EPtalk by Dr. Jayne 7/23/20

The big news of the last week has been the unexpected and mandatory shift in COVID-19 data reporting away from the Centers for Disease Control and directly to the US Department of Health and Human Services. It was done with minimal communication and in the middle of a pandemic, which isn’t the ideal scenario for any IT project. I guess the contractor involved had never heard of setting up a parallel system and validating data or having a robust cutover plan, let alone involving stakeholders and end users in the testing.

Needless to say, more than 100 industry groups have signed on to a letter asking the White House to reverse the shift. The major concerns revolve around transparency and data availability, but the undercurrent of public health policy versus politics is a factor as well.

Small news of the week includes a reprieve for Elizabeth Holmes, whose trial might be delayed until 2021 due to COVID-19 concerns. The trial was scheduled to start in October, but attorneys argued via Zoom that moving ahead with a trial would create risk. More than 170 people from 14 different states are on the witness list, with more than a dozen of them being high risk due to age. An August hearing will determine the exact date for a new trial.

This week has driven me to the maximum level of frustration with regards to COVID-19 testing. We are now seeing patients who have had five or more COVID tests because they continue to engage in risky behavior and “just want to get checked out.” We’re also running into employers who are requiring negative tests before allow patients to return to work. Those who have multiple positive tests but who are no longer considered contagious by the CDC standards are subjected to unnecessary medical procedures as they continue testing, which also takes away supplies from other patients. Employers are requiring testing of workers who have even remote contacts with potential patients, wasting more supplies.

We have been out of rapid testing kits for weeks, but somehow the NFL, NBA, their respective employees and the media have access to them. This is in the context of announcement that the US is trying to reduce unnecessary COVID testing. As far as I’m concerned, the message can’t get to these employers soon enough.

I also had my first patient come back in for a visit hours after he was texted with his positive COVID result, for a re-test “just to be sure, because it might be a false positive.” Hate to tell you, sir, but (a) you are still quarantined regardless of the outcome of this second test; and (b) congratulations on exposing my office staff, me personally, and everyone you might have come into contact with along the way. We had a difficult conversation which I’m sure will lead to a one-star or zero-star review, but at this point I say “bring it,” because in many ways, it would be relief to just get fired by my ratings-centric employer. I hate that the pandemic is turning something I used to love (seeing patients in person) into something I sometimes dread, and that it’s being driven largely by economic forces.

I found some time to recharge my batteries this week and enjoyed attending the Telehealth Innovation Forum on Tuesday and Wednesday. It was a welcome break from what I’ve been doing for the last several months. The sessions were engaging as well as fun. Tuesday’s end-of-day session included a live martini class, where we learned tricks of the trade. I was glad to learn that the way I shake my martinis is how the pros do it, but apparently I’ve been holding my jigger wrong.

Wednesday we had our volunteer activity of decorating backpacks that will be filled with school supplies and sent to Puerto Rico, while learning about the World Telehealth Initiative. As much as we think about telehealth as a convenience in some countries, it’s striking to realize how much of a true game-changer it can be in developing nations. Thanks to the many sponsors that made this activity possible and to Teladoc Health for putting it all together.

The US is still pretty keyed up about the promise of telehealth, although a new survey from Sage Growth Partners and Black Book Research highlights that many organizations anticipate a decline in telehealth volumes over the next year. Respondents cited lack of integration and/or interoperability as a key reason for dissatisfaction, along with a lack of data needed for continuity of care. Payment issues also made the list.

I say the jury is still out, because we have no idea what will happen when flu season starts and other respiratory pathogens start rolling in. If you’re still using Zoom to try to deliver virtual visits and haven’t begun the transition to an integrated system or one that at least plays nice with your EHR, I suggest you start looking.

In other telehealth news, I received an email announcing the “HHS Telemedicine Hack,” which is apparently a 10-week virtual learning community aimed at accelerating telemedicine implementation among ambulatory providers. The program includes various online panels and presentations along with virtual discussion boards. It runs from July 22 to September 23. I wonder if I’m the only one who thought it was weird that they announced it after it had already started. I read my CMS emails pretty religiously and searched both my voluminous inbox and my trash without finding any other announcements.

The American Board of Surgery admits a complete meltdown of its online general surgery board qualification exam last week. Candidates describe a “nightmare” scenario where morning test-takers finished Day One of two, but afternoon testers had technical issues, so the entire test was canceled early Friday morning. The Board promises to “regroup and develop a new process.” Candidates were also frustrated that the Board was communicating via Twitter rather than directly with them through email, citing delays in mass emails to over 1,000 impacted surgeons as an explanation.

The absolute highlight of my week was a care package from the folks at Medicomp Systems. The company is a Founding Sponsor of HIStalk, a former sponsor of HIStalkapalooza, and has supported our favorite charities as we’ve competed on their game show stage at past HIMSS conferences. Along with a UV sanitizing bag for my constantly rotating supply of masks, they managed to source some coveted N95 respirators from 3M as well as classily embroidered multi-layer masks that have both a bendable nosepiece and adjustable straps. They are the “little black dress” of masks.

Given our current situation, I’m thinking of shifting my love of shoes to one of stylish masks. A patient had on a bedazzled mask last week, so there’s plenty of opportunity for creativity and style. I’m touched that they would think of me and sincerely appreciate the additions to my PPE wardrobe.

What’s the sassiest mask you’ve seen? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/23/20

Hair loss treatment vendor Hims seeks deal to go public: sources

Online prescription delivery and telemedicine company Hims considers going public through a merger with an unnamed company.

Tasso raises $17 million for home blood-testing kits

At-home, blood-testing kit startup Tasso will use a $17 million Series A funding round to develop a companion app that will help users share their data with providers.

Walmart Health Expands to Florida, Bringing Affordable and Accessible Care to Local Communities

Walmart Health will expand into Florida next year, with additional openings slated for locations in Illinois.

Readers Write: Achieving True Interoperability Transparency May Depend on Adopting a National Patient Identifier System

Achieving True Interoperability Transparency May Depend on Adopting a National Patient Identifier System
By Kevin Hutchinson

Kevin Hutchinson is CEO of Apervita of Chicago, IL.

Let me say one thing right out the gate: I am typically not a fan of forcing industry-wide uniformity via burdensome and overly instructive government mandates. However, sometimes there’s too much at stake in healthcare and the private sector just can’t agree on standards on their own. So was the case with e-prescribing over 15 years ago, and so is the case now with interoperability.

When I was founding CEO for Surescripts and before I was a member of the inaugural ONC-created National Health Information Technology Standards Committee, it was hard to get stakeholders to agree on standards, as the EHR industry was generally slow to adopt anything. However, after we created the initial standards for e-prescribing via the National Council for Prescription Drug Programs (NCPDP), set firm deadlines, and CMS tied e-prescribing to MIPPA incentives, the different factions within the healthcare industry (all of whom had different agendas) came together and abided by a system that largely still works today.

So it makes sense for CMS and ONC to impose strict mandates and timelines — albeit with some COVID-caused relaxation — for interoperability compliance, because the fragmentation of health records is as dangerous as it has ever been to patients. But while each deadline moves us closer to a more integrated and transparent system, it’s not until the payer-to-payer interoperability deadline in January 2022 where we’ll finally be in our best position to eliminate costly problems created by siloed health data. We may finally see some health record consolidation.

However, like all kinds of sweeping reforms, the devil is in the details. I believe that it might not be as “successful” as we expect it to be unless the federal government steps up and mandates a national patient identifier (NPI) system.

Just because one’s health insurer is sharing data with their previous insurer doesn’t ensure a holistic record. It’s not outlandish to think that any American could have up to 10 different health insurers over their lifetime, especially given rising health costs, socioeconomic inequities, and an increasingly volatile job landscape. That’s 10 different organizations with 10 different technology infrastructures, data protocols, and health IT standards. Not to mention the complexity of a patient’s health record strewn across multiple EHR systems, that change over time, as well as patients changing doctors creating new patient chart IDs and no standardized format for those patient chart IDs.

Who is responsible for making sure IDs match up? Who is responsible for identifying potential health record duplication errors? These are small data nuances that can have life-or-death consequences.

I can tell you first hand that even after national standardization, there have been instances in e-prescribing when records for John Doe I were assumed to be a part of John Doe II’s record, which could have resulted in life-threatening medical errors if not caught and corrected. NPIs would make life easier and safer for patients, payers, and providers, but yet they still aren’t part of the interoperability equation.

The NPI debate isn’t new. In fact, it’s been around for more than 20 years. But it seems like now we may actually be moving in the right direction. Late last year, representatives from many NPI-supporting organizations signed on to a letter urging Congress to take action, arguing, “The absence of a consistent approach to accurately identifying patients has also resulted in significant costs to hospitals, health systems, physician practices, long-term post-acute care (LTPAC) facilities, and other providers, as well as hindered efforts to facilitate health information exchange.” As a result, the House of Representatives voted to remove the ban on funding NPI organizations.

As for payers, some would likely argue that NPIs would help them as well. Many within the payer community think NPIs could improve member safety, reduce overutilization and fraud, and help them understand how members performed in previous payer’s quality-based programs.

However, NPI opponents will often counter with concerns over privacy and security, higher costs, and serious medical errors due to human error. The costs, they argue, would be incurred from building a new IT system from scratch while also having to align on policies and standards to govern it. To that argument, I would just remind critics that there have already been huge costs incurred because we haven’t achieved full interoperability yet, and then ask them to imagine the wasted money if all current mandates and compliance initiatives ended up not solving the core problems.

As for the medical errors argument, fragmented health records are much more dangerous. Again, I don’t think we can be as successful with interoperability without an NPI system.

But it’s that last and most prevalent argument on privacy and security that makes me raise an eyebrow. We constantly hear that we can’t have NPIs because if the number is compromised, the patient’s entire health record would be accessible in one location. That argument falls a bit flat for me. There are already medical record numbers on pretty much everything. In today’s interoperability world, we use easily accessible patient information (names, address, gender, dates of birth, etc.) to create a universal patient ID and match disparate patient information the best we can.

The whole argument on NPIs should really be fought on the cybersecurity front. Why not implement data encryption standards that lock data down to the field level, so that each piece of information in an NPI record is its own walled garden? We’ve already seen the mistakes made by other consumer industries such as banking, which many have responded with increasingly deep levels of data encryption. It’s completely logical and viable for the healthcare industry to implement the same level of security available in other industries to ensure our sacrosanct health information is protected. If we did, then that would be good for all and put an end to the security debate on NPIs.

Morning Headlines 7/22/20

An Open Letter from the American Medical Informatics Association and the American College of Medical Informatics Regarding Public Health Reporting Deficiencies During the COVID-19 Pandemic

AMIA publishes an open letter that expresses dismay that HHS moved hospital COVID-19 reporting from CDC’s National Healthcare Safety Network to HHS Protect, saying that a pandemic isn’t the best time to go live on a new, untested system.

Allscripts cut to Sell at Goldman

Goldman Sachs issues an almost unheard-of “sell” rating to shares of Allscripts, which it says has an unfavorable health IT market position and questionable growth prospects.

Rush University Medical Center Set to Share New “Agile Adapt” Model Powered By CipherHealth for Pandemic Response in Underserved Communities

Rush University Medical Center develops Agile Adapt for its COVID-19 response, using CipherHealth’s patient engagement and communication platform to flex ICU capacity, coordinate with community services, support critical staff, monitor patients across all settings, and anticipate care needs.

News 7/22/20

Top News

HHS activates a new COVID-19 hospitalization data website that replaces the one that was previously operated by the CDC.

HHS says CDC’s old system collected data from just 3,000 of the country’s 6,200 hospitals, but the new one will report information from 4,500 hospitals that are submitting information using HHS’s newly mandated HHS Protect system.

AMIA publishes an open letter that expresses dismay that HHS moved hospital COVID-19 reporting from CDC’s National Healthcare Safety Network (which AMIA’s letter incorrectly referred to as National Health and Security Network) to HHS Protect, saying that a pandemic isn’t the best time to go live on a new, untested system. It also questioned the requirement that hospitals provide 20 new data elements explaining why they are needed or how they will be used. 

More than 100 healthcare-related groups asked in a letter to Vice-President Pence, Coronavirus Task Force Response Coordinator Deborah Birx, MD, and HHS Secretary Alex Azar that the administration reverse its decision and leave data collection and reporting to the CDC. AMIA signed that letter as well.

Reader Comments

From Surly Bonds  of Mirth: “Re: AMIA’s open letter about COVID-19 hospital data reporting. This just-published piece explains why open letters are pointless.” An opinion piece in The Atlantic says that “the genre of open letters should die” because they are generically written with the dead language that is required to get more signatures; signers should just publish their own individual opinion instead; and such letters appear cowardly in a “safety in numbers” sort of way. AMIA labeled its editorial as an “open letter” but it really isn’t — it wasn’t addressed to a particular person or organization and it wasn’t signed, so it’s just an uncredited editorial. 

HIStalk Announcements and Requests

It must be tough sledding out there for ad-supported websites given that I can’t view many of them on my IPad all of a sudden because of errors caused by their increasingly intrusive pop-up ads and embedded video. The home page of one site I used to look at occasionally has six ad zones, pop-up ad video, an overlay banner, and a long list of graphics-heavy sponsored content articles. Clicking on an individual article brings up a ton more of the same, plus it displays comments from an ad-supported service that throws up still more ads. Safari crashes about 50% of the time, especially if I dare touch the screen during the many seconds it takes for the junk to fully load. To further diminish the signal-to-noise ratio are “sponsored content” articles, where the site owner sells editorial space for puff pieces from companies that are labeled “partners” to make selling out seem less odious. Facebook and Twitter have endless faults, but I admit that I spend more time checking them than crudely monetized websites that offer little value amidst the electronic shrieking, low-value content that is memorable only because it is so poorly written.

Webinars

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

Acquisitions, Funding, Business, and Stock

WellSky’s private equity owner changes its mind about selling the company and instead brings in a new unstated investment from another private equity firm.

Goldman Sachs issues an almost unheard-of “sell” rating to shares of Allscripts, which it says has an unfavorable health IT market position and questionable growth prospects. MDRX closed down 8% Tuesday versus the Nasdaq’s 1% loss following the announcement. The company will announce Q2 results next week.

Sales

• Home health, hospital, and infusion provider Evolution Health chooses Dina’s Staff Screening and Check-In solution to automate its employee wellness and health screening process.

People

Cerner hires Peter Liebert, MS, MPA, MSc (California State Guard) as VP/CISO.

Mental health digital engagement vendor JourneyLabs hires Tim Bush (GE Healthcare) as CEO.

Ellkay promotes Shreya Patel to chief innovation and product officer and Ajay Kapare, MBA to chief strategy and marketing officer.

Announcements and Implementations

In England, Clinical Architecture is added to the supplier suite of the Greater Manchester Digital Platform, which is part of the national Local Health and Care Record program.

Rush University Medical Center (IL) develops Agile Adapt for its COVID-19 response, using its long-time vendor CipherHealth’s patient engagement and communication platform to flex ICU capacity, coordinate with media, support family-patient communication, coordinate with community-based servicers, support critical staff, monitor patients across all settings, and anticipate care needs.

Government and Politics

Medicare’s Part A trust fund, which pays for inpatient care, could run out of money as early as 2022, as swelling unemployment ranks have reduced payroll tax contributions and Congress tapped Medicare’s reserves to fund COVID-19 relief this past spring.

The defense department’s DARPA contracts with Duality Technologies to develop a privacy-preserving analytics that allow ML models to be trained without exposing personally identifiable information, such as in studying DNA attributes and COVID-19 symptoms.

COVID-19

CDC antibody testing analysis covering 10 states finds that the number of people infected with COVID-19 in the US is 2-13 times the reported rate, but those numbers are still far too low to confer herd immunity. Mississippi’s infections are an estimated 13 times the reported rate, meaning that the state has no way to find the asymptomatic spreaders and making distancing and mask-wearing even more important. Researchers emphasize, however, that US coronavirus testing is still in disarray, some commercially available tests are unreliable, and “convenience testing” is inherently biased, with results that are not necessarily generalizable.

President Trump restarted regular COVID-19 briefings Tuesday evening without the presence of the coronavirus task force or any health expert. The President admitted that the “China virus,” which he also called “the plague,” will probably “get worse before it gets better,” but pledged to provided states with needed supplies and touted the likelihood of quick vaccine development and distribution. He also said that tests are being rolled out that can deliver results in 5-15 minutes, which should alleviate the testing backlog. He also said “we did a lot of things right” in keeping deaths so far at 140,000 instead of “double, triple, or quadruple” that number. Reading from prepared remarks, the President said, “As one family, we mourn  every precious life that has been lost. I pledge in their honor that we will develop a vaccine and we will defeat the virus … my administration will stop at nothing to save lives and shield the vulnerable.”

The New York Times looks at a temporary COVID-19 hospital in Queens that cost $52 million (with a potential final tab of $100 million to federal taxpayers) but treated just 79 patients because of bureaucracy and turf battles. The city decided after the fact that patients would receive better care at crowded existing hospitals; the state didn’t operate a centralized program to transfer patients out of overwhelmed hospitals; the field hospital wasn’t equipped to accept ED patients; it couldn’t use its own ambulances to pick up transfers from hospitals since those facilities have exclusive agreements with specific ambulance companies; and doctors at public hospitals were told not to transfer patients out because the hospitals would lose revenue. The field hospital’s doctors were paid up to $732 per hour to complete paperwork and computer training with few patients to see, while one nurse practitioner says she felt guilty being paid $2,000 per day to look at Facebook.  

Facebook suspends the 10,000-member group account of Unmasking America, which calls masks a form of enslavement, claims that masks limit oxygen intake, and advertises the sale of fraudulent “face mask exempt cards.”

Other

Medical practices in Germany are locked out of reviewing payer claims and encounter data for eight weeks because the security certificate of an in-office hardware component had expired. Global IT firm T-Systems, a subsidiary of Deutsche Telekom (which is not related to US health IT vendor T-System), was forced to send technicians to 80,000 practices since they were unable to apply the software update remotely. The article was written by former CMS Innovation Center health IT lead Lisa Bari, MBA, MPH.

University of Pennsylvania medical school researchers say that screening patients for social determinants of health hasn’t improved outcomes, but may have created patient harm from sloppy implementation. The authors note that assigning untrained health system employees to fire off a list of privacy-encroaching standardized questions to patients could cause them trauma, discrimination, and legal consequences, not to mention that health systems may be setting unrealistic expectations in asking about needs they can’t fulfill. The authors advise health systems to perform an initial screening with a tablet-based app that allows easily data collection and aggregation, then follow up with a personal conversation when indicated. They also warn that more widespread SDOH screening may cause a rise in mandatory government reporting — for deportation or child welfare investigation, for example – and allow data-driven discriminatory practices, such as diverting ED patients to less-expensive care or allowing insurers to cherry-pick lower-risk patients.

A survey finds that few Americans think its OK for hospital-employed doctors to ask patients for hospital donations, for hospitals to pass patient names along to their fundraising office, or for the fundraising office to perform financial background checks to target wealthy prospective donors. All of these actions are legal, however. Respondents were split over whether a million-dollar donor should get room upgrades, fast-tracked appointments, and their doctor’s cell phone number.

Sponsor Updates

• Capsule Technologies receives an Authority to Operate declaration from the Defense Health Agency for its clinical surveillance and medical device connectivity technologies.
• Central Logic will host the virtual Summit on Healthcare Access and Orchestration September 15.
• The Chartis Group promotes Melissa Anderson to director.
• Jvion becomes a founding member of the AIMed Community Group.
• OptimizeRx appoints former Walgreens Boots Alliance President and CEO Greg Wasson to its board.
• CareSignal publishes a case study titled “How UnityPoint used CareSignal to Remotely Monitor COVID-19 Patients Safely from their Homes.”
• Collective Medical partners with Fallon Health to support better transitions of care for its high-risk members.
• Clinical Computer Systems, Inc. launches Obix BeCa fetal monitor in a cooperative agreement with Huntleigh Healthcare Limited, in which CCSI will be the sole US distributor.

Blog Posts

• Why You Should Be Archiving Your Legacy EHR Data (Summit Healthcare)
• What is Staff Augmentation in Healthcare IT? (314e)
• What is patient financial clearance? (Ability Network)
• Important Ways COVID-19 Should Change Your Clinic Moving Forward (Part 1) (AdvancedMD)
• Transition to Enterprise Imaging for Radiology (Agfa Healthcare)
• Protect Medical Devices from a Cybersecurity Threat (Capsule Technologies)
• COVID-19 in Detroit: A Live Case Study (CarePort Health)
• How to select a network and detection response solution (CI Security)
• 3 Ways to Improve Chronic Care Management (Collective Medical)
• CoverMyMeds Campus Update: Reaching Milestones & Reaffirming Our Commitment (CoverMyMeds)
• What Actions Should Payers Be Taking Now to Meet ONC/CMS Interoperability Requirements? (Cumberland Consulting Group)
• How to Keep Your Patients & Staff Safe During COVID-19 (EClinicalWorks)
• Interoperability Rules are Delayed: Why That’s Good News and Bad News (Ensocare)
• Eligibility-related denials: Once your biggest headache, now your best chance to improve revenue (ESolutions)
• Things to consider when embarking on a merger or acquisition (Nordic)

Contacts

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

Morning Headlines 7/21/20

R1 Announces Sale of its Emergency Medical Services Business to Sarnova Holdings, Inc.

R1 will sell its EMS RCM and electronic patient reporting services to Sarnova Holdings for $140 million.

DXC Technology Announces the Sale of DXC’s Healthcare Provider Software Business to the Dedalus Group for $525 Million in Cash

DXC Technology will sell its healthcare software business to the Italian Dedalus Group for $525 million.

HHS unveils new coronavirus hospitalization database, says it’s more complete than CDC’s

HHS launches a new website featuring hospital capacity data submitted by 4,500 of the country’s 6,200 hospitals.

WellSky Gains New Investment From TPG and Leonard Green & Partners to Advance Technology Innovation in Post-Acute and Community Care

Rather than sell post-acute software vendor WellSky, TPG Capital decides to make an equity investment in the company and bring on Leonard Green & Partners as another owner.

Curbside Consult with Dr. Jayne 7/20/20

The team at the Virtual Telehealth Innovation Forum and Teladoc Health continues to hit it out of the park with the preparations for their virtual conference. I received my welcome package at the end of last week, which includes “a notebook to capture thoughts” along with “cocktail making materials to unwind at the end of day 1 with our guided mixology session.” The cocktail supplies included a jigger, an insulated tumbler (courtesy of NTT Data), and an engraved cocktail shaker to commemorate the event. A girl can never have too many martini shakers, and the tumbler is the perfect accessory for my upcoming efforts as a pool sitter for my neighbor later this week.

They also emailed a shopping list for the martini-making session on Tuesday. The State Street Martini looks simple yet elegant: vodka, St. Germain, lemon juice, and basil. I have everything but the elderflower liqueur. I’m pulling long shifts in the ED the next couple of days, so I’ll be the person at Total Wine when they open on Tuesday morning so I can pick up the final supplies and get home for the conference sessions.

Another aspect of the virtual Telehealth Innovation Forum is for everyone to lunch together using a Grubhub gift card on Tuesday. I received an email over the weekend notifying me of my new Grubhub account and inviting me to set my password, so everything is happening as planned. The only element I’m missing is the supply package for the virtual volunteer activity on Wednesday, but I suspect it’s en route based on a random USPS Package Tracking notification I received.

I’m curious whether putting an event like this together is more or less stressful than trying to do one in person. Over the years, I’ve gotten to know the marketing teams of some of the major vendors pretty well and know how exhausting it is to put together an in-person show.

Earlier this year, I was accused of being negative towards marketing professionals when I wrote about the HIMSS rebranding efforts. I’m not going to deny the fact that I still find it annoying when companies spend too much time talking about their brand as opposed to talking about what they do or what they make. I loathe press releases with phrases like “our brand is reflected in our new color scheme” or when they attempt to explain nonsensical-sounding company names selected after mergers.

So far, my impression of this week’s conference and the surrounding communications are that they represent branding done right. They didn’t have to come out and say “our brand, with its clean, hip graphics and soothing light teal color typifies martini-loving healthcare folks,” but rather they’re letting their materials do the talking for them. Let’s hope the conference lives up to the hype.

I’m intrigued by the whole virtual conference transformation. I figured that without having to rent conference center real estate, pay for security, order signage, and provide an assortment of questionable finger foods and cheap drinks at the obligatory opening reception, that online conferences should be cheaper. That’s not the case with most of the conferences I’m seeing advertised.

Certainly organizers are playing up the fact that you don’t have to pay travel or hotel expenses, but they’re not discounting much off the fees. Most are not offering truly interactive sessions, so I can’t imagine they are spending as much money on conference software as they would have on hotel ballrooms or the trimmings. If someone really wants to put a believable message out to attendees, they should specifically note how much less their attendees will spend on exorbitantly-priced but mediocre coffee outside an exhibit hall, or how short the line in their kitchens will be for their beverages of choice.

Looking at international flight restrictions that are likely going to persist for months, it’s hard to imagine that an in-person HIMSS21 is even on the table. The US is doing so poorly with this that it’s going to be amazing that anyone from a country that has the virus under control would want to come here. A friend of mine from Australia that was scheduled to visit the States this fall told me his airline wouldn’t ticket anything for him this calendar year. I shamelessly booked my Las Vegas accommodations outside the HIMSS room blocks right after the Orlando hotel debacle, so on the odd chance that the virus “disappears” as was previously predicted, I’ll be covered with somewhere cheap. It won’t be as classy as my last stay at the Venetian, but $300 per night is steep, especially when you’re paying for it yourself and not charging it off to your company or health system.

One of the conferences I was supposed to attend in April was postponed to September, but with the COVID-19 cases on the rise in the South, it’s been canceled altogether. Although Southwest Airlines extended the expiration dates on tickets for flights during the first peak of the pandemic in the US, these tickets were somehow outside that window and are going to expire in October.

This is a weird year for me. I’ve only been on two planes the entire time, and I have to say I’m eager to go somewhere other than my house or to a medical facility. Since the tickets are use it or lose it, I’m tempted to book a random flight to a part of the country that’s relatively unscathed, if for no other reason than flying two segments would let me preserve my frequent flyer status and I’m out the money regardless. Too bad many of the beaches I usually frequent are in hot spot areas because I could use some sand between my toes about now.

I’d love to hear from marketing folks about your plans for virtual meetings and seminars. How does the planning of the different types of events differ? Is there commercially available software that meets your needs, or are you having to cobble solutions together? Have you had to institute special processes to make sure presenters are camera-ready in an appropriate environment? You can speak on the record or I’m happy to keep you anonymous. This is your chance to let the entire healthcare IT community peek behind the curtain of the new normal in professional meetings.

For attendees, what are your thoughts? Good, bad, or indifferent? Leave a comment or email me.

Email Dr. Jayne.

Readers Write: Five ICU Lessons COVID-19 Has Taught Us

Five ICU Lessons COVID-19 Has Taught Us
By  S. Ram Srinivasan, MD, MBA

S. Ram Srinivasan, MD, MBA is chief medical officer of Advanced ICU Care of St. Louis, MO.

Since March, critical care teams across the country have been stretched to the limit as they rushed to care for the surge of COVID-19 patients in their ICUs. They were forced to deal with an unknown threat that would infect an unknown number of patients and require as yet undefined treatments.

In reflection over the past few months, telemedicine has proved its continuing value for them, providing additional care support during the pandemic. Implemented as a collaborative care model, tele-ICU leverages remote intensivist-led clinical teams and sophisticated technology-enabled care services to deliver a virtual front line of 24 x 7 care in support of clinicians that are at the bedside of critically ill COVID-19 patients.

We have learned these five key lessons so far with regard to ICU care of COVID-19 patients.

COVID-19 has thrust virtual care into the spotlight overnight, with no sign of slowing down.

Telemedicine adoption, which was steadily gaining traction over the past few years, has been quickly recognized as an essential, efficient, and effective element of our healthcare ecosystem. Across inpatient and outpatient environments, patients and providers have embraced virtual care during the COVID-19 pandemic as a convenient tool that enables care access despite distance, shelter at home, and threat of infection.

For critical care, telemedicine enables highly skilled, technology-enabled care teams to reach ever-larger patient populations and do so with significant demonstrated clinical efficacy. In the course of the pandemic, tele-ICU has provided critical support to both bedside teams and their patients across the country.

COVID-19 is a pandemic consisting of regional impacts. Almost no one faces the “average” pandemic impact.

During the peak of pandemic impacts in April, we had partner hospitals that were urgently adding ICU capacity. At times, they had all of their critical care patients on ventilators and remained braced for an overwhelming deluge that never came. Our care to a set of hospitals experiencing this full range of pandemic impacts enabled us to leverage the regional differences. We were able to dedicate significant real-time care to high-volume situations and help other hospitals learn from the hotspots and prepare accordingly.

Telemedicine access to external expert resources is a powerful force multiplier, especially during crisis.

At the outset of the pandemic, we fielded urgent requests for ICU care services from a range of hospitals and other entities. A variety of accelerated response capabilities, including rapid implementations of standard tele-ICU installations and utilization of surge-compatible technology solutions, were quickly introduced. Over the course of one month alone, more than 50 of our partner hospitals initiated, expanded, or extended tele-ICU capabilities in response to the unprecedented demands resulting from the COVID-19 pandemic.

Further, the opportunity to leverage skills that were not already on site and were not already overwhelmed, without waiting for updated licensure or to recruit volunteers from other regions, provided immediate assistance to care teams most at risk and those that were exhausted. In some cases, this ready access to critical care expertise allowed local teams to enlist other specialists in critical care under the coaching of remote specialists, relieving overworked personnel and immediately expanding their available staff.

The benefits of tele-ICU during the pandemic extend beyond outstanding clinical care.

The multiple threats of the COVID-19 crisis caused hospitals and hospital systems to significantly rethink how to deliver critical care support to their patients under trying conditions. For example, tele-ICU service extended beyond specialized care and also became a means of reducing clinician exposure to the disease and preserving personal protective equipment (PPE). In these instances, hospitals equipped with these remote clinical capabilities relied on the telemedicine team to utilize video to “visit” the ICU room virtually to assess a patient, rather than have a bedside nurse or provider don PPE and enter the patient’s room.

In addition, we have found that tele-ICU outreach by critical care clinicians is well suited to comfort patients by providing social interaction during their isolation. Remote teams can help make a scared and lonely patient more comfortable – and less frightened.

Concerns such as a lack of ventilators came and disappeared quickly, as COVID-19 proved to be a fast-moving disease with rapidly evolving care protocols.

COVID-19 was initially viewed primarily as a severe respiratory illness and was treated as such. However, further treatment experience revealed that the virus was a much more complicated threat than a respiratory illness. Since then, the critical care community has found that proning patients – that is, placing them on their stomachs for prolonged periods of time – helps increase the amount of oxygen that gets to their lungs. In fact, in many instances proning the sickest coronavirus patients, accompanied by alternative methods of supplying oxygen, became a preferred solution to the initial plans for accelerated intubation. Similarly, various medication regimens were tested and evolved.

In our role as critical care specialists, it was our responsibility to our partner hospitals and clinicians to continue to keep abreast of these rapid developments. Drawing on information across multiple sources and geographies, we then quickly provided this clinical intelligence to those in a hot spot while updating mutual care protocols.

Morning Headlines 7/20/20

With CDC Sidelined, Some States Lose Access To Timely COVID-19 Hospital Data

Hospital associations in Missouri and Kansas warn that HHS’s abrupt change in hospital reporting leaves them unable to update their state COVID-19 dashboards and planning data.

CloudMD to Acquire Snapclarity Inc., an Enterprise Mental Health Platform, Expanding Telehealth Offering to Include Mental Wellness

In Canada, virtual medical care company CloudMD acquires digital mental health startup Snapclarity for $2.5 million.

Hattiesburg Clinic selects new CEO

Hattiesburg Clinic (MS) promotes CMIO Bryan Batson, MD to CEO.

Monday Morning Update 7/20/20

Top News

Hospital associations in Missouri and Kansas warn that HHS’s abrupt change in hospital reporting leaves them unable to update their state COVID-19 dashboards and planning data.

HHS gave just a few days’ notice for hospitals to send data to the new HHS Protect portal, whose required data elements differ from those that had been sent to CDC’s National Healthcare Safety Network.

The hospital associations say they don’t have access to HHS Protect.

The National Governors Association has asked the White House to delay the new hospital data submission requirements for 30 days.

Reader Comments

From Former KP: “Re: Kaiser Permanente and Epic. I was a KP IT executive at the time, and while Cerner may have made such an offer of basically free software in return for CERN shares (which I would not have been aware of in my role), the selection team of IT and clinical leaders made a single recommendation of Epic. The business case was developed exclusively on Epic for inpatient, outpatient, and all related specialty areas.”

HIStalk Announcements and Requests

Most poll respondents have done something health-related on a mobile device in the past year, most commonly collecting fitness tracker information, sending a message to a provider, or viewing their medical records as extracted from a provider’s EHR.

New poll to your right or here: which activities have you undertaken in the past month?

Webinars

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

People

Hattiesburg Clinic (MS) promotes CMIO Bryan Batson, MD to CEO.

Keith Hepp, SVP/CFO at The Health Collaborative and and board chair of the Strategic Health Information Exchange Collaborative, died last week.

COVID-19

COVID-19 hospitalizations are closing in on April’s record, although a lower percentage of admitting patients are ending up in the ICU. US deaths are at 142,000.

The White House blocks CDC officials from testifying this week at Congressional hearings about how to safely reopen schools.

A report from the National Academies of Science, Engineering and Medicine says that elementary school and special needs children should return to in-person education, but with group activities minimized, physical distancing enforced, surgical masks worn by all teachers and staff members, and cloth facemasks worn by all students. The report did not address the question of the community viral level threshold that would make it unsafe for schools in specific areas to reopen.

CDC will change its recommendation that COVID-19 patients be retested before ending their isolation. White House testing coordinator Admiral Brett Giroir, MD says retesting is not medically necessary and is overwhelming the country’s testing system. CDC will recommend that isolation end when the patient has not experienced symptoms for at least three days, provided that at least 10 days has elapsed since they first experienced symptoms.

FDA gives emergency use authorization to Quest’s PCR test for pooled samples that contain up to four individual swab specimens, allowing more people to be tested while using fewer resources. If the pool is positive, the individual tests are re-run individually to determine which pool members are positive.

A New York Times investigation says overly rosy COVID-19 projects by White House Coronavirus Task Force Coordinator Deborah Birx, MD encouraged President Trump to prematurely pursue reopening with lax thresholds and to push coronavirus response from the White House onto individual states. Birx convinced staffers from her White House office that the virus was fading, leaving only “embers” to fight as she relied heavily on assumption-laden models didn’t take lifting of mandates into account. She believed the US would mirror Italy, which was entirely wrong as that country’s residents were compliant with stay-at-home orders and distancing as many Americans started ignoring them as early as late April.  

Former TV game show host Chuck Woolery, whose Sunday tweet accused clinicians and others of lying about COVID-19 to hurt President Trump’s re-election chances — a tweet that was then retweeted by the President — takes down his Twitter in announcing a few hours later that his son has tested positive. A spokesperson for the former “Love Connection” host says Woolery is “taking a break from the abuse he has received from thousands of intolerant people.”

Other

I missed this earlier. Two BYU professors, one in nursing and one in IT, develop a homegrown, $20 open source Bluetooth stethoscope that allows clinicians to listen to a patient’s heartbeat at up to 50 feet away while still wearing PPE. The 3D-printed device also records the audio for later review. Commercial devices perform similar functions for several times the price.

In England, paramedic Danny Hughes provides a video example of using real-time transcription such as Google Live Transcribe (for Android only) to communicate with the hearing-impaired when the speaker’s mask prevents the patient from reading their lips.

Maryland’s attorney grievance commission reviews a complaint against a high-profile medical malpractice attorney who was recorded by the FBI as he told University of Maryland Medical System that he would keep quiet about deaths and other problems in its transplant program if the health system paid him a $50 million consulting fee. Attorney Stephen Snyder, who learned about the problems in representing malpractice clients, says he himself is the victim because of his offer to “help prevent any future tragedies.”  

Sponsor Updates

• OptimizeRx hires Dina Smyth as customer success manager.
• Pivot Point Consulting releases a new podcast, “How Healthcare Data Can Be Used to its Fullest Potential.”
• The Edison Awards features Vocera Chief Marketing Officer Kathy English in its latest podcast.

Blog Posts

• Using Deep Learning to Generate Medical Reports (Nuance)
• Hey Alexa, Why Isn’t My Pharmacy Using Natural Language Processing? (OmniSys)
• What’s holding up digital contact tracing? (OpenText)
• Despite COVID-19 Hospital Quarantines, Nurses Find a Way to Implement Mission-Critical Clinical Systems Across Seven States to Make Childbirth Safer (PeriGen)
• Comprehensive Clinical Communication to Support Mother-Baby Care Delivery (PerfectServe)
• Three Must-Haves in Your New Medicaid Strategy (Premier)
• How to Overcome the Security Challenges of a Remote Workforce (SailPoint)
• What to Look for in a Data Privacy Management Solution (Spirion)
• HIPAA-compliant messaging in the age of COVID-19 (Spok)
• Why You Should Be Archiving Your Legacy EHR Data (Summit Healthcare)
• How One Small-Town Pharmacists is Growing His Business with Heart-Led Care (Surescripts)
• 4 Undeniable Reasons to Make Telehealth a Permanent Fixture in PT (WebPT)

Contacts

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

Cerner News

In the UK, the Hampshire and Isle of Wight Integrated Care System will implement Cerner’s HealtheIntent population health management software and HealthEDW analytics. (9/16/20)

Adventist Health (CA) adds provider look-up and patient self-scheduling capabilities from Kyruus to its website, and embeds them within its Cerner-powered patient engagement software. (9/16/20)

Cerner hires Ron Lattomus (DRS Global Enterprise Solutions) to head its federal programs, including the VA’s EHR modernization project. (9/15/20)

Cerner will integrate AxiaMed’s patient payment solution with Millennium and other products. (9/14/20)

Four of Finland’s regions will work with Cerner to develop a digital platform to support moving municipal healthcare services under a regional authority. (9/11/20)

FCW reports that the VA’s implementation of Cerner’s scheduling solution in the Midwest’s VISN10 region will be followed by the full Cerner rollout there. VISN10 will go live on the VA’s 1.1 capability set for small and medium-sized hospitals. (9/7/20)

William Mintz (Leidos) joins Cerner as chief strategy officer. (9/4/20)

Cerner’s government services business receives a $161 million order to implement an enterprise healthcare services network at four VA medical centers in Ohio. (9/1/20)

Cerner integrates its systems with Amazon’s new Halo, a health and wellness wearable, app, and membership program. (8/28/20)

The VA launches its Cerner appointment scheduling system at the VA Central Ohio Healthcare System, with a VA-wide rollout to follow. (8/26/20)

Baptist Health South Florida President and CEO Brian Keeley says the health system will spend upwards of $100 million on a digital transformation over the next several years that will include adding new scheduling and registration capabilities to its Cerner system; investing in analytics; upgrading its website with more patient engagement tools; and bolstering its Amwell-powered Care on Demand telemedicine app. The search for a chief digital officer is underway. (8/21/20)

The bond rater of Wise Health System (TX) says that one reason the health system’s margin has slipped is the cost of replacing Cerner with Allscripts, which in addition to staffing expense, created $12 million worth of revenue cycle inefficiency. It notes, however, that Wise Health Surgical Hospital improved its revenue cycle performance in 2019 following the EHR implementation. (8/19/20)

Starboard Value, the activist investor whose purchase of just 1.2% of Cerner shares convinced the company to give it four board seats in April 2019, reduces its CERN holdings to 2.6 million shares, about 0.8% of the outstanding shares, worth less than $200 million. CERN shares have gone up 16% since the day Cerner capitulated, although the Nasdaq has moved up 38% in the same timeframe. (8/17/20)

Cerner-sponsored Life Aid, which was launched in March to address veteran and first responder suicide, will be featured in a Discovery Channel special on August 30. (8/17/20)

Politico reports that the VA will re-commence its EHR overhaul with a rollout at an unnamed facility in October. The conversion from VistA to Cerner was halted earlier this year as VA facilities focused on preparing for and treating COVID-19 patients. The VA has switched its go-live plans from facilities in bigger metropolitan areas to those in smaller cities in the Pacific Northwest and Midwest, citing a lack of access during the pandemic to clinical experts who had been expected to help with system customizations for the larger facilities. (8/7/20)

Cerner and VC firm LRVHealth invest $6 million in Xealth, a Providence Health & Services spin-off that has developed software to help providers find and prescribe digital health apps and programs. (8/7/20)

Nacogdoches Memorial Hospital (TX) and Cerner agree on partial payment to settle the $20 million the hospital owes for an implementation it delayed repeatedly and finally cancelled. (7/31/20)

Cerner will add Nuance’s virtual assistant technology to Millennium, allowing users to navigate by voice for chart search, order entry, and scheduling. (7/31/20)

Cerner reports Q2 results: revenue down 7%, EPS $0.44 versus $0.39, beating consensus earnings expectations but falling short on revenue. From the earnings call:

• The company says its revenue came in lower than expected because the pandemic impacted sales or timing of some low-margin offerings, such as technology resale and billed travel.
• Q3 revenue expectations have been reduced because of divested businesses and a larger-than-expected pandemic impact, but the company expects earnings to grow due to cost reduction.
• The company says it won’t cut R&D spending.
• Cerner says that while virtual go-lives work for simple implementations, the future model will be a hybrid, with fewer people on site who are supported centrally, which also reduces billable travel for the client. The company notes that employees are 25% more productive working remotely because avoiding two half-days of travel during the work week means they have five days billable per week instead of four.
• Cerner is looking beyond its Amwell virtual visit partnership to virtual hospitals and ICUs that would involve its CareAware platform.
• An analyst asked about a $35 million acquisition that he saw on the cash flow statement, which Cerner says was for a cybersecurity company that it can’t talk about otherwise.
• Cerner is interested in acquisitions related to research data and analytics.
• The grating phrase “new operating model” thankfully wasn’t uttered even once. (7/31/20)

Cerner announces CommunityWorks Foundations, a fixed-fee, cloud-based version of Millennium for Critical Access Hospitals that can be brought live in six months. (7/24/20)

Banner Health signs up for Cerner’s revenue cycle system, expanding its Millennium implementation. (7/17/20)

Cerner says it will keep employees working from home for at least several more months, pushing back its phased plan to bring up to 50% of employees back to office-based work. (7/17/20)

A new KLAS report that looks at advanced users of clinical communications platforms finds that Epic, Halo, and TigerConnect have the greatest breadth of workflows; PerfectServe and Telmediq have fewer workflows and are more widely used in inpatient settings; and Cerner, Hillrom (Voalte), Mobile Heartbeat, and PatientSafe Solutions focus on inpatient settings and have less use in outpatient. Cerner and Epic have tight integration with their own EHRs, as Epic Secure Chat provides fully embedded functionality and Cerner offers CareAware Connect Communications as a separate app. (7/8/20)

The White House’s 2021 budget request includes $105 billion for the VA, including $4.9 billion for IT and $2.6 billion (versus $1.5 billion this year) for its Cerner project. (7/8/20)

Cerner conducts another round of layoffs, this time involving 100 employees. The nails-on-blackboard corporate phrase “new operating model” was uttered yet again as an explanation. (6/24/20)

The VA gives Cerner a $99 million task order for sustainment support of hardware and software associated with its $10 billion EHR modernization project. (6/12/20)

A GAO review finds that the VA has implemented effective configuration decision-making in its Cerner implementation by holding national workshops and creating 18 EHR councils, but needs to improve representation at local workshops. The report also notes that while the VA and DoD both user Cerner, coordination is needed to allow sharing of information and tasks, such as VA’s requirement to maintain durable orders for life-sustaining treatment across patient encounters that is not supported by the DoD’s Cerner configuration. (6/8/20)

Congressional sources say the VA probably won’t restart its Cerner rollout until the fall because of COVID-19 demands. (6/5/20)

RCM company R1’s shares jumped over 9% on the news that it will acquire Cerner’s RevWorks business in a transaction valued at $30 million. As part of the deal, Cerner will offer R1’s software and services to customers and prospects. In an April 2019 earnings call, company reps said RevWorks had grown stagnant, contributing $200 million in annual revenue. Cerner had been using its RevWorks offerings “to more tightly align the client to Cerner” for additional sales of its software and services. (6/5/20)

North Central Health Care (WI) will implement Cerner’s Behavioral Health EHR in three multi-specialty behavioral facilities. (6/3/20)

Cerner hires Jerome Labat (Micro Focus) as CTO. (6/3/20)

Forty-nine municipalities in Sweden’s Västra Götaland region will implement Cerner Millennium. (5/29/20)

Cerner develops COVID-19 re-opening and social distancing projections for 60 countries using data from sources that include CDC, Johns Hopkins, Definitive Healthcare, and the COVID Tracking Project. (5/29/20)

Cerner joins the Fortune 500 largest US companies by annual revenue, coming in at #498. (5/20/20)

Cerner will begin moving employees back on campus Monday, starting with 10% of its workforce and aiming for no more than 50%. Employees will be encouraged to wear masks, fitness centers and cafeterias will be closed, elevators will be limited to two passengers, and staircases will be designated as one way. The company says positions in its consulting and client support areas may remain virtual permanently. (5/18/20)

Cerner announces that its annual conference, scheduled for October 12-14, will be conducted as a virtual event. The conference, one of Kansas City’s largest, is among 78 that have cancelled so far during the pandemic. City officials estimate that the cancellations will cost the local economy $137 million in lost hotel room bookings alone. (5/15/20)

Meditech News

AHIMA will offer Meditech Expanse as part of its online VLab, which offers students access to multiple software programs and corresponding lab lessons. (9/16/20)

Meditech launches Expanse Virtual Assistant, a voice navigation system powered by Nuance that can allows users to perform hands-free actions. (9/11/20)

Meditech reports Q2 results: revenue down 3.4%, EPS $0.88 versus $0.44. Product revenue declined 22%, but net income increased to $33 million. (8/3/20)

Meditech launches a diabetes prevention toolkit in Expanse. (7/14/20)

Remote EHR implementations enable Cayuga Medical Center (NY) and Mt. Graham Regional Medical Center (AZ) to go live on Meditech amid the COVID-19 pandemic. (6/9/20)

Newton Medical Center (KS) creates COVID-19 dashboards within Meditech’s business and clinical analytics to gain insight into bed occupancy, testing, and PPE supply. (6/5/20)

Meditech adds Apple Health support to Magic and Client/Server, making the app usable by all of its customers. (5/15/20)

A new KLAS report on US hospital EHR market share finds that Meditech Expanse is drawing new interest from customers outside its usual small-hospital base, with a new 400+ bed health system sale in 2019 giving the market a chance to see how Expanse scales. Meditech won about half the decisions made by its legacy customers in 2019, and half of its losses came from product standardization and provider M&A. Small, standalone hospitals were left with few choices after Athenahealth exited the inpatient market, with Cerner CommunityWorks and Meditech Expanse coming closest to meeting their needs. (5/1/20)

Weekender 7/17/20

Weekly News Recap

• Congressional Democrats criticize HHS for issuing a no-bid, $10.2 million contract in April for developing a hospital bed and supply tracking database to TeleTracking Technologies, the Pittsburgh-based hospital equipment and bed tracking vendor.
• Cerner and Epic delay their return to campus.
• Athenahealth renames its Centricity product line to AthenaIDX.
• University of California Health uses de-identified patient data from its Epic system to create a database for COVID-19 treatment research.
• Fax machines are part of a broken data system that is impeding US coronavirus response.
• Amazon will conduct a health center pilot with primary care service provider Crossover Health.
• A KLAS report on pediatric practice ambulatory EHRs names PCC as the clear leader.

Best Reader Comments

At Epic, we used to spend 6-8 months documenting current-state workflows and gathering current-state documentation so that the customer could translate into their own system. Again, customers pushed back (well, probably mostly executives who were on the hook for cutting checks) on the amount of time we spent on the early phases of the implementation where little “visible” results were being made. The implementation methodology continued evolving and cutting out more of the customization steps in favor of more expedited and less expensive installs. This gets the system live faster, but with less customization. There are cons to this, but there are actually many pros to this as well. (HITPM)

Being familiar with some of the events and people that encouraged Epic to become the Marine Drill Sergeant, it wasn’t really how Epic wanted to do things, it was initially customer demand (Kaiser made some strong suggestions, and one Kaiser executive in specific had some….issues) and then some pretty drastic personnel mismanagement in response to the 2007-2008 economy. (Guy M. Fay)

[On Athenahealth renaming the former GE Healthcare Centricity products to AthenaIDX] I’m sure the programmers GE laid off really appreciate that homage. (IDXreturns!)

[On HHS changing hospital COVID resource reporting databases] Is this even the problem space that this company is in, with only 15 or 20 positions open how are they able to take this project on? Awarding a 10 million dollar no bid project in April, 75 days ago, and turning it on with 2 days notice is plain and simply not going to work. I don’t even believe it is intended to work. I do believe there is a desire to further politicize data to obfuscate the current state of the epidemic. (AnInteropGuy)

I personally buy “The One Minute Manager” by Ken Blanchard for all of my new managers. The book offers simply and practical advice for managers. The initial version was published in 1982. (Shaun Priest)

Watercooler Talk Tidbits

Readers funded the Donors Choose teacher grant request of Ms. C in Kentucky, who asked for LEGOs to help her fourth graders develop science, math, and engineering skills. She reported in February, “Thank you so much for your amazing donation to our classroom. The LEGOs have been and will continue to be utilized in so many ways in our daily instruction. Obviously most of my kiddos love playing with LEGOs so these have allowed me to include a fun and engaging morning “tub” or center to our stations. I have used them and will continue to use them to help students have a better understanding of fractions. We are able to count the circles on the tops and create equivalent fractions. We can also use the pieces to add and subtract fractions as well as see why it is important to have like denominators when adding and subtracting fractions. I have also allowed students to get creative and use them to build things.”

Residents of a nursing home in England that is closed to visitors entertain themselves by recreating classic album covers from The Clash, David Bowie, and other musicians. Here’s a cultural teaching point, from me after reading a Twitter comment that surely the residents have never heard of The Clash – “London Calling” was released more than 40 years ago in 1979 and lead guitarist Mick Jones is now 65, so let’s not picture today’s nursing home residents hepping to Cab Calloway.

A 29-year-old mental health counselor in New York City whose household income is $22,500 describes the stress involved with owing nearly $300,000 in student loans as she continues her studies to earn a PhD.

Two New York doctors rig app-powered cellular walkie talkies targeted to kids to allow families to speak to isolated patients any time they want without exposing employees who would otherwise be setting up video chats. The app allows multiple people to contact the patient through the single device they have. The hospital developed a disposable casing so the devices can be reused. The devices cost $50 plus $10 per month for cellular service, and for kids, they include real-time GPS tracking, geofencing, playback of missed messages, and voice commands.

In Virginia, a physician assistant is fired after a black patient who suffers from anxiety and PTSD asked her about a Confederate flag he saw on her wall during a virtual visit, after which she adjusted her camera, told the patient he was seeing things that weren’t there and was paranoid, and doubled his sedative dose.

In England, Queen Elizabeth II knights Captain Sir Tom Moore, aka World War II veteran Captain Tom, who at 100 years of age hoped to raise $1,000 for NHS by walking laps around his garden in return for the health system saving his life and ended up generating $40 million in donations. Captain Tom holds two Guinness World Records – one for fundraising and another for being the oldest person to chart a #1 song in the UK for “You’ll Never Walk Alone,” performed with singer Michael Ball and the NHS Voices of Care Choir.

In Case You Missed It

• News 7/17/20
• EPtalk by Dr. Jayne 7/16/20
• News 7/15/20
• Curbside Consult with Dr. Jayne 7/13/20
• Monday Morning Update 7/13/20

Get Involved

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• Sign up for email updates
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• Contact Mr. H

Morning Headlines 7/17/20

‘Sole Source’ Contract for COVID-19 Database Draws Scrutiny from Democrats

Congressional Democrats criticize HHS for issuing a no-bid, $10.2 million contract to TeleTracking Technologies for the development of a hospital bed and supply tracking database, which has become the backbone of the newly mandated HHS Protect COVID-19 reporting system.

Cohere Health raises $10MM in Series A funding to drive adoption of highly collaborative approach with the patient as the focal point

Boston-based care coordination software startup Cohere Health launches with a $10 million Series A funding round.

Cerner won’t reopen its offices for at least several months

Cerner says it will keep employees working from home for at least several more months, pushing back its phased plan to bring up to 50% of employees back to office-based work.

News 7/17/20

Top News

Congressional Democrats criticize HHS for issuing a no-bid, $10.2 million contract in April for developing a hospital bed and supply tracking database to TeleTracking Technologies, the Pittsburgh-based hospital equipment and bed tracking vendor.

HHS has ordered hospitals to submit their COVID-related capacity, patient count, and supply information to the TeleTracking system, called HHS Protect, instead of the CDC’s National Healthcare Safety Network (NHSN), starting this past Wednesday. The administration says CDC’s database is outdated and requires manual entry that delays analysis.

CDC Director Robert Redfield, MD said Wednesday that CDC provided input into developing HHS Protect, which previously accepted both data that was submitted directly from hospitals as well as extracts from NHSN. Redfield says that requiring hospitals to send their data directly to HHS Protect will reduce duplicate reporting, help HHS make quick field changes, and allow CDC to focus its system on capturing reports from nursing homes.

Redfield says that CDC and state and local health agencies will have access to HHS Protect, adding that CDC will continue to provide daily updates and dashboards. Several outside sites use CDC’s dashboard for modeling, such as school reopening readiness.

Meanwhile, CDC’s hospital capacity dashboard went offline on Wednesday, the final day in which hospitals could submit data to NHSN.

UPDATE: HHS Assistant Secretary of Public Affairs Michael Caputo said Thursday afternoon that HHS has ordered CDC to restore the COVID-19 hospital dashboards that CDC “withdrew from the public Wednesday.” However, the dashboard indicates that information will not be updated after July 14.

Reader Comments

From Data Deliverance: “Re: HHS changing hospital-submitted operational data from CDC to HHS. The new database isn’t publicly visible. Can the public use other dashboards, such as the one from Johns Hopkins?” HHS collects daily hospital reports about beds, ventilators, cases, admissions, ED visits, remdesivir inventory, and details about staff and PPE shortages. Most of this information has minimal overlap with the infection dashboards published by Hopkins and other sites that I assume use data that hospitals have submitted to state health departments.

From Epic Historian: “Re: Kaiser Permanente. Early on they were considering both Cerner and Epic. Cerner offered a complex plan to rebate KP the software cost in the form of Cerner company shares, basically giving them the software for free (UPMC may have fallen for this). KP decided to pick Cerner for inpatient and Epic for outpatient (since it was already being used in some regions), and they asked Judy end Epic to run the integration. She told them to forget it, just use Cerner because one vendor is better than two. KP realized what she was saying and took Epic even though the inpatient system was pretty untested back then.” Unverified, but fascinating. This was in response to an email conversation I had with EH in which I described one instance (there were actually two, but I just now remembered the second) in which we as a big health system seriously pondered whether it would be cheaper to buy our fading vendor of choice as a company instead of their product, or if we did buy the product, whether our contractual demands that they were desperately willing to accept might drive them out of business anyway.

From Kay: “Re: HIStalk. I’ve enjoyed most of the 50-year career I’ve had in health IT and am lucky to have found something I loved. I’m finally retiring and will miss the industry and the wonderful people. You have made a huge difference to me and how I was able to do my job. You are the best. Ever. I want to thank your family for sharing you with us. By the way, I’m not retiring from reading your blog. Stay safe and well and clever and endlessly interesting.” I excerpted some of Kay’s comments, without including personal details, purely to thank her for those thoughts (hold on, got something in my eye here) and to wish her a happy retirement as an industry pioneer, a concept that I hope she celebrates both as the beginning of a fresh chapter as well as a reward for completing the previous one. I’m always uplifted to hear from someone who has enjoyed their career and their simultaneous personal life that raced by while they were pursuing it – it’s a lot easier to continue gratification than to catch up from deferring it.

Webinars

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

Acquisitions, Funding, Business, and Stock

Digital access and care navigation company Gyant raises $13.6 million in a Series A investment round. The company launched a COVID-19 digital screening tool several months ago with development help from investor Intermountain Healthcare that has since been deployed by 16 healthcare organizations.

Boston-based care coordination software startup Cohere Health launches with a $10 million Series A funding round. The company offers care paths, care journey recommendations, and physician behavior change. CEO Siva Namasivayam, MS, MBA was previously CEO of SCIO Health Analytics and an executive with Perot Systems.

Cerner says it will keep employees working from home for at least several more months, pushing back its phased plan to bring up to 50% of employees back to office-based work.

The six-month health IT review of Healthcare Growth Partners says that while COVID-19 has accelerated the shift to “hospitals without walls,” M&A transaction activity has slowed a bit and will likely stay that way through the end of this year, although not as much as in other industries. Underlying health IT investment sentiment remains strong among private equity firms. Private equity investors generally see COVID-19 as neutral with regard to valuations. The most common COVID-19 strategies that companies are using include applying for federal government relief (40%), accessing additional capital (30%), and delaying payables (30%). Many of them are furloughing or laying off employees or imposing pay cuts.

Sales

• Banner Health signs up for Cerner’s revenue cycle system, expanding its Millennium implementation.
• Boulder Community Health (CO) will implement data and analytics, RCM, and care coordination services from Optum.
• Virginia Mason Health System (WA) will use supply chain services and cost-management analytics from Premier.
• Parkview Medical Center (CO) will go live on Epic through a software-sharing arrangement with UCHealth.

People

Appriss Health promotes Krishan Sastry, MBA to president and CEO. He replaces Michael Davis, who will remain as executive chair.

Tom Underman (Accuray) joins Loyale Healthcare as VP of enterprise sales.

Announcements and Implementations

Banner Health implements acute-care telemedicine capabilities developed by VeeMed and Intel across its 28 hospitals.

Phynd Technologies announces GA of advanced provider search capabilities for patient-facing hospital websites and internal directories.

Vanderbilt University Medical Center profiles its Clickbusters campaign to reduce alert fatigue from Epic-generated best practice advisories. The program, operated by Vanderbilt Clinical Informatics Center, has reduced the nearly 500,000 weekly generated alerts by 10% and has set a goal of having users act on the recommendations 30% of the time instead of the current 8%. VUMC has also added a feature to allow clinicians to score their satisfaction with individual alerts and add suggestions for refining them that are sent to a review team.

Urgent care provider Remedy is working on virtual care solutions with Redox, one of 13 virtual care customers Redox has added to its network since March in a 46% increase.

A new KLAS report on legacy data archiving finds that Harmony Healthcare IT and MediQuant have a record of satisfying customers that have complex needs, while Triyam and Ellkay customers report getting their projects finished on time and with good communication. Sites that used MediQuant, Galen Healthcare, and Harmony Healthcare IT reported more delays, but some of those customers say it was their own lack of planning and expectation-setting that extended their timelines.

Athenahealth renames its Centricity product line to AthenaIDX, which includes Centricity Business (AthenaIDX), Centricity EDI Services (AthenaEDI), and Centricity Group Management (AthenaIDX). The product line has a long but tortuous history — the former IDX developed and sold the systems for years, GE Healthcare acquired IDX for $1.2 billion in 2005, GE Healthcare sold part of that business to private equity firm Veritas Capital in mid-2018 for $1.05 billion, Veritas named the acquisition Virence Health Technologies a few weeks later, and Veritas acquired Athenahealth for $5.7 billion a few months later and combined it with the Virence product line under the Athenahealth brand.

Government and Politics

An HHS OIG audit finds that CMS Administrator Seema Verma inappropriately spent millions of taxpayer dollars on contractors — some of them connected to Republican loyalists — who she engaged to polish her public image. CMS had paid more than $5 million to the contractors at above-market rates – up to $380 per hour — before halting the program following Politico’s investigation. CMS has 235 FTEs in its Office of Communications. Politico previously reported that Verma had directed contractors to craft her speeches, book her media appearances, obtain invitations for galas, and work to get her included on “Power Women” lists. HHS accepted the inspector general’s recommendations, but Verma disputed the findings and scolded OIG for investigating her when CMS is dealing with coronavirus. HHS Assistant Secretary for Public Affairs Michael Caputo, an advisor to President Trump, responded that the White House has confidence in Verma, but not his own department’s inspector general. Note: that acting inspector general is Principal Deputy Inspector Christi Grimm, who drew the White House’s ire and the nomination for her replacement in April after HHS OIG published results of a 300-hospital survey that indicated widespread shortages of PPE.

COVID-19

Oklahoma Governor Kevin Stitt, who was among the majority of attendees of President Trump’s June 20 rally in Tulsa who refused to wear masks, becomes the first state governor to test positive for COVID-19. He attended state meetings unmasked after being tested while awaiting results, forcing state and local officials who were exposed to him to begin their own testing and self-isolating.

New research using EHR data finds that, contrary to previous speculation, blood type has little impact on COVID-19 susceptibility or outcomes.

University of California Health uses de-identified patient data from its Epic system to create a database for COVID-19 treatment research.

The UK’s cybersecurity center warns that a Russian hacking group is targeting COVID-19 vaccine research and development organizations in the US, UK, and Canada to steal their intellectual property.

White House Press Secretary Kayleigh McEnany says in a press briefing on school reopenings that “the science should not stand in the way of this.”

In Bangladesh, a hospital owner is arrested for selling migrant workers certificates that they tested negative for COVID-19 without actually testing them. He sold 10,000 of the $59 certificates that allowed his untested customers to work in Europe as restaurant workers and grocery store clerks. The hospital owner, who sports a long criminal record, was arrested while trying to cross the border into India dressed as a woman.  Two other doctors were previously arrested in Bangladesh for issuing thousands of phony certificates.

Other

A small survey of health systems by The Chartis Group finds that 40% expect it to take at least a year to return to pre-pandemic patient volumes, and that 45% will reduce expenses by at least 10% during that time.

Weird News Andy acknowledges that stories like this are hard to swallow. Japanese doctors resolve a woman’s throat irritation by removing a sashimi-transmitted parasitic worm from her tonsils. You’re welcome for me not showing you the photo.

Sponsor Updates

• Frost & Sullivan recognizes Wolters Kluwer Health as a Frost Radar global leader in AI for healthcare IT.
• Healthwise names Cydni Waldner (Hawley Troxell Ennis & Hawley) general counsel.
• Hyland Healthcare partners with Life Image to optimize data and imaging access between providers and patients.
• The Philadelphia Business Journal honors InstaMed CFO Frank McAnally with its CFO of the Year Award.
• Black Book ranks Imprivata as the top company for client satisfaction for identity governance solutions.
• Redox has increased its roster of virtual care customers by 46% over the last several months.
• Loyale Healthcare parent company RevSpring integrates Loyale’s payment facilitator program with its Merchant Services offering.
• PMD adds a Web-based telemedicine option for patients who lack access to or don’t feel comfortable using mobile devices.

Blog Posts

• How Grady Improved Patient Safety in the ICU with Computer-Guided IV Insulin Therapy (Glytec)
• CGH Medical Center Finds Root Cause and Resolves End-User Citrix Performance Issues in Minutes (Goliath Technologies)
• The Best Virtual Care Setup for Your Clinicians (Access)
• Caring for caregivers: UNC’s Heroes Health Initiative supports healthcare workers’ mental health (Google Cloud)
• Employee Engagement During COVID-19: Using Culture to Manage Stress, Maintain Productivity (Health Catalyst)
• Pitfalls of Long Prescription Renewal Turnaround Times (Healthfinch)
• The Key to Improving Coaching Efficiency and Member Outcomes (Healthwise)
• Hey Epic – Epic’s New Voice Assistant (Optimum Healthcare IT)
• AHIP: Payers are Addressing Socioeconomic Needs During COVID-19 and Beyond (Imat Solutions)
• In the COVID-19 battle, did we leave our best players on the bench? (Imprivata)
• How to avoid expanding IT costs (Infor)
• Information Blocking: To Block or Not to Block (Nordic)
• 5 Ways to Increase Revenue with Healthcare Business Analytics (Ingenious Med)
• At a glance: Medical coding system updates for 2020-2021 (Intelligent Medical Objects)
• Healthcare’s COVID-19 Secret Weapon – Innovation (Loyale Healthcare)
• The Pros and Cons of Hiring Individual Contract Physical Therapists (MWTherapy)
• 10 Essential Elements of Wound Care Documentation (Netsmart)
• Human Connections and Telehealth: Navigating the COVID-19 Era (PMD)

Contacts

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EPtalk by Dr. Jayne 7/16/20

I was glad to have had some time off from the clinic recently. I’m tired of dealing with patients who have unrealistic expectations.

We’ve been running out of testing swabs for COVID-19 tests nearly every day. Patients absolutely lose their minds when our receptionists tell them we’re out. For everyone who ever said we can’t reform healthcare because it would lead to rationing, guess what? We’ve been here a long time and the fact that we can’t manufacture enough glorified Q-tips to help slay the monster isn’t very reassuring.

Speaking of the monster, I strongly recommend that people read this Twitter thread by Sayed Tabatabai, MD. Although I’m not working in the ICU, my friends who are agree with his depiction. It should be required reading for the PA in my practice who keeps posting selfies from bars, often hugging on someone who doesn’t live in her household. I think I’m going to start calling her Typhoid Mary the next time I see her.

I enjoyed this JAMIA piece on “User reactions to COVID-19 screening chatbots from reputable providers.” The authors recruited 371 people to watch a two-minute video of a staged chat between a user and a COVID-19 screening hotline. Participants were told that the video was either a real person or a chatbot, although the same video was used either way. The study found that perception of the agent’s ability was the primary driver of user response, noting the need to help users better understand that chatbots can use the same knowledge base as humans and can have the same quality outcomes as a human-human interaction.

The whole idea of “what is a chatbot” is somewhat debatable. The ones I’ve seen vary from using simple responses to suggest an outcome, to much more complex interactions. An example of the former is the CDC’s COVID-19 symptom checker, which basically uses data points such as age, location, medical conditions, and recent exposures to suggest whether you need a test or not. I wouldn’t consider it a true chatbot per se since it’s not truly interactive and users are just selecting items from a menu.

I’m working with a health system right now that is trying to create a chatbot, but it really isn’t interactive. Although the prompts are written in a conversational style and it tries to have a certain tone and vibe, it’s really no different than a person with a clipboard peppering you with questions. Needless to say, it has a high abandonment rate when patients try to use it, so we’re trying to walk the fine line between gathering the data they want and keeping patients from dropping out.

Other chatbot solutions parse the language in the user’s responses to make it a more interactive experience compared to selecting from a list and reorder the prompts based on information it receives. The most sophisticated ones also incorporate AI and machine learning to become “smarter” as they go, detecting new patterns and being able to identify elements such as regional variation in content.

I find some website-based chatbots annoying, especially if they keep popping up on the screen asking you if you need help even after you’ve already tried to minimize or close them. It will be interesting to see where chatbot technology goes in the next few years.

The American Academy of Family Physicians is talking up its new website that is set to launch on August 17. Among the changes is a replacement of unique user names by one comprised of the user’s email address. AAFP warns practices that use shared email addresses that it might be a good idea for physicians to have their own. I wonder how many physicians share email accounts at this point?

Other changes include “expandable mega-menus,” which sounds kind of scary. I hope they didn’t include a bunch of hidden controls. I’ve experienced other recent redesigns (including some Windows and Office elements) and am sick to death of controls being hidden until I mouse over them. It’s distracting and often requires a decree of precision that my tired hands and eyes don’t have at the end of the day. If you have the real estate, show the controls already.

I’m still wildly optimistic about the Telehealth Innovation Forum that is scheduled for next week, sponsored by the folks at Teladoc Health. They recently released their agenda and I love the calendaring portion of the process. It allows you go to through the agenda and select the sessions you’re interested in and creates a personal calendar for you. Once you’re done, you can select to have the whole thing set up for you in your calendar program of choice. In Outlook, it adds the appointments as a separate calendar that you can turn on and off, which is especially cool for those of us managing multiple calendars. I don’t have to have it cluttering up my screen until it’s time.

Much better than other conference platforms that create a calendar for you but require you to be in their app or logged into their website to see it. I’m also geeking out about the inclusion of a Mixology course on Tuesday afternoon where I can expand my martini skills. Wednesday afternoon is the volunteer activity. I’m still waiting for my backpack decorating kit to arrive, but I’ll have my fabric markers at the ready.

I’ve been away from patient care for a while but have to head back into the trenches on Friday. My boss has coined a new word – we are not short-staffed, we are apparently “overpatiented.” And the patients are becoming increasingly frustrated by our long wait times and lack of COVID testing supplies.

Despite seeing more patients in June than I’ve seen since I worked there, I received a very small productivity bonus due to low patient satisfaction scores. I’ve never been below 98% and this month I was apparently at 92%. The entire company’s scores were down, but it doesn’t make me feel less annoyed, especially since my employer received a nice chunk of Paycheck Protection Program funds. Seems like this would have been a good time to change the bonus formula to take into account the extenuating circumstances and properly compensate the team for working their tails off.

Not only have we been challenged by the high volumes, but nearly every patient is upset and cranky by the time we see them. I’m told that we should be glad to be employed, since our hospital colleagues are taking pay cuts. I guess we’re going to start going the way of many industries and join the race to the bottom.

Has your patient satisfaction suffered in the era of COVID-19? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/16/20

Noteworth Secures $5 Million in Funding to Fuel Expansion of Digital Medicine Technology

Care coordination, management, and remote monitoring vendor Noteworth raises $5 million in seed funding.

GYANT Closes $13.6 Million Series A Funding Round Led by Wing Venture Capital

Digital access and care navigation company Gyant raises $13.6 million in a Series A investment round.

Liberty Fox Technologies Joins GPMF Holdings Family Of Companies

GPMF Holdings acquires health IT-focused software developer and consulting firm Liberty Fox Technologies for an undisclosed sum.