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October 7, 2010 News 26 Comments

From Rickie in the Shadowlands: “Re: Siemens layoffs. 475 jobs in Managed Services and Professional Services (including Soarian support) will be transitioned to India and Romania, with the first wave of layoffs 60 days from last Thursday. The VP emphasized that no job is safe.” Rickie included the internal e-mails from both the VP (I don’t know his name) and from CEO John Glaser (still feels funny to think of him as vendor CEO and not hospital CIO). John’s seemed sincere and personal. The VP used every contrived buzzword and trite phrase known to man, coming across as smug in leading off with the “clarity and applicability” of his memo, moving to “evolve our delivery model,” “drive value to our customers and position for mutual success,” and finally in artfully finding a soothing phrase to describe trucking off 500 American jobs overseas, “introducing additional geographic diversity.” It’s bad enough to lose your job without having to hear brain-numbing Management Muzak as the soundtrack.

10-7-2010 10-01-44 PM

From Hot Nurse: “Re: nurses. The IOM released a report Wednesday recommending that nurses take leadership roles in healthcare redesign as physician partners. Within hours, the AMA issued a rebuttal, saying that nurses don’t have the education and training that doctors have and they should not assume an equal role. The IOM had science in its hand in saying that nurse practitioners have outcomes equal to or better than MDs. Seriously, the best they can come up with is ‘nurses aren’t our equals?’ In fact, physicians don’t want this low-paid work and we can’t recruit enough primary doctors anyway. The physician image has gone from gods to captains of ships to pathetic in my career. They have not supported IOM’s patient safety initiatives (checklists, handwashing) or embraced IT. They don’t want to do primary care, but don’t want anyone else to, either, and they have no plan for the coming tsunami. Nurses excel at patient engagement, communications, and education, which MDs avoid since they can’t bill for it. Their last big proclamation was that they won’t read PHRs for patient histories because nobody will pay them to do it. The poor economy is bringing out the worst in them.”

From Capitulator: “Re: Meditech’s database. We have a data repository, but given the latency in populating it, would like to access Meditech’s database in real time. Can you enumerate the companies that provide tools to do this? I gather that Blue Elm is one of these but we were hoping for something less expensive.” I need some help from Meditech experts on this one. If you have some advice, click the Add Comment link at the bottom of this post and fire away. Thanks.

From Dr. Love: “Re: patient estimation tools or eligibility software used by hospitals. Would you consider this as a topic for the future? We are interested in products that we can use in our application with simple imports and exports.” I’ll have to punt on this question, too. Little help?

From Picka Penny: “Re: Iowa HIE announcement. The scope was changed by the state to 40 hospitals, meaning ACS’s winning bid is less than $3,000 per hospital per month. I don’t see how they can even buy hardware and pay the expenses of the employees who will have to work free.” Unverified.

From Beantown MD: “Re: your list of reasons that hospitals buying physician practices won’t work this time around, either. You are absolutely correct. It will not work for the reasons you describe, which were the same reasons for the failure in the 1990s. Since then I have not seen any real change in how doctors view this issue. And for the record, these reasons are about the same for why Disease Management works so poorly.” Thanks, Doc (he really is a doc – I just didn’t give his name).

Listening: new from Canadian grunge rockers Finger Eleven, a little softer than their older stuff, so I went back to The Bluest of Gray Skies. All of it’s good, though.

I’ll be mostly incommunicado next week as I take a slightly-deserved hiatus with Mrs. HIStalk in a tropical locale, so the fabulous Inga will be wo-manning the helm in my absence. I’m hoping for none of those “it was better without you” comments when I come back.

10-7-2010 7-06-14 PM

My pal Lyndsey from Nuesoft (she friended me on Facebook and Liked HIStalk, so that makes her my pal) sent over some pictures of their sales folk at AAP last week, dressed in vintage clothing representing client-server technology compared to today’s cloud computing. That’s one hideous leisure suit (I’m having disturbing Mr. Furley flashbacks) and a couple of cute Trekkie outfits. You have to be fearless to be in sales, evidently.

Adobe wins the Blue Button Developer Challenge, sponsored by Markle Foundation and the Robert Wood Johnson Foundation. The challenge was to create a Web-based tool that downloads information from the VA or Medicare to help patients manage and improve health. Adobe’s Blue Button Health Assistant extracts immunizations, allergies, meds, health history, labs, and military service histories.

10-7-2010 7-38-56 PM

Terry Ketchersid MD, VP and chief medical officer of Health IT Services Group, suggests the 2010 book above in response to the reader’s interest in a book about HIT and the future. I see chapters by familiar names Don Berwick, Don Detmer, Bill Stead, and Jon Perlin. Terry’s company sells the Acumen EHR for nephrologists (a very small group, apparently) and they produce an EHR blog for them, including Meaningful Use information. Terry also marvels that I have time to write HIStalk, which was exactly what I was thinking Tuesday evening when I came home from work, ate in approximately 120 seconds, and didn’t leave the chair for the next five hours until I was finished writing Tuesday’s post. Tonight was a breeze at just 4.5 hours.

Voalte gets a writeup in their local Sarasota paper for implementing its iPhone-powered voice, alarm, and text system at Wahiawa General Hospital (HI).

10-7-2010 7-56-31 PM

Inga mentioned the new Allscripts Homecare Mobile. Above are a screen shots I found on their site. It will run on Windows Phone 7-based smart phones.

The VA puts its previously mothballed pharmacy re-engineering IT project back on track after redesigning the project structure.

The Technology Association of Georgia and other groups are sponsoring an all-day HIT Leadership Summit on November 9 at the Fox Theatre in Atlanta. I had to dig and scroll to find pricing, but it looks like $39 for members and $59 otherwise.

IntraNexus will integrate PatientSecure biometric patient identification into its SAPPHIRE Patient Access Manager and Advanced Clinical Manager solutions. Registration or clinical staff will direct the patient to place their palm over a scanning sensor, which will retrieve their records if they’ve been seen previously. My first thoughts were addressed in the fourth paragraph: it can be used to identify John Doe patients and can validate the bearer of an insurance card.

10-7-2010 8-27-39 PM

Stockholm-based Elekta boasts of the #1 KLAS rating of its MOSAIQ Radiation Oncology/MOSAIQ Medical Oncology systems among oncology information systems. You may recall that the company acquired IMPAC Medical Systems in 2005, making it the world’s largest oncology software vendor.

10-7-2010 8-31-59 PM

Both Davies Award winners in the ambulatory category are e-MDs clients, the company says. I like this: The Diabetes Center of Ocean Springs, MS is the first non-physician provider to win the Davies — it’s a nurse practitioner clinic. I’m shocked that Inga offered no commentary about their attire, which I think is quite fetching and possibly deserving of an award in the clinical couture category.

Jobs on the HIStalk Sponsor Job Page: Management Consultant for Clinical Workflow, Project Manager, Regional Director of Centergy Sales. On Healthcare IT Jobs: Data Extraction Architect, IT Systems Analyst, Implementation Specialist, Product Manager.

10-7-2010 8-47-42 PM

I like this: Meditech quietly supports the Lesley University New Teacher Community. They got Neil Pappalardo, Larry Polimeno, and Howard Messing to talk about teachers who made a different in their lives and took the great pic above, which I’m appropriating with full credit to their site because I think it’s an excellent shot of some pretty amazing guys. Sounds like a man crush, I know, but you cannot believe the business accomplishments and social contributions made by the Meditech founders and executives over the years. Neil Pappalardo’s story would be a Hollywood hit, I’m convinced. I’ll willing to write it.

10-7-2010 8-51-28 PM 10-7-2010 8-52-09 PM

Among the Phoenix-area companies presenting at a December investor conference: ClearData Networks (healthcare cloud hosting) and WebPT (a Web-based EMR for physical therapy clinics). I figured I’d give them a shout out just to be nice.

A Microsoft executive proposes that PCs be blocked from connecting to the Internet if they don’t have a health certificate, drawing an analogy to vaccinations. A security expert, referring to Microsoft’s endless security updates, said, “There may be some who would say that Microsoft shouldn’t be on the internet until they get their own house in order.” I think Microsoft is right in identifying a need to protect the Internet a bit better, although the devil is in the details.

This might be a record: 24 laptops are stolen in a Troy, MI pain clinic break-in.

An MIT graduate student develops a health monitoring system that uses a webcam built into a mirror to determine heart rate. It measures variations in facial brightness, a technique that the student thinks will also work to determine respiration and blood oxygen levels.

A free Internet tool developed by a UK-based non-profit research group predicts the drug regimen response of AIDS and HIV patients with 80% accuracy, better than any other method.

Former national coordinator (back when the government wasn’t spending much on HIT) David Brailer is elected to the board of Walgreens. I will have to drop him a note to recognize my local store, where I stopped the other day to buy Halloween candy and found a delightfully garish and well-made Hawaiian shirt perfect for vacation for $6.99. That’s healthcare in America: the same store that sells prescriptions and medical supplies also carries heavily discounted Hawaiian shirts, cigarettes, and motorized Halloween skeletons.

E-mail me.

HERtalk by Inga

Robert Wood Johnson University Hospital (NJ) selects ProVation Medical MD software for gastroenterology procedure documentation at is ambulatory surgery center.

Medicity secures contractual commitments with five new health systems representing 12 hospitals.

RemCare, developer of a care coordination software product, raises an additional $1.9 million in equity and warrants, bringing its current round funding to $3.3 million. RemCare’s CEO is Ben Albert, a former VP of client services for PatientKeeper.

The Health Information Partnership for Tennessee selects Axolotl’s Elysium Exchange platform for its state HIE project.

medgift

RelayHealth introduces MedGift, which sounds like a cool departure from its typical RCM and HIE connectivity services. MedGift is a patient gift registry and social network that facilitates communication between patients and their friends and family members. In addition to providing communication tools, MedGift allows patients to register for personal needs, wants, and wishes based on their individual circumstances. MedGift was actually founded by a cancer survivor is a free service for patients and their families.

AT&T partners with eCario machine-to-machine wireless data and mobile connectivity for near real-time, remote monitoring of cardiac patients.

phyllis teater

The Ohio State University Medical Center names Phyllis Teater CIO. She’s been serving as interim CIO since January.

Starting this weekend, downtown Kansas city will be packed with 6,000 Cerner health conference attendees. If you are one of them, send us a picture or a report from the front lines.

mvdashboard

iMDsoft introduces MVdashboard, an ICU tool that displays clinical and administrative metrics graphically.

Emmi Solutions, a provider of Web-based patient communication tools, names David Pearah CTO and SVP of product management. He was previously VP of the e-prescribing business unit of Allscripts and the former director of product management at Nuance-Dictaphone.

todd park volte

Trey Lauderdale of Voalte sent me a note this week saying he’d be presenting at the DC to VC: Investing in Healthcare IT Summit. Even though US CTO Aneesh Chopra and HHS CTO Todd Park were featured speakers, I told him it probably wasn’t worth a mention — unless he could get a picture with one of those guys in the (in)famous Voalte pink pants. Todd Park obviously has a sense of humor.

Halfpenny Technologies secures $2.6 million in VC funding, which it will use to deliver its Lab Hub platform.

A compliance analyst at UW Medicine Compliance warns providers of these patient documentation shortcuts in EHRs that might raise concerns during an audit: (a) cloning (cutting and pasting) form previous encounters; (b) templates that include pre-filled “negative” terms for each organ system, and (c) macros. CMS is especially concerned when they suspect templates are doing the bulk of the documentation.

Ninety percent of CHIME CIOs participating in a recent survey believe their organization will qualify for Stage 1 stimulus funds by September 30, 2012. They expressed concerns, however, that staffing deficiencies could affect their chances at implementing an EHR and receiving stimulus funding. The release of the survey results coincides with CHIME’s annual Fall Forum. Now what will be really interesting is to revisit these same issues over the next couple of years.

blumenthal chime

Speaking of the CHIME meeting, Ed Marx tells me he won the CHIME Charity 5k. Ed also sent over this photo of David Blumenthal, who spoke in front of 600 attendees and stressed the need for the government and healthcare providers to address consumers’ privacy and security concerns.

When reality is crazier than TV: Actor Brando Eaton files a suit against a prop company, charging it failed to inform actors that a defibrillator on set was a “real working device.” A fellow actor on Miami Medical (a show I’ve never heard of, but that Mr. H says he’s seen filming at Warner Brothers in Burbank) applied the defibrillator to Eaton’s chest during a scene and it sent electrical charges through his body. Eaton was taken to the hospital and later needed treatment and counseling for “anxiety, flashbacks, and apprehension.”

Several employees at a Michigan hospital are reprimanded over a photo taken during a break and later posted on Facebook. One picture was of a nurse removing a splinter for another nurse while in an empty operating room. The pair were part of a group written up for “unprofessional” behavior. Unless I am missing something (like patients were left unattended or a patient’s photo was posted), I’m thinking we are getting a bit overly sensitive about policing social media.

inga

E-mail Inga.

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Currently there are "26 comments" on this Article:

  1. Re: your pal Lyndsey and her interestingly-attired Nuesoft clan – I was lucky enough to get an invite to dinner with them last week in San Fran (sans leisure suits or Trek threads) and I want to tell you that they are some of the nicest pals you could have! What a wonderful bunch – with or without the fancy duds! (Thanks, again, Nuesoft-ians.)

  2. In Response to Comments From Hot Nurse: WOW! I can’t find one word in there that isn’t fairly Spot On! Let’s quit whining and fix this mess….together. Can we do that?

  3. To: Capulator…. would be happy to talk with you about MEDITECH’s DR, we run it in LIVE mode and use the heck out of it! One of MEDITECH’s BEST PRODUCTS. Be glad to go off line with you about it!

  4. I think the real person at fault in the defibrilator debacle would be either the prop master or set director, whichever actually got the thing on set. That person should have then alerted the stage manager and thus gotton the word out that it was “live.” Sounds more like a breakdown in communication than a manufacturing problem.

  5. Re: Dr. Love. Passport Health Communications Inc. was one of the first companies in the U.S. to offer electronic eligibility and currently works with one in three U.S. hospitals. Most providers do want integration with other systems, and Passport offers automated software that can easily pull and post desired patient data with little to no user interaction. It’s a much more efficient workflow and it’s more accurate because it eliminates the potential for manual error, which of course avoids denied or rejected claims.

    Patient payment estimation is in extremely high demand because of the increasing financial responsibility out of patients’ pockets. We have payment estimation software that can be integrated or stand-alone. It produces estimates by reconciling a hospital chargemaster, patient benefits and payer contracted rates (or any discounts for uninsured), in a matter of seconds. When combined with eCashiering (payment processing), it provides a full solution for managing payment, so you are able to confidently ask for and collect the patient portion up front, before treatment.

    These are certainly topics worthy of discussion. Contact us (passporthealth.com) and we’ll tell you more…

  6. RE HOT NURSE……Physicisns need to focus on getting more quality folks into their career..with fewer and fewer docs, we have to replce with other quality people. Remember that when it comes to hospitals it is the nurse that knows the patient and knows the systems…ususally supporting the docs that have no interest

  7. “I need some help from Meditech experts on this one. If you have some advice, click the Add Comment link at the bottom of this post and fire away. Thanks.” Try giving Iatrics a call, they are a great product extender for Meditech. We’ve used them before for interfaces and they are fast and reasonable on pricing.

  8. HOT NURSE is spot on. We have a serious problem in healthcare today with lack of Primary Care MD’s and the pipeline for producing enough in the next couple of years is not promising. Plus we can anticipate 30 million + new insured patients flooding the system looking for care. Advanced Practice Nurses and Physicians Assistants are filling this role in both the civilian and Federal sector. More importantly – their performance has been outstanding.

  9. About Hot Nurse, stating: “The IOM had science in its hand in saying that nurse practitioners have outcomes equal to or better than MDs.”

    My observations of my friends are that this is not true. What diseases are they treating, exactly? It is arrogance that enables NPs to think that they have the judgment and wisdom to treat a sick patient on their own.

    I think that the IOM BOD and authors of the study should do to independent NPs for their regular care, as should the POTUS.

    NPs with long white coats have pockets burgeoning with medical care cook books, and spend hours with computerized decision support (the modern recipe listing). Some are truly stupid.

    This is like having the patient look up her/his symptoms and start treatment.

  10. RE: Dr. Love’s question about Patient Estimators or eligibility software used by hospitals….there are a number of products on the market today that are designed as web based applications to allow hospitals to verify eligibility and estimate patient responsibility. TransUnion offers a Patient Payment Estimation application that uses our insurance eligibility response combined with modeled contracts to determine patient responsibility in real time. In addition, our Revenue Manager application allows hospitals to determine a patient’s ability to pay as well as determine if they may qualify for an entitlement program (e.g. Medicaid) based on percent to FPL. As far as ease of integration into a partner’s application, we have just released “Patient Financial Summary +” which delivers the following data elements (identity/address verification with Red Flag alerts, Likelihood of Collections, Probability of Financial Aid and Insurance Eligibility – full 271) via XML for easy integration into an existing partner application. I can provide marketing materials and examples of the PFS+ output if that would be helpful.

    Jim Bohnsack
    VP Product Development, TransUnion Healthcare
    Cell – 214.707.9432

  11. re: Hot Nurse’s comment “Nurses excel at patient engagement, communications, and education, which MDs avoid since they can’t bill for it. Their last big proclamation was that they won’t read PHRs for patient histories because nobody will pay them to do it.”

    Last I checked almost nothing in nursing gets reimbursed, and by and large physician effort is the only way that money actually flows into the patient care system. MDs *should* avoid work that doesn’t get paid for. In a law firm, I can tell you that people who can bill hours never engage in effort that can’t be billed, it’s a waste of valuable resources. There are few MDs that I know that make enough money to take that kind of time with every patient and still pay for their staff (i.e., the nurses and others), the margins just aren’t there and haven’t been since the ’80’s.

    What you should be complaining about is the compensation system. If they paid to keep patients well, everything you described would be something that MDs would do because it would give that result. Until then, complaining about people doing something that they’re specifically incentivized to do is pointless.

  12. CMS Compliance_”CMS is especially concerned when they suspect templates are doing the bulk of the documentation.”

    They should be concerned about the patients and this ought be added for template use: and the treatment, and the diagnosis, and the length of stay, and every thing else.

    Classical gibberish is being spewed from the cut and pasters, while doctors and nurses go mindless as they click away.

  13. RE HOT NURSE…I say WOW too. Dead on. I’m old enough to have witnessed the same, sad transformation of physicians. There are far too few providing the real leadership necessary to help us reduce costs and improve quality.

  14. Dr. Love,
    Great topic! With high out of pocket expenses, our customers are becoming more consumer driven. With an eligibility product we are able to identify their liability couple that with a price estimator and we will be able to provide our customers what they are asking for. This provides us the opportunity to help them manage their out of pocket expense through various payment options. Nobody likes a surprise bill in the mail for services they have already received. Regardless of how good the service is, this “suprise” creates customer dissatisfaction. We see this as an opportunity to be a leader in the industry.

  15. Suzy,

    I’m somewhat baffled by the assertion that your anecdotal information somehow refutes the IOMs statistical data regarding NPs and outcomes. As a medical professional, why would you comfortably assume that a few contrary examples refute statistical analysis entirely?

    And to say that some NPs are “truly stupid”? I guess there is plenty of arrogance to go around.

  16. To: Capitulator… May be tangential to your inquiry, but PatientKeeper can access MEDITECH data in real-time for its physician workflow applications (patient care, CPOE, eSignature, charge capture, documentation, and communications). Obviously PatientKeeper is much more than just a data extractor or database viewer for MEDITECH. FYI, 23,000 physicians at more than 400 hospitals (many of which use MEDITECH) find PatientKeeper apps very beneficial.

  17. i politely disagree with my colleague from boston. for hospitals to be buying practices, one must ask why physicians are willing to sell. the forces in play now as compared to 20 years ago are similar but different in the sense that reimbursement, particularly in relation to inflation, has been going down while costs have steadily gone up to a point where profit margins are really squeezed in a medical office. at some point, physicians reach a limit on how many patients we can actually see (or want to see) in a day. burnout seems to be more common, which makes employed positions without the added pressure of balancing the practice books much more appealing. a lot of young docs are more interested in benefits packages and weeks of vacation than running their own office. it’s relatively rare in my part of the country for young docs to buy practices from their older colleagues – so who else do you sell your clinic to but hospitals and large groups?

  18. doesn’t matter if nurses think they are capable of performing the same work as doctors. the only opinions that matter these days are those of lawyers. if nurses want to open up that can of worms for themselves, feel free.

  19. Capitulator: “Re: Meditech’s database.

    Mr. H please give Capitulator my contact info since one of my development skills is the abillity to design custom data cube software to extract data from numerous databases.

    TPD!

    [From Inga: Capitulator – Mr. H is out of pocket so drop me a note with your contact information if you want me to forward TPD’s info.]

  20. Capitulator, if you still need some advice or suggestions or even help with your DR, please let me know. I personnally implemented ours and have developed over 80 reports and distributioned subscriptions in the last two years. I use it push out everything from MRSA reports on ICU patients to hourly ED provider turnover rate by shift by day of week to Pharmacy rolling 45 day revenue charting to user audit trails….love to talk.

    PMacD







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