delightful to work with. We had last-minute panic when the venue we had booked closed its doors for good, leaving us to scramble to find a new place in First Food & Bar in the The Shops at the Palazzo (which is also closed now). See how many faces you recognize from the excellent video highlights reel. We had roses for the ladies, a DJ, the usual stage antics with JB as he drank a family-sized beer, two Elvis impersonators (a pro and Ross Martin as dueling Elvi), and probably the best food and drinks of any of the events. I watch that video every few weeks.
  • 2013, New Orleans. We headed to Rock ‘n’ Bowl, Ross and Kym Martin performed, JB’s performance was as wild as his shirt, we had a big-name zydeco band playing, and we ended with a bowling tournament. Video.
  • 2014, Orlando. Buses took folks to the House of Blues at Downtown Disney, we had the amazing Party on the Moon playing, and several entertainment booths were doing caricatures, magic tricks, and other fun stuff. Video.
  • 2015, Chicago. This was the first time we did the event on our own without allowing a single company to pay and thus call the shots to some degree. House of Blues Chicago was the best venue we’ve used with its opera boxes and lofty interior views. Party on the Moon was predictably outstanding and Judy Faulkner and Jonathan Bush presented each other with awards. Video.
  • 2016, Las Vegas. House of Blues hosted, JB did his Donald Trump imitation, and the band played on. Video.
  • 2017, Orlando. We ended the 10-year HIStalkapalooza run at House of Blues, whose box office got calls all week from folks thinking they could buy tickets and then trying to crash during the event when they heard the band rocking from outside. Party on the Moon, who loves our crowd, captured the final moment in the photo above as their set reached an explosive finish over the filled dance floor and the confetti blasted for the final time. Video.

Listening: new from reader-recommended Tame Impala. It’s a man rather than a band, following the modern configuration of one multi-instrumentalist guy recording the music tracks on his computer, making no money even with popularity since streaming pays next to nothing, and then grabbing some pick-up musicians to cash in by touring. He/they headlined Coachella last year with their brand of psychedelic music. I’m not sure how I feel about music being composed in computer-enhanced solitude since that sounds kind of deliberate and cold, but I like this OK and at least it doesn’t involve the “we’re a band” model of creativity by committee that usually isn’t sustainable.

The pandemic will get worse before it gets better, but imagine how it would be without the Internet and the ability it provides to to work from home, see patients remotely, inform the public, stash stay-at-home kids in front of streamed cartoons, and stay current on scientific developments. It has often brought out the worst in people (or perhaps just the worst of people), but let’s give some credit to Sir Tim Berners-Lee for inventing the World Wide Web in late 1990 that is benefitting the entire world now more than ever.


Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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


Acquisitions, Funding, Business, and Stock

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WebMD Health acquires Merck subsidiary The StayWell Company, which offers employee well-being, patient education, and patient engagement platforms.


Announcements and Implementations

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QliqSoft releases a white-labeled COVID-19 patient screening and education tool package for hospitals that will need to manage an expected surge of patients.

A Black Book survey finds that EHR interoperability remains a challenge for hospital network physician practices, half of hospitals aren’t using outside patient information, and some hospitals are waiting for their current vendors to release solutions before buying anything new.

Another Black Book survey of 3,000 hospital nurses finds that their nearly universal dissatisfaction with EHRs in 2014 has swung to the positive. Nurses say that a hospital’s choice of EHR is among their top three criteria for deciding where to work, and nearly all of them say that EHR expertise is a highly sought employment skill. The hospital nurses ranked Meditech as the #1 EHR for nurse functionality and usability.

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DocClocker pitches its patient wait time app, saying it cuts down on potentially infectious patient waiting room time and allows them to make short-notice appointments for available slots. The company also offers a version for families waiting for OR updates, publishes current and average provider wait times, collects user reviews, and sends notifications of appointments and delays. 


Privacy and Security

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CI Security polled security experts to come up with a list of items to help control security risks for healthcare workers who are telecommuting. It includes a work-from-home security assessment questionnaire. I was thinking as I read this that it would be awful to send employees home to prevent spread of a virus only to be hit hard with the computer kind as a result.


Other

Health systems are using technology to conserve resources that will be needed for treating COVID-19 patients:

  • Online questionnaires and chatbots to allow people to determine if they may have coronavirus infection, which helps keep the “worried well” from showing up for testing and treatment.
  • Virtual visits.
  • Thermometers and pulse oximeters for symptomatic patients to take home, with daily follow-up.
  • Videoconferencing and messaging systems to help coordinate efforts and for consulting with other facilities.

The CEO of a South Korea technology company says the country’s success in beating back coronavirus has been aided by the use of big data and AI:

  • The government’s platform stores the information of citizens and resident foreign nationals, integrates all government services with that system, and populates other AI-based apps.
  • A positive COVID-19 test sends notifications to everyone in the area with that person’s travel details, activities, and commute maps for the previous two weeks.
  • Government-run health services are notified of the person’s contracts to allow tracking and testing.
  • The country has offered drive-through COVID-19 testing for weeks. It has performed 250,000 tests versus just 22,000 in the US, at a rate of nearly 5,000 tests per million people there versus 65 here. 
  • The drive-through labs are powered by 5G, and drivers are notified of the nearest testing location.
  • When someone who lives or works in a large building tests positive, the government sets up temporary medical centers to test everyone.
  • Distribution of masks and other supplies is managed via AI-based regulation. Residents can buy two masks at a time using their ID cards. Price gouging has not occurred.
  • The government is running all offices digitally, with employees working from home. 

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New York looks at a potential COVID-19 care demands for 170,000 hospital beds versus the 53,000 total and 19,000 available in the state, with Governor Andrew Cuomo saying that patients may need to be moved from the high-concentration lower part of the state to other areas. He is asking retired medical professionals to contact their old hospitals to see if they can help and deploying National Guard medics and medical students to pitch in. The Department of Health will monitor available beds, ventilator beds, and isolation units as well as ED activity.

I give this editorial recommendation a good chance of happening. A medical student and a physician epidemiologist urge the federal government to create a military-operated healthcare system for coronavirus to take the load off hospitals that are likely to be overwhelmed. They recommend that the US Public Health Service oversee the operation of setting up COVID-19 diagnosis and treatment centers outside of city centers, but easily accessible to them. The advantages are that the US military is very good at training and deploying people rapidly and they could oversee unused medical resources such as retired physicians and nurses, residents, and laypeople who could be quickly trained similar to emergency medical technicians. Such facilities could also innovate technology to provide ventilator support, which has been the most precious commodity worldwide.


Sponsor Updates

  • ACG Utah presents Health Catalyst with its 2019 Deal Maker of the Year Award.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, announces a reseller agreement with AlertWatch to distribute their maternal safety system.
  • PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
  • Pivot Point Consulting creates a checklist of key considerations for COVID-10 preparation and offers phone appointments to assist organizations with planning and configuration.
  • QliqSoft launches a COVID-19 virtual patient communication kit.
  • The CEO Forum Group features Waystar CEO Matt Hawkins in a radio interview.
  • Wolters Kluwer Health offers coronavirus tools and resources for clinicians and medical researchers.

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HIStalk Interviews Eric Jordahl and Anu Singh, Managing Directors, Kaufman Hall

March 14, 2020 Interviews No Comments

Eric Jordahl and Anu Singh are managing directors over treasury and capital markets and mergers, acquisitions, and partnerships, respectively, at Kaufman Hall of Chicago, IL. 

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What are the most significant challenges hospitals will see as a result of the coronavirus pandemic and the resulting economic turmoil?

Anu

The problem is the time it takes away from more strategic and more management related tasks. The biggest challenge that executives are going to face is that the time, resources, and attention needed to deal with this will take them away from many other tasks. Prioritization of what is now strategic and what is most critical is going to have to get reshuffled. Time is a precious resource and we’re going to see it constrained even further.

Eric

I would agree with that. I focus on the treasury side of things, where it’s really all  about volatility. When you get into moments like this with a lot of volatility, it’s difficult to make solid decisions. Decision-making becomes an incredible challenge because it’s difficult to understand where markets are going, what good pricing looks like, and what good execution look like. Whether it’s the asset side of a balance sheet and the investments that hospital CFOs are worrying about, or the debt side that they’re worried about, volatility creates all sorts of challenges on either side of that balance sheet and makes decisions about what to do in the moment very, very difficult.

What will be the health system margin and cash flow impact of treating large numbers of patients?

Eric

There was a phenomenon in 2008 called deflating balance sheets. As the value of equity instruments went down on balance sheets and different things happened, client balance sheets got really strained. What was interesting, though, was that was across the whole universe of providers, especially with regard to credit positions, they weren’t really impacted by that event. Where things got dicey was when that whole-industry phenomenon was paired with weaker operating performance at a particular facility. That’s where organizations in 2008 had credit and rating kinds of problems. I think it will be similar in the world today, where a lot of the industry will be hit in similar ways.

The question is, will there be some pockets, areas of the country, facilities, or different things where the impact is disproportionate for whatever set of reasons? If 2008 was any kind of indicator, it’s those kinds of more isolated pockets that are going to be more problematic.

Provider credit and  uncompensated care will be a very big problem, and I think it escalates across the whole US economy. Conferences and sporting events are being cancelled. You see an economy that in some ways feels like people are saying, “Let’s just stop the economy.” The ripple consequence across everything, including healthcare providers, is going to be a challenge.

We’ll see what happens with payers and how their performance holds up. Obviously the government is heavily involved in payment around healthcare. I would expect, given that this was a healthcare crisis, that the government would be pretty actively involved in trying to create financial safety nets of some sort. But I don’t think anybody has a real clear idea right now of what that might mean.

How will non-core health system activities, such as mergers and acquisitions, proceed in the near term?

Anu

Anything that was a strategic initiative — M&A, innovation or a venture fund, acquisition of a physician practices or real estate, whatever the case may be — will continue.  When you have a good strategic rationale to do something in a way that is  battle tested, even an event like this that is upon us doesn’t necessarily change the strategy. What could change is the timing and the pace of those pursuits. It may take longer to complete those transactions.

Acquisitions that require third-party sources — a set of stakeholders selling a physician practice or a source of financing to help with an acquisition – will be more adversely impacted by this event, and you are looking at extended timelines. Some M&A processes may either slow down or follow a different pace. But like most things that come upon us without much warning and without much precedent or even a playbook of how to deal with this, it just slows some decisions down and adds an additional level of consideration. But if it passes strategic muster, it will probably continue.

What would be the early warning signs in a health system’s financials that current events might be causing problems?

Eric

From a treasury standpoint, going back to this thing about balance sheet deflation, a phrase that organizations sometimes use is “fortress balance sheet.” That is a is a balance sheet that is built to withstand shocks. Use of that concept is increasing. Most healthcare organizations raise external capital through external debt markets, where interest rates are falling and have fallen fairly dramatically. On the one hand, organizations think, “Oh this is great.” But on the other hand, other parts of their balance sheet  are affected by financial market dislocation.

It is really understanding your total exposure and how you are positioned to manage those exposures. A lot of CFOs learned great lessons from the 2007-2008 credit crisis, and most of them are coming into this with stronger balance sheets. But that’s still a question that will emerge. One of the main questions is, how long does this last? Does it have a long tail and we get hit with waves of financial market shocks? The longer we go into this, the harder it is going to be for healthcare balance sheets to hold up. That is something that all CFOs should be looking at.

Epic Cancels XGM 2020

March 13, 2020 News 2 Comments

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Epic cancels its Experts Group Meeting (XGM) 2020, which was expected to draw 9,000 attendees to Epic’s Verona, WI campus April 27 – May 8.

Epic is further responding to COVID-19 by:

  • Allowing employees to cancel or postpone non-essential business travel.
  • Expanding sick leave and work from home policies for employees who are experiencing symptoms or have elevated risk of complications.
  • Conducting large internal meetings virtually.
  • Offering users virtual options for training classes.
  • Serving food from campus cafeterias in individual to-go containers to prevent lines and modifying seating to reduce large gatherings in cafeterias.

Epic said in a statement, “We will miss seeing our guests at XGM this year, and are saddened that this change will impact the businesses in our community that help welcome and host the 9,000 guests who come to XGM. However, we felt that this decision was necessary to help slow the spread of COVID-19.”

Weekender 3/13/20

March 13, 2020 Weekender 2 Comments

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Weekly News Recap

  • COVID-19 dominates the national and healthcare news.
  • Use of telemedicine ramps up to meet COVID-19 screening and management needs.
  • HealthjStream acquires nurse scheduling app vendor NurseGrid, which offers the #1 most downloaded app for nurses.
  • FormFast changes its name to Interlace Health.
  • Final versions of the federal government’s interoperability and patient access rules are published.
  • HIMSS announces plans to offer some HIMSS20 sessions virtually.
  • Organizers cancel most of their upcoming conferences due to coronavirus concerns, including AMIA.

Best Reader Comments

Heading from a lot of friends inside of Epic that things are getting rough. No guidance from HR or the COVID team on what people are to do if schools close, no telework option given to any staff in the Verona office, some divisions (Implementation) have been given the guidance to attend all meetings via WebEx but that they still must physically come to campus. Little to no transparency from the leadership team, and they appear to be one of the only major tech company not implementing remote work. (Ex-Epic)

Epic’s travel policy is not right. They may think that they are helping us, but these people who go from one hospital to another may act as pollinators for COVID-19. We have already determined to cut all non-employees visiting our clinics and hospitals. (CMIO @ Med Centre)

Will 2021 finally be the year of the PHR now that these ONC rules came out? B.Well’s gimmick is to make the employer pay for it, though they can only swindle employers out of looking at the apps adoption rate for so long. IMO there isn’t enough value in a PHR to run a business. You either have to keep your costs extremely low or make money some other way. To me, two models come to mind. The Linux model, in which some devs do it as a passion project for awhile until it gets big enough that some institutional players start chipping in, maybe with some consulting opportunities with big health system or payer orgs. Or the Facebook model, in which you make it free for the consumer and sell their data. (What)

The big thing that’s missing for me personally is any accountability for breaches of apps or app vendors. My reading of the summary is that app vendors will not be HIPAA covered entities even if they are accessing and storing PHI. ONC is basically waving their hands saying consumers and app vendors can figure this out for themselves with a Terms of Service agreement. Key language from the summary: “In effect, this places more of an obligation on the party requesting the EHI and the individual to attempt to satisfy the precondition by providing a consent or authorization.” (Elizabeth H. H. Holmes)

I find there are two main reasons companies attend [the HIMSS annual conference]. Large mega vendors and even the larger names use it as a current customer meet and greet, and a chance to take them to dinner / schmooze (which they should be doing the other 51 weeks of the year anyway). The other are startups looking for investors or partners. Most don’t return the next year. Due to HIMSS rules on booth location based on seniority (I don’t disagree, just noting), these newbies are relegated to the basement level in building 2, or on the back wall of row 2400, where no one seems to go. Every time I’m asked about conference attendance as a key marketing tool, I tell the company my views. Even during a couple of job interviews I went against what I thought they wanted to hear, but was surprised they agreed with me. I’m not saying having a booth at conferences is a total bust, but isn’t a major tool in revenue growth for the majority of attending companies. Yes, I’m sure I’ll get some pushback from a few here where their effort pays off, but I’m betting it is a small slice of all vendors. (Contrary Ann)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. A in New York City, who asked for sensory play tiles for her class of autism and multiple disability students. She reports:

It is my honor and privilege to be working as a New York City public school teacher. It is in thanks to donors such as yourselves, who have enabled me to do my job even better. I am filled with such joy that you choose to help my students. It means so much to me to bring them an engaging educational experience that has meaning for them. My students inspire me every day, which I have seen inspires wonderful donors such as yourself.

I have already started using the sensory tiles and it is starting to make a difference for my students. Students who are in sensory overload are able to use them to self-soothe and get back to our lesson. We also use them for our lessons to show how colors mix and how force causes the colors in the tiles to move. They are so wonderful on so many different levels. These will allow my students to have an engaging experience exploring Science and STEM and keep control of their senses. Thank you for your kindness!

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Brilliantly making lemonade from the unfortunate HIMSS20 lemon is Medic.Life, which missed the chance to demo its upcoming “smart toilet” but touts its ability to detect virus markers in urine samples for early detection.  

Facebook, Ebay, and Amazon try to throttle back advertisements from price-gouging sellers of face masks and hand sanitizer.

The Los Angeles Times writes about doctors whose medically related poetry is published in medical journals, whose editors say they turn down a lot of badly written poems, but seek out those whose vivid imagery invokes an emotional reaction. A retired internist wrote this one:

Tell Me

Tell me the night silence
on the locked Alzheimer’s ward is broken
by a yell from room 206,

that an old man with flattened
nose and crumpled ears,
whose family moved away to Arizona,

whose doctor never comes
to visit, is standing
in the middle of that room, naked,

his freckled face a clenched fist,
urine and feces running
down his legs.

Then tell me that the fat one, twelve
years on the job,
working her second shift because

someone’s car won’t start,
comes with a pan
of warm water, a sponge and a towel;

how, back in bed, he
cries, You know—
I’m in the ring tomorrow with Killer
;

how a tiny smile begins, how
her hand reaches out
to flick down his wild flame of hair.

Now tell me again
why you don’t believe in angels.


In Case You Missed It


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Morning Headlines 3/13/20

March 12, 2020 Headlines 10 Comments

b.well Connected Health Secures $16 Million in Series A Funding

Employee-focused PHR vendor B.Well Connected Health raises $16 million in a Series A funding round, increasing its total to $27 million.

Heartbeat Health Raises $8.2M Series A to Expand Delivery of Best-in-Class Virtual Cardiovascular Care

Virtual cardiovascular care management solution vendor Heartbeat Health raises $8.2 million in a Series A funding round.

Epic tells employees to continue ‘essential’ travel, against county health officials’ advice

In addition to considering cancelling its upcoming, on-campus XGM event at its headquarters, Epic makes several social-distancing changes to workplace policies to slow the spread of COVID-19.

News 3/13/20

March 12, 2020 News 4 Comments

Top News

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A New York Times article says the use of telemedicine in COVID-19 screening and treatment is increasing.

Use of virtual visits keeps people out of the ED or medical practice waiting rooms who are either exhibiting symptoms or who are susceptible to infection.

Upfront triage also minimizes the exposure of healthcare workers and the quarantine that would result.

NYU Langone Health is encouraging its self-quarantined doctors to continue their work by offering virtual visits, while Intermountain Healthcare is considering delivering virtual care for patients who have COVID-19 and chronic medical conditions and can be safely treated at home in avoiding the exposure of traveling nurses who could spread the infection.


Reader Comments

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From Andre: “Re: COVID-19. Our pediatrician’s practice has temporarily disabled appointment checking via MyChart, apparently since adding screening questions isn’t easy.” It will be a struggle to convince practices and their patients that medical office visits create risk for staff and fellow patients. This particular practice also invites patients to call in when they arrive in the parking lot, then wait for a call back to proceed directly to the exam room to avoid potential waiting room exposure.

From Jeebo: “Re: MIPS filing deadline. Have you heard anything about possible extensions?” I haven’t, but I don’t follow it as thoroughly as Dr. Jayne and others, so I will invite reader comments.

From Mitchell: “Re: Loews Hotels. Has decided not to give any refunds for HIMSS20. Seems like they are the only ones.”

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From Airman: Re: travel. Dulles is a graveyard, all international flights cancelled and business travelers on the sideline. The hotel was one-third full, restaurants were empty. It feels like 9/11 60 days out. We are headed for a major recession from what I have seen. I took this photo at 4:40 p.m., probably the busiest time of day under normal circumstances.” Layoffs have already started in all travel-dependent sectors and I’m sure restaurants and retail businesses will take a major hit as people stay home. The compound effect that in our screwy US healthcare non-system, all those folks will lose their health insurance (if they were even offered it or were able to afford it in the first place) and any diagnosis and treatment they require for COVID-19 or anything else is going to strain their own finances and the system in general. We had better keep delivery drivers for Amazon and grocery delivery services healthy since they may be our most valuable lifeline. We will have learned many hard lessons once this outbreak winds down, but some of them are for the long-term good.

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From Corey Spears: “Re: ONC’s rule. Since it is waiting for final formatting, I took the liberty of creating a bookmarked version, which is much easier to navigate since there are so many internal references.” Thanks. That makes it much easier to find items other than by searching.

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From Life at Veeva: “Re: working from home. My company, Veeva, is good at accommodating remote work, but also created this video to help employees who ordinarily work in our corporate offices.” The five-minute video is packed with a lot of good information, much of it instructions for those who are new to the Zoom videoconferencing app.


HIStalk Announcements and Requests

I’m pondering whether we’ll have a future shortage of asterisks needed to explain 2020 sports records that involved shortened seasons and cancelled tournaments.


Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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


Acquisitions, Funding, Business, and Stock

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Health IT and consulting company Emids announces an undisclosed investment from BlueCross BlueShield Venture Partners. The Nashville-based company was acquired by New Mountain Capital last September.

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Amazon Care considers working with the Bill & Melinda Gates Foundation to deliver COVID-19 home testing kits in Seattle. Amazon has offered to come up with a logistics plan for delivery, free of charge, so that kits can be delivered within a few hours. Nose swabs in the kits would then be mailed to the University of Washington for analysis.

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B.Well Connected Health raises $16 million in a Series A funding round, increasing its total to $27 million. The company offers employees of subscribing companies a personal health record that is connected to hospitals, pharmacies, lab companies, and insurers; a gamified health journey; and a digital wallet for health expenses. CEO Kristen Valdes founded the company in 2015 after several years at disease management company XLHealth, which was acquired by UnitedHealthcare for $2.4 billion.

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Virtual cardiovascular care management solution vendor Heartbeat Health raises $8.2 million in a Series A funding round.

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From Cerner’s investment community meeting:

  • HealthIntent clients have been migrated to Amazon Web Services and Cerner-hosted CareAware customers will be migrated by the end of the year.
  • 90% of the company’s total revenue is recurring or highly visible.
  • Cerner expects its Works business to decline as a percent of revenues.
  • Core revenue growth will decline slightly due to EHR client attrition, but that will be partially offset by global and revenue cycle.
  • The company sees opportunity in the 30% of the market that runs non-current systems, most of them hospitals of greater than 200 beds.
  • Soarian and Millennium assets will be combined to form a revenue cycle offering and will be accessible via APIs, with about 18 months remaining on the three-year project.
  • Cerner sees three markets for data: life sciences, release of information, and payers. It says the EHR data it holds for provider clients represents one of the largest data assets in the world.
  • Mass tort lawsuits that require retrieving the medical records of thousands or millions of people have resulted in Cerner signing 65 law firms as clients for its HealthHistory business, which it says grew 30-40 times its revenue in one year.
  • HealtheIntent contains data from non-Millennium environments and has the advantage of refreshing itself every 17 seconds in the cloud.
  • Regional IDNs and community hospitals can make money participating in clinical trials, which isn’t a strong suit of Epic since it has mostly academic medical center clients. 
  • The company suggested that it will make acquisitions in the real-world evidence area.
  • Cerner has not yet seen a reduction in project activity due to COVID-19 and says it’s possible that demand for its services will increase.
  • The company says it is “incredibly disappointing” to lose customers to Epic, which is why creating a client success office was important. Those customers also will continue to run Cerner’s EHR for several years and will continue to use platforms such as HealthIntent and CareAware.

People

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Medical University of South Carolina hires Mark McMath, MBA (Methodist Le Bonheur Health) as enterprise CIO for information solutions.


Announcements and Implementations

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United Community & Family Services (CT) transitions to Epic from Greenway Health’s Prime Suite.

HIE-focused nonprofit The Health Collaborative selects Omni-HealthData’s cloud and analytics solutions.


Privacy and Security

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Hackers lure employees at several unnamed companies into opening emails purportedly from Vanderbilt University Medical Center (TN) that claim to have HIV test results in an attached file, which, when opened, prompts the recipient to download malicious software. Hackers have also engineered similar phishing campaigns that prey on COVID-19 fears, referencing CDC guidelines and safety measures.

An analysis of 1.2 million Internet-connected devices in hospitals finds that 83% run on outdated software, including Windows 7 and Windows XP.


Other

An opinion piece written by two Duke informaticists says that EHRs are ill suited for the COVID-19 pandemic due to poor information presentation, complexity that causes users to delay applying much-needed updates for months, and lack of public health reporting. They recommend that hospitals:

  1. Review their business continuity plan.
  2. Prioritize clinical system patch updates and enforce change control policies.
  3. Heighten cybersecurity vigilance.
  4. Deploy mobile apps that extend EHR capability to improve productivity and to guide management of COVID-19 patients.
  5. Use scribes to increase clinician efficiency.

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England’s NHS ramps up efforts to offer more COVID-19 care through online consultations, given that only half of practices have telemedicine capabilities. The health service has also launched a care management service with digital-first capabilities for patients in self-quarantine, and has increased testing capabilities from 1,500 patients a day to 10,000.

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The local news highlights the role the Avera ECare telemedicine network is playing in caring for COVID-19 patients virtually at 190 hospitals and 66 nursing homes across the country, particularly those in rural areas. Ten additional hospitals will go live with ECare’s services in the coming weeks.

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Chilmark Research is soliciting information from companies that are offering free COVID-19 related health IT solutions.

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The Onion sets the record straight on coronavirus.


Sponsor Updates

  • Provider data management software vendor Phynd reports a record year, adding six new health system customers in Q4 2019.
  • PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
  • Intelligent Medical Objects releases retrospective business updates.
  • Elsevier Clinical Solutions upgrades its ProspectoRx website.
  • Optimum Healthcare IT publishes a case study titled “Decentralized Epic Go-Live Success at Scripps Health.”
  • Ensocare Business Intelligence Engineer Matt Tweedy earns the Bob Cassling Service Excellence Award from parent company CQuence Health Group.
  • EPSi Associate Consultant Zac Steele joins the 2020 Millenial Cohort of the American Enterprise Institute’s Leadership Network.
  • CloudWave makes its disaster recovery solution available on Amazon Web Services.
  • Masimo will integrate Imprivata’s medical device access authentication technology into its Root and Iris hospital automation platform.
  • DataRobot and InterSystems partner to accelerate adoption of AI in healthcare.
  • CarePort Health supports CMS’ expanded commitment to care coordination in interoperability rule.

Blog Posts


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EPtalk by Dr. Jayne 3/12/20

March 12, 2020 Dr. Jayne No Comments

clip_image002 

The time change came and went on Sunday, but my Outlook calendar is still messed up for the week. The ET zone is once again correct starting next week, so I’ll just have to be extra vigilant for the next couple of days about making sure I’m on the right call at the right time.

My calendar was still accurate for the lunch and learn session on Wednesday with Dr. John Halamka, sponsored by Arcadia. The company rolled this over into a virtual session almost seamlessly, and a good number of people attended. For those of you not familiar with the company, they have a tremendous population health platform and have helped their customers save over $2.4 billion through 2018. The platform is mapped to over 50 EHR vendors, which is a feat in itself.

Dr. Halamka joined from the library at Unity Farm Sanctuary and talked about the concept of platforms in healthcare. Central points included the challenge of de-identifying data when creating data analytics platforms along with how to best use machine learning for early disease identification, cost reduction, and preventive intervention. There was also a good discussion of the need to use the right kinds of data sets to do investigations. For example, if you’re looking at data on Hispanic females, you probably don’t want to use the dataset for Rochester, MN if one is available that is more representative.

I got a chuckle out of the inadvertent activation of his Google Assistant while talking about their use of Google Cloud for data storage. That happens to me all the time. There was also a good discussion of strategies for delivering high-acuity care in the home, which is top of mind given the surge in COVID-19 around the globe. Mayo Clinic is apparently partnering with third parties to provide much of this infrastructure, with a pilot scheduled in July for Florida and Wisconsin. There was an audience question about how much of Mayo’s technology is homegrown versus using vendors. Mayo’s preference is to buy solutions rather than build, whenever possible.

There was a good discussion about the recent interoperability rules and the potential risks for patients managing their own data. Halamka anticipates an increase in innovation with data being under patient control. There was also a discussion about COVID-19 and Halamka voiced concerns about the number of entrepreneurs jumping on the problem. He hopes that solutions come from non-profit organizations or technology companies in support of non-profits as an alternative to profit-driven approaches to a major healthcare crisis. He also lamented the inability of solutions to determine the cost of medications based on a patient’s insurance coverage that goes to the individual plan level. There are some solutions that can get you in the neighborhood, but none that are truly accurate.

The moderator asked about the impact of AI on the animals at Unity Farm. He has 103 devices on the farm, including cameras that can monitor the impact of coyotes and other predators on its 250 animals. They haven’t gone to automated feeding yet since a major focus of the institution is care and compassion for the animals. I have enough trouble managing the handful of devices in my house, so I can’t imagine what that looks like. (If any has suggestions on why I suddenly have to reboot my laptop any time I want to print something, please let me know.) All in all it was a great call, and I appreciate Arcadia’s ability to pivot the session to a virtual format quickly.

I also made sure to honor GlobalMed’s invitation to their Wine and Whiskey Happy Hour by lifting a glass of Jameson. I was looking forward to seeing their backpack telehealth exam station, but I guess I’ll have to wait a bit.

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FormFast has rebranded as Interlace Health, noting that it “started as an electronic forms company and evolved into something much more valuable.” It now defines itself (along with thousands of other companies) as “a solutions company.” They go on to state that having the word “forms” in the name was limiting the perceptions of the company. I understand it, but I’m not sure the new name helps me understand their focus on “enabling seamless data capture and information exchange among providers, staff, and patients” either.

Lest we forget there’s a world out there beyond HIMSS and COVID-19, MIPS-eligible clinicians still have until March 31 to submit their 2019 data for the Merit-based Incentive Payment System. Data can be submitted until 8 p.m. ET on that day. Data submitted by claims have been ongoing throughout the year, and practices can also login for preliminary feedback on their Medicare Part B claims measure data. Clinicians are encouraged not to wait until the eleventh hour in case they need assistance from the Quality Payment Program Service Center.

If you’re bored, you can always choose to read from the pair of final rules released this week. Do we really need to get hit by both ONC and CMS at the same time? Although there are many aspirational comments that have been made by various government folks, let’s take a look at some of them.

From National Coordinator for Health IT Don Rucker, MD: “Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel, and every other component of their lives.” Although patients will have greater access, that’s not going to automatically make them more capable of better healthcare decisions. Healthcare is not ordering a pizza or booking a flight to Milwaukee. And comparing it to finances? Financial literacy isn’t exactly a strong point for many in the US. We need to spend money increasing health literacy, helping people understand the consequences of unhealthy behaviors, and teaching them basic facts about their own bodies and how to keep them running in good health.

I work with patients all the time who have amazing access to their data, but no way to interpret it or really understand what it means to them. I’m sure the counterargument is that third-party apps will help with that, but how many third-party apps are really going to be around purely for altruistic purposes? They will be there to gather data to sell it to other third parties, to pitch unproven solutions to medical concerns using unregulated supplements or other dubious methods, and more.

I’ll be judging the virtual shoe contest and socktastic submissions over the weekend, so please get your entries in for consideration!

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