News 5/6/20

Top News

Change Healthcare acquires ERx Network for $213 million.

The pharmacy claims and e-prescribing network reports $67 million in annual revenue.

Reader Comments

From Staying At Home Marketer: “Re: HIMSS conference. We learned this year that many people can work entirely from home, including doctors doing telemedicine. This could be the year that we learn the same about physically attending the HIMSS conference.” That could be the case. Vendors are (or will be) looking for new ways to reach prospects that go beyond the exhibit hall and its associated cost, and the exhibit hall is what powers not only the conference, but HIMSS itself. The conference will probably remain a big deal for those vendors who continue to participate even with its reduced critical mass, but others (especially those with shallower pockets) have a chance to even the playing field now that we’ve skipped a HIMSS conference and nobody is traveling. I’m hearing from companies that are interested in sponsoring HIStalk that I didn’t expect, although I’m losing some financially concerned ones as I assumed would happen. It will be interesting to see which companies benefit from adversity-forced strategic moves that go beyond trying to hunker down waiting for the old normal to come back.

From Opening Up: “Re: contact tracing. Technology could lead us out of this crisis.” Hardly, at least in terms of information technology in this country. We don’t have the discipline (and maybe rightfully so) to hide in our caves in hopes that someone will develop a vaccine or effective treatment. However, we trailed the world with our lackadaisical, “it will never happen here” approach to the virus while it was still potentially containable, so now the infection rate is out of control to stay, we’re a long way from herd immunity if there even such a thing with this bug, and you can’t contact-trace the entire country’s movements even with an app. Still, we need to use whatever tools we have available. I think we’re at a point, right or wrong, where we’re so anxious to get back to normal that we are willing to accept the inevitable casualties that will result (assuming it is someone else or their family, of course). It’s a good time to not be old, poor, or sick as we accept herd thinning as the acceptable price of avoiding an economic Stone Age. I’m struggling to find the right answer, or maybe struggling with the knowledge that any choice will kill people.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Infor. Infor Healthcare connects the business of healthcare with the mission of healthcare. Its healthcare operations platform elevates ERP to a strategic resource, enhancing delivery across the care continuum by delivering clinically connected capabilities that improve cost, quality, and outcomes. By bringing together supply chain management, finance, human resources, time and attendance, asset management, location-based intelligence, interoperability, and analytics, Infor gives healthcare organizations an industry-specific alternative to traditional enterprise resource planning (ERP) software. Thanks to Infor for supporting HIStalk.

HIStalk had some flaky moments on Monday during a denial-of-service attack that tied me up from Sunday morning until Monday night. I’m still doing some mostly unrelated cleanup that I discovered while figuring out the problem. One of those involves issues with the HIStalk display on mobile devices, which remains a work in progress since the original development company has abandoned the product I was using.

I caught up unexpectedly with Justen Deal (now Justen Burdette), who readers may remember as the 20-something Kaiser Permanente IT employee who in 2006 warned the organization about the uncertain of costs and stability of Epic, which was replacing a $440 million custom-written IBM system. Epic seems to have turned out fine at KP, so for the “everybody lived happily after” ending, Justen is living in Hawaii as CEO of mobile wireless provider Mobi.

Webinars

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

Acquisitions, Funding, Business, and Stock

Kaufman Hall acquires the Connected Analytics business of Change Healthcare for $55 million. The business generates $65 million per year.

In Australia, clinical intelligence vendor Pacific Knowledge Systems will acquire Pavilion Health, which offers cloud-based coding and auditing tools.

CPSI announces Q1 results: revenue up 1%, EPS $0.28 vs. $0.24, beating Wall Street expectations for both.  

Sales

• Orthopedic telemedicine provider OrthoLive chooses Ellkay to bring the EHR information of its patients into its telehealth app.
• Cooper University Health Care (NJ) chooses Accruent’s Connective healthcare technology management and Medical Device Security Analyzer as it brings its outsourced HTM program in-house. 
• UK-based medical chat, telemedicine, and appointment scheduling app vendor Babylon Health — whose NHS rollout as the tech platform for GP at Hand created a company valuation of $2 billion — gains its first US client in Mount Sinai Health Partners Provider Network (NY).

People

Impact Advisors hires James McHugh, MBA (Navigant) as managing director.

Announcements and Implementations

CareMesh offers state and local public health departments free use of its National Provider Directory.

A Black Book survey names Allscripts as the top-rated inpatient EHR vendor in community hospitals.

Nebraska Health Information Initiative goes live with a COVID-19 cases and results dashboard, powered by NextGate’s EMPI, InterSystems HealthShare, and KPI Ninja Universe.

Epic says that 3,000 patients of Community Health Network (IN) have used its MyChart COVID-19 symptom checker.

COVID-19

A COVID-19 model from Johns Hopkins Bloomberg School of Public Health predicts 3,000 US deaths per day and 200,000 new cases per day by June, but the school says those numbers are for a preliminary, FEMA-commissioned analysis rather than a final forecast. Hopkins adds, however, that the death count will rise significantly as governors reopen states despite meeting none of the federal criteria for doing so, such as a declining case count. Those numbers would represent an increase in daily deaths of 71% and an increase in daily new cases of 700%.

FDA says it will tighten its minimal requirements for companies to sell COVID-19 antibody tests, noting that the rush was on in mid-March to get some idea of population spread, but now the tests are being used to make individual decisions. FDA says companies are selling fraudulent tests, claiming their tests are FDA approved or authorized when they are not, and are marketing their tests inappropriately for at-home use. FDA will now require companies to submit their emergency use authorization requests, along with validation data, within 10 business days, and has also issued specificity and sensitivity thresholds for test developers.

Pfizer launches human trials of four variations of its COVID-19 vaccine, with the company saying that a successful candidate could be given clearance for emergency use or accelerated approval in the fall. Pfizer, like Moderna, is basing its vaccine on messenger RNA, a method that has never been used to develop an approved vaccine. More than 100 vaccines are being developed and 20 are expected to reach human trials this year. Initial tests involve patient safety.

Preliminary contact tracing studies suggest that most coronavirus transmission occurs by close, prolonged contact with someone who is experiencing symptoms. The highest risk factors were household contact, transportation, and dining, with family gatherings and church services giving high infection rates and those over age 60 at higher risk. Children are often infected, but do not seem to be driving outbreaks. The virus seems to spread best in cramped, poorly ventilated areas, such as homes, nursing homes, restaurants, and public transportation.

A survey finds that two-thirds of Americans don’t believe that reported COVID-19 death counts are accurate. Forty percent of Republicans think the death count has been overstated, while 63% of Democrats believe the actual death count is higher than the official number. Overall trust in federal government has dropped to 38% and more than half of those surveyed are worried that schools won’t reopen in the fall and that food shortages will develop in the next month.  

WHO warns that government reopenings don’t change the fact that coronavirus is still a global health emergency, as case counts are rising rapidly in poorly prepared Africa and South America.

Axios notes that COVID-19 has placed most clinical drug trials on hold, especially those that involve hospitals, and pharma startups face uncertain timelines, a need for more venture funding, and a requirement to conduct studies in multiple locations to avoid having a study halted due to a local outbreak. 

Johns Hopkins Bloomberg School of Public Health’s Center for Health Security recommends healthcare system changes that will be needed to address the pandemic, saying that the changes will cost billions but “certainly cost less than the trillions now being spent because our public health and healthcare system was not prepared or equipped for this pandemic.” Among them:

• The federal government should create an information sharing system to allow states and hospitals to work together to obtain PPE and medical supplies and improve its medical supply chain tracking and coordination. .
• Congress should create legislation to increase domestic production of PPE.
• Hospitals should buy more reusable devices in their respirator purchases, such as elastomeric face masks and PAPRs.
• Hospitals should not resume full services until ED visits, ICU census, ventilator use, and PPE use either plateau or return to pre-COVID levels.
• Hospitals should give every admitted patient a rapid COVID test to detect asymptomatic carriers.
• HHS should track hospital financial losses and establish short-term bridge funding for hospitals that are in danger of imminent collapse, while CMS should provide financial incentives for those that achieve specific goals for preparedness and infection prevention.
• Regulatory limits of professional licensure, certification, and scope of practice should be relaxed, including extending cross-state licensure beyond the compact-signing states.
• Barriers to conducting telephone or video encounters should be removed – state and federal regulations, HIPAA, and reimbursement that is lower than for in-person visits.
• Congress should use its emergency regulatory authority to authorize clinicians to work at top of license.
• Healthcare organizations should consider offering hazard pay to employees who are involved in direct COVID patient care and offer mental health counseling to all employees.
• Congress should make sure that all COVID-related costs are covered under the CARES Act, should require companies to provide 10 days of sick leave for all employees, and develop a plan to give Americans access to affordable healthcare insurance.
• Healthcare facilities should make significant investments in telemedicine, payers should pay them at the same rate as for in-person visits, and HHS and professional societies should publish guidance and best practices.
• EHRs should be searchable by public health personnel to aid situational awareness.
• The US needs to review hospital surge capacity given the existence of market forces that have driven down staffed bed levels.

MIT scientists develop STOPCovid, a one-hour, $10, minimal handling COVID-19 diagnostic test that offers 97% sensitivity and 100% specificity, requires no special instrumentation, and appears to work well with saliva samples. The FDA has not yet reviewed the test, but the project invites COVID researchers to request a starter kit, hoping to expand test-trace-isolate measures that are required to re-open society.

Sources say President Trump is shutting down the coronavirus task force, sending its responsibilities to FEMA. The frequency and length of the group’s meeting have already been reduced.

Sponsor Updates

• A Dimensional Insight survey finds that EHR analytics tools deliver lower user satisfaction than both analytics-specific platforms and in-house solutions, with more than one-third of users reporting slow queries and inadequately robust capabilities.
• Nordic posts a podcast titled “Rise in telehealth sessions alone won’t create great patient experiences.”
• AdvancedMD publishes a new e-book, “Telehealth: The Ultimate Guide to Maximizing Revenue, Keeping More of What You’re Paid, and Thriving Through Thick and Thin.”
• Dimensional Insight publishes a new report, “How Satisfied are Healthcare Organizations with EHR Analytics?”

Blog Posts

• Health Plans – Are You Ready for the New CMS Interoperability Rules? (Wolders Kluwer Health Language)
• 3 Changes That Will Impact the Post-Covid Patient Journey (Dina)
• Communications in the time of COVID-19: The unique role of pagers (Spok)
• Post Go-Live Training Tips (Optimum Healthcare IT)
• KLAS Report: 314e has the Most Satisfied Customers for Technical Services (314e)
• The Telehealth Paradigm Shift in a Post-Pandemic World (Access)
• How COVID-19 is Affecting Primary Care (Collective Medical)
• A “Thank You” to Healthcare Workers Selflessly Helping Patients (CoverMyMeds)

Contacts

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

Morning Headlines 5/5/20

CareCentrix Acquires Turn-Key Health

Home and post-acute care technology company CareCentrix acquires Turn-Key Health, which offers AI and analytics for palliative care management.

Google and Apple ban location tracking in their contact tracing apps

Apple and Google give developers rules for using their jointly developed contact tracing technology that include bans on the use of location tracking and using the data for targeted advertising or policing.

Cerner’s share of hospital market drops, while rival gains

Cerner loses market share for the first time in 10 years, a decline attributed in part to its loss of nine acute care customers and Epic’s gain of 55 new facilities.

Curbside Consult with Dr. Jayne 5/4/20

Many organizations are knee deep in the process of expanding coronavirus testing. Although it has become easier to get test kits, some of us are still eagerly awaiting the rapid kits from Abbott.

One of the challenges though with adding COVID-19 testing to your scope of services is dealing with the reporting aspect. COVID-19 is a reportable disease in all public health jurisdictions. Depending on how large your organization is (and how many counties or states it serves), the reporting aspect can be daunting.

I was excited to attend a webinar last week that was presented by the American Medical Informatics Association (AMIA). They reviewed the “eCR Now” effort to broaden the use of electronic case reporting for COVID-19. From a clinical informaticist’s point of view, it was the most exciting thing I’ve seen in weeks. For those of you who were like me and hadn’t heard of it, I’ll give you the highlight reel.

Electronic Case Reporting (eCR) is the ability to automate generation and transmission of case reports from EHRs to public health agencies so that those agencies can review and act on them. Depending on the jurisdiction, that might include sending a formal quarantine order to an affected patient, performing contact tracing, or enrolling them in a daily disease tracking and/or surveillance program. Public health agencies rely on case reports for numerous diseases and conditions beyond COVID-19, from sexually transmitted infections to dog bites.

The problem for providers is that each public health jurisdiction has its own reporting process, which may range from email to fax to phone calls. Automating this process from data already in the EHR is key, both in reducing the delay in getting information to the agencies as well as receiving information back from the public health agency.

Apparently a pilot for eCR was already in the works well before COVID-19 hit our shoes. Coordinated by a collaborative of healthcare, public health, and health IT industry partners, Digital Bridge came together to solve the problem of data exchange. After some small implementations, the effort began to expand in late 2019, with sites implemented in Texas, Utah, New York, and California, plus 19 other state and local public health agencies.

Once COVID-19 became a thing, they started reporting those codes through the existing infrastructure. By the end of January, 142,000 case reports had been sent from seven implementations. The process uses HL7 standard documents to move information from providers through HIEs or other exchange frameworks to a platform that is supported by the Association of Public Health Laboratories (APHL). For public health agencies that aren’t completely integrated, the platform can render the files in HTML, which functions a lot like the faxes they previously received.

Most of the current implementers are Epic and Cerner sites, but given the importance of public health reporting for COVID-19, there is a push to move eCR capabilities into more EHRs. They’ve created a program called “eCR Now” that has three main parts:

1. Rapid implementations for cohorts of organizations that have eCR-enabled EHRs.
2. A FHIR app that non-eCR-enabled EHRs can rapidly implement.
3. Extension of the existing eHealth Exchange policy framework through a developing Carequality eCR implementation guide

As far as the accelerated implementation cohorts, what used to take 2-3 months is now taking 3-4 days. In fact, Sutter Health has issued a challenge, promising a bottle of wine for any cohort participant that can beat Sutter’s implementation record.

Organizations whose EHRs don’t support the standard can use the FHIR app, which was due (along with its source code) to be released May 1. There’s a nationwide HL7 FHIR Virtual Connect-a-thon scheduled for May 13-15. EHR vendors that don’t support the standard are being encouraged to develop the ability to trigger report generation and send data based on the standard, and state and local public health agencies are being encouraged to accept eCR instead of requiring manual case reporting. Who doesn’t love getting rid of a clunky manual process?

Needless to say, I immediately took this information to a couple of the organizations I work with, because it’s the kind of project that’s a win-win in a lot of ways. Manual reporting sucks up time that could be spent doing other things, and being able to rapidly process information about COVID-19 diagnoses and lab tests is going to be key to our management of the disease especially without a vaccine or broadly-applicable treatments. Plus, I selfishly want one of my clients to bite on the idea because I love this kind of a project – it takes me back to my first “build from scratch” project more than a decade ago, when we decided to add CCOW functionality between several applications at my health system.

I still remember the calls with Sentillion, when they agreed to give us the software development kit and I had to quickly learn about Vergence and the fact that “the vault” didn’t live in a bank. It was probably my first deep dive into the world of development, and led me to meet all kinds of wild and crazy developers and even build a friendship with my own personal “Citrix Guy.” Sure, there were many late-night testing sessions (since we didn’t have a complete test environment and had to quietly test things in production after the physicians were off the system, but before the backups and billing runs started) and probably too much alcohol, but it was a really fun time that I will always remember.

Technology moves on. Microsoft bought Sentillion, all those developers are now working at other places, and CCOW has mostly gone the way of the dodo as healthcare organizations either move onto monolithic platforms that handle everything or instead move the data around through interfaces.

I’m hoping I get to work on an eCR project and that it continues to grow well beyond COVID-19 and into the realm of all the other reportable diseases that require complicated manual reporting. Many of us believe healthcare is entering into a time of massive transition, and we’re going to need lots of tech to get us through.

Anyone looking for an ex-CCOW expert that likes to play with FHIR? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: How Health Systems Use Technology in New Ways to Adapt to COVID-19

How Health Systems Use Technology in New Ways to Adapt to COVID-19
By Terry Zysk

Terry Zysk is CEO of LiveProcess of Chelmsford, MA.

Saving the lives of patients and protecting care providers during the COVID-19 pandemic is an unprecedented healthcare management challenge. Unlike a hurricane that passes in a few days, COVID-19 could be with us for quite a long time.

Some of the innovative US hospitals I work with are solving pandemic-related problems by repurposing already deployed or quick-to-deploy technology. Creativity is allowing these health systems to adapt to the COVID-19 crisis.

According to McKinsey & Company, as major events occur, responsive healthcare organizations focus on five areas to ensure access to care delivery: workforce protection, supply chain and resource stabilization, customer and staff engagement, stress testing, and nerve center integration.

Similarly, health systems on the front lines of COVID-19 are using technology with roots in hospital emergency management to dynamically rebalance business operations, share information, and collaborate in virtual command centers.

A public health emergency response creates large-scale logistical issues. Hospitals are changing protocols, rethinking workflows, repurposing clinical areas and redistributing staff to adapt to a shift in demand.

All of these changes require intense coordination and collaboration.

To replace rumors and stress with accurate and timely information, health systems are pushing information out to engage healthcare workforces. They are reaching employees at all facilities at once while also developing proficiency in minimizing alert fatigue throughout a long-duration event.

As more masks and gowns are needed to protect the healthcare workforce, hospitals and healthcare coalitions are using emergency management technology to share guidance on the use of PPE, request PPE from community partners, and coordinate and track regional inventory.

CDC requirements for monitoring employee health involve daily communication with healthcare providers. One health system is performing virtual health checks by reaching out to hundreds of affected personnel with survey technology, and then displaying the results on a quickly developed business intelligence dashboard.

At another hospital, human resources specialists used event sidebar communications in emergency management technology to collaborate in a virtual command center and optimize the redistribution of staff.

When converting hospital rooms or even entire floors into other types – such as negative pressure and isolation rooms and reconfiguring spaces create more ICU beds — a healthcare coalition electronically surveys its 18 facilities on their room and bed inventory. With automatic roll ups, leadership teams are producing up-to-date daily reports with minimal labor and a short turnaround time.

Staffing coordinators are using trackable one-to-many notifications with multiple choice response options to fill high-demand roles quickly and efficiently, leveraging tools typically used for mobilization and coordination in natural disasters.

In these many ways, health systems and coalitions are adapting to the current situation with new processes and proficiencies by using existing technology in new ways. Their experiences may spur ideas that help your own health system improvise and adapt to COVID-19 and other disruptive situations.

Morning Headlines 5/4/20

Data Interoperability and Exchange to Support COVID-19 Containment

In a new Duke University report, experts recommend that health officials should define a minimum data set for COVID-19 containment as part of participating in clinical data exchanges, among other short-term actions that can be taken to improve interoperability and data exchange for containing the virus.

Spok Reports First-Quarter 2020 Operating Results; Wireless Trends Continue to Improve and Year-Over-Year Improvements in Software Revenue Bookings

Spok reports Q1 results: revenue down 11%, EPS –$0.24 vs. $.04.

Dascena Announces Closing of $50 Million Series B Financing to Support Advancement of Diagnostic Algorithm Development Engine to Inform Patient Care and Improve Outcomes

AI-powered sepsis prediction company Dascena raises $50 million in a funding round led by Frazier Healthcare Partners.

Canada to invest $240M in online health care amid coronavirus, Trudeau says

Canadian Prime Minister Justin Trudeau announces funding for expanding digital healthcare capabilities and developing new telehealth services for primary and mental healthcare.

Monday Morning Update 5/4/20

Top News

A Duke University-convened expert group lists short-term actions that can be taken to improve interoperability and data exchange for containing COVID-19. It recommends that:

• Commercial labs and point-of-care test manufacturers should record patient demographics along with COVID-19 samples and add the information to their reports to enable contract tracing, and CMS should use payment adjustments to give them incentive to do so. This information would include patient name, date of birth, gender, race/ethnicity, contact information (address and/or telephone number), and the identifier that was used in collecting the sample (such as medical record number). This capability could be brought online quickly by using the existing clinical query function of CommonWell, claims clearinghouses, or other information service providers.
• State and local health officials should define a minimum data set for COVID-19 containment as part of participating in clinical data exchanges. Limited public health resources precludes developing API-driven data feeds, so existing intermediaries should be used instead, such as Health Gorilla or the PULSE system that is supported by the Sequoia Project and Audacious Inquiry. 
• Federal, state, and local officials should enhance their use of the National Syndromic Surveillance Program.

Reader Comments

From Marshall: “Re: Greenway Health. A rumored RIF of up to 10% of their workforce Thursday.” Unverified, but reported by several readers.

From Dill Fighter: “Re: Apple-Google contact tracing. I will address some misconceptions. The proposal mirrors the CDC in triggering notification only if you have spent at least 15 minutes within six feet of someone who is infected, so just walking by or checking out in a store won’t count. People won’t need to enable them since it will be built into the OS. Users don’t necessarily need to enter their own positive results – providers could enter them in a HIPAA-complaint way, such as entering only the Bluetooth ID of the phone.” My responses, adding to my initial comments:

• I missed the minimum time of contact specification, which according to Apple, requires 5-30 minutes of contact (the exact threshold must be defined by the public authority, which is responsible for analyzing the data). I assume that contact must be constant rather than cumulative.
• Apple and Google acknowledge that the six-foot range is a best guess based on Bluetooth signal strength and how the phone is being held. It will be thrown off if the phone is stored in a purse or backpack.
• Phone users don’t need to download the app, but they need to opt in when it is installed via an OS update. They can opt out or uninstall the app later, which may well happen if the app eats up battery power in the background.
• The user needs to manually install a second app that will be developed by their local public health authority (how that authority does that development isn’t clear). That authority sets the distancing rule and manages the entry of positive results, and without their app, the Apple-Google one does nothing. Apple and Google are suggesting that a future release of their app will eliminate the requirement of installing a public health app, although I haven’t seen a description of how that will work.
• It’s the user’s job to enter their own positive result using the public health service’s app. I haven’t seen any suggestion that the app will support providers doing it for them.
• Singapore saw barely more than single-digit adoption of its national contact tracing app. The country’s director of digital services, which developed the TraceTogether app, warns that they use it only to support manual contact tracing and it’s naive to see it as a replacement. He adds that “you cannot ‘big data’ your way out of a ‘no data’ situation,” such as the Washington state choir in which 45 of 60 members were infected despite distancing appropriately, likely because their singing projected respiratory particles further, and phone-based contact tracing would have missed that.

From HIMSSanity Cured: “Re: HIMSS. I don’t know about anyone else, but my consumption of HIMSS products and services is, and always has been, zero other than attending the conference.” Same here – I have no touch points with HIMSS other than the conference. I don’t read its publications, watch its webinars, attend its other events or local chapter meetings, pay for its certifications, follow its twitterati, view its endless ads, or participate in its plea for vendor-enriching government handouts (excuse me, “advocacy.”) I don’t say this as some kind of vindictive reaction to HIMSS policies and actions – I just don’t need anything that HIMSS offers and I don’t even think about the organization until it’s time to sign up for the conference (or not, as the case increasingly may be). They are just another vendor who I might contact in the unlikely event that I need something they offer. That’s just my opinion as a member, although even as a member I can’t say I’m thrilled at a lot of what HIMSS undertakes that seems more appropriate for a vendor than a member organization.

From Audioslave: “Re: podcast. Here’s a good one on public health.” I don’t listen to podcasts or watch videos that could have been presented as written articles instead. I know people have fun screwing around with their microphones and recorded video calls instead of writing, but they’re wasting my time to save theirs. I’ve done a zillion interviews and can say with confidence that skimming one in 45 seconds and reading the interesting parts more carefully is a lot more efficient than listening to a 30-minute conversation, especially when the questioner’s vanity prattling eats up an unreasonably high percentage of total run time. 

HIStalk Announcements and Requests

A surprisingly large number of poll respondents have experienced some form of virtual visit since the pandemic broke out 100 years ago in mid-March, with video visits leading the pack. A couple of folks said that the video interface failed and the fallback was a phone call, while one also questioned the how good of replacement those visits can be when they offer only conversation and observation without the clinician being able to use a stethoscope or hands-on techniques.

New poll to your right or here: Will you use the COVID-19 contact tracing app from Apple and Google as soon as it becomes available?

I wonder if masks could be made from a clear but comfortable fabric so we don’t all wander around in public looking like bank robbers in Westerns? If not, here’s my Plan B: custom-printed masks where buyers can insert a headshot so that the outside of the mask looks like what is underneath (hello, CVS and Walgreens photo departments). We “Arrested Development” fans will be celebrating Cinco de Cuatro on Monday, so I confess that I was inspired by George Michael’s muscle shirt.

Webinars

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

Acquisitions, Funding, Business, and Stock

Meditech reports Q1 results: revenue up 24%, EPS –$0.69 vs. $0.97, swinging from a quarter-over-quarter profit of $36 million to a loss of $26 million due to COVID-related stock losses and a decline in product bookings. Product revenue rose 77% and service revenue was up 3% in a quarter that was good for the company in the health IT market, but not so good in the stock market.

Spok reports Q1 results: revenue down 11%, EPS –$0.24 vs. $.04.

Government and Politics

President Trump nominates a replacement for the HHS principal deputy inspector general who interviewed hospitals about their COVID-19 concerns and reported their experience with shortages of coronavirus-related supplies and diagnostic tests. The President accused HHS career official Christi Grimm, MPA, who started working for OIG in 1999, of being politically motivated. The President has nominated as her replacement Jason Weida, JD, an assistant US attorney in Boston. 

COVID-19

CMS issues another round of COVID-19 regulatory waivers that include:

• Physical therapists, occupational therapists, and speech language pathologists can provide Medicare telehealth services.
• Hospitals can bill Medicare for services that are provided remotely by hospital-based practitioners.
• Evaluation and management services can be delivered to Medicare patients via telephone.
• Behavioral health and patient education services can be provided by telephone and will be paid at the same rate as for office and outpatient visits.
• Medicare will pay for COVID-19 tests that are ordered by any healthcare professional, not just a physician, who is authorized by state law.
• Pharmacies can operate pharmacist-staffed drive-through testing sites if they are enrolled by Medicare as a laboratory.
• Hospitals will be paid separately for performing COVID-19 testing as the only service to a particular patient.
• Medicare and Medicaid will pay for certain FDA-authorized serology tests.
• Hospitals can increase COVID-19 beds without reducing their payments for indirect medical education, while inpatient psychiatric and rehabilitation hospitals can admit more patients without reducing their teaching payments.
• Hospitals will be paid at OPPS rates for outpatient services such as wound care, drug administration, and behavioral health that are delivered in temporary expansion locations, such as parking lot tents, converted hotels, and patient homes.
• Long-term acute-care hospitals will be paid at higher Medicare payment rates for accepting acute-care hospital patients.
• Nurse practitioners, clinical nurse specialists, and physician assistants can order home health services, establish and review plans of care for home health patients, an certify and re-certify patients for home health services.
• Physical and occupational therapists can delegate outpatient maintenance services to assistants.
• Applications for new ACOs will not be accepted until 2021, but those whose participation is expiring this year can extend for another year.

Analysis of TriNetX’s global health research network finds that patients aged 30 to 50 make up 26% of all strokes among patients who tested COVID-positive, versus the typical rate of 11% in non-infected patients in that age group.

The US is betting big ($483 million) that a coronavirus vaccine can be developed by messenger RNA drug company Moderna, which has never brought a product to market, hasn’t had any of its nine vaccine candidates approved by the FDA, and has never had a product reach the third phase of clinical trials. Even the company’s former chief science officer / R&D president is shocked by the huge amount of funding the government is providing. Nature magazine criticized the company for having failed to publish a single peer-reviewed paper about products it was touting to investors, likening it to Theranos. Moderna’s market cap has risen to $16 billion.

FDA gives Gilead emergency use authorization to distribute remdesivir for severely ill COVID-19 patients, also allowing five-day use for non-intubated patients instead of the usual 10 days, which will extend the drug’s supply. Gilead is donating its entire inventory of the drug, 1.5 million vials, to the federal government, which will oversee its distribution.

New research indicates that blood pressure drugs in the ACE inhibitor category, contrary to early concerns, do not affect coronavirus infection or outcomes.

A New York City nursing home admits that 98 residents of the 705-bed facility have died from presumed coronavirus infection.

A Brigham & Women’s ED doctor warns that it’s not reasonable to compare deaths from COVID-19 versus influenza – COVID-19 deaths count only patients who tested positive or met specific diagnostic criteria, while flu deaths are estimated using a model that adjusts for assumed vast underreporting (I admit that I did not know this). Example: CDC estimate 2018-29 US flu deaths at 26,000 to 53,000 even though just 7,200 deaths were confirmed. Applying that same underreporting assumption to COVID-19 suggests that it could have already killed 600,000 people in America (versus the official count of 68,000), and even then we are early into a pandemic that may or may not weaken in the summer.

Former FDA Commissioner Scott Gottlieb says that we may hit 100,000 US deaths from COVID-19 by June and that cases are still rising in 20 states, indicating that mitigation steps didn’t work as well as expected.

Meanwhile, the number of confirmed cases seems to have hit a stubborn plateau, leading to the possibility that a “second wave” won’t happen in the winter because the first one won’t actually have ended by then, especially with relaxed mitigation measures that the virus has waited out (late May is likely the new March as the April mitigation indiscretions kick in as active infections and hospitalizations). Seasonality remains the best (but uncertain) hope for a summer break. Curve-flattening was successful only in extending the time period in which the same number of people get infected, are hospitalized, and die, but otherwise the virus is still out there just like before.

China’s state media creates a video that makes fun of the US’s coronavirus response. Meanwhile, a Department of Homeland Security report says China intentionally hid the extent of the pandemic so it could hoard drugs and supplies, as evidenced by unusual import and export numbers.

Other

Epic launches Epic Health Research Network, a public-facing site in which Epic’s customers can post their observational findings about COVID-19 or any other topical issues in health and public health.

UK Prime Minister Boris Johnson and his fiancé give their newborn son the middle name of Nicholas in honor of two doctors by that name who treated Johnson for COVID-19 last month.

Sponsor Updates

• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “Indications for Intubation.”
• OpenText’s information management solutions are now available as fully managed services on AWS.

Blog Posts

• Why Health Information Exchanges are an Important Pandemic Response Solution (Lightbeam Health Solutions)
• No Time for Training? No Problem! Georgia Health System Dives into LiveProcess to Manage COVID-19 Response (LiveProcess)
• Healthcare’s Economic Recovery will Depend on Rapid Adoption of RCM Innovation (Loyale Healthcare)
• Virtual care delivers on top priority for patient experience – safety (Meditech)
• Population Health Management: A Path to Value (Health Catalyst)
• Video Teleconferencing Security Tips for Zoom (Impact Advisors)
• 7 Essential Communication Tips When Reopening or Ramping Back Up Your Physical Therapy Practice (MWTherapy)
• Presenting Healthcare Heroes Their Capes on National Superhero Day (Netsmart)
• Preparing for “after COVID-19” – how can healthcare providers get ready for the pandemic’s re-scheduling aftermath? (Experian Health)
• How to Streamline the Patient Payment Collections Process When Staff is Stretched Thin (PatientBond)
• How to Measure Inter-professional Collaboration in Healthcare (PatientKeeper)
• 5 FAQs healthcare organizations are asking us about their FCC COVID-19 Telehealth Funding application (Pivot Point Consulting)
• Is your medical practice disaster and emergency proof? (PerfectServe)
• Contingency Planning During a Pandemic (Redox)
• Patient Engagement is Key to Telehealth Success (Relatient)
• Remote is the new normal: Enable workers, not hackers (SailPoint)
• Spirion Launches Program to Aid Local Restaurant Workers Impacted by COVID-19 Statewide Shut Down (Spirion)
• How to Handle Patient Moves and Bed Transfers; A17 HL7 Messages (Summit Healthcare)
• Safer, Hands-Free Communication for COVID-19 Environments – Deployed with Startling Speed (Vocera)
• 2 ways to support your payers through the COVID-19 crisis (Waystar)
• Envisioning a Better Normal: 3 Strategies to Prepare Your Practice for a Stronger Future (WebPT)

Contacts

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

Weekender 5/1/20

Weekly News Recap

• Arcadia acquires the assets of the Massachusetts EHealth Collaborative.
• A KLAS inpatient EHR bed win-loss report for 2019 shows big gains for Epic and Meditech, big losses for Allscripts and Cerner.
• Epic announces plans to add integrated telehealth to its product.
• VA OIG finds that the VA had not adequately planned its now-postponed first go-live, specifically in the areas of staffing, patient access given an expected 30% drop in provider productivity for 12-24 months, and missing functionality such as e-prescribing.
• Cerner’s Q1 beats earnings expectations, but falls short on revenue.
• Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments.
• Facebook’s coronavirus symptom survey is sending results from 1 million users per week to Carnegie Mellon University for predicting disease spread and county-by-county impact.

Best Reader Comments

People badmouth VistA, but many MDs we worked with used it at a VA and say they prefer it to Epic or Cerner systems. I assumed Millennium couldn’t be enhanced and customized to address AL existing military-specific capabilities in Stage 1. But not having basic e-prescribing capabilities (refills) that meet safety standards in 2020 in a multi-billion dollar EHR is alarming and a show stopper IMO given VA’s target population. Likely execs on top of food chain @ Cerner and VA OK’d plan to go-live without refills without deep understanding of potential harm and disruption for millions of vets (many depend on lifetime of meds for chronic pain, injuries and illnesses) and their families. (Ann Farrell)

People like the VA system because it doesn’t have the same data capture and billing systems as those serving commercial insurers. It also doesn’t have the same central oversight of the local orgs that a big health system does. That’s one reason why vets from different areas have such different experiences and opinions of the VA. I agree though that this particular screw up was probably caused by the exec team being told to go live without any real incentive to make sure everything works. (IANAL)

Not knowing all the key ways it spreads or just how fatal it is if contracted. Because we don’t have the denominators, which are key to knowing any of the rates. Exacerbated because the only people approved for COVID testing have to have symptoms, so no total population stats are known. New data is coming in on the head counts of those with antibodies who never reported sick, which provides hope this isn’t as bad as we are led to believe and that the death rate is greatly lower across the population than modeled. And the urgency is bolstered by CDC’s original instructions on coding U07.1 as being the underlying cause for any death when present (or suspected if no testing done) with co-morbidities and end stage conditions. NY is getting excoriated because they forced nursing homes to take hospital discharges of patients with COVID, which resulted in double digit deaths in those locations, because they are filled with the at risk elderly. And it also adds to the death count numbers that probably would not have occurred. These types of factors inflate the actual COVID death rate, but even then, it is coming in quite low (most stats now are showing actual death percentage under 2% and most don’t even achieve 1% of everyone who gets it.) (Icon O. Klast)

Among the things that have changed with the emergence of COVID-19 is the number of Epic generated press releases. Have there been more this year than all of previously recorded time? (AnotherDave)

If MDs want to improve the ratio of physicians to administrators, maybe they should pressure their colleagues to open more US medical schools. (Commenter)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. O in Kentucky, who ask for hands-on practice tools for class IPads. She reported in early February, “My students have already benefited so much from this addition of resources. As we learn to use our Osmos, we are finding even more ways to use them for teaching and learning than we even knew were capable. They work amazingly with some older IPads that we had on hand. We were able to resurrect this technology and give it a new purpose. I have also been able to share them with other teachers in the school to check out and use so that all students at my school have access to this resource. Students are excited to do math, reading, writing, engineering, coding, problem solving, and so much more.”

The Milwaukee paper describes how Epic’s 200 culinary team employees, freed up from providing up to 7,000 meals per day to employees who are mostly working off campus, are serving food pantries, long-term care facilities, frontline healthcare workers, and at-risk groups in the Madison area. The company also donated 47,000 pounds of food to food pantries and long-term care facilities between mid-March and mid-April. Epic is also offering curbside grocery pickup for its employees, which allowed a local produce company to bring its laid-off staff back to work.

In England, an NHS anesthesiologist creates a flashcard app that allows mask-wearing clinicians to communicate with COVID-19 patients using predefined on-screen text and voice messages. Rachael Grimaldi, BM developed Cardmedic in 36 hours while on maternity leave. The free app is being used by NHS trusts and by hospitals in 50 countries and is being expanded to include 30 languages, sign language, illustrations, and downloadable PDFs.

Doctors in Germany organize a protest called Blanke Bedenken (“naked concerns”) in which they pose nude in pictures to illustrate how lack of PPE puts their lives at risk. One doctor posed with a sign that reads, “I learned to sew wounds. Why do I now need to know how to sew masks?”

The New York Post profiles NYU Langone Hospital Brooklyn maintenance mechanic Hans Arrieta, who maintains the hospital’s ventilation and water systems. He has self-isolated by sending his family to live with relatives.

Kansas City Chiefs right guard and Super Bowl ring-wearer Laurent Duvernay-Tardif, MD makes Sports Illustrated’s daily cover for answering the call of Quebec’s health ministry for medical and nursing students to help give caregivers relief. He hasn’t completed a residency yet, so his assignment is to administer medications to patients in a long-term care facility. He observes, “I realize that I’m privileged. I didn’t lose my job. I don’t have three kids at home and a Zoom meeting and home school to teach. I know a bunch of my friends are going through difficult times; many are physicians who I met in medical school. I have friends who are working in emergency rooms. One does triage and tests patients for COVID-19. Those people are on the front line, and they’re giving everything to protect us.”

Children’s Memorial Hermann pediatric plastic surgeon Phuong “P. Danger” Nguyen, MD writes and performs a public service announcement featuring the song “Stay at Home.” It’s a project of Help the Doctor, an all-surgeon band.

In England, police in a small village seek to give some “words of advice” to someone who is walking around town wearing a 17th century plague doctor outfit. Some residents were frightened, some were amused, and one was pragmatic: “If it’s not illegal and he can’t wear it now, when could he?” Plague doctors wore the black outfits for home visits during the Black Death, with the beak-like mask that was thought to filter the disease leading to the disparaging doctor term “quack.”

In Case You Missed It

• News 5/1/20
• EPtalk by Dr. Jayne 4/30/20
• HIStalk Interviews Chris Klomp, CEO, Collective Medical
• News 4/29/20
• Curbside Consult with Dr. Jayne 4/27/20
• Readers Write: Healthcare Crisis Underscores Strategic Importance of Strong IT Support
• HIStalk Interviews Krishna Kurapati, CEO, QliqSoft
• Monday Morning Update 4/27/20

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 5/1/20

Arcadia Enhances Value-based Care & Interoperability Expertise with Acquisition of Massachusetts eHealth Collaborative Assets

Health data and software company Arcadia acquires assets of the Massachusetts EHealth Collaborative, including technology and customer accounts.

Twilio to Power Epic’s New Telehealth Video Offering

Epic will embed telehealth into its EHR using Twilio Programmable Video, which is also used by Kaiser Permanente,  MDLive, Doctor On Demand, and several health systems.

Tampa General, AdventHealth and other Florida hospitals come together to share coronavirus data

Fifty-one hospitals along Florida’s west coast partner with analytics vendor SME Solutions Group to form a collaborative to share COVID-19 patient data through a regional data exchange.

HHS Awards $20 Million to Combat COVID-19 Pandemic through Telehealth

HHS awards $20 million to six organizations to help them expand telemedicine access.

Cleveland Clinic, Epic develop home monitoring tool for COVID-19 patients

Cleveland Clinic works with Epic to customize its MyChart Care Companion remote monitoring technology for chronically ill patients to include COVID-19 care pathways.

News 5/1/20

Top News

Health data and software company Arcadia acquires assets of the Massachusetts EHealth Collaborative, including technology and customer accounts.

MAeHC President and CEO Micky Tripathi, MPP, PhD will join Arcadia as  chief alliance officer while continuing his roles with Argonaut, Sequoia, CommonWell, HL7, HL7 FHIR Foundation, and CARIN Alliance.

Reader Comments

From VCU Observer: “Re: VCU Health’s rip-and-replace of Cerner with Epic on May 1. At least one board member says the project hasn’t been approved nor the implementation costs outlined. The expenditure, rumored to be hundreds of millions of dollars more than Cerner’s upgrade bid, doesn’t make sense at this time.” Unverified. VCU announced a mid-2021 go-live when they chose Epic in December, which seems challenging given limits on travel and in-hospital presence for the all-important initial planning and on-the-ground design meetings.

From PPP Shooter: “Re: paycheck protection plan loans. The Small Business Administration has clarified that publicly traded companies, as well as the portfolio companies of private equity funds, are prohibited from receiving PPP loans and must pay them back by May 7 if they received them. Hundreds of publicly traded companies received these loans and the PE firm clarification may cause problems for the health IT world.” SEC filings indicate that 220 public companies need to return $870 million that they received before the rule was changed, with more that are likely still be disclosed since SBA has refused to release a list of the companies that received money. Publicly traded health IT company Castlight Health received the maximum loan of $10 million, but says it will return it.

From Pickle Bickering: “Re: contract tracing by smartphone app. Is it worth the privacy intrusion?” Apple and Google are doing exactly what big tech companies always do when barging into healthcare with minimal knowledge — they are thinking that a cool app can fix everything. App-based contact tracing is doomed to fail, in my opinion, and not just because of privacy issues:

• Not all Americans own smart phones and carry them at all times. Children, for example, appear to be significant spreaders and will become more so when schools and daycares reopen, but few of them will be carrying a contact-tracing app on a phone.
• Many people won’t use tracking apps because they don’t know they exist, don’t derive any personal benefit from their use, or refuse to be tracked regardless of privacy assurances. There is no way that Americans will accept an opt-out model in which they default to being users and also no way that a significant percentage will otherwise opt in.
• These apps have never worked in a country where their use was voluntary, nor rolled out late in a country whose initial COVID-19 response was as indecisive as ours.
• Accuracy is questionable. The six-foot range will flag contacts between cars, on opposite sides of plastic shields in stores, and where physical protection is in place and makes virus spread unlikely. I’m not confident that a record of whom I’ve passed within six feet of is all that useful in controlling coronavirus spread.
• Users are expected to manually enter their positive COVID-19 test result for the benefit of others who will then be notified. Then, unlike in other countries, it’s up to those people who get the “you’ve been exposed” warnings to take action since they are not identifiable.
• Contact tracing requires having a strong system of 14-day quarantine in place, such as providing private living space and checking up on self-monitoring. We can already guess that many nursing home residents, mass transportation riders, homeless people, prisoners, and laborers who live in employer-provided dormitories are infected, but any isolation is voluntary and limited by their resources.
• The bottom line: this sort of contract tracing works only if at least two-thirds of Americans use the app and we roll out widespread COVID-19 testing to identify those who are infected but symptom-free to catch potential spreaders early. Even then our society, as it returns to being mobile, will make it nearly impossible to address the potentially hundreds of people that someone could pass near in the days or weeks before they receive a positive test result.

From Looking For Answers: “Re: Clarify Health Solutions. Laid off 70 employees, about 40% of its workforce, on March 19. KKR gave it a bridge loan instead of agreeing to a Schedule C. I’ve seen nothing online, but a former colleague who used to work there told me.” Unverified. I don’t think I’ve ever heard of this particular analytics vendor, which has raised $63 million, almost all of that in a September 2018 Series B round by KKR. The company announced a couple of COVID-19 apps less than a week after this rumored layoff. 

Webinars

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

Acquisitions, Funding, Business, and Stock

Mayo Clinic (MN) will invest in Current Health and work with the company to develop COVID-19 predictive and remote monitoring technologies.

From the Cerner earnings call:

• Chairman and CEO Brent Shafer says he is pleased with the productivity and performance of its 27,000 employees after the majority of them moved to working from a virtual environment.
• The company expects the VA and DoD to revise their timelines due to COVID-19 and Cerner has factored that into its guidance.
• Cerner expects a slight drop in next-quarter bookings, but says clients are generally moving ahead and it won’t be a lot different than usual, especially since unlike the 2008 market crash, health systems were doing fine financially before coronavirus and stimulus money will help get them back on their feet.
• President Don Trigg says the federal government’s role of top regulator and payor will expand due to COVID-19 and health system consolidation will accelerate and extend into ambulatory practice.
• Clients are starting to ask about getting into the queue for services that will be in high demand.

Sales

• Penn State Health selects RCM software and services from R1 RCM.

Announcements and Implementations

A new KLAS report on US hospital EHR market share finds that Meditech Expanse is drawing new interest from customers outside its usual small-hospital base, with a new 400+ bed health system sale in 2019 giving the market a chance to see how Expanse scales. Meditech won about half the decisions made by its legacy customers in 2019, and half of its losses came from product standardization and provider M&A. Cerner saw its first-ever decrease in market share after losing four big clients in 2019, with its losses most often due to customers who standardized on Epic and those who were frustrated with Cerner’s revenue cycle management solution. Epic has grown to cover 40% of US acute care beds, with its new wins split between new decisions and standardization and acquisitions. Allscripts continues to steadily lose market share, with 2019 losses of customers of Sunrise (eight), Paragon (16), and Horizon (seven). Small, standalone hospitals were left with few choices after Athenahealth exited the inpatient market, with Cerner CommunityWorks and Meditech Expanse coming closest to meeting their needs.

Epic will embed telehealth into its EHR using Twilio Programmable Video, which is also used by Kaiser Permanente,  MDLive, Doctor On Demand, and several health systems. Investment firms are already warning companies like Teladoc that their reach into academic medical centers may be constrained with the availability of an Epic-embedded virtual visit platform that is staffed by a hospital’s own clinicians.

Critical access hospital Macon Community Hospital (TN) goes live on Cerner in a go-live that Cerner managed remotely.

Allegheny Health Network’s Saint Vincent Hospital (PA) implements virtual ICU software and support from Mercy Virtual.

Greenway Health announces GA of GRS Express, a suite of expedited RCM services to help practices maintain cash flow.

EPSi announces GA of COVID-19 Planning Analytics to help providers anticipate ICU capacity, financial burdens, and the impact of resuming elective procedures.

QliqSoft will incorporate the Suki voice-enabled digital clinical assistant in its telemedicine platform to create medical notes and perform tasks such as EHR information retrieval.

Reliance EHealth Collaborative is developing COVID-19 use cases via data management, analytics, and reporting from IMAT Solutions.

Government and Politics

HHS awards $20 million to six organizations to help them expand telemedicine access.

COVID-19

Conflicting studies on the use of remdesivir came out Wednesday following several incidents in which leaked information found its way to mainstream media headlines. Preliminary results from a government-run trial showed patient time to improvement was 11 days versus 15 days for placebo, which meets the NIH study’s endpoint, but the drug did not provide a statistically significant improvement in survival rate. Almost simultaneously, results of a peer-reviewed study performed in China showed no benefit from using remdesivir. Experts say the benefit isn’t necessarily how well remdesivir works, but a reminder that the virus has vulnerabilities that can be exploited incrementally to improve outcomes even in the in the absence of a blockbuster drug, as was the case with HIV/AIDS.

NIH announces a $1.5 billion challenge for rapid deployment of coronavirus diagnostic tests.

A Kaiser Health News article observes that hospital information that is stored in proprietary, siloed EHRs cannot support hospitals sharing their COVID-19 treatment experience. Experts say everybody knew from the early days of the $36 billion Meaningful Use program that hospitals were seeking systems to optimize billing, not public health. Health Catalyst CTO Dale Sanders was quoted in the article as saying that CDC should have developed a coronavirus data collection plan, with standardized terminology, that would have allowed hospitals with non-interoperable EHRs to look at the big picture (Health Catalyst is a member of the COVID-19 Healthcare Coalition that is trying to assemble information for real-time support). Public health systems are also often unable to accept electronically submitted information, requiring hospitals to complete manual forms that can take up to 30 minutes to complete and often even then with missing information.

Most of the tent hospitals that were expensively built to provide services to an expected crush of COVID-19 patients are scheduled for closure, having seen few patients:

• New York is shutting down two tent hospitals that didn’t see a single coronavirus patient, having spent $350 million in federal taxpayer money to plan and build temporary facilities. The only field hospital that saw patients, at Javits Center, will close Friday after treating 1,000 patients in the 4,000-bed facility.
• Chicago’s pared-back, $64 million, 500-bed hospital at McCormick Place has treated only 12 patients.
• Detroit’s 1,000-bed convention center hospital has seen just 36 patients and is scheduled for closure.
• Philadelphia will close its 200-bed temporary hospital in two weeks. It has never had more than six patients at a time.
• New Jersey’s four field hospitals totalling 1,000 beds have treated 346 patients.
• The temporary hospital that was set up in the New Orleans convention center is averaging 100 coronavirus patients.
• The Navy’s 1,000-bed USNS Comfort will leave Manhattan this week to return to its home port of Norfolk, having treated just 182 patients.

The Atlantic says Georgia’s rush to reopen businesses is an experiment “to find out just how many individuals need to lose their job or their life for a state to work through a plague” given that Georgia is moving forward despite meeting none of the accepted testing and infection success benchmarks. On the other hand, the article fails to note that the same number of people are likely to die either way, just over longer periods, unless we complete a technological Hail Mary in the form of a vaccine, effective treatment, or a sound containment containment strategy.

Privacy and Security

The New York Times says Europe’s world-leading GDPR privacy rules are falling short of expectations because of small national data protection budgets, lack of enforcement, and tech company pushback. The only tech company to have been penalized is Google, which paid a relatively paltry $54 million versus the law’s maximum of 4% of global revenue. Public experience with GDPR has been mostly negative as web users are forced to click through countless pop-up consent windows.

Other

Regions Hospital (MN) works with Medtronic to develop software that allows providers to remotely monitor and adjust ventilators. Regions providers say the software, which went from concept to implementation in just 10 days, has cut down on in-room visits to COVID-19 patients by 50%, and helps conserve PPE. Several other hospitals are also piloting the technology.

Experts say it’s not the imagination of Zoom users that the videoconferencing app leaves them anxious, unable to think clearly, and tired — the app’s bandwitdh-conserving degradation of video quality leaves the brains of users to fill in the image’s gaps, especially in trying to analyze poorly rendered or out-of-sync facial expressions. Telephone calls, oddly enough, offer a more natural feeling of presence and engagement.

Sponsor Updates

• Elsevier adds resources for biomedical and scientific researchers to its free Coronavirus Research Hub.
• The Chartis Group publishes a new paper, “After the Surge: Five Health System Imperatives in the Age of COVID-19.”
• InstaMed releases the 10^th edition of its “Trends in Healthcare Payments Annual Report.”
• InterSystems makes available the latest version of its HealthShare suite of connected health solutions, including capabilities to support final federal interoperability rules.
• Engage announces feature updates for its Wait Times app.
• Impact Advisors publishes a white paper titled “COVID19 Federal Stimulus Package – Impact on Providers.”
• HBI Solutions names Jackie Porter, BSN, RNC-E (Syapse) client success director.
• Meditech highlights the successful utilization of its virtual visit functionality at Citizens Memorial Hospital (MO), Grand View Hospital (PA), Avera Health (SD), and Mount Nittany (PA).

Blog Posts

• 3 Practices Finding Success with Telehealth (EClinicalWorks)
• Balancing the New Normal: Parenting, Practices, and Patients (PMD)
• Transitioning to a Remote Discharge Planning and Case Management Workforce (Ensocare)
• RT@COVID19 – Answering Sam Gamgee’s Questions (CloudWave)
• COVID-19: The Importance of Lab Professionals (Optimum Healthcare IT)
• COVID-19 Crisis: Why Now is the Time to Invest in Glycemic Management (Glytec)
• Leadership Insights with Scott Becker (The HCI Group)
• Healthcare Crisis Underscores Strategic Importance of Strong IT Support (HCTec)
• Struggling with Working from Home? Try These Tips! (Healthfinch)
• The impact of COVID-19 on healthcare systems from an imaging point-of-view (Hyland)
• Rapidly Expanding Capacity for the Coronavirus Pandemic and Beyond (Impact Advisors)
• 7 best practices for supporting telehealth, virtual care, and remote visitation amid COVID-19 (Imprivata)
• Provider Directory: How a Golden Record Can Be a Big Hit (InterSystems)
• Agility and COVID-19: IMO’s ongoing pandemic response (Intelligent Medical Objects)

Contacts

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

EPtalk by Dr. Jayne 4/30/20

I’ve always enjoyed baking, and once upon a time, I even worked in a bakery. Even with exposure to some truly exceptional baking, I’m very impressed by the Chicago-area physician who is creating cookies to honor key figures in the COVID-19 pandemic. Her designs are hand painted and include tributes to physicians such as Anthony Fauci, Ohio’s Amy Acton, and others. Pediatrician Priscilla Sarmiento-Gupana is truly an artist and I wish her good health, along with many happy hours of baking.

CMS has suspended advance payments to providers and is re-evaluating accelerated payments to hospitals. Over $100 billion in loans has already gone out the door, but many healthcare delivery organizations are still struggling. The payments split 40/60 between Medicare Part B providers and hospitals. Recipients are expected to repay the funds within one year. Reasons for suspending the program include the availability of funds through other programs, such as those in the CARES Act, along with the Paycheck Protection Program and Health Care Enhancement Act.

Most studies indicate a 60% decline in outpatient visits during March. Factors at play include providers who want to reduce exposure to their staff, along with patients who don’t want to come into contact with COVID patients. Between 30-50% of physicians report using telehealth for at least a portion of visits. Some specialties, such as ophthalmology, have been hit harder than others, primarily due to recommendations from their professional societies about practice closures.

An intrepid reader sent me this ad from SSM Health that promotes telehealth visits. He notes that the clinician is wearing the traditional dress of nurses in the UK’s NHS. Last time I checked, SSM was located in the central US. They recently furloughed over 2,000 employees, and I wonder if eagle-eyed proofreaders were among those let go.

I often see companies using cheesy stock photos without thinking deeply about whether those photos actually convey the culture of their organization or whether they represent their employees and patients. The picture reminded me that I’m two episodes behind on the new season of “Call the Midwife,” so I know what I’ll be doing tonight.

EHR vendors continue to work to make it easier for clinicians to document patient visits. A recent article in the Journal of the American Medical Informatics Association looks at the accuracy of the physician’s note compared with a concealed audio recording obtained from an unannounced encounter with a standardized patient. Standardized patients are typically professionals who compensated for filling the patient role during a mock office visit, where the clinical team’s performance is evaluated.

Researchers looked at 105 encounters across 36 physicians. They found 636 documentation errors, with 181 findings being documented that did not actually occur and 455 findings that occurred but were not documented. Nearly 90% of the notes had at least one error, with 21 of them over-coded and 4 under-coded. Theoretically, technologies such as ambient clinical intelligence could provide a solution to these issues. I look forward to seeing data on how well it delivers on its promises.

I haven’t paid much attention to the attempts at delivering a virtual HIMSS20, but this week an email came through that listed a session I was actually interested in. Unfortunately, going to the site wasn’t fruitful, as I couldn’t find the session I was looking for. The site has filters but not a keyword search, and since I didn’t want to dig through dozens of screens, I gave up. I’m not sure how well-received HIMSS20 Digital has been, but I doubt I’ll be back.

April 30 is the last day to submit MIPS data for 2019. The data submission window closes at 8 p.m. ET. CHS has added flexibilities due to the stresses that COVID-19 has placed on healthcare providers. Individual clinicians who aren’t able to submit MIPS data by April 30 will qualify for the “automatic extreme and uncontrollable circumstances policy” and will receive a neutral payment adjustment for the 2021 MIPS payment year. Groups and virtual groups will have to submit an application for the exception, and those can also be submitted until  8 p.m. ET on April 30.

Speaking of deadlines, May 1 is the deadline for payers to submit proposals for the Primary Care First program. It seems like it’s been a million years since we’ve talked about programs like this, as opposed to emerging infectious diseases. Delivery of primary care services has been significantly changed by COVID-19 and it remains to be seen whether Primary Care First will even get off the ground, let alone have the power to transform care.

I’m a sucker for evidence-based and data-driven approaches, so I enjoyed learning about the new scoring system that is being discussed by the American College of Surgeons to help surgery departments start scheduling medically necessary operations. The system looks at the level of hospital resources needed, the impact of a treatment delay on a patient, and the risk the procedure poses for the surgical team. The Medically Necessary Time-Sensitive (MeNTS) Prioritization process was published ahead of print and is gaining interest among surgeons who are operating under differing guidelines from various subspecialty organizations.

The system has been in use at the University of Chicago for approximately two weeks. They have been able to increase the number of non-emergency surgeries performed to approximately 15 per day. I’m sure that’s a far cry from their usual surgery volume, but hopefully the scoring system will help create a path forward.

Recent updates to Microsoft Word have been driving me crazy. I was glad to have my experience validated by a recent article in Smithsonian Magazine. Millions of typists were taught to place two spaces after a period, while modern keyboarding technique now only includes one space. I’m thinking about trying to teach myself to type with only one space at the end of a sentence. It might be something to challenge my brain since I’m not working clinical shifts. In the mean time, I’ve asked the new editing tool to tolerate my double-spacing.

One space or two? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/30/20

Apple and Google have begun testing their COVID-19 exposure notification API

Apple and Google deliver an initial version of their exposure notification API to several developers who are working with public health agencies, and promise a broader release in several weeks.

Regions Hospital tests new ventilator tech from Medtronic

Regions Hospital (MN) works with Medtronic to develop software that allows providers to remotely monitor and adjust ventilators.

Current Health partners with the Mayo Clinic for remote coronavirus patient monitoring

Mayo Clinic (MN) will invest in Current Health and work with it to develop COVID-19 predictive and remote-monitoring technologies.

HIStalk Interviews Chris Klomp, CEO, Collective Medical

Chris Klomp, MBA is CEO of Collective Medical of Cottonwood Heights, UT.

Tell me about yourself and the company.

I’m the CEO of Collective Medical. We are based in Salt Lake City. We operate the leading real-time care activation alerting and collaboration platform in the country. Our objective is to stitch together otherwise disparate hospitals, health systems, post-acute, clinics, primary care, specialty care, accountable care organizations, health plans, and others to understand where patients travel in real time, identify those who are facing imminent but avoidable risk, and then activate the most appropriate stakeholders to intervene on behalf of that patient to prevent this bad thing from happening to him or her.

We are in use by over 1,000 hospitals and health systems and several tens of thousands of other providers of varying types, including every national health plan in the country, loads of regional plans, and accountable care organizations.

The results are pretty extraordinary. We start with ADT data, but we augment that data with all sorts of incremental data types. Not for purposes of moving that data from point A to point B, which we think is the provenance of health information exchange, but instead leveraging that information in a secure and privacy-compliant manner to help providers intervene with those patients whose needs may go unmet.

Our objective is to improve patient-specific outcomes at the lowest possible cost. We find a tremendous amount of opportunity in the face of medically unnecessary, avoidable utilization.

How will the 21st Century Cure Act’s push for interoperability and ADT notifications affect health systems and medical practices?

A number of provisions within the rules are exciting. We are particularly focused on the recently modified Conditions of Participation, which require hospitals in their several forms, principally acute hospitals and critical access hospitals, to make downstream providers — primary care providers, post-acute facilities, and skilled nursing facilities — aware that a patient has been admitted or discharged. That’s a benign and simple ask, and yet it’s powerful.

We and others already facilitate this type of information awareness. But if you think about it in its most essential form, we as a country charge primary care providers with quarterbacking the care of their patients and coordinating that care across specialists in different acute and post-acute settings. Yet it’s as though we have been tying at least one, if not two, hands behind their backs while expecting them to call the play and throw the ball. They don’t even know when their patient is sitting in a hospital or why, and therefore they are not well positioned to intervene.

These rules are designed in a lightweight manner, right now with not much of a stick, for hospitals to just try a little bit harder to do more to help downstream providers coordinate care more effectively, to take the handoff  from the hospital in a timely manner. I’m sure there will be more to come, where over time, additional data will be required to be shared, perhaps discharge plans, test results, or others. Penalties will probably be instituted, so that stick may get a little bit bigger. But the carrot is also getting bigger as we increasingly shift toward value-based care arrangements. All of this is in the spirit of collectively caring for patients, collectively caring for our most vulnerable members in the community.

This is highly aligned with the strategy that we have been pursuing as an organization for many years. Our name is not by happenstance. We believe that in the concept of better together, as care teams collectively care for one even if they represent different organizations or have never met one another, they are united by their common stewardship for that single patient in that moment. That requires some level of data and clinical interoperability to align their efforts in the most efficient and effective manner. 

The rules are simply trying to remove a few barriers and provide a little bit of additional encouragement, in a light-touch manner, for hospitals and providers do this more effectively. We are excited about that.

What care coordination challenges or needs will be driven by the adoption of telehealth?

We have observed as a country this massive, singular, step-change function, where we shuttered brick and mortar care. I needed to go to a physician recently. All was fine and it wasn’t a big deal, but at the time, it was reasonably urgent and not something that telehealth could appropriately address. I had to pull out all of my powers of persuasion and negotiation to get seen by a provider in person. My family and I have been fortunate to be able to strictly self-quarantine over the last couple of months, and while recognizing that not everybody has that advantage, we were able to make that attestation. The provider acquiesced and agreed to see me and I was grateful for that.

Broadly as a country, hospital revenue is down between 40% and 70% because volumes are down. It is not just electives that have been postponed, but also anything that is essential but non-urgent. Some of that it is being pushed to telehealth, but emergency and inpatient volumes are significantly down.

I would not have expected this step-change function to have occurred without massive external or forcing function externality, and yet it has. It is showing us that many things can be done remotely. Telehealth is here to stay in a much more significant way.

As a result, sending a bunch of faxes and working the phone lines with telehealth providers is not a scalable or cost-effective solution. That puts more emphasis on the need for not just technical interoperability — to get the data to those providers who are not necessarily connected directly to an originating provider’s office, hospital, or health system — but to also also understand what they are recommending and doing. Then, drive that workflow back to the community, to whoever is going to pick up the ball and continue to provide care for the patient, both virtually and in a brick-and-mortar location. It’s both technical and clinical interoperability.

At the same time, I worry, even in the absence of good data or studies, that if you postpone something that needs to be done, it often gets worse and more costly. If you have been diagnosed with cancer or are delayed getting a mammogram, the longer you wait, the harder it is to treat. I worry about that. We have no data, so we don’t know the implications. If this lasts just 60 to 90 days, hopefully the damage will not be particularly acute, and telehealth will have been able to fill that gap along the way. Clearly they are seeing their volumes surge as a subsector. But if we continue to have waves of the pandemic and a vaccine doesn’t come into play, we may find that we have a bigger issue as a country, which is worrisome.

Governments and public health experts are trying to manage the pandemic with voluntarily emailed hospital capacity worksheets. What would be the benefits and challenges involved in providing a real-time view of cases and capacity?

I don’t think that the federal government needs an identified surveillance system that understands where individual patients are going, why they are there, and what care they are receiving. That feels like a big brother surveillance state that as a country, certainly as a citizen and as a patient with my own patient rights, I don’t want. I don’t think that we as a country need that. I have not heard anyone at the state or federal government level ask for an identified surveillance system, and certainly we are pretty close to a lot of folks in state and federal government.

The ask has been for a de-identified solution that would allow not just capacity planning, but real-time evidence of what is happening with disease’s progression. As we ramp up the volume of testing, it will look like we have a second wave of the pandemic. That will lead to all sorts of potentially poor policy decisions, because we now think that there’s an onslaught, when in fact there is not. Nothing has changed except our improved ability to measure.

If you can’t rely on testing until it’s at some sort of a steady-state stasis, with sufficient scale to accurately depict the representation of the infection fatality rate and case fatality rate, what then might you use as a proxy? ADT data is incredibly valuable in that regard. We can understand in true real time — on a de-identified basis that fully protects patient rights or that is even rolled up to the metropolitan statistical area or state level – if we are seeing increased or decreased volumes of both suspected and confirmed cases. We can pull in the lab data to augment this ADT data, which we are doing for a collective of several states across the country on a de-identified basis. 

This is not surveillance, but rather simply an aggregate macro view of what we are seeing from a trending perspective. It allows public policy leaders to make decisions about how to allocate scarce resources, such as ventilators and beds.

What is an entirely unacceptable and insufficient manner would be collecting things by paper, email, and Excel file. There are systems in place right now, including in government, that are trying to rely on that information. The resulting information is, at best, patchy, incomplete, and delayed by many days. We are hearing this from government leaders.

Just like we said about primary care providers having their hands tied behind their back, imagine being a policy leader. You are trying to decide if you should ease social distancing, reopen restaurants, or start to widen the aperture of what constitutes an essential business, because you are also worried about people starving out from massive economic decline. Yet you have, at best, a patchwork set of data that is not representative of what is actually happening with this hidden enemy. That’s a really difficult position.

You could make better decisions with a a highly privacy-compliant solution that has nothing to do with individual surveillance, but that instead shows de-identified, aggregated suspected and confirmed cases with an accurate denominator of total volumes presenting to an emergency department or inpatient care setting. That’s what is being asked for by folks in federal and state government. As a citizen, that makes me feel a lot better.

Do you have any final thoughts?

The pandemic marks a turning point in healthcare along many dimensions. It has many silver linings. States will be better enabled to build public health infrastructure that we previously could only dream of. We have a catalyst to understand the importance of this and to understand the importance of preparation. 

We need to align on a set of clear objectives. Those should obviously be patient safety and outcomes, provider safety, and guiding public health response to inform policy to allocate scarce resources broadly. But the very nature of our response  is showing the entire country the need for a more comprehensive and logically tuned health IT infrastructure that works together and is not operating in silos, whether it’s data silos, provider silos, or equipment provider silos. As a country, we need to come together. Slowly, I think we are starting to see that, even though we’ve had some gaps in our response efforts.

I’m hopeful that we will make the changes we need to make once we move past the acute or attenuated point of this crisis. A vaccine may not be our answer. We may go back to old-fashioned masks and social distancing to starve the disease out. Regardless, we need good data to understand how to proceed. That will happen only if we come together and continue to work on things such as what is being promulgated in the 21st Century Cures Act. 

I’m hopeful. I’m optimistic. We are a country that tends to rise together in times of crisis. I have no reason to believe that this will be any different. We are certainly seeing evidence of that across the country with all of the stakeholders with whom we partner.

Morning Headlines 4/29/20

IG: Veterans Affairs slow to heed lessons from DoD’s electronic health record rollout

A VA OIG evaluation of the now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center finds the VA had not adequately prepared for staffing and patient access issues, or for dealing with missing EHR capabilities that may have compromised patient safety.

Irvine-based company among first to offer COVID-19 antibody testing to employees

EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families.

Cerner Reports First Quarter 2020 Results

Cerner reports Q1 results: revenue up 2%, adjusted diluted EPS $0.71 vs. $0.61, beating analyst expectations on earnings and missing on revenue.

Particle Health Raises $12M Series A led by Menlo Ventures

Medical record API startup Particle Health raises $12 million in a funding round led by Menlo Ventures.

News 4/29/20

Top News

VA OIG evaluates the VA’s now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center (WA) that was scheduled for March 28, 2020, observing:

• The VA assumed that access to care would drop 30% for 12-24 months after go-live based on the Department of Defense’s Cerner experience. However, planned mitigation actions were not completed due to the VA‘s lack of guidance and budget constraints for adding employees, expanding clinical space, expanding clinic hours, and extending appointment times.
• The VA could not alleviate potential backlogs by referring patients to community providers because the hospital is already falling short of VA standards in that area, with a backlog of 21,000 open consults and an average wait time of 56 days. Employees were asked to work 8-10 extra hours per week to manually copy and paste information from one system to another to process the consults.
• VA and Cerner concluded in July 2019 that some EHR capabilities would be missing by the March go-live, including requesting online prescription refills via MyHealtheVet, which presented a patient safety risk. The VA decided to turn off access to prescription refills in Cerner’s HealtheLife patient portal because it did not meet VA standards.
• Hospital staff would have needed to enact 84 mitigations for the 62 systems that were at moderate to high risk of being unavailable.

Reader Comments

From AnotherDave: ”Re: Scanadu. Too bad it fizzled now that there’s a run on pulse oximeters. I pulled my First Edition from its paperweight duties and it still works. I bought it for $149 in the early bird Indiegogo deal in 2013, finally received it in February 2015, and the company’s business plan fell apart in May 2017 when its investigational study was shut down. With the right investment and re-branding, it would be a Handy COVID-19 Screener.” I never quite saw the appeal of the Scanadu gadget, maybe because the Tricorder references got old fast, it didn’t do a whole lot, and early digital health fanboys were practically mounting it in lustful consummation of their naiveté-fueled enthusiasm. The company said FDA required it to brick the device because it was part of a Scripps study that had ended. Crowd-funders got nothing and weren’t happy about it. Founder and CEO Walter De Brouwer went on to launch Doc.ai, which allows researchers to conduct medical studies via the smartphone of participants. Meanwhile, Scanadu renamed itself as Inui Health in late 2018, launched an FDA-approved app for in-home urinalysis, and then pretty much went nowhere.

From Mo Money: “Re: stock market. Good time to invest in health IT companies?” I don’t buy or recommend health IT stocks because that seems like a conflict of interest, but I’ll instead offer my long-held opinions about investing in general:

• No investment performs better in the long term than stocks, and long-term investing is where you accumulate net worth (which is the only personal financial metric that matters – it’s what you own that counts, not what you make).
• Markets have always eventually roared back after an emotion-driven downturn. The first time that doesn’t happen will be the end of American society, in which case your mattress full of cash won’t buy you anything important anyway.
• You have to buy dispassionately and stay in the market regardless of the ups and downs, which are just bumps in the road. Discipline pays.
• Define your specific goals (“getting rich” doesn’t count). It’s always a balance between reward and risk, and your tolerance and timelines for the former drive the required degree of the latter.
• The time value of money is powerful. The investment decisions you make in your 20s and 30s, even with small amounts of money involved, will far outweigh the decisions you make in your 50s and 60s.
• Don’t look at your portfolio value more than one per quarter, rebalance holdings to meet your chosen model, and don’t change your plan just because it’s up or down. Especially if you, like me, would feel anxiety or depressive remorse in having lost money (I swear I was the only person who was buying high and selling low during the dot-com boom).
• Buy mutual funds, index funds, or an investment company’s trading model. The odds that you will out-earn experts with your consummate stock-picking skills are minimal. Take a look at how well health IT stocks have performed against the Nasdaq index or S&P 500 in the long term before you get excited about applying your industry knowledge to stock picking.
• Don’t be influenced by people who brag about their investing home runs since it’s their batting average that matters (it’s more “Moneyball” getting on base frequently than striking out consistently while waiting to send the next shot over the fence).  
• Buying IPO shares means someone who knows a whole lot more about the company than you is anxious to unload.
• Don’t overload on your own employer’s shares in your 401(k). Not only are you are overexposed from a portfolio standpoint, any employer stumbles will probably bite you doubly hard as both an investor and an employee. 
• Stocks are worth what the market thinks they are worth, which may not track well to intrinsic valuation or reasonable expectations. No amount of stock-picking analysis will change that, and those who believe differently are efficiently separated from their money over the long haul. No formula, no matter how elaborately conceived, can take human foibles into account, and stock price is set by greed, fear, and hopes of finding a greater fool.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Spirion. The St. Petersburg, FL-based company has since 2006 offered accurate data discovery and classification solutions that give customers in several industries unparalleled data privacy, security, and regulatory compliance. Spirion’s platform gives healthcare organizations full visibility into their structured and unstructured data, both network- and cloud-based, to allow designing protection and monitoring without human effort or error. Spirion for Healthcare is a PHI management and data loss prevention tool that focuses exclusively on data at rest, which represents 100% of large breaches. Its rules-driven, sensitivity-tunable AnyFind technology uses contextual search discovery to find data sources such as payment card industry (PCI) data, PHI, and personally identifiable information no matter where it exists, while Sensitive Data Engine allows creating data deeper definitions to locate proprietary and unique organizational information. The company offers data security teams free 60-day use of Sensitive Data Manager during the COVID-19 crisis, also extending to stay-home employees free use of a Data Discovery Agent to identify the existence sensitive personal information on their computers. Thanks to Spirion for supporting HIStalk.

I found this Spirion explainer video on YouTube.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner reports Q1 results: revenue up 2%,adjusted EPS $0.71 vs. $0.61, beating earnings expectation but falling short on revenue. The company expects the biggest COVID-19 financial hit to occur in Q2, after which project and sales activity will improve if pandemic-related restrictive measures are relaxed. 

UnitedHealth Group’s Optum division is reportedly negotiating a $470 million acquisition of AbleTo, which offers virtual visits for behavioral care with its network of therapists and coaches. The company, which targets payers and employers, had previously raised $47 million through a Series D round, with Optum Ventures being one of its most recent investors. 

Sales

• OU Medicine (OK) chooses Artifact Health’s mobile physician query platform to drive complete and comprehensive patient chart information.

People

Nicklaus Children’s Health System (FL) hires David Seo, MD (University of Miami Health System) as VP/CIO.

Nephrologist Burton “Bud” Rose, MD, who created the industry-standard UpToDate computerized medical reference in his basement in 1992, died of COVID-19 last week at 77.

Announcements and Implementations

A new KLAS report on ambulatory revenue cycle management services finds high customer satisfaction with Athenahealth, R1 RCM, and Bolder Healthcare, while EMDs, CareCloud, and Greenway Health experienced a significant drop in satisfaction over the past year. Six of the eight reviewed firms were acquired in the past few years, some with positive results (Allscripts, Athenahealth, Bolder, and R1) and one showing a significant decline in satisfaction (EMD’s 2019 acquisition of Aprima, with 80% of the latter’s former clients expressing dissatisfaction since). KLAS concludes that third-party players are gaining traction and raising the customer satisfaction bar as disruptive new entrants.

Another KLAS report suggests how health IT vendors should conduct business during COVID-19:

• Sell the customer what they need to become successful (prescriptive sales) instead of allowing them to pick and chose products and services themselves.
• Pass on sales that are not a good fit to avoid future reputation damage.
• Have account managers proactively reach out to customers to help them understand the company’s vision and the product’s impact.
• Empower lower-level employees to solve customer problems.
• Create contingency plans to avoid support disruptions that could be caused by COVID-19 impact on offshore support resources.
• Drive adoption through training.
• Use internal expertise to guide customers instead of just giving them data or new reports.

Oneview Cloud for COVID-19 is being used for virtual care and virtual visitation in the coronavirus units of four New York City teaching hospitals.

A TransUnion Healthcare analysis of 500 hospitals finds that visit volume declined 32-60% in March.

GuideWell launches COVID-19 Health Innovation Collaborative, which seeks solutions that address the categories of COVID-19 self testing, virtual in-home care, protection of clinical staff, reduction of social isolation, and home delivery of food and supplies to at-risk populations. The application deadline is May 8.

COVID-19

Overall fatality rates compared to pre-pandemic numbers suggest that coronavirus-related deaths are up to 60% higher than official counts. New York City averages 6,000 deaths from mid-March to late April, but had 27,000 in the same period this year versus the 17,000 deaths that were officially attributed to confirmed or probable coronavirus.

Sixty Mayo Clinic physician volunteers are helping manage New York City’s COVID-19 ventilator patients remotely using an audiovisual connection and access to New York-Presbyterian’s Epic system. The doctors note that COVID-19 is like prolonged respiratory failure with unusual twists, such as blood clots and kidney failure.

EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families, with 40 of the 415 who were tested in a drive-through program showing antibodies that indicate previous or current infection. Of the 15 who showed a possible active infection, only one had symptoms. The company hopes the testing will give employees peace of mind and help it transition back to on-premises work.

Vice-President Pence was allowed to violate Mayo Clinic’s campus mask-wearing requirements during his visit there Tuesday, even as he met with employees and a patient who all wore them. Senior White House officials have never been shown wearing masks in public or in photo opportunities. Mayo said they told Pence’s team about the policy and referred further questions to them.

Quest Diagnostics announces availability of a $119 COVID-19 antibody test via its QuestDirect service that does not require a prescription, although purchasers must visit a Quest draw station to provide a blood sample. Public health officials again warn that nobody knows what the presence of coronavirus antibodies means with regard to immunity.

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that the US must create a COVID-19 vaccine because the country that does so will inoculate its own citizens first to restore its economy and gain global influence.

A New York Times report says that China’s factories have reopened, but job losses, reduced wages, and people staying home to avoid infection have left its economy sputtering from low consumer spending.

Other

Patients complain that they are being unexpectedly charged for virtual visits despite political proclamations and insurer announcements of waived co-pays and deductibles for COVID-related services, mostly because of the fragmented health system. Among the issues:

• Some doctors and insurers are charging patients upfront for the full cost of the virtual visit even when it is covered by insurance because insurers aren’t paying and the cash-strapped practices are anxious to collect revenue immediately.
• 100 million people get their insurance from employers that are self-insured and the big insurers don’t control the telemedicine benefits in that case.
• Insurers have waived patient charges only for in-network doctors.
• Some practices are charging for routine telephone calls now that Medicare and insurers are paying for virtual visits in all forms.

A New York Times article warns that parents are postponing well-child checkups for fear of COVID-19, leading to concerns that reduced immunization will cause outbreaks of measles and whooping cough. Pediatric EHR vendor PCC found from the records of 1,000 independent pediatricians that MMR vaccinations are down 50%, diphtheria and whooping cough 42%, and HPV 73%.

Physician and author Sid Mukherjee, MD writes in The New Yorker that the US healthcare system caused several issues in our coronavirus response:

• US medical infrastructure fell apart in failing to inventory adequate supplies of PPE and a Strategic National Stockpile that saw its role as supplementing, rather than meeting, state and local public health emergency needs.
• Testing failed because of the CDC’s distribution of faulty COVID-19 tests, the FDA’s requirement that only CDC tests be used (instead of the WHO tests that the rest of the world uses), and CDC’s distribution of tests only to military, state, and public health labs that perform a tiny fraction of all testing. The author notes that South Korea has so many test kits that it is exporting them to the US, which they did by quickly identifying potential vendors, certifying their products, and turning their factories loose to meet demand.
• FDA’s process for validating diagnostic tests that had been developed by other labs was inefficient, with criticism then causing it to overshoot in allowing 90 companies to sell antibody tests even though FDA has reviewed only four. 
• The value of distributing real-time, anecdotal treatment findings via social media and preprints was obvious though imperfect.
• Vital drugs fell in short supply because their low profit margins left manufacturers complacent and some of them are made in single factories that were disrupted, such as by Hurricane Maria in Puerto Rico.
• The “market-driven, efficiency-obsessed culture of hospital administration” caused leaders to fail to account for “organizational survival time” in the absence of a functional supply chain and the time required to recover from such disruption afterward.
• The difficulty of searching for information in EHRs and the time required to obtain institutional approval to do it left researchers flying blind. The author says that EHRs “actively obstruct patient care” and are bound by proprietary interests and privacy rules from delivering their potential as a searchable national repository of real-time, de-identified patient data that could be used as a “storm-forecasting system” for research and treatment dissemination.

In colorful COVID-19 political news, Grants, NM Mayor Martin “Modey” Hicks (D) defies state law in allowing gun stores and golf courses to reopen, concluding, “We’re not doing it no more” and that “that business, by God, is essential to that individual.” Governor Michelle Lujan Grisham says she may file a cease-and-desist order since it is “like opening up a public pool and having a pee section.” The mayor has ordered businesses to call 911 if the governor’s “Gestapo” shows up over a “little bug.“ He then told reporters he was heading off for a round of golf, and finding the course closed, fired the city manager.

Sponsor Updates

• Audacious Inquiry will work with HL7 International to develop an HL7 FHIR implementation guide as part of their work with the SANER project.
• CRN gives Avaya a five-star rating in its annual Partner Program Guide.
• Black Book’s latest survey finds that Evident’s Thrive EHR has earned top client ratings in small hospital EHR user satisfaction for the tenth consecutive year.
• Murray County Medical Center (MN) and TCare implement CareSignal’s COVID-19 Companion text messaging app.
• Wolters Kluwer launches virtual conferences to support medical societies amid COVID-19 meeting cancellations.
• CereCore congratulates its Epic team on helping HCA Healthcare expand its telehealth capabilities.

Blog Posts

• How Training Initiatives Helped Empower and Prepare Baylor Scott & White Health for COVID-19 (Part 1) and (Part 2) (314e)
• How Healthcare is Falling Behind in a Digital Economy (Part 2) (AdvancedMD)
• COVID19 Preparedness and IT Pandemic Preparation (CI Security)
• Elements of Consideration During CDI Review of COVID-19 Patients (Artifact Health)
• Rapidly Expanding Capacity for the Coronavirus Pandemic and Beyond (Impact Advisors)
• Now Could Be the Time to Shift Your Contact Center to the Cloud (Avaya)
• ONC-CMS Final Rules, Part 4 – Implementation (Datica)
• Updated Star Ratings: How CarePort Can Help (CarePort Health)
• Improving ED and ACO Collaboration Through a Common Technology Platform (Collective Medical)
• CoverMyMeds Campus Update: Spotlight on Sustainability (CoverMyMeds)
• COVID-19 and Virtual Health Services – Commonly Asked Q&A (Culbert Healthcare Solutions)
• Despite Delay – No Time to Lose (Diameter Health)
• Combatting COVID: 5 Benefits for Text-Based Screening Tools (Dina)

Contacts

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

Morning Headlines 4/28/20

Allscripts trims workforce by 5%, cuts pay for highest earners

Allscripts announces layoffs, which HIStalk readers reported earlier this month, plus pay reductions for high earners and executives like CEO Paul Black, who will see a 40% decrease for an anticipated six months.

Parkview Medical Center confirms cyber attack

Parkview Medical Center in Pueblo, CO works to restore its IT systems after an April 21 data breach.

Apple, Google pledge extra privacy protections

Apple and Google will update APIs for their jointly developed COVID-19 exposure tracking software to include randomly generated encryption keys, encryption of Bluetooth metadata, and an exposure time limit of 30 minutes.

Leading Telehealth Platform, Medici, Sees Immense Growth as Virtual Healthcare Continues to Rise

Telemedicine company Medici raises $24 million in a Series B round.

UnitedHealth’s Optum is in advanced talks to acquire remote mental health provider AbleTo for about $470 million

Optum considers acquiring mental telehealth company AbleTo for $470 million.

Curbside Consult with Dr. Jayne 4/27/20

Just when I was getting used to being furloughed from my clinical gig, I was called to action for three days of work that just happened to coincide with the expected peak of COVID in my state. Although I was initially eager to get back in the game, I must admit that 36 hours in the trenches has eliminated any such enthusiasm.

After my initial shock over a couple of things, I decided to give it the benefit of the doubt and try not to draw any conclusions until I had worked at three sites with three teams. Now, with those shifts in my rear-view mirror, I have to say that some of my first impressions were correct. Here’s what I learned.

I’m probably more likely to be exposed to the novel coronavirus by my colleagues than by the general public. Our team is generally young and healthy, mostly EMTs and paramedics. Many of them are super fit, with extensive workout and nutrition routines. Several of them questioned why I was wearing my N95 mask all day, even for patients who didn’t have respiratory symptoms. It’s clear that our internal education has not met the mark as far as their understanding the idea of asymptomatic spreaders or the need to treat everyone with universal precautions since you can’t tell from looking who might be a carrier.

Most of them were donning and doffing various masks (alternating between N95 and standard surgical masks) and setting them on the workstation counter in between patients. Only two of us had a dedicated “drop zone” for our masks (a.k.a. paper towels with our names on them). Others were lowering their masks under their chin in between patients, which is a less-than-great infection control procedure. The good thing is that most of them responded well to a little in-person education and started doing better with mask hygiene.

Leadership note: just because you send out memos and instructions, it doesn’t mean people get it and are following the instructions. Sometimes you need the face-to-face contact to get the message across. It’s an expensive kind of communication, but it’s worth it.

Speaking of masks, the general public isn’t doing a great job of wearing them even when they have the good ones. I saw too many people with masks covering the mouth but not the nose, and too many whose nose pieces weren’t pinched to fit well around the nose. People whose glasses are fogging up due to their masks are incredibly grateful when you teach them how to pinch the nose of the mask. We as healthcare providers take it for granted that people know how to use them correctly.

I saw everything from top-of-the-line 3M models to simple bandanas. The best one was a homemade model on a patient whose wife is a professional seamstress. As someone who does a little sewing myself, the craftsmanship was something to behold. I told him to be sure to let her know that the doctor noticed her attention to detail and excellent topstitching.

I also learned that a good part of our surge was made up of people coming in for non-emergent conditions. People certainly aren’t afraid to venture out for minor things such as having wax removed from their ears even though they don’t have symptoms. Multiple people were there for medication refills since they either couldn’t get in touch with their physicians or were having trouble getting refills in a timely manner, and I was happy to help them.

We did see our share of urgent and emergent conditions as well, including multiple cooking-related lacerations among people who don’t usually cook, along with several home improvement injuries. Patient education note: working on an aluminum ladder while barefoot is not a good idea. We also diagnosed and treated multiple sexually transmitted infections, so some people’s ideas of stay-at-home might be a little different than others.

I ordered my fair share of COVID-19 testing swabs, and now I get to play the waiting game to see how long it takes the results to return so I can start my own “known exposure” countdown. I don’t know when I’ll be asked to work again, but I’ll definitely be staying close to home until the results turn up. I’m grateful we have testing capabilities and can at least collect the samples in the office without having to send patients elsewhere or fight the health department for approval like I had to a little more than a month ago.

My employer is keeping a close count on the testing swabs since they aren’t sure when we can get additional supplies. We’re a long way from testing everyone who wants to be, as we were promised once upon a time.

After my first day of patient care, I pretty much fell into my bed. As I tried to fall asleep, I wondered how long it would take the tingling in my face to go away. If you wear them properly, the N95 masks are pretty tight, and I was glad that my face was back to normal by the morning. However, after three days in a row, my face feels like it’s been in a vise and I have a splitting headache that I can’t get to go away.

I cannot even fathom what it must be like for the healthcare workers who are on dedicated COVID units or who have been working like this for weeks on end. I’m hoping to cruise some forums for tips on pressure reduction before I go back again. Hopefully, my face will bounce back overnight since I’m supposed to film some EHR training videos for one of my clients.

I’m glad I could pitch in, but I feel guilty for having been parked at home while my colleagues have been working. It’s definitely more mentally and emotionally exhausting than the work we were doing before, even in the middle of flu season. I never thought I would wish to go back to the Flumageddon season of 2017-18, but I do, to some degree. At least back then we knew what we were dealing with, we could test for it, and we had a hope of treatment. With this situation, we’re often flying blind and looking for outlier symptoms, such as loss of smell or “COVID toes.”

I noticed that our EHR vendor has added quite a bit of telehealth-specific content. Even though we’re not using it, I was glad to be able to check it out. It prompted a good conversation with my scribe, who was also seeing it for the first time. She didn’t know I worked in telehealth. She recently wrote a paper about telehealth for an undergrad class. It was good to have a bright moment like that in the middle of a very tiring day, and hopefully she learned something beyond what her research had shown her.

She also offered me the tip of putting Preparation H on my face if the redness doesn’t go away. Apparently, she learned it “on the pageant circuit,” but I’m too tired to even remotely consider masking up and going to the store.

Have any tips for dealing with the squeeze of a badly fitting mask when there aren’t any other mask options? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Healthcare Crisis Underscores Strategic Importance of Strong IT Support

Healthcare Crisis Underscores Strategic Importance of Strong IT Support
By Rob Dreussi

Rob Dreussi is CIO of HCTec of Brentwood, TN.

Take a moment to thank those who work on the IT service desk. Who knew they would play an essential role in maintaining operational continuity and getting our patients and providers up and running on telehealth?

Every large-scale crisis exposes shortfalls and creates opportunities for improvement in healthcare. The COVID-19 pandemic has highlighted the need for hospitals to think differently and more strategically about their IT service desks.

EMR patient portal usage has increased as telehealth and other patient-facing solutions are being rapidly deployed. Maximizing that kind of technology, keeping it running, and supporting it properly requires people with specialized HIT skills, training, and experience. Technology may be the tool, but people and solid operating processes are required to make it work.

This crisis is a powerful reminder of the IT service desk’s higher purpose—helping providers and patients by either resolving their immediate problem or finding the best next-level person to assist them. A mature IT service desk employs a diverse team of experts, including agents, coaches, trainers, workforce analysts, quality analysts, and related technology SMEs. Collectively, this team enables healthcare providers and patients to leverage technology rather than be hindered by it.

However, IT service desks have struggled to meet the increased demands related to the COVID-19 pandemic because their resourcing plans are based on historical support volumes. Who could have predicted:

• Call volumes that are doubling and tripling.
• Supporting new applications almost overnight that typically would have been deployed over months.
• Assisting end users while they shifted in mass to working from home.
• Continuing to deliver services while the IT service desk itself shifted to working from home.
• Onboarding and training new agents 100% virtually.

Keeping up with all the change has been really hard.

The pandemic has put a spotlight on how the technical and user-facing skills that are needed for effective IT support have increased dramatically over the last decade. The demand for this dual skillset will only continue to increase as hospital clinical and overall operations grow increasingly reliant on technology. Already Meaningful Use and the movement toward value-based care have driven the adoption of complex clinical and business systems that require constant maintenance and inspire far greater security concerns.

Simultaneously, the expectations of providers and patients alike are rising, as we all have become accustomed to customer-friendly, tech-savvy support from companies like Amazon and American Express. As a result, the IT service desk’s role now includes representing the voice and brand of the health system. Delivering a strong overall experience — whether to patient, provider, or administrative user — is more critical than ever. In this new environment, the staffing, required skills and management of the IT service desk requires a more advanced and strategic approach.

It’s no surprise that COVID-19 has forced HIT support personnel to work overtime, late nights, and weekends. Their efforts are essential to ensuring that healthcare providers and their patients receive the support they need to improve delivery of care in a time when people need it most.

COVID-19 has made painfully obvious to a broader audience what we have always known — technology doesn’t always work as designed. It has also made it glaringly apparent that in healthcare we need people who understand how to effectively support technology so that patients and providers alike can leverage its power to improve care and outcomes.