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Weekender 4/17/20

April 17, 2020 Weekender 1 Comment

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Weekly News Recap

  • The FCC starts accepting applications for its $200 million telehealth expense reimbursement program and issues the first set of grants.
  • The American Medical Association and American Hospital Association publish a cybersecurity guide for working from home.
  • Meadville Medical Center (PA) recovers from its second malware-caused downtime of 2020.
  • Apple and Google announce plans to work together to develop Bluetooth-powered COVID-19 contract tracing on mobile phones.
  • Alphabet’s Verily defends its decision to limit access to its COVID-19 screening website to users who have created Google accounts.
  • Allscripts subsidiary CarePort Health publishes an analysis of COVID-19 using the inpatient EHR data it stores.
  • Democratic lawmakers express privacy concerns about a White House discussion of using hospital information for coronavirus surveillance, with Politico reporting that health HIT vendors Collective Medical, PatientPing, and Juvare have responded to White House inquiries.

Best Reader Comments

If you are simply extending an EMR that is already built, the short timeline [to configure a pop-up hospital] is reasonable. For ease, it’s basically a new nursing unit and you can leverage the order catalog and documentation that has already been built. You are utilizing the same make and model of devices that you use in the inpatient setting and you have the same pharmacy formularies. At its core, its a lot of copying and rerouting of printing / orders. Also keep in mind that these pop-up hospitals are not full service, so a lot of the custom build for the ancillary areas doesn’t need to be replicated. (Modern CIO)

Hospitals have always been a bit of a chimera: ERs and ICUs as public health infrastructure, sliding through surgery suites, labs, imaging and office buildings for physician practices that were more commercial, into outright profit-maximizing activities of many kinds, all under a not-for-profit umbrella in most cases. Throw in medical schools and huge research efforts and it is a mess. Pandemic has laid it bare. Our politics don’t exactly promise to sort out society’s needs here. Step out one level and it gets more perverse, as commercial health up the funding stream in the current situation are banking billions in payments for needed and unneeded care that isn’t happening. (Randy Bak)

The presence or absence of universal healthcare is not the determining factor in what is going on right now; the determining factors are the complete absence of a scientifically-informed Federal response, and an economy that relies on hourly wage labor in service industries, and minimal to no infrastructure to support us when those industries evaporate overnight. People’s ability (or inability) to pay for the treatment they receive if they become infected is a separate factor, and is significant in its own right, but is not the reason our economy just cratered. (HIT Girl)

With provider revenue dropping across the country and major expense reductions announced, it is time for our vendor community to step up and give us a break on those ongoing expenses. I’d like to see a 25-50% reduction for the duration of the crisis – a minimum three months. How about it, Partners? (Bill Spooner)

I agree that it would be nice it for the IT vendors (and others) to give the provider community a break on the provider expenses. I see most respectable, financially secure vendors working with the providers over the next few months until things normalize. However, vendors that are experiencing their own financial issues may have a hard time doing that. Bottom line, you can’t get blood from a turnip. We are going to have to all work together to move beyond this catastrophe. It is going to take much longer to recover than it did for us to get into this mess. CEOs and other top level executives from all business sectors are going to have to take a financial hit. Everyone is going to have to tighten their belt. This will be a true test of the survival of the fittest. Will be interesting to see which hospital groups, providers and provider groups, as well as IT vendors will come out on the other end of this event. (Not All In)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Mr. H in California, who requested components for his high school’s robotics team. He reported a few weeks ago, “I want to personally thank you for your generous gift of the pneumatic supplies needed for the Robotics team. The kids will use the pneumatic cylinders to manipulate game pieces for our competitions. Without these devices the robot would not be able to compete against more well-funded teams. So far, the students have started building our 2020 robot using the supplies that were graciously donated.”

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Providence St. John’s Medical Center (CA) suspends 10 nurses after they refuse to work in its coronavirus unit without N95 masks. One of the suspended nurses has since tested positive for COVID-19. An insider says the hospital ordered the nurses to work with only surgical masks and threatened to report them to the state nursing board for patient abandonment if they didn’t get to work. The hospital was giving N95 masks to doctors, who told the nurses they shouldn’t be working without them. The hospital declined to comment, citing labor laws and HIPAA, but has said it will now issue reprocessed N95 masks to all caregivers who care for COVID-19 patients. It has not reinstated the 10 nurses pending an HR investigation.

A cybersecurity firm finds 500,000 sets of login credentials for the Zoom teleconferencing service for sale on the dark web for use by Zoombombers, complete with emails, passwords, meeting URLs, and host keys.

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In Sweden, Princess Sofia completes a training program and begins working as a volunteer at Sophiahemmet Hospital, where she will disinfect equipment and work in the kitchen. 

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A pregnant COVID-19 patient who spent 11 days in a medically induced coma on a ventilator in a New York hospital awakens to meet her new son, who was delivered by emergency C-section right after she was admitted to the ICU. She was discharged Wednesday and her son Walter has tested negative for COVID-19.


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Morning Headlines 4/17/20

April 16, 2020 Headlines Comments Off on Morning Headlines 4/17/20

Representative Population Antibody Study Underway in North Carolina

Wake Forest Baptist Health partners with Scanwell Health to launch a study using at-home antibody testing kits that it hopes will give officials a better understanding of how prevalent the virus is in North Carolina.

FCC Approves First Set of COVID-19 Telehealth Program Applications

Just three days after opening the application window, the FCC awards over $3 million to six healthcare organizations in New York, Atlanta, Cleveland, New Orleans, and Pittsburgh for the purchase of telemedicine services.

AMA & AHA respond to rise in cyber threats exploiting COVID-19 pandemic

The American Medical Association and American Hospital Association create a cybersecurity guide for working from home.

Circle Medical Rapidly Expands Telemedicine Offering with New Investment

Decathlon Capital Partners makes a seven-figure investment in UCSF-affiliated primary care company Circle Medical.

FDA debuts new online portal to encourage donation of plasma from recovered COVID-19 patients

The FDA launches a website that connects recovered COVID-19 patients with opportunities to donate their plasma for treatment research.

Comments Off on Morning Headlines 4/17/20

News 4/17/20

April 16, 2020 News 8 Comments

Top News

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Meadville Medical Center (PA) recovers from its second breach of the year as it brings its systems back online after a March 26 malware attack.

Its Meditech software was back up and running March 31.

The hospital suffered a payroll system breach in late January.


Reader Comments

From Doctor Who: “Re: specialists covering COVID units. Would you want to be one of those patients?” I would not want to be (for multiple reasons), but my takeaway is that we don’t have many doctors left who can treat an entire human rather than just their singular body part niche or who can do more than crank out repetitive, high-paying procedures. We’re putting medical students and residents on the front lines in assuming they have useful skills to offer despite their inexperience, yet many of their counterparts in practice who already have completed an MD degree, broad training, and then residency in ophthalmology, dermatology, pathology, etc. have been away from general patient care for so long that they are often not much good for anything beyond performing nurse aide work. The percentage of medical school graduates from the past 40 years who are still practicing and can confidently perform basic patient triage, stabilization, diagnosis, and management must be tiny. I would trade those COVID-draftee specialists for a good nurse who can monitor vital signs, keep the pumps and ventilators going, administer drugs and start IVs with skill, and keep me comfortable and feeling cared for.

From Afternoon Delight: “Re: favorite albums. Someone on Twitter asked for favorites. What are yours? I need new quarantine music.” It’s hard to pick just a few, but these are ones that were groundbreaking, have stood the test of time (meaning most are old), and that have enough beginning-to-end brilliance that I find myself listening all the way through. I included two live albums that show the musicianship of the band better than their studio originals.

  1. Close to the Edge (Yes)
  2. The Rise and Fall of Ziggy Stardust and the Spiders from Mars (David Bowie)
  3. Master of Reality (Black Sabbath)
  4. A Hard Day’s Night (The Beatles)
  5. Forever Changes (Love)
  6. 2112 (Rush)
  7. Dark Side of the Moon (Pink Floyd)
  8. The Doors (The Doors)
  9. Life’s Rich Pageant (R.E.M.)
  10. Doolittle (Pixies)
  11. Live at Leeds (The Who)
  12. Are You Experienced (The Jimi Hendrix Experience)
  13. One Night Only (Bee Gees)
  14. Odessey and Oracle (The Zombies)
  15. Selling England by the Pound (Genesis)

Webinars

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

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


Sales

  • The California Department of Veterans Affairs will implement Netsmart’s MyUnity EHR to care for residents in its eight Veterans Homes.
  • Carle Health (IL) signs a five-year deal with Health Catalyst for its data and analytics software and services.
  • UK HealthCare (KY) selects virtual ICU software from Philips.
  • St. Elizabeth Healthcare will install radiology and breast imaging software from Sectra across its five hospitals and outpatient facilities in Kentucky and Ohio.

People

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Goliath Technologies names Karen Armor (5Nine) SVP of worldwide sales.

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Matt Williams (Loop Returns) joins Healthfinch as CTO.


Announcements and Implementations

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GE Healthcare and Microsoft retool software that was originally intended to debut at HIMSS into cloud-based monitoring software for COVID-19 patients in ICUs. The companies are offering the software for free, minus installation costs, through January.

Mayo Clinic (MN) develops a contact-tracing tool using EHR data that alerts staff if they come into contact with patients or staff members who have been diagnosed with COVID-19.


COVID-19

ProPublica finds that at-home deaths are skyrocketing in some cities, with the most likely causes being either COVID-19 or serious conditions that people didn’t report because of infection fears. New York City’s deaths outside of hospitals and nursing homes is running six times average. Detroit authorities responded to 150 “dead person observed” calls in the first 10 days of April versus the average of 40, almost all of those occurring in low-income neighborhoods. Some coroners are not listing COVID-19 as a contributing factor in the absence of a positive test even though CDC allows doing so, while some states are falling behind on death reporting due to low staffing and outdated computer systems. As with many aspects of coronavirus, we just don’t know.
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Verily assures senators that its COVID-19 screening website for California residents adheres to data protection standards, and adds that, despite criticism, it has no plans to open up the full platform to people who don’t have Google accounts.

UnitedHealth Group reports Q1 earnings of $5 billion on revenue of $64 billion, postulating that any higher costs of diagnosis and treating COVID-19 were more than offset by people who are cancelling their routine appointments and elective surgeries.

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UCSF Health develops a campus-wide COVID-19 dashboard that updates in near real time. I’m slightly surprised that it doesn’t include non-patient data such as availability of PPE, ventilators, drugs, and staff (including the number or percentage of staff infected or quarantined), but I’m guessing those metrics are monitored from a different dashboard.

The Washington Post highlights the approaches that health systems are taking to notify their employees of exposure to patients or staff with COVID-19. Mayo Clinic’s internal contact-tracing app seems to be unique, as most organizations mentioned in the article rely on ad hoc screening and testing methods with little to no transparency about cases, capacity, and PPE across their facilities. Meanwhile, CDC data suggest that at least 9,200 healthcare workers across the country have tested positive for COVID-19, 723 have been hospitalized, and 27 have died as of April 2.

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Wake Forest Baptist Health partners with Scanwell Health to launch an at-home antibody testing kit study in North Carolina that it hopes will give officials a better understanding of how prevalent the virus is in the community. The study will also incorporate syndromic surveillance technology from Oracle that will help to identify virus hot spots in nearly real time.

The FDA authorizes emergency use of a saliva test for diagnosing COVID-19 patients, which healthcare workers say will enable them to exponentially increase testing, save PPE, and limit staff exposure to the virus.

A Florida nursing home trade group asks Governor Ron DeSantis to give them immunity from negligence lawsuits that are related to COVID-19. The governor is already blocking media efforts to name facilities where residents have tested positive or to force nursing homes to disclose their resident deaths.

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The pandemic is causing financial problems for safety net hospitals that were already struggling with low-paying Medicaid patients. They are losing money from surgeries, losing employees to hospitals that are paying more to deal with the COVID-19 surge, and receiving little from the federal government’s stimulus plan whose payments are based on Medicare revenue rather than COVID-19 patient volume or extra costs.


Other

The American Medical Association and American Hospital Association create a cybersecurity guide for working from home.

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Researchers at MIT’s Computer Science & Artificial Intelligence Laboratory develop a router-like box that can be used to passively monitor COVID-19 patients at home. Ideal for seniors in assisted living facilities, the wall-mounted device is capable of monitoring movements, sleeping patterns, and breathing.

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Weird News Andy says this story isn’t as edgy after 26 years. A 76-year-old man in China who experienced lost vision in one eye and chronic headaches after being mugged 26 years ago is cured when surgeons remove a rusty 4-inch knife blade from his brain.


Sponsor Updates

  • The local paper profiles HCTec’s efforts to equip providers with telemedicine and optimized EHRs.
  • Gartner includes Imat Solutions in its “Healthcare Payer CIOs, Leverage Vendor Partners to Succeed at Clinical Data Integration Report.”
  • InterSystems releases a new episode of its PulseCast podcast, “Jeff Fried: A Deep Dive on Data Operationalization.”
  • Kyruus publishes a “Guide to Enabling Access During & After the COVID-19 Crisis.”
  • MerlinWave adds AxiaMed’s patient payment technology to its MWTherapy software for physical therapy practices.
  • Netsmart becomes a founding company of the Telewound Coalition.
  • HCTec creates HITComm, a LinkedIn group for healthcare stakeholders that focuses on sharing COVID-19 health IT solutions.
  • Zen Healthcare IT helps EHealth Exchange integrate AdVault’s digital advance care planning software with its health information network.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/16/20

April 16, 2020 Dr. Jayne 3 Comments

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HIMSS could learn a lesson from the American Academy of Family Physicians, which is offering a “worry-free registration” guarantee for its annual conference that is scheduled for October 2020 in Chicago. Attendees can cancel their registrations at any time, for any reason, up to the day before the meeting and will receive a full refund. Bookings prior to April 30 can also receive an additional $100 discount in honor of National Doctors Day. AAFP’s hotel policy is deposit-free and rooms can be canceled within 72 hours of the meeting without penalty. Cancelations within the 72-hour window will incur a one-night charge. It’s unclear if the world will be ready for major conferences by that point, but at least they’ve come up with a good solution to try to make a go of it.

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There has been a lot of chatter in the virtual physician lounge around plans for testing and contact tracing in preparation for the end of stay-at-home orders. Excitement about the point-of-care ID Now COVID-19 test from Abbott Labs has been building, as many practices already own the machines that are needed to run them. The company has shipped 560,000 test cartridges across the US, but I haven’t heard of anyone in my area receiving them despite having placed orders as soon as the company started taking them. An article says that the majority have been sent to “outbreak hotspots,” with a request for customers to prioritize testing for frontline healthcare workers and first responders. They are manufacturing 50,000 tests per day and plan to increase the capacity to two million tests per month by June.

Rapid testing is key to strategies for reopening the US economy, along with robust contact tracing. Even though San Francisco is located in a tech hotbed, they are going somewhat back to basics with their approach to contact tracing. They’re putting together a task force to interview patients and trace their interactions, building their team from 40 people to as many as 150. They are engaging researchers, medical students, and staff from the University of California, San Francisco.

Even though major parts of the process will be manual, the group will use online and phone-based tracking tools to follow up with exposed persons and assess them for symptoms. The team will also seek permission to review phone location data for additional tracking.

Where other countries are mandating use of state-developed apps to track movements and trace contacts, many people in the US would fight any mandatory sharing of data, despite the fact that they willingly give it up every day to random apps that sell their data and aren’t trying to keep people from dying.

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Testing and contact tracing efforts are going to be expensive and will further stress an already burdened healthcare system. Nearly every facility has a story of salary cuts and hiring freezes along with layoffs and furloughs. Hospitals are still struggling, even those who are not yet in the midst of the surge. They’re paying inordinate amounts for personal protective equipment and still can’t get enough of what they need to function under anything but crisis standards of care.

Next time you read an article about COVID response, look at the pictures. Are the clinicians wearing consistent PPE, or is it a hodgepodge of gear, some brought from home? Do people have head coverings, masks, gowns, and face shields? Do they have masks that fit? Are all clinicians protected, or just those performing the highest risk procedures?

It saddens me to know that I had better PPE when I played the Quipstar game show in Medicomp’s HIMSS booth than some of my colleagues now have. Once we reach the point where healthcare workers have enough PPE that they can use in the way it was designed, not in a way that is modified for scarcity, then we’ll know that we are moving in the right direction.

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Greenway health did a great job with their recent blog helping practices understand how the CARES Act may impact them. I’m on a number of vendor email lists and Greenway consistently sharesg relevant information without being too salesy. This particular piece included brief descriptions of the different types of loans and funds available to practices. It may help a practice who don’t know their options for weathering this storm.

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If you’re on the team maintains your facility’s charge master or load contracts, make sure you’re keeping up with all the changes CMS is throwing your way. Today’s update was an increase in the payment Medicare is making for certain high-volume coronavirus lab tests. This payment of $100 covers “COVID-19 clinical diagnostic lab tests making use of high-throughput technologies developed by the private sector that allow for increased testing capacity, faster results, and more efficient means of combating the spread of the virus.” High-throughput systems are defined as those that can process more than 200 specimens in a day. Medicare will also be paying new specimen collection fees for homebound patients and those who can’t travel, like nursing home patients.

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Road warriors of the US, rejoice. DoubleTree by Hilton has released the official bake-at-home recipe for their signature chocolate chip cookies. As a consultant who has opted to drive an extra hour each day from my hotel to the client site so that (a) I didn’t have to stay somewhere sketchy, and (b) I could have these cookies waiting for me, I am thrilled. I haven’t made them yet, but I am intrigued by the inclusion of lemon juice in the recipe. Apparently more than 30 million cookies are baked every year, and the cookie was the first food to be baked in orbit on the International Space Station a few months ago. It took two full hours for the cookie to bake in microgravity, although the experiment log documented the smell of cookies at 75 minutes. The official DoubleTree statement says, “A warm chocolate chip cookie can’t solve everything, but it can bring a moment of comfort and happiness.”

I bake an inordinate amount of cookies every year with my dad, so I couldn’t agree more. (The picture above is just a fraction of our 2019 effort). My local market is finally back in stock with flour, so these are on the schedule for the weekend.

Email Dr. Jayne.

Morning Headlines 4/16/20

April 15, 2020 Headlines Comments Off on Morning Headlines 4/16/20

GE Healthcare and Microsoft are bringing a COVID-19 patient monitoring tool to health systems

GE Healthcare and Microsoft retool software originally intended to debut at HIMSS into monitoring software for COVID-19 patients in ICUs.

Meadville hospital’s computer system not yet fully restored after malware attack

Meadville Medical Center (PA) expects to have all of its IT systems back up and running three weeks after a ransomware attack took everything offline.

Alphabet’s health company defends decision to require a Google account to use its coronavirus screening site

Following in Apple’s footsteps, Verily assures senators that its COVID-19 screening website for California residents adheres to data protection standards, and adds that it has no plans to open up the full platform to non-Google account holders.

Comments Off on Morning Headlines 4/16/20

Morning Headlines 4/15/20

April 14, 2020 Headlines Comments Off on Morning Headlines 4/15/20

Epic and University Hospital of New Jersey Partner to Lead Statewide Surge Response

Epic donates software and services to the temporary hospital set up in the Meadowlands Exposition Center by University Hospital (NJ).

Mayo Clinic develops COVID-19 tracking tool for staff

Mayo Clinic (MN) develops a tool using EHR data that alerts staff if they come into contact with a COVID-19 patient.

W2O acquires social media analytics platform Symplur

Marketing firm W20 acquires Symplur, a healthcare-specific social media tracking platform that it used to create a coronavirus media tracking tool for the California Life Sciences Association.

Comments Off on Morning Headlines 4/15/20

News 4/15/20

April 14, 2020 News 14 Comments

Top News

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The FCC opens the application window for its $200 million COVID-19 telehealth cost reimbursement program.

Applications are completed on an eight-page fillable PDF form that is then emailed to the FCC.

Non-profit healthcare provider sites that treat patients, schools, health departments, rural clinics, and skilled nursing facilities are eligible to have their expenses reimbursed for telecommunications and connected devices.

Awards are expected to be under $1 million per applicant, with the money being assigned on a rolling basis until the $200 million has been committed.


Reader Comments

From Just Laid Off by Allscripts: “Re: the US healthcare system. We like to believe that the public needs are best served when the organizations that provide the needs are run like businesses. Now we’re seeing the downside. While all healthcare organizations across the globe will struggle with the need to care for so many sick people, it seems beyond dysfunctional that hospitals might close or have to layoff healthcare workers because of not doing elective surgeries.” We also have the problem that most Americans couldn’t afford to pay modest healthcare bills even before the pandemic took income and health insurance away from millions of them. I’ve seen estimates that health insurance premiums will rise 40% or more next year, which takes us further down the death spiral of unaffordable premiums, unaffordable deductibles and co-pays, and health systems that expect to be paid richly for providing sometimes questionably necessary services. On the other hand, it wouldn’t surprise me if Americans get healthier over the short term as we reduce our contact with profit-maximizing providers and thus the dangers of overprescribing, overtreatment, elective surgery, and medical errors (the uptick in poor outcomes post-pandemic will be conveniently blamed on deferred maintenance). What we want or need as patients is incidental to whatever makes the cash registers ring. I would like to think that we as patients – which is everybody, not just all at the same time — will demand better, but most of us don’t have a lot of lobbyists and politicians in our pockets.

From Curves Flattened: “Re: COVID-19. Being sequestered accomplished the goal of flattening the curve. Well done!” My joy is restrained by the fact that “flattening the curve” is not the same as “reducing the area under the curve.” Drastic societal efforts so far were intended only to extend the timeframe over which people get infected and require hospital care. Your odds of being taken out by COVID-19 in the long term haven’t changed, other than maybe you get the chance to die unconscious on a ventilator instead of while gasping for air without one. We have no proven treatments and no vaccine. Meanwhile, our globally underperforming healthcare system isn’t the immediate problem – it’s that our world-leading logistics failed us in being unable to source and distribute COVID-19 tests, ventilators, and personal protective equipment.

From Tommy Hawk: “Re: webinars. I suggest that vendors, at least for the near term, allow webinar registration using non-corporate email addresses. This would allow those of us who are newly unemployed to continue our education and maybe our employment.” I agree, although for broader reasons. We make recordings of the webinars that we produce freely viewable on YouTube (I think we were the first to do this). We discourage webinar sponsors from requiring more than the absolute minimum of signup information since studies have shown a huge drop-off in registrants if you bug people to list their employer, job title, telephone number, buying timeline, etc. in ensuring a nagging contact afterward. I haven’t seen many webinars whose content would help a competitor, and I haven’t seen many companies whose competitive intelligence strategy consists of watching webinars. It reminds me of the old HIMSS conference days, when a few paranoid and mostly crappy companies posted sentries around their booth perimeter to shoo away non-providers who might be seeking out the nuclear secrets that were hidden inside.

From Seagull Soaring: “Re: HIStalk. My communication is a simple thanks and gratitude for all of your hard work on HIStalk. I read your site nearly every day and it makes me better at my job. You provide a great service. Thank you.” I’m gratified at the several recent messages like this one that came out of nowhere. Thank you for those who sent them. 

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From Michael Raymer: “Re: ventilators. Your original post led to finding our first large private donor. We will return the first ventilators to clinical use this week, three weeks after the initial idea. Thanks for your help! We need help continuing to identify ventilators. We have acquired almost 50 in one week.” Health IT long-timer Mike is the co-founder of the non-profit Co-Vents, which is refurbishing retired ventilators for clinical use to meet the short-term need.


HIStalk Announcements and Requests

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I’ve received some thoughtful answers from consultants about how their work is changing, as requested by a consultant reader who is struggling. Add yours to be included in my writeup later this week.


Webinars

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

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

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


Acquisitions, Funding, Business, and Stock

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Life sciences data and managed services vendor IntegriChain acquires the life sciences division of Cumberland, which provides managed services, advisory services, and systems integration for life sciences contracts, pricing, and revenue management.

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Marketing firm W20 acquires Symplur, a healthcare-specific social media tracking platform. W20 recently used the system to create a coronavirus media tracking tool for the California Life Sciences Association.


Sales

  • Highmark Health, Allegheny Health Network, and Gateway Health will implement Aunt Bertha, which connects people to social services that can help with food, housing, and transportation.

People

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Care team collaboration platform vendor Andor Health hires industry long-timer Raj Toleti, MS (Allscripts) as CEO and board chair.


Announcements and Implementations

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Henry Schein Medical offers providers free 90-day use of VisualDx, which enhances telemedicine visits with shared images and documents. 

QliqSoft adds patient and engagement content from Wolters Kluwer to its clinical collaboration and patient communication solutions.

ClaraPrice offers a service to help hospitals manage the ongoing reporting and payback of advance Medicare payments via the CARES Act.

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Epic announces in a second recent (and rare) press release that it has donated software and services to the temporary hospital that has been created in Meadowlands Exposition Center by University Hospital (NJ). Epic says its implementation took three days, with the first patient being admitted on the fourth day. The newly named Secaucus Federal Medical Station has beds for 250 non-COVID patients.


COVID-19

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that US employees may return to work as early as May, but employers should be prepared to offer onsite screening to detect infected but symptom-free workers. He says the rapid test platform of Cepheid is fast and requires less invasive swabbing, with other companies introducing similar machines. Gottlieb says that employers who can’t perform onsite testing should offer take-home tests or refer their employees to a local pharmacy or government program. He also recommends that employees who test positive continue being paid so they don’t have to choose between doing the right thing versus feeding their families.

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James Wright, MD, medical director at the private equity-owned Virginia nursing home that has seen 45 COVID-19 deaths among its residents so far, says that American society has chosen to warehouse its senior citizens in underfunded facilities that can’t afford adequate staffing and that are forced by economics to offer non-private rooms that don’t have access to the outdoors. His facility lost much of its staff as the outbreak began since most of them work multiple jobs and were ordered by their other employers to stop working there to avoid spreading the infection among facilities. More than 50% of the facility’s residents who tested positive have died. Wright concludes that “this will not be the last untreated virus to decimate our elders” and that “a publicly funded nursing home is a virus’s dream.”

A Harvard professor of epidemiology says that we don’t have enough data to determine who in the population might have developed coronavirus immunity. He speculates that most COVID-19 patients develop some degree of immune response, but its strength and duration is probably variable, and creating herd immunity requires a large percentage of people whose immunity is long lasting. The US’s low testing rate makes analysis impossible, but results from better-responding countries suggest that herd immunity isn’t significant. The bottom line is that scientists can’t predict immunity until widespread testing for both infection and antibodies is performed. In the absence of immunity, the only hope is a vaccine.

Preliminary evidence suggests that COVID-19 causes clotting events that can lead to thromboembolism, deep vein thrombosis, ischemic stroke, and possibly even cardiomyopathy. That may also explain why those patients go downhill so quickly from what seems like normal COVID-19 pneumonia. The presence of abnormal coagulation has been found to be predictive of pneumonia outcomes in COVID-19 patients, which could lead to recommendations that those patients be anticoagulated. 

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Analysis of the inpatient data of 1,000 hospitals by Allscripts subsidiary CarePort Health finds that COVID-19 mortality rates are about 10% overall, but 40% for those over age 85. A new finding from the analysis is that chronic kidney disease seem to increase death risk dramatically. More than half of patients who were hospitalized are under 65, while risk-adjusted death rates for men are 1.3 times that of women, both conclusions matching those of the CDC.

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Beaumont Health launches what it says is the country’s largest coronavirus serology testing program, where it hopes to test volunteers from its 38,000 employees to measure the incidence of antibody formation among people who had no COVID-19 symptoms. The health system will use the data in its return-to-work process and to identify possible donors for convalescent serum treatment. SVP/CIO Hans Keil, MBA, MA says the antibody test, which is not yet approved by the FDA, has been validated on 1,000 volunteers.

New York City increases its COVID-19 death count by 3,700 after including presumable coronavirus-related deaths that could not be confirmed because no tests were available. The city now reports more than 10,000 deaths.


Privacy and Security

Hartford Hospital (CT) announces that information about 2,400 patients was exposed in a February phishing attack in which hackers gained access to the email accounts of two employees. Several other healthcare organizations have reported similar attacks in recent months.


Other

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Sales of the stripped down Raspberry Pi computer, which starts at $35, set records as people teach themselves new skills at home and groups use them to create ventilator prototypes using hardware store components.

Doctors on the front lines of coronavirus are seeing their pay cut even as they are asked to risk infection, often without adequate PPE. This includes those whose compensation includes a significant component that is based on RVUs whose volume has been reduced with COVID-19 focus:

  • A California ED doctor who was forced to buy her own N95 masks on Craigslist will see her pay cut by at least 25%.
  • A New York ED doctor took a 10% pay cut and is expecting more.
  • The income of some specialists has dropped by 80% due to lack of procedures.
  • An urgent care company cut all salaries by 10% and confiscated all untaken PTO.
  • New York doctors are being asked to take unpaid positions at COVID-19 hotspot hospitals owned by NYC Health + Hospitals, while the organization is recruiting temporary nurses $10,000 per week plus travel expenses. 
  • Envision Healthcare will cut the pay of its doctors who work in areas that have lower patient volumes.
  • Alteon Health backed off some of its announced cuts after ProPublica reported its plans, but is still moving salaried doctors to hourly and then reducing their schedules.
  • Atrius Health is withholding pay for doctors and nurses or cutting it by 20%.

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In England, 99-year-old World War II veteran Captain Tom Moore, who hoped to raise $1,300 for the NHS’s coronavirus efforts by accepting donations for each 82-foot lap he completes around his garden using his walker, says he won’t stop even as donations have topped $3 million.

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Rio de Janeiro illuminates the Christ the Redeemer statue in medical gear on Easter Sunday to honor medical workers around the world who are battling coronavirus. Meanwhile, Brazil’s president, Jair Bolsonaro, maintains that coronavirus is “a measly cold,” asserts that it’s a media hoax intended to erode his political support, and says the virus is leaving Brazil on its own accord.


Sponsor Updates

  • Phynd will ingrate provider credentialing and privileges data from Symplr into Phynd 360, which allows organizations to publish provider  data and deploy consumer provider search tools.
  • TransformativeMed lists several health systems that are taking advantage of free use of its Cerner-integrated Core COVID-19 App for patient monitoring and data submission to health departments and the White House Coronavirus Task Force, among them UPMC, MedStar Health, UW Medicine, and Virginia Commonwealth University Health System.
  • Use of the EClinicalWorks Healow telemedicine app exceeds 1.5 million daily minutes amid the COVID-19 pandemic.
  • Montefiore St. Luke’s Cornwall Hospital (NY) and UPMC Western Maryland choose AHIMA’s compliant template library within Artifact Health’s mobile physician query platform.
  • Nuance names Avaya a top growth partner and, for the third consecutive year, its top producing channel partner.
  • Datica releases the latest edition of its 4×4 Health podcast, “ONC Final Rules on Information Blocking – Part 3.”
  • Mental Health Center of Denver implements CareSignal’s COVID-19 Companion text messaging app.
  • The Columbus business paper features the remote working strategies of CoverMyMeds.
  • Diameter Health publishes a multi-part series on new ONC, CMS regulations.

Blog Posts


Contacts

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

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Morning Headlines 4/14/20

April 13, 2020 Headlines Comments Off on Morning Headlines 4/14/20

FCC’s COVID-19 Telehealth Program Application Portal Opens on Monday

The FCC begins accepting applications for its $200 million COVID-19 Telehealth Program, which will help eligible providers purchase infrastructure, services, and devices needed to offer telemedicine during the pandemic.

Apple Responds to Senators Questioning Privacy of Covid-19 Tools

Apple responds to privacy concerns related to its COVID-19 screening app and website, stressing that the tools don’t collect user data, and that they are not bound by HIPAA guidelines.

Rapid roll-out of telehealth services in Iowa: ‘We’re just going crazy with it,’ one doctor says

Health systems in Iowa see telemedicine utilization rates skyrocket as reimbursement restrictions are lifted in light of COVID-19, prompting many to hope that virtual care will become part of their new normal after the pandemic has passed.

Mobilizing AI for Health to fight against COVID-19

As part of its AI for Health project, Microsoft will donate $20 million to advance the use of AI in the fight against COVID-19, particularly in the areas of data and insights, hospital resource allocation, treatment and diagnostics, research, and information dissemination.

Comments Off on Morning Headlines 4/14/20

Curbside Consult with Dr. Jayne 4/13/20

April 13, 2020 Dr. Jayne 2 Comments

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Despite my clinical employer’s failure to get on board with telehealth, many organizations are embracing it. The American Medical Association released a Telehealth Playbook last week. It has a lot of good information for people who might not be sure how to approach the process. It’s a bit lengthy at 128 pages, but don’t let that dissuade you, because the last 40 or so pages are worksheets.

The AMA did a good job gathering information from people who have figured this out in the past, when they weren’t in a rush as people are now. Situations are a little different when you are trying to ramp something up quickly or are using solutions that are unproven, though. Your mileage may vary to some degree, depending on how nimble your organization is and what your tolerance is for just getting something live without achieving perfection.

Not all organizations have done well with trying to manage patients remotely or making sure that the needs of patients with chronic issues are met. I have heard from multiple friends and neighbors who have visits scheduled during the next two weeks (while our state is still under a stay-at-home order) and they have received zero communication from their physicians on whether the visits will happen or how they might be executed. I’m sure some of them might be waiting to see how things unfold since they seem to change from day to day, but especially given the availability of patient portals and texting solutions to communicate with patients, it’s surprising that the practices are running silent.

There’s also an error component as practices shift visits. I have already had one pharmacy error when my primary physician canceled my annual visit. They usually send a year’s worth of refills to Express Scripts when I appear in person. This time they sent an order for a 90-day supply to tide me over until I have a visit, and Express Scripts promptly misprocessed it and sent me 30 pills. Four phone calls later, I still don’t have what I need. Fortunately I’m a bit of a pharmacy hoarder and always stay a month ahead on my refills, and it’s not something that will cause grave harm if I miss it for a few days, but I’m sure patients in those situations are experiencing similar confusion and delay.

The AMA playbook divides the process of implementing telehealth into 12 steps, with the first six being planning. Those steps typically include needs analysis, building a team, defining success, evaluating vendors, gaining buy-in, and contracting. In many organizations, these steps can take 12-18 months, and practices are now trying to do it in a matter of weeks (if not days). The playbook includes a concise “Warmup” section that talks about telehealth and provides some basic definitions, helping people understand synchronous versus asynchronous technologies and how they might benefit organizations. It glosses over some of the barriers to telehealth, though, listing them but not really explaining how much of a showstopper they can be for organizations.

Licensure issues are big, especially for organizations that are on state borders and see patients from multiple states. Although there has been some relaxation of interstate licensure during the COVID crisis, some states have their own regulations around it, where others are a bit more of a free-for-all. Even the big telehealth companies have handled temporary licensure waivers differently. One is requiring physicians to opt in to see patients in states where they are not licensed, while another is just assuming that its providers want to see patients from all states where there are waivers. Some of the waivers are already expiring, causing dramatic shifts in how many patient visits are available for physicians to staff.

Privacy and security issues are also paramount, especially given the recent federal relaxation in the level of security needed for billable visits. Providers can use commercial platforms that weren’t specifically designed for patient care, which may increase access, but also increase the risk of exploitation. Another concern is whether telehealth visits can deliver the same level of care as in-person visits with the same outcomes. Having worked for a telehealth organization that has a strong quality program, and where the antibiotic metrics are higher quality than those I saw in my brick and mortar practice, I have to say it’s more about the organization and its culture than it is about the delivery platform.

Funding a telehealth program is also a big issue. The playbook puts it squarely back on the practice to figure out, although it does define a few examples. Organizations will have to work with their payers to understand how visits might be covered and how they might impact other aspects or practice, including Accountable Care Organization cost and quality attribution. The document makes it clear that practices that go down this road will need to have dedicated resources to stay up to date on the constantly shifting landscape with payers, rules, and regulations.

Several of the steps they identify are being largely skipped over as organizations race to get telehealth solutions live. Some of them include getting feedback from staff on pain points and figuring out how different telehealth solutions might solve those issues, along with evaluating the organization’s readiness for telehealth solutions. It’s clear that whether organizations are ready or not, here it comes, so that definitely shifts the dynamic. Budgeting and identification of funding sources are also being skipped as organizations view telehealth as a way to try to preserve care delivery (and financial margins) versus just closing to patient traffic in the face of an outbreak.

Other pieces that are being skipped over include gaining stakeholder buy-in and identifying success metrics. From a vendor analysis perspective, it seems like many organizations are trying to go with solutions that might be already integrated with their EHR or otherwise using commercial solutions. There are multiple third parties that are offering no-risk or low-cost agreements for 90 days during the crisis, so that’s a good thing for practices who might just want a quick solution without significant commitment.

It’s a risk for vendors to take this approach, but if they have a solid offering and treat their clients well, it’s a great way to prove their capabilities. The contracting piece of the document made some great points about ensuring that clients understand who is going to have access to their patients’ data and ensuring scalability.

Steps 7-12 fall into the “Game Time” portion of the document. Some of these steps — like workflow design, prepping the team, and partnering with the patient — are being done in a matter of days in real life. Many of my colleagues are embracing telehealth. It will be difficult to convince them that they need to return to face-to-face visits for many of the issues they are treating. Patients are also happy with the convenience factor, so I don’t see it going away any time soon.

I’d be interested to hear from people who have rapidly executed a telehealth strategy. What worked and what didn’t? Are patients accepting it? Have you had claims come back and are there issues, or are you still waiting for the other shoe to drop? What would you warn someone who is farther back in the process? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/13/20

April 12, 2020 Headlines 1 Comment

Apple and Google partner on COVID-19 contact tracing technology

Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

Bankruptcy judge OKs sale of St. Vincent hospital to Patrick Soon-Shiong

A federal judge approves the $135 million sale of St. Vincent Medical Center (CA) to health IT, life sciences, and publishing mogul Patrick Soon-Shiong, MD who plans to turn it into a COVID-19 research facility.

Doctors at UCLA, UCSF create registry to study coronavirus effects on pregnancy

Researchers at UCLA Health and UC San Francisco launch the PRIORITY study and national data registry to better understand the effects of COVID-19 on pregnant and post-partum women.

Monday Morning Update 4/13/20

April 12, 2020 News 15 Comments

Top News

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Apple and Google will enhance their mobile devices with an API that will use Bluetooth to perform coronavirus contact tracing to help detect outbreaks.

The companies will release APIs next month that create interoperability between Android and IOS devices using apps from public health authorities. Following afterward will be the release of the full contact tracing platform.

The use scenario is this:

  1. User One carries their phone any time they’ are in public. They leave the app running.
  2. User One is assigned an anonymous, frequently changed identifier beacon.
  3. User One has close contact with User Two, who is also carrying their phone and running the app.
  4. User One tests for COVID-19. They manually enter their result into an app provided by a public health authority.
  5. User One gives their phone permission to upload a 14-day history of the identifier beacons with which they have had close proximity.
  6. User Two’s phone regularly downloads a list of identifier beacons from contacts who have tested positive.
  7. User Two’s phone alerts them that they have been exposed to someone who tested positive and tells them what they should do.

Obvious weak points of cellphone-based contact tracing:

  • Adoption in other countries that have tried this voluntary approach has been low (Apple and Google did not acknowledge that this technology wasn’t their original idea).
  • The app must be left running and the user must carry their phone everywhere.
  • The users must have smart phones; those with flip phones or no phones cannot participate.
  • Each person who tests positive must remember to enter their result.
  • Both contacts must be running the app. That means, given likely low adoption, that the odds of detecting a given exposure are tiny.
  • Bluetooth can detect proximity, but not the chances of exposure. It could record a contact anyone in nearby car or everyone behind doors in a hospital hallway.
  • People who don’t trust big companies like Apple and Google (especially the latter, given that its primary business model is using or selling user data), or who detest the concept of mass surveillance regardless of benefit, will likely opt out.
  • Public health systems must participate.
  • The US still lags in testing and results from some labs are delayed due to backlogs.

Reader Comments

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From Code Jockey: “Re: Epic consulting. Demand for my skills has evaporated as health systems have suspended EHR projects and cancelled contracting engagements. Given the 95% reduction in air carrier routes through September, there’s no way to get to their sites even if they need contractors. I’m now unemployed and trying to get a $17 per hour job at an Amazon warehouse. I’m wondering what people like me are doing – taking a break, shifting to other industries, or working remotely? What will consulting look like when this is all over, the former Monday to Thursday travel or 100% remote work? You also have Epic continuing to elbow into the contracting space. I wonder how the many staffing firms that have lined their pockets on the backs of contractors will be affected by the absence of engagements?” I offered to create a short survey for consultants to anonymously share how the pandemic has changed their work. Your thoughts might relieve some anxiety for people who are cooped up with little work available short term.

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From Financial Cannula Insertion: “Re: HIMSS20 hotels. Marriott Orlando Village is not refunding guests because they claim they were contractually guaranteed full payment by HIMSS. They’re keeping my ‘deposit’ of the full four nights that I prepaid. Here’s the email I received from the hotel GM.” The hotel says that HIMSS told it on multiple occasions that the conference would not be cancelled and asked that the hotel not release or resell any booked rooms. The hotel add that since the US had no travel advisories in place at the time the conference was cancelled (two days before FCI’s scheduled arrival), the cancellation was a HIMSS business decision that does not relieve it of honoring its vendor contracts. The GM says HIMSS signed a contract with all the Orlando hotels guaranteeing the attendee’s full payment. It’s interesting that HIMSS can legally guarantee payment terms on behalf of the actual customer, presumably by the online reservation terms specified by OnPeak since HIMSS doesn’t handle room bookings directly.

From Spumoni: “Re: HIMSS. I’m struggling with a path forward, as exhibitors seemed to be saying in your survey. Will travel return? Do I really want to sit shoulder-to-shoulder in sessions? Was the conference a boondoggle all along that was self-aggrandized by vendors along with their own importance? Meanwhile, I’m being bludgeoned by the pivot to online content delivery and life in the glow of Webex on a laptop.” It’s hard to predict the pent-up, post-isolation demand for big conferences in the potential absence of a coronavirus vaccine. People were always returning home sick even in past years, as my post-HIMSS18 poll found that 50% of respondents came home with a cold, flu-like symptoms, stomach problems, fatigue, headaches, or muscle aches. Beyond that is the economic question — is the considerable cost of attending and exhibiting worth it, especially given a year off to contemplate the value received? Or will it go back to exhibitors who mostly show up for fear they will look bad competitively if they don’t? Or will the conference irrecoverably lose critical mass with the near-certainty of fewer attendees, a sparser exhibit hall, and attendees who have grown comfortable conducting all aspects of their work remotely?

From Allscripts Sunset: “Re: Allscripts. Appears that it just hit five straight quarters without selling a Sunrise new logo deal.” Unverified.

From Allscripts Cuts: “Re: Allscripts. Word is that the board gave Black and Poulton six months in early March to cut $100 million per year in expenses. There was an expectation of laying off 1,000 to 1,500 people, but they likely used COVID to cut pay and travel to get layoffs into the 500-600 range. That will work only until full salaries return and travel picks back up.” Unverified.


HIStalk Announcements and Requests

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Most poll respondents have no personal experience with COVID-19, and thankfully few report the death of a family member, friend, or co-worker.

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New poll to your right or here, for hospital employees: which is true of your EHR maintenance fees as the pandemic cuts revenue? Click the poll’s Comments link after voting to explain.

Listening: Bachelor Girl, which I discovered while creating another playlist for my young friend (it includes Dua Lipa, James Bay, Florrie, Sia, and Hazel English). Bachelor Girl is an Australian duo that has been around for nearly 30 years, and what caught my attention was 1999’s “Lucky Me,” a cynical take on success that sounds more Nashville than Melbourne (it’s amazing that the lyric way back then says, “I’ve got so many friends on the internet, I could never be alone.” I’m also thrilling to the new album of the amazing Public Enemy and the best voice in rap, Chuck D, who raises goose bumps on 2007’s “Harder Than You Think.”

A third-hand acquaintance (well educated, upper class, long list of health conditions) is experiencing cough, fever, and fatigue and was reluctantly sent home by his employer. Some of his co-workers – who as essential workers spend their work days in close office contact — have since tested positive for COVID-19. He has dawdled in sending in his own test samples and continues to convene multi-generational family and neighborhood gatherings and takes regular, unmasked trips to grocery and hardware stores. Bill Gates was right in describing STDs – it would be easy to stop communicable disease outbreaks if those who practice bad behaviors suffered the consequences immediately instead of later or didn’t harm others in the process of doing something stupid.


Health-Related Technologies That the Pandemic Has Made (Or Will Make) Mainstream

  1. Telehealth and its integration with EHRs.
  2. 3D printing of medical supplies.
  3. Chatbots that can help keep the worried well out of the ED (instead of the previous model of hoping to bring them in as paying customers).
  4. Remote patient monitoring and clinician backup.
  5. Videoconferencing and team collaboration platforms.
  6. Patient engagement for monitoring patients who are recovering at home or who can be discharged to lower-acuity settings.
  7. Patient check-in and waiting room avoidance.
  8. Public health reporting and data aggregation.
  9. Online education.
  10. Predictive models for hospital resource needs, patient outcomes, and pandemic spread.
  11. Virtual conferences.
  12. Clinician collaboration platforms for sharing best practices and crowdsourcing treatment options.
  13. Robotics for contact-free hospital room deliveries.
  14. Rapid online publication of research findings.
  15. Syndromic surveillance.
  16. Virtual mental health services.
  17. Medical equipment clearinghouses.
  18. Contact tracing.
  19. Virtual programs for home exercise, rehabilitation, and wellness.
  20. Imaging AI for detecting specific conditions.
  21. Analytics and predictive modeling.
  22. Supercomputer-powered rapid drug and vaccine research.
  23. Wearables and mobile devices for the rapid assembly of clinical study cohorts and collection of study data.
  24. Platforms to connect people with social services.
  25. Voice assistants, such as Alexa and Siri, that have been enhanced with tools to answer specific health questions or to allow summoning help.
  26. Apps for relaxation and mindfulness for people who are quarantined and anxious.
  27. Ordering and delivery apps for food, supplies, and prescriptions.
  28. Platforms for matching clinicians and volunteers with hospitals in need.
  29. Internet-connected digital thermometers for outbreak detection.

Got more to add?


Webinars

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

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

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


People

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MaineHealth SVP/CIO Marcy Dunn died last Monday. She was 65.


Announcements and Implementations

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OmniSys offers all pharmacists — who can now administer COVID-19 tests as authorized last week by HHS — free online training that describes how to order tests, apply for a state license, perform the nasal swab, bill payers, submit positive cases, and share the results with the patient’s other care providers. The company has also enhanced its cloud-based retail pharmacy EHR with tools for documentation, reimbursement, and care plan communication.

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Experian Health offers a free, regularly updated list of COVID-19 and telehealth payer polity alerts for hospitals, medical groups, and pharmacies, describing 1,140 changes in medical coverage policy changes.


COVID-19

New York City reports that only 18,500 of its hospital beds are being used versus the 140,000 that experts feared would be required during the pandemic’s peak resource demand that happened this weekend. Hospitals are seeing declining ICU bed occupancy, hospitalizations stand at under 19,000, and the 2,800-bed emergency hospital that was created at Javits Center is treating just 300 patients. Officials credit residents of New York and nearby states for slowing the tide by staying home. Statistical experts say their surge projection models were likely thrown off by unreliable data from China and shorter than expected ICU stays. Meanwhile, physicians worry that the big drop-off in patients who normally seek hospital care for heart problems and strokes may indicate that they are fearful of going to the ED and are just suffering at home instead, possibly to their long-term detriment.

Mayo Clinic says that a COVID-triggered freeze on elective surgeries will trigger a $3 billion loss this year, forcing it to implement pay cuts and furloughs for salaried employees, freeze hiring, lay off contract employees, and stop some construction.

Politico reports that Democratic lawmakers have written to White House Senior Advisor Jared Kushner to express concerns about the patient privacy implications of his rumored discussions with technology companies to collect COVID-19 public health surveillance data. A White House task force wants to develop a national coronavirus surveillance system that would provide a real-time view into hospital ED visits and bed capacity using “multiple private sector databases,” raising fears of a Patriot Act type encroachment on privacy. A government spokesperson says that neither Kushner nor the White House are aware of such a project, but Politico uncovered a memo written by three companies – Collective Medical, PatientPing, and Juvare – that Politico says was in response to an administration request on the feasibility of quickly gaining visibility into how many patients are seeking hospital care.

The federal government’s distribution of the first $30 billion in emergency hospital grants raises the ire of some hospitals because payments are based on the volume of past Medicare billing amounts, not their coronavirus burden. Hospitals in lightly hit states, some of which continued to perform rofitable elective procedures, are being given 25 times the amount of money per COVID-19 case as those in New York. The formula also provides payments to providers who aren’t on the front lines, such as podiatrists and ophthalmologists. HHS said the goal was to get the money out quickly and it will focus the next round on providers who were most impacted by coronavirus.

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More evidence that New York City is unintentionally undercounting COVID-19 deaths – FDNY reports that cardiac arrest calls and DOAs have risen six-fold over the same period last year, which probably means that people who die of COVID are being counted instead as cardiac deaths. Italy saw the same six-fold increase in deaths, far more than the official COVID death counts.

A single long-term care facility in Virginia has recorded 40 deaths that are linked to COVID-19, with the medical director blaming lack of staff and equipment, low funding, and trying to isolate positive cases when people have lived in the same room for years. The facility is owned by private equity firm Tryko Partners, which operates 3,000 skilled nursing beds.

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The US federal government is using daily, e-mailed hospital worksheets to visualize bed capacity, but Germany has a live map.

Florida is underreporting COVID-19 deaths because the state health department has decided to count only deceased state residents, omitting snowbirds and tourists who die in Florida.

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United Airlines and basketball player Steph Curry honor the 20 USCF clinicians who volunteered to serve on the front lines of New York City hospitals.


Other

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The 3,000-bed temporary hospital that was created in Chicago’s McCormick Place convention center will use Epic in a partnership that involves Epic, Rush University Medical Center, and the City of Chicago. Chicago’s Department of Health reached out to Epic early in the planning.

This seems HIMSS20 related and perhaps could be instructional to HIMSS. Burning Man Project cancels its annual Black Rock City gathering for 2020 due to coronavirus and will instead run a virtual version that it says “will likely be messy and awkward with mistakes.” It asks ticket-holders to consider donating part of their full refund to the project so it can continue to support its key programs, noting that “things are looking a little grim” in trying to run year-round programs when 90% of the project’s annual income comes from Black Rock City. Tthe group has already undertaken layoffs and pay cuts. Burning Man also observes that rolling over this year’s ticket sales as a credit for next year’s event is not practical because that simply “punts the financial challenges to a future date.” The group had cancellation insurance, but it doesn’t cover pandemics. The CEO recorded a personal, heartfelt message to explain the situation, an approach of unscripted humility and openness that stands in contrast to the HIMSS “strictly business” approach that makes it feel more like an us-versus-them vendor than a non-profit that wears its lofty societal aspirations on its suit sleeve. I’m not sure how many HIMSS members and exhibitors feel a personal attachment or loyalty to the organization or its goals as its global ambitions and expansion strategy has made it impossible to define a typical member.


Sponsor Updates

  • MDLive reports visits and user registrations increase to all-time highs with virtual healthcare as first-line defense in fight against pandemic.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, launches the “Clinical Concepts in Obstetrics” podcast.

Blog Posts


Contacts

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

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Weekender 4/10/20

April 10, 2020 Weekender Comments Off on Weekender 4/10/20

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Weekly News Recap

  • The COVID-19 global tracking website that was put together in a few hours by a first-year Johns Hopkins graduate student is drawing one billion page views per day.
  • Allscripts lays off staff and cuts costs.
  • HIMSS revises its “no exhibitor refunds”policy for HIMSS20 and offers a 25% credit that can be applied to the next two annual conferences.
  • Despite an ongoing lack of COVID-19 testing nationally, hospitals aren’t using the available capacity of independent labs because they don’t have EHR ordering and results interfaces.
  • Duke’s Margolis Center for Health Policy, along with two former FDA commissioners and former National Coordinator Farzad Mostashari, MD, proposes a national COVID-19 surveillance system.
  • AMA publishes a physician guide for implementing virtual visits.
  • FCC publishes details of its $200 million COVID-19 Telehealth Program.

Best Reader Comments

Health systems are giving themselves gold stars for upping their stats on virtual visits, which I can’t help but find to be a tad disingenuous. Using the example from the Epic post, one organization had only 200 televisits during ALL of last year and are now counting 12,000 in just one week! Wow, except I’m not really feeling the celebration here. This success happened only because health systems were finally forced into telling their patients about the option that was probably there all along (it certainly was for Epic users). (Telehealth Princess)

The reason people didn’t do telemedicine before is because it wasn’t reimbursed at the same rates, or at all, in many cases. In addition to the obvious public safety advantages of video visits right now, insurers and CMS have agreed to broadly reimburse these services. On top of that, the government is also throwing money at hospitals to purchase telemedicine technology. The comparison to Napster is interesting. Healthcare does have a similar pricing and delivery problem that the music industry had. I wonder if some facilities will go the way of Tower Records in the coming future. So far “online doctor” services that attempt to bypass traditional payment models haven’t been particularly successful. We’ll see if that changes. (Elizabeth H. H. Holmes)

It sounds like Allscripts did a graduated pay cut. Meaning if two people are in the same role and the first employee makes more than the second, the first employee took a larger pay cut. Is that true? Doesn’t that punish harder working or more experienced or more talented employees assuming those people would be the one Allscripts would have originally given raises? (IANAL)

There will be titanic shifts across the whole economy that will reverberate for the rest of the year or even longer. Lots of docs are laid off already — the surgicenters are closed and many may not reopen.The disruption has only started. For many younger medical professionals who have never experienced a shrinking economy, the experience it will come as a shock that “MD” or “RN” does not means monotonically increasing wealth and well being. For anyone who remembers the 1990s, it is just a reminder of what we already knew. (Richard Irvin Cook)

In our county, a single for-profit health system owns the hospital and all urgent cares in the county. Last week, my wife had all of the symptoms of COVID-19 and she began to decline. I took her to the ED, and the note said that she was suspected of having COVID-19. The interesting part is they didn’t test her for COVID — their protocol was not to test anybody unless a positive test would change the treatment course. Instead of a single test, the did a CXR, metabolic panel, and a Chem 7. The Medicare reimbursement rate for a CDC COVID test is around $35.91, while my wife’s visit rang up $4,000. From a revenue perspective, it seems far more lucrative to not test for COVID-19. (Jim Bresee)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. S in New York, who asked for a VersaTiles math practice set. She said a few weeks ago, “The impact that these math VersaTiles have had on my children is immeasurable. It has allowed me to target weaknesses in individual students and help them understand the concept to mastery. The children are so focused on the task and so interested in the activities that the success rate has been through the roof. This has allowed those children who struggle, to move on to the next concept as they have now built that foundation. They have proven to be equally engaging and successful for those students who need to be challenged to do more. We will be forever blessed with your love and support.”

In Mexico, a man in a grocery store throws hot coffee on a nurse who was wearing scrubs as he shouts, “You’re going to infect us all.” Another nurse had an egg thrown at her as she waited for a ride, while residents of one small town threatened to burn their local hospital down if it treats any COVID-19 patients.

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A South Carolina ED nurse isolates herself by sleeping in a RV in her back yard that was provided by RVs 4 MDs, which helps healthcare workers find a place to stay during the pandemic.

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A hospital in Thailand fits newborns with face shields to protect them from coughing or sneezing that could contain coronavirus.

Pharma bro and Turing Pharmaceuticals profiteer Martin Shkreli offers to apply his drug development expertise to search for COVID-19 treatments in return for a three-month furlough from his seven-year securities fraud sentence.

Intensivist Julie John, MD makes a goodbye video for her children after coming down with severe COVID-19 symptoms at home and declining to call 911 because she didn’t want the presence of paramedics or the possibly being intubated to frighten her young children. She is recovering in quarantine, but even after 14 days the infection still leaves the 38-year-old doctor her feeling like she’s a 90-year-old woman with emphysema.


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Comments Off on Weekender 4/10/20

Morning Headlines 4/10/20

April 9, 2020 Headlines Comments Off on Morning Headlines 4/10/20

Behind the Johns Hopkins University coronavirus dashboard

The Johns Hopkins University and Medicine COVID-19 case-tracking site draws over 1 billion page views each day for its near-real time display of data from WHO, CDC, and other authorities.

The Nation’s Largest Convention Center Being Converted into a COVID-19 Alternative Care Facility in Chicago, To Be Equipped with Epic Health Records Software

The Chicago Department of Public Health will work with Rush University Medical Center to set up a temporary hospital within McCormick Place Convention Center that will use the medical center’s Epic system.

LabCorp and Ciox Health Enter Collaboration to Create Comprehensive Patient Data Registry

LabCorp and HIM vendor Ciox Health will develop a COVID-19 patient data registry for clinical researchers using de-identified lab testing data and data culled from EHRs.

Comments Off on Morning Headlines 4/10/20

News 4/10/20

April 9, 2020 News 2 Comments

Top News

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Nature magazine describes the spur-of-the-moment decision by a Johns Hopkins University first-year PhD candidate to create a global COVID-19 tracking dashboard for fellow researchers. He developed the site in a handful of hours.

The Johns Hopkins University and Medicine COVID-19 case tracking site is drawing over one billion page views each day for its near-real time display of data from WHO, CDC, and other authorities. 

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Developer Ensheng Dong (second from left in the photo above) is a first-year graduate student in civil and systems engineering with a focus on disease epidemiology. He also holds MS degrees in statistics and geography. He used his experience building a geospatial mapping tool to track measles hotspots to create the coronavirus display.

Dong’s thesis advisor, who help create the dashboard, has told him that this year isn’t normal and that he should “prepare for a really boring second to fifth years.”


Reader Comments

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From Down In Flames: “Re: Allscripts. Big layoffs this week.” Here’s some of what I’ve heard from the folks who emailed me. None of this is confirmed, just what they told me:

  • The company laid off 5% of employees across the board (some say it was more than that, perhaps 10%).
  • Salaries of high-earning employees were cut for six months: $100-150K (15%), $151-225K (20%), $226-325K (25%), more than $325K (30%).
  • Merit and promotion raises have been deferred until 2021.
  • All contractors have been dismissed.
  • An austerity travel ban that has been in place since early January is now being blamed on COVID-19.
  • Bonuses that were accrued in 2019 will be paid “sometime soon.”
  • Clients aren’t paying their bills due to lack of profitable elective surgeries.

From Allscripts Employee: “Re: Allscripts layoffs. Playing Titanic deck musical chairs continues, as even teams that are hitting goals are hit with reorgs every nine months that seem to be solely to allow executives to justify their existence. The C-suite will blame everything on COVID-19 instead of their many poor business decisions over the years (Practice Fusion, Avenel). They didn’t even warn employees, many of whom would have gladly left and found other jobs given the chance.” 

From PE Watcher: “Re: Allscripts. Paul Black is out of runway. The low share price has private equity circling to buy it cheap, then sell off the parts of the business like Veradigm that might attract a cash buyer.” MDRX shares are at $6.69, down 30% in the past 12 months and down 29% since Paul Black took over as CEO in December 2012 (versus the Nasdaq’s loss of 1% and gain of 162%, respectively). The company’s market cap is just over $1 billion.

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From Exhibit Hall of Shame: “Re: HIMSS. Making a slight pivot.” An email from Hal Wolf that was forwarded to me says:

  • Exhibitors will be credited 25% of their total HIMSS20 payments, to be spread over HIMSS21 and HIMSS22 (15% and 10%, respectively).
  • Startup and University Row exhibitors will be credited their full payment, spread equally between the two future conferences.
  • Paid exhibitor and client booth badges can be used at HIMSS21.
  • Payments for optional events — such as the Universal Studio outing, awards gala, and CIO Forum — will be credited against optional events at HIMSS21.
  • Some hotels are giving refunds, some aren’t, and HIMSS is puzzled why some of them are telling people to contact HIMSS when it’s the hotel’s decision and cancellation policy that determines if refunds are offered.
  • HIMSS has cancelled employee raises and bonuses for this year.
  • HIMSS notes on its updated FAQ that it is considering changing its hotel deposit requirement through OnPeak to just one night.

From Accounts Prayable: “Re: HIMSS20. Another outrage — we just received an invoice for ads in the Show Daily handouts, poorly named in this case since they were not actually handed out.”


Webinars

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

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


Announcements and Implementations

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NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center in Manhattan.

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Experian Health offers free access to a list of payer policy alerts related to COVID-19 and telehealth to help providers avoid payment delays.

Blessing Health System (IL) implements CareSignal’s COVID Companion educational text-messaging program for patients.

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Hyland Healthcare develops an enterprise version of its PACSgear server software for imaging capture and exchange.

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EMPI vendor Verato offers Telehealth Identity Bridge, which links a patient’s EHR and telehealth visits to give clinicians a full clinical history. The company offers health systems and health plans free use through the end of the year.


Government and Politics

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President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project. She takes over from James Byrne, who was fired in February for purportedly clashing with members of the leadership team. Powers is a US Air Force Academy graduate, holds masters degrees in military leadership and organizational management, and is a retired Air Force colonel and cyber communications officer. 

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CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner. The San Diego-based health IT company previously sued the VA to protest its no-bid selection of Cerner and then sued Cerner for patent violations.

VA Secretary Robert Wilkie assures Congress that parts of the VA’s shift to Cerner remain on schedule, including development of the VA-DOD Joint Health Care Exchange and other interfaces, infrastructure upgrades, clinical workflow design, and integrated testing. The transition to Cerner’s scheduling system will be delayed.


COVID-19

A National Academies of Sciences, Engineering and Medicine report that was commissioned by the White House warns that no evidence exists to suggest that coronavirus spread will mimic flu by tapering off in the summer, noting that coronavirus is running rampant in countries that already have high heat and humidity. The authors conclude that the potential absence of seasonality, along with global lack of immunity to coronavirus, make it unwise to count on those factors in developing strategies.

HHS tells a House panel that the federal government’s supply of personal protective equipment is depleted and states will receive no more. The federal government has distributed 11.7 million N95 masks versus the 3.5 billion the administration had said were needed, while just under 8,000 ventilators were sent out. HHS employees say the allocation was based on population, not state requests, which has led to shortages that required states to lend equipment to each other.

The federal government asks its health officials to track COVID-19 deaths by race after several states report that disproportionately high percentages of African Americans are dying. Every one of St. Louis’s 12 COVID-19 deaths were African Americans, although the significance of that finding will require looking at the presence of chronic disease and social determinants of health.

A Black Book survey finds that nursing homes are underreporting COVID-19 cases because of lack of technology, heavy use of agency and per-diem workers, and lack of ability for long-term care providers to find out which other facilities have cared for COVID-19 patients. Hospitals are discharging COVID-19 patients into long-term and subacute care without having test results and 96% of nursing home respondents say that they no longer believe that their facility is the best place for housing elderly, susceptible people.

Executives at Detroit Medical Center’s Sinai-Grace Hospital (MI) send ED nurses home after they refuse to work because of understaffing. Two nurses were covering 26 patients, 10 of whom were on ventilators, and seven night shift nurses are covering up to 100 patients versus the proper staffing of 21 nurses per shift . After ordering the nurses off campus, the hospital held day shift nurses over to cover for them, extending their shift to 24 hours.

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Nearly 100 residents of a California nursing home that has been hard it by COVID-19 are evacuated after employees fail to show up for work for the second straight day. Officials say that 34 residents and 16 employees have tested positive for coronavirus.

Experts warn that US COVID-19 testing remains constrained and is not growing rapidly even as the number of cases skyrockets, leaving the only option as continued mass social distancing rather than identifying and quarantining those who are infected. A Nature review finds that universities that offer certified COVID-19 testing are not operating at full capacity because of lack of contracts between providers, incompatible EHRs, the FDA’s requirement that labs hold a CLIA certificate, and a lack of federal leadership. A director of UC Berkeley’s genomics institute offered hospitals a free alternative to the state health department tests – which had a backlog of 57,000 – but explains, “I show up in a magic ship with 20,000 free kits and CLIA and everything, and the major hospitals say, go away, we cannot interface with you.” Sutter Health turned down at least one academic provider of COVID-19 tests because no electronic interface exists and it wants to expand its own testing capacity. Boston Medical Center agreed to use tests from Boston University School of Medicine only after a bioinformatics graduate student wrote a script to connect orders and results to its EHR.

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With numerous protective measures still in place, the City of Wuhan, China reopens to outbound travel after a nearly three-month lockdown to prevent the spread of COVID-19.

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Amazon Web Services will partner with the Yale School of Public Health to offer 30 hours of online training to people interested in becoming volunteer health workers. The course will teach them how to work at drive-through COVID-19 testing sites, support homebound patients over the phone, and record vital signs in pop-up triage facilities.

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University of California, Irvine designs and creates 5,000 3D-printed face masks for UCI Medical Center.  Their low cost allows them to be discarded between patients as requested by clinicians.


Other

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UC San Diego Health physicians pilot an internally developed machine learning algorithm that enables radiologists to better screen for pneumonia on chest X-rays, which can also turn up potential COVID-19 cases.

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UW Medicine launches the DoD-funded HIPPOCRATIC app-based research project, which will use health and wellness data from 25,000 volunteers to inform the development of predictive analytics ahead of future outbreaks. Researchers also hope to better understand the feasibility of using a smartphone-based screening tool instead of drive-through screening and testing sites.

American Association of Nurse Practitioners cancels its annual conference in New Orleans, offering full refunds to registrants and exhibitors. AANP is cancelling all the hotel rooms in its block (it does not use OnPeak or other housing service) and will not charge the one-night deposit.

“If you want to recruit fake doctors, we’re ready. We can help hand you stuff.” Past and present TV doctors come together to thank healthcare workers on World Health Day.


Sponsor Updates

  • Microsoft publishes a case study titled “SyTrue offers AI-based healthcare solution at no charge to public health organizations to help them fight COVID-19.”
  • The Tampa Bay Business Journal honors Greenway Health SVP Karen Mulroe as one of its 2020 Top Corporate Counsel honorees.
  • Healthcare Growth Partners publishes “Health IT March 2020 Insights.”
  • Esse Health expands its use of CareSignal software to include a COVID-19 text-messaging program for patients.
  • PMD announces record adoption of its telemedicine platform in March.
  • Collective Medical’s product offerings meet new CMS ADT notifications conditions of participation.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 4/9/20

April 9, 2020 Dr. Jayne 2 Comments

I’ve been reading tons of scientific papers this week, trying to keep up with recent research on COVID-19 while alternating other things I have put off, such as finishing my tax return. I know the deadline has been pushed, but I’m expecting a refund this year so wanted to get things moving.

I enjoyed coming across this decidedly non-COVID article discussing the “Association between lottery prize size and self-reported health habits in Swedish lottery players.” That’s a decidedly niche research set, for sure. In case you’re curious, the question they were seeking to answer was this: “Is unearned wealth from lottery winnings associated with more healthy habits and better overall health?” Looking at over 3,300 individuals up to 22 years after their lottery win, they found no statistically significant differences in long-term health behaviors.

I also took some time for personal healthy behaviors, such as continuing to binge watch “Poldark” and also watching the first two episodes of the new season of “Call the Midwife.” I enjoy its gritty portrayal of nurses in London during the 1950s and 1960s. Although it makes me grateful for the medical technology we have today, it also makes me wonder how things would be if we had a similar national focus on neighborhood-based care, including home outreach. If there’s any good to come out of this pandemic, perhaps it’s a re-evaluation of how we deliver care around the world.

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Speaking of remote care options, one of the things I wanted to see at HIMSS was the GlobalMed Transportable Exam Backpack. I was impressed by their exam cameras last year. They have integrated those plus a few more tricks into this bag, including EKG and ultrasound. Apparently its predecessor was a ruggedized briefcase that was used in various capacities, including treating Secret Service agents detailed abroad and enabling communication with physicians in the US. The images obtained with their cameras are better than what I sometimes see with my own eyes in the office, which makes me wonder about using solutions like theirs to augment in-office workflows as well as those in remote locales.

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April 12-18 is STD Awareness Week, and a recent writeup made me wonder whether social distancing will have much of an impact on sexually transmitted diseases. I live in one of the US cities with the highest rates of STDs, so a reduction in illness would certainly be welcomed. The article notes that the event used to be the full month of April, but even with the condensed timeframe, the goals are the same — raising awareness, providing education, encouraging testing, and reducing stigma, fear, and discrimination. Stay healthy, folks!

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When patients test positive for sexually transmitted diseases, public health agencies have to perform contact tracing. That kind of work has come into the spotlight with COVID-19. I’m hoping some of those technologies can be later adapted for routine use. A group of innovators from MIT and other organizations has created a solution that not only helps with tracking, but also helps maintain privacy for individuals who allow it to use their location tracking data. Patients’ memories aren’t always reliable over time and other countries have made great use of location data, not only for contact tracing, but to enable a return to a more normal level of human interactions.

I was glad to see CMS applying its Extreme and Uncontrollable Circumstances policy for clinicians who aren’t able to submit their Merit-based Incentive Payment System (MIPS) data by the recently extended April 30 deadline. The policy will be automatically applied to those who don’t submit – clinicians will be flagged and receive a neutral payment adjustment for the 2021 MIPS payment year. For those organizations who started data submission but aren’t able to complete it, a separate non-automatic application can also be completed.

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For those of you who spend most of the winter checking this graphic from week to week, I think we can safely say goodbye to flu season. Many of my coworkers would give anything to go back to even a bad flu season rather than what we’re dealing with now.

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It’s a safe bet that most medical school graduates from the Class of 2020 will receive their diplomas in the mail. My alma mater canceled its commencement exercises weeks ago, even before the first states started going on lockdown. They realized that people were already making travel arrangements and wanted to send a message for folks to stay home. It’s the first time the university has ever cancelled commencement, even with world wars and other conflicts.

They sent out an alumni blast today asking us to send messages to the newest graduates as they carry their brand new MDs into a world that none of us envisioned. Here’s to all the new physicians, nurses, therapists, and other healthcare providers heading into this brave new world. My virtual hat is off to you.

From HIT Girl: “Re: specialists. I am not a clinician, so this might be a doofus question, but how easy or difficult is it for a specialist to work as a generalist? Doctors and nurses are getting sick, getting exhausted, and visibly suffering moral distress. Can specialists be rotated in to take over and let people take some time off to regenerate (or recuperate, if sick)?” This is the approach many healthcare systems are taking, although they are trying to find synergies in what kinds of resources can do which kinds of work. For many subspecialists, such as cardiology and gastroenterology, their underlying training is in internal medicine and they have a lot of knowledge that can be brought to bear in the hospital setting. They might not do as well in the outpatient setting, where we see a broader spectrum of chronic care than what they are used to encountering.

Many physicians are taking online refresher courses to get up to speed before they’re redeployed to other clinical areas. My experience, in delivering urgent care and primary care at the World Scout Jamboree, is that a lot depends on the individual clinician and their training. The subspecialty surgeon with whom I worked had a terrible time treating basic primary care issues such as strep throat, and his continued frustration with the EHR added to his inflexibility and unwillingness to learn. Conversely, the pediatric rheumatologist slid right into adult-ish medicine without blinking and even made a couple of great saves.

Bottom line: your mileage may vary when redeploying physicians. There are some procedures I haven’t done in decades and wouldn’t have any business attempting them regardless of how many videos I watch.

Thank you to all the readers who sent me words of encouragement in response to my recent underemployment. I’m trying to pick up telehealth visits where I can, although the big surge seems to have passed in those as companies have onboarded new physicians in droves.

Several wrote with their own physician stories that could form an administrative hall of shame. One busy primary care doc who expertly transitioned to telehealth saw her schedule reallocated to her partners who weren’t as busy. Others were told to use vacation time to make up for closed clinic hours even though they were willing to see patients virtually. Another office is requiring all the providers to come to the office to deliver telehealth services, citing HIPAA and “place of service issues” as the reason providers can’t operate from their homes. The common theme was poor communication – major changes in how physicians operate probably shouldn’t be delivered via impersonal group text messages.

I appreciate each of your stories about your personal “new normal.” Please keep them coming.

Email Dr. Jayne.

Morning Headlines 4/9/20

April 8, 2020 Headlines Comments Off on Morning Headlines 4/9/20

Pamela Powers tapped to perform duties as VA’s No.2

President Trump appoints VA Chief of Staff Pamela Powers to the additional role of deputy secretary, making her the top authority over the VA’s EHR modernization project.

Epic Partners with New York Hospitals for COVID-19 Patients Treated at Manhattan’s Javits Center

NYC Health + Hospitals extends its Epic system to the field hospital set up for COVID-19 patients at the Javits Center.

CliniComp International Gets $429M DHA IDIQ to Help Manage Clinical IT Systems

CliniComp secures a $430 million contract to maintain parts of the DoD’s clinical information system while it migrates to Cerner.

Comments Off on Morning Headlines 4/9/20

Morning Headlines 4/8/20

April 7, 2020 Headlines Comments Off on Morning Headlines 4/8/20

Former FDA Leaders, Health Experts Urge Action Now to Contain COVID-19 in Future

Duke’s Margolis Center for Health Policy proposes a national COVID-19 surveillance system to allow the country to transition from universal stay-at-home orders to case-based, regional options.

Tyto Care Raises $50M to Expand Its Telehealth Exam and Diagnosis Offering Globally

Telemedicine and related device company Tyto Care raises $50 million in an oversubscribed funding round.

CyberMDX raises $20 million to protect connected medical devices with AI

New York City-based startup CyberMDX will use $20 million in new funding to scale its healthcare cybersecurity capabilities and hire an additional 30 employees.

Comments Off on Morning Headlines 4/8/20

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