From LaBido: “Re: Epic spinoffs. Spinoffs usually involve a better or new way of doing something. EHR vendors typically aren’t innovators of technology. They use someone else’s technology to develop an application. Given the complexity of developing a comprehensive system and the risk in introducing it into a maturing marketplace, it’s not likely that there will be a lot of new entries in the EHR world. There will be opportunities for new niche systems as long as the major vendors lack the functionality, but I would suggest that most niches have been filled (other than those that don’t have a lot of funding for systems, e.g., home health care and assisted living facilities.)”
From Capezio: “Re: Epic. I recently left Epic. The non-compete prohibits former employees from working with Epic products or competitors for a year. This includes consulting for or working directly with Epic clients as well as for/with clients who use or are implementing Epic’s competing products. Many former Epic employees return to grad school or seek careers entirely different than what Epic offered. After being run into the ground with long hours and hectic travel schedules, the last thing many of us want is more of the same. Epic makes it hard to stay in the game, and hard to want to stay in the game.” Unverified.
From NomsDePlume261: “Re: Super Bowl ED usage.” Interesting – visits dropped to nearly none while the game was on. I’m sure business was good before and after with accidents caused by drinking, spousal beat-downs, heart attacks, and hot wings-induced choking.
Listening: new rootsy soul from Amos Lee with guests that include Lucinda Williams and Willie Nelson.
Humor me, OK? Drop your e-mail address in the no-spam Subscribe to Updates box to your right so I can tell you about stuff. If you’re a early adopter trying out that little site called Facebook, do some Friending of Inga, Jayne, and me and maybe toss in a Like for HIStalk. Click the nausea-inducing green Rumor Report box to your right and securely and anonymously send me news and rumors. And here’s a thought I had on the sponsor ads to your left: they are fun and cool like Twitter because the enforced brevity of the small rectangle tells you everything important in a quick glance, saving you hours of trying to figure it out from their more verbose Web pages, not to mention that those companies follow HIStalk and therefore share something in common with you and me. Thank you for reading.
I sent the e-mail blast about David Blumenthal’s resignation while thinking the obvious question: who’s going to replace him? I bet the snowed-in HIMSS people will be burning the midnight oil to strategize. TPD had interesting conjecture: Blumenthal’s brother Richard is the new Democratic senator from Connecticut (sworn in just four weeks ago) and maybe having a brother running ONC was going to be a political problem for him. Not to mention that the ONC job is a tough one that doesn’t pay a whole lot (despite handing out billions to everybody else) and draws a constant stream of venomous and mostly partisan criticism from politicians.
On the Sponsor Jobs Page: Healthcare Informatics Specialist, Epic Prelude and Resolute HB Consultants, Project Manager – Michigan. On Healthcare IT Jobs: Integration and Support Specialist, Health IT Manager, Application Services Programmer / Analyst, Epic ADT Consultants / Analysts.
Paul Merrywell is named VP/CIO of Mountain States Health Alliance (TN). He was formerly VP of IS of Mercy Health System.
The HIStalkapalooza invitations haven’t been e-mailed yet, but they will be soon. We had a lot of sign-ups and will invite as many people as we can handle given the venue’s capacity. I always like to scan the job titles, which run something like this: 88 VPs, 72 presidents/CEOs, 26 CMIOs/CMOs, and 19 CIOs.
Speaking of the party, thanks to Medicomp Systems and COO Dave Lareau for not only paying for it, but also sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Chantilly, VA company offers dynamic (non-template based) EMR tools that require minimal clinician training, powered by its MEDCIN clinical data engine, developed by founder Peter S. Goltra going back to the company’s founding in 1978. The company works with academic doctors from big-name hospitals and the DoD to continuously enhance MEDCIN and to develop new EMR offerings. Their product is used by 100,000 clinicians, requires less than four hours of training, handles codes for reimbursement and Meaningful Use, and provides real-time information and clinical decision support. CLINITALK converts voice to data for physician documentation and coding without typing or clicking, using the MEDCIN engine to present and collect patient care information. A new product will be announced sometime before HIMSS. Thanks to Medicomp Systems for sponsoring HIStalkapalooza, HIStalk, and HIStalk Practice. If you come to the event, say hi to Dave and thank him for putting together such a great evening for HIStalk and HIStalk Practice readers.
I said that this week’s statement from eHealth Initiative was predictable in urging House Republicans to not touch HITECH money. eHI sent me a clarification: their concern is that the legislation only goes after Meaningful Use incentive payments since that money isn’t yet committed. Funds for RECs, HIEs, job training, etc. are not being targeted, meaning that the government would have paid for infrastructure without having the carrot needed to get providers to use it for quality improvement.
A reader suggested looking into PCAST documents for evidence that Microsoft Chief Research and Strategy Officer Craig Mundie and other Microsoft-friendly participants may have steered the group to recommendations that favor the company (Amalga, HealthVault). I guess it’s possible, but hard to believe even for a cynic like me. I e-mailed PCAST asking for meeting minutes and got a reply from PCAST Executive Director Deborah Stine, PhD, who sent a link to the webcast page. Those probably won’t help. I don’t have much time or knowledge of government intricacies, so if you do and want to snoop around, let me know.
It always bugs me that the biggest, least-needy hospitals get throngs of deep-pocket donors. The latest example: Stanford Hospital, spending $2 billion for a new Taj Mahospital, gets $150 million from Apple, eBay, HP, Intuit, Intel, and Oracle. Donations always come with strings attached, at least in my hospital experience, so they’ll probably have to buy iPhones to keep Apple happy since Intel wouldn’t like an all-Mac shop. I still argue that since hospitals can’t distribute their big profits to shareholders since they supposedly have neither, their executives build monuments to themselves like Egyptian boy kings.
Mediware’s Q2 numbers: revenue up 22%, EPS $0.21 vs. $0.10 but $0.06 of that was due to a one-time tax benefit.
Healthcare billionaire Patrick Soon-Shiong, MD buys Boston-based Vitality, Inc., which developed the wirelessly enabled GlowCap medication reminder system for drugstore pill vials. I went to the mHealth Summit presentation of Vitality CEO David Rose this past November and was impressed enough to mention it on HIStalk.
Sad: a nursing home is banned by emergency order from accepting diabetic patients after killing a patient with a 100-fold overdose of insulin. Employees admitted that they didn’t have a clue how to manage the patient’s insulin pump, so a one-time IV dose of regular insulin 10 units was ordered. The nurse injected the entire 10 ml vial IV. Employees were even confused when reporting the error to the patient’s doctor, explaining that they had given 100 units of insulin instead of 1,000. You might be surprised that a nurse would not find a 10 ml insulin dose unreasonable, but not if you knew the caliber of nurses LTC facilities get given their low pay and bad working conditions.
HERtalk by Inga
KLAS takes a look at Meditech consulting firms and finds the highest scores come from maxIT Healthcare customers. ACS ranks a close second, followed by Navin, Haffty & Associates, Dell, and CSC. KLAS also notes that Meditech customers are twice as likely to hire Meditech-focused consulting firms than those that advise on multiple vendor brands.
Also from KLAS: the adoption rate for surgery management solutions in hospitals is almost 90%. Hospitals are expanding their use of these systems beyond basic charting and scheduling and don’t necessarily feel pressed to implement a surgery system from their core EMR vendor. Unibased earned the highest customer ratings, followed by Epic and Meditech.
Ness County Hospital (KS), Tyler-Holmes Memorial Hospital (MS), and Beacham Memorial Hospital (MS) contract for ChartAccess EHR from Prognosis Health Information Systems. Prognosis says its revenues have grown 200% over the last year.
SCIOinspire acquires National Audit, a provider of claims auditing services.
Community Health Network of Central Florida and Parrish Medical Center implement MDI’s Viewpoint Analytics for data warehousing and healthcare analytics.
Parkview Health (IN) will install Zanett’s Clinical Online Delivery System software for order set management.
Chilmark Research investigates the HIE market in a new report, which includes analysis and rankings of 21 HIE vendors. Lead author and HIStalk friend John Moore forecasts more acquisitions in the HIE space over the next couple of years.
Nash Health Care Systems (NC) partners with TeleHealth Services for TeleHealth’s interaction patient education solution.
Nearly 60% of healthcare executives have HIE plans in the works and another 20% are in the pre-planning stage. Other findings from the same Beacon Partners survey: 1) a mere 5% of healthcare organizations say they have not applied for any federal or local grants; 2) over 40% of healthcare organizations plan to enhance their physician and patient portals; and 3) quality reporting is the top concern in hospitals’ efforts to achieve Meaningful Use.
The University of Iowa Hospitals and Clinics fires three employees after investigating the improper access of electronic medical records of 13 UI football players. Two additional employees will receive five-day unpaid suspensions.
AstraZeneca Pharmaceuticals and WellPoint subsidiary HealthCore are collaborating to determine the most effective and economical treatments for chronic diseases. Findings will be based on de-identified patient data collected from EHRs, WellPoint and BCBS insurance claims, and patient surveys.
On HIStalk Practice this week: physician-specific offerings at HIMSS. A low-cost concierge practice that accepts insurance. NCQA issues new PCMH standards that reinforce Meaningful Use incentives. Doctors want to share clinical data electronically with patients. And while you are visiting HIStalk Practice, be like all the cool kids and sign up for e-mail updates.
Starting salaries for female physicians average almost $17,000 less than those for men and the gap cannot be explained by specialty choice, practice setting, work hours, or other characteristics. One theory: women physicians seek greater flexibility and family-friendly benefits at the expense of a lower starting salary. The authors of this Health Affairs study do not rule out other potential explanations, including gender discrimination and that women are not as skilled as men at negotiating salaries.
Sponsor Updates by DigitalBeanCounter
- Billian’s HEALTHDATA launches a new version of its Portal healthcare database that includes over 3,000 data points across more than 40,000 healthcare facilities.
- Design Clinicals releases version 5.0 of MedsTracker, which includes enhanced clinical decision support and meets nearly all Stage 1 criteria for Meaningful Use.
- Microsoft announces new encrypted e-mail functionality that will allow users of the Quest Diagnostic Care360 EHR to transmit clinical information directly to patients. An encrypted copy of a patient’s clinical data is also automatically saved to patients’ HealthVault account.
- University of Washington Medicine chooses Hayes Management Consulting to provide strategic guidance to the organization.
- Eye Faculty Practice (NY) selects the SRS EHR for its 13-provider practice.
- Orion Health partners with Health Language, Inc. to imbed HLI’s Language Engine into the Orion Health HIE. The combined offering will facilitate data exchange by mapping data from disparate systems to standardized terminologies.
- The West Virginia HIT REC names Sage Healthcare a five-star vendor in its EHR Vendor Recognition Program.
- AT&T & Acuo Technologies announce a strategic alliance to develop vendor-neutral, cloud-based medical imaging storage solutions.
- NextGen announces that Palm Beach Orthopaedic Institute (PBOI) will leverage its revenue cycle management services.
- Charlotte Hungerford Hospital (CHH) selects MobileMD for its HIE and EHR.
- iSirona will participate in the Interoperability Showcase at HIMSS with its software-based medical device integration solution.
- Cooper Green Mercy Hospital (AL) selects Stockell Healthcare’s InsightCS patient access and revenue cycle management software solution
Dr. Gregg Goes to HIMSS
By Gregg Alexander
Reporting – 0, Blogging – 1
I have been given the unique opportunity of being a regular contributor to one of the components of THE industry standard “Healthcare IT News and Opinion” conglomerate, collectively known far and wide in HIT-dom as HIStalk. It is not a responsibility I take lightly.
On HIStalk Practice, the provider-focused offshoot of Big Daddy HIStalk, I have espoused both opinion and news. But to be honest, the news side of my offerings is miniscule in relation to the opinion side. I could never match the skill and wit which Mr. H and Inga bring to reporting healthcare IT news. “Damn it, I’m a doctor, Jim,” not a reporter.
That said, I am preparing to head off to HIMSS with a press pass courtesy of the inimitable Mr. H. Again, this is a responsibility I don’t take lightly. Thus listed with the HIMSS folks as a reporter (he said, using the term ever so lightly), it has been fascinating to see all of the reach-out from industry folks, mostly marketers, trying to get the word out about their product or about their “big announcement” at HIMSS or about their CEO’s scheduled talks, etc. Most have very much the same boilerplate look and feel as the majority of EHR products these days … and are about as inspiring as phlegm.
However, just as with EHRs, a few do stand out as different, as having something special to offer or a unique approach.(Extormity is not included in this assessment.)
One e-mail that particularly caught my eye recently was from a vendor who wrote, “I know you’ve blogged a lot about new EHR demos you’ve seen recently — all the innovations and disappointments, too — so I’ll try to spare you the hype….” Obviously this is someone who has taken the time to do some homework and/or is a regular HIStalk Practice reader. That is one request to which I wrote back immediately. (I hate hype and greatly appreciated the hype-sparing. Plus, I appreciate those who read the HIStalk sites.)
Another was from a “young company with a BIG story” who is taking on IT industry giants – and winning! As a trench grunt, I appreciate the little guy’s approach. They are another I answered quickly and have found very intriguing as I have begun to research their BIG story.
I’ll be providing more on stories that catch my eye or stimulate my curiosity, but please remember I’m from the opinion side; I’m a blogger, and perhaps most importantly, I look with the eyes of an end user. As an end user, I’m looking for that which gets my juices pumping and that which I think will do the same for my fellow providers. I look at the technology, sure, but perhaps just as important to me is the company behind the technology – the people, their philosophy, and how they interact with me and my fellow provider peeps.
I don’t even pretend to be dispassionate about this stuff. If I appear to show favoritism, well, maybe I do some. But, it is never because of kickbacks or payoffs. (Though I sometimes wish it were!) It is because I’ve met people and technologies who inspire my passion and I try to show that in what I write.
So, if while trying to report from HIMSS, my blogger/opinionator nature shows through, please understand. My roots are what they are.
From the trenches…
“Being a reporter is as much a diagnosis as a job description.” – Anna Quindlen
EPtalk by Dr. Jayne
Dear Dr. Jayne,
We’re a five-physician family practice and my doctors are balking at documenting in the room with the patient. My docs find it distracting and say they have to apologize for using the computer. They also spend too much time at the end of the day trying to finish their notes, or don’t finish them at all, which makes them cranky and causes issues with the revenue cycle.
Kept Visits Seeking Charges
There is an art to using the computer while seeing the patient. The provider’s ‘style’ of practice pre-EHR needs to be considered as they figure out how they are going to document. And the implementation teams and tech people need to be OK with it if not all providers document in the same way.
I tend to think about it this way: if users previously wrote in the paper chart while in the room, I encourage them to keep this workflow with the computer. They need to know their software well, though. If they are hunting through templates or pecking at the keyboard, it’s not going to flow.
If users didn’t write in the chart before, but instead went out into the hall to dictate, it’s easy to replicate that workflow as well, with workstations in a niche or cubby (provided there’s adequate privacy.) They still need hardware with them in the exam room, though, so they can reference the chart.
Seeing the patient with no computer is not OK. Providers who think they can remember everything about the patient without a chart are kidding themselves.
One exception is a situation where the provider talks to the patient first, then the patient changes clothes and the provider returns to do the exam, then the provider talks to the patient again after he/she dresses. It’s OK for the provider to not have access to the EHR during the exam as long as they have it during the rest of the visit. I provide this example for the non-clinical IT people because I said this once, and had a team member say they had a doctor with “dangerous” habits and this is what it turned out to be.
I do encourage everyone to do as much of their visit in the room with the patient as possible. At a minimum, reviewing the patient’s history and entering any prescriptions and patient assessment / plan information while they are face-to-face with the patient. It’s not just a matter of efficiency – it also ensures that information is documented so that the patient can leave the office with a printed visit summary for those practices that are working to demonstrate Meaningful Use.
Regardless of the approach, providers need coaching on how to interact with the patient and still maintain eye contact and rapport. During implementation, consider using mock patients (a trainer or a staff member can play the role) and practice how they’re going to sit, how they interact with the computer and the patient, etc.
Finally, a word on typing skills. If your EHR requires providers to free-text, or if your providers plan on using a lot of it because they hate clicking, for everyone’s sanity, please go to Amazon.com and purchase a copy of Mavis Beacon Teaches Typing. The Deluxe edition is $17.95 and eligible for free super-saver shipping, for goodness sake. There are few things more painful than watching someone with a post-graduate degree two-finger type. It’s not confidence-inspiring. And for those providers who say they can’t learn, tell them that if they learned the Krebs Cycle they can learn to type.
Dear Dr. Jayne,
We just signed with a vendor, and my docs are trying to figure out what kind of hardware to select. As pediatricians, is it better to go wireless? Desktops seem cheaper.
Caring for Kiddos
When I work with offices that are converting from paper to EHR, I spend a lot of time talking the users through the different hardware options and letting them test drive different configurations whenever possible. Keeping technology from interfering isn’t difficult, but does take some thought.
Practices with “traditional” exam rooms are the most challenging – those where even in the paper world, if the physician tried to use the writing surface, they’d be facing away from the patient. Most of these users held the paper charts in their laps. This becomes hard to do if you’re trying to juggle a laptop or tablet, or … ahem, a paper chart and a computer during conversion.
Practices sometimes cite budget as a reason for not reconfiguring exam rooms, although modifications are probably cheaper than a dropped laptop. Modifying the space is also cheaper than neck pain, carpal tunnel, or other consequences of poor exam room design. I encourage people to think outside the box. Pull-down wall units or pull-out trays in cabinetry work great when tablets or laptops are in use.
When I work with new start-up practices, I try to be involved during the design of the office space so that these issues can be addressed early in the process. Unfortunately, a lot of architects are still cranking out the same tired old layouts and have no idea about wall mounted monitors or pop-up keyboard trays on swing arms.
When practices don’t choose to go wireless, I advocate the smallest hardware possible, mounted under a desk or on a wall so it doesn’t interfere with housekeeping or wind up being interfered with by pediatric patients or children accompanying patients. For monitors, go with the largest size that’s practical and affordable. Patients like looking at lab values or imaging studies and it helps reinforce the idea that they are part of their care.
Make sure your docs understand that whatever they decide, they’ll be using it for several years. This helps them focus on the decision if they are glassy-eyed by this part of the process. It also sets the stage for when you have to come back to them in two or three years and ask for budget for a hardware update.
One more thing: make sure that if they test drive hardware that they do it using EHR software they have selected. Solitaire and word processing look great on everything, but when they figure out the wide-aspect laptop they chose makes their EHR look horrid, you’re going to be the one they call.
Have a question about medical informatics, electronic medical records, or what reflector thingies were actually used for? E-mail Dr. Jayne.