Top News

  Third-party firms that implement vendors’ applications outperform the vendors themselves – except in the case of Epic. Deloitte earns the highest overall marks among third-party firms in KLAS’s survey. Coastal and Peer Consulting outscored GE in overall customer satisfaction by 30 or more points; ACS and Vitalize beat Allscripts by 20-plus points, and Encore and Vitalize outscored Cerner by 20-plus points. Epic outperformed them all.

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Reader Comments

 

From Johnny “Hot Rocks” Garcia: “Re: making appointments online. Check out ZocDoc and take note of its investors!” ZocDoc allows searching for doctors within a ZIP code by specialty and accepted insurance. It’s pretty cool, although available only in eight metro areas so far. They have an iPhone app. Investors include The Founders Fund (run by the founders of PayPal, Napster, and Facebook), Jeff Bezos (Amazon) and the chairman and CEO of Salesforce.com. 

From Glenergy: “Re: Allscripts. A new general counsel – Jackie Studer from GE.” Unverified.

From Jordan: “Re: copied medical records. Kind of expensive for an electronic copy.” Texas Health Resources charges state-mandated fees for medical record duplication: $42.05 for the first 10 pages of a paper record, $64.07 if they’re on microfilm, and a flat fee of $76.20 for electronic records requested in electronic form. The state may set the price, but I would have to guess hospitals had input into the rather large numbers. That makes the paper statements of banks look like a great deal, although their free online option isn’t even offered by hospitals. Charging more for an electronic dump is odd, although if you’ve looked at a hospital chart, your $42.05 isn’t going to go far considering the stacks of paper that go far beyond 10 pages. Maybe they should just charge law firms 10 times that amount and let patients have copies of their own information at no cost. Most hospitals think they’re doing patients a big favor by letting them see what they’ve written about them.

From Viking: “Re: GE Healthcare. A marketing director friend had their job eliminated this morning, saying there’s a sweeping org change underway.” Unverified. GEHC doesn’t respond to personnel rumors, so I didn’t even bother asking.

From Terminator: “Re: PHRs. I wonder if their functions are gaining ground as standalone apps that people actually do use? For example, Walgreens keeps all my prescription records and I can access them from anywhere, so I have no reason to import them to a PHR. I use an online tool for diabetes logging, although it would cool if it were updated automatically from any meter I use. If I see a glucometer that allows batch uploads of data to a site like this one, I’m grabbing it! That’s all I want in a PHR except for lab data and the ability to communicate with providers, but patient portals are adding PHR-like features as well, some of which have access to data and have appointment-setting tools.” That’s the big debate – would consumers prefer an independent but minimally functional tool like Google Health or one that’s rich in function and data, but tied to a specific provider? So far, they seem to be saying B (and who can blame them, given that both are free?) Notice above that Walgreens even offers online pharmacy chat right from the public Web page, although it would be interesting to know who’s on the other end.

From LaidOffInDallas: “Re: UT Southwestern Medical Center. Just laid off several IT employees.” UT Southwestern just announced that, due to the loss of $31 million in state funding, it has cut 350 staff positions, laying off 105 employees.

From Former CIO: “Re: Epic art. I would suggest that Mr. Ciotti’s opinions about wasting client money are focusing on the wrong target. The vendors who are wasting money are those that spend more on marketing and less on development, thus producing products that are not integrated and do not support patient care needs. Perhaps the artwork enhances employee attitudes and they get more work done for the money. The cost of the product is a fraction of the true cost of ownership when one considers clinician time and effort. Even so, the cost of the product is still competitive.” At least Epic is sharing the investment with employees instead of hogging the goodies for its executives in a “we’re better than you” kind of way, such as companies that give the suits reserved parking spaces, private bathrooms, and offices that would hold 20 of the veal pen cubicles that the real workers toil in. I can’t vouch for Judy’s office since I haven’t seen it, but I picture it as quirky but modest. That’s a fun challenge: e-mail me with a description of the top dog’s office wherever you work – I will run them anonymously. If they have really splendid digs, make sure to snark it up some.

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HIStalk Announcements and Requests

Stuff you’ll want to check out this week on HIStalk Practice: Micky Tripathi details the difficulties associated with tracking and reporting clinical quality measures for Meaningful Use. HHS halts its mystery shopper program for measuring access to primary care. Experts suggest reasons practices are behind schedule for the HIPAA 5010 transition. Dr. Gregg struggles with HITECH guilt and living on the dole. Costco jumps into the EHR world with deals on Allscripts MyWay. AAFP launches its $90/year clinical messaging system. While you are over on HIStalk Practice, sign up for the e-mail updates like the rest of HIT’s coolest kids.

Listening: reader-recommended Belle and Sebastian, 70s-style indie pop from Scotland. A nice sample is here, if you can overlook the fact that the preachy announcer sounds like Mike Myers playing the Scottish dad in So I Married an Axe Murderer.

I’m thinking about refreshing the look of the site and maybe even changing the smoking doc logo in some way. I’ve been using this layout for years, and while I don’t really care all that much one way or another, I guess it’s time for an update (I think Inga is interested). If you have ideas, let me know. Most of the responses I’ve received in the past have been of the “don’t change anything” variety, so that’s the default course of action to challenge. 

I’ll probably publish a Monday Morning Update even though it’s Independence Day (please call it that rather than the Fourth of July). You can amuse me over the weekend by connecting on LinkedIn and Facebook, signing up for e-mail updates, or just checking in to let me know that I’m not the only one with HIStalk on my mind. Have a great holiday. I’ll be taking a few days off starting next weekend, leaving the fabulous Inga and Dr. Jayne in charge.

Jobs on the sponsors-only Job Board: Director of Marketing – Hospital Segment, Director Sales Operations, Senior Enterprise Sales Executive Hospital Southeast. On Healthcare IT Jobs: CEO & President, Clinical Nurse Analyst, Epic Resolute Consultant.

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Sales

Aspirus (WI) signs a clinical documentation contract for MedQuist’s DocQment EP.

University of Utah selects Authentidata Holding Corp. for its three-year telehealth project that includes health information exchange, workflow management services, and remote patient monitoring solutions.

University of Oklahoma chooses OmniMD as a preferred provider for medical transcription services.

VHA signs an agreement with Deloitte to offer RCM consulting services to its 1,350 not-for-profit community hospitals.

Ochsner Health System (LA) signs up for Philips VISICU, which will make it the first eICU program in the state when implementation is finished next year.

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Announcements and Implementations

InterSystems names Gila River Health Care (AZ) the winner of its Breakthrough Applications Award for using InterSystems DeepSee BI technology with its Diabetic Analysis Management System.

Scripting automation vendor Boston Software Systems celebrates its 25th anniversary.

Medtronic announces a free smart phone app for its CareLink telemetry system for implantable cardiac devices.

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Innovation and Research

Cisco announces its Android-powered Cius tablet, due out at the end of July, with the video above featuring Palomar Pomerado Health Chief Innovation Officer Orlando Portale (starting at around the 41 minute mark). The Cius will cost $700, has no 4G connectivity, has only a few dozen apps available from Cisco’s own store, and is sure to bring up the puzzled question, “Why would I want this instead of an iPad that costs less?”

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Technology

Oracle will buy storage startup Pillar Data Systems for an undisclosed price. That company’s CEO and majority shareholder: Larry Ellison, who also happens to be the CEO of Oracle. He claims he recused himself from the acquisition discussions, although he didn’t mention why a guy with an Oracle-generated net worth of $40 billion was off running another company on the side.

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Other

The developer of Nashville’s Medical Trade Center says it will not break ground until at least 60% of its space is leased. The developer anticipated this goal would have already been met, but a mere 20% of the space is under contract. Committed lessees so far include HIMSS, Steelcase, and mdi Consultants.

  A Florida doctor who moved to a cloud-based EMR a year ago loses access to the records when his Internet connection goes down. He’s been treating patients blindly for three days so far while Comcast tries to fix his broadband. I’ll predict that ONC won’t make his experience the focus of one of its feel-good EMR stories: “If can’t access a patient’s medical records, I’m afraid in the rush of things I might miss something or not do as good a job as I normally would.” His phones are down, too.

Note to companies seeking to become “leading” suppliers in healthcare: your message tends to be more powerful when you reference the correct vertical market in your press release (unless there’s a connection I missed between vehicle dealers and healthcare). 

I saw a press release about a survey claiming that more than 50% of consumers would choose a hospital based on their Facebook and Twitter presence. I found that hard to believe, so I e-mailed the company to ask for the methodology. They offered to provide it if I bought the report for $1,250. I guess I’ll just remain skeptical.

The coroner says mistakes made at Marin General Hospital (CA) helped kill an ICU patient. A doctor, a respiratory therapist, and three nurses were identified as putting the patient on a ventilator, then leaving the room without making sure it was working. It wasn’t.

A study of electronic prescriptions finds that about 10% contain at least one error, the same percentage as paper prescriptions. I only have access to the abstract, but I notice that (a) the electronic prescriptions reviewed were form 2008 for some reason; (b) the study treated all errors equally, with the most common being omitted information (which causes no patient harm); (c) it looked at “potential adverse drug events,” which could indicate lack of decision support on the e-prescribing end, but not necessarily (for example, I don’t know if they counted potential drug interactions as “errors” if the electronic prescriber of Drug A was the same one who prescribed Drug B, which is not necessarily either prescriber’s fault).

Weird News Andy says this man couldn’t have picked a better place to have a heart attack. He complains of chest pain during a cardiologist’s lecture on heart disease at Central Maine Medical Center, then collapses with no pulse or respiration. One of three cardiac nurses in the room jump starts him with a defibrillator, whereupon he is treated in the ED and is doing fine.

Strange: a former managing director of bankrupt investment banking firm Lehman Brothers is busted for trying to pass photocopied prescriptions for Oxycontin and Ritalin at the local drug store. Police follow his Range Rover to his $35 million home and arrest him.

Not healthcare related, but an indication of pervasive technology. The Pope tweets on an iPad to help launch a media portal. Yes, that Pope. You might want to friend him.

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Sponsor Updates

• T-System celebrates its 15th anniversary with a five-video series about the history of emergency medicine and of the company.
• ADP AdvancedMD will expand its workforce by 45% this and add up to 100 new jobs in the Salt Lake City area.
• West Penn Allegheny Health System (PA) will continue its rollout of Allscripts EHR to its employed physicians and begin offering Allscripts MyWay to its 2,000 affiliated physicians.
• East End Health Alliance (NY) and its member hospitals choose MedVentive’s Population Manager for sharing clinical information and monitoring performance against evidence-based medicine. MedVentive also announces that former Massachusetts HHS Secretary Charlie Baker is joining its governing board.
• MEDSEEK enters a strategic alliance with Diebold to offer an automated patient check-in, co-payment, and appointment scheduling solution utilizing Diebold’s self-service kiosk.
• ZirMed earns its highest-ever rating in the most release KLAS rankings. In addition, 100% of its surveyed clients indicated they would buy ZirMed again.
• Indiana University Health Centers select eClinicalWorks for two campuses.
• Iatric Systems announces that its PtAccess, Patient Discharge Instructions, PHR Connect, Clinical Document Exchange, Visual Flowsheet, and PHI Interface solutions have received ONC-ATCB 2011/2012 Certification.
• Capsule’s DataCaptor medical device integration software earns a KLAS score of 90.5 with three Konfidence Level check marks in the 2011 mid-term performance review.
• Washington and Idaho Regional Extension Center (WIREC) includes e-MDs as one of the seven vendors chosen for its initial Group Purchase Program.
• LawLogix joins Perceptive Software’s partner developer network to offer a central document repository with forensic-level audit controls using Perceptive’s ImageNow software, allowing HR departments to manage I-9 and E-Verify compliance requirements.
• A new KLAS report on HIEs names MobileMD as the highest-rated vendor serving the private HIE market segment.

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EPtalk by Dr. Jayne

Multiple news outlets (including HIStalk Practice) picked up the announcement that the Department of Health and Human Services is scrapping its “Mystery Shopper” initiative, originally aimed at determining whether physicians’ acceptance of new patients depended on type of insurance. Observant folks will notice they left the door open to bring this one back later though, stating, “we have determined that now is not the time to move forward with this research project.”

I don’t need a bunch of grant money to tell you the answer to the question of “can you get seen quicker with good insurance” is “yes.” And if we’re talking about specialist physicians, the answer is “double yes.”

I practice in a major metropolitan area with multiple health systems, numerous tertiary referral centers, and some topnotch medical schools. From experience, if you are a Medicaid patient who needs to see an orthopedic surgeon or a neurologist, there less than a handful of places that will see you at all, and even then you’re going to wait. Most likely, you’re going to wind up being seen in a residency clinic.

I’m fortunate to work for a health system that doesn’t force employed physicians to cap Medicaid patient panels — we have a mission to care for those in need. As a result, I do more than my share of Medicaid care compared to my private practice colleagues, who may cap at 150-200 Medicaid patients if they even take Medicaid at all (and many don’t). Reimbursement doesn’t cover the cost of the visit, and frankly, I don’t remember the last time my practice made a profit. If not for the mission of the health system and their generous subsidy, I’d have had to go out of business before I ever had a chance to make a go of it.

There are some patients who are working the system, but the majority of my Medicaid patients are folks that have fallen on hard times or have had other life-altering events such as an unplanned pregnancy or a severe medical issue impact their lives. Some of the most rewarding patient relationships I have are with these patients, who are genuinely appreciative of the care they get.

I practice evidence-based medicine and don’t refer unless I have to. It breaks my heart to have patients waiting six months or more to see a specialist when I know that if they had a commercial payer, I could get them an appointment within a few weeks. I’ve been forced to expand my scope of practice because specialists won’t see Medicaid patients. It’s almost like being the Little Doctor on the Prairie when in fact, I’m just a few doors down from Starbucks.

(And thank you to my “generous” specialty colleagues willing to proctor me in expanding my procedural techniques because you didn’t want to actually see the needy patients yourselves. Guess what? I don’t just do them on Medicaid patients now — I keep all the procedures in-house.)

I’d be happy to charge CMS, HHS, or anyone else willing to listen a hefty fee to tell them how to increase access for Medicaid patients. States such as Colorado are already at critical shortages of primary care physicians. Articles such as this should be required reading for the politicians deciding how to carve up the healthcare pie. Some ideas:

• Increase the attractiveness of the primary care specialties by increasing Medicaid and Medicare payments for primary care and other cognitive (non-procedural) specialties. The relatively low primary care salaries — coupled with hefty administrative burden, constant on-call and hospital work, and rising patient expectations — are no match for the financial lure of other specialties.
• Increase loan-repayment plans for primary care and/or offer more zero-interest loans for these disciplines. Most of my classmates came out of training with at least a quarter of a million dollars in student loans. Unless you have a vocation for primary care, a salary of $300-$400K each year looks a lot more welcoming than the $130-$140K primary care starting salary when you’re sporting a student loan payment that’s more than most mortgages.
• Increase the availability of case managers, care coordinators, dieticians, health coaches, and social workers for Medicaid patients at no cost to the physician. Don’t tie it to some ACO-type scheme. I promise with this infrastructure, if you build it they will come. (My apologies to William Kinsella for shamelessly poaching your line.)
• Remove administrative barriers for care of medically and/or socioeconomically needy patients, regardless of payer. In addition to the above, remove the requirement that physicians pay for translator services for patients and reimburse this through payers, public or private. I’ve paid over $450 for interpreter services for a visit that I was paid $24. And this is a patient that needed to come in every month because they were complicated – it was a minimum of $150 to get the interpreter to come. Thank goodness my health system is willing to subsidize this, because most private docs don’t have the luxury.
• Reduce the administrative burden related to health IT initiatives. If you’re going to require something (like submission of data to an immunization registry or submission of syndromic surveillance data) ensure that the states actually have an infrastructure to receive the data. Do not send me on a pointless mission to contact department after department across multiple states trying to find someone who has any idea what I’m talking about, only to find out my state can’t accept either kind of data.
• Make quality initiatives make sense. Micky Tripathi’s Pretzel Logic: The Quality measure Conundrum says it all. Most clinicians want to give good quality care. But when it becomes so complicated that the average physician is torn between the spirit of the incentive program and the somewhat malleable calculations to demonstrate it, there are a good chunk of docs that decide it’s just not worth it.
• Understand that the push for healthcare IT has actually made it easier for providers to “cherry pick” the healthy patients or “lemon drop” those that are non-compliant or have poor payers. Back when we had paper charts, it was a lot of work for providers to weed those patients out. Now docs can report on them on a monthly basis with the click of a mouse and decide which patients are too difficult to manage. Probably not what was intended, is it?

So even though it’s dead for now, I’m taking bets on how long it takes the Mystery Shopper program to show itself again. Any takers? E-mail me.

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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.

Why We Need Transformational Leadership

The labor and delivery room filled quickly with physicians and nurses. The walls turned inside out, revealing sterile equipment. The transfiguration from birthing suite to operating theatre was complete. I figured this was not a good sign.

Despite numerous inducements, my wife’s body refused to give up the gift inside. I went from active coach and participant to frightened bystander. Moved aside, I worked my way behind my wife, out of the path of clinicians and equipment, yet close enough to stroke her hair, hold her head in my hand, and whisper prayers in her ear.

While I wasn’t familiar with all the technology, I knew to keep an eye on the fetal heart monitor. Fluctuating wildly, the bottom kept falling out until the heart rate eventually registered as zero — and stayed there.

Seconds passed like minutes, minutes like hours. After cutting, vacuuming, forceps, and physical manipulation, our baby appeared. “We’ve got a floppy,” the doctor announced. He handed the bundle over to his partner, who whisked our child to a nearby table for resuscitation.

Nightmarish thoughts invaded my mind. Instead of returning home and rejoicing over a new life, would I be planning a funeral? Picking out a tiny casket? Mourning? Wondering if it would be worth trying again? While clinicians huddled around our daughter, we changed her name from Kirsten to Talitha.

Seven forever minutes later, a nurse displayed our child, swaddled in a blanket and breathing on her own. “Here’s your daughter,” she said, before they took her down the hall.

Talitha is an Aramaic word used by Jesus in the Gospel of Mark. A father chased after Jesus and pleaded for Him to heal his recently deceased daughter. Impressed by the man’s faith, Jesus went to his house. Upon seeing the lifeless body, He commanded “Talitha Kuom” (translated “young woman, arise!”). The girl awakened. Ours did also. Miracles still happen.

Talitha slept in isolation in the newborn intensive care nursery. We could look at her, but not touch. Strep B had caused the trauma, but she was also fighting pneumonia and a hole in her stomach. Physicians forecasted long-term physical and mental damage.

In our shocked state, we reviewed options with the clinical team. We signed releases, willing to assume any risk that might help Talitha survive. Our church pastors loved on us, praying for wisdom and healing. We gave thanks for the hospital and dedicated clinicians.

The biggest decision lay ahead. Should we undertake a risky “flight for life” transfer from our hometown hospital Level 3 NICU to a Level 1 NICU 90 minutes away? Adding complexity, Julie was not physically well after the trauma, and I did not want to separate her from Talitha. The receiving hospital specialists said they could consult remotely if there was an automated way to collaborate. But this was the early 90s.

I had been serving as the physician relations coordinator for this hospital. A year prior, I had been given an additional responsibility related to IT. The IT staff was struggling with physician adoption of a clinical system application module that allowed them to dial in (on a 2,400 baud modem) and have real-time access to clinical data. Because of my track record in working with physicians, I took the job of evangelizing this tool to the medical staff. We went from 5% to 90% adoption in one year.

What if?

What if we gave the consulting physicians direct access to the clinical record and they could treat my daughter from afar? Two hours later, they had access. Care coordination and collaboration began. This defining moment made my calling and career crystal clear. I knew I was to combine my leadership talents with my technical skills and apply them to healthcare information technology.

Eight long days later, Talitha was released, albeit on oxygen. The strep was treated, her pneumonia was resolved, and her stomach had healed itself. No physical impairment. Today, because of her high IQ, no one could ever know of the fight Talitha endured to be a part of our family. (Well, perhaps with the exception of her “Goth” period around age 14. LOL.)

And Julie? She, too had a miraculous recovery. The quarter-sized hole connecting her uterus and bladder (caused by a 9.5 pound baby) closed without surgical intervention.

This story is one example that illustrates the power of technology when it’s paired with leadership and harnessed to share clinical data. As we mash up transformational leadership with emerging technology, we will hear many more stories like Talitha’s that inspire us to do greater things.

This fall, we’ll celebrate our beautiful daughter’s 18th birthday. She is the reason I serve in healthcare information technology. I can’t imagine having any vocation outside of healthcare. I am a direct beneficiary, and it changed me forever.

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

French IT services vendor Capgemini is looking for IT services acquisitions in the US, particularly in the healthcare sector. Says the CEO, “We are a marginal player in several of the key markets. For instance, we are non-existent in healthcare in the US, which I think is a mistake. So we need acquisitions.” You may recall that Cap bought Ernst & Young Consulting in 2000, stuck their name on it (above), then sold it to Accenture five years later after losing a ton of money. I worked with E&Y quite a bit at a previous hospital employer back in their heyday and they were excellent for strategic planning, IT governance stuff, and security work. I had a couple of occasions to work with Cap and they were clueless.

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Reader Comments

From Susan: “Re: Kettering Medical Center (OH). Went live on Epic May 1 on inpatient, ambulatory, and revenue cycle.” The video is here.

From CloseToEpic: “Re: Epic. Heard from a Madison, WI apartment owner that Epic has hired approximately 2,000 new employees who will be starting end of summer. Apartments filling up around Madison.” Unverified, but reasonable.

From WildcatWell: “Re: Google PHR dead. Told ya so. Give a brother some love! Your EMR/EHR insight is THE industry leader. Let’s get all your readers together – I’ll buy the first round.” WCW is a good information source, but I notice that his drink offer was made anonymously.

From Academic CIO: “Re: HIStalk’s eighth birthday. You have really created a resource that, on top of the insight, information, and perspective you deliver, has replaced the trade mags we used to read to try to get a handle on what was happening in the industry (and which were really only giving the vendor-approved view anyway).” I really appreciate those kind words – thanks. The best part about it is getting to connect with some really interesting people and to help bring a variety of opinions to the table.

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HIStalk Announcements and Requests

Inga’s taking a semi-break, so I’m soloing this time around. She’ll be back shortly.

Vince Ciotti poses this (easy) question: “What vendor spends (wastes?) the most of its clients’ money on extravagant architecture and frivolous artwork?” Examples above from Vince’s collection.

Ed Marx added an update to his June 15 post with responses to reader comments.

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Sales

Sentara Healthcare (VA) contracts with TeleHealth Services for its interactive patient education solution.

SSM Health Care (MO) contracts with revenue cycle solutions vendor Passport Health Communications for SaaS-based eligibility and financial screening solutions and services for its 15 hospitals.

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People

Practice Fusion names Cora M. Tellez to its board. She’s the former president of Health Net and CEO of Blue Shield of California-Bay Region.

Mark Lederman, formerly VP/CIO at Interfaith Medical Center (NY), has been named VP/CIO at Chilton Hospital (NJ). We swap e-mails occasionally and he sent over the update, so congratulations to Mark.

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Announcements and Implementations

UMass Memorial Health Care (MA) integrates MyCareTeam’s MCT Clinical diabetes management system with its Allscripts ambulatory EHR, enabling patients to upload their glucose readings.

Chicago mayor Rahm Emanuel announces that Allscripts will add 300 new jobs in the city by the end of 2012. The company will also host its annual user convention at McCormick Place starting next year.

UPMC implements Oracle GoldenGate with Cerner’s 724Access software to help reduce potential EMR downtime.

A Bama Buddy find: a hospital reports that a batter’s box-type outline made of duct tape outside the rooms of infected patients helps reduce infections, reminding employees about contact precautions and giving them a safe zone in which they can still interact with patients without gowning up.

Allscripts announces Allscripts RCM Services at HFMA, which it describes as a cloud-based, outsourced business office for physician practices that is charged as a percentage of monthly collections.

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Government and Politics

CMS selects The Lewin Group for a project to reduce the number of hospital readmissions for Medicare beneficiaries and improve quality outcomes for patients transitioning from hospitals to other care settings. The company, which is part of OptumInsight, will receive $2.3 million for the first year of the five-year program.

California lawmakers put together a bill that would require clinicians to flag any information they change in electronic medical records. The bill originally required all changes to be identified by user and to let patients see changes to their own records, but those requirements were removed after big healthcare organizations expressed their opposition that California’s standards would then differ from federal standards.

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Innovation and Research

Deborah Peel MD of Patient Privacy Rights sent a link to this story about Personal, a soon-to-be-launched site that lets consumers store information about themselves and then sell it to commercial organizations willing to pay for it. It’s 100 “gems” include such information as when your next oil change is due and what kind of food you like, which they’ll broker on your behalf for 10% of the proceeds. It has some big-time financial backers. Her interest: something like that could give consumers control of their healthcare information, which is being freely sold without their consent for purposes not necessarily in their best interests. It could be used like a PHR, where people enter information that could be made available to sell (to companies) or to providers (for free).

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Technology

The Robert Wood Johnson Foundation introduces an online directory that includes performance measurements for hospitals and doctors. It links 197 reports with information on outcomes, cost of care, and whether patients received recommended tests and treatments.

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Other

The LA Times picks up the story reported here awhile back, in which a premature baby was killed by sodium chloride overdose due to a data entry error into a hospital pharmacy’s IV compounder software. The article tries to link that human error to IT safety in general, but the problem really was a lack of IT: Advocate Lutheran General Hospital apparently had no interface between its pharmacy system and the compounder software, so they let unlicensed personnel (pharmacy techs) do the manual data entry, where it’s pretty easy to accidentally swap the values of the electrolytes (although properly installed software should have given a warning). I’ve seen that problem first hand (unfortunately) and developed a simple but elegant solution (fortunately). If you’re a CIO, e-mail your pharmacy director and ask how IV formulas get to Abacus or whatever IV compounding software your hospital uses and whether they have warnings set up in it.

1-800 Labwear brings out a lab coat with outside pockets specifically designed to hold an iPad (which they spell incorrectly).

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Sponsor Updates

• Kony is named the Most Innovative Company of the Year by the American Business Awards in the technology company category.
• Hayes Management Consulting adds a Regulatory and Compliance services division that will focus on federal healthcare mandates, HIPAA billing and security policy, EDI V5010, and ICD-10. Anita Archer will lead the division.
• Northeast Valley Health Corporation (CA) and Community Health Center Network (CA) are among 32 community health centers to select NextGen EHR solutions.
• Vitalize Consulting Solutions earns an average score of 88.62 in its five service areas as measured by KLAS in its mid-term performance review.
• T-System celebrates its 15-year anniversary.
• Northern Virginia Regional Health Information Organization (NoVaRHIO) launches a pilot program with Picis that will allow ED clinicians from Inova Alexandria Hospital ED clinicians to quickly access prescription information.
• Medicity’s Health Information Exchange Solution for hospitals receives Federal Certification for meaningful use.
• Inland Northwest Health Services announces that the Spokane Virtual Lifetime Electronic Record (VLER) pilot is now enabling the secure exchange of electronic health information using the Nationwide Health Information Network (NwHIN) Exchange. The use of VLER improves the portability of health information to Veterans and active duty Service members in the Spokane, WA area.
• CMS awards the Medicare Part D Transaction Facilitator contract to RelayHealth.
• Orthopedic Institute (SD) chooses the SRS EHR  for its 38 specialty providers.
• East Liverpool City Hospital (OH) goes live on ChartMaxx by MedPlus.
• Thomson Reuters launches Infection Xpert, a clinical intelligence dashboard that combines real-time clinical surveillance information, patient information, and patient-specific reference content from Micromedex for reducing and managing hospital-acquired infections.
• Nashville’s 211 Call Center health navigator program, operated by Family & Children’s Service, chooses MyHealthDIRECT to allow operators to connect callers with available area providers specific to their needs, including the ability to search available provider appointments.
• Ness County Hospital (KS) goes live on the ChartAccess Comprehensive EHR from Prognosis Health Information Systems just four months after its selection. The hospital plans to meet Stage 1 MU requirements by the end of the year.
• Main Line Health (PA) signs a five-year extension with MobileMD for its 4D health information exchange service, which it has used since 2007 to connect four hospitals and more than 30 practices to create a virtual complete medical record.
• Workforce management software vendor Concerro licenses two labor analyses tools from Workforce Prescriptions to allow it to offer labor efficiency review services that cover scheduling practices, agency use, care delay causes, and policies that impact labor ability. Hospitals average $7 million in annual realized savings from labor misalignment. The company’s take on labor management is covered in its blog, with the latest topic being the complexity of managing hospital labor costs.
• NCR is exhibiting at HFMA this week (Booth 1420), talking about self-service solutions that improve efficiency, cost, and revenue cycle.

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More Thoughts on Google Health

Nobody’s really disappointed or even surprised that Google Health is dead (actually, few have even noticed, which tells you all you need to know about its problems). The only surprise is that such an unenthusiastic effort came from one-time paradigm-buster Google in the first place.

Actually, maybe the biggest surprise is that Google is shutting Google Health down in an embarrassingly public raising of the white flag. It would be one thing if they were spending a lot of R&D money on it, but there’s no evidence of that. The app is somewhere between simple and ugly, announcements of new functionality or connectivity have come along once in a blue moon, and no lofty promises were made that it would ever be anything more than it was. Given that GOOG’s market cap is $156 billion, and that pretty much nobody was using Google Health anyway, maybe they should have just abandoned it to die quietly instead of convening a very public funeral, raising ugly questions about the cause of death.

The only real traction Google Health got was among folks who wanted to see a brash, smart, and well-funded upstart barge its way into the healthcare IT vendor mix, elbowing out the companies that have been around for decades to shake them out of their maddening complacency. In that respect, Google ironically did what the non-healthcare IT vendors are sometimes blamed for doing: it laid down a smokescreen of rosy PR, under-delivered on even modest promises, ignored the advice that users and experts were giving, and then just cut and run when the going got tough, another healthcare dabbler that should have known better.

I thought Google Health would do OK, if for no reason other than the company seemed committed to hanging in there, at least initially (they threw the stereotypical launch party at HIMSS, then went silent). But the signs were there. The inexperienced folks they put in charge were replaced by even less experienced folks. Their HIMSS booth was a joke, an empty table with a few black-and-white photocopied half sheets of paper handouts. They didn’t make any acquisitions; they didn’t create any innovative technologies; they didn’t differentiate themselves publicly from HealthVault; and they made no apparent attempt to flex their muscle with the providers, EMR vendors, and insurance companies that were sitting on the key asset needed to make their product fly: data.

Sometimes visionary companies can create a market by thinking big and solving a problem consumers didn’t even know they had (MP3 players and Facebook, for example). This wasn’t one of those times. Google Health was a solution looking for a problem, much like its high-flying and equally dead stable mate Google Buzz. If nothing else, Google Health proved that Google is just as fallible as arch-rival Microsoft in thinking it understands what customers want without bothering to actually ask them.

Here’s my epitaph for Google Health, not as a PHR expert (which I’m not, since I have little interest in them) but as an average consumer/patient.

1. Google knows just one business: pushing ads in the faces of users willing to tolerate them in return for getting free access to some reasonably useful Web tools. Without large numbers of eyeballs, Google wasn’t interested, and without those useful tools, neither were the eyeballs.
2. The Google Health model required massive uptake to be successful by its standards, but it was designed to address the health needs of the vocal 2% rather than the indifferent 98%. Hospitals learned that lesson long ago – if you want doctors to use CPOE, you aim your technology at the average doc (busy, struggling, and administration-suspicious), not the geeked out, administration-friendly CMIO who has little in common with them other than wearing a white coat but who sometimes can dangerously convince everyone else they speak for the majority (not like Dr. Jayne, in other words, who actually practices medicine and uses the systems she supports).
3. When it comes to healthcare, consumers are not empowered, and no amount of technology will change that. They have a tiny bit of discretion when it comes to choosing a doctor, but almost none when choosing a hospital or insurance company. Cool Web tools or not, Joe Sixpack has no leverage over the massive bureaucracies of the average academic medical center or insurer.
4. Those massive bureaucracies suck big time at managing their own data. The last thing they want to do is (a) share their crappy and unreliable information with patients, or (b) import unvetted patient information from some other source and then have to figure out what to do with it since they are paid for piecework, not thoughtful reflection of piles of information.
5. “Health” is a good thing that everybody wants for everyone else, but “healthcare delivery” is a cutthroat fight for the financial pie. Collaborative tools are tough sell when the folks at the table are trying to stab each other in the back without being noticed, but especially so when Google didn’t even seem interested in working with them.
6. The average person (be careful who you picture – the masses are not healthcare- or IT-savvy) sees his or her own healthcare as someone else’s problem. They get sick, they use someone else’s money (insurance) to see a provider, they want immediate gratification from pills or surgery, they aren’t interested in information or recommendations of lifestyle changes. Few of them study the government’s dietary recommendations, interface their bathroom scale to a computer program, or participate in online support groups. They just want to be left alone, secure in the knowledge that their poor health choices can be overcome by an insurance-assigned doctor or hospital. Any suggestion that electively unhealthy folks pay more for their healthcare than electively healthy ones is met with cries of discrimination. The only way to get their attention would be to pay them to take better care of themselves, just like giving your kid $10 for each A on their report card.
7. Only a tiny number of zealots will accurately and consistently enter their health information into an online shoe box. Not only is it work, there’s no apparent payoff since most providers don’t have the time or interest to read what those folks entered (partially because the technologies they use don’t play well with others any more than those providers themselves).
8. Consumers use technology for three reasons: it provides them with emotional satisfaction (Facebook), it offers them convenience (Amazon, paying bills online), or it saves them money (eBay, Groupon). Google Health and most PHRs offer none of these benefits.
9. Addressing the convenience aspect requires removing the friction of healthcare delivery system transactions. They are horribly inefficient, often because the doctors, hospitals, and insurance companies themselves are horribly inefficient (which lends credence to the argument that arming either Joe Sixpack or providers with a lot of technology doesn’t necessarily make things better, particularly when it comes to patient outcomes).
10. Nobody really trusts big companies all that much, and people are especially suspicious of who sees their health information. Geeks might trust Google with their entire identity, but the average person probably won’t.

Now is probably a great time to retire the term Personal Health Record. It had a questionable premise to start with, but now Google has tainted it as being a plain, static Web page that’s about as fun to use as TurboTax and a whole lot less useful.

I’m an average patient and I want nothing to do with a Google-like PHR. What I want is to be able to:

1. Make electronic appointments, including being able to search for openings at multiple locations or among competing providers. I don’t want to have get on the telephone or compose an e-mail.
2. Request prescription refills.
3. See my lab results as soon as they are available, with a personalized explanation of what they mean.
4. E-mail my doctor and get a timely response.
5. Get specifically requested information to my doctor efficiently, and know that he’ll ask for the information he needs, it will remain on file in case it’s needed again, and I’ll have a say in the decisions made from it.
6. Get automatic reminders for EMR-triggered events (vaccinations, next physical exam due, etc.) but with the option to suppress those that aren’t helpful.
7. Manage someone else’s health with their permission, such as a child or parent.
8. Earn an insurance or treatment discount for following recommendations that result in measurably improved health.
9. Solicit bids or search prices for services not covered by insurance.
10. View any health information recorded about me with an efficient mechanism to correct any errors.

The average PHR doesn’t do most of these things. They can’t unless providers, insurance companies, and EMR vendors can be convinced to work together. Patients don’t have the sway to make that happen. Employers might, or perhaps some kind of government mandate.

Short of that, PHRs are going to struggle since, by definition, they are trying to bring competing parties together electronically without giving them an incentive to do so. That leaves PHRs as little more than a spreadsheet on which a few consumers can record their own information that nobody will look at.

Many folks who cheerlead for PHRs do so with a vested interest instead of as a consumer. So here’s the challenge to those inclined to comment on this post: instead of the usual pedantic posturing about PHRs as a technology or a business, tell me how YOU PERSONALLY use a PHR, what benefits you’ve received, and what you wish it would do. The “experts” can’t stop talking about Google Health, but none of them so far has admitted actually using it or any other PHR.

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Contacts

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

Ireland-based financial information and technology vendor Experian announced this morning that it will acquire Medical Present Value for $185 million in cash. The Austin, TX-based MPV offers revenue cycle services to providers that include eligibility verification, patient-friendly statements, credit scoring services, and claims software.

MPV, which has annual revenue of $45 million, will become part of Experian’s North America Credit Services division, which offers services for running small businesses. The company’s other healthcare product is SearchAmerica, a 2008 acquisition that evaluates patients for their likelihood of payment and eligibility for financial assistance programs.

Dan Johnson, president of Experian’s Healthcare Services, was quoted in the announcement as saying, “Healthcare providers in the US face growing challenges when it comes to billing and collecting payments for services. With the addition of MPV, Experian is able to provide a more comprehensive set of products and services across the healthcare payments life cycle and help clients manage multiple vendors through a single point of contact”

MPV was founded in 1998 and serves more than 75,000 providers. Its principal investors are Rho Ventures, CenterPoint Ventures, Star Ventures, and Care Capital.

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!

Will Meaningful Use and EMRs Help Jump the ACO Hurdle?
By Frank Poggio

The Accountable Care Organization (ACO) is the government’s latest attempt to improve quality of patient care and control the ever-escalating growth in healthcare costs. The Affordable Care Act (commonly known as the health reform law) encourages, via financial incentives and penalties, the formation of ACOs by organizing healthcare teams, technology, and knowledge around patient needs. 

As might be expected, there are many complex organizational, monetary, and other significant policy issues surrounding the ACO model of care delivery.

The ACO concept is not new to the healthcare world. In past decades, we called them PHOs (Physician Hospital Organizations) or HMOs (Health Maintenance Organizations).  Both of these in the 1980s and 1990s had only a small impact on healthcare costs. Many PHOs and some HMOs are still in existence today.

In fact, we have always had some form of ACO going as far back as 1939. For example, the Kaiser Health Plan, The Cleveland Clinic, Sharp HealthCare, Geisinger Clinic, and many others are basically ACOs. If they include an insurance component, they are more like an HMO.

The simplest definition of an ACO is a health care delivery system where the physicians and hospitals work under one corporation, have one set of synchronized patient objectives, and share in the profits  and losses from normal operations. Medicare wants doctors and hospitals to work together and accept one payment for all levels of care and accept the responsibility for coordinating the care of the patient across all modalities of care. 

Where ACOs work and why

The concept has worked at Mayo, Kaiser, and Cleveland Clinic because the attending docs are part owners of the hospital. They get paid a salary and bonus based on both the performance of their practice and the performance of the hospital and other health services.

For example, the physicians readily accept that fewer support staff will save the hospital money, which in turn could result in a year-end monetary bonus while hopefully improving patient care. That, in turn, can lead to more patient referrals and more revenues. The same is true for ordering fewer tests or procedures. Fewer tests equal less costs, and under a fixed payment system like Medicare DRGs, that means more profit.
 
But today, the independent physician makes his or her money seeing as many patients in his or her office as possible. The hospital is just a cost-neutral and convenient place for physicians to perform complex procedures. If an ACO is that simple and beneficial, why are there so few of them?

How did we get here?

Today and for the past half century, we have been in a situation where the person most responsible for “product definition” and most responsible for “bringing in the business” is not an employee of the hospital. That person is the attending physician, or sometimes called the independent practitioner.

It goes back to the establishment of the AMA and the AHA in the early 20th century. Both of these groups were focused on increasing utilization of hospital and medical services. Even at that time, just as today, medical care was relatively expensive. To drum up business, they both came up with the idea to sell a medical insurance policy.

Rather than work together, around 1940, the AMA founded Blue Shield and the AHA started Blue Cross. Each had similar, yet different objectives. Keep in mind that almost all doctors in the early part of the 20th century were independent practitioners and hospitals were places to be avoided.

In 1966, along came Medicare. If you go back and study the legislation of the day, you will find that physicians fought Medicare with a vengeance and wanted no part of the government or the institutional side of the package. Of course today, if you tried to take Medicare away, you’d have a rebellion — and not just from seniors. Medicare in 1966 solidified the doctor-hospital split via separate payment systems by creating Medicare Part A for hospital payments and Part B for physician payments.

Then in 1972, as the health insurance industry matured, the Federal Trade Commission became concerned that doctors and hospitals selling insurance was a little to cozy. The AMA had to spin off Blue Shield and AHA split with Blue Cross. Later, as the Blues saw themselves more as insurance companies than part of the medical establishment, many of the Blues merged and eventually morphed into today’s United Health, Wellpoint, etc.

To drive the hospital-physician wedge deeper, in 1993, Congress passed OBRA, which contained the infamous Stark amendment. The Stark amendment made it a crime for doctors to refer patients to a hospital in which they had a financial interest. The feds saw this as a conflict of interest that would drive up healthcare costs. 

The structure we have today — full physician independence — has been around a very long time. It has been repeatedly fortified through separate provider and piecework-based payment systems.

That raises today’s big question: who is accountable for all the care a patient receives? 
 
How can we create more ACOs?

Now, after more than a half century, the government has come to the conclusion that doctors working separately from hospitals with separate payment systems and different incentives is a counterproductive operating model. (too bad we didn’t see that coming when we initiated the Medicare-Medicaid systems.)

Under the duress of a very large federal deficit (in part, a result of healthcare costs), we are trying to reverse 70 years of misdirected legal and financial incentives. Under an ACO, the feds want both parties to work together, share the payments, and share the risks.

The ACO statute of April 2011 lists the following provider combinations as potentially eligible ACOs:

1. ACO professionals in formal group practice arrangements.
2. Networks of individual practices of ACO professionals.
3. Partnerships or joint venture arrangements between hospitals and ACO professionals.
4. Hospitals employing ACO professionals.
5. Such other groups of providers of services and suppliers as the Secretary determines appropriate.

Combinations 2 and 3 are what I call the “virtual’”ACO. Combinations 1 and 4 are more like the PHO/HMO of the past, or the Mayo model.

As stated by CMS, ACO compliance with the requirement to reduce costs and improve care may involve a range of strategies, which they state includes the following examples:

• A capability to use predictive modeling to anticipate likely care needs.
• Utilization of case managers in primary care offices.
• Having a specific transition of care program that includes clear guidance and instructions for patients, their families, and their caregivers.
• Remote monitoring.
• Telehealth.
• The establishment and use of health information technology, including electronic health records and an electronic health information exchange, to enable the provision of a beneficiary’s summary of care record during transitions of care both within and outside of the ACO.

Promote the virtual ACO

As can be seen from the compliance strategies, CMS is leaning heavily on HIT and EMR to help avoid some very difficult political battles. As an interim step, they are encouraging hospitals and physician groups to use EMR systems to build and support a virtual ACO.

In this scenario, the physician and the hospital would remain corporately separate, but the patient information and the payment would be shared. This dovetails with the new federal HITECH Act that promotes EMRs and stronger coordination of care via interoperability.

CMS has defined the five levels of ACOs and has set target dates for providers to achieve one of the levels. If a provider organization achieves an ACO level during the next five years, they will get a financial bonus. If they don’t, their Medicare payments will be reduced. Sounds like MU all over again.

Initially, the AMA was indifferent towards the ACO concept. AHA gave it mild support. But after CMS issued draft regulations in April noting the bonus-penalty provisions and the shared payment component, both associations came out strongly against it.

Of course, the 800-pound gorilla is who should run the ACOs, physicians or hospital executives? If there’s to be a single payment for Medicare patient services to the ACO, how do you split that payment?

CMS is staying out of this battle and leaving it to the docs and hospitals to fight it out. To say the least, AMA probably views it as the death knell for the independent physician practice, and AHA may see it as the surrendering of institutional autonomy to physicians.

I think it will be a long arduous road getting to real ACOs. Remember, the overall objective is to reduce the costs of healthcare. According to a CMS analysis of the proposed regulation, Medicare could potentially save as much as $2 billion over the first three years, so somebody’s ox has to get gored.

But as we stumble down this long and very bumpy road, I believe in the early years, the focus will be on the virtual ACO. The CIO’s office will be right in the middle of it. If you look at the Meaningful Use criteria for CCR, CCD, and interoperability, the first hurdle is staring us in the face.

Frank Poggio is president of The Kelzon Group.

Security: An Often Overlooked Meaningful Use Requirement
By Jeff White

During the first quarter of 2011 alone, there were media reports of inappropriate access to electronic Personal Health Information (e-PHI) of four sizeable healthcare organizations. This is damaging in terms of public relations, patient confidence, possible revenue loss, and increased costs to protect patients with exposed identifying details. It seems that many organizations are overlooking or delaying the need to perform a security risk assessment.

Yet under the HITECH Act, one of the core Meaningful Use measures is the requirement to “Conduct or review a security risk analysis … and implement security updates as necessary, and correct identified security deficiencies prior to or during the EHR reporting period to meet this measure.”

This measure is, therefore, a key task healthcare providers must conduct before attesting to their ability to meet Stage 1 requirements. Additionally, the risk analysis requirement in the HIPAA Security Rule is not only an integral part of meeting Meaningful Use for HITECH, but also for being in compliance with the law.

A risk analysis is the very foundation from which to build your information security compliance program. A security risk analysis should be conducted with active participation of internal auditors, IT leadership, and IT subject matter experts.

The Office for Civil Rights (OCR), the security watchdog for the Department of Health and Human Services (HHS), suggests that a covered entity use the National Institute of Standards and Technology (NIST) risk-based approach for doing a risk analysis, which encompasses nine primary steps:

1. System characterization to fully understand key technology components in your infrastructure.
2. Threat identification.
3. Vulnerability identification.
4. Controls analysis to assess the capabilities of your existing set of controls to meet your environment’s needs
5. Likelihood determination to assign likelihoods, considering the threat motivation and ability, the nature of the vulnerability, and current and planned controls
6. Impact analysis to analyze that impact, considering for each system the effects of lost confidentiality, integrity, or availability, and the effect of any current or planned mitigating controls
7. Risk determination, a combination of the impact rating and the likelihood determination
8. Control recommendations, a roadmap for planning controls for future implementation
9. Results documentation.

To prepare for Meaningful Use attestation, it is recommended to conduct the security risk analysis at both the technical design and system build phase when implementing a new EHR system. Additionally, it will be important to update the risk analysis further on in the MU Roadmap approximately four months prior to go-live.

As ongoing changes happen, new risk occurs. An annual risk assessment should become part of the compliance process; that is, the risk assessment can be merely updated as an addendum and not as an overbearing intrusion that competes with other organizational needs. A regular review of your risk posture is what is required to protect e-PHI. Too many new threat vectors and vulnerabilities are introduced into information environments each day. A reasoned, systematic, and consistent approach will help to achieve your organizational goals.

Spurred by the HITECH Act, the healthcare industry is embracing EHRs at an accelerating rate. This move carries with it a need for heightened responsibility since digital information can be copied, transmitted, or used so easily. As such, the risk accruing from this transition to electronic records must be well understood.

In its passage of HITECH, the US Congress took special consideration to note that security and privacy of patient records should be a paramount concern. In essence, HHS recognizes that the very success of the HITECH program rests in part on patients’ ability to trust provider information systems with sensitive information.

Jeff White is a principal with Aspen Advisors of Pittsburgh, PA.