Morning Headlines 5/23/13

Doctors and hospitals’ use of health IT more than doubles since 2012

HHS Secretary Kathleen Sebelius reports that HHS has exceeded its goal of transitioning 50 percent of eligible providers and 80 percent of eligible hospitals onto EHRs by the end of 2013.

Hagel says DoD to adopt commercial EHR 

Defense Secretary Chuck Hagel testified last month before a House Appropriations Committee to report that DoD had fallen behind on its plans to implement an integrated EHR with the VA; that much of the allocated money for the project had been spent with little to show for it; and that when the decision to launch a vendor search for a commercial EHR was made, he "didn’t think we knew what the hell we were doing." At the conclusion of that hearing, Hagel promised that he would halt the commercial vendor search and report back within 30 days with DoD’s new plan for delivering an integrated DoD/VA EHR. This Wednesday, bending to internal DoD pressure, Hagel reversed course on nearly all that he had said before the House Committee, reporting in a memo that DoD would resume its commercial EHR vendor selection rather than develop an integrated solution with the VA or adopting VA’s VistA.

All Maine hospitals sign on to electronic health records exchange

All of Maine’s acute-care hospitals have agreed to participate in HealthInfoNet, Maine’s statewide query-based HIE. Thirty-four of Maine’s hospitals are already connected to the network, and the last four are scheduled to go live by the end of the year. HealthInfoNet is also connected to 376 ambulatory practice sites.

Practice Fusion Continues To Reach Beyond Digital Health Records, Adds Free Expense Tracking To New Booking Engine

Free Web-based EHR vendor Practice Fusion launches a patient-facing site that allows patients to compare doctors and book appointments. After the appointment, patients can review their spending history across the entire history of their medical visits.

Readers Write: Pagers Cost Hospitals Billions Each Year

Pagers Cost Hospitals Billions Each Year
By Larry Ponemon, PhD

Earlier this month, the Ponemon Institute released a study titled “The Economic & Productivity Impact of IT Security on Healthcare” that aims to quantify the impact that the use of pagers and other outdated communication technologies has on healthcare. The research reveals that communication in healthcare lags behind other industries, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

As a result, outmoded communication systems waste clinicians’ time, limit patient interaction, lengthen discharge times, and lead to significant industry-wide economic loss.

The healthcare industry is facing some challenges in trying to balance the convenience benefit of new technologies with the need to keep patient health information protected at all times. While the implementation of electronic medical records and other new technologies is designed to improve efficiency and enhance patient care, it also has the potential to introduce risk, so IT departments must ensure that these new systems meet security and regulatory compliance requirements to keep private information protected.

As organizations struggle to strike this balance, the use of pagers and other outdated communications technologies continues as the status quo, in large part because of the perceived security and compliance risks associated with the use of smartphones and other modern technologies.

To quantify the impact this has and try to understand the scope, we surveyed 577 doctors, nurses, hospital administrators, IT practitioners, and other healthcare professionals. Overwhelmingly, respondents agreed that the deficient communications tools currently in use decrease productivity and limit the time doctors have to spend with patients. They also recognized the value of implementing smartphones, text messaging, and other modern forms of communications, but cited restrictive security policies as a primary reason why these technologies are not in use.

This study revealed that the use of pagers and other outdated communication technologies decreases clinician productivity and increases patient discharge times, collectively costing U.S. hospitals more than $8.3 billion annually.

According to our findings, clinicians waste an average of about 46 minutes each day due to the use of outmoded communication technologies. The primary reasons cited are the inefficiency of pagers, the lack of Wi-Fi availability, the inadequacy of e-mail, and the inability to use text messaging. On average, we estimate that this waste of clinicians’ time costs each U.S. hospital more than $900,000 per year. Based on the number of registered hospitals in the US, this translates to an industry-wide loss of more than $5.1 billion annually.

We also found that similar deficiencies in communications lengthen patient discharge time, which currently averages about 101 minutes. The majority of respondents said about half of this time could be eliminated if modern communication technologies were allowed. Specifically, 65 percent of survey respondents believe that secure text messaging can cut discharge time by about 50 minutes. Again, based on the number of registered hospitals in the U.S., we estimate that this ‘idle time’ during the discharge process costs more than $3.1 billion in lost revenue per year across the healthcare industry.

One of the primary reasons why smartphones and other newer technologies have not yet been adopted on a broad scale is the perceived security and compliance risks this would create. As a matter of both best practices and complying with HIPAA regulations, healthcare IT administrators are charged with keeping clinical systems and private health information protected at all times. As with other industries, we see that the reduction of risk often comes at the sacrifice of the convenience and productivity benefits of newer technologies.

For example, native SMS text messaging is not encrypted and therefore cannot be used to transmit private health information. Many hospitals have a policy forbidding the use of texting despite the fact that research like ours clearly demonstrates the value it would have on both clinical workflows and patient care. In fact, the majority of respondents to our survey said HIPAA compliance requirements can be a barrier to providing effective patient care. Specifically, HIPAA reduces time available for patient care, makes access to electronic patient information difficult, and restricts the use of electronic communications.

There is clearly a tension between giving caregivers access to the best possible technology to do their job effectively and ensuring that security and compliance requirements are met. Unfortunately we see that the pendulum seems to swing in favor of the latter, and while it is absolutely necessary to ensure security and patient privacy, clinician productivity and patient care suffer as a result.

One of the takeaways from our research is that healthcare professionals—both clinicians as well as IT staff—seem to understand these challenges and the benefits of deploying more modern communication technologies. For example, 74 percent of survey respondents said secure text messaging either has replaced pagers or will replace pagers within the next two years at their organization.

This is encouraging, and we think research like this will help the healthcare industry realize that the cost of implementing new, modern communication tools will be just a fraction of the economic and productivity costs of continuing to rely on pagers and other outdated technologies.

Larry Ponemon, PhD is chairman and founder of Ponemon Institute of North Traverse City, MI.

CIO Unplugged 5/22/13

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Don’t Sell Me, Bro’!

I haven’t stirred blog waters in a while, so let me throw a rock along the surface and see if it skips or splashes.

I admire those who are skilled in the art of persuasion. We need salespeople to bring ideas to help solve business problems. But timing is everything. Solomon waxed it eloquently in ancient days: “There’s an opportune time to do things, a right time for everything on the earth.”

Let me be straight. The right time to sell is never before, during, or after a speaker’s presentation. Yet this happens too often.

I recently finished the keynote for the Texas HIMSS conference. During Q&A, a salesperson launched into an infomercial. I was on my heels a bit and tried to move on. Instead of giving up, he launched into a second infomercial. I just wasted five minutes of precious audience time and subjected everyone to this windbag. I don’t remember a word he said or his company. This type of approach does nothing but spark tension and resistance.

The above incident broke the camel’s back. I am DONE with it. Hence, the motivation for this post and some practical advice on how to put things in their proper place.

Zeitgeist: “Understanding the intellectual and cultural climate of” the speaker presentation. Just for a moment, take off the sale’s hat and empathize with the presenter. Dependent on content, I have worked 10 to 20 hours to put something respectable together. Once it’s assembled, I rehearse at least the same amount.

For the above-mentioned HIMSS presentation, a colleague and I spent 20 hours putting together the content. We spent additional time with Advisory Board and Gartner to review and improve. I stayed up past 2 a.m. the night prior making last-minute adjustments. I spent three  hours before the curtain opened rehearsing again.

As is typical, when I finished speaking, I felt as if I’d completed a big race or mountain summit: exhausted and elated. I’m asking myself how I could’ve done better and I’m beating myself over the lines I missed.

After this presentation, a line formed at the stage to talk. Now don’t get me wrong, I love the interaction when it is an exchange of ideas. Ideas energize me. Interacting with individuals often helps me decompress. But I get indignant when feigned interest is actually a veiled sales pitch.

When you sell me, I completely shut down. I will not remember a word you say. I will toss your business card. One person actually pulled out their iPad to give me a demo of the newest product destined to solve our nation’s woes. Really?

What I love is when attendees come up and we share ideas or perhaps I can answer a couple of questions they had from the presentation. This is like a reward, and I will find energy to connect. I love to help. But don’t sell me, bro’.

To keep this from happening again, I developed some untested recommendations. I am interested in your ideas as well. Please contribute with a comment so we all make better use of this precious time. Both audience and speaker will appreciate these.

Facilitator

• Control the microphones. When you hand someone a mic, you have lost control. By holding it for them, you can prevent a hijack.
• Provide boundaries. Let the audience know upfront that questions are welcomed and encouraged, with two caveats: infomercials or pontification are shunned.
• Assertiveness. If someone violates these rules, protect the speaker and move on to the next question.

Speaker

• Be direct. If someone goes into sales mode, actively shut them down and move to the next question or person.
• Buddy system. Have a buddy with you as you prepare for the talk. If accosted, the buddy steps in.
• An associate. Appoint an associate to stand with you after the talk. If someone goes into sales mode, they can step in and you move to the next person. My wife is great at this during parties. If she senses a sneak attack, you’d better watch out.

What’s worse than being sold post-presentation? Being accosted before the presentation with a sales pitch. When heading into a presentation, the last thing on my mind is listening to someone drone on about their product or service. My thoughts are focused on exceeding audience and organizer expectations. I’m absorbed with logistics perfection: visuals, lighting, and sound. I’m gaining a sense for the flow and vibe of the room. Not to mention I’m straining to remember all my key points! This is a big deal. It is show time.

Don’t sell me, bro’!

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.

Morning Headlines 5/22/13

Local Health IT Firm Healthland Acquires Software Co.

Healthland acquires Jackson, MS-based post-acute care EHR vendor American HealthTech for an undisclosed sum.

Change in Directors or Principal Officers, Financial Statements and Exhibits

NextGen Healthcare board member Ahmed Hussein resigns after multiple failed attempts to take control of the company through proxy fights. He currently holds more than $100 million in company stock, which means that he can reinstate himself to the board in the future through cumulative voting rules.

Healthcare Innovation Council Calls Out CMS’ EHR Program as "Emperor Has No Clothes"

The Healthcare Innovation Council, an independent group of healthcare experts, has called upon Congress to reconsider the CMS Meaningful Use program since it is not furthering Congress’s goal of improving patient care. The group calls for a reboot of Meaningful Use before all of the money is spent. They are asking for a shift in focus away from hospital adoption of technology and toward improving the design and implementation of the EHR systems.

VMC’s electronic medical records system will increase efficiency, reduce medical errors

A Silicon Valley editorial praises Santa Clara Valley Medical Center’s $220 million Epic implementation, calling it a robust system that should lead to more efficient billing and significantly improve quality of care.

News 5/22/13

Top News

Healthland acquires post-acute care software vendor American HealthTech of Jackson, MS.

Reader Comments

From Dortlund: “Re: GE Healthcare. Charging a premium on top of annual maintenance for MU Stage 2 and ICD-10.” Not to mention spelling “after hours” as “afterhours” for some reason.

From CMIO: “Re: clinical informatics exam. I applied, paid, and took a board prep course and plan to take the practice test this summer. I did not do a fellowship, but I want to be on the inaugural class of the new board based on three years as CMIO. It is worth it for me, as this is my career and this is my credential.”

From NoLongerPhamis: “I LOVED the last Slideshare about GEHC/IDX. Almost fell out of my chair laughing. The part about seamless integration of marketing materials was spot on. I was there.” This was in a recent episode of Vince Ciotti’s HIS-tory.

Acquisitions, Funding, Business, and Stock

Healthcare consulting firm Information Resources Associates, Inc. merges with ESD.

Virtual visit technology vendor ConsultingMD raises $10 million in funding from Venrock.

Pittsburgh-based wound care EHR vendor Net Health acquires Integritas, which offers EMR/PM solutions for urgent care, occupational health, and hospital employee health. 

Quality Systems, Inc. investor and board member Ahmed Hussein, mostly known for criticizing his fellow board members and launching proxy fights in an attempt to take control of the company, resigns. He owns more than $100 million in QSII shares.

Sales

Orange Accountable Care, a subsidiary of Orange Health Solutions, will deploy Sandlot Care Manager, Sandlot Dimensions, and Sandlot Metrix.

Wellmont Health System (TN) expands its relationship with MModal to include MModal Fluency Direct and Fluency for Imaging as its clinical documentation platforms.

St. Joseph’s Imaging (NY) selects Merge Healthcare’s Outpatient Radiology Suite.

The ERx Group, a staffing provider for rural acute care and critical access facilities, will use T-System’s clinical, financial, and operational technology and services.

Southeast Alabama Medical Center selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

Western Maryland Health System (MD) will use Dimensional Insight’s business intelligence solution, The Diver Solution.

People

Long-term care EHR provider MatrixCare names Denise Wassenaar (Alliance Pharmacy Services) chief clinical officer.

Imprivata, expecting to go public within two years according to its CEO, names John Halamka, MD (Beth Israel Deaconess Medical Center) and former Phase Forward CFO Rodger Weismann to its board.

Stoltenberg Consulting appoints Douglas Herr (maxIT Healthcare) VP of Epic practice and client relations.

Announcements and Implementations

Peak Health Solutions partners with ChartWise to offer a solution that includes Peak’s clinical document improvement consulting and education program and ChartWise’s CDI software.

Stillwater Medical Center (OK) integrates its Philips IntelliVue patient monitors and Meditech ED management solution using the Accelero Connect healthcare integration platform from Accent on Integration.

North Shore-LIJ Health System adds cameras in operating rooms at its Forest Hills Hospital (NY) to remotely audit surgical teams for performing timeouts prior to procedures and to alert hospital cleaning crews when a surgery is nearing completion.

Fox Business News is running a week-long series called “How Private are Your Medical Records?” on “The Willis Report.” Monday’s episode featured Deborah Peel, MD of Patient Privacy Rights and Mark Rotenberg of the Electronic Privacy Information Center.

Covenant Health (TX) and MemorialCare Health System (CA) are named winners of the 2013 Crimson Physician Partnership Awards presented by The Advisory Board Company, saving a combined $20 million by presenting comparative performance information to their physicians.

CampDoc.com releases an electronic medication administration record module for its summer camp EHR.

Government and Politics

The Consumer Partnership for eHealth and the Campaign for Better Care submit a letter to the six Republican senators who last month questioned whether the implementation of the HITECH Act was money well spent. The consumer groups argue that MU is working and that delaying Stage 2 implementation and Stage 3 rulemaking will be detrimental to patients, will stifle innovation, and will delay progress towards interoperability.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

ONC posts positions (1, 2) for medical officer reporting to the Office of the Chief Medical Officer.

Twila Brase, RN, president and co-founder of Citizen’s Council for Health Freedom, says EHRs are burdensome and inaccurate, adding that they are turning doctors into data clerks. She adds, “Documenting a full clinical encounter in an EHR from scratch can be pure torment. The full chart doesn’t fit on the computer screen. Each element is selected by a series of clicks, double-clicks, or even triple-clicks of a mouse button. Hunting, clicking, and scrolling just to complete a simple history and physical exam is a tedious and time-wasting experience."

A Health Innovation Council commentary article says HITECH is causing, “A massive disruption of providers’ patient care focus as they chase Meaningful Use dollars; increased burdens on physicians, nurses and clinicians since EHRs as currently designed require more, not less, of their time and effort; and an unprecedentedly huge expenditure by providers on EHR hardware and software at a time when providers are under severe financial pressures.” The group recommends that the HITECH program either be redesigned to emphasize patient care, safety, and efficiency or be shut down completely and spend what’s left of the money on rewarding provider care improvement by whatever means they choose.  What is minimally noted in the press release is that the Health Innovation Council was formed and is run by Anthelio Healthcare, the former PHNS, a healthcare IT consulting services vendor.

In the UK, Health Secretary Jeremy Hunt announces creation of a $400 million fund to help hospitals with the cost of replacing paper-based clinical documentation and prescribing with electronic systems.

Other

MyMedicalRecords.com files another patent lawsuit, this time against the recent Allscripts acquisition Jardogs. The complaint states that the FollowMyHealth Universal Health Record infringes on MMR’s personal health record patents.

LSU Health Shreveport (LA) and Siemens Healthcare inform 8,330 patients of an unintentional disclosure of PHI  stemming from an error in a computer data entry field. LSU and Siemens, which prints and mails bills on behalf of LSU Health physicians, have now identified and corrected the error that caused the names and treatment information for one patient to incorrectly align with another patient’s mailing address.

Palomar Pomerado Health CMIO Ben Kanter, MD presented A Darwinian View of the Electronic Medical Record at a HIMSS SoCal meeting.

UPMC will outsource its transcription services to its development partner Nuance at the end of June, laying off 100 transcriptionists who have been offered jobs by Nuance.

Moore Medical Center (OK) is destroyed by a 200 mph tornado, but the 30 patients housed in the 46-bed hospital all survived, as did all of the hospital’s employees.

A Silicon Valley newspaper editorial lauds the $220 million Epic implementation at Santa Clara Valley Medical Center (CA), saying it will improve billing efficiency and quality of care, also avoiding the 1 percent Medicare penalty and instead reaping $11 million in HITECH funds.  

Weird News Andy says he’ll take one today if it can help find his car keys. A New York Times article says helper robots will be used to help care for the elderly.

Sponsor Updates

• ISirona employees participate in the Emerald Coast Mud Run benefiting Heart of the Bride, which supports orphans around the world.
• Valence Health offers a May 29 Webinar in its monthly series called Care Coordination and Patient Outcomes: Utilize Innovative Automated Population Health Solutions.
• DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.
• An Imprivata-commissioned survey of Canadian HIT executives reveals key barriers for clinicians when accessing patient data, including a lack of systems integration, privacy and security concerns, and slow access.
• McKesson’s Horizon Lab 13.5 becomes for the first LIS to receive EHR Module certification for MU Stage 2.
• Ingenious Med updates its impowermobile charge capture software to include the ability to create a virtual superbill at the point of care.
• Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.
• DirectTrust.org and EHNAC extend accreditation to ICA under its Direct Trusted Agent Accreditation Program.
• IHT2 hosts Health IT Summit Denver July 24-25.
• In a GetWellNetwork-sponsored Webinar May 29, administrators from Hasbro Children’s Hospital (RI) share details of how it improved patient satisfaction and workflow by joining patient-centered care technology with a meal ordering system at the bedside.
• Kareo posts a Webinar that answers the top six Stage 2 MU questions and offers three reasons to check out CMS eHealth.
• Several HIStalk sponsors earn a spot on the Informatics 2013 Top HCI 100 list, including 3M, ADP AdvancedMD, Allscripts, API Healthcare, Beacon Partners, Capario, CareTech Solutions, Covisint, Craneware, CTG, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, ESD, GE Healthcare, Greenway, Iatric Systems, Impact Advisors, Infor, Intellect Resources, MModal, McKesson, MedAssets, Medseek, Merge, NextGen, NTT DATA, Nuance, Optum, Orion, Passport Health, Philips Healthcare, Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, TELUS Health Solutions, The Advisory Board Company, The SSI Group, Vitera Healthcare Solutions, Vocera Communications, Wolters Kluwer Health, and ZirMed. Porter Research submitted, compiled, and reviewed sales figures to create the list.
• The Philadelphia Alliance for Capital and Technologies recognizes InstaMed  as its Technology Growth Company winner and Halfpenny Technologies a Life Science Growth Company finalist at the Alliance’s 2013 Enterprise Awards.
• Imprivata launches a migration program that enables customers using the Citrix SSO feature to migrate to Imprivata OneSign SSO. Also, Imprivata participates in a breakout session on desktop virtualization and SSO at this week’s Citrix Synergy conference in California.
• Emdat profiles Illinois Bone and Joint Institute, which realized a 50 percent year-over-year cost savings in documentation and correspondence costs using Emdat alongside its EMR.
• Beacon Partners hosts a May 31 Webinar integrating business intelligence and analytics through the healthcare enterprise and offers a white paper on why risk assessments help reduce an organization’s risk of a data breach.
• Awarepoint’s RTLS platform will be featured in an industry-wide interoperability demonstration at the Association for the Advancement of Medical Instrumentation 2013 Conference and Expo June 1-3 in Long Beach, CA.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Curbside Consult with Dr. Jayne 5/20/13

Several readers shared this link about a smartphone app that tracks patient activity and reports it to physicians. Called Ginger.io, the app is being studied at several hospitals in the US. The goal is to mine data on phone use and movement to show changes in patterns that could indicate illness or worsening of chronic conditions.

The app has to be activated by a hospital or health care company and obtains a baseline on personal activities once it’s activated. Caregivers are notified when there are changes in patterns of travel, phone calls, texting, etc. According to the Ginger.io website, it uses both passive data collected from the phone and active data reported by patients to create context-sensitive interventions.

The behavioral analytics platform is based on research from the MIT Media Lab. Several interesting papers are referenced on the website. With the level of data that can be gathered, privacy is a concern. The site claims to “only collect data we need to paint a rough texture of your behavior.” Patients are able to control whether data is shared with clinicians and researchers and can opt out at any time.

As a primary care physician I find the idea intriguing. The key is in the predictive ability of the algorithms to identify when a patient would benefit from an intervention. For this to really take off with hospitals and health systems, however, outcomes are not enough. It’s going to have to demonstrate cost savings as well. It will also take some patient education to make some of the “insights” valuable. Just looking at the screenshot, they’re pretty vague. “On Wednesday, you spoke with 2 fewer people than average.” “You interacted with 22% more people than average on Thursday.”

It reminds me of a virtual parent of high school students. You need to get out more. Stop talking on the phone and go to bed. You’re spending longer on your homework than usual. Get some exercise. You’re texting too much. Your music is too loud. There are twice as many miles on the car as there should be for where you said you were going.

Thinking back to what my phone has been up to the last several days, I wonder what the app and related algorithms would think of me. My boss is out of town, so I used Monday and Tuesday as rare opportunities to work remotely. I love working from home – I’m at least 40 percent more productive than in the office and feel a greater sense of accomplishment. I was able to use my land line and wasn’t running around so I made virtually no calls. Would it think I was withdrawn? Or would it interpret the flurry of text messages as I tried to reschedule a girls’ night out as evidence that my behavior was still within the range of normal?

Have you tried Ginger.io or do you know anyone who has? I’d love to hear what they have to say about it. E=mail me.

E-mail Dr. Jayne.

Morning Headlines 5/21/13

MyMedicalRecords Files Patent Infringement Complaint Against Jardogs, a Subsidiary of Allscripts

MMR Global files a patent infringement suit against Jardogs, recently acquired by Allscripts. The suit references Jardog’s FollowMyHealth patient portal as infringing on an MMR Global patent. Prior to this suit, MMR Global had been predominantly targeting hospitals and health systems in its string of lawsuits, but it appears that patient portal vendors will now be targeted as well.

WEDI announces ICD-10 best-practices initiative

Organizations from California, Massachusetts, Minnesota, and Wisconsin announce the formation of a new collaborative initiative with the goal of documenting and sharing best practices guidance to help hospitals prepare for ICD-10 conversion.

Computer error releases 8,330 LSU Health patients’ personal info

Louisiana State University and Siemens Healthcare have informed 8,000 patients that their personal health information was exposed after a bug in a Siemens system associated visit information with incorrect billing addresses. Siemens had been contracted to print and mail patient bills on behalf of LSU. The issue was discovered when patients began calling the hospital reporting incorrect names and treatments on their bills. No Social Security numbers, birthdays, or account numbers were exposed in the breach.

ONC’s Mostashari to Open HIMSS ICD-10 Forum with Insights on Interoperability, Testing & Big Data

National Coordinator for Health Information Technology Farzad Mostashari, MD, will deliver the opening keynote speech during the ICD-10 Forum on June 17-18.

Business Strategy: Accountable Care Maturity Model

IDC Health Insights has published a guide to ACO formation, detailing five stages of what it calls ACO maturity. The report emphasizes the importance of introducing new technologies, like data analytics and mHealth apps, to support post-acute care, but only after key maturity levels are reached.

Morning Headlines 5/20/13

Mitochon Intends to Exit the EHR Market and Cease Physician Services

Free web-based ambulatory EHR vendor Mitochon Systems has announced that it will close its health IT business unit. Mitochon was a Meaningful Use Stage I certified vendor with 12 attestations according to the most recently released CMS data.

Tableau Software soars in trading debut

Seattle-based Tableau, a data visualization vendor popular in the healthcare space, raises $254 million on its IPO Friday and shares closed up 64 percent at the close of its first day of trading.

Wake Forest Baptist IT director stepping down

Wake Forest Baptist CIO Sheila Sanders will step down from her position effective May 31st. She leaves her position for personal reasons, unrelated to recent difficulties with Baptist’s Epic implementation.

DePinho: M.D. Anderson to freeze wages, curb construction

MD Anderson announces a wage freeze, a reduction in hiring, and the postponement of construction projects due to lower than anticipated operating income for FY13. President Robert DePinho reports that an increase in donations and investment income is the only reason the institution will finish the year with positive net income.

Monday Morning Update 5/20/13

From The PACS Designer: “Re: Microsoft’s updated BAA. Microsoft has released an update for its Business Associate Agreement to encompass more secure communications tools for HIPAA compliance. The changes provide for healthcare organizations to leverage cloud solutions to improve clinician productivity, care team communication, and care transition coordination while maintaining compliance with the recently updated Omnibus HIPAA Final Rules.”

From Laboratorian: “Re: University of Michigan. Goes live June 1 with a massive IT rollout. This includes a new Epic (Denali) implementation and a completely new LIS, an experimental version of SCC-Soft being used at U-M for the first time. The LIS rollout, in particular, is particularly audacious in scope, being the culmination of a seven-year implementation cycle. Barcode-based tracking of both tubes and surgical pathology specimens will be on par with the level of automation seen at BML labs in Japan. The spatial location of every asset in lab space will be tracked in real time. The project benefitted from co-development of code with support from U-M’s own software engineering teams. Nearly 2.5 million lines of new code above base SCC product will drive this new version.” SCC is often forgotten as maybe the leading LIS vendor for big health systems, and writing 2.5 million lines of new code is just crazy. Obviously Beaker wasn’t going to do the job for UM, although it’s improving to the point that some larger Epic customers are cautiously committing to it.

More than two-thirds of respondents think that Meaningful Use Stage 2 should be extended for a year before starting Stage 3. New poll to your right: CMS released hospital Medicare pricing information for the top 100 DRGs. How valuable is that information to the public?

Jamie Stockton of Wells Fargo Advisors sent over his monthly summary of hospital EHR attestations by vendor. Customers of the big multi-national corporations whose business is mostly not healthcare IT (McKesson, Siemens, and GE) are the clear laggards.

Just in case you are wondering what it would be like to have HIMSS darling and cardiologist Eric Topol, MD as your doctor, ponder this quote from an NBC fluff piece from January that I just ran across: “These days I’m actually prescribing a lot more apps than I am medications.” He claims that up to 80 percent of the 20 million echocardiograms performed each year could be replaced by in-office smart phone tests, saving the healthcare system $13 billion per year. In a stunning piece of investigative journalism, the on-camera talking head (also a doctor) who has clearly performed her research convinces him to eat tortilla chips and goads him into saying positive things about his own books and devices.

EHR vendor Mitochon Systems notifies its customers that it will shut down its free cloud-based EHR service in mid-June. The company isn’t sure how doctors will retrieve the data they’ve entered on patients before the system is turned off, but says it will come up with something.

Data visualization software vendor Tableau Software, whose product is popular in healthcare, raised $254 million in its Friday IPO as shares soared 64 percent. I’ve played around with it a couple of times and it’s pretty cool – there’s a free trial download on the site.

Sheila Sanders, VP/CIO of Wake Forest Baptist Medical Center (NC), will step down effective May 31. The hospital says she’s leaving the $465K job for personal reasons that are unrelated to its struggles with Epic.

CareWire names advisors Ken Saitow and Phil Hotchkiss as president/CEO and EVP/chief product officer, respectively.

Encore Health Resources CEO Dana Sellers was recognized Friday, May 17 as a Distinguished Engineering Alumna by the Cockrell School of Engineering at The University of Texas at Austin. She was also named Friday as a finalist for the Ernst & Young Entrepreneur of the Year for the second consecutive year.

James Holtzman is promoted from CFO to CEO of Prognosis Health Information Systems.

Terry Boch (JET Health Solutions) joins Wellcentive as SVP of sales and marketing.

Susan K. Newbold PhD, RN-BC, director of Nursing Informatics Boot Camp, is selected as one of the 2013 “Women to Watch” by the Nashville Medical News.

MD Anderson, which just announced Epic as vendor of choice, will freeze wages, cut back on hiring, and postpone construction projects, hoping to offset an anticipated 2014 financial shortfall that it blames on the federal government (the Affordable Care Act, the budget sequester, and federal deficits) even though its rapidly increasing operating expenses seem to be its primary problem.

A controversial decision by Britain’s NHS allows life sciences and insurance companies to buy access NHS’s patient-identifiable data (“bespoke patient-level abstracts), even providing companies with an Excel worksheet to calculate their cost.

Partners HealthCare System (MA) made a $133 million profit in the latest quarter even after it took a $110 million accounting charge to write off computer systems slated for replacement. Most of that came from investment income, as operating income dropped from $41 million last year to $5 million.

Vince covers Part 1 of the HIS-tory of Allscripts this week (more specifically, TDS, which passed through many hands before landing in the Allscripts lap via its acquisition of Eclipsys.) Vince also scored a major coup for upcoming episodes – he e-mailed Judy Faulkner at Epic and asked if could talk with her about the company and she invited him to meet with her in Verona, which he did last week and is still gushing about. Those are going to be some great HIS-tory installments.

Sponsor Updates

• Carl Fleming of Impact Advisors raised $6,000 for St. Baldrick’s Foundation by having his head shaved at Impact Palooza 2013.
• Sunquest Laboratory v 7.0.1003 is certified as an EHR module by CCHIT.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.

Readers Write: 256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS

256 Shades of Grey(scale): The Dirty Little Secrets of Radiology and PACS
By Brad Levin

There is widespread agreement that radiology has been the epitome of success spreading PACS far and wide over the last two decades. Thousands of organizations transformed from the dark ages of film to digital operations. Early activity started in the mid-1990s and peaked in the mid-2000s. Once the 2000s were in full swing, many groups moved to PACS for the first time, but it was relatively common for PACS early adopters to have implemented their second or in rare cases, their third PACS by then.

Along came the late 2000s, when industry analysts KLAS and Frost & Sullivan called for the next wave of PACS replacements. Many systems had aged well beyond the average 5-7 year lifespan of PACS, and it seemed like a solid market forecast. However, in reality the replacements never came in earnest. 

Fast forward to present day and the institutional use of PACS has stagnated. PACS continue to be used past their useful life, problems persist, and upgrades are delayed. The other contributing factor is a majority of institutions today are using PACS born in the late 1990s or early 2000s. Their vendors purchased PACS largely through acquisition, and while these systems have been upgraded periodically, most of the core architectures remain largely unchanged.

This would be fine if time stood still, but of course it hasn’t. Over the last two decades, modalities have advanced at breakneck speed, producing computed/digital radiography, multislice CT, PET/CT, digital mammography, and the newest modality, digital breast tomosynthesis (or 3D mammography).

Modern technology has also dramatically changed consumer and physician expectations. Everyone expects instant gratification. Pay phones are extinct and we all use smartphones. The world is app-driven and tablet accessible. LPs/CDs have been replaced with MP3s. Medicine is mobile, and we’ve ditched our VCRs/DVDs for streaming media.

Today’s challenging healthcare environment, supported by yesterday’s PACS technology, has led to widespread chronic problems and missed opportunities. When I was told recently that some of the most senior leaders in imaging informatics had convened and were discussing how "Radiology Has Solved The Problems of Going Digital", I was stunned. Based on what I see at community hospitals, academic medical centers, IDNs, imaging centers, radiology groups, and teleradiology vendors, I know that statement couldn’t be farther from the truth.  

The vast majority of practices are digital, but are their problems solved? In my view, absolutely not. Just this week I spoke with a PACS administrator from a 400-bed hospital in the Southwest. I was told that when their network access peaks, performance gets crushed on PACS, taking up to a minute to launch even a small CR study. Radiologists launch the study on PACS, grab a coffee, and hope that when they come back they can start reading the study. While this may or may not be just a PACS issue, it is a persistent, unacceptable problem nonetheless.

If you are unaware of the state of your imaging operations, I encourage you to speak to your radiologists, referring physicians, PACS administrators, and your IT staff. You may also consider meeting with your affiliates, and plan on attending the upcoming SIIM 2013. If you tackle today’s Imaging problems with the same vigor you used to transform from film to digital, your problems will quickly go into the rearview mirror.

Brad Levin is general manager, North America for Visage Imaging.

Readers Write: Trade Shows: How to Make Sure You’re Heard When Everyone’s Screaming

Trade Shows: How to Make Sure You’re Heard When Everyone’s Screaming
By Cindy Thomas Wright

More than 1,000 companies exhibited at this year’s HIMSS. Did you go? If you did, can you name 10 companies and describe their trade show exhibits?

If you’re like most attendees, you can’t. Because with 30,000-plus people there and row after row of exhibits, you were probably on trade show overload.

Now let’s put you on the other side of the exhibit table. Your business is there, in a giant room filled with the hottest prospects in the world. How are you going to get their attention when you’re one in a thousand?

Well, you can’t just hit play on a PowerPoint and toss some business cards on a table. You need to engage, quickly and with impact. Here are a few points that will help you do so and can apply to HIMSS or any other trade show, such as HFMA coming up in June and AHIMA following in October.

Point 1

You have a brand. Bring it to the trade show. What is your brand positioning? What is your brand personality? Have you done the hard work to define who you are? Without a clear positioning, marketing is futile. You can’t tell a story that you haven’t written yet.

But if you do have your brand strategy locked down, that’s what your exhibit needs to tell the world. Throughout your trade show exhibit’s development, keep asking yourself, “Does this align with our brand?”

Point 2

Make sure the best people are manning your exhibit – and be sure they know their goals. Most people that you meet on the floor aren’t professional trade show folks. At HIMSS, for example, you might see people at the exhibits who are CIOs, program managers, or system developers by day, and they come to this one trade show a year. They are then tasked with “booth duty”, shall we say. 

What you see when you walk the floor is often folks looking down at their phones or a laptop, sitting in chairs meant for would be prospects, or perhaps taking a break to eat their lunch. Let’s face it, are you really going to approach anyone whose obviously eating lunch? Or who has their hands in their pockets or are busy texting? These are all issues that need to be addressed prior to the show. Be sure your representatives are outgoing, have their messaging perfected, know how to “triage” exhibit visitors and how to get them to the right person, and most importantly, be sure they know how to make everyone feel welcome and engaged.

Point 3

Don’t forget that you’re all about technology. We’re in the tech business. So don’t fire up your seven- year-old MacBook at the exhibit. And don’t click through a PowerPoint that looks like it was designed in 1989.

Look at the people manning the booth – do they look “modern”? Are they wearing shoes and eyeglasses from this millennium? Remember, everything you put out there has to be clean, polished, high-tech, new and smart. Because that’s what your company is, right?

Point 4

This isn’t just about you. It’s about them. So many trade show exhibitors see this as their chance to tell everybody all about them. But remember, people are looking for solutions to their own situation. Find out what people need, and show them how you can fill that gap. Trumpet your solutions in a way that’s interesting, but tangible.

Cindy Thomas Wright is the owner of Thomas Wright Partners.

Time Capsule: If EMR Vendors Designed Cars, the Steering Wheel Could Be Anywhere: Why a Universal Physician Interface Makes Sense (and will never happen)

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in November 2008.

If EMR Vendors Designed Cars, the Steering Wheel Could Be Anywhere: Why a Universal Physician Interface Makes Sense (and will never happen)
By Mr. HIStalk

I used to work in a two-IDN town. In fact, I had worked in the IT department of both of them (not at the same time, unfortunately, since that would have been a sweet paycheck).

Both IDNs bought big-ticket inpatient clinical systems within a few months of each other. Those who have worked in a two-hospital town or remember the Cold War understand this instinctively.

As inevitable as it was that rumors of one of us buying a system sent the other scurrying to draft an RFI, it was preordained that we would not consider the same vendor. Whichever IDN bought last would look like an unimaginative lemming, so there was no doubt that two vendors would be shuttling people into town for years.

I was shocked that the local newspaper not only cared about our respective deals, they took both IDNs to task in a rather scathing editorial for going our separate ways. In their minds, we had blown a golden opportunity to finally agree on something other than the fact that one of us was a plainly second-tier system (which one was another thing we didn’t agree on).

From a community perspective, they were probably right. Both places served mostly community-based physicians who practiced in hospitals of both IDNs. Our ruggedly individualistic decisions meant that most of the doctors in town would not only have to learn to use an EMR to keep in our smothering good graces (since ROI was dependent on massive, yet unlikely voluntary physician usage). They would have to learn TWO systems with nothing much in common except they both had a screen and a keyboard.

(That allowed us both to argue that we had chosen a better system than our cross-town loser competitors. In addition, there were only three real vendors that would have been acceptable and one of those was a little shaky at the time, so we went out of our way to avoid consensus).

Vendors would never object to this, of course. Software that looks and works alike has a name: “commodity.” In that respect, vendors had as much interest as we IDNs did in bucking the trend set by our competitor or vice versa.

Here’s an interesting idea, though. Why couldn’t CPOE and EMR systems have the same common user interface? They provide and accept the same basic information. Are screens really so highly proprietary and ingenious that they can’t be the same on all systems? Couldn’t they put their high-margin secret sauce somewhere else, like in clinical decision support, scalability, cost, or maintenance quality?

(You could almost make this happen in the old character-based days by using screen-scraping applications to redesign the front end, like Attachmate or programmable fake Windows front ends).

Everybody always says, “You can use a browser without reading a manual first.” As annoying as that statement is, everybody is right. Browsers, cars, TVs, and credit cards all look and work pretty much alike to the user. That increases adoption, yet still allows plenty of criteria on which vendors can compete and differentiate.

Physician systems operate under the most bizarre paradigm of any software application. The organization that buys them isn’t the one using them, for the most part, since doctors are self-employed (unlike pharmacists, rad techs, nurses, etc. who practice in just one place using just one system). Usage is voluntary and therefore sporadic. Those voluntary users (who are really our customers) are supposed to deal with it, show up for training, and read ongoing messages about bugs, upgrades, and downtime (times two or three, depending on the town).

If I were HIT King for a Day, my second decree (after putting a spending cap on HIMSS exhibits) would be this: every system intended for physician use will employ a common user interface whose visible appearance, terminology, and user interaction is fixed. Vendors who fail to comply will have their kneecaps broken by CCHIT.

What vendors do behind the scenes is their own business, but when you’re selling cars, no matter how clever your designers are, the steering wheels and pedals need to be in the same place if you want to move iron.