Top News

HHS posted proposed ACO regulations today. We’re working on an interview that will address the IT implications, but in the mean time, you can review the proposed rule and the HHS fact sheet.

Reader Comments

From Court Jester: “Re: Nebraska Medical Center. I hear they signed with Epic about a month ago and are unplugging GE. The primary reason Epic was selected over Cerner was its interface capabilities. They’ll be kicking things off in May.” UNMC published an announcement on its Web site in November confirming Epic as the vendor of choice.

From Steel Curtain: “Re: MED3OOO. Rich Goldberg is leaving his business development job at TeleTracking to take over as president of MED3OOO division CPU Medical Management Systems.” Unverified, although he’s no longer listed on TeleTracking’s site. The move would not be a huge surprise since MED3OOO has filled its executive team with a number of former Misys VPs over the last couple of years.

From MrSoul: “Re: IE6. This is a great tool as we watch IE6 sloooooowly fade into HIStory.”

From Pescetarian: “Re: Seattle Children’s. Dumping Microsoft Amalga for Tableau Software. The press releases three years apart are eerily similar. The hospital was a lighthouse reference for Microsoft in their own back yard, but implementation was terrible, maintenance was almost impossible, and clinicians hated it.” CIO Drex DeFord didn’t confirm that, but was diplomatic in telling me that they’re still working on Amalga and its small base of users, but are always looking for business intelligence opportunities that will put information into the hands of end users.

From Cray Zee: “Re: Trinity Health CMIO. Mike Kramer, MD has left the building.” Unverified, but the provided memo looks authentic. They wish him well, but immediately pledge undying love to their Cerner-powered Genesis project (seems strange that they would need to defend it). It’s a really ambitious project, not quite Kaiser-sized, but in the neighborhood.

From Art Glasgow: “Re: Duke. Mr. H, I thought I’d confirm your note regarding me joining Duke Medicine. I’m scheduled to start around May 1st and am excited and humbled at the prospect of joining such an esteemed institution.” Art is leaving his Ingenix CTO job to become CIO of Duke Medicine, which we ran as a reader rumor earlier this week. He replaces Asif Ahmad, who left Duke last June to take an EVP job with US Oncology. Thanks for the confirmation.

HIStalk Announcements and Requests

This week on HIStalk Practice: Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative, debuts Pretzel Logic, his new column on technology decision-making in medical practices. Epocrates introduces a mobile and Web-based EHR. HIMSS and MGMA offer a privacy and security toolkit for small provider organizations. A mainstream journalist attempts to explain the EMR industry — and does a pathetically poor job. The success of the ACO-like Atrius Health. Come visit and stay for awhile.

Listening: new from Whitesnake (yes, you read that right). I had mental pictures of hair-transplanted, shirtless-and-Spandex guys in their 60s leaning into a single microphone for yet another round of their coy, unskilled Reagan-era poser ballads, but it actually rocks out quite nicely with excellent production. David Coverdale sounds better now than then (just do yourself a favor and don’t Google his ex-wife and car-gyrating video star Tawny Kitaen for a current picture). Makes me want to load up the Jag with beer and tramp-stamped bleach blondes and head off to Rocklahoma.

Welcome to new HIStalk Gold Sponsor UltraLinq Healthcare Solutions of New York, NY. The company offers a FDA-approved, Web-based ultrasound and image management system that lets physicians review exams from anywhere, including on its iPhone app. The physician does their interpretation using auto-populating review worksheets, the reports are distributed through a variety of ways, everything is stored and universally accessed from a secure Web site, and they handle all the infrastructure. The system is low cost, secure, flexible, and portable. Thanks to UltraLinq for supporting HIStalk.

On the HIStalk Job Board: Social Media Manager, Clinical Business Analyst, Regional Director Centergy Sales. On Healthcare IT Jobs: McKesson PM – CPOE, Application Programmer, Cerner Clinical Analyst, Senior Clinical Analyst IT Implementation. I know the job market is good because my work phone rings off the hook from recruiters.

Make me happy: (a) drop your e-mail in the Subcribe to Updates box to your right so I can tickle your e-mail ivories with HIT love; (b) send me your rumors, news, incriminating photos, and secret documents by clicking the garishly green Rumor Report button; (c) acknowledge the great society that lets you read HIStalk free because of the largesse of sponsors listed to your left, who are more likely to continue that support if you click around a little and maybe buy some stuff from them; (d) find Inga, Dr. Jayne, and me on LinkedIn and Facebook and click the correct buttons to boost our fragile egos; and (e) give yourself one of those pistol-pointing gestures in the mirror for reading and contributing here in whatever way makes you (and me) happy.

Acquisitions, Funding, Business, and Stock

VisualMed Clinical Solutions issues a press release saying it will launch a “new initiative” in the marketing of its EHR product in the US, following a two-year interruption. The company says that the 2008 financial crisis left many institutions without resources to implement systems and “all decision making was entirely suspended.” Its chairman believes that the time is now right for a re-launch, given that the recovery is underway and government incentives are in place. I found the message curious, to say the least, so I did a bit of digging and found a June 2010 press release that bragged of $2.6 million in new orders. At that time, the company credited ARRA for the the boost in sales and market interest. The chairman was quoted as saying, “thanks to the new reforms, our time has come.” Finally, I went back and found a July 2008 press release saying the company had completed restructuring and planned to focus on the “more promising” markets of oncology, Internet, and private clinics. Nothing like having a consistent vision and marketing message.

Sales

Winthrop-University Hospital (NY) signs a seven-year order for cloud-based RIS/PACS and archiving services from Carestream Health.

People

Don Claunch, CIO of Wyoming Medical Center (WY), will take over as interim CFO.

Announcements and Implementations

Marfraq Hospital in Abu Dhabi launches its Cerner EMR following 12,000 hours of training over the last month.

North Kansas City Hospital migrates to Corepoint’s Integration Engine.

Strong Memorial Hospital (NY) at the University of Rochester Medical Center launches Epic EHR. URMC’s Highland Hospital will go live in June. Outpatient services are scheduled for the summer of 2012.

The two big Orlando hospital systems, Florida Hospital and Orlando Health, start a one-year data sharing project via the Central Florida RHIO.

Virginia Commonwealth University Medical Center goes live on the Central Logic ForeFront patient flow system.

Government and Politics

Victoria’s troubled HealthSMART project will need $200 million to finish the job, well over the original $360 million estimate.

Technology

If the rumors prove true, Google will be opting out of the health business. However, Cerner is looking forward to working with Google on its “fiber community” pilot. Google selected Kansas City this week as its pilot for a one-gigabyte-per-second broadband network. Other enthusiastic KC folks include representatives from the University of Kansas Hospital and KU Medical Center, who believe the faster network will help with telemedicine and transmission of medical records.

An editorial by Murray Feingold, MD mentions the mixed reviews of “the menage a trois in the examining room” – doctor, patient, and computer, but says it’s doctors using them incorrectly that make patients feel ignored. He closes with wise advice: “The use of a computer will be successful only if the doctor remembers that the patient is the most important person in the examining room, and not an inanimate computer.”

Other

ICSA Labs awards ONC-ATCB certification to its first three products.

Passport Health Communications becomes the first RCMS solutions company to achieves full accreditation with the HIEAP EHNAC.

A California health clinic that caters to the porn industry announces the possibility of a criminal breach into its medical record database. Personal information on as many as 12,000 current and former adult film performers may have been exposed. The uncovered details include HIV status, STD test results, and the actors’ “real” names. Mr. H, Dr. Jayne, and I are particularly empathetic about the last item.

Mark Rogers MD, a member of the Public Health Trust that oversees the rapidly flat-lining Jackson Health System of Miami, resigns with a warning that the Trust is incapable of saving it from failure. His final recommendations include bringing in an outside CIO.

It’s April Fool’s Day Friday, so I’m wringing my hands in anticipation to see if Epic will come up with another world class spoof on their home page. But to amuse you in the mean time, here’s a phony press release from Concerro. Call me peurile, but I love that stuff when it’s done well.

Sponsor Updates

• Allscripts ED, McKesson’s Horizon Lab, and Design Clinicals’ MedsTracker all earn ONC-ATCB certification. Allscripts ED product qualifies for complete EHR certification, while Horizon Lab and MedsTracker achieve modular certification.
• Congrats to ESD, which celebrates its 21st anniversary on April 1.
• Thomas J. Niehaus joins Encore Health Resources as EVP for client services. He’s the former president of CTG Healthcare Solutions and spent nine years with IBAX. We reported this a month before the announcement.
• Medical Center of Plano (TX) selects ProVation MD Software for gastroenterology procedure documentation and coding.
• Sayre Memorial Hospital (OK) will convert its ED from the T-System’s T-Sheets paper documentation system to T-System’s EHR.
• Blue Cross and Blue Shield Association names Health Language its preferred vendor to help BCBS companies transition from ICD-9 to ICD-10.
• Stephen Newman MD, COO of Tenet, leads a MED3OOO one-hour webinar on physician affiliation.
• Bridgehead Software is conducting its annual Data Management Survey, which looks at data and storage management trends year over year. Random respondents will be chosen to win an iPad, GPS, or Amazon gift cards.
• The Network Health health plan chooses MedVentive as its technology partner for Web-based performance analytics that will enhance its care management, outcomes, and finances.

EPtalk by Dr. Jayne

The American Medical Association announces the 2011 AMA APP Challenge, calling for medical students, residents, and physicians to submit their ideas for “innovative medical apps” to impact clinicians’ daily lives. Ideas will be scored on usefulness; appropriate fit with the AMA and its mission; innovation; suitability for app format; and being representative of the submitter’s expertise. Sorry to all the great coders out there, but you have to be a physician, resident, or student to submit (so go ahead, convince your CMIO or CMO to let you be his/her ghost writer!)

Personally, I’d like to see a knock-off of Urbanspoon , the app where you shake your iPhone to receive restaurant suggestions. You could input symptoms and shake it to view different possible diagnoses. Much more fun that the clinical decision support apps that are out there.

What’s your favorite medical app? Send me suggestions and I’ll check them out and report on the coolest.

Abbott Laboratories receives FDA approval for a blood testing system that transmits results wirelessly, allowing caregivers to remain at the bedside. The device does basic blood chemistry testing and blood counts as well as blood gases. I’m disappointed that future generations of medical students will be denied the opportunity to take the blood gas sample from the patient, place the syringe in a Styrofoam coffee cup filled with crushed ice, and run through the halls of the hospital in the middle of the night to the lab and back.

Wednesday was National Doctor’s Day. I’m sad to say I didn’t get invited to any celebratory lunches in the doctor’s lounge this year (cutbacks, I’m sure). Thanks to Inga for recognizing it on HIStalk Practice! Doctor’s Day has been celebrated on March 30th since 1933, when Eudora Brown Almond, wife of Dr. Cha Almond, commemorated the anniversary of the first use of anesthesia in 1842. She and the ladies of the Southern Medical Association would place flowers on physician graves. The day was officially recognized in 1958 by the US House of Representatives and by President George H.W. Bush in the 1990s. Even though you’ll be a day late, show some love to the docs you love (and be thankful for that anesthesia!)

Reading one of my specialty journals, I was surprised to notice that there were more ads for EHRs and technology products than for drugs. I don’t recall the balance being tipped before. There were also two paid advertisements from CMS – one for Meaningful Use, another for the HIPAA 5010 EDI standards. I wonder how many physicians are familiar with 5010 compared to Meaningful Use? The 5010 is mandatory January 1, 2012. If your billing system doesn’t support it, if you don’t have a plan to test it, or you don’t know what it is, time’s a-wasting.

I’m embedded in a practice this week, which is always interesting. It’s extremely challenging to try to train physicians, let alone having them retain the information. I wish there was a better way to help my colleagues understand the following:

• You actually need to show up for training.
• Checking e-mail or playing on your iPhone does not constitute “participation.”
• Your trainers are professionals who put a lot of blood, sweat, and tears into their efforts. Show them some respect.
• You don’t need an MD behind your name to be able to train EHR. Playing the “no one can understand how complex my specialty is” card just makes you sound whiny.
• If you don’t understand, or need more practice, speak up. Ignorance is NOT bliss where patient care is concerned.
• The EHR is not going away and complaining about it is not constructive. Your trainers didn’t select it, but they do have a vested interest at helping you use it the most efficient way possible.
• Yes, we did bring all this food, primarily to get you to show up. Apparently many physicians still operate under Residency Rules: see a donut, eat a donut. You know who you are.

A Special HIStalk Update from Mr. H – 4/1/11

It’s harder than it looks to continually create HIStalk. I’ve worked on it several hours each day, seven days a week since 2003. It has been my hobby, my passion, and my unintended business for all these years. It defines me more than anything I’ve done, maybe because the time and energy it requires precludes me from doing anything else. For that reason, I always thought I’d just keep doing it forever.

I was wrong. It’s time for me to move on.

I’m weary of the grind. I write from the time I get home until bedtime, rush home to conduct interviews after work, and spend the whole weekend doing everything from browser debugging to invoicing. I’m tired of the never-ending criticism about the site layout, the number of sponsors I have, and my perceived bias for or against certain vendors. Unlike every other blogger in history, I’m not allowed to help an out-of-work friend or make a music recommendation because someone is sure to launch off on me for daring use a couple of dozen words about something that doesn’t fit their personal interest profile.

I started HIStalk as a place I could muse and amuse a little. It’s become so serious that I’m not having fun any more.

Timing is everything. I can’t legally divulge details, but a certain member organization that runs a big conference reached out, wondering if I’d be interested in being acquired. I always say no, but they caught me in a weak moment. Their offer was, to say the least, significant (I can’t divulge the number, but it has six zeroes and the first number is bigger than a one). I think you would do the same if presented the opportunity to be set for life and to be free to do whatever the heck you want instead of what someone else demands.

You’ll see the changes coming here soon. I’m here for the transition until that "wish him well in future endeavors" announcement is made. In the mean time, I’m planning the next chapter in my life and I can’t wait.

Inga really is a woman, as I’ve had to defend to skeptics more than once. In fact, she’s a wonderful woman. Our relationship has grown from terse, pure-business e-mail exchanges to a lot more, resulting in full-on passion at HIMSS. We never meant for it to happen, but we were destined for each other, it seems. I can think of nothing but having her as my soul mate. Mrs. H and I will be parting ways so that Inga and I can head off to the beaches of Mexico to start a new life together, where we’ll be forming the band we’ve always dreamed about, the Frail Loops (think Pink Martini meets Insane Clown Posse). We’re still trying to loosen up Dr. Jayne to get her to join us down there.

We’ll keep reading HIStalk, of course. My replacement is an esteemed industry reporter who won an award for hard-hitting industry analysis at her last job at a chocolate magazine. The site will finally receive that big makeover everybody wants, fancying it up and loading it down with industry-sponsored podcasts and white papers so it looks more credible. There will be no more objectionable material for readers to complain about, like pithy dismissive asides, scandalous reader comments, or contrarian conclusions. The new HIStalk will offend no one.

We may do a little bit of consulting if the acquisition money runs low. Inga is working on a design deal with Jimmy Choo and considering starting a tequila brand like Sammy Hagar did, calling hers Ingatini. We may run a for-profit HIStalkapalooza in our trademarked counterculture way — you’ll have to bring us cash, liquor, food, and iPads to be allowed in. We’ve kept quiet about a planned member organization we may start with the working name of Have Electronic Records, but Sacrificed Solvency (HERSS).

But it won’t be anything like the work we’ve been doing all these years. Like Hollywood types, we need a break from being wealthy, adored celebrities (of the anonymous kind, in our case). Inga’s going to be a great mom to those babies from Cambodia we’re adopting next week. We’re naming them Neal and Judy.

It’s been a great eight years. The record shows I took the blows and did it my way. Thanks for the memories.

Contacts

Mr. H, Inga, Dr. Jayne, Dr. Gregg.

 View/Print Text Only

Bruce Cerullo is CEO of Vitalize Consulting Solutions of Kennett Square, PA.

Tell me about yourself and about Vitalize.

Vitalize has been around since 2002, when it was founded by my current partners. The founders are Mary Pat Fralick, who’s been out there in the industry with Elumen Solution and CTG, and Danny Arnold, who’s also of the industry.

I got involved back in very late 2007 where my little start-up company called Lucida — which is where I originally connected with you — was coming head to head with Vitalize everywhere we went. You know, if you can’t beat them, buy them, so we raised a bunch of money from private equity and we rolled Lucida into Vitalize and recapitalized the company. We have been on a wonderful growth trajectory since then.

Vitalize has nine different business units — we call them practices — organized around either software vendors or market segments. Like ambulatory, for example, or product management.

We recently acquired a Minnesota- based strategic consulting firm called Validus. Validus has a very, very strong reputation in some of the important strategic services capabilities that were a little upstream from the traditional Vitalize offerings. They actually do project leadership of Epic and other major software vendors and have done it well at places like Stanford Medical and Grady and Tampa General and the like. What we were looking to do was to continue to improve our service offerings to our hospital clients, so, it was a natural fit.

The Validus partners and founders are all now part of Vitalize and investors in Vitalize. I found that if your key leadership have a chance to invest real money, you get great alignment of objectives and everybody pulls to build an even better company together.

You describe the company as people-centric and team-centric. How’s that different than how businesses usually work?

First of all, we’re organized around individual practices. Instead of having 500 people who all report to this fellow named Cerullo, we have built strong business units within the Vitalize umbrella. You hang around with people like you. If you’re an Epic consultant, you have access to a hundred and something Epic consultants. You’ve got an Epic leadership structure who you identify with and work with and touch on a daily, weekly, monthly basis.

One of the fine arts to your business or mine, no matter how big you get, is to continue to try to feel small. By organizing around the unique people, skill sets, and market dynamics of the different sectors or sub-sectors of healthcare IT, that’s one of ways we do it — organizing around people like you. 

At the level of all of our employees, we do welcome baskets when people join us. We send out surprise Amex gift cards a couple of times a year and allow people to take their loved ones out to dinner. Coming up in early April, we’ll have 500-plus people all flying in to Austin, Texas for four days of fun and learning. It will cost us close to a million dollars to bring everybody in, but to us, it’s the glue. It’s the one time during the year where everybody gets to look everyone else in the eye and connect and bond and talk and laugh and have fun. We call it The Extravaganza, but it’s really a part training, part learning, part fun gathering of all our folks. We do that every year. It’s part of the people-centric aspect. It’s expensive, but it’s absolutely worth it.

Has the economy changed the quantity and quality of the resumes you’re getting?

The economy has provided the stimulus to hospitals to further invest in their information technology systems and people. It’s caused a lot of client demand for the kinds of consulting services firms like Vitalize offer. With that has created career portability and career growth opportunities for healthcare IT professionals.

Whether you work in a hospital system or Vitalize, human beings are motivated to build their careers and their resumes and to experience economic gain. The rebound in the economy certainly, and the stimulus dollars dedicated to healthcare IT, have created a lot of new job opportunities and growth for consultants. That’s the good news.

The challenge embedded in your question is making sure that we as a company can recruit and retain way more than our fair share of those seasoned consultants. I got statistics in the other day that said more than 70% of our consultants are former clinicians. They have that added value, if you will, when they parachute into the hospital having walked in the shoes of the people who are actually going to be the user community some day.

The average age is north of 40. The average level of work experience is more than 15 years in the clinical space where we have them aligned in our organization. We go after the senior folks.  We’ve been given our growth and blessed with having more than our fair share of them come to us and want to stay with us.

What are the big areas that customers are looking for help in?

Epic’s winning a ton of business. As a result, we’re getting a lot of new EMR install opportunities. Every vendor is active, whether they’re selling a lot of new stuff or not. There’s a lot of work around Meaningful Use and there is increasing amounts of work around 5010 and ICD-10. That’s happening across vendors.

Somewhere north of 60% of our current engagements are around an installation of a new EMR or a new EMR module. Twenty percent is optimization work, and another 20% is strategy and product management.

Are hospitals really doing anything with strategy or are they just executing the plan that the government pushed on them?

Well, here’s the good news. Hospitals that had a thoughtful strategic plan were already well down the path to Meaningful Use, so that’s good. Those who didn’t, they had one handed to them by the government.

However, what we’re seeing smart CIO of today focused on is back to their strategic plan of implementing good systems to manage quality and capture data and to get reimbursed by somebody. Very few are just trying to chase Meaningful Use. They are returning to a plan that is forward-looking beyond Meaningful Use. While we are doing a lot of Meaningful Use-related work now, hospitals are focused on getting the tools in place that will sustain them, regardless of  the next hurdle you have to clear for the government.

If you’re getting 60% new EMR installations now, then hopefully you’ll transition that to the optimization down the road, so your level of business won’t just be hump that goes away.

My personal opinion is that we’re in a hump. This hump is going to last well into 2013 — the initial work around installing next-generation software. To follow will be an acceleration in optimization work, for two reasons. Those who did it well in the install want to make it work even better going forward. Sadly, I think there will be a bunch of work around “optimization,” but it’s really fixing systems that were slammed in to try to get the Meaningful Use dollars and to avoid the penalties. I see a second wave hitting in 2013 to 2015, if you’re asking me to venture a guess.

Your acquisitions raised the headcount to over 450. Is that the next level of opportunity and challenge when you get that many folks?

Having scaled a very large company — Cross Country, a medical staffing company — there are inflection points, particularly in the services business. Typically north of 100 is an inflection point, north of 250, and north of 500.

The trick is to invest in the systems to support these fine people. You know, the billable folks. Having done this before — and this isn’t an ego statement — it’s just that we at Vitalize have invested in and we score in the 95, 96, 97% on all those key statistics in our yearly employee satisfaction survey that someone like me cares about. 

Consultant jobs are not easy. They’re on a plane on a Monday. They’re away from their family until Thursday night, and they get home exhausted and if their flights go off on time. A lot of the infrastructure when you get to be as big as we now are is geared to making the consultant’s life as easy on the road as we possibly can. A lot of money goes into that, with good results.

You did quite a few acquisitions in Cross Country. Do you see that continuing to happen at Vitalize?

Not nearly on the magnitude. For one thing the scale in the healthcare IT consulting sector is probably a tenth what the scale is in medical staffing. You’ve got 3 million nurses, you got 750,000 doctors, you got almost a million therapists. Those numbers are a lot larger, so there’s not the same scale opportunity.

Quite frankly, this is a much more highly specialized business than the world I originally came from. It’s nichey for good reasons. If you look at the landscape of companies like us in the early 2000s, Healthlink had been acquired or was being acquired by IBM. FCG and ACS … you know, the whole alphabet soup is huge now. They’re all half a billion to a billion-plus organizations. 

Then there’s a huge breakpoint between that level and MaxIT and us, because we’re the two roughly same-sized organizations in that middle market space. Everyone else is five, ten, 15 million in revenue. There’s a couple of up-and-comers who may be a little north of that, so there’s just not a ton of quality targets. 

Two, the really good firms and really happy doing their own thing and have created quite a lot of value on their own. They’re not easily acquired.

And, three — and this is probably the most important point — my belief a sign of a healthy organization is one that grows organically. If you’re growing just by acquisition, chances are there’s a reason for it, whereas our growth has been more than 80% organic and with 20% acquisitions of our three health partners back in March of ’09 and then Validus in January of ‘11. We’re not in a hurry, and finding quality partners is not an easy thing.

You mentioned that it’s a nichy-type business, but it’s a niche that everybody wants to play in. It looks like the pendulum has swung back where the big companies in slow-growth industries want to buy into consulting again. What’s your assessment of what’s going on there?

I think you hit that exactly on the head. I can’t speak for my competitors who sit in my chair, but we get two calls a week — more than that — from private equity firms who are dying to invest in our space, and for what you would broadly characterize as a strategic player who may be very strong in IT services, but not strong in healthcare at all. Or, maybe strong in “staffing,” but have no presence in IT.

There’s a lot of interest in our space. I predict there will be an acceleration in M&A activity. We’re stimulating it in our own and are looking to bring on additional capabilities or other big players trying to work their way in.

Two calls a week is interesting. Somebody builds a little consulting company, turns it into a big enough one to get some attention, sells it out, and then goes out and does it again.

Go back and do it again, right. In fact, you know the Encore people, Ivo and Dana. They’re a perfect example of what you just said. They had created something of great value, got absorbed by somebody else, respected their non-competes, and are back at it again. This is a world where you can actually do that.

Especially when the acquiring company messes up what you did.

Yes. All those people are free agents. They make their way back or they join a firm like ours, because truthfully, a lot of our key members are former Healthlinkers along the way.

You’re a venture partner with SV Life Sciences and you do your own investing. How would you describe the healthcare IT market from an investment standpoint, and how is it for start-ups in other companies trying to get a foot in?

I think it’s hard for the true startups. Right now, the mindshare of a hospital CIO is all around the big mandates. Even if you have game-changing software or a game-changing technology for healthcare, it’s not going to get any attention right now because there’s so many other big things to do.

As an investor, it’s a mixed blessing. On one hand, you’ve got a lot of entrepreneurs with really great ideas that aren’t able to get funding, so their valuation expectations drop and you can make investments at more reasonable valuations. That’s the good news. The bad news is it’s hard to scale right now because the attention and the energy and the dollars are going elsewhere.

The government keeps touting innovation, but its mandates to implement existing products doesn’t leave much room at the table for new players. Plus nobody will have money left to buy their product.

In the near term, but a smarter investor is looking out over a four- to seven-year horizon. Once the big things are dealt with, hospitals are still going to have to say, “So now what? We have these systems, we’re collecting this data, we have all these investments in pump and infusion technology, and we got to connect it all, and we’re going to have to farm the data and use it.” 

I think enabling technologies around collecting and analysis — true informatics –  will be the next wave. But the dollars and the energy on that will follow. This is what I think will be a double wave in the more macro restructuring of the healthcare IT universe.

For somebody who wanted to start a company like that, would this be a good time to get it going?

I think so. As an entrepreneur, you never want to get investors involved too early. They’ll take too much of your company. That’s just the way it works. On the other hand, you can’t do all you need to do without the mighty cash to do it, so it is a tradeoff.

My advice to entrepreneurs is bootstrap as long as you humanly can, because two things will happen. You’ll prove out your concept if it’s truly a good concept. At the end of the day, if you do raise outside money, you’ll be in a far better position to raise it at a valuation that’s favorable to you the owner.

Is there anything else you want to talk about or any concluding thoughts that you have?

If I could wave a magic wand for our industry, there would be additional investment in training the next generation of healthcare IT professionals. The most obvious source would be current clinicians who are ready to expand beyond direct patient care. The Vitalize experience has been that truly some of the most effective consultants are those who have walked a few miles in the shoes of the user community.

I would love to see some kind of a coordinated effort beyond government lip service to try to increase the pool. Everyone will benefit if they are more skilled people in our sector.

 View/Print Text Only

Top News

From Quilmes Boy: “Re: Google Health. Just heard a rumor that they are not pursuing development or sales.” Unverified, but strongly suggested by the Wall Street Journal as CEO Eric Schmidt steps aside as CEO to make way for co-founder Larry Page. If they back out of Google Health, that ought to have a major effect on … well, nobody. PHRs are the consumer versions of EHRs — potentially useful technologies that, rightly or wrongly, aren’t all that attractive to their target audience in their current form.

MedQuist (MEDQ) announces that it will voluntarily delist its stock from Nasdaq in April, saying MedQuist Holdings (MEDH, the former Cbay) has bought up 97% of the shares anyway. I suppose it’s just a way to cut the administrative cost involved with keeping two publicly traded entities going.

Reader Comments

From John’s Boy: “Re: Partners HealthCare. Announced today that acting CIO Jim Noga, formerly CIO for Mass General and its physician organization, will be promoted to CIO.”  Unverified, but John’s Boy helpfully included what looks like an internal e-mail announcement to that effect.

From Duke_ACC_Champs: “Re: another champion coming to Duke. Warrior Art Glasgow takes the health system CIO position.” Unverified. He is CTO for Ingenix.

From Siouxsie: “Re: Costco. You can buy everything there, even an EHR." Next time at Costco, I can pick up a set of tires, a five-pound bag of shredded mozzarella, a hot dog, and a copy of Allscripts MyWay (via Etransmedia). In fact, since they already have a pharmacy and a contracted optometrist, I’m surprised they haven’t stuck a doctor back there by the cigarettes and beer.

From GearShifter: “Re: browser. In our IT shop, we’d love to run IE9, we’d settle for IE8, but a couple of HIT application vendors require that we run the older versions of IE for their app to be supported or in some instances run correctly. Don’t always assume it’s IT keeping you down — sometimes it’s that shiny app someone selected.” Good point. I remember fighting those battles over Windows versions – one vendor requires the latest and greatest, while another refuses to certify its application on anything developed in the last five years. Even though the major browsers assume you will always want the newest version, you would think there would be a way to have multiple versions co-exist for situations like these (or to use Citrix or some kind of virtual desktop instead). I can understand requiring IE for official work use since it’s free and ubiquitous. As long as the desktops aren’t locked down, users can always grab their own copy of Firefox or Chrome to steer clear of interfering with the standard browser. And I’ll timidly suggest this: Apple doesn’t have that problem since it controls its entire proprietary hardware and software package. If you want that kind of Apple-like hospital system where there’s only one call to make and one neck to wring, your only choice is Meditech.

From Kid Rock: “Re: Allscripts. There are many things to look at when looking at the value of corporation (and earnings is just one of them – bear in mind that free cash flows and the determination of what should and shouldn’t be discounts are judgment decisions as well). Allscripts had a big investment year. Should the cost of goodwill and capital investment in buying Eclipsys be held against them? I’m not so ready to discount Allscripts.” I said pretty much the same thing. The best time to micro-analyze current financials to predict the future isn’t a few scant months after completing a big acquisition and a skillfully led untangling from a not very competent foreign parent company.

From Alhambra: “Re: your poll on who owns patient information. Unfortunately, that may be one of the major reasons we will have difficulty in attaining true record interoperability. The financial industry has made much more movement in the use of technology without any concern of data ownership.” I was thinking after the poll that people often don’t own all the information that pertains to them. Companies buy and sell e-mail addresses and detailed demographic information from those fake “registration cards” that everybody fills in after buying something that clearly doesn’t need to be registered, like a blender. Nobody complains about companies profiting from selling that information, which isn’t even de-identified. Ample precedent seems to exist that just because information pertains to you doesn’t mean you own it – school transcripts, driver’s license records, criminal history, credit history, etc. I’d be surprised if the lawsuit against Walgreens is successful for that reason. I think they have little to fear as long as there’s something in their Notice of Privacy Practices that covers that situation under the super-broad “treatment, payment and operations” blanket (which technically isn’t even necessary for de-identified data), which doesn’t even require them to give you an accounting of disclosures if you ask. Plus, how can a patient prove their de-identified information was sold?

From All Hat No Cattle: “Re: this paper. Interested whether you think the issues raised will generate much discussion.” Only the abstract is free, but from that, I’d say maybe a little. The “unanswered questions” about EMRs include clinician liability for reviewing a glut of electronic information and overrriding alerts, the lack of a way to report EMR software problems, and the lack of alignment of who pays for EMRs (in both money and time) vs. who benefits from their use. Neither the questions nor the lack of answers are new, but the further the practice of medicine moves up the food chain from small practices to bureaucratic government, insurance companies, and mega-corporations (both for-profit and not-for-profit), the less anybody’s going to worry about the individual clinician who’s on the wrong end of these issues. Unless you’ve gone off the grid with a cash-only practice, your soul has already been sold and resistance of many kinds (EMR among them) is futile. He who provides the tools makes the rules, and let’s face it – patient benefit aside, organizations love EMRs because they allow the executives to monitor and enforce compliance with corporate policies that may or may not be in the best interests of patients and providers. I’d like to be more positive, but medicine seems to be turning into one big 1990s-style HMO where nobody’s happy except big companies and their Wall Street investors romping happily through big profits fueled by delivering as little care as possible. What everybody doesn’t like about EMRs is no more than a symptom of the underlying problem.

From American_Idle: “Re: St. Raphael’s. Due to happen, surprised it took this long. Major Epic consolidation will result in many redundancies. St. Raphael’s HIS is very patchwork.” Yale New Haven Hospital considers buying its neighbor, Hospital of Saint Raphael.

HIStalk Announcements and Requests

My talented offshore programmer/DBA developed an elegant workaround to the bug that was causing some readers to have problems viewing this site using old versions of Internet Explorer, like IE6. Everything should be working correctly now.

Ed Marx has added an updated to his Leadership Equations post from last week.

Acquisitions, Funding, Business, and Stock

Physicians from Cleveland Clinic will provide updates and reviews of medical content for First Consult as part of a strategic relationship between Cleveland Clinic and Elsevier. Elsevier offers First Consult as an evidence-based resource tool for providers at the point of care.

Elsevier also just announced free access to both First Consultant and MD Consult from all IPs originating from Japan. Elsevier wants to make the resources easily accessible to clinicians caring for earthquake and tsunami victims.

Charge capture vendor Ingenious Med gets $3.25 million in funding from Council Ventures, which assigned the resulting board seat to HMS co-founder Tom Givens.

Sales

Amerinet selects 4medica as a healthcare IT supplier. Members of the purchasing organization are eligible for preferred pricing for 4Medica’s inpatient and ambulatory EHR products.

Emerson Hospital (MA) purchases the Pinpoint RX system from Centice, which chemically analyzes prescription drugs and automatically links to the relevant Medi-Span drug information.

University of Michigan Health System’s new C.S. Mott Children’s Hospital and Von Voigtlander Women’s Hospital, opening in November, will implement GetWell Town, the interactive patient care solution for pediatrics from GetWellNetwork. The system has been installed in over 20 pediatric hospitals. Also new from GetWellNetwork: Carroll Hospital Center (MD) chooses its interactive patient care solution, which will integrate with the hospital’s patient management, CPOE, pharmacy, nutritional, and other systems to handle patient education, service requests, and patient-clinician communication.

People

Lake Regional Health System (MO) promotes Scott Poest to CIO.

Announcements and Implementations

Rutland Regional Medical Center (VT) goes live on its $15 million EHR system March 1, which it hopes will qualify it for $5-$6 million in EHR stimulus incentives.

Government and Politics

The government of South Australia is cutting 100 healthcare IT jobs as it consolidates hospital IT functions into a centralized statewide structure.

Poor-performing VA hospitals are shaping up after the Department of Veterans Affairs starts publicly posting outcomes data.

Innovation and Research

Kaiser hoped its contest for ideas of how to build 100-bed hospitals of high quality (“innovative use of technology and facility design to improve access to care and foster collaboration and team care while remaining efficient and affordable.”) would generate 25 solid entries, but they’ve received nearly 400 so far from 21 countries.

Technology

Apple says it sold out its annual developers conference in under 12 hours. Tickets for the June 6-10 conference went for $1,599 each and are now selling as high as $4,599 on eBay and Craigslist. Crazy.

Other

Thomson Reuters names its 100 Top Hospital award winners, based on outcomes. The top four teaching hospitals are in Chicagoland: NorthShore University, Advocate Illinois Masonic, Advocate Lutheran General, and Northwestern Memorial.

Above is the next installment in Vince Ciotti’s look-back series called HIS-tory.

HIMSS Analytics says Meditech owns the largest chunk of the hospital EMR market, with its 25.5% share (1,212 installations) beating Cerner (13%), McKesson (12%), Epic (9%), and Siemens (8%).

Another benefit of EMR: speeding the pace and cost of clinical trials. Medical centers and pharma companies recognize that EMRs provide better tools to quickly and accurately find qualified patients to recruit. With EMR, recruiting the required number of patients for large trials can be reduced from years to weeks.

NextGen Healthcare and its parent company Quality Systems, Inc., recently challenged their employees and clients to raise $20,000 for The St. Baldrick’s Foundation to fund childhood cancer research. They exceeded their goal, raising $28,000. As a result, 15 NextGen/QSI leaders have shaved their heads, including  QSI President Pat Cline. Personally, I think bald is hot.

I got an e-mail blast from LinkedIn celebrating its 100 millionth member and noting that I (as real me, not as Mr. H) was among the first million people to join (in fact, I was around #100,000). I also noted while checking that out that the LinkedIn HIStalk Fan Club that Dann started is up to almost 1,500 very cool members.

Flush with being recognized by LinkedIn as an early adopter, I signed up for Amazon’s just-announced Cloud Drive. You get 5 gigabytes of free cloud storage for files (documents, MP3, video) and unlimited access from any computer, including a Cloud Player. Buy one Amazon MP3 album and they’ll raise your free capacity to 20 GB for the first year.

Sponsor Updates

• PatientKeeper appoints Chris Stakutis , previously with Computer Associates and IBM/Tivoli, as VP of engineering. 
• Wheaton Franciscan Healthcare (WI) picks CareTech Solutions to provide SEO services for its www.mywheaton.org website. CareTech also announces that it has added two new Web Content Management System. CareWorks Fundamentals and CareWorks Fundamentals Amped are lower-cost, standardized packages for hospitals with limited marketing budgets.
• Ozarks Medical Center (MO) picks ProVation Order Sets as its electronic order set solution.
• CynergisTek earns Gold partner status from FairWarning Inc., for its commitment to providing expertise and value to the healthcare community and for its consistent sales success.
• GE Healthcare introduces Centricity Research, a clinical research management solution.
• Wayne Memorial Hospital (NC) is implementing Ingenix’s LifeCode computer-assisted coding solutions, which apply NLP capabilities to identify diagnoses and suggest appropriate medical codes.
• Medical Society of Virginia will offer its members PM/EHR software and services from Sage Healthcare, which will include discounts, certification guarantees, and free upgrades.
• HT Systems signs two new customers for its PatientSecure palm vein scanning system: Altoona Regional Health System (PA) and El Centro Regional Medical Center (CA).

 View/Print Text Only

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The Status Quo: Profitability’s Biggest Enemy
By Tom Stampiglia

In just a few short years, the financial situation for healthcare providers has changed drastically. While patients only represented 12% of a provider’s revenue sources in 2007, they now account for almost a third of overall revenue, according to a Celent report. Between the rapid growth of high-deductible, consumer-directed care plans and a burgeoning self-pay population, patients are now responsible for a significant portion of both their medical expenses and a healthcare organization’s bottom line.

Despite these changing dynamics, many healthcare providers still employ the same conventional, long-standing approaches to revenue cycle management that were designed strictly with payers in mind. Even if these strategies are precisely what’s needed to capture quick and accurate reimbursement, they are unable to adequately address the unique challenges that come along with patient collections.

Why? Consider the industry standard for capturing patient fees. More often than not, patients are billed for their portion long after services have been rendered because providers are unable to determine exactly what the insurance company will allow for each procedure — the key variable in calculating a patient’s out-of-pocket obligations.

Unfortunately, this approach not only forces providers to postpone patient collections, but it also puts them at serious risk for payment delays and patient bad debt. In fact, more than half of patients’ healthcare obligations are never collected, adding up to more than $65 billion in lost revenues last year alone, according to McKinsey Quarterly reports.

By instituting practices designed to capture these funds at the time of service, healthcare providers can increase the odds that patients will fulfill their financial responsibilities. With recent technology advances, healthcare providers now have the ability to verify a patient’s eligibility and benefits status in real time and then pair it with the relevant CPT codes to determine insurance allowables.

Once allowables are determined, providers can apply patient responsibilities, including co-insurance and deductibles, to calculate precisely what the patient owes. Certainly this process could have been done before. However, using manual processes to examine each of these items for every patient would be cumbersome and unrealistic.

Beyond helping to accelerate cash flow, this upfront approach to patient collections brings greater transparency to payment processes and establishes a platform to conduct more effective patient financial counseling programs. With these initiatives underway, healthcare providers are well positioned to adopt a number of additional retail-based strategies proven to further enhance collections processes, such as introducing more patient-friendly billing statements, offering flexible payment plan options, and accepting credit or debit payments.

Another emerging trend that’s being met with great success is performing soft credit checks prior to the time of service. This approach, which acts like a form of financial triage, generates a rating of a patient’s likelihood to pay medical bills and gives providers the information needed to evaluate any associated financial risks. Once this information is in hand, providers can customize collection policies based on the unique circumstances of each patient.

Looking ahead, healthcare providers that implement these retail-based strategies and embrace their role as patient financial counselors will be well equipped to thrive in this new, patient-centered world. As consumers shoulder greater financial responsibility for care, it’s clear that change is critical to a healthcare organization’s survival, especially when it comes to capturing patient payments both at the point of service and beyond.

Tom Stampiglia is CEO of MPV of Austin, Texas.

Longitudinal Patient Record Systems – A Necessity for Accountable and Collaborative Care
By Alan Gilbert

In response to Dr. Jayne’s inaugural Curbside Consult regarding the lack of longitudinal care systems and the focus on episodic care, our experience has shown that a longitudinal patient record system is critical to realizing a goal of a more effective and efficient healthcare system that results in improved outcomes for patients. We believe that healthcare needs to be delivered at the point of need and not at the point of care.

One example of a longitudinal patient record is the National Clinical Network for Cleft Lip and Palate Services in Scotland. This project was established in 2000 to deliver interdisciplinary care between health professionals providing care for cleft lip and palate patients between birth and 20 years old. The objective was to provide a single record for a patient, creating a virtual multi-disciplinary care team for that patient including dentists, orthodontists, oral surgeons, speech pathologists, ENTs, audiologists, as well as the patients themselves, who were active participants in their own care. The platform accommodated clinical imaging, generated email,and letter alerts to remind clinicians and patient alike of their particular responsibility at specific times, and supported and facilitated audit and outcome assessments.

Benefits realized included:

• Improved communication – sharing of information across care providers
• Improved standards of care — a single source of patient information to monitor and analyze outcomes
• Improved coordinated care — interdisciplinary treatment planning and care has improved due to use of the platform
• Improved efficiencies — more effective use of clinicians’ time as well as the patients, their parents, and caregivers
• Improved data access — minimized risk of data fragmentation over multiple sites, reduced cost, time and effort incurred by offline data entry and replication
• Better patient satisfaction — through improvement in the organization of clinics and coordination among specialties
• Improved reporting — reports and analysis on a national basis

Another example of a longitudinal patient record is the National Sexual Health System in Scotland (NaSH) that was started in 2005. This strategy set out a framework for improving sexual health by enhancing access to information and services while enabling flexibility for local services to respond to local requirements. It also highlighted the need to be able to review existing data and develop a data collection framework to provide a more accurate picture of sexual health and wellbeing, in terms of both sexual conditions (chlamydia, AIDS, etc) and behaviors and attitudes.

Benefits realized included:

• Ability to produce and aggregate national sexual population and public health data
• Improved clinical care and access to patient clinical information by introducing more patient focused processes and the ability to communicate directly with patients through patient portals, secure email and text
• Streamlining of services enabling improved throughput and availability
• Increased ability to share clinical data across services nationally
• Removal of multiple manual record keeping systems
• Ability to address some clinical governance issues more effectively
• Reduced requirement for duplicate entry of patient data and better quality of data
• More efficient and increased integration of systems

These examples, as well as others in diabetes, cancer care, COPD, and infection control, all focus on the need for a technology platform that can create a consolidated clinical view of the patient, no matter their care setting.

Alan Gilbert is VP of business development for AxSys Health of New York, NY.

Playing the Percentages with EHR Uptime Will Not Pay Off
By Nelson Hsu

Playing with the percentages is risky for the many healthcare organizations on the electronic healthcare record (EHR) adoption curve. The percentages in question are EHR systems’ uptime – how often the applications are available and working at sufficient performance to meet healthcare providers’ needs. Industry standards, vendor claims, and assorted misconceptions about uptime conspire to make this critical area of EHR implementation a footnote where it needs to be near the top of the priority list.

EHR’s success depends as much on application availability as it does on functionality. According to a February 2011 report by AC Group Inc., system speed and availability was critical in physicians’ decisions to use an ambulatory EHR application. That’s a good start. Their perceptions of what constitutes acceptable levels of speed and availability, however, leave open the door to punishing financial and productivity costs.

A panel of physicians surveyed at a recent Medical Group Management Association Conference said if the system was not available a minimum of 99% of the time, then they would not consider the application reliable enough to use in the future. While that may sound reasonable, 99% is unacceptable for healthcare applications. System availability at that level roughly translates into an average of more than 87 hours of downtime annually — almost four days. And 99% isn’t even the minimum industry standard. The same AC Group report that included the physicians’ survey polled 37 EHR vendors and found that they don’t guarantee any better than 96% uptime.

That number of hours of downtime costs time and money. AC Group determined that for every minute an EHR application is down, the average physician practice spends 2.15 minutes to perform the required tasks manually plus the time required to update the computer systems once the system is back up and operating. The average cost of downtime, the survey analysis determined, was $8.13 per minute per provider, which equates to a median across all practice sizes and specialties of almost $488 per hour.

Nevertheless, most EHR software vendors will not even include uptime SLAs in their contracts unless specifically required to do so. When they are, almost every vendor AC Group talked to said that the cost of the system would increase from 5-20% for each 1% increase in uptime guaranteed beyond the standard 96%. With the products available today specifically designed for uptime assurance, there is no justification for levying such price premiums.

To gain the full value of their EHR implementations, physicians and healthcare managers must become their own uptime advocates. Eighty-seven percent of medical practices spend no time evaluating their EHR implementation’s uptime and service levels, instead leaving it to software providers who have little interest in it. Neglecting the amount of system downtime that a practice might experience could cost the average five-physician practice nearly $25,000 if the product is down just 10 hours during the course of a year.

Software providers may or may not recommend or provide a high-availability platform solution (either hardware or software) for their applications. Regardless, practices and clinicians must make this a requirement for the critical applications they depend on to run their practices and care for patients. The medical profession always tells patients to take responsibility for their own health. Now it’s time for the profession to take its own advice on this important issue.

Nelson Hsu is senior director at Stratus Technologies of Maynard, MA.

 View/Print Text Only

Dr. Jayne interviews Doug Farrago, MD

Earlier this month on HIStalk Practice, I posted a piece called “Meaningful Use: 15 Things Your Practice Can (and Should) Do Now.” I jokingly included an Item 16, which was a suggestion to immediately identify a CMHO for the organization – a Chief Medical Humor Officer.

CMHOs are hard to come by, so I wanted to introduce you to the self-proclaimed King of Medicine, Doug Farrago. Doug is editor and publisher of the Placebo Journal, often cited as “the Mad Magazine of medical humor.” Since starting the Placebo Journal in 2001, he has also published a compilation of stories, The Placebo Chronicles, as well as penning the Placebo Gazette e-newsletter and the Placebo Journal Blog. A man of many faces, he also stars in Placebo Television.

According to his website, “Dr. Farrago has risen to national prominence in the publishing world by providing a humorous outlet for physicians while fighting back against the medical axis of evil (pharma, lawyers, insurance, and a whole lot more.)”

I’ve been reading Placebo Journal since issue #2 and have also been a contributor, so I’m a bit biased. But given the sheer bulk of guidelines, regulations, mandates, programs, requirements, and dictates that most of us in healthcare IT deal with on a daily basis, being able to draw humor from all of it is a rare talent.

USNews.com once called Placebo Journal “raunchy, adolescent, and very funny.” When creating it, what was your objective?

The goal was to make people laugh. Plain and simple. The magazine is intended to distract docs from the crap we have to deal with. The stories we tell, like in the old doctor’s lounge, are what keeps us going. It enables us to commiserate.

How did you become King of Medicine?

Initially, I had posted an editorial in the Boston Globe about something ridiculous about our healthcare system that they wrote about. I wanted to piss off the ivory tower docs down there that pontificate on everything as if they are experts, but yet haven’t seen a patient in years. I made the point that maybe I should decide everything and should be named King of Medicine. It just stuck as I continued with the Placebo Journal.

You’ve also been an inventor and entrepreneur. How have those experiences impacted your ability to continue delivering quality medical care in a changing healthcare environment?

Absolutely … not. This is a job that is continually being bastardized by the idiots who have are trying to game the system. More and more people are jumping in the mix getting between the patient and the doctor. The only way to fix that is to get creative and go cash pay. I haven’t made the jump yet as I am owned by a hospital. It is really tough to get off the stripper pole.

How has technology impacted your practice in the last 10 years?

There have been some great advances with the ability to get information in real time. It has, unfortunately, opened up some bad stuff as well. We are entering a world of “industrialized medicine.” Mooooooo……

Do you use an electronic health record (EHR)? How has it changed the way you practice medicine?

EMRs are great for many things. The positive part is that I have info at my fingertips that was tough to get to in the old days. It is the never ending f#cking clicks and boxes that I can do without.

What’s your funniest EHR story?

I don’t remember one in particular. In general, I have been using an EMR for four years. During that time, I have lost the ability to make eye contact with people. Is that a new disease?

You’ve been fighting the establishment for some time. I understand you were once asked to leave the American Academy of Family Physicians annual meeting after covertly handing out copies of the Placebo Journal. The next year, you appeared in the exhibit hall in lederhosen. What’s next?

Unfortunately, our organizations have sold us all out. I am older and maybe a little wiser now. At this point, I just want to get people to lighten up a little and make a point in the process. Or just screw with their heads a little.

You used to work with professional boxers. Based on that experience, do you have any advice for physicians and their staff members as they try to navigate the CMS program for Meaningful Use?

THROW IN THE TOWEL AND WALK AWAY!!

As an employed physician, are you required to participate in the Meaningful Use program or are you able to opt out?

Right now, I am playing the game. My goal is to opt out of this garbage as soon as I can. Then I am going to wear a t-shirt that says, “I got your Meaningful Use right here” to the next big conference.

Although the Placebo Journal has always been a print publication, you recently made the decision to go strictly digital. I understand the unreasonable costs of utilizing a government-run agency had something to do with that. Although it was just the US Postal Service in this case, can you draw any parallels to what’s going on with other government forays into healthcare?

There are 82 federal programs dealing with teacher quality in this country. How is that working out for us? The same will happen with medicine. It is all bloat.

The local people at the USPS are great, but the fact is, no one mails letters anymore. Why are stamps so expensive? Why were there tons of people not getting my journal via snail mail every month? Too much government does not equal better service. Sorry, folks. The less middlemen in the healthcare system, the better.

You also do public speaking. Have you ever spoken on healthcare information technology topics? Any key thoughts you’d like to share with HIStalk’s readers?

I have not spoken on HIT, but my talks would still work as I can easily poke fun at what technology is doing to us. Besides, it would make you folks stop and think for a while. Maybe, just maybe, too much technology is bad. There is a human component to patient care, you know. An EMR can’t do a rectal exam … yet.

E-mail Dr. Jayne.

 View/Print Text Only