From Delgado: “Re: contracts. I thought you might want to check out a contract between an HIE and its EMR vendor participants. Some doozies: the price is fixed for all EMR vendors with no deviation and the vendor can’t charge for support for the first five years.” I was amused that this particular HIE requires that any communication to it be sent by both snail mail and fax. Maybe HIEs don’t really buy into the whole idea of electronic communication of important information.

From Nuther1BitesDaDust: “Re: MedeAnalytics. If Ralph Keiser is in as SVP, then Sandy Cugliotta must be out. When will they stop shooting the sales leader messengers? The stuff is losing in the market.” Unverified. Both still list the company as their current employer.

Listening: Sister 7, reader-recommended, female-led funk or rock or something (whatever it is, I like it). I can’t figure out if the Austin band is still active.

The magazines try to convince everybody that Most Wired matters. It doesn’t, according to the 82% of industry expert readers who said on my poll that it’s irrelevant to their choice of hospital (if HIT experts don’t care about a hospital’s HIT, who should?). New poll to your right, because I’ve run a similar one before and I know people get stirred up about it: what educational level should a hospital CIO have achieved? The poll accepts comments, so feel free to argue your position while expressing it.

I interviewed Debby Madeira, a nurse manager at Huntington Memorial Hospital (CA) about mobile devices on HIStalk Mobile. I don’t get the chance to interview front-line people all that often, so I would welcome more opportunities.

Verified: Ben Clark, SVP of client support for Allscripts, is leaving. He’ll be replaced by his Eclipsys counterpart, Cos Battinelli.

The Milwaukee paper does a nice piece on API Healthcare’s success following its acquisition by Francisco Partners and its appointment of J.P. Fingado as CEO.

Response to Ed Marx’s post on multitasking was overwhelming, with over 100 folks requesting a copy of his personal strategic plan. Inga and I e-mailed out a bunch of copies until Ed offered to let me make it available for anyone to download here (he felt sorry for us having to send individual copies). Note: browser quirks sometimes cause it to download as a .zip file (at least on my PC), so just rename it back to .docx so Word can open it.

Weird News Andy won’t refuse this story: paper medical records from four Massachusetts hospitals, including pathology reports, are found in a public dump. The hospitals said the former owner of a billing service used by their pathologists told them he dumped the records when he sold the company in June. I think he’ll probably regret that decision.

Shareholders of Eclipsys and Allscripts approve the acquisition of the former by the latter.

A reader sent over a copy of the McKinsey article that says hospitals will need to spend $80-100K per bed to meet HITECH requirements (with HITECH money offsetting only a small percentage of that), but will save $25-44K per bed per year as a result. Unfortunately, the article was light on detail, making any kind of critique impossible.

UK hospitals are using a not-for-profit social networking site for patients to post updates about the condition of patients. Patients can post messages or use instant messaging. NHS says the service doesn’t cost them anything to use, plus it saves nurses time since family members don’t have to call them for updates. Brilliant. I’d be selling ads, though.

Big contractor CSC says it will sue if NHS cancels NPfIT as it’s threatening to do.

E-mail me.

Epic Staffing Guide

A reader sent over a copy of the staffing guide that Epic provides to its customers. I thought it was interesting, first and foremost in that Epic is so specific in its implementation plan that it sends customers an 18-page document on how staff their part of the project.

Epic emphasizes that many hospitals can staff their projects internally, choosing people who know the organization. However, they emphasize choosing the best and brightest, not those with time to spare. Epic advocates the same approach it takes in its own hiring: don’t worry about relevant experience, choose people with the right traits, qualities, and skills, they say.

The guide suggests hiring recent college graduates for analyst roles. Ability is more important than experience, it says. That includes reviewing a candidate’s college GPA and standardized test scores.

I bet many readers were taught by their HR departments to do behavioral interviewing, i.e. “Tell me about a time when you …” Epic says that’s crap, suggesting instead that candidates be given scenarios and asked how they would respond. They also say that interviews are not predictive of work quality since some people just interview well.

Don’t just hire the agreeable candidate, the guide says, since it may take someone annoying to push a project along or to ask the hard but important questions that all the suck-ups will avoid.

Epic likes giving candidates tests, particularly those of the logic variety.

Given my dismal experience with clueless hospital HR departments (was that redundant?), I love this guide.

Editorial Critique

Chris Lehmann, editor in chief of the online-only Applied Clinical Informatics, asked me to discuss this editorial from the current issue. It’s called Electronic Health Records – Beyond Meaningful Use, written by Asif Ahmad, soon-to-be outgoing CIO at Duke University Health System (he’s leaving for US Oncology next month). Some of its points:

• HIT adoption in academic medical centers has experienced two key events since 2000: (a) publication of an IT chapter in IOM’s 2001 Crossing the quality chasm, and (b) the HITECH act.
• HITECH makes it too easy for hospitals to look at EHRs as just having a checklist of features that lead to a buying decision.
• Hospitals should use analytics to continuously improve their EHR systems.
• Duke believes that the natural extension of Meaningful Use includes (a) support translational research; (b) support patient empowerment; (c) streamline care delivery; (d) reduce costs; (e) enable knowledge extraction and application.

It conclusion, as I inferred it, is that instead of rushing to buy and implement new EHR products simply to qualify for HITECH payments, hospitals should use and improve what they have to meet their local needs.

My first reaction was that the editorial states the obvious. However, I’m reconsidering since cooler heads need to prevail during the EHR gold rush that’s consuming the energies and budgets of many hospitals, many or most of which are likely to be disappointed by the result.

Contrary to popular perception, HITECH does not require providers to buy new systems. They’ll get paid for results, not rebated for newly incurred IT capital expense. As long as their existing system is certified, the rest is based on how they use it. It’s not a vendor problem.

For some providers, their HITECH checks will be pure gravy. They’ll just use their existing systems better and earn a check without spending any new capital dollars.

For other providers, disappointment lurks. Just buying a new system doesn’t get you anything. Writing a big vendor check won’t automatically trigger even bigger government checks. HITECH money must be earned the hard way — by creating change.

I’ve been involved in a few hospital EHR selections and implementations. It takes quite a while to do them wrong and even longer to do them right. I would bet most of the Johnny-come-latelys won’t be ready by 2012 even if their vendors are. And I can only hope they don’t harm patients in their frenzied attempts to take the HITECH checkered flag.

Asif’s third point is easy to gloss over. Everybody talks about analytics, so it’s easy to miss his point: EHRs are massively complex living and breathing packages of processes that coalesce around business and clinical rules that are almost always poorly defined and documented. EHR customers cause many more EHR failures than EHR vendors. These aren’t set-it-and-forget-it systems that can be checked off as completed once the switch is thrown and the IT people are sent away to work on other stuff.

Asif doesn’t offer examples of analytics, but here are some I came up with. How has CPOE changed ordering and utilization patterns? How quickly can be be used to correct clinical problems, such as inappropriate drug utilization or lack of documentation needed for research or reimbursement? How quickly can CPOE and decision support changed clinical practice based on new findings, such as new dosing algorithms or promising adjustments in how diabetic patients are managed? How often do providers heed guidance offered in order entry and documentation? How have clinical system changes impacted length of stay, cost per DRG, and outcomes? What information is available to analyze outcomes by provider, by treatment, or by predisposing factors? What can be done to standardize practice by the use of order sets and predefined pathways? How can clinical systems support applied research, such as the effect of rotating antibiotics on a given service or the use of new medical devices in selected patient populations?

One of the most disgraceful aspects of US healthcare is also one of the least noticed: it takes decades before doctors actually use in practice the mountains of available (and expensive) research that could improve lives. Unless someone or something pushes them forcefully, doctors keep practicing like they did straight out of residency (that’s not opinion, that’s fact). The best way to get their attention is to pay them to do it a certain way. The second best way is to push them electronically by making it convenient for them to do the right thing.

Asif’s last point is also easy to gloss over as fluff, but it’s not. Let me paraphrase to make his point more clear: hospitals are lazy, incompetent, or both if they can’t think of anything better to do with their expensive new EHRs than punch an MU checklist and bank their stimulus check. I believe that’s Asif’s challenge to hospitals: do something with your EHR that benefits patients and not just your CFO.

Those with hospital experience know how big IT projects progress: (a) internal interest turns into impatience after the fun parts of the project, like site visits and system selection, are over; (b) once the hard work begins, the vendor and product chosen are almost always maligned as deceitful, undesirable, and unresponsive; (c) going live is such a drawn-out process that the project team is disbanded immediately afterward to catch up on deferred work; and (d) nobody goes back to measure before-and-after performance and push the organization to keep using, improving, and learning (often because that wasn’t budgeted upfront).

The five points he lists as the role of the EHR are nearly universally applicable. Even if they aren’t, every hospital should make their own list: what exactly do you hope to accomplish with this software other than to make people use it in some unspecified way? What are your success criteria and how will you measure them in a way that’s specific to patients? Is the organization capable of mandating change?

Practice makes perfect in almost everything, including EHR usage. Nobody get it right at go-live. Docs scream, nurses roll their eyes, and the IT people cast downward glances at their shoes even more often than usual. When the first batter doesn’t knock one out of the park, the crowd streams for the exits.

None of that makes any sense whatsoever. Quality improvement is, by definition, continuous. Usually it happens without anyone even noticing until some obscure quality geek armed with Excel e-mails out a graph that startles everyone: holy crap, we actually changed something for the better. The overriding question should always be: are we delivering better patient care today than we were yesterday?

Uncle Sam, Asif, and your vendor can tell you how to Meaningfully Use your EHR. They can’t tell you how to use it meaningfully. There’s a difference. Each hospital must choose its own goals and the methods by which it will achieve them. MU is the least common denominator, the gentleman’s C that causes no shame, but earns little respect. What hospitals do beyond being minimally compliant with the MU checklist is meaningful. That’s the part that will make all those taxpayer billions worth it.

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Larry Hagerty is president and CEO of MedAptus of Boston, MA.

Tell me about MedAptus.

Our focus is on the revenue cycle. We develop software tools, information capabilities, and related services to improve charge capture and charge management.

The company is about 10 years old. We’re headquartered in Boston. We have a development office in Raleigh, North Carolina.

We’re trying to eliminate inefficiencies and improve processes in the revenue cycle. Our customers are generally physician practices. The bulk of our product is in professional charge capture, or physician charge capture. We’ve been fortunate enough to be very successful in the major academic centers and integrated delivery systems because we’ve focused on flexibility and configurability of systems and integration with other systems and scalability.

Because we’re in the revenue cycle, clearly a lot of our value-added is in financial return. We do a lot of work in improving the top line of our customers because we’re helping them avoid missing charges. We help them in terms of the efficiency of that as well because we’re automating things that haven’t been automated and streamlining processes and helping them with compliance.

Charge capture sounds easy. Why isn’t it?

It’s a great question. I think that one big reason is that when one knows best what needs to be charged — which is as close to the point of care as you can be — the tools and systems that are in place aren’t really tuned to help you capture that and to manage it. The clinicians are working in a clinical environment. The systems and tools that they’re working with are geared to supporting that activity. The financial systems and administrative systems speak a different language.

A lot of our work is trying to make it easy for the doctors to capture what they need to know from that administrative or billing perspective and make that workflow between the doc and the administrative and coding staff very, very easy. These systems, again, they’re oriented differently. Connecting that and streamlining it is really where we spend most of our time and attention.

The industry is talking almost exclusively about the potential payout of meeting Meaningful Use requirements. How would you coach a physician looking at that potential return versus improving the way they capture and bill charges?

I probably couldn’t position it as one versus the other. I would say that, with regard to the charge capture work that we do — again, which interacts with the clinical domain but is not a direct part of it — there’s a much more clear and direct and immediate financial return, and it’s very significant. The clinical systems and Meaningful Use are trying to drive fundamental changes in clinical process. There are longer-term returns on those types of things. Also, there is a real return around the stimulus money.

Really, you have to be attacking both. It’s about timing and sequencing and integration.

When you look at the typical practice PM or EMR, what charge capture deficiencies does it have?

Depending upon what type of EMR system they have and how structured the documentation activity is in the creation of the initial charge, we make it very easy to do that to the extent that the system isn’t using it.

What’s more important are the things that go beyond that. We promote a lot more rules and flexibility and configurability to the physician. We do a lot to create the workflow between the physician and the administrators and the coders. We also do a lot of work that most EMRs don’t, around reconciliation and a lot of things that can be done to make sure that all the charges are captured independent of the tools around where the physician is entering their material.

That’s particularly true in an inpatient setting as well, where the EMRs and the operating systems that a physician may be working with don’t exist in the inpatient setting or they’re not there or not available.

We have a charge capture capability that cuts across those things and makes the job a lot more easy for them. We do things that are just out of scope, really, of a lot of their outpatient and office EMRs.

When you look at the big picture of the revenue cycle, what are the most important trends you’re seeing lately?

There’s a lot of consideration about reimbursement and reimbursement systems and how good the current system is and what we ought to be looking at in terms of bundling, whether it’s bundles of types of patients, or bundles of procedures and capabilities that go around an inpatient visit. I think that’s a very, very important issue and it’s going to change the way things happen.

ICD-10 is coming. Maybe it comes exactly when it’s projected now, or maybe it’s a little bit later, but that’s also a fairly significant item of operational impact.

Lastly, the fact that the EMR is going in place. That’s there, it’s going in, and the stimulus has helped with that. It’s had a big impact on our systems because we’re much more attuned to and aggressive about how our tools directly interact with and integrate and leverage that technology that’s being put in place than we might have been four or five years ago when those things were not moving as fast.

You mentioned ICD-10. How hard is it, overall, and how important is it to keep up with all the coding requirements that are constantly changing?

It’s tedious, it is hard, it’s extremely important, and it’s one of the values that a firm like ours provides because there’s leverage in doing that across multiple customers. It’s not impossible to do; it’s just a lot of work.

Something like ICD-10 is really more of a fundamental shift about the number of codes and some different approaches to the way the classification system is structured. That creates an additional challenge, but that’s what we do.

Isn’t it duplicitous for the government to talk about simplicity and transparency in healthcare, and yet it makes something as simple as getting paid so complex that companies like yours exist to support that?

One could only agree that the reimbursement system is not optimal and it ought to be streamlined. Frankly, we try to drive to do that. I think there’s plenty of room to streamline and improve and optimize processes and systems even with a lot of simplification.

What I would try to do is start the discussion around what are my objectives and what do I want to incent? Because that’s what the reimbursement system ought to be designed to do.

I do think that concepts of bundling are relevant in a number of these situations. I think concepts — to some level — of bundling around types of patients and things like that make sense. I think at various levels within the delivery system, counting what people do is an important part of reimbursement, but that may not be the case at the highest levels of reimbursement all the time.

I just think it’s going to be evolutionary. I would focus first on what objectives are you trying to get accomplished, and how to try to do that. Obviously, there’s a lot of discussion about does a reimbursement system incent more volume than one needs? I’d be looking at some of that if I were in a position of authority in looking at reimbursement systems.

What we’re trying to do is based on the rules that are put in place by the government and other payers. We’re trying to make sure that our customers accurately and efficiently bill properly against those rules. Our job is to understand what they are and get it right the first time. We streamline the process and make sure that the providers are getting it done accurately.

What percentage increase of charges that a practice is entitled to collect might a practice see with your product?

It’s a significant percentage. Five to 10% is not unusual. If they are in a paper process prior to us working with them, $20-30,000 a physician per year is a very routine kind of return that we get. This is because of things they may miss when they’re in an inpatient setting, defensive under-coding, and the inability to reconcile. We make sure they’ve captured all the business they’re charging. It’s a meaningful percentage.

How have the RAC audits changed your business?

They’ve probably created a little bit more of an incentive to use a tool like this because we create an audit trail of the billing and coding activity. As we’ve evolved our tools over time, we’ve expanded our audit capabilities. In a number of settings, data has been extracted to support the compliance work that our customers are doing.

Looking at the big picture of revenue, what impact do you think healthcare reform is going to have?

One is the volume of care through the government and other insurance mechanisms is going to expand. The mix of how reimbursement, or the mix of payments, will increase through the structured insurance industry. That’s an expansion kind of activity for the providers.

I think on the flip side, it would only be prudent to expect that there will be more pressure on reimbursement and more economic pressure on providers. So, while there’s an expansion of volume that’s going to go on, I think there’s going to be an increased push — and one that’s going to be more intense than has been felt in the past — around being efficient and effective and high-quality and high-caliber, both clinically and administratively.

Many people think physician practice reimbursement is going to go down no matter what. How do you see practices reacting if that happens?

I hope they get more competitive. You know, improve their processes. I think that’s what they need to do. Now obviously, we have a wonderful system of clinical capabilities, but there are real opportunities to do things better.

Any kind of environment where you’ve got an opportunity to automate things that can be automated, you have an opportunity to reduce cycle times. You have an opportunity to reduce errors, whether it’s administrative errors or clinical errors. You have an opportunity to reduce frustration, at least within the walls of the provider institution, by improving processes.

All those things have to happen, and happen more effectively. I think that’s the only move that will be a successful one.

When you look at the Meaningful Use requirements, do you see that as doing enough to encourage the kind of behavior that will make practices more efficient?

I would say that it’s probably a start and directionally good, but my personal view — and this doesn’t have much impact on our business directly — is it has to go beyond those things. Whenever you have rules like that, I think sometimes they get at form over substance. I think more has to be done over time.

If you look five to ten years down the road, what are your plans for the company?

We’re a niche leader in what we do. We’ve had a very good run. Our track record is good. Our customer base is strong. We see this area of charge capture and linking the clinical and the administrative systems more effectively being a big growth area. All of our energy is on doing as good a job as we can do with that and expanding our capability.

We’ll probably be doing more in the future with regard to channel partnerships with HIS vendors. For example, we have a nice growing relationship with Allscripts today, so we’ll probably do a little bit more of that, but our focus is all on this particular area. Whatever happens with us down the road, we expect that this charge capture and charge management functionality to be at the core.

Final thoughts?

With our policy reform and a lot of what’s going on in the industry, this is such a real important time for the delivery system. The rules are changing. We think it’s a neat time to improve operationally, clinically, and organizationally. There’s probably no more important time to try to get more aggressive and innovate in ways that can pay off than now.

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From Buck S. Pearl: “Re: West Virginia Health Information Network. It’s tough to explain paying a $200,000 salary for overseeing five temporary workers. The HIE’s director resigned abruptly a few months ago before the RFP was complete. They need to finish the RFP, pick a vendor, and start building the HIE or there’s going to be political hell to pay.” The biggest atrocity is that they’re try to convince people that their WVHIN acronym should be cutely pronounced “Win”, which surely nobody’s buying. Being an HIE, they’re burning through state and federal grant money like the party will never end.

From Luria: “Re: Catholic University’s MSIT-HIT. I figure this is the result of HITECH, but what do you do with a MS in IT with a concentration in HIT? Do CIOs really favor a newly-minted Master’s over a clinical background or work experience?” I would see it as an add-on to both that might help land some jobs that aren’t too specific (i.e., not project management, implementation, software analysis, etc.) I doubt it would get you a job on its own, but it could get someone into management. You’re probably right that it’s riding the HITECH coattails since it even mentions Meaningful Use. Let’s hear what readers think.

From DeAnne: “Re: Microsoft. They’re working with a vendor to create a mobile physician workflow solution for Azyxxi-Amalga.” Unverified.

Listening: Razorlight, catchy indie rock by guys from England and Sweden. I’ve listened to three of their albums today, one of them twice. A reader asked what music I listen to in the gym, so here’s the current heavy rotation: Hole, Beatnik Termites, Nine Black Alps, After Forever, and Luscious Jackson. It changes since I play stuff to death and then move on, but these have stood the test of time and and are fast enough to keep me from establishing a too-slow running pace that will propel me off the back of the treadmill.

Ed Marx’s post on multitasking was a hit, obviously. He has updated it with responses to those questions he was asked. Ed is, I think you’ll agree, The Man.

Some stuff you can (and should) do here: (a) stick your e-mail address in the Subscribe to Updates box to get instant notices when something new goes up; (b) justify my expense in buying a search engine application by using the Search All HIStalk Sites box, which digs though everything in HIStalk Practice, HIStalk Mobile, and seven-plus years of HIStalk without you having to lift a finger other than the one with which you click the little magnifying glass; (c) Friend or Like us on Facebook on the widget to your right to stroke the emotionally needy Mr. H and Inga; (d) report a rumor using the ugly green but securely anonymous Rumor Report box; (e) check out the ads of my sponsors, consider them when doling out your business, and thank them publicly or otherwise for keeping the HIStalk fires burning.

Sponsor jobs: Web Developer, HL7 Analyst, Regional VP of Sales, Clinical Product Specialist.

Weird News Andy sprouts this story, in which a man’s suspected tumor turned out to be a pea plant growing in his windpipe. He was fine once de-legumed.

This fascinates me: pictures taken by GPS-equipped smart phones and cameras contain invisible geotags that identify the exact location at which the picture was taken. It’s possible but complicated to disable that function in iPhones, but if you don’t, pics taken outside your home tell anyone who cares precisely where you live. Check out this site, which runs a stream of posted tweet pictures and the addresses from which they were taken, of which the site’s creator described the typical reactions: “’I’m going to punch you out,’ or ‘No duh, like I didn’t already know that’ or ‘Oh my God, I had no idea.’”

Thanks to the folks at ZirMed, a new Gold Sponsor of HIStalk. The Louisville, KY company offers services that include eligibility verification, payments, claims management, ERAs, collections, and analytics. Their latest offering is Patient Notebook, a green way to manage statements by sending them electronically and allowing patients to view, manage, and pay them online, saving providers 40% on mailing costs in the process. The provider can view delivery information and print a paper statement if needed. It also sends an electronic reminder and then a paper statement to patients slow to respond. Thanks very much to ZirMed for supporting HIStalk.

An LA Times blog suggests that HP CEO Mark Hurd got a raw deal by being ousted over falsifying $20K on expense accounts to hide his alleged philandering, citing the case of HP director and McKesson CEO John Hammergren. It argues that Hammergren joined his fellow HP board members in holding Hurd accountable for the same standards as other HP employees, yet McKesson admitted it fudged the formulas used to calculate Hammergren’s nest egg to raise it from $74 million to $85 million. I mentioned his “golden coffin” bennies last year, saying

Those provisions pay a lump sump to heirs when a senior executive dies, $25 to $39 million when John Hammergren meets his maker (in addition to the $80 million his family would get from his retirement plan) … You would think he founded the company instead of just coming on board eight years ago. Maybe Senator Grassley should look there if he wonders why healthcare is so expensive. But, if MCK shareholders would rather he get the money than them, so be it.

The VA starts posting a monthly list of data breaches that include lost BlackBerrys, unencrypted e-mails, mis-mailed prescriptions, and missing laptops (to their credit, all six laptops reported missing or stolen in July were encrypted). A fun non-breach item reported: a VA employee was caught using someone else’s SSN on her employment documents. “Per the OIG, the employee is definitely using the wrong SSN. The question is why.”

A tech article describes the SafeBaby Breast Milk Tracking (SBMT) system, which bar code matches babies against mothers and also checks expiration dates.

WakeMed (NC) rolls out Axial Alerts, an open source platform that allows pediatricians to review real-time clinical information from the ED of WakeMed’s new children’s hospital. I mentioned the Raleigh-based Axial Exchange in February when I listed the participants on the Health IT Venture Fair at HIMSS. Some of its execs are from Red Hat.

Jobs: Senior Project Manager, Epic Inpatient EMR Manager, NextGen Consultants, Marketing RFP Consultant.

A McKinsey Quarterly article (or at least the teaser part I can see as a non-subscriber) says HITECH-encouraged EMR adoption could save $40 billion per year.

Massachusetts regulators approve creation of a doctor shopper database to curtail prescription drug abuse.

Transition of control of Marin General Hospital (CA) from Sutter to the local healthcare district has gone well, except that “some of the imperfections have been in the IT area.” They had problems between their McKesson systems and their printers, causing delays in the outpatient lab. The CMO said the integrated system should be an improvement, but the nurse’s union rep said she’d heard the software was hard to use.

Dell is pitching its Android-powered Streak tablet to schools and will go after the healthcare market starting in the next few weeks.

E-mail me.

HERtalk by Inga

From Get Off of My Cloud: “Re: Ben Clark. He’s left Allscripts.” Unverified. Clark is/was the SVP of support for Allscripts and had been with Misys for a decade before that. True or not, I suspect we’ll see plenty of changes at Allscripts and Eclipsys over the coming months as talent is “synergized.”

Nuance introduces Dragon Medical Mobile Search, a free iPhone app that allows physicians to search for medical information using voice technology. A physician can use voice commands to search a variety of sources, such as Medline, Medscape, and Google. Definitely sounds cool. Anyone tried it?

NYC REACH, the REC for New York City, selects Business Technology Partners as a preferred vendor to help physicians implement EHR solutions.

CareFusion says it will cut about 700 management and support jobs following a big decline in net income. The company posted Q4 net income of $52 million compared to $96 million a year ago and expects the cuts will save as much as $120 million per year.

Microsoft names FormFast as a Certified Partner.

Southwest Medical Center (KS) selects Summit Healthcare and the Summit Express Connect interface engine to manage its Meditech connections.

Rhode Island’s medical board reprimands a neurosurgeon when a patient complains her medical record documented services she did not receive. The doctor blames his EMR, saying he erroneously clicked on items using the software’s drop-down menu tools. The insurance company was also billed. The board was skeptical of the doctor’s claim based on the number of items selected. He’ll have to attend a medical record-keeping class and pay $500 in administrative costs.

CliniComp announces that seven US Air Force, Army, and Navy military treatment facilities implemented its Essentris EMR in the second quarter.

IBM is working with the VA to test a new paperless claim process. The VA hopes the electronic process will reduce its backlog of 497,000 pending disability claims. Am I the only one shocked that this process is just now going paperless?

Another step in the right direction: the VA’s CIO says that for the last month and a half, the VA has been successfully using the DOD’s personal ID system for each of its service members. Meanwhile, the VA expects to announce its plans for modernizing VistA by the end of the year

DR Systems announces six new contracts for its Unity RIS/PACS, each worth between $225,000 and $1 million.

Pinnacle Health System (PA) will deploy MobileMD’s eShare module, which allows providers to exchange messages and share clinical documentation electronically.

A new reseller alliance between Crossroads Systems and Dell Services gives Meditech customers new options for virtual tape backup and encryption. The Crossroad solutions TapeSentry and SPHiNX are certified by Dell for Meditech and will be the first two products offered.

Cardinal Health Foundation awards over $1 million in grants to help 40 organizations improve healthcare efficiency and quality. Some of the selected projects include implementation of CPOE and/or bedside medication administration, medication reconciliation, and e-prescribing.

What you may have missed in yesterday’s HIStalk Practice: a good read from HemOnc Today that examines the good and the bad of EHR implementations; an iPhone app for identifying adverse side effects; and AirStrip Technologies scores some VC money. Oh, and show me you care by signing up for the e-mail updates when you pop over to the other site.

Hospital execs as a whole are underwhelmed with existing enterprise resource planning (ERP) tools, according to a new KLAS survey. The report’s author says, “Providers say they can expect either robust functionality or service and attention — not both.”  McKesson was the highest-rated vendor with a score of 74.5 out 100. Oracle was a relatively close second; Lawson was ranked a distant third.

Global IT and engineering provider Smartronix expands into HIT with the purchase of HIE vendor Cogon Systems. We interviewed the CEO three years ago.

In odd but non-HIT related news, a Seattle police officer tickets the parked vehicle of a 36-year-old man who appeared to be sleeping in the driver’s seat. The officer attempted to wake him by tapping on the window. When he failed to respond, she assumed he was a sound sleeper. Less than an hour, later the man’s girlfriend tracked him down with a GPS. Medics believe he had been dead in the car for several hours before he was found (and ticketed). The deceased man won’t be required to pay the $42.

E-mail Inga.

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

Confessions of a Reformed Multitasker

I was wrong. Multitasking is overrated. It’s the thief of our times.

New Years Eve 2008, on a plane en route to our Marx Family Annual Strategic Planning Retreat (above), I read Chasing Daylight. The author, Eugene O’Kelly, was the CEO and chairman of KPMG. At 53, he was diagnosed with a terminal brain tumor. He quit his job to settle accounts with friends and family and write a book to convey what he learned through the experiences of life and death.

Based on the principles espoused in the book, I added the following to my personal strategic plan:

• Live in the Moment
• Energy > Time
• Consciousness > Commitment
• Create Perfect Moments

The above principles originated from research done by the Human Performance Institute. I attended their “Corporate Athlete” training, where these concepts, and related evidence-based theories, took on renewed meaning. The idea of energy management struck me. I will post on energy management and the fit leader this fall.

Bottom line: if you desire high performance, then don’t multitask. Avoid a multitasking lifestyle if you care about the personal message you are sending people.

Gulp. Seriously? Guilty!

It had to start at home. Almost every evening, I’m home for dinner by 6 p.m. That’s a sacred time. But now, no BlackBerry, no checking messages, no calls, no social media, no vendor meetings. My energy and focus are on my family. Love is a verb. I show my love by giving them my undivided attention. Emotional energy is a relational factor that surpasses time. I don’t tell them, I show them that they are more important than my vocation.

In fact, the stronger the family relationship, the stronger I am as an employee. I find that leading others is a rewarding honor, and by definition, a CIO must give energy to those he serves. I have stopped multitasking where face-to-face encounters are involved.

I still multitask as described in Green Standard Time (above), but never when I’m with people. What message does it send when I’m not fully engaged?

Has your manager ever multitasked while you share your ideas or answer a question? How did it make you feel? Have you had to repeat questions or respond to duplicate inquiries as a result of someone multitasking? How about during conference calls when you call on someone only to get silence…and their phone isn’t on mute. (Guilty)

I wonder how many people I have inadvertently frustrated by having to revisit subjects previously discussed because I’d been trying to juggle tweeting, e-mailing, and preparing a presentation? Was I genuinely in the meeting to begin with?

After observing a leadership meeting, one of my favorite docs admonished the group for focusing more on e-mail than on the discussion. Kudos to him! How much productivity had been lost?

I am a huge advocate of technology and for displacing paper and paper-based processes with automation, but we must exercise balance. Use your iPads, mobiles, tablets, and laptops to conduct business, but be disciplined and remain focused on the subject and people, not your e-mail or twitter feeds. Make time for that later.

For those who still believe they can effectively multitask while still giving appropriate attention to family and staff, try this simple test from the New York Times. A Google search will reveal numerous scientific studies to support my thesis that high performance and multitasking are mutually exclusive. In fact, Stanford researchers found that multitasking may degrade our ability to think clearly, to separate relevance from irrelevance, and to remember and learn. They conclude by saying, “By doing less, you might accomplish more.”

The way I spend my time and invest my energy reveals what I believe most deeply.

***For those who have an interest in strategic planning on a personal basis, please leave a comment. We will send you a copy of my one-page personal strategic plan that contains the principles mentioned above and will provide you with a template from which to create your own plan. I have one-page plans like this for my career, marriage, and family. UPDATE: due to the large number of requests, the plan has been made available for download here.

Update 8/12/10

Thank you for the feedback. Clearly I was not alone in this journey! I will savor the overwhelmingly positive comments because future posts may nor resonate so well.

I do plan to tackle the challenging subject of the fit leader this fall. Good thing I was a soccer referee for so many years. I can handle the crowd when they don’t like my call.

Samantha Brown asked a couple of good questions. First, do I really make it home each evening by 6 p.m.? When I am in town, the answer is yes 98% of the time. I only have one routine after-hours meeting. It is a physician leadership dinner meeting that takes place bi-monthly. I am able to attend the meeting “virtually” from a hospital close to my home. As long as I am back in time for our weekly Argentine Tango lesson (a few doors down), the world is in harmony.

Finally, I did differentiate two types of multitasking. I am a proponent of multitasking, just not when it involves people directly. Are their circumstances when you are with people but you do not need to pay attention? Sure, but I would ask myself, “Is this the best use of my time?” If the answer is no, don’t be part of that meeting.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook, and you can follow him via Twitter – User Name “marxists.”

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From Staff Infection: “Re: HealthPort. I overheard that the Germany-based CompuGROUP is looking to expand beyond its Noteworthy acquisition. They want to have 30,000 US physician customers by the end of 2010 and have been peeking inside the kimono of HealthPort. Not a pretty sight, but I bet the brain trust at the Thurston Group (manages HealthPort) would unload it on the cheap. Reminds me of the old Steve Martin line of how to make a million dollars and not pay taxes — spend $30M on Companion Technologies and drive it into the ground and sell it for $1M.”

From Misys_Ex: “Re: from the QuadraMed user group. Michael Simpson, SVP of product strategy, has resigned after six months on the job.” Unverified.

From Alanya: “Re: your Las Vegas rant. That’s why I LOVE reading your blog. You make me laugh out loud on a Monday morning. It’s nice to get your perspective for those of us who are office-bound. Keep it up!” Thanks, sweetie. You may regret encouraging me.

From Irene O. Tican: “Re: McKesson. Lee Fowinkle, VP of engineering at McKesson Ambulatory, has left. He was leading the single database project and his departure will have a significant impact on MCK’s ability to deliver an ambulatory MU product.” Verified, at least the part about his MCK departure. I’m cackling to myself at the fake name I made up for this reader’s post, by the way (oncologists will get it).

From The PACS Designer: “Re: Google Wave. TPD has posted about the collaborative aspects the Google Wave platform. Google has announced that it’s ending all development on Google Wave. Some EHR experimenters are unhappy with this news, as they wanted to incorporate the Continuity of Care Record (CCR) and the Continuity of Care Document (CCD) using Google Wave to provide a complete record of a patient’s treatment history across institutions.” I can’t say I’m too surprised at this rare Google misstep. I got an early invitation to Wave, watched the endlessly long video that tried to explain it, tried it for a few minutes, and walked away for good because I couldn’t see the point. If you can’t explain it in less than an hour of edited video, nobody’s going to bite.

From Cassie: “Re: Mercer. Mercer has apparently lost another piece of IT equipment and thus lost employee data for City of Boise employees. I doubt Mercer is going to be signing deals in the State of Idaho anytime soon.”

From Amy: “Re: Aprima Medical Software User Group in Dallas. This is one of the best events I have attended. I am very happy with the path Aprima is taking. This is not an advertisement, but a shout-out for a job well done. An industry colleague turned me on to HIStalk – love it!” President/CEO Michael Nissenbaum invited me to attend the next one after reading my ACE recap. I interviewed him two years ago when the company was called iMedica and had recently licensed its product to Misys (now Allscripts) to sell under the MyWay name. He’s a pretty funny guy.

From Joe: “Re: pagers. Although it would seem this technology should have disappeared, some facilities do not have call penetration. They are also cheaper for workers who just need to receive brief messages.”

Watching: Pushing Daisies, an outstanding and highly awarded comedy-drama with some surprisingly effective poignant and romantic moments (I might have sniffled a couple of times — I’m sentimental). The narration and art direction is outstanding, as is the snappy dialog, the acting, the music, and the always endearing Kristin Chenoweth (instantly recognizable as Bebe’s chirpy assistant Portia from Frasier) and Swoosie Kurtz. Like most shows that require a reasonably cognitive audience, this one died fast, but has arisen from the dead (no pun intended) on Netflix. My highest recommendation.

Kern Medical Center (CA) recovers from a malware attack that took down most of its systems.

The Center for Biomedical Informatics at The Children’s Hospital of Philadelphia creates a free iPhone app that classifies adverse events in clinical trials.

My last post asking for keynote speaker suggestions generate several comments at the end of the article. Check it out.

Former QuadraMed VP Larry Visk joins PerfectServe as EVP of sales.

Santa Clara Independent Physician Association signs up for the Excelicare system (HIE, clinical apps, disease management) from AxSys Technology.

Omnicell will co-market Sentinel RCM (medication functions for 340B billing, drug diversion, inventory, drug cost, and J-code management) from Sentry Data Systems.

Ralph Keiser, formerly of Eclipsys, joins MedeAnalytics as SVP of provider sales.

MedNetworks raises $5 million in Series A funding. Its technology, licensed from Harvard, maps the social networks of doctors to empower its clients to “leverage existing data to disseminate information and focus interventions,” which suggests equal potential for good and evil.

Weird News Andy notes “a Hefty piece of lifesaving equipment” as a paramedic fashions a makeshift incubator from a trash bag and towels to save a preemie weighing less than two pounds.

This is exciting: Microsoft will start a beta of Visual Studio LightSwitch this month. It’s an business application builder (desktop and cloud) for non-programmers that can tie into information from SQL Server, SharePoint, and other data sources. I’m all over it once it’s up.

I was annoyed by the sluggish performance and uncomfortable bulk of my ancient laptop at ACE, so I bought an HP Pavilion DM3-2010us when I got home. I love the 13.3” display, 4.2 pound weight, long battery life, a fast boot option to get to the Web, and built-in webcam and N-capable wireless. It’s like a super-powered, stylish, reasonably sized Netbook. $499.95 at Office Depot after rebate. I didn’t realize how much I hated Windows Vista until I got this one with Windows 7, which is excellent. Now I don’t have to be jealous of those Mac users and their 13.3” lightweights. All it doesn’t have is a DVD drive: $37 for a USB-powered external at Newegg. I’ll be getting some looks at Panera, I hope.

HIMSS VP Pat Wise does a Q&A on What Meaningful Use Means to Nurses.

Actuaries estimate that medical errors cause the US economy almost $20 billion per year.

Speaking of actuaries, even the Medicare Chief Actuary says CMS’s optimistic estimates of Medicare cutbacks are a load of crap, at least unless voters are OK with providers going broke and refusing them service.

SaaS productivity application vendor Zoho and NetSuite form MedicalMine, a consumer tool for managing children with autism. Phase II involves a physician version and an EMR. Zoho has cool, easy-to-use apps, so this could be interesting.

Vangent will pay $65 million to acquire 450-employee Buccaneer Computer Systems, which provides healthcare IT services to the government. I found this interesting: Buccaneer, which previously processed Cash for Clunkers vouchers, wants to ride the wave of federal HIT spending, which is what caught Vangent’s interest.

One of the cooler things I’ve seen on a company’s home page: check out Kronos and the cute Australian who strolls out chatting from behind the application screen shot.

Oracle’s Larry Ellison criticizes HP’s board members for forcing CEO Mark Hurd to quit despite finding that he did not violate the company’s sexual harassment policy. “The HP board just made the worst personnel decision since the idiots on the Apple board fired Steve Jobs many years ago.”

I’m a bit behind in my e-mails, interviews, etc. as I get reacquainted with Mrs. HIStalk after my little Lost Wages junket, so bear with me. I have 15,000 sent e-mails in Yahoo Mail, if that gives you an idea of the volume of interaction I have with readers, sponsors, etc. Happily, I might add, so don’t let that stop you from giving me a holler.

E-mail me.

HERtalk by Inga

Meditech restructures its client services operations with the promotion of Joanne Wood to SVP of client services, Leah Farina to VP of client services, and Helen Walters to VP of clients. The three execs have a combined 68 years tenure with the company, which says a lot about these women and the company (all good). We reported this on July 30, but the official announcement just came out.

Lowell General Physician-Hospital Organization (MA) implements MedVentive’s business and clinical intelligence platform to manage risk contracts.

Another HIT acquisition: EHR/PM solution provider MedLink purchases Health Informatics, supplier of the Health Informatics Digital Pen and MD Form Manager. MedLink, by the way, partners with Patient Access Solutions to participate in the SunCoast RHIO program. MedLink’s president predicts 500 participating practices will generate over $11 million in EHR sales over the next four years.

Madison Center (IN/MI) reports a $25,000 reduction in transcription costs within two months of moving to Webmedx’s web-based medical transcription service.

Press Ganey Associates acquires the Quality Indicator Project division from the Maryland Hospital Association. The QI solutions provide tools for quality reporting, collection, and reporting.

Orion Healthcare Ventures completes its acquisition of Aspyra.

The CEO of Cooper University Hospital (NJ) reports the facility is now live on Epic’s physician documentation with 100% CPOE usage.

Former Eclipsys SVP Ralph Keiser joins MedeAnalytics as SVP of provider sales. Prior to Eclipsys, Keiser had senior leadership positions with EPSi, Cerner, and @OUTCOME.

In the first half of the year, MEDSEEK increased its total gross sales bookings 40% over the same period last year. YTD revenue grew 18%.

Merge Healthcare reports a $30.9 million Q2 loss, in part due to costs associated with its Amicas acquisition. Total sales, which include figures from Amicas, grew 89% to $29 million.

Nuance Communications also posts a loss amid higher revenue for its second quarter. The company lost $1.53 million, compared to last year’s $2.82 million loss. Revenue grew 13% to $273.2 million. Investors expected more revenue, leading the stock price to slip 16% on Tuesday.

Over on HIStalk Practice, Dr. Gregg Alexander comments on the industry’s newest bedfellows: insurance companies and EMR companies. Dr. Alexander calls it a move, “that would surprise most of us about as much as hearing that Coke and Diet Coke are actually made by the same company.”

At St. Mary Medical Center (CA), four staff members are fired and three disciplined for posting photos of a dying patient onto Facebook. The patient had multiple stab wounds and was nearly decapitated from a throat slashing. If you like blood and guts, I guess that might be pretty thrilling stuff and actually get you a few thumbs up. But seriously, how can people be so stupid?

Methodist Healthcare System (TX) selects TeleTracking Technologies’ RadarFind RTLS for five of its hospitals.

Highmark partners with A.D.A.M to provide a new iPhone application that includes medical reference content for members.

I forgot to mention last week that I finally got my new iPhone4. I hate the reception, which is not nearly as good as what I had on the 3G, and definitely not as good as a regular old cell phone. I’m looking for suggestions on bumpers or cases. I had the Otter before and I liked it because it was quite heavy duty and was survived being thrown between my purse and the console of my car. Now I’m open to anything that might enhance reception, if that is possible.

Memorial Hospital of Union County (OH) selects DigitalPersona Pro to provide secure EHR access and biometric authentication.

NextGen is awarded two-year accreditation as a provider of continuing medical education for physicians by the Accreditation Council for Continuing Medical Education.

Here’s a story that I am sure warms Dr. Deborah Peel’s heart. A US appeals court upholds the constitutionality of a Maine law that allows doctors to withhold their individual prescription-writing information from data mining companies.

UC Health University Hospital (OH) contracts with MRO Corporation to incorporate MRO’s ROI processing services with its EMR.

Wellpoint plans to align its P4P incentives with Meaningful Use criteria and implement a financing program to support HIT in rural and underserved communities.

From Weird News Andy, here are details on study by an Iowa State University student who obviously does not understand fashion. For her thesis, the student looked at the whether or not wearing high heels increased the risk of developing osteoarthritis. Big surprise here: the higher the heel, the greater the risk of joint degeneration and knee osteoarthritis. And (duh) heel heights change walking characteristics (slower speeds and shorter  strides). Any woman who has sacrificed her feet for fashion for any length of time could have saved this researcher lots of time and money and told her the same thing. Heels are about looking hot, not being sensible.

E-mail Inga.

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