EPtalk by Dr. Jayne 4/30/20

I’ve always enjoyed baking, and once upon a time, I even worked in a bakery. Even with exposure to some truly exceptional baking, I’m very impressed by the Chicago-area physician who is creating cookies to honor key figures in the COVID-19 pandemic. Her designs are hand painted and include tributes to physicians such as Anthony Fauci, Ohio’s Amy Acton, and others. Pediatrician Priscilla Sarmiento-Gupana is truly an artist and I wish her good health, along with many happy hours of baking.

CMS has suspended advance payments to providers and is re-evaluating accelerated payments to hospitals. Over $100 billion in loans has already gone out the door, but many healthcare delivery organizations are still struggling. The payments split 40/60 between Medicare Part B providers and hospitals. Recipients are expected to repay the funds within one year. Reasons for suspending the program include the availability of funds through other programs, such as those in the CARES Act, along with the Paycheck Protection Program and Health Care Enhancement Act.

Most studies indicate a 60% decline in outpatient visits during March. Factors at play include providers who want to reduce exposure to their staff, along with patients who don’t want to come into contact with COVID patients. Between 30-50% of physicians report using telehealth for at least a portion of visits. Some specialties, such as ophthalmology, have been hit harder than others, primarily due to recommendations from their professional societies about practice closures.

An intrepid reader sent me this ad from SSM Health that promotes telehealth visits. He notes that the clinician is wearing the traditional dress of nurses in the UK’s NHS. Last time I checked, SSM was located in the central US. They recently furloughed over 2,000 employees, and I wonder if eagle-eyed proofreaders were among those let go.

I often see companies using cheesy stock photos without thinking deeply about whether those photos actually convey the culture of their organization or whether they represent their employees and patients. The picture reminded me that I’m two episodes behind on the new season of “Call the Midwife,” so I know what I’ll be doing tonight.

EHR vendors continue to work to make it easier for clinicians to document patient visits. A recent article in the Journal of the American Medical Informatics Association looks at the accuracy of the physician’s note compared with a concealed audio recording obtained from an unannounced encounter with a standardized patient. Standardized patients are typically professionals who compensated for filling the patient role during a mock office visit, where the clinical team’s performance is evaluated.

Researchers looked at 105 encounters across 36 physicians. They found 636 documentation errors, with 181 findings being documented that did not actually occur and 455 findings that occurred but were not documented. Nearly 90% of the notes had at least one error, with 21 of them over-coded and 4 under-coded. Theoretically, technologies such as ambient clinical intelligence could provide a solution to these issues. I look forward to seeing data on how well it delivers on its promises.

I haven’t paid much attention to the attempts at delivering a virtual HIMSS20, but this week an email came through that listed a session I was actually interested in. Unfortunately, going to the site wasn’t fruitful, as I couldn’t find the session I was looking for. The site has filters but not a keyword search, and since I didn’t want to dig through dozens of screens, I gave up. I’m not sure how well-received HIMSS20 Digital has been, but I doubt I’ll be back.

April 30 is the last day to submit MIPS data for 2019. The data submission window closes at 8 p.m. ET. CHS has added flexibilities due to the stresses that COVID-19 has placed on healthcare providers. Individual clinicians who aren’t able to submit MIPS data by April 30 will qualify for the “automatic extreme and uncontrollable circumstances policy” and will receive a neutral payment adjustment for the 2021 MIPS payment year. Groups and virtual groups will have to submit an application for the exception, and those can also be submitted until  8 p.m. ET on April 30.

Speaking of deadlines, May 1 is the deadline for payers to submit proposals for the Primary Care First program. It seems like it’s been a million years since we’ve talked about programs like this, as opposed to emerging infectious diseases. Delivery of primary care services has been significantly changed by COVID-19 and it remains to be seen whether Primary Care First will even get off the ground, let alone have the power to transform care.

I’m a sucker for evidence-based and data-driven approaches, so I enjoyed learning about the new scoring system that is being discussed by the American College of Surgeons to help surgery departments start scheduling medically necessary operations. The system looks at the level of hospital resources needed, the impact of a treatment delay on a patient, and the risk the procedure poses for the surgical team. The Medically Necessary Time-Sensitive (MeNTS) Prioritization process was published ahead of print and is gaining interest among surgeons who are operating under differing guidelines from various subspecialty organizations.

The system has been in use at the University of Chicago for approximately two weeks. They have been able to increase the number of non-emergency surgeries performed to approximately 15 per day. I’m sure that’s a far cry from their usual surgery volume, but hopefully the scoring system will help create a path forward.

Recent updates to Microsoft Word have been driving me crazy. I was glad to have my experience validated by a recent article in Smithsonian Magazine. Millions of typists were taught to place two spaces after a period, while modern keyboarding technique now only includes one space. I’m thinking about trying to teach myself to type with only one space at the end of a sentence. It might be something to challenge my brain since I’m not working clinical shifts. In the mean time, I’ve asked the new editing tool to tolerate my double-spacing.

One space or two? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 4/30/20

Apple and Google have begun testing their COVID-19 exposure notification API

Apple and Google deliver an initial version of their exposure notification API to several developers who are working with public health agencies, and promise a broader release in several weeks.

Regions Hospital tests new ventilator tech from Medtronic

Regions Hospital (MN) works with Medtronic to develop software that allows providers to remotely monitor and adjust ventilators.

Current Health partners with the Mayo Clinic for remote coronavirus patient monitoring

Mayo Clinic (MN) will invest in Current Health and work with it to develop COVID-19 predictive and remote-monitoring technologies.

HIStalk Interviews Chris Klomp, CEO, Collective Medical

Chris Klomp, MBA is CEO of Collective Medical of Cottonwood Heights, UT.

Tell me about yourself and the company.

I’m the CEO of Collective Medical. We are based in Salt Lake City. We operate the leading real-time care activation alerting and collaboration platform in the country. Our objective is to stitch together otherwise disparate hospitals, health systems, post-acute, clinics, primary care, specialty care, accountable care organizations, health plans, and others to understand where patients travel in real time, identify those who are facing imminent but avoidable risk, and then activate the most appropriate stakeholders to intervene on behalf of that patient to prevent this bad thing from happening to him or her.

We are in use by over 1,000 hospitals and health systems and several tens of thousands of other providers of varying types, including every national health plan in the country, loads of regional plans, and accountable care organizations.

The results are pretty extraordinary. We start with ADT data, but we augment that data with all sorts of incremental data types. Not for purposes of moving that data from point A to point B, which we think is the provenance of health information exchange, but instead leveraging that information in a secure and privacy-compliant manner to help providers intervene with those patients whose needs may go unmet.

Our objective is to improve patient-specific outcomes at the lowest possible cost. We find a tremendous amount of opportunity in the face of medically unnecessary, avoidable utilization.

How will the 21st Century Cure Act’s push for interoperability and ADT notifications affect health systems and medical practices?

A number of provisions within the rules are exciting. We are particularly focused on the recently modified Conditions of Participation, which require hospitals in their several forms, principally acute hospitals and critical access hospitals, to make downstream providers — primary care providers, post-acute facilities, and skilled nursing facilities — aware that a patient has been admitted or discharged. That’s a benign and simple ask, and yet it’s powerful.

We and others already facilitate this type of information awareness. But if you think about it in its most essential form, we as a country charge primary care providers with quarterbacking the care of their patients and coordinating that care across specialists in different acute and post-acute settings. Yet it’s as though we have been tying at least one, if not two, hands behind their backs while expecting them to call the play and throw the ball. They don’t even know when their patient is sitting in a hospital or why, and therefore they are not well positioned to intervene.

These rules are designed in a lightweight manner, right now with not much of a stick, for hospitals to just try a little bit harder to do more to help downstream providers coordinate care more effectively, to take the handoff  from the hospital in a timely manner. I’m sure there will be more to come, where over time, additional data will be required to be shared, perhaps discharge plans, test results, or others. Penalties will probably be instituted, so that stick may get a little bit bigger. But the carrot is also getting bigger as we increasingly shift toward value-based care arrangements. All of this is in the spirit of collectively caring for patients, collectively caring for our most vulnerable members in the community.

This is highly aligned with the strategy that we have been pursuing as an organization for many years. Our name is not by happenstance. We believe that in the concept of better together, as care teams collectively care for one even if they represent different organizations or have never met one another, they are united by their common stewardship for that single patient in that moment. That requires some level of data and clinical interoperability to align their efforts in the most efficient and effective manner. 

The rules are simply trying to remove a few barriers and provide a little bit of additional encouragement, in a light-touch manner, for hospitals and providers do this more effectively. We are excited about that.

What care coordination challenges or needs will be driven by the adoption of telehealth?

We have observed as a country this massive, singular, step-change function, where we shuttered brick and mortar care. I needed to go to a physician recently. All was fine and it wasn’t a big deal, but at the time, it was reasonably urgent and not something that telehealth could appropriately address. I had to pull out all of my powers of persuasion and negotiation to get seen by a provider in person. My family and I have been fortunate to be able to strictly self-quarantine over the last couple of months, and while recognizing that not everybody has that advantage, we were able to make that attestation. The provider acquiesced and agreed to see me and I was grateful for that.

Broadly as a country, hospital revenue is down between 40% and 70% because volumes are down. It is not just electives that have been postponed, but also anything that is essential but non-urgent. Some of that it is being pushed to telehealth, but emergency and inpatient volumes are significantly down.

I would not have expected this step-change function to have occurred without massive external or forcing function externality, and yet it has. It is showing us that many things can be done remotely. Telehealth is here to stay in a much more significant way.

As a result, sending a bunch of faxes and working the phone lines with telehealth providers is not a scalable or cost-effective solution. That puts more emphasis on the need for not just technical interoperability — to get the data to those providers who are not necessarily connected directly to an originating provider’s office, hospital, or health system — but to also also understand what they are recommending and doing. Then, drive that workflow back to the community, to whoever is going to pick up the ball and continue to provide care for the patient, both virtually and in a brick-and-mortar location. It’s both technical and clinical interoperability.

At the same time, I worry, even in the absence of good data or studies, that if you postpone something that needs to be done, it often gets worse and more costly. If you have been diagnosed with cancer or are delayed getting a mammogram, the longer you wait, the harder it is to treat. I worry about that. We have no data, so we don’t know the implications. If this lasts just 60 to 90 days, hopefully the damage will not be particularly acute, and telehealth will have been able to fill that gap along the way. Clearly they are seeing their volumes surge as a subsector. But if we continue to have waves of the pandemic and a vaccine doesn’t come into play, we may find that we have a bigger issue as a country, which is worrisome.

Governments and public health experts are trying to manage the pandemic with voluntarily emailed hospital capacity worksheets. What would be the benefits and challenges involved in providing a real-time view of cases and capacity?

I don’t think that the federal government needs an identified surveillance system that understands where individual patients are going, why they are there, and what care they are receiving. That feels like a big brother surveillance state that as a country, certainly as a citizen and as a patient with my own patient rights, I don’t want. I don’t think that we as a country need that. I have not heard anyone at the state or federal government level ask for an identified surveillance system, and certainly we are pretty close to a lot of folks in state and federal government.

The ask has been for a de-identified solution that would allow not just capacity planning, but real-time evidence of what is happening with disease’s progression. As we ramp up the volume of testing, it will look like we have a second wave of the pandemic. That will lead to all sorts of potentially poor policy decisions, because we now think that there’s an onslaught, when in fact there is not. Nothing has changed except our improved ability to measure.

If you can’t rely on testing until it’s at some sort of a steady-state stasis, with sufficient scale to accurately depict the representation of the infection fatality rate and case fatality rate, what then might you use as a proxy? ADT data is incredibly valuable in that regard. We can understand in true real time — on a de-identified basis that fully protects patient rights or that is even rolled up to the metropolitan statistical area or state level – if we are seeing increased or decreased volumes of both suspected and confirmed cases. We can pull in the lab data to augment this ADT data, which we are doing for a collective of several states across the country on a de-identified basis. 

This is not surveillance, but rather simply an aggregate macro view of what we are seeing from a trending perspective. It allows public policy leaders to make decisions about how to allocate scarce resources, such as ventilators and beds.

What is an entirely unacceptable and insufficient manner would be collecting things by paper, email, and Excel file. There are systems in place right now, including in government, that are trying to rely on that information. The resulting information is, at best, patchy, incomplete, and delayed by many days. We are hearing this from government leaders.

Just like we said about primary care providers having their hands tied behind their back, imagine being a policy leader. You are trying to decide if you should ease social distancing, reopen restaurants, or start to widen the aperture of what constitutes an essential business, because you are also worried about people starving out from massive economic decline. Yet you have, at best, a patchwork set of data that is not representative of what is actually happening with this hidden enemy. That’s a really difficult position.

You could make better decisions with a a highly privacy-compliant solution that has nothing to do with individual surveillance, but that instead shows de-identified, aggregated suspected and confirmed cases with an accurate denominator of total volumes presenting to an emergency department or inpatient care setting. That’s what is being asked for by folks in federal and state government. As a citizen, that makes me feel a lot better.

Do you have any final thoughts?

The pandemic marks a turning point in healthcare along many dimensions. It has many silver linings. States will be better enabled to build public health infrastructure that we previously could only dream of. We have a catalyst to understand the importance of this and to understand the importance of preparation. 

We need to align on a set of clear objectives. Those should obviously be patient safety and outcomes, provider safety, and guiding public health response to inform policy to allocate scarce resources broadly. But the very nature of our response  is showing the entire country the need for a more comprehensive and logically tuned health IT infrastructure that works together and is not operating in silos, whether it’s data silos, provider silos, or equipment provider silos. As a country, we need to come together. Slowly, I think we are starting to see that, even though we’ve had some gaps in our response efforts.

I’m hopeful that we will make the changes we need to make once we move past the acute or attenuated point of this crisis. A vaccine may not be our answer. We may go back to old-fashioned masks and social distancing to starve the disease out. Regardless, we need good data to understand how to proceed. That will happen only if we come together and continue to work on things such as what is being promulgated in the 21st Century Cures Act. 

I’m hopeful. I’m optimistic. We are a country that tends to rise together in times of crisis. I have no reason to believe that this will be any different. We are certainly seeing evidence of that across the country with all of the stakeholders with whom we partner.

Morning Headlines 4/29/20

IG: Veterans Affairs slow to heed lessons from DoD’s electronic health record rollout

A VA OIG evaluation of the now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center finds the VA had not adequately prepared for staffing and patient access issues, or for dealing with missing EHR capabilities that may have compromised patient safety.

Irvine-based company among first to offer COVID-19 antibody testing to employees

EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families.

Cerner Reports First Quarter 2020 Results

Cerner reports Q1 results: revenue up 2%, adjusted diluted EPS $0.71 vs. $0.61, beating analyst expectations on earnings and missing on revenue.

Particle Health Raises $12M Series A led by Menlo Ventures

Medical record API startup Particle Health raises $12 million in a funding round led by Menlo Ventures.

News 4/29/20

Top News

VA OIG evaluates the VA’s now-postponed first Cerner go-live at at Mann-Grandstaff VA Medical Center (WA) that was scheduled for March 28, 2020, observing:

• The VA assumed that access to care would drop 30% for 12-24 months after go-live based on the Department of Defense’s Cerner experience. However, planned mitigation actions were not completed due to the VA‘s lack of guidance and budget constraints for adding employees, expanding clinical space, expanding clinic hours, and extending appointment times.
• The VA could not alleviate potential backlogs by referring patients to community providers because the hospital is already falling short of VA standards in that area, with a backlog of 21,000 open consults and an average wait time of 56 days. Employees were asked to work 8-10 extra hours per week to manually copy and paste information from one system to another to process the consults.
• VA and Cerner concluded in July 2019 that some EHR capabilities would be missing by the March go-live, including requesting online prescription refills via MyHealtheVet, which presented a patient safety risk. The VA decided to turn off access to prescription refills in Cerner’s HealtheLife patient portal because it did not meet VA standards.
• Hospital staff would have needed to enact 84 mitigations for the 62 systems that were at moderate to high risk of being unavailable.

Reader Comments

From AnotherDave: ”Re: Scanadu. Too bad it fizzled now that there’s a run on pulse oximeters. I pulled my First Edition from its paperweight duties and it still works. I bought it for $149 in the early bird Indiegogo deal in 2013, finally received it in February 2015, and the company’s business plan fell apart in May 2017 when its investigational study was shut down. With the right investment and re-branding, it would be a Handy COVID-19 Screener.” I never quite saw the appeal of the Scanadu gadget, maybe because the Tricorder references got old fast, it didn’t do a whole lot, and early digital health fanboys were practically mounting it in lustful consummation of their naiveté-fueled enthusiasm. The company said FDA required it to brick the device because it was part of a Scripps study that had ended. Crowd-funders got nothing and weren’t happy about it. Founder and CEO Walter De Brouwer went on to launch Doc.ai, which allows researchers to conduct medical studies via the smartphone of participants. Meanwhile, Scanadu renamed itself as Inui Health in late 2018, launched an FDA-approved app for in-home urinalysis, and then pretty much went nowhere.

From Mo Money: “Re: stock market. Good time to invest in health IT companies?” I don’t buy or recommend health IT stocks because that seems like a conflict of interest, but I’ll instead offer my long-held opinions about investing in general:

• No investment performs better in the long term than stocks, and long-term investing is where you accumulate net worth (which is the only personal financial metric that matters – it’s what you own that counts, not what you make).
• Markets have always eventually roared back after an emotion-driven downturn. The first time that doesn’t happen will be the end of American society, in which case your mattress full of cash won’t buy you anything important anyway.
• You have to buy dispassionately and stay in the market regardless of the ups and downs, which are just bumps in the road. Discipline pays.
• Define your specific goals (“getting rich” doesn’t count). It’s always a balance between reward and risk, and your tolerance and timelines for the former drive the required degree of the latter.
• The time value of money is powerful. The investment decisions you make in your 20s and 30s, even with small amounts of money involved, will far outweigh the decisions you make in your 50s and 60s.
• Don’t look at your portfolio value more than one per quarter, rebalance holdings to meet your chosen model, and don’t change your plan just because it’s up or down. Especially if you, like me, would feel anxiety or depressive remorse in having lost money (I swear I was the only person who was buying high and selling low during the dot-com boom).
• Buy mutual funds, index funds, or an investment company’s trading model. The odds that you will out-earn experts with your consummate stock-picking skills are minimal. Take a look at how well health IT stocks have performed against the Nasdaq index or S&P 500 in the long term before you get excited about applying your industry knowledge to stock picking.
• Don’t be influenced by people who brag about their investing home runs since it’s their batting average that matters (it’s more “Moneyball” getting on base frequently than striking out consistently while waiting to send the next shot over the fence).  
• Buying IPO shares means someone who knows a whole lot more about the company than you is anxious to unload.
• Don’t overload on your own employer’s shares in your 401(k). Not only are you are overexposed from a portfolio standpoint, any employer stumbles will probably bite you doubly hard as both an investor and an employee. 
• Stocks are worth what the market thinks they are worth, which may not track well to intrinsic valuation or reasonable expectations. No amount of stock-picking analysis will change that, and those who believe differently are efficiently separated from their money over the long haul. No formula, no matter how elaborately conceived, can take human foibles into account, and stock price is set by greed, fear, and hopes of finding a greater fool.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Spirion. The St. Petersburg, FL-based company has since 2006 offered accurate data discovery and classification solutions that give customers in several industries unparalleled data privacy, security, and regulatory compliance. Spirion’s platform gives healthcare organizations full visibility into their structured and unstructured data, both network- and cloud-based, to allow designing protection and monitoring without human effort or error. Spirion for Healthcare is a PHI management and data loss prevention tool that focuses exclusively on data at rest, which represents 100% of large breaches. Its rules-driven, sensitivity-tunable AnyFind technology uses contextual search discovery to find data sources such as payment card industry (PCI) data, PHI, and personally identifiable information no matter where it exists, while Sensitive Data Engine allows creating data deeper definitions to locate proprietary and unique organizational information. The company offers data security teams free 60-day use of Sensitive Data Manager during the COVID-19 crisis, also extending to stay-home employees free use of a Data Discovery Agent to identify the existence sensitive personal information on their computers. Thanks to Spirion for supporting HIStalk.

I found this Spirion explainer video on YouTube.

Webinars

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

Acquisitions, Funding, Business, and Stock

Cerner reports Q1 results: revenue up 2%,adjusted EPS $0.71 vs. $0.61, beating earnings expectation but falling short on revenue. The company expects the biggest COVID-19 financial hit to occur in Q2, after which project and sales activity will improve if pandemic-related restrictive measures are relaxed. 

UnitedHealth Group’s Optum division is reportedly negotiating a $470 million acquisition of AbleTo, which offers virtual visits for behavioral care with its network of therapists and coaches. The company, which targets payers and employers, had previously raised $47 million through a Series D round, with Optum Ventures being one of its most recent investors. 

Sales

• OU Medicine (OK) chooses Artifact Health’s mobile physician query platform to drive complete and comprehensive patient chart information.

People

Nicklaus Children’s Health System (FL) hires David Seo, MD (University of Miami Health System) as VP/CIO.

Nephrologist Burton “Bud” Rose, MD, who created the industry-standard UpToDate computerized medical reference in his basement in 1992, died of COVID-19 last week at 77.

Announcements and Implementations

A new KLAS report on ambulatory revenue cycle management services finds high customer satisfaction with Athenahealth, R1 RCM, and Bolder Healthcare, while EMDs, CareCloud, and Greenway Health experienced a significant drop in satisfaction over the past year. Six of the eight reviewed firms were acquired in the past few years, some with positive results (Allscripts, Athenahealth, Bolder, and R1) and one showing a significant decline in satisfaction (EMD’s 2019 acquisition of Aprima, with 80% of the latter’s former clients expressing dissatisfaction since). KLAS concludes that third-party players are gaining traction and raising the customer satisfaction bar as disruptive new entrants.

Another KLAS report suggests how health IT vendors should conduct business during COVID-19:

• Sell the customer what they need to become successful (prescriptive sales) instead of allowing them to pick and chose products and services themselves.
• Pass on sales that are not a good fit to avoid future reputation damage.
• Have account managers proactively reach out to customers to help them understand the company’s vision and the product’s impact.
• Empower lower-level employees to solve customer problems.
• Create contingency plans to avoid support disruptions that could be caused by COVID-19 impact on offshore support resources.
• Drive adoption through training.
• Use internal expertise to guide customers instead of just giving them data or new reports.

Oneview Cloud for COVID-19 is being used for virtual care and virtual visitation in the coronavirus units of four New York City teaching hospitals.

A TransUnion Healthcare analysis of 500 hospitals finds that visit volume declined 32-60% in March.

GuideWell launches COVID-19 Health Innovation Collaborative, which seeks solutions that address the categories of COVID-19 self testing, virtual in-home care, protection of clinical staff, reduction of social isolation, and home delivery of food and supplies to at-risk populations. The application deadline is May 8.

COVID-19

Overall fatality rates compared to pre-pandemic numbers suggest that coronavirus-related deaths are up to 60% higher than official counts. New York City averages 6,000 deaths from mid-March to late April, but had 27,000 in the same period this year versus the 17,000 deaths that were officially attributed to confirmed or probable coronavirus.

Sixty Mayo Clinic physician volunteers are helping manage New York City’s COVID-19 ventilator patients remotely using an audiovisual connection and access to New York-Presbyterian’s Epic system. The doctors note that COVID-19 is like prolonged respiratory failure with unusual twists, such as blood clots and kidney failure.

EHR vendor Kareo becomes one of the first companies in Southern California to offer free COVID-19 antibody tests to its employees and their families, with 40 of the 415 who were tested in a drive-through program showing antibodies that indicate previous or current infection. Of the 15 who showed a possible active infection, only one had symptoms. The company hopes the testing will give employees peace of mind and help it transition back to on-premises work.

Vice-President Pence was allowed to violate Mayo Clinic’s campus mask-wearing requirements during his visit there Tuesday, even as he met with employees and a patient who all wore them. Senior White House officials have never been shown wearing masks in public or in photo opportunities. Mayo said they told Pence’s team about the policy and referred further questions to them.

Quest Diagnostics announces availability of a $119 COVID-19 antibody test via its QuestDirect service that does not require a prescription, although purchasers must visit a Quest draw station to provide a blood sample. Public health officials again warn that nobody knows what the presence of coronavirus antibodies means with regard to immunity.

Former FDA Commissioner Scott Gottlieb, MD says in a Wall Street Journal op-ed piece that the US must create a COVID-19 vaccine because the country that does so will inoculate its own citizens first to restore its economy and gain global influence.

A New York Times report says that China’s factories have reopened, but job losses, reduced wages, and people staying home to avoid infection have left its economy sputtering from low consumer spending.

Other

Patients complain that they are being unexpectedly charged for virtual visits despite political proclamations and insurer announcements of waived co-pays and deductibles for COVID-related services, mostly because of the fragmented health system. Among the issues:

• Some doctors and insurers are charging patients upfront for the full cost of the virtual visit even when it is covered by insurance because insurers aren’t paying and the cash-strapped practices are anxious to collect revenue immediately.
• 100 million people get their insurance from employers that are self-insured and the big insurers don’t control the telemedicine benefits in that case.
• Insurers have waived patient charges only for in-network doctors.
• Some practices are charging for routine telephone calls now that Medicare and insurers are paying for virtual visits in all forms.

A New York Times article warns that parents are postponing well-child checkups for fear of COVID-19, leading to concerns that reduced immunization will cause outbreaks of measles and whooping cough. Pediatric EHR vendor PCC found from the records of 1,000 independent pediatricians that MMR vaccinations are down 50%, diphtheria and whooping cough 42%, and HPV 73%.

Physician and author Sid Mukherjee, MD writes in The New Yorker that the US healthcare system caused several issues in our coronavirus response:

• US medical infrastructure fell apart in failing to inventory adequate supplies of PPE and a Strategic National Stockpile that saw its role as supplementing, rather than meeting, state and local public health emergency needs.
• Testing failed because of the CDC’s distribution of faulty COVID-19 tests, the FDA’s requirement that only CDC tests be used (instead of the WHO tests that the rest of the world uses), and CDC’s distribution of tests only to military, state, and public health labs that perform a tiny fraction of all testing. The author notes that South Korea has so many test kits that it is exporting them to the US, which they did by quickly identifying potential vendors, certifying their products, and turning their factories loose to meet demand.
• FDA’s process for validating diagnostic tests that had been developed by other labs was inefficient, with criticism then causing it to overshoot in allowing 90 companies to sell antibody tests even though FDA has reviewed only four. 
• The value of distributing real-time, anecdotal treatment findings via social media and preprints was obvious though imperfect.
• Vital drugs fell in short supply because their low profit margins left manufacturers complacent and some of them are made in single factories that were disrupted, such as by Hurricane Maria in Puerto Rico.
• The “market-driven, efficiency-obsessed culture of hospital administration” caused leaders to fail to account for “organizational survival time” in the absence of a functional supply chain and the time required to recover from such disruption afterward.
• The difficulty of searching for information in EHRs and the time required to obtain institutional approval to do it left researchers flying blind. The author says that EHRs “actively obstruct patient care” and are bound by proprietary interests and privacy rules from delivering their potential as a searchable national repository of real-time, de-identified patient data that could be used as a “storm-forecasting system” for research and treatment dissemination.

In colorful COVID-19 political news, Grants, NM Mayor Martin “Modey” Hicks (D) defies state law in allowing gun stores and golf courses to reopen, concluding, “We’re not doing it no more” and that “that business, by God, is essential to that individual.” Governor Michelle Lujan Grisham says she may file a cease-and-desist order since it is “like opening up a public pool and having a pee section.” The mayor has ordered businesses to call 911 if the governor’s “Gestapo” shows up over a “little bug.“ He then told reporters he was heading off for a round of golf, and finding the course closed, fired the city manager.

Sponsor Updates

• Audacious Inquiry will work with HL7 International to develop an HL7 FHIR implementation guide as part of their work with the SANER project.
• CRN gives Avaya a five-star rating in its annual Partner Program Guide.
• Black Book’s latest survey finds that Evident’s Thrive EHR has earned top client ratings in small hospital EHR user satisfaction for the tenth consecutive year.
• Murray County Medical Center (MN) and TCare implement CareSignal’s COVID-19 Companion text messaging app.
• Wolters Kluwer launches virtual conferences to support medical societies amid COVID-19 meeting cancellations.
• CereCore congratulates its Epic team on helping HCA Healthcare expand its telehealth capabilities.

Blog Posts

• How Training Initiatives Helped Empower and Prepare Baylor Scott & White Health for COVID-19 (Part 1) and (Part 2) (314e)
• How Healthcare is Falling Behind in a Digital Economy (Part 2) (AdvancedMD)
• COVID19 Preparedness and IT Pandemic Preparation (CI Security)
• Elements of Consideration During CDI Review of COVID-19 Patients (Artifact Health)
• Rapidly Expanding Capacity for the Coronavirus Pandemic and Beyond (Impact Advisors)
• Now Could Be the Time to Shift Your Contact Center to the Cloud (Avaya)
• ONC-CMS Final Rules, Part 4 – Implementation (Datica)
• Updated Star Ratings: How CarePort Can Help (CarePort Health)
• Improving ED and ACO Collaboration Through a Common Technology Platform (Collective Medical)
• CoverMyMeds Campus Update: Spotlight on Sustainability (CoverMyMeds)
• COVID-19 and Virtual Health Services – Commonly Asked Q&A (Culbert Healthcare Solutions)
• Despite Delay – No Time to Lose (Diameter Health)
• Combatting COVID: 5 Benefits for Text-Based Screening Tools (Dina)

Contacts

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

Morning Headlines 4/28/20

Allscripts trims workforce by 5%, cuts pay for highest earners

Allscripts announces layoffs, which HIStalk readers reported earlier this month, plus pay reductions for high earners and executives like CEO Paul Black, who will see a 40% decrease for an anticipated six months.

Parkview Medical Center confirms cyber attack

Parkview Medical Center in Pueblo, CO works to restore its IT systems after an April 21 data breach.

Apple, Google pledge extra privacy protections

Apple and Google will update APIs for their jointly developed COVID-19 exposure tracking software to include randomly generated encryption keys, encryption of Bluetooth metadata, and an exposure time limit of 30 minutes.

Leading Telehealth Platform, Medici, Sees Immense Growth as Virtual Healthcare Continues to Rise

Telemedicine company Medici raises $24 million in a Series B round.

UnitedHealth’s Optum is in advanced talks to acquire remote mental health provider AbleTo for about $470 million

Optum considers acquiring mental telehealth company AbleTo for $470 million.

Curbside Consult with Dr. Jayne 4/27/20

Just when I was getting used to being furloughed from my clinical gig, I was called to action for three days of work that just happened to coincide with the expected peak of COVID in my state. Although I was initially eager to get back in the game, I must admit that 36 hours in the trenches has eliminated any such enthusiasm.

After my initial shock over a couple of things, I decided to give it the benefit of the doubt and try not to draw any conclusions until I had worked at three sites with three teams. Now, with those shifts in my rear-view mirror, I have to say that some of my first impressions were correct. Here’s what I learned.

I’m probably more likely to be exposed to the novel coronavirus by my colleagues than by the general public. Our team is generally young and healthy, mostly EMTs and paramedics. Many of them are super fit, with extensive workout and nutrition routines. Several of them questioned why I was wearing my N95 mask all day, even for patients who didn’t have respiratory symptoms. It’s clear that our internal education has not met the mark as far as their understanding the idea of asymptomatic spreaders or the need to treat everyone with universal precautions since you can’t tell from looking who might be a carrier.

Most of them were donning and doffing various masks (alternating between N95 and standard surgical masks) and setting them on the workstation counter in between patients. Only two of us had a dedicated “drop zone” for our masks (a.k.a. paper towels with our names on them). Others were lowering their masks under their chin in between patients, which is a less-than-great infection control procedure. The good thing is that most of them responded well to a little in-person education and started doing better with mask hygiene.

Leadership note: just because you send out memos and instructions, it doesn’t mean people get it and are following the instructions. Sometimes you need the face-to-face contact to get the message across. It’s an expensive kind of communication, but it’s worth it.

Speaking of masks, the general public isn’t doing a great job of wearing them even when they have the good ones. I saw too many people with masks covering the mouth but not the nose, and too many whose nose pieces weren’t pinched to fit well around the nose. People whose glasses are fogging up due to their masks are incredibly grateful when you teach them how to pinch the nose of the mask. We as healthcare providers take it for granted that people know how to use them correctly.

I saw everything from top-of-the-line 3M models to simple bandanas. The best one was a homemade model on a patient whose wife is a professional seamstress. As someone who does a little sewing myself, the craftsmanship was something to behold. I told him to be sure to let her know that the doctor noticed her attention to detail and excellent topstitching.

I also learned that a good part of our surge was made up of people coming in for non-emergent conditions. People certainly aren’t afraid to venture out for minor things such as having wax removed from their ears even though they don’t have symptoms. Multiple people were there for medication refills since they either couldn’t get in touch with their physicians or were having trouble getting refills in a timely manner, and I was happy to help them.

We did see our share of urgent and emergent conditions as well, including multiple cooking-related lacerations among people who don’t usually cook, along with several home improvement injuries. Patient education note: working on an aluminum ladder while barefoot is not a good idea. We also diagnosed and treated multiple sexually transmitted infections, so some people’s ideas of stay-at-home might be a little different than others.

I ordered my fair share of COVID-19 testing swabs, and now I get to play the waiting game to see how long it takes the results to return so I can start my own “known exposure” countdown. I don’t know when I’ll be asked to work again, but I’ll definitely be staying close to home until the results turn up. I’m grateful we have testing capabilities and can at least collect the samples in the office without having to send patients elsewhere or fight the health department for approval like I had to a little more than a month ago.

My employer is keeping a close count on the testing swabs since they aren’t sure when we can get additional supplies. We’re a long way from testing everyone who wants to be, as we were promised once upon a time.

After my first day of patient care, I pretty much fell into my bed. As I tried to fall asleep, I wondered how long it would take the tingling in my face to go away. If you wear them properly, the N95 masks are pretty tight, and I was glad that my face was back to normal by the morning. However, after three days in a row, my face feels like it’s been in a vise and I have a splitting headache that I can’t get to go away.

I cannot even fathom what it must be like for the healthcare workers who are on dedicated COVID units or who have been working like this for weeks on end. I’m hoping to cruise some forums for tips on pressure reduction before I go back again. Hopefully, my face will bounce back overnight since I’m supposed to film some EHR training videos for one of my clients.

I’m glad I could pitch in, but I feel guilty for having been parked at home while my colleagues have been working. It’s definitely more mentally and emotionally exhausting than the work we were doing before, even in the middle of flu season. I never thought I would wish to go back to the Flumageddon season of 2017-18, but I do, to some degree. At least back then we knew what we were dealing with, we could test for it, and we had a hope of treatment. With this situation, we’re often flying blind and looking for outlier symptoms, such as loss of smell or “COVID toes.”

I noticed that our EHR vendor has added quite a bit of telehealth-specific content. Even though we’re not using it, I was glad to be able to check it out. It prompted a good conversation with my scribe, who was also seeing it for the first time. She didn’t know I worked in telehealth. She recently wrote a paper about telehealth for an undergrad class. It was good to have a bright moment like that in the middle of a very tiring day, and hopefully she learned something beyond what her research had shown her.

She also offered me the tip of putting Preparation H on my face if the redness doesn’t go away. Apparently, she learned it “on the pageant circuit,” but I’m too tired to even remotely consider masking up and going to the store.

Have any tips for dealing with the squeeze of a badly fitting mask when there aren’t any other mask options? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Healthcare Crisis Underscores Strategic Importance of Strong IT Support

Healthcare Crisis Underscores Strategic Importance of Strong IT Support
By Rob Dreussi

Rob Dreussi is CIO of HCTec of Brentwood, TN.

Take a moment to thank those who work on the IT service desk. Who knew they would play an essential role in maintaining operational continuity and getting our patients and providers up and running on telehealth?

Every large-scale crisis exposes shortfalls and creates opportunities for improvement in healthcare. The COVID-19 pandemic has highlighted the need for hospitals to think differently and more strategically about their IT service desks.

EMR patient portal usage has increased as telehealth and other patient-facing solutions are being rapidly deployed. Maximizing that kind of technology, keeping it running, and supporting it properly requires people with specialized HIT skills, training, and experience. Technology may be the tool, but people and solid operating processes are required to make it work.

This crisis is a powerful reminder of the IT service desk’s higher purpose—helping providers and patients by either resolving their immediate problem or finding the best next-level person to assist them. A mature IT service desk employs a diverse team of experts, including agents, coaches, trainers, workforce analysts, quality analysts, and related technology SMEs. Collectively, this team enables healthcare providers and patients to leverage technology rather than be hindered by it.

However, IT service desks have struggled to meet the increased demands related to the COVID-19 pandemic because their resourcing plans are based on historical support volumes. Who could have predicted:

• Call volumes that are doubling and tripling.
• Supporting new applications almost overnight that typically would have been deployed over months.
• Assisting end users while they shifted in mass to working from home.
• Continuing to deliver services while the IT service desk itself shifted to working from home.
• Onboarding and training new agents 100% virtually.

Keeping up with all the change has been really hard.

The pandemic has put a spotlight on how the technical and user-facing skills that are needed for effective IT support have increased dramatically over the last decade. The demand for this dual skillset will only continue to increase as hospital clinical and overall operations grow increasingly reliant on technology. Already Meaningful Use and the movement toward value-based care have driven the adoption of complex clinical and business systems that require constant maintenance and inspire far greater security concerns.

Simultaneously, the expectations of providers and patients alike are rising, as we all have become accustomed to customer-friendly, tech-savvy support from companies like Amazon and American Express. As a result, the IT service desk’s role now includes representing the voice and brand of the health system. Delivering a strong overall experience — whether to patient, provider, or administrative user — is more critical than ever. In this new environment, the staffing, required skills and management of the IT service desk requires a more advanced and strategic approach.

It’s no surprise that COVID-19 has forced HIT support personnel to work overtime, late nights, and weekends. Their efforts are essential to ensuring that healthcare providers and their patients receive the support they need to improve delivery of care in a time when people need it most.

COVID-19 has made painfully obvious to a broader audience what we have always known — technology doesn’t always work as designed. It has also made it glaringly apparent that in healthcare we need people who understand how to effectively support technology so that patients and providers alike can leverage its power to improve care and outcomes.

HIStalk Interviews Krishna Kurapati, CEO, QliqSoft

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

Tell me about yourself and the company.

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

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

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

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

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

What factors distinguish one virtual visit solution from another?

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

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

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

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

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

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

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

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

How are health systems using chatbots?

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

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

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

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

What other technologies could see a usage uptick?

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

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

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

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

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

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

Morning Headlines 4/27/20

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

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

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

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

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

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

Private sector races to build virus apps to track employees

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

Monday Morning Update 4/27/20

Top News

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

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

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

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

HIStalk Announcements and Requests

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

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

People

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

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

Announcements and Implementations

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

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

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

COVID-19

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

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

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

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

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

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

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

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

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Weekender 4/24/20

Weekly News Recap

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

Best Reader Comments

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

In Case You Missed It

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

Get Involved

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

Morning Headlines 4/24/20

Banner Health $8.9 Million Data Breach Settlement Gets Court Nod

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

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

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

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

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

VR telemedicine platform XRHealth raises $7M

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

News 4/24/20

Top News

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

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

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

Reader Comments

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

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

Webinars

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

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

Sales

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

Announcements and Implementations

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

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

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

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

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

Government and Politics

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

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

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

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

COVID-19

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

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

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

A Kaiser Family Foundation poll finds that:

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

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

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

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

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

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

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

Privacy and Security

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

Other

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

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

This is pretty great.

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 4/23/20

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 4/23/20

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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