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Morning Headlines 10/6/20

October 5, 2020 Headlines No Comments

It’s a brand new day for Krames

StayWell, which includes Krames patient education solutions and the StayWell employee health platform, renames itself to Krames.

Hims, a direct-to-consumer health company, is going public via SPAC

Health and wellness telemedicine company Hims will go public by merging with a special purpose acquisition company overseen by Oaktree Capital Management, bringing the company’s valuation to $1.6 billion.

Q3 2020: A new annual record for digital health (already)

Rock Health’s latest analysis shows that 2020 is already the largest funding year ever for digital health, with $4 billion invested in startups through Q3.

New Jersey Urology is the First-Ever Urology Group to Launch Epic’s Electronic Health Record

New Jersey Urology becomes the first large, independent urology group to implement Epic.

Curbside Consult with Dr. Jayne 10/5/20

October 5, 2020 Dr. Jayne No Comments

Google is doing some interesting things with COVID data overlays for Google Maps. The company states that it introduced the COVID layer in Maps “so you can make more informed decisions about where to go and what to do.” The overlay shows the seven-day average of new COVID cases per 100,000 people, with labels that show whether cases are trending up or down.

The data was accurate for my area, which is a hotbed of COVID transmission. Based on the activity of people in general, I doubt many people are consulting Google Maps to decide where they should be going since local traffic patterns indicate that everyone is everywhere.

Part of the issue stems from our lack of a statewide policy, leaving it up to individual counties to decide whether they will have restrictions or not. I live in a more restrictive county and people are flocking to the neighboring jurisdictions for dining and social activities despite the fact that numbers are going up in those areas. We hear all about the fun they’ve been having at wineries, pumpkin patches, and haunted houses when they present to the urgent care for COVID testing.

Since we have six providers out with COVID, we’re not very amused. Even though I’m not in the office for a while, I still get the text messages begging for additional provider coverage. We’re already seeing patients who are positive for both influenza A and influenza B, and vaccination season has barely started. It’s going to be a long winter, I’m guessing.

Our practice’s leadership has been quiet at providing details on how many employees have been infected with COVID and whether the exposures have been work related. I see some fairly cavalier processes with masking at times and occasionally people are gathering in break rooms despite recommendations to the contrary. I’m trying not to judge – they might be part of our population that already has had COVID and maybe they’re sharing war stories over a sandwich, but it’s still eerie when you walk up on people unmasked and closer together than the recommended six feet.

As a former administrative type, I appreciate the organization’s reasoning for being mum, but as a patient care organization, I think it’s important to address the infection control issue head-on especially since we’re still having “extended use” of our N95 masks that borders on the absurd. Fortunately, I have some angels out there who have been sourcing masks for me, so between those and the work-issued ones, I am able to swap them out frequently. I still find it hard to believe that we’re in this position at this point in the evolution of the pandemic.

Further on the topic of “things that are surprising, but not really,” I continue to see a significant number of individuals out there in the working world who don’t seem to understand the concept of “the internet is forever and it’s certainly not private.” Employers, potential employers, customers, and prospects may be looking at our activity on social media. Personal accounts can be subject to scrutiny as well as professional ones, which is why it seems surprising when people post things that raise an eyebrow or even cause a full-scale cringe.

A friend was looking at the LinkedIn profile of someone who is actively seeking a new job and found a post that didn’t exactly scream “please hire me, I’m a serious professional.” I’m not even going to quote it because I can hear my dear sweet grandmother in my head saying, “Jayney-girl, that’s vulgar.”

It got me thinking about posts that I’ve seen lately on social media that have been more than a little out of line, considering that their authors are the leaders of companies or other public-facing figures. Granted, those of us that live in the US are in the middle of what might be the most polarized presidential election in modern history, but it seems that a good chunk of the population has completely lost its sense of decorum. Whether one agrees with the idea of a social media post or not, an inflammatory tone doesn’t reflect well on one’s company or one’s leadership ability.

It has gone beyond what we used to think as “questionable” posts involving scantily-clad selfies, strip clubs, large quantities of alcohol, or venturing into tasteless subject matter. I saw one executive who re-posted political material that openly mocked the LQBTQ+ community. I’m sure their community health center and reproductive health practice clients aren’t going to be amused by it. Part of me wanted to reach out and ask if he really did post it or if he had been hacked, but seeing some of the posts that followed provided an unfortunate answer to my question.

I’ve seen what I would consider to be bad behavior much more often from my friends at startups, which may not have the same corporate social media policies as established or publicly traded companies. I’ve seen some posts that are completely absent of common human decency , but if they don’t even meet that level, they’re definitely not going to meet standards of being respectful. I  was following a company to write a piece on a company, but but have canned it because I cannot in good conscience provide visibility for an organization whose leadership is openly hateful.

In the final days that we have leading up to our presidential election, I am encouraging people to remember how we used to interact with each other, with reasoned, thoughtful conversation rather than forwarded clips and disrespectful hashtags. Once upon a time we knew how to work together towards common goals rather than bashing each other. We still have tremendous problems to solve, particularly in the healthcare arena where all of us play a role. Chronic diseases haven’t gone away, nor have preventable harms in healthcare facilities. Maternal / infant mortality in the US is still shameful, and we’re nowhere near funding public health in the way we need to fund it even after COVID exposed our shortcomings. We’re still wasting healthcare dollars because of siloed data and lack of interoperability.

We still have a rough month ahead of us, but let’s all consider taking a vow of civility. Let’s think before we speak or write and read things twice before clicking “send” or “post.” I think we’ll all be the better for it.

Email Dr. Jayne.

Readers Write: TechQuity: Influencing Health Literacy, Equity, and Disparities in Spanish-Speaking Communities

October 5, 2020 Readers Write No Comments

TechQuity: Influencing Health Literacy, Equity, and Disparities in Spanish-Speaking Communities
By Alejandro Gutierrez, MPH

Alejandro Gutierrez, MPH is team lead, customer success at Activate Care of Boston, MA.

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If Hispanics in the United States were a country, they would be the second-largest Spanish-speaking country in the world, and with $1.5 trillion in buying power, the 15th largest consumer economy in the world. According to the latest US Census data, last year marked the first year that more than half of the nation’s population under the age of 16 identified as a racial or ethnic minority. Among this group, Latino or Hispanic and Black residents together comprise nearly 40% of the population. 

The nation is diversifying faster than ever, and Latino and Hispanic communities are at the forefront. Yet we know that language barriers to accessing essential health and social services exist for all non-English speaking populations.

Recently, a study of nearly 20,000 inpatient admissions revealed patients who requested an interpreter were granted access to one only 4% of the time, and that is just for inpatient hospital care. Imagine the situation for outpatient care and social services. As a nation and healthcare system, we must do better. 

These language barriers have a negative impact on the health and well-being of the Hispanic community. Hispanic women contract cervical cancer at twice the rate of white women. Hispanics are more likely to be diagnosed with diabetes and are twice as likely to die of the disease compared to non-Hispanic whites. The stats go on. The outcomes continue. Physicians are less likely to detect depression in Hispanics, and Hispanics are 50% less likely to receive mental health treatment or counseling.

How can the healthcare system work to fix these issues? For starters, with the use of technology, healthcare providers can improve language equity. That will enable the Hispanic patient populations to become part of the majority receiving quality health and social services. 

As a member of the Hispanic community and a current member of a company working to identify SDOH (social determinants of health) in at-risk patients and provide proper care, I understand how complicated navigating healthcare systems can be for native Spanish speakers. I chose to go into public health because of my experience working and living in St. Louis, Missouri. I worked for a non-profit called Athletic Scholars Academy that ran school-based programs in under-resourced communities to promote healthy eating, physical activity, and academic achievement.

For those four years of my life, I listened to the everyday experiences of students, parents, teachers, administrators, and other school community members and learned more than I ever could in a classroom. I was regularly reminded that so many communities around the US do not have access to resources or opportunities for people to be mentally, physically, socially, and economically healthy. I learned that these differences in health are avoidable and are rooted in injustices that disproportionately affect Black and Latino communities. Working to address these avoidable differences in health became my “why” in public health.

My father is Colombian, but grew up in Spain. My mother is Indian, but grew up in Kenya. I am half Indian and half Colombian. My parents were first-generation immigrants when they came to the United States as college students and have been here ever since.

I am a first-generation American, but hearing from my parents and grandparents about the inequities in Kenya, Colombia, and India, I could draw parallels to the inequities – avoidable differences in distribution of resources and opportunities – that disproportionately affect Blacks and Latinos in America. This further reinforces why I wanted to get involved in public health. I continue to use the privilege I have been given from my grandparents and parents to do more to address health inequities in the US.

One of the first things I am lucky to have is my ability to understand and speak Spanish fluently. With that ability, I can help one of the biggest barriers Latinos face. Speaking to Spanish speakers in their native language is the first step in showing Latinos that we in the healthcare industry understand and care about them.  

As a millennial, I see the power that technology can provide in the public health space. We know that many issues of health equity are often embedded in the disconnections between healthcare and social services. Technology can offer a new chance to connect these services across the continuum of care, and can provide a more efficient and secure way of sharing and communicating information across teams that are often disconnected.

Communities across the country are taking ownership of their own abilities to exchange data across sectors. This includes healthcare, but expanding the network to include social services, behavioral / mental health services, schools, jails and courts, government agencies, managed care organizations, and more. These vanguard communities recognize that it is not enough to simply refer individuals back and forth amongst their various organizations; they have to share in the work of the interventions. Screen-and-refer approaches simply move problems from one place to the next. Screen-and-intervene approaches – built around community information exchange, care coordination, and data-driven quality improvement – are key to reducing health disparities, improving health literacy in vulnerable populations, and achieving the health outcomes we all want to see.

Morning Headlines 10/5/20

October 4, 2020 Headlines 2 Comments

CorroHealth emerges as a leader in healthcare reimbursement solutions, following merger of four industry players

Four health IT companies are acquired by private equity firm The Carlyle Group and will operate under the single brand of CorroHealth – TrustHCS (coding services), Visionary RCM (coding services), T-System (emergency documentation technology), and RevCycle+ (coding solutions).

VA on the fence about homegrown patient portal

The VA tells a House subcommittee that it is considering retiring the My HealtheVet portal in favor of Cerner’s MyVAHealth, but that move would cost $60 to $300 million since it isn’t included in its Cerner contract.

HHS Renews $10.2 Million Contract For Controversial COVID-19 Data Tracking Company

HHS issues a second $10 million contract to TeleTracking Technologies for its HHS Protect COVID-19 hospital data collection system, even as Congressional committees are investigating the circumstances under which the company was awarded the no-bid first contract.

Clinical Trials Hit by Ransomware Attack on Health Tech Firm

Clinical trials software vendor EResearch Technology is hit by a ransomware attack, forcing contract research organizations – some of which are managing COVID-19 vaccine trials – to revert to paper.

Monday Morning Update 10/5/20

October 4, 2020 News No Comments

Top News

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Meditech will end its status as an SEC public reporting company by running a reverse stock split that will allow it to de-register its shares.

Shareholders with fewer than 5,000 shares will be paid out at $45 per share to reduce the shareholder count to under 300, which will allow the company to take itself private.

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Meditech says that its public reporting status benefits its competitors, incurs costs, and provides little benefit since its shares are not traded on any public market.

More than 1,500 current and former shareholders will receive a cash buy-back that ends their company ownership and will trigger capital gains taxes.

Neil Pappalardo controls 45% of the company‘s shares, both his own $450 million worth as well as another $308 million worth that he votes as the sole trustee of the company’s profit sharing trust.

Shareholders will vote on the proposal, but board members have unanimously approved it and own enough shares to ensure its passage.  


Reader Comments

From Sea Legs: “Re: Allscripts. Another big round of layoffs, restructuring and realigning regions yet again, and rumors that some products will be sold off.“ Unverified, but reported by several people claiming to be employees on TheLayoff.com. 


HIStalk Announcements and Requests

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Poll respondents who have experienced pandemic-driven job changes most often report seeing decreased compensation or benefits, but quite a few have changed jobs and a good number saw their compensation and/or benefits improved or were promoted. I didn’t offer a “no change” option because I was interested in the changes rather than the percentage who have or have not experienced them.

New poll to your right or here: what is your most valued use of LinkedIn? I only use it to verify the job title, job history, and educational credentials of someone I’m writing about or to grab their headshot, but lately Microsoft seems to be attempting to turn it into a businessperson’s Facebook, a place where overly aggressive salespeople are unleashed to pester strangers with boilerplate pitches, and a publishing site for articles of sometimes questionable quality.

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

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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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StayWell, which includes Krames patient education solutions and the StayWell employee health platform, renames itself to Krames. The company was acquired by Internet Brands, which owns WebMD and Medscape, from drug maker Merck in March 2020.

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Four health IT companies are acquired by private equity firm The Carlyle Group and will operate under the single brand of CorroHealth – TrustHCS (coding services), Visionary RCM (coding services), T-System (emergency documentation technology), and RevCycle+ (coding solutions). The SEO will be Patrick Leonard, MBA, who spent several years at McKesson before moving into health IT investment.

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Virgin Pulse announces Winter ‘20, a program for health plan members and employees of client companies that will provide connections to Apple Health and Google Fit, health incentives, AI-powered member interaction and recommendations, next-best-action wellbeing tools, and a partner ecosystem. It will also help users manage their health benefits, offers evidence-based programs for weight management and pre-diabetes, and provides health content.

Shares in the Global X Telemedicine & Digital Health exchange-traded fund (EDOC) rose 3.3% in the past month versus the Nasdaq’s loss of 1.1% and the S&P 500’s loss of 2.1%.


Government and Politics

The VA tells a House subcommittee that it is considering retiring the My HealtheVet portal in favor of Cerner’s MyVAHealth, but that move would cost $60 to $300 million since it isn’t included in its Cerner contract. The VA will initially run the two portals in parallel, with Spokane-area veterans getting the Cerner portal by default after the Cerner go-live there this month, while all others will continue to access MyHealtheVet. 

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Former venture capital executive David Wagner, who received loans and grants from Connecticut’s economic development agency while he was facing fraud allegations in other states, pleads guilty to securities fraud and wire fraud charges in a plea deal. The state’s money was given to CliniFlow, a company that Wagner controlled that he said would move three medical technology startups to a building owned by Hartford Hospital in a $45 million project that would create 195 jobs. Prosecutors say it was a Ponzi-like scheme in which money from new investors was used to pay off previous investors or to pay Wagner’s personal expenses. The startups were SpearFysh, Vox MediData, and 3si Systems.


COVID-19

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HHS issues a second $10 million contract to TeleTracking Technologies for its HHS Protect COVID-19 hospital data collection system, even as Congressional committees are investigating the circumstances under which the company was awarded the no-bid first contract. The next $10 million contract extension is due in March.

Regeneron presents the first results from early studies of its monoclonal antibody cocktail three days before the product was administered to President Trump. The placebo-controlled trial of 275 asymptomatic to moderately ill people found that the drug has little effect on those who have measurable coronavirus antibodies, but it reduces viral loads and symptoms in those who don’t. Eli Lilly reported similar results two weeks ago from testing of its single-monoclonal antibody, also reporting since its study is further along that it reduced hospitalizations and ED visits. Regeneron says patients should be screened for virus levels and antibodies to decide whether to use its product, while Lilly thinks theirs should be offered to all patients who are high risk because they are elderly, have diabetes, or are overweight. 

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Public health experts question the White House’s sole reliance on Abbott’s quick COVID-19 test as protection, in which event attendees who tested negative are told that masks and distancing are unnecessary. Abbott’s ID Now test has not been approved as a surveillance tool because of limited sensitivity that can give false negative results, with FDA’s emergency use authorization covering only people with symptoms. Quarantining was not done by the President and staffers, who traveled to public events after the known positive test result of Hope Hicks, while Attorney General Bill Barr, Vice-President Pence, and other White House and campaign officials say they won’t quarantine even now despite CDC recommendations. CDC guidelines call for a 14-day isolation period for anyone who has come in contact with someone who is known to be positive, regardless of the results of their own test or lack of symptoms. Minnesota’s three Republican congressmen flew home on a Delta flight Friday night in violation of Delta’s post-exposure policies.


Other

India’s recently announced National Digital Health Mission will provide each citizen with a national health ID card that is tied to an account that will eventually include their complete medical record from all providers and serve as a research database, but experts wonder how many hospitals (especially private ones) will participate in the voluntary information-sharing program. They suggest that the country follow the models of Thailand and India, whose digital platform integrates with private health services but is deployed at the district rather than national level to keep participant counts per system at a reasonable several million.

Clinical trials software vendor EResearch Technology is hit by a ransomware attack, forcing contract research organizations – some of which are managing COVID-19 vaccine trials – to revert to paper. The company says that three-fourths of the drug trials that led to FDA approvals last year were managed using its software.


Sponsor Updates

  • Relatient’s patient engagement technology seamlessly supports hybrid care with telehealth integrations.
  • WebPT becomes Physical Rehabilitation Network’s platform partner for its Therapy Alliance for rehab therapy clinics in California.
  • SOC Telemed names Eunice Kim (Symantec) general counsel.
  • OmniSys integrates digital Medicare enrollment capabilities into its suite of software solutions.
  • Business Insider’s “AI in Healthcare Administration” report includes Wolters Kluwer among healthcare AI leaders targeting physician burnout.
  • OpenText publishes a new report, “COVID-19 Clicks: How Phishing Capitalized on a Global Crisis.”
  • In partnership with InterSystems, Ready Computing continues to deliver successful interoperable and scalable solutions for healthcare organizations.
  • Redox re-enters the Salesforce/Mulesoft ecosystem.
  • FritoLay recognizes the community service of Surescripts executive Ron Tyson through his High Fives organization as part of its Everyday Smiler program benefiting Operation Smile.
  • Premier announces that 75% of its Population Health Management Collaborative ACOs participating in the Medicare Shared Savings Program earned savings for the government, with 44% of those qualifying for shared savings payments.

Blog Posts


Contacts

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

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Weekender 10/2/20

October 2, 2020 Weekender No Comments

 

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Weekly News Recap

  • A GAO report says that state prescription drug monitoring program databases would be more useful in patient care if they were more widely integrated with EHRs.
  • Nordic acquires Tasman Global.
  • The VA sets October 24 for its first Cerner go-live.
  • Epic and M Health Fairview offer Epic sites free use of an algorithm that can diagnose COVID-19 from chest X-rays.
  • A study finds that a high percentage of Apple Watch notifications of atrial fibrillation don’t result in a corresponding diagnosis and were likely not useful, also noting that nearly one-third of the patients who sought medical care as a result should not have been using the tool because they fall outside of FDA guidelines because of age or known AFib.
  • HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.
  • UnitedHealthcare and Anthem end their no-cost coverage of telehealth visits that are not related to COVID-19.
  • A malware attack at Universal Health Services takes down computer and phone systems at 250 facilities, with some hospitals closing departments and diverting patients.
  • Allegheny Health Network (PA) and a Pittsburgh investor create an innovation hub that will provide seed funding to companies that are involved in diagnostics, therapeutics, medical devices, and health IT.

Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. M in Texas, who asked for hands-on STEM kits for her middle school class. She reports, “They were excited to work with all the different kits. I began each lesson with an objective, explanation, and expectations. The kits were an extension to the lessons taught. My students couldn’t finish their work fast enough to get to the hands-on part of the lesson. It is really exciting to see students eager to learn. They were engaged the whole time. It was very interesting to see how students would come up with alternative solutions to the problems they were facing.”

A Virginia couple who found a bat under the bedsheets with them is given a $500 hospital estimate after insurance to get rabies shots. The hospital charged $36,000, leaving them with a $7,000 cost after their deductibles.

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Companies are using covert surveillance software to monitor their work-from home employees, reviewing their screenshots, login times, and keystrokes. One program takes a photo from the employee’s webcam at regular intervals for managers who miss the control they had when looking over the physical shoulders of employees. One employee was caught logging in at 9 a.m. and off at 5 p.m. doing nothing in between except writing two emails. I was pressured years ago by a peer executive to send her reports about screen time and browsing history of her licensed professionals, leading to our official IT position that we weren’t in the surveillance business and management must be pretty poor if the only measurable output is adequate time sitting in front of the computer.

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In Quebec, a hospitalized Indigenous patient records video of nurses belittling her in French, telling her that she is “stupid as hell,” that “she’s good at having sex more than anything else,” and “who do you think is paying for this?” She died shortly afterward of what the family believes was an accidental morphine overdose by staff, leaving seven children behind. The hospital has fired one nurse and the family is suing.

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Irma Dryden, a black woman who served as a nurse to the famed Tuskegee Airmen during World War II, dies at 100. The New York-born nurse was assigned to Tuskegee Airfield in Alabama as her first exposure to the Deep South, when the military was segregated and black service members weren’t allowed to eat until the white soldiers had finished. Her ashes will be interred at Arlington National Cemetery. The head of the Tuskegee Army Nurses Project observes that those in the Tuskegee Airmen were fighting Adolf Hitler over human rights, but faced segregation and discrimination in their own country and even in their own military service. 


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Morning Headlines 10/2/20

October 1, 2020 Headlines No Comments

Prescription Drug Monitoring Programs: Views on Usefulness and Challenges of Programs

A GAO report finds that lack of integration of state prescription drug monitoring program tools with EHRs is the key challenge in PDMP use for patient care, with lookups requiring 3-5 minutes without integration versus 2-15 seconds with.

Nordic Acquires Tasman Global

Nordic acquires Netherlands-based EHR consulting firm Tasman Global, which expands the company’s reach into Europe and Asia.

Third time’s the charm? VA sets new date for initial electronic health record rollout

The VA plans to go live with a first round of Cerner EHR capabilities on October 24 at the Mann-Grandstaff VA Medical Center in Spokane, WA, with a second round scheduled for next spring.

Phreesia Acquires Co-Developed Patient Care Applications by Merck and Geisinger

Patient intake platform vendor Phreesia acquires two workflow applications that were developed by Geisinger and drug company Merck.

FastMed Becomes the First Independent Urgent Care Operator to Launch Epic

FastMed Urgent Care goes live on Epic at its 29 Arizona locations, the first independent urgent care operator to do so.

News 10/2/20

October 1, 2020 News 2 Comments

Top News

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A GAO report finds that lack of integration of state prescription drug monitoring program tools with EHRs is the key challenge in PDMP use for patient care, with lookups requiring 3-5 minutes without integration versus 2-15 seconds with.

Physicians said PDMP access helps them detect doctor-shoppers and also helps them avoid prescribing duplicate drugs or ordering doses that are too high when taken with other drugs.

Most of the 31 doctors who were interviewed said their PDMP is not integrated into their EHR.

They also reported that they could not access the PDMPs of other states, that dispensing records from opioid treatment facilities and the VA aren’t always included, and that PDMP searches are hampered by patient matching problems.


HIStalk Announcements and Requests

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A reader asked me to note that Nordic VP Pat Hingley will hit the 50-year mark in her healthcare IT career Friday, going all the way back to her teen job as a full-time “data processing” employee who rigged an IBM 402 accounting machine (a punch card reader with an integrated printer) to produce clinic reports (gifters: the 50th calls for gold). Congratulations to Pat. Is anyone else out there hitting their health IT semicentennial?


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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Nordic acquires Netherlands-based EHR consulting firm Tasman Global, which expands the company’s reach into Europe and Asia. Tasman founder and CEO Adrienne Flatland was a Willow implementer at Epic for seven years, then started the company in 2015.

Walmart will offer Medicare Advantage plans for Georgia seniors that will give them access to its Walmart Health Centers.

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Patient intake platform vendor Phreesia acquires two workflow applications that were developed by Geisinger and drug company Merck – Family Caregiver (a SMART on FHIR-integrated patient-provider communication app) and MedTrue (medication reconciliation and adherence).

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Israel-based personal health monitoring solutions vendor G Medical Innovations files IPO plans that values the company at $329 million. The early-stage company reports annual revenue of $5 million. The company will de-list its shares from the Australian Securities Exchange, which have a market cap of $33 million, before moving to the Nasdaq. One-year performance on the ASX finds company shares down 65% to $0.04. 

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ProPublica looks at a private equity firm’s acquisition and expansion of Prospect Medical Holdings, which it expanded to 17 hospitals and loaded with $400 million in debt, with the PE firm’s CEO and one of his executive peers personally pocketing $222 million. Meanwhile, the hospitals report non-working elevators, ambulances that can’t fill their gas tanks because of unpaid gas card bills, and shortages of medical supplies and PPE because of overdue bills. One of its hospitals had the first COVID-19 death of an ED doctor, who reported being forced to wear a single mask for four days, while another had six COVID patient deaths in a 21-bed locked psychiatric ward due to poor infection control. The chain has been accused of fraudulent Medicare billing and is running out of cash with high debt and a laundry list of hospital quality issues.


People

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Medical practice marketing technology vendor PatientPop hires Arman Samani, MBA (AdvancedMD) as chief product officer. He was announced as chief product officer for animal health technology vendor Covetrus on June 1, 2020, but I guess that didn’t work out since it’s not on his LinkedIn.


Announcements and Implementations

FastMed Urgent Care goes live on Epic at its 29 Arizona locations, the first independent urgent care operator to do so. The company’s clinics in North Carolina and Texas are up next in early 2021. FastMed chose Epic in January 2020 and announced last month that it has formed a joint venture with Phoenix-based non-profit health system HonorHealth, which uses Epic, to operate all of its Arizona clinics.

Netsmart integrates its MyUnity hospice EHR with Delta Care’s pharmaceutical care solution, allowing hospice nurses to consult with Delta Care’s pharmacists for medication changes that are then integrated into the EHR.

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Amwell will integrate TytoCare’s $250 on-demand medical exam device with its telehealth platform, allowing providers use its stethoscope, thermometer, otoscope, tongue depressor, and camera in virtual visits. 

Banner Health reduces unnecessary medication-related decision support and dosing alerts by one-third, working with Cerner Continuous Improvement Delivery to by studying its own alert history and implementing best practices from other Cerner clients.

Specialty pharmacy operator AllianceRx Walgreens Prime will integrate medical data from the recently announced Inovalon DataStream. I spent several minutes reading the announcement and Inovalon’s website trying to figure out exactly what DataStream, ScriptMed Cloud, and Inovalon One do exactly (beyond spawning buzzwords) but I lost interest.

OSF Healthcare goes live on Kyruus ProviderMatch for Consumers on its website.


Government and Politics

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The Department of Justice charges 345 people, including more than 100 medical professionals, with submitting $6 billion in fraudulent medical claims, most of them related to telemedicine. Telemedicine company executives were accused of paying doctors and nurse practitioners to order medically unnecessary medical equipment, genetic counseling services, and pain medications with minimal or no interaction with the patient, then selling the orders to other companies. CMS has revoked the Medicare billing privileges of 256 more medical professionals for their involvement.

Mann-Grandstaff VA Medical Center (WA) will go live on Cerner on October 24 in the VA’s first activation.


COVID-19

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Bloomberg describes the coronavirus precautions used by the University of Arizona, which include installing tents so students can wait for classes outdoors in the shade, sending student health ambassadors around campus in golf carts to hand our masks and to offer distancing reminders, requiring returning students to take a rapid coronavirus test, and performing daily wastewater analysis to quickly identify dorms in which someone is infected. The program was designed by 17th Surgeon General of the United States Richard Carmona, MD, MPH, who is a public health professor at the university. He dropped out of high school to join the US Army Special Forces as a medic and was decorated for combat in Vietnam. He earned a GED, completed a nursing program, then attended UCSF to earn undergraduate and medical school degrees and later University of Arizona for an MPH. Carmona has practiced as a paramedic, RN, surgeon, and deputy sheriff and has held leadership roles in emergency services, hospitals, and the Pima County, AZ health system. He issued the Surgeon General’s report on the effects of second-hand smoke.

Cornell researchers find that President Trump is the single largest driver of coronavirus misinformation that has appeared in major English language news outlets around the world, which they found ran false information – often without the publication’s own commentary or correction — about miracle cures, political conspiracy theories, and Anthony Fauci, MD. Mentions of the President made up 38% of the overall “misinformation conversation.” Just under 3% of articles contained falsehoods.

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University of Minnesota researchers develop an Epic-integrated AI algorithm that can diagnose COVID-19 from chest X-rays, which Epic and M Health Fairview will make available to all Epic sites without charge. All 12 M Health Fairview hospitals are using it.

Northwell Health develops a COVID-19 early warning system that analyzes patterns in its website traffic to predict demand for staffing and supplies. It says the two-week prediction has tracked closely to actual caseload so far, adding that it will offer the source code to other health systems who have the expertise to convert it to work with their own websites.

The CEO of Pfizer says in a company memo that he is disappointed that political rhetoric around coronavirus and vaccine development is “undercutting public confidence,” adding that despite the $2 billion the company has risked in not accepting money from any government, it will not succumb to political pressure to release a vaccine either faster or more slowly than “the speed of science” allows.

Two companies that were developing at-home, antigen-based saliva tests for coronavirus have abandoned those plans, as public health experts say it was naive to think that the virus antigen would predictably collect in the mouth. Saliva seems to work for PCR testing, but those tests are subject to testing material shortages and require hours to provide a result.

The US government turns distribution of remdesivir back over to its manufacturer, Gilead Sciences. The drug, which has proven to be modestly useful in shortening COVID-19 hospital stays without reducing deaths and whose development was partly paid for by US taxpayers, costs $3,120 per course of treatment. The company will make at least $9 billion in 2020-21 since its manufacturing cost has been speculated to be less than $1 per vial.  


Other

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Kaiser Health News covers the offshore scribe industry, where young, aspiring healthcare professionals in India toil overnight their time to create EHR documentation of US office visits. Augmedix recruits college graduates who can pass tests for English reading, listening comprehension, and writing, then sends them to a three-month training program that covers medical terminology, anatomy, and physiology and then takes them through mock visits. Scribes there earn an average of $500 per month, 20% of what their US counterparts are paid, and their time is billed at $12 to $25 per hour. Companies say remote scribing is a small but growing part of the market. Doctor-owned Physicians Angels offers audio-only services (saying that video is intrusive to patients and scribes should be paying attention only to what the provider verbalizes), says it can’t be breached since scribes enter information only in the client’s EHR, completes charts the same day since anything else is just a transcription service, and offers a no-obligation trial for 30 days at $15 per hour. The company’s founder and CEO is a Toledo-based, US-educated otolaryngologist. 

Canada-based preventive health operator Medisys Health Group pays a ransom to restore the data of 60,000 of its patients. The company is owned by digital health solutions vendor Telus Health, which bought the chain from its private equity owner in August 2018 for $100 million. Parent company Telus, a telecommunications vendor, offers cybersecurity services. 

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Mayo Clinic researchers find in a small study that 85% of people who receive an atrial fibrillation warning from their Apple Watch don’t end up with a corresponding diagnosis, leading them to warn that such widespread screening is likely causing overuse of healthcare resources from the “worried well.” They also observe that 8.7% of the patients who reported Watch AF warnings were under 22 years of age and 22% had known atrial fibrillation, meaning that they should not have been using the Apple technology per FDA guidance regarding use cases that have not been studied.

Campbell County Health (WY) receives a $1 million insurance settlement toward an estimated $1.5 million in cost for a September 2019 ransomware attack that wasn’t fully resolved until December 2019.


Sponsor Updates

  • Insight Success names Goliath Technologies Chairman and CEO Thomas Charlton a top 10 influential leader in medtech.
  • Arcadia extends its free vaccination, preventative screening, and appointment reminder outreach program to additional at-risk patient populations.
  • Cerner releases a new podcast, “Why you don’t want to miss Cerner Health Conference 2020.”
  • Saykara will host a virtual roundtable on using AI to reduce physician burnout on October 28.
  • Hayes CTO Ritesh Ramesh wins Silver in the CEO World Awards, Executive Achievement of the Year for IT Services category; and the company wins Bronze for Team of the Year in the inaugural COVID-19 Business Response category.
  • Wolters Kluwer Health publishes a new report, “Closing the Nursing Education-Practice Readiness Gap.”
  • Medhost and Senator Bill Frist discuss improving rural healthcare.

Blog Posts


Contacts

Mr. H, Lorre, Jenn, Dr. Jayne.
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Contact us.

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EPtalk by Dr. Jayne 10/1/20

October 1, 2020 Dr. Jayne No Comments

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For those of you still playing along with the Medicare Promoting Interoperability Program, October 3 is the last day to begin the required 90-day EHR reporting period. This applies to eligible hospitals who want to try to avoid getting a negative payment adjustment (aka penalty) down the road.

It’s hard for some organizations to even care about the CMS programs any more. They are trying to keep their doors open on a month-to-month basis, and the idea of future penalties isn’t on the radar when they’re juggling staffing issues and figuring out how to protect their employees.

Another deadline approaching is that for submitting comments on the 2021 Proposed Rule for the Quality Payment Program. That comment period closes October 5 at 5 p.m. ET and comments may be submitted through regulations.gov.

COVID and the related lockdowns, shutdowns, and limitations to healthcare delivery are having negative impacts on patients in other ways. The Morbidity and Mortality Weekly Report from September 11 presents the results of a survey done in June looking at patients whose routine care was delayed. The survey estimates that 41% of US adults have delayed or avoided care, including 12% who reported having avoided urgent care.

A close friend of mine is going through some stress following a delay of care. When she was finally able to get in for her annual GYN exam, there were some abnormal findings, and now she’s beating herself up about whether they would have been found earlier had she gone in April as originally scheduled. I reminded her that in her age group she’s not even recommended to have an annual pap test, which means that her physician performed it “early” per the guidelines rather than “late” due to COVID. It’s hard for most laypeople to wrap their minds around how guidelines are constructed, especially when they’re worried whether they have cancer. At least her care team is running full tilt now, so hopefully she’ll have the answers she needs very soon.

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ONC announces the awardees for the STAR HIE (Strengthening Technical Advancement and Readiness of Public Health Agencies via Health Information Exchange) program. The goal was to support state and local public health agencies, as they use health information exchange services to respond to public health emergencies such as natural disasters and pandemics. Five HIEs were each awarded two-year cooperative agreements: Georgia Health Information Network, Health Current (AZ), HealthShare Exchange of Southeastern Pennsylvania, Kansas Health Information Network, and Texas Health Services Authority.

I enjoyed this article in Nature looking at how researchers are using virtual assistants to diagnose coronavirus infections along with dementia, depression, and more. Vocalis Health, a start-up with offices in Israel and the US, modified an app that was being used to detect worsening chronic obstructive pulmonary disease in an effort to detect COVID-19. They asked patients who had tested positive to use a research app to record their voices, with the recordings processed through machine learning to try to identify a COVID voiceprint. The article goes on to cover the history of voice analysis with neurodegenerative conditions such as Parkinson’s disease as well as how it can be used for behavioral health conditions like mania, where voice features can be telling. I ran the article past my favorite voice expert who thought it was “very fascinating,” although I’m personally curious about how it handles patients speaking different languages with different dialects and regional accents.

Greenway Health is getting into the telehealth game with a solution slated to be available in October. It claims to “deliver quality care from remote locations without interrupting established workflows” and they’ve got a video on the website from their chief product and technology officer, but I’d find it a lot more credible if they had a physician announcing it. The rest of the information requires you to provide your information, so I took a pass.

My state chapter of the American Academy of Family Physicians reached out to me on behalf of the state department of health as they try to plan for administration of a COVID-19 vaccine. The documentation is extensive, including a participation agreement and a multi-page provider profile that requires details down to the brand, model, and type of storage unit that will be used for housing COVID-19 vaccine prior to administration. Based on our already unstaffable volumes, I can’t see my practice agreeing to be an administration site, but you never know.

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I registered for the all-virtual Lenovo TechWorld conference today, to be held at the end of October. Based on my interests, it suggested a couple of sessions for me. I’m not sure where the “liquid cooling innovation” one might have come from, but it does sound pretty cool (pun intended). Unlike an in-person conference, it’s easy for the day-to-day to get in the way of virtual conferences, so we’ll see if I make it to any of the sessions.

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I’m mostly interested in seeing how the virtual conferences run and what platforms they use, as well as how they engage (or don’t engage) attendees. The Optum Forum had some glitches this morning, with participants having to log out and back in as well as reload their browsers to continue. Sessions that may have been missed are posted for on demand viewing through October 30, however.

I’ve been dealing with some non-work issues lately, so I’ve been much more likely to answer phone calls from unknown numbers. I had the ultimate bad cold call the other day. I answered the phone as I always do, “Hi, it’s Dr. HIStalk” and the caller says, “Jayne, this is Dave.” “Sorry, Dave who?” “You know, Dave, from XX company. We met at the YY conference a couple of months ago (insert name of conference that I most certainly didn’t attend, because you know, COVID) and you said to call you in a couple of months.”

“I’m sorry, what is this about?” “I wanted to follow up on your cybersecurity needs.” When I began to explain that I don’t have any cybersecurity needs, he literally hung up on me. Definitely not a best practice for the sales playbook, and needless to say, his number is now blocked. I’ll also be making sure that all my hospital and healthcare friends who might actually have pressing cybersecurity needs know what bozos the company has hired so that they’re not inclined to give them their business.

What’s the worst cold call you’ve received? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 10/1/20

September 30, 2020 Headlines No Comments

CORHIO and Health Current Join Forces and Announce Intent to Form New Regional Organization

Colorado-based CORHIO and Arizona-based Health Current announce plans to merge, potentially creating the largest HIE in the Western United States.

Private equity firm’s healthcare SPAC SCP & CO Healthcare Acquisition files for a $200 million IPO

Blank-check company SCP & CO Healthcare Acquisition files for an IPO of up to $200 million.

Nebraska Medicine to resume appointments, procedures after battling cyberattack

Nebraska Medicine resumes all appointments, procedures, and surgeries after making “significant progress” in recovering from a cyberattack on September 20.

HHS Announces Funding for Health Information Exchanges to Support Public Health Agencies – STAR HIE Program Funds Five Organizations to Improve Interoperability of Health Data

GaHIN, Health Current, HealthShare Exchange, KHIN, and Texas Health Services Authority will receive a combined $2.5 million from the HHS STAR HIE Program to better support public health agencies in their response to emergencies like COVID-19.

Apple Accused of Delaying Masimo Legal Fight to Gain Watch Sales

Masimo contends in a court filing that Apple is trying to delay a legal fight over allegedly stolen blood-oxygen monitoring technology in its latest Apple Watch so that it can gain more market share.

Readers Write: Technology Augmented by Behavioral Science Theory Leads to Improved Health

September 30, 2020 Readers Write No Comments

Technology Augmented by Behavioral Science Theory Leads to Improved Health
By Rhea Sheth

Rhea Sheth is a clinical and marketing intern at Carium and an undergraduate student at the University of California, Berkeley studying integrative human biology.

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Behavioral science is the study of human behavior. It asks the question: why do we act the way that we do? The simplicity of this question masks a complex science that underlies it.

Understanding human behavior has many invaluable applications in our society. If we can better understand human behavior, we can shape our policies in a way that will better engage individuals or present public health information in a way that will lead to an increased compliance rate.

The intersection of behavioral science and technology is an area of huge opportunity. With the rise of technology, there has also been a rise in the number of opportunities to move healthcare away from a fee-for-service model and instead move towards a value-based approach. The incorporation of behavioral science theory into mobile health platforms can help facilitate the movement towards more patient-centric care and improved health outcomes.

Research-backed behavior change techniques should be intentionally incorporated in digital health platforms to help individuals manage chronic disease. Influencing behavior change in chronically-ill patients is a crucial public health intervention. According to the CDC, 6 in 10 adults in the US have a chronic disease and 4 in 10 adults in the US have two or more chronic diseases.

Smartphone apps are a convenient, cost-effective way to provide behavioral interventions at the appropriate times. In addition, they help reduce healthcare disparities by increasing reach to populations who were previously unreachable due to demographic, socioeconomic, and geographic barriers.

Behavior change techniques can be woven into virtual healthcare tools to help users identify and manage negative behaviors that may be contributing to worsened health outcomes. Self-monitoring is one of the techniques that enable this type of positive behavior change and has been found to lead to reduced hospitalization and readmission rates.

In the context of healthcare, this includes tracking metrics indicative of health-related behaviors such as calories eaten, weight change, and blood pressure levels, often collected through devices such as wearables and fitness trackers. Through digital health platforms, users can track their desired metrics in which they can also see short-term and long-term trends in their health data. This data can be shared with care teams and providers can then keep track of their patients’ health metrics through remote patient monitoring (RPM).

According to the American Heart Association, through RPM, providers can obtain a more holistic view of the patient’s health through data, gain insight into a patient’s adherence to treatment, and develop a deeper patient-provider relationship. RPM can also help reduce healthcare costs by enabling timely health interventions before a patient’s health deteriorates to the point of requiring a costly procedure.

Before the rise of mobile health, self-monitoring was done primarily through paper journal methods, where participants would manually record entries such as calories eaten, blood pressure readings, and blood sugar levels. With recent advances in mobile technology, there are opportunities for more convenient, real-time self-monitoring. Rather than having to carry around a bulky paper journal, individuals can simply enter their data into a mobile device and see their short- and long-term trends.

For an individual with diabetes, taking a daily measurement of blood sugar can help increase awareness about their positive or potentially harmful behaviors. Seeing a huge spike in blood sugar one morning can cause the individual to, first of all, be aware that there is a change in their health, and then reflect on what actions could have caused that. They might remember that they ate three fudge sundaes last night and did not go on their daily walk. The question is, are they now likely to change their behavior?

Here’s where behavioral science comes in again. The act of self-monitoring has increased the probability of behavior change by making the individual aware that there is a change in their health. However, the act of self-monitoring does not guarantee that someone will change their behavior. The next day, the individual may have a craving for ice cream and engage in harmful behavior again.

While they may be aware now that eating ice cream is affecting their blood sugar in such a drastic manner, there may be other underlying factors that cause the individual to perpetuate a negative behavior. It may be that the individual does not understand the consequences of having high blood sugar because they haven’t received information regarding its risks. It may be that they are lonely and feel like no one cares about their health because they do not have frequent access to a healthcare professional. Or, it may be that the individual has a goal of reducing blood sugar but does not know how to achieve that goal and thus becomes demotivated.

To help mitigate the risk of perpetuated negative actions, mHealth apps can integrate different behavior change techniques with self-monitoring to enhance user engagement and increase the probability of behavior change, such as secure messaging and educational materials. Secure messaging is one way for providers and patients to interact and strengthen their relationship, and learning materials such as diabetes-self management education also help improve health outcomes.

Studies show that self-monitoring is more effective in improving health outcomes when used in conjunction with other behavior change techniques in this manner. Self-monitoring was also found to lead to reduced hospitalization and readmission rates.

Making sure technology caters to the complexity of a human being is imperative. Behavior change techniques help us do that. There is no one-size-fits-all solution for behavior change, but intentionally designing technology based on research-backed behavior change techniques has been shown to improve health outcomes. In this way, we make movement away from episodic transactional healthcare and instead towards mutually beneficial, patient-centered, and holistic healthcare.

Much like having a trainer at the gym can motivate people to reach their fitness goals and feel stronger, more confident, and successful, having a digital health platform with specific behavior techniques such as self-monitoring, health coaching, prompts / reminders to take medication, and motivational messages can help patients achieve their health goals.

Readers Write: Remember the Opioid Crisis?

September 30, 2020 Readers Write 1 Comment

Remember the Opioid Crisis?
By  Peter J. Plantes, MD

Peter J. Plantes, MD is physician executive with HC1 of Indianapolis, IN.

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The last few years have ushered in significant progress on the opioid crisis containment front. Acknowledging decades-long misinformation shortfalls, negligence, and improper prescribing patterns, the healthcare industry took important steps on national and state levels to get out in front of devastating statistics.

A March 2020 report suggested the needle was finally pointing in the right direction. The Centers for Disease Control and Prevention (CDC) reported a 13.5% decrease in opioid overdose deaths from 2017 to 2018.

Unfortunately, that report was quickly overshadowed by the global pandemic that brought the nation to its knees. Opioid misuse, like many other critical healthcare priorities, took a back seat to COVID-19. The fallout is notable. A recent analysis points to a spike in opioid overdose cases by 18% since the start of the pandemic.

It’s not just overdose rates that have many across the industry concerned about the current state of the opioid epidemic. Public health officials also report a surge in relapse rates due to limited access to treatment.

The reality is that 2020 has delivered a perfect storm of factors that are contributing to a problematic front for opioid misuse, including mass unemployment and the isolation created by stay-at-home orders that interrupted existing care plans and contributed to an increase in mental health issues. In addition, studies reveal that opioid prescription rates for procedures such as hip and knee replacements continue to rise. Prescription rule changes aimed at helping patients during the pandemic may also have had negative effects by opening the door to increased fraud and “doctor shopping.”

Amid alarming trends, today’s providers face a complicated front at the intersection of increased addiction and appropriate opioid prescribing. Within what is now a highly regulated framework, healthcare organizations must ensure that they are optimizing patient safety by following prescribing guidelines and adhering to ongoing monitoring processes to detect misuse.

This is especially true for patients covered under a population management program of health insurance (ACOs, Medicare Advantage, and HMOs.) Neglecting this opioid substance abuse patient population can result in poor financial performance as well as regulatory scrutiny. NCQA issued additional opioid abuse management measures that are required to be reported as part of HEDIS 2020 standards. These will encourage both:

  • Timely “Follow-up After High-Intensity Care for Substance Use Disorder” (FUI), and
  • Sustaining “Pharmacotherapy for Opioid Use Disorder” (POD) patients.

In late 2020 and heading into 2021, there is much at stake with the opioid crisis. Healthcare organizations should reprioritize efforts now and increase their engagement to get the opioid trajectory moving in the right direction. It will not be easy, as accessing the right data and complying with guidance remains complex for the average resource-strapped provider.

At a minimum, healthcare organizations need to address the problem by:

  1. Taking into account the public health emergency declared by HHS Secretary Alex Azar. This move on January 31, 2020 subsequently lead to the March 18, 2020 clarification from the US Department of Justice Drug Enforcement Agency (DEA) that healthcare professionals can now prescribe a controlled substance to a patient using telehealth technology.
  2. Improving leadership through opioid stewardship committees. The Joint Commission mandated that all healthcare facilities implement leadership teams and performance improvement processes in 2018 to address safe opioid prescribing. Opioid stewardship committees can advance best practices by identifying existing gaps and implementing processes that meet best-practice guidelines that include risk assessment, using state implemented Prescription Drug Monitoring Program (PDMP) data, laboratory testing, and patient education. 
  3. Conducting optimal patient risk assessments, monitoring, and education. Comprehensive risk assessments seek answers to the following questions: 1) Was a patient assessed for potential risk of misuse prior to a procedure or prescription? 2) Did the provider and patient have an open and honest discussion about whether opioids were the right choice? 3) Did a patient receive monitoring during follow-up care to ensure appropriate use of opioids? 4) Was a patient counseled on proper procedures for disposing unused opioids? These risk assessment standards should especially be part of telehealth-based opioid prescribing.
  4. Accessing the right data in the most efficient way possible. Access to PDMP data is a critical first step, but it doesn’t always provide the full picture, especially in cases where patients are doctor-shopping across state lines. Healthcare organizations can extend the value of this data by combining it with dispensing records from multiple states and intelligent drug consistency assessment via laboratory testing to support precision prescribing.

Smart prescribing and oversight of opioid risk is more important than ever, as is equipping providers with easy access to the right patient data for monitoring. Technology that efficiently brings together the right data and delivers it in an actionable way to providers is improving this outlook. Technology that does not hinder the doctor-patient encounter is especially important for effective delivery of safe opioid prescribing practices. The technology must assist the physician in rapidly and completely engaging all required regulatory expectations without creating an administrative bottleneck in the daily practice setting.

Readers Write: Debunking Price Transparency Myths to Enable True Progress

September 30, 2020 Readers Write No Comments

Debunking Price Transparency Myths to Enable True Progress
By Kyle Raffaniello

Kyle Raffaniello, MSHA is CEO of Sapphire Digital of Lyndhurst, NJ.

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For years now, the US has had the highest healthcare costs in the world. While high medical costs are nothing new, these costs, in combination with the financial impact of the COVID-19 pandemic, could turn healthcare from unaffordable to unattainable for many Americans. Now more than ever, we must kick the nation’s price transparency conversations into overdrive to increase industry competition and lower the cost of care.

Increasing price transparency in healthcare is not a new goal by any means. The term has been used for years to not much avail, but has gained headlines in recent months because the Trump administration is making it a health policy focus and has announced multiple rules aimed at increasing transparency. However, confusion and uncertainty still linger around what transparency truly means for healthcare and whether it really works.

The truth is that it’s the foundation to making healthcare more affordable for Americans. Unfortunately, several common transparency myths muddy the waters for all:

Myth #1: Transparency Doesn’t Work

Transparency not only works, it is essential to lowering healthcare prices in our country and saving money for consumers and employers. For example, a hospital in Kentucky recently heard about the success Kentucky Employee Health Plan (KEHP) was having helping members find cost-effective facilities for their care when they used digital shopping solutions. Now the hospital wants to lower its prices and be more competitive in order to keep local business, as consumers had been going to get procedures done at more cost-effective facilities. Market forces will compel high-cost facilities to lower their prices to compete.

Myth #2: Cost Equates to Quality

An age-old adage, cost equating to quality, is simply not true when it comes to healthcare. Through the use of the right digital shopping tools, consumers can compare cost options and quality to find and select low-cost facilities that have high marks on quality, equating to high-value care. It’s time we all understand that quality doesn’t need to be compromised for cost or vice versa – this isn’t an either-or scenario.

Myth #3: Industry Stakeholders Don’t Want to Support Transparency

A common misconception is that not everyone in healthcare supports transparency because it’s not in their best interest. The truth is that most industry stakeholders do support transparency — they simply have differing views on how to achieve it. We must accept that different parts of the industry have different viewpoints when it comes to strategy and focus on the ways we can come together to achieve the common goal.

A recent survey found that nearly half (47%) of Americans age 18-64 surveyed are more concerned about the cost of healthcare now than they were before COVID-19. That same percentage of people also said they plan to change how they access care as part of our “new normal.” It’s clear that consumers want to shop for care and the market wants to increase transparency. In order to align stakeholders and ignite change in healthcare, companies in the transparency space must educate consumers about the right tools, support, and information to compare care options and engage the consumer in actively shopping for that care.

When we talk about the right information, this goes well beyond publishing a list of prices for procedures online, as these lists are not true to what patients will pay out of pocket. True transparency involves digital shopping platforms that can present consumers with a look at how much they will individually owe based on their insurance provider and individual health plan. Additionally, the listing of prices does not provide insight into the quality of care at a particular hospital or medical facility.

Digital tools will include the important qualitative information consumers can’t get elsewhere to ensure they’re not only choosing low-cost care, but high-quality care as well. Offering incentives to help consumers go beyond their research and actively shop for their procedures is important, too. Some digital shopping tools offer cash rewards, as a share of the savings, for consumers who choose high-value care.

Everyone needs and deserves access to low-cost, high-quality care, and we need to work together as an industry to make that happen. Through raising awareness of these tools, more consumers will become empowered and incentivized to use them, ultimately making more informed and confident decisions about their care. Additionally, there will be healthy competition among hospitals and medical facilities in the industry, driving down costs for the entire healthcare ecosystem.

The need for robust transparency that presents an easy healthcare shopping and comparison experience for consumers has never been more important following the impacts from COVID-19. As facilities reopen and begin rescheduling appointments, we must put the pedal to the metal and bring true transparency to the healthcare industry. Transparency is no longer an option, but a necessity for the livelihood of the industry and the consumers who power it.

HIStalk Interviews Brent Lang, CEO, Vocera

September 30, 2020 Interviews No Comments

Brent Lang, MBA is chairman and CEO of Vocera of San Jose, CA.

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Tell me about yourself and the company.

I’ve been with Vocera for 19 years. I was brought in by the founders, initially as the VP of marketing back when it was just a few guys in a dark lab trying to figure out if they could make our product work. My wife used to tease me that I was the VP of business, as opposed to the VP of marketing, since I was trying to figure out our go-to-market strategy, our pricing strategy, and our target customer.

The company was not originally created as a healthcare-focused company. The founder’s vision was to enable wearable communication across multiple markets. One of my first jobs as a VP of marketing was to go out and interview a bunch of potential customers about the idea of wearable, hands-free communication. We started talking to some hospitals and nurses were so excited. I remember one hospital nurse saying to me, “You’re going to change the way nursing is practiced around the world.” At that time, I had no idea what she was talking about because I had not come from a healthcare background. I was more of a technologist, having made my way through Silicon Valley tech companies with an interest in technology and business strategy.

I fell in love with the impact that technology could have on hospitals and healthcare workflows. I was an industrial engineer back in school and never really thought about too much how I would use that until I started thinking about the role that communication can have on improving workflow and operations within a healthcare setting. I tell people all the time, just learn what you can, because you never know what knowledge you’re going to pick up along the way that will be relevant to you at some point in your future career, even though it may not seem particularly relevant at that particular moment in time.

Cell phones, apps, and phone-based texting were not around when the company was started. How have they changed the appeal or the marketing of healthcare-specific communications?

People forget that we created the company before Siri, Alexa, and the IPhone. Vocera revolutionized the idea of communication using voice as a user interface and thinking about mobility. We built the original Vocera badge because there weren’t any other appropriate devices. The closest ting might have been a Palm III, Palm V, or later, the Treo. Hands-free is critical in a hospital, so we built the device mainly because there was nothing else that would work. We have learned over the years just how essential the hands-free capability is.

We have embraced a range of different devices. Our strategy is very much about being device of choice, and our software platform supports iPhones, Android devices, tablets, and desktop interfaces. But we find that the closer a clinician is to direct frontline care, the more important it is to have that hands-free capability, and it’s even more relevant during COVID. But what has been important for us was to figure out ways to bring in those other modes of communication that you mentioned — text messaging, alerting, alarming, and other forms of media — into the platform and into the devices that we support.

The new Smart Badge recognizes a “wake word” to make everything hands-free. How important is that to clinicians?

We introduced the wake word earlier this year. You can say “OK, Vocera” to wake up the Smart Badge and allow you to issue a voice command, such as, “call the nurse for room 101” or “call a respiratory therapist.” You don’t have to have any interaction with a button on the badge at all. In this era where people are wearing personal protective equipment, or PPE, a lot of people are excited about the wake word functionality, because they are able to wear their Smart Badge underneath their gowns and maintain an entirely hands-free environment.

Could you integrate your system with inexpensive consumer voice assistants that could be placed in patient rooms, which would allow patients and nurses a simple, hands-free way to communicate, either along with or instead of a call system?

This is actually an area that we are really excited about. We are building a Vocera skill for Alexa that will allow you to put an Alexa device, like an Amazon Echo, in the patient’s room and enable the patient to issue voice commands. Those messages are then routed to the appropriate caregiver. We can leverage our software platform and routing intelligence so that we know who to notify if the patient asks for a blanket, but if the patient says that they are in pain, it can go directly to their nurse to take immediate action. 

It’s really combining, as you said, the consumer devices that are becoming so available and the prevalence of using voice as a user interface and speech recognition as a user interface, combined with the intelligence and routing capabilities of our software, and then the connectivity that we have out to the employees of the hospital. We’ve shipped over a million Vocera badges out into the marketplace. There are hundreds of thousands of people using them every day. That gives you an instant connection to nurses, transport techs, housekeepers, and food services. A patient can get immediate access to all those people, rather than it just being a hardwired connection back to the nurse station, where someone then has to figure out how to deal with that patient’s request. We are seeing a convergence of technologies that people have become used to and comfortable with in their personal lives and in their homes, merging with hospital-specific workflows and hospital-specific solutions that leverage the sophistication that we can build within software.

How has COVID affected the use of your products and the trajectory of the company?

The pandemic has raised the awareness for our company, our solutions, and the value proposition of what we offer, in particular, the hands-free capability. Every time a care team member removes or replaces their PPE, there’s a risk of contamination. Minimizing the number of times PPE is removed reduces the risk of infection and helps preserve these valuable resources. Whether that’s in a triage tent, an ICU room, or an isolation room, the hands-free capability of our solution has been really valuable, because it can be worn underneath the personal protective equipment.

We have seen the product being used in temporary tents being set up to triage patients. We’ve seen the Vocera badge being used connected to the bedrail, to allow patients to reach care team members and for nurses to do virtual rounding, where they can call a patient’s room instead of going in and out for a quick conversation, which keeps them safer and reduces the amount of PPE used. It allows them to reach out to family members. It has been exciting to see the role that that communication can play.

For our employees, our connection to our mission has never been stronger. Our mission is to improve the lives of caregivers, patients, and family members. While the pandemic has been tragic in many regards, it has been inspiring for the employees. Our level of employee engagement is higher than it has ever been because we have been part of the solution. It has been inspiring for employees to feel like they are doing something that is having a direct impact on patients, caregivers, and family members.

What sales and marketing changes have you made given travel limitations and the cancellation of HIMSS20?

We were one of the first companies to drop out of HIMSS when we saw the pandemic rising. Maybe it was the benefit of being out here on the West Coast and seeing what was happening in Washington. But we very quickly started transforming the company to being virtually oriented in our sales, services, and marketing efforts.

Just to give you an example, within 30 days of this all coming about, about 90% of our professional services had been transitioned to remote work using Zoom or other virtual technologies. Our sales team quickly embraced reaching out and working with customers on a virtual basis. Our marketing team did a really good job of creating new use cases and case studies talking about COVID-specific workflows and how the product could be utilized in these environments. We used it as an opportunity to support our customers. We issued several thousand free, temporary license keys for our software to customers who needed to increase their capacity to respond to COVID surge situations.

I’ve been incredibly proud of the response by the company and by the employees to support our customers and do the right thing during these really challenging times.

How do you position your offerings in rounding, patient experience, pre-arrival, and patient monitoring software within the framework of enterprise communications?

Our vision is around enabling the real-time health system across the care continuum. That is more than just voice communication. It is more than just communication broadly. It is all about eliminating the friction points in a patient’s journey and making sure that the right data is delivered to the right person, on the right device, at the right time, with the right level of urgency.

Take as an example our recent acquisition of Ease, which is a patient and family communication application. It enables caregivers to give updates to family members when a loved one is in the hospital for surgery, COVID, or other situations that prevent family members from visiting them. This speaks to our desire to expand to enable this real-time health system.

The company has its roots in the Star Trek communicator kind of mindset, but our software platform is much broader than that now. We have had to evolve as the industry’s has evolved. In the old days, a lot of actions in a hospital were triggered by a nurse walking into a patient’s room and noticing a change in their condition. The workflow started by the nurse needing to reach out to get the appropriate help. More and more today, patient monitors, physiologic monitors, smart beds, and the electronic health record are becoming expert systems. They can, in many cases, notice a change in the patient status quicker than the nurse who is walking into the room. The event that needs to be triggered from that, and the people who need to be activated as a result of that change in patient status, can be coming from lots of different sources beyond just the initial human interaction with the patient.

As a company, we focus on evolving what we do to be able to incorporate all this data coming from these expert systems, route it through our workflow engine, and more importantly, prioritize it and triage it so that we aren’t creating cognitive overload or cognitive burden on the clinician, so that they’re receiving just the most critical information. and know the most important activity to act on next.

You are at a blurred line between what you’ve traditionally done and new technologies that are gaining in popularity, such as chatbots, artificial intelligence-powered population health management, asynchronous text-based provider chatting, and patient-reported outcomes, all of which are usually offered by a standalone startup company. Do you see Vocera getting more involved in either these specific technologies or with those companies that offer them?

You’re absolutely right. Hospitals tell us all the time that they are looking to consolidate the number of vendors that they are working with. They are looking to build platforms that are unified and fully integrated.

We try to create as much of an open platform as we can. We want to be interoperable with data from a range of different systems. Whether it’s a piece of technology that we develop ourselves, creating an interoperability relationship or some sort of partnership, or a potential acquisition — those are all ways of building up a platform that is easy to use and is delivering the right information to the caregiver.

I love to see the innovation that is occurring in the space, because the more information and the more data that gets generated, the more of an opportunity there is for us to analyze that data, route that information, and provide better patient context. When a call or message comes in, it’s not just an interruption, it’s actually patient context-aware events that provide the caregiver with situational awareness that allows them to decide what the next action is.

Our strategy is to say that we are going to do a lot of this ourselves, but we’re also going to create open APIs and open standards that allow us to bring data in from other organizations. One of my favorite examples is sepsis alert technologies, those sophisticated algorithms that can  predict when a particular patient might be headed towards sepsis. The challenge with those is that often that the algorithm can identify the patient who is at risk, but it may not do a good job of notifying somebody who can take action. In that case, we do a simple integration with them, they send us that alert, and we route that to the appropriate caregiver. They can take action much more quickly than if we were just waiting for the clinician to go log into the electronic health record or some other expert system that has identified that the patient is at risk.

Do you have any final thoughts?

Technology vendors have an important role to play in transforming healthcare, whether it’s providing improved safety for clinicians and for patients, reducing the cognitive burden, our doing a better job of protecting our frontline caregivers. Technology must be part of the answer to bridge the gap between where we are and where we need to go. Vocera is really excited to have an opportunity to participate in that.

Morning Headlines 9/30/20

September 29, 2020 Headlines No Comments

HHS Launching Initiative to Track Physician Use and Burdens of Health IT

HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.

As insurers move this week to stop waiving telehealth copays, patients may have to pay more for virtual care

UnitedHealthcare and Anthem will end their virtual visit benefit Thursday, after which patients will once again pay co-pays, co-insurance, and deductibles for virtual visits that are not related to COVID-19.

JLL Partners strikes deal to buy Thoma Bravo’s MedeAnalytics

PE Hub reports that private equity firm JLL Partners will purchase MedeAnalytics from Thoma Bravo, which acquired it in 2015.

News 9/30/20

September 29, 2020 News 1 Comment

Top News

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Universal Health Services begins recovering from a Sunday morning malware attack that locked computer and phone systems at 250 facilities, forcing some to close departments and divert patients.

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An anonymous staffer reported seeing the phrase “shadow universe” on computer screens as the breach commenced, leading cybersecurity experts to assume that Ryuk ransomware was involved.


HIStalk Announcements and Requests

I had to switch concierge doctors after mine closed his practice to take a drug industry job. Allow me to correct my own convenient but incorrect use of the term “concierge doctor,” which mine was not. A concierge practice still bills your insurance company and/or you personally — you are just snootily buying your way around the velvet rope at a cost of thousands of dollars per year. What I have is “direct primary care,” where you pay an average of $75 per month for anytime access to your family practice doctor via call or text, unlimited office visits or telehealth sessions, wellness exams, physicals, health maintenance, minor in-office treatments and surgical procedures, and often at-cost labs and prescriptions right in the office. Savings on routine lab work alone – paying the heavily discounted doctor’s cash price instead of your insurance’s deductible — can cover much of the entire year’s cost. I feel like a VIP when I have a minor, obvious health issue (pinkeye and a swollen toe being the most recent examples), I text a photo to my doctor on a weekend or holiday, and almost immediately I have a prescription waiting to pick up at the drugstore, with follow-up available if I need it. I keep my regular insurance, with the few hundred dollars per year DPC cost a modest luxury that lets me avoid the usual poor customer service. I expect quite a few physicians fail at DPC due to inadequate business skills (especially marketing), but otherwise small panel size, lack of insurer meddling, and freedom from bureaucracy makes it a great model for both doctor and patient when done right. Plus doctors can choose which patients they want to work with.


Webinars

September 30 (Wednesday) 11 ET. “The Hidden Threat: New Research on Security Vulnerabilities and Privacy Gaps in Healthcare Apps.” Sponsors: Verimatrix, NowSecure. Presenters: Neal Michie, MEng, director of product management, Verimatrix; Brian Lawrence, direction of solution engineering, NowSecure. The presenters will present research on the security risk profile of 1,000 healthcare apps in managing patient privacy, how they compare to those in other industries, and where the biggest vulnerabilities lie. Attendees will learn how to make their healthcare apps more secure in managing protected health information.

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


Acquisitions, Funding, Business, and Stock

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Defunct personal health record vendor Medlio notifies users that cancer reference lab NeoGenomics Laboratories has acquired some of its assets, but will sunset the patient-facing mobile app and health records download service. Medlio co-founder Lori Mehen took a full-time product manager job with NeoGenomics Laboratories early this year.


Sales

  • Henry Mayo Newhall Hospital (CA) will implement Ensocare’s Transition and Choice automated referral software.
  • The US Air Force selects NeuroFlow’s behavioral health integration technology, beginning with deployment to a division of Space Force.
  • Provider communications platform vendor Updox will integrate its systems with inpatient EHRs using technology from Redox.
  • CareSignal will white-label a conversational AI chatbot from QliqSoft to automate the traditional call center model of remote patient monitoring.

People

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The Chartis Group promotes Roger Ray, MD to chief physician executive.

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Mount Sinai technology commercialization spin-off Rx.Health names Richard Strobridge (Nextbridge Health) CEO.


Announcements and Implementations

LifeBridge Health implements Artifact Health’s mobile physician query software at Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center in Maryland.

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West Tennessee Healthcare deploys Cedar’s patient engagement, messaging, and billing platform.

EMpower Emergency Physicians (AZ) and Integrated Care Physicians (FL) adopt RCM software and services from R1 RCM.

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A new KLAS report on  oncology software finds Elekta as the leader in both medical and radiation oncology software, with Varian (slated for acquisition by Siemens Healthineers for $16 billion) coming in second. EHR vendors Cerner and Epic have seen significant adoption of their medical oncology software, but with functionality gaps and click-heavy, multiple ways to complete tasks that hurt usability and training. Medical oncology EHR vendor Flatiron Health, acquired by drug maker Roche for $2 billion in April 2018, placed in the middle of the pack with strong product design and support expertise that is dragged down by poor communication around enhancement requests, upgrades, and delayed support response. Varian leads in the tiny field of radiation therapy treatment planning, as more than half of Philips Pinnacle treatment planning software customers say they’re switching to a different vendor (presumably Varian) due to lack of development effort and failure to keep promises.

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Best Buy-owned GreatCall releases the Lively Flip smartphone for seniors, which builds on the previous Jitterbug phone in adding Alexa voice services, a bigger screen and keyboard, a dedicated button for calling an urgent care provider, and 24/7 access to its telehealth service. The phone costs $100 plus a $35 activation fee, while monthly plans run $20 to $35 not counting unlimited text and talk, which adds $20. Best Buy acquired Great Call for $800 million in August 2018.


Government and Politics

HHS and ONC launch a program with the American Board of Family Medicine to measure the use and potential burdens of health IT by office-based physicians.

Premera Blue Cross will pay the HHS Office for Civil Rights $6.85 million to settle potential HIPAA violations stemming from a 2015 data breach that affected 10.4 million members. An OCR investigation found the Pacific Northwest payer failed to implement risk management and audit controls and failed to conduct an enterprise-wide risk analysis.


COVID-19

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Health systems are creating “one-stop shop” clinics for patients who have survived COVID but who are experiencing ongoing problems such as lung or heart damage, neurological issues, fatigue, and anxiety. The director of the Center for Post-COVID Care at Mount Sinai says that if even if less than 10% of infected patients experience long-term symptoms, that means 500,000 Americans will require medical care of unknown duration. He says half of the clinic’s patients have test results that show damage, while the other half have symptoms but inconclusive test results.

The White House will send 150 million Abbott BinaxNOW rapid coronavirus tests, purchased for $750 million, to states and other jurisdictions by the end of the year, with several million going out this week to be used for vulnerable populations such as nursing homes. The tests use a shallow nostril swab, require no special equipment, and give results in 15 minutes, so they can be used in medical practices and pharmacies. However, they are approved for use only in symptomatic people, must be administered within the first seven days of symptoms, and cannot be self-administered at home. Experts praised the news, but say 150 million tests is a drop in the bucket given their likely use and they still don’t solve the problem of assessing true prevalence. Public health officials also question how the results of the tests will be reported, particularly if administered outside the health system such as in schools.

The federal government has sent rapid COVID-19 test machines to 14,000 nursing homes since last month, but they come with a catch. The nursing homes must agree to test each employee and resident weekly and pay for their own supplies at $32 per test, meaning that even small facilities could be on the hook for thousands of dollars each week. They also report that manufacturer BD is back-ordered on testing supplies. Health departments haven’t figured out how to collect data from nursing home tests. Some facilities that have become frustrated by the cost and availability challenges of the BD tests are using state labs, but they don’t get results back for several days.


Other

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@Cascadia is right – the VaccineFinder website operated by Boston Children’s Hospital, CDC, Harvard Medical School, and HealthMap shows no locations offering flu vaccine anywhere, which I can personally contradict since I got my flu shot yesterday. At least some other vaccine searches seem to work, although the location list seems incomplete when it says no Walgreens in Chicago offers Tdap or shingles vaccine.

UnitedHealthcare and Anthem will end their virtual visit benefit Thursday, after which patients will once again pay co-pays, co-insurance, and deductibles for virtual visits that are not related to COVID-19. Nobody knows how much patients will have to pay or how the cost of a telehealth visit compares to the co-pay for an office visit. Other insurers that had planned to end expanded telehealth coverage on September 30 have extended the program until the end of the year.

A Spok survey of 600 healthcare professionals finds an inability to communicate effectively, remote workers, and lack of or insufficient devices have been the biggest communication problems during COVID-19. H

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Amazon announces a palm vein scanner that will let customers of in-person shops check out with a wave of the hand, which hopefully will reinvigorate the healthcare interest in that biometric technology that made perfect sense a few years ago to positively identify patients in a non-threatening way compared to fingerprints and retinal scans. HT Systems (PatientSecure, now owned by Imprivata) and Fujitsu (PalmSecure) were the healthcare players in palm vein scanning 10 years ago and I was a fan of the idea.

Not related to health IT, but fascinating and fun to watch, is this UK paramedic’s test of a 1,000-horsepower jet suit made by Gravity Industries for air ambulance response in the mountains of Cumbria. I pondered how much a private equity-owned ambulance or air flight service would charge for that trip in the US.


Sponsor Updates

  • Kyruus will host ATLAS, its Annual Thought Leadership on Access Symposium, virtually October 20-22.
  • CarePort Health wins the 2020 Tech Cares Award from TrustRadius.
  • CareSignal develops AI-powered predictive models to help providers and payers keep patients engaged with digital health programs.
  • Datica achieves top marks for interoperability solutions from Chilmark Research.
  • Everbridge announces that, in addition to Anthony Fauci, MD and Sanjay Gupta, MD, a former World Head of State will speak at its COVID-19 R2R: The Road to Recovery virtual leadership summit October 14-15.
  • Audacious Inquiry founder and CEO Chris Brandt joins University of Maryland St. Joseph Medical Center’s Board of Operations.
  • Arcadia publishes a new case study, “CareMount ACO Uses Arcadia Analytics to Build a Narrow SNF Network and Reduce ALOS by 4 Days.”
  • MassChallenge features “A Look at How OSF Health Care Teamed with Startup CareSignal to Help Their COVID-19 Response.”
  • Ellkay sponsors the BCBS 2020 Virtual Summit through October 2.
  • Experity opens registration for its half-day Virtual User Experience October 15.
  • Black Book Market Research publishes, “Top Healthcare Human Resources Outsourcing Solutions Vendors.”

Blog Posts


Contacts

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

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Morning Headlines 9/29/20

September 28, 2020 Headlines No Comments

Healthcare giant UHS hit by ransomware attack, sources say

Universal Health Services experiences a ransomware attack that has locked computer and phone systems at several facilities across the country.

Startup Hims Nears a Deal to Go Public Via Oaktree SPAC

Online health and wellness company Hims prepares to go public through a merger with Oaktree Acquisition Corp., which is raising $75 million to help fund the deal.

CloudMD Acquires Majority Interest in Innovative U.S. Based Provider of Cloud Based Practice Management and Electronic Health Records with US$4.9M in Sales

Canadian health IT vendor CloudMD will acquire a majority stake in Lynchburg, VA-based EHR, practice management, and RCM vendor Benchmark Systems from AntWorks for $4.4 million.

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Reader Comments

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

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