Curbside Consult with Dr. Jayne 6/22/20

Former CMS Administrator Donald Berwick was featured in the Journal of the American Medical Association last week, writing about “The Moral Determinants of Health.” I was glad to see it, as I sorely needed a break from COVID-related literature and from the ongoing firefighting related to the pandemic’s many downstream impacts. Given the level of turmoil in our society right now, coupled with a disease that is disproportionately affecting various segments of the US population, it was just the read that I needed.

Many of us chose careers in medicine because we wanted to make a difference. Those of us who selected the realm of primary care knew we were taking on the challenge of being among the lower-paid and often less-respected subspecialties, but that was often balanced out by the knowledge that what we would be doing would be important.

For many of our patients, we would be the first member of the healthcare team they would turn to. Our training would help us be uniquely positioned to help solve their problems, through promotion of healthy behaviors or the recommendation of medication therapies or surgeries when needed. We didn’t choose to fight insurance companies or administrators, but as we left residency training for the real world of healthcare, it was obvious we were going to have to operate in an environment for which we were ill prepared.

Whether or not a patient is insured often dictates the care a patient receives, and that quickly creates a line between the haves and the have-nots. My generation of physicians didn’t learn about social determinants of health (SDOH) in our training, but SDOH always formed an undercurrent as we rotated through various clinics and offices in different parts of town. Depending on the ZIP code, the care we recommended varied widely and was largely tied to factors that led certain patients to be sicker than others and whether they could afford to have the care the needed. I had been in practice for nearly a decade before I ever heard a label for this phenomenon.

Berwick notes how significant these factors are, stating that “the power of these societal factors is enormous compared with the power of healthcare to counteract them.” He mentions the “subway map” view of life expectancy, where life expectancies decline for every minute of a subway ride between the “have” and “have not” areas of cities such as New York or Chicago.

Berwick describes the lack of logic in how wealthy nations address health. Although science can identify social causes for poor health, we spend our resources on “expensive repair shops” including medical centers and emergency care, rather than on prevention. He notes a lack of political will to date in shifting the focus of spending upstream, where a difference could be truly made. He mentions the concept of moral determinants of health, one of which is “a strong sense of social solidarity in the US.” In this construct, “Solidarity would mean that individuals in the US legitimately and properly can depend on each other for helping to secure the basic circumstances of healthy lives, no less than they depend legitimately on each other to secure the nation’s defense.”

He goes on to describe the foundations of a “morally guided campaign for better health,” which includes such concepts as the US catching up with the rest of western democracies on such topics as ratification of international treaties and conventions on basic human rights, action on climate change, and statutory support for healthcare as a human right. He notes that “no sufficient source of power exists to achieve the investments required other than discovery of the moral law within… the status quo is simply too strong. The vested interests in the healthcare system are too deep, proud, and understandably self-righteous; the economic and lobbying forces of the investment community and multinational corporations are too dominant; and the political cards are too stacked against profound change.”

Berwick ponders what it means for healthcare to stay in its lane and whether health leaders should take on these social challenges. He believes that the healthcare community needs to go beyond caring for illness, and that “it is important and appropriate to expand the role of physicians and healthcare organizations into demanding and supporting societal reform.” He calls on the healthcare community to spend less time lobbying for regulatory relief and improved reimbursement and more time lobbying for universal health insurance coverage. He calls for the healthcare workforce to use the ballot box to drive change. He closes with this:

Healers are called to heal. When the fabric of communities upon which health depends is torn, then healers are called to mend it. The moral law within insists so. Improving the social determinants of health will be brought at least to a boil only by the heat of the moral determinants of health.

The physician community is a microcosm of our society, and I know plenty of physicians who would rapidly align either for or against these ideas. I spent time this weekend with a surgeon who is “so over this whole COVID thing” and just wants to operate, and also with a psychiatrist who is helping others deal with the trauma they’ve experienced from having multiple family members die due to the pandemic. They’ve had dramatically different exposure to the downstream effects of the pandemic, even though both “healers” live in the same ZIP code and their kids go to the same school. We have to find a way to get past the polarization and to see things from other’s perspectives rather than just shutting them out because we have different experiences that may have driven different viewpoints.

I’ve learned of healthcare organizations that are tackling these issues head on and others that are trying to go back to the pre-pandemic, pre-protest era we lived in prior to 2020. It will be fascinating to see how strategies evolve and what organizations are willing to shift revenue upstream to public health and community projects that might just eliminate good portions of certain service lines.

Berwick has certainly given us food for thought, and it’s an ambitious list of actions he proposes. However, we just picked one of them, such as the idea that healthcare should be a human right, and figured out how we could come to consensus, we would still be in a much better place.

Is your organization addressing the moral determinants of health, the social determinants of health, or just trying to figure out how to get elective procedures scheduled again? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/22/20

Kaia Health gets $26M to show it can do more with digital therapeutics

Virtual physiotherapy startup Kaia Health raises $26 million in a Series B funding round led by Optum Ventures.

Philadelphia-area health system says it ‘isolated’ a malware attack

Crozer-Keystone Health System (PA) suffers a ransomware attack by hackers who have threatened to auction the stolen data off on the dark web if their demands aren’t met within six days.

Putin calls for artificial intelligence to be used in healthcare

Russian President Vladimir Putin calls for the healthcare system there to roll out digital systems and to use artificial intelligence.

FEMA IT Specialist Charged in ID Theft, Tax Refund Fraud Conspiracy

A federal grand jury indicts a Detroit man for the 2014 hack of UPMC’s HR system, where he is accused of selling the information of 65,000 employees on the dark web to conspirators who used it to file fraudulent tax returns.

Monday Morning Update 6/22/20

Top News

In Russia, President Vladimir Putin calls for the healthcare system there to roll out out digital systems and to use artificial intelligence.

Putin told health workers in a videoconference that Russia should use its experience in successfully addressing coronavirus to improve the overall reliability of its healthcare system.

Reader Comments

From Options Exercise Program: “Re: PatientPing’s delayed funding announcement. If you’re going to disclose a raise, make it timely. When public companies do this, we (the investor research community) used to call it ‘painting the tape.’ It matters because the backdrop between now and then is very different. Raising the money during this current time (COVID) sends a very different signal of optimism than it did when the raise occurred. Same quarter plus or minus is fine, but not 16 months.”

HIStalk Announcements and Requests

More than half of poll respondents expect the use of virtual provider visits to increase in the next year over today’s already-increased levels, although two commenters correctly observed that the challenges are not related to technology limitations, consumer or provider preference, or clinical outcomes – it’s all about payments by CMS and insurers.

New poll to your right or here: For those who have had a recent telehealth visit: how was pre-visit information (allergies, meds, recent history, current problem, etc.) collected?

Listening: new from Travis, a Scotland-based (“Glaswegian,” a new word to me) indie band that has been around for 30 years. They couldn’t make a video for the new tune because of coronavirus lockdowns, so singer Fran Healy and his son drew their own.

Webinars

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

People

Arcadia promotes Debbie Conboy to VP of risk adjustment and quality products and hires Catherine Turbett, MHA (Lumeris) as VP of ACO and health plan account operations.

Announcements and Implementations

KLAS didn’t send me its “US Hospital EMR Market Share 2020” report, so I’ll summarize what its blog post says. Only Epic and Meditech had a net gain in hospitals in 2019. Epic has won most of the new big-hospital decisions over several years, but Cerner bagged the DoD/VA elephant. KLAS says there is room for another market entrant, but it glosses over the time, money, and determination that would be required to develop, sell, and install a new hospital EHR. On an unrelated note, I have a minor grammatical quibble with KLAS for writing “multi-tenet” instead of “multi-tenant.”

COVID-19

The New York Times reports that nursing homes are taking advantage of being off limits to ombudsmen during the pandemic by evicting low-profit residents — such as those on Medicaid — to free up beds for profitable COVID-19 patients. Some facilities have discharged residents with no notice to unregulated boardinghouses and cheap motels, sometimes without notifying their families. Nursing homes make much of their profit from post-surgery rehab patients who are covered by private insurance, the supply of which has dwindled as hospitals halted non-essential services. Seventy percent of US nursing homes are for-profit businesses, with 11% of them being owned by private equity firms.

Former FDA Commissioner Scott Gottlieb, MD says that the 10 states that are seeing record-high new COVID-19 cases (AL, AZ, CA, FL, NV, NC, OK, OR, SC, TX) are losing control of the epidemic, as doubling time has fallen to under 10 days. He questions whether the governments of those states possess the political will to implement mitigation steps that could slow the spread. Researchers have noted that states that have higher mobility and low testing and tracing are more likely to be experiencing outbreaks. Arizona’s positive test rate is at 17% and its case count has turned sharply upward, far more than any other state. Thoughts that COVID-19 will throttle itself back in the heat – which were already questionable given its early impact in warm areas of the globe – should consider Arizona (highs in Phoenix are at 110 degrees) as evidence to the contrary, or perhaps more specifically, that congregating indoors under air conditioning without masks once lockdowns have eased is great viral exploit.

President Trump tells attendees of his Tulsa rally that he ordered government officials to slow down COVID-19 testing. He explained, “When you do testing to that extent, you’re going to find more people. You’re going to find more cases. So I said to my people, slow the testing down, please.”

The American Red Cross says blood donations have dropped sharply due to lockdowns and coronavirus fears, and as an incentive to lure donors back, is offering them a free COVID-19 antibody test.

A Harvard working paper finds that the COVID-19 mortality rate of black people ranges from seven to nine times higher than that of white people, depending on age group, meaning that the “years of potential life lost” of both blacks and Hispanic / Latino populations are higher than that of whites despite their much smaller population. 

ProPublica reports that 12% of New Jersey’s nursing home residents died of COVID-19, along with 6% of all nursing home residents in New York, when the states ordered unprepared nursing homes to take all hospital transfers and prohibited them from testing prospective residents for COVID-19 in a “reverse triage” attempt to free up hospital beds. State officials based their order on federal guidance that allowed such transfers if the nursing home met a list of criteria, but nobody was sure who was responsible for assessing their readiness. A Wall Street Journal investigation found that 50,000 of the country’s 122,000 COVID-19 deaths have involved long-term care residents and employees.

Former FDA Commissioner Robert Califf, MD says that while the US is applying impressive technology expertise to COVID-19, we’re ignoring the basics, such as wearing masks and distancing.

Other

A federal grand jury indicts a Detroit man for the 2014 hack of UPMC’s HR system, where he is accused of selling the information of 65,000 employees on the dark web to conspirators who used it to file fraudulent tax returns. The LinkedIn of Justin Sean Johnson says he is a Oracle PeopleSoft expert who worked as a a self-employed cybersecurity researcher for several years, now employed as an IT specialist at FEMA.

Sponsor Updates

• Premier develops Intersectta, an oncology-focused group purchasing organization to source cancer and other specialty drugs.
• Relatient publishes a new case study, “Cherokee Health Systems Powers Telehealth with Patient Engagement, Goes Live Across 24 Locations During COVID-19.”
• CareSignal publishes a case study titled “How Mercy Built a Technology-Enhanced Care Management Model to Scale Care Management and Increase Patient Engagement.”
• Saykara congratulates customer OrthoIndy on receiving the Healthgrades 2020 Patient Safety Excellence Award.
• Spok appoints Brett Shockley (Journey.AI) to its board.
• TriNetX will partner with Parexel to advance real-world data use in clinical development.

Blog Posts

• IT Assessment: Am I Organized for Success in the Long Run? (Impact Advisors)
• PMD: Helping Practices and Patients Navigate Telehealth When They Need it Most (PMD)
• Getting Back to Regulatory Readiness (Premier)
• How to Put Your RPA in 6th Gear (Summit Healthcare)
• Leading a Data-Driven Healthcare Marketing Culture (SymphonyRM)
• Year of the Nurse and Midwife 2020 – What’s Your Story? (Vocera)
• More than PPE: Safety Precautions for Physical Therapists in the Age of COVID-19 (WebPT)

Sponsor Spotlight

Get-to-Market Health is a specialized consultancy focused exclusively on accelerating sales and driving revenue growth for healthcare solution providers. We work with business leaders to simplify the complexity and unique buying patterns of the healthcare market. Bringing deep, broad experience and valuable network connections, the partners at Get-to-Market Health are industry experts. We have worked at and with dozens of healthcare technology businesses ranging from small startups to large, established companies. We help our clients navigate the challenges they face as they work to drive revenue and market innovation.

(Sponsor Spotlight is free for HIStalk Platinum sponsors).

Contacts

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

Weekender 6/19/20

Weekly News Recap

• Health Care Service Corporation, the country’s fifth-largest insurer, will create a Payer Platform to connect its health plans to Epic-using health systems.
• Epic cancels UGM 2020.
• Proteus Digital Health, once valued at $1.5 billion, files Chapter 11 bankruptcy.
• Walmart acquires the technology assets of online pharmacy CareZone for a rumored $200 million.
• Surgisphere, the tiny company whose questionably sourced aggregated EHR data was responsible for two major research article retractions, appears to have shut down.
• Milliman acquires Wisconsin-based employee health monitoring technology vendor Healthio.

Best Reader Comments

I can’t help but wonder how this will affect minor telephone calls with doctors. In the past, I would occasionally call a doctor on the phone to check in on a test result or ask about a medicine and so on. These were relatively quick, focused calls for which there was no charge. But going forward, if telehealth becomes an accepted modality for paid services, what’s to stop a doctor from billing me for each of those calls? (Ben)

If you want providers to do something, you have to pay for it. I’ve got some nice cushy corporate insurance, so I can get my PCP to throw in a couple of freebie phone calls after he’s price gouged me on a few visits. If I had an ACA exchange plan, I doubt I’d get the same level of customer service. I’d rather the billing for telehealth and chat services gets formalized so that the people on government or skimpy plans can push for and get it. Otherwise it’s just going to be a perk for good employer plans, which means it won’t affect anything. (IANAL)

I am appreciative that CMS has relaxed some of the constraints for telehealth services billing during the pandemic but those rules were inane restrictions to begin with. Why should a patient ever have been precluded from getting telehealth at home, simply because they don’t live in a designated rural area? (ValueBasedSkeptic)

As to the hype around value-based payments, we’ve lived through this before with different names and slightly different variants. Improving quality sounds great, but we still can’t define or measure quality well, even for very clear-cut conditions. We’ve spent untold money and efforts on quality measures with lots of content from CMS, NQF and others. Yet for some specialties, there are few if any viable measures. Whether it’s framed as improving population health or some other positive sounding initiative, the main goal has always been shifting costs onto the backs of providers. (ValueBasedSkeptic)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. H in North Carolina, who asked for game buzzers and wobble cushions for her fifth-grade ADHD students. She reported in February, “My students come in every day begging to use the wobble cushions, as well as wanting to know if we will be playing a game with the buzzers. We will continue using these resources daily in our classroom until the end of the school year. I know my future students will be just as excited next year using the wobble cushions and game buzzers.”

Federal authorities arrest a Chinese citizen at LAX as he attempts to board a flight to China, charging him with obtaining a UCSF post-doctoral fellowship position so he could record lab layout details that could be replicated in China. The man, who turned out to be a major in the People’s Liberation Army, admitted that he had been stealing information in his year of employment there. His laptop contained UCSF study information and he had wiped his WeChat phone messages right before arriving at the airport. He is charged so far only with visa fraud.

Four ICU nurses sue Landmark Hospital (GA), claiming that the hospital ordered them to perform COVID-19 test swabbing incorrectly to ensure that the tests would come back negative.

NASA’s next Mars rover, scheduled for launch on July 20, will bear a plate that honors those who are on the COVID-19 front lines.

In Case You Missed It

• News 6/19/20
• EPtalk by Dr. Jayne 6/18/20
• News 6/17/20
• Curbside Consult with Dr. Jayne 6/15/20
• HIStalk Interviews Gadi Lachman, CEO, TriNetX
• Monday Morning Update 6/15/20

Get Involved

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

Morning Headlines 6/19/20

Nation’s Largest Member Owned Health Plan to Launch Epic Platform to Improve Patient and Provider Experience

Health Care Service Corporation will create a Payer Platform to connect its health plans to Epic-using health systems for reviewing patient data, managing claims payment and prior authorization, and facilitating care management.

All of Us Research Program launches COVID-19 research initiatives

NIH’s All Of Us research project adds three COVID-19 data collection components for researchers who are approved to study data from its 350,000 participants.

This Amazon-owned company says it will bring 500 jobs to Boise area by 2021

Online prescription drug delivery company PillPack will bring 500 jobs to Meridian, Idaho when it opens a 78,000-square-foot customer service center there next year.

News 6/19/20

Top News

Member-owned health plan Health Care Service Corporation will create a Payer Platform to connect its health plans to in-network Epic-using health systems for reviewing patient data, managing claims payment and prior authorization, and facilitating care management.

HCSC is the country’s fifth-largest health insurer, with 16 million members enrolled in Blue Cross Blue Shield plans in Illinois, Montana, New Mexico, Oklahoma, and Texas.

HCSC acquired care management solutions vendor Medecision for $121 million in mid-2008 and is a partial owner of clearinghouse operator Availity.

Reader Comments

From Cellular Terrorist: “Re: COVID-19. You should call out the states that refused to apply sound public health measures and are now having record-breaking case numbers.” The problem with the federal government allowing states to do whatever they want is that we as a country can’t or won’t curtail unencumbered travel, so a Florida resident or visitor who parties down mask-free could spread COVID to more responsible areas in the “weakest link” theory. COVID-19 has demonstrated that we Americans don’t care much about science and can’t be bothered with inconveniences like wearing masks unless they promise to save us instead of someone else, so perhaps the “we’re all going to get it eventually anyway” crowd is right. What happens in Vegas doesn’t unfortunately stay in Vegas when it comes to coronavirus.

From Contact Tracy: “Re: contact tracing. See this press release for what my company is about to launch.” As an occasional bearer of bad news, allow me to level-set you: (a) use of any contact tracing app in the US will be under 15% and will drop quickly, making zero difference, and what little adoption there is will be all Apple and Google; and (b) contact tracing in general in the US won’t work because nobody trusts anybody, especially anyone connected with government in any form, enough to give them any personal information, much less their contact names and information, and they won’t even answer phone calls and emails from public health officials. We had better excel at developing a vaccine since every prevention strategy that worked elsewhere — lockdowns, masks, widespread testing, contact tracing, travel limitations, and immunity passports – requires nearly universal adoption and won’t fly in a fatally divided country like ours. Not to mention that we are a lot unhealthier than much of the developed world and will experience a higher rate of coronavirus-related deaths as result. We’re at 120,000 now, more than two Vietnam Wars’ worth (and to paraphrase Chief Brody said in “Jaws,” you’re gonna need a bigger wall). 

HIStalk Announcements and Requests

The grocery chain pharmacy (those are always cheaper than drugstore chains in my experience) filled my 360-day prescriptions for blood pressure and cholesterol meds with a 91-day supply even though I wanted a full year’s worth and was paying cash using a GoodRx coupon. They said GoodRx rejected the 360-day quantity, so I called GoodRx and was quickly connected to a pleasant, actual human who verified that some vaguely described policy limits fills to a 91-day supply in some cases. She could not describe those cases or explain why the app would issue a coupon that was not valid. I still got a year’s supply, paying $82 instead of the expected $60, and only then because the pharmacist found a coupon from a GoodRx competitor. At least the recent federal change that prohibits PBMs gagging pharmacists from telling patients about lower-cost options worked for me and I was impressed with GoodRx’s customer service. Meanwhile, CNBC reports that the software guys who started GoodRx have built a business worth $3 billion in finding yet another illogical loophole in our illogical healthcare non-system.

Webinars

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

Acquisitions, Funding, Business, and Stock

PatientPing confirms the reader rumor that I recently ran: the $60 million Series C fund raise that it announced last week was actually completed in February 2019. The company told me that it held the announcement “to peg it to exciting company milestones and product capability rollouts,” which was explained to the Boston business paper as waiting on CMS to publish legislation that requires hospitals and EDs to send ADT notifications, a core capability of PatientPing. That CMS action was delayed, so the announcement was held as well. Experts note that private companies like PatientPing can announcing funding whenever they want or can skip an announcement altogether. It doesn’t feel right to me to hold off for 16 months, but only because a prospect might infer overly optimistic business conditions during a pandemic in which health systems have been nearly shut down for months.

Redox confirms a reader-reported rumor I sent their way, acknowledging that it laid off 44 people, about 25% of its headcount, on Tuesday. The company says it had planned to double its size in 2020 as it had in 2019 and hired accordingly, but COVID-19 changed the focus of financially strapped health systems. Redox is working with customers and partners to place those of its employees who were affected  –contact christine@redoxengine.com.

Social services referral software vendor Unite Us acquires Staple Health, an analytics company that focuses on social determinants of health.

Signify Research reviews the plan of Mednax to sell its radiology groups and Virtual Radiologic teleradiology business, with the company renaming itself back to its original name of Pediatrix Medical Group as a pediatrics and obstetrics business. Signify notes that the company paid $500 million for VRad in 2015, added 10 practices, and grew revenues by 10% to $3.5 billion, but piled on debt and saw EBITDA slide 24% over the four years. VRad is the world’s largest teleradiology provider. The company announced in early April that it would cut executive salaries, furlough and reduce the pay of non-clinical employees, and cut non-essential expenses in reaction to COVID-19. Signify expects VRad to benefit from its work on AI algorithms over the past several years.

Sales

• MultiCare Connected Care (WA) selects Innovaccer’s Data Activation Platform and InGraph population health analytics.
• Stonewall Memorial Hospital District (TX) selects CPSI’s Evident EHR and TruBridge RCM software and services.
• AdventHealth will implement Virtustream’s Healthcare Cloud to power its new Epic system.

People

Craig Joseph, MD (Avaap) joins Nordic as chief medical officer.

Arcadia promotes Debbie Conboy to VP of risk adjustment and quality products and hires Catherine Turbett (Steward Health Care) as VP of ACO and health plan account operations.

Announcements and Implementations

OrthoIndy (IN) implements Saykara’s AI-based physician charting app.

COVID-19

NIH’s All Of Us research project adds three COVID-19 data collection components for researchers who are approved to study data from its 350,000 participants:

• Testing at least 10,000 samples from recent enrollees for COVID-19 antibodies, hoping to determine rates of exposure by region.
• An online survey that asks about COVID-19 symptoms, stress, social distancing, and economic impact that participants can take monthly to understand effects over time.
• EHR data analysis from the 200,000 participants who have shared their information, with plans to standardize the information to investigate patterns, symptoms, associated health problems, and the outcome of drugs and other treatments.

Scientific American explains the accuracy rates of COVID-19 antibody tests, which are particularly important since the results are often considered reliable without verification. The authors explain that false-positive results, which are the most impactful, are more likely with low infection rates. Example: the same test that has 95% specificity (few false positives) and 95% sensitivity (few false negatives) will give a false-positive rate of 14% when the infection rate is 25%, but will issue falsely positive results 50% of the time when the infection is 5%. In other words, COVID-19 antibody tests are likely to issue a lot of false positive results that may encourage people to return to normal life because they think they are immune (not to even mention that nobody has proven that people who have COVID-19 antibodies are immune from reinfection).

FDA will participate in the COVID-19 Diagnostics Evidence Accelerator, a real-time diagnostic testing evaluation program that is a companion to the previously announced Therapeutic Evidence Accelerator.

The Equal Employment Opportunity Commission says that employers can’t require employees to take COVID-19 antibody tests before returning to work, basing its decision on CDC’s warning that antibodies don’t equate to immunity and therefore testing for them should not drive workplace decisions.

Other

It’s not just COVID-related fears that are keeping people away from medical practices and hospitals – the New York Times reminds readers that millions of Americans have lost jobs, income, and health insurance during the pandemic and can’t afford the high cost of healthcare, especially after reading about the aggressive debt collection practices of hospitals and practices. I’ll add one more item – even those who are able to get new health insurance will see their deductibles reset, meaning that someone with an ACA plan could be looking at several thousand dollars of deductibles before insurance starts paying anything.

Epic employees will return to the company’s headquarters in Verona, WI in four stages during July and August. Over one-third of the company’s employees have already returned to office work. The company says it is slowly resuming essential travel.

Researchers note that patient race and ethnicity are often used by algorithms that drive clinical decisions even though nobody knows whether underlying genetics are causing the observed differences in outcomes. The researchers caution that it’s not wise to simply apply a race-based digital fudge factor without knowing if genetic differences are responsible rather than societal issues, economic factors, or past inequities. Otherwise, minority patients may be denied services because of misinterpreted risk factors or the assumption of suboptimal outcomes.

Sponsor Updates

• RamSoft adds QliqSoft’s virtual visit technology to its RIS/PACS solutions.
• Healthwise receives five Digital Health Awards during the Health Information Resource Center’s 2020 spring competition.
• Intelligent Medical Objects publishes a new white paper, “The Evolution of the EHR.”
• Medhost joins the Amazon Web Services Partner Network as a Technology Partner.
• Black Book ranks Netsmart #1 in 10 categories across behavioral health and post-acute settings, including top overall post-acute care IT services and solution vendor.
• BridgeHealth offers its members access to flexible physical therapy solutions through WebPT’s Networks program.
• MDLive CMO Cynthia Zelis, MD joins the NCQA’s Taskforce on Telehealth Policy.

Blog Posts

• First CGM Basal-Bolus Insulin Titration Study Shows Future Potential for Remote Patient Monitoring (Glytec)
• Data scientists assist medical researchers in the fight against COVID-19 (Google Cloud)
• Finding the telehealth-life balance (Greenway Health)
• HealthNxt: The Next Great Advance in Virtual Care (The HCI Group)
• The Right Skills at the Right Time for Healthcare IT (HCTec)
• Activity-Based Costing in Healthcare During COVID-19: Meeting Four Critical Needs (Health Catalyst)
• I am still a nurse: Supporting the clinical voice of our customers (Hyland)
• Role of Health Data Analytics in Post COVID-19 World (Imat Solutions)
• Use Your COVID-19 Work to Build Data Governance (Impact Advisors)
• How to avoid disruption from loss of technical expertise (Infor)
• An Unprecedented Challenge: Serving Our Customers Through Passion and Commitment (InterSystems)
• CFO Playbook – Turning Financial Trauma into Transformation (Loyale Healthcare)
• Key Tips to Address Technology Frustration Within Your Organization (Netsmart)

Contacts

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

EPtalk by Dr. Jayne 6/18/20

More than 100 professional groups are lobbying Congress to create a safe harbor for COVID-19-related litigation. They are advocating protections against bad-faith legal action for primary care practices and physicians. The Coronavirus Provider Protection Act (HR 7059) would provide liability protection for services that are provided during the COVID-19 public health emergency period and for a reasonable time after the emergency declaration ends. It specifically notes issues around services that are provided or withheld in situations that may be beyond the control of physicians and facilities (e.g., following government guidelines, directors, lack of resources) due to COVID-19.

The threat of lawsuits hangs constantly over physicians. I’ve seen the toll it causes, both financially and emotionally, even if a case is dismissed. Some cases are filed well after the care was delivered, and we know that over the last six months, there has been quite a bit of care delivered that doesn’t follow published guidelines for a variety of reasons (including lack of guidelines, lack of appropriate personal protective equipment, lack of medical equipment, etc.)

Although some states have passed protections, it would be good to have a national standard, especially for providers who practice across state lines. There is also plenty of lobbying for protections in other industries, where workers might claim that their employers didn’t protect them adequately from the pandemic or that they were injured as a result. I see the waters becoming muddied rapidly and wouldn’t give the House bill good odds for passage. I would, however, give good odds on the US legal system becoming more entertaining if attorneys and judges started wearing wigs.

Since most of my summer fun has been canceled, I’ve used the time to wade through scores of emails that I intended to answer and were pushed down the inbox by the pandemic. I had missed the announcement of the newest tools from Athenahealth’s Epocrates division, one of which delivers consensus guidelines on drug therapies. The main data table includes not only the recommending bodies, but also the date of last update in a clean format, which is great for those who don’t want to try to sort out the status of multiple recommendations on a daily basis. There’s also a tool for drug therapy trial updates and a great listing of COVID-19 resources, including key points about clinical conditions that can be related to or mistaken for COVID-19.

As a consultant, I’m getting a little twitchy about the fact that I’ve spent three months in the same city without any travel. I’d love to get back on the road, spending time in other parts of the country and meeting people, but I’m not sure those days are ever coming back.

As much as I miss travel, I don’t miss being in a corporate office setting every day. As people go back to work, the CDC has recommended significant changes to US office settings. Recommendations to those returning to office jobs include temperature / symptom checks, distancing of desks (with plastic shields where spacing them out isn’t possible), and face coverings. All those organizations that spent money tearing out cubes and individual offices in favor of open-plan concepts are probably kicking themselves as they try to bring people back.

In a slap to the environment, CDC is recommending avoidance of mass transit or carpools in favor of solo transportation. Employee perks like communal coffee machines and snack stations are out as well, in favor of prepackaged, single-serve products. Not surprisingly, some companies are deciding that it’s better to keep workers remote and cut their office overhead. Even when I was in a corporate role, I was more productive on my “work from home” days due to the lack of interruptions and ability to frequently relax my brain with a distraction, even if it was moving laundry from the washer to the dryer between conference calls. We’ll have to see what productivity looks like over the long term.

It’s been a while since I’ve been up close and personal with concerns about my facility having Certified EHR Technology, so I enjoyed reading this recent ONC blog about the ongoing certification process. The 21st Century Cures Act requires the Department of Health and Human Services to establish Conditions and Maintenance of Certification requirements for the ONC Health IT Certification Program. There are seven Conditions of Certification that vendors will have to meet, along with ongoing Maintenance of Certification requirements. As physicians who have dealt with our own Maintenance of Certification pains, welcome to the club.

As tiresome as I found the Information Blocking requirement to be (everyone talks about it, no one does anything about it), I was intrigued by the Communications requirement. It prevents health IT developers from restricting or prohibiting communications about usability, interoperability, and security of certified health IT modules. I’m sure some vendors will continue to apply plenty of pressure to prevent such discussions, but would love to see some clients come clean about how awful their technology really is before others buy the same tired software.

Those who know me going way back know that I initially dreamed of being not just a doctor, but the first doctor on a long-term space station assignment. Needless to say, that didn’t work out (much to my parents’ relief, I’m sure), but I still enjoy keeping track of what goes on in the next frontier. I enjoyed the recent GlobalMed blog talking about the role of telemedicine in space exploration. It included discussion of the similarities between space travel and research in undersea environments and the need to to use data-driven approaches and technology to solve clinical problems when humans are hundreds of miles above the earth’s surface. If you’ve ever seen the story of the Antarctic explorer who performed his own appendectomy, it gives new meaning to crisis standards of care.

There is so much we have to learn about our potential to live and work in space and the role of technology in making it happen. For instance, we’re just figuring out how to bake chocolate chip cookies in orbit, which would definitely be on my wish list.

What did you want to be when you grew up? How close did you get? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/18/20

MTBC Acquires Meridian Medical Management, a Former GE Healthcare IT Company

Ambulatory health IT company MTBC acquires EHR, RCM, and practice management vendor Meridian Medical Management for an undisclosed sum.

TapestryHealth Purchases Telehealth Software Leader

Tech-enabled primary care support company TapestryHealth acquires Telemedicine Web Services.

Doximity Acquires THMED, Launches Curative Brand

Professional medical network Doximity acquires healthcare staffing company Thmed, which will rebrand to Curative as part of the deal.

Morning Headlines 6/17/20

Epic’s UGM 2020 is Cancelled

Epic cancels its UGM 2020 user meeting, which was scheduled for August 24-27 in Verona, WI.

Proteus Digital Health, once valued at $1.5 billion, files for Chapter 11 bankruptcy

Proteus Digital Health, the “smart pill” digital health company that was once valued at $1.5 billion, files Chapter 11 bankruptcy.

Abacus Insights Raises $35 Million in Series B Financing to Help Health Plans Liberate Data, Enabling Consumers to Make Better Health Choices and their Providers to Offer More Informed Recommendations

Abacus Insights, which combines EHR and third-party data to allow health plans to personalize the care experience of their members, raises $35 million in a Series B funding round.

Unite Us Acquires SDOH Analytics Company, Staple Health, To Provide Predictive and Comprehensive Social Care Integration

Social services referral software vendor Unite Us acquires Staple Health, an analytics company focused on social determinants of health.

CareMesh Raises $5M in Seed Funding to Scale Integration of its Healthcare Communications Platform 

CareMesh, which offers a communications platform that includes a national provider directory, event notifications, secure communications, and care transition workflows, raises $5 million in a seed funding round.

News 6/17/20

Top News

Epic cancels its UGM 2020 user meeting, which was scheduled for August 24-27 in Verona, WI.

Epic says some UGM elements will be offered online even though “we truly believe that an in-person meeting is irreplaceable.”

A CIO reader says the CEO council and CIO roundtable will still be offered, although they add, “Not sure who is attending either one given travel budget cuts.”

Reader Comments

From Newly Jobless: “Re: [company name omitted.] Laid off 25% of staff today.” Unverified. I didn’t get this in time to confirm with the company before my Tuesday evening deadline and I saw nothing on TheLayoff.com, but if you were affected, let me know.

From Prudent Investor: “Re: your readership stats. How now compared to last year?” Up, and I’m surprised to be getting more inquiries from potential sponsors than back in the heady days of Meaningful Use. I guess the lost conference year of 2020 left companies with more marketing money but fewer channels for exposure. Investment activity seems robust as well, so I suspect companies are eyeing the opportunity to gain competitive advantage in a suddenly leveled playing field.

From Hopeful Employee: “Re: Revint. I’ve been here two years and they just announced the third CEO since I started. I hope this one fires the management team and invests to integrate all these companies that New Mountain Capital has thrown together. They weren’t even honest about firing the current CEO, we employees aren’t idiots.” Scroll down to the People section for the new CEO’s details.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor Halo Health. The Cincinnati-based, physician-founded company offers the Halo Clinical Communication and Collaboration Platform (CCCP), a scalable, AWS cloud-based solution that includes secure messaging, on-call, role-based scheduling, VoIP calling, critical results, alerts, and care team tools in a unified mobile platform. The Halo Platform’s unique workflow management system instantly delivers time-sensitive information to the right person, role, or team, allowing health systems to accelerate patient care, increase clinician efficiency, and improve financial outcomes. Halo is a strategic technical and clinical workflow partner dedicated to achieving customer objectives such as standardizing communication, consolidating technology, and connecting the physician community. Thanks to Halo Health for supporting HIStalk.

Webinars

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.

Acquisitions, Funding, Business, and Stock

Proteus Digital Health, the “smart pill” digital health darling that was once valued at $1.5 billion, files Chapter 11 bankruptcy. The company staked its future on the support of drug manufacturers, who are known for deep pockets but a short attention span for shiny technology objects.

Walmart acquires the technology assets of online pharmacy CareZone for a rumored $200 million. The company’s app allows consumers to scan their pill bottles to create a medication profile, set up reminders, and track health measurements. CareZone will continue to operate its pharmacy, which was excluded from the network of pharmacy benefits manager Express Scripts a couple of years ago in a contract dispute.

Abacus Insights, which combines EHR and third-party data to allow health plans to personalize the care experience of their members, raises $35 million in a Series B funding round.

CareMesh – whose communications platform includes a national provider directory, event notifications, secure communications, and care transition workflows – raises $5 million in a seed funding round.

Surgisphere, the tiny company whose questionably sourced aggregated EHR data was responsible for two major research article retractions, takes down its website and social media accounts. I noticed that founder Sapan Desai, MD, PhD has also removed his LinkedIn. Some speculate that the company has shut down, which would be reasonable given the permanent stench that is now attached to its name.

People

Geeta Nayyar, MD, MBA (Greenway Health) joins Salesforce as executive medical director.

Revenue integrity technology vendor Revint hires Lee Rivas (RELX) as CEO.

Announcements and Implementations

Experity launches Face Sheet, a patient history view of its urgent care EHR that provides an overview of past visits, supporting urgent care “hybrid clinics” that are providing primary care services or other continuing services.

Inspira Health (NJ) goes live on KyruusOne and ProviderMatch for Consumers, both from Kyruus.

COVID-19 testing company Curative is using the interoperability platform of Redox to send results to state health departments.

Epic highlights the use of its Pulse Central, which aggregates data from 1,200 Epic-using hospitals, to send standard COVID-19 metrics to public health organizations in near real time.

Carequality publishes an implementation guide for electronic case reporting, which can be used to report infectious disease cases to public health organizations.

Access releases Impression, a new version of its paperless, web-based electronic forms solution that allows hospitals to send patients forms (such as for pre-registration) for electronic completion and signing from anywhere. 

The American College of Cardiology will offer its members Heartbeat Health’s digital platform for cardiology-specific telemedicine and virtual care, which incorporates doctor-patient sharing of wearables-powered diagnostics, remote patient monitoring, and outcomes tracking. I interviewed Heartbeat Health founder and CEO Jeff Wessler, MD, MPH a few months back and I confess that it’s one of my favorites – he was refreshingly thoughtful about his vision of how cardiology practice can be optimized with a combination of in-office visits and virtual care that emphasizes prevention as well as treatment.

COVID-19

FDA revokes its emergency use authorization of hydroxychloroquine and chloroquine for treating COVID-19, finding that the drugs don’t have enough potential benefit to outweigh their risk of side effects that are sometimes fatal. HHS Secretary Alex Azar says that the only impact of the decision is that hospitals can no longer use federal stockpiles of the drugs — doctors can still prescribe them however they want and the FDA change may clear up misunderstanding that they are for hospitalized patients only.

Researchers question whether the medical journal peer review process is broken following retraction of articles by NEJM and The Lancet whose flaws that were obvious to expert readers. Issues:

• Peer review isn’t intended to detect outright fraud, which may or may not be involved in the retracted articles that used data from Surgisphere.
• COVID-19 has created an urgency to get information to the front lines within days rather than the usual many months, leaving little time for review.
• The supply of unpaid, uncredited, well-credentialed peer reviewers is limited.
• NEJM says it should have used hospital data experts in its peer review and pledges to require independent validation of database quality going forward.

The New Yorker describes how some Utah startups with little healthcare knowledge threw together COVID-19 tools (testing, online assessments, and a command center) to rush into a no-bid contract with the state in public-private partnership called TestUtah that was expanded to other states. The reliability of TestUtah’s results came into quick question; it was using tests that had not been allowed in the US until an FDA emergency use authorization was issued; its testing machine was approved only for use on agricultural DNA rather than human RNA; and it was stockpiling hydroxychloroquine in planning to offer treatment as well as diagnosis. TestUtah processed its lab tests in an unmarked back room of a 122-bed hospital that had equipment stacked on old desks and conference room tables sitting on carpeted floors, using a home food sealing machine to seal specimens. CMS inspectors noted several problems with its process and threatened to sanction the hospital’s lab for failing to supervise its work. TestUtah blames the criticism it received on political partisanship and the desire of University of Utah’s lab company and Intermountain Healthcare to squelch competition. The state overrode the recommendations of its public health director to extend TestUtah’s contract, then demoted her.

A tiny lab in Texas is billing insurance companies several thousand dollars for a COVID-19 test that costs just $100 from the major labs, taking advantage of a mandate from Congress that requires insurers to pay the full costs of the tests for out-of-network lab work.

FDA gives emergency use authorization for US hospitals to use an AI-powered COVID-19 patient deterioration early warning tool that was developed by Israel-based tele-ICU platform vendor CLEW. 

Other

A study finds that the rate and completeness of public health disease reporting by hospitals, practices, and labs improves when using HIE-generated, pre-populated forms instead of filling out and faxing paper forms.

Sponsor Updates

• Pivot Point Consulting will offer health-risk trajectory analytics from Jvion to help hospitals get employees back to work and patients back to their normal care activities.
• A proof-of-concept study finds that patients who used Glytec’s Glucommander insulin dosing software with a continuous glucose monitoring system showed a 26% improvement in time in range.
• AdvancedMD releases a new e-book, “Post-COVID-19: Moving to ‘Better Than Normal’ – four essential elements in getting past merely normal.”
• Microsoft features Central Logic in its special COVID-19 podcast series.
• Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new episode of its Critical Care Obstetrics Podcast, “Simulation Mistakes.”
• Black Book ranks Nordic as #1 in client satisfaction in the category of strategic initiatives advisory.

Blog Posts

• 3 Reasons You Need Professional Healthcare IT Testing for Interoperability (314e)
• Three tips for a better nurse engagement that drives quality care (Ability Network)
• The Essential Resource Guide to Hospital-Enabled Virtual care: Part 1 of 5 (Access)
• 5 Reasons Why Health Systems Need to Implement an Enterprise Imaging Platform (Agfa Healthcare)
• The Case for a Situational Awareness Network for Emergency Response (Audacious Inquiry)
• Health Plan Learnings from Our COVID-19 Efforts (CarePort Health)
• Legacy Data Archive: Avoiding the Sticker Shock of Data Retention (CereCore)
• ChartLogic Lands Among SoftwareAdvice’s EHR FrontRunners (ChartLogic)
• Navigating new Medicare hospital outpatient department authorization requirements (Nordic)
• Be Ready for a Breach: The Case for Remote DFIR and Virtual Incident Response (CI Security)
• 10 Steps to Ensure ERP Health (Optimum Healthcare IT)
• Meeting the Needs of Complex Patient Populations Through Care Collaboration (Collective Medical)
• Electronic Prescription Management and Enrollment for Specialty Medications (CoverMyMeds)
• The Future of Healthcare: How Telehealth Will Change After COVID-19 (Dimensional Insight)
• BAYADA: Proactive COVID Safety Plan Helps Client Acquisition, Staff Retention (Dina)
• Finding a New Normal: The Patient Experience (EClinicalWorks)
• 7 must haves for your patient scheduling system (Experian Health)

Contacts

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

Morning Headlines 6/16/20

Walmart buys tech from Carezone to help people manage their prescriptions

Walmart acquires intellectual property and technology from medication management startup CareZone for $200 million.

Augmedics Employees Lead $15 Million Series B Financing to Secure and Successfully Launch Company Amid COVID-19 Crisis

Augmedics will use a new $15 million investment to further scale its augmented reality system, which allows surgeons to visualize 3D spinal anatomy and track instruments and implants while looking directly at the patient.

Microsoft 365: 1.2 million workers to get tools including Teams in this ‘landmark’ software deal

In an effort to improve security and connectivity between its users, England’s NHS will implement Microsoft 365 across its hospital trusts and data teams.

Kalderos Secures $28 Million in Series B Funding to Disrupt Business as Usual in the U.S. Healthcare System

Drug discount management software vendor Kalderos raises $28 million.

Curbside Consult with Dr. Jayne 6/15/20

I had the chance to catch up with a good friend last week. We were talking about the odds of telehealth truly achieving payment parity and continuing into the future. We share a healthy dose of skepticism, mostly around the fact that payers (including CMS) aren’t going to want to pay the same amount for an item that they used to get for less, and in some cases, for free.

Unless they’re involved in administration or work in a multi-state organization, most physicians don’t realize that CMS has different payment rates depending on what part of the country you’re in. These rates vary due to labor and real estate costs – it’s more expensive to hire nurses in the San Francisco area than in rural areas of the Midwest, for example. There have also been special payments to certain sites of care, such as designated Rural Health Clinics.

Providers are excited about being able to see patients in their own homes from their own homes, cutting down on commuting, office costs, budgets for professional clothing, and more. The reality, though, is that CMS and other payers are going to feel like they’re subsidizing your love of fuzzy bunny slippers, and it won’t be long before there is an adjustment.

CMS leadership has stated “I can’t imagine going back” and “People recognize the value of this, so it seems like it would not be a good thing to force our beneficiaries to go back to in-person visits.” I think a lot of folks in the technology space, especially those looking to get their piece of the pie with telehealth, are missing the key connection between doing the work and getting paid for it. Although equal payment drove the expansion of telehealth during the pandemic, it’s a good bet that once the payments start changing ,we start to see more visits being pushed back to the office setting unless providers are participating in programs where they’re paid on a capitated basis versus fee-for-service.

Mr. H picked up on conflicting comments that CMS has made around the long-term viability of telehealth and mentioned them earlier in the week, especially those made during announcements encouraging a return to face-to-face visits that “while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care.” I bet it won’t be long until they begin changing the payment structure.

Another dose of reality comes in the readiness of practices to actually see patients in person. Despite the multiple announcements encouraging patients and providers to get back to business as usual, some facilities just aren’t ready. I continue to hear from colleagues who can’t get adequate supplies of personal protective equipment, and  when they find supplies, prices are exorbitant. It seems like not much has changed since the start of the pandemic as far as the availability of N95 respirators, despite our having had months to ramp up the supply chain.

My employer has provided four N95s to each employee, which we are expected to rotate indefinitely until they become soiled or the straps break, in which case we can get a new one. If I want to take advantage of the Battelle hydrogen peroxide processing unit that my state has brought in, I have to personally drive my masks to a drop point across town, wait three days for them to travel across the state and be processed, and then drive across town to pick them up. We have one option for masks and no formal fit testing (since CDC waived it due to the public health emergency), so doing your own quickie fit test every time you put it on is how we roll. If you become allergic to the foam on the office-provided masks as some of us have, you’re kind of on your own since officially the CDC says we don’t need N95s and that simple surgical masks are OK since there are shortages.

For providers, continuing or expanding telehealth necessitates understanding the reality that telehealth requires a paradigm shift, and not everyone can make the jump easily. You have to go from being able to use reliable measurements performed by your staff to trusting patient-reported data or hoping that your patient can use available technology to capture their vital signs or pictures of a rash. You have to also start trusting other indicators of a patient’s status, such as level of anxiety, tone of voice, etc. that some have tuned out during in-person visits because it seems like many patients are anxious and stressed by the entire in-office visit process, especially if it occurred at a large healthcare complex with parking challenges, wayfinding issues, etc. Additionally, some specialties aren’t amenable to telehealth visits, so brick-and-mortar offices will continue to be a must.

For patients, access can be a double-edged sword. While some rural communities have embraced telehealth as a way to avoid long and time-consuming travel, others struggle with the connectivity that is needed for successful telehealth visits. Although the majority of adults in the US have access to a smart phone, that doesn’t mean that it’s their personal phone or that the access is 24×7. Sometimes it takes patients a couple of visits to get the hang of telehealth, and even then there can be issues with dropped calls or anxiety about displaying video of their living situation.

Only time (and the will of patients and payers) will tell how this is going to play out. If payers cut back, will we reach a point where patients will be willing to pay a premium for telehealth visits? Will clinical employers use telehealth as a way to shift more burden (including scheduling, pre-visit data gathering, and more) onto providers while saving money on ancillary staff salaries? Or will they embrace using ancillary staff to continue to perform pre-visit clinical work to better support physicians? Will telehealth technology improve to a point where it’s almost like being there, perhaps with the addition of virtual reality devices? Will data from third-party tools flow seamlessly into the EHR, or will we be stuck working with multiple systems and siloed data?

I’d be interested to hear what the HIStalk community thinks. What does your crystal ball say? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Gadi Lachman, CEO, TriNetX

Gadi Lachman, LLB, MBA is president and CEO of TriNetX of Cambridge, MA.

What was your reaction when you heard that prominent medical journals retracted two COVID-19 research articles due to concerns about the quality of the underlying aggregated EHR data that researchers analyzed?

It’s easier for me to talk about what we do and how we do it as opposed to talking about other companies. I’ve never heard of Surgisphere, the organization whose data was used.

EHR data is super valuable. In the world of clinical research, you want to use all the tools available to develop therapies, to develop cures, and to save human lives on a massive scale. That goes without saying. There is a powerful do-good in this industry of utilizing data for drug development, for therapy development, to fight disease, and to find cures.

Then, what is data? There are many different categories of data. Claims data, EHR data, data collected in the lab in the process of a clinical trial, patient-reported outcomes, and things like that. EHR data is forever being used in the clinical research realm. Every data type has its pros and cons, and every data type has a lot of value in helping those who develop new cures and new therapies.

I would almost say when you’re developing a new cure or you’re trying to understand a disease, you cannot do that without looking at EHR data, because that tells you what happens in the inpatient and outpatient settings. What happens with those patients? What therapies, what diagnoses, what medications, what do they report as going on with them, and what is the medical community doing to them? Then you follow to see the outcomes of those interventions.

EHR data is fundamentally basic for clinical research and has been widely and popularly used in that space. The question becomes, how can you ensure the quality? How do you know, as a researcher, what data you are looking at and what processes have been put into place and how much capital and human labor has been deployed to ensure the quality of the data?

TriNetX is a global network. We are in 26 countries. We take data for more than 150 healthcare organizations, including the likes of Johns Hopkins, Boston Children’s Hospital, MUSC, University of Iowa, and others. We work with many, many pharmaceutical companies, such as Sanofi, Novartis, AstraZeneca. We interact as a trusted advisor with those healthcare institutions. We are making sure that this EHR data can be used for clinical research. We look at it, we test it, and we compare it to other big data that we have to make sure it’s consistent. We look at how people are coding and inputting the data and report back any inconsistencies. We compare structured data to unstructured NLP data and see if there are discrepancies.

We have deployed $150 million of capital to accomplish that. We have people all over the world. We have data scientists who make sure that the data is clean and consistent. That data is getting a lot of love and attention. It gets to a level of quality where a researcher can say, I trust it. It makes sense to me. I’m going to research on it. I’m going to publish on it. It takes a lot to get to a level of quality that will be acceptable by the industry, by the standards of clinical researchers, and valuable for humankind to drive what we need to drive.

When I read about the processes or the numbers of things that have been published, those numbers didn’t make sense to me. It takes more than a very small group of people to do what needs to be done to get to that level of quality that is required.

In normal times of publishing and research, there is time to do things. We spend an ungodly amount of time on the data quality, but then there is time for the researchers to run it by peers. COVID-19 was almost the perfect storm for this bad episode, where everyone was running so fast that there was no time for researchers to perhaps do the checks and balances and the validation that they would otherwise do. A lot of people with good intentions. Researchers and physicians spend their career to save lives. They were caught in the middle of that perfect storm and they maybe failed. They didn’t have enough time to do what they need to do to check the quality and validate. It was just happening too fast, and this is where mistakes can happen.

Even within a single institution, researchers are sometimes pressing for data that doesn’t exist in the black-and-white form they expect, with consistent validation and procedure across service locations and across EHRs that fits neatly into a table without requiring a lot of analyst footnotes. How do you turn data from multiple health systems into a reliable source for research?

No two installations of the same EHR will ever be alike. Then you compound the problem by looking at different EHRs, then compound it again by looking at different countries.

We have invested a lot of hours and capital in the past six-plus years to tackle exactly that problem that you said. We have almost a Rosetta Stone in our master ontology. We have a centerpiece, a language that TriNetX adheres to. You take the best standards from all over the world and then go healthcare organization by healthcare organization. It doesn’t matter what you find there — you have to map it into your master ontology.

But this is the beauty of it. By mapping it, you develop a deep understanding of how that healthcare organization is talking, because that’s the only way to map it to something that is more coherent and consistent. That is what we do. It’s difficult, but by doing that, you start to create this standardization abstract layers. The analytics that we build, and all the functions that need to interact with the data, can now speak one language because we’re taking care of the translation. It is a massive investment. It is a core component of what we do.

I’ll give you an example. When COVID-19 happened, old diagnoses for old coronavirus conditions existed in the platform. Very quickly the different regulatory organizations started to release new codes to capture those patients, specifically the COVID-19 patients and tests. We implemented those codes immediately. But that doesn’t mean anything because your hospitals have to report on that as well. We work with an amazing network of healthcare organizations that rose to the challenge in starting to report on those codes.

It’s an informatics and software effort on our part, but it’s also a coding and informatics effort on the healthcare organization’s part. You apply all the quality checks and all the work that we do together as a network to be able to then show researchers and government entities that we’re working the results. These are the patients that we see. This is what they have. These are their profiles. Let’s see what’s working, what’s not working. The utilization of drugs, the utilization of everything. Outcomes. This is the result of massive informatics efforts where all the players have to join forces. It worked very well, it worked fast, and it was on a global scale. Not just the US, but hospitals all over the world rose to that challenge.

What questions should researchers ask to make sure the data that someone else collected is appropriate for their study?

You have to work with reputable companies. We announce the names of who joins our network. We openly talk about the quality processes and the checks that we do. We have hundreds of publications that have been reported on our data. It creates a level of trust. A network of more than 40 industry partners — healthcare organizations, life sciences, and and research entities — have been using us for the past six years and have trust.

A researcher will very rarely go to the record level. No one will let them see that anyway. Even if you looked at the record, do you also want to interview the patient? When you interview the patient, do they even know what they have? At the end of the day, you must trust an organization to create a quality data asset for you. You can audit it if you want. We are very open for everyone looking and auditing our processes, how we look at data, how we do our work. There is a lot around data governance, process, and people that we are very open about. We are open to suggestions and always getting better and better. That creates confidence within the research community to use the data assets that we have time after time.

A lot of research has been published in the last many, many years. A lot of the time, we allow researchers to analyze our data to verify that they can replicate the results that have been achieved through other means. By doing that, you create the ability to validate that a similar set of data on which you run a different set of science and algorithms on it gives a similar conclusion. Or you get a different conclusion, but you can explain the difference. That validates that you can trust this data asset, because time after time, it delivers the answers that you expected, which then gives you confidence to start asking new questions.

Are you seeing impactful COVID-19 research being performed using your platform?

It’s a huge impact. The pharmaceutical industry, contract research organizations, government, and we ourselves are publishing around COVID using our data asset. We are helping find a lot of things that are moving the industry forward in this rapid development of cures. For example, we have published that with COVID, compared to other like conditions, you get more strokes with younger populations. We have validated that assumption. It’s a huge learning, because physicians and the frontline people who are treating those patient now know that in young patients, they need to be on the lookout for other things that could be going on and make appropriate diagnosis and therapy decisions. It saves lives on order of magnitude immediately, not to mention providing insight for those who develop the therapies.

We have many examples of uses of drugs and outcomes that we supported. TriNetX has been in the forefront of fighting the COVID-19 pandemic. That makes everybody who works at TriNetX proud.

Morning Headlines 6/15/20

Milliman Announces Acquisition of healthIO to Offer Powerful Preventive Health Solution to Employers

Milliman acquires Wisconsin-based employee health monitoring technology vendor Healthio, which it will pair with its predictive analytics offering. 

NovaQuest’s Clinical Ink in second round of process

The investment firm owner of Clinical Ink is putting the drug clinical trials electronic tools company on the market after owning it for two years.

Remote work continues: Dane County’s top employers not rushing to reopen offices

Thirty-five percent of Epic’s workforce returns to its campus in Verona, WI, with more of its 10,000-member staff expected back over the summer.

It’s Time for a New Kind of Electronic Health Record

Former Mass General Brigham and Cerner executive John Glaser, PhD makes the case to redesign EHRs around the patient-clinician medical plan rather than their current role as a place to record the byproducts it generates.

Monday Morning Update 6/15/20

Top News

Milliman acquires Wisconsin-based employee health monitoring technology vendor Healthio, which it will pair with its predictive analytics offering.

Reader Comments

From Lab Matters: “Re: article titles. I see some that capitalize just the first letter of the first word, while others capitalize each word. Am I stuck in the grammar rules of the past? Please help settle my existential conflict.” I capitalize each word because a title looks like a weird sentence to me otherwise. Not to mention that the style guides of AP, APA, Chicago, MLA, and New York Times all agree that the first, last, and important words of an article’s title should be capitalized. However, a recent AP change suggests using “sentence style” for headlines and websites, where only the first word and any proper nouns are capitalized in a “Hawaiian shirt Friday” kind of formally dictated informality. This would be one of a few cases in which I disagree with AP since it seems to be bowing to those who didn’t know or didn’t follow its longstanding rules, although I acknowledge that sentence case is probably a bit easier to read as long as it is used consistently within the same website. I resolve my existential conflicts on style by carefully thinking through the options, choosing the one that makes most sense to me, and sticking with it, and in the spirit of grammatical harmony in the title capitalization question, I use the original style rather than my own when I cite an article from elsewhere. Let’s not even acknowledge that some health IT vendor website capitalize all letters in their press release and blog titles, maybe the same ones that insist on capitalizing all the letters in the company’s name (which gets put right back to first-letter-only here per AP style).

HIStalk Announcements and Requests

Folks who work in health IT are nearly evenly split over whether they would trust research findings based on aggregated EHR information.

New poll to your right or here: How will the use of virtual provider visits change between now and June 2021?

Welcome to new HIStalk Platinum Sponsor Saykara.The Seattle-based company is working to combat the epidemic of physician burnout that has surfaced from increasingly burdensome documentation requirements and time spent on EHR data entry. They’ve built the first fully ambient and autonomous AI-powered assistant for physicians. Their iPhone app, named Kara, listens to physician-patient conversations, then interprets and transforms the salient content required for notes, orders, referrals, and more, and enters both structured and unstructured data directly to the EHR. Kara is specialty agnostic and being used by doctors all across the country. Data shows that time spent charting is reduced by an average of 70%, after-hours (“pajama time”) charting is eliminated, and note quality and completeness is enhanced by 25%. Saykara was founded in 2015 by Harjinder Sandhu, a serial healthcare technology entrepreneur and former Nuance executive who has stood at the forefront of innovations in speech recognition and machine learning for more than 20 years. See their video featuring doctors from Hancock Health. Thanks to Saykara for supporting HIStalk.

Webinars

June 18 (Thursday) 12:30 ET. “Understanding the ONC’s Final Rule: Using FHIR HL7 for Successful EHR Integrations.” Sponsor: Newfire Global Partners. Presenters: Bob Salitsky, healthcare IT expert, Newfire Global Partners; Jaya Plmanabhan, MS, healthcare data scientist. This fast-paced, 30-minute webinar will provide an overview of the Final Rule and describe how technology vendors, payers, and providers can use FHIR HL7 to deliver true interoperability. Attendees will learn how to define the data, technology, and flows needed for their EHR integration projects; how products can retrieve health information while meeting compliance regulations; and the benefit of adopting quickly to the future of data exchange while simplifying future integration efforts.

Acquisitions, Funding, Business, and Stock

The investment firm owner of Clinical Ink is putting the drug clinical trials electronic tools company on the market after owning it for two years.

A false claims act whistleblower lawsuit brought against EHR vendor Medhost and Community Health Systems by two former CHS IT executives is dismissed, with the judge saying that the “heaps of alleged facts” that were presented don’t prove the claimed misconduct.

Sales

• United Methodist Communities (NJ) will implement systems from VirtuSense and Netsmart as funded by a grant from the FCC’s COVID-19 Telehealth Program.
• MetroHealth (OH) will use the social services referral platform of Unite Us. Co-founder and CEO Dan Brillman, MBA is a US Air Force Reserve major and pilot with campaigns in Iraq and Afghanistan, while co-founder Taylor Justice, MBA graduated from West Point and served as a US Army infantry officer.

People

Digital ambulatory surgery platform vendor ValueHealth hires Don Bisbee, MBA (Cerner) as president.

COVID-19

One-fifth of US nursing homes have less than a week’s supply of PPE on hand despite the federal government’s April 30 promise to help them with their needs to address COVID-19, which has killed 43,000 residents. Many have not received PPE shipments, some received only cloth masks and low-quality ponchos, and most say the quantities they received will last only a few days. The head of one Catholic nursing home group concludes, “The federal government’s failure to nationalize the supply chain and take control of it contributed to the deaths in nursing homes.”

A Seattle man who recovered from COVID-19 after a 62-day hospital experiences survivor’s guilt after seeing his hospital bill of $1.1 million, which doesn’t include the two-week rehab stay that followed. Medicare will cover most of his bill and he may pay nothing because of the federal government’s COVID-19’s bailout money, which the Seattle paper says is “like we’re doing an experiment for what universal health coverage might be like, but confining it to only this one illness.”

Rates of new cases and test positivity are trending up in Arizona, California, Florida,and Texas, suggesting that hospitalization and ICU bed usage will be increasing to possibly dangerously high levels over the new few weeks.

A new study of COVID-19 in Japan finds that symptom-free people aged 20-39 were most often the source of primary exposure, while healthcare facilities were most often involved. The authors also conclude that close-proximity singing, cheering, exercising, and bar conversation were associated with many of the clusters.

Other

Former Mass General Brigham and Cerner executive John Glaser, PhD makes the case to redesign EHRs around the patient-clinician medical plan rather than their current role as a place to record the byproducts it generates. He advocates keeping existing EHRs while addressing specific needs via wrap-around modules that providers can buy to meet their specific challenges (population health management, HIEs, patient-facing apps, and analytics). The next-generation EHR should include:

• A library of situation-specific care plans.
• Treatment algorithms.
• A master plan that is supplemented with to-do lists for each type of caregiver.
• Interoperability that allows the plan to travel across care settings, geographies, and EHRs.
• Decision support and workflow.
• Analytics tools that assess the patient’s individual plan and apply relevant lessons learned from the broader patient population.

County-owned, 647-bed New Hanover Regional Medical Center (NC) entertains acquisition and partnership offers from the state’s big health systems, with Duke Health offering $1.35 billion, Novant committing to $1.5 billion at closing and $2.5 billion in improvements, and Atrium Health offering a 40-year lease at $28 million per year and along with $2.2 billion in improvements.

Epic sends an internal email only to its diversity, equity, and inclusion employee groups, warning them that they should not participate in a virtual walkout in support of Black Lives Matter. Some white employees complained to the local paper that the email should have gone to everyone.The company also updated its employee policy to limit use of company resources for work purposes.

In Canada, the medical association of Newfoundland and Labrador complains about the government’s new app that connects people with a nurse practitioner in an extension of its 811 HealthLine telephone program. The doctors are unhappy that they weren’t consulted and are worried that the NP won’t see the patient’s electronic record, but the health minister says that’s a problem in general because some doctors use paper charts, some use an EHR, and some use Meditech’s regional implementation. He adds that the service was launched because people are happy with their virtual visits with doctors and they are equally effective as face-to-face visits in most cases, also noting that doctors don’t have a monopoly on providing healthcare services.

Sponsor Updates

• ChartLogic is named as a SoftwareAdvice.com’s EHR FrontRunner.
• PatientKeeper wins a Bronze PR Club Bell Ringer Award for its integrated marketing communications strategy.
• The local paper profiles PerfectServe’s efforts to provide providers with free software and services during the pandemic.
• The Big Unlock podcast features Phynd CEO Tom White.
• Redox releases a new podcast, “Powered by Battery with Redox CEO Luke Bonney.”
• Summit Healthcare names Amanda Mehlenbacher (Nicholas H. Noyes Memorial Hospital) implementation engineer.

Blog Posts

• How health systems can optimize revenues and resources (Ingenious Med)
• AI in Healthcare: 3 Tips to Avoid Common Pitfalls (Pivot Point Consulting)
• The Not-so-New Normal (PMD)
• Meeting Unparalleled Demand for Critical Supplies and Drugs (Premier)
• Explore the Pure//Accelerate “Un-keynote” Keynotes (Pure Storage)
• Virtual Patient Waiting Rooms: What They Are, Why You Need One, and How to Create It (Relatient)
• In Favor of the Shift (SailPoint)
• Classifying Data Processing (Spirion)
• Checking Up on Content, to Check in with Patients (StayWell)
• Right Around the Corner: 2021 CMS Rule Requiring Real Time Benefit Tools (Surescripts)
• End-of-Life Visitation with Safety and Compassion (Vocera)
• Everything You Need to Know About Legally Providing Telehealth (WebPT)

Contacts

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

Weekender 6/12/20

Weekly News Recap

• A new investment in workforce management software vendor QGenda values the company at $1 billion.
• Conversa, PatientPing, Wellsheet, and Kyruus announce significant new funding.
• Only three states have committed to using COVID-19 contact tracing apps from Apple and Google.
• GAO says the VA is doing a good job of getting clinicians involved in its Cerner implementation, but suggests choosing broader representation at its local workshops.

Best Reader Comments

If the medical record is not reconciled, then the source system is part of the problem. However, I have yet to see a system that has entanglement of the data that has been exchanged. Meaning that if Clinic A provides a referral for a preliminary diagnosis and the specialty adjusts the diagnosis and adds a new diagnosis, is the provider notified? That is the goal of 360x, but how many have implemented it — Cerner, Epic ? (Brody Brodock)

Once there are only a few EMR vendors left, then you can start telling your customers that they can’t do the thing in a way that prevents interoperability. The government could mandate that the EMR companies provide interoperability, but it either won’t work or will drive certain EMRs out of business. The situation is FUBAR in that respect. The problem is that healthcare delivery and organizations just aren’t that standardized and process oriented. They’ve never been exposed to the sort of environment that produces that. What we need isn’t a technology standard, it’s a process standard. As an example, accountants use GAAP so that they can calculate the revenues, losses, etc. for their company. When someone tells me their GAAP deferred revenue, I know what they mean and how they calculated it. When someone tells me that a patient has an active medication in their chart, I don’t have a good idea about what that means. (IANAL)

Due to my own illness that I’ve been dealing with for a decade plus, during the COVID surge, I’ve had five telehealth visits, one with PCP, others with specialists. Each started right on time, each accomplished what was needed effectively and efficiently. I dread the thought that there may be a retrenchment of telehealth and I’m forced back to in-person visits. I will resist. (John)

I’ve been in healthcare tech for over 30 years, sat on the HIMSS board, and been a member until 2016 when I came to the decision that HIMSS only cares about three things, money, promoting its own agenda, and removing alternate opinions from the dialogue. Until its membership and that of the vendor community wakes up and understands that those simple truths about what motivates HIMSS or its current leadership, nothing will change. I agree with HIStalk that HIMSS more than likely cannot afford to refund the money it collected without digging deep into the leadership’s compensation and its political machine lobbying Capitol HSill. It is my belief that its time to abandon HIMSS and allow it to either make it as a for-profit organization, which is what it really is verse it hiding under the veil of a non-profit, which it hasn’t been for decades. The educational aspects of HIMSS can be easily replaced by regional groups who can provide localized and national educational content by collaboration and by working with vendors who in lots of instances will pick up the costs. The vendors can form their own association with dues and hold an annual conference that they own, manage, and set the time and place. This would reduce costs all the way around facilitate greater transparency. (HIMSS Insider)

I’m pretty comfortable with a hospital firing a nurse who openly wishes for the death of people she doesn’t like. She is not able to fulfill her job functions. Not only did they do the right thing in firing her, if I were them, I’d also go back and do detailed reviews of all patient cases that she handled to look for irregularities or disparities in the care (“care”) she provided to people — before someone recognizes her as having been on a care team responsible for them or for a family member and starts asking questions about a bad outcome. (HIT Girl)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Mr. H in California, who asked for a computerized scientific calculator for his high school class. He reported in mid-February, “Because of your donations, my students will be able to learn about how an advanced graphing calculator works and get experience using this technology that will be an important aspect of their future math classes. Our school does not have the resources to provide all teachers with class sets of graphing calculators, but with this project, I can begin to teach students about how to use this advanced technology and provide exposure to it they will remember in their future math classes. In order to support future students in STEM subjects, students need to be familiar and have experience using technology and your donations have made that possible in my classroom.”

Creation and operation of a 1,000-bed COVID-19 field hospital in the New Orleans convention center cost $192 million, three-fourths of that provided by federal taxpayers. Occupancy peaked in early April with 108 patients and officials kept extending the contract even as patient count dwindled. Nurses who had nothing to do were paid $243 per hour with a guaranteed 98-hour workweek with time-and-a-half for overtime. The bored staffers volunteered to leave, but were told that it was a government contract and to keep showing up to sit around.

Healthcare staffing provider TeamHealth fires ED doctor Steve Huffman, MD, who is also an Ohio state senator, who asked during a public hearing on racism, “Could it just be that African Americans or the colored population do not wash their hands as well as other groups?” He defends his question as relevant to public health, and while admitting that he worded his question awkwardly, says “colored population” seems to be interchangeable with “people of color.”

Michigan’s Medicaid medical director is reprimanded and fined after admitting that he did not use the state’s prescription drug monitoring program system when prescribing opioids in his private practice.

UF Health Jacksonville suspends a 72-year-old doctor following complaints that he groped female patients, stashed money in their underwear, and undertook his examination of a 70-something woman’s neck mole by kissing it.

NBC News finds that Facebook’s feel-good TV ads that featured members of its Groups expressing support for healthcare and other frontline workers was faked, with none of the feature postings coming from actual Groups. Facebook admits that it mocked up the posts using stock photos and its own employees posing as group members, which it says was due to privacy concerns. The non-fake “Cheers For the Frontline!” group, unlike its happy TV counterpart, is struggling with spammers and trolls.

Doctors remove a mobile phone charging cable from the urethra of a man who told them, unaware of the anatomical impossibility of his declaration, that he swallowed it. Trust me that you do not want to watch the doctor’s Facebook-posted video of the removal procedure.

In Case You Missed It

• News 6/12/20
• EPtalk by Dr. Jayne 6/11/20
• Readers Write: An Interoperability Data Challenge — Out and Back Demonstrating Reflection
• News 6/10/20
• Curbside Consult with Dr. Jayne 6/8/20
• Monday Morning Update 6/8/20

Get Involved

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

Morning Headlines 6/12/20

Wellsheet Raises Series A Funding for Healthcare Workflow Platform to Reduce Time in the EHR and Physician Burnout

Provider workflow optimization company Wellsheet raises $3.8 million in a Series A funding round.

Leading Virtual Care Platform Conversa Health Raises $12 Million as COVID-19 Accelerates the Need for Digital Health

Automated virtual care vendor Conversa Health raises $12 million in a Series B funding round.

Apple and Google’s ambitious COVID-19 contact-tracing tech can help contain the pandemic if used widely. But so far only 3 states have agreed — and none has started to use it.

Just three states – Alabama, North Dakota, and South Carolina – will use contact tracing software from Apple and Google, while 17 have said they won’t use any apps and 19 remain undecided.