From Capillary: “Re: Allscripts. The CEO announced last week on the earnings call that the company was chosen by the Indiana REC, but the selections have been announced and Allscripts was left off. Anyone know what happened?” Allscripts confirms that you are correct. They have apologized to the REC for the unintentional miscommunication. The vendors chosen by the Indiana HITEC as appropriate for small and rural providers are athenahealth, iSALUS, and MDLand.

From UK Watcher: “Re: Aspira. Aspira is/was the UK feeder to IntelleHealth/iCapital, the consulting entity working some of the Cerner projects in the Middle East. Many of the recruits that they had secured in the UK were from Cerner UK and had been moved to the ME anyway. Will be interesting to see what happens to their tax-free and prior negotiated packages with the ‘new’ boss.”

From Privacy NOT: “Re: security breach. The Achilles right heel of HIT is failed privacy. The Achilles left heel of HIT is failed safety and efficacy. The rotator cuff tear of HIT is failed usability.” I don’t know about all of that, but it was in response to news of a stolen laptop from Thomas Jefferson University Hospital in June. The laptop was password-protected, but was not encrypted (I swear the hospital laptop encryption rate must be even lower than CPOE adoption, but in this case, it the employee’s personal laptop and storing PHI on it violated hospital policy). Laptops apparently aren’t encrypted at Texas Children’s Hospital either, as the hospital admits after the theft of a doctor’s laptop containing patient information.

From Smart Room Needed Here: “Re: UPMC. Hospitals should get their employees to watch the monitors.” A patient’s family sues UPMC Mercy Hospital, claiming he suffered permanent brain damage after choking on a clogged tracheotomy tube for 40 minutes before ICU nurses answered the cardiac monitor alarm. And in other UPMC news, it creates a VP of community relations position for a state senator who’s quitting. The closed UPMC Braddock Hospital is in his district, leading an official with Save Our Community Hospitals to state, “… Sen. Logan worked to ensure UPMC’s objective of closing and demolishing the hospital. Now we know why. Mr. Logan has received his ’30 pieces of silver’ as payoff for his work on UPMC’s behalf.”

A reader asked me to put together a list of some of the music I’ve recommended over the years, so I compiled and posted a list here. And in digging back through those archives, I dug up an old favorite to revisit: Nine Black Alps, hard rocking Brits.  

As hospitals issue press releases congratulating themselves on being Most Wired, most HIStalk readers think awards of that type mean nothing, while the majority of the remainder think they’re just self-promotion for magazines and CIOs. New poll to your right: will state HIEs be viable once their stimulus money has been spent?

Speaking of Most Wired, AHA says the criteria have been toughened up, requiring hospitals to at least claim (on the self-reporting survey) that they are actually using technology. So, if you are among the Most Wired skeptics who think it means nothing, imagine what it was like before (those old and now-suspect awards still pepper CIO resumes, I’m certain). If this were an art contest, it has gone from (a) who owns the most paintbrushes, to (b) who uses the most paintbrushes, but is still far short of actually evaluating (c) whose painting is the best and whether having the most paintbrushes made any difference. I was in charge of completing the survey for a Most Wired hospital for several years (I have a Most Wired Winner shirt somewhere) and even my hospital made fun of it given our hopelessly outdated and seldom-used clinical systems back then. I suspect that we and our fellow award-seekers were as optimistic as a vendor’s RFP department in our responses.

Are patients better off in a Most Wired hospital and can it be proved that the technology is responsible? No on both counts.  As I always say, if you are a good hospital, judiciously deployed IT can make you a little bit better. If you’re a bad hospital, all the technology in the world probably won’t help you improve (and may well increase your level of suckitude). If you are marginal, you might see improvement, but I wouldn’t count on it.

The folks at FierceHealthIT and I are swapping links for a few weeks, so you’ll see their headlines to your right and mine on their site. It’s a trial to see if we send each other readers. If not, we call the experiment quits.

Scott Storrer is ousted as CEO of MEDecision, replaced after just eight months by un-retiring founder David St. Clair (above) until a permanent replacement is named in six months or so. David’s blog entry on the subject is here.

Q1 numbers from NextGen parent Quality Systems: revenue up 24%, EPS $0.42 vs. $0.36, missing on consensus earnings.

A reader sent over workshop documents from a July 27-28 invitation-only meeting involving the Institute of Medicine and ONC, addressing the role of technology in continuous healthcare improvement. Some of the issues discussed: what can IT do to improve health and healthcare by 2020, what are the rate-limiting issues, how can data be used, how can innovation be fostered, how can healthcare cost be reduced by technology, how can disease management be improved by technology, how can consumers be engaged, and how can a global public network be created? Some familiar names were on the participant list: Molly Coye, Bill Bria, Mark Frisse, John Halamka, Rob Kolodner, Marc Probst, Stephanie Reel, and Paul Tang (familiar names not on the list were yours and mine).

UMass Memorial Health Care will announce Monday that it has chosen the Symedical terminology management and interoperability tool from Clinical Architecture to create a central data repository with a single terminology set.

HIStalk sponsor jobs: Interface Analyst, Epic Clarity Analyst, RVP Sales – Southeast, New England/NY, and Mid-Atlantic Territories.

McKesson’s Q1 numbers: revenue up 3%, EPS $1.10 vs. $1.06. My interpretation of nuggets from the call transcript: (a) Health Solutions and RelayHealth did fine; (b) Provider Technologies (the hospital technology part) underperformed, with revenue growth slowing to just 2% and profit down 7%; (c) they’re spending a lot of money on Horizon Clinicals and Horizon Enterprise Revenue Management, taking an $8 million accounting hit on HERM amortization during the most recent quarter alone; (d) John Hammergren says the company is interested in global acquisitions, but is often named just to increase the price that someone else eventually pays; (e) MCK isn’t seeing an increase in technology purchases by physician practices, but Hammergren says it’s because those practices aren’t yet paying attention to HITECH; (f) the company is confident that its products can get providers to Meaningful Use. My cheap seats analysis: Horizon Clinicals and HERM are struggling, which is hardly news other than it’s McKesson saying so (indirectly).

HHS withdraws HITECH’s breach notification final rule after reviewing the public comments. Organizations involved in a privacy breach would have been allowed to decide on their own whether to notify patients or just keep them secret. That’s significant given that the rule had already gone to OMB. A replacement rule will be issued “in the coming months.”

DrLyle weighs in on Meaningful Use on HIStalk Practice. A snip: “To correctly measure many of these details (e.g. give clinical summary to 50% of those who ask) we would need to figure out a way to keep track of who ‘asks’. That seems like a strange request for structured data and certainly should not be what a doctor is spending his time doing.”

Dossia Consortium names Jim Hansen, former CEO of the Kansas City-based CareEntrust HIE, as VP and executive director.

TriHealth and University of Cincinnati will spend up to $100 million each on clinical systems, with Epic being a candidate in both (I’d say shoo-in given that TriHealth already uses Epic in its physician practices). Also named as local hospitals bringing up Epic and spending more than $50 million each to do so: Mercy Health Partners, Cincinnati Children’s, Christ Hospital, and St. Elizabeth.

A senior at University of Maryland who created the DoseSpot electronic prescribing system is named a finalist for an entrepreneur award.

Doctors and nurses in Thailand wear black lab coats to protest a draft law that would allow patients to be immediately compensated for medical malpractice from a special fund. A medical union representative says, “It means our staff would have to be extra careful during work, which would decrease efficiency.”

An Alaska clinic becomes the first US site to use ALERT Clinic software, which I assume is from the Portugal-based ALERT that made a mini-splash a couple of years ago at HIMSS (I think I recall cute booth staff in red-striped white jumpsuits, but I could be wrong), then seemed to disappear without a trace. Everybody (me included) was impressed by what we saw, so I don’t know what happened. I pegged them as a hot new entrant.

A hospital employee is fired for posting a Facebook comment about the suspected killer of a police officer that she treated, saying she hoped he rotted in hell. The hospital said she violated HIPAA even though she didn’t mention the name of the suspect or her hospital.

A Stanford Medical School professor and novel writer worries about letting technology interfere with patient-physician relationships:

Rituals are about transformation. You know, we marry with great ceremony to signal a transformation. We are baptized in a ritual to signal a transformation. The ritual of one individual coming to another and confessing to them things they wouldn’t tell their spouse, their preacher, their rabbi, and then even more incredibly, disrobing and allowing touch, which in any other context would be assault, you know, tell me that that’s not a ritual of great significance. And if we short-change the ritual by not being attentive, or you are inputting into the computer while the patient’s talking to you, you basically are destroying the opportunity for the transformation. And what is a transformation? It’s the sealing of the patient-physician bond.

Hospitals in Victoria, Australia will arm 500 doctors and nurses with iPads in a pilot program.

Boy Scouts at this year’s Jamboree at Fort A.P. Hill, Virginia have access to AT&T WiFi and a wireless EMR system used by its 20 medical centers and team of EMTs. Next thing you know they’ll be using a GPS to track snipe.

Standard Register’s healthcare revenue fell short of expectations in Q2, mostly because of cheaper document management solutions.

The former CEO of Baltimore-based insurance company CareFirst BCBS, recipient of a contested $18 million severance package, joins Healthcare Interactive as an advisor. The company offers healthcare performance management systems of several types.

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From SnagMonkey: “Re: confirmation of Providence Oregon’s transition to Epic.” He (or she) sent over the July 19 internal announcement. GE Flowcast, GE Centricity, McKesson Horizon Clinicals, McKesson Star, and pretty much all the unnamed ancillary systems will be shown the door. Implementation starts in January, the first go-live will be in 2012, and the project will be finished 30 months after it starts. Thanks for the scoop.

From Girls Just Wanna Have Fun: “Re: acquisitions. Hold on to your hat the next six weeks. Lots about to start shaking loose. Can’t say more, but August and early September will be the most active HIT M&A announcement months in a very long time.”

From TooLate: “Re: iSoft. Massive cuts continue and positions will be eliminated. Major shifts, consolidation of leadership, off-site London meetings are more frequent, and more stock will be issued. Sound like everything is being done right except fixing the actual problems — product and leadership. Can’t wait to see this annual report.” Shares are at less than 14 cents US.

From ThinGreenLine: “Re: management changes at Meditech. It was previously announced that Steve Koretz would assume all installation and support responsibility for 6.0 product line. Now Joanne Wood will assume same for all Magic and Client/Server products. Joanne being promoted to Senior VP. Two new VPs promoted under her, Leah Farina and Helen Waters. Leah has her roots in the HCA group, while Helen came from sales. This is the change Howard Messing hinted at in his interview with you.” Verified by Howard. That’s Joanne above.

From MaxPayneUK: “Re: Apira. Closes operations and gives all employees to IntelleHealth, which insists that new employment contracts be signed. Not sure how that happened without violating labour laws, but there you go.”

From Jenny Penny: “Re: Jay Deady. Cheers Across Atlanta may be thrilled that he’s leaving Eclipsys, but as much as an ass as he can be, I challenge anyone who has ever worked for him to debate that he challenged them to do their best. He is super duper intense about work – certainly no dumb slacker like many HIT sales guys.” Ouch!

From Buck S. Pearl: “Re: West Virginia Health Information Network. Five vendors still in the running to run the state’s HIE: Thomson Reuters, CSC, Deloitte, Medicity, and HealthBridge. The selection deadline was June 30, but they are re-evaluating functionality (which probably means they don’t have enough money to buy what they want). They are also negotiating with NaviMed and Quadax for a separate claims and eligibility portal, with one or both offering it to the state at no cost to open up the chance to sell other services to providers (clever buggers).” Board meeting minutes are here (warning: PDF). I knew Thomson Reuters jumped into the HIE game in December, but it still seems odd to see their name among those others.

From Laboratorian: “Re: Epic’s Beaker laboratory information system. Anyone know much about it? Are its big new clients implementing it?” Beats me. Anyone know?

From Jimmy DeLorean: “Re: posting the Monday Morning Update on Sunday. It’s always great feeling like I’m getting Monday’s news a day or two early.    But, you certainly have earned more than a few Saturdays off, and I’m sure Mrs. H appreciated having your undivided attention for the weekend. How you’ve managed to hold down two full-time+ jobs all this time and still have a personal life (and sleep) is a remarkable feat, though. Someday you’ll have to write a book on time management and life balance, even if pseudonymously.” Thanks – that made my day. I like having a few readers who get antsy when I don’t post until Sunday afternoon since it makes me feel needed. Mrs. HIStalk did indeed appreciate my attentions (and vice versa).

From Loyal Reader Kathy: “Re: Meaningful Use. Since you put together such a great spreadsheet over New Year’s, I thought someone ought to do it for you for the final and give you a little time for Mrs. HIStalk.” Kathy did a great job putting together the final rule information, including both the requirements and the quality measures (download it as Excel since it won’t look right otherwise — it has two tabs). Very cool, thanks! UPDATE: Scribd has some Facebook auto-login crap that isn’t obvious, so if you’re not on Facebook, download from here or here instead.

Listening: new from Asia, back with the original members (Palmer, Howe, Downes, and Wetton). I’ve got tickets to see them live soon.

Q1 numbers from The Advisory Board Company, the new home for much of the former HIMSS Analytics management team: revenue up 18%, EPS $0.29 vs $0.27. Market cap is $682 million.

pMDsoft announces its native iPad charge capture application.

Weird News Andy goes non-weird in finding this: Americans are consuming fewer healthcare services, according to financial results of publicly traded healthcare-related companies. Evidence: fewer elective procedures performed, increased numbers of high-deductible insurance plans, fewer new prescriptions for maintenance drugs, and (of course) increased insurance company profits. Athenahealth was quoted for its observation that the number of claims per physician and the average value per visit dropped over last year. The WSJ article seems optimistic that consumers are getting smarter, but I’d bet they’re just holding off until they get those shiny new insurance cards courtesy of healthcare reform.

St. Vincent’s HealthCare (FL) signs a deal with CVS Caremark’s MinuteClinic to provide medical staffing and to work together on disease management. The organizations are integrating their respective EMRs to share histories and visit summaries.

Cerner’s Q2 numbers: revenue up 13%, EPS $0.65 vs. $0.52, guidance raised. Shares jumped a little (one-year CERN against the Nasdaq above, with Cerner in blue). I’ll repeat what I said earlier this week: it’s one thing for Epic to take some business away from Cerner, but Neal’s always going to book great numbers, keep shareholders happy, and let everyone who wants to ride the Ferris wheel with him do so by purchasing shares. Millennium may have fierce competitors, but the company is doing just fine.

Speaking of Cerner, the earnings call transcript is here. It’s mostly the usual hack phrases used by executives and analysts (traction, footprints, give some color around), but there were a few interesting points. They’ll open a Vision Center in Europe. They don’t sound like they’re doing too well (my read, anyway) in the small hospital and physician practice markets. They expect 75% of their clients to earn full HITECH payouts. They’re going after revenue cycle services with RevWorks. One analyst asked directly about Cerner repeatedly losing against Epic in academic medical center sales, which COO Mike Valentine deflected by bragging on CERN’s success with for-profit hospital chains because of Cerner’s predictability and ability to scale (he also referenced HIStalk indirectly, saying “So we added 15 new footprints this quarter. In more than half of those we competed against the firm that you mentioned that gets mentioned a lot on the HIT blogs, and that’s good. We’re like the strong silent type. We’re going to continue to compete with them.” I snorted Diet Pepsi with Lime out my nose when I read the part about the “strong silent type” given Cerner’s notorious (over) marketing machine (i.e, the Vision Center), but that probably resonated with the stock guys as being humble. Neal dropped by for his usual one quick comment at the end, obliquely mentioning the acquisition of Picis by Ingenix (United HealthCare) and implying that they see opportunity in the platform that digitization enables.

CPSI’s Q2 numbers: revenue up 22%, EPS $0.39 vs. $0.32, beating consensus estimates of $0.36 and providing in-line guidance. In the 8-K, they mention that fired former CFO Darrell West not only charged $55,000 to a company credit card to pay his taxes, he cashed in almost 5 million membership reward points for personal benefit.

IBM will sell and implement the “smart room” developed by UPMC, which involves staff-worn ultrasound tags that trigger the display of role-based clinical information on the monitor when they enter the patient’s room.

Paris-based Cegedim acquires Pulse Systems, vendor of the CCHIT 2011-certified Pulse Patient Relationship Management ambulatory EHR, along with solutions for e-prescribing, practice management, revenue cycle management, and patient self-service. Cegedim sells life sciences technology and is a pretty big deal with 8,600 employees and annual revenue of $1.2 billion (a little smaller than Cerner). They make it clear in the announcement that their interest is ARRA money. It also says that Pulse is profitable on annual revenue of $16 million, that Cegedim will pump another $13.5 million into the company, and that the value of the acquisition won’t exceed $58 million.

The former chair of the British Medical Association’s IT group urges doctors not to upload patient records to the Summary Care Record, saying it’s unsafe and should require patients to opt in instead of opt out. He’s setting up his EMR to prevent uploading unless patient consent has been checked off and is telling his peers to contact their EMR vendors to make the same arrangements.

This interesting article describes the advanced status of EMRs in Finland (91.1% penetration and a national health network), but calls out the pitfalls: it’s still hard for individual systems to communicate with each other, each local jurisdiction has different privacy rules, and the only way to transfer information when a patient moves to an area that uses a different EMR is to print everything out. I may need a site visit to Helsinki since I’ve not been for a few years and I like it there.

EyeHealth Northwest chooses NextGen’s PM/EMR for its 30 providers.

Free EMR vendor PracticeFusion launches its Research Division, which will publish lists of top-prescribed meds by specialty (which was in the announcement) and sell de-identified patient data (not announced, but that’s been the company’s stated plan, along with advertising to doctors, from the beginning — how else can they give away an EMR?) Some of their arguments on the Research Division page for providing patient data are a bit lame: (a) it’s a public health service; (b) it’s a research service; (c) Kaiser and the VA do it, so why shouldn’t we? (d) and lamest of all, under the category of Social Responsibility, “To keep this information from medical researchers would be a disservice to the safety and advancement of medicine in this country.” If you’re going to sell patient data, just say so — don’t try to make it sound noble.

Guess who’s an HIT demo dolly? Todd Park gets the thrill of having the leader of the free world pitch the site he built. Pretty cool. The President isn’t a Mac man, apparently.

United Health Group is rumored to be buying Executive Health Resources for $1.5 billion, making it part of Ingenix. The Newton Square, PA company staffs hospitals with Physician Advisors to maximize reimbursement, improve efficiency, and improve quality of care.

Mediware renews its agreement with William Blair, which includes exploring “a variety of strategic alternatives to enhance shareholder value.”

Odd lawsuit: a former nurse manager sues Halifax Health (FL) for discrimination after a failed romance with a radiology manager. She provided evidence that included a receipt for a romantic couples massage, but she dumped her beau after discovering she wasn’t the only co-worker with whom he was consensualizing. She says she was harassed after the breakup, including being asked by HR to dress as a go-go dancer during the employee banquet and having one of her patients delayed in radiology for no reason.

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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!

How to Use Meaningful Use Measures to Improve Internal Processes
By Shubho Chatterjee, PhD, PE

The final ruling on Meaningful Use was released by the Centers for Medicare and Medicaid Services in July of this year after a year of comment period and revisions. According to the final ruling, to be eligible for incentive payments, Eligible Professionals (EPs) are required to submit to the CMS, starting October 2011, 20 objective measures for 15 core objectives and an additional five from a menu of 10. For hospitals and Critical Access Hospitals (CAHs) the corresponding measures are from 14 core objectives and five from a menu of 10.

There are various efforts, dialogues, and debates underway regarding the ability of EPs, hospitals, and CAHs to meet the reporting requirements, whether the cost justifies the incentives, and the sheer human and technical capacity needed. I will not further add to the discussions but will rather focus on how the MU criteria can be used to further improve care delivery process, make it more efficient, and positively impact the operating margin. After all, a measure is related to the output of a process, and while a measure can be met, it can also be used to hone into the process and sub-processes for improvement.

Let us consider some of these Stage 1 measures and how the underlying processes supporting the reporting of the measure can be identified and improved to further improve the measure, the care delivery, and the operating margin.

Stage 1 Measure
More than 30% of unique patients with at least one medication in their list seen by the EP or admitted to eligible hospital’s or CAH’s ED have at least one medication order entered using CPOE.

Implication
Let’s assume that the provider meets the 30% threshold for the reporting period. A logical follow-through is to examine why the remainder are not CPOE and what were some barriers overcome to reach this threshold. Is it because for the remainder unique patient population, data entry is manual because other providing locations are not CPOE enabled, CPOE is available but under-utilized, or are there manual data entry requirements into and between various systems and consolidate the data to one final measure?

Each of these barriers point to a different challenge. The first is system unavailability (a business decision). The second is a change management (a people challenge). The third is a technical and process automation challenge requiring an interface or other electronic inputs, such as document management and integration.

Stage 2 and Stage 3 measures will increase the threshold. Thus the underlying process or system gaps should be identified not only to meet later Stage measures, but to improve process efficiencies as well.

Stage 1 Measure
More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.

Implication
Assuming the 40% threshold is met, what is necessary to increase the measure? Is it because of volume of data entry from single or multiple locations, or system not fully utilized, or could it be because the receiving pharmacy or is unable to manage additional increases to their receiving capacity from their customers? Again, the barriers are similar to the above and need to be analyzed and overcome.

Stage 1 Measure
More than 10% of all unique patients seen by the EP are provided timely (available to the patient within four business days of being updated in the certified EHR technology) electronic access to health information subject to EP’s discretion to withhold certain information.

Implication
This requirement has procedural, technical, and operational implications. The procedural requirements are in providing HIPAA compliant health information, while the technical requirements are in the mode of providing the information. For example, will a secure patient portal be created, will the information be provided in memory sticks or other portable devices, and if so, what is the encryption or data protection policy?

Note that, depending on the technical solution selected, there are supply chain and purchasing requirements as well, to maintain and increase the measure threshold.

Summary
While the MU provides financial incentives for healthcare organizations, it ends in 2015. It is important for healthcare organizations to use this opportunity, not only to prepare, apply for, and receive the incentives, but to examine their organizations deeply from People, Process, and Systems perspective to utilize and enhance the measures.

Only when these three supports are robust and reliable will the Meaningful Use be truly meaningful to the healthcare system, where the improvement of quality of care is the most important objective and operational improvements and business growth will likely follow.

Shubho Chatterjee is chief information officer of Miami Jewish Health Systems of Miami, FL.

Bringing Medical Terminology Management into the 21st Century — Just in Time for ICD-10
By George Schwend

ICD-10 promises to improve patient safety, the granularity of diagnosis codes, and diagnostic and treatment workflows as well as billing processes. Sounds like a dream, right? But close to three years from the mandated switch on October 1, 2013, most hospitals and health systems are still thinking of it as a nightmare, dreading the massive amount of time, effort, and money the transition will require.

What many fail to grasp is that ICD-10 is just one step on an endless road. There are already dozens of code sets that will probably eventually need to be integrated with each other — from SNOMED-CT and LOINC to RxNorm to local terminologies and proprietary knowledge bases — and all of them are constantly evolving. Look down the road and you can see ICD-11, already in alpha phase in Europe.

Instead of tackling each new iteration as if they were setting off on a major road trip through uncharted territory, providers, payers, and IT vendors need to ditch the proverbial roadmaps and get themselves a GPS unit. That way, they can simply enter each new destination as it comes along and travel there automatically.

And automation is what true semantic interoperability requires. Our metaphorical GPS could either be embedded in proprietary HIT software or plugged into a hospital’s or payer’s information system and triggered by specific events such as an update or the need to create new maps. It would allow users to automatically:

• update, map, search, browse, localize, and extend content
• incorporate and map local content to standards
• update standard terminologies and local content
• generate easy-to-use content sets to meet the needs of patients, physicians, and customer support professionals
• reference the latest terminology in all IT applications
• codify free text
• set the stage for converting data into actionable intelligence

Happily, software that fits the bill is already available, in use today at more than 4,000 sites on five continents. It provides mapping and terminology for leading HIT vendors, for health ministries like the UK National Health Service, and for standards organizations such as the IHTSDO, owner of SNOMED-CT., allowing them to not only implement new codes but synchronize codes throughout an enterprise, be it a physician practice or a country.

If you are still having nightmares about ICD-10, this your wake-up call. The ability to merge and manage diverse content from multiple sources — including free text from physician dictation — is what will turn ICD-10 from a frantic, one-off billing upgrade to one in a series of opportunities seized: to move clinical diagnosis to a new level, for example, to optimize EMRs, to meet meaningful use requirements, to satisfy quality initiatives such as the Physician Quality Reporting Initiative and to support robust analytics and reporting.

Can a roadmap do all that? Hardly.

George Schwend is president and CEO of Health Language, Inc. of Denver, CO.

HIE Market, A Shot in the Arm
By Tim Remke

The HIE market finally got a shot in the arm with the passage of the federal stimulus. This and other tailwinds sent hundreds of millions of dollars over the next few years toward the HIE market. From this point on, the HIE market gets muddled. Questions such as who is marketing their solutions to which markets, what deployed-use cases are functional or even operate at a high level, and what differences exist between multi-stakeholder, state, and private HIEs are mixed among many other multi-faceted questions.

The definition of a health information exchange has diluted the significance of surveys and results, particularly when they seek to understand what types of data are exchanged, the number of HIEs in the market and their respective operational capacity, and technological and governance structures. Simply, too many results are ‘self-reported’ and produce statistically insignificant, inaccurate, or misleading data points.

Of particular concern, several market surveys and reports related to the HIE market have commingled data by combining statistics from provider organizations that use solutions developed for basic hospital portals — a far cry from a broader HIE platform. Finally, HIEs may be private, multi-stakeholder, or statewide entities. In addition, payer system and public health play a role of delineation. The idea of ‘community HIE’ is limiting, and does not tier appropriately the HIE market.

With this perspective and understanding, we assess a few basic aspects of the current state of the HIE market.

Target Markets
A tremendous amount of friction exists over what specific HIE markets are accelerating at a pace greater than others, and which companies target each market. For example, a few vendors are persistent in their belief that the private HIE market is really the first ‘go-to-market strategy’ place. They look for localized geographies or a few hospitals to install an HIE platform as an overlay solution to act as a ‘buffer’ to a larger regional or statewide exchange.

Within the same HIE market, but more counter to this strategy, are the vendors who seek larger contracts from statewide or vast regional, multi-stakeholder exchanges. Two different approaches that produce some small and other more significant variation in solution focus and offerings. However, the data indicates a consistency that is expected. A

ll vendors will market to almost any market. However, slicing through the data, we see vendors that are targeted. All focus on hospital to hospital environments. Approximately 85 percent focus on providing an acute to ambulatory framework, also; and less than 40 percent offer a platform that readily integrates physician groups.

In addition, and somewhat paradoxically, many solutions are simply not designed to operate as platforms for vast geographic or state exchanges. Therefore, for the multi-stakeholder market, HIE solutions are discriminating. Contrast arises between target markets and the ability of the solution to match the specific market. Unlike other segments, HIEs seem as equally conflicting in details as they are syncopated — characteristics of a nascent market (relative to the past few years).

Critical Minimal Requirements
In recent months, we have seen a number of RFPs that contain a significant number of demands. However, they mask a serious issue in the HIE market. The reality is most HIEs are ill-equipped to take on sophisticated and complex solutions, use-cases, and technical architectures they greatly desire. Furthermore, over 65 percent stated the minimal exchange of data from information systems were posing “mission critical problems” with their respective exchange, and will succumb to “serious delays”. The table below looks at minimum versus preferred requirements for an exchange structure.

Conclusion
Finally, the HIE market is dynamic and has hit full stride. Companies that have weathered the storm seek potential exits (i.e. merger and acquisitions) while others are ramping their solution for the future. The market will likely extend an abnormal growth rate for the next one to two years.

However, many unanswered questions will remain. Business models, measured quality improvements, and funding, among other items persist into the future as open question marks. For example, initial stimulus funds will jump start statewide HIEs. However, after these funds have been depleted, real concerns about long-term viability and funding sources will endure.

Tim Remke is vice president of business development for HealthcareCIO, which produced the Health Information Exchange (HIE) Comprehensive Analysis & Insight report from which aspects of the above article were taken.

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From Gregarious: “Re: HCA. They are doing competitive pilots of Meditech 6.0 vs. Cerner, possibly as a move toward displacing the long-term HCA / Meditech relationship.” Verified. HCA will run a Cerner pilot in at least one hospital sometime next year. Meditech 6.0 is a big step from HCA’s Magic (pretty much starting over), so it makes sense to test the waters. The wild card could be how the hosting models compare. Several HCA hospitals have reached EMRAM Stage 6 on Magic, which ironically makes it harder for HCA to switch since you’d need heavy clinical usage from Day One to avoid moving backward. Any change (even to 6.0) will be painful.

From BeCarefulWhatYouWishFor: “Re: Epic. They are about to pick up another large academic facility in Nebraska. You can only imagine who is going to have the LastWord now.” Unverified, but thanks for the excellent punmanship in any case. As a couple of readers pointed out, it will be interesting to see if Epic can scale its model up to cover all these big implementations going on at once. A CIO reader who knows both systems says Cerner requires clients to take ownership of the design and use outside consultants, while Epic offers a more turnkey implementation at a higher price. It’s also interesting that Epic doesn’t offer hosting and Cerner is runnin hard with that offering, so that’s a key differentiator to some prospects.

From SnagMonkey: “Re: Epic. Not officially announced, but all Providence hospitals and hospitals in Oregon will convert to Epic.” Unverified.

From You’ll Know Who: “Re: Epic. Not only is Epic replacing Eclipsys and Cerner at sites, they are likely removing 30+ year old financial systems from McKesson, such as HealthQuest or the old Ibax product. That again highlights the lack of success with the ‘new’ Horizon ERM. It would be interesting to hear which products the CIOs looked at.” My ears are open if anyone wants to share.

From Ragnar Danneskjold: “Re: your comments about Cerner and corporate bureaucracy. Man, can you turn a phrase! I’m going to have that framed and put on my office wall (and then wonder why my career is not going anywhere ). Been loving your work for many years now. I don’t know how you do it, but keep on doing it.” Thanks.

From Cheers Across Atlanta: “Re: Eclipsys. Jay Deady announced today at the Eclipsys sales meeting that he will be leaving concurrent with the Allscripts acquisition.” Unverified.

From Reddy Kilowatt: “Re: PM/EMR in Asia. I’m looking for information (Web sites, articles, databases, etc.) on penetration in the smaller private practice market.” I have readers there, so if you know some sources, let me know.

From Anonymous: “Re: Merge Healthcare’s ortho imaging products. I’m surprised you didn’t catch wind of this.” I did, earlier this month when a reader tipped me off that Stryker was selling its imaging division (i.e., ortho products) to Merge.

From Lori S: “Re: AirStrip Technologies. They will announce that their cardio and critical care apps have received FDA approval, setting the bar high for other vendors.” Verified. The news just came across the wire Tuesday evening. AirStrip users can monitor patients in real time from their iPhone, iPad, and other mobile devices. That sound you heard was change jingling in the deep pockets of GE, Philips, etc. as they suddenly think AirStrip Technologies looks like something they’d like to get their hands on. I interviewed co-founder Cameron Powell, MD in February.

SRS will offer customers its hybrid EMR bundled with practice management and scheduling systems from Ingenix, calling it SRS CareTracker PM powered by Ingenix. SRS will also offer its EMR customers a migration path to the Ingenix CareTracker EHR. That’s interesting — Ingenix has been promoting CareTracker much more heavily recently, plus rumors suggest that the company won’t stop its HIT-related acquisitions with Picis.

I’m a sucker for hospital music videos, so here’s one from Lake Pointe Medical Center in Rowlett, TX, a top-rated Tenet facility celebrating its 5-Star Patient Satisfaction Rating for the full year of 2009.

Marshfield Clinical lists its CIO job. An advanced degree is not required.

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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 Authentic Leader (Death to the Cliché)

Summer of ‘86. The gas chamber awaited me.

This time, I made sure my protective mask was on correctly. Four years prior, at basic training as a seventeen-year-old, I had panicked and failed the test. Today, during the final days of training before being commissioned as an officer, I entered the tear gas chamber and approached the awaiting officer. Removing the mask, I stood at attention, mostly. Dry heaves bent my body in half.

The commander yelled, “Cadet Marx, do you have what it takes to lead your troops in difficult situations?”

“Yes, sir,” I gasped. Do. Not. Panic.

“Do you really have what it takes? They need courageous leaders, willing to lead by example.”

“Yes, sir!” The stinging gas closed my eyes to slits. Mucous cascaded over my lips and chin.

As if he knew my struggle, he kept me longer. “Cadet, I want you to sing the national anthem.”

Crap. I gave it my best shot. I’m certain I missed a couple of lines. But as I ran out the exit and filled my greedy lungs with fresh air, I emerged a leader. I now had an authentic story.

I’ve tried to never ask a subordinate to do something I would not do, or haven’t done. I’ve scrubbed toilets and worked factories with the best. Those leaders who pontificate on theories they don’t practice get zero respect from me.

If you say, “Go to where the puck is going,” do you know the precise nuance of that statement? Have you played hockey or just watched it?

“Pace yourself. It’s a marathon, not a sprint.” How many can relate to the effort it takes to sprint or run 26.2 miles? Probably few.

Although I hate clichés, I’m guilty of using them. I do my best to speak from direct experience. The difference between telling your own story and using a cliché comes down to credibility of message and messenger.

Where I work, our strategic plan is centered on climbing a mountain, to include base camps and a summit. At first, I thought I understood the immensity of what it meant to conquer a mountain, though I struggled to articulate the concept. I’d never done it. Sure, I walked a trail to the top of Pikes Peak in my youth. But climb a serious mountain?

I asked my fellow leaders if any of them had executed a technical climb. None had. So a few of us got together and planned a climb.

During our nine months of preparation, we lost 60% of our team. We invested, we studied, we sacrificed, we trained. Boy, did we train.

On July 17, 2010, five tired but exhilarated officers summited Long’s Peak. There, we unfurled our organization’s flag, a moment we’ll cherish for years.  
 

“Climb a mountain” took on an entire new meaning. We realized the sweat it takes to reach base camp. We faced the risks involved and the saw value of the teamwork required. When we speak with our respective employees, we can genuinely convey the energy it takes to reach a summit — genuineness based on experience.

By definition, leaders are in front guiding by example. Leaders explore. Just like in mountain climbing, leadership is risky, which is why so many stop actively showing the way. Sadly, some become active antagonists. I’ll save that for a future post.

Practicing visionaries. I believe a CIO cannot rely on how he or she operated 20 years ago or even one year ago. Don’t just talk about social media, live it. If you personally don’t tweet, yam, yelp, blog, etc, then don’t bother preaching about social media. You’re only lowering your credibility.

Patient care is shifting to the home setting, which means the virtual patient has arrived. Are you virtual, or are you still tethered to a landline in an office?

Do you discuss Mobile Health, HIE, Connected Health or Cloud, yet not actually deliver? I’ve encountered CIOs who talk HIE at length and could exchange information tomorrow, but they refuse to take action.

Your presidents face P&L pressures. Have you run a P&L center to make yourself aware of their challenges?

The healthcare industry has adopted electronic health records and has transitioned to a paperless environment. Are you still reliant on paper?

I wonder how many leaders grasp the double standard they communicate to their people. We talk about patient accountability, but is our physical fitness and lifestyle up to par with our vocation?

Finally, list the modifications you’ve made to your leadership style in the last two years. How have you adjusted to the emergence of multiple generations in the workplace? When you pass people in the hall, do they whisper, “He’s old school”?

Leading via clichés might make communication easier, but our people deserve more. The next time you hear grandpa’s hackneyed truism come out of your mouth, take it captive. It’s time to develop your own experienced-based story that will increase your credibility. Allow a cliché to catapult you to try new things and live your own genuine story.

Ever thought about climbing a mountain? Pick the peak you need to summit, and elevate your authenticity.

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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