Michael Rothman, PhD is co-founder, chief science officer, and board chair of Rothman Healthcare Corporation of San Francisco, CA.

Tell me about yourself and about Rothman Healthcare.

I have a PhD in chemistry. I’ve been doing data analysis for 30 years. I spent a good chunk of that time working for IBM, including a stint at IBM Watson Research Lab. I then went off and did consulting for a while. 

The reason that I got involved in this whole thing is a personal one. My mother was a patient at Sarasota Memorial Hospital. She went in to have a valve replacement operation. She did well initially, and then started fading. The problem is that no one understood that she was getting sicker until she was very ill. Without going into the whole story, she ended up dying about a week and a half later.

My brother and I spent a long time trying to understand what had gone wrong. What we decided was that, in a way, the system had failed her. It really is almost impossible to look at the electronic medical record and catch a slow deterioration in a patient’s condition, especially with the fact that there are so many different doctors and nurses that take care of a single patient.

We asked the question: why isn’t there a simple measure of a patient’s overall condition that can be plotted versus time to show a doctor or a nurse that someone is getting sicker?

We went in and spoke to the CEO of Sarasota Memorial, who let us come in to the hospital and try out some ideas for several weeks. That led to a real project about four months later. Over the next couple of years, we analyzed about 60,000 patient visits and data extracted from the electronic medical record at four different hospitals. That led to development of software — in fact, a product and a company to deliver that product — to do that very simple thing that we started out to do: provide a measure of a patient’s condition so that a doctor or nurse can see if a patient is getting sicker.

I have to ask the obvious question in terms of how Sarasota came to be involved with your product. Was that related to … you know what I’m getting at. Was this in terms of a lawsuit or something about your mother’s treatment, or was this just their interest in improving what you had seen firsthand?

That’s interesting. No, it was not involved with a lawsuit. We actually considered the idea of suing and rejected it because it’s an empty thing to do. It would not have been of any value to us to get a sum of money. What we wanted to do was try and prevent what happened to our mother from happening to someone else. No, there were no legal negotiations involved.

Did they undertake this with you in the spirit of recognizing that they had room for improvement and that you had something to offer as someone with skin in the game?

They were a pioneer in electronic medical records. My mother died in 2003 and they had already had an EMR, I think, seven or eight years.

Yes, they’re an Eclipsys client.

Yes, yes, and they had been frustrated really, by the lack of insight that they had been able to extract from all this data. They had all this data and it’s difficult to maintain, it’s expensive, and they were waiting for the real demonstration of value.

My brother had worked in data visualization for many years, and as I said, I worked in data analysis. When we came there, it just caught their attention. The CEO was very sympathetic about what had happened in my mother’s case, but there was something else in the background. There was this underlying feeling that something should be done with all this data.

Maybe what we want is people who are coming at it in a very fresh way. We did not have medical backgrounds. In fact, if we had, I don’t think that we really would have been successful, as it turns out.

If this could happen at Sarasota, it could happen anywhere because that’s a highly regarded hospital using a highly regarded clinical system that they’ve used very well for a long time. If you were talking about the experience of Sarasota to this point, what would be their results?

We developed this index, which we named in honor of my mother — the Florence A. Rothman Index. This is a general measure of a patient’s condition. It’s now part of a software product which we deliver and is being used at Sarasota Memorial.

In terms of a measure of success of this endeavor, it really was if we could help one person avoid what had happened to my mother, then that was the sign of success. But I think we’ve helped many people at this point, but I also think we can help many more.

I guess the toughest part is that you don’t really have any way to know whether your product helped. There’s no recordable event that says, “Hey, we just saved this patient because of something we showed a clinician.” Is that going to be a challenge to go into another site to have something more than just anecdotal discussion?

In fact, we did a clinical trial at Sarasota with 1,600 patients over about five months. It was with a randomized, concurrent control group. If a patient was born in an even year, his doctors or nurses would be able to see the graph, and if he or she was born in an odd year, they wouldn’t be able to see the graph.

We then looked at the outcome as measured, in this case by discharge disposition. What we found was that more patients ended up in a healthier condition and so were able to be discharged to home rather than to rehab or skilled nursing facility. We had a seven per cent increase in discharges to home. It turned out to be a number that was statistically significant.

We’re in the process of setting up clinical trials at a number of other hospitals to replicate this and to extend the work, and to show that we have benefit at not just Sarasota, but other hospitals as well.

As I was trying to conceptualize why this works, I thought of the stock market, where you may track five stocks and think you know everything there is until you look at a stock market index and a long-term trend. Then you realize that you got so wrapped up in the trees that you didn’t see the forest. Does it happen often that the data there but clinicians miss the trend?

Yes, that’s part of it. The thing is, there’s plenty of data. We’re not creating any more data. What we’re doing is two things. We take 26 different medical measurements which are available, basically, at all hospitals. We extract the amount of risk which is inherent in the value of each of these measurements and come up with a single score.

Now in a sense, that’s what a doctor or nurse does when they go in. They come up with an overall sense of how the patient is and a good doctor does it well, or a good nurse does it well. But the problem is if a doctor is rushed, a nurse is rushed, how completely can they really evaluate all the data that’s there? Even even more importantly, do they really know how that patient was the day before when maybe this is the first time they’ve ever seen the patient?

Getting that trend is very difficult to do, even if you’re a doctor and you’re sitting down and studying what’s in the medical record. It’s hard to figure out what the trend is, especially if it’s a gradual deterioration.

There’s one other thing, and that is doctors tend to look at three things when they’re doing an evaluation. They look at vital signs, they look at lab tests, and they look at the last doctor’s notes. However, there is a source of information that they tend to overlook, and that is the nurse’s assessments.

The nurses do what is called “the head to toe assessment” of the patient. It’s something that’s taught at nursing school. They evaluate each physiological system and they record it on the computer. Really, doctors don’t look at it.

One of the things that we’ve done is we’ve said, “Hey, this is actually very valuable information about how someone is.” So we used nursing data in the calculation of our score. It gives the doctor access to something that he doesn’t normally look at.

How did you come up with the 26? How do you know those are the most relevant ones? Are you continuing to see how well the correlate with patient status changes, or do you think you’ll be adding more measures?

We started by going to the electronic medical record and saying, “What’s there?” We looked to see what measurements really are available on all patients. Not only are they available on all patients, but they’re available and they are taken on a continuing basis on all patients. That really brings you down to a relatively small number of potential variables.

Then we tested the variables against different measurements and we looked at the independence of variables. We spent a long time working on the model building itself, but in answer to your question, are we continuing to test it and look for opportunities to enhance it? The answer is yes, although we are comfortable with what we have now. I’m sure that there will be opportunities to enhance it in the future.

Do you think there’ll be ways that you can build into the presentation of the information the ability to collect new information that will help you determine if the correlation is better since your system does not accept data entry?

Let me say two things. One is we’re presenting doctors and the nurses with this graph, and basically, every time a piece of data is entered into the electronic medical record, we recalculate the score and we put another point on the graph. That’s the operational side of it.

But what you’re getting at really is something that we thought of right at the outset, and that is when someone is doing medical research, one of the tough things is to have a good measure of an outcome. If you’re looking for mortality as an outcome, generally mortality is very low in procedures or when you’re dealing with one drug or another. So you need large sample sizes to get specifically significant differences between drug A and drug B, or procedure A and procedure B.

At the point at which our index becomes generally accepted as a measure of patient condition, all of a sudden you have another measure of outcome. You can say, “Hey, we have procedure A and the folks who went through procedure A ended up with an average score of 75 after a week, and procedure B, the folks ended up with a score of 65. And just to calibrate you, 100 is the best and 0 is close to the worst.”

You have a way of getting a quick read on the impact of procedure A versus procedure B, or drug A versus drug B, or workflow A versus workflow B. I think there’s a lot of potential in terms of helping in medical research.

Do you see it as being something that’s applied like a pain scale or a blood sugar reading where there’s a standing order that says if the patient’s Rothman Index gets to this, then transfer them to ICU?

We are not prescriptive, nor diagnostic. We’re not telling a doctor or a nurse what’s wrong with the patient or what to do. We’re basically alerting them that something is happening. But what you’re talking about sounds like the rapid response team Initiative. Is that what you’re referring to?

Yes. It seems like one of the key problems is failure to act. There’s something going on, no one notices, there’s no predefined pathways — someone just says, “Wow, this is bad,” and then nothing happens.

Absolutely. There was a talk given by Dr. Edgar Jimenez, who is the president of the World Federation of Societies of Intensive and Critical Care Medicine. He’s also an assistant professor of medicine at the University of Florida, University of Central Florida, and Florida State University, as well as director of medical critical care at Orlando Regional Medical Center. It was a talk given at the 6th International Conference on Rapid Response Systems in May at Pittsburgh. He was talking about some work that he’s done, preliminary work at Orlando Regional Medical Center with regard to rapid response teams.

One of the problems with rapid response teams is it takes the nurse on the floor to activate the system. Some nurses are going to be great at it, some nurses are not going to be great at it, but many times nurses are overwhelmed. As you say, someone can deteriorate and no one notice, so the team doesn’t get called.

They are very excited about the system because of a capability that we have. We produce a graph showing the patient’s condition over time. We can actually produce a single screen with several hundred graphs on it so you can look at the entire hospital on one screen. The graphs are color-coded and it’s really quite easy to see a decline, even though the size of the graphs themselves is small.

One of the clinical trials that we’re going to be doing is on the order of surveillance, where a member of the rapid response team sits in an office and looks at the entire hospital and says, “Hey, there’s a downturn on the sixth floor,” and picks up the phone and calls the nurse on the sixth floor and says, “What’s going on with Mr. Smith?” If the answer is, “I thought he was going home tomorrow, I didn’t know there was anything going on,” then the rapid response team becomes proactive. They activate themselves. They really become a backup for the doctors and nurses to try and prevent people from falling through the cracks.

I would think there’s some potential use even for things like staffing or for nurse acuity; where you have patients whose diagnosis doesn’t really tell you the significance of their care requirements. The number is relative, right? It isn’t just that your number gets worse, but that if your number is lower than some other guy’s number, you’re in worse condition?

It’s an absolute value and it also shows you changes. It’s interesting that you say that because whenever we’ve spoken to, especially a chief nursing officer, she says, “Hey, I can use this as an acuity tool to help me with staffing.” I think there is some dissatisfaction with the tools that are out there because they require nurses to enter data and they can be subjective.

Our system is, in a sense, an absolute measure of the patient’s condition. As I’ve said, we color-code the graph — red being the worst — and so you can say, “Hey, if I have five red patients in one nursing unit, one thing I’m not going to do is assign them all to the same nurse because that’s going to lead to a bad outcome.” It could also be used at a higher level in terms of management of nursing hours, although we’ve not gone down that pathway yet. But it’s been suggested.

I’m a believer in the 80/20 rule –– show me the 20% of patients who are the sickest and if I manage those well, I’ll improve my overall outcomes.

Yes, I think you are right on. We really think that we have a potential of making significant impact in the quality of healthcare and we have people who have had many years’ experience in hospitals who feel the same way. It’s very exciting for us.

I know that you worked with Helios, or ObjectsPlus as it used to be called, when you started connecting to Eclipsys at Sarasota. What kind of interfacing would be required for a non-Eclipsys user and how difficult is it to manage those interfaces?

We’ve spoken to a couple of the other EMR vendors. We are prepared to interface with any of the systems.

Really, we are self-contained. We touch the world in two ways. On the one hand, we go up to the hospital’s database and we extract data periodically, but we do it in a way which has no impact on response time. Hospitals are very sensitive to anything that may degrade their response time for doctors and nurses, so we have a way of not doing that. Basically, it’s not a real-time query, so we wait for real-time queries to finish.

The other place is when a nurse goes to a nursing station and she goes to her computer and she wants to see the graph. All we need to do is know who the current patient is that you’re looking at and we can be either loosely integrated or tightly integrated with the system. With Eclipsys, we’re tightly integrated, so that there’s actually a tab on the main screen that says Rothman Index. A Sunrise Clinical Manager user wouldn’t know that they’re not using Eclipsys-native software.

But if it’s a looser integration, it might be an icon on the desktop. You click on that icon and you’re already logged on to our system through a single sign-on software system which is controlling their screen. We would know which patient you’re pointing at. We just need to know which patient it is and our server has the data and has the values of the Index, and would then be able to display a graph.

Does it alert or is it just display? Does somebody have to notice that the number’s bad or can it automatically page and escalate?

We produce a graph, but we also produce a number. That number can be used in a rule that is created by the hospital to generate an alert.

What parts of the system do you consider the proprietary and how do you envision this turning into a business?

The algorithm is proprietary, although we’re submitting an article for publication which will give the general outlines of what we’re doing. Doctors don’t like the idea of a black box. I guess that’s the proprietary element of it — the algorithm.

We’ve submitted several patent applications on the work. But we’ve spent years now validating this and so, in a sense, the protection that we have is the fact that we’ve done all this work. If someone wanted to do the same thing, it’s going to take them quite a bit of time.

Are you going to try to sell this directly to hospitals or partner with vendors? How do you see this getting out in the field?

We’re starting out by selling it to individual hospitals. We’re starting clinical trials at a number of them. The basic idea is an annual license fee, which is based on the size of the hospital. But we can see going into the future that we might partner with one or another or maybe all of the EMR companies to make it available to their customers.

Is it satisfying to see this turn into a business when the original point of it was a very personal circumstance that you knew you could improve for others?

I think that in order to deliver this and really have the largest impact, we needed to make it into a business. If it were simply a study or a paper, I don’t think that it would have reached a lot of people.

The fact that we were willing to go the extra distance to make it into a product that hospitals would be able to use easily and it will reach a lot of people, that really is a way to achieve our original goal. We just didn’t want this to happen to someone else’s mother. I think we’re going to end up accomplishing that goal.

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From Polemic: “Re: Epic-certified resources. Only Epic knows and they’re not sharing. That leaves everyone else to make sense of what it means when someone claims to be Epic-certified (what module, what release, etc.) Tightly controlled certification keeps qualified people in high demand, but doesn’t seem to take into account the rate at which they are signing new accounts. One has to wonder whether the ‘we’re Epic, you’ll do it our way’ approach won’t perhaps come back to bite them someday.”

From Celling Yourself: “Re: AirStrip’s Sprint announcement. I don’t get this. AirStrip’s target customer carries an iPhone, which doesn’t work on Sprint.” It is interesting since the deal offers hospitals Sprint’s help creating an in-building Sprint infrastructure for running AirStrip’s apps on 4G smart phones, but AirStrip says it’s staying carrier agnostic. I can’t imagine docs giving up their iPhones (and thus AT&T now and possibly Verizon soon) or carrying a second Sprint-capable device only for on-property access. It sounds like little more than a targeted Sprint promo for its infrastructure business.

From Former McKessoner: “Re: long overdue. I’m one of the many departures from the McKesson senior sales ranks since the June 1 beginning of the fiscal year. It took over 10 years, but the Horizon undoing is coming fast. No new business, customers grudgingly upgrading.” Unverified. All I’ve seen is the recent KLAS report, which says Horizon lost more clients than it gained in 2009 (along with the other faders you might expect — QuadraMed, GE, and Eclipsys). The company has announced nothing pertaining to its Horizon strategy as far as I know, so unless a customer verifies they were told something officially (and those I’ve asked haven’t responded), I’d say it’s business as usual.

From Introspect: “Re: Houston hacker. Here’s an update with the hospital’s side of the story. I wish you had withheld judgment until at least hearing both sides of the story.” I agree, although I assumed the newspaper’s account was accurate and complete and I did hedge my bets by referencing the hospital’s “apparent” security incompetence. The original article said the hospital had to hire outside help to fix the problems the kid claimed he told them about. The CIO’s story is different, although he didn’t mention the problems the kid says he discovered. He says the 21-year-old had installed “back door” code on the hospital’s server that would have let him bypass security to log on at any time, which he accomplished by using a doctor’s password instead of actually penetrating the hospital’s security (I’m surprised he was able to do that with a doctor’s security privileges, which I assume means any doctor could do the same, but that’s not my area of expertise). As the CIO says, “He didn’t discover a breach, he was the breach.” The outside help was engaged to make sure the kid didn’t do anything else, the CIO told the newspaper.

At least most readers think their employer’s economic conditions are no worse than they were six months ago, although more say they’re unchanged than better New poll to your right: what’s your experience working for an employer that has won a “best place to work” award?

It’s easy to confuse patients about healthcare benefits. A non-profit clinic in California sends out ID cards to all its recent patients that include the patient’s name, medical record number, and doctor name. They wanted to speed up registration by giving staff information needed to look up patients in their new EMR. Puzzled patients seen at the clinic but not its regular patients are calling their providers and insurance companies demanding to know why they’ve been turfed off to a new clinic and doctor.

RemCare, fresh off $2.7 million in new financing, renames itself (warning: PDF) after its product, Care Team Connect. The Illinois company’s product helps hospital care managers by creating evidence-based discharge care plans and coordinating care, reducing readmissions.

Vanguard Communications, which offers the MedMarketLink marketing service for specialty practices, signs a partnership deal with Intuit Health to market its portal.

HP announces its Slate 500 would-be iPad competitor, which it will market to businesses (note the medical apps featured in the above promo). It’s more expensive (starting at $799) and runs Windows 7, meaning that unlike the iPad, it supports Flash. It comes with 2 GB of memory (which is needs since it’s running Windows), has a shorter battery life (Windows again), and does not support 3G (WiFi only). I’m guessing all of those facts led to the decision to steer a wide berth around the consumer market created and owned by Apple in the hopes that businesses are so pro-Windows they’ll pay more to get less. This will be problematic: all those users with iPhones, iPods, and iPads at home are not likely to be thrilled by their employer’s offering. Apple doesn’t make mistakes too often, but failure to reach detente over Flash is a big one since that’s one of few chinks in its armor and it involves all of its products as its competitors will tell you constantly.

Mobile Health Expo announces its 2010 award winners. HIStalk sponsors winning were PatientKeeper (best patient safety innovation) and Voalte (outstanding contribution to nurse communications).

Greenway acquires Visual MED’s PACS technology, which will power its PrimeIMAGE solution for its PrimeSUITE 2011 EHR.

The radiologist who founded teleradiology services vendor Virtual Radiologic launches an early stage venture fund that will invest in consumer, healthcare, and technology companies. Sean Casey was kicked out of the company, which he started and took public, with $68 million worth of stock. It was the subject of a private equity buyout for $294 million this past May.

HHS CTO Todd Park is added to the speaker lineup of the mHealth Summit next month, run by the NIH, its foundation, and the mHealth Alliance. Also speaking: Bill Gates, Ted Turner, and US CTO Aneesh Chopra. I’ll be filing daily reports from there as will HIStalk Mobile editor Dr. Travis Good.

The Austrian man who was the first person to use a mind-controlled robotic arm for driving dies in a single-car crash that may or may not have been related to the technology.

I can’t decide if HIMSS is clueless or evil with this announcement: attendees at the Orlando annual conference in February will be tracked by RFID for the benefit of exhibitors, who can “… derive a more accurate score of a visitor’s buying potential.” RSNA has been doing this, apparently, triggering specific booth ads to play based on who’s around (Philips is a happy customer cited in the above promo video). An RFID tag will be attached to conference badges that will let vendors track attendees by job and employer (and name if the conference allows it), ending the days of anonymous and obligation-free booth cruising. The technology will log booth visits and duration by product being viewed and will alert vendors in real-time when a “key prospect” is in the area (CIO alert! Ignore everyone else!) The conference keeps getting more similar to a cattle butchering operation: you’re herded into a holding pen (the exhibit hall) since the token educational offerings (getting less useful every year) intentionally go dark during major booth hours, you’re fed and watered in the exhibit hall with vendor snacks until it’s your turn with the the high-paying exhibitors, and now you’ll be tracked like livestock throughout the process. Let me just say that, as a paying attendee and member, I resent the hell out of this (I’m sure I can get info on how to cripple the RFID tag and I’ll run it here if so). I can imagine what was going through the minds of the HIMSS dim bulbs who approved this: hey, we can charge vendors even more by selling them the personal information of attendees, vendors can pounce like snakes when attendees identified by job title as a decision-maker enter their air space, companies can monitor whether competitors are encroaching into their proprietary neighborhood, and HIMSS can justify its exorbitant exhibiting costs by showing who dropped by. People seemed to be resigned to letting HIMSS do whatever it wants in the name of picking the pockets of its vendor members. I say it’s time for provider members to push back and make the conference theirs again. Being tracked as nothing more than a roving sales prospect is just insulting. HIMSS apparently doesn’t extend its claimed interest in patient privacy to its own paying customers in the Ladies Drink Free model in which it pimps access to low-paying providers to high-paying vendors.

AHRQ spends $26.5 million of its ARRA money to hire a high-powered PR agency. Ogilvy Washington will “market and promote” the findings of Patient-Centered Outcomes Research in a newly created Publicity Center. I didn’t volunteer to have my taxes used for wasteful economic stimulus projects, but if I had, I’m pretty sure dozens of millions for a HHS PR wouldn’t have been on my list even though the general idea of comparative effectiveness research is a good one (but hugely expensive – $1.1 billion in stimulus money).

Four NICU babies in a hospital in Canada are given insulin instead of heparin in their TPNs, killing one of them.

Shares in athenahealth jumped by 23% on Friday after good Q3 numbers that beat estimates.

E-mail me.

From BeKind: “Re: the Senate Committee on Veterans’ Affairs testimony about MUMPS. This dialog occurred at 75:26 in the video.”

Senator Richard Burr: If you maintain MUMPS can the private sector have full access into the VA system, into the MUMPS system, for the exchange of electronic information?

Roger W. Baker, Assistant Secretary for Information and Technology, Department of Veterans Affairs: I would answer it this way, I believe just as much as if we implemented it in any other language because at the bottom it’s the data that’s important.

Senator Burr: Let me turn to Mr. Tullman if I can just simply because he’s out there. Now, let’s see what the limitation is.

Glen Tullman, Allscripts CEO: What I would say is again that you can extract data from any system. What we’re really talking about, and I don’t want to get too technical, is the native exchange of information. So you can pull information out of a mainframe system and put it into a PC if you want two people to talk to each other. The question is why would you do that when you could have two PCs that were talking with each other? So again we think MUMPS was the right decision to make when it was made. We think there’s a reason to carry it forward. We’re just saying as we go forward into the future we need to broaden the understanding of what systems to use, what architectures to use, and what the general reason we need these systems for and that is for communication and I think that’s this idea of this community is important and no one’s using MUMPS to build systems that communicate and exchange data efficiently today in anywhere else but the US government.

Wow, there’s a lot of interesting stuff in this video of the committee meeting, which runs two hours (meaning I didn’t listen to every word yet). The chair, bless his heart, leads off by reminding everybody that the VA and its contractors flopped big-time with CoreFLS and the projects it had to kill because they weren’t being managed well. Ed Meagher talks about the VistA Modernization Committee’s recommendation to put VistA on a stabilization program while developing its replacement. Glen criticizes MUMPS-based systems (meaning not just VistA, but his company’s competitors Epic, MEDITECH, QuadraMed, etc.) and saying the military’s evolution requires new EMR requirements for data sharing. He also says its replacement should be either Microsoft-based or open source (technically, VistA sort of open source, so I assume he means non-MUMPS open source). He says its time for the government to learn from the private sector.

Tom Munnecke, a former VA guy who helped build VistA, testifies at around the 61 minute mark. He credits the original VistA developers, all of whom were clinicians turned developers, for its success, starting it with “good enough” and then refining it from field experience instead of sitting around writing specs. He said MUMPS criticism isn’t new, going back to the beginning, but it works and has been stable. He likes the open source idea for a VistA replacement but cautions against throwing out the lessons learned from VistA. He also advocates additional forms of communication other than the EMR, saying that 25% of VistA’s use was the Mailman app used to simply communicate among professionals (comparing that to today’s social networking). He talks up personalization that can be delivered by cheap, easily implemented tools.

The chairman also asks VA CIO Roger Baker directly what assurances he can give that they won’t screw up again like they did with their replacement scheduling system. He cites the VA’s cancelled or retooled projects as proof that they’ll kill projects with minimal chance for success (the “fail fast” approach of identifying and killing the dog projects fast before they cost too much). Munnecke agrees, but says users need to scale back expectations and allow the software to develop instead of going for the gold-plated Cadillac upfront.  

Munnecke: “Mr. Tullman’s comments have a number of technical issues that I think we need to talk about over coffee some time, but I probably largely agree with his conclusion. I don’t want to be characterized as pro-MUMPS. I do want to be characterized as having a very successful legacy system that has accomplished a lot and just going with the standards of the information technology industry and thinking we’re going to take the shiny new technologies and word on PowerPoint presentations and develop a successful system is not going to work.” When interrupted by Sen. Burr’s comment that he’s never heard anybody comment that DoD actually has working EMR software and wondering why it’s so hard to send DoD medical records to the VA, to which Munnecke replies, “I think you’d have to look at DoD actually throttling back CHCS and crippling the features that were design into it for communication in order to protect their bureaucratic stovepipes.”

Sen. Burr’s summation (in which he repeatedly refers to VistA as “the MUMS system”): “It is absolutely essential, in my estimation, that private sector companies buy in to what technology decisions you make at VA because of exactly what Mr. Tullman references, and that’s that this is no longer our population of people that we’re taking care of. They’re bouncing back and forth … if we want to reach the efficiencies long-term of private healthcare, as most have realized, then we’ve got to have this interoperability solved … if a company like Allscripts, a leader, is questioning whether they’ll be able to exchange through your system, I think we ought to pause for a minute and talk to those companies and find out what is your concern …”

Then came the comments BeKind mentioned above. Sen. Burr mentions that three people in the room have iPads, yet soldiers returning from the military hospital at Landstuhl have paper medical records taped to their chests, saying that the VA should collaborate with the private sector.

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From Wee Man: “Re: [vendor name omitted]. The rumor you recently ran about halted implementations and delayed upgrades for [product name omitted] is true, I’m 95% certain. Also, the same company’s flagship clinical product line [product name omitted] is going to maintenance-only.” I’m chickening out in naming the company since this is big news if it’s true and I’d hate to get in trouble just in case it’s not. I’ll say just this: the non-anonymous source is a good one, this rumor fits with some earlier stories and customer survey results that I’ve run, and some mighty big hospital systems are going to be super PO’ed if it’s true. If you have confirming evidence, send it my way.

From FormuLarry: “Re: Micromedex. They’ve released free versions of their drug information application for the iPhone and iPod. It’s not as slick as Epocrates, but the price is right.”

From Stifler’s Mom: “Re: Epic certifications. Can anyone share the exact numbers of certified people out there for products like Prelude, Bridges, Beacon, Cadence and the year/version? Also whether they have clinical backgrounds?” I’m pretty sure there’s only one source for that information so I wouldn’t get my hopes up, but if anyone knows, send it over and I’ll forward to Stifler’s Mom (I gave this non-anonymous HIStalk pal that name years ago and she adores it, not to mention it makes me cackle every time because I have a puerile sense of humor).

From Broadway Joe: “Re: Keane. Being purchased by NTT Data for $1.2 billion.” Rumor is that the Japanese company (part of Nippon Telegraph & Telephone Corp.) is in advanced talks to buy Keane, which is half owned by Citigroup. The deal is imminent, Tokyo newspapers are saying. Keane offers application, BPO, and infrastructure services, not to mention its healthcare presence (Keane Healthcare Information Systems), which markets the Keane Optimum system and other products.

From Oops, Here: “Re: glitches. We are not aware that any of these patients were injured after death.” Errors in loading UK driver’s license organ donor information to the NHS databases cause the wrong organs to be removed from 25 donors. Nobody noticed until prospective donors (the ones not already dead, in other words) complained that their information was wrong.

From Matt Mucha: “Re: my blood pressure chart. I’m a Web developer from Krakow, Poland who also happens to have hypertension. I created a tool to let people keep records online and share them with a doctor. I know you’ve written healthcare apps in the past, so I hope you can relate . Check out the video and forums. I’m not profiting from the site in any way.” It’s a pretty slick with a clean design. Nice job. Take a look. 

From Greed Earns Justice, Eventually: “Re: McKesson/HBOC scandal. Sales SVP Dominick DeRosa pleaded guilty in 2000 to one count of aiding and abetting securities fraud by hiding side agreements to manipulate revenue recognition. This past April, the judge overrode the prosecution’s request for probation and sentenced him to a year in federal prison. While waiting 10 years for his sentence, he appears to have built quite a resume, serving as CEO of OneWeb Systems, VP of sales at Transcend Services, and executive VP of sales at CareMedic. Rumor is that he was at MedAssets before getting the bad news about jail. Mastermind and former president Al Bergonzi is apparently doing his 41 months in Atlanta after being given more time than the prosecution requested. He’ll get out Christmas Eve this year. He’s been doing consulting work for former friends and one of the many HBOC acquisitions he coordinated. CEO Charlie McCall, who almost got off, is due to be release in 2019. Controller Timothy Heyerdahl was released in 2008 and CFO Jay Gilbertson was released earlier this year. I wouldn’t be surprised if he’s still in HIT somewhere.” He didn’t even mention Jay Lapine, one of few corporate counsels to ever be indicted for securities fraud (he got off on criminal charges a year ago and then settled the civil case against him, barred by the SEC from involvement with publicly traded companies for five years). McKesson’s executives, desperate back in 1998 to prove they could run something sexier than drug warehouses, paid Charlie $14.5 billion for a company everybody knew was a house of cards ready to collapse if he couldn’t fast-talk some rubes into taking it off his hands in a hurry. He did, with the announcement of the accounting scandal just a few months later evaporating $9 billion in McKesson shareholder value in a single day (the stock went from around 90 to less than 20 and still hasn’t hit that level since). Not to mention that a lot of HBOC software was as crappy as their corporate books, also widely known by nearly everybody. It’s always ugly for the foot soldiers when greed meets stupidity. Sorry for the rant, but what those guys did to McKesson’s employees (many of them unfortunate conscripts due to HBOC acquisitions), their hospital customers, patients, and to the industry really ticks me off even after a decade. 

Hosted pharmacy applications vendor MedKeeper announces its acquisition of DoseResponse from Keystone Therapeutics, a competitor in outpatient anticoagulation management software.

I mentioned the 21-year-old Georgia computer tech who was arrested for accessing a hospital’s computer system. I’m beginning to think he got a raw deal. He was working on a physician group’s hospital connectivity problems and documented seven problems with the hospital’s server, hoping to impress the hospital enough to land him a job. The hospital CIO and security person met with him, asked him for a copy of his resume and a list of the problems he found, and then came back in with police officers to arrest him. The kid’s been in jail since last week, with the hospital claiming he’s a danger to them since they can’t fix the problems he cited without outside help. Maybe the hospital should swallow its pride, admit its apparent security incompetence, and hire the kid cheap.

Acuitec announced its iCare mobile anesthesia apps for the iPhone, iPad, and iTouch at the American Society of Anesthesiologists conference in San Diego this week. Jessica sent me a press release that I can’t find online anywhere to link to, so you’ll have to take my word for it. The above is a shot of its Vigilance remote presence monitoring system running on an iPad, which I found while looking unsuccessfully for the press release. The Birmingham-based company is a joint venture with Vanderbilt University.

HIStalk pal Justen Deal sent over a position listing for “geek interns” at his Vieu Health startup that was a fun read (he’s a really good writer in a Joel On Software kind of way). I was hooked enough to read the whole thing. If you’re a techie and want to be underpaid (so Justen says), but live and ski free at a resort, get a MacBook Pro and a BlackBerry Torch, and work with “misfits, rebels, square pegs, and troublemakers,” you might want to connect with Justen. I have no idea what Vieu Health is building since they haven’t said yet, but it’s something to do with electronic health records and networks. Maybe I should follow his lead and get some interns myself since I always seem to be buried.

Former NaviNet SVP Tim Mills is named VP of sales and marketing of revenue cycle management company Avisena.

The Toronto newspaper profiles the involvement of Telus in Canada’s move toward digital healthcare. It mentions that Telus provided the software and technology behind The Ottawa Hospital’s plan to buy 3,000 iPads to run on the Telus-provided wireless network to access an aggregated database. That hospital’s CIO says the information needed by key staff members that is available electronically has gone from 30% in 2008 to 100% now. It also mentions the Oacis product, mentioned several times here previously. The healthcare division of Telus is bringing in $400 million a year. It’s a well-done article. Somehow Telus Health seems to come in under the radar in the US, but it’s an impressive operation run by a a large telecommunications company.

Cardinal Health Foundation will award $1 million in medication and OR safety grants in 2011 for the fourth consecutive year. Applications are due by December 3, 2010.

The Chicago Sun-Times covers the local healthcare use of iPads: University of Chicago Medical Center will give iPads to all of its internal medicine residents, a plastic surgeon uses her to explain reconstructive surgery to breast cancer patients, and one hospital says at least half of its ED docs bought their own iPads once they found that they could use the EMR on them.

Jobs on the HIStalk Sponsor Job Page: Clinical Executive Physician, Clinical Executive Nurse, Healthcare Consulting Lead. Platinum sponsors get free listings there. On Healthcare IT Jobs: Epic BSA Ambulatory EMR, Clinical Product Specialist, Epic Consultants.

In Germany, CompuGroup Medical AG says it will invest $180 million in its software over the next five years, most of that to further develop its Software Assisted Medicine medical knowledge system.

Ontario’s health administration is slammed by an auditor’s report that found the same expensive practices previously found in eHealth Ontario scandal last year: single-source contracts, overpaid consultants, and excessive expense reimbursement. One temporary executive who was making $275K per year billed the hospital an extra $150K for helpers, $14K for bonuses, a Christmas lunch, and world-wide travel, including $500 in telephone charges in one hotel stay.

Q3 numbers for UnitedHealth Group, parent of Ingenix: revenue up 9% to $23.7 billion, with net earnings of $2.15 billion in earnings from operations, easily beating expectations on revenue and earnings. The company gave guidance of $94 billion in revenue for the fiscal year. Ingenix revenue was $592 million, up 23%, with $70 million in earnings from operations. The announcement also gave the cost of the Q3 acquisitions by Ingenix (Axolotl, Picis, and A-Life Medical, I assume) at $1.9 billion in cash. UnitedHealth market cap is $41 billion.

Odd lawsuit: a couple says a waiter at the local Steak ‘n Shake gave their child a bottle of Blair’s Mega Death hot sauce for his chili, causing him to break out in hives (assuming the child wasn’t hitting the restaurant on his own, maybe the parents should have intervened). They’re suing for $10,000 in compensation and $50,000 in punitive damages.

E-mail me.

HERtalk by Inga

CMS incentive payments are taxable. That’s the opinion of Steven Waldren, director of AAFP’s Center for Health IT. I’d never really thought about it, but that hardly seems fair. Definitely not nice.

Cerner Ambulatory tops the list of a recent Ovum report entitled Selecting an Ambulatory EHR Vendor in the Healthcare Market. I mentioned this on HIStalk Practice yesterday, but it perplexes me so much that I’m also asking HIStalk readers to share their impressions. I don’t know much about Ovum (which is a division of DataMonitor) so I asked them to provide me more background on their research methodology. No response as of yet. Cerner, along with eClinicalWorks and GE Healthcare, make their short list of top vendors based on strong brand names “in the ambulatory market” and for demonstrating “market-leading positions.” The report also says Cerner is the “most versatile and multi-faceted” of all the vendors reviewed (which included Allscripts, Sage, NextGen, athenahealth, and Amazing Charts.) To be fair, I know Cerner ambulatory by reputation only, so for all I know Ovum is spot on. The Cerner folks have graciously offered to dispel my skepticism and asked me to stop by for a demonstration at MGMA next week.

Follow-up: back in March I mentioned the former MedAssets employee who was arrested after using a fake identity to get her job and stealing financial information on more than 1,200 patients. Katina Candrick was sentenced to 10 years and ordered to pay more than $163,000 in restitution. As I was looking for a photo of Candrick, I noticed that in 2008 she had been charged with fraud, falsifying identity, and fraudulent possession of a controlled substance after posing as a medical clinic employee and attempting to pick up prescription drugs at a CVS pharmacy.

HealthGrades says that overall hospitals are improving, but the gap between the best- and worst-performing hospitals is substantial. A typical patient would have a 72% lower risk of dying in a 5-star rated hospital compared to a 1-star rated hospital, and a 53% lower risk of dying by going to 5-star rated hospital compared to the US hospital average.

Baptist Health System (AL) contracts with Passport Health Communications for Passport’s IntelliSource software for revenue cycle management.

Virtual Radiologic is named the top-rated vendor in the KLAS Teleradiology Study 2010. KLAS notes that teleradiology contracts had historically been held by local radiology groups, but now hospitals and clinics have 40% of the contracts. Look for teleradiology volumes to rise in the next few years.

athenahealth posts a 33% in increase in third-quarter revenues ($63.1 million vs. $47.4 million). Excluding one-time items, the company’s net income doubled from last year, coming in at  $6.4 million or 18 cents per share. Analysts were looking for a 27% increase in revenue and 13 cents share. Basically, a darn good performance. The always entertaining Jonathan Bush will provide more details at 8:45 a.m. Friday on CNN.

AirStrip Technologies collaborates with Sprint to offer a bundled solution that includes Sprint’s clinical grade in-building coverage and AirStrip services for hospitals agreeing to expand or extend an enterprise commitment to the Sprint network for more of their employees.

Thomson Reuters releases a new version of Clinical Xpert Navigator mobile for iPhone, iPod Touch, and iPad devices.

Lots of good stuff on HIStalk Practice this week: in addition to the usual posts, we feature several HIT Vendor Executives who shared their opinions on what attendees will be discussing next week at MGMA 2010 in New Orleans. We also published a handy vendor guide summarizing what each of our exhibiting sponsors will be highlighting at MGMA (you can download a PDF to print and take along). Do us a favor: stop by their booths, ask for a tour of their offerings, beg for a trinket, and tell them thanks for powering HIStalk and HIStalk Practice.

Sponsor Updates

• Greenway introduces PrimeSPEECH, an integrated direct-to-EHR speech technology and PrimeIMAGE PACS solution. Both solutions are fully integrated with Greenway’s PrimeSUITE EHR and physician workflows.
• MED3OOO acquires health benefits consulting firm Insurance Solutions Group.
• Voalte partners with Meru Networks to extend its capacity in hospitals running the Voalte application. The company also announces a trial at Parkview General Hospital (IN).
• For the third year, Vitalize Consulting Solutions earns a spot on the Philly 100 List, coming in as the 57th fastest growing privately held company in the greater Philadelphia area.
• Bronx-Lebanon Hospital Center selects the Allscripts Care Management solution, which will integrate with the hospital’s existing Sunrise Clinical Manager system. Bronx-Lebanon also recently deployed Allscripts solutions in its ED and 40-physician multi-specialty practice.
• SRSsoft is named to Deloitte’s Technology Fast 500, which lists the 500 fastest growing (by revenue increase) high-tech companies.
• MedPlus parent company Quest Diagnostics releases its Q3 financials: revenues of $1.9 billion, down 1.7% from last year; net income rose to $198 million ($1.13/share) compared to $192.2 million ($1.02/share).
• McKesson signs an exclusive agreement with MedVentive to offer that company’s SaaS-based Analytics Advisor analytics solution to the payor market, where it connects payors and providers transparently around clinical and financial performance metrics.

I’ll be traveling to New Orleans this weekend to attend the MGMA conference. I’ll be on the lookout for cool HIT stuff, collecting giveaways, and hopefully learning a few new things. Look for updates and photos.

E-mail Inga.

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Kevin Maher, MHA is VP of product and outcomes management at McKesson Health Solutions.

Give me the elevator pitch on Personal Health Advisor.

I think about Personal Health Advisor as a multi-channel consumer engagement platform at its highest level. It’s really aimed at helping consumers to help them utilize online health tools and, in general, to provide consumers with both inbound and outbound health advice, recommendations, and services.

Who is the targeted user or customer?

The targeted users are health plan members and the target clients are typically health plans, which I would describe as any organization that holds some degree of financial risk for a population. That could translate into at least three segments. Certainly the payer segment, which is where we are focused today. Second, the employer in the self-insured employer market. Third would be the kind I like to describe as the fledgling ACO market.

There’s always a survey claiming consumers want to use tools like secure e-mail, personal health records, and assessment tools. So why don’t they?

I think our point of view on that would be that a lot of the lack of use goes to a few things. One is not enough skin in the game overall today. I agree that consumers are still largely shielded from the financial cost and burden of delivering healthcare.

I think a second issue we’re dealing with is who’s the trusted source for information — the payer or the provider? Our position is that the provider is a much, much better trusted source than the payer, so anything sponsored by the payer — or potentially, by the employer — in and of itself will create some barrier to use.

I think some of those barriers can be removed if the design of the benefit structure encourages the use of online, member-focused tools, which is what we are beginning to see with the clients that we’re working with on this solution.

So you’re saying an insurance company might say, “Sign up for our personal health record and get a gift certificate or get a discount on your premium”?

Correct, and it has to be meaningful. I think what the research has shown, and what we seem to see, is at the individual level, you’re talking somewhere around $500-$600 a year. You’d need to see that level of impact — the consumer would need to see that, and at the family level, at least double that to $1,200 or so — to really move the dial on engagement.

So to your point, without the right level of incentive, we’re seeing use rates in the single-digit range. When we see that level of benefit impact, whether or not it’s discounts or reductions in premium or gift certificates, we can see engagement rates upwards of 50%. That seems to be the big dial that the payer has ability to control and throttle.

When they provide these incentives or whatever encouragement that form takes, how do they do that beyond “you have to complete a questionnaire”? Are there targets that encourage actual outcomes that are wellness related and not just looking at a screen?

I would say that there are probably a few health plans that have moved to outcomes. Or, I wouldn’t even say health plans. I would say more employers, that have moved toward more outcomes-based rewards model, vis-à-vis the Safeways of the world.

I think most of the market is still on “perform an activity and we will reward you.” I think that transition from activity to outcome is likely to be a 3-5-year transition, but we’re certainly beginning to see clients thinking about using more biometric results to ultimately get that, or give that reward. So, whether or not it’s some kind of annual biometrics that’s evaluating blood pressure, LDL panels, BMI — that’s certainly the early, preventive information that consumers need to know about.

More employers and providers also talk about the use of Bluetooth wireless devices that are providing more immediate or more continuous feedback on some of those key metrics versus a 12-month look at it. But I would say again, most of the market today continues to be focused on — and I say this because it’s the reality and it’s relatively still a new concept — but most of the market is paying for activities today. That activity could be, to your point, completing a HRA, participating in a program, getting the biometrics done, seeing their physicians for preventive care testing, etc.

McKesson operates a 24-hour-a-day nurse hotline. In terms of a key differentiator, what resources does that require on McKesson’s end and what infrastructure do you have in place?

We’re the company that was formerly known as AccessHealth, which was actually the first company that offered a nurse hotline to the payer market. We, today, have about 30 million lives under management that we’re providing nurse line services to.

Approximately 600 nurses is a major differentiator. I mean, it provides that human channel, and I think a number of things that we are doing to tie the offline world and online world are, for example, nurses or nutritionists or pharmacists we have available. So we think about our line as a clinical hotline, not just providing nurse recommendations for acute health problems.

The nurses reinforce getting the preventive testing. They’re able to use that information to reinforce the availability of incentives that the sponsor is offering if a member performs a certain function. A clinical staff has the ability to push content after a call to a secure message center as a reminder — could be content, could be videos.

The ability to take information from provider, member, and health plan data and make that information exposed to the nurse, and make that nurse or that clinician smarter about the member’s health. Remember when we get that data, we’re able to push content from the call center or from a telephonic interaction into an a member care plan and tie those two again, those two different worlds come together through the integration of data.

I’m interested in the data sources that the Personal Health Advisor can collect and put together for the subscriber to review.

We have core data sources as follows. It’s basic member eligibility information. It is provider linkage information of provider files, again, from the payer. Medical claim information, pharmacy claim information, HRA health risk assessment information; and biometric information. And the biometric information at this point is contained to blood pressure, BMI, validated smoking cessation smoking status, and the lipid profile.

One of the things that interested me after the e-Patient Dave fiasco at Beth Israel Deaconess was information that may be correct or meaningful for billing purposes that may not be something that a consumer should be turned loose to interpret. Is there any level of oversight or preparation to ensure that what lay people see on the site is something they won’t misinterpret?

The medical claims, I think, is where it gets dicey. What we’re doing there is all of that information is being coded. It’s being coded using the SNOMED standard terminology codes. When members see that information in their personal health record, all they need to do is basically hover over whatever detail is on the page.

Say one of the line items was diabetes. You hover over that, click on it, and it presents a consumer definition of whether or not is was a diagnosis or a procedure code. It provides a consumer again, some sort of definition associated with each of the pieces of information that are being generated by claims data.

Underlying that is that we have mapped all of our clinical reference system content, and you may be familiar with that content. That content, historically, was sold into the provider market, continues to be a strong leader in the provider market. Providers historically printed these kinds of one- to two-pagers out for their members when their members would leave the office, explaining what their upcoming procedure was or their condition is that they’ve been recently diagnosed with.

That’s how we’re handling that pure medical information.

Who do you compete with in reaching the consumer and how is your offering different?

There are two or three big competitors that we see. I think, first and foremost, is WebMD. I think what’s different about our solution than WebMD probably revolves around the point that you made earlier — the telephonic channel, in addition to just the online channel. That’s number one.

I think, secondly, I’m not sure I’ve seen a whole lot of momentum or press release around extending the channel to a mobile channel. We’ve added three capabilities to our mobile channel for PHA. One includes taking the PHR and making that available through the mobile device. Second, is a pharmacy adherence tool. Third is a messaging tool that leverages our clinical staff.

I think it’s the telephonic channel and the mobile channels that we believe are our key differentiators from a WebMD. And then we’ve got our classical health management payer/employer competitors such as OptumHealth, Health Dialog, or Healthways. But we also see ourselves competing with other services that would be competitors of A.D.A.M. I mean, those are potential partners, longer-term.

Do your offerings leverage RelayHealth’s tools?

We looked at that. We do not leverage the RelayHealth tool today, but certainly know that long term, we’re going to need to figure out — along with the rest of the industry — how do you tether this PHR closer to the doctor? I think that’s a downfall in any PHR that is not somehow associated with, tethered to, or connected to that provider’s EMR. We know that’s a challenge we’re going to have to solve in order to make that PHR ultimately more valuable to both the member and the provider.

Quite frankly, the reason we did not reevaluate that when we were first building that, and the big drawback that we could not solve with Relay, was the belief that in the markets that we were selling to, that we needed to be able to pre-populate these personal health records with some type of information in particular, given that we were focused on the payer market.

We felt that we needed to be able to pre-populate this information with claims, and I think we all are aware that there’s significant … it goes back to one of your questions about ‘why aren’t these tools used as often as they are?’ At the time, clearly one of the big feedbacks that consumers were giving around PHRs is too much time to populate that information. We wanted to remove that barrier by pre-populating, and unfortunately, Relay did not have that capability.

What tools are needed to make a difference in either improved outcomes or reduced costs?

I think we think several things. We need to continue to evolve this solution to provide tools that focus on members that are driving the spend, which typically are members with chronic disease. I believe we’re going to need to add a number of features, both through the mobile channel as well as the online channel, that focuses on members with chronic disease.

I think number two is something that we’re working on right now that would tie together the concepts of multi-source data, number one.

Number two is using this data, and then be providing very clear information as it relates to this data — where they can go to take part in programs that utilize this information and where they’re sitting on this data. So are you in range or out of range on your blood pressure or whatever? Letting the member know what the incentive opportunity is and then making it clear in a single view. What are the activities, or what are the metrics you need to get to in order to collect that measure?

This is something that we’re working on right now. We’re calling it a Health Report Card, but it’s literally, you can think of it as a stoplight report — a red, yellow, green report that is a single view, that again, pulls together all of the major sources from claims data, self-reported data, biometric data – that presents whether or not incentives and opportunity, and if an incentive is an opportunity — if the member has to do these three activities, all in a single view — I think we view that as a critical aspect as well.

Pulling together the pieces from the various tools into a single actionable view for the member, and I think ultimately, this data — because of the conversation we had — needs to be able to be accessed to the provider as well. So much of this comes down to — is the provider also focused on making sure that the member’s getting the preventative testing that they need and helping support the messages that the payer is trying to deliver to that consumer, in terms of behavior change?

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

Note: we asked two consulting company executives to respond to a reader’s question: “Most physician offices say they are waiting for their EMR vendor to let them know how their systems will handle ICD-10 before they do any of their own prep work. Is this common? Vendors seem to be quiet on the subject.”

Preparation for ICD-10
By Peter Butler

From what we are seeing and hearing from healthcare organizations we work with, in general, the larger IDNs and healthcare organizations are addressing ICD-10 readiness through appointed committees to head up the planning for ICD-10. It is the smaller physician medical groups that are taking a “wait and see approach” to ICD-10 and vendor readiness. 

In one conversion with a medical group CEO who is also a practicing pediatrician, I was told that his concerns as it relates to ICD-10 were minimal. His view was it was mostly an IT issue. There is a small subset set of ICD-9 codes he uses regularly today and with ICD-10 that list will grow slightly, but nothing that will require a major amount of education or training.

We’ve seen many of the major IT vendors saying they are investing in ICD-10 readiness today. They are still doing their own due diligence internally before communicating details and specific plans with their customers which is why your reader may not be hearing much from the vendors.  

I was recently visiting with a vendor who has made ICD-10 and Meaningful Use their top priorities and slowed other R&D efforts to focus more resources on these two initiatives. We believe that the majority of vendors will deliver ICD-10 compliant upgrades in reasonable timeframes.

For providers, taking a “wait and see” position is dangerous, as ICD-10 codes will affect all services in all settings; and therefore all reimbursement. Providers must begin to inventory all of their vendor systems to determine their ability to be able to accommodate the EDI v5010 enhancements and expanded character sets. Workflows need to be inventoried so organizations can understand where testing and mitigation need to be planned. There are many constituents (i.e., insurance companies, labs, etc.) that also need to be managed and contracts reviewed to minimize the impact to provider reimbursement.

ICD-10 needs to be viewed more broadly than just complying with government regulations. The ICD-10 code set provides organizations with new opportunities to enhance their revenue stream. The key is to begin now and prepare a clearly defined transition plan.

Peter Butler is president of Hayes Management Consulting of Newton Center, MA.

Preparation for ICD-10
By David Vreeland

I’d say that the burden of implementing CMS V5010 and ICD-10 is largely going to be borne by the vendors, but it’s always the responsibility of the organization’s leaders to ensure that the organization is compliant with such regulations.

In a hospital, there are typically many more information systems in production and so the burden on the organization is larger because they need to responsibly ensure that they have a handle on all those vendors and determine what the plan is for accommodating the change to these new code sets across the various IT providers. They also will likely need to have a testing plan in place for interfaces, downstream system compatibility, etc.

On the ambulatory / physician practice side, I’d say that the approach is the same, but the complexity is likely significantly lower. But simply waiting until the vendor takes action is ill-advised.

As a physician, I’d be requesting information from my vendors about the development plan and timeline for these enhancements, and if the practice operates a practice management system that is provided by a different vendor than the EMR solution, I’d be looking at moving to an integrated solution. Most vendors we work with have a plan and timeline either in mind or on paper by this point, and it’s appropriate to ask for it.

David Vreeland is a partner with Cumberland Consulting Group of Brentwood, TN.

Back to School – For a Master of Biomedical Informatics Degree
By Jeremy Harper

With the recent influx of government funding in healthcare, educational opportunities abound. I have been lucky enough to receive a scholarship to Oregon Health & Science University’s (OHSU) Healthcare Informatics program. My passion is to work with healthcare organizations to ensure patient safety and innovative technologies. This article will cover how I found the OHSU opportunity and why I decided to attend a program that required moving to the other side of the country.

An elevator story about my personal background is that I attended The Ohio State University’s business degree program from August 2003 to December 2006, receiving a BS in General Business. I worked at Epic Systems from February 2007 to April 2009 and discovered a passion for healthcare IT.

After I left that company, I took my GRE, where I scored well but not brilliantly. I applied and was accepted to three graduate schools for healthcare informatics (Capella, UIC, UW Milwaukee) but I failed to procure funding, so I accepted a full-time position at an amazing hospital as a systems analyst. A month after starting, I transitioned to being the secondary interface engineer and over the past year spanned both positions.

While I found my work environment to be an amazing experience, I had a passion for education and furthering my career. To do this, I needed either to gain further professional experience or consider specific degree programs. I made the decision that I would find an online program that would allow me to continue to gain real world experience while furthering my education and qualifications.

To this end, I researched available programs online and sent a letter to Mr. HIStalk to ask which programs he could recommend. He came back with a number of programs, among them OHSU as one of the leading online programs. I went to their website (along with the others) and found that OHSU had received a grant that would fully fund a one-year online certificate program and a few masters’ degree students. I applied and was accepted to the master’s degree program.

That application was not instantaneous nor was it free. However, spending $358.72, (Including the A&P online course I took to be eligible for the program, not including the sunk cost of my GRE from 2009) was a small price to pay to have a fully funded degree program with stipend. The program itself will take six quarters, two of which will include an internship. This fall, I am taking courses in Java, scientific writing, and introductions to biomedical informatics, biostatistics, and healthcare. This scholarship provides me the freedom to focus solely on my education rather than needing to balance it with work.

There have been opportunity costs. Nothing is free, even on a scholarship. The highest costs are the same anyone attempting a work/life balance will have to face. My personal situation means I have a fiancé 2,800 miles away in Ohio. I will have limited time to see her until we are married next year. I left a position where I enjoyed my co-workers and found the work itself exciting and fun. I moved with only what could fit in my Toyota Corolla (far more and far less than you’d expect). I have needed to find a roommate because of my budget. I have needed to budget my funds closely to assure I will be able to attend school. All the type of sacrificed anyone going back to school will have to consider.

If you are considering further education, now is the time to look into opportunities. OHSU, for example, will be funding hundreds of more certificate program students, leaving those students half way to receiving a MBI degree from the program. If you visit the ONC website, you can research and find additional schools that have been funded. The ONC has also funded community colleges around the nation for a workforce re-education model that will put folks through approximately a nine-month program educating them on healthcare informatics.

Jeremy Harper is a student at Oregon Health & Science University of Portland, OR.

Customer Relationship Management in Healthcare
By Lindsey P. Jarrell

Consumerism is playing an increasingly important role in healthcare, one that hospitals need to address in order to deliver the level of service that patients are starting to expect. In fact, according to a 2009 survey of healthcare consumers by the Deloitte Center for Health Solutions, consumerism is such a powerful force in healthcare that it is a “defining characteristic between its past and its future that will impact every stakeholder’s value proposition and business models. Consumerism is not a fad; it is a trend of enormous significance.”[1]

Today’s consumers are highly attuned to the level of service in healthcare and their attitudes and behavior reflect this. Roughly one in four has switched or has considered switching hospitals, clinics, or doctors because of a negative customer service experience.[2] Slightly more than half of customers report that they choose hospitals “based on whether they believe employees understand their needs.”[3]

Consumers have many choices when selecting their healthcare providers and they are beginning to exercise their options. Almost one-third report comparing doctors before choosing one and 15% compared hospitals.[4] Unfortunately, healthcare consumers believe the system is performing poorly: 76% percent grade the system as “C” or below.[5]

Customer relationship management (CRM) is an approach used in many industries that focuses on addressing the unique needs of customers to increase value for both the customers and the organization.[6] CRM software is currently used in only about 15% of hospitals, but it is a growing trend.[7] It can help streamline operations to handle the multi-headed juggernaut of attempting to compete for lucrative customers, control costs, improve profitability, and foster a customer-focused cultural climate.

Today’s Healthcare Consumer

A growing number of consumers want to be actively engaged in their health. They compare doctors, hospitals, medications, devices, and health plans; explore alternatives to conventional approaches; and spend money to achieve their health goals.[8] They want to control their health information and prefer providers who use Internet-based tools to augment care.

The 2009 Deloitte survey showed that 57% want a secure Internet site that would enable them to access their medical records, schedule office visits, refill prescriptions, and pay medical bills. Forty-two percent of health care consumers want access to an online personal health record connected to their doctor’s office, one in five would switch physicians to obtain such access, and consumers are less concerned about privacy and security issues than in the past,.[9],[10] Many (62%) believe that hospitals vary with respect to quality.

Because they are increasingly sensitive to errors, poor service, and lack of useful tools that would enable them to navigate the system more effectively, they are receptive to innovations that offer greater value, better service, higher quality, and lower costs. What’s more, they embrace innovations that enhance convenience, personalization, and control of their personal health information. Consumers, especially those who are younger, are willing to try new service and change providers in order to obtain better value. They are highly receptive to technology that eliminates redundant paperwork and unnecessary tests and saves time and money.[11]

Why CRM?

It’s not surprising that consumers are often dissatisfied with their healthcare experience. Today’s healthcare environment is fragmented and complex, with numerous entities controlling access to information that exists, yet is inaccessible to both providers and patients. A lack of integration and workflow impedes the ability to deliver complete, accurate patient information, which has a negative impact on patient satisfaction and quality of care.
In seeking better tools to manage patients across the continuum of care, healthcare providers are turning to CRM software because it offers several components to address these issues. It provides integrated business systems that serve the medical staff, the administrative staff, and hospital stakeholders while also directly serving customers, giving them easy access to their healthcare history and on-demand knowledge of potential remedies.

Effective CRM systems are starting to integrate personal health records with the hospital’s data to provide a system for managing care-related activities, costs, and benefits, and enabling patients to have better online access to enhance the management of their healthcare. The benefits of this approach include:

• The ability to analyze the performance of routine processes over time (such as admissions, discharges, transfers and referrals) in order to eliminate unnecessary steps and increase patient satisfaction.[12]
• Developing customized workflows to automate care coordination activities between provider organizations (e.g. physician office, hospital and home health) which can lead to improved patient outcomes, increased operational efficiency, and reduced costs.[13]
• Proactively managing chronically ill patients (e.g., diabetes and congestive heart failure) to target them with communications about educational offerings and remind them of ways to manage their illness.[14]
• The ability to improve care coordination and reduce the risk of patient readmission.
• Reducing costs by consolidating systems and pooling resources to obtain economies of scale, improving utilization of appropriate healthcare resources and understanding the cost of treatments to drive business planning
• Preventing and mitigating medical errors by integrating CRM data with medical history and clinical data.[15]
• Generating marketing campaigns targeted at specific patient types by combining a knowledge base with scientific analytics and feedback mechanisms.[16]

With the advent of electronic medical records and the infusion of federal stimulus money that is helping to drive the widespread adoption of technology, CRM software may well be the next logical step in the increasing reliance and utilization of IT in healthcare.

CRM Components for Healthcare

Companies such as Siebel Systems, Salesforce, HealthForce and SalesBoom offer CRM solutions that are tailored to the needs of large and small providers. These systems often include the following components:

Integrated Data

In many industries, the majority of revenue comes from existing customers and healthcare is no different: about 80% of annual revenue comes from patients who have previously used the system.[17] Integrating enterprise-wide data is therefore a key component to improving customer service.

An integrated database allows hospitals to collect data, analyze individual needs and preferences, develop relevant messages based on these needs and preferences, and deliver communication through preferred channels (e.g., text messages, e-mails and phone calls). It requires an integrated combination of data and application programs to support analysis, opportunity identification, data mining, and communications management.[18]

Such a system is equipped, for example, to determine which patients are at greatest risk for disease or complications, allowing the hospital to provide appropriate interventions and communications at the right time. It can also help track and improve other processes, such as check-in procedures. The result is a more personalized relationship between providers and patients that increases patient satisfaction.

Customer Care and Recovery

The trend toward consumerism in healthcare means that patients expect to be treated as customers. One in four patients say poor experiences at hospitals or clinics have caused them to use or think about using walk-in centers as an alternative.[19] In its 2008 Hospital Pulse Report, Press Ganey found that the larger the hospital, the lower the overall patient satisfaction rate.[20] Coupled with the fact that the majority of hospital revenue is from repeat business, this means that hospitals need to find ways of increasing customer satisfaction — including rectifying mistakes — so that revenue is not lost.

CRM software solutions can facilitate the collection of patient-related information from a consumer perspective, facilitate complaint management by allowing hospitals to capture, review, approve, and access information about solutions to existing and past problems, and collect feedback data that can be used to improve operations. Feedback also helps mitigates risk in an environment in which government agencies are continually monitoring hospital performance. [21]

Predictive Modeling

CRM software can allow hospitals to predict patients who are at risk for developing certain conditions and identify those already diagnosed who are likely to develop complications, creating an opportunity for preventive interventions instead of more expensive treatments that may otherwise be required for acute episodes or chronic disease.[22] For example, predictive modeling can take into account co-morbidity, severity, frequency, physician, and specialty data to predict the likelihood of a patient with diabetes developing heart disease or the chance of a patient with hypertension developing glaucoma. This translates to earlier disease discovery, better management, improved intervention, and more relevant communications.[23]

Marketing

CRM-driven marketing can allow hospitals to deliver the right message to the right person at the right time. A comprehensive CRM database and analytical software can predict the likelihood of patients to require specific preventive interventions or develop certain health conditions. By leveraging CRM data, hospitals can implement customer-specific outreach to educate both diagnosed and undiagnosed patients.

For example, one hospital implemented a campaign targeted at diabetes patients. This involved mailings that included offers for free glucose screening and nutrition classes, as well as discounted diabetes and cholesterol screenings. The campaign resulted in incremental patients in three categories: patients with a first-ever diabetes diagnosis, patients who used services who had been undiagnosed, and patients who used services who had been previously diagnosed.[24]

CRM software is complimentary to both revenue cycle applications and electronic medical records within physicians’ offices and hospitals. One has only to think of the type and frequency of e-mails from retailers (e.g. hotel chains announcing special deals at exotic locations) that are carefully placed marketing campaigns based on a specific customer’s previous buying experience and profile. The power of using CRM lies in combining data collection, information management and market targeting vehicles to creating a proactive marketing approach that can increase the customer base.[25]

CRM Making a Difference

CRM has been successfully used to help hospitals capitalize on their data to increase patient satisfaction and boost earnings. Today, many hospitals are demonstrating a substantial ROI from implementing a CRM program. Below are a few examples of CRM at work:

• Children’s Hospital and Research Center at Oakland faced declining referrals and revenue stream, incomplete process follow-through, and decreased patient satisfaction. Using a contact center CRM strategy, the hospital saw a 22% increase in overall referrals and a 50% improvement in both patient and referring physician satisfaction levels.[26]
• A group of six Florida hospitals used CRM tools to launch a direct mail campaign that generated $1.9 million in new revenue in three months.[27]
• CRC Health required a platform to manage patient intake, track Web entities, and streamline operations to increase revenue. A CRM system enabled the company’s Web-generated revenue to jump from 4% to 26%. The company can now tie revenue to referral performance, boosting its growth potential. A tool to track web marketing effectiveness indicates to the dollar what is performing and what is not and the system even provides patients with available beds faster. As a result, CRC Health can serve a larger population.[28]
• Cedars-Sinai Medical Center wanted to improve low call-to-appointment conversion rates and patient satisfaction. The hospital designed a comprehensive contact center-based CRM strategy that improved appointment conversion rates from 22% to 48% and patient satisfaction by 42% over the first year. During that time, more than $3 million was generated in incremental revenue.[29]

Challenges, Tips and Insights

Implementing CRM software can be challenging. It needs to incorporate a variety of security safeguards including patient confidentiality and privacy issues as well as HIPAA compliance. A CRM systems can be costly and time-consuming to get up and running.

Naysayers may point to past efforts of hospitals to implement CRM systems that have failed. But the landscape of healthcare is changing, and CRM can be a valuable tool to help hospitals adapt to the trend toward consumerism and transparency. IT capabilities and technological advances have paved the way for more sophisticated second-generation software-as-a-service platforms and CRM has become both more affordable and more user-friendly.[30]

As with any widespread organizational change, enterprise-wide system compliance can be difficult to achieve. Internal resistance can be significant from top executives and administrators at the outset and from medical staff once implementation begins and the system is in place. It is important to develop strategies to assist team members at all levels in the organization in adopting a new CRM program.

When considering the implementation of a CRM program, hospitals should keep in mind that:

• Converting from a patient orientation to a customer orientation requires a cultural re-orientation.
• CRM is not a campaign or a one-time event, but rather an all-out approach to dealing with customers.
• Modifications in the language used in all customer encounters — even billing — can have a profound impact on the perceived quality of services.
• Quality is defined by the customer, not the provider.

Conclusion

Information is the fuel on which hospitals run and they must harness it to both continually improve performance and measure their record against competitors. During the next decade, the healthcare environment is likely to see an emphasis on improving, measuring, and reporting the quality and safety of care, link provider reimbursement to care performance, and demand greater levels of patient service.[31]

CRM technology gives hospitals the tools they need to thrive in today’s increasingly consumer-oriented healthcare market, while improving outcomes and reducing costs. While its implementation poses a number of challenges, installing CRM programs is an undertaking worth pursuing.

Lindsey P. Jarrell, FACHE is co-founder of Source88.

References

[1] Deloitte Center for Health Solutions. 2009 Survey of health care consumers. http://www.deloitte.com/view/en_US/us/industries/US-federal-government/center-for-health-solutions/60ea5a1264001210VgnVCM100000ba42f00aRCRD.htm. Accessed April 13, 2010

[2]Datamonitor. Addressing the challenges of consumer-driven healthcare. Published January 26, 2007.

[3] Datamonitor. ibid.

[4] Deloitte Center for Health Solutions. ibid.

[5] Deloitte Center for Health Solutions. 2010 U.S. healthcare consumerism survey. http://www.deloitte.com/view/en_US/us/Insights/centers/center-for-health-solutions/consumerism/2010-survey-health-consumers/index.htm?id=USGoogle%20Consumerism%20_HC_510&gclid=CO6Premo3qECFYNd5Qod9DjKIw Accessed May 17, 2010.

[6] Glaser J, Foley, T. The future of healthcare IT. Healthcare Financial Management. November 2008.

[7] Higgins, JK. Rx for hospitals: a big dose of CRM. CRM Buyer. http://www.crmbuyer.com/story/healthcare/68758.html?wlc=1274277431. Published November 20, 2009. Accessed April 8, 2010.

[8] Deloitte Center for Health Solutions. 2009 Survey of health care consumers. ibid.

[9] Deloitte Center for Health Solutions. 2009 Survey of health care consumers. ibid.

[10] Deloitte Center for Health Solutions. 2010 U.S. healthcare consumerism survey. ibid.

[11] Deloitte Center for Health Solutions. 2009 Survey of health care consumers. ibid.

[12] Smolke P, Virmani S. Why customer relationship management in healthcare? Presented at: Healthcare Information and Management Systems Society annual conference; February 24, 2008; Orlando, FL. http://www.mshug.org/docs/techforumOrlando2008/Smolke_P_Vimani_S_Closing.pdf

Accessed April 13, 2010.

[13] Smolke P, Virmani S. ibid.

[14] Smolke P, Virmani S. ibid.

[15] Healthcare industry CRM software solutions. www.crm.forecast.com.

http://www.crmforecast.com/healthcare.htm. Accessed April 13, 2010.

[16] Higgins, JK. ibid.

[17] Healthcare relationship management depends on tailored database. www.healthcareitnews.com. http://www.healthcareitnews.com/news/healthcare-relationship-management-depends-tailored-database. Published May 13, 2004. Accessed April 8, 2010.

[18] Healthcare relationship management depends on tailored database. ibid.

[19] Healthcare industry CRM software solutions. ibid.

[20] McKay L. Healing the sick. www.destinationcrm.com. http://www.destinationcrm.com/Articles/Editorial/Magazine-Features/Healing-the-Sick-55461.aspx . Published August 1, 2009. Accessed April 7, 2010.

[21] McKay L. ibid.

[22] Schumacher S. Patient relationship management: streamlined approaches for defragmenting healthcare. Health Management Technology. June 2001; 22(6).

[23] Healthcare relationship management depends on tailored database. ibid.

[24] Hallick J. CRM saves lives. www.destinationcrm.com. http://www.destinationcrm.com/Articles/Web-Exclusives/Viewpoints/CRM-Saves-Lives-60149.aspx. Published January 25, 2010. Accessed April 7, 2010.

[25] Higgins, JK. ibid.

[26] Young T. Hospital CRM: unexplored frontier of revenue growth? Healthcare Financial Management. October 1, 2007.

[27] Higgins, JK. ibid.

[28] CRC health builds custom solutions on force.com to streamline intake process and increase web-generated revenue. www.salesforce.com. http://www.salesforce.com/customers/healthcare/crchealth.jsp. Accessed May 18, 2010.

[29] Young T. ibid.

[30] Young T. ibid.

[31] Glaser J, Foley, T. ibid.

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