Allscripts sues telemedicine startup CarePortMD over its name

Allscripts sues telemedicine startup CarePortMD over its name

Allscripts is asking a federal court to void a telemedicine company’s trademark for the name “CarePortMD,” arguing it’s too similar to a trademark it holds for “CarePort,” according to a lawsuit filed Thursday.

Allscripts in its complaint accuses CarePortMD, a Newark, Del.-based telemedicine and urgent care company that formerly did business as ER at Home, of trademark infringement, false designation of origin and unfair competition. claimed it and its customers are harmed by CarePortMD’s use of “confusingly similar” branding.

Allscripts, which is based in Chicago, filed the lawsuit in a Delaware federal court.

Since November 2013 has held a trademark registration for “CarePort” from the U.S Patent and Trademark Office. Allscripts’ CarePort Health business, which announced plans to sell earlier this week, offers care coordination software that connects acute and post-acute care providers.

Allscripts has continuously used the “CarePort” mark since at least January 2013, according to the company’s complaint. Allscripts on Tuesday announced plans to sell its CarePort Health business to WellSky, a company that develops software tools for post-acute care providers, for $1.35 billion.

Allscripts in late 2019 learned about CarePortMD, which since September 2018 has held a trademark registration from USPTO for “CarePortMD.” The “CarePortMD” mark, according to its USPTO registration, is for “telemedicine services; urgent medical care centers; dispensing of pharmaceuticals; integrated outpatient healthcare services; medical clinic services.”

CarePortMD has been using that name since July 2018, according to the registration.

Allscripts’ counsel in December 2019 sent a letter to the attorney listed in CarePortMD’s USPTO registration, requesting that CarePortMD stop using the branding, according to the complaint. counsel also requested that the Delaware company abandon its trademark registration and transfer the CarePortMD domain name. A month later, it sent the letter directly to CarePortMD.

CarePortMD’s counsel responded to letter in January to say the company would keep using its branding. The two companies have not been able to resolve the dispute outside of court.

Allscripts in its complaint argues CarePortMD’s branding is “highly likely to cause confusion with services,” as they both provide healthcare services offered through online platforms.

Allscripts is seeking damages, as well as an order for CarePortMD to stop using its name and for USPTO to cancel CarePortMD’s trademark registration.

Dr. Ashok Subramanian, CarePortMD’s CEO, in an email said the company followed guidelines from USPTO to obtain its trademark registration and called the CarePortMD name a “conjugate of 3 common terms.” didn’t make any objections during the six-month period before CarePortMD was issued its registration, Subramanian said.

“We made several unanswered attempts to understand the nature of the concern after they approached us,” he wrote. “Unfortunately, we view this as an example of large business strangling promising startups for no justifiable reason — at the expense of the much-needed and effective care model we have deployed. We put our trust into the USPTO’s process of granting our trademark.”

Allscripts did not immediately respond to a request for comment.

Allscripts

Source: Allscripts sues telemedicine startup CarePortMD over its name

Cutting exposure to COVID-19 in EDs using on-site telehealth

Cutting exposure to COVID-19 in EDs using on-site telehealth

Telehealth has been gaining ground as a breakout star of the COVID-19 pandemic. Cutting

But while much of the recent attention has focused on using it to treat patients at home, the practice has also been vital to keeping clinical staff members safer as providers revamp emergency departments to curb the risk of infection.

Telehealth played a major role when Renown Health set up a medical tent during the early days of the pandemic to expand its ED’s triage capacity for patients with COVID-19 symptoms.

After getting their vital signs taken by a nurse in-person, patients would speak with an emergency medicine physician via video, who would determine whether they needed testing, treatment or another next step.

The Reno, Nev.-based system took down its alternate care site in June, but has kept aspects of that virtual component alive in its ED. “Our first priority is patient safety and patient care,” said Dr. Paul Sierzenski, an emergency medicine physician and chief medical officer for acute-care services at Renown. “Right next to that is our staff safety and staff care.”

When patients present at the ED, they’re immediately screened for COVID-19. Those with symptoms are sent to an individual room, where they’ll typically use a tablet or telehealth cart—which includes internet-connected devices, such as digital stethoscopes—to complete a virtual evaluation and assessment with a physician, depending on their acuity.

Renown uses software and hardware from a few different companies for its telehealth program.

It’s the first time the health system has used telehealth to connect its on-site physicians to ED patients, though it has provided telehealth consultations for specialty services like stroke care and behavioral health to EDs for years.

Some health systems were adding telehealth to their EDs before COVID-19 hit. Those with high ED visit volumes in particular had been rolling out processes for physician assistants or physicians—often based at a central station, but managing patients at multiple facilities—to help triage patients via telehealth, in an effort to reduce long wait times, said Arielle Trzcinski, a senior analyst at market research firm Forrester.

That type of “tele-triage” can help a facility manage capacity, since a remote physician assistant or physician can redirect patients who might be a better fit for urgent or primary care. For patients with more pressing cases, staff can start ordering lab tests and X-rays before a patient even gets to an exam room.

It’s become more common to see telehealth in EDs since March, as health systems have wanted to address patient surges quickly and use portable video equipment in new ways to decrease clinicians’ COVID-19 exposure, Trzcinski said. She believes many health systems will keep the new processes in place, at least for busy times of the year, such as flu season.

Emergency medicine staff at Aurora St. Luke’s Medical Center, a Milwaukee hospital that’s part of Advocate Aurora Health, had been thinking about using remote physician assistants to help triage patients, but the practice didn’t catch on until COVID cases started mounting. Since the spring, patients who present at Aurora St. Luke’s ED with COVID-19 symptoms are directed to a so-called “hot zone”; those without symptoms are sent to the “cold zone.” A telehealth cart with a tablet is rolled over, so a physician assistant—located elsewhere in the hospital—can remotely triage patients in both areas.

The tele-triage system lets remote physician assistants assess any patient without having to change personal protective equipment, said Dr. Bill Lieber, an emergency medicine physician who has practiced at the hospital for more than 15 years.

The tele-triage system is likely to remain at Aurora St. Luke’s after the pandemic subsides, Lieber said. Aurora St. Luke’s uses virtual care technology from EmOpti for tele-triage.

Aside from reducing risk of exposure, Lieber said it has helped with efficiency, since the physician assistant can remotely triage patients at other facilities while at Aurora St. Luke’s.

EmOpti bases its software fees on a facility’s annual ED visit volumes, according to Dr. Edward Barthell, an emergency medicine physician and the company’s founder and CEO.

It’s too early to share outcomes from Aurora St. Luke’s tele-triage use, but a sister hospital saw its typical patient wait time drop from 40 minutes to 10 minutes after implementing tele-triage, according to Barthell. The hospital’s length of stay for patients discharged from the ED decreased by 45 minutes.

Cutting

Source: Cutting exposure to COVID-19 in EDs using on-site telehealth

HHS Plan to Improve Rural Health Focuses on Better Broadband, Telehealth Services

HHS Plan to Improve Rural Health Focuses on Better Broadband, Telehealth Services

Knowing it may be met with some skepticism, the Trump administration Thursday announced a sweeping plan that officials say will transform health care in rural America. HHS

Even before the coronavirus pandemic reached into the nation’s less-populated regions, rural Americans were sicker, poorer and older than the rest of the country. Hospitals are shuttering at record rates, and health care experts have long called for changes.

The new plan, released by Health and Human Services Secretary Alex Azar, acknowledges the gaps in health care and other problems facing rural America. It lists a litany of projects and directives, with many already underway or announced within federal agencies.

“We cannot just tinker around the edges of a rural healthcare system that has struggled for too long,” Azar said in a prepared statement.

Yet, that is exactly what experts say the administration continues to do.

“They tinker around the edges,” said Tommy Barnhart, former president of the National Rural Health Association. And, he added, “there’s a lot of political hype” that has happened under President Donald Trump, as well as previous presidents.

In the past few months, rural health care has increasingly become a focus for Trump, whose polling numbers are souring as COVID-19 kills hundreds of Americans every day, drives down restaurant demand for some farm products and spreads through meatpacking plants. Rural states including Iowa and the Dakotas are reporting the latest surges in cases.

This announcement comes in response to Trump’s executive order last month calling for improved rural health and telehealth access. Earlier this week, three federal agencies also announced they would team up to address gaps in rural broadband service — a key need as large portions of the plan seek to expand telehealth.

The plan is more than 70 pages long and the word “telehealth” appears more than 90 times, with a focus on projects across HHS, including the Health Resources and Services Administration and the Centers for Medicare & Medicaid Services.

Barnhart said CMS has passed some public health emergency waivers since the beginning of the pandemic that helped rural facilities get more funding, including one that specifically was designed to provide additional money for telehealth services. However, those waivers are set to expire when the coronavirus emergency ends. Officials have not yet set a date for when the federal emergency will end.

Andrew Jay Schwartzman, senior counselor to the Benton Institute for Broadband & Society, a private foundation that works to ensure greater internet access, said there are multiple challenges with implementing telehealth across the nation. Many initiatives for robust telehealth programs need fast bandwidth, yet getting the money and setting up the necessary infrastructure is very difficult, he said.

“It will be a long time before this kind of technology will be readily available to much of the country,” he said.

Ge Bai, associate professor of accounting and health policy at Johns Hopkins University in Baltimore, noted that telehealth was short on funding in the HHS initiative. However, she said, the focus on telehealth, as well as a proposed shift in payment for small rural hospitals and changing workforce licensing requirements, had good potential.

“We are so close to the election that this is probably more of a messaging issue to cater to rural residents,” Bai said. “But it doesn’t matter who will be president. This report will give the next administration useful guidance.”

The American Hospital Association, representing 5,000 hospitals nationwide, sent a letter to Trump last week recommending a host of steps the administration could take. As of late Thursday, AHA was still reviewing the HHS plan but said it was “encouraged by the increased attention on rural health care.”

Buried within the HHS announcement are technical initiatives, such as a contract to help clinics and hospitals integrate care, and detailed efforts to address gaps in care, including a proposal to increase funding for school-based mental health programs in the president’s 2021 budget.

A senior HHS official said that while some actions have been taken in recent months to improve rural health — such as the $11 billion provided to rural hospitals through coronavirus relief funding — more is needed.

“We’re putting our stake in the ground that the time for talk is over,” he said. “We’re going to move forward.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

HHS

Source: HHS Plan to Improve Rural Health Focuses on Better Broadband, Telehealth Services

Telehealth seems here to stay – so how can it be improved?

Telehealth seems here to stay – so how can it be improved?

After the coronavirus began spreading in the United States this past spring, telehealth patient rates shot up in response, with some health systems reporting a whopping 4,000% increase in appointment numbers for virtual care.

There’s no doubt, in many practitioners’ minds, that telehealth has filled an existing need both spotlighted and exacerbated by the COVID-19 pandemic. It’s also clear, despite a dip in the initial numbers, that it’s not going anywhere anytime soon.

However, after the initial scurry to spin up an appropriate platform – sometimes within a matter of days – providers are also noting the ways telehealth can be improved.

Those who spoke with Healthcare IT News for this story made it clear that the benefits of telehealth outweigh the challenges. But there are certainly some shortcomings that should be ironed out. They can be addressed, providers and researchers say, with education, platform improvement and legislation to help telehealth live up to its full potential.

The future of reimbursement

The healthcare professionals we interviewed spoke to the ongoing uncertainty surrounding telehealth reimbursement as a major contributor to dissatisfaction.

“The primary hurdle is the impermanence,” said Dr. Diane Rittenhouse, a senior fellow at Mathematica, whose research expertise includes primary care and innovative models. “The insecurity of the future.”

Although the federal government has made dozens of temporary policy changes to try and ease access to telehealth during the pandemic, it remains an open question which ones will stick. Some, like the relaxation of geographic and originating site requirements, are broadly popular on both sides of the aisle. Others, such as payment parity, remain embroiled in logistics.

The Trump administration added complexity to the situation this week by issuing an executive order in favor of permanent telehealth provisions as well.

For primary care physicians in particular, said Rittenhouse, the uncertainty of payment adds to existing challenges.

“People were seeing patients in the virtual space before they had the reforms to payment to get paid for it. They were doing it essentially for free,” Rittenhouse said. Now, payment reforms have caught up – but it’s unclear how long they’ll remain in place.

“There’s this sense: ‘I like this. Patients like this. We seem to be able to have found success, but how are we going to continue to be paid for it?'” she asked.

Rittenhouse believes the fee-for-service model is not especially well designed for primary care and telehealth.

“It’s really an issue of not being able to survive if they’re delivering care for free. If they don’t get paid for it, if they don’t get reimbursed for it, then how do they function?” she asked.

Another issue for primary care providers, she said, is “change fatigue.”

“We’re asking for a lot of change in primary care over the last couple decades,” she said. “It’s good, and it comes from a good place, but these practices are being asked to add more team members, to work under different conditions, to adopt electronic health records, [and] to develop new population-based quality-measuring systems and reporting systems.

“When you’ve got this chronically underfunded system – or non-system – and you [hear], ‘OK, here’s a pandemic. OK, now you have to see patients in a new way. OK, now we’re going to pay you, but we don’t know how long,'” it exacerbates that fatigue, Rittenhouse said.

“While I think it’s important that primary care providers access the funds that have been made available during COVID-19 to help support their practices, I think more is needed. PCPs don’t have the infrastructure to apply for some of those funds, negotiate for some of those funds,” she said.

Rittenhouse, along with colleagues, recently proposed a primary care service corps to assist with some of these logistics.

“People are ill. Their patients are afraid. Practices are having to shutter. They’re having to take turns. There was a period where they weren’t paid at all. They’re burned out. They have their own mental illness and stress. It’s really, really a tough time,” she said.

“We’re asking for a lot of change in primary care over the last couple decades. It’s good, and it comes from a good place, but these practices are being asked to add more team members, to work under different conditions, to adopt electronic health records, [and] to develop new population-based quality-measuring systems and reporting systems.”

Dr. Diane Rittenhouse

Susan Conaty-Buck, DNP, an assistant professor at the University of Delaware and a member of the American Nursing Informatics Association, says that it’s vital to prioritize primary care pay-parity in telehealth.

“With telehealth, we have to make sure primary care provider parity continues,” she said. “Many states have worked hard to equalize access.”

“One of the challenges we’ve had is for reimbursement,” agreed Mona Ryan, a speech language pathologist and associate professor at the University of Oklahoma Health Sciences Center College of Allied Health.

Ryan’s clinic had offered telehealth for “quite a while,” she said, “but the rules were always so strict,” making it difficult for some patients who could have benefited from virtual care to access it.

“We’ve seen a lot of relaxation on those rules, but we’re hoping that [the government] sees [telehealth] as a location of service rather than a type of service,” she said. “We have a lot of clients whose attendance is better because they don’t have to drive here.”

“Cost parity would be nice,” said Dr. Conrad Flick, a family medicine specialist in Raleigh, North Carolina. “One of the things [to think about] for us is what the future holds about Medicare and Medicaid – and private insurance – and what they’re going to cover.”

“The regulatory, legal side – I think it’s just a matter of getting reasonable pay for this service,” he said.

Logistical improvements

The issue of broadband access has been of recurrent interest among elected officials and telehealth advocates, who say that without reliable internet patients are effectively being left behind.

“Some of our patients are still a little farther out,” said Flick. “Sometimes cell signals drop, and they may not have good coverage. … Sometimes you’ll call them and you can only see a static picture. Sometimes I call the person on the phone and try to complete the visit.”

“The biggest limitations are connectivity issues,” agreed Dr. Elizabeth Nelson, a family medicine provider at OU Medicine. “I’m not a tech-savvy person, so when things don’t go well it’s really frustrating.”

“It feels really silly to spend 15 to 20 minutes trying to connect with someone for a 10 to 15 minute appointment,” she said.

“The biggest limitations are connectivity issues. … I’m not a tech-savvy person, so when things don’t go well it’s really frustrating.”

Dr. Elizabeth Nelson

“Those nonverbal cues are what’s so helpful to me,” she continued. “There are plenty of times when I’m looking at a rash over video. If it’s super pixelated and I can’t see anything, it’s kind of worthless.”

Ryan’s clinic primarily serves children, some of whom are not able to engage effectively with telehealth sessions.

“I think that’s our biggest hurdle: How do you make it beneficial for those kids who need lots of hands-on to be successful?” she said.

“We had a couple of adults that just … couldn’t handle figuring out how to utilize [the technology],” she continued. “With adults that was the only shortfall, and it increased their anxiety and their lack of quality of life when they couldn’t connect. We don’t want to upset them further.

“Those clients – we just had to let them wait until our colleagues could see them in person again, because it just wasn’t working,” she said.

A number of providers spoke to tangible improvements vendors could make to telehealth services, including seamless EHR integration.

“We never really got what we hoped we would have, which is all EHR systems sharing information at the point of care,” said Flick. “Our [telehealth platform] is outside the EHR, and creating an integration would be helpful.”

Nelson, meanwhile, said her system’s current platform doesn’t allow her to send someone electronic instructions or a visit summary.

“People leave and forget half of what was discussed,” she said, especially patients with more complicated issues.

Nelson also pointed to remote patient monitoring as an undeniable future necessity.

“Vitals are a really necessary thing,” she said. “People don’t know if they’re losing weight, or if their blood pressure is running high if they have no symptoms. … We’re trying to figure out how we get people home cuffs. I think that’ll help facilitate virtual visits more if we can get some accurate information.”

And telehealth can certainly be a time-saver, but Flick said it can also make scheduling trickier.

“Timing is one of the harder issues,” he said. If and when delays occur, “people get assigned a time and they’re sitting there waiting for you to show up.”

He added: “We did not find as a business that it worked to schedule telehealth visit after telehealth visit.”

Provider and patient education

Although many people are familiar enough with video-chatting software to be comfortable with it, clinicians say virtual medical care can require an additional layer of expertise – particularly regarding telehealth with patients in their own homes, as opposed to facility-to-facility services.

“Part of it is developing a new methodology for physical assessment,” said Conaty-Buck. “When you go through a program, you have a lot of courses where people watch you do exams. The question becomes: ‘How do you make sure the student knows how to do those kinds of exams via telehealth?'”

The challenge with all advancements in health tech, she said, can lie with provider education.

“If you were not trained in advanced healthcare technology, the thought of adding artificial intelligence, or natural language processing – you’re faced with these wonderful things you could do, but where’s the time? What’s the reimbursement? Who will teach you?” she asked.

Providers may be willing to learn, but she pointed out, “You have to have people in the schools to teach them.”

“As it becomes a standard of care, then we have to teach it and we have to adopt it,” she said.

This also involves patient communication, she explained, including preparing them on the necessary technology and instructing them to be in a quiet place, if possible, for their care.

“It’s part of our job to educate the patient to help us help them,” she said.

“Not all providers are geared to do this,” said Dr. Mia Finkelston, medical director at Amwell. “It’s too novel for them. Maybe they’re scared and don’t feel confident with [their] history-taking skills. It isn’t for everyone.”

But, she pointed out, the pandemic has pushed some clinicians to try telemedicine who may not have done so otherwise.

“We’ve gained providers who do like it,” she said.

Overall, those who spoke with Healthcare IT News said that, while telehealth cannot completely replace in-person care, it represents lasting potential for innovation.

“There’s been lots of work in these areas. We just have to keep it up. We just have to keep up momentum,” said Conaty-Buck.

“The future is in trying to develop relationships with people. Some of the next generations don’t see what’s important about relationships. But that’s the best way to save money and get quality care,” said Flick.

“They’ve found lots and lots of ways to make telepractice work even better than I thought it could be,” said Ryan.

The pandemic, she continued, “has allowed a lot of people to be very generous with the things they’ve developed for telepractice. Resources have been abundant in a way they weren’t before. There are so many commercial apps and things you can use to make really fun, engaging therapy.

“It’s been neat to see how we’ve adapted,” added Nelson. “It gives people that hope and that comfort to be able to connect with their primary clinic with ease.”

Telehealth

Source: Telehealth seems here to stay – so how can it be improved?

House telehealth leaders move to cement regulatory changes for virtual care

House telehealth leaders move to cement regulatory changes for virtual care

Image Source: Pixabay
House lawmakers introduced a bill to continue the expanded use of telehealth beyond the health pandemic.
House

Leaders of the House telehealth caucus introduced legislation Thursday to permanently open up access to telehealth services for Medicare patients.

The bipartisan bill (PDF), the Protecting Access to Post-Covid-19 Telehealth Act, will extend the use of telehealth that was expanded during the COVID-19 pandemic by eliminating restrictions on the use in Medicare. That would provide a bridge for patients currently using the practices because of the coronavirus crisis and require a study on the use of telehealth during COVID-19, said bill co-sponsor Rep. Mike Thompson, D-California, in a statement.

The bill will expand the use of telehealth for seniors and those on Medicare and ensure that telehealth care be used during future disasters and emergencies, said Thompson, founder and co-chair of the Congressional Telehealth Caucus.

“We know telehealth can be an essential bridge in delivering care, particularly during a crisis and today we are working to ensure telehealth continues in a post-Coronavirus world,” he said.

The bill also was introduced by caucus co-chairs Reps. Peter Welch, D-Vermont, Bill Johnson, R-Ohio, and David Schweikert, R-Arizona, and caucus member Rep. Doris Matsui, D-California.

The proposed legislation will ensure that the “enormous resources invested in making this technology work are not wasted,” Johnson said.

What it would do

The proposed bill would provide many of the regulatory flexibilities that healthcare provider groups have been pushing for during the pandemic, such as removing arbitrary geographic restrictions on where a patient must be located in order to utilize telehealth services and enabling telehealth services to provided to patients in their homes.

The legislation also ensures federally qualified health centers and rural health centers can furnish telehealth services. And the bill would make permanent the temporary waiver authority for the Department of Health and Human Services (HHS) secretary for future emergency periods and the 90 days after the rescinding of a public health emergency period.

Healthcare groups overwhelmingly cheered the legislative efforts to make telehealth a routine part of healthcare delivery.

“The legislation would once and for all remove arbitrary geographic restrictions on all Medicare telehealth services and ensure access for patients for whom traditional office visits don’t always work,” said eHealth Initiative CEO Jennifer Covich Bordenick in a statement.

“We applaud Congressman Thompson and the House Telehealth Caucus for their continued leadership on telehealth and look forward to working with them to advance this critical legislation,” Covich Bordenick said.

Last month, Reps. Troy Balderson, R-Ohio, and Cindy Axne, D-Iowa, introduced a bipartisan bill, KEEP Telehealth Options Act, to lay the groundwork for the permanent expansion of telehealth.

That proposed legislation would instruct HHS and the Government Accountability Office (GAO) to study and report to U.S. Congress on the expansion of telehealth services during the COVID-19 outbreak, the uptake of those services by patients across the country and GAO’s recommendations for enhancing the quality of and access to these services.

It’s also possible that Congress will roll telehealth legislation into a “phase four” coronavirus relief legislation.

Other changes

During the pandemic, the Trump administration has opened up access to telehealth with sweeping—but temporary—changes to reimbursement policies.

In a matter of weeks, most of the barriers to telehealth reimbursement fell away, enabling many of the changes that provider groups have wanted for years: payment parity for virtual visits, the ability to provide telehealth to patients at home and allowing more providers to offer telehealth visits.

What remains up in the air is whether the regulatory flexibility on reimbursement is going to stick around.

Digital health associations and more than 300 organizations sent a letter to Congress calling for meaningful and permanent action to address statutory barriers to telehealth.

The Protecting Access to Post-COVID-19 Telehealth Act of 2020 addresses nearly all priorities (PDF) outlined in the letter, according to the eHealth Initiative.

A CMS official recently said that an upcoming Medicare payment rule will include proposals outlining how the Trump administration plans to permanently expand reimbursement for telehealth services.

But for some changes, such as eliminating geographic and originating site restrictions, congressional action is needed.

“Telehealth services have been a lifeline for more than 9 million seniors during the COVID-19 pandemic. The Protecting Access to Post-COVID-19 Telehealth Act will ensure that this access does not disappear once the coronavirus emergency is over,” said Krista Drobac, executive director of the Alliance for Connected Care, in a statement.

House

Source: House telehealth leaders move to cement regulatory changes for virtual care

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