From CONNECT Development Stalls: “Re: ONC. They have apparently decided to retain the CONNECT development contract with CGI. But since ONC is planning for Harris (the incumbent) to re-file its protest, no work will begin for another 3-4 months. The steam continues to escape from the CONNECT program. No word yet on who ONC has selected to replace the prior program leads, Dave Reilly and Vanessa Manchester.” Unverified.

From HITInsider: “Re: tough times in Verona? First, Epic clients complain about problems complying with Meaningful Use reporting requirements. Now I am hearing that during a recent Epic upgrade at Texas Health Resources, the system was down for THREE STRAIGHT DAYS. Recovery from this took an additional four days, with multiple subsystems failures during that time.” The THR problems weren’t related to Epic – it was a simultaneous Citrix upgrade that caused the problem. Epic was fine, according to CIO Ed Marx – users just couldn’t get to it (not that the distinction matters to users, but it probably does to Epic).

From JustWonderin’: “Re: Allscripts. Hearing it will outsource its TSC remote hospital operations. Not clear if it is just legacy Eclipsys or also legacy Allscripts.” Unverified.

From The PACS Designer: “Re: Verizon iPhone 4. InformationWeek provides us with some more aspects of the Verizon iPhone 4 due for release in early February. TPD likes the Wi-Fi mobile hotspot instance that this iPhone generates for five other devices.”

Thanks to Inga and Dr. Jayne for holding down the HIStalk fort during my short break. I am relaxed, sunburned, well romanced, and still picking Mojito mint from my teeth, all obvious markers that I needed and enjoyed some time off. I’m also way behind on e-mail, so I’ll hold the fascinating comments I received about Epic’s sales process until I have more time to assemble them. For those waiting on something from me, I apologize profusely – I’m in a constant state of overwhelmal (if that’s not a word, it should be, and my pipe-smoking doc’s picture should appear with the definition). 

The HISsies voting is closed – thanks to the 988 readers who took part.

I’ve mentioned New Zealand vendor Emendo, which sells the CapPlan capacity planning software for hospitals. The company, whose sales went from $0 to $10 million in its first three years, expects $50 million in revenue in the next three years and will sign deals with additional US partner companies this year.

Former Cerner COO Paul Black is named operating executive of private equity firm Genstar Capital LLC.

Karl Matuszweksi, MS PharmD joins First DataBank as VP of clinical and editorial knowledge base services. He was previously VP and editor-in-chief at competitor Gold Standard/Elsevier.

Weird News Andy has been busy, for sure. He entitles this find as “She must have been a valet girl.” A woman in labor pains drives herself to the hospital ED at 3:00 a.m., where a uniformed valet offers to park her car as she rushes inside. During her admission, she is given bad news: the hospital does not offer valet parking. The car was later recovered, but the grand theft auto suspect has not been. WNA also snorts at this report: cocaine-like designer drugs that are being sold in gas stations labeled as bath salts for $25 per half-gram bottle are causing suicides, poison hotline calls, and hospitalizations, especially in teenagers. Said a hospital’s ED chief, “They will do stuff that they wouldn’t ordinarily do, like dive from a third-story window into a pool.”

HIStalk’s newest Platinum Sponsor is interesting: IRM (Information Resource Management), part of the 34-hospital Inland Northwest Health Services of Spokane, WA. IRM is an informatics solutions service provider (consulting, implementation, management, and outsourcing, with emphasis on Meditech HCIS) and offers hospitals the services of its 300 IT experts, including the Meditech EMR, Bar-Coded Medication Verification Systems, centralized help desk, software development, and Web development via the shared service model, with an average satisfaction score of 4.89 on a five-point scale and a staff satisfaction score of 96%. For physicians, it developed an ASP model for hosting the GE Centricity PM/EMR, secure e-mail, document management, encounter forms, speech recognition, services for faxing and e-prescribing, and interfacing. I’ll make it a point to learn more since I’m interested in what they’re doing. Thanks to IRM and INHS for supporting HIStalk.

Former Cerner analyst Matt Wenzel is promoted from interim CEO to permanent CEO of Hedrick Medical Center (MO). He started with the hospital in 2006 as an IT analyst.

Bill Hamill, formerly of Picis and developer of the VOCEL Pill Phone app for clinical trials data capture, joins PerfectServe as regional sales VP for the western region.

Apple announces amazing Q1 results Tuesday after the market close, with revenue of $26.7 billion, profit of $6 billion, and a staggering 7.3 million iPads ($4.4 billion  worth) sold in the quarter. Apple also moved 14.1 million Macs, 19.5 million iPods (mine being one – love it), and 16.2 million iPhones, even before they were available on Verizon.

East Alabama Medical Center says it will get about $9 million in HITECH money over the next four years, with the first payment expected this year. They’ve spent $78 million to move to electronic systems.

Another Consumer Electronics Show announcement: BL Healthcare shows its remote Healthcare Access Terminal that offers HD-quality videoconference and sharing of medical telemetry data between patients and providers. It runs on the Verizon Wireless 4G LTE Mobile Broadband Network.

Old news that I might have missed: a network administrator at Pardee Hospital (NC) is charged with stealing $615K worth of Cisco equipment. The federal indictment says Joel Kimble filed false warranty claims, had the replacement items sent to his home address, then sold them on the gray market.

Australian HIT vendors had a terrible 2010 caused by delayed e-health projects, global financial woes, and an unfavorable currency exchange. Everybody knows about the hard fall of iSoft, but other companies with negative news are ISCGlobal (sold its claims processing assets for next to nothing), PHR developer Healthe Solutions Australia (went under in 2009), medical information publisher MIMS Australia (losing money, moving offshore), US-based Milliman Care Guidelines and First DataBank (closing down there, with FDB announcing losses), TrakHealth developer InterSystems Australia (borrowing money from parent InterSystems to cover losses), Global Health (reduced revenue), GE Healthcare IT Australia (reduced profit, was considered for shutdown), and Cerner (slim profits). This is an excellent article in AustralianIT.

KLAS announces a new report on clinical decision support, about which I’ll share all I know (which isn’t much: I don’t have the report). Hospitals say order sets deliver the biggest bang for the CDS buck, integration with third-party content doesn’t work very well, and Meaningful Use requirements are hurting CDS development (interesting since MU touts CDS, but apparently has slowed its progress).

HIMSS and Life Sciences Information Technology Global Institute unify (meaning, I assume, that HIMSS bought the San Diego-based organization but didn’t want to sound crass in the announcement by actually saying so). LSIT is developing references and standards for the life sciences market. It sounds ITIL-like.

Pharmacy automation vendor Swisslog buys Charleston, SC-based Sabal Medical, which sells medication software and and the sabalKOW drug dispensing cart for hospitals, for $9 million.

A survey in Japan finds that 10% of that country’s universities use cloud-based e-mail providers such as Google and Yahoo, raising concerns there that those companies don’t reveal where their servers are located, meaning they are likely outside of Japan and therefore not covered by Japanese law in case of privacy issues.

E-mail me.

HERtalk by Inga

Rush University Medical Center (IL) anticipates earning $28 million in federal incentives for its Meaningful Use of its Epic EHR. It went live in 2009 and will have 90% of its office-based physicians up by the end of the year.

DrFirst announces the establishment of its Hospital Services Group that offers consulting services.

Healthcare Information Xchange of New York completes its implementation of InterSystems HealthShare as its core HIE platform.

Michael Gold joins CareCloud as director of product development. He was previously with Sage Healthcare.

ONC awards Accenture a two-year contract to help identify standards and specifications to facilitate clinical data exchange.

More than a few folks have sent me a note asking if they missed the registration link for HIStalkapalooza. To clarify, Mr. H will post all the registration details on the 21st. Meanwhile, I am pleased to report we have lined up celebrity judges for the second annual “Inga Loves My Shoes” contest and the first annual HIStalk King and HIStalk Queen coronation that will be among the festivities there. The latter will recognize the best-dressed attendees, so don’t forget to pack a tux or sparkly dress. Mr. H has agreed to honor winners with amazing prizes, so it just might be worth that extra $25 checked bag fee to bring your party attire.

Speaking of HIMSS events, I was looking through the conference information and a few items caught my eye:

• Over 70 clinical information systems will be connected as part of the Interoperability Showcase. That’s a whole bunch of vendors making clinical data exchange look easy.
• For a mere $23, you can purchase lunch in the exhibit hall, including a drink and dessert. Menus available here. This is the Bistro HIMSS concept we wrote about last year, where companies can rent tables right in the exhibit area and provide food to their guests.
• One month out and so far, 903 companies are registered exhibitors, including 209 first timers. That’s about on par with last year’s numbers. 
• The annual 5K fun run is Tuesday the 22nd at 4:00. Sounds brutal after a day of walking around a huge convention center in heels. No thanks.

Inova Health Systems (VA) selects a suite of Oracle Health Science products for interoperability and analytics.

In yesterday’s HIStalk Practice, I mentioned a bit of juicy testimony from the HIT Standards Committee meeting last week. A reader forwarded this link, with instructions to cue the recording to 2 hours and 49 minutes to hear what Dr. Scott Monteith had to say. It’s worth taking five minutes to hear why he’s not too impressed with the whole Meaningful Use issue.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Texas Children’s Hospital will become the first pediatric hospital in the country to use iPhones with Voalte’s point-of-care communication solution.
• SCI Solutions is providing its access management solutions to NCO Group, a provider of business outsourcing services.
• Sunquest announces its new Sunquest Physician Portal outreach order and results web connectivity solution.
• Grays Harbor Community Hospital (WA) will use Access Intelligent Forms Suite to improve forms barcoding and version control in the ambulatory infusion services (AIS), cardiac rehabilitation, and diabetes education departments.
• T-System appoints Steve Armond as CFO. He most recently served as CFO of American CareSource Holdings.
• Medicity is participating in the IHE North America Connectathon 2011 this week at the Hyatt Regency in Chicago.
• dbMotion will showcase its latest technologies at HIMSS.
• MEDecision publishes an e-book titled Medical Loss Ratios: Important Implications for Care Management.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Why is it necessary to have a physician at the C-level or vice president level of administration at an academic medical center for informatics? Do the majority of academic medical centers have such a position or are they using a physician champion? What is the reporting relationship between the CMO and CMIO? What are the main job duties of a CMIO?

PeggyBRx

Dear Peggy,

First, let’s talk about the CMIO title. According to CMIO Magazine’s February 2010 issue (which happens to be lounging on my office credenza with the alumni magazines that I leave around because they have awesome cover art) less than two-thirds of us actually have the title. Some of us are Directors of Informatics, Medical Directors, or something else. Being a direct report to the CIO or CMO are each in the 30% range, with around 15% to the CEO.

Now that I’ve fulfilled my physician-esque need to cite data, let’s chat.

In my opinion, what’s more important than the CMIO title is the CMIO role itself. And that can be filled by either a named CMIO or a physician champion with another title, as long as he (or she, even though that same article said that 93% of respondents were men) has a clearly defined role and enough time to get the job done.

Too many organizations try to do the CMIO role on the cheap and add it to a physician with an already full plate, who may or may not know anything about information systems, and may or may not have good peer relationships. The majority of academic medical centers, especially if they are going to be successful, are going to have the CMIO role, whether they call it that or something else. I know of many mid-size hospitals and large medical groups that have also embraced the CMIO.

So what does a CMIO do? (Warning: literature search in progress! You can take the girl out of the medical library, but give her a laptop and a glass of Cab and she’s right back in it.)

According to the September 2006 issue of the Journal of the American Medical Informatics Association, the CMIO leads clinical IT initiatives, engages in strategic planning, participates in vendor selection, manages clinical IT staff, and leads process redesign. I generally agree with those main job duties, but they left out the more glamorous parts of the job:

1. Mediation between primary care disciplines and specialists. Everyone thinks they are the key to patient care. Welcome to the Village, y’all, and stop posturing.
2. Mediation between the Academic faculty and the Community physicians. Some days, you feel like you’re in a bad high school production of West Side Story, complete with Sharks vs. Jets.
3. Hostage negotiator when physician design committees won’t let the facilitators or subject matter experts out of the room even for a bathroom break, because they are too busy haranguing. (Tip: baked goods. Many physicians still bear the psychic scars of “see a donut, eat a donut” from medical school.)
4. Cat herder. Enough said.
5. Last bastion of patient safety. You put on your riot gear and take on the vendor’s CMO, whose code really might kill someone if they don’t fix it. It’s a rare part of the job, requiring confidence and a thick skin. I tend to psych myself up for this by remembering the most hateful attending who ever yelled at me as an intern. Previous military experience is also helpful. Hooah!

I hope this helps. It sounds like you’re on the way to some serious work – best of luck!

Dr. Jayne

Have a question about medical informatics, electronic medical records, or that itchy rash that won’t go away? E-mail Dr. Jayne.

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You may have read some stories about the Meaningful Use Hearings this past week. It’s always interesting to read what the regular press picks up on, but I’d thought I’d give you my "on the ground" report as well.

Background: ONCHIT created the Health IT Standards Committee, which is Federal Advisory Committee "charged with making recommendations to the National Coordinator for Health IT on standards, implementation specifications, and certification criteria for the electronic exchange and use of health information." This committee then has five sub-committees or workgroups: Clinical Operations, Clinical Quality, Privacy & Security, Implementation and the Vocabulary Task Force.

Each of these committees is staffed by volunteers from healthcare organizations and various vendors. I give them a lot of credit for spending the time to do this.

The Implementation Committee held a hearing last week on "Early Adoption of Meaningful Use", meaning they wanted to hear from Eligible Providers (EPs) and Hospitals about their early experience in preparing to meet MU requirements for this year. This makes sense. The government is going to potentially spend tens of billions of dollars on MU. It is smart to get a leg up to see if things are going smoothly from the start. And if not, figure out how they can start fine-tuning.

I was asked a few weeks ago to provide some input at this meeting (as an EP). I figured, hey, this is on my bucket list ("give testimony to a federal advisory committee"), so I’ll do it!

My first responsibility was to send in written testimony answering some questions they provided (e.g. tell us about your successes, your challenges, etc.) Next step was to fly to DC to talk to them in person. We would be given five minutes to provide oral testimony, and then there would be Q&A with the committee.

The first day and the start of the second had various HIEs and RECs commenting. Then came the active EMR users who were planning on applying for MU in 2011 (ten representing EPs, another ten representing hospitals). Most were physicians, along with a few CIOs.

While I was hoping to be in some hallowed marble halls, they did have us in a nice large conference room at a local Marriott. The Committee was in a U-shaped formation. Below that was a table where up to five presenters could sit and behind that was general seating for the public.

The following is my summary of the testimony given by these end users, with a slight bias towards the EP testimony. The following were relatively consistent themes, with my comments intermixed:

The good news is that this bill has indeed "stimulated" many organizations to move forward with various upgrades and focus on how to produce quality reports from the data in their EMRs.

But mostly we heard about the challenges.

• This is hard. It’s not impossible, but it’s a higher bar than many had anticipated because the requirements are not simple, nor are they fully explained. Everyone had at least some questions about interpretation. The worrisome thing is that if it gets to the point where users start thinking this is too hard, they won’t even try. I made it clear that I was thankful to be part of a hospital organization which is helping us with this process, but I feel sorry for those EPs who are trying to do it on their own. If you are one of those, make sure you ask your hospital if they can support you in any way and find out if there is a REC in your neighborhood who can help as well.
• There are lots of questions. For example, many wondered whether we could only use the EMR functions the vendor created or whether we could create our own (e.g. do we have to use a vendor’s "Smoking Status" form if we think we can build a better one). One big question I brought up was getting clarity on whether can we use scribes in the exam rooms to help with documentation and orders, as well as use other intermediaries later on to help with data collection (e.g. clerks or nurses to transfer free text into standardized forms).
• Time crunch. There is a very tight timeframe between the release of the requirements, embedding them into EMRs, the "rollout" of the new EMRs, and the updating of workflows and reports to ensure users are actually meeting the MU requirements. The government does not seem to fully appreciate all the steps involved, especially with large vendors who often need 18 months of lead time for making updates and for larger health organizations who then need a lot of time to do system upgrades. Many felt they really need to consider extending the timeframes for future stages, as rushing these upgrades can have some serious risks.
• Resource crunch. This is often a zero-sum game with resources. I was quoted by some media as saying that working on MU meant that our people could not work on other IT projects. That wasn’t exactly what I said, but rather that spending time on MU meant staff had less time to work on ANY other projects. And this can be an issue since the same people who are on MU committees are often also the ones dealing with operations and quality improvement in general.
• We need more flexibility. Not every practice is the same, and requiring 100% mandate of every requirement is not reasonable. My suggestion is that for Stages 2 and 3, they should create a variety of options like the Menu concept in Stage 1. The result should be that every practice could show they are using an EMR meaningfully, but they don’t all have to show they are doing it the same exact way.
• Functionality is not the same as usability. In other words, there is often a large gap between whether something can be done and whether it can be done in a usable manner. A function might meet the requirement’s definition while being very hard to use. An EMR vendor can get MU certification for their functionality whether their usability is great, good, or poor. Fortunately, the government is starting to look into usability requirements for the certification process, so let’s hope they follow through on that sentiment.
• Data sharing alone is never enough. Dr. Reid Coleman from Lifespan had the quote of the day when he said, "Data is like salt water… you need a filter to drink it". I’d also add that it helps to have good plumbing to connect it to the right facilities, and then also to have plenty of glasses available to make it easy for people to get it to the "final foot."
• Standards. There were lots of people saying they would like the government to make standards for a national MPI and for data in general. I loved the line that many people reiterated, saying "We’d rather have one bad standard we can work with than three good ones without a clear winner." On the other hand, we should make it clear we do NOT want the government to make standards about actual functionality – we can and should be creative in that domain.
• The cost of implementing MU may often be more than the actual monies themselves, when you factor in costs for various software upgrades, consultants, and change management. It also sounded like there were vendors charging significant amounts of money for MU upgrades, that consultants were increasing their fees due to demand, and that some RECs are charging doctors even though they are also receiving money from the government to help. One doctor pointed out that the government needs to either make the requirements easier or pay more (and we know they are not going to pay more).
• Certification requirements don’t always exactly match MU process requirements. Someone has to keep a better eye on this.
• Communication with CMS and ONCHIT has not been easy. The Committee pointed out the five different blogs and websites to get information. I’d suggest they consolidate down to one and create a content management system that can expand on the FAQ concept they currently have in place.
• The result of most of the above is that the biggest and the best are struggling with MU… so you have to wonder, how much harder will it be for others? This is an interesting contrast to the recent reports that "many" hospitals and EPs plan to apply for MU dollars based on a recent survey. My hunch is that most hospitals and doctors like to think they will apply for this, but that is altogether different than actually doing it. Considering that less than 25% of EPs even have basic EMRs in place, it will be interesting to see what happens. And in the end, some limited testimony and lightweight surveys will be long forgotten… the proof will be in the pudding.

Finally, it was concerning was that ONCHIT did not even send a representative to the meetings (one of them called in for the morning only). I do believe that the committee will represent us well, so let’s hope ONCHIT is listening to what they say and take serious the fact that there is increasing concern about the scope and timing of these requirements. If their goal is to make it so just 10-20% of the EPs can meet the MU criteria, then the folks from this meeting would say they appear to be doing well. But if their goal is to get over 50%, then they may need to rethink some of the complexity of the requirements and the timing involved in meeting them.

Full details and testimonies of this Committee Meeting are available online.

Lyle Berkowitz, MD is a practicing internal medicine physician, a healthcare IT consultant (www.DrLyle.com) and founder of the Szollosi Healthcare Innovation Program (www.TheSHIPHome.org). He blogs regularly at The Change Doctor (http://drlyle.blogspot.com/).

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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!

Remote Access Is Not Mobile Access
By Cameron Powell, MD

Healthcare organizations are quickly learning that both remote and mobile access strategies are required. See Table 1.

Remote access lets providers work in the hospital computing environment when they are not on location. This includes accessing the EMR and clinical applications via a PC or laptop from office or home. Secure the session with something like VPN, add the necessary authentication and encryption, and clinicians can use their Windows desktop and a browser to interact with hospital applications.

Offer mobile access when you need to empower providers to perform specific tasks anytime, anywhere. This would include visual assessment of images and waveforms, checking lab values, reconciling medication lists, checking allergy status – all while on the go. Providers want the data transformed into meaningful chunks; they don’t want to navigate the medical record from their Droid in order to make timely treatment decisions. Mobile data should be provided via native applications, built to run securely on a specific device and operating system.

Some organizations have considered using Citrix to provide interpreted or emulated application access to the EHR or CIS via a mobile device. Accessing patient monitoring data via a non-native solution is discouraged, because visual distortion is almost certain when things like medical aspect ratios cannot be controlled. [1] Further, the FDA is mandated to regulate mobile devices. [2], [3]

Mobile versus Remote Access

References

[1] http://ahealthydoseofmobility.com

[2] http://www.ebglaw.com/showarticle.aspx?Show=12184

[3] http://www.law.uh.edu/healthlaw/perspectives/2010/kumar-fdamobile.pdf.

Cameron Powell, MD is president, chief medical officer, and co-founder of AirStrip Technologies of San Antonio, TX. 

Transcription Today
By Diligent Monk

Transcription is back.

As EMR adoption picks up in response to Meaningful Use, it is worth noting that lurking in the shadows is a familiar enemy to EMR companies: transcription. The age-old practice of dictating for capturing clinical observation is the most efficient, accurate, and preferred method for physicians to document a patient encounter.

Over the past few months, announcements from large organizations have signaled a return to relevancy for the transcription industry. IBM, Nuance, 3M, HealthStory Project, major universities from around the globe, and many other dominant players in the transcription service industry have made significant strides in utilizing technology to create more value from transcripts.

Enter the transcription technology revolution.

Partnering the skilled labor of transcriptionists with technology produces a rich and accurate dataset from a traditional transcript. Whether labeled natural language processing (NLP) or discrete reportable transcription (DRT), the concept is quick, simple to understand, and the value is just now being seen by the industry at large.

Using extensible mark-up language (XML), data is pulled from transcripts and provided in common transport standards (CCR, CCD, CDA) to be used in EMR systems and reports. A physician can dictate his/her notes and collect all of the data required for meeting the objectives and measures for incentive payment per the HITECH Act without purchasing an EMR.

Historically, the EMR sale was built on an ROI derived from transcription savings. Looking at a practice or hospital balance sheet, the transcription bill seemed to be the easiest to pick on, and with the point-and-click interface promoted by EMR vendors, it was a straight replacement for clinical documentation. EMR adoption would eliminate transcription costs. As an industry, the transcript was losing its relevancy in an age of electronic records, but physicians and practices weren’t thrilled with the results. And back to the revolution.

Permitting a physician to dictate in their preferred and normal manner, coupled with the ability to ‘tag’ the data elements of importance from the note, provides the best of both worlds.

Unfortunately, this does nothing to eliminate that pesky transcription charge, which is still the focal point of many EMR pitches. The transcription industry, however, counters that the prevention of productivity loss will more than cover the cost of their services and therefore be a win-win for all involved. As well, the risk of errors in reports is significantly decreased by the medical language specialists that review documents for clinical quality and integrity before submitting back for approval from the physicians.

As crazy as this sounds, and as hard to believe as it may be, transcribing may be the best way for practitioners to achieve Meaningful Use and the most cost-effective for their practice. The technology continues to improve and adoption continues to be strong, so yes, transcription doesn’t appear to be going away, and that may be a good thing.

FDA Comes to HIT… But Through the Back Door
By Frank L. Poggio

For several decades, there has been a raging debate as to whether HIT systems should be regulated by the FDA. A search of HISTalk on ‘FDA’ brings up hundreds of mentions. Some clinicians believe FDA oversight is desperately needed; others feel it would be a major detriment to new development.

Now the debate is over. It came earlier this month through a back door called ONCHIT, probably while you were sleeping.

On January 7, ONCHIT issued the Permanent Certification Program Final Rules PCPFR. These are the rules that will transfer the testing activities from the ‘temporary’ agencies to ‘permanent’ ones as of January 2012. On the surface, you would think these rules would impact only the companies like CCHIT, Drummond, InfoGard, etc. But our creative friends at CMS–ONCHIT went many steps beyond that.

Here are some highlights from a vendor perspective.

A new entity was created called the ONC-AA called the Approved Accreditor agency. The current ATCB will be changed to ACB, or Authorized Certification Body.

In a nutshell, the ACB administers the test and the AA oversees the ACB. Today under the temporary rule, the ATCB does both. What is now a one-step process will become in 2012 a two-step process for software firms seeking certification. The AA will also be the agency that selects and contracts with the ACBs for testing services (such as CCHIT, Drummond, etc.) 

The new ONC-AA is required to insure that the ACBs conduct ‘surveillance’ of certified vendor products. Surveillance is CMS’s way of saying ‘audit’.

Here’s how the surveillance will work. The AA can walk unannounced into an ACB office and review all certification documentation, or can randomly sit in on tests. More importantly, the AA or ACB can audit at will, unannounced, the MU criteria out in the field at the providers shop to ensure the certified system really does what it was certified to do.

And it doesn’t stop there. Similar to the FDA processes, any user of a certified system (provider clients or their employees) can file a complaint directly with the ONC-AA or ACB stating that the vendor’s installed certified system DOES NOT MEET the certification criteria. At that point, the AA will conduct an investigation at the site and make a determination whether the vendor’s certification should be pulled.

If so, as with the FDA, press releases to that effect will be circulated. OUCH! Better start thinking about stronger client support in the future and set up internal channels to catch the gripes before they get so bad a user wants to scream ‘ONCHIT’.

On of my friends called this the ‘HIT Whistle Blower Act’, a good description. It’s just like the FDA: if a device or drug has an unexpected adverse impact, anyone can file a complaint. I hear a train a coming …

Frank L. Poggio is president of The Kelzon Group.

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HERtalk by Inga

From: Florence Bascom “Re: Selling for Epic. A rumor I have heard about their sales team is that their sales executives are not commissioned – which in itself would make it an extremely unique model compared to other HCSW orgs.” Mr. H mentioned his desire to talk to a former Epic sales rep (anonymously of course.) Comments like the above add to the intrigue.

From: Lu Wolf “Verizon vs. AT&T. David Letterman’s take on why fewer drop calls isn’t necessarily an improvement.” Very fun. Now that Verizon officially announces wireless service for iPhones as of February 10th, a predicted 26% of iPhone owners will likely switch from AT&T over the next year. I won’t be changing carriers, primarily because I live in a region where AT&T has much wider coverage. But seriously folks: why isn’t there an option that includes easy workflow, a fast network, and no dropped calls?

The SEC settles with Reza Saleh, a Perot Systems employee accused of insider trading when Perot announced its sale to Dell last year. Saleh, a longtime friend of Ross Perot, agreed to return all the money without admitting or denying any allegations. The SEC will also ask the court to impose financial penalties which could be as high as $25.8 million.

The local paper recognizes athenahealth’s $5,000 contribution to the Waldo County YMCA (MA). athenahealth donates a portion of its profits to organizations that enrich community health; what I find particularly cool is that athenahealth allows its employees to vote for which charitable organizations receive contributions.

Nearly one-third of malpractice claims are the result of mistakes that could have been caught by a surgical checklist, according to a new study out of the Netherlands. Researchers linked the reasons for 294 lawsuits with specific items on checklists and found matches in 29% of the cases. Could this be correct: checklists have been found to save lives and now money, yet only 25% of US hospitals use them?

Sage Healthcare will participate in  a series of workshops sponsored by the Florida Medical Association. The workshops, which include 18 sessions across nine cities, will offer guidance to doctors selecting and implementing EHR systems to meet Meaningful Use requirements.

Sierra View District Hospital (CA) initiates its $13 million, four-year  Meditech EHR implementation. The hospital plans to go live on its first phase by November.

I’ve been very unsettled the last few days, after learning my zodiac symbol has changed. Could it be that I am not adventurous, energetic, enthusiastic, confident, quick witted, selfish, quick-tempered, impulsive, and  impatient, but instead, compassionate, romantic, imaginative, intuitive, selfless, secretive, weak-willed, and a compulsive workaholic? In other words, am I no longer a self-centered, life-of-the-party diva,  but instead just a nice person who works too much? Unsettling, indeed.

Coastal Connect HIE plans to go live with patient data exchange by mid-February. The alliance, which is sponsored by the Coastal Carolinas Health Alliance, includes 11 hospitals along the coast of North and South Carolina.

Catholic Health Initiatives (CO) CEO and president Kevin E. Lofton says his organization will invest $1.5 billion in EHRs and other IT systems between 2010 and 2015. Cerner systems are deployed in larger markets and Meditech in smaller facilities.

Clinical integration provider Valence Health hires Dan Iantorno as VP of information technology.

In his last post, Mr. H mentioned that he and Mrs. H were escaping for a much needed getaway. He checked in with me long enough to share this: “We’ve been here barely more than a day and we’re totally relaxed and pampered. I needed a break more than I realized.” He also added that he took my advice and is sampling the beer, which seems to compliment the gourmet grub and ease the pain of his overexposure to sunshine. Sounds perfect.

Thankfully WNA never seems to rest, sharing news of gamers who hacked into the server of a New Hampshire radiology practice. Seems the Scandinavian infiltrators were hunting for more band-width to play Call of Duty: Black Ops. Per WNA, “They never saw it coming.”

Baylor Health Care System announces its intent to register for stimulus funds and demonstrate meaningful use of EHR. Baylor CIO David Muntz says his organization has spent over $250 million implementing EHR over the least 10 years and that five of its hospitals have successfully standardized its “processes and technologies based on a certified electronic health record.”  My translation for that statement is that Baylor has fully implemented EHR (Allscripts Sunrise, I believe) in five (of 26) hospitals. The remaining facilities will continue rolling out EHR over the next two years.

E-mail Inga.

EPtalk by Dr. Jayne

I’m shamelessly pandering to Meaningful Use with EPtalk, since indeed I am an Eligible Provider. It doesn’t have the same catchy ring as HIStalk or HERtalk, though. Like many physicians, I take issue with the term “Provider” in general. If they needed a word or phrase to summarize those of us on the front lines, the least they could have done is make us “Patient Care Jedi.”

To those of you emailed your greetings and warm wishes, thank you! After several years as a HIStalk reader with the occasional comment or rumor sighting, being on the other side of the screen is a bit strange. I feel like I know you all personally. As a physician, I’m deluged with information from all kinds of sources, but other than FDA drug recall notices, HIStalk is the only one I allow to deliver to my inbox rather than routing into a folder for later. Clicking that link and finding my own writing is quite a thrill!

Several of you have asked for additional details about my background, specifically related to HIMSS, memberships, vendors, and conflicts. There seems to be a common theme about objectivity. Like my other HIStalk BFFs, being part of this team gives me the opportunity to speak candidly about the products on the market today. I have hospital privileges at multiple facilities, so my user experiences have been diverse. I’ve seen (and been forced to care for patients with) the good, the bad, the ugly, and the horrific.

In the interests of full disclosure: Like Mr. HIStalk and Inga, I’ll be attending HIMSS as a regular attendee. My “day job” employer pays for an individual HIMSS membership (as well as my specialty society, the local MGMA chapter, and the Southern Medical Association). A previous employer made me a Life Member of the AMA. Although I’m not currently on any national task forces or committees, that doesn’t mean I haven’t been in the past or might not be in the future. I do serve at the state/regional level in advocacy efforts. I’ve not been employed by any software or hardware vendor. I have never been convicted of a felony and my blood type is O positive.

Now that we have that out of the way… I saw an invite to an AMA continuing education seminar called “High-Reliability Safety: Applications to Healthcare” that’s being held on Wednesday the 19^th. More info here.  They’ll be talking about embedding a “safety management system” in the healthcare environment. Unfortunately, I’ll be attending another tres exciting Meaningful Use Committee meeting at my institution, so if any readers happen to attend, email me with the interesting tidbits.

Multiple media outlets have been talking about the CDC report on EHRs in physician offices. National Coordinator for Health Information Technology David Blumenthal featured it under the extremely optimistic headline “EHR Adoption Set to Soar.” American Medical News was a little more restrained with “Physician EMR use passes 50% as incentives outweigh resistance.” Blumenthal goes on to celebrate the 41% of office docs and 81% of hospitals planning to apply for incentives, but goes on to note that many small practices “still need to learn about the opportunity they have.”

My thoughts on it: take it with a grain of salt. There are quite a few of my peers who are blissfully ignorant about this whole issue; maybe that’s not so bad. As for the study itself, the data was gathered via a physician self-reporting mail sample. Those of us that interview patients know what happens when patients self-report health behaviors – they either double it (exercise) or reduce it (alcohol) so that there’s no way of knowing what the patient is really doing. I think there might be a little bit of creative reporting by my peers here.

The survey looked at full vs. basic systems and although the headline “Physician EMR Use Passes 50%” sounds sexy, a closer look at the numbers reveals that 25% have a “basic” system and 10% have a “fully functional” system. The data doesn’t quite capture what portion of physicians have a system with bionic capabilities installed but are only using it to do the IT equivalent of crushing beer cans. (I recently visited a physician who was using her laptop as a base to stabilize an avalanche of journals, mail, and catalogs. She owns a gold-plated system. It was a shame.) If you dig deeper into the features that allowed a system to at least meet “basic” requirements, you could meet that with a word processor and some scanning software.

Bottom line: if a patient-care study had results like this, physicians would be extremely skeptical about its conclusions.

E-mail Dr. Jayne

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From Just the Fax, Ma’am: “Re: CSC’s healthcare group. From the confidential e-mail, ‘The market conditions in the overall economy have impacted our ability to build pipeline and to close on those opportunities we have been able to identify and pursue. As a result, financial performance is far below our commitments and we have been directed to improve our forecasts by reducing costs.’ The action: non-billable employees and those billable with less than 40% productivity must take 10 days of PTO or unpaid leave between January and April. IMHO – significant cause is inability to staff opportunities due to implementation consultants leaving right and left.” Unverified.

From The PACS Designer: “Re: XR-EXpress. An interesting image and data viewing software app for the iPhone called XR-EXpress has been released by New Mexico Software. You can manage cases, orders, and patient records easily and also check patient’s exam results.”

Listening: brand new rock-punk from Cage the Elephant from Bowling Green, KY. They’re barely old enough to shave, but they sound good, with some rawness that hints of the Strokes or Pixies. 

On the Jobs Page: Senior Project Manager, Director of Consulting – Healthcare IT, Allscripts V11 Implementation Consultants, Sales Representatives. On Healthcare IT Jobs: Epic Program Director, Enterprise Architect, IT Systems Analyst, HPP Functional Analyst.

Some of the nicest people you’d ever want to know are with Encore Health Resources, starting at the top with industry long-timers Ivo Nelson (chairman) and Dana Sellers (CEO). Encore sponsored the great HIStalk HIMSS reception at Max Lager’s in Atlanta last year, with Ivo, Dana, and our pal Amy getting elbow-deep in the minutiae with me to make sure you had a blast (Ivo made the executive decision to go open bar instead of drink tickets, which saved quite a few of you a small fortune on the overage). They now want to support us even more by becoming an HIStalk Platinum Sponsor, which I appreciate. Everybody knows Ivo – he founded Healthlink and sold it to IBM in 2005. I’m pretty sure EHR (get it?) is following Healthlink’s trajectory of unbelievable growth, solid reputation, and happy consultants (the company is already racking up awards for being a great place to work, so check out their job listings). Encore provides services such as strategic planning, system selection, implementation, optimization, health analytics, and project management. I interviewed Ivo a year ago when nobody (including me) had heard of Encore — he provided some surprisingly heartfelt and profound answers that are worth a re-read, which I just did. Thanks to Encore Health Resources for supporting HIStalk.

William Beaumont Hospitals (MI) expects to get $10.3 million in HITECH money.

I thought of something I’d like to write about: what it’s like selling for Epic. Surely there’s a former Epic iron-mover out there who would talk anonymously. The company claims they do no marketing and implies that their sales process is simple, but there must be more to that story given the large number of big deals they’re signing.

I’m whisking Mrs. HIStalk away for short hiatus somewhere warm and sandy this weekend (Inga’s terse but sincere directive: “Don’t drink the water. Do drink the beer.”) Inga and Dr. Jayne will be handling the Monday Morning Update so that I might travel laptop-free, although I’ll have the trusty iPod Touch for sneaking an occasional, furtive glance at e-mail.

I’ll be closing the HISsies voting in a couple of days, so if you got an e-mail link, use it soon. If you weren’t on the HIStalk e-mail subscriber list as of last Saturday, you can’t vote, sorry. Tying the poll to an e-mail address prevents the usual Internet vote fraud since only those I’ve e-mailed can vote (it worked the same way last year). I know that method excludes those who read by RSS reader or who just cruise over whenever they feel like it, but that’s the only way I could come up with to prevent companies from urging candidate-specific company voting and to hopefully block robo-voting scripts.

ONC’s David Blumenthal hits YouTube to pitch EMRs, citing survey results in hopes of eliciting the bandwagon effect among fence-sitters.

WSJ covers the growing number of patients ordering their own lab tests online, with heart-related tests being the most popular. One patient’s seemingly backward approach struck me as funny: “She says she would call her doctor if she got a worrisome test result.” Most states require a physician order, but the lab companies are hiring doctors to sign them after a quick review of the online request. Sometimes you do wonder, though: do certain tests or medical items really require a physician’s supervision for safety, or is that just a way to prop up the price?

Welcome to new HIStalk (and HIStalk Practice) Platinum Sponsor MD-IT. The Boulder, CO company is the leader in medical documentation for physician offices and clinics, offering them an alternative to “EMR interfaces that require you to become data entry clerks” in creating an using electronic clinical notes. The big picture includes the preferred form of data entry, a chart viewer, e-prescribing software, Internet access to patient records, and provider-to-provider messaging. Specific options include dictation transcribed by medical language specialists; front-end speech recognition as a standalone application or Word add-in; a Web-based platform for creating, storing, and sharing clinical notes; and several EMR options (built into its platform, interfaced to an existing EMR, or a package including the Ingenix CareTracker PM/EMR) that it says let doctors “dictate your way to Meaningful Use.” The company offers its services through a nationwide network of regional offices. Thanks to MD-IT for supporting HIStalk and HIStalk Practice.

As I’m prone to do these days, I moseyed to YouTube to see if MD-IT had anything there. Above is a demo of a doctor using its software.

HHS will open the 45-day comment period for potential Stage 2 Meaningful Use objectives next week. The proposed objectives and measures for Stages 2 and 3 are here (warning: PDF).

Randall Stephenson, AT&T chairman and CEO, tells a Brookings Institution panel that robust broadband will change the healthcare model, particularly monitoring and diagnostics. The head of Time Warner went for the funny bone in his assessment of healthcare bandwidth needs: “We’re just thinking about making more doctor shows.”

EHR users speaking at the Implementation Workgroup of the HIT Standards Committee are concerned about meeting Meaningful Use requirements, mostly involving timelines, cost of compliance, and lack of government guidance. Some I found in my skimming:

• RECS don’t have consistent standards.
• Using a computer during a visit requires doctors to develop an entirely new approach to the patient visit and the time required to document it.
• One practice couldn’t pay its owners because of the cost of an unexpected server replacement.
• A hospital system said it couldn’t get straight answers about some of the requirements, spending 15 hours per week and tens of thousands of dollars in attorney fees. They submitted 21 questions to CMS, with 10 marked as solved even though only one was answered. They submitted eight to ONC and got four answers.
• Several hospitals and practices had to develop their own reports even though they are paying the vendor for a certified product. Those reports had to be changed as CMS and ONC clarified the requirements.
• Customers are being forced to buy software they don’t need. Example: a hospital has its own integration with Google Health, but interpretation suggests they’ll have to buy the unneeded product of their vendor since it was used by the vendor to earn Complete EHR certification.
• The same hospital interprets the regs as requiring them to re-certify their own tools, such as file transfers, every time they apply an upgrade to their EHR or interface engine, with a cost of $8,000 to $10,000 each time.
• From a recent clarification, hospitals must own software that can meet all Meaningful Use requirements, even if defers those requirements for Stage 1.
• Intermountain Healthcare says they don’t think they’ll make the Stage 1 deadline in time at all hospitals, saying they have “a huge and seemingly insurmountable challenge in front of us as things stand today.” They’re not getting timely answers to their questions from ONC and CMS.
• One hospital using a certified vendor with certified quality reports says they’ve had to create their own reports anyway, which they called “an onerous, difficult and time consuming process.” They added, “It is our understanding that only one Epic customer has been able to successfully run all of the Eligible Hospital MU reports.” They’re delaying their attestation.
• One group’s pediatric practices have too few Medicaid patients to quality for incentives, so they aren’t really incented to use EHRs.
• A hospital informaticist expressed concern that too many EHRs are earning certification for Stage 1 that may not be around to move to Stages 2 and 3. He also suggested that usability should be incorporated into the certification process.
• The most entertaining comments came from James Fuzy of Mississippi Health Partners. He says EMR interfaces are too expensive and not standardized and suggests giving hospitals money to do the connectivity because they have the expertise. He doesn’t like mandatory statewide HIE participation since they would have to pay for it even though they have their own HIE. He suggests a Meaningful Use Guide for Dummies since doctors don’t know what it means and most don’t think they money will ever be paid anyway. He says that insurance companies buying HIEs is like “the fox now guarding the hen house” to use the information to direct care; he instead suggests that if insurers want patient data, make them pay the providers for it.

A Weird News Andy diversion: a hospital in what sounds like a dangerous part of Chicago has decided it will no longer accept ambulance patients, saying it can save $25 million per year and increase its outpatient business.

A self-serving Council for American Medical Innovation poll finds that 58% of respondents want the federal government to spend more on medical innovation. As Inga would say, the same percentage also like babies, puppies, and world peace. Never ask if people want something, especially if it sounds noble; the real test is to ask them to hand over the cash to pay for it.

Interesting: a woman whose Wii Fit Balance Board shows her leaning to one side gets checked out, resulting in a diagnosis of Parkinson’s disease. She said, “It’s quite amazing that a computer game was able to point out there was a problem.”

GE Healthcare’s CEO says “the US has snapped back” and it can grow profits 10% per year, although the snapping back seems to refer to increased healthcare spending, which is really not much of an accomplishment unless you like to watch a country slowly going broke.

Transcription software and services vendor iMedX, fresh off several acquisitions, raises $2.5 million in equity financing, increasing its total to $17 million.

The federal government sues New York City’s government for running a Medicaid mill, saying it authorized 24-hour home care for patients without obtaining documentation of need and costing federal taxpayers tens of millions of wasted dollars.

Drug shortages are driving hospitals crazy, but it’s not just them: FDA intervenes to help prisons obtain imported sodium thiopental after domestic supplies run short, delaying death row executions. They’re testing new drugs for their people-killing power.

E-mail me.

HERtalk by Inga

From Wilbur: “Re: Arizona shootings. Bad news on top of horrible news from out here in the great Southwest. Dumb, dumber, dumbest.” University Medical Center fires three clinical support staff members for accessing the medical records of victims of last weekend’s shooting. Officials say they are not aware that any confidential information was publicly released. The hospital has a zero-tolerance policy on patient privacy violations (cheers).

From Claude Noel: “Re: Manitoba eHealth. Saw a weird negative post about the project. Actually the project is going extraordinarily well. This is a very cool project that has had surprisingly little problems with implementation thus far.”

From Z-man: “Re: Moses Cone. I hear that as part of their contract with Epic, Moses Cone has to hire 92 FTEs that Epic screens and approves. Crazy, but I think it is a formula that works.”

NorthShore University HealthSystem launches Epic’s MyChart application for the iPhone, iPad, and iTouch.

Ten Sisters of Mercy Health Systems hospitals are targeting to begin their 90-consecutive-day Meaningful Use validation on April 1. Mercy says it has invested more than $450 million for EHR across its 28 hospitals and has the potential to earn $140 million in incentives.

Honolulu physicians practicing near Kapiolani Medical Center at Pali Momi are forming an HIE and will use the Wellogic Community solution to connect with labs, pharmacies, hospitals, and other providers.

Also from the Aloha state: The East Hawaii Region of Hawaii Health System Corp. commits to meeting an end-of-year deadline to implement EMR (Meditech, I believe). East Hawaii Region hospitals are eligible for more than $7 million in stimulus funds.

HP wins a 52-month, $30 million contract to create a statewide Medicaid HIE for Texas. The project includes creating an electronic health history system for all Medicaid patients.

Former Surescripts exec Kate Berry is appointed CEO of National eHealth Collaborative. Interim CEO Aaron Seib will continue with eHealth as a senior leader.

Are you curious how Gastorf Family Clinic (OK) managed to get their $42,500 stimulus check just two days after applying? A big thank you to Practice Manager Darrell Ledbetter for sharing details on HIStalk Practice. Bottom line: they were committed; their vendor (e-MDs) had the software in time; and they had solid assistance from their REC. Ledbetter says this initial payment alone almost covers what the practice paid five years ago for their EHR set-up.

Other goodies on this week on HIStalk Practice: an interview with Practice Fusion CEO and founder Ryan Howard, who shares some details of his company’s unique business model. Primary care docs and specialists have communication problems that aren’t necessarily improved with HIT. Nuesoft introduces its Nuetopia service and publishes another fun video. You know the drill: sign up for e-mail updates while you are over there. We are about to hit 1,000 confirmed subscribers. I promise to give you a free HIStalk Practice subscription if you are lucky subscriber # 1,000.

According to ONC, recent surveys indicate that 81% of hospitals and 41% of office-based physicians intend to seek Meaningful Use stimulus funds. Only 14% of office-based physicians say they are not planning to apply for incentives. David Blumenthal says these numbers indicate that the Meaningful Use process is increasing the willingness of providers to adopt EHR systems and that, “we are seeing the tide turn toward widespread and accelerating adoption and use of health IT.”

At this week’s advisory HIT Standards Committee meeting, several HIT gurus spoke out in support of including medical images in the next stage of Meaningful Use. Blumenthal agrees that it raises a number of questions worth tackling.

Alvarado Hospital (CA) sends layoff notices to 249 employees, or about 25% of its staff. The layoffs, which begin March 13th, affect 91 nurses, 10 pharmacists, and 13 technicians. Sad situation, but at least the financially troubled hospital gave workers 60 days’ notice.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• HealthTrust Purchasing Group aligns with 3M Health Information Systems to offer clinical documentation improvement consulting services and software and 3M IC-10 transition planning services to HealthTrust’s network of 1,400 acute care facilities.
• Picis receives certification for its EDIS, perioperative, and critical care products – all are  compliant with Stage 1 Meaningful Use measures.
  Edwards Air Force Base (AFB) replaces its PACS with McKesson’s Medical Imaging PACS under a new contract with the DoD.
• Nuance announces that 100% of ED physicians across St. Anthony’s Hospital Group (Centura Health) are using Dragon Medical to document patients’ medical reports.
• Memorial Hospital and Manor (GA) chooses ImageNow document management, imaging, and workflow from Perceptive Software for its HIM and registration departments, hoping to phase out paper medical records weighing an estimated 830,000 pounds.

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