Morning Headlines 8/10/20

Improving VA and Select Community Care Health Information Exchanges

A VA OIG report on how VA facilities and their community providers use HIEs finds utilization lacking for a number of reasons, and that the Cerner switch-over will improve the ease of exchange among VHA, DoD, and community providers.

Samaritan still dealing with effects of malware two weeks later, slowly restoring applications

Samaritan Medical Center (ME) brings its EHR, PACS, medication management, and care communication systems back online after a July 25 ransomware attack.

Epic adjusts staff’s return to work time frame

Epic changes its Monday mandatory return to campus, allowing employees who feel that their personal situation makes it unwise for them to return safely to campus to continue to work from home while Epic awaits further guidance from the county health department.

Monday Morning Update 8/10/20

Top News

VA OIG looks at how VA facilities and its community providers use HIEs.

The report finds that all 140 facilities have access to VA Exchange and VA Direct, but only 28 are using the latter because they weren’t offered training from DirectTrust or none of their community partners are using DirectTrust.

Twenty-two of 48 lower-acuity facilities still exchanging information via scanning, faxing, or mailing.

Users of Joint Legacy Viewer complain about cumbersome sign-on and poor data quality.

VA has 56 contracted VHIE community coordinators, but noted high turnover and engagement that “ranged from a high level of participation to little or no participation.”

OIG concludes that the Cerner implementation will improve the ease of exchange among VHA, DoD, and community providers.

The report recommends that the VA review barriers to using VA Direct, evaluate VA Exchange and VA Direct training programs, increase the number of community partners including other HIEs, and evaluate the work of the VHIE community coordinators. The VA accepted all four recommendations.

Reader Comments

From All the Marbles: “Re: newly rich Livongo executives. Does it even matter since they were all loaded before?” I’m speculating since I don’t know what it’s like having that kind of cash, but my reaction:

• Assets, not income, makes you wealthy, since you then have financial autonomy that nobody can take from you. Whoever signs your paycheck could stop doing so tomorrow. These folks are set for life.
• Everybody can find ways to spend ever-increasing amounts of money, but at some point pretty early in the wealth continuum, diminishing returns would kick in and the pleasure of buying a fourth house or third luxury car wouldn’t provide much of a thrill. I speculate that money makes things easier to some point, then starts making them harder and causes stress over losing a chunk of it via bad investment.
• Self-made people with big fortunes feel the psychological need to prove that earning it wasn’t a fluke, so they rarely sit poolside like a trust fund brat knowing they can’t outspend their interest and instead try new ventures (either the rich-person’s hobby kind or something a team can run day to day for them).
• I suspect rich, older folks realize that you don’t see hearses pulling U-Hauls, so they look for benevolent ways to publicly spend their money instead of bringing out the worst in squabbling, greedy family members.
• Everybody has some magic number that, given their personal expenses and ambitions, would allow them to live out their days comfortably free of job worries. In that sense, just as time is money when you’re making it, money is time when you want to stop making it. That might be a $1 million net worth for one person or a $50 million net worth for another and the combination of risk taken, luck, and the time value of money is what will or won’t  you there, hopefully in time to enjoy the result. I suspect that every one of those newly minted Livongo centimillionaires passed that point long ago, so while I’m sure they are thrilled to be sitting on an even larger embarrassment of riches today than last week, it won’t change their daily lives.

From Prime Spot: “Re: hospital parking. Lots of Twitter chatter about how it’s expensive and unfair to charge patients and families to park.” Hospital parking is always a mess, and I was shocked the first time I took a job with a health system that charged employees and even visitors for parking. My reactions then:

• Hospitals never have enough parking due to an absurdly large number of employees, doctors coming and going, patients and visitors coming in for ambulatory services on the same campus, and car-driving salespeople running around all over the place. We did an analysis of where employees and visitors were parking off campus and it was shocking — they would walk a half-mile to park in a residential neighborhood, either to find an available space or to avoid paying.
• Sometimes as an employee you can’t get a spot even though you’re paying monthly for one, and if you’re really unlucky, you might get relegated to offsite parking that involves a bus ride each way that isn’t nearly as nice as  its off-airport counterpart
• Hospital and university transportation services departments, like most bureaucracies, keep finding new ways to spend money on employees, vehicles, and infrastructure because they seem themselves as generating big profit, and all of that profit comes from permits and tickets.
• Hospital garages and parking lots are often located in areas where unrelated parking is in high demand or as part of a school where students will take up any available space, meaning that visitors wouldn’t get a spot if the per-hour charge wasn’t a deterrent to those with less motivation. Hotels charge paying guests $40-80 for overnight valet parking given the same demand with lack of alternatives.
• Hospitals sometimes don’t own their on-campus garages or contract out parking / valet services (I always picture mob involvement).
• It’s always funny that despite all the ways hospitals extricate money from patients under sometimes questionable circumstances, the only services for which bitter comparisons are made are parking and cafeteria.
• I personally would avoid on-campus appointments whenever possible, foreseeing sitting in traffic amidst impatient employees and lost visitors and then hiking quickly knowing I’ll be late (assuming I even know where I’m going from the bowels of the parking garage, like the “follow the yellow lines to the blue elevator, go up one floor, then cross the annex bridge and go down one floor” kind of hospital directions). I don’t like having my first aggravating customer experience before it even begins. Buy a dying mall and stick your doctors there.

HIStalk Announcements and Requests

HIMSS21 attendance is, for the most part, out of the control of HIMSS and instead will be driven by pandemic status, poll respondents say.

New poll to your right or here: For those assigned to work from home: would you return to campus if the company required it in the next few weeks? Basically a yes/no answer is the only one an employer will offer, so do you feel strongly enough about not returning that you’ll accept termination for refusing?

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

Several readers saw my mention of new Donors Choose projects and sent generous donations to fund another round of them, with their dollars boosted by matching funds from my Anonymous Vendor Executive as well as third-party matching sources. Here’s what I fully funded:

• A document camera for Ms. E’s elementary school class in Salinas, CA.
• A webcam, laptop stand, and wireless keyboard for Ms. H’s elementary school class in Timbo, AR.
• Lighting, headset, device mount, and easel for Mx. Smith’s third grade class in Las Vegas, NV.
• Digital resources for Ms. G’s elementary school class in Seagoville, TX.
• Digital resources for Ms. D’s kindergarten class in Hoskinston, KY.
• Five headsets for Ms. S’s elementary school class in Santa Ana, CA.
• Daily journals for online sharing for Ms. M’s second grade class in Oxnard, CA.
• Math manipulatives for remote learning for Ms. S’s elementary school class in Waco, TX.
• Classroom supplies for Ms. D’s middle school class in Collinsville, IL.
• Flocabulary vocabulary learning for Ms. H’s elementary school class in Las Vegas, NV.
• Digital resources for Ms. R’s elementary school class in Philadelphia, PA.
• Agriculture books for Ms. J’s middle school class in Kinston, NC.
• Math manipulatives for Ms. F’s elementary school class in Wyandanch, NY.
• 50 take-home library books for Ms. C’s elementary school class in Calumet City, IL.
• 25 sets of headphones for Ms. S’s elementary school class in Houston, TX.
• A document camera for Ms. E’s elementary school class in Steelton, PA.
• Remote video learning equipment for Ms. R’s elementary school class in Oklahoma City, OK.
• Social distancing and teaching supplies for Ms. B’s elementary school class in Irving, TX.
• A document camera for Ms. T’s elementary school class in Apopka, FL.
• Sight word games for at-home use for Ms. C’s elementary school class in Hempstead, NY.
• A webcam, microphone, and earphones for online instruction for Ms. T’s middle school class in Chicago, IL.
• Online language proficiency tools for Ms. M’s elementary school class in Fairdale, KY.
• Digital social studies content for Ms. K’s middle school class on Connellsville, PA.
• Lighting for teaching virtual classes for Ms. T’s elementary school class in Mission, TX.
• STEM kits for Ms. A’s kindergarten class in Sacramento, CA.
• Headphones and a USB camera for Ms. N’s elementary school class in Harbor City, CA.
• A USB headset for Ms. B’s elementary school class in Kenner, LA.
• Take-home math materials for Ms. H’s elementary school class in Madera, CA.
• 20 magic boards and binders for Ms. M’s elementary school class in Chicago, IL.
• Math and science books for recording for online lessons for Ms. P’s elementary school class in Philadelphia, Pa.

Webinars

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

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

Sales

• NIH will extend its use of OpenText’s Content Suite and AppWorks for electronic document management and workflows.
• Transaction Data Systems chooses Waystar for claims processing by its independent pharmacy customers.

People

Mee Memorial Healthcare System (CA) promotes Rena Salamacha, MS to CEO. She previously served as IT director, CIO, and chief strategy and technology officer, COO, and interim CEO.

Lisa Crymes, MBA (Change Healthcare) joins Preventric AI as chief marketing officer.

Announcements and Implementations

Elsevier expands its integration of its ClinicalPath (formerly Via Oncology) oncology decision support tool with Epic, including launching from Epic using SMART on FHIR, applying cancer staging data from Epic, navigating within Epic, queuing up treatment within Beacon protocols to reduce manual order entry, and documenting details as a note.

COVID-19

A New York Times analysis of CDC’s count of higher-than-expected death counts – probably caused by COVID-19 along with the situations it has created – at over 200,000 from March 15 through July 25 versus the official count of 161,000. This is a good full-impact number that would include the pandemic’s effect on stress, failure to seek medical care for other conditions, financial challenges, and failure to correctly account for deaths. I assume that it this number would also be subject to undercounting given the presumable decrease in deaths by accidents.

The field hospital created at Sacramento’s Sleep Train Arena sees just nine patients in 10 weeks, with $12 million in cost from rent paid to the Sacramento Kings, facility upgrades, and payment to 250 staffers. One traveling nurse company billed $428,000 to provide five pharmacists and five pharmacy technicians. Those involved say there was never a real plan on how to integrate with possibly overburdened hospitals and the state admits that it should have used local data to determine how to set up its 15 field hospitals.

Bill Gates says US COVID-19 tests are “complete garbage” because of delays in getting results, suggesting that paying companies for them only if the results come back in 24-48 hours would “fix it overnight.” He is optimistic overall, however, predicting that diagnostic and therapeutic innovation in the “rich world” will end COVID-19 by the end of 2021, with the rest of the world following a year later. However, he says it will take years to bring the global economy back to the levels of early 2020. He also notes that he would want remdesivir or dexamethasone today if hospitalized for coronavirus, but in 2-3 months the tool chest will expand with other antivirals and antibody therapy.

It’s been a busy COVID-19 week for one Georgia high school:

• The school suspended two students for taking a photo that showed a packed school hallway and sharing it to social media.
• After a national outcry, the school lifted the suspensions.
• Six students and three employees reported to the school that they had tested positive.
• Two brothers who reported experiencing symptoms were found to have gone to school Monday without wearing masks or social distancing, with a family member saying they didn’t realize the severity of the virus and weren’t encouraged to wear masks.
• The school moved to distance learning only for Monday and Tuesday while awaiting the results of contact tracing. They have told parents that they will notified Tuesday evening whether in-person instruction will resume.

Other

Epic changes its Monday mandatory return to campus, allowing employees who feel that their personal situation makes it unwise for them to return safely to campus to continue to work from home while Epic awaits further guidance from the county health department. Epic says Cleveland Clinic, a public health expert, and an epidemiologist are reviewing Epic’s plan, which originally called for bringing the first group of employees back to their offices on Monday and all employees working on campus by the end of September except for those at high risk, who could request an extension through November 2.

China’s Communist Party newspaper warns readers to “beware of health-tech firms’ snake oil,” which is pretty good advice. Its points, as written by a health policy lecturer in the London School of Economics:

• Big US tech companies have promised that analytics and AI will reduce costs and improve outcomes, but individual patient data is subject to subjective clinical judgment and is often plagued with missing records and lack of standardization.
• Those big US tech companies don’t know much about healthcare, and they rarely back up their black box algorithms with studies that prove their value.
• Predictive models are only as good as the data they are given, and since their assumptions are based on what is already know, they are best at reviewing the past and present rather than predicting the future.
• AI developers are, intentionally or not, just as biased as the rest of us, and using current healthcare data makes those systems prone to replicating past failures and successes.
• Hospitals and regulators shouldn’t just turn over patient data to developers – they should be actively involved in the design and deployment process.

Sponsor Updates

• The Dealmakers Podcast features PatientPing co-founder and CEO Jay Desai.
• Pure Storage’s Pure Good Foundation celebrates its fifth anniversary and announces that it has raised $2.3 million for charitable contributions.
• The Voice First Health Podcast features Gabe Charbonneau, MD and his use of the Saykara AI Assistant.

Blog Posts

• Addressing key questions and misperceptions of the 2021 E/M changes (Nordic)
• How to Beat the Prescription Drug Discount Card Game (OmniSys)
• Purpose Born of Frustration (OptimizeRx)
• From High Touch to High Tech: 5 Key Factors That Will Drive the Trajectory of Telehealth (Pivot Point Consulting)
• Better, Stronger, Faster: Leveraging the Amazon Cloud to Scale to the Demands of Telehealth (PMD)
• Five Reasons Health Systems are Prioritizing Integration with Specialists (Premier)
• (Re) Introducing Single-Sign On (SSO) (Redox)
• Why Remote Work is Not the New Normal (SailPoint)
• How healthcare prepares for cloud computing (Spok)
• Krames on FHIR: Blazing a trail in personalized patient education (StayWell)
• CMS Price Transparency Rule is Fast Approaching (Surescripts)
• Marketers, Clinicians, and Care Managers in the Patient 360 Ecosystem (SymphonyRM)
• Tufts Medical Center Elevates Human Experience in the Midst of the Pandemic (Vocera)
• How Advertising on LinkedIn Can Help Drive Patients to Your Physical Therapy Clinic (WebPT

Contacts

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

Weekender 8/7/20

Weekly News Recap

• Private equity firm Blackstone acquires 75% of Ancestry for $4.7 billion, which includes the DNA information of 18 million people.
• Teladoc reaches an agreement to acquire Livongo for $18.5 billion, digital health’s biggest deal ever.
• Epic announces plans to return employees to campus by September 21.
• Siemens Healthineers will acquire oncology technology vendor Varian Medical Systems, which includes several software products, for $16.4 billion.
• Virginia will become the first state to use the Covidwise exposure notification app from Apple and Google.
• CDC Director Robert Redfield, MD tells a House coronavirus committee that CDC was not involved in HHS’s decision to replace its COVID-19 hospitalization data system to a contractor-developed HHS system.
• Allscripts notes in its earnings call that the US Department of State’s 450 clinicians will use its TouchWorks and FollowMyHealth systems in its role as a subcontractor.

Best Reader Comments

[On Epic’s mandatory return to campus] Most egregious, for a company that beat into me from day 1 that I must make clear recommendations supported by data, they have no data. They released multiple products during the pandemic while working from home. Support ticket closure rates are up 10% in some applications. They have no metric for productivity, but are willing to die on the hill of “magical, spontaneous hallway conversations.” They’ve failed to create a culture that can exist outside of their physical workspaces; I was part of the very first inter-office chat pilot at Epic – Skype in 2017 – and had to fight tooth-and-nail for its roll-out. Even during non-pandemic times, I primarily called into my on-campus meetings because getting there would’ve taken 15 minutes. This is an abject failure of leadership from Judy, Carl, and the rest of the executive team. (Ex-Epic)

Bill Gates used to say that early on in the life of Microsoft, he used to eyeball how many cars were in the parking lot when he left (which often used to be late in the evening/night) to get a sense of how hard his people were working. He later admitted that it was a rather naive and inaccurate way of measuring productivity. And that was 40 odd years ago! Well, Bill G and Microsoft grew up! Seems like Judy and Epic haven’t. (Ghost_Of_Andromeda)

[On Teladoc’s acquisition of Livongo] Mr. Tullman and Mr. Shapiro poised to cash out (again). As has been proven with Allscripts and now here, it’s easier to raise money for a startup than it is to actually run a company. (It’s All Good)

[On Teladoc’s acquisition of Livongo] No quarterly profit ever and an 18.5 billion price tag… Is there that much waste reduction in the US healthcare non-system to account for such strange valuation? (Eddie T. Head)

Siemens acquires Varian. Ggreat news for Varian shareholders. Sad to see another technology company move to non-US ownership. Will be interesting to see how things shake out when Siemens decides to “integrate” the business. (Robowriter)

Watercooler Talk Tidbits

Readers funded the Donor’s Choose teacher grant request of Ms. S in Philadelphia, who asked for carpet and bean bag chairs to create a reading center for her after-school kindergarten program. She reported in February, “When my students first saw the new rug and bean bags in the library area, they asked me, how did we get that in our class? Can we keep it? I answered them how Donors Choose helped us get a funder to donate what we needed. They were surprised that a stranger gave us money . They were super excited and wanted to lay down on the rug to read. We follow D.E.A.R. (drop everything and read) in our schedule. With the new cozy area, the students are more interested in literature. The students enjoy sitting in bean bags, or laying down on the rug to read. They go and pick a book of their choice and start reading enthusiastically. We also use the rug to play different games, practice the numbers and the alphabet. Sometimes, the students just lay down on the carpet to relax. When they are having a bad day, they sit in bean bags and distract their mind. It helps students to calm them down and rejoin the class group when ready. Having a cozy and safe library area has been a life-changing experience for them.”

Maria Fareri Children’s Hospital (NY) designates eight-year-old Jorden Hutchins as an ambassador to the hospital after he survives a COVID-19 infection with Multi-System Inflammatory Syndrome in Children, which involved being placed on a heart-lung machine, undergoing heart surgery, and having multiple strokes and kidney failure.

Here’s a tech tip I learned for editing a web address or any other text on the IPhone or IPad. Hold down the on-screen keyboard’s space bar until it turns gray, which turns the keyboard into a trackpad for precise cursor positioning.

A furloughed urology nurse in Virginia sews cloth masks and 3D-prints 800 face shields for local teachers.

Volunteers for the non-profit Telehealth Access for Seniors are providing devices, instructions, and free tech support to seniors and low-income communities to support telehealth and digital connectivity with family and friends. Lia Rubel from Vermont (above) has collected 50 devices and raised $800 to help with the mental health of self-quarantined seniors. The organization overall has collected 1,500 used devices, $63,000 in donations, and has 315 volunteers in 26 states. The organization seeks IPhone 4 and above and second-generation or newer IPads, for which it provides data erasing instructions. Their GoFundMe has raised $29,000 so far. The founders are Yale undergrads Aakshi Agarwal, Hanna Verma, and Siddharth Jain along with high school junior Arjun Verma. Agarwal is double-majoring in molecular biology and political science, hoping to purse a law degree and then work in healthcare policy. She also co-founded a college admissions consulting service.

A nurse in an explosion-damaged hospital in Beirut runs to the NICU with a colleague to remove five newborns, captured by a press photographer who said that among the rubble and bodies, “The nurse looked like she possessed a hidden force that gave her self-control and the ability to save those children.”

In Case You Missed It

• News 8/7/20
• EPtalk by Dr. Jayne 8/6/20
• Teladoc To Acquire Livongo for $18.5 Billion
• News 8/5/20
• Curbside Consult with Dr. Jayne 8/3/20
• Readers Write: Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond
• Readers Write: CMS’s E-Notifications Condition of Participation: Three Topics to Know
• HIStalk Interviews Jay Deady, CEO, Jvion
• Monday Morning Update 8/3/20

Get Involved

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

Morning Headlines 8/7/20

Blackstone to buy Ancestry for $4.7bn

Blackstone will acquire a 75% stake in Ancestry for $4.7 billion, giving the private equity firm access to the company’s DNA information on 18 million people.

On-demand mental health service provider Ginger raises $50 million

Virtual therapy and psychiatry startup Ginger raises $50 million, which it will use to further market its services to public and private payers.

Cerner and Xealth Collaboration Helps Patients be More Active Participants in Health Care, Well-being

Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs.

VA pushes on with troubled health data transformation

Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October.

Infermedica raises $10.25M in Series A funding

AI-powered diagnostics startup Infermedica raises $10.25 million in a Series A funding round led by EBRD and Heal Capital.

News 8/7/20

Top News

Blackstone will acquire a 75% stake in Ancestry for $4.7 billion, giving the private equity firm access to the company’s DNA information on 18 million people.

The genealogy company, which launched a consumer DNA testing service last year that it has expanded to include genetic health risks and insights, reports annual revenue of over $1 billion.

Ancestry was valued at $3 billion in 2017 and considered running an IPO twice since then, but faced slumping sales as both it and competitor 23andMe laid off employees. 23andMe has sold the genetic data of its customers to drug companies for clinical studies, an area in which Ancestry lags.

Reader Comments

From Bug Frowner: “Re: Epic’s return to work requirement. Ignores its county’s public health order.” Dane County, Wisconsin’s July 7 emergency order says business “should, to the greatest extent possible” facilitate remote work to minimize in-office presence. Epic is therefore not specifically breaking any law that I can see since the wording is more of a recommendation. I would struggle to return to campus work as an Epic employee if I were high risk and otherwise fastidiously isolating, but we all know that bosses make the rules and our choices are to comply or leave. Media coverage has, as it often does, lapsed into the sensationalistic in portraying the complaints of a tiny percentage of Epic employees as a topic for heated debate into which Internet cheap-seaters feel the need to insert themselves. More interesting to me is that Epic says that only 24 of its employees have tested positive, which seems like a tiny number out of 9,000+ mostly young employees, but I assume they haven’t yet mass tested the folks who will be returning to campus. Judy Faulkner has said the company is working on immunity passport capabilities for its EHR, so maybe they’ll run employee antibody testing even though that has limited value outside of healthcare provider organizations given relatively low overall infection rates.

From Al Lewis: “Re: Livongo’s sale for $18.5 billion. The entire employer community doesn’t even spend $18.7 billion on diabetes-coded admissions. Not even close. Nor have they claimed to reduce that one item, the item that should concern employees the most. And they never explained why they want everyone to test multiple times a day when Choosing Wisely says most Type 2 diabetics are more likely to harm themselves than benefit through overtesting. Meanwhile, as I will be posting in a few hours, the price of insulin is skyrocketing thanks to greedy PBMs and employers aren’t doing a thing about it.” I interviewed Al Lewis, who I titled “workplace wellness skeptic,” a few months ago and asked him for reaction to the acquisition news.

From Donor Here: “Re: matching Donors Choose funds from Tyson Foods and your Anonymous Vendor Executive. Is that still available?” Donors Choose still lists 24 unfunded projects for which Tyson Foods is matching donations 10-to-1 and I still have ample matching funds available from my Anonymous Vendor Executive. Many other projects offer 2x or 3x matching from companies and organizations, which is still a lot of bang for the buck. I just received an email today from middle school science teacher Ms. W in Washington, for which our $32 donation (which was then matched 10 to 1) bought distance learning tools (microphone, graphics tablet, lighting, and a camera mount) as well as a 15% optional donation to fund the work of Donors Choose.  She told me this morning that her school just announced 100% distance learning to start and she will immediately use the new technology to retool her her hands-on science classes for home learning. Donation instructions:

1. Purchase a gift card in the amount you’d like to donate.
2. Send the gift card by the email option to mr_histalk@histalk.com (that’s my Donors Choose account).
3. I’ll be notified of your donation and you can print your own receipt from Donors Choose for tax purposes.
4. I’ll pool the money, apply all matching funds I can get, and publicly report here which projects I funded, including teacher follow-up messages and photos.

From Live Longo Glen Tullman: “Re: Teladoc acquring Livongo. Paid too much, in a hurry to cash in some of its own overpriced shares.” My thoughts on the deal:

• This is the third-largest acquisition of a US company this year. Teladoc will give $0.592 of its shares plus $11 in cash ($159 per share) to buy Livongo.
• I don’t get the synergy, other than that both companies have to keep employers and insurers subscribing for services their constituents may not use and that may provide minimal benefit.
• The implicit market value of the combined money-losing companies is an eye-popping $37 billion, nearly double that of Cerner.
• TDOC’s market cap is $16.5 billion, nearly quadruple that of a year ago, on just $716 million in annual revenue. LVGO’s market cap is $1.5 billion, eight times that of September 30, 2019 on $207 million in revenue (selling price is 90 times revenue).
• Shares of both companies regained some of their losses Thursday after dropping hard after Wednesday’s announcement.
• LVGO’s Q2 earnings report from Wednesday went mostly unnoticed in the acquisition news, but the company had a good quarter, with revenue up 125%, adjusted EPS $0.11, beating expectations for both.
• Livongo’s executives will pocket fortunes from the acquisition just 12 months after its IPO. Lee Shapiro’s shares are worth around $860 million, Glen Tullman’s around $700 million, and Zane Burke (who joined as CEO just 19 months ago) holds shares worth around $160 million.
• I’m skeptical in general about early-stage companies that sell services through employers and insurers with unproven promises about saving them money, so I’ll simply say (a) good job Livongo for convincing Teladoc of predicted synergies, and (b) good job Teladoc for riding the likely temporary share price bump even as virtual visits slack off and health systems launch their own competing offerings to diversify. I don’t see the value for shareholders, patients, or the healthcare system in general, but then again I’m not a centimillionaire stuffing wads of investor cash down my pants. 

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Nuance announces Q3 results: revenue down 10%, adjusted EPS $0.19 versus $0.20, beating analyst expectations for both. The company said in the earnings call that it has signed pilot agreements for its Dragon Ambient Experience with WellSpan, Boston Children’s, Children’s Atlanta, and Lehigh Valley.

CVS Health beats analyst expectations for Q2, reporting a 3% increase in revenue and adjusted EPS of $2.64 vs. $1.93. Utilization of telemedicine services through its Aetna network and MinuteClinics jumped over 700% during the quarter as patients stayed away from in-person office visits.

Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs.

Digital point-of-care prescription savings vendor OptimizeRx reports Q2 results: revenue up 25%, and adjusted EPS of $0.02 versus $0.09, beating analyst expectations for both.

CPSI announces Q2 results: revenue down 10%, EPS $0.12 versus $0.12, beating analyst expectations for earnings but falling short on revenue.

Signify Research says the crown jewel that Siemens Healthineers gets in its $16.4 billion cash acquisition of Varian Medical is the latter’s oncology software business, which has $600 million in annual revenue with an 18% year-over-year-growth. The report notes that oncology is positioned at the convergence of EHR, lab, radiology, and surgery systems and the need to collaborate for diagnosis and treatment creates complicated workflows. Elekta is Varian’s chief competitor in that area. Siemens Healthineers is focused on three digital areas — imaging AI, advanced imaging hardware, and lab diagnostics. Siemens Healthineers, spun  off from Siemens AG (which still owns 85% of its shares), is among a small group of medical technologies that have more than $20 billion in annual revenue, possibly coming in at #3 behind Medtronic and Johnson and Johnson.

Sales

• Michigan Medicine selects Mach7’s enterprise imaging technology. 
• CPSI selects cloud services from Google Cloud.
• The Iowa Health Information Network selects PDMP connectivity, analytics, risk assessment, and patient support technology from Appriss Health.

People

LexisNexis Risk Solutions promotes Josh Schoeller to CEO of its healthcare business.

Industry long-timer Andrew Eckert (Acelity) joins medical claims company Zelis as CEO. Eckert has held leadership positions at Eclipsys, TriZetto, and Valence Health.

Justin Manning (Nordic) joins Evergreen Healthcare Partners as principal consultant and VP of medical device and data integration.

Announcements and Implementations

UHIN adopts NextGate’s enterprise master patient index across its HIE network in Utah.

Redox announces GA of Data on Demand, giving developers the ability to query any EHR or health data sources via the company’s API.

AHRQ publishes an electronic patient-reported outcomes toolkit.

Government and Politics

Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October. The conversion from VistA to Cerner was halted earlier this year as VA facilities focused on preparing for and treating COVID-19 patients. The VA has switched its go-live plans from facilities in bigger metropolitan areas to those in smaller cities in the Pacific Northwest and Midwest, citing a lack of access during the pandemic to clinical experts who had been expected to help with system customizations for the larger facilities.

Politico also reports that two senators have introduced legislation that would make the post office’s address matching software available to EHRs via API for patient identification and matching.

COVID-19

An Ohio Department of Health contact tracing graphic shows how one infected church service attendee spread the virus to at least 91 people in five counties in less than three weeks. The graphic was tweeted by Ohio Governor Mike DeWine, who announced Thursday that he has tested positive for COVID-19 as part of the screening for his now-cancelled Thursday greeting of President Trump in Cleveland.

Virginia launches the Covidwise app, becoming the first state to launch an exposure notification app using technology from Apple and Google. The app notifies users if they come into contact with other users who’ve tested positive for COVID-19. Some public health experts have questioned the effectiveness of such apps, citing low and thus ineffective adoption rates, privacy concerns, false alarms, and a lack of nearby testing capacity.

University of Miami Health System launches a remote patient monitoring program for discharged COVID-19 patients using TytoCare home health devices.

The Harvard Global Health Institute and Google Cloud develop COVID-19 Public Forecasts, a free planning resource that offers healthcare workers 14-day projections of cases, hospitalizations, and deaths by county and state.

An MRI review of 100 recovered COVID-19 patients who had no pre-existing cardiac conditions — most of them who had experienced only minor COVID-19 symptoms and recovered at home — finds that 78% have cardiac involvement and 60% have ongoing myocardial inflammation. The authors conclude that cardiac involvement is unrelated to COVID-19 severity and warn that undetected inflammatory disease may present a large health burden in people who think they got over COVID-19 without incident.

The National Institutes of Health forms the Medical Imaging and Data Resource Center, which will use AI and machine learning to develop new diagnostic tools clinicians can use to better care for COVID-19 patients.

The New York Times explains how the US uniquely failed to control COVID-19:

• A tradition of prioritizing individualism over government restrictions, which has also saddled the country with a world-lagging and unequal healthcare system.
• Lack of effective travel restrictions in excluding from the ban the family members of American citizens and permanent residents returning from infection-ravaged areas, failing to address the infection’s spread to Europe promptly, exempting the UK from travel limitations, and failing to create a quarantine process.
• Lack of state travel restriction enforcement.
• Testing delays caused by the CDC’s distribution of faulty tests that it insisted be used over tests that were developed in other countries.
• Commercial labs charging patients for COVID-19 testing, which discouraged their use.
• Conflicting public mask advice from WHO and CDC, some of that based on the need to prioritize the limited supply of them for healthcare workers, and allowing masks to be turned into a political symbol with partisanship as its most accurate predictor.
• The push by federal and state governments to reopen the economy with the virus still uncontrolled, which caused outbreaks afterward and provided only a brief recovery as personal fear and unemployment caused people to limit spending anyway.
• Mixed and confusing messages from political leaders and partisan news media, including distributing medical misinformation and expressing unwarranted optimism.

Other

HIMSS hires a second Australian Digital Health Agency executive as CIO Ronan O’Connor joins former CEO Tim Kelsey. O’Connor’s new role was not specified, but Kelsey became SVP of HIMSS Analytics International in January 2020.

HIMSS will continue to publish the mobile health app best-practices guidelines of Xcertia, a now-dissolved project of HIMSS, the American Medical Association, the American Health Association, and DHX Group. The Xcertia standards body was formed in December 2016, last updated its guidelines in February 2019, and then went silent shortly afterward. The organizations haven’t announced why they pulled the plug. The three principals of non-profit app curation organization DHX Group seem to have moved on to other projects.

The local paper says that at least 13 Epic employees claim that the company has demoted team leads who expressed concern about its plan to bring employees back to campus, which Epic denies.

European Union authorities will investigate Google’s acquisition of Fitbit, worried that Google will target ads based on the user fitness data that Fitbit collects. Google says it has no such plans and has offered to sign a contract that limits its use of the data. A consumer group concludes, “It is hugely important that the E.U. carries out this in-depth examination because wearable devices like Fitbit’s could in future give companies details of essentially everything consumers do 24/7.”

Sponsor Updates

• InterSystems launches T2020, the latest version of its TrakCare EHR, which includes COVID-19 functionality, an enhanced user experience, and a unified workspace for patient records and documentation.  
• Cloud Computing Outlook names Goliath Technologies a Top Virtualization Solutions Provider.
• HCI Group Chief Digital Officer Ed Marx publishes a new book, “Healthcare Digital Transformation: How Consumerism, Technology, and Pandemic are Accelerating the Future.”
• Spok announces that all 20 adult hospitals and all 10 children’s hospitals named to US News & World Report’s 2020-21 Best Hospitals Honor Roll use Spok clinical communication solutions.
• Saykara’s voice-enabled mobile AI assistant  is named as a healthcare innovation awards finalist.

Blog Posts

• Fear: Circling the Wagon vs. Innovating (Access)
• A Diabetes Educator’s Guide to EGlycemic Management Software (Glytec)
• Halo Health Top Performer in KLAS Clinical Communications Report (Halo Health)
• Steps for Effective Patient and Staff Contact Tracing to Defend Against COVID-19 Spread (Health Catalyst)
• Health Payer Priorities in Face of Ongoing Pandemic (Imat Solutions)
• COVID-19: What we know and where we’re headed (Intelligent Medical Objects)
• No time for guessing games: Three things payers need to consider if they are to survive the impacts of deferred care (Jvion)
• How Hospitals Can Thrive in the Midst of Constant Change (LiveProcess)
• Healthcare’s COVID-19 Response is a Window to the Industry’s Future (Loyale Healthcare)
• 2021 Medicare Proposed Rule Released for Physical Therapy (MWTherapy)
• Patient Matching in the Era of COVID-19: Maintaining Control Over Patient Privacy and Data Governance (NextGate)

Contacts

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

EPtalk by Dr. Jayne 8/6/20

CMS continues to forge ahead as if providers have nothing else going on, releasing final scores for the 2019 Merit-based Incentive Payment System (MIPS) program. Every time I see one of these announcements, I’m again grateful that my practice decided to opt out and take the associated penalties. It’s worth seeing an extra patient here or there to cover any losses so we can focus on care delivery and not clicking boxes.

Other hot federal topics include a Medicare proposal to expand telehealth benefits permanently. I’ve seen what a benefit it can be for patients who don’t want to risk going to a physician office, but I’d like to see more practices offering it as a routine part of their care rather than patients having to go to third-party vendors for care.

A good chunk of what I do in the telehealth arena should ideally be managed by either the primary care provider or a subspecialist managing a particular condition, but our healthcare system continues to be broken in even basic ways. Several recent calls were around medication refills, not only for patients unable to make appointments with their regular physicians, but to even get a response to a refill request for a medication. When you hear some of the stories, you wonder if they’re made up, but based on the recent runaround I’ve had with my own family’s physicians, I have no reason to doubt the stories patients tell.

They also released the 2021 Proposed Rule for the Quality Payment Program via the Medicare Physician Fee Schedule Notice of Proposed Rulemaking. They did at least note that “in recognition of the 2019 Coronavirus (COVID-19) public health emergency and limited capacity of healthcare providers to review and provide comment on extensive proposals, CMS has limited annual rulemaking require by statute to focus primarily on essential policies including Medicare payment to providers, as well as proposals that reduce burden and may help providers in the COVID-19 response.” Although that’s small comfort to the people who have to wade through the original content of any proposed rule, at least they’re recognizing that most of us have other things on our minds. For those of you still in the game, comments are due by October 5 at 5 p.m. ET.

Props to Google Cloud for their “oops, that didn’t go so well” email after a bulk mail failure. It’s always good to tackle errors with a sense of humor, and I appreciate the acknowledgement rather than just getting another email. I also appreciated that their email linked directly to case studies about their products rather than forcing me to give my contact information to download an e-book or other fluff piece.

I’ve heard a lot of talk lately about EHR vendors that plan to use “AI” to help with physician documentation. In reading between the lines of some of these articles and ad pieces, the devil is truly in the details. One client was bragging about his vendor’s plans to add AI to their application and I was glad I was on a voice-only call because I’m sure I wouldn’t have been able to contain my facial expression. You have to have a reasonably robust backbone to add AI to an application, and this particular vendor is far from it. Their EHR is about two steps away from being a Microsoft Word document, and I can’t fathom how they think they’re going to “AI enable” that unless they’re just adding voice recognition and putting a lot of lipstick on it.

I think there is a tremendous amount of promise for AI-enabled documentation technologies, but to be as effective as a live scribe, they also have to be able to handle questions on information recall and analysis. I’m constantly asking my scribes to provide information from previous visits or to see if there are patterns with interactions. There are certainly technologies that can provide these functions as well and I’d love to see them be able to handle mainstream primary care and urgent care encounters like I see day-in and day-out. So far the only ones I’ve seen that are able to do a decent job are only able to do so in the subspecialty realm.

Low tech, but literally cool: Shipping giant UPS is readying freezer farms in preparation for the eventual shipping of vaccines against the novel coronavirus. Each unit can store up to 48,000 vials of medication, with a total of 600 units being placed at facilities in Kentucky and the Netherlands. I’ve only been on the receiving end of vaccination shipping and know what a major logistic undertaking it is for flu season, so I can’t imagine what it might look like when people are clamoring for the vaccine across the globe. (I am betting that for the 60% of US residents that say they won’t get it, there will be plenty of takers in the rest of the world.)

Since we don’t know what COVID will look like when flu season hits, many clinical organizations are already ramping up their plans for vaccination campaigns. There is plenty of good technology out there for the patient outreach piece and getting those patients who typically receive a flu vaccine should be easy. It’s also easy to identify the patients who have high-risk conditions and alert them to the benefits of the vaccine.

What’s not easy, however, is ensuring that practices have enough personal protective equipment for their staff members, which is still a struggle in many practices. Despite the availability of testing supplies in my community, many primary care offices are choosing not to test because of concerns about PPE, which sends patients to urgent cares, other health systems, or the CVS Pharmacy drive through. Fragmentation of care is still the order of the day for many patients, and until we get a national coordinated strategy, I imagine it will continue to be this way.

In the meantime, I’ll keep helping my clients ready their campaigns, prepare their word tracks for patients who are reluctant to vaccinate, and look at creative ways to leverage their technology assets to maximize scheduling and vaccine delivery. Just another day in the clinical informatics trenches.

How is your organization preparing for flu season? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/6/20

Teladoc Health reaches agreement to buy Livongo in a $18.5 billion deal

Virtual care provider Teladoc Health will acquire chronic condition management app vendor Livongo in a deal that values the company at $18.5 billion.

CVS Health raises forecast for year as it adapts to changing health-care habits

CVS Health beats analyst expectations for Q2, reporting $65.3 billion in revenue and adjusted EPS of $2.64 vs. $1.93.

Virginia First State To Try Pandemic App From Apple, Google

Virginia launches the Covidwise app, becoming the first state to launch an exposure notification app using technology from Apple and Google.

OptimizeRx Reports Second Quarter 2020 Revenue Up 25% to a Record $8.8 Million; First Half Revenue up 34% to Record $16.4 Million, with Accelerated Growth Expected in Second Half

Digital point-of-care prescription savings vendor OptimizeRx reports Q2 results: revenue up 25%, and adjusted EPS of $0.02, beating analyst expectations for both.

Teladoc To Acquire Livongo for $18.5 Billion

Virtual care provider Teladoc Health will acquire chronic condition management app vendor Livongo in a deal that values the company $18.5 billion, the companies announced this morning.

The announcement characterized the transaction as a merger, but the deal is structured as an acquisition. The combined companies will operate under the Teladoc name, Teladoc CEO Jason Gorevic will continue in that role, and Teladoc’s board chair will also remain in that role.

The share price of both companies dropped sharply midday Wednesday following the announcement. Both have seen their shares run up by multiples so far in 2020.

The companies expect their combined revenue to reach $1.3 billion in 2020. Teladoc just reported Q2 revenue of $241 million, up 85% as virtual visits increased by 203%.

Neither company has ever booked a quarterly profit. Teladoc went public in 2015, Livongo in 2019.

Morning Headlines 8/5/20

Centauri Health Solutions Adds New Analytics Capabilities with Acquisition of AppRev

Medicare and Medicaid reimbursement services vendor Centauri Health Solutions acquires Applied Revenue Analytics, which offers business intelligence solutions.

Epic Systems to require 9,100 employees to return to work at its Verona campus on Sept. 21

Epic pushes back plans to have all of its employees return to on-campus work by August, shifting to a deadline of September 21.

CPSI Announces Second Quarter 2020 Results

CPSI announces Q2 results, missing on its revenue of nearly $60 million but beating analyst expectations for earnings.

Rush and R1 Launch Innovation Lab to Drive Industry-Leading Quality and Patient Experience

Rush University System for Health (IL) and R1 RCM launch an Innovation Lab that will develop and commercialize analytics and solutions for value-based care.

News 8/5/20

Top News

Siemens Healthineers will acquire radiation oncology technology vendor Varian Medical Systems for $16.4 billion.

Varian’s software offerings include treatment planning, treatment delivery, QA, image sharing, patient-reported outcomes, and the Aria oncology information system.

Reader Comments

From Spoofer: “Re: LinkedIn. It’s turning into Facebook now that Microsoft owns it.” I steer clear of LinkedIn except when looking up someone’s title or job history for the “People” section, but I have noticed that is becoming a home for folks (many of them salespeople) who believe themselves to be inspirational or instructional. It’s also drawing in users who litter it Facebook-like with personal musings, political commentary, and of course endless pitches for their employer or themselves.

HIStalk Announcements and Requests

Tyson Foods offered a $10 match for each $1 donated for specific Donors Choose projects, so I put my Anonymous Vendor Executive’s money to work in fully paying for these requests, most of which involve the rapid transition to remote learning. Donors Choose also sent me a note observing that this is the eighth consecutive year that HIStalk readers have supported classrooms, funding 631 projects that have impacted more than 50,000 students. I’ve already heard from several of these teachers:

• A camcorder for virtual learning and an air purifier for Coach H’s high school class in Sebastopol, MS.
• Online materials and lessons for Ms. D’s middle school class in Fort Smith, AR.
• A GoPro camera for virtual physical education and dance classes for Coach K’s elementary school class in Fort Smith, AR.
• Five Amazon Fire tablets and cases to replace the book corner activity that was cancelled because of COVID for the elementary school class of Ms. C in Nebo, KY.
• Two Chromebooks for Ms. P’s elementary school class in Forest, MS.
• Two Chromebooks for Ms. W’s elementary school class in Forest, MS.
• Classroom library supplies, organizers, clipboards, pads, pencils, cushions, earbuds, and file folders (which are no longer allowed to be shared) for the elementary school class of Ms. B in Omaha, NE, who is a second-year teacher.
• 30 headphones for Ms. S’s elementary school class in Vicksbug, MS.
• Bean bag chairs, dry erase boards, pencils, gloves, Play-Doh, balance balls,fidget toys, lanyards, pillows, charts, learning resources, and a long list of supplies for the elementary school class of Ms. R in Omaha, NE, who is a first-year teacher.
• 60 social emotional learning lesson books for Ms. S in Madisonville, KY, who is an elementary school counselor.
• An IPad, tripod, and tablet mount for the elementary school class of Ms. C in Lake, MS, who will create an online library of instructional videos for absent students or if the school closes due to COVID.
• A yearbook camera and all supplies for Mr. G’s middle school yearbook club of gifted and talented students in Madisonville, KY.
• Two IPads and a webcam to teach virtual learners at Ms. G’s elementary school class in Forest, MS.
• Supplies for at-home learners of Ms. D’s second grade class in Portland, ME.
• Math materials for Ms. P’s elementary school class in Sterling Heights, MI.
• 30 sets of headphones and 20 water bottles to allow Ms. J’s first grade school class in Chicago, IL to practice healthy behaviors.
• Digital and online learning resources for Mr. V’s high school class in Lake, MS.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Medicare and Medicaid reimbursement services vendor Centauri Health Solutions acquires Applied Revenue Analytics, which offers business intelligence solutions.

Sales

• The US Department of State medical health units will implement Allscripts TouchWorks and FollowMyHeath, with the company serving as a subcontractor to MicroHealth. MicroHealth co-founder and CEO Frank Tucker served as a physician assistant, platoon leader, preventive medicine officer, and healthcare administrator for the US Army, CTO for Tricare, deputy CIO for the US Army Office of the Surgeon General, and an adjunct professor for several universities including the bioinformatics program of the Uniformed Services University of the Health Sciences. He has earned three master’s degrees (including in Physician Assistant Studies) and a doctorate of health science. The State Department chose the company for a $250 million project to manage the PHI of overseas government employees in 2019.

People

Brown & Toland Physicians (CA) hires Anne Barr, MBA (Counterpoint Advisors Network) as CIO.

Tom Foley (Cerner) joins AMD Global Medicine as VP of growth.

Ellkay hires Marc Probst, MBA (Intermountain Healthcare) as CIO.

Leidos promotes Liz Porter, MBA to president of its health group.

Amwell hires Serkan Kutan (Haven) as CTO.

Raymie McFarland (Glytec) joins glycemic management software vendor Monarch Medical Technologies as president and CEO.

Announcements and Implementations

Surescripts announces two new network capabilities for specialty pharmacies, a Medications Gateway that gathers information from the patient’s EHR and electronic prior authorization.

PerfectServe announces GA of Patient and Family Communication, which delivers health updates to patients and caregivers; provides a virtual room with appointment reminders and mobile check-in; supports video visits; and provides a patient inreach module for responding to on-call patient needs with direct messaging and video. Development of the system was driven by customer feedback during COVID-19.

Vyne renames its dental practice data exchange systems that were formerly sold under the NEA nameplate (claims processing, electronic claims attachments, and encrypted email) as Vyne Dental.

Imprivata publishes a digital identity framework that offers health systems advice on creating an identity and access management strategy.

Black Book surveys find that lack of interoperability has detracted from COVID-19 care and that progress has stalled, partly due to CMS’s delayed enforcement of rules. Nearly all respondents say COVID-19 clinicians don’t get complete patient records and most say manual processes fall short in submitting pandemic information to public health agencies. Another survey of 324 COVID-diagnosed patients finds none of them had their full patient record available electronically when seen by their COVID treatment provider.

Canada’s Health Sciences North goes live on Agfa enterprise imaging at 15 sites.

North Carolina’s state HIE NC, HealthConnex, goes live on real-time event notification built on Audacious Inquiry’s Encounter Notification Service.

COVID-19

CDC Director Robert Redfield, MD tells a House coronavirus committee that CDC wasn’t involved in HHS’s decision to move COVID-19 hospitalization data from the CDC’s system to HHS Protect. He says he was told only after the decision was made and did not discuss it with Vice-President Pence or HHS Secretary Azar. Redfield says it was the right decision since the driving factor was the need to track remdesivir supplies.

“CBS This Morning” runs a news item about Epic employees who are worried about the company’s return to campus. CBS News obtained an Epic employee survey in which several hundred respondents (out of Epic’s 9,000+ employees, which CBS labels a “backlash”) expressed concerns. Epic sent an employee email Monday night saying it will bring in national experts to review its plan, also noting that 24 employees have tested positive for COVID-19, with none of those cases being attributed  to Epic. Epic will require its Wisconsin employees to return to campus on September 21.

Ellen MacKenzie, PhD, dean of the Johns Hopkins Bloomberg School of Public Health, says that COVID-19 is providing a lesson to “invest in public health or else” in failing to be prepared for the next crisis, concluding, “We cannot let the legacy of a public health crisis be the devaluing of public health itself.”

President Trump says that it is unreasonable to compare the US’s COVID-19 death rate per population to that of other countries with lower numbers, saying, “You have to go by the cases … we’re first, the best … you’re not reporting it correctly … because we do more tests, we have more cases … death is way down from where it was.” He concluded, “They are dying, that’s true. And it is what it is. But that doesn’t mean we aren’t doing everything we can. It’s under control, as much as you can control it.”

New York City’s health commissioner Oxiris Barbot, MD resigns, saying Mayor Bill de Blasio has underused the department’s disease control expertise. A notable example was his reassignment of contact tracing responsibility to Health + Hospitals. She also created controversy in COVID’s early days by urging residents to visit restaurants and festivals as usual and said in a press conference that masks should be work only by those showing symptoms of infection. NYC Health + Hospitals Chief Population Officer Dave Chokshi, MD, MSc has already been chosen to replace her.

Rutgers University’s football program has 28 COVID-infected players and employees who have tested positive after several players attended an on-campus party. Meanwhile, 18 players and coaches of the Miami Marlins baseball team have tested positive and the team admits that it played a game on July 26 knowing at that time that four players had tested positive. Thirteen players and staff of the St. Louis Cardinals tested positive in the past week.

San Antonio Metro Health removes 619 COVID-19 cases from Sunday’s count after finding duplicate entries as it prepared to switch to a new contact tracing system. The agency says the data it receives from labs, hospitals, and doctors, as well as for people who have been tested in multiple locations, may contain misspellings, dates of birth, or different street abbreviations That can cause the same patient to be reported as multiple cases.

Delays in receiving COVID-19 testing results, caused by basic supply shortages and lack of a national strategy, are hampering the efforts of businesses and schools to reopen to employees and students who test negative. Delays of several days to weeks render the tests pointless.

Other

The New York Times examines whether telemedicine is here to say, raising these points:

• CMS’s coverage will end when the pandemic is no longer a declared public health emergency unless Congress passes legislation making it permanent.
• Insurers haven’t yet committed to paying for telemedicine visits comparably to in-person ones and may view telemedicine as a way to pay less.
• The cost and quality of telemedicine remains unproven for managing chronic conditions.
• Many or most patients prefer or require in-person visits.
• Insurers worry that telemedicine will increase visits without improving patient health, raising costs unnecessarily.
• Telemedicine may provide justification for doctors to bill phone calls that weren’t charged before, such as providing lab results or advising a patient to come in to the office.

A federal judge denies the plaintiff’s request to move a privacy lawsuit against UPMC to state court. UPMC is accused of sharing patient data with third parties for marketing purposes without their consent. The judge says the the lawsuit was correctly sent to federal court because UPMC was participating in HITECH.

In Argentina, an apparent server configuration error exposes the information of 115,000 people who had applied for COVID-19 quarantine exemptions. Researchers found that they could use basic information that had been exposed (ID number, gender, and phone number) to email the “circulation permit” to any email address. The exposed database was almost immediately attacked – but not disabled – by a “Meow bot” that finds and destroys exposed online data, speculated to have been created by a vigilante security expert who was annoyed by administrators who fail to secure online databases.

Sponsor Updates

• Bret Kinsella of Voicebot.ai hosts a podcast with Saykara founder and CEO Harjinder Sandh to talk about the company’s AI assistant for physicians.
• CareSignal and Innovaccer will partner to offer their remote patient monitoring and population health data technologies, respectively.
• ESolutions and Homecare Homebase collaborate to help home health agencies manage CMS Review Choice Demonstration.
• The Voicebot Podcast features Saykara founder and CEO Harjinder Sandhu.
• Surescripts earns Black Book’s #1 ranking in patient data exchange and interoperability.
• Fortified Health Security publishes its “2020 Mid-Year Horizon Report” on the state of cybersecurity in healthcare.
• QliqSoft incorporates Elsevier’s Interactive Patient Education with its Quincy chatbot and Virtual Visit software.

Blog Posts

• Preparing your stakeholders for new information blocking rules (Nordic)
• Hurricane Prep During the COVID-19 Pandemic (Optimum Healthcare IT)
• What is the Role of a Project Manager in EHR Implementation? (314e)
• Where to Find COVID-19 Reimbursement Rates & Billing Change Information (AdvancedMD)
• Better control, a single, intuitive interface and scalable to your needs (Agfa Healthcare)
• Blueleaf Banter: Trends in the Community Connect Space (Bluetree)
• Recapping Our Virtual Care Coordination Summit, “COVID-19 in Detroit” (CarePort)
• ATA Conference Opioid Panel: Three Perspectives, One Goal (CareSignal)
• Care Collaboration: The Key to SNFs Addressing COVID-19 (Collective Medical)
• Service! Nonprofit Offers Help to Industry Peers When They Need It Most (CoverMyMeds)
• Healthcare Technologies Set to Break Out as a Result of Pandemic (Dimensional Insight)
• 3 Steps to Protect Home Care Workers in a COVID-19 Era (Dina)
• Hire the Best! Tips for Finding Office Talent (EClinicalWorks)
• Manual Care Transitions Are Having a Bigger Financial Impact Than You Think (Ensocare)
• CMS Rolls Out Review Choice Demonstration (ESolutions)
• Digital Wayfinding and COVID-19 Response for Hospitals (Everbridge)
• Delivering Primary Care in an Urgent Care Clinic (Experity)

Contacts

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

Morning Headlines 8/4/20

Allscripts Cloud-Based EHR Solution to Support MicroHealth, LLC for Use Within the United States Department of State

MicroHealth will implement EHR and PHR technologies from Allscripts as part of its work to transition the US Department of State’s Health Units to a cloud-based EHR system.

DAS Health Acquires New England IT Company

Health IT and consulting firm DAS Health acquires managed IT and cybersecurity company Technology Seed for an undisclosed sum.

President Donald J. Trump Is Expanding Access to Telehealth Services and Ensuring Continued Access to Healthcare for Rural Americans

President Trump signs an executive order extending telemedicine flexibilities and provisions after the public health emergency ends.

Curbside Consult with Dr. Jayne 8/3/20

I’ve written about business continuity planning previously. It seems like every year it becomes a germane topic as we experience tropical storms, hurricanes, wildfires, and floods across the US and around the world. Throw in a global pandemic that shuts down medical offices and curtails hospital services and you’ve created a situation where continuity planning is an absolute necessity. Did I mention cyberattacks and ransomware? These are a couple of other good reasons to go through a planning exercise if you haven’t done so already.

Business continuity planning is part of the consulting work I do, so I’m no stranger to helping organizations walk through some of the circumstances their practices might encounter. As a CMIO, people expect me to be versed in the IT side of things, and many clients are concerned with the obvious things like EHR outages, power outages, etc. Clients living in coastal areas typically have a decent hurricane / storm plan, but many organizations haven’t thought about the natural disaster aspect. One summer my little corner of the world experienced floods, tornadoes, an earthquake, and locusts, so it was a bit of a sign that we all need to think about these things.

As I’ve worked with clients on this the past couple of years, we’ve spent more time discussing cyberattacks and ransomware, as numerous healthcare organizations have been hit by this. As of the last couple of weeks I have a great new case study for this with Garmin. They were hit by an attack that disabled their services for more than a week. They claim they didn’t lose any client data from their sites, but the reality is that clients lost data because they couldn’t sync their devices with the Garmin services. Understanding the anger in the client community about exercise data from wearables should make physicians think twice about how patients would feel if their actual medical information were lost or held for ransom.

When I go through a business continuity planning exercise with a client, I usually include a discussion of what it would look like if key human resources became unavailable. For example, what would happen if the CEO or COO departed the organization? Do others have signatory or contracting authority, and how would day-to-day operations run? For smaller practices, what is their plan if they lose a key biller or scheduler? Most of the time we’re focused on the operational and financial side of the house, with a brief but general discussion on the clinical side.

The clinical side of business continuity planning certainly came into focus earlier this year with COVID-19, as practices shifted to a telemedicine models and looked for new technologies to be able to safely reopen their patient care operations. I added a couple of different dimensions to my client-facing materials based on those experiences and they’ve been well received by organizations I’ve worked with. Still, I was thinking in more broad strokes about how organizations might be impacted if they can’t see patients and looking at it from a macro level.

Unfortunately, this week I had to think about it from a micro level, as my practice suddenly lost one of our full-time providers. Since I’m just a worker bee at my brick-and-mortar practice, I’ve never been privy to their business continuity planning and didn’t worry about it too much since my clinical work isn’t my main source of support. One would think that in the event of the loss of a provider, they could use the same checklists they might use when a provider quits or retires. It quickly became apparently, however, that they either didn’t have such checklists or were so overwhelmed by grief that they hadn’t worked through the process.

My involvement started when one of the nurse practitioners called me, as the most senior physician working at the time, asking what to do about the fact that the EHR was still putting my late partner’s DEA number on her prescriptions. Pharmacies in our area have an issue with NPs who write controlled substances and often ask for the supervising provider’s information as well, so we’ve added that to our prescriptions. I’m not sure if it’s custom code with our EHR vendor or a feature that they offer, but it’s how we roll. This was three days after his passing, so I can only guess that the other midlevel providers for whom he was the collaborating physician either didn’t write any controlled substances prescriptions in those days or didn’t think about what went out on the script since it hadn’t yet been addressed. In the short term, I supervised the NP for the prescription in question so the patient could be managed, but it made me wonder about the plan.

I also had the unique experience of staffing my late partner’s primary practice location, where our staffers had created a temporary memorial with flowers, photos, candles, and other tokens representing his personality. I’m not sure the organization had thought about how that would impact patients or the staff working at the location, since many patients had questions about the memorial and what had happened that our employees were unprepared to field. I was surprised by one particular patient who hounded me for details. I learned later that she had already posed the same questions to the receptionist and the nurse, but wasn’t deterred by their comments about the situation. Having to constantly respond to questions certainly weighed on the staff throughout the day.

As someone who has led other organizations, part of me wanted to go ahead and raise the question to leadership about the handling of the memorial and potential word tracks for staff, but didn’t want any inquiry to be seen as interfering with our practice’s collective grief. Knowing there are often no good answers to these issues, I opted to say nothing and let the organization figure it out. It felt like a bit of a cop out since usually I’m one to tackle problems head on, but maybe it was part of my own grief reaction. It was hard enough to get through the day with his presence all around us, and after a long day of COVID patients, I was ready to let it go.

It also served to illustrate something I’ve acutely questioned this year, the idea of “who cares for the caregivers?” Most of us are getting burned out and certainly all of us are tired, and the worst part is we know that there is no end in sight. My colleagues who have been in military operations have had the best advice for coping, but I’m concerned that this recent loss will put some of our team over the edge.

I hope sharing this story encourages organizations who may not have thought about these issues to add them to your to-do list, because it’s only a matter of time before a similar loss might impact them. If you haven’t done business continuity planning, you need to do it now. If you’ve already done it, take a moment to look at your plan to see how your organization plans to handle the loss of key staffers and consider how co-workers and the community might be impacted by such a loss. Having a plan and implementing it during stressful times certainly beats feeling like everything is swirling around you.

Email Dr. Jayne.

Readers Write: Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond

Five Strategies to Ensure Cybersecurity During COVID-19 And Beyond
By Patrick Yee

Patrick Yee is chief technology officer of Ensocare of Omaha, NE.

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To quote New Zealand-born novelist and playwright Anthony McCarten, “We’re living in extraordinary times.” To which I’ll personally add, “that call for extraordinary security measures.”

In March, the Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) issued COVID-19 HIPAA waivers to promote data sharing and telehealth, relaxing laws over the good faith use and disclosures of protected health information (PHI). The resulting explosion of COVID-19 demonstrates that providers need fast access to tools that identify, collect, track, and exchange data on the flux of infected patients.

Protecting the privacy and security of patient data is the health IT industry’s fundamental civic duty during a nationwide public health crisis. While a hospital’s core competency has never been and will never be information technology (IT), taking care of patients is.

As providers rightfully focus on saving lives, their IT teams have undergone a massive shift to working from home while tackling first-time coronavirus related challenges and juggling data security maintenance. Compounding the situation are short-staffed medical facilities where IT resources are needed the most.

Here are five strategies to help you protect and secure your organization’s patient data and network from cyber attacks.

Make sure your escalation procedures are sound.

A healthcare worker who spots a questionable issue must be free to report their concern so it can be addressed swiftly. Most every IT department has in place a reporting process, either a formal ticketing system or an on-call employee who accepts phone calls. Once the IT staffer quickly escalates the issue to the appropriate leader or medical professional, the healthcare worker can resume their day job. Whether the issues involve coronavirus or basic security breaches, e.g., an email phishing attack from an unfamiliar source, all team members, even those on the clinical side, should be empowered to bring up potential dangers to the appropriate parties.

Instruct your IT team to be extra diligent investigating unknown emails, links, and websites.

Cyberattacks targeting hospitals, practices, and healthcare organizations are on the rise dramatically, which can be at least partially be attributed to the exploitation of the coronavirus.

Unfortunately, remote workers are also being singled out. A recent McAfee report uncovered a correlation between the increased use of cloud services and collaboration tools during the COVID-19 pandemic, along with an increase in cyberattacks targeting the cloud. External attacks on cloud accounts grew 630% from January to April. Cisco WebEx, Zoom, Microsoft Teams, and Slack saw an increase of up to 600% in usage over the same period.

Healthcare staff members working remotely are more vulnerable and understandably distracted supporting COVID-19 patient care, which could make them easy prey for cybercriminals. The pandemic represents a huge opportunity for bad actors to compromise your systems with things like phishing emails that include faulty links and websites, ransomware attacks, and intrusions on sensitive data. Regularly remind your remote workforce to report suspicious activities by following your organization’s security protocols.

Review your intrusion detection strategy (IDS) or continue to monitor if you already have one.

An IDS is a network security technology that was originally built for detecting vulnerability exploits against a target application or computer. Intrusion prevention systems (IPS) add the ability to block threats in addition to detecting them, and have become the dominant deployment option for IDS technologies. More broadly, think of intrusion protection as personal computer security, but in a format that can look between different servers and flag suspicious activity. You should be reviewing and updating your technology and strategy regularly to ensure that you’ve kept up with all applicable best practices.

Ensure that your remote employees have corporate VPN and two-factor authentication services.

This telework protocol should already be part of your business continuity plan. It should be reviewed and updated periodically to ensure traffic is handled securely.

Home internet networks simply are not as secure as your office network. VPN and two-factor authentication services are recommended for remote connection to support the goal of making remote work as seamless as possible. Be aware that, short of completing mission-critical projects, at-home internet outages will not necessarily cause a security issue. A larger issue is whether the remote worker has the right modem installed to handle many different in-home users.

Encourage employees to use corporate laptops with encrypted hard drives that are not shared with family members.

Keep doing all of the good things you were doing before the pandemic.

Everything in your systems security plan is still valid with some possible changes for critical business continuity that should be maintained and exercised. HIPAA compliance might be relaxed, but security protocols remain doubly important in our current health crisis.

Readers Write: CMS’s E-Notifications Condition of Participation: Three Topics to Know

CMS’s E-Notifications Condition of Participation: Three Topics to Know
By Jay Desai

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

In March 2020, the Centers for Medicare and Medicaid Services (CMS) finalized the new Interoperability and Patient Access Rule, which creates a new Condition of Participation (CoP) that requires hospitals, psychiatric hospitals, and Critical Access Hospitals to share electronic Admission, Discharge, Transfer (ADT) based event notifications (e-notifications) with other providers across the continuum of care whenever patients have inpatient or emergency department care events.

To help these organizations prepare for the e-notifications CoP, a recent hospital executive survey was conducted to gauge industry awareness about the regulation (the survey results can be found in an online e-book called “The Route to Compliance. A Simplified Pathway”). Responses from hospital CIOs and compliance executives collected through dozens of conversations, virtual focus groups, and webinars revealed three key areas that need more awareness.

#1: The Requirements

According to the survey, which was conducted in May and June of 2020, just 17% of hospital CIOs or compliance personnel are familiar with the e-notifications CoP. The goal of the new CoP is to increase information sharing across the care continuum as a way to enable better care coordination leading to improved patient outcomes. This compliance requirement will go into effect on May 1, 2021 and adds to the list of CoPs hospitals must fulfill to successfully maintain their CMS provider agreement and certification. The fact that CMS used its most consequential regulatory lever, a CoP, to create the new e-notification requirement underscores the importance the agency places on increasing provider access to needed information.

Hospitals should answer how they or their third party intermediary solution will comply with the following requirements:

• Identify and send e-notifications to post-acutes.
• Meet cross-regional provider notification needs.
• Ensure appropriate data sharing rights, security, and trust.
• Send notifications in real time.
• Manage continuous provider-patient relationship changes.
• Demonstrate compliance to meet survey requirements.
• Ensure community-based providers have excellent user experience.
• Meet compliance by the May 1, 2021 deadline.

#2: Provider-Requested Notifications

This topic is particularly important to health systems with large provider and post-acute referral networks. Hospitals must send e-notifications to community-based providers that have established care relationships with patients and that need the information for treatment, care coordination, or quality improvement activities. This includes primary care practitioners, Federally Qualified Health Centers, Accountable Care Organizations, other entities identified by the patient as primarily responsible for their care, and post-acute providers (skilled nursing facilities, home health agencies, etc.). Identifying which providers have established care relationships is critical and requires that hospitals, or their intermediary, possess two foundational capabilities:

• Ability to collect patient-identified provider information at the point of care.
• Ability to obtain care relationship information from providers through a patient roster and notification request process.

The first capability allows hospitals to determine any providers with whom the patient wants their information shared by giving patients the ability to identify providers at the point of care. The second capability allows hospitals or intermediaries to determine any additional practitioners, groups / entities, or post-acutes that need to receive notifications for treatment, care coordination, or quality improvement activities. The roster and notification request process allows providers to identify their care relationships through rosters, e.g. patient panels or census lists, and receive e-notifications based on hospital care events that match to patients on those rosters. Having both of these capabilities gives hospitals the ability to determine the required providers that need notifications thereby eliminating e-notification gaps that would lead to non-compliance.

#3: Health Information Exchanges (HIEs) as Intermediaries

Hospitals have the option to use an intermediary, such as an HIE or vendor, to fulfill the e-notification function under this CoP. In the survey cited above, 60% of respondents familiar with the rule somewhat agree with the statement, “that their local HIE will ensure 100% compliance with the CoP.” Just 17% fully agreed with that statement. Given that HIE capabilities vary widely by state and region, compliance will depend on whether the HIE can fulfill the minimum requirements specified within the final rule. Those requirements include:

• Event types and timing. Notifications must be sent at the time of patients’ inpatient admission, discharge, and transfer and at emergency department presentation and discharge.
• Notifications recipients. Established PCPs, practice groups / entities, and post-acutes irrespective of geographic location that request notifications for treatment care coordination, or quality improvement activities.Practitioners, practice groups / entities, and post-acutes irrespective of geographic location that are identified directly by patients as primarily responsible for their care.
• Notifications content. Notifications must include, at minimum, patient name, treating practitioner name, and sending institution name.

Notifications also need to be sent in accordance with patients’ privacy preferences and applicable federal and state laws and regulations. Additionally, to minimize security incidents and inaccurate notifications, a high accuracy match rate is needed to ensure notifications are sent to appropriate providers. Ultimately, hospitals are accountable to meet compliance requirements even when e-notification functions are delegated and they should therefore ensure all minimum compliance requirements are met.

Given the significance of the new e-notifications CoP, hospitals should take time to carefully assess and validate internal or third-party capabilities against the new requirements to ensure they can meet compliance by May 1, 2021. With the proper solutions in place, hospitals can share real-time patient data with other community providers to support treatment and care coordination efforts, bolster value-based care initiatives, and, most important, improve health outcomes for patients while achieving e-notifications CoP compliance.

HIStalk Interviews Jay Deady, CEO, Jvion

Jay Deady is CEO of Jvion of Suwanee, GA.

Tell me about yourself and the company.

I’ve been in health IT for 30 years, having started in 1989 with Cerner. I’ve had a series of opportunities and roles on both the clinical revenue cycle and analytics sides of the business. Mostly focused on providers, but with some exposure to payers along the way and keeping my career focused solely on health IT.

Jvion is an industry-leading prescriptive AI company. Our mission is to drive down preventable harm to patients, both clinical and cost-related harm, however we can. That has been company’s mission since Day One. The co-founders have done a great job bringing the company forward over the last eight or nine years. I was fortunate to have the opportunity to join a few months ago as CEO.

Are health systems interested in how AI and predictive analytics work under the covers, or are they just looking for solutions that can deliver the results they need?

They are definitely looking at some of the details. The reason is that over many years, certain terms in healthcare and healthcare IT tend to get somewhat abused and therefore misunderstood. It was “workflow” and “analytics” back in the day and now everybody seems to be an “AI” company. Health systems, ACOs, and payers want to understand how Jvion is different from some other company that claims to be in the space. They are clearly interested in the outcomes and benefits that current clients are achieving and they want to understand how our approach is different.

Do health systems, and particularly clinicians, struggle to trust AI that functions as a black box with hidden proprietary algorithms?

It’s a balancing act. We have proprietary technology and methods, and other companies might say the same. Under an NDA, we will go to a certain depth to explain how it is that we do what we do. Fortunately, we have a relatively large number of clients that have been using Jvion for a while, so those documented outcomes and references help in those conversations. Details about how we approach the data science and strong peer references help. We also use a model control study versus just a benchmarked pre- and post-analysis. We have a lot of rigor around documenting the outcomes we have helped clients achieve.

Will AI become another example where technology companies try to solve problems they don’t understand because they don’t know healthcare?

There is some of that. There’s another side as well. On one hand, you have AI companies that don’t understand how healthcare works. They don’t understand the triangle between a patient / member, a payer, and a provider and how you add value to each constituent by understanding their alignment. On the other hand, AI draws a lot of different correlations and can provide a lot of different solutions for a company that does healthcare, but understands that healthcare is complex and needs help with a lot of questions. It’s challenging, from a corporate perspective, to narrow the focus so that you can efficiently scale versus answering one question for one client and trying to multiply that.

How important is it when training a model to avoid amplifying existing biases and to resist the urge to overstretch the model’s capabilities?

One of Jvion’s differentiators is that we have 33 million lives with between 2,500 and 4,000 data points within our machine. We don’t take in a large volume of data for one particular client, which will be biased to their capture solely, and then run the analysis only against that. Our scale and our nine-plus years of experience allow us to leverage the underlying clusters across those 33 million to even out any regional or local biases that might come from a single data source or data from a single region.

What information from outside the EHR can help identify patients who could benefit from an intervention?

Beyond EHR data, the machine uses publicly available data from the federal government, such as community vulnerability and social determinants of health. There are various capabilities around lab data and claims data. EHR-specific data makes up less than one-third of the data that we have in the machine.

What do clients most commonly learn when they apply a broader set of analytics capabilities to data that extends beyond their Cerner and Epic systems?

There’s a lot of additional data that isn’t contained within the EHR. Cerner and Epic are clearly trying to go down the path of balancing, however they describe it, between analytics and AI. But there’s additional behavioral data — environmental data, lifestyle data, transportation data, and even weather. These have impact on the health of a population and on the health of an individual in a specific area, but they aren’t within the EHR. That is one way that we significantly differentiate our offering from the nuanced early capabilities of what Cerner and Epic are doing.

Is social determinants of health information useful other than recognizing that an individual has a problem that goes beyond the health system’s ability to fix it?

Our clients aren’t just hospitals. While source data for SDOH does in some cases come from health systems, we gather information from other sources.

We break our market down into three segments. We have health systems on the provider side. We have population health entities on the provider side, where on their own or in conjunction with maybe a payer joint venture. There are ACOs or other initiatives where some level of risk is being taken around the defined population, whether that is the hospital’s employee base if they are really large or expanded into a provider-sponsored health plan. We have more than hospitals as clients and sources of SDOH.

What opportunities have arisen from helping customers address COVID-19?

It certainly was an unexpected impact for the industry, the nation, and for Jvion. I started as a new CEO three days after Georgia locked down, and multiple months into my career at Jvion, I think I’ve met 18 of my colleagues in person. I just went on my first in-person client visit in Georgia two days ago, wearing masks and socially distancing. Otherwise, it has been a virtual engagement, and that has had a big impact on general business operations.

At the solution level, the hospital provider segment has been impacted the most. Their economics have been fairly devastated. They were a 2-3% margin business, generally not for profit. They lost 30-60% of their high-margin business for a period of time. Our average health system client will probably be off 20, 30, or 40% of the financial operating numbers they had expected for the calendar year, and that is massively impactful from the operations side. From the caregiver side, the daily onslaught of delivering care in this COVID world versus a multi-service line clinical care delivery system is very different.

We initiated a COVID map that we pushed out for free. We worked with Microsoft on it. It’s available online. We’ve had 4 to 5 million hits and uses of it, everybody from the Pentagon and the White House Task Force to the CDC and others. We mapped down to the actual block area to show the vulnerability of a particular community, which is more beneficial – particularly for health systems – than looking at government data that’s at a county level. We expose that for our clients as well as anybody that would care to use it. We’ve been happy with the massive use.

For our clients, we took a look at their current patient lists, applying both the COVID map and other data we created and something we do for our normal solutions. We don’t just create a list of folks who might be susceptible to a negative quality event coming up and predict that. We do that, but we also put that in rank order based on the ability to intervene with a suggested intervention that could make a positive trajectory change and improve the potential outcome based on what the current trajectory is. A number of our clients are using that to outreach to those in their capture who might be the most susceptible and vulnerable from a COVID perspective to make sure patients are getting assistance.

We created a triage select solution, which we refer to as a vector. It works both for COVID and for any type of potential respiratory-impacting areas or diseases, such as basic flu, where you may need to make triaging decisions around the right time and appropriateness to ventilate. How do you prioritize that as the patients are presenting? That helps our clients deal with the onslaught of folks coming in.

I’m really proud of the team here at Jvion and appreciative of the feedback that we got from our clients in critical, overwhelming times. We were able to take that input, understand their needs, and bring our resources, assets, and capabilities to assist.

Do you have any final thoughts?

The US health system environment has faced challenges in my 30-year career and in the past, but they were more financially market oriented, where hospitals had reduced access to the bond market during the financial crisis, for example. But I’ve never seen anything that was so impactful to the actual operations of the health system itself. We will move through this at Jvion. 

We are also looking at our prescriptive AI, which historically has been solely clinical in nature, to understand the challenges of our health system clients. In those parts of the country that are post-COVID or in a lesser COVID world, how do they start getting a return to care? One client’s research found that 68% of community patients are reluctant to seek care because of fear of going to a medical facility related to COVID.

That deferment of care is having a major impact on the providers and the services that they can provide to patients. They will have higher acuity and more severe illness and disease state based on the deferment of that care. If they’re a commercially insured patient or member, payers have an influx of money today based on all the deferment of care, but there’s a tsunami coming of that care having to be delivered, and it will be more expensive later than right now.

It’s an interesting alignment period, with patients getting the care they need sooner than later, providers needing those types of patients back into their health system, and payers wanting them to get the care now versus deferring it and it being more expensive later. We’re focused at Jvion on how we can help drive that alignment across those three constituents whose interests are aligned with a single incentive.

Morning Headlines 8/3/20

Lemonaid Health Raises Oversubscribed $33 Million Series B to Expand Telehealth Offering

Telemedicine and prescription drug vendor Lemonaid Health raises $33 million in a Series B funding round, increasing its total to $55 million.

Samaritan computer systems still down as investigation into malware continues

Systems of Samaritan Medical Center (ME) remain down from a July 25 malware attack.

Siemens Healthineers Expands Into Cancer Care With $16.4 Billion Deal for Varian

Siemens Healthineers will acquire radiation oncology treatment and software developer Varian Medical Systems for $16.4 billion.

Exclusive: Prescription drug marketplace GoodRx files for IPO – sources

Reuters reports that Web-based prescription savings company GoodRx is preparing to file for an IPO.

Monday Morning Update 8/3/20

Top News

From the Allscripts earnings call, following the posting Q2 results that sent shares up 19% on Friday:

• The $365 million sales price of EPSi to Strata Decision Technology represents 7.5 times trailing 12-month revenue at 18.5 times adjusted EBITDA.
• The company sold no new Sunrise systems, although some existing customers extended their agreements.
• Allscripts will migrate the 450-clinician US Department of State medical units to a cloud-based version of TouchWorks and FollowMyHealth.
• CarePort is managing 40% of post-acute transitions in the US, with 18 million referrals per year.
• Allscripts says that while lower patient volumes and the DoJ settlement caused Q2 revenue to drop year over year, those headwinds will have smaller impact going forward.
• The company says that while it isn’t actively considering selling other parts of “the portfolio,” its data analysis and care coordination systems do more business outside the Allscripts EHR customer base and could stand on their own.
• Pressed by an analyst who observed that the company boosted its quarterly margin by cutting R&D to a level lower than that of competitors such as Epic, Allscripts says it moved work to its offshore employees and downsized its project management offices.

Reader Comments

From Anita Bath: “Re: HIMSS21. Odd that they still haven’t tweeted out that the date has changed.” I didn’t see any mentions on their so-called news site or HIMSS.org (except they’ve added it to the “Events” page) and no actual announcement was made on the conference website, which contains a mix of HIMSS20 and HIMSS21 references. Urgency is minimal since we’re a year away, but let’s hope communication and transparency improves compared to how the cancellation was mishandled. My primary PR advice would be to explain the often-repeated claim that the HIMSS contract prohibits it from offering refunds to attendees and exhibitors – why would HIMSS sign that, and with whom? (my interpretation is that the contract doesn’t require it to provide refunds, which is a vastly different issue). I’m not getting my $895 registration fee back regardless, so given that sunk cost and the fact that I would rather visit Baghdad than Las Vegas in the similar August weather, I will evaluate all over again whether it’s worth it. HIMSS has a big job in trying to drum up the bandwagon effect that makes HIMSS21 seem like a can’t-miss event, which is challenging because we will have already missed it for 30 months and ROI was questionable even before the unexpected contemplation period. And of course there’s the possibility that our coronavirus mess will still be keeping people home even a year from now, especially those from the entire rest of the world that has handled it better, and Las Vegas visitors will probably find COVID to be an exception to the “what happens in Vegas stays in Vegas” mantra for bad behavior. The HIMSS21 floor plan shows 1,249 booths booked by about 350 vendors so far, including the usual big footprints of Cerner, Epic, Allscripts, EClinicalWorks, InterSystems, and Change Healthcare.

From Nick Rails: “Re: HIMSS. They have a long dry spell until August 2021, when the next bolus of revenue comes in.” I’m pretty sure exhibitor and attendee count will be down a lot, and some of those who show up will be applying credits for money they gave HIMSS years before. I expect all member organizations (especially the majority that, unlike HIMSS, gave full refunds for their cancelled conferences) to downsize while simultaneously strong-arming vendors to spend more money to offset those losses. That could create a downward spiral wherein the provider members (the “ladies” in the “ladies drink free” model of attracting those who are willing to pay for access) get so tired of being hit on that they stop coming.

From Long Memory: “Re: Strata. I seem to remember Allscripts suing them at one point over EPSi, which Strata is now acquiring.” Allscripts sued Strata Decision Technology in June 2016, claiming that the company hired former Allscripts Chief Marketing and Strategy Officer Dan Michelson as CEO in 2012 and then used confidential Allscripts information to displace Allscripts-owned EPSi from KLAS’s #1 spot with Strata’s StrataJazz. I don’t know how that lawsuit turned out, but Strata will now own EPSi. Those with long industry memories will recall that Eclipsys acquired EPSi in early 2008 for $53 million in cash.

From Florida Unmasked: “Re: Baptist Health Jacksonville. Over 1,100 beds, signed with Epic last week. Didn’t see it here, so maybe it’s off-the-recordish.” Verified – they signed last week. Epic will displace Cerner.

HIStalk Announcements and Requests

Most poll respondents aren’t worried about career time bombs that are ticking away somewhere online, although it’s interesting that more folks worry about public information than social media posts. Probably because they can control the latter but not the former, which makes Google stalking unchallenging.

New poll to your right or here: Which factor will have the greatest impact on HIMSS21 attendance?

Pondering: why do company executives who boast that they have “right-sized” their business never take the blame for wrong-sizing it in the first place?

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Meditech reports Q2 results: revenue down 3.4%, EPS $0.88 versus $0.44. Product revenue declined 22%, but net income increased to $33 million.

Exchange-traded funds provider Global X ETFs launches the Global X Telemedicine and Digital Health ETF (EDOC) that will invest in telemedicine, analytics, connected health, and administrative digitization. The top percent holdings among its 40 investments are Ping An Healthcare, M3, Alibaba Health, Nuance, Teladoc Health, Veeva, Tandem Diabetes Care, Dexcom, Agilent Technologies, and Insulet. Also in its portfolio are Livongo, Cerner, Premier, R1 RCM, and Allscripts. I may start tracking the fund’s performance versus market indices, especially if I can set up some kind of portfolio tracker to monitor the share performance of the individual holdings.

Vocera announces Q2 results: revenue up 6%, adjusted EPS $0.10 versus $0.07.

Telemedicine and prescription drug vendor Lemonaid Health raises $33 million in a Series B funding round, increasing its total to $55 million.

People

Bruce Brandes, MBA (Avia) joins Livongo as SVP of directed virtual care.

Announcements and Implementations

Researchers who reviewed TriNetX’s research database found that cancer screenings fell 90% in the first four months of 2020 compared to 2019.

COVID-19

A new CDC projection shows 20,000 more US COVID deaths in the next three weeks, raising the total to 173,000.

Data scientist Youyang Gu, MEng, whose online pandemic tracker has been among the most accurate, believes that the US has passed its peak of cases and expects daily deaths to top out this week. He warns, however, that many states ignore CDC’s reporting guidelines for “probable deaths,” which could skew his model. He expects to see 230,000 US deaths by November 1. Deaths are increasing most in Florida, Texas, and Mississippi, while cases are increasing most in Missouri and Oklahoma.

A YMCA sleepaway camp in north Georgia sees a COVID-19 outbreak in its first few days of operation, with 76% of campers and staff whose test results were reviewed by CDC showing positive. The camp took several precautions, including requiring campers to show proof of negative test results, but did not mandate mask-wearing, housed campers 15 to a cabin, and led groups in singing and cheering.

NPR calls out more problems with HHS’s COVID-19 hospitalization data switchover from CDC’s reliable system to a new $10 million one built by contractor TeleTracking. Hospital-submitted information appears to go live immediately before being QA’ed, sometimes with obvious errors, and HHS has backtracked on its original promise of updates multiple times per day to committing to only a weekly refresh. Hospital capacity information on HHS Protect Public Data Hub was last updated July 23 as I look just now 10 days later. Among several state-level anomalies, NPR found that CDC’s old system showed that 24% of Arizona’s inpatient hospital beds were occupied by COVID-19 patients, but the new system shows 42% occupancy even with 82 fewer patients, and Colorado’s state dashboard lists 341 hospitalized patients on July 30 versus HHS’s 491. 

Major League Baseball faces the possibility that its just-started season may end quickly as a second team cancels games after players and staff test positive for COVID-19. Meanwhile, 27-year-old Red Sox pitcher Eduardo Rodriguez, who returned after a “mild” case of COVID, is out for the season due to COVID-caused myocarditis in a reminder that “recovering” from COVID doesn’t necessarily mean a return to previous health. 

Recreational boat-owning Americans are sneaking across the border to Canada and turning off their transponders like drug dealers, as locals decry having people from the “biggest Petri dish in the world” going ashore into their otherwise protected communities with no masks or distancing. Eighty percent of Canadians want the border to remain closed to Americans, who are seen as widely ignoring rules of personal responsibility.

Other

Systems of Samaritan Medical Center (ME) remain down from a July 25 malware attack.

Sponsor Updates

• Redox releases a new podcast, “EConsults and Coping with the Year 2020 with Gil Addo of RubiconMD.”
• Customers give Spirion their highest ratings in Gartner’s latest report on enterprise data loss prevention solutions.
• Netsmart lists 16 hospice and palliative care organizations that recently signed for its EHR.

Blog Posts

• My internship at Nuance in the wake of COVID-19: uncertainty and satisfaction (Nuance)
• Texting Consumers is Smart Business Strategy (OptimizeRx)
• How Virtual Waiting Rooms Protect Patients, Staff, and Productivity (PerfectServe)
• MIPS 2020 – What’s New? (PMD)
• Uncover the Hidden Pharmacy Supply Expenses (Premier)
• Pure Accelerates Hospital’s Recovery from Ransomware Attack (Pure Storage)
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• Telehealth technology: from scramble to strategy (StayWell)
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• Using Google Maps and Business Messages to Attract More New PT Patients (WebPT)

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