Weekender 3/13/20

Weekly News Recap

• COVID-19 dominates the national and healthcare news.
• Use of telemedicine ramps up to meet COVID-19 screening and management needs.
• HealthjStream acquires nurse scheduling app vendor NurseGrid, which offers the #1 most downloaded app for nurses.
• FormFast changes its name to Interlace Health.
• Final versions of the federal government’s interoperability and patient access rules are published.
• HIMSS announces plans to offer some HIMSS20 sessions virtually.
• Organizers cancel most of their upcoming conferences due to coronavirus concerns, including AMIA.

Best Reader Comments

Heading from a lot of friends inside of Epic that things are getting rough. No guidance from HR or the COVID team on what people are to do if schools close, no telework option given to any staff in the Verona office, some divisions (Implementation) have been given the guidance to attend all meetings via WebEx but that they still must physically come to campus. Little to no transparency from the leadership team, and they appear to be one of the only major tech company not implementing remote work. (Ex-Epic)

Epic’s travel policy is not right. They may think that they are helping us, but these people who go from one hospital to another may act as pollinators for COVID-19. We have already determined to cut all non-employees visiting our clinics and hospitals. (CMIO @ Med Centre)

Will 2021 finally be the year of the PHR now that these ONC rules came out? B.Well’s gimmick is to make the employer pay for it, though they can only swindle employers out of looking at the apps adoption rate for so long. IMO there isn’t enough value in a PHR to run a business. You either have to keep your costs extremely low or make money some other way. To me, two models come to mind. The Linux model, in which some devs do it as a passion project for awhile until it gets big enough that some institutional players start chipping in, maybe with some consulting opportunities with big health system or payer orgs. Or the Facebook model, in which you make it free for the consumer and sell their data. (What)

The big thing that’s missing for me personally is any accountability for breaches of apps or app vendors. My reading of the summary is that app vendors will not be HIPAA covered entities even if they are accessing and storing PHI. ONC is basically waving their hands saying consumers and app vendors can figure this out for themselves with a Terms of Service agreement. Key language from the summary: “In effect, this places more of an obligation on the party requesting the EHI and the individual to attempt to satisfy the precondition by providing a consent or authorization.” (Elizabeth H. H. Holmes)

I find there are two main reasons companies attend [the HIMSS annual conference]. Large mega vendors and even the larger names use it as a current customer meet and greet, and a chance to take them to dinner / schmooze (which they should be doing the other 51 weeks of the year anyway). The other are startups looking for investors or partners. Most don’t return the next year. Due to HIMSS rules on booth location based on seniority (I don’t disagree, just noting), these newbies are relegated to the basement level in building 2, or on the back wall of row 2400, where no one seems to go. Every time I’m asked about conference attendance as a key marketing tool, I tell the company my views. Even during a couple of job interviews I went against what I thought they wanted to hear, but was surprised they agreed with me. I’m not saying having a booth at conferences is a total bust, but isn’t a major tool in revenue growth for the majority of attending companies. Yes, I’m sure I’ll get some pushback from a few here where their effort pays off, but I’m betting it is a small slice of all vendors. (Contrary Ann)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. A in New York City, who asked for sensory play tiles for her class of autism and multiple disability students. She reports:

It is my honor and privilege to be working as a New York City public school teacher. It is in thanks to donors such as yourselves, who have enabled me to do my job even better. I am filled with such joy that you choose to help my students. It means so much to me to bring them an engaging educational experience that has meaning for them. My students inspire me every day, which I have seen inspires wonderful donors such as yourself.

I have already started using the sensory tiles and it is starting to make a difference for my students. Students who are in sensory overload are able to use them to self-soothe and get back to our lesson. We also use them for our lessons to show how colors mix and how force causes the colors in the tiles to move. They are so wonderful on so many different levels. These will allow my students to have an engaging experience exploring Science and STEM and keep control of their senses. Thank you for your kindness!

Brilliantly making lemonade from the unfortunate HIMSS20 lemon is Medic.Life, which missed the chance to demo its upcoming “smart toilet” but touts its ability to detect virus markers in urine samples for early detection.  

Facebook, Ebay, and Amazon try to throttle back advertisements from price-gouging sellers of face masks and hand sanitizer.

The Los Angeles Times writes about doctors whose medically related poetry is published in medical journals, whose editors say they turn down a lot of badly written poems, but seek out those whose vivid imagery invokes an emotional reaction. A retired internist wrote this one:

Tell Me

Tell me the night silence
on the locked Alzheimer’s ward is broken
by a yell from room 206,

that an old man with flattened
nose and crumpled ears,
whose family moved away to Arizona,

whose doctor never comes
to visit, is standing
in the middle of that room, naked,

his freckled face a clenched fist,
urine and feces running
down his legs.

Then tell me that the fat one, twelve
years on the job,
working her second shift because

someone’s car won’t start,
comes with a pan
of warm water, a sponge and a towel;

how, back in bed, he
cries, You know—
I’m in the ring tomorrow with Killer;

how a tiny smile begins, how
her hand reaches out
to flick down his wild flame of hair.

Now tell me again
why you don’t believe in angels.

In Case You Missed It

• News 3/13/20
• EPtalk by Dr. Jayne 3/12/20
• Working from Home Tips from HIStalk Readers – Avoiding Feeling Disconnected
• Working from Home Tips from HIStalk Readers – Daily Routine
• Working from Home Tips from HIStalk Readers – Software
• Working from Home Tips from HIStalk Readers – Environment
• Readers Write: Walmart Health Centers Are Here — Here’s How to Respond
• News 3/11/20
• Curbside Consult with Dr. Jayne 3/9/20
• HISsies Awards 2020 Winners
• HIStalk Interviews Diana Nole, CEO, Wolters Kluwer Health
• HHS, ONC Release Final Rule on Interoperability, Information Blocking, and Certification
• Sponsor HIMSS20 Presentations Rescheduled as Virtual
• Monday Morning Update 3/9/20
• HIMSS20 Cancellation Impact for Exhibitors

Get Involved

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

Morning Headlines 3/13/20

b.well Connected Health Secures $16 Million in Series A Funding

Employee-focused PHR vendor B.Well Connected Health raises $16 million in a Series A funding round, increasing its total to $27 million.

Heartbeat Health Raises $8.2M Series A to Expand Delivery of Best-in-Class Virtual Cardiovascular Care

Virtual cardiovascular care management solution vendor Heartbeat Health raises $8.2 million in a Series A funding round.

Epic tells employees to continue ‘essential’ travel, against county health officials’ advice

In addition to considering cancelling its upcoming, on-campus XGM event at its headquarters, Epic makes several social-distancing changes to workplace policies to slow the spread of COVID-19.

News 3/13/20

Top News

A New York Times article says the use of telemedicine in COVID-19 screening and treatment is increasing.

Use of virtual visits keeps people out of the ED or medical practice waiting rooms who are either exhibiting symptoms or who are susceptible to infection.

Upfront triage also minimizes the exposure of healthcare workers and the quarantine that would result.

NYU Langone Health is encouraging its self-quarantined doctors to continue their work by offering virtual visits, while Intermountain Healthcare is considering delivering virtual care for patients who have COVID-19 and chronic medical conditions and can be safely treated at home in avoiding the exposure of traveling nurses who could spread the infection.

Reader Comments

From Andre: “Re: COVID-19. Our pediatrician’s practice has temporarily disabled appointment checking via MyChart, apparently since adding screening questions isn’t easy.” It will be a struggle to convince practices and their patients that medical office visits create risk for staff and fellow patients. This particular practice also invites patients to call in when they arrive in the parking lot, then wait for a call back to proceed directly to the exam room to avoid potential waiting room exposure.

From Jeebo: “Re: MIPS filing deadline. Have you heard anything about possible extensions?” I haven’t, but I don’t follow it as thoroughly as Dr. Jayne and others, so I will invite reader comments.

From Mitchell: “Re: Loews Hotels. Has decided not to give any refunds for HIMSS20. Seems like they are the only ones.”

From Airman: “Re: travel. Dulles is a graveyard, all international flights cancelled and business travelers on the sideline. The hotel was one-third full, restaurants were empty. It feels like 9/11 60 days out. We are headed for a major recession from what I have seen. I took this photo at 4:40 p.m., probably the busiest time of day under normal circumstances.” Layoffs have already started in all travel-dependent sectors and I’m sure restaurants and retail businesses will take a major hit as people stay home. The compound effect that in our screwy US healthcare non-system, all those folks will lose their health insurance (if they were even offered it or were able to afford it in the first place) and any diagnosis and treatment they require for COVID-19 or anything else is going to strain their own finances and the system in general. We had better keep delivery drivers for Amazon and grocery delivery services healthy since they may be our most valuable lifeline. We will have learned many hard lessons once this outbreak winds down, but some of them are for the long-term good.

From Corey Spears: “Re: ONC’s rule. Since it is waiting for final formatting, I took the liberty of creating a bookmarked version, which is much easier to navigate since there are so many internal references.” Thanks. That makes it much easier to find items other than by searching.

From Life at Veeva: “Re: working from home. My company, Veeva, is good at accommodating remote work, but also created this video to help employees who ordinarily work in our corporate offices.” The five-minute video is packed with a lot of good information, much of it instructions for those who are new to the Zoom videoconferencing app.

HIStalk Announcements and Requests

I’m pondering whether we’ll have a future shortage of asterisks needed to explain 2020 sports records that involved shortened seasons and cancelled tournaments.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

Health IT and consulting company Emids announces an undisclosed investment from BlueCross BlueShield Venture Partners. The Nashville-based company was acquired by New Mountain Capital last September.

Amazon Care considers working with the Bill & Melinda Gates Foundation to deliver COVID-19 home testing kits in Seattle. Amazon has offered to come up with a logistics plan for delivery, free of charge, so that kits can be delivered within a few hours. Nose swabs in the kits would then be mailed to the University of Washington for analysis.

B.Well Connected Health raises $16 million in a Series A funding round, increasing its total to $27 million. The company offers employees of subscribing companies a personal health record that is connected to hospitals, pharmacies, lab companies, and insurers; a gamified health journey; and a digital wallet for health expenses. CEO Kristen Valdes founded the company in 2015 after several years at disease management company XLHealth, which was acquired by UnitedHealthcare for $2.4 billion.

Virtual cardiovascular care management solution vendor Heartbeat Health raises $8.2 million in a Series A funding round.

From Cerner’s investment community meeting:

• HealthIntent clients have been migrated to Amazon Web Services and Cerner-hosted CareAware customers will be migrated by the end of the year.
• 90% of the company’s total revenue is recurring or highly visible.
• Cerner expects its Works business to decline as a percent of revenues.
• Core revenue growth will decline slightly due to EHR client attrition, but that will be partially offset by global and revenue cycle.
• The company sees opportunity in the 30% of the market that runs non-current systems, most of them hospitals of greater than 200 beds.
• Soarian and Millennium assets will be combined to form a revenue cycle offering and will be accessible via APIs, with about 18 months remaining on the three-year project.
• Cerner sees three markets for data: life sciences, release of information, and payers. It says the EHR data it holds for provider clients represents one of the largest data assets in the world.
• Mass tort lawsuits that require retrieving the medical records of thousands or millions of people have resulted in Cerner signing 65 law firms as clients for its HealthHistory business, which it says grew 30-40 times its revenue in one year.
• HealtheIntent contains data from non-Millennium environments and has the advantage of refreshing itself every 17 seconds in the cloud.
• Regional IDNs and community hospitals can make money participating in clinical trials, which isn’t a strong suit of Epic since it has mostly academic medical center clients. 
• The company suggested that it will make acquisitions in the real-world evidence area.
• Cerner has not yet seen a reduction in project activity due to COVID-19 and says it’s possible that demand for its services will increase.
• The company says it is “incredibly disappointing” to lose customers to Epic, which is why creating a client success office was important. Those customers also will continue to run Cerner’s EHR for several years and will continue to use platforms such as HealthIntent and CareAware.

People

Medical University of South Carolina hires Mark McMath, MBA (Methodist Le Bonheur Health) as enterprise CIO for information solutions.

Announcements and Implementations

United Community & Family Services (CT) transitions to Epic from Greenway Health’s Prime Suite.

HIE-focused nonprofit The Health Collaborative selects Omni-HealthData’s cloud and analytics solutions.

Privacy and Security

Hackers lure employees at several unnamed companies into opening emails purportedly from Vanderbilt University Medical Center (TN) that claim to have HIV test results in an attached file, which, when opened, prompts the recipient to download malicious software. Hackers have also engineered similar phishing campaigns that prey on COVID-19 fears, referencing CDC guidelines and safety measures.

An analysis of 1.2 million Internet-connected devices in hospitals finds that 83% run on outdated software, including Windows 7 and Windows XP.

Other

An opinion piece written by two Duke informaticists says that EHRs are ill suited for the COVID-19 pandemic due to poor information presentation, complexity that causes users to delay applying much-needed updates for months, and lack of public health reporting. They recommend that hospitals:

1. Review their business continuity plan.
2. Prioritize clinical system patch updates and enforce change control policies.
3. Heighten cybersecurity vigilance.
4. Deploy mobile apps that extend EHR capability to improve productivity and to guide management of COVID-19 patients.
5. Use scribes to increase clinician efficiency.

England’s NHS ramps up efforts to offer more COVID-19 care through online consultations, given that only half of practices have telemedicine capabilities. The health service has also launched a care management service with digital-first capabilities for patients in self-quarantine, and has increased testing capabilities from 1,500 patients a day to 10,000.

The local news highlights the role the Avera ECare telemedicine network is playing in caring for COVID-19 patients virtually at 190 hospitals and 66 nursing homes across the country, particularly those in rural areas. Ten additional hospitals will go live with ECare’s services in the coming weeks.

Chilmark Research is soliciting information from companies that are offering free COVID-19 related health IT solutions.

The Onion sets the record straight on coronavirus.

Sponsor Updates

• Provider data management software vendor Phynd reports a record year, adding six new health system customers in Q4 2019.
• PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
• Intelligent Medical Objects releases retrospective business updates.
• Elsevier Clinical Solutions upgrades its ProspectoRx website.
• Optimum Healthcare IT publishes a case study titled “Decentralized Epic Go-Live Success at Scripps Health.”
• Ensocare Business Intelligence Engineer Matt Tweedy earns the Bob Cassling Service Excellence Award from parent company CQuence Health Group.
• EPSi Associate Consultant Zac Steele joins the 2020 Millenial Cohort of the American Enterprise Institute’s Leadership Network.
• CloudWave makes its disaster recovery solution available on Amazon Web Services.
• Masimo will integrate Imprivata’s medical device access authentication technology into its Root and Iris hospital automation platform.
• DataRobot and InterSystems partner to accelerate adoption of AI in healthcare.
• CarePort Health supports CMS’ expanded commitment to care coordination in interoperability rule.

Blog Posts

• Back to the Basics: Patient Engagement (EClinicalWorks)
• Are Your Remote Workers Working? (Goliath Technologies)
• HC-Tec COVID-19 Update (HCTec)
• What do you say to change? Bring it on. (Hyland)
• Did You Know You Can Have Clean, Current and Complete Data with the Imat Platform? (Imat Solutions)
• Four Steps to Enhancing Organization Effectiveness Through Your Analytics Strategy (Impact Advisors)
• Federal interoperability and information blocking rules finalized (Intelligent Medical Objects)

Contacts

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

EPtalk by Dr. Jayne 3/12/20

The time change came and went on Sunday, but my Outlook calendar is still messed up for the week. The ET zone is once again correct starting next week, so I’ll just have to be extra vigilant for the next couple of days about making sure I’m on the right call at the right time.

My calendar was still accurate for the lunch and learn session on Wednesday with Dr. John Halamka, sponsored by Arcadia. The company rolled this over into a virtual session almost seamlessly, and a good number of people attended. For those of you not familiar with the company, they have a tremendous population health platform and have helped their customers save over $2.4 billion through 2018. The platform is mapped to over 50 EHR vendors, which is a feat in itself.

Dr. Halamka joined from the library at Unity Farm Sanctuary and talked about the concept of platforms in healthcare. Central points included the challenge of de-identifying data when creating data analytics platforms along with how to best use machine learning for early disease identification, cost reduction, and preventive intervention. There was also a good discussion of the need to use the right kinds of data sets to do investigations. For example, if you’re looking at data on Hispanic females, you probably don’t want to use the dataset for Rochester, MN if one is available that is more representative.

I got a chuckle out of the inadvertent activation of his Google Assistant while talking about their use of Google Cloud for data storage. That happens to me all the time. There was also a good discussion of strategies for delivering high-acuity care in the home, which is top of mind given the surge in COVID-19 around the globe. Mayo Clinic is apparently partnering with third parties to provide much of this infrastructure, with a pilot scheduled in July for Florida and Wisconsin. There was an audience question about how much of Mayo’s technology is homegrown versus using vendors. Mayo’s preference is to buy solutions rather than build, whenever possible.

There was a good discussion about the recent interoperability rules and the potential risks for patients managing their own data. Halamka anticipates an increase in innovation with data being under patient control. There was also a discussion about COVID-19 and Halamka voiced concerns about the number of entrepreneurs jumping on the problem. He hopes that solutions come from non-profit organizations or technology companies in support of non-profits as an alternative to profit-driven approaches to a major healthcare crisis. He also lamented the inability of solutions to determine the cost of medications based on a patient’s insurance coverage that goes to the individual plan level. There are some solutions that can get you in the neighborhood, but none that are truly accurate.

The moderator asked about the impact of AI on the animals at Unity Farm. He has 103 devices on the farm, including cameras that can monitor the impact of coyotes and other predators on its 250 animals. They haven’t gone to automated feeding yet since a major focus of the institution is care and compassion for the animals. I have enough trouble managing the handful of devices in my house, so I can’t imagine what that looks like. (If any has suggestions on why I suddenly have to reboot my laptop any time I want to print something, please let me know.) All in all it was a great call, and I appreciate Arcadia’s ability to pivot the session to a virtual format quickly.

I also made sure to honor GlobalMed’s invitation to their Wine and Whiskey Happy Hour by lifting a glass of Jameson. I was looking forward to seeing their backpack telehealth exam station, but I guess I’ll have to wait a bit.

FormFast has rebranded as Interlace Health, noting that it “started as an electronic forms company and evolved into something much more valuable.” It now defines itself (along with thousands of other companies) as “a solutions company.” They go on to state that having the word “forms” in the name was limiting the perceptions of the company. I understand it, but I’m not sure the new name helps me understand their focus on “enabling seamless data capture and information exchange among providers, staff, and patients” either.

Lest we forget there’s a world out there beyond HIMSS and COVID-19, MIPS-eligible clinicians still have until March 31 to submit their 2019 data for the Merit-based Incentive Payment System. Data can be submitted until 8 p.m. ET on that day. Data submitted by claims have been ongoing throughout the year, and practices can also login for preliminary feedback on their Medicare Part B claims measure data. Clinicians are encouraged not to wait until the eleventh hour in case they need assistance from the Quality Payment Program Service Center.

If you’re bored, you can always choose to read from the pair of final rules released this week. Do we really need to get hit by both ONC and CMS at the same time? Although there are many aspirational comments that have been made by various government folks, let’s take a look at some of them.

From National Coordinator for Health IT Don Rucker, MD: “Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel, and every other component of their lives.” Although patients will have greater access, that’s not going to automatically make them more capable of better healthcare decisions. Healthcare is not ordering a pizza or booking a flight to Milwaukee. And comparing it to finances? Financial literacy isn’t exactly a strong point for many in the US. We need to spend money increasing health literacy, helping people understand the consequences of unhealthy behaviors, and teaching them basic facts about their own bodies and how to keep them running in good health.

I work with patients all the time who have amazing access to their data, but no way to interpret it or really understand what it means to them. I’m sure the counterargument is that third-party apps will help with that, but how many third-party apps are really going to be around purely for altruistic purposes? They will be there to gather data to sell it to other third parties, to pitch unproven solutions to medical concerns using unregulated supplements or other dubious methods, and more.

I’ll be judging the virtual shoe contest and socktastic submissions over the weekend, so please get your entries in for consideration!

Email Dr. Jayne.

Working from Home Tips from HIStalk Readers – Avoiding Feeling Disconnected

Our company uses the Google suite, so we have instant messaging. But we also have buildings in multiple states and people that work in different buildings that need to work together, so it doesn’t really matter to me if you’re in the building a town away, another state, or home.

Communicate with colleagues via MS Teams, Outlook and phone.

ideo conference, chats, texts.

Talk on the phone vs. sending an email. Once an email thread gets beyond 3-4 responses, take the conversation out of email and schedule a 15-20 minute phone conference. This will expedite problem resolution and connect you with your peers more often!

Make all of the company web meetings you can. I’m one the few who seems ok with web cam, but even without this join and talk.

My team has a group chat on Teams that is very active and we also meet frequently on webex which keeps me connected at work.

Our team does a good job of using email to communicate ongoing issues. We use this method even when in the office, since a few team members are always out of the office traveling to clients.

Lots of phone calls. Some video conferencing. My kids are grown, so I do have to make an effort to go places. I power walk every day at the end of my day, that’s solitary too. And to everyone who says work from home is less productive, this is not my experience. I closed my brick and mirror office six years ago and I often have to log in and tell my employees to log off and go do life. We only have had one who took advantage. She was fired via video, that’s was a little weird. And I had FedEx pick up her assets.

Conference calls aren’t suited well for small talk. Take 3-5 minutes at start of small calls to just check-in about life. After being remote 10+ years, I have found this to make me feel more connected, and the calls are ultimately more productive because you feel connected.

Keep Slack and Zoom online and randomly video call colleagues to check in and discuss instead of using email.

More consciously leveraged the video capabilities through webex.

Lots of phone calls! Go outside for lunch.

Enjoy the bliss of solitude!

By talking on the phone with folks. I have never been a fan of texting, I prefer a quick phone call and human voice, when possible. I also use MS Teams for chat with some of my closer team members. I also like to just call to check in and say hi once in a while, see how life is, even if I don’t need anything for work. Just like you would if in the office at a water cooler. Our team also meets for happy hour or lunch about once a quarter, sometimes more often.

It really is impossible to replace the water cooler, but you can make an effort to stay involved. If I have the time, I will more often now pick up the phone and call someone when I have a question instead of emailing because it increases the odds we will chit chat for a couple of minutes which helps me to feel more connected. Additionally, we use our cameras when we have internal meetings to help with the face to face feel. And, I schedule morning coffee with a couple of co-workers who also get to work early. Before our days start to get busy, we turn on our cameras, drink coffee, and chat like we would do in the office – mixing work and personal life into our conversations.

Conference calls scheduled at regular intervals. Avoiding breaks in between that are too small to accomplish much. I prefer a few back-to-back meetings, with larger focus blocks (an hour or longer) where I can knock out larger tasks / follow-ups without being interrupted.

I feel connected. I have trouble disconnecting from work when I am working from home. I have to leave my space and close the door to get away from work at the end of the work day in order to disconnect.

Instant Messaging. It’s up 100% of the time I’m online and helps not only with communication, but also in keeping me accountable for being at my desk instead of doing laundry, etc. Also, scheduling lunch dates with friends to get me out of the house.

We use Slack collaboration software corporate wide to ensure everyone stays connected and have some “fun” Slack rooms in addition to work focused rooms. We pay attention to who is using this tool. If someone isn’t, we find out why quickly. It’s actually a part of our quarterly reviews. We also have multiple meetings a week using video conferencing. Twice a week with the entire team. That being said, we have experienced that some folks simply do not do well long term working remotely. Managers suddenly finding themselves managing new work from home employees due to Coronavirus should be aware this can be tough for some beyond the first week, and watch for signs of disengagement.

It is difficult because you are disconnected. Setting up regular video calls with colleagues, much the same as you would at the office. allow yourself to be interrupted by calls (Zoom is particularly good for this when talking to colleagues). If you live alone, get  o the coffee shop with your laptop or pad for an hour or so each day; go for a walk; just don’t sit in the house all day every day. I also talk to myself quite a lot – but that maybe something else altogether!

Jabber/IM coworkers.

Schedule video meetings. At least one. Think of it less as a “meeting” and more of a “staying connected.” Be more deliberate about the midday, not-work time you have at work. You still need that at home, too.

Jabber, Skype, MS Teams, my phone, and email. Lots of interaction with my client and/or company.

Some tips specifically for managers/leaders. Schedule more one-on-one meetings with your team members than you would usually have – like short (10 minute) check-ins every day or every other day – to take the place of them being able to stop by your desk or stop you in the hall with a question. Even if you are “available” via Slack or email, you will need to be more proactive about communication. All the advice about “don’t just sit around in your pajamas!” goes triple for people in leadership positions. Be able (in terms of your workspace and attire) to hop on a quick video call with your team at any point throughout the day – don’t fall into the trap of waiting until a scheduled call to pull yourself together. It will help maintain a sense of normalcy if you maintain your typical level of professionalism.

Social/catch up discussions as part of the meetings, i.e. be sure to avoid diving right into the meeting agenda before some personal discussions, to establish a sense of camaraderie.

Video-conferencing and phone calls over email as communication tools.

Chat is a good way to get in quick conversations and smiles with other remote employees. We also have an awesome internal forum called Remotely Interesting, that is geared to all remote employees. Keeps people connected with pictures of pets, daily routines, thoughts of the day, and podcasts.

Get out of the house when you can. The gym is my favorite, but with the virus going around, that’s getting harder. Walking around the neighborhood helps.

This is less of an issue for introverts ;). Use chat programs for quick questions that you would normally walk over to people’s desk for. The biggest issue I’ve seen having worked from home extensively in my past is that there are a number of managers who don’t know how to manage remote employees. Managers need to set clear expectations on what work needs to get done and by when and then trust employees to do that work without micromanaging. Have a daily check-in for the department scheduled if this is something new for you (a la a stand up in the Agile Methodology). Get a good sense of what each employee’s “blockers” are that they need resolved before they can move their work forward and work on resolving those quickly. As an employee, figure out what your own blockers are first thing in the morning after figuring out what you need to do that day and voice those items to people who can help resolve them.

Review internal websites for company updates. Listen to the radio to hear another human’s voice. Call into meetings. Video can feel awkward if the other end is not doing it, but suggest it anyway.

I try to see local teammates for lunch when possible. I try to allow time for chit chat with colleagues to keep a human element alive in our interactions.

Video chat with colleagues I’m working on projects with rather than just messaging. Also, step out of the house and work from a public space or coffee shop at least once a week if you can.

Skype and call folks on site during the day. For no reason, just to say hi or how about that Netflix show. Have coffee or lunch out with anyone at least once or twice during the week.

Use the telephone and actually make calls. IM or email enhances the disconnect. My thought is if I would have talked to them in person at work I will make an actual phone call.

To not feel disconnected from colleagues, have a “webcam always on” rule for meetings. Outside of work, you have to be more deliberate about planning. If you see an event like candle making or craft beer night that interests you, reach out to friends and invite them. Set up a standing happy hour or a night once a week where you and a couple friends rotate on who cooks and hosts. If you’re really social, go to a co-working space.

It is good to try to have your team online during a similar block of time so Instant Messaging and team meetings can keep everyone connected.

I have not found that to be a problem. My company has a large percentage of WAH employees. Either via Slack, text message, phone, or conference call, I usually speak to a couple of dozen people daily. However, I recognize that I could be the exception that does not need a lot of interactions to feel connected. I also recognize that I waste less time working from home. All of the hallway, lunchroom, water cooler chit-chat is minimized making for a much more productive day of work.

Fortunately my role has me on the phone with people all day long. I also use our internal “inmail” to touch base with my team mates and other friends in the company. However I set it on busy or do not disturb for at least two sets of two hours so I’m undisturbed.

I chat other coworkers throughout the day, hold weekly meetings with team members, and interact with others via Facebook and Twitter.

Text with colleagues… send appropriate memes. When in doubt, ask if you can have a call. I don’t find that I am any more connected with a web / video meeting” vs. phone call. Also, I like to take advantage of going for a walk in the community.

Of course it depends what you job is, but email and messaging should allow you to keep up and contribute. Texting if it is a normal activity already.

Chat with colleagues – make sore to have “adult” discussions. Maybe schedule a team meeting just to touch base.

Frequent online team meetings and a direct phone application the receives and makes phone calls that appear to originate at my office. In most cases, people I interact with don’t know or realize that I’m not in my office.

Mandate that all participants in any remote meeting have their cameras on – no excuses. This makes sure everyone comes to work in as professional a manner as they would when they come to the office.

Videoconferencing for most of my calls, lots of chat messaging throughout the day. And real person-to-person interaction – run out to get lunch at least a couple days a week to see some other humans.

I don’t. I am actually more comfortable this way. But I also spend time chatting with friends and family via the phone (remember, you can still just talk to people on them!), FaceTime / Skype, and through email and text. I’ve had some friends that were doing “digital happy hour” where they would all pour a drink (or four), get on a multi-person web conference, and just hang out. I hated it and stopped, but they’ve been doing it a few times a week for years now. Seems that they enjoy it. Use the extra time in your day (you’ll have it, I promise) to come up with something relevant to your work that actually improves connection to co-workers. Something specific. I’ve never been a “status update” person on my work, but since I’ve been home, I do it every day, and so does my entire team. It’s a cool form, it opens up discussion, it has room for non-important updates, which are usually filled with anecdotes, stories, jokes, etc. to make the others feel a bit more connected. But when we share them with each other, it does provide a bit of the Monday morning water cooler like connection to my colleagues.

Email, video capabilities within MS Teams, RingCentral or webex work well too. Take a break and hit the coffee shop or telecommute from a Starbucks of DD for an hour or two.

Requesting that people turn on video for web meetings feels much more connected than voice only. Scheduling more daily video check-ins to take the place of impromptu office chats. Go for a walk in your neighborhood and work with the windows open (weather permitting) so that you have less of a feeling of being locked away in a bunker.

Working from Home Tips from HIStalk Readers – Daily Routine

I try to sign in early and usually don’t end up taking a formal lunch. Working from home gives you the flexibility to do a little bit of everything, so be flexible. I get up and walk around, take the dogs for a walk, get some fresh air, and then crank out a project. It is very easy to start going stir crazy, especially if you’ve been on the couch for eight hours. I wake up, take a shower, grab a snack, and start working. When I need to, I take a break, run to the store, whatever. I get all work emails / notices to my cell as well, so it gives me some freedom. As long as I can get to a computer if needed, I can take care of any tasks that are needed.

Get up about the same time as usual. Follow usual morning routine. Start work at usual time. Take my usual lunch break. Work through the afternoon but take a walk in mid-afternoon. Stop working at usual time. Do not watch TV except the 30 minute noon news during lunch.

Work like crazy from dawn until mid morning, take some time to exercise on the elliptical or treadmill or outdoors, gather some nourishment, then do some household chores. Finish the day off with a flurry from 4-9.

Always, I mean ALWAYS put on shoes and a collared shirt. Make sure you’re in the mindset to work. Sweatpants doesn’t do this.

Wake up as if you are going into the office. Take a shower, dress in halfway decent clothes ,and be “in the office” early. Take a break for lunch, as usual, and work until the time you would arrive home if you are commuting. Think of the added productivity if you reduce your “commute” from, say, 30 minutes to 30 seconds!

830-5 every day.

I start work a bit earlier when working at home due to no commute, but otherwise follow the same general patterns I do at work.

I try to follow the same daily routine as if I am working in the office.

I’ve been doing this for seven years now. I get up and take a glance at IM and email just to make sure nothing urgent popped up overnight. I get dressed and actually prepare as it I might have to leave the house. I’m not in work clothes but I do style my hair. It just mentally changes my game.

Start and end at the same time. Make it clear to family and friends you are working and not to be interrupted

Wake up early, leave the house for a workout. Then get a cup of hot tea and triage messages, get a fruit-veggie smoothie and some breakfast and start highest acuity calls for the day. Take a mid-to-late afternoon break to take a walk and get away from the desk to help with transition away from work. After an evening with the family, occasionally get back online to finish anything up for the day.

Same as work. Keep the same times. Take a few more breaks since you work for a longer period of time.

Before working remotely, I’d average around 3,000-5,000 steps from being at work. After going remote, that went down to 500. I’ve had to force myself to get up such as taking some conference calls while pacing. I’ve also taken the time I used to commute and force myself to get up at the same time and exercise.

Make sure you get up and get ready for work, put on clothes, do your hair, etc.

Most important tip: don’t get sucked into doing the dishes, making shortbread, making pickles, etc.! Unless you are a chef, the kitchen is where dreams go to die.

Get up, get the kids ready for school, they are out the door at 7:35 a.m. Then I wash my face, brush my teeth, and drink a glass of cold water. Then I check my emails, LinkedIn, HIStalk, local newspaper. Around 9 a.m. I make breakfast and get back to work. To be honest, some days are so busy that I miss lunch, but usually I make a sandwich or a Trader Joe’s frozen meal. Kids get home at 3 p.m., greet them and make snacks. Back to work until 5 p.m.-ish.

When I work from home I get to work early, trading in my commute time for work time. This allows me to get off earlier, which I love. Same as when I am in the office, I start my day with coffee and email catch-up. I try to take short breaks to walk around the house for a few minutes every couple of hours in between meetings since I naturally sit more at home than when I am in the office. Since I am not eating lunch with co-workers, I will instead use the time to either take a walk or make a phone call to a friend or family member that I have put off.

I like to exercise first thing, then shower, make a real breakfast / coffee, etc. As close to my usual non-working-from-home-routine as possible. I stay in comfortable clothes, but change out of what I would sleep in, to help with the mindset / transition to focusing on work. I like to listen to the news (NPR or podcasts) while I make/ and at my breakfast to simulate a commute / transition to focusing on my day.

Dress differently, but email first when I am at my office or at my desk. I do get up to pet the dogs routinely when I am home.

Keeping office hours is key for me so my day stays on track, but also so I can take guilt-free breaks and my friends / family know when I’m available.

We require that our home-based employees work a predictable schedule that is worked out with their manager. We have multiple interactions each day with fellow team members.

Work from home, don’t live at work. You will find that you have much more time available. Tasks take less time to complete when distractions are reduced. Try to avoid the temptation of getting directly out of bed and sitting at your desk. Try to maintain personal spaces in your time that allow for breaks. It is not unusual for me to take a complete break during the day and go and do something quite different – shopping, cooking, reading, even watching sport – for an hour or so brings you back to your work refreshed.

After morning routine of getting kids to school, come home, put a load of laundry in the washer, prep my lunch, and sign on a few minutes before 8 a.m. I use productivity timers to build in breaks during the morning where I make tea, refill my water, or change over the laundry. If the weather is nice, I take a half-hour lunch, eat, and take the dog for a quick walk. After signing back on, I work through the rest of the day, taking a few breaks along the way. When I sign off at 4:30, I make notes for the next morning and shut down, including closing the door to the office so I’m not tempted to work on something later in the evening.

Treat every day like you’re going into work. Get dressed. Shower. Eat breakfast. Fix your hair. Do not get distracted by the house stuff you couldn’t do if you were at work. This is especially going to be true if the kids get stay-at-home orders from school If you’re used to a regular commute, make sure you treat that as “not at work time.” You can use that new found time to do the other things if you want.

I set an alarm and get up the same time every day. Either go to the Y or walk outside. Take a shower and get dressed when I get back. Getting dressed is key! I eat lunch and breakfast at my desk. If I don’t go for a walk in the morning, then sometimes I will take one during the day, if weather allows. I try to leave my desk and walk around the house at least every hour.

Following “normal” work hour schedule, and avoid working at all hours, since doing so implies that you’re available 24/7 and clients/co-workers begin to expect that. The biggest disadvantage of working from home is that you can’t socialize / connect with co-workers since you’re not just running into them in the hallway. Scheduling some catch up /social chatter time is always good during the phone calls, to ensure you’re in the know about the happenings that may be taking place while you’re remote.

I wake up at 6 a.m., do yoga / meditation, shower, and dress in business casual. Although it might be tempted to wear sweats at home, I’ve found that dressing professionally really helps get me in the correct headspace for work. I go to my home workspace and log in at 8.

Morning coffee, catch up on HIStalk, plan the day and hope to stick to the agenda!

Start work as soon as you can in them morning. It’s easy to fall in the habit of lounging around. And make sure you get walks outside. I aim for once in the morning and once at lunch. It’s easy to forget taking breaks and to get up and move.

Schedule times to get up and do something besides be at your computer. It’s not cheating on work; you’ll be more productive this way.

Follow the same morning routine – exercise / shower / etc. Get dressed. Don’t try to work in your PJs. It won’t work well for you. Stop promptly at the end of your day. Since you’re in the same physical space, it’s important to have that distinction.

I am not a good example! My goal is to shower by the time my husband gets home. One thing I do is prep dinner ingredients in the late afternoon to get a break from the desk and do something for me/family. I rarely eat at my desk so that I break up the day.

I schlep to work in my jammies with coffee in hand and shower at lunch time. Leave work on time and go walk the dogs! Cook for your family. You’re home! enjoy it.

I have the same routines if home or at the office.

Grab food and water and get to my computer ~5 min before my first meeting (8:30 a.m.) After the meeting, clean up from breakfast, stretch, and do any administrivia tasks while my mind wakes up. I block off after the morning meeting until lunch for my mind intensive work because I’m more awake and less likely to be distracted. On lunch, I mute all computer notifications and step away for an hour to eat, go on a walk, and clean up a bit. Post lunch I do less mind intensive things because I can’t concentrate as well. At the end of the day, I plan out what I’ll do the next day, clean up my work area and prep it for the next day (refill humidifier, clear off desk, set out anything I know I’ll use), and then I mute notifications and put my computer away. The most important part of the routine is to make yourself unavailable outside of normal working hours. This doesn’t mean turn your phone all the way off – you need a way to contact you – but you shouldn’t be checking your email / Slack notifications / work board. Set the boundaries between work and home or you’ll always feel stressed because you’re always “on.”

Try to keep the same business hour schedule as the rest of your team / company.

Wake up at 5:00. Go to the gym. Shower, breakfast, morning news. At my desk by 8:00. Work mostly all day, with no formal lunch break. Fruit and healthy grazing through the day. Workday is finished by 4:30-5:00. The biggest lesson for me was that it is important to have your workday start and stop. If you are not precise with that, your work and personal lives can get inextricably intertwined to the detriment of others in the home.

My office is upstairs, so every morning I take my purse and coffee upstairs as if I’m mentally going to work. I work from 8 a.m.- 12 noon, take one hour for lunch and do not eat at my desk – I go downstairs. I come back up promptly at 1 p.m. and then finish out my day at ~5:30 p.m. I also turn off my email notification so I’m not distracted.

Getting ready like it is a usual day is HIGHLY RECOMMENDED. You don’t have to wear the best clothes, but look presentable. If you don’t, you run the risk of unexpected web / video conferences popping up and you are not looking the part. It also helps set a defining cadence just like you’d have in the office so you can more easily shut down when it is time.

Try to keep regimented; defined start / stop times

Get up, take a shower, get coffee and then go into “office.” Don’t plan to get other home tasks done during working hours.

Almost identical to my in-office routine, with the exception of no commute time.

Treat as normal work day. Take a lunch break or eat at your desk.

Same as you would with the office. Don’t break that routine – get up, prepare, and “go to work.” If your commute is longer, perhaps listen to the same radio show or podcast for the same time period. If it makes you feel better, dress the same, but I can honestly say this is the least regimented thing I stick to. Don’t stay in pajamas though — that will end badly for motivation.

Be disciplined – always create a to-do list and check things off as you go. This is even more important remotely than at the office.

In at 8 a.m. with coffee. Respond to priority emails first (I’m always checking email on my phone outside of work hours). Try to clean up my inbox as much as possible before jumping into calls. Before the end of the day, review what’s planned for the next day or two to make sure I’m prepped as needed. I’ve been working from home for almost 21 years and can’t imagine going back to an office.

Drop the kids off at daycare then come back and pour a cup of coffee, review my Outlook calendar and tasks for the day, catch up on the industry headlines, and then dive into work..

It’s as if I go to work each day, but my commute is a walk down the hall to a spare bedroom. I work only once I have taken care of my personal needs (shower, dress, eat, etc.). I take four complete breaks a day, including lunch. When I end my day, I formally end my day and do my best to disconnect from work, even if I am still playing on my computer. I actually invested in a ‘home’ computer so I can actually not feel compelled to log into anything when I am surfing, streaming, or gaming.

Get up and shower and dress casual but keep the same routine as if you were going to work. Don’t take calls in PJs.

Set a daily schedule of items to do. Take frequent breaks to get up, walk around, and go outside. Stick to my schedule, and when the day is done, close my computer and walk away. I try to think of my office space the same as a cubicle.

Working from Home Tips from HIStalk Readers – Software

Our company uses MS 365 plus a VPN for remote work. Our phone system is a ShoreTel VOIP solution. We cannot use personal systems for work.

Only that well-behaved software that can be used natively in a browser. Everything else has some idiosyncrasy. Leads to shouts of “It dropped me again.”

Whatever you use at the office. Don’t get fancy.

Skype.

Any web conference tool, favorite is Slack.

Webex works fine for meetings. ShareDrive + Teams for collaboration.

We use the same software that we use when working in the office. Only difference is a VPN connection into the office network.

We use 8×8 VOIP phones which includes IM and videoconference Internally. Externally we use GoTo products for accessing customers remotely.

Zoom is hands-down the only platform that never fails, is intuitive, and quick to get started.

My company uses Zoom for meetings. It works pretty well. We also VPN into our network.

Very enterprise specific. We use Virtual Desktops, so a remote user gets the same “computer” they have a work.

WebEx, secure text messaging,

My company recently switched to Microsoft Teams which, for me, is a must to keep in contact with my co-workers. However, it lacks some of the functionality needed for client meetings, so for those I stick with WebEx.

For our remote workforce, we use Citrix and VPN to provide remote access to all of our applications, both on premise and in the cloud. We use Okta for two-factor authentication. We use Zoom for video conferencing, and we typically supply staff with laptops and tablets with camera, audio, and some sort of headset. Those of us that use personal devices still use the same software to engage. We use Jabber for chat, but moving to a new platform for unified communications that will support mobile workers securely no matter where they are. (Dr. First Backline with RingCentral WIFI calling for clinical staff at the bedded facilities).

Slack or similar company wide collaboration software. We use Google Suite because it is easy to share / edit documents from anywhere, while still maintaining the proper permissions. And we have a Confluence based company wiki that is a key part of how we share information. We just created a Coronavirus Information page for all employees.

I use Office365 with all work files in Dropbox plus local external backup and additional cloud backup (loss of files is a disaster). The fastest bandwidth available also helps – I am fortunate to have Gigabit optical via FIOS. Meeting software is Zoom although I connect to whatever the other participants use. Most external meetings are done without video. A headset makes a huge difference.

Jabber or other instant messaging program for quick communication. Confluence for maintaining single location for file access.

Zoom. And any of the many online document collaboration systems (OneDrive or Google Docs). You have to start thinking outside the local computer and local network. Starting working on things in shared locations.

Video conference apps/software are extremely useful to feel more connected to colleagues and supervisors – I’ve used Skype, MS Teams, Zoom, and Webex, but I think Google offers something like these also.

The laptop from the client is already well outfitted. I add Toggl for timekeeping.

Zoom for meetings (less distracting in my opinion than Google meets since you can see everyone at once). If you work late, use f.lux to help your eyesight. Slack for communication (you can do a free trial).

Microsoft Office suite is my go to. Jabber for IM and phone.

Test the VPN / remote access software and web meeting software in advance of having a collaboration session. Some organizations do not have the bandwidth or licensing for all the potential remote access sessions, so be aware and have contingency plans (e.g., direct calling, call trees, sending documents in advance, use of other forms of web collaboration like Office 365). Stick with the software used by your employer that is supported and secured. You don’t want to break policy and place your company, customers, and self at risk.

The list of software I use is extensive, a blended set of local, enterprise and cloud-based applications. I also us a cobbled together unified communications system based on Microsoft.

Zoom, BlueJeans, Skype, Facetime.

Zoom – over any other web conference software.

We use MS Teams. Some of us use the video option and some of us (me and the majority of my teammates) don’t. Chrome browser.

Microsoft Teams is essential to staying connected and collaborating with my coworkers.

We use Zoom for conferences, Slack for communication, BaseCamp for project management.

Zoom and Skype for business are great for keeping in touch with your team.

Working from Home Tips from HIStalk Readers – Environment

Multiple monitors are essential and a quiet secluded space. Natural light is preferred, but supplemental ambient lighting can help. A good chair is helpful.

Lighting: natural light is best but use what you can so as not to diminish what you can see. Music: I find Jazz is best for a rationale rhythm.

Give yourself an office with a window if possible.

Separate desk location is key vs. working from kitchen table with lots of distractions. No music or TV…gotta focus!

Open desk area, lots of natural light.

I work at my kitchen table by a window which offers plenty of natural light. I listen to music when not on calls. I work in a hoodie when not on video sessions with clients.

A separate space dedicated for work. Be it a home office, or a temporary space setup to accommodate. I have found that working from the couch or recliner does not lead to me being as productive than working from a dedicated space.

Separate space, mutable phones if you have dogs or kids, conference calls can be challenging. But everyone usually pretty great about it. I have music streaming kind of low or NPR. something about the low murmur of other voices keeps me focused. Desk location is huge. I personally need to see outside so windows matter to me.

Create your own space in your house or apartment. A good spot is away from the kitchen!

An environment with natural light, perhaps by a window where you can see life outside. Make sure that if you’re taking video calls that you have good front-lighting and there is nothing crazy behind you; some people have desks that are extremely distracting and messy.

Set up an office-like experience. Have a desk and workstation away from traffic. Don’t sit on the couch or have the TV on. Use Webex or other conferencing software for meetings.

Know yourself. I need quiet, so I carve out dedicated space away from foot traffic and distractions. My wife also works from home and is productive with background television and radio.

Somewhere quiet at home. Having a desk at home works best. Avoid couch, kitchen table, etc.

Music is OK for some tasks, discouraged for others. For focused working, music without lyrics is best: Henri Texier is a favourite, also Pat Metheny, Herbie Hancock, Ahmad Jamal.

I have been working from home almost 100% for seven years now. Best environment for me is at my desk next to a large window. Sunlight lamp on (I live in the PNW). I don’t listen to a lot of music during the work day because I am on the phone a lot. I think a Bluetooth headset / earpiece is essential to being hands-free during those meetings.

For me, I need to be able to shut the door to eliminate distraction. I prefer to face the window so I have natural light and don’t feel so enclosed. Having two large monitors is a must. I love that my desk will convert from sitting to standing (you can get an add-on for your desk for under $200 on Amazon). I can get distracted easily so I do not keep a TV in my office and any music I play is “coffee shop” in nature on a low volume.

I need a space separate from my comfortable / living space – desk, kitchen table, etc., away from distractions and noise.

Desk location that is secluded. No printing unless necessary and a shredder if it is. Widescreen monitor helps with good lighting. Music is always an option. Alexa is my spell checker and office assistant for some things.

Natural light, classic music

We recommend that our employees have a dedicated office space that isn’t in their bedroom and where they can shut the door. A good internet connection is a requirement. We provide a special network device to provide the same level of security we have in our company office. Of course, we’ll flex on all things BUT security to meet special needs related to Coronavirus.

A dedicated space is ideal (if possible). It allows you to separate work from home in a way that helps with the routine. Natural light is really important, supplemented by high-temperature artificial light. Sound is very much a personal thing; sometimes none, sometimes podcasts, sometimes music – depending on the task at hand.

Natural light, instrumental / classical music, home office desk. No coffee shop background noise for me.

Anywhere can work: office, kitchen, coffee shop, co-work space, etc. You have to treat it like the office. Good headphones without anything playing are good at minimizing noises around you so leave them on even if you’re not “listening” to anything.

Plenty of light, facing window, a good chair, and proper ergonomics – a sit/stand desk if you can swing it.

Desk location with structured work hours, to ensure productivity. Of course it goes without saying that you need reliable internet access and appropriate hardware – laptop, phone (I prefer a non-mobile device for best sound quality), sound-controlled room, etc. with meeting- and communication-friendly software (Outlook). “Meeting friendly” convening software is desired, however, I haven’t yet discovered a good program / software, since Skype is not good quality.

A big monitor is cheap and essential. Plug a full-size keyboard into your laptop instead of the built-in version. Elbows at right angles to keep your wrists flat, which isn’t always possible on countertops or other non-desk surfaces. Make “going to work” like commuting, set an alarm, dress, be at your desk. I need a view to the outdoors to prevent cabin fever. Do your most important work first in the day. Stay out of the kitchen except at lunchtime and don’t eat at your desk – take lunch as an actual break.

Designate a room in your home for “work hours” and let any family / roommates know that this room is unavailable during these hours to avoid distraction. When I first worked from home years ago, I found that my significant other at the time expected me to manage household duties concurrent with the workday – this will NOT work, so set expectations early on.

I am fortunate to have a home office with a window and a door. Music is always on in the background, mostly smooth jazz to keep my mood smiling.

You to have a space where you can close the door. It helps keep everything separate. Also make sure situate yourself well for web meetings. A window behind you on a sunny day can make it hard for teammates to see you.

The couch, the dinner table, outside in non-direct sunlight during nice weather.

Set up a dedicated work space. Do what you can to make sure it’s ergonomically correct. You can end up with arm and back pain quickly.

Do not use overhead lighting. I only have a lamp on my desk and use a bulb that is near daylight colored. My desk is in a room that serves only as my office as to keep the stress contained. I have a window, which I highly recommend. I sit with my elbows at 90 degree angles and my forearms are supported by the arms of my chair. I have a docking station for my laptop and have two screens that sit at eye level.

Don’t work in your bedroom unless you must – the bed will be calling your name all day. If your bedroom is the best option, have a desk and make it feel like a work area. Also, plan your meals – prep them ahead if you can as if you were going to the office. You’d be surprised at what chunk of your time it takes to cook in the middle of the day.

Fortress of solitude, currently in the basement. Wired LAN connection. Gig speed internet service. Extra big monitor to extend to. 101 key keyboard a must.

When I am the only one home, I work in our open first floor as I feel I am not hiding in an office. It is nice to see the day. If there are others home with me I hide in my office room.

When I’m doing mind-heavy work, laptop plugged into two external monitors on a dedicated desk in a separate room. Music without lyrics or in another language so I don’t get distracted listening to the words. Lots of light but nothing hitting the screen that could distract me. When I’m doing other work/on meetings – plush rocking chair that has a small desk close by for food and drinks and surrounded by plants/out on the porch if it’s nice enough. The rocking helps me burn energy and stay focused when I’m on one of those meetings that I have to be on but I don’t have to do anything on.

Set a dedicated space that you can walk away from when not working. Natural light is the best and soft local radio station music helps keep you engaged while at home.

Ambient daylight, with my desk near the window. Winter is tough due to the short days and not much sunlight. No music. TV on, muted. Occasionally, talk radio is on as background noise.

I’ve been working from home for 11 years – I’ve set myself up with desk lighting rather than overhead, my stand-up desk faces a large window with a great view. I don’t do well with background music – it distracts me. I do make sure to have soft beds on my couch for my French Bulldogs to stay close! I also have a small mini refrigerator in my office and stock with water, snacks, etc. so I stay upstairs until lunch.

I use a dedicated space with a door that can be closed when I need to focus, lower the impact of noise from other areas of the house, and take a call or participate in a web meeting. A window and natural light can help one feel a little more connected to the world. Access to music can help some focus. Watching what you have in the background is important for web meetings. Using dual monitors is a productivity bonus and having the option for a standing desk is great too. With the standing desk, I prefer to have a padded standing area. Just like at work, focusing on ergonomics helps with productivity and the potential pains of your home work area (e.g., proper chair, chair height, desk / table height, foot rest, monitor height). I have a whiteboard that I can easily show from the webcam on my laptop but before I had that, I’d use the 3M sticky top flip charts (be sure your markers won’t bleed through to write on the wall, or if you’re concerned, use 4-5 layers).

Try to find a quiet, dedicated area, with good connectivity.

Separate work area from other daily activities. Try to make sure there is a caregiver for your children if they are also home – you can’t work and care for kids at same time. Make sure to turn off computer at end of day, otherwise, those “pings” from alerts are too tempting.

Dedicated home office with a good wired (not Bluetooth) headset.

Dedicated office space or kitchen table, with a window and soft music. No TV on.

Dedicated work space – not at kitchen table.

For heads-down work, quiet and secluded is best with no tv / distractions. If you have a desk, use it. If not, do not work somewhere where you commonly relax or recreate, as those habits will be picked up with work. For me, brighter is better, so natural light is always premium wherever I work. Quiet is also premium, so I where noise cancelling headphones a good chunk of my day. They also double as a Bluetooth headset.

Dedicated office – no distractions.

Office with a door. Dual monitors. I use my employer-provided iPhone and my own Apple AirPod Pros (the noise cancellation feature on the Pros is awesome) for all of my work calls. Wireless headset / earbuds are a must.

I’ve worked from home since 2014 and my best advice is to create a dedicated space for working. Ideally an office with a door so you can open it in the morning and close it in the evening, just like going to your workplace. You have to create a clear distinction between work time and personal time, and having a dedicated work space helps by creating a physical barrier.

Set up a dedicated workspace, don’t just move into a living room or kitchen. Make it a formal area in which you ‘work’ — otherwise, you may just end up being perpetually distracted. Also, consider it a commute and take the transition from home to work seriously. Take breaks. Go for a walk (alone, to maintain your distancing), do something else, stand up, the same way you’d do at an office. Fight the urge to carry your office throughout your home. Maintain your hours and normal work environment. Get a good lamp, get a good area to spread out your work. Make sure the angle of your monitor is not going to have a sun glare issue.

Sit somewhere that you can see out a window, ideally with a view where you can see people, cars, etc. going on outside. It’s easy to feel isolated when you don’t physically see any other people.

Morning Headlines 3/12/20

Leading Digital Transformation Services Firm emids Receives Investment from BlueCross BlueShield Venture Partners

Health IT and consulting company Emids announces an undisclosed amount of funding from BlueCross BlueShield Venture Partners.

Amazon and Gates Foundation may team up to deliver coronavirus test kits to Seattle homes

Amazon Care considers the logistics of working with the Bill & Melinda Gates Foundation to deliver COVID-19 home testing kits in Seattle.

Former National Coordinators Applaud Interoperability Rules

Six former ONC leaders applaud the publication of the final interoperability rules and highlight several areas they are especially pleased with, including the development and enforcement of information-blocking rules.

Diagnostic Errors, Maternal Health Top ECRI’s 2020 Patient Safety Concerns

ECRI includes patient matching in the EHR, overrides of automated dispensing cabinets, and communication breakdowns across care settings in its annual list of top patient safety concerns.

What Are Your “Working From Home” Tips?

Many people are working from home for extended periods for the first time. If you’ve done it, what advice can you offer for those doing their jobs from home for a few weeks?

Readers Write: Walmart Health Centers Are Here — Here’s How to Respond

Walmart Health Centers Are Here — Here’s How to Respond
By Derek Baird

Derek Baird, MBA is SVP of Avia of Chicago, IL.

I recently wrote about Amazon’s looming threat to health systems and physician practices. I closed with a comment that Walmart poses an even greater threat. Many (actually, most) of you disagreed. Since we all have unexpected free time this week, I hope you’ll hear me out.

Walmart Health is back in the news, thanks to the opening of their second Health Center and a not-so-subtle statement from former Apple CEO John Sculley, “Walmart Health will cause a consumer revolution.” Those are bold words from a smart man (and healthcare investor). Note: John’s been wrong at least once. He drove Steve Jobs out of Apple.

Walmart has run pharmacies since the 1970s and a small number of retail clinics for many years. Last September they opened the first Walmart Health Center. It’s not your 1990s-style retail clinic crammed in a closet next to the pharmacy. The 10,000 square foot clinic sits next to a Walmart Supercenter in suburban Georgia. It provides services ranging from physical exams to dental visits to x-rays. Notably, it is staffed by physicians.

The second clinic opened in another Georgia suburb in January with a similar footprint and services. Mark Wahlberg was at the opening. Makes sense since he’s a model of men’s fitness. On the other hand, he owns a burger chain delivering saturated fat to the masses. Speaking of brand dissonance, purists like me grumble about Walmart providing healthcare services in the building next door to its lucrative tobacco counter. I doubt their shoppers share my scruples.

Not only does Walmart offer a super-convenient one-stop shopping option, the digital experience is great. It features all the stuff we admire in solutions from cooler companies like Amazon, Carbon, and 98point6: clean website UI, extended hours, online scheduling, transparent pricing, text reminders, etc.

One hundred fifty million Americans visit a Walmart every week, though most healthcare executives aren’t part of that cohort. We spend lot more time discussing Amazon and other technology offerings even though 90% of us live within 10 miles of a Walmart store. Many Walmart shoppers are commercially insured  — with $1,600 average deductibles — and are likely tempted by the sound of $40 for an office visit and $25 for a teeth cleaning. I know I am.

Out of the gate, Walmart’s model is differentiated, difficult to replicate, and a savvy marriage of physical and virtual assets. Like Amazon’s not-yet-launched offering, Walmart designed its services to address glaring flaws in traditional offerings. But unlike Amazon and other direct-to-consumer telehealth offerings, it’s not reliant on virtual care. In most markets, virtual care is still hampered by stubbornly low awareness, understanding, and adoption. It will be a lot easier for Walmart to launch virtual care than it will be for Amazon to replicate Walmart’s foot traffic. Let’s keep an eye on Whole Foods.

If you’re more likely to visit Sam’s Club than Walmart, then the Walton family has you covered, too. They launched a set of innovative healthcare packages—including family bundles—for members last year. The bundles include free generic medications, a Humana-supported provider network, and $1 virtual visits through, yes, 98point6.

Here’s the kicker. Unlike Walgreens or CVS, Walmart doesn’t appear interested in partnering with local health systems. These Health Centers are launching to make up for health system shortcomings. They will gladly displace primary care physicians sitting behind ineffective call centers, packed schedules, opaque pricing, and myChart logins.

Just like small town Main Street retailers, health systems will have to compete.

Here’s how to get started. First, aim to match Walmart on digital convenience. Your digital front door must make it just as easy to access care as it is to grab an appointment at the Health Center. Put your price list online. Offer virtual visits for those who don’t want to leave the couch. Offer virtual queuing (“save my spot”) for urgent care centers. Your goal here is to approach competitive parity. This will require an intentional, multi-year focus on convenient access and virtual care. If you don’t have your key executives focused on this effort, it’s time to pull together a task force and allocate substantial capital.

Next, leverage your incumbent advantages so you don’t have to match on price. You have brand equity, data, and locations that can be assets rather than liabilities. If you can marry your clinical expertise with personalized communications to patients, they will value that continuity and credibility.

Some good news: Walmart is not going to scale as quickly as Optum or CVS. They have two, soon to be three, locations. You have a little time to prepare. Unless you’re in Georgia.

Morning Headlines 3/11/20

Changes and Clarifications from the Proposed Rule to the Final Rule

ONC publishes a six-page summary of changes that were made to the draft version of HHS’s interoperability rules in producing the just-released final version that took public comments into account.

HealthStream Acquires NurseGrid, #1 Rated and Top Downloaded App for Nurses

HealthStream acquires 20-employee nurse scheduling app vendor NurseGrid for $25 million in cash.

Genstar Capital Announces Recapitalization of ConnectiveRx

Genstar Capital recapitalizes ConnectiveRx, continuing as the majority investor and bringing in new funds as minority participants.

DXC Technology to Sell U.S. State and Local Health and Human Services Business to Veritas Capital for $5.0 Billion

DXC Technology will sell its technology-enabled health and human services business to Veritas Capital for $5 billion.

News 3/11/20

Top News

ONC publishes a six-page summary of changes that were made to the draft version of HHS’s interoperability rules in producing the just-released final version that took public comments into account:

• Vendors have 36 months to release Electronic Health Information (EHI) Export that supports exporting a single patient’s data and exporting all patient data for users who are switching health IT systems.
• FHIR Release 4 was chosen as the standard for API certification.
• Health IT vendors are prohibited from restricting the sharing of screenshots and videos of their screens, but are allowed to limit such use to protect their intellectual property.
• Compliance with the information blocking provision is not required until six months after the final rule is published and timelines for assessing civil monetary penalties will be determined later.
• EHI is defined to be the HIPAA-designated record set starting in 24 months, but until then, it is the USCDI standard.
• It will not be considered information blocking to notify patients that the apps they’ve chosen may or may not follow best practices.
• An actor can require patient consent or authorization before providing access to EHI, but they must make reasonable efforts to provide a consent form.
• An actor can limit the content of its response to requests to access, exchange, or use EHI without being considered information blocking, which allows them to negotiate terms.They can also fulfill requests in an alternative manner if they have technical limitations or can’t reach terms with the requester.
• Fees may be charged for accessing, exchanging, or using EHI.

ONC will host a series of webinars that explain the new rules starting Wednesday, March 11.

I asked Cerner to provide a high-level summary of what the new regulations mean for developers:

• The appropriate open and unimpeded access, exchange, and use of EHI is firmly established. Information blocking is barred as a general rule.
• Most favored nation behaviors and use of unlevel playing fields to favor some over others for participating in health information exchange will not be tolerated by HIT vendors.
• HIT vendors will need to establish business practices that abide by five vendor-oriented exception conditions that set guardrails for fee development; non-discriminatory business practices; evaluating requests for access, exchange and use of EHI; and for responding to such requests in a good faith manner.
• HIT vendors will need to embrace the era of the API as a critical basis for interoperability going forward, whether for enabling access by patients / consumers, for exchange of EHI with other providers, and for other needs for interoperability.
• Current HIT vendors of certified HIT must keep their clients current by making available updated certified HIT capabilities for interoperability and the essential data set required for exchange (Version 1 of the US Core Data for Interoperability- USCDI) within 24 months for most requirements (36 months for EHI Export).
• HIT vendors will need to attest to HHS and their certifying body as to their compliance with conditions of certification that assure most importantly that they will not engage in information blocking, provide real world support for interoperability, and that they will support API access for all verified registered users (including developers) who seek to connect applications to said APIs to access EHI held by an HIT vendor’s certified products

Reader Comments

From Jake: “Re: coronavirus. The clinical director for a regional hospital in Oregon, which is undergoing a COVID-19 outbreak, is peddling rumors that the flu vaccine makes you susceptible and recommending $200-$500 immune system testing through her side business. Unconscionable.” Stefanie Haines – who has a BS in clinical laboratory science and a doctorate in healthcare administration – also owns the local fitness center, which is a member of a national chiropractic group that sells various snake oils, like vaccine detox. She uses her Facebook page to push debunked conspiracy theories about vaccines, promotes the fitness center’s own services, and claims that coronavirus is a deep state conspiracy that can be prevented by using her immune system tests and nutritional supplements. You will rarely be wrong if you assume that people and companies will do the most profitable thing over the right thing.

From Amtrakker: “Re: HISsies. Epic again? Seriously?” HIStalk readers did the nominating and voting as always, with me doing nothing except shelling out $99 for SurveyMonkey so I could tie ballots to the email addresses of HIStalk subscribers to prevent the ballot box stuffing that would be guaranteed with the typical online poll. I always hope for dark-horse winners to make my job more exciting than just copying Epic / Judy / John Halamka / KP / beers with Bush slides over year after year to announce the winners, but the majority rules.

HIStalk Announcements and Requests

I’ll change out this week’s poll early since folks voted quickly, in which three-fourths of respondents said HIMSS did the right thing in cancelling HIMSS20.

New poll to your right or here: To what level are you avoiding crowded places and unnecessary travel due to COVID-19 concerns? I would not want to be in the cruise industry right now – I checked a couple of websites and the discounts are massive, such as an eight-day cruise on a highly rated ship for $299. Ships are still leaving ports, even Seattle, and returning to discharge petri dish passengers to go home all over the country.

I posted a list of sponsor virtual sessions that were repurposed from the lost HIMSS20. Most of them are, like their original counterparts, scheduled for this week. It’s a good time to get some desk-side education.

It is time (pun intended) to stop with “EST.” It will be “EDT” until November 1, or just “ET” if you want to wash your hands of the distinction in favor of a year-round replacement that prevents you from embarrassing yourself.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

HealthStream acquires 20-employee nurse scheduling app vendor NurseGrid for $25 million in cash. Nurses use its mobile app to manage their schedules, trade shifts, and communicate with each other, while managers use it to publish work schedules. HealthStream expects the money-losing company to contribute less than $500,000 to its revenue in 2020.

Genstar Capital recapitalizes ConnectiveRx, continuing as the majority investor and bringing in new funds as minority participants. The company has doubled in size since Genstar’s initial investment in 2015.

People

Philip Meer, MBA (Evariant) joins PatientKeeper as CEO.

Announcements and Implementations

FormFast changes its name to Interlace Health.

OptimizeRx adds COVID-19 related CDC alerts to its health network of EHR users.

Intelligent Medical Objects partners with Perspecta and the Regenstrief Institute to integrate its Precision Patient Summary with the clinical data viewers of those organizations, which includes the VA through its use of Perspecta’s HealthConcourse.

Salesforce announces enhancements to Health Cloud: provider management, provider search, provider relationships, an analytics solution for care management, and integration with Bridge Connector’s Destinations for integrating EHR data.

Parkland Center for Clinical Innovation publishes “Building Connected Communities of Care: The Playbook for Streamlining Effective Coordination Between Medical and Community-Based Organizations.”

AMA will fast track development of a CPT code for coronavirus tests.

Government and Politics

Premier expressed satisfaction with the new ONC rule, but would like to see more security and privacy requirements implemented for third-party app vendors. They are also disappointed that CMS does not go further to reduce provider burdens, particularly with the new ADT Conditions of Participation requirements and their accelerated implementation timeframe.

Other

The American College of Healthcare Executives, America’s Health Insurance Plans, American Organization for Nursing Leadership, Future of Individualized Medicine, American College of Medical Genetics and Genomics, National Comprehensive Cancer Network, Congress on Healthcare Leadership, VMed, ACC, ENDO, and several other groups join HIMSS and AMIA in cancelling upcoming conferences due to COVID-19 concerns. Massachusetts has declared a state of emergency after 51 new coronavirus cases were found, with 70 of the state’s 92 cases related to a drug company’s 175-attendee conference in Boston last month.

ICU doctors in Italy warn that government reassurances aside, conditions there have deteriorated as COVID-19 ramps up:

• Hospitals are getting dozens of admissions for fever, breathing problems, and cough each day, all with positive swabs and all being diagnosed as bilateral interstitial pneumonia.
• Up to 10% of cases are requiring ICU care for extended periods.
• Hospitals that are overwhelmed at 200% of capacity have converted all ORs to ICUs and are diverting all other emergencies, including trauma and strokes (note: Italy has more physicians and hospital beds per capita than the US).
• Hundreds of patients who have severe respiratory failure are being given nothing except a reservoir mask.
• Patients who are over 65 or who have other medical conditions aren’t even being assessed.
• The situation progressed from a few positive cases, then to some respiratory failures that took up ED resources, then to respiratory deterioration that filled ICUs.
• Staff illness made it hard to cover shifts, while mortality from other causes then spiked because of lack of resources.
• Doctors and nurses have infected their own relatives, some of whom are dying. 

Former FDA Commissioner Scott Gottlieb, MD says it’s too late for COVID-19 containment and thus contact tracing is a waste of resources, predicting that more widespread testing will reveal existing large outbreaks. He says the next two weeks will be “very difficult” and urges shutting down movie theaters and other places where people gather indoors, requiring business to offer teleworking, and slowing transportation. He also says that while coronaviruses usually don’t circulate in the summer, nobody knows about this one. He says that March and April will be tough months, but the epidemic curve could start to go down at the end of April and the situation should improve considerably by summer. He says sporting events such as the NCAA’s Final Four may need to played in empty gyms and conferences should be cancelled: “Do you want to continue to hold conferences and have to run the risk that your entire attendee list is put into a quarantine because there was someone there who is infected?” He concludes that COVID-19 is a pandemic even though WHO is “not wanting to label it yet out of some odd sense of political correctness that I can’t fully appreciate.”

Let’s clear those pre-HIMSS20 tweet buffers, folks (especially the HIMSS-employed ones).

It looks as though the “FHIR Festival” website has gone dark, which I assume is because HL7 and maybe HIMSS expressed minimal amusement at its use of trademarked terms. It was a parody site, which is legal to the extent that you can afford lawyers to argue your case. The good news is that it wasn’t really all that funny once you recovered from that initial small giggle from being caught off guard.

Sponsor Updates

• Customers of professional liability insurer IronHealth can apply their risk management reimbursement dollars toward PeriGen’s PeriWatch Vigilance early warning system for labor problems.
• Bright.md offers free coronavirus screening tool to hospitals.
• Diameter Health adds new FHIR product capabilities to its data normalization and enhancement platform to enable payers and HIEs to share larger sets of data with other healthcare stakeholders.

Blog Posts

• Back to the Basics: Patient Engagement (EClinicalWorks)
• The Importance of Requirements Management for Epic Implementations (314e)
• Throwback: Why Infection Control and Tablets Go Hand-in-Hand for Hospitals (Access)
• Evolve beyond museum relics in your practice (AdvancedMD)
• Avaya Spaces Collaboration App Offered Free to Help During the Coronavirus Outbreak (Avaya)
• HIMSS is Cancelled, Now What? Four Things Health IT Companies Should Do Right Now (Datica)
• 8 Best Practices for Working Remotely (CI Security)
• How Care Coordination Can Help Decrease Utilization (Collective Medical)
• Provider Burnout: No Silver Bullet for Change (CoverMyMeds)
• Patient Safety Awareness Week: Annual Reminder to Advance Quality Healthcare Initiatives (Capsule)

Contacts

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

Morning Headlines 3/10/20

Pager Announces $33M Financing Round

Concierge care coordination app developer Pager raises $33 million in a Series B round, bringing its total raised to $63 million.

PatientKeeper Appoints Philip Meer CEO

Former Evariant EVP Philip Meer becomes CEO of PatientKeeper.

HHS Finalizes Historic Rules to Provide Patients More Control of Their Health Data

ONC publishes its 1,244-page Cures Act Final Rule.

Curbside Consult with Dr. Jayne 3/9/20

I’m beyond aggravated at the lack of communication from HIMSS regarding hotel cancellations and refunds.

All of the FAQ entries on the conference page say they’ll provide a notice within 14 business days. I called my hotel on Friday and tried to cancel and inquire about a refund, but was told that, “Our GM is handling it and we’ve been instructed not to speak with you.” I emailed the HIMSS refund email address with a formal request instead. (Did I mention I still haven’t received a notification that the conference was canceled?) Today, I was reading Mr. H’s Monday Morning Update and saw the link to an OnPeak refund. Although the link is no longer live, it instructed me to call the hotel directly.

After multiple calls and being rolled over to Marriott’s corporate reservation line, I was at least given a cancellation number, as well as the direct phone number for an assistant GM at the hotel. We’ll see if she returns my call. I’ve stayed at the same hotel eight years in a row and have status with Marriott, so I hope they at least make an effort. I don’t expect a full refund, but anything at all would be appreciated for those of us who pay for our trip to the show out of pocket.

Many of the folks I was scheduled to meet with at HIMSS just rolled our already-scheduled appointments into ones by phone, which made things easy. I’ve decided I’m still going to keep other pieces of my conference schedule, including starting to drink wine, whisky, or other cocktails at 4 p.m. on Tuesday and Wednesday, depending on which vendor events I was scheduled to attend. I’m going to be sure to eat seafood on Monday night in honor of Nordic Consulting’s elegant (but canceled) event at The Oceanaire Seafood Room. Tuesday’s dinner will be Italian in honor of the canceled Citrix event at Maggiano’s, and Wednesday will be contemporary Southern cuisine in honor of Red Hat’s event at Itta Bena. Thursday night I was most likely to be eating some kind of granola bar on the plane while flying home, so I don’t plan to replicate that evening.

I’d like to invite all our readers to participate in my own virtual “Shoe-A-Palooza” and “Sock-It-To-Me” competitions. Send me your photos of the shoes and socks you planned to wear this week and I’ll pick my favorites. Be sure to let me know if you want to be added to the history books using your real name or if I should pick a kicky pseudonym to keep you anonymous.

COVID-19 has made it to my community, leading to considerable angst as patients panic and community physicians struggle to understand how we are supposed to care for patients. The biggest point of contention is the fact that we can’t even protect ourselves. Outpatient physicians who aren’t employed by big health systems have either no access to simple surgical masks or access that is intermittent at best. An informal survey of close friends reveals that 10 out of 10 of us don’t have access to gowns.

I’ve had to call the state epidemiologist several times for suspected patients. It’s an arduous process that hasn’t led to testing for any of the patients involved. Due to the shortages, we can’t care for flu patients properly by having them wear a mask when they’re diagnosed, which might be contributing to a bump in flu in our area despite numbers from the CDC that it should be waning.

I never thought I’d have to start thinking about whether to quarantine myself when I come home from work, emerging from my room only to run out the door and head to the office. I’m fortunate in not having small children or childcare issues. Many of my physician peers are struggling to figure out how they’re going to be able to see patients if more schools close. Right now it’s just a handful, but only time will tell.

It’s unclear how the recently-passed $8.3 billion in funding will impact the efforts of frontline providers. I’m monitoring news sources from across the country as well as around the world to see how our local response compares to that of others. Kudos to the Washington Post for offering free access to their articles covering the novel coronavirus. You have to subscribe to an email newsletter to get the access, but it’s good to have multiple sources of information. I’m heartened by the decision of some insurers to cover coronavirus testing, but the devil will be in the details as far as how it actually works out. Some payers are considering policies to waive co-pays for testing, but most patients won’t know how their coverage is until they get the bill.

In positive news, the CDC’s Advisory Committee on Immunization Practices voted to recommend a pre-exposure vaccine for the Ebola virus. It’s at least some comfort for the healthcare providers who work at federally designated Ebola treatment centers in the US, for those who work at Biosafety Level 4 labs, and for the genuine heroes who volunteer to respond to Ebola virus outbreaks across the globe. The single-dose vaccine has been shown to be 100% effective when used in a ring vaccination strategy, which basically means that everyone socially connected with a patient within 21 days of their illness must be vaccinated. Ebola virus outbreaks have taken a back seat to COVID-19, but the virus is still classified as a “public health emergency of international concern” in the Democratic Republic of the Congo.

The focus on vaccines is also good news for biotech firm Moderna Inc. whose experimental coronavirus vaccine is being tested on a small group of adults. The study is only a test of the safety of various doses of the vaccine and whether the subjects produce an immune response. Actual vaccines are likely to be more than a year away. Participants will receive two vaccines over the course of a month and will have to complete 11 face-to-face visits and four phone visits during a 14-month period. Those completing the entire trial will receive $1,100. I would say the real value of participation is priceless, should the vaccine progress to a full recommendation. My medical school is also working on vaccine research, so I’m eager to follow the developments.

I’ll be reporting later this week on my at-home virtual HIMSS efforts, so be sure to send those shoe and sock photos along. I’ll be glad to have something else to focus on than the reality of counting the days until I’m personally exposed to COVID-19.

Email Dr. Jayne.

HISsies Awards 2020 Winners

HIStalk Interviews Diana Nole, CEO, Wolters Kluwer Health

Diana Nole, MBA is CEO of Wolters Kluwer Health.

Tell me about yourself and the company.

I’ve been at Wolters Kluwer for five years, and in and around healthcare since 2006, starting in the radiology area. Wolters Kluwer focuses on the education of medical practitioners, nurses, and pharmacists and helping them with clinical decision support tools and ongoing educational tools. The business itself is a little over $1 billion and has around 3,000 employees. We employ a lot of clinical people, which is a rarity among vendors. We couple technology and clinical expertise.

What progress has been made in turning research findings into frontline provider decision support?

We are heavily focused on that area. People search journals for a tremendous number of use cases. One of our core clinical decision support tools, UpToDate, was created from the discovery that you can’t just have somebody looking through all the journals, yet you need this information updated and you need it in the actual practice of decision-making and the clinical workflow. Even within UpToDate, we still serve up the information based on what the clinician is asking for, kind of the “Google for doctors,” but deeply curated and precise.

A customer told me they love the product, but don’t want to completely rely on the doctor knowing what to look for. More and more we are integrating the information with the EHR systems to support the patient context. We can serve up the most relevant topics for the topics for that particular patient. That’s why we introduced UpToDate Pathways. 

On the journal’s content, we continue to look for things that would be easier to absorb. We’ve applied artificial intelligence to pharmacovigilance for the life sciences industry, where we can sort the information that they’re looking for so that information that is more relevant and might need to be addressed sooner appears right at the top.

We continue to talk with customers about what they do with the information after they get it. What other systems do they need to have it integrated in? What’s the workflow? That will be more and more of our focus — deeply integrating it into the practical workflow. There’s an overwhelming amount of information for those who are practicing.

What’s involved with tailoring the information to the patient level?

You rely on interoperability with the EHR systems. We always have it resident within — you can launch it from the EHR — but more and more we’re trying to have relevant information from the patient record passed into UpToDate, which can then augment a search, but it can also tell you that clinical pathways exist for this particular context of this patient.

Let’s say they have AFib and you need to figure out the best treatment pathway, with particulars about this patient. What other kinds of things are you dealing with in terms of this patient? That helps get the evidence and the information that you want to look at down to a smaller, personalized set.

How do you see artificial intelligence affecting your business and healthcare in general?

It’s a big topic. I’m smiling because of my computer science background, where I always think technology should make something more useful. We are applying it, like many other vendors, and trying to be pragmatic. We’ve all seen these big taglines where the robot will see you versus the doctor. We don’t think that’s going to be be the immediate use of AI. We’re focusing on how to reduce variability in care. 

We even start way back at education. How is the person educated? It’s not in a lecture hall any more. Now we have tools that use AI and do adaptive testing, so the student can self-test their knowledge. You can’t game the system – it asks the student in many different ways how they would answer certain things. That has been proven to get a much deeper level of education and clinical judgment, to  get them ready to get out there.

Other specific use cases involve strong evidence, where you just need the information quicker. We are applying AI to areas like sepsis detection, C. diff, another hospital-acquired infection. AI that can constantly learn the pattern that indicates that a patient may be experiencing it can make the information available sooner. It can be better than a human at continually checking those things.

In my prior world of radiology, AI will be applied to some promising areas involving the images themselves that will help the radiologist. We’re seeing a good impact and tangible improvements.

How much of clinical practice can be directly supported by available evidence? Do you have to consider in product design that recommendations aren’t as black and white to the clinician as they are to the computer?

Everybody wants to help a patient get better. The patient themselves always wants to get better. But so many breakdowns exist within the system, so that even if the doctor follows the evidence guidelines, will the rest of the care team play out and will the patient follow it? It was surprising to me so see on a recent survey just how often that doesn’t happen.

Why somebody might choose to not follow the evidence is probably a deep psychological issue. In addition to having toolsets, not everything is black and white. Clinicians build their knowledge base through other assets, such as talking with their fellow clinicians. There’s also complexity, and sometimes in the most complex cases, I have to make a decision, see the result, and then take another fork in the decision-making and see what that is.

Where we focus is to your earlier point. For certain practices where there is extremely strong evidence, there shouldn’t be any reason to not follow it. That is being more and more adopted. People ask, if we move from from fee-for-service to value-based care, will that push it even further? I think maybe it does, but in general, everybody is trying to get access to the evidence in the best way possible way and to follow it, but there are definitely places where that can fall down.

What is coronavirus teaching about using technology to address a quickly changing and widespread medical situation?

People have compared and contrasted it with SARS and other things in the past. Getting constant news and updates is creating a lot of uncertainty. What should I be thinking? What should I be doing? We and other vendors are trying to help by putting the best evidence and information out there so we can get people focused on the facts at hand and how to treat it best. 

People are being prudent at the settings they put themselves in. They are saying, why put ourselves at risk for further issues by having conferences, meetings, or heavy travel? People are starting to be much wiser about that.

What is different now than in the past is this constant update of information and the lack of true facts on what situations you should avoid. They are in contrast with one another. We need to focus on the facts at hand, what people really know about the situation.

How are providers and life sciences companies using technology to work together on research?

Our Health Language product, which normalizes data, is being used in a life sciences setting for post-clinical trials, where a drug is out in treatment. They are getting data from patients who are using the drug in real time from EHR and other systems. They normalize it to potentially adjust the treatment pathway for this specific patient, and then more quickly understand through their own research whether things need to be modified.

It was impressive to me to learn how this normalization tool can be used in such a great way. In the past it, it probably fell apart a bit — how you get the data out, make sense of it, and do that across so many disparate systems. At least nowadays, everybody really is in a digital record of some type. That’s on the back end for the treatment purposes, but obviously you can see where people could get access to data and then try to work on things across systems of data. That will hopefully help solve problems like coronavirus and others more quickly.

Do you have any final thoughts?

I really am glad that I made the move into healthcare from a vendor perspective in 2006. I continue to be so impressed with the people who I get to work with and the customers I get to interface with. There are big problems out there, but I see tremendous tenacity and passion for trying to solve them.