Scott Coons is president and CEO of Perceptive Software, a Lexmark company, of Kansas City, MO.

Give me some brief background about yourself and about the company.

I’m an engineer and a computer scientist by education. I’m kind of boring, to be honest. I’m the founder of Perceptive Software. We’re the makers of ImageNow.

We’re in the enterprise content management space. We offer products and solutions around the management of enterprise content across multiple sectors, including healthcare. We’ve got a great team here and lots of happy healthcare customers that are using our product in a lot of different areas.

I was reading Web site write-up on Citizens Memorial Healthcare, an outstanding IT shop in a small hospital. How are they using your technology?

I don’t know all the details in their specific case. However, I’ve spent time with their CIO. They fully endorse our product as a core component to what they’re trying to get done. They really see us as an ECM platform that they can use everywhere in the hospital, from HIM to administration to order management to back office operations as well, including financial operations and human resources.

We preach vendor independence whenever possible. Obviously we try to build software that takes as little professional services as possible. Citizens has really embraced that. They have a strong IT shop and are ideally suited to be able to go in quick, integrate quickly in all the ways that they like to integrate, and then just expand throughout the hospital.

That’s really one of our approaches we take with all of our customers. Obviously we’re there to help them use the technology, configure the technology, optimize the technology any way they want us to. But at the end of the day, we try to build software that is more about the software and less about the professional services that go along with it.

Can you describe the different places in the hospital that your offerings might be found or how they might be used?

In general, it’s all about managing the content, whether that content is derived from paper or some unstructured information that needs to be accessed in support of some clinical process or back office workflow process. Any time you need to manage a workflow around that and have access to that content, we’re used. There isn’t a place in a hospital or acute care facility that our product’s not being used.

How much of your overall business is healthcare?

In terms of new business, it’s our largest industry sector, our fastest growing. I’d estimate at about 35% or so.

The debate continues on the value of the hybrid patient with some scanned components. How do you see scanned documents and workflow built around them fitting in with a completely electronic system creating and using discrete data?

In any enterprise environment, there’s always a collection of data above and beyond paper-based data, scanned-based data that needs to be managed and processed. I think in our case the ImageNow product line can manage any content no matter what its source. Our solution solves the problem of multiple systems needing to speak with each other and needing information for various content stores and various snippets of data. 

We can bridge the gap between disparate systems to do that, environments where they’ve started to centralize on one basic clinical system. There’s always the need to collect and manage a bunch of disparate data in support of that system. It’s more than just dealing with document images — it’s dealing with any type of enterprise content that helps the clinician provide patient care.

With the push toward interoperability, people are always assuming they will need complicated interfaces that may or may not be proprietary. It sounds like you’re saying that documents could be the interface between the systems.

Absolutely, they can be. You’ve got to solve the problem when somebody walks in with a bunch of data you’ve yet to capture into your systems. if it’s a good enterprise content management system, you can just bridge the gap and exchange data between multiple systems.

Interoperability is a big deal for us. We’re fully behind it and participate in various IHE Connectathons.  The engineering team is all over the standards that are emerging.

One of the things that most interested me when I interviewed Denni McColm from Citizens Memorial a couple of years ago was that the only paper they were handling came from outside hospitals that weren’t up to their level of automation. Do you find it interesting that they took that approach to avoid handling someone else’s paper?

It doesn’t surprise me. I think if you do your job and you build software and solutions that are easy to use, then the motivation is to get anything and everything related to the patient in one folder, if you will, so you have access to it. I’m sure they saw the benefit of getting everything into their content store even if it wasn’t originated from their hospital.

The company makes a distinction between not just managing electronic documents, but the information life cycle. Can you describe what that means to you and how it works?

I think that the interesting thing is, from content type to content type, it’s not always about keeping that content around forever. You have to put policies around how long you’re going to keep it, when you destroy it. That’s really the definition of the life cycle from capture to destruction.

It’s a big problem that a lot of the healthcare industry doesn’t always understand … the compliance regulations and whatnot. We have to make sure, based upon content type, that we can manage it completely through its life cycle and put policies around it for destruction. I think that’s a part of just being a solid enterprise content management product.

There are a lot of things that we do outside of healthcare that lend themselves to the healthcare space. The retention policy management suite that we have actually was derived in government and our financial services requirements, so we think it’s something that healthcare space needs. We have a lot of healthcare customers that are using it.

Speaking of that, what lessons that you’ve learned serving other industries that might apply to healthcare? And from what you just said, does that relate to regulatory or audit type capabilities?

It is heavily related to regulatory and audit capabilities. I can come up with hundreds of examples of where what we do and one industry is an advantage to another industry. You’re still building solutions specifically for an industry. You still have to pay close attention to the role of the user. We do a lot with persona-based development. 

But content that’s not closely tied to a core business system — whether it’s a clinical system, CRM, an accounting system, whatever the system might be — managing that content is the same across all industry sectors. It’s really how you put the workflows in place and understanding that role of the user that’s accessing the data needs the data at a moment’s notice. That’s where you really have to customize specifically for the industry, but there’s a lot of overlap. That’s why we service so many various industry sectors.

You mentioned your background as an engineer. It’s uncommon to see an engineer as an entrepreneur leading a company instead of the usual salespeople or suits. What are the advantages of that and how does that fit within Lexmark?

A great question. As you can tell, I don’t give a very good interview. I think that’s one of the disadvantages having an engineer lead the company.

This business is very systematized. Quality is extremely important to us. I think that’s an advantage that comes from being an engineer. Obviously I work very, very closely with the R&D department, being that I was the original R&D department. It’s about building really good software and being able to predict use cases that the customer or the industry can’t predict so that you’re ready for them as they grow into the software, that they leverage the software to serve new processes or new workflows.

But I think that one of the strengths of Perceptive is that we are highly technical. We build a product that’s very scalable, something that we’re proud of that we think is very easy to use. Our mantra is always to put content and context to whatever the problem is that we’re trying to solve.

As it relates to Lexmark, what’s interesting about that is that Lexmark is led by engineers themselves. That was part of the attraction when we first got to know them. I’m an electrical and computer engineering major and their CEO at the time was the electrical engineer. Their current CEO is a mechanical engineer. Their whole executive team is full of engineers. I think that we share a common bond to build really, really good product and to listen very carefully to our customers and have a really closed development cycle on what our customers want and really giving feedback, and then rolling that back into the product line. 

The Lexmark acquisition has been great for us. They understand we’re different. We’re software, they’re hardware. They were public, we were private. They were really big, and we were not as big. They’ve been extremely supportive in where we’re going and what we want to do. They’ve really gotten next to helping us grow and better our product into the markets we serve. They’re a great company and it’s a great fit.

As you were describing the advantages and disadvantages of being an engineer, I couldn’t help but picture you reading Dilbert, and I bet you do…

I do. <Laughs>

Do you have times where you can’t decide whether you’re going to identify with Dilbert or the pointy-haired boss?

<Laughs> I read it everyday, I laugh every day, and yes, I can identify to both characters. It’s a great comic strip.

For a company with an engineering culture, your Kansas City location has a lot of fun employee stuff, like video games and chair massages. How would you characterize the culture there and how does that translate into value for the customers?

I think there’s a passion here that is contagious.  Culture is always a reflection of the people. But is the culture attracted by or created by the people, or are the people attracted to the culture? I think it’s a little bit of both.

We try to hire the best and the brightest, those that have a very inquisitive mind, aren’t afraid to take risks if it means bettering the product for our customer. We really preach innovation. The culture is a reflection of that and they are a reflection of that culture. We have a good time. Our motto is to work hard and play hard. We’re about really building game-changing ECM products that our customers will enjoy, that our customers will put to use, and will have solid things to say about it. Everybody here at Perceptive believes in that mission. We enjoy what we do.

What issues in healthcare do you think will have an impact on how you conduct business in the next three to five years in terms of product development?

The government’s involvement in healthcare is always something that we closely watch. Meaningful Use, all those various topics are things that we have to be aware of. We have to be in tune with what’s going on.

No matter what the trend is in healthcare in the upcoming years, we’re in good shape to be able to handle whatever comes in front of us. As much as an industry might try to exorcise out paper, we have built a system again that can handle any type of content that’s related to the core mission of healthcare. We can manage that content and make it available and put a process around it. 

We feel good about where we are. Obviously you have to continue to work hard and listen to the customer and talk to the customer where they see things are going and what they need. We do a lot of that. We feel pretty good about where we are and where things are going.

Any final thoughts?

I appreciate the time. I think that we have a good story to tell and we appreciate the opportunity to tell it through HIStalk. We’re excited about where we’re going and what we’re doing. We want to thank all of our customers for their support over the last ten-plus years.

Top News

The California Hospital Association files suit against the state public health department to block a requirement that hospitals report detailed information about surgical site infections starting June 1. CHA says most hospitals don’t have the information available electronically, so they would have to take time away from patient care to dig through records manually.

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Reader Comments

From Ricky Roma: “Re: Dr. Jayne’s IT comments. Doctor, we live in a world that has networks, and that network has to be guarded by men with decreased budget and staff. Who’s gonna do it? You? The executive staff? We IT guys have a greater responsibility than you could possibly fathom. You weep for your iPad, and you curse IT. You have that luxury. You have the luxury of not knowing what I know. Denying iPhones, while tragic, probably saves PHI. And my existence, while grotesque and incomprehensible to you, saves PHI. You don’t want the truth, because deep down, in places you don’t talk about in the doctors’ lounge, you want me on that network. You need me on that network. We use words like governance, security, encryption. We use these words as the backbone of a career spent defending something. You use them as a punch line. I have neither the time nor the inclination to explain myself to a physician who sees patients under the blanket of the very security that I provide, and then questions the manner in which I provide it. I would rather you just said thank you and went on your way, Otherwise, I suggest you log on to a PC like everyone else. Either way, I don’t give a damn what device you think you are entitled to.” Brilliant as always from one of my favorite (but seldom heard) contributors.

From Mile High Club: “Re: WSJ article on use of corporate jets. It includes a searchable database, finding that destinations often coincided with the vacation homes of executives. McKesson had 41 flights to Martha’s Vineyard and Laconia, NH (probably someone’s house on Lake Winnipesaukee).”

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HIStalk Announcements and Requests

This week on HIStalk Practice: additional background on the RWJF report that found diabetics treated by practices with EHRs received significantly better care than those treated at paper-based offices. Turns out the paper-based offices also had almost five times more non-insured or Medicaid patients than the EHR-based practices and twice as many non-white patients. Also: Julie McGovern of Practice Wise shares tips for creating a disaster recovery plan. A new organization is launched to certify medical scribes. Less than one-third of physicians are expected to remain independent by 2013.  Dr. Gregg shares HITECH support woes and wins. If you like the ambulatory world (and who doesn’t?) then you’ll want to make sure to sign up for the HIStalk Practice e-mail updates.

In almost totally unrelated to HIT news: a couple of girlfriends and I stayed at a upscale hotel recently for a little getaway. All three of us came home with what I have diagnosed to be bed bug bites (you know, I did the Internet research thing and compared my bites to the online photos.) Which leads me to wonder: are bed bugs the latest work hazard for HIT road warriors? It’s a totally disgusting topic, I realize, but it’s an issue I never really worried about in my traveling days. FYI, I complained to the hotel; they checked the room and told me they found no evidence of bed bugs. BFFs and I are thus considering whether we’d be better off visiting a dermatologist or simply seeking a psych consult.

Listening: Black Joe Lewis & The Honeybears from Austin, TX, recommended by a reader. Here’s what I e-mailed to her: “I’m doing hideously uncoordinated chair-based dance moves to Booty City, thinking I’ve gone back in time to the 60s to listen to Edwin Starr doing 25 Miles from Home. Now I’m going to want to accentuate everything I say with an emotional ‘HUuaaH’ just like this guy (and James Brown) I’m making that ‘white man trying to be funky’ look by scrunching up my nose, sneering, and and squinting as I bob my head out of time with the music and do some walking bass on the air guitar.”

On the Jobs Page: Solutions Executive – Virtual Office, Technical Marketing Engineer – Work from Home, Healthcare IT Technical Recruiter. On Healthcare IT Jobs: Allscripts Test Manager and Test Resource, Implementation Consultant, Meditech PCM Implementation Analyst.

First, do no harm. Once that’s done, (a) sign up for e-mail updates in the box to your upper right (unless your display is set to low resolution, in which case it could be just about anywhere); (b) send me news, rumors, and anything that would tickle my sophomoric humor; (c) find Inga, Dr. Jayne, my sites, and me on your favorite social not-working tool and make the appropriate electronic connections so we can feign mass appeal; (d) accept my personal challenge to randomly inspect five of the admittedly large number of ads to your left and click them, waiting excitedly as in the presence of Monty Hall to see what’s behind Door Number 3 and knowing that you are thereby supporting us keyboard-clackers who work absurd hours after our day jobs; and (e) don’t worry, be happy.

Thanks to Bulletin Healthcare, new to both HIStalk and HIStalk Practice as a Platinum Sponsor. The publishing company sends out electronic newsletters to 400,000 doctors every morning by 8:00 a.m., working with two dozen leading medical associations to meet the unique news requirements of their members  as a valued member benefit (American Medical Association’s AMA Morning Rounds, American College of Physician Executives’ ACPE Daily Digest, and American College of Cardiology’s CV News Digest, to name a few.) The Reston-based company is the medical division of Bulletin News, which provides executive news briefings for the President and most of the Cabinet. They’re happy to tell companies about their advertising programs, should yours have an interest. Thanks to Bulletin Healthcare for supporting HIStalk and HIStalk Practice.

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Sales

The Regional Medical Center at Memphis (TN) purchases Carestream Health’s Vue RIS for radiology scheduling and reporting.

The University of Virginia Health System extends its licensing agreement for Streamline Health’s document workflow solutions and adds Streamline’s Correspondence Workflow application.

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People

Press Ganey promotes Robert Draughon from president and CFO to CEO, replacing Richard B. Siegrist, Jr. Siegrist will transition to chief innovation officer and remain on the board. We reported this Monday, courtesy of a rumor report from South Bend Snoop.

PatientSafe Solutions names Joseph Condurso president and COO. He was a CareFusion VP and also spent time with Cardinal Health.

EnovateIT president Fred Calero wins Ernest & Young’s Entrepreneur of the Year award for Michigan and Northwest Ohio in the healthcare services category.

Vivek Kundra, the nation’s first CIO, will quit in August to take a Harvard fellowship. Like his boss, opinions vary on whether he has accomplished anything of positive significance. Nobody has said much about a possible successor, so I don’t know if Aneesh Chopra has the cred or interest.

Industry long-timer Rick O’Pry, founder of JR O’Pry Consulting and IntraNexus, launches a consulting company called HIT Strategists.

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Announcements and Implementations

St. Michael’s Hospital (MN) will go live on Meditech on July 1.

Mayo-Austin (MN) apologizes to patients for long registration delays caused by the EMR it installed in April, saying it “has temporarily slowed down our registration process and phone response time as we check the accuracy of patient information and become more proficient with the system.” They’ve hired more staff. I bet decreased patient satisfaction and increased headcount to do the same work wasn’t in their business plan.

Omnicell’s OmniRX medication dispensing system wins Best in KLAS for hospitals 200 beds and over.

PDR Secure launches the RxEvent adverse event reporting service, which will allow doctors to report drug problems directly from their EHR. It was developed in conjunction with Greenway, the American Pharmacists Association, and athenahealth.

UPMC announces its HealthTrak mobile app for iPhones and iPads that allows patients to review their test results, history, meds, and appointments. It’s based on Epic’s MyChart.

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Innovation and Research

Fujitsu works with a hospital in Japan to roll out a patient guidance system based on e-paper. Patients carry an electronic card holder that guides them to diagnostic departments, checks them in, and accepts their payment. They can wander around while waiting since the system calls them when it’s their turn (not that hospitals have anywhere interesting to wander around in anyway, but at least they could distance themselves from Unemployment TV).

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Technology

Ottawa Hospital is deploying mobile technology in a big way, purchasing 2,800 iPads for its 456-bed facility. The CIO notes that its iPad and iTouch users include doctors, nurses, pharmacists, respiratory therapists, and even janitors.

Online physician networking site QuantiaMD finds that over 30% of physicians use tablet devices, 20% of them in clinical settings.

Panasonic announces that it will bring out an enterprise-grade, Android-powered Toughbook tablet in the fourth quarter.

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Other

Sparrow Health System (MI) hosts a job fair in an attempt to fill 70 to 80 IT job openings. Analysts will support the health system’s $100 million Epic EHR implementation. Starting salaries are $50-80K.

The Missouri Hospital Association estimates that 90% of the state’s hospitals use an EHR for at least one of 24 functions. On average, hospitals use about nine EHR functions, though 44% use at least 13.

CapSite believes the ambulatory EHR and PM market will exceed $3 billion through 2013, with 63% of physicians replacing their current PM systems for an integrated PM/EHR and 38% upgrading or replacing their current PM. Capsite’s 2011 U.S. Ambulatory EHR and PM Study also predicts that 50% of physician will be investing in ambulatory EHR systems. In terms of current market penetration, Allscripts and Epic each have 16%, followed by eClinicalWorks, NextGen, and GE.

A tornado in Verona, WI left Epic powerless for most of last Thursday, forcing it to run on backup generators.

A California man is arrested for pretending to be a medical doctor. A patient got suspicious after he told her to treat her kidney disorder by eating watermelon in a hot tub.

Weird News Andy is speechless about this story: a woman in Sweden with fever, chills, and aches calls four times over four days for an ambulance, but is turned down because she is still able to speak. She dies. But WNA is tittering at this piece about English hospitals warning employees that their uniforms must not expose their midriffs or “excess cleavage” (whatever that means) after patients complained.

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Sponsor Updates

• SCI Solutions posts a video describing its new Arrival Manager product and a cool flipbook of its annual Innovations in Access Management magazine.
• MEDSEEK wins the 2011 Frost & Sullivan North American Health Records Technology Leadership award.
• FormFast and T-System collaborate to integrate the print management portion of FormFast’s workflow software with the T-Sheets documentation system.
• CareTech Solutions announces that two of its clients won 2011 Aster Awards for their Web sites.
• AsquaredM is offering a June 23 Webinar on improving revenue cycle performance with Lean Six Sigma.
• Hanger Orthopedic Group will deploy NextGen Ambulatory EHR and PM at its 675 orthotic and prosthetic patient care centers in 45 states.
• The Tennessee-headquartered RegionalCare Hospital Partners selects Healthcare Management Services (HMS) to provide clinical and financial applications .
• McKesson VP and medical director David Nace, MD is speaking about bundled payments at this week’s AHIP conference in San Francisco.
• A health center customer of TELUS Health Solutions wins an Ingenious Award for using the company’s remote patient monitoring solution to increase nurse productivity, reduce home visits, and save $450 per patient.
• Humana will offer financial assistance to physicians adopting Allscripts EHR as part of is as part Humana Medical Home EHR Rewards Program.
• Pinehurst Dermatology (NC) contracts for the SRS EHR.
• API Healthcare hires Kathy Douglas, RN, MHA as the company’s chief nursing officer. She founded the non-profit On Nursing Excellence.
• TeleTracking Technologies will preview its new RTLS solution at the 2011 Association for Advancement of Medical Instrumentation conference being held June 25-27 in San Antonio.
• HHS’s Office of Minority Health and Quest Diagnostics announce a program to  donate 75 MedPlus EHR user licenses and one year’s subscription fees to physicians in small practices serving minority populations in Houston.
• Perceptive Software names Glenn Cross VP of Marketing.
• MED3OOO is offering an on-demand Webinar on Why ACOs Should Be Physician Led that features Amit Rastogi MD, president and CEO of PriMed LLC, a 70-provider medical group in Connecticut.

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EPtalk by Dr. Jayne

Mile·stone (noun)

1. A stone functioning as a milepost.
2. A significant event or stage in the life, progress, development or the like of a person, nation, etc.

I believe in celebrating milestones. With the rapid pace that many of us run each day, it’s easy to overlook key events. We get used to doing the same tasks each day / week / month / year, falling into the cycle of “lather-rinse-repeat” and losing sight of the work that we are accomplishing.

I encourage my team to remember that, although this may be the 43rd time they’ve trained “E-prescribing 101,” this is the first time the users in their classes are seeing it. I remind them to remember the impact they are having on our end users and that completion of each class is an accomplishment.

We just took our 250th physician live on one of our clinical systems. The go-live wasn’t any different than any other go-live — the physician was aggravated that he had to be there and I was aggravated at having to deal with his surliness towards the IT team. However, calculating the number of times we’ve executed the same process multiplied by the number of people needed to work closely together to successfully get that physician live, it becomes significant. If you would have offered me a bet at the start of the rollout that we’d have this many physicians live on that application at this point, I wouldn’t have taken it.

We tend to take for granted the things that seem to be always present. Maybe we celebrate the beginnings and the ends — the new teammates and the retirements — but we forget to mark the events that happen along the way.

The five-year anniversary of an incredibly challenging project is passing without anyone in our organization other than those of us who were on the team at the beginning noticing. On one hand, maybe it’s good that the tool has become such a part of the organization that it’s not a big deal. But for those of us who still have flashbacks from the go-live (and probably a little post-traumatic stress disorder), it’s amazing.

Celebrating milestones helps us learn what others value and why it matters. Last Wednesday was HIStalk’s eighth birthday. Although Mr. H mentioned it, he tends to be the somewhat shy and retiring type, so it was pretty low key. I’d like to do my part to celebrate HIStalk and reflect on the impact Mr. H and company have had on me.

As a reader, HIStalk provides a reliable, humorous, and entertaining source of information that I could not possibly have uncovered without hours of sifting through the announcements, updates, and studies that come through my inbox and across my desk each week. It gives me tidbits of industry gossip that sometimes hit too close to home.

I’ve learned things about competing health systems that I could not have sleuthed out on my own. I’ve surprised vendor execs by asking them to confirm rumors about their companies that they haven’t even heard themselves. I’ve experienced HIStalkapalooza and the IngaTini.

As a member of the HIStalk team, I’ve had the opportunity to see different sides of vendors as Inga and I cruised the aisles at HIMSS, at one point switching badges to see if it made a difference in how we were received. One of the high points was meeting Mr. H for the first time in the HIStalk limo, changing into our doctor disguises and walking down International Drive with Inga in her amazing boots. We saw our sponsors, many of whom compete directly with each other, breaking bread together at the HIStalk luncheon.

I’ve learned that whether people like a particular piece I’ve written or whether they hate it, I don’t take it too personally either way.

This has been an opportunity to meet amazing people, make new friends, and learn that being anonymous can be a challenge. Using Dr. Jayne’s e-mail address, I’ve emailed people I’ve known for years — and have been ignored. I’ve socialized with key players in government and healthcare and have had to bite my lip to keep from saying, “OMG, if you knew you were talking to Dr. Jayne you would not have just said that.”

I’ve also built necessary career skills – namely the ability to keep coffee from coming out my nose when my co-workers quote HIStalk pieces that I’ve had a hand in.

Best of all, I’ve learned that what may seem like an insignificant event at the time can be a life-changing one. I’d like to thank a certain vendor exec for casually asking, “Do you read HIStalk?” over drinks on a certain day in 2009. At the time, I didn’t. But thanks to that simple question, along with the faith and support of Mr. H and Inga, as well as the camaraderie of Dr. Gregg and Dr. Travis (MD recently conferred!) I’m about to click SEND on Dr. Jayne’s 50th post. Here’s to milestones.

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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.

To BE Innovative, YOU Must … Be Innovative

No one can avoid the term "innovation." It is the holy grail of the 21st century, the hope for modern-day business. 

In his 2011 "State of the Union" address, the President stated, "… the first step to winning the future is encouraging American innovation." Walk into any bookstore or library and the shelves are stocked with books and magazine articles on how to make innovation happen.

Yet despite the resources available and the attention given, innovation still eludes leaders. According Rick Kash and David Calhoun in their book How Companies Win, one trillion dollars was invested last year in the name of innovation with little return. Why?

As with many companies, ours touted innovation as key to growth and culture, yet the concept remained more of a dream than a reality. Then things started to change. Transformation began with a small group of individuals that discovered in order for their company to be truly innovative, innovation had to start with them. You see, to BE innovative, YOU must be innovative.

This evolution has given us national recognition for innovation. Disruptive business models and clinical discoveries have exponentially increased.

How does innovation begin?

First, come to terms with the fact that innovation does not happen by copying a genius like Steve Jobs or Leonardo da Vinci. Nor does it happen by copying the culture of 3M or Google. These men and companies are outliers. You cannot replicate results by cutting and pasting their experience. Gladwell’s latest work, Outliers, highlights this phenomenon brilliantly.

Innovation is organic and personal. This is why innovation begins with you.

Second, while I believe we are born innovative, the cumulative effects of societal norms have rendered the bulk of us innovatively impotent. To release the innovation inside of us will require significant effort. Start by purposefully casting off the well-meaning restraints put on you from parenting, schooling, and work policies. Retrain yourself to walk in freedom and creativity.

Ninety percent of the fuel required for a trip to the moon is expended at lift-off, as the spacecraft breaks loose of the gravitational chains holding it captive. It’s the same with the innovation journey. Balls to the wall.

Nine methods you can leverage to BE innovative:

1. Embrace mentoring. Step away from the parental type of mentoring, where you’re paired up with someone reportedly “older and wiser.” Instead, pair up with someone younger, who looks, dresses, and talks in ways that might make you uncomfortable. The more uncomfortable and stretched you are, the better.
2. Active passion. Passion stokes the fire of innovation. Exactly what brings out your passion doesn’t matter. Just find something that brings you life and energy. Painting, gardening, dancing, big wave surfing, or jujitsu, whatever. Passion provides content and context for innovation mash-ups and convergence.
3. Leverage technology. Innovation drives technology, so it is critical to play in this area. Taking on technology forces you to become a continuous learner. Studies have shown that the more we push the boundaries of learning, the more our brains neuro-connections increase and retain their elasticity. Nicholas Carr provides an excellent overview in his book The Shallows. The converse is true; not pushing boundaries negatively impacts a person’s ability to exhibit innovation.
4. Experience > observation. Go and experience the world. IDEO Partner and Stanford Professor Diego Rodriguez says, “Experience the world instead of talking about experiencing the world.” Stop watching "reality TV." Rather, go and make your own reality. Increase your diversity of experience. As with passion, this will increase the content and context for innovation.
5. Disruption enables innovation. The fainthearted are not capable of innovation. You’ve gotta be courageous and take risks. Baby steps are for babies. Go big. Man or woman up.
6. Practice exorcism. Time to get rid of the devil’s advocate inside you and inside your organization. Ban the phrase and practice. Dissent is encouraged in the context of collaboration, but self-proclaimed “demons” have no place in your organization or life.
7. N2 > N. Adopt a systems-like approach to help you manage ambiguity, variation, and change. While the world is increasingly complex, you can cut through it all and maintain clarity. Embrace complexity on your terms and leverage for greater innovation.
8. Eliminate broken promises. Innovation without execution is a broken promise. As they say in my adopted home of Texas, don’t be “all hat, no cattle.” Failure to follow through zaps your innovation.
9. Embrace failure. Start celebrating failure, even reward it. In the smoldering ashes of failure, innovation rises. When you fail, be public and positive.

By following these nine steps, we were able to become innovative. Once we became innovative, our organization began to be innovative. No magic formulas or mimicking of other people or cultures will work.

Begin with the person in the mirror — you.

Update 6/28/11

Thanks for your comments, most of which focused on the exorcism of the devil’s advocate. Clearly you must have a culture of encouraging rigorous debate and contrarian opinions. Iron sharpens iron and it is during these times of challenge that ideas get honed or put to appropriately put to death.

What I am talking about is people who are not constructive, but always are the first to shoot down ideas, hiding beneath the “devils advocate” defense without offering anything new.

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

Three Kentucky healthcare systems will form a single organization with a combined 91 hospitals, clinics, and home health agencies. The new system will include the University of Louisville Hospital, the James Brown Cancer Center, the six-hospital Jewish Hospital & St. Mary’s Healthcare, and the seven-hospital St. Joseph Health System. As part of the deal, Catholic Health Initiatives will make an incremental capital infusion of $320 million to support the system.

A new Robert Wood Johnson Foundation report finds that 51% of office-treated diabetics in Cleveland received all the care they needed from practices using electronic medical records vs. 7% from paper-based practices. A similar correlation was found for diabetic outcomes. I didn’t see study methodology so I can’t really evaluate it to determine if it adequately proved cause vs. effect, but it’s interesting.

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Reader Comments

From Paula: “Re: Vince’s HSD piece. What about McDonnell-Douglas IHS? It was an innovative system for its time. When McAuto decided to get out of the hospital systems business, it was sold.” Here’s a reply from Vince:

Thanks for reading these dusty old bits of trivia! Yes, IHS (Integrated Health Systems) was one of many turnkey minicomputer systems that the shared giants offered in the 80s – which is going to be the next epoch in HIS-tory covered. McAuto bought IHS in the mid-90s as a DEC-based "total" HIS, to complement their wide array of other turnkey mini offerings, including HDC, MHS, LabCom, RXCom and RadCom. SMS offered a bunch of minis too: ACTIon 400, 700 & 1200, Spirit Choice, and MS4. Ironic the shared giants got into minis so big! Stay tuned for all the details in two weeks."

From Former TMISer: “Re: Commission on Professional and Hospital Activities (CPHA). Vince might want to do a piece on them since they were maybe the first to computerize healthcare data on a large scale. It was a grant-supported non-profit that collected, processed, and stored abstracted data on more than 50% of hospitals back in 1969, offering three products: Professional Activity Study, Medical Audit Program, and Length of Stay Study. All were paper-based printouts. CPHA was influential in the development of the International Classification of Diseases and its length of stay data contributed materially to the development of DRGs.”

 

From The PACS Designer: “Re: StartUp Health. In addition to HIStalk giving smaller companies a chance to succeed, the federal government has announced a program called StartUp Health. This new effort will help entrepreneurs create a long-term roadmap for success by providing education, support, and capital to build a health and wellness business.”

From augurPharmacist: “Re: American Society of Health-System Pharmacists. The Summer Meeting in Denver has lots of HIT content. Discussions include bar code scanning at each step of the intra-hospital supply chain such that ‘when a drug product changes hands, it gets scanned.’ There’s a growing awareness about the technologies required to enable intended pharmacist practice model change from inside the pharmacies to the patient side. Lots more information available on pharmacy’s professional initiative referred to as PPMI by searching ‘PPMI.’”

From J.U. Stice: “Re: nextEMR. Looks like they are the most recent ONC-ATCB certified EHRs to die on the vine. No employees, unpaid bills, empty promises. Classic story of underfunding and no marketing traction. If you build it, they will come? I don’t think so.” I contacted CEO and Founder Alan Faustino MD, who provided this response:

Reports of our demise have been greatly exaggerated. While we have experienced our share of growing pains, like most companies in this economy, we are still offering the same outstanding service and support that has help us survive in this turbulent and confusing HIT period. As a matter of fact, we have been vetted out by several organizations recently from a financial and technology point of view and have been successful in developing strong relations that will sustain this company today and into the future. As an example, we have been chosen as the EMR of choice for the McFarland group to implement and use EMR for research initiatives. We have weekly webinars and look forward to using our technology to better the overall success and increase influenza immunization to the under represented in this country. I can assure you that the NMA and the Cobb institute would no likely involve themselves with a company not in operation. As a matter of fact, we have in conjunction with the McFarland group a webinar tonight and welcome anyone to join and "feel our pulse" Like many businesses, we have had to let go of some employees for financial or performance reasons. However, we wish these people well and hopefully they will find more constructive things to do with their time. However, I do appreciate the "press." Hopefully, HIStalk will allow us to show a different perspective on our company and welcome the opportunity to let the physician community know how nextEMR, along with our partners, are giving physicians the technology to be frankly better physicians today.

From Chip: “Re: poll on giving patients a list of employees who accessed their electronic medical record. You have to do this to pass ARRA and EHR certification requires it, so vendors must have overcome any technical hurdles.”

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HIStalk Announcements and Requests

I have to give a shout out to Best Buy for some superior customer service I just received. I bought a new Asus PC from them, but noticed it had integrated graphics rather than the advertised 1 GB ATI graphics card, which was almost certainly an error in the specs Asus gave them (or perhaps an Asus manufacturing mistake). It wasn’t a huge deal and it wasn’t Best Buy’s fault, but I called the local Best Buy store where I had picked it up (I had done ship-to-store) and they told me to bring it over. They gave me a brand new 2 GB card ($100) and for “my inconvenience” (basically, next to none), they had the Geek Squad folks install it while I waited – all at no charge. I felt bad for even calling since the graphics aren’t all that important to me, but Best Buy really came through. The new PC is working great and I’m finally off Vista and WinXP (except at work, of course, where the ten-year-old XP still reigns unchallenged).

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Sales

Norton Healthcare (KY) purchases the Morrisey Concurrent Care Manager application to automate its care management processes

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People

James Hauschildt EdD, MA, BSN, RN is named academic dean of Saint Luke’s College of Health Sciences (MO). He was formerly with Dearborn Advisors, Dell, Cerner, and the Air Force nurse corps.

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Announcements and Implementations

Massena Memorial Hospital (NY) goes live on MEDHOST’s EDIS.

Shands Healthcare (FL) goes live on its $95 million Epic EMR at three facilities. A fourth facility will be added in September and several faculty practices will go up next year. The same article includes some interesting facts about Epic: the company has 240 customers; one-fourth of the country’s physicians use Epic software; and, 110 million patients (38% of all patients) will be in an Epic system once pending implementations are complete.

The School of Medicine at the University of Alabama-Birmingham starts its EHR implementation, which will be completed in five phases over the next 18 months. Stephen Stair MD, the physician executive sponsor of the project, provides an update above.

West Tennessee Healthcare System deploys BIO-key International biometric ID software within its Sentillion Vergence solution.

A nine-physician internal medicine group in Michigan sells itself to Oakwood Healthcare, saying it passed on aligning with Henry Ford Health System because HFHS couldn’t get its EMR installed quickly enough. HFHS says the EMR wasn’t a priority because they are replacing their McKesson system with a $100 million custom system from RelWare and didn’t see the point in installing a system that will be gone in two years. Oakwood uses NextGen, but signed a contract in April to implement Epic in its hospitals and practices at a cost of $60 million.

Philips will roll out its eICU system in India within a year.

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Government and Politics

Maine legislators vote to allow residents to opt out of the state’s HIE database.

Mark your calendar: July 3 is the last day eligible hospitals and critical access hospitals can begin their 90-day reporting period in fiscal year 2011 for the Medicare EHR incentive program. Eligible Providers have until October 3.

The Boston Globe points out that the state still does business with IBM’s Cognos division even as one of the company’s former salespeople goes on trial for giving kickbacks to the speaker of the house of Massachusetts in return for getting software contracts without going through the required bidding process. Neither IBM or Cognos, which had not been acquired by IBM at the time of the alleged incident, have been charged, but it’s possible the SEC could get involved if evidence suggests that the sale boosted the acquisition value of Cognos.

The UK’s NHS says that even though the country’s “digital by default” policy requires citizens to communicate with government agencies by digital means, that requirement will not be imposed on those seeking health services. Instead, the government will meet whatever demand citizens have, with one of its technical leaders saying, “The idea that we should wait for everyone to agree before offering digital services is ludicrous.”

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Innovation and Research

A study finds that implementation of healthcare IT had no effect on outcomes for nursing home patients, other than it seemed to make them more disruptive.

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Other

HIMSS names Hudson River Healthcare (NY) as its single finalist for the Community Health Organization Davies award.

Mayo Clinic’s chairman of health policy and research says that the clinic won’t be participating in an ACO, at least based on the proposed rule. According to Douglas Wood MD, Mayo’s objections include the use of oversight boards to judge performance, the proposed anti-trust rules, the methods of measuring effectiveness of care, and the way patients would be assigned to ACOs.

maxIT Healthcare celebrates its 10-year anniversary by sending out its executives in an RV with a cool paint job, driving across the country to visit its consultants and clients in the field.

 

Weird News Andy noodles out a great story about a doctor and a diva (he clarifies they are not one and the same in this particular case). An opera singer (on the left above) shopping at a Manhattan Trader Joe’s gets annoyed at a teenaged boy who blocks her husband from grabbing a frozen Pad Thai dinner. Hubby complains loudly, so the boy’s mom (a doctor, on the right above), bellows out, “Get that pole out of your ass.” The opera singer admits that she then slapped the doctor, but adds that she needed slapping because the doctor was “getting into her personal space.” The opera singer is on trial for attempted assault.  

Here’s a great interview and character study of Bill Gates, who talks about global health and how his kids will need to find regular jobs because he’s not giving them much money (“much” meaning quite different things to Bill than to you and me). Trivia: he bristles when the reporter asks if his kids have iPhones, iPads, or iPods, saying, “They have the Windows equivalent … they are not deprived children.” You forget how young he was (21) when he and Paul Allen started Microsoft in 1975 – the photo above is from 1984, well into the company’s growth and the year that Windows was launched. He looks about 12.

I like this well-written and just-sarcastic-enough editorial by a physician and former president of AAPS, whose bio contains this wry observation: “As a life-long dog lover and trainer, she realizes that her dogs have better access to medical care and more medical privacy than she has, and her veterinarians are paid more than physicians in the United States for exactly the same types of surgery.” Among her unhappy but amusing observations (not all of which are correct) about medical practice is this:

Now there’s also “healthcare reform.” That includes the push for the EHR (electronic health record). Physicians are being bribed with $44,000 for installing one that meets the government’s desire to have your formerly private medical record on a government database. With this system, a keystroke can fill your medical record with mistakes, yet a physician can’t write a progress note without learning to navigate a computer program so obsessive that the detail required to order a simple test would do for a moon landing. The former head of CMS (Centers for Medicare and Medicaid Services), Nancy-Ann Min DeParle, made around $2 million dollars working for the company whose program it is, before she became an unaccountable “Czar” in the present regime.

A female visitor trips while walking out of the elevator at Louisiana Medical Center and Heart Hospital. She claims permanent injuries to her arm, shoulder, and neck that cause her pain and suffering, disability and mental anguish, loss of income, loss of earning capacity, and expenses. She’s suing the hospital for $600,000.

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Sponsor Updates

• Highmark selects MEDecision’s collaborative health management solutions to support the management of its 4.8 million members.
• Practice Fusion hires Edwin Miller as its first VP of product management. He previously worked for Curaspan, Artromick, and athenahealth.
• Health Language is demonstrating its upgraded version of LEAP I-20 at booth #335 at this week’s AHIP conference in San Francisco.
• CareTech Solutions and its client, Central Maine Medical Center (ME) are chosen by the Ohio Hospital Association to present an IT security case study, Security Assessments: A Tool to Manage Risks and Achieve HIPAA Compliance, at OHA’s annual meeting this week in Columbus.
• The 49-bed Monroe County Medical Center (KY) contracts with Healthcare Management Systems for its EHR suite.
• The City Paper of Nashville and Nashville’s Entrepreneurs’ Organization name ICA president and CEO Gary Zegiestowsky as one of the top ten entrepreneurs in the Nashville area.
• ZirMed earns a #79 ranking on HCI’s 100 list of top HIT companies.
• Business Alabama magazine and Best Companies Group name MEDSEEK one of the 2011 Best Companies to Work For in Alabama.
• PatientKeeper releases its Charge Capture solution for Android.
• Nebraska Medical Center chooses Voalte’s integrated communication solution.
• Sage Healthcare Division announces that more than a dozen healthcare facilities have chosen Sage Intergy Meaningful Use Edition.
• Moses Cone Health System (NC) selects ProVation Order Sets for its five hospitals.
• Duncan Regional Hospital (OK) will implement T-SystemEV STAT to manage average length of stay in its ED.
• North Shore-LIJ Health System extends its enterprise agreement with Surgical Information Systems by choosing the SIS Anesthesia documentation solution.
• The entire recruiting team of Intellect Resources achieves Certified Personnel Consultant certification.
• NYU Langone Medical Center implements the PatientSecure palm scanning solution for biometric patient identification. A patient commented, “This technology makes you feel like a VIP. You just put your palm on the scanner and you’re done registering at your doctor’s office, no clipboard, no hassle of paperwork to check in, plus, it’s absolutely secure. It’s immediate and instantaneous. Never in my life have I experienced health care like this before. ”

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Contacts

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

A good friend of mine works for a large academic medical center that has restrictive IT policies. Fiercely loyal to certain vendors, the IT gatekeepers restrict hardware choices, from server infrastructure to smart phones. Apple products are largely banned, and the popularity of the iPhone has led many employees to carry multiple handheld devices. Corporate e-mail can only be received on personal phones if the employee knows the “right” people in IT who are willing to bend the rules to make the customer’s life easier.

Although I appreciate that it’s important to discourage employees from playing Angry Birds or from Facebooking on company time, they’ve taken control to extremes. His hospital IT department seems to be missing the point that their prime role is to support staff in the safe and efficient care of patients. Making it more difficult for clinicians to do their jobs isn’t in harmony with that mission, not to mention the cost of the hospital paying for owned handhelds and then reimbursing staff for personal devices.

When I saw a recent article called Doctors Driving IT Development with their Mobile Device Choices, I immediately thought of him. I instant messaged the link to him on both his hospital device and his iPhone to see which one was read first. Of course, it was the iPhone. Surveys estimate that over 80% of physicians are using smart phones, up 11% from 2010. The article states, “Instead of hospitals and vendors telling physicians to adapt to their preferred ways of using technology, physicians are gaining the power to sway hospitals and vendors to their preferred way of using it.”

Albany Medical Center is cited as allowing physician-owned devices on their network to meet physician demand. Administrators created a project to allow physicians to test drive an iPhone, iPad, and BlackBerry over a three-month period. The Apple products were clear leaders. I’ve personally used all three, and each has its strengths and weaknesses depending on the demands placed on them by users.

Everyone talks about usability these days, although in most contexts, it is application usability being discussed. I don’t hear as many discussions about hardware usability as I used to. That’s a tremendous “miss” in my opinion. I hear a lot more discussion of the color choices for carts used in computer on wheels implementations than I do about the computers that will ride on those carts. (And for the record, if I was asked — which I wasn’t — I would have picked colors that would have helped identify which users left their carts abandoned in the hallways for me to weave through on rounds — red for phlebotomy, pink for OB registrars, green for interns, etc.)

Some CIOs I know are quick to blame software vendors for poor usability, failing to realize that hardware often plays as much a role in how usable a clinical application is as does the operation of the application itself. Case in point: an orthopedic surgeon to whom I regularly refer patients cornered me in the doctors’ lounge complaining about his EHR (which happens to be the same one I use in practice). He wanted to know how I stand “all that scrolling you have to do all day long.”

I told him I haven’t had to scroll since taking Version X of the application in 2009 and asked if he was on an older version. No, he said he was on the same version I was. Even though he’s employed by a competitor, as the designated “computer expert,” I wanted to help him. (Plus, he’s a darned good surgeon and always sends me a nice bottle of wine at the holidays.) I asked him to send me a screen shot of his scrolling problem.

After a brief phone call to explain how to do a screen shot, I had his answer. His wide-aspect laptop didn’t allow his workflow to appear without scrolling. His application fell off the bottom of the screen and he had a huge amount of white space on the right. The scope of choice allowed by his IT department is this — Tablet PC (one option) vs. Laptop (one option) vs. Desktop (one option).

For the last two years, he had been blaming the software vendor, when really it was the hardware. I sent him a screen shot of my workflow — the patient’s chart fits neatly on the screen with no problem. Although I’m sure his laptop is great for streaming Netflix, it wasn’t a good choice for his EHR.

I understand that there are a great number of choices in the market today and hospitals can’t be expected to support each and every one. It’s not practical for contracting and procurement, it’s expensive, and it’s a support nightmare. On the other hand, IT departments have a duty to provide hardware that properly displays applications and meets user needs for durability, portability, and speed.

Hardware vendors are savvy and will continue to create new platforms and expand on those already in the marketplace. Users are savvy and will always want the latest and greatest in hopes that it will make their work easier. IT teams who can temper their own needs and wants in favor of those of caregivers and end users will continue to have greater successes than those who don’t.

E-mail Dr. Jayne.