Top News

The UK’s National Audit Office (NAC) says that the billions spent so far on the country’s National Programme for IT has been poorly used and the project needs to be reassessed. The NAC concludes that the investments don’t represent value for the money and officials are not confident that spending more will be any different. The NAC believes the project’s core aim of having an electronic record for each patient will not be achieved.

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Reader Comments

From Frank Mac Court: “Re: study on operational RHIOs. Here’s more information on the study.” Earlier this week, I mentioned the report that found only 13 of 75 operational RHIOs met the basic criteria for Meaningful Use. The information was collected in early 2010 and the authors admit that “data exchange could have accelerated in the interim.”  It’s likely that today there are more than 13 HIEs exchanging Meaningful Use-caliber data, though admittedly it’s still a pretty small club.

From Certs Two Mints in One: “Re: [vendor name omitted]. One of our sites is under siege by these folks, whose product holds only Modular EHR certification. They told the customer in writing that they ‘will be ONC-ATCB certified as a complete EHR for Meaningful use by July 1st, 2011.’ Vendors are supposed to be prohibited from pre-announcing their status and clearly they are saying something they can’t know is true. Maybe they failed and have made software changes that they assume will earn them certification.” That’s at least a poor choice of words – swapping ‘will’ with ‘hope to’ would have removed all grounds for complaints from either customers or the certifying body.

From Sarah: “Re: ONC and security awareness. If you heard and met some of the so-called IT consultants that standalone providers hired, you would think they needed some awareness. Many of the providers we deal with have IT people that can’t even set up a domain or workgroup correctly without leaving gaping security and permission holes, let alone manage security at a level we implement internally to protect their PHI. In some areas, the only option (no joke) is Geek Squad. They need step-by-step list for the techs and automated verification tools that providers can run themselves during annual security audits.” I think those are great ideas. Hospitals are reasonably good at basic security, but physician practices often don’t even know they need it, much less how to make it happen.

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HIStalk Announcements and Requests

Listening: the just-released Rome from Danger Mouse, spaghetti western-style music mixed with a little R&B and played on vintage instruments (the keyboards are amazing) recorded straight to tape, some by the original musicians from The Good, the Bad, and the Ugly and similar movies. Mellow 60s hip with that shimmery, sharp, echoey movie soundtrack sound that makes you think that a guitar-carrying Claudine Longet could wander in looking wide-eyed and pensive in a mini-dress at any moment. Guest Norah Jones sounds sweet and Jack White is pretty good. If you’re in the right mood (and I’ll leave you to decide what that mood is), it’s transcendent.

This week on HIStalk Practice: the irreverent Joel Diamond, MD resurfaces and ponders what HIStalk would be like if it offered with some quaint, Andy Rooney-style observations. Don Michaels, PhD and VP of Hayes Management Consulting makes his premier on HIStalk Practice and offers tips to determine if one’s organization is ready for an ACO. Julie McGovern with Practice Wise shares insight into the high quality talent to be found in the country’s HIT programs. Massachusetts governor Deval Patrick helps eClinicalWorks celebrate the opening of its new office. Computer trumps doctors in detecting acromegaly. The AMA Board of Trustees argues against EMR standardization, claiming it would stifle product innovation. Participants in an ACO demonstration project contend that CMS’s proposed ACO framework is too risky. While you are paying a visit to HIStalk Practice, check out some the Web sites of some of our sponsors and learn more about their nifty products and services.

On the sponsor-only Jobs Page: Program Manager, Data Implementation Engineer, Healthcare Informatics Analyst, Systems Engineer. On Healthcare IT Jobs: Clinical Nurse Analyst, Regional Business Development Manager, Clinical Project Manager, Director Technical Infrastructure, Allscripts Report Writer.  

I had a routine doctor’s office visit this week. I observed perhaps 10-12 employees of the university-owned practice as I waited my turn, ranging from the front desk people to assistants to nurses. Every single one of them, other than my doctor, were somewhere between significantly to massively overweight, while all the patients in the waiting room were pretty much of normal size. I wondered how effective those employees are at convincing patients to change their dietary and exercise habits? That reminded me of the two respiratory therapists I’ve known who smoked constantly, with their cigarette packs prominently sticking out of their shirt pockets as they counseled patients on good pulmonary health. Healthcare is a funny business.

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Acquisitions, Funding, Business, and Stock

Israel press reports that Reed Elsevier is in talks to buy Israel-headquartered dbMotion for $250-$300 million. dbMotion officially told me they could not comment. In February, dbMotion and Elsevier announced a partnership to integrate Elsevier’s analytics solutions into dbMotion’s interoperability platform.

Proof that Irrational Exuberance II is upon us even amidst a recession and smothering national debt, only this time limited to just a handful of darling companies. LinkedIn share prices more than doubled in their first day of trading Thursday, opening on the high end of their range at $45 and closing at $94.25. That values the company, which lost money for years until finally eking out a $15 million profit last year, at almost $9 billion. Hopefully the huge ranks of the unemployed will somehow benefit from the trickle-down effect of millionaire secretaries and trade-in VC wives buying Ferraris and McMansions. I hate everything about LinkedIn except that just about everyone is on it.

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People

   

HIMSS runs a bio and interview of its 1990s CEO John Page. Interesting: he says his greatest achievement was splitting HIMSS off from AHA, which he said was essential for its survival. He also mention his greatest challenge – trying not to disenfranchise the management engineers that formed HIMSS as the IT side of the house started invading and eventually pushed them out like greedy European settlers marching red-skinned Americans off their land and into concentration camps called “reservations.” It must be lonely being among the tiny ranks of folks making up the MS part of HIMSS.

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Announcements and Implementations

Detroit Medical Center anticipates receiving $40 million in Meaningful Use incentives, including $16-$17 million this year.  Meanwhile, Beaumont Hospitals is planning for $26 million, including $10.3 million this year.

Verizon Wireless and Medco Health Solutions release a mobile app to guide patients and doctors to the lowest cost prescription drug. The app gives information on out-of-pocket costs and lower cost options, based on a patient’s specific insurance plan.

Ford will expand its Sync in-car automation to create “the car that cares,” planning to roll out allergy alerts and connected medical devices to monitor blood sugar with the help of its partners Medtronic, WellDoc, and SDI. I don’t get the point, not to mention that the last thing we need is a bunch more marginally skilled drivers screwing around with yet another electronic device instead of paying attention to the road. Maybe Ford can add monitors for bladder distension and grumbling stomachs and fund the whole project by running GPS-localized restaurant and gas station ads.

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Government and Politics

CMS announces that the first Medicare EHR incentive payments will be issued this week. Greenway Medical says their client Childs Medical Clinic (AL) was among the first to receive funds Thursday, as was Cerner client Dr. Juan Salazar (TX).

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Innovation and Research

An upcoming study in an economics journal claims that higher usage of EMRs would save a lot of babies. You can guess what they did: combined old (2006) data from several sources that include that of HIMSS Analytics, taking a guess at when those systems went live (since HIMSS Analytics reports products bought but not yet installed), did some kind of county-level breakdown, and found that EMRS are “associated” with lower infant mortality (leading to the dramatic title, “Can Healthcare IT Save Babies?”, that in my mind is a question left unanswered.) I would have been more convinced had they looked at infant mortality at individual hospitals pre- and post-EMR, also ruling out related OB-specific systems that don’t really require EMRs. I don’t doubt that hospitals with the ambition and money to buy EMRs may well have better outcomes with newborns (possibly because they aren’t usually in poor, inner city neighborhoods), but its a stretch to say it was the EMR itself that made them better (or to assume, even with everybody and his brother installing EMRs, that we’ll be seeing a drop in infant mortality anytime soon). It’s a free PDF download if someone wants to critique it in more detail.

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Other

Officials with Saint Elizabeth Regional Medical Center (NE) say they will hold off on plans to form an ACO, following the release of proposed ACO rules. The hospital fears potential financial risks may not be sufficient to cover high initial investment costs, including IT-related expenses.

KLAS looks at partial and extensive IT outsourcing and concludes that CareTech, Dell, and Siemens rank high in both categories. CTGHS topped all firms for partial IT outsourcing and CareTech led for extensive IT outsourcing.

In the under-200-bed community hospital market, 80% of organizations report confidence in their vendor’s ability to ultimately satisfy Meaningful Use requirements. The other 20% are looking to replace their vendor. All of the Cerner clients participating in this KLAS survey expressed confidence in Cerner’s ability to meet Meaningful Use; at least three customers from each of the other seven vendors felt achieving Meaningful Use with their current vendor would be a long shot or probably won’t happen.

Weird News Andy likes this quote about NPfIT from UK MP Richard Bacon: “This turkey will never fly and it is time the Department of Health faced reality and channelled the remaining funds into something useful that will actually benefit patients. The largest civilian IT project in the world has failed.”

A NEJM editorial says the provider payment system based on CPT and E&M codes forces EMR vendors to modify their programs to create reams of repetitive and clinically worthless documentation instead of doing something useful, like improving clinical decision support. It points out that payments encourage upcoding and over-documenting, but nobody has come up with a better alternative.

Alan Cremer, founder and acting CEO of drug database search application vendor IntelliDex, e-mailed to ask me to mention that he’s looking for a president and CEO for the company. If you have startup leadership experience, preferably in a medical informatics company, check out the job description and consider throwing your hat into the ring.

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Sponsor Updates

• iSirona demonstrated its integration technology at last month’s Vision User conference in Salt Lake City. The company used its software to upload patient vitals from a Stryker Bed InTouch and a Fukuda Denshi bedside monitor, which were then verified and uploaded into the Siemens clinical suite.
• H/P Technologies, which provides staffing and consulting for all Meditech modules, will exhibit at MUSE May 31–June 3 in Nashville.
• The MSO Mississippi Health Partners selects RelayHealth to provide health information exchange for its 800 physicians and 13 hospital members.
• ESD hires Dan Oberle as VP of business development. His previous employers include Santa Rosa Consulting, CTG, and ACS.
• Orion Health and NextGate partner to include NextGate’s  MatchMetrix EMPI and Provider Registry products in the Orion Health HIE solution.
• Dossia partners with Health Language Inc. to embed HLI’s language engine into the Dossia Health Management System.
• API Healthcare announces that it achieved its highest number of deployments ever during the first quarter of 2011.
• Ovum, part of Wolters Kluwer Health, introduces OvidMD, a clinical tool that incorporates medical research with Wolters Kluwer’s UpToDate resource tools.
• Children’s Hospital of Orange County (CA) selects MobileMD to provide HIE services to its 800 physicians and 1,000 referring physicians.
• Healthcare Innovative Solutions co-sponsors a Victoria Era fashion show, which raised over $1,000 for the Seville Food Pantry (OH).
• Hayes Management Consulting unveils a partnership with The Coding Network to provide audit and remediation services to physician practices using MDauditComplete.
• Capario says it is now processing inbound 5010 claims (Errata version) and providing 5010 ERAs with submitters.
• Sage SVP Tony Ryzinski offers up 10 areas for improvement when managing the revenue cycle.

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EPtalk by Dr. Jayne

WebMD reports this week that even mild exercise with the Wii Fit game can improve fitness for COPD patients. Big surprise: patients are more likely to stick with exercising at home if it’s fun. I have to admit, the Wii is one of my guilty pleasures and its price point is more realistic for people than some of the other game consoles. If it gets people off the couch for even 10 or 15 minutes a day, I say go for it — although I’m not sure I want to know what my blood pressure looked like when I was trying to find the last three i-points on Island Flyover. But then again, there’s something therapeutic about crashing your biplane into the ocean repeatedly after a long day listening to physicians complain about computers.

I keep getting e-mails from the American Medical Association about their AMAGINE physician portal ,which “offers a low-cost approach to meet the needs of your practice and achieve each level of meaningful use.” If you’re a provider or someone who works closely with a provider, have you checked this out yet? I’d be interested to hear what you think. Featured products on the site when I stopped by included NextGen, Ingenix CareTracker, and Care360 EHR.

I’m still a bit in awe of being a minor Internet celebrity. I wonder if Centers for Disease Control spokesman Dave Daigle was ready for his brush with fame? The normally sleepy Public Health Matters blog featured a new topic this week: Preparedness 101: Zombie Apocalypse. The site has been so popular after being named a Twitter “Top Tweet” that it’s intermittently crashing, so be patient. I’m not sure of the specific impact of zombie apocalypse on IT infrastructure (my medical training was more in dealing with the brain-eating aspects of zombie behavior) but it’s always good to be prepared and make sure you have a disaster plan for each of your critical systems. If anyone has a good zombie preparedness checklist for enterprise EHRs, please share!

I agree with Inga, it was feeling like a bit of a slow news week, at least until I came across this headline: Don’t forget! Your computer job is still killing you. Based on the multitude of upgrades our organization has to complete in order to be ready for Meaningful Use attestation, I was sure the author had been following me around. I’m not sure about their level of medical fact-checking, but I do like their graphics. It’s a good reminder for those of us who have traded walking the clinical halls of academic medicine for a more desk-jockey lifestyle that we need to get up and move.

Finally, having spent some time attending a renowned Southern institution famous for matriculating Mrs. degree candidates, I learned that there are a few things that aren’t fit for discussion in mixed company if one wants to catch a good husband. Since I’ve turned into a grizzled IT veteran (although I do know how to identify a fish fork and exactly how to use it) I’m going to break that rule today. Last November, Mr. H mentioned a UK team that was working on a smart phone app that would instantly diagnose sexually transmitted diseases after urine or saliva was … ahem … applied to a chip that would then be attached to the phone, leading to a quick diagnosis. It seems this product will have an expanded target market after June 1 since Apple has approved a “prostitution-friendly” app aimed at pairing “sugar daddies” with willing companions. I was going to say something pithy about Adam, Eve, and an Apple until I read further to find it’s compatible with Android and BlackBerry devices as well. Instead, to the App Store, I say — “well bless your little heart.”

 

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Contacts

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

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

This is the third in a short series of posts on The CIO’s Best Friends, BFFs who are critical in ensuring CIO effectiveness. This time we cover the vendor account executive–CIO relationship.

Don’t Fudge the CIO–Account Executive Relationship

I was new in my role as a director. For that matter, I was new to managing a vendor relationship. I was getting by, but only because the vendor account executive (AE) took pity and mentored me in how to manage such a relationship.

I had a responsibility to implement new applications to make our hospital easier to use than the competitor down the street. We had significant success, but it had little to do with my abilities. It was the AE.

I nearly ruined this relationship.

I set out to leave the office, looking forward to a family vacation the next morning. I don’t recall the infraction, but I said something unfair and unkind to the AE. I knew I was wrong and felt awful. I fired off an e-mail apology,  but I wanted to do more. My time was scrunched.

On my desk laid two large, wrapped boxes of fudge from the famous Rocky Mountain Chocolate Factory. An AE from another company had shipped these to me as a thank you for hosting a site visit for a prospect. I set aside one box for my team and intended to open the other. In my haste to demonstrate remorse, I repurposed that second box, taped my handwritten note to it, and sent to the offended AE. Damage repaired, I left for vacation.

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I posted previously on maximizing vendor relationships, which I prefer to call partnerships. Strong relations in this area are instrumental to the success of provider organizations. The AE is the face of the partner and is as critical to the relationship as any product or service provided.

Partners use unique approaches and generally assign one or two AEs to the provider. I prefer one AE. Some partners have multiple AEs representing specific products and services, which I find suboptimal and challenging to manage. Others call their representative an AE, but those are only a salesperson in disguise. Some are assigned exclusively to healthcare, while others are assigned to diverse industries but have some exclusivity to specific accounts.

I’ve experienced many approaches. What trumps any specific structure is the AE themselves. A strong AE can overcome the weakest structure. Conversely, a weak AE can ruin the reputation and business of the most progressive vendor.

That said, here is what I have found works best:

• Single AE. I can’t handle multiple relationships with multiple partners. But a single AE with a handful of partners is doable. Have you ever bought a car and had to work with the salesperson, and the manager, and the fleet director …
• Formal structure. See link.
• Relationship. We don’t have to like each other, but it doesn’t hurt if we do. Clearly you can’t allow a friendship to trump business judgment. I tend to keep a safe distance for the protection of all parties.
• Transparency. I have yet to meet one AE who did not appreciate brutal honesty. It took some getting used to, but it was a freeing experience. Being transparent allowed for honesty, so I also knew the truth of what a vendor could or could not do. Don’t BS me with jargon — give it to me straight.
• Identity. Who do you work for? I prefer an AE who makes me feel as if they work for me. Obviously they must remain loyal to their company, but bravo to those who master the identity question.
• Accountability. Do what you said you’ll do, and be timely.
• Accessibility. If I need you, be there. I’ll do the same for you.
• Value-added service. Go the extra mile to help me with my business.
• Empathy. Give me an AE who cares about what I need, not about what they have on the dock to sell. Understand our world and our challenges. Skip the clichés — relevancy makes a difference.
• Integrity. I need to work with someone I can trust and solve business problems with.
• Post-sale support. Service and support after the deal is sealed. True relationships continue long past the initial sale. Maintain communication after the big sale and provide service that allows both parties to learn and continually improve.

I asked my partner AEs for their perspective. Their key success factors proved similar:

• Alignment. Beginning with the end in mind. Have a clear understanding of the alignment between strategic business initiatives, IT’s role in supporting those initiatives, and being able understand the relative priority of the active projects for the organization as a whole.
• Questions. If brevity is the soul of wit, the ability to ask good questions is the soul of a successful AE. Questions indicate a desire and willingness to help as well as a tacit admission that he or she doesn’t know all the answers — but they’ll work on your behalf to find others who might.
• Listening. Contrast this with an AE that does all the talking and simply discusses features and benefits or licensing arrangements. They make little effort to learn your business, and they’ll never learn your business while they’re doing all the talking.
• Relationships. Work “with” rather than “around” IT leadership to build relationships with the lines of business. Excellent AEs collaboratively develop relationships, think strategically, and have a network of partners and friends who can help you. They include you in those relationships, and conversely you are able to return the favor. Having a long-term view of the relationship helps navigate through the tactical day-to-day issues that may surface.
• Communications. Talk through expectations at a personal and organizational level. e.g. what do you want from your AE and what do you want from the vendor? Meet regularly to update both organizations on goals and strategy. Ensure accessibility and responsiveness on both sides. Have frank discussions about what’s working and what can be improved. Set agreed-upon and mutually shared goals.
• Trust. Built over time through the experience of working together.

The benefits to all parties are measurable: More innovative ideas to help the company improve its market position. More revenue generating and clinically effective solutions. More cost savings proposals. More vendor stability for the account, reducing personnel turnover. Success for both organizations and, by association, the AE and CIO.

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Following my vacation, I returned to the office and found a note from the AE I had offended. “Ed, thank you for your card. Apology accepted. And thank you for the box of fudge. FYI– next time, you might want to make sure there is no note inside of it (from another partner). I am glad your demo went so well! I had a good laugh, and all is forgiven.”

Embarrassed and humbled, I put my tail between my legs. But I did learn many great lessons through that AE. So remember, if you receive fudge from me …

What are your ideas on what makes for a great AE relationship? I would love to hear from both AE and providers.

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

Top News

HHS’s Office of Inspector General spanks its fellow agency ONC for pushing interoperability without mandating security controls or encouraging standards. Examples of what it wants to see: requiring portable media to be encrypted, requiring two-factor authentication for remote access to PHI-containing systems, and mandating timely OS patch application and antivirus updates. OIG based this work on a previous project that looked at providers, in which it found unsecured wireless networks, lack of application vendor support for OS-level changes, poor antivirus practices, lack of event logging, allowing shared user accounts, and giving too many users administrative rights over their PCs.

ONC’s response to this report: (a) we turfed security work off to HITSP and incorporated some of its specs as HHS policy and in EHR certification requirements; (b) Stage 1 of Meaningful Use requires providers to fix their own security problems; (c) our job is to convince providers to use EHRs and we will worry about security later in the process; (d) our chief privacy officer is drafting a plan. It sounds to me like the typical external auditor’s report: their job is to find stuff to make sure you keep hiring them, while yours as the IT shop is to balance their sometimes ivory tower observations with your own realities. My only takeaway is that ONC should spend some of its billions to push security awareness, which you would think highly paid hospital and vendor IT people wouldn’t need, but apparently they do.

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Reader Comments

From Mia: “Re: CompuGroup. Big layoffs at Noteworthy Medical (last week, I think) and other of their companies. Will be interesting to see how many of the 420 ONC-ATCB certified EHR companies are around five years from now.” Unverified.

From CPOE Zealot: “Re: medication error. Incidents such as these give CPOE a bad rap.” The parents of a five-week-old premature baby who died after being given 60 times the ordered dose of IV sodium chloride sue Advocate Lutheran General Hospital (IL) for wrongful death. Like most fatal medication errors, CPOE was a non-factor here: — most in-hospital medication error deaths are caused by incorrect IV preparation or administration. In addition, the doctor ordered stat labs and then a re-test after getting a high sodium level back, but nobody drew it, leaving the baby on the hyper-concentrated fluid for 20 hours. There is one good reason CPOE gets a bad rap in cases like these, though: vendors sell and hospitals buy the seemingly logical argument that CPOE prevents patient harm, when what it mostly does is prevent lots of errors that were being caught anyway (like poor handwriting, in which somebody just calls the doctor for clarification). The risk of harm doesn’t change much unless you work at the sharp end of the stick where EHRs fear to tread – medication preparation and administration. The best IT systems in existence (including bedside bar-code checking) couldn’t have saved this baby’s life when hospital employees, despite experience and best intentions, are just as prone to distraction and carelessness as the rest of us humans, especially when they are overwhelmed and tired (sometimes because their peers were laid off to help pay for CPOE systems).

From Wireless Observer: “Re: Cerner. Word on the street is that Cerner is getting ready to announce some big organizational changes and these are not good kind of changes for the employees (may be good for Wall Street, however). This is supposed to hit the CareAware division pretty hard.” Unverified. CareAware is Cerner’s solution for connecting medical devices to EMRs (video above).

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Acquisitions, Funding, Business, and Stock

FairWarning will hire 70 employees over the next 24 months.

Salt Lake City-based MediConnect Global announces plans to hire 100 employees across multiple departments.

Cerner names SenSage its “Accelerate Partner of the Year” for demonstrating speed to value for Cerner and its customers. SenSage also an expanded alliance with Cerner to offer a SaaS-based version of P2Sentinel, Cerner’s enterprise clinical system auditing program.

CareCloud partners with Xpress Technologies to launch a combined EMR/PM solution for urgent care facilities and hospital ERs.

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Sales

Sharkey Issaquena Community Hospital (MS) selects Custom Software Systems ChartSmart EMR.

Onslow Memorial Hospital (FL) contracts with Language Access Network  to provide hospital video language interpretation services.

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People

 

Awarepoint names Ralph Keiser (MedeAnalytics) EVP of sales and Jaime Ojeda (PCTS) EVP of marketing and business development.

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Government and Politics

CMS announces plans to release applications for “mature ACOs” interested in participating in its new Pioneer ACO Model and taking part in shared savings. CMS is also seeking input on the idea of an Advance Payment ACO Model, which would give certain ACOs access to their shared savings up front so they could build the required infrastructure. For providers wanting to learn more about ACOs, CMS is offering four free Accelerated Development Learning Sessions beginning in June.

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Innovation and Research

Of the 75 operational RHIOs in the US, only 13 meet the basic criteria for Meaningful Use (e-prescribing, clinical data exchange, quality reporting) according to Harvard researchers. I don’t have access to the study, but apparently the findings are based on data from 2009 (so old they use the term RHIOs, apparently). Surely there’s been some improvement since 2009. If you’ve seen the full report, please share your insights.

JAMA reports that the use of telemedicine in ICUs reduces mortality rates and length of stay.

The New Zealand government awards a $252K grant to Vensa Health to conduct further research related to its mobile health reminder system. The company recites an impressive list of technology features, but like just about every mobile health vendor, they have no evidence showing that their product is effective in improving health. Like Bill Gates told me at lunch once (well, OK, me and a huge ballroom full of people at the mHealth Summit), reminders and education don’t necessarily work when it comes to wellness – plenty of fat people own bathroom scales.

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Other

I got another “urgent news” e-mail blast today from one of the rags that reinforces my argument that most industry publications either (a) can’t distinguish real news from press releases, or (b) don’t care as long as it draws readers and advertisers. Today’s hot news: a bond rating agency issued a press release claiming their study correlated use of advanced IT to hospital profitability and quality. I downloaded the “special report” from Fitch Ratings and it was, as I expected, not worth the excitement, being even less methodical (and therefore even less useful) than the Most Wired survey. Here’s a summary.

• The bond ratings company looked at only the 291 hospitals that use its services. That’s out of maybe 6,000 US hospitals – a tiny, non-randomized, non-representative sample that excludes for-profit and government facilities.
• They checked Leapfrog, Baldrige, and Healthgrades and found that 75 of their clients had won a quality award (all awards are created equal in drawing room studies like this that just match Readily Available Data Set A with Readily Available Data Set B).
• They checked with HIMSS Analytics and found that 24 were at EMRAM Stages 6/7 (ignoring all other forms of IT except inpatient clinical).
• Apparently disappointed to find that only 12 of the 24 EMRAM 6/7 hospitals had won quality awards, they invented an excuse related to “the evolution and maturation of how quality is measured.” (maybe that should have been the headline – that half the hospitals who reached IT Nirvana haven’t won even one major quality award as a result).
• They found that richer hospitals won more quality awards and had more IT (neither of which necessarily has anything to do with patient outcomes).
• They looked at utilization trends and concluded that higher IT hospitals (meaning richer ones) are improving, although they did not look at their absolute performance (meaning a hospital could still be terrible as long as it’s less terrible than before).
• The bottom line: even if the bond ratings firm had conclusively proved any kind of relevant correlation (which they most definitely did not), that still wouldn’t have proved causation. The implicit message in running this yawner of a study as real news is that everybody now has the justification to buy more IT, which is an absurd conclusion for an industry that somewhere down deep is supposedly based on science.

Speaking of questionable studies, here’s another one: do seven percent of doctors really use video chat in patient care? I’m not interested enough to buy the company’s report to evaluate its methodology, but I would have to bet that they surveyed a disproportionate number of telemedicine physicians or tele-ICU intensivists. Most docs won’t even e-mail patients, much less fire up a Skype session for a leisurely and probably unreimbursed Webcam chat.

Quality IT Partners, Inc. announces its Facebook launch featuring a dedication to the Scott Hamilton Cares Initiative, including a song and video written and produced by the company.

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Sponsor Updates

• Sonoma Valley Hospital (CA) picks ProVation Order Sets.
• BridgeHead Software will exhibit at the 2011 International MUSE Conference May 31-June 3 in Nashville.
• Emdeon introduces Emdeon Audit Advantage, which will provide real-time prescriber eligibility and patient coverage alerts to pharmacies. The company also wins a five-year GSA contract that allows it to offer products to  over 90 government entities.
• Healthwise Patient Education EMR module earns ONC-ATCB certification.
• Imprivata announces GA of OneSign Anywhere for authentication and single sign-on for remote and mobile users.
• Delta Health Alliance, one of the country’s 17 Beacon Health communities, collaborates with Medicity to connect participating physicians and hospitals.
• Daughters of Charity Health System (CA) expands its partnership with Passport Health Communications and adds three additional RCM solutions from Passport’s eCare Patient Access Suite.
• McKesson medical director David K. Nace, MD is named first vice chairman of the board of directors of the Patient-Centered Primary Care Collaborative.
• Practice Fusion says it has grown from a team of four in 2007 to 75 today. The company is expects to reach 150 employees by the end of the year and is seeking new office space.
• MyHealthDirect assumes a silver-level sponsorship for the 19th Annual Medicaid Managed Care Congress this week in Baltimore. CEO Jay Mason will also participate in a panel discussion on ACOs and patient-centered medical homes.
• API Healthcare publishes a whitepaper entitled Achieving Quality of Care and Controlling Costs, which includes best practices for workforce automation.
• Concerro creates a Mac versus PC parody that compares healthcare scheduling solutions with paper-based systems.
• The City of Philadelphia selects eClinicalWorks to provide an EHR/PM solution for the Department of Public Health, which includes 230 providers and 20 primary care and correctional clinics.
• JEMS Technology announces a rental program that allows hospitals to provide smart phone video consultation capabilities (JEMS Consults) to their physicians starting at under $1,000 per month.
  

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Contacts

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

When I started as a solo practice physician, if someone had told me that someday I would be able to have actual conversations about the business side of the house, I would have told them they were crazy. As a naïve postgraduate, I actually believed that most of practice would be about caring for patients. Tincture of time and a few rides on the revenue cycle roller coaster quickly proved otherwise. (No one likes going bankrupt, which is a real danger for small practices these days).

Knowing other providers have also had this experience, it shouldn’t have been surprising to me that business-related articles on HIStalk have generated quite a bit of feedback. In a recent EPtalk, I talked a bit about the need for office-based physicians to work on maximizing their use of practice management systems as a prelude to maximizing their use of electronic health records.

One reader asks:

When determining the first pass clean claims rate, do you count as ‘unclean’ a claim that (1) doesn’t make it through the EDI/clearinghouse scrubber (rejected), or (2) makes it through the clearinghouse/scrubber but is then denied by insurance (e.g., wrong coding, more medical information needed, etc)? I have seen a clean claims rate calculation as being just those rejected by the scrubbers, but I have also seen it where it includes every claim that wasn’t paid with only one touch.

I have to rely on my anonymous celebrity claims expert Bianca Billinghouse, who responds:

First pass is defined as a clean claim when it makes it through the practice management system’s claims scrubber as well as the clearinghouse. If it doesn’t make it through the clearinghouse, this is what we term a rejection. The office staff typically didn’t run their claim edits and it was caught by the clearinghouse. These count against the practice. If it makes it all the way through to insurance and results in a denial, depending on the reason, then it falls into controllable or not controllable denial. We see this often with eligibility, even though we are attempting to do this upon check-in.

I also got a fair amount of feedback on last week’s Curbside Consult about evaluation of practice management systems and their readiness for 5010. Several readers suggested other organizations as sources for evaluating practice management systems, such as KLAS or AC Group.

Another wrote with an interesting perspective on 5010 compliance, which I thought I’d share:

The new 5010 standard, in the short run, is the same old data repackaged a slightly different way from the 4010 standard. The truth is that if you send your claims via a clearinghouse in the short run, you don’t need to do anything. The clearinghouse and the insurance companies need to be able to exchange data in the 5010 format by January of 2012, and many companies are doing testing now through the end of the year. The reason that a provider doesn’t need to stress about this is the actual new data from the provider — i.e. ICD-10 codes — don’t go into effect until 2013.

Software companies, as you can imagine, use any change as a way to sell an upgrade or new release, and most of my clients are told you must do this or that. Whenever you are told you must do something by a software company, nine times out of ten you probably don’t. If you’re an office that sends all your own claims yourself direct to all the insurance companies, you may need an upgrade by January 2012. If you use a clearinghouse or a billing service, you probably have another year until your software needs to accommodate ICD10 codes. If you’re looking at a $2,000 upgrade vs. paying a clearinghouse $50 per month to take care of things for you, that is your choice.

Considering that my primary ambulatory system is with a vendor that doesn’t charge for upgrades (they’re included in maintenance), I have no skin in the game on upgrading vs. not upgrading as a cost-saving maneuver. Interestingly though, the same day I received that e-mail, I also received my snail mail copy of American Medical News with the headline, “Not electronic-claim compliant? Then expect no payments in 2012.”

The article mentions that 5010 requires submission of nine-digit ZIP codes on claims, which I suppose a clearinghouse with the postal database can “plug” as the claims pass through. It also includes the ability to “distinguish between principal diagnosis, admitting diagnosis, external cause of injury, and patient reason for visit codes” which I can’t imagine a clearinghouse being able to manipulate unless I’m not understanding what that means. (Damn it Jim, I’m a doctor, not a biller!)

However, 5010 is also a precursor to ICD-10. I worry that physicians who think they can delay the upgrades for 5010 adoption will unwittingly delay progress towards adoption of the new coding standard, which is already anticipated to be an extremely difficult transition for physicians.

Of course, another conversation with Bianca was in order:

He’s obviously using the clearinghouse spin, touting that they will take care of everything. Ultimately, it’s still the provider’s responsibility to comply with the mandates. I wouldn’t feel comfortable relying solely on my clearinghouse to map/plug the required loops/segments. He’s right that clearinghouses help in the process, but what will the clearing house do when its clients don’t get their claims paid because the primary payer wants 5010 and the secondary wants 4010 or even paper?

The American Medical News article goes as far as recommending that practices increase cash reserves and consider lines of credit to buffer potential rejections after the switch, which certainly doesn’t do anything to reduce physician anxiety. Personally, I’m extremely thankful that Bianca is looking out for my colleagues and me (no one ever gives the billing / claims / collections folks the credit they deserve). But I still I think I might have to temper my anxiety over ICD-10 with a nice Riesling.

E-mail Dr. Jayne.

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

The Four Principles of Getting Things Done Well
By Mark Johnston

There are thousands of self-help and business books out there, each promising to change your life with the author’s “new” and “revolutionary” ideas. But when it really comes down to it, most of these books are based on fads or the repackaging of old knowledge, and are not worth the cover price.

In my experience, someone who’s looking to get more done in their professional and personal lives (and to do it better) can do so by practicing four simple things until they become habit: organization, prioritization, execution and discipline. Let’s take a quick look at each one:

Organization

Is your desk a mess? What about your car? If you answer yes to either of these, chances are your work life is messy, too. To be effective, you must become more organized. My advice? Go clean your desk. Tomorrow, clean your car. The next day, clear out your garage (or, if it’s really that bad, this next weekend).

Then start on your paper-based and electronic documents. Create a logical file structure so that you can find any piece of information you need within seconds. Do you travel a lot? Then keep a pre-packed bag of travel-sized toiletries in your carry-on bag.

Indentify other areas of your business and personal life that are disordered, and do the necessary! Sounds simple, but you’ll be amazed at how much productivity you’ll gain by weeding out disorganization.

Prioritization

In business, particularly at a small company where everyone wears a lot of hats, there are always 101 things to get done. If you think every one is of equal importance, you’ll never get anything done, let alone to the best of your ability.

Instead, write weekly and daily to do lists, with the most crucial things at the top. This crosses over into organization, showing how these principles are closely connected. Again, this may sound patronizing, but to make an impact, you need to get your daily activities in order.

Execution

All the organization and prioritization in the world is useless if you don’t follow through. Know you’ve got to finish writing a report? Block off two hours on your calendar and set your IM status to “busy” so you won’t be disturbed. Create a distraction-free work environment that lends itself to focusing on your priorities, and start checking items off your to-do list.

Procrastination will kill your productivity and decrease your effectiveness in business and in your personal responsibilities. As Nike ads say, “Just do it!”

Discipline

To regain control — over your workspace, your documents, your to dos, your life — takes discipline. Is it fun to reorder every file on your computer and put them in logical folders and subfolders? Is it fun to write detailed lists of your daily and weekly priorities? What about cleaning your desk, garage and car?

No, no and no, but such tasks are effective because they remove mental and physical clutter.

Discipline is the daily practice of doing what needs to be done, and is the umbrella that overarches organization, prioritization, and execution. Discipline doesn’t just apply to work, but also to eating right, working out, and making time for your family. If practiced for a few weeks, discipline becomes a habit that will apply to most situations for the rest of your career and lifetime.

It is all too easy to confine the combination of organization, prioritization, and execution to your office, and to focus so much on work that it becomes the only thing in your world – to the detriment of your family, friendships, and other non-work commitments. Equally, it is possible to let the many responsibilities of your personal life (particularly when you have kids) minimize your efforts in your job.

Both scenarios are examples of imbalances that prevent us from being all we can be. That’s why discipline is so crucial. It enables us to regulate each aspect of our lives so we’re living out a commitment to excellence in everything we do.

The first time I shared these principles with a younger team member I was mentoring, his wife came up to me at a company event and said, “I don’t know what you did to him, but he picks up after himself, our car is clean, and he cleared out the garage for the first time in 10 years!” So, even beyond what they will do for your work life, these principles can make you more popular in your home. And that’s got to be worth something!

Mark Johnston is president of Access of Sulphur Springs, TX.

Building a Healthcare Storage Archive
by Charles Mallio, Jr.

The healthcare storage archive is a centralized repository managed by IT, but made available to all departments throughout the organization. It is home to the approximately 80% of hospital data that is static, unchanging, and best managed in a centralized repository that provides the appropriate protection based on the profile of the data.

This healthcare archive should have the ability to store the data intelligently and to leverage the mix of media assets available in the organization. This includes reserving the highest cost storage assets — typically fiber-channel disk in a storage area network — for the dynamic data and managing static data on more cost-effective media, such as lower-cost disk, optical, tape, or even cloud.

With its storage archive in place, an organization can eliminate storage silos, optimize existing storage assets, facilitate data interoperability, and provide a level of data protection that enhances its disaster recovery strategy. And it does all this while delivering a strong return on investment in existing and future storage infrastructure.

Data Interoperability

With a truly healthcare-aware archive in place, the CIO can collaborate with peer department heads to facilitate enhanced data interoperability of systems. To do this effectively, the archiving solution must leverage healthcare standards by which these systems can interact and fully exploit the benefits of shared data. These standards include:

• HL7 (Health Level 7), for the exchange, integration, sharing and retrieval of electronic health information.
• DICOM (Digital Imaging and Communications in Medicine), for the storage and transmission of medical images and medical imaging data.
• XDS/XDS-I (Cross Enterprise Document Sharing / for Imaging), for the sharing of clinical documents, images, diagnostic reports, and related data.

In addition to the above, the archive should have the ability to index both metadata and content to make that data easily searchable, by both applications and end users.

Data Protection 

The healthcare archiving solution must provide safeguards against data loss and security breaches. It may do this by methods inherent to the solution, by leveraging the features of specific storage devices, or by a combination of both. However it achieves these objectives, it should accommodate the following features:

• Multiple copies of data, stored on disparate media types in separate locations, will ensure survivability of data in the event of a disaster. The healthcare archive should employ a user-configurable, intelligent policy engine to determine the optimal number of copies and locations
• Data replication complements the multi-copy strategy by facilitating mass duplication of entire repositories of data to a secondary location.
• Encryption prevents unauthorized access to data in the archive. This is critical for Protected Health Information (PHI), as well as financial records and sensitive communications.
• Digital fingerprinting technology ensures that data retrieved from the archive is identical to data committed to the archive, safeguarding against deliberate or accidental data tampering.

The data protection characteristics of the healthcare archive also complement IT’s disaster recovery strategy. While backup is necessary for whole-system retrieval, it is not optimal for the more granular recovery allowed by an archive. Furthermore, backups do not protect against file corruption, whereas an intelligent archive ensures the integrity of the data committed to it.

Return on Investment

By investing in a healthcare archive, hospitals not only gain the aforementioned benefits, but can also realize substantial cost savings. By eliminating storage silos and consolidating expensive primary storage, tier-1 storage assets are no longer underutilized. Thus, hospitals do not pay for expensive storage that sits idle.

Organizations also have more flexibility to employ cheaper storage where the data access profile or data value supports that decision. And by employing intelligent data management policies to move infrequently accessed data to lower-performing, but more energy-efficient devices, they can be more “green” with their storage strategy, which translates into costs saved on power and cooling.

Charles Mallio, Jr. is vice president, product strategy and business development, of BridgeHead Software of Surrey, UK.

IT Governance Remains a Top Organizational Challenge
By Dan Herman

IT governance has been topic of interest for many years. Even though the concept has been embraced within the healthcare industry, the reality is that it’s still not operationally working well within most healthcare organizations.

According to the 22nd Annual HIMSS Leadership Survey released in March 2011, the metrics regarding IT governance look strong at first glance. The majority of respondents (87%) reported that there is a strong level of integration between the IT strategic plan and the organization’s overall strategic plan. In addition, nearly three-quarters of senior IT executives reported that they sit on the executive committee at their organization. 

The HIMSS Leadership Survey does a good job of tracking the pulse of the industry, but our industry needs to reevaluate how we measure the effectiveness of IT governance. IT governance should be looked at holistically and not merely whether the IT plan is integrated with the organization’s business plan and whether the CIO sits on the executive team.

Strategic alignment is definitely an important element of IT governance, but having effective committee structures, well-defined roles and responsibilities, specific processes and workflows, and a project portfolio management structure to drive value delivery, measure performance, and manage risk and resources are critical success factors for IT to help the organization achieve its objectives.

In the past three years, we have assisted over 30 clients with their IT strategic planning efforts. In 80% of the cases, enhancing existing IT governance, decision-making, executive sponsorship, and project prioritization processes have been a key focus of the planning effort.

There is a finite set of variables to control: funding, resources, and scope. It’s important to focus on a limited set of major projects that support the organization’s strategic goals. Appropriate alignment of IT resources ensures that IT is spending the organization’s money prudently, and effective IT governance is essential to making that a reality.

Critical success factors for effective IT governance include the careful definition of who is responsible and accountable for decisions. Executive involvement is critically important for holding the clinical and business sponsors, as well as IT leaders, accountable for project success. Executive involvement is also vital for assuring that resources are actually available until projects are completed.

IT should not be the primary sponsors of projects, so clinical and management sponsors must be involved from the beginning as well as the clinicians who will actually use the systems implemented. Executives must also assure adherence to the governance process, so that the benefits of governance are received.

While executive and board involvement is always cited as important in IT governance, translating that into specific roles and responsibilities isn’t easy or obvious. The task is to define roles and responsibilities that result in the effective allocation of resources and in successful projects.

There are a number of considerations in determining committee structure. Authority, time, and expertise are important considerations.

IT governance requires the definition of a process for project proposal, consideration, approval, and management. This process is often closely related to or integrated with the capital budgeting process, especially in terms of the timeline for project approval.

IT governance will not result in successful projects unless effective project management is in place.

In conclusion, governance remains one of the biggest challenges of healthcare IT. Organizations continue to battle with the dilemma of having much more demand for IT services than supply and budget to service. Requests for new projects arrive with typically no effective mechanism to control how projects get prioritized, funded, and resources allocated. IT then gets put in the position where they’re overwhelmed, under-budgeted, and under-delivering.

With the number of competing initiatives on the priority lists of hospital executive teams such as Meaningful Use, ICD-10, and Accountable Care Organization structures and their IT implications, it’s even more essential that a strong governance model be deployed to prioritize initiatives, align projects and capital spend with key organizational priorities, establish the appropriate champions and sponsors to successfully drive the top priorities forward, and define ways to measure results.

Dan Herman is founder and managing principal with Aspen Advisors of Pittsburgh, PA.