News 11/25/20

Top News

Germany-based health IT company CompuGroup Medical will acquire ambulatory-focused health IT vendor EMDs for $240 million.

CGM paid a similar amount earlier this year to acquire Cerner products that are marketed in Germany and Spain.

EMDs, which acquired competitor Aprima nearly two years ago, employs 1,400 people in the US and India to serve 60,000 practice-based end users.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Lumeon. The Boston-based company helps health systems take control of their care delivery processes by orchestrating and automating care journeys to operate with predictability and efficiency. It acts as the auto-pilot for healthcare delivery in coordinating teams, communications, tasks, and decisions to deliver superior outcomes at a lower cost, optimize resource utilization, and increase revenue. Lumeon’s solutions are enabled by their cloud-based care pathway management (CPM) platform. Capitalizing on the patient’s electronic health record (EHR), health systems can start simply with immediate benefits and evolve to orchestrate their entire care process. More than 70 progressive health systems across 12 countries have deployed Lumeon’s multi-award-winning platform. Thanks to Lumeon for supporting HIStalk.

I found this Lumeon explainer video on YouTube.

Listening: the new studio album from AC/DC, which won’t change your mind about the band either way since its sound is so predictable that it could be generated by AI. The accomplishment here is perseverance rather than boundary-pushing, but that alone is remarkable enough given the recent loss of Malcolm Young to dementia and then death, the dismissal of Brian Young due to hearing loss, the home imprisonment of drummer Phil Rudd for attempted drug-related murder for hire, the resignation of bass player Cliff Williams, and the presence of “where’s all me mates gone” 65-year-old schoolboy uniform-wearing Angus Young as the only remaining original member until recently. Johnson is back at 73 years of age after successful hearing treatment, Rudd returns post-incarceration, and Williams is back as a tribute to Malcolm Young, restoring to 60% the count of current members who were heard on 1979’s “Highway to Hell.” AC/DC’s recent business plan has been releasing a loss-leader album of songs that are indistinguishable from their hits, then cranking up the touring cash machine for fans who are happy to expensively relive their youth’s soundtrack of “Back in Black” and “Dirty Deeds Done Dirt Cheap” for the thousandth time. Monetization will thus be a race between COVID limitations and the bandmates’ advancing years, but at least they’ve put out their first studio album in six years and it holds the #1 spot on Billboard’s chart, only their third album to summit that commercial apex (“Back in Black” was a curve-flattened release, selling 25 million copies, but over such a long period that it peaked at #4).

Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

December 3 (Thursday) noon ET. “Unlocking the Power of Data: How HIEs Can Better Support Their Participants.” Sponsor: Intelligent Medical Objects. Presenters: Jaime Bland, DNP, RN, CEO, NEHII; Naresh Sundar Rajan, PhD, CTO, NEHII; Matt Cardwell, PhD, VP of client services, IMO; John Laursen, VP of business development, IMO. HIEs need accurate, actionable, and normalized EHR data to unlock its analytic power to support alerting, regulatory reporting, interoperability, and clinical surveillance. The presenters will describe how to interpret the descriptions and standard code sets that health system partners send, how leading HIEs use normalized data to improve their client and community offerings, and how a new normalization approach may provide operational savings.

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

Acquisitions, Funding, Business, and Stock

AI-powered predictive data modeling vendor ClosedLoop.ai raises $11 million in a Series A funding round. Co-founder and CTO Dave DeCaprio helped lead MIT’s Human Genome Project before stints at GNS Healthcare and Mount Sinai’s Icahn School of Medicine.

Special purpose acquisition company GigCapital2 will merge with Cloudbreak Health and UpHealth Holdings to create a digital health management company that will be valued at $1.35 billion. The SPAC raised $150 million during its 2019 IPO and plans to raise another $160 million to finance the deal.

Digital patient communications company Well Health raises $45 million in a Series C financing round, bringing its total funding to $75 million.

Sales

• Union Hospital (IN) selects Masimo’s SafetyNet patient management system to help discharged COVID-19 patients recover at home.

People

Dana Safran (Haven) joins Well Health as SVP of value-based care and population health.

University of Utah School of Medicine hires Yves Lussier, MD (University of Arizona) as chair of biomedical informatics.

Sarah Sample-Reif (Incredible Health) joins Zivaro as chief strategy officer.

Announcements and Implementations

Philips announces a vendor-neutral Radiology Operations Command Center that uses telepresence to conduct imaging operations virtually.

In England, Leeds Teaching Hospitals NHS Trust goes live on Agfa HealthCare’s enterprise imaging software.

Campbell University (NC) and Wayne HealthCare (OH) implement Emerge’s ChartGenie data-conversion technology as they respectively prepare to implement Athenahealth’s EHR early next year.

Kettering Health Network (OH) adds CenterX’s real-time prescription benefit and electronic prior authorization capabilities to its e-prescribing workflows within Epic.

A Lumeon survey of patient access executives finds that patient experience and access to care will be their most important differentiators in 2021, while more than half believe that fragmented processes and technology – such as the 72% of providers that still manually call waitlisted patients to fill cancelled appointments — prevent them from meeting their patient access goals

COVID-19

The number of hospitalized COVID-19 patients hit another record Monday at 85,836. The COVID Tracking Project warns that states probably won’t file complete reports until next week and thus numbers will be underreported as they were over Labor Day. It’s fascinating that a pandemic that has killed 258,000 Americans still doesn’t warrant state employees working weekends and holidays.

Experts say that CDC’s warning last week that small gatherings involving non-cohabitants are responsible for a lot of COVID-19 spread is not supported with data, but has been repeated enough times to convince states to limit such gatherings, perhaps illogically. US contact tracing has been overwhelmed with non-participation and overly wide coronavirus spread, but where state data is available, the leading sources of infection spread remain long-term care facilities, food processing plants, prisons, healthcare settings, restaurants, and bars. The New York Times notes that while Minnesota’s governor has banned people from different households from meeting indoors or outdoors, the state still allows churches, funeral homes, and wedding venues to hold indoor gatherings of up to 250 people. A Vermont ban of neighbors walking together distanced and masked while restaurants remain open for indoor dining is “bizarre,” says an infectious disease modeler who notes, “I can get together with nine of my best friends and sit around a table at a restaurant, so why can’t I do that in my house?”

Urban hospitals are being overwhelmed by COVID-19 patients from rural areas in which masking orders are either absent or ignored, with the head of Kansas City’s health department saying that it’s unfair for city residents to be denied an ICU bed that is occupied by a resident of a county that goes mostly maskless.

Other

Federal prosecutors seek a judge’s approval to use texts and other digital exchanges between Theranos founder Elizabeth Holmes and former president Sunny Balwani to help prove that the pair – who were once romantically linked – knew that the company’s technology was not as groundbreaking as they led investors to believe. Messages refer to terrible validation reports, the “painful” FDA approval process, and one of their labs being a “disaster zone.” The delayed trial will take place in March.

Sponsor Updates

• Unite.ai features Saykara founder and CEO Harjinder Sandhu.
• Change Healthcare will participate in a fireside chat during the Guggenheim Digital Health Virtual Summit December 8.
• Clinical Architecture releases a new podcast, “Healthcare Terminology Standardization and Normalization.”
• InterSystems releases HealthShare 2020.2 with expanded HL7 FHIR API capabilities

Blog Posts

• The Importance of Test Cases for UAT During Epic Implementation (314e)
• 4 Workflow Tweaks that Can Increase Total Revenue in Your Clinic (AdvancedMD)
• KLAS DHIS 2020 Panel discussion on Enterprise Imaging and Innovation with Luc Thijs, President, Agfa Healthcare (Agfa HealthCare)
• Blueleaf Banter: Rock Your Rosters – Roster & Panel Management (Bluetree)
• Improving Communication Between Providers for Optimized Medicare Beneficiary Outcomes (CarePort Health)
• When to do a tabletop exercise (CI Security)
• Time Sensitive HEDIS Measures: Improving ED Follow Up (Collective Medical)
• Telehealth Prescribing is Low – Decision Support Can Help (CoverMyMeds)
• FHIR: What Payers Need to Know (Diameter Health)
• A better way to navigate EClinicalWorks (EClinicalWorks)
• A Nurse’s Greatest Fear: Missing Signs of Preventable Patient Deterioration (Capsule)

Contacts

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

Morning Headlines 11/24/20

CompuGroup Medical strengthens US business with one of the largest acquisitions in company history

Germany-based health IT company CompuGroup Medical will acquire ambulatory-focused health IT vendor EMDs for $240 million.

GigCapital2 to merge with two telehealth firms in $1.35 billion deal

Special purpose acquisition company GigCapital2 will merge with Cloudbreak Health and UpHealth Holdings to create a telemedicine company valued at $1.35 billion.

Signify Health Acquires PatientBlox to Accelerate Prospective Episode of Care Payment Models, Advance Transition to Value-based Care

Value-based care coordination and payments vendor Signify Health acquires blockchain startup PatientBlox for an undisclosed sum.

CentralReach Acquires AI-Based Scheduling Algorithm to Automate Scheduling Operations for Autism & ABA Care Delivery

Health IT vendor CentralReach acquires Cartocal and will incorporate its automated scheduling technology into its software for providers specializing in applied behavior analysis.

Curbside Consult with Dr. Jayne 11/23/20

The Center for Medicare & Medicaid Innovation (aka the CMS Innovation Center) announced the list of participants in the Primary Care First initiative this week. The program was delayed due to a variety of issues prior to the pandemic, which really pushed it back. It’s finally slated to start on January 1, 2021.

I wonder how the selected participants feel about having roughly 40 days to get everything in place? Most of them have been working on other initiatives that share the same goals as this program for some time, but it’s an entirely different thing to actually get a new program ready to launch in your organization. Trying to do so in what most people are experiencing as the largest peak of the pandemic is yet another level of pain altogether.

What is Primary Care First? It’s been so long since I talked about it that many of us have probably forgotten. It was designed as a voluntary alternative payment model slated to “reward value and quality by offering innovative payment model structures to support delivery of advanced primary care.” The program is supposed to last five years. More than 900 primary care practices were selected and there are 37 identified regional partnerships with commercial, state, and Medicare Advantage plans. Practices had to be in an area with a regional partner in order to participate, which excluded a good chunk of the country.

The program changes the payment structure for patients in participating plans, with the idea that even though not all the patients in the practice may be covered by one of the partner payers, that the practice would effectively up its game in delivering the same level of high-quality primary care services to all patients.

In exchange for performance-based payments and reduced administrative burdens, practices agree to assume financial risk as they try to reduce the total cost of care. There is also a so-called “seriously ill patient” option for practices that treat high-need, seriously ill patients who don’t currently have a primary care provider.

Overall, the model is supposed to revolve around patient-focused care and a high level of care coordination. The reduced administrative tasks are supposed to free providers to spend more time with patients. The program is also designed to “foster practitioner independence by increasing flexibility for primary care, providing participating practitioners with the freedom to innovate their care delivery approach based on their unique patient population and resources.”

Practices are scored based on clinical quality and patient experience measures which include: a patient experience care survey, controlling high blood pressure, diabetes hemoglobin A1c control, colorectal cancer screening, and advance care planning.

I’m sure the practices that applied many months ago had no idea where we would be come January 1, and I wonder if many of them might try to opt out. The final selection of 900-odd practices is quite a way off from being representative of the roughly 210,000 primary care physicians in the US. I’m not even sure, given some of the other variables that were involved in selecting the participants, that the cohort will be able to generate the statistical power needed to prove whether its outcomes (clinical and financial) are truly better than other care delivery paradigms. These practices have been at least dipping their toes in the waters of value-based care for years, with many of them being mostly submerged.

The list of payer participants is dominated by Humana, with a handful of other plans and a sprinkling of Blue Cross / Blue Shield players. Looking at the practice list, it’s a little tricky trying to tell who is who because the participants are mostly listed by the name of their brick and mortar entity, which may not portray the health system ownership behind them. I learned about these naming relationships the hard way: when I was employed at a practice owned by Big Hospital System, they were keen on each practice having its own brand, which wasn’t always the greatest idea when they upcharged you for customizing various things with the practice name versus just being able to say “BHS Medical Group” in your outbound reminder messages, etc.

A couple of the big players show up with a handful of practices each: AdventHealth (formerly Adventist), Ascension, Baptist Health, Beaumont, Cambridge Health Alliance, Cedars-Sinai, Cleveland Clinic, John Muir Physician Network, Temple Physicians, Virtua Primary Care, and Warren Clinic. The University of California has the most participation with 39 sites, and OhioHealth is the runner up with 26 locations. My state isn’t part of the identified Primary Care First regions, so I won’t be able to get very many in-the-trenches stories from regional peers, but I did see at least four of my former clients on the list. Hopefully my contacts are still working there and are willing to keep me posted on how things are going.

Even for the practices with the most value-based care experience, trying to launch this program during a surging pandemic will be key. Colorado is a participating state, and recent reports estimate that 1 in 49 Coloradans are COVID-positive right now. Practices that are reeling with those kinds of numbers are going to be hard pressed to spend time preparing to embrace prevention and management of chronic diseases, which are certainly being exacerbated by the pandemic.

In the urgent care space, I see so many patients who either can’t get in to see a primary care physician or whose physicians have frankly abandoned them. My friends in telehealth report dramatic increases in the number of patients requesting visits for COVID-like symptoms. There’s even a surge in people who have had COVID tests at drive-through clinics but who are struggling to reach their primary physicians and are reaching out to telehealth providers to get documentation that they meet CDC guidelines to return to work.

I wish the best for the Primary Care First practices. We need to bolster our primary care and public health infrastructures – of that, there is no doubt.

We had a conversation at urgent care yesterday around what the health care system will look like in the US after it’s been completely decimated by COVID. This was right after we were notified that four providers had been diagnosed the day before, including the one who had been sitting at my workstation less than 12 hours previously. The nearly 100 patients I saw have no idea what kind of bills are coming their way, especially if they are positive and need hospitalization. I see a tsunami of medical bankruptcies on the horizon. If the Affordable Care Act is repealed and more people have to pay out of pocket for preventive services, I don’t see them having tremendous cash reserves to do so, and this could drive even greater healthcare expenditures down the road.

I’ll continue to follow the adventures of Primary Care First and report back with what I find. If you’re involved in the initiative, I’d love to hear from you. Until then, stay healthy, stay safe, and stay six feet back.

Email Dr. Jayne.

Morning Headlines 11/23/20

UVM Medical Center takes cautious steps to restore services after cyberattack

University of Vermont Health Network begins restoring access to Epic beyond a read-only view at inpatient and ambulatory sites of UVM Medical Center.

ClosedLoop.ai Secures $11M Series A Funding to Assist Healthcare Organizations Improve Clinical and Financial Outcomes

AI-powered predictive data modeling vendor ClosedLoop.ai raises $11 million in a Series A funding round led by Greycroft and .406 Ventures.

Butterfly Network, a global leader in democratizing medical imaging, to be listed on NYSE through a merger with Longview Acquisition Corp.

Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE in a merger with a special purpose acquisition company that values the company at $1.5 billion.

VA Moves to Expand Its 5G Experimentation

The VA will expand its 5G testing to sites in Florida and Seattle following its initial work in its Palo Alto hospital, looking at technologies such Microsoft HoloLens for surgical navigation and adding telemetry monitoring to new areas of hospitals.

Monday Morning Update 11/23/20

Top News

University of Vermont Health Network begins restoring access to Epic beyond a read-only view at inpatient and ambulatory sites of UVM Medical Center. The health system says that effort will require several days, with other sites to follow.

The health system will need to back-enter data nearly 30 days’ worth of manually recorded data. UVM systems have been down since October 28.

The IT team will focus on restoring MyChart once they have brought Epic back up.

HIStalk Announcements and Requests

Poll respondents are optimistic about their job prospects for the next year, with 80% of them expecting to hold the same or better job and 80% of those assuming they will be working for the same employer.

New poll to your right or here, and of course your answers are not trackable or identifiable: How much total compensation will you receive from your primary employer in 2020?

Welcome to new HIStalk Platinum Sponsor Emerge. The Dallas-based company’s solutions empower healthcare professionals with superior medical data intelligence, resulting in enhanced workflows, increased efficiency, and higher quality of care. ChartScout, launched by SSO from the EHR, removes the barriers between caregivers and EHR data by accessing data from structured, free-text, and scanned image data, providing an intuitive patient chart search and visualization and personalized dashboards to facilitate patient overview and management by showing care gaps, calculations, scores, and decision support. ChartPop provides a tailored, cross-sectional view of the active patient population to create pursuit lists, fill gaps in care, and work toward better population management. The ChartGenie data conversion service provides a seamless transition between an old EHR to a new one and/or into Emerge’s cloud. A subscription also provides access to the data from both systems into a single synthetic patient view using ChartScout and ChartPop, removing data siloes and the need for toggling between EHRs. Thanks to Emerge for supporting HIStalk.

Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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

Acquisitions, Funding, Business, and Stock

Phone-connected ultrasound transducer manufacturer Butterfly IQ will go public on the NYSE in a merger with a special purpose acquisition company that values the company at $1.5 billion.

Announcements and Implementations

Drug company Bayer will support five startups as part of its G4A Digital Health Partnerships Program. The initial class of early-stage companies are Caria (evidence-based menopause support), Elly Health (audio chronic condition education), Decipher Biosciences (genomic testing), Sweetch (data-powered disease management recommendations), and MyOnCare (patient and care team communication).

Government and Politics

The VA will expand its 5G testing to sites in Florida and Seattle following its initial work in its Palo Alto hospital, looking at technologies such Microsoft HoloLens for surgical navigation and adding telemetry monitoring to new areas of hospitals.

COVID-19

COVID-19 tests, new cases, and hospitalized patients set records Friday, with 82,000 hospital inpatients straining capacity in many areas.

About 1,000 hospitals have reported critical staffing shortages to HHS, although not all hospitals are submitting staffing data to the abruptly implemented HHS Protect reporting system. Hospitals note that while it’s easy to add beds, shortages of skilled personnel will force them to prioritize who receives care.

Henry Ford Health System has had 169 employees test positive for COVID-19 in the past week, straining the five-hospital system as 19% of 900 workers were found to have coronavirus.

St. Louis hospitals say that state reports showing hospitals with plenty of available regular and ICU beds are dangerously misleading to the public, as the information that is reported to the federal government looks at beds that are licensed, not those that are staffed for appropriate COVID-19 care.

The government says that shipments of Pfizer’s COVID-19 vaccine could start December 11, the day after FDA’s vaccine advisory committee meeting, assuming its data review is positive.

Operation Warp Speed scientific advisor Mocef Slaoui, PhD tells CNN that he expects US life to return to somewhat normal by May as a significant portion of the population will either have received a vaccine or recovered from previous infection with some degree of immunity, slowing coronavirus spread.

WHO recommends against using remdesivir to treat COVID-19 after an expert panel’s review of studies finds that it does not improve any important patient outcome, including the rate of ventilation and death. FDA gave the Gilead drug fast, full approval in October despite modest results from questionably rigorous studies.

Updated CDC guidance says that most COVID-19 infections are spread by people who do not have symptoms, making mitigation measures even more important.

Most health systems that were polled by Premier say they aren’t ready to receive and manage the administration of COVID-19 vaccines. Issues:

• Pfizer’s vaccine requires storage at –70 degrees Celsius, which will require procurement of large ultra-cold freezers in each health system market or location and development of dry ice policies and procedures.
• Some health systems have been designated as state vaccine distribution hubs and will need to track location, quantity, and storage temperatures in real time.
• CDC has not yet announced how populations will be prioritized to get the vaccine.
• Healthcare workers who will get the vaccine early will need to be pre-scheduled for staggered appointments to avoid potential coronavirus exposure while waiting in lines.
• IT systems will need to be evaluated to capture and report vaccine storage, vaccinations administered, doses on hand, and participation in training programs, with all of the information ideally linked to the health system’s EHR.
• Appointments for the second dose of the two-dose regimen should be made during the first-dose visit, followed by reminders to the phone number and email address captured at that time, to make sure patients receive the second dose.

The Texas National Guard sends 36 troops to El Paso to help overworked morgue personnel deal with the large number bodies of coronavirus victims and setting up a new central morgue expansion.

Other

Expert authors say in a Harvard Business Review article that telehealth has great promise, but unintended consequences include exacerbating disparities in access and challenging clinicians with video fatigue, longer work days, and a blurring of work-life boundaries. They also note that virtual visits can increase healthcare spending via new utilization. They use HITECH experience with EHRs to suggest facilitating equitable access by offering digital help and language interpretation, engaging patients and their families, scheduling provider virtual visits in specific sessions instead of on top of a full workday, and integrated telemedicine platforms (especially those offered by for-profit telehealth services) with EHRs for continuity of care.

A Singapore doctor search and patient review website raises the ire of country’s medical and dental membership organization, whose practitioner information the company apparently scraped from its website without permission. The company says it will ignore the request of Academy of Medicine, Singapore to remove its details about practitioners and will also ignore any requests of AMS members who ask not to be listed.

The Pro Football Hall of Fame honors Laurent Duvernay-Tardif, MD, who skipped the 2020 season as right guard for the Super Bowl champions Kansas City Chiefs to work as an orderly in a long-term care facility on the COVID-19 front lines.

Sponsor Updates

• OptimizeRx hires Nick Hill (Passport) as director of project management.
• PatientPing publishes a new Use Case Spotlight, “How Heartland Alliance Health Improves Patient Engagement and Care Coordination Outcomes for Vulnerable and High-risk Patients.”
• Cerner appoints Major General Elder Granger, MD, US Army (retired) to its Board of Directors.
• Pure Storage introduces the Pure Validated Design Program to simplify deployment of partner solutions.
• Redox releases a new podcast, “No Beers, No Bars, just ELRs: Electronic Lab Reporting Requirements with Dr. Louise Laurent.”
• Relatient and TriNetX ranks on the Deloitte Technology Fast 500.
• SOC Telemed will present at the virtual Piper Sandler Healthcare Conference December 2.
• Waystar publishes the results of a new study, “Consumer Attitudes Toward Medical Bills + the Price Transparency Rule.”
• Well Health and Wolters Kluwer partner to embed EmmiEngage interactive multimedia programs on diabetes education into the Well platform.

Blog Posts

• The Power of Sharing Saves Lives: hospital wins battle against time for one patient’s aortic emergency (Nuance)
• Personal Leadership: How We Lead In Our Daily Lives (OmniSys)
• The Data That Moves Us (Netsmart)
• Why healthcare needs a Dewey Decimal System for Data Governance (Nordic)
• Three Ways Healthcare IT Can Mitigate Physician Burnout (PatientKeeper)
• Improve Patient Experience Before, During, and After Care (PerfectServe)
• Let PMD Be Your Coding Assistant (PMD)
• How Health Systems Are Preparing for a COVID-19 Vaccine (Premier)
• How to refocus your cybersecurity team’s assumption of compromise paradox to a data protection model (Spirion)
• 4 critical steps to effective communication in nursing – and how technology can help (Spok)
• Big Savings in the Big City (Surescripts)
• Managing Chronic Disease During a Pandemic: Tips to Help your Patients (SymphonyRM)
• Walking the Clinical Empathy Tightrope: How Much to Too Much? (WebPT)
• Be on the Alert! Telehealth does come with challenges: 3 ways to make your life easier (Well Health)
• Thought Leadership Perspectives – E-cigarette or Vaping Product Use – Associated Lung Injury in Adolescents (Zynx Health)

Contacts

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

Katie the Intern 11/20/20

Howdy, HIStalk readers! I’m back with another interview column that covers a HIStalk reader who is a professional in the field. On top of learning about the healthcare industry and the consulting side of IT, I also got some great advice about how to take a deep dive into learning about the ecosphere as a whole. Buckle up! 

I interviewed Zack Henderson with Pivot Point Consulting last week. Zack is a senior consultant who works in the implementation of Epic’s different modules and programs. “I work really closely with their analysts, their users, the operational leadership to develop training programs,” Zack said. “Specifically, for their emergency departments, their obstetrics, their long-term care, and case management control.”

I asked Zack to explain to me a little about what Pivot Point does, as I am unfamiliar with the term “consultant” in its application to healthcare IT. Zack said that his company works with several clients in a five-hospital health system in Illinois where he is based, but also across the United States. Pivot Point works on EHRs, ERP (Enterprise Resource Planning, yes, it has been added to my Google doc of abbreviations), analytics, telehealth, and other projects. He has been with Pivot Point for about a year. 

Before Pivot Point, Zack worked for Epic. Zack, like most Epic employees, was brought into Epic with little experience and no history as an HIStalk reader. 

“I came across HIStalk when I started working at Epic. It was one of the online sources that they [Epic] recommended we visit and try to go explore,” Zack said. “It was a great source for a lot of us, and it continues to be. Being able to read those stories and asking, how is that going to change the work that I am doing in a year? In five years?” 

I found it fascinating that Epic encouraged employees to read HIStalk and other IT blogs to gain experience. It is eye-opening for someone who is new to the field and new to HIStalk to see the reach of HIStalk and its impact. Zack said that HIStalk helped him become familiar with how many different aspects there are in the healthcare IT world. 

“Having moved on and into the consultant world, every day I feel like I learn about a new app or a new regulation or a new feature to try out or a new product that is being brought to market,” Zack said. 

There were stories and discussions that were used for training at Epic, Zack said, but much of his HIStalk reading was used to look at the macro level of the health care industry — where the industry is going, new tech such as AI and voice activation, and cool things that are happening. HIStalk keeps Zack in the loop of what is new to the industry. 

“I visit HIStalk about every other day and find it to be a great one-stop shop for keeping up with everything going on in the world of healthcare IT,” Zack said. “I pay particular attention to news about EHRs, specifically news about Epic customers as well as stories about mergers, acquisitions, divestitures, and strategic HIT efforts by health systems.”

Zach also talked about how he appreciates the variety of pieces that HIStalk covers, sharing his love for the various interviews that help him understand what problems and solutions are being solved with technology. He also said that Dr. Jayne’s columns remind him of the impact that technology has on and with patient care. 

“The world of healthcare IT is so broad and there’s always something new and cool being worked on,” Zack said. He’s not exaggerating, as I am just beginning to learn the intersections of healthcare and technology and their interconnected impact on each other and on the world. I asked Zack for some advice about learning and understanding these things better as I become more immersed in the industry. His main piece of advice was to research some of the historical aspects of the healthcare IT world. He mentioned researching Dr. Plummer at Mayo back in the 1900s, so I did just that. 

Dr. Henry Plummer was a scientist and engineer who entered the healthcare field as a physician’s assistant in the late 1800s. Even before working in the health field, Dr. Plummer took an interest in the endocrine system at the age of 16. This lead to a medical degree from Northwestern University, which fueled his impactful medical career. 

Dr. Plummer was hired by Dr. William Mayo, director of the fledgling Mayo Clinic, in 1901. Dr. Plummer wanted to create a streamlined system of patient information access because doctors originally only kept single notes on separate patients. Alongside his colleague, Mabel Root, Dr. Plummer initiated a chart system of patients so that doctors could easily access information in one place. The medical record was born on July 1, 1907, and has only grown from there. Dr. Plummer served Mayo Clinic until his death in 1936. 

Zack’s advice to look at this history led to more research about how quickly the EHR developed over time. Hardware became more widely available as early as the 1920s, and though the internet was not created until the 1960s, the growth of the health records system was consistently exponential. While there was only one health record in 1907 at just one clinic (Mayo), as of 2017 86% of office-based physicians use or have used an EHR. 

Understanding an important piece of the healthcare IT world, EHRs, has given me a strong foundation into the impact of technology and how it can literally change and save lives. I enjoyed learning about Dr. Plummer and the growth of the health records system, now electronic, and want to continue this kind of historical study. The technological advances we know in this industry today were developed from a single idea, and as Zack said, Dr. Palmer “…really set the course for where we are now.” 

I think the best piece of advice I received from this interview is something that I am coming to find as I learn. I’ll let Zack’s quote end us out, as he says it best. 

“Healthcare IT is just really cool. The macro-level work that we get to do in this field is really, really cool and we get to impact millions of lives.” 

That’s it for today! Hope you all have a great weekend. Thanks, as always, for reading and for welcoming me. 

Katie The Intern

Email me or connect with me on Twitter.

Weekender 11/20/20

Weekly News Recap

• Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive.
• Nuance sells its transcription services business and EScription technology to newly formed DeliverHealth Solutions, in which Nuance will hold a minority share.
• Time’s list of “The Best Inventions of 2020” includes the Vocera Smartbadge.
• Central Logic acquires Ensocare.
• Amazon launches an online pharmacy.
• ECRI announces that it will shut down its Partnership for Health IT Patient Safety collaborative on December 31 after seven years.
• UC San Diego Health reports the benefits of moving UC San Diego’s student health service to Epic.
• Researchers find that including a patient’s headshot in the EHR significantly reduced ED wrong-patient order entry errors.

Best Reader Comments

Cogito is more of an umbrella term for all of Epic reporting. It’s a brand more than a technology. Chronicles, which is a component of Cogito, is the piece most like OLTP because it uses the transaction processing database. Farther up the analytical stack, Cogito includes Radar, SlicerDicer, Clarity, Caboodle, Predictive Analytics, and even some AI support. All these items leave the TP database behind in order to do their thing! (Brian Too)

Part of the current benefit of the Uber style of telemedicine is that it is a nationally scaled model that outcompetes your local urgent care on price per quality visit. It is too big and remote for your local health system to crush with a location dependent monopoly. People say they want their local provider, but a telemedicine visit with their own provider is likely to cost MORE than an in person visit due to the technology overhead and the fact that the provider isn’t operating at the top of their license compared to an in-person visit, where they are prepped by an MA or possibly delegated to an NP. It’s interesting to think about the future that Kharraz proposes. In that future, I would probably prefer telemedicine until I met my deductible, then demand in-person visits. I’m not going to fiddle around with some “AI”-powered intake form and choppy video when the difference is $20 in co-pay rather than $300-plus without the deductible. The only cost reduction that could allow is having work-from-home be a perk for providers. That’s most likely going to come up in cash-strapped orgs or rural areas serviced by a provider that doesn’t want to reverse commute. (IANAL)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. A in Michigan, who asked for engineering centers for her Grade 3-5 learners that she teaches as an auxiliary science teacher who travels to different schools every day. She reported in April, “These kits are amazing!!!! The students were so engaged. They liked seeing the real-world component and then trying to engineer a structure to resemble that image. Some students just loved using their imagination and building whatever creation they could come up with. The team work was phenomenal, solving problems and working out disagreements on what to do next or how to build. They were sharing thoughts and materials. Each kit provided different building materials so if they struggled with one type of material or build, they could try another. The kids were always surprised when it was time to clean up because they were so involved and enjoying the chance to create. Thank you so much for providing these kits for my science classes. They were used in four different buildings for grades 1-5. They really hit the design and engineering standards for every grade. I can’t wait to use them again next year. THANK YOU!”

A Tennessee grandmother starts a 51-month prison sentence for impersonating a nurse, having been hired by eight nursing homes and home health agencies over six years by using nursing license numbers she found on the state’s online licensing system.

The president and CEO of Sanford Health, who is not a clinician, emails employees to say that he has recovered from COVID-19, believes that he is immune, and therefore has “no interest in using masks as a symbolic gesture” and won’t be wearing one.

Zoom eliminates its 40-minute meeting limit for subscribers to its free packages on November 26-27 to allow families to celebrate Thanksgiving safely online.

In Case You Missed It

• News 11/20/20
• EPtalk by Dr. Jayne 11/19/20
• HIStalk Interviews Kevin Coppins, CEO, Spirion
• Readers Write: Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones
• News 11/18/20
• Curbside Consult with Dr. Jayne 11/16/20
• Monday Morning Update 11/16/20
• Katie the Intern 11/13/20

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 11/20/20

Clearlake carves out nThrive’s tech arm in $1bln-plus deal

Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive, which was formed in late 2015 by private equity firm Pamplona Capital in combining its MedAssets and Precyse acquisitions.

Subtle Medical Raises $12.2 Million in Series A Funding to Expand Its AI Imaging Solutions

AI-powered medical imaging enhancement company Subtle Medical raises $12.2 million in a Series A round led by 3E Bioventures Capital.

Medsphere Systems Corporation Acquires Micro-Office Systems

Medsphere acquires Micro-Office Systems, which offers custom medical practice technology services and a patient engagement service.

Nuance Announces Fourth Quarter and Fiscal Year 2020 Results

Nuance announces Q4 results: revenue down 9%, adjusted EPS $0.18 versus $0.23, beating Wall Street estimates for both.

News 11/20/20

Top News

Nuance sells its transcription services business and EScription technology to newly formed DeliverHealth Solutions, in which Nuance will hold a minority share.

The new 2,000-employee company was formed by private equity firm Assurance Healthcare Partners and outsourcer Aeries Technology Group.

CEO Michael Clark, MBA is an industry long-timer who was most recently SVP/GM of provider solutions with Nuance’s healthcare division.

Reader Comments

From EHR Warrior: “Re: SpringCharts. Another EHR headed for the dustbin. No longer ONC certified and the website lists no physical address or team members.” Unverified. The LinkedIn of CEO Jan Watson says that she’s still there, along with a dozen other folks.

From Meditech Follower: “Re: Meditech. AVP Larry O’Toole is no longer at the company and customers working with him were not informed. He was also Meditech’s representative on CommonWell’s board.” Larry’s LinkedIn says he left Meditech in October after 18 years and is consulting.

From Focus Please: “Re: telehealth and attention spans. A recent survey found that the attention of many patients wanders during their virtual visits.” The survey found that three-fourths of male patients and 39% of women say they didn’t pay full attention during their virtual visit, with their most common distractions being surfing the web, texting or emailing, watching news or movies, and checking Facebook. It’s fascinating to me that our best and brightest have applied their daunting intellectual horsepower to successfully draw us irresistibly to stare stupidly at our phone screens in trading real-world involvement with mindless distraction, even when we are sick, driving, or eating in an expensive restaurant (back when that was a thing). I can’t imagine booking a virtual visit and then watching a movie or scrolling Facebook during it (those must be multi-device patients), but I also can’t picture how patients would think it’s OK to play a video game, drive a car, or drink a cocktail during a telehealth visit, all of which were reported in significant percentages. I bet virtual visit doctors see all kinds of bizarre behavior on the other end of their video sessions, such as domestic violence, sexual activities, illegal acts, and endangering situations. The Internet has robbed us of our comfortable naiveté that most people in the country are like us, which is true only to the degree that we are some combination of ignorant, lazy, cruel, selfish, and immoral.

HIStalk Announcements and Requests

How you know your previous job was a misfire – when your new employer’s hiring announcement brags your time with an employer that wasn’t your most recent one.

Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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

Here’s the recording of Wednesday’s webinar, sponsored by Mend, titled “Do You Really Have a Telehealth Program, Or Just Videoconferencing?”

Acquisitions, Funding, Business, and Stock

Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive, which was formed in late 2015 by private equity firm Pamplona Capital in combining its MedAssets and Precyse acquisitions. Reports suggest a valuation of more than $1 billion for the business, which has EBITDA of $100 million. NThrive recently reorganized its technology business into NThrive Technology, which is led by CEO Sloan Cardy, MBA.

Nuance announces Q4 results: revenue down 9%, adjusted EPS $0.18 versus $0.23, beating Wall Street estimates for both. NUAN shares are up 104% in the past 12 months versus the Nasdaq’s 39% rise, valuing the company at nearly $10 billion.

Medsphere acquires Micro-Office Systems, which offers custom medical practice technology services and a patient engagement service.

Outcomes4Me, which offers a free cancer treatment navigation app, raises $4.7 million in funding.

Israel-based telemedicine vendor K Health raises $42 million in a Series D funding round, increasing its total to $139 million, and will partner with Mayo Clinic to improve its virtual care services. The AI-powered app applies logic gleaned from a 20-year EHR database of an Israel-based HMO to compare a patient with similar ones and to list likely diagnoses, then offers text-based chat with a doctor. Patients pay $19 for a one-time text encounter that can include issuing prescriptions or $9 for a primary care monthly membership that provides unlimited visits.  

The Nashville business paper notes that Bridge Connector spent most of its recent $25.5 million funding round before shutting the company down. The company also received up to $5 million in April from federally guaranteed Paycheck Protection Program loans.

Sales

• Sarasota Memorial Health Care System will implement Glytec’s EGlycemic Management System.
• One Brooklyn Health selects Infor Cloverleaf Integration Suite.
• The VA will integrate with state prescription drug monitoring programs using Appriss Health’s PMP Gateway.

People

Kate Palazzolo, MS (Allscripts) joins Care.ai as chief growth officer.

Medstreaming hires Steve Schroeder (Elekta) as EVP of sales.

Terri Steinberg, MD, MBA (ChristianaCare) joins Medecision as group SVP of analytics and population health and chief medical officer.

Announcements and Implementations

Ellkay announces LKHive, a platform that allows entrepreneurs to share and develop their health IT ideas and products and potentially receiving mentorship, market advice, and funding. 

QliqSoft’s Quincy Healthcare Chatbot and QliqConnect Secure Texting platforms are added to Epic App Orchard.

Health First (FL) deploys Vocera Ease for patient and family communication.

Cerner offers CommunityWorks clients a video visit platform that will be free through 12/31/21.

A new KLAS report on ERP finds that Workday meets customer needs with strong human capital management and less-capable supply chain functionality, Oracle Cloud’s satisfaction scores have jumped in the past year, and Premier delivers a solid product that excels in supply chain management despite weakness in human capital management. Infor customers are least satisfied with CloudSuite due to relationship and communication issues, while 62% of Allscripts customers say they’ll be moving on because of limited development and no announced plans to move the product to the cloud. 

Time’s list of “The Best Inventions of 2020” includes the Vocera Smartbadge in the “Connectivity” category. It’s a good list, full of interesting items that were in most cases new to me. 

COVID-19

States reported 164,000 new COVID-19 cases Wednesday, along with 1,869 deaths and a record 79,000 hospitalized inpatients. Wyoming is reporting that over 70% of its tests are coming back positive.

AHA is reporting hospital staffing shortages in up to 25 states due to both an increased number of coronavirus patients as well as employees who are out sick with the virus, with no option to bring in outside help from less-affected areas because there aren’t any. Stat reports that hospitals are paying up to $6,000 per week for traveling ICU nurses, double their pre-COVID rate. Hospitalizations are a lagging indicator, so hospitals worry about staffing for the inevitable infectious crisis that will be caused in December and January by holiday gatherings in which mitigation recommendations were ignored.

Aspirus Wasau Hospital (WI) will send some COVID-19 inpatients home to free up beds, relying on nursing calls, telehealth, and help from family members to care for them.

Mayo Clinic reports that 900 of its employees have contracted COVID-19 in the past two weeks, 93% of them having been exposed away from work and most of the rest from eating in its break rooms.

CDC advises Americans to celebrate Thanksgiving at home with only the people they have lived with for 14 or more days. The announcement came in CDC’s first media briefing in months as CDC noted the risk of having travelers spread infection around the country.  

CHIME and the Patient ID Now Coalition urge people to ask their senators to support repealing the national patient identifier ban, saying that it’s especially important to be able to positively identify people whose COVID-19 vaccination will involve one of potentially several available products that require a two-dose regimen over several weeks.

Epidemiologists question why New York City has closed its relatively low-risk schools indefinitely six weeks after reopening while allowing high-risk bars, gyms, and restaurants to remain open.

Cooper University Health Care will roll out the Heroes Health frontline worker mental health support app that was developed by the UNC Institute for Trauma Recovery. Employees are sent a weekly self-assessment questionnaire, tracking tools, and resource links.

Sponsor Updates

• Black Book ranks Imprivata as a top vendor of identity management and governance solutions, and Spok as a top vendor of secure communications platforms for hospitals and health systems.
• Frost & Sullivan recognizes Nuance with its 2020 Global Company of the Year Award.
• The Massachusetts Technology Leadership Council awards Everbridge Tech Top 50 awards in the categories of COVID-19 Response and Business Accomplishment.
• Industry Era includes Goliath Technologies CEO Thomas Charlton in its list of Top 10 CEOs of 2020.
• Collective Medical gives its customers access to Vital’s AI-powered care coordination software for hospital EDs and patients.
• Jvion wins the 2020 Georgia Healthcare Innovation Challenge and will conduct a beta test of its clinical AI solution with Navicent Health.
• Meditech congratulates 14 hospital and health system customers on their Digital Health Most Wired recognitions from CHIME.
• OptimizeRx is ranked #432 in Deloitte’s Technology Fast 500.

Blog Posts

• Lori Weiss on the Role of the CDCES in Nurse Education and Patient Safety (World Diabetes Day) (Glytec)
• Alarm Fatigue Solutions Your Organization Can Implement Right Away (Halo Health)
• How to engage and enhance digital user experiences (The HCI Group)
• Six Strategies to Navigate COVID-19 Financial Recovery for Health Systems (Health Catalyst)
• 6 Top Esignature Software Challenges & Solutions for Hospitals (Access)
• While Hospitals are Busy Fighting COVID-19, The Competition is Getting Serious (Loyale Healthcare)
• 5 Questions to Ask When Creating Custom Health Education (Healthwise)
• InterSystems Virtual Summit 2020: Day One Keynote and Day Two Keynote Recaps (InterSystems)
• Patient Perspectives on Virtual Care Part 3: How to Expand Access to Virtual Care and Generate Future Interest (Kyruus)
• Promoting a Culture of Innovation at Medhost (Medhost)
• How to help patients live well with COPD (Meditech)
• Best Practices for PT Practice Compliance (MWTherapy)
• Building a Golden Provider Record (NextGate)

Contacts

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

EPtalk by Dr. Jayne 11/19/20

Although telehealth has certainly been helpful for many organizations trying to boost patient access during the COVID pandemic, a recently study shows that it was not fully able to offset the loss in available patient care slots. Overall, telehealth was able to help organizations recoup about 40% of the decline in ambulatory office visits. Not surprisingly, patients from low-income ZIP codes and racial / ethnic minorities were less likely to use telehealth services than those from more affluent areas.

The study looked at more than 6 million private payer claims, but there’s still a gap in understanding visits for patients with public payer coverage (Medicare, Medicaid) as well as those telehealth visits that may have occurred but not been billed since providers were struggling to understand how to get paid for telehealth.

Office visits were most dramatically affected, but vaccine administration, mammograms, colonoscopies, and HbA1c tests were also reduced significantly.

I have to admit that I was part of that mammogram cohort and didn’t end up getting my semi-annual imaging until August. The facility where I usually have my mammogram didn’t bother to send me a reminder that I was overdue or let me know when they had resumed services, so it was completely on me as a patient to make sure I caught up. Good thing I did before COVID spiked and services were limited again.

Sometimes the titles of articles say it all, and this piece in JAMIA definitely caught my attention: “Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID19 healthcare workers.” The article reviews the National Institutes of Health Clinical Center’s approach to rolling out an Asymptomatic Staff Testing System. The Center is the 200-bed hospital arm of the NIH that delivers patient care and research support. Due to the type of research being performed, over 60% of the patients admitted are immune compromised either from an underlying health condition or an experimental treatment. This underscores the need to deliver continuous surveillance of healthcare workers and prompt identification of those who may be positive for COVID-19.

One of the program’s goals was to deliver weekly testing for eligible healthcare workers. They used existing EHR and other systems to identify workers and allow them to self-schedule their testing appointments. Automation was prevalent throughout the process, including check-in, specimen tracking, and laboratory interfaces. As the process was designed, they “identified the difficulty in following the organization’s formal software development process under the time requirements” and mitigated this by using existing systems where possible. The whole process from task identification to early adoption was only four weeks, which would be a near impossibility for many healthcare organizations.

To determine how successful they were, the team looked not only at the primary outcome of identifying infected workers, but also surveyed the healthcare worker customers on the process as well as the facility process owners. I wish I saw more organizations follow this approach with a 360-degree evaluation where they pay attention to all the feedback, not just internal customers such as infection control departments or human resources. One of the findings was a need to ensure that patients / workers set up accounts on the patient portal, which is a common challenge among healthcare organizations.

I always get a kick out of articles that cover poor password management habits, and this year’s list shows that the more things change, the more they stay the same. Review of data from hacking forums and the dark web revealed that the most commonly used passwords in the US include “password” and “123456.” The latter (and the multiple variations similar to it) shows that it’s not just users behaving badly, but vendors who should have logic behind their password requirements that would disallow such sequential numbers. Humorous options in the top 20 include superman, iloveyou, football, and letmein.

Although some vendors may be complicit, the other side of this coin is the vendors or entities that make ridiculously complicated password requirements or rules for frequent changes. These approaches have been shown in some studies to actually increase security risk, as users may be more likely to write passwords down.

One of my clients falls into this bucket. They make you change your password every 30 days, and the requirements include upper case, lower case, numbers, symbols, and a length of at least 10 characters. Maybe their goal is to push people to use randomly generated passwords coupled with a password manager, but that’s not always practical when using shared workstations. Regardless, I wasted half an hour of their tech’s time this morning (and a billable 30 minutes of my time) dealing with an expired password after I missed the prompt to change it.

Big thanks to the gals in my life who sent a couple of recent care packages. Jenn knows my love for putting my feet up with a good book and surprised me with the world’s softest socks, along with energizing foot lotion and an Amazon gift card, which I promptly swapped for a new read. There were also some addictive gummy bears, but I’ve had to tuck them in my snack drawer lest I eat the whole bag. My favorite revenue cycle informant, Bianca Biller, sent the famous “Bionic Apple” from Merb’s Candies in St. Louis. Let me tell you, this thing is a Granny Smith apple covered with the smoothest caramel you’ve ever seen and rolled in chopped pecans. Did I mention it was the size of a softball? It made an excellent lunch while I enjoyed a webinar presented by some of my favorite folks.

For your friends and colleagues at the tip of the clinical spear, the next few months are likely going to be some of the worst times they’ve ever experienced professionally. I’m thankful for my friends and their support. Hopefully my newly energized feet will give me a bounce as I head back to the trenches tomorrow.

What are the best pick-me-ups you’ve ever received? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/19/20

Central Logic Acquires Ensocare to Ease Transitions from Hospital to Post-Acute Care

Healthcare access and orchestration solution vendor Central Logic acquires Ensocare, which automates the referral of hospital patients to post-acute care.

K Health raises $42 million to expand its AI-powered telemedicine platform

Israeli company K Health raises $42 million and announces that the Mayo Clinic will integrate its telemedicine technology with its clinical data analytics platform.

Nuance Announces Sale of HIM Transcription and EHR Go-Live Services Businesses to Accelerate Growth as Conversational AI Market Leader

Nuance will sell its health information management transcription business and EHR go-live services business to DeliverHealth Solutions, of which it will become a minority shareholder.

COTA Secures $34M in Growth Capital and Triples Data Access to Better Serve Life Science Partners and Provider Institutions

Oncology-focused analytics vendor Cota announces a $34 million Series D funding round led by Baptist Health South Florida and ONC Capital, alongside a $20 million investment from Varian Medical Systems.

HIStalk Interviews Kevin Coppins, CEO, Spirion

Kevin Coppins, MBA is president and CEO of Spirion of St. Petersburg, FL.

Tell me about yourself and the company.

Spirion is headquartered in sunny St. Petersburg, Florida. We serve the data privacy and data security markets. I joined Spirion just over a year ago. Before that, I spent the previous couple of decades working across a variety of tech companies, both in the cybersecurity space as well as in the networking space. I started way back when at Novell. 

With every role that I’ve held, I’ve had the opportunity to work with healthcare organizations across the US and around the world. Every company you talk to says they are different, their industry is different, or something is different. Healthcare is the only one that gets to carry that badge and actually mean it, because everybody else is much the same. Healthcare is definitely different.

How much information does the average health system have that they don’t know about or don’t realize is unprotected?

I typically start with a question. How much data do you have? Somebody tries to answer the question, and then they stop and say, we have no idea, because you don’t. Think about how fast data flows in and flows out, how it moves. It gets stored in the cloud, and then it gets replicated in the cloud, and you just don’t know. It’s a fair answer now, and people have gotten more comfortable saying that they don’t know. A few years ago, it was a little bit nerve-racking to acknowledge that you don’t know that.

The next question that you ask is, of the data that you don’t know how much you have, how much of that would be considered sensitive, and how do you define it? That depends on the industry, but healthcare will definitely go to HIPAA. Other industries will  go to GLBA or PCI. It depends on where they are regulated, because that’s where their brain thinks. You have to take a step back and say, that might be how regulation defines “sensitive,” but how would your patients define sensitive? How would your clients define sensitive? How would your board define sensitive? People take a step back and say, that’s interesting, we didn’t look at it that way.

First you have to define it. Then the challenge comes to, where does it live? Not just how much do I have, but where could it possibly be? That usually leads down another interesting conversation topic as well.

Is healthcare the worst of two worlds, where you have the legally defined protected health information, but you also have the business data of a health system that could be a multi-billion dollar enterprise?

Privacy is an overused term these days, but when you think about privacy, it’s fluid. How privacy is defined for you might be different than how it’s defined for me. It might be different how it’s defined for a provider versus an insurer. How that data is used or misused can also then help define what privacy means.

While regulations have tried to go ahead and put a fork in it, healthcare data back in February is different than it is today. I didn’t really care if the world knew what my body temperature was in February, but now, you could have a bias against me for having a temperature that’s not within the range that you’d expect. Or if you were to find out that somebody living in my townhouse complex was diagnosed with COVID, maybe then I’m not allowed to go to work the next day. A lot of information that’s associated — a combination of that PHI, but also proximity and demographics, et cetera — can be leveraged to help during a pandemic, but can also be leveraged after that to start doing some things that people might not be as comfortable with.

What is the biggest driver that might take a health system from going beyond being minimally compliant with HIPAA to having some enthusiasm about implementing tools and systems to protect data beyond what is legally mandated?

Every board across the US is waking up saying, how can I spend more money on something that doesn’t add direct value to what I do? [laughs] That’s the challenge of privacy security. CISOs deal with that challenge all the time. Vendors like us walk around and say, “If you don’t do it, you’ll be fined, flogged, and frozen and all these bad things will happen to you.”

Until organizations start making it personal, it doesn’t usually get traction. By personal, I mean recognizing that the data that you’re protecting isn’t some amorphous blob of sensitive data sitting in an Azure cloud store. It’s information about your neighbors. It’s information about your community. A lot of healthcare providers are community centric. Something happens to that data and it impacts the entire community, which includes your kids’ teachers and your own relatives.

A good example is that once your child who is under 10 years old has had their Social Security number compromised and used to get credit card, they begin their financial life in the hole. Then it starts becoming a little bit more real. There’s so many more ways than just identity theft in the ways normal people think about how privacy can be breached and how majorly impactful it can be when you start being impersonated by people online, et cetera, et cetera. Or you start getting discriminated against.

One example that I heard that is relevant today is that we’re supposedly getting closer to this vaccine. Let’s say the vaccine is rationed, and you have to meet a certain set of criteria in order to be to the front of the line for the vaccine. It would be pretty easy to figure out what that criteria are, mine for those criteria, and then sell identities that meet that criteria so people can go buy it and be first in line. Then when you go to get your vaccine, somebody says, “Nope, you’ve already gotten it.” Wait a minute, no I haven’t. That’s when it starts hitting home.

It’s really making it personal and shifting that gear to say, this isn’t just a nice thing to do it. It isn’t just a regulatory thing to do. It’s a critical thing to do. That’s when organizations start to shift.

Are hospitals thinking about security differently after the recent surge of ransomware attacks?

Yes, for sure. One of the first things they are asking themselves is, do I have a secure copy of my data, so that if I am ransomed and they want to shut me down, I can rebuild? The second piece is, how much data do I really need? How much of that is critical to my operations, and how much is non-critical? They are starting to think about data in a different way, because ransomware is either about shutting it down and saying, I’m not going to turn you back on until you give me something, or they will actually sell off your data. I’ve got all your sensitive data, and I’m going to release it if you don’t do something. The idea that data can actually hold you hostage is a new concept for boards to think about. That has started putting a different value on that data.

The unfortunate impact of that is people are paying a lot more attention for the wrong reasons, versus waking up and saying, we should do this because it’s the right thing. People who start solving for the privacy problem because it’s the right thing to do typically don’t have the ransomware and breach issues. They have solved it organically and culturally within the company versus as a by-product of something they think they are supposed to do because their regulator said so.

How does a health system reduce the risk that is associated with the data they discover?

The first thing is to reduce to the absolute optimal the number of copies that you need to have of that data, and then make sure that it can’t replicate itself. With cloud stores today, if you are looking at your laptop right now, it’s probably syncing to a OneDrive, Google Drive, or  Dropbox. When you save something, will save in the three other spots. Getting a handle on what sensitive data is, how that data can move, and how that data can be stored will be a big step in the right direction to solving the problem. We talk about reducing the threat surface of sensitive data, and you do that by understanding where it is and how much you have. You can only do that once you define what it means to your organization.

Healthcare is fairly new to the cloud and we’ve seem some inadvertent exposures because of incorrect cloud configuration. Is that situation commonly or easily detected?

A cartoon shows the son saying to his father, what are clouds made of, Daddy? And he says, mostly Linux servers, son. [laughs] It’s an abstracted version of storage, of a place to store stuff. The challenge is that people don’t recognize that where they are storing it is completely unsecured and it’s completely open.

Being able to say, wait a minute, this is sensitive data is step one. Step two is, how secure is it? Well, it’s sitting on a server that is wide open to the entire universe. OK, that’s a problem. How active is it? Nobody has actually accessed it since the Reagan administration, so we are OK. Actually no, there have been 10,000 hits on it from foreign countries in the last 15 minutes, so it’s a problem. 

It’s not just a matter of knowing that it’s sensitive data, it’s knowing the level of access to the sensitive data and the level of activity around it. You combine those three things together to create a pretty good heat map that would say, I need to shut this down or I have a challenge or issue here. If I can reduce the threat surface and I have fewer locations where sensitive data lives, it gets a heck of a lot easier to manage it.

We had less impact than I expected from GDPR, which could have changed how we think about storing, securing, and using data, especially consumer data. Will we see further effects from GDPR or other legislation?

You see it in California already for sure with CCPA and CPRA. You have the New York Shield Act and 32 other states that are actively debating privacy legislation. With the election behind us now, there’s definitely privacy legislation that’s at a Congressional level as well. So you absolutely will, it will continue to shift. Even CCPA has changed three times since it went into effect last year. It will continue to shift and morph because privacy is fluid.

The wrong lens to look through is, how big have the fines been for GDPR? Well, there’s been some massive ones. How many have been collected on how many have made it through the courts? We’re waiting to go ahead and see.

You have to take a step back and say, what’s the right level of stuff to do from a privacy standpoint? If you show that you are trying to proactively get ahead of the problem, then more often than not, you’re going to be in pretty good stead with the regulators. It’s not trying to keep up with the regulations, but more trying to keep up with the culture, and that usually takes a rethinking of how you move and store data. That wake-up call doesn’t typically come until there’s a breach or something bad that could happen to you that you saw happen to the healthcare organization across town.

Are health systems funding and completing projects related to security, privacy, and data protection?

They are absolutely taking it more seriously. We’ve seen an uptick, even during these crazy times, over the last six months in healthcare because they recognize that it’s a journey that they have to start. They don’t a panacea button that it solves all their issues, but they start saying that they have to get the right processes in place and the right underpinning tools in place to start getting ahead of this problem.

Most healthcare organizations didn’t pop up overnight. They have been around for 50, 100, or 150 years. If you think about the technological age, every healthcare organization that I’ve walked into has equipment and systems that go back to the time the first building was built, that date all the way to the time the most recent building was built. They have a little bit of everything, and across that little bit of everything lies a lot of complexity. For a while, the answer was, we’re just going to throw our hands up because this is too hard to get our heads wrapped around. Now it has shifted into, we have to start somewhere, so let’s put a stake in the ground and let’s start pulling the thread through it.

It’s a hard problem, especially in healthcare. Healthcare is different. A lot of it is because there’s a lot of legacy systems with a lot of legacy information that’s really, really important, but that weren’t designed to protect data the way it’s expected to be protected today.

How do you see that situation changing over the next 3-5 years?

The concept of data and sensitive data is at the core of both security and privacy. The next thing that goes around that is, what is the definition of sensitive as it pertains to privacy? Then also, what is the definition of identity as it pertains to security? I think that recognition is starting to happen, where people say, it’s not a matter of if I’m going to be breached, it’s a matter of when. The perimeter is not going to hold, so when they get in, what are they going to be able to do, and what are they going to be able to find? That gets back to the data part of the question.

People are starting to move in the right direction. They are starting to say, I need to get a handle on my sensitive data footprint so I know what the threat surface is. Then when I am compromised, I know what has happened or is happening and I can minimize the risk. I think you’ll continue to see over the next 3-5 years more and more efforts with a data-centric look at the overall infrastructure and security. That will spawn privacy. You cannot have privacy without security, but you can have security without privacy. We are already seeing that in how people are talking and thinking about how they are leveraging systems. It’s getting more and more prevalent.

Do you have any final thoughts?

When it comes to security and privacy and all the drama and all the noise that you hear about it and read about it, just boil it down to this — am I doing everything I can today to protect what matters most to the constituents I serve? And what matters most to them is their individuality. Recognizing that you hold the digital versions of those physical selves and treating those digital versions as you would treat the physical one is just as important, so make it personal.

Readers Write: Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones

Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones
By Ray Costantini, MD, MBA

Ray Costantini, MD, MBA is co-founder and CEO of Bright.md of Portland, OR. This article recaps a recent video conversation he had with Ries Robinson, MD, SVP/chief innovation officer of Presbyterian Healthcare Services of Albuquerque, NM.

When the coronavirus first spread through the US, fears of exposure and lockdown mandates kept patients at home and forced providers to pivot almost exclusively to deliver care virtually. I don’t know of any health systems that navigated that process smoothly and easily, though for the healthcare systems that had already implemented a robust digital strategy, that transition was less painful than for others.

Systems rushed to implement telehealth tools, often repurposed consumer video platforms like Zoom, FaceTime, or Hangouts. This was a reasonable solution for the short term. But after more than seven months of quarantine, doctors and health systems are more comfortable using digital tools for care, and it’s clear that patients will use and expect virtual care options beyond the pandemic. 

So how does a system turn a short-term solution into a long-term one? By prioritizing the patient experience. Here are four ways you can use digital tools to support patients through their journey to receive care, beyond a quick implementation of video tools. 

Provide Free Online Screening

To keep both patients and healthcare workers safe by keeping as many people as possible out of high-contagion areas like the ER and urgent care clinics, one large healthcare system made a free, high-quality, online coronavirus-screening tool available to anyone in the state. Patients who showed potential COVID-19 symptoms or exposure would then be advised to take a test. Everyone else received guidance and education about the virus and any other steps they should take for self-care at home. 

At drive-through testing sites, there were billboards with a QR code that, when scanned, led patients to the online screener they could take while waiting in their cars. One executive at the system noticed many cars leaving the line. Assuming the patient had grown frustrated with the long wait, he approached a few cars to ask why they were leaving. Many of them said after taking the online exam and receiving feedback from a provider, they felt comfortable their symptoms were not COVID-related.

It’s a great example of using a digital tool ahead of an in-person appointment, providing real value for patients and minimizing any frustration for those who didn’t need to wait for a full test.

Bridge the Digital Divide

For some patients, connecting with healthcare providers via video was reassuring and convenient. For many others, though, the digital divide has only grown larger during the pandemic. 

When a healthcare system we work with found that 30% of their patient population was unable to conduct a video visit due to a lack of hardware, bandwidth, affordability, comfort with tech, or language barriers, they implemented digital tools that allowed them to more easily access care. Today, patients need as little as a 3G network connection and can conduct their healthcare interview in Spanish or English.

Ensuring equitable access to virtual care is critical for a successful long-term implementation of digital tools. 

Understand what Patients Want

If 2020 was the year of virtual care, then 2021 will be the year of the patient experience. As the coronavirus crisis changed everyone’s lifestyle and habits, new direct-to-consumer competitors gained traction, and in many cases, the convenience exceeded patient expectations. Health systems are increasingly aware of the need to retain their patients, and re-engage those who they’ve lost to these digitally forward, new-entrant competitors.

The good news for healthcare systems is that patients still trust their own doctor over retail medicine or big tech. As one chief innovation officer at a large health system told me, “If you’re in the business of delivering on patient satisfaction and high-quality care, you’re in a better position of fighting off the competition.”

For the long term, offer care when and how your patients want it: immediately, online, and for not too much money.

Help Providers Focus on Patients

It’s not news that healthcare workers have been severely impacted by the pandemic, whether they are in an ER in a COVID hotspot or struggling to manage a household while delivering care remotely. The stress has led to early retirements and leaves of absence, compounding an already severe physician resource shortage.

Healthcare systems that have managed the crisis well have used digital tools to create elasticity for their providers, giving clinicians more control over their time and from where they can deliver care. Virtual care delivery solutions that automate administrative tasks can also reduce the amount of time it takes to deliver care, so clinicians can help you prioritize the patient experience, instead of focusing on the technology of an appointment. 

It sounds counterintuitive, but a thoughtful implementation of digital tools humanizes healthcare: letting computers or software do the tasks that require repetition, precision, and consistency so that humans are free to do what we’re good at: critical thinking, problem solving, listening patiently, and responding compassionately.

Morning Headlines 11/18/20

Introducing Amazon Pharmacy: Prescription Medications Delivered

Amazon launches an online pharmacy, giving customers the ability to order prescriptions, compare prices, and consult with pharmacists.

SOC Telemed Reports Third Quarter 2020 Results

SOC Telemed, which began trading on the Nasdaq last month, reports an 11% dip in Q3 revenue, attributable to a decrease in hospital utilization during the pandemic.

Upfront Healthcare Raises $11.5 Million in Series B Funding Round Led by Baird Capital and Co-Led by LRVHealth

Communication and patient engagement platform vendor Upfront Healthcare raises $11.5 million in a Series B funding round, increasing its total to $21.5 million.

AccuReg Acquires Digital Patient Engagement Technology Company

RCM vendor AccuReg acquires Zenig, a patient engagement company focused on appointment reminders, touchless check-ins, virtual waiting rooms, and communication tools.

News 11/18/20

Top News

Amazon launches an online pharmacy, giving customers the ability to order prescriptions, compare prices, and consult with pharmacists. The service will be available in 45 states starting this week.

Prime members will receive free, unlimited two-day shipping and discounts on certain drugs.

Somewhat hidden in Amazon Pharmacy’s webpages is a GoodRx-like Prime prescription savings card that is accepted by most major pharmacy and grocery chains.

Amazon jumped into the pharmacy space in 2018 when it acquired prescription delivery service PillPack for $753 million. PillPack — which offers prescriptions on 30-day schedules to typically older, sicker patients — will remain a standalone service, though its infrastructure was used in Amazon Pharmacy’s underpinnings.

Shares of CVS, Walgreens, Rite Aid, and GoodRx dropped between 7.5% and 18% on news of the launch.

Reader Comments

From Musical Box: “Re: classic rock. I take it you aren’t a fan from your recent comments.” I dislike country music because “country” artist dues-paying should involve a modest rural upbringing, grounded lifestyle, and non-pop expression of musical tradition that goes beyond having a record company provided an always-handy cowboy hat, but I would still rather listen to faux country than an algorithm-driven “classic rock” radio station that sounds like a nursing home playlist in ignoring anything that came on this side of Ronald Reagan’s presidency. I’m pretty sure that the 20-something musical geniuses in Pink Floyd were hoping with “Money” to enlighten rather than entertain car-bound cubicle commuters, who have since rescheduled the band’s creative output from late-night mental space travel to morning Muzak.

HIStalk Announcements and Requests

Thanks to Diameter Health for upgrading its HIStalk sponsorship to Platinum. The company sets the standard for clinical data optimization with automated, scalable, auditable technology that provides greater value to organizations that depend on multi-source data streams, such as health plans, HIEs, HIT, insurers, and health systems. Thanks to Diameter Health for supporting HIStalk. 

A benefit and a challenge of being a grammar Nazi — so labeled by folks who roll their eyes at the concept that we can all communicate more effectively by honoring basic rules of the road — is that while someone else’s wording and spelling choices are often amusing, they sometimes make me think way too much. Case in point: my laptop updated Windows this morning and gave a message, “Don’t turn off your computer,” leading me to mentally debate whether a better choice would have been, “Don’t turn your computer off.”

Webinars

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

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

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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

The recording of this week’s webinar, “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats” by Everbridge VP/CISO Sonia E. Arista is live on YouTube.

Acquisitions, Funding, Business, and Stock

Healthcare access and orchestration solution vendor Central Logic acquires Ensocare, which automates the referral of hospital patients to post-acute care.

AliveCor will use a $65 million Series E funding round to further develop its remote cardiology technology with expanded telemedicine capabilities, and the addition of detection and condition management services. The company gained FDA clearance last year for the first consumer-grade product to monitor heart activity on six different leads.

SOC Telemed reports an 11% dip in Q3 revenue, attributable to a decrease in hospital utilization during the pandemic. Company shares on the Nasdaq have dipped slightly since its debut last month through a merger with SPAC Healthcare Merger Corp.

Patient self-scheduling app vendor Solv raises $28 million in additional funding, increasing its total to $51 million. The company says that online appointment scheduling in its network has increased from 22% to 60% of the total, app usage has increased sixfold in the past year, and users have booked 700,000 virtual visits since March 2020 versus 9,000 in all of 2019. The founders came from real estate site Trulia.

Communication and patient engagement platform vendor Upfront Healthcare raises $11.5 million in a Series B funding round, increasing its total to $21.5 million. Co-founders Ben Albert and Carrie Kozlowski started the company in early 2016 after working with The Advisory Board Company’s Crimson Care Management system.

Sales

• Northern Health in Melbourne, Australia, will implement Cerner towards the end of 2022.
• Leidos awards 3M Health Information Systems a contract to deploy its computer-assisted coding technology to DoD treatment facilities as part of the DHMSM initiative.

People

Allan Kyburz (PeriGen) joins OnShift as RVP of field sales.

Augmedix names Saurav Chatterjee (Lumiata) as CTO.

Janet Dillione (Action Medical Technologies) joins health monitoring solutions vendor Connect America as CEO.

Behavioral health IT vendor Tridiuum hires Philip Vecchiolli (Optum) as chief growth and strategy officer.

Announcements and Implementations

ECRI will shut down its Partnership for Health IT Patient Safety collaborative on December 31 after seven years, with the emailed announcement lauding its accomplishments without explaining its demise. The physician reader who forwarded ECRI’s email says that it’s a shame to be shutting down one of few national efforts that focuses on health IT safety, while also noting that providers haven’t demanded such a project or offered much support. That reader concludes, “I want to shout out to my fellow clinicians and their professional organizations (loudly enough that they listen) that assuming someone else will take care of safety will eventually lead to more federal intervention, particularly in the new administration. ”

Change Healthcare develops social determinants of health-focused analytics using de-identified claims data, enabling providers to identify determinants that impact patient visits across population segments and care settings.

A Black Book survey names Fortinet as the top-rated vendor of end-to-end enterprise cybersecurity suite software and services.

A new KLAS report on health system financial improvement consulting finds that PwC and Accenture are reliably high performers, while several Huron clients reported issues with their assigned consultants and Optum performs poorly in engagement execution.

COVID-19

A record 73,000 people were COVID-19 hospital inpatients in the US as of Monday. Eight states, all of them in the Midwest, are exceeding 400 hospitalizations per million residents. Cleveland is overwhelmed to the point that the city could not assemble case counts Sunday or Monday.

Sweden bans gatherings of more than eight people as it abandons its model of allowing coronavirus to run its course in hopes of developing herd immunity instead of implementing population safeguards. The prime minister urges citizens to “don’t go to gyms, don’t go to libraries, don’t host dinners. Cancel.”

Switzerland reports that every one of the country’s ICU beds is occupied, with zero capacity for COVID and non-COVID patients.

Other

Delaware public health officials disclose that a now-former employee mistakenly emailed the COVID-19 test results of 10,000 people to an unauthorized user.

Zocdoc founder and CEO Oliver Kharraz, MD says in a TechCrunch column that legacy telehealth services like Teladoc were built in an Uber-like “randomized triage care” model to connect people with whatever doctor is available to address their rash or cold instead of developing an ongoing, trusted relationship with a provider who can take a more holistic health approach. He says, “Patients are far better stewards of their own health than a random doctor generator” and observes that 90% of surveyed telehealth patients would rather choose their provider instead of being assigned one randomly. Most patients also favor selecting a nearby doctor so they can continue the conversation in person if needed.

Sponsor Updates

• The Chartis Group’s Center for Rural Health partners with the Nebraska Office of Rural Health to announce the winners of the 2020 Rural Provider Excellence in Quality Award.
• InterSystems has enabled Greater Houston Healthconnect to manage the flow of clinical data during the COVID-19 pandemic.
• Wolters Kluwer enhances its Sentri7 clinical program for opioid stewardship with artificial intelligence.
• The Women Talk Tech Podcast features CarePort Health founder and CEO Lissy Hu, MD.
• Cerner associates will provide Thanksgiving meal baskets to the families of Veterans Community Project in Kansas City.
• The American College of Healthcare Executives interviews Change Healthcare President and CEO Neil de Crescenzo.
• Clinical Architecture CEO Charlie Harp will present during the AMIA 2020 Virtual Annual Symposium on November 16.
• CI Security announces a strategic partnership with Synnex to deliver managed detection response and professional cybersecurity services.
• Diameter Health will host the virtual Diameter Forum 2020 December 3-4.
• Engage shares a video featuring San Luis Valley Health IT Director Brian Heersink sharing the hospital’s experience working with Engage on its implementation of Meditech Expanse.
• Ellkay highlights Chief Innovation & Product Officer Shreya Patel as part of its Women in Health IT series.
• Pivot Point Consulting, a Vaco company, offers complimentary guidance to providers interested in applying for the FCC’s Connected Care Pilot Program.
• Wolters Kluwer Health adds Emmi Care Plan, a new Alexa skill for post-discharged patients, to its EmmiTransition solution.

Blog Posts

• How to Taper Down Support After Epic Go-Live (314e)
• Physician Champions and Healthcare IT Projects (Optimum Healthcare IT)
• The Natural Growth Path of Patient ESignature Solutions in Hospitals (Access)
• How to Automate Your Behavioral Health Practice Operations (AdvancedMD)
• Clinica Alemana in Chile transitions to Enterprise Imaging (Agfa HealthCare)
• Information Blocking Rules and CMS Notification Requirements: Exciting Steps Toward our Healthcare Data Future (Audacious Inquiry)
• Changing telehealth benefits: What’s ahead and how to prepare (Bluetree)
• Cyberattacks on Healthcare: Key Takeaways for Plan B (Downtime Procedures) (CereCore)
• The Relationship Between EHR Usability, Experience and Performance (ChartLogic)
• Improving Workflows to Impact Patient Access (CoverMyMeds)
• Show Me the Money Methods! (EClinicalWorks)
• Solving Post-Acute Care Transition Challenges (Ensocare)

Contacts

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

Morning Headlines 11/17/20

Centauri Health Solutions Adds Referral Management and Analytics Capabilities with Acquisition of Ivy Ventures, LLC

Centauri Health Solutions bolsters its physician referral services with the acquisition of Ivy Ventures, developer of referral services using proprietary scheduling, analytics, and outreach software.

AliveCor Closes $65 Million Financing to Accelerate Growth of Its Remote Cardiology Platform For Consumers, Employers, and Providers

AliveCor will use a $65 million Series E funding round to further develop its remote cardiology technology with the addition of telemedicine and detection and condition management services.

Heads Up Health Closes $1.35M Seed Round Led by Innosphere Ventures

Health data tracking, aggregation, and analytics software startup Heads Up Health raises $1.35 million in a seed round led by Innosphere Ventures.

Curbside Consult with Dr. Jayne 11/16/20

We’ve officially crossed into COVID hell in my part of the country.

The largest health system just announced the rescheduling of elective surgeries at all 15 of their hospitals, starting Monday and extending for the next eight weeks. Employed physicians have been instructed not to travel and must be ready to return to the hospital within 24 hours when summoned. Operating room capacity for scheduled cases is being reduced by upwards of 30% to allow for redeployment of staff to other areas. Another system has redeployed their operating room nurses to the medical/surgical floors and has brought in travel nurses to staff the ORs, but not everyone can find enough travel nurses even if they can afford them.

I imagine this is what it felt like to be in New York City in the spring. It doesn’t feel like we learned anything from their suffering because we’re now officially in the same boat.

Our urgent cares have tried to reduce volumes by limiting the number of COVID tests we do for patients who are asymptomatic, but it’s not much help since we’re in a phase where nearly every patient has symptoms. Schools are moving from in-person and hybrid models back to fully virtual, and parts of the state are headed back towards stay-at-home and safer-at-home orders.

My staff is working harder than ever, but they are most definitely at the breaking point. Sometimes I feel guilty about being only part-time for in-person care, and then I remember the work that I’m trying to do with my clients to better manage patients without the need for in-person encounters and their associated exposures.

Here are my free consulting tips for practices trying to figure out how to manage patients in the outpatient space more efficiently, since we’re all trying to do more with less. These are things that I have been recommending to practices for years, but for some reason, they still are trying to do things the hard way:

Refill management

If your system has technology to help with refill management, use it. If you don’t, consider a solution like Healthfinch to help tame the beast. If you don’t have technology, consider creating a policy that allows delegates to manage refills on behalf of physicians.

I still work with a lot of physicians who can’t let go of the idea that only they can manage refills, and their inboxes are flooded with refill requests. These are usually the same people who aren’t giving refills to their patients to last through the next scheduled visit, let alone to last through the year. I recommend that physicians who struggle with this idea start with one or two health conditions where medication refills are the lowest risk, and let their staff dig in. Make a list of the criteria for refills – this may include a visit within the last 365 days and no overdue labs – and start letting your support staff support you.

Inbox management

I’m a big fan of the “touch it only once” mantra. Use your technology to help you sort your inbox and then work it deliberately by section. If you only have a minute or two, select a lab result to manage or a refill request to manage, not a patient phone call. Don’t go through your inbox looking at things and trying to re-prioritize it over and over. You’ll waste a ton of time along the way.

Set up dedicated time during the day to manage the inbox, or plan to work it before or after seeing patients. Even if you’re used to calling your patients with results, consider leveraging the patient portal or secure texting if patients have opted in for these services. They’re much more convenient for patients and will save you time.

Invest in technology that can free your staff

Practices are still using humans to call patients and ask them COVID screening questions. If your organization has the ability to screen patients through a portal or other tools, use it. If not, there are many cool technologies out there such as Asparia that not only manage appointment reminders, but can help provide a safe arrival experience and triage patients who may need to avoid coming into the office.

You should also maximize the use of digital check-in or other workflows that might be available in your patient portal. For my most recent new patient visit, I uploaded copies of my insurance card and photo ID on my phone before even walking in the door, resulting in a contactless visit. When you save those minutes for your staff, it adds up, and those resources can be redeployed for use with patients who need real-time or face-to-face contact, or to better support you as you embrace telehealth visits.

Don’t be afraid of telehealth visits

With everyone being concerned about COVID and the availability of inexpensive devices for home biometric assessments, you would be surprised how many patients can provide a full suite of vital signs for a telehealth visit. Blood pressure cuffs and thermometers are plentiful, and pulse oximeters are becoming a regular part of the home first aid kit for many families courtesy of Amazon, Target, and other major retailers. Of course, this may vary depending on the patient population served, but I think physicians might be pleasantly surprised if they ask about access to these devices. If the patient doesn’t have one, they might have a neighbor or family member who does.

I’ve been practicing telemedicine for a while now and I’ve found it useful for picking up factors that I might not pick up at an office-based visit, such as fall risks in the home. I’ve also seen full ashtrays on the coffee tables of patients who claim to have stopped smoking, so you never know what you might find. Learn the rules for telehealth billing for your specialty – many specialty societies have published cheat sheets for their members.

Leverage your staff for telehealth visits

Staff can meet with the patient prior to the visit and update histories, document vital signs, flag medications for refill, etc. All too often I see the physician trying to do all these tasks even though they would have allowed support staff to do them in the in-person world. Sometimes the technology doesn’t make this easy, but there are ways to work around it to maximize the physician’s time.

Many of these elements go back to something that is so hard for some physicians to learn, and that is that they need to run their practices with everyone working to the top level of their licensure. If you’re lucky enough to have a registered nurse in the office, make sure you’re truly using them to deliver nursing services and not to do things that could be done by a medical assistant, patient care tech, or receptionist. I’ve been hearing the same arguments from subsets of physicians for decades, and if there’s one thing 2020 has taught us, it’s the need to break existing paradigms because “business as usual” is effectively over.

How has your organization tried to streamline the ambulatory paradigm in 2020? Leave a comment or email me.

Email Dr. Jayne.