Health 2.0 2010 – Two Perspectives, One Attendee

I attended my second Health 2.0 conference in San Francisco last week and find myself suffering from multiple personality disorder as a result. My multiples (only 2) are the geeky, health policy, propeller-head Ben; and the Investor Chair Ben. Allow me to share both views.

What an amazing ecosystem (or is it an incubator)!:

Health 2.0 is easily the most forward-thinking conference I attend, and the sense of energy and excitement there amazes me. I even started following a Twitter feed for the first time! Yes, it’s a bit like the Internet conferences I attended in the dotcom days, but there’s much more of a focus on empowering patients, improving decision making and making healthcare better.

Unlike the e-health conferences of yore, while investors do attend, they’re not throwing money around. With over 1,000 attendees and close to 50 sponsors this year, the conference is clearly a success. Kudos to Matthew and Indu (who I actually think might be the best entrepreneurs in the room) for putting it together and creating a bit of a sandbox in which people can play.

Another industry veteran and I were musing that it has a similar feel (albeit smaller scale and way hipper) to the Microsoft Healthcare Users Group (MS-HUG) conferences we used to attend about a decade ago. That is to say, it’s an outstanding networking and business development venue. Yes, the term ecosystem was way overused, but there’s a degree of earnestness that I find alternately annoying and endearing.

As expected given the 2.0 theme, many of the “companies” are focusing on social networking and “user generated healthcare”. I’m not sure if tweeting what I eat or posting how many steps I take will change my behavior, but a number of the other attendees seemed to think so.

Bottom line for this Ben is, as a very smart entrepreneur turned venture capitalist observed, “Health 2.0 is a great chance to catch the vibe and see what people are thinking about five years out.” He went on, however, to say he’d likely invest elsewhere for the next few years as he waited for the market to catch up. This brings us to what did Investor Chair Ben think.

Let the Angels Sing (Because the VCs Aren’t Likely To)

All of the above notwithstanding, I saw few, if any, investing opportunities.

Yes, some of the sessions had interesting ideas, but I couldn’t shake the 90s Internet conference feel. Too many companies were more into showcasing how edgy and disruptive they were, then how lucrative, proprietary or sustainable they were. There’s this tone of self-congratulation that I find off-putting (but maybe I’m just old!).

While I wasn’t able to attend the DC to VC conference the day before (another part of Health Innovations Week), chatting with some folks from a major publisher who did, I was told that none of the pitches they heard talked about a business model or how they’d make money. Of the companies I saw or spoke with that did have a business model, as with last year, too many were focused on advertising revenue or were just too small in scale to attain institutional financing. That, perhaps, is part of the appeal and charm of Web 2.0 in general. It allows someone to develop a website or app in their loft or garage and perhaps make a few hundred thousand dollars a year doing it, quit their day jobs working for the Man and, best of all, in this case, improve the health status of a sizable number of people in the process.

This shoestring/boot strap ability is great and exciting, but it typically does not create something an institutional investor who wants to generate returns for their funds’ investors (and themselves) is likely to care about, hence my conflicting viewpoints. Did I see a few companies that were likely institutionally backable? Yes, but with the criteria of having reasonably high entry barriers and/or capable of generating $10-20 million in EBITDA (earnings before interest, taxes, depreciation and amortization – a key financial metric used by investors), I’d say less than five. It not being a venture forum event, I will decline to name them, but I’d be surprised if they were EMRs solely for iPads (how long will it take NextGen, Sage or AdvancedMD to develop their own?) or a service that allows me to get a text message of my last STD status to prove I’m healthy before I hook up (though the founder of Qpid.me did a great pitch).

Trying to integrate my two personalities, I’ll observe the following about Health 2.0 and its eponymous conference:

Health 2.0 is real and becoming mainstream. Sponsors included Cerner, RelayHealth (aka McKesson), OptumHealth (part of United, sister of Ingenix), and Sage (fka Medical Manager). These aren’t companies jumping on the bandwagon or trying for some gloss either; for the most part they have a commitment.

Part of the power and excitement are the low entry barriers and the ability to bootstrap on a shoestring (Inga, just which is the right footwear metaphor here?) For minimal cost and time, a developer or entrepreneur can make a difference in people’s health status/quality/access…

…but raising capital will be a challenge and a home run (or even a triple) exit isn’t a likely outcome.

There were some innovative ideas and great, exciting and high energy people…

…but more features and products than companies.

I’ll close with a link to a very worthwhile Forbes article written by some of the best HCIT VCs in the business. In addition to athenahealth, they’re currently invested in four private companies that I personally find fascinating. Their lessons learned are well worth noting.

Ben Rooks spent ten years as a sell-side equity analyst covering HCIT and related sectors before spending six years as an investment banker where he closed transactions ranging from $40 to 365 million. Seeking to make an honest living, he then founded ST Advisors, LLC where he works with healthcare companies and their sponsors, most often on issues around strategy, financing, and outcomes/exit planning. After all this time, he still can’t wait for HIMSS!

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From The PACS Designer: “Re: Windows Phone 7 launch. Microsoft has scheduled the Windows Phone 7 launch for October 11. If Windows Phone 7 is as good as Win 7 in combination with Bing, then we’ll see some interesting apps that could start to be used by healthcare providers and patients.” I’m not a big fan of the name for sure, and I don’t know how many people care about the Zune Hub. The Windows Phone Live cloud service seems cool. Overall, I don’t think it’s exaggerating to say that lines of would-be purchasers Monday morning (or lack of them) will tell you a lot about the odds that Microsoft will return to innovation relevance. I can’t imagine anyone giving up a recently purchased iPhone or Droid to get one — they’ll have to energize the fence-sitters. You don’t want to be slow to a market involving long-term contracts.

From Five Grand, Here: “Re: Harvard. Capitalizing on fear and anxiety, they’re going to the bank after promoting them. Even with a visit to the Harvard Faculty Club, am I the only one who thinks this is a rip-off?” The Harvard School of Public Health offers two-week program on HIT leadership for $4,995, not including hotel and dinners. Faculty includes Glaser, Halamka, and Middleton. Hospital people are so insecure and indecisive that I’m sure the mid-levelers with budget money show up (and probably add an intentionally vague note about their new Harvard “education” on their resume, which is part of what the $5K buys in their minds, I’d bet). The site says the attendee satisfaction is high. I’ll reserve judgment until someone who has been tells me their outcome, i.e. everything else aside, did their employer, who is likely quite different from Harvard, get their money’s worth in sending them? Sometimes expensive is worth it.

From Paisano: “Re: GE. I heard they’ve restructured the sales force. Any insights?” I don’t usually follow sales force restructurings, but anyone who wants to chime in can. I’m bored easily by endless territory realignments, new management bringing in recycled ideas already tried and failed elsewhere, and messing around with the sales function instead of fixing the real problem of underperforming products or executive management.

From Mark Wagner: “Re: HIStalk article EMR: One Size Does Not Fit All. Evan Steele made some accurate observations in his recent physician practice EMR post. There are many variables that influence the eventual success or failure of an EMR deployment at a practice. Practice specialty is absolutely one of them. Since HIMSS10, KLAS has been compiling a report that drills down on EMR vendor performance by specialty. As the need for more information by specialty was raised in this forum, it seems appropriate to also announce here that KLAS is releasing a first-of-its-kind ambulatory EMR specialty report on Tuesday. Beginning October 12, providers will be able to download a complimentary copy of the KLAS EMR specialty report and vendors can purchase a copy of the report. Mr. Steele correctly points out that KLAS only accepts evaluations from live users of a system. KLAS feels that live users are best equipped to report on current release quality, vendor responsiveness. and the level of customer support. Former users often share comments about failed experiences and KLAS reports that feedback when it is offered. KLAS welcomes research topic suggestions and questions about what we do and how we do it. Please contact us at info@KLASresearch.com.” Mark is the director of ambulatory research at KLAS.

From Mark: “Re: Meditech’s history. I love telling this story. Beverly Hospital was the beta when Meditech was introducing color terminals. Their controller and CIO went to visit Neil in the development building in Cambridge, which was actually two buildings, one old and one new, joined on a few floors. When you walked from the second floor of one to the second floor of the other, there was still a step because the floors weren’t the same height from the street. They went into the room where Neil was putting the final touches on the EPROM that was going to become the master for the new color terminals. All that was left to do was to pick out the colors that would be used for certain menus and pop-ups. Neil let the people from Beverly choose the color palette for hundreds of thousands of color terminal users.”

From John Smith: “Re: Ingenix. Layoffs in the payer and government group (the division that acquired AIM Healthcare). Rumor is about 100 people this past Wednesday.” Unverified.

HIE vendor Halfpenny Technologies gets $2.6 million in VC funding.

Thanks and welcome to North Highland, supporting HIStalk as a Gold Sponsor. The company, based in Atlanta but with 45 offices all over the US and elsewhere, does things differently. Instead of flying consultants out from a central location at the client’s expense, they have experienced consultants who work out of the same cities as their clients, or as they say, “Our consultants trade hotel rooms and security checkpoints for dinner at home and Little League practice.” Their results are real and measurable and their work is guaranteed. Thanks to North Highland for supporting HIStalk.

I was thinking about the impending Siemens layoffs, scheduled to start in early December. I know the Thanksgiving to New Year’s holiday season is long (15% of the year, basically), but companies could at least appear to be more humane by whacking their previously valued associates after January 1 instead of during the holidays. Cutting people loose right before Christmas means executives either don’t care or have let the situation become so desperate that the only answer they have for their own poor planning is to decisively overreact.

Carol from RelayHealth, who describes her specialty as “all-around-helping-providers-get-paid products”, offers a new white paper for readers interested in the point-of-service payment question asked earlier. You can download it here.

It seems that the IS department is going to be doing the Meaningful Use attestation work in most hospitals, although many clearly haven’t decided for sure. New poll to your right: how well will the Windows 7 phone compete against the iPhone and Droid?

If you’re an HIStalk sponsor and didn’t get your invitation from Inga for out little get-together in Orlando at HIMSS, e-mail her. We look forward to seeing you there.

Nuance and IBM are collaborating to develop Clinical Language Understanding, a healthcare-specific natural language tool to extract discrete data from clinician narrative.

Bon Secours Health System will use medical error tracking tools from Quantros.

BCBS of Nebraska chooses NaviNet’s provider communications portal for real-time eligibility checking and claims status and remittance.

I’ll leave you with one of the many amazing moments (this one from 1987) from St. Elsewhere, the best hospital drama ever. This is the memorable scene where Dr. Westphall expresses his opinion of the hospital administrator sent in by Ecumena, its new for-profit owner.

E-mail me.

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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.

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.

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.

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).

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.

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.

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.

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.

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.

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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.

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.

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.

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.

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.

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.

E-mail Inga.

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

Healthcare Passion Refueled

My passion for healthcare began in high school while working in environmental services at an outpatient facility (they called us “janitors” back in the 80s). From that point forward, different encounters have renewed that passion. The most dramatic experience was personal.

A Journey Home

Four years ago this month, my mom traded her earthly rags for a robe of righteousness. After a courageous four-year fight against the ravages of ovarian cancer, Ida Wilhelmine Marx bid us farewell. The entire experience had a profound impact on me not only as a son, but also in my profession.

My mom and I were tight. As I blindly plodded my way through adolescence, she represented mercy and grace. When I shoplifted, got arrested for joy riding (at 14 years old), set the house on fire, partied excessively, and flunked junior high, she was there. I’m convinced that if it weren’t for my father’s discipline balanced by my mother’s care, I would not enjoy the successes of today in my education, career, and family.

Radiance

Mom suffered much from illness her entire life. She took the cancer in stride: eight rounds of chemo, two rounds of radiation, and a couple of surgeries. Her sole desire before transitioning from this life to the next was to celebrate her 50th wedding anniversary. When we transferred her to hospice, it became apparent that she would be a few weeks shy of reaching her goal. With my parents’ permission, my brothers and sisters planned an early 50th anniversary party and vow renewal — the final celebration of Mom’s life. Knowing our world would change the following day, that night we put on a heck of a celebration.

Hollywood could not have written a better script. Hospice physicians agreed to give my mom life-sustaining nutrients and fluids through the big day (normally not allowed). They arranged for a “Sentimental Journey” pass: a limousine (ambulance) service for my mom and dad to the picturesque Cheyenne Mountain Resort in Colorado. Two paramedics waited in the background just in case their services were needed (they weren’t). They quipped how special my mom was because the only other person who ever received two paramedics as an escort was Dick Cheney when he came to town.

All seven of us children attended, plus all 15 grandchildren. My parents invited their closest friends. With the backdrop of the Rockies and all the majesty of a traditional wedding ceremony, I had the privilege of walking my father to the front. My oldest brother Mike had the honor of escorting my mom in her wheelchair to join my dad at the altar. She looked ravishing. My sisters had dressed her to the “nines.” Her dream was unfolding in real time.

Each of her children had a part in the ceremony, as did each grandchild. Assigned to deliver the sermon, I decided not to use notes, but instead prayed that God would intervene and deliver a message that would bless my parents and set vision for successive generations. The primary message: my parents had created a legacy of marriage that would impact not only the first generation (my siblings and me), but the grandchildren, and their grandchildren, and so forth. The fact that my parents stuck it out and endured a lifetime full of sickness and health is a testimony to the world: “Yes, it can be done.”

The ceremony ended with the exchanging of vows. A co-worker of mine had arranged for a Papal blessing of the 50th milestone as well, which touched my parents deeply. We printed the blessing in the renewal program. Unity candles, songs, prayers, and standing ovations lent to the evening’s incredibleness. But this was only the beginning.

One Heck of a Show

We then entered the adjoining room for a superb five-course meal. Taking advantage of the live music and dance floor, Dad rolled Mom out in her wheelchair to dance. My parents are fantastic dancers, and seeing my dad wheel my mom around was moving. Throughout dinner and beyond, we danced to our hearts’ desires. All four sons danced with my mom, who was clearly delighted. Even my son Brandon danced with her, to which she commented, “You’re not dancing. You’re just shaking your ass!”

Next came toasts, the garter ceremony, and all the similar accruements of a fine celebration. At that point, Mom addressed the room with loving words. Dad tried but fell apart. As a finale, guests and family formed a tunnel by joining hands. Dad wheeled Mom through as we hugged, kissed, cried, and spoke blessings.

Returning to her limousine, she was still beaming. My dad shared that as he laid Mom in her bed that evening, she said, “We sure gave them one hell of a show tonight, didn’t we?”

Timing

During her illness, I flew out often to visit her. I wanted to be at her side when she transitioned, just as she had been at my side so many times. I missed by eight hours, but that was OK. Over the years, I’d left no doubt in my mother’s heart of my care, admiration, appreciation, and love for her. Arriving shortly after her passing, I supported my brokenhearted father and assisted siblings with the funeral arrangements.

Kiss

My mom had taken her last breath shortly after midnight. Two of my siblings and my father were at her bedside and described that, while painless, her body struggled for every last breath. As a result, her mouth was stuck wide open. The hospice nurse explained that, given the timing, the mortician would be the only one able to close Mom’s mouth. My sister-in-law, an ICU nurse manager, validated this.

Meanwhile, my dad knelt at Mom’s bedside and held her frail body, the first time in months where he could hold her without causing her pain. He kissed her lips. Wept over her. Sometime in the next two hours, while they awaited the mortician’s arrival, Mom’s mouth closed…and she smiled. Comfort permeated the room and reinforced our belief that she had indeed transitioned to a happier place.

Passion Fueled

My mom’s battle allowed me to spend considerable time in various care settings. I observed the processes, evaluated technology, and pondered how things could be improved to benefit caregiver, family, and patient. The clinicians treating my mom lacked the communications and clinical decision support needed to deliver the highest quality of care. I was shocked by the lack of access to critical and timely clinical data. The wasteful amount of paper utilized and manual processing disappointed me.

I ended up creating medication reconciliation lists and pulling together charts. I swore it would never be this way in my work environment. As I took mental notes from the perspective of patient and family, my passion to leverage technology and transform the clinician and patient experience was renewed.

It’s this passion that drives me in my daily work. This is why I’m tenacious in advocating technology, why I continually innovate and collaborate with clinicians, and why I blog. This is why I advocate for stronger IT leadership. It’s the heartbeat behind why I spend more time with my people on leadership, customer service, process, and passion than I do on virtualization or cloud computing.

Until my people have a heart for patients and are in a position to empathize with their plight, the technology platforms, while critical, will be limited. The full potential of technology in the delivery of high quality healthcare comes with a transformed heart.

Thanks, Mom, for refueling my passion as a leader of healthcare technology.

What fuels your passion? What stokes your fire? Leave a comment below.

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

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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!

EMR: One Size Does Not Fit All
By Evan Steele

A recent comment on HIStalk, by a hospital CIO about what he identified as the best EMRs for enterprise systems and their physicians, highlights a problematic and all-too-prevalent misconception. The fact is, it is impossible to satisfy both hospitals and community ambulatory physicians with the same EMR product.  Furthermore, even the ambulatory market cannot be looked at as a whole. EMRs designed for primary-care physicians respond to a set of needs that are very different from those of specialists.

Enterprise EMRs simply do not work in high-volume ambulatory practices. This is particularly true for specialists’ practices. Many hospitals have had some success with Epic and other hospital-focused EMRs, but success has been limited when these same hospitals ask physicians — again, particularly the specialists — to implement these systems in their practices. A monolithic enterprise product cannot possibly support equally well such different workflows, patient care scenarios, and providers’ needs.

Within the ambulatory market itself, it is time to bifurcate the EMR discussion into two groups: EMRs for primary care physicians and those for specialists.

Industry analysts typically lump all EMRs into one category, which does not adequately differentiate the market segments or their distinct needs. The major EMR vendors have massive footprints in the marketplace, yet a small company like SRSsoft has the lion’s share of referenceable high-volume, prominent specialty practices in areas like orthopaedics and ophthalmology. Why? Because one size does not fit all, and it is impossible to satisfy the needs of both groups without compromising the needs of one.

The American Academy of Orthopaedic Surgeons (AAOS) acknowledged this issue in its recently released EMR Position Statement, pointing out that “Many systems are geared toward primary care medical practice, which can limit the utility of EHRs for specialty surgical practice.” It correctly suggests that “the different needs and uses of EHR by disparate medical specialties should be recognized.”

Specialists represent approximately 50% of the physician market, a sizeable segment that is largely being ignored. How are specialists to determine which EMRs are designed for their needs?

KLAS, the closest our industry has to a JD Powers–type of rating source, does not break out its ratings by specialty. This means that if an EMR vendor does well in the ambulatory primary care market and has high KLAS ratings, an unsuspecting specialty practice might purchase their product based on those ratings, only to find out that the product does not fit their unique needs. 

Exacerbating the situation is the fact that KLAS only surveys practices that have actually installed the EMRs. It does not survey practices with failed implementations. Since specialists represent a disproportionate number of the failures, the information is even further biased.

The result is that there are thousands of specialists who purchase EMRs from highly rated and/or household name vendors, but who end up with failed implementations and significant financial loss.

One size does not fit all. There are good EMR solutions available for every type of physician. It is incumbent upon the individual physician to research and identify the product that best suits his/her practice’s needs.

Evan Steele is CEO of SRSsoft of Montvale, NJ.

ClickFreeMD Comment Response
By Bob Gordon

Note: Mr. H here. I’m breaking my “no commercial pitch” rule this one time because Inga had questioned the business model of ClickFreeMD, which offers practice systems including billing for a flat monthly fee rather than the traditional model of a percentage of collections. Inga’s point was that the percentage model encourages the billing company to collect. CEO Bob Gordon was nice enough to e-mail Inga an explanation and we thought his response might interest some readers even though it is hardly unbiased. I’m not endorsing their product and I have no connection to ClickFreeMD.

ClickFreeMD leapfrogs the percentage-based provider business model. Consider the following:

• No start-up, implementation or training charges.
• The flat fee is lower on an equivalent percentage basis than most practices would pay for outsource medical billing alone and far less than in-source options.
• If the practice improves its revenue or we boost it (which we often can do), the equivalent percentage drops through the floor.
• The breadth, quality, and integrated end-to-end nature of our software, services, and support are unrivaled. Physicians are paying twice as much elsewhere for much less elegant solutions today.
• The flat fee sticks. If encounter or charge values increase, the flat fee stays the same and the practice captures cost free revenue. If it drops outside ordinary seasonality range, the rate is adjusted down pro-rata so our physicians’ earning power is fully protected.
• Importantly, the flat fee is backed by a performance guarantee that makes sure we work every claim or we rebate half of the flat fee. There is no equivalent protection in a percentage-based model. In fact, any claim that takes more than 15 minutes to resolve in a percentage system is probably costing them more than they are making, and hence billing company profitability is at some point in the collection continuum inversely correlated to increasing practice collections.
• Our contracts all have 90-day outs and low price match guarantees for comparable services.

You may ask how we do this. We have deep domain expertise from running billing companies, back offices, and technology companies for decades and have organized a Southwest Air-like discount fee, high-result business model that is very scalable. We expect that ongoing volume will feed a virtuous cycle for all, continuing to allow us to offer more for less while achieving top results.

One of the most striking things we are doing is the least recognized — giving the practice their flat-fee price, online and instantly, as well as their included services, without asking them to give us any information. Try this anywhere else like Athena and what we do in 30 seconds becomes a multi-day process that involves e-mail / telephone / online discussions and/or meetings and requires the practice undressing for the vendor. We are completely ONE-WAY transparent. That’s because we want the practice to decide if they want to contact us — after they are satisfied that this is a superior value for them and only then. We aren’t interested in lead nurturing them to death. 

This is about "more dollars for doctors" and great news in the group practice fight to sustain their independence. We are doing our part to create a reversal of fortune in the group practice community with a unique business model that raises revenues faster than costs, delivers immediate and ongoing savings, and provides the tools and support that allow them to be ready for tomorrow.  

Like the boiled frogs of lore, physicians have been nickel and dimed by payers, billing companies, and others, overpaying to under-produce for so long, they find themselves working much, much harder for less and less. We’re changing that and we’re passionate about it! Thank you for your consideration.

Bob Gordon is CEO of Click4Free of Chevy Chase, MD.

It’s Official: The Rush for Talent Has Begun
By Tiffany Crenshaw

In recent weeks, a number of existing and prospective clients have called me for a pulse on the healthcare IT recruitment marketplace and thoughts on how to attract quality resources. After a number of such calls, I decided to put my thoughts in writing and share.

Let’s start with the good news. Industry hiring is definitely picking up and employed candidates are now less afraid to make a career change then they were three to six months ago.

As for hot products, it’s no secret that Epic is hot, hot, hot. Hospitals are purchasing Epic left and right. Honestly, there are simply not enough Epic resources, especially Epic-certified resources, to go around, so the talent war is raging. Cerner recruitment remains modest but steady, while McKesson needs are starting to rebound after quite a lull.

In the ambulatory market, we are seeing more and more requests for eClinicalWorks and Allscripts. New names like Sage and Greenway are coming to light. And occasional needs for Meditech, Siemens, IDX/GE and Eclipsys are surfacing.

On the integration side, Cloverleaf and e-Gate skills are still in demand, but we are seeing more requests for Web-based and lesser known products like Ensemble, Symphony, and Rhapsody.

The hiring demand is highest by far for hands-on resources to design, build, and install EMR applications. However, there is a fair amount of activity for sales, project management, and training professionals, including go-live support.

CPOE, clin doc, pharmacy, oncology, and HIM are generating the most recruitment activity within the applications. Based on new client requests, we foresee growing needs for business intelligence, security, and report-writing resources.

In addition to employers’ desire for one or more of the skill sets mentioned above, most are adding clinical designation to the requirements. Over 50% of our job requisitions right now require clinicians. Pharmacists, nurses, and physicians with healthcare IT experience are in great demand.

However, post-recession hiring is creating challenges previously unheard of in my 12-year history recruiting in this industry. The process is now wrought with excruciatingly slow interview scheduling, shrinking employee benefits packages, little to no relocation assistance, and financially conservative offers resulting in more and more frustrated candidates.

Things have changed drastically since the lowest points of the recession. After the release of Meaningful Use requirements, recruiting mania has taken off. Everyone seems to have hiring needs. Candidates are getting called left and right by internal and external recruiters. Just check out a few of the job boards if you don’t believe me — you’ll see countless job postings. Furthermore, check out all of the recruiting firms with no previous healthcare IT experience trying to break into this market as experts claim abundant need for resources.

If your organization is currently or will be in the market soon for these in-demand resources, you may want to evaluate your hiring process, recognize that your competition is fierce, and take note of a few trends our candidates and clients have shared with us quite candidly over recent months.

• New car syndrome. Candidates are migrating to new implementations. Who can blame them? It’s more exciting to be on the ground level and see a project through from A to Z.
• Red carpet treatment. Employers who roll out the red carpet win. When weighing decisions between job offers, candidates almost always choose the employer who provided quickest response time and showed sincere interest in them. (Both response time and sincerity are simple and no-cost ways to roll out that red carpet.)
• Relocation blues. Relocation is a HUGE issue right now. Even if candidates want to move, they can’t do so because of the housing market. Kudos to all of the organizations willing to work around this by providing remote work, commuting, or coverage of interim living expenses.
• Communicate. Many, many candidates are feeling jerked around by potential employers because of lack of communication in the interview process. Here’s what they are thinking: “If I don’t feel valued as a candidate, how are they going to treat me as an employee?” On the flip side, these candidates are communicating with plenty of their peers. Too many hospitals and consulting firms are getting bad reputations as being lousy places to interview and to work.
• Too much is not always a good thing. In the quest for resources, too many organizations are panicking and calling in all of the troops — internal recruiters, employee recruiting bonuses, dozens of external recruiters and advertisements. Candidates get called multiple times by different sources all looking to fill the same positions. Not only do they end up confused, but all the activity makes candidates suspicious. They wonder what’s wrong with an organization that has such a hard time attracting and retaining talent?
• Get on board. We are hearing more and more horror stories about candidates showing up on the first day only to find their new employer is not ready for them. This gets them off to a bad start from the get-go. Employees stay longer and perform better when they feel welcomed and the transition process is smooth. The period of time between offer acceptance and start date can also be a black hole, when candidates are most vulnerable. Employers are losing candidates this far into the game because they aren’t communicating with them. If you don’t have a formal on-boarding program, now is probably a good time to look into it.
• Disconnect between human resources and hiring managers. As an outside firm, we work with both HR representatives and hiring managers. We hear complaints on both sides about the other on a regular basis — namely due to lack of response. The hiring managers want candidates fast. And HR wants answers fast. Throw candidates in the mix who get frustrated as well and it’s a nasty situation. However, we find that employers who really engage the final decision-maker in the process from beginning to end and set response expectations up front have the least amount of frustrations and the most successful outcomes.

In summary, you can safely say that the industry is quickly changing to a candidate-driven market and that the market is impacted heavily by post-recession recovery and Meaningful Use. It is official. The rush for talent really has begun.

Tiffany Crenshaw is president and CEO of Intellect Resources of Greensboro, NC.

The Coming Speed Bump in the EMR Market
By Jon Shoemaker

It’s no secret that there is currently a mad rush occurring, not unlike The Oklahoma Land Rush of the 1800s, where hundreds of companies both new and old are getting into the business of healthcare information technology. Some come with industry expertise. Others come to take advantage of the financial opportunity. Consider Best Buy, the consumer electronics giant, that will install your EMR using their Geek Squad. So much for needing clinical expertise!

I believe this climate of frenetic activity will cause the EMR market to encounter a large, steep speed bump in the next 10 years. It won’t be from all of the EMR installations or supporting all of these systems, as this will create thousands of jobs and supporting infrastructure that currently does not exist. The bump in the road will come when all of these new digital silos must talk to each other as required in Phase II of Meaningful Use (MU). It is the very selling point of these systems — simple communication and usability — which become the Achilles heel of these EMRs.

EMR’s to date are not installed with a common code structure for identifying exams, studies, or services, all of which will need to be exchanged outside of the office in Phase II of MU. The reason for this lack of standardization has nothing to do with EMR functionality or capability — it is that everyone is still thinking locally not globally.

To ensure true interoperability and exchange of patient health information, EMRs must be installed to satisfy the local requirements, but also with the forethought that they will integrate to larger systems. This requires standards and standardization. The absence of a standard will require the use of translation services so that HIE repositories use the same codes for exams performed across the region.

Translation services, while a viable alternative to standardization, require one-off knowledge for the database structure and logic for each customized local EMR as well as that of the destination repository. This level of granularity creates layers of complexity for maintenance and mapping. Any changes to local system will mandate updates to the translation engine. The support nightmare of constant mapping modifications to assure the proper codes are sent outbound or received inbound will be effectively unsustainable.

Once all of the paper silos are replaced by digital silos, there will be enlightenment of EMRs that were installed incorrectly, don’t address the clinical workflows of the office, and don’t communicate outside of the office with a standard communication protocol using standard coding methods. This will lead to a second phase of the EMR revolution will include translation services and reinstallation of EMRs to address workflow and data gaps. This will have to be resolved before integration to a larger HIE repository can take place.

If we begin now with standardization of workflow and codes and ensure they are addressed with current EMR installations, we will be in a better place in five years and users will see the true benefits of these systems. With our current strategy of “every man for himself,” we risk losing users’ confidence once these systems are installed and address workflow and physician concerns. Once we lose the users’ confidence, they will stop using the system and re-adoption efforts will prove Herculean.

As you begin planning your EMR implementation, there are hundreds of questions to ask. When it comes to meeting the long-term requirements of MU as well as realization of the true benefits of an EMR, here are a few to begin with:

1. Have we reviewed and documented our office workflow?
2. Are we using the new SNOMED codes?
3. Are we following standardized codes for services rendered?
4. Does the installation team understand clinical workflow or do they look glassy-eyed when we discuss medical terms?
5. Is our vendor of choice an IT company trying to cash in on the HIT initiative without clinical experience and knowledge which could place our business at risk?
6. How will this EMR connect us in the future to larger integrated systems?

Jon Shoemaker is senior consultant with Ascendian Healthcare Consulting of Sacramento, CA.

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