Top News

CPSI announces Q4 numbers: revenue down 2%, EPS $0.59 vs. $0.61, raising questions about the state of the hospital clinical systems market.

Reader Comments

From Vegas Question: “Re: HIStalkapalooza invitations. Will the e-mail come from your usual address or a new one? My spam folder is pretty large and I don’t want to miss it.” Invitations and regrets will be sent from histalkapalooza@contactESD.com this week. The walk-up plan will be described for those we couldn’t invite because of capacity. Check at the registration table at 8:00 and if we have room due to no-shows, we’ll let more folks in.

From Rick: “Re: GE Healthcare. Restructuring of its IT division continued Tuesday with an announcement that it will terminate the Centricity Advance hosted EMR/PM solution immediately. Customers will have to make arrangements to move their data out of the cloud before the system is taken offline. All development in its Hospital and Large Practice division has been halted and products placed in maintenance-only mode, including Centricity Business revenue cycle solution. The Centricity EMR product will be sunset with no Version 10 release, replaced by the Centricity Practice Solutions combined EMR/PM system.” I asked GE Healthcare for a response Tuesday evening and agreed not to run the rumor then since the spokesperson indicated that it contained inaccuracies. Here are the main points from GE Healthcare:

• The company will shut down its hosted PM/EMR solution Centricity Advance (the former MedPlexus product that GE Healthcare acquired in March 2010) on June 30, 2012.
• The decision was made because of market overlap between the Centricity Advance product and Centricity Practice Solution.
• Customers can retrieve their data in read-only form until December 31, 2012.
• Customers will be offered an upgrade to the Centricity Practice Solution PM/EMR, with data migration, training, and implementation costs covered by GE.
• The company will eliminate an unspecified number of jobs related to the announcement.
• The Centricity Business revenue cycle product is unaffected by the announcement.

From Expat Consultant: “Re: Dubai Health Authority embezzlement. These people own the company representing Epic in the current bid for DHA business.” Two men are charged with embezzling $250K from a company providing services to the DHA.

From Rebecca: “Re: HIMSS presenters. Have you thought about listing sessions that will be presented by HIStalk’s loyal followers and contributors? You have so many followers attending and it would be nice to encourage them to attend educational sessions.” I’m a sucker for doing good deeds even though I’m already overwhelmed, so if you’re speaking at a session that’s on the regular HIMSS educational track (not in the exhibitor’s theater, on the show floor, etc.) you can enter your information here and I’ll try to put out a list.

From Ileus: “Re: links to HIStalk Practice and HIStalk Mobile. I can never find them. Why not put them at the top of the page?” That’s a good idea that we’ll take one step further by placing tiny links at the bottom of each news post, starting today. That way, readers using mobile devices and RSS feeds can click them. I hadn’t thought about the ease of finding the links, to be honest.

HIStalk Announcements and Requests

Highlights from this week’s HIStalk Practice: eClinicalWorks CEO Girish Navani highlights his company’s 2011 achievements and 2012 goals. SBA loans to doctors have surged in the last 10 years. Seven states have still not initiated Medicaid EHR incentive programs.  Julie McGovern of Practice Wise discusses New Year’s resolutions, vendor relationships, and setting realistic and appropriate expectations.  The ever-irreverent Dr. Joel Diamond explains the history of ICD-10 (it’s a must read.) Actually, I think everything on HIStalk Practice is a must read, so make sure you are signed up for e-mail updates.

On the Jobs Board: Senior Product Manager of Healthcare Solutions, SCM Go-Live Support, Epic Credentialed Trainers. On Healthcare IT Jobs: Director of Technical Operations, Allscripts Application Analyst, IT Director and IT Leader.

Inga, Dr. Jayne, and I do our HIStalk work in a bubble of lonely anonymity, so we always enjoy connecting with readers, even if only by electronic means. We enjoy seeing the names of the 2,128 folks who have signed up for Dann’s LinkedIn-based HIStalk Fan Club, which is almost four years old now (hello to the new folks there from Citizens Memorial Healthcare, American College of Cardiology, McKesson, Cornerstone Advisors, Vitera Healthcare, DrFirst, Medibis, Medicity, GE Healthcare, and Lehigh University). We accept all friend/connection requests from Facebook and LinkedIn, connecting you to a pretty big web of people that might come in handy someday. We like it when you send us news and rumors, subscribe to the e-mail list, click the ads of our sponsors, and use the Resource Guide and Consulting RFI Blaster. And of course thanks for reading, and thank goodness you do since we would be wasting our time here otherwise.

I forgot to give a proper introduction and welcome to Dr. Rick, whose first EHR Design Talk has earned a great response from the Twitterverse and from reader comments. He chose where to start his series, but you get to decide where it goes from there through your interaction with him. You will no doubt appreciate his active (and sometimes almost immediate) response to your comments, indicating his keen interest in usability and your thoughts on what it means to EHR users. It takes a lot of effort to research and write posts like his, so thanks to Dr. Rick for sharing his time and expertise with us.

Acquisitions, Funding, Business, and Stock

drchrono closes a $2.8 million funding round. The company says 15,000 users have registered.

EHR and PM provider Image MD (formerly eHealth Made EASY) announces it has increased its invested capital from $15 million to $25 million over the last year.

Quality Systems, the parent company of NextGen, reports Q3 earnings: revenue up 23% to $112.8 million; net income up 20% to $21.1 million. The company’s $0.36 EPS missed analysts’ estimates by $0.02.

Masonicare (CT) selects the Summit Express Connect interface engine to provide interface integration between Masonicare’s MEDITECH HIS and ancillary systems.

People

Former Clinecta President Jeffrey A. Pfund joins JEMS Technology as COO.|

Brian Mitchell, formerly of GE Healthcare, joins ClearDATA Networks as vice president of sales.

M*Modal (MedQuist) promotes Michael Clark to EVP of global sales.

University of Chicago Medical Center promotes Sameer Badlani, MD from associate CMIO to CMIO.

Healthcare data analytics and consulting firm Sg2 appoints Eric Louie MD, MBA as chief medical officer.

Former Microsoft Health Solutions Group VP Peter Neupert joins venture capital firm Health Evolution Partners as an operating partner, joining former ONC head David Brailer MD.

Healthcare Data Solutions, a provider of healthcare databases and intelligence services, names Scott Thompson (InfoGroup) its CTO.

Drexel DeFord, VP/CIO of Seattle Children’s Hospital, will serve as 2012 chair of CHIME’s board of trustees.

Rick Schooler, VP/CIO of Orlando Health (FL) is named CHIME-HIMSS John E. Gall Jr. CIO of the Year.

Leigh Ann Myers RN joins PerfectServe as VP and chief clinical officer. She was previously with PatientSafe Solutions.

Announcements and Implementations

Virtua (NJ) goes live with the first phase of its enterprise-wide device infrastructure using Nuvon’s VEGA System to connect to its Picis perioperative solution.

Upstate University Hospital (NY) introduces Upstate MyChart, giving patients online access to their medical records. The hospital is part of SUNY Upstate Medical University, which is in the midst of $40 million Epic implementation.

API Healthcare announces that 20 hospitals have recently gone live with its workforce management solutions.

M*Modal Inc and Merge Healthcare partner to integrate M*Modal’s speech and natural language understanding technology into Merge solutions.

Siemens HSB CEO John Glaser and Texas Health Resources SVP/CIO Ed Marx are among the presenters of a January 31 webinar, Can Healthcare Providers Afford to Ignore Social Media?

MedAssets announces general availability of its Access Integrity suite for front-end RCM processes.

Greenville Hospital System University Medical Center (SC) goes live on Holon’s CPOE Medication Order Management solution at all of its facilities.

Government and Politics

ONC head Farzad Mostahari MD predicts that at least 100,000 providers will receive EHR incentive payments by the end of 2012. In a blog posting that discusses his forecast for HIT in the coming year, he says:

I see 2012 as the year in which health IT truly comes of age. While much work still needs to be done, the groundwork is firmly in place for what promises to be a breakthrough year in the adoption and widespread use of health IT in ways that improve care for individuals, improve health outcomes for populations, and increase the value we get from our health care dollars.

A just-published article in The Center for Public Integrity’s iWatch News covers the special interest advocacy activities (or political influence peddling, according to rival Mitt Romney) of Newt Gingrich’s for-profit Center for Health Transformation. It lists some examples of Gingrich pitching his clients in various government hearings for projects requiring major government expenditures, among them GE Healthcare, Siemens, Allscripts, and HealthTrio. The center’s project director is mentioned as testifying that the Department of Labor should require healthcare providers to use electronic medical records, which it implies morphed into HITECH. Gingrich also appeared at a press conference in the Senate Office Building to promote a bill requiring e-prescribing, in which at least 20 of his paying clients had a financial interest.

The government says that an upgrade to Symantec’s Veritas Storage Foundation caused the significant downtime experienced by the Military Health System’s AHLTA clinical system last week.

ONC’s Office of the Chief Privacy Officer announces a project to identify best practices for mobile device privacy and security. They will convene a public roundtable in the spring.

Other

Affiliated Computer Services (ACS) officially adopts the Xerox name, two years after its acquisition by that company.

Server problems at a clinic in Canada cause month-long issues, including the inability to access patient records and the complete shutdown of the telephone system for a day.

Healthcare Growth Partners releases its latest healthcare IT industry review, covering Q4 and reviewing 2011’s activities. It’s a very well done review of macroeconomic and healthcare IT industry factors that will affect merger and acquisition activities and share performance of publicly traded companies. I really liked the chart above that describes why some companies command high revenue multiples when acquired, while others don’t. What it’s showing is that recent acquisitions aren’t following the typical trend, with more premium-priced acquisitions than usual. I would attribute to the fifth factor listed in the rightmost section – deep-pockets outsider companies are making it rain to snap up available players so they can scratch their itch to get into healthcare quickly, even if irresponsibly. Whether they’ll stay in is another question (most don’t.)

Weird News Andy declares that bacon is the new duct tape, noting a report from Michigan doctors who stopped a four-year-old girl’s platelet-related nosebleed by shoving raw bacon up her nose. One of the doctors said he got the idea from his military days, when pork was recommended as an antihemorrhagic. WNA postulates that the story was sponsored by the ThinkGeek product above.

An Oklahoma hospital that took a $500K donation from country singer Garth Brooks to build a women’s center to be named after his mother but then used the money for other projects is ordered to give Brooks his money back plus another $500K as punitive damages. The hospital argued that the gift from Brooks was originally made anonymously and without restrictions and that he was fuzzy on details about the meeting when asked later.

• Fulcrum Methods launches its ICD-10 assessment, remediation, and program management tools.
• T-System’s T SystemEV EDIS successfully completes the highest level of interoperability tests at IHE’s Connectathon.
• Sunrise Health System (NV) becomes the first health system in Nevada to use AirStrip CARDIOLOGY.
• MEDecision’s January 31 Webinar will feature a discussion on the use of coordination solutions and EHRs to lower costs and improve care. 
• Concerro announces the keynote speakers for its April 2012 Concerro Client Conference.
• Southeast Alabama Medical Center selects PatientKeeper Mobile CPOE to compliment its McKesson HIS.
• MedAptus announces that its Professional Intelligent Charge Capture solution was named Mobile Data Systems Category Leader in KLAS’s annual report.
• Medicity validates its interoperability capabilities at the IHE North American Connectathon 2012.

EPtalk by Dr. Jayne

The media have been all over reports about physicians distracted by their electronic devices. I laughed out loud at this headline, though: Paperwork causes unintended distractions for physicians and nurses. This quick little piece on KevinMD.com is worth the read. I think sometimes we’re so aggravated by our technology that we forget what it was like before.

As a physician, I’m annoyed by lawmakers’ attempts to control how I practice or how patients care for self-limited illnesses. The recent spike in state and municipal laws that restrict purchasing of over-the-counter cold remedies is an example. Communities typically decide (often in patchwork fashion) that these will now be available only by prescription. This drives me crazy, because although I can purchase it over the counter without a prescription, if I prescribe it for a patient it is considered a controlled substance and requires the use of my DEA number and the use of special prescription paper as it cannot be electronically prescribed (at least not now in the state where I practice.)

In turn, this causes patients to spend a co-pay to come see me, plus the insurance company to fund the rest of the cost for an office visit, all so that the patient can purchase a drug that should have cost $4.99 at the local discount store. An article I recently ran across  lets us know that not only have the meth makers outsmarted the restrictions on pseudoephedrine purchase, they’re also driving up healthcare costs in unintended ways. Users have turned to small-batch techniques (the “one pot” or “shake and bake” approach) to make their own meth rather than relying on the large batches typically produced by dealers. This has caused a spike in burn patients when the experiment literally blows up in the user’s face. An Associated Press survey reports that up to a third of burn patients were injured making meth. These patients are often uninsured and their care is more costly than that of other burn patients. The ultimate cost could be in the hundreds of millions of dollars. Definitely something to think about.

Insurers are moving into the mobile health game. Aetna, WellPoint, and UnitedHealth Group are among payers who have jumped into the fray in a big way. I enjoy following HIStalk Mobile and am supportive of things that help patients get more in tune with their health care and personal wellness. I’m a bit skeptical, though, about in-car health. I’d rather encourage people to get out of their cars instead of convincing them that time sitting in them is terribly worthwhile.|

Speaking of personal fitness: for some, obesity continues to cause issues even in death. Due to the potential for decreased learning when working with obese cadavers as well as the difficulties in preparing and storing them, some medical schools are rejecting donations based on size. Scientific donation of a body is a true gift and I am grateful to those individuals and families who choose this route. I’m sad for those who want to make this gift but are unable to do so.

One of my closest friends is gridlocked with his employer over the use of the CMIO title. He’s been doing the job for years but they refuse to recognize him. It may be just a name, but to bolster his spirits I want to share some unusual executive titles. Hang in there, and remember that in your head, you can have whatever title you want. Personally, I think I’ll choose Imperatrix. Now I just need to figure out something equally important-sounding for Inga.

I’ve been trying to get into Twitter, but it seems to be conspiring against me. Since I haven’t been wasting any time tweeting, I’ve been able to continue my pre-HIMSS shoe shopping. Although I’m not eligible for the “Inga Loves My Shoes” contest, I don’t want her to think I’m a slouch, so I’ve been texting her with my finds. So far I seem to be meeting her standards, but I’m not convinced I have the perfect pair just yet.

In response to Monday’s Curbside Consult, readers are continuing to send some great suggestions. I’m looking forward to hitting some of them soon. Please keep them coming!

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Mobile.

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

The Annual Review

They say people fear giving a speech more than death. I say people fear performance reviews more than speech and death combined.

Despite having had some excellent managers over the years, I can’t say that I ever had a review I enjoyed or gained much from. And frankly, I am not sure how many helpful reviews I deal out. Reviews are not a strength for most. They should be.

Admit it. You appreciate the person who lets you know the tag is sticking out on the back of your shirt. Or that you have oatmeal stuck in your braces. If I’m going on a date with my wife, I often ask my teenage daughter, “Do I look hip in this outfit?” Her enthusiastic nod—or more often, her grimace of embarrassment—tells me the truth. She helps me improve.

We want to know these details about ourselves, trivial as they may be. So why does our attitude change in the work setting? Nothing trivial there. In fact, our efforts—and non-effort—can have a serious affect on the department, if not the entire organization. My performance is never self-contained. My conduct, attitude, and effectiveness cascade through the ranks. My subordinates frequently do what I do … and what I do NOT do. Not surprisingly, their people follow their example.

Does your annual review reflect the real you? Do your assessments accurately reveal your staff?

How easy it is to cave in to temptation and give overly optimistic reviews to avoid discomfort. I’ve done it; you’ve done it. We’re all guilty. At the end of the day, I kick myself because I’ve shortchanged everyone. In fact, I’ve undermined my employee and my organization. Worse yet, if I’m not modeling appropriate and accountable reviews, my subordinates will follow my poor example. (Ouch. I feel the pain as I write.)

This post is as much of a kick-in-the-rear encouragement to me as it is to you. Since it’s that time of year again, we the leaders are going to invest the time and energy to make the review honest and meaningful. You with me?

Here are four tips:

1. Spandex. Brutally, honest friend. If you want to know where you stand with weight management, pull on a pair. Someone can tell me I’m fit, but when I see the rolls of fat hanging over the spandex … as Clapton might sing: ♫ “It don’t lie, it don’t lie, it don’t lie … Spandex!” ♫. This sort of accountability keeps me on the right path. We need Spandex feedback in our careers to ensure that our performance remains in check. Give honest feedback even when it’s uncomfortable. Your employee deserves to know the truth no matter how brutal. Nobody likes flab.
2. Satiate the hunger. Deep down, most of us long to improve. If I can give my subordinates one tangible thing to work on, most will clutch it like a pit bull clenching a bone. Imagine if your boss gave you one strength to focus on every year to help you move to the next level and you really did something with it. You might become CEO. That annual performance review might become something to look forward to.
3. Break it down. Several years ago, I switched to doing performance reviews quarterly with several of my directs. This helped make the annual review less dreadful with those who chose this format. When you’re tracking progress, evaluating, and encouraging throughout the year, there are no surprises to contend with. The annual review almost becomes a formality.
4. Abundance of counselors. If I don’t get a bone to chew or my Spandex feels loose, I move on to other senior leaders that I trust. Some of the best feedback for improvement I ever received did not come out of my manager’s review, but rather from the next office over. I encourage my directs to seek the same. The combination of both leads to spectacular outcomes.

For Christmas, I received the latest in athletic gear, compression shorts. Compression shorts are medical grade – Spandex on steroids. While I track my pulse, pressure, Vo2, weight, blood chemistry, and speed, few things let me know where I stand health-wise better than my new shorts. They offer a whole new level of accountability and transparency.

Honest feedback to stimulate improvement is what our people and organizations need the most. That and Spandex.

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.

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Top News

MedQuist Holdings changes its name to M*Modal, which is the business MedQuist acquired last year for $130 million in cash. CEO Vern Davenport rang the Nasdaq opening bell to commemorate the company’s rebranding and new MODL trading symbol. The company also confirms that most of its executives will work from an office to be opened in Raleigh, NC while company headquarters will remain in Franklin, TN.

Reader Comments

From Lourde: “Re: Party attire. I finally found my shoes for the party last night. Super excited that that is off my plate!! Choosing the perfect shoe – so ‘stressful.’” I feel your pain. I will admit to no one how many pairs of shoes I have bought in the last month because I keep finding what I think are the “perfect” pair. Since we are talking shoes, it’s a good time to mention that this year’s Inga Loves My Shoes contest during HIStalkapalooza will include special shoe categories. Our judges (Lindsay Miller of RelayHealth and Timur Tugberk of DrFirst) have not yet revealed the categories, but I promise to share more soon. Meanwhile, if you are seeking fame in the overall best dressed contest, keep in mind you’ll have an opportunity to be crowned HIStalk King and HIStalk Queen, as well as Best Elvis Impersonator and Best Attire Left in Vegas. Ladies and gentleman, start your shopping.

From Party Central: “Re: invite from DIVURGENT. We are hosting our Kingpin Bowling Social event Monday night during HIMSS. It’s at 8:00 pm at the Palms Casino and Resort Kingpin Suite and we’d love HIStalk readers to join us.” Sounds fun and gives me an excuse to wear my bowling shoes! Here’s the invite and RSVP information.

From Number Cruncher: “Re: Practice Fusion. Their latest press release indicates 130,000 users. Are those all doctors?” The Practice Fusion folks tell me that about 40% (about 52,000) are physicians. I asked for clarification to understand if the 52,000 physicians were all considered “active” users, but not yet received a reply. Regardless, assuming the US has 600,000 office-based physicians, the 52,000 figure would give Practice Fusion about 8.5% of the market.

From GilaMonster: “Re: Awarepoint. Has laid off 10% of its workforce.” We asked the company, with this response from Merrie Wallace, EVP of product solutions and marketing:

Awarepoint has seen a record-setting year for sales contracts and hospital implementations in 2011. Along with its steady growth last year, Awarepoint strategically acquired Patient Care Technology Systems (PCTS) in order to become the only complete RTLS solution optimizing healthcare workflow. After the acquisition, an analysis of the workforce revealed duplicate positions and a decision was made to restructure the workforce. Around 10 positions have been consolidated, though Awarepoint continues to hire strategic positions to support growth and customer support.

From RS: “Re: Catholic Healthcare West. Just changed their name to Dignity Health.” The 40-hospital CHW also drops its Catholic Church affiliation and opens up its governing board to non-Catholics, although its 25 Catholic hospitals will retain the sponsorship of local congregations. The press release mentions the $1.8 billion it is investing in electronic health records. The organization announced plans to triple its revenue, so the change allows it to acquire and partner with hospitals without running afoul of church policies.

HIStalk Announcements and Requests

Our own Travis Good MD of HIStalk Mobile will serve as a guest speaker of a January 31 Kony Solutions webinar, Mobile Strategy for Pharma – Opportunities and Challenges.

Acquisitions, Funding, Business, and Stock

The Advisory Board expects to realize a $3.5 million gain on its recent sale of its OptiLink business to Kronos. Also, Texas Governor Rick Perry announces that his state will invest $500,000 in The Advisory Board, which plans to create more than 200 jobs and invest $8.1 million to expand its Texas operations.

Sales

Rockingham Memorial Hospital (VA) selects Amcom Software’s messaging and communications solutions.

The VA contracts with Decision Simulation’s virtual patient platform for its simulated training and education program for healthcare providers and educators.

Montrose Memorial Hospital (CO) selects PatientKeeper’s application suite.

Unity Health System (NY) chooses dbMotion’s interoperability platform for its 70 locations.

CentraCare Health System (MN) picks iSirona’s device connectivity technology to deliver patient data from its ventilators into its Epic EMR.

Cooley Dickinson Physician Hospital Organization (MA) signs a contract for MedVentive Risk Manager, which it will use to manage its new Alternative Quality Contract with BCBS.

Intermountain Healthcare chooses the mobile application development platform from Kony Solutions to develop its own apps.

The State of New York chooses First Databank and Ernst & Young to survey drug average acquisition costs, a Medicaid reimbursement benchmark authorized by the legislature in 2011.

People

GE Healthcare IT appoints Michael Jackman VP and GM of its specialty solutions business. He was previously with iSoft, Carestream Health, and Kodak.

The Huntzinger Management Group names William C. Reed VP of business development. He’s the former president and CEO of AllOne Health and CIO of Geisinger Health System and Thomas Jefferson University Hospital.

Rubbermaid Medical Solutions names Cheryl D. Parker, PhD, RN-BC, FHIMSS as its chief nursing informatics officer. She was previously with Motion Computing.

Noel Williams, CIO of HCA, announces her retirement, effective at the end of May.

M*Modal names Amy Amick as COO. She was previously GM of worldwide services for Microsoft’s Health Solutions Group.

Mediware promotes VP and Controller Robert W. Watkins to CFO.

Announcements and Implementations

Kaiser Permanente announces that its 9 million patients can access their medical information on a new, free Android app, with an iPhone version to follow in a few months. It offers appointments, secure e-mail, lab results, refills, and a facility locator, all available to both patients and their families acting on their behalf.

UPMC moves all its electronic transactions with suppliers to Toreion’s EDI exchange solution.

Isabel Healthcare and BMJ Group partner to offer Best Practice, which combines Isabel’s diagnostic tools with BMJ’s clinical content. BMJ publishes the British Medical Journal and is a wholly owned subsidiary of the British Medical Association.

Cerner chooses TrustHCS to provide its clients with ICD-10 education.

Innovation and Research

Children’s Hospital Boston offers a $25,000 prize to the researcher who develops the winning best practices for communicating the information found in a patient’s genome to physicians and patients to improve outcomes. The prize carries one of the most contrived and awkward names ever – CLARITY, which they explain stands for “Children’s Leadership Award for the Reliable Interpretation and appropriate Transmission of Your genomic information.” One of the three project leaders is Isaac Kohane MD, PhD of the Children’s Hospital Informatics program. Applications are due March 12.

Technology

Tanking BlackBerry maker Research in Motion continues its unbroken streak of questionable decisions, naming one of its two low-visibility COOs (the one in charge of the RIM’s Playbook tablet, whose sales were so bad even at $99 fire sale prices that the company had to write down $485 million) to replace its two recently department co-CEOs. The new boss says he will mostly follow the path set by his predecessors, except he will hire a chief marketing officer. Shares have dropped 80% from their February 2011 price and took another 4% hit on the CEO announcement.

Apple’s Q1 numbers: revenue up 73%, EPS $13.87 vs. $6.43, crushing estimates with the its highest-ever revenue and profit. In the quarter, the company sold 37 million iPhones (up 128%), 16 million iPads (up 111%), 5.2 million Macs (up 26%), and in the only negative news, 15.4 million iPods (down 21%). The company has $98 billion of cash in the bank. Your $10,000 investment three years ago would be worth more than $50,000 today.

Other

Medical records scanning and document management company EDCO Group will increase the number of employees in its Sioux Falls, SD facility from 40 to 70, helped out with development money from the state’s workforce commission.

Weird News Andy says this isn’t weird, just cool, even though he’ll pass on a spot on the camera recovery team. Researchers in Israel take the “pill cam” intestinal camera system to the next level by developing a version that can be steered by the magnet of an MRI machine.

In a rare public appearance by an Epic executive, COO Steve Dickman provides some company facts to a local technology group:

• 2011 sales exceeded $1.2 billion, up 45% from 2010
• The company expects to add 30 large customers this year
• Construction continues on a new 11,000 seat on-campus auditorium
• 38% of US patients are covered by an Epic product
• The company hires 1,500 new employees a year from 150,000 submitted resumes
• Only five employees work in sales, while 55% do implementation and support
• The average employee age is 29
• The company says it has no interest in buying competitors or being acquired itself

The Wall Street Journal runs a point-counterpoint article on whether the US should implement a national patient identifier. Arguing for: Michael Collins MD, chancellor of the University of Massachusetts Medical School. Arguing against: Deborah Peel MD, psychiatrist and founder of Patient Privacy Rights. Reader votes are running 59% no, 41% yes.

An Ohio hospital’s transparency policy regarding medical errors blows up in its face when the chief medical officer tells the family of a deceased knee surgery patient that his death was caused by malfunctioning lab equipment, which delayed reporting of the high serum potassium level that contributed to his heart attack. Unbeknownst to the hospital, the family had smuggled a tape recorder into the meeting and used the chief medical officer’s recorded admission as evidence in its wrongful death lawsuit against the hospital.

A Florida jury finds that an HCA-owned hospital allowed an uncredentialed surgeon to perform gastric bypass surgery on a patient who suffered brain damage. They award the patient $178 million.

Stanford University researchers find that women report feeling about 20% more pain than men for unknown reasons. Previous studies found that women are more likely to tell doctors about their pain and to delay seeking treatment for it. Here is my theory: men like to be perceived as macho, especially if they happen to be under the care of a cute nurse of the opposite sex. Meanwhile, women feel more cumulative pain between the experience of childbirth and the subsequent carrying of infants, toddlers, kids, and 40-pound bags of dog food. All that, of course, while wearing four-inch heels.

Sponsor Updates

• Humedica and West Health Policy Center announce their collaboration to identify healthcare cost drivers that can be lowered through the use of technology.
• Premier Healthcare Alliance Inc announces a group purchasing agreement with UltraLinq Healthcare Solutions.
• Ingenious Med extends its mobile offerings to Android mobile devices.
• Sparrow Laboratories uses EMRHub from Lifepoint Informatics to send lab results to provider EMRs.
• MEDecision achieves full pass certification for its interoperability tests at the 2012 IHE Connectathon.
• NextGate announces its successful testing of MatchMetrix EMPI at the IHE Connectathon 2012.
• Commonwealth Orthopaedics (VA) selects SRS for its 91 providers.
• McKesson announces an ICD-10 transition service.
• Aspen Advisors publishes a case study on its ICD-10 readiness assessment for East Jefferson General Hospital (LA).
• Jon Phillips of Healthcare Growth Partners discusses his firm’s trade show strategy for HIMSS.
• CHRISTUS Health (TX) selects Compuware’s Gomez Platform to optimize the performance and availability of its EHR.
• AT&T announces communication and infrastructure tools to allow providers to use tablets and messaging more securely.
• Over 10,000 New York State healthcare providers had enrolled in either the NYC Health Department’s NYC REACH program or the NY eHealth Collaborative by the end of 2011.
• Intelligent InSites offers a January 25 Webinar on applying RTLS visibility and lean production principles to healthcare.
• MEDSEEK announces support for the ONC’s “Putting the I in HealthIT” program, which seeks to empower patients to become partners in their own health.
• DrFirst releases a Healthcare Hero video, also offering a HIMSS conference night on the town (limo, dinner, and show) as a prize to one selected person who leaves a comment on the video’s YouTube page.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

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Computer-Centered versus User-Centered Design

Within the next few years, most physicians in this country will have converted from paper-based charting to electronic health record (EHR) technology. This is an unprecedented technological change in healthcare delivery. Whether this technological transformation succeeds will in large part depend on the design of the EHR software itself.

As a physician in clinical practice, my day-to-day care of patients depends in large part on how easy or difficult it is to interact with my EHR. Like many of my colleagues, I find that while my EHR provides all the necessary functionality, using it requires too much cognitive effort. In other words, the EHR design is computer-centered instead of being user-centered.

What’s the difference between computer-centered and user-centered design? Let me give an example.

Imagine that you and your very young son have recently started playing tic-tac-toe against each other on two networked computers. Your son thinks he should be winning more games, so he proposes a change, not in the rules, but in your screen view, in order to make the odds more even.

While his screen view of the tic-tac-toe grid will remain the same, your screen view will no longer be the standard three-by-three grid, but rather will be a single row of nine boxes.

He enlists his older sister, who is great with computers, to program your new user interface. Each of you can only see your own screen.

The first three boxes in your row correspond to the three boxes in the top row in his grid, the next three boxes in your row correspond to the three boxes in the middle row of his grid, and the last three boxes in your row correspond to the three boxes in the bottom row of his grid.

So, for a particular game, your respective screen views would be as follows:

All of the sudden, you find that you’re working pretty hard just to play tic-tac-toe. You’re working hard because you can no longer ‘see’ the problem.

First you have to mentally reconstruct the normal three-by-three tic-tac-toe grid, then mentally segment your row of nine boxes into three groups of three, and then transpose each segment back onto the appropriate part of the tic-tac-toe grid that you are keeping in your head. (Alternatively, you might decide to solve the problem using a different strategy, but that would still require cognitive effort on your part.)

With a lot of effort, you’re able to stay pretty even with your son, but then your daughter introduces a second challenge — a two-second time limit for each move. At this point, your son starts winning a lot more games than you, restoring family harmony.

What is interesting about this example is that, from a logical perspective, the two screen views contain exactly the same amount of information. And, in fact, if a computer program were using an algebraic algorithm to play tic-tac-toe against you, the screen view would be immaterial.

But for humans, it is clear that the grid view works better. It works because we can literally ‘see’ the solution.

If we see a tic-tac-toe grid, we can visually superimpose horizontal, vertical, or diagonal lines at will. If we are faced with the game position below, we don’t have to compute the slope of the line passing through the two Xs or solve an equation to know whether that line would also pass through the square on the bottom right.

In other words, the human brain is an extremely powerful computer, but one that evolved to help us survive in the physical world by making sense of our spatial environment. Our brain is almost always better at solving problems visually than by using formal logical or mathematical operations.

Donald Norman, a cognitive scientist and pioneer in applying human cognition to design, has written extensively on this topic. In Things that Make Us Smart, he devotes a chapter to why certain design variants are easier for humans than others, even if the variants are formally identical. He includes one diabolical example which turns tic-tac-toe into a variant of Sudoku.

Humans enjoy solving mental games and puzzles for fun, which is why we invent things like Sudoku, but we don’t enjoy them at all when they interfere with complex tasks. Physicians need to be able to devote their full cognitive attention to patients in order to help solve their very real health puzzles.

As physicians, we need user-centered EHR designs that take advantage of our innate visual and spatial perceptual abilities and stay in the background, instead of competing with patients for our finite cognitive resources. Far too many EHR designs force us to play linear tic-tac-toe.

Next post:

Why T-Sheets Work

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues.

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I was inspired by Ed Marx’s post last month, Transformation Through the Written Word. He talks about doing book studies with his direct reports, which then expanded throughout the workplace. The thing that most fascinated me about Ed’s piece was his book list. Having been the victim of a boss who tortured his team with 17 Irrefutable Laws of Teamwork, I was surprised (and quite pleased) to find books on his list which didn’t scream “teamwork!” or “leadership!” or “business!”

I’m a voracious reader, although lately I’ve been reading some fairly insubstantial fluff in an attempt to reduce stress and achieve relaxation. One of my best friends keeps recommending things like The Mathematics of Life or The Omega Theory,  but I just can’t seem to get into the mode for deep thinking.

I liked the fact that Ed’s list is eclectic – it includes James and the Giant Peach and Disney psychology along with the classic management and leadership-themed works. One of my personal favorites is The Checklist Manifesto: How to Get Things Right  by Atul Gawande. This book should be required reading for everyone who does anything which remotely impacts patients or other living things. I’ve liked Atul Gawande since reading his first book, Complications: A Surgeon’s Notes on an Imperfect Science, years ago. It helped to make sense of the things I encountered during training and in understanding the psychological complexity of events physicians are exposed to.

Speaking of psychological complexity, I’m already tired of the run-up to the November elections. One of the hot topics is healthcare reform. I’m not convinced that any of the candidates is qualified to actually speak to the issues. The general public gets pulled into the rhetoric as well. I end up discussing healthcare politics with a patient at least a couple of times a day. I recently ran across a book that should be required reading for anyone who thinks they are educated regarding the delivery of healthcare in the United States.

I don’t want to turn into Oprah, but I’m throwing it out there as the first “Dr. Jayne’s Book Club Challenge.” Some talking points from my friend Doug Farrago (of Placebo Journal fame) really sum it up:

• Our society has warped our perception of true risk. We are taught to fear vaccinations, mold, shark attacks, airplanes, and breast implants when we really should worry about smoking, drug abuse, obesity, cars, and lack of basic hygiene.
• Somehow we have developed an expectation that our health should always be perfect.  We demand unnecessary diagnostic testing, antibiotics for our viruses, and narcotics for bruises and sprains. And due to time constraints on physicians, fear of lawsuits and the pressure to keep patients satisfied, we usually get them.
• The bottom line is that most conditions are self-limited. “Our best medicines are Tincture of Time and Elixir of Neglect.”
• There is tremendous financial pressure on physicians to keep patients happy. But unlike business, in medicine the customer isn’t always right. Sometimes a doctor needs to show tough love and deny patients the quick fix. A good physician needs to have the guts to stand up to people and tell them that their babies gets ear infections because they smoke cigarettes. That it’s time to admit they are alcoholics. That they need to suck it up and deal with discomfort because narcotics will just make everything worse. That what’s really wrong with them is that they are just too damned fat.  Unfortunately, this type of advice rarely leads to high patient satisfaction scores.

It’s available now from Amazon, although not yet in Kindle format, which I know will make some of you sad. If you’ve read it, let me know what you think. And if you know anyone in politics, feel free to leave copies on their desks.

E-mail Dr. Jayne.

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