Ask the Chair

All these HCIT companies have been issuing press releases lately informing us that they are going to present at the 28th annual J.P. Morgan Healthcare Conference. What is that and should I even care?

The J.P. Morgan Healthcare Conference is the biggest healthcare-focused investor conference of the year.

Now, almost all the large and middle market banks have conferences for their institutional investing clients to meet with public companies, hear their pitches, chat with management, and hobnob in general. While most of them are sector-specific (be it healthcare, gambling — which is probably a fun conference, energy, consumer goods, etc). J.P. Morgan is truly the mother of all healthcare investing conferences.

Formerly known as the H&Q Conference until JPM acquired Hambrecht and Quist, the conference is held every January in San Francisco (home of H&Q), by tradition at the Westin St. Francis in Union Square. All next week, CEOs and other officers of healthcare companies and their hangers-on will converge on the City by the Bay.

It’s important to know that HCIT is just a small part of the fun and often lost in the excitement of pharma, biotech, managed care, medical device, and healthcare service companies all showing up to tell their stories. I’ve often thought that if the next big San Francisco Earthquake occurs during this week, healthcare costs would drop by a meaningful percentage!

But why the flurry of press releases? Under SEC Rule FD (for Fair Disclosure), because the companies participating might say something material to their stock price, the fact that they’re presenting needs to be disclosed in advance, and presentations are usually Web-cast, too. Note that back before this rule was adopted, companies would often disclose information only in this type of setting (i.e., only for institutional investors to act on).

Making the conference even more interesting (and widely attended), in addition to the public company presentations, banks invite up and coming private companies to present in a separate track. This allows both private (i.e., venture or PE) investors to look for investment opportunities for their portfolios and public investors to have access to private companies that might not be on their radar yet – giving them a chance to check out what’s coming down the IPO path someday, likely to compete with a public company they hold in their portfolio, or increase their knowledge of the industry as a whole. More importantly, it allows the bankers to show some love to prospective clients by giving them a forum and an audience.

What’s particularly interesting about the JPM conference (and H&Q before it) is the size of the crowd it draws. Because so many companies and investors are in one place, others follow (Metcalf’s Law in action, perhaps). Not only are J.P. Morgan bankers on hand, healthcare investment bankers from its competitors can be found in the vicinity of Union Square as well, in addition to a bevy of others who service the industry (including me), a practice commonly known as “poaching”. The city fills up with not only the companies and investors invited, but companies, investors, and assorted others who weren’t invited and won’t be attending anything official.

As a result, the week becomes a mammoth series of meetings, receptions, and the like hosted by PE and venture funds and even competing banks. It’s like the joke about why the atheist goes to temple: “Meltzer goes to talk to God, I go to talk to Meltzer”. To me, the H&Q Conference (as many still call it) is second only to HIMSS as a time to have 3+ days worth of consecutive meetings with clients, prospects, and old friends. Just like at HIMSS, you can be at a coffee shop or street corner waiting for a meeting to start and run into people you’ve known for years.

Does the non-investing HIStalk reader need to care? Well, unless you’re wondering where everyone went, but truly, not a whit. However, since the question was asked, and Mr. HIStalk has asked for the “insider view”, I thought this might provide some interesting color on explaining the recent press release action.

My next post (coming soon), will discuss the hows and whys of QuadraMed and Amicas’ announcements last month that they were escaping the slings and arrows of the public equity markets into the waiting and eager arms of private investors. In the meantime, please keep those interesting questions coming.

Ben Rooks
The Chair

Ben Rooks is the founder of ST Advisors, a strategic consultancy offering long-term and project-relationships to companies and financial sponsors. He earned an MBA in healthcare management from The Wharton School of the University of Pennsylvania, has done healthcare IT equity research, and has worked as an investment banker in over 25 successfully closed healthcare and medical technology transactions valued from $40 to $365 million.

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From Nurse Carol: “Re:  meaningful use. Will you provide links and document numbers for commenting on the proposed rules?” I e-mailed ONCHIT just to make sure I understood the process and they kindly verified: the 60-day comment period starts with the date the rules are published in the Federal Register, which is scheduled for next Wednesday, 1/13. Comments can be left on regulations.gov. I’ll run the exact link once it’s available.

From Nosy me: “Re: GE. GE has put their Centricity EMR implementation on hold at UMDNJ School of Osteopathic Medicine due to lack of payment. UMDNJ, the health university of New Jersey, contends that they have gotten nothing for their investment so far except extended timelines and escalating bills.” Unverified.

From The PACS Designer: “Re: Thoma Bravo LLC. PACS vendor AMICAS has decided to accept an offer from Thoma Bravo LLC to buy their shares at $5.35/share. TPD is very familiar with AMICAS and their acquisition of Emageon. While the AMICAS PACS is a great product, the Emageon PACS is just the opposite and the reason AMICAS may want to go private is to keep their shareholders from finding how bad things really are with the Emageon product line. Having Thoma Bravo LLC is just what the patient (AMICAS) needs to get better!”

From IKnowPlenty: “Re: things that make you go ‘hmmm’. The keynote address for AHA’s annual leadership meeting is disgraced climatologist Al Gore. I fail to understand what he has to do with healthcare or hospitals, other than wanting to sell them carbon credits.” He finally got his big house LEED certified once word got out on the Internet he invented that his electricity usage was more than a dozen times the average. He’s about as relevant as the other speakers, though: Freakonomics guy Steven Levitt, former White House secretary and Vanity Fair editor Dee Dee Myers, and film maker Ken Burns. You know it’s a stretch when the guy with the most relevant healthcare credentials is talking head Sanjay Gupta. These folks don’t speak free, so your hospitals (meaning patients and taxpayers) are footing their bill. According to tax records, AHA took in $120 million last year, of which $22 million was pure profit (in a non-profit way). Three of its executives made more than $1 million, the CEO made $2 million, and all are appalled that anyone would suggest that healthcare reform is needed.

From FinSoft: “Re: QuadraMed. Steven Russell gets 86’d as collateral damage from the Dunn hiring.” The 8K also gives Tom Dunn’s hiring details.

From Nasty Parts: “Re: Sage. I hear they will announce a new president shortly and Lindy Benton will stay on as SVP of sales.” Unverified, although Nasty Parts has a pretty good track record.

From CongestiveITFailure: “Re: CCIM. Community Care Information Management, another Ontario Ministry of Health and Long Term Care eHealth agency, is currently being run by the partners from Blue Pebble, a consulting firm. There is a serious conflict of interest, as Blue Pebble hires their own eHealth subcontractor consultants and places them (on a contract basis) within CCIM. They take a percentage of their subcontractors’ daily rate and pay them via a third-party vendor so as to skirt current provincial salary disclosure rules. The partners from Blue Pebble consulting were put together by the current Ontario MOHLTC Associate Deputy Minister John McKinlay. Another scandal is imminent with such a conflict of interest.” Unverified, but I found this October article that says the same thing. Three of the project’s senior managers set up Blue Pebble and then got 30% of the project’s consulting business. CBC says Blue Pebble also did work for the disgraced eHealth Ontario and its predecessor, Smart Systems for Health Agency. An anonymous informant said Blue Pebble was using the government’s people and technology and charging them for it.

From MalaysiaHITFan: “Re: HIT vendors. Surprised no announcement out of HIT vendors on what are presumably sizeable contracts. Focus on openness must be why Epic missed the cut.” I saw the article, but couldn’t decide whether I was interested in it. Malaysia awards contracts to Microsoft, Eclipsys, Cerner, and IBA Health for new systems, although the date of those contracts isn’t mentioned, so I’m thinking its old news. Still, the projects are interesting: teleconsultations, personalized education, CME, smart cards, and a Lifetime Health Plan for every citizen (which the article candidly says “became the biggest failure of the Ministry” when the business model turned out to be shaky and the managing company went bust). Now they’re doing an HIE instead.

Cardinal Health announces a bar code-powered inventory and ordering system called Connect System (catchy name) for laboratories.

Wait … what’s that sound? Someone crying out for help? Why, it’s my HISsies nominations, pining for some Web-based intimacy with all those knowledgeable HIStalk readers who would be the first people I would ask to name the Industry Figure of the Year, the Best and Worst Vendors, the CIO of the Year, and of course the happy winner of The Pie. The upcoming voting won’t be all that interesting if the only nominations I get are from vendors nominating themselves for the good awards and their most hated competitor for the bad ones. I’ll close the nominations out this weekend, so vote now or forever hold your peace.

Twin County Regional Hospital (VA) expands its McKesson Paragon implementation to include Practice Partner. It’s in Galax, a town I like although I’ve been only a couple of times (the Rex Theater for live bluegrass, Aunt Bea’s for barbeque, and a bounty of fiddle players).

The College of American Pathologists releases its updated XML version of the CAP Cancer Checklists, used for cancer description and reporting.

Many thanks to Wellsoft, new on board as a Platinum Sponsor of HIStalk. What you should know about the company: (a) it offers a highly awarded emergency department information system; (b) Version 11 has some cutting edge new features (anatomical diagrams, clinical decision support, medication reconciliation, and a patient entry kiosk), and (c) the Wellsoft EDIS has some powerful technology behind it, such as Oracle, interfaces to all hospital information systems, remote updating, guaranteed 15-minute support response time, and custom reporting. Get on their mailing list here and check out the video. They will be in Booth 7005 at HIMSS, FYI, which reminds me that a couple of years ago at HIMSS, I went to some super-geeky, small-room session on clinical decision support architecture or something like that and I noticed a casually dressed, deeply immersed guy sitting a couple of seats over. I checked his badge and it was John Santmann, MD, founder of Wellsoft. I don’t think I’ve ever seen a CEO in a real HIMSS session and a hardcore one at that, so I admired him immediately. End of pointless anecdote.

Hocking Valley Community Hospital (OH) will implement Keane Optimum iMed and migrate to Optimum Patcom.

I’m all for free speech, but the same people posting the same comments about EMR safety and FDA regulation under multiple phony names (yes, I can tell) is wearing a bit thin. I sometimes agree with the argument, but I don’t need it jammed down my throat several times a day. Would I be wrong to delete those comments?

Listening: a recommendation from Tom in Verona, WI (gee, wonder where he works?): Nothington, polished and pop-tinged punk that immediately motivated me to attempt a frowning-faced, intense desk drum solo that nearly slung the watch off my arm. An excellent choice. I was going to listen to part of just one song to be nice to Tom, but I keep playing them over and over.

Vanderbilt opens BioVU for internal research projects with IRB approval. It’s a DNA data bank with 75,000 samples linked to the de-identified EMR records of their owners. One of the first studies will look for a relationship between DNA and drug response.

I got some info on the contract between Universal Health Services and Cerner. It’s a pretty big rollout: ED, clin doc, orders, CDR, meds, biomedical device integration, LIS, pharmacy, and OR. Not ADT or accounting, which are notoriously weak links of Cerner (heard much about ProFit lately? Exactly.)

Practice management vendor AdvancedMD acquires EHR vendor PracticeOne, hoping to roll the products together into a SaaS solution.

This might make a good remote hosted EMR commercial: thieves break into a medical practice and steal its Fujitsu Lifebooks, but as the CEO tells the reporter, “None of the electronic medical records reside on the computers or on our property” since they use a hosted service.

Capital Regional Medical Center (FL) publishes its ED wait time to the iPhone via iTriage.

Several former executives of iSoft, including the former chairman and CEO, face criminal charges in Britain for making false and misleading statements.

AT&T will launch five Android-powered mobile phones in the next few months, one made by Dell and another rumored to be a version of Google’s just-announced Nexus One.

At the International Consumer Electronics Show, Cisco demonstrates a home version of its TelePresence videoconferencing system, showing how it could be linked to medical devices to pass voice, video, and data from patient to physician. At the same show, Skype announced that its application is now capable of making high definition video calls and will be incorporated into HDTVs (as a newfound Skype Video user not even using HD, video calls via Skype are still one of the coolest things ever, just like being in the room with the person on the other end of your free call).

Two Regenstrief informatics fellows win AMIA student awards, one for a graphical tool to examine drug interactions, the other for a system that proposes drug and lab suggestions based on physician ordering habits. I’m thinking I should cover more of this research-based informatics stuff since it interests me and it’s innovative.

eClinicalWorks will offer patient education from Krames, including 1,300 aftercare instructions in several languages that are suggested to physicians based on EMR information as well as for direct patient access through eCW’s patient portal.

Odd lawsuit: an MRI clinic’s car injury claim is fully paid by its insurance company, receiving the state-allowed maximum $10,000 in PIP benefits. Their attorney sues the insurer for $2.59. For once, an insurance company gets to accuse someone else of being a scumbag. “Who has the greater motivation to sue in this case, the MRI clinic that’s seeking $2.59 or an attorney who charges about $375 an hour for his services?”

E-mail me.

HERtalk by Inga

From Father Time: “Re: meaningful use timeline. It is my belief that the MU clock will start ticking 10/1/2010 as that is the start of the government’s 2011 fiscal year. I am certainly no authority on the subject, but it would seem the government would use their year vs. calendar or any other for the time period used  to verify meaningful use of hospitals and providers.  If you consider that time period and use the HMS/CMS 90-day model, a hospital would have to begin to prove meaningful use BEFORE July 1, 2011. In hospital years, that is REALLY soon!” I agree with Father Time that the MU clock could start as early a 10/1/2010 for hospitals (in fact my graphic indicated that). HIMSS also said 10/1/2010 in their webinar this week. However, the committee’s “recommendation” is that the Secretary choose the calendar year (starting 1/1/2011) for meeting the definition, which would give both hospitals and vendors more time to ramp up.

From CPOE Guy: “Re: EMR and girl talk. Maybe I don’t understand girl talk, but those of us providers using Epic (Kaiser for example) are doing at least 99% order entry; in my case it’s 100%. The only exceptions in our organization is for super emergency verbal orders during codes where the doc can’t get to a computer, and even there it is frowned upon. Our prescribing is 100% electronic for normal Kaiser patient prescriptions not requiring written (the former ‘triplicates’  such as morphine, Ritalin). I write handwritten prescriptions only for non-Kaiser patients who wish to fill their meds elsewhere and even then, I enter these electronically into the EMR to keep our record complete.”

From Outta Touch: “Re: Latest meaningful use guidelines. In the last few days, I’ve asked a few doctor acquaintances about their impressions on the latest proposed meaningful use definitions and certification guidelines. Most have simply given me a blank stare, asking what I was talking about. Am I running with the wrong crowd or is the average doctor just not interested?” My guess is both. Who wants to hang out with doctors that can’t talk techie? Give me a Dr. Alexander or Dr. Diamond any day. And, I suspect that most doctors are more concerned with practicing medicine and getting paid then they are with dealing with the minutiae. Most practices have at least one doctor or an administrator who is more interested in following the specifics. Plenty of doctors are happy to defer to the “experts” until they are handed a tablet and told to enter a prescription.

From Jabez William Clay: “Re: draft rules on the EHR incentive plan. Have you guys seen this?” The CSC study that indicates US hospitals are only halfway ready to qualifying ARRA payments. In fact, only two-third of hospitals have identified gaps in their current systems. A quarter of the 58 hospitals think they meet at least 70% of the readiness criteria.  

From Felice Fontanta” “Re: ARRA questions. Thanks for your analysis! Very helpful. A few questions I haven’t seen answers to yet: How and when are the funds going to be disbursed? Say you demonstrate MU in the 1/1/2011 – 3/31/2011 time period, when and how will you be paid your $18k? And,  In terms of qualifying docs, is the Medicare program restricted to Medicare providers? So a pediatrician would not be eligible for any funds unless they have a significant Medicaid panel?” The legislation says that incentive payments be disbursed in a single consolidated payment or in periodic installments, as the Secretary may specify. However, the recommendation is for a single lump payment “as soon as we ascertain” meaningful use for the applicable reporting period. Regarding participation in the Medicare incentive program, it is restricted to Medicare providers. Pediatricians can participate in the Medicaid program if at least 20% of their patient volume is Medicaid.

Mr. H and I have had multiple questions posed to us regarding the latest certification and meaningful use recommendations. We don’t claim to be experts, but we are happy to try to get clarification on certain points if we can. Here are a few FAQs that we have gathered from readers, this week’s HIMSS webinar, and the CMS website:

Q: To count as CPOE, must the provider personally (hands on keyboard) enter the order, or may physical entry of the order, under the provider’s direction, be done by other staff?

A:  The reg states “directly”.

Q: Our pathologists are employed by a clinic and physically work in a clinic. Do they qualify as eligible Medicare outpatient providers?

A: Depends on whether the clinic or the hospital provides the facilities or the equipment.

Q: Is an eligible hospital is only an acute care facility or does it include other types of facilities, such as rehabilitation facilities?

A: CMS uses the "CCN" – the CMS certification number assigned to each hospital – to assess whether or not a hospital is eligible.

Q: If a hospital ER is using CPOE for all orders, does it qualify for the 10% of CPOE for a hospital?

A: The ER is counted as outpatient, so no, it will not fulfill the 10% CPOE requirement for an inpatient facility. (HIMSS waffled a bit on this during their webinar but finally came to this conclusion.)

Q: On the hospital side, must the physician enter the CPOE order directly? Or may they have their MA do the entry under their authority?

A: The reg states "directly".

Q: If only 10% of the hospital’s staff is using the certified system, and the rest are still paper-based, would this satisfy the CPOE requirement?

A: The requirement is that 10% of all orders be entered by CPOE.

Q: Do State Mental Health Hospitals qualify for incentive payment? What about long term care providers such as nursing homes?

A:  No. The following types of institutional providers are eligible for incentive payments under Medicare and/or Medicaid provided they meet the applicable criteria. Under Medicare, institutional providers eligible for the EHR incentive payments include “hospitals" as defined under section 1886(d) of the Social Security Act and critical access hospitals. Under Medicaid, these institutional providers are acute care hospitals and children’s hospitals.

Q: If you are a provider or hospital and not a meaningful EHR user, when do the penalties kick in?

A: Starting in calendar year 2015 for physicians and FY2015 for hospitals. At that time, CMS will begin to reduce Medicare Market Basket adjustments. There are no payment adjustments associated with the Medicaid provisions.

Q: How will the public know who has received incentive payments under the Recovery Act?

A: CMS will post the names of those receiving Medicare incentives online. The list will include the elements identified in the Recovery Act: name, business addresses, and business phone number of all Medicare eligible professionals and hospitals who received incentive payments under the Recovery Act. There is no such requirement for CMS to publish the names of those receiving Medicaid incentive payments,though States may opt do so.

That last fun fact was Mr. H’s favorite, by the way. Surely it will be a boon to telemarketers who will have all the information required to pounce on the nouveau riche doctors.

SCI Solutions launches Schedule Maximizer (v32) which includes e-mail appointment reminders, expanded portal functionality, and several new revenue cycle reports.

An Arkansas doctor is indicted for planting a bomb that critically injured the chairman of the Arkansas Medical Board last February. Dr. Randeep Singh Mann, who had been previously penalized by the Arkansas Medical Board for overprescribing medication, was charged with planting a car bomb that left the board chairman with blindness on one eye, damaged hearing, and several broken bones. Mann was already facing federal weapons charges for possessing unregistered machine guns and explosives that are permitted only for military use.

Wake Forest University Baptist Medical Center (NC) selects QuadraMed’s Enterprise Scheduling for scheduling hospital ancillary procedures.

Allscripts strikes a deal with CVS Caremark to migrate thousands of users from the proprietary CVS iScribe e-prescribing tool to Allscripts e-prescribing.

Surgical Information Systems picks up an endorsement from the American Hospital Association for its surgery scheduling system.

Our favorite pink pants-wearing friends at Voalte say their Voalte One iPhone application is now generally available, following a successful pilot program at Sarasota Memorial Hospital (FL).

CHIME raises some concerns about the newly released meaningful use regulations, particularly with the short timeline for hospitals to implement EHRs. They believe that the 2014 deadline for hospitals and EPs to meet Stage 3 criteria is too soon. CHIME also says the extensive reporting requirements will be burdensome for hospitals. And, CHIME points out that since hospital-based physicians aren’t eligible to receive stimulus funds, it may create a disincentive for health systems to invest in ambulatory EMRs. To that last point, I don’t quite agree, since hospitals will need the physicians to have EMRs to meet interoperability requirements.

E-mail Inga.

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Lawson Software announced this afternoon that it will acquire integration vendor Healthvision and its parent company, Quovadx Holdings, Inc. for $160 million. The all-cash transaction is expected to close later this month.

Lawson said it expects to use Healthvision’s Cloverleaf technology, used in 33% of North American hospitals, to connect multiple source systems and help providers comply with interoperability requirements. Healthvision also offers a Health Information Exchange platform and MediSuite, a clinical applications suite marketed in Canada.

HIStalk contact Thomas Servo reported on December 11 that Healthvision’s owner, Battery Ventures, would announce a sale of the company around New Year’s.

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Glen Tullman’s 10 for ‘10: Top 10 Healthcare IT Trends for 2010
By Glen Tullman

1. 2010 Will Be the “Year of the EHR”

We are at the beginning of the fastest transformation of a major sector of our economy in the history of the United States. The American Recovery and Reinvestment Act has provided billions in incentives to encourage adoption and “meaningful use” of Electronic Health Records. Given the time-stamped nature of the program, we can expect to see a dramatic increase in EHR adoption. Physician groups recognize the need to deploy an EHR now to be ready to demonstrate “meaningful use” by 2011, when the ARRA incentive payments kick in.

With CMS issuing the requirements for an EHR to qualify for meaningful use, many physician groups that were sitting on the sidelines will feel more comfortable getting their EHR initiative underway. It is clear that 2010 will be the “Year of the EHR”, not only because of the rapid rise in adoption rates, but more so because of the positive impact that this technology will have on how patient care is delivered.

You will continue to see two different approaches to acquiring EHRs. The first are investments by physician groups focused on creating efficiency in their practice and collecting the stimulus incentive. The second are community-based decisions where hospitals and health systems invest on behalf of their owned and affiliated physicians, with an eye toward referrals and being “easy to do business with.”

The most recent example is North Shore Long Island Jewish Health System with their program to connect approximately 7,000 affiliated physicians. In 2010, many more health systems will realize the benefit of leveraging the ARRA incentives and the Stark Safe Harbor to help build stronger connections with affiliated physicians in their communities.

2. Not “One System” . . . “One Patient Record”

The old thinking that you need the same system across your hospitals and ambulatory providers will give way to a new way of thinking. As more physicians automate and connect, the large IDNs, academic medical groups, and other integrated systems will put less emphasis on a single IT solution and more emphasis on connecting existing systems to build One Patient Record. This will enable caregivers to access a comprehensive view of all data available about a patient from any location within or outside of the system. Clearly, many physicians already have systems installed in their practices, so establishing a connection to these existing practices will be as important as the rollout and connection to new practices. Organizations that think strategically about this endpoint will find themselves better positioned to take advantage of new opportunities that will emerge in the market.

3. Communities Will Connect

Healthcare is still a local phenomenon. Depending on the estimates you use, 90 percent of all patient care is provided within 30 miles of a patient’s home. Given its local nature, the first priority must be to electronically connect caregivers across a community, leading at some point in the future to a national health IT infrastructure. In 2010 we’ll see more health systems banding together with others in their communities to create local health information exchanges as well as other approaches that enable One Patient Record across a region. A local network is easier to manage and already proving successful with HIEs like the Transforming Healthcare in Connecticut Communities (THICC), which connects that state’s top 20 hospital systems with each other and with major physician groups.

4. Service and Support Will Become Competitive Differentiators

One of the key reasons ARRA was passed was to create jobs. According the White House, over 50,000 will come from the healthcare information technology sector. Allscripts will hire hundreds of new employees, not only to help our clients deploy the technology, but also to assist them in using it in a meaningful way and optimizing the technology to deliver quality care. Clearly there will be a premium on process redesign and consulting services. Those who have the resources and can deliver these services will be rewarded.

5. Innovation Will Begin to Drive Sales and Use of EHRs

Innovation will become a differentiator and drive adoption as it has in other industries. The ability to access your EHR via your phone (iPhone, BlackBerry, Windows Mobile, etc), use a kiosk to register, check labs at home via a portal, and pay your bill via Quicken Health are all examples of physician/patient-focused innovations that deliver simplicity, customer service, and also take out cost. Using advanced technology from outside the four walls of healthcare is symbolic of the transformation of healthcare into more of a consumer-driven business.

6. Revenue Cycle Management Will Become Integrated

Given the need to focus on new EHRs, most physician groups will choose not to replace their existing practice management systems. As a result, in 2010 the larger hospital vendors and EHR/Practice Management vendors will leverage their large installed bases to aggressively move into Revenue Cycle Management. Early leaders in the standalone RCM space will see growth slow and those firms that can integrate RCM with widely-used EHR and PM will dominate.

7. Management Reporting Will Transition to Actionable, Quality Patient & Population Management

As information becomes more available across bigger networks, more emphasis will be placed on developing proactive quality feedback rather than simply reporting. The focus will be on changing caregiver behavior by driving actionable feedback to providers at the point of care, not after the fact. This is the first step toward the development of true “information systems”.

8. Payers, PBMs, and Pharmacies Will Use EHRs to Deliver Information

As the market for Electronic Health Records heats up, we’ll begin to see payers, pharmacy benefit managers, and pharmacy chains partnering with e-prescribing and EHR solutions to efficiently deliver new kinds of information on best practices, care plans, and additional clinical guidance to physicians as they begin to directly tie compensation to results. We have already seen this with current pay-for-performance programs and it is likely a preview of things to come.

Changing physician behavior at the point of care has been the Holy Grail of healthcare. Now the “cable system and set-top boxes” will finally be in place to do just that. Think of this as a formulary, but with a focus on something beyond just the cost of a medication or which one to choose .. but rather an entire plan of care for the patient.

9. Intuitive is Best

Whether it’s ease of use or ease of deployment, “easy” is a must in 2010. We’ll see the customer experience transformed in both areas with an emphasis on intuitive, easy-to-install, easy-to-learn systems (think the difference between your average cell phone and the iPhone).

10. Software as a Service

Software as a service has been advertised as “the” solution for healthcare. The reality is that SaaS is a great option and will be one of a number of solutions. The fact is that physicians don’t really care whether the Electronic Health Record and Practice Management Systems, along with other solutions, are hosted, client-server, or SAAS — they just want them to be easy to access and use. And, many physicians think software as a service is synonymous with monthly payments, like leasing a car. That is a critical and appealing element. The answer is that SaaS will need to be a part of a vendor’s solution set.

As noted, we are watching and participating in a major economic transformation, one that is being driven from all sides. What we know is that while Electronic Health Records are not sufficient by themselves to solve the healthcare crisis in America, they are a necessary component of any solution that drives safer, higher quality healthcare provided cost effectively.

2010 will be the “Year of the EHR” and our current healthcare system of disconnected silos will begin the transition into a connected system of health.

Glen Tullman is CEO of Allscripts.

Major Flaw In Claims Operations Model Found Responsible For Payer Overpayments
By Stephen Ambrose

As part of the insurance industry, subrogation has at times been a bit of a dirty word to policyholders and personal injury attorneys, but a necessity to payers. Known as “the great balancer”, the "right of subrogation" means that a (health) insurer may choose to take action to recover a calculated amount from a claim paid to a policyholder if the loss was caused by a third party.

A major flaw identified within today’s subrogation model is the inability for a payer or their outsourced vendor to accurately identify only those times when their policyholder has pursued and successfully settled a third-party claim. There exists no public database of third-party liability claim filings and the use of court records only applies to less than ten percent of all claims anyway.

Over many years, the most widely utilized method for identifying policyholders who are involved in injury claims is through an indirect identification method of data mining patient claims via diagnostic codes, billed procedures, doctor type, and accident / injury check boxes. Such flagged information generally leads to form letters sent to the patient, who is supposed to complete and return them, both timely and accurately, to the payer or their outsourced claims vendor.

This ubiquitous system of TPL claim involvement has suffered from a number of shortfalls including patient accuracy, inability of complete follow-up, use of indirect identifying factors, timeliness of detection, as well as missing claims filed for chronic illness and malpractice. These factors greatly limit a payer’s knowledge of wasteful injury claim overpayments and make identification of TPL claims more of a “good-guessing” game.  Additionally, the current system allows outsourced claims vendors to demand large collection fees from recoveries made on behalf of their payer clients.

A new model of injury claim identification offers health payers greatly increased TPL claim knowledge while addressing waste reduction and delivering more cost-effective operations to the payer community. Known as Collaborative Subrogation, or Subrogation 2.0, this Web-based technology connects patient release-of-information (ROI) requests, made of the provider with a health payers claim department.

The innovation of better identifying TPL claims stems from limitations, inherent within the use of claim forms and electronic claims data, submitted by providers in their billing. Chiefly noted and now improved upon is the understanding that injury claims are not just “accidents”, but rather any claim involving, in part, the use of medical billings to substantiate value. This opens up areas of medical malpractice, chronic illness, product liability, and other non-auto liabilities.

Collaborative Subrogation is employed as a lower-cost, Web-based operation, where health payers use an online search engine to match provider-submitted TPL data. The approach is one of layering on a new model, in conjunction with existing subrogation software and outsourced vendors. 

Stephen Ambrose is executive director of SubroShare.

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From HIPPAcrates: “Re: notice of proposed rule-making. The summary spreadsheet is very useful, thanks. I just found this error in the government document and hope it’s not an omen.” Even the feds can’t spell HIPAA with the full wording right in front of them. Surely I’m not the only one who knows how to modify Word’s dictionary to catch gaffes like this.

From Dean: “Re: MU. Was just reviewing your summary of the meaningful use doc. Very nice work, even better than Halamka’s at geekdoctor, of course you probably don’t have a Kevlar suit or a handy folding bike! I think a great reader poll would be to ask whether people with CPOE installed have implemented drug-drug or drug-allergy interactions. My bet is that most people who have tried this have turned it off. I think this is a terrible requirement. Current drug-drug interaction checkers are way too sensitive and generate way too many false positives. I’ve reviewed some papers that reported over 25% of medication orders generated alerts. That is unacceptable in my book.” Maybe he needs the Kevlar suit because of bike-induced thigh chafing. The problems with clinical warnings are:

• Practitioners universally believe they don’t personally need them, but they think they should be turned on for their less-capable peers.
• Duplicate drug checking throws out a ton of false alarms and is useless 99% of the time.
• Allergies are often entered without the type, severity, and onset of the reaction, meaning that everybody’s “makes my stomach hurt” allergies trigger the Cry Wolf syndrome and allergy warnings are overridden 95% of the time.
• Users aren’t always given the tools to modify the warnings to suit their needs, such as expanding the by-the-book dose ranges and setting their own ranges based on experience.
• The few vendors of clinical data rigidly adhere to conservative manufacturer data and the advice of their overly cautious lawyers in overweighting accuracy at the expense of usefulness.
• Systems don’t allow personalizing the alerts, so while the family doc might benefit from a renal warning for a particular drug, it’s a sure bet that the nephrologist who gets the exact same warning surely won’t.
• Of all these, the last one could be easily implemented, other than the fact that data vendors, hospitals, and IT people don’t trust their docs to turn off warnings that they don’t value (a rather condescending “computer knows best” outlook).

From Crumbgirl: “Re: GE Centricity Enterprise. You will hear big news out of Indiana if you have not already!” I haven’t heard anything so far.

From Infodoc: “Re: your MU summary. Thought you’d like to know that the Advisory Board referenced your Meaningful Use summary in their Meaningful Use briefing published Monday. HIStalk is becoming a good example of a disruptive technology.” Honestly, all it took was a couple of hours of skimming the documents to pick out the relevant parts. I think the trick is that, as a nerd, I was the only pseudo-journalist sitting home with nothing better to do right before New Year’s. I do appreciate the nice comments about it, though. And I do like to disrupt whenever possible.

From Bob in Accounting: “Re: Epic’s newsletter list for customers to prepare for meaningful use.” My 99% condensed summary of what it said: (a) upgrade; (b) finish rollouts; (c) implement e-prescribing; (d) install MyChart; and (e) install Care Everywhere for data sharing.

From Chris: “Re: EHR. First off, I really appreciate your ongoing coverage of all things health IT related. As I’ve been reading your site and others, I’m failing to identify a distinction between EMR and EHR in terms of the ARRA/HITECH legislation, ‘meaningful use’ and certification criteria. Is there a true distinction between the two? I feel as though I see them used almost interchangeably. Thank you for your insights and clarification!” Theoretically, HITECH applies only to EHRs since the products must be certified and, by definition, all certified EMRs are actually EHRs since they are interoperable. I have a philosophical disagreement with that loose terminology, however, probably because vendors have latched onto it for marketing purposes for the same old products that pre-dated the EHR term. EMRs are used to treat patients. EHRs are used to manage health and community wellness, including collecting data from a much wider net than just doctors and hospitals. I’ll stand by my crotchety proclamation: I don’t care what vendors say, none of them have an EHR. That’s why I always call them EMRs unless I’m quoting someone else.

From Lacey Underall: “Re: Humana. A dermatologist takes them to small claims court. Way to go!” I love this. A dermatologist, tired of Humana not paying his claims for years ($120K total) but unwilling to pay a lawyer 40% to go after them, takes the insurer to small claims court by bundling the claims into packages that fall within the $5,000 limit. Humana’s lawyer is surprised, given that he has never been to small claims court. The doctor tells him, “This is the first of 25 claims we’ll be submitting … Humana could save those $350 filing fees times 25 and his time and fees times 25 if they would just process our claims." Even though the tactic hasn’t worked for other doctors because Humana got their case moved to federal court, it did this time: Humana coughed up $80K and the doctor is hoping to collect the rest of what they owe him before their next court date.

I’ll be charitable in characterizing the post-holiday response to my HISsies nominations plea as modest. The voting that will follow next week or so is going to be pretty dull if nobody nominates their best and worst vendor, industry figure of the year, etc. It takes just a minute or two and validates my pathetic existence, so humor me.

Former Cerner sales VP Mike Supple joins recruiting firm B.E. Smith as SVP of business development.

Ten-provider Orthopaedic Center of Southern Illinois chooses the SRSsoft EMR after its free trial, saying the docs are saving 30-60 minutes each per day.

Madrigal sent me an e-mail announcing Meditech’s merging of PtCT into its regular organization, which I reported last week. The company has posted the announcement and a company Q&A.

Universal Health Services chooses Cerner and its Remote Hosting Option for its 24 hospitals. The modules weren’t stated (red flag – did they commit to all of Millennium or just a few modules?), but per FlimFlam Man, they will replace Opus Healthcare, Siemens pharmacy and ADT, RMS, and others.

Cerner also announces a deal in which Tenet will increase its Millennium use from 14 hospitals to 47. Shares were up 6% today, hitting a 52-week high and raising the market cap to $7.29 billion and nearly making Neal Patterson a hemi-billionaire (he’s got $496 million worth).

Revenue cycle vendor Passport Health Communications names David Whitt CFO.

Jobs: Eclipsys Systems Engineers/DBAs, Anesthesia Product Specialist, Clinical Implementation Specialist.

Former Eclipsys SVP Tom Dunn joins QuadraMed as SVP of sales and marketing.

Tennessee gets $2.7 million in stimulus money for a project that CMS says will improve patient outcomes. Reading further: the money will be spent on “planning activities”, like doing a study to figure out why doctors won’t use EMRs.

Three Montana provider organizations go live on the beta version of EMix, a vendor-neutral cloud computing platform from DR Systems for sharing radiology images and reports. They claim it’s as easy to use as e-mail. The company pitches charging patients to manage their images online, for which it takes a cut of the revenue.

Newham University Hospital NHS Trust says its Cerner system is saving it money and reduced patient wait times. Patients in the same area are using Philips home monitoring diagnostic equipment in a test for NHS.

The owners of paging and communications systems vendor Amcom Software sell controlling interest to a partnership of a private equity firm and a venture capital firm. The private equity firm says they’ll probably sell it at some point.

I think I missed this when it was announced: Epocrates names Geoffrey Rutledge MD PhD, formerly of Wellsphere, as CMO/EVP of product development.

Google announces its Nexus One Android-powered cell phone. It seems anti-climactic, hardly an iPhone-killer. Too bad it didn’t involve cheap cell service, although maybe the master plan is to serve up phone ads that offer a lower cost all around.

Odd lawsuit: a woman sues Walgreens, claiming that a store employee leaving the bathroom knocked her down with the door. She wants medical costs, damages and “other sums to compensate her for her injuries,” claiming that Walgreens should have instructed employees to look before opening the door, for failing to tell her to move, and for failing to equip the door with a warning device.

E-mail me.

HERtalk by Inga

In yesterday’s HIStalk Practice, I touched on a few nuggets of information about the latest EHR meaningful use recommendations. I might add it is worth a read because there are some points Mr. H and I haven’t seen covered elsewhere (and while you are there, sign up for the e-mail updates.) One particularly confusing item relates to the timeline for proving meaningful EHR use in order to earn incentive dollars. I tried to summarize a bit on the timeline for getting money, but because it is particularly confusing, I decided a graphic might help (click it to enlarge).

For those that want to follow along at home, this information is found around pages 23 to 31 in the larger, 557-page document. As I interpret things, to qualify for stimulus money during 2011, a hospital or eligible professional (EP) must demonstrate meaningful use of EHR for “any 90-day period within the first payment year.” The earliest possible start date for that 90-day reporting reporting will likely be January 1, 2011. The latest day to start a 90-day reporting period and still qualify for 2011 money is October 1, 2011. After earning incentive money in the first year, entities will be required to prove meaningful EHR use for a full year, starting on January 1, in order to qualify for second-year funds. Thus, if an entity qualified any time during 2011, it would have to continue to prove that it used its EHR meaningfully from January 1, 2012 to December 31, 2012 in order to qualify for the 2012 incentive funds. And, if the entity doesn’t try to qualify for the first time until sometime in 2012, then it must prove meaningful use for the full year beginning January 1, 2013, to get the second-year funds. And so forth. If someone interpreted things differently (or can explain this better), please advise.

athenahealth signs a deal with Caritas Christi Health Care to offer athenaclinicals to 500 employed providers and 1,200 affiliates. CIO Todd Rothenhaus, MD, the Caritas SVP/CIO, confirmed to me that Caritas will offer athena and eClinicalWorks, which was announced previously.

I was talking EMRs with a girlfriend at lunch today (isn’t that what most gal pals do?) and we agreed that we can’t think of any providers that currently enter 80% of their orders themselves. We thought we might come up with a doctor who uses e-prescribing 75% of the time (but we thought of lots of reasons why a patient and provider might prefer the paper prescription). We couldn’t come up with a single small office group that is currently capable of sending patient data electronically to other providers (often times because the receiver can’t accept the data). The one bright spot is that the recommendations clearly state that “documenting a progress note for each encounter” is not a requirement for proving meaningful use. Otherwise, the mountain is high.

Ridiculously sad, any way you look at it. An unemployed, unmarried 35-year-old mother of nine sues three doctors and two nurses after being sterilized against her will. The mom was delivering baby number nine via a planned C-section and and asked for an IUD to be implanted immediately after delivery. Instead, the doctors performed a tubal ligation.

Trinity Health (MI) buys 1,200 bundled EHR/EPM software licenses from NextGen, increasing its rollout to all employed providers in its network.

Happy 2010, by the way. The ever-generous Mr. H gave me a bit of time off during the holidays, but now I am back at it. Mr. H and I have each waded through pieces of the latest meaningful use documents in hopes of becoming industry experts. Unfortunately, at least in my case, more wading is required. I was hoping there might be some clarification about what exactly a “certified EHR technology” is. Of course “CCHIT” is never mentioned anywhere, even though it seems a given that CCHIT will be a requirement since they are the only certifying body out there. Why can’t the Secretary or the ONC come right out and say it’s CCHIT 200x for now? That way buyers know what is required and vendors know what they need to do if they want to participate.

Send Inga meaningful words.

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