News 4/8/20

Top News

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

People

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

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

Announcements and Implementations

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

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

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

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

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

COVID-19

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

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

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

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

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

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

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

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

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

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

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

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

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

Other

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 4/7/20

VA pauses work on EHR during coronavirus

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

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

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

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

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

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

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

Curbside Consult with Dr. Jayne 4/6/20

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Readers Write: Strained but Secure

Strained But Secure
By Troy Young

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 4/6/20

New York is merging all its hospitals to battle the coronavirus

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

CDC Unveils 1st National Coronavirus Pandemic Tracking System

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

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

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

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

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

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

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

Monday Morning Update 4/6/20

Top News

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

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

Reader Comments

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

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Announcements and Implementations

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

COVID-19

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

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

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

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

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

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

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

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

Other

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Weekender 4/3/20

Weekly News Recap

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

Best Reader Comments

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

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

In Case You Missed It

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

Get Involved

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

Morning Headlines 4/3/20

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

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

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

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

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

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

FCC Adopts $200 Million COVID-19 Telehealth Program

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

News 4/3/20

Top News

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

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

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

Reader Comments

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

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

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

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

People

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

Announcements and Implementations

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

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

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

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

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

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

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

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

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

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

Government and Politics

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

The CDC seeks a new chief data officer.

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

Privacy and Security

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

COVID-19

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

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

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

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

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

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

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

Other

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 4/2/20

Monday was Doctors’ Day. I had pretty much forgotten until I looked in my non-work email account and saw this greeting from Cerner. Specifically, it was from their Jamboree Team that supported us at the World Scout Jamboree last summer in West Virginia. It was a nice reminder of better times, when I was able to watch 40,000 people from around the world work together and get to know each other.

Our current situation is a reminder of just how global we really are. Since that Cerner team is used to supporting an international clientele, I wonder if any of them will be deployed to support the Cerner Millennium implementation at London’s 4,000-bed Nightingale Hospital?

This is going to be a rough year (or two) for doctors. I’m glad to see that professional organizations are stepping up. Whether it’s statements about the rights of healthcare providers to wear their own personal protective equipment if their employers cannot provide it or extensions for continuing education requirements, it’s appreciated. I have several friends in private practice who have taken out personal lines of credit to try to pay their staff members and who are forgoing their own salaries indefinitely. I suspect this might be the death knell for many independent practices, depending on how solvent they were prior to the crisis.

Vice President Mike Pence sent a letter to hospital administrators this week requesting that they report data in connection with coronavirus testing along with data on bed capacity. The data is to be reported in a de-identified fashion to ensure patient privacy. In a nod to 1990, all data is to be reported based on a spreadsheet, which is due every day at 5 p.m. ET for the period ending the previous midnight. Hospitals will be submitting this critical data to a FEMA email address. Since everyone likes a redundant process, hospitals must also report daily data to the National Healthcare Safety Network’s COVID-19 module, which went live March 27.

Unbelievable, but in cybersecurity news, hackers have targeted the World Health Organization in the midst of this crisis. Tactics include creating a fake website that poses as a WHO email login portal to try to obtain passwords. Hackers had previously tried to spoof the WHO in an attempt to get money and private details from unsuspecting users. I hope what goes around comes around for these scoundrels.

A great piece in Kaiser Health News last week illustrates what it’s really like to be in an ambulatory setting and trying to confront COVID-19. This mimics what I’m hearing across the country. Although some organizations have stopped routine visits, others are forging ahead at full speed. Practices that can are pushing telehealth, but safety net organizations and others that are unable to limit in-person visits are having to rapidly redesign processes.

There are challenges in making sure exam rooms are clean in between patients. My own practice had to do an air handling study to figure out how long it would take to circulate the air out of our largest exam rooms should a high-risk patient be treated in them.

Many practices are doing “at the door” screening and triage, which often takes the form of a clipboard. Others are turning to novel solutions using chatbots and algorithm-based screeners.

Although adaptations are being made for telehealth payments, the article notes that some states are slow to get to speed with transitioning their Medicaid programs to a new payment model. It also notes the phenomenon of patients who “misrepresented their COVID-19 risks in order to get past screening.” We’re experiencing that in our environment as well, with patients desperate to be seen. Unfortunately, we have little to offer those we genuinely suspect of having the illness since care is largely supportive. Patients have latched onto media coverage of unapproved drugs and are requesting them. I’d love to be able to put a sign on the door that says simply, “No, you cannot have a Z-pack.”

From Other Duties as Assigned: “Re: from the front lines. I spent two shifts this week as a screener for all employees, clinicians, patients, family, and vendors. I’m usually a tech guy. It was a bit harrowing. In my state, we are hard pressed to maintain our PPE supplies and are repurposing surgical units to COVID. Our revenue will drop by 40% if this continues up the curve.” The writer wanted to remain anonymous, which is not difficult since this scenario is playing out at hospitals across the country. Kudos for stepping out of your comfort zone and giving it your all. Fighting this pandemic is definitely a team sport, whether you are supporting interfaces or enforcing the use of hand sanitizer at the door.

Lots of companies are throwing out cool COVID-related dashboards, showing various things such as hospital bed capacity (Definitive Healthcare) and effectiveness at social distancing (Unacast). Some of them are pretty fascinating, but it’s easy to go down the rabbit hole of interesting data and fail to do actual work. I’m limiting my COVID-related web surfing in an effort to actually remain productive.

I’m normally not a huge fan of Eric Topol, but I did enjoy his recent piece on how the “US Betrays Healthcare Workers in Coronavirus Disaster.” I think “betrayal” is the word that many healthcare workers are feeling right now, whether you’re a physician, nurse, therapist, tech, dietary worker, housekeeper, facilities engineer, security staffer, transporter, phlebotomist, or just about any role in the healthcare ecosystem. Many of us have spent our careers in service to others, but are having difficulty coping with the fact that when the going gets tough, our employers abandon us with salary cuts and furloughs. Their ultra-lean “just in time” inventories have left millions of workers without the basic protections of a safe workplace as defined by the Occupational Safety and Health Administration.

My clinical employer is still working hard to get us PPE, but it’s an uphill battle. A shipment of 500 gowns doesn’t do much for an organization that executes over 1,500 patient visits a day. We still don’t have company-supplied N95 masks, but we do have lab goggles for everyone. I’m eternally grateful to friends and family that dug through their basements or hit stores that were rumored to have legitimate masks, because I’m now covered with a set of masks I can rotate as I work. We’ll see how they hold up since they’re supposed to be single use and I’ll be wearing them up to 14 hours a day, but at least I have them, and the generosity of my support system allowed me to provide a few to colleagues as well.

Tonight’s dinner table conversation included such topics as “remember when we used to go out to eat” and “who wants to call the elders to make sure they’re actually at home,” along with something from a college math class that I’m sure I knew once upon a time. I’ve mostly adapted from my lack of travel, although the occasional tiny bottle of hotel shampoo brightens my mood. I have thousands of dollars in airline credits just waiting until the skies are safe again, so I’m making my post-2020 bucket list.

A friend sent me this photo, allegedly from a restaurant in Ohio. I’m not sure what all is going on with this concoction, but I do want to experience it in the future. If you know where I can find it, leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/2/20

MHS Genesis deployment suspended amid COVID-19 pandemic

The DoD presses pause on its roll out of MHS Genesis to better enable its care teams to focus on treating COVID-19 patients.

Exclusive: HCA subsidiary lays off dozens of contractors

Health IT consulting firm CereCore lays off dozens of employees contracted to work for parent company HCA Healthcare.

Microsoft helps Swedish Health Services develop COVID-19 app to track hospital resources

Microsoft and Swedish Health Services (WA) develop an app to help staff track COVID-19 patients, and hospital capacity and supplies.

eConsult solution company AristaMD secures $18 million in Series B funding

AristaMD will use $18 million in new funding to further develop and scale use of its e-consult and referral software for primary care physicians.

Morning Headlines 4/1/20

Cerner Millennium EHR to be used at London’s 4000-bed temporary hospital

London’s 4,000-bed Nightingale Hospital, a COVID-19 emergency treatment facility created inside a convention center, will run Cerner Millennium.

Calling all COVID-19 Health IT Projects

ONC updates its Interoperability Proving Ground, making it easier to find projects already underway that are using health IT to address the pandemic.

Olive Raises $51M to Accelerate its AI Workforce for Healthcare

Healthcare workflow automation company Olive raises $51 million in a funding round led by General Catalyst.

News 4/1/20

Top News

CMS issues coronavirus waivers and rules:

• Physicians can bill for telehealth visits at the same rate as in-person visits.
• Hospitals can bill for services that are performed outside their four walls, such as directing patients via telehealth to offsite screening locations.
• CMS will pay for 80 additional services when provided via telehealth.
• Hospitals can hire local clinicians.
• Hospital physician assistants and nurse practitioners can practice without physician supervision as permitted by state law.
• CRNA’s can work without being supervised by a physician.
• Hospitals are allowed to provide personal services for medical staff, such as meals or laundry service, while they are working at the hospital.
• Supervision of medical residents can be performed virtually.
• Medicare will pay for respiratory equipment for any medical reason.
• Hospitals will not be required to create written visitation policies for COVID-19 patients.
• The time in which hospitals must give patients a copy of their medical record is increased.
• Hospitals can triage patients in state-approved community settings in a “hospitals without walls” model, such as ambulatory surgery centers, hotels, and dormitories.
• Hospitals can contract with ASCs to provide essential surgeries, for which Medicare will pay hospital rates.
• COVID-19 testing can be performed in homes, dedicated testing sites, and other community settings.
• Hospital EDs can perform COVID-19 tests at drive-through testing sites.
• Ambulances can transport patients to a wide range of locations when other transportation is not appropriate, such as community mental health centers, FQHCs, physician offices, urgent care facilities, and ambulatory surgery centers.
• Physician-owned hospitals can temporarily increase their number of beds, ORs, and procedure rooms.
• Hospitals can provide physician practices with medical equipment and telehealth equipment and provide childcare services for workers.

Reader Comments

From Booth Happy Hour: “Re: HIMSS. Have they responded to your recap of HIMSS21 exhibitor plans?” No, and I wouldn’t expect them to since that wasn’t the point. I did the survey only because I was getting lots of exhibitor complaint emails and I don’t know how HIMSS is communicating individually with the 1,300 of the booth renters, especially the significant percentage of them that are vocally unhappy about being told to suck up their exhibit, hotel, and travel costs for the cancelled conference and return happily for another round in HIMSS21. HIMSS is no doubt busy dealing with the aftermath of HIMSS20, running Virtual HIMSS, frantically planning for HIMSS21, and trying to save the organization. Hopefully its transparency and humility will ramp up once the dust settles. Meanwhile, my body clock can’t comprehend that it was just three weeks ago today (as I write this on Tuesday) that the HIMSS20 exhibit hall would have been opening for the first day. I just read the book “A Short Stay in Hell” as urged by Mrs. HIStalk, and while I didn’t get much out of the rather depressing tome because I prefer quality entertainment such as “Tiger King,” today’s real world seems similarly never ending.

Webinars

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

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

Announcements and Implementations

London’s 4,000-bed COVID-19 emergency treatment facility, Nightingale Hospital – created inside a convention center —  will run Cerner Millennium, extended from the implementation of Barts Health NHS Trust.

Government and Politics

CMS asks hospitals to report their COVID-19 testing data to HHS. HHS also asks hospitals to report their bed and ventilator supply and COVID-19 patient counts by emailing a manual worksheet every afternoon. The electronic gaps in our public health and surveillance reporting are startling.

COVID-19

China ships the first of many shipments of COVID-19 emergency medical supplies to the US – 12 million gloves, 130,000 N95 masks, and huge numbers of masks, gowns, hand sanitizer units, and thermometers. An additional 22 flights are scheduled over the next two weeks. The government is paying for the flights, but a distributor is paying for its contents, 60% of which will be sold to the federal government and the rest to the distributor’s own private customers. We were sending respirator masks and protective suits to China just two months ago, so maybe we’re buying some of our own stuff back.

New Yorkers crowd together in defiance of public gathering regulations to get their flag-waving selfies with USNS Comfort, missing the irony that their irresponsible actions might land them or someone else a coveted COVID-19 respirator spot.

European Union countries struggle to develop virus-tracking apps that do not infringe on personal rights or GDPR, noting the apparent success in Singapore and South Korea of using phone-based digital tracking of those who are infected. Poland is tracking people who are under home quarantine via an app, while Germany’s health minister demands a national debate on the ethics of using cell phone tracking technology.

Google opens free access to several public COVID-19 datasets to researchers, accessible from its Google Cloud Console and its BigQuery ML.

Experts warn that the US’s fragmented health system will create financial hardship for patients who are tested for COVID-19, especially since it’s early in the insurance deductible year. Insurers have agreed to waive co-pays for the test itself, but visits to the ED to have the test performed, surprise bills from out-of-network EDs and contracted ED doctors will increase, and surprise billing protections were excluded from the federal government’s coronavirus bill after lobbyists for hospitals and physician staffing firms played “the COVID card.”

Nursing homes are refusing to accept hospital patients until they test negatively for coronavirus, a practice that frustrates hospitals that are anxious to free up beds. Hospitals say it takes days to test patients who were not suspected of having COVID-19 even when tests are available, but nursing homes don’t usually have separate isolation areas and worry about fatality rates of up to 50% once coronavirus starts spreading inside their walls.

Salesforce CEO Mark Benioff lays out his plan for combatting COVID-19. Few of his items are being discussed by the actual people in charge.

Other

Intermountain Healthcare cuts the pay of physicians, nurse practitioners, and physician assistants due to “changing needs created by COVID-19.”

The New York Post reports that while frontline workers at Mount Sinai Health System are forced to beg for protective gear and wear garbage bags in its absence, CEO Kenneth Davis, MD was working from home in his six-bedroom, eight-bathroom Miami waterfront mansion, having been there since early March and advised to stay there by his doctor to avoid coronavirus exposure. He chose the $3.4 million Florida home over his $2 million one in Long Island and the $7 million one he owns in Aspen. Davis made over $12 million in 2017 and $6 million in 2018. Meanwhile, the hospital’s health network president is also in Florida, working from his oceanfront condo. I understand that much of what these guys do can be virtual, but somehow I expect more them given that they are both (a) doctors; and (b) health system leaders. Not to mention highly paid compared to the troops they’re sending into battle short on weapons against an enemy that targets not just themselves, but their familes.

University Medical Center (TX) suspends an anesthesiologist who wore a respirator face mask in the hospital hallway as he was leaving an emergency intubation. The chief of anesthesia texted him: “UR WEARING IT DOWN A PUBLIC HALL. THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART. MAYBE LESS.” (the all-caps styling and insistence on calling it “Wuhan virus” isn’t encouraging). Meanwhile, an anesthesiologist at Seattle hospital was also threatened with firing for wearing a surgical mask in the hall. Other hospitals have taken the opposite approach in requiring all caregivers to wear a mask in all hospital spaces. You would think that non-clinical hospital suits could find something more useful to do than fret over trained doctors protecting themselves in whatever way they feel is appropriate, or barring that, just work from home and stay out of the way of people who are saving lives in between watching them end.

The Department of Defense orders all medical and dental facilities to postpone elective procedures for 60 days.

Hospitals in New Zealand will use 1000minds “knowledge codification” software – which scores patients to decide which of them get surgery – to guide ICU doctors in choosing which COVID-19 patients get an ICU bed. The software’s non-healthcare uses include businesses evaluating potential new products, shortlisting RFPs, selecting students for admission or scholarships, picking an engagement ring, evaluating job candidates, and choosing “best actress” type arts awards.

The home of an Arkansas family practice medical resident who is separated from his wife and one-year-old as he treats COVID-19 patients is destroyed by a tornado. A friend started a GoFundMe with a goal of $2,500 that has raised $108,000 so far. The photo above was of Jared Burks, MD watching his son crawl for the first time as he came home after a two-week stretch, right before his home was destroyed while he was inside. Maybe those Mount Sinai executives can loan him one of their mansions.

This is the cover of the current issue of The New Yorker.

Sponsor Updates

• Arcadia helps to form the COVID-19 Healthcare Coalition.
• Avaya expands free offers for work-from-anywhere apps to help businesses respond to the COVID-19 pandemic and protect employee health.
• Bright.md adds B Capital General Partner Karen Page to its board.
• Nordic offers free best practices and suggestions as responses to healthcare organization questions in its Ask Nordic service.
• Meditech offers free, six-month access to its Scheduled Virtual Visits functionality to its patient portal customers.
• Datica releases a new podcast, “ONC Final Rules on Information Blocking – Part 1.”
• CI Security makes available a work-from-home security assessment.
• CompuGroup Medical offers free telemedicine software to members of the Arizona Medical Association.

Blog Posts

• The Vital Role that HIEs can Play in Disease Control and Outbreak Management (314e)
• EHR Patient Reporting Module to Help Combat COVID-19 (AdvancedMD)
• Avaya Cloud Office is Here, and Your Workplace Will Never be the Same (Avaya)
• The Interoperability and Patient Access Final Rule: The Importance of PACs (CarePort)
• ONC & CMS Interoperability Regulations: Part 4 – Clinicians and Caregivers (Diameter Health)
• Going remote: Creative solutions to keep projects moving (Nordic)
• Health IT Support: Making the Shift to Remote Management (CereCore)
• Leveraging Technology Against COVID-19 in the Pacific Northwest (Collective Medical)
• CoverMyMeds’ Affinity Council Fosters an Environment of Inclusion (CoverMyMeds)
• Should I Still Be Interviewing During the Coronavirus Pandemic? (Direct Recruiters)
• The Growth of Telehealth and How Analytics Can Support It (Dimensional Insight)
• 6 Ways to Build a Medicare Advantage Partnership (Dina)

Contacts

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

Morning Headlines 3/31/20

Trump Administration Engages America’s Hospitals in Unprecedented Data Sharing

To better allocate federal resources to areas in need, CMS asks hospitals to share COVID-19 testing data with HHS, and bed capacity and supply data with the CDC.

Supply chain companies to launch healthcare industry exchange

Supply chain tech company Resilinc will work with Stanford Health and Premier to launch a Web-based supply exchange that will match hospitals in need of COVID-19 equipment with manufacturers and donors.

New COVID-19 Preparedness App Fills Interoperability Gaps For Surge Preparedness

Epic and OCHIN develop an app for the Washington State Health Care Authority that enables healthcare workers, volunteers, and patients to perform COVID-19 screenings and find local emergency care.

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

CMS expands telemedicine coverage to 80 additional services and will now reimburse physicians for virtual visits at the same rate as in-person visits.

Curbside Consult with Dr. Jayne 3/30/20

I’m still getting tone-deaf emails from HIMSS touting the value of Virtual HIMSS. They are also pitching a white paper that I can download to “understand in real time how your patients experience every interaction along the continuum of care; make patient feedback quick, meaningful, and actionable; and protect and improve your market share.” Honestly, with what is coming, I don’t think health systems are worried about protecting their market share. They are either knee-deep in COVID-19 or trying to prepare for it.

The hospitals in my area are busy giving very carefully worded interviews to the press about their stock of personal protective equipment. They usually go like this: “As of today, March 29, we have enough.” Reports from friends who work at those facilities are pretty bleak and we’re not even in a hot zone.

I also heard report that HIMSS isn’t wasting any time invoicing corporate members for their annual renewals, which has to sting for vendors who recently ponied up a good chunk of change to exhibit at a conference that didn’t happen.

I tend to skewer many different parts of the industry, so I don’t want to miss the opportunity to highlight physicians who are behaving badly. States are coping with a burst of prescriptions for drugs that are being used to combat coronavirus, often being written by physicians for themselves or their families. In response, states are requiring physicians to include a diagnosis code on every prescription for the suspect drugs, one of which is azithromycin.

Although including a diagnosis code on prescriptions is a best practice for medication safety, the reality is that many physicians don’t do this unless their EHR is set to require it. Those physicians just going about their business treating strep throat in penicillin-allergic patients are getting pharmacy callbacks, which clogs up the system. Some organizations have flipped the switch to require a diagnosis code for all prescriptions, which is making everyone unhappy.

Bottom line, folks: prescribing unproven drugs for your family in a situation like this one is unethical. If you are doing it, shame on you.

On the positive side, AMIA has announced that its Clinical Informatics Conference scheduled for May 19-21 will now be virtual. The CIC is a must-attend conference for many clinical informaticists who are in the trenches with hospitals and health systems versus being in academic settings. In addition to occurring on its scheduled dates, organizers will share the content with registrants using a learning platform. The CIC has grown tremendously since its inception, roughly doubling in size every two years. I wish AMIA the best in trying to make this new format happen.

Recently my clinical practice has hit a lull as we wait for the surge of coronavirus patients to hit. I’ve gone from delivering medically focused care to delivering care with a more psychological focus. A good number of patients in both my in-person and telehealth practices just want advice and aren’t able to get it from their primary physicians, or don’t have primary physicians to reach out to.

I’m also giving a fair amount of public health advice both in my practice and on various Facebook groups and community forums. Medical misinformation abounds these days, and people are coping with requests to stay at home with some unhealthy behaviors.

Our local high school had to recently close its athletic fields because one of the club football teams called a practice despite a stay-at-home order being in place. Parents drove their middle school children to participate in contact football, which baffles me. Other people are getting together in groups to have social distance tailgating parties, where the six feet of social distancing is just an illusion. Another group of moms got together and backed their minivans up facing each other, then crawled into the back end and drank Starbucks. People are asking me what I think about these practices, and sometimes I struggle to find the right response.

We live in the most connected time in human history. The technology to bring people together while they are apart is amazing. Most of us in the US have ready access to free video calling, conference calls, unlimited long distance, and more. However, people are struggling to feel “close” to people unless they are within a certain physical proximity. Have we lost the ability to have relationships with people unless we are literally face-to-face with them?

Some of my best friends live across the country and around the world, but I can “talk” to them within moments through texting or online messaging. They are literally at my fingertips through the magic of the cell phone. For those people who psychologically must have face-to-face contact, I’m recommending they do it with a single friend and from a distance, rather than mimicking one of the group distancing solutions I’m seeing.

People who are getting together in these groups are missing part of the point about healthcare providers wanting or needing them to stay home. When you’re on the road, you put yourself at risk for accidents, which puts first responders at risk, and possibly healthcare providers. It also puts you at risk – you can give the virus to them, and they can give it to you, since many of us don’t have adequate personal protective equipment.

It’s one thing to go out to get essentials. It’s another thing to go meet up with friends because you’re bored. I strongly encourage people to rethink what they’re doing, especially if they’re under a stay-at-home or shelter-in-place order.

For those of you who might be struggling with this, I have some tips to share from retired NASA astronaut Scott Kelly. As someone who spent her formative years wanting to be an astronaut (specifically, the first doctor in space, but I didn’t quite hit the mark), I have tremendous respect for those who journey to the ultimate frontier. As he says in the piece, “Flying in space is probably the only job you absolutely cannot quit.” Some highlights from his recommendations: follow a schedule, but pace yourself; go outside (safely and prudently); find a hobby; keep a journal; listen to experts; and take time to connect.

As an anonymous blogger, the last one is important to me. I correspond frequently with a few regular readers, and it’s good to have kindred spirits. If you’re not sure who to reach out to, check on a neighbor, reach out to an elderly person in your religious organization, or consider reaching out to someone from work who you typically see in passing but don’t get to talk to regularly. We can all make new connections as well as our existing ones, and you might just find yourself brightening someone’s day in this challenging time.

Those of you who have been reading my work for a while know I’m an avid baker, and one of my favorite prescriptions is for pastry therapy. I didn’t write myself a script for a Z-pack to fight coronavirus, but I did treat myself to a new cast iron skillet complete with Rosie the Riveter. She reminds me that we can do this, and like our parents and grandparents during major world upheavals, it’s going to take all of us to get this done. Thank you to my friends at Lodge for keeping the foundry going and the online orders shipping.

To the rest of you, I leave you with tonight’s pastry therapy offering: the Chocolate Chip Skillet Cookie. I promise it bakes up much better in the 10-inch Rosie the Riveter skillet than it ever did in my trusty 12-inch one. Bon appetit!

Email Dr. Jayne.

HIStalk Interviews Ed Marx, Chief Digital Officer, The HCI Group

Ed Marx, MS is chief digital officer of The HCI Group of Jacksonville, FL.

Tell me about yourself and your job.

I started my health career at age 16 as a janitor in a healthcare facility. Since that day, I knew my purpose in life was in healthcare. I didn’t know how it would manifest itself. Certainly not as a chief digital officer for a major global organization.

What does a chief digital officer do?

My objective is twofold. One is to make sure that we as an organization digitally transform ourselves. I always say that you have to eat your own dog food. If we are going to consult or sell or whatever to customers around the world, we had better be able to use ourselves as the number one use case.

Second is to take those same learnings and teach people how to leverage technology in order to see digital transformation in whatever their specific objectives are. It runs the gamut. 

What is digital? I can give you the formal definition as I see it, but really it’s a natural evolution of technology, but centered around experience. Helping organizations achieve that and to continue their evolution to enable the organization’s objectives.

What organizations are doing digital transformation well in healthcare?

I give credit to everyone who is doing anything, because at least they are moving the needle. I’m going to answer your question specifically with a couple of the obvious ones, but in addition to that, a lot of small hospital systems are doing good things.

We always highlight the bigger ones that have more resources. Certainly you talk about the Mayo Clinic and Cleveland Clinic. They have done a lot for a long time to continue that evolution, and now revolution, of technology enablement. Those are a couple of organizations that are doing a really nice job.

The impetus of the situation that we are in today is only going to help everyone accelerate that journey. That journey has been slow, especially compared to other industries. But we have an opportunity to catch up and see the fruition of all of that technology can do to enable superior clinical care.

Are health systems looking at new entrants like Walmart, Amazon, and Walgreens that have created new consumer experiences and just throwing up their hands and say they can’t match them, or are they choosing specific aspects they can implement?

We have new entrants because those companies are looking to continue to grow their margin. They look at the percentage of GDP that healthcare makes up and think it’s an area that they should focus on.

But a second reason, which maybe never should have happened, is that few of us were leveraging digital transformation and changing the whole experience. You’ve seen that in other industries. People get upset when you compare healthcare to other industries and I know healthcare is different, but from a technology point of view, you saw disintermediation of multiple industries by new entrants who said, we’re going to be more about the experience. We’re going to use automation and “digital,” quote unquote. We can do it at a lower cost point. Those sorts of things.

Whether it’s big tech or it’s retail, they are seeing the same thing. Not only is there a huge opportunity in terms of what the spend is, but in healthcare, we haven’t done it necessarily the best way because we weren’t forced to. Now we have globalism, consumerism, and retail giants who are all focused about the experience of big tech. That’s why we’ve seen this happen.

We need to learn quickly. What is the secret sauce that a retail giant might bring in terms of the experience? That’s really it. I keep using the word “experience,” but it’s really a focus on the experience. Then enabling all the technologies that they are using on a day-to-day basis to make their life easier. That’s what we need to learn. 

In some cases, we need to partner and we should partner. Sometimes it’s better to partner and do good things in the world than to sit back and watch your business be disintermediated.

Sometimes it’s better to be second in learning from the mistakes made by whoever got there first. Will we see organizations leapfrogging that first generation of consumerism?

That is happening with some forward-thinking hospitals and health systems. They are taking the time to analyze what’s going on in retail, how they created those new, enhanced experiences, and taking some of those learnings. We’re seeing that now. I’ve heard of many health systems that are working on their basic patient portal, and you know those aren’t about the experience. It’s a good start, but again, years behind what other industries have been doing.

Some forward-thinking hospitals and healthcare systems are keeping that as the foundational base because of all the integration it has. They they are building layers on top of it that get all about the experience. So I do think you can …  I don’t know if it’s actually leapfrogging, but at least keeping pace.

The leapfrogging might happen in partnerships. It will be hard for a healthcare organization to compete with the capital and innovation mindsets that some of these outside entrants bring, whether it’s retail or big tech. I would see it very challenging for a healthcare organization, especially an average healthcare organization, to bring together the mindshare and the capability to leapfrog, but I think you could leapfrog if you selected a good partner.

How will the coronavirus pandemic and the economic shock that accompanies it affect healthcare’s digital transformation?

I’m thinking two or three things, and I’ve thought quite a bit about this in the last several days. One is that it’s going to be the pure acceleration of everything we’ve been trying to do, the whole virtual care continuum. I came from a leading organization and 1% of our outpatient visits were virtual, with a goal of getting to 50% in four years. I haven’t checked back, but I bet they are pretty close to 50% now. 

Part of that stack, too, is healthcare at home. This was another thing that I put out there, that 25% of inpatient visits will be at home in the next four years. I get the feeling we’re going to get there much quicker.

Those are two examples. I think those are permanent. I don’t think that after this, we’re going back.

Another is a new way of work. I’ve been a big proponent of working from home as a way of work for 10 years. We’re not going to go back. There is no reason, ever, to travel to go use a computer. I’m sure some companies and hospitals will disappoint me, but those days are gone. That will do tremendous things for healthcare in terms of taking out costs.

These concepts of virtual care and a new way of work will come together to change everything. Why would you ever want to go and sit in a waiting room? Those two changes are going to be permanent.

How will the possible new emphasis on public health change the health IT discussion with regard to interoperability, analytics, and aggregating patient data?

I’m less optimistic on that one. I hope this brings our country together to be more serious and more intentional on public health. It took this crisis, this terrible situation, to make it happen. You bring all these smart people together and the resources that everyone has with public-private and we can do amazing things. We should have done it a long time ago.

I’m hoping that this is a catalyst that changes our public health for good. That we become a more healthy country, that people take wellness more seriously and more personally, and that our country is able to be predictive and preventative at the same time so that nothing like this could ever occur again.

Do you have any final thoughts?

I hope that my fellow CIOs and chief digital officers continue to lead the trajectory that we are on. I’ve always been critical of myself and my peers in terms of why we lag behind other industries. Now, because we’ve been given clarity, focus, and budget, I’m hearing from a lot of my colleagues about all the awesome things they are setting into motion now. May it always continue. May we take that leadership mantle and not tarnish it, but brighten it for the good of our patients and the communities that we serve.

Morning Headlines 3/30/20

Apple announces COVID-19 website and app in partnership with CDC and the White House

Apple develops a COVID-19 screening website and app that it developed in a partnership with the CDC, the White House’s coronavirus task force, and FEMA.

Bright.md Raises $8 Million Series C Round to Bring Critical, Asynchronous Virtual Care to Health Care Systems and Their Patients

Bright.md raises $8 million in a Series C funding round, increasing its total to $20.5 million.

Conference Cancelled

Medical Users Software Exchange cancels its 2020 MUSE Inspire Conference that was scheduled for May 26-29 at Maryland’s Gaylord National Resort & Conference Center.

COVID-19 Community Based Testing Guide

Verily’s Project Baseline issues a guidebook for running COVID-19 community-based testing sites under the a federally supported, state-directed program.