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Morning Headlines 3/16/21

March 15, 2021 Headlines No Comments

Meet Dr. B, the startup promising a better way to distribute leftover vaccines

ZocDoc founder Cyrus Massoumi launches Dr. B, a website that helps eligible people locate thawed COVID-19 vaccines in danger of going to waste.

Dagrosa Capital Partners LLC Invests in Telemedicine Company, Hoy Health LLC

DaGrosa Capital Partners invests in Hoy Health, a bilingual telemedicine, remote patient monitoring, and medication access company based in Morristown, NJ.

Well Health Provides Management Update and Makes Seed Investment in Fertility Start-up Venture

Canadian Well Health Technologies makes a seed investment in startup fertility clinic Twig Fertility, which plans to open a location in Toronto with digital health offerings

Readers Write: Consensus Building: X12’s Cornerstone for Standards Development

March 15, 2021 Readers Write 1 Comment

Consensus Building: X12’s Cornerstone for Standards Development
By Cathy Sheppard

Cathy Sheppard is executive director of X12 of Arlington, VA.

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Josh Kallmer, executive vice-president of the Information Technology Industry Council, said in a July 29, 2019 letter to Financial Times, “The US technology sector has long supported an industry-led, voluntary, consensus-based model of standards development because it works ─ and in the world of standards, the first move is not the last.”

With an incalculable investment of time and resources, it’s true that the world of developing standards to shape new interoperable technologies is a highly structured process. This proven process, albeit time-intensive, involves various mechanisms for creating, vetting, and approving standards supporting an evolving solutions roadmap.

At the center of rigorous standards development is consensus building, defined by the Program on Negotiation at Harvard Law School as a process involving a good-faith effort to meet the interests of all stakeholders. A consensus-building approach allows groups to reach an agreement among relevant stakeholders and maximize the overall gains to everyone.

Appropriately, the first tenet of X12’s six corporate principles is: Publish high-quality, consensus-based standards that are simple, efficient, responsive to the needs of stakeholders, and delivered in a timely manner.

X12 is an ANSI-accredited Standards Developer that has been focusing on the development and ongoing publication of cross-industry interoperable data exchange standards for more than 40 years. X12 develops and maintains its work for use by implementers in different formats that are proven, reliable, efficient, and effective to drive business processes globally. With more than 320 transaction standards, 1,400 data elements, and in excess of 40,000 codes available for use, X12’s body of work can be used to conduct nearly every facet of business-to-business operations.

In fact, billions of transactions based on X12 standards are utilized daily to facilitate rich and consistent standardized electronic exchange across various industries including finance, government, healthcare, insurance, supply chain, transportation, and others.

In the health insurance industry, X12’s activities support transactional standards, processes, and activity reporting used by commercial and government healthcare organizations. For example, X12 standards provide for eligibility and benefit inquiry and information response, claims, and code lists.

The Provider Caucus is an informal industry group comprised of X12 member representatives who advocate issues on behalf of healthcare provider organizations. Provider participation in subcommittee workgroups is encouraged to ensure their important viewpoints and collective knowledge are included in the collaborative discussions.

As the world continues to bravely battle the pandemic in 2021, X12 is proud that healthcare organizations are actively using X12 standards to electronically transport medically necessary information whenever and wherever needed to advance patient care operations.

Voluntary consensus benefits B2B standards development

From batch processing of large amounts of data to the proliferation of digital technology innovations, X12 standards have evolved to allow more people to use standards in different ways. But the wealth of four decades of X12’s strong, collaborative work remains critical to standardized messaging, powering an expansive vocabulary of data elements and constructs that unlock many opportunities to develop creative, interoperable solutions to complex business challenges.

For X12, consensus means that its diverse membership of technologists and business process experts has an equal voice in a non-competitive, safe forum deciding what those business-to-business transactions should comprise and how they should be formatted. Large member companies are not favored over smaller member companies.

X12 members listen to each other’s interests, ask questions, and gather shared knowledge weighing the pros and cons of implications in the decision-making process of developing or updating a standard. These companies are committed to working to find solutions that the majority supports.

As both technology and X12’s ability to support trading partners through different products advance, consensus standards must also evolve. Consensus standards must progress over time to ensure they continue to meet the needs of stakeholders and stay in tune with emerging interoperable technologies. For example, the X12 Unit or Basis for Measurement Codes have changed 600 times over the past 33 years.

X12’s approach to consensus-based standards development

To remain competitive and profitable in today’s economy, a seamless electronic exchange of business data among the company, partners, and customers is necessary. X12 standards establish a common, uniform language that facilitates business transactions.

X12 employs a three-prong approach to consensus building among stakeholders:

  1. Open-minded, with vision and insight related to data exchange in both current and developing technologies.
  2. Responsive to business requirements presented by other organizations.
  3. Collaborates enthusiastically with other SDOs, industry groups, government, and business-focused entities.

X12 members meet regularly to develop and maintain high-quality data standards that streamline and facilitate consistent electronic interchange of business transactions. X12 standards support transactions such as order placement and processing, shipping and receiving information, invoicing, payment, cash application, administrative healthcare, and insurance data.

X12’s open, transparent, and consensus-based environment empowers members to voice comments, recommend changes or updates, and address and vet issues from every point of view. Looking through a technology lens, members take into account the particular business workflows and use cases to create standards supporting e-transactions and enhanced interoperability that crosses industry and company boundaries.

Anyone, including the general public, can submit a request, idea, or suggestion for revising or developing X12 standards or products by completing this form, accessible on the X12 website. X12’s current maintenance request process supports a predictable annual release cycle and is frequently referenced as ARC, as illustrated below.

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Supporting a consensus building process, X12 members drive all aspects of standardization work, including defining the scope, content definition, and technical content. In simplest terms, the multi-layered maintenance and stakeholder process involves extensive vetting and negotiation among member representatives and other materially interested parties. Members also have the option to vote whether to approve revisions, and if approved, the revisions undergo both technical and quality assurance reviews prior to publication. X12 publishes new versions of its consensus-driven products annually.

Conclusion

“Change is the only constant in life,” said the Greek philosopher Heraclitus. True, but as technology has brought exponential growth and rapid change, some constants in business must remain in order to help the future thrive.

Tens of thousands of organizations count on X12 to develop high quality standards upholding business-to-business information exchange. X12 members are confident knowing that X12 transactions are grounded in a consensus-based approach designed to benefit users and satisfy their business needs, today and tomorrow. Having an equal voice is key to achieving fairness in mutually accepted solutions.

Readers Write: Without a Subscription Revenue Model, Hospitals and Health Systems Will Cease To Exist

March 15, 2021 Readers Write 1 Comment

Without a Subscription Revenue Model, Hospitals and Health Systems Will Cease To Exist
By Matt Lambert, MD

Matt Lambert, MD is chief medical officer of Curation Health of Annapolis, MD.

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Two of the most common current topics in conversations with our provider and payer partners are speculating when we might emerge from the pandemic and what effect it might have on the future of value-based care.

With the decreasing number of COVID-19 cases, hospitalizations, and deaths intersecting with the rising number of vaccinations, I think we will be in a manageable place in the very near future. In a similar analysis, the differing trendlines for payers and providers in the last year may give us insight into the future of value-based care.

The providers, with a model based on episodes of care, find themselves challenged by diminished revenue from decreased volume. On the other hand, payer organizations are well poised for the coming years, primarily because their revenue has been consistent since people have continued paying their monthly health insurance premiums during the pandemic.

I find it ironic that providers find themselves behind the payers in recurring revenue or subscription revenue models since that is what hospitals were seeking when they invented health insurance almost 100 years ago. While researching my book, “Unrest Insured,” I learned that Blue Cross was founded by Justin Ford Kimball in 1929 basically to keep the lights on at the hospital. Upon taking an executive role at Baylor, Kimball found himself unable to pay the bills and decided to seek some recurring revenue. He leveraged his relationships as a former education leader and negotiated a deal with the local teachers’ union — 50 cents a month payment in exchange for 21 days of hospitalization annually. Describing it in today’s terms, he established a per-member, per-month reimbursement model between a patient population and a provider that had established its own payer. This desire for steady revenue, which allows for any organization to plan much further ahead, is what created our current healthcare system.

Many things have changed over the passing century. Payers became less aligned with individual hospitals and more judicious in how much they paid for certain services. Reimbursement became increasingly complex and codified. The Baylor model clearly incentivized hospitalization (which explains why early in my career I could still admit patients for exhaustion), while new medical techniques allowed for advanced outpatient treatment. But 90 years of divergence may be corrected by the accelerated pace of change brought on by one year of a pandemic, change that may bring us back to the original intent of health insurance.

Value-based care means a lot of things. It favors value over volume and outcomes over throughput. It puts a premium on information sharing and coordination of care, which can be made even more robust with new technology. But let’s be clear, it also provides recurring revenue, which makes it easier to plan for providing care and weathering the unknown.

COVID-19 taught me, as a clinician, many lessons. The pandemic has also reinforced the very real reality that fee-for-service continues to break healthcare, and in this current antiquated system, healthcare providers continue to be hit hardest. In order to stabilize our healthcare system, providers need more support and resources in order to prioritize the transition to value-driven care. More so, we need to not shy away from the critical need for recurring revenue for providers.

Without this recurring revenue model — or what has been called value-based care now for years — hospitals and health systems will not be able to survive the next storm, and clinicians like me may no longer have a job.

Curbside Consult with Dr. Jayne 3/15/21

March 15, 2021 Dr. Jayne 2 Comments

For math fans, this weekend included Pi Day (3.14), but for me, it also included my one-year COVIDversary. Exactly 12 months ago, I cared for my first COVID-19 patient, who happened to be part of the first cluster of patients in my city.

I remember finding out two days later that the patient was positive, and then seeing on the news that she was part of the cluster and had been admitted to the hospital. Along with the physician assistant who also saw her, I spent the next two weeks checking my temperature and wondering if we were going to get it and if we were going to die. In talking to my med school friends who also work on the emergency and urgent care front lines, we all made promises to see each other “on the other side” not knowing what was next.

There are over two million people dead across the globe, and that includes several thousand US healthcare workers. It’s truly stunning to think about the road we’ve been down with our hospitals and healthcare employers and how we are still struggling with protecting these valuable resources. Many organizations are still managing N-95 respirators under extended-use protocols or even crisis standards of care. The majority of my healthcare worker friends have given up on N-95s because they’re so difficult to get even in the hospital, being saved for “known COVID-19” patients even though we know at this point in the game that a tremendous number of patients can be symptom-free. Many healthcare workers are vaccinated, which gives us some degree of relief that we’re protected. No vaccine can be 100% effective, though, and I have unvaccinated people in my household, so I’m sticking with the N-95.

Although very few people get to see my face these days (other than on a videoconference, that is) ,my skin tells the story of the pandemic, with ongoing creases from extended N-95 use and exponential growth of wrinkles. Maybe my skin would have been more resilient had I been in my 30s, but along with more than 70% of the physicians in the US, I’m part of the over-40 crowd, so I’m sporting the perpetually tired look. One of my residency classmates has an exclusively cosmetic practice and promises she can do wonders with modern pharmaceuticals, but the last thing I want to get into right now is an elective medical adventure.

As I wind down my clinical employment, it continues to be challenging. Our new owners have removed some of the protective policies that we previously had in place. Where they used to cap the number of patients in the building to nine per provider at a time (which was challenging enough), it’s now only limited by the number of exam rooms in the building, which can be 15 to 17 at some locations. That means patients have a secondary wait in the exam room after they’ve already waited in their car or at home, which means they’re often cranky by the time we make it into the room. I’m sure the folly of this change will be apparently when it starts hitting our patient satisfaction scores, but I’ll be gone by the time that lagging data turns up.

The cognitive dissonance involved in an urgent care shift is hard to explain to non-healthcare folks. We’re still seeing acutely ill COVID-19 patients, but are also seeing long-haul patients with ongoing symptoms. I might spend a significant amount of time with a patient who is in a bad way, or who just lost a family member, and then have to walk into the next room to see a patient who just wants testing so they can go on vacation. The majority of the pre-travel testing patients are oblivious to the suffering around them and often tell us how ridiculous it is that they even have to be tested. It’s a lot to tolerate sometimes, and in those situations, I’m grateful that my mask, goggles, and scrub cap obscures my facial expressions.

That’s a big contrast from my consulting work, which is challenging as well as fun, and makes me feel like I’m helping people get better care. I’m working on several projects to address the backlog of cancer screenings that were created by the pandemic. Knowing that my work will have a direct impact on patients makes a difference. Diagnosing cancer is never a good thing, but diagnosing it earlier certainly is, especially when it can be managed more effectively. Patients seem genuinely grateful that we’re reaching out to them to let them know they are overdue for screening and to educate them on current COVID-19 mitigation policies at the health system’s locations. Passing them a link to allow online scheduling has been very effective, and certainly more productive than postcards or mailed reminders.

The highlight of Dr. Jayne’s week was connecting with friends at Medicomp as the inaugural guest for their new podcast, “Tell me where IT hurts,” hosted by Chief Medical Officer Jay Anders, MD. I usually spend some time with their team at HIMSS shooting the breeze and it was good to catch up and talk about the industry, where we’ve been, and where we might be going. I’ would rather have done it in person with a glass of wine, but the conversation was enjoyable all the same.

The highlight of my personal week was some time in the outdoors. Even with some intermittent rain, it was good to be camping again and teaching a bit of outdoor school. I always enjoy time spent with like-minded folks who understand the pleasures of food cooked in cast iron, and the delicacies did not disappoint. The wildlife certainly didn’t care that people were out and about, as we got to experience the sounds of the Circle of Life as a coyote found its dinner. It was less of a highlight for the  members of our party who stumbled on the remains. Still, it’s a reminder that there’s a whole world outside where primal forces still rule, regardless of what we as people try to do to shape it.

For my healthcare worker readers who might be marking their own COVIDversaries, I salute you. It’s been a long year and none of has made it out unimpacted. Here’s to a better 2021 with less time putting out healthcare fires and more time tending campfires.

What’s your favorite cast iron recipe? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Mary Kay Ladone, SVP, Hillrom

March 15, 2021 Interviews 1 Comment

Mary Kay Ladone is SVP of corporate development, strategy, and investor relations of Hillrom of Chicago, IL.

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Tell me about yourself and the company.

I am an executive with more than 30 years of healthcare experience in a variety of areas — finance, financial planning, operations, strategy, corporate development, and investor relations. I am also privileged to serve as a member of the board of trustees for Edward-Elmhurst Health, which is one of the largest systems in the Chicagoland area. I have been at Hillrom for just about five years after spending most of my career at Baxter International and its spinoff Baxalta.

I am happy to be a part of the Hillrom team. Hillrom is a medical technology leader. We have a diversified global business, with $3 billion in revenue spread across three businesses — patient support systems, frontline care, and surgical solutions. Hillrom’s portfolio spans all care settings — acute care hospitals, ambulatory or physician care, and the home setting.

I couldn’t be prouder and more excited to share with you some of my perspectives on our connected care strategy and how we continue to accelerate growth and drive value for our patients and caregivers. We are focused on executing on our strategic priorities and advancing our vision.

Some people might be surprised that the company’s home page highlights “advancing connected care” rather than hospital beds. What business units support that concept?

Hillrom has historically been known as the leading bed company, but if you have followed Hillrom over the last several years, you know that we have significantly diversified our portfolio. We have strengthened our business model and established a strong track record of performance. All of which has led to a pretty exciting and compelling transformation and transition of Hillrom into a medical technology leader. For example, today our hospital bed portfolio accounts for just less than a quarter of Hillrom’s total revenue versus about 50% of our total revenue 10 years ago.

Our vision of advancing connected care is tied directly to our mission of enhancing outcomes for patients and their caregivers. It is integral to everything we do across all three of the businesses. Our primary goal is to collect data and to turn that data into actionable insight that allows for real-time interventions and enhances patient outcomes.

Our connected care efforts are focused primarily on improving workflows, lowering costs, and improving diagnosis and patient care. We estimate that there are over 1.3 million Hillrom devices in the field that can be connected across a variety of the care settings, including acute care and surgical environments, the ambulatory or physician office setting, or in the home. Our diversified portfolio includes an ecosystem of smart devices, including our smart beds, communication, and connectivity solutions. We have sensors and devices that can continuously monitor patient vital signs. We have a suite of diagnostic tools. We have respiratory health products that are used in the home to treat cystic fibrosis and other respiratory diseases, such as bronchiectasis and COPD.

What is involved with turning a large amount of medical device data into information that a clinician can use for real-time decision-making?

We are continuing to invest — in both our internal R&D programs through organic innovation and through external or M&A — to build an ecosystem of connected devices that will put actionable information in the hands of the caregivers. You don’t want to overwhelm the caregiver with too much information, because that makes it less actionable and less valuable to them.

An example is the launch of our digital offerings or algorithms later this year that will target two of the most costly non-reimbursable expenses for the hospital — patient deterioration and patient falls. Our value proposition with these algorithms is focused on lowering hospital costs while increasing quality and enhancing outcomes.

In terms of patient deterioration, we are utilizing our EarlySense sensor. This is a contact-free continuous monitoring sensor that monitors heart rate and respiratory rate 100 times per minute. This data is then collected and aggregated. The algorithm can provide an alert through our mobile communication platform that provides for early detection and intervention at the first sign of deterioration. This is important, as patient deterioration or sepsis is an expensive complication that costs the healthcare system more than $20 billion annually. The earlier the intervention, the more likely the ability to achieve a better outcome at a lower cost.

Another example would be our Excel Medical acquisition, which brought to us medical device integration capabilities as well as waveforms that can be visualized on the mobile device. It also provided us with an alert and alarm management system. This system is set up to prioritize alerts, organize them, and send them to the caregiver in a prioritized fashion so that they can act on the most important of those alerts. It helps them improve their workflow and improve the workflow efficiencies across the healthcare system.

The acquisition of Voalte gave Hillrom a solution that includes devices, integration, and communication. Does that provide a competitive advantage given the importance hospitals place on reducing vendor count and complexity?

Yes. We have actually done two acquisitions in the area of care communications. You mentioned Voalte as an example. We have traditionally been the leader in the traditional nurse call systems for our acute care customers, but in doing so, we have realized that we could accelerate our connected care strategy by building on this leadership position and creating an ecosystem of solutions that leverages our smart beds as the hub for communications data and connectivity.

The acquisition of Voalte and then the acquisition of Excel Medical that I just mentioned differentiated Hillrom as the only provider of a comprehensive mobile communication solution that provides voice, text, alert and alarm management, digital wave forms, and medical device integration. You are right that it is important that our acute care customers can buy that one solution from one vendor and not have to piece it together and tape together a variety of solutions from a variety of vendors.

The pandemic has increased the use of remote patient monitoring, both in hospital areas that weren’t previously equipped for monitoring as well as the home. Will that have permanent impact?

Hillrom has been a leader in traditional patient monitoring within the acute care setting with our vital signs monitoring devices and other devices that we’ve integrated into our smart beds, like the EarlySense sensors we just discussed that monitor heart rate and respiratory rate. We also have a WatchCare device that monitors incontinence events and can help reduce infection and pressure ulcers. But you’re right, the pandemic has also highlighted the importance of remote monitoring capabilities, and this is one of our core focus areas as we look to shift care closer to the home.

I can give an example of one of the opportunities that we embarked upon at the beginning of the pandemic. Our company quickly pivoted our R&D efforts and we introduced what we called our Extended Care Solution, which combined our Spot 4400 Vital Signs device with a patient app and a clinical review portal to help extend patient care beyond the wall of the healthcare facility. Clinicians can access the patient’s temperature, blood pressure, and Sp02 measurements. The patient doesn’t have to be in the hospital setting. They can do this at home, and that provides an enhanced level of care. This is a trend that is accelerating given the pandemic, and one that we continue to look at both from an internal R&D perspective, but also from an M&A perspective, as a potential opportunity for Hillrom going forward.

What will be the company’s most important areas of focus in the next 3-5 years?

I think it goes back to our strategic priorities. One, about being a category leader across our various portfolios and businesses. We want to continue to expand internationally and penetrate emerging markets, where today our exposure to emerging markets is under index relative to our peer group.

We want to continue transforming our portfolio. We have recently exited some lower-growth assets and we have been turning to M&A as a key driver for future accelerated growth.

We have also been experiencing and demonstrating a strong track record of performance and operational excellence, during the pandemic in particular. We have stepped up to help our hospital customers during this difficult time.

We are focused on what we consider our core growth platforms. These would include the areas of care communications, respiratory care, patient monitoring, and surgical kinds of activities. All these care categories represent attractive markets and areas where we believe Hillrom brings capabilities as well as a competitive advantage where we can win. These are going to be the areas that will drive our success in the future.

Do you have any final thoughts?

The transformation we have seen at Hillrom from a bed company 10 years ago to a medical technology company today is exciting. It has been compelling. We have doubled our size in terms of revenue. We have rebranded the company. We have our vision of advancing connected care that we are all focused on, driving the growth across our key strategic growth platforms in areas that we believe are addressing some of the healthcare system’s biggest challenges. We hope to bring comprehensive solutions to the table that help our healthcare customers and caregivers and enhance patient outcomes over the long term.

Morning Headlines 3/15/21

March 14, 2021 Headlines No Comments

Healthcare artificial intelligence company establishing headquarters in Loudoun

India-based healthcare AI vendor Zasti will open its US headquarters in Loudoun County, VA.

$2.8M Deal Ends Suit Over Pocketed Health Trade Show Fees

HIMSS pays $2.8 million to settle class action charges brought by HatchMed and other HIMSS20 exhibitors who complained that they received no refund when the conference was cancelled.

Crossover Health Announces Expansion of Amazon’s Neighborhood Health Centers and Virtual Care Services

Crossover Health expands its health centers and virtual care for Amazon employees and their dependents to five regions in Texas, Arizona, Kentucky, Michigan, and California.

Monday Morning Update 3/15/21

March 14, 2021 News 4 Comments

Top News

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HIMSS opens registration for HIMSS21.

The full in-person conference costs $895 at the early bird rate, which includes the digital program, while digital-only registration costs $395.

HIMSS says the digital program will not be a duplication or live stream of on-site activities. It will contain “keynote-level conversations,” company announcements, education sessions, and networking opportunities.

Those who registered for HIMSS20 and intend to apply their credit to HIMSS21 need to click an individually emailed link to roll over their registration instead of registering again. The rollover email also interestingly notes that registrants must upload a headshot that will be printed on their badge, which I’m guessing is related to HIMSS20 registrations, which are not transferrable to another attendee.

The HIMSS21 exhibitor list shows 416 companies, 69 of them first-time exhibitors.

Meanwhile, HIMSS pays $2.8 million to settle class action charges brought by HatchMed and other HIMSS20 exhibitors who complained that they received no refund when the conference was cancelled. Lawsuit class members have two options: (a) apply a 50% credit of their HIMSS20 exhibitor fees to HIMSS21 and another 10% for HIMSS22; or (b) take a 20% cash refund of HIMSS20 fees along with a 30% credit of those fees applied toward HIMSS21 and 10% applied toward HIMSS22.


HIStalk Announcements and Requests

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Vendors, you know what you should be doing to create better webinars and presentations: (a) focus on the value to attendees instead of pitching product; and (b) get a credible presenter who can demonstrate enthusiasm and knowledge. I feel sorry for marketing people who are tasked with checking the “we did a webinar” box, then have to strong-arm any available presenter to develop a program, create slides and notes, and then deliver a decent presentation. I think that’s why webinars often feature company salespeople as the key presenters, which is convenient but not exactly compelling to prospective attendees.

New poll to your right or here, in a repeat from several years ago: Which organization most often provides poor customer service in your personal experience?

Listening: Sandy Denny, the lead singer of British folk rock band Fairport Convention in the late 1960s. Her voice was angelic and her phrasing immaculate, but her life was tragic – her many self-harm injuries that resulted from a lifetime of behavioral health problems caused her physical pain and substance abuse that led to her death in 1978 at 31 years of age. She had little commercial success despite boundless talent, and while her song “Who Knows Where the Time Goes?” (which she wrote at 19) is often played at funerals, most people think it was written by Judy Collins because Collins covered it (her version is also excellent). Trivia: Denny sang “The Battle of Evermore” with Robert Plant on Led Zeppelin IV as the only guest artist the band ever recorded. Along similar musical lines falls Australia’s The Seekers, best known for their peppy movie song “Georgy Girl,” but better represented by “I’ll Never Find Another You,” in which I imagine Judith Durham and the band still elicit occasional listener tears 57 years later with a deceptively simple but strongly arranged song that was flawlessly executed without ego or technical assistance. It is a jarring but satisfying reality to hear the same youthfully exuberant foursome recreate their performance identically in their 70s.


Webinars

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


Acquisitions, Funding, Business, and Stock

Shares of insurer Clover Health, which went public via a SPAC merger on January 8, have dropped 46% since then versus the Nasdaq’s 1% gain, valuing the company at $3.6 billion.

India-based healthcare AI vendor Zasti will open its US headquarters in Loudoun County, VA.

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PatientBond launches Insights Accelerator, which provides health systems and other providers with healthcare consumer market research and psychographic data for marketing.

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Musculoskeletal exercise and health coaching app vendor Hinge Health acquires Enso, which offers an electrical nerve stimulation wearable for pain relief. Enso says 56% of its users experience immediate pain relief and 36% report improved physical function.


Announcements and Implementations

UCM Digital Health adds clinical content from UpToDate and Emmi to its virtual health platform using the Content-as-a-Service cloud model of Wolters Kluwer Health.

Crossover Health expands its health centers and virtual care for Amazon employees and their dependents to five regions in TX, AZ, KY, MI, and CA. The company was founded in 2010 by Medsphere co-founder Scott Shreeve, MD, who I interviewed about his long-ago career change in October 2019.


COVID-19

CDC reports that 106 million COVID-19 vaccine doses have been administered of 136 million distributed, with 21% of Americans having had at least one dose and a remarkable 63% of those over 65 having taken their first shot. Over 14% of US adults have been fully vaccinated. High penetration of nursing home vaccination has pushed cases, hospitalizations, and deaths hugely down.

Former FDA Commissioner Scott Gottlieb, MD says that the US’s aggressive vaccination program has greatly reduced the risk of variants that are causing big case upticks in Eastern Europe and Italy that have brought back lockdowns. He agrees with President Biden that July 4 gatherings will be safe to organize since vaccine supplies should be ample for everyone in April.

The New York Times looks at how buggy self-scheduling systems are slowing down COVID-19 vaccinations due to being used in ways that were not foreseen in their design, errors caused by the demand for frequent updates, lack of interoperability, the challenges of tracking two-shot administration, crashes caused by high demand, and lack of security in allowing appointment links to be shared and re-used. 

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An NPR survey finds that the highest percentage of vaccine hesitancy is in Republican men and supporters of former President Donald Trump, while hesitancy among blacks is now even lower than that of whites. The idea that black Americans are unusually vaccine hesitant and thus will require extra convincing was disproven by this survey.

Two Johns Hopkins epidemiologists warn in a New York Times opinion piece that COVID-19 testing should not be scaled back in diverting resources from surveillance to vaccination. They say the volume of rapid antigen tests needs to be increased and the price reduced to support routine use in testing students, employees, and families considering a gathering.


Other

HIMSS will move from its 33 W. Monroe headquarters in Chicago to a 30,000-square-foot space that it has subleased from Gartner Research at the 24-story River North Point building at 350 N. Orleans Street, the former Apparel Center that is connected by skywalk to the Merchandise Mart.

In Canada, CBC picks up the story of a military veteran who killed family members and then took his own life after a patchwork of EHRs failed to alert his new doctor about his psychiatric treatment in the military for proper follow-up. It notes that Nova Scotia is trying to move to a one patient, one record system, but is years away, as family practices use a single ER but hospitals run SHARE, Meditech, and One Concept systems that can’t communicate with each other. Experts note that even if the ideal system is implemented in Nova Scotia, providers still won’t be able to see a patient’s records from other provinces. 

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UCHealth CMIO CT Lin, MD provides a fascinating look at how workers at a drive-through vaccination site optimized their processes (UCHealth wrote a playbook on how to do mass vaccinations). He describes using Epic’s Rover smartphone app for mobile documentation, but EHR use also created problems – other Epic-using facilities sometimes charted vaccine administration on the wrong patient, so their shared data incorrectly said they had already received shots when they showed up. I can heartily endorse the “problem line” approach he describes since I used it at the final HIStalkapalooza – we moved people who were having problems (like showing up without being invited) to a dedicated table to keep the main line moving. We can only wish that airlines (remember them?) took this approach instead of allowing all available ticket counter or gate staff to frown together in puzzlement over a single monitor while everybody in line scowls.


Sponsor Updates

  • The local paper profiles the experience of four InterSystems interns.
  • The McBee CareThreads Podcast features Kim Elsberry, senior director of population health at Netsmart.
  • Spirion joins the Microsoft Intelligent Security Association.

Blog Posts


Contacts

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

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Katie the Intern 3/12/21

March 12, 2021 Katie the Intern No Comments

Hi, HIStalk! So sorry it has been a few weeks. I’ve been working on some COVID-19 research pieces, applying for full-time jobs, and working in my other part-time positions. Hope you all are well! 

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Today’s column features an interview with Jack Jeng, MD, MBA, chief medical officer at Scanwell Health. He has served in the role for two years and worked in roles managing partnerships, business development, and medical and regulatory affairs. 

Scanwell Health developed an app for users to complete laboratory tests and obtain fast results from home. Tests include UTI and kidney disease detection, but Scanwell Health hopes to soon have COVID-19 antibody and antigen tests available.

“We develop software to allow at-home medical testing to be performed,” Dr. Jeng said. “We take existing tests that have already been developed by manufacturers and we help them adapt it so that now it can be used at home with the help of the Scanwell software.” 

The Scanwell Health app takes a photo of a testing strip (for tests such as the UTI detection test) and runs the image through computer vision algorithms to obtain lab results, Dr. Jeng said. There is little wait time and users obtain results in the privacy and comfort of their home. 

“You don’t have to worry about sending any samples back to a lab or about waiting for results,” Dr. Jeng said. “You get the results pretty much immediately.” 

Scanwell’s software doesn’t just return lab results using this color-metric technology. It also walks users through how to complete at-home lab tests and connects them to health care provider partners. For the UTI test, Scanwell Health connects test takers to Lemonaid if they’d like to see a provider after they receive test results. Responses typically come from providers within two hours of submission.

“Once you get the result, you can choose to complete a telehealth consult by tapping a button in the app that takes you to a telehealth provider,” Dr. Jeng said. “You would answer some questions with their doctors, and if appropriate, the doctor would write you a prescription.” 

So how do these tests work? Users order a test and then a QR code is scanned when ready to use. The Scanwell app loads instructions for that test and explains how a user will perform the collection needed. For the UTI test, the app tells users to collect a urine sample on the provided test strip or “scan card.” The app will then start a timer for the reaction time and tell the user to take a picture of the test strip. 

“It will run a few algorithms to make sure the lighting is standardized, there are no shadows, and the quality of the image is appropriate,” Dr. Jeng said. “If it passes all those checks, it will then look at the change in color on the test strip and give you a result right away.”

The algorithms used by Scanwell software standardize the image taken by the user, Dr. Jeng said. “Ultimately, it is using the smartphone’s camera and our software’s algorithms to give you the result.”

Scanwell Health is partnering with Innovita to develop tech for COVID-19 antibody testing. Scanwell is also partnering with Becton Dickinson for a COVID-19 antigen test. While both of these tests are still in development phases, Scanwell Health is excited about their ability to give users fast results for COVID-19. 

The developing COVID-19 antigen and antibody tests won’t use the color-changing technology used in the UTI tests. These tests will use lateral flow assay testing, Dr. Jeng said, to detect the presence of a particular substance similar to a pregnancy test.

The COVID-19 antibody test should offer results in as little as 15 minutes. This test is performed after a finger prick, which would also be guided by the Scanwell Health app. The collection card will then be photographed by the user. These lab results will eventually be counted for COVID-19 case numbers because they will be documented through lab testing.

“Once the test is available to the public, we’re able to facilitate state and federal public health reporting requirements because we have an app that is the one doing the analyzing of the test strip,” Dr. Jeng said. Scanwell Health will be able to share these results because there is no reliance on users reporting a positive or negative result. 

While these COVID-19 tests are still in their study phase and will need to go through the FDA review process, the technology that Scanwell Health makes for reading these tests has been used for many years. Scanwell Health’s founder and CEO, Stephen Chen, MBA developed the idea from a family business that manufactures in vitro diagnostic tests. 

“He was working at the family business on the next generation of urine analyzers when he came up with the idea of what is now Scanwell,” Dr. Jeng said. Stephen Chen saw the potential that smartphones offered for users to have better access and control of healthcare related testing. Since 2010, Chen worked on the idea of smartphone powered test analyzers and founded Scanwell Health in 2018 after FDA clearance of the UTI test. 

As far as the future of Scanwell Health beyond the developing COVID-19 antibody and antigen tests, Dr. Jeng said that Scanwell hopes to bring this ease-of-access testing to rural areas without close healthcare access. The possibilities for future tests are unlimited, as testing does not have to be limited to infected diseases but can also provide tests for chronic disease testing and monitoring. 

“Our focus is on bringing as many tests into the home as possible because we recognize that more and more people are seeking ways to get care from home,” Dr. Jeng said. “It really enables people to test and get treated on their terms, where they want, when they want.”

Scanwell Health also has a chronic kidney disease test and is working on studies for monitoring kidney disease over time. Scanwell Health received a $1.6 million grant from the NIH for this study with the hopes that it could provide insight into early signs of chronic kidney disease by testing participants once a month.

Dr. Jeng said that Scanwell is exploring options for their tests to be documentation of negative COVID-19 tests in the future. Scanwell Health also has a focus on bringing testing to middle to low-income countries. They work with an organization called Find to develop malaria tests in pilot countries such as Cambodia, Indonesia, Rwanda, and Sudan. Scanwell Health hopes to expand testing so that people all over the world have better access to testing and healthcare technology.

“When we look at lower-income countries, they don’t have the same kind of infrastructure as we do. They don’t have the same number of labs and access to testing, but a lot of them do have smartphones,” Dr. Jeng said. “Our approach, we think, is really universal, and what may be considered convenient in the United States could be the only way to do testing in another country.”

That’s it for this column. Hope you enjoyed! 

Katie The Intern

Katie

Email me or connect with me on Twitter.

Weekender 3/12/21

March 12, 2021 Weekender No Comments

weekender


Weekly News Recap

  • PatientPoint acquires one-time high flyer Outcome Health.
  • Brainlab acquires Mint Medical.
  • A former Practice Fusion sales exec pleads guilty to obstructing a federal investigation into the company’s EHR change to push opioids on behalf of its drug company client.
  • Telus will acquire Babylon Health’s Canadian operation.
  • Harris acquires Bizmatics.

Best Reader Comments

[Small banks being like small providers facing large competitors] This is a good analogy from a tech angle, but bad from a business angle. Your local bank had assets that big banks were interested in. Your local practice or average small hospital does not. What will happen to them is more like what happened to independent pharmacies. When CVS came to town, the payout for your local pharmacy owner was a sign-on bonus for their new employment contract at CVS. (IANAL)

[On Newfoundland and Labrador choosing Change Healthcare Canada to develop staff scheduling software] Healthcare staff scheduling is a well-developed product category. I’m very familiar with this sector. Workbrain, Kronos, and QHR Technologies all have good solutions on offer. Also, the $28 million in incentives? Newfoundland has a bad budget deficit and no idea how to pay that off. I mean, there was semi-serious talk of just asking the federal government to come in and take over. [Brian Too]

Insurtechs, like Oscar and Clover, offered a little bit more [than provider portals] – aggregated patient histories, simplified rostering, and direct scheduling – but they weren’t light years ahead. The biggest difference between the two groups was in how much better the insurtechs were at marketing their provider portal tools … Traditional insurers didn’t attempt to defend their tech at all. They offered the kind of bland, no-frills login page you’d expect to see guarding an enterprise intranet. Investors generally believe disruption = tech superiority, so it’s not hard to see why insurtechs would take the advantage of owning that perception, especially when incumbents are leaving it unchallenged and free for the taking. (J-Hambone)

It feels like there is a lot of combined insurer-health tech-healthcare provider activity lately. My PCP is at Atrius Health, which Optum bought. And Cigna just bought MDLive, which I would guess is the third or fourth biggest telehealth company. Those are both areas that health systems thought they could grow into, but insurers are beating them out. And I’m sure that the little startup insurance companies are doing product R&D and plan to prove something works before getting bought by Optum or one of other big dogs, sort of like how in the 90s it seemed like everyone was trying a crazy software startup and Microsoft would then buy the ones that worked out. (IANAL)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Ms. P in Florida, who asked for 10 books whose theme is “it’s OK to be different.” She reports, “Thanks to your kindness and generosity, I can choose from a multiple of well written and diverse literature. This means that my little friends can find themselves represented in the stories that I read. These students who were previously marginalized in literature are now the heroes or heroines. We learn so much from the different cultures that it created an atmosphere of acceptance for diversity. For example, we started playing music from different cultures as a form of acceptance. The Caribbean kids got to share soca with the class and next week the Latinos will choose a song for us to enjoy. My kids welcome diversity and see the beauty in everyone now.”

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In England, a 27-year-old former teacher from Canada who has experienced two rounds of osteosarcoma that has metastasized and is likely terminal hopes to finish a 16-week hospital rotation that will allow her complete her medical degree requirements. Krista Bose was not allowed to work in hospitals until she finished a chemotherapy round that would have made it unsafe for her to be exposed to COVID-19 patients. She explains why she is is willing to accept what could be a life-threatening risk to complete her MBBS: “No matter what I say, or what I want, or what I hope, my life is limited. This might be the last year my life … I’m willing to take that risk … If I have a limited amount of time left, but I spend that time doing what I love with the people I love and working towards my goals and working for the sake of other people and to help patients, then that’s a life worth living.”

University of Missouri pays $16 million to settle personal injury and false advertising claims over a university-developed knee repair procedure that plaintiffs claim had an 86% failure rate. One of the two developers is a veterinarian, who the lawsuits claim was allowed to perform the procedure without supervision. He holds a distinguished chair position in the university’s medical school, is chief of its orthopedics research division, and is director of operations and research of its joint center.

Police charge a Miami-area woman with practicing medicine without a license after she botched two attempts to perform a $2,000 nose job on a man who was left disfigured. The man says she also prescribed antibiotics and painkillers under a doctor’s name. She appears to be the operator of Millennium Anti-Aging and Surgery Center, a medical spa that offers plastic surgery, Botox, weight control plans, electrotherapy, and general surgery. It is conveniently located adjacent to the House of Kabob and a traffic ticket lawyer.

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Northwell Health donates items that were used to inject the US’s first dose of coronavirus vaccine — at Long Island Jewish Medical Center on December 14, 2020 — to the medical collection of the Smithsonian’s National Museum of American History. The donation includes the scrubs, ID badge, and vaccination record card of Sandra Lindsay, RN, MS, MBA, director of critical care patient care services. 


In Case You Missed It


Get Involved


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Morning Headlines 3/12/21

March 12, 2021 Headlines No Comments

Brainlab Acquires Mint Medical to Advance Quality and Structure of Data Gathered in Clinical Routine and Research

Germany-based imaging workflow vendor Brainlab acquires Mint Medical, which provides a structured workflow for analyzing medical images.

100Plus Announces $25M Funding by Prominent Investors to Transform the Remote Patient Monitoring Market with its Rapidly Expanding Solution

AI-enhanced remote patient monitoring vendor 100Plus raises $25 million and has signed distribution agreements with AdvancedMD, DrChrono, and Athenahealth.

Forward Health Raises $225M to Expand Nationwide

Forward Health, which offers direct primary care at a flat fee of $149 per month in eight US cities, raises $225 million in a Series D funding round.

Tausight Closes $20 Million Series A Financing to Discover and Help Secure Protected Health Information (PHI)

Tausight, a Boston-based startup focused on securing PHI, raises $20 million in a Series A funding round.

WELL Health to Boost its Digital Health SaaS Revenue and to Expand EMR Business to International Markets with Proposed Acquisition of Intrahealth

Vancouver-based Well Health will acquire Intrahealth, a New Zealand EHR vendor, for $15 million.

News 3/12/21

March 11, 2021 News 2 Comments

Top News

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Sponsored point-of-care patient education vendor PatientPoint acquires one-time high flyer Outcome Health to form PatientPoint Health Technologies.

The acquisition was rumored in October 2020, when the value of the combined companies was estimated at $600 million.

Outcome Health was valued at $5 billion until November 2019, when its two founders and two of its executives were charged with $1 billion in fraud for overstating revenue and inflating ad performance to overcharge drug company advertising clients.

Outcome Health’s founders, former CEO Rishi Shah and former president Shradha Agarwal, along with the two other executives, have pleaded not guilty to fraud and are scheduled to stand trial in February 2022.


Reader Comments

From Digital Dragoon: “Re: technology and insurers. Some of these tools will be threats to individual hospitals and practices, probably the smaller ones.” Maybe, but the bigger threat is those providers staying relatively small, which means they can’t compete effectively in many areas. Small banks were a good example of limited-scale operations that may or may not have jumped on ATMs and online services, but they were going to be toast regardless because they were being circled by competitors who were committed to change – not just semi-accepting of it – in a quest to gain economy of scale. Also note that those small banks didn’t usually fail and instead sold out profitably to the better-funded and more intense regional chains that were rapidly on their way to becoming national powerhouses, courtesy of altered anti-competitive laws (changing regulations is another thing that big companies can do that smaller ones can’t). Most of those small banks were probably not unhappy about being bought out and may have conducted themselves all along knowing that they were likely to enjoy a financially successful outcome. Takeaway: technology doesn’t necessarily drive success, but it is often competitively used by successful companies who pair it with ambition and skilled execution.


HIStalk Announcements and Requests

Dear PR people: I almost never read a press release that starts with the word “today” given that (a) every announcement pertains to “today” (it being an announcement and all); and (b) the date of the announcement’s already defines “today” better than the word, which won’t be “today” when someone reads it tomorrow.

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Reader Mark’s generous donation, with matching funds applied from my Anonymous Vendor Executive and other sources, fully funded these Donors Choose teacher grant requests:

  • Headphones for virtual learners of Ms. B’s elementary school class in Houston, TX.
  • A mobile whiteboard for math lessons for Ms. C’s first grade class in Fresno, CA.
  • A document camera for Ms. M’s kindergarten class in Sharon, WI.
  • Mobile carts and storage bins for simultaneous in-person and virtual class of Ms. A in Dallas, TX.
  • Math manipulatives for Ms. M’s elementary school class in Detroit, MI.

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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Germany-based imaging workflow vendor Brainlab acquires Mint Medical, which provides a structured workflow for analyzing medical images.

Forward Health, which offers direct primary care at a flat fee of $149 per month in eight US cities, raises $225 million in a Series D funding round. 

Vancouver-based Well Health will acquire Intrahealth, a New Zealand EHR vendor, for $15 million.


Sales

  • Walgreens uses Nuance’s Intelligent Engagement conversational chatbot to help customers schedule their COVID-19 vaccinations by telephone.
  • Northeast Georgia Health System chooses Kyruus ProviderMatch to create a system-wide provider directory and power patient-provider matching for consumer search.
  • CareMount Medical will deploy RCxRules Revenue Cycle Rules Engine for claims scrubbing and submission.
  • Northeast Ohio Medical University licenses VisualDx to teach observational clinical reasoning and differential diagnosis, especially in patients with dark skin, which represent 28% of the VisualDx images versus 19.5% in common medical education resources.
  • Michigan Medicine contracts for 3M’s speech recognition, coding, and clinical documentation products. 3M acquired MModal’s technology business, which included most of the products involved in this sale, in early 2019 for $1 billion.
  • Healthcare Outcomes Performance Company selects Emerge to convert data from its legacy EHRs to Athenahealth, normalize the data sets, and create a searchable database.
  • Leon Medical Centers (FL) will implement Bluestream Health’s telehealth platform.

People

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Lauren Verdery (EY) joins Nordic as SVP of brand, marketing, and communications.

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Health Data Movers hires Monte Hess (Quest Diagnostics) as VP of sales and recruiting.

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Industry long-timer Jeff Litterst, who was most recently director of enterprise sales at NThrive, died Monday at 57.


Announcements and Implementations

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PeriGen’s Vigilance continuous labor monitoring system goes live in Area 25 Health Centre in Malawi in a project with Baylor College of Medicine and Texas Children’s Hospital. Facebook posts about the center by Mr. Omar of Child Legacy International show a patient meal (all products were harvested from the health center’s own garden except the rice) and a local artisan teaching expectant mothers how to weave.

Health Catalyst launches an updated Healthcare.AI suite of products and services.

Healthcare Growth Partners advised Bizmatics on its acquisition by Harris Healthcare.

Censinet announces RiskOps, which consolidates enterprise risk management and operations across clinical, regulatory, cybersecurity, research, and supply chain.

Metro Health – University of Michigan Health reports that hypoglycemia and hyperglycemia were reduced by 54% and 40%, respectively, since its implementation of Glytec’s EGlycemic Management System. Metro Health implemented the cloud-based system remotely last year as COVID-19 interrupted its planned rollout.

Google Cloud announces GA of an API that collects and stores the privacy choices of an app’s users, then validates individual data requests to determine if they should be allowed based on those stored user preferences.


COVID-19

WHO declared COVID-19 to be a pandemic on March 11, 2020. I ran reader poll results that day in which 75% of respondents said that cancelling HIMSS20 was the right thing to do. That day’s HIStalk also included warnings about ICU demand and a shortage of ventilators and staff in hospitals in Italy, as well as comments from former FDA Commissioner Scott Gottlieb, MD (just before the pandemic was officially declared) warning that the US was already overrun with coronavirus, public gatherings would need to be curtailed, and businesses should plan to offer teleworking.

One year after the pandemic was declared, CDC reports that 96 million doses of COVID-19 vaccine doses have been administered of 128 million distributed, with the US on track to have 100 million citizens vaccinated by early April. The US has contracted for more than enough supply to vaccinate everyone.

COVID-19 was the US’s third-leading cause of death in 2020 as overall deaths jumped 15%.


Other

In Canada, a doctor who treated a veteran who later committed a triple murder and then killed himself says that a better connection between provincial and military EHRs “would certainly be beneficial.” He said that accessing the patient’s Halifax records required using that province’s buggy SHARE web viewer, but even then, some of the doctors who saw the patient kept only paper notes that weren’t being scanned into Meditech and SHARE, so he didn’t know the patient’s history. The man had been home from residential psychiatric treatment for two months and the doctor still didn’t have access to his chart, leading to confusion over who was supposed to be coordinating his care.

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A study of clinical decision support rules in nine Epic-using sites finds that 0.5% of the statements contained errors in Boolean logic, whose nested true-false statements can be hard for people to intuitively understand. The authors recommend that EHR vendors consider adding the open source error-checking tool that they developed for the study. They also note that their method can detect only logic statement errors, not cases in which a statement won’t work as expected, such as a rule that attempts to identify patients outside of normal weight range by selecting BMI < 25 and BMI > 25, where “and” should be “or” since both conditions will never be simultaneously true and thus no patient will ever be selected.


Sponsor Updates

  • Everbridge receives a new patent related to its Public Warning system, pertaining to technology focused on hybrid population alerting systems and intelligent sending of messages in public mobile networks.
  • Authority Magazine features “Kelly Maggiore of Impact Advisors on The 5 Leadership Lessons She Learned From Her Experience.”
  • The Chartis Center for Rural Health honors Mercy Health Lakeshore as a 2021 Top 100 Critical Access Hospital.

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 3/11/21

March 11, 2021 Dr. Jayne No Comments

I had an opportunity this week to do something I haven’t done in a while, and that was to support a go-live.

It was very different than my pre-pandemic experiences, with very few implementation support staff actually on the ground. I was pulled into it by chance. A friend of mine has been helping lead a major health system EHR replacement project for more than 18 months. Along the way, the health system acquired a small cardiology practice and had allowed them to stay on their legacy EHR until the main roll-out was complete. They planned to circle back and do the conversion.

I’ve been involved peripherally over the last couple of quarters since the cardiologists are on a fairly niche system and I had done a couple of conversions off of that system previously. Often people don’t realize until they get to an EHR conversion how bad the data management is in their current system. For example, the legacy system stores blood pressure values in a single text field rather than having separate fields for the systolic and diastolic numbers. It also didn’t have restrictions on it that prevented users from entering non-numerical values or excessively high values, so we had to make some difficult decisions on how much data we were going to try to bring into the new system and how we would prevent poor data from coming across.

Generally, the physicians understood the need to make those decisions, but they were a little more resistant to the overall conversion process because they would be giving up all their individually-customized visit templates and coming onto the health system’s enterprise version. I was asked to do a fair amount of “physician whispering” as part of the project, making sure that they understood the “what’s in it for me?” component of the conversion. We knew it would go more smoothly if they felt they were receiving a benefit as opposed to being forced to do something they didn’t want to do.

Surprisingly, one of the more difficult physicians was the youngest, who had actually trained on the EHR they were moving to. In breaking down his concerns, it seemed like most of his resistance stemmed from being upset that he had come into a private practice situation where he thought he would be on a partner track. Now he was one of hundreds of physicians employed by a large health system. There’s a lot of psychology to unpack there, and being able to explain the benefits of integration every time he threw up a red flag was helpful.

The practice’s super users were responsible for doing most of the support during the go-live, with backup from a vendor-specific consultant. I was engaged to be on call as escalation support for physicians who needed significant hand-holding or who had issues that would take a little longer to work through, since the super users were trying to do their day jobs as well as support the go-live. We knew that two of the doctors would be leaving early in the day due to other commitments and would likely need help in the evening as they logged back in to complete charts, and I was going to be plugged in there as well. One of them did really well and only sent me a couple of text messages with specific questions, but the other became an immersive support experience.

Most of his frustration was around the fact that he had decided to leave the office for a conflict that he decided wasn’t ultimately worth his time, and he was aggravated that he was now having to make up work in the evening. He wanted to do a web support session. We spent the first 15 minutes with me just listening to his frustrations as he worked through his inbox, which was full due to being out of office, not because of the new EHR.

He actually had a decent knowledge of the system, but felt like he needed someone to tell him he was doing the right things with his documentation rather than trusting his intuition. He kept getting interrupted by family issues and jumping off and on our support session, which didn’t help the situation. Having done this for a long time, I understand the importance of work-life balance and that family life happens, but the ability to focus on the thing in front of you is ultimately key for long-term success.

The physicians knew that their support window was closed between midnight and 6 a.m., so I did get a little bit of a break before starting the morning’s adventures. Everyone is scheduled to be in the office this morning (as opposed to being at the hospital or doing procedures), so that will be all hands on deck. Fortunately, the practice managers have held the line at making sure schedules are slightly reduced to allow the staff to adjust to the new system, so I hope things run smoothly. I hope the physicians who are used to being perpetually double-booked don’t find the relaxed schedule too shocking. Maybe they’ll be inspired by seeing how it can be when you’re not running every day on a steep uphill climb.

Everyone seemed to be in good spirits this morning and I’ve only had two calls, so that’s a win in my book. We’ll see what the rest of the week holds. I do like mid-week go-lives because they allow people to have a break after the first few days on a new system and then come back refreshed the following week.

I’m not on call for coverage this weekend, so I’ll be looking forward to a break as well. Spring has finally arrived in my neck of the woods and I will be spending some quality time outdoors. Although there’s a fair amount of rain in the forecast, it will be nice to get away somewhere out of cell service range and just enjoy the fact that winter is on its way out.

What are you most looking forward to about spring? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 3/11/21

March 10, 2021 Headlines No Comments

MRO Announces Acquisition of Cobius Healthcare Solutions

Release-of-information and clinical data workflow software vendor MRO acquires Cobius Healthcare Solutions, which offers reimbursement and compliance risk management technologies.

PatientPoint Combines with Outcome Health to Create PatientPoint Health Technologies

Digital pharma advertising and patient education company Outcome Health has merged with competitor PatientPoint to create PatientPoint Health Technologies.

Hack of ‘150,000 cameras’ investigated by camera firm

Hackers use a “super admin” account to tap into Verkada security cameras in hospitals, clinics, manufacturing plants, jails, and businesses.

Morning Headlines 3/10/21

March 9, 2021 Headlines No Comments

Cedar Closes $200M in Series D Funding to Continue Fueling Growth as a Leading Patient Financial Engagement Platform for the Healthcare Industry

Patient payment vendor Cedar raises $200 million in a Series D investment round led by Tiger Global Management, giving it a $3.2 billion valuation.

Rennova Terminates Discussions with TPT Global Tech, Inc.

Rural hospital operator Rennova Health cancels plans to sell its software and genetic testing interpretation divisions to InnovaQor, which would also include telehealth technology that Rennova had licensed from TPT Global Tech.

Health Recovery Solutions, Remote Patient Monitoring and Telehealth Leader, Completes Series C with LLR Partners

Remote patient monitoring and telemedicine vendor Health Recovery Solutions announces a Series C funding round led by LLR Partners.

Ibex Medical Analytics Raises $38 Million to Accelerate Adoption of AI-powered Cancer Diagnostics in Pathology

AI-powered cancer pathology diagnostics vendor Ibex Medical Analytics raises $38 million in a Series B funding round, increasing its total to $52 million.

Ambulnz (dba DocGo), a Leading Provider of Last-Mile TeleHealth and Integrated Medical Mobility Services, Announces Agreement to Become Publicly Traded via Merger with Motion Acquisition Corp.

Emergency medical services-focused telemedicine company DocGo will merge with Motion Acquisition Corp. to become a publicly traded company with a $1.1 billion valuation.

News 3/10/21

March 9, 2021 News 1 Comment

Top News

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Former Practice Fusion Director of National Accounts Steven Mack pleads guilty to attempting to obstruct the federal investigation into the relationship between Practice Fusion and Purdue Pharma after admitting he deleted hundreds of relevant computer files from his work-issued laptop.

Practice Fusion paid a $145 million settlement in January 2020 to resolve federal allegations that it violated the False Claims Act by configuring its EHR software to influence the prescribing practices of its end users for the benefit of opioid manufacturers like Purdue.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor GetWellNetwork. The Bethesda, MD-based company’s interactive solutions engage patients and families, empower clinicians, and deliver outcomes that matter. It has been helping to unite providers and patients as partners in the healthcare journey for 20 years. From inpatient to outpatient, its comprehensive cross-continuum platform bridges care settings to create a seamless experience for patients and their families. Recent big news for the company was its acquisition of Docent Health, which offers AI-enabled outreach technology for consumer engagement and “next best step” in their care across episodes. Thanks to GetWellNetwork for supporting HIStalk.


I took a look at the technology being touted by some of the insurance companies and for-profit primary care chains that claim that their “full tech stack” differentiates them from stodgier but infinitely larger and more profitable competitors. That seems to be especially common in companies that offer Medicare Advantage plans. Consumer-facing apps usually had some combination of these capabilities:

  • Appointment scheduling.
  • Messaging, either directly with clinicians or with a “concierge team.”
  • Telehealth visits.
  • Plan details and benefits management.
  • Status of claims, payments, prescriptions, and lab results.
  • Doctor and urgent care finder.
  • Cost comparisons, either drug or procedure.
  • Smart watch or fitness tracker connectivity for health prompts, activity goals, synchronization.
  • Prescription renewal requests.
  • Home prescription delivery.
  • Lifestyle assessment (sleep, diet, stress, exercise).
  • Alerts and reminders.
  • Collaborative sharing of EHR data and clinician notes (this was one specific national primary care practice).

These services alone don’t offer much competitive advantage since they are commonly offered. I expect that back-end systems contribute more to how companies market themselves, upsell to members, and create efficiency that may or may not translate into efficiency that can boost margins, so these seem a lot more important. Some of those I thought of:

  • Anything that can help an insurer get to the scale needed to reduce per-member costs, improve provider negotiating position, and improve actuarial forecasts. Predicting and controlling costs is the bread and butter of insurance companies, which are not, despite their self-assigned labels, technology firms.
  • Sales tools, especially for insurers and their broker network.
  • Automated onboarding systems.
  • Any kind of self-service capabilities that can reduce administrative costs.
  • Enrollment for clinical trials, selling data to drug companies.
  • Supporting paperless communications.
  • Efficiently serving employers, who are the actual customer for most US-sold health insurance.
  • Analytics to nudge members into behaviors that reduce short- or medium-term costs (companies aren’t likely to worry about long-term costs since members come and go and these public traded companies worry quarter to quarter).
  • Customer relationship management to help overcome impersonal relationships at scale and to sell additional services, either those offered by the company or co-marketed through a third party.
  • Chatbots to support members with administrative needs at scale.
  • Patient education.
  • Chronic condition monitoring and at-home monitoring to reduce the need for provider services.
  • Customer segmentation and analytics to support variable pricing.
  • Tools for clinicians to help ensure evidence-based practice, reduce documentation burden, increase payment efficiency.
  • Fraud detection.
  • Trying to integrate the web of third-party services that is the US healthcare system (labs, specialists, out-of-network providers, pharmacies, medical devices, home care, etc.) to provide a single experience that customers value.

My admittedly superficial conclusion is that most of the consumer-facing technology that insurers are rolling out is limited, focusing mostly on administrative tasks, upselling and cross-selling, and giving customers an alternative to long phone wait times for questions or complaints. A significant reason for this limited technology arsenal is that pure insurers have a mostly intrusive administrative role between the provider and the patient. It’s a different and much more interesting story when the insurer has vertically integrated itself to offer its own services in competing with providers who accept its insurance (as in the Kaiser Permanente model). 

For me, then, companies that have a small insurance footprint (in terms of enrollees, markets served, revenue, etc.) seem to be highly at risk to big competitors who can outspend them, replicate their innovative tech tools, and just buy those companies if they get too sassy. US healthcare is almost always dominated by big companies that kept getting bigger, and late starters who hope that tech-powered disruption can upend the market (whether the insurance market or the stock market) may find that to be harder than it sounds.


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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Canadian telecommunications company Telus will acquire Babylon Health’s Canadian operations. The deal includes a $70 million licensing fee for virtual care technology already used by Canadians in the Babylon by Telus Health app. Babylon Health is reportedly exploring IPO options via merger with an SPAC.

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Patient payment vendor Cedar raises $200 million in a Series D investment round led by Tiger Global Management, giving it a $3.2 billion valuation.

Rural hospital operator Rennova Health cancels plans to sell its software and genetic testing interpretation divisions to InnovaQor, which would also include telehealth technology that Rennova had licensed from TPT Global Tech. Rennova says the companies could not agree on terms, but it will still pursue separating its software assets.

AI-powered cancer pathology diagnostics vendor Ibex Medical Analytics raises $38 million in a Series B funding round, increasing its total to $52 million.


Sales

  • USA Health (AL) selects Twistle’s COVID-19 vaccine management technology, including automated patient outreach and adverse effect reporting.
  • Wellstar Health System (GA) will offer its employees digital health and wellness resources from Sharecare, and will work with the Atlanta-based company to develop similar tools for patients.
  • Hartford HealthCare (CT) will implement Cedar’s patient billing software.
  • The Christ Hospital Health Network (OH) selects Omnicell’s automated Central Pharmacy Dispensing Service.
  • Mountain Health Network (WV) will work with Infor, The Chartis Group, and Avaap to implement Infor’s CloudSuite ERP technology.

People

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Kevin Johnson, MD, MS (Vanderbilt University Medical Center) joins University of Pennsylvania as professor, VP of applied informatics at University of Pennsylvania Health System, director of a new informatics center, and senior scientist in science communication.

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Southwestern Health Resources hires Donghui Wu, PhD, MBA (Texas Health Resources) as VP of data science and analytics officer.

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Investor and advisor Scott Vertrees joins Heal as CEO, replacing co-founder Nick Desai, who remains a shareholder.

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H1 names Julie Stern (HealthReveal) CISO and VP of engineering.

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Alcatel-Lucent Enterprise promotes Lisa Simpson to head of North American sales.

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Provider analytics vendor Trilliant Health hires Sanjula Jain, PhD (The Health Management Academy) as SVP of market strategy / chief research officer.


Announcements and Implementations

Fifteen VA health systems and medical centers in 11 states join Medicom’s health information network.

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Change Healthcare announces GA of Data Science as a Service, which assists customers in using de-identified claims and social determinants of health data for analytics projects.

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Philips will add OpenDoctor’s radiology patient self-scheduling technology to its new Patient Management Solution of its Radiology Workflow Suite. The system will also offer contactless registration, automated communication, and intake questionnaires.

Meditech launches a genomics solution for its Expanse EHR, which includes the ability to collect and store patient genetic information, connect to reference labs, and enable personalized treatment. Its embedded pharmacogenomic alerts are provided by First Databank.

PVerify launches a real-time and batch Medicare Beneficiary Identifier lookup solution that can be accessed via API, Excel file batch processing, or individual patient lookup on the company’s portal.


COVID-19

CDC says it’s OK for people who have been fully vaccinated against COVID-19 to gather indoors without masks and distancing, as long as the group is made up of either all people who have been fully vaccinated or those from the same household who are not at increased risk. Masks and distancing are still recommended while in public, while visiting with unvaccinated people who are at increased risk, or when assembling in groups that involve multiple households. Domestic and international travel are still not recommended, advice that CDC defends by citing a lack of information about the impact of variants. 

A study finds that the relationship between obesity and negative COVID-19 outcomes is nearly linear, as increased BMI is associated with higher rates of hospitalization and death. Severely obese patients were 33% more likely to be hospitalized and 61% more likely to die of COVID-19 than non-obese people.

A study that was performed using University of California EHR data finds that 27% of people who tested positive for COVID-19 experienced symptoms that lasted 60 or more days afterward, including shortness of breath, chest pain, cough, or abdominal pain. Many of those people did not originally experience any symptoms when they tested positive, and the severity of any initial symptoms didn’t always line up with eventual post-COVID problems. Patients in all age groups had long COVID effects, including 11 of the 34 children in the study. The study was limited in that (a) it was not able to review people who were asymptomatic but didn’t get tested; and (b) the static 60-day snapshot would have missed an unknown of people who don’t develop problems until after two months.


Other

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A long-time hospital IT technologist friend of HIStalk and supporter of my Donors Choose projects sent a CIO job opening my way for Denver Health. You can read all about its clinical and community services (the latter are extensive), and on the IT side, Denver Health is in the 91st percentile of Epic’s gold stars program and recently migrated its self-hosted data centers to colocation centers (the new CIO will lead development of a full-blown cloud strategy). US News & World Report ranks Denver and nearby Colorado cities as four of the best five places to live in the US (Boulder, Denver, Colorado Springs, and Fort Collins). What better candidate can you get, my reader asks, than someone who routinely reads HIStalk? I appreciated that thought so much that I decided to mention the job opening here, which I usually wouldn’t do.

University of Washington researchers develop an Alexa skill that can detect heart rhythm problems in people who sit within two feet of a smart speaker during a telehealth visit. They are also looking at whether the same technology could detect sleep apnea in the home.


Sponsor Updates

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  • Clinical Architecture staff volunteer at the Gleaners Food Bank of Indiana.
  • Capsule receives the 2021 New Product Innovation Award in the North American remote ventilator surveillance industry.
  • Humber River Hospital in Canada deploys Ascom’s transformative tech ecosystem for improved patient safety.
  • CarePort announces that more than 130 hospitals and health systems selected CarePort Care Management in 2020.
  • CereCore publishes an overview of Meditech reporting and regulatory submission.
  • The Cerner Charitable Foundation approves medical grants for 66 children.
  • SOC Telemed earns full URAC accreditation in telemedicine.
  • Frost & Sullivan features Change Healthcare in its Executive Brief, “Empowering Healthcare with a Cloud-based Enterprise Imaging Strategy.”
  • ChartSpan will market its services to members of the Kentucky Hospital Association.
  • Clinical Computer Systems, developer of the Obix Perinatal Data System, releases a new Clinical Concepts in Obstetrics podcast, “Cardiac Disease in Pregnancy.”
  • Divurgent releases a new episode of The Vurge podcast, “Using AI to Identify and Correct Issues with Claims.”
  • Waystar adds text statements to its line of payment tools, and announces that nearly 300 healthcare facilities now use its Price Transparency solution.

Blog Posts


Contacts

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

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Morning Headlines 3/9/21

March 8, 2021 Headlines No Comments

Former Practice Fusion Sales Executive Pleads Guilty To Obstructing Government Investigations Into Purdue Pharma And Practice Fusion

Former Practice Fusion Director of National Accounts Steven Mack pleads guilty to attempting to obstruct a federal investigation into the relationship between Practice Fusion and Purdue Pharma after admitting he deleted relevant computer files.

Heal Appoints Veteran Operational Leader Scott Vertrees as Chief Executive Officer

Investor Scott Vertrees joins Heal as CEO, replacing co-founder Nick Desai, who remains a shareholder.

HIE Networks Relaunches as Centralis Health

Tallahassee, FL-based health data exchange vendor HIE Networks rebrands to Centralis Health.

Curbside Consult with Dr. Jayne 3/8/21

March 8, 2021 Dr. Jayne 4 Comments

The Washington Post ran a piece this week on Zoom fatigue. It brings up some good questions about whether calls really need to have a video component and links to a paper on the topic titled “Nonverbal Overload: A Theoretical Argument for the Causes of Zoom Fatigue.”

The author, Jeremy Bailenson, PhD, is a professor and founding director of Stanford University’s Virtual Human Interaction Lab. He concludes that there are four major causes of videoconferencing fatigue:

  • Excessive direct eye gaze as people look at faces close up rather than at notes or other places in the room.
  • Increased cognitive load interpreting nonverbal behaviors.
  • Constant self-evaluation from seeing ourselves in real time.
  • Reduced mobility for those used to walking and talking on phone calls or in person,

Bailenson recommends use of the “hide self” view and minimizing the video call screen as potential solutions. He also recommends that meeting hosts specifically ask attendees to look around their environments and move around as they would in an in-person meeting.

Another paper from Andrew Bennett, PhD, assistant professional of management at Old Dominion University, is pending publication in the Journal of Applied Psychology. It offers some specific suggestions for reducing videoconference fatigue:

  • Hold meetings earlier in the work period.
  • Enhance perceptions of group belongingness.
  • Mute if not speaking.
  • Take breaks from looking at the screen, both during and between conferences.
  • Establish group norms for mute, camera, acceptability of multitasking, hand raising, etc.

Interestingly, Bennett’s research found inconclusive evidence for changes in webcam usage or using the “hide self” view.

Other potential solutions to videoconference fatigue might be to do calls as audio only. Those of us who have been videoconferencing for years have already been through this and created solutions.

At some companies, the first few minutes of a call includes video so that everyone can see each other and have a time of relationship building with a little bit of chit-chat. Then cameras go off as the meeting gets underway. I like that approach personally because I take a lot of notes during meetings and people sometimes find my downward gaze to look like inattention. I’m still a pen-and-paper girl for many of my notes because I find it helps me remember content better. I also like to keep my microphone live all the time so that I don’t forget to unmute before speaking. I have a quiet work environment so this generally works, and my pen makes far less noise than my clacking keyboard would.

I personally find Zoom calls to be fatiguing only when dealing with individuals who haven’t figured out how to effectively use the system. We’re a year into this pandemic and if you don’t know where the mute button lives by now, I really feel for you. This sentiment is found in numerous comments on the Washington Post article, along with other positive impacts of remote work including decreased commuting time and expenses. I was also annoyed with a recent Zoom call that I knew was going to be audio-only when it wouldn’t let me in because I tried to access it on a computer that doesn’t have a webcam. I don’t know if that’s a setting on the host side since usually I just use my laptop, but it resulted in some last-minute scrambling.

I might be in the minority, but I find the use of Zoom backgrounds to be distracting, especially when there is a lot of bleed-through or issues with people moving around a lot and having parts of their body disappear. If you’re a fan of backgrounds, I definitely recommend investing in a green screen so you can get the best performance out of the system. Otherwise, I would recommend trying to find a calm corner to customize for when video is needed or considering something like a folding screen to provide a neutral background.

I am on far too many calls where people have children and pets running around in the background, and that’s definitely distracting. I once terminated a call when I dialed in to find my coworker sitting by her pool with her children in it. She said she didn’t want them to be in the pool without her, but thought it was OK to be on a call. I’m a firm believer that if you’re supposed to be supervising your kids in the pool, you had better be giving them your full attention. She disagreed, but I certainly didn’t need to enable her dangerous behavior.

Another angle on Zoom fatigue is to make sure that you are leveraging the leisure time benefits of videoconferencing as well as the work-related ones. I have monthly happy hours with people all across the country that wouldn’t be as much fun if we were only on the phone. It helps establish the role of videoconferencing in building relationships and not just driving one crazy. I’m about to embark on a trip with one of my video happy hour friends, and if our conversations are any indicator, it should be a doozy of an adventure. Without building a friendship on video, we might not have even thought about this since our previous interactions were mostly built on emails about cute shoes and boots.

Zoom has also allowed me to continue to take music lessons despite the pandemic. I previously studied in my instructor’s home, and since she has an elderly relative in the household, she stopped in-person lessons fairly early in the pandemic. I was happy to avoid the 90-minute round trip commute. Although Zoom isn’t perfect, the platform has made some significant enhancements to allow it to better handle events such as music lessons. The “original sound” feature has been enhanced, along with other audio settings, to allow a truer audio representation. My only issue with it is that I can’t seem to default it on, so sometimes I forget to turn it on for every lesson. As an adult beginner on this particular instrument, I was definitely less anxious about playing my first recital via Zoom than I would have been had I been in an auditorium with my 5- to 9-year-old peers.

What do you think about the idea of Zoom fatigue? Leave a comment or email me.

Email Dr. Jayne.

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