HIStalk Interviews Krishna Kurapati, CEO, QliqSoft

Krishna Kurapati, MS is founder and CEO of QliqSoft of Dallas, TX.

Tell me about yourself and the company.

I’m the founder and CEO of QliqSoft. We’ve been in business for eight years. I have been tech entrepreneur for over 20 years. I started a couple of companies that were successful, one in communications and the other in security. That’s where I found the epiphany of having a secure communications company in healthcare.

How has demand for your virtual visit solution changed in the last few weeks?

Coronavirus stopped the healthcare system and its providers from seeing the patient in a personal, face-to-face setting. That has driven everybody to find ways to address that problem.

We had a simple solution that allowed quickly onboarding patients. The challenge in telehealth is always adoption by patients. The providers have the tools, but patients don’t want to download an app or get to a desktop. A key healthcare requirement with COVID-19 is ease of use, and providers were looking for a simple solution that allows them to reach their patients effectively. That’s one reason that tools like ours quickly sprung up and got lot of traction in the marketplace with providers.

From the demand point of view, we have never seen such a huge uptick in the use of telehealth. One health system is delivering 10,000 to 20,000 video visits in one day. That is unheard of. It used to take  a year or more for somebody to do that kind of volume, and how they’re doing it in one day. Some of our customers used 365 days’ worth of video minutes in just one week. There is a huge demand. There’s a bunch of solutions, but we offer something simple for providers to reach patients.

What factors distinguish one virtual visit solution from another?

Everybody is going virtual. The time to onboard and train is important. How fast can you onboard a clinic, practice, or health system? Then, how can they customize it to meet their needs?

A small practice and a large practice have different requirements. A dermatologist has different needs than an internist. They all want to get on board faster, but they also have specific requirements.

Traditional telehealth solutions have been built around monolithic, large implementation needs, and those do not help in rapid fashion. We built, with our Quincy chatbot and Quincy video visits platform, fast tools that let you onboard a provider, bring them up on video visits, and customize it to meet their needs. The solution needs to be easy for the patient, but it also must allow getting providers online and using the tool quickly.

Has the pandemic changed the long-term strategy of health systems that were using third-party telehealth services before, but now are offering virtual visits with their own providers?

Face-to-face visits will not go away after COVID-19. The need to see a patient face-to-face and give them advice will come back in a big way. But providers will offer services such as follow-ups, post-op visits, and other ancillary services virtually, along with services that have traditionally been offered by all-in-one telehealth solutions. As a patient, you trust the provider you know and who treats you. That has been a big problem with the all-in-one solutions all along. That option was OK, but not great.

When you have traditional providers offering the same solution, the patient gets better access to healthcare from wherever they are. They don’t have to leave the workplace. They don’t have to travel 50 miles from a rural area.

COVID-19, if you see a silver lining, has shocked the industry to go all in and see what the experience is. Some providers may hate it now, but I’ve talked to several of them, my customers and my friends, now that they are using the solution. Some wonder why they weren’t doing it before, saving time for themselves and the patient. Even some specialists, like orthopedic surgeons, are using it for post-follow-ups in a way that they were never using it.

The industry has shifted overnight in being forced to use it, but in turn, there’s a lot of lessons and a lot of best practices. The new way of doing business is not going to change.

How are health systems using chatbots?

Healthcare is good at using calls, faxes, and other technologies for inbound stuff, such as referrals or patient access. These technologies existed for a long time, and suddenly there is pressure on them. Call volumes went up. People are always on text and they know how to use it. The chatbot gave initial productivity to health systems that wanted to tackle call volume, to offload it and get people the appropriate help. The chatbot can send a form, send a survey post-visit, collect information that humans had traditionally collected, or serve in the arcane way of answering services.

Chatbots already had found their footing in traditional support and sales models in other industries. Healthcare has now found their value in this tough time when volumes are so high.

Once healthcare organizations have adopted the technology and become comfortable with the outcomes, they will next use it in places where it makes sense, such as post-op surveys, pre-op information gathering, and helping patients who are really in need. It’s the 80-20 rule — 80% of patients can be served by the chatbot.

COVID-19 has accelerated technology adoption, both for virtual visits and for using automated responses and navigating patients using chatbots.

What other technologies could see a usage uptick?

Think about physician pain points before and after COVID-19. They want to continue to serve their patients effectively and efficiently. How can they do it? What are the tools and technologies beyond the EHR?

It has to be a mix of digital and face-to-face, but beyond chatbots and virtual visits, there’s a need for other AI-based tools, such as for transcription and other technologies that can simplify the problem of EHR productivity. The timing is right, with everything becoming virtual.

Technology would go a long way toward furthering patient care if it could transcribe the physician-patient communication and immediately put a 30-page document into the EHR without the physician typing anything. The end goal should be to allow the physician to interact with the patient face-to-face without worrying about the technology.

How will the company’s direction change after we find a new normal?

Our goal is to help customers to achieve better outcomes and better efficiencies. I have been a strong believer in these two technologies for the last four to five years. Before that, it was secure messaging. We’re going to double down on our efforts to continue to serve our customers and innovate to meet their needs. A technology evolution is starting, and it will create requirements and needs that we can’t anticipate.

Think of a new product being introduced, such as the first IPhone, versus where it is today. We will see a rapid evolution of products towards the complete virtual value for healthcare. Community-wise, for a country or as a world, this will be a good outcome in the long run. If another pandemic happens, we will be prepared. These technologies will stay and evolve rapidly and we want to be part of it.

Morning Headlines 4/27/20

Cerner Provides Access to De-Identified Patient Data for COVID-19 Research and Vaccine Development

Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments.

Mark Zuckerberg: How data can aid the fight against covid-19

Facebook is offering users a coronavirus symptom survey that was created by Carnegie Mellon University, with results from 1 million users per week being sent directly to CMU for predicting disease spread and county-by-county impact.

Bankruptcies, tech-savvy doctors, and data for the greater good: The CEO of health-tech giant Epic shares her predictions for how US healthcare will change after the coronavirus

Epic CEO Judy Faulkner says customers have reported revenue declines of up to 55%; and that post-pandemic mergers, acquisitions, and layoffs are likely, especially as small providers are purchased by large health systems with greater financial reserves.

Private sector races to build virus apps to track employees

Several companies are developing potentially mandatory apps that will monitor the spread of COVID-19 in offices and workplaces.

Monday Morning Update 4/27/20

Top News

Epic CEO Judy Faulkner discusses possible post-coronavirus healthcare changes in a Business Insider interview:

• Some hospitals and medical practices will file bankruptcy, as she notes that Epic customers have reported revenue declines of up to 55%.
• Mergers, acquisitions, and layoffs are likely, especially as small providers are purchased by large health systems that have greater financial reserves.
• Video visits and at-home monitoring are here to stay.
• Public health surveillance and the associated standardized data requirements will be a focus.

Meanwhile, Epic offers customers COVID-related applications with no charge for licenses, implementation, and support during the pandemic:

• Bugsy Infection Control for infection tracing.
• MyChart Bedside for communicating with isolated patients.
• Remote Monitoring.
• Secure Chat.
• Transfer Center.
• Willow Inventory for tracking PPE.
• Rover for handheld nurse charting.
• Nurse Triage.
• MyChart, with no per-patient cost for new sign-ups.

HIStalk Announcements and Requests

Poll respondents didn’t express a lot of positive thoughts about HIMSS, with transparency, value, and humility being the attributes they chose least often. I’m guessing that much of the ill will was caused by vendors and registrants who lost money from HIMSS20 refund decisions, but I also speculate that significant dissatisfaction and resentment has existed for years but has been masked by high HIMSS conference attendance numbers, which may have not been accompanied by any particular love or respect for HIMSS as an organization versus as an unavoidable vendor that runs the industry’s de facto gathering. Some respondents provided their own negative terms instead of choosing from the positive ones I listed. I doubt that any of us could come up with easy fixes, even if HIMSS were to agree that its past missteps require correction.

New poll to your right or here: Which types of virtual visit have you had since mid-March?

Listening: new from Delanila, moody, sultry alt pop fronted by composer Danielle Eva Schwob with the topical title of “It’s Been A While Since I Went Outside.” She filmed the official video (“visual poem”) herself in a COVID-emptied Manhattan. Her entire catalog under this name is just four singles, but all are magnificent and immediately addictive. I’m also enjoying the new, posthumously released single from Chicago rapper Juice WRLD, whose lyrics in “Righteous” (“taking medicine to fix all the damage”) foretold his drug overdose death in December 2019 at 21 years of age at Midway International Airport, when he downed of handfuls of pills to hide them from federal agents who were searching the private jet on which he was traveling (successfully, as it turned out) for the drugs and guns that were on board. Lastly, if you’re looking for a song that will burrow into your brain like toxoplasmosis, try “The Other Girl,” which sounds like Taylor Swift but is actually country pop singer Kelsea Ballerini with singer-songwriter Halsey (the latter’s first musical posting in 2012 was a parody of a Swift song, so there you go). 

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Vocera announces Q1 results: revenue up 15%, adjusted EPS –$0.14 vs. –$0.17, beating Wall Street expectations for both. 

Amazon surveys its sellers about their health plans, creating speculation that it will offer health coverage.

Sales

• Tift Regional Medical Center (GA) goes live on LiveProcess Emergency Manager to power its virtual command center.
• Commonwealth of Massachusetts will offer free virtual visits to uninsured state residents who have COVID-19 symptoms or have been identified through contract tracing, powered by virtual care provider Doctor On Demand.

People

Eric Rose, MD (Intelligent Medical Objects) joins the VA’s Office of Health Informatics as chief terminologist.

New Jersey Innovation Institute hires Jennifer D’Angelo (Bergen New Bridge Medical Center) as VP/GM of healthcare.

Announcements and Implementations

In Australia, Queensland Health cancels its laboratory information system replacement contract with Sunquest after two years and having spent $24 million of the $43 million original contract award. It will instead upgrade its Auslab system that Sunquest was intended to replace.

Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments. 

Waystar launches an analytics and business intelligence module ahead of schedule to support the coronavirus-driven decisions healthcare organizations are making.

COVID-19

Researchers study the 14 available coronavirus antibody tests on which the hopes of reopening the US economy rest. Only three of the 14 tests — many of which are manufactured in China — delivered consistently reliable results, and none were perfect. All but one test sometimes gave false positive results (which could lead someone to think they are immune when they are not), the tests performed better when the patient had been infected for longer periods, and none of the tests have been approved or studied by the FDA. Meanwhile, an urgent care center near me is pitching COVID-19 testing for $40 cash plus the cost of the video visit, the latter of which is covered my many insurance plans for coronavirus screening. The unstated important point of all this is that (a) we have zero evidence that even correctly resulted seropositivity means that someone is immune, and (b) even if they are immune, we don’t know for how long. We could kill people by sending them back to work or causing them to throw coronavirus caution to the winds by assuming that past exposure indicates immunity. What we don’t know about this virus is nearly everything, except that it spreads and kills people with ruthless efficiency.

A Stanford seroprevalence study – which was was already being widely questioned for recruiting self-selected users via Facebook and going straight to a press release with no peer review — takes another hit when BuzzFeed News finds that the physician wife of the lead author recruited participants via a wealthy school’s listserv, skewing the demographics of participants. The preprint article estimated that up to 81,000 people are infected in Santa Clara County versus the officially reported 956, which would indicate a much lower death rate than previously believed. Another author is maverick Stanford researcher John Ioannidis, MD, DSc, of which an expert concludes may be “so attached to being the iconoclast that defies conventional wisdom that he’s unintentionally doing horrible science.” He and another of the paper’s authors had previously questioned in a Wall Street Journal op-ed piece and in several Fox News appearances whether the threat of COVID-19 is overblown.

Facebook is offering users a coronavirus symptom survey that was created by Carnegie Mellon University, with results from 1 million users per week being sent directly to CMU for predicting disease spread and county-by-county impact. The first set of results will be published Monday. The map above indicates percentage of people with symptoms in each county (the redder, the worse), but I noticed that the symptom map allows showing percentage of people with symptoms by hospital referral region, which is useful in hospital planning (Rapid City, SD is about to get hammered).

US nursing homes have seen more than 10,000 deaths related to COVID-19, and nine of them that experienced coronavirus outbreaks that triggered “immediate jeopardy” federal citations were found to have significant problems meeting basic health standards – lack of PPE, failure to enforce physical distancing of residents, inadequate staffing, and failing to recognize and react to coronavirus symptoms. Routine federal inspection of nursing homes was stopped on March 20. They complain that federal help has been non-existent as hospitals received all the focus. More than half of reported COVID-19 deaths in some states were nursing home residents.

The Economist warns that governments are borrowing money at a level not seen since the end of World War II despite a dramatic drop in taxes collected, piling up coronavirus-related debt from issuing stimulus money and relief checks for people and businesses. The authors conclude that such spending is sensible in trying to forestall further economic slump — especially in the lower-risk US as the world’s reserve currency and with low interest rates — but working down the 1945 debt all over the world required high taxes on capital, the benefit of inflation, and a baby boom that was accompanied by higher levels of education. The authors also expect that the public — especially senior citizens who vote against politicians who attempt to limit entitlement spending — will demand higher levels of healthcare spending.

Former CMS Acting Administrator and United States of Care founder Andy Slavitt lists his takeaways after talking nearly non-stop to to scientists from all over the world:

• Making effective, breathable, and even fashionable masks available at low or no charge to the entire US population could protect us (at worst) or eradicate the virus (at best) due to the power of exponential math of the infection rate. Masks, rather than a vaccine or therapy, may be the silver bullet.
• We will solve the shortages of tests, ventilators, and hospital beds.
• Individual immune response rather than the strain of the virus may drive COVID-19 outcomes.
• Creating an effective vaccine by 2021, proving that it is safe, and then manufacturing and distributing it to the entire globe involves many challenges.
• Even in the absence of a vaccine, COVID-19 could be managed as a chronic disease.
• A vaccine may only be partially effective or may offer partial inoculation, in which case it could still be used in healthcare workers and high risk people.
• We need to produce so much PPE that a glut is created, taking profiteers out of the picture.

VA officials reverse their previous insistence that it is providing adequate PPE even as employees stated otherwise. VA Executive in Charge Richard Stone, MD says FEMA ordered the VA’s vendors to redirect its shipment of 5 million masks to FEMA for restocking the emergency stockpile, forcing the VA to limit employees who work directly with COVID-19 patients to one mask per day, while other employees who delivered food and medications to COVID wards received only one mask per week, with orders to staple the straps if they broke. The VA says that 1,900 of its own employees are sick with COVID-19 compared to the 6,300 infected veterans it has treated. The VA did not have enough tests for its employees until recent weeks, but its absenteeism rate is still tracking below the normal average at 4% as poorly equipped employees keep showing up for work.

White House officials are discussing plans to replace HHS Secretary Alex Azar, sources say, following widespread criticism of the federal government’s early response to the pandemic and misstatements to the White House about Azar’s reported demotion of HHS vaccine expert Rick Bright, PhD. 

Other

Something triggered a memory of XG Health Solutions, the Geisinger analytics and consulting spinoff that was splashily introduced in 2015 without much buzz since, The company apparently closed its doors last summer (shutting down instead of selling out for even a “better than nothing” price is a key indicator of spectacular failure). I attended their HIMSS15 launch and concluded:

From the hallway conversations I heard and my own opinions, here are the positives: Geisinger has developed a lot of expertise and content that’s less ivory tower than most big academic medical centers, they put some thought into involving the patient in the use of their apps, and the SaaS-based subscription means new best practices can be put into place quickly. Negatives: the company has significant venture capital ownership (they aren’t Geisinger, in other words), you might suspect that Geisinger applied soft pressure to the newly named EHR vendor partners to get on board with uncertain future commitments, and so far they’re a company that hasn’t done much to dent the market other than to do Geisinger stuff and make announcements. Success in commercializing hospital software is elusive, and while Version 1.0 is easy, it’s Version 2.0 that gets ugly with upgrades, design decisions, and testing. The first non-Geisinger betas will be important. 

Best tweet of the weekend, although “other” would have been a lot more sarcastically effective and epidemiologically accurate than “only.”

Sponsor Updates

• Impact Advisors publishes a white paper titled “The Future of EHR Implementation Post-COVID.”
• Experian Health’s MyHealthDirect scheduling solution is now available in the Epic App Orchard.
• Health Catalyst makes COVID-19 insights derived from its Touchstone platform of 80 million de-identified patient records available to customers, hospitals, public health authorities, governments, and biopharma working on treatments.
• NextGate publishes a new white paper, “Why Patient Identity Management Tools are Critical for COVID-19 Surveillance.”
• KLAS includes Nordic solutions in its latest report, “COVID-19 Technology and Services Solutions Guide.”
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “Team Skills Simulation Training.”
• PerfectServe congratulates customer Prisma Health on FDA approval of its VESper ventilator expansion device.
• Experity will host a virtual job fair May 2 from 9am-noon CT.
• Patient engagement vendor Relatient joins the Epic App Orchard.
• ROI Healthcare Solutions announces comprehensive EDI optimization offerings for Info users.
• Summit Healthcare publishes the “Galway Clinic Success Story: Solving Complex Interoperability Needs with the Latest in Integration Technology.”
• In Europe, Synteract leverages the TriNetX platform and COVID-19 Rapid Response Network to find and enroll patients for coronavirus clinical trials.

Blog Posts

• Why health IT matters: Not on the front lines of COVID-19, but not on the sidelines either (Spok)
• Maximizing Annual Wellness Visits with Telehealth in COVID-19 (Lightbeam Health Solutions)
• Quickly Find and Share COVID-19 Resources Across Your Healthcare Coalition or Health System (LiveProcess)
• Financial Strategies for the Post COVID-19 Recovery (Loyale Healthcare)
• Amid crisis, hospitals provide communities with mental and emotional support (Meditech)
• The Biggest Barriers to Healthcare Interoperability (Health Catalyst)
• Charles Corfield’s COVID-19 Weekly Assessment (NVoq)
• Three ways automation can help weather the storm of uncompensated care (Experian Health)
• How Healthcare Providers Can Deliver the Best Online Payment Experience During Challenging Times (PatientBond)
• Why E-Notifications Matter More Than Ever (PatientPing)
• Beyond HIPAA-Compliant Texting: Top Healthcare Communications Solutions (PatientKeeper)
• Week 2 WFHighlights & Pointers: Heart-Warming Stories & Success as a WFH Parent (Pivot Point Consulting)
• Virtual Visits vs. Zoom – The Era of Telehealth (QliqSoft)
• Digital Tools Prove Essential to the Revenue Cycle During COVID-19, Will be Key to Recovering After (Relatient)

Contacts

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

Weekender 4/24/20

Weekly News Recap

• Banner Health’s judge-approved $8.9 million payout for a massive data breach in 2016 includes $500 for each patient in the class and $2.9 million for plaintiffs’ attorneys.
• The federal government announces that it will delay enforcing compliance with final interoperability rules so that healthcare stakeholders can focus on COVID-19-related operations.
• Cognizant alerts customers that a ransomware attract is disrupting some of its services.
• Several companies work together to create a database of de-identified, patient-level data for COVID-19 researchers.
• The VA and DoD launch a health information exchange that allows providers from both organizations to exchange patient information with community partners.
• Google announces GA of the Google Cloud Healthcare API.
• CMS announces that hospitals in areas that have low coronavirus outbreak risk can start offering routine services again.
• FDA waives limitations on using digital health for treating psychiatric disorders.
• UW Medicine (WA) publishes its IT experience in dealing with the health system’s coronavirus response.

Best Reader Comments

Re: VA & DoD HIE capabilities. Are we going to just sit here and pretend that both agencies weren’t already bi-directionally exchanging CCDs with huge amounts of outside clinicians via the eHealth Exchange for years? Maybe the massive note formatting issues from VA-crafted documents were just a fever dream of mine. (Perplexed)

These CCF models had the peak in mid-June WITH the distancing staying in place since mid-March. Those have been discounted. They also predicted 100,000 dead in Ohio in March WITH distancing. Then 10,000 dead in April. Their models have been WILDLY off. And unfortunately the public health people have been bludgeoning the politicians with freakishly wrong modeling, which has led to scaring the public to death and closing businesses indefinitely. (Meltoots)

RE: SDH referral platforms. The SIREN network (out of UCSF) published its evaluation last year (full disclosure I was a consultant on it). What’s missing from all these platforms and reports on them is their actual impact on health outcomes. (ex-hhc)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in North Carolina, who asked for multicultural development materials for her at-risk, pre-school class.  She reports, “This project been a surprising resource for my young students. The children noticed right away the different families’ cultures and they love to talk with their friends about what they see. The school is in a military town and most of my students come from different ethnic backgrounds. I appreciate the posters of real families from around the world. I cannot thank you enough for supporting our classroom.”

A scrubs-wearing nurse from Canada who told border authorities that she was driving to Detroit to help Henry Ford Hospital with COVID-19 is arrested when officers open her Ford Fusion trunk and find 150 pounds of marijuana.

A bankrupt 25-bed critical access hospital in rural Oklahoma has only eight nurses and an office manager remaining as full-time employees, hoping to trim expenses by operating just the ED to attract a buyer. A company submitted the sole bid of $200,000 at a bankruptcy auction, but has backed out of the deal as coronavirus left it worried about being unable to meet operating costs. The hospital is one of 18 facilities that have closed or entered bankruptcy after being taken over by EmpowerHMS, which is being investigated by the Department of Justice for billing out-of-state lab tests through the hospitals to take advantage of their higher payment rates.

Detroit ED physician Luda Khait-Vlisides, MD, MS raises money to buy tablets to allow patients who are being placed on life support, allowing them to have what could be their final family conversations via video since visitors aren’t allowed.

A hospital nurse in Texas posts a note in the window of a COVID-19 patient’s isolation room to explain why he was staying longer than expected.

In Spain, a taxi driver who regularly drives people to the hospital for free is surprised there by doctors and nurses, who give him a standing ovation, an envelope with money, and the negative results of his coronavirus test.

In Case You Missed It

• News 4/24/20
• EPtalk by Dr. Jayne 4/23/20
• Readers Write: Blowing the Whistle on Technology Fraud in the Healthcare Industry
• HIStalk Interviews Jeremy Schwach, CEO, Bluetree Network
• News 4/22/20
• Curbside Consult with Dr. Jayne 4/20/20
• How the Pandemic is Changing Consulting Work (Survey Results)
• Monday Morning Update 4/20/20

Get Involved

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

Morning Headlines 4/24/20

Banner Health $8.9 Million Data Breach Settlement Gets Court Nod

Banner Health (AZ) will pay $8.9 million to settle claims from its 2016 data breach, which exposed the information of 3.7 million patients and health plan members.

The FDA just approved Columbia’s Covid-19 plasma therapy study, backed by Amazon

Amazon commits $2.5 million to an FDA-approved clinical trial at Columbia University that will assess whether plasma from 450 COVID-19 survivors can be used in potential treatments for the virus.

Tech company pays $1.7 million in restitution for defrauding hospital electronic records programs

EHR vendor KPMD pays $1.7 million to settle charges that Southwest Regional Medical Center (OH) falsely attested to state and federal governments that its ED met the requirements for EHR incentive payments even as the hospital was shutting down.

VR telemedicine platform XRHealth raises $7M

XRHealth raises $7 million, bringing the virtual reality-based telemedicine startup’s total funding to $15 million.

News 4/24/20

Top News

Banner Health will pay $8.9 million to settle claims from its 2016 data breach. An Arizona federal judge approved the settlement, which was reached in early December, on Tuesday.

Each patient who is covered by the class action will receive $500, while the plaintiffs’ attorneys will earn $2.9 million.

Cyberattackers breached Banner’s credit card payment system that is used in its food outlets, then extended their attack to other systems, exposing the information of 3.7 million patients and health plan members.

Reader Comments

From COVID Thoughts: “Re: traveling contractors. How will hospitals address vendors and consultants coming on site post-COVID? If widespread testing is not available, will they permit traveling contractors in their hospital and office buildings?” I’ll open the floor to what, at this point, will be speculation at best. I assume that whatever precautions hospitals will take with patient visitors – temperature checks, limits on numbers, etc. – will be applied to business visitors, but I wouldn’t expect getting them into the building will be a high priority. They could require meeting at locations other than buildings where patient care is provided.

From Disengage: “Re: chatbots. Those should keep people out of the ED even after the pandemic is controlled.” Don’t count on it. The customers of those chatbots are health systems who make a lot of money from ED patients in normal times, where the ED helps keeps heads in beds. The sudden interest in doing the opposite — keeping people away from the ED who don’t need to be there — could well be temporary. Health systems are happy to have full EDs as long as someone is paying, and I expect them to deploy their post-pandemic chatbots accordingly. You don’t run a successfully restaurant by testing prospective diners to verify that they are actually hungry.

Webinars

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

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

Sales

• Cerner expands its VA contract with Vecna Technologies to include greater EHR systems integration and go-live support at Mann-Grandstaff VA Medical Center (WA).
• TCARE, which offers a family caregiver support program, will use CareSignal’s COVID-19 programs (linking to local public health resources and information, a self-monitoring text system, and staff support) for its 20 million members.
• The VA expands its contract with CirrusMD for the text-based VA Health Chat, in which VA employees provide medical advice, manage prescription refills, and schedule appointments.

Announcements and Implementations

Cleveland Clinic and SAS share predictive modeling code on GitHub that can help hospitals better prepare for COVID-19-related supply chain, capacity, medical device, and financial scenarios.

The Dallas VA implements cloud-based COVID-19 monitoring, surveillance, and tracking solutions custom-developed by CliniComp across 42 sites.

The Regenstrief Institute partners with the Indiana Health Information Exchange, Indiana University School of Medicine, and several state-based agencies to develop a COVID-19 tracking and response dashboard using data from the state’s health systems and labs.

A KLAS report on technical services providers finds that Galen Healthcare and 314e have the broadest range of clients, J2 Interactive and Navin, Haffty & Associates  are most consistent in client satisfaction, and those four vendors offer the best balance of prce and performance. Client scores from Atos, which grew in the US by acquisition, place it at the bottom. Prominence earned top scores for quality of staff and its deep Epic expertise.

Epic reports that hundreds of hospitals are using its machine learning predictive model to alert clinicians of patients whose conditions are worsening. COVID-19 modules are being validated and used. 

Government and Politics

HHS updates providers on the distribution and timing of CARES Act Funds, stressing that payments will be made weekly beginning Friday. High-impact areas such as New York will be allocated $10 billion.

EHR vendor KPMD pays $1.7 million to settle charges that Southwest Regional Medical Center (OH) falsely attested to state and federal governments that its ED met the requirements for EHR incentive payments even as the hospital was shutting down. KPMD’s contract called for the hospital to send the company its government incentive payments. KPMD’s CEO Krishna Surapeneni later bought the hospital in September 2013 and closed it one year later.

CMS, ONC, and the HHS Office of the Inspector General announce they will delay enforcing compliance with final interoperability rules so that healthcare stakeholders can focus on COVID-19-related operations.

FedScoop profiles HHS Protect, health data visualization technology used by the White House’s Coronavirus Task Force that comprises 187 datasets from federal agencies, state governments, healthcare facilities, academia, and industry partners. The dataset, developed and managed by the HHS Office of the CIO, gives 200 users access to COVID-19 case count sources; hospital capacity, utilization, inventory, and supply data; government and industry supply chain data; lab testing data; and data from community-based testing sites.

COVID-19

Scientists determine that coronavirus was spreading undetected in the US by early February and the first known death occurred February 6, as international and domestic travelers then spread the infection. New York City had 600 people with unidentified infections in mid-February and confirmed its first COVID-19 case on March 1, but the city may have had more than 10,000 cases by then.

NIH Director Francis Collins, MD, PhD cites research that found that 44% of coronavirus transmissions occur before the infected person develops symptoms, which will make contact tracing harder. Those studies suggest that people can spread the infection for 2-3 days before they become ill themselves, which then requires tracking down and quarantining 90% of their close contacts who by then have been exposed.

A Health Affairs blog post warns that US maps that show few COVID-19 cases outside of metro areas are misleading, concluding that “the virus is everywhere” based on hospital referral regions where people travel across county and state lines to seek hospital care. Case rates are increasing in all of those regions. The authors recommend that the referral region information be considered by states that are loosening their distancing requirements.

A Kaiser Family Foundation poll finds that:

• 51% of Americans think the worst is yet to come with coronavirus, down 23 percentage points from three weeks ago.
• 80% say shelter-in-place is worth it to protect people and limit spread.
• The majority of respondents say they can continue physical distancing and shelter-in-place for more than another month.
• Two-thirds of people support phone-based contact tracing after they were told that it could allow schools and business to reopen.
• Twice as many people would be willing to download a contract tracing app if the data was managed by local or state health departments or the CDC instead of a technology company.
• 38% worry that companies will sell data from contact tracing apps, while 33% think the federal government will use the data for purposes that go beyond tracking coronavirus spread.Two-thirds say they would not feel safer if phone-based contact tracing were in place.

Partners HealthCare (MA) turns its internal employee communications app into a COVID-19 messaging tool, giving its 78,000 staff members daily updates on testing protocols and stay-at-home policies.

Johns Hopkins University hosts a free public course titled “Understanding the COVID-19 Pandemic: Insights from the Experts.”

Researchers find that ambulatory practice visits dropped 60% overall starting in mid-March, a reduction that has not been fully offset by the upswing in telehealth visits.

A study finds that of 318 coronavirus outbreaks (three or more cases) in China, only a single outbreak happened outdoors and that outbreak involved just two cases. The study did not take note of the fact that most of the outbreaks occurred during winter when people would have been mostly indoors anyway, but the results may still encourage states to allow churches, restaurants, and gym classes to reopen with a recommendation to use outdoor spaces. The study also found that home contacts were involved in 80% of outbreaks and most of those involved 3-5 cases. A significant percentage involved public transportation.

Facebook removes its “pseudoscience” user interest category — which tagged 78 million people — after a website discovered the targeting option when its reporter was served an ad for a radiation-blocking hat. Consumer Reports found that despite Facebook’s declared crackdown on false pandemic content, the magazine was able to buy ads claiming that social distancing doesn’t work and that drinking bleach preserves health.

Drugmaker Jaguar Health — whose only product is the diarrhea medication Mytesi that is approved for use in HIV/AIDS patients who are being treated with antiretroviral drugs — raised the price from $11 to $37 per tablet in early April, right after asking FDA to allow its use for COVID-19 patients being treated with remdisivir. The FDA denied the request. The company says it is going broke fast because insurers won’t pay for Mytesi, which is made from tree sap.

Privacy and Security

Hackers expose the stolen logon credentials of 25,000 users from WHO, NIH, CDC, and the Gates Foundation. WHO says only 457 credentials of the original 6,835 remain active. A white-hat hacker who gained access to WHO’s system using the stolen data says that nearly 50 accounts use “password” as their password, while others use the user’s name or “changeme.” White supremacist groups that have targeted hospitals and medical workers published the stolen credentials to their members almost immediately.

Other

USCF’s Atul Butte tweets that patients can send their Apple Health-stored ECGs to their providers using Epic’s MyChart patient portal.

Hospitals that hope to avoid Joint Commission penalties by throwing away medical supplies with a close expiration date are now scrambling to obtain PPE.

This is pretty great.

Sponsor Updates

• CareSignal and Texas Health Aetna launch a free, text-based COVID-19 education messaging service.
• Ellkay releases a video in celebration of Medical Professionals Week 2020.
• The Big Unlock Podcast features Wolters Kluwer Health VP and General Manager of Clinical Surveillance Karen Kobelski.
• Hyland Healthcare and HIMSS Media publish 2020 Connected Care and the State of Interoperability in Healthcare study results.
• Imprivata expands its collaboration with Microsoft to offer new digital identity innovations.
• InterSystems announces that RxMx has built its new Chameleon platform on InterSystems IRIS for Health, powering a new COVID-19 testing and monitoring solution for employers.
• Glytec customers AdventHealth and CHI Franciscan will lead the “Computer-Guided Insulin Dosing” session at the 2020 Diabetes Technology Society Virtual Hospital Diabetes Meeting April 24 at noon ET.
• The local business paper profiles the rapid uptake in adoption of the Healow telemedicine app from EClinicalWorks.

Blog Posts

• Adding Value in 2020: Keeping It Simple (PMD)
• Shift in the Medical Mindset (EClinicalWorks)
• New Feature Lets Users Instantly See if a PAC Provider Accepts COVID-19 Patients (Ensocare)
• Intelligent Monitoring of the End-User Experience is Necessary in Healthcare Environments More than Ever (Goliath Technologies)
• Protecting businesses against cyber threats during COVID-19 and beyond (Google Cloud)
• Resolve these 3 front desk challenges (Greenway Health)
• Local Telehealth Businesses are Booming During the Pandemic (HCTec)
• COVID-19 and the Importance of Health Informatics (Healthcare Growth Partners)
• Furry Friends of Healthfinch (Healthfinch)
• COVID-19, Loneliness, and Cabin Fever (Healthwise)
• Enterprise Imaging: Answers to Fundamental Questions (Impact Advisors)
• Maximizing capacity for rescheduled elective and routine care (Nordic)
• Tips I learned running IT for the US Air Force during 9/11 (Imprivata)
• Virtual Care Visits and the Importance of Electronic Data Access (InterSystems)
• Business as (un)usual: Security, continuity, and the COVID-19 response (Intelligent Medical Objects)
• How Health Systems are Responding to COVID-19 – And Using Tech to Do It (Kyruus)
• Combatting COVID: 5 Benefits For Text-Based Screening Tools (Dina)

Contacts

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

EPtalk by Dr. Jayne 4/23/20

Telehealth is a hot topic in the virtual physician lounge, with various specialty organizations providing cheat sheets and other reference materials to help practices figure out how to get paid. The American Academy of Family Physicians put together a nice table and flow chart identifying the appropriate E&M codes to use for various clinical and technology scenarios.

As the coronavirus response shifts, some states are allowing their emergency licensing waivers, which allowed many of us to see telehealth patients across state lines without separate licenses in those states, to expire. The recent expansion of telehealth coverage by the US Department of Health and Human Services also allowed providers to avoid HIPAA penalties for the good-faith provision of telehealth during a public health emergency, which led to a boom in use of things like Skype, FaceTime, Facebook Messenger, and other non-secure platforms. It’s unclear exactly how long the “public health emergency” status will last and how much warning we’ll have before the original rules return in force.

Although many healthcare delivery organizations are strapped for cash due to declines in elective procedure revenue, it’s time for them to start thinking about how they’ll transition to a HIPAA-compliant solution. In addition to the HIPAA angle, providers deserve better than using consumer apps. To have the best efficiency and patient safety features, telehealth platforms should integrate with the EHR and scheduling system for streamlined documentation and follow up.

I’ve heard of a couple of health systems looking at telehealth as a way to reduce their physical footprint and get out of costly leases. One executive I talked to spoke of turning some of their offices into the medical equivalent of WeWork sites, where providers could purchase just the time and space they need for face-to-face visits, which may fall below 25% in some specialties.

Stories about providers having their hours cut are everywhere, along with recent reports that healthcare staffing giant Envision Healthcare might be preparing to file for bankruptcy. The company has over $7 billion of debt. The entry of private equity into healthcare in recent years has sucked money out of the system at an alarming rate. Perhaps its time for hospitals to go back to employing physicians and treating them like valued members of the community instead of commodities.

Several physicians have asked me if I had read the statements from the Office of the National Coordinator regarding flexibility with the Interoperability Rule, and I had to admit that I hadn’t. The bottom line is the ONC and CMS, along with the HHS Office of the Inspector General (OIG – just wanted to see how many abbreviations I could string together) announced “a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on March 9th.” They went on to say that this “flexibility” is specifically due to the COVID-19 public health emergency. The discretionary period will run for three months past the original compliance dates, but I wouldn’t be surprised if it ends up being extended.

I was initially excited to see an email from Provation offering a “free COVID-19 order set and care plan” in order to “keep all our healthcare heroes equipped with the latest evidence-based order set and care plan content available for COVID-19.” Unfortunately, it requires provision of your email address and company info prior to access, followed by acceptance of terms of agreement that say you can download a single PDF copy “solely for evaluation purposes.” Given the lack of proven treatment for COVID-proper, there wasn’t anything too earth shaking in it.

I was pleased to see the American Academy of Family Physicians come out with a forceful statement about the lack of evidence for off-label use of medications for COVID. Physicians are getting numerous requests for unproven drugs, and those who give in to the badgering are inadvertently causing shortages for people that need the drugs for their actual approved use.

A colleague clued me in to a Miami organization that mailed her mother a bottle of hydroxychloroquine without her requesting it, along with information stating that patients were being placed on it as a preventive. I was happy to see that references to that activity have been sanitized from its website, although the South Florida Sun Sentinel preserved the CEO’s statements and advocacy for the drug for posterity. I hope regulators and license officials take the time to investigate any shenanigans that have already occurred.

I was also happy to see the announcement of an AMIA webinar next week focusing on Electronic Case Reporting. This is a problem I’ve been trying to solve for a client. Due to geographic spread, they have to report COVID-positive cases to dozens of public health authorities, all of whom have different forms. Required transmission modalities include phone, fax, email, web forms, and snail mail. The client has largely given up on reporting, preferring to ask for forgiveness rather than permission. Hopefully the pros on the call will have some ideas to help so I can stop tearing my hair out. If any readers have inside scoop, please share with the rest of the class.

I was less happy to see the CMS document detailing strategies on how to reopen healthcare delivery in the US. First off, its title “Opening Up America Again” is a little too close to a political slogan than should be permissible with an official CMS document. I detest the use of the word “America” as a synonym for “the US” because it makes us appear ignorant of the fact that “the Americas” are a big place inhabited by lots of people other than us.

In short, the document recommends that organizations use telehealth when they can, but in-person care can resume in areas that have “the resources to provide such care and the ability to quickly respond to a surge in COVID-19 cases, if necessary.” Consideration should be given to facilities, workforce, testing, and supplies.

However, the CMS statement on Personal Protective Equipment (PPE) is weak. Basically they are recommending only surgical facemasks for healthcare workers unless high-risk procedures are being performed, and “patient should wear a cloth face covering that can be bought or made at home if they do not already possess surgical masks.” No mention was given to the relative ineffectiveness of cloth face coverings or the lack of science supporting their use, nor of the studies that show that in some circumstances cloth face masks can actually increase transmission of infection.

On the delivery side, the plan is to “conserve PPE,” which basically means healthcare organizations can require their employees to use items in ways that contradict documented approved uses and increase risk to staff. I fully understand that we can’t just use new masks for every patient like we used to, but I would love to see Seema Verma have a conversation with my friend Lil, a pediatric OR nurse who was denied a new mask by an OR supervisor despite her mask being soaked with sweat (and likely ineffective, since you’re not supposed to wear them if they’re saturated).

The document also calls for routine screening of workers and designation of “COVID-19 Care zones” and “Non-COVID Care” (NCC) zones, with separate buildings or separate entrances in the same building and with staff not crossing from zone to zone. It goes on to say that “all patients must be screened for potential symptoms of COVID-19 prior to entering the NCC facility, and staff must be routinely screened for potential symptoms as noted above. When adequate testing capability is established, patients should be screened by laboratory testing before care, and staff working in these facilities should be regularly screened by laboratory test as well.” I’d love for someone to sit down and explain how that should work in the average primary care office or urgent care, because it doesn’t feel like CMS is thinking beyond the hospital walls.

What do you think about the plan to reopen healthcare in the US? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/23/20

Cleveland Clinic and SAS share COVID-19 predictive models to help hospitals plan for current and future needs

Cleveland Clinic and SAS make predictive models available on GitHub that can help hospitals better prepare for COVID-19-related impacts on supply chains, capacity, medical devices, and finances.

Nearly 25,000 email addresses and passwords allegedly from NIH, WHO, Gates Foundation and others are dumped online

SITE Intelligent Group discovers that activists have shared 25,000 email addresses and passwords stolen from WHO, NIH, CDC, and the Gates Foundation.

IT services company Cognizant warns customers after ‘Maze’ ransomware attack

IT services company Cognizant – owner of RCM vendor TriZetto – confirms that a ransomware attack has caused service disruptions for some of its clients.

Readers Write: Blowing the Whistle on Technology Fraud in the Healthcare Industry

Blowing the Whistle on Technology Fraud in the Healthcare Industry
By Joseph Gentile, Esq.

Joseph Gentile, JD, Esq. is a partner with Sarraf Gentile LLP of Great Neck, NY.

The healthcare industry has always been an area susceptible to fraud. In fact, government investigators estimate that in 2016, about $95 billion was improperly paid out by Medicare and Medicaid. That’s only a single year’s amount of fraud in just two of the government’s many healthcare programs.

With an aging population, increased healthcare spending, the passage of the CARES Act, and the government’s multi-trillion dollar effort to mitigate the health and economic effects of the COVID-19 pandemic, fraud in the healthcare industry will only increase. With social distancing become the new normal, the use of technology to deliver healthcare services will also increase. Fraud in this area will, therefore, likely increase.

As a result, the need for insiders to blow the whistle on technology fraud in the healthcare industry is more important than ever. Whistleblowers help ensure that these precious government dollars go towards stopping the harmful effects of the virus and shoring up our economy—and not to line the pockets of opportunists.

The best tool for combating this scourge is the False Claims Act (FCA), a Civil War-era law that was passed to address the fraudulent sale of decrepit horses, ill mules, and faulty rifles to the Union Army (which not only stole tax dollars, but endangered soldier’s lives). The FCA has since been expanded to cover most government dollars, including healthcare spending such as Medicare, Medicaid, and Tricare.

The FCA has been regularly used to fight technology fraud in the healthcare industry. Just last year, the Department of Justice announced a $57.25 million settlement against Greenway Health LLC (Greenway), a Tampa, Florida-based developer of electronic health records (EHR) software for causing its users to submit false claims to the government by misrepresenting the capabilities of its EHR product Prime Suite and providing unlawful remuneration to users to induce them to recommend Prime Suite. 

The US Attorneys whose offices prosecuted the fraud said it best. According to Christina E. Nolan of the District of Vermont, “These cases are important, not only to prevent theft of taxpayer dollars, but to ensure that the promise of health technology is realized in the form of improved patient safety and efficient healthcare information flow.” According to Byung J. “BJay” Pak of the Northern District of Georgia, “Medical professionals and patients depend on the security and competency of electronic health records as a means to improving both the quality and coordination of health care services… Vendors who falsify the viability of their products erode the integrity of public health systems and will be held accountable for their misrepresentations.” 

Cases like Greenway are just the tip of the healthcare fraud iceberg. Indeed, the FCA has been used to recover billions in healthcare fraud and was most recently used in the government’s historic $1.4 billion recovery from Reckitt Benckiser Group involving the marketing of Reckitt’s opioid addiction treatment drug Suboxone. Whistleblowers were awarded over $100 million.

While blowing the whistle may not be easy, the FCA encourages it by offering anti-retaliation protections for those who out the fraud as well as lucrative financial rewards. Where the government obtains a recovery as a result of fraud, the whistleblowers are generally awarded between 15% and 30% of the recovery. Because many FCA healthcare cases are large by nature, the FCA’s financial rewards to whistleblowers have been historically large as well.

Our healthcare industry is being tested like never before, and the people in it — especially those who are working to use technology to improve its delivery and accuracy — play a critical part in ensuring its effectiveness, now more than ever. Those same people can help ensure that the billions of dollars being spent on healthcare aren’t being wasted by fraud. Every dollar counts. Pplicing that is not only a civic responsibility, but legally protected conduct that can result in significant economic awards.

HIStalk Interviews Jeremy Schwach, CEO, Bluetree Network

Jeremy Schwach is CEO of Bluetree Network of Madison, WI.

Tell me about yourself and the company.

Bluetree is about 400 people strong. We help the largest healthcare organizations in the country tackle their biggest problems. About half of our folks come from an IT background, specifically Epic, and the other half comes from a provider background and really understands the business of healthcare. We put those two things together, we figure out what our clients need, and then we jump on it.

How will current events affect the consulting business, both now and in the future?

A lot of our work is core IT related. In some instances, we are as busy or even busier in certain areas. In other instances, we are helping with the big strategy projects that our clients have pushed.

For the most part, we haven’t seen anything totally cancelled. There’s a lot of instances where our clients are saying, and rightfully so, “We need to stay focused on the crisis at hand.” They are dealing with what the rest of the world is dealing with from an economic standpoint, trying to figure out how to prioritize.

Certainly the bottom isn’t falling out. We are taking a long-term view. We’ve seen new opportunities around telehealth. Organizations have moved incredibly quickly for their size compared to how long it has taken historically to get big enterprise projects done. We feel good about the long term and we know that we need to make sure that we are weathering the storm like the rest of the world.

Epic, Cerner, and Meditech have turned around a lot of COVID-19 related changes quickly, ranging from terminology updates to mobile hospital support to telehealth integration. Are customers taking advantage of these new options?

I would say yes. It’s amazing how focused the mission becomes when you are dealing with something that is as acute, and in some cases as devastating, as the current crisis. It ranges from vendors who are putting their best foot forward to clients who have accelerated two-year projects to get them done in two weeks.

I’m impressed with our own folks, who have gotten creative in tough situations. We were remote-first to begin with, so we had a little bit of an advantage. But no one was prepared to take on full childcare and also support their clients who were, in some cases, as busy as ever fighting on the front line. A lot of people in healthcare deserve a ton of credit as their mission comes into focus in times like these.

Are your clients worried about cash flow after being forced to temporarily shut down their most profitable services?

Everybody is concerned, in part because it’s hard to plan. How long does this thing go? When do we start letting patients come back in? “Elective” is the wrong word considering that no one wants to get surgery. At some point, you have to let patients back in.

That is made more difficult by the regional nature. We work with a 160 clients across the country, most of them large. You can take an inner city hospital that is battling this thing on the front lines. Then you go two hours in any direction and you can find a hospital that has had few or no COVID patients. They’re still planning for it, so they have the the same economic hardship from reduced census and lack of profitable electives. While the regional nature is bizarre, everybody is in the same economic quandary.

What technologies have been recently embraced that will stick after things get back to some kind of normal?

We are seeing the same things that you listed in your post. A lot of digital tools. Chatbots getting deployed more widely.

What is interesting is the amount of infrastructure that is required to stand up something like telehealth. Most people look at telehealth as the tool itself and the availability of physicians. There’s an underbelly infrastructure that is a big part of the heavy lift. For example, we take patient calls for some of our clients and have expanded that service because our clients need it. But regardless of the telehealth tool, a whole demographic of patients are just not going to be comfortable using it. It’s basic things, like opening the right browser and getting webcams set up. We’ve seen this huge spike in patient calls as a result of some of these new tools, and it’s not even COVID related, necessarily. You have to build an infrastructure around these things.

We expected our clients to kick the can on some of our big strategic projects to keep everybody focused. We haven’t seen that happen. In some ways, our clients are even more focused on this consumerization of healthcare. We do a lot of work on patient access centers. Because we are accelerating these new tools, clients are having to create the customer service infrastructure that other industries have built up over 10 years, but that is new to healthcare. We are seeing a lot of demand, and these hard, big projects that impact tens of thousands of users continue to move forward.

If you want to put in cool new texting apps or the latest fancy bell and whistles from your new startup, you need that baseline infrastructure. A patient has to be able to call in, talk to somebody about financial counseling, get a nurse in real time, get their prescriptions refilled, or get an appointment scheduled. Now you are adding telehealth volume and chatbot questions to that mix. Our clients are accelerating building that core infrastructure, because otherwise it’s hard to do anything in the consumerization patient world. It was surprising how quickly something so strategic kicked into high gear.

What interesting changes are you seeing from Epic and other vendors?

A lot of what clients are leveraging now existed in the past. We have just re-prioritized in healthcare. Vendors haven’t released a lot that is brand new or that was spun up quickly, but certainly they have been incredibly available on the analytics front. Maybe one of the surprising outcomes was Epic and other vendors working with the federal government to figure out, because of their large footprint, how to help from an overarching view of what’s happening in the country. Vendors weren’t necessarily doing or even feeling comfortable doing that historically. The current times demanded that, so they stepped up to the plate.

MyChart tools, chatbots, and telehealth all existed. It was a matter of prioritizing and then building the infrastructure.

What types of companies will be best positioned to weather the crisis and emerge strong on the other side?

We were acquired by Providence in July, which gave us a longer-term view. Our approach has been that current events are changing healthcare dramatically, and in some cases for the better. When we come out of this, the changes that we are already feeling will be accelerated. The opportunities in healthcare continue to grow and are maybe even being expedited by the current crisis. Anybody who takes a long-term view is going to be better positioned. We are doing everything we can to keep the team together, but our goal is to make sure that when times that are slower, we take advantage of the opportunity to build and focus on what our clients need now.

Your readers will roll their eyes when I say this because every CEO has to say this, but I personally feel incredibly fortunate to be attached to Providence. We are a small company that has an opportunity to make a big impact, because even as a small company, we work with some of the largest, most influential healthcare systems in the world, and on some of their most strategic projects. We feel fortunate to be in that position.

As a small company, you’re wondering about your long-term view and whether you can go about it as a solo practitioner. It is doable, but incredibly hard and increasingly rare.

You wonder if you  should take the financial buyer route, such as private equity. You know the pros and cons of that. One of the cons is that your company will be sold every three to five years by an owner that really cares about just one thing, which is their prerogative and goal.

Then you have the strategic, who will look at how to leverage the skill set, the people, or the customer base. 

Providence came to us in February and basically said, there’s a fourth option. We have this 170-year-old, mission-driven non-profit with an enormous footprint. We are one of the largest Epic clients on the planet. We want to keep delivering this vision for another 170 years. We know healthcare is changing, so we want to do things differently.

That was the Providence sales pitch to us. We could help them modernize and innovate, but we could also gain an opportunity to do things differently, remain independent, and work within a new commercial entity that can go out and do bigger things. We get the platform to do what we already do, but with a bigger impact.

We are nine months through it and it has been incredible. They have been an amazing partner because they aren’t a PE shop or a traditional strategic. They are totally different and they have been true to their word. We are fortunate to have them as a partner.

The initial announcement said that Providence planned to build a $1 billion business from their acquisition of Bluetree, Engage, and other companies. How is that working and what is the strategic direction?

The vision has been super clear from the beginning. It’s not easy to do. They’re a large organization. Those wheels have been turning for a very long time.

Before the acquisition was finalized, I had a chance to sit down with Mike Butler and Rod Hochman, the president and CEO. They said, tell me one other organization that is 170 years old, founded by a group of women, with our scale, that cares deeply about a non-profit mission, and that has survived for all these years because of that vision. Rod laughed and said, don’t think too hard about it because there isn’t any other.

They are in a unique position because of longevity, their 114,000 caregivers, and the skill to do it differently. Because of that vision, it’s been clear what we need to build. One of their guiding principles was that this would not be Bluetree and Engage folding into Providence. They could build that themselves. This is taking advantage of their scale and all of the smart people they have to build something different.

What’s been most surprising to us is that a consulting company, we’ve got folks across so many clients. We’ve got a pretty good long view of what’s happening. We felt like we could make a difference for Providence, and that’s important.

The crisis has shown us, in a short period of time, that Providence has as much to give us as we have to give them. Their response to the crisis has been unbelievable, that an organization with that level of scale could move that quickly. They had the first confirmed COVID-19 case in the US, so they had a head start. Not only did they stay focused and organized, they allowed us to come in and learn from them as they were going through this. Because they have this amazing non-profit vision, we posted their learnings publicly. Our website has a COVID-19 page and a lot of the content was from Providence’s learnings.

We did a deep dive as they were building their analytics tools across their large geographic regions and we learned a lot from them as they looked at cash, preserving cash, and accelerating cash as we come out of this. We got an inside view, the chance to exchange ideas, and then the opportunity to publish it quickly because it was good for the world. That drove home the fact that this is such an unusual partnership in healthcare.

Morning Headlines 4/22/20

Leading Healthcare Companies Announce COVID-19 Research Database

Several healthcare companies create COVID-19 Research Database, a secure repository of de-identified, patient-level, longitudinal datasets from claims and EHRs.

Statements from the Office of the National Coordinator for Health IT and the Centers for Medicare & Medicaid Services on Interoperability Flexibilities amid the COVID-19 Public Health Emergency

CMS says it will extend deadlines for compliance with final interoperability rules so that healthcare stakeholders can focus on COVID-19-related operations.

Microsoft hires a former GE exec to work with health companies in the midst of the coronavirus pandemic

Microsoft hires former GE Healthcare head of imaging Tom McGuinness as its VP of global healthcare.

News 4/22/20

Top News

The VA and DoD jointly launch a health information exchange that will allow clinicians to access patient records that are stored in the EHRs of community partners and health systems.

The HIE will connect to CommonWell later this year.

Both organizations were already able to access information from their own community health partners, but the HIE allow all providers to see data from all community partners.

Most of the 215 partners that are participating in the exchange can both send and receive patient data, although some allow only one-way sharing.

Reader Comments

From Burned by TriZetto: “Re: TriZetto. We installed EClinicalWorks at our practice last year and chose TriZetto from the three revenue cycle vendors ECW offered us. ECW just announced that they are abandoning the company and their integration because of a massive security breach at TriZetto.” Cognizant, which acquired TriZetto for $2.7 billion in cash in 2014, was hit this past weekend by Maze ransomware. ECW has blocked all integration to TriZetto’s clearinghouse and patient statements. The Maze malware not only encrypts computers, it exfiltrates company data to the servers of the attackers, who then demand payment with the threat of publishing the data online. The publicly traded Cognizant, which reports annual revenue of $17 billion, warns in a new SEC filing that the attack could negatively affect its financial results. Meanwhile, Cognizant continues to offer end-to-end security solutions, including threat and vulnerability management and cyber threat defense.

Webinars

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

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

Acquisitions, Funding, Business, and Stock

Analytics vendor Komodo Health lays off 23 employees, representing 9% of its headcount, three months after it raised $50 million in a funding round. The company collects the de-identified data from 15 million patient encounters each day to follow patient journeys and analyze outcomes.

People

Microsoft hires Tom McGuinness (GE Healthcare) as corporate VP of global healthcare.

Announcements and Implementations

Google announces GA of the Google Cloud Healthcare API. The company also highlights its tools for supporting COVID-19 efforts, including Google Meet for virtual care, G Suite for sharing information, a newly launched Rapid Response Virtual Agent for patient interaction, Google Maps Platform for giving directors to patients, and researcher credits for Google Cloud

Nuance launches Dragon Ambient Experience (DAX), which creates clinical notes from the physician-patient conversation in either physical or virtual visits.

Surescripts reports that e-prescribing represented 80% of all prescriptions in 2019, while use of real-time benefit checking and electronic prior authorizations increased significantly.

Lark Health offers its text-based stress and anxiety coaching service to health plans and employers at no charge through July 1.

Redox announces a rapid deployment model that allows telehealth software developers to bring their solutions live with EHR integration in two weeks.

Premier enhances its solutions for COVID-19, including COVID-specific alerts for clinical surveillance, an early warning system for patient volumes, surge prediction, supply use prediction, COVID-19 clinical guidance, intervention effectiveness monitoring, and best practices deployment.

PCare will deliver provider-prescribed patient guidance and education from Quil on its interactive patient system and digital rounding solution, with COVID-19 Care Journey being among the first offerings.

COVID-19

CMS announces that hospitals that are located in areas that have low coronavirus outbreak risk can restart providing non-emergent, non-COVID-19 services. CMS advises hospitals to monitor COVID-19 trends in their area; prioritize by patient need; ensure that providers, staff, and patients wear facemasks at all times; screen staff and patients for symptoms before they enter the facility; and limit volumes so that six-foot distancing can be practiced in areas such as waiting rooms.

Baystate Health executive Andrew Artenstein, MD describes in a NEJM letter the health system’s drama-filled effort to obtain face masks and N95 respirators at five times the normal price from a broker who had a connection in China. The hospital team traveled to an industrial warehouse to meet two trucks that had been marked as food service vehicles to avoid being detained. FBI agents arrived demanded proof that the supplies were not bound for black market resale. The agents were satisfied, but the health system then had to use its political contacts to keep the shipment from being seized by the Department of Homeland Security.

Providers who accept CARES Act relief funds are barred by mandatory acceptance terms in which they pledge to not balance-bill COVID-19 patients for out-of-network charges.

FDA authorizes use of LabCorp’s home self-test for COVID-19, in which a collection kit of nasal swabs and saline is used by the patient to take their own sample, which is then mailed to LabCorp for processing.

Former FDA Commissioner Scott Gottlieb, MD warns that most available serology tests have not been reviewed by the FDA and their quality varies, with some tests potentially being wrong half the time when they tell patients they have coronavirus antibodies. The tests are useful for public health studies, but not worth much for making decisions about individuals.

Influential technology investor Mary Meeker looks at the influence of coronavirus, with these healthcare-related observations:

• COVID-19 research is being published at 20 times the rate of prior infectious diseases at the same stage.
• Clinical research is rapidly mobilizing, with 500 clinical trials underway with 5 million participants.
• The pandemic has exposed healthcare flaws that may be the call to arms to rethink a system that consumes 8% of GDP, $1.2 trillion in 2019 federal spending, and 28% of the federal budget.
• Primary care hasn’t changed much since 1918’s Spanish Flu outbreak, as patients still visit the office (possibly infecting others), the doctor diagnoses based on outward symptoms, the patient is sent home to watch and wait, and the patient either gets better or goes to the ED.
• A lack of connected data, despite decades of EHR investment, have left federal and state healthcare officials using spreadsheets to track hospital utilization and capacity. Prediction models have varied wildly based on the use of assumptions. Providers are too overwhelmed with  workload and high volumes of data to deliver the benefits of digitization.
• Innovation will be driven around telehealth, connected devices for monitoring, rapid point-of-care testing, connecting the “dark pools” of EHR data using interoperability and APIs, using automation to improve data capture quality, and applying AI to EHR data to drive insights to providers at the right time.

Several healthcare companies create COVID-19 Research Database, a secure repository of de-identified, patient-level, longitudinal datasets from claims and EHRs. Researchers will be able to evaluate drug effectiveness, identify demographic and pre-existing condition risk factors, and predict the public health impact of quarantines.

Sponsor Updates

• Bluetree employees across the country make 609 masks for nine organizations in eight states.
• Avaya CEO and President Jim Chirico discusses on Fox Business how the company is donating video services to businesses during the pandemic.
• Clinical Architecture releases a new edition of its Informonster Podcast, “Three Takeaways from the COVID-19 Pandemic and the Importance of Managing Data Quality.”
• Dina wins the 2020 Transition of Care Challenge, sponsored by the New Orleans Business Alliance and Tulane Health System.

Blog Posts

• COVID-19 and the Importance of Health Informatics (Healthcare Growth Partners)
• Enterprise Imaging: Answers to Fundamental Questions (Impact Advisors)
• The New Normal of Healthcare After COVID-19 (Optimum Healthcare IT)
• EHR Go-Live Support from a Distance of Six Feet (314e)
• Norman Regional Health System Implements Zero-Contact Registration Process (Access)
• Learn how to strategically add telemedicine into your practice (AdvancedMD)
• Keeping CDI Teams Productive and Patient Data Accurate During the COVID-19 Pandemic (Artifact Health)
• What I Learned from 10 Years of Competing Against Avaya (Avaya)
• Pandemic Pivot: 5 Ways CareSignal Aligns with Revenue-Generating Telemedicine Codes (CareSignal)
• 7 Things Users Shouldn’t Do While Working From Home (CI Security)
• The Struggles Facing Rural Hospitals (Collective Medical)
• Medication Access During Uncertain Times (CoverMyMeds)
• Tools and Reports to Support Our Clients Impacted by COVID-19 (Crossings Healthcare Solutions)
• How the COVID-19 Pandemic is Affecting Children’s Hospital Operations (Dimensional Insight)

Contacts

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

Morning Headlines 4/21/20

VA, DoD implement new capability for bidirectional sharing of health records with community partners

The VA and DoD launch HIE capabilities, giving government providers the ability to share health data with their private-sector counterparts.

Aledade Raises $64 Million Series C on Nationwide Growth of Value-Based Care Network

Practice management company Aledade plans to expand its California footprint with a new $64 million funding round.

A buzzy healthcare startup that raised $50 million from Andreessen Horowitz 3 months ago just cut staff amid the coronavirus pandemic

After raising $50 million in January, healthcare data and analytics startup Komodo Health lays off 23 employees – nearly 9% of its staff.

Amazon is teasing a new health care offering — for its sellers

Amazon surveys its sellers to determine their satisfaction with current health insurance offerings and their interest in alternative coverage.

Our Healthcare API and other solutions for supporting healthcare and life sciences organizations during the pandemic

After a year in beta, Google Cloud announces GA of its Cloud Healthcare API, which enables the sharing of data between healthcare apps and those built on Google Cloud.

Curbside Consult with Dr. Jayne 4/20/20

Lots of conversation in the virtual physician lounge on when we will know when it is safe to start to resume “routine” patient care again.

Most of the employed physicians I know have taken salary cuts, and many of my independent peers are holding any physician payments while they try to cover expenses and staff salaries. Practices are running with a skeleton crew, and I’d estimate about half the practices are offering some kind of telemedicine services. (More telemedicine with primary care or non-procedural based subspecialties, less with those that relied on office or hospital-based procedures for their income.)

I know of a handful of physicians that have totally hung up their white coats. They were either close to retirement and are just “done with it,” so to speak, or their employers offered them some kind of buyout to ease the payroll.

A couple of us have been talking about last week’s New York Times piece on how we can safely move away from lockdown and stay-at-home conditions. We’re starting to see other countries that previously looked like they had a good handle on the pandemic who are starting to re-impose controls based on a resurgence of cases, which is unnerving. My state hasn’t hit its projected peak just yet, and without a robust testing strategy, it’s not even clear when we’ll know that we’re peaking. Too many patients are dying at home or in situations where they haven’t been tested.

The NYT piece quotes milestones laid out in an American Enterprise Institute report, which was authored by a group whose expertise many of us trust. One of the key points for moving forward is that “local hospitals are safely able to treat all patients requiring hospitalization without resorting to crisis standards of care, and the capacity exists in the state to test all people with COVID-19 symptoms, along with state capacity to conduct the active monitoring of all confirmed cases and their contacts.”

We’re a long way from that were I am. Healthcare workers don’t always have N95 masks, and those who do are being asked to wear them in a way that hasn’t been shown to be effective. Some care sites such as urgent cares aren’t offering any kind of decontamination or reprocessing – employees are just expected to rotate whatever masks they have (many of which were obtained from hardware stores or family members) until they disintegrate. Local hospitals are trying to figure out reprocessing, but it’s unclear how much the precious masks can take.

An ICU nurse friend of mine posted on Facebook how thrilled they were to get hand sanitizer from a local distillery. The post was accompanied by a photo of a colleague wearing a woodworking respirator. This is in a premier hospital in an affluent suburb of a major metropolitan area, not a safety-net facility or a place without resources.

It doesn’t feel to those of us on the clinical side like we’re even remotely ready to start talking about implementing societal changes that would place a larger burden on healthcare organizations. I applaud the companies like Battelle that are innovating (their mask reprocessing strategy is pretty cool, and the Pentagon is sinking big money into additional units for deployment across the country) but for goodness sake, healthcare workers are wearing trash bags for protection. Trash bags! In the year 2020, in the United States of America. To be honest, did any of us really see that coming? Did we ever think we’d practice in a situation where that was acceptable?

I’m furloughed from my clinical gig, but I still read the email updates. Their strategy when they run out of barrier gowns is to use cloth patient gowns and launder them since all sites have a washer. Let’s see, they’re cloth, they’re not moisture-proof, and then people are going to be at risk handling them for the laundry process. Sounds like a great plan. I think I’d rather have the trash bag, to be honest. They’ve had to remove the glove dispensers from patient rooms because the gloves were being stolen. It’s surreal.

I know many of our readers work for healthcare organizations and you already know these things. If you haven’t seen them with your own eyes, you’ve probably heard about them on command center calls or during supply chain management huddles or in any number of ways in which your world is being impacted by this pandemic. Healthcare organizations are burning through money without hopes of their coffers being replenished for some time, especially since some of them depend on non-emergent services for up to 80% of their budgets.

Families are in the same situation, burning through any emergency funds they had saved, unsure when they’ll be back to work. People are having to make tough choices, and the answers aren’t as cut and dried as any of us would like them to be.

At least in my area some of the safety nets are back up and running. School-based meal pick-up services had been halted after some worker infections, and one of the major food banks had closed temporarily while they figured out a sustainable strategy for continuing to help people.

One of the local community health centers is opening additional drive-through testing sites. I’m not sure how they got their hands on so many tests, but since their community is being disproportionately impacted by the pandemic, I’m glad they have them. At the same time, they’re working very diligently to try to make sure their patients have needed medications and chronic care services, to make sure they don’t just stay COVID-free, but also protect their health as much as possible.

It seems like a lifetime ago we were debating how much money hospitals were spending on massive EHR projects or whether they would ever see their return on investment. I hope all those organizations are pushing the limits of whatever features and functions they can to make the caregivers’ lives easier. I hope the executives are rolling up their sleeves and helping on the front lines and that they’re supporting the staff who feel uncertain or frankly afraid. It’s going to be a long time before we get to any semblance of “normal” and people need all the support they can get.

With that in mind, and in order to support your stress-baking habits, I offer up the Taste of Home Giant Buckeye Cookie. The inhabitants of Casa Jayne give it a “10 out of 10, would eat it again.” I would strongly recommend the ice cream to go along with. We didn’t have it, and it would have been lovely. Even if your local grocer is out of flour, you can probably score the cake mix it calls for.

What has your favorite stress baking recipe been? Leave a comment or email me.

Email Dr. Jayne.

How the Pandemic is Changing Consulting Work (Survey Results)

Consultants responded to three questions:

• What kind of consulting do you offer?
• How has the pandemic affected your work, job, or firm?
• How do you think your work will change once the pandemic is controlled?

Healthcare IT consulting

My company is seeing large reductions in revenue due to clients putting projects on-hold due to COVID-19. Luckily not all projects have stopped so the company is still generating revenue. My company has put a thoughtful, deliberate financial plan in place to preserve our company and jobs. The hope is that we’ll be able to ramp up quickly when COVID-19 is over or controlled. Our company has been transparent about the plan and is keeping us updated. All non-essential expenses have been cut; we are taking pay cuts temporarily (which will be paid back at a later time); we are required to take PTO; company has worked with our PE firm to secure additional cash. With all that, morale remains positive. Company is doing a good job of supporting working from home and staying connected to clients, increasing company connectivity through virtual fun events, etc.

From an IT perspective, we anticipate more M&A work since there may be more distressed hospitals looking for a savior; more telehealth / virtual visit strategy and plans; assistance with financial optimization.

Third party Cerner consultant

Working remote from home instead of on site Monday-Thursday. Project I am on is on hold until after Covid-19 settles down. There still are minor maintenance items, busy work, and weekly meetings. Really not much going on. My client has all its IS staff working from home as well.

Unsure. If this goes on for the 12-18 months to develop a vaccine, could be long time before I take another flight/on site on regular basis. Management already told us to not plan any travel until late June at the earliest. Client is in a hot spot that still has increasing cases. Contract is up in five months, so expect if nothing has changed most likely will not get renewed.

Epic analyst. I’m Boost (consultant through Epic)

It’s affected the work I’m doing day-to-day, but nothing beyond that. I had a steady gig with a long-time customer already (six years while I was at Epic in Madison, and three years in Boost with them since then). I already worked from home except for go-lives. If anything, the fact that other employees at my customer are now working from home has made my job better and easier. Normally, I don’t hear the water cooler talk or get pulled in to help with little things because they have someone sitting right next to them who can do it instead, and that’s just easier than messaging me on Teams or calling me. But now that no one is sitting right next to another analyst who can help, I get looped in on a lot more. It’s been nice! Also, as one of the quicker learners on our team, I’ve been the one to jump in on a lot of the new, highly integrated stuff we need to do for COVID. And normally I don’t do anything with our Infection Control module, but in the past week I’ve learned most of the workflows and data elements and am helping to take the load off our already-overworked, single infection control analyst. People like me who can be flexible, coordiinate across applications, and learn quickly are always in high demand. I’ve found that during a crisis like this, that’s even truer.

I hope my customer increases the opportunity to work from home so that some of the benefits I’ve seen will stick around. But I think that’s unlikely — they already offered work-from-home for 1-2 days a week depending on tenure. So overall, I don’t think it will change once life is back to normal (or whatever our “new normal” will be).

Sales and marketing consulting for vendors

Some of the smaller vendors we serve are struggling due to providers asking to defer payments, so in order to protect their teams from layoffs, they’ve reduced or cancelled our consulting contracts. Others have asked for reduced but continued work, but have asked us to defer our billing until their cash flow improves.  We’re taking the opportunity to focus on value-add content we can provide to vendors. This comes in the form of sales tips, marketing tips, or training ideas for their teams. We’re also exploring other ideas for services we could offer that would allow for a reduced presence of vendor personnel in a hospital or health system.

We expect that work will pick back up eventually, but it may take some time to get back to the client volumes we’ve been accustomed to. A lot of the work we do is remote anyway and has always been on Zoom or other video conferencing platforms, so in that regard it’s been an easy transition. It’s more about revenues stabilizing for the vendors so that they have money to spend on consulting work again.

Helping practices build high-performing remote care management

Increased: initial urgent response to expanding any existing telemed across the enterprise and/or rapid adoption from scratch. Decreased: existing chronic care management and remote monitoring have been pushed to the back burner, which is understandable. But overall, remote care management as a delivery vehicle will be a paradigm shift driven by micro and macro factors.

We expect demand to increase. Thanks to COVID, the interest in remote care has been thrust into the spotlight and the toothpaste is not going back in the tube. We believe practices and enterprises will quickly expand from simple video visits to the full suite of on-going remote care & perpetual patient management. Reimbursements are already in place, MACRA / MIPS & transition to value is already in place and COVID has put a spot light on the weaknesses of traditional episodic care. Integrating remote care into healthcare delivery will be a dominate theme in the next few years of healthcare consulting. Consider these entire categories that have multiple reimbursements each: televisits, e-visits, virtual check-ins, remote chronic care management, remote physiologic monitoring, transitional care management, principal care management, behavioral health integration, collaborative care management and oncology care management.

Clinical EHR optimization

We have less business overall, and our active projects are getting delayed. Clinical leads who normally partner with us are understandably getting called to the front lines.

There is a lot of pent up demand and we are expecting a big bounce once things get back to normal. We may have to grow our team if too many delayed projects need to re-start all at the same time.

Epic OpTime

I’ve now seen more internal emails circulating referencing lower hours or rate reductions, delayed or deferred projects, and providing information on COBRA, bench time, and offboarding. So clearly developing between just last week and this week. The firm has been communicating frequently, weekly calls scheduled presently. It seems the extended timeline of COVID is leading to more affected engagements than I realized, and presently I’m one of the lucky ones (knock on wood). Relatedly, in connecting with some former clients staff, it seems they may be seeing layoffs disguised as furloughs taking place. Last time I saw something like this was at an employer during the financial crisis last decade. Using layoffs predicated on anticipating expected financial hardship to remove staff that no one previously could be bothered to do the paperwork to track performance issues and terminate (or maybe just didn’t like them). Salaries and hiring were frozen as well, so it was a bit awkward when instead of a loss they cleared a large profit. They ended up paying bonuses to staff to make up for the bypassed annual increases. Oddly enough the staff terminated into a recession with a high unemployment job market (and were frequently still unemployed months later) never were offered their positions back when they started hiring again relatively soon after.

I find rate reductions to be sticky personally, so I wonder how much more downward pressure this might create. Working at a state institution presently I can view the staff salaries for my FTE colleagues, and, combined with the benefits they receive, we are getting progressively closer to where the risk/reward of the consulting lifestyle is rather narrow. I continue to see consultants (talented ones) take FTE roles as the margin on consulting pay shrinks. I wonder who will be left willing to travel, have generally inferior benefits, and have greatly reduced job security for only an extra 20% (after reducing for the higher insurance premiums, HSA contributions to cover that high deductible plan, and at this client anyway an actual funded generous pension!).

Epic consulting

I’m getting no engagements. Health systems have suspended their EHR projects, suspended or cancelled consulting engagements, and flights aren’t available to get people on site.

I’m guessing that at some future point in time (maybe Oct/Nov) there will be a HUGE demand for skilled and experienced Epic resources. By laying off folks and terming projects in flight, Epic users have, whether they understand it or not, chosen to upset the state of their install. Post this current world, sites with Epic will need to (very quickly) make changes to ensure they are capturing all the revenue they can AND update clinical workflows and related. AND, I suspect, they will all be reviewing most of their foundational views on the industry as a whole and how to leverage technology effectively (telehealth as an example).

Epic sites have been slow to embrace the 100% remote engagements because their mid-level managers have no idea how to work in that environment. I suspect that will change very quickly. Firms all across the country have spent countless dollars on building state of the art buildings and campuses to house their workers, yet for the last x number of weeks, those same workers have been working from home and overall the work is getting done and the world has not stopped spinning.

Managed services –tier two support

My firm has lost several big clients in the past few weeks. Some have been long existing clients. So far nobody has been laid off and they are trying to make sure that does not happen. I have a certification that is not that common, so I am hopeful that will help keep me employed.

I don’t believe things will return to normal for many months after the pandemic is controlled. As internal IT staff shifts back to the normal day to day of enhancements, quarterly updates I think our services will be as much in demand as they had been.

Interim management

Consulting gig cancelled with no plan to re-engage for the next year

Organizations are looking at priorities and margins. Telehealth has greatly disrupted how care will now be delivered

Epic

We are seeing some delays of new projects, with most existing projects converting to remote.

I think more organizations will realize it’s silly to spend the money on weekly travel to get consultants onsite. Hopefully more will consider full or partial remote arrangements.

Imaging

$15K of work evaporated in early March “postponed” until midsummer, when the clients felt they would have a better grip on available budget money would be available. Now that I am seeing layoffs left right and sideways, I am not counting on anything coming through at any time. I have also had a few potential clients ask me for an outline of what I felt needed to be done for them and how I would do it and after I submitted it for review they used what I submitted as a template to have the work done internally instead. Nice

It will easily take a year for things to settle down if not longer. Contract prices are going to be negotiated like never before with the low bidder (not necessarily he best candidate) getting the job if anyone gets it.

Implementations, optimization, and go-live support

All implementations, projects and go-lives have been delayed. Most consultants have now been moved to answer phones for MyChart and Telehealth support working remote.

Assume implementations and go-lives will move forward, still requiring support from consultants.

Epic principal trainer consultant

My most recent contract wrapped up March 31, and I was planning to travel internationally for six weeks. When I realized early-March that international travel was not going to happen, I began scrambling to try to find a new contract. A couple of projects I was submitted for are on hold, one project is going to be interviewing in the next few weeks, but there have been absolutely no new leads from my recruiting network in over three weeks. I am certified in multiple modules, have 8+ years of Epic experience and 5+ years of consulting experience, so I am used to receiving many leads if I have upcoming availability.

I think that hospitals will realize that much of the onsite work that has been done in the past can be done remotely, so there will be more remote options available. I have seen the trend shift towards that in the past three years in general. I also think that it may be more difficult for hospitals to budget money for consultants to assist with upgrades and staff aug because they will be trying to make things right with the clinical staff that had to have wages cut and were laid off due to drop in rev from surgeries, etc.

Mostly IT implementation, management and business strategy on occasion

The work is not slowed down. Clients converted their project teams to full remote work, consultants included. After reassessing priorities, all my projects will continue with no more than minor schedules changes. For one project the end users in an administrative department were converted to remote and so we will provide a remote go-live.

I anticipate that clients will go back to expecting onsite consulting support, but be more open to remote support.

Imaging: Operations, Clinical and Technology Services

Our firm has adapted to largely virtual consulting, which has had a much smaller impact to the substance of interaction as well as the quality of outcome (early feedback). In addition, the lack of need for travel buffers has RADICALLY improved our team’s focus and amount of actual work completed on a daily/weekly basis. While several clients have postponed and/or reduced scope of projects, much of the ongoing work is continuing. We believe this is due to the fact that most organizations realize that the current reduction in elective procedures will become a tsunami of work once we slowly “reopen” our businesses. Many in the ambulatory setting see this time as an opportunity to achieve important, but not previously urgent, initiatives.

I believe business as usual will be different for a very long time. Social distancing will be the norm going forward until we have all types of testing in place and ultimately a vaccine. In addition, the shift in engagement is changing people’s minds about what value face-to-face actual brings in working together and collaborating.

EHR implementations

We have switched to remote-only work. A number of clients have suspended or postponed ongoing projects, as well as a few cancellations. Furloughs have begun.

I feel that there will be some resumption of projects in the three to four months following control of COVID, but the recovery by most hospitals from the financial obligations / disaster imposed by COVID will take nine to 12 months, and non-critical IT projects will be on hold until providers are more comfortable with their finances.

Epic lab

The contracts for all of the Epic consultants with my major Canadian provincial healthcare system are not being renewed. New consulting opportunities have dried up. Normally I’m constantly being contacted by consulting firms and new roles are quick to find, especially in Beaker, but it’s been very tough right now.

Back to normal, but a rough time between now and then.

Epic clinicals

My firm has had some contracts canceled or postponed, but they’ve also continued to get requests for resources. They have implemented a hiring freeze and implemented an across-the board pay cut. My work on my current contract has not changed

Not sure. My contract runs into next year, and since my work hasn’t really changed, I don’t think that it will.

Epic analyst

Stayed the same. I already consulted entirely remotely for my customer for the past couple years. Projects (non COVID-19 related) are still moving forward, though a bit slower than normal. I am a bit worried about my contract being up soon.

I can’t imagine any org will feel that on-site consultants at the analyst level are necessary on a regular basis. Especially consultants who the org has worked with in the past (with proven results and work habits). Possibly for higher level work, where face time is a bit more important.

Epic clinical / advisory consulting

I’m an independent consultant and I’ve already lost one future contract for a project that the healthcare system deemed “elective” even prior to the pandemic. I think there’s potential to be brought on in a COVID capacity due to my relationship, but with hiring freezes, it’s all the more daunting. I always try to provide value-based consulting and I have continued to do so through the pandemic, but I have found myself trying to prove my value more so during my current contract to ensure it’s not seen as expendable. I hate this behavior in consultants, but find it all the more  necessary as active implementations are halting within other spaces at my current health system. My anxiety is definitely up. I’m hearing that the health system I work at has instituted the force majeur clause for several of their IT vendors. I have a couple outstanding invoices but am taking no news as good news for now.

The run-of-the-mill Epic-certified analyst-level consultant will move to managed care or salaried positions at lower rates with the big firms. There will be a market opportunity for firms to cash in on back-to-normal type activities. I expect management consulting will win many of the larger contracts, with the Epic consulting firms scooping up the staff aug opportunities with the new, cheaper work force. There will be more open IT positions as some clinical staff will have returned to floor. Obviously more remote work and less travel. That’s a given.

Epic analyst

Personally, I have gone from 75% remote to 100% remote. They have not involved me in very much COVID-related build, and the non-COVID work has started to dry up. We have been assured that they are not planning to let us go, but I am skeptical that they will be able to keep the current number of consultants when doctors and nurses around the country are seeing layoffs and pay cuts. I know I am one of the lucky ones, but I do live in constant fear of that luck running out.

I expect to be able to return to being on-site some of the time eventually. But I also expect the client to be trying to cut costs. Travel expenses and Epic optimization projects may be easy budget cuts, so I am anticipating either my contract ending early or just not being renewed. Now that WFH has been established and the IT sky didn’t fall, I hope that clients in general will be allowing their FTEs more remote time as part of “normal life” and that will also translate to more consulting projects that are 50% or more remote. In my experience, customers who are not WFH-friendly have an issue with trusting their team to get the job done when they are not being monitored in person. Maybe now they will realize that some folks are happier and more productive when they don’t need to spend hours every day commuting and dealing with office environments. Being open to WFH can allow you to hire and retain the best workers with the skills you need, regardless of their geographical location.

Epic OpTime

So far no change in my work, but at the beginning of March, all travel was suspended for three months. I’ve started totally remote and all staff at the client are also working from home through at least May. My firm has been communicating a great deal during the pandemic and not saying much at all. We received an email addressing benefits for those whose engagement was cut short, so that isn’t a good sign. They didn’t do much for those that are finding themselves without work.

I think it’s quite likely that we’ll be seeing more remote opportunities once they have worked with staff remotely and see the cost savings.

Full practice management consulting soup to nuts, EMR specialists

Because we are not solely reliant on our EMR consulting work alone, we’ve been very busy helping private practices with their layoffs and PPP loans. In 2009 when the economy collapsed, most of my income was Centricity consulting, I had to lay off most of my staff, it was crippling. The lessons I learned from that near financial ruin: 1. Have some recurring revenue, so we resell products we were already consulting on (I used to think being a pure consultant with no financial ties was admirable, now I realize it was naive!). 2. Diversify products, don’t be a single product consultant. We consult on several and sell/support Aprima. 3. Let your best customers know what this means to your business. My larger Centricity groups did not want to lose their access to me and my team, so we worked out ways to keep working that they could afford.

Because I made the necessary changes in 2010, I think we will be pretty close to back to normal when this is over.

Epic

My client was one of the first major hot spots and I asked to stop traveling near the end of February because I was concerned. Now everyone is required to work remotely. Contract extended.

Not at all

Epic inpatient

I was brought on for a hospital implementation, and a month into the contract, I was let go. I’m lucky that I worked as a FTE for a while so I can collect unemployment. I do believe with the stimulus contractors will be able to as well. Working in the consulting space we all should have a decent nest egg as contractors end unexpectedly a lot. I’m in the process of doing house projects, selling stuff I don’t need, and hoping we get back to a “normal” in July

I think companies will shift more consulting roles to remote to help cut down on travel costs.

Epic and Cerner

Projects that had a runway for continuation with a backlog of work, such as build or testing, have continued. But all new projects have been put on hold. Once the work that is scheduled is complete, then those projects will be put on hold pending next phase.

I think it will take a while for health systems to return to normal as they assess financials and timelines for projects. The bottom line I think a lot of consultants will be on the bench for the second and third quarters.

Cerner build and training

Moved to 100% work from home/remote. Still enough work with build to sustain through end of April 2020.

Shift to more remote work

Epic upgrades

100% shut down

Slow return to work as it is unclear on how soon hospitals will allow contractors back into their physical spaces.

Epic

My contract is still on remotely, but others have been paused.

Hopefully more health systems will be open to remote work.

Safety

Most projects on hold/delay. Some remote work, but very little.

More remote work versus travel to save on costs.

IT operations, Epic and Cerner PM and clinical consulting

Working remotely the time. Doing Zoom meetings and FaceTime calls.

I’m not sure. As a clinician, we still need to physically touch patients to collect samples and administer meds / therapies / procedures. Telehealth is part of the solution, but it isn’t the complete answer. As usual, payers are lagging behind the providers.

IT strategy and project management

Clients have stopped or suspended the strategy projects all together. The project management engagements have shifted from implementation of new/upgraded technology to telehealth related projects and it is 100% remote. The work on most everything else has been suspended indefinitely, primarily due to the unknown financial situation of the organizations upon returning to “normal.”

Some of the work will return, but I believe the financial impact to healthcare is going to be very significant and longer lasting than the pandemic. Capital is going to be scarce and priorities will be on maintaining financial stability. Unfortunately that will mean fewer projects for consultants for quite some time.

EHR

I remain 50% billable working for my customer remotely, which is enough to keep my employed through my company. The other 50% of my time is spent brainstorming on how we can transform our company and offer value to our customers in the new COVID world. Implementations, upgrades etc, will pick up again and companies that can prove that that can offer value remotely will stay in the game. We are learning that we don’t need to be Monday-Thursday travelers to continue to provide value, we have to tools to be just as effective and efficient from our home offices.

I have been as efficient 100% remote as I was when I was spending $2K a week traveling on site. I think we will beef up the at home technology, Video, VPN etc. for our staff and provide customers with a cost effective, safe alternative to flying a team on site every week.

Implementations, optimization, and support with Cerner software

Project on hold, most consultants furloughed. Some were asked to stay at reduced hours.

Unsure. Most but not all things can be done remotely from home.

Large EHR implementations

Nearly all projects have slowed / suspended, delayed, some cancelled. Furloughs for employees imminent.

Remote work will continue with travel at half pre-covid levels. Existing projects will be restructured due to budget impacts and new projects will take longer to approve

Epic application analyst

Currently unemployed

Have had multiple interviews from local hospitals/IDNs prior to pandemic. No follow-up calls / meetings scheduled at this point as hiring activity has stalled.

Healthcare IT management consulting

HIT consulting has already been down for the past two years given the disillusionment with the EHR investment and deteriorating health system margins. I am now on a project helping a clinical trial data management company develop AI use cases.

I don’t know. Doing work remotely is effective much of the time, but developing a deep relationship with the client still requires face-to-face time in various individual and group settings. I hope we get back to traveling and meeting as we did in pre-pandemic times but I’m not counting on it

Implementation, workflow analysis but not just for Epic

Basically, the pandemic has shut us down. We’re all working remotely, for longer hours because we’re all paranoid that if we don’t, we’ll get laid off. In the absence of consulting work, we’re doing a lot of cold calling to drum up opportunities in other areas that our firm has to offer. For example, we also offer online training that can be done remotely. This would be great for providers that are currently doing staff augmentation

I try not to think about it because it simply makes me depressed.

EMR

Delayed all projects to at least August and maybe out further. No layoffs yet

More remote work

Business and management consulting

Contracts cancelled or scope of work substantially reduced. New projects delayed.

Things will be slow to pick up. Customers will reevaluate priorities. Current project funnel will change substantially. Expect 12 to 18 months before any semblance of normalcy.

IT strategy, M&A, implementation, optimization, revenue cycle

Few projects are continuing. Expected work with post-implementation optimization and M&A conversions postponed indefinitely. University systems least impacted such as UK but that may change as states rethink budgets. Performance improvement, value-based care, PAMA AUC, and price transparency projects being pitched are not being sold.

Will likely depends on how fast business and regulatory requirements re-enage. There will be a large pool of consultants competing for same work, driving cost per hour and associated wages down even further than had occurred already. Some staff aug firms that cross industries might have overhead and corporate costs covered by industries less impacted than health care, such as federal, banking or similar. Private equity backers of many of the current consulting firms may seek to shed firms during the pandemic or afterward. Some firms will be shuttered. Private equity investors will be fewer and harder to find. Public firms that had acquired firms will have large write downs of goodwill, although this already happened in last few years as HITECH dollars ended.

Part-time contracting for a health system for MIPS

Dwindling down. It was going to dry up anyway until later in the year.

MIPS reporting may be easier for 2020 so less need for my support.

Epic

Personally, busier than ever building out COVID-19 related facility structure.

Back to a less urgent routine. Upgrades, optimizations, hopefully some new installs.

Epic Bridges consultant

I took a 21% pay cut to my overall compensation

Hopefully more remote work!

Analytics project management

No client travel, working 100% from home. Hoping clients continue with projects

Regular travel to a client will no longer be required. I see travel dropping to once a month.

Pharmacy informatics

lient is occupied by COVID-19 planning and isn’t readily available for questions, etc. I was already working remotely, but because of travel restrictions, no site visits or physical assessments can be done. I don’t think there has been a significant impact to the consulting firm — yet

Hopefully, the client will be able to be more engaged with the project. I will still be working remotely but anticipate I will be working more hours.

EHR implementation project management

Working from home 100%, which I have done periodically throughout my consulting career. My projects are all still a go with the occasional delay due to COVID-19.

If the pandemic is controlled sooner, my projects should be back on track and ready to go forward. If the pandemic takes longer, there is a possibility that all work will stop.

Strategic

Evaporated

The bigger question is will it ever return at all. The tail of this is wide and long and the possibility that much will not return. Even with a willingness to return to normal, there will be no funds and resources to carry on as before. With every corner of society impacted, the available $$$ have gone. What returns will be small, focused, and highly limited. Hopefully, the majority of any future healthcare spending will be on clinical expenditure and not in non-essential administrative crap

Morning Headlines 4/20/20

Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort

CMS will now require nursing homes to report COVID-19 cases directly to the CDC, and that they inform residents, their families, and representatives of cases in their facilities.

Private Equity Firm sues Intel over Failed Acquisition

A private equity firm sues Intel for failing to consummate a deal in which the firm intended to buy Intel’s Care Innovations remote patient monitoring subsidiary in early 2017.

Enforcement Policy for Digital Health Devices For Treating Psychiatric Disorders During the Coronavirus Disease 2019 (COVID-19) Public Health Emergency

FDA waives limitations on using digital health for treating psychiatric disorders, whether new conditions or created by the public health emergency.

Beaumont Health says 112K patients were impacted by data breach

Beaumont Health (MI) notifies 112,000 patients of a 2019 data breach that compromised employee email accounts and patient information.

Microsoft is launching a ‘plasmabot’ to encourage people who recovered from the virus to donate their plasma as a possible treatment

Microsoft and a group of pharmaceutical companies launch a chatbot that screens recovered COVID-19 patients to determine if they are eligible plasma donors.

Monday Morning Update 4/20/20

Top News

UW Medicine (WA) publishes its IT experience with COVID-19 in the journal Applied Clinical Informatics. The organization:

• Participated in the hospital incident command system.
• Moved to iterative implementations in some areas, such as escalating COVID-19 related EHR change requests.
• Developed a real-time dashboard of critical metrics.
• Worked with HR and local sites to develop internal email lists for specific areas and topic types, including a master list of EHR users for change notification.
• Worked with groups that oversee community communication (websites, automated emails, appointment reminders, on-hold contact center telephone messages) to align messaging.
• Created intranet and extranet pages to house COVID-19 resources, with the former including screening and testing algorithms, policies and procedures, and printable posters for clinics.
• Developed workflows for specimen collection for the organization’s self-developed COVID-19 lab test to cover new areas (such as employee health) and to print labels for community organizations that still use paper and faxed orders.
• Developed COVID-19 lab ordering under easily found synonyms and configured those orders and related interfaces to bypass the co-signature requirement.
• Created a master order set that includes hyperlinks, lab orders, ICD-10 codes, billing codes, and discharge instructions.
• Created a documentation template that includes a checklist of symptoms and risk factors, testing recommendations, and support for virtual visits.
• Implemented a centralized lab results notification process since the lab is serving non-UW Medicine patients, using remote professionals to monitor an EHR inbox and communicate positive and inconclusive results and posting negative results within one hour on the patient portal for established UW Medicine patients.
• Trained 500 primary care physicians in telemedicine, then extended the service to areas that serve vulnerable patients. This involved acquiring equipment, managing software licenses, supporting remote access, and integrating teleconferencing into Epic.
• Masked the personal telephone numbers of providers who are conducting virtual visits remotely by using Doximity Dialer or the phone system’s call forwarding feature.
• Set up ICU telemedicine carts with cameras to allow practitioners to conduct visits remotely and thus save PPE.
• Supported surge planning by providing emergency-level system access, EHR changes, EHR expansion to new areas, and support for a drive-through testing site with cellular hotspots that were later replaced with microwave line-of-sight connectivity.
• Supported teleworking by extending teleconferencing, VPN, and file-sharing tools and helped employees check out their desktop equipment for home use.
• Fended off an increase in phishing attempts and malware.
• Learned these three lessons: (1) integrating videoconferencing into the ambulatory EHR should have been given higher priority; (2) expanding the telemedicine solution would have helped, including ramping up training and installing more cameras; and (3) a larger supply of equipment to support teleworking and telemedicine would have been beneficial.

Reader Comments

From Show Me The Shortage: “Re: LexisNexis COVID-19 drill-down of provider and hospital bed shortages. Seems like the socio info could be used for flattening the curve, or at least being proactive for prep for health crises.” I wondered how LexisNexis was getting the data to display at-risk populations, community shortages of critical care resources, and COVID-19 deaths (that’s the death map above). They aren’t, exactly – the age, comorbidity, and socioeconomic data is based on historical national percentile rankings, while the critical care resource shortage display is derived from comparing the high-risk population percentage with the known number of specialists, hospital beds, and ICU beds (it’s not a real-time snapshot). They don’t say where they’re getting COVID-19 death counts, but I assume it’s Johns Hopkins since they credit them as a dataset resource. It’s an interesting exercise in data presentation, but I would say it is questionably actionable in a pandemic crisis where none of the factors that are modeled can be changed in the short term. I also question the usefulness of dividing the data by county since we are hardly constrained by those virus-indifferent borders in seeking the closest medical care. All of this is the kind of information needed to plan a war, not fight one, and we are still massively failing in even basic public health execution, such as getting people tested and protecting providers with basic gear.

From Another Doctor Who: “Re: whole-body doctors. Here in the Midwest, doctors who can treat an entire human are not rare. I realize you are inured by loud reports of professionals behaving badly, but the good clinicians are not making noise. They are just practicing their trade and attempting to be human themselves. Here’s how I know I am surrounded by holistic physician colleagues: When I have a family or friend that needs a referral, I have multiple choices, even to the point of not referring too many to one person, matching up personality, and even type of humor (that’s a tricky one). Cynicism is usually an accurate worldview, but watch the availability bias. Ditto for our nurses; it is a team sport.” Some specialists are no doubt comfortable and skilled in handling general medical issues, but it probably relates to how long they’ve been out of residency and how far their specialty is from whole-body medicine (internal medicine is right on it, electrophysiology or diagnostic radiology, maybe not). My point is that doctors are not interchangeable, and our system of training and payment – not to mention the incessant onslaught of new medical knowledge and application — creates specialists whose bedside contributions in a pandemic may be limited. Regardless, you would rather have them than not, and it’s selfless of them to volunteer for dangerous duty that falls outside their chosen practice area.

HIStalk Announcements and Requests

Two-thirds of hospital poll respondents are paying their EHR maintenance fees as usual, although another 25% are either asking their vendor for a break or are reducing or deferring payments by necessity.

New poll to your right or here: which terms would you apply to HIMSS? I can’t include all the possible options, so click the poll’s Comments link after voting and describe which I missed. I’m not looking for shade-throwing here – I’m genuinely interested in how industry people, especially HIMSS members and exhibitors, view their relationship with the organization. I’m happy to share my own views as a member, but perhaps I should save that until after the poll closes. 

Webinars

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

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

Acquisitions, Funding, Business, and Stock

A private equity firm sues Intel for failing to consummate a deal in which the firm intended to buy Intel’s Care Innovations remote patient monitoring subsidiary in early 2017. The complaint says that Intel signed an exclusive agreement to sell the business, but then used the private equity firm’s offer to negotiate a higher price from the eventual buyer, venture fund ISeed Ventures. The Intel-GE Care Innovations joint venture was formed in August 2010.

People

University of Maryland Medical System promotes Joel Klein, MA, MD to SVP/CIO. He had served in the interim role since July 2019. 

Announcements and Implementations

Netsmart launches a telehealth solution for behavioral health, home health, hospice, senior living, and social services providers.

A peer-reviewed observational study of data from Glytec’s insulin management software finds that the mortality rate of hospitalized COVID-19 patients was much higher for patients who had a history of diabetes and uncontrolled hyperglycemia, confirming WHO’s determination of diabetes as a comorbidity that affects survival. More surprisingly, the study also found that 42% of patients who had no history of diabetes and who experienced inpatient hyperglycemia died in the hospital, which is seven times the death rate of patients who had neither diabetes nor hyperglycemia. The results are interesting, although not definitive due to the absence of proving causation versus correlation, the inability of the authors to review the longitudinal records of patients, the likely contribution of other comorbidities (how many of the patients who died also had heart disease?), and the limitations of looking only at particular hospitals whose policies, resource availability, and socioeconomic case mix might have skewed the results.

KLAS looks at three vendors of technologies related to social determinants of health in surveying a small number of customers (four to 12 organizations):

• Healthify, which screens patients and creates a referral summary. Clients are seeing benefits, including better communications and identifying patient needs, but EHR integration is a challenge and ROI is hard to determine.
• Aunt Bertha, which allows searching for community resources and tracking referrals. Clients report ROI and are enjoying the community organization relationships the system allows them to build. They would like to see better EHR integration. Clients report the highest satisfaction among the three products and 100% would buy it again.
• NowPow, which supports referrals to community resources. Customers find value in it and 100% would buy it again.

COVID-19

The World Health Organization warns that while COVID-19 serological tests can detect antibody evidence of previous infection, they cannot predict whether a given person is immune to re-infection. WHO says several countries believe they can incorporate presumed immunity from tests into their reopening plans, but nobody knows what the results mean and the rate of false negative results is concerning.

FDA waives limitations on using digital health for treating psychiatric disorders such as obsessive compulsive disorder, anxiety, insomnia, depression, substance use, PTSD, autism, and ADHD, whether new conditions or created by the public health emergency. Developers must have tested their app, apply cybersecurity protection, and require the user to verify that they should contact a doctor before using. The exception, which will remain in place until the public health emergency ends, does not include apps that are intended to treat a specific psychiatric condition, that address conditions that may require urgent intervention, or that replace in-person or telehealth visits.

Kaiser Health News says that hospitals aren’t able to quickly repair broken ventilators or bring mothballed ones back into service because ventilator manufacturers don’t allow hospital biomedical engineers or third party service companies to repair them. Manufacturers make money from controlling who can service their machines, using software locks and internal-only manuals to prevent unauthorized repairs. These limitations have elicited a “right to repair” movement like the ones organized for cars, farm equipment, and cell phones that allow owners to fix their own devices or hire whoever they want to do so. One manufacturer has only two technicians available to service an entire state, which is a bottleneck in the pandemic.

A report from the Johns Hopkins Bloomberg School of Public Health, with former FDA Commissioner Scott Gottlieb, MD as a co-author, lists public health principles for use by governors as they reopen their states. Excerpts:

• The only epidemic control measure that is available in the absence of a vaccine continues to be social distancing combined with case-based interventions. Large-scale distancing measures will need to be reinstated if the epidemic’s growth returns.
• A loosening of distancing measures requires meeting four criteria: (a) a 14-day day decline in new cases; (b) having enough diagnostic tests available to test, at minimum, every person who tests positive and their close contacts; (c) having adequate hospital capacity and personal protective equipment for healthcare workers; and (d) having enough people assigned to perform contract tracing for new cases.
• State leaders must communicate clearly what is being done so that it is not taken as approval for an immediate return to normal activities.
• Prolonged, close contact among people creates the highest risk and must be considered in deciding what to reopen – risky situations include people who travel or share meals together, religious services, family gatherings, cruises, prisons, and long-term care facilities.
• Businesses still need to have people work from home or outside of large groups whenever possible. They should require employees to wear non-medical cloth masks, employ physical barriers where possible, keep people at least six feet apart, and continue paying employees who have been exposed or who are sick at home.
• The risk of reopening schools is uncertain, and tele-education may need to be provided in any case to accommodate high-risk students and those whose parents want to keep them safe at home.
• Risk of transmission in outdoor facilities such as parks, pools, beaches, and playgrounds is lower than indoor settings, especially if people maintain distancing.
• Church services introduce high risk.
• Mass transportation is high risk, but limiting it disproportionately affects under-resourced populations.
• Mass gatherings, such as sporting events and conferences, should follow WHO guidance.
• Re-opening should be separated into phases of 2-3 weeks to allow review of case counts, hospitalizations, and deaths.

Farzad Mostashari, MD gives the epidemiologist’s view of where we are with coronavirus:

• The number of new cases isn’t reliable because nobody is collecting when the patient’s symptoms began versus when the test results became available.
• The high (and increasing) rate of positive tests (at nearly 20% nationally) probably means that only high-risk people are being tested, so we don’t know the extent of the pandemic.
• New York City’s ED trend should be watched closely. 
• New York City recorded 9,447 non-COVID deaths in just over one month versus the normal of 5,400.
• Cases are being undercounted based on the ratio of cases to deaths, and deaths are being undercounted as well because it can take up to a month for a patient to die from coronavirus. He thinks new US cases are more likely running 400,000 per day versus the 30,000 that are being reported.

A new NBC News / Wall Street Journal voter poll finds that:

• 60% are worried that the government will lift stay-at-home measures too quickly and cause more deaths.
• 32% worry that the restrictions will remain in place for too long, harming the economy.
• 44% approve of the White House’s handling of the pandemic, while one-third of respondents are satisfied with the federal government’s efforts to provide COVID-19 tests and medical supplies.
• CDC continues to earn a high level of public trust even though its public visibility has been nearly eliminated.

The CDC’s failure to get a COVID-19 test rolled out quickly was caused by poor manufacturing processes that contaminated one of the test’s three components, according to an HHS review. FDA has concluded that CDC violated its own lab standards in failing to isolate the kit-making process. The kits were usable, but CDC took more than a month to remove the spoiled component. The CDC also made mistakes in choosing to include the problematic component at all (since it added little value but delayed rollout) and decided to make the kits themselves in Atlanta instead of using an outside contractor.

Federal authorities arrest California internist Jennings Staley, MD for selling an undercover FBI agent a $4,000 “COVID-19 family treatment pack” that included hydroxychloroquine, azithromycin, anti-anxiety medications, IV drips, and use of a hyperbaric oxygen chamber. The doctor guaranteed the FBI agent that the kit would prevent or cure coronavirus, bragged about smuggling the hydroxychloroquine into the US from China, and sold the agent package upgrades that included Viagra and Xanax. He’s charged with mail fraud. The doctor also operates Skinny Beach Med Spa, which offers medical weight loss, testosterone and growth hormone treatments, laser hair removal, tattoo removal, face rejuvenation, vein removal, Botox, vampire facials, platelet rich plasma therapy  injections, hangover IVs, and body sculpting (that’s a lot of external medicine for an internal medicine doctor).

Best tweet of the weekend.

Other

Weird News Andy observes that a leopard was “spotted” (WNA is showing off that he knows that leopards don’t have stripes) in a hospital bathroom in India. It was captured safely and relocated.

Sponsor Updates

• Cerner is collaborating with Fortified Health Security to offer managed security services to healthcare organizations, regardless of their EHR vendor.
• Elsevier launches the COVID-19 Healthcare Hub for free access to toolkits, expert insights, research resources, and COVID-19 guidelines.
• Wolters Kluwer will give AHIMA members access to a custom solution within the MediRegs Compliance Suite that includes content on federal regulatory changes to HIM professionals.
• Meditech releases updated decision support and guidance for coronavirus.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a the latest episode of its Critical Care Obstetrics Podcast, “Maternal Levels of Care.”
• Pivot Point Consulting VP of Advisory Services Laura Kreofsky receives Consulting Magazine’s 2020 Women Leaders in Technology Award.
• Redox releases a new podcast, “Digital Health Startup Advice with Dr. Roxie Mooney.”
• The National Council for Prescription Drug Programs re-elects Surescripts CIO Mark Gingrich to its trustee board, and elects Director of Standards Tim McNeil and Manager of Clinical Informatics Larry King to two NCPDP workgroups.

Blog Posts

• Using Facesheets to Act on Powerful Information (Lightbeam Health Solutions)
• Innovation: The Lasting Legacy of the COVID-19 Crisis (Loyale Healthcare)
• Rural Health Models in the Age of COVID-19 (Meditech)
• Using Improvement Science in Healthcare to Create True Change (Health Catalyst)
• Physical Therapy Work from Home Telehealth – HIPAA Compliance Basics (MWTherapy)
• 4 Ways Location Data Can Help Public Health Experts Fight COVID-19 (NextGate)
• Three Big Trends that Will Impact Pharmacy Communication (Omnisys)
• How health plans can prepare now to close gaps in care when COVID-19 subsides (Experian Health)
• How to Improve Telehealth for COVID-19 (PatientBond)
• Real-time Solutions for Provider Organizations to Increase In-person and Telehealth Appointments Amidst COVID-19 (PatientPing)
• Three Communications Challenges Impacting Collaboration in Healthcare (PatientKeeper)
• New CMS Tools and Guidelines for COVID-19 Now in Effect (QliqSoft)
• What Our Four Core Values Really Mean (SailPoint)
• Stay professionally connected while socially distant (StayWell)
• COVID-19 Pandemic: Prevent the Oncoming Medical Information Crisis (SyTrue)
• COVID-19 clinical pathways available at no charge for 12 months. (Voalte)
• Communication Workflows in Pop-Up Bed Locations: We Can Help (Vocera)
• 4 steps to getting the most out of your analytics (Waystar)
• New Telehealth and COVID-19 Updates for Google My Business (WebPT)

Contacts

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