Morning Headlines 4/13/20

Apple and Google partner on COVID-19 contact tracing technology

Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

Bankruptcy judge OKs sale of St. Vincent hospital to Patrick Soon-Shiong

A federal judge approves the $135 million sale of St. Vincent Medical Center (CA) to health IT, life sciences, and publishing mogul Patrick Soon-Shiong, MD who plans to turn it into a COVID-19 research facility.

Doctors at UCLA, UCSF create registry to study coronavirus effects on pregnancy

Researchers at UCLA Health and UC San Francisco launch the PRIORITY study and national data registry to better understand the effects of COVID-19 on pregnant and post-partum women.

Monday Morning Update 4/13/20

Top News

Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

The companies will release APIs next month that create interoperability between Android and IOS devices using apps from public health authorities. Following afterward will be the release of the full contact tracing platform.

The use scenario is this:

1. User One carries their phone any time they’ are in public. They leave the app running.
2. User One is assigned an anonymous, frequently changed identifier beacon.
3. User One has close contact with User Two, who is also carrying their phone and running the app.
4. User One tests for COVID-19. They manually enter their result into an app provided by a public health authority.
5. User One gives their phone permission to upload a 14-day history of the identifier beacons with which they have had close proximity.
6. User Two’s phone regularly downloads a list of identifier beacons from contacts who have tested positive.
7. User Two’s phone alerts them that they have been exposed to someone who tested positive and tells them what they should do.

Obvious weak points of cellphone-based contact tracing:

• Adoption in other countries that have tried this voluntary approach has been low (Apple and Google did not acknowledge that this technology wasn’t their original idea).
• The app must be left running and the user must carry their phone everywhere.
• The users must have smart phones; those with flip phones or no phones cannot participate.
• Each person who tests positive must remember to enter their result.
• Both contacts must be running the app. That means, given likely low adoption, that the odds of detecting a given exposure are tiny.
• Bluetooth can detect proximity, but not the chances of exposure. It could record a contact anyone in nearby car or everyone behind doors in a hospital hallway.
• People who don’t trust big companies like Apple and Google (especially the latter, given that its primary business model is using or selling user data), or who detest the concept of mass surveillance regardless of benefit, will likely opt out.
• Public health systems must participate.
• The US still lags in testing and results from some labs are delayed due to backlogs.

Reader Comments

From Code Jockey: “Re: Epic consulting. Demand for my skills has evaporated as health systems have suspended EHR projects and cancelled contracting engagements. Given the 95% reduction in air carrier routes through September, there’s no way to get to their sites even if they need contractors. I’m now unemployed and trying to get a $17 per hour job at an Amazon warehouse. I’m wondering what people like me are doing – taking a break, shifting to other industries, or working remotely? What will consulting look like when this is all over, the former Monday to Thursday travel or 100% remote work? You also have Epic continuing to elbow into the contracting space. I wonder how the many staffing firms that have lined their pockets on the backs of contractors will be affected by the absence of engagements?” I offered to create a short survey for consultants to anonymously share how the pandemic has changed their work. Your thoughts might relieve some anxiety for people who are cooped up with little work available short term.

From Financial Cannula Insertion: “Re: HIMSS20 hotels. Marriott Orlando Village is not refunding guests because they claim they were contractually guaranteed full payment by HIMSS. They’re keeping my ‘deposit’ of the full four nights that I prepaid. Here’s the email I received from the hotel GM.” The hotel says that HIMSS told it on multiple occasions that the conference would not be cancelled and asked that the hotel not release or resell any booked rooms. The hotel add that since the US had no travel advisories in place at the time the conference was cancelled (two days before FCI’s scheduled arrival), the cancellation was a HIMSS business decision that does not relieve it of honoring its vendor contracts. The GM says HIMSS signed a contract with all the Orlando hotels guaranteeing the attendee’s full payment. It’s interesting that HIMSS can legally guarantee payment terms on behalf of the actual customer, presumably by the online reservation terms specified by OnPeak since HIMSS doesn’t handle room bookings directly.

From Spumoni: “Re: HIMSS. I’m struggling with a path forward, as exhibitors seemed to be saying in your survey. Will travel return? Do I really want to sit shoulder-to-shoulder in sessions? Was the conference a boondoggle all along that was self-aggrandized by vendors along with their own importance? Meanwhile, I’m being bludgeoned by the pivot to online content delivery and life in the glow of Webex on a laptop.” It’s hard to predict the pent-up, post-isolation demand for big conferences in the potential absence of a coronavirus vaccine. People were always returning home sick even in past years, as my post-HIMSS18 poll found that 50% of respondents came home with a cold, flu-like symptoms, stomach problems, fatigue, headaches, or muscle aches. Beyond that is the economic question — is the considerable cost of attending and exhibiting worth it, especially given a year off to contemplate the value received? Or will it go back to exhibitors who mostly show up for fear they will look bad competitively if they don’t? Or will the conference irrecoverably lose critical mass with the near-certainty of fewer attendees, a sparser exhibit hall, and attendees who have grown comfortable conducting all aspects of their work remotely?

From Allscripts Sunset: “Re: Allscripts. Appears that it just hit five straight quarters without selling a Sunrise new logo deal.” Unverified.

From Allscripts Cuts: “Re: Allscripts. Word is that the board gave Black and Poulton six months in early March to cut $100 million per year in expenses. There was an expectation of laying off 1,000 to 1,500 people, but they likely used COVID to cut pay and travel to get layoffs into the 500-600 range. That will work only until full salaries return and travel picks back up.” Unverified.

HIStalk Announcements and Requests

Most poll respondents have no personal experience with COVID-19, and thankfully few report the death of a family member, friend, or co-worker.

New poll to your right or here, for hospital employees: which is true of your EHR maintenance fees as the pandemic cuts revenue? Click the poll’s Comments link after voting to explain.

Listening: Bachelor Girl, which I discovered while creating another playlist for my young friend (it includes Dua Lipa, James Bay, Florrie, Sia, and Hazel English). Bachelor Girl is an Australian duo that has been around for nearly 30 years, and what caught my attention was 1999’s “Lucky Me,” a cynical take on success that sounds more Nashville than Melbourne (it’s amazing that the lyric way back then says, “I’ve got so many friends on the internet, I could never be alone.” I’m also thrilling to the new album of the amazing Public Enemy and the best voice in rap, Chuck D, who raises goose bumps on 2007’s “Harder Than You Think.”

A third-hand acquaintance (well educated, upper class, long list of health conditions) is experiencing cough, fever, and fatigue and was reluctantly sent home by his employer. Some of his co-workers – who as essential workers spend their work days in close office contact — have since tested positive for COVID-19. He has dawdled in sending in his own test samples and continues to convene multi-generational family and neighborhood gatherings and takes regular, unmasked trips to grocery and hardware stores. Bill Gates was right in describing STDs – it would be easy to stop communicable disease outbreaks if those who practice bad behaviors suffered the consequences immediately instead of later or didn’t harm others in the process of doing something stupid.

Health-Related Technologies That the Pandemic Has Made (Or Will Make) Mainstream

1. Telehealth and its integration with EHRs.
2. 3D printing of medical supplies.
3. Chatbots that can help keep the worried well out of the ED (instead of the previous model of hoping to bring them in as paying customers).
4. Remote patient monitoring and clinician backup.
5. Videoconferencing and team collaboration platforms.
6. Patient engagement for monitoring patients who are recovering at home or who can be discharged to lower-acuity settings.
7. Patient check-in and waiting room avoidance.
8. Public health reporting and data aggregation.
9. Online education.
10. Predictive models for hospital resource needs, patient outcomes, and pandemic spread.
11. Virtual conferences.
12. Clinician collaboration platforms for sharing best practices and crowdsourcing treatment options.
13. Robotics for contact-free hospital room deliveries.
14. Rapid online publication of research findings.
15. Syndromic surveillance.
16. Virtual mental health services.
17. Medical equipment clearinghouses.
18. Contact tracing.
19. Virtual programs for home exercise, rehabilitation, and wellness.
20. Imaging AI for detecting specific conditions.
21. Analytics and predictive modeling.
22. Supercomputer-powered rapid drug and vaccine research.
23. Wearables and mobile devices for the rapid assembly of clinical study cohorts and collection of study data.
24. Platforms to connect people with social services.
25. Voice assistants, such as Alexa and Siri, that have been enhanced with tools to answer specific health questions or to allow summoning help.
26. Apps for relaxation and mindfulness for people who are quarantined and anxious.
27. Ordering and delivery apps for food, supplies, and prescriptions.
28. Platforms for matching clinicians and volunteers with hospitals in need.
29. Internet-connected digital thermometers for outbreak detection.

Got more to add?

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

April 28 (Tuesday) 1 ET: “COVID-19: Managing an evolving patient population with health information systems.”Sponsor: Intelligent Medical Objects. Presenters: Julie Glasgow, MD, clinical terminologist, IMO; Reeti Chauhan, senior product manager, IMO. IMO recently released new novel coronavirus descriptors to help clinicians accurately record diagnoses and also created free IMO Precision COVID-19 Sets to help identify and analyze patients with potential or documented infection. The presenters will discuss these new tools and describe how to use them optimally.

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

People

MaineHealth SVP/CIO Marcy Dunn died last Monday. She was 65.

Announcements and Implementations

OmniSys offers all pharmacists — who can now administer COVID-19 tests as authorized last week by HHS — free online training that describes how to order tests, apply for a state license, perform the nasal swab, bill payers, submit positive cases, and share the results with the patient’s other care providers. The company has also enhanced its cloud-based retail pharmacy EHR with tools for documentation, reimbursement, and care plan communication.

Experian Health offers a free, regularly updated list of COVID-19 and telehealth payer polity alerts for hospitals, medical groups, and pharmacies, describing 1,140 changes in medical coverage policy changes.

COVID-19

New York City reports that only 18,500 of its hospital beds are being used versus the 140,000 that experts feared would be required during the pandemic’s peak resource demand that happened this weekend. Hospitals are seeing declining ICU bed occupancy, hospitalizations stand at under 19,000, and the 2,800-bed emergency hospital that was created at Javits Center is treating just 300 patients. Officials credit residents of New York and nearby states for slowing the tide by staying home. Statistical experts say their surge projection models were likely thrown off by unreliable data from China and shorter than expected ICU stays. Meanwhile, physicians worry that the big drop-off in patients who normally seek hospital care for heart problems and strokes may indicate that they are fearful of going to the ED and are just suffering at home instead, possibly to their long-term detriment.

Mayo Clinic says that a COVID-triggered freeze on elective surgeries will trigger a $3 billion loss this year, forcing it to implement pay cuts and furloughs for salaried employees, freeze hiring, lay off contract employees, and stop some construction.

Politico reports that Democratic lawmakers have written to White House Senior Advisor Jared Kushner to express concerns about the patient privacy implications of his rumored discussions with technology companies to collect COVID-19 public health surveillance data. A White House task force wants to develop a national coronavirus surveillance system that would provide a real-time view into hospital ED visits and bed capacity using “multiple private sector databases,” raising fears of a Patriot Act type encroachment on privacy. A government spokesperson says that neither Kushner nor the White House are aware of such a project, but Politico uncovered a memo written by three companies – Collective Medical, PatientPing, and Juvare – that Politico says was in response to an administration request on the feasibility of quickly gaining visibility into how many patients are seeking hospital care.

The federal government’s distribution of the first $30 billion in emergency hospital grants raises the ire of some hospitals because payments are based on the volume of past Medicare billing amounts, not their coronavirus burden. Hospitals in lightly hit states, some of which continued to perform rofitable elective procedures, are being given 25 times the amount of money per COVID-19 case as those in New York. The formula also provides payments to providers who aren’t on the front lines, such as podiatrists and ophthalmologists. HHS said the goal was to get the money out quickly and it will focus the next round on providers who were most impacted by coronavirus.

More evidence that New York City is unintentionally undercounting COVID-19 deaths – FDNY reports that cardiac arrest calls and DOAs have risen six-fold over the same period last year, which probably means that people who die of COVID are being counted instead as cardiac deaths. Italy saw the same six-fold increase in deaths, far more than the official COVID death counts.

A single long-term care facility in Virginia has recorded 40 deaths that are linked to COVID-19, with the medical director blaming lack of staff and equipment, low funding, and trying to isolate positive cases when people have lived in the same room for years. The facility is owned by private equity firm Tryko Partners, which operates 3,000 skilled nursing beds.

The US federal government is using daily, e-mailed hospital worksheets to visualize bed capacity, but Germany has a live map.

Florida is underreporting COVID-19 deaths because the state health department has decided to count only deceased state residents, omitting snowbirds and tourists who die in Florida.

United Airlines and basketball player Steph Curry honor the 20 USCF clinicians who volunteered to serve on the front lines of New York City hospitals.

Other

The 3,000-bed temporary hospital that was created in Chicago’s McCormick Place convention center will use Epic in a partnership that involves Epic, Rush University Medical Center, and the City of Chicago. Chicago’s Department of Health reached out to Epic early in the planning.

This seems HIMSS20 related and perhaps could be instructional to HIMSS. Burning Man Project cancels its annual Black Rock City gathering for 2020 due to coronavirus and will instead run a virtual version that it says “will likely be messy and awkward with mistakes.” It asks ticket-holders to consider donating part of their full refund to the project so it can continue to support its key programs, noting that “things are looking a little grim” in trying to run year-round programs when 90% of the project’s annual income comes from Black Rock City. Tthe group has already undertaken layoffs and pay cuts. Burning Man also observes that rolling over this year’s ticket sales as a credit for next year’s event is not practical because that simply “punts the financial challenges to a future date.” The group had cancellation insurance, but it doesn’t cover pandemics. The CEO recorded a personal, heartfelt message to explain the situation, an approach of unscripted humility and openness that stands in contrast to the HIMSS “strictly business” approach that makes it feel more like an us-versus-them vendor than a non-profit that wears its lofty societal aspirations on its suit sleeve. I’m not sure how many HIMSS members and exhibitors feel a personal attachment or loyalty to the organization or its goals as its global ambitions and expansion strategy has made it impossible to define a typical member.

Sponsor Updates

• MDLive reports visits and user registrations increase to all-time highs with virtual healthcare as first-line defense in fight against pandemic.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, launches the “Clinical Concepts in Obstetrics” podcast.

Blog Posts

• The Downstream Impact of COVID-19: Building a Strategy with Telehealth and Chronic Care Management (Lightbeam Health Solutions)
• Using LiveProcess for COVID-19 Response: Real World Tips from Our Customers (LiveProcess)
• Healthcare organizations implement remote testing in light of COVID-19 (Meditech)
• Remote Healthcare Work: Best Practices amid COVID-19 (Health Catalyst)
• Leveraging Virtual Care Amid COVID-19 (Netsmart)
• Building a Healthcare Data Strategy with Big Rocks (Omni-HealthData)
• Social Distancing and the Power of Patient Engagement (PCare)
• Automation can help track active coverage during the COVID-19 chaos (Experian Health)
• 12 tips to manage a remote contact center in healthcare (Spok)
• Backfilling for clinical team members redeployed to the front lines (Nordic)
• Tips for Educating & Communicating with Patients During the COVID-19 Pandemic (PatientBond)
• Pivot Point Perspective: 6 Strategies to Accelerate EHR Build Outs for Drive-Thru Clinics (Pivot Point Consulting)
• Enabling Workforce Continuity – It’s Time to Rethink Identity (SailPoint)
• How to Improve Physician EHR Adoption During an Implementation: Part 2 (Santa Rosa Consulting)
• 6 ways to maintain your well-being during a pandemic (StayWell)
• Healthcare’s catastrophic revenue gap is here. Accelerate recovery now. (SymphonyRM)
• Cloud-hosted communications for makeshift care areas. (Voalte)
• COVID-19: 6 Simple Tactics for Safer, More Efficient Communication (Vocera)
• How to Deliver, Document, and Bill for Different Types of Remote Rehab Therapy (WebPT)

Contacts

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

Weekender 4/10/20

Weekly News Recap

• The COVID-19 global tracking website that was put together in a few hours by a first-year Johns Hopkins graduate student is drawing one billion page views per day.
• Allscripts lays off staff and cuts costs.
• HIMSS revises its “no exhibitor refunds”policy for HIMSS20 and offers a 25% credit that can be applied to the next two annual conferences.
• Despite an ongoing lack of COVID-19 testing nationally, hospitals aren’t using the available capacity of independent labs because they don’t have EHR ordering and results interfaces.
• Duke’s Margolis Center for Health Policy, along with two former FDA commissioners and former National Coordinator Farzad Mostashari, MD, proposes a national COVID-19 surveillance system.
• AMA publishes a physician guide for implementing virtual visits.
• FCC publishes details of its $200 million COVID-19 Telehealth Program.

Best Reader Comments

Health systems are giving themselves gold stars for upping their stats on virtual visits, which I can’t help but find to be a tad disingenuous. Using the example from the Epic post, one organization had only 200 televisits during ALL of last year and are now counting 12,000 in just one week! Wow, except I’m not really feeling the celebration here. This success happened only because health systems were finally forced into telling their patients about the option that was probably there all along (it certainly was for Epic users). (Telehealth Princess)

The reason people didn’t do telemedicine before is because it wasn’t reimbursed at the same rates, or at all, in many cases. In addition to the obvious public safety advantages of video visits right now, insurers and CMS have agreed to broadly reimburse these services. On top of that, the government is also throwing money at hospitals to purchase telemedicine technology. The comparison to Napster is interesting. Healthcare does have a similar pricing and delivery problem that the music industry had. I wonder if some facilities will go the way of Tower Records in the coming future. So far “online doctor” services that attempt to bypass traditional payment models haven’t been particularly successful. We’ll see if that changes. (Elizabeth H. H. Holmes)

It sounds like Allscripts did a graduated pay cut. Meaning if two people are in the same role and the first employee makes more than the second, the first employee took a larger pay cut. Is that true? Doesn’t that punish harder working or more experienced or more talented employees assuming those people would be the one Allscripts would have originally given raises? (IANAL)

There will be titanic shifts across the whole economy that will reverberate for the rest of the year or even longer. Lots of docs are laid off already — the surgicenters are closed and many may not reopen.The disruption has only started. For many younger medical professionals who have never experienced a shrinking economy, the experience it will come as a shock that “MD” or “RN” does not means monotonically increasing wealth and well being. For anyone who remembers the 1990s, it is just a reminder of what we already knew. (Richard Irvin Cook)

In our county, a single for-profit health system owns the hospital and all urgent cares in the county. Last week, my wife had all of the symptoms of COVID-19 and she began to decline. I took her to the ED, and the note said that she was suspected of having COVID-19. The interesting part is they didn’t test her for COVID — their protocol was not to test anybody unless a positive test would change the treatment course. Instead of a single test, the did a CXR, metabolic panel, and a Chem 7. The Medicare reimbursement rate for a CDC COVID test is around $35.91, while my wife’s visit rang up $4,000. From a revenue perspective, it seems far more lucrative to not test for COVID-19. (Jim Bresee)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. S in New York, who asked for a VersaTiles math practice set. She said a few weeks ago, “The impact that these math VersaTiles have had on my children is immeasurable. It has allowed me to target weaknesses in individual students and help them understand the concept to mastery. The children are so focused on the task and so interested in the activities that the success rate has been through the roof. This has allowed those children who struggle, to move on to the next concept as they have now built that foundation. They have proven to be equally engaging and successful for those students who need to be challenged to do more. We will be forever blessed with your love and support.”

In Mexico, a man in a grocery store throws hot coffee on a nurse who was wearing scrubs as he shouts, “You’re going to infect us all.” Another nurse had an egg thrown at her as she waited for a ride, while residents of one small town threatened to burn their local hospital down if it treats any COVID-19 patients.

A South Carolina ED nurse isolates herself by sleeping in a RV in her back yard that was provided by RVs 4 MDs, which helps healthcare workers find a place to stay during the pandemic.

A hospital in Thailand fits newborns with face shields to protect them from coughing or sneezing that could contain coronavirus.

Pharma bro and Turing Pharmaceuticals profiteer Martin Shkreli offers to apply his drug development expertise to search for COVID-19 treatments in return for a three-month furlough from his seven-year securities fraud sentence.

Intensivist Julie John, MD makes a goodbye video for her children after coming down with severe COVID-19 symptoms at home and declining to call 911 because she didn’t want the presence of paramedics or the possibly being intubated to frighten her young children. She is recovering in quarantine, but even after 14 days the infection still leaves the 38-year-old doctor her feeling like she’s a 90-year-old woman with emphysema.

In Case You Missed It

• News 4/10/20
• EPtalk by Dr. Jayne 4/9/20
• News 4/8/20
• Curbside Consult with Dr. Jayne 4/6/20
• Readers Write: Strained but Secure
• Monday Morning Update 4/6/20

Get Involved

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

Morning Headlines 4/10/20

Behind the Johns Hopkins University coronavirus dashboard

The Johns Hopkins University and Medicine COVID-19 case-tracking site draws over 1 billion page views each day for its near-real time display of data from WHO, CDC, and other authorities.

The Nation’s Largest Convention Center Being Converted into a COVID-19 Alternative Care Facility in Chicago, To Be Equipped with Epic Health Records Software

The Chicago Department of Public Health will work with Rush University Medical Center to set up a temporary hospital within McCormick Place Convention Center that will use the medical center’s Epic system.

LabCorp and Ciox Health Enter Collaboration to Create Comprehensive Patient Data Registry

LabCorp and HIM vendor Ciox Health will develop a COVID-19 patient data registry for clinical researchers using de-identified lab testing data and data culled from EHRs.

News 4/10/20

Top News

Nature magazine describes the spur-of-the-moment decision by a Johns Hopkins University first-year PhD candidate to create a global COVID-19 tracking dashboard for fellow researchers. He developed the site in a handful of hours.

The Johns Hopkins University and Medicine COVID-19 case tracking site is drawing over one billion page views each day for its near-real time display of data from WHO, CDC, and other authorities. 

Developer Ensheng Dong (second from left in the photo above) is a first-year graduate student in civil and systems engineering with a focus on disease epidemiology. He also holds MS degrees in statistics and geography. He used his experience building a geospatial mapping tool to track measles hotspots to create the coronavirus display.

Dong’s thesis advisor, who help create the dashboard, has told him that this year isn’t normal and that he should “prepare for a really boring second to fifth years.”

Reader Comments

From Down In Flames: “Re: Allscripts. Big layoffs this week.” Here’s some of what I’ve heard from the folks who emailed me. None of this is confirmed, just what they told me:

• The company laid off 5% of employees across the board (some say it was more than that, perhaps 10%).
• Salaries of high-earning employees were cut for six months: $100-150K (15%), $151-225K (20%), $226-325K (25%), more than $325K (30%).
• Merit and promotion raises have been deferred until 2021.
• All contractors have been dismissed.
• An austerity travel ban that has been in place since early January is now being blamed on COVID-19.
• Bonuses that were accrued in 2019 will be paid “sometime soon.”
• Clients aren’t paying their bills due to lack of profitable elective surgeries.

From Allscripts Employee: “Re: Allscripts layoffs. Playing Titanic deck musical chairs continues, as even teams that are hitting goals are hit with reorgs every nine months that seem to be solely to allow executives to justify their existence. The C-suite will blame everything on COVID-19 instead of their many poor business decisions over the years (Practice Fusion, Avenel). They didn’t even warn employees, many of whom would have gladly left and found other jobs given the chance.” 

From PE Watcher: “Re: Allscripts. Paul Black is out of runway. The low share price has private equity circling to buy it cheap, then sell off the parts of the business like Veradigm that might attract a cash buyer.” MDRX shares are at $6.69, down 30% in the past 12 months and down 29% since Paul Black took over as CEO in December 2012 (versus the Nasdaq’s loss of 1% and gain of 162%, respectively). The company’s market cap is just over $1 billion.

From Exhibit Hall of Shame: “Re: HIMSS. Making a slight pivot.” An email from Hal Wolf that was forwarded to me says:

• Exhibitors will be credited 25% of their total HIMSS20 payments, to be spread over HIMSS21 and HIMSS22 (15% and 10%, respectively).
• Startup and University Row exhibitors will be credited their full payment, spread equally between the two future conferences.
• Paid exhibitor and client booth badges can be used at HIMSS21.
• Payments for optional events — such as the Universal Studio outing, awards gala, and CIO Forum — will be credited against optional events at HIMSS21.
• Some hotels are giving refunds, some aren’t, and HIMSS is puzzled why some of them are telling people to contact HIMSS when it’s the hotel’s decision and cancellation policy that determines if refunds are offered.
• HIMSS has cancelled employee raises and bonuses for this year.
• HIMSS notes on its updated FAQ that it is considering changing its hotel deposit requirement through OnPeak to just one night.

From Accounts Prayable: “Re: HIMSS20. Another outrage — we just received an invoice for ads in the Show Daily handouts, poorly named in this case since they were not actually handed out.”

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Announcements and Implementations

NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center in Manhattan.

Experian Health offers free access to a list of payer policy alerts related to COVID-19 and telehealth to help providers avoid payment delays.

Blessing Health System (IL) implements CareSignal’s COVID Companion educational text-messaging program for patients.

Hyland Healthcare develops an enterprise version of its PACSgear server software for imaging capture and exchange.

EMPI vendor Verato offers Telehealth Identity Bridge, which links a patient’s EHR and telehealth visits to give clinicians a full clinical history. The company offers health systems and health plans free use through the end of the year.

Government and Politics

President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project. She takes over from James Byrne, who was fired in February for purportedly clashing with members of the leadership team. Powers is a US Air Force Academy graduate, holds masters degrees in military leadership and organizational management, and is a retired Air Force colonel and cyber communications officer. 

CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner. The San Diego-based health IT company previously sued the VA to protest its no-bid selection of Cerner and then sued Cerner for patent violations.

VA Secretary Robert Wilkie assures Congress that parts of the VA’s shift to Cerner remain on schedule, including development of the VA-DOD Joint Health Care Exchange and other interfaces, infrastructure upgrades, clinical workflow design, and integrated testing. The transition to Cerner’s scheduling system will be delayed.

COVID-19

A National Academies of Sciences, Engineering and Medicine report that was commissioned by the White House warns that no evidence exists to suggest that coronavirus spread will mimic flu by tapering off in the summer, noting that coronavirus is running rampant in countries that already have high heat and humidity. The authors conclude that the potential absence of seasonality, along with global lack of immunity to coronavirus, make it unwise to count on those factors in developing strategies.

HHS tells a House panel that the federal government’s supply of personal protective equipment is depleted and states will receive no more. The federal government has distributed 11.7 million N95 masks versus the 3.5 billion the administration had said were needed, while just under 8,000 ventilators were sent out. HHS employees say the allocation was based on population, not state requests, which has led to shortages that required states to lend equipment to each other.

The federal government asks its health officials to track COVID-19 deaths by race after several states report that disproportionately high percentages of African Americans are dying. Every one of St. Louis’s 12 COVID-19 deaths were African Americans, although the significance of that finding will require looking at the presence of chronic disease and social determinants of health.

A Black Book survey finds that nursing homes are underreporting COVID-19 cases because of lack of technology, heavy use of agency and per-diem workers, and lack of ability for long-term care providers to find out which other facilities have cared for COVID-19 patients. Hospitals are discharging COVID-19 patients into long-term and subacute care without having test results and 96% of nursing home respondents say that they no longer believe that their facility is the best place for housing elderly, susceptible people.

Executives at Detroit Medical Center’s Sinai-Grace Hospital (MI) send ED nurses home after they refuse to work because of understaffing. Two nurses were covering 26 patients, 10 of whom were on ventilators, and seven night shift nurses are covering up to 100 patients versus the proper staffing of 21 nurses per shift . After ordering the nurses off campus, the hospital held day shift nurses over to cover for them, extending their shift to 24 hours.

Nearly 100 residents of a California nursing home that has been hard it by COVID-19 are evacuated after employees fail to show up for work for the second straight day. Officials say that 34 residents and 16 employees have tested positive for coronavirus.

Experts warn that US COVID-19 testing remains constrained and is not growing rapidly even as the number of cases skyrockets, leaving the only option as continued mass social distancing rather than identifying and quarantining those who are infected. A Nature review finds that universities that offer certified COVID-19 testing are not operating at full capacity because of lack of contracts between providers, incompatible EHRs, the FDA’s requirement that labs hold a CLIA certificate, and a lack of federal leadership. A director of UC Berkeley’s genomics institute offered hospitals a free alternative to the state health department tests – which had a backlog of 57,000 – but explains, “I show up in a magic ship with 20,000 free kits and CLIA and everything, and the major hospitals say, go away, we cannot interface with you.” Sutter Health turned down at least one academic provider of COVID-19 tests because no electronic interface exists and it wants to expand its own testing capacity. Boston Medical Center agreed to use tests from Boston University School of Medicine only after a bioinformatics graduate student wrote a script to connect orders and results to its EHR.

With numerous protective measures still in place, the City of Wuhan, China reopens to outbound travel after a nearly three-month lockdown to prevent the spread of COVID-19.

Amazon Web Services will partner with the Yale School of Public Health to offer 30 hours of online training to people interested in becoming volunteer health workers. The course will teach them how to work at drive-through COVID-19 testing sites, support homebound patients over the phone, and record vital signs in pop-up triage facilities.

University of California, Irvine designs and creates 5,000 3D-printed face masks for UCI Medical Center.  Their low cost allows them to be discarded between patients as requested by clinicians.

Other

UC San Diego Health physicians pilot an internally developed machine learning algorithm that enables radiologists to better screen for pneumonia on chest X-rays, which can also turn up potential COVID-19 cases.

UW Medicine launches the DoD-funded HIPPOCRATIC app-based research project, which will use health and wellness data from 25,000 volunteers to inform the development of predictive analytics ahead of future outbreaks. Researchers also hope to better understand the feasibility of using a smartphone-based screening tool instead of drive-through screening and testing sites.

American Association of Nurse Practitioners cancels its annual conference in New Orleans, offering full refunds to registrants and exhibitors. AANP is cancelling all the hotel rooms in its block (it does not use OnPeak or other housing service) and will not charge the one-night deposit.

“If you want to recruit fake doctors, we’re ready. We can help hand you stuff.” Past and present TV doctors come together to thank healthcare workers on World Health Day.

Sponsor Updates

• Microsoft publishes a case study titled “SyTrue offers AI-based healthcare solution at no charge to public health organizations to help them fight COVID-19.”
• The Tampa Bay Business Journal honors Greenway Health SVP Karen Mulroe as one of its 2020 Top Corporate Counsel honorees.
• Healthcare Growth Partners publishes “Health IT March 2020 Insights.”
• Esse Health expands its use of CareSignal software to include a COVID-19 text-messaging program for patients.
• PMD announces record adoption of its telemedicine platform in March.
• Collective Medical’s product offerings meet new CMS ADT notifications conditions of participation.

Blog Posts

• Keeping clinicians and patients safe through remote ventilator visibility (Capsule)
• The Journey to Empowering Patients via Apple Health (Engage)
• Flattening the Curve with Telehealth (EClinicalWorks)
• We’re all in this together, now and forever (Hyland)
• Imprivata GroundControl: Enabling secure virtual visits during hospital lockdowns (Imprivata)
• Clinical terminology in a time of uncertainty (Intelligent Medical Objects)
• What Consumer Search Behavior is Telling Us About Coronavirus & Implications for Access to Care (Kyruus)
• COVID-19: Enlisting the EMR in the fight (Optimum Healthcare IT)
• Leveraging MEDITECH’s EHR During the COVID-19 Pandemic (Meditech)
• Cross-Functional Teams of PMD: It Takes an Orchestra! (PMD)

Contacts

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

EPtalk by Dr. Jayne 4/9/20

I’ve been reading tons of scientific papers this week, trying to keep up with recent research on COVID-19 while alternating other things I have put off, such as finishing my tax return. I know the deadline has been pushed, but I’m expecting a refund this year so wanted to get things moving.

I enjoyed coming across this decidedly non-COVID article discussing the “Association between lottery prize size and self-reported health habits in Swedish lottery players.” That’s a decidedly niche research set, for sure. In case you’re curious, the question they were seeking to answer was this: “Is unearned wealth from lottery winnings associated with more healthy habits and better overall health?” Looking at over 3,300 individuals up to 22 years after their lottery win, they found no statistically significant differences in long-term health behaviors.

I also took some time for personal healthy behaviors, such as continuing to binge watch “Poldark” and also watching the first two episodes of the new season of “Call the Midwife.” I enjoy its gritty portrayal of nurses in London during the 1950s and 1960s. Although it makes me grateful for the medical technology we have today, it also makes me wonder how things would be if we had a similar national focus on neighborhood-based care, including home outreach. If there’s any good to come out of this pandemic, perhaps it’s a re-evaluation of how we deliver care around the world.

Speaking of remote care options, one of the things I wanted to see at HIMSS was the GlobalMed Transportable Exam Backpack. I was impressed by their exam cameras last year. They have integrated those plus a few more tricks into this bag, including EKG and ultrasound. Apparently its predecessor was a ruggedized briefcase that was used in various capacities, including treating Secret Service agents detailed abroad and enabling communication with physicians in the US. The images obtained with their cameras are better than what I sometimes see with my own eyes in the office, which makes me wonder about using solutions like theirs to augment in-office workflows as well as those in remote locales.

April 12-18 is STD Awareness Week, and a recent writeup made me wonder whether social distancing will have much of an impact on sexually transmitted diseases. I live in one of the US cities with the highest rates of STDs, so a reduction in illness would certainly be welcomed. The article notes that the event used to be the full month of April, but even with the condensed timeframe, the goals are the same — raising awareness, providing education, encouraging testing, and reducing stigma, fear, and discrimination. Stay healthy, folks!

When patients test positive for sexually transmitted diseases, public health agencies have to perform contact tracing. That kind of work has come into the spotlight with COVID-19. I’m hoping some of those technologies can be later adapted for routine use. A group of innovators from MIT and other organizations has created a solution that not only helps with tracking, but also helps maintain privacy for individuals who allow it to use their location tracking data. Patients’ memories aren’t always reliable over time and other countries have made great use of location data, not only for contact tracing, but to enable a return to a more normal level of human interactions.

I was glad to see CMS applying its Extreme and Uncontrollable Circumstances policy for clinicians who aren’t able to submit their Merit-based Incentive Payment System (MIPS) data by the recently extended April 30 deadline. The policy will be automatically applied to those who don’t submit – clinicians will be flagged and receive a neutral payment adjustment for the 2021 MIPS payment year. For those organizations who started data submission but aren’t able to complete it, a separate non-automatic application can also be completed.

For those of you who spend most of the winter checking this graphic from week to week, I think we can safely say goodbye to flu season. Many of my coworkers would give anything to go back to even a bad flu season rather than what we’re dealing with now.

It’s a safe bet that most medical school graduates from the Class of 2020 will receive their diplomas in the mail. My alma mater canceled its commencement exercises weeks ago, even before the first states started going on lockdown. They realized that people were already making travel arrangements and wanted to send a message for folks to stay home. It’s the first time the university has ever cancelled commencement, even with world wars and other conflicts.

They sent out an alumni blast today asking us to send messages to the newest graduates as they carry their brand new MDs into a world that none of us envisioned. Here’s to all the new physicians, nurses, therapists, and other healthcare providers heading into this brave new world. My virtual hat is off to you.

From HIT Girl: “Re: specialists. I am not a clinician, so this might be a doofus question, but how easy or difficult is it for a specialist to work as a generalist? Doctors and nurses are getting sick, getting exhausted, and visibly suffering moral distress. Can specialists be rotated in to take over and let people take some time off to regenerate (or recuperate, if sick)?” This is the approach many healthcare systems are taking, although they are trying to find synergies in what kinds of resources can do which kinds of work. For many subspecialists, such as cardiology and gastroenterology, their underlying training is in internal medicine and they have a lot of knowledge that can be brought to bear in the hospital setting. They might not do as well in the outpatient setting, where we see a broader spectrum of chronic care than what they are used to encountering.

Many physicians are taking online refresher courses to get up to speed before they’re redeployed to other clinical areas. My experience, in delivering urgent care and primary care at the World Scout Jamboree, is that a lot depends on the individual clinician and their training. The subspecialty surgeon with whom I worked had a terrible time treating basic primary care issues such as strep throat, and his continued frustration with the EHR added to his inflexibility and unwillingness to learn. Conversely, the pediatric rheumatologist slid right into adult-ish medicine without blinking and even made a couple of great saves.

Bottom line: your mileage may vary when redeploying physicians. There are some procedures I haven’t done in decades and wouldn’t have any business attempting them regardless of how many videos I watch.

Thank you to all the readers who sent me words of encouragement in response to my recent underemployment. I’m trying to pick up telehealth visits where I can, although the big surge seems to have passed in those as companies have onboarded new physicians in droves.

Several wrote with their own physician stories that could form an administrative hall of shame. One busy primary care doc who expertly transitioned to telehealth saw her schedule reallocated to her partners who weren’t as busy. Others were told to use vacation time to make up for closed clinic hours even though they were willing to see patients virtually. Another office is requiring all the providers to come to the office to deliver telehealth services, citing HIPAA and “place of service issues” as the reason providers can’t operate from their homes. The common theme was poor communication – major changes in how physicians operate probably shouldn’t be delivered via impersonal group text messages.

I appreciate each of your stories about your personal “new normal.” Please keep them coming.

Email Dr. Jayne.

Morning Headlines 4/9/20

Pamela Powers tapped to perform duties as VA’s No.2

President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project.

Epic Partners with New York Hospitals for COVID-19 Patients Treated at Manhattan’s Javits Center

NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center.

CliniComp International Gets $429M DHA IDIQ to Help Manage Clinical IT Systems

CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner.

Morning Headlines 4/8/20

Former FDA Leaders, Health Experts Urge Action Now to Contain COVID-19 in Future

Duke’s Margolis Center for Health Policy proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options.

Tyto Care Raises $50M to Expand Its Telehealth Exam and Diagnosis Offering Globally

Telemedicine and related device company Tyto Care raises $50 million in an oversubscribed funding round.

CyberMDX raises $20 million to protect connected medical devices with AI

New York City-based startup CyberMDX will use $20 million in new funding to scale its healthcare cybersecurity capabilities and hire an additional 30 employees.

News 4/8/20

Top News

Duke’s Margolis Center for Health Policy – along with former FDA Commissioners Mark McClellan, MD, PhD (the center’s director) and Scott Gottlieb, MD, former National Coordinator Farzad Mostashari, MD, and other participants – proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options. Recommendations:

• Roll out rapid diagnostic testing everywhere and for every person with COVID-19 symptoms, allowing quick identification of those infected and of those at high risk (such as healthcare workers), and conduct random tests to detect small outbreaks.
• Use the test-and-trace results to feed a national syndromic surveillance system that transparently reports outbreaks.
• Conduct widespread serologic testing to identify immunity markers and to supporting making decisions about sending people who are immune back to work.
• Require providers that receive federal coronavirus grant money to actively participate in the surveillance and response system.
• Encourage standards-based lab results reporting (CDC, CMS, and ONC).
• Incorporate ADT notices into the surveillance system for COVID-19 detection and for correlation to clinical observations, admissions, and transfers to ICU (CDC).
• Publish daily summaries from the surveillance system at the metro area level.
• Improve the use of technology to manage case-based isolation.
• Develop a common platform to query data from hospital EHRs, HIEs, and CommonWell and Carequality (CDC, ASTHO, ONC, and OCR).
• Help health systems and insurers manage patients who have tested positive (CDC).
• Publish best practices and case management models to maximize the ability to treat new cases at home or in local isolation facilities (CDC).
• Pay providers based on case outcomes (CMS and CDC).
• Lead and fund projects to answer questions about asymptomatic spread, the impact of more refined physical distancing measures, the ability predict and influence case severity, and the role of children in transmission (CDC).

Reader Comments

From Anointed Two: “Re: HIMSS20 hotels. I can almost understand Marriott keeping one night’s deposit, but keeping the entire prepaid amount is inexcusable greed. I hope that we vendors remember how HIMSS and OnPeak did nothing to negotiate on our behalf when it comes to HIMSS21.” The hotel rather coldly told this reader this: “The agreement that the hotel entered with HIMSS was an advance payment of each attendee regardless of circumstances. The hotel will be retaining these prepayments.” The HIMSS rationale for requiring exhibitors to book hotels through OnPeak is that the convention center allocates exhibit hall space based on hotel rooms booked. I can confidently predict going forward that convention centers will have all the space any exhibitor could ever want given the dying conference business, not to mention that the HIMSS track record should be adequate to convince the convention center to not stiff it on space. All that aside, I don’t think the hotel policies have caused many gripes in the past, so unless another HIMSS conference is cancelled inside the no-refund window, it’s probably all moot anyway, although I would refuse on principle to book any Orlando hotel for HIMSS22 that screwed me for HIMSS20.

HIStalk Announcements and Requests

I tweaked my current poll about personal COVID-19 experience to include “presumed positive” in addition to “tested positive” (since testing availability is still a train wreck). It’s still not perfect but the best I can do without creating a multi-page survey that nobody would complete, but you can always add more descriptive comments after voting.

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Acquisitions, Funding, Business, and Stock

Hospital operator Quorum Health files Chapter 11 bankruptcy as part of a pre-packaged plan to reduce debt. The company says its 23 hospitals and Quorum Health Resources subsidiary will continue to operate normally.

Companies that inserted mandatory arbitration terms in their business and employment agreements to avoid class-action lawsuits (Epic was the US Supreme Court test case for employers) are subverting the process they created after being overwhelmed with mass arbitration claims. Big companies – which assumed that people wouldn’t bother filing claims — are now refusing to pay the arbitration costs that they themselves specified. One law firm filed 6,000 arbitration claims on behalf of independently contracted delivery drivers for DoorDash, which balked at paying the $9 million in arbitration fees and then rewrote its terms to require using a particular arbitrator whose rates were lower. An unsympathetic federal judge ordered the company to pay the fees, saying, “Your law firm and all the defense law firms have tried for 30 years to keep plaintiffs out of court. And so finally someone says, ‘OK, we’ll take you to arbitration,’ and suddenly it’s not in your interest any more. Now you’re wiggling around, trying to find some way to squirm out of your agreement. There is a lot of poetic justice here.”

People

Clinical AI vendor Jvion hires industry long-timer Jay Deady (Recondo) as CEO.

Chris Aulbach, MS (Cognizant) joins CipherHealth as chief product officer.

Announcements and Implementations

The American Medical Association publishes a  128-page physician guide for implementing virtual visits, which includes a section on evaluating related technologies.

Santa Barbara Cottage Hospital (CA) goes live on PeriGen’s PeriWatch Vigilance automated maternal-fetal early warning system. Part of that system is a centralized acuity management tool that facilitates remote monitoring of laboring patients anywhere, providing flexibility for COVID-19 staffing.

HCA Healthcare and Google Health create the COVID-19 National Response Portal to allow hospitals to share pandemic metrics.

Audacious Inquiry launches the Situation Awareness for Novel Epidemic Response (SANER) Project, which is working on a specification to allow hospitals to send situational awareness reports to public health authorities.

Epic almost never issues press releases, but pushed out this one touting its telehealth capabilities. It calls itself “the nation’s largest electronic health records company,” which it certainly isn’t in terms of company headcount or revenue compared to Cerner, but perhaps is that among companies whose only business is selling EHRs. Novant Health went from 200 video visits per year to 12,000 per week, while NYU Langone Medical Center is conducting 6,500 virtual visits per day, more than 70% of its total. Another Epic update says the company’s EHR now includes two COVID-19 related patient registries to track known or suspected cases.

COVID-19

Former FDA Commissioner Scott Gottlieb, MD tells CNBC that someone needs to take ownership of the surveillance and isolation program to get it in place by August, along with developing 1-2 drugs that can help treat COVID-19 patients with even modest success, to avoid having the economy stall at 80% of pre-coronavirus levels. He expects schools to reopen in the fall, but with added vigilance to detect local outbreaks, and reiterates that development of a vaccine is the ultimate solution at least 18 months down the road.

National COVID-19 hospitalization numbers are trending down, as the curve-flattening seems to have worked in reducing demand for ICU beds and ventilators. Deaths are still increasing in New York as a lagging indicator (731 on Monday), but are expected to be lower than initial projections for both New York and the US.

Amazon launches a hospital-only section of its Prime service for selling face shields, masks, thermometers, ventilators, exam gloves, and sanitizer. The company will verify the qualifications of potential buyers and will waive its commissions on purchases.

Educational non-profit EDX and Harvard launch an free online course on ventilator use, hoping to help those clinicians who are reassigned to the ICU.

The New York Times explains why official coronavirus death counts are probably far below the actual numbers:

• Coroners don’t have the tests they need to detect coronavirus.
• Early cases in February and early March were likely listed as being due to pneumonia or influenza.
• The system of filling out death certificates and the responsibility for doing so is inconsistent.
• Also inconsistent is the reporting of deaths in which coronavirus is proven or suspected to be present, but not necessarily provable as the single cause of death.

HCA Healthcare-owned West Hills Hospital and Medical Center (CA) suspends a nurse for asking Facebook friends to donate personal protective equipment that her employer wasn’t providing. The hospital says she mentioned in a private chat group that her unit was treating COVID-19 patients only and those statements violated HIPAA and the hospital’s social media policy. She’s in quarantine after being exposed to the virus. An ED nurse at the same hospital said that he was also suspended after mentioning that he was working in a COVID-19 unit. Some healthcare workers are filing whisteblower lawsuits after being fired for issuing social media pleas for PPE.

ICU nurses at Newark Beth Israel Medical Center (NJ) were so desperate for gowns and masks that they raised money on GoFundMe to equip themselves via Ebay purchases. Hospitals executives then suspended Olga Matievskaya, RN, BSN, the nurse who organized the campaign, for distributing unauthorized PPE.

HHS OIG’s survey of 323 hospitals from late March lists their coronavirus-related concerns. President Trump dismissed the report in Monday’s coronavirus briefing, saying “it’s wrong” and scolding the inspector general on Twitter for not talking to “admirals, generals, VP, and others in charge” before publishing the hospital survey results. Hospitals report:

• They are experiencing severe shortages of testing supplies and waiting seven or more days for results, limiting their ability to monitor the health of patients and staff.
• Shortages of PPE are widespread, federal and state help is uncertain, and some vendors are price gouging.
• Hospitals aren’t always able to meet staffing needs due to a people shortage, also worrying that exposure fears and burnout may contribute to short staffing.
• Post-acute care facilities won’t accept hospital discharges until the patient tests negative for COVID-19, tying up acute care beds.
• Hospitals are running out of IV poles, medical gases, linens, toilet paper, food, thermometers, disinfectants, and cleaning supplies.
• They are worried about ventilator shortages that may force them to choose which patients get them.
• Costs are increasing as revenues decrease with elimination of elective procedures, quickly depleting cash reserves.
• Guidance from federal, state, and local authorities is ever-changing and inconsistent, and public misinformation is causing patients to show up unnecessarily.

This is well outside my area of expertise, but a New Jersey hospital needs PPE and asked me to forward contact information for anyone who has access to it. Email me and I’ll forward the information.

Cerner sent these hospital recommendations for dealing with COVID-19 patient surge, from St. Joseph’s Healthcare System (NJ) VP/CIO Linda Reed, MSN, MBA:

• Review and implement the EHR vendor’s COVID-19 updates and packages.
• Review telehealth documentation and education.
• Prepare to develop lab interfaces for state surveillance.
• Create daily dashboard reporting.
• Review the IT requirements for opening surge beds in non-traditional areas.
• Implement the new COVID-19 diagnosis and billing codes.
• Prepare to support additional work-from-home technology needs.
• Review government reporting requirements.
• Use remote support tools to support desktops to limit trips to hospital units.
• Prepare for updating EHR access to accommodate clinicians who are reassigned.
• Use remote patient visualization technology to limit room entry.

Other

A Florida business paper covers Orlando Health’s replacement of Allscripts Sunrise with Epic. Orlando’s other big health system AdventHealth, is also implementing Epic, replacing Cerner.

A Baltimore TV station covers the use by Lifebridge Health and Johns Hopkins of technology from Emocha to keep in touch with self-quarantined clinicians. It offers symptom reporting, asynchronous video check-ins to verify thermometer readings, and two-way messaging.

Verizon cancels making onsite Internet connectivity service calls for homes and businesses, with some users reporting they were given a date of November to regain connectivity.

Miss England 2019, Bhasha Mukherjee, MBBS, shelves her overseas humanitarian work and returns to the UK to work at NHS’s Pilgrim Hospital. She explains, “When you are doing all this humanitarian work abroad, you’re still expected to put the crown on, get ready, look pretty. I wanted to come back home. I wanted to come and go straight to work.”

Sponsor Updates

• AGS Health spotlights employee Adelaide Rose’s mask-making efforts for hospitals in New Jersey.
• Medsphere’s ChartLogic division adds integrated telehealth to its ambulatory EHR that allows patients to launch video rooms from its patient portal for a virtual evaluation.
• Baxter Regional (AR) expands its use of EClinicalWorks technology to include virtual visit capabilities.
• Access releases COVID-19 Rapid Response EForms, which allows hospitals to offer contactless registration by sending patients an online screening form and then pre-registration documents to complete and sign remotely.
• Diameter Health partners with insurance technology company Clareto to improve underwriting and claims adjudication with data-cleansing technology.
• Experity updates its travel screening questionnaire to help urgent care providers identify new cases of COVID-19.
• Healthwise launches a Coronavirus Resource Center.
• Datica releases a new podcast, “ONC Final Rules on Information Blocking – Part 2.”
• CareSignal and Americares bring a new COVID-19 text messaging program to the uninsured.
• Clinical Architecture joins the COVID-19 Interoperability Alliance.

Blog Posts

• Leveraging Business Intelligent for COVID-19 Screening (314e)
• How are you coping? We love success stories. (AdvancedMD)
• Keeping Veterans and Responders Connected During a Crisis (Avaya)
• Social Distancing, Flattening the Curve, & Raising the Bar (Bright.md)
• What is Zoom Bombing? Immediate Steps to Protect Your End Users (Burwood Group)
• The Critical Role of Interoperability During COVID-19 (CarePort)
• Mentoring in the Tech Industry is Rewarding but Requires Time and Soul Searching (CentralLogic)
• How HIE is Playing a Role in Navigating the Coronavirus Outbreak (ChartLogic)
• Expanded Telemedicine Regulations: Documentation Requirements Overview (CereCore)
• NAS Strategies Across the Nation (Collective Medical)
• Expanding How CoverMyMeds Helps Patients Access Their Medications (CoverMyMeds)
• How Analytics can Help Hospitals Better Manage Their ICUs (Dimensional Insight)

Contacts

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

Morning Headlines 4/7/20

VA pauses work on EHR during coronavirus

Following in the DoD’s footsteps, the VA decides to delay its Cerner EHR project as clinical teams focus on COVID-19 patients.

Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey March 23-27, 2020

An HHS OIG survey of 323 hospitals finds their biggest challenges in preparing for and treating COVID-19 patients are associated with testing and treatment, and protecting staff.

Alliance of Va. hospitals launches dashboard tracking the status of medical needs

The Virginia Hospital & Healthcare Association develops a dashboard to help hospitals across the state visualize the number of COVID-19 hospitalizations, facility capacities, and data on PPE and medical supply inventories.

HHS Announces Upcoming Funding Action to Provide $186 Million for COVID-19 Response

The CDC will offer select state and local health departments $186 million to build out or improve on testing and surveillance capabilities, and predictive analytics.

Curbside Consult with Dr. Jayne 4/6/20

I was awakened this morning by a call from my clinical employer. Usually those early morning calls are along the lines of someone being sick and asking if I can cover a shift, or it’s one of my partners asking follow-up questions on a patient visit from the night before.

This morning’s call was absolutely surreal. They were notifying me that they’re taking me off the schedule for the rest of the month.

It would have been one thing had they just laid it out cleanly and said it was a low census issue. Instead, the person calling (who probably hadn’t discussed the word track with HR) went on and on about needing to have physicians “give up their shifts” because of other providers who have student loans to pay or whose spouses have been laid off from their jobs. I suppose they assume that physicians of a certain age don’t have student loans or other critical deb, and whatever other assumptions they made about my finances made me less needy of work than others.

I was frankly shocked that they would approach it in the way that they did. It is certainly not something I would handle with an early morning phone call.

A quick check of the “under revision” schedule shows that the majority of shifts being moved around were indeed those belonging to physicians, while keeping the physician assistants and nurse practitioners working. As it is in so many things, it appears to be about the money, because it certainly doesn’t look like it’s about having the most experienced clinicians available to treat patients who might have complex presentations. And it’s definitely not about presenting such a drastic change in a way that might be palatable to those affected.

They went on to babble about needing me to provide coverage “when the surge comes, whenever that is” as if we’re supposed to just pick up extra shifts at their beck and call. Mind you, this is an organization that declined my offer to help them stand up a telehealth program at the beginning of the COVID crisis. Where other similar clinics are using technology to deliver care and allay patient concerns in a way that makes patients (and staff) feel safe, we’ve entrenched and have watched the world pass us by.

I’m certainly not alone, as plenty of hospitals and practices have furloughed physicians in various subspecialties due to lack of demand. My ophthalmologist friends have been largely benched since they spent the majority of their time performing surgeries that are now classified as elective.

As someone who is used to manning the front door of the healthcare system, I didn’t think it would be me. It certainly doesn’t scream job security to know that when the going gets tough, decisions aren’t going to be made on quality of care, patient satisfaction scores, or the ability to treat patients quickly and thoroughly (since I’m an A+ performer in those areas).

Needless to say, I’ll be doubling down on the informatics work and telehealth visits for a while. Frankly, I wish they would have just pink-slipped me, because I’ve definitely lost that loving feeling.

Email Dr. Jayne.

Readers Write: Strained but Secure

Strained But Secure
By Troy Young

Troy Young is chief technology officer of AdvancedMD of South Jordan, UT.

Healthcare providers are pressed to the max, working to deliver ample care to the increasing volume of patients infected with COVID-19. Employees rise to the challenge and learn to get the job done in vastly different circumstances, be it on the front lines, in the back office, or remotely.

While we all try to navigate the new realities this pandemic presents, computer hackers are exploiting them: “Don’t let a crisis go to waste” is their mantra. Indeed, the novel coronavirus crisis has led to a rise in cyber scams and other security breaches as healthcare providers move quickly to redistribute workloads and manage care overflow.

Hackers are using tactics that capitalize on emotions of fear and anxiety and behaviors of internet users looking to stay on top of the situation during these uncertain times. They entice healthcare workers to open malicious files and links by:

• Creating a sense of urgency.
• Implying or stating that the e-mail comes from a person of authority.
• Offering a resolution to a difficult problem (the current virus, shortage of medical supplies, people in need, and similar) in exchange for sensitive information.

These tactics are especially effective during a time of crisis, when urgent communications from employers, friends, family, and government agencies are filling inboxes. These e-mails may include fake virus tracker maps, hand hygiene instructional sheets, or online marketplaces for high-demand items. Hackers have impersonated the World Health Organization (WHO), for example, in recent phishing emails.

As is the case with security at any other time, employees are the first line of defense against cyberattacks that are predicated by false communication. Providers should review policies with staff—whether employees are on site or working from home—and adhere to standard security plans and general workflow processes during the pandemic. Some scams are so well concealed that employees get fooled. These are best practices to keep top of mind:

• Always be suspicious of unexpected emails. Check the sender’s email address.
• Always look closely at any URLs, even those that are supposedly from people within the organization. Check the link by typing it into the browser.
• Never open a file attached to an email that was unexpected, or one that looks suspicious in any way. Take a pause to think through the purpose of the email. Don’t feel rushed or pressured to take any action.
• Never provide personal information like usernames / passwords or financial information after clicking through an e-mail link.

Even if someone falls prey to a phishing attack, organizations can mitigate risk by following these precautions:

• Require multi-factor authentication (MFA, or two-factor authentication) on as many accounts as allow them, especially banking and e-mail accounts.
• Enable automatic software and operating system updates on computers and mobile devices.
• Download anti-virus and anti-malware software on the network and personal computers as well as mobile devices. Windows and MacOS include these by default; just confirm they’re enabled and up to date.
• Back up all data.

The current crisis has highlighted organizational weaknesses in healthcare security and privacy protocols amid the urgent need to respond to government lockdown mandates, patient emergencies, and employee shortages due to illness. Employers have been rushed to establish telecommuting capabilities for staff who don’t typically work from home: when the need to expand capacity outstrips the organization’s ability to apply the security and privacy measures, risk increases exponentially. Also, as telecommuting employees increasingly use virtual meetings to communicate with each other, the National Institute of Standards and Technology (NIST) has recently published guidance on protecting virtual meetings from eavesdroppers.

VPNs are commonly used by healthcare organizations with telecommuting staff to provide secure access to technology resources. Microsoft recently warned that hackers are attacking vulnerable networks and VPNs, having particular success with a ransomware campaign known as REvil (or Sodinokibi). Organizations that use VPNs should refer to guidance from the Department of Homeland Security to secure their VPN and network infrastructures.

The COVID-19 crisis has also dramatically increased the use of telemedicine, which has emerged as an essential tool for providing contactless patient care. Regarding penalties, HHS recently notified providers that OCR has relaxed enforcement of HIPAA privacy rules during the crisis. This is great news for clinicians and patients, but providers should still be deliberate about using technology that is HIPAA-compliant and be sure to have BAAs in place with their vendor of choice.

The uncertainties of this global pandemic has many of us feeling vulnerable right now. Let’s control what we can. That includes built-in cybersecurity protocols that keep patients, employees, and organizations secure.

Morning Headlines 4/6/20

New York is merging all its hospitals to battle the coronavirus

New York State virtually merges all of the state’s 200 hospitals into a single state system that will share staff, patients, and supplies under the direction of the state’s department of health.

CDC Unveils 1st National Coronavirus Pandemic Tracking System

CDC rolls out COVIDView, an outbreak monitoring tool that displays key indicators that will be updated weekly.

Google is now publishing coronavirus mobility reports, feeding off users’ location history

Using its collection of mobile location data, Google begins publishing reports of how well people in 131 countries are following government directives to remain at home during the pandemic

98point6 Launches New Patient Resources to Ensure Best-In-Class Experience

AI-powered telemedicine company 98point6 will use a $43 million Series D funding round to launch its new patient wait-time dashboard and triple its physician staff by the end of April.

Here’s how doctors are monitoring more than 350 Delaware coronavirus patients virtually

ChristianaCare shifts technology it developed for a virtual primary care practice to remotely monitor COVID-19 patients.

Monday Morning Update 4/6/20

Top News

The FCC publishes details of the $200 million COVID-19 Telehealth Program, for which it will start accepting applications immediately.

The program will fully fund provider purchases of telecommunications, information services, and connected medical devices to provide remote services, with an emphasis on those that help low-income Americans and veterans.

Reader Comments

From Recovering CIO: “Re: provider layoffs. As they start to hit, I wonder how the organizations of readers are looking at funding in the CARE Act as well as the FCC’s $200 million telehealth funding.” I’ve created a submission form for provider readers to tell us.

From Imburse Me First: “Re: hospitals. Do they have incentive to game insurers, Medicare, or the bailout program by claiming patients died of COVID-19 when they don’t know for sure?” I’m guessing hospitals have the theoretical incentive to overstate COVID-19 deaths (I was reading a wacky conspiracy theory about that on Twitter), but I’ll ask experts to weigh in. My question is how deaths are categorized as being caused by COVID-19 – have all those patients tested positively, and was COVID-19 the cause or was it an incidental condition? Shelter-in-place should have reduced deaths from car accidents and injuries, so shifts in the numbers for deaths from heart disease, cancer, stroke, respiratory disease, and diabetes might indicate creative coding, although most of those are also predictors of COVID-19 outcomes. Obviously this is not a good time to suffer from a serious non-COVID condition that requires medical or surgical intervention, and we may see problems down the road as a result.

From Panama Jacques: “Re: your logo. Doctors should not be smoking – what a poor example for a healthcare site.” I’m happy for the recent uptick in readership, but it has sparked yet another round of smug observations from newbies who feel uncommonly blessed with perceptive powers. Your logo doctor smokes a pipe? The Monday Morning Update comes out Sunday? You’re biased for or against (insert any health IT vendor or political party here)? You write about music? Why are the news posts so long when I’m too busy to read it all? I started writing HIStalk four years before the first IPhone came out and haven’t changed it much since 2003. People have either kept reading it or they’ve moved on. Annual reader survey numbers for “reading HIStalk helps me do my job better” are always high (92% this year), so those folks apparently aren’t sweating the doc’s pipe or my periodically professed love for oddball music.

From Was A Community CIO: “Re: HIMSS20. Looks like a cash grab for OnPeak or HIMSS. Hyatt waived penalties for room cancellations due to COVID, but the charge remains on my card and Hyatt says they returned the money to HIMSS. Someone has my company’s money and I don’t think it’s Hyatt.” HIMSS says in the email thread that was attached that Hyatt didn’t send it money. I checked other conferences and it seems that OnPeak uses the credit card to hold the reservation, but it’s the hotel itself that actually charges your card for the initial deposit. In that case, I don’t know why Hyatt would have sent your refund elsewhere, which leads me to suspect they are the problem rather than HIMSS or OnPeak. I would probably dispute the charge with your credit card company since it shows Hyatt as the recipient. That will put the ball in Hyatt’s court.

HIStalk Announcements and Requests

Most poll respondents report experiencing some negative effects in working from home, most commonly related to exercising less, feeling disconnected, or eating unhealthily.

New poll to your right or here: what is your personal experience with COVID-19? Vote and then click the poll’s “Comments” link to tell us more.

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

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Announcements and Implementations

PatientBond offers hospitals its digital engagement services at no cost through June 2020, providing a weekly patient education email campaign related to COVID-19 prevention, detection, and treatment.

COVID-19

The Trump administration is considering paying hospitals at Medicare rates for treating uninsured COVID-19 patients, taking the money out of the $100 billion that was designated for hospital relief. The government proposed such payments as an alternative for opening up the ACA insurance marketplace for the many millions of Americans who have lost their jobs in the past few weeks, but experts question how payment would be assigned when patients may receive treatments for conditions other than COVID-19 in a single hospitalization.

The White House explains that the COVID-19 supplies it is bringing in from China and sending to states are actually going to commercial distributors for resale to the highest bidder, as the federal government does not want to disrupt the supply chain.

New York State virtually merges all of the state’s 200 hospitals into a single state system that will share staff, patients, and supplies under the direction of the state’s department of health. Challenges include how billing will work when a patient is moved to an out-of-network hospital, how staff can be moved to a distant facility without disrupting their families, and determining how hospitals pay each other for the resources they share.

CNBC profiles the New York City “disease hunters,” who after 9/11 set up a syndromic surveillance system using data from hospital EDs. One of those involved was NYC Department of Health Assistant Commissioner Farzad Mostashari, MD (later National Coordinator, now CEO of Aledade), who looked at his old system on March 4 (the day before HIMSS20 was cancelled) and started tweeting about a high volume of patients with flu-like symptoms, when the city had only 100 confirmed COVID-19 cases. As with many public health projects, this one suffered from federal-state clashes, a heavy-handed yet underfunded CDC, and overall public health funding cuts in 2019.

The first and best public health school in the world, Johns Hopkins Bloomberg School of Public Health, lists the “5 Ways the US Botched the Response to COVID-19.”

The Gates Foundation is testing seven coronavirus vaccines and is building manufacturing capacity for each of them to speed up any eventual production, even with the knowledge that one or two of them at most – and possibly none of them – will be found to be effective. He says the parallel process will waste a few billion dollars, but it’s worth it given the trillions of dollars that are being lost economically.

CDC rolls out COVIDView, an outbreak monitoring tool that displays key indicators that will be updated weekly. Sounds like a good idea, other than it’s late in the game and the infrequent updates limit usefulness. I truly don’t understand why the federal government isn’t tapping into the Cerner, Epic, and Meditech EHR databases that cover the vast majority of hospitals and a significant portion of their ambulatory operations, and instead is asking for daily worksheets to be emailed. Maybe epidemiologists just aren’t aware of the trove of real-time electronic data that hospitals are sitting on, or don’t have the right people demanding access to it.

Hospital staffing firms that are owned by private equity firms are cutting the hours and pay of their doctors as COVID-19 has reduced the demand for other services, especially elective procedures. Among them: TeamHealth, SCP Health, US Acute Care Solutions, Envision Healthcare, and Alteon Health. The latter laid off clinicians for 1-6 months and won’t guarantee hours for part-time employees, explaining in an internal email, “Anyone not willing or unable to share the burden will need to be terminated to preserve employment for those who really feel part of our team and care about their co-workers.” An anonymous ED physician who works for Alteon said. “Healthcare workers are being applauded in the streets and we are being stepped on by them.” Meanwhile, the wave of hospital layoffs and furloughs has turned into a tsunami as our screwy healthcare non-system finds itself under attack financially as well as microbiologically.

Other

Maryland-based contractor Cesar Capule, who was working on the Epic go-live at St. Agnes Hospital (WI), fell ill with COVID-19 symptoms during the project, was asked to self-quarantine at a local hotel, and eventually was admitted to the hospital’s ICU, where he was ventilated and died 17 days later on March 29. He was 49. I could find no further information about him.

A Palo Alto news site describes how Stanford Health Care is using telemedicine to screen patients who are worried they have COVID-19, saving the health system PPE and potential provider exposure in having ED doctors do video screening of people in the drive-through testing location. Stanford is now doing 40% of visits virtually, 50 times its pre-pandemic volume.

New Jersey’s governor calls for volunteer COBOL programmers (which he calls “cobalt”) to maintain the 40-year-old state systems that issues unemployment checks.

The New York Times profiles people who have moved to the US from other countries, but are going back because of our lack of universal healthcare, ineffective COVID-19 response, and overwhelmed hospitals in which even insured patients may not be adequately treated. Some had bought travel insurance as their primary healthcare coverage because US insurance is so bad.

The chief medical officer of Scotland, who appears in TV public service announcements in which she urges people to stay home, is formally warned by police after being captured in a photo walking her dog outside her second home that is 45 miles from Edinburgh. Residents of that town are annoyed at visitors who are traveling to their second homes and walking outside, some of them relocating from cities to self-isolate in their vacation homes where goods and medical services are scarce. Others note that while she is being vilified, Prince Charles – who has tested positive for coronavirus – moved freely from London to Balmoral. It is indeed good to be (future) king.

@drnic1 found this fun story. A bored, working-from-home astrophysicist in Australia is inspired by coronavirus to invent a necklace that sets off an alarm when the wearer touches their face. Not only did he inadvertently invent the opposite (the necklace alarms constantly until it detects a hand approaching the face), he also had to visit the ED to have the sensing magnets removed from his nose. His partner took him to the hospital where she works because “she wanted all of her colleagues to laugh at me.”

Sponsor Updates

• Spok offers a video tribute to healthcare workers who are on the front lines of COVID-19, including a wall of thanks from employees.
• Meditech extends its virtual visits offer to all customers for a six-month period.
• Wolters Kluwer Health releases a new educational video, “Understanding COVID-19 and How to Stay Safe.”
• The Chartis Group publishes an IS checklist for COVID-19.
• Wolters Kluwer Health adds COVID-19 tools to Sentri7 (infection prevention rules and population of Notifiable Conditions for COVID-related lab tests and results) and Health Language Clinical Interface Technology (access to COVID-updated SNOMED CT and ICD-10 codes).
• PerfectServe offers free software and services for Patient & Family Communication and free services to implement best practices for COVID-19 purposes.
• Relatient offers a free download, “Using Patient Engagement Solutions to Communicate with Patients during the COVID-19 Pandemic.”

Blog Posts

• Navigating Uncertainty: CMS Signals that Value-Based Care is Here to Stay (Lightbeam Health Solutions)
• The COVID-19 Financial Crisis: 6 Steps Hospitals Can Take Now to Help Their Patients and Themselves (Loyale Healthcare)
• Health IT crisis and disaster planning recommendations for COVID-19 (Meditech)
• COVID-19 Healthcare Cybersecurity: Best Practices for a Remote Workforce (Health Catalyst)
• As of 3/30/20, Medicare Has Still NOT Added PT, OT, or SLP as Telehealth Providers (MWTherapy)
• Long-Term Advocacy Effort Pays Off with Patient-Centered Changes to 42 CFR Part 2 Privacy Regulations (Netsmart)
• How Can OmniSys Help Your Pharmacy Support COVID-19? (OmniSys)
• COVID-19: The Implications for Industries (OpenText)
• Could the coronavirus make patient portals access point No. 1? (Experian Health)
• What Consumer Search Behavior is Telling Us About Coronavirus & Implications for Access to Care (Kyruus)
• 5 Benefits Provider Organizations, Health Plans, and ACOs are Seeing with PatientPing’s COVID-19 Flag (PatientPing)
• A Tool for Our Times (PatientKeeper)
• Pivot Point Perspective: New COVID-19 codes to improve data capture for tracking and payment (Pivot Point Consulting)
• 5 Ways to Boost Urgent Care Clinic Morale During Uncertain Times (Experity)
• Fool’s Gold and the Future of AI (Waystar)
• Videos from our Healthcare IT Interoperability Virtual Conference (Redox)
• Our Customers Have Our Hearts (SailPoint)
• Addressing COVID-19: Santa Rosa Offers Support (Santa Rosa Consulting)
• Prevent social distancing from becoming social isolation (StayWell)
• Managing change on a burning platform (Nordic)
• How to Convert Non-HL7 Files to HL7 Messages (Summit Healthcare)
• COVID-19 Influx: Using SymphonyRM’s HealthOS to Manage Through a Pandemic (SymphonyRM)
• Keep in Touch: 3 Technologies That Connect Rehab Therapists and Patients from a Distance (WebPT)
• Learning from COVID-19: Urgent Call for Innovation (Capsule)

Contacts

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

Weekender 4/3/20

Weekly News Recap

• HHS and CMS issue a long list of waivers and rules that relax limitations on telehealth billing, off-premise hospital services, PA/NP/CRNA supervision, COVID-19 testing, and sharing of patient information by business associates.
• Microsoft warns hospitals about VPN vulnerabilities that may attract ransomware hackers.
• FCC allocates $200 million to help providers buy telehealth equipment and services.
• CereCore lays off employees as its parent, HCA Healthcare, implements COVID-related expense cuts.
• The Department of Defense pauses its MHS Genesis Cerner implementation to focus on COVID-19.
• HHS asks hospitals to share COVID-19 testing data and to send bed capacity and supply inventory information to CDC via emailed worksheets.
• Apple develops a COVID-19 screening website and app in partnership with the federal government.

Best Reader Comments

10+ years after the HITECH act, countless billions of dollars being invested into EHRs, and endless hype about information exchanges, the government solution right now is to have everyone send VPOTUS a spreadsheet. (Low-Tech Act)

The dysfunction and regulatory ridiculousness of our health care system is laid out in perfect form when you look at all of the items CMS must DEREGULATE in an health care emergency — with the only interpretation being that more are completely unnecessary burdens on the physicians and other health professionals working day in and day out to treat patients. Absolute absurdity all around. (Regulatory Overreach)

If even a small portion of these comments [from HIMSS20 exhibitors] are true and come to fruition – and I agree overall – HIMSS will be greatly diminished. I wonder how many people HIMSS have laid off? And whether leaders are taking a haircut? Or will they cut and run? Sorta sucks that many of us – myself sort of included, but here I am – hesitate to share our true feelings for fear of being blacklisted, lose points, have the powers that be think poorly on our comments, etc. HLTH Forum in October WILL BE the canary in the coal mine for healthcare events in 2020. (ShimCode)

I think the way to be prepared for a once-every-100-year event is not by maintaining a large, expensive, and underutilized permanent bed capacity, but having detailed plans and the necessary supplies/materials to expand temporarily in an emergency. In spite of clear history and warnings from epidemiologists, we don’t seem to have done a very good job preparing for this eventuality at the organization, state, or national level. I’m not saying the challenges aren’t herculean, just that they should not have come as a surprise. (Surprised surprised)

Watercooler Talk Tidbits

Readers funded the Donors Choose teach grant request of Ms. H in Maryland, who asked for STEAM lab equipment for her class. She reported a few weeks ago, “The additions to our classroom were a surprise to our students. I waited until it was time to go home to display them. The looks on their faces were PRICELESS! I told them to write their questions on paper and being them to me the next day. I allowed students in groups of four to demonstrate how to use each activity in front of the rest of their peers. Each one of these have become a regular part of our day. For example, during our past Fun Friday Lab, I constructed an obstacle course for students to build and navigate the robot through. There were three rules to this Lab. 1) you must work with a partner, 2) you cannot use your hands or feet at any time while operating the Robot, and 3) When assisting with navigation, you must use directional words (left, right, forward, backward etc.). As you can see in the pictures, this is their favorite activity. This week we are adding the robot with the Twister mat to practice coding algorithms.”

The National Bobblehead Hall of Fame and Museum is accepting $25 pre-orders for a version featuring the federal government’s Anthony Fauci, MD, with $5 of each sale being donated to the American Hospital Association.

The $3.5 million Philadelphia home of private equity tycoon Joel Freedman, owner of shuttered Hahnemann Hospital, is vandalized after the city’s mayor accused him of demanding an excessive price to reopen the facility to increase COVID-19 patient capacity. Freedman bought the money-losing, safety net hospital for $170 million in early 2018, then closed it and filed bankruptcy for the hospital business while splitting off the land to develop condos.

Montefiore Medical Center (NY) insists that the New York Yankees ponchos it included in bags of personal protective equipment for clinical staff were gifts, disputing the statements of employees who said they were told to wear them as PPE.

FDNY thanks employees of hard-hit Elmhurst Hospital during shift change. BBC News profiled “the young doctors being asked to play God” at the hospital, which called nine codes in a single 12-hour shift on Wednesday, of which none of the COVID-19 patients survived.

Meanwhile, zealots are using #filmyourhospital to offer video proof that the lack of ambulances and foot traffic outside hospitals means that coronavirus is a media hoax, a psychological operation, an excuse to implement martial law, or the first step toward imposition of digital currency to create “one world order.” Some of the filmers chased hospital and ambulance employees down the street to demand an explanation for the scam.

A good Samaritan in Detroit uses $900 of his savings to offer free gas for nurses at Detroit Medical Center.

In Case You Missed It

• News 4/3/20
• EPtalk by Dr. Jayne 4/2/20
• News 4/1/20
• Curbside Consult with Dr. Jayne 3/30/20
• HIStalk Interviews Ed Marx, Chief Digital Officer, The HCI Group
• Monday Morning Update 3/30/20
• HIMSS20 Exhibitor Plans for HIMSS21

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 4/3/20

OCR Announces Notification of Enforcement Discretion to Allow Uses and Disclosures of Protected Health Information by Business Associates for Public Health and Health Oversight Activities During The COVID-19 Nationwide Public Health Emergency

The HHS Office for Civil Rights loosens HIPAA regulations to give healthcare business associates more leeway in sharing PHI “in good faith” during the pandemic.

Microsoft works with healthcare organizations to protect from popular ransomware during COVID-19 crisis: Here’s what to do

As remote workforces increase, Microsoft alerts several dozen hospitals to VPN infrastructure vulnerabilities that may attract ransomware attackers.

Google’s AI accurately predicts physicians’ prescribing decisions 75% of the time

Researchers from the University of California, San Francisco and Google develop an algorithm using EHR data capable of predicting physician prescription choices 75% of the time.

FCC Adopts $200 Million COVID-19 Telehealth Program

The FCC allocates $200 million to help qualifying providers purchase telecommunications, broadband services, and devices essential for offering telehealth services.

News 4/3/20

Top News

Health IT consulting firm CereCore lays off dozens of employees contracted to work for parent company HCA Healthcare, which has announced plans to cut costs in order to avoid its own layoffs.

The hospital operator has already seen several of its outpatient facilities close as procedure volume takes a nosedive in the wake of COVID-19.

The company’s senior leadership team will take a 30% pay cut for the duration of the pandemic. CEO Sam Hazen will donate his salary in April and May to the company’s charitable fund.

Reader Comments

From Slag Pile: “Re: hospital layoffs. How can this happen when they are staring down the barrel of crushing COVID-19 volumes?” Let us ponder the “only in America” healthcare system that we have allowed to be created, in which the million-dollar executives of architecturally imposing hospitals are responding to the most destructive health crisis in generations by firing their caregivers because of insufficient pandemic profit margins. I doubt any other country in the world would allow this to happen, but that’s true of nearly all aspects of US public health and healthcare delivery, where even hospices and nursing homes have been snapped up by private equity firms. We let healthcare become a big business, but then are surprised when it acts like one.

From Tilted Beret: “Re: HIMSS20 cancellation. This ‘interview’ with Hal Wolf is a fluff piece with no mention about refusing refunds, what it means to vendors and sponsors, etc. The ‘journalist’ is the director of content development for HIMSS – unbelievable!” I wouldn’t expect too many hardball questions or brutally honest answers when a HIMSS employee interviews the HIMSS CEO for a HIMSS publication, but maybe they could have put their collective heads together to come up with something more useful than to express “all about me” regrets that the HIMSS rebranding and new product announcements didn’t go as planned, that cancelling was the right call (which we now know), and a pitch for HIMSS Digital (which Hal says was already being worked on before HIMSS20). Hal also says that it’s a “great thing” that registration fees roll into HIMSS21, which is a less-great thing than getting your money back.

From YouveGotMailToIgnore: “Re: medication change request. Sent my specialist one through their portal. Before, the CMA would talk to the doctor and send an update back. Now the response is to schedule a telehealth visit. Maybe they are hurting for revenue, but it’s ironic since the last time I requested a telehealth visit I was denied.” My oft-repeated summary: people and companies will always choose the action that pays them the most. They didn’t need the money then, and now they do and insurance will pay – your preferences as a customer weren’t important then and they aren’t now. In fact, I should correct myself in calling a  patient a customer – unless you’re paying cash or have full discretion about who and how much your insurance pays, you aren’t really one.

From Administrator: “Re: patient surveys. The company that does ours sent a note telling us why we have to keep spending on sending these to patients during the crisis. Our clinicians would be fine if we stopped. Are revenue pressures forcing healthcare systems to try to get out of existing contracts or push for concessions?” I doubt most contracts contain customer “I can’t or really don’t want to pay” clauses that would render their contracts void or convince the vendor to renegotiate terms, but maybe readers can elaborate. I doubt anyone will do better than getting extended payment terms (with interest accruing).

From AM: ”Re: 3D printing. One of our patients donated face shields to our family medicine office that he printed. Pretty cool, and makes me think it would be worthwhile to purchase a 3D printer for the office. People are doing really good things out there, including developing cleaning stations in shipping containers and the couple who had gourmet chocolates delivered to our office. Sometimes negative attitudes and people usurp all our energy, but it’s important to remember that there are so, so many awesome people in the world who keep us going during the stressful days, and we have had an endless run of those lately.” Instructions and design files are here. Everybody is noticing the sudden mainstreaming of virtual visits, but 3D printing will also earn a spot on the list of technologies that coronavirus will turn into a standard.

From CopyPaste: “Re: ‘HIPPA.’ Even the government can’t spell it right all the time, at least in this Senate document.” We can only wish that this was the worst example of the federal government’s healthcare failings.

Webinars

April 15 (Wednesday) 1 ET: “Scaling front-line COVID-19 response: virtual education, screening, triage, and patient navigation.” Sponsor: Orbita. Presenters: Lawrence “Rusty” Hofman, MD, medical director of digital health, Stanford Health Care; Kristi Ebong, MPH, MBA, SVP of corporate strategy, Orbita. The presenters will describe how chatbots can be quickly deployed to streamline individual navigation to the appropriate resources, administer automated virtual health checks for monitoring and managing specific populations, increase access to screening and triage for high-risk populations across multiple channels (web, voice, SMS, and analog phone), and reach individuals in multiple languages.

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

Acquisitions, Funding, Business, and Stock

Startups are desperately trying to save their businesses in the suddenly terrible economy by remotely laying off masses of working-from-home employees.

People

Healthcare analytics technology vendor Geneia promotes Heather Lavoie, MBA to president and CEO.

Announcements and Implementations

CloudWave announces GA of OpSus Edge, on-site infrastructure technology designed to help healthcare organizations manage, secure, operate, and maintain critical applications.

Swedish (WA) implements an app developed with Microsoft that helps staff track COVID-19 patients, and hospital capacity and supplies.

OptimizeRx announces GA of TelaRep, giving physicians the ability to virtually consult with medical science liaisons about patient treatment plans.

LiveProcess offers health systems free access to its COVID-19 Response Package, which includes a virtual situation center for shared awareness, coordination, and tracking. It is based on the company’s SaaS-powered LiveProcess Emergency Manager for emergency response.

Lumeris develops a free and open source model to predict COVID-19 hospitalizations, essentially creating a patient registry that requires about 60 minutes worth of user work. The authors say the model tested as being more accurate than others, in the process finding that another company’s model delivered results that were less accurate than simply guessing when applied to people under 65. It works with population health platforms from Cerner, Athenahealth, EClinicalWorks, and Epic. Lumeris SVP of analytics Michael Cousins, PhD was involved and he is a biostatistician with a ton of experience.

Health Catalyst offers free use of its Patient Safety Solution COVID-19 module and Capacity Planning Tools to healthcare organizations.

Premier, Stanford Medicine, and Resilinc form The Exchange at Resilinc, a cloud-based platform for hospitals to identify, locate, and exchange critical medical items during the COVID-19 outbreak. The group purchasing organization-agnostic system is accepting provider and industry group members at no cost.

First Orion offers providers free use of its programmable Inform product, which allows them to show their organization’s name on Caller ID to avoid the 84% of calls – including medically critical ones — that aren’t answered by people because they don’t recognize the caller’s number.

CPSI offers free access to TalkWithYourDoc.com, a new, standalone telehealth platform that was developed by its Get Real Health subsidiary.

KLAS finds that while organizations are highly satisfied with standalone Epic ambulatory implementations, those who use it via the Community Connect model of signing up with a host organization are less satisfied, although even then their satisfaction is about the same as that of competing ambulatory EHRs. Some Community Connect users fault Epic for allowing host organizations to sell a subpar offering, with some perceiving lower value even though Community Connect costs less than contracting directly with Epic.

Government and Politics

The Department of Defense presses pause on its roll out of MHS Genesis to better enable its care teams to focus on treating COVID-19 patients. The Cerner-based EHR software has already gone live at eight sites. Original implementation plans had called for the system to be deployed in 23 waves through 2024.

The CDC seeks a new chief data officer.

The HHS Office for Civil Rights loosens HIPAA regulations to give healthcare business associates more leeway in sharing PHI “in good faith” during the pandemic.

Privacy and Security

As remote workforces increase, Microsoft alerts several dozen hospitals to VPN infrastructure vulnerabilities that may attract ransomware attackers.

COVID-19

England’s NHS is considering developing a contact tracing app that alerts people if they have had recent contact with someone who later tested positive for COVID-19. Oxford researchers proposed such an app in a March 31 in Science, saying that it can help avoid mass quarantines while still helping contain coronavirus spread.

Fred Hutchinson Cancer Research Center computational biologist Trevor Bedford announces the launch of the NextTrace project, which aims to help coordinate data from commercial, state, and academic testing labs and voluntary contact tracing data to better inform public health responses to COVID-19.

A follow-up hospital supply survey from Premier finds that active care for COVID-19 patients creates a surge demand 17 times greater than typically seen for N95 respirator masks, nine times greater for face shields, six times for swabs, five times for isolation gowns, and three times for surgical masks.

New York City records its first COVID-related homicide victim, an 86-year-old hospital inpatient who was assaulted by another patient for breaking social distancing guidelines. Cassandra Lundy, a 32-year-old seizure patient with 17 previous arrests, was charged with disorderly conduct.

The Army Corps of Engineers converts the Javits Convention Center in New York City to a care facility for 2,000 non-COVID-19 patients. Military personnel have also helped to transition the Billie Jean King National Tennis Center in Queens into a similar facility.

The State of New York launches an online portal to connect healthcare facilities with volunteer healthcare workers. The portal is part of Governor Andrew Cuomo’s recently announced Central Coordinating Team, a hospital network that will help facilities share data, staff, and beds.

Health officials in China developed the country’s world-class infectious disease tracking system after the SARS outbreak that was supposed to prevent political meddling with outbreak detection, but local health officials who were afraid of sending bad news to Beijing withheld coronavirus information and overrode doctors, delaying the country’s response. Central health officials learned about the outbreak from whistleblowers who leaked internal documents rather than the early warning system. Later, local authorities minimized the severity of the situation, created narrowed reporting criteria, and required cases to be reviewed by bureaucrats before reporting them to Beijing.

Other

In what’s being touted as a world first, a medical team successfully delivers diabetes medication and receives a patient’s return blood sample via drone delivery to a remote island off the coast of Ireland.

Several health systems in Wisconsin make headlines for continuing to sue patients for unpaid bills during the pandemic. Patients in default have reported being served papers by processors (without masks or gloves) as recently as March 28.

Sponsor Updates

• Wolters Kluwer Health accelerates roll out of coronavirus alerting, reporting, and ICD-10 and SNOMED CT codes.
• Frost & Sullivan recognizes Greenway Health with its 2020 North American Customer Value Leadership Award.
• SyTrue will provide its SyHealth for Population Health solution free of charge to qualified public health organizations.
• ComputerWeekly.com profiles Google Cloud CEO Thomas Kurian and the company’s efforts to support the fight against COVID-19.
• Engage receives a five-star rating from Securance Consulting for the fifth year in a row as a Best Practice Meditech Hosting Provider.
• Clinical Computer Systems, developer of the OBIX Perinatal Data System, offers free system configuration, connectivity, and licensing for customers who are setting up temporary units or isolation suites for COVID-19 patients, which includes pregnant women who need fetal monitoring.
• Elsevier releases a new episode of its COVID-19 podcast, “Medical Informatics and COVID-19: Role and Utility of Hospital Digital Resources and Telemedicine in Managing the Pandemic.”
• Imat Solutions enables real-time health data reporting and analytics for its customers in response to COVID-19.
• InterSystems releases a new PulseCast podcast, “Lygeia Ricciardi: Prioritizing Patient-Centered Design.”
• Intelligent Medical Objects publishes a new white paper, “Interoperability, information blocking, and the coming data tsunami.”
• PatientKeeper announces GA of its Meditech-friendly Clinical Communications Suite Now.
• Health Catalyst adds registry, dashboard, and capacity planning tools to its suite of COVID-19 solutions, and will soon add a new set of financial impact planning resources.

Blog Posts

• Feature Releases in PMD: A Lesson in Teamwork (PMD)
• How SG Pediatrics is Using TeleVisits to Help Patients (EClinicalWorks)
• Speeding Up Discharge Communication with Post-Acute Providers in a Crisis (Ensocare)
• New Virtual Training in Response to COVID-19 Restrictions (EPSi)
• COVID-19 public dataset program: Making data freely accessible for better public outcomes (Google Cloud)
• New resources to help you report for 2019 (Greenway Health)
• Introducing the Digital Healthcare Transformation Playbook (The HCI Group)
• The Impact of COVID-19 on Prescription Renewal Requests (Healthfinch)
• Forgiveness and Grace: Surprising Advice for Working from Home (Healthwise)
• COVID-19: Planning to Support Temporary Facilities (Optimum Healthcare IT)
• Close paper gaps with intelligent medical records classification (Hyland)
• Imat Solutions Helping Customers to Identify Patients at Risk of COVID-19 (Imat Solutions)
• Pivoting to Quickly Operationalize Teleheatlh for COVID-19 (Impact Advisors)
• Provider systems face a new crisis from COVID-19: Staffing (Imprivata)

Contacts

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