Following the COVID-19 outbreak, telehealth EHR integration helped UPMC Pinnacle train thousands of staff members in a week. May 26, 2020 - The deadly spread of COVID-19 has forced health systems to adopt telehealth at a rapid rate. And for University of Pittsburgh Medical Center (UPMC) Pinnacle, telehealth EHR integration has been an asset in putting that telehealth delivery to scale.

The central Pennsylvania health system, which has over 160 clinics, has had telehealth capabilities since 2012. But, according to, Salim Saiyed, chief medical informatics officer at UPMC Pinnacle, said the health system needed to greatly accelerate its telehealth adoption to reduce patient, provider, and clinician exposure to the virus.

“We wanted to reduce exposure because COVID-19 is very contagious and we did not want our providers and nurses to enter the patient rooms,” Saiyed said in an interview with EHRIntelligence. “The telehealth solutions are automated, so an ER nurse can call in and it picks up automatically so the patient does not need to touch anything.”

But introducing telehealth across a broad care continuum — and doing so quickly — can be challenging. Prior to COVID-19, not a lot of patients weren’t even using telehealth, and even some clinicians were reticent to adopt the tool.

It’s been enough for a bit, isn’t it? For three months now, there has been little space in the world for any other kind of news. That is, news without the word ‘coronavirus’. But there was innovation, there is excitement and, well, even some weird (although useful!) inventions that appeared while the world has been in lockdown. So here’s an outlook on such news, all, promise, without that particular C-word.

CAREMINDr President and CEO Harry Soza discusses how remote monitoring is changing chronic care management.

In just a matter of months as the COVID-19 pandemic spread across the country, healthcare-provider organizations have been faced with unprecedented challenges in patient care that have resulted in lower patient volume for ongoing care. But some hospitals and group practices have been turning to patient-engagement strategies and technologies to keep care across the board moving and support business continuity.

THE PROBLEM

Albany, New York-based Community Care Physicians, which boasts 72 physician practices, is one such healthcare organization. In the diverse and complex healthcare environment, there are many things that complicate the decision-making process, including how to communicate with patients and where to communicate.

On 26 May, the UK government said the National Health Service would provide access to remdesivir to adult and adolescent COVID-19 patients meeting certain clinical criteria, to speed up their recovery. Treatment was authorised through the Medicines & Healthcare products Regulatory Agency (MHRA)’s Early Access to Medicines Scheme and will be prioritised for patients who are likely to benefit the most.

The antiviral drug, originally developed as an Ebola treatment, is currently undergoing clinical trials for COVID-19 around the world, and preliminary data show it can shorten the time to recovery by about four days, from 15 to 11 days.

This step is part of a collaboration between the UK and manufacturer Gilead Sciences. Similar arrangements have already been made with other countries, including the U.S. and Japan. In mid-May, Gilead licensed remdesivir to five generic drug makers with operations in India and Pakistan, which is reported to help to make the medicine available to 127 countries. The manufacturers will not pay royalties until either a second drug is approved, or the pandemic is declared ended.

In the laboratory, remdesivir has been found to inhibit the growth of several notable viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Middle East respiratory syndrome coronavirus (MERS), SARS-CoV-1, and SARS-CoV-2. In early April, the European Medicines Agency approved remdesivir for compassionate use in COVID-19 patients.

Meanwhile, WHO’s clinical trial of another much-hyped potential COVID-19 treatment, hydroxycholoroquine and chloroquine, has been paused. This was announced by WHO Director-General Dr Tedros Adhanom Ghebreyesus at the media briefing on COVID-19 on 25 May.

Albert Hsiao, M.D., Ph.D., and his colleagues at the University of California San Diego (UCSD) health system had been working for 18 months on an artificial intelligence program designed to help doctors identify pneumonia on a chest X-ray.

When the coronavirus hit the U.S., they decided to see what it could do.

The researchers quickly deployed the application, which dots X-ray images with spots of color where there may be lung damage or other signs of pneumonia. It has now been applied to more than 6,000 chest X-rays, and it’s providing some value in diagnosis, said Hsiao, director of UCSD’s augmented imaging and artificial intelligence data analytics laboratory.

His team is one of several around the country that has pushed AI programs developed in a calmer time into the COVID-19 crisis to perform tasks like deciding which patients face the greatest risk of complications and which can be safely channeled into lower-intensity care.

May 21, 2020 - The spread of COVID-19 illustrates the need for a national health information technology infrastructure, according to an article published in JAMA.

To help curb the pandemic, health organizations and researchers need timely, accurate, and reliable health information.

Specific to the current case of coronavirus, researchers need to know how many individuals tested positive for COVID-19, demographic data from those individuals, the number of individuals who are seen at health facilities, how many were hospitalized and how they were taken care of, and the length of the hospital stay.

Vice President Mike Pence and the Centers for Medicare & Medicaid Services (CMS), requested hospitals report COVID-19 testing data directly to the US Department of Health and Human Services (HHS).

Since private and commercial laboratories already report their findings, Pence asked all hospitals that are performing “in-house” or onsite testing to report testing data to HHS each day.

April 03, 2020 - It’s now considered common knowledge that providers need to address a patient’s social determinants of health. These factors such as an individual’s financial situation, ability to get healthy food options, and access to reliable transportation can be more important to an individual’s health outcomes than the actual clinical care he receives.

In fact, commonly cited statistics show that clinical care influences just 10 to 20 percent of a patient’s outcomes, while social determinants of health impact the remainder. If a patient cannot adhere to his hypertension care plan if the medication is too expensive for him to buy every month, then outcomes will suffer. Similarly, outcomes will not improve for an obese patient, if she cannot afford healthy food options or get to a grocery store miles away from home.

But providers are often unaware of this information and some have previously felt it was not their responsibility to address. Only as the evidence has grown have providers felt a push to incorporate these non-traditional risk factors into their clinical decision-making.

“Slowly but surely, the evidence base is showing the benefits of doing social needs screening and social needs interventions. Until recently, there wasn’t an empirically strong evidence base, even though intuitively it’s quite obvious that if you can address the patient’s food insecurity, it’s going to help their diabetes outcomes,” said Rachel Gold, PhD, MPH, senior investigator at Kaiser Permanente Center for Health Research and lead research scientist at OCHIN, Inc.

Despite budgetary strains from the COVID-19 pandemic, a new report predicts regulatory requirements and medical-service spending growth will benefit electronic health record vendors in the years to come. The electronic health record industry has benefited from steady growth over the last few years, but a new report warns the financial squeeze from COVID-19 may lead to setbacks for many EHR vendors.

Even so, the business research company Freedonia Group points out in its report that the crisis has also demonstrated the importance of both EHRs and interoperability between systems.

Report authors also predict that EHR vendors will benefit from regulatory requirements around EHR implementation and projected growth in hospital spending.

“US expenditures on electronic health records (EHRs) are forecast to total $19.9 billion in 2024,” according to the report, which predicts hospital EHR spending will reach $9.9 billion.

Your staff has been going above and beyond for more than two solid months treating cases of COVID-19 and containing community spread of the coronavirus. But it may be coming at the cost of their mental well-being.

COVID-19 forced stakeholders in the healthcare landscape to adopt a new perspective in this sphere. Telemedicine rose to fame as a ready-made solution; artificial intelligence’s contribution became more apparent from early outbreak predictions to resource management; and digital health technologies lent a helping hand early on.

Another promising area joining the fight is network medicine, a branch of network science. The latter field studies the interaction between actors within a network. Such analyses are applicable to virtually any sector, from the world wide web through social networks to how molecules interact with each other. Applying such theories to human biology yields network medicine; the study of biological networks to better understand and help treat diseases.

Researchers have tested the performance of machine learning and artificial intelligence (AI) algorithms used in medical image recognition and found they were highly unstable and might have led to false negatives and false positives.

The in-app study collects wearable data and asks participants about their recent symptom history. Fitbit has launched an in-app study the company says could help develop an algorithm for detecting potential COVID-19 cases prior to symptom onset.

Device owners over the age of 21 who live in the U.S. or Canada who either had a confirmed case of COVID-19 or recently experienced symptoms consistent with the disease are invited to take part in what the company has dubbed the Fitbit COVID-19 study.

Along with providing their recent device data, these users will be asked to answer a series of questions found within the Fitbit app’s Assessments & Reports section. They ask participants about their COVID-19 or flu history, whether they experienced or are still experiencing disease symptoms, and other information about medical history and demographics.

Device owners must opt in if they are interested in participating and sharing their data, and may withdraw from the study at any time, according to the company.

Apple and Google today rolled out their digital contact tracing technology that can be used by public health agencies to track COVID-19. Find out how the tech giants’ collaboration on technology could accelerate the process of tracking and tracing the virus.

In sharing the story of this process and the tips learned along the way, Erica Galvez of Manifest MedEx hopes more healthcare leaders will recognize that they do already have the tools to respond to the call for remote caregiving.

QUEENS, NY - In one of the best examples in recent memory of medical self-ownership, a proactive patient not only sought medical attention but also did his own admission orders and H&P when it turned out his concerns warranted further work-up. “I can’t always expect someone to hold my hand through everything in life, including when medical issues pop up,” explained Max Adderley, who states he’s noticed his stool turning black since yesterday. “I realized I needed to take ownership of my own health, to advocate for myself.”

Health care professionals always applaud patients who taken ownership of their own health, in the form of regular checkups, being compliant with medications or therapies, and seeking evaluation for any acute issues sooner than rather than later. However, to actually to do one’s own admission, that’s next-level thinking.

“Adderley is one gold standard patient, he insisted that I take it easy, that he would do all the orders and notes, he even told the nurse that he’d put in his own IV and he did,” explained hospitalist Tanya Smith. “I even double checked his owners, everything was on point: he’s NPO, started on a PPI, he’s ordered for serial hemoglobin levels, he even consulted GI. The best part? He ordered only Tylenol for pain.”

May 19, 2020 - The Office of the National Coordinator for Health Information Technology (ONC) final interoperability rule has the potential to transform EHR systems by improving interoperability and addressing clinician burden, according to health IT experts from Pew Charitable Trusts and American Medical Association.

Similar to how cellular phones have transformed technology and enhanced daily life for individuals, Pew explained that application programming interfaces (APIs) and enhanced interoperability mandated in the ONC final rule can have a similar positive impact on the future of EHRs.

While the ONC final rule takes a hard stance on information blocking, it also calls on medical providers and device developers to promote patient data access using third-party apps and APIs.

“Many Americans already use programs that rely on these types of interfaces, perhaps without realizing it,” Ben Moscovitch, project director for Health Information Technology at Pew; Ashley Ashworth, Pew; Matt Reid, AMA; and Laura Hoffman, AMA, wrote in a recent post. “For example, APIs are the underlying technology that enables online shopping and personal finance tracking. If broadly used in health care, they could usher in a new era for EHRs, enabling patients, clinicians, and researchers to access data in simpler, more efficient ways than they’re able to today.”

Ransomware attackers have focus on the healthcare industry as their target de jour. The attacks are hard to prevent and costly. In this guest post, Rick Clark, corporate security director for a provider of accounts receivable management and revenue recovery solutions for the healthcare industry, reveals how hospitals can protect themselves.

Two medical professionals cited a study that found three pillars that could decrease clinician burnout in the ever-evolving medical landscape. May 18, 2020 - Enhancing provider autonomy, competence, and relatedness can improve intrinsic motivation and potentially reduce clinician burnout, according to a perspective piece published in The New England Journal of Medicine.

COVID-19 has shined a spotlight on clinician burnout and its massive impact on healthcare professionals in an unprecedented manner.

EHR implementation and the changes in the healthcare system were supposed to make life easier for clinicians across the country. However, the burden that it has caused has not only had a profound impact on clinicians, but it is also costing the healthcare system roughly $4.6 billion per year, according to the entry.

“Initially, the prevailing attitude was that burnout is a physician problem and that those who can’t adapt to the new environment need to get with the program or leave,” wrote article authors Pamela Hartzband, MD, and Jerome Groopman, MD. “Some dismissed the problem as a generation of ‘dinosaur’ doctors whining and pining for an inefficient, low-tech past. But recently, it has become clear that millennials, residents, and even medical students are showing signs of burnout.

Hartzband and Groopman examined a study written by Gagné M and Deci EL, that was published in JAMA Internal Medicine.

One person in Wuhan eats an uncooked bat, and your local Walmart runs out of toilet paper. This is such a surreal scenario, no wonder people are looking for alternative answers to how their normal lives got blown into pieces in the matter of weeks. And while conspiracy theories are usually a marginal phenomenon, in this age of misinformation, these theories seem to take over the place of truth and science.

While the truth is usually complex and often hard to understand, these clean-cut conspiracy narratives are designed to prey on pre-established suspicions, so they can seem like viable alternatives. And unfortunately, in our ever-connected social networks, these theories have a tendency to spread just as rapidly as COVID-19 does.

Besides hospitals and academic institutions, dozens of nonprofits, including so-called “nongovernmental organizations” - or NGOs - around the world must protect their COVID-19 research and related activities from those seeking to steal data or disrupt their operations, says cyber risk management expert Stanley Mierzwa of Kean University.

A wide variety of these nonprofit organizations are potential targets for cyberattacks during the COVID-19 pandemic. These include those that exist to “advance science around the world with research and serving to advance particular missions,” he says in an interview with Information Security Media Group.

Other nonprofits work on policy issues or public health concerns, he notes. “They often research and recommend strategies to governments in countries and can be involved with implementing programs,” he says. “Any of these could be targeted for cyberattacks if they are involved in pursuing COVID-19 research activities … including the response to COVID-19.”

Attacks on these organizations could affect their partners as well, he adds.

COVID-19 can cause serious cardiovascular complications including heart failure, heart attacks and blood clots that can lead to strokes, emergency medicine doctors report in a new scientific paper. They also caution that COVID-19 treatments can interact with medicines used to manage patients’ existing cardiovascular conditions.

The new paper from UVA Health’s William Brady, MD, and colleagues aims to serve as a guide for emergency-medicine doctors treating patients who may have or are known to have COVID-19. The authors note that much attention has been paid to the pulmonary (breathing) complications of COVID-19, but less has been said about the cardiovascular complications that can lead to death or lasting impairment.

“In writing this article, we hope to increase emergency physicians’ knowledge and awareness of this new pathogen and its impact on the cardiovascular system,” said Brady, of UVA’s Department of Emergency Medicine. “As we encounter more and more patients with COVID-19-related illness, we are increasing our understanding of its impact on the body in general and the cardiovascular system in particular. The rate of learning on this area is amazingly rapid. Information continues to change weekly, if not daily.”

The company is building the world’s largest RWE platform in behavioral health and chronic diseases to expand data-driven, evidence-based care for people managing behavioral health conditions. Founded in 2015, Singapore-headquartered digital health and data analytics company Holmusk yesterday announced a $21.5 million funding round, led by Optum Ventures (OV) and Health Catalyst Capital (HCC) and included existing investors Heritas Capital and other individuals.

Dr Vijay Barathan from OV and Charles Boorady from HCC will be joining the Board of Directors.

Holmusk has offices in New York City, London and Shanghai. The new funding round allows Holmusk to expand its US operations in New York City, and enables investment in its proprietary technology to harness and analyze real-world data to accelerate drug development and data-driven medicine.

Singapore-MIT Alliance for Research and Technology (SMART), MIT’s research enterprise in Singapore, has received a grant from the National Medical Research Council (NMRC) COVID-19 Research fund for the acceleration of research and development of rapid paper-based serological and diagnostic tests for COVID-19.

In Israel, using an AI-based system has been found to be an effective way to help find people most at risk of severe COVID-19 complications. Maccabi Healthcare Services, a leading health maintenance organisation (HMO) in the country, said the system enabled it to determine who among its 2.4mln members were in the high-risk group.

The AI company Medial EarlySign co-developed the technology, which was adapted from an existing system trained to detect people most at risk from flu. The system is backed by huge sets of medical data from Maccabi going back 27 years. These medical records include a person’s age, BMI, health conditions (eg, diabetes; heart disease), and history of hospital admissions.

By trawling through this comprehensive database, the AI tool has already identified around 40,000 of Maccabi members in the high-risk group. These members were then prioritised for testing.

In addition, the AI system helps with assessing the level of treatment these at-risk members might need should they get sick: 1) home-based care; 2) confinement in a quarantine hotel; or 3) admission to hospital.

Maccabi is currently in talks with major health providers in the United States who have shown interest in using the AI system to help flag their own high-risk patients. However, bringing such a tool to the U.S. and other countries may not be that easy. In the U.S., for instance, medical records are kept in “data silos” of hospitals and other healthcare organisations. “Our ability to develop algorithms to identify individuals as high risk is limited by the lack of data sets,” notes Darren Schulte, an MD and CEO of AI firm Apixio, who hopes that the current pandemic will bring about needed improvements in data sharing.