From Kelli: “Re: Epic Beaker lab system. Epic isn’t much help in installing this application. Neither the technical or application side is a font of knowledge. I know it’s not a seasoned app, but I would still expect the company that coded it to have more knowledge about it.”

From Madeleine: “Re: immunization registry EMR interface. After multiple communications with [vendor], they decided that if the test submission of the Immunization Interface to the I-CARE registry fails, they will still charge us the full price of the interface. I asked for a refund if it fails and they declined to do so. The cost to our practice with be $6,000 for the interface and $900 for interface support, unfortunate since our three-provider practice already invested heavily in hardware to be able to upgrade to the vendor’s MU version. Even if all three providers are awarded MU in 2011, we will have paid more into the system to obtain MU than we will get back from the EHR Incentive payment.” We forwarded the comment to the vendor, giving them a chance to explain or maybe change their minds even though we (and possibly they) don’t know who you are. In the mean time, I’ll leave their name to give them time to respond. Hopefully you didn’t implement for the money alone because it won’t be the pot of gold you might have thought (as you are now finding out).

Nearly 3/4 of respondents to my last poll don’t think Meaningful Use will improve patient outcomes and patient safety. New poll to your right: given Oppenheimer’s initiation of coverage of certain healthcare IT stocks, which company’s shares would you buy today for long-term appreciation?

Meanwhile, the newly issued “underperform” rating that Oppenheimer gave Cerner didn’t dampen investor enthusiasm after the company posted strong quarterly numbers after Thursday’s market close. Shares closed Friday at $120.18 after touching on a new all-time high of over $124 in mid-morning. Cerner’s market cap is just over $10 billion, pushing the value of Neal Patterson’s holdings to beyond the half-billion dollar mark.

The Boston Business Journal reports that athenahealth’s SEC filings indicate that CEO Jonathan Bush earned $4 million in total compensation in 2010 and made another $4.4 million from exercising stock options. ATHN shares are at $46.21, double their July price and valuing the company at $1.6 billion.

From Meditech’s just-filed SEC quarterly reports: revenue up 20%, EPS $0.77 vs. $0.60. Product revenue made up $15.6 million of its $20.2 million increase in revenue. Meditech paid $13.7 million to acquire the remaining of shares of ambulatory EMR vendor LSS in February, with its total cost to buy the company just over $17 million.

This week’s Time Capsule editorial, revived from the slumber it has enjoyed since I wrote it in 2006: Just Back from HIMSS? Finish Implementing Yesterday’s Fads First. A sample: “Newly-minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.”

Weird News Andy is back after a break, entitling this find as “Here I sit, broken-hearted” and in Rohrshach test fashion, observing that the photos look like Jelly Bellies to him. Scientists genetically engineer E. coli bacteria to release specifically colored pigments in the presence of various maladies, turning bowel movements into a color-coded diagnostic tool.

Helen Devos Children’s Hospital (MI) creates My Baby View, which allows parents of newborns (who have an average length of stay of 27 days) to view their babies remotely. Parents ask for live video by calling the nurse, who positions the camera and e-mails back instructions for logging in to a secure Web site to view the video stream. The system was funded by a $25,000 grant from Ronald McDonald House Charities of Outstate Michigan.

Welcome to new HIStalk Platinum Sponsor dbMotion of Pittsburgh, PA. The company’s service oriented architecture (SOA)-based interoperability and HIE solution gives caregivers a real-time view of integrated patient information from disparate clinical systems and multiple facilities, providing the benefit of integrated patient records without system replacement. Providers get better information to make decisions and less time searching for important information, reducing unnecessary procedures and poor integration between acute and primary care settings. Its Semantic Framework enables information exchange across diverse systems. It also supports clinical effectiveness through population management, turning mountains of information into meaningful information for use by clinicians, for health surveillance, and to enable disease management. Thanks to dbMotion for supporting HIStalk.

India’s newest export: American babies, carried there by Indian women willing to become birth surrogates for cash in an arrangement called “rent-a-womb.” India’s minimal regulation and low prices encourage doctors to manage the high-profit process and for women to carry the babies of foreign strangers in return for several thousand dollars. A couple from Canada complain that the Indian doctor jacked up the price right before their baby’s due date, saying the original proposal was the “base price,” then billed them for the hospital stay at triple the usual price without paying the hospital its share. The couple paid the hospital directly, but the doctor’s staff prevented them from getting an exit visa to leave the country. It ended costing about the same as it would have in the US.

Driscoll Children’s Health Plan (TX) chooses Sandlot for its HIE, connecting it with Driscoll Children’s Hospital.

Mary Anne Leach, VP/CIO of The Children’s Hospital (CO), is named by the Denver Business Journal as its CIO of the Year for non-profits.

Sad: the Seattle Children’s Hospital critical care nurse and 27-year hospital employee who killed a baby with an overdose of calcium chloride last year after making a calculation error hangs herself.

Michael Dell speaks at the Health Evolution Partners Leadership Summit, saying the “insights gleaned from working with healthcare organizations around the world” have convinced him that higher-quality care is correlated to higher-quality information. He encouraged healthcare leaders to unlock healthcare information (buy Dell EMR solutions), empower caregivers (buy Dell mobile devices), improve business processes (buy Dell revenue cycle services), and use information for innovation (buy Dell medical archiving solutions).

API Healthcare and Kronos have explained why they cancelled merger plans, but the Department of Justice offers an explanation of its own, saying Kronos would have controlled 70% of the time and attendance market in healthcare and that “the abandonment of this transaction means that consumers will continue to receive the same benefits of competition, including greater innovation and lower prices, they’re now receiving.” That would make a great quote for API’s marketing collateral if you ask me.

More on the $4 million lump sum retirement package (plus $150K per year for life) given to the president and CEO of Salinas Valley Memorial Healthcare System (CA), which has one 269-bed hospital. The payouts were apparently structured into seven different plans to skirt IRS rules, with the board president justifying the amount by saying the payouts were OK’ed by an outside executive compensation firm and that the hospital has to pay big bucks to compete with for-profit companies. The union president says the district should be ashamed since the hospital is cutting 25% of its workforce and that the consulting firm who recommended the layoffs was paid $10 million in the last year to “do the job (the executives) should be doing.”

Strange: EMTs are called to the home of Doctor #1 to transport Doctor #2, who the inebriated partygoers thought was having a heart attack. During the ride, Doctor #2 unfastens his seat belt and starts hitting the EMT’s female co-worker. Doctor #1, riding shotgun, swore at the EMT and told him he would have his EMT license revoked. At the hospital, Doctor #2 unfastens his seat belt again, so the EMT holds him down to prevent the cot from overturning, inspiring Doctor #1 to rush over and punch the EMT in the jaw. Doctor #1 later pleads guilty to battery; the EMT files suit against him and wants his medical license revoked.

E-mail Mr. H.

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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 February 2006.

Just Back From HIMSS? Finish Implementing Yesterday’s Fads First
By Mr. HIStalk

Every HIMSS annual conference is the “Year of the Something.” CPOE, PDAs, networks, wireless, or CHINs. Newly-minted experts fill HIMSS meeting rooms with audiences of the mildly curious, the crassly opportunistic, and consultants desperate for a fresh horse to ride.

Sometimes the Something booms, although often only after several years. Sometimes it disappears without a whimper. Neither outcome dampens the enthusiasm of HIMSS, consultants, and vendors to push a new, carefully-orchestrated Something each year, likely because fewer people would attend conferences, hire consultants, and buy new products otherwise. Maybe they learned that from the car makers.

This is the Year of the RHIO. I’m not against that, but it would be nice if organizations finished implementing yesterday’s fads first, like CPOE and electronic medical records. Those are still a hopeful dream for the vast majority of hospitals. And, we know they can deliver value today.

At least some of the RHIO hype appears to be genuine (unlike the Year of the PDA, which everyone knew was a joke). It seems that technologies developed by Connecting for Health and IHE will allow RHIOs to interconnect, at least according to groups chewing through government grant money. The enthusiasm is palpable, although those with functional memories will recall that technology problems weren’t what ended the Year of the CHIN in the first place.

Eventually, RHIOs will provide patient benefit (at least three to five years from now, I expect). In the mean time, they could become CPOE redux: encouraging premature interest in immature products by unprepared organizations, consuming resources and organizational energies that could have been spent on more worthwhile projects.

Most hospitals still haven’t implemented bedside bar coding, smart IV pumps, electronic MARs, and clinical decision support, all comparatively inexpensive slam dunks compared to CPOE. But, we convinced ourselves to lead with CPOE through some bizarre logic. We’re still trying to get physicians to use it years later, passing up some great patient safety opportunities along the way.

In any case, RHIOs are about to morph from a science fair project run by grant-fueled big contractors to the mainstream. Uncle Sam is sending just one receiver downfield, and it’s RHIOs. Whether you are ready doesn’t matter. That virtually no doctors have EMRs that can contribute or use clinical data doesn’t matter. That hospital clinical systems still capture only a small percentage of electronic data doesn’t matter. What does matter is that RHIOs are hot and hospital executives will be encouraged to hop on the bandwagon.

I think many RHIOs will go right down the toilet through lack of a sustainable financing model, poor governance, or a general lack of interest in cooperating with barely tolerated competitors. Those that are successful will at least spur demand for better clinical systems in all settings. That’s good. According to several HIMSS speakers this week, we’re turning our backs on those systems just as they are becoming good enough to use.

Let’s celebrate the shockingly fast progress that’s been made on RHIOs. Clearly lots of good work has been done. But, remember that your first obligation is to ensure good outcomes for patients under your facility’s care right now. We need to finish implementing all those now-gauche technologies that didn’t make the HIMSS hot list this year.

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Aaron Kaufman is vice president, healthcare and life sciences solutions, of Kony Solutions of Orlando, FL. 

Give me some brief background about yourself and about Kony Solutions.

I’m GM and vice president of the healthcare division of Kony Solutions. I come from 15 years of healthcare expertise in health information technology. I was previously the chief technology officer for Cardinal Health’s specialty division. Prior to that, I was the vice president of Infomax Development, which is like the CTO over at US Oncology. Before that, I was running a fund tranche as well as some activities in healthcare information technology activities for Patrick Soon-Shiong out in Los Angeles. He started a company called Abraxis Bioscience and I helped out with that and a couple of other initiatives that he had going.

Kony Healthcare is about six months old. Kony as a company was started in 2007 by a gentleman by the name of Raj Koneru. He saw an opportunity, a mixed bag of issues in mobile in general. He eventually realized there was some continuing expansion and divergence in the mobile space. As mobile platforms keep arising, new operating systems keep getting deployed. Companies go into this maintenance spin that gets them into a point where they’re not releasing new features or functionalities, but having to keep up with their application and not focusing on the features and functionalities that their applications should be focused on. 

He eventually identified this problem and solved it with this concept of a mobile platform solution. The Kony platform is several things. It’s a studio, it’s a server. We have some vertical apps in the healthcare market space and several of the other spaces too, but really that studio and server are there to help you develop apps that are truly future-proof for changes in healthcare, whether a new device comes out, a new operating system comes out, or a change to an operating system happens.

I’m interested in the Write Once, Run Everywhere approach. Companies trying to get mobile apps out quickly focus mostly on the iPhone and iPad and ignore significant devices like the BlackBerry and Android. Is that the wrong approach and if so, how do you help them avoid it?

All the companies that we talk to are trying to get an application out the door. They see it’s going to take developers and a specific code base to get an application out the door, whether it’s doing Objective C, C++, or doing Java development for Android. That’s all fine and dandy, but you only hit about 50% of the marketplace at max with those two platforms. If you want to hit the consumers, the broad base of consumers, you’ve got to get to more platforms, like BlackBerry, Symbian and Windows Phone 7. Those kind of devices are covered on our platform. 

But it’s not just getting the app out to market, it’s maintaining it as well. Not only are you doing yourself an injustice by releasing under a small group of platforms for your opportunity in the marketplace, but actually creating a maintenance nightmare and a cost nightmare for having a team of five to ten people per app, per platform in place just to get an app out the door and maintain it. Again, like I said earlier, in order to maintain this app, you’re going to be focusing mostly on the changes in mobile and not your app’s features and functionalities for your business needs as time evolves.

Are you finding that companies, especially in healthcare, are saying, “Hey, you can get to our Web page on a mobile device, so we’re good to go?”

I think the companies that we’re talking to and the ones we generate interest from organically or internally or approached us have all seen the need to have a native application, mostly because of the user experience. The users are looking in an app store before they typically go out and search the Web to find whether or not a site is mobile enabled. If they find a mobile-enabled site, they’re realizing the functionality doesn’t really fit the size and screen of smart phone capabilities and they want to fully leverage their smart phone capabilities with its GPS, accelerometer, camera … there’s all sorts of nice features that you can leverage through the native experience.

With HTML 5 coming out and the specs being really loose, there’s still an unclear roadmap on how HTML 5 will be able to affect the broad base of all the smart phones that are out there. Everybody calls for different standards, like what happened with in general with mobile in the back and HTML 4 coming out in the past. It’s an evolution that is to come eventually, but we still feel like there’s always going to be some divergence in least common denominator with the HTML 5 spec that the browsers are going to implement. I still feel native applications are the way to go.

Obviously our platform does all native applications as well as mobile web as well as SMS, Facebook, Twitter integration, etc. But again, our healthcare clients and our customers that are coming to us are really, truly interested in native applications first and then secondarily being able to use the same application and Write Once, Run Everywhere concept to deploy their mobile application.

Describe Kony Mobile Healthcare and who’s using it and what they’re using it for.

In the healthcare space, because we’re about six months into it, our healthcare customers are finding us as a competitive advantage, so I’m unable to share our client list. We’re basically in 45 top global 500 company brands that are out there. We’re working with some of the largest payer and provider organizations in the healthcare in general and some very, very large HIT companies that have long tail and short tail.

Since you can’t name specific healthcare customers, who is your target audience and what are the possibilities of using Kony Mobile Healthcare?

I think the keys are the three Ps: the payers, the health plans; pharmaceutical companies; and the providers themselves through the HIT vendors. We’re not going to go after each individual provider. We’re going to try to capture those guys through the HIT vendors. That’s our key focus.

We’re really multi-sector, multi-domain in healthcare. Several verticals inside of healthcare, obviously. We’re also focusing on the distribution logistics companies as well. There’s really nothing in healthcare that we’re leaving out that’s consumer facing as well as provider facing.

How would a vendor use your solution?

They would leverage our platform, our IDE and server, to develop an application that can exhibit the true mobile use cases for their application in the best fashion possible. Obviously we do a lot of human factor engineering to our healthcare expertise here to help them guide and mold and shape their application to fit the mobile environment.

We actually have a third offering outside of the studio and server, which are our vertical apps. By vertical app, I mean applications that are specific solution accelerators for the healthcare segment. For example, you have a starter application, a solution accelerator application, for the payer space that has the key features like find a doc, locate a pharmacy, being able to do a prescription refill, senior benefits, senior co-pay, senior deductibles, stuff like that.

From your experience in other industries, what opportunities do you see in healthcare to leverage mobile device technology and your tools?

There’s a lot of buzz around location-specific services, where you physically are at the time of care being needed — an urgent care center needs to be found, being able to use your GPS to find out where you are and which care center is closest, what the wait time might be, and possibly even how far away or the hours of operation. Then also helping with disease management, the concept around where you are, all the workflow and situational-based concepts that that exist, whether it’s retail like your at the Walmart or some retail store trying to but a product and you use RedLaser to take a picture so  you can see if you’re actually getting a good deal.

We hope to see that kind of use case also in healthcare, and leverage mobile application shopping and shopping carts that we’ve done for the airlines, as well as for working with the retail companies that we’re working with. Maybe you’re wanting to buy durable medical equipment while in your payer app, your health plan, and you want to see what you’re benefits are and associated with your payments on actually purchasing something through the store. 

It’s almost like a mash-up  concept. There’s a lot of that going on as well in the other spaces. We can mash up some healthcare functionality that’s not just specifically related to your benefit, but maybe actually helps you procure, whether it’s a durable medical device or a pharmacy prescription benefit, etc.

Walgreens seems to be the healthcare poster child, with a suite of mobile products that really changed the dynamic of how retail pharmacy works. Is anyone coming to you and using them as an example they want to emulate?

Some of our PBMs are asking us for features like that. Being able to take a picture of UPC code and implementing that into your PHR, saying “I’m taking this over-the-counter medicine,” being able to do stuff like that. Also taking a picture of your current prescription through a brick and mortar and possibly converting that to a mail order drug because it will see cost benefit savings that way.

Are hospitals being aggressive in their use of mobile technology, or are they happy with offering ED wait times and facility directions? Will some push the envelope to interact with consumers and physicians?

We’re definitely getting buzz around the larger healthcare provider systems out there, like the ones that have 700-plus beds. Some of the smaller guys are pinging us through their HIT vendors, so some of the HIT vendors are getting notices from their smaller hospital systems and are getting up to us what they heard about Kony is doing in the healthcare space and how they might interested in acquiring some of the technology use cases and accelerators that we have. But for the most part, the large providers are the ones creating demand, which is I guess what’s really been driving HIT for the longest time.

As someone who’s seen the mobile evolution in other industries, where do you see this ending up in a few years in healthcare?

I see all the features that are being used in the other industries hopefully being used in healthcare. Key ones, like social media. Being able to be a part of some discussion groups that are characterized around your disease type, where apps are not just miniature apps that solve a specific need, where apps are more portal-like, like the Facebooks of the world, where you can do multiple functions. Things that are out there in other industries, such as being able to a product and what store that product’s at and what the cheapest way is to get that. That’s some of the stuff that we hope to see in healthcare.

The biggest concept for me that I see really playing out is how the ones with all the cash — which is the payers, the health plans, the pharma companies — are going to leverage mobile. We see the pharma creating media brand apps today to educate patients around the drugs that they’re taking or drugs that they could be taking. We see payers helping their members find a physician, maybe lowering some of their healthcare costs by recommending pharmacy benefits management or disease management.

All these things put together can create pretty interesting concepts in the way a lot of the technologies are coming together with service-oriented architecture and open APIs. If HIT truly delivers its value and starts to open up the ability to place orders in to EMRs remotely and with proper audit logs and all the laws and security mechanisms in place, there could be a pretty interesting app being created. Many of our companies who we’re working with can all work together to create an app that’s the best for the patient, whether it’s managing their current health or their current diet, knowing what they bought at the grocery store, linking in the customer loyalty cards into their healthcare and knowing what their diets look like, and just overall management. As the ACOs continue to evolve, there’s some interesting disease management, population management use cases that could come out from mobile leveraging, social leveraging the entity around a patient, not just specific things that a patient would deal with when they’re sick.

Have you seen in other industries where where the concepts of mobile, such as the app store and better usability, have pushed back into mainstream IT and changed the expectations for how applications should look and work?

Absolutely. That demand in the marketplace, like consumerism, is hitting even the providers, who are expecting certain things to happen on their iPads when they’re at a hospital. Being able to refill a prescription, being able to communicate with their patients, e-mail, all that integrated secure messaging. It’s really interesting to see some of the requests that are coming from the providers as well as the consumers are expecting functionality around their medical viewpoints and the whole device, and that pressure is going to continue to come as consumers get more and more averse to using some of these other industry apps.

Any concluding thoughts?

Our Write Once, Run Everywhere platform in the healthcare space really helps healthcare organizations, whether you’re a plan, whether you’re a provider, whether you’re an HIT company, whether you’re a distribution and logistics company, to leverage the costs. If you’re going to go out and develop an app, we’re an enterprise app development solution for mobile. We don’t just create the app, we actually service the app. We have lots of back-end analytics, etc.

There’s lots of things to look at when you’re trying to pick a platform or even develop a mobile application. The enterprise approach is typically a company approach. We’re not two guys in a garage trying to build an app. We are building enterprise class apps that you can manage, monitor, see how you’re usually using the app, has analytics behind it, you can understand what changes you might need to make to the app.

We’re able to build seven of the operating systems out there. You have Apple, you got Android, you got Blackberry, you got Windows Phone 7, Symbian, etc. We also have eight form factors on the mobile device. Every smart browser renders things differently. We render on those 6,500 different devices for mobile Web and that’s coming from one code base. We also have SMS-MMS services that will offer two-way applications, so if a patient doesn’t have a full-featured phone, they could request information through SMS, through a short code or through a phone number, that returns back data to them. We also have integration with social media, Facebook, and Twitter. We also have Windows presentation framework which allows us to do Windows Kiosk applications from the same code base. And then we focus obviously on all the tablets.

Where no one comes close to competing with us is that within 30 days of release of a new operating system version to the developer community, we will have all those features with deprecations, etc. all covered under our platform. Ninety days after a brand new device comes to market, for example a Playbook, we’re also able to get that under wraps and our Write Once, Run Everywhere platform. You’re able to easily use your app and deploy your app into that app store. When Windows Phone 7 came out, we were one of the first, if not the first, to launch our enterprise apps that we developed for our customers into the Windows Phone 7 app store.

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Top News

Wolters Kluwer Health will acquire Lexicomp, a provider of drug information and clinical content for pharmacists and clinicians.

Toshiba will buy medical imaging software company Vital Images for $273 million. Toshiba Medical Systems is the largest customoer of Vital Images. Toshiba America Medical Systems also announces that Donald L. Fowler, a former VP of Siemens Medical’s MR business unit, will be the division’s GM and SVP.

Cerner’s Q1 results: revenue of $491.7 million, up 14% from a year ago. Profit was $64.6 million or $0.75/share compared to last year’s $0.59/share. Cerner also says it signed a record $524.9 million in new bookings, a 30% jump over last year.

Reader Comments

From Sam Adams: “Re: GE and tax protests. Did you see the pictures of people protesting outside the GE/IDX building last week on tax day?” Thanks to Sam for sending the link. GE Healthcare’s Burlington, VT facility was the chosen site for protestors rallying against the US corporate tax code, which they believe unduly benefits large corporations. Earlier this month, The New York Times reported that GE paid zero federal taxes on $14.2 billion in profit.

From Epicwatcher: “Re: Epic. I’ve heard from three sources that Epic might go for an IPO. It would be a good time to go to market, but I doubt Judy would go for it.” Unverified, but agreed on both arguments. It would be a great time but it probably won’t happen.

From Keep em Honest: “Re: Cerner. Interesting coincidence that Cerner COO Mike Valentine resigned within 48 hours of the first Siemens customer attesting for MU. HIT sleuths will recall that Valentine’s signature was on a letter penned to rival Siemens customers back in 2009 that claimed Siemens would not be able to get their customers to MU in time. As it happened last week, Siemens was the first of the major HIT vendors to have a customer attest.”

From JD: “Re: cloud backups. Your readers might be interested to learn about GNAX, a company in Atlanta that provides data center and cloud hosting services. Its customers include a number of hospitals in the Atlanta area. I toured their facility a few months ago and was very impressed by the many backups they had for their backups in case of things like power outages, floods, etc. (though I readily admit I am still learning when it comes to the cloud).” I found the video above on YouTube, which is fun as well as educational because there’s a great keg party going on right behind the speaker in the HIMSS11 exhibit hall. I should mention that I know JD and this isn’t shilling – she’s in an unrelated healthcare business.

HIStalk Announcements and Requests

This week on HIStalk Practice: Dr. Gregg contemplates dancing stars and easy EMRs. Rob Culbert debuts his Consultant’s Corner column with suggestions for the successful development of medical groups. CaroMont Health partners with athenahealth. Greenway Medical helps out the Boys & Girls Clubs. Triangle Capital Corp. bets big on house-calls. A urology group asks a judge to evict a hostile doctor. While you are visiting, join 1,063 of HIT’s coolest kids and sign up for the e-mail updates. You know you wanna.

Thanks to new HIStalk Gold Sponsor JEMS Technology of Orion, MI. This is cool stuff: a physician can perform a HIPAA compliant JEMS Consult via smart phone or tablet. Examples: consulting on a patient who’s on the surgery table, conducting a stroke evaluation from any location, getting or giving a second opinion, and safely evaluating prisoners without entering facility. The on-site person chooses the camera feed, the remote consultant presses the JEMS icon on their smart phone and enters their password, and the consultant is instantly participating in a live JEMS Consult from wherever they are, including the ability to carry on a conversation with those on the other end over the video stream. Benefits include making surgeons happier, decreasing OR time with on-the-spot consultations, and potentially reducing lawsuit risk. AT&T chose JEMS as its partner for handheld video streaming in healthcare. Thanks to JEMS Technology for supporting HIStalk.

Preaching to the PR people, continued: everyday is an adjective, not a phrase. You might wear everyday shoes, but you wear those shoes every day, not everyday. That was in a press release I got today and I was appalled. On the other hand, I was happy just to receive it since Yahoo Mail was down all afternoon and is still acting flaky even though the mail’s going through. Maybe this cloud thing is overrated.

On the other hand, I was beaming at the simple fix to my slow wireless Netflix streaming to the TV via my Roku box: powerline network adapters. I was skeptical, but they worked right out of the box: plug an adapter into a wall jack and connect it by network cable to your router, plug the other in the wall jack next to the TV and run the network cable from there to the Roku. Two minutes and $85 later, no more wireless bottlenecks – it’s like I had Cat 5 wiring right to the TV.

Listening: new from Augustana, straight-ahead Springsteen-type rock.

Jobs on the sponsors-only job board: Director, Revenue Cycle Solutions – Virtual Office, Product Specialist – Physician, Inside Sales Executive/Telesales, Systems Engineer. On Healthcare IT Jobs: Business Development Manager, eGate Integration Analyst, Epic Clinical Applicataions Specialist.

Your honey-do list: (a) sign up for e-mail updates to your upper right; (b) visually inspect HIStalk Practice and HIStalk Mobile as my quality assurance specialist to make sure Inga and Dr. Travis are doing a good job; (c) Friend, Like, or Connect everything HIStalk-y on Facebook and LinkedIn to help Inga, Dr. Jayne, and me feel like immensely popular celebrities, which offers some illusory consolation as we contemplate our reality of toiling in solitude like monks copying scripture on papyrus; (d) avail yourself of the Rumor Report function to send me whatever you know that is scandalous, insightful, or funny; (e) intently observe the impressive lineup of sponsor ads to your left, paying them homage with an occasional click in recognition of their sometimes misplaced confidence that sponsoring HIStalk means their days of worrying about being the subject of negative news or snotty commentary are over. And thank you for riding shotgun in the HIStalk weenie wagon by reading what we write since it would be pointless otherwise.

Acquisitions, Funding, Business, and Stock

A federal jury finds that a former Mayo Clinic researcher misappropriated trade secrets and violated his employment contract when he left Mayo for a job at Mount Sinai Medical Center. However, the jury ordered Mayo to pay Dr. Peter Elkin $143,222 in royalties for record-keeping software that was eventually sold by the company, LingoLogix, to Cerner for $5.7 million. Elkin and Mayo have been battling the issue since 2008. Mayo says Elkin tried to undermine the commercialization of the software. We profiled the technology (pre-Cerner) back in 2008. A Mayo representative sent over their summary of the verdict, saying the amount awarded to Elkin was money they had already planned to pay as his share even before the lawsuit was filed. The non-profit Mayo requires all funds that result from commercialization of its intellectual property be returned to it.

Telehealth provider iMetrikus changes its name to Numera. The company says its new brand “reflects the company’s focus on developing high-quality, low-cost methods of collecting objective patient health and biometric data and integrating this into popular electronic medical records, care management, and personal health records .” I don’t get how a name change “reflects” any of that, but then again I majored in economics and not marketing. The company also appoints Tim Smokoff CEO “to spearhead the newly branded company.” Smokoff is the former GM of Microsoft’s World Wide Health Industry Solutions Group.

athenahealth reports Q1 earnings of $69.9 million, a 28% increase over last year. Net income was $3.3 million, or $0.09/share, versus 2010’s $0.01/share.

Oppenheimer, which just started coverage on Cerner with an “underperform” rating, initiates coverage of Allscripts with an “outperform,” setting a $25.00 price target. Shares closed Thursday at $20.61, giving the company a market cap of $3.9 billion. Above is a one-year share price chart showing Allscripts (blue), Cerner (green), and the S&P 500 (red).

Sales

McLeod Health (SC) picks MedeAnalytics’ Patient Access Intelligence product for front-end patient collections and insurance verification.

The VA awards telehealth system provider Robert Bosch Healthcare a new contract for its Health Buddy System.

Reference lab PAML (WA) selects 4medica for clinical pathology lab ordering and results reporting.

Three HCA hospitals in South Florida sign up for AirStrip Cardiology to allow physicians to read ECGs on their smart phones.

People

IGI Health hires Lee Barrett as president and CEO. Founder Arthur Kapoor will assume the role of chairman. Barrett has previously served as executive director of EHNAC CEO of Claredi.

Streamline Health Solutions appoints Stephen H. Murdock as CFO.

Harry Greenspun, MD joins the Deloitte Center for Health Solutions to focus on health sciences and government clients, leaving his position as EVP and CMO at Dell Healthcare Services. He came to Dell as part of its Perot Systems acquisition.

Former Misys Healthcare CEO Vern Davenport is named to the advisory board of public health consulting firm SciMetrika.

PenRad Technologies hires Dan Bickford as EVP of sales and business development. He was co-founder and EVP of Confirma, now Merge Healthcare.

University of Wisconsin-Madison gives Judy Faulkner and four other alumni its Entrepreneurial Achievement Award.

John Glaser of Siemens is mentioned as being on the board of KEW Group, a Boston-area startup that is buying and partnering with community cancer centers that will use its personalized medicine and clinical IT platform. According to the company’s site, he is a founder.

Garrick Palmer, formerly of Oracle, IBM, and Cerner, joins Fujitsu to lead healthcare sales of its biometric solutions, such as the PalmSecure palm vein scanner.

Announcements and Implementations

AHA gives its exclusive (paid) endorsement to nVoq’s SayIt in the category of healthcare voice recognition. I have to say that I’ve never heard of it. I didn’t know that Nuance even had competitors that it hasn’t already acquired.

Sharp HealthCare uses Oracle’s SOA Suite and Weblogic to create its patient portal.

Government and Politics

HHS is considering a “mystery shopper” program to assess primary care physicians on their willingness to accept new patients and to provide them with services in a timely manner. The Office of the Assistant Secretary for Planning and Evaluation will contact 465 PCPs and simulate requests for appointments for both privately and publically insured patients. I have just two words to summarize my opinion: budget crisis.

CMS announces that it will offer conference calls next week to provide information about the Meaningful Use attestation process. They are scheduled for Tuesday for hospitals and Thursday for EPs. Signups close the day before the session.

The LA Times brings to light public pensions, including those of healthcare executives. The president and CEO of a public hospital district received a $3 million lump sum retirement payout when he turned 65, worked two more years at $688K per year, will get another $900K when he retires for a second time this week, and will get a pension of $150K per year for life. “I think I’ve earned it,” he says.

Other

Road warriors take note: Columbia University researchers find that extensive travelers are 260% more likely than light travelers to rate their health as fair to poor. Extensive travelers are also 92% more likely to be obese and have higher cholesterol and blood pressure.

Thieves steal $100,000 worth of copper from the Cerner campus and cause “a substantial amount of property damage.” The copper was in a building under renovation.

An internal audit at University of Iowa Hospital and Clinics finds “flaws” involving its $61 million Epic system, including inconsistent use and information being incorrectly entered or not at all. One pediatrician had not switched to Epic for prescriptions and was using an outdated system that lacked audit controls. Significant lag times were noted in three departments and 32 bills were missed in November as physicians were not entering charges in a timely fashion. One regent noted that “younger staff are more comfortable with the new technology but older staff have a harder time adapting.” So is it flawed software or flawed workflow?

Imaging the World wins a $100,000 grant from the Bill & Melinda Gates Foundation for its low-cost rural ultrasound project for areas of high maternal and neonatal mortality. The founders are Kristen DeStigter, MD (Fletcher Allen Health Care associate professor and vice chair of radiology) and Brian Garra MD (chief of imaging systems and research at the Washington DC VA and associate director in the imaging division of the FDA).

Employees of the Allscripts office in Raleigh, NC used Thursday’s “Take Your Daughters and Sons to Work Day” to prepare kits of personal items for victims of the April 16 tornadoes, which will be distributed by the Salvation Army.

Pompare Technologies files suit against Hospira, Cerner, and Epic, claiming those companies infringed on its patent for controlling an IV infusion pump. Pompare doesn’t come up in a Google search. Its patent was granted Tuesday and it set the lawyers loose on Wednesday, seeking to recover damages “but in no event less than a reasonable royalty.”

A couple’s lawsuit against a hospital in which the woman claimed she suffered marital problems and traumatic anxiety after a physician’s assistant stole the narcotic from her epidural pump is thrown out by a skeptical jury. The woman claims her motivation was purely to improve hospital safety, saying she wanted to make sure “this was something that wasn’t hid in the closet.” The jury foreman found her intentions less noble, saying “Every time we got to a particular count, it was like Swiss cheese. I almost felt bad for their attorney.”

Sponsor Updates

• Grant Memorial Healthcare (WV), a 45-bed facility, selects HMS’s clinical and financial applications.
• Iatric Systems receives ONC-ATCB certification from CCHIT for its Public Health Immunization Interface solutions.
• Wake Endoscopy Center (NC) will implement ProVation MD software for gastroenterology procedure documentation and coding and ProVation EHR and patient charting.
• Brazosport Regional Health System (TX) picks the e-Forms Repository downtime registration solution from Access.
• RelayHealth announces the general availability of ProSMART, an on-demand pharmacy claims adjudication reporting product for payers. Pharmacy benefits manager Restat is deploying the solution.
• Sunquest Information Systems is honored for its development of a CRM system that integrates sales and support functions.
• Heartland Regional Medical Center (MO) implements Voalte’s iPhone communication solution. The company also gets a story in its hometown Sarasota, FL paper for the pilot program, mentioning that nurses there can use their Voalte-powered iPhone to access the hospital’s GE call system, Philips Emergin alarms, Cisco wireless, and Siemens telephone system. It also notes that the company will hire developers to port its application to Android smart phones.
• Childs Medical Clinic of Samson, AL becomes the first Greenway Medical Technologies PrimeSUITE 2011 customer to attest and receive payment notice for Stage 1 Meaningful Use incentives.
• Billian’s HealthDATA adds contact information for more than 10,000 long-term care executives to its online market intelligence portal, which now includes more than 3,000 data points covering more than 40,000 US healthcare facilities.
• The Vancouver Clinic (WA) goes live on Epic ambulatory, with implementation assistance from the Epic practice of Culbert Healthcare Solutions.

EPtalk by Dr. Jayne

Dear Dr. Jayne,

Do you plan to attest for Meaningful Use in 2011 or 2012?

Dave the Healthcare Bean Counter

Dear Dave,

Are you a plant from my day job? Seriously, I get this question all the time. And the answer is, “most likely 2012.” We’re going to play the game under the Medicare rules, so we can’t ask for a check just for having purchased a system.

Like many other organizations across the US, we will have to upgrade to our vendor’s certified product before we can attest. Even though we’re able to do 90% of what Meaningful Use intends us to do, without the certified version, we may not be documenting in the precisely specified field that’s used for the certified version.

I alluded to this last week when I talked about tobacco use documentation. Do I ask every patient about their tobacco use and counsel those who use tobacco that they need to quit? Do I have a reportable discrete field in which to document? Absolutely. Am I documenting using one of the six required data points? Not so much, until I upgrade.

Additionally, after the upgrade, we’ll want to allow time for our providers to transition to the new fields (and some of the slick new workflow that comes with the upgraded version, independent of Meaningful Use) as well as to benchmark where our physicians stand.

I work for a large health system, which (news flash!) had priorities established long before MU was a blip on the horizon. We have a multi-year strategic plan that we’re trying to execute, with important outcomes like reducing length of stay, preventing medical errors, and providing care to the underserved and indigent. We’re targeting diabetes and obesity. We’re delivering thousands of babies and providing preventive care.

Needless to say, our IT department is fairly busy supporting all those initiatives. Although a fair amount of resources has been shifted to achieving MU, we don’t get to stop working on those priorities just because someone is handing out cash.

I’m grateful that our organization has gone with this approach. I think there are enough rational folks here who understand that MU is a bit of a shell game and will most certainly cost providers more than the payments they receive. But they’re also savvy enough to know that we don’t want to miss out on any of the money. Although we had plans to do the technology anyway, it’s definitely nice to have our friend Uncle Sam pick up part of the tab.

There was a recent discussion in the doctor’s lounge that revolved around whether Congress would repeal the provisions of health care reform and whether there would be any money available. Several independent physicians were discussing their plans to attest as soon as possible, just in case the funding dries up. Others lobbied for not even bothering, fearing or hoping that the program will disappear.

They asked my opinion, and it was this. If you plan to attest this year, keep going. Make plans to run interim reports to see how you’re doing and where you stand on the metrics, and implement programs and processes to get your numbers up if needed. Don’t let the fact that you can do it in either year delay you from your plans.

If you planned to attest in 2012, keep chugging away as well. If you meet your metrics early, you can always go ahead and submit and be ahead of the game.

Dr. Jayne

Contacts

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

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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!

There is Nothing Normal about the “New Normal”
By Tom Carson

I recently had a conversation with a physician friend of mine. He shared the experience of their hospital system’s EMR implementation for their ambulatory practices, which is, so far, an 18-month project and counting.

This project has resulted in a 12% decrease in physician-generated revenue, 75% of which is attributable to reduced physician productivity. Fewer patient visits, in other words. When I asked what they intended to do about what sounded like a serious problem, he told me, “Nothing. Our administrators are calling this the ‘New Normal’ for production.”

If this had been the first time I heard this explanation, my jaw would have dropped. I mean, really, whoever heard of implementing technology to decrease the productivity of the most expensive resource in the healthcare delivery chain?

As it is, the “New Normal” mantra is being repeated often. Vendors of these products (and their customers) must be hoping it catches on as truth, preserving the reputations of both.

Here is my problem with reduced productivity as a “New Normal.” Management doesn’t really believe it. If they did, hospital administrators in these provider organizations would be reassuring all the physicians involved that to make up for their productivity losses, they would all be given 12% raises and their visit quotas would be reduced accordingly.

No longer would doctors be spending 2-4 hours each day off the clock to catch up on documentation responsibilities made more burdensome by their new system requirements. Instead, the dark side of the “New Normal” is the implied expectation that doctors will suck it up and find a way to return to former levels of productivity, regardless of personal cost. That is simply not sustainable.

Every business leader I know understands the correlation between happy employees and satisfied customers. An unhappy work environment creates stress in all parts of our lives. it is destructively unsustainable for both individuals and the companies that employ them. When doctors are free to practice medicine on their terms, the organizations that employ them can attract better doctors. The result is satisfied patients and better outcomes. This is a positive feedback loop that is sustainable.

I don’t know when this breakdown of honest communication and respect occurred, but it would be in the best interests of patients, physicians, and provider management to fix it. Here are my ideas. 

Management, you do not have to settle for a “New Normal” that reduces your economic performance and crushes the enthusiasm of your staff. Ask yourself if you would have made the system purchase under the terms you did if the vendor had explained up front that you should factor in a 12% revenue reduction. If the answer is no, then do your fellow administrators and the industry at large a huge service and start raising Cain. Eventually, your vendor, or his replacement, will honestly address the problems.

I have never seen a documented case in which average physician productivity in an ambulatory setting did not decline following implementation of an EMR system. There are ways to recover productivity outside of the vendor’s design, including the use of virtual scribes, physical scribes, and speech recognition for some physicians. These won’t be free, but they will cost much less than what good physicians cost.

Physicians, you owe it to yourselves to not fall into the trap of believing that you can overcome long-term limitations through the short-term measure of working more hours. You owe it to your management group to provide fact-based feedback on the realities of what is going on at the patient encounter level.

I am not anti-EMR. Far from it. My company has been committed to moving physicians to electronic records for 11 years. However, we have always believed that the transition will work best when working with and for the physicians — not around them.

Tom Carson is president and CEO of MD-IT of Boulder, CO.

Build IT Right
By Guy Scalzi

According to Modern Healthcare’s 32nd annual Construction and Design Survey published March 14, the healthcare construction industry continues to show signs of rebounding. There’s pent-up demand from years of capital freezes that will soon explode, so it’s more important than ever to get the information services right the first time when designing and building any new facility.

Timing is Everything. IT professionals need to be involved as soon as possible in the planning or design specification stage and stay actively plugged in throughout the project.

IT – A Critical Element of Design. IT must be involved before the design specification is generated to define what applications and technology will be used in the space. It’s important that as soon as required work space is estimated, the space needs of the hardware to support the activities are included and the plans reflect those needs. This is the time to get it right, so the workflow will be enhanced by the space, not compromised.

The overall project budget should incorporate IT requirements. Many times, the square footage needs to be reduced or the planned services have to be scaled back to fit within the amount of available dollars. Don’t try to retrofit old IT equipment into the space to save on budget because this technology is often at the end of its life cycle or not powerful enough to run the current software.

Best Practices and Next Practices. The new space should make optimal use of the next release of major software applications and functionality. iPhones and iPads are already being incorporated into new releases of HIS software. This means fewer requirements for viewing data on workstations, but a heightened need for docking stations and additional places to enter data. New space will most likely take advantage of RFID tags and generally richer user interfaces requiring powerful hardware.

Not a Night and Weekend Job. Depending on project size, there needs to be one or more IT staff dedicated from design to opening. Questions will arise on a daily basis, and bad decisions are made when there’s a lack of knowledgeable IT input.

New Sandbox for Strategic IT Direction. This is an opportunity to pilot new processes, systems, and technology. There’s no reason to move workflow, applications, or hardware that are only marginally acceptable, or failing. While beta testing of applications should be avoided, technology that’s proven elsewhere but still new to your organization can be piloted.

Test, Test, and Test Again. A few weeks before the opening, fully staff for two or three days with test patients cycling through the systems, at about half of what’s expected at peak volume. Data can be entered in a test database, so it’s easy to review but won’t interfere with production. Necessary changes can be implemented quickly and be ready for the next test session.

Blanket with Support. On opening day, have as many IT people and vendor staff as possible on site during all hours of operation. While the staff is in a learning mode, they’ll be receptive to new ideas and skills. A lot of progress can be made quickly.

By applying these and other industry best practices, IT can be strong partners in ensuring healthcare facilities meet the needs of patients and practitioners alike.

Guy Scalzi is a principal with Aspen Advisors of Pittsburgh, PA.

Summary of the ONC EHR Usability Meeting 4/21/11
By Vicente Fernandez

”A computer makes it possible to do, in half an hour, tasks which were completely unnecessary to do before.” Larry Wolf, Health IT strategist, Kindred Healthcare (original author unknown)

”Cumbersome system design is the biggest threat to the ARRA investment.” Kamal (Bill) Hashmat, CEO, CureMD

“Every industry believes it’s ‘special’ and doesn’t want to deal with the issue of standards. Variability of design and display of common and necessary information is not creativity, it’s chaos.” Ben Shneiderman, PhD, University of Maryland, CureMD

Synopsis

Most of the discussion seemed to pivot around the pleas from the provider community to standardize usability measures by either making them a part of certification, creating a Consumer Reports-like system of reporting and comparing EHRs and/or mandating a common user interface.

There was also a call for EHRs to be held to accessibility standards, to support system-wide interoperability for the wholesale migration of data from one product to another, and to be more transparent with their internal usability and accessibility guidelines.

Probably the most intriguing testimonies were from Ben Shneiderman from the University of Maryland, Stanley Wainapel MD of Montefiore Medical Center, Eva Powell from the National Partnership for Women and Families, Mary Kate Foley of AthenaHealth, Carl Dvorak from Epic, and Doug Solomon of IDEO.

Cerner was also represented by David McCallie, who contributed this interesting insight: “The tools [EHRs] are designed for the volume of documentation instead of the value of the information.”

Executive Summary

Although the conference title specifically stated EHR (Electronic Health Record) Usability, the presentations and discussions were applicable to all types of electronic and Web applications across all healthcare environments. The resulting work and recommendations from the Health IT Policy Committee will have far-reaching effects, and are likely to impact all forms of future human-computer interaction in healthcare settings.

The EHR Usability Conference presented fresh and insightful perspectives from five separate panels: Care Provider, Patient/Consumer, Vendor/Technology Developer, Measurement and Improvement, and  Options Around Usability.

The most important items addressed were:

• The current state of usability in healthcare applications
• Accessibility standards in healthcare applications
• How usability affects the well-being and lives of patients/consumers
• How usability should be included in health technology certification
• The roles of vendors, providers and organizations in developing usability standards and guidelines
• The role of the Federal Government in producing and enforcing usability standards and guidelines
• The roles of vendors, providers and patients in ensuring that delivered products are usable

Dominant opinions and recommendations from providers, consumers, developers and experts included the following.

Current usability in healthcare applications is atrocious

• Difficult to navigate.
• Time consuming.
• Frustrating.
• Cluttered and disorganized.
• Unsearchable.
• Leads to fatigue and ultimately burnout.
• Does not adequately support disabled community.
• Does not adequately support clinical workflows.
• Critical information is dispersed & buried.

Recommendations to vendors

• Develop streamlined methods of entering, retrieving and displaying complex data sets.
• Display data from disparate sources in fewer, simpler views.
• Create navigation pathways that match the workflow and thought flow of clinical work.
• Design and build applications within accessibility guidelines and enable integration with accessibility hardware and software.
• Support patient-centered information flow.
• Provide a mechanism or process for the customer to submit feedback for rapid changes and fixes.
• Allow for customizable views of varied information from multiple sources.
• Modularize and increase interoperability of product offerings.
• Publicize internal usability guidelines and standards.
• Work closely with the clinical community to develop best practices and appropriate workflows.
• Limit or change the use of structured data capture for specific workflows.
• Incorporate usability personnel and best practices in product development.
• Design and build products to support effective partnerships between providers across care settings, and between patients and providers.
• Design and build products to support a patient-centered healthcare system.
• Work with regulators to develop standards and tests to measure usability.

Recommendations to HIT professional associations and certification agencies

• Develop usability standards and metrics.
• Work with regulators to develop standards and tests to measure usability.
• Publicly report usability comparisons across healthcare applications.
• Create reporting mechanisms for the healthcare community to voice their opinions and relate their experiences with healthcare applications.
• Develop methods of measuring and relating usability to “effectiveness.”
• Educate and provide guidance to vendors on a user-centered design process.
• Educate providers on what to look for in a user-centered design vendor.

Recommendations to provider institutions

• Allocate the appropriate personnel and resources for effective application implementation.
• People, systems, processes, and hardware.
• “Vote with your wallets” – create the demand and pay for products with high usability standards.

Recommendations to government agencies/regulators

• Work with providers and vendors to develop standards and testing as a part of certification.
• Require public reporting of comparative vendor performance of usability.
• Foster an innovative vendor environment by requiring interoperability at the enterprise level to allow the wholesale migration of an organization’s data from one vendor to another and requiring interoperability at the modular level so that providers can select the best combination of applications that will work together seamlessly.
• Require healthcare applications to meet accessibility guidelines.
• Mandate consistency in the presentation of standard data types.
• Mandate a common user interface.
• Promote the wealth of usability science and resources already available.
• Allocate resources to get feedback on usability from providers.
• Develop simple, best practice guidelines for providers to follow in selecting, customizing and implementing healthcare applications.
• Garner best practice workflows for safety.
• Develop usability quality measures that coincide with the specific practices.
• Increase transparency and discussions around usability efforts.

Vicente Fernandez is “just a dude trying to make a difference in healthcare with my skills as an interaction designer.”

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