From ACC_Champs: “Re: NCHICA’s response to Accounting of Disclosures. By getting input from all sides of the issue, they have drafted a great response.” Some of their concerns:

1. Just because few people ask for Accountings of Disclosures now doesn’t mean they won’t in the future, requiring hospitals to do a lot of unpaid work.
2. The scope needs to be better defined since not everything is stored permanently in the EMR (such EKG strips, as I read from their example).
3. The definition of “access” should be clarified, such as if someone searches for “John Smith” in an EMR and is shown a long list of John Smiths, is that considered “access” of every one of them?
4. It’s not as easy to generate an Access Report as you might think, with hospitals churning out tons of data from many systems (one hospital found that an average six-day inpatient stay generated 1,800 accesses).
5. Access logs aren’t something the typical patient would be able to understand, meaning they may expect someone to spend time explaining them.
6. Patients who don’t understand that hospitals have a lot of unseen people involved in their care are going to file unwarranted complaints to OCR.
7. Employees aren’t protected from ambulance chasers or crazy patients who could easily obtain their full names by requesting an access report.

From Quaid: “Re: Siemens. Hawaii Health Systems Corporation just signed a $28.7 million deal for Soarian.” Verified.

From Anony: “Re: Piedmont Healthcare, Atlanta. Can’t believe I haven’t seen it here yet, but they’re moving from Allscripts to Epic.” As usual, the best way to verify is to check the hospital’s job postings since the Epic implementation method requires hiring a ton of people fast, including posting all jobs instead of just reassigning current staff. Piedmont listed several inpatient Epic positions on July 12, so I’d say that’s confirmation. I should also mention that Johns Hopkins signed its Epic contract this week. Both will apparently be Allscripts Sunrise losses.

From Anonymous: “Re: Allscripts. Continuing to reduce workforce in Raleigh as jobs are offshored, with 15-20 folks gone in the last week or two.” Unverified.

From Nasty Parts: “Re: Compugroup. Heard on the street that they’re buying the Sage Healthcare business. Folks at Compugroup USA HQ openly talking about it.” Unverified.

From KnowurCMIO: “Re: Cerner and Epic. Epic has indeed started expanding overseas — they have a satellite HQ in the Netherlands and have already installed there. I suspect they will begin seeing rapid growth once the implementations stateside slow down. Spaarne Hospital was the first EpicCare client in Europe in 2007.”

From Bob: “Re: shoe hoarder. I read this and thought of Inga.” A Philadelphia mom who happens to be a big-money poker champ owns 1,200 pairs of shoes (one pair worth $4,000) stored in four closets, one of them a converted sitting room. She’s profiled in a film about shoe nuts, which concludes that such compulsion is related to seduction and sex. I’ll let Inga to clarify her own motives.

Here’s the latest HIStory from Vince, this time covering Dynamic Control.

Listening: the new CD from teen rockers Jessica Prouty Band, sent over by her mom, who has a lot of history in HIT. Their sound has matured a lot over the years I’ve followed them, putting them right up there with Evanescence, Within Temptation, and some of the other female-led metal rockers. Big sound for a four-piece, with singer Jessica handling the bass very well. This is a really polished production – you would never suspect that the members are barely old enough to drive to their gigs. Video here.

My Time Capsule editorial from 2006 this week: When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In, snipped herein: “From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time.”

Most respondents believe that HITECH’s legacy will be increased EMR adoption, although the “waste of taxpayer money” camp was right on their heels. New poll to your right, spurred because I got a HIMSS member survey recently: how would you grade your satisfaction level with HIMSS? As always, you are able and encouraged to add your comments by clicking the Comments link on the poll, visible after you’ve either voted or clicked the View Results link.

HIMSS moved its Chicago headquarters this weekend.

Sage announces Intergy v7, which includes user enhancements, certification of all 44 ONC-ATCB clinical quality measures, and 5010 support for the PM/EMR system.  

NHS Scotland contracts with Imprivata for its OneSign single sign-on and password reset solution.

A reader sent over the full text EHR articles that were just published in the July issue Journal of Oncology Practice. Here’s a brief rundown of those I found interesting.

• A US Oncology team, working with iKnowMed to standardize over 500 chemo regimen order sets, found that 10% of them needed to be eliminated, with changes required for all the rest (other than changes in title, the most common changes involved updating the cited references and changing doses and cycles). They mention that EMRs can help address drug safety issues.
• NorthShore (IL) looked at the cultural impact of moving all inpatient and outpatient oncology ordering to Epic in 2005. The main benefit was data sharing among members of the multidisciplinary team (labs, rads, referrals, appointment information) and patient communication (secure communications, online test results). Chemo ordering in Beacon was found to be more complete and safer, with the percentage of complete documentation going from 67% to 93% and pharmacy interventions also increasing. They’re at 100% e-prescribing (other than for narcotics and oral chemo), outpatient med rec is over 90%, and AR days have dropped to 30. They’re using Epic’s data for research and quality monitoring.
• A Vanderbilt group looked at improving compliance with nursing guidelines on chemo administration and documentation using their systems (WizOrder, Horizon Meds Manager, Horizon Expert Documentation, StarPanel). Pros: two-signature compliance improved, standardized MARs were easier for nurses to follow, alerts improved safety. Cons: systems could not track doses by relative day or dose number, could not document infusion stop time, stat and verbal orders required an override, and pharmacy had to adjust schedules frequently to avoid “wrong time” alerts.
• Johns Hopkins pediatric oncologists wrote up their CPOE design process and creation of Eclipsys Sunrise MLMs to check height and weight, to force inclusion of hydration orders, and to provide the capability to adjust chemo doses by percentages. They also developed a fast-track process for creating and approving new order sets.
• Memorial Sloan-Kettering described their Eclipsys CPOE chemo ordering implementation. They created 1,250 adult and 466 pediatric order sets and mandated CPOE-based ordering. They reported nearly universal use of the order sets. I didn’t see anything that documented clinical outcomes, but they did mention problems related to cumulative dose calculations and alerts.

From McKesson’s earnings call:

1. They talked a lot about acquiring Portico Systems (surprising given that McKesson is a massive company acquiring a relatively tiny company for $38 million, which would be just a few weeks’ pay for CEO John Hammergren since he took home $151 million last year) and said little about their drug business.
2. Technology Solutions  revenue was up 6%, but only because of revenue recognition timing – they expect growth to be a little better than last year’s 2%.
3. Hammergren mentioned “significant progress” in the technology business, but basically said focus is on implementation rather than sales even though the company is “continuing to strategically position the business for continued growth.”
4. He said that clinical systems are today’s opportunity, but a lot of McKesson’s customers are running 20-year-old financial systems that might be candidates for Horizon Enterprise Revenue Management.
5. He thinks that big companies (“the anchor tenant”) will be the healthcare IT winners in the payer, hospital, and physician practice markets since smaller companies won’t be able to get to those prospects cost effectively.
6. He mentioned some “consolidation in our overhead and our selling infrastructure last year.”
7. An analyst asked directly about IT customer retention in calling 2010 “a tough year” for McKesson, with Hammergren’s response being that the company had spent a lot over the last two years to make its products better and he hopes the market share changes are a trailing rather than a leading indicator, with the potential of a slight rebound in market share this year with Paragon as the leader.

My sideline analysis of the MCK call (your comments are welcome):

1. Most of the analysts’ questions involved the company’s challenges in the IT business, again surprising given its core business of drug distribution.
2. McKesson seems to be acknowledging that it’s falling behind Epic and other vendors on the clinical systems side and is placing its only hope on a pendulum swing back to financial systems and its struggling HERM.
3. The company hopes that product improvement will stop the market share slide.
4. I inferred no commitment to innovation, acquisitions, or thought leadership, just that McKesson is banking on its huge size and customer touch points to keep selling all of its products.

 

The local paper covers the $36 million Epic system that will be in place when Orange Regional Medical Center (NY) moves to its new hospital next week. It says that stimulus money will cover half the cost.

In Canada, Nova Scotia will implement a $27 million system for sharing patient medication information, with all pharmacies expected to be linked by 2013.

Hawaii Governor Neil Abercrombie announces that Thomas Tsang, MD will join his healthcare transformation leadership team. He is ONC’s medical director over Meaningful Use, but it’s not clear from the announcement whether he’s resigning that post.

GE Healthcare Performance Solutions acquires Medical Event Reporting System, a Web-based system that helps hospitals collect and analyze patient safety events. It was developed by Columbia university with AHRQ support. The company, also called MERS, had been a GE Healthcare JV partner since 2008. A white paper on its use by Mount Sinai Hospital (NY) is here. GE says it’s working on rollouts to 16 hospitals.

From Cerner’s earnings call:

1. The company talked up its physician practice sales, saying its improvements in the user interface and workflow positioned its products well as clients look for systems that integrate inpatient and outpatient.
2. CERN says it is different from competitors in its willingness to connect to other systems.
3. They are expecting Meaningful Use to keep driving sales for years.
4. They suggest that 50% of US hospitals will reselect their core systems in the next 5-7 years as even those customers who are happy today will find their vendors falling short with regard to interoperability and reporting.
5. The ProFit financial system is doing better.
6. CERN says they expect to take on more outsourcing contracts since they are more able to hire scarce HIT employees than hospitals.
7. Neal didn’t pop in for even his usual one-paragraph drive-by.

Shares in Omnicell touched off a 52-week-high Friday after turning in good numbers after the market close Thursday: revenue up 6.6%, EPS $0.08 vs $0.02. The one-year share price (blue) against the S&P 500 (green) is above. Market cap is $567 million.

Meditech filed its quarterly report Friday, with revenue up 25% and EPS up 33% ($0.86 vs. $0.64). The cost of acquiring the 78% of shares in ambulatory vendor LSS that it didn’t already own was given as $13.7 million in cash, with LSS’s first quarter performance being $0.8 million in net income on $5.4 million in revenue.

Strange: the former head of Alberta Health Services (Canada), who left his job in November after repeatedly telling reporters at an emergency meeting that he was too busy eating a cookie to answer their questions, gets $735K in severance. He seemed overly peeved, but made sense in pointing out that maybe the eager beaver talking heads should attend the scheduled press briefing that was being held in 30 minutes instead of chasing him down the street for their own personal on-camera moment.

E-mail Mr. H.

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in June 2006.

When CIOs Are Under Pressure, “Man of Action Syndrome” Kicks In
By Mr. HIStalk

Hospitals and vendors don’t brag when their IT projects harm patients. Therefore, I’m not surprised that press releases haven’t announced several recent, disastrous examples where IT leaders overrode worried clinicians and continued with a flawed clinical system go-live to the detriment of patient care.

Being of a clinical background, I’m compelled to give this scenario a name and an acronym, even though I can’t diagnose or cure it. Man of Action Syndrome, or MAS, is the psychological need of someone in IT authority to veto those more knowledgeable clinicians who express well-founded patient safety concerns about clinical IT projects.

The name is not sexist since I’ve not yet seen a female CIO so afflicted. MAS also seems to spare CIOs with a clinical background.

Its victims are generally male, Type A, ego-driven MBAs with a history of programming or consulting. Anxious to add value by showing business savvy and decisiveness in an ill-suited environment of caring and empathy, they won’t allow budgets or dates to slip. It’s a quantitative thing.

A wise old project management saying is, “Good, fast, cheap — you can only pick two.” Unfortunately, those with MAS obsess on ‘fast’ and ‘cheap,’ knowing that it’s far easier to bury (no pun intended) qualitative project shortcomings that fall into the ‘good’ category. You can always blame users or the vendor.

I’ve been on both sides of the fence. IT people add value in formalizing system selection and planning. Those are repeatable processes where past experience may improve the chance of success. Unfortunately, that kind of management-by-control experience doesn’t work with clinical process change.

Ideally, an assembled group of clinicians would drive clinical system projects. However, it’s hard to engage them. That’s when MAS kicks in: “My neck’s on the line, so here’s what we’re going to do.”

From my limited experience, I would say that CIOs overrule the concerns of nurse informatics people nearly 100 percent of the time and IT-based physicians at least 50 percent of the time. Because those people represent a large number of their disenfranchised non-IT counterparts, the CIO has, in effect, dismissed the concerns of an entire discipline, often with reasoning such as, “They don’t see the big picture” or “They don’t know the pressure I’m under to deliver ROI and on-time implementation.”

Maybe practicing clinicians should be the ones making the go/no-go decision without IT people or other hospital management in the room. I’ve seen clinicians leave meetings shaking their heads, worn down from trying to get their message across to an IT team more comfortable hard-selling their own agenda instead of listening to what’s best for patients.

Perhaps the evolving role of the chief medical information officer will eventually balance the MBA approach. Maybe we’ll see more CIOs who have cared for patients instead of thriving in a Dilbert-esque world. Possibly the new wave of clinicians formally trained in informatics will provide credibility to concerns that the software doesn’t work, the users aren’t ready, or the communication has been poor. Non-IT hospital leadership may eventually understand that that silver bullet they paid for is just lead under the paint. Until then, if you’re a CIO with symptoms of Man of Action Syndrome, please contact your health care professional at once.

Top News

Cerner’s Q2 numbers: revenue up 15%, EPS $0.42 vs. $0.33, beating earnings expectations by a penny after excluding one-time items.

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Reader Comments

From AzEMRGuy: “Re: Tucson Medical Center. Hiring for multiple Epic positions.” Above is the hospital’s recruitment video, which talks up Epic opportunities. I assume that means Allscripts Sunrise is egressing unless TMC switched systems since the last time I was there. CORRECTION: reader Zaphod Beeblebrox correctly notes that I confused University Medical Center in Tucson (a Sunrise client) with Tucson Medical Center. TMC is already an Epic customer.

From Instamatic: “Re: displaced CIS vendors. This chart from the KLAS newsletter says 2010 sales volume remained about the same as 2009. Would you assume that most of the displacements are Epic’s?” I would assume so, especially given the win/loss numbers that KLAS put out along with the graphic (almost two-thirds of sales to 200+ bed hospitals went to Epic, with Horizon customers being especially ripe for the plucking). I’ve been saying for a year or two that Epic is dominating the market of mid-size hospitals and up (say, 300+ bed community hospitals, but also academic medical centers and IDNs), putting a big-time hurt on Cerner, non-Paragon McKesson, and the former Eclipsys. Not to mention as the healthcare system inevitably consolidates under healthcare reform, more organizations will hit Epic’s sweet spot of size and scope as they look to standardize. Vendors such as GE, QuadraMed, and Siemens weren’t much of a sales factor anyway, so that would seem to leave Epic on the high end and Meditech and Paragon for everyone else as the only vendors booking significant net-new customers. That’s not considering rural and critical access hospitals, which would look at Meditech, Paragon, HMS, Prognosis, and a few others. I think you’ll see the others trying to make their numbers with hosting, upselling, and services – in other words, they’re in a mature market, which can throw off some nice profits while waiting for the inevitable downward slide to accelerate. They all have other business lines, so they’ll be fine. I’m not saying that’s good or bad, just how it looks to me.

From Mathemagician: “Re: Cerner. They can’t compete with Epic any more for hospitals of more than a couple of hundred beds, so they have three ways to drive growth: (a) sell to very small hospitals that don’t already have systems; (b) provide outsourcing services to existing customers, such as IT outsourcing and revenue cycle management; and (c) sell outside of the US where Epic doesn’t tread.” I would agree, adding also Cerner’s apparent interest (possibly Epic-motivated) in providing actual healthcare and healthcare management services rather than just IT products and services. Cerner’s biggest competitive weapon is its market cap, which provides options that the company appears to be tentatively exploring.

From rsm2800: “Re: Journal of Oncology Practice. The July issue contains 12 articles about EHRs in oncology.” Only subscribers can read the full text articles, but the titles relate to CCHIT certification; Memorial Sloan-Kettering’s chemo ordering system (which must be the amazingly cool Allscripts Sunrise work I saw at HIMSS last year); CPOE in peds oncology; standardized CPOE order sets; EMR-based checklists; use of natural language processing to extract clinical information from free text documentation; chemo medication administration systems; patient-physician e-mail; EMR effects on culture; CPOE outcomes; and the interest in sharing information by those with cancer. The topics sound excellent.

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HIStalk Announcements and Requests

Have you kept up with HIStalk Practice this week? A few highlights: MGMA joins CHIME and other professional organizations in calling for HHS to withdraw its proposed HIPAA accounting of disclosure rules. DrFirst intros an e-prescribing option for controlled substances. The American Academy of Ophthalmology publishes a list of EHR requirements for ophthalmologists seeking to achieve Meaningful Use incentives. Salaries for physician practice managers remained flat in 2010.  Sign up for the e-mail updates while you are passing through and thanks for reading.

I featured Aventura in the latest Innovator Showcase this week. Just to recap the process: several dozen companies nominated themselves to be included; my expert team of investment bankers and providers chose eight of them after reviewing their application materials; and those companies will complete a video, a customer testimonial, and a telephone interview to be presented with their showcase article. Two of the eight have been featured so far. It’s quite a bit of work for the companies and for me, but readers have asked me repeatedly to give creative vendors a chance to be seen.

Keep an eye on the swinging pocket watch … you are getting sleepy … when you awaken, you will feel happy and rested. You will immediately sign up for e-mail updates to your upper right … your legs and arms are getting heavy … you will make the inevitable electronic connections offered by Facebook and LinkedIn to Inga, Dr. Jayne, and Mr. H … you can barely keep your eyes open …. you love HIStalk’s sponsors and will feel fulfilled by clicking their ads … going into a deeper sleep as you pledge to send me news, rumors, articles, or anything interesting … you’re become a little more alert … when I count three you will awaken rested and refreshed, feeling better than you’ve ever felt … one, two … and almost forgot, you’ll bark like a dog every time you hear the word “interoperability,” you’ll never embarrass yourself again by writing trite Internet phrases such as “wow, just wow” or “Best. Wine. Ever” and you’ll send love notes to Mr. H and Inga … three. Thanks to readers for reading, sponsors for … sponsing, and caregivers for caring.

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Texas Health Resources contracts with Streamline Health for its Epic Integration Suite.

The Tehachapi Valley Healthcare District Board of Directors (CA) approves the purchase of Healthland’s EHR. The local paper reports that the $400K five-year cost of HMS was one-fourth that of competitor McKesson.

HealthSouth selects Cerner to provide EHR for its 97 inpatient rehab facilities.

Memorial Hermann chooses CodeRyte for computer-assisted coding.

Hoag Memorial Hospital Presbyterian (CA) signs for Unibased ForSite 2020 Resource Management System for enterprise scheduling and a patient portal.

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People

Former Wipro Technologies CIO Laxman K. Badiga joins Anthelio as COO.

Pat Cline, president and board member of Quality Systems, announces that he will retire this year.

Accretive Health names Joseph Bellini chief revenue officer.

Shared Health hires former WebMD founding COO Michael Heekin as CEO.

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Announcements and Implementations

Misys Open Source Solutions wins the international “Best Use of Open Source Technology” award for its Misys Connect HIE solution.

The Rhode Island REC accepts ABILITY Network as an health information service provider to provide its member secure health information exchange.

Epocrates announces first phase availability of its Epocrates EHR mobile and Web-based EHR, designed for primary care practices with 10 or fewer physicians. The company will also offer a license to a native Apple iPhone app that supports remote patient look-up, schedule access, and e-prescribing capabilities.

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Other

CMS’ Office of the Actuary predicts that national healthcare spending will hit $4.6 trillion by 2020, up from this year’s $2.7 trillion. The biggest increase in spending (8.3%) will occur in 2014, when many federal health reforms take effect.

The Salt Lake City paper observes the challenges of connecting physician practices and hospitals via Utah’s Clinical Health Information Exchange, with incompatible EMRs leading the list. An interesting tidbit that may have been inadvertently disclosed by a University of Utah Health Care spokesperson: they’re using Cerner on the inpatient side and Epic for outpatient, but will soon migrate to a single system. You’ll want big odds if you’re betting on Cerner to win that deal.

The Town of Freetown (MA) lays out the requirements Meditech will need to meet to develop a five-story, 186,000 square foot office building there that could bring up to 800 jobs to the area. Meditech’s costs are estimated at $80-100 million.

Tampa General Hospital (FL) files a $9.2 million claim against the estate of a deceased 29-year-old patient who had spent five years as an inpatient. Maybe they should use any proceeds to hire case managers or buy equity in a skilled nursing facility that will accept transfers.

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Sponsor Updates

• Cottage Hospital (NH) achieves Medicare Stage 1 Meaningful Use through its use of the Healthcare Management Systems (HMS) EHR.
• Michigan Eye Institute chooses the SRS EHR for its eight-provider, five-location practice.
• Five providers from Aquidneck Medical Associates (RI) receive an $18,000 check for their Meaningful Use of the eClinicalWorks EHR, making them among the first in the state.
• Microsoft recognizes MEDSEEK as its 2011 US Public Sector Partner of the Year.
• Milwaukee Health Care Partnership and Wisconsin Health Information Exchange (WHIE announce a two-year extension of their contract with My Health Direct.
• St. Mary’s Regional Medical Center (OK) selects Merge Healthcare’s cardiology solution, while Sisters of Mercy (MO) adds the company’s iConnect solution.
• Mount Carmel Health Partners (OH) chooses MedVentive Population Manager to support improved patient care and clinical outcomes.
• Lexmark reports record earnings for Q2 and acknowledges the contribution of its Perceptive Software business unit.
• Health Language Inc (HLI) launches an upgrade to its Provider Friendly Terminology solution, now containing over 120,000 terms.
• T-System announces a call for entries for its Client Excellence Awards.
• Sentry Data Systems expands to a new office in Austin, TX while partnering with UT’s health IT program.
• GetWellNetwork adds two options for its interactive patient care system, a multi-function touchscreen and a lower-price, eco-friendly nettop.
• ZirMed announces successful transmission of claims and receipt of electronic remittance advices using HIPAA 5010 format.

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EPtalk by Dr. Jayne

Quite a few organizations are using scribes as part of their EHR. A local hospital (which happens to be an Epic client) recently started using scribes in the emergency department, with the goal of having scribe coverage for all emergency physicians by early next year. According to a PR piece, several companies provide scribes and offer scribe training, with an estimated 200-plus hospital emergency departments starting to use scribes over the last two years.

Our group experimented with scribes several years ago when there weren’t as many formal opportunities for scribe training. We mainly wanted to use scribes in physician offices to aid EHR adoption and provide a safety net for older docs who were close to retirement and resistant to EHR implementation, but who still needed to get data into the system for patient safety and care continuity purposes.

A medical assistant or medical secretary would typically receive additional training, but it was rare for the practice to go the distance and hire someone to do the staffer’s usual work while he/she was scribing. As you can imagine, it doesn’t go well when you take a full-time employee and add another full time job to his/her plate. The program was dead before it ever left the gate.

Scribe staffing firms target pre-medical and pre-nursing students who are looking for experience in the healthcare field who are willing to work cheap. Starting salary for a scribe is $8 to $10 an hour. After preclinical training, the firm that’s staffing our local hospital includes a 100-hour “apprenticeship” with a senior scribe before new scribes are allowed to work independently.

The non-profit American College of Clinical Information Managers (ACCIM) recently emerged to hopefully help the rapidly proliferating scribe programs develop standards and monitor themselves. A visit to their website revealed an online training program and an exam leading to certification as a Clinical Information Manager, which can be taken after as little as 100 hours of work with a minimum of 100 patients documented. The exam costs $40 and an annual certification costs $20.

I like the idea that they require certified scribes to complete 20 hours of continuing education a year. Our state medical board only requires 25 hours for physicians and I think that’s pretty sad. Although the website said it would have a list of individual certified scribes, I wasn’t able to find it. Corporate members of the ACCIM include Scribe America and Emergency Medicine Scribe Systems.

As a physician, I’d love to know that all my data is being captured the way I like it while I can focus on the patient in front of me. From experience, though, I know it’s hard to have that level of teamwork and trust when you’re in a shift-work environment. I’ve done my share of emergency department work, and unless the scribes are remarkably consistent, I think it would be hard to have a different one for every shift.

The local paper profiled this change, noting that the scribes “win” by seeing jobs first-hand as they are “attached to the hip of a physician.” Do they really? I wonder what the average shelf life of a scribe is?

Depending on what they see, it might send them running in the opposite direction of actually entering the healthcare field. Most pre-med students are pretty smart cookies who will quickly figure out if they truly have a calling for days where you stand for 12 hours without a meal or a trip to the bathroom in exchange for taking on upwards of $250,000 in student loan debt.

On the other hand, it’s a great way to get experience and actually get paid. Back in the dark ages when I was an undergrad, unless your parent was a doctor and would hire you to work in the office, the only experience you could get was as a volunteer. I’d certainly rather have had the opportunity to do scribe work than to do what I did, which was to edit a medical textbook written by an extremely cranky researcher who had chosen someone without a firm grasp of the English language to do a first pass on her book before firing him. Although frustrating, I must say it prepared me for some of the technical manuals and white papers that grace the ever-growing stacks on this CMIO’s desk.

Do you have scribes at your hospital or health system? Do they make for happier EHR users? E-mail me.

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Contacts

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

Company name: Aventura
Address: 1001 17th St. Suite SL-100, Denver, CO 80004
Web address: www.aventurahq.com
Telephone: 888.484.4643
Year founded: 2008
FTEs: 25

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Elevator pitch

Aventura overcomes technical hurdles that exist at the intersection of where your caregivers use your computer systems to deliver the computing experience that doctors and nurses demand. 
 
Business and product summary

Aventura is in the business of making caregivers happy and IT look like heroes. Aventura’s revolutionary new platform fundamentally improves the usability of computing systems for doctors and nurses, leading to increased productivity. Aventura also centralizes and standardizes many aspects of the enterprise environment, saving IT significant time and headaches. Our software is licensed to hospitals through enterprise agreements, and our raving fans are the caregivers that use our solution every day.

The best way to understand Aventura is through a quick example of a user’s experience. A doctor or nurse logs on at a new terminal in a patient room using dual-factor authentication (smart cards, proximity cards or biometric). Based on who this person is, their new location, and any other pre-defined set of rules established by the hospital, Aventura begins updating this person’s existing desktop session (which has been securely locked from their last location) before displaying it.

For example, printing defaults are updated, some applications may be hidden, necessary ones pop up automatically, and some URLs (including already open ones) may be restricted or hidden. This updated desktop and all appropriate applications are then presented to this caregiver.

What is most important about this process is that it all happens in less than five seconds. Log-out is as instant as removing his card. Access is simple and secure. Usability for doctors and nurses is significantly increased because they are no longer wasting time logging in and accessing the right applications and data, and instead can focus on the job they signed up to do: provide incredible patient care.

Who is your target customer?

Today Aventura sells its services to small, medium, and large size hospitals. In the future, Aventura will be delivering its services also to physician practices.

What customer problem do you solve?

Aventura is a small company focused on solving one enormous healthcare IT problem. All the billions of dollars being spent on new IT systems and improving clinician productivity will never realize their full potential because of a “weak link” at the intersection of where doctors and nurses have to access these systems. Adoption of these new systems, including CPOE, suffers not because of the applications themselves, but because of the painful process and useless time wasted by doctors and nurses trying to access these new applications 50 to 70 times a day.

That is simply unacceptable for us, so we’re doing some pretty amazing things to fix it. Aventura has designed something totally new, an architectural framework that delivers what caregivers need in order to do their job from any location, securely, in less than five seconds every single time.

Aventura architecture (click to enlarge)

Who are your competitors?

Today, there are no other companies in the market providing the breadth and depth that Aventura delivers when it comes to delivering a dynamic computing environment. While there are a number of folks piecing together clinical desktop solutions using various virtualization and SSO solutions, these projects don’t overcome the technological barrier and the associated issues of roaming a static desktop session.

Why are you better than your competitors?

The idea for Aventura was born in a hospital. We understand that doctors and nurses want instant access to the right data and computing services from any computer at any time. However, in order to make this happen, we recognized that there are significant architectural limitations in today’s computing environments, and that the only way we were going to be able to address this problem is with an architectural solution.

Other companies have partial fixes; single sign-ons, roaming desktops, expensive one-offs, but they are all still based on a static operating system that was never designed to serve people who work on dozens of different computers in a single day.

Aventura’s new platform called Enterprise Operating Framework allows us to dynamically update clinicians’ computing sessions, and respond to their needs based on who and where they are. Access is intuitive and consistent and completely respects the way clinicians want to work. Further, Aventura is designed to provide this improved caregiver experience using whatever computing infrastructure a hospital currently has in place.

In other words, we can deliver our dynamic computing experience using any virtual desktop technology, or what is even more cool, leveraging only the existing PCs that most hospitals have in place.

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Pitch video

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Customer interview (infrastructure and customer support manager for a two-hospital, 300-bed system)

What problems have you solved using the Aventura technology and what has been the overall impact on the hospital?

Aventura has allowed us to extend the refresh cycle of the hardware inventory and still take advantage of new software technology that requires greater processing power and memory.  The smart card solution improved the security and authentication process, which helped meet HIPAA requirements.  The ease of use and ability to move the user’s desktop from workstation to workstation has greatly improved the clinician’s workflow.

If you were talking to a peer from another hospital, what would you say about your experience with Aventura? 

We have had a very positive experience with Aventura.  Their staff has been responsive to requests for enhancements and is readily available to provide technical support when needed.

How would you complete this sentence in summarizing for them: "I would recommend that you take a look at Aventura under these circumstances:”

If you would like to reduce the cost of your hardware refresh and provide a secure, standardized desktop solution for your end user.

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An interview with Howard Diamond, CEO of Aventura

Hospitals seem pretty happy with single sign-on and technologies like Citrix that allow wireless users to stay connected even though their connection may drop temporarily as they move around. Why do they need your product?

I probably don’t accept your basic premise. Most of the customers that we have and most of the pilots we’ve got going are people that are probably already using an SSO and are already using virtualization like Citrix or VMware or Terminal Services. They still have significant problems in terms of caregivers getting access to the different systems and applications they use. 

The average nurse logs in 50 to 70 times a day. Even with an SSO, the amount of administrative burden on them is pretty dramatic.

This would be a fairly key piece of infrastructure if your technology sits between the clinicians and their systems. How do you convince hospitals to trust that aspect to a relatively small company?

That’s a challenge, without question. The approach we take from a sales perspective is we have three phases of implementation.

Our first phase is what we call a lab pilot. If somebody is seriously interested in our technology, for $15,000, we come and show them how it would work in their specific environment to connect it to their specific infrastructure. They get to play with it for three to four weeks in a lab environment.

Once they’ve done that, they opt to go into what we call a production pilot. They try the technology in a real unit of the hospital with real caregivers interacting with real patients.

Based on those two experiences, they then make the decision to buy the software. We set up a pretty sophisticated try-and-buy in their environment.

Sounds like that’s good for the customer, but difficult for the company since hospitals have a long buying cycle anyway. Is it difficult to plan your business around a long-term pilot?

There are two different pieces to it. First of all, we charge $15,000 for the lab pilot. We charge $40,000 for the production pilot. We’re not doing it for free.

We have a hospital doing their production pilot right now. One week into the production pilot, they called us up and said, “All right, we’re convinced. We want to buy the software now.” Even though the theory is that it can lengthen the sales cycle, what is actually does is truncate it, because once they get the technology in front of the caregivers, the caregivers who are not using the technology see the caregivers who are and say, “Wait a minute, you’ve got to be kidding me. We’re not going to wait three months to get access to that. We want access to it now.”

Who is it that makes that decision and what objectives do they have when they come to you or you come to them?

Our point of entry is usually a CMIO if they exist. A lot of time we work directly with IT, but our focus is to get caregivers directly involved pretty quickly because the core of the technology really dramatically addresses things from the caregiver’s perspective. So where there isn’t a CMIO, we work with both CMOs and their like and influential doctors. We definitely get the caregivers involved very early in the process.

Has anybody done studies of the benefits?

Yes, pretty dramatic. Caldwell, which is actually just finishing up their lab pilot and moving to a production pilot, has actually already done a research study where they claim that their analysis showed that doctors would save over 40 minutes per shift and nurses would save over 80 minutes per shift using our technology.

What’s your method of pricing the solution and how do customers justify its cost?

The approach is it like a SaaS charge. Our base price is $15  per user per month. 

The ROI actually is pretty easy to do. We show dramatic productivity gains on the caregiver’s side. Because of the fact that we do things like manage printing and provide them with a significant amount of self-help from a printing perspective, we actually show some pretty quick specific gains for IT, particularly in terms of reduction of calls to help desks.

I saw your Web site mentions the roving printer concept. I guess that’s a weakness in a lot of clinical systems. Is that a big draw for customers?

Yes. I’ll be honest with you — when my staff first built it into the product, I thought it was pretty boring. It was not an area that I had particular interest in. It’s turned out to be a dramatically important thing.

It turns out that pretty much every back-end system out there, particularly the EMRs, are horrible when it comes to managing the printing. The fact that we fixed that has actually become an enormous positive for us, even though as CEO, I was too stupid to understand that for a while.

You mentioned a couple of customers on your site, Denver Health and Alegent. Where are they in their implementation and how many clinicians do they have using the devices?

Thousands. Denver Health has been using the technology for a few years and they use it everywhere. The same thing is true of Alegent at their 10 hospitals. If you talk to Mike Westcott, who’s the CMIO at Alegent, he’s actually an embarrassingly great evangelist for us. Greg Veltri, who’s the CIO at Denver Health, is as well. In both cases, they’ve got literally thousands of caregivers using our technology every day.

I was curious why you sell only to healthcare. It seems like that the solution that you have would be of interest to other industries. Is healthcare just the entry point, or is there something unique about healthcare that makes this more attractive than it would be elsewhere?

You’re pretty on top of it. I’m impressed. The reality is that we work with a lot of virtualization partners. The very first thing they ask us whenever they get to know the technology is why we’re not bringing it into other industries.

This technology was born in a hospital, it was developed in a hospital, and the founder started it there. I came and took over the company a little over a year ago. We will go more horizontal in the next year and a half, but I believe that small companies fail a lot because of lack of focus. 

Since the heart of the company is in healthcare, we’ll establish our beachhead in healthcare pretty strongly before we move horizontally. But there are a number of other industries that are appropriate for it, and a lot of the virtualization partners we work with want to bring it into places like manufacturing and legal right away.

What do you hope to gain from this exposure?

When we get in front of caregivers, they are blown away by the technology. It literally is something that every time we do a bake-off comparing our technology with anything else out there. Caregivers give it a dramatic grade. 

The exposure is just a really important thing. It’s a very small company. We’re just starting out. The technology has just been released in its new form as we talked about some of the stuff we submitted to you. Getting exposure is just great for us.

Top News

McKesson completes its $38 million acquisition of provider management tools vendor Portico Systems, announced last month.

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Reader Comments

From The PACS Designer: “Re: LogMeIn Central.  LogMeIn has announced a new cloud based service called LogMeIn Central for IT administrators to monitor network uses by iPad and iPhone users.  As the expansion of iPad usage increases in institutions, it appears to be a solution that could ease the management and demand for information access by users.”

From Epic Guy: “Re: Johns Hopkins. Announced today at Epic that they are our latest enterprise customer. Probably not a big surprise to most readers of this blog.”

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HIStalk Announcements and Requests

Listening: reader-recommended Joe Bonamassa, an amazing blues/rock guitar virtuoso. Here’s live video of his cover of Yes’s Heart of the Sunrise and Starship Trooper. Pretty old school for a guy who’s only 34.

The folks at CapSite hooked me up with access to their database of actual RFPs, proposals, and hospital contracts after I wrote a little about it a few weeks back. I pulled up a few vendor products and was instantly looking at individual facility price breakout worksheets and actual PDF contract scans (I love terms and conditions, so I was engrossed, although I felt kind of dirty reading some other hospital’s contract even though the facility name was redacted). They’re offering a free 30-day trial of CapSite Lite to providers. I’m not pitching it, just saying that if you would benefit from seeing the kind of deals other hospitals are getting or interested in market reports, you could give it a look for free.

Prognosis Health Information Systems is supporting HIStalk as a Platinum Sponsor, which I appreciate. The Houston-based company offers the Web-native, standards-based, HIE-ready ChartAccess EHR for rural and community hospitals, one of the first to be certified by CCHIT way back in 2007 and again among the first with ONC-ATCB Stage 1. Its affordable, modular solutions include CPOE, clinical decision support, eMAR, pharmacy, clinical documentation, ED, lab, radiology, ADT, document management, patient scheduling, patient accounting, and even an ambulatory EHR, all running on client-free SQL Server with a choice of local or remote hosting. Its value prop involves minimal hardware cost, centralized maintenance and upgrades, automated backups, and shortened time to go-live (Ness County Hospital in Kansas was live four months after choosing ChartAccess.) They’ll even finance its purchase. Thanks to Prognosis for supporting the work we do.

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Acquisitions, Funding, Business, and Stock

GE Healthcare has begun the previously announced relocation of the global headquarters of its diagnostic imaging business from Waukesha, WI to Beijing, China.

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Sales

Memorial Sloan-Kettering Cancer Center chooses iSirona for medical device integration with Epic outpatient and Allscripts Sunrise inpatient.

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People

Martin Tursky, one-time CIO at Aultman Hospital (OH), is named president and CEO of Memorial Hospital of Rhode Island.

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Announcements and Implementations

Wentworth-Douglass Hospital (NH) goes live on Soarian’s CPOE this month and on Soarian Financials in October.

Southern Coos Hospital (OR) goes live this week on McKesson’s Paragon EHR.

CodeRyte announces an NLP-based Health System Coding that extracts information from supporting documentation to support accurate HIM coding.

Concerro releases a new video pitching its Internet-based ShiftSelect employee scheduling and shift management system. The male actor is a Bill Shatner-type scenery-chewing bad actor (maybe intentionally so — check out his hammy foot-stomping emphasis at 1:00), but his female counterpart is good.

Italy-based pharmacy technology vendor Health Robotics takes on a Spanish partner to help with US marketing after a legal squabble with former distribution partner McKesson. In a no-holds-barred announcement in March (written by too-perfectly named marketing coordinator Claudia Flaim), Health Robotics accused McKesson of having a “David/Goliath syndrome” in taking a “bullying strategy” after being “unwilling to cope with competition” and then making up “a non-existent excuse for its own failures.” I don’t know who’s right or wrong, but give the scrappy upstart points for coming out swinging, although heavy legal expenses so early in a product’s rollout can’t be good for business, especially when you’re a new Italian company trying to get a US foothold.

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Government and Politics

The VA will allow iPhones and iPads on its hospital networks starting in October, with initial access provided to e-mail and VistA. It’s even considering allowing employees to choose one of those devices instead of a laptop. CIO Roger Baker says his IT department will soon roll out approved access to cloud computing applications, which got some VA users in trouble last year who were found to be keeping patient information in Google Docs.

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Other

Four hundred Kaiser Permanente IT employees collectively lose 1,500 pounds in its CIO Challenge, including computer specialist Frederick Curiel.

Thumbs up to Apple. Over the weekend, my iPhone slipped out of pocket and hit the pavement, cracking the screen. I scheduled an appointment at my local Apple store with one of the Geniuses, even though I didn’t have much hope they could do anything beyond selling me a new iPhone 4.  After I flashed the designated Genius my best Inga smile and showed him the sad state of my phone, he explained that cracked screens were not covered by warranty. However, he said he would go ahead and switch out my old phone for a new one at no charge. Perfect customer service and the right thing to do, especially given Apple’s  release of the Phone 5 in just a few weeks.

Uh oh. Apparently Google is deleting the Google+ accounts of users not using their real names. Lame. If Inga HIStalk stops following you, go ahead and blame Google.

Nurses at a New Zealand hospital complain that “dumb” staff scheduling software from HealthRoster is to blame for nurse fatigue, saying it creates schedules with long runs of consecutive work days and rotating shifts that allow as little as seven hours between them.

The Chicago Tribune profiles some health-related Web startups that include HealthTap (personalized health information from a panel of experts), Simplee (healthcare expense tracking), ZocDoc (book provider appointments online), and Practice Fusion (free EMR). That’s a lot of Rounded Arial fonts and blue color schemes.

Weird News Andy can’t decide whether it’s the instrument or the “doctor” that’s not the sharpest knife in the drawer. Police find a 63-year-old man lying naked outside his house with a knife handle sticking out of his stomach, which he then removes and replaces with a lit cigarette. He had noticed a protruding hernia and decided to remove it with a butter knife. A surgeon contributed advice that is most likely unneeded by anyone other than this individual: “It is absolutely impossible for someone to fix their own hernia.”

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Sponsor Updates

• Ampla Health chooses MED3OOO’s InteGreat EHR for its eleven FQHC and community health centers.
• CAP/SNOMED Terminology Solutions is selecting beta sites to participate in full Lab Interoperability Cooperative pilot.
• Gateway EDI is offering resources for HIPAA 5010 conversion preparation.
• NextGen offers an August 3 webinar on clinical data sharing, with the CMIO of Colorado Associated CHIE and the CMO of Avista Adventist Hospital presenting.
• Wellsoft welcomes new clients AnMed Health (SC), Capital Health (NJ), Southwest Mississippi Regional Medical Center (MS), Pikeville Medical Center (KY), and Thomas Jefferson University Hospitals Methodist Hospital (PA).
• RJ Infusion Services (KS) selects Perceptive Software’s ImageNow to give instant access to patient records from anywhere.
• Baptist Memorial Health Care (TN) selects RelayHealth for a 14-hospital HIE.
• Children’s Memorial Hospital (IL) selects Merge Healthcare’s iConnect to give radiologists and treating providers immediate on-site and remote access to images.
• New York eHealth Collaborative selects e-MDs as a Meaningful Use Partner.
• East Orange General Hospital (NJ) goes live with GE Centricity Enterprise.
• Practice Fusion names the Top Five Worst Electronic Medical Record Myths.
• Tampa General Hospital (FL) selects CareTech Solutions’ Service Desk to augment its existing help desk, focusing on physician support.
• University of North Carolina Hospitals, University of Washington Medical Center, University of Kansas Hospital, and University of Kentucky Hospital go live with Physician Insight Plus from Carefx, which provides dashboards that tracking, analyzing, and comparing performance on clinical and operational outcomes, safety, and utilization.

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Contacts

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