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EPtalk by Dr. Jayne 6/18/20

June 18, 2020 Dr. Jayne No Comments

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 6/18/20

June 17, 2020 Headlines 1 Comment

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

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

TapestryHealth Purchases Telehealth Software Leader

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

Doximity Acquires THMED, Launches Curative Brand

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

Morning Headlines 6/17/20

June 16, 2020 Headlines No Comments

Epic’s UGM 2020 is Cancelled

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

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

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

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

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

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

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

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

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

News 6/17/20

June 16, 2020 News 3 Comments

Top News

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

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

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


Reader Comments

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

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

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


HIStalk Announcements and Requests

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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

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


People

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

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


Announcements and Implementations

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

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

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

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

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

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

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


COVID-19

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

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

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

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

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

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


Other

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Morning Headlines 6/16/20

June 15, 2020 Headlines No Comments

Walmart buys tech from Carezone to help people manage their prescriptions

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

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

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

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

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

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

Drug discount management software vendor Kalderos raises $28 million.

Curbside Consult with Dr. Jayne 6/15/20

June 15, 2020 Dr. Jayne 2 Comments

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

HIStalk Interviews Gadi Lachman, CEO, TriNetX

June 15, 2020 Interviews No Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Morning Headlines 6/15/20

June 14, 2020 Headlines No Comments

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

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

NovaQuest’s Clinical Ink in second round of process

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

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

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

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

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

Monday Morning Update 6/15/20

June 14, 2020 News 15 Comments

Top News

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


Reader Comments

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


HIStalk Announcements and Requests

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

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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


Sales

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

People

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


COVID-19

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

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

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

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


Other

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

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

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Weekender 6/12/20

June 12, 2020 Weekender 1 Comment

weekender 


Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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

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


In Case You Missed It


Get Involved


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Morning Headlines 6/12/20

June 11, 2020 Headlines No Comments

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

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

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

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

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

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

News 6/12/20

June 11, 2020 News 2 Comments

Top News

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Silicon Valley investment firm Iconiq makes a “significant” investment in healthcare workforce management software vendor QGenda that values the company at just over $1 billion.

Francisco Partners, which considered selling the company in May, will remain Atlanta-based QGenda’s majority owner.


Reader Comments

From Going Live: “Re: EHR go-lives. Are they still happening? What measures are being taken to protect those involved?” The only go-lives I’ve heard about in the past couple of months were done remotely, but perhaps others have been involved in the traditional version and can report. I would be surprised if hospitals that were preparing for COVID overrun and banning patient visitors were simultaneously undertaking a go-live that involved on-site help.

From Confused: “Re: [vendor name omitted.] Announced new funding, but this news is 16 months old, according to former employees.” I reached out to the company, which says it held the announcement “to peg it to exciting company milestones and product capability rollouts.” I’m not listing their name since this could be commonly accepted practice for all I know and there’s no reason to call them out if so. I didn’t find any of the usual investment sources that listed the actual funding date — they all used the recent announcement date instead. Maybe the biggest takeaway here is that while it is impressive that companies are announcing new funding during a pandemic and its associated economic downturn, the funding itself may have occurred before all that happened or when its competitive situation was different than now.

From Doctor Doctor: “Re: COVID-19. I’ve seen a lot of dumb opinions and advice from doctors quoted on news sites and social media.” As have I. People erroneously think that all doctors from every practice setting are science-based, apolitical, free of commerce-related bias, current in their knowledge, and just as qualified as epidemiologists, virologists, and public health experts to speak authoritatively on COVID-19’s transmission, mitigation strategies, and treatment.


HIStalk Announcements and Requests

Somehow I missed that John Glaser left Cerner back in November 2019, according to his LinkedIn. He’s on the board of health IT-related organizations Press Ganey, EHealth Initiative, InTouch Health, American Telemedicine Association, PatientPing, Relatient, and Scottsdale Institute, also serving as a senior advisor to Brighton Park Capital.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Provider search and scheduling software vendor Kyruus raises $30 million in a venture round from Francisco Partners, bringing its total funding to $155 million.

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Wellsheet raises $3.8 million in a Series A funding round. The New Jersey-based startup has developed software that uses predictive analytics to optimize provider workflows.

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Genetic clinical decision support company ActX secures a patent pertaining to cloud-based storage and real-time distribution of biological information.

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


Sales

  • Health and Social Care Northern Ireland signs a $351 million contract with Epic for implementation across five trusts and its ambulance service.

People

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Optum promotes former Center for Medicare and Medicaid Innovation director Patrick Conway, MD to CEO of its Care Solutions group.

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Virtual care technology vendor Conversa Health promotes Murray Brozinsky to CEO.

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Kevin Lynch (Netgain) joins Datica as CEO. Co-founder and former CEO Jeremy Pierotti takes on the role of president.


Announcements and Implementations

Goliath Technologies helps Maimonides Medical Center (NY) anticipate, troubleshoot, and resolve Citrix slowdown issues.

Nuance Dragon Medical One voice assistant users can now access UpToDate clinical content from Wolters Kluwer Health.

Novant Health (NC) implements iQueue for Operating Rooms from LeanTaas to help its surgical facilities ramp back up to pre-COVID-19 capacities.

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Health Catalyst will launch a quality reporting product that combines its Data Operating System with measures, visualizations, and workflows from Able Health, which it acquired earlier this year.


Government and Politics

The VA gives Cerner a $99 million task order for sustainment support of hardware and software associated with its $10 billion EHR modernization project.


COVID-19

Regeneron begins the first clinical trials of antibodies for COVID-19 treatment, which if successful, could be cleared for emergency use by fall assuming production can be ramped up.

Researchers identify 12 malware-distributing Android apps that were disguised to look like COVID-19 contact tracing apps issued by the governments of Brazil, Italy, Russia, Singapore, and other countries.

Business Insider reports that just three states – Alabama, North Dakota, and South Carolina – will use contact tracing apps from Apple and Google. Seventeen states have said they won’t use contact-tracing apps at all, while 19 remain undecided.

None of the 140 customers of a Missouri hair salon whose hair was cut by two stylists who worked for eight days despite having active, symptomatic COVID-19 infection have become infected. Health department officials credit the salon’s insistence on mask-wearing by both customers and employees, its wider spacing of chairs, and its staggered appointment times to reduce group waiting. The stylists have been released from isolation. Experts are increasingly convinced that wearing masks could significantly reduce the spread of COVID-19.

Mount Sinai (NY) uses a grant from Microsoft’s AI for Health program to develop an informatics center dedicated to COVID-19 research.

The Department of Justice charges the president of a biotechnology company with submitting $69 million in fraudulent COVID-19 and allergy testing claims to mislead investors. Arrayit’s Mark Schena, PhD allegedly paid kickbacks to doctors for ordering allergy testing regardless of medical need, used the revenue to misrepresent the company’s prospects to investors, then jumped on the COVID-19 bandwagon with diagnostic tests whose accuracy was questionable.


Privacy and Security

StayWell secures the portal it hosts for the State of Kentucky’s health and wellness incentive program after discovering two data breaches that exposed employee email addresses, passwords, and biometric screening and health assessment data. The breach also resulted in fraudulent gift card redemptions.


Other

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Bloomberg Businessweek describes the negative effects of private equity firms buying dermatology practices, 10% of which are now owned by PE firms:

  • The PE formula of drastically cutting costs and flipping the business for a profit in 3-5 years with a 20-30% annualized return makes it difficult to serve both patients and investors effectively.
  • Corporate-owned medical practices are illegal in many states, but lawyers get around that by creating a management company that buys a practice’s non-clinical accesses and bills its doctors for its services, which is supposed to keep medical decisions separate from profit-seeking ones even though PE firms admit that they insert themselves into the clinical side of the practice.
  • Doctors in solo practice can sell out for $7-12 million, with some of that paid in equity. Patients are not notified of the practice’s new owner.
  • Some of the acquiring firms pay cash bonuses to offices that hit daily and monthly financial goals, encouraging them to perform as many procedures as possible. In some cases, medical assistants earned their bonuses by falsifying documentation and doctors were told to falsely claim that they were supervising PAs.
  • PE firms push dermatologists to perform more high-profit procedures such as cosmetic surgery, laser treatments, and Mohs surgeries, the latter of which are sometimes performed by traveling labs that are flown in or that work from temporary parking lot clinics.
  • PE firms buy labs and hire their own pathologists to keep revenue in-house, which is legally allowed under Stark laws only for dermatology and a few other specialties.
  • Doctors are pushed to see more patients and sometimes are forced to use inferior medical supplies and equipment. One dermatologist says their employer insisted that surgery patients be sent home with open wounds so they would be forced to return the next day for suturing, which allowed the practice to bill them a second time.
  • 25% of the dermatologists with the highest biopsy rate work for private equity-backed groups who encourage diagnosing “Pre- pre- pre-cancer” to get patients to have skin blotches removed.
  • A dermatologist says that the debt-saddled chains are struggling to find their expected buyers since “there’s a limit to how much money you can make when you’re sticking knives into human skin for profit.” As a result, the PE firms are moving into specialties that perform more invasive procedures, such as urology.

Sponsor Updates

  • Banner Health (AZ) expands its use of Spok’s Care Connect communication software.
  • Health Catalyst will partner with life sciences company Sprim to use real-world evidence to inform clinical trials for liver disease.
  • Gartner includes Imat Solutions in its “US Healthcare Payer CIOs Boost Medicare Advantage Star Ratings Using Engagement Hubs and Insights” report.
  • The “HIT Like a Girl” podcast will feature Intelligent Medical Objects CEO Ann Barnes on June 10.
  • NextGate’s identity-matching EMPI solution is now available in the Microsoft Azure Marketplace.
  • Arcadia makes available a COVID-19 Recovery Toolkit to help its customers resume normal operations.
  • Wolters Kluwer Health helps to develop and virtually host the American Diabetes Association’s 80th Scientific Sessions June
  • Providers from five health systems will present their experience with implementing Glytec’s EGlycemic Management System during the 2020 Diabetes Technology Society Virtual Hospital Poster Session. 12-16.
  • PCare adds on-demand movies and television shows from Tubi to its COVID-19 Tablet Configuration Solution.
  • Optimum Healthcare IT posts a case study titled “ Virtual Epic Go-Live at Valley Children’s Healthcare.”

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 6/11/20

June 11, 2020 Dr. Jayne 2 Comments

CMS Administrator Seema Verma blogged for Health Affairs last week, sharing a discussion of CMS payment model flexibilities that stem from COVID-19.

The healthcare system in the US was broken to begin with and the pandemic has pushed many organizations past their breaking points. Many of my physician colleagues have retired, closed their practices, or been downsized by their employers in the name of cost savings. Hospitals and health systems have laid off countless employees from everywhere in the process. Very few job classifications have been spared, and I suspect we’ll see a number of CEO, COO, and CFO heads start rolling before long.

Although it was a well-written read, I was disappointed that it mostly rehashed the changes that have been ongoing for the last several years in attempting to transition us from a fee-for-service to a fee-for-value model. She mentions the concept of providers taking financial risk as “the cornerstone of value-based care,” but over the last few months, most providers have figured out that financial risk is the cornerstone of all of fee-for-service as well. Plenty of providers and hospitals who counted on a certain number of procedures or encounters have been hobbled, if not sent to bankruptcy. It’s not clear if they would have been better off under value-based care arrangements since they don’t fit every specialty and situation. Verma notes that such arrangements “provide stable, predictable revenue,” but that doesn’t really apply to urgent and emergent care situations or unpredictable needs for things like cancer surgeries.

She goes on to talk about flexibilities CMS is adding, but a quick look at the summary table shows that many of the changes are extensions of existing models or delays to the start of upcoming or changing models. A handful of models have changes to their financial methodologies. Verma also mentions flexibilities with telehealth, which I hope become permanent. Nearly every patient I’ve spoken with has been happy with their telehealth visits and not having to experience the hassle of visiting an office.

Congress is paying attention to telehealth, with a bill recently introduced that would require HHS to study how telehealth has been used during the pandemic and to deliver a report back to legislators within one year after the emergency ends. The bill is HR 7078, the Evaluating Disparities and Outcomes of Telehealth During the COVID-19 Emergency Act of 2020.

I didn’t have time to dig deeply into the federal register since I’m in the middle of a couple of big projects, but I’d be interested to see how they define telehealth and how data points would be gathered. Many physicians I know haven’t been using proper billing codes while they deliver telehealth, instead performing what is essentially a free visit in the name of ensuring patients are cared for. Some of the major telehealth vendors don’t use standardized billing codes, especially if they offer a direct-to-consumer option. The bill would require analysis of the types of telehealth platforms used as well as the locations where care was delivered (hospital, physician office, health clinic, private home, etc.) I wonder how they would classify the RV flying down the highway, which was my patient’s location the other night.

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ONC announces its all-virtual Tech Forum for August 10-11, 2020. Sessions will include a mix of keynotes, panel discussions, and breakout sessions. The full agenda isn’t available, but I registered anyway. How can you not like a conference that gives you more than an hour for lunch plus two 30-minute breaks and you can do it all from the comfort of your own home? Get your fuzzy bunny slippers ready and I’ll see you there.

News of the weird: A surgery professor in California leverages telehealth and maggots to treat a patient’s wound, saving his limb and likely his life. David Armstrong, DPM, PHD is co-director of the limb salvage program at the University of Southern California Keck School of Medicine. The maggots in question, which he refers to as “nature’s microsurgeons” are larvae from the common green bottle fly. The patient had experienced tissue death after a surgical procedure, but also had diabetes and recurrent pneumonia and was high risk for an emergency department visit due to COVID-19; the necrotic tissue in his arm placed him at high risk for sepsis. Armstrong shipped a package of larvae to the patient then instructed a home care nurse via video on how to apply the larvae and dress the arm. Two days later, they used a telehealth encounter for a dressing change. After another course of treatment, the necrotic tissue was reduced from 46% to less than 1%.

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I worked with the best scribe this week. He was geeking out on ICD-10. With the nice weather and lifting of stay-at-home orders, we’ve been seeing plenty of orthopedic injuries and trauma. At the end of the day when reviewing and signing my notes, I was glad to be surprised by entries that went well beyond the usual sprains, strains, and lacerations:

  • W29.3XXA Contact (accidental) with hedge-trimmer (powered).
  • Y92.832 Beach as the place of occurrence of the external cause.
  • Y93.G2 Activity, grilling and smoking food.
  • Y92.828 Other wilderness area as the place of occurrence of the external cause.

My recent shifts haven’t been much to smile about, so I was glad for the distraction. Needless to say, I rewarded him handsomely via our on-demand bonus system. He’s leaving soon for medical school, so he’ll definitely need the extra dollars.

Although emergency physicians aren’t expressly there to deliver preventive care, I’d like to offer some guidance based on my recent experiences. First, if you’re going to be using an electric hedge trimmer, may I suggest not “rushing to beat the heat of the day” and also wearing a pair of sturdy work gloves. Second, if you’re going to engage in a beach barbecue, follow the instructions on the charcoal lighter fluid and don’t squirt it on the coals beneath the already-cooking food. Third, if you’re going to use the hunting knife you just sharpened to open the cheese and sausage packages on your picnic table, please wear shoes. That’s a wrap on today’s safety moment, folks.

What’s your favorite summertime ICD-10 code? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 6/11/20

June 10, 2020 Headlines No Comments

Kyruus Secures $30 Million Investment from Francisco Partners

Provider search and scheduling software vendor Kyruus raises $30 million in funding from Francisco Partners.

Cerner Gets Potential $99M VA Software, Hardware Sustainment Task Order

The VA gives Cerner a $99 million task order for sustainment support of hardware and software associated with its EHR modernization project.

Cue Health Closes $100 Million Series C Financing to Support Launch of Rapid Molecular Testing Platform

App-based testing company Cue Health will use $100 million in new financing to expand its San Diego headquarters and further develop and commercialize its portable COVID-19 testing kit.

QGenda Announces Strategic Growth Investment From ICONIQ Capital

Iconiq Capital invests in Atlanta-based healthcare workforce technology company QGenda. 

Readers Write: An Interoperability Data Challenge — Out and Back Demonstrating Reflection

June 10, 2020 Readers Write 10 Comments

An Interoperability Data Challenge — Out and Back Demonstrating Reflection
By Brody Brodock

Brody Brodock is a principal with AdaptTTest Consulting of Raleigh, NC.

I want to offer up a challenge that will express the current state of interoperability within regional systems. The challenge involves the top N most frequently used values within domains, exchanged via C-CDA within your community of practice, reconciled and incorporated, then returned to the sender, where the originating sender then reconciles and incorporates the returned items.

This should be a simple task that any certified EHR can accomplish with 100% accuracy. However, if you get better than 80% success in the first part of the exercise, I will be greatly surprised. If you can successfully exchange above 50% on the second round, I will be impressed. I would even argue that two systems from the same vendor will be challenged.

We should keep this to the required domains: medications, problems, and medication allergies. Other domains should be left out to reduce complexity. This gets messy really quickly.

You will need to gather from your system:

  • Problems. Problem text, problem code, problem code set, status, date added, date updated, and onset date.
  • Allergies. Allergy category, allergy severity, reaction, reaction severity, allergy dates with specificity, status, and the codes for allergy and allergy reaction.
  • Medications. This might get trickier as some systems load meds into different table sets depending on the order type (prescription or order). But essentially you need the medication name, medication code, status, date of entry, order expiration date, dose, dose form, frequency, SIG, PRN, and DAW.

Once you gather these extracts, (you might need to limit the period), you should slice and dice the data to tell you what the most frequently used (MFU) items are. You don’t generally need to associate the metadata to other data elements. Knowing that the top medication allergy is penicillin is sufficient, the top reaction might be hives — they don’t need to be associated in this round.

HIPAA note: watch out for names in the SIG, and purge any “zzz” names you come across.

Now that you have your list, take the top 10 from each and add them to your new patient. Then another set of patients that reflect the metadata objects: status, dates, reactions, severity, PRN, DAW, etc. If you have the ability to add free text med allergies, then submit a patient safety defect report to your vendor, but send the free text allergy anyway. Try “pentillacillian” with “anti fylaktic” — yes, I have seen that.

Medications should be a mix of your top 10 prescriptions, plus your next 10 with your top SIG, plus the next top 10 with all of your statuses. Add a couple that are tapered dose, vaccines with multiple dosages, and multiple formulations (albuterol syrup, pill, and rescue inhaler) all active.

Your CDS/DUR systems are supposed to alert for for all of these domains. Once you reconcile and incorporate these items into your system, pick a couple of items like penicillin with anaphylaxis and attempt to prescribe that. You should get an alert. A significant battery of CDS/DUR tests should be done with this data.

Now that you have built up the patients, have your development team automate them so they can be duplicated on demand. If you don’t have an automation team, ask your vendor for their scripts. These tests should be part of your standard operational and production qualification tests — OQ/PQ.

Now send these patients via a summary of care or a transfer of care (try both — they should be different) to your geographic neighbors. Whichever systems from which you receive transfers, referrals, and notes. They will be ambulatory, acute, ED, SNF, and specialty facilities. But more importantly, they will be different systems, or at least different configurations of like systems.

Take these C-CDAs and send them through your Direct HISP, email, or sneaker net (HIPAA rules apply and these must be fake patients). You can name them “MedicationTest-xxx” where xxx is an alpha counting scheme: aaa is the first, aab the second, all the way to zzz being patient 676. If you can create patients with numbers in them, I would be surprised, but go ahead and try one of those patients too. “Patient 0” shouldn’t be possible, so it will probably blow up on the receiving end.

The receiving facility should then bring in the C-CDA and perform reconciliation of the listed domains. Problems, medication allergies, and medications should now be in this patient’s record.

The expected result is 100% accuracy in the exchange. No conversions, no substitutions, no increased or decreased specificity, no “go fish” in presenting the user with a series of options to reconcile. These are the most frequently used, so there should be no problem.

Your actual results will not be even close to 100%. You will have allergies that switch category, reactions that aren’t recognized, medication APIs that are switched to brands, problems that are either more specific or less specific than the incoming problem, dates that will increase specificity from year or null to DD/MM/YYY:Time, and multiple formulations that will be considered duplicates (three albuterol formulations).

Now without further modification, the receiving facility should create the same type of C-CDA and return it to the originating facility. A full round trip. The record that is returned will look like a completely different patient than the one that you sent out. Statuses and dates will be converted to something else and your medication intolerance will suddenly become a medication allergy. All sorts of fun here.

This is why healthcare interoperability singlehandedly enables the fax industry.

This is the first part of a long and complex set of tests, a simple out and back. Yet the exchange will demonstrate how badly the industry needs to get its data house in order. The results will not change just because you were using different technology. If you are using FHIR to write data back into your solution, you are going to have the same problems.

Morning Headlines 6/10/20

June 9, 2020 Headlines No Comments

PatientPing Secures $60 Million in Series C Funding to Continue Expansion of National Electronic Notifications Network

PatientPing raises $60 million in a Series C funding round, increasing its total to more than $100 million.

Babylon Health admits GP app suffered a data breach

London-based Babylon Health fixes a software error that allowed several users to view the archived telemedicine sessions of other patients.

Kristin Myers, MPH, Appointed Executive Vice President, Chief Information Officer, and Dean for Information Technology

Mount Sinai Health System (NY) promotes Kristin Myers, MPH to EVP/CIO and dean for IT.

News 6/10/20

June 9, 2020 News 5 Comments

Top News

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PatientPing raises $60 million in a Series C funding round, increasing its total to more than $100 million.


Reader Comments

From X-Treem Geek: “Re: Duke–UNC anti-trust lawsuit brought by physicians. Looks like they will soon face a new lawsuit for faculty.” Duke University and University of North Carolina paid $54.5 million in mid-2019 to settle a class action lawsuit in which academic physicians found evidence of a decades-long “no poach” agreement in which the schools agreed to avoid recruiting each other’s doctors to keep salaries in check. The new case seeks damages for non-medical faculty members who were not part of the original lawsuit.


HIStalk Announcements and Requests

Cerner tells me that tiny analytics vendor Surgisphere – which is under fire for its use of EHR data of unknown provenance to publish error-filled, now-retracted COVID-19 research studies – is not a Health Facts customer. Surgisphere has declined to disclose how it obtained a massive database of de-identified patient encounters from hospital EHRs, and many large health systems say they’ve never provided such data to the company. Meanwhile a non-profit in Africa that was using a Surgisphere-provided COVID-19 Severity Scoring Tool powered by the same database rescinds its recommendation of the software.

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

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Webinars

June 10 (Wednesday) 1 ET. “COVID-19: preparing your OR for elective surgeries.” Sponsor: Intelligent Medical Objects. Presenters: Janice Kelly, MS, RN, president, AORN Syntegrity Inc.; David Bocanegra, RN, nurse informaticist, IMO. The presenters will cover the steps and guidelines that are needed for hospitals to resume performing elective surgeries and how healthcare information technology can optimize efficiencies and financial outcomes for the return of the OR.

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


Acquisitions, Funding, Business, and Stock

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Business Insider profiles Doxy.me, which saw the user count for its browser-based telehealth platform jump from 80,000 in January to 700,000 now. The company is run from the house of the CEO, Medical University of South Carolina Assistant Professor Brandon Welch, MS, PhD, whose doctorate is in biomedical informatics. Headcount has increased from 15 full-time employees to more than 50. The company says it isn’t interested in the pitches it is suddenly getting from venture capital firms that have until now characterized telehealth platforms as a commodity. Welch, who says the company’s main competitor is Zoom, concludes, “The only thing providers care about is a way to connect with their patients. They don’t need all the other crap that other telemedicine solutions are providing. We just keep it simple and made it easy to sign up.” Doxy.me’s basic product is free, with paid upgrades available for expanded functionality and institutional use.

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Banyan Medical Systems offers its virtual care and telemedicine platform with no upfront costs to eligible hospitals that are waiting for funding from FCC’s COVID-19 Telehealth Program. I did a double take at the company’s information page that says funding expires on June 31, 2020, a day that will live in infamy for not actually existing.


Sales

  • Poplar Bluff Regional Medical Center (MO) will implement Pulsara’s telehealth and communication platform.
  • Rady Children’s Hospital – San Diego chooses Syft’s Synergy for supply chain management.
  • FDA will use HealthVerity’s privacy-protected data exchange for performing COVID-19 research on real-world datasets.
  • North Carolina’s HHS will use a COVID-19 version of the OpenBeds Critical Resource Tracker to track treatment and equipment resources across the state. The existing OpenBeds platform was developed to allow states to pool their behavioral health resources. OpenBeds is owned by Appriss Health, which is best known for its state prescription drug monitoring program systems.

People

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Mount Sinai Health System (NY) promotes Kristin Myers, MPH to EVP/CIO and dean for IT.


Announcements and Implementations

A Black Book survey finds that 93% of hospitals and large physician practices have seen financial IT system shortcomings exposed during the pandemic. Most CFOs say they will not reduce or defer financial system spending as they look to IT to improve revenue capture and to provide analytics and forecasting support.

Nemours Children’s Health System (FL) saw its telehealth visit count jump from 800 in April 2019 to 30,000 in April 2020, where it uses InterSystems technology to exchange information between its EHR and the its CareConnect virtual system for scheduling appointments.

OptimizeRx says that a partnership with an unnamed organization will expand the reach of its specialty medication platform to 300 health systems that use Cerner and Epic.


Government and Politics

Insurers, hospitals, and unions are pushing Congress to spend $100 billion to pay the COBRA insurance payments of 27 million laid-off workers who would basically get their health insurance for free. They are also supporting expanded ACA subsidies and Medicaid, but expect the COBRA bill to gain the widest support in Congress since it bypasses ACA-related politics.


COVID-19

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WHO makes a questionable statement that people who are free of COVID-19 symptoms don’t spread the infection, failing to differentiate between “asymptomatic” (infected patients who never experience symptoms) from “pre-symptomatic” (those who are infected but don’t exhibit symptoms until days later). WHO based its conclusion on a tiny review of contact tracing in China, whose findings are not in agreement with four rigorous studies that used actual data instead of people who simply speculate that their infections came from someone with symptoms. The resulting mass media clickbait interpretation makes the definitive statement that people won’t become infected if they avoid those with obvious symptoms, which could affect mitigation strategies such as encouraging social distancing and wearing masks. UPDATE: WHO clarifies that 6-41% of people who are infected don’t have symptoms but can still spread it, with 40% of infections coming from those symptom-free people. WHO says it regrets calling such spread “very rare.” Bottom line: nothing new has been learned and WHO takes a black eye for allowing scientists to confuse the public with poorly worded or researched comments, although they are at least allowing scientists to speak without bureaucratic filters. WHO also said in its correction that nobody should assume that its employees who are speaking at press conferences are speaking on behalf of WHO, which is truly bizarre.

Experts warn that temperature screening of employees and customers provides false reassurance given New York data showing that 70% of people admitted to the hospital for COVID-19 did not have a fever.

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Getting people back to work in high-rise office buildings that house thousands of workers creates a new problem with social distancing – limiting the number of people who are allowed in an elevator simultaneously while avoiding having them log-jammed in close proximity in the lobby.

HHS will run out of its free supply of remdesivir by the end of this month as Gilead tries to ramp up production of the antiviral, whose modest benefit to hospitalized COVID-19 patients was enough to convince HHS to distribute it to some hospitals.


Other

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Mozilla names the OpenMRS EHR as one of three open source winners of a $50,000 grant from its COVID-19 Solutions Fund. The award will be used to create the OpenMRS Public Health Response system that will include data collection tools, reports, and interfaces with public health systems.

Tuesday saw mixed messages from CMS Administrator Seema Verma on telehealth. She told STAT that “it would not be a good thing to force our beneficiaries to go back to in-person visits,” but then hinted that CMS needs to look at whether it should pay the same rates as in-person visits. She then said in an announcement encouraging the reopening of healthcare facilities that “while telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care.” I’m wondering if those who jubilantly predicted that the telehealth genie could not be put back in the bottle may have overestimated, as it seems clear that many providers and patients prefer in-office care; practices are more efficient (and therefore more profitable) when their providers are flitting between multiple exam rooms simultaneously, using non-physician helpers optimally, and perhaps upselling other services; kludgy solutions like Zoom and Skype offer an underwhelming, make-do experience; and the couple of months of virtual-only visits may not have been adequate to permanently change habits. All it would take is a pullback in CMS’s emergency payment and licensure policies to fill the waiting rooms again.

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In India, a state government investigates the case of an 80-year-old hospital patient whose family could pay only part of his bill. The hospital, worried about collecting the balance owed, refused to discharged the man and instead tied him to the bed.


Sponsor Updates

  • CompuGroup Medical sponsors recognition of Teachers of the Year in its US headquarters in Phoenix. The company provides CGM ELVI for telehealth, which allows teachers and students to connect virtually for counseling and speech therapy sessions.
  • Artifact Health engineering VP Jake Lieman describes the company’s experience in integrating its mobile physician query platform with Cerner using Cerner’s APIs.
  • Impact Advisors is named to CRN’s 2020 Solution Provider 500 list for the sixth consecutive year.
  • Clinical data exchange capabilities from InterSystems helps Nemours Children’s Health System scale its CareConnect telemedicine service.
  • XpresSpa will use AdvancedMD’s practice management and EHR software at its new XpresCheck COVID-19 screening and testing facilities in US airports.
  • CompuGroup Medical recognizes Teachers of the Year in Phoenix, the home of its US headquarters.
  • Elsevier Clinical Solutions adds Portuguese-language content to its COVID-19 Healthcare Hub.
  • Ellkay supports the Alpine Learning Group’s virtual Go the Distance for Autism Ride as a platinum sponsor.

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Reader Comments

  • David Lareau: The concepts in the graph database need to be mapped to the relevant vocabularies and code sets for the different domain...
  • Joe Magid: If you've not had a chance to watch Rachel Maddow on MSNBC, she had a pretty steady stream of video tales from the trenc...
  • nirvous: Sure, graph databases are hip. But how does reformulating a proprietary clinical vocabulary as a graph database solve th...
  • Brody Brodock (Adapttest): While I do agree that the current EHR schemas are not the best at categorization or enabling clinical decision making, I...
  • Frank Poggio: Re: The old ways of building EHRs to support tracking of transactions for billing will not suffice... If I have hear...

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