From HISJunkie: “Re: SureScripts as an ATCB just for e-prescribing. How an e-prescribing clearinghouse be an objective judge about a vendor’s functionality? If I don’t use their clearinghouse, where does that put me? I think the certification process is going to get much stranger in the new year.”

From Athenahealth Win: “Re: win. They just took out a huge Allscripts/GE-IDX install. Should be announced soon.” Unverified.

From Limber Lob: “Re: Maryland Board of Physicians newsletter article on e-prescribing of controlled substances. I really enjoyed the first two and last two sentences. Another EHR skeptic!” It reads: “The health care community has lived through the initiation of electronic health records. They will, we are told, save time and money and reduce medical errors … Use of the term ‘interim final’ by the DEA suggests that this field, and the concomitant federal records, are evolving. For more information, go to the Internet.”

From Promises Promises: “Re: gag clauses. None here.” This document lists Allina’s terms and conditions for practices that want to use its Excellian (Epic) system. It says Excellian isn’t a substitute for human thinking and requires practices that want to use it remotely to: (a) verify its behavior; (b) don’t rely on it for anything critical – ask the patient instead; (c) don’t use it to communicate any important results; (d) look out for programming errors; (e) test it before letting users on; and (f) don’t disclose Epic’s trade secrets. You’d think they didn’t have much confidence in their $250 million implementation from all the disclaimers, but I’m sure that’s just the Allina and Epic lawyers expensively talking.

Listening: new from Ryan Adams (just to be clear, not Bryan Adams – this one’s from North Carolina instead of Canada and is married to Mandy Moore). Actually, the new double album consists of three-year-old tracks that had been gathering dust until he started his own record label and released the 80s-theme concept album a couple of weeks ago. Sometimes it sounds like U2, sometimes like Tom Petty, sometimes like The Cars or Spandau Ballet. I guess those are the 80s musical references at work. And Watching: Doc Martin on Netflix, which is a very nice British dramedy. If it’s realistic, the Brit GPs store paper medical record folded into a little 5×7 or so envelope, so they must not churn out the insurance- and lawsuit-required documentation like here. I could spend hours looking at and listening to Louisa (Caroline Catz).

I have Uri Geller sitting right here beside me and he’s telekinetically moving your fingers to the Subscribe to Updates box to your upper right, forcing you to type in your e-mail address and name so that you might live a fuller life in HIStalk one-ness. You will receive no spam since I don’t care about money enough to sell or rent the subscriber list to the many companies that keep asking. You will, however, get everything important in HIT as soon as Uri or I push the “send” button.

A family member got an iPad. I played around with it for a few minutes and liked it a lot (amazing display), although I think smaller tablets sold by competitors might be more my speed. It was nice to have a display larger than that of my iPod Touch but a bit much to haul around. I like the idea that you can get a no-contract AT&T data plan for it for $25 per month for 2GB (cheaper than an Aircard, but that’s in addition to your smart phone plan, unfortunately). I’m really happy with my iPod Touch despite still not having played any MP3s or videos on it (I take a second-generation Nano to the gym since I’m rough on stuff there). It is amazingly handy to grab the Touch from the nightstand and be checking e-mail or Web browsing at WiFi speeds within five seconds of having the urge to do so. Mrs. HIStalk probably hates it since on those rare occasions I watch TV with her, I constantly pounce on the Touch to recite trivia from IMDB about whatever she’s trying to watch or do the “alive or dead” quiz about some actor on the screen. The shows she watches aren’t very cerebral, so I think I may be more fascinating anyway, although I don’t have the nerve to ask if she agrees.

Ed Marx has updated his Why I Fired and Rehired Myself post, which he’s good about doing in response to your comments (even the nasty ones).

Here’s a shout-out for HIStalk pal Michael Christopher and CarePrecise, which offers a variety of ways to access the federal government’s healthcare provider database with data points on three million providers that include UPINS, Medicare IDs, state license numbers, phone numbers, separate tables of newly added and newly dropped providers, etc. They also have medical marketing tools for you vendor types. Michael’s a genius, so you get to talk to him if you buy something (I talked to him once as Real Me and not Mr. H and was mightily impressed, which doesn’t happen too often).

I wasn’t quite prepared for the immediate response to my casual blurb about maybe needing to hire someone to help Inga and me out. I expected to get an e-mail or two, but not from household name type people (VPs, retired CIOs, people who have published or edited magazines, etc.) Let’s just say I’m honored that folks at that level read HIStalk, much less want to help with it, and I want to hire every one of them because they all sound great. It’s a low-rent operation here, so we’ll see how it turns out (I’m behind on responses, but I’ll get there). Several did the same as Inga when she first contacted me years ago: listed 10 sassy, cynical, funny reasons I should hire them. Here are some of the ones I liked as showing a deep understanding of the HIStalk (anti) corporate culture:

1. I am considered a pain in the ass by 95% (or more) of people who know me.
2. I know the industry, the jargon, and where some of the bodies are buried.
3. I really, really want a cool avatar like Inga has, although I firmly insist on a bit of virtual Botox.
4. Smart-ass, I am (much more fun if you say it like Yoda). Above all, this is the personality trait that appears to be the key to the HIStalk inner sanctum.
5. I am certain that you’ll get more impressive volunteers to write for you than me. That being said, you shouldn’t pick them because they’re too busy and they suck in their own perceptions of HIT.
6. My husband says, “I’d hire you. You are smart and cute.”
7. But enough about me, let’s talk more about me.
8. I am a passionate sports fan, mainly that of European soccer. I will defend to the end the reason for soccer not blossoming in America is that our social fabric is built on competition, not community, and therefore we cannot support soccer on a national or regional scale. It has nothing to do with boredom or slow-moving play, as we support baseball and American football, which border on tedium with the amount of time-outs, commercials, and gratuitous jock-adjusting. Soccer is like the ballet — no matter how much you hate it, you know it will end at a reasonable hour.
9. Actually, in all candor, my experience makes me a perfect fit for this role, not OJ and the leather glove, but an honest-to-goodness Isotoner glove-type fit.
10. I always attend HIStalk events at HIMSS!

I think I’d need one of my attorney readers to help decipher the legalese, but it sounds to me like Cerner and Mayo Clinic prevailed in an intellectual property lawsuit they brought against a former Mayo physician. Mayo said he took his knowledge of a natural language processing application that Mayo was commercializing to Merck, which may or may not have planned to commercialize NLP software (depending on who you believe). Cerner apparently licensed the software from Mayo and sells it as Discern nCode. He wrote it in MUMPS for you haters out there. I lost interest at this point (earlier, actually), but if you didn’t, here you go.

Wolters Kluwer Health buys EMR training software developed by a research team at University of Tennessee. Its intended audience is schools of nursing for training students on EMRs. UT gets a cut of sales. The iCare web page is here.

Geisinger Health System (PA) notifies 3,000 patients of a data breach that occurred when a former doctor at one of its hospitals e-mailed information about his patients to his home e-mail account. Geisinger says it notified patients because the information wasn’t encrypted even though it’s almost certain that nobody else saw it. So there’s your first HITECH-related action and one that doesn’t involve EMR bribes – it requires providers to send breach notices to affected patients.

Thirty-six top-earning executives at the University of California are threatening lawsuits against the UC system if it doesn’t increase their retirement payouts. The university is changing its pensions (most of us would need a dictionary to know what those are) since they were underfunded by $20 billion by the perpetually fiscally irresponsible state. Among those signing the demand: UCSF CIO Larry Lotenero (paid $377K) and UCLA health system CIO Virginia McFerran ($477K), along with mostly hospital and investment management people. The bank bailout is going to look like a child’s allowance as states start going broke over wildly generous salaries and pension plans, loading their payrolls with double-dipping “retirees” and employees jockeying their positions for their last year before retirement since guaranteed lifetime payments are based on final salary.

Strange lawsuit: a mentally ill patient who had spent years in a psychiatric facility sues its operator, the State of New York, for nearly letting him die with an untreated infection. He wins, but the state asks the judge to give it his $1.7 million award in return for treating him without payment for 10 years. The judge agreed, so the patient got nothing.

Happy New Year!

E-mail me.

HERtalk by Inga

ONC names Surescripts its sixth Authorized Temporary Certification Body, but only for e-prescribing and privacy and security.

Central Florida RHIO names Jeanette Schreiber its new chair. She’s associate dean and chief legal officer for the UCF College of Medicine.

One week after hitting a last-minute snag, McKesson completes its acquisition of US Oncology.

I am back at home after a week of holiday merriment in the land of No Internet. I had intended to make it a working vacation, but underestimated how very slow my connection would be. After two days of pulling my hair out each time the connection dropped, I finally had to fess up to Mr. H that my escape from civilization was not going as planned and that, alas, HIStalk Practice would have to skip a day. Now, as I sit at my desk using lightning-fast Internet, I must say that I am surprisingly happy to back at work. I promise that my renewed attitude has nothing to do with the Help Wanted sign Mr. H posted during my absence, nor the fact that two dozen people more qualified than me are vying to become Mr. H’s new BFF. Actually I am pleased that so many people “get” how fun this job can be and I am hoping it will give both Mr. H and me more time to work on some other fun projects.

Speaking of fun projects: the upcoming HIStalkapalooza event during HIMSS. Mr. H spilled the beans on a few details and I must also make a couple of comments. First, I have high expectations for contestants in the “Inga Loves My Shoes” contest. It’s quite easy to participate – just pick out the most fabulous pair of shoes from your closet and wear them to the party. A trusted Inga stand-in will eye your feet and select the winning footwear. If shoes aren’t your thing but you want to impress the HIStalkapalooza universe (and definitely me), dress your very best and you will automatically be in the running for HIStalk King or Queen. Here is a tip for the soon-to-be-legendary King and Queen contest: if you are wearing a straight-from-the-booth vendor tee shirt,  you will not win this incredible honor. Those wearing tuxedos and chiffon will automatically make the semi-finals. Wearing pirate costumes or pink pants may only get you a Mr. or Ms. Congeniality award. I am trying to convince Mr. H that we need some amazing prizes for our lucky recipients, but no decisions yet. Meanwhile, I am dreaming of IngaTinis, red carpets, and dancing the night away.

An Ohio surgeon is sentenced to a year in prison for having his office manager pose as a doctor while he was out of the office. The office manager for Dr. Charles C. Njoku had previously been sentenced to three years of probation, including one year of home confinement. The two also must pay restitution of $131,000 for billing Medicare and Medicaid as if the office manager were the doctor seeing patients.

I would love to know which EMR this doctor uses. An internist treating a complicated patient complains that her EMR will not allow her to write an evaluation exceeding 1,000 characters. When the physician calls the EMR help desk for assistance, the tech replies, “Well, we can’t have the doctors rambling on forever.” And the industry wonders why doctors resist EMR adoption.

The mHealth market continues to boom, with over 200 million apps now in use. About 70% of people worldwide are interested in owning at least one mHealth application and are willing to pay for it. Countries with large populations and limited healthcare options, such as India and South Africa, are the most interested in mHealth. Look for the number of mHealth apps to triple by 2012.

Puget Sound Blood Center (WA) is launching the GCI ConnectMD private medical network to connect with Swedish Medical Center, Cherry Hill Campus.

Government auditors report that the CDC lost or misplaced more than $8 million in property in 2007, including a $1.8 million hard drive and a $978,000 video conferencing system. Whoops. The CDC says it has now instituted better controls and that 99% of its property was accounted for in 2009.

A computer tech in Michigan is arrested for allegedly violating state hacking laws and gaining access to his then-wife’s e-mails to confirm his suspicions that she was having an affair. Turns out she was, with her ex-husband. The wife (who is now actually the alleged hacker’s ex-wife) realized the computer had been hacked when personal e-mails showed up in a child custody pleading involving her first husband (hacker was husband number three). Computer geeks, lots of husbands, and adultery – it just doesn’t get much juicier than that.

Sponsor Updates

• Greenway Medical Technologies announces a new web site covering EHR adoption incentive programs.
• PatientKeeper is moving to new headquarters in Waltham, Massachusetts in a building adjacent to the Massachusetts Medical Society and the New England Journal of Medicine.

E-mail Inga.

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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!

The Role of Automation in Reconciling Patient Records
By Beth Just

Duplicate patient records have long been a serious problem for hospitals, creating the potential for missing or inaccurate patient information that can lead to life-threatening care situations. They are also a substantial drain on financial, health information management (HIM), and IT resources.

Industry estimates are that 3-15 percent of patient records at a typical hospital are duplicates. That number skyrockets to 30 percent or higher for facilities that have been acquired or merged or are part of an integrated network. Exacerbating the sense of urgency surrounding the elimination of duplicates is the impact they can have on a hospital’s ability to qualify for incentive payments under HITECH. In particular, duplicates artificially inflate the number of unique patient records, which are the basis for several Stage One criteria.

That is why eliminating existing duplicates and preventing the creation of new ones must be an integral part of any facility’s data management strategy. In addition to easing the burden of achieving Meaningful Use, doing so also eliminates significant cost drain. One three-hospital system determined that the duplicate volume for its health system was more than 17,000 records.

The estimated annual cost of those duplicates? Anywhere from $554,000 to more than $1.2 million for repeated tests and treatment delays, as well as incremental costs related to longer registration times and correcting duplicate records.

The challenge is that reconciling and eliminating duplicates is a cumbersome, manual process that requires staffing resources most hospitals cannot spare. What’s more, these processes do nothing to prevent future issues.

Traditionally, the reconciliation process is executed entirely on paper. Potential duplicate records are identified as patient charts are pulled. They are then assigned to the HIM staff, which must analyze previous charts and other information to verify whether they are actual duplicates before they can be eliminated.

Even if a hospital’s information system provides reports of duplicate records, the data they contain typically is limited to key identifiers, such as name and date of birth. More research is generally required once potential duplicates are identified.

Progress on reconciliations is also typically tracked on paper, leaving room for error and duplication of work.

By automating portions of the reconciliation workflow, hospitals are able to quickly and efficiently weed out existing duplicates and prevent new ones. By allowing multiple duplicates to be reviewed in a single view, automated processes also heighten user control over the merge process, lessen the time required to complete the process and enable more effective quality assurance before records are merged. High-level process will also support merging records in downstream systems while reducing manual steps and associated costs.

Automation can also reduce the time and resources required for reconciliation. The best systems will also automatically document decision validity, track productivity and generate comprehensive, user-friendly reports that provide a complete view of efforts and insights into problem origination points.

After six months of manually analyzing duplicates records, the previously mentioned hospital system chose to leverage the efficiencies of an automated reconciliation process to eliminate duplicates prior to its transition to a new clinical information system. Today, it relies on the software to maintain clean, high-quality patient records. The automated solution resolves upwards of 500 duplicate records monthly at each of its three hospitals – and it does so with fewer resources than had previously been dedicated to the process.

Beth Just is CEO and president of Just Associates.

How Healthcare Is Different
By Rambling Man

Healthcare is unlike any other industry for a ton of reasons, a few I found the time to ruminate upon this morning.

What industry does not know its costs? There are examples of providers performing this analysis, but most community hospitals, ambulatory care centers, and primary physician offices operate from ignorance of this information. How can providers negotiate payer contracts without this knowledge?  This information will become increasingly important as the industry evolves from traditional payment models with ones based on quality of care and outcomes. This begs the question: how will we measure quality care and outcomes? The answer will inevitably involve more consumer involvement.  

How will the industry respond to the increasing demands upon the primary physician? Today’s reimbursement models force physicians to fit more patients into their daily routine, while still making the same amount of income. This model will eventually change the face of healthcare, and perhaps for the better. Demands on physicians to stay current with new clinical data, juggle a schedule of seeing 36 patients a day, and “practicing the art” seems super-human and may be outdated. 

These demands, combined with an alarming decrease in physician ranks, will create a new layer between the patient and the science. This new layer may be satisfied with Nurse Practitioners or Physician Assistants, or a skill-set not yet defined that focuses on data gathering and psychological insight.

How can patients do to better the system? Medicine addresses our physical vulnerability and fear of death, which are the darkest of human emotions. Physicians must have a serious sensitivity towards the emotional needs of patients, and one could argue society’s reaction towards death has worsened in the last fifty years. 

For many, years of pain or confinement to bed are better alternatives to accepting the inevitable. We expect our physicians to be the best scientist and psychologist all wrapped up into one package, but how have we changed as consumers? We need to bear a larger portion in the direction of medical care, and the systems that provide medical information to the consumers must be simplified for all. Health data banks, where consumers store health information and pay for data analysis, will emerge and become the centers of our data. 

And finally, and arguably more difficult, is that we require a change in attitude regarding death. Fear of death is the motivation behind the largest portion of healthcare expenditures. Has our consumer psychology foregone quality of life in favor of quantity? Changing these attitudes will not happen overnight and will not be easy.  Each of us facing our ultimate demise need to do so with dignity and faith that death is a beginning to a larger chapter in our existence.

As I Stand With Nozzle In Hand
By Mr. HIStalk

Pumping gas is boring. There’s nothing you can except fidget and enjoy the fumes (which I do). The high point for me is spotting a squeegee in a nicely full container so I can at least pretend that my windshield is dirty and entertain myself for a few seconds by cleaning it (or curse the lazy clerks who’ve left the squeegee in a desert-dry container because they just don’t care).

Sometimes I read the stickers on the pump, like the last inspection date or how to find the emergency shut-off valve (daydreaming of heroically saving an entire neighborhood by stopping a spreading ocean of flame as I sprint confidently to shut down the pumps like John Wayne in Hellfighters). While scanning for those exciting tidbits the other day when I was in another state, a sticker on the pump caught my attention. Under a picture of a scowling, R. Lee Ermey-lookalike state trooper, it said Drive Off, Lose Your License.

I marveled at the political clout of the gas station owners. Shoplifting, walking out on a restaurant tab, or any kind of petty theft are all subject to a ponderous legal system with generally light penalties for first-time offenders. The punishment, if it ever comes, is generic and disjointed from the crime. But somehow the gas guys used their political grease to get politicians to approve a very specific (and severe) penalty for a specific type of theft affecting only them.

Obviously the R. Lee sticker was designed to get your attention. The Lose Your License part is a lot more dramatic than, Drive Off, You Will Probably Not Be Arrested and At Worst Will Get a Slap On the Wrist Months From Now Even If You Are Arrested, and That’s Assuming the Unmotivated Dry-Squeegee Clerk Cares Enough to Chase You Down the Street To Get Your License Number.

I was appalled. What does skipping out on a gas station tab have to do with the privilege of driving? That makes about as much sense as … uh oh … penalizing doctors for not using electronic medical records.

Gas stations could have eliminated their problem without judicial favoritism by simply requiring cash customers (are there really any left?) to pay before pumping. Just like EMR vendors could have boosted use of their products beyond the pathetically tiny percentage of busy, pre-HITECH doctors willing to use them by making them easier to use and designing them to increase doctor efficiency rather than accumulating interesting but not always clinically helpful data for insurance companies and the increasingly intrusive Uncle Sam to poke around in to find reasons not to pay for services already rendered.

Even though I’d paid at the pump, I decided to go into the C-store for a soda and some nutritionally devastating snacks (anybody for an jelly orange slice or a pack of those mini-donuts slathered with coconut gunk?) On the wall beside the “deli” (where the commissary-made sandwiches encased in their nitrogen-filled coffins are moved from totes to the refrigerator in a form of “cooking”) was the C-store’s health inspection sign.

I read those. If I’m going to a strange restaurant (especially if it’s Asian or Mexican), I’m going to seek it out right away to make sure the cooks at least occasionally wash their hands and don’t store the goat carcass designated for employee lunches in the same refrigerator as the desserts, at least during the inspector’s surprise visit. (As a second-level review, I always check out the customer restrooms since whatever disgusting state those are in is ten times cleaner than the areas customers can’t see, like the kitchen).

I want to see those health inspection signs on hospital and practice doors. Give me a letter or number score of how well they adhere to quality measures, as measured by a totally independent and fear-inspiring government bureaucracy (not the chummy Joint Commission, which has given hospitals glowing scores right before the state inspectors came down on them like the wrath of God for running shockingly lax operations). I would turn tail just as quickly from an impressively ornate medical provider’s facility with a C-minus score as I would from a $5.39 all-day Chinese buffet restaurant that doesn’t even own a trash can (but with illegal immigrant employees who probably wash their hands more than the average doc even though they’re deboning chicken thighs instead of probing people).

So thumbs-down for making up new penalties to encourage whatever behaviors the politicians and those who influence them have decided are desirable. Thumbs-up for letting businesses run their own affairs, but with mandatory full disclosure to their customers. Let the market decide whether and EMR-wielding C-minus practice is preferable to an A-grade practice using an IBM Selectric and one of those, “Sara, this is Sheriff Taylor” telephones that look like the far end of a clarinet.

But in the mean time, I’m thinking about applying a for a few paltry million of the HITECH bonanza to create an EMR awareness program for the paper-clinging providers. I’m calling up R. Lee Ermey, posing him in a government-looking suit and power tie, and putting him on stickers for manila folders that read Write Order? Lose Income.

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From BeKind: “Re: Texas patient privacy breaches. Mentioned in this article.” It also mentions that JPS Health Network is spending $94 million on its Epic implementation.

From Jennifer: “Re: QuadraMed QCPR. Now fully certified!” CCHIT certified QCPR as a hospital EHR on December 23.

From Skinny Minnie: “Re: vendor gag clauses. A billing vendor’s new customer did a YouTube testimonial about why they switched from their previous vendor (service and cost). The previous vendor told the customer they were violating the terms of their contract, which says they can’t ‘disparage or denigrate’ them, and insisted they make their new vendor take the video down.” No link was provided, but I found a YouTube video featuring a customer of the same ‘new’ vendor explaining why they replaced the same ‘old’ vendor, specifically mentioning the monthly cost of each. Either the ‘old’ vendor missed this one or it didn’t get taken down after all.

From Alfonso: “Re: healthcare IT tools for Accountable Care Organizations. I ran across an article touting two companies that are attracting VC and private equity interest – MedVentive and AmalgaMed. Investors are looking at the next two years as being critical for capturing market share as payment reform in the form of ACOs restructures healthcare delivery.” AmalgaMed is a new startup founded by a couple of entrepreneurs with benefits management experience.

Genesis HealthCare System (OH) sells $20 million worth of buildings to pay for an EMR system, freeing up cash flow to fund mission-critical projects.

TPD has updated his list of iPhone apps.

Who knew that Tom Selleck was a cheesy-mustached technology thought leader way back in 1993? Or at least he sounded that way as he read the script that AT&T gave him for these old commercials. I ran across a mention of this compilation video on something called Dvice, from Syfy.

Inga and I have been swamped lately, with a ton of new sponsors, interviews, HIMSS planning, etc. I’m thinking I need to hire someone part-time to help out. I could use someone who knows the industry, writes really well, and enjoys dealing with cool people like our sponsors and contributors by e-mail and telephone. Pay won’t be impressive, but it’s a good chance to learn and to get your name out there. Those interested should do like Inga did years ago: e-mail me and tell me why I should hire you since my natural inclination is to just suck it up and work more hours myself.

Registration for CMS’s Medicare and Medicaid EHR incentive programs starts next week. Instructions and the link to the registration page (when it’s turned on) are available here. You can register now even if you haven’t implemented anything yet.

Weird News Andy notes that of the 20 least-efficient charities in the country, only one relates to healthcare: Charleston Area Medical Center Foundation (WV), which runs an administrative expense ratio of 49% and earns one star from CharityNavigator. In comparison from the most-efficient list, Brother’s Brother Foundation, which includes medical supply donation among its projects, runs an expense ratio of 0.0% and has earned a four-star rating from CharityNavigator (which is where I always look first before donating). I have to be honest: having worked for hospitals nearly all of my life, they’d be last on my list of organizations to which I’d donate. Charity is big business at that level, with highly paid foundation employees, lots of private club donor schmoozing, and constant trading of favors (like donors making their contributions contingent on hiring their company as a vendor or giving their worthless kids phony jobs). Not to mention that I would never fund a charitable cause that pays executives $1 million or more like many hospitals.

Cerner shares are continuing their generally upward trend, closing Tuesday at $96.01. You could have bought shares for $72 in September (or $16 in 2003).

India-based NIIT Technologies Limited acquires the Preferr patient referral system, developed by Visions@Work of Clermont, FL.

E-mail me.

HERtalk by Inga

Manatee Health System (FL) will spend $2.5 million to implement Cerner, with Manatee Memorial Hospital and Lakewood Ranch Medical Center making the switch in August.

St. Joseph’s Hospital Health Center (NY) will hire at least 25 people "with considerable information-technology (IT) experience, preferably in the health-care field." The additions will double the size of the existing IT department.

UPMC introduces a mobile version of MyHealth Connect, giving users smart phone access to UPMC Health Plan information. The initial phase includes details on UPMC’s provider directory. Future versions will include a virtual ID card and access to members’ PHRs.

US Oncology names Karen Gibson SVP and CIO of its technology services, reporting to EVP Asif Ahmad. She was previously CIO of Life Technologies and of GE Healthcare Information Technologies.

Sponsor Updates

• Cumberland Consulting Group promotes Mary Francis Shaw, Dao Dang, and Chris Wolfert to executive consultant.
• Allscripts CEO Glen Tullman will join the founders of Wikipedia and eMedicine to discuss the impact of the Internet on healthcare on January 6 at the University of South Florida Alumni Center in Tampa.
• CareTech Solutions offers a money-back guarantee to hospitals that try its Solution Found service desk offering.
• Picis will incorporate the AORN Syntegrity framework into its perioperative suite.

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.

Why I Fired and Then Rehired Myself

The capstone of holiday seasons past has been The Plunge: leaping into the icy waters of Lake Erie wearing nothing but swim trunks. Each New Year’s Day, we Cleveland Triathlon Club members gingerly — if not insanely — worked our way across the snow and ice then charged into the lake. Once we reached waist-high water, we crowned our feat with a head-first dive. Like an arctic baptism, the Plunge symbolically washed away the old and welcomed the new.

A few years back, I used this event as the demarcation point for firing and rehiring myself. I plan to do the same as we head into 2011. I think we all should give ourselves the pink slip.

A few years ago, Intel was losing market share and profitability. Consequently, the company floundered. Knowing it was a matter of time before the Board would take mending actions, the leadership (Grove, Moore) discussed a particular phenomenon they’d observed. Nearly every time a company or division installed new leadership or brought in consultants, their outcomes improved.

Their conclusion: the new leader came in energized and with a fresh pair of eyes. Knowing they were being evaluated, he or she took their responsibility more seriously than the former, uninspired leader.

Subsequently, Intel’s old leadership had a brainstorm. Why not fire themselves and come back to the job as the new leaders? They said:

If existing management want to keep their jobs when the basics of the business are undergoing profound change, they must adopt an outsider’s intellectual objectivity.

They fired themselves over a weekend. After shifting markets (from memory chips to microprocessors), Intel became the clear leader in a very competitive market.

At that time, I worked for University Hospital. Although neither the hospital nor IT were in dire circumstances as Intel was, we needed to guard against complacency. I challenged my leaders to follow my example and take time over the holidays to reflect. Pondering how you would approach your position as a new employee is a healthy and worthy assignment.

Look at yourself as a potential candidate for your position. How will you evaluate the talent, change processes, and adjust the service mix? Should you alter your interactions with customers, your personal engagement, or your attitude? Will you embrace ideas you formerly rejected or feared? What strategies and tactics will you deploy to ensure business and clinical convergence with the health system? Do you have the fortitude to remove employees who add no value? Are you stretching the boundaries of innovation? Do you demonstrate courage despite resistance? How will you be a better servant…? The variations are endless.

To survive, you probably won’t need to change anything you’re doing. But to thrive means constantly reinventing yourself and operating differently. As a team, we embraced change, adopted an innovation-oriented culture, and began to walk in the fullness of our authority. What Got You Here Won’t Get You There.

Several other UH leaders fired and rehired themselves that New Year’s Day of 2007. The result? We experienced a dramatic shift moving from transactional to transformational services that had a net impact on our business and clinical operations. Our business, quality, and service metrics shot up to new heights. I experienced exponential growth, both personally and professionally.

Since I no longer live by the Great Lakes, I have to find a new point of demarcation. By the time you read this, I will have hang glided over the Swiss Alps (JungFrau). At the moment I leap off the mountain into the alpine chill, I will fire myself as CIO. An internal shakeup. I’ll let the present perceptions of my role plummet to the icy depths.

By the dawn of the New Year, I’ll find innovative eyes to view the future. Only then will I rehire myself.

Are you willing to give yourself the pink slip?

Update 12/30/10

Thank you for the comments, both positive and negative. I really liked the idea about being re-interviewed by your staff in this sort of process…have to incorporate that somehow going forward. Clearly I can’t respond to every comment, but as always, readers are welcome to contact me directly where we could further exchange ideas. Happy New Year!

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

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From The PACS Designer: “Re: Flock. As the number of social web sites continues to increase, it becomes a challenge to keep up with all the goings-on amongst your web friends. Now you can have all your social web sites in one browser with Flock. You can view HIStalk’s Facebook and Twitter sites in one place to keep your browsing activity from consuming too much of your time. TPD hopes everyone had a Merry Christmas and wishes all a Happy New Year!”

From Nicole: “Re: Merry Christmas. My kids like reading HIStalk with me and often ask me to read them the news clips. My son (the oldest) likes the business news, my daughter liked the story about Zsa Zsa’s husband.” That’s fun. I’m hoping HIStalk isn’t your story of choice because it puts them to sleep faster at bedtime. I’m a fan of  “out of the mouth of babes” wisdom, so I’m picturing them at HIMSS passing judgment on speakers and booths. I bet they would have priceless observations.

From FamilyPhysician: “Re: instant messaging. Doximity lets you find any healthcare provider in the US (not just your hospital system) and communicate via text securely if they agree. I use it from my iPhone, but you can also use it from the web. Hospitalist groups in my area are using it as well as outpatient docs like me.” This isn’t quite the objective testimonial it seems since it came from a Doximity co-founder, but I’ll allow it since the product seems pretty cool. You can only give it a test drive if you’re a doc since the sign-up form checks your name against a list of licensed physicians.

From ChiefCookandBottleWasher: “Re: Jim Stalder. You interviewed him a few years ago. He has joined Cook Children’s Health care System in Fort Worth as their new VP/CTO. They’ve gone through a number of IT leadership changes over the years.” Verified, according to his LinkedIn profile. I assume he replaces Tracy Waller, who left in August to work for an oil company services company as an IT consultant. Jim was CIO of Mercy Health Services (MD) when I interviewed him three years ago.

I expected readers to vote their preferred form of FDA regulation of clinical systems in order of least- to most-comprehensive. That wasn’t how it played out, although survey topics stirring up more emotion seem to generate less reliable results. For whatever reason, the most-restrictive choice (vendors must prove safety and effectiveness the same as drug makers) was the #1 choice. New poll to your right, for providers: is your software vendors’ enhancement road map more focused on making new sales than meeting the needs of existing customers? You are welcome to leave comments.

Listening: Patto, described by the reader who suggested it as “raw, bluesy rock n’ roll with a jazz twist.” The band was obscure even its 1970-73 lifespan and tracks are hard to find on the Web, but it still sounds good (to me, it’s UFO meets Steppenwolf). Check out the guitar solo on this one. The namesake founder, who also started up Boxer, died in 1979 at 36.

John Stone is named CIO at Fairmont General Hospital (WV). 

It’s eight weeks until the HIMSS conference, just so you know. I’ll be starting up the HISsies in the next couple of days. Below are the results from last year. I’ve already decided to add two new categories, Most Fun Vendor and Best Informatics Professional, but the floor is open for your ideas of additional categories. I like to change them up a little each year. I’m thinking about adding a Lifetime Achievement Award as a serious award.

2010 HISsies Winners

Smartest vendor strategic move
athenahealth guarantees Meaningful Use

Stupidest vendor strategic move
GE Healthcare loses enterprise clients

Best healthcare IT vendor
Epic

Worst healthcare IT vendor
GE Healthcare

Best CEO of a vendor or consulting firm
Jonathan Bush, athenahealth

Best provider healthcare IT organization
Cleveland Clinic

Provider or vendor organization you would most like to work for if salary, benefits, and job title were not factors
Epic

HIS-related company in which you’d love to be given $100,000 in stock options that can’t be cashed in for 10 years
Epic

Most promising technology development
Smart phone apps

Most overrated technology
Speech recognition

Biggest HIS-related news story of the year
ARRA/Meaningful Use

Most overused buzzword
Meaningful Use

When _____ talks, people listen
David Blumenthal

Most effective CIO in a healthcare provider organization
John Glaser, Partners

HIS industry figure with whom you’d most like to have a few beers
Judy Faulkner, Epic

HIS industry figure in whose face you’d most like to throw a pie
Neal Patterson, Cerner

HIStalk Healthcare IT Industry Figure of the Year
David Blumenthal

Each year right about now, I start getting more e-mails asking about the HIStalk event at HIMSS. We plan to have the sign-up page live by January 15 or so. I can tell you this one’s going to be memorable – the sponsor, [name coming soon], is going crazy with super-fun ideas that the 500 or so lucky attendees will enjoy (Inga and I keep trying to probe their upper limits: How about we shine a giant HIStalk logo on the outside of the building? Done. Say, wouldn’t it be cool to bring in a professional video crew so I can run party video on HIStalk afterward? You got it, Mr. H.) So for you as a prospective attendee: Did you ever want to feel like a celebrity on Oscar night, making a dramatic entrance on the red carpet while sipping an IngaTini and being interviewed on live camera? Do you like great food and an open bar? Do you like the idea of a full-length concert at HIMSS with a real band playing on a real music hall stage? Did you enjoy the “Inga likes my shoes” contest last year, all the other fun beauty queen sashes, the HISsies, and surprise guests? Would you enjoy special recognition for physicians in the audience, beautiful ladies in their best party fashions as orchestrated by Inga, and maybe even a King and Queen winner just like at your prom? It’s so big and crazy that the sponsor convinced me to use the name to which I was jokingly referring to it as our plans got more ambitious: HIStalkapalooza, sponsored by [name coming soon]. So there you have it: HIStalkapalooza, Monday, February 21, 2011, 6:30 until 11:30 p.m. Eastern at BB King’s Blues Club in Orlando. Thanks very much to [name coming soon] for helping me honor HIStalk’s sponsors and readers in a soon-to-be-legendary way.

Weird News Andy’s radar picks up this story: Beth Israel Deaconess Medical Center (MA) admits that its surgeons miscounted vertebrae in three surgeries in the past three months despite taking the usual precautions, causing them to operate on the wrong part of the spine. The hospital says human error was involved and it can’t find a connection, although two of the three surgeries were performed by the same surgeon. The hospital also admits that it is working to fix problems found by inspectors, including using a checklist developed by another hospital to help surgeons mark their site correctly.

RAND had glowing things to say about CPOE in its 2005 study paid for by Cerner and other HIT vendor. Its new analysis, sponsored by a non-vendor group, finds that healthcare IT hasn’t generally improved the Core Measures scores of hospitals using it. However, the conclusion of the study’s lead author isn’t that HIT isn’t effective, but rather that outcomes measures are too broad to show HIT-related improvements. It was the usual drawing room type study that linked readily available but questionably useful information together to draw new conclusions: the HIMSS Analytics database, the AHA survey, and Core Measures numbers. It would be great if the effects of HIT were so dramatic that overall outcomes improved (not just Core Measures ones), but that’s probably not realistic, especially over a short timeframe. You’d have the same problem trying to make a quality case for almost anything: management changes, process redesign, policy changes in the use of drugs or devices, or better credentialing of staff. Measuring quality isn’t as easy as measure drug safety and effectiveness, where it’s not that hard to set up control groups, measure specific and immediate physiologic changes of effectiveness in patients, and monitor for easily recognized adverse reactions.

Thanks to Imprivata for its support of HIStalk, joining us as a Platinum Sponsor. I think you may infer from the above that the Lexington, MA company is justifiably proud of its #1 rating in KLAS’s Single Sign-On category. The company offers the OneSign single sign-on suite (say that three times …), OneSign authentication management, and the Imprivata PrivacyAlert system that detects and audits EMR snooping. Resources: a OneSign webinar, an overview of OneSign VDA for virtual desktops, and a data sheet covering PrivacyAlert and its out-of-the-box data support for Millennium, Sunrise, Meditech, and other healthcare apps. You might also want to check out Identity 360, the company blog. I don’t recall if I mentioned this, but OneSign Secure Walk-Away won the Security Innovation of the Year award from the British Computer Society two weeks ago. It uses a webcam to detect when a clinician walks away from their logged-in workstation, forcing a new user log in with their own credentials to improve security and avoid medical mistakes. I interviewed CMO Barry Chaiken just a few months ago.  Thanks to Imprivata for keeping the HIStalk wheels turning.

Strange lawsuit: a neuroradiologist and an endocrinologist playing a round of golf take their second shots of the first hole and head off to find their balls. The endocrinologist finds his and takes his shot, shanking the ball into the head of the neuroradiologist, blinding him. The neuroradiologist sues the endocrinologist, saying he should have yelled “Fore!” The appeals court throws out the case as had two previous courts, saying that the neuroradiologist was standing 15-20 feet from the endocrinologist at a 50-80 degree angle, making it unreasonable to expect the other golfer to yell “Fore!” before swinging since nobody was even close to his expected line of fire. The neuroradiologist’s attorney probably did little to elicit sympathy for his client, who has been unable to practice full time since the original 2002 incident, by claiming his eight-year lost income is “more than you and I will ever make in a lifetime.”

Canada-based healthcare document management solutions vendor Accentus acquires two transcription companies: ZyloMed (FL) and Transolutions (IL).

Virtual Radiologic completes its all-cash, $170 million acquisition of Nighthawk Radiology, paying a 100% premium to the market closing price of NHWK when the deal was announced in September.

A gastroenterologist’s editorial in the Cleveland Plain Dealer says EMR should stand for End of Medical Rapport, an unwelcome technological intrusion into the doctor-patient relationship being pushed by insurance companies, the government, and EMR vendors. I don’t buy this a bit since my doc is a big EMR user and, if anything, it makes our time together more valuable to me. As in most of life, it’s not what you have, but how you use it. His method: (a) we chat for a couple of minutes before he even looks at the screen since the assistant or nurse has already entered my vitals and chief complaint; (b) the monitor is placed on the desk beside the patient chair, so we’re still sitting close to each other and the monitor is to our side instead of between us; (c) he quickly looks up the information he needs, then turns back to me for the rest of our session; (d) he doesn’t type while we’re talking and generally hardly at all while I’m in the room; (e) if we’re talking about something, like my lab values, he pulls them up on the screen and we go over them together. Now my doc is great overall: he doesn’t wear a white coat because he thinks it’s too authoritarian, he always leads off with a friendly handshake and some chit-chat, and he is highly supportive of helping patients find their own healthcare answers, so it could be that his patient style is just so good that the EMR can’t overcome it. Maybe someone should write a how-to guide for docs on how to minimize EMR disruption since I’m pretty sure it can be done.

I don’t think I’ve ever watched a soap opera even once (being a non-viewer of Unemployment TV, I didn’t even know they were still on), but apparently on All My Children last week, someone named Greenlee got into a hospital’s computer using a stolen password to find out that someone was pregnant. Scenery-chewing overacting and hammy dramatic gestures ensued, I’m certain.

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