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!

On the Largest Medicare Fraud Case in History – $100 Million
By Deborah Peel, MD

Key points:

• This case is “the largest single Medicare fraud case” in history.
• “There were no real medical clinics behind the fraudulent billings, just stolen doctors’ identities," says Janice Fedarcyk, FBI assistant director-in-charge. "There were no colluding patients signing in at clinics for unneeded treatments, just stolen patient identities."
• The organization stole the identities of doctors and filed applications to bill Medicare in their names, often providing a clinic address on the application that was, in fact, the location of a mailbox, according to the indictment. The organization then obtained the stolen identities of thousands of Medicare beneficiaries, including the identities of about 2,900 patients treated at the Orange Regional Medical Center in Orange County, NY.
• Members of the organized crime ring also are charged with operating a multi-million dollar scheme to defraud health insurance companies in the New York area by submitting claims for medically unnecessary treatments.
• In some cases, defendants allegedly staged auto accidents to generate fake patients who would then undergo unnecessary and expensive treatments that would be billed and reimbursed.

What I still do not get is the inability of very smart people in government, healthcare, and HIT to miss the REALLY big picture.

Privacy isn’t about preventing tomorrow’s profits or blocking meaningful use of data. It’s about the fact that if Americans lose ALL control over personal information in healthcare, we will lose all our privacy rights in the Digital Age. Period. All of them. For every kind of information / data about us. Our strongest rights to control personal information are our rights to control health information.

If we lose the war over control of personal information in health, the US will become a total surveillance state and we will have lost the most precious right individuals have in Democracies: the right to be let alone. Do you think that we can remain a Democracy if everyone — government and private corporations — knows everything about us? There is a reason for the saying “information is power.” 

By the way, I am not in the Tea Party or a radical. Standing up for medical ethics, the law, and the right to privacy is a very conservative position!

The big take-away is that as long as patients’ sensitive electronic health information and demographics are so poorly protected, millions of employees of hospitals, clinics, insurers, pharmacies, and health IT vendors will have open access to steal it. We will continue to see an explosion of multi-million dollar healthcare fraud, identity theft, and medical identity theft, unless we radically redesign our health IT systems, protect health data wherever it flows, and restore the right of consent.

The high-profile of this case is supposed to discourage criminals and potential criminals, but when millions of employees in healthcare, government, and health technology corporations have open access to all patient health data, the likelihood of getting away with data theft is high. The innumerable outside hackers and criminals whose business is stealing valuable health data will never stop.

The only solution is to require comprehensive and meaningful privacy and security for all health data, wherever it flows:

1) Restoring patients’ rights to control electronic health information would end open to the nation’s health data by millions of employees of the healthcare system, insurance, government agencies, and technology industry. Requiring informed consent before ANYONE can see our records is simple, cheap, and easy if we require robust electronic patient consent for all data use or exchange.

2) Requiring and enforcing ironclad, state-of-the-art security for all health IT systems and health data wherever it is held online is essential.

If we don’t require and build trusted systems now, before ‘wiring’ all health data systems together, before systems are ‘interoperable’ and before every American is required to have an electronic health record, we will destroy privacy for generations. Once our sensitive data is ‘out’, like Paris Hilton’s sex video, it can never be made private again. And when healthcare systems cannot be trusted, people refuse to get needed treatment, fearing their jobs and futures will be endangered. Creating a healthcare system that people are afraid to use is a national disaster. Trust takes a long time and is very expensive to rebuild.

The implications for Democracy if we lose the right to privacy in healthcare are dire.

Deborah C. Peel, MD is the founder of Patient Privacy Rights.

Before Extending Software Support Contracts, Consider Alternatives
By Tony Paparella

It’s common for a healthcare organization to become unnecessarily tied to an extended support contract when it retires an HIS in favor of a new system. The old system is not an ideal data storage solution. Although patient accounting and clinical data sets still require some functionality and real-time user access, the legacy application is expensive overkill for what is needed.

Support contracts typically run a year or more in length, meaning they’re oftentimes paid for longer than necessary. Furthermore, it may be difficult to negotiate favorable rates and terms with a vendor facing long-term loss of revenue.

Other times, purchasing a contract isn’t an option; the system may be so outdated that the company that owns the software no longer offers support. This places the organization in a precarious position, facing potential loss of vital data. Furthermore, IT staff may become burdened with legacy system upkeep, deflecting efforts away from the new HIS.

“Doing nothing” or opting for an inadequate option invites serious compliance and financial risks. Millions of dollars (and the jobs of CIOs and department directors!) can be lost to: interruption to account billing/cash flow; inability to respond to a payer audit (such as RAC and commercial insurance audits); noncompliance with Federal and State data retention requirements; loss of access to the legal medical record and; increased hardware/software expenditures.

Additionally, fines for non-compliance with Federal employment record, HIPAA and other retention requirements can be significant. Depending on the statute, data retention requirements range from three to 28 years – meaning a short term, one-dimensional solution won’t do.

Fortunately, signing an extended support contract isn’t the only option for organizations that must access and manage legacy data.

Internal warehousing may be considered as an alternative – metaphorically, a home for data, albeit largely unfurnished. Though data access and management is inherently restrictive, this option is typically the most time- and cost-efficient to implement.

In a full detail conversion, all legacy account data is converted into the new system. If precisely executed, compliance and cash flow are maintained. Often, however, the vendor will decline to bring old data into the new HIS. Hence, the risk of cash flow interruption. A high degree of planning and analysis is required before implementation.

Legacy data can also be migrated to a healthcare active archive specifically designed to allow end users to access and update accounts, run reports and, in some cases, post payments and bill accounts. Advance preparation is essential. In some instances, an organization may need to specifically task an IT team member with helping coordinate the migration of data.

Proper planning and preparation will help your organization sidestep a burdensome legacy system support contract. Understand the risks and investigate your options many months in advance.

Tony Paparella is president of MediQuant Inc.

What one hospital charges for a particular procedure varies widely based on a host of factors. Understandably, many providers who are otherwise all for transparency when it comes to patient outcomes are reticent to disclose cost data. There are real reasons for concerns on the globalization of medicine. However, health care is largely a local phenomenon.

What are the compelling reasons for being as transparent with prices as with anything else? For one, increasingly, consumers are armed with price information today that exceeds anything they could have assembled even just a few years back. Also, in the mind of many consumers, price equals quality. Logical or not, this notion has become ingrained as a result of their consumer experience in other industries.

Wine under one label is deemed more expensive than wine under another label, even in the case where the wine has proved to be exactly the same, from the same source, processed and delivered in exactly the same manner.

Reputation Enhances Price

At the supermarket, branded merchandise still sells at a premium compared to store or generic brands that offer the same ingredients, molecule by molecule. Your hospital’s reputation could prove to be the deciding factor in whether or not a patient will plunk down more money to be treated by you over others who, based on all comparison measures, offer exactly the same care and service.

Suppose a consumer does his homework and finds that you and a competitor have entirely equal success rates for particular procedure, and you charge 15% more. Is this a reason to fear price transparency? No, because with all the data available for a consumer to peruse to his heart’s content, the decision to choose one provider over another is multifaceted. Price is one factor, albeit an important one, among several.

Many consumers will go with the lowest price. Many will choose the best value – a blend of price and quality. Short term, there is not much you can do about the prices for some of the procedures you charge. In the long run, everything is up for grabs.

More Business, Lower Prices

The more often a hospital performs a particular procedure, and the more experience its doctors accrue, the better it is able to offer that procedure at a lower price. Even in health care, greater business volumes contribute to economies of scale. In the short run, you can’t do that much about the volume you handle for any particular procedure. In the long run, you could seek dominance in your local or regional area by publicizing your experience in a given procedure. Thus economies of scale could result and price transparency would work to your favor.

At Alegent Health, based in Omaha NE, the prevailing attitude is that consumers have a right and ought to be able to easily know how much a provider charges. Three years ago, Alegent launched My Cost, found at www.alegent.com, a consumer-friendly feature that offers cost estimates for a variety of tests, procedures, appointments, and services.

So, You Want Cost Data

Visitors can simply enter the name of their insurance providers and any co-payment or deductible information. The system then presents a cost estimate that is useful in personal health care decisions.http://www.alegent.com, The visitor is also treated to financial assistance information via links provided, and a phone number in case their anticipated procedure is not listed on the site. Now up and running for nearly three years, more than 50,000 cost estimates have been generated at My Cost.

Alegent’s experience in promoting price transparency has been that consumers appreciate the honesty and openness of the organization. Instead of price transparency scaring away potential business, in this case it has led to stronger provider-patient relationships. Alegent’s CEO says transparency “isn’t necessarily easy, and it does take courage, but in the end it is the right thing to do for consumers and the community.”

Make the Commitment

Commitment to transparency takes guts. Yet, what other choice is there? Fortunately, as we’ll see, there is room for creativity and initiative.

Providing information on the results that your hospital achieves for patients, at the medical condition level, is vital. Your data needs to include patient outcomes with an adjustment for risk based on prior conditions, the overall cost of care, and measurements for both extending through the care cycle.

Transparency also encompasses offering the experience your hospital has in treating specific medical conditions, by volume of patients, coupled with delineation of such treatments based on methods of care offered. Your processes, in the long run, can be improved only by understanding how results are achieved, which methods are most effective, how they might be refined to make critical differences, and what the actual outcome of such refinements have been.

Details Count

Outcomes for a specific medical condition can and should be expressed many ways. For, say, shoulder surgery several validated measures exist such as range of movement, reduction of pain, and ability to function. Still other outcome measures for shoulder surgery include the interval between the initiation of care and return to normal activity such returning to work or playing tennis again.

Data related to the particulars of patients, known as patient attributes, such as gender, age, genetic factors, and prevailing conditions, are vital elements of transparency and are essential for assessing risk. Accurate diagnoses are vital for both the patient and the provider. A transparent provider will publish measures of diagnostic accuracy including cost, timeliness, and completeness.

Outcome measures that only address episodic interventions fall short because they fail to yield results meaningful to the patient. Such short-sighted reporting and consequence scoring can be counterproductive and lead to the publication of misleading data.

Failure is not pretty and human beings instinctively want to avoid reporting their own shortcomings, much like organizations. Still, ineffective treatments – errors in procedure, medication, or treatment – and complications following a procedure need to be identified and scored. As unpleasant as this task may be, it is a step on the path to improved levels of treatment and overall service. You cannot fix a problem that you refuse to acknowledge.

Expand Your Measures

A traditional core measure, “the 30-day readmission rate,” tracked by the government, is of course a potential indicator of poor quality. Who wants too many patients are readmitted within 30 days for the same problem.

You may be able to devise your own kind of data measures by tinkering with traditional data measures. For example, you could align your total quality management efforts, such as your Six Sigma Performance Improvement initiatives, around improving the 30-day readmission rate and devote resources to that. In turn, for each of the core measures which need to be fully transparent, you may wish to devise two, three, four or more strategies to ensure that your scores improve over time. Rest assured, other providers will be doing the same.

Costs Mysteries No More

Unlike most businesses, many hospitals, to this day, don’t know what their actual charges ought to be. They charge for this procedure or that based on tradition, competition, payer contracts, or whatever cost data they can scrape together. A comprehensive understanding of true cost is often lacking. If and when the government mandates that hospitals publish price and quality information, they will need the technical ability to do so.

In almost all cases, some web restructuring proves to be vital. There needs to be a huge consumer section that is highly inviting. Take the bull by the horns and invite the consumer to go patrolling through your data. Just as industrial companies publish annual reports with a profit and loss statement, balance sheet, and cash flow analyses, you might choose to offer a five-year projection as to the life cycle cost of a procedure and its follow up.

Implications for Your Hospital

• Is transparency part of your agenda for your weekly and monthly meetings?
• Has your hospital developed policies and procedures in relation to transparency?
• Within your own office or division, are top officers involved in the transparency discussion?
• Have you attended any conferences and symposiums on transparency?
• Are you monitoring other providers who have already made the conversion to transparency?
• Are you devising plans to capitalize on the inherent opportunities in offering transparent data?

Colin Konschak is the managing partner of DIVURGENT, a management consulting firm. His book on this topic was just released.

 View/Print Text Only

From The PACS Designer: “Re: CCHIT’s EACH program. TPD is happy to see that the CCHIT organization has realized that many hospitals have custom EHRs, and now through their new EACH program, they will be able to get current hospital EHR configurations certified more quickly than going to an all new EHR product.”

From Mrs. Marine: “Re: Veterans Day. Many thanks for your gracious acknowledgment of our servicemen and women. My husband is a 20-year Marine and I still get a chill when someone goes out of their way to thank him (or me) for his service. I would also like to acknowledge the many companies in healthcare IT that provide opportunities to military spouses like me to achieve in our own careers in spite of the many challenges that a military life presents. I can tell you from my own experience that I am a better employee, wife, and mother because I have had the support of my company in every way. To Mac, Mike, Tom, and Clair — I will be forever grateful. To the industry, thank you for taking care of us…all of us.”

One more military note: congratulations to HIStalk pal Admiral Cindy Dullea, who retired from the Navy after 30 years of service last month. She is a board-certified informatics nurse and was Deputy Commander, Navy Medicine National Capital Area and Deputy Director, Navy Nurse Corps, Reserve Component. She continues as SVP of marketing at SCI Solutions, which has been a sponsor of HIStalk for most of the 7.5 years that I’ve been writing it.

Accelarad announces its Turbo Gateway DICOM image transmission technology, which it says will speed up image delivery to and from cloud-based repositories via the Internet by up to 300% (4.5 CT images and 9 MR images per second).

Wilson Memorial Hospital (OH) names Larry Meyers as CIO. He was previously IT manager with Children’s Medical Center of Dayton.

A study of 250 hospitals by CapSite finds that 25% plan to invest in new Vendor Neutral Archive solutions.

Jobs from the HIStalk Sponsor Job Page: Healthcare Consulting Leader, Channel Account Manager – Cerner, Product Manager – Mobile Point-of-Care Solutions, Senior Manager Segment Marketing. On Healthcare IT Jobs: Implementation Engineer – Eastern Region, Systems Analyst Programmer V, Cerner FirstNet Analyst, Interface Engineer.

PolyRemedy brings on two new executives: Jeffrey Tingle (previously with the Risk Management Foundation of Harvard Medical Institutions) as software development VP and Heath Umbach (from WebMD) as director of product management. The company offers a Personalized Woundcare System that allows clinicians to assess and document using Web-based tools.

Aetna’s incoming CEO says the company will enter the US HIT market to take advantage of healthcare reform. Earlier talk I’d heard pointed to mostly consumer-focused Web tools, but you never know who they might buy.

The Norwegian government will support the Maternal mHealth Initiative with a $1 million donation.

The Institute for Clinical Systems Improvement licenses Nuance’s RadPort radiology ordering solution to support a Minnesota initiative to ensure medically appropriate use of MRI, CT, PET, and nuclear cardiology tests. The state expects to save $28 million per year based on the success of a 4,000 physician, year-long pilot. Docs get the benefit of not having to get pre-approval for the tests as long as they complete the online information needed to generate a clinical appropriateness score using rules derived from the American College of Radiology’s Appropriateness Criteria.

Coro Health receives $2 million in funding from a former Walmart CEO to deliver music “prescriptions” to long-term care patients that can help with cognitive stimulation and socialization, claimed to improve memory, reduce medication needs, and improve mood.

One of the companies showcased to President Obama during his recent visit to India was Teleradiology Solutions, India’s largest teleradiology vendor. The company says its radiologists cover the night shifts of 100 US hospitals from Bangalore. They’ll be at RSNA.

Speaking of RSNA, if you’re going and want to provide updates for HIStalk readers, we’ll take ‘em.

I’ve been really behind after attending the mHealth Summit, trying to catch up at the hospital and at HIStalk Intergalactic Headquarters (an upstairs bedroom that I just painted because Mrs. HIStalk was tired of the crappy builder’s whitewash that we had never changed). I have new sponsors to announce, reception details to hint at coyly, and HISsies to get started shortly. I’m hoping to dig out this weekend in case I’m tardy with something you’re expecting from me. To those folks, thanks for your patience, and to everyone else, thank you for reading and thereby giving me an excuse to do something that at least passes for productive on occasion.

A Harris Interactive study finds that smart phone users don’t care whose brand name is on their apps as long as they are highly recommended and offer a good user experience.

This flies against everything I’ve been taught about medical errors: the systems and procedures at Seattle Children’s were not at fault in three serious medical errors, a state investigation concludes. Everything was in place to protect patient safety, it said, which is then puzzling as to how the errors could have occurred. It also doesn’t explain why the hospital revised its medication policies after killing an 8-month-old with a tenfold overdose of calcium chloride. The investigation now focuses on the individual caregivers, which often means they get all the punishment as rogue operators (which they sometimes are, but not usually).

A Massachusetts county sheriff faults a police dispatcher for the death of a woman who choked to death on a marshmallow. Her husband called 911, but the dispatcher didn’t give him instructions on performing the Heimlich maneuver or CPR during the 12-minute call.

An Associated Press article covers informed consent applications that allow patients to review the risks of their procedures using multimedia, even from their own homes. Mentioned specifically: Chicago-based Emmi Solutions, which sells such a system used by 100 hospitals. Also mentioned: Dialog Medical, which is used by all of the VA’s hospitals.

It’s shocking that Weird News Andy missed this story: a South Carolina man high on hallucinogens is arrested after attacking officers investigating a home burglary, resisting to the point deputies have to use pepper spray, nightsticks, and a Taser on him. He’s taken to the ED, where the doctor notices a computer mouse cable dangling from his nether regions. An X-ray confirms that the rest of the mouse was where you might expect. He doesn’t remember how it got there, which is quite a testament to the power of hallucinogens.

E-mail me.

HERtalk by Inga

From Saxifraga: “Re: Facebook fan. Do I win a prize for being the 1,000th person to like you on Facebook?” I’d send you some fabulous virtual gift if I had one of those goofy Facebook apps set up. Thank you, Saxifraga, and our other 999 fans for your support. Mr. H and I are feeling very connected these days and we’re always happy to friend you on Facebook and connect with you on LinkedIn. You can also join the HIStalk Fan Club on LinkedIn, be a fan of the HIStalk page on Facebook, or follow us on Twitter. Basically, we are trying to be very hip when it comes to social media. It’s satisfying in a pathetic sort of way.

A reader tells us that Saint Alphonsus Regional Medical Center (ID) went live on Cerner October 15th and has reached almost 90% CPOE adoption, also deploying SurgiNet and FirstNet across all its patient and ambulatory areas.

Henry Ford Health System (MI)  announces plans for a $5 million expansion of its Rochester Hills data center, which will create 20 to 30 jobs a year for the next several years. Its technical employees are focused on the rollout of CarePlus Next Generation, the newest version of the health system’s homegrown EMR.

Healthcare providers rely on vendors with which they have an established relationship when selecting a Recovery Audit Contractor (RAC), according to KLAS. The most-considered vendor is Healthport (23% of the time), followed by MediRegs (16%) and 3M (14%.) Of the 98 provider organizations participating, 92% said they already selected a RAC solution; more than half only considered one RAC offering.

VHA selects TeleTracking’s RadarFind and its RTLS network as an option for its 1,400 member hospitals.

Yuma Regional Medical Center (AZ) will use InterSystems Ensemble for the development of interfaces with its Epic EHR application.

The VA contracts with DSS, Inc. for its Mental Health Suite EHR, which it will implement in all 153 of its hospitals.

Accenture wins a 10-year, “indefinite delivery / indefinite quantity" contract with the CDC for information management and IT infrastructure services. The total contract has a ceiling of $4 billion over the life of the contract.

The president of GE Healthcare’s business unit predicts that his division will see 10% profit annual growth, mostly due to an increase in world demand on big medical equipment. John Dineen expects particularly strong growth from China, which could grow 20% a year through 2015.

Halfpenny Technologies names Gai Elhanan, MD, MA as the company’s CMIO. He was most recently chief of healthcare informatics at 3M Health Information Systems.

The American Medical Informatics Association declares that “hold harmless" clauses in contracts between HIT vendors and providers are unethical and that vendors should not be automatically absolved for errors or defects in their software. Instead, vendors and customers should share the responsibility for patient safety and error management. AMIA also states that safe and successful HIT systems require ethics education on the part of vendors and clients. Great recommendations, but I don’t see vendors rushing to ask attorneys rewrite their standard contracts.

CCHIT announces that it will offer a new EHR certification program for hospitals beginning December 15th. The EHR Alternative Certification of Hospitals (EACH) program is an ONC ATCB certification program that is designed for hospitals that have uncertified legacy software, customized commercial products, or self-developed EHRs.

MonteFiore Medical Center (NY) activates DaVincian Technologies’ GUARDIAN to streamline patient registration and scheduling and improve data accuracy.

Sponsor Updates

• The Methodist Hospital System (TX) engages MEDSEEK to create an integrated patient portal based on data from its Eclipsys inpatient system, NextGen outpatient program, and Medicity HIE.
• Informatics Corporation of America (ICA) promotes John Tempesco from VP of client services to chief marketing officer and hires Brian Higdon, formerly of Affinion Group, as vice president of client services. Former TeraMedica Healthcare Technology VP Sandra H. Lillie also joins ICA as VP of sales and business development. In addition, ICA adds three Vanderbilt University Medical Center officials to its board of directors.
• Bridgehead Software partners with Perceptive Software to offer a combined solution that includes Perceptive’s ImageNow enterprise content management application and Bridgehead’s virtualization storage solution.
• Picis hosts an audio conference November 16th featuring several HIE leaders discussing the financial, operational, and clinical considerations of establishing health information exchanges.
• MED3OOO is recognized by Everything Channel’s CRN Magazine as a Top Healthcare VAR.
• Gillette Children’s Specialty Healthcare (MN) chooses Carefx and Indigo Identityware for single sign-on, context management, and clinical workflow.

E-mail Inga.

 View/Print Text Only

From Icarus: “Re: HIMSS Middle East conference in Dubai. Over 400 attendees are here. Lots of interest from providers in Qatar, Saudi Arabia, Pakistan, and UAE. Vendors include Allscripts, Cerner, First DataBank, Zynx, InterSystems, GE, and Hospira.” Thanks for the photo.

From Matt Yourity: “Re: business models and mHealth. What will work is ‘mHealth Plus,’ apps that are integrated with a person-centric longitudinal health record (with clinical information, claims, patient-entered information, and data from devices). Apps can integrate with each other and with processes in a robust middle layer. The business model is that we’re all paying for the cost of bad behavior, so there’s the incentive. Cute apps built in a silo are not the future.” It struck me at the conference that mHealth is where HIT was 20 years ago – everybody building their own single-purpose app because it’s cool (and because they can) rather than thinking big picture with regard to integration and user convenience. That’s a function of maturity, I think, so hopefully the “cute app” state will go away when investors realize there’s no profit potential and they probably won’t get much patient or clinician uptake anyway. If your solution requires going to a specific product’s Web site, there’s a good chance it won’t fly. The mHealth people need to be put in room with the PHR people since both need some help. The mHealth projects seem to mostly involve people with no enterprise IT experience. They’re doing what spare bedroom programmers always do – building cool stuff that may not be optimal if it ever needs to scale or broaden.

From Hollis Figg: “Re: Dell. Roger Davis, SVP of physician services outsourcing from the former Perot, has left abruptly.” Unverified. His LinkedIn profile is unchanged.

From Scratching my Head: “Re: EHR certification process. Any consultants you’d recommend that can help vendors make sense of it?” I’m sure there are several. The one I know that’s offering that service is Frank Poggio from The Kelzon Group. You’ll notice his text ad running in the right column (which is how I knew he was working with vendors on certification). Others can comment on this post and I’ll waive my usual “no commercial pitches” rule.

From Jesco White: “Re: mHealth. Your report concludes that there is no money to be made, but the opposite appears to have been reckoned by Verizon. They are supporting a big Health IT event in Atlanta.” I should have qualified my assessment by saying that the cellular carriers and phone makers are fully intending to monetize mHealth in some way, perhaps my making it a value added service that either costs extra or results in higher service fees. They were the dominant vendors at the mHealth Summit. It’s the people writing apps that haven’t figured out a business model.

From Digital Bean Counter: “Re: TAG healthcare IT summit in Atlanta. Aside from a decent turkey sandwich, it was a letdown. McKesson took the cake for the most part. I was surprised that the Verizon and Intel reps knew little to nothing about HIT, let along whatever it was they were trying to sell. The summit was mostly around the hype of hiring new people. I was amazed at how many attendees were out of work, between jobs, or in school. Funny thing is, when the floor opened up for questions, panelist balked at the ‘why can’t I get a job when I have experience’ question. At least the eye candy was decent – the industry is still doing a great job at hiring pretty ladies to rep their respective companies.” Maybe that’s what the panelists didn’t want to say – you can’t get a job unless you’re cute.

From Lucky Tech: “Re: weird news candidate. What’s next – pregnancy testing via SMS messaging?” UK researchers are working on a smart phone app that will analyze urine to instantly diagnose sexually transmitted diseases.

From CIODude: “Re: IBM. I’ve had numerous meetings this week with with ex-IBMers. It struck me that the lead healthcare people at most of the major technology companies  are all people who left IBM. Neil de Crescenzo left and is now Oracle’s lead executive. Jamie Coffin leads Dell’s healthcare group and Doug Cusick who led IBM’s global healthcare team is now leading HP. The IBM/Healthlink execs are all at Encore. Who’s left? For the first time in my career, I can’t name a single IBM healthcare executive and I’ve been very active in this industry for many, many years. What’s going on at IBM where they can’t keep people?”

From Happy Valdez: “Re: LSS. At the Meditech CIO conference, rumors were swirling about LSS Data Systems being shut out and Meditech opening a partnership with eClinicalWorks.” Unverified.

I don’t usually post news on Wednesday night, but I’m way behind from being at the mHealth Summit this week, even though Inga skillfully kept things under control. I figure I might as well clean up my inbox now instead of waiting until Thursday evening. It will be back to normal Thursday night.

Listening: We the Kings, Florida-based power pop. They’re young, clean (no explicit lyrics), and cheery. Nice sound.

Google changed its appearance this week in honor of the 115th anniversary of the X-ray, Weird News Andy noted. He also brought up the fact that Google was caught (accidentally) sniffing personal information from WiFi connections, adding, “Just how do people trust their PHR on Google Health? I don’t.”

Thursday is Veterans Day, observed on November 11 as the signing of the armistice ending World War I, which took place on the 11th hour of the 11th day of the 11th month. This is a day set aside to honor all military veterans, living or dead (Memorial Day is for those who died in their service to the country, which I say because people often don’t know the difference). But the main thing you should do tomorrow is to thank those who have served, regardless of whether their orders involved something that you agree with (they don’t get to choose). Which I would like to do right now: thank you.

I’m pleased to welcome Thomson Reuters as a new Platinum Sponsor of both HIStalk and HIStalk Mobile. The company offers the Clinical Xpert solution suite, which delivers real-time data to clinicians via the Web and a variety of smart phones (Windows Mobile, Palm, BlackBerry, and the just-added iPhone/iPad/iPod Touch). Clinical Xpert has been the KLAS Category Leader for Mobile Data Systems for eight years in a row. It gives providers tools to improve quality and reduce cost without changing the underlying IT systems, including the pharmacist dashboard I’ve written about lately, a surveillance tool to prompt clinicians to intervene, the patient information app, a billing system (powered by Ingenious Med), and a handoff tool. Thanks to Thomson Reuters for supporting HIStalk and HIStalk Mobile.

Beryl adds two new regional VPs for its Patient Experience Group: Rick Jacob (formerly of CareTech Solutions) and Nicole Nicoloff (from Community Health Network in Indiana).

Weird News Andy notes that some Romans have put a halt to construction of a planned NHS Lothian primary care clinic in Scotland. They’re not walking a picket line, they’re dead – construction is delayed for at least six months after workers uncovered Roman artifacts from 140 AD, including skeletons and weapons.

Nova Scotia’s health minister denies the request of two large hospitals to change privacy laws to opt-out instead of opt-in, which would have allowed them to market to patients and families using information on file unless those individuals expressly declined. The hospitals said they would make sure not to send promotional materials to parents of deceased children, for example, but the health minister said they should stick to taking care of patients. The hospitals implied their marketing campaigns could have raised $40 million over the next five years.

Virginia Commonwealth University Health System chooses 4medica’s lab and anatomic pathology result viewing and exchange solutions.

Someone who should know tells me that the Kansas City paper had the story wrong in saying that Cerner and Pulse didn’t make the original HITREC cut there, but were added afterward because they are local. Here’s the real story, they say: the Missouri and Kansas RECs had different lists and came together in a complex way to arrive at a single list, but that list was only for negotiating purposes. Missouri’s list was the one in which docs and office staff scored vendor demos and both Cerner and Pulse made that list, which wasn’t intended to be a final preferred vendor list. The whole thing was a little too complex to hold my interest, but basically the paper was correct in saying that there were two lists, but incorrect in assuming that Cerner and Pulse were added to List A to create List B.

Another point of view from someone who knows the HITREC situation there says the news isn’t whether Cerner is or isn’t on the list, but rather that their Tiger Institute investment made it questionable at all considering the whole KC-MO joint process was killed off because of that. This person says Cerner has never said how much it’s spending on the Tiger Institute program since it would then be obvious what benefits they expect to achieve from it, so they just call it “cost neutral” and nobody asks further questions. There’s speculation that since the newly elected governor’s campaign organizer is a Cerner VP that Cerner will somehow take over the state HIE effort, especially since their big campus investment on the Kansas side gives them additional clout.

Someone forwarded an e-mail update from Shareable Ink to Inga that noted two events it mentioned as making “a big splash in the industry news over the past couple of weeks.” One was $4.5 million in new financing. The other was my interview with T-System CEO Sunny Sunyal, who talked quite a bit about the DigitalShare joint project between the companies. That was pretty cool to see.

Interesting: the DoD keeps finding reasons not to use the VA’s VistA system (arrogance seems to be the main one), but the Army is looking for someone to install WorldVistA in a military hospital run by Iraq’s government in Baghdad.

Sponsor Updates

• Blanchard Valley Health System (OH) renews its outsourcing contract with CareTech Solutions.
• An article by Maryland McCarty, IS director at Atlanta Medical Center, in the Atlanta hospital newspaper talks about its implementation of SCI Schedule Maximizer and Order Facilitator. The hospital says they’ll be at the forefront of patient scheduling, which will increase the use of their registration kiosks to reduce wait time. It also mentions that physicians can view availability in real time to make sure their patients get scheduled as promptly as they would like.

E-mail me.

 View/Print Text Only

One day after reporting strong revenue growth for the third quarter and the appointment of Jeffrey Surges as CEO, Merge Healthcare has acquired Fletcher-Flora Health Care Systems, HIStalk has learned. The Anaheim, CA-based Fletcher-Flora develops and distributes a laboratory information system.

Merge reported $45.2 million in revenue for third quarter, compared to $16.9 million in 2009. Adjusted net income was $.04/share, down from $.06/share last year. Surges, who was previously president of sales for Allscripts, replaces Justin Dearborn, who will take up the newly created role of president and concentrate on Merge’s international operations.

 View/Print Text Only

One thing you can say about the mHealth Summit: they give you your money’s worth in terms of long days with minimal downtime. Today, for example: it was straight through from 9:30 a.m. until 4:30 p.m. with just one five-minute break (even the lunch was all presentations).

They just can’t figure out the whole refreshment thing, though: the one-and-only concession stand that had mile-long lines yesterday was CLOSED today. The only food in the entire building was two levels down at an overwhelmed Starbucks. Man, that was annoying – the food and drink markup is insane, but even then you can’t get anyone to simply show up and sell you the stuff.

I wanted a soda, but of course there are no machines in the building since that would compete with those kiosk people who couldn’t be bothered to actually show up, so I finally worked up the nerve to go outside among the boarded-up buildings and street people to find an incredibly dumpy place willing to part with a dented and off-tasting can of Diet Pepsi for $1.50.

I also noticed that many of the convention center outside doors were locked, the water fountains I tried didn’t work, and some of the bathroom faucets didn’t either, all of which makes me wonder how well maintained the place is. It’s not a bad-looking building and it’s comfortable and well laid out, but the iffy neighborhood on three sides, lack of maintenance, and signs pointing to non-existent food stands left a somewhat negative impression. 

The first speaker came out with his real-time streaming physiologic data displaying on the big screen, collected by a tiny Bluetooth-enabled monitor in his shirt pocket going to a cheap cell phone (blurry, artificially sharpened photo courtesy of the crappy iPod Touch camera). It was pretty cool, but the real-world problem is tougher: who’s going to read that data and react to it? He mentioned that doctors aren’t interested because they don’t have the time to watch data that’s usually meaningless, plus malpractice attorneys would have a field day dragging them to court if they missed something.

That’s the big unanswered challenge: the world is short nearly every kind of healthcare worker, so any mHealth solution would ideally reduce their workload, not increase it.

Ted Turner was an early keynote. I had a snarky comment involving his trying to coerce Hanoi Jane into having three-ways (since he got unwanted PR when she divulged that in her book), but I’ll let that pass. Ted was pretty cool, very low key. I actually thought his answers were all going to be of the yes-no variety until he finally got warmed up and started talking a little. I saw no evidence of the infamous “Mouth of the South” from his younger years (he’s 71 now).

Ted was kind of all over the place, most of it not health-related, but he was still entertaining. He of course gave the UN $1 billion and told a fun story about that. The US was refusing to pay $1 billion in UN dues, so Ted was going to pick up the tab, but the UN wasn’t allowed to take the money directly from him. He said he originally toyed with the idea of buying the debt from them for 80 cents on the dollar, then doing what the UN couldn’t do in suing the US for the unpaid balance, which would have netted him $200 million with minimal work. What he really did was to set up a foundation to support the UN and to do charitable work, some of which involves health (lots of it involves elimination of nuclear weapons and war, which as he cleverly points out, can make all the health gains obsolete if people are killing each other intentionally).

So I didn’t get much healthcare stuff out of Ted, but I loved this story that he used to illustrate the point that conventional wisdom is often wrong. After he started CNN, he also started The Cartoon Network, which everybody told him was stupid since the experts assumed nobody watches cartoons. He said that The Cartoon Network now draws an audience 2.5 times the size of CNN’s, but nobody admits to watching it. As he said, “Bugs Bunny is still funny.”

Carolyn Clancy of AHRQ spoke for a few minutes, but all I wrote down was a couple of not-too-interesting projects at Denver Health and Vanderbilt and this link to a list of innovative projects. She also said the mHealth should be part of Meaningful Use, but didn’t elaborate on that.

Several speakers made these points: the industry needs to move away from single-focus projects that try to beat out a competitor. The way to win is through collaboration. Nearly all of them seemed amazed at the number of attendees since I guess it was a pretty sparse band of research geeks that attended last year’s inaugural conference.

This was a good point made in a morning session. The goal of mHealth in developed countries is to increase the efficiency of care delivery that’s already happening. In developing countries, it’s to provide access to care that doesn’t exist, leapfrogging the phase we’re in here. An example given was SMS appointment reminders that can be cancelled by replying.

One of the best speakers was Patricia Mechael from Columbia, who did a Letterman-like list of things the industry needed to do to hold itself more accountable. As she said in calling for better outcomes research, sending a million text messages doesn’t necessarily change behaviors.

I went to a session in which technologies were shown that send information back to providers. The first was PhiloMetron’s PTMS, the “Patch That Measures Stuff.” This was pretty darned cool, a bandage-like disposable patch (seven-day lifespan) that can track several measures. The most interesting thing they’re working on (gathering the data for FDA review) is auto-sensing of calories take in and calories burned (don’t ask me how they do that – in fact, don’t ask them because they won’t say). They’re planning to use the patch to drive dietician counseling. A variant detects the formation of wounds, like pressure ulcers. The company says the patch can be sold for around $30 at scale, so for $1,500 a year, you are wired 24×7 like an astronaut or something.

A UCLA researcher reviewed his cell phone microscope for cytology, which was cool because to get the size and price down (it’s the size of a quarter, 35 grams, and around $10 to make) it has no lenses. It does some kind of cell-level shadow analysis that allows the cell image to be reconstructed on the back end by software running on a laptop or server. It was nearly perfectly accurate from the pictures shown. I think he said it could be used for water safety and field testing for diseases by experts (not regular citizens, in other words).

Vitality showed its smart pill bottle and the compliance improvements resulting from its use. That’s another of those problems technology alone can’t fix – if patients won’t even take their prescribed meds, then what do you do? At least it has a business model – drug companies make more profit when patients take more pills, so maybe they’ll pay for the gadgetry.

So then it was lunch with Bill Gates, which had people ganging up at the ballroom entrance well in advance. Bill would have felt the pressure to be highly informative and entertaining had he known how bad the lunch was given its $75 ticket price (which I hope went to Bill’s foundation and not the caterer). My table had a spirited debate about whether the hideous drink in the pitcher was iced tea or fruit punch, which was an equal split until I postulated that it tasted like really bad fake lemonade with really bad iced tea from concentrate dumped in.

Bill seemed genuinely humble and introspective, speaking clearly and patiently like a really good teacher. Maybe age does that to you since both Bill and Ted (no Excellent Adventure pun intended) were a lot less animated than in their youth. Bill is amazingly well versed in healthcare and his big thing is reducing mortality of children under 5, which means Bill is a vaccine man big-time. He likes the idea of registering all births so that vaccine reminders can be given.

I found this fascinating: you would think that saving all of those babies would increase world overpopulation, but Bill says no – studies have shown that there is no such thing as a country with good health and a high population growth. For some reason, saving those babies actually reduces the population. He also said that nearly all of the world’s overpopulation is coming from urban slums.

He also likes the idea of digital currency to avoid having the local despots stealing the aid money intended for needy citizens. Apparently it can be handled purely by cell phone.

He brought up again that you can send all the reminders you want and people can pass tests showing they understand what they should be doing, but that doesn’t mean they will actually do it. He proposed for obesity that cell phone sensors should detect a lack of movement, then shake to remind the person to exercise. If they don’t, he said, don’t allow them to make calls until they do five push-ups (pretty funny guy, that Bill). As he put it, it’s been shown that you can take someone who exercises 80% of the time and get them closer to 100%, but for the large majority doing 0%, reminders don’t seem to work.

He also mused that the problem with public health problems is that they take years to develop, which makes people ignore risky behaviors since the time between exposure and suffering is long. He said that it would be better if AIDS killed people instantly because they would have an immediate incentive to avoid risky behaviors (as he said, they would know from the piles of bodies outside bars and brothels not to go inside).

The moderator asked him to name one technology that will be the next big thing after communications tools. He said robots, saying that computers can already see, listen, and move around. He observed that it would be tough to program a robot to help an elderly patient out of bed and to the toilet, for instance, but once the programming was done, the robot would be tireless and consistent.

Bill Gates is the man. I thought so before, but now I’m convinced. Rubber chicken or not, I got my $75 worth.

Aneesh Chopra was next up. The US CTO is a White House position, which was obvious since much of his pep talk involved bragging on the Obama Administration’s healthcare IT accomplishments. He talked up the VA’s telemedicine projects, the Blue Button initiative, and Meaningful Use. He bragged on the wisdom of making EHR certification modular, saying it would allow niche vendors to complete in specific areas of functionality.

He mentioned something about Project SMArt, a universal API into legacy hospital systems that will be available in the spring.  I found its Web page here. Apparently that mention today was its coming out party, according to the page. It was mentioned previously as an iPhone-like front end to legacy systems and there’s a developer contest involved. This could be interesting, so we’ll see where it goes.

I met with Travis Good of HIStalk Mobile after the lunch and then called it a day since I had to meet someone. The conference runs through tomorrow, but like most conferences, I would expect the last day to be less interesting and less well attended.

My summary is this. mHealth is not very well defined. Is it doctors reviewing PACS images by smart phone? Personal health records? Sending SMS text messages to moms-to-be? Using mobile devices to function as remote microscopes and medical devices? Offering face-to-face telehealth consults? Remotely controlling medication dispensing?

This conference focused on global health, primarily patient education and reminders. Most of the rest of what you might logically call mHealth wasn’t really covered since this is a meeting of mostly researchers and public health people. There wasn’t much here for you if your interest is in medical services delivery (hospitals and practices).

If anything, that kind of global health work is probably more noble and impactful than trying to sell EMRs to HITECH-yearning providers who don’t really see reason to change. There isn’t much money in global health. The meetings tend to be academic focused – no motorcycle giveaways or bribes to visit the vendor booths. They also tend to involve countries other than this one, either (a) those that are well ahead of the US in that area or (b) those who can’t provide even basic medical care services to their citizens.

What will be really interesting is to see how next year’s conference shapes up (December 5-7, 2011). Will many of this year’s attendees decide that the content wasn’t relevant to their work, even if seeing Ted Turner and Bill Gates in the ads convinced them to show up this year? Or will word spread and the conference grow to cover more of what could be defined as mHealth? And most of all, will the realization that this kind of global health-focused mHealth is probably never going to be profitable leave it as the domain of grant-funded researchers running endless pilot projects that sound great but don’t impact outcomes?

Beats me. I’m glad I came this time, but I don’t think I’ll be back next year unless I’m somehow improbably more involved in mHealth than I am now. We have our own problems in hospitals and practices and it seems to me that the players, the methods, and the rewards are so vastly different that this group of mHealthers have nearly nothing in common with us HITers, so I found little to learn and little to offer that was relevant. I admire the work they are doing, though.

 View/Print Text Only