News 5/20/20

Top News

Microsoft announces Cloud for Healthcare, its first industry-specific cloud offering.

The platform provides capabilities to deploy virtual visits, assessment chatbots, remote monitoring, referral management, patient engagement tools, and intelligent outreach.

The new Booking app in Teams allows providers to schedule, manage, and conduct virtual visits from inside Teams.

Microsoft is offering a six-month free trial of Cloud for Healthcare.

Reader Comments

From Nutter Round: “Re: Epic. I’m interested in how the company is responding to Wisconsin’s overturning of stay-at-home recommendations. Will it penalize employees who take advantage of the ‘right’ to congregate in bars?” I will invite Epic folk to weigh in, although I can’t imagine that the company is mounting an operation to surveil the after-work activities of its employees.

From Remote No More: “Re: returning employees to in-office work. I work in the IT department of a healthcare provider in a large city. I’d like to hear how other provider IT departments are planning for such a return. No sense in planning this in a silo.” Good question, thanks. I’ve created a quick response form for provider IT department folks to anonymously describe their policies and practices for bringing remote workers back to the office. HIStalk crowdsourcing is of high value to readers who are looking for ideas, so please take a moment to respond. I’m sure we would all be interested in general hospital policies about bringing at-home workers back to the office as well.

From Long-Time Reader: “Re: not HIT related. A piece of the GI snare broke off during removal of a polyp from my duodenum. My lawyer’s GI expert says standard protocol does not requiring examining the snare afterward to see if it broke since the assumption is that the patient will just pass it anyway.” This was not an anonymous submission and therefore represents a real request for help, so GI clinicians are welcome to comment.

From Media Horror: “Re: MedTech Breakthrough Awards. Seems like yet another shady healthcare racket.” The company is suspiciously protective of its privacy given that it claims to be a marketing intelligence organization even though it seems only to dispense awards. Its minimal online presence hides everything important: physical address, executive names, telephone number, and award judging methodology. It masks its website’s domain registrar and lists no employees on LinkedIn other than the “photo not supplied” and generically named managing director James Johnson. It seems to offer no products or services beyond handing out awards. I can’t say that it’s a health IT racket, but I can say that it at least bears a strong physical resemblance to others I’ve seen that typically involve offshore companies.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Narrative Shift. The Herbster, WI-based company crafts written and visual narratives for companies who understand the value of generating excitement and curiosity about their products and services with prospective customers. A powerful narrative builds the brand effectively, gets the attention of prospects, and establishes stickiness with current customers. The company has 23 years of healthcare experience and thus does not require customers to educate its team or to develop their own marketing and sales deliverables. Narrative Shift is especially interested in working with new and founder-led ventures. As the company concludes, “We’ve seen too much crappy marketing and design developed for health technology companies,” motivating it to take on the mission of delivering attractive, witty, creative, and effective messaging. Thanks to Narrative Shift for supporting HIStalk.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner joins the Fortune 500 largest US companies by annual revenue, coming in at #498. 

PE Hub reports that Francisco Partners is looking for a buyer for medical practice scheduling platform vendor QGenda. FP made its growth investment in June 2016. The Atlanta-based company reportedly has EBITDA of $25 million on revenue of $75 million.

Omada Health, which offers a chronic disease management platform primarily to employers, acquires digital physical therapy solution vendor Physera for a rumored $30 million. Physera has raised $10.8 million, most of it in a March 2019 Series A funding round.

Sales

• Collective Medical is providing the technology that Cigna uses to quickly identify and manage its customers who visit an ED with symptoms of possible COVID-19 infection.

People

Experity hires Kim Commito (WellSky) as SVP of product management.

COVID-19

A JAMA Network editorial says that the federal government could be collecting COVID-related patient data in real time using existing EHRs and HIEs rather than emailed worksheets and anonymous digital thermometer reports, but it would first need to overcome issues such as opt-in requirements, willingness of hospitals to participate given the possible alienation of their profitable patients, and lack of a national identifier. The authors recommend creating a national health IT infrastructure that would allow real-time, patient-level data collection as has been done in other countries (including using cell phone-based location data), but with its use limited to public health emergencies.

The geospatial expert who developed Florida Department of Health’s COVID-19 dashboard that was touted as the gold standard by the White House says she was fired after refusing to “manually change data to drum up support for the plan to reopen.” Rebekah Jones was offered a settlement to resign after disagreeing with her bosses. They had ordered her remove a column containing the date in which patients said they first experienced symptoms since some of those occurred weeks before the state officially admitted that residents had been infected. Florida’s government has declined to provide race and ethnicity case details and won’t give scientists the underlying data that the site uses to allow them to perform their own analyses, while a graph published by the Georgia Department of Health that showed a continuous case decline was found to have been sorted in descending rather than chronological order.

President Trump tells reporters that he is taking the unproven malaria drug hydroxychloroquine to prevent coronavirus infection. Asked about the medical evidence that supports his decision, he replied, “Here’s my evidence: I get a lot of calls about it.” FDA softened its previous advice immediately after the president’s statement, moving from a position that consumers should not take the drug outside the hospital setting to advising that it’s up to them and their doctor to decide.

Fluid physics researchers determine that six-foot physical distancing is adequate as long as wind speed is zero, but saliva droplets can travel up to 20 feet in even a light breeze.

Moderna reports that the coronavirus vaccine it is developing has raised antibodies in the eight patients who are receiving it, with levels comparable to those seen in recovered COVID-19 patients. Experts warn that many drug trials look good in early phases but fail quickly afterward.

A preliminary, small study in South Korea finds that recovering COVID-19 patients do not spread infection, as the virus they shed is dead. The government will therefore allow patients who have been discharged from isolation to return to work or school without obtaining a final negative test.

COVID Exit Strategy maps the readiness of states to reopen safely based on the White House-issued gating strategy of disease spread, hospital capacity, and testing capacity.

Utah, North Dakota, and South Dakota have rolled out contact tracing apps without much success in generating participation rates of under 2%. Utah’s Healthy Together app has resulted in zero instances in which contracts were traced.

A health reform professor says she was wrong in calling for the federal government to require that private insurance pay for COVID-19 testing. Reasons: a huge number of people need to be tested, many of them retested repeatedly; providers can set whatever price they want with the cost ranging from $50 to $1,000 per test; it doesn’t help people who don’t have insurance; and insurers will need to reduce test access or raise premiums to cover the cost. She says a better approach is a testing and vaccination fund, overseen by the federal government, to provide free diagnostic and antibody tests for anyone who needs them to return to work or classes. That group could also negotiate pricing for a vaccine if and when one is developed.

Sponsor Updates

• MassChallenge features CareSignal in its new video, “Innovation in the Age of COVID-19.”
• Meditech AVPs Janet Desroche and Cathy Turner, RN speak with ANIA President Cheryl Parker, PhD, RN about the company’s response to the COVID-19 outbreak.
• Experian launches an interactive US map showing populations most susceptible to developing severe cases of COVID-19.
• MedTech Breakthrough names Kyruus Provider Match for Consumers as its “Best Patient Registration & Scheduling Solution.”
• Vocera Vina is named “Best Overall MHealth Solution” in the MedTech Breakthrough Awards.”
• Clinical Architecture releases the latest edition of its Informonster Podcast, “A History and Analysis of ICD-10.”
• ConnectiveRx will participate in a virtual job fair May 27 from 8:30-10 a.m.

Blog Posts

• The Benefits of Healthcare IT Staff Augmentation for Acute Needs (314e)
• A New Normal: Rethinking Elective Procedures & Informed Consents (Access)
• How to Scale & Optimize Your Telehealth Offerings (Part 2) (AdvancedMD)
• A conversation with Brian Sanderson, National Healthcare Leader at Crowe LLP (Artifact Health)
• Cares Act Part III: Why telehealth should be in your future plan (Bluetree)
• Unprecedented Times Call for Unprecedented Humanity and Thoughtfulness (Bright.md)
• Health IT and the COVID19 Pandemic (Datica)
• Real-time home health notifications and patient insights (CarePort)
• Ways to Improve Interoperability During the COVID-19 Pandemic (ChartLogic)
• 2020 Health System CIO Priorities – CHIME Survey (CereCore)
• How the COVID-19 Pandemic is Affecting Care at Children’s Hospitals (Dimensional Insight)
• Planning to Reopen Amid COVID-19? 5 Steps for Success (Dina)

Contacts

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

Morning Headlines 5/19/20

Holmusk Announces Closing of US$21.5 Million Series A Funding Round, Led by Optum Ventures & Health Catalyst Capital

Behavioral health and chronic disease-focused technology and analytics company Holmusk raises $21.5 million.

MTBC Reports Record First Quarter 2020 Revenue

The health IT company attributes record Q1 revenue of $22 million, a 45% increase over the year before, to its CareCloud acquisition in January.

Cerner joins the Fortune 500

Cerner breaks into the Fortune 500, a ranking of companies with collective revenue representing two-thirds of the country’s economy, at 498.

Amazon extends telemedicine pilot to warehouse employees in Seattle area

Amazon expands its Amazon Care telemedicine service initially offered to its Seattle office workers to nearby warehouse employees.

BlueCross BlueShield of Tennessee to make telehealth coverage permanent after expansion amid COVID-19 crisis

Insurer BlueCross BlueShield of Tennessee announces that it will continue to cover expanded telemedicine services after the pandemic ends.

Curbside Consult with Dr. Jayne 5/18/20

As a consultant, you never know what’s going to come your way. Even projects that seem like they’re going to be straightforward might not be, as was the case with something I worked on recently.

I was dealing with a practice that had an issue with a staff member who was allegedly snooping through employee charts. They asked me to take a look at their audit trails and put together documentation so they could confront her. Finding the data in the EHR was easy since it has an activity log for each patient encounter that can be accessed by clicking a link at the end of the visit note. This is front-end visible data, so any user with the right access can look at it. That made me wonder why they needed to hire a consultant in the first place, other than to be able to say that they worked with an expert resource. I was sad that I didn’t even need to access the database.

The next step was cross-referencing the access time stamps with the actual patient visit time stamps, to either rule in or rule out whether the staffer might have rightfully accessed the charts as a part of the clinical encounter. When the charts are being accessed at midnight, it starts pointing towards an unusual pattern of behavior. When the midnights occur while the employee is supposed to be on vacation, you start to know that you have a winner.

Getting confirmation of the employee’s work schedule and days off was one of the biggest challenges since the practice didn’t want people to know they were investigating the employee. I had to talk to the payroll people to confirm the dates. Much of my engagement was being coordinated through an office manager who was relatively new to the practice, so I assumed that either she was just overwhelmed and wanted me to deal with everything or wasn’t sure of all the data points that needed to come together to make the case for inappropriate access.

Once we had the data in hand, the next step was putting together a report of the intrusions into various charts. Excel is my second language, so I had it all documented in a couple of hours and sent it over.

This is where the engagement turns strange. They wanted me to add documentation to each episode of chart access to specify why it was inappropriate. Sure, I said, send me over your employee handbook and I’ll tie each episode back to the relevant parts of your code of conduct and whatnot. I also offered to review their HIPAA training materials and link my findings back to that as well, functionally putting the nail in the coffin of this medical records misadventure. Since I haven’t been working clinically, I was happy to add a couple more hours to the engagement.

I didn’t hear back for a couple of days and the office manager didn’t respond to follow up emails. I escalated to calling (which I rarely do) and didn’t hear back from the voice mail messages I left either. I finally became irritated and reached out to the physician in charge of the practice, figuring that since he signed my engagement agreement, the buck would stop with him. I caught him in the car, and either he was distracted and just started talking off the top of his head or he had forgotten that they had left out a few key points when they hired me to do this work.

The snooping employee in question turns out to be the ex-wife of one of the practice’s physician owners. The situation is not just an employee discipline problem, but is also linked to a spousal support situation, with concerns that if the employee / ex-wife is terminated, the physician owner / former spouse might have to pay more. He doesn’t want her terminated.

Are you kidding me? Is this not something that could have been brought up when the engagement was outlined? I guess I’ll have to add some interrogatory questions around this type of shenanigans to my engagement intake form.

The plot thickened further. It turns out that the practice didn’t send over the employee handbook because they don’t have one. They also have no documentation of its employees having attended HIPAA training except for a log showing the date the employee watched some YouTube video on HIPAA. That video is no longer accessible, so we have no idea what they watched or whether they agree that they watched it. There is no documentation of a post-test or other evidence of mastery, so it’s going to be awfully hard to tie the misbehavior back to clear violations of office policy. The practice is liable for a HIPAA violation, but they can’t claim that the employee should have known better if there’s no documentation that she ever knew what HIPAA was or how it affected her.

Once this mess became apparent, it was clear why they hired a consultant. No one in the practice wanted to deal with the steaming pile of finger-pointing and ex-spousal angst that it was.

A couple of days later (and after a couple of calls with all parties involved on the practice side), the engagement was again expanded, with additional time for the creation of office policies and procedures regarding HIPAA training, chart access, use of practice resources outside working hours, and more. What started as a simple little project became not only a decent amount of work, but a great story for my next healthcare virtual happy hour. You simply cannot make this stuff up.

I have no idea what forces transpire to make a practice think it’s OK to operate this way in the year 2020, but apparently it has been going on for a long time. They were shocked that I also recommended they discuss this with their various liability carriers and their general counsel, to obtain additional advice on what to do next. I love writing policies and procedures, so it was great to settle into the sofa and spend some quality time with my laptop on a long, rainy weekend. I’m presenting their updated training plan to them next week along with their new employee handbook. Although this after-the-fact effort won’t do much to help them with their problem employee / ex-spouse, it will at least put them on a more solid footing moving forward.

How does your practice handle employee medical records violations? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/18/20

Cerner, Hallmark, H&R Block: when Kansas City’s big employers plan to return to office

Cerner will begin moving employees back on campus Monday, starting with 10% of its workforce and aiming for no more than 50%.

UnitedHealth Group and Microsoft collaborate to launch ProtectWell™ protocol and app to support return-to-workplace planning and COVID-19 symptom screening

Microsoft and UnitedHealth Group offer their self-developed ProtectWell coronavirus symptom screening app, which they will use for their own employees, to all US companies at no charge.

Software problems thwart patient consultations with NHS specialists

The NHS and its remote consult vendor, Attend Anywhere, attempt to get the health service’s telemedicine software up and running reliably after several outages last week.

House and Senate Democrats Introduce Public Health Emergency Privacy Act

Lawmakers introduce the Public Health Emergency Privacy Act, which would require individuals to opt in and that data collected for pandemic efforts be deleted afterward, and would prohibit using the data for purposes outside of public health.

Monday Morning Update 5/18/20

Top News

Cerner will begin moving employees back on campus Monday, starting with 10% of its workforce and aiming for no more than 50%.

Employees will be encouraged to wear masks, fitness centers and cafeterias will be closed, elevators will be limited to two passengers, and staircases will be designated as one way.

The company says positions in its consulting and client support areas may remain virtual permanently.

Reader Comments

From Allscripts Insider: “Re: Allscripts layoffs. About 60 people on Monday, several of whom I know.” Unverified, but reported by several folks.

HIStalk Announcements and Requests

Few poll respondents have been tested for COVID-19, although a significant percentage tried but couldn’t get access to a test. Maybe I should ask about antibody testing now that those are more widely available.

New poll to your right or here: How do you expect your family’s financial security to look on January 1, 2022 compared to the same day in 2020?

Webinars

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

Acquisitions, Funding, Business, and Stock

In Asia, health tech giant Ping An Healthcare, whose market cap is $15 billion, removes Wang Tao as chairman, executive director, and CEO.

Announcements and Implementations

Banner Health launches chatbot-powered “virtual waiting rooms” from LifeLink to collect patient check-in information before all telehealth and in-person office visits.

Microsoft and UnitedHealth Group offer their self-developed ProtectWell coronavirus symptom screening app, which they will use for their own employees, to all US companies at no charge.

COVID-19

Few of the 1,200 LifeBridge Health employees who have been tested for COVID-19 antibodies are positive, suggesting that most of its employees do not have immunity.

In England, BBC looks at the healthcare technologies that have changed in response to COVID-19:

• One hospital developed a “call for help” app for ICU workers who need assistance and who otherwise would need to leave a patient’s room and use another set of PPE, with the app featuring large fonts for viewing through visors and sensitive buttons that respond to double-gloved fingers.
• Expanded staffing of the NHS’s 111 national non-emergency medical help line.
• Creation of machine learning models that predict demand for ICU beds and ventilators, now being extended to estimate length of stay.
• Rapid rollout of video consults, with 88% of GP practices in Wales offering them within a month, after which their use was extended to hospitals, mental health services, and nursing homes.

Former National Coordinator David Blumenthal, MD, MPP and his brother, Senator Richard Blumenthal, JD (D-CT) warn that COVID-19 contact tracing – whether by app or by human contact tracers – is intrusive by definition, as identifying contacts requires reviewing social media posts, text messages, credit card statements, and other personal records. They say that while the notification system that Apple and Google are rolling out limits contains privacy-preserving technologies, the US is overdue for a federal consumer privacy law. Senator Blumenthal and several other Democratic senators and representatives introduced on Thursday the Public Health Emergency Privacy Act, which would require individuals to opt in, require that data that is collected for pandemic efforts be deleted afterward, and prohibit using the data for purposes outside of public health.

FDA orders the shutdown of a broadly supported Seattle COVID-19 population testing program pending federal government review. Seattle Coronavirus Assessment Network ran afoul of FDA by telling participants the result of their tests, which places the program within the realm of diagnostic – rather than surveillance – testing, requiring a different FDA group to review the safety and accuracy of its at-home collection kits. A predecessor program that identified the first US cases of COVID-19 infection using patient swabs from a previous flu study was ordered closed by federal and state officials because the researchers did not have patient consent for the new use of their samples and their lab was not certified for diagnostic testing.

New York City Mayor Bill de Blasio chooses Health and Hospitals to run the city’s COVID-19 contact tracing program instead of the Health Department, which has extensive experience in doing the same work for tuberculosis and HIV. Health and Hospitals CEO, Mitchell Katz, MD had previously urged the mayor to avoid mitigation measures, arguing that most people recover and will then contribute to herd immunity. Katz’s predecessor says, “Just because they both have ‘health’ in the name doesn’t mean they’re in the same business … this is a job for the Health Department.”

Former FDA Commissioner Scott Gottlieb, MD notes that the pandemic has slowed dramatically in the US after a long plateau, a trend that could be boosted by seasonality as summer sets in. Cases are declining or flat in most states, but a handful have an expanding case count and relaxation of mitigation steps will cause growth. He also notes that 40% of states don’t report COVID-related hospitalization, so the national count is incomplete.

Sponsor Updates

• Health Catalyst appoints Mark Templeton (DigitalOcean) to its board.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Clinical Concepts in Obstetrics podcast, “Team Skills.”
• Spirion raises over $9,000 for local restaurant workers impacted by COVID-19 closures through its This One is On Us restaurant relief program.
• StayWell publishes a new infographic, “Content marketing strategies to recharge from COVID-19.”
• Surescripts publishes a new report, “Pharmacist Perspectives on the Specialty Fulfillment Process.”
• TriNetX adds the Brazil-based Techtrials integrated, real-world dataset to its global health research network.
• Vocera publishes a new CNO Perspective, “Nurses Have Stepped Up. Now It’s Time to Support Them as We Move Forward.”

Blog Posts

• Answering the $3 Trillion Question: Five Critical Strategies Essential to Healthcare’s COVID-19 Financial Recovery (Loyale Healthcare)
• How Meditech Customers Worldwide are Meeting the Challenges of the COVID-19 Pandemic (Meditech)
• The Top Five Insights into Healthcare Operational Outcomes Improvement (Health Catalyst)
• 6 Small Changes to Complement Your Physical Therapy Marketing Strategies (MWTherapy)
• Growing Stronger Through Change (Netsmart)
• MythBusters! Credentialing and Contracting (OmniSys)
• Automating Charity Care Checks for a Better Patient Financial Experience (Experian Health)
• COVID-19 Highlights Physician Burnout, Mental Health Concerns in Healthcare (PatientKeeper)
• Understand Contact Tracing & Digital Tools Available Now (Pivot Point Consulting)
• Protect Your Data Against Increased Ransomware Risks (Pure Storage)
• Introducing Botcasts (QliqSoft)
• How to plan for outages and build team resilience during a pandemic (Redox)
• How Medical Practices & Groups Use Digital Health Campaigns to Close Gaps in Care & Deliver Better Outcomes (Relatient)
• Forget your password while working remotely? We can help! (SailPoint)
• 5 Reasons Why You Need an Independent Partner for Meditech Projects (Santa Rosa Consulting)
• Three Data Errors Stifling Healthcare Marketing Outreach and Trust (SymphonyRM)
• The Dos and Don’ts of Telehealth Billing Compliance (WebPT)

Contacts

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

Weekender 5/15/20

Weekly News Recap

• Cerner moves its October health conference to an online format.
• Epic is working with an unnamed group on a COVID-19 “immunity passport.”
• AMA publishes privacy principles for companies that aren’t HIPAA covered entities, such as technology firms.
• Quarterly reports from Livongo and Health Catalyst beat Wall Street expectations for revenue and earnings.
• Akron Children’s Hospital creates the country’s first endowed chair in telehealth and appoints its CMIO to the role.
• Researchers find that an app’s four-question COVID-19 questionnaire can determine with 80% accuracy if the user is infected.
• KLAS says that more than 100 Epic customers are using its AI-powered model, making it the only inpatient EHR vendor to have a significant number of sites live on AI.

Best Reader Comments

Epic/COVID-19: If Epic has really done rigorous analysis on 100 million patients and 30 drugs, don’t they owe it to the public health experts (and to public at large) to publish that information? … Same goes for the deterioration index mentioned in the conversation. If this index has really been successful in providing early alerts to front line clinicians at over 100 health systems (and has discriminated meaningfully between COVID-19 induced crash and other underlying cause of crash) and has been a factor in reducing COVID-19 related mortality (or even in reducing hospital stay or ventilator use etc.) then that’s a huge success and breakthrough! Why not publish those results and performance of the index? Why not publish it so that other non-Epic hospitals can also use it and save lives? (Corona_Verona)

Direct Trust is doing good work, but it is mostly around how to get the next generation out and building standards for the solutions to use. Who uses, how they interpreted, and what they exchange via those standards will dictate how effective their efforts will be. Carequality is an interesting concept, but if you don’t solve the underlying interoperability failures, then you are back to the same problem. I know several EHRs are trying to get together and do formative testing between themselves, but it is slow going and has been recently hobbled. We know with certainty that certification testing is not sufficient to solve this problem Here is a challenge for you. Can you exchange your top 100 problems, allergies, medications, procedures, labs, results at 100% accuracy with the top three ambulatory, acute, and SNF solutions? Can you then create a longitudinal record for the top 10 most common conditions with and without co-morbidities — and exchange that with 100% accuracy? (Brody Brodock)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a ubiquitously overused excuse for inaction and unwarranted “privacy” protection. And it is definitely a favorite blocking tactic of hospital administrators, especially witless ones. I have been told at my bank and grocery store that rule or policy was for preventing a potential HIPAA violation. Just for giggles, I generally ask the earnest clerk/cashier: “Who is the covered entity in question?” or “Which of the 18 protected health information identifiers are being exposed?” When they admit they don’t know what I am talking about, I explain that they obviously do not understand the HIPAA law. (Wadiego)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. M in Washington, who asked for math manipulatives for her kindergarten class. She reported in February, “My students are aware that generous and thoughtful folks have donated these manipulatives in order to enhance their math skills. I am so happy to know that my current and future students will all benefit and become better mathematicians because of your generosity. We are currently working on composing and decomposing numbers, and the number windows came in so handy. Critical thinking is happening. With the rockets, students had to basically find the numeral, the appropriate ten frame, the tally, and the array that represent the same number. Seeing how the students persevere and seeing their smile brings me so much joy.”

A Cambridge, MA pub that reopened as a COVID-19 antibody testing site in partnership with the owner’s physician brother lasted four days before the city shut it down over zoning issues. According to the vice mayor, “I felt that it was a little bit odd and quite honestly concerning to see a restaurant pivot from serving food to being a phlebotomy site.”

FDA provides guidance for disinfecting refrigerated trucks that temporarily held human bodies so that they can again carry food.

A doctor treating a COVID-19 patient at Advocate Christ Medical Center (IL) leaves the man’s sister a voicemail but fails to hang up afterward, with the doctor’s phone then continuing to capture her telling co-workers, “Look, he’s going to die. It’s just a matter of time. For the safety of everybody that’s involved, we should not do chest compressions on him.” The man died 10 days later, after which his sister expressed concerns that he didn’t receive all the care he could have.

An Emmy-winning camera operator records parts of his two-week COVID-19 hospital stay on his phone, hoping to leave his family a record of what he feared would be his final days. He is recovering at home and says he hopes his videos will encourage people to maintain physical distancing and wear masks. His wife’s mother had died from COVID-19 two weeks before his admission in mid-March.

A woman in labor whose husband rushed her to a Louisville hospital only to find the doors locked gives birth on the sidewalk, with a 911 dispatcher walking her husband through the delivery. He couldn’t find anything to tie off the umbilical cord, so he used one of the COVID-19 masks that his grandmother had knitted for the family. The couple’s new son is fine.

In Case You Missed It

• News 5/15/20
• EPtalk by Dr. Jayne 5/14/20
• HIStalk Interviews Richard Atkin, CEO, Greenway Health
• News 5/13/20
• Curbside Consult with Dr. Jayne 5/11/20
• HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health
• Readers Write: Have You Lost Your Job?
• Monday Morning Update 5/11/20

Get Involved

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

Morning Headlines 5/15/20

Donation to Akron Children’s establishes new chair that may be first in nation

Akron Children’s Hospital (OH) will use a $1 million donation to endow the country’s first chair in telehealth, to be held by CMIO and oncologist Sarah Rush, MD.

Utah has rejected the Apple-Google approach to tracing coronavirus, and is using an app made by a social media start-up instead

The state of Utah opts for contact-tracing app technology from Twenty, a social media startup that pivoted from developing a meet-up app to the Healthy Together app in just three weeks.

23andMe study to recruit sickest Covid-19 patients in bid to unravel role of genetics in disease

In an effort to find out if genetics plays a role in COVID-19 symptoms, 23andMe enlists hospitals to help it recruit severely ill patients for an expanded study.

News 5/15/20

Top News

Cerner announces that its annual conference, scheduled for October 12-14, will be conducted as a virtual event.

The conference, one of Kansas City’s largest, is among 78 that have cancelled so far during the pandemic. City officials estimate that the cancellations will cost the local economy $137 million in lost hotel room bookings alone.

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor Pure Storage. The Mountain View, CA-based, NYSE-traded company gives technologists their time back. Pure delivers a modern data experience that empowers organizations to run their operations as a true, automated, storage-as-a-service model seamlessly across multiple clouds. One of the fastest-growing enterprise IT companies in history, Pure helps customers put data to use while reducing the complexity and expense of managing the infrastructure behind it. Healthcare organizations enjoy always-available EHR information with always-on encryption and quality of service, with no performance impact and no tuning required. Virtual desktop infrastructure applications are accelerated with <1 ms latency and 99.9999% FlashArray availability. With a certified customer satisfaction score in the top one percent of B2B companies, Pure’s ever-expanding list of customers — which includes Atlantic Health System, Carilion Clinic, and Intermountain Healthcare – are among the happiest in the world. Thanks to Pure Storage for supporting HIStalk

Webinars

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

Acquisitions, Funding, Business, and Stock

Health Catalyst reports Q1 results: revenue up 28%; EPS -$0.06 vs. -$0.23, beating analyst expectations for both. The company said in the earnings call that uptake of its free, rapidly developed COVID-19 analytics package is strong, including its patient and staff tracking solution and capacity planning tool. Health Catalyst expects its professional services revenue to dip due to hospital financial challenges and says it may discount those services as a long-term partner. The company will consider acquisition of capital-struggling startups that have developed apps that could help hospitals with revenue, cost, or clinical quality.

Health IT entrepreneur Tim Peck, MD launches Curve Health to help hospitals and nursing homes coordinate and manage patient care. Peck’s previous venture, Call9, shut down last summer after raising $34 million with help from investors that included 23andMe’s Ann Wojcicki and Ashton Kutcher.

Sales

• Boston Children’s Hospital will implement KyruusOne provider data management and Kyruus ProviderMatch for Consumers.

People

Wolters Kluwer moves Stacey Caywood, MBA, who is CEO of the company’s Legal & Regulatory division, to CEO of its Health business. She replaces health IT long-timer Diana Nole, MBA, who has joined Nuance as EVP/GM of its healthcare division.

Trinity Health names Eileen Matzek, MBA (Amita Health) as CIO of Loyola Medicine (IL).

Recently hired Haven Healthcare COO Mitch Betses will manage the company’s operations until a replacement is found for Atul Gawande, MD, who confirms that he will step down as CEO and transition to board chair. Betses is a pharmacist and has spent most of his career as EVP of CVS Health.

Nordic promotes Sriram Devarakonda to advisory services managing director and practice leader; Ian Mamminga to SVP of managed services solutions; and Andy Mueller to SVP of managed services operations.

Announcements and Implementations

True Women’s Health (MI) deploys a menopause virtual care and support app that it built using OptimizeRx’s RMDY digital health tools. The app provides educational videos, trackers, surveys, coaching and telehealth consults, appointment scheduling, and progress and symptom tracking.

NHS Trusts in southwest England will set up a temporary hospital using Epic software from Royal Devon and Exeter NHS Foundation Trust.

Change Healthcare offers de-identified COVID-19 claims data for analysis of disease progression, intervention effectiveness, and overall health system impact.

HBI Solutions develops an EHR-friendly fall risk assessment algorithm for elderly patients.

Meditech adds Apple Health support to Magic and Client/Server, making the app usable by all of its customers.

Government and Politics

Thirty amicus briefs were filed from both sides of the political aisle with the US Supreme Court on Wednesday in support of the Affordable Care Act, which Republican state attorneys general and the White House are seeking to repeal. Economic scholars warn of the damage that would be caused by eliminating what could be the only health insurance option that is available to the 37 million newly unemployed Americans, along with the many billions of dollars worth of uncompensated care that struggling hospitals would be forced to provide.

COVID-19

The New York Times looks at why some city hospitals were being overwhelmed with COVID-19 patients even as others had 3,500 open beds, sometimes under the same corporate umbrella of Health & Hospitals. Governor Andrew Cuomo concludes, “We don’t really have a public healthcare system. We have a system of hospitals.” Load-balancing challenges include moving unstable patients and overcoming the hospital ethos of treating every patient who arrives there. The state basically took over capacity and transfer management to fix the problem of competing, brand-obsessed “independent duchies” that couldn’t overcome their cultural differences to work together voluntarily.

Experts question the accuracy of COVID-19 testing numbers given the lack of federal reporting guidelines. Some states track the number of samples rather than the number of patients, some do not report racial or ethnic breakdown of cases and deaths, and others have switched methods midstream to make past versus present comparisons impossible. Virginia just started combining the results of viral tests and antibody tests, which is indefensible statistically and epidemiologically but expedient politically, with the chief of staff of the state’s Democratic governor (a pediatric neurologist) explaining that Virginia wants to move ahead of other states in its number of tests per capita. Virginia joins Colorado and Arizona in using the questionable numbers to justify re-opening and to allow bragging on improving testing numbers that still lag much of the developed world.

A study finds that just 4.4% of the population of France, which was hit hard by COVID-19 with 27,000 deaths, has been infected, making it unlikely that countries can reach herd immunity to avoid a second wave of infection as social restrictions are eased

CNBC interviews Epic CEO Judy Faulkner, who made these points in response to some inexpert questions:

• Epic customers have increased their telehealth business by an average of 100-fold, with some going from 20 daily visits to 8,000.
• The company analyzed its database of 100 million patients to see if any of 30 targeted drugs might protect patients against COVID-19, finding that none did. They will next look at outcomes from convalescent plasma therapy, the use of remdesivir, and whether patients who recovered from COVID can become infected again.
• Faulkner says, “We were actually the originators of interoperability” in the early 2000s, first among Epic users, then with all EHR users via Share Everywhere.
• Epic is working with an unspecified group to develop a phone-based “immunity passport” that indicates that the user has tested positive for COVID-19 antibodies (though the unmentioned challenge is that nobody has proven that the presence of those antibodies ensures immunity and quality of the tests is all over the place in the absence of FDA approval of the predominantly China-developed tests).
• Asked about whether Epic will develop contact tracing phone apps, Faulkner cited a healthcare blog’s poll (presumably the one I just ran on HIStalk) that showed two-thirds of people wouldn’t participate.

The state of Utah opts for contact-tracing app technology from Twenty, a social media startup that pivoted from developing a meet-up app to the Healthy Together app in just three weeks. Once out of beta, the app will become part of the state’s contact tracing program.

23andMe enlists hospitals to help it recruit patients for a study of severely ill COVID-19 patients. The consumer genetics testing company hopes to find genetic correlations that could explain why some patients become sicker than others.

Collective Health, which offers insurance administration tools for self-funded employers, develops an evidence-based return-to-work app that performs worker risk assessment, screening, and testing.  The company notes that the app protects employees because their information isn’t shared with their employer, who only sees a completed “pass” that can be used to allow the employee to return to work.

Kaiser Health News shares a story of a restaurant worker who tested positive for COVID-19 in late March, after which her co-workers were notified immediately that they should self-quarantine. The woman’s second job was as a cafeteria cashier at University of Washington Medical Center, which did not notify co-workers or even require the infected employee to wear a mask while working. Employees of other hospitals say they either aren’t notified or aren’t told who the infected co-worker is, which means they don’t know the extent of their exposure.

President Trump tells employees of a medical equipment distribution center Thursday that COVID-19 testing is “overrated” in suggesting that the US’s world-leading number of cases is due to over testing. He said, “When you test, you have a case. When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases.”

Australia’s NSW Health reduces patient wait time to receive negative COVID-19 test results from several days to several hours by using a text messaging bot to send them electronically to those who opt in.

Former National Coordinator CEO Farzad Mostashari, MD and former CDC Director Tom Frieden, MD, MPH say in a CNN editorial that the crisis-created bias toward action is encouraging tech companies like Apple and Google to push proximity-based contact tracing apps as an “overreaction of surveillance,” as low usage could then encourage the next step of hiding the apps or coercing users to run them. They say tech companies should improve the accuracy of information they allow on their social media platforms, open up access to de-identified user data to help public health officials understand the response to shelter-at-home and distancing strategies, and support human contract tracers, all while “first doing no harm.”

Other

Strata Decision Technology’s newly launched National Patient and Procedure Volume Tracker shows that 55% fewer Americans sought hospital care in March and April at the 51 health systems studied. Some areas with the largest drops potentially involve life-threatening problems, such as cardiology and oncology. Volumes dropped by more than half for congestive heart failure, heart attacks, and strokes, raising again the ongoing question of what is happening with those patients. The health systems that were studied reported a staggering average revenue drop of $1.35 billion each in the two-week study period.

Akron Children’s Hospital (OH) will use a $1 million donation to endow the country’s first chair in telehealth, to be held by CMIO and oncologist Sarah Rush, MD.

Sponsor Updates

• Ellkay’s LKCOVID-19 lab connectivity package that supports testing, results, and state reporting processed 1.6 million COVID-19 tests in April.
• Hyland offers free subscriptions to its ShareBase cloud-based sharing and collaboration tool.
• Imat Solutions releases a new podcast, “Reliance EHealth Collaborative Leverages IMAT for COVID-19 Response.”
• Veradigm will incorporate Specialty Patient Enrollment software from Surescripts into its AccelRx specialty medication fulfillment solution.
• Optimum Healthcare IT publishes a white paper titled “ Targeted Training: Promoting EHR Efficiency.”
• A 2020 US EMR Market Share report from KLAS highlights Meditech as one of two EHR vendors that saw significant market share growth in 2019.
• Wolters Kluwer Health releases a new report, “Next-Generation Nurses: Empowered + Engaged.”

Blog Posts

• Telehealth: Healing Action at a Distance (EClinicalWorks)
• How Sesame pivoted during COVID-19 to support local healthcare providers (Google Cloud)
• The Importance of Informed Audits in the Time of COVID-19 (Hayes Management Consulting)
• The Evolution of the Chief Information Officer (The HCI Group)
• Dang, wish I’d have had a good automated IGA system … (Imprivata)
• 5 areas to consider when reopening your operating room (Nordic)
• Protecting and Supporting Clinicians Fulfills a Nurse’s Call to Caregiving. (Infor)
• Interoperability’s Role in Fighting the Pandemic (InterSystems)
• Preparing for the Return of Elective Surgeries (Intelligent Medical Objects)
• What April’s Consumer Search Behavior is Telling Us About Coronavirus & How to Prepare for Recovery (Kyruus)
• Navigating Pandemic Relief Options (Meditech)
• Medical Device Integration: Essential Infrastructure (Capsule)

Contacts

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

EPtalk by Dr. Jayne 5/14/20

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 5/14/20

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

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

Health Catalyst Reports First Quarter 2020 Results

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

RxSense Announces Investment From Parthenon Capital

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

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

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

Dr. Atul Gawande Assumes New Leadership Role at Haven

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

HIStalk Interviews Richard Atkin, CEO, Greenway Health

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How would you characterize the state of interoperability?

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

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

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

Do you have any final thoughts?

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

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

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

Morning Headlines 5/13/20

App Shows Promise in Tracking New Coronavirus Cases, Study Finds

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

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

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

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

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

News 5/13/20

Top News

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

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

Reader Comments

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

HIStalk Announcements and Requests

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

Webinars

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

Acquisitions, Funding, Business, and Stock

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

Sales

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

Announcements and Implementations

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

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

COVID-19

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

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

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

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

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

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

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

Other

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 5/12/20

Carbon Health Lands $26M, Triples Headcount

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

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

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

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

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

AMA issues new principles to restore trust in data privacy

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

Curbside Consult with Dr. Jayne 5/11/20

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Lissy Hu, MD, CEO, CarePort Health

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Do you have any final thoughts?

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

Readers Write: Have You Lost Your Job?

Have You Lost Your Job?
By Jim Gibson

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Happy hunting.