Top News

 

HHS issues a proposed rule requiring healthcare providers, health plans, and their business associates to maintain an access report detailing all disclosures of patient information within an EHR or accounting system. Providers must also record every EHR chart access, including details on who opened the patient chart, the date, and the time. The access report must be made available at the request of patients.

Cerner announces a two-for-one stock split, with a June 24 distribution date. Shares closed Tuesday at $120.10, valuing the company at just over $10 billion. Neal Patterson holds $512 million worth. Above is the one-year CERN share price (blue) compared to the S&P 500 (green).

Reader Comments

From All Hat No Cattle: “Re: HHS’s HIT certification. Seems like another needless scam.” ONC announces availability of six Health Information Technology Professionals examinations: (a) clinician / practitioner consultant; (b) implementation manager; (c) implementation support specialist; (d) practice workflow and information management redesign specialist; (e) technical / software support staff; and (f) trainer. ONC is offering vouchers to qualified applicants; otherwise, it’s $299 for the first exam and $199 for each additional. ONC pre-nicknamed the exams HIT PRO, which is trademarked for some reason. I’m not entirely sure what the point is – in the “Why Take the HIT Pro” explanation, they talk about a shortage of qualified HIT workers, implying that passing the test makes someone qualified. There are no educational or occupational prerequisites for taking the 125-question tests, although the target audience is the folks who have finished one of those short, ONC-funded HIT programs that community colleges offer.

From MadCow: “Re: Loma Linda University Medical Center. Pulling an EMR swap, from Cerner to Epic.” Verified. LLUMC’s board approved Epic last week, which will be rolled out through their entire system. Epic will replace Cerner for inpatient and ambulatory clinicals, GE for faculty practice management, and a homegrown registration and billing system. LLUMC will keep their Cerner lab apps because Epic’s Beaker is a few years away from having the capabilities needed for an organization of that size.

From HITuser: “Re: Meditech 6.0. Have they implement any sites running multiple facilities?” A good question, which I will open up to those HIStalk readers who surely know. I’d have to guess yes.

HIStalk Announcements and Requests

A reader asked if I could interview someone from St. John’s in Joplin about their emergency preparedness lessons learned once things settle down there. If anyone is reading from there and would be willing at some point, let me know.

Watching: Life on Mars, a quirky one-season sci fi/cop show in which the lead character is sent back in time to 1973. Harvey Keitel is excellent in it, former Cosby kid Lisa Bonet has a role, and the pop culture (hair, clothes, music, etc.) are cool. Lots of Bowie tunes. It’s the American remake, predictably inferior to the original British version, they say, so I’m hoping the original hits Netflix streaming.

Welcome to new HIStalk Platinum Sponsor Impact Advisors of Naperville, IL. The company’s service offerings include strategic advisory (IT performance assessment, strategy, system selection, contracting, ROI, HITECH readiness, governance, and facilities planning) and strategic implementation (planning, readiness, project leadership, staff augmentation, project oversight, interim management). Impact Advisors has won several awards,including Best in KLAS for Planning and Assessment for three straight years. They’ve also bagged some “Best Places to Work” recognition in case you’re looking for opportunities (I see they need implementation specialists for Epic and Cerner at the moment, as well as HIT strategy folks). Founders Andrew and Peter Smith are HIT long-timers and have boatloads of experience working with hospitals and physician groups and are on the speed dial of quite a few big-name CEOs and CIOs as their trusted advisors. Former FCG President Steve Heck is a VP there, so you can catch up with him when you contact the company. Many thanks to Impact Advisors for supporting HIStalk.

It’s a quiet week by all appearances, which is a relief since I’m trying to catch up after a few days of being semi-off. It seems like about half of the 7,359 HIStalk e-mail subscribers are kicking back an “out of the office” reply this week, so good for everybody who is getting away a bit for the unofficial beginning of summer. It’s a great time to send in your news, rumors, guest articles, or whatever goodies you have that might interest others.

Acquisitions, Funding, Business, and Stock

A London newspaper says that Sage is reviewing its healthcare business and will likely sell it, although it did not provide details or sources.

A Chicago Tribune story on excessive executive pay speculates that McKesson shareholders may push back on the compensation of CEO John Hammergren at this summer’s annual meeting. He’s California’s third-highest-paid CEO at $54.6 million for the year ended last March (the company hasn’t released his FY2011 take).

Announcements and Implementations

IBM announces the expansion of its Dallas-based Health Analytics Solution Center, including the addition of new technology and the doubling of its solution architects and technology specialists. Mobile technologies, remote patient monitoring, and analytics are some of the areas IBM says the Center is addressing.

Health information network provider Availity earns EHNAC recognition for achieving the requirements for the 5010 Readiness Assessment program.

MIM Software introduces the VueMe App for iPad, iPhone, and iTouch. The app allows patients to view diagnostic images that have been sent them from their doctors, or to share those images with a specialist.

Government and Politics

Your tax dollars at work: as of May 19th, the Medicare EHR incentive program had paid providers $75 million; the 15 state Medicaid programs paid an additional $38 million. Including HIT training programs and RECs, HHS says it has doled out a total of $1.7 billion to promote EHR adoption. ONC coordinator Farzad Mostashari also notes that EHR use among primary care physicians increased from 20% in 2009 to 30% in 2010.

ONC publishes a proposed rule that addresses how the agency can remove an approved accreditor of the permanent EHR certification program. The ruling establishes a process to deal with situations where the ONC-AA engages in misconduct or does not perform its responsibilities.

Weird News Andy notes that the Feds are cracking down on healthcare fraud by threatening to file criminal charges against corporate executives whose companies are caught in wrongdoing, even if the executive had no direct knowledge of the illegal activities. Instead of just accepting a fraud settlement from big companies who treat it as a cost of doing business, Uncle is pulling out previous precedents that it says allow it to hold executives personally responsible, noting that several Fortune 500 companies have bought their way out of Medicare fraud several times (can I get an amen?) A quote from HHS’s chief counsel for the inspector general:

To our way of thinking, the men and women in the corporate suite aren’t getting it. If writing a check for $200 million isn’t enough to have a company change its ways, then maybe we have got to have the individuals who are responsible for this held accountable. The behavior of a company starts at the top.

Maybe the government should have cracked down on this guy: a man who used patient information to charge phony narcotics prescriptions to a federal employee insurance plan gets off with a six-year sentence and a fine. He had pleaded guilty to charges of healthcare fraud, HIPAA violations, and identity theft in obtaining the drugs to sell.

In the UK, a member of Parliament says NHS should fire CSC from its $5 billion NPfIT contract since it has implemented only three hospitals in nine years. MP Richard Bacon, always a great source for quotes, says NHS CIO Christine Connelly’s assertion that it would cost more to fire CSC than to let them finish the work is “incredible,” saying if that’s true then everybody involved with Connecting for Health should be fired. Tony Collins reports on a leaked memo that says CSC is proposing to cut the number of trusts it will implement from 220 to 80, but at a rate per trust that’s double what the current contract specifies.

Other

Bizarre: 53% of surveyed teens say they would rather lose their sense of smell than their personal technology, while 47% say they want to be remembered for their social network connections.

 Sponsor Updates

• Carlos A. Labrador, MD (FL) is named as one of 15 eClinicalWorks clients to receive EHR incentive checks from CMS.
• Dell InSite One is managing over four billion diagnostic imaging objects and associated reports with its managed cloud enterprise archive.
• Fujitsu names Perceptive Software its Central Region Premier Partner of the year.
• T-System partners with Isabel Healthcare to integrate its T-SystemEV EDIS with Isabel’s diagnosis decision support content.
• Lawson Healthcare recognizes five provider organizations with its 2011 Customer of the Year Awards.
• maxIT Healthcare will provide consulting services for Meditech Magic users who are implementing the OrderEase software from Iatric Systems .
• Twenty Meditech hospitals have selected Imprivata OneSign in the last six months, bringing Imprivata’s Meditech client base to 150.
• HMS DIRECT, HMS’s remote hosting service division, expands it data center capacity to accommodate the growth of the company’s ASP business.
• Molina Healthcare picks GE Centricity Practice Solution as its primary EMR/PM platform.
• A Gateway EDI/LarsonAllen study finds that physician practices that have adopted RCM tools have higher revenues and collect more patient payments at the time of service.
• NCR is holding a June 16 Webinar called Revenue Cycle: Why Self-Service is Key, featuring Elmhurst Memorial Hospital.

Contacts

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

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Dr. Jayne Interviews KC Frank, EVP, Document Imaging Systems Corp.

KC Frank is executive vice president of Document Imaging Systems Corp. (DISC) of St. Louis, MO.

Give me some background about yourself and DISC.

DISC has been in business since 1958. Originally founded as a microfilm company, DISC has evolved into a document management solution provider focused on improving our client’s business processes. In 2007, DISC was acquired by The Flesh Company, a 98-year-old print solutions provider. I joined DISC as vice president in 2003 and have helped develop new solution offerings, strategic relationships in healthcare, and growth strategies. I am a long-time member of MGMA, AIIM, AIIM, ARMA, and TAWPI and recently received an AIIM Distinguished Service Award for accomplishments in the Information Management industry.

One of your marketing campaigns, which has been mentioned on HIStalk, is “No hybrid EMRs.” What do you mean by this?

A hybrid EMR is one where providers rely on both an electronic and paper chart post-EMR implementation. I have heard countless stories of physicians walking into encounter rooms with both a paper chart and a tablet PC. Managing patient care in a dual environment is both incredibly inefficient and frustrating. Without a solid strategy to eliminate the paper charts, the hybrid EMR will be a reality for physician groups as they migrate to EMR.

Many practices I talk to think they can scan their documents cheaper or better themselves. What’s your experience?

If organizations truly understood the process of conversion before starting, they would probably all outsource. About 50% of the clients we work with have tried to scan on their own first. Most organizations underestimate the time, difficulties and costs associated with converting their paper charts. It’s been proven many times over that a scanning process managed and executed by inexperienced staff results in double and sometimes triple the cost of outsourcing to an expert service provider.

It’s common sense. Businesses get better each time they execute a process. DISC has converted over a billion documents in our history. Physician groups may have never scanned a single chart when they start planning their implementation. Service providers like DISC are converting documents using technology designed for large batches of scanning, including scanners that cost in the hundreds of thousands of dollars. With better technology and processes built on experience, it’s difficult to imagine a healthcare organization that could scan cheaper and better.

How is working with outpatient medical practices different from working with a hospital, or say an academic medical center?

There are subtle differences such as project design, chart setup, document types, chart access needs, and workflows. Ultimately, with strong project management by the client and service provider, the differences are negligible.

Do you just work with local clients? What’s the farthest client or most exotic locale you’ve visited to convert charts?

We typically provide services on a regional basis. Since we are certified by both Allscripts and NextGen to provide services in the central region of the United States, the majority of our clients reside in an 18-state central region of the US. We’ve provided services as far west as California and as far east as North Carolina. Do they practice medicine in Hawaii? We’re still waiting for that call.

Thinking of some of your more difficult customers, what are some pieces of advice for practices preparing to convert from paper charts to an EHR?

First, decide on a conversion strategy. Will you outsource or attempt an in-house conversion? Will you scan all charts prior to go-live or scan by the schedule after go-live? Will you scan the entire chart or just a portion of the chart? All key strategic questions. Many times organizations lean on providers like DISC to help understand the pros and cons of each of the strategies.

Pick a strong project manager. Many times the HIM or medical records director is the right choice. Make sure the person you choose cares about the success of the project. Do not hire temp staff to manage the project.

If you choose to outsource, choose a partner that has experience with medical record conversion and the EMR you are migrating to. A service provider that doesn’t have experience with your EMR system may not be able to get the documents filed appropriately in that system.

If you plan to scan yourself, do time tests to determine how long it’ll take to scan a chart. This is critical. If an organization plans to scan by the schedule, meets with 200 patients per day, and can scan a chart in 20 minutes, it’s simple math to determine that it’ll take about 66 hours per day (8 FTEs) to keep up on that project. Don’t be caught off guard.

DISC does more than just scan old paper charts. What other solutions do practices need to manage the mountains of paper they’re used to moving? Will you go out of business when all the old charts are scanned?

If we relied solely on scanning historical charts, we would be out of business in five to seven years. Fortunately, we have developed other solutions in both document and content management to evolve with our clients. Although paper is slowly being eliminated from business processes, the volume of electronic documents and content continues to increase.

Today, we are offering solutions such as Daily Go-Forward Scanning, Revenue Cycle Document and Content Management, Accounts Payable Automation, Electronic ROI, and Business Intelligence. We also offer a variety of solutions in other vertical markets, including finance, manufacturing, education, and government. We plan on being around another 50 years.

Does it make a difference whether a scanning vendor partners with an EHR vendor?

Absolutely. Having intimate knowledge of the system the healthcare organization is implementing allows the scanning vendor to automatically load the electronic charts directly into the patient chart within the EMR. Without the auto load, healthcare organizations may be left with electronic charts stored and retrieved in a third-party system or internal network drive. This, of course, is not optimal since providers have to work within two systems to find charts instead of just the EMR.

Both Allscripts and NextGen realized the importance of this integration and put certified programs together to support their clients. DISC is a part of both of those programs.

You’re located in the Midwest, an area hit hard recently by floods and tornadoes. Any great “saves” with your clients during these disasters?

We actually did have a client this year ask us to scan hundreds of boxes of records stored in the first level of their building due to flood concerns. Unfortunately, natural disasters have a history of reducing the historical content of a business to rubble; specifically all the important documentation which resides in a paper format. Fortunately, companies like DISC can digitize that critical information so disaster recovery of those documents is as simple as reloading a backup.

Any final thoughts?

Another common strategic discussion we have with clients is whether or not they should scan the entire chart or just a portion. We have seen successful projects on both ends. Understand that the benefits many organizations expect when going to an EMR, such as eliminating chart filing labor costs and reusing paper chart storage space for revenue-generating opportunities, will not be realized until the entire chart can be removed from the chart room. This decision is typically made with one of two goals in mind – to satisfy clinical needs (partial scan) or to satisfy business needs (full scan).

E-mail Dr. Jayne.

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From Pericles: “Re: Allscripts outage at Allegheny General. The article refers to the company’s ‘New Jersey headquarters’ instead of Chicago. Could they have named the wrong vendor?” I assume the problem was with a hosted version of the Sunrise application, which is run from the former Eclipsys hosting center in Mountain Lakes, NJ. That operation and service was turned over to ACS/Xerox just over a month ago in a 10-year, $500 million outsourcing deal.

From Nosmo King: “Re: Nuance. As result of the Nuance partnership with 3MHiS that created CAPD (Computer-Assisted Physician Documentation), there are rumors that Nuance might buy the troubled document creation and management business of 3MHiS, formerly known as SoftMed.” Unverified.

From Mercy IT Gal: “Re: St. John’s Regional Medical Center, Joplin. It’s been a crazy week here at Mercy. A lot of time and effort is going into making sure the patients are taken care of, making sure our co-workers are OK, and securing the assets that were in the hospital. The mobile hospital is pretty wild – looks like a MASH unit (picture attached). The mobile hospital is an attempt by Mercy to show the community of Joplin that we’re not going anywhere. Mercy is committed to the Joplin community and will not abandon them in their time of need, even if it means setting up a temporary structure until we can get something new built. The frustration at work can get pretty high at times, but I can tell you that this week I’ve been pretty proud of working at Mercy. It’s amazing how people have come together looking for a way to help. Probably one of the best stories I’ve heard is from someone who volunteered to answer the hotline assigned to checking to make sure our Joplin co-workers were safe. She said she got a call from someone who had some damage, but was overall OK. She was concerned about her job and stated that she didn’t want to go to Freeman because Freeman is a for-profit hospital.  She said her heart was at Mercy and that’s where she wanted to be. I didn’t mean to turn this into a propaganda e-mail touting the virtues of Mercy, but as you can guess, this has been an emotional week and I guess it’s getting to me. Thanks again for all the hard work you do to keep us healthcare geeks informed and entertained. In case you don’t hear it often enough it really is appreciated. I hope you take some time to relax over the holiday weekend with Mrs. HIStalk.”

Update 5/29: the temporary hospital was scheduled to open Sunday afternoon in time for the President’s visit. Above are additional pictures from St. John’s – the photo album is here. The one with the printer in the lower left is what’s left of the data center.

From Sy Alice: “Re: abstract from the American Urological Association meeting. I imagine the good doctor could have phrased this better: “Good treatments are available for all patients and, depending on what the patient is willing to do, every man can get an erection if he sees a physician specializing in sexual dysfunction.” I’m not touching that with a … well, I’m just not touching that.

From The PACS Designer: “Re: CloudFoundry. CloudFoundry is the world’s first open Platform as a Service (PaaS) offering. The CloudFoundry.org Web site is a community-driven open source project that is led by VMware. With the CloudFoundry Beta, you can try for free the VMware Horizon App Manager, which is an open, user-centric management service for accessing cloud applications.”

From Lab Rat: “Re: Epic Beaker. I wouldn’t even think about implementing it until Epic gets back to work on it, especially in a larger hospital. Label printing is way more complicated to set up than with Cerner or Meditech and instruments were having troubles with the labels.” A Beaker site contact I asked agrees that it needs work.  

Photo: Patriot Guard Riders 

Monday is Memorial Day, a day to honor those men and women who have died in military service to the United States. Try to squeeze in a few minutes among picnics, car races, and the beach this long weekend to remember the fallen who earned that one day of honor the hard way (many of them barely old enough to vote). It’s perfectly fine to be anti-war and anti-military and still be supportive of those in the service – most of the fallen didn’t get to pick the cause they died for, so you can’t hold that against them. I ran one of my favorite poems on Memorial Day 2005 and a time or two since. My flag is flying and I hope yours is too – it’s the (very) least we can do.

Listening: Lez Zeppelin, an all-girl Led Zep cover band (not as weird as it sounds since Robert Plant shrieked like a girl most of the time anyway and cute girl rockers are always better). I’m not a fan of cover bands or even Led Zeppelin in general, but somehow I like their albums (yes, they’ve done two) that are note-for-note covers of the originals. I’m air guitaring to Dazed and Confused right now, wishing I was watching them live. Also: Manchester Orchestra, Atlanta-based emo-ey indie that veers into hard-rocking territory every now and then and sounds just fine.

About two-thirds of provider respondents aren’t so sure their employer has good enough security practices to keep their medical records private. New poll to your right: how loyal are you to working in healthcare?

I was going to run a poll on CHIME’s CIO credential, but I remembered that I did that two years ago. The opinion then was 91% negative (13% said it’s a vanity credential, 33% said it has no connection to competency, and 43% said it’s just another way for CHIME to make money).

Six-employee MobiuSoft of Flint, MI says they’ll hire up to 144 more folks in the next 18 months if their HIE product earns certification (that’s what I’m inferring from the newspaper article, anyway). Former Genesys PHO VP Jerry Van Horn formed the company in 2009.

Quality Systems (NextGen) announces Q4 numbers: revenue up 24%, EPS $0.64 vs. $0.45, beating analyst expectations for both.

Thanks to new HIStalk and HIStalk Practice Platinum Sponsor Gateway EDI of St. Louis, MO. The 30-year-old company’s 85,000 physician users trust its fully integrated tools and proactive service team to monitor their claims, catching and fixing issues before they cause problems for their practices. The fast-growing company’s founder was a physician who created new solutions when existing claims processing tools weren’t doing the job. Users rave about the personal support they get from the customer service department, with one happy physician customer calling them “the Nordstrom of EDI.” Providers get paid faster, big practices enjoy the customization capabilities of the Web-based software, and vendors offering Gateway EDI’s solutions with their PM software give customers an all-in-one solution. Thanks to Gateway EDI for supporting HIStalk and HIStalk Practice.

ED doc Kevin Kitka, DO of Mercy/St. Johns Regional Medical Center of Joplin, MO describes what it was like to be working in the hospital as it was severely damaged by the recent tornadoes. He’s an excellent writer:

A small child of approximately 3-4 years of age was crying; he had a large avulsion of skin to his neck and spine. The gaping wound revealed his cervical spine and upper thoracic spine bones. I could actually count his vertebrae with my fingers. This was a child, his whole life ahead of him, suffering life threatening wounds in front of me, his eyes pleading me to help him. We could not find any pediatric C collars in the darkness, and water from the shattered main pipes was once again showering down upon all of us. Fortunately, we were able to get him immobilized with towels, and start an IV with fluids and pain meds before shipping him out. We felt paralyzed and helpless ourselves.

Speaking of St. Johns, nearby hospitals accepting its evacuated patients had a heavy OB load. The hospitals credit GE Healthcare for rushing a team of employee volunteers to get fetal monitoring set up, one of them driving four hours to get to the hospital and another doing configuration from her laptop while hunkered down in her pantry because her own Dallas neighborhood was under a tornado watch.

Allscripts fires PwC as the auditor of its financial statements. I don’t really understand the reasons or the impact from the SEC filing, but maybe someone can enlighten me.

It looks like Cerner has a new logo and a tag line of “Health care is too important to stay the same.” I like the new one much better – it uses green (my favorite color, and everybody wants to use green these days) and it ditches the robotic-looking, all-caps-shouting CERNER in favor of a cute, non-threatening rounded font that everybody uses when trying to look Web 2.0.

Cerner’s just-published 2010 annual report has a chatty letter from president, chairman, and co-founder Neal Patterson with some fun quotes:

• Thirty-one years ago, had we known exactly how hard, how long and how costly it would be, we might have chosen a different industry. I am thankful today for how youth and ignorance can sometimes prevail over conventional wisdom.
• In my professional experience, vision is the thing you as a leader use to give your organization the courage and motivation to invest in new ideas years before they produce economic returns.
• We view our work over the past 30 years as analogous to building the foundations and laying the electrical grid for a great city that hasn’t been built. Reaching the place where we can actually start to build on top of that foundation is inspiring for us and our clients. Things are starting to get fun.
• In the past several years, we have made changes to our health plan, fired our third party administrator (we prefer to think of it as eliminating our first insurance company), launched an on-site new age clinic and pharmacy, incorporated biometric measurements for our population, realigned the economic incentives for associates in our health plan price tags and rolled out a data-based wellness management program that
  provides personalized health profiles for our associates.
• The Cerner of today is known for care; we expect the Cerner of five or 10 years from now will be recognized for health as much as care. As I mentioned, we can see a plausible scenario where health actually becomes the bigger portion of our growth.
• This is the start of my fourth decade at Cerner. This is the first decade that I will not finish—at least not in the role of CEO. Unfortunately, there is a direct correlation between years of experience and chronological age. Often when I share Cerner’s age (31 years), I make the offsetting remark that Paul, Cliff and I were all in our 20s when we started Cerner. In my case, I was 29. If you add thirty-something to any age, the numbers start getting large. I don’t intend to end this decade as Cerner’s 70-year-old CEO … which is frustrating because this is going to be the most exciting decade yet.
• [This is an entry on his personal to-do list, referring to his sister-in-law Linda, who died of sepsis due to lack of care coordination] Save Linda’s life. Make it systematic that preventable events that harm people are exposed to the appropriate caregivers and eliminated. This will not bring back Linda, but it may prevent the next 50-year-old schoolteacher from rural America from dying unnecessarily from the uninformed, sometimes inadequate, sloppy, delay-ridden thing we call a healthcare system.

Here’s Vince Ciotti’s latest HIStory, which points out the parallel of a 1960s government program that drove financial systems development and sales much like ARRA is doing for EMRs today.

McKesson’s lawsuit against Epic isn’t over. A federal court will rehear McKesson’s case, which claims that Epic’s MyChart infringes on a RelayHealth patent covering patient-doctor communication via the Web. The previous ruling let Epic off the hook, saying that Epic’s customers and not the company itself set up MyChart. The issue at hand is whether Epic encouraged its customers to do so, and if so, whether that constitutes patent infringement.

Rennselaer Polytechnic Institute is awarded a $1.2 million NIH grant to develop patient-specific “phantoms” that can model the organ-specific radiation exposure involved in CT scans.

The new management team at Guam Memorial Hospital finds financial irregularities that include paying $25K per year for software that generates a form that they say could easily be photocopied instead.

Interesting: Regenstrief doctors are developing software that will use EMR data to determine which warnings and side effects are relevant to individual patients, creating dynamic prescription labels.

High-powered venture capital firm Venrock adds Bob Kocher, MD as a partner, expanding to three partners who will focus on healthcare IT companies. He was previously with McKinsey, Brookings, and the Obama administration. Venrock’s previous investments include athenahealth, RelayHealth, Awarepoint, Castlight Health, Coderyte, and Vocera.

Hospital and population health applications vendor Healthways outsources its application development and technology management services to HP in a 10-year, $380 million deal.

GE Healthcare and Thomson Reuters will offer drug companies and other researchers a database that combines de-identified patient EMR data from GE with de-identified claims and prescription data from Thomson Reuters.

A study of 17 physicians in a clinic moving from an old EMR to a new and more powerful one finds that prescribing errors dropped, but mostly because use of unapproved abbreviations was reduced. The total number of other errors increased at the 12-week mark and was identical to baseline at 12 months, suggesting that EMR implementation may cause errors early on and have little effect after a year. Most of those same doctors said the alerts weren’t useful, it was too slow in handling prescriptions and refill requests, and the more sophisticated system wasn’t any safer than the old one.

England’s NHS Direct hotline launches a free mobile app that allows patients to assess symptoms, get self-care advice, and contact NHS’s telephone nurses. It’s Android-only for now, with an iPhone app coming in a few weeks.

Population and risk management software vendor MedVentive raises $1.5 million in convertible promissory notes and warrants. I interviewed Nancy Ham (president and CEO) and Nancy Brown (chief growth officer) last August. I asked some reasonably good questions about technology support for ACOs and whether providers are fixated on EMRs while ignoring potentially more important solutions.

Sponsor Updates

• The use of AirStrip OB by Lovelace Health Systems (part of Ardent Health Services, which uses it in all of its hospitals) is profiled in the New Mexico business paper.
• Billian’s HealthDATA is hosting a June 8 Webinar called Providers’ Perceptions: Mobility in Healthcare. They’re also offering a free white paper titled Social Media Strategy for Healthcare Vendors.

E-mail Mr. H.

In Mr. HIStalk’s Monday Morning Update (5/23/11), Vince Ciotti’s HIStory slide show installment focused on the former Lockheed / Technicon … / Alltel / Eclipsys companies and their health information systems. However, this installment is full of factual errors.

Ron Johnson was NOT one of the original Lockheed engineers. Ron was hired at the Technicon company (1980?) as director of marketing, and he was let go after a brief stint.

In addition, the late George Kennedy was NOT one of the original Lockheed engineers. At Technicon, compared to others, George’s role was thin and short-lived. 

Ralph Korpman, MD was involved as a pathologist for the Technicon laboratory information system and famously sold a version of it to the then-HBOC (lawsuits followed; settled out of court).

Jack Whitehead, who owned Technicon Instruments, a laboratory system company (Tarrytown NY), bought the original Lockheed system (along with many of its engineers) and named the company Technicon Medical Information Systems (TMIS), as it was called when I joined the company in 1978. TMIS was set up to take the Lockheed system and commercialize it. 

It was pretty clear who drove that vision in those early days. Unsung heroes, such as Sam Virts, Ralph Boyce, Dick Kortum, Chuck Tapella, Bob McCord, Mel Hodge, Stan Grahams, Bob Williams, Dave Brown, Carole Widener, RN, Shirley Hughes, RN, ……….. (and forgive me for leaving out so many who deserve to be included here).

Around the same time that TMIS started, Spectra 2000 Medical Information Systems was started by another group of former Lockheed engineers and initially financed by Transamerica (LA). This company was later bought by Medicus; Richard Jelineck, PhD, et al. The two competing TMIS and Spectra systems obviously were similar. What set the systems apart functionally was Spectra’s MIS provided the first colored screen text. However, Technicon’s MIS was fully installed and used in a hospital based on documented cost / benefits.

In 1975, two reports were written about the TMIS system: One was written by Battelle Columbus (OH) Laboratories – Final Report on Evaluation of the Implementation of a Medical Information System in General Community Hospital. The other was Demonstration and Evaluation of a Total Hospital Information System – El Camino Hospital, Mountain View CA.

El Camino Hospital has never employed physicians nor have physicians ever owned the hospital. ECH was and still is a community-based, district facility. The community physicians from the Sunnyvale Clinic and the smaller Mountain View Clinic were key supporters of the TMIS. Other, key, physician leaders, such as Ralph Watson, were part of smaller physician practices / groups. The fact that these community physicians were not employed and there was success in gaining wide-scale adoption of CPOE during the 1970s is an accomplishment that other companies and products required 25+ years and paid incentives to achieve.

In 1981, Jack Whitehead sold TMIS and the lab system division, Technicon Instruments, to Revlon. TMIS became Technicon Data Systems (TDS). In 1984-85ish, Revlon sold TDS back to Jack Whitehead’s son, John, who again took the company private and renamed the company TDS Healthcare Systems. Technicon Instruments was sold to a number of companies after Revlon, with its legacy now part of the medical division of Siemens. The name “Technicon” was bought by Bayer and cannot be reused.

In 1996-97, John Whitehead sold TDS Healthcare Systems to Alltel. This lasted 2-3 years before Alltel sold it to Harvey Wilson (formerly of SMS) who started Eclipsys with the idea that he would take the Brigham & Women’s home-grown HIS, put it in a “box”, and take the market by storm.  Harvey lasted awhile at Eclipsys, but his vision never even came close to fruition. 

Yes, a handful of those old Technicon, TDS, … systems still chug away.  On the other hand, Mr. Ciotti writes that he is a frustrated English major, and he can’t even use / spell the word "it’s" correctly! Thankfully he wasn’t a frustrated history major, because he really would have had no excuse for all the “HIStory” errors in this installment (and others?).

This reply was composed by the following, former TMIS / TDS / Alltel /……employees, who remain proud having been able to work with the above, early system, company, and exceptional engineers and clinician developers … and who remain alive and well working in today’s world of healthcare IT:

Jane Baseflug, RN
Connie Berg, RN
Edith Caesar (retired)
Ann Farrell, RN
Deborah (Debby) Kohn, RHIA
Elizabeth West

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Top News

St. John’s Regional Medical Center (MO) may not be salvageable, according to hospital’s president Gary Pulsipher. He says St. John’s, which is part of Mercy Health System, will open a 60-bed mobile hospital by Sunday and will rebuild. The hospital went live on EHR less than a month ago, but will soon be back online to connect the mobile hospital with other Mercy sites.

Reader Comments

From Easily Amused: “Re: magazine typo. A finance newsletter described a vendor as ‘provider of elf-service and revenue cycle management applications.’ I had visions of Santa’s helpers pitching in to improve collections.” At least they aren’t involved in elf gratification.

From Meaningless User: “Re: attestation. Do you have any info regarding which hospitals have attested to MU and what their success has been? I have not yet heard any announcements or rumors of a hospital achieving MU yet.” I doubt there’s a publicly available list, but some have met the Stage 1 requirements. It would be interesting to know if any have been turned down, but that’s not the kind of news that makes vendor press releases (not to mention that hospitals probably wouldn’t apply unless they were pretty sure they qualify).

HIStalk Announcements and Requests

In case you missed it this week on HIStalk Practice: Kareo lends advice on how to handle medical billing after a zombie apocalypse. Massachusetts eHealth leads the nation in enrolling primary care physicians for its REC. AMA reports a 45% increase in profits for 2010.  Dr. Gregg reflects on egos in the industry. And my personal favorite: the fake doctor who used toothpicks to treat his patient.  None of this news appeared on HIStalk , so if you follow the practice side of technology and aren’t signed up to get HIStalk Practice e-mail blasts, then you are getting left in the dust.

I’m taking a few days off for fun family stuff and trying to spend minimal time on the laptop, so I’m a little bit disengaged at the moment as I struggle to resist the gravitational pull of work and focus on non-work. I’ll be happy to get back to endless HIStalk hours in a few days.

Acquisitions, Funding, Business, and Stock

 

Standard Register enters a definitive agreement to acquire 100% ownership interest in informed consent provider Dialog Medical. Terms of the deal were not disclosed.

Resilient Network Systems raises $5 million in Series A funding, led by Alsop Louie Partners. Resilient’s technology facilitates the electronic transfer of health records.

People

Former Healtheon/WebMD CEO Mike Long is named president and CEO of EGHC, of which he was already board chair. The company’s businesses include a health plan, the Lumeris quality management software line, and ClearPractice EMR.

Announcements and Implementations

HIMSS introduces the ICD-10 PlayBook to educate providers on the transition to ICD-10

Allegheny General Hospital (PA) resorts to paper recordkeeping Wednesday after shutting down its Allscripts EMR. The hospital says it upgraded the system over the weekend and began having slowdown problems Monday and Tuesday. The hospital voluntarily shut down the system for about 12 hours while Allscripts fixed the issues.

CHIME reports that 109 individuals have earned Certified Healthcare CIO designation since the credentialing program was launched in July 2009. I said it was a dumb idea then and I’ll stand by that opinion now. Obviously the credential hasn’t exactly gone viral if only 109 out of thousands of hospital CIOs have signed on over two years, voluntarily jumping onto the hamster wheel of spending hospital money on renewals and going to CHIME meetings to earn CE. To each his own, but I’d be embarrassed to use a non-educational  credential earned by passing a multiple choice test of job-specific knowledge (designed by asking CIOs what they do on the job, then testing them to see if they theoretically know how to do it). My theory has been that CHCIO appeals to CIOs who feel inferior to their better educated C-level peers because they never expended the minimal effort required to earn a graduate degree by any of a zillion inexpensive, flexible, geography-indifferent programs that are out there.

athenahealth releases its sixth annual PayerView Rankings and awards Aetna the top spot among major players. BCBS-RI was the best overall performer, while state Medicaid providers were the worst in terms of days in AR and denial rates. Compared to last year, payers averaged payment one day faster with 5% fewer denied claims.

RCM provider RealMed announces its integration with Epic’s billing software.

Medicomp Systems announces that its Quippe electronic documentation system SDK is available for licensing to EMR developers. The browser-based, iPad-friendly system (which Dr. Gregg, Inga, Dr. Jayne, and I all raved about after working with it at HIMSS) uses the company’s MEDCIN-powered patented prompting technology to create and present EMR information in an amazingly intuitive way that even a non-doctor like me could use immediately after a ten-minute overview.

NCO Healthcare Services earns the “Peer Reviewed by HFMA” designation for several products related to eligibility, bad debt, and and extended office services.

Government and Politics

More grumblings about the proposed ACO regulation, this time from seven US senators. The lawmakers send Secretary Sebelius a letter urging HHS to withdraw its proposed ACO rules, saying, “the proposed ACO regulation will fail to accomplish its purpose” of better quality care and lower costs. The senators claim the proposed rules do not align incentives and accountability and include requirements that are too complex and an ROI that is uncertain.

CMS clarifies financial incentives for ACOs in rural areas, saying participants would be eligible for a savings exemption. CMS says that ACOs with fewer than 10,000 assigned beneficiaries would be exempt from the 2% savings threshold required of larger ACOs.

Add BIDMC to the list of hospitals claiming to be the first to receive HITECH money, $2.57 million in its case.

Other

Emergency physicians claim the biggest challenge to cutting costs in the ED is fear of lawsuits. An American College of Emergency Physicians poll finds that 53% of ER docs say the main reason they conduct the number of tests they do is fear of being sued.

Sponsor Updates

• SCI Solutions is attending and exhibiting this week at the National Association of Healthcare Access Managers conference in San Antonio, providing their traditional “Stress Free Zone” that features massages and cocktails.
• ESD heads to MUSE later this month (booth 910) as well as the Canadian E-Health Conference (booth 203). The ESD folks also shared that their KLAS ratings are up should you be interested in taking a look.
• Oklahoma Surgicare picks Provation MD software for gastroenterology documentation and coding.
• NextGen announces that Springfield Center for Family Medicine (OH) received federal funds for demonstrating Meaningful Use under the Medicare incentive program.
• Tim Reiner, VP of revenue management for Adventist Health System, describes that organization’s use of self-service technology from NCR for patient collections in a YouTube video.
• Yavapai Regional Medical Center (AZ) contracts for several applications from Lawson Software.
• Prime Healthcare Systems, California’s largest for-profit system at 14 hospitals, expands its use of document management technology from FormFast  to improve health information, revenue cycle, and patient registration.
• Self Regional Healthcare (SC) chooses RelayHealth as its HIE partner to improve care and support the Meaningful Use efforts of its eligible providers.
• Tele-Tracking releases Patient Flow Dashboard for monitoring enterprise-wide patient flow and getting more efficient use of existing capacity.

EPtalk by Dr. Jayne

I’ve been fairly critical of the federal Meaningful Use program lately. For the record, I want to mention one piece of the program (even if it did get relegated to the Menu Set) that I’m absolutely in favor of: increasing the number of providers who report syndromic surveillance data to public health agencies.

We’ve seen huge benefits to the field of epidemiology with increasing availability of health-related data. I still like the Google Flu Trend site as an idea even if it’s only search data. And “old school” diseases aren’t going away – the number of measles cases reported across the US just hit a 15-year high. 

The ability to track, trend, and prevent killer diseases is one of the cooler things we can do with healthcare IT (and one that’s proven to work, mind you). Can you imagine the TV show Quincy ME  if Jack Klugman had population-based aggregate data to work with?

In that same vein, a throwdown to my favorite elected officials. Hey Congress, how about putting together a true “Menu Set” of information technology interventions that have been proven to be effective and incentivizing them individually so that providers aren’t faced with the “all or none” problem with Meaningful Use? Any of us who have had to fill out the awful paperwork from the county health department to report a sexually transmitted disease would be happy to interface it directly from our EHR at the click of a button.

The American Medical Association offers a new app to assist with CPT codes. Only available for Apple users at this point, it allows you to search for, track, and e-mail selected codes. The first problem I had with it is that it apparently ignores the iPad’s gyroscope – it can only be viewed in portrait mode, which is a bummer for those of us that like to prop the iPad on our desk landscape-style so we can stream Netflix while we multi-task.

Navigation to the various sets of codes was pretty easy, but there wasn’t enough information on the screen to make a decision about the right code. The user would have to select each code and read the description. It would be more helpful to have a quick blurb visible on the screen rather than having each entry on the list say “office consultation,” which isn’t very helpful. (It was particularly unhelpful in the preventive codes section, but I couldn’t get a screenshot off my iPad to show, so I clipped this from the AMA Web site.)

I didn’t receive any IT-related checklists for a potential Zombie Apocalypse, but Inga did turn up Kareo’s thoughts on handling medical billing after the fact. I hadn’t really thought about Web-based telecommuting as a strategy to prevent employees from being eaten, but it does make a lot of sense.

Rest assured that due to our decentralized, multi-state virtual office architecture, the HIStalk staff is at significantly lower risk for being decimated by zombie attack than most health IT vendors.

Although Kareo’s piece mentions they didn’t know the code for having one’s brain eaten, I can propose (courtesy of IMO’s Problem IT product): E968.7 Assault by human bite and E979.8 Victim of crime or terrorism.

The Journal of the American Medical Association reports on Navigating the Challenges of In-flight Emergencies. There are apparently minimal standards for emergency medical kits, but kits and employee training vary from carrier to carrier. Airlines also have their own reporting systems and protocols, often relying on physician passengers rather than employed medical control officers on the ground.

The article proposes standardized reporting to the National Transportation Safety Board; expert recommendations for first aid kits (and eventually evidence-based kits based on the data gathered through reporting); enhanced training for flight attendants; and enhanced ground-to-air medical support.

Having had to respond to “Is there a doctor on board” more than once, I’m in agreement. Plus, it looks like an excellent opportunity for vendors to go after another potential customer base. Anyone want to hire a sassy CMIO to write your content for airline medicine? I’d be happy to travel all summer and write code for the most common airline emergencies I encounter along the way.

Contacts

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

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Top News

The market for anesthesia information systems is predicted to increase 50% by 2012 and be valued at $4 billion by 2017. Vendors battling for market share include Picis, GE Healthcare, Draeger, IMDsoft, Merge, and Philips.

From TopCrush: “Re: AAOE meeting. I’m at the American Association of Orthopaedic Executives in Orlando this week, along with a few hundred other folks and about sixty exhibitors. ACOs are definitely a concern for these guys. Orthopedic docs are scared of being left out and worried about the financial ramifications. Kind of funny but they have a VIP entrance for participants that have been coming for years or on a chapter board.  AAOE set up a fun Sports Lounge in the middle of the show floor – shuffle board and fuse ball included.” Thanks for the update from the field. I wish I had a special door I could walk through every once in awhile, just to make me feel more important.

Mr. H semi-left me on my own tonight, just in case you were wondering why there are fewer smoking doctor images that usual. Mrs. H deserves a date night every once in awhile and I hope he is taking her somewhere special.

Community Health Network (IN) appoints Ronald Strachan CIO. Strachan is the former CIO for WellStar Health System and for HealthEast Care System.

Shared Health names Hedge Burt VP of sales. Burt has served as SVP of business development with Entrada, as well as VP of provider sales for Kryptiq.

PACSGEAR names Eli Rapaich CEO. Rapaich succeeds company co-founder Brian J. Cavanaugh, who will assume the role of COO. Most recently Rapaich served as VP of sales at Philips Healthcare.

The DoD awards SAIC a $53 million contract to provide IT and EHR system support to the TRICARE Management Activity MHS.

Gulf Coast Medical Center (FL) will move to Epic EMR next month.

CMS notifies Jefferson Regional Medical Center (AR) that it has met Stage One Meaningful Use requirements and will receive approximately $3 million. Jefferson uses Allscripts’ Sunrise Clinical Manager EHR.

Catholic Health Initiatives selects Beryl to provide outsourced patient experience solutions, including physician referral services.

Hospital EHR vendor eCareSoft, the US subsidiary of Mexico’s largest HIT vendor, embeds task-oriented tutorials and collaborative e-learning tools into its application. Hospital users can share shortcuts and workarounds and provide feedback to the vendor’s support team right from the application.

Trinity Health (MI), Baycare Health (FL), and Jackson Health System (FL) go live on the LegacySuite solution from Legacy Data Access. LegacySuite provides data storage and Web-based solutions for retired HIT applications.

The Federal Health Architecture (FHA) awards CGI Group a one year contract for $5.7 million to support FHA’s CONNECT NHIE Gateway solution.

Swedish Medical Center (WA) picks PRISM contact management software from Aegis Health Group to automate its physician relations management process.

Jefferson County Hospital (MS) selects Custom Software Systems to provide ChartSmart EMR, document management, and lab modules.

Texas Health Resources, where Ed Marx serves as CIO, receives over $19.5 million in Medicare EHR incentive payments for the meaningful use of its Epic system. THR has invested more than $200 million on its EHR initiative.

A new study concludes there’s no consistent association between EHRs and clinical decision support in ambulatory patient visits. Researchers looked at data from 2005-2007 so perhaps newer decision support tools might paint a different picture. However, only one of 20 indicators showed superior quality with EHR visits versus non-EHR visits.

The video above is from St. John’s Regional Medical Center in Joplin, MO, heavily damaged after taking a direct hit from a tornado. Its 183 patients were evacuated, but five patients and a visitor died and several employees were injured. Hospital x-rays were found 70 miles away, with the hospital asking anyone finding hospital records to hold them while they figure out a way to collect them. Missouri’s disaster medical team has set up a makeshift 30-bed hospital in a tent, staffed by 40 doctors, nurses, pharmacists, and support staff.

Health IT ranks among the top 10 most popular career path for college graduates, according to a University of CA-San Diego study. Top jobs include healthcare integration engineers, system analysts, clinical IT consultants, and technology support specialists.

• DIVURGENT will host a CHIME College Live session June 8th entitled Accountable Care Organizations: Overview and the Role of Information Technology.
• Thomson Reuters’ Meaningful Use Quality Manager 1.0 earns ONC-ATCB modular certification from CCHIT.
• Voalte signs up to resell the Epocrates Essentials premium clinical suite with Voalte’s communications solution.
• CynergisTek CEO Mac MacMillian and Ohio Presbyterian Retirement Services CIO Joyce Miller-Evans will present at the Colorado Health Information Management Association’s Long Term Care Spring Meeting this week.
• Geisinger Health System (PA) picks Orion Health Rhapsody Integration Engine as its integration platform.
• Vocera CEO Bob Zollars is named a finalist for the Ernst & Young Entrepreneur Of The Year award for Northern California.
• The Redwood Falls City Council (MN) approves the $50,000 purchase of Provation software for the Redwood Area Hospital. The hospital will interface the software with its Meditech EMR.
• Awarepoint is awarded a patent for its wireless interaction-based tracking system.
• MED3OOO announces the general availability of InteGreat V6.4, which includes the components required to meet Meaningful Use standards.
• University Hospitals Bristol NHS Foundation Trust implements Imprivata OneSign for its 5,100 users.
• Baylor Health Care System (TX) affirms its plans to implement GE Centricity EMR across its entire HealthTexas Provider Network of more than 500 physicians.
• Prime Healthcare Services (CA) expands its rollout of FormFast document management technology to its recently acquired facility, Alvarado Hospital.
• BridgeHead Software celebrates the 10th anniversary of its partnership with MEDITECH.
• Lakeland Healthcare (MI) selects the ChartMaxx Epic integration package to integrate their physicians’ ChartMaxx EMR with the health system’s Epic program.

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

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