From Smells Like Teen CCHIT: "Re: did you get wind of this already? I don’t remember hearing about it on HIStalk yet but I could be wrong! It gets less juicier as you read, but leaves at least one major issue open for interpretation." Link. Don’t get too excited – nearly every point in the "very troubling post" is wrong, starting with the first paragraph (HBOC is indeed the former HBO & Company). CCHIT was dissolved, but only to change its organization type. CCHIT is still a private, non-profit organization and it’s entirely irrelevant as to which state it’s incorporated in since you don’t have to incorporate in the state in which you operate (surely everyone’s heard of the huge number of Delaware and Nevada corporations out there). Conflicts of interest with HIMSS? Obviously – HIMSS, AHIMA, and NAHIT founded it in 2004, so clearly they share an agenda and aren’t exactly secretive about that fact. Mark Leavitt of CCHIT used to work for HIMSS, but left to take the CCHIT job. CCHIT has paid staff, but most of the work is done by volunteer commissioners. CCHIT’s criteria are publicly vetted and open for anyone to see, so it’s not like they’re doing some kind of beauty pageant judging with no oversight. I could go on, but clearly it’s a waste of time — someone with an axe to grind decided to air their prolific ignorance or denial of the facts publicly. The legitimate gripes about CCHIT are its fees (but it is a self-supporting nonprofit), its existence (but Brailer sold the world on CCHIT-certified EHRs for interoperability reasons even though most of the CCHIT criteria have nothing to do with interoperability), and its failure to get its stated job done (reducing EMR purchase risk of doctors to move the adoption needle).

I’m not going to dwell on this, but suffice it to say the folks at MEDHOST dealt professionally with the issue I mentioned previously involving comments sent to me regarding a competitor. I appreciate their support.

The stimulus bill is signed, so right or wrong, it’s happening. I have to commend Allscripts for being on the ball – they had a new ad (to your left) to me almost immediately that links to a resource page for providers. We’ll stay in touch with our EMR vendor contacts since it will be interesting to see how the stimulus actually gets operationalized and what providers do.

And now that we’re getting stimulated, may I offer a brief criticism of Saint Obama on the day he signed the stimulus bill and yet the Dow dropped another 300? Enough of the gloom and doom predictions of just how bad the economy is and how long it will take to recover. We’ve got the pessimism angle covered, thanks. You’re supposed to inspire us with your energetic optimism, which is why people vote for big-picture vision-painters and not analytical realists. Take it from Ronald Reagan: the economy will recover when people believe it can. It’s your job to convince them. Thank you.

Jobs: Client Services Director, SCM Clinical Consultants, Epic Resolute Professional Billing Consultant. Sign up for weekly job blasts.

Least-shocking news of the day: the Electronic Health Records Association and HIMSS support spending taxpayer billions on their wares, reminding everyone that broad, noble-sounding causes always mean someone makes bunches of money.

Hong Kong’s hospital authority will spend $130 million over 10 years on a national e-health project, linking to the free physician EMR being developed by the Hong Kong Medical Association at government expense.

Picis signed several EDIS deals in Q4: Alegent, Palisades, Inova, and others listed in the press release.

Modern Healthcare gives its latest round of awards to big-salary hospital CEOs who have spent a lot on healthcare IT. Other than making the healthcare IT vendor advertisers happy and encouraging consumption of their products, I don’t understand why buying IT merits an award. First, their IT projects were presumably for their own organization’s benefit, not to get an award from an ad-supported magazine. Second, there were only 48 nominees for three awards, so obviously hospitals aren’t all that interested. Third, why give an award for "leadership and commitment" (tools) instead of outcomes of their use (results)? No offense to the winners, but we ought to be a little more mature than treating IT like its own little Most Wired science fair with winners and losers. Other than Concord Hospital this year, every past winner seems to be the huge, massively budgeted and staffed health system that represents about 0.1% of the hospitals out there purring happily along with non-award winning technology. All the hospitals I knew of (including my own) who won Most Wired made fun of it offline, so I don’t think anyone really thinks these magazine contests mean much (at least the HISsies recognize bad achievements, like stupidest strategic move and the much-discussed Pie in the Face award). Modern Healthcare is usually more rational than the cheerleading HIT magazines, so I’m disappointed. Next think you know they’ll be giving away a car at HIMSS to bribe people to visit advertiser booths.

Eclipsys names former Per-Se CEO Philip Pead to its board. Says he’s a managing partner of Beacon Point Partners that’s supposedly a healthcare consulting organization, but I’m guessing it’s just his own shingle since the only connection I could find had an address in a building full of multi-million dollar condos in Coconut Grove, FL.

Microsoft will be selling Amalga in the UK, at least if customers want it.

Ronald Tomo is named CIO of Nassau Healthcare Corp. (NY), coming over from Episcopal Health.

This is interesting, but confusing. An Illinois clinic CIO who used to work for Allscripts is rolling out a registration kiosk for his clinic, which he developed under his separate company, and which Allscripts will resell.

South Dakota pharmacist and physician groups want the state to join those that have rolled out a doctor shopping prescription database.

Vint Cerf, who beat Al Gore in creating the Internet, makes the case that online privacy is relative. His example: if you’re in the ED, you don’t care about privacy at that moment because you want staff to see your medical records so they can help you. But, that proxy should be limited by time, so that the ED has a few hours to check out your information, but your doctor has longer. That’s an interesting concept: time limits can be a privacy enforcer (after you’re discharged or transferred, for example).

A Texas company wants a judge to let it tap into the accounts receivable of shuttered Brownsville Tri-County Hospital (PA) to collect the money owed to it, blaming inept hospital staff for its failure. "The audit revealed that (the hospital) and its personnel do not fully understand the components and functions of the (computer billing system) due to the fact that expertise in neither hospital billing nor financial reporting exists within the hospital."

Check out this amazing photo and story from the UK, showing "the world’s highest intensive care ward" in a C-17 Globemaster transport jet in which British troops critically injured in Afghanistan are brought back for treatment.

Sad lawsuit result: a baby born in 1988 with brain damage is awarded a $2.4 million medical negligence award in 1999 from a Boston hospital. She lived with her father, who was just sentenced to five years in federal prison for spending more than half her money on race cars, drugs, and his own attorney fees in trying unsuccessfully to beat an attempted murder charge in 2004.

E-mail me.

HERtalk by Inga

SouthEast Alaska Regional Health Consortium (SEARHC) launches the ALERT EDIS from ALERT Life Science Computing. SEARHC is in the middle of a two-year, $5.4-million transition to EHR, one of first and largest of its kind for tribal health systems.

Mount Sinai Medical Center (NY) signs a multi-year contract with GE Healthcare for management consulting and IT services.

The VA discovers that a contractor providing medical transcription services violated department rules by allowing employees to use computers that did not adhere to the government’s security policy. The contractor has been suspended, even though there is no evidence that patient information was disclosed.

A Utah study finds that 98% of stroke patients evaluated using telestroke consulting technology received appropriate treatment, compared to 82% of those evaluated by telephone alone.

Conifer Revenue Cycle Solutions files a warning letter with the Texas Workforce Commission that confirms 57 employees will be laid off by April 13th. The 2,300 employee Conifer is a division of Tenet Healthcare. The affected employees are employed with within Conifer’s Center for Patient Access Service.

As everyone scrambles trying to figure out how to get their piece of the economic stimulus package, I am wondering how things will shake out with vendors. For example, what if your product is not CCHIT certified? Are you going to lobby against any policy that formally requires providers to have CCHIT–certified products in order to receive subsidies? Or are you going to rush to get your product certified? Do vendors need to start ramping up their implementation staff (if they haven’t already?) I also wonder if providers will attempt to hold vendors liable should a provider fail to be using EHR “meaningfully” in time to qualify for the various adoption deadlines.

Informatics Corporation of America (ICA) announces that its solution is live and aggregating data from all core clinical systems at Northwest Healthcare (MT).

Former McKesson VP of Customer Operations Tom Pianko joins Occupational HealthLink as executive VP of business development and marketing.

Two former Healthlink executives launch a new HIT consulting firm named Encore Health Resources. Ivo Nelson is chairman and Dana Sellers is president and CEO.

Fairfield Medical Center (OH) deploys Imprivata’s SSO technology.

IntelliDOT appoints Margaret Laub to its board of directors. She is CEO of the HIT outsourcing company Policy Studies, Inc. and a former president for McKesson Health Solutions.

Cardinal Health chooses CareFusion as the new moniker for its $4 billion clinical and medical product business spinoff. You may recall that they acquired CareFusion awhile back, so they are getting good use of the name.

I’ve received a number of e-mails recently asking if any fake Ingas will be floating around HIMSS. Truthfully, I have no idea. I wonder if fake Ingas are too “last year?” Perhaps too frivolous in these days of tight budgets? On the other hand, who could resist a wise (and sexy) fake Mr. H, with sort of a George Clooney-ish look? Wouldn’t we all feel a little more reassured that our HIT world is safe if we had a few Mr. Hs bopping around?

PatientKeeper and St. Vincent’s Hospital Manhattan will host an eSeminar focusing on the hospital’s use of PatientKeeper’s charge capture and clinical portal. The event features CMIO Dr. Richard Roistacher and takes place February 26th from 2-3:00 EST.

Mediware introduces a new product designed to manage the storage, preparation, and administration of mother’s milk used in hospitals. All Children’s Hospital (FL) has already adopted Mediware’s LacTrack SafeLx software.

HIMSS is hosting a series of Webinars highlighting the new economic stimulus package and its effect on healthcare. In additional, HIMSS has added 10 new sessions on the topic for the April convention.

Advocate Good Samaritan Hospital (IL) selects Patient Care Technology Systems’ Amelior ORTracker system.

A KLAS study concludes that healthcare providers are largely unaware of the RTLS solutions on the market and their capabilities. Only 29% of those surveyed could list an RTLS by name and 59% were unable to identify which RTLS offerings they would consider using.

E-mail Inga.

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Federal regulators filed a complaint in Dallas federal court today against billionaire R. Allen Stanford and three of his companies, including Antigua-based Stanford International Bank, alleging "massive fraud" in promising unreasonably high rates of return on $8 billion worth of CDs sold by the bank. The judge has entered a temporary restraining order and has frozen Stanford’s assets.

"We are alleging a fraud of shocking magnitude that has spread its tentacles throughout the world," said the SEC’s director in Fort Worth, TX. Most of the subpoenaed company witnesses, including Stanford, either failed to appear or could not account for the $8 billion in assets claimed to be housed in the bank.

Earlier reports suggested that the bank had laid off significant numbers of employees, weeks after Stanford paid $20 million in prize money to the winners of a single cricket match at which he arrived in a gold-plated helicopter.

Stanford International Bank is the primary shareholder of Health Systems Solutions Inc, which last week backed out of its plans to acquire imaging vendor Emageon for $62 million after Stanford International declined to provide financing. HSS paid $9 million in escrowed money to Emageon for failing to complete the transaction.

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Response to EHR Outcomes Studies Cited by Reader "Pragma"
By Frank Fontana

The author (Pragma) commenting on MD Leader 1/27/09 needs to come clean on their own studies cited before criticizing someone else in such a sarcastic manner.

I followed the links to the "studies" cited. All but one either (a) have nothing to do with studying whether EHRs improve quality or not, or (b) were authored by those in the business of promoting EHRs. The one that does make an attempt to measure quality improvements acknowledges that their work may be skewed towards positive results because of the self-selecting clinics that participated.

I imagine the commenter could also readily cite studies showing that cigarettes weren’t damaging to one’s health, conveniently not mentioning the fact they were funded by tobacco companies.

http://www.bmj.com/cgi/content/full/bmj%3b330/7491/581
This was authored by IT clinical consultants.

http://www.itif.org/files/HealthIT.pdf
This is not a study. The author is an analyst at the Information Technology and Innovation Foundation, which is committed to articulating and advancing a pro-technology public policy agenda.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2253693
This is not an EMR study. It is a study of an electronic prescribing application, funded by the very same vendor.

http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=685103 
The report “examines the experiences of five provider organizations in developing, testing, and implementing quality-of-care indicators, based on data collected from their electronic health record (EHR) systems." It is not a study of whether EHRs improve quality or not.

http://www.cchit.org/about/casestudies/index.asp
This was a study by the Certification Commission for Healthcare Information Technology, which notes that “Case studies bring CCHIT’s work alive.”

http://www.fhin.net/eprescribe/Benefits/AdvantagesToProviders.shtml –
Not an EHR study. Another electronic prescribing study, again funded by a provider of electronic prescribing applications.

http://www.fiercehealthit.com/story/ehrs-boost-quality-raise-costs-at-community-clinics/2007-01-22
Link is to a “leading source of Healthcare IT news with a special focus on … EMR adoption…” The study itself notes that five of the six clinics lost money on their EHRs, though quality improved. Regarding the improvement of quality, the study also notes “this retrospective, qualitative study obtained data from a small, purposeful sample of six CHCs, with additional information from two network ASPs. Study CHC cases likely were more successful than cases that declined to participate.” One of the two authors is a graduate student in Biological and Medical Informatics.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1479999
Not an EHR study. Not a study at all. Rather its a report by a large group practice of its experience integrating an online communication channel with its already existing EMR.

Parallel processes of manufacturing companies operating disparate systems for producing goods sold in the marketplace correlates to analytic processes driving the medical community exotic and disparate diagnostic testing on human subject typically referred as “patient.”  The extent of the diagnostic testing or physiologic surveillance depends on the complexity of the test entity, POS environment, and the instrumentation employed to product the sub-clinical finding commonly called “tests results” or real-time somatic analytics.

Often more times than necessary, these clinical tests or surveillance systems are performed while the patient takes up temporary residence in a full-service acute care health center with state-of-the-art equipment employing all the modern instrumentation afforded to the hospital in the medical service area. These tests can be diverse as Magnetic Resonance Imaging (MRI) to the simple blood test for Magnesium (Mg) or measurement of body temperature. 

If one were to count up the total testing menu provided by a typical urban hospital charge master, the resulting number of frequently reimbursed test procedures would be over two thousand, continually increasing as technology proliferates in the diagnostic in vivo market. If each and every testing procedure performed by a healthcare entity were available online and accessible to everyone involved in the medical process, then this paper would not be necessary and no new information would be reported.  This sadly, is not the case.

The purpose of this paper to examine the multitude of diagnostic testing being performed by accredited hospitals on their patients to consider an interoperability gateway called Point of Diagnostic Service (PODS). Simply stated, Diagnosis Oriented Architecture (DOA) is the underlying structure, or more appropriately surrogate architecture, to service oriented architecture (SOA) supporting communications between clinical service diagnostics. In this context, a diagnostic is defined as a unit of work to be performed on behalf of some computing entity, such as clinical diagnostic instrumentation or medical devices.

DOA defines how two computing entities, such as programs, interact in such a way as to enable one entity to perform a unit of work on behalf of another entity. Diagnostic interactions are defined using a description language equivalent to service oriented architecture.  Each diagnostic interaction is self-contained and loosely coupled, so that each interaction is independent of any other interaction. If one diagnostic entity is non-functional, the service structure will maintain functionality*.

Enterprise diagnostic process, usually initiated by Computerized Provider Order Entry (CPOE) protocols, can be orchestrated by communications between the Web services and gateway diagnostics talking to other gateway diagnostics executed by the underlying framework that DOA provides as a surrogate function to the Enterprise Service Bus. The patient in this case study is the central focus of all medical activity emanating pathophysiologic signaling functioning as medical broadband for investigation to determine cause and effect of presentational or prodromal symptomatology.

NOTE: The foundation for the “Interoperable Patient” is Point of Diagnostic Service (PODS) unified platform, the first critical inch of HIT considered the ecatheter for diagnosis extraction, transformation, and loading of clinical data into the longitudinal enterprise diagnostic repository or colloquial “The Patient Cloud.”

*Advancing the Adoption of Medical Device “Plug & Play” Interoperability to Improve Patient Safety and Healthcare Efficiency.” Center for Integration of Medicine & Innovative Technology. 2008.  http://mdpnp.org/uploads/MD_PnP_White_Paper_April_2008.pdf

The bulk of the HIT language in the bill is pulled directly out of the HR 6357, which Dingle introduced last summer. I don’t see how  NeHC is going to serve as the Policy Advisory committee since the language requires the Policy Committee to have a dramatically different makeup that will mostly be political appointments. For anyone who has ever run a complex project, there is a huge difference between staying close to your stakeholders and asking them to serve on your board of directors. The NEHC board was the result of a six-month open process and the governance model and board composition was designed to include people with multiple areas of expertise. This bill just destroyed that process.

Membership and Operations

(1) IN GENERAL- The National Coordinator shall provide leadership in the establishment and operations of the HIT Policy Committee.
(2) MEMBERSHIP- The HIT Policy Committee shall be composed of members to be appointed as follows:

(A) One member shall be appointed by the Secretary.
(B) One member shall be appointed by the Secretary of Veterans Affairs who shall represent the Department of Veterans Affairs.
(C) One member shall be appointed by the Secretary of Defense who shall represent the Department of Defense.
(D) One member shall be appointed by the Majority Leader of the Senate.
(E) One member shall be appointed by the Minority Leader of the Senate.
(F) One member shall be appointed by the Speaker of the House of Representatives.
(G) One member shall be appointed by the Minority Leader of the House of Representatives.
(H) Eleven members shall be appointed by the Comptroller General of the United States, of whom–

(i) three members shall represent patients or consumers;
(ii) one member shall represent health care providers;
(iii) one member shall be from a labor organization representing health care workers;
(iv) one member shall have expertise in privacy and security;
(v) one member shall have expertise in improving the health of vulnerable populations;
(vi) one member shall represent health plans or other third party payers;
(vii) one member shall represent information technology vendors;
(viii) one member shall represent purchasers or employers; and
(ix) one member shall have expertise in health care quality measurement and reporting.


Knowing Your Clinical Client
By HIT Project Manager

This is not a direct response to any article or comment made, but just a moment of serendipity this morning as I conducted a walk-through of one of our endoscopy units.

IT work is crucial to the performance of the unit. They are increasingly going digital with their process as endoscopic imaging merges with the rest of the electronic medical record.

Some observations as I walked around:

Doubling unit volume shows up in the “seams”
Each room in the unit has had to deal with added technology requirement as an afterthought. Its like how our homes look after choosing a builder’s model where one of the four bedrooms can be made a home office since you’re only having two kids. Once you’ve had four children instead, the home office is now a storage room, the wiring is outdated, and you will need to switch out the old DSL modem for broadband wireless solution if you ever get a chance to use the room for an office. Meanwhile, your PC sits on a cardboard box because the IKEA desk is in offsite storage to make more room.

Clinicians do not have time to learn technology 
Clinicians truly appreciate when we don’t insult their intelligence and years of clinical training by talking down to them and instead speak to one another as colleagues/peers. I love working with and for clinicians for this reason. They are some of the most gracious people you meet when you give them the same respect and care they give, like the RN supervisor on this unit. It is a true joy to work with her and serve her technology needs.

Technologists cannot afford to be oblivious to clinical workflow
In contrast to my last thought, I don’t think technologists (at least those like me in a project management/clinical analyst role) can afford not to get into the weeds of how and where clinicians work. If you do not spend enough time in the unit you provide technology support for, you will inevitably be the “home builder” that sells the client on a “home office” when you should have more appropriately advised a wireless solution. Only a visit to the clinical unit will permit you to forecast the growth that the clinician tries to communicate in the 10 minutes they have between cases.

The devil is in the details, they say.  Being an eternal optimist with a healthy dose of reality, I see that the optimal technology solution is the one that is completely transparent to its end users. Such a solution should work effortlessly and invisibly since, in the end, it’s the clinician-patient relationship that really matters. We technologists remove the distractions to help foster that relationship. 

The article in the Sacramento newsletter commenting on Kaiser-based clinicians’ struggle between time with technology vs. time with patient is a bit overstated, in my assessment. I can’t think of any physician or nurse I met that I who would say they are less effective because of the technology improvements that have been implemented. At worst, they consider them neutral to their work, and they have come up with creative workarounds where they are not. At best, they consider technology as having freed them from the mundane aspects of healthcare administration so they can spend more time with patients.

Godspeed to our efforts at making technology the best for them.

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The views and opinions expressed in this blog are mine personally, and are not necessarily representative of Texas Health Resources or its subsidiaries.

“Other Duties As Assigned”
By Ed Marx

One objective of this blog is to give a transparent window into the life of a healthcare CIO. Certain aspects of being a CIO, which generally apply to the entire C-Suite, are the numerous external “other duties as assigned.” The list is by no means complete and only reflects what I’ve grown to understand from working at two large healthcare systems. But I suspect every CIO operates in one if not most of these assignments. (I will remain purposefully vague as to which role is current or former.)

Politics. Be involved. Get out there and shake hands to further the cause of healthcare and your institution. Sometimes this means attending fundraisers for a politician who represents healthcare or for your city or state hospital association. Take part in advocacy efforts and help educate our governing bodies.

Fundraising. Lead by example through the opportunities that come your way. Create margin in the household budget. In addition to established opportunities, we created our own annual IT fundraiser for a children’s hospital that raised over $100K this last year.

Parties. Important social gatherings pop up often, and attendance is not always voluntary. I started out naïve; now I own a tux.

Appointments. Consider these an honor and an opportunity to give back to the larger community. I have held very formal State level appointments as well as less formal city and county appointments on behalf of my employer. But don’t be a wallflower. Speak up, invest yourself to further the cause. Otherwise, don’t bother accepting the position.

Boards. Many organizations are in dire need of talented people to help provide direction and ensure accountability. These Boards can range from an international for-profit corporation to a local, not-for-profit homeless shelter. Always check for potential conflicts of interest first.

Task Forces. Often times these are directly related to healthcare but in a broader community sense. For instance, you might join a task force to research the feasibility of a regional HIE.

Advisory Councils. My all time favorite was serving on the College of Design and Merchandising (fashion) Council at Colorado State University. I was the only non-model, non-designer asked to join the judging panel at the annual fashion show. Lights, models, cameras, crowds—and me sitting at the runway’s end with a tie that didn’t match my suit.

Professional Associations. It’s critical to remain actively involved to advance our profession. I have served on several national HIMSS committees and as State Chapter President (TN and OH). I have spoken on behalf of HIMSS and CHIME throughout the country.

Speaking & Publishing. There is a healthy expectation that we add to the body of knowledge by sharing best practices, evaluated experiences, and tangible results. I have spoken on behalf of and been published in and outside of healthcare. The bonus: it contributes to your growth.

The common thread between these “other duties as assigned” is what makes them so valuable and important and why you need to take an active role. They:

Allow you to give back to the broader community at large
Provide a framework for you to help advance a specific organization or initiative
Enhance your own personal and professional development
Broaden your networking and social contacts
Enhance your organizations position in the community and profession
Force you to think outside of yourself
Ideally makes the world a better place

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. Ed encourages your interaction through this blog. (Use the “add a comment” function at the bottom of each 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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From Barney Rubble: "Re: AtStaff. AtStaff, Inc. of Durham, NC laid off some 15% of its workers, including sales and marketing along with some other belt tightening (people)." Unverified.

From A-Fraud: "Re: Picis interview. Why not challenge Cozzens with [laundry list of company criticisms] … as a potential customer, we need to know this and Picis would not share this information with us!" The sender attempted to camouflage his or her information, but a little sleuthing revealed that it came not from a hospital or prospect, but from someone at Picis EDIS competitor MEDHOST (hopefully not encouraged by the company). Picis must be a formidable competitor if it’s come to that.

Mary Pettys, a software director for TriZetto, was one of the passengers who died in the Buffalo plane crash. Condolences.

Kaiser had a terrible 2008, swinging from 2007 net income of $2.2 billion to 2008 net loss of $794 million. Reading between the lines, investment losses were to blame, "marked down to current market values for financial reporting purposes." Interestingly, most of the press release brags on IT and HealthConnect, which is obviously a key strategy (as you would expect given the cost). Like everyone else, Kaiser will defer capital projects. An ominous sign: Kaiser’s total membership declined by 30,000 last year, the first drop in five years (maybe due to unemployment?)

I see that 113 people who attended HIMSS last year have completed the poll to your right. Results: only about half of them are going to HIMSS this year and 75% of respondents say their organizations will send fewer people this year. HIMSS may be getting a lot of early registrants, but it sure looks unlikely that attendance will match that of last year’s conference.

The CEO of Royal Free Hospital in England complains that its early adopter implementation of NPfIT’s Cerner Millennium costs it dozens of millions because of extra costs, lack of billing data, and reduced patient throughout. NHS says early adopters always have to spend and suffer more and that hospitals often fail to set adequate training budgets (all true in my experience). 

Listening: Flo Rida. If you already have a stripper pole and strippers in your house, this is all you need – they will instantly start gyrating since it’s a club staple, so I hear (I haven’t been in a strip club since they were dancing to Toto).

Jonathan Bush of athenahealth and John Glaser of Partners HealthCare will speak at the Transforming Healthcare conference in Boston the evening of Thursday, February 26. HIStalk readers get a discount – see the text ad to your right.

Cleveland Clinic strikes a deal with MinuteClinic to provide clinical consultations as backup to nurse practitioners in nine CVS store MinuteClinics, with integration of their respective electronic medical records, with patient-approved access to the clinic’s Epic MyChart information.

We did an "HIT Moment" with Vatsal Thakkar MD of NYU, who’s an actual user of the free Practice Fusion EMR. He has some quite interesting thoughts that are worth a read.

The drug industry got its hands into the stimulus bill’s earlier versions, creating a new lobbying group to make sure big pharma controls medical information and keeps provisions that require cost effectiveness out of any outcomes research. The drug makers don’t like the $1.1 billion earmarked for comparing medical treatments and want it removed, claiming it will lead to government rationing (the drug industry loves the "it’s expensive, but worth it" argument that it often makes directly to patients spending someone else’s money). An interesting quote in the article: "When the government’s Agency for Health Research Quality suggested in 1995 that there were too many unnecessary back surgeries, doctors and industry groups attacked the conclusion. Mr. Cannon noted that Congress at the time slashed the agency’s budget and stripped its authority to make medicare-payment recommendations. ‘They almost killed AHRQ,’ said Dr. Avorn. "The memory of their near-death experience hasn’t been forgotten."

Early reports are that privacy groups like the final stimulus bill, with ACLU giving its stamp of approval. No comment yet from Patient Privacy Rights.

BT’s earnings took a big hit after writing down the value of most of its big IT contracts, including its NPfIT ones.

Indian IT vendors are expecting to get contracts from HITECH. iSoft was named, which is strange since neither it nor parent company IBA Health sell into the US as far as I know, but maybe plan to do so.

Emageon gets the $9 million of escrowed money from Health Systems Solution for the latter’s failure to consummate the merger transaction with the former. In the meantime, the SEC, FBI, and IRS are investigating HSS’s parent company, Antigua-based Stanford International Bank, wary of missing another Madoff-type situation in which investors received abnormally high rates of return in what turned out to be a Ponzi scheme.

Merge Healthcare announces Q4 numbers: revenue down slightly, EPS $0.03 vs. -$0.28. With annual revenue tracking at $60 million, nobody’s probably paying much attention, but it’s at least a start toward some kind of recovery from three years or so ago when shares were in the high 20s vs. $1.65 now.

HITECH Provisions of the Stimulus Package
By Dr. Herzenstube

After reading through the entirety of the HIT language of the bill (title XIII, which covers all but the Medicare and Medicaid incentives), here are the bits I find most noteworthy.

1. The bill seems to stipulate a role for a certification organization a la CCHIT. "The National coordinator, in consultation with the Director of NIST, shall keep or recognize a program or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle." (3001.c.5).
2. However, that certifying body will not be the one to decide on the certification criteria. That will be the role of the HIT Standards Committee, with final say — at the individual criterion level — lying with the Secretary of HHS: "The National Coordinator shall review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee." (3001.c.1).

   …and the HIT Standards Committee will take its marching orders about what to focus on from the HIT Policy Committee. "The HIT Policy Committee shall recommend the areas in which standards, implementation specifications, and certification criteria are needed … and shall recommend an order of priority for the development, harmonization, and recognition of such standards, specifiations, and certification criteria." (3002.b.2.A)

   "…the HIT Standards Committee [shall] recommend to the National Coordinator standards, implementation specifications, and certification criteria…consistent with the latest recommendations made by the HIT Policy Committee.." (3003.b.1.A) (The bill also stipulates some areas that the HIT Policy Committee must address in some manner, e.g. segmentation of data to facilitate limited disclosures of PHI).

3. 3008.b Implies that the AHIC Successor, aka NeHC, might serve as the HITPC or HITSC (although HITSP has developed many of the interoperability implementation specifications used by CCHIT, most CCHIT criteria relate to innate functionality of EHR systems, NOT interoperability features, and were developed by the CCHIT workgroups themselves. It will be a major shift to have CCHIT relegated to basically just a testing organization, with criteria developed by another entity).
4. HIPAA will now apply to business associates of covered entities just as it applies to covered entities (13401.a)
5. "Pay for privacy". Upon written request of the patient, disclosures to health plans for payment or health care operations must exclude any PHI pertaining "solely to a health care item or service for which the health care provider involved has been paid out of pocket in full." (13405.a)
6. Accounting for all disclosures including for PTO. "An individual shall have a right to receive an accounting of disclosures … The Secretary shall promulgate regulations on what information shall be collected about each disclosure." (13405.c.1.B)

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