EPtalk by Dr. Jayne 5/14/20

EHR vendors have officially started canceling their annual user conferences or moving them online, with Cerner receiving coverage in the Kansas City Star. NextGen Healthcare hinted at a move to virtual in their recent earnings call, but I haven’t seen a formal announcement.

I agree that large gatherings, especially those with international attendees, are as Cerner officials noted, “irresponsible and ill-advised.” Epic is still showing their event scheduled for August 24-27 in Verona, with hotel reservations open through June 18. This year’s theme is “The Magnificent Land of Oz,” but I just hope it doesn’t turn into a magnificent viral exposure.

Funds are being granted from the pot spelled out in the CARES Act. The Department of Health and Human Services will distribute $20 million to four telehealth programs for pediatric and maternal care, and two projects focused on increasing the portability of medical licenses across state lines. The grants are being awarded through the Health Resources and Services Administration (HRSA), with two grants of $2.5 million flowing from HRSA’s Federal Office of Rural health Policy to the Federation of State Medical Boards (FSMB) and the Association of State and Provincial Psychology Boards. The FSMB launched the Interstate Medical Licensure Compact initiative back in 2017, attempting to make it easier for physicians to become licensed in multiple states. Those of us whose main licenses are in states that don’t participate are out of luck as far as being helped by the Compact.

Although HHS hopes the grant recipients will “work with professional and state licensing boards and national compacts to develop a streamlined process for telehealth clinicians to obtain multi-state licensure,” it begs the question whether this shouldn’t be for all clinicians and not just those practicing telehealth. I would love to be licensed in multiple states and travel more, but maintaining multiple licenses is a pain and a significant expense. I would love to see medical licensure go national since we have to take standardized national board exams anyway. States can still discipline physicians for improper activities that take place within their boundaries, but let’s free up the licensure pathway.

The remaining $15 million was granted through HRSA’s Maternal and Child Health Bureau, with $6 million going to the American Academy of Pediatrics, $4 million each going to the Association of Maternal and Child Health Programs and the University Of North Carolina-Chapel Hill’s Maternal health Care program, and $1 million going to Family Voices, which is a New-Mexico-based program for families of children with special healthcare needs. The grants are aimed at increasing telehealth services for adolescents, young adults, children with special healthcare needs, and pediatric practices that need to develop telehealth capacity for rural and underserved areas. Other offerings include virtual doula care, remote prenatal care, and behavioral health services.

I’ve spent what seems like a lifetime in bad meetings, many of which are not productive because there are no agendas and no designated scribes. It’s hard to follow up on action items when no one documents them. I was excited to hear about Cisco’s Webex Assistant, which claims to be AI_powered and capable of “everything from automatic note-taking and real-time transcription, to identifying meeting highlights and action items.” I watched their very slick video and have to say I’m intrigued. I’d be interested to hear from anyone who is actually using it. How does it work in real life? Can it handle speakers with different accents? Is it able to parse medical or technical verbiage? Or does it quickly become like Clippy and you just want it gone?

On the flip side, I was on a great call the other night, having been invited to a virtual happy hour with a group of sassy ladies. I’m glad we didn’t have a virtual assistant capturing our conversation because it was wide-ranging, and at least without a transcript, we have plausible deniability. It did get me thinking, though, that Cisco’s product would be even more compelling if you could put it in “snark mode” and have it capture side bar notes such as “Bob’s dog is barking again” and “We can hear the ice cubes clinking in Dave’s glass. Based on the pitch, it’s half empty. Do you think it’s vodka?”

Speaking of slightly stalker-ish software, my clinical employer (from which I am once again furloughed after working a couple of shifts) is offering social medial monitoring as part of its defined benefits plan. The package promises to deliver “actionable alerts when there are any potentially racist, derogatory, vulgar, or inappropriate comments within your social media posts.” Since I know my employer is already monitoring what we post and occasionally asks us to take things down, I’m not terribly interested in giving them or their affiliates any more personal information than they already have.

An editorial in JAMA Internal Medicine addresses the topic of “Commercial Influences on Electronic Health Records and Adverse Effects on Clinical Decision Making.” They retell the story of the Practice Fusion opioid prescribing debacle in plain terms that might be news to physicians outside the healthcare IT industry — that the pharmaceutical manufacturer’s marketing team contributed to the design of clinical decision support alerts that promoted opioid prescribing practices that deviated from the standard of care.

The authors call on EHR purchasers to “require vendors to attest that no commercial interests improperly influenced clinical decision support design and that all tools are based on unbiased and clinically appropriate standards.” That might work for out-of-the-box code, but I’ve also seen healthcare organizations and providers themselves manipulate clinical decision support tools, including order sets, to preferentially position services with a higher profit margin for the organization. Somehow we’ve got to get past the place where money is a key driver in the delivery of healthcare.

Atlas Obscura is one of my favorite time-wasters, and I’m always intrigued when something medical is mentioned. This entry hit two targets – women in medicine and handicrafts. The pillow sham in question dates to 1896, when a group of graduates of the Woman’s Medical College of Pennsylvania embroidered their signatures along with medical symbols such as a doctor’s bag, a thermometer, and a skeleton. My medical school class was the first at my school that had more women than men, and I am in awe of the women who truly pioneered our path during the 1850s.

For trivia buffs, the Woman’s Medical College of Pennsylvania was the alma mater of “Dr. Quinn, Medicine Woman,” which remains one of my favorite medical TV shows of all time, along with “M*A*S*H,” “Call the Midwife,” “St. Elsewhere,” and “Trapper John, MD.”

What’s on your list of favorite medical movies and TV shows? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/14/20

Cerner moves its annual conference online, canceling one of KC’s largest gatherings

Cerner announces that its annual conference, originally scheduled for October 12-14, will become a virtual event.

Health Catalyst Reports First Quarter 2020 Results

Health Catalyst reports Q1 results: revenue up 28%; EPS -$0.06 vs. -$0.23, beating analyst expectations for both.

RxSense Announces Investment From Parthenon Capital

Parthenon Capital makes an undisclosed investment in prescription savings and analytics vendor RxSense.

HHS Awards $15 Million to Support Telehealth Providers During the COVID-19 Pandemic

HHS grants $15 million to 159 organizations for telemedicine training.

Dr. Atul Gawande Assumes New Leadership Role at Haven

Atul Gawande, MD confirms that he will transition from Haven Healthcare’s CEO to chairman of its Board of Directors.

HIStalk Interviews Richard Atkin, CEO, Greenway Health

Richard Atkin, MBA is CEO of Greenway Health of Tampa, FL.

Tell me about yourself and the company.

Greenway Health’s customers are predominantly physician-owned practices, Federally Qualified Health Centers, and community health centers. We offer a broad range of solutions to those customers. 

I’m an engineer by education and training, so I tend to think about problem, process, root cause, and solution. I’ve been fortunate enough to have been in healthcare for over 25 years in a number of roles, a number of them at the CEO level, with companies such as Sunquest Information Systems, Spacelabs Medical, and Datex-Ohmeda, which is a part of GE Healthcare. Most of those are in the acute care space, so the transition to Greenway and ambulatory care has been a pretty exciting journey for me.

What technologies have seen uptake during the pandemic that will remain in the mainstream afterward?

Certainly the pandemic has validated the role of the electronic health record and the importance of the data that’s within it. I think it will also create an interesting dialogue between what is personal about the data and what can or should be shared for the benefit of the greater good. That’s one aspect that will become increasingly discussed going forward.

You mentioned telehealth. As restrictions ease and there’s a return — not to normal, but to a new normal — technologies for remote consults and ensuring that those consults are seamlessly included in the patient record will become increasingly important. The pandemic has created an awareness that you don’t always need to be face to face to get the advice and the treatment that’s required.

The importance of patient engagement solutions such as portals and messaging will, along with the telehealth, become increasingly important. The connected patient and the use of the internet to that ensure information flows seamlessly. All of those are going to be more important. It probably put more context to the new regulations, like 21st Century Cures, which were aimed at making data more liquid and transportable. It’s going to be an exciting time.

The other thing that was occurring but will be accelerated is the view that fully cloud-native solutions —  SaaS, cloud solutions, hosted solutions — create added benefit. They maybe reduce the reliance — certainly in practices, which are relatively small companies or organizations, small businesses — on in-person back office support through the increased use of SaaS solutions.

Are you seeing new demand for public health reporting from EHRs?

Public health and population health are always being discussed. The adoption has been lower than previously anticipated. A large proportion of our customers, the Federally Qualified Health Centers and community health centers, operate in that public health space.

Most of the discussion about data or information has been that it’s personal and private, and therefore is owned by the patient. Of course, that’s still true at a very large level. But for the public good — for public health, social determinants of health, and the management of things like a pandemic – there is a need to be able to share information, which currently could be difficult with the focus that has been on PHI as the primary driver of the conversation around data and information.

Do you see more emphasis on specific patient privacy concerns related to EHRs?

That has always been a significant part of the ambulatory space. Protected health information and the privacy associated with that has been restrictive in terms of how we use data. I understand the concern about selling information or having a commercial relationship around the data. I was really referring to public health and pandemic data analysis and management, even to the extent as we come out of the COVID-19 pandemic, the way in which we could use data to ensure that the ambulatory practices get the support that they need.

Greenway serves largely physician-owned practices or independent practices and businesses. Headlines around the pandemic are largely about the acute care space, and rightly so since they are on the front line, with bed shortages and the impacts on staff. Those are real challenges.

For the ambulatory segment, the issues are significant in the physician office space. Around 97% are reporting a reduction in revenues. There’s about a 60% or 70% reduction in visits, a 75% to 80% reduction in revenues, affecting over 97% of those practices. Those are huge issues. Many of them have had to furlough, lay off staff, or even close the doors, particularly those that serve the more elective elements of ambulatory care. 

Restarting those businesses is going to be challenging. We could use analysis of data to help, whether at the state, local, or even the national level. Some of the data that is currently blocked by PHI could help signal when and where practices need help. That’s a very different use of data than selling it to a pharmaceutical company or trying to monetize it. We need to get our arms around public health and public good as we think forward beyond the pandemic.

Are those independent practices at risk of closing or being acquired by health systems that have deeper pockets?

Those are real risks. Maybe for context I can describe how we’ve been dealing with that during the emergency, because many of our customers are operating at very reduced levels of visits. We pulled together a team early, led by our chief medical officer, Dr. Nayyar. The regulations are changing rapidly, being alleviated. Telehealth is one example, but there are many others, including billing requirements. Our team is reviewing, multiple times a day, any changes in the information at the state or the national level. We have ensured that the EHR solutions have the right workflows within them — diagnosis codes, CPT codes, billing codes, et cetera. Then we’ve put together a series of educational webinars, largely around the business aspects of running a small business or small practice. What grants are available, small business loans, how to apply for the loans, some of the criteria.

We are focused, at the moment, on helping them get through in the best way they can. Our view is that if we do that, first, that’s our responsibility as a partner. Second, if they come through this in the best shape possible, then we can work with them beyond this pandemic into the new normal.

There are reports that many physician-owned businesses might look to the local hospital to acquire them. Of course, those hospitals themselves are being significantly impacted, so that may or may not be the real path, or maybe it’s a private investment.

Ambulatory care is where we all, as a population, interact most with the healthcare system. We rely on the acute care space when we really need it. But on a day-to-day basis – for preventative medicine, routine visits, even medical exams for schools and sports as they restart, and so on — it’s the ambulatory part of the healthcare system. My view is that while it will be affected like every other part of society and the economic system, it will survive. It’s a much-needed part of the healthcare system, and it’s just that their needs will be a little different. Part of the solution to that is the technologies that we just talked about.

The pandemic took patient portals from an “only in healthcare” disdain to becoming a central point of presence that providers are using to launch new patient-facing technologies, such as chatbots and telehealth visits. How are patient portals being viewed now?

I agree with you. The patient portal is a critical and essential part of the suite of solutions. It always has been talked about that way, as you imply in the question, and yet the full adoption and then the full utilization of the portal has been relatively low.

Like telehealth, I think this will be one of those catalysts to say that the best way to interact with the patient — to keep the conversation going between the physician and the patient, particularly in the ambulatory space — is via a portal. There’s much more that you can do with it than pay your bill.

We are seeing the patient portal as a key part of our strategy. We included it in our product strategy under the heading of healthy outcomes. That’s where the patient-centric solutions are, along with some other ones like the population health and public health that we talked about. The role of ambulatory care is just as much to ensure that the population is healthy and doing the proactive things to stay healthy as it is to treat the illnesses that people have.

How would you characterize the state of interoperability?

It is still embryonic at best, let’s say. I don’t think the technologies, or the history of technology, have helped greatly, since healthcare was pretty early to adopt software solutions. The vast majority of EHRs on the market were designed or architected more than a decade ago. In fact, a decade-old EHR is still considered a relatively new entrant. And yet our view of what interoperability, user experience, ease of use, and connectivity should look like has changed dramatically in the last decade. 

EHRs generally in the industry are somewhat of an inhibitor to the ability to have true data liquidity and ease of interaction and interface. That’s one reason that Greenway and Greenway’s board is committed to developing a next-generation solution that is fully cloud native.

While the state of interoperability is embryonic, the vision for what it can create is well formed. The pandemic and various other elements of even recent legislation will force an acceleration of the view of how we ensure that the data is available where and when it’s needed for the best results, for both the patient and for the healthcare system overall.

Do you have any final thoughts?

Our focus is on supporting the ambulatory physician practices and community health centers. We’ve done a lot to help them in the present pandemic, including launching a new revenue cycle product. But they are really hurting. The ambulatory practices are hurting in a way that doesn’t grab the headlines as much as it does about the acute care.

Our customers need a lot of help to return to a new normal. That’s what we are committing to. But I really hope that as your readers read this interview, they realize that there is something else here. A healthy healthcare system in the US requires a healthy ambulatory segment, too. We need to ensure that they survive and do well beyond this pandemic. That’s our focus.

To all of your readers, just be safe and be well. We will get through this.

Morning Headlines 5/13/20

App Shows Promise in Tracking New Coronavirus Cases, Study Finds

Researchers find that a symptom checking app being used by people in the US, UK, and Sweden can determine with 80% accuracy whether a user has COVID-19 based on just their age, sex, and presence or absence of four symptoms.

Stellar Health Secures $10 Million in Series A Funding Led by Point72 Ventures

Value-based primary care care improvement company Stellar Health raises $10 million in a Series A investment round.

CNBC’s Bertha Coombs Interviews Epic Founder and CEO Judy Faulkner from CNBC’s Health Returns Summit Today

Epic CEO Judy Faulkner says the company won’t pursue incorporating COVID-19 tracking and tracing into its software based on consumer privacy concerns.

News 5/13/20

Top News

The American Medical Association publishes privacy advocacy principles that address the reluctance of some patients to share information with their physicians over fears that data brokers and technology companies will misuse it. The AMA is targeting third parties that gain access to patient information, but that are not covered entities that are bound by HIPAA. Some of its points:

• People should be told before their data is collected how it will be accessed, used, disclosed, or processed, along with the purpose that is involved and any secondary use by others.
• They should be able to opt out of having their data sold or shared.
• They need to be able to protect and share information at a granular level instead of at the document level.
• They should be able to direct a provider to delete their data throughout its ecosystem, including when an entity closes or is acquired.
• People should be able to download their information in machine-readable form.
• A patient’s data should be used to train algorithms only when the patient has opted in.
• Medical records apps should allow users to add annotations to their copy of the record.
• Notices of privacy practices should be written at an elementary school reading level and avoid ambiguous terms such as “we may share this data with our partners to improve quality.”
• Entities should make their de-identification processes publicly available.
• FTC should be empowered to define unfair data processing practices, minimum privacy and security standards, and minimum data elements for specific purposes. It should also be given authority to establish fines that are based on level of disregard or knowing conduct.

Reader Comments

From Amazon Primate: “Re: Atul Gawande. Surely he is getting fired and not just stepping back from Haven.” I was puzzled when the three sprawling corporations chose the high-profile Gawande because of his lack of experience running a big company and his insistence on keeping his day jobs as an author and surgeon, so Haven seemed more like an ivory tower Boston think tank than a hard-charging startup (the company is a non-profit, after all). The real question is, what expectations do Haven’s joint venture owners – Amazon, Berkshire Hathaway, and JPMorgan Chase – have for the company now that it has paddled along seemingly aimlessly for two years? Everybody (except Optum) wanted it to be a disruptor in prescriptions, primary care, analytics, and insurance, but its announced purpose was simply to lower healthcare costs for those three companies alone, not to barge belligerently into the swanky country club of healthcare’s good old boys to benefit society. I would be wary of any company that can’t even pick a name for itself in its 14 months. Haven’s chances would probably have been better if it was Amazon alone running the show, although Amazon’s PillPack hasn’t exactly kicked a dent in the healthcare universe.

HIStalk Announcements and Requests

I’m probably the only Gmail user who didn’t already know this, but I discovered today that an email that has been routed to the Social or Promotions category tabs can be dragged and dropped onto the Primary tab. This is good for me since I usually mass delete everything that isn’t in the Primary tab, but sometimes I want to use an email from there as a reminder (like some site having a sale).

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

In the Netherlands, Gilde Buy Out Partners will acquire medical software vendor Corilus from its private equity owner.

Sales

• In the Netherlands, Franciscus Gasthuis & Vlietland goes live on contact-free continuous monitoring from EarlySense, whose system tracks 100 data points per minute using a sensor placed under the patient’s mattress. A wall-mounted display outside the patient’s room, plus the lack of sensors and wires that require adjustment, minimizes caregiver contact with isolated patients.
• Guam Hospital Authority chooses Medsphere’s CareVue EHR. I believe it will replace Cantata Health’s Optimum system.
• Connecticut Children’s Medical will implement Keriton Kare’s breast milk management system.
• Baystate Health (MA) integrates HCPro’s clinical document improvement physician query templates in Artifact Health’s mobile platform. 

Announcements and Implementations

A new KLAS report looks at how inpatient EHR vendors are using AI. Epic is the only vendor with a significant number of live sites, with over 100 customers using its Cognitive Computing Platform for predicting readmissions, patient risk, mortality, ED, at-home fall risk, sepsis, hospital-acquired disease and patient deterioration. Epic’s customers choose its platform to avoid bringing in another vendor and report that it is easy to deploy its machine learning models. Customers who are accustomed to Epic’s out-of-the-box model report slightly lower satisfaction, often because they haven’t addressed the operational challenge of acting on its recommendations. Cerner has a handful of customers live on HealtheDataLab, which is a self-development toolkit rather than a package of pre-built models.

Yale New Haven Health System goes live on Capsule’s Ventilated Patient Surveillance workstation to monitor COVID-19 patients. The enhancement to Capsule’s Remote Surveillance application – which YNHHS uses for its InSight Tele-ICU program – monitors streaming data from ventilator and escalates events to clinicians. The hospital’s temporary ICU rooms don’t always have hall windows, so the workstation allows monitoring medical devices in the absence of direct visibility. Capsule is offering clients free licenses for at least six months.

COVID-19

In the UK, NHS and researchers analyze the de-identified records of 17.4 million adults using the OpenSAFELY analytics platform. They found that COVID-19 patients are more likely to die if they are of Asian or black ethnic origin, poor, male, or have uncontrolled diabetes or severe asthma. The study notes that the higher mortality rate of people who are not white and who live in deprived areas cannot be attributed to co-morbidity, validating policies that protect the highest-risk residents. The OpenSAFELY team developed the platform in five weeks with no funding, running its analysis within the platform of EHR vendor TPP’s SystmOne.

Seniors who are worried about the reported poor outcomes and long-term consequences of being placed on a ventilator are adding “no intubation” statements to their advance directives. Experts admit that ventilator survival rates are low, but add that study methodologies have been inconsistent, some hospitals in other countries were overwhelmed and that likely made deaths more likely, and healthy adults fare better than those who have debilitating chronic conditions, making the intubation decision for a given individual less clear.

New York City hires Salesforce to create its contact tracing program, which includes a call center, CRM system, and a case management system to augment the work of 2,500 contact tracers.

Stanford University psychiatry professor Keith Humphreys, PhD says that public health experts are overly optimistic in thinking that the US can match the contract tracing success of other countries. He says US residents aren’t deferential to government authority, they closely guard information about where they live and work, and they probably won’t stay home for 14 days just because a health worker asks them to. He urges officials to consider what will happen if people refuse to be tested or defy orders to isolate, predicting that we’ll end up with a Swedish coronavirus policy (voluntary measures only) not because we chose it, but because we couldn’t agree on an alternative.

Researchers find that a symptom checking app that is being used by 2.5 million people in the US, UK, and Sweden can determine with 80% accuracy whether a user has COVID-19 based on just their age, sex, and presence or absence of four symptoms: loss of taste or smell, persistent cough, fatigue, and loss of appetite. COVID Symptom Study found that the loss of taste and smell was the strongest predictor and was rarely wrong, having been reported by two-thirds of the 15,000 app users who eventually tested positive.

Wuhan, China discovers six new cases of COVID-19, and as a result, will test every one of the city’s 11 million residents over a 10-day period. The US has administered 9 million tests in total with 25,000 new cases per day and a world-leading 80,000 deaths. We have more new cases per million residents per day at 76 as a real-time measure of infection spread, with Russia, the UK, and Sweden trailing not far behind.

Mercy Health Hackley Campus fires Justin Howe, RN 10 days after he spoke to a newspaper about the hospital’s failure to provide PPE and its ban on employees bringing in their own masks. The hospital claims that Howe, who is president of the nurse’s union local, violated HIPAA by accessing medical records inappropriately.

Other

The Indianapolis business paper profiles startup Olio, whose mobile app is used by nursing homes to alert hospitals that a patient they have transferred there needs assessment or treatment, potentially avoiding an automatic trip to the ED.

Beth Israel Deaconess Medical Center describes how its clinicians were overwhelmed by its move to telehealth visits because tasks that were previously performed by medical assistants before the physician entered the exam room — measuring vital signs, documenting the chief complaint, reconciling medications, and managing prescription renewals – became the physician’s job. BIDMC created a pre-visit survey via OpenNotes that patients were invited to complete via a patient portal message, with their entries then being saved in the EHR for pre-visit review or copying and pasting into the note.

I don’t think I’ve ever heard of the Future of Health conference, but if you have and you care, it will go virtual for the September 23-25 event at a registration cost of $995 for providers (free for those who are willing to sit through six virtual company pitch sessions, which I’m guessing is all of the provider attendees). Maybe demand is unmet for the chance to stare at a monitor and webcam all day, or to hang out in a virtual exhibit hall.

Weird News Andy urges readers to spare the rod. In Israel, a construction worker who felt OK after he fell from a second-floor walkway realizes from the reaction of bystanders that a metal rod had penetrated his head. Surgeons removed the rod and were surprised to find afterward that the man seems to be fine, with no damage to his speech or ability to walk.

Sponsor Updates

• Datica releases a new episode of its 4×4 Health podcast, “Working in Healthcare: Vasanth Kainkaryam.”
• Black Book Market Researchers publishes the third installment of its survey series gauging consumer attitudes towards seeking medical care during the pandemic.
• ConnectiveRx SVP of Business Development John Herley wins PM360’s Elite Sales MVP Award.

Blog Posts

• How we can Leverage Epic to Drive COVID-19 Immunity Tracking (314e)
• ONC Cures Act Final Rule Summary (Audacious Inquiry)
• Your go-to guide on charge automation in Epic (Bluetree)
• Asynchronous Telehealth Gets CMS Green Light (Bright.md)
• Despite Pushed Deadlines, Interoperability Remains a Priority (CarePort)
• The Appropriate Use Criteria 2021 Deadline: Asked and Answered (CereCore)
• Making Visible What Can Be Invisible During a Pandemic: Mental Health Support Through Care Coordination (Collective Medical)
• Telehealth in the time of a pandemic (CoverMyMeds)
• 10 Focal Points in Transitioning to the New Normal (Culbert Healthcare Solutions)
• A Tale of Two C-CDAs: A Revolution in Usable Clinical Data (Diameter Health)

Contacts

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

Morning Headlines 5/12/20

Carbon Health Lands $26M, Triples Headcount

Primary and urgent care company Carbon Health adds $26 million to its Series B round with additional funding from investor DCVC.

New York City partners with Salesforce on coronavirus contact tracing program, mayor says

Mayor Bill de Blasio taps Salesforce to develop a customer relationship and case management system for the city’s contact tracing program, an arrangement similar to the one the company has entered into with the state of California.

Mount Sinai deploys Google Nest cameras for COVID-19 patient monitoring and communication

Mount Sinai Hospital (NY) pilots Google Nest cameras in 100 rooms to remotely monitor COVID-19 patients as the company prepares to donate 10,000 cameras and software to hospitals across the country.

AMA issues new principles to restore trust in data privacy

The American Medical Association develops new privacy principles to help guide consumers on how they can control, access, and delete personal health data collected about them by third parties.

Curbside Consult with Dr. Jayne 5/11/20

If you’ve been a longtime reader, you probably know that I’ve done quite a bit of camping. I also usually teach at an outdoor leadership course a couple of times each year, which is good for stories on team dynamics and resilience. Needless to say, COVID-19 has put a bit of a dent in my outdoor activities, canceling three planned local camping trips, the outdoor school, and an outdoorsy trip to Victoria, BC.

This weekend I attended my first virtual campout, where everyone put up their own tents close to home and we got together on a Zoom meeting. As with any adventure, there were some learning opportunities. First, a shortage of my usual extra-wide egg noodles at the supermarket negatively impacted my standard Dutch oven dinner, so if I’m going to do it again, I had better plan in advance so I can avoid the linguine-esque ones we wound up with. The corn bread muffins cooked outdoors in a cardboard box oven, were delightful, however.

Next, I learned that I probably shouldn’t have put the laptop right next to me, since campfire smoke always finds me and therefore my laptop. After a quick run into the house for canned air, we were back on track.

The third thing I learned was that bad skits can be absolutely hilarious when performed on a conference call. I think I’m going to have to consider assigning remote skits for the next consulting gig I get where teambuilding activities are needed.

Last, I had the opportunity to confirm what I already suspected, which is that the people in my immediate household have some pyromaniac tendencies. Fortunately, we kept the inferno confined to the actual fire pit, and no grass was harmed this time. We were rewarded with great weather, so although the overall experience was a little strange, I’m glad we did it.

It was a welcome departure from the chaos that has been the last two months of my professional life. Run around frantically trying to get personal protective equipment so you can fight a pandemic? Check. Figure out how to quarantine yourself away from the others in your house? Check. Get furloughed and wind up with unanticipated free time? Check. Channel that free time into random IT projects? Check.

At the end of each calendar year, I go through a planning exercise and try to forecast what my year will look like based on what I think clients will ask me to do. This year was going to be full of travel, with lots of trade shows, expos, and meetings. We all know how that turned out. However, I was pulled into projects doing things I never thought would be on my plate. Need to set up chatbot-based screening for patients arriving at a drive-through testing clinic for a disease no one had heard of two months ago? Sure! How about using the ZIP code data from the patients to figure out where to put an expansion site for additional testing? Definitely. What about figuring out how to help practices reopen safely, routing patients to different reception areas depending on their symptoms? Of course.

I did more telehealth visits in a couple of weeks than I did all of last year, and even though it has its challenges, I’m fully convinced that it’s a critical part of healthcare strategy for the future. Patients like it, clinicians like it, and with the right supports and an appropriate mix of in-person care, it could really make the difference for some patients. It’s also a way to allow providers who might not be able to practice in a face-to-face setting to continue seeing patients.

A good friend of mine went through chemotherapy last year, and although she felt up to seeing patients, her physician wouldn’t clear her to work in the office. Telehealth would have been ideal for her, but it wasn’t on her health system’s radar at the time. Especially with the shortage of primary care physicians, we don’t want to lose people who are willing and able to care for patients.

There’s also been a fair amount of wackiness the last couple of months, mostly in the form of conspiracy theories and distrust of “the medical establishment.” I never thought I’d have to reassure people that my highly-regarded medical school didn’t offer a course in “Conspiracy 101” and that I don’t actually get paid more for diagnosing patients with COVID-19 than I do if I diagnose them with boring old bronchitis or pneumonia. I also never knew that so many grown adults didn’t wash their hands before all of this happened, or that some of them still think it’s optional. If there’s one good thing that comes out of the pandemic, it’s that maybe we’ll have fewer colds and flu because people have actually learned that washing your hands is important and you should stay home when you’re sick.

As we approach the middle part of the year, I typically do a brief planning check-in to see whether my forecasts are on track and what I think the bottom half of the year will bring. Guess what? All bets are off this time. I think instead of trying to plan, I’m going to just hit the patio with a bottle of wine and spend a couple of hours contemplating what’s blooming in the yard and wondering whether my pampas grass will come back after the household pyros torched it this spring rather than simply cutting it off as usual. (I realize that prairie fires are a thing and are part of a healthy ecosystem, but I don’t think my single clump of grass deserved what it got.)

If there’s one thing I’ve learned this year, it’s that although having a plan is generally a good idea, if the universe decides to start throwing flaming meteors at you, all you can do is adapt. For the first time in a long time, I have absolutely no idea what I might be working on in three months, let alone six. I don’t even know if some of my health system clients will be solvent in the bottom half of the year, or whether my small practice clients will ever reopen. It’s pretty clear, though, that we’re going to need plenty of IT solutions to get through some of the challenges that are coming, although they probably won’t be with the traditional vendors we’ve all looked to in the past.

What do you think the bottom half of the year will hold, personally or professionally? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health

Lissy Hu MD, MBA is co-founder and CEO of CarePort Health of Boston, MA.

Tell me about yourself and the company.

I’m a physician by background. I started the company to better bridge hospitals and the care partners that they work with, such as nursing homes, home health agencies, hospice, all the post-acute settings that patients will need after their hospital stay. We are in just over 1,000 hospitals, 180,000 post-acute care providers, and 43 states. It has been a pretty amazing journey.

How is the pandemic changing the relationship between hospitals and skilled nursing facilities?

People are realizing more than ever that nursing homes are critical part of the care continuum. These long-term care facilities, where we house our elderly and our vulnerable populations, are incredibly susceptible to COVID. A huge crisis is going on in nursing homes across the country. As a result, they’ve stopped admitting patients. They are scrambling for PPE just like everybody else and for staff to care for their existing residents.

But in American society and healthcare, these nursing homes are also short-term rehab centers, where they take patients from the hospital. That helps to keep the whole healthcare system flowing, so that that you don’t have bottlenecks on the hospital end. They don’t have any places to safely discharge their patients for rehabilitative care, especially for COVID patients, where they are in the hospital for a long time.

Consider a 50-something patient who has never had any rehab needs. Once they’ve been in the hospital for a couple of weeks and on a vent, they’re deconditioned. They are going to need rehabilitative care. The pandemic has made it clear just how interdependent hospitals and post acute-care providers are.

A lot of the hospitals we work with are strengthening their partnerships and their connectivity.  With some of the software that we’ve built between themselves and post-acute, they have been able to leverage some of those existing relationships in this time of crisis. It has been heartening to see hospitals continue to value their post acute-care providers.

On the other hand, being connected to these post-acute care providers, we see their EHR data. We see the spikes and deaths. Each of those data points is someone’s grandmother, someone’s parent. It’s just hugely, hugely sad.

Will the level of information exchange between hospitals and post-acute care providers change with this new level of dependence?

I’ve been on the phone with state and federal government officials talking about the pandemic response need for more support for post-acute care providers and more tools that help them. It’s not exactly in the area that I work in, in terms of our software that is connecting hospitals and post-acute care providers. But in those conversations, it is surprising that they are recognizing, for the first time, that these nursing homes play these dual roles. A lot of people think of nursing homes as these residential facilities. Awareness is building that they are also an outlet, a step-down unit if you will, for hospitals.

Prior to the pandemic, people were thinking about how to better work with their post-acute care providers on the hospital end. Because of things like bundles and ACOs, hospitals needed to think about the patient, not just in terms of their particular hospital stay, but their recovery period. I think we’re going to continue to see more of that with the interoperability rule.

One thing that a lot of people didn’t expect with the CMS interoperability role was mandating electronic notifications. Not only to the physician — CMS included skilled nursing, home health, and other post-acute care providers. That’s recognition that these post-acute care providers play an important role in the care continuum.

Here’s one example. When a skilled nursing facility transfers a patient into a hospital, they don’t know what happens to that patient. They’re calling the patient or calling the hospital to find out whether that patient is going to come back. Should they hold the bed, or should they not? When we built our software to be able to better communicate between the hospital and the post-acute provider, our infrastructure allows them to get notified about what actually happens to that patient. Are they just there for observation, or will they be admitted? That allows the skilled nursing facility to prepare.

That became even more important with COVID. The skilled nursing facility would send the patient back for testing into the ED. Maybe they would get tested, stay there for a couple of days, and then get sent back with one negative test. But with one negative test, because of how vulnerable that patient population is, the skilled nursing facility is still going to put that patient in an isolation room and use PPE. You need to know about that second negative test, which is when you can start to put the patient back into the larger residential community and start to conservative PPE.

We made some small modifications in our platform that transmits those lab results back to the skilled nursing facility. These skilled nursing facilities get confirmation that the patient is negative and can be moved out of an isolation room. Even small improvements in connectivity can have a big impact in terms of the skilled nursing facility and their ability to care for these patients, while also protecting all the other residents. I expect to see much more of that coming on to the other end of the curve with the CMS interoperability rule and in some of the requirements on the notification side. Not just the PCP side, but on the post-acute side as well.

Sometimes the biggest interoperability challenge involves integrating the received information into workflows. How do you see that working with ADT notifications?

It’s funny that even though I’m a physician who built a technology company, I always think that technology is probably just 50% of the answer, if not less. It may be a little bit heretical to say that as a CEO of a tech company. But the other big component realistically is thinking through the workflows. If people send notifications in a way that requires someone to log into a portal and view an event, you’re taking the nursing home out of their own workflow. That presents a huge barrier to adoption in terms of making the information usable and actionable for that skilled nursing facility.

We have 180,000 post-acute care providers on our platform, so we think that we’re in the right position to surface these notifications into the workflows of skilled nursing facilities and other post-acute providers . They are in our systems every day. We see them doing really practical stuff with this information, like deciding whether to hold the bed of a patient who has gone to the ED while waiting on confirmation that they will be admitted. The hospital benefits as well, since when they send a referral to that the skilled nursing facility for a different patient, the skilled nursing facility has a bed available because they aren’t holding one unnecessarily.

They are going to be able to use this information in practical ways. But it’s important that the information is delivered into their workflow rather than every hospital adding another place that the skilled nursing facility needs to log into and look at. It’s hard to do the right thing in using that information if you put barriers in place.

How has the company’s focus changed with the pandemic and what new requirements to you expect from customers?

We’re seeing more focus on electronic communication. For example, we have a product called CarePort Guide that helps patients and families make decisions about post-acute care. It has things like the quality scores, pictures, and virtual tours. We built that tool because even pre-pandemic, it was the patient’s adult children who were making decisions about where the patient would go. We’ve seen a huge spike in use of that platform because now hospitals don’t allow visitors. We’re seeing more usage because of the need to do virtual tours since nursing homes have also locked down.

Our tools allow the hospital and post-acute care providers to communicate. Instead of somebody at the admissions office leaving a phone message for a hospital nurse case manager, they can communicate bi-directionally since both of them are on the platform. There’s just a lot less friction. We’ve seen the number of electronic communications spike because the nursing home staff are no longer able to go into the hospital to screen these patients or to talk with them in person prior to receiving that transfer.

We’re going see, beyond just telehealth, more and more electronic delivery of care in a lot of other areas. Even in areas that people wouldn’t typically think about, such as the communication among the hospital, the post-acute care provider, and the patient who is making these decisions.

Since our platform connects hospitals and post-acute care providers, we are tracking patients from the time they enter the ED all the way through their recovery period. A lot of our customers are asking us to track COVID patients to understand how to prepare post surge. What will their recovery needs be? People didn’t really know. We are starting to aggregate data across all of the 1,000 hospitals that we work with and all of their EHRs — Epic, Cerner, Meditech, Allscripts, and all the electronic systems used on the post-acute care side. We are tracking something like 22,000 patients from the minute that they enter into the ED through their inpatient course, through their ICU course, through their post-acute course. We’re starting to see trends that are helpful for our customers as they are managing these patients across the continuum.

Do you have any final thoughts?

As we move into this new normal, we are seeing the interdependence between hospitals and post-acute care providers. Although the interoperability rule has been delayed for good reason, people will start to see this rule as being really important coming out of the pandemic, or going into the second wave of the pandemic. There’s a real need and opportunity to be able to share patient information in real time so that we can monitor and track these patients and communicate better with one another. That need is being crystallized in the heightened reality of COVID.

Readers Write: Have You Lost Your Job?

Have You Lost Your Job?
By Jim Gibson

Jim Gibson is a recruiter with Gibson Consultants of Wilmington, NC.

I remember the first time I lost my job. It was terrifying. I was the sole breadwinner, with three small children and a mortgage.

If you’ve recently lost your job, I know how you feel and I hope the tips below will help.

In the days following my job loss, my emotions followed the usual course: surprise, hurt, anger, acceptance, and finally determination. That is, determination to find another job, a good one, one that would allow me to feel good about myself again. Although I had convinced myself that I was mentally tough, my ego was bruised – badly.

The days seemed like weeks and the weeks like months, but ultimately I got a better job, and it didn’t really take that long.

Then I became a recruiter and saw many others enjoy the same good fortune after enduring the pain and anxiety of a job loss. Not all, but many.

This includes 2008 – 2010, when a global economic collapse had many fearing another Great Depression.

People at all levels and in all industries were losing jobs. Companies were folding, retirement accounts were being depleted, and housing values were falling, for many their largest source of equity.

Financially healthy companies were laying off tens of thousands in anticipation of a recession. Talk about a self-fulfilling prophecy! Of course, the media were piling on, fanning the flames of fear and misery.

It was maddening,  and a hard time to be optimistic.

Yet, it ended. People found jobs and many were thrilled about where they ended up.

There are differences between then and now, but there are also similarities. We feel the weight of uncertainty, but we also believe this too shall pass. I do, and I believe many will end up in better positions.

It’s hard to account for why some people land on their feet more quickly than others, but you can improve your odds by keeping the following in mind.

• Self-agency. This is listed first because it’s the most important. You must believe that you have the power to improve the current situation.
• Clear your head. A mental transition from having a job to looking for a job takes a little time. It’s critical to decompress, find enjoyable distractions, spend time with loved ones, and get negative feelings under control before beginning a job search.
• Goal of two. Have a goal of choosing between two good job offers. This eases the pain if a prospective job opportunity disappears. It also can shorten the search by suppressing the temptation to go easy while the “sure thing” plays out … or doesn’t.
• View it as a job. A job search is a job. It’s good to clear the head, but when the search starts, it is your full-time job.
• Start with your brand. A career is usually the result of opportunities presented and accepted, not intentional paths. Being unemployed is a chance to change that by thinking carefully about what you enjoy and are good at, and what you don’t enjoy and don’t do well.
• Perhaps a couple of options. You may know what your next job will look like, or you may have the flexibility to do either of a couple of things (e.g., operations or a client-facing role, remaining in a hospital or joining a health plan.) More than one option requires different versions of your resume, cover letter, etc.
• Don’t rely on recruiters. Approaching recruiters is an inefficient approach. Most work on a limited number of open positions, so it’s hit-or-miss.
• Two-pronged approach. After identifying your ideal role(s), work your network and contact employers.
• Your network. This shows the value of your LinkedIn network. It’s also a great time to make new connections. Remember to spoon-feed connections with specifics about desired roles, organizations, etc.
• Employers. Build a comprehensive list of potential employers and hiring managers. Corporate websites and LinkedIn are good starting points, as are trade group sites (HIMSS, AHIP, etc.) If targeting vendors, the exhibitor page of the annual convention site is a gold mine.
• Don’t apply to job listings. Some will disagree, but I find this to be a colossal waste of time. People do get jobs this way, but it’s a low percentage activity. It’s so easy for people to apply that the number of applicants can be staggering. Even the perfect candidate’s application may get buried and never seen.
• A numbers game. This is a numbers game. Think 150-200 targets, not 20-25.
• Get organized. Developing a system for staying organized is essential. It allows for a methodical approach to managing a high volume of contacts.
• Physical activity. A job search is intense. Incorporating a regular regimen of physical activity will help periodically clear the mind in order to stay strong and on top of your game.
• Only one job is needed. This is a good thing to remember, especially as opportunities progress slowly and sometimes disappear.
• Expect to be ghosted. Anyone who has looked for a job knows that the most agonizing part is waiting while the other party remains silent and inaccessible. Expecting this, while pursuing other opportunities, eases the strain a bit.
• Don’t take it personally. Sometimes conversations stop abruptly or jobs mysteriously disappear without an explanation. It’s often because of events beyond your control. Don’t beat yourself up over this.
• Some days it will just plain stink These days need to be kept to a minimum, but they will happen. Shutting down the computer and taking the afternoon off is sometimes the smartest move.
• This is your career, but it’s not you. As difficult as it may be at times, you must try to keep your self-esteem intact. Looking around at your loved ones and surroundings can reinforce a sense of gratitude and perspective.

Finally, even though difficult in more ways than one, this can be a fulfilling challenge. After all, you’re selling the most irresistible product around – you!

Happy hunting.

Morning Headlines 5/11/20

Gawande in Talks About Leaving Helm of Health-Care Venture Haven

Insiders report that Atul Gawande, MD, MPH will resign as CEO of Haven Healthcare and move to a less-operational role as chairman.

Allscripts Healthcare Solutions, Inc. (MDRX) CEO Paul Black on Q1 2020 Results – Earnings Call Transcript

During its Q1 earnings call, Allscripts representatives say recent layoffs helped to eliminate $75 million in annualized costs, and they are reviewing product lines to see if any non-core businesses should be sold.

Livongo Health EPS beats by $0.07, beats on revenue

Livongo reports Q1 results: revenue up 115%, EPS -$0.06 vs. -$0.79, beating Wall Street expectations for both.

Monday Morning Update 5/11/20

Top News

From the Allscripts earnings call, following a Q1 report in which the company fell short of analyst expectations for both revenue and earnings:

• The company’s 22 Virtual HIMSS sessions drew 900 registrants.
• Virtual visits conducted with FollowMyHealth’s telehealth platform went from no demand to 70,000 visits in April.
• The virtual visit platform is licensed on a per-provider, per-month model, with President Rick Poulton explaining that patients are seen by their own hospital-provided doctor instead of “whoever happens to be hanging out on a couch that day.”
• 500 researchers have applied for access to its Veradigm COVID-19 research database.
• Its CarePort care transition system has tracked the care of 22,000 COVID-19 patients across settings, with early findings indicating that 10% of middle-aged hospitalized patients who are diagnosed with COVID-19 die .
• Allscripts estimates that the pandemic impacted its Q1 revenues by $7-10 million, from both lower volumes and delayed purchase decisions, and otherwise the company would have met its revenue guidance.
• Memorial Sloan Kettering Cancer Center is among the health systems that have extended their inpatient system agreements at a total value of $100 million.
• The company eliminated $75 million in annualized costs via layoffs in late March through April.
• Allscripts is reviewing its product lines to see if any non-core businesses should be sold.
• The company doesn’t expect to spend capital on acquisitions any time soon.

MDRX shares closed up 9% Friday, returning the company’s market cap to just over $1 billion. They are down 38% in the past year versus the Nasdaq’s 14% gain.

Reader Comments

From CPAhole: “Re: contracts. I’m interested in how companies and providers will change their agreements after this pandemic. The typical force majeure clause just doesn’t cut it here.” I’ll run a survey for vendors and customers to describe any changes they’ll make to agreements going forward to address issues that the pandemic has exposed  — like providers being unable to pay their bills, vendors being unable to perform on-site services, or companies protecting themselves in pre-acquisition due diligence. The rarely invoked, usually boilerplated force majeure T&C will undergo new scrutiny and legal tests as pandemic-driven economic issues force vendors and customers into uncharted territory, like HIMSS citing that clause in refusing to issue HIMSS20 exhibitor refunds.

HIStalk Announcements and Requests

The idea of using tech-powered contact tracing to control the coronavirus takes a hit from last week’s poll. Two-thirds of readers (who are heavily involved in healthcare and technology) say they won’t use the Apple-Google app right away, echoing the likelihood that the US won’t see anywhere near the 60% adoption that is required for effectiveness.

New poll to your right or here: Have you been tested for active COVID-19 infection?

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

Listening: Michael Kiwanuka, the British singer-songwriter who provides the haunting opening theme to “Big Little Lies,” which we’re watching on Prime Video. It’s the perfect spacey, mysterious intro to a show set on and around the beaches of Monterey, CA. It’s just as connected to the series as the use of Cecelia Krull’s “My Life Is Going On” on “Money Heist.”

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Atul Gawande, MD, MPH will resign as CEO of Haven Healthcare and move to a less-operational role as chairman, insiders report. The Amazon – Berkshire – JPMorgan company, which has had minimal healthcare impact since its splashy debut in January 2018, is searching for a new CEO as Gawande’s interests refocus on coronavirus policy and advocacy work. Haven COO Jack Stoddard resigned last year after nine months on the job and was not replaced.

Livongo reports Q1 results: revenue up 115%, EPS -$0.06 vs. -$0.79, beating Wall Street expectations for both. The company said in the earnings call that it has been selected by the Government Employee Health Association that provides medical and dental plans to 2 million employees. LVGO shares are up 42% versus the Nasdaq’s 11% rise since the company’s July 2019 IPO, valuing it a $5 billion. Executive Chairman Glen Tullman owns shares worth $344 million, while CFO Lee Shapiro’s holdings are worth $302 million.

Sales

• Willis-Knighton Health System (LA) chooses CloudWave’s OpSus Healthcare Cloud for hosting its Meditech Expanse system that is being implemented. 

People

Nordic promotes John Manzuk to SVP of managed services delivery.

COVID-19

A New York Times report finds that virus-wary Americans had already slowed their spending, traveling, and dining out before lockdown orders were issued, raising the strong possibility that state re-openings won’t restore the pre-pandemic economy as businesses and potential customers remain unconvinced that it’s safe to conduct person-to-person business.

FDA Commissioner Stephen Hahn, MD, NIAID Director Anthony Fauci, MD, and CDC Director Robert Redfield, MD are self-quarantining for 14 days after being exposed to Vice-President Pence’s spokesperson Katie Miller, who has tested positive for COVID-19.

The Department of Justice charges Henry Gindt II with selling stolen COVID-19 test kits directly to patients for up to $200 through his YouHealth website, then failing to provide the test results. Gindt’s LinkedIn says he was a co-founder of President Trump’s Office of American Innovation, where he says, “Key wins included combining the electronic medical records (EMRs) of Department of Defense and VA employees and soldiers.”

A researcher identifies what he says is a flaw in India’s government-mandated COVID-19 contact tracing app – which uses both GPS and Bluetooth — that allows him to identify the location of all infected users. The government requires all employees and military members to use Aarogya Setu, as well as people who live in containment zones and those who are returning from other countries. The app presents a chatbot-powered symptom checker and travel history questionnaire and health authorities track answers in a database and contact those who might be infected.

NYC Health + Hospitals investigates ED nurse Lillian Udell, who recorded her co-workers talking about shortages of PPE. The health system says she violated HIPAA even though no patients were shown. Another nurse whose PPE pleas on “60 Minutes” earned the praise of the hospital’s president said of Udell’s case, “I feel like a lot of hospitals are using HIPAA almost under the guise of patient protection and safety, and privacy safety. But really it becomes more apparent to me, at least, that HIPAA is kind of being used to gag people. We’re all experiencing the most difficult working conditions we’ve ever faced. And everybody who is speaking out is doing so to advocate for patients, ultimately. It looks like hospital administrations tend to run to HIPAA for their protection, not so much patient protection.”

Other

Kaiser Health News notes that at least half of the top 10 recipients of HHS’s emergency provider funding have either paid criminal penalties or settled billing fraud charges in the past. Florida Cancer Specialists & Research Institute, which hasn’t started paying its recently imposed $100 million federal penalty for anti-competitive practices, got $67 million in federal bailout money. Experts observe the irony of health systems being paid at rates that are based on their Medicare billing when they were also accused with falsely inflating their Medicare bills through fraud and abuse. Other health systems that are in the top 10 that have paid to settle fraud charges are Dignity Health, Cleveland Clinic, Memorial Hermann, and Mass General.

A display company in Colombia offers small hospitals an $85 cardboard patient bed that, if the occupant dies, converts to a casket.

Sponsor Updates

• PatientKeeper supports healthcare workers at Portsmouth Regional Hospital.
• MDLive reports significant growth of its behavioral health business as its virtual therapy service provides safe, timely access to care during the pandemic.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new edition of its Critical Care Obstetrics podcast, “Sepsis Simplified.”
• RxVIP Concierge offers CareSignal’s COVID Companion text-messaging app through its new “Stand Up to COVID19” patient initiative.
• Relatient joins the Cerner App Gallery with mobile-first self-scheduling and waitlist solutions.
• T-System offers DrFirst’s telemedicine software to its urgent care and emergency department customers.

Blog Posts

• Request telehealth and COVID-19 lab payer matrix (Nordic)
• Healthcare’s COVID-19 Recovery Plan is Beginning to Take Shape and Patient-Friendly Tech is Center Stage (Loyale Healthcare)
• Recognizing the not-so-everyday heroism of nurses (Meditech)
• Nurses Week 2020: Perspectives from two nurses (Spok)
• The Healthcare Analytics Adoption Model: A Roadmap to Analytic Maturity (Health Catalyst)
• Why Patient Identity Management Matters Now More Than Ever (NextGate)
• Creating a Successful Virtual Care Platform (Netsmart)
• How long will providers be able to tap into CARES uninsured reimbursement benefit for COVID care? (Experian Health)
• ONC Final Rule Addresses Concerns with Requirements, but Only Provides 6 Months to Comply. (Pivot Point Consulting)
• 5 Warning Signs Your Answering Service Might be Hurting Your Practice (PerfectServe)
• CMS Hospice Relief (QliqSoft)
• What April’s Consumer Search Behavior is Telling Us About Coronavirus & How to Prepare for Recovery (Kyruus)
• How to request and offer help when capacity demands change. (Redox)
• Why Identity? (SailPoint)
• Interoperability Creates Healthcare for (All) the Ages (Surescripts)
• The Power of Virtual Patient Connections During COVID-19 (Vocera)
• Communication: The Secret to Staying Viable in Uncertain Times (WebPT)

Contacts

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

Weekender 5/8/20

Weekly News Recap

• Allscripts reports Q1 results that miss Wall Street expectations for both revenue and earnings.
• CVS Health beats Q1 expectations and reports a 600% increase in telemedicine visits in its MinuteClinic business.
• Change Healthcare acquires ERx Network, sells its Connected Analytics business.
• Johns Hopkins recommendations for addressing COVID-19 include making EHRs searchable by public health officials, creating a platform for hospitals to share PPE and medical supply availability, and improving healthcare supply chain tracking and coordination.
• Duke University’s interoperability recommendations for containing COVID-19 include collecting and reporting patient demographics with samples, defining a minimum data set, and expanding the use of the National Syndromic Surveillance Program.
• CMS issue waivers to pay full rates for telephone-based encounters.
• Epic launches a public website where customers can post their observational findings about COVID-19 or other health and public health issues.

Best Reader Comments

My former employer (an EHR company) had onsite primary care clinics for all employees that were also set up as somewhat of a showcase of how to “EHR” well. All the exam rooms had two armchairs facing a large monitor that the physician’s laptop was connected to. After the exam the doc would move the conversation over to those chairs to write up the note and finish the visit, making the act of writing the note more of a collaborative experience. As a patient, it felt a lot better than the doc plugging away on a laptop on their little stool while the patient sits on butcher’s paper. (EHRing well)

There’s actually a FHIR-based replacement to CCOW called FHIRCast that’s been in the development / connectathon testing stage for about two years. (Not sure if it’s in production anywhere yet.) There’s actually a track focused on testing it and playing with it during the May 13-15 connectathon too. I’m sure you’d be welcome to show up and dabble! (Lloyd McKenzie)

Re: remdesivir study. Statistical significance means less than 5% probability the result is due to chance, but you have to specify the one thing you’re measuring in advance. They didn’t do that—instead changed from mortality to recovery time. This sort of thing raises the question of how many more slices of the apple they would have taken until something passed the test. (Robert D. Lafsky, MD)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. F in Michigan, who requested Osmo learning sets for her first grade class. She reported in early February, “My students absolutely love Osmo. While they believe that they are playing, they are learning so much! My students are using Osmo Coding Awbie and Osmo Detective Agency both cooperatively and independently. They look forward to Friday afternoons, which is when we have technology time to explore and learn. Prior to the funding of this project, I only had two sets of these games. By donating to my project, my students now have the choice to work on their own or with a buddy to feed strawberries to Awbie as they code a path for him or solve the mystery in Paris. My students are so excited to explore with Osmo!”

Intermountain Healthcare cancels its agreement to send COVID-19 capacity data to data monitoring vendor Banjo following reports that the company’s CEO was a white supremacist as a teen and served as the getaway driver in a KKK synagogue shooting. The company has received $100 million in funding to develop police surveillance tools, with the state of Utah being a big customer until it cancelled after Damien Patton’s history surfaced. He says he was a homeless high school dropout who was taken in by skinhead and white supremacy groups.

The Ascension Seton nurse whose sign for co-workers explained why he was staying so long in the room of a COVID-19 patient provides this explanation:

I just feel like I was doing, as a nurse, what I’ve been taught. That’s what you do. I work at Seton and we have a policy that no one ever dies alone. It doesn’t matter, any circumstance. COVID makes it more difficult, but no one dies alone. Someone’s going to be there in your room with you.

A Harvard Medical School professor says that pathogen-fueled anti-immigration sentiment isn’t new, as early US immigration laws were created out of fear of disease, especially cholera. A New York City mob, led by wealthy landowners, stormed the city’s 1,000-bed New York Marine Hospital, called Quarantine, in 1858 and burned it down, returning the next night to use battering rams to level what remained. Many of Quarantine’s patients were new immigrants who had arrived by ships on which health inspectors found at least one person who was suspected of having an infectious disease, which then forced all of the ship’s occupants into lockdown.

Food service vendor Aramark opens makeshift grocery stores in several New Orleans hospitals so that healthcare workers don’t have to go shopping for essential and hard-to-find groceries after work.

In Case You Missed It

• News 5/8/20
• EPtalk by Dr. Jayne 5/7/20
• News 5/6/20
• Curbside Consult with Dr. Jayne 5/4/20
• Readers Write: How Health Systems Use Technology in New Ways to Adapt to COVID-19
• Monday Morning Update 5/4/20

Get Involved

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

Morning Headlines 5/8/20

Allscripts announces first quarter 2020 results

Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.09 vs. $0.16, missing Wall Street expectations for both.

HHS OIG Toolkits for Calculating Opioid Levels and Identifying Patients At Risk of Misuse or Overdose

HHS OIG creates freely available statistical tools for analyzing prescription claims data to identify patients who are at risk of opioid misuse or overdose.

Braid Health Raises $9 Million in Seed and Series A Funding Led by Lux Capital

AI-powered digital imaging company Braid Health will use a $9 million funding round to further develop its software and create a virtual network of specialists.

Ballad Health vendor to locate center in region, add 500 jobs

Ensemble Health Partners will build an office to accommodate 500 new employees and 1,100 Ballad Health staffers who will transition to the RCM vendor once the hospital goes live on Epic in June.

News 5/8/20

Top News

Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.09 vs. $0.16, missing Wall Street expectations for both.

MDRX shares dropped 6% in after-hours trading immediately following the announcement after closing up 6.5% on the day. The company’s market capitalization is $952 million.

HIStalk Announcements and Requests

I fixed HIStalk’s mobile layout, also adding an option to place an icon on your device’s home screen to enable one-click access.

Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre to present your own.

Acquisitions, Funding, Business, and Stock

Shares of embedded communications technology vendor Twilio, which Epic recently chose to power its telehealth offering, rose 25% Wednesday after  the company reported a Q1 revenue increase of 57% to $365 million. The company also raised Q2 revenue guidance by another 35%. Twilio is valued at $22 billion.

The US Court of Appeals upholds a district court’s dismissal of a class action lawsuit against EClinicalWorks in which the estates of two deceased patients claimed that errors in ECW’s system displayed incomplete or inaccurate patient data to providers. The appeals court says the plaintiffs lacked standing to sue because they provided no proof that anyone was harmed.

CVS Health announces Q1 results: revenue up 8%, EPS $1.91 vs. $1.63, beating analyst expectations for both. The retailer saw a 600% jump in telemedicine visits through its MinuteClinics, part of an overall spike in its digital services that helped the essential business realize first-quarter sales of $67 billion.

Sales

• Perry Community Hospital will use remote cardiac and respiratory monitoring software from Coala Life to launch a remote monitoring program for its patients in rural Tennessee.

Announcements and Implementations

CarePort Health releases an interoperability solution that meets CMS’s Conditions of Participation requirement that hospitals send ADT notifications to primary care physicians and post-acute care providers.

Premier adds perinatal quality analytics to its QualityAdvisor improvement software.

LogMeIn releases a healthcare edition of its GoToMeeting videoconferencing platform that meets HIPAA requirements by offering a Business Associate Agreement, with a cost of $16 per user per month for unlimited sessions and minutes.

Intelligent Medical Objects releases an open source standardized terminology package for COVID-19 that allows aggregating and sharing patient problems, procedures, and labs information.

People

Experity names Callan Young (Anaplan) SVP of marketing.

Wil Lukens (CenTrak) joins Critical Alert as VP of sales.

Wolters Kluwer Health hires Frank Jackson (Prognos Health) as VP/GM of its Health Language business.

Government and Politics

HHS awards $583 million to 1,400 federally-funded health centers to help them expand COVID-19 testing.

HHS publishes a list of the 142,000 healthcare providers that received money from the $50 billion HRSA Provider Relief Fund, in which money was paid based on their Medicare net patient revenue. The median payment was $9,600, the average $142,000. The top 10 recipients are:

1. Dignity Health ($180 million)
2. Cleveland Clinic ($103 miliion)
3. Stanford Health Care $(102 million)
4. Memorial Hermann Health System ($92 million)
5. NYU Langone Health ($92 million)
6. County of Los Angeles ($81 million)
7. HMH Hospitals $(77 million)
8. Florida Cancer Specialists and Research Institute ($67 million)
9. Memorial Hospital for Cancer and Allied Diseases ($64 million)
10. Massachusetts General Hospital ($58 million)

HHS OIG creates freely available statistical tools for analyzing prescription claims data to identify patients who are at risk of opioid misuse or overdose.

COVID-19

The White House rejects CDC’s recommendations — which it commissioned — on when and how state and local officials should allow business owners, restaurants, schools, and churches to reopen. “Guidance for Implementing the Opening Up America Again Framework” was supposed to have been published Friday, but the public health agency’s scientists were told it “would never see the light of day.” The White House repeated in a Wednesday briefing that states are responsible for their own COVID-19 response.

A Premier survey finds that hospitals will need to expand their COVID-19 testing capacity by more than 200% to even partially resume full services. The hospitals say they are constrained by lack of testing reagents (41%) and swabs (40%). Most hospitals hope to screen employees for coronavirus symptoms before resuming non-emergency procedures, but just 32% say they have enough COVID-19 tests for frontline workers, so most will limit testing to those employees who exhibit symptoms.

Government officials in the UK consider rolling out “immunity passports” to qualifying individuals as part of forthcoming plans to ease the country’s lockdown. The digital certificate would incorporate facial biometrics and antibody test results into an app that employees could use to gain entry into their workplaces.

NIH launches a study to determine whether the low number of reported cases in children is due to natural immunity or infection without symptoms.

The US — unlike Italy, Spain and China —has not seen a significant decrease in daily new cases following the infection’s peak, which occurred here on April 26, causing former FDA Commissioner Scott Gottlieb, MD to warn that the virus could continue as a “slow burn of infection across the country … we still have a lot of infection.”

Axios reports that some White House officials believe that COVID-19 death counts are being inflated because hospitals get paid more for treating coronavirus patients. Other insiders believe the actual number is lower because presumptive cases are not being verified by autopsy, also noting that data reporting standards are not uniform.

An MIT Technology Review article says epidemiologists and public health experts struggle to draw population-level conclusions from COVID-19 testing results, as each state sets its own standards for data collection and reporting. Some states still accept provider reporting via fax and Excel. The results of at-home tests won’t necessarily be reported to the state at all, and those tests have varying accuracy. The authors recommend using CDC’s FHIR-based tool to report directly from EHRs and non-profit Logica has developed an open source interoperability platform for health system COVID-19 reporting. Experts say that it would be ideal if the federal government took the lead on public health data efforts, but that isn’t likely to happen.

Johns Hopkins University updates its COVID Control study app, in which volunteers submit their temperatures and any symptoms daily to detect outbreaks.

In England, Imperial College epidemiologist Neil Ferguson — whose group’s prediction of massive numbers of COVID-19 deaths in the absence of mitigation strategies led the UK and US governments to implement drastic measures — quits his UK government advisory role after a newspaper reports that he broke the stay-at-home rules he advocated by allowing his girlfriend to visit him. Complicating the issue is that both Ferguson (called “Professor Lockdown” there) and his girlfriend are married to other people, each of them have children at home, Ferguson has tested positive for coronavirus, and the woman says her husband is showing symptoms.

Other

Germany-based hospital and dialysis center operator Fresenius is hit with a ransomware attack. US and UK government cybersecurity centers warned Tuesday that state-sponsored hacking teams are targeting organizations that are involved in COVID-19 response.

A JAMIA-published study looks at how Mayo Clinic’s move from Cerner to Epic affected its patient satisfaction scores, concluding that the scores dropped significantly and didn’t return to previous levels for 9-15 months. Areas most affected were access, wait time, and receiving information about delays. Satisfaction dropped before go-live, which the authors hypothesize was due to schedulers using two systems and implementing new processes as well as pulling team members offline for training.

In England, anonymous artist Banksy creates a painting for Southampton General Hospital depicting a child replacing his superhero dolls with one of a nurse.

Good tweet.

Sponsor Updates

• Goliath Technologies releases a new video, “How to Reduce Barriers to Clinician Satisfaction with Cerner.”
• Wolters Kluwer Health launches a Rapid Onboarding module in Lippincott Procedures to help hospitals prepare nurses for COVID-19 care.
• Impact Advisors hires James McHugh (Guidehouse) as managing director.
• Intelligent Medical Objects releases a new e-book, “Leveraging the EHR for effective clinical workflows.”
• InterSystems releases a new PulseCast podcast, “Don Woodlock: Capturing Cleaner Data Across the Care Continuum.”
• Spok supports and honors nurses during Nurses Week.
• The local paper profiles the Western PA Home & Community Task Force’s use of CarePort Health’s Guide technology, which helps connect hospitals with best-fit, post-acute care facilities for their patients.

Blog Posts

• Remedying the Financial Impact of COVID-19 with a Measured Return to Financial Security (Engage)
• Sustaining Medical Practice During COVID-19 (EClinicalWorks)
• Adapting Your Health Technology Business to a Post-COVID-19 World (Get-to-Market Health)
• 14 Innovations in Insulin to Mark Glytec’s 14th Birthday (Glytec)
• Maintaining Cash Flow in the Wake of COVID-19 (Greenway Health)
• How blockchain can prevent the next global pandemic (The HCI Group)
• COVID-19: Telemedicine’s Catalyst (Healthcare Growth Partners)
• Patient Education can Eliminate Three of Your Biggest Challenges (Healthwise)
• Imat Solutions Featured in KLAS COVID-19 Technology Solutions Guide (Imat Solutions)
• Video Teleconference Security Tips for Zoom (Impact Advisors)
• Let healthcare information technology help – we have a lot to offer (Imprivata)
• Improving Nurse Retention and Driving Value-Based Care (Capsule)

Contacts

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

EPtalk by Dr. Jayne 5/7/20

This week is National Nurses Week. I salute all the nurses who taught me what I really needed to know to be successful on the wards, since most of it wasn’t covered in the formal curriculum presented by the medical school faculty.

I came across this pastry shout-out to nurses from physician Cindy Chen-Smith @artmeetscookie and was blown away by the airbrushing. Whether you’re a superhero in chunky shoes, New Balance sneakers, sassy heels, or tactical boots – I salute you.

I also enjoyed reading the comments on National Nurses Day from Patti Brennan, director of the US National Library of Medicine (and a nurse herself). She notes, “While the Library can’t manufacture more time, fabricate personal protective equipment, or stand beside the bed of a patient in need, we can help nurses find freely accessible literature.” Brennan mentions special search strategies such as LitCovid, which I admit I’d never heard of. It’s a curated hub for tracking the most recent scientific information about our current situation and categories articles by topic and by geographic location.

I enjoy seeing the breadth and depth of the projects my clinical informatics colleagues are working on. This research letter published in JAMA Internal Medicine last week looks at “Internet Searches for Unproven COVID-19 Therapies in the United States.” Since we’re looking at a disease with no reliable proven treatments there are plenty of ideas floating around the internet (and directly from political figures) that are catching people’s attention. The authors looked at internet searches that were “indicative of shopping for chloroquine and hydroxychloroquine” by monitoring Google searches “originating from the United States that included the terms buy, order, Amazon, eBay, or Walmart” in combination with chloroquine or hydroxychloroquine.”

They cross referenced the data against the dates when Elon Musk and President Trump endorsed the drugs, as well as the date when news reports on treatment-related poisonings were published. The authors found that “queries for purchasing chloroquine were 442% higher following high-profile claims that these drugs were effective COVID-19 therapies.” Searches for buying hydroxychloroquine were 1389% higher. Searches for purchasing the drugs continued to remain high following news reports of their dangers, although at a lower level (212%).

In the discussion, the authors note that “Google responded to COVID-19 by integrating an educational website into search results related to the outbreak, and this could be expanded to searches for unapproved COVID-19 therapies.” I’m sure there will be more research questions to come in this area as the pandemic rages on.

Most of my physician colleagues have been doing at least some level of telehealth, and after a couple of months, some of them swear they don’t want to go back to in-person care at the same levels they practiced previously. Many patients don’t want to go back either, especially in economically depressed areas and among patients who previously had to travel long distances to receive treatment. A Stat news piece looks at patients in coal country, where the University of Pittsburgh Medical Center (UPMC) has seen a 3,700% increase in telemedicine visits.

One of the reasons for greater patient satisfaction during telehealth visits was noted by UPMC’s CMIO, who noted that who “doctors are able to type notes while facing the patient, instead of looking over their shoulders.” That seems like an operational / technical issue to me. Perhaps UPMC should look at reconfiguring their exam rooms and employing laptops on carts or a better type of device to make their in-person visits more hospitable. He also notes the struggle with initial visits, with patients succeeding on the second or third attempts.

Although many physicians are assuming that the wild, wild west of telehealth (non-HIPAA-compliant platforms, reduced requirements on service location) will continue, we’ll have to see what the payers decide to do. We’ve already seen many of the cross-state licensure waivers end, and there’s already a lot of financial pressure to return to the status quo. (How do you justify charging a facility fee when neither the provider nor the patient are in the facility? Inquiring minds want to know.)

As hospitals start to pass the peak of COVID-19 and clinical care teams start to learn to breathe again, the folks in finance are continuing to have increased anxiety. They have to figure out what it will take to make their balance sheets positive again, or at least less negative.  A recent article featured Dan Michelson of Strata Decision, who discussed what CFOs will need to weather the long-term changes after the COVID-19 storm. I’ve chatted with Dan a couple of times, and he’s usually spot-on in his observations.

Among the things he recommends: rolling budget forecasting, adherence to coding guidelines for complications and secondary diagnoses, and being able to anticipate patient behavior changes, especially the desire for non-emergency procedures. Organizations will also need to truly understand their costs, including PPE, overtime, and additional supplies in the new world post-COVID. They’ll also need to understand the role of self-pay in their overall financial picture, since many patients have lost the health insurance that was tied to their employers.

Another issue in the “new normal” post-COVID is understanding how we catch up on diagnoses that were missed due to multiple months of delayed preventive services. A report from the IQVIA Institute for Human Data Science looks at trends in the US for five common cancers.  The report estimates that 80,000 cases may be missed across breast, cervical, colorectal, lung, and prostate cancers based on decreased screening volumes in April compared to February.

I’m high risk for two of those conditions and am behind on my regular tests due to the closures, so I can definitely understand concerns about screening delays from the patient perspective. Interestingly, I’ve received no communications from either of the providers involved in my regular screenings, so I suppose I’m left to assume that their strategy for handling patient recalls during the pandemic was to just stop contacting people. That’s not much of a strategy for patients who might not be as compulsive about their health as I am. I’ll just keep bumping my calendar reminders forward a few weeks at a time until I hear the hospital is back in the screening business.

The American Academy of Family Physicians came out with a checklist for reopening practices to non-essential face-to-face visits. Usually their advice is pretty practical, but one bullet caught my eye. They recommend that common areas such as patient waiting rooms and staff break rooms should remain closed if possible. Although they recommend allowing patients to wait in their cars until it’s their turn to be seen, they conveniently avoided any recommendations on where staff should take breaks. In my travels, I’ve seen plenty of people eating in clinical care areas because they don’t have time to take an actual break or the office doesn’t have adequate facilities.

Seeing patients face-to-face in these new conditions is more tiring than before and staff do need a place to take a break (not to mention a safe place to take their mask off so their skin can breathe). They also call for staff to wear face masks, gowns, eye protection, and gloves when caring for suspected COVID-19 patients, We’re still in a shortage of gowns, so that’s just not realistic.

There was a recent story on “Good Morning America” encouraging graduates to donate their unworn gowns for healthcare providers to use as personal protective equipment. Although I appreciate the sentiment, I’m horrified that several months into this situation, we’re still in crisis mode. Will the surgeons be asked to wear hand-me-down graduation gowns to the operating rooms now that they’re starting to book cases?  I think not.

Does your staff get to use the break room, or to do they take their meals in their cars? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/7/20

CVS Health first-quarter revenue rose 8% as customers rushed into stores to buy essentials; shares up

CVS Health sees a 600% jump in telemedicine visits through its chain of Minute Clinics, part of an overall spike in its digital services that helped the essential business realize Q1 sales of $67 billion.

TimeDoc Health Secures $5.7 Million Series A Financing Round

Chronic care management technology and services startup TimeDoc Health raises $5.7 million in Series A round of funding led by Vocap Investment Partners.

Cerner Earns Top Client Satisfaction Ratings for Inpatient EHR Vendor in Large Health Systems and Medical Centers, 2020 Black Book Survey

A Black Book survey names Cerner as the top-rated EHR vendor in large hospitals, and in outsourced tech support for hospital networks.

Morning Headlines 5/6/20

Nashville health care company sells one business, reclaims another in $268 million of deals

Change Healthcare acquires ERx Network for $213 million, and sells its Connected Analytics business to Kaufman Hall for $55 million.

PointClickCare Acquires Co-Pilot Analytics Solution

Long-term and post-acute care health IT vendor PointClickCare acquires Consonus Healthcare’s Co-Pilot analytics software.

Britain’s Billion-Dollar Babylon Health App Set To Launch For ‘Millions’ Of New Yorkers

Mount Sinai Health Partners implements Babylon Health’s app, which includes telemedicine and new COVID-19 Care Assistant capabilities.