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Morning Headlines 7/20/20

July 19, 2020 Headlines No Comments

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

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

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

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

Hattiesburg Clinic selects new CEO

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

Monday Morning Update 7/20/20

July 19, 2020 News 1 Comment

Top News

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

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

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

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


Reader Comments

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


HIStalk Announcements and Requests

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

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


Webinars

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


People

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

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


COVID-19

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

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

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

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

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

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

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


Other

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

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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Cerner News

July 19, 2020 News No Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meditech News

July 19, 2020 News No Comments

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

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

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

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

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

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

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

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

Weekender 7/17/20

July 17, 2020 Weekender No Comments

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Weekly News Recap

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

Best Reader Comments

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

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

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

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

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


Watercooler Talk Tidbits

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

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

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

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

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

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


In Case You Missed It


Get Involved


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Morning Headlines 7/17/20

July 16, 2020 Headlines No Comments

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

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

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

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

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

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

News 7/17/20

July 16, 2020 News 6 Comments

Top News

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

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

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

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

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

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


Reader Comments

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

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

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


Webinars

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


Acquisitions, Funding, Business, and Stock

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

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

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

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


Sales

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

People

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

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


Announcements and Implementations

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

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

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

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

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

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


Government and Politics

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


COVID-19

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

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

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

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

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

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


Other

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

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


Sponsor Updates

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

Blog Posts


Contacts

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

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EPtalk by Dr. Jayne 7/16/20

July 16, 2020 Dr. Jayne No Comments

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Email Dr. Jayne.

Morning Headlines 7/16/20

July 15, 2020 Headlines No Comments

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

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

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

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

Liberty Fox Technologies Joins GPMF Holdings Family Of Companies

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

Morning Headlines 7/15/20

July 14, 2020 Headlines 1 Comment

Amazon Makes Health Care Access Even Easier for Employees with Launch of New Third-Party Health Centers

Amazon will conduct a health center pilot with primary care service provider Crossover Health, which will operate 20 Neighborhood Health Centers in five cities that will serve Amazon employees and their families.

Bottleneck for U.S. Coronavirus Response: The Fax Machine

The New York Times reports that a broken data system — which often includes fax machines as a primary means of communication — is hampering US COVID-19 response.

EConsult Solution Company AristaMD Adds Ascension Ventures and .406 Ventures to Investment Syndicate, Completing Its $24 Million Series B Financing

AristaMD adds $6 million to its Series B investment round with additional funding from Ascension Ventures and .406 Ventures.

Athenahealth Rebrands Centricity Business to athenaIDX, Reflecting Continued Strategic Focus on Helping Health Systems, Hospitals, Billing Services, and Large Practices Optimize Financial Performance

Athenahealth rebrands its Centricity products, acquired from GE Healthcare through a series of acquisitions and mergers, to AthenaIDX in homage to original developer IDX Systems.

News 7/15/20

July 14, 2020 News 8 Comments

Top News

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A New York Times article says that a broken data system — which often includes fax machines as a primary means of communication — is hampering US COVID-19 response.

The article notes that:

  • Nearly all lab results were reported digitally to public health departments before the pandemic, but a shortage of testing capacity and high payments brought in new lab companies that aren’t set up for public health reporting and they insist on using fax.
  • Washington State’s health department brought in 25 National Guard members to perform manual entry of information that is not being sent electronically.
  • The public health department of infection hotbed Harris County, TX was overwhelmed when its fax machine was “just shooting out paper” when a lab faxed hundreds of pages of test results all at once.
  • Information that is sent outside of data feeds – by phone, email, snail mail, and fax – is often duplicated, sent to the wrong recipient, or missing important patient information. Nationally, 80% of test results are missing demographic information and half don’t have addresses. New federal guidelines, which recommend but don’t require that senders include such information, don’t take effect until August.
  • Reporting test results in Austin, TX requires reviewing 1,000 faxes per day that arrive on average 11 days after the test was taken, making the results worthless for contact tracing. The health department is telling people who are experiencing symptoms to just assume that they are positive.

In related news, the White House is considering asking governors to send the National Guard into hospitals to help them collect daily COVID-19 information about patients, supplies, and capacity. The American Hospital Association is not happy with this news, saying that hospitals have cooperated with “evolving data requests” and suggesting that the Guard’s expertise could be better used elsewhere.


Reader Comments

From Livongo vs. Allscripts: “Re: CEOs. Tullman’s big mistake was keeping his existing executive team with the Eclipsys acquisition, and they didn’t understand the acute market. Black’s dbMotion acquisition was a disaster since it sold only to existing customers and many of them have dumped the whole thing for Epic. Black also purchased garbage products from NantHealth right after its owner bought Sunrise for his Verity hospital chain, after which Allscripts sunset the products and Verity filed bankruptcy and bagged out of the contract. The Healthgrid acquisition was good, but the McKesson acquisition was a disaster, sending the Paragon customers who could afford to switch to competitors. The Practice Fusion acquisition fueled Veradigm, which has done well, but it cost them $160 million in DOJ fines plus legal fees. I haven’t seen any announcement of new Sunrise or TouchWorks sales for a long time. Bottom line is that the industry seems to trust Tullman more than Black and somehow the board has for some reason allowed Black to remain after seven-plus years as the stock dropped 50%.”

From Gerald Aldini: “Re: management. I’ve been offered a promotion that would place me over my co-workers. Good idea or not?” Becoming the boss of your peers is certainly awkward, but more importantly, are you a builder or a leader? Which makes you prouder, sequestering yourself to create something amazing or being in charge of people who do so under your guidance? Rules-breaking artists won’t likely be happy taking a rules-enforcing job supervising other artists, regardless of the expanded authority, office, and paycheck that comes with that responsibility. I’ve had quite a few conversations with management peers over the years in which we secretly expressed a longing to return to our happy days of headphones-on programming, where our cubicles were a secret doorway to a universe of our own creation and we left our work problems behind when we headed home. Take the management job if you get that same satisfaction from convincing or coercing people to do what you want instead of what they want and love conference room arm-wrestling with peers over resources and priorities. One more piece of advice, which I took myself when I begrudgingly accepted a health system promotion from doing what I loved to taking a promotion doing something I didn’t even like — a co-worker will probably take the job if you don’t, so reporting to a former peer may be more distasteful than the other way around even if you don’t really relish the new job.


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor Jvion. The Suwanee, GA-based company delivers clinical AI solutions that allow providers and payers to manage unforeseen health risks, improve health outcomes through personalized recommendations, improve patient and member engagement, and reduce costs. These go beyond simple predictive analytics and machine learning to identify at-risk patients who are likely to benefit from specific interventions. The company’s product has been deployed by 300 hospitals across 50 health systems that report an average 30% reduction in preventable harm and annual savings of nearly $14 million. Specific use cases include hospital-acquired conditions, healthcare-associated infections, readmissions, bedside patient rescue, discharge optimization, patient experience, oncology care, and behavioral health. The company just released its solution suite for payers, which includes population health, cost and utilization management, behavioral health, and member activation and engagement. The company was recently featured in a New York Times article for its COVID-19 employer recovery package that predicts exposure and infection risk. Industry long-timer Jay Deady is CEO, so thanks to Jay and to Jvion for supporting HIStalk.

I found this recent YouTube video in which Duke University Health System’s chief analytics officer describes how the health system uses Jvion to manage falls and allocate resources.

Listening: new from Everybody Loves an Outlaw, a Texas duo who can crank out Janis Joplin-like blues. I’m not a fan of slide guitar and handclapping bar songs so I pass on those, but their moodier songs hit the spot. I’m fascinated that Taylor kept laying down tasty guitar licks as Bonnie practically mounted him lustily on camera at the 2:20 mark before she redirected her passion back to the song “I See Red,” which describes killing a philandering lover.


Webinars

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


Sales

  • FDA licenses access to the TriNetX global health research network for its Sentinel Program, which will give it access to de-identified, real-world data for monitoring the use and potential shortages of critical COVID-19 drugs.
  • In England, the National Institute of Health and Care Excellence and Flatiron Health will study real-world evidence from Flatiron Health’s EHR database starting with a comparison of predicted versus actual survival outcomes. NICE produces evidence-based guidance for the National Health Service.

People

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Chris Belmont, MBA (The HCI Group) joins Memorial Hospital at Gulfport as VP/CIO.

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Direct Recruiters, Inc. promotes Kasey Kaiser and Josh Olgin to partner.

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Apervita hires industry long-timer Miya Gray, MS (BrainScope) as SVP of customer success.

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Meta Healthcare IT Solutions founder and CEO Sal Barcia, RPh, MS announces on LinkedIn that he is leaving the company after 29 years.


Announcements and Implementations

Surescripts announces that 21 healthcare organizations are live on its Clinical Direct Messaging service for transmitting Electronic Case Reporting of COVID-19, with another 18 sites in progress.

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Amazon will conduct a health center pilot with primary care service provider Crossover Health, which will operate 20 Neighborhood Health Centers in five cities that will serve Amazon employees and their families. The first center will open in Las Colinas, TX and will offer extended hours to accommodate employee work schedules.


COVID-19

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The White House orders hospitals to bypass CDC in their COVID patient data submissions, telling them to send their daily Excel files instead to CDC’s parent HHS to track hospital capacity, resources, and PPE availability. People sometimes forget that the sprawling HHS bureaucracy includes the alphabet soup of OCR, ONC, AHRQ, CDC, CMS, FDA, and NIH.

A CDC editorial in Tuesday’s JAMA Network calls for universal wearing of masks, saying that “the public needs consistent, clear, and appealing messaging that normalizes community masking” as a civic duty.

Quest Diagnostics admits that its average turnaround time for COVID-19 results has increased from 4-5 days two weeks ago to more than seven days now. The company also warned investors that Q2 revenue will be 6% lower because it is performing fewer more lucrative tests during the pandemic.

In one city in India, COVID-19 patients will be required to use city-issued electronic token to be admitted to private hospitals, whose beds the city wants to reserve for patients who have symptoms. Private IT firms developed the technology that an around-the-clock city team will use to assign tokens that contain a specific bed number.

In what could be a preview of sending kids back to school, a New York mom who kept bringing her child to an in-home daycare while waiting to receive her own COVID-19 test results spreads the infection to at least 16 people in four families, including six children, a sibling, seven parents, and two grandmothers. The mom was tested on a Tuesday and continued to bring her child to daycare every day until she received her results on Friday. She apologized for ignoring the quarantine, saying she had nobody else to care for her child, who also tested positive.

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The public health department of Catawba County, NC does an amazing job of contact tracing in showing how a 20-person, mask-free family gathering led to 14 infections, with those symptom-free folks then spreading COVID to at least 41 people over just 16 days, including a bunch of co-workers, some beach trip companions, an 85-year-old neighbor, and some children. It’s probably safe to assume that the spread has gone further since.

Four former CDC directors say in a Washington Post op-ed piece that public health faces two opponents – COVID-19 as well as political leaders who are determined to undermine CDC’s work. They particularly dislike the White House’s threat to weaken CDC’s return-to-school guidelines, saying that “the only valid reason to change released guidelines is new information and new science, not politics” and observing that disdain for policies and practices that worked all over the world has led the US to have 4.4% of the world’s population but nearly 25% of its coronavirus infections.

Israel reports that 47% of the people who were diagnosed with COVID-19 last month were infected in schools, following a sudden decision to reopen them.

In Florida, Sunday’s huge jump to 15,300 new COVID-19 cases on Sunday may be due to Florida Department of Health data reporting backlogs. A Virginia lab that performs 10,000 to 13,000 tests every day for Florida residents says it can’t explain how state data showed 52,000 results from it on Sunday, of which 7,000 were positive, both numbers representing around half of the state’s total. Still, 16% of the state’s tests were positive, which indicates an increasing infection spread.

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The Texas Tribune reports that hospitals are turning away COVID-19 patients and holding up ambulances for up to 10 hours at their EDs due to a lack of capacity.

A CNBC article describes why Israel was so successful in the initial phase of the pandemic before fanning a viral resurgence by opening too soon:

  • Universal healthcare coverage is offered, sold by four competing non-profit insurers, They all use the same technology, making public health surveillance easy.
  • The country created a predictive model to identify high-risk people, then sent them SMS and phone messages and doctors to offer them telemedicine and home care.
  • The largest of the insurers sent daily symptom questionnaires to members to identify potential hot spots early.

Other

Two people file a class action lawsuit against Teladoc Health, claiming that telehealth company hired a marketing firm to make robocalls that pitched Teladoc’s $30 monthly membership plan, which in their case involved dozens of calls made to their numbers that they had listed on the Do Not Call registry.

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An observational and interview study of IT-involved people in nine healthcare organizations characterizes in broad terms how they see the relationship they have — or want to have — with their EHR vendor, with these categories:

  • Marine drill sergeant. Healthcare organizations with limited knowledge or discipline expect their EHR vendor to force them to follow a standard implementation or configuration, especially if they have struggled previously with a heavily customized system that reflected illogical workflows.
  • Mentor. The client wants the vendor to make non-binding recommendations based on their experience with other customers.
  • Development partner. An organization that sees itself as an innovator chooses an EHR vendor that can develop new features to support their experimentation.
  • Seller. The customer just wants to buy a system with minimal ongoing vendor contact.
  • Parasite. A vendor with one dominant customer neglects its other customers to the detriment of both the vendor and the singularly important customer.

My take on this: the above EHR vendor categories highlight the industry’s change in which early (and mostly failed) inpatient EHR vendors encouraged customers to make programming demands to support their often illogical processes in the “we are special” heyday. It’s pretty remarkable that Epic has made the “marine drill sergeant” vendor role not only acceptable, but desirable (although Meditech arguably developed that role). Nobody would have predicted that young, healthcare-inexperienced EHR vendor employees could convince C-level executives with decades on the job to re-examine their processes that were often in place only because the hospital’s managers had never worked elsewhere and didn’t know any better. Epic’s brilliance is bribing clients (in the form of rebates) to follow best practices, applying pressure at the CEO/CFO level where those big checks made out to Epic are signed, and gaining buy-in for massive organizational changes using go-live pressure that keeps the customer from noticing that their long-protected Band-Aid is being ripped off.

Epic publishes yet another press release, which makes me wonder what’s changing in Verona since they had never run any until recently.

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Tweet of the day.


Sponsor Updates

Blog Posts


Contacts

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Get HIStalk updates.
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Morning Headlines 7/14/20

July 13, 2020 Headlines No Comments

Allscripts and Microsoft Extend Strategic Alliance to Transform Cloud-Based Health IT Solutions

Allscripts will offer an Azure cloud-based version of its Sunrise EHR as part of a five-year extended agreement with Microsoft.

VA’s Post-Pandemic Plan: Expand Health Care Services at Walmarts

VA Secretary Robert Wilkie says the agency will add more Walmart-based telehealth sites once the pandemic winds down.

Kidney diagnostics developer Renalytix AI sets terms for $78 million US IPO

UK-based Renalytix AI, which has developed a predictive algorithm using data culled from EHRs, hopes to raise $78 million in an IPO this week.

Curbside Consult with Dr. Jayne 7/13/20

July 13, 2020 Dr. Jayne 2 Comments

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HIPAA has been a thing for most of my medical career. Although the Health Insurance Portability and Accountability Act was actually enacted on August 21, 1996, it didn’t actually begin to go into effect until April 14, 2003 when the HIPAA Privacy Rule was required. Of the sub-parts of HIPAA, this is the one that most people know the most about.

It is also frequently used to create an inappropriate barrier to information sharing. I can’t count the number of times that hospitals have told me they can’t tell me the status of a patient who I have referred to their emergency department “due to HIPAA.” Apparently they think that HIPAA is a magical force field, and if you’re not part of the hospital’s medical staff, you can’t be allowed in.

Despite the Privacy Rule being in place more than 17 years, I’m working with an IT organization that isn’t doing very well from a Privacy Rule standpoint. They are a mature user of their EHR, having been on the system for at least a decade. However, their use of its features hasn’t kept pace with the evolution of the tool, and they find themselves in a bit of a legal pickle.

I enjoy working on projects like these. It gives me a chance to dust off my database skills and help a group understand its vulnerabilities and how it can improve. Some of these items spill over into the HIPAA Security Rule, circa 2005, with its emphasis on technical safeguards for protecting patient information. In the spirit of sharing some free consulting, I offer you the lessons learned from my client’s situation.

First, have a documented policy and procedure on access to electronic health record systems and other ancillary applications, such as laboratory information systems, radiology information systems, and any other systems where Protected Health Information is stored. These are part of the administrative safeguards in the Security Rule, but beyond that, you can’t claim employees didn’t do the right thing when you never spelled out what actions were right and what actions were wrong. The policy should include a mention of educational resources to be sure that staffers understand the terminology of HIPAA and understand how those elements fit the systems they access.

I remember the health system I was working for when the Privacy Rule went into effect made a series of videos that were themed somewhere in the vicinity of gangsters a la Al Capone, and the fact that they’ve stuck with me this many years later shows that they were memorable. The video linked back to written content that we had to review along with an acknowledgement we had to sign in order to continue being employed. The organization I’m working with at present has an outdated employee handbook with little mention of HIPAA and the obligations of staff to do the right thing.

Second, be sure you have clearly documented job descriptions as well as roles and responsibilities. When you find out that someone administrative was trolling around in EHR charts that have nothing to do with their role in the billing department, you don’t want them to explain that they were “helping Dr. X that day” or that someone was out so they were doing “other duties as assigned” with no way to prove or disprove that what they were doing in the EHR was inappropriate. For those situations where people do have to cross cover, make sure they know where their boundaries are. As an example, someone covering telephone messages for refill requests probably doesn’t need to be accessing the alcohol and tobacco history in patient charts.

Third, make sure you are keeping up with the security features of your EHR. If it allows you to restrict security by job role, make sure you have this set at the most granular level appropriate for the job roles in your organization. Purely clinical employees shouldn’t have access to the billing side of the system, and non-clinical employees who might have to reference clinical information should have their access appropriately controlled. If a billing team member often has to provide copies of office visit notes or test results, give them access to those parts of the system. Do not give them access to document on clinical visit templates or to order medications.

I’ve seen unfettered access more times than I care to recall. If your system allows use of inclusion/exclusion lists to further secure subgroups of patients (such as employees, or professional sports teams, or VIPS) consider using those features.

Fourth, make sure you understand the audit functionalities of your system and that you have a policy in place for regular auditing, even if it is just spot auditing. Of course, if you see high-profile or celebrity patients, you might need to have a more active audit program, but many organizations can get away with spot audits to make sure employees are doing the right thing.

One of the issues facing my client right now is that they didn’t have the right pieces of the audit tool enabled. Although they were tracking access to clinical data, they weren’t properly tracking whether that data was updated, printed, exported, or simply viewed.

Finally, make sure you have a policy that addresses access of patients’ own charts or those of their family members. Even if a staff member is legally permitted access to a patient’s information, whether by being a parent / guardian or through a signed release, it’s probably not a good idea to allow them to access those charts on their own. In my practice, if I want to print a copy of my own lab results for my personal records, I have to work with one of our clinical staff to request the document and have them generate it for me, just like any other patient would. The only difference is that I’m making my request in person rather than over the phone. Our process keeps everyone honest and reduces the risk of inappropriate access.

These are simple things, and you would think organizations would have figured them out by now. Unfortunately, quite a few haven’t.

How does your organization handle similar issues? What’s the wildest HIPAA violation you’ve seen? Leave a message or email me.

Email Dr. Jayne.

Morning Headlines 7/13/20

July 12, 2020 Headlines No Comments

Top supplier of electronic medical records to pay $2.55M for cybersecurity firm

In Canada, clinic operator and EHR vendor Well Health Technologies will acquire the cybersecurity division of Cycura.

Former Gwinnett healthcare executive pleads guilty to sabotaging medical shipments

A former VP of finance for a medical device packaging company in Atlanta pleads guilty to trashing the company’s computer systems after being fired.

Ahead, a platform that connects psychiatrists with patients, raises $9 million

Mental healthcare startup Ahead raises $9 million in a funding round led by online B2B pharmacy company Truepill.

Monday Morning Update 7/13/20

July 12, 2020 News 1 Comment

Top News

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A KLAS report on pediatric practice ambulatory EHRs names PCC as the clear leader.

PCC and Athenahealth scored well in product robustness and value.

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The report says that PCC significantly outperforms other vendors in relationships with its personal approach, proactive support, and hands-on executive involvement.


Reader Comments

From Livongo and Prosper: “Re: CEOs. In 7.5 years as CEO of Allscripts, Paul Black has taken the stock from $13 to $6.50 per share with a $1B market cap. In one year, Glenn Tullman has Livongo’s stock at $108 with a market cap of $10B. Black helped push Tullman out and now Tullman is laughing all the way to the bank. How does Black still have a job?” I’ll offer these points in resisting the urge to oversimplify the situation:

  • Tullman had Allscripts in a complete mess during the last few years of his tenure, including making questionable acquisitions, infighting with Eclipsys loyalists after buying that company, taking a snake oil sales approach to milking the Meaningful Use cow, fumbling clownishly over the MyWay EHR, claiming that the company’s science fair of acquired old products were integrated by definition since they all ran Microsoft SQL, and desperate suing its own customers and prospects that had chosen competing products.
  • Black’s performance has been more measured, but not very inspiring or visionary. He, too, was at the helm during some major corporate gaffes, such as making a deal with equally desperate NantHealth, announcing but never actually selling the Avenel EHR, and buying Practice Fusion with the full knowledge that it was waiting for the DOJ hammer to fall for helping drug companies push opioids inappropriately. He’s made some potentially good decisions that have taken the company outside its core EHR business in hoping to avoid getting squashed by the Epic juggernaut and strong ambulatory competitors, but I can’t recall hearing anything all that exciting about TouchWorks and its stablemates in years.
  • Livongo is surfing on a sea of employee health hype that it’s hard to see lasting forever, especially given the failure of similar companies to prove their value via unbiased outcomes studies. Tullman has deep experience in working the stock market, having taken Allscripts through a Series J funding round or something like that before going public, so he’s in his element as Livongo board chair.
  • Black is better than Tullman was in always announcing something new that makes it hard to judge apples-to-apples quarterly company performance, usually an acquisition that promises fresh opportunities in some hot sector.
  • Allscripts wasn’t much of an innovative development shop under either CEO and has exhibited little in the way of vision or passion.
  • Tullman mostly stuck to EHRs and related technology during his Allscripts days, while Black favors buying distressed health IT merchandise to wring out a few drops of profit while hoping to sell the customer base something else.
  • We don’t know how much of either company’s success is due to its highest-ranking executive. Neither Tullman nor Black were board chair of Allscripts while serving as CEO. Tullman is board chair at Livongo but not CEO. Nor do we know that Allscripts would perform any better under a different CEO who doesn’t control the board. You can do only so much while investors are staring you down quarter by quarter and most of your products are in mature markets that have strong competitors.
  • My conclusion is that only some degree of a publicly traded company’s performance can be attributed to the CEO. Tullman was damaged goods after the board put the company out of its misery by firing him, but he has certainly made a better name for himself after founding Livongo, which surprised me.

HIStalk Announcements and Requests

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It’s 55-45 on my poll asking whether it’s OK for an employer to fire someone for off-work action or social media posts that don’t result in legal charges. Commenters point out that free speech protection in the First Amendment applies only from the actions of government, not employers, and employers are free to send an employee packing for nearly any reason that doesn’t violate Equal Employment Opportunity requirements. My definition of “OK” was intentionally fuzzy since company reasons for termination can be equally so, but the bottom line is that people lose their livelihoods every day for reasons that may have little to do with job performance.

New poll to your right or here: Which of these activities have you performed on a mobile device in the past year?


Webinars

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


People

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Mick Brown (Change Healthcare) joins post-acute telehealth provider Third Eye Health as VP of strategy for health systems and ACOs.


COVID-19

The US has nearly 52,000 people hospitalized with COVID-19, approaching April’s peak of 60,000 and nearly doubling the June 15 count. Texas has 10,000, California 8,000, and Florida 7,000. Florida reported 15,300 new cases on Sunday. Deaths have finally taken a national upturn as expected from the case and hospitalization counts, now standing at 134,000. Nursing homes are once again being hit hard, with some reporting dozens of deaths and residents making up 40% of the COVID-19 deaths in Texas.

America’s push to get students back in school will be a global experiment since no other country has every tried to institute a return to campus during raging coronavirus outbreaks.

The White House reportedly canceled the scheduled media appearances this week of Anthony Fauci, MD after he disputed President Trump’s assertion that a lower death rate shows US progress, which Fauci he called a “false narrative” that could lead to complacency. Fauci says he hasn’t spoken to the President since early June.

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Morgues in parts of Texas and Arizona are full and refrigerated trucks are being set up there.

The federal government sends an Army medical task force and HHS disaster response team to Houston.

Atlanta will reactivate a 200-bed COVID-19 field hospital at the Georgia World Congress Center after closing it in May after it had treated just 17 patients. The state has also contracted with Piedmont Healthcare to add 100 ICU and surgical beds to deal with the COVID-surge. Both actions came after health system CEOs urged the governor to help them continue their profitable elective surgeries. 

More than two dozen Mississippi state senators, its lieutenant governor, and its House speaker test positive for coronavirus after weeks of close-quarters meetings in which most or all of them ignored mask recommendations.

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Intensivist Nick Mark, MD describes the problems with using the benign term “ICU capacity”:

  • Critically ill patients go to the nearest hospital, so statewide figures mean little if the nearest available ICU beds are hundreds of miles away.
  • Higher ICU census is associated with worse outcomes.
  • ED boarding of patients waiting for ICU beds have an increased risk of death because EDs don’t have the staffing ratios and facilities needed for long-term patient care.
  • COVID-19 patients need much longer stays than the ICU average of around three days, tying up beds for a long time and more likely to need ventilator support.
  • ICU capacity is often calculated across all types of beds (medical, surgical, cardiac, burn, trauma, and even pediatric) and in some cases count PACU beds as ICU.
  • Not all ICUs can provide interventions such as negative pressure rooms, dialysis, and ECMO and other interventions for acute respiratory distress syndrome.
  • Step-down rooms can be “upleveled” into an ICU, but skilled staff will be in short supply. ICU staffing is based on an expected occupancy of around 60%.
  • Burnout, PPE shortages, and healthcare worker infection are likely with expanded ICUs.

SNAGHTMLe52fe0

I missed this earlier: hospitalist and CMIO Dirk Stanley, MD, MPH lays out how to determine COVID-19 status from a patient’s EHR. Thanks to @CraigJoseph for tweeting the link.


Other

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A former VP of finance for an Atlanta medical device packaging company pleads guilty to trashing the company’s computer systems after being fired, which he accomplished by using a phony logon that he had created beforehand. The company distributes PPE, shipments of which were delayed due to deleted data from its ordering and fulfillment systems.


Sponsor Updates

  • Selling Power includes Nuance as a “Best Company to Sell for” on its annual list.
  • PatientPing publishes a new e-book, “CMS’s E-Notifications CoP: The Route to Compliance.”
  • Black Book Research publishes a new report, “Exploring Physicians’ Perspectives on How COVID-19 Changes Care.”
  • Pure Storage publishes a case study, “St. Joseph’s Health achieves speed and reliability with Pure Storage.”
  • Redox releases a new podcast, “The Digital Episode of Care with Bronwyn Spira of Force Therapeutics.”
  • The Journal of Psychopharmacology publishes an article on a study of comparative rates of delirium of various types of AHTs that used real-world data from TriNetX.
  • Vocera releases a new Caring Greatly Podcast, “Physician Suicide and the Impact of COVID-19 – Pamela Wible, MD.”

Blog Posts


Contacts

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

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Weekender 7/10/20

July 11, 2020 Weekender No Comments

weekender 


Weekly News Recap

  • Health Catalyst will acquire Healthfinch for $40 million in shares and cash.
  • A Health Affairs blog post calls for ONC to start measuring the impact of the interoperability requirements of the 21st Century Cures Act.
  • VA seeks robotic process automation to import patient documents from external providers into VistA and Cerner.
  • Walgreens will spend $1 billion over the next five years to open VillageMD primary care clinics in up to 700 of its stores.
  • Informatics pioneer Octo Barnett, MD dies at 89.

Best Reader Comments

The new interoperability regulations that were promulgated in March are like any other regulations, they are only as good as the enforcement actions that will be taken. Thus, while it is fine to have a wish list of those things ONC should track, more importantly is simply enforcing the regs as they stand. Of course, putting on my cynic hat, I see this article from academics as a lead up to a research grant from ONC to support an academic endeavor to measure these metrics. (John)

Those proposed metrics are a bit confusing to me. Measuring things that aren’t in the rule as a way of implicitly adding the things we all wish were actually in the rule (but aren’t) doesn’t seem right. (Brendan)

The main barrier to telehealth is financial. I work for providers who are using telehealth extensively for med refills and wellness visits, and it has been working well. They and their patients want to continue using it, but the insurers continue to waffle on payment policies and suggest that they will only pay for online visits during the pandemic. Of course practices are preparing to bring patients back in whenever possible under those conditions. (Amanda B)

I work in mental health and much of what we do can be delivered quite well by telehealth and often by phone for patients without the ability or devices to do telehealth. The vast majority of our patients do not want to come into the office and the vast majority of our clinicians do not want to sit in a small poorly ventilated office where there is a risk of COVID transmission. However, our organization is strongly encouraging us to see more patients in person because the rates for phone calls are less than telehealth or face-to-face and because the insurers are already jerking us around on reimbursement with the likelihood of additional payment-related travails from insurers and CMS down the road. (RightOn)

Unfortunately, your assessment of telemedicine is spot on. Absent a significant change in healthcare and healthcare delivery in this country, profits ($) will continue to drive behavior, despite the fact that we have the worst outcomes on a number of measures of health and healthcare in the world (including our management, or lack thereof, of COVID-19. (Michael J. McCoy, MD)

Dr. Jayne, I am so embarrassed and ashamed of our healthcare system as I read what you are experiencing in the trenches. We are about four months into this Coronavirus pandemic. I was a little more forgiving (but not much) in March since supposedly this virus caught us off guard. But now? Really? After working in healthcare since the 1970s, I have no words anymore. Just tears. (JT)

Two ways to do something, the right way and again. Allscripts has showed a willingness to take the second option as a standard practice. So, until that stops, they will lose customers. Remember the business model is to buy startups and then promise to integrate them, while not requiring them to integrate. (AnInteropGuy)


Watercooler Talk Tidbits

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Army veteran Richard Rose III of Port Clinton, OH died July 4 of COVID-19 at 37, with his previous Facebook posts in which he disdained wearing masks and checked in at crowded bars and parties now forming his obituary. He said just before he died that he probably caught the virus at the party on the upper right. Meanwhile a 30-year-old man who intentionally exposed himself to the virus by attending a COVID-19 infection party dies of it, telling his hospital nurse, “I think I made a mistake. I thought this was a hoax.”

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A Vice article describes how biomedical technicians are buying non-working, 20-year-old ventilators on Ebay, then using a handmade dongle to program around manufacturer protections so they can fix them. They can then sell the repaired device to US hospitals to meet COVID-19 demand. Newer models validate the identity of the repair tech to make sure they’ve paid the manufacturers’ $10,000 to $15,000 fee that allows them to bypass the anti-repair technology, so the market is in older machines that don’t have that protection. Ventilator manufacturers say their machines are complex and they need to limit who can work on them, while hospitals say it’s their own liability if their highly trained technicians make a mistake, which has apparently never resulted in a manufacturer lawsuit. Hospitals also note that manufacturers wouldn’t sent techs onsite in the early days of COVID, so they were stuck with machines they needed that were awaiting repair.

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A Nebraska ED nurse renders aid at a two-car accident that she encountered on her way to her daughter’s wedding.


In Case You Missed It


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Morning Headlines 7/10/20

July 9, 2020 Headlines No Comments

Health Catalyst Announces Agreement to Acquire healthfinch, a Healthcare IT Company that has Helped Define the Clinical Workflow Optimization Space with its Award-Winning Software

Health Catalyst will acquire Healthfinch, a clinical workflow optimization technology vendor headquartered in Madison, WI, for $40 million in cash and shares.

VA Wants to Automate Digitization of its 5-Mile-High Electronic Health Record Backlog

The VA seeks solutions for automating the digitization of old and new patient health records and ensuring they are linked to the correct patients.

Measure The Impact Of The ONC’s New Interoperability Rules Now

Health policy experts call for ONC to start measuring the impact of the interoperability requirements of the 21st Century Cures Act using six initial metrics.

Kindbody Raises $32 Million in Series B Funding to Grow Employer Benefits Solution and Fuel U.S. Expansion

Technology-enabled women’s care company Kindbody raises $32 million in a Series B round led by Perceptive Advisors.

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