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HIStalk Interviews J. Erin Hutchinson, Owner, Narrative Shift

September 9, 2020 Interviews No Comments

J. Erin Hutchinson, MA is owner of Narrative Shift of Herbster, WI.

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Tell me about yourself and the company.

I’m a Midwestern farm girl, so I don’t like to talk about myself, as most of us don’t. I’ve spent my career starting companies, starting with clothing stores and video store chains. I have 45 years’ of experience in the healthcare technology world. Ten years ago, after launching many small ventures, I started what is now Narrative Shift.

We help founder-led companies and startups in the healthcare and biotech space successfully launch their products and services. We help them craft compelling narrative to create curiosity and excitement among their target customers so that they are interested in having a conversation. All of us are bombarded with lots of shiny marketing stuff, but it’s hard to get your message out there so that people take action and have that initial sales conversation. We do full-service graphic design, marketing, and go-to-market strategy. It’s a startup advisor in a box, as I like to say.

You went from being a psychologist to leading teams at Epic, engineering companies, and consulting firms. How have you applied your psychology knowledge in those roles?

I worked for Epic back when it was fewer than 100 people. In my late 20s, I was working with physicians and surgeons who were new to technology, to the point that I had to teach them how to turn on a computer and use a mouse. A surgeon threw a keyboard at my head once, so that’s when I used my clinical psychology skill set to get people to change.

In helping new companies get launched and bringing more revenue to tech startups, I draw from that background of how we communicate and connect with other people. Companies tend to get myopic. They may have the best thing since sliced bread, but they lose track of being able to put themselves in their customer’s place. I help these companies craft their identity and craft their story so that it is communicated and connects with their target audience.

Tech people are not always the best at the human element, so my background has helped a lot. Plus I was a child and adolescent psychologist where humor is important, especially when you are working with young kids. I bring that to my work with my clients. Starting and growing a company is hard work and I like to bring a little bit of fun to that.

What is narrative therapy?

I was trained in, and my dissertation was in, using the narrative approach in working with children and adolescents. I could bore anyone to tears with all of the heavy post-modern theory aspect of narrative therapy, but in essence, it’s that we as humans create meaning and communicate with each other through through narrative, through stories. That is the core element of how we express our experience. The essence of successful design and marketing is that you have to communicate to your customer through a story.

Bringing the narrative therapy approach involves working with your clients to understand the narratives that shape their world view, and then working with them to re-author those in the way that they see themselves. Maybe they can re-author their narratives to psychologically shift their perspective.

Founders are usually interesting and have a lot of personality and humor, but they seem to be coached into dullness as their companies grow, to the point that all communication is filtered through conference rooms pull of people who suck the life out of it. Can large companies be interesting and fun?

To be 100% transparent — and sometimes I’m painfully so — one benefit of owning a company is that you can choose to be that way. I choose not to work with many large, established companies. They are either overly prescriptive about “this is how we must present ourselves” or they have armies of corporate marketing people who are maybe good at putting on events, but not so great in figuring out better ways of connecting with their customers.

We in healthcare are do a really bad job of using creative ways to get the interest of target customers and target markets. I set a rule with clients that if they want shiny, happy stock photos of people who look like doctors and nurses, then they need to find a different agency to work with. I generally shy away from those companies that grow and become the Borg.

Early-stage or founder-led companies, which more often maintain that entrepreneurial culture, are more open to being creative and asking for help to find their voice, establish their identity, and craft the narratives that will get prospects interested. I’m probably trying too hard to be politically correct in saying that big companies are boring. Those that grow successfully need to maintain that fine line, but cut through the noise by being a little bit irreverent and not being afraid to try something different in their marketing. It’s easier to do that if you have strong leaders who maintain that entrepreneurial spirit and don’t hire a bunch of marketing Borgs or large agencies without experience in healthcare or healthcare tech, which perpetuates this culture of stock photo websites and material and messaging that all looks the same.

How much do you help create strategy rather than just communicate it?

It’s a little bit of both. I love working with smaller companies and startups because I’ve been in the role of starting companies. I’ve been a part of many ground-floor new ventures. I’ve done the work. I didn’t just get a marketing or design degree. I’ve gone through the process of getting funding and I know what that takes.

With my background as a therapist, many clients ask for help because they hate their website or their sales pipeline isn’t growing. But most of the time, that ends up turning into a combination of helping to craft the strategy, especially from a go-to-market perspective, as well as the messaging and those narratives. I find it impossible to separate those two. Maybe it’s because I’m opinionated, honest, and open that I can’t hold back, so I give my advice and clients can take it or leave it. I can’t just churn out stuff that looks pretty and sounds good. If I can help someone with their strategy and to be more successful in growing their company, I’m going to do that.

Because of my background and being one of the few firms out there that specializes in the provider market, they don’t have to spoon feed me and educate me on their business and their customers. I know it. That also helps me to be more strategic and holistic in the work that I do with my clients. It also means they don’t have to go through the agonizing process of writing a lot of copy for me to clean up because I can already articulate what is needed to their customers.

Social media tech companies have embraced psychology in ways that aren’t entirely positive, getting people to keep coming back, pushing analytics-targeted ads, and entertaining them with short videos. Does that change the way that companies might get and keep the attention of prospects?

Because of the evolution of media and how people consume information, there’s no longer a standard recipe of what will work for a particular type of company or customer. I tell clients that some things aren’t worth wasting your time on. You aren’t going to get a hospital CEO to call you just because you have a great Twitter feed. Some clients I’ve worked with think a social media presence will magically result in more customers.

I wish that the diversification of media and expansion of the ways people get information make it easier to grow your company and to get the attention of your customers, but frankly, it has made it a lot harder. You have to spend more time understanding who they are, developing your buyer personas, and then figuring out where they are. What are they looking at? How do you get in front of them and get their attention? You need to have a multi-pronged approach. We no longer have four TV channels, three radio stations, and two newspapers.

It goes back to psychology understanding. What do you have to offer? What is your secret sauce? What makes you special? Whose attention are you trying to get? The psychology component gets infused into figuring out which tools to leverage and crafting campaigns and materials that are targeted at these types of potential customers. That was simpler before social media.

Some companies based their entire marketing strategy around the HIMSS conference, then reaped whatever benefit they received for a whole year. How will that change in the absence of in-person conferences for now and with provider customers whose priorities are dramatically different than they were six months ago?

I’ll be blunt. If there is one upside to the pandemic that we’re living in, it’s that it upended the HIMSS apple cart. My guidance to clients for at least the last five years is, don’t do it – don’t spend the majority of your marketing budget on this one event. Feedback from the last 10-15 companies that I’ve worked with, which has gotten louder over the last few years, is that they sunk a ton of money into HIMSS and got next to zero return, other than meeting a few new people. I’m hoping that this has forced companies to reevaluate and rethink their spending. I will be curious to see, by the end of this year or the middle of next year, if companies look back and realize that HIMSS didn’t really impact their bottom line that much, and they got good results using other methods.

Will that level the playing field so that small companies can use creativity rather than a big bank account and sprawling booth to chase business?

The benefit is that people have to think differently about getting their name out there and marketing themselves. The benefit of in-person conferences was getting face time in forcing your way in front of those most likely buyers. The companies that will succeed now will be creative and able to adapt. That’s harder for a large company that has entrenched corporate marketing departments and strategies, where it’s harder to adapt and be willing to diversify in trying different things and methods. Established, bigger companies put 75% of their marketing budget into HIMSS or other conferences. Now there’s the freedom to take that money and be more creative and use a variety of marketing campaigns.

Smaller players are relegated to the HIMSS “basement,” sometimes literally on the fringes of the big show floor. This is a time where it’s harder to get healthcare buyers to pay attention to you. They playing field is leveled if you are creative an willing to try different things. Your prospects aren’t getting the impression that since you don’t have a big booth, you’re not worth talking to.

I live in a very rural, isolated part of the country that relies on tourism. I’m involved in the local farming and arts communities. We have offered for 15 years a local artist studio tour, with hundreds of people visiting this tiny town of 100 people that I live in. We couldn’t do it this year because of the pandemic, so we pivoted to a virtual tour. We’ve had three times the traffic as we had last year, which had been our most-attended year. This has made made everybody think differently about how you can market and sell art and for artists to connect with potential buyers as well as just people who appreciate art. Corporate America and companies that sell into the provider market might be surprised by the amazing results they can see if they connect with people virtually.

What psychological observations do you have from working in 100-employee Epic now that it’s 10,000-employee Epic?

They have had to adapt some things as they have grown, but I’m not surprised that the company’s culture has remained consistent, since it is 100% driven by the founder. She has remained consistent in her perspective on how she wants the company to be portrayed, even in things like not wanting to get a bunch of “professional” marketers and designers.

Back in the day, I was one of the people producing the UGM multimedia presentations. It was all employees, and now they have people they pay to do that. But the company has always been proud of not devoting tons of time and resources to sales and slick marketing, and that has helped them continue that same kind of vibe. Going back to pure psychology, Judy established the narrative of what she wanted Epic to be early on and has not deviated much from that as the company has grown.

Some great case studies will be written in the next decade or so that Epic didn’t follow the rules of the road, but still scaled the company without growing up, maturing, and making everybody wear suits. People will look back and see that you can be true to yourself if you establish that really strong identity and strong narrative. You can grow and become the monolithic, 10,000-pound gorilla.

Do you have any final thoughts?

Everyone is struggling. 2020 has been a year that none of us could have expected. If you are struggling, like we all are, this is a great time to reevaluate and take a look at how you are communicating and defining the story you want to tell. Think about trying something different, because honestly, what’s it going to hurt? The rules have been broken by the fact that we are living in a completely new reality. Have fun with that a little bit.

Morning Headlines 9/9/20

September 8, 2020 Headlines No Comments

United States District Court Northern District of Illinois Eastern Division: Memorandum Opinion and Order

A federal court dismisses a class action lawsuit that was brought by a University of Chicago Medical Center patient who objected that the hospital shares the de-identified records of adult patients with Google for machine learning research.

NIH awards Fairfax company $39M contract

The National Institutes of Health awards Vibrent Health a $39 million contract to continue providing participant management technology for its All of Us research program.

ConnectiveRx and HelpAround Transform Mobile Access for Specialty Medication Patients

ConnectiveRx invests in HelpAround, a patient engagement and medication adherence startup that is focused on app-based messaging for patients undergoing specialty treatments.

Seattle health tech startup Optimize.health raises $15.6M for remote patient monitoring service

Optimize.health raises $15.6 million after pivoting from developing smart pill bottles to remote patient monitoring services.

Telehealth firm Amwell looks to raise about $560 million in U.S. IPO

Amwell expects to raise $560 million through its mid-September IPO of 35 million shares priced at between $14 and $16.

News 9/9/20

September 8, 2020 News No Comments

Top News

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A federal court dismisses a class action lawsuit that was brought by a patient of University of Chicago Medical Center who objected that the hospital shares the de-identified records of adult patients with Google for machine learning research.

The plaintiff says the hospital shares patient dates of service and free-text medical notes, both of which could make it easier for Google to re-identify their data. He adds that the company could link his information to the many databases it controls, including geotracking information, which could compromise his anonymity.

The court found that while the hospital probably breached the express contract that is represented by its Notice of Privacy Practices by “selling” de-identified data in return for free software licenses, courts have not ruled that such data has market value. It also said that the plaintiff did not prove that the value of his records was diminished by having them shared with Google.

The court noted a legal precedent in which a HIPAA violation can’t be pursued as a breach-of-contract lawsuit.

The patient sought damages, an argument that the court found was not supported by proof of any losses. The ruling also observed that the plaintiff signed the hospital’s authorization form, which specifies that patients don’t get paid even if their information is used to create commercial value.


Reader Comments

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From HITCurious: “Re: HIMSS20. The exhibitor settlement contract alludes to class action lawsuit. Anyone have details?” HIMSS provided a timely response to my inquiry, which I appreciate:

HIMSS confirms that in early June, one of its exhibitors filed a lawsuit in federal district court in Illinois, seeking a refund of fees for the 2020 Global Conference. This exhibitor also seeks to represent a class of other exhibitors that it claims are similarly situated. This lawsuit is captioned HatchMed Corp. v. Healthcare Information and Management Systems Society, Inc., Case No. 1:20-cv-03377 (N.D. Ill.). HatchMed alleges that HIMSS had an obligation to refund fees paid by exhibitors for the 2020 Conference, after the Conference was cancelled due to COVID-19. No class has been certified, and HIMSS disputes the basis for HatchMed’s claims. 

HIMSS is grateful for the support of exhibitors and attendees through these unprecedented times, and gratified by the overwhelming support of exhibitors for the upcoming HIMSS21 conference, scheduled for August 2021.

[HatchMed, which sells nurse call cables and device mounts and reports 2-10 employees, booked a 10×20 booth for $11,075].


HIStalk Announcements and Requests

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Reminder: if you have struck out on your own in health IT marketing/PR at some point in your career, share your experience with those who are considering such a move.


Webinars

September 9 (Wednesday) 1 ET: “APIs for Data Liquidity in Pandemic Times.” Sponsor: Chilmark Research. Presenters: Brian Murphy, research director, Chilmark Research; Gautam “G” Shah, VP of platform and marketplace, Change Healthcare; Drew Ivan, chief product and strategy officer, Lyniate; and Dave Levine, MD, co-founder and chief medical officer, Datica. This webinar will present the findings from a recently published research report on the state of the healthcare API market. The presenters will describe their work in deploying APIs to enable new functionality to address COVID-19. They will cover the use cases that have been most reliable for enabling effective data liquidity, how developers are using APIs to respond to the pandemic, and how different parts of the healthcare system are making APIs more widely available.

September 17 (Thursday) 1 ET. “ICD-10-CM 2021 Updates and Regulatory Readiness.“ Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP of global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will review additions, deletions, and other revisions to the 2020 ICD-10-CM code set that will be critical in coding accurately for proper reimbursement.

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


Acquisitions, Funding, Business, and Stock

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ConnectiveRx invests in HelpAround, a patient engagement and medication adherence startup that is focused on app-based messaging for patients undergoing specialty treatments.


People

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Access EForms promotes Rob True to VP of professional services.

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Collaborative Imaging names Arun Douglas (Zinc) chief technology and security officer and David Silva (Baylor Scott & White Health) chief compliance officer.

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Health Catalyst co-founder Steve Barlow returns as SVP after a three-year missionary stint. Bryan Hinton will be promoted to CTO in replacing Dale Sanders, who will move to senior advisor.

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Australian Digital Health Agency hires Amanda Cattermole, MS, MBA (Services Australia) as CEO. She replaces Tim Kelsey, who took an SVP job with HIMSS in January 2020.


Announcements and Implementations

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A new KLAS report finds that health system use of a single vendor for all revenue cycle needs remains a work in progress, with clients of Change Healthcare and Experian Health reporting the highest usage of available components as the slow transition from best-of-breed solutions continues. Waystar clients say they want to implement available patient access functionality, those of NThrive say its technology can handle complexity, and both companies have multiple customers using HIM functionality that has limited industry-wide enterprise use.


COVID-19

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North Carolina becomes the latest of several states for which published COVID-19 numbers have been skewed due to data reporting problems. The state’s HHS says that unspecified technical issues have caused hospitalization data to be underreported since Friday.

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Stat assesses the progress that has been made by Operation Warp Speed in its first five months:

  • It spent $10 billion to support vaccine manufacturer research and production.
  • It spent $450 million to support the monoclonal antibody treatment manufacturing capacity of Regeneron (and soon to Eli Lilly, which is working on a similar product). This is its only investment in COVID-19 treatment.
  • It has done little with diagnostics.
  • It has issued $500 million worth of no-bid contracts with companies that manufacture syringes and glass vials.
  • Stat gives OWS low marks for transparency, such as explaining why it chose particular vaccine projects to fund.

Economics researchers estimate that the 500,000 attendees in early August’s Sturgis, SD motorcycle rally — most of whom did not wear masks or use social distancing — created 250,000 new coronavirus cases that will incur $12 billion in public health costs.

A pre-print of a randomized study of 464 hospital inpatients by India-based researchers finds that convalescent plasma treatment was not associated with reduced mortality or a halt in disease progression. The authors note that while CP therapy is authorized for off-label use in India and is safe, it requires a lot of resources to collect and store plasma and its sale on the black market has driven prices up.

The Washington Post says that businesses that perform “deep cleaning,” spray disinfectant freely, and make employees wear gloves is just “sanitation theater” that may distract from the more important need for people to socially distance, wear masks, and avoid enclosed spaces. it may also provide a false sense of security in making it appear that the virus can be controlled.

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A pathologist employee of Texas-based freestanding ED operator Physicians Premier ER quits after the company bills his insurer $11,000 for a COVID-19 antibody test. The doctor, who ironically oversees the company’s COVID-19 antibody testing program, was a temporary employee between jobs whose short-term “junk insurance” plan was issued by United Healthcare-owned Golden Rule. ED staff told him that he wouldn’t have to pay anything. Golden Rule paid $2,100 without questioning the total, but then the facility sent him a bill for $8,900, which included services he says he didn’t receive in his 30-minute visit. The company’s advertising says the test costs $75 and Medicare pays $42 for it. The doctor reported his concerns to Golden Rule, whose investigator told him he wasn’t surprised and then didn’t follow up.


Other

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A local news outlet looks at the impact observational studies that are published through Epic’s recently launched Health Research Network have had on COVID-19 treatments:

  • Data queried by researchers at Lee Health (FL) showed that COVID-19 patients were three times as likely as others to develop blood clots, which led doctors to routinely give blood thinners to high-risk patients.
  • Mount Sinai Health (NY) researchers found that patients in their 60s and 70s with dementia were more likely to be hospitalized or die from COVID-19 than patients the same age without dementia.
  • Epic’s own analysis of COVID-19 patients with high blood pressure found those on RAAS inhibitors did no worse than those on other drugs, and did better than those not taking any blood pressure medication.
  • The company’s months-long analysis of cancer screenings has found that, though they have rebounded from significant drops in the spring, they’re still one-third lower than normal.

Sponsor Updates

  • Arcadia publishes a new case study, “CareMount ACO Uses Arcadia Analytics to Build a Narrow SNF Network and Reduce ALOS by 4 Days.”
  • Collective Medical enables SNFs to rapidly generate reports on COVID-positive patients and report to CMS.
  • ESolutions publishes a new white paper, “How the RAP Phase Out will Affect HHA Billing Requirements.”
  • Everbridge risk intelligence provides major corporations, healthcare organizations, and government entities with situational awareness to mitigate threats from COVID-19.
  • Health Catalyst completes its seventh annual and first ever virtual Healthcare Analytics Summit, with record registration of over 3,500 attendees.

Blog Posts


Contacts

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

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Morning Headlines 9/7/20

September 6, 2020 Headlines 2 Comments

VA reboots health record rollout

The VA’s implementation of Cerner’s scheduling solution in the Midwest’s VISN10 region will be followed there by the full Cerner rollout.

Race for Coronavirus Vaccine Pits Spy Against Spy

The FBI warns University of North Carolina and other universities that state-sponsored cyberhackers from China, Russia, and Iran are targeting their COVID-19 research data.

Lessons from a Virus Tracing Dud

The state of Utah paid $3 million plus $300,000 per month to a small technology firm to develop its Healthy Together contact tracing app, which is being used by just 200 people.

Monday Morning Update 9/7/20

September 6, 2020 News 3 Comments

Top News

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FCW reports that the VA’s implementation of Cerner’s scheduling solution in the Midwest’s VISN10 region will be followed by the full Cerner rollout there. VISN10 will go live on the VA’s 1.1 capability set for small and medium-sized hospitals.

COVID-19 has delayed developing the 2.0 set for its large centers that will go live first at Mann-Grandstaff VA Medical Center in Spokane, WA. Go-live there is set for spring 2021.

VISN10 was the first scheduling go-live because Wylie VA Ambulatory Care Center was a user of the previous Epic-powered MASS scheduling, which is being retired.

I’m assuming that this change explains the VA’s recent award of a $161 million work order to Cerner for infrastructure work in VISN10, which was announced last week without details.


Reader Comments

From Legal Beagle: “Re: telehealth medication counseling. The White House has asked the Supreme Court to reinstate a rule that requires women who are seeking pregnancy-ending drugs to make a physical visit to a doctors’ offices or clinics to pick up the pills for home use, which was a previous FDA requirement that was relaxed due to COVID-19 exposure concerns. What science exists to explain FDA’s view that only this particular drug out of thousands requires a face-to-face encounter instead of telehealth for patient safety? ACOG and others are challenging the must-travel rule, which the White House is asking the Supreme Court to overrule even pre-trial.”


HIStalk Announcements and Requests

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Poll respondent expectations for Amazon Halo are low. Naysayers say the wearable isn’t all that innovative among a plethora of fitness trackers, while one respondent provides this rather brilliant if non-cheery warning: “Imagine if you will a dystopian corporate future where one of the largest companies in the world provides all products and meals in a cardboard box left at your door, your personal data is bought and sold without your knowledge, and they provide you with faceless grey tracking bands that silently tracking your movements and health metrics. Oh wait, I’m describing Amazon today.”

New poll to your right or here, triggered by something you’ll read further down the page: Would you be comfortable working for a company that regularly fires “adequate” employees in seeking only stars?

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A reader asked me about leaving the corporate health IT world and hanging out their own shingle in areas such as marketing and PR. If you’ve done that sometime in your career, please share your experience and I’ll run the answers on HIStalk.

Thanks to the following companies that recently supported HIStalk. Click a logo for more information.

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Listening: Pentagram. I believe that “Starlady” is one of the most brilliantly written and performed hard rock songs ever, not even counting that it was recorded on a shoestring by a bunch of nobodies. I will listen to that song 10-20 times in a row every now and then just to appreciate the drumming and guitar and the way the rhythm swells and the transitions move it in different directions. Kiss’s Gene Simmons and Paul Stanley watched a mid-1970s rehearsal and decided to pass on signing Pentagram to Casablanca Records because they weren’t pretty (hello, no-makeup Gene Simmons, meet mirror) and Kiss is more of a profit-obsessed corporation than a group of inspired musicians (not to to mention the least-talented band I’ve ever seen play live). I’m due a re-watch of “Last Days Here,” a documentary about Pentagram’s rocky history and its only permanent member and modestly talented Bobby Liebling, whose mental and drug problems created a large group of alumni – 11 guitarists, nine bass players, and 11 drummers. But in the late summer days of 1976, their supernova was captured on primitive recording equipment while the world was distracted by lesser musical lights.


Webinars

September 9 (Wednesday) 1 ET: “APIs for Data Liquidity in Pandemic Times.” Sponsor: Chilmark Research. Presenters: Brian Murphy, research director, Chilmark Research; Gautam “G” Shah, VP of platform and marketplace, Change Healthcare; Drew Ivan, chief product and strategy officer, Lyniate; and Dave Levine, MD, co-founder and chief medical officer, Datica. This webinar will present the findings from a recently published research report on the state of the healthcare API market. The presenters will describe their work in deploying APIs to enable new functionality to address COVID-19. They will cover the use cases that have been most reliable for enabling effective data liquidity, how developers are using APIs to respond to the pandemic, and how different parts of the healthcare system are making APIs more widely available.

September 17 (Thursday) 1 ET. “ICD-10-CM 2021 Updates and Regulatory Readiness.“ Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP of global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will review additions, deletions, and other revisions to the 2020 ICD-10-CM code set that will be critical in coding accurately for proper reimbursement.

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


Acquisitions, Funding, Business, and Stock

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Shares in the exchange traded fund Global X Digital Health & Telemedicine underperformed the broader market in the past month, slipping 1.9% as the Nasdaq index rose 4.2% and the S&P 500 was up 3%.

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Shares in videoconferencing tech firm Zoom run up 41% after the company reports strong, pandemic-fueled revenue and earnings, making the company worth more than IBM and increasing the value of shares held by its founder-CEO to $20 billion. I wouldn’t be a buyer given low switching costs and barriers to entry, questionable future demand, and the target on its back that comes with sudden, unplanned ubiquity, but maybe my lack of vision is why I’m not wealthy. A $10,000 investment in ZM on March 6 would be worth more than $32,000 today, or $40,000 had you sold last Tuesday.


Sales

  • Holy Redeemer Health System expands its partnership with Dina to connect its hospital and home care agencies and organize and empower its post-acute, home and community-based care providers.

COVID-19

Several drug companies that are working on a COVID-19 vaccine will sign a pledge that they will release a vaccine only after data exists to prove that it meets efficacy and safety standards, seeking to reassure the public that White House pressure to get a vaccine on the market before the election won’t affect their science. President Trump suggested Friday that he is involved in the regulatory process, saying that a drug companies have told him that vaccine approval would take 2-3 years under a “a more typical kind of president.”

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The FBI warns University of North Carolina and other universities that state-sponsored cyberhackers from China, Russia, and Iran are targeting their COVID-19 research data. China is using information taken from the World Health Organization to choose targets and is also using its US university research partnerships to collect information, while China and Russia are using social media to spread disinformation about the virus to fuel the US anti-vaccine movement.

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The state of Utah paid $3 million plus $300,000 per month to a small technology firm to develop its Healthy Together contact tracing app that is being used by just 200 people, even after the state shut down its primary but most controversial feature of user location tracking. The primary business of year-old tech firm Twenty, which developed the app, is an meet-up app that targets Millennials. Both founders are BYU graduates.

The WHO says new evidence shows that severe and critically ill COVID-19 patients should be treated with steroids such as dexamethasone, hydrocortisone, and methylprednisolone as a standard of care in first-line treatment. 


Other

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I read an interesting article on the culture of Netflix, which the company makes sure that prospective employees understand before hiring on. Some points:

  • The mission, vision, and value statements of most companies are ignored. They demonstrate their actual values by who they reward and who they fire.
  • Netflix encourages independent decision-making, shared information, plain speaking, and the avoidance of rules in creating dream teams of people, valuing people over process.
  • Good employees listen before reacting, think clearly under pressure, and are concise and articulate in speech and writing.
  • Employees are expected to say what they think if it’s in the best interest of the company, even if it is uncomfortable, and are expected to say things about co-workers only if they would be willing to say them to their faces.
  • The dream team concept means that “we give adequate performers a generous severance package” so they can replace them with a star. They suggest that people who value stability, seniority, and companies that are willing to work around ineffective performance look elsewhere.
  • Netflix has a team, not a family, since families include unconditional love and life-long attachments that teams do not. They say, “Unconditional allegiance to a stagnant firm or to a merely adequately performing employee is not what we are about.”
  • Managers run the “keeper test” to decide who to retain – which if their employees would they fight to keep if they were considering leaving the company?
  • The company does not hire “brilliant jerks” since the cost to teamwork is too high.
  • Netflix does not give raises, but instead surveys the talent market and pays at the top end of what employees could make elsewhere since “the market for talent is what it is” and “your economic security is based on your skills and reputation, not on your seniority at one company.” They encourage employees to interview for jobs outside the company and share what they learn with their managers.
  • The company observes that as companies get bigger, they place too much emphasis on process, the average talent and passion level slips, and they then throw more management at the pockets of chaos that result and stifle creative thinkers who question the status quo.
  • All company documents are published for everyone to read and comment on.
  • The company does not implement spending controls, contract signing controls, and policies for travel, entertainment, and gifts, assuming that employees will use good judgment and seek advice as needed.
  • Netflix has no vacation policy except to take one when needed.
  • Employees get to choose the mix of salary versus 10-year fully vested stock options for their salary. Employees who leave keep the full value of their options.
  • Netflix has seen a few examples of employees abusing their freedom, but avoids over-correcting because most employees can be trusted.
  • Decisions are made by one assigned “captain” instead of committees that are slow and diffuse responsibility and accountability.
  • The company does not believe in executives who remain immersed in deep product details or micromanagement, instead priding itself on how few decisions senior managers make.

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CNET describes Sutter Health’s use of EICUs in two hubs to scale up services to handle up to 600 patients to meet any COVID-19 surge. It also observes the geographic opportunities, such as Emory Healthcare’s use of intensitivists in Western Australia to monitor its patients in Georgia. Sutter says that development of the EHR was the most important for their EICU program, followed by increased bandwidth, high-definition cameras, and cheap LCD monitors.


Sponsor Updates

  • Opus Research recognizes Nuance as a leader in its “Intelligent Authentication and Fraud Prevention Intelliview Report.”
  • Consulting and managed services firm IntraSystems will offer its customers Citrix app monitoring solutions from Goliath Technologies.
  • OpenText publishes a new study, “Hybrid Cloud Enables Agile Content Management and Collaboration.”
  • Pure Storage names Jason Rose (SAP) chief marketing officer.
  • Spirion launches new compliance and analytics products to simplify compliance with expanding privacy laws and regulations.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Weekender 9/4/20

September 4, 2020 Weekender No Comments

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Weekly News Recap

  • Analytics-powered remote patient monitoring vendor Biofourmis raises $100 million.
  • Nordic lays off 72 employees.
  • The US Coast Guard goes live on DoD’s Cerner-powered MHS Genesis.
  • Personal health record and real-world evidence vendor PicnicHealth raises $35 million in Series A and B funding rounds.
  • TigerConnect acquires Adjuvant’s physician scheduling tool.
  • AMA releases CPT 2021.
  • Ascension Health announces plans to lay off 223 IT employees and outsource their jobs.
  • Konica Minolta will pay $500,000 to settle false claims act charges related to its acquired Viztek Exa EHR.

Best Reader Comments

”If Medicare requires use of something [CPT codes], it should be in the public domain, but there’s too much money and lobbying involved to make a change” nailed it. But isn’t money and lobbying so much of what has led to our great American non-system in the first place? (Kevin Hepler)

Any well-designed archive should require multi-level authentication to delete any study. Preferably this has at least three distinct administrators who all need to sign off on any deletion, even an individual one, let alone thousands. VNAs and even standard PACS archives don’t delete the data, but instead just change the pointer to the revised study it if a study is modified. That way you still have both studies saved. The disaster recovery data in the cloud should NEVER be allowed to be deleted by ANYONE under ANY circumstance. (Youshouldknowbetter)

Not sure why PicnicHealth was able to raise that kind of round as their pricing model is anything but sound. Maybe for the most worried well, Silicon Valley parents types (e.g. those with $$$ to spare) but for the vast populace, that pricing is a non-starter. (John)

InfoGard is paid to rubber stamp certifications and treats some fraud fines as the cost of doing business. I think the real story here is that HHS and the feds rely so heavily on private contractors and private industry. Teasing out why and enacting change is something not even on anybody’s radar. Fifty years ago, the feds would have just done this certification work themselves and there wouldn’t be the same mismatched incentives. Now it is outsourced three different ways, costs more, and still nothing gets done. (IANAL)

I find it interesting that the testing organization, (InfoGard) couldn’t ferret out hard-coded data. It is really as simple as sampling from the top n (100) plus alpha and noticing that every time you change the value for n the source system has to go back and redo their work. Or, asking the question, “Can you show me your dictionary for x in SQL?” then ask them to do a count of that dictionary and compare it to the expected value. If you are off by hundreds of thousands, then you hard-coded values. By that I mean, RxNorm has 70k? values in the in/min and brand TTY? If the solution under test can’t show an RxNorm table, or its equivalent (Medispan, First Databank, Multum) with a pretty close proximity to that number, then you have a Houston moment. This isn’t rocket surgery. That pattern of ask/fail/return with the correct answer wouldn’t pass a grade school teacher’s closed book exam sniff test. Just as it should never have passed their tests. (AnInteropGuy)

Have you invested in the Echo ecosystem from the beginning and participated in the evolution of functions that go way beyond just “features”? If so, you may know how it has enabled neurologically compromised seniors to have voice-activated and managed communication access they would not otherwise have, along with fall risk options, security, and safety, all for no additional cost beyond the acquisition of devices, plugs (flex), etc. The core premise of Halo is not simply for the worried well. I appreciate the non-screen and the investment in the core and am very much look forward to the evolving features and benefits. There are a lot of “worried well” gadgets out there (remember the HIMSS-aligned “Misfit” series). Halo is not one of them. (Smart Platforms)

[Paper forms are still used] because the UI of a typical paper form has been developed for several hundred years and the UI of your tablet was developed by some contractor who just learned “hello world.” Paper doesn’t freeze or run out of battery or break when you drop it or require an IT guy or struggle to be read by the tech averse. Plus the company pays the receptionist to sit their anyway and they are the only place in town that accepts your insurance. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. H in Michigan, who asked for math games for her readiness program for students aged four or five. She reported in early March, “The math games were used for our March into Math event that encourages parents to learn and take home math-related materials to help children continue to learn at home. This by far was the most successful mathematics event we have hosted so far. The room was completely filled. As students walked in with their parents, they immediately saw the table display of all the games and became very excited about our evening. These materials have helped us demonstrate a variety of mathematic concepts that are needed for them to be successful in pre-school as well as transitioning into kindergarten. Thank you for your support and making an impact on the lives of my students.”

CVS-owned chronic care management service Accordant apologizes to a patient who described her anxiety over COVID-19 to one of its telephone nurses, who then told the woman that she didn’t need to worry because “the CDC is lying to us and doctors are being paid to lie about COVID.”

Americans who are used to day-tripping to Mexico or Canada to buy prescriptions or medical services for much less money are “trapped in their own healthcare system” now that those borders have been closed to non-essential travel. A Texas man had dental work done in Mexico for $750 that would have cost $10,000 on this side of the border, then found that he could buy his $275 insulin for $20 there. He formerly skipped eating for days at a time to ration his insulin, calculating his lifespan at the number of days’ supply of insulin he has on hand plus three days. A pharmacy in Vancouver that has served some American customers for years is dealing with those who have been laid off, taking the distinctly non-American approach of, “We’ve sent them what they needed and we tell them, pay us when you can.”


In Case You Missed It


Get Involved


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Morning Headlines 9/4/20

September 3, 2020 Headlines No Comments

Premier Inc. Earns First Place in AHRQ Predictive Analytics Challenge

AHRQ names Premier as the winner of its predictive analytics challenge, in which its PremierConnect most closely predicted admissions and length of stay.

Nordic taking proactive steps to serve clients more effectively in a COVID-19 world

Nordic lays off 72 of its 1,000 US-based employees due to the pandemic-induced financial disruptions its customers have faced.

Defense Innovation Unit Selects Google Cloud to Help U.S. Military Health System With Predictive Cancer Diagnoses

The DoD’s Defense Innovation Unit will work with Google Cloud to develop a digital pathology solution that will include augmented reality microscopes and AI models for more accurate and timely cancer detection.

News 9/4/20

September 3, 2020 News 5 Comments

Top News

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Boston-based Biofourmis raises $100 million to further develop its predictive analytics-based remote patient monitoring technology.

The company sells data and intervention opportunities to drug companies and offers hospitals a platform for monitoring their newly discharged patients remotely.

The company’s products have earned FDA 510(k) clearance for heart failure and arrhythmia detection.

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Biofourmis uses Biovotion’s Everion armband sensor, which monitors 22 parameters, including heart rate, temperature, respiratory rate, blood oxygenation, motion intensity and steps, energy expenditure, sleep quality, and heart rate variability. Biofourmis acquired Biovotion in November 2019.


Reader Comments

From Significant Brother: “Re: remotely hosted EHRs. A practice asked their hosting vendor why the information of 50,000 of their patients was missing. The vendor told them that someone in the practice had deleted multiple directories. Should a vendor’s security practices allow records to be deleted by the thousands, especially in light of MU and HIPAA requirements for protecting patient records?” Readers, please weigh in. We’re missing an important piece of the story here — did the vendor identify the employee, were that user’s credentials maintained properly by the customer, and were backups or logical (rather than physical) deletes not available for restoring the missing records? Healthcare has seen a few instances where a fired employee trashed company data, and cloud configuration might allow limiting the extent of their destruction. But if the practice fired someone without turning off their access, or if they are sloppy in giving users more privileges than their jobs require, then that’s the age-old issue of running a business like something other than a business.

From Transmaniacon: “Re: COVID testing technology. I’m interested in a cloud-based patient registration system – basically a lightweight EHR – that can be installed quickly and easily to send results back to the person. Maybe you know of something.” I’ll enlist reader help here.


HIStalk Announcements and Requests

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Jenn is continuing to update the Cerner-specific news page for: (a) those who care mostly about only Cerner news, and (b) those who want to see a longitudinal view of previous, significant news from the company. These items have already been vetted and summarized by appearing in HIStalk, so it’s not just regurgitated fluff. I also added a menu item called “Company News History” that lets you jump to that page, and maybe later to similar news summary pages for Epic, Meditech, and Allscripts. Somebody who asked for this years ago expressed interest in sponsoring this particular page and of course I didn’t retain that information because I lack discipline, so let me know if that was you.


Webinars

September 9 (Wednesday) 1 ET: “APIs for Data Liquidity in Pandemic Times.” Sponsor: Chilmark Research. Presenters: Brian Murphy, research director, Chilmark Research; Gautam “G” Shah, VP of platform and marketplace, Change Healthcare; Drew Ivan, chief product and strategy officer, Lyniate; and Dave Levine, MD, co-founder and chief medical officer, Datica. This webinar will present the findings from a recently published research report on the state of the healthcare API market. The presenters will describe their work in deploying APIs to enable new functionality to address COVID-19. They will cover the use cases that have been most reliable for enabling effective data liquidity, how developers are using APIs to respond to the pandemic, and how different parts of the healthcare system are making APIs more widely available.

September 17 (Thursday) 1 ET. “ICD-10-CM 2021 Updates and Regulatory Readiness.“ Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP of global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will review additions, deletions, and other revisions to the 2020 ICD-10-CM code set that will be critical in coding accurately for proper reimbursement.

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


Acquisitions, Funding, Business, and Stock

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Nordic lays off 72 of its 1,000 US-based employees due to the pandemic-induced financial disruptions its customers have faced.

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Publicly traded Medicare primary care center operator Oak Street Health will open clinics in three former Walmart Care Clinic locations in Texas. Shares of the Chicago-based company, which operates 55 locations, jumped 90% on their first day of trading in early August, with the company now valued at $12 billion.


Sales

  • Bayless Integrated Healthcare (AZ) will implement Saykara’s app-based, automated clinical documentation software across its eight locations in Phoenix.
  • Prime Therapeutics selects RxRevu’s Real Time Benefit Check, giving prescribers on-demand information about drug options and pricing, and pre-authorization requirements.

People

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William Mintz (Leidos) joins Cerner as chief strategy officer.


Announcements and Implementations

DeWitt Hospital (AR) implements Azalea Health’s EHR.

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Arkansas Surgical Hospital adopts Medhost’s cloud-based EHR.

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KLAS finds that the risk adjustment and analytics space is dominated by Change Healthcare, Cotiviti, Inovalon, and Optum, although of that group, only Optum was willing to share its customer list. Apixio and SCIO Health Analytics stand out in customer satisfaction, while Advantasure has the least-satisfied users.

AHRQ names Premier as the winner of its predictive analytics challenge, in which its PremierConnect most closely predicted admissions and length of stay.


Government and Politics

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The US Coast Guard goes live on the DoD’s Cerner-powered MHS Genesis EHR at four facilities in California, with facility-wide deployment expected by 2024. The Coast Guard join the DoD’s EHR program two years ago after spending $60 million over seven years to unsuccessfully develop its own software.

The DoD’s Defense Innovation Unit will work with Google Cloud to develop a digital pathology solution that will include augmented reality microscopes and AI models for more accurate and timely cancer detection.


COVID-19

CDC Director Robert Redfield, MD sends an urgent letter to state governors asking them to clear the way for getting McKesson-operated COVID-19 vaccine distribution sites up and running by November 1. That presents challenges — the leading vaccine candidates require storage and delivery at below-freezing temperatures and people who get the shot must return for a second injection 3-4 weeks later. States will need to create immunization registries to track those who have received the initial dose, remind them to come back for the second dose, and ensure that the doses are distributed to the right locations in adequate supply. Hospitals will need to arrange delivery logistics and freezer capacity for a large amount of product, while rural clinics and health centers will be especially challenged.

The US, EU, Japan, and UK have contracted with drug companies for 3.7 billion doses of a successful COVID-19 vaccine and China and India will use the doses they manufacture for their own citizens, leaving much of the world, especially poor countries, without access to any successful vaccine.

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Atul Gawande says in The New Yorker that the key to beating coronavirus in the US is what other countries have done — running widespread, inexpensive testing and recommitting to public health. He notes that the only-in-America health system’s maze of referrals, prior authorizations, co-pays, insurer policies, large number of uninsured people, and inconsistent screening criteria have made it hard for people to get tested, and delayed results reporting by the four companies that run most US tests is limiting their value. He concludes, “The lunacy of our testing system is the lunacy of our health system in a microcosm.” He advocates addressing logistics issues, such as creating a testing grid similar to that of electric companies, where samples would be routed to labs with excess capacity while others are overwhelmed, describing the testing industry as, “The big four commercial labs are really logistics and distribution companies wrapped around a network of regional laboratories.” He calls out the success of San Francisco, which applied its experience in addressing HIV/AIDS to mobilize a rapid, effective COVID-19 public health response.

Penn State’s athletic medicine director says that one-third of Big Ten athletes who tested positive for COVID-19 showed mycoarditis on cardiac MRIs, regardless of whether or not they showed COVID-19 symptoms. 

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Israel’s largest hospital uses facial recognition software, in conjunction with its existing security cameras, to identify visitors who aren’t wearing masks and give them encouraging messages like, “No mask kills my vibe.”


Other

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TechCrunch profiles Peer Medical, a startup that offers lung cancer patients the ability to share treatments with each other using de-identified EHR data. Patients can search Peer Medical’s database by biomarker, stage, age, or gender to review verified treatments and care journeys.

A Surescripts report on health IT adoption finds that e-prescribing and real-time prescription benefit utilization have increased over the last six months.

Two-thirds of Americans who file bankruptcy do so because of healthcare expenses. Experts say a lot of those people have insurance that provides poor financial protection given that only 40% of Americans have enough savings to cover a $1,000 emergency expense.

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Points from Epic CEO Judy Faulkner’s online interview with Cleveland Clinic CEO Tom Mihaljevic, MD:

  • She was supposed to college summer work at University of Rochester in particle physics, and since she had never seen a computer, they gave her a Fortran book and one week to learn.
  • She applied to graduate school in math, but University of Wisconsin moved her without asking to computer science, which she did not know was an option. She worked with informatics pioneer Warner Slack, MD and was later asked to develop a clinical system in the days before commercial EHRs and widespread use of commercial database management software.
  • She started Epic as a half-time employee with two half-time assistants, working from a basement.
  • She says the Midwest is a great company location because people are friendly and work hard and having a rural footprint means the company has room to put up new buildings as needed.
  • Technology is moving from rules-based systems to artificial intelligence, with statistical methods providing ways to issue early alerts for potential sepsis and to manage drug-drug interactions.
  • Clinician notes are four times longer in the US than in other countries due to the administrative requirements for getting paid.
  • Clinicians should review their software options to make the system work their way, and where that isn’t possible, examine how they do things to see if there’s a better way that the system can support. It’s helpful to have specialist physician builders who know how to configure systems for their specialty.
  • Epic has created the role of BFFs, who take the “best friends forever” approach in recognizing and publicizing client innovation and bringing back developments from other clients.
  • MyChart is available to 165 million patients. Only 0.5% of MyChart users want to manage their own information, and the even that tiny number falls off with time. Patients want their health system to maintain and exchange their records.
  • Epic Cosmos has 60 million customer patient records that are being used for research. Epic is building a “best care for your patient” module that will use this data along with that of the specific patient to provide clinicians with evidence-based recommendations.

Sponsor Updates

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  • Cerner associates deliver care kits, school supplies, and gift cards to those affected by Iowa’s devastating windstorm.
  • Wolters Kluwer publishes “5 Forces for the Future: Virtual care reaching the vulnerable.”
  • Frost & Sullivan recognizes Jvion with its 2020 North American Technology Innovation Leadership Award for its Care Optimization and Recommendation Enhancement (CORE) technology.
  • Premier takes first place in AHRQ’s Bringing Predictive Analytics to Healthcare Challenge.
  • Bumrungrad International Hospital in Thailand uses InterSystems TrakCare Lab Enterprise to create one of the first fully digital microbiology laboratories in the world.
  • MDLive works with the Soldiers’ Angels’ Women of Valor Program to offer caregivers of veterans virtual care for physical and mental health.
  • NextGate updates the usability, reporting, and performance of its Enterprise Master Patient Index with version 11.
  • Goliath Technologies partners with IntraSystems to help IT professionals anticipate, troubleshoot, and document Citrix end-user performance issues.

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 9/3/20

September 3, 2020 Dr. Jayne 4 Comments

It’s been a busy week in the consulting trenches. Several of my clients had projects that they wanted to take live on September 1. I commend them for choosing that as a go-live date because it’s a Tuesday. Far too many people want to do go-lives on Mondays.

I’m usually opposed to Monday go-lives because it’s typically a busy day, whether you’re in the inpatient world or the outpatient world. Patients who have been ill over the weekend are trying to get appointments and complex surgeries are often scheduled earlier in the week to better optimize discharge planning prior to the weekend. I’m also a fan of doing go-lives on Thursdays, because if it’s rocky, you only have two days in the week and then people can rest over the weekend. Even in hospitals, things are slower over the weekend and many services are only offered on an emergency basis.

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CMS has released the Fiscal Year 2021 Inpatient Prospective Payment Systems (IPPS) for Acute Care Hospitals and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule. That’s certainly a mouthful, and I’m not sure the abbreviations help. There are several highlights within the Medicare Promoting Interoperability program. Some of these make perfect sense, such as being to use any continuous 90-day period as the EHR reporting period, and keeping the measure that looks at queries of Prescription Drug Monitoring Programs as optional. Others leave me scratching my head, such as “Modifying the name of the Support Electronic Referral Loops by Receiving and Incorporating Health Information measure to the Support Electronic Referral Loops by Receiving and Reconciling Health Information measure.” I get that they’re trying to better describe what hospitals have to do, but it just adds to the confusion.

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The American Medical Association released the 2021 Current Procedural Terminology (CPT) code set this week. There are some major changes involved, with one outlet describing it as the first major overhaul in more than 25 years. The changes coincide with those proposed by the Centers for Medicare & Medicaid Services and are intended, according to AMA, to free physicians from “irrelevant administrative burdens that led to time-wasting note bloat and box checking.” Office-based clinicians will certainly welcome the elimination of specific history and physical exam elements for code determination.

Since AMA owns the rights to the codes, they’re happy to sell you resources to support the transition, including books and videos. If you use an EHR, chances are that the AMA license fee is already baked into what you are paying for maintenance. Personally, I think if Medicare requires use of something it, should be in the public domain, but there’s too much money and lobbying involved to make a change.

ONC has opened a funding opportunity to “measure the use and impacts of health IT among a nationally representative sample of US office-based physicians” as well as to “produce national-level data on interoperability among office-based physicians.” Prospects have until September 11 to apply. The awardee will run a three-year program to gather “insights on the implementation and effects of federal health IT policies as well as identify disparities or unintended consequences resulting from their implementation.” Funding is $290,000 for the first year with additional funds “subject to availability and progress made against the program.” The program starts September 30, 2020, so it looks like ONC is ready to make a quick decision.

New data from the Centers for Disease Control shows that nearly 30% of healthcare workers with COVID-19 were asymptomatic and nearly 70% reported never having been formally diagnosed with COVID. Researchers looked at 13 hospitals across the US, where up to 6% of staff caring for COVID-patients had tested positive themselves. The concern is that those symptom-free staffers may have spread the infection to patients and co-workers. The report concludes that universal masking of healthcare workers is important, as is a coordinated testing program for frontline workers.

I see patients with COVID every time I work. The highest number of positives I’ve seen in a single work day is 20, which is a lot. Fortunately, my time in the room with patients is limited. I’ve been fortunate to have enough N95 masks so that I don’t have to reuse them too many times, and a family friend made me a fantastically lightweight face shield. Still, being constantly exposed is a stressor and I try not to interact with people in person if I don’t have to, although it’s rough. I’ve made a couple of exceptions, but with distancing and masking, and always with transparency about my exposure history.

I’ve also had the benefit of being able to stack my clinical shifts recently, so I work a ton at once but then have longer stretches without face-to-face patient care. Even with my healthcare friends, we debate who has been the most exposed and whether getting together in person would be riskier than anything else we do. I’d like nothing more than to sit and sip a cocktail and decompress with one friend in particular, but I’m not sure how long it will be before we both feel the timing is right.

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I had a chance to play the Zoom Happy Hour game with one of my friends this week, which was tons of fun with lots of laughing involved. She’s a total extrovert and it was great to swap stories about the “new normal” in our respective parts of the country. I’ve been making it a point to connect with people who’d I usually see while traveling since my next business trip is probably months off. As a foodie who loves to try new things across the US, sticking close to home has been a challenge. I’ve checked out a bunch of cookbooks from the library, but unsurprisingly, this cocktail edition is my new favorite.

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While we’re in the boozy frame of mind, big props to my friends at Medicomp Systems for sending another care package my way. I’m resupplied with N95 masks along with some Medicomp ones, which I really like because they’re adjustable and don’t sag. They also included some high-octane hand sanitizer supplies, including handy bottles for pocket or purse. I was also advised that the large bottle could be used either as a refill or for slamming down during a zoom meeting. Based on some of the calls I’ve had lately, I’m not opposed to it.

Have you made your own homebrew hand sanitizer or are you sticking with Purell? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 9/3/20

September 2, 2020 Headlines No Comments

Coast Guard Begins Deploying Pentagon’s New Electronic Health Records System

The US Coast Guard goes live on the DoD’s Cerner-powered MHS Genesis EHR at four facilities in California, with facility-wide deployment expected over the next two years.

WELL Health to Expand into US Market with Proposed Majority Stake in US Telehealth Leader Circle Medical and Announces $23M CAD Offering with Group of Investors Led by Mr. Li Ka-shing

Canadian Well Health Technologies will acquire San Francisco-based primary care company Circle Medical for $14 million.

Insurer Centene invests in start-up Hazel Health in $33.5 million venture funding round

Student-focused telemedicine startup Hazel Health raises $33.5 million in a Series C round led by Bain Capital and Owl Ventures.

Boston startup Biofourmis raises $100m for remote medical tech

Biofourmis raises $100 million to further develop its predictive analytics-based remote patient monitoring technology.

HIStalk Interviews Guillaume Castel, CEO, PerfectServe

September 2, 2020 Interviews 1 Comment

Guillaume Castel, MBA is CEO of PerfectServe of Knoxville, TN.

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Tell me about yourself and the company.

I worked 14 years in technology, first with IBM and then Cisco Systems. I was fortunate to rise through the ranks. I come from a family of healthcare providers and executives and I am married to a physician-epidemiologist, so I felt I had no choice but to go into healthcare. I joined The Advisory Board Company in Washington, DC in 2014. It was probably the most consequential experience I have had in my career, an amazing 4-5 years before we sold the company to Optum.

Then I went to work for a health system in the DC area. I put what I thought I knew into practice and learned what it means to deliver care every day. I joined the advisory board of PerfectServe about two years ago at the request of our private equity sponsors, and then about a year and a couple of months ago, I became the CEO of the company.

PerfectServe offers unified healthcare communications solutions to help physicians, nurses, and care team members provide patient care. We serve 145,000 physicians, 240,000 nurses, and 600,000 users. I mention those metrics because we track them each month to remind of us the importance of the work that we do and the number of lives that we are privileged to touch each day.

How has the company absorbed its recent acquisitions of Lightning Bolt, CareWire and Telmediq?

PerfectServe acquired three companies in essentially 12 months. Telmediq was complementary to PerfectServe. CareWire was in the slightly different space of patient engagement, which was visionary at the time. Lightning Bolt has become a critical part of our company in delivering scheduling capabilities for physicians, and increasingly, beyond physicians.

We spent a great deal of time thoughtfully integrating the various capabilities and thinking about how we could make the sum of the parts bigger than what they were. What we have now is a cross continuum way of enabling communications at scale for the largest health systems in the United States. We embed optimized and sophisticated dynamic schedules to make sure that we get the right communication to the right person at the right time, which is critical. Then, in this era of ongoing crisis for health systems in the United States and beyond related to COVID, it has become critical to help patients who are inside the four walls of the hospital communicate with their families and for hospitals to communicate with patients who have gone back home.

How has technology changed the ways that hospitals and practices are serving patients compared to a year ago?

We have gone through an acceleration of a three-year roadmap into a three-month timeframe. Care providers suddenly had to manage patient flows safely at volumes that they could not have anticipated. They also had to provide as much care as possible without requiring the patients to come into physical spaces such as a physician office, an ambulatory setting, or an inpatient setting.

The news was most prominent around the advent of telehealth, but telehealth is not new. It has been important in care delivery for years. But we have learned that we can and should provide good care remotely.

PerfectServe has committed to helping our clients through the crisis with bi-directional texting capabilities with their patients and families from home or anywhere they wish to be. We built a video capability, which took off in March, April, and since then because it does not require scheduling – it is completely ad hoc. It is secure and does not require infrastructure for hospitals to deploy it. These are the required ingredients for any solution to become relevant.

Some of our most innovative and forward-leaning clients expected to do 1,000 telehealth visits in 2020, but have already done 300 times that number. Our essentially app-less offering was the most convenient way, in a moment of urgency, for physicians to get in touch with their patients at home or elsewhere.

Do you see a second wave where organizations that quickly implemented consumer tools such as Zoom or Skype will look for video solutions that are more specific to healthcare?

People did what they could during the urgency. Health systems and physician groups are essentially doing pervasive preparedness for what another wave of COVID or another virus outbreak could mean to them. They are thinking about not just what’s required, but what the perfect design would be to stay connected to their patients in a moment of crisis. That goes far beyond having access to video capability.

It needs to be integrated in the way that you would want your physicians, nurses, and care team providers to communicate with the patient. It needs to be safe. It needs to be the right person at the right time. It needs to be secure. It needs to be connected with your EMR. It needs to be connected with the way you would want to manage clinical communications within your hospital.

Horizontal technology providers just aren’t going to get there. They don’t understand the workflows. We are seeing a lot of work and money being spent on how to deal with the next wave or the next crisis. That pushes us and assures that health systems and their patients will be better prepared for the next time.

I saw on your website that 85% of patient records contain their cell phone number, which allows providers to text them with health management questions and appointment reminders with minimal work and infinite scale. I also saw an interesting statistic about how patient portal use can be increased dramatically by texting patients a link to the log-in or to materials that exist within the portal.

It’s fascinating to me what we’ve had to do over the last six months. What you are touching on is critical. We build products at PerfectServe by spending a lot of time with our clients, making sure that we are educated, vetting the solution, and testing it. What we heard about engaging with patients remotely in their use of portals is that it can’t require a three-month deployment. It needs to be lightweight, secure, and app-less. This concept of asking a patient or a patient family member to download yet another application was a non-starter and will continue to be.

We put our best brains on it. We established the most practical things that folks can use in a moment of urgency, and that was essentially a link. We send a link to the phone number that was gathered at the point of registration the week before, the month before, or the year before. That has changed the way practitioners are embracing new technologies.

What are some practical uses of escalating messages that haven’t been responded to within facility-defined parameters?

Our approach to that issue is that we need to enable person-to-person communication, nurse-to-nurse communication, nurse-to-doctor communication, and care team member-to-care team member communication. We also need to track and document that whatever communication was sent has been received and read. The traceability, the ability to audit backward, is critically important to our clients, and we believe that that level of sophistication is now baseline. You don’t get that level of transparency with emails.

We believe that we are differentiated by our standard of delivering the right message to right person at the right time. We do that using algorithms that leverage what we think of as situational variables. The person’s role is the one that is most often mentioned, but it’s much more complicated than that. It also includes their department, the facility, the day, the time, and the call schedule. We establish deep, optimal communication that is based on those variables.

It’s essentially an optimized communication pathway that folks can standardize around. Our most sophisticated clients have established standards across their 10, 20, and sometimes 30 facilities to establish a standard around communications. We track and we give the sender the ability to see who has received the communication, who has opened the communication. It doesn’t need to be sent back that it has been read, but you can track it. We believe, and have always believed, that this is critically important. People are now accepting this is a benchmark and a standard.

Texting, as the preferred messaging mode of many or most people, is a channel by which messages can be scaled infinitely, covering health follow-ups, pre-visit questions, appointment reminders, and anything else that the provider organization feels is important. How do organizations decide how to use that capability optimally without seeming annoying or impersonal to their patients?

Our job is to give our clients options to communicate with their patients in the way they believe is most effective. I don’t believe that voice has completely gone away, so we need to continue to enable that. Texting is core, unquestionably, and video has become important. Six months ago, people communicated maybe 20% by videoconference and the rest of the time with just regular conference calls, but now 90% of my days are spent in front of a camera.

Our goal is to give our clients options for their patients, a multi-channel array of capabilities. The ability to do appointment reminders, surveys, and education pre- and post-visits or procedures is critical. We see it now. I’ve been spending a ton of time with potential partners around this concept of education for patients who are coming in for surgery or an oncology appointment. The more you know, the better prepared you will be and the less stressed you will be, which has proven to have an impact on the efficacy of the care you’re receiving.

We are using all those ways of communicating to funnel real quality to patients, pre and post, having an interaction with a care provider. That’s not going to go away. How people decide to digest it, how proactive health systems are in actually promoting it, is a  matter of sophistication level. We are committed to helping any and all systems, regardless of where they are on that spectrum of sophistication. But I believe that the engagement with patients and consumers will grow through text.

People don’t talk as much about the importance, the crucial importance, of the call center. We see call centers as a core to that multi-channel communication strategy. They are a huge part of how clinical communications are relayed to and from the front lines and patients and family members. There are massive opportunities for health systems to engage more effectively.

People like texting because it can be real time if both parties are available and interested, but it can also be asynchronous if you don’t catch someone at the right moment. Does that same concept apply to video, where two people converse via video messages that aren’t necessarily answered in real time?

I think it’s all based on the use case, the degree of acuity, the stress expressed by the patient, and the urgency expressed by the health system. These are all variables that come into play. We think that having three or more ways of applying communication strategies to the situation is the right answer.

Texting seems most convenient for less-urgent situations, but when you’re back home after a round of chemotherapy, you want immediate video or voice feedback from a care professional who can tell you that how you feel is normal and you don’t need to drive an hour to come back to the facility to be checked out. We will continue to invest in having as many communication strategies as possible to allow every use case to be facilitated by our platform.

Do you have any final thoughts?

The journey is what we think of as unified communications. It crosses boundaries and it cannot be an afterthought. It needs to be core to the mission of the company that commits to delivering it. Similarly, workflow enhancements can be achieved by combining technology and innovation with experience and know-how, not just releasing tools and demanding that a clinician use them.

All 350 of us at PerfectServe wake up in the morning with a desire to solve bigger problems for our clients and their patients.We start with the end in mind. We are excited about the progress that we have made with our clients and the progress that they are making with their patients.

Morning Headlines 9/2/20

September 1, 2020 Headlines No Comments

PicnicHealth Announces $35M in Funding to Accelerate Medical Research Based on Real World Data

PicnicHealth, which assembles a user’s health history from their medical records, packages them into a PHR, and then allows the user to send their anonymized data to drug companies as real-world evidence for research, raises $35 million.

TigerConnect Acquires Call Scheduler, Launches Fully Integrated TigerSchedule to Simplify Physician On-Call Scheduling

TigerConnect acquires Adjuvant’s physician scheduling tool, which it will release as TigerSchedule in combining physician scheduling with clinical collaboration.

Apple and Google will build their coronavirus contact tracing software right into your phone

Apple and Google will include COVID-19 exposure notification in the next updates of IOS and Android, eliminating the need for users to install them as a separate app.

News 9/2/20

September 1, 2020 News 12 Comments

Top News

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PicnicHealth — which assembles a user’s health history from the medical records of their providers using phone and fax, packages them into a personal health record, and then allows the user to send their anonymized data to drug companies as real-world evidence for research — raises $35 million in Series A and B funding rounds.

It’s not a free or even inexpensive service. Users pay $299 upfront to have their information gathered from their providers and then $39 per month to keep it current. They can choose the research studies to which they want their information released, but receive no compensation.

It seems unlikely that large numbers of people will pay that much. CareSync had a similar service with more user benefits and charged a fraction of this cost before the company shut down in June 2018.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Cerner. Cerner Corporation’s health technologies connect people and information systems in thousands of contracted provider facilities worldwide, dedicated to creating smarter and better care for individuals and communities. Recognized globally for innovation, Cerner assists clinicians in making care decisions and assists organizations in managing the health of their populations. The company also offers an integrated clinical and financial system to help manage day-to-day revenue functions, as well as a wide range of services to support clinical, financial, and operational needs, all focused on people. Healthcare is too important to stay the same. Thanks to Cerner for supporting HIStalk.

I found this YouTube video that describes how Great Lakes Health System is creating a single patient record using Cerner.


Webinars

September 3 (Thursday) 2 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

September 17 (Thursday) 1 ET. “ICD-10-CM 2021 Updates and Regulatory Readiness.“ Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP of global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will review additions, deletions, and other revisions to the 2020 ICD-10-CM code set that will be critical in coding accurately for proper reimbursement.

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


Acquisitions, Funding, Business, and Stock

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TigerConnect acquires Adjuvant’s physician scheduling tool, which it will release as TigerSchedule in combining physician scheduling with clinical collaboration.

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Germany-based Semalytix — which analyzes patient-generated treatment experience information from their posts on blogs, forums, and social media and sells the insights to drug companies – raises $5 million in a Series A funding round.


Sales

  • Oregon Health & Science University will implement Bright.md’s automated telehealth platform as part of its Virtual Care Hub, which will guide patients through an online interview whose results are combined from their EHR information to display a chart-ready SOAP note to the provider.

People

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Chris Bayham, MBA (Brookdale Senior Living) joins payer-provider precision medicine technology vendor Xsolis as COO.

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SignalPath hires Andy Corts  (Sarah Cannon Research Institute) as as SVP of sponsor and CRO solutions.


Announcements and Implementations

Collective Medical releases an infection control reporting solution for skilled nursing facilities that allows them to meet federal requirements for reporting COVID-19 cases to the federal government.

The American Medical Association releases the 2021 CPT code set, which includes the proposed CMS changes that take effect January 1, 2021.

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Boston startup Statum Systems announces a mobile communication and collaboration system that communicates with traditional paging systems as a backup to WiFi and cell connections. Users add a smart card to their ID badge or smartphone case to allow their phone to connect via Bluetooth to a pager receiver, after which the system will choose from the best available communications network even during outages or when in areas with low signal penetration.


Government and Politics

The VA awards Cerner a $161 million contract to implement an enterprise health services network at four of its Ohio facilities. I assume, but haven’t confirmed, that this is a milestone payment for the VA’s general implementation of Cerner.


COVID-19

HHS bids out a $250 million contract for a public relations firm to “defeat despair and inspire hope” related to COVID-19 and to encourage businesses to reopen to restart the economy, with most of the money to be spent by the end of the year.

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New White House medical adviser neuroradiologist Scott Atlas, MD is urging the White House to embrace a herd immunity strategy for COVID-19, calling for lifting restrictions so that the virus will spread through healthy populations while the government focuses on protecting high-risk people. Sweden’s use of that strategy yielded infection and death rates that are among the highest in the world and failed to prevent economic problems. Epidemiologists, of which Atlas is not one, project that reaching 65% herd immunity in the US would require over 2 million deaths.

Wesleyan University is testing every student and on-campus employee twice per week for COVID-19,  arranging for a 10-day isolation period for those who test positive, and performing contact tracing. Students, faculty, and staff members bring their ID to a tent, where they are given a nasal swab kit, perform their own swab, and return their sample to testing staff. The school has reported four positive results in nearly 5,000 tests.

An article in The Atlantic explains why contact tracing works everywhere in the world except the US:

  • The US didn’t start early before case numbers became unmanageable.
  • People often don’t answer their phone when called by someone they don’t know.
  • Test results often take several days to arrive and people don’t always self-isolate while waiting for them.
  • A significant number of Americans don’t trust the government or believe in conspiracy theories.
  • The US doesn’t provide much social support, so those who test positive are expected to isolate away from work and family at their own expense and in what could be space-limited living quarters.

NIH announces that a Phase 3 trial of an investigational COVID-19 vaccine that was developed by Oxford University has begun and will ultimately include 30,000 adult volunteers in 30 states. AstraZeneca has purchased the rights to the vaccine.

ProPublica notes that the US has no overall strategy for testing symptom-free people for COVID-19 because of the different needs involved with clinical versus public health use. Symptom-free testing offers no clinical value since treatment would be the same whether positive or negative, but public health departments want to be able to identify those silent carriers to assess the overall severity and source of the infection’s spread and to perform contact tracing to ask people to isolate themselves.

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The National Institutes of Health concludes says the data used by the FDA to support its Emergency Use Authorization for convalescent plasma treatment is not adequate to recommend the treatment or to make it a standard of care. NIH says no conclusions can be drawn in the absence of randomized clinical trials even though FDA, HHS, and the White House publicly announced the EUA as a historic breakthrough that will save 35 of 100 hospitalized patients in misinterpreting the study’s results.

The US will not participate in the World Health Organization’s 170-country Covax effort to develop, manufacture, and equitably distribute a coronavirus vaccine. A White House spokesperson announced that “we will not be constrained by multilateral organizations influenced by the corrupt World Health Organization and China.” Experts say the downside of the “America first” policy is that if none of the vaccines being tested here work, then Americans won’t have access to successful ones that other countries are testing. The global concern is that the US will hoard doses and vaccinate even low-risk people while other countries are left without.

Florida’s health department cuts ties with Quest Diagnostics after it discovers that the company failed to submit 75,000 COVID-19 positive results going back to April. Quest apologized, saying that a technical issue prevented it from reporting 75,000 test results of the 1.4 million tests it performed, and notes that individual patients and providers received their results in a timely manner even though the state did not.

Studies find that proper ventilation can help reduce coronavirus spread indoors, as researchers recommend that schools and business upgrade their air circulation systems and open windows when possible.

Apple and Google will include COVID-19 exposure notification in the next updates of IOS and Android that begin rollout immediately, eliminating the need for users to install them as a separate app. Users will receive a push notification of the public health options that are available in their area should they choose to opt in.


Sponsor Updates

  • Arcadia makes its Outreach module available for free to payer and provider partners so that they can communicate with patients about pediatric vaccination needs and other gaps in care.
  • Impact Advisors publishes a white paper titled “EHR Hostring Strategies and Options.”
  • The Chartis Group hires James Green as a director of its revenue cycle practice.
  • CereCore wins ClearlyRated’s 2020 Best of Staffing client and talent awards for service excellence.
  • Public sector technology vendor Tyler Technologies and Cerner will help state health departments comply with Medicaid reporting requirements using Tyler’s Entellitrak and Cerner’s HealthIntent.
  • Clinical Architecture releases a new episode of The Informonster Podcast, “The COVID-19 Interoperability Alliance.”
  • Dresner Advisory Services names Dimensional Insight an overall leader in business intelligence in its annual Industry Excellence awards.
  • Everbridge and the National Center for Missing & Exploited Children celebrate six years of successful collaboration.

Blog Posts


Contacts

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

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Morning Headlines 9/1/20

August 31, 2020 Headlines No Comments

CMS agrees to cover ‘breakthrough’ medical devices

A proposed CMS rule would give Medicare beneficiaries access to medical devices the FDA designates as breakthrough technology.

Cerner Unit Books Potential $161M VA Health Network Deployment Order

Cerner’s government services business receives a $161 million order to implement an enterprise healthcare services network at four VA medical centers in Ohio.

Madison nurses start company to provide online COVID-19 screening

Former Epic nursing innovation and product lead Bre Loughlin, RN co-founds Nurse Disrupted to offer virtual COVID-19 screening to men’s and women’s shelters in Madison, WI.

Curbside Consult with Dr. Jayne 8/31/20

August 31, 2020 Dr. Jayne 1 Comment

Over the last few years, I’ve done quite a bit of work with healthcare IT startups. There are hundreds of people out there who think they have the next big thing and jump headlong into the journey of trying to make it a reality. It’s a difficult road from having an idea to going live in production, and an even more challenging one taking a product from go-live to profitability. We’ve all seen the startup failures and even those that make it to the big time seem to struggle becoming profitable.

The biggest issue I’ve seen with some of the startups I’ve worked with is that they fail to determine how they’re going to govern themselves and their application. I’m a huge fan of governance, not only because good fences make good neighbors, but because being able to make decisions effectively also helps prevent wasted effort and rework when it turns out something was built that doesn’t make sense.

There are numerous governance questions that need to be addressed. First, there are issues about how the organization will be formed. Is it a partnership, a limited liability company, or something else? Does everyone have an equal share in the profits and liabilities? Is the company based somewhere with favorable laws? I was recently approached by a startup that had no corporate structure. While I’m comfortable contracting with individuals, I wasn’t comfortable having one partner hire me to fix what sounded like a problem with one of the other partners.

Next, there are issues around contracting and spending money. Who has signatory authority for contracts? Who has the ability to spend money? Can everyone spend money up to a certain threshold, but do expenditures above a certain point require a greater decision-making authority? What kinds of expenses qualify as business expenses? Do various functions have budgets and are expenditures regularly reviewed to ensure things are not getting out of hand? Are the appropriate checks and balances in place?

There are certainly more “business-y” things that have to be done when you’re contemplating a startup, but operational and product governance also needs to be in place if an effort is going to be successful. On the operational side, is there a mission and a vision for the company? Do the involved parties have a common understanding of what they are trying to build and sell? Or are there simmering disagreements about whether the effort is more technology-based or service-focused, or a bit of both? Who is the target audience, and does the group understand their needs? I’ve seen plenty of great ideas fall flat because no one involved in the visioning process understands the target audience, or even the target industry. Cue the music for all the big tech companies that thought they could “do healthcare” and exited after spending a lot of money and not accomplishing much.

There also needs to be some level of product governance figured out before the first line of code is even written. Who makes decisions on what the product is going to do? In a startup, people may wear multiple hats, but who owns the functions of product management, clinical oversight, development/dev ops, testing, marketing, and sales? If there are competing priorities, how will decisions be made? Who determines minimum viable product? Who will represent the voice of the customer? Who will keep up with regulations, if applicable? I once worked in a startup that had a brilliant development mind who didn’t play well with others. He’d stay up all night writing code, without running anything past the clinical advisors (and often without running it past others who were writing conflicting features). When his ideas were shot down, not only did we have to untangle the content from the application, but it took days and sometimes weeks to get him back to his happy place where he could be productive again.

Another sticking point I see people get in trouble with is the management of contractual requirements for customers or prospects. This goes back to the mission and vision part. If a client or prospect asks for a feature to be built as part of a contractual requirement, who makes the decision? Is it more important to land the customer, even if it means delaying other planned features or moving away from the product’s comfort zone? If a contractual requirement is agreed upon, does the agreement contain enough detail to make the feature a reality, or will there be room for the client to claim that it wasn’t properly delivered because the contract was vague? I see a lot of startups that try to be everything to everyone and move well outside their comfort zone and often into the danger zone because they lack governance.

One of the most important things that startups need to develop is the ability to say no. Sometimes a prospect just isn’t a good fit or has needs that are beyond where the company is in its development. It can be more important to walk away from a deal rather than saddle the team with an unwinnable situation, or unreasonable product demands. I recently worked with a group that had a truly cool offering that was just coming into its own when COVID hit. A large health system approached them about modifying it a little and trying to scale it up to fill a COVID-related need. Fortunately, the managing partners said no, because trying to get the health system live would have been a huge distraction from all their other priorities for the year. Although some argued that it was a missed opportunity, the reality is that saying no gave the company additional opportunities to be true to their core mission and their existing clients.

Seeing a cool idea become reality is incredibly exhilarating. It’s also exhausting, and I’ve seen it weigh heavily on individuals, their families, and their careers. Playing in that part of the industry isn’t for the faint of heart, although it’s a relatively great place if you’re an adrenaline junkie or if you enjoy staying awake at night sweating all kinds of things which might go wrong. It’s fun to wake up wondering what adventures each new day might bring, but it’s even more fun when you get to do it within the confines of a leadership team that’s done the legwork needed to increase the odds for success.

What’s your best (or worst) startup story? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 8/31/20

August 30, 2020 Headlines No Comments

GoodRx files to go public with a rare characteristic: Profits

Prescription shopping vendor GoodRx files for an IPO, showing first-half results of $55 million in profit on $257 million in revenue with high growth in both.

Ascension Michigan health system to lay off and outsource 223 IT jobs in Troy

Ascension Michigan will lay off 223 employees of its IT network operations and service desk in October as the health system outsources their jobs.

HHS Deputy Secretary Hargan Statement on Appointment of Acting CIO

HHS Principal Deputy CIO Perryn Ashmore will begin serving as acting CIO following the resignation of Jose Arrieta.

Monday Morning Update 8/31/20

August 30, 2020 News 6 Comments

Top News

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Konica Minolta will pay $500,000 to settle false claims act charges involving its former subsidiary Viztek, which the federal government says fraudulently obtained certification for its Exa EHR that allowed users to falsely collect Meaningful Use payments.

Also named was EHR certification company InfoGard, which “facilitated and participated” in Viztek’s false attestations by certifying the product even as its tester noted obvious manipulation.

Details of the whistleblower’s complaint, in which the government intervened without filing its own complaint, are more interesting than the $500,000 settlement might suggest:

  • PACS vendor Viztek announced rollout of its EHR-PACS integrated Exa EHR in mid-2014. It developed that product in reworking its previously acquired Opal EHR, which was ONC certified.
  • Viztek’s India-based developers underestimated the work that was required to bring Exa EHR up to 2014 edition standards.
  • The whistleblower – Exa EHR’s product manager – said Viztek founder and president Joe Cermin told her that “I don’t care if you have to lie, beg, cheat, steal, or kill” to earn certification since failure to do so would jeopardize the millions of dollars that would result from the company’s acquisition by Konica Minolta, which was underway during the certification testing.
  • Konica Minolta acquired the 120-employee, North Carolina-based Viztek in October 2015.
  • Viztek chose the remote testing option so it could manipulate the testing scenarios using a hard-coded product version that was never released. The whistleblower was told to keep multiple tabs open on her screen, one to run the test script and the other to show an already-configured result. The software failed testing at several points, at which time the company’s executives would ask for a break to allow two on-call teams in India to dummy up test results on two versions of the software, then demonstrate the result of whichever team finished first. At several points, the developers accidently displayed live patient data.
  • The developers hard-coded the EHR to pass the XML output requirements for Common MU Data Set by using programming they found on an ONC testing website. They didn’t even bother to remove the other EHR vendor’s name that was still embedded in the programming.
  • InfoGard “facilitated and participated” in the false attestations by giving Viztek multiple attempts to pass and approving frequent breaks and delays that gave developers time to falsify the programing. The InfoGard tester passed the product even though she noticed that on-screen version numbers, colors, and field layouts changed after the developers had taken breaks.
  • The UL subsidiary of Underwriters Laboratories acquired InfoGard in December 2015.

Reader Comments

From Debbie Downer: “Re: [health IT executive name omitted.] Does it seem they had to be at least somewhat evil to have made their way to the top?” We all have a good-bad behavior ratio that changes situationally, earning us a perceived “jerk score” that may be based on only superficial aspects of our character as observed at our most inopportune moments. Steve Jobs, Bill Gates, Elon Musk, and Neal Patterson kicked their dents in the universe with a psychologically obsessive focus, notoriously flaring temper, an intolerance of naysayers, psychological issues that in some cases were tied to a traumatic childhood, and a general indifference to the wellbeing of the folks who were rowing their corporate boat. But they built lasting and daringly innovative companies in their image that likely would not have happened if they were easygoing everymen. It’s probably not true that nice people finish last, but it is true that people who are successful in any field have to push themselves and others in ways that cheap-seaters would likely find despicable. Whether that leaves them happier on their deathbeds or whether society is better off as a result is an issue that is above my pay grade. Maybe my conclusion is that you can be happy only if you act as your natural self, regardless of how acceptable that may or may not be to others, and the vast majority of jerks don’t accomplish all that much.

From Woodstock Generation: “Re: US withdrawal from WHO. All of my HIM colleagues say no impact will result. We will continue to use ICD-10 diagnoses from WHO and modify them as usual to crate our ICD-10 CM. We will also will continue to create procedure codes (ICD-10 PCS) for use only in the US.”


HIStalk Announcements and Requests

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Many poll respondents say that their family connection and money situations have improved in the past year, although quite a few others don’t have much positive to report (with “optimism” taking a big hit, likely due to COVID-19).

New poll to your right or here: how much consumer and healthcare impact will the Amazon Halo wearable have?


Webinars

September 3 (Thursday) 2 ET. “How Does A Global Pandemic Reshape Health IT? A Panel Discussion.” Sponsor: Intelligent Medical Objects. Presenters: Rob Wallace, chief product officer, IMO; Andrew S. Kanter, MD, MPH, chief medical officer, IMO; Lori Kevin, VP of enterprise IT and security, IMO; Sahas Subramanian, MCA, enterprise architect, IMO. As COVID-19 continues to spread, regulation changes, code system updates, and an increased reliance on technology are making it hard to stay on top of the many ways the pandemic is altering health IT. What’s more, we’re confronting challenges that rely heavily on technological solutions – like accurate reporting tools or telehealth adaptations – and we need those solutions now. The panel of subject matter experts across the enterprise will share insights on how the global pandemic is reshaping the health IT world.

September 17 (Thursday) 1 ET. “ICD-10-CM 2021 Updates and Regulatory Readiness.“ Sponsor: Intelligent Medical Objects. Presenters: June Bronnert, MSHI, RHIA, VP of global clinical services, IMO; Theresa Rihanek, MHA, RHIA, mapping manager, IMO; Julie Glasgow, MD, clinical terminologist, IMO. IMO’s top coding professionals and thought leaders will review additions, deletions, and other revisions to the 2020 ICD-10-CM code set that will be critical in coding accurately for proper reimbursement.

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


Acquisitions, Funding, Business, and Stock

Prescription shopping vendor GoodRx files for an IPO, showing first-half results of $55 million in profit on $257 million in revenue with high growth in both. The company was valued at $3 billion in a 2018 funding round.


COVID-19

US COVID-19 deaths are at 183,000, with 220,000 projected by November 1.

Public health experts question whether COVID-19 PCR tests are overly sensitive, causing people who are carrying insignificant amounts of virus to be labeled as positive and treated as contagious. The answer isn’t to stop testing, as CDC’s controversial new guidance suggests, but instead to use the newly introduced rapid tests that are less sensitive. Other options would be to confirm PCR tests a few hours later with a rapid test, or to interpret the same PCR test result using lower cycle threshold ranges. A run of samples at New York’s state lab identified 794 positive results using the common setting of 40 cycles, but detuning the sensitivity to 35 cycles reduced that number in half, which would make the results more meaningful and make contact tracing easier. The experts also question why labs report their test results as simply positive or negative instead of listing the actual measured viral load.

HHS dismisses two of its high-level PR experts following the backlash that followed erroneous statements made by FDA Commissioner Stephen Hahn, MD about the effectiveness of convalescent plasma treatment that he later declined to correct in a public forum. Hahn, President Trump, and HHS Secretary Alex Azar touted FDA’s Emergency Use Authorization of the treatment as a “very historic breakthrough” that offers a 35% reduction in deaths, a wildly incorrect misinterpretation of results from an observational study that showed that a tiny subset of patients had 35% fewer deaths when given the treatment early versus those who were given it later. Hahn tweeted that he misspoke in characterizing the findings as an “absolute reduction” instead of a “relative reduction,” but he has not elaborated further or provided more accurate information to the public. No randomized clinical trial has been done to prove that convalescent plasma treatment reduces deaths, and even taking the data at face value suggests a 5% mortality reduction at best from using the 100-year-old treatment.

FDA assigns Emergency Use Authorization to allow all hospitalized COVID-19 patients to receive remdesivir, although no research has been published to prove its benefit. FDA issued an EUA in May for using the drug in non-ventilated hospitalized patients who need oxygen. FDA Commissioner Stephen Hahn, MD said that “data show that this treatment has the potential to help even more hospitalized patients,” citing one study from May and another that found only that five days of treatment work as well as 10. Hospitals worry that broader authorization is unproven, it came in the absence of new research, and the EUA will make it harder to obtain the drug for patients whose need is better documented by evidence.

FDA Commissioner Hahn says the agency will authorize widespread use of a COVID-19 vaccine via Emergency Use Authorization before Phase III clinical trials are complete if they think the benefits outweigh the risks. He says it won’t be a political decision – companies apply for such authorization and FDA makes a determination based on the evidence they submit. The only countries that have approved vaccines before their clinical trials were completed are China and Russia.

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People who are misinterpreting CDC’s data are spreading the rumor that only 6% of reported coronavirus deaths were caused by COVID-19, confusing the fact that 6% have COVID-19 as the only ICD-10 code listed while the other 94% include COVID-19 as well as comorbidities such as obesity or diabetes, as is common in many Americans and nearly ubiquitous in older people. It was already widely published that older, sicker people are more likely to die of COVID-19, as are minorities and those who are poorer. The pandemic won’t just go away by pretending that people who die of pneumonia in conjunction with coronavirus infection didn’t really die of COVID-19 and therefore everybody else’s odds are better. But you want to blame people for letting COVID-19 kill them by daring to be older, sicker, poorer, or less white, then these are some good numbers to share with others who don’t really care about their deaths either.


Other

Ascension Michigan will lay off 223 employees of its IT network operations and service desk in October as the health system outsources their jobs. SVP/CIO Gerry Lewis said in a blog post two weeks ago that “we have begun shifting some of our technology functions to third-party partners who specialize in these services” as part of its “digital transformation.”

Cleveland Clinic President and CEO Tom Mihaljevic, MD will interview Epic CEO Judy Faulkner on Wednesday, September 2 at 6 p.m. ET as part of the speaker series “Ideas For Tomorrow.” It will be live-streamed on Facebook and YouTube Live.

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Elon Musk’s Neuralink demonstrates its skull-inserted brain-computer link in a pig, as the company continues its progress toward creating “neural shunts” that could allow paraplegics to regain use of their limbs. Musk also envisions people communicating using “conceptual telepathy” without writing or speaking. He admits that people will be wary of the technology that he calls “a Fitbit for your skull,” acknowledging that “this is increasingly sounding like a ‘Black Mirror’ episode.”


Sponsor Updates

  • OptimizeRx CEO William Febbo will present at the LD 500 virtual investor conference on September 3.
  • The National Council for Prescription Drug Programs honors Surescripts Clinical Informatics Manager Larry King with its Rising Star Award.
  • TriNetX announces that Duke-NUS, a medical school in Singapore, has joined its global research network.
  • Vocera will present virtually at the Baird 2020 Global Healthcare Conference September 9, Wells Fargo Virtual Healthcare Conference September 10, and Morgan Stanley Virtual Global Healthcare Conference September 14.
  • Wolters Kluwer launches “5 Forces for the Future” series to reimagine healthcare post-COVID-19.

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