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Morning Headlines 11/12/20

November 11, 2020 Headlines No Comments

RxVantage Acquires onPoint Oncology

App-based life sciences resource company RxVantage acquires OnPoint Oncology, which offers oncologists reimbursement data and analytics related to cancer care.

SA Health scores $200m to complete ehealth records system rollout

In Australia, SA Health will spend $146 million to finish its stalled roll out of Allscripts Sunrise EHR and patient administration system over the next three years.

Hendrick Health System shuts down IT networks because of ‘security threat’

Hendrick Health System (TX) shuts down IT systems at its main campus and several clinics after becoming aware of a network security threat.

Book Report: “UnHealthcare: A Manifesto for Health Assurance”

November 11, 2020 Book Review 3 Comments

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Spoiler alert: a technologist turned billionaire investor opines that healthcare can be saved only by technologists and billionaire investors.

Non-healthcare people who sell books or companies are always predicting the suddenly imminent rise of consumerism that will upend the deeply entrenched healthcare establishment. They say (and sometimes even believe) that our smart phones will empower us consumers to Uberize an industry of insurers, drug and device manufacturers, doctors, health systems, and politicians. Our discretionary healthcare spending and technology assets will force them to cower to our demands to be treated as individuals and choice-empowered customers.

Do you feel more empowered in your dealing with hospitals, doctors, pharmacies, and your insurance company? Has your phone disrupted the status quo and created a choice-laden healthcare environment of competition and price transparency? Has your armada of consumer technology made you healthier? You probably won’t like this book if not, because it is re-promising a brave new healthcare world in arguing that the old one can’t survive despite the fact that the entrenched players keep getting bigger, richer, and more influential.  

Hemant Taneja started and sold Livongo and other companies, making him a billionaire. Steve Klasko, MD, MBA runs Thomas Jefferson University and Jefferson Health, and while I guess he’s not quite in the billionaire category, he has augmented his generous Jefferson millions with lucrative board seats and participation in a freshly planned IPO of Teneja and other Livongo alumni. The world view of the authors isn’t necessarily yours or mine, either as industry participants or patients.

Both authors think that Livongo’s diabetes management technology was a game-changer, although last time I looked, we still have a few dozen million diabetics in the US, many of whom can’t afford insulin, much less Livongo. Livongo certainly did a good job in convincing employers to pay for its service and also convincing Teladoc Health to buy it for $18.5 billion so it could offer something that is synergistically sexier than selling plain old telehealth visits, but I’m not smart enough to determine whether it measurably improves the health of its users or the medical costs they incur, much less that it has revolutionized American healthcare as a whole.

The authors believe in the concept of “health assurance,” where people keep themselves healthy by being constantly wired up to sensors that pump out a continuous stream of real-time data that is dutifully and invisibly overseen by artificial intelligence. This, they predict, will “help us mostly forget about doctors, pills, hospitals, and insurance companies.” It will be consumer centric, data driven, cloud based, and built using open technology standard and empathetic user design (Taneja’s technologist identity comes out pretty strong here in focusing on the geek factor).

The key to reinventing healthcare, the authors insist, is bringing in tech startups, rewarding them with billion-dollar valuations, and then standing back while they disrupt everything in sight. I’m not opposed to that idea, but the track record of eager, naive outsiders hasn’t been pretty. Nobody knew healthcare could be so complicated.

Healthcare wasn’t built to be consumer friendly, the authors argue convincingly. It was built on the concept of mass production to address the scarcity of doctors, hospital beds, medical devices, and drugs that doesn’t really exist today. Baby boomer demographic changes, along with employer-provided health insurance, marginalized patients as a mostly powerless widget that was milked profitably by various healthcare fiefdoms who always blame everybody else for high cost and low quality. All of this is true.

Klasko explains that Jefferson Health paradoxically had to scale up (via acquiring competitors and starting new businesses) to allow it to eventually unscale sometime down the road. He claims Jefferson will then emerge butterfly-like as a wellness brand with no physical address, freed of the incentive to crank out profitable procedure volumes. Sounds great, but I haven’t seen many examples where the health system that was scaling up voluntarily took a less-profitable but more consumer-centric path down the other side. Expecting people or companies to do something that doesn’t pay them the most is usually cause for disappointment.

I can’t decide whether Klasko’s business dealings make him a better or worse advocate for a new business model for non-profit healthcare systems, but “non-profit” is more about accounting than mission for many health systems these days anyway. Still, both authors stand to make even larger fortunes if their tech company healthcare bets pay off, so maybe a bit of skepticism is warranted when their tech hammer is on the lookout for nails to pound.

Back to the healthcare assurance concept. You don’t need to have physicals or see your doctor until AI – which will be provided by a health system as part of a pre-primary care subscription — flags your data as unusual. Then you will complete a chatbot questionnaire and then see a doctor – probably virtually – and if something seems amiss, booking your appointment online, being updated with SMS messaging that eliminates the need for a waiting room, and spending time actually talking to the doctor since they don’t waste visit time taking measurements that the sensors have already sent them. That makes good sense, depending on the accuracy and completeness of the available sensor inventory (which is minimal at present).

I’m not sure I agree with the authors that the next logical step is that pricing will become transparent and insurance will return to its original form as being a hedge against risk, not a way to pay for routine services that are otherwise unaffordable. You would need more than 134 pages to explain how that could happen. UnitedHealth Group has more money that even Hemant Taneja and seems disinclined to make less of it.

Taneja is an investor in Ro and he loves their model of cranking out telehealth visits to sell ED and insomnia prescriptions online. Whether that is a consumer-friendly innovation or a lapse of professional responsibility by its doctors is beyond the scope of this discussion. The psychology of men who are embarrassed to tell their in-person doctor about their receding hairlines is probably different from someone who is facing a life-threatening condition that will never go away.

The authors also like the tech-heavy healthcare membership system of Forward, which uses biometrics, blood tests, genetic analysis as a baseline to then offer monitoring and unlimited visits for $149 per month, with no insurance accepted. They think that services like this could be targeted to subgroups such as those over 70, pregnant women, or young athletes as a form of unscaling. This seems perfectly logical and immediately achievable to me, although I’m sensitive to the fact that while many of us can afford these cash-only services, most Americans can’t and will still be staring at “The View” while being coughed on by the fellow occupants of whatever waiting rooms are left.

Health assurance would require fewer people in administration, but more in customer service, marketing, and technology. High-income proceduralists (dermatology, radiology, orthopedics) would become less valuable and thus paid less than family doctors and pediatricians. Medical schools would need to place less value on memorization skills and instead look for incoming students who exhibit empathy, creativity, and communication since they will need to treat the entire patient (sleep, diet, exercise, etc.) Hospitals will become the post office in the age of email, and insurers will be hurt most as the need for their middleman services is greatly reduced. If you want to disrupt those huge, highly profitable entities that will spend whatever it takes to keep the goose laying golden eggs, you’re going to need a bigger boat.

The authors posit that we’re at a tipping point (aren’t we always, according to authors?) because of the weaknesses COVID has exposed and the high premiums and deductibles of health insurance, which will turn most people cash payers against their will and encourage them to seek good experiences at good value.

From the regulatory point of view, the book calls for a single national medical license (agreed) and to redefine FDA’s role in safety and efficacy in regulating only the former and letting the market judge the latter (they say Livongo was held back by FDA’s efficacy requirements, wah).

As a curmudgeonly skeptic (or experienced realist, perhaps) I agree with some points of the book, but I would not predict a mass overhaul of a system that regularly lines lawmaker pockets to retain the status quo, especially if companies expect cash-strapped Americans to cough their own money to pay for gadgetry and services that mostly interest the worried well who are striving for data-powered immortality. In that regard, I would say this book’s emphasis on highly valued startups and profitable disruption makes it more of a business read than a balanced review of meeting society’s healthcare needs equitably and funding it as a public good. As a non-profit hospital lifer, I’m already uncomfortable with the idea of having a hospice owned by a private equity firm.

I’m also not convinced that today’s sensors and the invasive nature of wearing them can provide enough data to function like a car’s gauges and warning lights for a remote observer. The connection between DNA and health, or even medical treatments, has barely been touched, and has little impact on medical decisions. We haven’t asked doctors what information they would need to replace the traditional exam, assessed whether today’s sensors can provide that data, or proven that streams of patient data makes them healthier or avoids cost (and in fact, whether we should also ask them how they feel or have concerns that sensors can’t measure). Do you want your doctor to be a trusted life ally or a savvy mechanic, and what are you willing and able to pay for your vision of healthcare?

My review of “The Patient Will See You Now,” I realize, is similar to this one, although that review was funnier and snarkier. That book came out nearly six years ago – are we disrupted yet?

HIStalk Interviews William Febbo, CEO, OptimizeRx

November 11, 2020 Interviews No Comments

William J. “Will” Febbo is CEO of OptimizeRx of Rochester, MI.

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Tell me about yourself and the company.

I’ve been the CEO and director of OptimizeRx for the last five years. I have 20 years experience in health technology. More specifically, I always find myself drawn to the challenge of connecting the life science industry with healthcare providers like doctors, both clinically and commercially. I focus on technology, data, and compliance as the key drivers.

OptimizeRx is a digital health platform that focuses on bringing adherence and affordability solutions to healthcare providers, patients, and the life science industry. We are publicly listed on the Nasdaq.

What are the ethical considerations involved with presenting sponsored product information to physicians within their EHR workflows?

We are highly focused on that. Our goal is to help drive positive patient outcomes by supporting patient affordability and overall adherence to doctor-recommended treatment plans. The doctor is driving the bus here, and anything we do is going to be triggered by activity the doctor is doing.

The market is fragmented. Doctors use electronic health records from many companies and spend hours a day on them. The last things we would want to do is add more clicks and distraction that would slow down their day and or bring content that’s just not relevant to that point-of-care experience.

We have a strong filter. Our partners have a strong filter. When you are trying to help patients and doctors with affordability and adherence, it’s really about connecting at the right time with the right people. There are certainly rules that apply. Compliance is a big piece for me when you’re trying to help in this arena. We understand that incredibly well, as do our EHRs who manage all the data. We have several filters layered in there, plus laws, and we respect them all greatly. We are helping the doctor prescribe what they want, then helping the patient afford that based on the insurance they have.

The other piece of the equation is that once people have their medication, how do you help them stay on it? We’re a big believer in SMS text as a way to stay connected to the patient once they have double opted in on that. We see compelling results when they make that choice. They are always given the flexibility to not engage or to stop being engaged.

How do you decide the best opportunities to pursue now that you have created the network and are engaging participants in it?

We have a team that has a lot of depth in terms of the life science industry, as well as the technology around networks. We focus on is the patient journey, the care journey, that we’ve all experienced personally. It sounds like industry talk, but you feel something, you go to the doctor in various settings, you’re then in the system through diagnosis and prescription, and then you pick up medication or have it delivered. We focus on the pain points for our clients, the doctors, and the patients along that journey. If we don’t meet those three criteria, we just don’t do it. 

This is not a pure advertising model. This is a model where the life science industry can bring messages — mostly clinical in nature, mostly unbranded — and give the doctor some information at a time when they’re thinking about a particular disease or therapeutic area. Then as the patient is leaving that setting, we want to be able to stay with them and help them understand and afford the medication treatment and to have the support be there. It’s through a mobile device and chatbot, which sounds like it isn’t real, but it’s better than being alone and often that additional support is what keeps people on the therapy the doctor has selected.

How do you connect your innovation lab to the folks who assess market need?

The innovation lab is really exciting. We partner with our channel partners, which can be an EHR, someone at point of dispense and retail pharmacy, or someone who does digital appointment scheduling. We focus in on those pain points. 

What has been exciting over the last few years for all of us — not just OptimizeRx, but other people in this space — is that we have both sides of the equation, the clients who can finance it and the users, providers and patients who are engaged and open to using these new methods of connectivity.

When I came in about five years ago, this company had one solution, which was focused on basically digitizing the co-pay and getting that to the doctor so they could enable it for a prescription after selection and help the patient. When we looked at all that, and we looked at our partners, we saw that there were just so many other solutions that we could bring that could address a pain point for the client, the physician, the patient, or all three. We focus on those at the innovation lab. 

We have in the recent past rolled out a hub-enrollment forms, which is in-workflow digitized, which is a pain point for physicians, anyone in the administrative side within a physician’s office, and the patient. It simplifies the paperwork process and the signatures required to process hub enrollment for a specialty medication.

We’ve also rolled out something called TelaRep. This came out of the disruption that the life science industry saw with their sales reps. Physicians can, within the workflow of the EHR, reach out to a sales representative with a question. They can do that by text or email, saying give me a call or they can do it actually through a telehealth type of video type interaction. We are really proud of that one because it, first of all, we had the technology, so we went to the innovative lab partners and said, look what we can do. Pharma had a real challenge with reps being at home, but doctors still have questions. If you look at the number of questions doctors had that went through the MyViva program and others, it’s exponentially higher. It showed that reps answer a lot of questions for doctors, around dosage, mostly. 

Those are two examples of solutions that came out of the innovation lab, where we’re close to the partners. We could talk to the clients and we could launch them all within six months, which we are very proud of.

What motivates EHR vendors to give you access to their workflows?

They are focused on their members. Helping doctors deliver care. Having the right tools to do that, to effectively try to spend less time on the EHR and more time with the patient. When we bring solutions like TelaRep and hub enrollment, it’s clear that that’s a tool for the doctor. That’s a pain point.

The other things that doctors have highlighted to the EHR partners is financial burden and any way you can bring those costs down. Patient education is another one. Prior authorization is another pain point that companies like CoverMyMeds address. We focus in on those pain points, and our partners know those pain points even more than we do because they hear from their members, the physicians. It’s a good filter test to not bring things that wouldn’t work for the doctor.

How has the pandemic changed the use of your product?

The life science industry has billions of dollars set aside for co-pay programs. We saw an increase in demand and awareness for that given the disruption in the economy for people. We also focus on specialty medications more than the gen meds, and while gen med certainly dropped because office visits dropped, you can’t go off specialty medications. You really have to stay on them. 

We saw our partners who didn’t have telehealth solutions immediately adopt it any way they could just so that they could keep a sidecar to the EHR, keep that connectivity going. We were impressed with how that was handled by everybody, because that’s a behavioral shift. Adoption rates were relatively low around telehealth and they went immediately high because they had to. The good news for everybody — patients, doctors, industry, and our EHR partners – since it is an efficiency all around. It should save time and money and keep care going through times of disruption.

Are you receiving inquiries about how your platform could help with distribution of a potential coronavirus vaccine?

When this pandemic hit in February for all of us here in the States, we as a team obviously immediately went to no travel and stay at home, like everybody. But we said, let’s make our technology available for doctors and patients for CDC alerts. Let’s just do that. Let’s not charge anything, let’s just do it for free. That’s our way of helping in a small way and it felt really good.

We immediately put those CDC alerts into the workflow for our partners. Doctors were able to see them. We allowed patients to set up an SMS text program for free, which is still active. I view the short term in a similar format. We have an opportunity to help our clients get to those targeted populations of patients that are going to be needing to take the vaccine first.

This is not going to be a rollout for everyone to take it. The CDC will segment the market, find those in need, and go to there first. We think we have a great position to help our clients through that network and we stand ready to do it. Some of those conversations are starting. Obviously we all were thrilled to see the news from Pfizer this week. I think we’ll see others, but there’s still a lot of logistics between today and when they would need to communicate to the HCPs.

This week’s earnings call had a lot of enthusiasm and momentum that struck me as being more genuine that I sometimes hear. You’ve made a couple of key acquisitions, are using your innovation lab, and your product is doing well. Where do you want to take the company in the next several years?

We are small enough to be incredibly sincere. As you get bigger, it does get a little harder, but culture is big and we’re all in it to help outcomes and build a business.

We cited a McKinsey study that found that nearly 70% of US consumers use an online channel to manage health and wellness. Over 50% of US healthcare providers are digital omnivores who use three or more connected device professionally. I think of the network that we have already created and how we are expanding into retail and devices connected to medical professionals and patients. 

I see us as becoming a preferred digital communication platform for life sciences, principally patients and doctors, while being focused on affordability, adherence, and a little bit of care management. We are very fired up to get this kind of behavioral shift, which a lot of marketing dollars can’t even buy. Something has to push the shift.

I’ve been in the industry for 20 years and pharma is incredibly innovative clinically, but cautious commercially. We are at a stage where a lot of the digital solutions combine data-driven insights, compliance, and transparency, and those are matching nicely with the devices we all carry and use and our expectations for them. We do our banking. We do our shopping. Why wouldn’t we manage our health there? It makes for an exciting next three to five years as we try to reach more physicians, reach more patients, and help our clients drive outcomes.

Morning Headlines 11/11/20

November 10, 2020 Headlines No Comments

HST Pathways and Casetabs Merge and Secure Majority Investment Led by Bain Capital Tech Opportunities

Ambulatory surgery center software vendors HST Pathways and Casetabs will merge with the support of investments from Bain Capital Tech Opportunities and Nexxus Holdings.

Carbon Health Secures $100M in Series C Funding to Become Leading National Healthcare Provider

Tech-enabled primary care company Carbon Health raises $100 million in a Series C funding round, bringing its total raised to $172.5 million.

eClinicalWorks, LLC – Corporate Integrity Agreement

HHS OIG imposes additional Corporate Integrity Agreement terms on EClinicalWorks, which paid $155 million in 2017 to settle false claims act charges.

Cigna Ventures, Humana, and Optum Ventures Among Investor Set Re-Upping in Buoy Health Series C Financing

AI-powered symptom checker and provider search startup Buoy Health raises $37.5 million in a Series C investment round led by Humana and Cigna Ventures.

OptimizeRx Third Quarter 2020 Revenue Up 110% to Record $10.5 Million, Driving Non-GAAP Net Income of $1.1 million or $0.07 Per Share

OptimizeRx announces Q3 results: revenue up 110%, adjusted EPS $0.07 versus –$0.07, with shares jumping 10% to give the company a valuation of $350 million.

News 11/11/20

November 10, 2020 News 15 Comments

Top News

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Managed care company Centene will acquire AI-powered healthcare analytics vendor Apixio for an undisclosed amount.

The acquisition comes at a time of strong growth for Apixio, which expects its annual revenue to increase by 50% and its staff to expand by 25% by year’s end.


Reader Comments

From UpAndComer: “Re: HIStalk. I look at it quickly each day or two, but it’s too long to read.” Some folks have short attention spans, where any block of text longer than a tweet creates an eye-rolling “TL; DR” that suggests writer incompetence. Spend 5-10 minutes per day reading the HIStalk headlines and scanning the news posts and you’ll be keeping up with the industry that employs you. About 90% of readers say reading here helps them do their job better, and not to be conveniently negative, their doing a better job might involve taking someone else’s because they are willing to put more effort into it.


HIStalk Announcements and Requests

Wednesday, November 11 is Veterans Day, where we celebrate the service of those American men and women who have – living or dead, in war or peace, and in assignments domestic or foreign – put on a uniform for our common good. Around the world, Commonwealth nations will honor their war dead Wednesday on Remembrance Day, which is more like our Memorial Day.


Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the “network door” they can open. This network infrastructure-oriented webinar will address overcoming the challenges of architecting a network to provide security, management, and monitoring for IoT, devices, and users using ALE’s Digital Age Networking blueprint, a single service platform for hospital networks. Digital Age Networking includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will describe enabling COVID-19 quarantine management, contact tracing, locating equipment and people, and ensuring the security of patients and more.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

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

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

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

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


Acquisitions, Funding, Business, and Stock

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Digital health company Eko will use a $65 million Series C funding round to launch a remote-monitoring program for cardiopulmonary patients and expand clinical use of its devices and algorithms for disease screening.

Ambulatory surgery center software vendors HST Pathways and Casetabs will merge with the support of investments from Bain Capital Tech Opportunities and Nexxus Holdings.

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OptimizeRx announces Q3 results: revenue up 110%, adjusted EPS $0.07 versus –$0.07. Shares jumped 10% on Tuesday, valuing the company at $350 million. OPRX share price is up 130% in the past year versus the Nasdaq’s 36% gain.


Sales

  • BrightStar Care joins Dina’s home care coordination network.
  • Townsen Memorial Hospital (TX) will implement CPSI’s Evident cloud-based EHR and TruBridge RCM software.
  • Allegheny Health Network (PA) will install Omnicell’s automated medication dispensing systems at its 13 hospitals.

People

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Colleen Woods, MITM, MPA, MA (CMH Consulting Group) joins Integrity Health as CIO.

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Rachel Feinman (Florida-Israel Business Accelerator) will join Tampa General Hospital (FL) in the new role of VP for innovation, which will include oversight of the hospital’s new InnoVentures fund, accelerator, and lab.

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Mark McArdle (ESentire) joins Imprivata as SVP of product and design.

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Impact Advisors promotes Kim Reitter, MBA to VP.

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Cheryl Cruver, MPA (Sonifi Health) joins AGS Health as chief revenue officer.


Announcements and Implementations

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The 673d Medical Group in Alaska, including the Eielson Air Force Base and Joint Base Elmendorf-Richardson, goes live on Cerner as part of the DoD’s MHS Genesis program.

PatientPing connects to the MedAllies National Provider Directory to better enable providers to send patient care transition notifications via Direct messaging.

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A new KLAS report on ambulatory patient intake management finds that top player Phreesia has improved its patient check-in tools with at-home forms and questionnaire completion that includes COVID-19 screening, while customers of Epic and Athenahealth-only Epion Health say they are receiving near daily, free COVID-19 self-service updates covering check-in and payment. AdvancedMD has stopped marketing its high-performing, EHR-agnostic solution outside its own EHR user base. Top rated for increasing office efficiency are Epion Health, Phreesia, and OTech Group. The report issues a marketing warning about CareCloud Breeze, which it says “consistently and significantly underperforms” with poor support and customer upselling under new owner MTBC, which acquired CareCloud for $36 million in January 2020.


Government and Politics

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HHS OIG imposes additional Corporate Integrity Agreement terms on EClinicalWorks, which paid $155 million in 2017 to settle false claims act charges. OIG will require the company to:

  • Send a Patient Safety Issue Advisory to each customer’s patient safety contact, notifying them that ECW’s EHR creates a material risk of patient harm from reported incidents of data loss, prescription errors, and having the information of different patients display in the record of a single patient.
  • Enhance its Patient Safety Notifications to include a plain-language problem description and how customers can mitigate or correct the issue, also flagging those issues that place patient safety at risk.
  • Submit a monthly progress report describing the company’s progress on fixing known issues such as: (a) problems handling special characters, assigning incorrect data types, and truncating data; (b) displaying data from multiple patients on a single screen; and (c) failing to code allergens to they can be used to perform automated drug-allergy checks.

COVID-19

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Pfizer announces that its coronavirus vaccine is showing 90% effectiveness so far in clinical trials, exceeding the expected 50% to 60% effectiveness level and potentially clearing the way for a mid-December emergency use authorization from FDA. The company has not published its data yet and cautions that it does not know how long the vaccine’s protection will last or whether new safety concerns will emerge as the study continues. Manufacturing and distribution challenges must be overcome, as do those involving consumer reluctance. The vaccine was not developed as part of the US government’s Operation Warp Speed — Pfizer decided to spend its own money instead of that of taxpayers to free its scientists from external involvement.

FDA gives emergency use authorization to Lilly’s antibody treatment for COVID-19, allowing its use for non-hospitalized patients as soon as possible after a positive test. Obese people over age 65 appear to benefit most from the treatment. Lilly says it can manufacturer enough doses to treat one million people by the end of the year, although the US is running 110,000 new infections each day.

A cell phone tracking study finds that a small number of “super-spreader” geographic points of interest account for most coronavirus infections, and limiting occupancy at those locations is more effective than broad lockdowns to prevent spread. The study of hourly cell phone movement of 98 million people also finds that the higher rate of infection among disadvantaged groups is associated with their inability to reduce mobility and their more frequent visits to crowded locations.

Tulsa health officials say that no ICU beds are available in the city. Meanwhile, El Paso is almost out of ICU beds, one in five coronavirus tests are coming back positive, and a single funeral home has 220 bodies waiting for burial or cremation, most of them due to COVID-19.

Patient safety organization ECRI finds that more than 50% of disposable isolation gowns it tested failed to meet even the lowest level of protection against pathogens that include coronavirus. They warn that gowns that are manufactured outside the US or obtained from non-traditional suppliers may not be safe and effective despite their appearance, labeling, or packaging. ECRI recently found that 70% of China-manufactured KN95 respiratory masks failed US standards.

Cleveland Clinic makes its COVID-19 risk prediction model available to any patient with access to Epic’s MyChart patient portal. Patient risk scores are then automatically shared with their providers.

AMA announces coronavirus vaccine-specific CPT codes to allow tracking, reporting, and analyzing use of the two likely products.


Other

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Sky Lakes Medical Center (OR) says that an October 27 recent ransomware attack from which it is still recovering will hit the 176-bed hospital’s bottom line hard even with business interruption insurance, as it has had to cut back on elective and outpatient services and will need to replace 2,000 computers.

Wired magazine notes that CMS will soon start paying for existing AI-powered diagnostic tools for retinopathy and for detecting strokes from CT scans, a milestone in having Medicare pay for software analysis rather than provider time alone. Providers say that CMS’s proposed payments may not be sufficient to encourage screening using the AI tools.

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A Bloomberg Businessweek analysis ponders whether Hims – which offers telehealth-prescribed erectile dysfunction and hair loss drugs at prices much higher than those of local pharmacies – is misusing its “shiny veneer, wellness lingo, and ability to prescribe over the Internet” to make prescription medications too easy for people to obtain. The article notes that each Hims doctor cranks through hundreds of online patients per week, they often prescribe drugs for uses that FDA has not approved, and the company treats doctors like salespeople who are “leasing your license for $100 per hour” instead of clinicians who are looking out for the best interest of patients and adhering to medical ethics. The doctors say they are pushed to approve nearly every prescription and are lied to by patients who misrepresent their medical history just to get the drugs they want. State-level telemedicine restrictions have been mostly lifted, so telehealth companies are moving into other areas, such as psychology, in extending their business model of selling more drugs. Hims will go public by the end of the year with an expected valuation of $1.6 billion.


Sponsor Updates

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  • HCTec supports Operation Stand Down in Nashville, helping the group prepare for its Veterans Day Heroes Breakfast by assembling medical and dental hygiene kits.
  • CoverMyMeds and Cosi Science Museum distribute 500 Learning Lunchboxes at a local elementary school in Franklinton, OH.
  • Forbes recognizes Cerner as among the world’s best employers.
  • CereCore will present during the virtual NCHIMSS Fall Conference November 17.
  • Forbes includes Cerner on its 2020 list of World’s Best Employers.
  • Change Healthcare releases a new podcast, “CommonWell’s Paul Wilder on Interoperability, Healthcare Policy, and the Pandemic.”
  • CI Security will exhibit at the virtual Dallas Cybersecurity Summit November 11-12.
  • CareSignal will participate in a virtual showcase of remote patient monitoring solutions for safety-net populations on November 18 as part of the Remote Patient Monitoring Innovation Challenge.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
Get HIStalk updates.
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Morning Headlines 11/10/20

November 9, 2020 News No Comments

Centene Signs Definitive Agreement to Acquire Apixio

Managed care company Centene will acquire AI-powered healthcare analytics vendor Apixio for an undisclosed amount.

Eko Raises $65 Million in Series C Funding to Close the Gap Between Virtual and In-Person Heart and Lung Care

Digital health company Eko will use a $65 million Series C funding round to launch a remote-monitoring program for cardiopulmonary patients, and expand clinical use of its devices and algorithms for disease screening.

WELL Health to Acquire 100% of INSIG Corporation, a Leader in Telehealth Services in Canada

Canadian clinic operator and EHR vendor Well Health Technologies acquires virtual care and charting automation company INSIG.

HIStalk Interviews Carm Huntress, CEO, RxRevu

November 9, 2020 Interviews No Comments

Carm Huntress is CEO of RxRevu of Denver, CO.

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Tell me about yourself and the company.

I started RxRevu about eight years ago. I have about 20 years of early-stage startup experience. RxRevu is my first endeavor into the healthcare or digital healthcare space. 

The company has been focused mainly on drug cost transparency to providers for most of its history. It’s an exciting space and a lot is happening, both with our customers and even at a regulatory level.

What outcomes can result when a patient arrives at the pharmacy where their prescription was sent electronically and they’re told it will cost $200 instead of the $15 they expected?

When you look at the data, it’s pretty interesting. About one-third to two-thirds of prescription abandonment, depending on the studies that you look at, is due to cost. That’s only getting worse now with consumer-driven healthcare.

When you think about adherence, when you think about getting the patients on the medications and keeping them on the medications that are so important in terms of driving positive outcomes, cost is the biggest thing. A lot of the work we do is focused on preventing that sticker shock at the pharmacy, which leads to abandonment and the patient not taking their medication.

It’s harder to be a savvy consumer with electronic prescribing since you have to choose the pharmacy upfront without knowing the prescription’s cost, then extra work is required to send it to a different pharmacy that perhaps has a better deal. How does your system improve that situation?

We identify that as a major issue today. If the prescription is already gone to the pharmacy, the consumer really doesn’t have much choice. What we realized is there’s this point of shared decision-making at the point of care between the provider and the patient before the script is sent to the pharmacy. That’s a really important point as they are making that decision.

RxRevu works directly with the payers, pharmacy benefit managers, and insurance companies to bring real-time cost transparency to that point of prescription, that point of shared decision-making between the provider and the patient. As the provider is prescribing, we’ll show the cost of that drug at the preferred pharmacy of the patient. We will show lower-cost therapeutic alternatives.

We will also show drugs that have less administrative overhead, both for the provider and the patient, in terms of time to therapy, such as a drug that requires prior authorization that will take time, but there’s a preferred therapy from the patient’s insurance company or PBM that does not require a prior auth. The provider can simply select that and route the prescription to the patient’s pharmacy.

The last thing we do is show alternative pharmacies. Maybe it’s mail order, or there’s a better opportunity for the patient to save money just by going to a different pharmacy in their network. We will show that as well. 

Our goal is to bring that individual patient cost transparency around their drugs to the provider at the point of care, so both the provider and the patient can make the most informed prescription decision.

Does it benefit the prescriber as well since they can not only prescribe the most cost-effective therapy, but also avoid the extra work of issuing a second prescription or sending the original one to a different pharmacy at the patient’s request?

We are, so far, one of the rare tool that providers really like. Out of all the surveying we do, we get very high marks on, “This is really valuable information that I’ve been looking for.” There’s been a lot of distrust, when this information was static and not real time, and now we can provide it real time on a patient individual basis. The number one reason coming back from providers is that while it takes maybe a few more seconds to look at the cost information and make a better-informed decision, reducing the headache of pharmacy callbacks and patient friction in getting them on therapy and keep them on therapy is a huge benefit to providers.

That saved time means a lot for them and their clinical staff. Statistics show that it costs about $15,000 per year for a doctor or their clinical staff to manage prescription administration, such as prior auths, pharmacy callbacks, and those types of things. It’s a pretty costly administrative thing. We are trying to cut that off by getting this information front of the doctor upfront so that all these issues that we’ve talked about have been sorted out prior to the patient getting to the pharmacy to pick up the script.

What were the integration challenges involved with collecting real-time information from insurance companies and pharmacies and then inserting it into the EHR workflow so that it is actionable?

It’s a challenging two-sided market, and very hard to set up. On one side, you have to set up the direct connectivity between us and the PBMs, the pharmacy benefit managers, to bring real-time cost transparency into our network. There’s many of those that we have to connect to. We’ve connected so far to about 150 million insured Americans and our network continues to grow. Our hope is that eventually we’ll have complete coverage in the US, and there’s some good things coming, from a regulatory standpoint, that will help us achieve that.

On the flip side, once you aggregate all that data, you have normalize it and standardize it so you can provide it to the electronic health records. Today we are partnered with Epic, Cerner, and Athenahealth, which arguably are the biggest ambulatory providers in the US. It’s integrated directly into the electronic health record and the prescribing workflows. That’s a big challenge in terms of making sure that the integration is done well and is part of the workflow.

We have focused heavily on the prescriber experience and making sure that it’s really in line with what they are doing today. If the doctor has to go out to a portal or another service, they don’t use it. They won’t take the time. We wanted to ensure that this is part of their workflow, so that as they are ordering the prescription, they can see this cost transparency information.

It’s occasionally cheaper for the patient to pay cash instead of using insurance, especially if they have a discount coupon. Can you detect those situations where they will pay less by not using their insurance?

We look at all sorts of discount cards, things like GoodRx. What we found in our research is those discount cards are only beneficial about 5% of the time compared to a patient’s co-pay. There are certain situations where the drug is not covered, or other situations where a discount card may be beneficial, but the truth is that while insurance is getting more expensive and co-pays are going up, it’s most beneficial to get on whatever their insurance is. Where there are cost-saving opportunities, there’s usually a therapeutic alternative or lower-cost preferred drug in the same class that would be significant in terms of savings to the patient. They’re just unaware of that, and so is the provider, and that is the information we are providing. That can lead to significant savings to the patient.

Who pays for your service?

Whoever the risk-bearing entity is that covers the pharmaceutical costs. In this case, most of the PBMs and payers we work with cover the cost. We offer this free to providers across our entire footprint. A provider using Epic, Cerner, or Athenahealth doesn’t  get charged for this and it’s part of their workflow. We want to save money for the patient and the insurance company.

How does a physician or group connect?

A small practice might be running Athenahealth, which is a cloud-based EHR, so we are automatically turned on. The providers don’t have to do anything,. We are enterprise deployed across the entire Athena footprint.

In the case of where the health system is running an on-prem instance of the EHR, which has happened a lot more in Epic, we have to come in and do about 10 hours of work to install our network into the electronic health record. It’s not too much overhead and is pretty easy to do compared to the value you get from turning us on.

What role do you see for the federal government in prescription pricing and transparency?

There is now a 2021 Part D mandate to require cost transparency for payers and PBMs that support that market. That has been huge in growing our network as more PBMs provide this as a service. We think those mandates will expand and potentially lead to provider mandates, where they will be required to have this information available to them in the EHR over the next few years.

Our hope is that this will drive a bigger discussion about cost transparency across all services, so that just like any other shopping experience that we have in our life where we know the price upfront, we can get that for prescriptions, but all services. We are one of the leading indicators of the value of this because our payer and PBM partners are seeing significant ROI in terms of cost savings to both them and their members, as well as reduction in administrative overhead in terms of prior auth and other administrative things they face with prescription drugs.

Why did so many large health systems invest in your Series A funding round?

I think there’s a couple of reasons. The first is their identification of the administrative burden and time that their providers spend managing prescriptions and the benefit they saw in having cost transparency at the point of care.

Secondly, this is helping them move into value. If you think about the push in healthcare towards value-based arrangements –ACO, fully capitated, or shared savings — prescriptions are a critical part of that success. If they have to take prescription drug risk, this type of service, in terms of having cost transparency, is critical.

Also, because cost and adherence are so tied, they want to make sure they get the patient on a drug they can afford, because that is the biggest thing that drives outcomes and prevent things like readmissions.

That was a lot of the driving force behind health system interest in working with us and having this type of technology embedded in their health systems as they move to risk and to better manage their labor costs.

Where do you see the prescription transparency movement as well as your company moving in the next few years?

We will see a pretty broad expansion of cost transparency services across all payers. I think it’s obvious that we can’t really measure value unless we know what things cost. We have proved, at least in the prescription drug space, that having this information leads to better-informed decision-making by providers and saves significant money to the payers and PBMs. The cost transparency movement is here, it’s here to stay, and it is only going to expand.

We are focused on helping providers make the most clinically effective decision that is both cost-effective and convenient for the patient. We are going to help providers, as well as patients, get that most cost-effective drug. We will support health systems as they move into value more aggressively and take on risk to optimize costs, especially around prescription drugs. Our fundamental belief is that the whole prescription drug value chain should be based on value and the outcomes that these drugs deliver to the patients who take them.

Curbside Consult with Dr. Jayne 11/9/20

November 9, 2020 Dr. Jayne 6 Comments

It’s been a busy week in the clinical trenches. If you had ever told me that I would see nearly 150 patients over two urgent care shifts, I would have told you that you were crazy. Nevertheless, it’s the world we’re living in.

I’m continually impressed by the ability of my team to dig down deep, but we’re starting to push hard against leadership for some kind of daily cap on the number of patients we can see. As an urgent care, we’re not subject to the same rules as hospital emergency departments, which means we can turn people away. It’s not ideal, but neither is the reality of 12-hour shifts turning into 14, 15, or 16-hour ones, especially when staff is scheduled to see patients again the next day with less than eight hours turnaround time.

I’ve asked to cut my schedule down for our next scheduling block, but it doesn’t start until January. I have a sneaking feeling they’ll give me the same number of shifts regardless, because I don’t see us becoming less swamped when the projections show that COVID cases will likely be at their peak during the third week of January.

I’m keeping myself grounded with informatics projects as way to try to preserve my sanity. A couple of articles caught my eye, because even with a pandemic upon us, clinicians are still dealing with heavy burdens of non-clinical work and technical systems that don’t always deliver the support promised.

This piece in the journal Pediatrics highlights the fact that pediatricians are averaging nearly seven hours of EHR use each day. Researchers found that EHR documentation and review of patient records totaled 6 hours, 40 minutes of the time that the EHR was in use. That’s an average of 16 minutes per visit, with approximately 12% occurring after hours. Researchers looked at EHR log data from January to December 2018 for all pediatricians and adolescent medicine physicians who practice in the 2,191 health care organizations represented in the Cerner Millennium EHR Lights On Network database. This encompasses over 20 million outpatient encounters by 30,000 physicians.

The study is interesting because researchers could look at the variability in time as it compared to optimization efforts across similar EHR platforms, as well as roles and responsibilities for data entry and the differences in implementation and training across organizations. I’ve seen wide variability across organizations’ use of the same platform that can lead to “make or break” type workflows. The quality of training physicians receive also seems to be directly proportional to their success with the EHR and whether they succeed in the system or struggle. Other interesting facts from the study:

  • More than 94% of pediatricians in the US use an electronic health record.
  • Active users were defined as those who logged into the system with activities recorded <45 seconds apart; clicked  the mouse at least three times per minute; completed at least 15 keystrokes per minute; and who had mouse movement of greater than 1,700 pixels per minute.
  • After-hours use was defined as that between 6 p.m. and 6 a.m. local time on weekdays and anytime on weekends (which may not accurately reflect “non-office” times for those working half days or coming in early to work on the EHR).
  • Physicians practiced at various locations: integrated delivery networks (34%), regional hospitals (30%), independent physician groups (22%), and academic medical centers (11%).
  • The physicians monitored on the Network represent a 44% sample of US pediatricians based on comparison with the 2018 American Board of Pediatrics database.
  • Pediatric rheumatologists spent much longer in the EHR at 30 minutes per encounter.

The study was limited by the fact that it only looked at physicians on Cerner Millennium. It also excluded other provider classes, such as physician assistants or nurse practitioners. The authors conclude that a need exists to “continue to identify and eliminate unnecessary and low-value activities across the entire physician workflow.” I don’t think anyone would disagree with that.

The second article, from JAMA Network Open, looked at the impacts of e-consultations on the workload of primary care providers. The authors looked at Veterans Health Administration primary care providers who were using e-consultations to interact with subspecialists. Researchers interviewed 34 clinicians who had experience with e-consultations in 2017. Although primary care clinicians felt that the process improved clinician communication, they also felt that the burden for additional diagnostic testing and follow-up was shifted from the subspecialists to themselves. They also thought that they were being asked to diagnose and manage conditions that were not only outside their comfort zone, but possibly outside their scope of practice.

The study was limited by its small sample size as well as its qualitative approach, and researchers were not confident that participants were objective. Participants also noted the need to track and follow up on e-consultation requests as a barrier, which seems tangential to the actual consultations themselves, although still important. Participants also felt that the templates that were  used to document were not user-friendly and/or included required fields that were not relevant to care. I love qualitative research and appreciate the fact that the authors included actual respondent quotes in the article. The authors conclude that various workflow improvements could be made in tracking and documentation systems that would help the primary care clinicians.

However, they didn’t seem to mention the need for further analysis on the other end of the e-consultation request. What do subspecialists think about it? What kind of burden does it add to their day? Are there other modalities, such as virtual visits, that deliver the same outcome for the patients (including decreased time to subspecialist consult) that would be more acceptable all the way around? As in many studies, more research is needed, but I hope next time they look at both sides of the workflow.

These articles underscore the need for those of us on the healthcare IT front to continue to do what we can for better outcomes for patients and clinicians alike. We also need to feel empowered to challenge operational and clinical teams to address dysfunctional workflows that might not be helped by technology and to help those teams think through the idea that tech might not be needed to save the day.

Have you been involved in the e-consultation process at the VA? What’s your take on it? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/9/20

November 8, 2020 Headlines No Comments

Update on Cyberattack

Six-hospital University of Vermont Health Network has regained access to a week’s worth of patient schedules following its October 25 malware-caused systems outage.

Region’s Leading Academic Medical Center Launches New Venture Capital Fund, Tampa General Hospital InnoVentures

Tampa General Hospital (FL) launches InnoVentures, a venture fund that will also offer an accelerator program and in-house lab that will give staff the chance to test out ways of improving operational efficiencies within the hospital.

Change Healthcare (CHNG) Tops Q2 Earnings and Revenue Estimates

Change Healthcare reports Q2 results: revenue down 5%, EPS $0.32 versus $0.27, beating Wall Street expectations for both.

Building Company Culture And Innovating The Future With Judy Faulkner

Epic will launch EpicShare.org in the next few weeks, which will enable healthcare people, whether Epic users or not, to share innovative ideas for solving common clinical problems.

Vizient to Acquire Intalere, Expanding its Supply Chain Capabilities

Intermountain Healthcare (UT) sells its Intalere supply chain management business to its clinical and operational analytics vendor, Vizient.

Monday Morning Update 11/9/20

November 8, 2020 News No Comments

Top News

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Six-hospital University of Vermont Health Network says that it has regained access to a week’s worth of patient schedules following its October 25 malware-caused systems outage. Otherwise, computer systems have been down for 12 days.

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It is still unable to provide full chemotherapy services to cancer patients at UVM Medical Center and is sending some patients to its other hospitals. The hospital has cancelled all breast imaging studies for Monday, November 9, and says it can’t let patients know about their cancelled appointments because it cannot access their information. Email is offline throughout the health system.

A Vermont National Guard cybersecurity team is on site to help review all end-user computing devices for malware.

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An oddly worded announcement suggests that 300 UVM Medical Center employees have been “impacted” by having “seen their jobs disrupted by this event,” with 130 accepting temporary assignments and the rest furloughed, and 30 employees were impacted at Central Vermont Medical Center.


Reader Comments

From Little Friend: “Re: HIStalk readers. I’m wondering how many come from imaging centers, physician groups, and mammography?” I don’t know, but it would be great if readers who fall into those categories would check in anonymously with this 10-second form, after which I’ll report back.


HIStalk Announcements and Requests

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Three-fourths of poll respondents most frequently pick up their prescriptions at the drugstore counter or drive-though, another 20% from a US pharmacy via the mail, and less than 2% have it delivered in person by the drugstore or a third-party service. My wording of “drugstore” was intentionally imprecise, but I’ll say that my experience with coupon and price search features from companies like GoodRx I’ve found that the deals are almost always better at chain grocery store pharmacies. Example: a 30-day supply of generic Lipitor 20mg in Atlanta is $7-$8 cash price at Kroger and Publix, $19 at CVS, and $49 at Walgreens. Also note that it’s cheaper to get a larger quantity in a single prescription – the atorvastatin is $7 for a 30-day supply at Kroger, but only $12 for a 90-day supply and $27 for a full year’s worth – you would save nearly 70% (plus time and gas) buying a 365-day supply.

New poll to your right or here: which activities will you participate in over Thanksgiving? I’m curious since coronavirus is spreading at will and many of us are numb from pandemic fatigue, so our winter holiday activities are likely to add even more fuel to the infectious fire.

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

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Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the “network door” they can open. This network infrastructure-oriented webinar will address overcoming the challenges of architecting a network to provide security, management, and monitoring for IoT, devices, and users using ALE’s Digital Age Networking blueprint, a single service platform for hospital networks. Digital Age Networking includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will describe enabling COVID-19 quarantine management, contact tracing, locating equipment and people, and ensuring the security of patients and more.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

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

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

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

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


Acquisitions, Funding, Business, and Stock

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SOC Telemed virtually rings Nasdaq’s opening bell on Wednesday in its first day of trading. Shares opened Wednesday at $9.58, closed at $9.26, and ended the week at $9.00, valuing the company at $288 million.

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Change Healthcare reports Q2 results: revenue down 5%, EPS $0.32 verus $0.27, beating Wall Street expectations for both.

The one-month share performance of the Global X Telemedicine and Digital Health exchange-traded fund shows a rise of 2.9% versus the Nasdaq’s 4.6% increase and the S&P 500’s 2.6% rise. EDOC shares have increased 14% since its July 29 inception versus increases in the Nasdaq of 12.3% and of the S&P 500 of 8.1%. EDOC’s top holding is Tokyo-based, Sony-backed M3, Inc., which offers a pharma sales support platform, a cloud-based EHR, telehealth services, and websites.


People

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Retired family medicine physician William Earl Davis, III, MD died last week in Winona, MN at 80. He implemented the first EHR in Minnesota, served as CMIO of Winona Health, and received Cerner’s Lifetime Achievement Award in 2015.


Government and Politics

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The annual report of the VA’s 16,000-employee Office of Information and Technology in the year of COVID highlights:

  • Its big jump in Net Promoter Score since March.
  • Its above-average disability and pension claims processing even as its employees were forced into telework.
  • Release of its Microsoft-powered coronavirus chatbot.
  • Rollout of a virtual hearing solution.
  • Mobilization of speech recognition to workers who don’t have VA-issued laptops.
  • Procurement and deployment of 199,000 laptops and 11,000 mobile devices for connecting with patients.
  • Expansion of its telehealth system with fivefold capacity in a few weeks.
  • Rollout of remote check-in and screening tools for patients.
  • Implementing tele-critical care services.
  • Supporting a sharp rise in use of its My HealtheVet patient portal and prescription refill system.

COVID-19

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States on Saturday reported a record 128,000 new COVID-19 cases, 56,000 hospitalized patients, 11,000 COVID-19 patients in ICU beds, and 1,097 new deaths. Sixteen states reported record-high COVID-19 hospitalizations on Friday and the Dakotas are reporting per-capita case and death rates that have never been seen globally and are still rising, as noted by Eric Topol. Former FDA Commissioner Scott Gottlieb, MD says the actual case count is probably five times that number and that lack of state-level mitigation will cause case numbers to explode in the next few weeks. Cases and deaths are rising even in long-term care facilities, where protecting vulnerable residents is a national priority.

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A Tampa Bay newspaper’s investigative report finds that Florida Governor Ron DeSantis’s office allowed conservative blogger Jennifer Cabrera to examine 700 COVID-19 death certificates – records that the state has refused to allow academics and journalists to review in arguing that they are not public — to fuel her article that COVID-19 deaths are being over-reported by counting people who died “with it” rather than “of it.”

White House Chief of Staff Mark Meadows tests positive for COVID-19, along with at least six other newly diagnosed White House advisors and campaign officials. He attended the President’s election party Tuesday night in which several hundred attendees, many of them not wearing masks, gathered inside the White House. Also testing positive is Rep. Matt Gaetz (R-FL), who in March appeared on the House floor wearing a gas mask to mock COVID-19 as a hoax.


Other

A California psychiatric practice will pay $25,000 to settle HHS OCR charges that it failed to provide a patient with a copy of her records despite multiple requests. OCR had originally closed the complaint after discussing the incident with the practice, but reopened it a month later when the patient reported that she still hadn’t received the records. The case is the tenth HHS OCR investigation into HIPAA Right of Access Initiative incidents.

Epic CEO Judy Faulkner says the company will launch EpicShare.org in the next few weeks, which will allow healthcare people, whether Epic users or not, to share innovative ideas for solving common clinical problems.


Sponsor Updates

  • Phunware integrates provider data management and search capabilities from Phynd Technologies with its Multiscreen-as-a-Service enterprise cloud platform.
  • Nuance will participate in the Guggenheim Digital Virtual Health Summit December 8-9, and the Barclays Global Technology, Media, and Telecommunications Conference December 10.
  • QliqSoft posts a recording of its recent webinar with CareSignal titled “Facilitating Deviceless Remote Patient Monitoring using AI-Driven Chatbots.”
  • Redox releases a new podcast, “Vida on Virtual Chronic Care and Mental Health.”
  • The Passionate Pioneers Podcast features RxRevu CEO Carm Huntress.
  • Spirion partners with Seclore for persistent rights management to bolster its data privacy management framework.
  • TriNetX achieves re-certification for the ISO/IEC 27001:2013 Information Security Standard.
  • Vocera releases a new podcast, “The Value of Human-Centered Design in Healthcare with Nick Dawson.”

Blog Posts


Contacts

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

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Katie the Intern 11/6/20

November 6, 2020 Katie the Intern 4 Comments

Hi, HIStalk readers! Katie The Intern here. I’m back and somehow made it through my first week of learning healthcare IT. How do you all keep up with this industry with such poise?

I find myself wanting to be interesting and somewhat humorous. I Googled healthcare IT humor and found a Pinterest board full of IT jokes. Once I feel like I’ve earned a few throwaway dad jokes in the IT department, I’ll share them. If you have any, I’d love to read them! 

How Journalists Use Sources

Mr. H suggested that I briefly discuss how journalists choose and use sources. From my studies and experience in journalism, the best sources are sources that are timely and factual. You’ll think, jeez, you paid for that class? But, you’d be surprised how many sources I have replaced because the information they promised to have or the timeframe in which they promised to deliver that information fell through. There is no story without sources. There is no information to be shared unless that information is substantial to reporters. We choose sources and statistics that are tangible, honest, and valuable. 

That being said, sources must also be willing to talk to journalists about what they know. I briefly studied media law, and in my opinion, protecting a source can sometimes prove more valuable than the information itself. Establishing trust with private sources, especially those whose employment teeters on that information’s publicity, is a very valuable practice.

The protection of a journalist when using an anonymous source is known as a shield law. Shield laws vary from state to state, and do not completely provide protection in all cases. Shield laws come from the first amendment and allow a journalist to claim that consumers have a right to newsworthy information despite the source it comes from. This varies in court, medical journalism, private investigations, and others. 

Shield laws apply to publications that claim to be information sources, i.e., your average newspaper, online news hubs, and most of the places you read or watch news. Blogs and private boards typically do not fall under shield laws because the information is not classified as news, but as opinion. To be completely honest, I don’t know much more about media law and where the line is drawn when information is not bound to a specific state (HIStalk readers submit information from all over). But I will do more research and update you in my next post. I’ve been reviewing sites I read in school, and this Columbia Journalism Review article is a good start. 

What I can say is, a journalist’s reputability is on the line, too, when reporting with anonymous sources. A good journalist will do their research on a source and make sure they are who they claim to be and the information they are giving is factual. A good journalist will establish themselves as trustworthy and reputable so that readers feel they can trust what they’re reading.

Now for more of what I think about sourcing information on blogs! Opinion is valuable as long as it is labeled as opinion. Rumors are valuable as long as they are labeled as rumors. Sourcing for both should follow similar guidelines. Sources should be able to confirm where they obtained their information. Sources should confirm their connection to their information. Sources should provide as much documentation as possible. It is on the journalist to confirm that these things are valuable and truthful. As long as rumors can be substantiated (such as, this could be true, but it is a rumor), then reporting on them is fair and fun. Making private or rumored information public can be quite exhilarating. HIStalk readers seem to enjoy rumors and the discussions they sponsor. 

Thoughts on Health IT News Reporting

As a journalism major, I am finding great value in reading HIStalk even though I have never read much about healthcare IT. It has opened my eyes to niche industry reporting and blogging. I did not realize the scope of the HIStalk world and the worlds that it revolves in. Niche reporting is a safe industry, but the niche does have to be big enough to be sustainable. I am learning that finding a niche and being good at hosting discussions about it is quite sustainable. Mr. HIStalk has gotten this right for almost two decades, as you all know. 

I’ve been reading other sites and comparing their reporting practices with the aggregation and types of coverage that Mr. HIStalk uses for the news he posts. In one sense, HIStalk cannot compete with regular news, simply because the audience is expecting only healthcare IT news. Any other information would seem out of place and boring. On the other hand, HIStalk outpaces other healthcare IT sources because of its unique atmosphere of readers and discussion. Blogs and news are both competitive sources, but luckily they are competitive in their own niches and universes and not so much with each other.

My future columns will consist of what I am learning, interviews with young professionals in the IT field, interviews with marketers and PR people about how and why they use HIStalk, and more research on what I have been learning. 

I am also looking for a “beat,” so to speak, that I can write about each week. My first thoughts on this focus on the growth and prevalence of using telehealth to cut down treatment times in hospitals and clinics. For example, I talked to a family friend who discussed how telehealth saves time in diagnosing a stroke in a patient, allowing life-saving medication to be administered faster. It would be both entertaining and enlightening to interview various IT employees at different levels and get their take on what telehealth has done, what it can do in the future, and how fast it will grow. Mr. H suggested looking into news and information about consumerism in telehealth, which I am also interested in writing about but would certainly need ideas for expansion of that topic. 

If you have any ideas on expanding these topics or believe they would not be as interesting as I find them to be (being new to this field, I recognize some topics that I find exhilarating are old news to the professionals), do comment or send me an email. I’d love feedback and advice!

Overall, I feel I am learning a great deal from Mr. H, HIStalk readers, and from reading about healthcare IT online. I am very appreciative of those who took the time to send me emails, advice, and tips as I learn more about this field. Thank you for reading, and I look forward to furthering my HIStalk studies with you all. 

Katie The Intern

Katie

Email me or connect with me on Twitter.

Weekender 11/6/20

November 6, 2020 Weekender No Comments

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Weekly News Recap

  • Vermont sends a National Guard cyber response team to to help University of Vermont Health Network check its computing devices for malware.
  • Healthcare integration technology vendor Bridge Connector will reportedly shut down.
  • Teladoc Health completes its acquisition of Livongo.
  • SOC Telemed begins public trading following its merger with a special purpose acquisition company.
  • The founder and former CEO of a patient-focused oncology technology company sues an investor who she says pushed her out and blocked an attractive acquisition offer.
  • Hospitals shut down and beefed up their email systems in an effort to prevent ransomware attacks.

Watercooler Talk Tidbits

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Readers funded the DonorsChoose teacher grant request of Ms. P, who asked for hands-on STEM activities for her gifted and talented grade 4-6 class in Connecticut. She reported in late April, “If you could have seen how my students faces lit up when they saw the Legos and K’Nex, excitement is an understatement. The students easily dove in to building their ideas with the new materials. We started with trying to build the tallest structure. The student jumped in to build a “skyscraper”. They found what worked to support the height of their builds and if their building could withstand a wind. Next, We moved in to their own choice creations. My fifth grade group start to build a Ferris Wheel from the K’Nex. They quickly learned the correct spacing and how to to make the structure stable enough to hold weight. They are working on making it spin from the center point. The fourth grade student were able to show their creative side in creating robots, cars, windmills and other creation from the Legos. They will be working writing stories that explain their new creations. In the future, my students will be using the Legos and K’nexs to do fraction math, test science concepts and build new inventions. My students love hands on activities. They truly enjoy being able to put their ideas in to real life practice.”

Upstate University Hospital (NY) quarantines 36 medical residents who attended an off-campus Halloween party in which a co-worker tested positive afterward. The hospital is threatening to discipline the residents for their “egregious lapse of judgment.” 

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BuzzFeed News interviews several unemployed nurses and nursing students who have turned to sex work using the OnlyFans app, which allows to collect tips from people who pay to view their nude photos and videos and to chat with them.


In Case You Missed It


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Morning Headlines 11/6/20

November 5, 2020 Headlines 7 Comments

Vermont National Guard to assist UVM Health Network

Vermont’s governor sends a National Guard cyber response team to help University of Vermont Health Network inspect each of its end-user devices for malware after a cyberattack on October 25.

Koa Health secures over €14m initial funding and spins out of Telefónica’s moonshot factory

Koa Health launches its digital mental healthcare solutions and services in the US with a $16.5 million Series A funding round.

Connected Care Pilot Program Application Window to Open on Nov. 6

The FCC will begin accepting applications on November 6 for its Connected Care Pilot Program, which will provide up to $100 million to help providers cover costs related to connectivity for telehealth programs.

News 11/6/20

November 5, 2020 News 1 Comment

Top News

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The Nashville business paper reports that healthcare integration technology vendor Bridge Connector will close its doors less than three months after completing a $25.5 million Series B funding round.

The company has obtained $45.5 million in total funding. 

Bridge Connector is reportedly laying off 160 employees, effective in 60 days. It claims to have 750 live customer sites.


HIStalk Announcements and Requests

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Brilliant and timely: I heard about “webinar dining room” vendor EatNGage from a HIMSS chapter presentation. Webinar or online meeting presenters pay booking fee plus $25 for an entree and beverage to be delivered to each attendee, after which the registrant is sent a link that displays their restaurant delivery and menu options. The company says that providing lunch reduces no-shows dramatically and more closely simulates the usual onsite sales activities. BMC, for example, found that webinar attendance jumped from 28% to 95% and attendees stayed connected throughout the event because they were eating during the presentation (that reminds me of my college roommate’s pragmatic dating methodology, which was to always invite girls for dinner because “hey, they gotta eat.”) The per-meal price includes food, delivery, tax, and tip. I suspect that in some areas the only dining choices (if any) will be dull pizza places or low-quality chains, but maybe not. The system also offers an option to provide meals only for specifically designated attendees, like the hottest prospects.

Listening: new 1970s-style acid, experimental guitar from Tom Morello, formerly of Rage Against the Machine and Audioslave. Interesting guy: he graduated from Harvard and moved to Hollywood, where he had to support himself as a stripper. He also worked in the office of US Senator Alan Cranston, but got in trouble for telling a constituent who called to complain about Mexicans moving into her neighborhood, “Ma’am, you’re a damn racist.” He also does fantastic, folky protest songs under the name The Nightwatchman, including this spectacular 2012 song “Save the Hammer for the Man” with Ben Harper. And for head-nodding and air-drumming, you can’t beat RATM, which will supposedly reunite for a world tour next year.

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HIMSS updates its conference webpage to indicate that HIMSS21 registration will open in January. It includes a FAQ, most of which involves endless reciting of its “no refunds” policy. They are using OnPeak for hotels again, and even though they say registrations can be cancelled or changed through July 12, HIMSS20 attendee bad blood is sure to make folks think twice before sending OnPeak money again. Hotels still show available rooms on Expedia, but at higher rates – the Venetian is $365 plus an appalling $51 per night resort fee, while HIMSS and OnPeak have it for $229 with free WiFi and no resort fee required (or $25 per day if you are stuck in 1995 and can’t live without a newspaper and in-room phone calls for your fax machine). Weather should be a balmy 113 degrees or so, with the desert humidity boosted by vagrant urine and porn slapper sweat.

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HIMSS21 exhibitors, take note of these rules, sternly enumerated but most likely enforced only if booth neighbors complain:

  • All activities must take place inside the purchased booth space, with no spillover into the aisle and no noise exceeding 75 decibels. A sound level meter costs just $20 on Amazon, so I could have fun endlessly reporting violators.
  • Anyone wearing a vendor badge who enters another vendor’s booth without permission will have their badge revoked and their employer will lose all their exhibitor points.
  • Giveaway items must have the company’s logo attached.
  • Speakers must face into the booth, not into the aisles (please don’t mess with my aisle-facing magicians).
  • Exhibitors can’t use speakers or PA systems, which I don’t see working at all since nearly every in-booth presenter has to use them to be heard by dozens of people.
  • Exhibitors are “required to remain in their own booth space” at all times (so how do they get there, then?) and run around the hall wearing attention-gathering items, such as flashing lights.
  • Cameras and video equipment are not allowed on the show floor (careful, HIMSS TV and all those would-be YouTube stars filming videos that nobody will ever watch) and companies that take photos of anything other than their own booth will be docked exhibitor points. I applaud getting rid of the aisle-clogging audio and video productions, although I don’t think that will happen.
  • “Circus-like activity” is not allowed, and “clothing must be worn at all times (including tops and bottoms).” The exhibit hall might be the only place in Las Vegas that will be free of circus-like activity and half-naked performers.

Webinars

November 11 (Wednesday) 1 ET. “Beyond the Firewall: Securing Patients, Staff, and the Healthcare Internet of Things.” Sponsor: Alcatel-Lucent Enterprise. Presenter: Daniel Faurlin, head of network solutions for healthcare, Alcatel-Lucent Enterprise. The biggest cybersecurity risk for healthcare IoT isn’t the objects themselves, but rather the “network door” they can open. This network infrastructure-oriented webinar will address overcoming the challenges of architecting a network to provide security, management, and monitoring for IoT, devices, and users using ALE’s Digital Age Networking blueprint, a single service platform for hospital networks. Digital Age Networking includes an autonomous network, onboarding and managing IoT, and creating business innovation with automated workflows. Specific use cases will describe enabling COVID-19 quarantine management, contact tracing, locating equipment and people, and ensuring the security of patients and more.

November 12 (Thursday) 5 ET: “Getting Surgical Documentation Right: A Fireside Chat.” Sponsor: Intelligent Medical Objects. Presenters: Alex Dawson, product manager, IMO; Janice Kelly, MS, RN, president, AORN Syntegrity; Julie Glasgow, MD, clinical terminologist, IMO; Lou Ann Montgomery, RN, BSN, nurse informaticist, IMO; Whitney Mannion, RN, clinical terminologist, IMO. The presenters will discuss using checklists, templates, the EHR, and third-party solutions to improve documentation without overburdening clinicians. They will explore the importance of surgical documentation in perioperative patient management, the guidelines and requirements for surgical documentation and operative notes, how refining practices and tools can improve accuracy and efficiency, and the risks and implications of incomplete, inconsistent, and non-compliant documentation.

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

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

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

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


Sales

  • Micro-hospital Cabot Emergency Hospital (AR) will implement EPowerDoc’s emergency department information system.

People

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Joann Kern, RN (State of Maine) joins Vesta Healthcare as chief product officer.


Announcements and Implementations

Meditech launches Virtual On Demand Care, which allows patients to choose “see a provider now” from the Expanse patient portal or app to launch a video chat. 

Cape Cod Healthcare goes live on Epic.

Hackensack Meridian Health goes live on Kyruus ProviderMatch for Consumers.

Black Book names Nuance as the top vendor in medical speech recognition and AI technologies.


COVID-19

The US reported nearly 103,000 new COVID-19 cases Wednesday, the first time daily new cases have hit six figures. Another 1,097 deaths were reported that day, increasing the US total to 241,000.

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Iowa reported 4,706 new cases in 24 hours with test positivity rates at 44%. Illinois had 9,935 new cases and 97 deaths.

The New York Times looks at providers who are charging “COVID fees,” claiming that they need to recoup the cost of PPE and increased sanitation. Some state attorneys general say such fees are not legal based on consumer law or insurer contracts. Dental practices are using them most often, and dental insurance leaves patients to pay everything that isn’t specifically covered, such as an extra $15-$25 for the cost of PPE used in a cleaning. One assisted living facility charged residents a one-time $900 fee for masks, cleaning supplies, and meal delivery. AMA has asked Medicare to pay $6.57 for PPE, which is much less that some providers are charging.


Other

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The founder and former CEO of oncology patient relationship management software vendor Navigating Cancer sues Merck’s innovation fund — one of the company’s investors — for pushing her out in what she says was gender discrimination that was intended to turn the company into “a boys’ club.” Gena Cook says that Navigating Cancer, which has raised $44 million, received an attractive acquisition offer from a competitor of Merck, but Merck blocked the sale. She also claims that Merck’s board rep wanted to decrease the influence of competitor-owned Flatiron Health by moving Navigating Cancer into data products and away from patient care technology.

River Hospital (NY) shuts down its email system indefinitely following increasingly frequent hospital ransomware attacks.

Vermont’s governor sends a National Guard cyber response team to help University of Vermont Health Network inspect each of its end-user devices for malware. UVM Medical Center, which has been offline since October 25 and is is open for urgent medical needs only, is asking patients to bring their own previously printed visit summaries and prescription containers to their appointments.

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A Cone Health (NC) dermatology practice was apparently taken down by malware clothing.


Sponsor Updates

  • QliqSoft posts a recording of this week’s webinar titled “Enhanced Patient Access with Chatbot Supported Scheduling.”
  • Authority Magazine features Experity SVP of Product Management Kim Commito on how its technological innovation will shake up healthcare.
  • Fortified Health Security releases a new video, “A Few Thoughts on Ryuk, Trickbot, and the Joint Cybersecurity Advisory.”
  • Elsevier partners with the Canadian Association of Pathologists to provide their members access to ExpertPath, a diagnostic decision support system for pathologists.
  • The I Don’t Care Podcast features NextGate CTO Dan Cidon and his take on interoperability challenges.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 11/5/20

November 5, 2020 Dr. Jayne No Comments

Our friends at the Massachusetts Institute of Technology have created a cough detector that claims to identify COVID-positive patients even if they do not have symptoms. The system uses artificial intelligence models to identify characteristics of cough sounds that can’t be detected with the human ear. Researchers propose embedding the technology in cell phones as an early detection device. The work leverages technology that is already in process for early identification of Alzheimer’s disease. Researchers note that AI algorithms can identify various factors from a cough, including a person’s gender, language fluency, and emotions.

Researchers used thousands of recorded coughs as well as voice recordings to train the model. In the COVID analysis sample of 1,000 patients, the model was accurate for 98.5% of COVID-positive patients, including 100% of asymptomatic patients. They acknowledge that the algorithm is no substitute for proper testing, but see it as a tool that could differentiate between healthy and unhealthy coughs, alerting people to the need for testing.

I started a new project this week with a client whose attempts at value-based care delivery were in shambles. They had someone on staff who was designated as the manager of quality initiatives. Apparently she would come to meetings and “talk big” about the work she was doing, but actually had a complete lack of understanding of the work that needed to be done in order to drive the quality needle. When the physicians’ contracted health plans would send membership rosters to the practice, she simply stuck them in a binder rather than actually doing anything with them, such as confirming whether the patients on the roster were active patients in the practice or seeing whether they were current on preventive screenings or recommended health services.

In meeting with the practice’s leadership in scoping the engagement, it was clear they didn’t understand some of the basic concepts of value-based care, including the need to understand patient attribution and to reach out to those patients for whom they had been deemed responsible. I felt like we needed to take it back to a 100-level course, so this week began with some educational sessions to explain the basics of attribution and empanelment.

They seemed so surprised to hear that a payer would use claims to attribute responsibility for care that it made me wonder whether they had been completely absent from all discussion of value-based care over the last decade. Certainly they hadn’t been reading the literature that was regularly put out by their specialty society. I’ve found that the American Academy of Family Physicians has done a great job creating materials for physicians, but unfortunately, they can’t force their members to read them.

The empanelment discussion was a good one as well, since it immediately devolved into an argument about how large their panels should be or whether it was acceptable for some providers to have larger panels than others. Fortunately, our engagement includes a subproject to look specifically at physician panel size since their wait times for appointments seem to indicate that their panels are too large. They have physicians who have cut back their hours due to health reasons, but who continue to accept new patients, and the process is creating a mismatch in supply and demand. I’m surprised no one ever recommended that they close panels, but then again by the time I wind up consulting with a practice, usually there has been a series of “things no one ever told us.”

Even though these engagements can be challenging because the client has a lot to learn and I have to figure out how to get them where they need to be without them feeling like I’m completely upending their world, they can be really enjoyable. I’m usually able to make a difference for staff as well as physicians, because staff has often been compensating for overloaded schedules and isn’t experiencing the fulfillment they could be if the practice truly embraces team-based care. The project will be a little slower going than I’d like because we’re doing everything remotely, so there’s not that burning platform of having a consultant on site. It should be a good counterbalance to the grueling months ahead in the land of urgent care.

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I had the opportunity this week to spend some quality time around a backyard fire pit with one of my favorite clinical informaticists. Even though we live in the same metropolitan area, we used to just run into each other at the annual AMIA meeting. Since there aren’t any in-person meetings this year, we made it a point to get together since the scheduling stars aligned to provide us an evening where we were both free.

He has always worked in the academic space, where I’ve been more in the health system and vendor arenas. We still face many of the same challenges, though, including clashes with upper management who don’t always see the value in physicians who work on the technology side. We’re also tasked with helping bridge the gap between organizational leadership and end users who might not understand why applications are implemented in a particular way that best supports organizational goals but might not meet specific users’ expectations.

Both of us have had a lot of job changes in the last several years, and it was good to get his perspective on how the pandemic has (or in many ways, hasn’t) transformed care delivery at his organization. Some things never change, and his practices are still doing manual appointment reminder phone calls and manual COVID screening, which seems to me a shocking waste of human capital. As a clinician, I’d much rather see those staffers redeployed as care navigators, health coaches, or in working with patients who aren’t candidates for digital reminders or screenings, or who have complex situations to navigate such as arranging rides, coordinating with family caretakers, etc.

I enjoyed filling him in on some of the interactions I have with startup companies and how they’re trying to solve various healthcare workflow issues as efficiently and economically as possible. There’s definitely some inertia at his institution, but it would be fun to do a project together some day. Until then, we’ll have to settle for commiserating by the fire, six feet apart.

What new solutions is your organization deploying to handle the next wave of COVID or to prepare for vaccination? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 11/5/20

November 4, 2020 Headlines No Comments

Exclusive: Fast-growing Bridge Connector to shutter operations

The local business paper reports that health data integration vendor Bridge Connector, which announced a $25.5 million Series B round of financing several months ago, will shut down operations.

Mississippi State Medical Association launches MHAX: Mississippi Health Access Exchange

The Mississippi State Medical Association partners with the Konza Nationwide Network, an HIE operator, to launch the Mississippi Health Access Exchange.

Frazier Healthcare Partners Announces Acquisition of Accuity Delivery Systems

Investment firm Frazier Healthcare Partners finalizes its acquisition of revenue integrity and clinical documentation improvement company Accuity Delivery Systems.

Hospitals on high alert after phishing emails target executives

A number of hospitals in Massachusetts shut down email systems or put stronger filters in place after federal officials warn of phishing emails targeting executives.

Aptar Pharma Acquires the Assets of Cohero Health, a Digital Respiratory Health Company

AptarGroup acquires Cohero Health, a digital health company specializing in the management of respiratory diseases.

Morning Headlines 11/4/20

November 3, 2020 Headlines No Comments

Teladoc Health Completes Merger with Livongo

Teladoc Health completes its $18.5 billion acquisition of Livongo with a valuation of $28 billion.

Louisville health care company expanding operations, creating 80 new jobs

Healthcare supply chain analytics and technology vendor Handle will add 80 new jobs to expanded operations in Kentucky.

City Health Department failed to terminate former employee’s access to protected health information

The City of New Haven in Connecticut will pay $202,400 to the HHS Office of Civil Rights to settle potential HIPAA violations related to its health department’s failure to implement employee termination procedures, enabling a former staffer to download the PHI of nearly 500 patients.

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Reader Comments

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

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