News 3/18/20

Top News

HHS OCR won’t assess penalties on providers who use non-HIPAA compliant communication technologies to provide telehealth services during the COVID-19 public health emergency. This relaxation of rules applies to all healthcare services, not just those that are related to COVID-19.

Providers can use any form of personal audio or video communication, such as FaceTime, Facebook Messenger, Google Hangouts, and Skype.

Telehealth services may not be delivered via public-facing apps like Facebook Live, Twitch, and TikTok.

Reader Comments

From Convener: “Re: conference bridges. Is anyone reporting that they are giving busy signals?” The free services like the one I use – which make money by charging AT&T using a “last mile” telecommunications loophole that AT&T hates passionately – have complained that AT&T has blocked their customers from using the conferencing services following an FCC rule change. I haven’t heard anything otherwise. The demands placed on videoconferencing services for online meetings and education must be incredible, leading to rampant (but unfounded so far) speculation that they will “break the Internet,” along with heavy use of streaming video and audio by folks newly assigned to work from home. Microsoft Teams went offline for several hours on Europe’s first work-from-home day.

HIStalk Announcements and Requests

Poll respondents said they want to see more COVID-19 news and reports from the field on HIStalk. I’ll tread lightly in covering just the most important items.

I’ll add the COVID-19 items as a separate section and continue soliciting reports from the field, as on my open survey. It would be great to get provider entries that could benefit a lot of patients and healthcare workers.

I was thinking as I saw photos of under-40 folks packing bars, concerts, and beaches that perhaps they are frustratingly uninformed or irresponsible, but then I went to the dark side and pictured them convening  “boomer remover” gatherings to exploit their lower coronavirus mortality risk to extract revenge on their elders for mismanaging their economic or environmental futures. I bet Stephen King is working on that novel as we speak.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

I’m studiously avoiding watching the stock market, especially when it comes to my 401(k), but here’s how some publicly traded health IT-related stocks have performed over the past month, compared to the big market indices (at Tuesday morning’s market pre-open):

1. Teladoc (up 4%)
2. Premier (up 3%)
3. NantHealth (down 18%)
4. Vocera (down 18%)
5. Cerner (down 21%)
6. Livongo (down 26%)
7. McKesson (down 28%)
8. Nasdaq composite (down 29%)
9. S&P 500 (down 29%)
10. Dow Jones Industrial Average (down 31%) 
11. CPSI (down 32%)
12. Nuance (down 35%)
13. Inovalon (down 35%)
14. Allscripts (down 41%)
15. Health Catalyst (down 43%)
16. Castlight Health (down 44%)
17. Change Healthcare (down 45%)
18. NextGen Healthcare (down 53%)
19. Evolent Health (down 68%)

An investor’s New York Times opinion piece predicts big problems for companies that piled up debt when borrowing was cheap, with the pandemic-demolished sectors of auto, hospitality, and transportation being the worst offenders. The author also says that companies that have been taken private by private equity firms carry debt averaging six times their earnings, leading to “zombie” companies that don’t generate enough profit to pay even the interest alone.  

Announcements and Implementations

LOINC publishes codes for COVID-19 lab testing.

OptimizeRx launches a free consumer text message alert program that delivers CDC-issued COVID-19 information to any SMS-enabled device. Text VIRUS to 55150.

Collective Medical offers free use of its ADT-based collaboration network through the end of 2020 to help with COVID-19 response. Healthcare organizations can go live on its lightweight solution in less than one week without cost or obligation for the rest of the year. It offers frontline providers quick identification of high-risk patients.

Asparia develops a COVID-19 tool for Epic App Orchard that contains three elements: a chatbot appointment scheduler, a patient questionnaire that alerts staff of possible infection risk, and enhanced appointment reminders that can extend character limits to allow including enhanced education and instruction. The app won’t be listed on App Orchard for several weeks, but can be requested through Epic or Asparia.

T-System will provide free influenza and COVID-19 T Sheets to providers that include point-of-care documentation, diagnosis, and treatment tools that incorporate the latest CDC guidelines. Templates are available for ED, pediatric ED, and urgent care.

Bluetree publishes a COVID-19 resource page that includes ideas for leading remote projects, developing reporting functionality, and clinical decision support build workflow.

Healthwise creates a Coronavirus Resource Center of consumer-friendly educational information and care instructions that are free to all.

Meditech offers Expanse Ambulatory customers use of its Scheduled Virtual Visits functionality for six months at no charge.

The White House’s Office of Science and Technology Policy joins Microsoft, Chan Zuckerberg Initiative, and other groups to create a COVID-19 open research dataset of scholarly literature. The groups have issued a challenge for AI experts to develop text and data mining techniques to help scientists answer high-priority COVID-19 questions.

Government and Politics

CMS issues a fact sheet on how Medicare will pay for virtual services during the pandemic. Medicare can pay for office, hospital and other visits via telehealth, unlike previously when those visits were covered only for patients in rural areas. Payment will be the same as for in-person visits.

Hackers attack HHS’s computer network in what insiders say was an attempt to undermine the government’s response to the coronavirus pandemic. It appears to have been a distributed denial of service attacked that was quickly stopped.

COVID-19 News

England’s Imperial College COVID-19 response team self-publishes a paper whose impact is reverberating around the US and UK, with the White House getting an early look a week ago that may have influenced its 180-degree turnaround in how the pandemic is viewed and managed. The team describes two strategies for the two countries: mitigation (flattening the curve to reduce peak healthcare system demand) and suppression (reversing growth and case numbers in an indefinite program will awaiting development of a vaccine). Summary points:

• Mitigation, such as home isolation of suspected cases and social distancing of high-risk people – is not preferred. It could reduce peak healthcare demand by two-thirds and cut deaths in half, but would still result in hundreds of thousands of deaths and overwhelmed hospitals, particularly in terms of ICU beds.
• Suppression, as was practiced in China, requires social distancing of the entire population, home isolation of cases, and household quarantines, possibly supplemented with closing all schools. The practice would need to continue until a vaccine can be developed and produced in adequate quantity to treat the entire population, which could take 18 months or more. A compromise may be to regionally relax and tighten social distancing based on public surveillance case numbers.
• In the absence of any action, the computer model suggests that peak US deaths will occur in June, 81% of the population will be infected, and 2.2 million people will die (not counting those whose deaths from other causes are related to overwhelmed hospitals). ICU bed capacity will be exhausted by the second week of April and demand will peak at 30 times the available number of ICU beds.
• A strong surge is likely again in the fall, so action now is urgent.

The government of Spain temporarily nationalizes all of the country’s hospitals and private health providers.

A hospital in northern Italy whose supplier ran out of oxygen mask valves uses 3D printing to create its own. The original is on the left, the 3D printed version is on the right.

A Premier survey of 179 skilled nursing / assisted living facilities finds that two-thirds of them can’t get personal protective equipment such as masks and face shields. Distributors have addressed shortages by allowing customers to buy quantities consistent with their historic usage to prevent hoarding, but many senior living facilities have never needed any until now and thus can’t get any.

Positive news:

• Scientists across the world are anecdotally reporting preliminary, sporadic success in treating COVID-19 with old drugs that were developed for something else. That’s a common story in pharma, and while individual patient impact may be limited, such treatment carries minimal risk and – like the HIV/AIDS fight in the 1980s and cancer today – provides encouragement that progress can be made even in the absence of guaranteed prevention or a complete cure.
• Regeneron says it plans to start widespread testing of an antibody treatment by summer. Former FDA Commissioner Scott Gottlieb, MD urges a “Manhattan-style project” to accelerate the rollout of this and similar antivirals that could be first used to protect healthcare workers and high-risk people.
• China and South Korea are reporting greatly diminished numbers of new cases, although their success is attributed to widespread testing and social limitation that was not done in the US.
• High-throughput testing systems are coming online in the US, with the new rate-limiting item being the supply chain for reagents and swabs.
• The US Army’s advanced medical technology group publishes a pre-solicitation notice for developing COVID-19 testing technology, studying repurposed drugs that could offer effective treatment, creating AI models that can track spread, and implementing patient monitoring technologies.
• Scott Gottlieb concludes, “We’ll remember spring of 2020 as a very hard time. It’ll change the way we do things, but it will end either by nature or at hand of our technology. We’ll get through this together.”

Other

I ran across the COVID-19 online screening tool of Medical City Healthcare (TX), which offers a slick questionnaire powered by Zipnosis. I intentionally answered just enough questions positively to make my diagnosis uncertain, after which it offered one-click access to a free online virtual visit for screening. Medical City Virtual Care offers visits for minor conditions such as pink eye, lower back pain, diarrhea, and yeast infection for $45. I saw it from the consumer’s point of view and was impressed.

Nashville-based Center for Medical Interoperability was awarded a $3 million grant from the CDC last year to extract EHR information from hospitals that would allow CDC to monitor the inventory and demand for personal protective equipment, but hospitals haven’t been willing participants. According to Melanie Thomas, CIO of pilot site Nashville General Hospital, “It’s difficult and scary sometimes to share data and equipment, especially with your competitors, because you want to have the advantage.” She says it’s easier for her taxpayer-funded hospital to share information because they don’t have the money to stockpile masks and gowns anyway. CDC has added $600,000 to the project’s funding and is hoping for an accelerated go-live schedule starting in May, with participation optional.

Cerner announces the actions it is taking in response to COVID-19, including creation of a client update web page:

• Employees who jobs allow them to work from home are asked to do so from March 16-30, with extensions possible.
• Offices will remain open for employees who need to be physically present, but social distancing strategies will be implemented.
• No non-critical and international travel is allowed.
• Employees who are returning from high-risk locations or cruises are required to work from home for two weeks.
• Critical travel will continue for clients who want Cerner people on site, but higher-risk employees (over 60, immunocompromised, those with chronic conditions, and those exposed to high-risk others) have been asked to avoid travel.
• A COVID-19 update has been pushed to Millennium clients, while Soarian clients already have strong communicable disease screening tools.
• Ready-to-use, staffed telehealth services will be offered to clients via Amwell.

The local paper profiles Sentara Healthcare professional development specialist Heike Nicks, MSN, RN, who worked with IT and nursing employees to automate the process of screening newborns for inherited disease, including sending blood samples to the state lab and getting results back within five days. She got the idea from a commercial product, but Sentara ended up enhancing its EHR to collect the needed information and to process secure messages.

Newport, OR’s police department urges residents to stop calling 911 when they run out of toilet paper. The department added a lengthy, humorous list of alternatives.

Sponsor Updates

• Integration technology vendor Summit Healthcare partners with data management vendor BridgeHead Software to offer healthcare data extraction and consolidation services.
• The Jacksonville Business Journal profiles The HCI Group’s hiring and expansion plans.
• KLAS recognizes Imprivata as one of the 2019 “Revenue Cycle Unicorns” in its latest performance report.
• Omni-HealthData parent company Information Builders embraces FHIR to harness and harmonize data across healthcare systems.
• OptimizeRx offers a free interactive text message alert program that delivers COVID-19 information issued by the CDC.
• Netsmart postpones its Connections 2020 event originally scheduled for March 29-April 1 in Denver.
• Avaya offers complimentary work-from-anywhere contact center solutions to help address COVID-19 challenges.
• CompuGroup Medical offers its CGM ELVI Telemedicine service for free to medical providers.

Blog Posts

• Brown Clinic: Community Values With Leading-Edge Technology (EClinicalWorks)
• A Wishlist for ERP Software Improvement in the Next Decade (Optimum Healthcare IT)
• Making a rapid shift to online training (Nordic)
• How to Build a Business Case for ESignature in Registration (Access)
• 5 Ways to Unleash Your Practice’s Full Potential (AdvancedMD)
• CMS Interoperability and Patient Access Final Rule (Audacious Inquiry)
• Best practices for a remote worker strategy (Avaya)
• COVID-19 & Digital Health (Bright.md)
• ONC-CMS Final Rules, Part 2 – Information Blocking (Datica)
• What is IT and Clinical Engineering Convergence? (Burwood Group)
• Patient Matching 101: Why Getting it Right is Critical (ChartLogic)
• Health IT Crisis and Disaster Planning Recommendations for COVID-19 (CereCore)
• InfoSec Pros Should Do These 8 Things During the Coronavirus Outbreak (CI Security)
• Elevating the Patient Journey Through Innovative Solutions (CoverMyMeds)
• Cash Posting: No Longer a Data Entry Role (Culbert Healthcare Solutions)
• ONC & CMS Interoperability Regulations: Part 1 – Payer Impact (Diameter Health)
• How Data Visualization Can Help During the Coronavirus Pandemic (Dimensional Insight)
• Hospitals Shift to Digital Engagement in Response to Coronavirus (Dina)
• Preventing Medical Errors with Patient Monitoring and Integrated Device Data (Capsule)

Contacts

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

Morning Headlines 3/17/20

Alphabet’s Verily launches a limited coronavirus screening website

Verily pilots a COVID-19 resource, screening, and testing website for Google account holders in the San Francisco Bay Area who agree to sharing some of their data with the company.

Cyber-Attack Hits U.S. Health Agency Amid Covid-19 Outbreak

HHS recovers from a Sunday cyberattack in which its servers were overloaded with hits over the course of several hours.

Tempus Announces $100 Million in Series G Financing

Cancer-focused precision medicine company Tempus will use a $100 million investment to expand into new consumer markets and offerings for diabetes, depression, and cardiology.

Telemedicine companies are struggling to serve ‘extreme volumes’ of patients as coronavirus calls surge

Patients face virtual care delays as telemedicine companies experience IT glitches and staffing shortages due to COVID-19-related visits.

With launch of COVID-19 data hub, the White House issues a ‘call to action’ for AI researchers

The federal government releases the COVID-19 Open Research Dataset, a machine-readable collection of constantly updated scientific literature that health officials hope AI researchers will use to uncover new insights into COVID-19’s incubation, treatment, symptoms, and prevention.

What Are Your Health System’s Coronavirus Reports and Tips?

The US healthcare system is reacting to the coronavirus threat. For those who work in health systems, what have you learned, what IT advice can you share, and what are you seeing from the front lines?

Curbside Consult with Dr. Jayne 3/16/20

Mr. H recently published a reader comment that asked for more COVID-19 news that isn’t necessarily healthcare IT specific. While he waits for responses to his poll about the issue, I’m going to go with the leading response and share some reports from the field.

The American Medical Association recently published “A physician’s guide to COVID-19” that I will use it as the framework for some comments. Before I begin, please note that the comments below are not necessarily my own. Some have been culled from my personal Facebook feed, text messages, and chats with friends. All are presented anonymously. They are the words or thoughts of the individual physicians, nurses, medics, techs, and frontline folks and in no way reflect the opinions of their employers. Readers, please excuse my digression from the usual, because what we are experiencing right now is anything but usual.

Communicate your COVID-19 updates and details about your preparedness plan with both staff and patients.

• OMG, the president of our medical group just went on TV and bragged about our testing capabilities at the same time an email went out to the staff that said that we were not telling the public we could test. #cluster
• TV reporter knew more about hospital plan than MDs did.
• Admin is more focused on updating the EHR (which they did without telling us, then had to roll it back, then updated again without so much as an email). Makes us feel unstable and vulnerable and we don’t need that right now.

Take measures to keep “Persons Under Investigation” (PUI) and others with suspected COVID-19 symptoms separate from the rest of your patients.

• We are a walk-in facility and we don’t know whether a person is high risk until they’re at the front desk with the receptionist. They are taken to the first available exam room and the door is marked with a Post-it to let people know they’re high risk. The medical assistant and physician who see the patient put their initials on the Post-it so that no one else inadvertently walks in. Anyone else think this crazy low tech? What if the sticky falls off?
• Our office canceled all well visits and are seeing sick only. They have to call and be triaged by RN or provider. They wait in their cars and we text them when they can come in.
• It’s still flu season. Who has symptoms that DON’T look like coronavirus?

The CDC recommends specific measures to minimize the spread of infection that include: proper use of PPE, including eye protection.

• LOL! We haven’t reliably had masks in clinic since February. Admin seems to think that outpatient departments don’t see sick people. No gowns and no face shields, either. Other hospitals have drive-through testing clinics with nurses in full PPE reaching through car windows. We’re swabbing patients in our street clothes. No showers at work and nowhere to change. Most of us are stripping in our garages before going straight to a hot shower at home. I haven’t seen an N-95 mask since residency.
• Why do nurses in China have three layers of protective gear but I can’t get a disposable gown?

Misinformation about COVID-19 is being shared across social medial and other platforms at alarming speed. Physicians have a duty to correct dangerous and misleading myths that could harm patients’ health. Read the biggest misconceptions.

• I continue to encounter people who think this is all media hype or a political tool. Do they really think that millions of people in Italy give a damn if this makes Trump or anyone else look bad?
• OMG. If I see one more post about “quarantine babies” nine months from now, I want to scream. As an OB/GYN, does anyone remember Zika Virus? We don’t know what this virus will do to a developing fetus. Use protection, people!

I worked today, and it was a rough one. Although patient volumes were (thankfully) down by about one-third, nearly every visit involved an in-depth discussion about risk factors for coronavirus infection. I had to counsel multiple patients that they should not go visit their grandparents or other elders, even if feeling well. Probably half of them seemed to take my advice, the other half plan to do it anyway.

People were still asking if they should take spring break trips, despite footage of the crushes of travelers at O’Hare and DFW airports all over the news. Friends texted from Colorado, miffed that the ski resorts were closed. I mentioned that hospitals there are communicating with physicians that they are past containment in the state, moving to a strategy of mitigation, where only hospitalized patients would be tested. It will just be assumed that symptomatic patients have it and need to be quarantined and managed at home if they are well enough. Patients are upset that elective procedures have been canceled, and apparently Sunday at the urgent care is the place they have chosen to try to get their issues addressed.

We’re still in early days with this pandemic in the US and the stress levels I’m seeing are off the charts. People are using humor to try to get through, but as a veteran of a Level 1 trauma ED, I can tell it’s a mask for some who are really scared. I’m in a lower acuity setting now, but I can’t imagine what this is going to look like over the next 30 days.

Workers in non-healthcare environments are also stressed, including supermarket employees and restaurant workers. Parents don’t know what they’re going to do for childcare when schools close. People living paycheck to paycheck don’t have the means to stock up on supplies. Han Solo would definitely have a bad feeling about this one. I’m sure we’ll all find our new normal, but it’s going to take some time.

I had intended to judge the results of the non-HIMSS shoe and sock contests tonight, but after I came home, worked through my well-planned decontamination routine, and then discovered my hot shower would be hampered by a broken shower head that was akin to standing under a garden hose, I was just done. I have plenty to be grateful for – I’m not working the intensive care unit, I’m not working a big-city trauma service, and at least part of the time I can work from home. I have plenty of non-perishable food and I know how to recognize good leaves and bad leaves in case I need to operate without toilet paper. My sense of humor is still intact, or at least I hope so.

What has changed in your life in a post-COVID world? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Jay Desai, CEO, PatientPing

Jay Desai, MBA is co-founder and CEO of PatientPing of Boston, MA.

Tell me about yourself and the company.

I’m CEO and co-founder of PatientPing. Prior to starting this company, I worked at Medicare at the Innovation Center and helped support many of the value-based care initiatives there – ACOs, bundled payments, and a number of the new payment models.

I started this company in September 2013. PatientPing is a care coordination platform. We have a number of products. Our flagship product, Pings, delivers real-time event notification when patients have admissions, discharges, and transfers at emergency rooms, hospitals, skilled nursing facilities, home health agencies, and a number of other sites of care.

How widely are ADT notifications being used?

It has really matured as an industry and as a problem that is being solved across the country. For several types of organizations, ADT notifications are becoming a critical part of their infrastructure to do their work. Accountable care organizations, in particular, those that serve Medicare and Medicaid patients that have frequent visits to the emergency room or the hospital. On the Medicare side, skilled nursing facilities, home health agencies, and other post-acute care providers. I don’t know if I could say explicitly the majority, but a large number of ACOs are using event notifications to do their care coordination activities.

A lot of the opportunities for medical management, improvement of quality, and cost savings tends to be when patients are repeat visitors to the emergency room. That’s an opportunity to prevent a subsequent ED visit by engaging them in after-hours primary care, urgent care, and things like that. At least informing them that that’s available to them to avoid a future visit.

Then on the post-acute care side, there are opportunities to reduce skilled nursing length of stay and have patients treated in home care as opposed to skilled nursing. Those are cost savings opportunities in lower-acuity settings for patients to get the same amount of recovery or hopefully the same speed to recovery. Those alerts are important to be able to trigger those workflows that drive the care coordination that ultimately drives the outcomes.

That’s on the ACO side. More broadly than that, health plans are using notifications. Primary care groups often are doing it for their transition of care activities. Hospitals are using it for their readmission reduction activities. Bundled payment organizations are using it for some of their initiatives. But I think we’re seeing the most widespread adoption among ACOs.

How has your solution avoided being bogged down in the competitive, technical, and cost issues that have hampered interoperability in general?

The need was apparent to me seven or eight years ago. ACOs that we were supporting were very keen to know when their patients went to different providers. I wouldn’t say that it was widespread, commonly accepted, or appreciated that hospitals didn’t feel that it was competitive information that they were sharing, say, with a competitor hospital that had a value-based care program.

Say you’re a big health system within a region. Your patient goes to your #1 competitor within the region. Then that competitor has patients that come to your hospital. In the early days of trying to build this organization, it wasn’t the easiest conversation to convince both of them to share ADT feeds, even though it is just ADT feeds and it’s a pretty lightweight set of information. That kind of notification is already happening, often between hospitals and primary care providers. But it wasn’t that easy.

It has gotten easier over time, where people say, I’m OK with sharing ADT because I need to receive that information, recognizing that I probably need to give it up if I’m going to receive it. We’ve had this conversation with thousands of hospitals many, many, many times over the years. The industry has evolved to the place where there’s more comfort doing it.

Some groups in many parts of the country still aren’t that excited or comfortable with notifying the community PCP, their competitors’ PCPs, or value-based care organizations that they have one of their patients. But it’s a lot more common and folks are more willing to do it.

You had a limited rollout the last time we spoke three years ago. Now that you have established the network and created trust, will you wrap more services around that same connectivity that you use for Pings?

The business has matured quite a bit. We have ADT feeds from over 1,000 hospitals across the country of a denominator of 4,000 to 5,000. We have about 4,000 to 5,000 post-acute care providers that are providing us their ADTs, skilled nursing and home health. That’s the senders of ADT.

We have close to 1,000 provider organizations receiving electronic notifications. That includes ACOs, health plans, Federally Qualified Health Centers, and post-acute providers that have an interest in knowing when the patients go to those 1,000 hospitals and 4,000 to 5,000 post-acute providers. They represent over 10 million patients. The business has scaled quite a bit. We have encounters that are being tracked by providers across the country, at sites across the country. It’s kind of neat to see the network grow.

We think about the future as this. ADT is a really great data source. Every ADT is an opportunity to help a patient who is having an emergency room visit, is being hospitalized or discharged, or is being transitioned to a skilled nursing facility. Every one of those encounters is an opportunity to wrap around products and services to ensure that the care transition is happening more safely and smoothly.

As an example, a patient shows up in the ER. We may know that they have had several other ED visits, they may have had prior utilization of a skilled nursing facility, they’re currently on VNA, or they have an affiliation with an ACO care program. The care coordinator at the hospital or the emergency room is left with the decision of how to best support that transition of care. We think that with the historical context we have on that patient, some of the knowledge we know about their whereabouts, can support that care manager’s decision on what to do next. That could be supporting a care transition and linking that patient into the care program that is most beneficial to them. That could come through a range of products and services.

We are excited to be able to continue to make sure that every one of those admits and discharges and the subsequent care they receive is high quality and safe.

What are hospitals required to do with notifications under the new CMS rule?

The CMS rule contains a number of provisions. The one that we’re focused on is the conditions of participation for electronic notification. They are requiring all hospitals, psych hospitals, and critical access hospitals that have a certified electronic medical record system to provide notification of admit, discharge, and transfer, at both the emergency room and the inpatient setting, to the patient’s care team. They are very specific in terms of what is considered the patient’s established care team. They are also very specific about the information that must be included in that notification.

One key provision is a six-month implementation timeline. Hospitals need to have a system to provide these notifications by September 9, 2020.

How would they meet the requirements without using PatientPing?

Hospitals will have two categories of notification recipients. One is the patient-identified practitioner. A patient comes to the hospital and says, “My doctor is Dr. Desai.” The hospital has the burden to send the notification to that particular provider. That typically happens through EHR workflows. The EHR will have an active directory where they can look up the email address or other provider contact information and then send the notification through.

That often happens at discharge through the transition of care document, the CCD. There are established workflows to send ADT alerts to the patient’s designated provider. Companies like ours don’t necessarily help with that. EHRs typically do a pretty good job with sending those notifications directly, as identified by the patient.

This rule includes a second category, recipients who have a need to receive the notifications for the purpose of treatment care coordination and quality improvement. They narrow it even further to say entities affiliated with the patient’s primary care practitioner as well as post-acute service providers and suppliers with whom the patient has an established care relationship. Entities affiliated with the patient’s primary care providers will include groups like their primary care practice. Their affiliated accountable care organization that is a function of their primary care relationship. It may include groups like their Federally Qualified Health Centers or the independent physician association that their primary care provider is a part of.

Hospitals will need the capability to deliver notifications to those groups. That is different than just sending a notification to the patient’s designated doctor. It’s more driven by a roster or a panel. If I’m the ACO, I may have a roster of patients and I want to watch the ADT notifications that are being rendered. I then want to do a match between those two and then send a notification.

To do that, a hospital probably will benefit from having essentially a router of those ADTs that can compare the list of patients against those ADT messages that are to be generated. They may need more than one router. They may send their data to their HIE that delivers data locally within their region. They may send their data to a national network like ours that provides notifications outside of their state. Or they may have their router point the data to wherever it needs to go. But there are a number of stakeholders that may be out there in the communities surrounding the hospital that have an interest in knowing when the patient shows up at that hospital, and they have a valid reason to do that.

This will be particularly relevant for some of the larger academic medical centers that are referral sites for many patients across the country. Cleveland Clinic, Mayo Clinic, and Hospital for Special Surgery receive patients from all over the country. There may be providers out there in the community who have an interest in knowing that the patient is presenting at that particular hospital. Service providers can help route that notification through to the various endpoints where it needs to go.

Do you have any final thoughts?

The CMS and ONC operability rules are totally groundbreaking. I’m excited about what they will do for patient care. CMS and ONC had a lot of hard decisions to make, and I’m impressed by their commitment to supporting patient care, care coordination, and quality improvement. Many hospitals have been thinking about this and putting solutions in place.

We think this will create a broader national framework under which this information is going to flow. We’re excited about that. We’re excited to support it and be part of the solution. Obviously we won’t be the only solution. We’re excited to be part of this solution and we think that there’s going to be a lot of good things that happen for patient care as a result.

We’ve been committed to this mission for a very long time. ACOs, provider groups, and health systems are doing a lot of really hard work to try to support patient care. Data is often at the center of that strategy, or is at least part of the strategy. Being able to facilitate these care transitions with more real-time data sharing across all the different places that patients might go will do a lot to support care. I’m excited to be part of the solution and the momentum that will come with it.

Morning Headlines 3/16/20

New CPT code announced to report novel coronavirus test

The American Medical Association creates a CPT 2021 code for the SARS-CoV-2 novel coronavirus, which will allow tracking of cases.

WebMD Acquires the StayWell Company

WebMD Health acquires Merck subsidiary The StayWell Company, which offers employee well-being, patient education, and patient engagement platforms.

Hartford HealthCare will bring 700 jobs to downtown Hartford and build new venture studio in $24 million renovation of office complex

Hartford Healthcare (CT) will spend $14 million to develop a new access center that will coordinate care and schedule appointments for patients across its 400 locations, pilot a telehealth urgent care clinic, and house an incubator space for healthcare startups. 

Epic Systems cancels spring XGM conference that draws thousands

Epic cancels its Experts Group Meeting (XGM) 2020, which was expected to draw 9,000 attendees to Epic’s Verona, WI campus April 27 – May 8.

Cerner employees to work remotely

Cerner tells employees who can do so to work remotely until March 30, adding that its offices will remain open with social-distancing policies to employees whose work requires them to be on site.

Monday Morning Update 3/16/20

Top News

The American Medical Association creates a CPT 2021 code for the SARS-CoV-2 novel coronavirus, which will allow tracking of cases. The code is available for immediate use.

AMA has also published “A Physician’s Guide to COVID-19.”

CDC and AMA have published a video interview with a highly cited physician who heads a hospital’s anesthesia and ICU departments in northern Italy. The interview calls out the death rate they have seen in Italy, which is minimal for younger people, but jumps to 8% for those aged 60-69, 34% for those 70-79, 44% for 80-89, and a likely statistical aberration of just 9.3% for those patients over 90. The doctor’s takeaway message is to increase ICU and ventilator beds now.

Reader Comments

From Beyond the Pale: “Re: Epic’s announcement to employees. Here’s the full text. Epic’s failure to invest appropriately in collaboration tools and its reliance on physical proximity positions them poorly to work from home. I worked several years for Epic in a leadership role, where I ardently defended them, but this is disappointing to see.” The email says those employees who can report to work on campus should do so. If that isn’t possible, then work from home is allowed for the two weeks starting Monday, March 16, but customer issues, project readiness meetings, or internal meetings may require coming to campus. The message seems mixed – you can work from home if you can’t come to campus, but you might have to come to campus anyway.

From Joyous Boys: “Re: COVID-19. I would like to see you include more news about it that isn’t necessarily health IT specific.” Jenn told me she thinks it is a bit tone-deaf to stay in our non-COVID lane when we are pretty good at extracting truly insightful or newsworthy items. My counterpoint is that even though we stay on top of COVID-19 news that we could summarize efficiently, that kind of information is amply available elsewhere. I will let readers decide what if any changes are needed with a poll. HIStalk readership is high lately, so it’s good for me to understand what people are looking for. But as my life’s motto explains, I’m not looking for extra work.

From Top Gun: “Re: HIMSS20. HIMSS was to let us know in 14 days about hotel and registration refunds. My team made reservations through the HIMSS site, so I didn’t do anything while I waited to hear. Since then, HIMSS updated its FAQ to say – without notifying anyone – that it’s up to individual hotels whether to offer refunds. Now that we’ve waited, hotels won’t refund anyone, and registration has rolled over to HIMSS21. What if we can’t go or won’t have as many attendees? I want my money back. I already swallowed flight costs for several people, and now I have to swallow hotel and registration as well? Anyone else mentioned this? I’m considering protesting the charges on my credit card.” Above are the original and current versions of that FAQ. I don’t quite get the “14 working days” (why 2.8 weeks?), but HIMSS said in the original item that “an advisement will be sent” and the replacement wording says only that HIMSS won’t object if the hotel wants to refund your payment and the hotel should be called as soon as possible. You could protest the charges (hint: say “billing error”) and the charge will probably be reversed, but that will last only until the credit card folks contact OnPeak, which will claim it did everything correctly and get the charge reinstated. If you didn’t have travel insurance that covers cancellation, you may be out of luck, even if you’re contemplating suing since there’s probably a force majeure clause hiding somewhere. At least non-exhibitor attendees had a theoretical but heavily discouraged option to book lodging on their own – the HIMSS exhibitor contract requires them to pay for two OnPeak rooms per 100 square feet of booth space.

HIStalk Announcements and Requests

It’s a bit surprising that one-third of poll respondents – presumably healthcare people — are making no effort to avoid crowds and unnecessary travel, but I’ll generously assume that early voters from a week ago – or about a year in COVID-19 news – have since changed their practices to those of the majority. Or perhaps low-risk people, those who are blessed with youth and vigorous immune systems, don’t understand that such restrictions are intended to prevent them from inadvertently killing Grandpa or Grandma by introducing them to their microorganism tenants. 

I can’t even comprehend that I should be fresh off a return from a HIMSS20 trip right about now. The conference was cancelled just 10 days ago as I write this, but it seems like it’s been a couple of months. Meanwhile, interest in our webinars has picked up as an alternative to the HIMSS that never was, so ask Lorre nicely and she will extend her previously offered webinar discount.

New poll to your right or here, for health system employees: what strategies have changed with COVID-19?

We ran a mention last week from the local paper that United Community & Family Services (CT) was moving to Epic from Greenway Health’s Prime Suite, which the paper said was necessary because Prime Suite is being discontinued. That article was incorrect, as Greenway very kindly let me know – Greenway is still investing in the development of Prime Suite and has no plans to discontinue it. Prime Suite had 48 software releases in 2019 and last year saw the introduction of Prime Suite Reporting 2019 and Prime Suite v18.00.01.00. Thanks to Greenway for just alerting me nicely instead of going nuclear with indignation for assuming the local reporting to be accurate.

I ran accidentally across a HIStalkapalooza video that recalled happier times when industry folks danced the night away, complete with fleeting thoughts that maybe I should do a scaled-back version at HIMSS21, assuming we emerge on the other side of COVID-19 and will need cheering up. Year-by-year highlights:

• 2008, Orlando. A reception for 200 attendees in what was then the Peabody Hotel, with some outstanding food in an upscale setting. I was worried that nobody would want to attend, and figuring I should offer some kind of stage presentation, I quickly threw together the first HISsies voting to fill time.
• 2009, Chicago. Trump Tower failed us a bit in being so expensive that we had to limit attendance, food cost was ridiculous so we could offer only a few passed snacks, and they neglected to provide a decent stage and sound system and thus few attendees could see or hear Jonathan Bush present the HISsies. But the view was fantastic and the attendees were fun.
• 2010, Atlanta. We took over Max Lager’s pub, a bagpiper played outside, Judy Faulkner wore the “No Pie for Me” sash that I ordered to celebrate Neal Patterson’s pie-in-the-face HISsies win, Ross Martin did his “Meaningful Yoose Rap” live, and JB turned his allotted five minutes to present the HISsies into a long, crazy stage show on a day when ATHN shares had tanked.
• 2011, Orlando. I first used the term “HIStalkapalooza” that year at BB King’s. JB did the awards again and we had a blues band.
• 2012, Las Vegas. This is still my favorite because ESD sponsored the event and Brittanie Begeman was delightful to work with. We had last-minute panic when the venue we had booked closed its doors for good, leaving us to scramble to find a new place in First Food & Bar in the The Shops at the Palazzo (which is also closed now). See how many faces you recognize from the excellent video highlights reel. We had roses for the ladies, a DJ, the usual stage antics with JB as he drank a family-sized beer, two Elvis impersonators (a pro and Ross Martin as dueling Elvi), and probably the best food and drinks of any of the events. I watch that video every few weeks.
• 2013, New Orleans. We headed to Rock ‘n’ Bowl, Ross and Kym Martin performed, JB’s performance was as wild as his shirt, we had a big-name zydeco band playing, and we ended with a bowling tournament. Video.
• 2014, Orlando. Buses took folks to the House of Blues at Downtown Disney, we had the amazing Party on the Moon playing, and several entertainment booths were doing caricatures, magic tricks, and other fun stuff. Video.
• 2015, Chicago. This was the first time we did the event on our own without allowing a single company to pay and thus call the shots to some degree. House of Blues Chicago was the best venue we’ve used with its opera boxes and lofty interior views. Party on the Moon was predictably outstanding and Judy Faulkner and Jonathan Bush presented each other with awards. Video.
• 2016, Las Vegas. House of Blues hosted, JB did his Donald Trump imitation, and the band played on. Video.
• 2017, Orlando. We ended the 10-year HIStalkapalooza run at House of Blues, whose box office got calls all week from folks thinking they could buy tickets and then trying to crash during the event when they heard the band rocking from outside. Party on the Moon, who loves our crowd, captured the final moment in the photo above as their set reached an explosive finish over the filled dance floor and the confetti blasted for the final time. Video.

Listening: new from reader-recommended Tame Impala. It’s a man rather than a band, following the modern configuration of one multi-instrumentalist guy recording the music tracks on his computer, making no money even with popularity since streaming pays next to nothing, and then grabbing some pick-up musicians to cash in by touring. He/they headlined Coachella last year with their brand of psychedelic music. I’m not sure how I feel about music being composed in computer-enhanced solitude since that sounds kind of deliberate and cold, but I like this OK and at least it doesn’t involve the “we’re a band” model of creativity by committee that usually isn’t sustainable.

The pandemic will get worse before it gets better, but imagine how it would be without the Internet and the ability it provides to to work from home, see patients remotely, inform the public, stash stay-at-home kids in front of streamed cartoons, and stay current on scientific developments. It has often brought out the worst in people (or perhaps just the worst of people), but let’s give some credit to Sir Tim Berners-Lee for inventing the World Wide Web in late 1990 that is benefitting the entire world now more than ever.

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

WebMD Health acquires Merck subsidiary The StayWell Company, which offers employee well-being, patient education, and patient engagement platforms.

Announcements and Implementations

QliqSoft releases a white-labeled COVID-19 patient screening and education tool package for hospitals that will need to manage an expected surge of patients.

A Black Book survey finds that EHR interoperability remains a challenge for hospital network physician practices, half of hospitals aren’t using outside patient information, and some hospitals are waiting for their current vendors to release solutions before buying anything new.

Another Black Book survey of 3,000 hospital nurses finds that their nearly universal dissatisfaction with EHRs in 2014 has swung to the positive. Nurses say that a hospital’s choice of EHR is among their top three criteria for deciding where to work, and nearly all of them say that EHR expertise is a highly sought employment skill. The hospital nurses ranked Meditech as the #1 EHR for nurse functionality and usability.

DocClocker pitches its patient wait time app, saying it cuts down on potentially infectious patient waiting room time and allows them to make short-notice appointments for available slots. The company also offers a version for families waiting for OR updates, publishes current and average provider wait times, collects user reviews, and sends notifications of appointments and delays. 

Privacy and Security

CI Security polled security experts to come up with a list of items to help control security risks for healthcare workers who are telecommuting. It includes a work-from-home security assessment questionnaire. I was thinking as I read this that it would be awful to send employees home to prevent spread of a virus only to be hit hard with the computer kind as a result.

Other

Health systems are using technology to conserve resources that will be needed for treating COVID-19 patients:

• Online questionnaires and chatbots to allow people to determine if they may have coronavirus infection, which helps keep the “worried well” from showing up for testing and treatment.
• Virtual visits.
• Thermometers and pulse oximeters for symptomatic patients to take home, with daily follow-up.
• Videoconferencing and messaging systems to help coordinate efforts and for consulting with other facilities.

The CEO of a South Korea technology company says the country’s success in beating back coronavirus has been aided by the use of big data and AI:

• The government’s platform stores the information of citizens and resident foreign nationals, integrates all government services with that system, and populates other AI-based apps.
• A positive COVID-19 test sends notifications to everyone in the area with that person’s travel details, activities, and commute maps for the previous two weeks.
• Government-run health services are notified of the person’s contracts to allow tracking and testing.
• The country has offered drive-through COVID-19 testing for weeks. It has performed 250,000 tests versus just 22,000 in the US, at a rate of nearly 5,000 tests per million people there versus 65 here. 
• The drive-through labs are powered by 5G, and drivers are notified of the nearest testing location.
• When someone who lives or works in a large building tests positive, the government sets up temporary medical centers to test everyone.
• Distribution of masks and other supplies is managed via AI-based regulation. Residents can buy two masks at a time using their ID cards. Price gouging has not occurred.
• The government is running all offices digitally, with employees working from home. 

New York looks at a potential COVID-19 care demands for 170,000 hospital beds versus the 53,000 total and 19,000 available in the state, with Governor Andrew Cuomo saying that patients may need to be moved from the high-concentration lower part of the state to other areas. He is asking retired medical professionals to contact their old hospitals to see if they can help and deploying National Guard medics and medical students to pitch in. The Department of Health will monitor available beds, ventilator beds, and isolation units as well as ED activity.

I give this editorial recommendation a good chance of happening. A medical student and a physician epidemiologist urge the federal government to create a military-operated healthcare system for coronavirus to take the load off hospitals that are likely to be overwhelmed. They recommend that the US Public Health Service oversee the operation of setting up COVID-19 diagnosis and treatment centers outside of city centers, but easily accessible to them. The advantages are that the US military is very good at training and deploying people rapidly and they could oversee unused medical resources such as retired physicians and nurses, residents, and laypeople who could be quickly trained similar to emergency medical technicians. Such facilities could also innovate technology to provide ventilator support, which has been the most precious commodity worldwide.

Sponsor Updates

• ACG Utah presents Health Catalyst with its 2019 Deal Maker of the Year Award.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, announces a reseller agreement with AlertWatch to distribute their maternal safety system.
• PatientPing launches an educational website dedicated to CMS’s interoperability and patient access rule.
• Pivot Point Consulting creates a checklist of key considerations for COVID-10 preparation and offers phone appointments to assist organizations with planning and configuration.
• QliqSoft launches a COVID-19 virtual patient communication kit.
• The CEO Forum Group features Waystar CEO Matt Hawkins in a radio interview.
• Wolters Kluwer Health offers coronavirus tools and resources for clinicians and medical researchers.

Blog Posts

• The Power of Voice: Strengthening Communication in Health Care (PMD)
• The Best Ways Self-Insured Employers Can Manage Healthcare Costs (Lightbeam Health Solutions)
• ONC Cures Act Final Rules – Another Milestone for the Empowered Healthcare Consumer (Loyale Healthcare)
• Expanding Access to Care With healow TeleVisits (EClinicalWorks)
• How to create a culture that values patient safety (Meditech)
• 8 Tips for Issuing a Statement to Your Physical Therapy Practice Patients Regarding Coronavirus (COVID-19) (MWTherapy)
• #EachforEqual: improving gender equality on International Women’s Day (Nordic)
• Combating sepsis: How to improve sepsis response [with case study] (Spok)
• Are your Home Healthcare clinicians frustrated with the amount of time spent on patient charting? (NVoq)
• How COVID-19 will change how we work forever (OpenText)
• How Adopting Wearable Technology Could Increase Your Healthcare Organization’s Market Share (PatientBond)
• Don’t Rely on Luck for Your Patient Collection Strategy (Patientco)
• Population Engagement Amid COVID-19 Crisis: Health Systems Respond (Qliqsoft)
• What I wish I had known about selling to health systems (Redox)
• MEDITECH Receives Black Book Research’s Highest Client Satisfaction Award for Inpatient EHR (Meditech)
• Using Patient Engagement Software to Help Patients Navigate COVID-19 (Relatient)
• HIMSS is Cancelled, but Our Focus on Patient and Staff Safety will Continue (Vocera)
• The Independent Clinic’s Guide to Competing with Corporate PT Giants (WebPT)
• The Value of Body Systems Care Plans (Zynx Health)

Contacts

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

HIStalk Interviews Eric Jordahl and Anu Singh, Managing Directors, Kaufman Hall

Eric Jordahl and Anu Singh are managing directors over treasury and capital markets and mergers, acquisitions, and partnerships, respectively, at Kaufman Hall of Chicago, IL. 

What are the most significant challenges hospitals will see as a result of the coronavirus pandemic and the resulting economic turmoil?

Anu

The problem is the time it takes away from more strategic and more management related tasks. The biggest challenge that executives are going to face is that the time, resources, and attention needed to deal with this will take them away from many other tasks. Prioritization of what is now strategic and what is most critical is going to have to get reshuffled. Time is a precious resource and we’re going to see it constrained even further.

Eric

I would agree with that. I focus on the treasury side of things, where it’s really all  about volatility. When you get into moments like this with a lot of volatility, it’s difficult to make solid decisions. Decision-making becomes an incredible challenge because it’s difficult to understand where markets are going, what good pricing looks like, and what good execution look like. Whether it’s the asset side of a balance sheet and the investments that hospital CFOs are worrying about, or the debt side that they’re worried about, volatility creates all sorts of challenges on either side of that balance sheet and makes decisions about what to do in the moment very, very difficult.

What will be the health system margin and cash flow impact of treating large numbers of patients?

Eric

There was a phenomenon in 2008 called deflating balance sheets. As the value of equity instruments went down on balance sheets and different things happened, client balance sheets got really strained. What was interesting, though, was that was across the whole universe of providers, especially with regard to credit positions, they weren’t really impacted by that event. Where things got dicey was when that whole-industry phenomenon was paired with weaker operating performance at a particular facility. That’s where organizations in 2008 had credit and rating kinds of problems. I think it will be similar in the world today, where a lot of the industry will be hit in similar ways.

The question is, will there be some pockets, areas of the country, facilities, or different things where the impact is disproportionate for whatever set of reasons? If 2008 was any kind of indicator, it’s those kinds of more isolated pockets that are going to be more problematic.

Provider credit and  uncompensated care will be a very big problem, and I think it escalates across the whole US economy. Conferences and sporting events are being cancelled. You see an economy that in some ways feels like people are saying, “Let’s just stop the economy.” The ripple consequence across everything, including healthcare providers, is going to be a challenge.

We’ll see what happens with payers and how their performance holds up. Obviously the government is heavily involved in payment around healthcare. I would expect, given that this was a healthcare crisis, that the government would be pretty actively involved in trying to create financial safety nets of some sort. But I don’t think anybody has a real clear idea right now of what that might mean.

How will non-core health system activities, such as mergers and acquisitions, proceed in the near term?

Anu

Anything that was a strategic initiative — M&A, innovation or a venture fund, acquisition of a physician practices or real estate, whatever the case may be — will continue.  When you have a good strategic rationale to do something in a way that is  battle tested, even an event like this that is upon us doesn’t necessarily change the strategy. What could change is the timing and the pace of those pursuits. It may take longer to complete those transactions.

Acquisitions that require third-party sources — a set of stakeholders selling a physician practice or a source of financing to help with an acquisition – will be more adversely impacted by this event, and you are looking at extended timelines. Some M&A processes may either slow down or follow a different pace. But like most things that come upon us without much warning and without much precedent or even a playbook of how to deal with this, it just slows some decisions down and adds an additional level of consideration. But if it passes strategic muster, it will probably continue.

What would be the early warning signs in a health system’s financials that current events might be causing problems?

Eric

From a treasury standpoint, going back to this thing about balance sheet deflation, a phrase that organizations sometimes use is “fortress balance sheet.” That is a is a balance sheet that is built to withstand shocks. Use of that concept is increasing. Most healthcare organizations raise external capital through external debt markets, where interest rates are falling and have fallen fairly dramatically. On the one hand, organizations think, “Oh this is great.” But on the other hand, other parts of their balance sheet  are affected by financial market dislocation.

It is really understanding your total exposure and how you are positioned to manage those exposures. A lot of CFOs learned great lessons from the 2007-2008 credit crisis, and most of them are coming into this with stronger balance sheets. But that’s still a question that will emerge. One of the main questions is, how long does this last? Does it have a long tail and we get hit with waves of financial market shocks? The longer we go into this, the harder it is going to be for healthcare balance sheets to hold up. That is something that all CFOs should be looking at.

Epic Cancels XGM 2020

Epic cancels its Experts Group Meeting (XGM) 2020, which was expected to draw 9,000 attendees to Epic’s Verona, WI campus April 27 – May 8.

Epic is further responding to COVID-19 by:

• Allowing employees to cancel or postpone non-essential business travel.
• Expanding sick leave and work from home policies for employees who are experiencing symptoms or have elevated risk of complications.
• Conducting large internal meetings virtually.
• Offering users virtual options for training classes.
• Serving food from campus cafeterias in individual to-go containers to prevent lines and modifying seating to reduce large gatherings in cafeterias.

Epic said in a statement, “We will miss seeing our guests at XGM this year, and are saddened that this change will impact the businesses in our community that help welcome and host the 9,000 guests who come to XGM. However, we felt that this decision was necessary to help slow the spread of COVID-19.”

Weekender 3/13/20

Weekly News Recap

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

Best Reader Comments

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

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

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

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

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

Watercooler Talk Tidbits

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

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

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

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

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

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

Tell Me

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

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

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

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

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

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

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

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

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

In Case You Missed It

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

Get Involved

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

Morning Headlines 3/13/20

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

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

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

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

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

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

News 3/13/20

Top News

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

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

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

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

Reader Comments

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

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

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

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

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

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

HIStalk Announcements and Requests

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

Webinars

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

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

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

Acquisitions, Funding, Business, and Stock

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

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

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

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

From Cerner’s investment community meeting:

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

People

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

Announcements and Implementations

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

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

Privacy and Security

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

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

Other

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

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

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

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

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

The Onion sets the record straight on coronavirus.

Sponsor Updates

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

Blog Posts

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

Contacts

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

EPtalk by Dr. Jayne 3/12/20

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Working from Home Tips from HIStalk Readers – Avoiding Feeling Disconnected

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

Communicate with colleagues via MS Teams, Outlook and phone.

ideo conference, chats, texts.

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

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

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

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

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

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

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

More consciously leveraged the video capabilities through webex.

Lots of phone calls! Go outside for lunch.

Enjoy the bliss of solitude!

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

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

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

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

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

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

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

Jabber/IM coworkers.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Working from Home Tips from HIStalk Readers – Daily Routine

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

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

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

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

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

830-5 every day.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Try to keep regimented; defined start / stop times

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

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

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

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

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

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

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

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

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

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

Working from Home Tips from HIStalk Readers – Software

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

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

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

Skype.

Any web conference tool, favorite is Slack.

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

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

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

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

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

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

WebEx, secure text messaging,

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

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

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

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

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

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

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

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

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

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

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

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

Zoom, BlueJeans, Skype, Facetime.

Zoom – over any other web conference software.

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

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

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

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

Working from Home Tips from HIStalk Readers – Environment

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

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

Give yourself an office with a window if possible.

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

Open desk area, lots of natural light.

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

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

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

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

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

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

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

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

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

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

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

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

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

Natural light, classic music

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dedicated work space – not at kitchen table.

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

Dedicated office – no distractions.

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

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

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

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