HIStalk Interviews Jeremy Schwach, CEO, Bluetree Network

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

Tell me about yourself and the company.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 4/22/20

Leading Healthcare Companies Announce COVID-19 Research Database

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

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

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

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

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

News 4/22/20

Top News

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

The HIE will connect to CommonWell later this year.

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

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

Reader Comments

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

People

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

Announcements and Implementations

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

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

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

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

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

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

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

COVID-19

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

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

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

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

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

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

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

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Morning Headlines 4/21/20

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

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

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

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

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

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

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

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

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

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

Curbside Consult with Dr. Jayne 4/20/20

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

How the Pandemic is Changing Consulting Work (Survey Results)

Consultants responded to three questions:

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

Healthcare IT consulting

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

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

Third party Cerner consultant

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

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

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

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

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

Sales and marketing consulting for vendors

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

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

Helping practices build high-performing remote care management

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

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

Clinical EHR optimization

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

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

Epic OpTime

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

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

Epic consulting

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

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

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

Managed services –tier two support

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

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

Interim management

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

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

Epic

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

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

Imaging

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

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

Implementations, optimization, and go-live support

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

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

Epic principal trainer consultant

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

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

Mostly IT implementation, management and business strategy on occasion

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

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

Imaging: Operations, Clinical and Technology Services

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

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

EHR implementations

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

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

Epic lab

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

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

Epic clinicals

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

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

Epic analyst

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

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

Epic clinical / advisory consulting

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

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

Epic analyst

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

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

Epic OpTime

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

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

Full practice management consulting soup to nuts, EMR specialists

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

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

Epic

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

Not at all

Epic inpatient

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

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

Epic and Cerner

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

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

Cerner build and training

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

Shift to more remote work

Epic upgrades

100% shut down

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

Epic

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

Hopefully more health systems will be open to remote work.

Safety

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

More remote work versus travel to save on costs.

IT operations, Epic and Cerner PM and clinical consulting

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

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

IT strategy and project management

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

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

EHR

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

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

Implementations, optimization, and support with Cerner software

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

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

Large EHR implementations

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

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

Epic application analyst

Currently unemployed

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

Healthcare IT management consulting

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

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

Implementation, workflow analysis but not just for Epic

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

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

EMR

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

More remote work

Business and management consulting

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

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

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

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

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

Part-time contracting for a health system for MIPS

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

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

Epic

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

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

Epic Bridges consultant

I took a 21% pay cut to my overall compensation

Hopefully more remote work!

Analytics project management

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

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

Pharmacy informatics

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

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

EHR implementation project management

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

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

Strategic

Evaporated

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

Morning Headlines 4/20/20

Trump Administration Announces New Nursing Homes COVID-19 Transparency Effort

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

Private Equity Firm sues Intel over Failed Acquisition

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

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

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

Beaumont Health says 112K patients were impacted by data breach

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

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

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

Monday Morning Update 4/20/20

Top News

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

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

Reader Comments

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

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

HIStalk Announcements and Requests

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

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

Webinars

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

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

Acquisitions, Funding, Business, and Stock

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

People

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

Announcements and Implementations

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

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

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

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

COVID-19

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

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

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

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

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

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

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

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

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

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

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

Best tweet of the weekend.

Other

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

Sponsor Updates

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

Blog Posts

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

Contacts

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

Weekender 4/17/20

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

In Case You Missed It

• News 4/17/20
• EPtalk by Dr. Jayne 4/16/20
• News 4/15/20
• Curbside Consult with Dr. Jayne 4/13/20
• Monday Morning Update 4/13/20

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 4/17/20

Representative Population Antibody Study Underway in North Carolina

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

FCC Approves First Set of COVID-19 Telehealth Program Applications

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

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

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

Circle Medical Rapidly Expands Telemedicine Offering with New Investment

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

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

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

News 4/17/20

Top News

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

Its Meditech software was back up and running March 31.

The hospital suffered a payroll system breach in late January.

Reader Comments

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

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

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

Webinars

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

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

Sales

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

People

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

Matt Williams (Loop Returns) joins Healthfinch as CTO.

Announcements and Implementations

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

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

COVID-19

ProPublica finds that at-home deaths are skyrocketing in some cities, with the most likely causes being either COVID-19 or serious conditions that people didn’t report because of infection fears. New York City’s deaths outside of hospitals and nursing homes is running six times average. Detroit authorities responded to 150 “dead person observed” calls in the first 10 days of April versus the average of 40, almost all of those occurring in low-income neighborhoods. Some coroners are not listing COVID-19 as a contributing factor in the absence of a positive test even though CDC allows doing so, while some states are falling behind on death reporting due to low staffing and outdated computer systems. As with many aspects of coronavirus, we just don’t know.

Verily assures senators that its COVID-19 screening website for California residents adheres to data protection standards, and adds that, despite criticism, it has no plans to open up the full platform to people who don’t have Google accounts.

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

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

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

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

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

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

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

Other

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

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

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

Sponsor Updates

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

Blog Posts

• A view of COVID-19 from the frontlines and the importance of ventilator surveillance (Capsule)
• How Dallas Renal Group is Providing Care While Social Distancing (EClinicalWorks)
• Infection Control Resources for Post-Acute Care Providers (Ensocare)
• Preparedness, PPE, Pediatrics: On the Front Lines of COVID-19 (Glytec)
• Working From Home: 5 Tips to Promote Health and Wellness (Optimum Healthcare IT)
• How Google Cloud is helping COVID-19 academic research (Google Cloud)
• Standing Up a Virtual Business Office (Nordic)
• EHR integrations for COVID-19: resources and solutions from our Marketplace Partners (Greenway Health)
• Call to Action for Compliance and Revenue Integrity Teams: Address COVID-19 Impact Proactively (Hayes Management Consulting)
• Patient Education and Telehealth: Finding Opportunity Amid COVID-19 (Healthwise)
• How ‘we’ built our crisis management tracking app in 24 hours (hint: magic) (Hyland)
• Imat Virtual Health Record Offers a 360-Degree View of Patients Across the Full Continuum of Care (Imat Solutions)
• The New Normal: Tips on Working from Home (Impact Advisors)
• Imprivata GroundControl: Facilitating increased demand for telehealth and virtual care, on-site (Imprivata)

Contacts

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

EPtalk by Dr. Jayne 4/16/20

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 4/16/20

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

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

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

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

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

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

Morning Headlines 4/15/20

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

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

Mayo Clinic develops COVID-19 tracking tool for staff

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

W2O acquires social media analytics platform Symplur

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

News 4/15/20

Top News

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

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

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

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

Reader Comments

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

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

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

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

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

HIStalk Announcements and Requests

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

Sales

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

People

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

Announcements and Implementations

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

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

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

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

COVID-19

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

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

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

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

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

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

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

Privacy and Security

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

Other

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

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

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

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

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

Sponsor Updates

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

Blog Posts

• 3 Aspects of Epic Implementation that Could be Impacted by COVID-19 (314e)
• CMS Telehealth Billing Correction (AdvancedMD)
• Supporting EMS Readiness for COVID-19 with Avaya Spaces (Avaya)
• Epic Best Practices: Phoenix (Bluetree)
• COVID-19 National Response Portal: Join the Hospital System Data Sharing Initiative (CereCore)
• How Payers Can Leverage Claims & ADT Data (Collective Medical)
• Leadership During the COVID-19 Pandemic: Dan Charney, President & CEO at DRI Shares Thoughts (Direct Recruiters)
• How Artificial Intelligent is Helping Fight COVID-19 (Dimensional Insight)

Contacts

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

Morning Headlines 4/14/20

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

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

Apple Responds to Senators Questioning Privacy of Covid-19 Tools

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

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

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

Mobilizing AI for Health to fight against COVID-19

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

Curbside Consult with Dr. Jayne 4/13/20

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.