Jim Traficant is president of Harris Healthcare Solutions, the healthcare business of Harris Corporation of Falls Church, VA.

Give me a brief background about yourself and your new job. Congratulations, by the way, on being promoted to president.

Thanks. It’s a great privilege.

I’ve been at Harris now for 10 years. I worked at a small business prior to joining Harris, so I’ve experienced both large and small companies. I’ve worked in government and commercial business. I’ve got 25 years’ experience as a technologist and as a business executive, but my passion for transforming healthcare comes as a result of being a patient.

I’ve had two liver transplants. The first one, my neighbor saved my life. We were the fifth to have the surgery, the first that weren’t related. I have had two transplants in between an episode of sepsis. 

In my experience traversing the healthcare market, I learned that people are passionate about their work in healthcare, obviously. They have lots of data, but what was missing was information.

After my second transplant, I sent a note to the Harris CEO asking to take the company into healthcare. Harris is a pretty large company. We move information with lives at stake in every market we serve, like defense and intelligence. We have two million passengers that ride on our Harris Network for the FAA. I knew if we could move information in healthcare like we did in those other markets that we could save lives, make a difference, and maybe even create a business. 

Five years ago, I didn’t know if I would ever get to work again. To be honored by working at Harris and leading us in healthcare is a privilege I could not have imagined. It’s just terrific.

Harris has mostly been known, as you said, as a government contractor. It seems like that may not necessarily be the case going forward. Will the company go after the commercial healthcare markets?

The way I like to describe it is that Harris will have a significant role to play in helping to shape the future of healthcare, and healthcare is going to have a significant role in shaping the future of Harris. It’s a really good match.

Tell me about the strategy behind the Carefx acquisition.

We were really fortunate. Early in our healthcare venture — we’d been at this for four years now — we were awarded the Nationwide Health Information Network Connect program. We were working on behalf of the Federal Health Architecture to integrate the largest creators of health information, like military health, the VA, and Indian Health Services, so they could share information securely with each other and then provide that information to the largest consumers of health information at the federal level, like National Cancer Institute, the CDC, Social Security — which spends, you know, a half billion dollars a year just trying to find health information so they can determine benefits.

We had a couple of breakthroughs in that process. One was that Social Security used to take on average 83 days to find health information to determine benefits for our citizens. When they went through the gateway that we created for the Federal Health Architecture, this program called Connect, they went from 83 days to 24 seconds getting that information. That’s the kind of transformation I think the nation’s looking for out of IT being applied in healthcare.

A second thing we learned was that over half of the care provided for our active duty and retired service members comes out of the private sector. If we were going to play a role in transforming healthcare, it wasn’t sufficient that we could just get the federal sector connected to try and create a tipping point in health information exchange. We had to connect it to the private sector. 

What Carefx brought to us was this real strength in the private sector. They were at over 800 hospitals globally, over 650 in the US. What we had done at the federal level to provide this integration and connectivity connecting the infrastructure, they did on the commercial, side but in a different context. They were able to take the information from where it was created and deliver it to the computer screen and organize it the way a clinician thinks and works according to their workflow — labs, images, med reconciliation. 

It seemed like a perfect fit. Culturally, it was a perfect fit. They’re just great talent, great people, very deep in the healthcare domain, and really able to inform this rich technology base that Harris has as we move out and try to play a role in transforming healthcare.

That acquisition was a pretty strong signal of the interest of Harris to get into the commercial space. Do you see the potential for more acquisitions, or do you think Harris will be more of a builder than a buyer?

I would say this about Harris. It’s a great company. It has answered national priorities in almost every dimension over its hundred-plus year history. Healthcare is a national priority that’s going to require bold thinking and a strong presence and Harris is one of those companies. We’ll continue to grow organically, and I would expect over time that we’ll do more acquisitions. We’re committed to playing a key role in healthcare, so all of those options are going to be in play.

Healthcare divisions of big and broad conglomerates seem to lose some of their innovative capabilities. Do you see the Harris culture being different?

We have a very rich culture. In fact, it was one of the surprising things for me when I came out of a small business into this large, now six billion dollar company.

One of the things that many don’t know about Harris is that defense and intelligence invest very dramatically in Harris to take the state of the art in a number of technical disciplines and advance it or apply it in unique ways. In combination of significant investment plus what we contribute, we do about a billion dollars of research and development a year.

What we’ve seen is there are great parallels in healthcare to the challenges that have been faced in these other markets. I’ll just give you an example. What we saw post-9/11 in the intelligence community was we had all of the data. What was missing was a situational awareness at the national level that would be able to piece together all the information that was in these isolated pockets. 

In healthcare, what we see is a very fragmented market. There’s lots of data, but it’s isolated with stovepipes. It needs to be connected. Then we need to make sense out of the information and create situational awareness for healthcare just like we do for intelligence.

The other corollary we see is when you think about what an intelligence analyst does, they sift through a variety of information sources and then apply judgment in a time-critical fashion with national security and lives at stake. We provide that information on a global scale and enable that capability. It’s exactly what physicians do. They have to piece together information on disparate sources and apply judgment in a time-critical fashion with lives at stake. 

We see this transference of technology from our core markets into healthcare as a totally logical and compelling way for us to do this. All this innovation that exists really distinguishes us from a lot of the players in healthcare.

For example, from a security standpoint, we are very unique nationally for ability to secure information and move it anywhere in the world and any device authorized to see it. In healthcare, it’s not going to be, “Can we secure information in healthcare?” It’s going to be, “Can we translate our security in a way that can be meaningful in healthcare, that they can afford it, that it can be used in a very efficient way?”

The innovation exists in Harris. I would say these other companies have innovation as well, but the passion, the national mission, the sense of purpose applies directly. One of the ways I like to communicate healthcare inside Harris and also with our potential customers is that Harris is uniquely trusted at the intersection of life and data and every market that we serve.

It’s a very natural extension for us to move into healthcare. The response we’re getting in healthcare, I think, is evidence of the fact that we really have something to offer.

Harris is used to taking on projects with a large price tag and large scale. Who do you see as your customer in healthcare?

We started at the federal level because it was familiar. We knew how to compete. There are also some real strong forces at play when you look at military health. Harris being a defense contractor — that’s a logical place for us to participate.

The Department of Veterans Affairs — how do we take care of our servicemen and women who served us so well for so long? Those entities are not only providers of care, but they are payers. We knew there would be alignment and rewarding of enterprise solutions that would deliver efficiencies that would help us provide better care at a lower cost. 

We began there and got traction almost immediately, moving our technologies from the intelligence community for imaging, for example. We created an architecture for military health. We acquired a company in the VA that allowed us to do imaging across the enterprise for the VA, and then connectivity between DoD and the VA, not only from the integration or interoperability standpoint, but also for images and photographs and scanned documents, all of those being shared and able to be associated with a health record.

We knew that to transform healthcare, we had to move into commercial sectors. We’re not looking at healthcare in the same way we would look in defense or intelligence. We recognize that the buying and the programs tend to be much smaller in size, but we believe and we’ve demonstrated we could move technologies and do it very efficiently and create compelling solutions that will be affordable and transformative in the healthcare context. 

We’re very excited about what this market has to offer. Just from a business context, it’s hard to deny that it’s four times the size of the Defense Department. I think that’s why others are pursuing it. We’re looking at more as a chance of, if we can make a difference in healthcare, focus on the transformation, then the money will take care of itself. So far that’s been the way it’s played out.

You mentioned the VA and the DoD. I’m interested in the conversations being held about whether they should buy or build or how they can agree on a single system. You have a unusual perspective and viewpoint. What are your observations?

I think we have to be careful in one sense. I think there needs to be seamless system. It can’t be that the information struggles to come back from theatre to stateside and then into the VA. And then we have to think about the continuum. It doesn’t stop there. It has to be able to be connected to the private sector as well. That’s when ONC and some of these federal initiatives become really important as we set the foundation for how healthcare will happen in the US.

The military mission is different from the VA mission. I think we need to make sure that whatever we come up with, I’m not sure one size fits all. But we have to make sure that we can fit the military mission primarily for the military, and then make sure that what we’re providing for the VA is able to provide a continuity of care that bridges both the military as well as the private sector.

I don’t know if you can do that in one off-the-shelf system. You might be able to. I don’t think anybody knows, to be honest.

The other thing that the VA is challenged with, but I give them credit, is they get to work through these very hard solutions on a very large scale in a public way. Everybody’s watching every move they make, so if there’s any flaw, it gets exposed and printed. Most enterprises don’t have that type of scrutiny. 

What the VA and the military have been able to do — quite extraordinarily when you look at enterprise healthcare in managing multi-millions of patients and doing it securely and on that scale — they really helped advance healthcare in the United States. I commend them for what they’re trying to do. I’m not sure what the solution needs to be, but they got the right minds looking at it and I’m confident they’ll come up with the right answer.

Have the taxpayers seen value from their projects?

I’d have to say yes. They have seen value. You have to remember that the VA has led in a lot of instances. Ninety percent of all doctors trained in the United States go through a VA facility in the course of their training, so there’s a benefit broadly to the US for what the VA has done that we can’t lose.

At the same time, there are new technologies and new systems that are coming into healthcare. I think the VA, very strategically, is looking, “Hey, we’ve been doing it our particular way, but that doesn’t mean it has to be the way we do it going forward.” So again, I give them credit that they’ve been self-reflective and wherever they can leverage commercial investment and solutions, I expect that they will do that more, not less, but time will tell.

Harris recently announced the joint venture with Johns Hopkins Medicine to do some work with medical imaging products. I’m curious what the scope of that project is.

Hopkins saved my life on more than one occasion. My first transplant was there. I had sepsis and they again saved my life a second time. I knew a lot of the physicians there. 

I went back to them and after I was given the privilege of starting a healthcare business. I said, “Look, you saved my life, maybe even saved my career.” We started working together. What materialized is when they looked and saw the kinds of things we could do in imaging. I’ll just give you an example. 

In the intelligence space, somebody at the edge of the network — one of our servicemen or women serving in harm’s way — makes a request of imagery of some type. We go through a discovery process and find what’s been requested and enhance it with additional information that would make it more germane to their circumstance. We deliver it anywhere in the world on any device authorized to see it in near real time. It is awesome. Harris is literally a national asset in the imaging context.

What we see is a very unique ability to translate some of those technologies to healthcare in an accelerated way and create solutions that didn’t exist previously. That’s the opportunity we see at Hopkins. They’re the most trusted name in healthcare. Harris, I’d like to argue, is the most trusted name in secure information management. When you put those two things together, it enables Hopkins to leverage the information sciences in very unique ways, in this case particularly imaging, and help fuel the transformation that the nation’s looking for. We’re very excited about what’s possible in that relationship.

When you look at what healthcare IT advances are out there or potentially coming, as a technologist and a taxpayer and a patient, what gets you excited?

A couple of things. I think that when we move from a disintegrated, fragmented, and we can argue primarily paper-based system — although there’s a lot going on to digitize it. But if we had a digital system versus a paper-based system, it would better than what we have, but a far cry from what we need.

What has to happen is it has to be a connected framework for healthcare — where instead of walking into a hospital with your life at stake and your information carried under your arm in a notebook with some CDs in your hands hoping somebody can make sense out of this and figure out how to save your life — that the information shows up when you do and it’s a complete picture of your health. And now we take the knowledge base of these tremendously skilled and dedicated clinicians and enable them to take more information and apply judgment against it in an accelerated way. We will totally transform healthcare.

If we get to a data-driven care delivery model, OMB has said we will take out one-third of the national spend. When you look at the impact nationally of healthcare, the cost of healthcare in the United States and what we get as a return that investment, we’re not getting nearly the return that we need.

The technology will not in itself transform healthcare, but it will enable that transformation. I consider it a privilege and my life’s calling to be part of that transformation, leveraging the rich technologies of Harris to make it happen.

Doctors don’t want to type into a computer all day and patients have no interest in entering their information into personal health records. Do you think there’s a challenge that we may either not have anybody willing to create data or that there won’t be enough people sitting on the back end to monitor and react to it?

I think we’re going to get better at this. We’re in the very early stages of a transformation and it’s a little bit awkward right now. 

I came out of the aerospace world previously. We used to fly satellites, for example. Like in the Apollo 13 movie, they’re staring at streams of paper that are flowing and guys are sitting down and doing math equations trying to solve hard problems. Then we went to the computer, and all we did was emulate what we were doing on paper. We did it on the computer. We would look at strings of bits and bites and try to make sense out of it.

Eventually we advanced the interface so that we could run constellations of satellites with one or two operators. We did that because we were able to distill the information from bits and bites and go from data, to information, to knowledge. 

That’s going to happen in healthcare. It won’t be that we’ll supplant the clinician or the judgment in healthcare, but we’re going to give them a stronger knowledge base from with to apply judgment and be able to deliver it in a simple, easy to assimilate way. It’ll just become part of the workflow.

I really think we’re just in an awkward phase of transition. This is going to get to a point where it will be second nature, just like it is for us on our smart phones and how we engage even socially using computer technology. It’s certainly going to transform healthcare.

What would you say are the most significant opportunities and threats to healthcare IT as an industry?

That we allow it to be digital and fragmented is the biggest threat.

Once we connect the framework for healthcare, there’s going to be innovation in healthcare in an accelerated, unprecedented way that healthcare has never experienced previously. There’s going to be an enablement of a system approach to healthcare that has never been possible previously. We’re going to see competitive models. We’re going to see efficiencies delivered.

We’re going to go through a transformation. I’m not sure how quickly it will happen. It might take us five years. I hope it happens in less than 10, but we’ll get to a place where the information flows in healthcare like it does in other industries.

The biggest risk is that we continue to behave as if digitizing is sufficient, we continue with proprietary technology, we continue in monolithic systems.

My confidence in healthcare is that it’s just part of the transition. It will be the first phase of the transition. It won’t be the endpoint. We will certainly get to a place where we’re operating in a system framework, information flowing securely and ubiquitously. It will patient-centric, data-centric — a whole network built around patients. I think that’s the biggest opportunity. It takes advantage of what America’s great at, and that’s innovation and technology.

I think we’re in a great spot to lead the world and help to transform this. I think it’s going to go from a terrific cost and drag on our national economy to fueling our national economy in ways that we have not imagined.

Do you have any concluding thoughts?

First, thank you for doing this interview. I really appreciate it.

I also would like to thank the caregivers in healthcare. They’re the unsung heroes. They’re the part of the healthcare system that’s yet to to be tapped. I think they know a lot about how we can improve it. I think this future state of technology is going to make it more efficient, better care, lower cost, and transform this economically in the United States.

The last thing I would say, and this is personal, is I’d like to thank the people that work with me at Harris Healthcare for their passion and dedication. I like to say the two best days in a person’s life are the day you’re born and the day you know why. We are fulfilling what for me is a dream. The people that are working with me are just the finest. That goes for the latest part of our family at Carefx — just great people, committed to making a difference. I’m just proud to be associated with them.

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I was looking for the perfect quote to start this week’s Curbside Consult and thought I had it nailed. Like many avid readers, I tend to remember bits and pieces of great literature, but not everything. Just enough to do passably well at cocktail parties and trivia nights, but not well enough to lead a book club.

So, when I hit the Internet to validate the quote I was going to use, I was blown away by the parts I had conveniently forgotten.

It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity, it was the season of Light, it was the season of Darkness, it was the spring of hope, it was the winter of despair, we had everything before us, we had nothing before us, we were all going direct to Heaven, we were all going direct the other way…

This is the opening of A Tale of Two Cities by Charles Dickens. I was going to use the best of times / worst of times metaphor to talk about two recent physician visits, one of which was electronic and one was paper. I’ll let you guess at which one was which because the poignancy of the rest of the quote and how applicable it is to healthcare in general strikes me too much to want to talk about anything else.

First published in 1859, the story is set in the tumultuous time of the French Revolution. The opening line serves largely to portray the contrasts inherent in that time — poverty vs. affluence, ignorance vs. enlightenment, good vs. evil, and so on. When you think about it, sometimes it seems that things haven’t changed as much in the last two hundred as we might have hoped. It feels like we’re on the cusp of a different kind of revolution, and not necessarily for the better.

Undoubtedly, this is the best of times for many people. People are living longer, largely due to improvements in health technology. Mechanical replacements for diseased body parts, amazing new drugs, implantable defibrillators — you name it.

We are, however, in a system with a great deal of inequality about how this technology is employed, resulting in a great cost to society and for many a great personal cost as well. Medical bankruptcies are again on the rise, accounting for more than sixty percent of all personal bankruptcy filings. The worst of times, indeed, when people have to choose between purchasing food and filling their prescriptions.

Meaningful Use should be the poster child for the age of wisdom and the age of foolishness. It seemed so promising: “free” federal money for providers to do what they should have been doing all along, implementing systems to improve patient care and strengthen patient safety. Many providers were already doing these things, and it seemed so easy to reward them.

The way it’s unfolding, though, is just sad. The disparity between the Medicaid and Medicare incentive programs is laughable. At times, the whole business feels like a crapshoot. If this were an investigative study, it would never have made it past the Institutional Review Board.

Many of us on the healthcare IT side of things are living in the spring of hope. We’re well on our way to having the right software installed with the right workflows and the right numerators and denominators kicking out at the end.

For some of us though, this will lead right into the winter of despair. Meaningful Use is the ultimate pass/fail class. Miss the mark by half a percent on one measure and you’re out. This doesn’t seem in keeping with the spirit of trying to improve healthcare and health outcomes.

What if we treated patients like this? “I’m sorry Mr. Jones. I know you’ve done a tremendous amount of hard work to get your diabetes under control, including exercising and losing weight. However, your hemoglobin A1c level only came down from 9.0 to 6.2. The goal was 6.0, so you lose. Here’s a scarlet ‘L’ to wear on your shirt. I’m raising your health insurance premiums by 40%.”

Many of my peers have done the math and know that even with the penalties that are coming, they can “do nothing,” see one or two more patients a day, and come out far ahead of their colleagues who are on the MU hamster wheel. Could the unintended consequence of ARRA and healthcare reform be the downfall of Medicare and decreased health outcomes for our growing senior population? Will it be the final blow to an already ailing primary care workforce? Will it be little more than a windfall for technology interests and consultants?

Only time will tell. But I leave you to ponder on the closing lines of the book.

It is a far, far better thing that I do, than I have ever done; it is a far, far better rest that I go to than I have ever known.

E-mail Dr. Jayne.

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From The PACS Designer: “Re: SlideRocket. Microsoft PowerPoint has been the dominate force in the presentation arena for business applications, but there are new ideas surfacing that could challenge their market share.  One is a Web-based application called SlideRocket, acquired by VMware last month. You can try it by importing an existing PowerPoint presentation to see what a Web-based format can do to enhance your creative abilities.”

From Little Birdie: “Re: [SVP name omitted]. Fired from Ingenix last week.” I’m leaving the name off since nobody likes seeing themselves in unflattering headlines, but the source is a good one.

From Lawdy Mama: “Re: Ford’s in-car medical monitoring. The target is much larger. Truckers include a large population of diabetics and, since they live on the road, have problems managing their disease. It can also be dangerous for diabetics to drive while suffering dizziness or other symptoms.” I’m always fascinated by trucker health since I talked to a guy once who runs a company that provides healthcare services from truck stops – it was truly fascinating to hear about their particular risk factors and the challenges of delivering healthcare services to them when every minute off the road costs them money. I guess I can see the value there, although Ford didn’t mention trucks in their announcement. As long as the built-in device doesn’t require drives to interact with it (or drivers exercise reasonable caution by pulling over when doing so), then there may be some medical value.

My Time Capsule editorial this time deals with missing clinical information, even in supposedly advanced IT systems. A snip: “I can think of only two reasons: (a) command and control is so fragmented within our episode-based system of revolving door specialists that everyone assumes that someone else is watching the big picture, or (b) providers are too busy to do anything more than patch and mend, buried in piles of disjointed facts that are difficult to comprehend and act upon.”

I got a nice e-mail that I need to anonymize quite a bit, but here’s the gist. The author said reading HIStalk for years taught him/her two major lessons that he/she will use directly in his/her new vendor leadership role: (a) move your products up the value chain via application and technology integration, and (b) if your product enhances expensive hospital information systems, then price it accordingly based on the value it delivers. The conclusion: “Your blog sure cut down my learning curve for many things healthcare. I thank Dr. Jayne the newcomer, Inga, and yourself for your commitment to the industry.” I really appreciate that.

CMS may not show a lot of confidence in providers, but the feeling is apparently mutual. New poll to your right, for providers: are you confident that your employer’s security practices will keep your medical records private?

I found this installment of Vince Ciotti’s HIStory to be his most interesting so far, in which he also mentions the EMR that’s 40 years old and still running today (and it’s not Meditech).

Welcome to new HIStalk Platinum Sponsor Kony Solutions of Orlando, FL. They help companies (more than 35 Fortune 500 ones, in fact) get their message out to every mobile device that’s out there, providing a highly configurable out-of-the-box solution that allow companies to put mobile-rich apps (smart phone, mobile web SMS, etc.) in the hands of consumers in as little as a few weeks and at a lower cost than any other solution. These are not cookie cutter templates. Healthcare examples of what they can do: generate outbreak alerts, manage appointments, do prescription refills, and create provider-finder apps. Like their ad says, just putting an iPhone app out there is missing a bunch of consumers who use other technologies. I interviewed Aaron Kaufman, VP of the company’s healthcare and life sciences solutions division, just a few weeks back. Thanks to Kony Solutions and Kony Healthcare for supporting HIStalk.

Thanks to the readers who sent over new Annals of Internal Medicine articles on RHIOs and EMRs. Talking points: (a) only 13 of 179 RHIOs reported that they could meet Stage 1 Meaningful Use requirements, and (b) two-thirds of RHIOs won’t survive financially once their grant money runs out. The RHIO article points out that it’s not surprising that RHIOs can’t wean themselves off the taxpayer teat since free-flowing HITECH money encourages them to start up, but nobody wants to pay for information exchange except for directly beneficial transactions such as lab results. It also mentions that RHIOs are being held back by low EHR adoption (the accompanying editorial says RHIOs struggle “in exactly the same way as a cable company would if no one owned television sets.”) Here’s all you need to know about the article, which comes from its summary: “No RHIO in the nation met our expert-derived criteria for the comprehensive HIE needed to substantially improve care quality and efficiency.” The article had some unintentional humor in the footnotes: the authors who concluded that RHIOs are pretty much a failure were, like the RHIOs themselves, supported by ONC grant money. Doh!

Even Epic’s contractors get big new buildings. The company working on Epic’s never-ending construction projects figure they’re never going to be finished at this rate, so they build a 22,000 square foot building to hold their 65 on-site professionals that oversee several hundred construction workers. The construction company says they will have up to 700 people on site next year as they ramp up work on Epicenter 2, a second on-campus Epic auditorium that will seat up to 13,000 people.

A book detailing the 2004 murder of Cerner nurse Julie Keown by her husband (he poisoned her Gatorade with antifreeze), has been published.

A study finds that hospitals are over-promoting their robotic surgery gadgets and, in 73% of their Web sites, are using word-for-word questionable information provided to them from the manufacturer who sold them the equipment. According to the Hopkins surgeon who led the study, “To me, this is exactly what is wrong with American health care.  We are adopting technology without being up front about the outcomes to consumers. And we adopt technology before we properly evaluate it.”

Bizarre lawsuit: a woman sues an Ohio hospital, claiming it mailed her picture of her premature baby who died there. She says she received 154 pictures of her dead baby propped into a variety of poses, including some of his body being held by an unknown hospital employee, even though the mother told the hospital she didn’t want pictures taken.

Sponsor Updates

• DIVURGENT’s latest newsletter addresses activation management. The ACO book by partner Colin Konschak is now available on Amazon.
• Practice Fusion is hiring at its San Francisco headquarters, looking for talent in account management, marketing, engineering, legal, customer engagement, and executive management.

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 March 2006.

Information Technology Can’t Easily Fix Health Care System Gaps
By Mr. HIStalk

A New England Journal of Medicine study last week found that ethnicity, income, insurance status, and geographic area do not influence the preventative care received by Americans. Great news! Well, not entirely — we’re collectively getting only about half the care we should. The embarrassing gap just isn’t prejudicial, that’s all.

The study used a RAND Corporation list of several hundred medical care standards that are hardly controversial, with common-sense items like, “Providers should reassess the alcohol intake of patients who report regular or binge drinking at the next routine health visit.” So, if the standards make universal sense, why aren’t they being followed? Unless you know of doctors who wake up vowing to harm their patients, it must be something else.

I can think of only two reasons: (a) command and control is so fragmented within our episode-based system of revolving door specialists that everyone assumes that someone else is watching the big picture, or (b) providers are too busy to do anything more than patch and mend, buried in piles of disjointed facts that are difficult to comprehend and act upon.

The authors recommend IT as the solution. Why not? No judgment is required, just analysis of discrete data elements with specific combinations of values. It’s a piece of cake compared to fly-by-wire electronics on a jet.

Sounds good, but I’m seeing red flags all over the place. Can your clinical information system or practice management application detect the following situations?

• Patients <75 years old presenting with an acute myocardial infarction who are within 12 hours of the onset of MI symptoms and who do not have contraindications to thrombolysis or revascularization
• Patients with major depression who have medical record documentation of improvement of symptoms within six weeks of starting antidepressant treatment
• Patients under age 75 with preexisting coronary disease who have an LDL level >130 mg/dl after six months of dietary cholesterol-lowering treatment

You don’t have to go far to find out. If your database person can’t do it in SQL, it probably can’t be done.

AHRQ and other groups have observed for years that we collect a lot of data, but often in unusable forms (paper, free text, or scanned documents), in scattered locations, entered too late to be actionable (diagnoses, surgical records), and with logic and structure better suited for creating bills than delivering care. Reading these standards makes that obvious. We IT folks are on the hook to solve the problem, but current systems (and use of them) are going to be a problem.

RAND was kind enough to make its standards freely downloadable as a public service at . If you’re a CIO, vendor executive, or system user, evaluate your system’s capabilities to capture and repose the necessary data elements. Then, look at how many are actually available.

How many of the standards are you managing by automation today? How many are you working to add? Think competitive advantage since it’s unlikely that this kind of scrutiny will just go away.

I maintain that most hospitals, even those using advanced clinical functions like CPOE and clinical decision support, still are missing much of the electronic data needed to make clinical decisions. While the NEJM article wasn’t written to make that observation, I think it ends up doing exactly that.

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An HIT Moment with ... is a quick interview with someone we find interesting. W. Sanders Pitman is president and CEO of SuccessEHS of Birmingham, AL.

What were your conclusions about the HIMSS conference and the interests of those who attended it?

HIMSS is the largest tradeshow in our industry, and despite the struggling economy, a record number of people were in attendance this year. This is a very expensive venue for the vendors and each year seems to bring a new level of extravagance.

There is so much information and hype it is very difficult for even the most experienced healthcare executive to discern the true differences among the many vendors at the show. For the novice, I would expect that they came away confused and hardly able to truly differentiate the offerings of the many vendors as it relates to their specific practice and set of circumstances.

I do think, however, that HIMSS is a good opportunity for various vendors to identify complementary offerings and business relationships.

What steps are you taking to get your clients to Meaningful Use?

We have numerous initiatives underway to ensure that our providers can capitalize on the EHR incentive programs. From the start, we sought to help our clients achieve Meaningful Use by seeking certification at the earliest moment possible; we were among the first in the country to achieve certification as a Complete EHR.

Following our certification by CCHIT, an ONC-ATCB, in September of 2010, we launched a series of weekly webinars for our clients, educating physicians on the incentive programs and on changes they could begin making in their workflow to achieve Meaningful Use. Recorded classes were published to our Learning Management System (LMS) so clients who were not able to participate in the webinars could access this information at their convenience. These webinars are still being offered live on a weekly basis.

We also developed a comprehensive Meaningful Use Toolkit which was distributed to clients and is also available for on-demand access via our LMS. This toolkit contains an introduction to the incentive programs, information on enrolling and understanding the program, an overview of all Meaningful Use measures, a Physician Toolkit, a System Administration Toolkit and links to additional resources. The Physician Toolkit is designed to provide physicians with concise information and screenshots demonstrating the system functionality to support Meaningful Use, while the System Administration Toolkit guides practice administrators through the system configuration changes needed to support the Meaningful Use measures. We designed this toolkit to walk our clients step-by-step through the process of achieving Meaningful Use.

Our goal is not just to provide the tools needed to achieve Meaningful Use, but to partner with our clients to make sure that they understand what they are eligible for, how to use the system to obtain it, and that the system/staff proactively work with the physician to ensure compliance.  We will be providing configuration options to “prompt” physicians when compliance opportunities are being missed in an effort to maximize physicians’ opportunities to achieve compliance at the point of care.

Lastly, we have not changed our pricing nor are we charging our current clients an additional fee for the Meaningful Use features, webinars, or toolkit.

What are the specialized requirements of Community Health Centers?

Community Health Centers (CHCs) are, in many cases, run more like a business than a lot of private practices. Typically the physicians are employed, the clinics rely heavily on grant money (which can be a daunting application process for the practice), and they have strict reporting guidelines. These factors make the workflow for the clinics more detailed in regard to data capture and do not allow the flexibility private practices sometimes enjoy in determining the extent to which they want to engage with the EHR.

To some extent, it seems these organizations are a testing ground for what is coming in healthcare reform.  Requirements that have been placed upon CHCs for years are now making their way into private practices.  For example, CHCs participate in Disease Collaboratives that require reporting on protocol compliance for patients with depression, diabetes, and more. Managing clinical protocols and reporting on compliance has now made its way into many of the initiatives for private practices. Many of the initiative programs that are around today in private practices have existed for years in some form with the CHCs.

Specialized requirements for CHCs include the need to:

• Manage sliding fee scales for indigent patients
• Perform monthly, quarterly, and annual reporting such as UDS, cost reports, Ryan White, collaborative reports, and more
• Submit claims with very specific formatting requirements – CHCs have different billing guidelines for Medicare and Medicaid. These are typically paid on an encounter basis, so there are special requirements for billing, posting payments, and transferring balances. 

It has been our experience that Community Health Centers really take to heart the mission of serving the underserved. There is a genuine interest in improving the quality of care for patients. They are often providing a wide scope of services, including comprehensive primary care, dental services, behavioral health, and HIV care while documenting the data necessary to meet federal reporting requirements. Clinical decision support is important to achieving the goal for these clinics of not just meeting the federal reporting or billing requirements, but improving patient care.

There are hundreds of EHR and PM vendors out there. If a practice is interested in choosing one, what criteria and methods should they use to distinguish one from another?

Evaluating EHRs is a daunting task, with so many vendors to choose from and so many features to comprehend. Of course, certification is a huge help in determining which products include core features needed to operate efficiently and profitably.

Unfortunately, the evaluation process only starts with selecting a certified vendor. The disconnect between Certified EHRs and Certified EHRs that can deliver value is significant, and if you choose incorrectly, you may end up with a vendor who is not aligned with your goals and offers no assurance that you will actually receive value. There is a way to accurately measure the potential of Certified EHR vendors — you must consider more than the features and functions a system brings to the table.

When evaluating EHRs, keep in mind that single-database, integrated EHR and practice management systems work the most seamlessly, as there is no need to build and maintain an interface between the two systems. Be sure to consider whether the system is scalable enough to meet the changing needs of your practice. Also evaluate the level of support offered by the vendor, as this varies widely across the spectrum of EHR providers and can make a huge difference in the level of satisfaction with the software.

Quite often the relationship you develop with the vendor is just as important as the feature set you are buying. At some point you are going to run into serious issues (it is almost guaranteed). Having a stable company with experienced leadership that you can count on in a real time of need can be the difference between success and failure.

Do you think usability will be rolled into Stages 2 and 3 of Meaningful Use? Are vendors doing enough to design and test their applications to comply with formal usability standards?

There is talk of trying to roll in usability, but it will be extremely difficult. With most government certification programs you must have a clear set of guidelines that are not subjective. For phase 1 Meaningful Use certification, ONC utilized both CCHIT and Drummond Group. They were very clear that the requirements must be followed to a T with no deviation.

Since usability is largely a subjective issue, I do not know how they can establish ironclad guidelines to quantitatively measure it. With different certifying bodies and many judges employed by each certifying body, it will be virtually impossible to insure continuity.

I think EHR vendors are going through the natural progression that follows any new developments in technology. We first all scrambled to meet the fundamental requirements as dictated by ONC. I am sure that most vendors did their best to consider workflow while developing the base requirements, but given the fact that the core requirements were not finalized until the summer and we early birds were testing in the fall, there is always room left for improvement which, again, follows the natural progression.

ONC has dictated a set of fundamental requirements which is a good thing for the industry, but I think it is up to each vendor to focus on usability in their own way. At the end of the day, it is up to the free market to decide what is “usable” and what is not.

In the automobile industry, there are governmental guidelines that must be adhered to for safety and emissions, but the individual features like color, style, and usability of available options are up to the consumer. In that same vein, I believe that having specific feature requirements as dictated by ONC is a good thing, but in the end, usability and personal taste depend upon the individual consumer.

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