From Maeby Fünke: “Re: Epic. I hear it’s telling new customers they don’t need to worry about staffing or hiring consultants — they are providing them with a test they can administer to college grads to determine if they have the aptitude for this type of work. Does anyone know if it’s something they created or bought commercially?” If anyone has a copy, I’d be interested in seeing it just for fun.

From Expert Witness: “Re: UPMC. Doctors and nurses do not speak to patients any more. All done by clicks, cut, and paste. If the computer says it’s right, it must be.” The family of a deceased UPMC Passavant patient files suit against the hospital and her doctors, claiming her home med methotrexate was incorrectly entered into her medical history as taken daily instead of weekly. Nobody caught the mistake when she was transferred to a specialty care center, so she was given the drug daily for 16 days until she died. If that’s found to be true, the hospital will learn a harsh lesson about the importance of medication reconciliation, not to mention that surely ample warnings were issued by its clinical systems (Cerner, I assume). It’s not a new problem.

From GenX’er: “Re: Ingenix. Former Misys VP Art Glasgow was named CTO of Ingenix. The announcement says he’s consolidating IT across the business. Big job.” Verified. He was promoted from SVP/GM of health information networks at Ingenix, where he’s worked since November 2008 after stepping down as Payerpath GM for Misys.

From Down Under Deepwater Horizon: “Re: Myki. Myki, my mates, is the failing, money-devouring ticketing system for public transport in Victoria, which has blown A$ Billion.” Hospitals in Victoria, Australia complain about the government’s $280 million (US) HealthSMART system, four years late and way over budget like the Myki system DUDH mentioned. Hospitals are being stuck with the tab for HealthSMART, which I mentioned in 2008 when they scrapped their first attempt after bring up zero hospitals on Cerner Millennium. It’s supposed to connect hospitals and provide e-prescribing capability. The government refuses to give a completion date or confirm the amounts that hospitals are being charged.

Listening: Broken Bells, new melodic indie rock from a couple of guys from Danger Mouse and The Shins. Also, my old favorites, The Vincent Black Shadow.

Chris Longhurst, MD is named CMIO of Lucile Packard Children’s Hospital at Stanford. 

An SIS survey finds that 92% of hospital executives rate the success of their perioperative departments as important or extremely important to overall hospital success, with quality and financial performance being their key concerns.

Vermont Information Technology Leaders names athenahealth as a Preferred EHR Partner.

Welcome to new HIStalk Gold Sponsor Diligence Analytics. Led by President and Chief Research Officer Wendy Shellhorn, PhD, MPH, MEd, the Tampa, FL-based company provides professionally conducted research and analysis services to healthcare and HIT. That includes surveys and data analysis to help clients make smart business decisions, bridging the gap between small businesses and their larger competitors. We thank Diligence Analytics for choosing to support HIStalk after what I’m pretty sure was a thorough analysis.

Inga’s taking a much-deserved break to bronze her loveliness and rest her creative mind in a tropical location, but she must be thinking about HIStalk since we’ve exchanged more e-mails today than when she’s on the job. She’s fussing, though: she’s trying to score an iPhone 4 online and can’t get through. It’s not just her, apparently.

Cooper University Hospital (NJ) goes live with iSirona’s software-based solution to integrate patient information from medical devices with its electronic medical record. Cooper VP/CIO Mike Sinno will talk about the project in a June 30 Webinar.

GE Healthcare announces Centricity Advance, an SaaS solution for small practices that includes PM, EMR, and a patient portal. It must be a pretty big deal: among the “thought leaders” discussing EMRs Tuesday night at the National Press Club with GE were Newt Gingrich and Peter Basch, MD.

Quality IT Partners releases a new white paper, What Every Healthcare Organization Should Know about Deploying IT when Planning and Designing a New Healthcare Facility.

CareTech Solutions, owned by Compuware, Oakwood Healthcare System, and Detroit Medical Center, names two DMC executives to its board: president and CEO Michael Duggan and EVP/CFO Jay Rising. DMC just signed an agreement to be purchased by for-profit Vanguard Health Systems, clearing the way for the required legal reviews.

 
Photo: Cpl. Tyler J. Hlavac, USMC

Corpsmen with the 4th Marine Logistics Group are trained to use the AHLTA EMR on a Symbol MC70 mobile device in preparation for deployment to Afghanistan. They will use it to upload combat casualty information to AHLTA’s clinical data repository and to access treatment guidelines for biological, chemical, and radiation attacks.

eClinicalWorks buys 100,000 square feet of office space in Westborough, MA, making room for the 100-200 employees it will add to its current 1,100-employee headcount in the next year. The company’s revenue exceeded $100 million in 2009.

Roadside Medical, a health services company for truckers, will open three new clinics, all of which will feature iPads, telemedicine, and an EMR. Some snooping uncovered their technology partner: TeleMedExperts, which uses the TotusMedica.US PM/EMR.

Daniel Barchi, SVP/CIO of Carilion Health System (VA), e-mailed to let me know about its Epic go-live. “We have an incredible group of IT and clinical folks who just wrapped up one of the most aggressive simultaneous hospital and physician practice EMR implementation in the nation. Without hiring any external consulting company, this amazing group of folks simultaneously over two years converted eight hospitals and more than 100 physician practices to a single EMR for all clinical documentation, finances, and orders.” The photos above are from the last hospital go-live at Bedford Memorial Hospital, 23 months after the first big-bang go-live at 800-bed Carilion Medical Center. They trained 8,000 users, converted from nine EMRs plus paper, and hit 92% CPOE adoption. Nice work.

DIVURGENT Healthcare Advisors is offering a webinar this Friday called Meaningful Use Monitor and Gap Analysis Tool.

Nuance announces Enterprise Turbo Speech 8.1, the background speech recognition component of its Dictaphone Enterprise Speech System.

HHS will convene a Consumer Choice Technology Hearing at the Grand Hyatt Hotel in Washington, DC on June 29 from 8:00 a.m. until 5:00 p.m. I don’t have a link, but it’s a demonstration of several privacy technologies by the Privacy and Security Tiger Team of the HIT Policy Committee. Deborah Peel, MD and David Kibbe, MD are among the panelists who will discuss the demos.

Mass layoffs by hospitals are affecting more workers than at any time except right after Hurricane Katrina-induced closings.

iSoft reassures investors after its share price drops by half in the last couple of weeks, saying any inferences that its Northern Cluster NPfIT contract is in jeopardy are incorrect. That’s a three-month share price chart above.

Continua Health Alliance is creating a library of open source utilities that will help mobile health developers create applications for personal health devices and health records.

Varian Medical will move its employee applications from BlackBerry to the iPhone, saying iPhone OS 4.0’s security and management capabilities appear to be adequate.

A study finds that doctors will use even unproven technology as long as they get paid to do so. Mentioned specifically is computer-aided breast cancer detection, for which the manufacturer successfully lobbied Congress to mandate Medicare coverage despite lack of proven superiority and the large number of false positives it issues.

Greenway launches BlogEHR, which features the company’s executives writing about healthcare IT.

Cerner earns an award for encouraging healthy lifestyles for its employees. Except when Neal had the fitness center locked down during working hours, anyway.

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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!

The EHR Manifesto
By Recently RIFed

A spectre is haunting America — the spectre of Meaningful Use. All the powers of traditional vendors have entered into a holy alliance to exorcise this spectre: Executive Office and ONC, Allscripts and Eclipsys, Epic, Cerner, McKesson, and Meditech.

Where is the software vendor that has not been decried as unusable by its opponents in power? Where is the software vendor that has not hurled back the branding reproach of unusable software, against the more integrated vendors, as well as against its reactionary adversaries? (My apologies to Karl and Friedrich).

10 Point Program to Improve EHR software

1. Less configurable. The Demotivators® said it best “When people are free to do as they please, they usually imitate each other”. Every hospital or physician practice is unique — they uniquely solve the exact same problems everyone else is facing.
2. Better designed. End-user input and UI design should be part of the specs, not the pilot.
3. Customer-prioritized enhancements. Fifty percent vendor-driven (sales and demo feedback, regulatory requirements, infrastructure, etc.), 50% prioritized by customers. Yearly process, projects grouped to be equal number of hours, one vote per licensed bed, top x projects will be roadmapped to fill 50% time.
4. Consensus-driven standard content and configuration. Vendor designed, large group customer editing — majority rules, everyone uses.
5. Remote hosted. 99.999% uptime, capacity and response time are key requirements.
6. Rapid install. If you’ve followed 1-5, training the end-users should be the most time-intensive phase of the implementation.
7. Qualified buyers. We’ll sell to you if you agree to: follow our standard workflows, use our standard build and participate (end-user input, content design, and prioritization). Must agree to mandate adoption! Better to support 50 involved, committed customers than 100 unhappy, non-standard, partially-implemented, low-adoption targets.
8. Equitable pricing. Low upfront, subscription-based. Every customer pays the same, scaled by size or volume.
9. Play nice with other vendors. Integration > Interfacing > Interoperating.
10. Record portability. Remove vendor lock-in. The intersection of the NHIN and CCDs with the market transitioning to replacement will make this a necessity. You know it will be mandated eventually.

I can’t think of a single vendor that would get a passing grade on my 10-point scale (even the industry darling would only receive a 40%). But please, prove me wrong and post comments. As I review my RIF package and dust off my resume, I’d love to be proven wrong (and find out they’re hiring) …

Personally, I’d love to see a new breed of vendors emerge. Maybe someone will submit a FOIA request and hire a team of developers and clinicians to polish and fill in missing functionality. Maybe even someone willing to follow my manifesto and explore a co-op or non-profit corporate structure. Forget the socialization of medicine, let’s socialize the vendors. Until that happens, I’ll continue to remain anonymous and try to work from within.

One of the challenges that most EHR systems will have in satisfying the government’s Meaningful Use requirements will be to establish connectivity and interoperability with other providers’ systems and ancillary services. Disparate data from multiple providers must come together as a more complete patient-centric record to achieve this goal, and not all providers are ready for it. These and other business and logistical issues are some of the challenges that health information exchanges (HIEs) have encountered.

One solution is to use technology to leverage data generated through existing business relationships. This can be done through a Web-based, patient-centric “Integrated Health Record” (IHR) that integrates data from multiple sources and institutions. An IHR provides up-to-date, community-wide, patient-centric data such as lab and imaging orders and results, incorporating both hospital and reference labs.

It also can be used for ordering prescription drugs and leverage the patient’s allergies, drug history, and even lab data to prevent adverse events. Physicians can even follow the inpatient encounters for patients admitted in connected hospitals, along with outpatient data, from anywhere over the Web.

IHRs also improve the ability for patient care teams — physicians who must collaborate to provide comprehensive care — to coordinate care and share patient records. Today, such clinical information between referring physicians is shared via fax, mail, or phone. Even when practices have EHRs, they’re often unable to send key patient data electronically to other physicians who may be using different EHR systems.

The Meaningful Use criteria require such exchanges to occur using standards such as Continuity of Care Document (CCD) and the Continuity of Care Record (CCR), but few systems are capable of using such standards. That’s partly because EHRs aren’t designed for information exchange and also because, in the absence of HIEs, the transmittal of CCDs requires point-to-point interfaces. An IHR that already can create connections to multiple EHRs can act as a link to exchange CCDs or CCRs.

The IHR is not designed to replace EHRs or CPOE systems, but rather to collaborate with them to connect them with other information sources. In that sense, the IHR unifies and facilitates the patient-centric data exchange between various entities to realize the formation of HIEs. The IHR further facilitates the integration of data from multiple sources by normalizing data from disparate sources using standards specified in Meaningful Use, criteria such as LOINC for discrete lab data.

Rather than upfront investments in MPI and other expensive technologies, HIE pilots can greatly benefit from the use of technologies like the IHR. The IHR can not only serve as basic HIE, but facilitate HIE participation by providing key information where and when it’s needed on the front lines of patient care.

Ravi Sharma is president and CEO of 4medica.

Thoughts on Eclipsys-Allscripts
By Tim Elliott

The coming together of two heavyweights in the healthcare IT industry, Allscripts and Eclipsys, has the potential to open doors for their existing and future customers, third-party developers, and patients. There will be some challenges, too — including helping current customers integrate legacy Allscripts and Eclipsys systems alongside new modules — but this can be considered another opportunity for outside vendors whose technologies bridge the gaps between Eclipsys and Allscripts applications.

Detractors may be lampooning the Allscripts / Eclipsys “One network, one platform, one patient” slogan, but in truth, the merger does create a cohesive, cradle-to-grave care solution by uniting pre-acute, acute, and post-acute care information, as well as simplifying financial and performance management with non-clinical data.

The use of a common .NET technology stack offers the possibility of seamless integration and increased usability for clinicians and administrative staff. It also makes it easier for third-party software providers to deliver bolt-on solutions that further enhance Allscripts / Eclipsys offerings in physician practices, hospitals, home health, and other care environments. These external vendors will be crucial if Allscripts / Eclipsys is to succeed in bringing together previously disparate patient populations, which will require capturing and managing data from multiple sources in a centralized manner.

Tim Elliott is CEO of Access.

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From Nikki Sevven: “Re: Eclipsys. I’ve talked to a lot of clients and they all think the Allscripts acquisition is great. The turnover in management at Eclipsys has been a big concern and their perception is that Allscripts has better leadership and execution. Also, the lack of a good ambulatory product has taken Eclipsys off a lot of hospital short lists. Eclipsys users believe the inpatient products are good, but the company has been lacking an end-to-end strategy that could compete with Epic.” Despite my initial cynicism and concerns about product overlap, I’m starting to take cautious sips of Glen’s Kool-Aid after talking to some Eclipsys customers. Everybody knew that Eclipsys was struggling and someone would have to buy them eventually, so it’s not terrible news that it’s now and it’s Allscripts. The road is full of potholes, though, and Allscripts management will be tested while Wall Street watches intently to see if performance matches hype. There’s still a rumor that Microsoft will swoop in post-merger and buy the whole thing, which would not be good, but I wouldn’t worry about it yet. Eclipsys has some good products in Sunrise, the old EPSi, the old Bond Clinician, etc. but like Nikki says, its revolving door management has always been suspect and its execution clumsy. Any outcome was likely to have been painful to Eclipsys customers in some way, but this one’s probably the least so since Allscripts needs both the customer base and the products for its own success.

From Lars Poker: “Re: Allscripts. Glen pulled off one heck of a coup. He bought his company back and got Eclipsys in the bargain!” He sure did. Glen’s got some shrewd board room moves, which was evident in the equally complex and multi-player Allscripts-Misys merger. Everybody seems to miss that important point: deporting Misys will help Allscripts immensely. Another often-missed point: Epic was stifling the prospects of both companies since nobody does outpatient-inpatient integration better, so this was pretty much the only option on the table to develop a counterattack before hospitals lock in with their long-term dance partners. I still think it’s late in the HITECH game to be trying to create an Epic competitor, but we’ll see. I’ve said it before: Judy Faulkner was either darned lucky or darned smart to start Epic on the outpatient side and then move into inpatient, which the good old vendor boys had great fun with until she starting beating them like a drum.

From UKnowMe: “Re: HISEA. Do you know who the members of the Healthcare Information System Executive Association are?” I admit that I hadn’t heard of it. Some Googling turned up the fact that it’s 30 or so CIOs who meet twice a year for some unnamed purpose (whatever it is, I bet vendors are buying the drinks). Those whose names turned up include Marc Probst from Intermountain, Bert Reese from Sentara, and Bill Montgomery from HSHS. Maybe someone will tell me more.

From The PACS Designer: “Re: MeeGo. TPD has been using a Windows 7 netbook for awhile and noticed that a new application, MeeGo for netbooks, has been announced. MeeGo v1.1, whose development platform is specifically targeted toward netbooks, will be released in October and will include support for touch-based devices.”

Listening: Ride, British psych/guitar pop styled after My Bloody Valentine. Long defunct: they broke up the band in 1995, but it lives on in the digital promised land.

Rob Sumter is named COO/CIO of The Regional Medical Center at Memphis (TN). 

Inga was talking to an A-list CIO and big Allscripts customer about the merger news. She asked if he got a heads up from Allscripts. He said no — the first he heard of it was from HIStalk. Inga was amused, I was pleased.

Speaking of Allscripts, Chief Innovation Officer Stanley Crane dropped me a note in response to a reader’s question about the company’s remote access solutions. Stanley says Allscripts Remote covers several mobile devices, including iPhone, BlackBerry, iPad (just released this week), and Android (hitting the street in a couple of weeks). These connect to Allscripts Enterprise EHR and Professional EHR, with connections to MyWay and Misys EMR being tested now. They use the connection called UAI (University Application Integrator) that he and I talked about at length in our May 2007 interview, which I enjoyed enough to want to do it again (coming soon).

We heard that some Eclipsys customer CIOs and CMIOs convened a meeting last week with Allscripts to discuss integration of the two vendors’ products (they didn’t know about the acquisition, obviously, but talk about a timely thought!) I heard that Steve O’Neill, VP of IS at Hartford HealthCare, was there, so I asked him about it. They talked about using the open integration tools (UAI and Helios) to help hospitals with their integration challenges in creating a complete acute care and ambulatory solution that appears seamless to the user, with several of the hospitals there (including Steve’s) volunteering to be pilot sites. He was happy with the result, obviously even more so now that the acquisition has been announced.

Speaking of which, I asked Steve what he thought about the acquisition. He says Hartford is excited about the news and anxious to continue working with Allscripts on the integration. Obviously he likes that option much better than dumping Eclipsys and starting over. The hospital is also building an open source HIE using Misys Open Source Solutions (MOSS), which is another key corporate integration project. That’s a hugely important vote of confidence: Hartford has used Eclipsys Sunrise for years, and if I remember right, was the development site for the Premise throughput product that Eclipsys bought.

Congratulations to our CIO blogger par excellence Edward “Ed” Marx of Texas Health Resources, named by Texas Governor Rick Perry as chair of the Texas Health Services Authority Corporation. That group is coordinating development of an electronic health information infrastructure for the state.

Thanks to the folks at MedPlus, a new Platinum Sponsor of both HIStalk and HIStalk Practice. The Quest Diagnostics company offers innovative interoperability solutions that include the Centergy suite of integration solutions (community sharing of clinical data, including data exchange, ambulatory EHR, clinical portal, patient portal, and document management), ChartMaxx document management and imaging (2009 Best in KLAS in that category), and the Web-based Care360 suite that’s used by 70,000 practices, including modules for Labs & Meds, ePrescribing, EHR, and Mobile. Fun facts to know and tell: MedPlus software has connected 160,000 doctors, 100 EMR vendors, several big HIEs, 100 hospitals, 300,000 administrative users, and a total of over one million clinicians. As if that weren’t enough, they are now much-appreciated sponsors of a couple of marginally interesting blogs that I’m too modest to name, for which Inga and I thank them.

Here’s Aaron’s word cloud of the proposed Meaningful Use rule. I think the two biggest ones pretty much say it all.

I took some scorn from a couple of readers when I truthfully said that in the three hospital systems I’ve worked for that were choosing a clinical system, doctors and nurses didn’t get their top choice in any. The results of last week’s poll suggest that it’s not just me: around 38% of respondents say the medical staff and nurses have the most influence, but over 55% said IT or Finance are the primary decision-makers. New poll to your right: who will benefit most from the proposed acquisition of Eclipsys by Allscripts? I know we’re talking a lot about that, but acquisitions always make conversation (unless you work at either company and are sweating over your employment prospects, always an ugly by-product of corporate copulation).

I was chatting with an acquaintance from Telus Health Solutions, of which I’m rather a fan since its Oacis solution comes highly recommended by Frank Clark of MUSC (they use the physician portal and are rolling out a new Oacis Health Data Warehouse). Oacis is up to 200 sites now, but what I found interesting was that the company let customers convince them to create a high-availability option for its Oacis Clinical Data Repository. They did, but booked zero sales as a result: the base product requires no archiving steps and never goes down, so nobody felt the need to buy a specific HA version. I’d say that’s an expensive but effective testimonial.

Colchester East Hants Health Authority (Nova Scotia) uses Access Intelligent Forms Suite to barcode forms scanned into Meditech Scanning and Archiving, printing admissions forms packets and pre-filling the forms from Meditech.

University of Virginia Health System will switch its clinics to Epic in September, the first phase of its $122 million project. Inpatient goes up in March of next year.

The Clinical Pharmacology drug information database is now available for smart phones, with a free trial available.

Dr. Sam and the Managed Care Blues Band (Sam Bierstock, MD) has a new CD called Healthcare Reform Blues. I’m head-bobbing to the title track. Sam says it’s free to anyone who can prove they’re in the country illegally.

Inga and I frequently make fun of badly written and no-news press releases, Web sites with spelling errors, and poorly prepared interview subjects. We’re happy to offer you a solution for avoiding our snarky wrath: NPC Creative Services, LLC, which has joined our merry band as an HIStalk Platinum Sponsor. The company offers a full range of media and PR services, specializing in working with healthcare IT and technology vendors. They create media relations programs, write press releases and white papers, and handle trade show media relations. They also develop content such as product profiles, presentations, and newsletters. Some of their work is described here. Inga and I hear from PR people occasionally since we are unqualified pseudo-journalists who somehow got on various contact lists — we are much more receptive to professional, fun, and skilled creative types who know what they’re doing (Mitch and Liz Roop from NPC fit that description). I’m not saying we’ll pay more attention to your press releases just because NPC writes them better than most, but I’m not saying we won’t, either. Thanks to NPC for supporting HIStalk. Maybe we’ll convince them to do a PR campaign for us.

Castlight Health, the former Ventana Health Services that was started by RelayHealth founder Giovanni Colella and HHS CTO/athenahealth co-founder Todd Park in 2008, raises $60 million from investors, adding to its previous $21 million. One of those investors is Cleveland Clinic. The company’s Web site works with companies to provide their employees with views of their health benefits and costs, highlighting out-of-pocket costs and steering them toward cost-saving opportunities. It lets patients search for medical providers by price, which the company finds by reviewing explanation of benefits forms. Todd told me about it when I interviewed him (still one of my favorite interviews) in September 2008, or at least I assume it was the same project even though he referred to it as Maria Health:

I have recently got involved in another venture which was mentioned in the Washington Times article, called Maria Health, which I’ve started with Giovanni Colella, who was CEO of RelayHealth and then Sapient before that. Our venture capitalist is Bryan Roberts of Venrock, who is one of the lead VCs behind athena. It’s actually a consumer-oriented company. It’s super duper early so I can’t really get into specifics at this point, but generally speaking, it’s a company that’s seeking to take an athena-like approach to helping healthcare consumers navigate an increasingly complicated healthcare system. It’s got a great team, veterans of athenahealth and Yahoo who are part of it. It’s off to a great start. It’s too early to talk a lot about, but it’s been a ton of fun for me to learn more about the consumer space.

The VA announces the 26 winning ideas in its IT innovation competition. It’s hard to evaluate them given only their titles, but some are easy to figure out: including patient pictures in CPRS, using touch screen software for nurse triage, and rolling out wireless and hands-free voice communications. And speaking of Todd Park, he was one of the judges.

Catholic Health Initiatives announces a $1.5 billion project to upgrade clinical IT in its 72 hospitals, planning to hire at least 200 people, most of them to be based in Denver. Key partners are Cerner, Meditech, and Allscripts. if you ever wanted to move to Denver, this is a once in a lifetime opportunity.

Informatics Corporation of America will host a Thursday webinar called Five Key Elements to a Successful Clinical Information Implementation. I’m thinking there should have been “System” before “Implementation”, but I’ll go with the announcement’s wording.

The Daily Mail documents conditions in the Chinese plant (aka “the i-Nightmare factory”) that makes components of the iPhone and other consumer devices and which has had a rash of employee suicides. The company’s response: they brought in monks to exorcise evil spirits, installed nets around the dormitories the employees were leaping from, appointed “spotter teams” to watch the employees and ship troubled ones off to a mental hospital involuntarily, and forced employees to sign a contract saying they won’t kill themselves and giving up their legal rights if they do (tick, tock). But as I always caution when talking about a so-called sweat shop: ask the employees before unleashing the moral outrage whether you’re doing them a favor by having their employer shut down. Sometimes a sucky job is better than none. 

Sad: a patient being being transported by ambulance dies when a software glitch causes its onboard oxygen system to fail.

Starting Monday, all Virginia Beach (VA) ambulances will carry a tablet PC that allows them to communicate with any Sentara hospital. They say it’s the first program of its kind.

Five California hospitals are fined $675,000 for electronic privacy violations, with UCLA’s Ronald Reagan Medical Center getting hit with a $95,000 penalty for employee snooping in Michael Jackson’s records.

Strange: a woman with an old shoulder injury and no insurance can’t get a specialist to see her, so she shoots herself in the shoulder in hopes of getting treatment. It didn’t help: the local hospital fixed the wound, but left the old injury unrepaired.

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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. 

The Staff Retreat: Boon or Boondoggle?

The staff retreat. I love getting away with my staff or peers to kindle enthusiasm for the upcoming year. I thrive on the challenge of a ropes course and then reminiscing the near falls while feasting that night. Call me sentimental, but I get warm fuzzies singing Kumbaya. I’ll soak up the euphoria through to the end, and by the final night, the world seems good.

But then Monday hits.

Think about it. How many retreats have you attended about which you could later declare, “That was time and resource well invested”? If we evaluate the staff retreat ROI the same way we do personal investments, would we eliminate them? Do the qualitative intangibles carry sufficient weight to support the expense? Let’s be intellectually honest about this.

During my first two years at Texas Health Resources, I reorganized my staff, and then we got our strategy, tactics, and operations under control. After all the hard work, which paid off in great advancements, my team and I were ready to go deeper. This year, we opted for a new approach. What transpired during our two days alone was worth the time, money, and emotion. (You can see video of the retreat here.)

I asked our IT training leader to coordinate and facilitate our retreat. He spent six months participating in my direct report leadership meetings, observing and interviewing.

Thanks to his facilitation, the self-revelation and discovery proved transformational. After he led us to the point of openness and honesty, we called out every elephant in the room, banning any sacred cows. No unmentionables were allowed and no secrets, which was rough.

As we let it all hang out, emotions ranged from anger to peace. We cried and laughed — executive therapy unsurpassed and revolutionary. Gestalt. My team told me some tough things like ‘make more clear decisions’, ‘appreciate diversity of styles,’ ‘have more respect for those in operations,’ and ‘tone down expectations.’

I needed to hear this. When I came home, my wife corroborated each one.

Learning that we all struggled with similar issues helped us build trust and respect. To avoid slipping back into old patterns, we created new team operating principles. We redesigned our meeting structure and reworked our communications. And we agreed to have our facilitator regularly check up on us to ensure accountability and make refinements. We left exhausted, but balanced by hope.

When and why should you conduct a retreat? They say that a key differentiator between a good team and a great team is the quality of professional relationships connecting members. A retreat can help with this, especially as you first form a team, or when you feel the team’s effectiveness has plateaued. Every team has a dysfunction (or two) so you will never be short on content.

I’ve set out to do an annual retreat if for no other reason than to keep us from going backwards. A retreat, done right, can be the catalyst for pushing the team to the next level of effectiveness faster. If you focus on prescriptive methods that target specific areas for improvement, you can reengage on what is most important. Artfully creating a transparent atmosphere leads to discussing difficult issues and even to broaching the unmentionables. Ideally, you’ll find a cleansing of the souls, and people will focus on what’s important rather than personal agendas.

These are the keys to success within the leader’s control.

Situational Leadership
Understand the fine line between running the retreat and contributing as a participant. At certain times, I expanded on ideas and offered opinions and feedback. On other occasions, I sat back and observed, allowing the team to speak and interact freely. A pre-session discussion with the facilitator taught me when to contribute and when to back off so the participants wouldn’t shut down. To aid the process, he facilitated the meeting, soliciting responses and redirecting discussion.

High Tolerance for Ambiguity and Patience
in order to uncover and discuss the significant issues on a progressively deeper level, the facilitator follows a certain process. As CIO, I had to have faith in this process and patience for it to unfold in an appropriate manner. Occasionally, I wanted the retreat process to move faster especially during the initial topics. The participants, however, had to be brought to deeper levels systematically; otherwise, they would not be transparent enough in the latter part of the agenda. I had to exhibit positive behavioral attention and body language to demonstrate my approval of the process.

Humility
This was tough. I had to exhibit a willingness to draw out and hear feedback, both positive and critical. Success depended upon my authentic desire for improvement. This behavior cannot be forced. It’s either within the CIOs behavioral acuity or it’s not. If not, other objectives will need to be identified for the retreat to prevent further damage that can occur at the team level.

Transparency
A higher degree of transparency will bring a higher degree of retreat success. Although the CIO does not (and should not) become a completely "open book" during this session, the more sharing of his work, priorities, strategy, and thought processes, the better the outcome.

Trust
A CIO must exhibit a strong level of confidence in his direct reports and faith in their skills and abilities. Recognize their willingness to improve and keep in mind that all people learn and improve at different paces. And believe that the retreat process will make a difference if completed well.

Continuing Commitment to Growth
The CIO must understand and embrace the reality that improvement on an individual and team level is a continuing process. A retreat alone will not create a lasting behavioral change, so commit to on-going professional development.

Expectations Identified 
Make your expectations clear. That is, the purpose of the retreat is to help move the team to the next level of performance (or whatever objectives the CIO has identified). Leave no doubt in the participants’ minds about what the retreat is to accomplish, how success will be measured, and what the subsequent steps will be. 

Of course, in all these steps, success is equally dependent upon the skill and experience of the facilitator. The more experience the facilitator has, the higher the level of success. Michael Cholette served us brilliantly and was a key contributor to the content of this post.

Do you have what it takes? Got courage? You’ll need it if you want to see a revolution happen from the inside out at work. So step out of the box and try something new. Redefine your retreat. Boon times ahead!

Update 6/17/10

The retreat was held specifically for my leadership cloud. Save for requisite HR stick-and-box org charts, we use more of a protean organizational structure that allows for greater flexibility and agility. In this case it was my CMIO, CTO, and leaders representing applications, value realization, and our hospital IT clouds. So to Dr. Stein’s point, we did have the only MD engaged that is in my cloud.

My strategy was to begin with my cloud first. If we could nail it and get results, we would extend outward. Early returns are strong. As pointed out, we are blessed with an IT training manager who was an executive coach prior to joining our organization. Remember, he spent six months (!) with us observing before we had the retreat. That familiarity and comfort was a key to success.

Ed Marx is senior vice president and CIO at Texas Health Resources in Dallas-Fort Worth, TX. 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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From Vic Damone: “Re: Eclipsys Helios. I think that this is a capital idea. No company today can meet all needs of the enterprise. Look at all of the Microsoft-based products out there or, perhaps even more similar, look at all the add-on products for an iPhone. Even in the Epic world there has been a lot of custom development, either by Epic or sometimes by the client. There was none in the Eclipsys world, at least on the Sunrise side.” Agreed. It’s cool. Cerner has something similar, giving clients access to the code hooks to customize and extend their apps. As a customer, you definitely want that.

From CPAhole: “Re: Allscripts. Over $650 million of Goodwill and Intangibles, most of which should be written off as the products are abandoned. That does not include at least $50 million in acquisition costs associated with the Medinotes/Bond acquisition. There will be many past sins buried in the Eclipsys reorganization costs.”

From PACSman: “Re: Allscripts. Glen Tullman was the mentor to Michael Ferro in Merge Healthcare’s takeover bid of AMICAS. IMHO, Merge will be the next Allscripts acquisition IF they can stay alive for the next 6-12 months.”

From Lederhosen: “Re: Eclipsys and HIEs. HIE strategy eludes me totally on both vendor and client side. Is it really sustainable? Why do two or more competing health delivery organizations want to participate? How many interfaces need to be supported? We’re still struggling just to get EHRs up or just trying to get a provider to use a PC.”

From Wildcat Well: “Re: Philadephia. Why was an EMR/PHR guy called up for a fourth presentation to Comcast’s top brass?”

From Fan # 2333787: “Re: eClinical Works. Has Sam’s Club quietly discontinued their partnership with eClinicalWorks? The link that they originally publicized is now redirected to their main page and a search brings up nothing relevant.” eCW will provide an official response to your question, but advises in the meantime that some of the Sam’s Club health offerings have been moved under Walmart Health and Wellness. More to follow.

From GoGreen: “Re: Dale Sanders. You were interested in how Northwestern University’s school of medicine CIO Dale Sanders ended up in the Cayman Islands. Please send Inga there to get a first-hand report. Many thanks for your excellent site!” I’ve been to the Caymans several times and I’m pretty sure I remember seeing telephones there, so instead, Inga could call him from home while she stands in a sandbox wearing a bikini just to get the island flavor. I’ll pay for her braids. 

Inga and I appreciate the support of Stockell Healthcare Systems of Chesterfield, MO, a brand new HIStalk Platinum Sponsor. The company’s tagline is The Revenue Cycle Information System Company, including its InsightCS suite that streamlines patient access, reduces payment delays and denials, manages payer rules upfront, and submits cleaner claims with better point-of-service collection. Specific solutions include revenue cycle management, patient access, patient accounting, order management, reporting, worklists, and business intelligence, all built on the .NET framework and using scalable Microsoft technologies such as SQL Server and Reporting Services that lower the cost of ownership. We thank the folks at Stockell for supporting HIStalk.

This is a fun idea: Hilo Medical Center (HI), which converted from paper to Meditech in May in a project it calls Health Connect, names its Health Connect Baby, the first newborn brought into the world using its new EMR.

I said in 2007 that I thought Second Life was clunky and pointless despite all the hospitals and webheads raving about how transformative it was going to be for business and consumer commerce. Maybe in a virtual world, but in the real one, Second Life parent Linden Labs is tanking. Predictably, Second Life proved to be as pointless for corporations as it was for everybody else, although the article mentions that Children’s Memorial Hospital (IL) is doing something that doesn’t sound all that useful on it. My words from 2007: “I tried Second Life once and was bored after a few minutes of fumbling around, but apparently it’s quite the hit, especially for nerds whose First Life isn’t what they’d hoped.” Twitter will be next, I predict, like any other tech fad that’s overrun with spammers, corporate marketers, and creeps.

HIMSS promotes John Hoyt to EVP, Organizational Services, which apparently includes running HIMSS Analytics since Dave and Mike bailed bailed for greener ($$) pastures. I know John from his Martha Jefferson Hospital CIO days. Hospitals considering Cerner knew to call him about the rampant performance issues Millennium was having back then in his little hospital. On site visits, I thought the hourglass was a screensaver.

The Minnesota nurse strike happened Thursday, with 12,000 of them walking off the job at 14 hospitals. The planned sympathy strike in California was blocked by a judge. Agencies charged up to $2,000 and more to provide replacement nurses for the day, including an extra day of orientation. Want to bet that some of the strikers came back as agency nurses for the day, covering a different hospital to avoid detection? Seems suspicious that the strike was supposedly over the nursing shortage, yet replacements were found.

Now I’m really glad I moved HIStalk to a new server last week. The Allscripts-Eclipsys news sent traffic through the roof, with over 8,200 visitors on Wednesday alone. Without the new hardware, you’d have been looking at the same hourglass as those early Millennium clients. Of course, HIStalk reported it first, thanks to Inga being up and about in the middle of the night on Twitter and Facebook (insomnia, she claims) and readers who e-mailed me from Europe and elsewhere, allowing me to send out the blast well before 7 a.m. Eastern. A reader comment: “Thanks for the excellent coverage that HIStalk provides. I got a call from an investor advisory company asking me to do a conference call about the merger. Not having seen the news, I was blindsided, so while the person was talking, I quickly turned to HIStalk, got the general info, and sounded completely informed and up to date!”

I always urge readers to put their e-mail addresses in the Subscribe to Updates box to the right. Signups were heavy Wednesday, so I’m guessing my dire warnings were accurate: know-it-alls who got the Eclipsys news before daylight Wednesday because they’re on the list must have started contacting colleagues to smugly tell them the news. That’s what I would have done.

Holon gets a double welcome: one as a new Platinum Sponsor of HIStalk, but a second as a new entrant into healthcare IT. The Atlanta-based Holon (from the Greek holos, or “whole”) offers its Holon Process Adaptability Interoperability Framework, an enterprise application integration (EAI) platform that supports interoperability, data exchange and translation, workflow, a rules engine, and document management capabilities. The hardware- and software-agnostic solution lets hospitals extend and enhance their existing systems without resorting to point-to-point connections, thereby easing the transition to CPOE and challenges with Meaningful Use. Obviously there’s a lot of interesting detail on their site, particularly on the downloads page. The company is new to healthcare, but its parent and executives have a long history of providing tools to accelerate workflow and enhance business processes (not to mention that some of its execs have deep healthcare roots). Thanks to Holon for choosing HIStalk to get the word out.

Our own Dr. Gregg Alexander uses Eclipsys PeakPractice in his practice. His thoughts on the Allscripts acquisition are on HIStalk Practice.

Texas Medical Institute of Technology is offering a free Webinar on bar coding solutions from pharmacy to bedside, with speakers that include Charles Denham, David Bates, Eric Poon, and some other high-profile presenters. It’s next Thursday, June 17, at 1:00 p.m. Eastern.

TPD is updating his iPhone Apps List, so let him know (through me) if you’ve seen something interesting.

Jobs: Ambulatory EMR Administrator, Clinical Process Consultant, Soarian Clinicals – Plan of Care, Soarian Pharmacy and MAK.

A New York Time article says rural Iowa clinics are the first in the US to use telemedicine and telepharmacy to remotely dispense abortion pills.

An employee of Phoenix Health Systems, contract IT services provider to Salem Hospital (OR), is arrested for allegedly causing $200,000 worth of damage to a hospital administration building by stuffing a drain with paper towels and leaving the water running. I guess he wasn’t clever enough to be a hacker.

The VA announces an $80 million technology competition for solutions to its biggest problems, targeting areas such as telehealth and clinical applications that integrate with VA systems.

I really like this article: librarians at the William H. Welch Library serving the medical school, public health school, and hospital at Johns Hopkins University are transforming themselves into “informationists” who work side-by-side with researchers and students to help them find the information they need. The goal is to shut down the central library, which is scarcely used in an electronic information age, and to make “the library be wherever you are.” I’ve always said librarians and HIM people should be the stars of the healthcare information age, except nearly all of those I’ve known are quiet and passive. I’m not judging — IT and finance people are often like that, too since that’s what draws them to those fields instead of being salespeople or entrepreneurs.

A strange new medical research finding: almost 8% of people studied had sexsomnia, a propensity to have sex while sleeping. It was three times as prevalent in men (insert your own punch line here).

E-mail me.

HERtalk by Inga

From Joe: “Re: EMR warning, in response to Suzy RN. Although you make some great points, I believe you are directing your ire in the wrong direction. It would be Dr. Blumenthal’s evangelism that is creating plenty of angst and running our patient care quality and integrity of our physicians off a cliff, But, this is not a message he invented. He is, like a good soldier, merely working hard to promote the message from the White House and with the WH’s CTO breathing down his back and insuring he stays on message. Our industry must take our messages of caution and slowdown to Secretary Sebelius and 1600 Pennsylvania Ave.”

Like unsavory ambulance chasers, several law firms commence investigations into “possible breaches of fiduciary duty” and other violations associated with the Allscripts/Eclipsys acquisition. Must we?

WakeMed Health and Hospitals adopts Clinical Xpert Billing, a charge capture solution from Ingenious Med and Thomson Reuters.

mPay Gateway announces the general availability of its Advance Payment Plan, an enhancement to its point-of-care product that allows physician offices to establish patient payment plans.

I’ve spent the last couple days talking to all sorts of people about the Allscripts and Eclipsys. In general, people tell me they believe it’s a good move and especially beneficial to Eclipsys. Allscripts brings a strong management team with a proven track record of merging companies and products. Allscripts also has one of the strongest marketing machines in HIT. Allscripts has a strong ambulatory EHR solution (or three or five) which will appeal to many health systems in Eclipsys’ sweet spot. Meanwhile, Allscripts increase its chances selling EHR to more of these large health systems. Of course there are many unknowns and uncertainties (what products, management structure, integration, company cultures etc.) but I don’t see the move as some disaster waiting to happen. In fact, it might actually work out pretty well on several fronts. It will be fun watching it unfold over the coming months.

Emdeon taps Franklin Baumann, MD as chief medical officer to provide clinical oversight and strategic planning for Emdeon’s Interactive Care Management suite. He has served in clinical leadership positions at UnitedHealthcare, Dreyer Medical Clinic, and Rush-Copley Medical Center.

Colorado Casualty Insurance files a federal lawsuit that contends it’s not liable for reimbursing the University of Utah for $3.3 million in costs associated with a 2008 data breach in its hospital. The case is related to the theft of backup tapes containing PHI for 1.7 million patients, which were stolen from a private vehicle belonging to an employee of a secure storage company. This may be a case to watch.

RealMed signs a multi-year claims processing agreement with UHealth, University of Miami Health System, and the UM Miller School of Medicine.

Henry Ford Hospital (MI) names Dr. John Popovich its new CEO and president. Popovich, a pulmonary disease and critical care medical specialist, has been with Ford since 1975.

Siemens Healthcare enters an agreement with SSI Group to resell SSI’s ClickOn LinX technology for claims editing and transmission.

Start-up company Healthrageous secures $6 million in Series A financing for its personalized health technology platform. The solution was developed with Partners Healthcare Investors’ Center for Connected Health.

Dell continues to make hay in healthcare, inking a deal with Stellaris Health Network (NY) for hosting of its Meditech system, disaster recovery, and network and application support.

I was fascinated by this article that highlight the success of electronic health records in a small town in Spain. They informed citizens via radio announcements that they could electronically schedule appointments and renew prescriptions. Patients asked doctors if they could use it, which led physicians to adopt it. Doctors and pharmacists are encouraged to manage drug costs. Not sure how much of the Spanish approach could be translated to the US, but perhaps there are a few gems there worth stealing.

A few sponsor updates to round out your week:

• Mary Staley-Sirois joins DIVURGENT as a principal responsible for leading the company’s clinical transformation practice.
• Rich Fishback, formerly with Thomson Reuters and MercuryMD, has joined Salar, Inc. as RVP of sales for the Southeast, where he’ll lead sales efforts for the company’s electronic documentation and charge capture solutions for hospitals. 
• North County Health Services (CA) selects Sage Intergy’s EHR, practice management and community health center modules for its 53-provider practice.
• Ingenix completes a system-wide rollout of enhancements to its CareTracker EHR, providing physicians the capability to demonstrate Meaningful Use.
• Caritas Christi Health Care (MA) deploys MedAptus’s Intelligent Charge Capture suite.
• MED3OOO signs a multi-year agreement with RealMed to provide claims processing.
• maxIT Healthcare announces creation of a new healthcare management consulting division, led by former Dearborn Advisors SVP/Partner Reese Gomez.

E-mail Inga.

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