From Kip Keino: “Re: Ultimate Software. I heard a rumor they are for sale. They are an HR Payroll Saas Provider with significant healthcare presence.” I haven’t mentioned them since way back in 2004. Rumor is they’ve hired an investment banker to get the sale underway, although the company officially denies it. With a market cap of $1.5 billion on a couple of hundred million in revenue (and a PE ratio of 740!), I’d say it’s strongly possible, especially with Oracle and SAP flush with cash and a lot of hatred for each other.

From Dabney: “Re: WellStar. Lots of speculation why CIO Ron Strachan departed. This article in the local paper says he was fired and speculates why four senior execs, including the CEO, have been fired over the last six months or so.” The attorney representing the former medical group president and former CIO says they came to him about unspecified work issues. They were marched off the property by security this week. The article suggests the firings may have been related to a possible whistleblower lawsuit. The five-hospital Marietta, Georgia system paid the state $2.7 million last fall to settle improper Medicaid billing charges, which was followed by the firing of CEO Gregory Simone.

From The PACS Designer: “Re: lino – Online Stickies. TPD has found an application called lino -Online Stickies that provides sticky notes for your iPhone or iPad. It seems to be an application that could help practitioners through the posting of reminders during clinical rounds.”

From GI Doc: “Re: NEJM article. What do you think of it? It’s certainly a laundry list of problems in healthcare IT, but all I can see are a lot of vague prescriptions based on wishful thinking about how to solve them. But it sure puts the author in a position to say ‘I told you so’ about just about anything that can and probably will go wrong in the future.” It’s hard to believe this compendium of trite EHR observations warranted NEJM real estate. How many times do we need to read that healthcare IT has potential, but more work is needed to make it perfect? I’m as cynical as anybody, but those who use lack of perfection as rationale for doing nothing annoy me. I can’t think of any other industry that has argued so hard against using computers, although I’d support more government standards and even internal, IRB-type oversight within a given institution since I’ve worked in enough well-intentioned IT shops to distrust their project objectivity vs. patient safety (and some hospitals stupidly let their IT department single-handedly run projects that directly affect patients, which makes as much sense as turning them over to the departments that oversee electrical and plumbing). I’ve concluded that almost no one is objective about healthcare IT: the same person is nearly always for it or against it and will argue their position endlessly. Someday they’ll figure out that IT is neither good nor bad, so it deserves neither universal accolades or criticism — it’s just a tool that can make outcomes and cost better or worse depending on who’s using it, what they’re using, and how they’re using it (no different than a paper chart, an antibiotic, or a scalpel). Technology alone rarely makes sucky providers better or excellent providers worse.

I’m running the first of my “time capsule” editorials I wrote for an industry newsletter over several years (odds are you haven’t seen them since it was a boutique-type publication with a limited, high-level audience and no free subscriptions). I didn’t want to send an e-mail blast because some high-strung reader was sure to complain about the two seconds required to delete it, but the first is Is Forcing Physicians to Use Computers a Flawed Paradigm? I wrote it in 2006, but I’ll be surprised if it doesn’t still trigger some impassioned comments.

Listening: The Golem, a rock opera new on CD from Black Francis (aka Frank Black of the Pixies).

 

Nobody in my most recent poll thinks EMR vendors own the patient information stored on their systems, but that hasn’t stopped companies like Cerner and Practice Fusion from selling it. Beyond that, a full 29% of readers think the provider owns the data, not the patient. New poll to your right: should the VA/DoD replace VistA with an internally developed open source system or go with a commercial package, such as Epic’s? I’ve asked a similar question before, but I’m curious to see what readers think now as the Wisconsin politicians try to steer the government toward Epic.

A few readers have reported sudden problems reading HIStalk using older versions of IE. I’ve got a programmer trying to code around an IE design limitation that plagues no other browser (Firefox, Chrome, Opera, etc.) Microsoft fixed it all recent IE versions, but “don’t make us work harder” IT shops often lock down IE to old versions, frequently IE7 (released over five years ago) but sometimes even IE6 (released 10 years ago). Internet Explorer 9 is the current version, as of a couple of weeks ago. I would explain the nature of the bug, but I doubt anyone really cares other than me. My guy’s pretty close to a fix, I think. If I wasn’t already an IE non-fan, this would do it.

T-Mobile, soon to be part of AT&T if regulators approve, makes two healthcare-related announcements. GeaCom’s Phrazer, a video-powered translation product (video above, which would have been a lot more effective edited down to two tight minutes since it meanders painfully), will run on its network, as will wireless sensor-based monitoring from BeClose.com.

ONC posts its five-year strategic plan and invites public comment. The bullet points: (a) continue pushing Meaningful Use to increase adoption and information exchange; (b) reduce costs by improving population health via technology; (c) update the government’s approach to privacy and security; (d) give individuals access to their health information;  and (e) use healthcare information to improve healthcare knowledge.

The Motley Fool uses Allscripts as an example of why investors should ignore a company’s earnings (which are subject to accounting decisions) and instead look at its free cash flow (operating cash flow minus capital expense) from high-quality sources, ignoring that produced by items such as not paying suppliers or increasing accounts receivable collection in a non-sustainable way. It says 29.2% of Allscripts’ operating cash flow comes from “questionable sources,” such as stock-based compensation and related tax benefits. I’m not sure I buy the argument, at least as long as a company generates consistent earnings, but I suppose you could consider free cash flow an early warning system for earnings that could be threatened down the road. Not to mention that Allscripts had a high capital expense that brought down its free cash flow number, which could be a great thing if it’s using that capital to expand to increase future earnings (and not to mention that who knows what any of this means with the Eclipsys acquisition still fresh).

AssureRX Health gets $11 million in Series B financing, with additional investment from previous shareholders that include Cincinnati Children’s Hospital and Mayo Clinic. The Mason, OH company’s GeneSightRX test helps doctors dose drugs based on a patient’s genetic makeup, initially covering psychiatric drugs.

A report by the Nashville Technology Council concludes that the city is “the Silicon Valley of healthcare IT” based on the number of open IT jobs there. I’d say the methodology was shaky at best: a company checked national and local job portals and counted the open tech positions in Middle Tennessee, finding 925 open positions. I don’t know that I’d consider open jobs as a strong indicator of a city’s influence or appeal, although Nashville certainly has some big companies (mostly for-profit, but not all) that influence healthcare in ways sometimes good, sometimes not. Having no state income tax certainly helps in recruiting people and companies.

And speaking of Chamber of Commerce-type bragging, Georgia says it’s the #1 state in terms of healthcare IT revenue at $4 billion. It helps to have McKesson Provider Technologies in your back yard since I’d bet at least 25% of that figure is theirs, not to mention that many companies have Atlanta regional offices but not their national headquarters (like San Francisco-based McKesson and the former Eclipsys, now part of the Chicago-based Allscripts). Still, companies boost local payrolls and the tax base with a local presence, even if all the big decision-makers live elsewhere. Above is a map of Atlanta company offices from TAG Health (click to enlarge).

Voalte’s nurse communication system gets coverage on the Tampa TV station. It’s a good piece, although the talking head TV doctor wearing a gratuitous white coat in the TV studio (with a Fox 13 logo on it to boot) is a bit much.

Boston’s mayor welcomes NaviNet to the city and its new headquarters. It wasn’t  big move for the company, which offers provider-insurer connectivity, eligibility, PM/EMR, and patient communications — they relocated from Cambridge (1.8 miles from their old address to their new, according to Google Maps). Note to Nashville and Atlanta: according to Hizzoner’s fightin’ words, “Boston is unquestionably the country’s premier location for healthcare and technology innovation.”

Hello, Becker’s ASC Review: e-prescribing is not the same as inpatient CPOE.

A report says that Dutch technology vendor i.Know has been acquired by Intersystems. The company’s healthcare offering turns text-based information, such as clinician documentation, into structured data to create a physician dashboard for the patient. You can play around with a demo on their site at least theoretically, although all I got was a black screen.

E-mail Mr. H.

Carl Bertrams is SVP of HT Systems / PatientSecure of Tampa, FL.

 

Tell me a about your background and about the company.

March 1 was my 22nd anniversary in this crazy business. I originally started out in more traditional management consulting, back in the day when information systems was mostly flowcharts. I think I learned programming on punch card decks, so that probably makes me sound really old.

After doing that for a while and really understanding process, I landed accidentally in healthcare in 1989 with a small company here in Chicago that did electronic billing for hospitals. I remember my first day. I came in and I really didn’t know a UB-82 from a hole in the ground. That’s when hospitals were moving from paper to electronic and business just took off, so it was a great way to get introduced to healthcare on the non-clinical side.

About the time that UB-92 came along, we hit the medical necessity market and really jumped on the Medicare fraud and abuse bandwagon for about eight years. We did a lot of cool technology around that when really nobody else was doing that. And then, most recently, kind of worked my way up the revenue cycle, spent some time in HIM. We sold one of our companies to 3M and got into transcription a little bit and ended up, finally, at the front of the revenue cycle river and patient access. 

HT Systems was started in 2005. The principals of the company literally have decades of experience helping hospitals improve revenue cycle efficiency one way or the other. Basically it’s about hooking specialized technology to the big vendor platforms. That’s what we’ve done on and off for 20 years. 

PatientSecure is really the coolest technology I’ve ever been associated with. It’s revolutionary way to positively identify the patients at any point in the access stream, whether it’s inpatient, outpatient, or emergency room. We do it using palm vein authentication technology. 

If you look at it at the 50,000-foot level, it’s really pretty simple. We create a one-to-one link between the patient and his or her medical record. We do that through the unique vein pattern in the palm of your hand. Every time the patient returns to the hospital or to the clinic, they simply put their hand on a scanner, and within a few seconds, their unique medical record is pulled up automatically in front of the registrar. It’s like doing a retinal scan in the palm of your hand. We don’t replace the existing ADT or registration system — we just make that process a lot faster and a lot more accurate.

When hospitals hear biometrics, they probably think of finger-type security for employee access to IT systems. Why is palm vein security better and how did you get the idea to move it out front to the patient?

Like a lot of good ideas, it started with some hospitals. Our alpha site is the Carolinas HealthCare System in Charlotte. It’s a very innovative group down there. They had been a long-time customer of ours.

When you think about fingerprints, that’s a good example you bring up. If I’m working for you and part of my job description is to punch in and do it with my thumbprint, that’s part of my job. But the experience that healthcare has had trying to have patients provide fingerprints, especially at the point of patient access, has not been that great. Carolinas had tried that and didn’t have success with it.

About that time – this was 2007 – they were looking with us at the Fujitsu PalmSecure device. It is not only significantly more accurate than a fingerprint, but doesn’t have the negative connotation that people associate with fingerprints, like law enforcement and all that. It’s contact-less and a technology for its time. Across the board, we have 99-plus percent patient adoption of the technology.

Have your clients found improvement in knowing that the person presenting an insurance card is really the person who’s entitled to the service?

This last year, the statistics I read said there were over ten million people in the United States who fell victim to identity theft. The fastest-growing form of that identity theft is medical identity theft. In 2005, medical identity was about 3% of the total, or a quarter million people. Last year, it was 7%. You’re talking about 700,000 cases of pure medical identity theft, and then maybe another half a million cases where people are complicitly lending their insurance card to their brother who lost his job or there’s some sort of minor conspiracy going on there between the patients.

This literally just shuts the door on that, but it also addresses the human error element. We’re putting the system in in Harris County in Houston, A Houston Chronicle story said there are 466,000 patients in their MPI that shared the same name with as least 24 other people in the system. You can imagine that whether you’re there with a stolen ID, or you just come in and say, “My my name is Jim Johnson” and there’s 37 other Jim Johnsons in the system, the chance for error at the front end is bigger than I think most people would think it is.

I know at my hospital we have that problem all the time, where either the patient gives the incorrect name or someone looks it up wrong, doesn’t find it, and enters the other name, and then they have to go back and merge the medical records. That’s a pain because not all systems, including the clinical ones, handle patient merges all that well. That’s pretty much eliminated, correct?

It is if you do it right on the front end. When the patient comes in for the first time, they’re in the hospital system, but not in the biometric system. You put your hand on the sensor. It’s going to say we don’t know you biometrically. At that point, the registrar does what they do every day — ask you for ID. Most of our customers will only enroll a patient if they present a valid photo ID. I find you in the system and do a one-time enrollment where I’m linking you to that medical record. 

From that point forward, when you walk in, you put your hand on the sensor. You’re basically finding yourself in the system. It’s virtually impossible for you to ever have a duplicate medical record downstream from that enrollment, and more importantly, to have a medical record overlay. That’s a much more serious situation where you’ve picked the wrong record of the same-named person and now you’ve laid their medical results and lab tests and blood type and all those things on top of it. In a good situation, that can just be a hassle for IT — like you said, merging the medical records — but in the worst-case scenario, you give somebody the wrong medicine or you kill somebody and the hospital is looking at a lawsuit that is hard to get away from.

The other benefit would be that most every provider organization has multiple venues of care, whether it be clinics or physician practices that are owned or affiliated, plus their own inpatient facilities. If you were connected to the same system, or maybe even if not, you could enroll the patient once and be sure that no matter where they show up, you know who they are.

That’s one of the cool things about the way we set up the technology. You can have an unlimited number of unique identifiers associated with the same single biometric.

Duke is a good example. They have GE Centricity at the clinics, they’ve got Siemens Invision at one hospital, they’ve got Meditech at another, they’ve got a homegrown at the big university, they have their own EMPI. I could be five or six different numbers within the system. By putting my hand on the sensor, it knows who I am, and it’s smart enough to know that, “Oh, I’m in Durham, pull me up in Invision. Oh, I’m in Raleigh, pull me up in Meditech.” 

Just as you were saying, a lot of mistakes happen when somebody gets registered at the physician’s office or at the clinic, but is registered differently at the hospital. That’s one of the places where the mistakes happen. By having this cross the whole enterprise platform, you tend to eliminate that mistake.

You mentioned that your hardware is from Fujitsu. How are you adding value to that? What is your secret sauce that brings you into the picture as part of the value chain?

The Fujitsu device is a near-infrared camera — great technology. With biometrics, you need to very aggressively manage the biometric database. It isn’t one plus one equals two. There are a lot of moving parts.

We wrote the algorithms, the search algorithms. We make it incredibly fast and easy for you to be found in the database, even if you come into the emergency room unconscious. If you were previously enrolled, they’d be able to bring this to the bedside and know who you are, as opposed to treat you as John or Jane Doe. 

Our secret sauce is really those proprietary algorithms and the edit engine that we wrote. I think that makes us a really comfortable partner for our hospitals. We have decades of experience being under the hood of all these different HIS and PMS platforms. We know the workflow. We know how these things operate. We’re very comfortable in all these different platforms. We’re not just technology guys come in and selling something slick to the hospital. We know hospital revenue cycle and bring a technology that absolutely shows them an ROI, but makes it easy to adopt both by their staff and by the patients.

If I’m a hospital and I’m interested in your solution, what’s involved with implementing it and how do you price it?

The pricing model is enterprise-driven, so there’s a one-time software license fee. The enterprise could be that I’m a 200-bed community hospital and that’s the start and end of it. It could be that I’m 17 hospitals across three states with 57 clinics and 20 owned physician practices.

There’s an implementation fee and that goes up or down based on how many different interfaces we need to write and how many different points of entry that we’re actually going to roll this out to. Our implementation fee is all-inclusive of the interfaces, the on-site implementation, and the user training. We sit there with the hospital staff while they actually enroll patients and answer those questions that come up.

It’s a pretty light install. It all happens behind the hospital’s firewall. We operate on SQL Server. It can be a virtual server. It’s a very small footprint. Carolinas, with almost two million patients in the database — they’re probably a couple of gigs of storage. It’s amazingly small of a footprint that drives this whole engine.

For that 200-bed hospital that you mentioned, how long would it take to implement and roughly what would the cost be?

The implementation time is a pretty standard 60 working days, two to three months from the time we say let’s go, have a kickoff meeting, and figure out where in the workflow they want to insert this. We do a lot of the interface work off site — dial into their test system — and then we put the technology on site and do the training. 

From start to finish, a hospital is normally going to be live in a couple or three months at the most. If they want to be more aggressive, it can be shortened sometimes.

In terms of a ballpark figure, if I’m a 200 bed hospital and have 15, 20, or 30 points of entry that I want to cover, you’re probably talking about $100,000 to $150,000 as a one-time cost with an annual maintenance fee beyond that. We also have a model where if a hospital doesn’t want to lay out upfront capital, they can spread the whole thing out over three years and there’s no money up front and we don’t tag on any interest.

We try not to nickel and dime. The one thing I’ve learned in twenty-some years of hospitals is give them a price and let them budget it and be done with it. If hardware breaks, we replace it. We extend the warranty on the hardware for as long as somebody’s a customer. If your interface needs to be tweaked, if you want a custom report, all that’s included. The only time that you’d be looking at additional fees was if you took out Meditech and put in McKesson, where you have to totally rewrite the feeds. Other than that, it’s pretty straightforward.

Your website mentions that Japanese banks are already using the palm vein scanning and also that standardized test companies are moving in that direction. Do you see other potential uses in healthcare, for instance, anything related to patient safety?

We’re meeting with some folks around the country who want to look at this for e-prescribing. You could certainly put this in the nursery and control who’s coming in and out. We’ve had hospitals that want to use it also as a vendor identification system. For us, we’ve started in patient access, but we certainly see a lot of other use cases. Once you’ve got the technology, extending it to another place in the system is a minor cost.

Any concluding thoughts?

In healthcare today, there’s a lot of cool technology, as we saw at HIMSS. But for those of us in the revenue cycle — the non-clinical side of healthcare — the bottom line is the bottom line. CFOs are tired of hearing about this fluffy, feel-good kind of ROI. You’d better be able to show them that you actually are reducing costs, or you’re solving a problem and improving quality and patient safety, really prove it. We feel this technology does that every day.

Patient access is the filter at the front of the revenue cycle. If you get it right there, everybody else’s job downstream is a lot easier. If you screw it up at the front, you know what they say about stuff running downhill. We help the hospital get the very first job done right, and that’s identifying the patient. If we can do that, the ROI is undeniable. 

HT Systems is in a great space in the market. We love what we’re doing. We also really love the fact that there’s vehicles like HIStalk out there to help us get this message out and to give us feedback from the field, from the vendor community, and from the hospital community. 

It’s exciting time for us. We think we’re just at the beginning of a big set of waves that are going to come down. Other than that, we just looking forward to keep telling people about what we’re doing.

There is one last thing I would like to say. I’d really like to let our Fujitsu partners and friends over in Japan know that we’re thinking about them and praying about the situation over there. They’ve got a tough road to go, but it’s a great culture and a great spirit, and I’m sure that they’re going to ultimately recover from this as strong as ever. Our thoughts and prayers are definitely with them.

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in January 2006.

Is Forcing Physicians to Use Computers a Flawed Paradigm?
By Mr. HIStalk

Welcome to my weekly column, which will appear every Thursday morning as part of the Inside Healthcare Computing Electronic Update. For those subscribers who don’t know me, I’m Mr. HIStalk. I’ve been writing the blog HIStalk under that keyboard name for almost three years now, cranking out nearly 500 long and detailed articles about the health care IT industry, interviewing CEOs, and providing sniggering, sophomoric humor to an industry that often takes itself too seriously.

I don’t use my real name because I’m a cynical blowhard who likes to speak his mind. I think I’m entitled to that privilege after many years in the HIT industry as a clinician, vendor peon, informatics practitioner, and IT director for a couple of large IDNs. On the other hand, getting vendors, member organizations, and industry notables riled up (especially those associated with the hospital from which my paycheck flows) is hardly a ticket to job security. So, let’s just leave it as Mr. HIStalk, if that’s OK with you. I still need that day job.

My writing here will be specific to one timely topic, different than the highly-condensed news and occasional editorial that I write for HIStalk. I have just one objective: to make you think. Like an aging hippie, I’m imploring you to question authority and don’t trust people who tell you what to believe (even me).

Let’s jump into what’s new. The online world has been abuzz about the Children’s Hospital of Pittsburgh article in the December issue of the journal Pediatrics, which suggests CPOE caused increased mortality in the hospital. I’ve put some of my thoughts about this on HIStalk, but let’s look at this story from another angle. Namely, is the paradigm of forcing physicians to use our computer systems personally and directly a flawed one?

Think of your most recent meeting with a local banker, attorney, real estate agent, dentist, or accountant. Did they place a computer monitor between themselves and you, making your conversation nearly inaudible over their furious keyboard tapping? Did you trust their advice even though they weren’t staring at the computer screen while awaiting an infusion of wisdom from faceless offshore programmers whom they’ll never meet personally? Did you think less of them because they listened and talked instead of typed?

I haven’t seen that. So why then do we expect doctors to be held to a different standard? It doesn’t make much sense, especially considering that they’re mostly self-employed and are as much a hospital customer as patients. Is it realistic to believe that their profession alone requires them to interact constantly with a computer to be effective, both providing information for use by others and receiving similar information in return?

Suppose you go into a restaurant and the waiter informs you that a new policy requires you to enter your order directly into a PDA, which will also provide recommendations and dietary warnings that someone has decided you should be forced to review. This will also solve the problem of illegible food orders and wastage due to poor waiter handwriting, along with incorrect tallying of your final bill (and maybe slyly pitching high-margin alcohol and desserts along the way). Maybe you’d see this as a good thing, maybe not. And if not, you’d go elsewhere.

As a customer, the only place that I see a lot of computers in use is in retail establishments, where the user is the lowest level of employee. Those folks aren’t rocket scientists. They didn’t have to go away for a week of training, nor do they have to tape reminders to their smocks or juggle 10 passwords. The systems they use were written with them in mind: simplified, optimized to their workflow, and nearly impossible to mess up. The part-time kid at McDonald’s can get your hamburger order right just as easily at Wendy’s, every time. Very smart minds dumbed down the systems to be as foolproof as the French fry cooker.

CPOE systems, on the other hand, are confusing, even to long-time users who have attended training. Just ask a nurse or pharmacist exactly what will happen when they change the schedule of a QID order and you’ll see what I mean. Hospitals that found their clinical systems too inconvenient for impatient nurses to use (turfing them off to unit secretaries) are now surprised at CPOE pushback from the docs. If their systems are so great, how come every nurse doesn’t already use them for medication barcoding, for entering nurses’ notes, for receiving point-of-care recommendations, and for shift scheduling based on expertise?

I’m not saying that CPOE is a bad concept. I’m saying that CPOE systems (and user implementations of them) need to be better to avoid harming patients, as the Pediatrics article’s authors described in Pittsburgh. If not, then please don’t install anything that makes the situation worse. And if those systems really do reduce unwanted outcomes and decrease costs as everyone believes (but few have proven), shouldn’t whoever benefits from that situation be willing to pay doctors for the indisputable extra time it takes to use the systems, possibly in the form of reduced malpractice insurance premiums or higher reimbursement?

Maybe what we should be pitching is electronic medical records — still a new concept to the hospitals that are chasing the sultry siren of CPOE instead of automating the basics first. Let’s worry less about who does the keyboarding and concentrate instead on making all existing information available in electronic form.

In the meantime, vendors can do a better job in designing CPOE that works for doctors, not programmers. And we in hospitals can rethink whether we’re using doctors optimally by having them interact with computers, doing the same things they did on paper, or whether new roles are needed for “information assistants.”

Top News

iSoft suspends trading in its stock and puts itself up for sale. That probably forces the hand of primary contractor CSC to buy the company itself given its own commitments to the UK’s NPfIT project (although you never know – Cerner might give iSoft a look given its global ambitions). Just about every vendor and consulting company involved with NPfIT, including NHS itself, has suffered despite the billions the British government has spent on its ambitious but largely failed centralized healthcare IT strategy.

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Reader Comments

From Hate Manual Entry: “Re: JarDogs. A large medical practice is exiting their selection of JarDogs as their preferred vendor of portal services as the company is unwilling to sign a BAA agreement. Their stance is that they do not have independent access to the patient data. As a subsidiary of Springfield Clinic, one can only assume they are receiving poor legal advice from the practice perspective vs. a software vendor. Who would sign without a BAA in place? Mr. HIStalk, do you know anyone in high places at JarDogs to confirm or deny this stance?” The company’s response: “To date, Jardogs has not lost any FollowMyHealth deals as a result of a BAA issue.”

From Epic Interest: “Re: VA and DoD. Here’s the letter from the Wisconsin congressional delegation. You can see here that besides Epic as a company and Judy as an individual, her husband Gordon has been keeping up with her political donations penny for penny. The PCAST report listed only four institutions as health IT success stories – the VA and three Epic sites.” All the recommended sites use Epic, of course. Judy gave $349K and Epic another $726K in political contributions, but that was over a 13-year period. I don’t know that $82K per year in donations buys a lot of clout these days, but having thousands of taxpaying employees surely does.

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HIStalk Announcements and Requests

The new format stays, with the voting 62% to 38% in favor. Old-schoolers can still look forward to a more informal and category-free Monday Morning Update.

This week on HIStalk Practice: a PCMH pilot results in lower costs and better outcomes. The SoloHealth kiosk is coming to a grocery store near you. Kaiser Permanente Hawaii sees an uptick in patients using online tools to schedule appointments and communicate with physicians. The owner of storage units holds medical records hostage over unpaid rent. One hundred percent of readers say they love or like the news presented on HIStalk Practice, so we promise it’ll be a good read.

Tonight’s post will be a bit shorter than usual since I’m taking Mrs. HIStalk to a concert (I’m dressed in all black and scowling so I’ll look emo-intense, which I’m sure will amuse her). Your regularly scheduled verbosity will return with the Monday Morning Update.

On the Jobs Board: Implementation Tester, VP/Director, Microsoft Alliance, Regional Director of Enterprise Sales. On Healthcare IT Jobs: Cerner Clinical Analyst, IT Systems Analyst, Eclipsys Clinical Consultants, Clinical Informatics Specialist.

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Acquisitions, Funding, Business, and Stock

Fortune Magazine publishes its annual list of World’s Most Admired Companies and HCA is named best medical facility. McKesson was the overall leader in the healthcare wholesalers category, while Henry Schein took the top spot for social responsibility and global competitiveness among healthcare wholesalers.

Publicly traded EMIS, the UK’s largest EMR vendor, shuts down its operations in Canada without having established significant market share there. The company blames the lack of national standards that fragments the Canadian market into 10 provinces that each have their own certification requirements.

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People

Good Samaritan Hospital (IN) promotes Chuck Christian from director of IT to CIO.

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Announcements and Implementations

Southeast Texas Medical Associates reports that its use of IBM business analytics has helped doctors identify trends and assess treatment protocols, which in turn have reduced the number of patient hospital readmissions by 22%. In addition, physicians have reduced the required time to evaluate patients’ data prior to treatment from an hour to a second.

The South Florida REC says that more than 1,000 physicians have signed up to receive EHR adoption and implementation services.

Maine Primary Care Association (MPCA) partners with Arcadia Solutions on an initiative to gather and standardized electronic PHI for evidence-based decision making. MCPA is connecting 19 community health centers to a centralized database for aggregate reporting.

The REC PaperFree Florida updates its list of qualified vendors.

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Innovation and Research

The engineering school at UC San Diego announces a call for entries for its Southern California Healthcare Technology Acceleration Program (it would have been acronym heaven if they’d used “uptake” instead of “acceleration.”) Three to five programs will be chosen that can lower the cost of an area of California healthcare by greater than 30%. They will receive mentorship and up to $100,000 in funding, with suggested areas including chronic disease management, reduced procedure cost, and telehealth.

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Technology

I feel like I have a new PC with all the speed I’m getting. Reason: Firefox 4.0 (super fast) and a much-needed upgrade to Yahoo Mail, which had slowed down to the point of being nearly unusable. Now if someone could just fix Netflix streaming, which is dog-slow now that everybody and his brother has signed up.

We might have guessed right on the supposedly big announcement from billionaire Patrick Soon-Shiong. Most of what he had to say at the CTIA conference seemed to be pie-in-the-sky predictions about personalized healthcare, but he mentioned object recognition (like that developed by the computer game company he just invested in) as having medical application.

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Other

LinkedIn membership hits 100 million this week. Sounds like a great reason to link up with Mr. H and Inga. Or if you rather, friend Mr. H, Inga, or Dr. Jayne on Facebook. Or just like HIStalk. LinkedIn, by the way, says nine percent of its members are in the high-tech community, though a mere 74 individuals are Elvis Tribute Artists.

I’ve griped before the some of the allegedly HIT-focused news blasts have unrelated stories that seem to indicate a lack of reporter knowledge about healthcare IT. Example above, from the loftily titled Health IT Strategist (I never see much of anything strategic in their headlines, but whatever). So I wondered why I hadn’t heard of Teleflex, which earned a big mention here. Reason: the “medical technology” it wants to focus on (the reason it’s selling its boat steering products division) has nothing to do with IT – they sell catheters, ventilation supplies, and laryngoscopes. Just what strategically thinking CIOs are worrying about these days.

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Sponsor Updates

• Six oncology treatment centers add IntelliDose software to their Allscripts EHR to handle oncology-specific functions. Allscripts and Intellidose signed a partnership agreement last year.
• Sunquest Information Systems announces three enhancements to its ICE 5.0 Solution Suite, which is principally intended for use in primary and secondary care NHS Trusts.
• Baycare Health System (FL) selects Medicity’s HIE solutions to connect with community providers and to share patient data. McKesson’s Practice Partners, Allscripts and GE Centricity are among the first EHR applications the HIE will integrate.
• The 17-provider Orthopaedics East & Sports Medicine Center (NC) selects SRS e-prescribing application as a first step towards full EHR adoption.
• AT&T partners with BlueLibris to provide wireless connectivity for a wearable, personal monitoring device that provides near real-time monitoring of patient physical activity.
• HMS clients Rockcastle Regional Hospital (KY) and Breckinridge Memorial Hospital (KY) are awarded incentive checks for their EMR adoption. Rockcastle received a check for $630,000; Breckinridge for $194,000.

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EPtalk by Dr. Jayne

According to a recent Intuit Health survey, offering e-mail and online payment would boost collections. American Medical News cites patient confusion as a frequent cause of delayed payments. Additionally, physician practice spending on bills and attempts to collect would be reduced. Surprisingly, the study notes that half of patients still pay with paper checks. Although I agree in principle, I think that before practices and health systems deploy these systems, key players need to enroll themselves and try it out first hand.

There are winners and losers in the game. My last experience with the online bill pay website at a large academic medical center (which shall remain nameless) was somewhere on the scale between “exasperating” and “who are they kidding?” Luckily since I’m a patient at a practice with a topnotch patient portal, I’ve experienced the other end of the spectrum, completing their new patient questionnaire from my sofa rather than in an uncomfortable waiting room chair.

USA Today features hospital robots used to transport everything from pharmacy supplies to linens. Units are programmed with hospital floor plans and use sonar, infrared, and laser sensors to avoid people and obstacles. This isn’t a new concept – one of the hospitals associated with my medical school had one. It wasn’t sophisticated (running along a painted line on the floor and beeping at you when you were in its way) and only operated during the night shift.

HealthDay highlights a recent study  which concluded that text messaging can help heavy smokers quit. Text reminders to document cravings, smoking, and mood were seen to be “as effective as more costly and harder-to-use handheld devices.” I wonder if I can get a grant to do a text message study reminding compulsive text messagers to close their phones and enjoy the spring weather?

Low-tech but fascinating. Most physicians have war stories about the most interesting cases they’ve seen. Some take it a step farther and collect medical artifacts. Personally, I have a collection of medicinal alcohol prescriptions that were written during Prohibition. I used to be a patient at an ophthalmology practice where the physicians had a curio cabinet of items they had removed from patients’ eyes – metal fragments, projectiles, and even fish hooks. Chevalier Jackson MD practiced in the late 1800s and early 1900s and kept a collection of foreign bodies swallowed by patients during his career. Over 2,000 items are on display at the Mütter Museum in Philadelphia, with a slideshow available for the curious.

Social media fans take note: The Dayton Business Journal reports that 41 percent of people turn to social media for healthcare information, with 94% of them leveraging Facebook for medical advice. I was starting to feel pretty good about my Facebook following until I saw that the Centers for Disease Control and Prevention has 80,000 fans and the American Cancer Society has 226,000. Regardless, you can still friend Mr. H, Inga, or Dr. Jayne.

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Contacts

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

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

Leadership Equations

After receiving my diploma and officer commission, I headed to the Army Engineer School. Next to aviation, engineering was the most sought after Army career. The other 120 lieutenants in my class were either academy or engineer school wunderkinds. What was I, a psychology major, doing here?

The first week of evaluations earned me a pass to engineer “reform school.” Because of a mix-up in orders, I never got there; I stayed and clung for dear life. To make a long story short, I studied my rear off learning a few fundamental equations and applying logic — meaning I forewent partying with the wunderkinds. I eventually grasped the theories and their practical applications …

Fast forward …

i2i. The department chairman of emergency medicine, University Hospitals Case Medical Center, phoned me. “Ed, this is Dr.Michelson. Do you know what is going on in our emergency department right now?” He was so upset I thought I was on speakerphone being broadcast all through the pediatric Level1 Trauma Center.

I politely ended the call. As a new CIO, I did not want to have impersonal relationships. I wanted to talk face to face.

When I arrived, Dr. Michelson was directing traffic and evaluating patients. One of the IT applications had failed and was wreaking havoc on their process flows. Investigating the situation, I realized we could alleviate some of the cramped conditions by updating their technology. Although it took a couple of hours to restore the application, the next day we gave back additional space to the ED. Simple things, like replacing monitors, PCs, and multi-function devices.

The next day, I received a call from the chief medical officer. “Ed, I heard what happened yesterday. Nice work. That is the first time a CIO ever left the ivory tower and walked the walk.” The story went viral, and the benefits to an eye to eye approach become clear. I soon coined the term i2i and encouraged its adoption by all in IT. From that point, I stopped handling serious matters by email or phone.

Another rise in the growth curve. I also began to use i2i in crucial conversations and confrontations.

We had a physician executive who routinely abused anyone standing in his way. Because he produced results, his behavior was tolerated. After exhausting escalations with chain of command and human resources, I took matters into my own hands. Over coffee, I mustered my courage and laid out the situation to this senior officer. He hid behind his coffee cup, but we connected i2i, and my message landed. That was the last time he abused my staff.

p3. I met up with some docs to talk CPOE and how to amp adoption. As hard as I tried to connect, they weren’t buying. My points were valid and my objective admirable, but no progress. I took another run at these influential physicians, this time with my CMIO, and he got it done.

Those docs never disrespected me. They were simply more open to advice from a peer with experience than some suit administrator with a theory. In many of my medical staff interactions, I leverage the strength of having a physician speak to a physician. I engage to learn and support, so I think of it as p3. The situation transcends physician to a physician to the next power, where you have physicians collaborating with physicians and administration. As a result of p3, we have seen our CPOE reach maximum levels.

e4e. I received a call from the medical director of our newborn intensive care unit (NICU). This NICU consistently ranks in the nation’s top five. After several attempts to get resolution on technical matters, the medical director had become exasperated with IT. Out of 20 mobile carts, only two were operational. She stated that nurses and physicians were standing in line to update charts and enter orders to take care of these beautiful babies. I was aware of this escalating over a few days, but was certain we had resolved it. I told her, “I’ll be right over.”

I had our field services manager and three technicians meet me at the unit. I could not believe what I saw. Nurses and physicians were waiting around to use the two available carts. The sides of the halls were littered with unusable carts as if a tornado had passed through.

What if my child were here? I became indignant. As I approached the medical director, I saw the tears of frustration. All I could think to do was embrace her. We both cried. Frustration, anger, compassion. Someone cared. Now it was time to execute. It was critical to meet emotion for emotion, or e4e.

We borrowed carts from other units. Within 30 minutes, we had 10 working. Others were replaced or repaired within 48 hours. When I returned to our IT offices and found my director and VP of operations still chatting about how to fix the problem, I replaced them.

i2i, p3, and e4e have become part of my nature. While there is no formula to leadership, these equations make up the framework from which I operate. At the end of the day, nothing demonstrates care and commitment like looking someone in the eye, identifying on someone’s level, weeping with those who weep, and laughing with those who laugh.

Technology is the easy stuff. Knowing technology can never make you a better leader.

Oh yeah, and engineering school? I learned the basic equations and graduated near the top of the class.

Update 3/28/11

Thanks again for your readership and comments. Dr. Lafsky is correct on my English — thanks for pointing this out!

I like the idea that several shared along the lines of walking in the customers shoes. Early summer, I hope to share some of our success in this area that has helped tremendously.

As for Blah, I embrace him/her and would enjoy the opportunity to chat sometime. His/her facts are incorrect, but I hold no ill will towards him/her. I have made many mistakes, some of which I described in Biggest Blunders. I will make more. Ideally never the same ones. Let the person who is without fault cast the first stone.

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.