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

Crisis Reveals Leadership

I finished my first week as CIO exhilarated. I slipped out early and headed for a haircut (I had hair back then). The grating buzz of the “emergency broadcast system” disrupted WTAM’s sports update. A power outage that began in the Northeast had hit Ohio. This was not a test.

Out the window, I watched traffic come to a halt. Electricity stopped, rendering signals colorless. I called my family and staff, but cell networks were overwhelmed. I returned to the office.

They say nothing in life is certain except death and taxes. I differ. Crisis is a sure thing. By definition, life is a series of crises, and a showcase of our ability to react. Death, sickness, raising teenage daughters….

Life and career choices determine the number and severity of crises you might experience. But one thing remains true: you will have them. Great leadership will minimize the volume of crisis, but every leader will encounter one. Preparation and execution determines how healthily you emerge.

No course, audit, or survey can tell you as much about your leadership than a crisis. If you want a test that shows what you are made of, crisis will reveal your abilities. Those who aspire for greater responsibility must understand that to whom much is given, much is required. The higher your position — be it family, church, community, or work — the higher the probability that you will be leading in crisis. Be prepared.

I have mishandled some crises and led well through others. In each case, I came to terms with my abilities. Failures and successes totaled, here are things I learned. Master these so they become part of your core leadership abilities.

Take Responsibility Immediately

Do not blame a vendor or an employee. You are the CIO. Crisis happened on your watch. Take responsibility and focus on resolution.

Leadership

• Chain of Command. Ensure everyone knows chain of command, especially when multiple teams are involved working on solutions. Given sleep cycles, you do not want lack of clarity to slow progress.
• Battlefield Promotions. Expend your energy working with the motivated, not trying to motivate the worker. Make on-the-spot promotions as needed. Now is not the time for staff development.
• Fit Leader. Sometimes a crisis can span multiple days. You have to be fit to be effective. Don’t argue with me, argue with science. Most can perform well for 24 hours, but notable performance degradation begins thereafter.
• Visibility. You must be on site. Make a point to lead all customer calls (except on sleep rotation) and walk the floors of impacted hospitals. Walking floors is mandatory for all the command center commanders (my directs).
• Deploy Listening Posts. During a crisis, it may appear that the sky is falling. You’ll hear exaggerated reports. Your plans will be incongruent with reality and spread panic and fear. Having your own listening posts will help discern reality and lead to quicker resolution. Another reason why personally walking the floors is critical.
• Ask the Right Questions. We live in an instant society with on-demand entertainment and microwave food. We often don’t have all the pieces necessary to solve a problem that might arise. The delta between the immediate need for an answer and the time it takes to find the right solution frequently generates stress. In this scenario, stress begins to ebb when you finally start asking the right questions and start getting the right answers. And, like any good jigsaw puzzle, the pieces naturally begin to fit together… as they were intended to.

Processes

• Operations. I am most familiar with ITIL. The operational process you choose to leverage is immaterial, but having established and routine processes is a key success factor during a crisis. You do not have time to reinvent the wheel.
• Downtime Procedures. Again, establish and practice.
• Disaster Recovery/Business Continuity. Most organizations have a DR plan, but few have BC drills. Conduct BC drills quarterly. This enables you and your staff to better handle the stress and drama of an actual crisis before it happens.
• System Access. Avoid single points of failure. In an emerging world of ubiquitous electronic health records, you must have devices and systems pre-deployed to ensure access to data in a catastrophe.
• Business Resumption Plan. While key to focus on solutions, you must also direct your staff and customers on business resumption planning well before the solution is in place.

Practical Logistics

• Food. Assign someone to ensure a steady food and coffee supply. Let your key people focus on tasks, not noisy bellies.
• Sleep. Have a rotation for rest, like airline pilots on international flights. Have comfortable places for people to sleep and nap if staying on premise.
• Command Center. Stand up a center within one hour of calling a disaster and staff it 24/7. Should stay open 2x length of actual event. Do not shut down prematurely.
• Assist Customers Impacted. Constantly ask, “How can we serve you? What else can we do?” whether IT related or not. I deployed staff to delivering water supplies and purchasing fans. Double or triple the number of staff on site. Visibility in crisis is crucial. Keep high staffing levels until the customer signals enough. I saw firsthand how our clinicians reacted to seeing a significant presence on the floors with questions like "How is the system working? How can I help?" This reassured our clinicians that we were taking the crisis seriously.
• Communications Plan. Strong communication fills the void that otherwise gets populated with incorrect messages. Helps develop customer allies in solving crises, as opposed to antagonists. Publish your cell phone number. Start all communications by highlighting your organization’s mission. This serves as a common rally point for all involved. Be consistent in your messaging. Key messages might include accountability, transparency, action, calm, and hope. Execute your plan as published. Leverage multiple venues such as conference calls, e-mails, collaboration tools, portals, etc. Embrace corporate communications. They are experts in communications and can help you develop, adjust, and execute your communications plan.

Profit from Crisis

Document throughout, and take history of all actions and issues. This is critical in averting future crises. Resist the pressure to return an organization to status quo so you can profit from the crisis. Not seeking opportunities or pursuing the underlying cause of the crisis might leave your organization open for future conflict.

• Wiki. Open a wiki and encourage staff and customers to post notes real time. Use these for practical insights during the crisis to document key lessons learned.
• Document Lessons Learned. Encourage all customers to take notes during the crisis so they can make adjustments to the processes.
• Downtime Procedures. These may never have been exercised. The best time to make real world adjustments is while downtime procedures are active.

Engage Outside of IT

• External Expertise. It is a sign of strength to reach outside of your organization for help. If I sense the crisis is longer than two hours, I am on the phone calling peers and vendors.
• Guru Council. Set up a council of advisors to make sure your plans are logical and nothing is missing. Council members are not in the heat of the battle and can provide unstressed ideas.
• Vendor Management. Do not hesitate to escalate early and often. You have no time to dally. Let the level of severity determine when to go to the CEO.
• Engage Senior Leadership. Do not hide what is happening. Engage senior leadership immediately and keep them informed. Bring senior leadership directly into the loop with vendor senior management. This ensures your crisis will receive appropriate attention.

Internal

• Take care of your staff. Keep everyone focused on solutions not blame. Share all positive feedback as received.
• Have multiple teams working on multiple solutions. On two occasions, the primary plan failed to bring about resolution. Fortunately, secondary plans already underway saved the day.
• Ask for ideas from staff not associated with the crisis.
• Levity. Despite the crisis, you must work hard to ensure a calm atmosphere. Staff will think more clearly when you de-stress the environment. I recall Day Two of a crisis when someone began playing Christmas music and a sing-along started. It alleviated an otherwise tense situation.

Ending Well

When the crisis is over, the work begins.

• Send a Thank You. Personally acknowledge all those impacted, first your customers and then your staff. These might include nurses, medical staff, and practices.
• Root Cause Analysis (RCA). Figure out what happened and what can be done to avoid this same crisis. Do not skip this. Publish the RCA and include action and mitigation steps. Monitor for execution.
• Assimilate all lessons learned, downtime procedure modifications, etc, into enhanced processes.

We are all healthcare IT leaders, and my hope is that some might profit from the ideas posted. What ideas and tips do you have that I failed to cover? We will send a “crisis agenda” template to all those who post a new idea.

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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Jennifer Lyle is co-founder and CEO of Software Testing Solutions of Tucson, AZ.

Tell me about yourself and about the company.

I’m co-founder and CEO of Software Testing Solutions. We’ve been around since 1999. We specialize in building technology-based quality assurance solutions to hospitals. We provide an automated testing solution — focused on laboratories and the blood banks to date –– to help them test, re-test, and maintain regulatory compliance throughout those systems in a way that’s much more efficient, much more effective, and with a lot more coverage than was possible manually.

The hospitals I’ve worked at all tried to use off-the-shelf scripting tools to write their own software testing scripts, but all of them abandoned the idea because of some application quirk or Citrix problem. Or, they realized we would never get enough benefit to have been worth the analyst time required. How is your product different?

That’s absolutely true. I think the latest studies show that across all the companies that try, it’s only like a 37% success rate. It’s very difficult to take the tool off the shelf and to take people who are not automation experts and have them develop robust, maintainable, and reusable scripts.

That’s where we are different. My background is as an automation engineer. The other co-founders of the company were a programmer and a med tech. We were able to take our expertise and our years and years of industry experience of how to use that tool and build something that really became an expert in the functionality of the system under test, so it was completely reusable and maintainable for the client.

The other problem with automated testing tools as they come off the shelf is that the average medical person is not an automation engineer. They can’t sit down and figure out exactly how to programmatically get the script to do what they want or set up the variables to do the variations of the testing that they want. 

Our solutions have a very straightforward front end that makes the system look a lot like a Cerner application or a Sunquest application under test. They fill in the blanks and use drop-down boxes to tell the system how and what they want to test. We keep the underpinnings up to date, so as the system under test goes through release after release by the vendor, we maintain it. The user never sees the underlying testing tool. This way, they can use it from the very first time and use it for years and years. We have folks that have been using it for over eight years in testing and validation.

I assume that software vendors use automation for their in-house QA testing. Do they offer similar tools to their customers so they can do their own validation?

Not that we’ve found. The vendors work very hard to do a very good job of testing their application that they’re developing with the data that they have.

As you know, every hospital sets up their catalog and their procedures totally differently than the next hospital. The flags they’re going to use, the warnings they want turned on, and where they want them turned on vary. It’s hard for those application developers to write a scripting tool that’s robust enough to make it productive for the client.

We prefer to not partner too tightly with any one vendor, especially in the world of the laboratory and the blood bank. The regulatory agencies prefer that if you’re getting assistance in your testing that it not be from the vendor who’s providing the solution. They believe that the more eyes that are looking at the system with a different perspective, the better the chances are that you’re going to find errors. If the people who programmed it are the people who are testing it, it’s testing with blinders on.

Your flagship offering is for the Sunquest LIS, but you’re now offering similar products for Allscripts / Eclipsys Sunrise and Epic, right?

Right. We’ve just started a division called Ratio. The focus of that division is on meeting the testing and validation needs of hospitals implementing CPOE systems. We’re going to be in the GE market, the Allscripts / Eclipsys Sunrise market, and Epic and Cerner as well.

It just seems such a like a perfect, natural flow to go from the laboratory and the blood bank now into the CPOE area. We’re having such a massive rollout of CPOE systems that it’s getting very difficult for the hospitals to exhaustively test all the permutations of patients and orders, where warnings should fire, where messages should appear, and where something should be allowed but something else shouldn’t. Automation would serve that industry very, very well right now. We’ve got the technology to do that.

It’s laborious for analysts to have to do all that testing and documentation. But to automate the process, do you need the cooperation of the application vendors?

We make them standalone. We don’t have any tight relationships with the vendors. Our clients are the end-user hospitals. They provide access to the systems to help us develop our testing scripts and to help us understand the sets of conditions that they want to test — what therapeutic duplications they want to test, what allergies, what drug-diagnosis interaction.

That lets us tailor it to how the hospitals want to use it, since again, it varies so much from hospital to hospital of what they need and what they want. We really want to serve the end-user community here. The vendors are doing the absolute best job possible with testing their solutions in-house, but once those systems are out in the field, you have the variety that comes with the unique configuration of every single institution.

Hospitals would ideally test often, every time they or their vendor make a change. Is your product more of a turnkey solution than a toolkit?

It is turnkey. When we provide that the solution to the client, we train them on how to use it. It’s very, very straightforward and simple for them to use.

Maybe you’ve put a new laboratory interface in and you want to make sure your Epic lab orders are crossing correctly over to your downstream and ancillary systems. With a few clicks of the mouse, our solution will extract all of your lab’s procedures out of your Epic database and, with a click of the button, it will place the orders for you. Once the lab has resulted those orders, another button will go in and look them all up and take the screen prints of those transactions coming back. You can do your results review checking at the same time. We provide a basic set of the patient-procedure pairings or patient-medication order pairings that you want to do.

What we’d love to do over time is continue to work with other industry-leading groups to identify the most common serious medication errors out there so we can build an even bigger sampling of prepackaged conditions.  We can quickly tailor those to a site, let them test it that way, and also give them the ability to add their own. Such as, if in my institution, I want to make sure that if a patient comes in with these demographics and these particular drugs are ordered, I want to see this type of warning.

We want to do both. We want to give you that prepackaged capability, right now, right off-the-shelf within an hour’s worth of training … have it be there and be productive for you and have it grow with you as your institution changes.

I would assume the primary return on investment is to free up analyst time, plus the chance to avoid a software-caused medical disaster that could lead to a lawsuit. What ROI parameters do customers consider before purchasing?

You’re definitely looking at the time and labor savings. You’re looking at a much more accurate testing protocol because it is being done by a computer, not by a human. It allows you to thoroughly do regression testing, which is going to get your releases in quicker as well. As you mentioned earlier, that’s a big problem with the vendors coming out with new releases. It takes the client quite a while to be able to implement those and a lot of that piece is in the testing.

The other area we’re seeing more concern about is providing proof of testing and being able to document. There’s a stronger push by the government getting more into Meaningful Use criteria and mandating certain testing. Our tool provides great comprehensive documentation in the form of reports and screen prints that these combinations have been tested and have been exercised. We can repeat this again at any point that the hospital desires: monthly, quarterly, annually, or when they take a new release. Whatever they feel is appropriate for their site.

Who’s your competition?

We’re very innovative in this particular role. In this particular area, I don’t know of anybody who has this style of an automated solution. There are consultants that you can hire to come in and manually exercise your system and check on it. The Leapfrog Group has their great CPOE tool that you can use and take to see how you’re doing on that performance, but that’s a pretty limited scope of combinations that you’re going to be testing. 

I think this is the leading edge. This is the next place where we can take a great step with technology to make CPOE implementations faster, to make them stronger, to get the benefit out of them, and the Meaningful Use that we’re trying to get out there, and show that the patient safety element is still out there as we implement.

As CPOE is implemented properly, it drives the quality of care and efficiency. When it’s flawed, it can lead to more issues. If we’re going to do it, let’s do it right and let’s make sure it’s functioning as we expect.

What are the challenges and rewards of being a small company offering a niche product that is targeted to customers of specific application vendors?

We’re focusing on the key players in the CPOE world. We’ve leveraged off of our installed base from the laboratory and blood bank side, where a lot of those site have Epic and Allscripts / Eclipsys in them. We’re also developing it with another client for GE and for Cerner.

I think when we have those fully out there, that’s a good representative piece of the market. We’ll continue to look forward and build more solutions for other vendors out there as the client need appears.

You’ve been in business for ten years. What skills and characteristics does it take to succeed?

It’s very customer-focused. We need to deliver value to our end user. We have to make a difference in their software quality. They need to be able to see a meaningful return of their investment in the form of time freed up from the analysts. They have to feel that they are catching things that would have gotten into production and caused patient harm, and we need to provide this at a very cost-effective price point.

So far, that’s what we’ve been able to deliver. In the entire history of our business, we’ve offered a full one-year, 100% money-back guarantee to all of our clients. We guarantee to people who have invested in our product that this is going to work for you. If it doesn’t, then we’re going to make sure you have your funds back to go find something that will work for you.

Putting that hospital’s needs first, respecting their business, and earning a seat there and providing value is what’s kept us in business and kept with us very, very loyal customers.

Have customers contacted  you and said, “Wow … this would have been a disaster if your system hadn’t caught this problem.”

Yes. We’ve had a number of those in the blood bank. We’ve had a number of those with implementing CPOE and the results for review crossing back where certain laboratory flags on tests results were not being carried correctly back into the results viewer in the HIS system, so the physicians were not seeing appropriate results. All of which could have caused a lot of harm if they had gotten through.

Where do you see the healthcare IT industry going in the next five to ten years?

I think it’s explosively growing. ARRA and our move toward CPOE is going to give us an unprecedented opportunity to get more technology out there and to drive quality care. It’s going to provide some challenges along the way. I think as long as we keep making sure we’re focusing on solving the little challenges that come up as we implement these great steps, these great strides, we’re going to see a huge benefit going forward.

We just have to make sure that, as we implement it, it really is working correctly. The tolerance for error in our industry is very, very small. But I think we’re going to see care at great new levels and great more efficiency. That’s what we’re really looking for – patient safety and a more efficient use of resources.

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From Chi-Town Native: “Re: HIMSS. Their swearing off Chicago as a site for the annual conference helped trigger an overhaul of McCormick Place operations. Now they’re returning in future years.” HIMSS scratches its cross-town pal’s back by dragging all of us attendees back to Chicago in the bleak dead of winter (they call it "spring” there once the vernal equinox is past, even during the snow storms) in 2015 and 2019. Being a skeptic, I still fully expect to find overpriced hotels, surly workers, and the bad weather that vendors love since it keeps everyone hanging around the exhibit hall. Still, I found a list of proposed changes that sound good on paper: outsourced convention center management, allowing competing electrical contractors, letting exhibitors do some of their own tasks like sweeping or plugging in a monitor without having team of nasty union workers threatening physical violence, cheaper setup and food services, and free WiFi everywhere.

From Jerry MindMeld: “Re: Detroit Auto Show. The Car of the Year is one nobody you know has driven. What’s the car equivalent of your EMR? Bentley? Produces a cloud of smog like a 1981 Le Car? A souped-up ‘74 Camaro that only one guy can fix?” I told Jerry that some applications are like concept cars: they look good when being showed off by hot models, but when you try to buy one, you find they don’t really exist. I drive a beat-up econobox that’s seven years old, so obviously I’m one of those Point A to Point B types.

From Hello Larry: “Re: eHealth Entitlement in Canada. Despite what Canada Health Infoway has said about speeding up the Manitoba eHealth project, it is essentially dead due to mismanagement, poor planning, and lack of vision. The health minister, in the December announcement that IBM will run the project for $22.5 million, said ‘there has been no progress made, no clinical EMR consultants hired, and once again Canada Health Infoway has dropped the ball on Canadian taxpayers.’” Unverified.

From Longtime Informatics Professional: “Re: stop the presses. ONC clarifies the difference between EMR and EHR.” Their definition is the same as mine: EMRs are electronic versions of paper treatment records, while EHRs focus on the broader health of the patient and extend beyond a single provider’s walls to share information from all clinicians who provide that patient’s care. Where we differ is that ONC seems to believe such an animal exists, so they use the term EHR universally. I believe that’s wishful thinking and therefore EMR is still correct in most cases (certification as an EHR notwithstanding since that implies theoretical product capability, not actual use). I might also quibble that the R in both acronyms suggest the records (database), not the application(s) that created those records, so I stubbornly stick to calling those data-creating applications “clinical systems” on the hospital side, with the collective end result being an EMR (you can buy applications, but not an EMR unless a single product covers every single hospital department, including diagnostic images). I’m open to reader suggestions for better names since I dislike both of these.

Healthcare Management Systems (HMS) hires two execs: Jack Holt (McKesson) as VP of client services and Todd Redmon (Dell) as VP of customer support.

A Computerworld article suggests that FDA may start regulating hospital data networks that connect FDA-approved medical devices. It points out the now-legendary four-day network outage at CareGroup (BIDMC) in 2002 would have been much worse had they not run medical devices on a separate network that stayed up. Said a GE Healthcare systems designer, “I’ve been to meetings of biomedical engineers. If you ask them if there are any cases where IT has disrupted patient care, all their hands go up.” I’ll argue from the IT side, though: some of those so-called biomedical experts, especially on the vendor side, don’t know squat about enterprise networking — they’re used to just happily plugging their stuff into whatever open network jack they can find without letting anyone in IT know, then high-tailing it when the campus network starts crashing. Maybe both observations highlight the need for IT and biomed to be a single organization, perhaps with FDA oversight when medical devices are involved.

Calling all data geeks: Heritage Provider Network is offering a $3 million prize for creating an algorithm that can analyze patient information to predict which ones will need hospitalization six months in advance, which would allow providers to intervene and save the health system billions of dollars. Teams of any composition can pre-register now for the two-year competition. If you’ve ever worked with neural network training, it’s kind of like that: teams get three sets of de-identified patient data containing inpatient and outpatient encounters, medication dispensing, and outpatient lab results. They develop their algorithms using the Training Dataset, which contains a binary flag indicating whether or not the patient was admitted. Once teams have fine-tuned their algorithms, they run them against a Quiz Dataset and submit their results to see how well they predicted admissions. Then comes the grand finale: qualified teams run their algorithms against a Test Dataset to see if their algorithms merely regress well against a known result or whether they are actually predictive (most of the time, perfect regression curves and neural networks turn out to be dumb when fed additional data points).

I hear that National eHealth Collaborative (the former AHIC Successor that supports the Nationwide Health Information Network) will name a CEO in Wednesday.

Thanks to new HIStalk Gold Sponsor Elumin Healthcare Solutions, Inc. The Sammamish, WA company offers management consulting (selection, contracting, implementation, technology, and clinical transformation), consulting services related to products from its vendor partners (Allscripts, Cerner, Epic, and HealthWare Systems), and the MyWay PM/EHR and Payerpath claims management as an Allscripts reseller. They’re an official Epic Consulting Partner, in case you were wondering. CEO Mark Williams has a long industry history, including time spent at Intermountain and Siemens Medical, so you’ve probably run across him at some point. Thanks to Elumin for supporting HIStalk.
 
Google CEO Eric Schmidt says if he wasn’t running Google and if he wanted to get involved in healthcare IT, he would go to the major research universities to find existing software that could be open sourced, concluding that , “My guess is that a platform like that would be remarkably different from the platforms we are using today.”

Thanks to the 692 folks on the HIStalk Update e-mail list who have voted in the HISsies so far. I’ll send a final e-mail reminder Wednesday and we’ll finish it up. As I predicted, a few readers complained as they always do that (a) the nominees were not much different than last year; (b) I must be involved in a romantic relationship with Judy Faulkner since she and Epic were on the ballot a lot; and (c) I must be clueless to have missed some obvious nominees. To reiterate: anyone could nominate and all I did was take the top four vote-getting nominees (or five in one case of a tie) in each category and put them on the ballot.

I’ve also received a few e-mails about HIStalkapalooza. You haven’t missed anything: the online “I want to come” Web page will go up somewhere around January 21 and will be mentioned here. A rather impressive roster of specialists is finalizing details, like how to make an IngaTini and what time the band’s going onstage.

An article by the now-merged Huffington Post Investigative Fund and the Center for Public Integrity questions the digital divide that may be created as providers with affluent patients are able to invest more resources in electronic medical records that those that care for low-income patients (although if I were a wag, I’d say rich organizations may find their higher income and productivity going down if they buy and implement unwisely). I hadn’t heard of this group: National Health IT Collaborative for the Underserved, formed almost three years ago by groups such as HHS’s Office of Minority Health, a big government contractor, and HIMSS.

NCHICA (North Carolina Healthcare Information & Communications Alliance) is soliciting abstracts for its annual conference at the Grove Park Inn in Asheville, NC on September 25-28. The Word application form is here and is due February 1.

Former Eclipsys sales SVP Jay Colfer joins Prognosis Health Information Systems as EVP of client solutions. OpenView Venture Partners made an investment in the company last month.

Butler Health System (PA) says it has personalized patient care by using a location-driven patient flow and communication solution that includes products from Intelligent InSites (RTLS), Ekahau (patient and equipment RFID tags), and Vocera (caregiver voice communications).

The Supreme Court will decide whether states are allowed to ban the sale of prescription data to drug companies. Vermont outlawed the practice, but was sued by data mining companies and drug trade groups because that particular lack of privacy protection makes them billions.

HIStalk links to Epic-related stories provided so many incoming hits to website of The Verona Press that its top stories of 2010 had to be separated into Epic and non-Epic lists. They nicely mentioned HIStalk specifically. Epic articles outdrew other big news stories about deer season, a sausage factory fire, and bear sightings.

E-mail me.

HERtalk by Inga

From Not Sheldon: “Re: Project Shoes. Last night’s Big Bang Theory TV show contained an idea for a smart phone application for a program where you can take pictures of cute shoes, and then learn where to buy them. Of course I thought of you.” I don’t know the TV show, but I love the app! It’s Shazam for Shoes! And speaking of shoes, Mr. H asked me if I wanted Dr. Jayne to provide some surgical shoe covers to help protect my shoe identity at our upcoming sponsor lunch at HIMSS. Of course I turned the idea down flat. I suppose he doesn’t see the sense in lugging a extra pair of shoes to Orlando when the shoes may only be worn an hour. I’m sure plenty of readers understand that sometimes it does make sense to pack six pairs of shoes for three days of travel.

Geisinger Health System (PA) will implement NextGate’s patient indexing software to enhance the sharing of clinical data across the organization.

Northeastern Pennsylvania HIE picks Covisint ExchangeLink to provide clinical messaging support for its participating physicians.

Southern Ohio Medical Center implements MetaCare IntelliDocs clinical documentation solution.

Keystone HIE (PA) and partner GE Healthcare announce plans to expand the region’s HIE to augment its chronic disease management capabilities. Area health case workers will have access to KeyHIE functionality to retrieve cross-team communications and receive auto-generated notifications of patient encounters.

IBM and Complex Medical Information Systems implement HIT solutions built on Lotus Notes Domino in several Russian public hospitals .

Spending for EHR by all providers is expected to grow to approximately $3.8 billion in 2015, with ambulatory EMR making up $1.4  billion of that number. A mere $2 billion was spent on EHR in 2009, including $633.5 million for ambulatory EHRs. That’s an overall compound growth rate of 11.5% and a whopping 14.2% in the ambulatory space. Just in case IDC Health Insights’ numbers are anywhere close to correct, you best hold on tight for the ride.

Michael Critelli, the former CEO of Pitney Bowes, is appointed president and CEO of Dossia, for which he had been serving as board chair.

Staggering: treatment costs for diabetes grew from $18.5 billion in 1996 to $41 billion in 2007. That includes $10 billion for outpatient care and $19 billion for prescription drugs. Nineteen million American adults were treated for diabetes in 2007, twice the number as in 1996.

With the hottie Dr. Jayne now on board, I am am more focused than ever on maintaining my youthful appearance, so this new, free iPhone app has come none too soon  Beverly Hills surgeon Dr. Payman Simoni created it to let users to see how they might look with a bit of enhancing. You can upload a photo of yourself and then play around to create a new nose, face lift, or the like. I went for the eyebrow lift. I think it makes me look more surprised than young, so for now, I’ll continue seeking the fountain of youth.

 E-mail (the un-enhanced) Inga.

Dr. Jayne

By now, you’re wondering, “Is Dr. Jayne really a physician? Does she actually see patients? Does she know what she’s talking about? Does she ever go out for cheeseburgers and beer, or perhaps the amusing house wine?” and other questions. The answer to all these (and many more) is yes! And so, Dear Readers, a bit more information about the newest HIStalk correspondent:

By day, you’ll find me in the CMIO trenches. By night — well, we’ll save that for another time. The life of a CMIO is never dull; there’s always a fire to be put out somewhere, and usually an angry physician behind the scenes holding a lit match.

I can’t blame them, though – they’re faced with tremendous changes that sometimes seem to threaten their core identity. Healthcare delivery didn’t change much for decades, but the past fifteen years have been Mr. Toad’s Wild Ride. Not only in the science behind the practice of medicine, but in how we are compensated, the equipment we must use, and the rules we must follow to care for patients. There are few industries that have gone through this pace of change. Physicians claimed E&M Coding was going to be the ultimate downfall of medicine in America. Meaningful Use makes that look tame by comparison!

My colleagues who view the profession as a calling tend to take this just a little bit personally. Each one of you has worked with these physicians. I spend a good chunk of time with docs like these, doing something between hand-holding and crisis counseling, depending on the person and the situation. Thank goodness for those psychiatry rotations that taught me never to sit between the agitated patient (or colleague) and the door.

When I’m not working directly with physicians, I’m exercising my clinical brain, working on evidence-based order sets, protocols, formularies, clinical reporting, training strategies, and making sure anything new is communicated in duplicate and triplicate for my colleagues who still refuse to read their e-mail (although I bet they use Facebook to see pictures of their grandchildren, but just won’t admit it.)

Speaking of Facebook, a shout-out to my new friends! I have a long way to go to catch up with Mr. H and Inga.

I also see patients, in an old-school, white-coat kind of way. I use the same systems that my colleagues claim I am using to interfere with the practice of medicine, force them into retirement, or otherwise torment them.

When I’m not handing out Kleenex or making sure we are doing quality clinical work, I exercise my technical brain. This is the part of me that loves playing “vendor Jenga” to see if we can actually make diverse clinical systems communicate with each other while using an amount of staff resources equal to half of what we asked for. Pull out the lower blocks and stack them on top – without toppling the tower! Tricky but challenging, and extremely rewarding when it works.

I enjoy working with our analysts and technical teams and helping them understand why (or why not) a particular piece of software is going to be accepted by clinicians or if we need to budget for our Implementation Analysts to start wearing Kevlar. And if they’re nice to me, I write my own SQL queries to get at information I want. And if they’re not nice to me, I might just play the “doctor card” and make sure they have no idea that I even know what Management Studio is. I also work closely with our vendors and doing the odd bit of development work and focus groups.

So, Dear Readers, now you know my skill set. Send me your provider-centric thoughts, questions, and conundrums. These will be answered in our new “Dear Dr. Jayne” feature – although I’ll be responding with a glass of wine in hand and you’re on your own for Kleenex.

E-mail Dr. Jayne.

 Sponsor Updates by DigitalBeanCounter

• Voalte partners with Rauland-Borg Corporation to integrate Rauland-Borg’s Nurse Call with Voalte’s iPhone communications solution.
• MED3OOO’s InteGreat EHR V6.4 earns ONC-ATCB certification through CCHIT. MED3OOO also announces the appointment of Jim Altenbaugh as VP of tech services implementation and training.
• Vocera Communications acquires Wallace Wireless, a developer of software to deliver pages, text messages, and alerts directly to smart phones. The acquisition is Vocera’s fourth since October.
• Lancaster Hospital selects ProVation Order Sets from Wolters Kluwer Health.
• Chadron Community Hospital contracts with Keane Healthcare Solutions for the full suite of Keane Optimum applications, including Optimum Clinicals.
• Geisinger Health System is using Precyse’s NLP coding software and  M*Modal’s NLP voice to text technology to enhance its clinical documentation and coding.
• Vermont Information Technology Leaders (VITL) selects Greenway’s PrimeSUITE EHR to leverage its REC; Colorado Regional Extension Center (CO-REC) does the same.
• Greenway also partners with DiagnosisONE to provide clinical decision support for its EHR deployments.
• NextGen releases v.5.6 SP1, offering several new enhancements such as clinical quality measures for Meaningful Use and 5010 healthcare transaction compliance.
• iMDsoft increases its global presence compliments of its MetaVision Suite, which went live at 45 sites, 11 countries, and in seven languages in 2010.
• OSF St. Joseph Medical Center (IL) renews its multi-year contract with GetWellNetwork and goes live with GetWellNetwork’s system integration for its Epic-based EMR.
• San Luis Valley Regional Medical Center (CO) signs a five-year technology outsourcing contract with CareTech Solutions.
• Holon Solutions will participate on an HIE panel at iHT2 Health Summit in Atlanta.
• CapsuleTech is hosting an enterprise device connectivity  webinar on January 19th.
• Nuesoft announces its Nuetopia service that combines its EHR, billing software, and revenue cycle management services.
• Bridgehead achieves a 40% year-over-year income increase for FY2010 thanks to its focus on the healthcare vertical.

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Dewey Howell MD, PhD is founder and CEO of Design Clinicals of Seattle, WA.

How’s business?

Business is good. We’re seeing more and more interest in med rec and what we’re doing, not only with medication reconciliation, but some of the stuff we’ve added to our platform around Core Measures and a number of modules that extend beyond that med rec fit into organizations’ Meaningful Use plans quite well. Like every vendor in the space, we’re definitely seeing an uptick in business because of all the Meaningful Use discussion.

I think most of the readers know what medication reconciliation means, but in case someone doesn’t, can you give a description?

Medication reconciliation is nothing new. It’s something that doctors, nurses, and pharmacists have been doing for decades. It’s just the process of gathering medications when a patient arrives at your organization, reviewing that list, and making sure it’s accurate. Then every time you write new orders or change a patient’s care, you review that list again and make sure that they aren’t pieces of that list that you need to re-address. Finally, when you send the patient back home, looking over their home medications before they arrived at the organization, making sure the patient knows exactly what you want them to do at home or how you want them to proceed with any instructions around the medications. Again, med school, nursing school, and pharmacy school 101.

When we talked three years ago, you said hospitals were just checking off Joint Commission’s medication reconciliation box but not really improving patient safety because of low compliance with paper-based processes. Is that still the case?

We are primarily still seeing folks doing this on paper. That’s because so many of the vendor systems still haven’t provided electronic solutions and work flow that is manageable in the context of the other systems.

I think the real problem is that we consider med rec a very broad piece that touches nurses, pharmacists, and doctors. In many hospital systems, those functions are very different applications. To really make it work, you need a process that touches all of those users. That’s hard to do in the silo design of a lot of those systems.

Do you think that doctors are adequately involved or it is it just being turfed off to nurses and pharmacists?

I think as a hospital moves to physician order entry, doctors are by necessity involved, because at that point when they’re writing their orders, it’s at those points that the medication reconciliation needs to happen. If the doctors are doing that electronically, it had better be included into their electronic workflow.

A lot of nurses and pharmacists are still carrying the brunt of reconciling. That’s because it has been perceived as an administrative task. Just document it on paper so we can have it on the medical record that we’ve touched these meds and looked at them, as opposed to having it as a real integral part of the clinician’s thought process at the time of ordering.

The rules change as of July 1, right?

Joint Commission surveyed med rec for a few years in 2006. Then in 2009, Joint Commission stopped scoring med rec because hospitals weren’t able to meet the strict language of the mandate. Hospital after hospital was getting cited on their survey, so Joint Commission took a couple years off. 

They just recently announced that coming July 1, they’ll be re-scoring it again. They’ve revised the goal. They put out that goal for public review several months ago. Now it’s been finalized and published for scoring on July 1.

Do you think the nature of medication reconciliation will change with interoperability and HIEs?

I think it will. Medication reconciliation has been put into Meaningful Use. It’s in that discretionary set or menu set for Phase 1, but it’s very clear that it’s going to continue to be an important part of the Meaningful Use standards in Phase 2 and 3.

You mentioned HIEs. I think in an HIE environment, it becomes really critical to have a tool that allows you to reconcile medications across multiple sources. HIEs are great for bringing a wide variety of data, including medications, together from hospital after hospital and a variety of clinics in a connected community. But to make that data usable still requires a human reconciliation process because there’s a limit to what can be reconciled electronically by computer logic.

Compared to either paper or functions that vendors would typically call medication reconciliation, what are the key functionality points of your application and why is it superior?

The first one starts out on intake. We’ve taken a great deal of care to make sure that the medication list that’s gathered by nursing, or if they use pharmacy or pharmacy techs on intake, that the list is as accurate as possible. One of the first challenges with med rec is getting as accurate a list as is possible. There’s a component that is never going to be solved by any solution because patients don’t know what they take.

Whenever possible, if the solution can help with things like common misspellings get translated automatically and ensuring that the doses and the routes and the frequencies are relevant to that med. The idea is that the path of least resistance is medication sentences and orders documented on the med history list that makes sense. You don’t end up with these really dirty lists that the doctors don’t know what to do with and that don’t make clinical sense.

The other two pieces that have become critical are allowing the doctor to review that list at the time of ordering — not as a separate process, but an integral part of the ordering process. Just by doing admission med orders, med rec has been satisfied, as opposed to doing your admission orders, then coming over to a piece of paper or another system or screen and doing med rec. It should be integrated right into the way the doctor orders. That’s how we’ve done since Day One. 

The other really superior piece is translating that intent to the doctor at the reconciliation steps into a very usable, patient-friendly, complete instruction sheet for the patient. It tells the patient in very clear language what to stop, what to continue, and what’s changed. It all gets translated. Even free text stuff that the doctor types gets translated. A lot of folks will say they translate in patient lay language, but there’s a lot of sort of techie challenges around doing that in a practical way. We’ve been doing it that way for four years, so it ends up being really quite complete.

We have support for something we call minimal use workflow. In the new mandate, they call it 24-hour areas or something along those lines. It allows you to designate certain areas of your hospital — whether that’s the ED or day surgery or endoscopy, these outpatient treatment center areas — where you don’t have to do the full-blown reconcile and address every single med, but rather in an abbreviated process that really makes a lot of clinical sense.

You got more live sites then when we talked last time. What are you learning from them?

We have good coverage now around the country. I think what we’re seeing is that, similar to what we saw early on but it’s just been repeated many times now, if you engage your doctors in a process of medication reconciliation that makes sense to them, the process goes a lot better if doctors, nurses, and pharmacists are all engaged, as opposed to saying “this is a nursing problem” or “this is a pharmacy problem”.

You tell the doctors, “We’re not taking something that was previously a clerical job and making them do it. What were doing is enhancing the normal work and thought process that you do anyway, while at the same time, satisfying the med rec mandate.” With that kind of explanation and understanding, I think docs engage.

CIOs are worried about CPOE because it’s hard to implement. What advice would you have for the CPOE designers?

Our application is a great way to start off in CPOE and to meet that CPOE portion of Meaningful Use, because 30% of patients have to have at least med order done electronically. Across all of our sites, the organizations that are using our product meet that level of performance just by doing med rec and admission transfer and discharge. It’s a very easy to meet that part of the mandate.

Really? They meet the new more stringent medication reconciliation criteria plus count as a a CPOE order each time you do it on a patient?

That’s exactly right.

That’s pretty cool.

Yeah, exactly. We have a few of our newer customers and some of our existing clients that are specifically using the use of our product as meeting those two parts of the mandate.

Go ahead, I didn’t mean to interrupt you.

Vendors have struggled with CPOE.  When they put together those systems, they were so focused on medications and medication ordering, and I think it’s a real chilly feel for a lot of CPOE system. There’s a couple of reasons. A lot of CPOE systems were historically started with experience that industry had from pharmacy ordering systems, and doctors aren’t pharmacists, as you know. Taking something from pharmaceuticals and what’s dispensable and what’s on the pharmacy shelf to an order that the doctor expects is a very difficult process.

I think the approach that many vendors have had is that CPOE systems basically spend six to nine months building that abstraction or taking the order from the pharmacy level to the physician level. You end of making a lot of decisions in a conference room with a small group of people. Maybe they’re not all clinically relevant decisions, so you end of doing a whole lot of reiteration and it can be a big mess, depending on the expertise on your team and how much resource you have to build those systems.

We did something very different. We started out with a product from First DataBank called Order View. This was brand new when we started the company. We built our application from scratch around it. It’s a product that was specifically designed for CPOE systems. Going from pharmacy-level data, that First DataBank had been very good at obviously, to physician-level orders. What’s brilliant about the product is you have the ability to present data to the doctors in the way they expect to see it, but at the same time, you can turn that into a pharmacy-fillable order without a lot of effort. It comes out of the box ready to do that.

With CPOE, most of the real patient benefit involves medications. You can’t make a patient better with diagnostic testing or lab tests along and you’re not going to harm a patient in most cases by doing those incorrectly. Without meds, there’s not much of a CPOE patient safety story.

Absolutely right. I think that’s why going with a product like ours — that is really so focused on medications and has spent four and half years getting medication ordering right — as your initial strategy into CPOE makes a lot of sense. It’s where the big bang for the buck is, for two reasons. One, as you mentioned, in patient safety. And two, for physician usability. 

With CPOE systems, it’s an order of magnitude easier to make entering a nursing order or a rad or or diet orders — making that entry process easy for doctors is an order magnitude simpler than making a pharmacy order easy and effective.

If you look down the road, where do you see the company and the medication reconciliation piece going?

I think organizations realize the importance of medication reconciliation. I think as we’ve grown and gotten more market share, people are relaxing that here’s a solution to med rec that works. They don’t have to change their corporate strategy. They don’t’ have to change their HIE or HIS strategy and still implement this third-party vendor. My hope is we’re going to see a lot more traction in helping with that medication ordering space.

We talked about the inpatient all in this interview so far, but we actually have a fair amount of use in outpatient areas as well. Beyond that market penetration for medication reconciliation, we have a couple of development partners that we’ve built this medication reconciliation out to full CPOE. It was a logical next step for us, because as we just talked, we got the medication ordering and that very central portion of CPOE done right and better than most vendors out there have been able to achieve. It made sense to layer in the additional clinical modules to have a complete system.

So you’re now able to operate as an integrated CPOE system?

That’s right. It’s a standalone CPOE system that stands outside of the HIS vendor, but it integrates with the HIE or HIS strategy, sharing data back and forth as needed for effective CPOE. It’s pretty tough to have a fully standalone island CPOE system because there are so many dependencies, but coming in the very first part of Quarter 1, we’re going have our CPOE system up and running.

What kind of customers would be prospects for it?

Since we just have a couple of development partners and are just building out the project, we haven’t done a market analysis. My guess is it’s going to be the small- to medium-sized hospitals, a couple hundred beds and less, that maybe have a system where their docs have tried to do some portions of the order entry and it hasn’t gone very well, so they’ve really struggled to get adoption and they’re not sure how they’re going to get the doctors to become Meaningful Users.

Most organizations are in the very low percentages of adoption. These small organizations, to have a CPOE system that actually promotes physician adoption while at the same time being easy to employ without requiring a big, extensive build and implementation process, is a pretty attractive thing.

Any final thoughts?

We didn’t talk much at the beginning about how the medication reconciliation mandate has changed. I think it is probably pretty important to note that the mandate is a bit different from the original one. It gives organizations a little bit more flexibility. The thing I like the most about the changes to the mandate is it’s less prescriptive. It says that we recognize that med rec isn’t the same everywhere — it’s not even the same within a given organization. This enables organizations to meet the mandate, following the sprit of the mandate as opposed to following the letter of the law without it accomplishing much. That’s what I like most about the changes to the mandate.

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From EHR Geek: “Re: Vitalize. Mr. HIStalk, why didn’t you post the Vitalize purchase of Validus on your real page? It’s only on the HIStalk Fan Page of Facebook.” I was torn on that one. I had just blasted out the SIS news and I couldn’t decide if this item was of broad enough interest to justify another e-mail (I don’t want to give readers alert fatigue), so I just posted it as a Facebook status item until the next scheduled post (this one). That’s another good reason to Friend/Like us there since I usually post news blasts there, too. Anyway: Vitalize Consulting Solutions acquires (warning: PDF) Minneapolis-based Validus Consulting, which has around 60 consultants providing strategic advisory and project leadership services. Vitalize, which offers strategy, EHR implementation, revenue cycle, project leadership, and application / technical resources, says it’s now the largest privately owned HIT consulting firm, with more than 450 consultants. I hadn’t realized that former Allina Excellian (Epic) VP Kim Pederson, who I interviewed awhile back, is a Validus principal. I also didn’t realize until Googling something else that industry pioneer Bill Childs, who just won CHIME’s Lifetime Achievement Award, is a Vitalize VP (there might be no HIStalk if Bill hadn’t broken the HIT journalism ground with Healthcare Informatics). I know and like the Vitalize folks and I’m amazed at the company’s growth under CEO Bruce Cerullo, a long-time friend of HIStalk. 

From Jerry MindMeld: “Re: joke of the day. Dr. Blumenthal was at Congress yesterday during the reading of the Constitution. He looks over at the stenographer and realizes they are typing every word spoken for the entire day, every speech and every vote. He leans over to the guy sitting next to him and says, ‘Jeez, I wish we had that in my industry — it would make practicing medicine a lot easier.’" I’m here all week – try the veal.

From The PACS Designer: “Re: Dimdim. Mr. H, since you now can’t use Dimdim collaboration software due to Salesforce.com’s privatizing it, why not go to Yugma, which is another collaboration application on the web?” I will give it a look. The biggest differentiator among the Webinar-type tools is how well they record and archive the session, especially the audio portion. I also liked ReadyTalk. I’m kicking tires because I really like the idea of providing some kind of education at a higher level of quality than you usually see (i.e., less of a commercial pitch).

From Leopold Stoch: “Re: Paul Levy. Stepping down as CEO of Beth Israel Deaconess.” I guess John Halamka’s boss is down to blogging as a job for now, but I’m sure he will have many opportunities.

New HIStalk contributor Jayne (or Dr. Jayne if you or she prefer) introduces herself below. What sold me on her: (a) she writes well and in a non-stuffy HIStalk way; (b) she’s funny; (c) she has a great education and medical experience; (d) she works in an informatics role, but still maintains a medical practice, so she knows a broad swath of the industry; and (e) she’s an HIStalk fan and gets what we do. E-mail her your greetings if you like. We thought a recurring “Ask Dr. Jayne” feature would be fun, so let’s have any questions you’ve always wanted to ask an informatics doc (what does she think of EMRs, how important is usability, how does she interact with the EMR in the exam room, etc.) Her brand new Facebook is looking a bit bare, so I’m sure she could use a friend or two there.

Listening: Young Fresh Fellows, a Seattle-based alt pop band that’s been around for 30 years. I played their 2009 album and immediately bought it for the gym iPod, which almost never happens. Their music is hard to categorize – sometimes its Pixies punkish, sometimes REM jangly, but it’s always fun (extra points for using “bereft” in a lyric and then rhyming with it).  

I’m intrigued by these poll results: 52% of readers plan to keep the same job and employer in 2011, but a full 42% are expecting to land a better job, either with the same employer (18%) or a different one (24%). Only 3% expect to move to a worse job, with about the same percentage saying they’ll retire or quit this year. New poll to your right: what are your plans for the HIMSS conference?

Thanks for your HISsies nominations. I’m e-mailing out survey ballots this weekend, so watch your inbox and please vote. Thanks, too, to readers who nominated Inga and me for several categories even though the instructions said not to.

HIMSS government relations VP Dave Roberts posts the organization’s priorities for the new Congress, the main ones being keep HIT bipartisan and keep the HITECH money flowing despite all the good reasons it shouldn’t. He also lists what he says are the priorities of HIMSS members, such as establishing a Meaningful Use grievance process and spending even more taxpayer dollars, this time on “health IT action zones.”  He asks for feedback.

Say hello to new HIStalk Platinum Sponsor Shareable Ink. The Nashville-based company’s concept should resonate with quite a few hospitals and practices: you shouldn’t have to disrupt clinician workflow to move to electronic health records. Shareable Ink’s enterprise-grade digital pen and paper technology lets clinicians keep documenting the way they like without turning themselves into patient-ignoring keyboard zombies, yet it translates their work into digital, discrete, and shareable EHR data as if they’d labored over a keyboard instead. Anybody can implement it quickly since there’s no software running on site (it’s zero-footprint Saas) and there’s no boondoggle IT project standing in the way of hospitals and practices anxious to move to EHRs and collect their HITECH checks. It integrates (with registration, EHR, CDR, etc), it pre-fills forms from inbound interface data, and it makes paper smart with form-based electronic rules and outbound alerts (e-mail, SMS, page). You don’t have to force behavior change on set-in-their-ways ED docs and anesthesiologists (not to mention that 90% of hospital daily progress notes are, of course, written by hand and that’s a tough battleship to turn). It must be cool since T-System, whose paper forms (T-Sheets) are an ED mainstay, chose Shareable Ink to power its DigitalShare electronic ED encounter documentation system. Shareable Ink also just released an analytics package that lets organizations mine all the handwritten data it converts, so paper documentation from anesthesia, ED, and progress notes can be electronically reviewed for quality and efficiency metrics without chart pulls. Thanks to Shareable Ink for supporting HIStalk.

I turned myself on a little writing about Shareable Ink, so I headed over to YouTube to see if there was a demo. Here’s one from a year ago, as co-founder and CMO Vernon Huang MD (sounds like a fascinating guy: Hopkins biomedical engineering degree and GWU MD, practicing anesthesiologist, worked for Apple, was a Navy flight surgeon) shows how his sloppy doctor handwriting (sorry, Doc) is turned into an electronic record without his doing anything.

The Walgreens drugstore chain, in my mind, leads the way with consumer-friendly mobile apps for their patients / customers (text alerts, patient-scanned barcodes for prescription refills, health risk assessments, kiosks, EMR, e-Prescribing, etc.). The company’s CMO moderated a digital health session at the CES Digital Health Summit. Too bad the rest of healthcare doesn’t have such clearly aligned incentives (invest in technology, sell more stuff as a result, make more money, everybody’s happy).

Drug maker Roche files suit against a software company it bankrolled and intended to acquire. Medical Automation Systems had agreed to be acquired by Roche for $40 million, but then got a better offer from a competitor. Roche sued, saying it has right of first refusal and shouldn’t be required to participate in a bidding war. The company’s RALS software is used in the Accu-Check and CoaguCheck point-of-care monitoring systems to send results to hospital clinical systems. Wish you’d thought of it, right?

The promotional video for the just-announced new version of the Microsoft Surface coffee table thingy shows people collaborating over radiology images and ultrasounds. It reacts to both touch and objects, where it “seamlessly merges the physical and digital worlds.” It works like a massive iPad on four legs, accepting all kinds of gestures and manipulation. I have to say it seems cool and a pretty good deal, with the new version priced at $7,600 compared to the original’s $12,000 price tag. Imagine an EMR built for a screen that size run by touch – docs would love it. It would also be amazing for patient teaching, but you’d have to bring the patient to the Surface instead of vice versa (unless someone invents a SOW – a Surface on Wheels).

Speaking of the Surface, I found this old picture of MEDHOST’s ED dashboard running on it. I found pretty much no information on MEDHOST’s site about it, so I don’t know if they still offer it or if anyone ever bought one. It looks good, though.

Eris Medical Technologies, created in a Youngstown, OH incubator, will provide its erisRX charge capture management software to Florida Hospital Orlando. Founder Jennifer Wexler used to work at FHO as well as Orlando Health, while co-founder Kelly Bucci comes from Deloitte. 

We had a slip-up in Friday’s post due to a bogus news alert (old Web pages sometimes suddenly pop up as news – I’ve been burned by that a couple of times). Mark Briggs is still CEO at HIE solution vendor VisionShare, which he joined in May – the link we ran was to an older (undated) press release from when he took an earlier job.

J.P. Morgan’s healthcare conference runs this week. Ben Rooks wrote about why you should care (or not) in his HIStalk column from a year ago.

e-MDs says CMS’s first HITECH check for a physician practice went to one of its clients just two days after CMS registration opened. Gastorf Family Clinic (OK) got $21,250 each for its two doctors. They told doctors they’d get big checks and that one’s ginormous.

Speaking of HITECH registration, CMS says 4,000 providers registered for EHR incentives in the first four days after its site went live on January 3.

Inga and I have decided that we should have vendor tee shirts made for HIMSS that read, “Want to be profitably acquired? Sponsor HIStalk.” The list of sponsors recently completing successful transactions (these would be listed on the back) includes Medicity, Ingenix, Picis, Sentillion, Eclipsys, eScription, Sunquest, and now SIS. There are plenty more, but those are some of the larger and more recent ones.

Philips buys Pittsburgh-based medSage, developers of an automated telephone-based system for home health patients to reorder supplies. Their executive bios are fun: “Bob is the ‘Old Guy’ on the medSage Team … has been in the healthcare industry for over 30 years (our abacus will not go any higher) … Bob is the ‘Really Big Guy’ on the medSage Team. (If you have met Bob in person, you know what we mean!) For that reason, Bob is to be Mr. October, November, AND December in the 2009 medSage Team promotional calendar.” Let’s hope they keep Bob happy since if they don’t, it sounds like he’s got a couple of potential discrimination suits to choose from.

A judge overturns a community college’s dismissal of four nursing students for posting cell phone pictures of themselves posing with a placenta on Facebook. The instructor of the students told them it was OK to take the picture as long as any identifying information was removed, even though the students told here they planned to post the pictures on Facebook. The student whose case set the precedent for the others is worried about her reputation preceding her for an eventual job. “I am concerned that my name is all over the Internet. All you have to do is Google ‘placenta.’” She’s right – above is my Google News search result, complete with her smiling placenta pose.

E-mail me.

Why Me? 
By Dr. Jayne

Let me just start by saying that I’ve idolized Mr. HIStalk and Inga for quite some time. So when Mr. H posted that he was interested in finding someone to help out, I was tres excited. I put together a few thoughts, crossed my fingers, and clicked “send” with visions of IngaTinis dancing in my head. A few spins of the planet later, here I am, excited to be part of the HIStalk family!

Why did I want to write for HIStalk? First, I wanted to be able to provide a physician perspective on hot topics in healthcare IT. Now that Meaningful Use is finally here, understanding the real impact the new rules are having on patient care is going to be important. Who better to talk about it than someone who is actually seeing and treating patients?

Don’t worry though, I’m a serious IT staffer (also a shoe aficionado, so the chance to work with Inga was a huge part of this, but we’ll save that for later) who lately spends more time talking the IT talk and walking the IT walk than personally caring for patients. But I still see enough patients to be able to regale you with strange-but-true stories about what happens on the other side of the exam room door.

Second, I enjoy expressing my creative side, love writing, and am fluent in a variety of poetic forms. Healthcare IT words are just about as hard to rhyme as medical words; although it might be possible to rhyme “ruptured appendix” with “clustered index” it would have to be a really special poem to make that work so you’ll all just have to keep reading and see what I come up with. (A special shout out will go to the first reader who pulls that one off.)

Third, IT systems and patients are more similar than most people would think. When they’re healthy they’re happy and you enjoy going to work every day, and when they’re “sick” they can drive you mad. I’ve spent the last several years of my career trying to help bridge the gap between “the IT people” and “the clinical people” and being able to do that on a larger scale seemed cool. We all want the same things – and if I can give the “computer guys” and the “doctors that just hate the system” some tips and tricks to better interact with each other, then I’ve helped make all of our lives a tiny bit better.

Finally, a tiny part of me wanted a guaranteed invite to HIStalkapalooza (OK, maybe it was a very big part). Although I suppose as a team member I’m likely excluded from the “Inga Loves My Shoes” and HIStalk Queen contests, I might try anyway, so dust off those shiny taffeta ball gowns and the ruffled tuxedo shirts, and I’ll see you there.

Say hello to Jayne.

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