Morning Headlines 8/25/20

Google is investing $100 million in telehealth provider Amwell, which will use Google Cloud

Amwell files to go public as Google Cloud announces that it will invest $100 million in the telemedicine company and become its preferred cloud partner.

VA rolls out new patient-appointment tool, as part of electronic health record modernization transformation

The VA Central Ohio Healthcare System goes live on a centralized scheduling solution as part of its agency-wide transition to Cerner technology.

Hartford HealthCare pushes ahead in pandemic to bring workers to office building on prominent corner in downtown Hartford

Hartford HealthCare (CT) will move forward with plans to open a patient care access center in downtown Hartford that will include a telemedicine-equipped urgent care center.

Curbside Consult with Dr. Jayne 8/24/20

There’s a lot of talk in the healthcare industry about “wellness.” Everyone is trying to cash in on it, and it seems like there are as many different definitions of wellness as there are companies trying to figure out how to make it part of their portfolio.

As a physician who strives to practice evidence-based medicine, I find many of the elements that are rolled up under the wellness umbrella to be questionable.

I ran across an insurance company last week that is encouraging its members to have “wellness labs” performed. This sounds like a good idea until you look at the contents of the lab panels, which include multiple tests that aren’t recognized as screening tests and aren’t recommended unless patients are experiencing symptoms. We all know that when tests are ordered that aren’t needed, we not only increase the healthcare cost burden, but also place patients at risk, as additional tests may have to be performed to further evaluate the results of a test that shouldn’t have been performed in the first place. I find it shocking that payers would want to spend money on unproven evaluations. I don’t fully understand what they hope to accomplish.

When various groups try to define wellness, they include anywhere from five to eight dimensions of wellness, including emotional, environmental, financial, intellectual, occupational, physical, social, and spiritual aspects. All of these certainly impact the ability of individuals to achieve their ideal state of health, but it’s difficult to quantify the complex interactions and how modifying one dimension might lead to changes in the others.

Many of the companies that are trying to get into the wellness space seem to be playing on people’s insecurities as a means of generating profits rather than being truly interested in the science as we understand it. Gwyneth Paltrow and her Goop brand has made millions of dollars selling wellness products ranging from nutritional supplements to sex toys. Wellness is the place to be, but that doesn’t change the fact that I tend to think twice about organizations that make it a central focus.

This really hit me the other day as I drove by a shop that had a “find wellness here” banner to promote their sales of CBD oil. Even though there is a small body of evidence looking at it, many of the shops promoting it aren’t selling medical-grade product and are certainly hyping it well beyond what the evidence shows.

Especially with confusion around the proven effectiveness of various products, patients have an extremely difficult time determining which wellness interventions they should most vigorously pursue. Does a mammogram or a pap test carry the same weight from a wellness perspective as trying to eat healthier to reduce cardiovascular risk? How do those interventions compare to improving emotional and spiritual health? Should EHR vendors be branching out to gather more data about the dimensions of wellness in addition to gathering all the usual discrete data about recommended screening tests? Or should we recognize that the jury is still out on many of the aspects of wellness and stick with trying to manage the conditions and interventions for which we have the best data?

I have a potential client who would like me to help them build a dedicated wellness practice. I’m struggling with the idea. I know how to help them accomplish what they’re trying to do and can help them with both the operational and technical pieces. They plan to staff the practice with their usual physicians, who will take turns seeing the wellness patients. If they find something that requires more in-depth follow up, they will refer the patients back to the traditional practice.

The client doesn’t seem to care whether the physicians have much buy-in to the concepts of wellness, or whether they are prepared to address all the different dimensions of wellness. In talking with them about their goals, it feels like they’re just trying to catch a ride on a popular concept while making some money along the way. One partner specifically mentioned wanting to keep patients away from telehealth practices that offer wellness services.

On one hand, it would be easy to just take the engagement and get the work done. However, part of me will still have doubts about the validity of the plan since it seems more about the money than offering a comprehensive portfolio of services that would help support their patients in the pursuit of better health.

This situation underscores the issues with healthcare in the US today. We have a mismatch of incentives that leads providers to look for ways to bolster the bottom line at the expense of initiatives that are designed to shift to a value-based approach. Organizations cite the idea of “no margin, no mission” as a way to justify some of the choices they make. Given the financial beating that many practices have taken this year, you can’t blame them.

The decision might be out of my hands, as I’m not sure they’re going to be willing to spend the amount of money that will be needed to build the whole wellness concept from start to finish, including marketing, staffing, and changes to their EHR and other technical systems. I bid on several projects like this each year, where people think they are going to be able to do major projects on the cheap, and then seem shocked when someone fully spells it out for them. I can’t imagine that any of the larger consulting companies can do it more economically unless they’ve dramatically slashed their rates due to slowdowns from the pandemic.

Plus, the practice need to be ready to handle the losses they will incur over the next year or so until they know whether it’s going to turn out the way they hope. Given the uncertainty of the pandemic and the upcoming flu season, I’m surprised they are willing to even consider taking the plunge.

What do you think of the idea of wellness? Do you think it’s a good time to take the plunge on new service lines? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jose Barreau, MD, CEO, Halo Health

Jose Barreau, MD is chairman and CEO of Halo Health of Cincinnati, OH.

Tell me about yourself and the company.

I’m a physician and oncologist. I practiced until 2015. I was involved in creating a cancer institute and what I called multidisciplinary care, where a patient can come in and see all of their oncology doctors — surgical, medical, and radiation – at the same time. That got me interested in communication and collaboration and how that is important to a health system.

Halo Health offers a clinical collaboration platform. It is a cloud-based application that goes across health systems and has every clinician on it — doctors, nurses, and medical staff. It allows them to message each other, call each other, and receive alerts. It supports real-time clinical communication on one application across the system. We focus on real-time, high-priority, urgent and emergent information and communications.

How would you describe the clinical collaboration platform market and how Halo Health differs from its competitors?

We are focused on role-based communications, which is different in healthcare than in other businesses. About 40 to 50% of healthcare communication with a role you know – such as “cardiologist on call” or “charge nurse on the 14th floor” – rather than a named individual. Our platform allows for accurate manual and schedule-based, role-based communication, which differentiates us from anyone else.

How has the care team definition changed with COVID-19 and the rise of telehealth?

We started off as a secure texting application. We realized pretty quickly that secure texting is OK, but it is poorly adopted. People only text the people they know are working at that moment, so the platform is adopted only in pockets. Identifying roles and communicating call message and alert roles opens up the other 50% of the health system in a single platform.

With COVID, we really needed to set up teams, identify contacts, and get people moved through the system quickly. For example, “COVID charge nurse” is a role that multiple people fill based on the time of day, and a role-based platform can support that.

How has the mix of message types changed between real-time voice and asynchronous text?

I learned two things in studying communication and collaboration. Doctors and nurses want to do things faster, but they also want to be interrupted less. A doctor or nurse is interrupted from a patient encounter every time their phone rings since they are usually in front of a patient. That’s a problem when just calling them or messaging them with routine information. You want to give them a chance to respond when they can, and asynchronous communication is effective for situations where you don’t need to answer right away, but instead can wait a few minutes to wrap up your conversation with the patient. Nurses and doctors want patients to feel like they are the most important thing in the world to them at that time.

Do clients expect their messaging systems to be integrated with other systems?

They do. The big question is, what do you integrate? We are trying to clearly define that to protect the platform. We don’t want all the information that’s out there. If you want something from the EHR, we want you to go to the EHR. We also want to keep integration real time, so we integrate with the nurse call system, the PBX, physiological monitoring, and those types of things.

We have to do discovery about what that organization thinks is important. Even the level of integration with the EHR depends on what the organization wants.

Do you have to protect clinicians from being barraged with messages that non-clinicians send just because it’s convenient for them to do so?

I battled a long time with that when I was practicing medicine and directing the cancer institute. Some physicians are comfortable with being contacted when needed, but others don’t want anyone contacting them. We do a lot with healthcare leadership, such as chief medical officers. I personally feel that physicians should be open to communication from everyone, but everyone should know what is appropriate to communicate at what time, and that’s our philosophy.

I don’t think doctors and nurses should be on separate platforms, although some people believe that. I think that’s a huge mistake. One communication platform for everyone is appropriate, as long as the platform can provide certain protections and users have been educated on what is real time and reminded that they are interrupting a doctor or a nurse.

I find it funny that people talk about interrupting doctors, but nurses get interrupted all the time and nobody is saying much about that. Nurses are barraged with alerts and all this type of stuff. It’s OK to interrupt nurses eight times when they’re with a patient, but it’s not OK to interrupt a doctor. I would argue that nurses often spend more time with patients and develop stronger relationships with them.

It needs to be looked at holistically across the organization in terms of each role, but each doctor, nurse, or other clinician should be easily accessible. That’s our philosophy.

Email is notorious for allowing people to add others to a conversation without turning any of the discussion into actual assignments. Are messaging workflow components available to assign actions and log them as either completed or reassigned?

Everything in a clinical collaboration platform like ours is auditable and traceable. It’s usually individual-to-individual or individual-to-role. Everyone has an ID, and there’s an individual behind that role. Everything that is sent, delivered, and read is tracked. If you send a message to five people on the code team, all of them have the responsibility to read the message and respond to the code. The sender can see who has read it and who hasn’t.

You can put controls in place for resending and escalating, but if the message was directed to you or the role you’re filling, you are responsible. That’s why the role-based platform component is important, and having accuracy on the other side so that someone receives the alert or message.

What capabilities of secure communications systems have changed with the availability of cloud-based systems?

We are 100% Amazon technology. We evaluated a lot of technologies in 2015 and felt Amazon gave us the most scalability, reliability, and security. We signed a business associate agreement with them and developed a good partnership.

The Amazon platform gives our product scalability. We can have a huge organization on the West Coast, a huge organization on the East Coast, and another in the Midwest, and all of them can add users and mobile transactions without affecting response times or delivery times. We can add organizations on the fly and constantly release products and features as software as a service. Health systems, physicians, and nurses should be on the latest, greatest technology in the most current version at all times and cloud technology allows us to do that.

How do you see the company’s future?

We have built all the channels, the alerting, the calling, and the messaging. We have a tremendous amount of data going through our system. A lot of it was never captured before, stuff on pagers or on personal phones. We’re focused on data analytics to create insights around communication patterns and communication workflows to define their impact on patient outcomes.

We want to get the right information to the right person, make it accurate, improve patient throughput, reduce staff burnout, and increase clinician satisfaction. The future is in creating those insights and continuously optimizing workflows to improve patient care. We add features and functionality solely to improve patient care. Then we need to have data to show the chief medical officer, the CFO, and people who are playing for the platform how it adds value to patient care in their health system and how it creates return on investment.

Do you have any final thoughts?

The lack of communication and collaboration is one of the biggest, if not the biggest, causes of patient harm right now. Solving this problem will save more lives than a new medication. It has been fragmented in the past. We should all get behind unifying it and shedding a spotlight on the importance of communication and collaboration to keep making progress.

Morning Headlines 8/24/20

Outset Medical on deck for IPO

Outset Medical, which offers a portable, cloud-connected home dialysis machine that can integrate with EHRs, files for a $100 million IPO.

Appeals court further erodes huge 2016 jury award for Epic Systems

A US appeals court reduces the $280 million in punitive damages that Tata Consultancy Services had been ordered to pay Epic in a 2014 trade secrets lawsuit, saying that $140 million is a reasonable figure.

Exo Raises $40M Series B Extension To Bring Ultrasound Device To Market

Handheld ultrasound device manufacturer Exo raises $20 million in a Series B round, increasing its total to $100 million.

Monday Morning Update 8/24/20

Top News

Outset Medical, which offers a portable, cloud-connected home dialysis machine that can integrate with EHRs, files for a $100 million IPO.

The only connection required for the touchscreen-operated, sensor-managed portable machine is a wall outlet and tap water that it uses to create its own dialysate.

The company has raised $450 million, most recently $125 million in a Series E funding round earlier this year.

Reader Comments

From Puzzled PR: “Re: partnership press release. Why didn’t you mention our announcement?” I ignore any announcement that I can’t figure out within 15 seconds, including this infuriatingly imprecise one that has puffed some sort of “partnership” to the point I can’t tell who (if anyone) actually bought something. I doubt it was newsworthy anyway, but I honestly couldn’t tell. Too many PR cooks spoil the announcement broth in rendering simple statements such as “what does this company do” into intentional inflated gibberish in shooting for high-falutin’ prose and instead hitting their own foot. I typically don’t mention partnership announcements (because who cares?) and I also pass on “news” items that affect only existing clients who surely be contacted individually anyway. The folks whose committees ruin clear communication by over-polishing it always seem shocked that the rest of the world doesn’t take notice, either because they couldn’t figure it out or it was of minimal value even before being butchered.

HIStalk Announcements and Requests

A possibly surprising 60% of provider employees who registered for HIMSS20 say they won’t attend HIMSS21 even if COVID-19 isn’t a factor by then. Most respondents, based on what they know today, have already made plans one way or another, with few of them saying they don’t know yet.

New poll to your right or here, repeating one I did in the pre-COVID days of last summer that seems like years ago: what’s better about your life now compared to a year ago?

Webinars

September 3 (Thursday) 2:00 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

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

Acquisitions, Funding, Business, and Stock

Handheld ultrasound device manufacturer Exo raises $20 million in a Series B round, increasing its total to $100 million. The company will launch the device and its workflow software over the next few months in the US.

Hyland acquires Germany-based robotic process automation software vendor Another Monday.

A US appeals court reduces the $280 million in punitive damages that Tata Consultancy Services had been ordered to pay Epic in a 2014 trade secrets lawsuit, saying that $140 million is a reasonable figure. Tata continues to fight the lawsuit, arguing that it did not misuse the information that its consultants were accused of copying from Epic’s UserWeb while claiming to be Kaiser Permanente employees. The original jury award was $940 million, which was lowered to $420 million to comply with Wisconsin state caps on punitive damages. Epic accused Tata of stealing its intellectual property to improve its competing product Med Mantra. Tata employee Philippe Guionnet, who managed the company’s contracts with Kaiser, was the whistleblower who conveyed his suspicions to Epic.

People

Vinnie Whibbs (TogetherMD) joins TVR Communications as VP of enterprise solutions.

COVID-19

Updated models predict 227,000 to 300,000 US COVID-19 deaths by November and December. The current US death count is at 176,000.

Former FDA Commissioner Scott Gottlieb, MD warns that a new HHS policy that removes FDA’s authority to oversee lab-developed tests will lead to direct-to-consumer tests that operate without FDA oversight and will leave FDA with no authority to take enforcement action against bad tests. FDA had traditionally not actively regulated such tests anyway, but now will be unable to work with test makers to improve quality in the absence of a process that was working.

FDA will reportedly authorize the use of convalescent plasma from recovered patients for treating COVID-19 under pressure from the White House on the eve of the Republican National Convention’s kickoff, although its Emergency Use Authorization will make it harder to conduct randomized clinical trials, which have never been performed on the procedure.

California’s infectious disease monitoring system recently went down for 20 days, hampering the efforts of local health departments to manage their pandemic response. The state’s backlog of 300,000 lab tests contained 15,000 that were positive for COVID-19, eliminating the possibility for individuals to isolate themselves and for public health officials to perform contact tracing. An outage in the state’s CalREDIE database prevented delivery of electronic lab reports to counties. Mendocino County performed its tracking by telephone and fax machine as usual, leading to its decision to shut down bars in even though the state’s backlogged electronica data showed the county as doing fine.

An August 7 wedding reception at a Maine inn with 65 attendees – 15 more than state law allows – has resulted in 53 known COVID-19 cases that were discovered by contact tracers. A woman who did not attend the reception died after becoming infected by someone who did.

In Ireland, two high-ranking federal government officials resign and others are under pressure after getting caught attending an 80-attendee golf tournament and dinner that was illegal given the country’s 50-person limit. The newly resigned / fired minister of agriculture, who had held the position for just six weeks, had warned citizens three days before that house parties were spreading the virus and that “COVID loves to party.”

Other

A Catholic hospital in Toronto opens up its Internet content filtering system to allow doctors to access the websites of abortion clinics for patient referrals.

Scientists in China say that their AI algorithm can predict coronary artery disease by looking at a person’s photo for signs of thinning or gray hair, wrinkles, and ear lobe creases.

Sponsor Updates

• The RedSail Technologies QCompass podcast features OmniSys Chief Innovation Officer David Pope, PharmD.
• SymphonyRM’s HealthOS: Health AI Powered Patient Engagement is now available on the Salesforce AppExchange.
• Waystar will open an office in Utah, creating up to 70 jobs over the next seven years.

Blog Posts

• New Survey Shows Telehealth Growth (Ingenious Med)
• Speed chart completion with cloud-based speech recognition (Nuance)
• Keeping up the fight on cancer during pandemic (OpenText)
• Telehealth: Any Way You Want It (PMD)
• Inside the Model that Predicts Surges in COVID-19 Cases (Premier)
• How Data Helps Wellsource Combat Chronic Disease (Pure Storage)
• Q3 2020 Product Updates: Integrate More with Less Code (Redox)
• Relatient Powers the Virtual Waiting Room with Contactless Patient Engagement (Relatient)
• How the COVID-19 Pandemic Shifted Prescribing Patterns: A Look at Real-Time Prescription Benefit Transaction Data from the First Half of 2020 (RxRevu)
• Leading with Intention: Integrity (SailPoint)
• Health Care Decision Making: Mobile Access to Financial Data is Helping Hospitals Respond (Strata Decision Technology)
• The Source for Patient Data Prescribers Can’t Go Without (Surescripts)
• Lessons Learned as We Prepare for COVID Wave 2 (Vocera)

Contacts

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

Weekender 8/21/20

Weekly News Recap

• HHS denies a Wall Street Journal report that says COVID-19 hospital data reporting will revert back to CDC’s control using a new system.
• Bankrupt smart pill developer Proteus Digital Health sells its assets to Japan-based pharmaceutical company Otsuka for $15 million.
• Clinical communications vendor Vocera acquires EASE Applications, which offers messaging tools to connect family members and a patient’s care team.
• Health IT vendor TeleTracking refuses to answer the Senate Health Committee’s questions about its $10.2 million contract to develop a HHS COVID-19 hospitalization reporting database.
• HHS CIO Jose Arrieta resigns unexpectedly after 16 months on the job

Best Reader Comments

Spoke with an MD yesterday, they’re doing pot over the phone now. Great job, telehealth, you really saved the world this time. Meanwhile, back at the facility, kidney patients are bearing a COVID burden on top of the mortality rate associated with dialysis. Point: mobile works, big brick things with windows that don’t open don’t. Disclaimer: I’m talking about patient healthcare, not funding a better grasp on a sinking anchor. (richie)

I would rather some dumb startup provide access to marijuana cards, Rogaine, birth control, contact lenses, etc. than have to wait in line behind those people in the doctor’s office. Those are mostly just doctor employment programs anyway, which they don’t need. (IANAL)

Here’s how your insurance company thinks about [telemedicine]. You know that nurse line that they run where you can call in and ask questions? What if the people on that line could write prescriptions, order and interpret labs, etc.? What percentage of doctor’s office visits could they cover? Rough guess would be 1/3 of your typical PCP visits. How much less could the total cost be for that office visit? Maybe it is 60 percent of the in-person cost, more in high rent areas or areas with limited physician supply. When an insurance company is required to spend 80 percent of revenue on claims and they optimistically have a margin of 5 percent, it is a no brainer for them to try as hard as possible to make their telehealth solution work for their consumers. I agree it doesn’t make sense for traditional fee-for-service health systems to be using telehealth. Instead, it is something that cuts the traditional health system out of the relationship because they are too expensive or their service is too bad. Which makes the idea of health systems buying telehealth services sound strange to analysts. Why would health systems want to fund their competitors unless they have no hope of putting the telehealth cat back in the bag? (Bogon)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. P in Texas, who asked for programmable Ladybugs for her kindergarten class. She reported in February, “These little robots are the STAR of our classroom right now. I wish that I could send you a video of the children using the ladybug robot and coding remote. The shrieks and laughter were amazing. When I sent the videos and photos to the parents, they were thrilled, as well. I can tell how meaningful it is to these parents that their children learn more and accomplish more than they were able to at their age. It is really sweet. The first time I showed the children how to use it, they thought it was pretty cool. The first time each child got to program in a code and watch the ladybug travel over the mat, THEY WENT WILD!!! It was the perfect example of how seeing something happen can be a learning experience, but actually doing something is the best way to learn. Thank you for providing this opportunity for my littles.”

Google launches a six-month certificate program that will prepare students for high-paying technical jobs, such as data analyst, project manager, UX designer, and IT support specialist. The company says that college is too expensive for many Americans and a diploma shouldn’t be required for economic security. Google will treat the career certificates equivalent to a four-year degree in its own hiring, will fund 100,000 scholarships to the program, and will offer apprenticeships and job search services. 

An Alaska doctor is indicted for $9 million in Medicaid fraud for requiring his addiction patients to undergo a urine test that he sent to a lab he owns in Tennessee, for which he billed $3,000 to $8,000 each. A cash-paying patient filed a complaint with the state’s medical board. The doctor is posting rambling videos to YouTube proclaiming his innocence in referring to himself in the third person. Bonus footage minimizes COVID-19 and the “mind control” involved in mandating mask wearing, says his tests are expensive but nothing compared to what Medicare pays for a COVID-19 admission that “in most cases, is not even as bad as a cold,” and his persecution under the Obama administration for donating money to Republicans.

Missouri’s medical board revokes the license of a 70-year-old doctor who amputated a patient’s toe on the porch of his office, a machine shed that does not have running water. He says, “Everything was absolutely perfectly sterile, out in the bright sunshine and fresh air.” His practice’s website is full of bizarre conspiracy theories, along with his offer of video counseling ($50 per 15 minutes) for marital difficulties and unruly children, also offering student tutoring at the same rate. Googling turns up previous charges for narcotics distribution.

In Case You Missed It

• News 8/21/20
• EPtalk by Dr. Jayne 8/20/20
• News 8/19/20
• Curbside Consult with Dr. Jayne 8/17/20
• Monday Morning Update 8/17/20

Get Involved

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

Morning Headlines 8/21/20

Troubled Covid-19 Data System Returning to CDC

HHS denies a Wall Street Journal report that says COVID-19 hospitalization data reporting, which was moved to an HHS system with little warning and with criticism from some members of Congress, will return to CDC’s control under a new system.

Trump plots broad health data overhaul after troubled rollout of Covid-19 database

The federal government has launched Modernizing Public Health Reporting and Surveillance, a multi-year initiative to improve data quality at state and local health departments.

Experity Announces Acquisition of Calibrater Health

Urgent and primary care software vendor Experity acquires patient relationship management company Calibrater Health.

Patient engagement startup raises $15 million from Google’s Gradient Ventures

Physician practice-focused patient engagement vendor Klara raises $15 million in a Series A round, bringing its total raised to $32 million.

News 8/21/20

Top News

The Wall Street Journal reports that COVID-19 hospitalization data reporting, which was moved to an HHS system with little warning and with criticism from some members of Congress, will return to CDC’s control under a new system.

HHS denies the report, saying that no plan is on the table to have CDC take over again.

The WSJ article quotes a recent statement from Deborah Birx, MD that it interprets as signalling a move to a new CDC system. It did not read that way to me.

In a possibly related item, Politico reports that the federal government has launched Modernizing Public Health Reporting and Surveillance, a multi-year initiative to improve data quality at state and local health departments. Ideas being discussed include automating hospital and lab reporting, moving to electronic case reporting, replacing data systems, and digitizing mobile coronavirus testing sites. Experts worry that the program will conflict with existing efforts and question whether technologists at the White House’s US Digital Service have the knowledge to solve a problem that has vexed public health officials for years.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Healthcare Triangle. The Pleasonton, CA-based company brings together healthcare cloud and security vendor 8K Miles and health IT advisory and implementation services consultancy Cornerstone Advisors. It offers services such as IT strategy and planning, cloud technology, Epic and Meditech consulting, EHR managed services, backup and disaster recovery, data management and analytics, performance data, value-based care insights, supply chain management, and staffing optimization. The company’s customers include provider, payer, and life sciences organizations, with five of the world’s biggest pharma companies using its healthcare data pipeline management, analytics, and aggregation services. I interviewed Chairman and CEO Suresh Venkatachari a couple of months ago. Thanks to Healthcare Triangle for supporting HIStalk.

I cruised YouTube for Health Triangle videos and found this “Week in Review” series that I think is brilliant, especially given that I have no interest in the usual lame podcasts and videos from industry amateurs. The host is Health Triangle Director of Business Development and industry long-timer Damian David, who delivers a smooth, relaxing news recap and interview that he follows with a remarkably good song performance. Other episodes feature fine covers of “With or Without You,” “Sweet Melissa,” “The Wind Cries Mary,” and “Ring of Fire.”

Listening: new from Bully, which sounds like a new grunge album from Courtney Love and/or Hole. Bully isn’t really a band any more – singer-songwriter Alicia Bognanno did a Courtney in in sending her musical mates packing while keeping their collective moniker. She’s also like Love in being bipolar and thus prone to sprinkling her recordings with therapeutic yelling and growling that makes you happy she’s not mad at you. Bognanno is amused by those who compare her music to grunge, explaining that being born in 1990 means she didn’t exactly grow up listening to Nirvana.

Webinars

September 3 (Thursday) 2:00 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

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

Acquisitions, Funding, Business, and Stock

Clinical communications vendor Vocera acquires EASE Applications, which has developed messaging tools to help family members communicate with a patient’s care team during hospital stays. EASE co-founder Patrick de la Roza, now an SVP/GM at Vocera, started the company while working as a system administrator at AdventHealth Nicholson Center in Orlando.

Bankrupt smart pill developer Proteus Digital Health sells its assets to Japan-based pharmaceutical company Otsuka for $15 million. Otsuka had been an investor and partner of Proteus, which pre-bust was valued at $1.5 billion, apparently by folks with unreasonably optimistic expectations. Going down in flames with Proteus is the nearly $500 million poured into it by investors who rode the rocket up and then down through a Series H funding round.

Change Healthcare enhances its Enterprise Imaging Network with the acquisition of Nucleus.io, a cloud-based medical imaging company.

Emids acquires payer-focused IT consulting company FlexTech, its second acquisition since purchasing Encore Health Resources in 2017.

Urgent and primary care software vendor Experity acquires patient relationship management company Calibrater Health.

Year-old, China-based health platform operator JD Health raises $830 million in a Series B funding round. The company – which raised $1 billion in November 2019 Series A round that valued it at $7 billion – offers pharmacy delivery, telehealth services, genetic testing, and hospital systems. It processes 100,000 diagnostic inquiries each day and is working on an online family doctor service that will serve up to 50 million families. New investor Hillhouse Capital was founded in 2005 by a Yale graduate with $20 million in seed capital from Yale’s endowment fund and was named after a New Haven street. The investment firm, which focuses on businesses in Asia, runs a joint venture with Mayo Clinic to boost that provider’s influence in China.

Sales

• Genesis Health System (IA) will use Bright.md’s SmartExam software to power its expanded telemedicine service.
• Florida-based hospice Haven selects Netsmart’s MyUnity EHR.

People

Impact Advisors promotes Susan Stewart to VP and Amy Reid to VP of recruiting.

Senior home care support and technology vendor Seniorlink hires Amy McConnell (NantHealth) as chief compliance officer.

Steve Eckert (Avaap) joins Cook Children’s Health Care System (TX) as CTO.

Announcements and Implementations

Baptist Health South Florida President and CEO Brian Keeley says the health system will spend upwards of $100 million on a digital transformation over the next several years that will include adding new scheduling and registration capabilities to its Cerner system; investing in analytics; upgrading its website with more patient engagement tools; and bolstering its Amwell-powered Care on Demand telemedicine app. The search for a chief digital officer is underway.

In Australia, SA Health implements interoperability software and services from InterSystems to interface its Notifiable Infectious Disease Surveillance system with new workflow technology as it prepares for future waves of COVID-19.

Carilion Clinic (VA) implements Wolters Kluwer’s AI-powered Sentri7 clinical surveillance software to more quickly identify patients at risk for C. diff infections.

Higi adds OptimizeRx’s prescription savings and patient educational materials to its Smart Health Stations that are installed in pharmacies and retailers.

Capsule Technologies announces GA of a cloud version of its Ventilated Patient Surveillance workstation that runs on Microsoft Azure. 

COVID-19

Researchers find from cell phone data that 7% of workers at a given nursing home also work in at least one other facility, calculating that eliminating such shared staffing would reduce COVID-19 infections by 44%.

The federal government forced companies to manufacture billions of dollars worth of ventilators under the Defense Production Act, but most of them are gathering dust in the national stockpile as COVID-19 treatment protocols de-emphasized their use after a high percentage of intubated patients died and their role in infecting caregivers was questioned. Less then one-fourth of hospitalized COVID-19 patients are placed on ventilators, a big drop from the pandemic’s early days. The federal government says it will either sell or give away dozens of thousands of the devices to other countries.

Pooled COVID-19 testing, which worked well in other countries to reduce the use of short-supply reagents, can’t be used in the US because our infection rates are so high. Partial samples from several patients are combined, the batch is tested for coronavirus, and a positive result triggers re-testing of the retained samples from the batch. Efficiency is good until positivity rates hit 5-10%, at which time the re-testing that is required takes more labor and reagent than testing the individual samples. Experts also question whether the pooled tests miss people with low levels of virus and worry about the extra work that is required for lab techs since robotic processors are overwhelmed.

I received a forwarded internal email from Baylor College of Medicine that looked at the Houston metro area’s wildly fluctuating COVID-19 testing numbers, which recently tripled. That turned out to have been caused by a state system upgrade on August 1 that increased doubled reporting capacity, which triggered a big surge as the backlog was being cleared. The email notes that public health has poorly integrated systems and still are sent manual results, including faxes, that someone has to enter.

Other

University of Colorado Health CMIO CT Lin, MD shares numbers on video versus in-person visits since the beginning of the year. In-person visits (purple) dropped off sharply in early March and were outnumbered in a handful of weeks by the virtual visits (cyan), but in-person visits have mostly recovered after the state ended its stay-at-home policy and virtual visits have gone back down. Total visit counts seem about the same now as in January and February, but virtual visits went from essentially zero to about 15% of the total. Extrapolation is always dangerous — especially looking at the seemingly unstoppable telehealth upturn in March — but one might speculate that even though some patients have been forced to discover the convenience and lower infection exposure of virtual visits, they still prefer seeing clinicians in person and having related services provided at the same time. It may also be that either (a) they would rather have an in-person visit, but might have a virtual one forced upon them for one reason or another; or (b) clinicians either get paid more predictably or can offer more services when sitting in the room with the patient. Visits from outside UCHealth’s network also aren’t accounted for, so third-party virtual visits and urgent care might be impacting the numbers. Lastly, it may be that a higher than normal number of virtual visits were due to deferred higher-acuity or chronic disease management services. I would be interested in seeing a drill-down of both visit types by nature of the visit, demographics of the patient, new versus existing patient, categorization of visits by diagnosis and services rendered, and the recency of previous visits.

I missed this earlier as an interesting wearables story. Texas Tech fires its woman’s basketball coach one day after a USA Today investigative report calls out its “culture of abuse” that included forcing players to wear heart rate monitors during games and punishing those whose pulse dropped below 90% of capacity for more than two minutes.

Sponsor Updates

• Medicomp Systems releases an updated version of its Quippe Nursing care planning and clinical documentation software.
• Goliath Technologies publishes a new case study, “Terralogic, IT Service Provider, Avoids ‘Citrix is Slow’ Escalations.”
• Phynd’s Schedule Advisor, which allows patients to see a provider’s open scheduling slots, is now available in Epic’s App Orchard.
• The HCI Group launches a Referral Incentive Program Department.
• PatientPing and Lyniate will develop a hospital connector solution for integrating ADT notifications using integration engines from Corepoint and then Rhapsody.  
• Kyruus adds online scheduling for virtual visits to its ProviderMatch for Consumers software for health systems.
• KDL Lab in Russia implements InterSystems TrakCare Lab Enterprise.
• Pure Storage publishes a new case study, “McArthur Lab Adds Capacity and Performance with FlashBlade.”
• Capsule announces GA of a cloud-deployed and -managed version of its Ventilated Patient Surveillance workstation, part of its Medical Device Information platform.
• Nuance’s virtual assistant technology for Hey Epic! in Hyperspace is now available through its Dragon Medical One cloud-based clinical documentation solution.

Blog Posts

• Virtual Roundtable: Physician Leaders Discuss How to Maximize the Value of Unique Device Identifiers (UDIs) (First Databank Health)
• As COVID-19 Overloads Hospitals and ICUs, Glycemic Management Can Help (Glytec)
• How McKesson used Google Cloud to rethink their database architecture (Google Cloud)
• Virtual Implementation for Cloud Communications Platforms (Halo Health)
• Build Versus Buy a Healthcare Enterprise Data Warehouse: How IT Leaders Choose the Best Option for Their Organizations (Health Catalyst)
• 5 Tips for Successfully Implementing Charlie in Your Prescription Renewal Workflows (Healthfinch)
• SHIEC 2020: Imat Solutions Giving HIEs Power to Expand Service Offerings (Imat Solutions)
• Leading Academic Study Shows the Value of Imprivata OneSign to Hospitalists (Imprivata)
• The 20-Year Evolution of Patient Electronic Signatures (Access)
• Building trusted relationships in this time of remote connections (Infor)
• Telehealth: Any Way You Want It (PMD)
• 3 Often Overlooked Payment Channels That Can Help Streamline Collections (InstaMed)
• History, never repeats. Or does it? (InterSystems)
• Supply Chain Management During a Medical Surge: How Hospitals Can Work Together (LiveProcess)
• Virtual Health Demands Virtual, Affordable Patient Payment (Loyale Healthcare)
• 6 Signs It’s Time to Hire a Physical Therapy Practice Management Consultant (MWTherapy)
• Our Healthcare Heroes Deserve a Day of Rest (Netsmart)

Contacts

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

EPtalk by Dr. Jayne 8/20/20

There’s been so many notices from CMS in my inbox lately that I missed a biggie, and that was the recent release of the 2021 Medicare Physician Fee Schedule. CMS is planning to shuffle some of the telehealth codes, eliminating 70 or so codes from the 80-ish that were created to cover services during the pandemic. They are adding more than a dozen new codes, though, and some advocates are hopeful that the public comment period will lead them to add even more. They’re going to have an uphill battle since CMS isn’t convinced that the services are beneficial outside the context of a public health emergency. The organization will be looking for data to make a decision, and in reality, none of us know how long the declared emergency will last. Flu season will soon be upon us – I’ve already had patients trying to get vaccinated – and only time will tell.

The Physician Fee Schedule noticed was tucked in between about 10 emails about new resources and strategies and collaboration spaces for eCQM projects. In my previous life with a large health system, the clinical quality measures fell under my purview. I’m fairly certain that dealing with all the calculations and making sure our EHR was handling them properly killed more than a couple of my brain cells. I have tremendous respect for the IT and clinical teams that live in that world all the time, and just wish there could be an easier way to go about gathering the data needed to drive value-based care.

The American Academy of Family Physicians launched their new redesigned website today. Although it’s much cleaner than the old one, virtually no information is available from the home screen without going through menus. The entire first page is sucked up by a big graphical tile and the concept repeats down the screen, offering little value. They also changed the login scheme from one using the member number to one using an email address, forcing every single user to change their password.

A blurb they sent out about the update mentions the addition of new “mega-menus” for users to find their content, and I’m definitely not impressed. The menus are so long you have to scroll through them, and they completely cover the rest of the screen even though a good chunk of the menu popup is blank. Seems like perhaps it’s supposed to be optimized to some other form factor than the PC I was using it on. The menus are so big though I can’t imagine them on a phone screen. It took me four clicks to access content I used to find with one, so I give the update a grade of C at best.

A better website was the one for the COVID-19 Prevention Network, which I visited to volunteer for a potential vaccine trial. Based on the questions, I’m not sure what their ideal candidate looks like, but if they are seeking people who are constantly exposed to unmasked sick people, I might know a couple.

My clinical employer sent out a notice from a local medical testing place that is also doing vaccine trials, but I’d much rather participate in one that is part of a university study versus the commercial lab that was offering cash to participants. Not to mention that I have no desire to be part of a safety trial, but would be happy to be a guinea pig for one that determines whether the vaccine is effective in the real world.

I’ve read several articles in the last couple of weeks about so-called toxic positivity and its negative impact on people as they try to cope through the pandemic. Although experts agree that having a positive mindset can help with coping, when overdone, it can make it seem like the only way to deal with a negative situation is to put a happy face on it.

I’m a huge fan of Fred Rogers. As an adult reading about his life, one of the things I came to appreciate about him is that he told children that it was OK to feel mad, or sad, or bad. One of his goals was to help his viewers learn to process those emotions in a productive way. One study from 2018 looked at “The psychological health benefits of accepting negative emotions and thoughts” and found that those who don’t manage difficult emotions don’t do as well as individuals who manage them effectively.

I used to have someone in my life who told was constantly telling me to smile, which I loathed. Trust me, there is nothing to smile about when you’ve been on call in the critical care unit for over 24 hours, have had to pronounce patients dead overnight, or have had to do any of a number of difficult things that healthcare professionals do all the time. Years later, I understand that the real reason I hated the comment was that it was an attempt (conscious or not) to minimize or invalidate my experiences or to try to mold them into something that the other person was more comfortable with. As we learn more about the trauma that healthcare providers experience and other concepts such as moral injury, it becomes even more important to give ourselves permission to be less than OK.

Getting through this pandemic and whatever other economic and societal crises go along with it will be a long, hard slog across the globe. I saw a figure the other day that some 20% of first line healthcare workers had contemplated suicide in the last 90 days, which should be setting off alarm bells. As someone who has been personally touched by physician suicide this year, I encourage everyone to try to find moments to check on your co-workers and to care for each other.

This week provided another crazy day at the urgent care, where I was completely understaffed and “over-patiented.” We have some newer-ish staffers who are still a little freaked out about COVID, unlike the rest of us who are just used to it by now. Mask, double mask, face shield, let’s go. We were trading stories about whether we’re still doing the whole “strip in the garage and run to the shower” track and field event when we get home from work. 

The paramedic I was working with had me literally laughing out loud. His wife won’t let him in the house until he strips in the garage, sprays a cloud of Lysol, and walks through it to the shower. He refers to it as “the fog of war,” which was just the right degree of hilarious coming from a guy who served his country in both Iraq and Afghanistan and who could probably kill me three different ways with chewing gum and a popsicle stick. Somehow the camaraderie made up for the 68 patients I saw by myself, and I’m actually looking forward to my next shift.

What’s the funniest thing you’ve heard in the time of COVID? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/20/20

Brightline Raises $20 Million to Bring Behavioral Health Care to Kids and Families Across California and Beyond

Pediatric behavioral health startup Brightline will use a $20 million funding round to further develop and expand access to its virtual visit services.

Baptist Health begins $100 million total digital transformation

Baptist Health South Florida looks to hire a chief digital officer as it prepares for health IT projects, including additional Cerner implementations, that will help it offer patients improved care through a more Amazon-like experience.

Vocera Acquires EASE to Improve the Healthcare Experience for Patients and Families

Clinical communications vendor Vocera acquires EASE Applications, which has developed messaging tools to help family members communicate with a patient’s care team.

Otsuka approved to buy bankrupt smart-pill maker Proteus’ assets, overcoming opposition from Novartis

Japanese pharmaceutical company Otsuka will acquire the assets of Proteus Digital Health, which filed for bankruptcy in June, for $15 million.

Morning Headlines 8/19/20

Bridge Connector Raises $25.5 Million in Series B Funding to Advance Interoperability Layer for Health Care

Nashville-based interoperability platform vendor Bridge Connector raises $25.5 million in a Series B funding round, increasing its total to $45 million.

Change Healthcare Acquires Nucleus.io

Change Healthcare enhances its Enterprise Imaging Network with the acquisition of Nucleus.io, a cloud-based imaging and workflow software company.

WebMD and Krames Launch Back to Care Program, Connecting Patients with Prescription Assistance

WebMD and Krames launch WebMD Back to Care, which connects patients with available prescription payment assistance programs.

News 8/19/20

Top News

Interoperability platform vendor Bridge Connector raises $25.5 million in a Series B funding round, increasing its total to $45 million.

The Nashville-based company will use the funding to continue the rollout of its new Destination integration service. It says it is on track to boost growth by 1,000% in 2020.

Reader Comments

From Cam Sandford: “Re: telemedicine. I think the pushback against online classes offers a value warning.” Students who are paying megabucks for college tuition are not happy at being taught over the equivalent of Skype at full price, even though their degrees will presumably be worth the same in the end. The convenience factor isn’t convincing students and their parents that trading the campus experience for home learning is a good deal. The biggest risk to telemedicine is that patients often still have to go somewhere as a result –pharmacy, lab, x-ray facility, ED, or specialist – and that cancels out much of their overall convenience. I also wonder how patient satisfaction fared in the telemedicine tsunami, especially when segmented into the “I just need a prescription” kind versus complex, ongoing patient management. Most of us don’t conduct our business virtually with lawyers, accountants, and financial advisors and we might have the same reluctance to turn our medical issues over to the flickering image on a video screen, especially if we are just assigned some random, available doctor that we don’t know, can’t contact for follow-up questions or concerns, and will never see again. It would also be interesting to compare the experience, credentials, and outcomes of doctors who are willing to sell telemedicine time to those who aren’t, just like you don’t see top-tier actors and athletes hawking custom video birthday greetings on Cameo.

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

September 3 (Thursday) 2:00 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

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

Acquisitions, Funding, Business, and Stock

Perhaps this is telemedicine’s next acquisition, Medical cannabis telemedicine provider PrestoDoctor expands to Illinois after success in other states in selling medical marijuana cards for $50 to $200, depending on the state. It is fascinating to see how many buzzy startups sell nothing but rubber-stamped doctor prescriptions delivered impersonally online, adding minimal value and contributing little to drug safety and appropriate use by at least occasionally prescribing whatever the patient wants to keep the patient and their employer happy.

Sales

• Michigan Medicine chooses Sectra for enterprise imaging.

People

CloudWave promotes Erik Littlejohn, MBA to president/COO and Joseph Badziong, MBA to CFO.

Ciox Health hires Nick Giannasi, PhD (Change Healthcare) as chief product officer.

Todd Johnson (GetWellNetwork) joins Avia as SVP/practice leader.

Nordic hires Jeff Buss, MS, MBA (EY) as CIO.

Announcements and Implementations

WebMD and Krames launch WebMD Back to Care, which connects patients with available prescription payment assistance programs. The information will be included in end-of-visit patient education materials provided by Krames, which joined WebMD as part of its StayWell Company acquisition from drug maker Merck in March 2020.

Virginia Cardiovascular Specialists deploys PatientKeeper for reviewing patient information and capturing professional charges on mobile devices.

3M-owned MModal says that 150 healthcare organizations are using its virtual assistant technology that captures the doctor-patient conversation to automatically document the encounter.

COVID-19

FDA warns labs and providers that Thermo Fisher’s TaqPath COVID-19 test kit can deliver false positive results unless labs apply software updates and follow the company’s instructions for vortexing and centrifugation.

University of North Carolina at Chapel Hill moves undergraduate classes online just one week after the start of in-person classes. The university reported several COVID-19 breakouts in communal living areas and a 13.6% test positivity rate that quickly filled its isolation dorm. UNC had ignored CDC’s recommendations, declined to follow the county health department’s recommendation to delay in-person classes for five weeks, and didn’t tell faculty members about the health department’s warning that it should not bring students back to campus. The independent student newspaper published an editorial about the clusters of infection under the headline “UNC has a cluster****” on its hands,” except they used letters instead of asterisks in describing how the university should have know that students would immediately start behaving recklessly at parties even before last Monday’s class start. Football practice will continue, however, and a home game is scheduled for UNC’s largely closed campus on September 12.

North Carolina’s health department says Monday’s case count was lower than expected because a commercial lab was late in sending its data file, the second week in a row where testing numbers were wrong due to lab data problems.

A ProPublica report says that cellphone tracking data shows that visitors to Las Vegas casinos, which re-opened on June 4, are likely spreading coronavirus to communities all over the country. Travel-related transmission cannot be easily detected by contact tracing, which is local rather than national in nature.

Three  New Jersey hospitals implement thermal scanning to screen patients, visitors, and employees as they enter the premises, ignoring WHO’s conclusion that such scanners – which were never intended for medical use — do little except provide a false sense of security since many COVID-infected people are free of symptoms.

Other

Ohio-based contract Epic analyst Gurnee “GG” Green will be featured in the Democratic National Convention this week, explaining how her custom clothing boutique that she opened in December 2019 has struggled due to COVID-19.

The bond rater of Wise Health System (TX) says that one reason the health system’s margin has slipped is the cost of replacing Cerner with Allscripts, which in addition to staffing expense, created $12 million worth of revenue cycle inefficiency. It notes, however, that Wise Health Surgical Hospital improved its revenue cycle performance in 2019 following the EHR implementation.

Sponsor Updates

• The Ettain Group donates laptops to the Dottie Rose Foundation in support of its STEM and family-assistance efforts.
• Clinical Architecture will present during Logica’s Summer 2020 Virtual Meeting August 18-20.
• Everbridge wins The Help Desk Institute’s 2020 Best Customer Experience Award.

Blog Posts

• CDC advice for managing a staffing shortage – and how Ability can help (Ability Network)
• Three Simple Steps to Reducing Accounts Receivable (AdvancedMD)
• The 21st Century Cures Act: Deadline Approaching November 1 (Bluetree)
• Navigating the Next Phase of Telehealth Adoption (Bright.md)
• 3 Common Misconceptions About Business Associate Agreements (Datica)
• HAP’s Experience Managing Members During the COVID-19 Surge (CarePort)
• Mental Health Risks for COVID-19 Frontline Healthcare Workers (Optimum Healthcare IT)
• Price Transparency 2021 – Are You Ready? (Health Triangle)
• Addressing Physician Burnout via EHR Inboxes and Patient Message Management (ChartLogic)
• What You Need to Know About the CMS Interoperability & Patient Access Rules (Collective Medical)
• Rethinking Data Protection with Air-Gapped, Consistent Backups in the Cloud (CloudWave)
• Five Ways Providers Can Help Mitigate Telehealth Access Challenges (CoverMyMeds)
• 7 Keys to Better EHR Usability (EClinicalWorks)
• Home Care’s Increased Role During the COVID-19 Pandemic (Ensocare)
• Helping Hospitals Get Back on Their Feet with Advanced Analytics (EPSi)
• McKnight’s Power Panel EBook – Succeeding Despite the 2020 Pandemic (ESolutions)

Contacts

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

Morning Headlines 8/18/20

Thirty Madison raises $47 million for its direct to consumer treatments of hair loss, migraines and indigestion

Consumer-facing telemedicine and prescription delivery startup Thirty Madison raises $47 million, bringing its total funding to $70 million.

Omnicell to Acquire Pharmaceutical Strategy Group’s Leading 340B Software-Enabled Service Business

Medication management vendor Omnicell will acquire Pharmaceutical Strategy Group’s 340B Link business for $225 million.

Patient Square Capital Formed To Become The Premier, Dedicated Health Care Investment Firm

Healthcare investment veteran Jim Momtazee announces the launch of Patient Square Capital, an investment firm that will focus on technology-enabled services, medical devices, digital health, providers, and consumer health.

Curbside Consult with Dr. Jayne 8/17/20

Sunday was National Rum Day. Alas, I spent it treating patients rather than enjoying fuzzy drinks in the sun somewhere.

Today was a case study on how broken the healthcare industry is. Given the economy, over the last few weeks we’ve seen a surge in people questioning their deductibles and trying to figure out what the cost of care might be prior to checking in to be seen. Of course we haven’t done anything remotely close to installing real-time eligibility checking and usually don’t have a clue what their benefits might be due to convoluted payer contracts, so they stand at the front desk and debate whether they want to be seen or not. I feel for them because most of them need care, but are feeling like they’re stuck between a rock and a hard place in deciding what to do.

We’re seeing a mix of patients who are terrified that they might have COVID, those who are likely to actually have COVID but don’t think it could possibly happen to them, and the usual things that come into an urgent care, such as lacerations, chest pain, and traumatic injuries. We’re also seeing patients at the urgent care who are terrified of going to the ED since the state is in a surge situation, so they stay at home too long with complicated problems. Tonight ended with an elderly patient who fell and whose family kept them at home due to those fears rather than seeking care. Ultimately, they did little more than prolong the patient’s pain and delay definitive care for her broken femur.

We’re also seeing a total breakdown in the primary care infrastructure. Patients can’t get in touch with their providers to determine the best place to seek care. We’re seeing more and more patients relying on us for basics and necessities such as medication refills and quarterly labs.

Despite everything that is supposed to be going on in the realm of value-based care and management of costs, it feels like things are upside down and we’re just lighting money on fire rather than delivering coordinated care. If we as a society can’t manage something as straightforward as medication refills, I’m not sure how we think we’re going to motivate patients to make major health-related changes or meet their growing psychosocial needs as the pandemic rages on.

I struggle to figure out the answer. I’m certain technology isn’t the full answer, although I’m eternally grateful that Epic has essentially taken over the market in our area. Nearly every patient has a phone and can access MyChart, so those of us in the urgent care trenches can figure out what’s going on. Except for those patients who flit around the urgent care market between CVS Health Hub, the Walgreens clinic, and the handful of urgent cares in town, in which case all bets are off. Most patients don’t know that they can coordinate their MyChart accounts though and pull in data from the different health systems, so it feels like I do a fair amount of technology teaching some days as we try to see an integrated picture of patients who seek care across the different systems.

I have noticed an improvement in the medication history information we can receive back through Surescripts, which helps quite a bit when you’re trying to figure out how compliant your patients are. Our prescription drug monitoring program database also continues to perform like a champ, which helps bridge the gaps. Still, the bottom line is that I’m usually in at least three or four different systems trying to do my job, which doesn’t seem right in the middle of a public health crisis that should be driving us towards greater sharing and improved patient care.

I’ve also noticed an increase in patients who want to discuss politics during their visits. It always gives me a little chuckle when they ask me whether I think COVID is as bad as the media make it out to be. My double mask and the face shield should be an indicator. Still, it doesn’t seem like there’s much realization that healthcare workers are desperate to not take the virus home to their family members, or that we are stressed to the max and both physically and mentally exhausted, given the complaints that we get when anyone has to wait more than 30 minutes for their visit.

We’re squandering resources right and left as colleges and universities mandate COVID testing, but on a clinically inappropriate timeline. A negative test 10 days before move-in day is meaningless unless the students have been quarantining. We’re also still seeing employers that demand patients who have negative tests get a second negative test to return to work despite the CDC updates that occurred more than three weeks ago that say this is unnecessary. I’m sure the local school district’s HR department is far wiser than infectious disease experts, so we do what has to be done regardless of whether it makes sense or is a good use of resources or not.

I had an interesting conversation with my scribe today, I didn’t realize he is a COVID survivor. He was pretty sick and spent a couple of weeks in the hospital, receiving convalescent plasma and not requiring intubation. He’s glad to be recovered, but worries about the long-term consequences of the disease, especially since he’s under 30 and hopefully has many years ahead of him. He’s focused on making it to medical school in a year or so and I can’t help but think that his experience will make a difference in the kind of physician he grows into.

He had never heard of clinical informatics, so I was able to do some education there. It’s good for those who aspire to join the healthcare team to know the underpinnings that try to hold it all together. We talked about some of the work I’ve done in the past, which had me hankering for a good lab interface build or maybe some kind of a legacy EHR conversion. It’s funny how the things we thought were arduous at the time take on a whole new look when we’re faced with something that has changed our perspective as radically as COVID has.

Regardless of how tedious our days seem or how frustrating some of the interactions might be, the reality is that we’re dealing with someone’s mom, dad, grandmother, daughter, sister, and more. It’s a unique privilege to care for people. I’m hoping we will eventually be able to elevate our game and find a better path forward.

What is your employer doing to change the big picture of healthcare or drive innovation forward? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/17/20

Firm Helping Run U.S. Coronavirus Database Refuses Senators’ Questions

Citing an NDA, health IT vendor TeleTracking refuses to answer the Senate Health Committee’s questions about its $10.2 million contract to develop a HHS COVID-19 hospitalization reporting database to replace one used by CDC.

HHS CIO Arrieta unexpectedly resigns

HHS CIO Jose Arrieta resigned unexpectedly Friday night after 16 months on the job, saying he wants to spend time with his kids.

Epic Systems consolidating four departments into one division

Epic notifies employees that it will immediately consolidate its training, implementation, QA, and technical communications under an application services division.

Medical Debt Collection Firm R1 RCM Hit in Ransomware Attack

Revenue cycle company R1 RCM works to recover from a ransomware attack that occurred just as the company was preparing to release its quarterly financial results.

Monday Morning Update 8/17/20

Top News

Health IT vendor TeleTracking refuses to answer the Senate Health Committee’s questions about its $10.2 million contract to develop a HHS COVID-19 hospitalization reporting database to replace one used by CDC.

TeleTracking says it signed an NDA that prohibits it from explaining to Congress how it collects and shares data, the nature of its proposal to HHS, and communication it may have had with the White House or other government officials.

The Pittsburgh-based company directed such inquiries to HHS, which has not responded to a June 3 inquiry from Senator Patty Murray (D-WA), who asked why the government was creating what seemed to be a duplicate data collection system.

HHS CIO Jose Arrieta, who defended the contract and insisted that the work was bid competitively despite appearances that it was not, resigned Friday.

TeleTracking’s contract runs just five months, after which it can bill the government for an extension.

Reader Comments

From Concerned Exhibitor: “Re: HIMSS21. What are companies doing now that it has been moved to August? The contract says that if HIMSS21 cancels for any reason, HIMSS will keep 50% of exhibitor payments. Wondering if people will be attending, or will it be a vendor pool?” I’ll make that my weekly poll below, but based on the one I did a couple of weeks ago, nobody will decide anything until they can assess the pandemic situation.

From Minesweeper: “Re: HIMSS21. You should get them to sponsor the return of HIStalkapalooza – bet that would get people back in the mood to attend the conference!” I’ve never missed the headache and financial risk that was involved with throwing a party for everybody else for 10 years, so I’m happy to abrogate that responsibility.

HIStalk Announcements and Requests

Two-thirds of poll respondents say they would not return to campus if so required by their employer, although skeptics might observe that respondent bravado might not evidence itself in a “get in here or you’re fired” scenario, possibly also noting that Epic employees who were (at that time) being forced back to campus for reasons they might not find adequate may have worked to get out the vote.

New poll to your right or here: Health system / provider employees: do you think you’ll attend HIMSS21? (assume COVID isn’t a factor by then). I realize that the unknowns are significant at this point, but I’m curious about those who have a pretty good idea of which way they’re leaning if pandemic issues are excluded. If the pandemic is still active, then it might just be exhibitors talking to cardboard cutouts.

Listening: new from Fantastic Negrito, the stage name for 52-year-old, Grammy-winning blues singer Xavier Dphrepaulezz (clearly the rebrand was justified). He had a rough upbringing and supported himself with various illegal activities over the years, but has turned into a thoughtful observer of society and the power of individuals to change it.

Welcome to new HIStalk Platinum Sponsor Capsule Technologies, which is upgrading from Gold. The Andover, MA company offers Medical Device Information Platform, which provides device integration, vital signs monitoring, and clinical surveillance solutions. It captures streaming clinical data from connected systems and transforms it into context-rich information for clinical documentation, alarm management, patient surveillance, decision support, predictive analytics, clinical research and more. The company’s 2,900 global clients use its platform to improve patient safety, simplify workflows, and raise satisfaction. The company recently announced its Ventilated Patient Surveillance workstation, launched at Yale New Haven Health System, that allows staff to monitor live streaming data from ventilators to minimize in-room exposure and PPE consumption for patients in temporary ICU rooms that don’t have hallway windows or easily-heard alarms. CEO Hemant Goel is an engineer by training with 30 years of healthcare IT leadership experience. Thanks to Capsule Technologies for supporting HIStalk.

Webinars

August 19 (Wednesday) 1:00 ET. “A New Approach to Normalizing Data.” Sponsor: Intelligent Medical Objects. Presenters: Rajiv Haravu, senior product manager, IMO; Denise Stoermer, product manager, IMO. Healthcare organizations manage an ever-increasing abundance of information from multiple systems, but problems with quality, accuracy, and completeness can make analysis unreliable for quality improvement and population health initiatives. The presenters will describe how IMO Precision Normalize improves clinical, quality, and financial decision-making by standardizing inconsistent diagnosis, procedure, medication, and lab data from diverse systems into common, clinically validated terminology.

September 3 (Thursday) 2:00 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

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

Acquisitions, Funding, Business, and Stock

Starboard Value, the activist investor whose purchase of just 1.2% of Cerner shares convinced the company to give it four board seats in April 2019, reduces its CERN holdings to 2.6 million shares, about 0.8% of the outstanding shares, worth less than $200 million. CERN shares have gone up 16% since the day Cerner capitulated, although the Nasdaq has moved up 38% in the same timeframe.

People

Karen Mellin (Swisslog) joins Harris Computer as EVP.

Announcements and Implementations

India Prime Minister Narendra Modi announces the National Digital Health Mission, in which all citizens will be issue a health ID card that links to a hospital-stored record of doctor visits, prescriptions, and tests. The voluntary program’s six systems include HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, E-Pharmacy, and Telemedicine, of which all but the last two are already running. The government will issue specifications to allow companies to develop FHIR-connected solutions for the system. 

Government and Politics

HHS CIO Jose Arrieta resigned unexpectedly Friday night after 16 months on the job, saying he wants to spend time with his kids. It was the first CIO job for Arrieta, whose background was technology contracting.

Also resigning Friday were CDC’s chief of staff and deputy chief of staff, political appointees who had been accused by the White House of being insufficient loyal. They are forming a consulting firm.

COVID-19

The US death count ran past the 160,000 mark this weekend in 5.3 million cases.

COVID Tracking Project says Texas testing numbers are out of whack, with the number of tests dropping by 50% over a 10-day period followed by a record number of new tests on August 13 even as cases didn’t decline much. State-level data does not match that of the five countries with the highest volume of testing to date. The project reviewed the state’s data file and speculate that a state system upgrade to an electronic lab reporting system caused some tests to be uncounted in mishandling “pending assignment” tests. Questionable numbers from Texas are skewing national data because of the state’s size and significant COVID-19 outbreak.

FDA issues emergency use authorization for the SalivaDirect COVID-19 rapid diagnostic test that was developed by the Yale School of Public Health. The test offers major supply chain benefits since samples can be collected in any sterile container, it does not require a RNA extraction kit that is prone to shortages, and it can use a variety of common reagents and instruments. It also does not require use of a long nasal swab for sample collection. Yale will provided the test as an open source protocol to anyone who wants to manufacture it. Material cost is about $1 to $4 and results take just three hours. The NBA has been using the test since June.

Researchers prove that N95 masks can be cleaned for re-use by using multi-cookers such as the Instant Pot, which inactivated 99.9% of virus in a 50-minute dry heat cycle without pressure. Filtration capability was not affected after 20 cleanings.

Google Cloud extends free access to its COVID-19 public datasets through September 15, 2021.

CDC Director Robert Redfield, MD warns that public health will be jeopardized in the fall if Americans don’t start wearing masks, distancing, and improving the 50% flu shot rate to 65%. Otherwise, he says the combination of COVID-19 and flu could overwhelm some health systems.

Trials of promising antibody drugs to treat COVID-19 are being delayed by hospitals that are reassigning researchers to patient care roles as well as patients who are reluctant to participate. Companies that hoped to start shipping antibody doses by September are now looking toward the end of the year. Delayed test results are excluding prospective study patients because the drugs must be started within a few days of symptom onset. Hospitals also express concern about giving researchers on-campus space and bringing infected patients to campus for their infusions. Patients are passing in some cases because they assume they’ll get better on their own and don’t want to bother with participating if they might get a placebo anyway.

A CDC survey finds that 31% of unpaid caregivers for adults and 22% of essential workers considered suicide in previous 30 days.

Other

Revenue cycle company R1 RCM is apparently hit by a ransomware attack.

Epic notifies employees that it will immediately consolidate its training, implementation, QA, and technical communications under an application services division.

Cerner-sponsored Life Aid, which was launched in March to address veteran and first responder suicide, will be featured in a Discovery Channel special on August 30.

Bizarre: cosmetic surgeons are being overwhelmed with patients have who noticed sags and droopy eyes on their Zoom calls and want to trade their Botox for the scalpel. Some patients have realized that distancing and face masks are ideal for hiding post-op bruises and swelling. One 62-year-old woman spent $20,000 on a tummy tuck and breast job, rationalizing that she isn’t spending money on gas and shopping. Demand is also up for liposuction to address pandemic-driven weight gain.

Sponsor Updates

• CI Security publishes its “2020 H1 US Healthcare Data Breach Report.”
• OpenText reports fourth quarter and fiscal year 2020 financial results.
• PerfectServe announces bidirectional integration between its clinical communication platform and Nuance’s PowerConnect Actionable Findings solution within the radiologist’s Nuance PowerScribe reporting workflow.
• Relatient adds virtual waiting room capabilities to its patient engagement platform to meet the need for contactless and remote patient arrivals.
• CNBC’s Mad Money features SailPoint CEO Mark McClain.
• Spirion wins 2020 Tech Ascension Awards for Best SecOps and Best Compliance Solutions.
• TriNetX opens registration for the virtual TriNetX Summit September 22-23.

Blog Posts

• Top 10 Ways COVID-19 is Changing U.S. Healthcare Systems (Get-to-Market Health)
• RADLogics’ AI-powered solution supports the evaluation of COVID-19 patients (Nuance)
• Adherence for medication’s sake doesn’t work. Here is what does. (OptimizeRx)
• Mental Health: How Telehealth Technology Can Help (PMD)
• How Experience in Alternative Payment Models Put Providers a Step Ahead in Pandemic Response (Premier)
• Fighting Prescription Friction: How Real-Time Prescription Benefit Tools Can Streamline the Prescribing Process (RxRevu)
• Rethinking Work in Identity (SailPoint)
• Connect 20 Virtual Registration is Here (and it’s free!) (Spok)
• Redlands Community Hospital’s Multi-Channel Marketing Approach to Patient Engagement (StayWell)
• #Dedicated to a Bright Future and Better E-Prescribing (Surescripts)
• How to Fix Patient Outreach: Intelligence Oriented Outreach & the Patient 360° (SymphonyRM)
• Price transparency final rule: 6 steps to prepare (Waystar)
• 6 Ways to Become a Physical Therapy Clinic Owner (WebPT)

Contacts

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

Weekender 8/14/20

Weekly News Recap

• MDLive announces plans to go public early next year.
• Health Catalyst announces its acquisition of Vitalware for $120 million.
• Epic reverses its mandatory return to campus policy, approving working from home through at least the end of the year.
• Waystar will acquire ESolutions, valuing the company at $1.3 billion.
• Craneware raises $100 million for acquisitions.
• Providence Services Group acquires Navin Haffty.
• VA OIG recommends that the VA work on increasing its use of VA Direct and improve oversight of its VHIE community coordinators.

Best Reader Comments

The most surprising aspect of the Teladoc-Livongo deal is how investors and healthcare analysts don’t seem to understand the telehealth market. The walk-in or urgent care telehealth visit has a razor thin margin for telehealth companies. Almost 100% of the $50  fee charged to consumers goes to pay the physician labor or pay for the ads. The market is national, so any telehealth agenecy can join if they are willing to spend the ad dollars or offer slightly cheaper visits for a brief period as telehealth is uniquely price shoppable. On the other hand, your average physician is used to being protected from national competition by having a very local, captive market and they have many options when it comes to keeping their income above say 120 grand a year. Plus consumers prefer in person visits if the cost and convenience are the same, so providers always can fall back to that. It is very hard to reduce provider labor cost. So the telehealth agency gets squeezed between a price sensitive consumer, a provider who demands the bulk of the revenue from consumer, and the cost of ads which are raised by investors repeatedly dumping their money into new telehealth companies driving up demand on the ads displayed when people search video doctor. So every telehealth company that has lasted more than a few years has some strategy that gets them out of the urgent care market. (detroitvseverybody)

[Teladoc acquiring Livongo for $18.5 billion] reminds me of the post-deregulation period in the airline business, 1980s into the 1990s, when airlines fetched this kind of insane money from all over. I was there for that and it didn’t end well. (Deetelecare)

Providence Services Group now owns two MEDITECH focused service organizations while Providence is in process of migrating multiple MEDITECH hospitals to Epic. Plus, Providence is large Epic client. So basically MEDITECH helps fund a large Epic client since NHA and Engage are two of its partners. (Chris Hill)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. G in Ohio, who asked for white boards for her high school class in urban Cleveland. She reported in late February, “I cannot express how much these white boards have helped my students in class. We use them every day in order for them to practice different concepts in class. These white boards allow for my students to have immediate feedback in class and work through concepts even faster. They have taken pride in their work and have grown so much since having these white boards available in class. Thank you so much for allowing my students the opportunity to use these white boards every day in class.”

A COVID-19 hospital in India lists its challenges: relatives keep barging in rooms to bring isolated patients meals, air conditioners don’t work in the sweltering heat and humidity, new patients are housed with those known to be infected, families sit curbside with the bodies of family members waiting for funeral home pickup, and armed guards protect the hospital administrator. 

An Alabama neurosurgeon crashes his $200,000 sports care while doing 138 miles per hour in a 45 zone, killing his 24-year-old medical school passenger. He’s charged with manslaughter. Police say the doctor was intoxicated and suffered only minor injuries.

Chicago chose a politically connected company to develop a temporary 2,750-bed COVID-19 hospital in the McCormick Place convention center at a cost of $66 million, passing on another company that offered to do the work without fees. Federal taxpayers will foot 75% of the bill for the hospital, which saw just 38 patients. Wielding influence in the selection was the private company that oversees Navy Pier, which is run by political allies of former mayor Richard Daley.

A medical practice in England discovers why patients aren’t answering its phone calls – a phone system error caused its Caller ID to show the name of a massage parlor.

Can’t wait for Las Vegas at HIMSS21? MGM hotels is offering “Viva Las Office,” a work-from-Vegas package that includes discounted flights, rooms in the Bellagio or Aria hotels, and a personal concierge. Big cheeses can blow their company’s cash with “The Executive” package, which includes a luxe suite, $75 food and beverage credit, a discount on JSX semi-private jet travel, a day’s cabana rental, a poolside massage, and a mask and hand sanitizer. Plus you can study COVID-19 in person since 95% of new Nevada cases originated in the city, comping visitors from all over the country with yet another situation that happens in Vegas but doesn’t stay there.

In Case You Missed It

• News 8/14/20
• EPtalk by Dr. Jayne 8/13/20
• News 8/12/20
• Curbside Consult with Dr. Jayne 8/10/20
• Monday Morning Update 8/10/20

Get Involved

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