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Morning Headlines 5/11/20

May 10, 2020 Headlines No Comments

Gawande in Talks About Leaving Helm of Health-Care Venture Haven

Insiders report that Atul Gawande, MD, MPH will resign as CEO of Haven Healthcare and move to a less-operational role as chairman.

Allscripts Healthcare Solutions, Inc. (MDRX) CEO Paul Black on Q1 2020 Results – Earnings Call Transcript

During its Q1 earnings call, Allscripts representatives say recent layoffs helped to eliminate $75 million in annualized costs, and they are reviewing product lines to see if any non-core businesses should be sold.

Livongo Health EPS beats by $0.07, beats on revenue

Livongo reports Q1 results: revenue up 115%, EPS -$0.06 vs. -$0.79, beating Wall Street expectations for both.

Monday Morning Update 5/11/20

May 10, 2020 News 6 Comments

Top News

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From the Allscripts earnings call, following a Q1 report in which the company fell short of analyst expectations for both revenue and earnings:

  • The company’s 22 Virtual HIMSS sessions drew 900 registrants.
  • Virtual visits conducted with FollowMyHealth’s telehealth platform went from no demand to 70,000 visits in April.
  • The virtual visit platform is licensed on a per-provider, per-month model, with President Rick Poulton explaining that patients are seen by their own hospital-provided doctor instead of “whoever happens to be hanging out on a couch that day.”
  • 500 researchers have applied for access to its Veradigm COVID-19 research database.
  • Its CarePort care transition system has tracked the care of 22,000 COVID-19 patients across settings, with early findings indicating that 10% of middle-aged hospitalized patients who are diagnosed with COVID-19 die .
  • Allscripts estimates that the pandemic impacted its Q1 revenues by $7-10 million, from both lower volumes and delayed purchase decisions, and otherwise the company would have met its revenue guidance.
  • Memorial Sloan Kettering Cancer Center is among the health systems that have extended their inpatient system agreements at a total value of $100 million.
  • The company eliminated $75 million in annualized costs via layoffs in late March through April.
  • Allscripts is reviewing its product lines to see if any non-core businesses should be sold.
  • The company doesn’t expect to spend capital on acquisitions any time soon.

MDRX shares closed up 9% Friday, returning the company’s market cap to just over $1 billion. They are down 38% in the past year versus the Nasdaq’s 14% gain.


Reader Comments

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From CPAhole: “Re: contracts. I’m interested in how companies and providers will change their agreements after this pandemic. The typical force majeure clause just doesn’t cut it here.” I’ll run a survey for vendors and customers to describe any changes they’ll make to agreements going forward to address issues that the pandemic has exposed  — like providers being unable to pay their bills, vendors being unable to perform on-site services, or companies protecting themselves in pre-acquisition due diligence. The rarely invoked, usually boilerplated force majeure T&C will undergo new scrutiny and legal tests as pandemic-driven economic issues force vendors and customers into uncharted territory, like HIMSS citing that clause in refusing to issue HIMSS20 exhibitor refunds.


HIStalk Announcements and Requests

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The idea of using tech-powered contact tracing to control the coronavirus takes a hit from last week’s poll. Two-thirds of readers (who are heavily involved in healthcare and technology) say they won’t use the Apple-Google app right away, echoing the likelihood that the US won’t see anywhere near the 60% adoption that is required for effectiveness.

New poll to your right or here: Have you been tested for active COVID-19 infection?

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

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Listening: Michael Kiwanuka, the British singer-songwriter who provides the haunting opening theme to “Big Little Lies,” which we’re watching on Prime Video. It’s the perfect spacey, mysterious intro to a show set on and around the beaches of Monterey, CA. It’s just as connected to the series as the use of Cecelia Krull’s “My Life Is Going On” on “Money Heist.”


Webinars

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


Acquisitions, Funding, Business, and Stock

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Atul Gawande, MD, MPH will resign as CEO of Haven Healthcare and move to a less-operational role as chairman, insiders report. The Amazon – Berkshire – JPMorgan company, which has had minimal healthcare impact since its splashy debut in January 2018, is searching for a new CEO as Gawande’s interests refocus on coronavirus policy and advocacy work. Haven COO Jack Stoddard resigned last year after nine months on the job and was not replaced.

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Livongo reports Q1 results: revenue up 115%, EPS -$0.06 vs. -$0.79, beating Wall Street expectations for both. The company said in the earnings call that it has been selected by the Government Employee Health Association that provides medical and dental plans to 2 million employees. LVGO shares are up 42% versus the Nasdaq’s 11% rise since the company’s July 2019 IPO, valuing it a $5 billion. Executive Chairman Glen Tullman owns shares worth $344 million, while CFO Lee Shapiro’s holdings are worth $302 million.


Sales

  • Willis-Knighton Health System (LA) chooses CloudWave’s OpSus Healthcare Cloud for hosting its Meditech Expanse system that is being implemented. 

People

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Nordic promotes John Manzuk to SVP of managed services delivery.


COVID-19

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A New York Times report finds that virus-wary Americans had already slowed their spending, traveling, and dining out before lockdown orders were issued, raising the strong possibility that state re-openings won’t restore the pre-pandemic economy as businesses and potential customers remain unconvinced that it’s safe to conduct person-to-person business.

FDA Commissioner Stephen Hahn, MD, NIAID Director Anthony Fauci, MD, and CDC Director Robert Redfield, MD are self-quarantining for 14 days after being exposed to Vice-President Pence’s spokesperson Katie Miller, who has tested positive for COVID-19.

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The Department of Justice charges Henry Gindt II with selling stolen COVID-19 test kits directly to patients for up to $200 through his YouHealth website, then failing to provide the test results. Gindt’s LinkedIn says he was a co-founder of President Trump’s Office of American Innovation, where he says, “Key wins included combining the electronic medical records (EMRs) of Department of Defense and VA employees and soldiers.”

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A researcher identifies what he says is a flaw in India’s government-mandated COVID-19 contact tracing app – which uses both GPS and Bluetooth — that allows him to identify the location of all infected users. The government requires all employees and military members to use Aarogya Setu, as well as people who live in containment zones and those who are returning from other countries. The app presents a chatbot-powered symptom checker and travel history questionnaire and health authorities track answers in a database and contact those who might be infected.

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NYC Health + Hospitals investigates ED nurse Lillian Udell, who recorded her co-workers talking about shortages of PPE. The health system says she violated HIPAA even though no patients were shown. Another nurse whose PPE pleas on “60 Minutes” earned the praise of the hospital’s president said of Udell’s case, “I feel like a lot of hospitals are using HIPAA almost under the guise of patient protection and safety, and privacy safety. But really it becomes more apparent to me, at least, that HIPAA is kind of being used to gag people. We’re all experiencing the most difficult working conditions we’ve ever faced. And everybody who is speaking out is doing so to advocate for patients, ultimately. It looks like hospital administrations tend to run to HIPAA for their protection, not so much patient protection.”


Other

Kaiser Health News notes that at least half of the top 10 recipients of HHS’s emergency provider funding have either paid criminal penalties or settled billing fraud charges in the past. Florida Cancer Specialists & Research Institute, which hasn’t started paying its recently imposed $100 million federal penalty for anti-competitive practices, got $67 million in federal bailout money. Experts observe the irony of health systems being paid at rates that are based on their Medicare billing when they were also accused with falsely inflating their Medicare bills through fraud and abuse. Other health systems that are in the top 10 that have paid to settle fraud charges are Dignity Health, Cleveland Clinic, Memorial Hermann, and Mass General.

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A display company in Colombia offers small hospitals an $85 cardboard patient bed that, if the occupant dies, converts to a casket.


Sponsor Updates

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  • PatientKeeper supports healthcare workers at Portsmouth Regional Hospital.
  • MDLive reports significant growth of its behavioral health business as its virtual therapy service provides safe, timely access to care during the pandemic.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new edition of its Critical Care Obstetrics podcast, “Sepsis Simplified.”
  • RxVIP Concierge offers CareSignal’s COVID Companion text-messaging app through its new “Stand Up to COVID19” patient initiative.
  • Relatient joins the Cerner App Gallery with mobile-first self-scheduling and waitlist solutions.
  • T-System offers DrFirst’s telemedicine software to its urgent care and emergency department customers.

Blog Posts


Contacts

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

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Weekender 5/8/20

May 8, 2020 Weekender No Comments

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Weekly News Recap

  • Allscripts reports Q1 results that miss Wall Street expectations for both revenue and earnings.
  • CVS Health beats Q1 expectations and reports a 600% increase in telemedicine visits in its MinuteClinic business.
  • Change Healthcare acquires ERx Network, sells its Connected Analytics business.
  • Johns Hopkins recommendations for addressing COVID-19 include making EHRs searchable by public health officials, creating a platform for hospitals to share PPE and medical supply availability, and improving healthcare supply chain tracking and coordination.
  • Duke University’s interoperability recommendations for containing COVID-19 include collecting and reporting patient demographics with samples, defining a minimum data set, and expanding the use of the National Syndromic Surveillance Program.
  • CMS issue waivers to pay full rates for telephone-based encounters.
  • Epic launches a public website where customers can post their observational findings about COVID-19 or other health and public health issues.

Best Reader Comments

My former employer (an EHR company) had onsite primary care clinics for all employees that were also set up as somewhat of a showcase of how to “EHR” well. All the exam rooms had two armchairs facing a large monitor that the physician’s laptop was connected to. After the exam the doc would move the conversation over to those chairs to write up the note and finish the visit, making the act of writing the note more of a collaborative experience. As a patient, it felt a lot better than the doc plugging away on a laptop on their little stool while the patient sits on butcher’s paper. (EHRing well)

There’s actually a FHIR-based replacement to CCOW called FHIRCast that’s been in the development / connectathon testing stage for about two years. (Not sure if it’s in production anywhere yet.) There’s actually a track focused on testing it and playing with it during the May 13-15 connectathon too. I’m sure you’d be welcome to show up and dabble! (Lloyd McKenzie)

Re: remdesivir study. Statistical significance means less than 5% probability the result is due to chance, but you have to specify the one thing you’re measuring in advance. They didn’t do that—instead changed from mortality to recovery time. This sort of thing raises the question of how many more slices of the apple they would have taken until something passed the test. (Robert D. Lafsky, MD)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. F in Michigan, who requested Osmo learning sets for her first grade class. She reported in early February, “My students absolutely love Osmo. While they believe that they are playing, they are learning so much! My students are using Osmo Coding Awbie and Osmo Detective Agency both cooperatively and independently. They look forward to Friday afternoons, which is when we have technology time to explore and learn. Prior to the funding of this project, I only had two sets of these games. By donating to my project, my students now have the choice to work on their own or with a buddy to feed strawberries to Awbie as they code a path for him or solve the mystery in Paris. My students are so excited to explore with Osmo!”

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Intermountain Healthcare cancels its agreement to send COVID-19 capacity data to data monitoring vendor Banjo following reports that the company’s CEO was a white supremacist as a teen and served as the getaway driver in a KKK synagogue shooting. The company has received $100 million in funding to develop police surveillance tools, with the state of Utah being a big customer until it cancelled after Damien Patton’s history surfaced. He says he was a homeless high school dropout who was taken in by skinhead and white supremacy groups.

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The Ascension Seton nurse whose sign for co-workers explained why he was staying so long in the room of a COVID-19 patient provides this explanation:

I just feel like I was doing, as a nurse, what I’ve been taught. That’s what you do. I work at Seton and we have a policy that no one ever dies alone. It doesn’t matter, any circumstance. COVID makes it more difficult, but no one dies alone. Someone’s going to be there in your room with you.

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A Harvard Medical School professor says that pathogen-fueled anti-immigration sentiment isn’t new, as early US immigration laws were created out of fear of disease, especially cholera. A New York City mob, led by wealthy landowners, stormed the city’s 1,000-bed New York Marine Hospital, called Quarantine, in 1858 and burned it down, returning the next night to use battering rams to level what remained. Many of Quarantine’s patients were new immigrants who had arrived by ships on which health inspectors found at least one person who was suspected of having an infectious disease, which then forced all of the ship’s occupants into lockdown.

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Food service vendor Aramark opens makeshift grocery stores in several New Orleans hospitals so that healthcare workers don’t have to go shopping for essential and hard-to-find groceries after work.


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Morning Headlines 5/8/20

May 7, 2020 Headlines No Comments

Allscripts announces first quarter 2020 results

Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.09 vs. $0.16, missing Wall Street expectations for both.

HHS OIG Toolkits for Calculating Opioid Levels and Identifying Patients At Risk of Misuse or Overdose

HHS OIG creates freely available statistical tools for analyzing prescription claims data to identify patients who are at risk of opioid misuse or overdose.

Braid Health Raises $9 Million in Seed and Series A Funding Led by Lux Capital

AI-powered digital imaging company Braid Health will use a $9 million funding round to further develop its software and create a virtual network of specialists.

Ballad Health vendor to locate center in region, add 500 jobs

Ensemble Health Partners will build an office to accommodate 500 new employees and 1,100 Ballad Health staffers who will transition to the RCM vendor once the hospital goes live on Epic in June.

News 5/8/20

May 7, 2020 News No Comments

Top News

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Allscripts announces Q1 results: revenue down 3%, adjusted EPS $0.09 vs. $0.16, missing Wall Street expectations for both.

MDRX shares dropped 6% in after-hours trading immediately following the announcement after closing up 6.5% on the day. The company’s market capitalization is $952 million.


HIStalk Announcements and Requests

I fixed HIStalk’s mobile layout, also adding an option to place an icon on your device’s home screen to enable one-click access.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Shares of embedded communications technology vendor Twilio, which Epic recently chose to power its telehealth offering, rose 25% Wednesday after  the company reported a Q1 revenue increase of 57% to $365 million. The company also raised Q2 revenue guidance by another 35%. Twilio is valued at $22 billion.

The US Court of Appeals upholds a district court’s dismissal of a class action lawsuit against EClinicalWorks in which the estates of two deceased patients claimed that errors in ECW’s system displayed incomplete or inaccurate patient data to providers. The appeals court says the plaintiffs lacked standing to sue because they provided no proof that anyone was harmed.

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CVS Health announces Q1 results: revenue up 8%, EPS $1.91 vs. $1.63, beating analyst expectations for both. The retailer saw a 600% jump in telemedicine visits through its MinuteClinics, part of an overall spike in its digital services that helped the essential business realize first-quarter sales of $67 billion.


Sales

  • Perry Community Hospital will use remote cardiac and respiratory monitoring software from Coala Life to launch a remote monitoring program for its patients in rural Tennessee.

Announcements and Implementations

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CarePort Health releases an interoperability solution that meets CMS’s Conditions of Participation requirement that hospitals send ADT notifications to primary care physicians and post-acute care providers.

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Premier adds perinatal quality analytics to its QualityAdvisor improvement software.

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LogMeIn releases a healthcare edition of its GoToMeeting videoconferencing platform that meets HIPAA requirements by offering a Business Associate Agreement, with a cost of $16 per user per month for unlimited sessions and minutes.

Intelligent Medical Objects releases an open source standardized terminology package for COVID-19 that allows aggregating and sharing patient problems, procedures, and labs information.


People

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Experity names Callan Young (Anaplan) SVP of marketing.

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Wil Lukens (CenTrak) joins Critical Alert as VP of sales.

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Wolters Kluwer Health hires Frank Jackson (Prognos Health) as VP/GM of its Health Language business.


Government and Politics

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HHS awards $583 million to 1,400 federally-funded health centers to help them expand COVID-19 testing.

HHS publishes a list of the 142,000 healthcare providers that received money from the $50 billion HRSA Provider Relief Fund, in which money was paid based on their Medicare net patient revenue. The median payment was $9,600, the average $142,000. The top 10 recipients are:

  1. Dignity Health ($180 million)
  2. Cleveland Clinic ($103 miliion)
  3. Stanford Health Care $(102 million)
  4. Memorial Hermann Health System ($92 million)
  5. NYU Langone Health ($92 million)
  6. County of Los Angeles ($81 million)
  7. HMH Hospitals $(77 million)
  8. Florida Cancer Specialists and Research Institute ($67 million)
  9. Memorial Hospital for Cancer and Allied Diseases ($64 million)
  10. Massachusetts General Hospital ($58 million)

HHS OIG creates freely available statistical tools for analyzing prescription claims data to identify patients who are at risk of opioid misuse or overdose.


COVID-19

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The White House rejects CDC’s recommendations — which it commissioned — on when and how state and local officials should allow business owners, restaurants, schools, and churches to reopen. “Guidance for Implementing the Opening Up America Again Framework” was supposed to have been published Friday, but the public health agency’s scientists were told it “would never see the light of day.” The White House repeated in a Wednesday briefing that states are responsible for their own COVID-19 response.

A Premier survey finds that hospitals will need to expand their COVID-19 testing capacity by more than 200% to even partially resume full services. The hospitals say they are constrained by lack of testing reagents (41%) and swabs (40%). Most hospitals hope to screen employees for coronavirus symptoms before resuming non-emergency procedures, but just 32% say they have enough COVID-19 tests for frontline workers, so most will limit testing to those employees who exhibit symptoms.

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Government officials in the UK consider rolling out “immunity passports” to qualifying individuals as part of forthcoming plans to ease the country’s lockdown. The digital certificate would incorporate facial biometrics and antibody test results into an app that employees could use to gain entry into their workplaces.

NIH launches a study to determine whether the low number of reported cases in children is due to natural immunity or infection without symptoms.

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The US — unlike Italy, Spain and China —has not seen a significant decrease in daily new cases following the infection’s peak, which occurred here on April 26, causing former FDA Commissioner Scott Gottlieb, MD to warn that the virus could continue as a “slow burn of infection across the country … we still have a lot of infection.”

Axios reports that some White House officials believe that COVID-19 death counts are being inflated because hospitals get paid more for treating coronavirus patients. Other insiders believe the actual number is lower because presumptive cases are not being verified by autopsy, also noting that data reporting standards are not uniform.

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An MIT Technology Review article says epidemiologists and public health experts struggle to draw population-level conclusions from COVID-19 testing results, as each state sets its own standards for data collection and reporting. Some states still accept provider reporting via fax and Excel. The results of at-home tests won’t necessarily be reported to the state at all, and those tests have varying accuracy. The authors recommend using CDC’s FHIR-based tool to report directly from EHRs and non-profit Logica has developed an open source interoperability platform for health system COVID-19 reporting. Experts say that it would be ideal if the federal government took the lead on public health data efforts, but that isn’t likely to happen.

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Johns Hopkins University updates its COVID Control study app, in which volunteers submit their temperatures and any symptoms daily to detect outbreaks.

In England, Imperial College epidemiologist Neil Ferguson — whose group’s prediction of massive numbers of COVID-19 deaths in the absence of mitigation strategies led the UK and US governments to implement drastic measures — quits his UK government advisory role after a newspaper reports that he broke the stay-at-home rules he advocated by allowing his girlfriend to visit him. Complicating the issue is that both Ferguson (called “Professor Lockdown” there) and his girlfriend are married to other people, each of them have children at home, Ferguson has tested positive for coronavirus, and the woman says her husband is showing symptoms.


Other

Germany-based hospital and dialysis center operator Fresenius is hit with a ransomware attack. US and UK government cybersecurity centers warned Tuesday that state-sponsored hacking teams are targeting organizations that are involved in COVID-19 response.

A JAMIA-published study looks at how Mayo Clinic’s move from Cerner to Epic affected its patient satisfaction scores, concluding that the scores dropped significantly and didn’t return to previous levels for 9-15 months. Areas most affected were access, wait time, and receiving information about delays. Satisfaction dropped before go-live, which the authors hypothesize was due to schedulers using two systems and implementing new processes as well as pulling team members offline for training.

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In England, anonymous artist Banksy creates a painting for Southampton General Hospital depicting a child replacing his superhero dolls with one of a nurse.

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Good tweet.


Sponsor Updates

  • Goliath Technologies releases a new video, “How to Reduce Barriers to Clinician Satisfaction with Cerner.”
  • Wolters Kluwer Health launches a Rapid Onboarding module in Lippincott Procedures to help hospitals prepare nurses for COVID-19 care.
  • Impact Advisors hires James McHugh (Guidehouse) as managing director.
  • Intelligent Medical Objects releases a new e-book, “Leveraging the EHR for effective clinical workflows.”
  • InterSystems releases a new PulseCast podcast, “Don Woodlock: Capturing Cleaner Data Across the Care Continuum.”
  • Spok supports and honors nurses during Nurses Week.
  • The local paper profiles the Western PA Home & Community Task Force’s use of CarePort Health’s Guide technology, which helps connect hospitals with best-fit, post-acute care facilities for their patients.

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 5/7/20

May 7, 2020 Dr. Jayne 2 Comments

This week is National Nurses Week. I salute all the nurses who taught me what I really needed to know to be successful on the wards, since most of it wasn’t covered in the formal curriculum presented by the medical school faculty.

I came across this pastry shout-out to nurses from physician Cindy Chen-Smith @artmeetscookie and was blown away by the airbrushing. Whether you’re a superhero in chunky shoes, New Balance sneakers, sassy heels, or tactical boots – I salute you.

I also enjoyed reading the comments on National Nurses Day from Patti Brennan, director of the US National Library of Medicine (and a nurse herself). She notes, “While the Library can’t manufacture more time, fabricate personal protective equipment, or stand beside the bed of a patient in need, we can help nurses find freely accessible literature.” Brennan mentions special search strategies such as LitCovid, which I admit I’d never heard of. It’s a curated hub for tracking the most recent scientific information about our current situation and categories articles by topic and by geographic location.

I enjoy seeing the breadth and depth of the projects my clinical informatics colleagues are working on. This research letter published in JAMA Internal Medicine last week looks at “Internet Searches for Unproven COVID-19 Therapies in the United States.” Since we’re looking at a disease with no reliable proven treatments there are plenty of ideas floating around the internet (and directly from political figures) that are catching people’s attention. The authors looked at internet searches that were “indicative of shopping for chloroquine and hydroxychloroquine” by monitoring Google searches “originating from the United States that included the terms buy, order, Amazon, eBay, or Walmart” in combination with chloroquine or hydroxychloroquine.”

They cross referenced the data against the dates when Elon Musk and President Trump endorsed the drugs, as well as the date when news reports on treatment-related poisonings were published. The authors found that “queries for purchasing chloroquine were 442% higher following high-profile claims that these drugs were effective COVID-19 therapies.” Searches for buying hydroxychloroquine were 1389% higher. Searches for purchasing the drugs continued to remain high following news reports of their dangers, although at a lower level (212%).

In the discussion, the authors note that “Google responded to COVID-19 by integrating an educational website into search results related to the outbreak, and this could be expanded to searches for unapproved COVID-19 therapies.” I’m sure there will be more research questions to come in this area as the pandemic rages on.

Most of my physician colleagues have been doing at least some level of telehealth, and after a couple of months, some of them swear they don’t want to go back to in-person care at the same levels they practiced previously. Many patients don’t want to go back either, especially in economically depressed areas and among patients who previously had to travel long distances to receive treatment. A Stat news piece looks at patients in coal country, where the University of Pittsburgh Medical Center (UPMC) has seen a 3,700% increase in telemedicine visits.

One of the reasons for greater patient satisfaction during telehealth visits was noted by UPMC’s CMIO, who noted that who “doctors are able to type notes while facing the patient, instead of looking over their shoulders.” That seems like an operational / technical issue to me. Perhaps UPMC should look at reconfiguring their exam rooms and employing laptops on carts or a better type of device to make their in-person visits more hospitable. He also notes the struggle with initial visits, with patients succeeding on the second or third attempts.

Although many physicians are assuming that the wild, wild west of telehealth (non-HIPAA-compliant platforms, reduced requirements on service location) will continue, we’ll have to see what the payers decide to do. We’ve already seen many of the cross-state licensure waivers end, and there’s already a lot of financial pressure to return to the status quo. (How do you justify charging a facility fee when neither the provider nor the patient are in the facility? Inquiring minds want to know.)

As hospitals start to pass the peak of COVID-19 and clinical care teams start to learn to breathe again, the folks in finance are continuing to have increased anxiety. They have to figure out what it will take to make their balance sheets positive again, or at least less negative.  A recent article featured Dan Michelson of Strata Decision, who discussed what CFOs will need to weather the long-term changes after the COVID-19 storm. I’ve chatted with Dan a couple of times, and he’s usually spot-on in his observations.

Among the things he recommends: rolling budget forecasting, adherence to coding guidelines for complications and secondary diagnoses, and being able to anticipate patient behavior changes, especially the desire for non-emergency procedures. Organizations will also need to truly understand their costs, including PPE, overtime, and additional supplies in the new world post-COVID. They’ll also need to understand the role of self-pay in their overall financial picture, since many patients have lost the health insurance that was tied to their employers.

Another issue in the “new normal” post-COVID is understanding how we catch up on diagnoses that were missed due to multiple months of delayed preventive services. A report from the IQVIA Institute for Human Data Science looks at trends in the US for five common cancers.  The report estimates that 80,000 cases may be missed across breast, cervical, colorectal, lung, and prostate cancers based on decreased screening volumes in April compared to February.

I’m high risk for two of those conditions and am behind on my regular tests due to the closures, so I can definitely understand concerns about screening delays from the patient perspective. Interestingly, I’ve received no communications from either of the providers involved in my regular screenings, so I suppose I’m left to assume that their strategy for handling patient recalls during the pandemic was to just stop contacting people. That’s not much of a strategy for patients who might not be as compulsive about their health as I am. I’ll just keep bumping my calendar reminders forward a few weeks at a time until I hear the hospital is back in the screening business.

The American Academy of Family Physicians came out with a checklist for reopening practices to non-essential face-to-face visits. Usually their advice is pretty practical, but one bullet caught my eye. They recommend that common areas such as patient waiting rooms and staff break rooms should remain closed if possible. Although they recommend allowing patients to wait in their cars until it’s their turn to be seen, they conveniently avoided any recommendations on where staff should take breaks. In my travels, I’ve seen plenty of people eating in clinical care areas because they don’t have time to take an actual break or the office doesn’t have adequate facilities.

Seeing patients face-to-face in these new conditions is more tiring than before and staff do need a place to take a break (not to mention a safe place to take their mask off so their skin can breathe). They also call for staff to wear face masks, gowns, eye protection, and gloves when caring for suspected COVID-19 patients, We’re still in a shortage of gowns, so that’s just not realistic.

There was a recent story on “Good Morning America” encouraging graduates to donate their unworn gowns for healthcare providers to use as personal protective equipment. Although I appreciate the sentiment, I’m horrified that several months into this situation, we’re still in crisis mode. Will the surgeons be asked to wear hand-me-down graduation gowns to the operating rooms now that they’re starting to book cases?  I think not.

Does your staff get to use the break room, or to do they take their meals in their cars? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 5/7/20

May 6, 2020 Headlines 2 Comments

CVS Health first-quarter revenue rose 8% as customers rushed into stores to buy essentials; shares up

CVS Health sees a 600% jump in telemedicine visits through its chain of Minute Clinics, part of an overall spike in its digital services that helped the essential business realize Q1 sales of $67 billion.

TimeDoc Health Secures $5.7 Million Series A Financing Round

Chronic care management technology and services startup TimeDoc Health raises $5.7 million in Series A round of funding led by Vocap Investment Partners.

Cerner Earns Top Client Satisfaction Ratings for Inpatient EHR Vendor in Large Health Systems and Medical Centers, 2020 Black Book Survey

A Black Book survey names Cerner as the top-rated EHR vendor in large hospitals, and in outsourced tech support for hospital networks.

Morning Headlines 5/6/20

May 5, 2020 Headlines No Comments

Nashville health care company sells one business, reclaims another in $268 million of deals

Change Healthcare acquires ERx Network for $213 million, and sells its Connected Analytics business to Kaufman Hall for $55 million.

PointClickCare Acquires Co-Pilot Analytics Solution

Long-term and post-acute care health IT vendor PointClickCare acquires Consonus Healthcare’s Co-Pilot analytics software.

Britain’s Billion-Dollar Babylon Health App Set To Launch For ‘Millions’ Of New Yorkers

Mount Sinai Health Partners implements Babylon Health’s app, which includes telemedicine and new COVID-19 Care Assistant capabilities.

News 5/6/20

May 5, 2020 News 3 Comments

Top News

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Change Healthcare acquires ERx Network for $213 million.

The pharmacy claims and e-prescribing network reports $67 million in annual revenue.


Reader Comments

From Staying At Home Marketer: “Re: HIMSS conference. We learned this year that many people can work entirely from home, including doctors doing telemedicine. This could be the year that we learn the same about physically attending the HIMSS conference.” That could be the case. Vendors are (or will be) looking for new ways to reach prospects that go beyond the exhibit hall and its associated cost, and the exhibit hall is what powers not only the conference, but HIMSS itself. The conference will probably remain a big deal for those vendors who continue to participate even with its reduced critical mass, but others (especially those with shallower pockets) have a chance to even the playing field now that we’ve skipped a HIMSS conference and nobody is traveling. I’m hearing from companies that are interested in sponsoring HIStalk that I didn’t expect, although I’m losing some financially concerned ones as I assumed would happen. It will be interesting to see which companies benefit from adversity-forced strategic moves that go beyond trying to hunker down waiting for the old normal to come back.

From Opening Up: “Re: contact tracing. Technology could lead us out of this crisis.” Hardly, at least in terms of information technology in this country. We don’t have the discipline (and maybe rightfully so) to hide in our caves in hopes that someone will develop a vaccine or effective treatment. However, we trailed the world with our lackadaisical, “it will never happen here” approach to the virus while it was still potentially containable, so now the infection rate is out of control to stay, we’re a long way from herd immunity if there even such a thing with this bug, and you can’t contact-trace the entire country’s movements even with an app. Still, we need to use whatever tools we have available. I think we’re at a point, right or wrong, where we’re so anxious to get back to normal that we are willing to accept the inevitable casualties that will result (assuming it is someone else or their family, of course). It’s a good time to not be old, poor, or sick as we accept herd thinning as the acceptable price of avoiding an economic Stone Age. I’m struggling to find the right answer, or maybe struggling with the knowledge that any choice will kill people.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Infor. Infor Healthcare connects the business of healthcare with the mission of healthcare. Its healthcare operations platform elevates ERP to a strategic resource, enhancing delivery across the care continuum by delivering clinically connected capabilities that improve cost, quality, and outcomes. By bringing together supply chain management, finance, human resources, time and attendance, asset management, location-based intelligence, interoperability, and analytics, Infor gives healthcare organizations an industry-specific alternative to traditional enterprise resource planning (ERP) software. Thanks to Infor for supporting HIStalk.

HIStalk had some flaky moments on Monday during a denial-of-service attack that tied me up from Sunday morning until Monday night. I’m still doing some mostly unrelated cleanup that I discovered while figuring out the problem. One of those involves issues with the HIStalk display on mobile devices, which remains a work in progress since the original development company has abandoned the product I was using.

I caught up unexpectedly with Justen Deal (now Justen Burdette), who readers may remember as the 20-something Kaiser Permanente IT employee who in 2006 warned the organization about the uncertain of costs and stability of Epic, which was replacing a $440 million custom-written IBM system. Epic seems to have turned out fine at KP, so for the “everybody lived happily after” ending, Justen is living in Hawaii as CEO of mobile wireless provider Mobi.


Webinars

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


Acquisitions, Funding, Business, and Stock

Kaufman Hall acquires the Connected Analytics business of Change Healthcare for $55 million. The business generates $65 million per year.

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In Australia, clinical intelligence vendor Pacific Knowledge Systems will acquire Pavilion Health, which offers cloud-based coding and auditing tools.

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CPSI announces Q1 results: revenue up 1%, EPS $0.28 vs. $0.24, beating Wall Street expectations for both.  


Sales

  • Orthopedic telemedicine provider OrthoLive chooses Ellkay to bring the EHR information of its patients into its telehealth app.
  • Cooper University Health Care (NJ) chooses Accruent’s Connective healthcare technology management and Medical Device Security Analyzer as it brings its outsourced HTM program in-house. 
  • UK-based medical chat, telemedicine, and appointment scheduling app vendor Babylon Health — whose NHS rollout as the tech platform for GP at Hand created a company valuation of $2 billion — gains its first US client in Mount Sinai Health Partners Provider Network (NY).

People

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Impact Advisors hires James McHugh, MBA (Navigant) as managing director.


Announcements and Implementations

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CareMesh offers state and local public health departments free use of its National Provider Directory.

A Black Book survey names Allscripts as the top-rated inpatient EHR vendor in community hospitals.

Nebraska Health Information Initiative goes live with a COVID-19 cases and results dashboard, powered by NextGate’s EMPI, InterSystems HealthShare, and KPI Ninja Universe.

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Epic says that 3,000 patients of Community Health Network (IN) have used its MyChart COVID-19 symptom checker.


COVID-19

A COVID-19 model from Johns Hopkins Bloomberg School of Public Health predicts 3,000 US deaths per day and 200,000 new cases per day by June, but the school says those numbers are for a preliminary, FEMA-commissioned analysis rather than a final forecast. Hopkins adds, however, that the death count will rise significantly as governors reopen states despite meeting none of the federal criteria for doing so, such as a declining case count. Those numbers would represent an increase in daily deaths of 71% and an increase in daily new cases of 700%.

FDA says it will tighten its minimal requirements for companies to sell COVID-19 antibody tests, noting that the rush was on in mid-March to get some idea of population spread, but now the tests are being used to make individual decisions. FDA says companies are selling fraudulent tests, claiming their tests are FDA approved or authorized when they are not, and are marketing their tests inappropriately for at-home use. FDA will now require companies to submit their emergency use authorization requests, along with validation data, within 10 business days, and has also issued specificity and sensitivity thresholds for test developers.

Pfizer launches human trials of four variations of its COVID-19 vaccine, with the company saying that a successful candidate could be given clearance for emergency use or accelerated approval in the fall. Pfizer, like Moderna, is basing its vaccine on messenger RNA, a method that has never been used to develop an approved vaccine. More than 100 vaccines are being developed and 20 are expected to reach human trials this year. Initial tests involve patient safety.

Preliminary contact tracing studies suggest that most coronavirus transmission occurs by close, prolonged contact with someone who is experiencing symptoms. The highest risk factors were household contact, transportation, and dining, with family gatherings and church services giving high infection rates and those over age 60 at higher risk. Children are often infected, but do not seem to be driving outbreaks. The virus seems to spread best in cramped, poorly ventilated areas, such as homes, nursing homes, restaurants, and public transportation.

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A survey finds that two-thirds of Americans don’t believe that reported COVID-19 death counts are accurate. Forty percent of Republicans think the death count has been overstated, while 63% of Democrats believe the actual death count is higher than the official number. Overall trust in federal government has dropped to 38% and more than half of those surveyed are worried that schools won’t reopen in the fall and that food shortages will develop in the next month.  

WHO warns that government reopenings don’t change the fact that coronavirus is still a global health emergency, as case counts are rising rapidly in poorly prepared Africa and South America.

Axios notes that COVID-19 has placed most clinical drug trials on hold, especially those that involve hospitals, and pharma startups face uncertain timelines, a need for more venture funding, and a requirement to conduct studies in multiple locations to avoid having a study halted due to a local outbreak. 

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Johns Hopkins Bloomberg School of Public Health’s Center for Health Security recommends healthcare system changes that will be needed to address the pandemic, saying that the changes will cost billions but “certainly cost less than the trillions now being spent because our public health and healthcare system was not prepared or equipped for this pandemic.” Among them:

  • The federal government should create an information sharing system to allow states and hospitals to work together to obtain PPE and medical supplies and improve its medical supply chain tracking and coordination. .
  • Congress should create legislation to increase domestic production of PPE.
  • Hospitals should buy more reusable devices in their respirator purchases, such as elastomeric face masks and PAPRs.
  • Hospitals should not resume full services until ED visits, ICU census, ventilator use, and PPE use either plateau or return to pre-COVID levels.
  • Hospitals should give every admitted patient a rapid COVID test to detect asymptomatic carriers.
  • HHS should track hospital financial losses and establish short-term bridge funding for hospitals that are in danger of imminent collapse, while CMS should provide financial incentives for those that achieve specific goals for preparedness and infection prevention.
  • Regulatory limits of professional licensure, certification, and scope of practice should be relaxed, including extending cross-state licensure beyond the compact-signing states.
  • Barriers to conducting telephone or video encounters should be removed – state and federal regulations, HIPAA, and reimbursement that is lower than for in-person visits.
  • Congress should use its emergency regulatory authority to authorize clinicians to work at top of license.
  • Healthcare organizations should consider offering hazard pay to employees who are involved in direct COVID patient care and offer mental health counseling to all employees.
  • Congress should make sure that all COVID-related costs are covered under the CARES Act, should require companies to provide 10 days of sick leave for all employees, and develop a plan to give Americans access to affordable healthcare insurance.
  • Healthcare facilities should make significant investments in telemedicine, payers should pay them at the same rate as for in-person visits, and HHS and professional societies should publish guidance and best practices.
  • EHRs should be searchable by public health personnel to aid situational awareness.
  • The US needs to review hospital surge capacity given the existence of market forces that have driven down staffed bed levels.

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MIT scientists develop STOPCovid, a one-hour, $10, minimal handling COVID-19 diagnostic test that offers 97% sensitivity and 100% specificity, requires no special instrumentation, and appears to work well with saliva samples. The FDA has not yet reviewed the test, but the project invites COVID researchers to request a starter kit, hoping to expand test-trace-isolate measures that are required to re-open society.

Sources say President Trump is shutting down the coronavirus task force, sending its responsibilities to FEMA. The frequency and length of the group’s meeting have already been reduced.


Sponsor Updates

  • A Dimensional Insight survey finds that EHR analytics tools deliver lower user satisfaction than both analytics-specific platforms and in-house solutions, with more than one-third of users reporting slow queries and inadequately robust capabilities.
  • Nordic posts a podcast titled “Rise in telehealth sessions alone won’t create great patient experiences.”
  • AdvancedMD publishes a new e-book, “Telehealth: The Ultimate Guide to Maximizing Revenue, Keeping More of What You’re Paid, and Thriving Through Thick and Thin.”
  • Dimensional Insight publishes a new report, “How Satisfied are Healthcare Organizations with EHR Analytics?”

Blog Posts


Contacts

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

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Morning Headlines 5/5/20

May 4, 2020 Headlines No Comments

CareCentrix Acquires Turn-Key Health

Home and post-acute care technology company CareCentrix acquires Turn-Key Health, which offers AI and analytics for palliative care management.

Google and Apple ban location tracking in their contact tracing apps

Apple and Google give developers rules for using their jointly developed contact tracing technology that include bans on the use of location tracking and using the data for targeted advertising or policing.

Cerner’s share of hospital market drops, while rival gains

Cerner loses market share for the first time in 10 years, a decline attributed in part to its loss of nine acute care customers and Epic’s gain of 55 new facilities.

Curbside Consult with Dr. Jayne 5/4/20

May 4, 2020 Dr. Jayne 1 Comment

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Many organizations are knee deep in the process of expanding coronavirus testing. Although it has become easier to get test kits, some of us are still eagerly awaiting the rapid kits from Abbott.

One of the challenges though with adding COVID-19 testing to your scope of services is dealing with the reporting aspect. COVID-19 is a reportable disease in all public health jurisdictions. Depending on how large your organization is (and how many counties or states it serves), the reporting aspect can be daunting.

I was excited to attend a webinar last week that was presented by the American Medical Informatics Association (AMIA). They reviewed the “eCR Now” effort to broaden the use of electronic case reporting for COVID-19. From a clinical informaticist’s point of view, it was the most exciting thing I’ve seen in weeks. For those of you who were like me and hadn’t heard of it, I’ll give you the highlight reel.

Electronic Case Reporting (eCR) is the ability to automate generation and transmission of case reports from EHRs to public health agencies so that those agencies can review and act on them. Depending on the jurisdiction, that might include sending a formal quarantine order to an affected patient, performing contact tracing, or enrolling them in a daily disease tracking and/or surveillance program. Public health agencies rely on case reports for numerous diseases and conditions beyond COVID-19, from sexually transmitted infections to dog bites.

The problem for providers is that each public health jurisdiction has its own reporting process, which may range from email to fax to phone calls. Automating this process from data already in the EHR is key, both in reducing the delay in getting information to the agencies as well as receiving information back from the public health agency.

Apparently a pilot for eCR was already in the works well before COVID-19 hit our shoes. Coordinated by a collaborative of healthcare, public health, and health IT industry partners, Digital Bridge came together to solve the problem of data exchange. After some small implementations, the effort began to expand in late 2019, with sites implemented in Texas, Utah, New York, and California, plus 19 other state and local public health agencies.

Once COVID-19 became a thing, they started reporting those codes through the existing infrastructure. By the end of January, 142,000 case reports had been sent from seven implementations. The process uses HL7 standard documents to move information from providers through HIEs or other exchange frameworks to a platform that is supported by the Association of Public Health Laboratories (APHL). For public health agencies that aren’t completely integrated, the platform can render the files in HTML, which functions a lot like the faxes they previously received.

Most of the current implementers are Epic and Cerner sites, but given the importance of public health reporting for COVID-19, there is a push to move eCR capabilities into more EHRs. They’ve created a program called “eCR Now” that has three main parts:

  1. Rapid implementations for cohorts of organizations that have eCR-enabled EHRs.
  2. A FHIR app that non-eCR-enabled EHRs can rapidly implement.
  3. Extension of the existing eHealth Exchange policy framework through a developing Carequality eCR implementation guide

As far as the accelerated implementation cohorts, what used to take 2-3 months is now taking 3-4 days. In fact, Sutter Health has issued a challenge, promising a bottle of wine for any cohort participant that can beat Sutter’s implementation record.

Organizations whose EHRs don’t support the standard can use the FHIR app, which was due (along with its source code) to be released May 1. There’s a nationwide HL7 FHIR Virtual Connect-a-thon scheduled for May 13-15. EHR vendors that don’t support the standard are being encouraged to develop the ability to trigger report generation and send data based on the standard, and state and local public health agencies are being encouraged to accept eCR instead of requiring manual case reporting. Who doesn’t love getting rid of a clunky manual process?

Needless to say, I immediately took this information to a couple of the organizations I work with, because it’s the kind of project that’s a win-win in a lot of ways. Manual reporting sucks up time that could be spent doing other things, and being able to rapidly process information about COVID-19 diagnoses and lab tests is going to be key to our management of the disease especially without a vaccine or broadly-applicable treatments. Plus, I selfishly want one of my clients to bite on the idea because I love this kind of a project – it takes me back to my first “build from scratch” project more than a decade ago, when we decided to add CCOW functionality between several applications at my health system.

I still remember the calls with Sentillion, when they agreed to give us the software development kit and I had to quickly learn about Vergence and the fact that “the vault” didn’t live in a bank. It was probably my first deep dive into the world of development, and led me to meet all kinds of wild and crazy developers and even build a friendship with my own personal “Citrix Guy.” Sure, there were many late-night testing sessions (since we didn’t have a complete test environment and had to quietly test things in production after the physicians were off the system, but before the backups and billing runs started) and probably too much alcohol, but it was a really fun time that I will always remember.

Technology moves on. Microsoft bought Sentillion, all those developers are now working at other places, and CCOW has mostly gone the way of the dodo as healthcare organizations either move onto monolithic platforms that handle everything or instead move the data around through interfaces.

I’m hoping I get to work on an eCR project and that it continues to grow well beyond COVID-19 and into the realm of all the other reportable diseases that require complicated manual reporting. Many of us believe healthcare is entering into a time of massive transition, and we’re going to need lots of tech to get us through.

Anyone looking for an ex-CCOW expert that likes to play with FHIR? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: How Health Systems Use Technology in New Ways to Adapt to COVID-19

How Health Systems Use Technology in New Ways to Adapt to COVID-19
By Terry Zysk

Terry Zysk is CEO of LiveProcess of Chelmsford, MA.

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Saving the lives of patients and protecting care providers during the COVID-19 pandemic is an unprecedented healthcare management challenge. Unlike a hurricane that passes in a few days, COVID-19 could be with us for quite a long time.

Some of the innovative US hospitals I work with are solving pandemic-related problems by repurposing already deployed or quick-to-deploy technology. Creativity is allowing these health systems to adapt to the COVID-19 crisis.

According to McKinsey & Company, as major events occur, responsive healthcare organizations focus on five areas to ensure access to care delivery: workforce protection, supply chain and resource stabilization, customer and staff engagement, stress testing, and nerve center integration.

Similarly, health systems on the front lines of COVID-19 are using technology with roots in hospital emergency management to dynamically rebalance business operations, share information, and collaborate in virtual command centers.

A public health emergency response creates large-scale logistical issues. Hospitals are changing protocols, rethinking workflows, repurposing clinical areas and redistributing staff to adapt to a shift in demand.

All of these changes require intense coordination and collaboration.

To replace rumors and stress with accurate and timely information, health systems are pushing information out to engage healthcare workforces. They are reaching employees at all facilities at once while also developing proficiency in minimizing alert fatigue throughout a long-duration event.

As more masks and gowns are needed to protect the healthcare workforce, hospitals and healthcare coalitions are using emergency management technology to share guidance on the use of PPE, request PPE from community partners, and coordinate and track regional inventory.

CDC requirements for monitoring employee health involve daily communication with healthcare providers. One health system is performing virtual health checks by reaching out to hundreds of affected personnel with survey technology, and then displaying the results on a quickly developed business intelligence dashboard.

At another hospital, human resources specialists used event sidebar communications in emergency management technology to collaborate in a virtual command center and optimize the redistribution of staff.

When converting hospital rooms or even entire floors into other types – such as negative pressure and isolation rooms and reconfiguring spaces create more ICU beds — a healthcare coalition electronically surveys its 18 facilities on their room and bed inventory. With automatic roll ups, leadership teams are producing up-to-date daily reports with minimal labor and a short turnaround time.

Staffing coordinators are using trackable one-to-many notifications with multiple choice response options to fill high-demand roles quickly and efficiently, leveraging tools typically used for mobilization and coordination in natural disasters.

In these many ways, health systems and coalitions are adapting to the current situation with new processes and proficiencies by using existing technology in new ways. Their experiences may spur ideas that help your own health system improvise and adapt to COVID-19 and other disruptive situations.

Morning Headlines 5/4/20

May 4, 2020 Headlines No Comments

Data Interoperability and Exchange to Support COVID-19 Containment

In a new Duke University report, experts recommend that health officials should define a minimum data set for COVID-19 containment as part of participating in clinical data exchanges, among other short-term actions that can be taken to improve interoperability and data exchange for containing the virus.

Spok Reports First-Quarter 2020 Operating Results; Wireless Trends Continue to Improve and Year-Over-Year Improvements in Software Revenue Bookings

Spok reports Q1 results: revenue down 11%, EPS –$0.24 vs. $.04.

Dascena Announces Closing of $50 Million Series B Financing to Support Advancement of Diagnostic Algorithm Development Engine to Inform Patient Care and Improve Outcomes

AI-powered sepsis prediction company Dascena raises $50 million in a funding round led by Frazier Healthcare Partners.

Canada to invest $240M in online health care amid coronavirus, Trudeau says

Canadian Prime Minister Justin Trudeau announces funding for expanding digital healthcare capabilities and developing new telehealth services for primary and mental healthcare.

Monday Morning Update 5/4/20

May 3, 2020 News 2 Comments

Top News

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A Duke University-convened expert group lists short-term actions that can be taken to improve interoperability and data exchange for containing COVID-19. It recommends that:

  • Commercial labs and point-of-care test manufacturers should record patient demographics along with COVID-19 samples and add the information to their reports to enable contract tracing, and CMS should use payment adjustments to give them incentive to do so. This information would include patient name, date of birth, gender, race/ethnicity, contact information (address and/or telephone number), and the identifier that was used in collecting the sample (such as medical record number). This capability could be brought online quickly by using the existing clinical query function of CommonWell, claims clearinghouses, or other information service providers.
  • State and local health officials should define a minimum data set for COVID-19 containment as part of participating in clinical data exchanges. Limited public health resources precludes developing API-driven data feeds, so existing intermediaries should be used instead, such as Health Gorilla or the PULSE system that is supported by the Sequoia Project and Audacious Inquiry. 
  • Federal, state, and local officials should enhance their use of the National Syndromic Surveillance Program.

Reader Comments

From Marshall: “Re: Greenway Health. A rumored RIF of up to 10% of their workforce Thursday.” Unverified, but reported by several readers.

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From Dill Fighter: “Re: Apple-Google contact tracing. I will address some misconceptions. The proposal mirrors the CDC in triggering notification only if you have spent at least 15 minutes within six feet of someone who is infected, so just walking by or checking out in a store won’t count. People won’t need to enable them since it will be built into the OS. Users don’t necessarily need to enter their own positive results – providers could enter them in a HIPAA-complaint way, such as entering only the Bluetooth ID of the phone.” My responses, adding to my initial comments:

  • I missed the minimum time of contact specification, which according to Apple, requires 5-30 minutes of contact (the exact threshold must be defined by the public authority, which is responsible for analyzing the data). I assume that contact must be constant rather than cumulative.
  • Apple and Google acknowledge that the six-foot range is a best guess based on Bluetooth signal strength and how the phone is being held. It will be thrown off if the phone is stored in a purse or backpack.
  • Phone users don’t need to download the app, but they need to opt in when it is installed via an OS update. They can opt out or uninstall the app later, which may well happen if the app eats up battery power in the background.
  • The user needs to manually install a second app that will be developed by their local public health authority (how that authority does that development isn’t clear). That authority sets the distancing rule and manages the entry of positive results, and without their app, the Apple-Google one does nothing. Apple and Google are suggesting that a future release of their app will eliminate the requirement of installing a public health app, although I haven’t seen a description of how that will work.
  • It’s the user’s job to enter their own positive result using the public health service’s app. I haven’t seen any suggestion that the app will support providers doing it for them.
  • Singapore saw barely more than single-digit adoption of its national contact tracing app. The country’s director of digital services, which developed the TraceTogether app, warns that they use it only to support manual contact tracing and it’s naive to see it as a replacement. He adds that “you cannot ‘big data’ your way out of a ‘no data’ situation,” such as the Washington state choir in which 45 of 60 members were infected despite distancing appropriately, likely because their singing projected respiratory particles further, and phone-based contact tracing would have missed that.

From HIMSSanity Cured: “Re: HIMSS. I don’t know about anyone else, but my consumption of HIMSS products and services is, and always has been, zero other than attending the conference.” Same here – I have no touch points with HIMSS other than the conference. I don’t read its publications, watch its webinars, attend its other events or local chapter meetings, pay for its certifications, follow its twitterati, view its endless ads, or participate in its plea for vendor-enriching government handouts (excuse me, “advocacy.”) I don’t say this as some kind of vindictive reaction to HIMSS policies and actions – I just don’t need anything that HIMSS offers and I don’t even think about the organization until it’s time to sign up for the conference (or not, as the case increasingly may be). They are just another vendor who I might contact in the unlikely event that I need something they offer. That’s just my opinion as a member, although even as a member I can’t say I’m thrilled at a lot of what HIMSS undertakes that seems more appropriate for a vendor than a member organization.

From Audioslave: “Re: podcast. Here’s a good one on public health.” I don’t listen to podcasts or watch videos that could have been presented as written articles instead. I know people have fun screwing around with their microphones and recorded video calls instead of writing, but they’re wasting my time to save theirs. I’ve done a zillion interviews and can say with confidence that skimming one in 45 seconds and reading the interesting parts more carefully is a lot more efficient than listening to a 30-minute conversation, especially when the questioner’s vanity prattling eats up an unreasonably high percentage of total run time. 


HIStalk Announcements and Requests

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A surprisingly large number of poll respondents have experienced some form of virtual visit since the pandemic broke out 100 years ago in mid-March, with video visits leading the pack. A couple of folks said that the video interface failed and the fallback was a phone call, while one also questioned the how good of replacement those visits can be when they offer only conversation and observation without the clinician being able to use a stethoscope or hands-on techniques.

New poll to your right or here: Will you use the COVID-19 contact tracing app from Apple and Google as soon as it becomes available?

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I wonder if masks could be made from a clear but comfortable fabric so we don’t all wander around in public looking like bank robbers in Westerns? If not, here’s my Plan B: custom-printed masks where buyers can insert a headshot so that the outside of the mask looks like what is underneath (hello, CVS and Walgreens photo departments). We “Arrested Development” fans will be celebrating Cinco de Cuatro on Monday, so I confess that I was inspired by George Michael’s muscle shirt.


Webinars

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


Acquisitions, Funding, Business, and Stock

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Meditech reports Q1 results: revenue up 24%, EPS –$0.69 vs. $0.97, swinging from a quarter-over-quarter profit of $36 million to a loss of $26 million due to COVID-related stock losses and a decline in product bookings. Product revenue rose 77% and service revenue was up 3% in a quarter that was good for the company in the health IT market, but not so good in the stock market.

Spok reports Q1 results: revenue down 11%, EPS –$0.24 vs. $.04.


Government and Politics

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President Trump nominates a replacement for the HHS principal deputy inspector general who interviewed hospitals about their COVID-19 concerns and reported their experience with shortages of coronavirus-related supplies and diagnostic tests. The President accused HHS career official Christi Grimm, MPA, who started working for OIG in 1999, of being politically motivated. The President has nominated as her replacement Jason Weida, JD, an assistant US attorney in Boston. 


COVID-19

CMS issues another round of COVID-19 regulatory waivers that include:

  • Physical therapists, occupational therapists, and speech language pathologists can provide Medicare telehealth services.
  • Hospitals can bill Medicare for services that are provided remotely by hospital-based practitioners.
  • Evaluation and management services can be delivered to Medicare patients via telephone.
  • Behavioral health and patient education services can be provided by telephone and will be paid at the same rate as for office and outpatient visits.
  • Medicare will pay for COVID-19 tests that are ordered by any healthcare professional, not just a physician, who is authorized by state law.
  • Pharmacies can operate pharmacist-staffed drive-through testing sites if they are enrolled by Medicare as a laboratory.
  • Hospitals will be paid separately for performing COVID-19 testing as the only service to a particular patient.
  • Medicare and Medicaid will pay for certain FDA-authorized serology tests.
  • Hospitals can increase COVID-19 beds without reducing their payments for indirect medical education, while inpatient psychiatric and rehabilitation hospitals can admit more patients without reducing their teaching payments.
  • Hospitals will be paid at OPPS rates for outpatient services such as wound care, drug administration, and behavioral health that are delivered in temporary expansion locations, such as parking lot tents, converted hotels, and patient homes.
  • Long-term acute-care hospitals will be paid at higher Medicare payment rates for accepting acute-care hospital patients.
  • Nurse practitioners, clinical nurse specialists, and physician assistants can order home health services, establish and review plans of care for home health patients, an certify and re-certify patients for home health services.
  • Physical and occupational therapists can delegate outpatient maintenance services to assistants.
  • Applications for new ACOs will not be accepted until 2021, but those whose participation is expiring this year can extend for another year.

Analysis of TriNetX’s global health research network finds that patients aged 30 to 50 make up 26% of all strokes among patients who tested COVID-positive, versus the typical rate of 11% in non-infected patients in that age group.

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The US is betting big ($483 million) that a coronavirus vaccine can be developed by messenger RNA drug company Moderna, which has never brought a product to market, hasn’t had any of its nine vaccine candidates approved by the FDA, and has never had a product reach the third phase of clinical trials. Even the company’s former chief science officer / R&D president is shocked by the huge amount of funding the government is providing. Nature magazine criticized the company for having failed to publish a single peer-reviewed paper about products it was touting to investors, likening it to Theranos. Moderna’s market cap has risen to $16 billion.

FDA gives Gilead emergency use authorization to distribute remdesivir for severely ill COVID-19 patients, also allowing five-day use for non-intubated patients instead of the usual 10 days, which will extend the drug’s supply. Gilead is donating its entire inventory of the drug, 1.5 million vials, to the federal government, which will oversee its distribution.

New research indicates that blood pressure drugs in the ACE inhibitor category, contrary to early concerns, do not affect coronavirus infection or outcomes.

A New York City nursing home admits that 98 residents of the 705-bed facility have died from presumed coronavirus infection.

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A Brigham & Women’s ED doctor warns that it’s not reasonable to compare deaths from COVID-19 versus influenza – COVID-19 deaths count only patients who tested positive or met specific diagnostic criteria, while flu deaths are estimated using a model that adjusts for assumed vast underreporting (I admit that I did not know this). Example: CDC estimate 2018-29 US flu deaths at 26,000 to 53,000 even though just 7,200 deaths were confirmed. Applying that same underreporting assumption to COVID-19 suggests that it could have already killed 600,000 people in America (versus the official count of 68,000), and even then we are early into a pandemic that may or may not weaken in the summer.

Former FDA Commissioner Scott Gottlieb says that we may hit 100,000 US deaths from COVID-19 by June and that cases are still rising in 20 states, indicating that mitigation steps didn’t work as well as expected.

Meanwhile, the number of confirmed cases seems to have hit a stubborn plateau, leading to the possibility that a “second wave” won’t happen in the winter because the first one won’t actually have ended by then, especially with relaxed mitigation measures that the virus has waited out (late May is likely the new March as the April mitigation indiscretions kick in as active infections and hospitalizations). Seasonality remains the best (but uncertain) hope for a summer break. Curve-flattening was successful only in extending the time period in which the same number of people get infected, are hospitalized, and die, but otherwise the virus is still out there just like before.

China’s state media creates a video that makes fun of the US’s coronavirus response. Meanwhile, a Department of Homeland Security report says China intentionally hid the extent of the pandemic so it could hoard drugs and supplies, as evidenced by unusual import and export numbers.


Other

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Epic launches Epic Health Research Network, a public-facing site in which Epic’s customers can post their observational findings about COVID-19 or any other topical issues in health and public health.

UK Prime Minister Boris Johnson and his fiancé give their newborn son the middle name of Nicholas in honor of two doctors by that name who treated Johnson for COVID-19 last month.


Sponsor Updates

  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases the latest edition of its Critical Care Obstetrics Podcast, “Indications for Intubation.”
  • OpenText’s information management solutions are now available as fully managed services on AWS.

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Weekender 5/1/20

May 1, 2020 Weekender 1 Comment

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Weekly News Recap

  • Arcadia acquires the assets of the Massachusetts EHealth Collaborative.
  • A KLAS inpatient EHR bed win-loss report for 2019 shows big gains for Epic and Meditech, big losses for Allscripts and Cerner.
  • Epic announces plans to add integrated telehealth to its product.
  • VA OIG finds that the VA had not adequately planned its now-postponed first go-live, specifically in the areas of staffing, patient access given an expected 30% drop in provider productivity for 12-24 months, and missing functionality such as e-prescribing.
  • Cerner’s Q1 beats earnings expectations, but falls short on revenue.
  • Cerner offers health systems and researchers free access to the de-identified data of COVID-19 patients for developing epidemiological studies, clinical trials, and medical treatments.
  • Facebook’s coronavirus symptom survey is sending results from 1 million users per week to Carnegie Mellon University for predicting disease spread and county-by-county impact.

Best Reader Comments

People badmouth VistA, but many MDs we worked with used it at a VA and say they prefer it to Epic or Cerner systems. I assumed Millennium couldn’t be enhanced and customized to address AL existing military-specific capabilities in Stage 1. But not having basic e-prescribing capabilities (refills) that meet safety standards in 2020 in a multi-billion dollar EHR is alarming and a show stopper IMO given VA’s target population. Likely execs on top of food chain @ Cerner and VA OK’d plan to go-live without refills without deep understanding of potential harm and disruption for millions of vets (many depend on lifetime of meds for chronic pain, injuries and illnesses) and their families. (Ann Farrell)

People like the VA system because it doesn’t have the same data capture and billing systems as those serving commercial insurers. It also doesn’t have the same central oversight of the local orgs that a big health system does. That’s one reason why vets from different areas have such different experiences and opinions of the VA. I agree though that this particular screw up was probably caused by the exec team being told to go live without any real incentive to make sure everything works. (IANAL)

Not knowing all the key ways it spreads or just how fatal it is if contracted. Because we don’t have the denominators, which are key to knowing any of the rates. Exacerbated because the only people approved for COVID testing have to have symptoms, so no total population stats are known. New data is coming in on the head counts of those with antibodies who never reported sick, which provides hope this isn’t as bad as we are led to believe and that the death rate is greatly lower across the population than modeled. And the urgency is bolstered by CDC’s original instructions on coding U07.1 as being the underlying cause for any death when present (or suspected if no testing done) with co-morbidities and end stage conditions. NY is getting excoriated because they forced nursing homes to take hospital discharges of patients with COVID, which resulted in double digit deaths in those locations, because they are filled with the at risk elderly. And it also adds to the death count numbers that probably would not have occurred. These types of factors inflate the actual COVID death rate, but even then, it is coming in quite low (most stats now are showing actual death percentage under 2% and most don’t even achieve 1% of everyone who gets it.) (Icon O. Klast)

Among the things that have changed with the emergence of COVID-19 is the number of Epic generated press releases. Have there been more this year than all of previously recorded time? (AnotherDave)

If MDs want to improve the ratio of physicians to administrators, maybe they should pressure their colleagues to open more US medical schools. (Commenter)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. O in Kentucky, who ask for hands-on practice tools for class IPads. She reported in early February, “My students have already benefited so much from this addition of resources. As we learn to use our Osmos, we are finding even more ways to use them for teaching and learning than we even knew were capable. They work amazingly with some older IPads that we had on hand. We were able to resurrect this technology and give it a new purpose. I have also been able to share them with other teachers in the school to check out and use so that all students at my school have access to this resource. Students are excited to do math, reading, writing, engineering, coding, problem solving, and so much more.”

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The Milwaukee paper describes how Epic’s 200 culinary team employees, freed up from providing up to 7,000 meals per day to employees who are mostly working off campus, are serving food pantries, long-term care facilities, frontline healthcare workers, and at-risk groups in the Madison area. The company also donated 47,000 pounds of food to food pantries and long-term care facilities between mid-March and mid-April. Epic is also offering curbside grocery pickup for its employees, which allowed a local produce company to bring its laid-off staff back to work.

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In England, an NHS anesthesiologist creates a flashcard app that allows mask-wearing clinicians to communicate with COVID-19 patients using predefined on-screen text and voice messages. Rachael Grimaldi, BM developed Cardmedic in 36 hours while on maternity leave. The free app is being used by NHS trusts and by hospitals in 50 countries and is being expanded to include 30 languages, sign language, illustrations, and downloadable PDFs.

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Doctors in Germany organize a protest called Blanke Bedenken (“naked concerns”) in which they pose nude in pictures to illustrate how lack of PPE puts their lives at risk. One doctor posed with a sign that reads, “I learned to sew wounds. Why do I now need to know how to sew masks?”

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The New York Post profiles NYU Langone Hospital Brooklyn maintenance mechanic Hans Arrieta, who maintains the hospital’s ventilation and water systems. He has self-isolated by sending his family to live with relatives.

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Kansas City Chiefs right guard and Super Bowl ring-wearer Laurent Duvernay-Tardif, MD makes Sports Illustrated’s daily cover for answering the call of Quebec’s health ministry for medical and nursing students to help give caregivers relief. He hasn’t completed a residency yet, so his assignment is to administer medications to patients in a long-term care facility. He observes, “I realize that I’m privileged. I didn’t lose my job. I don’t have three kids at home and a Zoom meeting and home school to teach. I know a bunch of my friends are going through difficult times; many are physicians who I met in medical school. I have friends who are working in emergency rooms. One does triage and tests patients for COVID-19. Those people are on the front line, and they’re giving everything to protect us.”

Children’s Memorial Hermann pediatric plastic surgeon Phuong “P. Danger” Nguyen, MD writes and performs a public service announcement featuring the song “Stay at Home.” It’s a project of Help the Doctor, an all-surgeon band.

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In England, police in a small village seek to give some “words of advice” to someone who is walking around town wearing a 17th century plague doctor outfit. Some residents were frightened, some were amused, and one was pragmatic: “If it’s not illegal and he can’t wear it now, when could he?” Plague doctors wore the black outfits for home visits during the Black Death, with the beak-like mask that was thought to filter the disease leading to the disparaging doctor term “quack.”


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Morning Headlines 5/1/20

April 30, 2020 Headlines No Comments

Arcadia Enhances Value-based Care & Interoperability Expertise with Acquisition of Massachusetts eHealth Collaborative Assets

Health data and software company Arcadia acquires assets of the Massachusetts EHealth Collaborative, including technology and customer accounts.

Twilio to Power Epic’s New Telehealth Video Offering

Epic will embed telehealth into its EHR using Twilio Programmable Video, which is also used by Kaiser Permanente,  MDLive, Doctor On Demand, and several health systems.

Tampa General, AdventHealth and other Florida hospitals come together to share coronavirus data

Fifty-one hospitals along Florida’s west coast partner with analytics vendor SME Solutions Group to form a collaborative to share COVID-19 patient data through a regional data exchange.

HHS Awards $20 Million to Combat COVID-19 Pandemic through Telehealth

HHS awards $20 million to six organizations to help them expand telemedicine access.

Cleveland Clinic, Epic develop home monitoring tool for COVID-19 patients

Cleveland Clinic works with Epic to customize its MyChart Care Companion remote monitoring technology for chronically ill patients to include COVID-19 care pathways.

News 5/1/20

April 30, 2020 News 7 Comments

Top News

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Health data and software company Arcadia acquires assets of the Massachusetts EHealth Collaborative, including technology and customer accounts.

MAeHC President and CEO Micky Tripathi, MPP, PhD will join Arcadia as  chief alliance officer while continuing his roles with Argonaut, Sequoia, CommonWell, HL7, HL7 FHIR Foundation, and CARIN Alliance.


Reader Comments

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From VCU Observer: “Re: VCU Health’s rip-and-replace of Cerner with Epic on May 1. At least one board member says the project hasn’t been approved nor the implementation costs outlined. The expenditure, rumored to be hundreds of millions of dollars more than Cerner’s upgrade bid, doesn’t make sense at this time.” Unverified. VCU announced a mid-2021 go-live when they chose Epic in December, which seems challenging given limits on travel and in-hospital presence for the all-important initial planning and on-the-ground design meetings.

From PPP Shooter: “Re: paycheck protection plan loans. The Small Business Administration has clarified that publicly traded companies, as well as the portfolio companies of private equity funds, are prohibited from receiving PPP loans and must pay them back by May 7 if they received them. Hundreds of publicly traded companies received these loans and the PE firm clarification may cause problems for the health IT world.” SEC filings indicate that 220 public companies need to return $870 million that they received before the rule was changed, with more that are likely still be disclosed since SBA has refused to release a list of the companies that received money. Publicly traded health IT company Castlight Health received the maximum loan of $10 million, but says it will return it.

From Pickle Bickering: “Re: contract tracing by smartphone app. Is it worth the privacy intrusion?” Apple and Google are doing exactly what big tech companies always do when barging into healthcare with minimal knowledge — they are thinking that a cool app can fix everything. App-based contact tracing is doomed to fail, in my opinion, and not just because of privacy issues:

  • Not all Americans own smart phones and carry them at all times. Children, for example, appear to be significant spreaders and will become more so when schools and daycares reopen, but few of them will be carrying a contact-tracing app on a phone.
  • Many people won’t use tracking apps because they don’t know they exist, don’t derive any personal benefit from their use, or refuse to be tracked regardless of privacy assurances. There is no way that Americans will accept an opt-out model in which they default to being users and also no way that a significant percentage will otherwise opt in.
  • These apps have never worked in a country where their use was voluntary, nor rolled out late in a country whose initial COVID-19 response was as indecisive as ours.
  • Accuracy is questionable. The six-foot range will flag contacts between cars, on opposite sides of plastic shields in stores, and where physical protection is in place and makes virus spread unlikely. I’m not confident that a record of whom I’ve passed within six feet of is all that useful in controlling coronavirus spread.
  • Users are expected to manually enter their positive COVID-19 test result for the benefit of others who will then be notified. Then, unlike in other countries, it’s up to those people who get the “you’ve been exposed” warnings to take action since they are not identifiable.
  • Contact tracing requires having a strong system of 14-day quarantine in place, such as providing private living space and checking up on self-monitoring. We can already guess that many nursing home residents, mass transportation riders, homeless people, prisoners, and laborers who live in employer-provided dormitories are infected, but any isolation is voluntary and limited by their resources.
  • The bottom line: this sort of contract tracing works only if at least two-thirds of Americans use the app and we roll out widespread COVID-19 testing to identify those who are infected but symptom-free to catch potential spreaders early. Even then our society, as it returns to being mobile, will make it nearly impossible to address the potentially hundreds of people that someone could pass near in the days or weeks before they receive a positive test result.

From Looking For Answers: “Re: Clarify Health Solutions. Laid off 70 employees, about 40% of its workforce, on March 19. KKR gave it a bridge loan instead of agreeing to a Schedule C. I’ve seen nothing online, but a former colleague who used to work there told me.” Unverified. I don’t think I’ve ever heard of this particular analytics vendor, which has raised $63 million, almost all of that in a September 2018 Series B round by KKR. The company announced a couple of COVID-19 apps less than a week after this rumored layoff. 


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Acquisitions, Funding, Business, and Stock

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Mayo Clinic (MN) will invest in Current Health and work with the company to develop COVID-19 predictive and remote monitoring technologies.

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From the Cerner earnings call:

  • Chairman and CEO Brent Shafer says he is pleased with the productivity and performance of its 27,000 employees after the majority of them moved to working from a virtual environment.
  • The company expects the VA and DoD to revise their timelines due to COVID-19 and Cerner has factored that into its guidance.
  • Cerner expects a slight drop in next-quarter bookings, but says clients are generally moving ahead and it won’t be a lot different than usual, especially since unlike the 2008 market crash, health systems were doing fine financially before coronavirus and stimulus money will help get them back on their feet.
  • President Don Trigg says the federal government’s role of top regulator and payor will expand due to COVID-19 and health system consolidation will accelerate and extend into ambulatory practice.
  • Clients are starting to ask about getting into the queue for services that will be in high demand.

Sales

  • Penn State Health selects RCM software and services from R1 RCM.

Announcements and Implementations

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A new KLAS report on US hospital EHR market share finds that Meditech Expanse is drawing new interest from customers outside its usual small-hospital base, with a new 400+ bed health system sale in 2019 giving the market a chance to see how Expanse scales. Meditech won about half the decisions made by its legacy customers in 2019, and half of its losses came from product standardization and provider M&A. Cerner saw its first-ever decrease in market share after losing four big clients in 2019, with its losses most often due to customers who standardized on Epic and those who were frustrated with Cerner’s revenue cycle management solution. Epic has grown to cover 40% of US acute care beds, with its new wins split between new decisions and standardization and acquisitions. Allscripts continues to steadily lose market share, with 2019 losses of customers of Sunrise (eight), Paragon (16), and Horizon (seven). Small, standalone hospitals were left with few choices after Athenahealth exited the inpatient market, with Cerner CommunityWorks and Meditech Expanse coming closest to meeting their needs.

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Epic will embed telehealth into its EHR using Twilio Programmable Video, which is also used by Kaiser Permanente,  MDLive, Doctor On Demand, and several health systems. Investment firms are already warning companies like Teladoc that their reach into academic medical centers may be constrained with the availability of an Epic-embedded virtual visit platform that is staffed by a hospital’s own clinicians.

Critical access hospital Macon Community Hospital (TN) goes live on Cerner in a go-live that Cerner managed remotely.

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Allegheny Health Network’s Saint Vincent Hospital (PA) implements virtual ICU software and support from Mercy Virtual.

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Greenway Health announces GA of GRS Express, a suite of expedited RCM services to help practices maintain cash flow.

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EPSi announces GA of COVID-19 Planning Analytics to help providers anticipate ICU capacity, financial burdens, and the impact of resuming elective procedures.

QliqSoft will incorporate the Suki voice-enabled digital clinical assistant in its telemedicine platform to create medical notes and perform tasks such as EHR information retrieval.

Reliance EHealth Collaborative is developing COVID-19 use cases via data management, analytics, and reporting from IMAT Solutions.


Government and Politics

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HHS awards $20 million to six organizations to help them expand telemedicine access.


COVID-19

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Conflicting studies on the use of remdesivir came out Wednesday following several incidents in which leaked information found its way to mainstream media headlines. Preliminary results from a government-run trial showed patient time to improvement was 11 days versus 15 days for placebo, which meets the NIH study’s endpoint, but the drug did not provide a statistically significant improvement in survival rate. Almost simultaneously, results of a peer-reviewed study performed in China showed no benefit from using remdesivir. Experts say the benefit isn’t necessarily how well remdesivir works, but a reminder that the virus has vulnerabilities that can be exploited incrementally to improve outcomes even in the in the absence of a blockbuster drug, as was the case with HIV/AIDS.

NIH announces a $1.5 billion challenge for rapid deployment of coronavirus diagnostic tests.

A Kaiser Health News article observes that hospital information that is stored in proprietary, siloed EHRs cannot support hospitals sharing their COVID-19 treatment experience. Experts say everybody knew from the early days of the $36 billion Meaningful Use program that hospitals were seeking systems to optimize billing, not public health. Health Catalyst CTO Dale Sanders was quoted in the article as saying that CDC should have developed a coronavirus data collection plan, with standardized terminology, that would have allowed hospitals with non-interoperable EHRs to look at the big picture (Health Catalyst is a member of the COVID-19 Healthcare Coalition that is trying to assemble information for real-time support). Public health systems are also often unable to accept electronically submitted information, requiring hospitals to complete manual forms that can take up to 30 minutes to complete and often even then with missing information.

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Most of the tent hospitals that were expensively built to provide services to an expected crush of COVID-19 patients are scheduled for closure, having seen few patients:

  • New York is shutting down two tent hospitals that didn’t see a single coronavirus patient, having spent $350 million in federal taxpayer money to plan and build temporary facilities. The only field hospital that saw patients, at Javits Center, will close Friday after treating 1,000 patients in the 4,000-bed facility.
  • Chicago’s pared-back, $64 million, 500-bed hospital at McCormick Place has treated only 12 patients.
  • Detroit’s 1,000-bed convention center hospital has seen just 36 patients and is scheduled for closure.
  • Philadelphia will close its 200-bed temporary hospital in two weeks. It has never had more than six patients at a time.
  • New Jersey’s four field hospitals totalling 1,000 beds have treated 346 patients.
  • The temporary hospital that was set up in the New Orleans convention center is averaging 100 coronavirus patients.
  • The Navy’s 1,000-bed USNS Comfort will leave Manhattan this week to return to its home port of Norfolk, having treated just 182 patients.

The Atlantic says Georgia’s rush to reopen businesses is an experiment “to find out just how many individuals need to lose their job or their life for a state to work through a plague” given that Georgia is moving forward despite meeting none of the accepted testing and infection success benchmarks. On the other hand, the article fails to note that the same number of people are likely to die either way, just over longer periods, unless we complete a technological Hail Mary in the form of a vaccine, effective treatment, or a sound containment containment strategy.


Privacy and Security

The New York Times says Europe’s world-leading GDPR privacy rules are falling short of expectations because of small national data protection budgets, lack of enforcement, and tech company pushback. The only tech company to have been penalized is Google, which paid a relatively paltry $54 million versus the law’s maximum of 4% of global revenue. Public experience with GDPR has been mostly negative as web users are forced to click through countless pop-up consent windows.


Other

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Regions Hospital (MN) works with Medtronic to develop software that allows providers to remotely monitor and adjust ventilators. Regions providers say the software, which went from concept to implementation in just 10 days, has cut down on in-room visits to COVID-19 patients by 50%, and helps conserve PPE. Several other hospitals are also piloting the technology.

Experts say it’s not the imagination of Zoom users that the videoconferencing app leaves them anxious, unable to think clearly, and tired — the app’s bandwitdh-conserving degradation of video quality leaves the brains of users to fill in the image’s gaps, especially in trying to analyze poorly rendered or out-of-sync facial expressions. Telephone calls, oddly enough, offer a more natural feeling of presence and engagement.


Sponsor Updates

  • Elsevier adds resources for biomedical and scientific researchers to its free Coronavirus Research Hub.
  • The Chartis Group publishes a new paper, “After the Surge: Five Health System Imperatives in the Age of COVID-19.”
  • InstaMed releases the 10th edition of its “Trends in Healthcare Payments Annual Report.”
  • InterSystems makes available the latest version of its HealthShare suite of connected health solutions, including capabilities to support final federal interoperability rules.
  • Engage announces feature updates for its Wait Times app.
  • Impact Advisors publishes a white paper titled “COVID19 Federal Stimulus Package – Impact on Providers.”
  • HBI Solutions names Jackie Porter, BSN, RNC-E (Syapse) client success director.
  • Meditech highlights the successful utilization of its virtual visit functionality at Citizens Memorial Hospital (MO), Grand View Hospital (PA), Avera Health (SD), and Mount Nittany (PA).

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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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