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September 22, 2011 News 10 Comments

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9-22-2011 8-54-10 PM

mrh_small The British government says it will “urgently dismantle” the failed $18 billion NPfIT project in favor of locally controlled initiatives after a series of gloomy reports from government auditors, with the final report released Thursday concluding, “There can be no confidence that the programme has delivered or can be delivered as originally conceived.” NHS will keep only the parts that work (e-mail, the appointment system, PACS, and the communications infrastructure). They also admit that the cost of getting out of various big-dollar contracts will probably exceed the cost of just paying out the rest of the money specified in the vendor contracts. The co-director of a patient advocacy group summarizes, “Thank goodness politicians have decided to stop money being poured into a huge bottomless pit. Now we must pray that they don’t sanction pouring it into endless incompatible regional pits.”


Reader Comments

9-22-2011 6-58-43 PM

mrh_small From Steve Stifler: “Re: Epic UGM. Judy’s dreams of world domination are beginning to seem credible. Carl Dvorak was very clear that he doesn’t want videos of the meeting showing up in HIStalk and nobody wants Judy mad at them.” That’s Judy in costume above. Several readers sent over photos and links to unlisted YouTube videos from the meeting. I’ll be nice to Carl and Judy and not run them here, especially since they wouldn’t be all that interesting to anyone without an Epic connection anyway.

9-22-2011 7-48-30 PM

mrh_small From Graying CIO: “Re: Epic UGM. This image says more to me than any other about the power and scope of Epic. Buses for the user group meeting attendees snake into the distance next to a two-acre hole in the ground that will be a future 10,000+ seat auditorium, replacing the 6,000-seat one that is too small. Others were struck by the image as well – I saw at least five people whip out their phones and take the same picture. The interesting thing about the executive overview (two hours of insight opened by Judy Faulkner and closed by Carl Dvorak about Epic, the healthcare IT environment, and Epic product development) is that it was positive and Epic is clearly on a growth tear, but that ICD-10 and Meaningful Use have drawn all of the focus and attention for the past few years and will continue to do so. Epic is responding well, but Carl was very clear that these topics have interfered with innovation both within Epic and by its customers.”

9-22-2011 8-56-39 PM

mrh_small From CommunityHIZ: “Re: HP firing its CEO. I think this whole HP thing is a ruse orchestrated by Hammergren. This is kind of like Alabama thanking God for Mississippi every night before bed. With HP in shambles, nobody will focus their attention on Hammergren’s self-created mess at McKesson. (For those who don’t know, Hammergren serves on HP’s board).” More below, including my slightly critical evaluation of HP’s board (“the most inept board in America”) when they hired the guy not even a year ago.

9-22-2011 7-24-30 PM

mrh_small From NoNeedHere: “Re: Accretive Health lawsuit. Juicy details in the legal documents.” A summary from the proceedings: revenue cycle management vendor Accretive Health hired an SVP over revenue cycle operations at four hospitals even though he had basically zero revenue cycle experience. He was fired and sued the company claiming sexually and racially discriminatory conduct by a mid-level supervisor, while the company said his work was substandard and hospitals were complaining about him. The district court found for the company and the US Court of Appeals affirmed the judgment in favor of Accretive on Wednesday. I’m blurring the names, although they’re in the public record if you really care.

mrh_small From Larry Leisure: “Re: Sage. Unloads healthcare division. What a mess over there. I’m running for athena as fast as I can.” Thanks to Larry for e-mailing me about the announcement this morning just a couple of minutes after it came out. He probably knows that I like scooping everybody, which I believe I did in getting out a quick news blast since I happened to be at my desk at the hospital at the time. I actually think the news is good for the healthcare group. Let’s be honest, Misys and Sage shared more than their British heritage, financial software focus, and US EMR company ownership – they were never really all that interested in the US healthcare market other than for its potential to boost their predictable but unsexy profits. You’ve got to be kidding me that Sage’s CEO is blaming HITECH and healthcare reform for messing up its PM/EMR cash cow, especially when the unit booked a not-too-shabby 13.5% profit margin in the latest financial report (maybe the healthcare management team could do OK if it weren’t for the transoceanic shackles.) I can only interpret his statement to mean that once customers got a taxpayer-funded incentive to increase their EMR investment, they took the opportunity to look elsewhere. If I were a Sage Healthcare employee or customer, I’d be clinking the champagne flutes that the Brits are turning tail and letting the historically successful Vista Equity Partners take over the franchise, even though it’s likely they’ll be doing some painful but necessary cost-cutting (you can do the math: they’re paying about 1.4 times revenue or 10x annual profit, so a margin boost is needed to justify the price.) Your thoughts (anonymous if you like) are welcome since I’m just a cheap-seater here. What’s good about this deal, what’s bad, and what should Vista do?

mrh_small From THB: “Re: McKesson vs. Epic. Are we back in court again for this? The issues the parties were asked to brief are: If separate entities each perform separate steps of a method claim, under what circumstances, if any, would either entity or any third party be liable for inducing infringement or for contributory infringement? See Fromson v. Advance Offset Plate, Inc., 720 F.2d 1565 (Fed. Cir. 1983).” This is the case in which McKesson sued Epic for infringing on its patent involving Web-based doctor-patient communication, such as for appointment and refill requests. The district court tossed that case out in April 2011, saying that McKesson couldn’t prove that Epic or any other single party performed all the steps in the claimed infringement by Epic’s MyChart.


HIStalk Announcements and Requests

9-22-2011 9-24-41 AM

inga_small The latest good stuff from HIStalk Practice: athenahealth and meridianEMR update their Meaningful Use dashboards. Mitochon Systems blasts fellow free EHR vendor Practice Fusion for its “over-reaching claims.” A whopping 90% of physicians say they use at least one social media site for personal use. Julie McGovern shares insights on software upgrades, compassion, and expectations.  Speaking of expectations, I expect you to sign up for HIStalk Practice e-mail updates when you take a peek at these stories. And thanks for reading.

mrh_small Inga’s away schmoozing around at some conference, so the little red squares will be in scarce supply today. She will be back by the time you read this.

mrh_small Listening: Opeth, genre-bending progressive metal from Sweden. Not for everybody, but I like it.

mrh_small We like readers signing up for our e-mail blasts, connecting with us on Facebook and LinkedIn, sending us rumors, and supporting our sponsors. Since you are smart, we will trust you to take that subtle hint.

mrh_small On Healthcare IT Jobs: Epic Applications Systems Analyst – Ambulatory, Data Warehouse Architect, Business Intelligence Developer, Epic Beacon Consultant.

9-22-2011 6-18-16 PM

mrh_small Welcome to new HIStalk Platinum Sponsor MedAssets of Alpharetta, GA. The company provides solutions for revenue cycle (patient access, charging coding, UM, billing, A/R management, etc.); supply chain management (contracting, sourcing, inventory management, distribution, A/P); resource management (decision support, performance analytics, process improvement, workforce solutions), and consulting services. Their elevator pitch is easy to understand – they will sustainably improve provider operating margins by 1.5% to 5%. Case studies on their site include Fletcher Allen Healthcare ($12 million in benefit from contract management improvements and  data-supported contract renegotiations), Cooper University Hospital (reduced A/R days from 60 to 37 and added $43 million to the bottom line), and Westchester Medical Center (identified $8.9 million in supply chain savings by using analytics to examine costs right down to the individual screws used in orthopedics). Note and appreciate their non-animated ad. Thanks to MedAssets for supporting the constantly clacking keyboards of HIStalk.


Acquisitions, Funding, Business, and Stock

mrh_small The bumbling HP board fires its equally bumbling CEO Leo Apotheker after 11 ugly months on the job, hiring former eBay CEO Meg Whitman to replace him. Apotheker, the third fired HP CEO in six years, gets a $25 million parting gift to go away. SAP canned him after only seven months before HP inexplicably brought him in on a golden throne, so he raked in dozens or maybe hundreds of millions in his total two-company CEO tenure total of 18 months. I said this when HP hired him in October 2010:

Speaking of SAP, HP and “The Most Inept Board in America” choose the former CEO of SAP to be HP’s next CEO. SAP fired the Germany-born Leo Apotheker after a disastrous seven months as CEO, although some say he was the scapegoat for a terrible company strategy that predated him. HP is paying him like he’s a star: $1.2 million in salary, incentives of 200-500% of that with $2.4 million guaranteed, $72 million in options, a $4 million signing bonus, and $4.6 million in moving expenses (that’s a lot of U-Hauls). I’ll go with the summary of Oracle CEO Larry Ellison: “I’m speechless. HP had several good internal candidates … but instead they pick a guy who was recently fired because he did such a bad job of running SAP.” Their pre-Hurd CEO pick was an ultra-expensive termination, too: HP’s value dropped in half after Carly Fiorina orchestrated the company’s merger with Compaq. She was let go in an ugly fight about the time the company admitted that it spied on the personal phone records of journalists and its own board members trying to find out who was leaking information about its strategy.


Sales

9-22-2011 2-53-57 PM

Ellenville Regional Hospital (NY) selects Craneware’s Chargemaster Toolkit-CAH solution to atuomate its charge master management process.

9-22-2011 2-52-00 PM

The University of Texas MD Anderson Cancer Center chooses MedQuist’s Speech Understanding and Natural Language Understanding platform from M*Modal for its ClinicStation EMR and RadStation radiology systems.

Swedish Medical Center (WA) signs for Microsoft Amalga for coordinating care and managing populations.


Announcements and Implementations

9-22-2011 2-03-53 PM

Biggs-Gridley Memorial Hospital (CA) will go live on the Prognosis ChartAccess EHR in January.

The Gorge Health Connect (OR) HIE creates a video that shows how it’s using the government’s Direct Project (via Medicity) to connect providers in a pilot project.

Vodafone signs a deal with NantWorks to develop mobile healthcare services. That’s the new name for the technology companies owned by Patrick Soon-Shiong, the physician and drug company founder whose $7 billion net worth earns him the #39 spot on the Forbes list of richest Americans.


Innovation and Research

A study published in Health Affairs finds that the Meaningful Use Stage 1 hospital CPOE threshold of 30% of orders probably won’t have much impact on heart-related Medicare deaths, but the proposed 60% Stage 2 threshold should be enough to move the outcomes needle.

David Bates will lead a team of researchers from Brigham and Women’s Hospital in using supercomputer-powered analysis of the hospital’s EMR data to look for complex correlations among patient characteristics, genetics, drug interactions, and outcomes of heart failure patients. They hope to create computer models that can help choose effective heart failure interventions.


Other

9-22-2011 2-16-51 PM

Beacon Partners’ ACO Readiness Study finds that only 15% of healthcare organization respondents are “very familiar” with ACOs and 61% say they are “somewhat familiar.”

9-22-2011 2-23-23 PM

Speaking of ACOs, providers view Cerner and Epic as the vendors that are most ACO ready. 

St. Rose Hospital (CA) is cutting 10% of its workforce due to problems that include “complications involving a new McKesson computer system that went live in late June, the recession’s impact on the hospital’s fragile bottom line, and managed care contracting snafus, including a two-week period in July when ‘we were not able to get bills out,’ [CEO] Mahoney said.”

mrh_small Former National Coordinator David Blumenthal, now back at Harvard, talks up EMRs at a Boston event. He talked about his own long-ago personal experience with EMRs, although I’m never clear what kind of practice he had or whose EMR he used. Some of the docs in audience apparently made negative comments about time required to use the EMR. One said, “The computer is really like that third person in the room, and a 2-year-old at that. It’s hard to manage” Blumenthal urged patience, saying, “The current crop of products is not the crop we will have in five years. However, we will be just as unhappy with the crop we have in five years because our imaginations will soar ahead of reality.”

University Medical Center (NV) lost $70 million last year, but the CEO says he thinks next year’s move to electronic medical records will save money in the form of reduced labor costs and errors.


Sponsor Updates

  • Indiana University Health Bloomington and Paoli Hospital go live on McKesson’s Horizon Patient Folder electronic document management system.
  • Greenway Medical Technologies announces that its PrimeSuite EHR client, Alpine Urology, is the first practice to connect to CORHIO’s HIE. 
  • The Pittsburgh Technology Council awards TeleTracking Technologies its Tech Titan MVP award.
  • TeleTracking’s user conference will be held next month in San Diego.
  • MEDSEEK announces GA release of Quick Response Codes to facilitate the patient marketing programs of hospitals. 
  • Anesthesia Business Consultants and iMDSoft announce their partnership to offer a complete AIMS and anesthesia billing solution.
  • Joan Coner of maxIT Healthcare is recognized in Strathmore’s Who’s Who Worldwide Edition for her 20+ years of contributions and achievements in healthcare consulting.
  • Orion Health announces receipt of ONC-ATCB 2011/2012 certification of its Clinical Portal V7.0.
  • Covisint releases a new whitepaper entitled Performance-Based Care for Accountable Care Organizations.
  • MediServe clarifies newly announced changes to Medicare Part C Advantage plans.
  • GE Healthcare will introduce an HIE in Australia. 
  • The Rothman Institute  (PA/NJ) selects the SRS EHR for its 100-provider, 14-location practice.
  • Michigan Health Information Network Shared Services engages OptumInsight for its HIE platform.
  • Central Penn Business Journal names MEDecision to its list of 100 Best Places to Work for the third straight year.
  • MD-IT announces the addition of Quality Transcription Services to its Medical Transcription Service Organization Associate program.

EPtalk by Dr. Jayne

Lots of folks are talking about the recent Department of Health and Human Services plan that would allow patients direct access to their laboratory test results. The proposed rule involves three HHS agencies: CMS, CDC, and the Office for Civil Rights.

Changes to the Clinical Laboratory Improvement Amendments (CLIA) are required to allow this. Patients would be able to receive copies of their lab reports on request. When faced with patients receiving lab results directly (as opposed to receiving them from their physician or another health professional), many physicians react negatively.

The consumerization of healthcare has had profound impacts on how care is delivered. Patients are better able to participate as a member of the healthcare team, which is good. However, the potential impacts of releasing lab (or any other diagnostic testing) data directly to patients should not be overlooked.

These are not uncharted waters. Many health systems already release data directly to patients, often after a delay of a day or two to allow the ordering physician to review the results and contact the patient. Others release results only after the ordering provider has signed off, again presumably to allow a conversation with the patient where needed.

Physicians worry that direct release of lab data to patients (particularly without annotation) will generate a flurry of phone calls. Before I used an EHR, I would mail each patient a copy of their lab results with my notes / comments / care plan written directly on the results. It was efficient and made for clear documentation in the chart. The occasional “abnormal” result of no significant consequence was simply marked “OK,” and 99% of patients did well with this approach. Of course, there was always the occasional patient who would call wondering if their low chloride level (one point below cutoff) was a health concern, despite the “OK.”

Radiology reports are a little trickier. Narrative reports are sometimes less clear and informative, particularly if you deal with (as I have lately) a radiology group that refuses to definitively address what they see and instead dictates a jumble of “might be” and “can’t rule out,” punctuated by the always-present “clinical correlation needed.”

My health system releases both lab and radiology reports to the patient through a secure portal, but only after a time delay. Depending on the nature of the test, the delay is shorter or longer. For example, blood tests such as cholesterol levels are released after a day or two, but CT and MRI scans are held for seven days. This gives us time to contact patients about their situation before they see the results.

Since we’ve been doing this, I’ve had several patients who had significant concerns about what they’ve seen on their reports. Many patients, even after they’ve heard from the team about their results or changes to the care plan, head straight to Google to find out what all those big words mean. What they see sometimes leads to panic and fear.

When patients in this situation call, my recommendation is to add them on to the schedule same-day or as soon as possible. Unfortunately, talking about it on the phone lacks the face-to-face reassurance that patients often need. If they come in, I can pull up the films and we can review them together along with any Internet articles they’ve been reading. The visit is reimbursable and provides an additional opportunity for health counseling or disease management education.

It will be interesting to see how lab vendors decide to handle this. Most will probably go with online patient portals, I’d guess. Depending on how often your insurance carrier or provider changes lab vendors, this could lead to multiple places where patients have to access their data over time, assuming they decide to provide the information in an ongoing fashion vs. a one-time release.

Do you work for a laboratory provider? How is your organization planning to address this? E-mail me.

Jayne125 


Contacts

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

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Currently there are "10 comments" on this Article:

  1. I’m a little surprised anyone aside from a few thoughful well-connected hospital execs and the insurance companies really think they understand what an ACO really is or how it’s supposed to work. I don’t think any EMR manufacturer even has a clue how to be ready for an ACO, except maybe United aka Optum and McKesson. That KLAS report isn’t much more than hopes and dreams for providers who think their current EMR will get them anywhere in the ACO world. There’s no EMR on the market anywhere close to being ACO ready. The leaders like Kaiser and Mayo have already figured that out.

  2. Anyone puzzled by Epic’s dazzling market share capture would do well to read “Inside the Tornado,” by Geoffrey Moore. The short version is that a pragmatic herd-like market like hosptial IT will resist change until the risk of resistance outweighs the risk of changing, at which time there is a sudden and dramatic swing for the perceived market leader, defined by whichever company is perceived to offer the whole product with the least risk.

    It has nothing to do with the actual product which is, in my opinion, kinda lame.

  3. From the Guardian Newspaper of the UK: “The problem is, it didn’t deliver”, said a Department of Health source.

    “It was too ambitious, the technology kept changing, and loads and loads of money has been put into it. It’s wasted a lot of money that should have been spent on nurses and improving patient care, and not on big international IT companies.”

    Let the truth be known. Patients suffer while the HIT vendors and their executives profit.

  4. The demise of Sage was predictible.

    The original intent of the prurchase was to sell accounting software into the customer base (just like MISYS said when they bought Medic), couple that with a slew of old legacy products that they should have “sunsetted” the first day(gee, just like MISYS should have done when they bought Medic)…it was a failed strategy from the start. Even if they had an EMR produrct that was well thought out and easy to use (which neither Sage nor MISYS had), it was doomed to fail. All the other factors ( lack of understanding of US healthcare, revolving door for Senior management, lack of innovation, etc.) contributed, but the original overpriced purchase based upon lack of research was the cause. Good people in the trenches gave it their all, they are unfortunately the ones that have born(and will bear) the burden of this flawed thinking.

  5. >>> A study published in Health Affairs finds that the Meaningful Use Stage 1 hospital CPOE threshold of 30% of orders probably won’t have much impact on heart-related Medicare deaths, but the proposed 60% Stage 2 threshold should be enough to move the outcomes needle.

    This paper is NOT a study, but rather a retrospective analysis trying to make sense of prior reports on CPOE which comes to an unsupported conclusion.

    Their claim was based on one actual study:

    “that the introduction of a computerized provider
    order entry system was associated with a 20 percent
    reduction in mortality at an academic children’s
    hospital.15”

    Yet they mention (and ignore) 2 other studies:

    “Mark Del Beccaro and coauthors reported no significant
    change in mortality after computerized provider order
    entry implementation,13 and a study by Adam Keene and
    colleagues resulted in similar inconclusive findings.14”

    NONE OF THESE STUDIES have been run in an unbiased, prospective, 2 arm manner (scientific method) which is the only way to actually make such a claim that stage 2 CPOE will make any sort of difference. It may actually increase errors and face so much resistance from physicians who will lose more precious time to bureaucratic popup notifications that it cause the quality of care to falter.

    This type of unsupported bluster statement by Health Affairs will not help the cause of the uptake of EHR. Shame on them- they should do better with their editorials. Physicians are not that stupid.

  6. Ben – It is not surprising at all really that a strategic competitor didn’t purchase Sage. Their principal EMR offering (Intergy) is based on an old technology stack, its expensive especially when you add up all of the components compared to eCW, and they have several product limitations (e.g, don’t really have a competitive SaaS/hosted solution and their mobile functionality is limited).

    The strategy of buying a large legacy practice management software base and selling into it has been debunked as a failure too. Failed with McKesson. Ditto Sage. Allscripts had more somewhat more favorable results but that was because they were much more aggressive employing several tactics to get the legacy Misys customers into the fold.

    Legacy ambulatory EMR herd is going to start to get culled a bit and this is only the beginning over the next few years. Too bad a lot of doctors and organizations are going to get left holding the bag.

  7. hmmm world domination..where have we seen that before Japanese, German and Italian Facism, Soviet Communism, Amway… The annual pilgrimage by the true believers to Verona Wisconsin in order to bask in a cult of personality of Epic proportions.







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