From Sara Dippedy: “Re: crass KLAS. Our company suffered for years under KLAS ‘extortion.’ If we didn’t pay to belong, we were relegated to an asterisked account, insinuating that we were hiding something. All it took was one ticked off IT underling to nail you with an anecdotal crack, even though they were often happy as a bird 24 hours later. Opinions vary due to overambitious vendor guarantees and unrealistic customer expectations. We need an independent, not-for-profit testing authority, like Consumer Reports.”

From EHR Geek: “Re: proctologist. Did I beat Weird News Andy to the punch?” You did. A New York proctologist is arrested at his oceanfront condo for submitting $3.5 million in false Medicare charges, including charging for 85 hemorrhoidectomies performed on the same patient and procedures adding up to more than 24 hours in a single day. My mind immediately offered several witty comments, but I’m sure yours has already done the same.

From Me So Corny: “Re: eHealth Align. The Kansas City HIE’s board approved signing with ICA’s CareAlign as its HIE solution on Friday. It will be announced this week.” Verified, apparently, since it’s on ICA’s Twitter feed.

From The PACS Designer: “Re: ResolutionMD Mobile. The reading of image files on the iPhone is getting easier with ResolutionMD Mobile. The app is free from the iTunes Store. One of the key features is the DICOM processing, and storage stays on the server with window and level manipulation residing on the iPhone.”

Listening: a 1995 CD from obsolete harmonic Canadian power poppers Zumpano. Sounds great.

The California Academy of Family Physicians will use (warning: PDF) a $145K grant from The Physicians Foundation to create an online EMR resource for physicians, including a readiness assessment and tools for EMR selection. “We liken it to changing the tires on a moving car. Our physicians struggle every day to keep the doors open and keep patients healthy. Look, the office doors are open, patients are coming in, it’s flu season — and at the same time you have to adopt an EMR?”

I ran across a cool open source laptop security app called Prey Project. You install its invisible client on your laptop or mobile phone. If the device is stolen, the app phones home via the Internet or text message, sends you its location determined from geolocation services, takes the thief’s picture via webcam, grabs a screenshot of whatever the thief is doing, and locks down the PC. It will look for any open WiFi hotspot if the device isn’t connected to the Internet. If you’re feeling vengeful, you can annoy the thief by remotely triggering an alarm or an onscreen warning.

Doctors in Australia are warned by the New South Wales medical board not to make “flippant and derogatory” comments about patients after a patient complains. Related: the Australian Medical Association questions whether it’s a good idea for doctors to accept the Facebook friend requests of their patients, saying it’s inappropriate for them to blur the professional-social line.

This week’s company-wide e-mail from Kaiser chairman and CEO George Halvorson makes the point that by collecting ethnicity information in HealthConnect, Kaiser can uncover important ethnicity-specific health risks. He makes an interesting point: since every Kaiser patient has the same coverage, treatment, and providers, the only variable is often ethnicity.

Lisa Busby, CIO of Inter-Lakes Health, is named interim CEO after Kevin Haughney quits.

A couple of readers offered software alternatives for mind mapping. Luke O’Scyte recommends for the iPad and iPhone Headspace ($3.99) and iThoughtsHD ($9.99). For the desktop, he’s trying the open source Freemind, which Les also recommends. Ben suggests the free XMind. 

The Health 2.0 conference will be held October 7-8 at the Hilton San Francisco. Companies sending speakers include O’Reilly Media, Microsoft, HHS, Executive Office of the President, Wired Magazine, The New York Times, Cerner, Google, Kaiser Permanente, and WebMD. Other events during Health Innovation Week include a developer’s challenge at the Googleplex, a REC/HIE summit, and HealthCampSFBay. Early bird registration ends Thursday. You can save an extra $100 by using code “HIStalk” when you sign up. I have no financial interest – I’m just being nice in mentioning it.

Epic UGM photos from Wisailer.

Hyland Software, the OnBase document management company, acquires Computer Systems Company of Cleveland, OH. CSC offers document imaging, revenue cycle, and OB/GYN workflow and EHR tools.

Northern Ireland electronic document management vendor Kainos wins its third NHS contract in the last few months.

The Government Accountability Office appoints 19 members to its Patient-Centered Outcomes Research Institute, which was authorized under the Patient Protection and Affordable Care Act. It’s a big deal: this group will get $500 million per year of the $1.1 billion in ARRA money set aside for comparative effectiveness research, including setting research priorities and overseeing clinical trials. CMS can use its results for what sounds like setting co-pays that will encourage more effective treatments. The dean of UCLA’s medical school will head the group.

A patient sues Medical City Dallas (TX) for mishandling her electronic medical records after being called by collectors claiming she owed money for psychiatric treatment. The hospital had mistakenly chosen her medical record for that of an uncooperative psych patient with the same name, then merged the two accounts. Afterward, the hospital sent her a letter saying they would fix the problem, she got more collector calls, and she found the same patient had been admitted again and the same mistake had been made.

Greenway announces the start of its two-day, regionally-offered Meaningful Use training sessions for customers.

It would be fascinating to know why (heavy vendor response?) 75% of readers wouldn’t use a free, ad-supported EMR. New poll to your right: are the product ratings offered by KLAS representative of product performance in a way that’s useful to providers?

An ISMP survey finds that providers are exasperated with never-ending drug shortages. For those unfamiliar, let me explain why that’s a big deal for hospitals. Sometimes there’s only one source of a given drug, meaning doctors are forced to order alternatives they don’t know much about, often drugs that are less effective or more dangerous. Nurse are suddenly looking at unfamiliar drug packages, increasing the chance of medication error. From an IT standpoint, systems have to be changed: automated dispensing cabinets have to be set up for the new item, CPOE and pharmacy systems may require modification, and any systems that read drug bar codes must be re-programmed. Imagine being a high-acuity patient and finding out that your anesthesiologist or surgeon can’t have his or her critical drug, which they know inside and out from years of predictable use, and instead will be rolling the dice on some alternative they’ve already judged inferior, all because a drug company is mysteriously out of the A-team product. Nobody seems to know why shortages happen, but speculation usually runs to the cynical in my hospital: scumbag pharma tactics, wholesaler market fixing, and hoarding by other facilities who hear shortage rumors (that hoarding is often by us, I should add, since we’re just as unhappy about running out of drugs as anyone else and we don’t hesitate to use our clout to jump the line).

The FCC opens up “super WiFi”, the white space airwaves formerly taken up by analog TV signals, a boon for wireless device and service vendors (including those selling hospital technology). An early adopter is rumored to be Microsoft, which supposedly needed only two towers instead of thousands of routers to cover 500 acres on its Redmond campus. Strange: country singer Dolly Parton filed a complaint – she’s worried about the effect on wireless microphones.

This should fuel the usual HIT takeover rumors: Oracle’s Larry Ellison says the company’s string of acquisitions will selectively continue with semiconductor companies and vendors of industry-specific software.

This is scary, especially since it’s probably true here: the #1 organization that graduating college students in Canada would most like to work for is the federal government.

E-mail me.

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Paul Brient is president and CEO of PatientKeeper of Newton, MA.

 

Describe what PatientKeeper does.

PatientKeeper focuses very much around automating the day in the life of a physician. We started out about 11 years ago with the observation that physicians weren’t using technology, in hospitals in particular. Some physician practices invested more and more in automating their core workflows, but physicians were largely left out. The general response was to blame the physicians.

We’ve taken a bit of a different tack and said maybe if we blame the technology or looked at the technology differently, we could get physicians to voluntarily adopt technology. Eleven years ago, we weren’t sure that was going to work. Today, we’re pretty excited that we’ve got about 23,000 doctors that have voluntarily adopted our product.

When you look at the Meaningful Use requirements, do you think they put the proper on emphasis on physician utilization?

Certainly the brilliance in Meaningful Use is that it focuses on at least one of the two third-rail workflows in hospitals, that being CPOE. Without it, I know that our organization wouldn’t be spending as much time on CPOE as we are now. I’m certain that our clients would not be spending as much time on CPOE as they are now. That’s one of the last pieces of physician workflow — the other piece being physician documentation — that has really not been adopted in any meaningful way.

If the goal is to get physicians to fully automate their workflow, having focus on it is a good thing. I think, obviously, it’s a very difficult task to come up with the right way to structure those incentives and structure that motivation. I don’t envy anyone in Washington that had to go through that.

In your mind, was it good news or bad news when they throttled back the CPOE target percentage?

It’s certainly a very odd metric for the inpatient hospitals to focus on one medication — I think it’s now ‘per year’ is the interpretation — that needs to be entered electronically. It’s more of a, ‘Hey, this is important — let’s get started.” Here’s a hurdle which I think that it would be pretty unnatural to try to even achieve that particular hurdle because that’s a bit of awkward workflow for doctors. Again, I think it’s a very difficult thing for them to do. I think the key thing is it’s a stake in the ground that says CPOE is important.

Stage 2, hopefully, will be much more significant in terms of really requiring meaningful adoption of CPOE. I think that if that isn’t, then there may be some organizations that don’t really go full-bore. I mean the goal here is to get most of the doctors in a hospital using CPOE. It’s the ultimate goal. One hundred percent is unrealistic given most community hospitals, but 80% and 90% is pretty realistic. How you get there is a little baby step. Hopefully the next step is a bit bigger.

What would you advise hospitals to do now to be ready for the next stage or to accomplish more than just the minimum requirement now?

The timeframes are getting compressed and we spent a long time getting ready. I think it’s a year and a half from the ARRA legislation to the final ruling of Meaningful Use in an overall six-year timeframe, so we spent a lot of time starting. I think that if an organization said, “Hey, I’m just going to try to do the letter of the law here,” there are lots of crazy ways that people have conjectured that an organization could get to the letter of the law in Phase 1.

I think they’re missing the gift of this. The gift is, “Hey, we’re going to give you some more time to get a proper rollout in place. We’re also going to give you some money, because if the first round is relatively easy to comply with, you get the money from that so you can invest in your ongoing rollout.”

I think if you just said, “We’re going to try to maliciously comply,” or “comply to the letter of the law” and don’t have your eye on the prize, you’re then going to get caught in the same squeeze everyone was complaining about when it was a hard hurdle early on.

So unless you’re intending just to say, “We’re going to do Stage 1 and not do Stage 2 and 3,” which I guess would be a strategy, I think that you really need to be focused on how are you going to get to real adoption of CPOE in the provider community, which is still not an easy task just because you have a little more time to get it done.

Will it be different for community-based hospitals whose physicians practice at their discretion versus hospitals that have employed physicians?

I think very much so. We think of the world as three kinds of facilities. As the academic facilities with a large resident population where CPOE has been most successful — where you have the most control, obviously. Then there’s the more employed model hospital in the community setting, although they overlap. And then there’s this, we’ll call it the “classic community hospital,” where you’ve got physicians that are non-employed and in many cases practice at multiple institutions that are your competitors.

That’s obviously the most difficult environment in which to implement these advanced kinds of workflows and get physician adoption. It’s also the environment where we spend a lot of our time because physician adoption of IT has been particularly problematic in those areas. That’s not all of our customer base, but it’s certainly where we can solve some pretty big problems for our customers.

How are hospitals using technology to attract physician business?

It’s interesting. If you put yourself in the seat of a CEO of a community hospital and you’re not employing physicians, you’re trying to get physicians to refer to your facility. There aren’t very many levers that you can pull to make it more attractive for physicians. Most of the levers, really, are around making the physicians more productive and more efficient. Everything from, “Here’s some nice food or doctor’s lunch, they don’t have to go out and get food” to “Here’s some OR block time” and things like that.

We’re seeing a lot of organizations rely on technology and say, “Look, we can put technology in place. It’s going to save you time when you practice here and reduce hassle.” That’s a big win for doctors because essentially, what they do is they sell their time. So if you make them 10% more efficient by coming here versus going there, that translates pretty directly into more patients, more revenue, a more effective physician. We work with a lot of organizations that really have physicians-facing technology as part of their competitive differentiation in the marketplace.

People aren’t paying much attention to is the fact that the majority of community-based physicians practice in multiple facilities. Are there going to be concerns or push-back from doctors that they’re expected to learn more than one system for more than one hospital?

Very much so, and unfortunately, not just more than one from more than one hospital.

We’ve done some studies of community physicians. When you start adding up all the different systems they have to use, even in a hospital, and then you replicate that at two or maybe three hospitals, it’s just chaos. Early in the day when PDAs first started coming, a lot of them had PDAs just for their usernames and passwords. Of course now they’re on their iPhones and Android phones, but it’s a real problem.

If you think about something as critical as order entry, you have to learn two different user interfaces with potentially two different order sets. Since we talk a lot about evidence-based medicine — which is great, except that 70% or so of the orders in the order set aren’t evidence-driven — two hospitals in the community might have very different-looking order sets.

That’s a real challenge and something that I think people … I know our customers in those situations fully appreciate the challenge, but it didn’t really resonate as much, I think, in the Meaningful Use dollar.

You mentioned evidence-based order sets. It’s interesting that in most hospitals, all they’ve done is to take the market basket of every possible order already being used, dump it in an order set, and say, “OK, we’ve accomplished something.” How do you see that progressing to get to where it is more evidence-based and not just reflecting current practice?

It’s really interesting and very challenging. Especially if you start with a notion, which I think is pretty well-documented, that the majority of the orders in an order set aren’t evidence-driven. You end up with these crazy order sets, which is here are all the personal preference items for all the physicians in one order set, so it’s like nine pages long. Clearly that’s not useful really to anyone other than you can check a box and say, “Yes, I have an order set here.”

I think where things are going, and why people are trying to push this, is the core evidence around conditions are reasonably non-controversial, not necessarily practiced by everybody, but at least when you present it to someone, you don’t get a lot of push-back. There’s starting to be organizations like Zynx and Provation and others that have evidence-based order sets you can purchase and you can say, “Here’s the evidence piece.”

The trick is what to do about the rest of the orders. I think that’s where you can end up with the simplest, from a technology perspective. It’s, “Let’s go with doctors together and we’ll agree here, in this medical staff, on all the non-evidence-based orders and which ones we’re going to put in and make it more reasonable.”

Again, that works great in an academic setting where you’re trying to teach everyone to practice medicine, so it’s good. In a community setting, especially one with splitters and voluntary physician staff, it’s almost impossible to get the bandwidth to do that.

I think you’ll see organizations really want to try to say, how do we take evidence and then allow the physician convenience items to be managed separately from the evidence so that we still have a nice evidence-based, consistent practice of medicine here, but if I want the nurse to call me when a temperature is 102 or their hematocrit hasn’t gone up by more than 10% every hour or whatever the triggers I like to use. They’re different with another doctor. I don’t necessarily think that we try to homogenize that across all the surgeons in the community.

Is it reasonable to expect, given the status of the technology today and how people are likely to deploy it, that we’ll see an immediate improvement in healthcare delivery with an increased utilization of technology?

That is the $20 billion question. Clearly with Stage 1 Meaningful Use, we’re not going to see a significant impact on the cost or quality of healthcare delivery. The requirements aren’t such that that’s going to make a difference. It’s a process, and I think that the people that put together Meaningful Use really recognized that process.

I think that in order to really get a big impact, we have to change behavior, and that isn’t just a technology problem. You can put all the standard order sets in the world in front of physicians, but unless they do something different as a result and you’re able to change the way they practice or the way they interact with information or the way they operate with the care teams, then this isn’t going to make a difference at all. Except for perhaps to save some time with ward clerks and save some paper and things like that.

I believe that technology’s a really critical tool. With a fully electronic environment, you can see in real time what’s being ordered. You’ve got computer systems that can generate alerts and understand things. Used properly, it can make a huge difference, but it’s got to be used properly. I don’t think we’re going to see those impacts until the late stages of Meaningful Use, and probably thereafter.

I’m sure you’re familiar with the studies that show in some cases, increases in mortality as a result of putting in CPOE systems. Obviously, that’s using things improperly, but it is not a given and it’s not just a, “Check the box, it’s automated. Look, wow, it’s better!” It’s not like factory automation. It is really something that’s going to become part of the process, part of the culture, but you have to have it in place in order to do that.

If I were to read intent into the Meaningful Use approach, I really think that’s what’s going on here. I think that it’s an investment that will pay off, but it’s not immediate. My fear is that the world at large is looking for an immediate kind of increase and improvement. Just like, frankly, many other automation tasks in other industries, the improvements aren’t that immediate, but they’re there.

Do you think this is the carrot and there’s a stick yet to come?

I don’t know. Certainly, the stick is an important part of the legislation. The stick isn’t that big, frankly. You can take away the Medicare increases for organizations, but of course people remind us that Medicare’s been going down recently. I think it’s going to be difficult, politically, for the government to impose much of a stick. That’s just my conjecture.

I think the stick will come, probably more from peer pressure, if that’s the right term — competition of industries — but these hospitals are geographically separate. But I think if we can get 60-70% of the hospitals in the country to whatever Stage 3 Meaningful Use is, then it becomes a, “Look, you have to do this to keep the doors open.”

Hospitals have adopted all sorts of things. We don’t give them credit for basically going filmless in the imaging side. Most nursing workflow automation, pharmacy automation, lab automation — all these things have happened. Bar code meds administration — all these things have happened without Meaningful use, so I think there will still be pressures in the industry.

I think what this has done is brought these applications that probably would have been very low on the list of priorities to the forefront. I think if there can be a real effort to get most of these hospitals going, the rest will fall in line without a stick.

How big a game-changer is mobile access going to be?

We think it’s fundamentally important for so much of physician adoption. Not so much because it’s the only way, or even the primary way someone would put data in or look at data. But just like your e-mail and your BlackBerry are so fundamentally important to the way knowledge workers work today, without my BlackBerry, my e-mail’s a very different thing.

Likewise with physicians, when we give them desktop access and mobile access, it gives them the ability to work in ways that fit so well the way physicians work, especially these physicians that have multiple, different hospitals. Great, we’ve got lots of computers at our hospital. You go to the next hospital, in some cases they’re a huge pain to get at. Sometimes you can’t get into your other hospital system –  you’re not comfortable on the floor pulling up some of the hospital’s stuff. You get a call — you can’t get access to information in your car, so it really is a really important, critical part of the physician workflow.

If you go into the CPOE world in particular, you see a lot of adoption challenges with CPOE around the simple orders, the bedside order, where you walk in and the nurse says, “I want to give the patient a medication for nausea.” Today, that’s a simple thing. I’ll just note in the chart because I’ve got it here in my hand. It takes 5-10 seconds to write down the order. In the CPOE world, now I’ve got to go get a computer, I’ve got to get logged in, I’ve got to get the order in. Maybe that’s only a minute and a half, but I do that times 20 and now I’ve wasted a half hour of my day being annoyed.

Whereas on my iPhone or my Android, three taps and the person’s got the medicine. That’s even easier than the chart and I know that it’s checked so I don’t have to think about what meds they’re on already. So in cases of contraindication, it comes right away so I can be confident in that. I think it’s a game-changer in CPOE. I think it eliminates some of the real issues that we’ve heard from physicians, even in organizations that have been successful in the CPOE world.

Any final thoughts?

Well, it certainly is an exciting time to be in healthcare IT. I know you’ve been in this industry for quite a long time. I have been my entire career. Up until about two years ago, I showed up at a cocktail party and told people I was in healthcare IT and people kind of looked at me funny and we’d talk about something else. Now, everyone’s excited about it. They’re like, “Wow, this is going to really make an impact,” and I think that’s both a blessing and a curse.

I’m hopeful that, as an industry, we’re able to deliver the impact, the ultimate impact. Bending the cost-curve, improving quality, and frankly, helping make it less painful for patients and doctors. But ultimately, for patients to access the healthcare system. I think technology holds a lot of promise for that.

We didn’t talk a lot about HIE, but I think that’s another area of opportunity for the industry, where it could really become a really important game-changer around patient engagemen,t a reduction in patient frustration that I think can also save a lot of costs.

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From Clinical Wisdom: “Re: KLAS. A friend told me that Eclipsys paid KLAS $300K per year. Can KLAS accept mega-bucks from vendors they evaluate without being influenced by their cash? Imagine Consumer Reports taking money from car companies. I think they owe those who buy their reports a full accounting of what they earn from vendors and what those vendors are promised.” We’ve been around and around the KLAS business model over the years. Providers don’t usually pay KLAS for the reports; they get them free in return for providing data, so they would not be surprised to find that vendors pay big bucks (i.e., it’s the HIMSS “ladies drink free” model). I asked Adam Gale in my 2007 interview if the company would be willing to have its survey and ranking process audited by an outside expert. He said yes, but that hasn’t gone anywhere as far as I know. He offered this comment when I asked if being paid by vendors is a conflict of interest:

I would say we have one of the world’s strangest business models, where internally, if you ask anyone at KLAS who our customer is, they’d tell you it’s the provider. That sometimes irks the vendors because they pay a reasonable amount of money to have access to the subscriber data. One vendor, as a mistake, sent us an e-mail intended to be internal that said, “Doesn’t KLAS understand who the customer is based on how much money we spend?” We hold that up and cheer. The vendor is not our key customer. The provider is. We frame every vendor question in terms of, “Will it help providers make a better decision?”

From Spell Czech: “Re: CareFusion Pyxis. Are they really struggling against Omnicell? I hadn’t heard that. Love the blog — been reading for a couple years now!” I’m sure Pyxis still holds most of the market, but it wasn’t long ago that they never lost customers. Both my current and previous hospital employers reconsidered whether Pyxis was worth keeping (clunky software, arrogance, bad support). In one case, we begrudgingly stuck with them because McKesson’s product wasn’t fully baked and Omnicell was struggling. In the other, we dumped Pyxis and never looked back. My conclusion is that, finally, Pyxis has some real competition from both of those now-acceptable alternatives and the market is reacting at least somewhat to that, even though those competitors share some of the same flaws (too many engineers making design decisions and worrying about moving parts instead of nurse-friendly software). I haven’t heard anything about Cerner’s entry into that business. Competition is good for everyone, especially the customer and patient.

From Mighty: “Re: ED denominator for Meaningful Use. CMS has finalized it, though I don’t see it mentioned in many places.” The CMS clarification says that only ED patients who are admitted as inpatients or who are treated as observation patients count toward the CPOE requirement and other parts of MU.  

From Computer Giant: “Re: UPMC. Can the EMRs not solve this problem?” That was tongue in cheek, in case you couldn’t tell. UPMC howls when a state report finds that flagship UPMC Presbyterian-Shadyside has a higher-than-expected mortality rate for CHF, septicemia, respiratory failure, and stroke. Their excuse is the standard: “our patients are sicker,” but when the state responded that everything was severity-adjusted, UPMC then commented that their younger patients throw off the stats. I’ve yet to see a hospital that took the news constructively that it’s underperforming. Be comforted: in their own minds, every hospital is above average.

From Peggy: “Re: Epic co-op. I love your site. I read it religiously! Our hospital is evaluating vendors to replace our clinical core and Epic is (of course) one of them. I’m interested in the consulting co-up you mentioned. Would you mind sharing more information?” I don’t have details, but I’m sure they will emerge publicly at some point.

From Slidell Computer: “Re: executive director of Physician Hospitals of America. She’s leaving. Rumors are circulating that changes will force physician-owned hospitals to sell out or close. Maybe she sees the writing on the wall.”

From Not Quite: “Re: GOP’s Pledge to America. It returns the country to the 2008 budget, ARRA stimulus money for EHR systems will end, and according to polls, the GOP will take over Congress. Shouldn’t all EHR purchases stop now since they won’t get their incentives?” I’ll stay out of the political debate since I distrust all politicians equally (except maybe Chuck Grassley and Ron Paul), but I would say that anyone buying an EHR solely because of Uncle Sam’s promised largesse should think twice even without the Pledge to America. CMS is like a devious cat owner waving a laser pointer around: they love to see providers jump around in reaction to ever-changing and mind-bendingly complex policies that address what initially seemed like simple, good ideas to make sure no payouts actually occur.

Wisailer, a reader attending Epic’s UGM, shared some of the interesting aspects from the meeting so far (his or her words, not mine):

• According to Judy, one of Epic’s goals is "to improve health care for the world," based on their estimate that 30% of the US population is covered by an Epic EMR.
• She says “do what Epic says" and your implementation will succeed.
• Epic has spent 66,000 hours on Meaningful Use, which Carl Dvorak seemed to imply has slowed down their transition to Web-based applications.
• The customer base is 224, up from 190 last year, and many of the sessions were oriented to new installations.
• 200,000 physicians use Epic.
• Vendor ally — boring. Lots of suites and pretty smiles. More consultants, fewer device and service providers.
• Swag consisted of pre-washed, BPA-free water bottles with special refill funnels at water coolers.
• The Haiku iPhone app will be extended to the Droid soon.
• Canto, a new Epic iPad application, will be released in the near future. LOTS of buzz about this product.
• Horse-drawn carriages are giving tours of the campus and bikes are available directly across from Epic Farms, thought by many to be the production source of Epic Kool-Aid.

The pic above of some of the Epic festivities, which looks like a more affluent, less crowded, and much colder (highs in the 60s this weekend) version of Woodstock, is from Dave Yost’s blog.

As Inga told me, we’ve been outed by Google. I set up HIStalkTV a few months back on a slow Sunday afternoon just to play around with posting HIT-related videos that I found amusing or useful. The site is suddenly popping up on search engines for some reason and readers are e-mailing us about it. It’s definitely beta and I haven’t really decided what to do with it if anything, but feel free to send me your thoughts. We even had one of our favorite PR people ask about sponsorship opportunities, which I appreciate even though I’ve given that zero thought.

I was motivated by Ed’s CIO Unplugged post about his use of MindManager for mind mapping, list making, etc. (maybe because he featured HIStalk prominently in the picture). I tried some of those programs years ago and lost interest, but figured I would look again since I really like the concept for creativity. I lost interest in MindManager again when I saw that it has become Visio-ized (tons of overly complex functionality added for corporations and priced accordingly — $349), so I found a simpler alternative that seems to work great: MindVisualizer ($79). I’m running the free trial and will probably buy it because it’s pretty darned slick. I used it today to make a few plans for the HIStalk reception at HIMSS and the tool didn’t get in the way of my thought process, which is the most important criterion.

This seems remarkably open minded considering the source: on the HIMSS blog, the senior director of federal affairs (Tom Leary) asks for comments on the federal government’s role in ensuring the safety of HIT products. Supposedly the only reason the FDA doesn’t regulate HIT today is because of some fancy, long-ago behind-the-scenes political footwork by various groups and vendors, so maybe HIMSS is considering taking an official position. Why not chime in?

A fun Medgadget post: the National Space Biomedical Research Institute has developed an astronaut EMR that combines a mobile monitoring device with software. The EMR is iRevive from 10Blade, which was designed for EMS users (you mean astronauts don’t enjoy the benefits of a certified EHR?)

Continuing my rant on badly written press releases, this HIE one speaks for itself. For the love of God, doctor and press release writer, take a breath! In addition to the hopelessly dense text, it starts off with (1) a mini-editorial; (2) a snooze-inducing history lesson; (3) a ton of quotes, apparently all so equally significant that none could be omitted to make it readable; and (4) in the VERY LAST paragraph, one long sentence that contains the only real news in all that fluff. There is a reason that companies pay experts to craft their communication instead of doing it themselves.

Precyse Solutions will unveil its new Automated Clinical Documentation software and Computer Assisted Coding software engine at AHIMA in Orlando next week.

Weird News Andy entitles this as “Half a woman is better than none.” Doctors in Canada take a drastic step to save a 31-year-old woman with untreatable bone cancer: they cut her body in half by removing her leg, lower spine, and part of her pelvis, then do a “pogo stick rebuild” in fusing her remaining leg back to her body. I wish I had her positive outlook: “I have no problem getting around. If I need to, I’ll crawl (up stairs) or scooch like a kid.” The most bizarre aspect of the story in my mind, however, was how the doctors described the size of the tumor: they said it was the size of a calzone.

Welcome and thanks to brand new HIStalk Platinum Sponsor T-System of Dallas, TX, which created and sells what is surely one of the most effective, well-accepted, and ingenious paper documentation solutions ever devised: the famous T-Sheets, on which over 30 million ED visits are documented each year. The company offers other versions for ED nurses, order sets, urgent care, and primary care, but I’m sure they would also want you to know about T SystemEV, the company’s emergency department information system (with modules for patient tracking, status board, nurses, physicians, and CPOE) that’s used by 240 hospitals. It offers comprehensive physician and nurse documentation, clinical content, a short learning curve (often just one shift, they say), status board, prescription writing, discharge instructions, CPOE, lab integration, real-time coding capture, and patient satisfaction and reporting tools. All are important for Meaningful Use, of course. Former McKesson MPT President Sunny Sunyal recently joined T-System as CEO, so I’d say he did his due diligence and liked the company’s performance and potential. Thanks to T-System for supporting HIStalk — Inga and I appreciate it.

All adult hospitals in Milwaukee County, WI will use My Health Direct for ED referrals to community health centers, courtesy of an agreement signed with the Wisconsin HIE. I interviewed Jay Mason, the chairman and CEO of My Health Direct, in June.

I was checking up to see what’s happening with long-time HIStalk bestie Scott Shreeve MD, formerly of Medsphere and now building Crossover Health, a member-based medical practice that will provide individualized urgent, primary care, and online health services from clinics in California (Newport Beach, Foothill Ranch, and Aliso Viejo). I didn’t think I’d be interested in the construction video above, but it’s pretty fascinating to see how that company and others are taking a very different approach to healthcare delivery for those who can pay for it themselves.

Some unusually juicy jobs on the HIStalk Sponsor Job Page: Sales Director, VP of Solutions Marketing, McKesson Consultants, Head of Quality Systems, Sales Director. On Healthcare IT Jobs, Senior Account Executive for VA, Sales Professional – North Carolina, Clinical Systems Analyst III, Epic Project Managers, Eclipsys Documentation Consultant.

Home care mobile solutions provider CellTrak Technologies announces the latest version of its smart phone system, which includes Android capability. It’s also sold in Canada by TELUS Health.

The US Army awards a research grant to InterSystems to look at its HealthShare platform to exchange data between Madigan Healthcare System (WA) and South Sound HIE.

Medical College of Wisconsin spinoff Imaging Biometrics gets an $800K NIH grant to develop its software that helps clinicians distinguish tumors from healthy tissue.

Odd: a woman’s iPhone is stolen while she is hospitalized and in labor.

E-mail me.

HERtalk by Inga

From Hamlet: “Re: KLAS, Epic, etc. KLAS found that nearly 70% of new 2009 hospital EMR purchases were for an Epic or Cerner integrated solution. Reading HIStalk, you would think Epic cleaned everyone’s clock.” They cleaned a lot of the clocks that counted, i.e. the big, influential hospitals with lots of beds and big dollar volume.

From A-Rod: “Re: on the move. Long-time healthcare CIO Bob Kaplan has been appointed EVP and CIO of Audax Health Solutions in Washington, DC. Bob has been CIO of WebMD, NCQA, IFMC, National Preferred Provider Network, and PHP Healthcare Corp.”  According to the Audax Web site, the company is an early-stage startup developing products that “change how patients and providers interact.”

From Sunshiney: “Eclipsys wins. Mercy Memorial Hospital System in Michigan is replacing McKesson with Eclipsys and Sidra Medical and Research Center in Qatar picks Eclipsys’ inpatient EHR.” Both verified.

Capario promotes sales and marketing VP Jim Riley to president. He replaces Andrew Lawson, who will be moving to another company within Martin Equity Partners, the entity that owns Capario. Riley was previously VP of sales and marketing for Payerpath, where he also worked under Jim Brady, Capario’s executive chairman.

Saint Barnabas Health Care System (NJ) picks EDIMS and its EDIS software for its six-hospital system.

Scribe Healthcare Technologies introduces Scribe Mobile, a new dictation app for the iPhone, iTouch, and iPad.

Yet another entity announces its ICD-10 conversion strategy. Global IT service provider HCL Technologies will use Health Language’s Language Engine solution as part of its end-to-end ICD-10 conversion solution.

Central Jersey HIE Project selects Advanced Data Systems, Greenway Medical, and MDTablet as its recommended EHR vendors. Well, at least that is what I think was said in the HIE’s very rambling press release.

Holy Redeemer Health System (PA) will implement MobileMD and its 4D HIE technology to provide connectivity among the hospital, community physicians, and other area care providers.

This week on HIStalk Practice: InfoGard provides an update on when they’ll begin EHR certification and testing. A medical office janitor lands in jail after selling patient charts to a recycling company for $40. Theories on why medical office hiring is up despite declining revenues. A new study reveals the top EHR/PM companies in the ambulatory world.

A sign of the times: San Juan College (NM) says it will shut down its medical transcription program at the end of the school year. School administrators admit that computers are increasingly taking the place of traditional medical transcription, so the school will instead focus on modernizing its coding and HIT degrees.

The local press highlights Rapid City Regional Hospital and its migration to Meditech. The hospital has implemented bedside medication verification and is now moving to physician documentation. The transition is not without its opponents, including one neurologist who is apparently not a big fan of EHRs:

They are good for insurance companies and good for controlling data, but it’s not necessarily good for patient care. The travesty is, so far the systems are bad. You’re not talking to the patients. You’re talking to the computers. If the doctor has to type, they’re not going to add very much information. Either you input data or you take care of patients, but you can’t do both well.

KLAS finds that the oncology market has been mostly ignored by enterprise software vendors, with best-of-breed vendors dominating the market. Enterprise vendors are more focused on the medical, rather than radiation oncology market, and often vendors are less interested in functionality and more focused on integration with other systems. Epic is named the closest enterprise system to delivering an oncology solution. Cerner, Eclipsys, GE, Meditech, and Siemens offer varying functionality as well.

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.

Tool Time

This is a picture of my home workbench. I think you can tell from it that I’m not a productive handyman. I learned some time ago that power tools were not my thing. I leave that work to those who have a passion and talent for it.

What does stoke my fire is leveraging IT to enable improved clinical and business outcomes. Thus, I have a much greater interest in my career “workbench.”

What follows is what works for me. Perhaps it will inspire some new ideas for you. Either way, share what works for you in the Comments section.

A common thread throughout my life is the principle of simplicity. Hardware, software, or systems that are robust, yet easy to use,are my tools of choice.

Software

Texas Health is a Microsoft strategic partner and my applications largely reflect this. I use the Office suite exclusively, including OneNote. Everything is integrated and I can easily move in and out of these apps without any format or compatibility challenges.

I use Office Communication Server (video, voice, IM) as my communications tool for all of the aforementioned reasons. It is very simple and easy to have all of my primary business applications on the same platform.

Two exceptions include Yammer and Mindjet Manager Pro. Yammer is our internal collaboration software, often referred to as “Twitter for Business.” The use of Yammer has helped our enterprise in some incredible ways, including responding to emergencies (H1N1, power disruptions) and leveraging the wisdom of the crowds.

Mindjet is a tool to help me organize my thoughts for presentations, meetings, and yes, my blogs.

Hardware

Texas Health is also a HP strategic partner and my device is my office, so I currently have a ProBook 5310. I love that my video and communications devices are all built in. No air cards, phones, or cameras to mess with. It’s all included and very lightweight for travel. Because I like to mess with people’s minds, I have an Apple logo affixed to the black casing, which causes people to scratch their heads.

Mobile

I’ve had a BlackBerry for years and do not plan to change anytime soon (sorry, partners). I upgrade each year and currently have the Storm2. On more than one occasion, I have gone without my ProBook and just leveraged my BlackBerry. I am trending this direction as a permanent solution, albeit I think we are a couple of years out.

What I absolutely will not carry around is a laptop and a mobile and something akin to an iPad. This is way too many devices. I know people who function like this and in some cases, add a pager and/or office phone to boot. That’s just plain silly and gives IT a bad vibe. If you use more than two devices, your life is unnecessarily complicated.

Manbag

Since I operate within a virtual office, another key tool is my leather briefcase. People make fun of my soft-sided manbag because it is worn and weathered. Well, there’s good reason for its scuffed look — I’m always on the go, visiting my team and my customers. It is practical and durable.

Systems

The least tangible but most important of all the tools is what I call “systems.” A system is a well-established routine that you no longer have to think about that enables your highest level of productivity. You can have the greatest tools in the world, but you hamper your effectiveness by not automating manual and routine processes. Sound familiar? Think EHR/CPOE.

One of my “systems” is to have everything I need for the next day’s adventure ready and updated the evening before. When I wake up, I am out the door and driving to the gym in five minutes. Manbag included.

What about you? What’s on your workbench? What tools work best for you?

Update 9/27/10

Thank you for your comments and input on tools that work for you. There is no single perfect tool for everyone, but it is critical that you find one that works best for you.

There were some great suggestions on HIStalk for mind mapping-like software. You should certainly give one of these a try and see if it helps you organize your thoughts and work.

As for “where’s the beef?” as one reader asked, I have posted on more technical subjects like cloud computing, mobility, and virtualization, but I tend to focus more on leadership oriented topics. In my journey, I have found plenty of great technical expertise in our industry, but believe what is lacking to make us more strategic is fundamental leadership.

My focus is on leadership, service, partnerships, and strategy. I will sprinkle in a few thoughts on the more technical side, so stay tuned and keep letting me know what you would like to see.

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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UnitedHealth Group announced after the market close Tuesday that it will acquire computer-assisted coding vendor A-Life Medical of San Diego, CA. Terms were not disclosed.

UnitedHealth Group will add A-Life Medical to its Ingenix Health Care Delivery business, extending a strategic alliance formed between the companies last year to develop advanced coding solutions.

A-Life Medical’s products include the LifeCode natural language processing solution, which analyzes clinical documentation to identify diagnoses and procedures and recommend ICD-9 and CPT-4 codes to coders. Its Actus computer-assisted coding product will allow Ingenix to market services to providers transitioning to ICD-10 by the mandatory October 1, 2013 date.

The acquisition is UnitedHealth’s fourth technology-related buy so far this year, having previously absorbed Picis (high acuity systems), Executive Health Resources (medical necessity and compliance), and Axolotol (health information exchange systems).

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