Morning Headlines 3/24/20

Amazon will deliver and pick up at-home test kits provided by new coronavirus program in Seattle

With help from Amazon Care and local health systems, the Seattle Coronavirus Assessment Network launches to deliver and pick up at-home COVID-19 testing kits in Seattle’s King County.

Thoma Bravo shuts down Imprivata process as covid-19 fears fuel market volatility

Thoma Bravo calls off its potentially $2 billion sale of digital healthcare identity company Imprivata.

Go inside the nerve center of a Western Washington hospital system dealing with coronavirus

CHI Franciscan relies on a mission control center to monitor capacity, supplies, and staffing for COVID-19 patients across its eight hospitals.

Telehealth Startups Pause At-Home COVID-19 Testing After FDA Tightens Guidelines

Several telemedicine companies halt their roll outs of at home COVID-19 testing kits after the FDA stresses that it has not authorized any testing kits for at-home use.

As some local businesses close, Jacksonville healthcare company hires hundreds

The HCI Group will hire for between 500 and 600 jobs in the coming weeks as it ramps up efforts to help hospitals with their health IT and managed services needs during the pandemic.

Curbside Consult with Dr. Jayne 3/23/20

Another crazy week in the trenches, and the “organizational behavior” consultant part of me wishes I could get some of my clients to listen to reality and take solid advice. Everyone is completely stressed, and justifiably so, but we need to figure out how to get through this.

This morning, I had a very painful conversation with a client who asked me to update him on what other similar organizations are doing with their outpatient clinics. Are they closing, running modified hours, consolidating by patient needs, etc. I put together a careful analysis with summaries and walked through them.

The client proceeded to yell at me and explain why each option wouldn’t work for their organization. I tried to gently remind him that his “ask” was for me to answer the question of “what are similar organizations doing in this situation” as opposed to “how should we handle this?” Because frankly, if he had asked the latter question, I’d have been likely to tell him it’s time to just pack it up and go home, because their lack of understanding of this pandemic and failure to follow CDC and OSHA guidance is putting their staff and patients at risk.

The bright spot of the week was a patient who asked me how I was doing as a person and how my family was holding up with me being on the front lines. He was sincere and caring. It was a welcome change from having to deal with the previous patient, who was self-absorbed and flatly refused to quarantine himself “because it’s boring and I can’t stand it any more” despite his fever of 102 and symptoms that were consistent with COVID.

Like just about every healthcare worker in the US at this point, I’ve been exposed to multiple positive patients, and without the recommended gold-standard N95 mask. Still, I can control the environment in the office and can wash my hands immediately after every single interaction, which is a lot better than what happens when you make a furtive trip to the grocery store. Plenty of people are still picking up items, looking at them, and putting them back, which is less than ideal during a pandemic. Our local grocer installed handwashing stations outside the front door, but I’d give myself even odds of being infected at work versus by the general public.

Our non-clinical staff members are having the hardest time with the situation. They are not trained for it and really didn’t know what they were getting into compared to the clinical workers. They’re constantly on edge, and one of them was crying in the break room during my last shift. Talking to physician colleagues across the country, they’re seeing the same thing.

We’re all supposed to act tough and not afraid, but as people, we want to validate our staff’s concerns and let them know that we share some of the same feelings. Unfortunately, some administrators across the country see such empathy as akin to “feeding into fear mongering.” I have two friends who received verbal counseling about the conversations they had with staff because they didn’t toe the corporate sunshine and lollipops line. When the CDC is telling healthcare workers to tie a bandana on their face if they don’t have appropriate personal protective equipment, we’re well past the sunshine zone.

Friday, March 20 was Match Day for fourth-year medical students across the country, many of whom have had their classes canceled and rotations ended for the rest of the year. Graduations have been canceled as well. Instead of learning their fate in an auditorium with friends, they learned it online. Good luck to each and every one of them. I remember what that day was like and can’t imagine how surreal it must feel to the class of 2020.

Speaking of surreal, I urge all organizations to go through any automated or pre-scheduled communications and make sure they make sense given the current situation. When the schools are closed and parents receive a notice about the 7 a.m. ACT prep session, that’s not a confidence builder.

Similarly, when vendors send out tone-deaf emails about patient loyalty or market share to health systems that have publicly announced that they will run out hospital beds within 10 days, that’s not a winning marketing strategy.

I’ve received several emails from HIMSS that are utterly devoid of acknowledgement of the present situation. Given that HIMSS might not survive after the loss of revenue from HIMSS20, I would urge them to not aggravate people. Their constant blasts about Virtual HIMSS are bordering on the absurd for people who are knee deep managing issues at their hospitals and health systems as the new normal.

On the flip side, I received a call from my bank, which is checking in with their small business banking customers to see if they can help with anything. The business they were calling about is my side hustle that I’m cultivating for retirement, so it’s not a major source of income. Still, it was a nice gesture.

Last week, on March 18, CMS announced that all elective surgeries and non-essential medical, surgical, and dental procedures should be delayed during the COVID outbreak. This is not only to preserve hospital capacity (some of those elective patients have poor outcomes and wind up in the ICU), but also to conserve personal protective equipment. Many outpatient offices have canceled well visits unless they include vaccinations.

My primary physician and ophthalmologist canceled all their annual visits and offered refills for the next six months, so thank you. Unfortunately, some major players in the healthcare industry are behaving badly and refusing to follow this directive. You know who you are, and shame on you. Please get with the program, I’m betting you’ll wish later you had all those masks and gowns back. If you’re organization is still doing elective procedures, this piece from a Seattle vascular surgeon is a great read.

I’m keeping this brief so I can go back to the telehealth front lines. I haven’t been able to exercise my newly granted ability to see patients in states where I don’t have a license since there are so many patients to be seen in my home state. To all of you on the in-person front lines, stay safe, stay sane, and just keep putting one foot in front of the other.

Email Dr. Jayne.

HIStalk Interviews Patrice Wolfe, CEO, AGS Health

Patrice Wolfe, MBA is CEO of AGS Health of Newark, NJ.

Tell me about yourself and the company.

I’ve been in the healthcare industry for over 25 years, with the majority of that in the HCIT space, including revenue cycle management. RCM is an exciting and growing field, and if you do it right, you’re improving the financial health of provider organizations, which frees them up to redeploy resources that can be focused on patient care.

AGS Health is a revenue cycle outsourcing company that provides A/R management, coding, and analytics services to major health systems and physician practices, as well as to billing and EMR vendors. In 2019, we managed over $35 billion in A/R and coded over 25 million charts. We have 6,200 employees in the US and India, which is pretty amazing for a company that was founded in 2011.

What is the business environment of RCM and how has it changed over the years?

It has changed a lot. Given the penetration of EMRs and associated technologies, a lot of the manual effort that was needed to validate patient eligibility, submit claims, post payments, and reconcile remittances is now automated. In the past, the vast majority of A/R was payer-related, which just isn’t the case today. High deductibles are here to stay and providers are struggling to capture every dollar. 

The basic mission of RCM hasn’t changed – to optimize the speed, accuracy, and efficiency with which revenue is maximized and collected.

The revenue cycle is very complex. Too much so. Different departments frequently handle different parts of the cycle, which means there may be no real coordinated strategy for RCM. There are a few things I find promising, though. The industry is trying to bring as much as possible up to the front of the revenue cycle, such as advanced eligibility verification and patient liability estimation prior to the patient showing up for care. It’s a lot easier to collect a payment when you’ve told the patient in advance what they will owe.

Robotic process automation, or RPA, is eliminating low-value work from the rev cycle and driving greater efficiency. I think we eliminated about 80 FTEs of low-value work last year just using RPA, and our teams are doing more rewarding work as a result. A lot more can be done on this front.

Areas like coding used to be focused on maximizing the completeness and accuracy of clinical information for billing purposes.  Today, we’re seeing new and innovative uses for this data, which include risk-based analysis, provider scorecards, benchmarking, and analytics.

RCM is highly influenced by payer policies. I sit on the board of a large payer, so I see the challenges on that side of the equation also. There are a few friction points that I think are problematic for both parties. First, claim denials have been rising, which creates a lot of work for providers and vendors like us. Second, prior authorizations are labor intensive and remain stubbornly manual. We have a lot of work to do as an industry to resolve these issues.

What effects on health system RCM do you expect to see from coronavirus-related economic slowdown?

We are seeing the impact of COVID-19 in many areas right now. This is so hard for the provider community. In the last week, providers are canceling all elective procedures. That has an immediate impact on revenue, not to mention access to care. Some payers are shutting down call centers and stating that claims payment may be delayed. We use the call centers on behalf of our customers to resolve payment denials and delays, verify eligibility, and check on claim status. Limiting our ability to do that impacts revenue, not to mention the resultant lag in overall claims payment.

Providers are experiencing workforce shortages due to staff illness, inability to work from home, or reprioritization of work tasks. This is going to get worse. We are trying to help as much as we can from a staff augmentation perspective.

The administration approved some Section 1135 waivers to improve access to care, such as wider use of telemedicine, and allowing Critical Access Hospitals to have more than 25 beds. That’s great, but it’s confusing to both providers and payers as to how to operationalize these changes and ensure accurate reimbursement. I fear this is going to be a big mess.

Also, while new coding changes have been approved for COVID-19, it will take a while for provider systems to be updated with these coding updates, which translates into increased coding denials.

What are the benefits and challenges involved with managing a highly educated, technically savvy global workforce of six thousand people?

You forgot millennial. The vast majority of our team in India is under 30 years old, which is really interesting. I get asked for a lot of selfies when I’m there.

Regarding the benefits, as you mentioned, our entire team in India is college educated. They are open-minded, comfortable with change, and very ambitious. I do monthly live chats with our various locations and I hold quarterly focus groups when I’m in India. I get many questions about career progression and company strategy. These are people who can see themselves as leaders and problem solvers, which is exactly what we need in such a high-growth company.

In addition, almost 50% of our overall workforce is women, which is exciting for me.

The challenges of a large, global workforce really are around communication, training, and career paths. We are high growth, so things are changing all the time. That means I have to over-communicate on many topics and via many different methods, as do the other leaders.

We hired over 2,000 people in 2019, so grounding them in our business is critical. We have an incredible hiring and training infrastructure that can adapt rapidly as we add new clinical specialties and customer types.

I mention career paths because, as I said earlier, we have a lot of young, ambitious people who want to grow within AGS Health. We promote through the ranks as a regular practice. In addition, several people from our India team have relocated to the US to serve in customer-facing roles with amazing success. It’s been a win-win and we plan on expanding this program.

What I’ve come to realize is that, while revenue cycle outsourcing sometimes leads to job loss in the local community, we’re frequently doing RCM work that has been put to the side in hopes that someone in the organization will get to it eventually. For example, we do a lot of small-balance collections, maybe accounts of less than $1,000 or even less than $200. It makes financial sense to hand those to us because our labor costs are so much lower. These activities generate real cash for the organization that otherwise might have been written off. There are other examples like this around credit balance resolution and denial management.

Another challenge we’ve faced in the US is the labor shortage in both rural and urban areas, where things like clinical coding expertise may be hard to find or highly competitive. Even with computer-assisted coding tools, trained coders are still a critical part of the RCM process. In this part of our work, we are supplementing the teams our customers already have in place.

Readers Write: EHR Vendor Priorities for Successful Innovation and Marketplace Development

EHR Vendor Priorities for Successful Innovation and Marketplace Development
By Seth Joseph

Seth Joseph, MBA is founder and managing director of Summit Health of Lincoln, RI.

With the release of the final interoperability and information blocking rules, one of the goals of the Office of the National Coordinator for Health IT is to establish an ecosystem of innovation. They mandate that electronic health records (EHR) vendors open up their APIs and effectively serve as the foundation — the platform — for marketplace development. 

But when it comes developing an EHR-based marketplace for innovation, there are a host of challenges under the ONC’s latest guidance,  from the short timeframe in which they are being asked to develop these marketplaces to a lack of experience in network development (i.e., growing sustainable, platform-based businesses). 

With these challenges in mind, what can EHR vendors be doing now to ensure they are in the best position to develop a successful marketplace for innovation?

Establish sound (neutral) governance structures and processes

EHR vendors must carefully think through and give plenty of consideration to developing governance rules, standardizing the rules of engagement for platform development and the governance processes first, then creating documentation around it. Accounting for these fundamentals at the beginning will ensure that there’s a repeatable, scalable process when onboarding new developers to the platform. 

For example, which developers are allowed on the EHR vendor’s platform and marketplace? How do they become certified? How can EHRs ensure that developers abide by all state and federal regulations regarding health data exchange and privacy and security, such as HIPAA?

There are also issues such as those that Amazon is facing in having to determine exactly if/what proprietary data can be used to compete with third-party app developers for the platform. What is allowed and how should the rules and regulations be managed?

The importance of having a strong governance process and operating guidelines becomes clear when considering the issue Apple faced in 2019 related to its app store search results. According to a New York Times analysis of six years of App Store user searches, Apple’s own apps ranked first in the results for at least 700 search terms in the store. That isn’t exactly a vote of confidence for third-party IOS app developers, or the kind of attention Apple wants on its marketplace.

While all of this due diligence will require legal, technical, and business development work, it’s a necessity, as marketplaces will not scale and networks cannot grow effectively without it.

Invest in support resources

Third-party developers will vary in their technical, business, and organizational maturity. From implementation support and technical resources to data management and standardization support, EHR vendors should invest in the necessary resources to ensure that marketplace vendors clearly understand the rules of the road and also are set up to do as well as possible. 

Third-party developer success leads to marketplace success. While EHR vendors may not believe that marketplace success is important to their success in the short term, they would be wise to consider why Airbnb is among the most highly valued lodging businesses. It’s not because it runs a better hotel than Hilton or Marriott (it doesn’t), but because it allows hosts and renters to connect and transact on its platform.

Expectations and investment

Turning a software business into a platform business can be exciting and promising, but it’s important to temper expectations. For instance, while 2018 revenue from Salesforce.com’s third-party developer platform was the business’s highest growth area (41% annual growth rate), that only represents 20% of the organization’s revenue overall. That took over a decade to reach since Salesforce.com’s developer marketplace has been in existence since 2007.

It’s especially important for executives who are managing the marketplace to set realistic expectations internally regarding likely marketplace growth over the next 3-5-year period, then determine how much and what kinds of investments will be required to support that. 

Bring in an unbiased, experienced marketplace manager

There are many reasons why EHR vendors are not in a great position to be managing platform-based marketplaces on their own, but all map back to their inexperience in network development.

For example, under the new rules, EHR vendors will have to respond to developer requests for access within 10 business days. How will those companies manage this process in appropriately screening for privacy, security, and technical concerns while also determining how to address developers who might compete with new functionality that the company itself is planning? How will the EHR vendor think about quality management, in terms of the impact of varying levels of developer and application quality and what that means to the EHR’s brand with its customers? 

Growing a marketplace also requires redundant instances of technology and managing multiple integrations and different types of partner relationships at once. EHR vendors are inexperienced in and ill-equipped in these areas.

Given these challenges, EHR vendors should strongly consider outsourcing the management of their EHR marketplace to an entity that has the right experience and knowledge of standing up and supporting third-party developer marketplaces.

In fact, an effective marketplace manager that works with multiple EHR vendors should be able to deliver increasing value to each one of them by standardizing processes, refining implementation approaches, and managing multiple developer relationships. This is similar to the value they deliver to third-party developers by allowing them to connect once and gain access to multiple EHRs.

For EHR vendors, the innovation train is pulling up to their platform. While conditions might not be ideal since time is scarce and marketplace development in healthcare is still in its infancy, now is the time for EHR vendors to prepare and ensure that when that train reaches its destination, there is a solid foundation from which to grow as a marketplace innovator.

Readers Write: Prognostication Is A Fool’s Errand

Prognostication Is A Fool’s Errand
By Jeremy Harper

Jeremy Harper, MBI is chief research information officer of Regenstrief Institute of Indianapolis, IN. The views and opinions expressed in this article are his personally and are not necessarily representative of current or former employers.

Regardless of how COVID-19 progresses, we have scenarios ranging from (a) everyone is going to die as the stock market goes to zero, to (b) we will be back and running at full steam in a matter of months. I’m optimistic that we will go back to work and keep moving, but less optimistic that we will successfully lower the curve enough to make a significant difference.

However, there will be permanent repercussions of the choices we’ve made so far, things we as employers haven’t had time to adapt to.

Employers need to prepare for the social impact of employees who have suddenly been moved to remote work arrangements en masse. Many employers have had people working remotely for a week and a half at this stage, and states are rolling out more stringent quarantines.

Below I attempt to predict the impact of remote work arrangements for our organizations.

One-Month Quarantine

People

If we have remote work for a month, I anticipate that most will re-integrate into their work routines with relish. Having children out of school also helps. It’s hard to be a full-time caregiver and a full-time employee. Even with dedicated efforts at sharing, it’s hard to balance the workload. People may enjoy the time off, but much like a vacation, they will return to the office and be glad for the peace of a single job.

Prepare your remote work policy, though, because people will be pointing to the last month to explain that if can be done for every one of their jobs.

Organization

Workflows haven’t changed. They might be re-envisioned online, but they have been optimized for in-person, office setups.

If you don’t see an end in sight, start preparing your IT to support wikis, group teleconferences, Slack etc. Optimization of the remote work arrangement is worth the expense.

In general, the organization just needs to grudgingly get through this time period.

Two-Month Quarantine

People

Employers must prepare for a mass outpouring of employees who point to their productivity over the past two months as justification for them to be remote for significant portions of their schedule. “What happens if I am only in the office Tuesday and Wednesday every week, or Thursday and Friday?” will be a common refrain. We still like the in-person interaction, just not every day.

Organization

We will start to see workflows shift and adapt towards an assumption of remote work and effort.

Some people will take vacations while maintaining their digital presence to avoid using vacation time. Vacation could look like visiting family and friends who they never have time to see in person. It might be the dream trip to Hawaii, although during a global quarantine, it probably won’t be to other countries.

Three-Month or More Quarantine

People

Employees will have adapted to a remote work arrangement, they are searching for alternative employment, or the government stipends will be sufficient for them to stay home. Not everyone can handle remote work arrangements. People will start moving to their dream locations, as in,  “I’ve always wanted to live in another state.”

Organization

We as employers have started to change our office policies to meet the need of this new normal. This is no longer waiving policies, it is rewriting them.

We will start to see employees migrating. They won’t all be in a single time zone. We will no longer have the ability to call them in person. They will want to have accommodations for their new time zone and their working later or earlier.

New collaboration tools that were mentioned in Month 1 become a necessity. You might have new opportunities to bring in global talent since if everyone is remote, you no longer need everyone to be based locally. Alternative arrangements for office buildings that are sitting closed will be considered and leases will be dropped.

Upcoming Societal Changes We Need to Discuss as a Community

The requirement for strong telemedicine arrangements outside COVID.

The obesity epidemic is not likely to be helped by quarantine.

Regulatory barriers.

Data analytics, collaboration, and productivity.

Morning Headlines 3/23/20

CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

CMS will grant exceptions for reporting requirements and data-submission extensions for healthcare providers participating in Medicare quality reporting programs.

Boris Johnson met with healthtech startups Babylon and Thriva to discuss scaling up coronavirus testing

The UK government enlists the help of healthcare and consumer technology companies to address the coronavirus pandemic.

Pence’s medical licensing comment stirs confusion

Vice President Pence’s statement about waiving state licensure limitations on telehealth doctors has created confusion, since only states can waive those restrictions, few have done so, and the federal government’s legal authority to preempt states is not clear.

Negative for ‘Coronavirus,’ positive for COVID-19: Stanford Medicine reformats reports after confusion

Stanford Health redesigns lab reports in its MyHealth portal after several students complained that their reports indicated testing negative for coronavirus, only to be notified soon afterward that they were positive for COVID-19.

Monday Morning Update 3/23/20

Top News

The UK government enlists the help of healthcare and consumer technology companies to address the coronavirus pandemic.

Companies in attendance at a high-level meeting include Babylon (symptom checking chatbot) and Thriva (at-home blood tests).

Startups that have reported surges in demand for their products there include Nye (secure doctor-patient message via telephone and video), Patchwork (matching doctors with available hospital work shifts), and Pando (WhatsApp-like teamwork and collaboration).

Reader Comments

From Mark: “Re: University of Arkansas Medical Sciences. Has a web page set up specifically for their employees on quarantine. Their concern was that their staff who test positive (and they test everyone daily!) and are quarantined, will need food, meds, and goods delivered to their houses while in quarantine. Any employee can use this. So if you are working long hours and don’t have time to shop for groceries, for example, you can visit the site and make a request. Great way to support their staff in this time of need. Kudos!” We are hopefully coming to the realization that lockdowns aside, the only way some of us will survive is if our caregivers and their families make their own sacrifices to remain on the job. We’re woefully short on ventilators, but even those aren’t worth much if we don’t have experts to run them. We have to figure out how to keep hospital employees healthy, get them back to work after exposure, and support them in ways that go beyond paying them on time.

From Freeman Victim: “Re: HIMSS20 cancellation. Freeman is not refunding anything except booth disassembly. They are billing us for furniture rental through March 11 and we received an invoice today for handling the return of our booth, which was on top of the exorbitant shipping we had already paid. The original invoices didn’t spell out the policy for HIMSS cancellation, yet new ones include a policy of charging vendors full fees for services that were nod delivered. I know cancellation hurt them, but they could do a better job sharing that instead of squeezing exhibitors for every last penny in charging for services they didn’t actually deliver. I would encourage HIMSS to crack down on this, because if the event cancellation itself doesn’t cause exhibitors to question its overall value, Freeman’s handling of it will.” I assume that every cancelled conference is creating a mass of frustration and outright anger at the costs that won’t be refunded, whether simply billed anyway (Freeman) or rolled over as an unwanted credit for future services (HIMSS). It may be a tough sell for companies to sign up for HIMSS, Freeman, OnPeak, etc. all over again for next year, assuming there is a next year. The monetization of every conference moment and physical attribute has always seemed wildly excessive to me, so perhaps conferences — like other aspects of our economy and personal lives — will change positively following an unwelcome but necessary recalibration.

HIStalk Announcements and Requests

The health system employers of respondents to last week’s poll are responding to expected overwhelming demand by reducing non-COVID-19 services and making physical changes to their facilities. Those who are delaying system implementations and upgrades are matched by those who are looking for new technologies to improve their services, with use of health IT consulting not changing. Readers also say they are ramping up telehealth capabilities and searching for workforce management tools.

New poll to your right or here: Which leaders are doing a good job in responding to the COVID-19 outbreak?

Readers asked about Providence St. Joseph Health making MacGyver-like provider face shields from components foraged from local craft and office supply stores (the need to do so, while shameful, is out of scope for this mention). Providence has published instructions for creating face shields and a video showing volunteers how to sew face masks from Providence-supplied kits.

I’m being overwhelmed with companies that want me to mention their COVID-19 related technology rollouts. I will do so if: (a) the offering is free, seems broadly useful, and has limited strings attached; and (b) it can work for everybody and not just existing users of other company products. Enhancing an existing product is of interest only to current customers, and in that case, you don’t need me to notify them on your behalf.

Listening: new from Nada Surf, one of my favorite bands of all time. They’ve been playing alternative music together as an intact unit since 1990, with an easily identifiable sound that still stays fresh with each new album. I remembered the band while creating (“curating,” as the cool kids say) a multi-hour Spotify playlist for a friend who is social distancing all alone, but is preparing for a long drive to join family. She’s younger with accordingly different musical tastes and in need of something upbeat, so I chose for her Anderson .Paak, Arlissa, Birdy, Cassie, Shakira, Hinder, Leona Lewis, Radiator Hospital, Tennis, Vargas & Lagola, Alexandra Stone, and a few of my own unrelated favorites she’s never heard such as The Hives, Juliette & The Licks, and The Tragically Hip. Her playlist sits in Spotify adjacent to my unfinished work titled “HIMSS20.”

Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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

Announcements and Implementations

TransformativeMed offers Seattle-area hospitals free use of its COVID-19 / Core Work Manager. The product is already being used at UW Medicine, which says the application “is critical for our tracking of suspected and confirmed cases.” The Cerner-integrated app allows clinicians to track and segments lab tests and results, monitor symptom checklists, and submit information to the state health department.

Experity offers urgent care clinics free use of its COVID-19 Check-in Triage app, which sends questions to scheduled patients via two-way messaging and then tells them how to proceed with their visit. Experity launched a year ago in merging Clockwise.MD, DocuTAP, and Practice Velocity.

Epic continues to update its “Managing Coronavirus Disease (COVID-19) with Epic” paper, which provides guidance on reporting capacity management, reporting nurse data and patient throughput, managing COVID-19 patients at an outpatient pharmacy, creating a training plan, and reporting on the outbreak for managers and leadership.

COVID-19

A reader comment spurred me to ponder whether the country’s haphazard public health reporting makes optimal use of data housed in the Epic and Cerner systems, which cover much of our bed capacity. It doesn’t matter when, where, or how COVID-19 testing was performed on individual patients – those systems track suspected and confirmed cases, they store the demographic and clinical information of patients, and they record the progression and outcome. Individual health systems are surely monitoring this information, but I don’t know if it’s being aggregated for review at the state and national level. We’re missing one significant denominator – the number of asymptomatic or previously infected people who didn’t seek medical attention from hospitals – but the trove of information otherwise is massive and complete.

Early CDC data analysis finds that COVID-19 hits younger people harder in the US than was seen in China and Italy. They also worry that a long incubation period means that seemingly healthy people are walking around spreading the virus before they know they are infected.

Aunt Bertha creates FindHelp.org, which allows community members to search for and connect with personally vetted social programs such as financial assistance, food, and emergency services. Hospitals can add the information to their community resource sites. The Aunt Bertha team added 700 programs in four days and is adding hundreds each day. I interviewed founder and CEO Erine Gray a few months ago and the work they do is impressive even in normal times.

A Kaiser Health News data analysis finds that half of the counties in the US have no ICU beds, also noting that ICU beds per older resident vary widely. Experts note that hospitals with ICU beds cluster in high-income areas where patients have private health insurance. More positively, those rural counties are often located near larger cities– if you need an ICU bed, you care more about availability and distance than whether it’s in your county or someone else’s.

Cerner updates its COVID-19 response to include mandatory employee work from home through April 30 where possible, institution of an emergency pandemic time off policy, stopping all international and non-critical travel, and a 14-day quarantine at home for employees who have traveled to a high-risk location or have been in contact with someone who has.

Vice-President Pence’s statement about waiving state licensure limitations on telehealth doctors has created confusion, Politico reports, since only states can waive those restrictions, few have done so, and the federal government’s legal authority to preempt states is not clear. The Federation of State Medical Boards maintains a list of states that have waived licensure requirements in response to COVID-19, either for in-person encounters or for telemedicine. It’s still not legal for a doctor to conduct a virtual visit for a patient who is sitting in a state where the doctor isn’t licensed unless that state has waived its requirements. It would be so much easier if licensing was based on the doctor’s state rather than the patient’s.

Teledentistry provider SmileDirectClub, which sells plastic teeth aligners, will open its 3D printing facility for creating COVID-19 supplies, such as face shields and respirator valves. The company, whose 3D printing capacity is among the country’s largest in producing 20 million mouth molds per year on 49 HP Jet Fusion 3D printers, asks medical supply companies that need help and are willing to provide STL 3D printing files to get in touch.

Italy reports that nearly 800 people died and 6,500 new cases were reported Friday, with 5,000 deaths so far. Spain had 1,400 deaths and 3,800 new cases as its case growth tracks to exceed that of Italy. Doctors in hospitals in Spain are sedating patients over 65 and then removing their ventilators to free them up for younger patients. Meanwhile, CDC continues to report US cases only Monday through Friday.

New York-Presbyterian Hospital reports having 558 COVID-19 inpatients as of Sunday morning, 20% of them in ICU and many more likely bound for there.

Health departments in New York City and Lost Angeles advise doctors to skip testing people with mild respiratory infections for coronavirus unless the results would change the clinical management of those patients. The recommendation acknowledges a strategy that is shifting from containment to slowing the transmission.

In another change in how COVID-19 is viewed, scientists call for quick development of a serological test to determine whether someone has been exposed to coronavirus and has developed some level of immunity as a result. That information will help drive public health decisions since if people can develop immunity after exposure (nobody knows that yet), they could return to work, including to healthcare jobs.

Former FDA Commissioner Scott Gottlieb, MD says this about the COVID-19 current state:

• The best hope of having a therapy available by summer is antibodies. As such, bulk manufacturing should be ramped in parallel just in case something is found to work, allowing rapid rollout.
• Efforts should be focused on widespread testing (such as point-of-care testing in physician offices) and serology to help understand coronavirus epidemiology.
• We need as a nation to define the COVID-19 endpoint and develop a plan to get there rather than taking haphazard actions without federal leadership.
• The US is seeing much higher numbers of young people having confirmed cases, with 56% of New York City’s being under age 50.

FDA gives emergency authorization for molecular diagnostics firm Cehpeid to start shipping a 45-minute coronavirus test that will run on its 23,000 GeneXpert systems, of which 5,000 are in the US and are capable of running hospital tests 24×7.

An ED doctor shares her hack for using a single ventilator to support up to four patients. She warns that such use is off-label, but also notes that anything goes in a disaster.

Just a note of who to believe on Twitter: people with expertise in data visualization, statistics, journalism, or medical practice still aren’t epidemiologists. Understanding COVID-19 from a public health perspective requires specific expertise. Choose your experts wisely and avoid the armchair kind. I also note that many non-healthcare tech folks are rushing out apps that do little to help with the coronavirus response – we have ample supplies of imitative symptom checkers and tracking maps, so please channel your talents into creating something more useful.

Privacy and Security

I got a press release from telemedicine technology and services vendor Banyan Medical Systems about a free hospital COVID-19 offering, but note to the company: Bitdefender says your website is ironically infected with a virus of a different kind (a cryxos trojan).

Other

Stanford Health redesigns lab reports in its MyHealth portal after several students complained that their reports indicated a negative coronavirus test result, only to be notified soon afterward that they were positive for COVID-19. Stanford explains that the first results listed are for normal seasonal coronavirus, but the COVID-19 test takes longer and positive results then trigger a phone call from a nurse instead of immediate release of results to the portal. One of the students who was fooled is the daughter of UCLA Director of Clinical Informatics and pediatrician Paul Fu, MD, MPH, who is self-quarantining after experiencing COVID-19 symptoms. He says other health systems are reporting similar problems with patient communication, adding, “One of the things that we focus on when we put information out through patient portals is to empower our patients to become partners with us in delivering healthcare. The other thing is to help them understand what the data means, and that how we present the data is clear and unambiguous.” Paul isn’t happy that his COVID-19 exposure probably came from his daughter since Stanford didn’t cancel its Family Weekend on February 27-28 and then abruptly sent students home without self-quarantine instructions since testing wasn’t available.

Idiots with too much free time on their hands are “Zoombombing” public Zoom meeting in then blasting pornography to participants. The default Zoom setting is that any participant can share their screen. The company urges hosts of large public meetings to change the default so that only they can share their screen. It also recommends that private meetings be set to invitation-only with a password required. Users also suggest disabling “Join Before Host,” enabling “Co-Host” to allow others to moderate, disabling “File Transfer,” and disabling “Allow Removed Participants to Rejoin.”

NYC Health’s guide to sex and COVID-19 suggests not having sex with anyone outside your household, noting that “you are your safest sex partner” in advocating video dating, sexting, and chat rooms. It also helpfully notes that shared keyboards and screens should be disinfected after their use for those purposes.

Sponsor Updates

• Bluefield Regional Medical Center (WV) uses Live Process software to notify managers of updated COVID-19 communication and guidance documentation.
• Meditech announces event changes for March and April.
• Spok appoints Christine Cournoyer (N-of-One) to its board.
• CompuGroup Medical sets up a dedicated website and phone line for providers to request six months of free CGM ELVI Telemedicine.
• Experity publishes “E/M Coding for the 2019 Novel Coronavirus (COVID-19).”
• Relatient names John Glaser to its board.
• Vizient awards a group purchasing contract to CI Security for managed detection and response cybersecurity services.
• ROI Healthcare Solutions creates a virtual booth after the cancellation of several conferences.
• Impact Advisors posts a white paper titled “Keeping Your EHR Implementation  On Track Amid COVID-19.”
• StayWell creates a COVID-19 resource hub for patients, members, and communities.
• The Dallas Business Journal features T-System’s efforts to offer providers COVID-19 documentation resources.
• Voalte parent company Hillrom donates $5.5 million in medical devices for critical and intensive care to 25 hospitals fighting COVID-19.
• PerfectServe offers clients free COVID-19 automated patient and family outreach software and free services to implement best practices.
• Wolters Kluwer Epidemiologist Mackenzie Weise appears on a special PBS “NewsNight Conversations: Coronavirus.”
• Zynx Health publishes new COVID-19 order sets and care plans.

Blog Posts

• COVID-19: Preventative Measures, Why We Need to Act, and Maintaining a Clear Head (Lightbeam Health Solutions)
• Delivering care differently in the age of COVID-19, through virtual care (Meditech)
• A Roadmap for Optimizing Clinical Decision Support (Health Catalyst)
• Your telehealth journey: Moving forward quickly (Nordic)
• Medicare Announces Reimbursements for SOME Remote (e.g. like telehealth) PT Services During COVID-19 (MWTherapy)
• Advocating Together to Expand CCBHCS (Netsmart)
• How COVID-19 will change how we work FOREVER (OpenText)
• PCare’s IPC COVID-19 Checklist (PCare)
• How healthcare providers are tapping into unique scheduling solutions to manage COVID-19 patient testing (Experian Health)
• Tips for Increasing Healthcare Consumer Trust in AI (PatientBond)
• Impeccable Timing (PatientKeeper)
• 8 considerations to fast-track telehealth (Pivot Point Consulting)
• 3 Ways to Save Nurses’ Time with Better Communication (PerfectServe)
• I Get by with a Little (Access Modeling) Help from my Friends (SailPoint)
• We’re all Contributing to Change in Healthcare (Summit Healthcare)
• Communicating COVID-19: An Editorial Calendar for Healthcare Marketers (SymphonyRM)
• COVID19: Protecting Staff, Protecting Patients (Vocera)
• FAQ: Using E-Visit Codes to Bill Medicare for Rehab Therapy Telehealth During COVID-19 (WebPT)
• Doctors are staying calm and informed about the coronavirus. The public should, too (Greenway Health)

Contacts

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

Weekender 3/20/20

Weekly News Recap

• Hospitals ask the federal government for a $100 billion bailout to offset their costs of diagnosing and treating COVID-19.
• COVID-19 predictions and recommended federal government actions dominated the news.
• HHS announces that it will allow physicians to practice across state lines, although individual states must waive their own requirements.
• HHS OCR relaxes its requirements on the use of consumer video technologies such as Skype and FaceTime for offering telehealth services.
• Telemedicine companies struggle with a high volume of demand that strains their infrastructure and provider availability.
• WebMD acquires StayWell.
• Epic cancels its XGM conference.
• Cerner asks all employees who are able to work from home to do so.

Best Reader Comments

We are a hospital with numerous clinics making about $350 million per year in gross revenue with an average profit margin of 1.3% over the last 10 years. Our best estimate is that we will lose $10 million per month that this continues. That doesn’t even take into account our cash reserves that keep us afloat, which are being decimated in the market. We absolutely will see hospitals go bankrupt and/or be acquired this year without a bailout. (Bobby Bailout)

[COVID-19 testing data]. Epic has released functionality (COVID-19 Pulse Dashboard) that will aggregate de-identified data across their organizations. Considering they boast that their organizations cover half the US population, I would think they should be able to get some good aggregated data soon. Hopefully they do a good job of collecting the right metrics and cooperating with research institutions to help bring out some of this data. I hope Cerner is also looking to or already is doing something similar considering they also have a large share of US population. (AC)

I will think twice before ever booking our hotel rooms through OnPeak again. If we would have booked through the hotel directly, we would have been able to cancel with no fees. If you book with OnPeak/HIMSS, you lose your shirt. For what? A small room discount? Live and learn. (Jennifer)

On the practice side, most places have a little door barricade set up. People get a symptom check in the barricade one by one before they get in the waiting room area. People are told to call for instructions before approaching the clinic. On the hospital side, most of the clinical folks I’ve talked to have been told not to talk about internal details with the public. (What)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. P in California, who asked for robotics programming blocks for her kindergarten class. She reports, “The Cubelet blocks were exactly what I needed to connect computer science principles to solving real world problems. Our first experiment with the Cubelets was a simple challenge, to connect the blocks so their robot would move around the table and then stop. The kids were so excited to work together, every member of the group was trying different combinations and excitedly chiming in suggestions. I listened to these five year olds problem solve and collaborate and thought, ‘Wow. These are exactly the 21st Century skills that they need to be practicing.’ Thank you so much for giving us these high interest, durable robot blocks. You’ve made my class very happy, and given me a tool I will be using frequently in the future.”

Carnival offers the federal government use of some of its cruise ships as temporary healthcare facilities for non-coronavirus patients in major coastal cities, potentially freeing up hospital beds for treating COVID-19.

China exonerates a Wuhan doctor it had reprimanded for warning about the coronavirus outbreak in an almost unheard-of admission by the Communist Party that it made a mistake. The party apologized to the family of Dr. Li Wenliang, who died of COVID-19. The government’s treatment of the doctor stirred uncommon public anger, with complaints that it was hiding outbreaks, punishing journalists, and valuing its own image over public safety. Several citizen journalists and critics were arrested and some disappeared after sharing information online about the outbreak. Insiders also claim that Wuhan’s claim of zero new cases is untrue because the local government suspended testing and discharged quarantined, symptomatic patients early to make President Xi Jinping look good during his scheduled visit there.

Italy presses 10,000 final-year medical school students into COVID-19 service, waiving the final exams normally required to put them on the front lines nine months early.

A California private practice doctor offers appointment-only drive-up coronavirus testing outside his office, with cash prices starting at $200. He has performed 40 tests, received eight results, and identified one positive patient. Mask shortages have forced him to buy from Craigslist scalpers.

Ten conferences that have been cancelled at the Orlando’s Orange County Convention Center have hit the area with a $363 million economic impact. HIMSS is mentioned as working by mid-February to arrange on-site medical services to convince exhibitors not to pull out. The local paper intercepted emails from HIMSS in which it expressed dissatisfaction with the Visit Orlando convention bureau, which it said was not supporting the conference by agreeing to distributing attendee health information at local hotels. The photo above was taken on Wednesday, March 4, the day before HIMSS20 was cancelled.

Fox’s “The Resident” TV drama, which is filmed in Atlanta, donates masks, gowns, and other supplies to Grady Hospital. “Grey’s Anatomy” and “Station 19” have donated masks and gloves to a Los Angeles fire station.

In Case You Missed It

• News 3/20/20
• Readers Write: COVID-19: You Aren’t Ready
• Health System Frontline Reports and Tips – Coronavirus Response
• EPtalk by Dr. Jayne 3/19/20
• HIStalk Interviews Jeffrey Wessler, MD, CEO, Heartbeat Health
• News 3/18/20
• Curbside Consult with Dr. Jayne 3/16/20
• HIStalk Interviews Jay Desai, CEO, PatientPing
• Monday Morning Update 3/16/20
• HIStalk Interviews Eric Jordahl and Anu Singh, Managing Directors, Kaufman Hall

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 3/20/20

Hospitals ask for $100 billion coronavirus bailout

The American Hospital Association, American Medical Association, and American Nurses Association ask the federal government for $100 billion to offset COVID-19 diagnosis and treatment.

Ransomware Gangs to Stop Attacking Health Orgs During Pandemic

Several ransomware hacker groups say they will refrain from attacking healthcare organizations during the pandemic.

Surge in patients overwhelms telehealth services amid coronavirus pandemic

Telehealth services are being overwhelmed with a surge in patients that is stressing their technology and their supply of physicians.

Local medical tech startup shuts down operations

Medical credentialing-as-a-service startup MedSpoke closes, citing recent changes to its client base.

News 3/20/20

Top News

The American Hospital Association, American Medical Association, and American Nurses Association jump on the federal government bailout train by asking for $100 billion to offset COVID-19 diagnosis and treatment.

Hospitals say they will lose revenue from delaying elective procedures and will spend more on training, supplies, and employee childcare.

The letter to Congress didn’t mention that insurers, including the federal government in the form of Medicare and Medicaid, will pay hospitals and doctors for providing care to COVID-19 patients.

HIStalk Announcements and Requests

I’ve added a “comments” link to the bottom of every HIStalk post, a much-requested feature that allows reading or adding comments without scrolling back up.

Unrelated, outside of social distancing: need something interesting to eat with your canned soup? I made what I will modestly call “good” baguettes that were easy (no kneading), quick, and required just flour, water, salt, and yeast. They passed Mrs. H’s test of being crusty on the outside and soft (but not spongy) in the inside. You might as well have something homey while at home and make it smell good besides.

Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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

Sales

• Nebraska Health Information Initiative selects NextGate’s enterprise master patient index.
• The Cardiovascular Center of Puerto Rico and the Caribbean will implement Medsphere’s CareVue EHR.
• Topeka, KS-based HIE Konza will use Diameter Health’s data normalization and enhancement software to deliver de-duplicated CCDs to its members.

People

MDLive names Chairman Charles Jones CEO, Christopher Shirley (Catasys) CFO, and Andy Copilevitz (Walgreens) COO.

University of Washington Medicine pathology professor Stephen Schwartz, MD, PhD died Wednesday of COVID-19.

Announcements and Implementations

Children’s Hospital of The King’s Daughters (VA) implements analytics and data management software from Dimensional Insight.

Cobre Valley Regional Medical Center (AZ) rolls out Meditech Expanse, with consulting help from Engage.

Health Catalyst will make available COVID-19 patient and staff tracking, public health surveillance, and staff augmentation support capabilities.

Jump Technologies makes its inventory management software available to hospitals for free for a limited time.

Dina offers COVID-19 rapid response tools, including self-assessment of quarantined patients, remote monitoring of discharged and isolated patients and healthcare workers, patient self-assessment, and checking the health of staff members daily with text-based remote screening questions. 

Blue Shield of California offers its network hospitals a customizable COVID-19 Screener and Emergency Response Assistant for consumers. Mobile device or hospital website users answer questions whose answers direct them to the most appropriate medical setting. Blue Shield is covering the cost of implementation, which takes 48 hours, and three months of updates. The tool was developed by Gyant, which offers digital front door and patient engagement technology.

Allscripts announces its COVID-19 response, which includes a fast-tracked telehealth implementation plan for FollowMy Health, rollout of an EHR-agnostic automated triage tool, and employee travel restrictions.

Registry reporting vendor Iron Bridge offers free access to system to allow hospitals and labs to report COVID-19 cases to the CDC faster.

Verge Health offers free access to its Compliance Rounding solution that helps hospitals complete the COVID-19 CMS Infection Prevention Worksheet and CDC Hospital Preparedness Assessment

CompuGroup Medical offers free provider use of CGM ELVI Telemedicine, which allows them to collect patient information, share information, and provide care from anywhere.

Government and Politics

HHS will allow physicians to practice across state lines in an effort to prevent staffing shortages during the COVID-19 pandemic.

HHS asks for $21 million in additional 2020 funding for ONC to “support the emergency expansion of a patient lookup system to aid patients and COVID-19 medical response” via an online database.

COVID-19

Former FDA Commissioner Scott Gottlieb, MD provides thoughts on COVID-19:

• Therapeutic response involves three efforts: developing a vaccine (which he thinks will take two years), trying existing antivirals, and developing an antibody that can be given as a monthly injection to protect frontline healthcare workers and high-risk people.
• He expects the epidemic to peak in late April and early May, with hopes that it will have run its course by July and will leave enough people who have recovered from it to create herd immunity. His biggest fear is that it will come roaring back in September and cause another epidemic that will last all winter.
• Point-of-care diagnostics similar to the flu swab are needed to allow doctors to quickly quarantine people who are infected instead of waiting 24-48 hours (he says that test can be developed within three months). Then roll out widespread surveillance testing to see how the virus is circulating. He says the nation’s posture is not sustainable unless such surveillance can be put in place while waiting for a vaccine to be developed.

Former National Coordinator and Aledade founder and CEO Farzad Mostashari, MD – who has strong syndromic surveillance experience — identifies issues with COVID-19 data collection and analysis, likening the current state of testing to giving a haphazard set of people a new drug, collecting information sloppily, and then trying to use that information to determine whether it works:

• The public health value of counting positive tests is minimal without understand each individual’s condition, their source of exposure, and how they compare to those whose tests are negative.
• The preliminary data that is being reported to the CDC is frequently missing hospitalization status, ICU admission status, death, and age. CDC does not know the denominator of how many people have been tested.
• Labs should be required to submit aggregate information on every test they perform, not just those with positive results.
• Sentinel testing needs to be performed.
• A serosurvey is needed, where a random sample of households in a large city is tested and surveyed to understand the fatality and infection rates.
• ED visits for cough, fever, and flu-like symptoms need to be studied to determine how many are COVID-19 related.

Bill Gates address coronavirus in a Reddit “Ask Me Anything,” where he observes about COVID-19:

• US testing is disorganized. The federal government needs to provide a questionnaire website for consumers that prioritizes the testing, such as making sure that healthcare workers and the elderly are tested first. 
• Labs that perform COVID-19 testing need to be connected to a national tracking system.
• Gates and his researchers feel that the Imperial College models are too negative given that China’s shutdown reduced case numbers that showed little rebound. The Imperial College models were based on influenza.
• He expects treatments for COVID-19 to be available before a vaccine, which would keep people out of ICUs and off ventilators. The Gates Foundation is funding research on bringing all industry capabilities into play.
• The Foundation is working on a plan to send test kits to people at their homes to try to offset the US’s disorganized testing.
• He expects individuals to be assigned digital certificates to show that they have recovered, or when a vaccination is available, that they have received it.

Mitre urges the federal government to take immediate action to halt the short doubling time of new COVID-19 cases in the US:

• Close all schools.
• Give businesses incentives for allowing working from home.
• Shut down all places of social gathering, including restaurants, bars, theaters, concerts, and sporting events.
• Provide home food supplies to everyone who needs them.
• Seal the US borders to all forms of traffic and transport.

Cerner temporarily closes its Realization campus after an employee tests presumptively positive for COVID-19.  The company had already announced a work-from-home policy for most employees.

National medical group Mednax comes under fire for telling clinicians that if they require a two-week quarantine following coronavirus exposure, they must use their sick leave or PTO.

First Affiliated Hospital of Zhejiang University and Alibaba Health publish a 60-page, detailed COVID-19 prevention and treatment handbook that accumulates information gained from China’s outbreak.

Healthcare workers at Providence St. Joseph Health in Washington fashion face shields out of supplies from craft stores and Home Depot, including marine-grade vinyl, industrial tape, foam, and elastic. The health system is evaluating the quality of material used for surgical tray liners in case they need to repurpose them for masks.

YMCAs in Memphis, TN convert into childcare facilities for healthcare workers and first responders.

US funeral homes are asking families to scale back or postpone funeral services, limit attendees, and conduct services virtually to comply with federal guidelines that limit gatherings of more than 10 people. The funeral homes are also increasing worker protection since nobody knows now long the coronavirus can live on the tissue of the deceased.

Pulizter-winning cartoonist Mike Luckovich of The Atlanta Journal-Constitution posted this work.

Privacy and Security

Government officials in Massachusetts warn the public, particularly seniors, of COVID-19 testing scams: “Testing can only be ordered by a treating physician. We have heard about teams in white coats going door-to-door offering virus testing. This is NOT a valid offer. What they are really interested in is robbing the elderly or stealing their identity. And we have heard reports of callers pretending to be a nurse offering test results once they get a credit card number. These kinds of calls are also not for real.”

Several ransomware hacker groups say they will refrain from attacking healthcare organizations during the pandemic.

Other

Telehealth services are being overwhelmed with a surge in patients that is stressing their technology and their supply of physicians. Cleveland Clinic reports a fifteen-fold increase in telehealth visits and is doing phone consults and recorded video visits to try to keep up. University of Pennsylvania has increased telehealth staffing from six to 60, but is running days behind, while Jefferson Health is receiving 20 times the number of virtual visits and is scrambling to enlist more doctors.

ProPublica looks at the role medical conferences have played in spreading COVID-19.

The New York Times calls the Zoom videoconferencing service “where we work, go to school, and party these days.” People are convening virtual birthday parties and cannabis hangouts, teens are referring to themselves as “Zoomers,” college students are using it for blind dates, it’s being used for virtual college graduations, and experts worry that it will turn into a Facebook-like cesspool of live online mass shootings and child porn that will force the company to moderate content. Zoom’s soaring share price values the company at $29 billion.

Sponsor Updates

• Kyruus incorporates Gyant’s chat-based virtual assistant into its patient-provider routing and scheduling software.
• Intelligent Medical Objects will release free COVID-19 terminology content and value sets to customers on March 26.
• Omni-HealthData adds enhanced social determinants of health data to its health information management software.

Blog Posts

• Brown Clinic: Community Values with Leading-Edge Technology (EClinicalWorks)
• A Message from Ensocare’s President on Our Coronavirus Response (Ensocare)
• Trouble Finding Citrix Expertise? The Answer is Technology (Goliath Technologies)
• Remote work essentials: How IT can prepare for a distributed workforce (Google Cloud)
• Digital health solutions for business continuity during a pandemic (Greenway Health)
• COVID-19 Pushes Telemedicine Into the Spotlight – Are You Prepared? (PMD)
• Pandemic Response as part of your DR/BC Solution (The HCI Group)
• This Historic Ruling by the ONC Means More Empowered Patients (Healthwise)
• While we work from home, healthcare providers stand on the pandemic frontline (Hyland)
• Yale New Haven matches workstation locations to clinician log-ins to help manage Coronavirus (Imprivata)

Contacts

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

Readers Write: COVID-19: You Aren’t Ready

COVID-19: You Aren’t Ready
By Jeremy Harper

Jeremy Harper, MBI is chief research information officer of Regenstrief Institute of Indianapolis, IN. The views and opinions expressed in this article are his personally and are not necessarily representative of current or former employers.

Chief research information officer means that I design systems to connect clinicians, research, and IT for a living. I’m paid to think outside the box. 

I’ve been tracking coronavirus since mid-January. I want to acknowledge as I write this that as of March 19, 2020 we have about 10,000 individuals in the US who have been identified with this disease. We are not at a crises today, but we might be in a week. About 3,000 new cases were identified yesterday.

Our health systems are built upon a tower of electronic assumptions for patient care, triage, and scheduling. If you review the CDC pandemic preparation documentation, we are focused on minimization of the event in lowering the curve. I’m calling on the IT and informatics Industry to look beyond minimization to what happens if we fail. We are not ready.

A crises of this magnitude brings us back to a simpler time, one that requires a massive streamlining. We’re seeing vendors begin to release capabilities for streamlined remote visits, but we need to be prepared internally for our health system operations.

We can’t just focus on how our back office connects remotely, because if the worst happens, our health administration will be ignored in favor of saving lives. We’re going to be rushing to convert swaths of our hospital beds to ICU beds like Italy has done, or creating new hospitals like China did. We are going to see all those beautiful individual rooms that have been built at hospitals over the past 30 years doubled up. 

This will be a new health system in a matter of days, and we have not designed our systems to deal with this. As an executive consultant, I’ve participated in pandemic preparedness and emergency drills in numerous health systems. We are suddenly faced with a situation that has the potential to dwarf the worst-case scenarios we have envisioned.

Almost every report that you have spent years building will suddenly become useless. They will be repurposed for decisions they weren’t intended to support. AI/ML won’t solve this one for you, because this is something new, something that will break every model we have worked to build.

Think about your automated systems to alert clinicians to close charts. If people are dying in the hallways, it doesn’t matter. Closing charts, filling in discrete fields (this one kills me as a researcher — we need discrete data desperately to identify best practices), and most clinical decision support suddenly go out the window.

I’ll take a personal example of what we’re about to face on the clinical and administrative front. My father had an esophagectomy about five months ago. They caught the cancer early. He was asymptomatic, aside from a cancer that was going to kill him. His 10-hour “elective” surgery might not be taking place or might be delayed right now as health systems gear up for COVID-19. He has had strictures (throat closing off) since the surgery. He has already been informed that they might cancel his next appointment (where they put him under and stretch his throat) depending on patient load due to COVID-19.

If we see mass cancellations of these an other “elective” process items, then we’re going to need better reports that prioritize patient rescheduling that is based on acuity rather than who gets on the phone and connects first, or who knows how to manipulate the scheduling system the best. This isn’t Ebola, where simple screening questions and changing our triage process will cut it.

What you can do now:

• Start building reports to support your providers in triage to get the right people to the front of the line.
• Identify how we’re going to support a world where we might ask the public to donate CPAP/BIPAPs to keep people breathing through the disease.
• Stop assuming that you are dealing with a “business as usual, just remote” situation, and use this time to prepare for a world where the EMR is low on the priority list.
• Work with researchers to identify the data we need to get treatment recommendations out to the world quickly.
• Use your time and expertise to help groups in need.
• Figure out your best practices and start telling people about the changes you are making.

I have a full-time job. I do executive consulting on the side. I have a beautiful three-year-old and a wife I love. I know how hard it is to find more time during an “all hands on deck” situation. We are all in this together. Let’s be ready.

Health System Frontline Reports and Tips – Coronavirus Response

A large Midwest health system with a medical school:

Optional daily huddle from noon to 1 p.m. Monday thru Friday. We are all working remotely and can’t walk to desks to have a conversation, but have new challenges. A dedicated time to discuss any concerns has helped many times.

Continuity of command structure. Statistics show that as much as 30% absence rates could be realized. We have been asked to document our command structure at least three levels deep.

A Boston health system:

A patient does not exist in Epic until they have a visit or a bed. With new tents being added, lobbies being bedded, and new ICU beds being planned, Epic builders and managers, physicians, and leadership are working overtime getting it all built.

The command center has been fully operational for nearly two weeks.

Telemedicine visits were built and rolled out in record time, hundreds and hundreds of them Monday.

I am not sure anyone outside of the Epic world understands how much work this takes,  but it has all come together safely with the hope of improving the health of well-being of our providers and patients. I’m sure Epic was busy themselves supporting us and all the other hospitals (and my Epic contact was working at home, btw).

Keep on keeping on. Endless time at home nowadays to work, work, work.

Small, rural health system in the Pacific Northwest:

Agility matters. Stay hyper-informed about what is going on locally and nationally. Literally try to guess what is going to happen next and keep planning for worst-case scenarios, which so far have been proven to be the case every time.

Keep it simple. A quickly deployed 60-70% solution is better than nothing at all. Suboptimal is the new normal.

Focus on telehealth. Our system has a limited number of providers who cover wide geographic areas. The fact that some of them are either infected or self-quarantined means we have to figure out how to get them to be able to have access to patients from wherever they’re located.

Expect and plan for a big support overhead with telehealth and work from home from all levels of IT. Set expectations on support levels, be transparent in how you’re prioritizing support, and be evangelical about focusing on providers and patients.

Expect all of your technology partners to be fairly overwhelmed. If you are looking for hardware, you are going to have to be creative in your sourcing. Don’t be too proud to reinstall decommissioned hardware or to move things around between environments to the most critical areas such as networking or desktop provisioning/support. Also, look to the cloud.

Stay engaged with your clinical and operational leadership. Force your way into any and all planning and response meetings, ask for a seat on all incident response teams, and continually give risk assessments and rational resource constraints.

Dust off your disaster plans and business continuity plans. They can be a great guide for remote workforce management. Keep your CISO and compliance officer close at hand. Don’t do anything stupid in your rush to facilitate what your clinical and operations leadership needs to accomplish.

We have been a user of Webex for years. Didn’t realize we had a limit of 200 users until we started doing town halls for staff. Have asked Cisco to expand to 1,000 users, which should be enough.

North Carolina health system spanning urban and rural areas:

Big investment in telehealth capability – network upgrades, training Investments in telework for non-essential personnel. Dashboards to track cases in house, pending tests, supply projections, vent availability.

Bay Area system:

It’s a strange mix of prepared process and optimistic feeling. We’re doing everything right – ramping up work from home, limiting visitor access, etc. But there’s still a general business-as-usual vibe from everyone that feels almost a little surreal for me. I get that it’s a lot better than blind panic, but it still makes me wonder how well everyone is going to mentally adjust in a few days when it gets really bad. Still, I’m happy to be somewhere that started taking precautions very early.

This is not the time to be particular about work from home. Everyone who can should, with as little “proving” and red tape as possible. Just do it! Maybe people will be less productive — there’s a pandemic on, that’s what happens. For essentials who need to be in, try to at least spread out the load so the density is lessened.

Make sure you know what your reporting looks like when you exceed bed capacity NOW, instead of learning as it happens. Be prepared for helpdesk to be a pinch poin, and try to find ways to lessen their burden by socializing fixes to common problems.

National hospital system:

This past weekend, we conducted an IT checkout process for 300+ employees to ensure staff who we are sending home were well prepared. Lots of them were familiar with email access, but less so with a soft phone Avaya routing of their desktop phone to their computer (avoids using a second port off your switch when forwarding phones directly) and various other IT tips. This avoided a flood of calls to the IT help desk, letting us take calls from our hospitals as normal.

From a cleaning perspective, we are just now purchasing relatively inexpensive dry hydrogen peroxide cleaning devices that can clean airborne and surface viruses and other contaminants. This should allow us to have increased safety in rooms vacated by patients positive with the virus.

EPtalk by Dr. Jayne 3/19/20

I was back in the clinical trenches today. At least in the urgent care world, it was eerily calm at times, although we did see some big rushes at the beginning of the day. People are getting the message to stay home, although some ventured out.

I want to offer some advice for those of you who need to seek medical care. First, this is not a time to take the family. If you need someone to drive you, great, but have them wait outside and not enter the facility. I saw two families today with multiple children in tow, but multiple parents. It would have been better if the second parent, who didn’t participate in the visit at all, remained in the car with the siblings.

Second, look out for your healthcare workers. If you see that something has gone wrong with their personal protective equipment, say something. Although I’m sure the worker in the picture above knows that their forearms are exposed, therefore defeating the point of a gown, maybe they would have done something different if a patient or co-worker had said something.

Third, please do not question why your provider is wearing a mask. We have our reasons, and some are personal health issues. We might also be protecting you from our cough or sneezing since it’s also allergy season. We are healthcare providers and you need to trust us to make decisions for our health and yours. I have had colleagues at other facilities that have been told they can’t wear masks because they’re “panic-inducing” for patients.

Many of your healthcare workers are terrified. If they wear the one crummy mask they have access to and have been wearing every day for a week, give them a break. Maybe they’re just scared because physicians in our area have already been infected.

Last, please think before you complain about wait times. You never know when the team is tied up transferring a critical patient to the hospital or doing another critical task, like starting the autoclave so we can get more instruments sterilized. For those patients who are coming in apologizing for being sick, it’s OK and you don’t need to apologize. That’s what we’re here for.

I was excited to hear announcements that licensure requirements for telehealth are going to be relaxed. The reality, though, is that it is on a state-by-state basis, and not all the states are playing along. I can see patients in Florida and North Carolina as well as the states where I have licenses, but we’re a long way from letting available physicians flex to cover the areas with the most need.

Most of the telehealth visits I’ve done in my off hours have been for routine things. Patients either don’t want to risk going to a physician’s office or the offices are overwhelmed and not keeping up with phone volumes. I handled some medication refills along with sinus infections, urinary tract infections, and pinkeye. These are routine things in primary care and I’m glad to be part of the solution as clinics struggle to cope with their new normal.

CMS has also relaxed telehealth rules for Medicare and Medicaid as far as which visits providers can bill. Medicaid is still subject to state regulation, so that might take time, just as with the state license issue. New federal policies also let clinicians use technology beyond established telehealth platforms, such as Apple’s FaceTime, Facebook Messenger, Google Hangouts, Microsoft Skype, and more .

Speaking of virtual care, I practiced some virtual self-care this week as my cello instructor moved my lessons online. I had to run a cable from my laptop to the router to make it work and we experienced some distortion of the sound when I was too close to the microphone, but it worked out well. I only started playing last summer, so I smiled when I saw this article about two young cellists who played a socially distant concert on the porch of their elderly neighbor. The article mentions that their repertoire included Suzuki Book 1 and Book 2. I’m just finishing the latter, so perhaps it’s time for a concert.

From Cultural Afficionado: “Re: Google Arts & Culture. I was led there by an article about virtual tours of museums around the world for folks who are self-quarantining (is that a proper verb?) While looking over the rest of the site, I found a ‘Spotlight on Shoes’ section that included this story, ‘Amazing Shoes of Turin.’ Enjoy, and thanks for your contributions to HIStalk!” I’ve been enjoying all kinds of virtual adventures as I force myself to take frequent breaks away from scientific articles and other reports about COVID-19. My favorite video is the one of the penguins at the Shedd Aquarium in Chicago, who were allowed to roam the building after it closed to visitors. We need a little levity in times like these, and penguins always get the job done.

From Homeward Bound: “Re: telecommuting. I work for a health plan with about 2,000 employees. The organization had very little telecommuting before this outbreak. This crisis has forced a huge amount of scrambling to get hardware to people who need it, and more importantly, get management to figure out how to manage people they don’t see on a daily basis. It will be very bumpy for the time that everyone is working remotely. Work will get done, but not as much as usual. It will be interesting to see whether the old-school leadership tries to put the genie back in the bottle once we don’t all have to be remote. The lack of telecommuting has been a real negative for recruiting for a long time.” I hope managers are keeping an eye on productivity because they might be surprised. Of course it varies from employee to employee, but some of us get much more done in a non face-to-face situation. I’m sure others have trouble focusing or maintaining the self-discipline needed to work remotely. Lack of childcare is another factor in this situation compared to other work from home efforts, so if productivity dips, I hope they don’t judge too harshly.

It’s time to announce the results of my virtual Shoe-A-Palooza and Sock-It-To-Me competitions. A single champion dominated in both categories — Dr. Nick van Terheyden. In his submission, he notes: “My Scottish Leather Ghillie Brogues. Not for the whole show, but for my now-cancelled Whisky Tasting at the NextGate booth on Tuesday.”

There’s a potential 18-month trajectory for the COVID-19 crisis, so let’s hope we get to see that ensemble at HIMSS21.

Email Dr. Jayne.

Morning Headlines 3/19/20

RubiconMD Raises Another $18M to Connect Primary Care Physicians to Specialists

E-consult software vendor RubiconMD raises $18 million in a Series C funding round led by Deerfield Management.

Trump administration will allow doctors to practice across state lines to address pandemic

HHS will allow physicians to practice across state lines in an effort to prevent staffing shortages during the COVID-19 pandemic.

A new app would say if you’ve crossed paths with someone who is infected

MIT and Harvard researchers develop an open-source app that tracks the movements of users and alerts them if they come near someone who has self-reported testing positive for the coronavirus.

HIStalk Interviews Jeffrey Wessler, MD, CEO, Heartbeat Health

Jeffrey Wessler, MD, MPH is a practicing cardiologist, assistant clinical professor of medicine at Columbia University Irving Medical Center, and founder and CEO of Heartbeat Health of New York, NY.

Tell me about yourself and the company.

I’m a cardiologist by training. I started Heartbeat Health three years ago with goal of bringing a virtual care model to cardiovascular disease. Virtual care has evolved from telemedicine only as a platform, then urgent care chatbots, then some of the singular disease verticals such as diabetes. Now with Heartbeat Health, we have a chance to take on some serious disease processes, such as cardiovascular disease.

Little of a cardiology practice’s work is preventative, right?

That’s right. The majority of cardiovascular care happens after patients get sick. They get referred into the system after they have had a heart attack, uncontrolled blood pressure, or resistant symptoms. That made sense 20 years ago, when we really did need to focus our resources on treating those who had advanced disease.

But we’ve gotten pretty good at that as a field now. The advanced treatments are amazing and they work really well. The next phase, and where the ball is now, is now to keep people out of that advanced disease, emphasizing early disease management and prevention. That is the huge missing component with the care system.

Standalone healthcare apps tend to move the overall needle very little, so you have integrated your platform with your cardiology practice that provides the hands-on component. How do you see the company scaling?

What makes cardiology different than, say, weight loss management or exercise management is that these are really sick patients who need physical care. It’s this hybrid model of virtual when you can, digital when you can, but then get patients to the right care at the right time when they need it. 

By that, I mean the physical care environment for diagnostic testing, in-person evaluation, and hospitalization if needed. Being able to navigate between those two settings is really not done in the market right now. That’s our sweet spot — how to get people to the right place when they need it and everything else managed via the app.

You are offering services to employers and individuals. From the individual’s perspective, how would that work for someone who doesn’t live in New York City?

The best way to think of the New York office is as the test kitchen or the R&D lab for our clinical experience. But across the country, you would download the app, go through the risk assessment and data collection phase, undergo a tele-visit to speak with the doc and discuss the specific results — what the risk factors are, what they mean, and what the necessary next steps are. Then we would get you to a Heartbeat preferred partner who can do a stress test or arrhythmia monitoring as needed, then get that information back into the app for ongoing management.

The physical care happens very successfully in cardiology across the country. It’s just that too often, the wrong patients are getting to those doctors. By that, I mean not necessarily the right time or the right level of patient getting to the right specialist. That’s where we step in and say, it doesn’t matter where you are — California, Nebraska, Florida – the key step that we do is getting your data, interpreting it, organizing it, and then telling you and showing you where to go.

Do cardiology practices see Heartbeat Health as a competitor or a potential partner?

As a cardiologist, I’ve given a lot of thought to this. My goal is to become a partner for the highest quality cardiologists across the country. I have incredible respect and admiration for the level of work that’s being done. I want to make their practice habits better, faster, and easier, to trim some of the inefficiencies and administrative burden of what happens when you get the wrong patient and have to figure out parts of the care model that you’re not necessarily best at. Let’s focus you to get exactly who you want to be as a cardiologist and get you to do your best care. In that sense, I think Heartbeat really is a friend and a partner rather than taking business from them. We’re helping to augment their practices.

Will you integrate wearables, EKG, and monitoring solutions?

We are leaning heavily into the wearables and the device landscape. This is such an exciting part of the field right now. We have all of these consumer devices — the Apple Watch, AliveCor, Omron blood pressure cuffs – and cardiologists don’t really know what to do with that information yet. There are now hundreds of thousands of patients with Apple EKGs who are asking, what does this information mean?

This plays a role in how we find the high-risk individuals based on those wearables, identify what that information means for their care pathway, and determine when it’s relevant. This is a layer of service that is being provided on top of the devices to cut out some of the unnecessary data, focus on the relevant and important ones, and then use it to help people and help patients get into the right care.

Atrial fibrillation is probably the highest profile cardiac condition now that consumer devices like the Apple Watch and AliveCor issue warnings to users. How do you manage those newly worried consumers?

This is a very hot topic right now. You are wise to be identifying it as a real issue. The first answer is, we don’t know yet what to do with asymptomatic patients who are being diagnosed with AFib because of an Apple Watch or an AliveCor. All of the guidelines for stroke prevention and heart rate and rhythm control have been done in patients in whom we know that the atrial fibrillation is causing problems. That is mainly symptomatic patients, those with elevated stroke risk due to age or comorbid conditions, high blood pressure, diabetes, and prior strokes. These patients are fundamentally different than an otherwise healthy person who is being diagnosed with AFib through a screening device.

This group needs to studied rigorously, and Apple is working on that. They just launched their first important study, the Heartline study, which is focused on older adults wearing Apple watches and what to do with those who are diagnosed with AFib.

But our best guess of what to do with the younger population is to take the arrhythmia or the AFib that is diagnosed by the Apple Watch and use it to focus on modifiable risk factor controls. Make sure blood pressure stays controlled, make sure cholesterol stays controlled, make sure these patients are exercising and eating well so they don’t develop diabetes. In that sense, use AFib more or less like a elevated risk factor that gives us indication of a higher risk of cardiovascular events or heart disease, but one that we can work hard on reducing if we can control everything else that’s modifiable.

Health apps often fail to change user behavior and are abandoned quickly once the novelty wears off. Do you have an advantage in having self-selected people with cardiology concerns, or do you need to use psychology to keep them interested?

I am a huge skeptic of behavior change apps. I think they have proven time and time again that they can work for very short periods of time, but have no sustained, long-term results.

My hypothesis, and where Heartbeat stands in this challenging landscape, is that it is important to establish a care environment. In particular, a patient-doctor relationship, in which an expert in the field with clinical experience can discuss one-on-one with a patient – face-to-face in our case — what your specific risk factors are, what they mean, why they affect the heart, and based on thousands of patients before you, what happens if left uncontrolled.

The tele-visit sets the stage for downstream adherence, engagement, and going to follow-up appointments and diagnostics. It’s a relationship-based intervention, not dissimilar to coaching, but we think of it as clinical coaching. Patients are more likely to do something and to follow through into care when the doctor explains the importance or the relevance of this condition rather than just an app popping up and saying that it’s time to stand up, go for a run, and eat well.

How does the model work from an insurance perspective?

By being an enterprise-based business model where the self-insured employer or the payer is sponsoring this as a benefit, we refer to people within that network. The advantage of that is that we can focus on finding providers that are doing high-quality care. For us, that means following evidence based-guidelines. Not using the diagnostics that will net them the most fee-for-service money, but the ones that are appropriate based on conditions and risk factors. In doing so, this is the classic value-based play to the payer. We can improve outcomes at a reduced cost, and therefore by starting with Heartbeat, we can guarantee a value-based process, lower events at lower costs.

Will be be a challenge to accumulate enough outcomes evidence to get employers to have confidence that their cost of offering the service will be offset by benefits?

Wellness interventions are in a rocky territory right now. Most people are getting wise to the fact that they don’t really provide clinical benefit. We take that head on by saying, if you want to provide clinical benefit, go after the people that you can demonstrate clinical outcomes on.

Our first layer is to identify those high-risk patients. This is the hot-spotting concept. It has come under fire a little bit lately because the data is not necessarily bearing out what everyone thought would be the case. But for cardiovascular disease, if you take high-risk people and those with comorbid conditions and elevated cardiovascular risk if not early disease, those are 100% the people who are leaving to the cost centers of these healthcare employers and payers with heart attacks, arrhythmias, heart failures, hypertensive crises, and ED visits for chest pain. These are very predictable numbers. If you can get ahead of it and get these patients early care, we can predictably reduce those episodes. That comes with really tremendous cost savings.

Do you have any final thoughts?

The landscape of digital health is changing. We have landed at a place where wellness and digital solutions are coming under fire. The disease-specific ones are starting to work, mostly in the diabetes prevention space, but we are left with this next era of digital management, which is, what do we do when patients actually get sick and need, quote, “traditional healthcare?”

This is the area that I’m incredibly excited about and that Heartbeat Health is taking on. When patients move from digital-only solutions into the traditional care system as they’re getting sicker, how can we get in there and try to halt the disease progression process, provide some online app-based and virtual touches to early care and early progressive management so that we can prevent these outcomes? This will be the next decade of digital healthcare, using it to manage those patients who need it the most.

Morning Headlines 3/18/20

Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency

HHS OCR will not assess penalties on providers who use non-compliant communication technologies to provide telehealth services during the COVID-19 public health emergency.

As Coronavirus Spreads, a Telemedicine Company Raises $60M

AmWell raises $60 million in equity, according to a recent SEC filing.

Medicare Telemedicine Health Care Provider Fact Sheet

CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic.

LOINC Prerelease Terms

LOINC publishes codes for COVID-19 lab testing.

News 3/18/20

Top News

HHS OCR won’t assess penalties on providers who use non-HIPAA compliant communication technologies to provide telehealth services during the COVID-19 public health emergency. This relaxation of rules applies to all healthcare services, not just those that are related to COVID-19.

Providers can use any form of personal audio or video communication, such as FaceTime, Facebook Messenger, Google Hangouts, and Skype.

Telehealth services may not be delivered via public-facing apps like Facebook Live, Twitch, and TikTok.

Reader Comments

From Convener: “Re: conference bridges. Is anyone reporting that they are giving busy signals?” The free services like the one I use – which make money by charging AT&T using a “last mile” telecommunications loophole that AT&T hates passionately – have complained that AT&T has blocked their customers from using the conferencing services following an FCC rule change. I haven’t heard anything otherwise. The demands placed on videoconferencing services for online meetings and education must be incredible, leading to rampant (but unfounded so far) speculation that they will “break the Internet,” along with heavy use of streaming video and audio by folks newly assigned to work from home. Microsoft Teams went offline for several hours on Europe’s first work-from-home day.

HIStalk Announcements and Requests

Poll respondents said they want to see more COVID-19 news and reports from the field on HIStalk. I’ll tread lightly in covering just the most important items.

I’ll add the COVID-19 items as a separate section and continue soliciting reports from the field, as on my open survey. It would be great to get provider entries that could benefit a lot of patients and healthcare workers.

I was thinking as I saw photos of under-40 folks packing bars, concerts, and beaches that perhaps they are frustratingly uninformed or irresponsible, but then I went to the dark side and pictured them convening  “boomer remover” gatherings to exploit their lower coronavirus mortality risk to extract revenge on their elders for mismanaging their economic or environmental futures. I bet Stephen King is working on that novel as we speak.

Webinars

March 25 (Wednesday) 1 ET: “Streamlining Your Surgical Workflows for Better Financial Outcomes.” Sponsor: Intelligent Medical Objects. Presenters: David Bocanegra, RN, nurse informaticist, IMO; Alex Dawson, product manager, IMO. Health systems that struggle with coordinating operating rooms and scheduling surgeries can increase their profitability with tools that allow for optimal reimbursement. This webinar will identify practices to optimize OR workflows and provider reimbursement, discuss how changes to perioperative management of procedures can support increased profitability, and explore factors that can impede perioperative workflow practices.

March 26 (Thursday) 12:30 ET. “How to Use Automation to Reduce ‘My EHR is Slow’ Complaints.” Sponsor: Goliath Technologies. A common challenge is that a clinician is ready to work, but their technology is not. EHRs can be slow, logins not working, or printers and scanners are offline. Troubleshooting these end user tickets quickly is nearly impossible, especially in complex environments that might include Citrix or VMware Horizon. This webinar will present real-world examples of how leading health systems are using purpose-built technology with embedded automation and intelligence to proactively anticipate, troubleshoot, and prevent end user performance issue across their IT infrastructure and EHRs.

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

Acquisitions, Funding, Business, and Stock

I’m studiously avoiding watching the stock market, especially when it comes to my 401(k), but here’s how some publicly traded health IT-related stocks have performed over the past month, compared to the big market indices (at Tuesday morning’s market pre-open):

1. Teladoc (up 4%)
2. Premier (up 3%)
3. NantHealth (down 18%)
4. Vocera (down 18%)
5. Cerner (down 21%)
6. Livongo (down 26%)
7. McKesson (down 28%)
8. Nasdaq composite (down 29%)
9. S&P 500 (down 29%)
10. Dow Jones Industrial Average (down 31%) 
11. CPSI (down 32%)
12. Nuance (down 35%)
13. Inovalon (down 35%)
14. Allscripts (down 41%)
15. Health Catalyst (down 43%)
16. Castlight Health (down 44%)
17. Change Healthcare (down 45%)
18. NextGen Healthcare (down 53%)
19. Evolent Health (down 68%)

An investor’s New York Times opinion piece predicts big problems for companies that piled up debt when borrowing was cheap, with the pandemic-demolished sectors of auto, hospitality, and transportation being the worst offenders. The author also says that companies that have been taken private by private equity firms carry debt averaging six times their earnings, leading to “zombie” companies that don’t generate enough profit to pay even the interest alone.  

Announcements and Implementations

LOINC publishes codes for COVID-19 lab testing.

OptimizeRx launches a free consumer text message alert program that delivers CDC-issued COVID-19 information to any SMS-enabled device. Text VIRUS to 55150.

Collective Medical offers free use of its ADT-based collaboration network through the end of 2020 to help with COVID-19 response. Healthcare organizations can go live on its lightweight solution in less than one week without cost or obligation for the rest of the year. It offers frontline providers quick identification of high-risk patients.

Asparia develops a COVID-19 tool for Epic App Orchard that contains three elements: a chatbot appointment scheduler, a patient questionnaire that alerts staff of possible infection risk, and enhanced appointment reminders that can extend character limits to allow including enhanced education and instruction. The app won’t be listed on App Orchard for several weeks, but can be requested through Epic or Asparia.

T-System will provide free influenza and COVID-19 T Sheets to providers that include point-of-care documentation, diagnosis, and treatment tools that incorporate the latest CDC guidelines. Templates are available for ED, pediatric ED, and urgent care.

Bluetree publishes a COVID-19 resource page that includes ideas for leading remote projects, developing reporting functionality, and clinical decision support build workflow.

Healthwise creates a Coronavirus Resource Center of consumer-friendly educational information and care instructions that are free to all.

Meditech offers Expanse Ambulatory customers use of its Scheduled Virtual Visits functionality for six months at no charge.

The White House’s Office of Science and Technology Policy joins Microsoft, Chan Zuckerberg Initiative, and other groups to create a COVID-19 open research dataset of scholarly literature. The groups have issued a challenge for AI experts to develop text and data mining techniques to help scientists answer high-priority COVID-19 questions.

Government and Politics

CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic. Medicare can pay for office, hospital and other visits via telehealth, unlike previously when those visits were covered only for patients in rural areas. Payment will be the same as for in-person visits.

Hackers attack HHS’s computer network in what insiders say was an attempt to undermine the government’s response to the coronavirus pandemic. It appears to have been a distributed denial of service attacked that was quickly stopped.

COVID-19 News

England’s Imperial College COVID-19 response team self-publishes a paper whose impact is reverberating around the US and UK, with the White House getting an early look a week ago that may have influenced its 180-degree turnaround in how the pandemic is viewed and managed. The team describes two strategies for the two countries: mitigation (flattening the curve to reduce peak healthcare system demand) and suppression (reversing growth and case numbers in an indefinite program will awaiting development of a vaccine). Summary points:

• Mitigation, such as home isolation of suspected cases and social distancing of high-risk people – is not preferred. It could reduce peak healthcare demand by two-thirds and cut deaths in half, but would still result in hundreds of thousands of deaths and overwhelmed hospitals, particularly in terms of ICU beds.
• Suppression, as was practiced in China, requires social distancing of the entire population, home isolation of cases, and household quarantines, possibly supplemented with closing all schools. The practice would need to continue until a vaccine can be developed and produced in adequate quantity to treat the entire population, which could take 18 months or more. A compromise may be to regionally relax and tighten social distancing based on public surveillance case numbers.
• In the absence of any action, the computer model suggests that peak US deaths will occur in June, 81% of the population will be infected, and 2.2 million people will die (not counting those whose deaths from other causes are related to overwhelmed hospitals). ICU bed capacity will be exhausted by the second week of April and demand will peak at 30 times the available number of ICU beds.
• A strong surge is likely again in the fall, so action now is urgent.

The government of Spain temporarily nationalizes all of the country’s hospitals and private health providers.

A hospital in northern Italy whose supplier ran out of oxygen mask valves uses 3D printing to create its own. The original is on the left, the 3D printed version is on the right.

A Premier survey of 179 skilled nursing / assisted living facilities finds that two-thirds of them can’t get personal protective equipment such as masks and face shields. Distributors have addressed shortages by allowing customers to buy quantities consistent with their historic usage to prevent hoarding, but many senior living facilities have never needed any until now and thus can’t get any.

Positive news:

• Scientists across the world are anecdotally reporting preliminary, sporadic success in treating COVID-19 with old drugs that were developed for something else. That’s a common story in pharma, and while individual patient impact may be limited, such treatment carries minimal risk and – like the HIV/AIDS fight in the 1980s and cancer today – provides encouragement that progress can be made even in the absence of guaranteed prevention or a complete cure.
• Regeneron says it plans to start widespread testing of an antibody treatment by summer. Former FDA Commissioner Scott Gottlieb, MD urges a “Manhattan-style project” to accelerate the rollout of this and similar antivirals that could be first used to protect healthcare workers and high-risk people.
• China and South Korea are reporting greatly diminished numbers of new cases, although their success is attributed to widespread testing and social limitation that was not done in the US.
• High-throughput testing systems are coming online in the US, with the new rate-limiting item being the supply chain for reagents and swabs.
• The US Army’s advanced medical technology group publishes a pre-solicitation notice for developing COVID-19 testing technology, studying repurposed drugs that could offer effective treatment, creating AI models that can track spread, and implementing patient monitoring technologies.
• Scott Gottlieb concludes, “We’ll remember spring of 2020 as a very hard time. It’ll change the way we do things, but it will end either by nature or at hand of our technology. We’ll get through this together.”

Other

I ran across the COVID-19 online screening tool of Medical City Healthcare (TX), which offers a slick questionnaire powered by Zipnosis. I intentionally answered just enough questions positively to make my diagnosis uncertain, after which it offered one-click access to a free online virtual visit for screening. Medical City Virtual Care offers visits for minor conditions such as pink eye, lower back pain, diarrhea, and yeast infection for $45. I saw it from the consumer’s point of view and was impressed.

Nashville-based Center for Medical Interoperability was awarded a $3 million grant from the CDC last year to extract EHR information from hospitals that would allow CDC to monitor the inventory and demand for personal protective equipment, but hospitals haven’t been willing participants. According to Melanie Thomas, CIO of pilot site Nashville General Hospital, “It’s difficult and scary sometimes to share data and equipment, especially with your competitors, because you want to have the advantage.” She says it’s easier for her taxpayer-funded hospital to share information because they don’t have the money to stockpile masks and gowns anyway. CDC has added $600,000 to the project’s funding and is hoping for an accelerated go-live schedule starting in May, with participation optional.

Cerner announces the actions it is taking in response to COVID-19, including creation of a client update web page:

• Employees who jobs allow them to work from home are asked to do so from March 16-30, with extensions possible.
• Offices will remain open for employees who need to be physically present, but social distancing strategies will be implemented.
• No non-critical and international travel is allowed.
• Employees who are returning from high-risk locations or cruises are required to work from home for two weeks.
• Critical travel will continue for clients who want Cerner people on site, but higher-risk employees (over 60, immunocompromised, those with chronic conditions, and those exposed to high-risk others) have been asked to avoid travel.
• A COVID-19 update has been pushed to Millennium clients, while Soarian clients already have strong communicable disease screening tools.
• Ready-to-use, staffed telehealth services will be offered to clients via Amwell.

The local paper profiles Sentara Healthcare professional development specialist Heike Nicks, MSN, RN, who worked with IT and nursing employees to automate the process of screening newborns for inherited disease, including sending blood samples to the state lab and getting results back within five days. She got the idea from a commercial product, but Sentara ended up enhancing its EHR to collect the needed information and to process secure messages.

Newport, OR’s police department urges residents to stop calling 911 when they run out of toilet paper. The department added a lengthy, humorous list of alternatives.

Sponsor Updates

• Integration technology vendor Summit Healthcare partners with data management vendor BridgeHead Software to offer healthcare data extraction and consolidation services.
• The Jacksonville Business Journal profiles The HCI Group’s hiring and expansion plans.
• KLAS recognizes Imprivata as one of the 2019 “Revenue Cycle Unicorns” in its latest performance report.
• Omni-HealthData parent company Information Builders embraces FHIR to harness and harmonize data across healthcare systems.
• OptimizeRx offers a free interactive text message alert program that delivers COVID-19 information issued by the CDC.
• Netsmart postpones its Connections 2020 event originally scheduled for March 29-April 1 in Denver.
• Avaya offers complimentary work-from-anywhere contact center solutions to help address COVID-19 challenges.
• CompuGroup Medical offers its CGM ELVI Telemedicine service for free to medical providers.

Blog Posts

• Brown Clinic: Community Values With Leading-Edge Technology (EClinicalWorks)
• A Wishlist for ERP Software Improvement in the Next Decade (Optimum Healthcare IT)
• Making a rapid shift to online training (Nordic)
• How to Build a Business Case for ESignature in Registration (Access)
• 5 Ways to Unleash Your Practice’s Full Potential (AdvancedMD)
• CMS Interoperability and Patient Access Final Rule (Audacious Inquiry)
• Best practices for a remote worker strategy (Avaya)
• COVID-19 & Digital Health (Bright.md)
• ONC-CMS Final Rules, Part 2 – Information Blocking (Datica)
• What is IT and Clinical Engineering Convergence? (Burwood Group)
• Patient Matching 101: Why Getting it Right is Critical (ChartLogic)
• Health IT Crisis and Disaster Planning Recommendations for COVID-19 (CereCore)
• InfoSec Pros Should Do These 8 Things During the Coronavirus Outbreak (CI Security)
• Elevating the Patient Journey Through Innovative Solutions (CoverMyMeds)
• Cash Posting: No Longer a Data Entry Role (Culbert Healthcare Solutions)
• ONC & CMS Interoperability Regulations: Part 1 – Payer Impact (Diameter Health)
• How Data Visualization Can Help During the Coronavirus Pandemic (Dimensional Insight)
• Hospitals Shift to Digital Engagement in Response to Coronavirus (Dina)
• Preventing Medical Errors with Patient Monitoring and Integrated Device Data (Capsule)

Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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