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Monday Morning Update 7/6/20

July 5, 2020 News 2 Comments

Top News

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Medical informatics pioneer G. Octo Barnett, MD died June 30 at 89, according to colleagues.

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Massachusetts General Hospital hired Barnett in 1964 to implement a hospital information system on a time-sharing computer, from which the Laboratory of Computer Science was founded. Barnett was director of the lab until his retirement in 2012.

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Barnett, who referred to himself as a “farm boy” and “country doctor” from his upbringing in Alabama, was involved with the development of COSTAR, one of the first ambulatory EHRs, and DXplain, a diagnostic decision support system. He led the LCS group that in the mid-1960s developed early versions of the MUMPS programming language and Cache’ database, which are still used by vendors such as Epic, Meditech, and InterSystems and formed the foundation of the VA’s VistA. He was a founder and original member of AMIA.

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Joan Ash and Dean Sittig interviewed Barnett in 2004 as part of a medical informatics oral history project. It is a fascinating read. An excerpt from his advice for informatics fellows:

Get to know the people in the field. Listen and to learn from them. Go to meetings and try to be open to a whole variety of different viewpoints and projects. Don’t get discouraged too easily because there’s going to be some bad times. Hope that in some sense, you’re lucky, that basically things work at the right time and place, because it is very much fortuitous circumstances. It’s very much a time for questioning. I could certainly never have planned my career on any sort of rational, “OK, here’s what I’m going do: Step 1, Step 2, Step 3 … “ You can’t demand a hope for serendipities. That’s the problem, you can’t plan for them. I suppose the best you can do with serendipity is be aware it’s an opportunity when it’s your time.


Reader Comments

From Epic Watcher: “Re: Epic. All these headlines from unfortunate internal emails to pulling employees back to campus. You haven’t provided many thoughts about this.” I’m not an Epic employee, so I’m not all that interested and have no basis on which to opine. They can run the company however they like, and employees and customers are free to act accordingly. My only observation is that Epic has no problems attracting and keeping employees and their industry dominance speaks for itself. I don’t think the company is known for crowdsourcing its strategy and tactics to insight-blessed cheap-seaters .

From HIT CEO: “Re: HIStalk. Thanks for what you’re you’re doing. You have literally changed the industry for better and for good. There aren’t that many people that you can isolate, but what you’ve done with your site, all the way back to the early 2000s, is really fascinating, and seeing the way it has evolved is kind of cool. It hasn’t always been flattering to companies I’ve worked for, but that doesn’t matter because it gives a voice to people.” Thanks.


HIStalk Announcements and Requests

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The good news for conference organizers is that most poll respondents think they will return to some semblance of in-person normalcy, but the bad news is that they think it will take years to do so. 

New poll to your right or here: Is it OK to fire an employee for off-work actions or social media posts for which no legal charges are filed?

It has been more than a week since my young relative was tested for COVID-19 after potentially being exposed at work. She still has not received her results and her family (including a doctor) are anxious about how to conduct their lives meanwhile and what will change for them if her results are positive. We aren’t going to make much of a dent in this pandemic if we can’t fix the simple logistics of testing for it and reacting quickly to positive results.

We streamed “Hamilton” on Friday and it was spectacular, right down to playing the Roots over the closing credits. Related to it is the best health IT video ever, Mary Washington Healthcare’s self-introduction to Epic from 2017 that featured “Hamilton” inspired music and costumes that are appropriate to their historical location of Fredericksburg, VA.


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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Montreal-based patient scheduling and waiting room management software vendor Chronometriq acquires Health Myself, a Toronto patient portal startup.


People

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Allegheny Health Network names John Lee, MD (Edward-Elmhurst Health) as SVP/CMIO. He replaces Robert White, MD, who is retiring.


COVID-19

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COVID-19 test positivity rates continue to increase, especially among young adults, leading to the near certainty of wider spread and increased hospitalization and death weeks down the road. New US cases were at 57,000 on Friday and total deaths are over 132,000.   

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North American retail traffic is slowing after weeks of strong gains, suggesting that consumers are choosing to limit their exposure regardless of local, state, and federal government policies. It’s down 50% from this time last year.

The US-Mexico border closes to visitors due to COVID-19 concerns, only this time it is Mexico that is preventing Americans from entering Sonora, which is on the other side of the wall from infection-ravaged Arizona. Meanwhile, England joins the EU in trying to keep visitors from the US out, waiving its mandatory 14-day quarantine for visitors from 50 countries. That policy is still more generous than that of the EU, which banned American travelers entirely last week.

Premier calls for national stockpiling standards after its survey finds that 90% of healthcare providers as well as states are months-long quantities of masks, gowns, and test kits, creating product shortages and directing supplies away from frontline caregivers in the absence of a national strategy.

Houston doctors say hospital EDs are sending patients with obvious COVID-19 symptoms home without testing them, reserving testing for patients who meet the criteria for immediate admission. A Memorial Hermann ED doctor says hundreds of likely cases are sent home from its 17 EDs without testing because of concerns about the availability of supplies.

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In India, low-cost ventilator manufacturer AgVa Healthcare is accused by former employees of manipulating its software to show that patients were receiving more oxygen than they actually were. One hospital reported significant differences between the device’s FiO2 display and patient response, with ventilated patients experiencing restlessness, tachypnea, and sweating. Another hospital rejected the company’s ventilators, but eventually accepted them only as backups to their ICU-grade counterparts. AgVa Healthcare says the accusations are misleading, as its ventilators were tested on actual patients in both hospitals following these reports and the hospitals agreed that they worked as expected.

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A research institute in South Korea develops a robot that performs COVID-19 nasal swabs as controlled by a remote technician. It includes a live video connection and force feedback for the operator, who is not exposed to the patient during the process.

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This is an epidemiologist’s nightmare, as LA residents flee their closed restaurants, bars, and beaches for less-restrictive San Diego in moving a lot of virus around and increasing the chances of another stay-at-home order. Unfettered travel should come with a free tee shirt that says, “My neighbor took a road trip and all I got was this lousy coronavirus.” My suspicions are that viral spread on beaches is minimal, but it’s the bars and restaurants that are involved in beach trips that create a COVID Petri dish.


Other

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Chicago’s Roseland Community Hospital loses telephone and Internet service for more than 24 hours when a car crash brings down the connectivity of broadband provider Wow and the hospital’s failover to cell phones didn’t work.


Sponsor Updates

  • Spok publishes an e-book titled “The link between the quadruple aim and improved clinical communications.”
  • VentureFizz’s Lead(H)er series features PatientPing Chief People Officer Tiffany Mosher.
  • RxRevu reaches 100,000 prescribers and exceeds 10 million transactions through its real-time prescription benefit solution in 2020.
  • SymphonyRM releases a new video, “HonorHealth’s AVP Healthcare Marketing on Growth and Loyalty.”
  • Visage Imaging makes the latest version of its Visage 7 Enterprise Imaging Platform available.

Blog Posts


Contacts

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

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Weekender 7/3/20

July 3, 2020 Weekender No Comments

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Weekly News Recap

  • WellSky’s private equity owner considers selling the company at a valuation of up to $3 billion.
  • Epic will delay the return of employees to campus by month following a local uptick in COVID-19 cases, but says it is impossible to maintain its culture when employees are working from home.
  • UCSF pays ransomware hackers $1.14 million to regain access to its medical school servers.
  • A cybersecurity firm reviews Internet traffic of six Fortune 500 healthcare companies and finds significant security exposure and hacks in progress.
  • Telehealth visit counts have steadily declined since their mid-April peak, dropping from 14% of all visits to less than 8% as the availability of in-person visits returned.
  • Smartphone urinalysis company Healthy.io acquires competitor Inui Health, formerly known as Scanadu, for $9 million.

Best Reader Comments

CMS continues to blast out information like nothing else is going on in the world. Can you spell TONE DEAF???? (JT)

As to definitions, we use these. Telemedicine is doctor to doctor consults, e.g. suspected stroke patient at rural hospital. Telehealth is doctor to patient, omni-channel, asynchronous and synchronous. Virtualcare / health is telehealth combined with remote patient monitoring. (John)

Often the more important distinction is telehealth / medicine vs. virtual care. The former generally implies synchronous communication to replace an in office visit (whether via video, voice, or real-time chat). While the latter brings in asynchronous communication via chat with different care providers, data from connected devices (scales, blood pressure, SpO2, EKG, spirometers) and find a way to present it to the care team and integrate into the EHR that makes care more efficient. (Greg Chittim)

I’ve been using virtual health as the umbrella term that includes (1) telehealth (which involves any modality- video, phone, messaging) between a provider and a patient; (2) eConsult, which is any modality between two providers; and (3) autonomous health, which is any modality between a computer and a patient. My gut is that we will get to a new baseline of 20-30% of telehealth visits assuming reimbursement continues to be at least close to parity in a FFS system. And for healthcare systems in a capitated model, we may see much more. (Lyle Berkowitz)

I am afraid you are too correct in your assessment of the veracity of some state data. We can look at the assertions and testimony of Rebekah Jones, the Florida state chief data scientist who describes the manipulation of data as an example. There are other states that appear to be in similar states of data invalidity for political purposes. This is on top of the problems with data quality that are just inherent to EHR information. I am not sure how to see these trends and infection byproducts in a single EHR, unless that is a combinatorial EHR (acute, ambulatory, ED, etc.) or through a data aggregator. If our testing was both active and historical (covid markers) then we could tag patients then watch their subsequent treatments, Dx, and Rx — maybe through case reporting? But again, if you take that route then you have to trust the health departments to not be influenced by politics. (Brody Brodock)


Watercooler Talk Tidbits

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The Alabama Board of Nursing investigates a complaint brought against a nurse who shouted “Heil Hitler” to the Mobile, AL city council meeting and then threatened its members as they approved a mandatory mask-wearing ordinance. A councilman replied nonchalantly, “Good gracious alive. Heil Hitler?”

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A newly graduated nurse who had just left her wedding with her new husband “went into nurse mode” when she stopped to render aid at the scene of an auto accident while still wearing her gown.

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An unnamed female CEO of a Detroit health IT company pays $3.5 million in cash for a Sarasota, FL condo.

Twitter and JPMorgan Chase will remove the common programming terms “master,” “slave,” and “blacklist” from their source code following complaints from black engineers. Twitter will also replace “grandfathered” and “dummy value.” 

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In England, a five-year-old boy who just learned to walk on prosthetic legs following amputation raises $1.5 million so far (versus his goal of $600) in a 10K walking challenge for Evelina London Children’s Hospital, which saved his life as an abused, weeks-old baby. He was inspired and congratulated by 100-year-old World War II veteran Captain Tom, who raised $40 million for NHS charities by walking 100 laps around his garden.


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Morning Headlines 7/3/20

July 2, 2020 Headlines No Comments

Sale process underway for TPG’s WellSky

Private equity firm TPG is considering the sale of post-acute care software vendor WellSky at a potential valuation of $3 billion.

Epic Systems slows reopening plan, calls in-person work its key to success

Epic will delay the phased return of employees to its campus in Verona, WI by one month, citing its culture of on-site collaboration as vital to the success of its customers.

Startup aims AI at clinician scheduling

AI-focused SwitchPoint Ventures and PhyMed Healthcare Group launch Polaris Health, a Nashville-based vendor of analytics for provider scheduling optimization.

News 7/3/20

July 2, 2020 News 6 Comments

Top News

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Private equity firm TPG is considering the sale of post-acute care software vendor WellSky at a potential valuation of $3 billion.

TPG acquired Mediware from Thoma Bravo in early 2017, then renamed it to WellSky in September 2018.

Mediware was formed in 1980 with a focus on blood and pharmacy management solutions. It went public in 1991. Thoma Bravo took the company private in 2012 for $195 million.


Reader Comments

From Lab Matters: “Re: more existential writing style issues. EHR or EMR?” The term EHR is aspirational marketing-speak for the purely imaginary technology that contains all of your provider’s health information, your own observations and narrative, health alerts and reminders, and your health and wellness practices and purchases, all happily interoperating in real time from all data sources (including wearables) to allow an individual to monitor themselves and share their information with anyone they like as an overall picture of their health, a tiny part of which involves provider visits. What we actually have an EMR, which is an electronic but siloed version of a specific provider’s paper chart that records the episode information that clinicians need to send bills. Meaningful Use rechristened decades-old EMRs to EHRs provided they met easy, questionably relevant certification requirements, causing marketing people to wet their pants in anticipation of lipsticking their poorly selling EMR pigs for doctors to ride to the taxpayer trough. I still call it an EHR even though I’m violating my principal of not using terms incorrectly just because everybody else does. Every encounter I’ve had in hospitals and medical practices involved technology that barely met the definition of EMR, much less EHR.

From Mr. T: “Re: Baylor, Scott & White Health. The largest not-for-profit health system in Texas completed their Epic deployment with a go-live on 6/27 at their seven remaining non-Epic hospitals. This completes a multi-year rollout to standardize all BSWH clinics and hospitals on Epic and displaces Allscripts at the 13 hospitals that were the former Baylor Healthcare System.”


Webinars

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


Sales

  • OU Medicine and OU Health Sciences Center (OK) choose Optimum Healthcare IT for their Epic implementation.

People

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Anesthesiologist Lee Fleisher, MD joins CMS as chief medical officer and director of its Center for Clinical Standards and Quality.


Announcements and Implementations

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Intermountain spinoff Castell implements analytics from Arcadia to help its provider, payer, and ACO customers transition to value-based care.

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After its investment news last month, QGenda announces GA of Insights, analytics that aggregate scheduling and labor data across departments for greater visibility into provider capacity and availability.

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Children’s of Alabama implements virtual desktop and EHR infrastructure from Pure Storage.

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Health Catalyst offers Care Management Suite, a set of analytics-based apps designed to help providers with patient risk stratification, enrollment, and program management.


Government and Politics

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The FCC adds nearly $200 million to 2020 funding for its Rural Health Care Program, which has helped providers in remote areas leverage broadband networks for telemedicine during the COVID-19 pandemic.


COVID-19

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The outbreak continues to careen out of control as the US surpassed 50,000 new cases in a single day for the first time on Wednesday, with a national positivity rate of over 7% even with higher testing numbers. Florida reported more than 10,000 new cases on Thursday. Arizona reported more than 3,000 news cases with a 25% positivity rate. The county with highest number of new cases per 100,000 population is in East Carroll Parish, LA, with 194 versus the national average of 7. Florida does not publish hospitalization and death counts, but Arizona’s daily deaths are continuing their sharp climb.

Good advice to state governors from former FDA Commissioner Scott Gottlieb, MD: focus on functions that are critical for keeping the economy going and society functioning rather than “congregant settings inside that are purely entertainment” that should be closed. He says he would prioritize getting schools back open.

More than 40 high school principals who attended an in-person school leadership meeting in California are quarantined after one attendee who wasn’t having COVID-19 symptoms at the time tests positive days later. 

Young people in Alabama are throwing COVID-19 parties, urging infected people to attend to intentionally spread coronavirus to the others. Organizers are offering a cash prize for the first attendee who gets infected.

The NBA reports that 25 of its 351 players have tested positive since June 23, plus 10 of 884 team employees.

The White House plans to implement pooled testing by the end of the summer, where portions of 5-10 samples will be pooled into a single sample, and if it tests positive for COVID-19, the retained amount of the individual samples from the batch will be individually tested to identify infected individuals. Experts wonder why the US hasn’t already implemented that strategy already given its low cost, preservation of testing capacity, and success in other countries such as China, Germany, and Israel. CMS has ruled that pooled tests are not diagnostic and thus can be performed by any lab, but retesting samples from a positive batch is considered a diagnosis and can be performed only by certified labs, adding a delay of several days. Pooled testing isn’t practical in situations where positive results are common, such as in meatpacking plants or states whose infection is rampant.

Former CDC Director Tom Frieden, MD, MPH says that most US testing isn’t much good because it takes days to receive results, people aren’t isolated in the meantime, and contact tracing isn’t being employed to warn contacts quickly.

A young relative of mine was notified that her restaurant co-worker had tested positive for COVID-19 and thus my relative needed to be tested. This was last weekend, and she still hasn’t received her results five days later. I didn’t ask if she has been isolating while waiting to hear whether she is infected, but studies have shown that most people don’t. Tom Frieden is right – we’ll get a ton of spread from people who are tested but waiting for results, and that’s not even counting the several pre-symptom days where they were shedding virus without knowing they were infected.


Other

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Bloomberg questions the health IT vendor rating methods of Black Book Market Research, which they say (a) is funded by vendors despite claims of independence; (b) conducts a huge number of surveys despite being a tiny company and thus is more like Yelp than J.D. Power, and (c) published two conflicting EHR surveys in which it first declared Cerner to be the VA’s best choice for meeting President Trump’s VA-related health issues, then shortly after named Allscripts the top EHR vendor (in Black Book’s defense, they were clear about applying different criteria, although naming Allscripts as #1 vendor was indeed odd). The scattershot Bloomberg article claims that Black Book published bios of fake executives, but I think that’s because a development website is visible online that I suspect was mocked up from random LinkedIn headshot grabs (including one person who is pictured twice under different names) but that was never on the production site from the web caches that I checked. It’s really a lot of nothingness – try to extract a list of factual bullet points as I did and you’ll see that the story mostly just throws unrelated items against a wall on which none stuck.

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The advent of drive-through COVID-19 testing sites may be giving rise to drive-through clinics. A global architecture firm has designed such a facility for hospitals that are hoping to attract outpatients back with convenient, contamination-free appointments. Two Northeast facilities have expressed interest.


Sponsor Updates

  • Halo Health will co-present with Atrium Health during the virtual AWS Healthcare & Life Sciences Web Day July 9.
  • The Orange Chair Podcast features Hyland VP of Product and Strategic Planning Scott Dwyer.
  • Medhost President Ken Misch discusses his personal health journey and the future of rural healthcare on the A Second Opinion Podcast.
  • NextGate publishes a new white paper, “Patient Privacy and Data Governance in the Era of COVID-19.”
  • Redox partners with Vonage to offer providers private, embedded, and customizable video capabilities; and the ability to build apps; share health data, and securely connect with patients and other providers.
  • CarePort Health shares the success Henry Ford Health System has had using its care coordination technology to safely transition patients from the hospital to post-acute care.

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 7/2/20

July 2, 2020 Dr. Jayne 1 Comment

We had more craziness in the clinical trenches this week. Several of our sites ran out of COVID-19 testing swabs and we were told by vendors that shipments were being diverted to Texas, Florida, and Arizona. I’m not sure how we’re supposed to prevent outbreaks if we can’t test, but welcome to the world of supply chain shortages. It’s not like we haven’t had months to ramp up production, or that we aren’t unaware of the need to keep testing for the foreseeable future.

I’ve spent a good chunk of my professional career helping practices with capacity management as they transition from regular (long wait time) scheduling to open access scheduling, along with figuring out how to ramp up or down with EHR go-lives and upgrades. I’ve never dealt with anything like the capacity management needed to handle the unpredictability of COVID, so if anyone else has tips or tricks, I’m listening.

The New York Times also picked up on the issue of variability in testing capacity. One of the physicians interviewed mentioned lack of personal protective equipment as a reason why primary care practices aren’t taking on testing.

Many of the staffers at my practice gave up on having full PPE long ago and aren’t gowning up when performing swabs. Although we have an adequate but not ample supply, it’s a pain getting gowned up, and most of our staff members are taking their chances. Those of us who aren’t actually performing the swabs aren’t allocated gowns, so you just get in the habit of figuring you’re exposed and sprint to the shower when you finally arrive home.

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CMS continues to blast out information like nothing else is going on in the world. This time it was an update that “2021 MIPS Self-Nomination Materials” are apparently are now available, so Qualified Clinical Data Registries and Qualified Registries can now start the paperwork for next year. I feel like I’m a million miles away from MIPS right now, and I’m betting 80% of the US healthcare folks share the sentiment.

The FCC continues to fund telehealth projects as more organizations enter the space. I have practiced on several of the major telehealth platforms, and all I can say is that they have a long way to go before they have the features that physicians really need to do a good job. My experience is that they’re clinging to their episodic care roots and there’s not much funding to create the kind of longitudinal health record that is needed for coordinated care.

None of the systems I’ve worked in have the ability to receive records from patients or providers (or at least I’ve never been trained on how or where to see them), so it’s like starting with a new patient every single time. They are also light on clinical decision support. Documentation is barely a step above Microsoft Word, with many providers keeping their own cheat sheets for copying and pasting.

A recent report from McKinsey & Company looks at the potential for a $250 billion shift to telehealth in upcoming months and years. That’s approximately one-fifth of what payers spend on ambulatory and home health visits. I’m not sure I’m quite that optimistic given the fact that in the month since the report was released, many patients are going back to brick-and-mortar visits. Since we didn’t ramp up remote provision of other services like blood draws for chronic condition monitoring, it’s often just as easy for a patient to go back to their physician’s office for labs and a visit than it is for them to do a telehealth visit and then have to go to a reference lab’s patient service center. In order for a seismic shift to occur, we have to figure out how to deliver other outpatient services remotely and how to practice telehealth in non-crisis situations.

Other care delivery paradigms such as Direct Primary Care (DPC) are also gaining traction. I was interested to see that Baylor Scott & White is including DPC as part of its health plan. Employers can choose to separate primary care from other fee-for-service offerings. There are a lot of different flavors of DPC out there, and in this one, the physician is paid a flat rate for all primary care services regardless of the number or type of visits. It’s much more like old-school capitation than true Direct Primary Care, which cuts out the middle layer between the patient and their health provider. Another typical hallmark of DPC is that the physician no longer needs software or staff to handle coding and billing processes, which leads to savings. I think the Baylor approach is going to lead to practices not realizing the benefits because they’re going to have one foot in the boat while the other is still on the dock.

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From LegalTroubles: “Re: lawsuits from healthcare staff or unions around PPE and related issues. What are your thoughts?” Workers, including physicians, will have little recourse if they suffer illness, injury, or even death from inadequate PPE and unsafe workplace conditions. I’m a member of several COVID-specific provider forums and everyone is singing the same song about lack of PPE and being expected to work at a ridiculous pace in many areas. Any lawsuits will be defended by lawyers claiming that employers were doing what they could in a national health crisis. The reality is that that nearly 90,000 healthcare workers have been sickened by COVID-19, 600 have died, and there’s no end in sight.

I’ve worked in probably close to 100 facilities in my career. Healthcare workers have never had the level of oversight from the Occupational Safety and Health Administration that you see on most construction job sites. When is the last time you saw a “days since last accident” poster in the patient care areas of your hospital? Personally, I never have, except once on the loading dock of big-city tertiary care center.

The other day I refused to provide care to a thrashing patient due to the risk of a needle stick injury. I had to wonder whether I would be backed up by administration.

Even if employers operated with the level of diligence that they should, playing the “sorry, we just can’t get supplies” card is our new reality. The abject failure of this nation to fully leverage the Defense Production Act or other legislative actions or incentive programs to provide healthcare workers with the protective equipment they need (and deserve) is despicable. The reality is that each and every one of us, more so than the general population, wakes up each morning waiting for the other shoe to drop and wondering whether every cough or sniffle is the beginning of the end.

Do we have any MD/JD or DO/JD or legal folks in the room? What’s your take on the reader question? Leave a comment or email me.

Email Dr. Jayne.

Morning Headlines 7/2/20

July 1, 2020 Headlines No Comments

FCC Announces Funding Increase in Rural Health Care Program for Funding Year 2020

The FCC adds nearly $200 million to its Rural Health Care Program, which has helped providers in rural areas leverage broadband networks for telemedicine during the COVID-19 pandemic.

Samsung invests in genetics-focused telehealth company as coronavirus rages

Genomics telemedicine company Genome Medical raises $14 million in a funding round led by Samsung’s Catalyst Fund.

Evidation Raises $45 Million Series D, Hires CCO To Accelerate Commercial Momentum and Expand Into Virtual Health

Health data aggregation and research company Evidation Health raises $45 million and hires Sam Marwaha (Boston Consulting Group) as chief commercial officer.

Morning Headlines 7/1/20

June 30, 2020 Headlines No Comments

How hackers extorted $1.14m from University of California, San Francisco

UCSF pays a negotiated $1.14 million to ransomware hackers to regain access to servers in its medical school.

NexHealth Raises $15 Million in Series A Funding

NexHealth will use a new $15 million investment to further scale its APIs for EHR and dental practice management systems.

Optimize.health Raises Seed Extension Round to Scale Digital Health Offering

Ambulatory-focused remote patient monitoring startup Optimize.health raises $3.5 million in a seed round led by Bonfire Ventures.

News 7/1/20

June 30, 2020 News 7 Comments

Top News

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UCSF pays $1.14 million to ransomware hackers to regain access to servers in its medical school.

BBC gained real-time access to the price negotiations between UCSF and the customer service website (!!) of the hackers, which was used to negotiate the final payment amount.

The UCSF negotiator told the hacker that the university had been financially devastated by COVID-19 and offered $780,000 instead of the demanded $3 million, finally settling on $1.14 million.


Reader Comments

From TheRona: “Re: KLAS. Santa Rosa Consulting and The HCI Group have their scores temporarily suspended pending a ‘data integrity review.’ What’s the scoop?” I reached out to KLAS and received a statement from Adam Gale that I’ll summarize as follows. KLAS found during its routine data checks that an unnamed company was offering to boost vendor KLAS scores for a price via sample manipulation, sometimes falsely claiming to vendors to whom it was pitching that they were working in partnership with KLAS. KLAS says it immediately removed suspicious survey responses and data, also noting that few companies responded to the unnamed company’s offer.

From Buzzword Compliance Department: “Re: telehealth and telemedicine. Interested in the difference. Anyone care to elaborate?” I’ve seen unconvincing arguments that the terms mean different things, and I acknowledge the vast difference between “health” and “medicine” without the prefix, but I think usage has made the terms synonymous. It’s like EMR and EHR – we pretend to support “health” and use that term even though we really just care about the “medicine” part of delivering profitable encounters. I would say that telemedicine specifically refers to physicians practicing medicine from a location that is remote from the patient, while telehealth theoretically could involve other kinds of practitioners or non-professionals who are helping someone with health issues or even activities that don’t involve patients directly. Now let’s move on to “virtual visit” – is that video only, or does a telephone conversation, SMS message, or email exchange count? (I’m voting the latter).


HIStalk Announcements and Requests

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Welcome to new HIStalk Platinum Sponsor RxRevu. The Denver-based company improves healthcare by supporting informed, consistent, and frictionless prescription decisions, partnering with the largest PBMs and payers to bring accurate insurance coverage and cost data into the prescriber’s EHR workflow. The company’s Real-Time Prescription Benefit cost transparency solution brings real-time patient- and pharmacy-specific information, such as cost, coverage restrictions, deductibles, and therapeutic alternatives. Prescription Decision Support promotes condition-appropriate prescribing and cost transparency to improve patient safety and satisfaction while reducing prior authorization work. The company is working with 2,000 health systems that use Epic or Cerner, and in the first five months of 2020, it processed coverage and cost information queries from 110,000 providers in completing 10 million transactions with PBMs. Thanks to RxRevu for supporting HIStalk.

I rarely edit or otherwise alter reader comments, but I’m reminding myself and readers of the significant exception – I don’t allow comments that accuse people by name of doing something illegal or immoral. I’ve edited or deleted a couple this week because it is not fair to allow someone who is anonymous to make unproven accusations about someone who isn’t, although sometimes the political ones fall into that gray area of “public figure” with some health IT relevance and I’ll let them slide.


Webinars

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


People

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Fortified Health Security hires Dave Glenn (CBI) to the newly created role of chief revenue officer.


Announcements and Implementations

New Zealand’s MercyAscot private surgical facility goes live with InterSystems TrackCare during the country’s COVID-19 lockdown, using Microsoft Teams and remote training tools to perform a virtual implementation.

Healthcare managed detection and response services vendor CI Security announces integration with Internet of Things and Internet of Medical Things security vendors Ord, Medigate, and Cylera.

AMIA changes its November 14-18 annual meeting to a virtual event.


Government and Politics

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DOJ charges Miami entrepreneur Jorge Perez and several co-defendants with fraudulently billing $1.4 billion in healthcare charges from his EmpowerHMS hospitals, netting him $400 million. Jorge Perez bought or took over management of 18 struggling, tiny hospitals and promised to save them by using them to bill out-of-state lab tests at rural hospital rates. One hospital in a town of 1,800 billed $92 million in lab tests in just six months. Insurers got wise and stopped paying for the tests, causing 12 of the hospitals to file bankruptcy and eight to close. Hospital employees reported that their electricity was turned off for non-payment, they were stuck with medical bills due to unpaid insurance premiums, and one hospital had its beds repossessed while patients were in them. One of the defendants is Seth Guterman, MD, who had developed software to maximize rural hospital billing and who is president and founder of Chicago-based EHR vendor Empower Systems.


COVID-19

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Anthony Fauci, MD tells the Senate’s HELP committee on Tuesday that he wouldn’t be surprised if the daily number of new COVID-19 infections in the US rises from 40,000 now to an eventual 100,000. He warned Sunday that the US may not reach herd immunity even if a successful vaccine is developed because so many people will probably refuse to take it.

CDC Principal Deputy Director Anne Schuchat, MD says it is no longer possible to bring COVID-19 under control in the US, with the daily record number of new infections making it impossible to control the outbreak with contact tracing and quarantine. She says the experience with coronavirus will be similar to the Spanish flu of 1918 and nothing will stop it until a vaccine is developed. Schuchat was a key CDC player in previous outbreaks of H1N1 and SARS. Meanwhile, HHS Secretary Alex Azar says the” window is closing” to use the only available tools to address COVID-19 – distancing and masks.

Morgan Stanley’s COVID-19 model says epidemic doubling time has worsened to 41 days from 46 days last week, with Texas and Florida likely to have uncontrolled spread within 10 days if they don’t take aggressive action.

Arizona reported 4,700 new cases on Monday, with the largest increase being those aged 20-44 who also make up 22% of hospitalizations. The state has re-closed bars and other businesses, prohibited gatherings of more than 50 people, and pushed back school openings until mid-August. Florida reported 6,000 new cases on Monday with a positive testing rate of 14.4%.

A Harvard-NPR analysis finds that while US testing has improved to about 600,000 per day, it would take 4.3 million tests per day, coupled with contact tracing and a focus on people in high-risk settings, to suppress the infection’s spread.

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The EU opens travel to its 27 countries starting Wednesday to residents of 14 nations whose 14-day COVID-19 infection rate per 100,000 people is as good or better than the EU average. Residents of the US will not be traveling to Europe for the foreseeable future.

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Texas Medical Center redesigns its ICU capacity report to reflect the ability of its hospitals to use flexible capacity, responding to concerns from Governor Greg Abbott, who said that the previously reported 100% ICU occupancy was unduly alarming people. Projected bed occupancy growth predicts a move to Phase 2 ICU capacity on Wednesday. The total number of admitted patients who tested positive for COVID-19 was stable for weeks at under 500 per day until May 30, when the number started its steep, steady climb to the current 1,500+. The state’s Phase 2 reopening started on May 18.

Researchers find an emergence of a condition they are calling Multisystem Inflammatory Syndrome in children who are hospitalized for COVID-19. Those affected have heart problems, coagulation disorders, and gastrointestinal symptoms.

Former FDA Commissioner Scott Gottlieb, MD says that rapidly increasing case numbers in high-population states like Florida, Texas, and California mean that half of the US population will have had COVID-19 by the end of the year even if the current rate doesn’t increase.

Two Texas friends got tested for COVID-19 at the same facility before spending two weeks camping with others, yielding the same result (negative) but wildly different charges – one who didn’t want to bother using his insurance paid $199 in cash, while his friend is now stuck with a $900 balance that remained from Austin Emergency Center after her insurance company negotiated down the original $6,400 charge. She then went to the local TV station, after which the facility predictably cancelled her balance due.

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A Michigan college bar that was allowing patrons to ignore distancing and mask requirements is linked to 107 new cases of COVID-19. Meanwhile, UW Health says that contact tracers are finding that a high percentage of newly infected COVID-19 patients in Epic’s home county of Dane were exposed from large gatherings in bars.


Other

Telehealth visit counts have steadily declined since their mid-April peak, dropping from 14% of all visits to less than 8% as the availability of in-person visits returned. Potential red flags in this finding are: (a) telemedicine visits were counted from scheduling software appointment types, which may not be reliable; and (b) the report counted percentage of total visits as in-person visits were increasing, which provides no insight into the change in the absolute count of telehealth visits.


Sponsor Updates

  • Johns Hopkins Medicine will add HCPro’s library of physician query templates to its physician query system from Artifact Health.
  • The Chartis Group publishes a new white paper, “Under Attack: Five Practical Steps to Thwart Increased Cyber Threats.”
  • Clinical Architecture makes available its presentation from HL7’s FHIR DevDays, “Data Quality in FHIR: Lessons from the Field.”
  • Ensocare welcomes Ashley Gorham (Medical Solutions) as an account executive.
  • Hyland Healthcare will use MedPower analytics and tools to manage end-user training on its enterprise information platform.
  • In Australia, MercyAscot implements TrakCare patient administration and billing software from InterSystems.
  • Dimensional Insight will sponsor the St. Jude Walk/Run Boston on September 26.
  • Health Data Movers hires recruiters Brett Kimes (Oxford Healthcare IT) and Durc Strand (Pivot Point Consulting).

Blog Posts


Contacts

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

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Morning Headlines 6/30/20

June 29, 2020 Headlines 4 Comments

Flexwise Health Completes Merger with Prescience Health

On-demand nurse staffing company Flexwise Health merges with predictive staffing analytics vendor Prescience Health under the Flexwise brand.

System shutdown puts hold on Tennessee COVID-19 report; far SWVA adds another case

The National Electronic Disease Surveillance System Base System suffers a system failure over the weekend caused by high volumes of data input, compromising the the State of Tennessee’s ability to accurately report COVID-19 data.

Healthy.io, Israeli maker of smartphone urinalysis tech, buys its largest U.S. rival

Smartphone urinalysis company Healthy.io acquires competitor Inui Health, formerly known as Scanadu, for $9 million.

Curbside Consult with Dr. Jayne 6/29/20

June 29, 2020 Dr. Jayne 2 Comments

Back in the early days of Meaningful Use and the beginnings of the transition from volume-based payments to value-based care, I used to be knee-deep in politics, legislation, and regulation. Over the years I gradually spent more time with my nose to the grindstone helping organizations figure out how to transform and adapt to what were then final rules. From there I moved into more technology roles, helping vendors tweak their offerings and helping clients optimize their implementation.

I got away from following legislators and the courts, but the year 2020 has brought all that back on my radar. Understanding how closely tied the US healthcare system is with the US political system, especially through lobbying by powerful interests, I’m once again following the US Supreme Court and US Congress more carefully, along with various parts of government that are responsible for promulgating rules, policy, and guidelines. It’s a different place to be in, but still within the CMIO wheelhouse.

The US Supreme Court was busy last week, and although I thought I understood the meat of the DACA (Deferred Action for Childhood Arrivals) program situation, I failed to fully appreciate its ramifications on healthcare. When thinking of those impacted by DACA, most news stories feature high school students, college attendees, or young people in the workforce who are concerned about being deported after being brought here as children. An article put out by the AMA notes that approximately 30,000 of the workers impacted by the DACA decision are in the healthcare workforce.

What would our healthcare delivery situation look like with 30,000 fewer workers, some of whom have skillsets that are in shortage? Those impacted include physicians, nurses, and pharmacists. Looking at just the physicians and physician trainees, they have the potential to care for anywhere between 2 and 5 million patients during the course of their medical careers. Our nation continues to have a significant nursing shortage, to the point where we bring in travel nurses from around the world to staff patient beds in many parts of the US. Many of the lower-wage jobs in large urban health centers are staffed by immigrants, and I’m sure some of them fall under DACA as well.

The Department of Homeland Security will be re-visiting this issue and providing documentation to try to have the matter heard again, since the decision hinged on some specific details. If they do, I’m sure the more than 30 healthcare organizations that submitted a “friend of the court” brief for this case will continue to advocate on behalf of those impacted by an additional consideration of the program. In the mean time, hospitals and healthcare organizations should work to gain a better understanding of the immigration status of their workers.

CMIOs have historically been a lightning rod for complaints about physician burnout since EHRs were the vehicles used to add additional documentation burden and cumbersome workflows as part of federal incentive programs. In more than one client situation, I’ve been pulled in to use this expertise to try to address burnout that’s being exacerbated by the ongoing pandemic. I never sought to be known as “the EHR guru and burnout expert,” but that’s how I was introduced the other day. Although I’ve helped a couple of organization streamline their workflows, mostly around ordering and results management related to COVID, I’ve been doing additional work on the organizational development side to help leaders work better with clinicians who can only be described as shell-shocked.

I feel validated every time I see an article about this phenomenon. The AMA wrote about it recently in a piece titled “Four ways COVID-19 is causing moral distress among physicians.” I’ve worked a string of back-to-back shifts at urgent care, which essentially has become the emergency department because people are afraid to go to the hospital and come to us instead. I even had a gunshot wound the other night who required a trip to the operating room, which freaked my staff out, but given where I did my residency training, didn’t make me blink.

Already existing physician burnout is being exacerbated by not only a lack of effective treatments for the COVID-19, but lack of adequate personal protective equipment, which receives zero media coverage but is do-or-die for most of us. Now we’re dealing with either an extended first wave or a nascent second wave populated by patients who refuse to social distance or wear masks but desperately need our help when they find out they’ve been exposed at the neighborhood block party or their child’s sports practice. Frankly I’m tired of exposing myself personally while trying to help patients who just don’t give a damn or who are all about instant gratification.

Today I had every room in the center fully utilized, some rooms with 2-3 patients in them as part of a family unit, and was still 10-deep in the waiting room (which was actually 10-deep with people waiting in their cars in 90-degree weather.) Fortunately, I had my favorite physician assistant to help me fight the battle and we kept each other’s spirits up. We could only be described as “medieval warrior meets LL Bean” since I was wearing a modified welding face shield that looked like I meant serious business, and she was wearing a face shield with plaid trim. Based on our shifting case mix, I’m once again isolating in a corner of the house mostly away from others, and I guess if it continues to get bad, I could always go back to staying in a tent in the yard.

At least I’m a fully trained physician and making the choice to expose myself to this craziness voluntarily, which can’t be said of the thousands of resident physicians who are staffing hospital beds and clinics across the country. Earlier this month, residents in New York staged a walkout at their Brooklyn hospital, sharing a list of demands they want met prior to a potential second wave. During the peak of the surge, residents felt alone and abandoned by their facility’s leaders, forced to cope with a lack of supplies and little recourse. I found the statistics in the article staggering, including the fact that by May, a whopping 70% of the emergency medicine residents had tested positive for COVID-19. Residents also cited 160 patients in an emergency department that was 100 patients over capacity. Needless to say, this is not ideal.

A couple of readers have asked why I focus so much on the “in the trenches” experience lately rather than writing about healthcare IT. In addition to it being what I’m living on a regular basis, it’s something that all of us on the technology side need to understand. Organizations are trying to roll out numerous solutions to help solve problems and make things smoother for us, but I truly believe that to be effective in that effort they need to understand where we are, physically, mentally, and emotionally. We’re not going to show up on a web-based training session when we’re post-call and exhausted, and if we’re not focusing on what a trainer is saying because we haven’t eaten in 10 hours and really need to go to the bathroom, it’s something that should be considered.

I’d be interested to hear from readers on how your organizations have modified rollout plans for new solutions or how you’re addressing changes to functionality while your end users are on the edge. Are you making tweaks to try to streamline systems, or are you staying static to allow people to focus on other matters? Leave a comment or email me.

Email Dr. Jayne.

HIStalk Interviews Matt Wilson, SVP of Healthcare Strategy, Infor

June 29, 2020 Interviews No Comments

Matt Wilson is SVP of healthcare strategy for Infor of New York, NY.

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Tell me about yourself and the company.

I’m a healthcare IT lifer, with 27 years in the industry. It’s kind of a family business. My father was an HIT executive going back into the 1970s, so I have been in and around this business for my whole life. I am fascinated in the way it has evolved and I enjoy watching its trends. It’s a pleasure having the opportunity to participate.

Infor is a global cloud computing company with deep investments in industry-specific lines, executives, and products, such as Infor Healthcare.

How has adoption of cloud technology in healthcare changed?

Adoption of cloud technology gives us an opportunity to manifest a remote workforce, which we’ve seen through the pandemic, and we will see more of that. Cloud provides the ability to rapidly respond to customer needs with updates that don’t require the same kind of effort as on-site, on-premise solutions. We can engage our customers more consistently and more rapidly, which is an enormous benefit of cloud in addition to the reduced costs of maintenance.

Are you seeing a new urgency for agility in your customers since the pandemic started?

We are. Customers need us to be agile, especially in areas such as supply chain and real-time location services. Our objective has been not to get in our customers’ way, but simply to make ourselves available for what they need. We have found that our greatest opportunity to help has been engaging with something that takes a couple of weeks instead of the months and months that we’re used to with typical implementations.

How do you see the synergy between EHRs and enterprise resource planning systems?

Infor as a company, and I as an individual, are focused on how create a more balanced ecosystem. We have spent years and years, decades in fact, investing in EHRs. I was a beneficiary of that, as I helped build Cerner through the late 1990s and early 2000s. The lack of commensurate investment in ERP has created an imbalance.

We believe we can move the industry by modernizing the technology, driving a set of functionalities that contribute to the core mission of patient outcomes and a better system of health and wellness. You must have world-class systems and functionality across the core pillars of finance, supply chain, and human capital management. The way that we use interoperability and the way we orient ourselves to that core mission is critically important.

What is left to accomplish with ERP?

We need to bring together those investments to orient themselves to a single goal. We have tended to think about upgrades and technology as an ability just to upgrade the tech itself. The future holds orienting towards making one leverage off of the other, creating that ecosystem and integrating some of the billions of dollars we spend each year on management consulting on transformation. That transformation creates change. Tech should be used to sustain change. As you are moving forward with big transformation projects, how can you use your clinical solutions, your revenue solutions, and your business solutions to sustain the efficiencies, cost reductions, and tech advancement? That will be critical as we move forward, and we can play a big role in that.

As EHR and ERP vendors get bigger, does the opportunity still exist for smaller vendors to offer an ecosystem of wrap-around products?

Our Cloverleaf solution is the most widely implemented integration engine. True interoperability creates a wire that connects both traditional and nontraditional data sources and care venues, but should be used to facilitate small tech, where the gating factor for cool, innovative companies to have their products used by big health systems is the IT organization. They don’t have the time and resources to complete the interfaces, or there’s a lack of understanding around anything from security standards to interoperability.

Big platform companies like Infor and the large clinical software vendors should think about how we can facilitate the inclusion of that other cool technology that can help drive value. How can we more easily connect them into that ecosystem for the purpose of creating balance? That should be one of the central themes that we as big platform vendors should be thinking about. I think a lot about that in my role at Infor.

How do you assess the federal government’s interest in interoperability?

The Cures Act has laid down to the letter the requirement to interoperate. Vendors often give lip service to how they’re adhering to that, and some vendors continue to push back. We are seeing an absolute requirement to go do that. We’re looking to facilitate it.

What we need is an attitude change. While it can legitimately be an impediment to competitiveness, what we should be thinking about is how we’re working together to advance an industry right now that is not in the best of shape, an industry that is critical to us as a society. We need to take that signal, act on it, and find ways to include others. We are seeing those signals from life sciences, big lab testing companies, and payers that they need to be a part of that as well. They are developing standards that are oriented towards meeting those federal guidelines and making data liquidity a prime imperative in healthcare.

What was your reaction when you saw that the information that is needed for pandemic-related public health reporting was being sent by fax machines and emailed worksheets?

It’s just such an incredibly inefficient process. There is regulation to begin phasing out fax machines, but we need to move more quickly. That’s an area that we think will evolve quickly, even potentially with stimulus, in the area of supply chain and public health reporting. Those are necessary when something goes wrong, such as a once-in-a-generation pandemic.

The billions and billions that we’ve spent were sufficient in areas such as telehealth, but didn’t get us where we needed to be in terms of a fractured and disrupted supply chain and using antiquated technology to quickly report on outcomes. Interoperability becomes a central theme, and while we have had so many attempts with CHINs, RHIOs, and the rest of the alphabet soup, we still haven’t effectively created a true system-wide capability to normalize data and move that data around for those purposes that you’re describing. That’s critical as we move forward.

Are customers asking for new capabilities or guidance to help them stabilize their supply chains?

We asked clients what they need most. We responded quickly by developing supply chain dashboards for PPE. We are proud of how we were able to participate in a bit of a solution. We think that will be an ongoing need, the requirement to connect disparate supply chains and to develop functionality to find clinically equivalent alternatives when a particular supply, device, or PPE item becomes unavailable. We have to evolve with our use of AI, machine learning, and physically connecting suppliers. We will work closely with our customers as we go forward because it will be critical if we experience something like COVID-19 again.

What product opportunities do you see with AI?

For us, again as a platform company, we have so many opportunities to advance and help. It’s really listening to the market. What we are hearing from caregivers and business operations associates is that supply chain becomes a huge issue. We saw human capital management evolve and the role of chief human resources officer created around the country, and we expect to see more senior executive supply chain personnel taking roles in the strategy of the organization.

We also see a huge need around real-time location services in contact tracing, to be able to efficiently understand where a diagnosed patient has been, what equipment they have touched, and where that equipment is at the moment. Apple and big tech companies are working on that for consumer. We have solutions, but more importantly, we need to continue to evolve that inside of the hospital system. It’s critical when you have something like COVID-19 or Ebola that you know where things are, whether they are usable, and who is coming in contact with them.

The pandemic seems to be accelerating the health system acquisitions that create sprawling regional or even national enterprises. How do you respond as your customers get bigger and move into business areas that don’t involve traditional hospital operations?

You respond by listening, even though that is a bit of an obvious answer. We also try to educate ourselves to become healthcare experts. We spend a lot of time talking to outside interests, outside experts, and trying to understand where we should push, advance, and lead through thoughts and action.

We saw two things advance during the pandemic. We saw not only telehealth and the inevitability of pushing healthcare out more directly into the community, but we also saw an evolved need for inpatient facilities. We had been moving away from that over the last decade as we attempted to decentralize healthcare, but all of a sudden, we saw this need to ramp up quickly.

As a software vendor, the key is flexibility. Are we making core investments in the things that we do well today? Are we making core investments in technologies that allow us to be flexible, like contact tracing and interoperability, things that allow us to move where healthcare is and to bring our solutions and services where our customers need them, not where we think we’ve designed them to operate? That’s a critical piece.

Do you have any final thoughts?

We hope that investors and users will give us the opportunity to display how a traditional ERP company can become central to a mission. It’s not enough to upgrade technology, create a better user look and feel, and deliver greater functionality in its traditional sense. We can be accretive to the broader picture of healthcare by providing this healthcare operations platform that helps balance out that ecosystem, works together with clinical, and advances the overall mission of the organization. That’s what Infor is looking to do, and we invite others to speak with us and give us that chance.

Morning Headlines 6/29/20

June 28, 2020 Headlines No Comments

Risky Assets and Traffic Still Prevalent in Leading Healthcare Orgs

Cybersecurity firm Expanse finds exposed Remote Desktop Protocol servers and potential exposure to state-sponsored attacks, among other security weaknesses, after monitoring the Internet traffic of six unnamed Fortune 500 healthcare companies.

Microsoft to close physical stores, take $450 mln hit

The COVID-19 pandemic accelerates Microsoft’s plans to close all of its retail stores.

Oscar’s health insurance platform nabs another $225 million

Tech-heavy, direct-to-consumer insurance startup Oscar raises $225 million, prompting analysts to speculate it may be considering an IPO.

Monday Morning Update 6/29/20

June 28, 2020 News 5 Comments

Top News

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Cybersecurity firm Expanse finds from monitoring the Internet traffic of six unnamed Fortune 500 healthcare companies that:

  • Half are getting traffic from exposed Remote Desktop Protocol servers, which allows brute force password guessing.
  • One-third are receiving Internet accesses from the deprecated Server Message Block v1 that is used for printer and port access, a popular way to spread major attacks such as Petya and Wannacry.
  • One-third showed regular traffic from servers and devices in Iran, opening them to the possibility of state-sponsored attacks in the absence of geographic traffic filtering.
  • Every company had outbound Tor traffic originating from its network, indicating that their security policies do not prohibit it.

Some of the RDP servers had brute-force password-guessing attacks underway and did not have Network Level Authentication enabled.

The SMB traffic indicates that those companies were already the victim of data exfiltration.


HIStalk Announcements and Requests

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Three-fourths of poll respondents who have had a recent telehealth encounter provided their pre-visit information via an electronic form or upon being asked by someone other than the provider. Some gave their information directly to the clinician, while 12% either weren’t asked about allergies, meds, history, etc. or had to volunteer it.

New poll to your right or here: When will healthcare conference attendance rise to 75% of pre-COVID levels? Your answer will need to incorporate your predictions of the underlying factors, such as availability of an effective COVID-19 vaccine, healthcare business conditions, attending conferences versus alternatives, etc.

I was thinking about the challenge of getting people to wear masks despite their indifference, ignorance, or pathetic choice of ways to protest whatever it is that they’re angry about. My idea – hire marketing people to mount multiple targeted campaigns like the successful “Don’t Mess with Texas” anti-littering one from years ago. We know now that the pandemic isn’t going away soon, so we have time to convene focus groups and think of creative ways to encourage people to put them on given that rational thought isn’t doing it. I suggest distributing free masks that bear the same kind of lowbrow messages that people are willing to deface their cars to display publicly — think stick figure families, cartoons of a Ford truck owner peeing on a Chevy, 13.1 and 26.2 ones (ironically placed on vehicles), or those oval ones with made-up airport codes touting town pride. We know that marketing and social media advertising change behavior in ways that science and empathy won’t.


Webinars

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


Acquisitions, Funding, Business, and Stock

Microsoft will close all of its physical stores.


People

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Predictive EHR workflow vendor Wellsheet hires Frederik Lindberg, MD, PhD (Friend Health) as VP of product management.


Announcements and Implementations

Redox publishes a podcast that describes its recent layoff of 44 employees and how it made the decisions that were required, making the process transparent in hoping to help other companies that are navigating their recovery from the pandemic.


Government and Politics

The White House asks the Supreme Court to overturn the Affordable Care Act, which would eliminate health coverage for 23 million Americans.


COVID-19

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Case counts spiked in 36 states over the weekend, with Florida’s nearly 10,000 new cases on Saturday rivalling New York’s worst historic levels. More than 40,000 new cases were reported nationally on Friday as the CDC reports that actual numbers are likely six to 24 times higher. The US death count is at 127,000 as experts question whether the economic pain that was inflicted during the months-long but effective national shutdown was worth it now that complacence has raised the “flatten the curve” imperative once again.

Texas Medical Center stops publishing its base and surge ICU numbers, right after Houston area hospitals walked back their “our ICUs are about to be overwhelmed” message just 18 hours later in saying that they have plenty of capacity and their earlier dire warnings were overly alarming. This came days after the governor ordered hospitals in four Texas counties to stop performing profitable elective surgeries. Some Harris County hospitals are ignoring the governor’s order and the Texas Hospital Association says individual hospitals should be able to decide for themselves whether to perform elective procedures. The state has 5,500 patients hospitalized with COVID-19, extending its 16-day string of ever-increasing inpatient counts. TMC just announced that it will bring back the missing information in a form that better explains the capacity situation.

Texas reports hours-long lines for COVID-19 testing, along with limited capacity due to a shortage of supplies and crashing of websites for testing sign-up.

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In Australia, the government’s $2 million COVID-19 contact tracing app has been downloaded 6 million times, but has yet to identify any contacts that hadn’t already been found via manual tracing. The app seems to have problem when the IPhone of the user or their contact is locked. Problems have also been noted with IPhones and Android phones sharing information. Of 926 new cases, only 40 people had the app installed and allowed health officials to look at the contacts it had flagged.

Former FDA Commissioner Scott Gottlieb, MD predicts that schools won’t open in the South in the fall due to the overwhelming infection spread. He also notes that the US was doing a poor job of contact tracing even before the daily new infection count hit 40,000, where such activity becomes basically impossible anyway.

A New York Times report says that college towns will be hit hard economically from COVID-19 due to reduced on-campus living, cancelled sporting events, and closed bars, calling out specifically campuses in rural areas such as those of Cornell, Amherst, and Penn State.

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Arizona — which still hasn’t closed bars, mandated the wearing of masks, or prohibited large indoor political rallies without masks — publishes a point system to decide who gets ICU resources versus those who will be left to die without them. Arizona has 2,700 patients hospitalized with known or suspected COVID-19 (triple the number from a month ago) and nearly 500 are on ventilators (double the month-ago count). Nearly 90% of adult ICU beds are occupied. Imagine how bad it would be if the mostly elderly snowbirds in Arizona and Florida weren’t gone for cooler weather elsewhere.

New York State reported just five COVID-19 deaths on Saturday versus its previous peaks of around 800. The state mandates a 14-day quarantine for visitors from high-infection states.

Harvard’s Ashish Jha, MD, MPH raises the interesting point that while young patients have lower COVID-19 mortality rates than older ones, it is true of every disease that younger people have better survival odds. He looks at it differently: a 40-year-old patient who is admitted for COVID-19 has the same mortality rate as a 70-year-old who has a heart attack. Coronavirus still kills 5% of hospitalized patients aged 35-44 and Florida’s numbers are skewing much worse.

Members of the Congressional Hispanic Caucus demand that HHS explain its HHS Protect COVID-19 data project, for which it issued a $25 million contract with Palantir, whose data products are used by ICE to find and arrest immigrants. HHS says the HHS Protect information is de-identified. The CIA is an investor in the company.

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UCSF’s Bob Wachter, MD summarizes the present state nicely.


Sponsor Updates

  • PMD VP of Business Development Ted Ranney, MBA publishes a Medical Economics article titled “Telehealth best practices: Building a long-term workflow.”
  • Nuance announces that its AI Marketplace for Diagnostic Imaging is accelerating AI adoption for radiologists at leading healthcare systems.
  • OmniSys and RedSail Technology announce a strategic partnership to bring innovative clinical and revenue cycle solutions to independent and long-term care pharmacy markets.
  • IDC recognizes Pure Storage as a top five vendor in the OEM storage space.
  • Redox releases a new podcast, “Layoffs.”
  • Saykara launches a YouTube channel.
  • Summit Healthcare publishes a new case study, “Surgery Partners: Improving Processes with RPA Across all Meditech Platforms; Magic, 5.x, 6.x, and Expanse.”
  • Researchers publish “Factors Associated with Prescribing Oral Disease Modifying Agents in Multiple Sclerosis: A Real-World Analysis of Electronic Medical Records” based on data from TriNetX’s network.

Blog Posts


Contacts

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

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Weekender 6/26/20

June 26, 2020 Weekender No Comments

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Weekly News Recap

  • Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions.
  • Public health officials in Austin, TX blame COVID-19 case counts that vary wildly by day on labs that are sending test results by fax.
  • The American Hospital Association loses its bid to stop the federal government from requiring hospitals and insurers to publish their negotiated prices, but will appeal.
  • Massachusetts eHealth Collaborative shuts down after 15 years.
  • CMS begins publishing a monthly Medicare COVID-19 Data Snapshot.
  • CMS announces the creation of CMS’s Office of Burden Reduction and Health Informatics.
  • Russian President Vladimir Putin calls for the healthcare system there to roll out out digital systems and to use artificial intelligence.

Best Reader Comments

While in theory I like the idea of requiring hospitals and insurers to publish their prices, I’m somewhat skeptical of the actual benefit this may provide to patients. To the majority of patients in this country who are insured by a commercial payor or CMS, unless the anticipated out of pocket costs are also provided, I suspect the published price itself will be ineffective in driving patients to lower cost alternatives … with health system monopolies and the ubiquity of employer-provided health insurance, patients simply don’t have much of a choice either where they get their care or who their insurance provider is, which will only cause prices to continue to rise. (Dr. Gonzo)

Administrator Verma’s heart seems to be in the right place and the tweets carry a lot of bite. But I am skeptical that asking current health systems players to take on the role of addressing social and economic factors of their patients is going to work. Those who know the system know very well that American health system has had its knee on the neck of racial minorities and economically disadvantaged for a long time. You don’t get to be a part of $4,000,000,000,000 annual industry without shattering a few million middle class dreams. (SeismicShift)

I would question how many companies are as worried now about how to “strategically reallocate those unused marketing dollars” but rather how to use those funds to meet a demanding payroll and to stay afloat until the markets are open and the economy levels out. (Just Wondering)

Healthcare is but one symptom of a system ripe for correction. What can we say about the richest nation in world history with currently 48 million of us lacking nutritious food on a regular basis, including 16.2 million children? USA needs to look long and hard at its fantasy that we all are existing on a level field. (Kevin Hepler)


Watercooler Talk Tidbits

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Readers funded the Donors Choose teacher grant request of Mr. H in Georgia, who asked for a robotic center for his school’s media center. He reported in February, “Thank you for your generous donation. It has truly exposed boys and girls in a variety of grade levels to how coding can be a fun learning experience. We have built the robots, practiced building block languages, and have even implemented different movements with the Kamigami Robots. An activity the students always look forward to in the program is playing tag with the robots. Each student has to use the coding language to try and disable the other robot in a specific time session. I am working to continue to create authentic and innovative activities that will promote their knowledge of computer science. The smiles on the students’ faces would not have been possible without your support.”

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Dermatologist and YouTube star “Dr. Pimple Popper” Sandra Lee, MD unsuccessfully tries to hide her social media tracks after insulting nurses everywhere.

In Russia, a nurse whose hospital employer reprimanded her for showing up for work in a see-through PPE gown with a sports bra and short underneath because she was getting overheated lands a modeling contract.

Columbia University ED doctors describe how to tame your email inbox using crisis resource management techniques:

  • Have one person summarize multiple status reports into a single email that is sent at the same time each day and with the same subject, format, and section headings.
  • Include the titles of everybody who is sent a group email or is added to thread.
  • If a recipient is being included just as an FYI for one message in a thread, use BCC so they don’t get future group messages.
  • Don’t just make broad requests for help – assign tasks to specific individuals with timelines and expectations on reporting back. Otherwise “email is commonly abused as a tool for putting work on somebody else’s desk without having to confirm that they can take it on.”
  • Add action requests to the subject line in brackets “[respond EOD].”
  • Ask why you are being added to an existing email chain and what expectations are involved.
  • Use the SBAR concept (situation, background, assessment, recommendation) to make communications concise.
  • Encourage people to speak frankly.

The former CEO of Union General Hospital (GA) and one of its doctors are sentenced to federal prison for their roles in scheme in which the doctor prescribed the CEO 15,000 doses of opioids in return for being paid for additional hospital work and being placed on its board.

A Colorado anesthesiologist gives up his medical license and serves 30 days in jail after turning off all the patient monitors in a hospital’s recovery room with a rant about how the noise creates alarm fatigue for nurses, then choking a nurse who told him to leave the machines alone.


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Morning Headlines 6/26/20

June 25, 2020 Headlines No Comments

Kaufman Hall Software Becomes Syntellis Performance Solutions

Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions, with investment from private equity firms Thoma Bravo and Madison Dearborn Partners.

Cedar Gate Technologies Acquires Citra Health Solutions

Analytics-focused, value-based care management vendor Cedar Gate Technologies acquires Citra Health Solutions and its EZ-Suite claims, benefits, and care management software.

Leidos receives $170M task to provide MHS GENESIS Stage 6 Enterprise Services

The DoD gives Leidos a $170 million task order for MHS Genesis services that will include program management, enterprise sustainment, license maintenance, and operational management services.

Mayo Clinic launches advanced care at home model of care

Mayo Clinic (MN) launches a home healthcare service using technology from Medically Home under its new Mayo Clinic Platform, an initiative that aims to create new ventures using the latest technologies.

News 6/26/20

June 25, 2020 News 3 Comments

Top News

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Kaufman Hall spins off its enterprise performance management software division as Syntellis Performance Solutions, with investment from private equity firms Thoma Bravo and Madison Dearborn Partners.

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Kaufman Hall’s Kermit Randa will move to the new company as CEO.

The business was created from Kaufman Hall’s Axiom Software and its recently acquired Connected Analytics practice of Change Healthcare.


Reader Comments

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From Barely Covered Enmity: “Re: Shafiq Rab leaving Rush University Medical Center. Interesting that his LinkedIn says he is a senior advisor to Michael Dandorph, the CEO of Wellforce. Bill Shickolovich is still listed as CIO, but Dandorph came from Rush. Wellforce is a relatively new player in MA, with Tufts Medical Center primarily on Siemens, Lowell General on Cerner, and Melrose-Wakefield on Meditech. Most affiliated providers are on eCW. They have announced plans to move all to Epic.”

From Generally Specific, MD: “Re: telemedicine EHR entries. Our billers tell us that we have to record three numeric entries in the vital sign section of our EHR to quality for telemedicine payment. You’re allowed to take the patient’s word on height and weight (yup). Some people will give you a temp, home blood pressure check, or data from Apple Watch or Fitbit. When all else fails, I see if they can feel a pulse (big one in neck if wrist fails) and have them count while I time 15 seconds on my phone. Or watch them breathe. If someone doesn’t look good, I have to get them seen in person anyway.”

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From Swag Seeker: “Re: conferences. Will HLTH cancel?” They already have. HLTH announced last week that the October event will be virtual (meaning: a flop.) HLTH has held just two conferences in its short existence, the first in May 2018. I would not want to be HIMSS, RSNA, or other non-profits that fill the bank mostly from their member conferences, but HLTH is even worse off in being funded by VCs and having no other line of business to fall back on. HLTH made some puzzling decisions about locations and dates early on but managed to lure a lot of healthcare luminaries and their expense accounted-fueled groupies to generally positive reception. They will now try again in Boston in October 2021, assuming that (a) they survive, and (b) that anyone cares by then. Conferences aren’t coming back strong until a year or two after a vaccine is proven to be effective, if ever, and we may have found better ways to spend the time and money of our employers by then.


HIStalk Announcements and Requests

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I’m watching and recommending  the Netflix medical documentary series “Lenox Hill,” which follows four doctors and their patients at Northwell Health’s Lenox Hill Hospital. Fun fact: Northwell pays featured neurosurgeons David Langer, MD (above) and John Boockvar, MD more than $2 million each per year. Google-stalking suggests that Langer’s summer house in the Hamptons, site of the retreat the doctors attended, is worth a cool $3 million. Still, they seem like highly competent, mostly nice guys, although I bet that being surgeons that some critical, loudly recited monologues to eyes-downcast co-workers were left on the virtual cutting room floor.


Webinars

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


Acquisitions, Funding, Business, and Stock

The Massachusetts EHealth Collaborative will sell its remaining assets and shut down operations. The non-profit sold its technology assets and customer accounts to population health management and analytics vendor Arcadia last month. The majority of its employees, including President and CEO Micky Tripathi, have joined Arcadia.


Sales

  • Idaho will integrate its PDMP data into statewide EHR and pharmacy systems using Appriss Health’s PMP Gateway solution.
  • Teleradiology company Rapid Radiology selects OpenText’s EMR-Link software to ensure smoother transfer of imaging results to providers at long term care and skilled nursing facilities.
  • The University of Illinois Hospital and Health Sciences System will implement PhysIQ’s PinpointIQ remote patient monitoring technology to monitor employees for signs of COVID-19, and high-risk COVID-19 patients for signs of deterioration.
  • Wexford PHO goes live on the all-payer population health management solution of SPH Analytics.
  • Fairfield Medical Center (OH) chooses Updox for patient flow management, in-office productivity, and virtual care.
  • The DoD gives Leidos a $170 million task order for MHS Genesis services that will include program management, enterprise sustainment, license maintenance, and operational management services.
  • Texas Health Aetna will use the SMS/IVR technology of CareSignal for remotely monitoring patients with diabetes, hypertension, and asthma.

People

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Cambridge Health Alliance names Hannah Galvin, MD (Beth Israel Lahey Health) as CMIO.

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Shannon Werb (Virtual Radiologic) joins DispatchHealth as COO.

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The HCI Group names Will Conaway (Prime Healthcare) VP of provider delivery.


Announcements and Implementations

The Froedtert & the Medical College of Wisconsin rolls out a remote patient monitoring program for pregnant patients using technology from Babyscripts made available through digital health prescription vendor Xealth, which includes the health system among its investors.

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PatientPing launches an e-notification service for patient admissions, discharges, and transfers that ensures providers are compliant with the Condition of Participation laid out in the final Interoperability and Patient Access rule from CMS.

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Nordic develops an evaluation and management transition service to help health systems comply with CMS’s E/M updates, set to take effect January 1.

UCI Health (CA) adds Everbridge’s MediNav wayfinding technology to its My UCI Health app.

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MuleSoft announces GA of Accelerator for Healthcare, a set of prebuilt APIs, integration templates, and best practices that can help developers more easily integrate data from different EHRs into healthcare projects. Salesforce acquired the company in 2018 for $6.5 billion.

Mayo Clinic (MN) launches a home healthcare service using technology from Medically Home. The service falls under the health system’s relatively new Mayo Clinic Platform, an initiative led by John Halamka, MD that aims to create new ventures using the latest technologies.

Healthcare voice AI vendor Suki launches a new voice service that it says will deliver faster, more accurate company responses from normal physician speech. Its digital clinical assistant has also been enhanced with ICD-10 coding, Epic integration, and delivery of an app for Android smartphone users.


COVID-19

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Texas Governor Greg Abbott bans elective surgeries in Bexar, Dallas, Harris, and Travis counties to free up bed space for the state’s rapidly expanding epidemic. Texas Medical Center says it will need to tap surge capacity this week and is on track to exceed total capacity within two weeks. The governor will also halt further reopening phases, acknowledging the state’s “massive outbreak” after it rushed to reopen despite increasing numbers. Abbott said two weeks ago that there was no reason to worry about reopening because “we have so many hospital beds available to anybody who gets ill.” Texas allows churches, governments, daycare centers, and camps to operate without occupancy limits, while bars, sporting events, swimming pools, libraries, and amusement parks can operate at 50% occupancy. Restaurants are limited to 75% capacity. Abbott, who previously refused to require mask-wearing and barred local officials from implementing their own mask requirements, encouraged Texans to wear masks in announcing his executive order Thursday. Perhaps it bears repeating that being discharged alive from a COVID-19 hospital stay doesn’t preclude a shortened lifetime of suffering, never-ending medical interventions, and hugely diminished quality of life. The ability to get an ICU bed and ventilator should not provide a false sense of security.

Public health officials in Austin, TX blame COVID-19 case counts that vary wildly by day on labs that are sending test results by fax, requiring their employees to re-enter the information manually. County officials want to know which labs are involved for possible enforcement of the state law that requires digital reporting.

COVID-overwhelmed Arizona is experiencing the same problems that other states ran into early in the pandemic — long lines for testing, a shortage of testing capacity, and a lack of coordination among hospitals and doctors offices to match testing demand to availability.

West Virginia Governor Jim Justice fires Cathy Slemp, MD, MPH, commissioner of the state’s Bureau of Public Health, claiming that her office unintentionally inflated COVID-19 case counts by failing to exclude recovered patients.

CVS Health announces GA of Return Ready, a customizable COVID-19 screening, testing, and analytics program for employers and universities that also offers digital tools for symptom monitoring and contact tracing.

Bars are increasingly looking like a COVID-19 breeding ground in states where they are open, with factors being close quarters, fearless young customers who don’t wear masks, proprietors who flout distancing and crowd size mandates, and loud conversations that spray more droplets. Patrons who don’t know they’ve been infected are spreading the infection to people who are more cautious.

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COVID-19 is forcing health system to change their plans for developing hotels to house elective surgery patients and visitors, many of them cash-paying residents of other countries. Miami’s $500 million, 680-foot tall Legacy Hotel and Residence will feature a 256-room hotel, a 100,000 square foot medical center, condos, bars, restaurants and shops, but its CEO says he doesn’t use the term “hospital” for reasons that go beyond the legal one of not offering emergency services — “You’re in a luxury hotel. You don’t want to be around people who are dying.”


Other

The American Hospital Association loses its bid to stop the federal government from requiring hospitals and insurers to publish their negotiated prices. AHA had argued that the White House did not have the legal authority to require such disclosure, that compliance would create overwhelming administrative burdens, and that such transparency might increase prices. The federal judge disagreed, ruling that informed customers should drive prices down and that hospitals attack transparency measures in general to keep patients in the dark about pricing. Hospitals are appealing the ruling.

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A review of the VA’s HIT-related outpatient diagnostic delays over several years finds five key high-risk areas: overwhelming EHR inbox notifications and communications and lack of coverage for absences; lack of interoperability and visible surfacing of important information; technical problems; data entry issues; and systems that don’t track test results. It cites previous studies in which PCPs reported missing abnormal test results because of an overloaded EHR inbox that requires more than an hour per day to work through. Specific cases were interesting:

  • Physicians who were notified by note to correct an EHR entry sometimes signed off without actually making the correction.
  • One clinician missed an abnormal test result that was among the 200 inbox notifications they received in one day.
  • Results were sent to clinicians who were on leave or who had left the organization with no one assigned to cover their inbox.
  • Use of note templates sometimes caused the recipient to miss important information.
  • Clinicians missed information due to delays in obtaining records, missing fax reports, delays in outside organizations posting diagnostic information to record-sharing portals, and failure to notify the clinician to review records that had been scanned.
  • Clinicians sometimes failed to review abnormal test results in subsequent encounters.
  • One clinician had customized the EHR to display only abnormal results, but missed one abnormal result because an abnormal cutoff value had not been defined.
  • Inactive radiology codes failed to trigger notification.
  • Abnormal result warnings were set to disappear when opened, so clinicians lost track if they were interrupted.

Sponsor Updates

  • VMblog features an interview with Goliath Technologies CMO Stacy Leidwinger.
  • Google Cloud hires Kathy Bonanno (Palo Alto Networks) as finance lead.
  • Halo Health publishes a case study, “Schedule-Driven Communication Improves Collaboration for Great River Health System.”
  • Pivot Point Consulting expands its telehealth services to offer end-to-end solutions, from strategy to platform selection to implementation.
  • Hyland CEO Bill Priemer shares his thoughts on potential challenges and the unknowns around working from home.
  • The Boston Globe features Imprivata CEO Gus Malezis in an article assessing COVID-19’s impact on office work.
  • Seeking Alpha profiles digital prescription savings and patient engagement company OptimizeRx.
  • Vocera partners with Mediaplanet to launch the “Empowering Our Healthcare Heroes & First Responders” media campaign.
  • PMD successfully completes its annual SOC 2 Type II and HIPAA security audits.

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 6/25/20

June 25, 2020 Dr. Jayne 4 Comments

This week has been absolutely crazy, with plenty of firefighting of both the informatics and clinical varieties.

A client that I did a quality project for last year is in the middle of an EHR go-live with “virtual elbow support,” but they had no physician super-users identified. Hard to believe, but there are still physicians out there who feel like they really need to learn it from a physician. For the client, figuring that out right before the go-live was a big miss. I’ve been playing WebEx Whack-a-Mole with a couple of physicians who won’t listen to the resources right in front of them and trying to convince them to get with the program. I’m always happy to help clients who are in a rough place, but it’s exhausting.

At the same time, my clinical practice has been having record-breaking days that make the “Flumageddon” season of a couple of years ago look like a cakewalk. They’re constantly pleading for people to come in on their off days, and I’ve covered a couple of times just so the physicians who are scheduled can have a break to sit down, eat, and have a minute to themselves. Still, it’s a never-ending revolving door of COVID swabbing, antibody testing, and processing of lab results as well as following up on infectious patients. Add in the usual summertime orthopedic injuries, lacerations from whacking the back of your head on a diving board while trying to execute the perfect cannonball jump, and a couple of ruptured appendixes in patients who were “afraid to go to the hospital” and it’s a recipe for disaster.

We’re leading the region with antibody (serology) testing, and I have to say I have mixed feelings about it. The visits take a tremendous amount of time, as we counsel patients to understand that having a positive antibody test isn’t the immunity passport that they thought it would be based on what they saw on Facebook. Many of the patients had respiratory infections in January or February and we have to explain that with that timeline, it’s much more likely that they had flu or bronchitis or one of the other garden-variety illness that was going on.

The rates of positive antibody results in my area are low, and although it’s good data from the public health perspective, it doesn’t do anything for the management of individual patients and it sure adds a lot of cost to the healthcare system. Since most insurers are covering it 100%, patients are eager to feel like they’re “doing something.” The American Medical Association continues to be vocal in spreading the word that antibody tests aren’t the path back to our old normal. We still know too little about what protection antibodies might provide or how long it may last, and there are risks for both false-positive and false-negative tests.

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The traditional July 1 start date for new interns and residents is less than a week away, and I don’t envy them the weirdness that they’re walking into. I was glad to read this heartwarming piece about a mother and daughter who both graduated from medical school this spring and matched together for residency. The elder Dr. Kudji had been a registered nurse and a nurse practitioner prior to entering medical school in her 40s and matched in family medicine. The younger Dr. Kudji will be pursuing a residency in general surgery.

Another piece sent by a reader tugs at the heart strings: A pediatric cardiologist in Bolivia was challenged to find a machine to create implanted devices to fix heart defects through a non-invasive procedure. He turned to the country’s indigenous women to weave the amazing devices by hand, often using a single piece of wire. It’s worth the watch just to see the devices in action as they deploy.

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Less heartwarming was the invitation I received from the American Telehealth Association for their virtual conference, a mere three days before the multi-day meeting was to start. They must be desperate for attendees because they offered a code for $350 off the regular $650 registration price. I don’t know of too many physicians who can clear their schedule with just a couple of days’ notice. InTouch Health did a must better job promoting their upcoming conference with more than a month notice. The July conference is free and features multiple tracks, including a COVID one.

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This week, CMS announced the creation of the Office of Burden Reduction and Health Informatics. It’s designed to continue the “work of reducing regulatory burden to allow providers to focus on patients instead of paperwork and reducing healthcare costs.” It appears to stem from the Patients over Paperwork Initiative (with CMS stubbornly refusing to capitalize the O, for some reason).

The CMS press release touted its successes, but as a frontline urgent care clinician, absolutely nothing has changed as a result of this ongoing work. My staffers are still collecting plenty of data elements that aren’t helpful at the point of care for the conditions I’m treating in the majority of my patients. There may have been benefits in reporting and streamlining of conflicting initiatives, but that doesn’t help us in the exam room.

CMS Administrator Seema Verma was quoted as saying the new office will “increase the use of health informatics” and I’m as eager as the next person to see what they have in store. Perhaps we could start with a nationwide unique patient identifier, since CMS says that “fostering innovation through interoperability will be an important priority.” That will also help with their goal of “new tools that allow patients to own and carry their personal health data with them seamlessly, privately, and securely throughout the healthcare system.”

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From Just Betty: “Re: BJC HealthCare. Check out this data breach notification letter from one of its flagship hospitals. The return address on the letter is for a construction company in Sacramento, CA. Do you think it’s a scam?” There’s nothing quite like following one unfortunate event with another one. In this case, some suspicious activity in employee email accounts resulted in an investigation that was “unable to determine whether the unauthorized person actually viewed any emails or attachments in the employee email accounts.” Compliance officers reviewed the contents of those email accounts and found patient information that may have been accessible, including patient name, date of birth, account number, diagnoses, medications, providers, treatments, and facility locations. It’s hard to believe people are still emailing files around that contain PHI. The return address does indeed belong to a construction company 2,000 miles away from the corporate headquarters. In addition to looking for some employee training to prevent phishing, I bet they’re also looking for a breach notification vendor.

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A reader sent me a link to a paywalled article about a “recovery area” at New York City’s Mount Sinai Beth Israel hospital. Designed for healthcare workers who need to escape, it features recliners, music, and aromatherapy to reduce stress. They’ve opened more than 10 rooms at different facilities and note a self-reported reduction in stress after only a 15-minute visit. Since this was the week I was supposed to be volunteering at a camp which is instead holding “Virtual Summer Camp,” I’m de-stressing in my yard. Today’s challenge was to build a camp gadget or campsite improvement. I’m not sure what my neighbors think of my COVID-essentials dispenser, but my fellow virtual campers enjoyed it.

What’s your favorite knot or lashing? Leave a comment or email me.

Email Dr. Jayne.

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