Jeffrey Kao is general manager of NCR Healthcare.

Tell me about yourself and about NCR Healthcare.

I’ve been in the healthcare IT world for quite a while. My career started in 1989. I was an executive inside with GE, went to IDX, and then transferred back to GE with the GE acquisition of IDX. My last assignment was with Hill-Rom, also in the healthcare information and nurse call communication.

NCR is best known as National Cash Register, but in the past 25-30 years, we’ve been best known as a self-service company. We want to empower our customers and patients and everybody associated with helping service the industry, whether it be in ATM, travel, or gaming. 

With all the transactions and all the need inside of healthcare, we’re becoming a bigger and bigger participant inside of healthcare. We’re eager to participate in the category and really empower the patients associated with servicing themselves in a very complex network that’s in need of revamping and modernization.

Most high-volume businesses like airlines, banks, and big box stores have an impressive array of customer-facing self-service technologies. How do hospitals and medical practices stack up and where do you think they’re going to go with it?

We are leading the technology frontier in many categories, but falling behind in others. Healthcare informatics is one of the particular cases. If you think about a high-volume transaction basis in any industry, I can’t think of any other where you can’t schedule an appointment online with physicians to speak of. You can do that in terms of servicing your car at Jiffy Lube today.

We’re still an industry that’s very antiquated and backward in terms of how we communicate with our customer or patients. Very little secure messaging occurs over the network. I can’t think of any other industry in which e-mail, SMS, and text messaging hasn’t transformed in terms of our transactions dealing with anybody. We are an industry dominated in terms of forms, informatics, and payers and all kinds of bureaucracies in which we are still dealing primarily with paper, imaging systems, and document management systems. 

By the nearest estimate — without even prescription drugs and so forth – with provider and hospital dealings every single day, there’s two billion transactions happening in a given year, but very few of them are automated and happen on a consistent basis in which we empower the consumer where the patients actually having to deal with the category of self-service. It’s all still very intensive. That’s why I think we’re prime in terms of automating the space with our expertise in other industries that we can bring some of these practices into healthcare.

You worked at IDX and GE. Do you think traditional vendors are focused on customer self-service or is it going to take a company like NCR to add that on?

It requires a complement of companies working together. In IDX, we were obviously big in terms of the provider space, automated provider workflows. But if you think about it, we really started with the healthcare informatics first. We started with the big customers first. We really didn’t take a perspective associated with what the consumer actually needs.

For example, I’ve relocated to Duluth, Georgia. Like in any relocation, our employees were looking for primary care providers, looking to embed ourselves, ingrain ourselves, and get the kids registered for schools. It was hard finding a primary care provider. It was hard to navigate through the system, We waited in line for six hours to basically get shot records updated for our kids. I think those are the kinds of things that have a predominant role for self-service.

It’s amazing. We moved our headquarters from Dayton, Ohio to Duluth, Georgia. We brought over about a thousand covered lives associated with our entity. Over and over again, the experience associated with providers is they offer little or no tools in terms of registering ourselves, in terms of understanding who our payers are, in terms of being able to register for appointments.

We provide a preventive care benefit to all of our employees, meaning physicals and so forth, are 100% paid for by employees. Yet overall, if you look at our employee experience, not a single provider has ever contacted us to go in and get a physical. With all the electronic medical record adoption, with all of the investments in healthcare IT, something as simple as contacting one of our employees, one of the kids, or one of our spouses to come in for an annual physical doesn’t occur on a regular basis. 

This is a primary role for us in, terms of providing self-service. At eight o’clock at night when I’m clearing my e-mail messages, a reminder that says, “Hey, you’re 40 years old, you really need to come in for a check-up. By the way, click on this link. Go in there and register yourself, provide the necessary demographic information, update your present patient history, and come on in, because I think the care of you and your family is important.”

I think something as simple as that doesn’t exist in our industry or any of the patient populations today. This is what we really need to transform, especially with the advent of healthcare reform and changes. Empowering the consumer to handle the most mundane transactions that we have to do every single day. That’s why we’re so excited about this category.

In most industries, there would be two reasons to use customer-facing technology. One would be for general efficiency, the other would be to give customers what they want. What do you see that healthcare customers want to be able to use that they typically can’t?

I think there are always three things. One is that you’ve got to deliver a service that your customers or your patients want. We all carry computers, we all carry tablets, we all carry smart phones and mobile devices. We want to interact for all the services that we do. Today it’s really naïve to think that any service industry would neglect self-service, whether it be online banking, checking in at an airport, and so forth. I think for the most part, everybody is going to demand technology.

If you think about retail health, take a look at Walgreens. Every Walgreens store offers prescriptions, but they’re going to get into the primary care space and taking care of providers. They’re going to offer online scheduling, they’re going to offer electronic forms, they’re going to offer online check-in. The employee clinics are doing it today at Cisco and so forth. I think consumers are going to drive that demand, first and foremost.

I think the second thing is, with 34 million people coming into the healthcare system, unless we continue with the practice that we have today, we’re going to drive up a huge amount of administrative costs if we don’t adapt a different practice associated with enabling the consumer to self-service themselves to cut the administrative burden. 

Thirdly, I think it’s the central part of the Obama administration in terms of cutting medical errors. What better way to prevent all of the redundant entering and keying in and scanning and documentation and printing and so forth, other than making sure that the person in charge of his own personal information enters it correctly into the system, is adequately documented, adequately categorized, adequately feeding into all the ancillary systems? I think this is where self-service has a primary role in terms of cutting administrative costs, enabling the consumers, and also making sure that it’s more accurate and more up to date, and giving the power back to the patient and providers in terms of time to care for each other.

You mentioned Walgreens. They have a financial interest in interacting in more creative ways with their customers than the average hospital or physician. Do you think that the lack of incentives is the reason that physicians and hospitals have not looked more at engagement-type technologies like Walgreens has?

I think that’s a great question. Engagement technologies …  any time you talk about physicians and hospitals, it’s a little bit different.

I think for the most part that physicians haven’t engaged because there hasn’t been a solution out there that services the way they need to purchase and support the technology. There are 850,000 physicians in the United States. That’s a big number. But primarily, these physicians are still in relatively small, aggregated groups. The last number I’ve seen, they’re still in five doc or less groups. For them to buy their technology the same as a hospital is very challenging. They don’t have a CIO, they don’t have IT space. For the most part, they have found their way onto the Web through some kind of hosting service, but to be able to manage technology the way the big IDNs do is very challenging.

This is where companies like NCR and others need to find a way to support them in their mission for self-service that doesn’t require them to buy millions of dollars of hardware and capital, but rather understands the way they want to practice medicine, the way they want to service their customers, and offer it in a holistic hosted way that doesn’t require them to support all this technology, but supports it for them. In fact, we need to be just more than a technology provider. We need to be a total solution provider.

I think that’s what’s going to enable a 20-doc group to offer a service to their patient population that allows them to self-service, that allows them to smart schedule, that when somebody logs in their system, they’re registering for their five-year old kid or a seven-year-old kid that knows that the patient’s going to prefer a time slot between two-thirty to five o’clock because that’s when they’re out of school. For a person that’s a working professional, they prefer to go in the morning or late at night so they can go before work or after work. For a retired person that has a little bit more schedule flexibility, maybe between the hours of ten and two. For the middle summer when the flu season’s not impacting the patient volume, to draw somebody in for a physical, or two weeks before school starts, to linearize that volume because everybody’s trying to get their physicals to participate in school sports or get their shot records updated so they can participate.

I think the systems are there. The logic is there. Those patterns exist inside the healthcare system, but we don’t provide the providers assistance to systematically manage the way their patients want to be treated. We know there are bottlenecks inside the healthcare system. The week before school starts, the pediatric offices are full because everybody’s trying to get their shot records and physicals done. There’s a way of linearizing that volume. In middle of summer, nobody has the flu — it’s the perfect time to run people through physicals and preventive care. But right now, it’s a lousy time. We’re in the height of the flu season. There are patterns associated with what we can do to help the physician practice associated with participating in self-service that will benefit the patient as well as enable provider their business practices.

When you talk to a hospital about self-service, they probably most often picture the kiosk, which I know you offer. If you look down the road and where kiosks are and where they might ultimately move to, where do you see that developing?

In terms of the hospital segment, the kiosk is an equally important participant, but that’s not the only technology. It has to be a hybrid of three technologies — the portal, the kiosk, and the mobile environment. Here’s why.
Think about our complex setting. I have a friend with breast cancer. If you think about what needs to go through the transaction, many of the forms and the preparation and so forth really need to happen in the comforts of our own homes, associated with basically entering the form, maybe the prep associated with the visit, preparation in terms of somebody to take you there and take you home from the hospital in an ambulatory visit. If you think about it, the visit really happens in terms of the preparation in terms of self-service, making sure of the insurance and demographics and so forth, because it’s a traumatic time already.

Once you update all the things that you can do online, what needs to happen associated with the kiosk is you need to know what happened on the Web so that the same experience continues when you go on the site. When you think about an oncology visit for a typical patient, the first visit may be checking in, just making sure that the hospital or the IDN knows that you are there, followed by a management of your visit for the whole day. It may be a visit to the lab to make sure they draw blood and do a white blood count. After that, you may have to wait for the results.

Depending on the result, then your workflow gets changed. It may be going to imaging, or it may be going to chemotherapy. After that, observation, and finally released to make sure that you are properly cared for and arrive home safely with somebody driving you home.

If you think about that experience as a holistic portal, the in-presence visit management experience requires not just one technology worth thinking about in terms of kiosks, but really managing expectation on the portal, managing forms and so forth so that you can streamline your visit, using the kiosk to basically take you from place to place making sure that your visit happens in a consistent, coherent way and you don’t bypass any of the procedures because the handoffs are very complex in healthcare. And then, finally the discharge and the scheduling of the next visit. 

Along the way, smart alerts can remind you where you need to be and what you need to do, because most of us walk around with a cell phone. I think that’s what our customer service, our self-service experience, inside the hospitals and physician offices, need to be. Many procedures are now outpatient, but the visits in a complex IDN setting are many-modal, many departments, highly complex. All these systems need to be tied together in terms of giving you a holistic view and holistic experience.

What you get in one setting, in one department, you need to carry forward to the next one. It makes no sense for you to do four stops and update your patient records, your demographics, your insurance, and your insurance cards, and everything else four times. That’s the waste inside of our systems and leads to a less than satisfactory and costly experience in terms of what the IDN or hospital or physician actually knows what’s going on with you.

When you look at the Meaningful Use emphasis on use of technology by providers, do you think that will create opportunities to push technology out to patients?

I definitely think so. If you can think about Meaningful Use, a major portion of it is updating the patient associated with the right information. I think EMRs and the traditional hospital information systems offer the foundation in making sure that all the information is electronically stored and compiled in a meaningful way.

But what Meaningful Use sometimes overlooks is that all the information is stored on a server somewhere. How do you intend to interact with your patients to provide the information meaningful to your patients? It does you no good to have the demographic information as well as the results on the computer. Moreover, you have to advise the patients. I think all the Meaningful Use criteria I have seen require a portal or some kind of informatics that gets back to the patient.

I think this is where we have an important role to play. Centered on our self-service strategy at NCR, it is really not how the information is stored or what information or technology the hospital or the physician has, but how do we enable the interaction between the information to the patient so we can empower the patient to have the right information? Allow them to enter the information. Have them manage their own visit. Have them manage their own care in a meaningful way with the technology that’s already embedded in the system.

I think that’s a little bit of a twist in terms of what we’re doing, but we intend to be a very strong participant in making all this electronic medical record and all this electronic data exchange meaningful to the patient.

Any final thoughts?

The moment is ripe in terms of a change in the way that medicine is practiced. I know many people talked about it in the past, but I consider self-service this way. It’s like making soup. We have 34 million people coming into the system, probably driving on the order half a billion additional transactions into the system, with probably declining reimbursement rates. The pressure associated with it is we’ve got to get better, more accurate, faster, and cheaper with how we care for this volume.

If you look at the industry over and over again, whatever segment we’ve looked into, people have gravitated to a self-service model to enable the consumer or the patient to do more, to have more accurate information. Over and over again, what industries have done is gone to the Web, gone to kiosks, and gone to mobile devices.

I think the moment is right for us, over the course of the next three years, to experience something that’s revolutionary in US healthcare associated with Meaningful Use, with adoption of self-service technology, whether it be portal, mobile, or in-presence with a kiosk. I don’t think there’s going to be one winner inside of these three technologies, but it’s going to be a combination of these technologies all working in a coherent way, reaching all the technology on one single platform that allows a unique patient experience. I think this is why it’s so exciting being inside self-service, inside healthcare IT right now. I think the moment is right for that tip.

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Janet Dillione is executive vice president and general manager of the healthcare division of Nuance. Jon Lindekugel is president of 3M Health Information Systems.

Nuance and 3M Health Information Systems announced this morning a broad, strategic partnership to deliver ICD-10-ready clinical documentation and coding solutions, starting with Computer-Assisted Physician Documentation, which combines Nuance’s speech recognition technology with 3M’s Clinical Documentation Improvement content.

CAPD allows physicians to dictate encounters in their own words while prompting them for any additional information needed for proper ICD-9 and ICD-10 coding, enabling clinical documentation improvement a the point of dictation. It was designed to accelerate the implementation of ICD-10.

I interviewed Janet Dillione and Jon Lindekugel Tuesday afternoon before the announcement.

Tell me what the announcement means in simple terms.

Janet: Nuance and 3M have decided to partner to go after very deep innovations around clinical documentation, specifically targeted at the physician. Both companies saw the same thing happening with the coming of ICD-10. We had similar ideas of how to blend the strengths of both companies together. We viewed each other’s strengths as very complimentary and several months ago, initiated conversations.

We think with our Computer-Assisted Physician Documentation, we are able to bring an incredible piece of innovation and a really time-saving, ground-breaking change to physicians and the way they will document with ICD-10.

Jon: The partnership combines 3M’s core strengths in coding and Clinical Documentation Improvement with Nuance’s advanced speech recognition and Clinical Language Understanding technology. With the combination, we think we’ll be able to make a step change in helping physicians capture accurate documentation, especially with the coming ICD-10 transition, and do so in a way that will leave the physician more time for patient care. And in the process, help facilities achieve full and appropriate reimbursement, accurate quality reporting, and ultimately, successfully make the transition to ICD-10.

In a nutshell, we’re taking 3M’s industry-leading Clinical Documentation Improvement approach, which a lot of hospitals rely on today in their HIM and documentation improvement departments, and applying all the technology that Nuance brings and its industry-leading technology to deliver that content to the point of care, to the physician.

Describe how Computer-Assisted Physician Documentation works and how it looks to the physician as they’re dictating.

Janet: If you’re a physician in your classic workflow, you can be using Dragon. We have several hundred thousand physicians using Dragon. Physicians like the dictation technical workflow. You’ll be dictating through Dragon and will be able to take both unstructured data from the narrative, apply Clinical Language Understanding to it, as well as bring in any data that may have come in through a template that’s up in that EHR. We will grab that data and pass it into the 3M CDIS clinical knowledge environment, where we will have an environment with Clinical Language Understanding.

Essentially, we will be able to send back out of that engine to the physician, “Did you mean CHF unspecified, or did you mean an acute MI? Did you mean this, or did you intend to say something else?” Really trying to replace what happens today, with manual follow-up, where the next day, hours later, or even post-discharge there’s a lot of manual intervention going on with these charts and people poring through the narrative as well as what’s coming through the templates to try to get accurate documentation, both for the patient quality and the reporting that’s required as well as reimbursement. They’ll be able to automate that entire work flow and do it at the moment that physician is there inside that work flow.

Jon: We believe we’ll be able to drive physician-sensitive prompts, a limited set of prompts, directly to the physician to improve the accuracy of documentation right at the point that documentation is occurring.

Is your sense that there will be an overall time savings for the physician compared to dictation and then follow-up questions?

Jon: Yes.

Janet: Absolutely. There should be time savings for the physician, not to mention the efficiency and savings for the overall delivery system. We should be able to reduce this manual back-end intervention that’s happening now.

Who’s the ideal prospect?

Janet: Any delivery system that needs to deliver patient care with physicians as ICD-10 is being implemented. I guess that means the US delivery system. [laughs]

Jon: Every hospital in the United States healthcare system will significantly benefit from CAPD, be it their physician community through CMIOs who are interested in automated tools to reduce administrative burden on physicians to the financial community, CFOs concerned about receiving accurate and full reimbursement, reducing compliance risk, and getting cost out of the system. From an IT perspective, CIOs who need to ensure accuracy and completeness of the information flowing through the EHR.

ICD-10 has caused people to seek alternatives to manual physician lookup of codes, especially since there will be so many more of them. How do you think this approach will be accepted by the market compared to lookups or other on-screen prompting?

Janet: I think you’re exactly right. That’s what was interesting as we began to talk to each other. The industry to date had been predominantly focused on the back side, trying to help the coders with a lot of tools, and 3M has some fantastic innovation there.

But when you began to really understand what happens with documentation and how that stuff gets clarified, you really find how many queries and pings and e-mails are hitting the physicians, some of which get answered and some of which don’t. That’s where we thought that we could really bring the efficiency and the real breakthrough. We have had the opportunity to validate this. We have shown a mock-up to some physicians and we’re typically getting an a-ha reaction of, “That’s what we needed.”

Jon: On the very specific topic of customer reaction, we were able to show it to seven customers, large delivery systems, last week. The feedback was unanimously positive and they immediately jump into a detailed design mode because, “This is exactly what we need, and here’s the 15 additional things you need to make this do.” It was pretty exciting to see.

The other thing that gets validated as we review it with customers is that the value of this as a passive ICD-10 training tool, frankly. By deploying this long before the actual October 2013 date, physicians, in effect, are being trained on the level of granularity that their documentation needs to include as we move to ICD-10. As we deploy this as an ICD-10 solution, it’s going to drive that education surrounding what’s needed in documentation, framing it in a passive way that isn’t a classroom lecture. It’s a real, live, on-the-job learning exercise for the physicians that will make the transition much smoother when we get to 2013.

For organizations that haven’t given as much thought to ICD-10 as they should have, what are the opportunities that it brings to them, assuming that CAPD makes it easier to capture the codes accurately and quickly?

Janet: ICD-10, because of the sheer scale of it, is forcing just about everybody to question how they do what they do today. There are estimates of almost a 50% reduction in efficiency on the coding side. That’s stunning. Even if you could afford the budget to increment your staff, there isn’t enough talent in the market.

Folks who have not started to look at it, when we make this announcement, I think it will show them a way to not only start to look where they had typically been looking, but also to really look for process innovation. How can we do things differently here? How can we do things more intelligently? How can we bring more of the intelligence up to the front part of the process?

Jon: On the cost side, we view this is as a direct means of driving training and accurate documentation upfront and we will take some cost out of the ICD-10 transition by deploying the solution upfront. On the other side of it, our computer-assisted coding will now be powered by the Nuance Clinical Language Understanding natural language processing module, which will take cost out of the back end for sure, offsetting some of the increased coding resource requirements surrounding ICD-10.

When we lay all that out, we really hope to offset the increased cost during the transition for the provider networks in a way that enables all of the advanced analytic work longer term that should be able to be done from the much more granular view of medical transactions and the delivery of healthcare.

Any concluding thoughts?

Janet: I think the industry will be a little bit surprised to see these two partners coming together. People will see how quickly this came together and how amazingly aligned the vision was with both companies. Jon and I actually met a matter of months ago and we started to see the synergies between these two companies. The teamwork has been fantastic and I can tell you that the organizations — the R&D folks, people who meet with customers every day — are positively pumped to get this out there and get this in front of the customers. We really think we’ve got something unique here.

Jon: It’s really just taking two great brands in the healthcare IT space that deliver great best-of-breed solutions and combining them in a way that really is going to solve some significant client problems and pain points. We’re just thrilled, both companies. Everybody involved is really excited about the opportunity. We just can’t wait to get the announcement out and get going on it.

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From Wombat: “Re: Blumenthal replacement at ONC. Stephen L. Ondra, MD is the frontrunner.” Unverified. He’s a veteran, neurosurgeon, and senior policy advisor for health affairs at the VA. I doubt he’s a heavy EMR user, but I guess at ONC level that will always be the case. Maybe that should be a pre-requisite.

From CIO or CPA: “Re: Allscripts. Am I the only one that wonders about the Allscripts balance sheet? Nearly $1.6B out of a total of $2.4B assets is either intangibles or goodwill. There is also $460M of long term debt. This is a total of about 85 % of total assets. This compares to Cerner’s totals at about 21%. Seems like a large hole. What am I missing?”

From WildcatWell: “Re: Verizon Health Information Exchange. May offer its own MU-certified EMR to physicians who subscribe, use Verizon Business, FiOS, whatever. Info could then be pushed right into a doc’s home. Game changer, baby!”

From PureSpam: “Re: McKesson. Not a rumor – big layoff happening now (Tuesday morning).” Nasty Parts sent this on Monday: “Wholesale slaughter of the McKesson sales force on 2/15. Over 450 folks being let go.” Monday’s rumor from Doolittle specifically named McKesson, although I didn’t until I gave the company time to respond to my inquiry (they didn’t). I don’t have firm confirmation, but one insider places the number at 84% of the sales organization, or about 200 people. Supposedly a consulting firm convinced MCK that the client executive role was not worth keeping. I’ll let you know if they provide a statement.

From IKnowPlenty: “Re: vendor parties. Any insight about what they’re doing for entertainment? Keep up the good work – I enjoy every issue.” I haven’t followed the events too closely since I never have time to go. I think I signed up for the Allscripts party on Tuesday evening at Hard Rock Live with the hopes they’ll have name entertainment just in case I have time to attend, but in Orlando you usually end up with white-bread Disney day-jobbers doing an imitation of a band.

Just a brief note on HIStalkapalooza: it’s more than completely full from those who signed up during the designated period, so I can’t add more folks – sorry. I wish everybody could be there, but we just don’t have the room.

Kaiser’s George Halvorson extols the virtues of its new computerized clinical library in his organization-wide e-mail this week. It’s available everywhere to users, is being used 10,000 times per day, and in addition to references, also includes includes best practices, protocols, and links for using Kaiser services.

I feel odd mentioning new HIStalk Platinum Sponsor GE Healthcare since I don’t always have nice things to say about the company and they know their sponsorship won’t change that. Still, I was encouraged (and said so) a few weeks back when they were quick to reply honestly to a rumor I asked them about (true, as it turned out) and I admire them for supporting a somewhat loose cannon. Everybody knows GEHC, so let’s talk about what they’ll show you if you head over to that block-long booth they always have (#2401) at HIMSS: Centricity EMR solutions (Advance for small practices, Practice Solution for mid-sized ones, Centricity EMR for the big boys, and Enterprise for hospitals); eHealth Solutions (HIE, image exchange, and community desktop portal); digital pathology from its UPMC partnership; the Qualibria Clinical Knowledge Platform; and other tools (wireless devices, patient monitors, etc.) You can schedule a demo here (if it were me, I’d check out the HIE and Qualibria products since those are new, I think, and I don’t know a thing about either product) or head over to a theater presentation. Thanks to GE Healthcare for supporting an honest and opinionated HIStalk instead of some fawning publication or site.

Allscripts announces Q4 numbers: revenue up 87%, EPS –$0.03 vs. $0.10. The costs of the Eclipsys acquisition took MDRX into the red; otherwise, it would have beaten estimates at $0.20.

Valley Regional Hospital (NH) chooses the HMS hospital information system.

Orlando Health is partnering with Rothman Healthcare to evaluate the Rothman Index as an admissions patient surveillance tool and to enhance the effectiveness of the health system’s Rapid Response Team. I interviewed Michael Rothman in October and it was one of my better ones, if I do say so myself, because it’s an interesting product they’re creating and they’re doing it for passion, not money.

Quite a few of you filled out my reader survey – thanks. I only run it once a year, so this is your last chance to weigh in. I read every response and try to find time to run with a few of the ideas offered every year.

An ABC News piece covers a project by a former Stanford student to improve healthcare in Africa by setting up a telemedicine network based on text messages sent via discarded cell phones. I mentioned it last June when it was called FrontlineSMS:Medic. The new name is Medic Mobile.

Deborah Peel, MD of Patient Privacy Rights was scheduled to testify Tuesday before the PCAST work group of the HIT Policy Committee and HIT Standards Committee. Her group’s concerns: (a) universal data exchange formats without privacy consideration will make it easy to violate patient privacy; (b) it takes time to build privacy into systems; and (c) de-identification doesn’t really work very well.

University Hospitals (OH) will expand its deployment of the Allscripts EHR and Sunrise Enterprise.

A Boston Globe article covers patient harm caused by alarm fatigue with hospital patient monitors. It mentions a 15-bed unit at Johns Hopkins that averaged 942 critical alarms per day. It also cites a Mass General case in which a patient slowly died while experiencing a fatal heart attach after his cardiac monitor was turned off and staff did not respond to ongoing alarms triggered by his low heart rate. A nurse was quoted: “We have 17 types of alarms that can go off at any time .. It becomes … background.” Studies also found that up to 85% of the alerts are false alarms.

CSC’s big NPfIT contract is in danger of being cancelled over repeated missed implementation dates, some of the go-lives years overdue. NPfIT has gone through many vendors, some of them big, and I don’t know of any that made any money. It probably wouldn’t break CSC’s heart to be shown the door.

Privacy software developed by a Canadian researcher is being tested by two hospitals. It scores the likelihood of being able to identify a particular patient based on their available information and then selectively de-identifies the records as needed. I see by Googling that he’s already formed a company to sell it.

HHS launches the HealthIndicators.gov portal, opening up the HHS health indicators data vault to developers and researchers.

Billionaire Patrick Soon-Shiong makes another healthcare technology investment, this time in UK-based wireless monitoring device vendor Toumaz. The company will start by developing sports sensors, but will then look at wireless healthcare.

A Virginia hospital, hit by Facebook-posted rumors that patients were dying of sepsis contracted there, strikes back by saying “not true” on its own Facebook page. At least it doesn’t cost anything to argue on Facebook.

E-mail me.

HERtalk by Inga

From Fancy Nancy: “Re: HIStalkapalooza attire. I am so excited about the reception coming up and am wondering how formal people are dressing? I need your guidance and wisdom.” Fancy Nancy, I am so glad you asked. I hope that we see lots of velvet and taffeta and strappy high heels. If you can’t decide whether it’s worth it to pack that special outfit, here is something to consider: the two winners of the Inga Loves My Shoes contest will each receive a $100 gift certificate from Zappo’s, courtesy of Mr. H. Then there is the HIStalk King and Queen event for the the best-dressed attendees. These royal winners each take home iPod Touches (not the cheesy 8GB version, but the new 32GB model, complete with Facetime and HD video recording). Here is a hint, if you want to be in the running: don’t be late. We will have a red carpet entrance, and if you really want to strut your stuff, make sure you take a moment for a photo and chat with our red carpet interviewers. The formal presentation part of the evening will begin at 8:00 p.m. and our finalists will be selected by that time. To give you an idea of how high the bar is set for the shoe contest, our esteemed judge sent me the above photo of what will be adorning her feet. Meanwhile, our head judge for HIStalk King and Queen has been cramming to watch all eight seasons’ worth of “What Not to Wear” and to memorize all of Stacey and Clinton’s rules.

From Pretty in Pink: “Re: Winning party attire. Real men wear pink, so I am hoping that someone from my team will have a shot at HIStalk King.”  While we love you pink-pants-wearing guys, we hope you have time to change before heading to BB King’s. Of course, if you show up in a pink tux, our judges will likely make you a finalist.

A big thank you to everyone who shared with me news of other fun evening events during HIMSS.  Some of the hot parties include Cuba Libre for “music , dancing, food, and fun” and a casino night at one of the big hotels. It seems like I also saw something about an event at the Amway Center with appearances by Orlando Magic players, but I can’t find that e-mail. So much for staying in and ordering room service.

Misys Open Source Solutions will leverage technology from Apixio to improve data search and filter capabilities.

Allina Hospitals & Clinics (MN) deploys Mobility XE, a mobile VPN solution from NetMotion Wireless.

2010 was the second worst year in the last 15 for mass hospital layoffs , affecting a total of 10,490 individuals.

Nuance continues to be the “power player” in the speech recognition market, according to a new KLAS report. Nuance’s eScription was the highest rated back-end system, followed by Dolbey Fusion Speech. Nuance’s PowerScribe and RadWhere led the front-end speech segment, followed by MedQuist’s SpeechQ. KLAS says the speech recognition market is ripe for healthy growth, with only one in four hospitals employing the technology.

GE’s philanthropic organization, the GE Foundation, awards $500,000 to two Erie, PA-based community health centers to support increased access to quality healthcare. Meanwhile, GE Healthcare enters into a joint development and marketing agreement with SAS to use SAS Analytics in GE’s Patient Safety Organization to mine data on patient safety adverse or near-miss events.

Siemens Healthcare announces that five healthcare systems have contracted for Soarian systems, including Baptist St. Anthony’s Health System (TX), Peconic Bay Medical Center (NY), Children’s Hospital (LA), Touro Infirmary (LA), and MaineGeneral Health.

Ken Graham, the newly unemployed CEO of El Camino Hospital (CA), will receive almost $1 million in severance pay. El Camino’s board of directors fired Graham last week “without cause.” Nothing like a million bucks to ease the pain.

Did you have a chance to look through Mr. H’s Must See Vendors for HIMSS11? Here are two reasons it’s worth your time: 1) you will be amazed at the variety of products and services that encompass the HIT world; and  2) there are some pretty nifty giveaways. I have printed my PDF version so I know which booths to hit. If you are short on time, here are a few tips, starting with the offerings exclusively for HIStalk readers:

• Vitalize Consulting (3070) – if you connect a “link” on their Chain of Hope, they will donate $5 plus an additional $5 if you say you are a HIStalk reader.
• Virtelligence (2131), MED3OOO (917), Emdeon (2201), and Cumberland Consulting (6943) are each hosting special HIStalk reader-only drawings for iPads.
• Iatric Systems (3601) – (3) $50 iTunes gift cards for readers.
• Enterprise Software Deployment (2777) – special drawing for a Sonos Music System.
• Billian’s HealthDATA/Porter Research (4579) – snack packs to the first 100 HIStalk readers.
• API Healthcare (3463) – HIStalk reader-only drawing for a Dell Inspiron Mini Netbook.

For the HIStalk-exclusive goodies, you pretty much just need to mention you are a reader – no secret handshakes required. While you are touring the exhibit floor, here are a few other recommended stops:

• CareTech (1831) – raffling off a $1,000 donation to a recipient’s hospital foundation.
• Enovate (2738) – iPad giveaway.
• Enterprise Software Deployment (2777) – in addition to the HIStalk-only drawing, they are giving out cozy flip flops and a chance to win a FLIP camcorder.
• HT Systems/PatientSecure (218-10) – if you register to meet with them in advance, you have a chance to win an Android-based tablet PC.
• Keane (1548) – iPad giveaway.
• MEDecision (2563) – Starbucks coffee (!)
• Microsoft (3101) – Microsoft Arc Mouse giveaway.
• NCR (2805) – a singed copy of Paper Kills 2.0 by Next Gingrich to the first 25 people to schedule a booth appointment.
• NextGen (2163) – chances to win a smart phone or iPad. NextGen will also have “splash” artists creating works that will be given away.
• Sage (1713) – sign their Red by Sage Wall of Inspiration to commemorate someone’s life that’s been touched by heart disease, then get a chair massage.
• Wolters Kluwer (6162) – chance to win a trip for four to the US Masters in Augusta.

E-mail Inga.

Sponsor Updates by DigitalBeanCounter

• Design Clinicals now supports integration with GetWellNework, allowing hospital patients to use the in-room TV to request bedside delivery of prescribed meds.
• Clairvia says sales of its Care Value Management software grew 85% during the last six months of 2010.
• MEDecision is launching a mobile application that enables providers to access its Clinical Summaries through smart phones and electronic tablets.
• GetWellNetwork announces a record number of new contracts, upgrades, and expansions with new hospitals.
• The Boston Globe cites Nuance’s Dragon Medical software in an article titled, “Writing exactly what they say.”
• Riverside HealthCare (IL) selects the eClinicalWorks EHR.
• Five CareTech Solutions clients will share their experiences at HIMSS11.
• Colleen Hittle, managing partner at Anson Group, will be a featured panelist at Indiana University’s Life Sciences conference on February 25 in Indianapolis. Shout out to DigitalBeanCounter’s alma mater!
• Imprivata partners with Thales, an information systems security leader, to deliver high level SSO cryptographic security.
• Stan Cassidy Centre for Rehabilitation (SCCR) chooses Orion Health’s Patient Portal to improve communication between patients and providers.
• Access will demonstrate the new version of its electronic forms offering at HIMSS, which includes an iPad version.
• Siemens will conduct on-the-spot interviews of experienced talent  at their HIMSS booth, with a specific interest in candidates for product line management and enterprise services positions.
• Phelps County Regional Medical (MO) will replace its document management system with Perceptive Software’s ImageNow document management, imaging, and workflow solution, integrated with Meditech.

EPtalk by Dr. Jayne

Barely a week left before HIMSS and I’m still having fun opening the mail every day. However, being in a part of the US that’s been having some weather, I don’t envy my mail carrier dealing with the vendor postcard that was mailed in an 8×10 rigid envelope that required it be carried through the proverbial rain, snow, sleet, and hail to my front porch. Yes, you got my attention with that, but you also could have gotten my attention with a smaller mailing, like the new Rapid Rewards update mailing that Southwest Airlines just sent. The size of a standard CD case, it caught my attention and kept my mail carrier warm and dry in his truck.

Lawson also got my attention (but in a positive way) with their tagline “Top Performers Make the Difficult Look Easy” and photographs of the contortionists they’ll be featuring in their booth. Although fascinating, I have a hard time watching acrobats because it brings back memories of Gross Anatomy class and having to memorize the name of every muscle, bone, and tendon.

Reader Bill, a veteran of the healthcare marketing trenches, emailed Mr. H and me about marketing:

Some folks complain about your HIStalk banner ads; I have embraced them as interesting. Not because I am sold on their offerings – not in the least. But when clustered together and winking at me with their clever little Flash graphics as I scroll, they seem otherworldly, almost anthropomorphic – "look at me!" "No, look at me!”

Mesmerized, I am transported to nearly 100 drab marketing conference rooms where overworked copy and graphic drones are prodded by their regional or national suit to, "Gimme something that ‘pops.’ Stale coffee, half-eaten bagels and doughnuts, pencil sketches, and wads of paper strew the table. Projector images flip through the ridiculous and unrealistic royalty-free stock photos of too-pretty male and female models with stethoscopes posing as healthcare workers. Bright young graphics and PR managers all convinced that they have the next best attention-grabbing gimmick.

With that in mind, my pre-HIMSS Winner of the Week is Aventura, which grabbed my eye with their tag-team Halloween-hued envelopes. The orange envelope held a fairly standard piece, but I enjoyed their promise of fixing all my staff’s roaming profile and VDI issues “in a way that will loosen their hands from your throat.” I’m not so sure though about their promise to “do things that will make clinicians run up and kiss you.” The black envelope held an invite to yet another private hands-on demo where they plan to show “the ultimate technological feat: how to make clinicians think you’re a decent, thoughtful, kind-hearted person.” I give them an A+ for marketing and a gold star for being a vendor that understands my world.

One last thought on marketing: the issue with the RelayHealth Facebook contest to create a welcome gift basket for me has been fixed – it no longer tries to get you to upload a video. I was starting to feel cyber-neglected due to lack of submissions until a reader e-mailed about the issue. The contest ends on February 18th, and if your suggestion gets high votes, you win a prize. Right now the field is wide open, so you’re guaranteed to be a winner! (I did shamelessly seed it with my own entry, though.)

I heard from some readers responding to my challenge to share the one product, add-on, or offering that is indispensable for practice. Several suggested a vendor who is also on Mr. H’s “Must See” list, so I thought I’d share it in advance of HIMSS so those of you who are not familiar can be sure to check them out. Intelligent Medical Objects (also an HIStalk Platinum Sponsor) will be at Booth 3517. I’m already a user and can tell you they saved my sanity as a physician and my life as a CMIO, providing the biggest “win” I’ve ever delivered to my docs. (And no, I’m not on their payroll, before some of you ask. But they did buy me drinks once as my ‘real’ self.)

Enough HIMSS-induced prattle. I have two articles to share this week.

First, from the Journal of Family Practice February 2011 issue, the first published case report in the United States of teenage text-induced tendinitis (although they did get scooped by The Medical Journal of Australia). This fourteen-year-old was texting four hours a day using only one thumb. The authors cite data that shows injury is related to high thumb movement velocities, with females being faster texters than males and thus more symptomatic. Use of a two-thumb style was protective, as was (drum roll) limiting daily texting activities, slowing down, and watching posture.

Second, the Atlanta Journal-Constitution reports that two brand-new members of the Georgia senate have teamed up in an effort to force Medicaid clients (not sure why we can’t call them patients any more) to use an ID card with their photo and PHI on a data chip and to scan their fingerprints at the doctor’s office (at least they didn’t call us providers again).

Although I applaud legitimate efforts to fight fraud, I take issue with this proposed legislation for several reasons. First, doctors are already dealing with the unfunded mandate of Meaningful Use (anyone who believes this is a money-maker, we need to chat) and now you want us scanning fingerprints at $200 a device? Do you two newbie politicians have any idea about health IT or what it would take to implement this?

Second, they want the patient fingerprinted both on arrival and when they leave the office. Have they never heard of efficiency? Is the patient going to be a victim of identity theft while they are being treated? (Maybe our backless paper gowns can steal more than dignity!)

And third, this is going to be another reason why physicians and other providers are going to stop participating in the Medicaid program (as if low payments, administrative burdens, and medically complex patients with multiple socioeconomic factors influencing their care are not reason enough). The estimated program cost is $26 million. Vendors, start your engines!

Have a question about medical informatics, electronic medical records, or what good has ever come of turning your head and coughing? E-mail Dr. Jayne.

Dr. Gregg Goes to HIMSS
By Gregg Alexander

Amidst the din, nay, cacophony of getting-close-to-HIMSS e-mails from marketers (and Marketeers) and the PR firm mouthpieces for all things HIT, it gets pretty difficult to wean the worthwhile from the worthless … and most appear more -less than -while. Filters are running full bore these day as I try to figure out which pre-HIMSS blasts actually contain any real value.

One made it through a few weeks ago, when the cacophony was more hubbub than holler. Several factors, especially the concise descriptors the e-mailer used, allowed it to reach through my mental blockade (which has become quite the barricade these days out of sheer volume overload necessity). I am happy that it did, because it helps me to honestly say that not all the pre-HIMSS hype is just hype. There’s a few who truly deserve to be noticed. Here’s how:

Today, I had a sneak peak demo of a product that will be rolled out at HIMSS which I am actually thrilled to see coming. VitalHealth Software, which is the result of a collaboration between Noaber (pronounced knob-er) Foundation out of the Netherlands and Minnesota-based Mayo Clinic, is rolling out VitalHealth EHR at HIMMS. I truly think it is an EHR that is going to make a lot of people stand up and take notice. It is Web 2.0 for EHRs, human user interface at the fore, stupid simple on the surface while kick-ass smart below decks, easy on the eyes, workflow-savvy. It is what an EHR should look and act like.

If you’re hitting HIMSS, I highly recommend taking a peek. If you’re a provider looking for an EHR tool that has been turned on a really smart lathe, it should almost be mandatory. It is flat-out cool.

——————

Pretty much every talking HIT head has had a chance to spout about David Blumenthal’s announced return to academia. (I can’t wait to hear what the buzz around the HIMSS water coolers will be about his replacement.) Sure, he has to head back to keep his spot on the Harvard starting lineup, but who knows what other thoughts may have traversed his mind as he saw the sands running low in the sabbatical hourglass? Here is one possible scenario that I just loved from an author (I only wish I’d written it) who prefers to remain anonymous:

“I think Dr. Blumenthal sees the writing on the wall. Excerpt from his recent internal dialogue:

Government David: ‘CMS says we gotta make ‘em go CCHIT before they NIST and, after that, make ‘em achieve MU, build an HIE, become an ACO, and then get NCQA to issue new PCMH regs.’

Human David: ‘OMG, this is wack. AMF.’ (Adios, Mother ——-s.)”

——————

Another pre-HIMSS marketeering note: maybe it works differently on real reporters, folks who deal with this kind of “Hey, listen to me!” on a regular basis, but in my opinion, the incessant reiteration and second / third / fourth e-mails from PR companies trying to land an interview time for their clients is mostly just off-putting. Especially if the first e-mail blast was poorly drafted, impersonal, insincere, or one of the typical hastily performed cut-n-paste jobs that seem so common. I’ve had a fairly busy inbox for some time, but the pre-HIMSS blasts have probably doubled my Junk…er, Inbox files.

My suggestion: put the effort in the first time and odds would be way better that you won’t need the second, third, fourth, etc.

——————

Most of you may remember the now-defunct TEPR (Towards the Electronic Patient Record.) I remember how helpful and well-attended it was back in Salt Lake City in 2005. What once was a thriving HIT showcase and helpful place for providers looking to learn more and get hands-on product experience died an ignominious death after the poorly attended 2009 exhibition in Palm Springs. Granted, it supposedly morphed into mHealth, but mHealth doesn’t fill the same bill, not by a long shot.

All the pre-HIMSS blasts have prompted me to consider if there is any way that the thriving, almost bursting at the seams HIMSS conference could one day soon go the way of the once grand-ish TEPR. I mean, once the numbers have reversed and 85% of providers are working electronically and, especially, once the Obama-bucks have run dry, will there really be a need for this digital bacchanalia?

Not sure, but I’ll tell you what: I enjoyed TEPR in ’05 and I’ll betcha HIMSS ’11 is gonna be a ball – especially that HIStalk Reception!! Enjoy ‘em while you got ‘em.

E-mail Gregg.

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George Schwend is president and CEO of Health Language.

Give me some background about yourself and about Health Language.

I started in healthcare after college in pharmaceutical sales, which was boring. I moved to clinical laboratory sales, my first introduction to IT. This was back in the 80s when there was Cerner and Sunquest and a company called LabForce that I got involved with and developed an IT system. It just fascinated me. Then I expanded into doing blood banking systems. 

My real excitement came when we got out of the application side and got involved with tools. I was the founder of the company that delivered an integration engine called Cloverleaf. I don’t know if you’re familiar with it.

I am.

We founded that company and delivered it. Cloverleaf has probably had more owners than any other product in healthcare IT over the years [laughs], but it’s a very successful product. It changed the way people integrated systems. 

Healthcare IT started out as islands of information. Everybody bought best-of-breed systems, and then somebody realized one day that they were doing an awful lot of data entry. They started doing point-to-point interfaces, which were ugly and expensive. We came up with the same concept at the same time that STC did with DataGate. We were competing products and that product has gone on.

We went public, went on to another company name. I did what you’re supposed to do at that point — I built a new house on a golf course on a lake [laughs].

As I was realizing I was never going to be a great golfer and I couldn’t catch all the fish, I started thinking about the next horizon. The next horizon came from thinking about what we accomplished with an integration engine and then what the next big problem was going to be. In the final analysis, we had integrated systems and we allowed data to move around, but we never integrated information.

What Health Language is all about is true interoperability. Integration engines move data around. Language Engine, which is our flagship product, actually integrates the data so it’s usable across the enterprise, wherever it goes, wherever it’s needed. Health Language has been a pretty big success and we are growing rapidly.

Tell me what the Language Engine does.

We manage and handle standards and vocabulary across applications. We use consumer-friendly terms. We have physician-friendly terms. 

The problem with communications in healthcare is everybody speaks their own healthcare dialect. Machines to people, to nurses, to doctors, to laboratorians — a lot of stuff can get lost in the translation. If you create a large set of content that embodies all the standards — the financial standards, the clinical standards, the specialty standards — and you put that in a large database and then create some technology that will serve that up to whatever user or to whatever event is happening and tag everything, you get very usable data across the entire enterprise.

How important is terminology to where Meaningful Use is going?

I think it’s hugely important. Technology has been there for a while. We’re doing really neat stuff with technology. The problem is that we haven’t done a whole to improve the data or the information. 

For Meaningful Use, we make the data far more usable. Even in the case of triggering alerts, if the wrong terms might be used and there’s not a database that says those two things are the same, you’re not going to trigger that alert. The efficiency or the effectiveness of the computerization of healthcare is not maximized unless the data is close to 100% readable by everybody that relies on it.

We see ourselves in a very horizontal technology — horizontal across healthcare. If anybody generates or stores or reads data, does statistical or outcomes analysis, clinical trials, or is in the payer sector … if they’re using healthcare data, we can make their current tools better and make the data they’re looking at much more usable.

Are you seeing more interest because interoperability means providers have to talk to each other now, just like systems needing to talk to each other created the need for the integration engine?

A tremendous amount. Interoperability, I’ve kiddingly said, is our middle name. If you take HL7 and what it does — and it’s a very critical piece of the pie — and then take SNOMED and the ICD and all of those and put those and put them in a mapped environment where all of those things are usable, you’ve got your interoperability. You’ve got portable records that can be read anywhere and understood anywhere. I think we play a very significant role in Meaningful Use.

You also offer an alternative to providers for looking up SNOMED and ICD-9 codes to create problem lists and documentation. What’s important about that other than provider satisfaction?

Let me explain our business. We have a large technology group at Health Language. We also have a large medically competent content team. That’s doctors, nurses, laboratorians, all the different regiments within healthcare specialty. They build content and our technology people build tools that automate that and make it easily accessible either sitting on a network or embedded by an application vendor.

In the case of ICD-9 or ICD-10, or in the case of Meaningful Use or Accountable Care Organizations — which, by the way, in my opinion is a new name for an HMO, isn’t it? [laughs] — that content group keeps everything current. It makes problem lists almost a standard product. We allow individual users to create and add to those problem lists or make their own unique problem list. We serve all that up with the Language Engine, making it available to all users across the spectrum.

Who are your competitors?

A number of folks are trying to do a really good job with delivering content, vocabulary, and standards. What differentiates HLI is that we are truly an IT company of equal stature to any IT company out there, as well as a content purveyor. I don’t think anybody comes close to the tools that we provide and a true engine technology to make the delivery and the maintenance reasonably manageable.

Content takes a long time to build, so I would think being the first mover gives you advantage.

We believe it does. We believe that’s why we’ve attracted so many new partnerships from the system integrators out there. There is probably not a major system integrator that we’re not partnering with right now. They make proposals to the insurance side of the industry for handling the transition from ICD-9 to ICD-10. A key component in their service package is that engine itself and then the content we can provide with it.

It was a big deal when government licensed SNOMED for all users and, more recently, Kaiser donated its Convergent Medical Terminology to HHS. How important were those developments?

Kaiser’s a major player. Kaiser was probably the stimulus for our company. A bunch of people from IBM’s Watson Research Center and Kaiser started to attack this terminology communications and vocabulary issue in healthcare. That became some of the core basis for what Kaiser ended up doing. Kaiser Rocky Mountain won the Davies Award for what they did.

When those people were done with that work, they were cut loose. We were just finishing up with Healthcare Communications, which was the Cloverleaf company. I started to think about where we should go next. I hired a whole bunch of those folks and many of them are still with us today. They had a real core expertise on managing vocabulary and standards.

We’ve gone light years from there, but to answer your question specifically, when anyone makes available a good quality content mix like Kaiser had, we applaud it. We were the first to put out a press release to commend them for making that available. Our tools can adopt any standard, any set of content, and manage those in concert with all the others. It just enhances our position and offering.

What are your thoughts on the technical specifications about nomenclature in Meaningful Use?

They’re all practical. They’re saying, “If you’re going to claim this Meaningful Use investment in IT, it’s got to do certain things,” and those things are all logical. I don’t see a problem with any of them and I don’t see why anyone else should. I think they just make medicine and healthcare better.

What’s the state of readiness for the conversion to ICD-10?

I won’t be the first to say I think we’re all behind the curve on it, but a lot of people are gearing up to try to make a very hard run. The sane thing to do would be run parallels on ICD-10 and ICD-9 for literally a year — through all the seasons, through all the types of things that are recorded and charged for, etc. — to make sure you’ve got it right.

We’ve done some really interesting things in putting our technology on a Web portal and allowing customers to manage their own mappings and use our mappings and modify them. Those things are of improving the speed to market of getting ready.

One criticism of ICD-10 is that it’s a huge list of codes that are more granular, but hard to pick from. Do you see that as an improved market for your product?

Yes, definitely. The granularity is a good thing for healthcare. Fifteen thousand to maybe 150,000 — that’s a major paradigm shift. That’s why I believe the tools are absolutely essential right now. And as you know, ICD-11 is not that far behind.

We’ve been doing international ICD-10 business with customers around the world for almost ten years now, so we’re very ICD-10 astute.

And that creates new product opportunities?

Yes. The more you have to juggle and plow through to get it right, the better it is to have tools that help work you through those, that give you logical maps, that make you think through, “Am I making the right connection here? Am I using the right codes"?” And hopefully getting no one in trouble with fraud and abuse issues down the road, almost by accident, because it’s such a complex problem.

Do you see new terminology developments that will be needed for interoperability, such as for genomics?

I don’t see anything on the immediate horizon. I think the real issue is that all of the standards are in constant change and flux. They’re constantly being changed. If you could envision a pile of pick-up sticks and every stick had a different standard on it … we’re managing something close to 180 different standards worldwide right now in our content base. Everybody isn’t using all of them, but people use varying numbers of how many standards they juggle in a given day and those standards can change daily, weekly, monthly, annually. 

Keeping it all mapped together and keeping it all usable so nothing breaks is an art form. That’s the real problem if you don’t approach the situation from an, “I need a solution that will take me long into the future and not a quick fix on how do I get from ICD-9 to ICD-10.” The demand for all kinds of vocabulary requirements and all kinds of different standards is going to get greater, not lesser.

What’s the current state of text analytics and do you think there are additional opportunities to leverage that?

We do a lot of natural language processing-like services. We are talking with a lot of the text, the voice, the natural language processing folks. We have a lot of projects going on. Nobody is, I think, 100% comfortable with where all of that is without some human intervention, but it’s getting closer all the time.

Do you think the PCAST report’s recommendation to turn existing data into discrete document data by tagging it could work?

The problems always come when what’s written is “pneumonia” vs. “no sign of pneumonia,” catching all those little innuendos and not getting into trouble and not just grabbing “pneumonia.” Do I think it’s possible? Yes, I do. I think it’s just a matter of time. I just don’t think we’re there yet.

There are two ways to solve the problem of everybody wanting coded data — either make the providers code the information going in or to try to code it on the back end. There’s not really any easy way to do it except maybe to use products like yours to make it more palatable on the front end.

That’s true, but we also do it on the back end, too. We’ve run historical databases through our Language Engine and gotten a very high turn — not 100%, so I’m always reluctant to hold up some false Holy Grail when somebody will ask me to make it work for them and we just can’t get to 100% — but we can do an awful lot of that today.

For aggregated studies or for public health type uses, it’s probably plenty good. You might not want to make an individual treatment decision from it, but I would assume that if you just had lots of data to plow through, you could make some general inferences that you’d be comfortable with.

I agree with you. That’s an excellent way to state it. You’re right.

Where do you take the business from here?

We see a tremendous amount of growth over the next couple of years. We believe that the need will continue to grow and we’ll continue to be intimately involved with all kinds of standard delivery across the entire spectrum.

We have some development projects that we hope to announce down the road. Right now, we’re very busy taking care of the high demand for ICD-9 to ICD-10 and Meaningful Use standards. 

We work with clinical application vendors. We work with system integrators. We work with individual hospitals like Partners in Boston and Ascension Healthcare. The more the government continues to try to move us into a more common world, the more of a need and the greater the need is going to be for what we do right now.

Any final thoughts?

Healthcare and the initiatives currently going on are the next quantum major step for healthcare and healthcare IT. Everything that’s being done today, everything that’s being required and requested, will move healthcare into truly the next generation. It’s an exciting time to be involved and I’m just glad we’re part of it.

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Stephen S. Hau is president and CEO of Shareable Ink of Nashville, TN.

Tell me about yourself and about the company.

I’ve had the privilege of starting two very provocative healthcare IT companies. At the age of 25, I dropped out of a PhD program at Harvard to start a company called PatientKeeper. I started that with a physician friend of mine, Dr. Joe Bonventre. We founded that company based on a very simple observation — doctors are highly mobile professionals because they walk about three or four miles a day, they cross different care settings, juggle numerous information systems, and rarely sit in front of a desktop computer.

From that starting point, many people worked together to build a very interesting and valuable company. I spent over 12 years at PatientKeeper. I collaborated with some wonderful people, learned a lot, and formed some strong opinions about the industry that ultimately lead to my next venture.

About two years ago, I left PatientKeeper to start another healthcare IT company called Shareable Ink with another physician friend of mine, Dr. Vernon Huang. This time, the simple observation was twofold. One, healthcare will become more electronic, and I think everyone agrees with that. And two, without a new approach to healthcare IT, that transition to being electronic will be very, very difficult.

During the formation phases of Shareable Ink, I got very excited about the potential of digital pen and paper technology. As you might know, digital pen and paper technology utilizes a special ballpoint pen with a small camera embedded in it that’s capable of recording and transmitting the user’s pen strokes. I felt that if this basic technology could be augmented with the right software, we could deliver a hugely valuable tool for clinicians and healthcare organizations. 

I put the band back together, bringing back some very talented friends, including some amazing engineers. I’m a firm believer that great software is a balance between technology and psychology, I say this a lot. It’s really only when clinicians truly embrace the tools when the tools aren’t cumbersome to them that we can deliver the full potential and the benefits of IT.

Companies either say “Doctor, you have to enter everything, so here’s your keyboard and this is where you’re going to live your life from this point forward,” or they say, “We don’t believe in that. You never have to type anything. Doctors should be consuming data and not creating it.” You’re giving them an alternative.

That’s right. We look at digital pen and paper as an input modality into electronic systems. It’s not really an “either-or”, but a “both.”

We initially set out to explore three clinical settings: emergency departments; operating room, specifically anesthesia; and physician practices. The factoids are that 80% of ED is documented on paper, 93% of anesthesiologists document on paper, and the vast majority of small doctors’ offices document on paper.

In the ED space, we’ve partnered and have had a great success with T-System. Sunny, the CEO you interviewed recently, is a real visionary. T-System has 1,700 emergency departments using its paper templates. That’s almost every other emergency department in the country. Our joint product, DigitalShare, helps those EDs become more electronic and thereby shortens revenue cycles, improves compliance, enhances access to clinical records. We accomplish all this without any change of the physician behavior. The clinician literally doesn’t have to do anything differently. 

We’ve seen similar benefits with anesthesiologists. We recently announced that NorthStar Anesthesia had huge success with our product and decided to expand it to 34 hospitals.

In the coming weeks, you’ll hear an announcement from a very large, well-known, publicly traded EMR vendor. Their customers will now be able to use their current paper documentation templates as an optional input mechanism into EMRs.

In a way, your company exists because EMR usability is at least perceived to not be very good. Do you see your product as a happy medium that lets vendors avoid rewriting their products with usability in mind?

Digital pen and paper can be an option for getting the clinician’s information into those systems. Their analogy is dictation. It’s a longstanding challenge where the entire industry wants the electronic data, but at the same time, we have to be mindful that physicians have very specific workflows that they’re comfortable with. For a period of time – and it looks like this will continue – dictation has been a way for physicians to input information. I think digital pen and paper is another example.

I’m also a fan of tablet computing. We’ll be introducing our take on tablets later this year. I think that might be another physician-friendly input mechanism into the electronic system.

Do you see digital pen and paper competing with tablet PC handwriting recognition or electronic forms completely contained in a tablet? Is that a direction you want to go?

Absolutely. Our business is really about helping healthcare organizations become more electronic. We do that by providing tools that physicians are comfortable with using as a way of capturing information from the physician. Pen and paper may be a way to go, dictation may be a way to go, and tablets might be a way to go as well. We’ll support whatever physicians are comfortable using.

We’ve had a very different take on tablets, at least, in terms of what I’ve seen out there. I’ve seen a lot of vendors take their desktop applications and try to convert it into a tablet application. We take an approach where, frankly, physicians are already comfortable with a way of inputting information, so we will use tablets as a way to mirror current physician workflows. Where they might have been scribbling on a piece of paper, they’ll have a choice to either scribble using a digital pen or scribble with a stylus on a tablet.

People underestimate the importance of the visual cues that you get when you write something in your own handwriting. There’s a whole psychology around how you place it and how bold you write and whether you draw an arrow to it or whether you scribble a drawing along with it. Is that something that physicians miss when they’re forced to type?

Yes. What we hear frequently is that the physician-patient interaction changes quite a bit when you introduce a computer keyboard. What we’ve found is that by utilizing digital pen and paper, physicians get to maintain a workflow they’re accustomed to.

I’ve observed that the documentation process is often interactive. Physicians aren’t court stenographers, where they’re literally just transcribing a predictable stream of words. The documentation process can often be non-linear, where there are surprises and they jump around and make changes during the documentation process.

I can see where patients would perceive a physician writing as they speak to be paying extra close attention and being extra careful, whereas typing almost seems like you’re being ignored.

Right. We’ve heard that before. As a consumer of healthcare, I can appreciate that as well.

Where do you see the role of the digital pen and paper for providers trying to meet Meaningful Use requirements?

Shareable Ink currently supports Meaningful Use in several ways, including the capturing or recording of clinical quality measures required under Meaningful Use. As an example, in the ED setting, we help capture emergency department throughput. In the anesthesia setting, we help capture antibiotic administration prior to surgery, which is just a quality measure.

In broader terms, we support the move to Meaningful Use, because what we’ve observed is the more the hospital becomes electronic, the harder it is to deal with existing paper processes. Shareable Ink takes those paper processes that are difficult to automate and we make them electronic with hardly any impact on the otherwise busy IT department.

If the IT department is the gatekeeper as they sometimes are, what would be your pitch to them about the cost and the technology and the manpower required to implement digital pen and paper?

Shareable Ink has taken a unique approach in terms of how we deploy our technology. All our software is hosted off site. There isn’t software to install on PCs. That obviously shortens the initial installation process, but also the go-forward support. We offer our product as Software as a Service, so it’s very, very easy to get started and also quite reasonable to manage going forward.

The advantage of interacting directly with a computing device is that the programmer can provide edits and completion messages and warning messages as the form is being completed. Do you have those tools available?

Yes. Our software can provide immediate feedback, including decision support, through our companion Web application. In this particular configuration, a USB cradle is connected to a Web-capable computer, and within a few seconds of docking the digital pen into the cradle, the pen strokes are delivered to our remote servers where they’re processed. That feedback is provided to the clinician in a browser window.

You’ve identified anesthesia as a key market. How are they using digital pen and paper?

The anesthesia market is a great example. For decades, there have been these so-called AIMSs – anesthesia information management systems – that have been marketed to anesthesiologists. They have, for the most part, not been very successful. In fact, as I mentioned today, 93% of anesthesiologists document on something called an anesthesia record, which is for the most part a two-page piece of paper.

But with that said, there is a need to go electronic, especially these large anesthesia groups. They’re essentially service organizations that compete with each other on the basis of the quality of their work. But that data is hard to come by. A lot of provider groups hire FTEs to spot-check individual records to make sure they’re being compliant with best practices.

With the Shareable Ink approach, the anesthesiologist continues to do what he or she has done for years, which is documenting on a paper anesthesia record, but that document is converted electronically to data. That data is available to medical records, but that discrete data is also available for compliance checking, for providing anesthesiologists immediate feedback if records aren’t complete or if they’re not being compliant with certain measures, and when the data is aggregated, to provide the provider group an ability to evaluate all of their providers on an objective basis.

It occurred to me as you were saying that in a hospital, the higher the level of acuity or specialty, the more the physicians’ practice becomes less free-form and more form-driven. The ED, ICU, surgery, anesthesia — all of those are more form-driven than general medicine or some of the other broader specialties. Are there others you’ve thought of that are form-centric that would find an easier transition to digital pen and paper than to just say, “Here, start typing.”

That’s a great observation. I would say that so much of healthcare is form-based. I didn’t fully appreciate that until we started Shareable Ink. I’ve been in environments where physicians will bring out their highly customized form … I’ve got a couple of MIT degrees, so when I observed this, I thought, “Well, gosh, that’s not really intellectual property, that’s just lines on a piece of paper.”

With reflection and maybe some maturity in my thought process, what I discovered was that what these physicians are showing us is their most highly customized, specialized tools that they’ve built that simply work for them. Shareable Ink, to some extent, is about taking what works for physicians and turning it into electronic data that the industry and the market requires.

What did you learn from PatientKeeper that you’ve taken to Shareable Ink?

I learned a lot from PatientKeeper, but I think what I appreciate most is the psychology of software design. The reality is, at the end of the day, it’s not about necessarily the robustness of the technology, not necessarily about the level of sophistication of the code or algorithms behind the scenes. Where the rubber meets the road really is, is the tool ultimately physician-friendly? Is the tool something physicians can be very comfortable with and can begin using right out of the box without an instruction manual?

Where do you see the company and the product going out in the next few years?

The great news is that, in a short amount of time, we’ve won a lot of customers. Our focus right now is taking great care of our customers. As an additional benefit, is we’re learning a ton from our customers. Every day I’m being educated about the next generation of applications they would like us develop. Not only is our customer pipeline very strong, our product pipeline is also very, very robust.

Any concluding thoughts?

I appreciate the opportunity to be included in your blog. As I mentioned, everything we’ve learned about healthcare IT has come from candid conversations with customers and other leaders in the industry. The Shareable Ink suggestion box is always open and we’re eager to get candid feedback from the industry.

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