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Morning Headlines 11/20/20

November 19, 2020 Headlines No Comments

Clearlake carves out nThrive’s tech arm in $1bln-plus deal

Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive, which was formed in late 2015 by private equity firm Pamplona Capital in combining its MedAssets and Precyse acquisitions.

Subtle Medical Raises $12.2 Million in Series A Funding to Expand Its AI Imaging Solutions

AI-powered medical imaging enhancement company Subtle Medical raises $12.2 million in a Series A round led by 3E Bioventures Capital.

Medsphere Systems Corporation Acquires Micro-Office Systems

Medsphere acquires Micro-Office Systems, which offers custom medical practice technology services and a patient engagement service.

Nuance Announces Fourth Quarter and Fiscal Year 2020 Results

Nuance announces Q4 results: revenue down 9%, adjusted EPS $0.18 versus $0.23, beating Wall Street estimates for both.

News 11/20/20

November 19, 2020 News No Comments

Top News

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Nuance sells its transcription services business and EScription technology to newly formed DeliverHealth Solutions, in which Nuance will hold a minority share.

The new 2,000-employee company was formed by private equity firm Assurance Healthcare Partners and outsourcer Aeries Technology Group.

CEO Michael Clark, MBA is an industry long-timer who was most recently SVP/GM of provider solutions with Nuance’s healthcare division.


Reader Comments

From EHR Warrior: “Re: SpringCharts. Another EHR headed for the dustbin. No longer ONC certified and the website lists no physical address or team members.” Unverified. The LinkedIn of CEO Jan Watson says that she’s still there, along with a dozen other folks.

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From Meditech Follower: “Re: Meditech. AVP Larry O’Toole is no longer at the company and customers working with him were not informed. He was also Meditech’s representative on CommonWell’s board.” Larry’s LinkedIn says he left Meditech in October after 18 years and is consulting.

From Focus Please: “Re: telehealth and attention spans. A recent survey found that the attention of many patients wanders during their virtual visits.” The survey found that three-fourths of male patients and 39% of women say they didn’t pay full attention during their virtual visit, with their most common distractions being surfing the web, texting or emailing, watching news or movies, and checking Facebook. It’s fascinating to me that our best and brightest have applied their daunting intellectual horsepower to successfully draw us irresistibly to stare stupidly at our phone screens in trading real-world involvement with mindless distraction, even when we are sick, driving, or eating in an expensive restaurant (back when that was a thing). I can’t imagine booking a virtual visit and then watching a movie or scrolling Facebook during it (those must be multi-device patients), but I also can’t picture how patients would think it’s OK to play a video game, drive a car, or drink a cocktail during a telehealth visit, all of which were reported in significant percentages. I bet virtual visit doctors see all kinds of bizarre behavior on the other end of their video sessions, such as domestic violence, sexual activities, illegal acts, and endangering situations. The Internet has robbed us of our comfortable naiveté that most people in the country are like us, which is true only to the degree that we are some combination of ignorant, lazy, cruel, selfish, and immoral.


HIStalk Announcements and Requests

How you know your previous job was a misfire – when your new employer’s hiring announcement brags your time with an employer that wasn’t your most recent one.


Webinars

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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

Here’s the recording of Wednesday’s webinar, sponsored by Mend, titled “Do You Really Have a Telehealth Program, Or Just Videoconferencing?”


Acquisitions, Funding, Business, and Stock

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Private equity firm Clearlake Capital will reportedly buy the software business of revenue cycle management company NThrive, which was formed in late 2015 by private equity firm Pamplona Capital in combining its MedAssets and Precyse acquisitions. Reports suggest a valuation of more than $1 billion for the business, which has EBITDA of $100 million. NThrive recently reorganized its technology business into NThrive Technology, which is led by CEO Sloan Cardy, MBA.

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Nuance announces Q4 results: revenue down 9%, adjusted EPS $0.18 versus $0.23, beating Wall Street estimates for both. NUAN shares are up 104% in the past 12 months versus the Nasdaq’s 39% rise, valuing the company at nearly $10 billion.

Medsphere acquires Micro-Office Systems, which offers custom medical practice technology services and a patient engagement service.

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Outcomes4Me, which offers a free cancer treatment navigation app, raises $4.7 million in funding.

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Israel-based telemedicine vendor K Health raises $42 million in a Series D funding round, increasing its total to $139 million, and will partner with Mayo Clinic to improve its virtual care services. The AI-powered app applies logic gleaned from a 20-year EHR database of an Israel-based HMO to compare a patient with similar ones and to list likely diagnoses, then offers text-based chat with a doctor. Patients pay $19 for a one-time text encounter that can include issuing prescriptions or $9 for a primary care monthly membership that provides unlimited visits.  

The Nashville business paper notes that Bridge Connector spent most of its recent $25.5 million funding round before shutting the company down. The company also received up to $5 million in April from federally guaranteed Paycheck Protection Program loans.


Sales

  • Sarasota Memorial Health Care System will implement Glytec’s EGlycemic Management System.
  • One Brooklyn Health selects Infor Cloverleaf Integration Suite.
  • The VA will integrate with state prescription drug monitoring programs using Appriss Health’s PMP Gateway.

People

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Kate Palazzolo, MS (Allscripts) joins Care.ai as chief growth officer.

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Medstreaming hires Steve Schroeder (Elekta) as EVP of sales.

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Terri Steinberg, MD, MBA (ChristianaCare) joins Medecision as group SVP of analytics and population health and chief medical officer.


Announcements and Implementations

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Ellkay announces LKHive, a platform that allows entrepreneurs to share and develop their health IT ideas and products and potentially receiving mentorship, market advice, and funding. 

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QliqSoft’s Quincy Healthcare Chatbot and QliqConnect Secure Texting platforms are added to Epic App Orchard.

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Health First (FL) deploys Vocera Ease for patient and family communication.

Cerner offers CommunityWorks clients a video visit platform that will be free through 12/31/21.

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A new KLAS report on ERP finds that Workday meets customer needs with strong human capital management and less-capable supply chain functionality, Oracle Cloud’s satisfaction scores have jumped in the past year, and Premier delivers a solid product that excels in supply chain management despite weakness in human capital management. Infor customers are least satisfied with CloudSuite due to relationship and communication issues, while 62% of Allscripts customers say they’ll be moving on because of limited development and no announced plans to move the product to the cloud. 

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Time’s list of “The Best Inventions of 2020” includes the Vocera Smartbadge in the “Connectivity” category. It’s a good list, full of interesting items that were in most cases new to me. 


COVID-19

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States reported 164,000 new COVID-19 cases Wednesday, along with 1,869 deaths and a record 79,000 hospitalized inpatients. Wyoming is reporting that over 70% of its tests are coming back positive.

AHA is reporting hospital staffing shortages in up to 25 states due to both an increased number of coronavirus patients as well as employees who are out sick with the virus, with no option to bring in outside help from less-affected areas because there aren’t any. Stat reports that hospitals are paying up to $6,000 per week for traveling ICU nurses, double their pre-COVID rate. Hospitalizations are a lagging indicator, so hospitals worry about staffing for the inevitable infectious crisis that will be caused in December and January by holiday gatherings in which mitigation recommendations were ignored.

Aspirus Wasau Hospital (WI) will send some COVID-19 inpatients home to free up beds, relying on nursing calls, telehealth, and help from family members to care for them.

Mayo Clinic reports that 900 of its employees have contracted COVID-19 in the past two weeks, 93% of them having been exposed away from work and most of the rest from eating in its break rooms.

CDC advises Americans to celebrate Thanksgiving at home with only the people they have lived with for 14 or more days. The announcement came in CDC’s first media briefing in months as CDC noted the risk of having travelers spread infection around the country.  

CHIME and the Patient ID Now Coalition urge people to ask their senators to support repealing the national patient identifier ban, saying that it’s especially important to be able to positively identify people whose COVID-19 vaccination will involve one of potentially several available products that require a two-dose regimen over several weeks.

Epidemiologists question why New York City has closed its relatively low-risk schools indefinitely six weeks after reopening while allowing high-risk bars, gyms, and restaurants to remain open.

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Cooper University Health Care will roll out the Heroes Health frontline worker mental health support app that was developed by the UNC Institute for Trauma Recovery. Employees are sent a weekly self-assessment questionnaire, tracking tools, and resource links.


Sponsor Updates

  • Black Book ranks Imprivata as a top vendor of identity management and governance solutions, and Spok as a top vendor of secure communications platforms for hospitals and health systems.
  • Frost & Sullivan recognizes Nuance with its 2020 Global Company of the Year Award.
  • The Massachusetts Technology Leadership Council awards Everbridge Tech Top 50 awards in the categories of COVID-19 Response and Business Accomplishment.
  • Industry Era includes Goliath Technologies CEO Thomas Charlton in its list of Top 10 CEOs of 2020.
  • Collective Medical gives its customers access to Vital’s AI-powered care coordination software for hospital EDs and patients.
  • Jvion wins the 2020 Georgia Healthcare Innovation Challenge and will conduct a beta test of its clinical AI solution with Navicent Health.
  • Meditech congratulates 14 hospital and health system customers on their Digital Health Most Wired recognitions from CHIME.
  • OptimizeRx is ranked #432 in Deloitte’s Technology Fast 500.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 11/19/20

November 19, 2020 Dr. Jayne 6 Comments

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Although telehealth has certainly been helpful for many organizations trying to boost patient access during the COVID pandemic, a recently study shows that it was not fully able to offset the loss in available patient care slots. Overall, telehealth was able to help organizations recoup about 40% of the decline in ambulatory office visits. Not surprisingly, patients from low-income ZIP codes and racial / ethnic minorities were less likely to use telehealth services than those from more affluent areas.

The study looked at more than 6 million private payer claims, but there’s still a gap in understanding visits for patients with public payer coverage (Medicare, Medicaid) as well as those telehealth visits that may have occurred but not been billed since providers were struggling to understand how to get paid for telehealth.

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Office visits were most dramatically affected, but vaccine administration, mammograms, colonoscopies, and HbA1c tests were also reduced significantly.

I have to admit that I was part of that mammogram cohort and didn’t end up getting my semi-annual imaging until August. The facility where I usually have my mammogram didn’t bother to send me a reminder that I was overdue or let me know when they had resumed services, so it was completely on me as a patient to make sure I caught up. Good thing I did before COVID spiked and services were limited again.

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Sometimes the titles of articles say it all, and this piece in JAMIA definitely caught my attention: “Unveiling the silent threat among us: leveraging health information technology in the search for asymptomatic COVID19 healthcare workers.” The article reviews the National Institutes of Health Clinical Center’s approach to rolling out an Asymptomatic Staff Testing System. The Center is the 200-bed hospital arm of the NIH that delivers patient care and research support. Due to the type of research being performed, over 60% of the patients admitted are immune compromised either from an underlying health condition or an experimental treatment. This underscores the need to deliver continuous surveillance of healthcare workers and prompt identification of those who may be positive for COVID-19.

One of the program’s goals was to deliver weekly testing for eligible healthcare workers. They used existing EHR and other systems to identify workers and allow them to self-schedule their testing appointments. Automation was prevalent throughout the process, including check-in, specimen tracking, and laboratory interfaces. As the process was designed, they “identified the difficulty in following the organization’s formal software development process under the time requirements” and mitigated this by using existing systems where possible. The whole process from task identification to early adoption was only four weeks, which would be a near impossibility for many healthcare organizations.

To determine how successful they were, the team looked not only at the primary outcome of identifying infected workers, but also surveyed the healthcare worker customers on the process as well as the facility process owners. I wish I saw more organizations follow this approach with a 360-degree evaluation where they pay attention to all the feedback, not just internal customers such as infection control departments or human resources. One of the findings was a need to ensure that patients / workers set up accounts on the patient portal, which is a common challenge among healthcare organizations.

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I always get a kick out of articles that cover poor password management habits, and this year’s list shows that the more things change, the more they stay the same. Review of data from hacking forums and the dark web revealed that the most commonly used passwords in the US include “password” and “123456.” The latter (and the multiple variations similar to it) shows that it’s not just users behaving badly, but vendors who should have logic behind their password requirements that would disallow such sequential numbers. Humorous options in the top 20 include superman, iloveyou, football, and letmein.

Although some vendors may be complicit, the other side of this coin is the vendors or entities that make ridiculously complicated password requirements or rules for frequent changes. These approaches have been shown in some studies to actually increase security risk, as users may be more likely to write passwords down.

One of my clients falls into this bucket. They make you change your password every 30 days, and the requirements include upper case, lower case, numbers, symbols, and a length of at least 10 characters. Maybe their goal is to push people to use randomly generated passwords coupled with a password manager, but that’s not always practical when using shared workstations. Regardless, I wasted half an hour of their tech’s time this morning (and a billable 30 minutes of my time) dealing with an expired password after I missed the prompt to change it.

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Big thanks to the gals in my life who sent a couple of recent care packages. Jenn knows my love for putting my feet up with a good book and surprised me with the world’s softest socks, along with energizing foot lotion and an Amazon gift card, which I promptly swapped for a new read. There were also some addictive gummy bears, but I’ve had to tuck them in my snack drawer lest I eat the whole bag. My favorite revenue cycle informant, Bianca Biller, sent the famous “Bionic Apple” from Merb’s Candies in St. Louis. Let me tell you, this thing is a Granny Smith apple covered with the smoothest caramel you’ve ever seen and rolled in chopped pecans. Did I mention it was the size of a softball? It made an excellent lunch while I enjoyed a webinar presented by some of my favorite folks.

For your friends and colleagues at the tip of the clinical spear, the next few months are likely going to be some of the worst times they’ve ever experienced professionally. I’m thankful for my friends and their support. Hopefully my newly energized feet will give me a bounce as I head back to the trenches tomorrow.

What are the best pick-me-ups you’ve ever received? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/19/20

November 18, 2020 Headlines No Comments

Central Logic Acquires Ensocare to Ease Transitions from Hospital to Post-Acute Care

Healthcare access and orchestration solution vendor Central Logic acquires Ensocare, which automates the referral of hospital patients to post-acute care.

K Health raises $42 million to expand its AI-powered telemedicine platform

Israeli company K Health raises $42 million and announces that the Mayo Clinic will integrate its telemedicine technology with its clinical data analytics platform.

Nuance Announces Sale of HIM Transcription and EHR Go-Live Services Businesses to Accelerate Growth as Conversational AI Market Leader

Nuance will sell its health information management transcription business and EHR go-live services business to DeliverHealth Solutions, of which it will become a minority shareholder.

COTA Secures $34M in Growth Capital and Triples Data Access to Better Serve Life Science Partners and Provider Institutions

Oncology-focused analytics vendor Cota announces a $34 million Series D funding round led by Baptist Health South Florida and ONC Capital, alongside a $20 million investment from Varian Medical Systems.

HIStalk Interviews Kevin Coppins, CEO, Spirion

November 18, 2020 Interviews No Comments

Kevin Coppins, MBA is president and CEO of Spirion of St. Petersburg, FL.

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Tell me about yourself and the company.

Spirion is headquartered in sunny St. Petersburg, Florida. We serve the data privacy and data security markets. I joined Spirion just over a year ago. Before that, I spent the previous couple of decades working across a variety of tech companies, both in the cybersecurity space as well as in the networking space. I started way back when at Novell. 

With every role that I’ve held, I’ve had the opportunity to work with healthcare organizations across the US and around the world. Every company you talk to says they are different, their industry is different, or something is different. Healthcare is the only one that gets to carry that badge and actually mean it, because everybody else is much the same. Healthcare is definitely different.

How much information does the average health system have that they don’t know about or don’t realize is unprotected?

I typically start with a question. How much data do you have? Somebody tries to answer the question, and then they stop and say, we have no idea, because you don’t. Think about how fast data flows in and flows out, how it moves. It gets stored in the cloud, and then it gets replicated in the cloud, and you just don’t know. It’s a fair answer now, and people have gotten more comfortable saying that they don’t know. A few years ago, it was a little bit nerve-racking to acknowledge that you don’t know that.

The next question that you ask is, of the data that you don’t know how much you have, how much of that would be considered sensitive, and how do you define it? That depends on the industry, but healthcare will definitely go to HIPAA. Other industries will  go to GLBA or PCI. It depends on where they are regulated, because that’s where their brain thinks. You have to take a step back and say, that might be how regulation defines “sensitive,” but how would your patients define sensitive? How would your clients define sensitive? How would your board define sensitive? People take a step back and say, that’s interesting, we didn’t look at it that way.

First you have to define it. Then the challenge comes to, where does it live? Not just how much do I have, but where could it possibly be? That usually leads down another interesting conversation topic as well.

Is healthcare the worst of two worlds, where you have the legally defined protected health information, but you also have the business data of a health system that could be a multi-billion dollar enterprise?

Privacy is an overused term these days, but when you think about privacy, it’s fluid. How privacy is defined for you might be different than how it’s defined for me. It might be different how it’s defined for a provider versus an insurer. How that data is used or misused can also then help define what privacy means.

While regulations have tried to go ahead and put a fork in it, healthcare data back in February is different than it is today. I didn’t really care if the world knew what my body temperature was in February, but now, you could have a bias against me for having a temperature that’s not within the range that you’d expect. Or if you were to find out that somebody living in my townhouse complex was diagnosed with COVID, maybe then I’m not allowed to go to work the next day. A lot of information that’s associated — a combination of that PHI, but also proximity and demographics, et cetera — can be leveraged to help during a pandemic, but can also be leveraged after that to start doing some things that people might not be as comfortable with.

What is the biggest driver that might take a health system from going beyond being minimally compliant with HIPAA to having some enthusiasm about implementing tools and systems to protect data beyond what is legally mandated?

Every board across the US is waking up saying, how can I spend more money on something that doesn’t add direct value to what I do? [laughs] That’s the challenge of privacy security. CISOs deal with that challenge all the time. Vendors like us walk around and say, “If you don’t do it, you’ll be fined, flogged, and frozen and all these bad things will happen to you.”

Until organizations start making it personal, it doesn’t usually get traction. By personal, I mean recognizing that the data that you’re protecting isn’t some amorphous blob of sensitive data sitting in an Azure cloud store. It’s information about your neighbors. It’s information about your community. A lot of healthcare providers are community centric. Something happens to that data and it impacts the entire community, which includes your kids’ teachers and your own relatives.

A good example is that once your child who is under 10 years old has had their Social Security number compromised and used to get credit card, they begin their financial life in the hole. Then it starts becoming a little bit more real. There’s so many more ways than just identity theft in the ways normal people think about how privacy can be breached and how majorly impactful it can be when you start being impersonated by people online, et cetera, et cetera. Or you start getting discriminated against.

One example that I heard that is relevant today is that we’re supposedly getting closer to this vaccine. Let’s say the vaccine is rationed, and you have to meet a certain set of criteria in order to be to the front of the line for the vaccine. It would be pretty easy to figure out what that criteria are, mine for those criteria, and then sell identities that meet that criteria so people can go buy it and be first in line. Then when you go to get your vaccine, somebody says, “Nope, you’ve already gotten it.” Wait a minute, no I haven’t. That’s when it starts hitting home.

It’s really making it personal and shifting that gear to say, this isn’t just a nice thing to do it. It isn’t just a regulatory thing to do. It’s a critical thing to do. That’s when organizations start to shift.

Are hospitals thinking about security differently after the recent surge of ransomware attacks?

Yes, for sure. One of the first things they are asking themselves is, do I have a secure copy of my data, so that if I am ransomed and they want to shut me down, I can rebuild? The second piece is, how much data do I really need? How much of that is critical to my operations, and how much is non-critical? They are starting to think about data in a different way, because ransomware is either about shutting it down and saying, I’m not going to turn you back on until you give me something, or they will actually sell off your data. I’ve got all your sensitive data, and I’m going to release it if you don’t do something. The idea that data can actually hold you hostage is a new concept for boards to think about. That has started putting a different value on that data.

The unfortunate impact of that is people are paying a lot more attention for the wrong reasons, versus waking up and saying, we should do this because it’s the right thing. People who start solving for the privacy problem because it’s the right thing to do typically don’t have the ransomware and breach issues. They have solved it organically and culturally within the company versus as a by-product of something they think they are supposed to do because their regulator said so.

How does a health system reduce the risk that is associated with the data they discover?

The first thing is to reduce to the absolute optimal the number of copies that you need to have of that data, and then make sure that it can’t replicate itself. With cloud stores today, if you are looking at your laptop right now, it’s probably syncing to a OneDrive, Google Drive, or  Dropbox. When you save something, will save in the three other spots. Getting a handle on what sensitive data is, how that data can move, and how that data can be stored will be a big step in the right direction to solving the problem. We talk about reducing the threat surface of sensitive data, and you do that by understanding where it is and how much you have. You can only do that once you define what it means to your organization.

Healthcare is fairly new to the cloud and we’ve seem some inadvertent exposures because of incorrect cloud configuration. Is that situation commonly or easily detected?

A cartoon shows the son saying to his father, what are clouds made of, Daddy? And he says, mostly Linux servers, son. [laughs] It’s an abstracted version of storage, of a place to store stuff. The challenge is that people don’t recognize that where they are storing it is completely unsecured and it’s completely open.

Being able to say, wait a minute, this is sensitive data is step one. Step two is, how secure is it? Well, it’s sitting on a server that is wide open to the entire universe. OK, that’s a problem. How active is it? Nobody has actually accessed it since the Reagan administration, so we are OK. Actually no, there have been 10,000 hits on it from foreign countries in the last 15 minutes, so it’s a problem. 

It’s not just a matter of knowing that it’s sensitive data, it’s knowing the level of access to the sensitive data and the level of activity around it. You combine those three things together to create a pretty good heat map that would say, I need to shut this down or I have a challenge or issue here. If I can reduce the threat surface and I have fewer locations where sensitive data lives, it gets a heck of a lot easier to manage it.

We had less impact than I expected from GDPR, which could have changed how we think about storing, securing, and using data, especially consumer data. Will we see further effects from GDPR or other legislation?

You see it in California already for sure with CCPA and CPRA. You have the New York Shield Act and 32 other states that are actively debating privacy legislation. With the election behind us now, there’s definitely privacy legislation that’s at a Congressional level as well. So you absolutely will, it will continue to shift. Even CCPA has changed three times since it went into effect last year. It will continue to shift and morph because privacy is fluid.

The wrong lens to look through is, how big have the fines been for GDPR? Well, there’s been some massive ones. How many have been collected on how many have made it through the courts? We’re waiting to go ahead and see.

You have to take a step back and say, what’s the right level of stuff to do from a privacy standpoint? If you show that you are trying to proactively get ahead of the problem, then more often than not, you’re going to be in pretty good stead with the regulators. It’s not trying to keep up with the regulations, but more trying to keep up with the culture, and that usually takes a rethinking of how you move and store data. That wake-up call doesn’t typically come until there’s a breach or something bad that could happen to you that you saw happen to the healthcare organization across town.

Are health systems funding and completing projects related to security, privacy, and data protection?

They are absolutely taking it more seriously. We’ve seen an uptick, even during these crazy times, over the last six months in healthcare because they recognize that it’s a journey that they have to start. They don’t a panacea button that it solves all their issues, but they start saying that they have to get the right processes in place and the right underpinning tools in place to start getting ahead of this problem.

Most healthcare organizations didn’t pop up overnight. They have been around for 50, 100, or 150 years. If you think about the technological age, every healthcare organization that I’ve walked into has equipment and systems that go back to the time the first building was built, that date all the way to the time the most recent building was built. They have a little bit of everything, and across that little bit of everything lies a lot of complexity. For a while, the answer was, we’re just going to throw our hands up because this is too hard to get our heads wrapped around. Now it has shifted into, we have to start somewhere, so let’s put a stake in the ground and let’s start pulling the thread through it.

It’s a hard problem, especially in healthcare. Healthcare is different. A lot of it is because there’s a lot of legacy systems with a lot of legacy information that’s really, really important, but that weren’t designed to protect data the way it’s expected to be protected today.

How do you see that situation changing over the next 3-5 years?

The concept of data and sensitive data is at the core of both security and privacy. The next thing that goes around that is, what is the definition of sensitive as it pertains to privacy? Then also, what is the definition of identity as it pertains to security? I think that recognition is starting to happen, where people say, it’s not a matter of if I’m going to be breached, it’s a matter of when. The perimeter is not going to hold, so when they get in, what are they going to be able to do, and what are they going to be able to find? That gets back to the data part of the question.

People are starting to move in the right direction. They are starting to say, I need to get a handle on my sensitive data footprint so I know what the threat surface is. Then when I am compromised, I know what has happened or is happening and I can minimize the risk. I think you’ll continue to see over the next 3-5 years more and more efforts with a data-centric look at the overall infrastructure and security. That will spawn privacy. You cannot have privacy without security, but you can have security without privacy. We are already seeing that in how people are talking and thinking about how they are leveraging systems. It’s getting more and more prevalent.

Do you have any final thoughts?

When it comes to security and privacy and all the drama and all the noise that you hear about it and read about it, just boil it down to this — am I doing everything I can today to protect what matters most to the constituents I serve? And what matters most to them is their individuality. Recognizing that you hold the digital versions of those physical selves and treating those digital versions as you would treat the physical one is just as important, so make it personal.

Readers Write: Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones

November 18, 2020 Readers Write No Comments

Prioritize the Patient Experience to Turn Short-Term Telehealth Solutions into Long-Term Ones
By Ray Costantini, MD, MBA

Ray Costantini, MD, MBA is co-founder and CEO of Bright.md of Portland, OR. This article recaps a recent video conversation he had with Ries Robinson, MD, SVP/chief innovation officer of Presbyterian Healthcare Services of Albuquerque, NM.

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When the coronavirus first spread through the US, fears of exposure and lockdown mandates kept patients at home and forced providers to pivot almost exclusively to deliver care virtually. I don’t know of any health systems that navigated that process smoothly and easily, though for the healthcare systems that had already implemented a robust digital strategy, that transition was less painful than for others.

Systems rushed to implement telehealth tools, often repurposed consumer video platforms like Zoom, FaceTime, or Hangouts. This was a reasonable solution for the short term. But after more than seven months of quarantine, doctors and health systems are more comfortable using digital tools for care, and it’s clear that patients will use and expect virtual care options beyond the pandemic. 

So how does a system turn a short-term solution into a long-term one? By prioritizing the patient experience. Here are four ways you can use digital tools to support patients through their journey to receive care, beyond a quick implementation of video tools. 

Provide Free Online Screening

To keep both patients and healthcare workers safe by keeping as many people as possible out of high-contagion areas like the ER and urgent care clinics, one large healthcare system made a free, high-quality, online coronavirus-screening tool available to anyone in the state. Patients who showed potential COVID-19 symptoms or exposure would then be advised to take a test. Everyone else received guidance and education about the virus and any other steps they should take for self-care at home. 

At drive-through testing sites, there were billboards with a QR code that, when scanned, led patients to the online screener they could take while waiting in their cars. One executive at the system noticed many cars leaving the line. Assuming the patient had grown frustrated with the long wait, he approached a few cars to ask why they were leaving. Many of them said after taking the online exam and receiving feedback from a provider, they felt comfortable their symptoms were not COVID-related.

It’s a great example of using a digital tool ahead of an in-person appointment, providing real value for patients and minimizing any frustration for those who didn’t need to wait for a full test.

Bridge the Digital Divide

For some patients, connecting with healthcare providers via video was reassuring and convenient. For many others, though, the digital divide has only grown larger during the pandemic. 

When a healthcare system we work with found that 30% of their patient population was unable to conduct a video visit due to a lack of hardware, bandwidth, affordability, comfort with tech, or language barriers, they implemented digital tools that allowed them to more easily access care. Today, patients need as little as a 3G network connection and can conduct their healthcare interview in Spanish or English.

Ensuring equitable access to virtual care is critical for a successful long-term implementation of digital tools. 

Understand what Patients Want

If 2020 was the year of virtual care, then 2021 will be the year of the patient experience. As the coronavirus crisis changed everyone’s lifestyle and habits, new direct-to-consumer competitors gained traction, and in many cases, the convenience exceeded patient expectations. Health systems are increasingly aware of the need to retain their patients, and re-engage those who they’ve lost to these digitally forward, new-entrant competitors.

The good news for healthcare systems is that patients still trust their own doctor over retail medicine or big tech. As one chief innovation officer at a large health system told me, “If you’re in the business of delivering on patient satisfaction and high-quality care, you’re in a better position of fighting off the competition.”

For the long term, offer care when and how your patients want it: immediately, online, and for not too much money.

Help Providers Focus on Patients

It’s not news that healthcare workers have been severely impacted by the pandemic, whether they are in an ER in a COVID hotspot or struggling to manage a household while delivering care remotely. The stress has led to early retirements and leaves of absence, compounding an already severe physician resource shortage.

Healthcare systems that have managed the crisis well have used digital tools to create elasticity for their providers, giving clinicians more control over their time and from where they can deliver care. Virtual care delivery solutions that automate administrative tasks can also reduce the amount of time it takes to deliver care, so clinicians can help you prioritize the patient experience, instead of focusing on the technology of an appointment. 

It sounds counterintuitive, but a thoughtful implementation of digital tools humanizes healthcare: letting computers or software do the tasks that require repetition, precision, and consistency so that humans are free to do what we’re good at: critical thinking, problem solving, listening patiently, and responding compassionately.

Morning Headlines 11/18/20

November 17, 2020 Headlines No Comments

Introducing Amazon Pharmacy: Prescription Medications Delivered

Amazon launches an online pharmacy, giving customers the ability to order prescriptions, compare prices, and consult with pharmacists.

SOC Telemed Reports Third Quarter 2020 Results

SOC Telemed, which began trading on the Nasdaq last month, reports an 11% dip in Q3 revenue, attributable to a decrease in hospital utilization during the pandemic.

Upfront Healthcare Raises $11.5 Million in Series B Funding Round Led by Baird Capital and Co-Led by LRVHealth

Communication and patient engagement platform vendor Upfront Healthcare raises $11.5 million in a Series B funding round, increasing its total to $21.5 million.

AccuReg Acquires Digital Patient Engagement Technology Company

RCM vendor AccuReg acquires Zenig, a patient engagement company focused on appointment reminders, touchless check-ins, virtual waiting rooms, and communication tools.

News 11/18/20

November 17, 2020 News 4 Comments

Top News

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Amazon launches an online pharmacy, giving customers the ability to order prescriptions, compare prices, and consult with pharmacists. The service will be available in 45 states starting this week.

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Prime members will receive free, unlimited two-day shipping and discounts on certain drugs.

Somewhat hidden in Amazon Pharmacy’s webpages is a GoodRx-like Prime prescription savings card that is accepted by most major pharmacy and grocery chains.

Amazon jumped into the pharmacy space in 2018 when it acquired prescription delivery service PillPack for $753 million. PillPack — which offers prescriptions on 30-day schedules to typically older, sicker patients — will remain a standalone service, though its infrastructure was used in Amazon Pharmacy’s underpinnings.

Shares of CVS, Walgreens, Rite Aid, and GoodRx dropped between 7.5% and 18% on news of the launch.


Reader Comments

From Musical Box: “Re: classic rock. I take it you aren’t a fan from your recent comments.” I dislike country music because “country” artist dues-paying should involve a modest rural upbringing, grounded lifestyle, and non-pop expression of musical tradition that goes beyond having a record company provided an always-handy cowboy hat, but I would still rather listen to faux country than an algorithm-driven “classic rock” radio station that sounds like a nursing home playlist in ignoring anything that came on this side of Ronald Reagan’s presidency. I’m pretty sure that the 20-something musical geniuses in Pink Floyd were hoping with “Money” to enlighten rather than entertain car-bound cubicle commuters, who have since rescheduled the band’s creative output from late-night mental space travel to morning Muzak.


HIStalk Announcements and Requests

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Thanks to Diameter Health for upgrading its HIStalk sponsorship to Platinum. The company sets the standard for clinical data optimization with automated, scalable, auditable technology that provides greater value to organizations that depend on multi-source data streams, such as health plans, HIEs, HIT, insurers, and health systems. Thanks to Diameter Health for supporting HIStalk. 

A benefit and a challenge of being a grammar Nazi — so labeled by folks who roll their eyes at the concept that we can all communicate more effectively by honoring basic rules of the road — is that while someone else’s wording and spelling choices are often amusing, they sometimes make me think way too much. Case in point: my laptop updated Windows this morning and gave a message, “Don’t turn off your computer,” leading me to mentally debate whether a better choice would have been, “Don’t turn your computer off.”


Webinars

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

December 3 (Thursday) noon ET. “Why Patient-Centered Billing: How University Physicians’ Association Increased Revenue and Reduced Days to Pay.” Sponsor: Relatient. Presenter: Christy Bailey, VP, University Physicians’ Association. Financial recovery calls for a better patient financial experience as providers drive revenue, engage patients, and reduce costs and bad debt. The presenter will talk about patients as payers and how delivering a financial experience that meets their expectations can improve the financial outcomes of providers, hospitals, and health systems.

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

The recording of this week’s webinar, “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats” by Everbridge VP/CISO Sonia E. Arista is live on YouTube.


Acquisitions, Funding, Business, and Stock

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Healthcare access and orchestration solution vendor Central Logic acquires Ensocare, which automates the referral of hospital patients to post-acute care.

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AliveCor will use a $65 million Series E funding round to further develop its remote cardiology technology with expanded telemedicine capabilities, and the addition of detection and condition management services. The company gained FDA clearance last year for the first consumer-grade product to monitor heart activity on six different leads.

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SOC Telemed reports an 11% dip in Q3 revenue, attributable to a decrease in hospital utilization during the pandemic. Company shares on the Nasdaq have dipped slightly since its debut last month through a merger with SPAC Healthcare Merger Corp.

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Patient self-scheduling app vendor Solv raises $28 million in additional funding, increasing its total to $51 million. The company says that online appointment scheduling in its network has increased from 22% to 60% of the total, app usage has increased sixfold in the past year, and users have booked 700,000 virtual visits since March 2020 versus 9,000 in all of 2019. The founders came from real estate site Trulia.

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Communication and patient engagement platform vendor Upfront Healthcare raises $11.5 million in a Series B funding round, increasing its total to $21.5 million. Co-founders Ben Albert and Carrie Kozlowski started the company in early 2016 after working with The Advisory Board Company’s Crimson Care Management system.


Sales

  • Northern Health in Melbourne, Australia, will implement Cerner towards the end of 2022.
  • Leidos awards 3M Health Information Systems a contract to deploy its computer-assisted coding technology to DoD treatment facilities as part of the DHMSM initiative.

People

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Allan Kyburz (PeriGen) joins OnShift as RVP of field sales.

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Augmedix names Saurav Chatterjee (Lumiata) as CTO.

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Janet Dillione (Action Medical Technologies) joins health monitoring solutions vendor Connect America as CEO.

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Behavioral health IT vendor Tridiuum hires Philip Vecchiolli (Optum) as chief growth and strategy officer.


Announcements and Implementations

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ECRI will shut down its Partnership for Health IT Patient Safety collaborative on December 31 after seven years, with the emailed announcement lauding its accomplishments without explaining its demise. The physician reader who forwarded ECRI’s email says that it’s a shame to be shutting down one of few national efforts that focuses on health IT safety, while also noting that providers haven’t demanded such a project or offered much support. That reader concludes, “I want to shout out to my fellow clinicians and their professional organizations (loudly enough that they listen) that assuming someone else will take care of safety will eventually lead to more federal intervention, particularly in the new administration. ”

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Change Healthcare develops social determinants of health-focused analytics using de-identified claims data, enabling providers to identify determinants that impact patient visits across population segments and care settings.

A Black Book survey names Fortinet as the top-rated vendor of end-to-end enterprise cybersecurity suite software and services.

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A new KLAS report on health system financial improvement consulting finds that PwC and Accenture are reliably high performers, while several Huron clients reported issues with their assigned consultants and Optum performs poorly in engagement execution.


COVID-19

A record 73,000 people were COVID-19 hospital inpatients in the US as of Monday. Eight states, all of them in the Midwest, are exceeding 400 hospitalizations per million residents. Cleveland is overwhelmed to the point that the city could not assemble case counts Sunday or Monday.

Sweden bans gatherings of more than eight people as it abandons its model of allowing coronavirus to run its course in hopes of developing herd immunity instead of implementing population safeguards. The prime minister urges citizens to “don’t go to gyms, don’t go to libraries, don’t host dinners. Cancel.”

Switzerland reports that every one of the country’s ICU beds is occupied, with zero capacity for COVID and non-COVID patients.


Other

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Delaware public health officials disclose that a now-former employee mistakenly emailed the COVID-19 test results of 10,000 people to an unauthorized user.

Zocdoc founder and CEO Oliver Kharraz, MD says in a TechCrunch column that legacy telehealth services like Teladoc were built in an Uber-like “randomized triage care” model to connect people with whatever doctor is available to address their rash or cold instead of developing an ongoing, trusted relationship with a provider who can take a more holistic health approach. He says, “Patients are far better stewards of their own health than a random doctor generator” and observes that 90% of surveyed telehealth patients would rather choose their provider instead of being assigned one randomly. Most patients also favor selecting a nearby doctor so they can continue the conversation in person if needed.


Sponsor Updates

  • The Chartis Group’s Center for Rural Health partners with the Nebraska Office of Rural Health to announce the winners of the 2020 Rural Provider Excellence in Quality Award.
  • InterSystems has enabled Greater Houston Healthconnect to manage the flow of clinical data during the COVID-19 pandemic.
  • Wolters Kluwer enhances its Sentri7 clinical program for opioid stewardship with artificial intelligence.
  • The Women Talk Tech Podcast features CarePort Health founder and CEO Lissy Hu, MD.
  • Cerner associates will provide Thanksgiving meal baskets to the families of Veterans Community Project in Kansas City.
  • The American College of Healthcare Executives interviews Change Healthcare President and CEO Neil de Crescenzo.
  • Clinical Architecture CEO Charlie Harp will present during the AMIA 2020 Virtual Annual Symposium on November 16.
  • CI Security announces a strategic partnership with Synnex to deliver managed detection response and professional cybersecurity services.
  • Diameter Health will host the virtual Diameter Forum 2020 December 3-4.
  • Engage shares a video featuring San Luis Valley Health IT Director Brian Heersink sharing the hospital’s experience working with Engage on its implementation of Meditech Expanse.
  • Ellkay highlights Chief Innovation & Product Officer Shreya Patel as part of its Women in Health IT series.
  • Pivot Point Consulting, a Vaco company, offers complimentary guidance to providers interested in applying for the FCC’s Connected Care Pilot Program.
  • Wolters Kluwer Health adds Emmi Care Plan, a new Alexa skill for post-discharged patients, to its EmmiTransition solution.

Blog Posts


Contacts

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

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Morning Headlines 11/17/20

November 16, 2020 Headlines No Comments

Centauri Health Solutions Adds Referral Management and Analytics Capabilities with Acquisition of Ivy Ventures, LLC

Centauri Health Solutions bolsters its physician referral services with the acquisition of Ivy Ventures, developer of referral services using proprietary scheduling, analytics, and outreach software.

AliveCor Closes $65 Million Financing to Accelerate Growth of Its Remote Cardiology Platform For Consumers, Employers, and Providers

AliveCor will use a $65 million Series E funding round to further develop its remote cardiology technology with the addition of telemedicine and detection and condition management services.

Heads Up Health Closes $1.35M Seed Round Led by Innosphere Ventures

Health data tracking, aggregation, and analytics software startup Heads Up Health raises $1.35 million in a seed round led by Innosphere Ventures.

Curbside Consult with Dr. Jayne 11/16/20

November 16, 2020 Dr. Jayne No Comments

We’ve officially crossed into COVID hell in my part of the country.

The largest health system just announced the rescheduling of elective surgeries at all 15 of their hospitals, starting Monday and extending for the next eight weeks. Employed physicians have been instructed not to travel and must be ready to return to the hospital within 24 hours when summoned. Operating room capacity for scheduled cases is being reduced by upwards of 30% to allow for redeployment of staff to other areas. Another system has redeployed their operating room nurses to the medical/surgical floors and has brought in travel nurses to staff the ORs, but not everyone can find enough travel nurses even if they can afford them.

I imagine this is what it felt like to be in New York City in the spring. It doesn’t feel like we learned anything from their suffering because we’re now officially in the same boat.

Our urgent cares have tried to reduce volumes by limiting the number of COVID tests we do for patients who are asymptomatic, but it’s not much help since we’re in a phase where nearly every patient has symptoms. Schools are moving from in-person and hybrid models back to fully virtual, and parts of the state are headed back towards stay-at-home and safer-at-home orders.

My staff is working harder than ever, but they are most definitely at the breaking point. Sometimes I feel guilty about being only part-time for in-person care, and then I remember the work that I’m trying to do with my clients to better manage patients without the need for in-person encounters and their associated exposures.

Here are my free consulting tips for practices trying to figure out how to manage patients in the outpatient space more efficiently, since we’re all trying to do more with less. These are things that I have been recommending to practices for years, but for some reason, they still are trying to do things the hard way:

Refill management

If your system has technology to help with refill management, use it. If you don’t, consider a solution like Healthfinch to help tame the beast. If you don’t have technology, consider creating a policy that allows delegates to manage refills on behalf of physicians.

I still work with a lot of physicians who can’t let go of the idea that only they can manage refills, and their inboxes are flooded with refill requests. These are usually the same people who aren’t giving refills to their patients to last through the next scheduled visit, let alone to last through the year. I recommend that physicians who struggle with this idea start with one or two health conditions where medication refills are the lowest risk, and let their staff dig in. Make a list of the criteria for refills – this may include a visit within the last 365 days and no overdue labs – and start letting your support staff support you.

Inbox management

I’m a big fan of the “touch it only once” mantra. Use your technology to help you sort your inbox and then work it deliberately by section. If you only have a minute or two, select a lab result to manage or a refill request to manage, not a patient phone call. Don’t go through your inbox looking at things and trying to re-prioritize it over and over. You’ll waste a ton of time along the way.

Set up dedicated time during the day to manage the inbox, or plan to work it before or after seeing patients. Even if you’re used to calling your patients with results, consider leveraging the patient portal or secure texting if patients have opted in for these services. They’re much more convenient for patients and will save you time.

Invest in technology that can free your staff

Practices are still using humans to call patients and ask them COVID screening questions. If your organization has the ability to screen patients through a portal or other tools, use it. If not, there are many cool technologies out there such as Asparia that not only manage appointment reminders, but can help provide a safe arrival experience and triage patients who may need to avoid coming into the office.

You should also maximize the use of digital check-in or other workflows that might be available in your patient portal. For my most recent new patient visit, I uploaded copies of my insurance card and photo ID on my phone before even walking in the door, resulting in a contactless visit. When you save those minutes for your staff, it adds up, and those resources can be redeployed for use with patients who need real-time or face-to-face contact, or to better support you as you embrace telehealth visits.

Don’t be afraid of telehealth visits

With everyone being concerned about COVID and the availability of inexpensive devices for home biometric assessments, you would be surprised how many patients can provide a full suite of vital signs for a telehealth visit. Blood pressure cuffs and thermometers are plentiful, and pulse oximeters are becoming a regular part of the home first aid kit for many families courtesy of Amazon, Target, and other major retailers. Of course, this may vary depending on the patient population served, but I think physicians might be pleasantly surprised if they ask about access to these devices. If the patient doesn’t have one, they might have a neighbor or family member who does.

I’ve been practicing telemedicine for a while now and I’ve found it useful for picking up factors that I might not pick up at an office-based visit, such as fall risks in the home. I’ve also seen full ashtrays on the coffee tables of patients who claim to have stopped smoking, so you never know what you might find. Learn the rules for telehealth billing for your specialty – many specialty societies have published cheat sheets for their members.

Leverage your staff for telehealth visits

Staff can meet with the patient prior to the visit and update histories, document vital signs, flag medications for refill, etc. All too often I see the physician trying to do all these tasks even though they would have allowed support staff to do them in the in-person world. Sometimes the technology doesn’t make this easy, but there are ways to work around it to maximize the physician’s time.

Many of these elements go back to something that is so hard for some physicians to learn, and that is that they need to run their practices with everyone working to the top level of their licensure. If you’re lucky enough to have a registered nurse in the office, make sure you’re truly using them to deliver nursing services and not to do things that could be done by a medical assistant, patient care tech, or receptionist. I’ve been hearing the same arguments from subsets of physicians for decades, and if there’s one thing 2020 has taught us, it’s the need to break existing paradigms because “business as usual” is effectively over.

How has your organization tried to streamline the ambulatory paradigm in 2020? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/16/20

November 15, 2020 Headlines No Comments

Student Medical Records at UC San Diego Make Epic Change and a California First

UC San Diego Health reports the benefits of moving UC San Diego’s student health service to Epic, including instant access to medical records from 262 US health systems for its 39,000 students.

Inclusion of patient headshots in electronic health records decreases order errors

Researchers find that including a patient’s headshot in the EHR significantly reduced ED wrong-patient order entry errors without creating provider burden.

Oklahoma to Launch Health Information Exchange

The Oklahoma Health Care Authority will launch a statewide HIE in the fall of 2021, initially focusing on connecting Medicaid providers.

Monday Morning Update 11/16/20

November 15, 2020 News 2 Comments

Top News

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UC San Diego Health reports the benefits of moving UC San Diego’s student health service to Epic in August 2019.

The university says the Epic go-live gave it instant access to the medical records of 262 US health systems for its 39,000 students. Clinicians accessed 250,000 documents in the first six months from hospitals and CVS drugstores in several states.

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Student Health was able to quickly convert to virtual visits for mental health when the pandemic struck. It then used Epic to power its Return to Learn initiative by allowing 1,480 students to self-test for COVID-19 and then to have diagnostic testing automatically ordered if indicated.

Challenges that were addressed included identifying student health records in external EHRs, limiting access to PHI based on medical necessity, and integrating immunization records. The university also had to obtain student permission to use their Social Security numbers to identify their records and to share their records with other institutions.


HIStalk Announcements and Requests

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A significant number of poll respondents will spend Thanksgiving among people with whom they don’t live without employing mitigation measures. Not to be a downer, but small gatherings are top spreader events and winter holidays will be especially risky with record infection levels, family members flying in, and extended close contact that is moved indoors because of weather. I, too cling to the “they are careful and so are we, so I’m sure we’ll be fine” hope that unfortunately hasn’t proven to be broadly accurate given pre-symptomatic spread. We misspent our limited supply of public health goodwill in the spring by implementing draconian lockdowns that were supposed to buy us time to muster our national resolve to prepare hospitals, develop testing capacity, stockpile PPE, create contact tracing programs, and educate the public, but we basically just delayed the inevitable by flattening the curve while doing nothing that might have reduced the area under it. The world’s first COVID Christmas is going to be challenging.

New poll to your right or here: Where do you expect to be working a year from now?


Webinars

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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


Acquisitions, Funding, Business, and Stock

Harris acquires UK-based Genial Genetics and Genial Compliance Systems, which sells genetics-related laboratory information systems


People

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Bay Area Hospital (OR) hires primary care physician William Moriarty, MD as CMIO.

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Industry long-timer Peter Siavelis, MHI, MBA  (Waystar) joins Cardinal Health as SVP/GM of acute care distribution and services.

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Sensyne Health hires Derek Baird, MBA (Avia) as president, North America.

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Walter Kerschl, MD, MMM (Cerner) joins WVU Medicine Camden Clark Medical Center as VP/chief medical officer.


Announcements and Implementations

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A KLAS study of health system connectivity to post-acute care organizations finds that only Epic and Meditech provide solutions in all areas, as Cerner offers long-term and behavioral health modules but resells home health and hospice technology from strong performer MatrixCare. Netsmart has significant market share in standalone organizations that aren’t connected to health systems, having acquired solutions from Allscripts, Change Healthcare, DeVero, and HealthMedx, but customer satisfaction has dropped following post-acquisition lapses in support, development, and integration. PointClickCare is the strongest performer in long-term care, but no vendor consistently meets behavioral health needs. Records-sharing with acute care organizations from which referrals are sent is inconsistent, with Cerner and Epic having a high percentage of customers connected to CommonWell or Carequality, Meditech and Allscripts having low interoperability adoption, and the majority of users of all four systems reporting faxing as the most common method of exchanging information.


COVID-19

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The US reported a record 1.7 million COVID-19 tests, 170,000 new cases, and 68,500 hospitalized patients on Friday, as deaths moved up 30% from their seven-day average to 1,300.

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Former FDA Commissioner Scott Gottlieb, MD notes that mobility drives infection spread, and while hard-hit states such as SD, ND, UT, and WI are showing modestly reduced mobility, coronavirus isn’t broadly keeping people from their shopping and recreation.

A 38-hospital study of 1,250 COVID-19 patients who were discharged from March 16 to July 1 finds that within 60 days, 7% of them had died, 15% were rehospitalized, 13% were still experiencing persistent symptoms, and 15% were unable to return to normal activity. Forty percent of those who had been employed were unable to return to work — mostly because of poor health, but also because their jobs had been lost – and of those who did go back to work, 25% were assigned reduced hours or modified duties. The study dispels any notion that hospitalized COVID-19 patients return unscathed to their prior states of health and financial security.

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Illinois officials won’t reopen the 2,250-bed emergency COVID-19 hospital that was built inside McCormick Place at a cost of $81 million – most of that paid by federal taxpayers — and closed three weeks after opening after having seen only 38 patients. IT costs totaled nearly $4 million, including $400,000 paid to Rush University Medical Center to install and support Epic.

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A 55-attendee wedding reception in rural Maine creates a COVID-19 outbreak of 177 cases in the local community, a long-term care facility, and a prison. Guests did not comply with mask-wearing and distancing requirements and the facility didn’t enforce those rules or collect contact information from the guests. They did conduct temperature checks, but all were normal. The index patient had no symptoms the day of the reception, but came down with fever, runny nose, cough, and fatigue the day after. Half of the guests tested positive within two weeks, as did a venue staff member, a vendor, and a guest who was not part of the reception. One attendee attended a school meeting later the same day they started coughing, after which two school employees tested positive and the school’s opening was delayed by two weeks. Six residents of a long-term care facility died after the infection was spread by a guest who had a close interaction with one of its employees. None of the wedding reception guests themselves died.

An Ohio court orders the state health department to release information about COVID-related hospital bed capacity, medical supplies, and staffing to an investigative reporting outlet. The health department had argued that its Surgenet resource tracking system is a security record that could be used in terrorism response, but the court said that the computer system is just a repository for the requested data and the department would need to prove that the records themselves prevent or mitigate terrorist acts.

States and cities warn that that the logistical challenges of distributing a COVID-19 vaccine may be hard to overcome, among them promoting its availability, convincing people to get the vaccine despite its quick development, delivering supplies securely, hiring or recruiting volunteers to administer it, and recording and tracking the two-dose protocol. A new federal government system called Immunization Gateway was developed to connect state vaccine registries for people like snowbirds who get the two doses in different states, but most states aren’t connected. The CEO of the National Association of County and City Health Officials, says, “A month before the vaccine is about to become available is not the time to think about making systems across 3,000 health departments in 50 states interoperable.” CDC also wants to track real-time demographic information to identify low-vaccination populations and regions, but must convince states to turn over the personal data of their residents. CDC is also considering rollout of a phone-based tool to ask recipients if they’ve had any problems.


Other

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Researchers find that including a patient’s headshot in the EHR significantly reduced ED wrong-patient order entry errors without creating provider burden.

UCHealth CMIO CT Lin, MD records a ukelele-powered “It is a Telehealth World.” Careful examination of his backdrop reveals COVID-related ephemera, such as Clorox wipes and what appears to be a Fauci bobblehead.


Sponsor Updates

  • Forbes includes OpenText on its list of World’s Best Employers for 2020.
  • OptimizeRx hires Antonio Bogdanovic and Iva Lozancic as project managers.
  • Pure Storage receives the Flash Memory Summit 2020 Best of Show Award for Most Innovative Flash Memory Technology.
  • Spok publishes a new infographic, “Which communication solution is best for your healthcare organization?”
  • Waystar publishes a new trend analysis, “Price Transparency + Healthcare Consumerism.”
  • Well Health launches a Use Case Library to offer best practices and product use cases.

Blog Posts

Sponsor Spotlight

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Visage Imaging (“Visage”) just went live today with our new corporate website and our latest corporate video. Visage will be virtually exhibiting at the upcoming Radiological Society of North America (RSNA) 2020, November 29 – December 5, 2020.

(Sponsor Spotlight is free for HIStalk Platinum sponsors).


Contacts

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

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Katie the Intern 11/13/20

November 13, 2020 Katie the Intern 1 Comment

My learning this week consisted of interviews with readers of HIStalk. These readers also work in healthcare IT and either use HIStalk to some capacity for their job or rely on HIStalk updates to stay in-the-know for work updates. I’ll be summarizing one of those interviews and some of what I have learned about healthcare IT from it as well. 

This interview was with a gentleman I’ll call Steven since he prefers to remain anonymous. Steven works at a hospital as an Epic data architect. As he described to me, his job revolves around how to best make use of the reporting software that is in the hospital’s contract with Epic. Steven says that the hospital’s contract is structured under a strict fee, so the more the hospital uses it, the more benefit the hospital receives. Value is maximized when benefit is increased without a cost increase. All right!

When Steven started at his position, his hospital was just beginning to implement Epic. He had gained experience with Epic from his previous job with a pharma-related company. That is where he was introduced to HIStalk, as he started on the vendor side and moved to the provider side, where he has been for more than five years. 

“That was kind of like a dream of mine, to switch out of the vendor and onto the provider side,” Steven says. “Now I work on the provider side, and it’s kind of a glorious, wonderful thing. It was super meaningful even before the virus hit, and then the virus hit. All of a sudden my job changed dramatically and took on even more meaning.” 

Steven uses HIStalk to understand the general direction of where to take Epic at the hospital. HIStalk helps him understand the direction of the healthcare IT industry in general, allowing his team to make decisions about when to invest in additional effort in Epic or consider using another vendor. 

Before going too much into the interview, I wanted to write about what I learned about Epic and other EHRs (electronic health records, point for me) vendors. I’m sure HIStalk readers understand Epic and EHRs, but for me, this interview revealed a lot about how some of Epic’s programs are used by architects and applied to patients, staff, and hospital data. 

Epic has a software package called Cogito, an analytical database that allows the analysis of patient data as a whole rather than one patient’s data. Steven touched on Epic’s systems known as OLTP (Online Transaction Processing) and OLAP (Online Analytical Processing) and their different uses inside of Epic. The OLTP is useful for looking at one single point for data references, such as a single patient or a provider’s schedule. The OLAP makes it easy to search across an entire population, Steven says. These processes are the analytical tools that he uses to increase the value that his hospital gets from using Epic. 

Steven’s job revolves around understanding certain sets of data to ensure the hospital is able to get the information they need. He uses that information to answer the hospital’s questions, such as which doctor has the most expenses, how financials are doing, or how efficiently the hospital has vaccinated patients.

“I lead a team of 12 and I call the technical shots on how we are going to meet the businesses needs in being able to understand the data across the whole environment,” Steven says. 

This is where HIStalk comes back into play for Steven. He often uses HIStalk to guide his arguments for or against the renewal or discontinuation of programs for his hospital. Understanding the healthcare IT ecosystem allows Steven to see if the products his hospital is using are continuing to meet the needs of providers and patients there. 

“Being aware of what startups are doing or who is buying what helps me make arguments for or against whatever approach people are wanting to talk about in the data space,” Steven says. “Knowing what is happening outside of that, what their competitors are doing, helps me understand, ‘Is this person’s desire for this thing, is that what is best for us?’”

It is this understanding of desire and needs that recently drove Steven to argue for the discontinuation of a software program that many hospitals use. He argued to not renew a contract with a vendor program made by SAP Business Objects, business intelligence software that is not meeting his hospital’s needs. Though it is a partner’s software that Epic recommended, the hospital will be one of the first to turn it off. 

Much of this interview with Steven brought me to a deeper understanding of the crosshairs of analytics, vendors, and running a hospital’s data systems to maximize value. Researching EHRs, talking with Steven, and learning more about the main players in the EHR industry has been eye-opening for me as someone new to the field. I really learned just how important it is to stay connected to the industry, as it helps healthcare IT workers better apply system tools to patients and providers alike.

I do hope this column helped readers gain at least a deeper understanding of the role of a data architect in hospitals. I know that I learned a great deal about Epic, computer software, data analysis, and understanding the importance of keeping up with the industry.

In next week’s column, I’ll be breaking down another interview with another reader who uses HIStalk to stay connected. He is a younger professional in the field and also gave interesting tips on how to learn about the industry as a whole.  

I also plan to begin researching COVID-19 deaths and how hospitals decipher who died strictly from COVID-19 versus from complications it caused. I am hoping to share some interesting information from that research in the coming weeks! 

Thank you for reading. I am enjoying the healthcare IT industry and learning new stuff every day. 

Katie The Intern 

TLDR, as a reader requested – Katie The Intern conducted an interview with an Epic data architect and learned about EHRs, data evaluation, and how an architect makes decisions at work with the help of HIStalk’s industry summary.

Katie

Email me or connect with me on Twitter.

Weekender 11/13/20

November 13, 2020 Weekender No Comments

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Weekly News Recap

  • Health Catalyst announces Q3 results that beat Wall Street expectations for revenue and earnings.
  • Providence will implement Nuance’s Dragon Ambient Experience for EHR documentation and will co-develop solutions covering other areas.
  • Australia’s SA Health is given another $146 million to complete its years-overdue implementation of Allscripts Sunrise.
  • Ambulatory surgery center software vendors HST Pathways and Casetabs announce plans to merge.
  • Managed care company Centene will acquire AI-powered healthcare analytics vendor Apixio.
  • HHS OIG imposes additional Corporate Integrity Agreement terms on EClinicalWorks, including requiring the company to notify customers that its EHR creates a material risk of patient harm.
  • Sky Lakes Medical Center says that its October 27 ransomware attack, recovery from which is continuing, will hit its bottom line hard and will require replacing 2,000 computers.
  • University of Vermont Health Network, whose systems remain offline from an October malware incident, has regained access to a week’s worth of patient schedules.
  • The VA’s 16,000-employee Office of Information and Technology publishes its fiscal year report, which primarily addresses the COVID-related challenges it met.

Best Reader Comments

I am a Livongo customer and I don’t think it has revolutionized anything. It has some nice features. You get as many strips as you want, which is good so you have extra test strips when sick. The meter keeps track of how many strips you have left and one click on your meter will order more for you. Maybe a new diabetic would find the coaches helpful. All that doesn’t look like a revolution to me. (Kathy)

Re: Bridge Connector. Stunning news. I was traveling last week and woke up to the news this morning. This has got to be one of the more epic startup failures since CareSync went bust a couple of years ago. Good luck to all those affected. (D.L. Miller)

Provider organizations should support sustained efforts to continuously pare down the EHR interaction time required by clinicians. This is not a one-time exercise. It requires highly knowledgeable and skilled individuals, though, ones with operational, clinical informatics, and IT wisdom. I would venture to say that CIOs should now track measures such as reduction of interaction time as badges of honor / performance metrics, just like in years past organizations tracked EMRAM levels. The Less is More Awards? (Azmat Ahmad)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. G in California, who asked for STEM kits for her first-grade class. She reported in January, “Thank you so much for your generous donation! My students are going to benefit greatly from your thoughtfulness and have an enriched learning opportunity thanks to your contribution to our project. My students and I can’t wait to get this project started. They are excited to explore the STEM bins and get into engineering mode! These Stem bins are going to put their problem solving skills and creativity into high gear while learning in a fun way using fun materials. I truly appreciate your dedication to education as you are going to greatly impact my students’ learning.”

A Mississippi pharmacist who is among several defendants who are accused of defrauding insurers of $510 million in a compounding pharmacy pain cream scheme says that he gave a local doctor – who is also charged — $127,000 to buy himself a new Jaguar. The pharmacist says he wanted to keep the doctor happy to keep the prescriptions coming for cream that was billed at up to $13,000. The pharmacist said a Rush Health Systems employee scoured its patient database to find those whose insurance was likely to pay.

Utah Valley Hospitals has stopped five conspiracy theorists who have tried to bluff their way into the ICU to prove that it isn’t full as claimed. The hospital’s telephone operators are also being bothered people calling every day demanding to know if the ICU is full.

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A 63-year-old man who had spent weeks in a Jacksonville, FL hospital’s ICU recovering from COVID-19 marries his long-time fiancée the day before his discharge because they wanted hospital staff “to share the life they gave us back.”

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Hollyanne Milley, a cardiac nurse who is married to the Chairman of the Joint Chiefs of Staff General Mark Milley, saves a veteran who collapsed during a Veterans Day ceremony at Arlington National Cemetery by performing CPR. She said afterward that it was even more unusual a few years ago when she was attending an Army Ball and performed CPR in her evening gown.


In Case You Missed It


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Morning Headlines 11/13/20

November 12, 2020 Headlines No Comments

Health Catalyst Reports Third Quarter 2020 Results

Health Catalyst reports Q3 results: revenue up 20%, adjusted EPS –$0.21 versus –$0.27, beating Wall Street expectations for both.

Amazon Alexa Care Hub update will make it easier to help aging family members

Amazon introduces Care Hub, a free Alexa app feature that allows people to connect to a loved one’s Echo device from an app to view their Alexa activity, set alerts, or answer their call for assistance.

Solv Health raises $27 million as health care providers move online

Web-based urgent care appointment booking and telemedicine startup Solv Health raises $27 million in a funding round led by Acrew Capital.

Jarrard Phillips Cate & Hancock Joins The Chartis Group

The Chartis Group acquires strategic healthcare communications and change management firm Jarrard Phillips Cate & Hancock.

News 11/13/20

November 12, 2020 News No Comments

Top News

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Health Catalyst reports Q3 results: revenue up 20%, adjusted EPS –$0.21 versus –$0.27, beating Wall Street expectations for both.

HCAT shares are up 3% in the past year versus the Nasdaq’s 39% gain, valuing the company at $1.5 billion.

Health Catalyst shares began public trading in late July 2019, with a first-day close of $39.17. They are now at $35.55.

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The company also announces several promotions: Patrick Nelli to president; Bryan Hunt to CFO; Jason Alger, MS to chief accounting officer; and Adam Brown to SVP of investor relations and financial planning and analysis.


Webinars

November 16 (Monday) 1 ET. “COVID-19 and Beyond: A CISO’s Perspective for Staying Ahead of Threats.” Sponsor: Everbridge. Presenter: Sonia Arista, VP and global chief information security officer, Everbridge. While hospitals worldwide work to resume elective care amid COVID-19, they’re quickly adapting and responding to a variety of emerging risks that have tested their resilience, including a surge in cybersecurity and ransomware attacks. This webinar will highlight emerging IT vulnerabilities and best practices designed to help hospitals anticipate and quickly mitigate cybersecurity risks. A former hospital CISO will share her expertise in responding to high-impact IT incidents and mitigating risks during critical events given the “new normal” that COVID-19 has created.

November 18 (Wednesday) 1 ET. “Do You Really Have a Telehealth Program, Or Just Videoconferencing?” Sponsor: Mend Family. Presenters: J. D. McFarland, solutions architect, Mend Family; Nick Neral, national account executive, Mend Family.  Healthcare’s new competitive advantage is telehealth, of which a videoconferencing platform is just a small part. This presentation will describe a comprehensive patient journey in which an organization can acquire new patients, reduce check-in time, reduce no-shows, and increase patient satisfaction, all using virtual care. Health systems did a good job in quickly standing up virtual visits in response to COVID, but telehealth and the digital front door are here to stay and now is a good time to re-evaluate tools and processes that support patient scheduling, digital forms, telehealth, and patient engagement as part of a competitive strategy.

November 18 (Wednesday) 2 ET. “Leveraging a Clinical Intelligence Engine to Solve the EHR Usability Crisis.” Sponsor: Medicomp Systems. Presenter: Jay Anders, MD, MS, chief medical officer, Medicomp; David Lareau, CEO, Medicomp. Healthcare is long overdue for a data makeover. Clinician burnout is fueled by inaccurate, inconsistent, and incomplete clinical data, but that can be improved without scrapping existing systems. The presenters will describe the use of tools that work seamlessly with EHR workflows to deliver actionable data, improve interoperability; support the clinician’s thought process; and improve usability for better decision-making and accurate coding.

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

Here’s the recording of this week’s webinar titled “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things,” sponsored by Alcatel-Lucent Enterprise.


Sales

  • UAE’s Mediclinic Middle East joins TriNetX’s global health research network.

People

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Angelo Campano (Ogilvy Health) joins OptimizeRx in the newly created position of SVP and principal of agency channels.

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Kevin Brubaker (MiHIN) joins Glooko as RVP of enterprise health systems.

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Atlantic Health hires Sunil Dadlani, MBA, MS (NYS Department of Health) as VP/CIO.

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Rick Howard, MBA (Ascension Technologies) joins Apervita as chief product officer.


Announcements and Implementations

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Cerner incorporates Well Health’s app-free clinician-patient interaction capabilities into its HealtheLife patient portal, which will allow provider organizations to deliver health information, reminders, and virtual visit scheduling.

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Amazon introduces Care Hub, a free Alexa app feature that allows people to connect to a loved one’s Echo device from an app to view their Alexa activity, set alerts, or answer their call for assistance.

Providence will implement Nuance’s Dragon Ambient Experience for EHR documentation and will co-develop clinical intelligence and revenue cycle solutions.

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Amwell announces a fast-track video visit option, IPad software, and a new telemedicine cart.

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A new KLAS report finds that connection of post-acute and behavioral health providers to CommonWell and Carequality is in its early phases, but 88% of the early adopters find the connection valuable. Netsmart has connected up to 35% of its MyUnity and MyAvatar customers, who can pull outside information such as medication lists into its EHR and use tools to search incoming CCDs for relevant lab results and progress notes. Users appreciate the time savings in not needing to chase down encounter data, with the next step being to make the process seamless and improve usability with automated queries, patient matching, and inserting external data into the patient record. The early adopters say their vendors made connection easy, but most of those vendors charge setup or licensing fees.

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Meanwhile, KLAS updates its previous report on acute and ambulatory interoperability via CommonWell and Carequality, concluding that NextGen Healthcare is the only ambulatory-specific EHR vendor that provides a strong usability experience for all interoperability workflows, including the especially challenging reconciliation of duplicate medication data. Cerner has doubled the number of customers that are connected to CommonWell, while Athenahealth and Epic lead overall adoption in having connected nearly all their customers. Meditech has slow uptake, while CommonWell founding member Allscripts shifted to Carequality and connected its first customer in the second half of this year using DbMotion, which will be required for Sunrise and TouchWorks to connect going forward. Epic’s Happy Together is strong at integrating outside lab data and is working on automatic ingestion of progress notes and lab data, while Cerner has strong capabilities for incorporating outside data into its patient record.


COVID-19

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New cases (144,270) and hospitalized patients (65,368) hit new single-day records Wednesday, as another 1,421 Americans died of COVID-19. The Midwest is especially impacted.

Doctors Without Borders sends international aid workers to the US to help with uncontrolled coronavirus spread.

CDC’s updated guidance says that masks protect both the wearer and people around them from coronavirus. It notes that multiple layers of denser cloth work best, also adding that increasing mask use by 15% could help prevent lockdowns and their associated $1 trillion economic loss.

Provider-employed informaticians: has your organization planned for how it will document the administration of coronavirus vaccine doses and send reminders to those who start a two-dose regimen to complete it?

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Former FDA Commissioner Scott Gottlieb, MD warns that unlike New York’s peak pandemic weeks in the spring, hospitals won’t be able to bring in temporary workers from less-ravaged areas now to address their COVID surge because demand is national rather than regional.

HHS announces that several chain pharmacies – representing 60% of US drugstores – will provide coronavirus vaccine at no cost to patients, among them CVS, Walgreens, Walmart, Costco, Albertsons, Kroger, and Publix. The announcement says that HHS expects one or more vaccines to be approved by December 31.


Other

Australia’s SA Health obtains another $145 million to complete its years-overdue rollout of Allscripts Sunrise, a project that was reset in 2018 after an independent review found that SA health failed to get outside help (including from Allscripts), failed to implement a sound governance model, and struggled to make the Allscripts product meet Australian billing needs.

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VTDigger says no end is in sight for the malware-induced mayhem at University of Vermont Medical Center, whose two-week computer downtime has left employees working without patient schedules, recording patient information in manila folders, administering medications from hand-transcribed notes with no barcode checks, turning away imaging patients, and using walkie-talkies and fax machines since the phone and email systems are down. The hospital president warns that exhausted employees will need to enter the mass of manually-recorded information in Epic once that system becomes available.

An independent consumer survey commissioned by DocASAP finds:

  • 84% of those surveyed plan to get a coronavirus vaccine when it becomes available.
  • The doctor’s office is perceived as the safest place to get the vaccine compared to hospitals and pharmacies.
  • 44% would prefer to receive medical care via a combination of in-person and telehealth visits.
  • People will switch providers to get an earlier appointment or more convenient location.
  • Online scheduling was preferred by 48% versus 39% by phone.
  • Text messaging is the preferred method of receiving appointment reminders.
  • The top healthcare issues all involve cost – loss of insurance, reduced costs, and protecting pre-existing conditions. Access to mental health services was the top issue for 21% of respondents.

Sponsor Updates

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  • Jvion team members pack food boxes as Emergency Food Aid Volunteers for Urban Recipe.
  • Cerner works with state and local officials to help secure $6 million in federal funding to create 5,300 new tech industry apprenticeships.
  • Innovaccer leverages the Surescripts nationwide information network, including its Medication History for Populations tool, to help close care gaps and alert users to medication non-adherence.
  • The Sales People Podcast features Goliath Technologies CEO Thomas Charlton.
  • Halo Health updates its Halo Clinical Collaboration Platform with Halo Link to better enable providers to collaborate across health systems.
  • Hayes wins Silver in the Team of the Year During COVID-19 category, and Bronze in the Company Innovation of the Year category in the annual Gold Bridge Business and Innovation Awards.
  • Healthwise wins two ClearMark Awards from the Center for Plain Language for its patient education content.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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EPtalk by Dr. Jayne 11/12/20

November 12, 2020 Dr. Jayne No Comments

My inbox has been bountiful this week, with so many good stories that link to healthcare IT that I just kept flagging items to come back and read later, only to find my entire screen full of flagged emails.

My urgent care is swamped with patients wanting COVID testing, and although there are enough supplies to go around, there simply isn’t enough staff. Since most of our payer contracts require patients to see a physician to document medical necessity for testing, and there’s only one of us at a site, it’s just an endless parade of testing visits. That is, until something acute comes in, and then there is an adjustment as we remember how to see “traditional” urgent care patients again.

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I was excited to see this article in Nature Medicine looking at how fitness trackers might be useful to detect biometric changes associated with COVID-19. I know patients will always want testing “to know for sure” as well as to make sure they can take advantage of workplace policies that require a positive test for paid time off, but it would be nice to have other tools that patients could use to help risk stratify themselves. That way they could figure out if they really need to stand in line for hours for a test at an urgent care center or if they could do a video visit with their primary physician and arrange testing at the health system’s drive through tent in a day or two.

The study Digital Engagement and Tracking for Early Control and Treatment (DETECT) study looked at data from more than 30,000 individuals from all 50 US states. They found that adding sensor data to symptom-based models improved their accuracy. Regional health officials in my area are lamenting the inability for temperature- and symptom-based screeners to identify infected patients, so at this point anything would help. Our schools just went back in person, and within 24 hours, were sending people home to quarantine due to exposure. The idea is that using device data could help identify clusters before infection spreads. That would have been useful in the aftermath of a recent parent-approved Halloween party thrown by some local teens, where over 200 high-schoolers attended.

A recent article in JAMIA looked at the advantages of human scribes compared to other options, particularly looking at patient safety aspects. They used a multidimensional sociotechnical framework to look at how different health systems use scribes. The dimensions were technical, environmental, personal, and organizational; 81 individuals were interviewed, including scribes and clinicians. They were asked about why they chose to use scribes as well as the background and training of scribes, along with pros and cons of their implementations.

One interesting finding was that since many health systems rely on college students for scribing, that geography is a factor in whether a practice can find a good scribe or not. That would definitely underscore why virtual scribe solutions are popular, since not every town has college students, let alone highly-motivated pre-medical or nursing students who would make good candidates.

Respondents did note a preference for real-time scribes versus using voice recognition software after the fact. The turnover in good scribes is an issue that was also validated in the research, and I experience that every year when medical school and physician assistant school acceptances are issued.

Fortunately, our scribe program staffs ahead of those transitions but it’s always a challenge to have the new scribes ramped up prior to flu season. You can bet that with COVID they’ve definitely earned every bit of experience they claim. I’m still waiting to hear from any readers (or friends of readers – come on, help a girl out here) who might be using one of the Ambient Clinical Intelligence solutions offered by Nuance or one of the other voice recognition vendors. There was a great deal of interest in the system at HIMSS a couple of years ago, but I have yet to encounter anyone actually using it in the wild.

The Journal of the American Medical Association tackled a weighty topic recently with its piece on “Science Denial and COVID Conspiracy Theories: Potential Neurological Mechanisms and Possible Responses.” Although this was a “Viewpoint” article rather than a research article, it has some interesting points. The first is the relationship between neurodegenerative disorders such as dementia with the adherence of an individual to false beliefs. Other psychiatric disorders include similar manifestations, such as delusions of grandeur and paranoia. The author proposes that false beliefs form due to faulty sensory information and impairment of brain systems designed to evaluate thoughts and beliefs.

Until reading the article, I had forgotten about Capgras syndrome, where certain dementia patients believe that a loved one has been replaced by an impostor. He explains the mechanisms by which that occurs as well as other delusions associated with dementia. He goes further to discuss the role of social media in amplifying conspiracy theories and other misinformation.

Based on what we know about dopamine and the addictive nature of social media, I can concur with his assertions. Mix in some low science literacy and we wind up where we are, with patients who legitimately believe that COVID is being spread by 5G cellular towers. He calls on the medical community to “mount systematic efforts around science education beginning in childhood and across the lifetime.” It’s a nice idea, but right now many of us are simply too exhausted from treating COVID patients.

From the Hall of Shame: Several towns along the east coast trusted a private physician to set up COVID testing clinics, but he proceeded to over test while billing exorbitant rates. Some patients were charged upwards of $1,900 and he was also recommending daily telehealth visits for a separate fee. Of course, his game wasn’t discovered until the bills started hitting, which typically takes at least 30 days for most patients with health insurance. Towns were effectively duped, with promises of a speedier economic recovery through greater testing. They in turn promoted the services, and then the physician took advantage.

Seems like a pretty clear ethics violation and I hope the relevant licensing boards take note. The physician is clearly delusional, stating that he tested for all kinds of other respiratory viruses because “just testing for coronavirus is one of the most dangerous things you could do… it is crystal clear that mentality is bad for public health.” I’d argue that unnecessary testing is also bad for public health, as is medical bankruptcy. People like him are the reason patients don’t trust the medical establishment. It takes far too many good experiences to undo the damage caused by a bad apple like this one.

Have you received a balance billing statement for COVID testing or related services? Leave a comment or email me.

Email Dr. Jayne.

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Reader Comments

  • AnInteropGuy: I would hope that we have better medicine and science than we did 67 years ago. Our understanding of virus mechanisms ar...
  • Angela C. Witt: Most of the suggestions you have to improve order management in the EHR are features available in current vendor product...
  • masterblaster: I was intrigued by your statement of "Because they so tightly control access to the vendor’s documentation, I have no ...
  • IANAL: In spite of AMA lobbying, regulatory changes in the early 2000s allowed pharmacists to give flu shots. Costs fell, acces...
  • Brian Too: My theory is that telehealth is a bigger benefit for the patient than it is for the clinician (though there are clinical...

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