News 9/13/11

Top News

President Obama declares this week to be National Health Information Technology Week.

Reader Comments

From MT Hammer: “Re: All Type acquisition. As you reported earlier, MedQuist makes it official.” Sort of, anyway – the financial advisor  to All Type Medical Transcription Services issues a press release about its role in the transaction. Reported here on August 25 by Hammer, who didn’t hurt ‘em.

From Proud athenista: “Re: athenahealth’s MU dashboards. The other day I was surprised to learn my very own company was going public with our MU transparency and just read the great interview with Jonathan Bush. Whodda thunk it would ever happen? I suggest that all vendors share their numbers.” PA is referring to last week’s HIStalk Practice  interview with athenahealth CEO Jonathan Bush, who discussed the company’s decision to publish the performance of its athenaclinical clients against Meaningful Use metrics. We are happy to share similar information from other vendors, though I can only think of a couple of others that are offering those details.

From Funky Bunch: “Re: Medicare attestation numbers. Here is some information from CMS that you may have seen.” CMS says $149 million has been paid as of July 31, but it doesn’t give a provider count or breakout of hospitals vs. eligible professionals. Medicaid incentive payments total $248 million and registrants for both programs total 77,549. Hospitals would get pretty big checks for their Medicare attestation, so that number might represent a fairly low number of EPs. On a related page, CMS answers the question of whether audits will be performed: maybe, so keep your documentation for at least six years, it says, else the payment “will be recouped.”

From Just Askin’: “Re: Innovator Showcase. Is that paid promotion?” I’m kind of insulted that you would ask that, but no. Interested companies applied and my volunteer review team (investment guys and a hospital person) choose a handful from the several dozen that they felt were truly innovative based on some rather probing application questions. One of those companies happened to be a current HIStalk sponsor by coincidence and all of them earned their spot strictly on merit.

From Farmer Joe: “Re: Meaningful Use incentives. You seem to make a lot of implied negative statements about spending taxpayer dollars on these. Farm belt clinics are faced with closing due to low patient volume and MDs looking to retire, but with no residents who want to join them due to low pay and practices still on paper. These rural communities provide 80% of the food in this country. Every American who eats anything they don’t grow or hunt themselves should be glad to pay money to keep these practices in business to keep young farmers from quitting and moving to cities.” Sounds like a bit of a stretch that farmers will stop farming if the rest of us don’t buy EMRs for their doctors. If we have to subsidize money-losing medical practices, then I’d rather do it directly instead of paying them to adopt a particular technology that isn’t guaranteed to improve either their medical capabilities or their profitability. And I’m nearly always going to be against new government spending like HITECH, stimulus, TARP, artificial jobs creation, or whatever other cause du jour has aroused our debt-happy and votes-desperate Congress. As someone once said, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”

Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: a net loss of $7,000 vs. a loss of $76,000 last year; revenue $4.1 million vs. $4.7 million.

Telehealth provider Teladoc secures $18.6 million in funding
.

EDI provider MD On-Line acquires healthcare communications company Strategic EDGE Communications.

Sales

Via Christi Health (KS) purchases QuadraMed’s Identity Management solutions.

Newberry County Memorial Hospital (SC) selects Summit Healthcare to provide interface engine technology for its Meditech system.

Wilmington Health (NC) chooses Humedica MinedShare as its clinical data warehouse.

People

HHS Secretary Kathleen Sebelius announces the appointment of Leon Rodriguez as director of the Office for Civil Rights, replacing Georgina Verdugo. He was chief of staff and deputy assistant attorney general in the Justice Department’s Civil Rights Division. He was nominated by the President last December to be Administrator of the Department of Labor’s Wage and Hour Division, but that nomination was withdrawn last week.

vRad names Sandy Schmitt SVP of Strategy and Development. She was previously with Allina and VHA.

 
AT&T names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She was previously with Vangent.

MediClick promotes President Mike Merwarth (above) to CEO, taking over for Ron Kupferman, who remains chairman of the board.

Hon S. Pak, MD joins AirStrip Technologies as a senior advisor. He was previously CMIO for the Army Surgeon General and is an innovator in telemedicine, particularly teledermatology, and is a graduate of the United States Military Academy and a former combat medic.

Announcements and Implementations

HIMSS names four additional winners of its 2011 Davies Awards of Excellence: Kaiser Permanente (Organizational / Epic); Fallon Clinic (Ambulatory / Epic); James F. Holsinger, MD (Ambulatory / e-MDs); and Hudson River Healthcare (Community Health Organization / eClinicalWorks).

McKesson introduces McKesson Practice Choice, a Meaningful Use certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Zynx Health will hire 40 new employees, including those with technical and sales experience.

Anvita Health is awarded a patent for a decision support system that can apply a variable medication patient co-pay, which it calls “dynamic, context-specific pricing.” Its intended use is to encourage optimal prescribing by charging the patient extra if he or she insists on getting prescriptions for drugs known to lack efficacy or safety. Co-pays can be reduced if a patient accepts a less-expensive cancer drug that matches responsiveness markers, or if patients are compliant with their prescribed meds.

A group of University of Alabama in Huntsville professors launches Decision Innovations, whose first product is a nurse staffing dashboard started as a 2008 pilot project with Catholic Health Initiatives. The company won the $100,000 Alabama Launchpad 2011 Business Plan competition and is setting up shop now.

Health benefits provider WellPoint signs a deal to develop commercial healthcare applications using IBM Watson technology. Few specifics were given, but the press release suggests that the applications could help physicians choose treatment options and direct patients to providers who have the best track record in treating their condition. WellPoint says it will start pilot projects early in 2012.

Government and Politics

HHS awards $8.5 million to 85 community health centers in Beacon Communities for the adoption of HIT.

HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied to received Meaningful Use incentive payments and 70% of primary care physicians in rural communities have signed agreements with RECs.

A proposed HHS rule would give patients direct access to their own lab test results.

Technology

Microsoft previews Windows 8 (that’s the working name, anyway). This SlashGear hands-on review shows it running on a tablet (assuming someone other than Apple is making them by the time Win 8 hits the streets). The big question for me: how well does a design that looks like it was borrowed from the iPad work on a desktop using a keyboard and mouse? Microsoft is betting the cash cow that consumers and businesses want their desktop and laptop PCs to have a radically different user interface.  

Software that creates natural-sounding news articles from a set of facts could write medical journal articles, the company that developed it says. They claim it can compose a unique, smooth-reading article in about one minute that even experts can’t tell wasn’t written by a human.

Other

The Canadian hospital that refused to name the nurse who breached the electronic records of 5,800 patients, citing her right to privacy, changes its mind after the province’s privacy officer declares there is no such law in a newspaper’s letter to the editor. The hospital now says it will give the nurse’s name, but only to patients who state by letter that she accessed their files.

An interesting article in the Charleston, WV newspaper covers Charleston Area Medical Center’s patient transfer center, an air traffic control-like room with a huge electronic status board showing bed status in its three hospitals.

I awoke this morning realizing I had been dreaming that a network technician was working to maximize the speed of my home network. I gloated when he told me how impressed he was with the labeling of all the devices, and I was school girl giddy when he complimented me on the strength of my passwords. We then discussed the merits of various printers. I am clearly overdue for a vacation.

A former pediatric nurse at NYU Langone Medical Center says hospital employees snooped in her medical records and, from her history and diagnosis of endometriosis, assumed she was a virgin. Her co-workers then kept trying to convince the 41-year-old woman to have sex, she says, with a neurosurgeon making references to “The 40-Year-Old Virgin” movie. She’s suing the hospital for $45 million, claiming it didn’t protect her medical records.

Wake Forest Baptist Medical Center (NC) fires and sues a former administrative director for “unjustified, vindictive, malicious, and gratuitous actions.” His transgression: he alerted the state that it was overpaying his employer under the terms of its health plan. The state auditor agrees, saying sloppy state contracting and oversight allowed the hospital to overbill by $1.34 million. The hospital says it was none of the former employee’s business and its contract allows it to raise prices without notifying the state.

The Wall Street Journal highlights the industry’s transition from ICD-9 to ICD-10 and mentions several of the wackier codes. One of my personal favorites: V91.07XA (burn due to water skis on fire.) athenahealth’s CTO Jeremy Delinsky correctly notes that, “You have millions of transactions flowing in the healthcare system and this is an opportunity to mess them all up.”

  Even Weird News Andy finds this cringe-worthy news item from China “too weird for words.” A man bathing with live eels as part of a spa’s exfoliation treatment is startled when he looks down at his private area and sees a six-inch-long eel disappearing by the obvious method of ingress. The eel found its way to his bladder on its own, but removing it required a three-hour surgical procedure.

Sponsor Updates

• Sandhills Pediatrics (SC) receives $184,000 in ARRA incentives from its use of SRS.
• MEDSEEK announces the availability of ecoSmart Patient Precision predictive analytics technology.
• Practice Fusion forecasts that 5,000 of its eligible provider clients will receive $18,000 in Meaningful Use incentives in 2011.
• Two T-System employees, CMIO Robert Hitchcock, MD and Center for Performance Excellence Manager Janie Schumaker, RN, are elected to the board of the Emergency Department Practice Management Association.
• Aspen Advisors releases a case study on the Epic implementation of St. Anthony’s Medical Center’s (MO). 
• BridgeHead Software announces the successful integration of its MediStore archive technology with  three leading PACS products.
• Ben Michelson of Hayes Management Consulting discusses lessons learned from ICD-9 implementations in a guest article.
• Wolters Kluwer Health releases a ProVation MD module to support participation in the ACC National Cardiovascular Data Registry CathPCI Registry.
• Thomson Reuters introduces MarketScan Treatment Pathways to analyze medical care, outcomes, and costs.
• TeleTracking Technologies announces the availability of its RTLS to the UK healthcare market.
• Cumberland Consulting Group provides a checklist of 10 things hospitals should consider as they undergo EHR implementation.
• MidMichigan Health uses Concerro’s ShiftSelect in its retiree return-to-work program.
• The AHA Center for Healthcare Governance selects CareTech Solutions and its customer San Luis Valley Regional Medical Center as presenters for its Fall Symposium.
• The Massachusetts Department of Public Health replaces its e-Forms system with Access’s electronic forms on demand solution.
• AT&T contributes $100,000 to support a mobile health initiative to use smartphones in diabetes education.
• Elsevier / CPM Resource Center will integrate its evidence-based clinical practice guidelines and documentation solution into the McKesson EMR of Medcenter One(ND).
• Iatric Systems adds the federal government’s Blue Button capability to its PtAccess patient portal, which allows patients to download their health information as a text or PDF file.

Contacts

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

HIStalk Innovator Showcase – Health Care DataWorks 9/12/11

Company name: Health Care DataWorks, Inc.
Address: 1801 Watermark Drive, Suite 250, Columbus, OH 43215
Web address: www.hcdataworks.com
Telephone: 614.255.5400
Year founded: 2008
FTEs: 20

Elevator pitch

HCD provides business intelligence solutions that enable healthcare organizations to improve quality and reduce costs.

Business and product summary

Our products are innovative in that they are an accelerator for organizations that recognize the need to leverage their siloed data to improve their performance, but don’t want to spend years building an enterprise data warehouse (EDW) from scratch. Health Care DataWorks (HCD) brings a pre-built, packaged EDW that is immediately ready to feed data. Our clients are able to see value within months rather than years.

HCD’s EDW Appliance bundles robust hardware, AIX operating system, Oracle 11g database, HCD’s own comprehensive enterprise data model, plus hundreds of pre-built standard reports and a dozen pre-built dashboards with hundreds of key performance indicators with drill-down capability covering quality, Meaningful Use readiness, revenue cycle, operating room, nursing scorecard, to name just a few. 

Our company is innovative in that it was founded and is managed by people that grew up in hospitals and health systems, as opposed to within a vendor organization. Our CEO has been a healthcare CIO for most of the past 20 years at various-sized organizations. Our COO led business intelligence development efforts at a major academic medical center for over eight years. As such, HCD has “walked a mile” in the shoes of its clients and has a unique, first-person understanding of the problems that healthcare executives are trying to solve with integrated data.

Finally, HCD is innovative because — unlike the Goliaths in the industry that it typically competes with, such as Oracle, IBM, and SAP, which have many product lines and foci — HCD has a laser focus on delivering innovative, value-added business intelligence solutions to hospitals and health systems, and as such, can be much more nimble and responsive to its customers.

Strategic Roadmap — for organizations very early in thinking about how they will use BI / analytics / EDW. This process will ensure you have buy-in for whatever decisions you make in this area and takes approximately five months.

Dashboard Appliance — for organizations that want to do a proof of concept for an EDW or to meet a specific need that requires a dashboard solution. Low price allows starting on the path towards an EDW without losing any of work done in populating the dashboards.

EDW Appliance — for organizations that are ready to build an Enterprise Data Warehouse and want tools and technology to accelerate that process.  

Target customer

Large and mid-market hospitals and hospital systems.

HCD’s products allow the users to pull data from multiple source systems making the data accessible in one location. The ability to run reports and drill down using friendly dashboard interfaces gives decision makers the information required to make knowledge-based action plans.

Competitors

Microsoft, Oracle, and IBM are a few of the better-known competitors in the industry.

Advantages over competitors

As a spin-off from the Ohio State University Medical Center, the founders of Health Care DataWorks have developed and worked the product from the ground up.

List five fast facts about the company or product.

1. Ohio State University Medical Center spin-off.
2. All five founders have worked or still work with the EDW at OSU.
3. Won TechGenesis Grant of $50,000 after to a market analysis that determined a large unmet need for the product.
4. Named Gartner “Cool Vendor” 2011.
5. The EDW Appliance was one of the first data warehouse solutions to achieve Stage 1 Meaningful Use certification.

Pitch video created specifically for this Showcase

What problems have you solved using HCD’s product and what has been the overall impact on your organization?

We are in the very early stages of implementation, having just signed a contract. Our vision project vision statement is:

To support our mission and vision, we will implement a set of business intelligence tools and a data warehouse, starting in 2011, that will transform integrated clinical, financial, and operational data from the disparate systems throughout the organization to information that is aligned and driven from the strategy and will support real-time decision-making to enhance clinical care, support research, and facilitate economic and financial forecasting

The impact to the organization has not been profound as of yet, but we are looking for some innovative solutions which will empower our decision-makers with data to make good business and clinical decisions. Having the data at their fingertips vs. having to contact IS for the data or to run a report; providing dashboard capabilities related to their KPIs and quality indicators; looking at predictive analytics to utilize the value of the data as we look at risk-based contracts, etc.

If you were talking to a peer from another organization, how would you describe your experience with HCD?

The experience has been very positive. HCD has been very responsive and knowledgeable about healthcare data warehouse and business intelligence. They have also been very flexible in terms of contracting and even providing a proof of concept phase of the project / contract. It has been a much different experience working with a smaller, more nimble company than some of the bigger players who may dictate how the process will work.

How would you complete this sentence if again speaking to a peer? "I would recommend that you take a look at HCD under these circumstances:"

HCD is a startup company, and as such, you will be taking on more risk than a mature vendor, but the risk may well be worth the reward given their current products, future offerings, and expansive healthcare knowledge.

An interview with Herb Smaltz, CEO of Health Care DataWorks

A lot of big companies sell dashboards and data warehouses. Why would customers choose to buy from a small, healthcare-only vendor?

We are laser focused on healthcare. Competitors obviously have lots of different product lines, lots of different vertical markets.

The other thing that resonates with our customers is that we all came from the health system. I’ve been CIO pretty much my whole career, dating back to even before you could call it a CIO job. I’ve been doing this for a long time, sitting in that chair trying to solve these kind of problems. Our COO, Jason Buskirk has been working in the BI department building BI apps and solving those problems from a development standpoint inside the health system for eight years. All of us on the senior team that spun this technology out of Ohio State have been doing this for a long time.

We’re a young company. We’re three years old now, but we’ve been harboring this technology over 13-14 years now in a major academic medical center with built-in health system. Again, trying to solve these kinds of problems of data integration and really making sense of really heterogeneous, really potentially dirty data to solve business problems. 

I think those things resonate with our customers. That we walked a mile in their shoes and were one of them, if you will. Even though we are clearly a vendor company, well grew up in health systems and the technology has really been hardened in that kind of an environment.

We went through those years of at OSU where we were stubbing our toes on the best way to build a data model; the best way to build performance; the best way to build query capabilities. For most startups, they’re stubbing their toes with their customers as they build their product.

I think all those things make it a little more comfortable for folks to go with Health Care DataWorks.

You offer your product as an appliance in one configuration. Realistically, what kind of time, effort, and skill set would a client need to connect everything and go live?

That’s one of the things that we offer as a value proposition. We’re really an accelerator for organizations that are right at that precipice of trying to figure out how to get all their data to work together.

If you talk to people like Gartner and others, for the folks who try to build it themselves, it’s a good three-year prospect to build it from scratch. We’ve packaged everything: the hardware, operating system, Oracle 11g database licenses, our own very comprehensive data model, and tons of content. Lots of pre-built dashboards with scorecards and hundreds of reports. 

Essentially, we can just drop that in to an organization’s data center or just use our hosted data center, whichever they prefer. Instead of sitting around a table having discussions about how these tables should be built and what these data elements ought to be called and how the table joins ought to work, they’re immediately just working on populating this packaged data warehouse appliance that we bring to them. Within four to six months, they’re typically using one of the dashboards. They’re using a bunch of standard reports in whatever area they’re focused on.

But one caveat. Source data that comes from those various EMR systems, ERP systems, scheduling systems — you name it, there’s tons of systems in a hospital and health system — they’re notoriously dirty. When you bring that heterogeneous data into an appliance, what it exposes is some of that dirty data. 

One of the things that can cause delays is data governance. Seeing that the data is not good, having to go back to the source systems and the owners of those source systems — whether that be the chief medical officer or nursing or wherever the data was pulled from — and work with them on how to best move forward. Do you want to expose the data as it is, with some asterisks and caveats? Such as, “There are number of blank fields, but from this day forward, we’ve asked our registration folks to fill those fields in.”

That whole data quality, data governance within each hospital is a new core capability that they really need to develop. The ability to take their data from their various systems and help to make that cleaner and cleaner and cleaner over time.

But typically, it’s four to six months from the time that we sign a contract to the time that they can get use of a set of reports or a dashboard or a scorecard.

It’s been a year since you signed Orlando Health. What results have they seen?

Orlando Health is one of those organizations that this issue of data quality and data governance has come up. Very quickly, we were able to get their quality dashboard in place. One of the things they wanted to do to before they exposed it to their users was to clean up all their data.

I’m a fan of, you know, “data gets better with use.” Now to be sure, at a physician level or a patient level, you want to make sure that data is right. There’s that tradeoff. Orlando Health has really focused a lot on their data quality. They’ve been busy for a number of months working on data quality, getting the data quality up to speed. But their dashboard was ready and loaded with data within months of getting the appliance in place. 

With another customer, Essentia Health, we did a proof of concept with them. Just three months later, they got a Top of the Hospital dashboard up. They put in place a data governance group, which has been meeting and working on those sorts of things. 

It’s one of those things where the technology really isn’t the thing that holds people back. It’s the ability to make decisions about the data that it exposes and how they want to deal with that and handle it. In some cases their source system data is very clean and they can very quickly move on and deploy that to users. In Essentia’s case, that’s what happened.

In Orlando Health’s case, they had a number of fields that were blank in their source systems. For example, a referring physician is one of those that was blank. They had 160,000 instances of a blank referring physician. If you want to do analysis on where your patients are coming from, it’s important to fill that in. They had to go back to their registration department and essentially say, “We really need this field filled in.”

Anybody you talk to in the marketplace will tell you there’s no silver bullet technology that can overcome poor source system data quality issues. With all of our customers, we absolutely offer that acceleratory capability, to immediately let them start using the data. The question really becomes is whether the data coming from their source systems is of a high enough quality that they want to expose that to end users to make business decisions on. We very much work with them on that data governance process in making decisions around that and helping them to the point they’re exposing that data to make business decisions.

What do you hope to gain from the exposure?

As you mentioned, we are a small company. We don’t want to take anything for granted. We want folks to get an understanding of the company, the fact we’re laser focused on healthcare providers in particular. We very much appreciate it. Any small company can benefit from people knowing about you. We hope to be included in more RFPs, and we’re getting more and more. We just closed Presbyterian Health System  in Albuquerque, New Mexico and Children’s Medical Center Dallas. Because we’re competing against folks like Oracle, IBM, and Microsoft and the exposure really does help.

Curbside Consult with Dr. Jayne 9/12/11

Mr. H’s recent Time Capsule on hospitals wanting software to do the dirty work of changing physician behavior is as true today as it was five years ago. All too often, we see the fallout of this strategy – poor adoption, user dissatisfaction, and worse.

The editorial mostly discusses CPOE, which was the hot ticket item at the time. Back then, there wasn’t a lot of attention to the ambulatory space, although Meaningful Use has certainly brought that to the forefront for many organizations.

Changing physician behavior on the ambulatory side, whether in an integrated delivery system or in a private practice, brings different challenges than on the inpatient side. Hospital have well-defined governance rules and entities to deal with problems when they arise. (note that I said ‘when’ – this is not an ‘if’ situation. There will be problem providers.)

Typically, you have a medical executive committee of some kind, made up of department chairs, service line directors, administrators, etc. Each specialty department typically has a chair who can address behavior issues with providers. Providers (both compliant and difficult) are used to these enforcement structures as they pertain to delinquent medical records, unsigned verbal orders, and the like.

Providers are used to JCAHO-dictated processes and procedures, care plans, and lots of administrative involvement and oversight. They are typically subject to medical staff bylaws of some kind and can lose their hospital privileges for misbehavior.

The ambulatory space in many organizations, however, is like the Wild West. Physicians are used to a high degree of autonomy. Even in hospital-owned provider organizations, leadership is often unwilling to be the ‘stick’ needed to change behavior. The average primary care physician generates roughly $1.5 million in downstream revenue and organizations are afraid of disruptions to referral and test ordering patterns. Unless there are legal or regulatory issues at stake (and sometimes even in those cases), physician non-compliance is often overlooked.

Implementing an ambulatory EHR is seen by some as a relatively easy way to address these behaviors. Rather than deal with true process and workflow issues, the thought is to just mandate the behaviors through system configuration. The software becomes the third-party “bad guy” to force change.

This rarely ever goes well. Users placed in these situations (both provider and other) immediately demonize the software, the implementation team, the selection team, and the vendor. This negative response isn’t very helpful or productive for anyone.

I’ve been involved in implementations where physicians were told that something is required by JCAHO or Meaningful Use when it frankly had nothing to do with either. It was just used as an excuse to try to make physicians behave one way or another. That puts implementation staffers in the middle of this fight. I’ve seen savvy physicians who know their facts completely derail training and implementation efforts as they argue with training staff who may or may not know they’re part of a manipulation effort, but either way, are not decision-makers.

Independently owned or smaller practices are also subject to manipulation efforts, but usually from within (unless there’s a Stark-related subsidy involved – that adds an additional level of potential control.) Typically, a subset of partners or a lead partner will try to leverage the EHR to change colleague behavior or practice patterns rather than addressing them head on.

We all know the old adage that putting automation on a dysfunctional process will only serve to make it more dysfunctional at a faster rate. Practices who try to implement EHR without cleaning up internal issues first place themselves at significant risk. Much like a driver’s license exam, there ought to be a test before practices are allowed to implement. I know some vendors who do readiness assessments and will reschedule practices who don’t have their acts together, but most seem to allow them to forge ahead regardless of the risk.

Some key advice for ambulatory organizations ready to implement EHR:

• Decide on what level of customization will be allowed. Will it be at the practice, specialty, or provider level? If you’re really willing to support provider-level customization regardless of outcomes, cost, or impact, then you don’t have much to worry about as far as changing physician behavior.
• For practice- or specialty-level decision-making, start the change management process prior to implementation. Standardize order sets and get agreement in the paper world. Make sure new protocols and initiatives actually work in your culture before adding an EHR to the mix.
• Revisit state and federal laws and regulations. Ensure compliance before implementation so that providers clearly understand the origin of the mandate.
• Revisit standing orders and care protocols. Make sure they are up to date. Build them accurately into the EHR and work with your vendor to ensure effectiveness.
• Analyze staff roles and responsibilities. Optimize performance and clarify expectations. If staff isn’t up to par, start remediation now. Help staff understand that EHR will change their jobs regardless of their role, and if they can’t live with that, they need to adjust or start looking elsewhere.

These items seem deceptively simple, but in fact are the hardest things a practice needs to do to be successful and are often the ones that are ignored. Implementing an EHR is not going to accomplish this for you. There are no magical lines of code to deliver a keyboard-induced shock to their sneaky little fingers. Non-compliant physicians will simple use the EHR as an excuse for their behavior rather than change.

Organizations with large numbers of “outliers” may need a formal change management initiative in addition to EHR implementation efforts. The benefit is well worth the cost.

E-mail Dr. Jayne.

Monday Morning Update 9/12/11

From Jimmy Doogan: “Re: McKesson InSight conference September 20-23. Will HIStalk be covering? The tone will be interesting, as I would say the MPT part of the company hunkers down to milk their existing customers.” I wish I had the time to attend conferences, but it’s hard getting time off from the hospital. I’d be keenly interested in reports from everybody’s favorite convention city (Pittsburgh) if someone wants to volunteer be the official HIStalk mole. A key MCK metric will be the number of attendees, since those Horizon sites already announced as moving to Epic or other systems probably won’t bother sending folks to InSight. They will get some offset, though, from the increasing number of users of Paragon and other systems. Key questions I’d like to see answered: (a) how viable is Horizon Clinicals as go-forward strategy for both MCK and its customers; (b) how is the company positioning itself to compete against competitors (notably Epic and Allscripts) that have tied the inpatient and ambulatory sides of the house together; (c) what is the status of Horizon Enterprise Revenue Management as reported by real-life users; and (d) given that most of the MCK products are still mid-performing silos of legacy acquisitions, are they willing to invest in actually building products appropriate for the reality of healthcare reform, or will they just run a prevent defense in trying to keep the maintenance and services revenue stream going as long as possible (or sell the whole MPT package off, if you believe the occasional rumors.)

From Ingram Connor: “Re: The Advisory Board Company. Dave Garets is quietly putting together a dream team of industry heavyweights. Mike Davis, Jim Adams, Jim Klein, Ernie Hood, Peter Kilbridge, Ken Kleinberg, Doug Thompson, and Daphne Lawrence.” I also heard (and I think it’s OK for me to say) that Dale Sanders, CIO of Cayman Islands Health Services Authority, will be joining ABCO this week, although continuing as a senior advisor to the Caymans.  

From Sir Lord Baltimore: “Re: low check number on EHR incentive payment. Incentives are paid the same way an eligible professional receives his or her Medicare or Medicaid reimbursement. Many receive payments electronically, so they also receive the incentive payment electronically.” Makes perfect sense – thanks. I’d still think that as much as ONC and HHS congratulate themselves publicly on how well they’re spending taxpayer dollars that they’d provide specific HITECH payment numbers if those numbers are in fact impressive.

From The PACS Designer: “Re: eMix for image sharing. TPD is all for promoting the sharing of patient image files, and now eMix is available to enhance patient image file sharing. The service is road map to  a Meaningful Use application, provided courtesy of DR Systems.”

From Snidely: “Re: Lucile Packard Children’s Hospital. I’ve heard they’re being forced to adopt Epic since Stanford uses it and Epic is ‘interoperable’ only if everybody else is on Epic. This is the Epic Octopus, where once they get into a system, everybody has to switch to it if they want to talk to each other. That makes Epic much more expensive than the initial quote if you want your systems to communicate.” Unverified. If true, I assume that means Cerner, installed just four years ago and the subject of several Packard articles touting its patient safety features, gets the boot.

Most hospital respondents say their boards make at least a token effort to seem analytical before approving IT projects put before them. New poll to your right, with the idea triggered by Inga’s interview of Jonathan Bush: how comprehensively will HHS audit providers who get HITECH checks by the honor system of attestation?

I don’t know what you were doing back in the innocent summer days of July 2006, but I was writing this week’s Time Capsule editorial, CCHIT’s First Certification List is Unsatisfying, where I said, “I think the federal government will encourage the use of certified EMR products by sweetening reimbursement or making it a requirement for government-related purchases.”

HHS Secretary Kathleen Sebelius will kick off the Consumer Health IT Summit Monday afternoon (September 12) at 1:00 Eastern (the announcement says EST – doesn’t it bug you when people incorrectly say EST instead of EDT instead of just sticking with the always-appropriate ET?) Anyway, Farzad Mostashari of ONC will also be on hand. You can watch via live webcast. Bring your own lunch.

The Kickstarter project for the GAUCHOS open source EMR for volunteer clinicians won’t likely make its $84,000 fundraising goal with only $4,700 raised and five days to go, meaning they’ll get nothing since Kickstarter is all or none. The project continues, however.

Weird News Andy breaches the surface of this subject: a billing contractor for Stanford University is blamed for posting the medical information of 20,000 of its ED patients on a website. Someone posted the Excel worksheet on a tutor-hiring site for students, asking for help with creating a bar graph from the patient information. The worksheet sat there for a year, visible to anyone. The billing company, Multi-Specialty Collection Services LLC, seems to have gone into seclusion since its Web page has apparently been taken down and the owner isn’t returning media calls.

Gerber Alley: The Final Chapter, courtesy of Vince. I’m picturing some Nancy Sinatra-style go-go boots out of frame in the attractive young lady’s picture on Slide 5 (now someone’s grandmother, I’d guess.)

US Rep. Barney Frank (D-MA) tells the Massachusetts Historical Commission to get off Meditech’s back and let it build offices in Freetown, MA, saying he was “unpleasantly surprised” by the group’s demand that Meditech conduct a year-long archaeological study before starting construction. Meditech said they’d take their 800 jobs elsewhere. A local newspaper editorializes: “From their lofty perch in points north, members of the commission — who, on the topic of dirt, sure do know how to muck up a good situation — are strikingly out of touch with the workaday world of the SouthCoast, which holds the dubious distinction of consistently ranking among the state’s highest areas for unemployment.“

It’s a mess at Parkland Memorial Hospital (TX), as the Justice Department launches an investigation and CMS announces termination of the hospital’s Medicare agreement on September 30, although Parkland can keep those privileges by accepting help from outside consultants (gee, wonder which option they’ll choose?) The hospital already announced plans last week to replace President and CEO Ron Anderson, whose held that job for almost 30 years, saying it will create a new job for him next year. To outsiders, Parkland is mostly known — at least by mature audiences — as the place where JFK and Lee Harvey Oswald died nearly 50 years ago (followed by Jack Ruby a few years later).

An employee of Methodist Hospital (TX) is charged with using patient information to take out short-term loans in their names, buying herself a $125K Maserati, a BMW convertible, and some nice Gucci clothes.

Bizarre: a UK factory electrician is nearly killed when a compressed air line goes up his shorts and into his rectum, inflating him like a balloon. “There was air fizzing around inside my back passage and stomach. It was so weird,” he observes. It was reportedly a co-worker’s prank.

E-mail Mr. H.

HIStalk Interviews Todd Cozzens, CEO, Accountable Care Solutions – Optum

Todd Cozzens is CEO of the Accountable Care Solutions group of Optum.

Give me some brief background about yourself and your new job within Optum.

We were on our way to going public last year with Picis. Along the way, healthcare reform hit smack dab in the middle of that process. The services business of Ingenix — really, the analytics and information technology part of that business — was getting much more involved in the provider space. 

They really started to see what’s going to happen in hospitals for the sickest patients. Hospitals are going to become big EDs, ORs, and ICUs. You’re going to need a technology that can give you the data to follow those acutely ill patients. That’s why they were interested in Picis. We talked, it was a good fit, and we finished that transaction almost exactly a year ago. I joined the company and stayed on. 

About four months ago, we started a new business unit called Accountable Care Solutions, which is really the bringing together of the technology — the analytics pieces, the clinical transformation capabilities, some population analytics — clinical transformation, and care management capabilities. Those are the three essential components, and these are fairly service-intense technologies. There’s technology at the core, but you need actuaries on the population health, you need clinical people, change management people, on the clinical transformation end you need one-on-one people, case managers on the care management piece. Those are the capabilities that we have in this new business unit.

We signed our first major deal with Tucson Medical Center last year. That’s getting close to going live. We’re working on several other of these where we are really enabling what we call Sustainable Health Communities. Not really ACOs, because ACO is a defined term by Medicare.

It’s been really exciting. It’s the third time in my career that I’ve been at that next big change point in where things are going. I think we’re in the top of the first inning of the biggest change in healthcare that we’ve seen.

You obviously made a fortune selling Picis to Optum, but then you had to turn your company over to a bigger company, ending at least one chapter of your role as an entrepreneur and starting a new one as a corporate executive.What was going through your mind?

Throughout my career, I’ve been able to change my thinking cap and my leadership cap from a small-company entrepreneur to a bigger company CEO. My only bad experience was when we sold Marquette to GE. GE doesn’t appreciate domain experts that they bring in. They like to bring in their lighting and plastics leaders and put them over the healthcare businesses that they acquire. 

Optum was more experienced. They’re just chock full of domain experts from all aspects of healthcare. I thought I was a healthcare expert, but I can tell you after being with all these guys on the actuary side, on the payer side, on the provider side, on the physician side, and all the capabilities they have in government policy and analytics and payer mechanics –  it’s incredible the knowledge within this company. They’ve got a lot of great thinkers and they’ve got a lot of raw research being done.

I’m extremely impressed by the depth and breadth of the talent in this organization. That’s why it’s been exciting and refreshing, especially as we approach this more collaborative model of care that we’re seeing.

How is the company approaching that market?

Optum is purpose-built for this. The payer part of Optum deals with 1,700 payers, not just United, so they’ve got a huge portfolio of products and services that they enable payers with. On the provider side, with the acquisition of Picis, Executive Health Resources, A-Life Medical, etc. you’ve got big revenue cycle practice, big clinical performance practice, big consulting, one of the largest Epic implementers.  Then on the government and policy side with Lewin Group. It’s really been a very strong combination of skills that we’re able to bring to bear into a hospital. 

These Sustainable Health Communities or ACOs are really being led by health systems. The larger IDNs are now starting to really grasp that this is where they got to go. They’ve got to learn how to adopt a lot of the techniques that payers have used for years. Not just how to analyze my census, but how do I analyze population in the community, and how do my lines of service relate and adapt to that population? Do we have the correct number diabetes experts and doctors and care services? Can we predict what’s going to happen?  Are lines of service performing above or below national benchmarks? Are we looking at the patient care more longitudinally rather than transactionally?  

As hospitals go from fee-for-service to fee-for-value — which many are doing — they’re going to need a lot of help. That’s not been their core expertise in the past. They’ve been focused on core operations in the hospital and not even that much on the pre-hospital or post-hospital care. But they’re the ones that are leading this new kind of care model. They need to pick up a lot of these skill sets and capabilities to be able to manage risk. That’s what Optum. with all the analytics technology and capability in this area, has been doing for years on the payer side.

Enabling Sustainable Health Communities is our core focus. We help clients with the three qualities they need to build them – connected, intelligent, and aligned.

We says Sustainable Health Community because a) it’s got to be sustainable, because the current system is unsustainable; b) it’s community-oriented — you’ve got to understand the entire community, not just the patients who are coming into the hospital census. Health is not just about who’s getting sick — it’s about how do you keep people out of the hospital. That’s what we really focus on. In order to do that, we tell hospitals that you’ve got to have these three capabilities. 

You got to be connected. Your physicians and your hospital and your payers have got to all be connected and looking at the same set of data. That’s what happens when businesses vertically integrate — they get connected. They’re going to be aligned and incentives align in how you’re looking at the data.

Intelligent means you’ve got to be intelligent about it because you got to have the analytics and be able to look at the patients, the population health empirically. We bring those three capabilities around those areas and it’s been taken very well in the marketplace.

Kaiser is one of the few programs that has really addressed population management. Do you think others can follow their lead, and if so, what kind of technology are they going to need compared to what Kaiser has invested in?

Kaiser’s done a lot. They’re a health plan, provider, and a physician group all under one roof. We look forward to the day where it’s not just the Kaisers and the Geisingers that are recognized as the collaborative care models.

We see virtual Kaisers being put together every day, or even more integrated models where the IBM might want to start their own health plan. In addition, as everybody knows, the IDNs are back to buying up physician groups like there were during the managed care days, but there’s a much different motivation for doing it today. They’ve got better tools to manage that.

But you’re right. In order to integrate to a more collaborative model, they’re going to need the type of technologies we have to enable them. We see large IDNs and community hospitals like Tucson Medical Center who are getting ready. Some of them are starting with their own employees. Some of these health systems –  38,000, 40,000 employees – that is a great population to go at risk on. They’re already self-insured in most cases with these.

Some are just trying to realign with their payers. Some want to get clinically integrated to pass FTC muster. Some want to do it comprehensively — they see this as the future. They see that with the way that healthcare reform is going, with the federal budget cuts, that they’re going to have to do entitlements. They don’t see any way to avoid moving in this direction.

One of the presumably unintended consequences of the combination of Meaningful Use and Accountable Care Organizations has been that practices are selling out because they really can’t compete technologically. Do you think we’re better off with fewer independent physicians and even more dominant healthcare systems?

I think in most markets there’s going to be two or three viable competitors. I do believe, though, that the real benefit out of this is much more collaborative care. In other words, the less transactional care, much more focused on longitudinal care, where you understand what kind of population is going to come to the hospital, you transform the way you take care of those patients, and then you follow them up individually, post-discharge — are they taking their meds, etc. Then you overlay that with significant wellness programs. That’s the new model.  That will benefit all of us greatly.

As far as the competition point of view, healthcare is a $17 trillion business. Hospital and physician care is $3 trillion. I’ve never seen a trillion-dollar company, so I think there’s going to be plenty of room for competition and innovation. 

Healthcare is local, so it will be specific by market. That’s its competitive nature. But in most markets, there will be viable competitors. There will be the ones that really grasp this whole concept of accountable care and collaborative care before the others and enable themselves. They’re going to be the real winners. There definitely will be some more consolidation and there definitely will be some winners and losers in this.

There’s some urgency for providers who’ve never really been very good at working with each other to suddenly come together in a way that’s mutually rewarding and efficient so they will be ready to take on broad risk for outcomes. How long do you think it will take for them to be ready to do that? Will it be in time given the push to have ACOs in place?

The legal push here is the CMS’s definition of 2014 rules coming into effect. I think it’s going to take longer than that, there’s no question about it. Implementation of all those regulations will take longer than expected.

We’re seeing a three- to five-year horizon, where early adapters like Tucson Medical Center and others that we’ll see in the 2012, 2013 timeframe. You’ll see a big early market the end of 2013, and then you’ll see an early majority in 2014, 2015.

There’s a lot to do. The ideas are already pretty well organized. The ones that already have some sort of risk pool, you know, they may have a group left over from the old days or they have done something with their own employees or something. The ones that have already done some experimentation with risk will be the first ones to cross over.

There’s a lot of CEOs out there in health systems that do have extensive risk experience, people that have worked in Massachusetts and California. It’s not that there’s no experience out there on the provider side.

We do believe that within five years, over half of the health systems are going to have some sort of accountable care model.

A lot of the providers are just now implementing electronic medical records, which were designed mostly just for transactional efficiency and episodic billing, not really anything related to population health. Do they have a choice about whether to buy and use additional tools that support something beyond just their own transactions?

The data that we have right now to manage populations is largely claims data. Claims data is rich and pure and really empirical. You can get a lot of mileage out of claims data and will in the future.

Obviously once you can take the discrete clinical data and really leverage that, you’ll get an even richer data set. The problem with clinical data is that in one hospital, there will be 85 different definitions of heart rate, even in the best implementations done across the board with one system by really good implementers. Getting clean data out of the hospital, the clinical data, will take some time. Having the right analytic tools overlaid on the claims data tools and used in conjunction with them is how technology will develop over time.

Right now, we already have tools that are capable of doing the job. They will get better, the tools that will be doing this four or five years from now. I’m fully convinced that the next EMR will be an accountable care information management system, or some acronym we’ll develop that rolls off the tongue better by then. A lot of the data will come from the EMRs, but other sources as well.

Any concluding thoughts?

It’s exciting times. I’ve been very impressed with the capability of this company and their willingness to put the assets together and understand that this is both an early market, but an inevitable market. I laud them for their foresight and I’m excited to lead this effort.

Time Capsule: CCHIT’s First Certification List is Unsatisfying

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 July 2006.

CCHIT’s First Certification List is Unsatisfying
By Mr. HIStalk

The Certification Commission for Healthcare Information Technology’s long-awaited announcement of the initial class of 20 certified ambulatory electronic medical records products this week was oddly unsatisfying. Rather than being an exclusive club, most big-name vendors made the list.

As I’ve said previously, certification has little value if most products earn it. Prospects considering the usual vendors won’t find their job any easier: everybody scored 100%. No one likes a game that ends in a tie.

CCHIT may ramp up the standards for future years. Maybe this initial pass was made intentionally easy (or, maybe vendors put a lot of resources into enhancements – we don’t know). That’s how certification usually works. You make it easy enough to be attractive initially and then toughen it up once it catches on.

The biggest companies dominate the list. Not coincidentally, they market the most expensive products to the largest physician practices. For them, the cost was inconsequential. On the other hand, they were already facing each other in system selections. Their prospects didn’t need much encouragement to consider EMRs. For those reasons, certification doesn’t really change anything for anybody in this category.

The winners were those newly certified products whose sweet spot is smaller practices. They have tons of competitors and CCHIT’s endorsement may help them rise above the crowd. They just have to figure out how to effectively market their new credential.

Now that we have certified products, we’ll find out if the marketplace values that status. If so, cautious vendors who sat out the first round will jump in line quickly. If not, even those who earned certification this week may opt out of future rounds. Vendor flaunting of the credential is the only way word will get out to the masses, although it wouldn’t be surprising if CCHIT forged relationships with physician and practice management groups to co-brand their certification efforts in some way.

What about customers? I’ve talked to several CEOs of ambulatory EMR companies and they don’t agree on the benefit of certification to physician practices. It may increase EMR adoption, but that’s a guess. It may reduce buyer risk, but only in the limited areas it measures. It may shake out vendors perceived as weak, but it may also provide a misleading stamp of approval to immature products with unproven support and longevity. It may improve reimbursement, but no one’s quite sure how. Customers still need to consider many factors in deciding when or what to buy.

I think the federal government will encourage the use of certified EMR products by sweetening reimbursement or making it a requirement for government-related purchases. We know the government is encouraging adoption of electronic records, so why wouldn’t it show a preference for certified ones? You might see the same nudging from insurers or regulators. It all depends on how well certification catches on.

Impatient people like me may have expected too much of an immediate product differentiator in this first round of certification. Still, CCHIT has done a good job defining the process, sticking to its timetable, and communicating its progress. Perhaps its most important work is yet to come.

News 9/9/11

Top News

I reported weeks ago that Beth Israel Deaconess Medical Center was prepared to offer its CEO job to Stanford Chief Medical Officer Kevin Tabb MD, who has spent nearly all of his medical career in informatics roles on both the vendor and provider sides of the house as an IT geek. BIDMC announced Tuesday that he has accepted the position. My assessment then was that “he would be a geeky kindred spirit for CIO John Halamka,” which both FierceHealthIT and DotMedNews quoted and nicely credited to HIStalk.

Reader Comments

From Inquiring Mines: “Re: Medicare stimulus check. A local group got their federal check and its check number was less than 200, an ungodly low number to have been issued. A provider in the group was told only 6,000 providers had filed to date. Am I missing something? The Medicare spigot doesn’t seem to be flowing as expected.” IM sent a scan of the provider’s check and it does appear that, unless CMS has multiple accounts (this one is called “EHR Incentive Payment Account”) they haven’t issued many checks to date.

From Pacman: “Re: Mayo – Elkin lawsuit. A $1.9 million attorney’s fee award for Mayo against Dr. Elkin.” Unverified. This is the suit in which a Mayo doctor (Elkin) sued Mayo over software he developed while employed by them, but then took the source code with him when he left. The jury found in favor of Mayo in April, but also ruled that the doctor is due royalties under Mayo’s royalty sharing policy. As is nearly always the case with lawsuits, the big winners are the lawyers.

From Harvey: “Re: Mediware. Reported a very solid quarter, but indicated that their labor costs have gone up. It would seem that, despite overall job market woes, there’s a bit of a bidding war on for HIT staff.” Mediware’s Q4 numbers, announced Wednesday: revenue up 20%, EPS $0.25 vs. $0.12, with a big DoD blood bank software contract pushing the numbers up. The one-year share price is above, with MEDW (blue) compared to the Nasdaq (red) and the S&P 500 (green). Market cap is $91 million.

HIStalk Announcements and Requests

Listening: Black and White America, the new album from Lenny Kravitz. Retro 60s funky with big horns in places, modern soul elsewhere, and melodic rocking on some tracks. A great sound throughout and lyrics that aren’t the usual dance track drivel. I get quite a few e-mails from readers wondering how to get back in the habit of listening to new music and I would recommend this as easy to enjoy – it’s got a nice beat, it’s not explicit (he’s religious), and it’s original. And Watching: Mercy (a pretty good hospital yarn) and The Good Guys (a funny cop buddy series). Netflix is predictably in full meltdown mode since any fool could see that its content providers like Starz would be holding it hostage once their old contracts ran out, so I’m watching now before the lack of programming (or increase in price) pushes me to cancel.

Jobs on Healthcare IT Jobs: eGate Integration Analyst, Senior Systems Analyst – Physician Systems, Implementation and Account Manager, Pegasus Health IT Director. There’s quite few interesting jobs there.

HIT is a contact sport, so get off the couch and interact with us: (a) subscribe to the e-mail updates so you can be a like Paul Revere galloping down the cubicle rows shouting out the latest shocking news that I’ll deposit in your inbox if only you’ll allow me; (b) do all that friend / like / connect stuff on your choice of social media sites, seeking out HIStalk, Dr. Jayne, Inga, and me so that we might consummate our union electronically; (c) send me news, rumors, or whatever interests you about the industry; (d) behold with wonderment (and perhaps some strategic mouse-clicking) the graphical proof to your left signifying the unlikely fact that impressively powerful healthcare technology firms are willing to support an anonymous muckraker who struggles to keep a hospital job given the extensive time required to keep up with all the HIT windmill-jousting that needs done; and (e) appreciate that our world revolves around patients, no matter how much electronic insulation separates them from us. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Mediware’s Q4 numbers: $16 million in revenue, up 20% from last year; net income $6.3 million vs. $3.2 million.

Private equity firm The Riverside Company acquires Avatar International, which administers patient satisfaction surveys.

Teleradiology firm Virtual Radiologic acquires the 60-radiologist practice Diagnostic Imaging, Inc. (PA/NJ).

Hospital revenue cycle predictive analytics vendor Apollo Data Technologies Health, Inc. changes its name to MethodCare, Inc.

Sales

CHRISTUS Health (TX) selects HiSoftware’s Compliance Sheriff for SharePoint solution for HIPAA compliance with Sharepoint data.

Royal Caribbean Cruises selects eSeaCare EHR for its Azamara Club, Celebrity, and Royal Caribbean International cruise lines. Dang, I sure need to do a site visit.

CMS contracts for ICD-10 code translation technology from 3M Health Systems to assist with the conversion of the agency’s systems, applications, and reports from ICD-9.

People

Zynx Health appoints Bill O’Connor, MD (Allscripts) as SVP of global product management and marketing and David Cerino (Microsoft Health Solutions) as EVP and COO.

CSC promotes David Levitt from account director to VP of HIT solutions for its North American Public Sector Health Services division. 

Healthcare investment bank Leerink Swann names Bill Suddath managing director of the firm’s Healthcare IT and Technology Enabled Services franchise. He was previously with Robert W. Baird & Co.

AHIMA appoints Lynne Thomas Gordon, MBA, RHIA, FACHE as CEO. She was previously with the Children’s Hospital at Rush University Medical Center.

CentraCare Health System (MN) names Amy Porwoll CIO, replacing the retired Charles Dooley.

Announcements and Implementations

Humility of Mary Health Partners (OH), which includes three hospitals owned by Catholic Health Partners, goes live on its $56 million Epic system.

Accenture completes an assessment and plan to support implementation and interoperability standards for a statewide HIE for the Texas Health Services Authority.

The VA will expand its Virtual Lifetime Electronic Record pilot in which the health records of veterans are electronically shared with the Department of Defense aid private healthcare facilities. It says the HIE capabilities will be live this fall.

The ONC launches HealthIT.gov, a new website which includes HIT information for both healthcare professionals and consumers. It’s definitely prettier and easier to navigate that older ONC site, but contains much of the same information.

MetroWest Medical Center (MA) debuts its use of the EarlySense system, which uses motion sensors placed underneath beds to track patients’ vital signs. Massachusetts Governor Deval Patrick was on hand.

TeraMedica introduces a medical archiving solution capable of managing from 25,000 to 10 million medical image procedures.

Free EHR vendor Mitochon Systems announces built-in connectivity from its EHR to Hoag Hospital’s Medicity-powered HIE.

Qualcomm and Life Care Networks launch a Wireless Heart Health 3G mobile health project in China. Components include smartphones with ECG sensors, Web-based EMR software, and clinic-based 3G wireless workstations that give 30 physicians access to the electronic records and ECG data.

Government and Politics

Federal agents arrest 42 people in South Florida for suspected Medicare fraud. Assisted living facilities and related businesses convinced out-of-state elderly and disabled people to come to Florida for a fresh start (and to bring their Medicare cards along). They’re accused of submitting $160 million in phony claims, of which Medicare dutifully paid $90 million without question. The lead FBI agent chastised HHS for not preventing fraud upfront, saying that it takes extensive resources to catch the crooks, who by the time they’re arrested, have usually spent all the money.

Innovation and Research

Albert Einstein College of Medicine of Yeshiva University will use an NIH-funded grant to study advanced retroviral drug therapy in HIV/AIDS patients in Central Africa. Clinics will implement the OpenMRS open source medical record to collect data, also giving governments the option to make its use a national initiative.

Technology

Inova Health System (VA) partners with a genomics company to sequence the genomes of 500 pre-term NICU babies and their parents to identify OB-related diagnoses and treatments. Information from Inova’s EMR will be used to study outcomes.

Other

A physician’s guest editorial in The New York Times makes the common observation that electronic medical records are good as long as the caregiver doesn’t let the computer interfere with their relationship with their patients.

In the old days, when a patient arrived in my office, I laid the paper chart on the desk between us. I looked directly at the patient. As we spoke, I would briefly drop my eyes to jot a note on the page, and then look right up to continue our conversation. My gaze and my body language remained oriented toward the patient nearly all the time. In the current computerized medical world this is impossible. I have to be tuned toward the computer screen to check labs, review X-rays, read prior notes, document the patient’s current concerns. Like most internists, I know that the interview is the most important part of a patient visit. It always yields far more information than the physical exam, which, in many ways, is an afterthought. But now that the computer is impeding the intimacy normally achieved during the talking part of the visit, I find that I rely on the physical exam more. Once the patient and I have broken free from confines of the desk, with its dictatorial PC, we have a more comfortable realm, that of touch. As soon as there is skin-to-skin connection, conversation flows more easily. In the absence of a machine lodged between us, the traditional doctor-patient relationship is restored.

An Ontario hospital notifies patients that an employed nurse inappropriately accessed the records of 5,800 patients. The mother of one of them was upset by the hospital’s  response to her request for details:  they won’t release the nurse’s name because doing so would violate the breacher’s privacy.

Weird News Andy likes this ink: an 81-year-old grandmother gets a chest tattoo that says, “Do Not Resuscitate,” fearing that doctors won’t see the DNR entry in her medical record. “I do not want to be half dead, I want to be fully dead … I don’t want to lie for hours, months or even years before dying. I don’t want my family to remember me as a lump. My mother-in-law lived to be 106 and in the last six years of her life she’d have been much better dead. She was miserable.”

Also from WNA is this story in which England’s Primary Care Trusts are demanding that family physicians reduce their use of ultrasound, MRI, and CT scans. WNA has a cost-saving solution: send them through TSA’s body scanners.

Police in China are investigating the death of a patient during a fire in a hospital OR. Employees evacuated themselves and all patients except one, a man whose leg was being amputated under general anesthesia. When they returned, they found him on the OR table, dead of smoke inhalation.

Sponsor Updates

• The Disposable Film Festival and Practice Fusion launch Disposable Film Festival Health to encourage original short films about health, medicine, patients, or doctors. Participants will compete for a $5,000 prize.
• Orion Health is adding more than 100 new positions, with about two-thirds in New Zealand and the rest in North American and the Asia-Pacific region. Most of the openings are in R&D.
• Ten unaffiliated physician practices connect to the Coastal Connect HIE (NC) and begin the electronic transmission of patient referral data using Medicity’s iNexx technology.
• Radiology Associates LLC (LA) selects McKesson Revenue Management Solutions for practice management and medical billing services.
• Robert Freedman of Hayes Management Consulting will moderate an ICD-10 panel discussion at HCCA’s New England Regional Annual Conference on September 9 in Boston.
• Stockell Healthcare Systems and ZirMed announce a partnership in which ZirMed’s claims management will be integrated with Stockell’s Insight Revenue Cycle Information System.
• Decatur Medical Center (IL) will deploy Wolters Kluwer Health’s ProVation Order Sets. Wolters Kluwer also signs a multi-year contract with Health Shared Services British Columbia for its Lexicomp solution.
• TeleTracking Technologies announces the formation of its RTLS Workflow Consulting Group. The company is also hosting a free webinar, RTLS Asset Management and How to Make the Most of Your Owned Equipment Resources.
• MediServe clarifies the PAI Discharge Window. 
• Cumberland Consulting Group promotes Tom Howard to principal.

EPtalk by Dr. Jayne

JAMA is e-mailing physicians to take part in a survey regarding mobile electronic devices. Questions included: what devices are owned; plans for new device purchases; how much time is spent each day using a mobile device for medical information; when during the day devices are used; how important the device is for various pursuits; and desirability of a medical journal app for full text articles.

Mailbox alert: The Centers for Medicare & Medicaid Services will be mailing revalidation requests to over a million health care providers, more than half of which are physicians. Providers who enrolled prior to the institution of new screening criteria on March 25, 2011 will have 60 days to recertify their enrollment or be blocked from billing Medicare. Providers worry that the already cumbersome Medicare enrollment process will negatively impact honest providers rather than catch the crooks for which it was intended.

This week’s New England Journal of Medicine includes Electronic Health Records and Quality of Diabetes Care. The authors looked at diabetes care data from 569 providers at 46 practices from 2007 to 2010, concluding that the “findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types.” The practices included safety-net providers and publicly reported performance data. On composite standards for diabetes care, EHR locations scored higher than paper-based locations for outcomes and also showed a higher annual improvement (after adjusting for insurance, age, sex, race, ethnicity, language, income, and education.)

The authors note that this is in contrast to other recent studies showing no improvement in quality for practices using EHR. They attribute their favorable results to looking at systems with clinical decision support that is specifically designed to improve care and which include mechanisms for care coordination and provider communication. Additionally, patients had to visit the practice two or more times during the study period for inclusion. The authors propose that this demonstrates a “mutual commitment to longitudinal care” which may have been lacking in other studies.

Medical Economics recommends some LinkedIn groups for social media savvy physicians to join. I was disappointed to not see the reader-created HIStalk Fan Club on the list. With over 1,800 members, it beats all but two of the groups listed.

Several of my friends who are consultants in the health IT realm spend most of their weeks traveling from practice to practice. Since food is no longer served in most parts of the not-so-friendly skies, road warriors are often subjected to the carry-on fare of their neighbors. One former colleague was so offended by his neighbor’s snack he e-mailed me from 30,000 feet looking for sympathy. Normally I’d tell him to “suck it up,” but he snapped a photo of the fare: Ahi tuna jerky. The aroma was bad enough that someone asked a flight attendant to speak with the passenger about putting it away. I’m not sure about the rationale behind dehydrating a perfectly good piece of fish, but to all the road warriors out there, may your flights be fish-free.

Have a health IT road warrior horror story? E-mail me.

Contacts

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

CIO Unplugged 9/7/11

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.

News 9/7/11

Top News

AmerisourceBergen Corporation completes its $35 million acquisition of IntrinsiQ. The company, which offers the IntelliDose oncology dosing application, will become part of AmerisourceBergen’s ION Solutions unit.

Reader Comments

From Auntie Social: “Re: Twitter. I’ve never found much value in Twitter. I’d rather have the Readers’ Digest version of a speaker’s talk versus endless Tweets of every point. Other Tweets are just self-indulgent promotions. However, with the recent earthquakes, hurricanes, floods, and fires, I am finally seeing its value and am hooked.” The fifth hottest Twitter topic in August: Hurricane Irene. Justin Bieber was ranked #2.

From Celerite: “Re: transparency. Vendors should not tolerate employees who use inside testing results to trade stocks of partner companies. Avoid costly mistakes by asking your vendor how they prevent this.” I’m afraid I didn’t really follow this, especially the customer angle, but maybe I’m slow.

From A. Tool: “Re: GE. They’re laying off Americans and moving their X-ray division from Wisconsin to China, but earlier this year, Obama picked Chairman Jeff Immelt as ‘jobs czar’ tasked with figuring out how to create US jobs. Is he really the most qualified guy to be providing employment advice?”

Acquisitions, Funding, Business, and Stock

One Medical Group closes $20 million series E funding, led by Maverick Capital. Epocrates co-founder Tom Lee is the CEO and founder of One Medical, which operates nine physician offices in San Francisco and New York. They use a self-developed EMR and other technology to minimize administrative overhead.

Billionaire Patrick Soon-Shiong forms a new company, NantWorks LLC, that will combine his technology businesses, some of which involve healthcare, under a single umbrella.

Sales

Sandlot adds five Texas Health Resources hospitals to its HIE platform.

People

SRS hires Michael P. Lang as EVP of sales. He was previously with RelayHealth and GE Healthcare.

MedQuist announces new executives from M*Modal, which it recently acquired: Michael Finke (president – above), Juergen Fritsch (chief scientist), and Detlef Koll (CTO.)

John Reiffenberger is promoted to CIO of the VA’s Black Hills Health Care System (SD).

Announcements and Implementations

Rhode Island’s HIE currentcare (highly annoying all lower case and then italics) is capturing clinical data using InterSystems HealthShare.

Covenant Health System and Memorial Hermann develop clinical integration programs, in which independent physicians and a health system collectively negotiate commercial payor contracts that include quality and cost incentives. Both programs use CRIMSON physician performance and population management tools from The Advisory Board Company. Covenant reports reducing their average length of stay by 1.1 days and having no reported cases of ventilator-associated pneumonia for 18 months, while Memorial Hermann’s physician group had a 29% shorter length of stay and 15% fewer complications than non-participating doctors.

Government and Politics

HHS grants $11.9 million to 40 rural health networks to support EHR adoption.

In Australia, New South Wales will spend $115 million this year on healthcare IT projects that include a statewide electronic medication management system, a specialist EMR, a system for ICUs, infrastructure upgrades, and new corporate systems.

President Obama, addressing the American Legion conference in Minneapolis last week, touches on electronic medical records:

At the same time, our outstanding VA Secretary, Ric Shinseki, is working every day to build a 21st century VA. Many of our Vietnam vets are already submitting their Agent Orange claims electronically. Hundreds of you, from all wars, are requesting your benefits online. Thanks to the new “blue button” on the VA website, you can now share your personal health information with your doctors outside of the VA. And we’re making progress in sharing medical records between DOD and VA. We’re not there yet. I’ve been pounding on this thing since I came into office. We are going to stay on it, we’re going to keep at it until our troops and our veterans have a lifetime electronic medical record that you can keep for your life.

Other

Healthcare leads employment growth, adding 30,000 jobs in August. Ambulatory health provided 18,000 positions and hospitals another 7,700.

Varian’s ARIA oncology system moves from last place in KLAS’s 2010 oncology system report  to first, beating out Elekta/MOSAIQ and IntrinsiQ/IntelliDose. Epic Beacon earned the highest overall performance score, but was not ranked because of a limited sample size.

Weird News Andy asks, “Who has the brains, who has the heart, and who has the skin in the game?” as he ponders this story: Britain’s NHS is considering turning over its transplant program to a private German company that pled guilty last year to illegally transplanting human organs. The Netcare subsidiary of General Healthcare Group paid over 100 poor children from Brazil and Romania to donate kidneys for its rich customers, performing the surgeries at a hospital in South Africa.

Sponsor Updates

• Allscripts is hosting a meet and greet career event for its services organization this week in Tampa.
• Aspen Advisors ranks #1 out of 350 firms for consultants’ attitudes on their firms’ business outlook.
• Comanche County Memorial Hospital (OK) selects the eClinicalWorks EHR for its employed physicians and non-affiliated practices.
• AdvancedMD offers free Webinars this month entitled, “Four Easy Steps to Qualify for Meaningful Use.”
• Surgical Information Systems goes live at Battlefords Union Hospital and Lloydminster Hospital in Canada.
• PatientKeeper CEO Paul Brient  will speak at the Stifel Nicolaus Healthcare Conference in Boston this week.
• MD-IT releases MD-IT iConnect for the Android operating system, enabling smart phone dictation, direct access to the MD-IT Platform, and the ability to view patients’ longitudinal history from a mobile device.

Contacts

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

HIStalk Innovator Showcase — Trans World Health Services 9/5/11

Company name: Trans World Health Services, Inc.
Address: 10509 Professional Circle, Suite 102, Reno, NV 89521
Web address: www.transworldhealth.com
Telephone: 775.852.9440
Year founded: 2003
FTEs: 7

Elevator pitch

We provide software and consultancy to help FQHCs, Community Health Centers, and other healthcare providers deliver better, more cost-effective care.

Business and product summary

We offer three product lines – Health Center Accelerator (real-time performance improvement software), Better Care Better Value Suite (comparative benchmarking and analytics software and services), and process improvement consultancy, which all work together to give Community Health Centers and other healthcare providers the tools they need to best manage their activities. We evaluate the client’s operation; apply analytics and experience to correct process flow issues; determine which meaningful measures need to be inspected and monitored; implement the appropriate libraries of performance improvement dashboards, alerts, and interfaces to the source data systems; and train and support the users.  

Users include all levels of management right through to front-line staff within the administration, finance, and clinical areas. Our cost model is based on packaged or risk-based fees for initial consulting and implementation, and a monthly license fee for use of the monitoring software and/or access to the benchmarking service. The system can either be locally hosted or delivered in a SaaS environment. By delivering real and measurable improvements in organizational performance, the return on investment for our
pilot site is greater than 500% on an annualized basis and paid for itself within the first three months of deployment.

Who is your target customer?

While our targets could legitimately be any healthcare organization from a small primary care clinic or physician practice to the largest integrated delivery network or payer organization, our current focus is on Federally Qualified Health Centers (FQHC) and Community Health Centers.

What customer problem do you solve?

We highlight and solve process and efficiency impediments that are preventing Health Centers from delivering optimal service levels so they can use their resources more effectively. This leads to cost reductions per patient encounter and increases the ability of the organization to deliver more care and treat more patients with current or slightly expanded resource levels in line with their core mission.

Who are your competitors?

Excluding competitors that are split between pure practice management consulting and pure complex dashboard, workflow, and analytics software providers (which are many and very expensive), there are few companies that offer pre-packaged, healthcare customer-specific dashboard software including pre-packaged efficiency best-practice consulting. Those that do exist, for example: onFocus Healthcare; DashboardMD; The Advisory Board; and MedeAnalytics; are mainly hospital and integrated delivery network focused. Within the Health Center marketplace, we have only found one that would appear to be even slightly similar in positioning: InterPoint Partners.

Why are you better than your competitors?

Our senior management each has over 25 years of senior expertise in healthcare performance improvement, process redesign, quality improvement, clinical utilization, and software development. That translates into knowing right where to go to uncover meaningful areas to focus and improve. Our dashboard software mashes multiple clinical, financial, and operational data sources and runs in real time, providing users with immediate access and drill-down capabilities to see why and where the problems are occurring either at the moment they can be addressed, or by identifying them through proprietary forecasting techniques to prevent problems from even arising through early warning alerts. Traditional single silo reports that are typically run days or weeks after the fact become irrelevant since they are produced too late to save the critical time-limited resources.

Pitch video created specifically for this Showcase

Customer Interview (CEO of a non-profit, community-owned health center)

Your organization was seeking financial and quality improvements. What results have you seen and how much of that was attributable to Trans World Health Services?

The actual results have been about $500,000 to $700,000 in increased revenue over the last 18 months, and about 70% is directly attributable to processes identified through the use of the accelerator and the consultative services.

Organizations always say they have plenty of data, but little information. Was that your situation before, and how has that changed?

We had an enormous number of spreadsheets and data. We also had data integrity issues. It wasn’t until TWHS did a forensic analysis and helped us to clearly define and analyze the data did we reach a point where we could actually begin making rock-solid data supported decision making. It has removed significant amount of doubt and discussion from our ability to operate.

If you were speaking to a peer from another group, how would you complete this sentence: "You should talk to Trans World Health Services under these circumstances:" 

If you plan on surviving the challenges of healthcare reform. This product and the services offered by TWHS will revolutionize the way Health Centers function and operation in the future. Don’t be caught later wishing you had made the investment.

An interview with Bryan Lang, founder and CTO of Trans World Health Services

Tell me about the company.

The market that we’ve targeted and really gone after in America is the Community Health Center market, Federally Qualified Health Centers, FQHC lookalikes, and rural clinics. This market has been tremendously underserved. They’re under tremendous increase in growth and demands. They’ve never had this technology available before.

We developed this technology that was used in every single hospital in England to be able to visualize and to predict where you’re going. We wanted to make it available to this very cost-effective market segment in America. That’s our focus right now.

What do we do differently from the others? Well, it’s a very underserved market. You have occasional dashboard add-on products to the HER. For example, NextGen has an add-on dashboard product, but you get to build your own using that product. 

Our approach is very different. There are five points in our framework. We want to pull information together so they can see and understand what’s going on. We have the analytics to identify variances and opportunities for improvement. We have the predictive modeling to show where they’re heading. We embed best practices into our software so that rather than building your own, you can see exactly where you are relative to others, relative to your own benchmarks, and what you need to do to make a difference. Finally, the data quality in the health center market is substandard in many cases; we really want to be able to show data quality improvement on auditing capability so they can trust their data. 

A simple example of combining the information from various systems involves patient scheduling. If a Health Center is not fully booking its appointment slots, we’re able to say, “Why is that?” and take a look at where the patterns are. Take a look from their population health management systems or their disease registries to say clinically who should be treated, and to be able to combine that, put a value associated with it. 

For example, “This is the value of your diabetic population that needs to be seen.” Combine that data to put it in front of them, in front of the booking people — the people who need to be seen so they can call them up, fill those empty appointment slots, and run a full schedule. That’s a combination using the practice management system, possibly a population health management system or an electronic medical record, and financial information to say, “This is how you affect a positive change by filling your appointment schedules more.” Ultimately that leads to increased revenue with existing staff, so that that’s better for their financial performance.

I ran across a presentation from Livingston Medical Group that was pretty impressive. Can you describe some of the results that they have realized using your product?

Livingston was a very interesting client. They brought us in originally because of the concern about losing productivity due to the implementation in electronic health record. What they wanted to do was have us make them more efficient.

We originally got into a common measure of productivity, which is their providers were not achieving three patients per hour. Three patients per hour essentially is the baseline that many Health Centers run on. We then were able to take a look in that by pulling the data together showing visually that this wasn’t a function of providers slacking off — this was a function of the fact that they had not filled those appointment slots. They hadn’t even provided the providers with enough patients to be able to see to make their targets.

Right off the bat, we were able to pull this information and change some of their fundamental processes so that they could start filling those slots and achieve better provider productivity and revenue. Unfortunately, about this time, they had a tremendous financial crisis. California stopped paying, and then they had outsourced their billing services. Unfortunately, their billing backlog started climbing. They were not able to generate bills. They were not able to bring in revenue. Their financial system went into a crisis.

At that point, neither the billing company nor they were able to see where the problems were. They just didn’t have access to the information. We were re-tasked to be able to open up the information, show the visibility, provide insight into where the problems were in the process. 

We found a huge number of bills that had never been transmitted. We found reasons for blockages and why they hadn’t been paid. We were able to very quickly open all this up so they could see where the problems were, see what they needed to do to solve the problem, solve the problems, and then see the revenue flowing through. It was a very, very narrowly averted crisis. As John will say, they came within a couple of weeks of not being able to stay operational. That was one of the things that we were able to provide for them.

We also showed them how we could provide a huge additional amount of retained earnings for them. Some were north of 700% was what our estimates showed if we changed a few of their fundamental processes and brought them in line with what best practices would be. You hear all this and you say, “Well, that’s something that systems aren’t going to be able replace consultants,” and, no they aren’t. We really believe that the consultancy component is a big part of what we deliver. However, by building in what a lot of consultants normally would do into the software, embedding those best practices, making it a problem-focused solution, so you can see if you have a problem in a given area. 

You can say, for example, “How financially effective are our letter campaigns – our recall letter campaigns to get patients to come back in?” It’s very, very difficult to get answers to that information. That’s a question that is asked in our system, so you go right to that question and click on that and you can go right down into where you can see letter campaign by letter campaign. How effective are you every time you send out a batch of letters to get patients back in, how many are there coming in, and what value is that offering to the organization as a result of sending these recall letter campaigns out.

That’s some of the things that we did at Livingston. We’ve had a very, very good working relationship with them. We originally came in there at saying, “We’ll work with you as long as you believe us to be effective in helping you out” and added to the library item after library item to our system so that we just keep on building module after module. It’s a very interesting market and we look forward to staying in it for awhile.

Healthcare customers tend to like solutions that have quick implementation and payback. What you’re offering sounds like technology and consulting services that require a commitment to change on the customer’s operational side. How do you sell that?

We sell that in two ways. We sell it in a traditional manner where that’s bundled together, where there’s a package of consultancy based on the problems that they’ve identified and very, very similar problems exist across the spectrum. Based on the problems identified, this is what we’d do for the system to be able to plug our system into the various other systems, to be able to present the information to their executive team, and then to be able to work through the top five problems or issues that they want to focus on. We generally package that in terms of an initial three months’ worth of consultancy as well as the software. From that, they make their own determination on how much consultancy they want to have going forward.

There must be a fair amount of overhead in getting those sales by helping them identify their problems and then convincing them that your combination of services and product can help resolve them. Do you see that as a limiter of your growth potential?

Getting in the door is very interesting. We try to minimize the cost of sales, because these price points are not at all what business intelligence systems would be for hospitals. We try to go to conferences or out where groups of them come together or meet in groups. We also do a lot of WebEx demos.

But the problems are very similar across the spectrum of Community Health Centers in America. Once we have a set of solutions, we can say, “You’re probably looking at this, this, and this. Let’s show you what this would be” and you get head nods around the table very quickly.

What do you hope to gain from this exposure?

We hope to gain a lot understanding of how we can make a difference in helping Community Health Centers. Ultimately, we’d certainly like to go back to our original market, which is hospitals, and take that and step forward from the traditional models, but really build that consultancy behind it to say, “Where are my problems and what do I need to do about the problems now, today, so that they don’t become a statistic tomorrow?”

Curbside Consult with Dr. Jayne 9/5/11

Today is Labor Day, which according to the United States Department of Labor, is dedicated to the social and economic achievements of American workers. I decided to spend a bit of time crunching numbers from the Bureau of Labor Statistics. The BLS predicted that healthcare would generate 3.2 million new wage and salary jobs between 2008 and 2018.

The Bureau also predicted that computer systems design and related services would be one of the fastest growing industries in the economy. Management, scientific, and technical consulting services were forecast to be the fastest growing, with an 83% increase.

Of course, a recession has a way of throwing a wrench into things, but I’d be interested to see how far off the mark these numbers are when it’s all said and done. ARRA and HITECH legislation have had and will continue to have a significant impact on employment in the healthcare IT segment.

The industry continues to move at high speed, not only on the development side, but in implementation as well. For the latter, I worry that too many organizations are moving at a pace that is foolhardy. Every day I hear another horror story from a colleague.

There was the one about the hospital that didn’t have their support structure figured out just four six weeks before their scheduled go-live on clinical documentation. Numerous project members tried to call a “time out” to arrange appropriate resources, but leadership forged ahead anyway in order to be able to go-live before a competitor. Physicians had no super users or trainers on the floors to help them, just a call center number.

Then there was a facility that didn’t have all the end-user hardware in place for a CPOE go-live, but went live anyway. Physicians were frustrated and actively developed ways to circumvent workflow, including hiding from nurses and phoning verbal orders from the doctor’s lounge. Juvenile, but understandable.

My personal favorite is from a small primary care practice. A few weeks prior to go-live, a competing practice hired away several key staffers. The practice used a temp agency to quickly fill the positions and stayed with their original go-live data. The temporary staffers had only a few hours of training and the practice didn’t block patient schedules to allow time for documentation. Tempers flared and staff refused to return to the assignment, making matters worse. Rather than pausing to regroup, the providers elected to continue to try to implement.

I don’t understand why anyone thinks that continuing to steamroll ahead when these situations come up is a good idea. Sure, some people continue to drive their cars with the “check engine” light on, but this is the equivalent of driving not only with a dashboard light illuminated, but also with a flat tire and smoke coming from under the hood. I can’t imagine that these same physicians would start a surgery with missing instruments or with a scrub tech who has never done the scheduled procedure.

It is folly to try to implement with an untrained staff, a recognized lack of hardware, or without an appropriately scaled support structure. It doesn’t matter how much time, money, or effort has been invested in the planning – it’s simply a recipe for disaster. If you are on one of these runaway freight trains, you know what I’m talking about.

October is approaching and many eligible providers and hospitals are going to try to achieve Meaningful Use attestation in the last 90 days of the year. I imagine I’ll continue to hear lots of stories from the field, as organizations that are simply not ready move forward, no matter the cost or chaos.

Have a war story to share? E-mail me.

E-mail Dr. Jayne.

Monday Morning Update 9/5/11

From It’s All Good: “Re: Sage Healthcare. Tom Chmielewski, VP of product management, leaves to ‘pursue other interests,’ following the recent departures of project management execs Mike Burger (PM/EHR), Rob Price (practice analytics), and Mark Martin (EDI). It’s an interesting time to be cleaning the product management house. Who’s minding the store for Stage 2 and beyond?” A source verifies that Tom Chmielewksi has left the company.

Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in August. Click a logo for more information.

Listening: reader-recommended Metric, female-led Canadian indie rock with only a little bit of guitar (reminds me a little of Muse, but more subdued). I was surprised that I missed a band this good, but it turns out I didn’t: I recommended them back in April 2009. Really good stuff, fresh and tight. I’m happy for the reminder to listen to them all over again.

My Time Capsule editorial this week, archeologically excavated from the ash heap of history circa 2006: “Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior.” A free sample of the equally free product: “No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines.”

InterSystems acquires Siemens Health Services France from Siemens, whose Clinicom system is used by 60 French hospitals. InterSystems will pair Clinicom with its TrakCare HIS, which offers electronic patient records, documentation, order entry, flowsheets, patient management, ED, OR, rad, lab, pharm, and billing. InterSystems acquired TrakCare and its Australian developer, InterSystems application partner TrakHealth, in 2007.

The joint VA-DoD EHR will yield an open source results, at least according to VA CIO Roger Baker. That statement didn’t come from DoD, which has a rich history as an intractable, contractor-enriching bureaucracy not interested in giving up control or collaborating outside its walls.

Indiana Secretary of Commerce Mitch Roob will resign to become president and CEO of WoundVision, an Indianapolis company that sells software that performs risk assessment and predicts pressure ulcers. He replaces founder James Spahn MD, who will remain board chair.

Microsoft will work with Social Interest Solutions, a non-profit that connects low-income individuals and families to health resources. Microsoft wants to use the organization’s knowledge to get involved with government health insurance exchanges.

This article says US News & World Report used HIMSS Analytics data to choose their top hospitals, which I thought was bizarre since HIMSS Analytics looks only at IT metrics and US News evaluates death rates, reputation, and several non-IT factors. Turns out the story is not really correct: USN&WR used the HIMSS Analytics information only to create a Most Connected Hospitals list by cross-referencing its own top hospitals with those that are EMRAM Stages 6 or 7.

We are collectively torn on the issue of whether Congress should rescind HITECH money. New poll to your right, for hospital employees: to what degree does your board review and analyze big IT requests before approving or rejecting them? I got the idea from Joel French’s interview, in which he marveled that boards of struggling hospitals approve $70 million system purchases (I assume he meant Epic) without any guarantee the investment will help the bottom line. My experience with hospital boards is that members (community movers and shakers, hefty donors, and a token smattering of social advocates) are mostly interested in the community relations aspect rather than deep diving into operational decision-making. Rightly so, hospital executives would argue. It’s like Congress: the outcome of  big decisions is a foregone conclusion since the execs have persuasively lined up the support they need long before the issue is brought up for a board vote.

This article says hospitals are using doctors with questionable objectivity or even “doctor bots” (example 1, example 2, both using the same doctor name but pictures of different people) to spit out medical advice via Twitter, which gain a following and reap AdSense revenue for the commercial sites they link to. The bots take existing articles of questionable value that have no references or detailed information, swap words using an electronic dictionary to make it look like something new, and then tweet links to it. My first thought was that laws would surely prohibit either falsely claiming to be an MD or dispensing questionable advice as one, but then I realized that (a) someone would have to file a complaint, and (b) those laws are mostly at a state level, so it may not be clear whose domain something like this falls under.

Cayman Islands Health Services Authority CIO Dale Sanders tells me the national healthcare conference will be held November 17-19 at the Ritz Carlton in Grand Cayman. I think I need to be there.

Meditech cancels plans to build an office building in Freetown, MA after the state historical commission overrides an archaeological firm’s recommendations and insists that the company dig, sieve, and log the contents of a two-foot layer of dirt covering 21 acres, which Meditech says would have taken at least a year. Town officials fear the company will look out of state for a substitute location. The mayor of Fall River, where the company already has offices, says his town will beat any Freetown offer.

Healthcare RTLS vendor Versus Technology announces Q3 results: revenue down 15.4%, net income –$15,000 vs. $38,000.

Oroville Hospital (CA) is profiled in a local publication for its impending implementation of the WorldVistA’s EHR, the first US hospital to go live on that particular variant of the VA’s VistA. From the Bob Wentz, the 153-bed hospital’s CEO: “Why do most healthcare organizations and doctors’ offices have software owned by a company? … What if they wanted to change to a different provider? What would it cost them to get out? And they would get no help transferring their data.” On the other hand, he’s not exactly objective – according to the article, he’s associated with Tenzig Corp., which it says offers hospital implementation services for VistA. I don’t know what happened to the hospital’s original plan to implement Medsphere’s OpenVista, announced in 2007, that caused them to switch to WorldVistA. It was announced a few days ago that WorldVistA EHR 2.0 earned ATCB certification as a complete inpatient and ambulatory EHR, with Oroville proving money, enhancements, and coordination.

More from Vince Ciotti on Gerber Alley. Care to share some vendor reminiscing from back in the day? (that being defined as pre-1990, let’s say, involving visionaries or now-defunct companies). E-mail Vince.

Continua Health Alliance releases its 2011 Design Guidelines for personal health devices, with new coverage of Bluetooth Low Energy temperature sensors, ZigBee networks in which a single sensor communications with multiple hosting devices, and user identification over a Wide Area Network interface.

A survey in Ireland finds that almost 50% of people diagnose themselves using the Internet instead of seeing a physician. Nearly half of those surveyed said they would use SMS or IM to communicate with their physician if available.

A hospital in England ditches the “do not disturb” vests that nurses were wearing to prevent distractions during medication administration. Patients hadn’t complained, but newspapers had run quotes from other areas in which visitors claimed to be miffed at being told to leave the nurses alone until they had given all their meds, even though studies have shown significant error reduction when nurses are allowed to focus on the task at hand. One might logically conclude that if it weren’t for the social aspect of being hospitalized, hospital units should be closed off to outsiders just like the psych ward or an auto garage. You’ve got dangerous equipment and drugs being hauled around, bodily fluids flowing, people trying to focus on life-and-death tasks, and patients having life-threatening events, all while visitors are getting in the way, asking questions, and spreading germs. It’s like trying to run a busy restaurant kitchen where patrons are allowed to wander in and out and maybe reach around the chef for a sample.

A futurist’s view of sleep technology and the “hotel room of the future” predicts that within 20 years, sleepers will be able to choose their dreams and share them with others; wear active contact lenses that will deliver 3D TV images directly to their retinas; and participate in virtual lovemaking where feelings and emotions are shared via skin sensors.

Government contractor CSC acquires Baltimore-based Maricom Systems, which provides informatics and data management systems used by HHS. 

Allscripts files suit against Virginia-based consulting company Visus, alleging trademark infringement. Allscripts claims the company used its company and product names without approval to promote EHRs. Visus has removed references to both Allscripts and NuWave from its site (before and after image above) after both companies insist they have no relationship with Visus.

A nursing professor in Canada conducts a telenursing pilot project in which nurses monitor home-based diabetic patients using smart phones and the Internet. Part of the project involved creating an interactive telehealth platform that is being commercialized by McGill University with Magellan Global Health, of which the professor appears to be president and COO after the company was merged with her medical tourism company. Being a professor has to be the best job in the world. You get a substantial paycheck for teaching a few classes a week at a pretty campus that offers lots of entertainment opportunities, you get grant money and eager beaver student research assistants, and there’s plenty of time to run consulting or product businesses on the side.

Jeffrey Kriseman, an Arizona State University PhD student, is profiled for developing an open source messaging system used to exchange public health information for disease surveillance. It’s being used by Nevada providers to submit reportable lab results to public health agencies, qualifying them for HITECH money. Kriseman is finishing his PhD in biomedical informatics.

Strange: the FBI investigates a prosthetic manager at University of Minnesota Medical Center, accusing him of convincing patients to replace their perfectly useful artificial limbs with new ones, after which he would sell their old ones on eBay.

Stranger: a 17-year-old part-time doctor’s billing clerk is arrested in Florida after posing as a physician’s assistant, convincing the hospital’s HR department to give him a PA badge so he could work in the ED where he examined patients, dressed wounds, and performed CPR on a patient in cardiac arrest. He was caught after he pestered HR to upgrade his badge so he could hang out in the doctors’ lounge, but gave the excuse that he was working undercover for the police. He had previously been dismissed from a Sheriff’s Explorer teen police program for wearing a deputy’s badge and bulletproof vest in public.

E-mail Mr. H.

Time Capsule: Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior

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 July 2006.

Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior
By Mr. HIStalk

An editorial in the latest American Journal of Managed Care titled “Defending Computerized Physician Order Entry From Its Supporters” stresses that physician order entry (CPOE) and clinical decision support systems (DSS) are separate entities, despite popular perception. Ross Koppel, a sociologist and Penn professor, says that sloppy terminology has confused the respective benefits and shortcomings of CPOE and DSS.

Ross’s sociologist view is interesting. We’re expecting a lot from immature CPOE and DSS systems that most hospital executives can’t define, even when they’re plunking down hard-earned capital dollars to purchase them.

CPOE is a smart typewriter that, standing alone, has little ability to improve patient outcomes. It prevents transcription errors, although those seldom harm patients because they’re usually caught anyway. CPOE makes it easy to choose common order defaults instead of “winging it.”

Beyond that, the benefits (both clinical and financial) come from DSS, not CPOE. (I’ve often joked that hospitals could use e-mail as a poor man’s CPOE system – just let the doc free-text whatever he or she wants and send it to the appropriate department, thereby eliminating transcription and turnaround time errors for free.)

Commercially available DSS systems are, unfortunately, mostly frightfully immature, even more so than CPOE. Early adopters share war stories of nagging alerting, inflexible third-party rules, the inability to customize and personalize, and problems with performance-sapping rules engines incapable of delivering alerts of any more sophistication than the old hard-coded screen edits. No wonder doctors have been underwhelmed.

Still, the real problem is right down Ross’s alley. Hospitals usually buy CPOE and DSS because they’ve failed to control physician behavior otherwise — often euphemized as “reducing practice variation” or “practicing evidence-based medicine.” They want software to do the dirty work that they can’t or won’t: telling physicians that they’re wrong and demanding that they change. When docs don’t follow the electronic cookbook’s rules any better than the paper ones it replaced, systems and vendors are blamed.

I’ve been involved in two CPOE/DSS implementations, both involving large IDNs and well-known vendors. In both cases, hospital administrators ill-advisedly shot their patient safety technology wad on CPOE, confident that it would improve patient care better than any other investment (despite ample contradicting studies). Physician adoption was universal in one, minimal in the other, but one element was common: 90% of the expected DSS benefit never materialized. Pre-implementation enthusiasm gave way to the grim reality that the system wasn’t going to be much help in changing practice patterns. We purchased DSS, but implemented a smart typewriter.

No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines. Displaying a few dumbed-down alerts won’t convince them they need to change. But if your hospital has already spent a few million on CPOE and DSS thinking that was the case, you’ve learned that already.

Maybe physicians will recognize the next generation of systems as their ally, not their enemy. After all, they want the best outcomes for their patients, too. Where they disagree is that we have the answer right now with these first-generation CPOE and DSS applications that we can’t even define.

News 9/2/11

Top News

CMS issues its final rule on changes to the e-prescribing incentive program and includes multiple hardship exemption categories for EPs. EPs have until November 1, 2011 to request a hardship exemption for the 2012 eRX payment adjustment.

Reader Comments

From CDH: “Re: Epic trainers. More disgruntled ones, this time at Central DuPage Hospital. Of 27 hired, eight have left. They were told they would be certified, but in reality were only credentialed. The principal trainers have purely HR backgrounds without any go-lives under their belt. Training plans are being revised daily as they have not yet stopped the back-end build for the November 6 go-live.” Unverified.

From Arch Moore: “Re: WVHIN and Thomson Reuters. You reported that deal back on January 24, more than seven months before they announced the contract. I heard contract negotiations hit a big snag in June when Thomson Reuters announced to the world (and Wall Street) that they were thinking of getting rid of their healthcare business. Rumor is it was a surprise to everyone. WVHIN must have been impressed with CareEvolution since the deal went through.” Thanks for reminding me. I was thinking I’d said something about this from a reader’s rumor report back in the winter.

HIStalk Announcements and Requests

Wondering what you may have missed this week because you still haven’t signed up to get HIStalk Practice? Wonder no more: EHRA tells CMS that requiring providers to submit patient-level data for CQMs is too big a burden. I annotate toenails using Healthfusion’s MediDraw. athenahealth launches a PCMH accelerator program.  Retail medical clinics are flourishing.  If it’s fall, then it must be time for user group meetings.

On HIStalk Mobile, Dr. Travis covers all the news about apps, home health technology, and mobile health, but also summarizes what it takes to succeed in developing successful apps for consumer health.

On the Jobs Board: McKesson Consultants, Epic Implementation Project Manager, SCC/SMM Consultants. On Healthcare IT Jobs: Epic Physician Trainer, Clinical Nurse Analyst, NextGen Trainers / Consultants.

Allow me to compress my usual Thursday spiel into one-word imperatives, just for the sake of brevity: (a) subscribe; (b) Friend; (c) report; (d) click; and (e) thanks. Did you get all that?

Listening: Ghost on the Canvas, a moving last studio album from Glen Campbell, diagnosed with Alzheimer’s this year. I was never much of a fan, but maybe I should have been given this album’s outstanding songwriting, vocals, and guitar work. To my ears, the 75-year-old, who has sold 45 million records in his 50 years in music, has never sounded better or benefitted so much from fresh-sounding production and contributions from folks like Jakob Dylan and Billy Corgan. It’s everything you’d expect from someone looking back at a life well lived: reflective and poignant, but optimistic (A Better Place says it all). Glen never got much attention from the music industry because he straddled genres (country? pop?) and was goofy on TV and movies, but somebody must be blackballing him if this album doesn’t reap a truckload of awards even without the sympathy vote.

Happy Labor Day, celebrating the rapidly diminishing ranks of us who aren’t out of work or happily drawing government entitlements while practicing leisure. You fashion purists will no doubt be placing your white clothing and seersucker suits into storage next week as summer unofficially ends. For me, it’s college football, perhaps some well-crafted barbeque, and a beer or two unless Mrs. H unveils plans of her own. I will most likely post Monday Morning Update this weekend since that’s what I do, even though fewer folks will read it (time to slip in something really scandalous!) Enjoy the holiday.

Acquisitions, Funding, Business, and Stock

Despite reporting “disappointing” Q2 results Wednesday, SAIC CEO Walt Havenstein speaks positively about the company’s recent acquisition of Vitalize Consulting Solutions:

The addition of Vitalize will expand SAIC’s health solutions portfolio in both commercial and federal markets to help customers better address electronic health records implementation. The combination of Vitalize’s expertise and integrating commercial off-the-shelf software for electronic health records and systems with SAIC’s information integration data analytics, and cyber security capabilities creates a powerful combination in the marketplace.

SAIC’s Q2 numbers: revenue of $2.6 billion (a 6% y/y drop), EPS of $0.32. Analysts expected $2.77 billion and $0.35. Shares fell 13.5% on Thursday, making it the top loser on the NYSE and hitting an all-time low, after the company said reduced government spending is hurting its top line.

Ingram Micro announces a Healthcare Partner Network of healthcare VARs and managed service providers.

Shares in NextGen parent Quality Systems hit a 52-week high Wednesday before slipping a little on Thursday. Market cap is $2.66 billion. Big holders Sheldon Razin and Ahmed Hussein own $459 million and $423 million worth, respectively.

IV equipment maker B. Braun Medical sues CareFusion for patent infringement, claiming CareFusion’s Alaris smart IV pumps violate its patents that include wireless communication with hospital clinical information systems.

Sales

Twelve Community Health Centers in Puerto Rico choose SuccessEHS EHR/PM for their 190 providers and 26 sites.

People

AHIMA names Lisa Spellman as its representative to lead the health informatics committee for the international standards organization ISO/TC215. She was previously with HIMSS and Allscripts.

Steven Liu MD, founder and chairman of Ingenious Med, is named Physician Entrepreneur of the Year by Modern Physician.

Announcements and Implementations

The Buchanan County Health Center (IA) goes live on its first phase of Meditech.

The Greater Dayton Area Hospital Association and HealthBridge announce the go-live of the Greater Dayton Area Health Information Network, which connects four hospitals and over 200 physicians.

The fishing city of Navotas in the Philippines rolls out EMR at nine health centers and one “lying-in” clinic. Midwives will be equipped with 22 BlackBerry smartphones, allowing them to collect patient data as they make house visits.

Physicians connected to Brooklyn HIE can access patient records via from their ClinicalWorks EHR.

Optum enters a strategic relationship with Monarch HealthCare (CA) to manage the clinical operations of its 2,300 independent physicians.

athenahealth launches athenaCoordinator to facilitate care delivery among hospitals, practices, and other caregivers.

Government and Politics

A scathing and well-written reader editorial about “inane” Maryland Medicaid isn’t too keen on accountable care organizations:

Mr. Ransom seems to think that doctors, including the rural ones, will flock to the idea of reward for cost savings and better care management. The people who are enamored with these payment models are mostly lawyers, journalists, politicians, medicolegal pundits, bureaucrats and software companies, especially the last that endlessly inundate the medical profession with ideas that neither materialize in enhanced care for patients nor in increased income for doctors. Instead these ideas have resulted in jobs and increased income for government auditors, care deniers and people who connect doctors to the care deniers, paper pushers and bean counters; folks who will never set eyes on a patient in their lifetime.

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Innovation and Research

A doctor from Wichita State University (KS) develops an iPhone concussion symptom detection app for high school football teams. Concussion Manager, which costs $25 per player, tests before-and-after balance, memory, and reaction time on the sidelines, allowing coaches to take the player out if warranted.

Other

Insiders are responsible for the majority of PHI breaches, with 35% involving employees snooping on their co-workers and 27% the records of friends or relatives. Loss or theft of physical records or equipment account for an additional 45% of breaches.

Fred Trotter reviews the VA’s recently announced VistA Custodial Agent, concluding that, “it doesn’t suck (much).”

Weird News Andy finds the Yale School of Medicine announcement of a paper-free curriculum a little weird (there’s that word again), balancing the $100K annual savings against the $600K upfront iPad cost, inevitable repair bills, and the likelihood of buying Apple’s hot new model every couple of years as being similar to “federal government thinking.” He likes the idea, but finds predicted print savings to be an unconvincing way to justify the cost.

Weird News Guy sent over this link: if you insist on removing animals from their natural habitat and locking them up thousands of miles from home so humans can stare at them, at least give them iPads like the Milwaukee County Zoo has done for orangutans. They play with apps on the donated iPads and will soon have Skype, which will allow them to videoconference with their inmate counterparts elsewhere. That’s obviously a testament to the iPad’s ease of use. Wonder how they’d fare with an EMR? 

Former Carthage Area Hospital (NY) CIO Skip Edie says he was interviewing an out-of-work CIO for an IT position when the hospital’s CEO called the candidate in Edie’s office to tell him he should interview for Edie’s job. Edie says he saw the writing on the wall and turned in his four-week notice, only to be marched off the property. Two days later, Edie’s wife, a patient accounting manager for the hospital, gave her four-week notice and was also escorted out within 10 minutes, she claims. The CEO says both left on their own and would not comment further.

Strange: the Christmas Eve death of a radiologist from Jackson Memorial Hospital (FL) is ruled an accident by the sheriff’s office, which determined that the woman’s necklace became entangled in the shiatsu massager she was using in her bedroom, strangling her. Her husband, also a doctor, says he found her unconscious. The FDA is advising owners to not only throw the specific massager (above) away, but to break it into pieces and put the parts in different batches of trash.

Great news if you are good looking: more attractive people earn an average of $250,000 more during their careers than those who are less good-looking. Not only do the best-looking third of the population earn 5% more money than the average or ugly, they also get better deals on loans. And if you are a pretty woman, you are more likely to marry a higher-earning man. I’m now wondering if Mr. H would give me a raise if I invest in some “cosmetic upgrades.”

Sponsor Updates

• Merge Healthcare’s OrthoEMR v4.0 receives ONC-ATCB certification.
• Hayes Management Consulting reports that Ohio State University Physicians’ use of MDaudit has helped the practice reduce regulatory risk.
• Lancaster General Hospital (PA) selects Wolters Kluwer Health’s ProVation MD software.
• Healthwise will participate in next week’s The Forum 11  Annual Meeting of Care Continuum Alliance in San Francisco.
• NextGen is offering a webinar September 12 to demonstrate its Inpatient Clinicals.
• API Healthcare is exhibiting at the this month’s ASHHRA Annual Conference in Phoenix and the Healthcare Staffing Summit in Philadelphia.
• Vocera smart phones and badge communicators can now receive alerts and notifications from Extension, Inc.
• Greenway Medical announces that PrimeMOBILE now available on iPad as a native app.
• Healthcare Innovative Solutions will participate in this month’s Kansas Hospital Association’s Meaningful Use Summit in Topeka and the South Carolina Hospital Association / South Carolina Medical Association TAP Conference in Hilton Head.
• The Orthopaedic Institute of Central Jersey and Orthopaedic Spine Institute select SRS EHR for their combined 19 providers.
• 3M Health Information Systems partners with Krames StayWell to encode Krames StayWell’s patient education library using the 3M Healthcare Data Dictionary.
• Imprivata and Teradici announce updates to Teradici PCoIP firmware and Imprivata OneSign software that will provide integration and interoperability of PC-over-IP (PCoIP) zero client devices with authentication management and single sign-on software.
• Medicare awards Faith Community Hospital (TX) incentive funds following its successful Meaningful Use attestation using to Prognosis EHR.
• Aspen Advisors publishes two new case studies: Fairview Leverages Seasoned Project Managers to Ensure Successful EMR Rollouts and University Hospitals Prepares for Meaningful Use Attestation. 
• The Fullerton Radiology Medical Group (CA) picks McKesson’s Revenue Management Solutions for its 10-physician practice.
• The Advisory Board and Mercy Clinics announce their inaugural Health Coach Training course in Des Moines, IA in October and November.
• ZirMed partners with training solutions provider Contexo Media to launch ZirMed University, an online portal that provides training on the ZirMed solution as well as courses for continuing education credits.

EPtalk by Dr. Jayne

Earlier this year, the American Medical Association launched a contest to identify an innovative new application for handheld use. The top ten finalists have been announced and voting is open through an AMA website. You do, however, have to be a member to vote. Finalists are in two categories (Physician and Resident/Medical Student) and include applications for tracking hospitalized patients, surgical equipment preferences, and resident duty hours. Personally, my favorite is “What’s Not Covered,” which helps determine what organisms might escape a patient’s current antibiotic regimen.

Speaking of apps, HHS, through the Office of the Assistant Secretary for Preparedness and Response (ASPR) has issued a challenge for a Facebook application to connect friends who agree to check on each other during emergencies and communicate to the community via social media. “Additional accolades” are promised to entries with a “fun or game-like atmosphere for the user.” Maybe some smart developer can cross Angry Birds with a zombie apocalypse theme. Even smarter Facebookers will be sure to friend Inga, Mr. H, and yours truly.

I mentioned last week that Hofstra North Shore-Long Island Jewish School of Medicine is training their incoming medical students as emergency medical technicians. According to a reader, it’s not as new or revolutionary as it sounds – this was done in 1980 at The Medical College of Pennsylvania:

Bradley K, Anwar RA, Davidson SJ, Mariano J. A time efficient EMT-A course for first year medical students. Ann Emerg Med. 1982 Sep;11(9):478-81. PubMed PMID: 7114594.

Another reader alerted me to news about the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, which I mentioned as recently announcing it would interface with a similar system in Ohio. Kentucky House Speaker Greg Stumbo is seeking information regarding the system’s use (or lack thereof) by the Kentucky Board of Medical Licensure. Stumbo wants to know why the Board isn’t using data on prescribing habits across various geographic areas to investigate suspect physicians.

The article notes that only 30% of Kentucky physicians are using the system. Let’s see: I’d wager that 0% of suspect (or even slightly shady) physicians would use the system, so I’m not sure how more scrutiny of the data would really be a benefit. It goes on to mention that Public Citizen ranks the state as having the twelfth strictest board for disciplinary actions per 1,000 physicians, having been third and second in previous measurement periods.

September is Women in Medicine Month. I’m thankful for the women who came before and paved the way for the rest of us. I’ve been privileged to have some outstanding women as mentors. We’ve come a long way since Elizabeth Blackwell became the first woman to graduate from a US medical school in 1849. There’s still a bit of inequality out there, however: even with record numbers of women in medicine, my medical class was the first one in our institution’s history where women outnumbered men. We felt this acutely when 60+ women were crammed into a gross anatomy locker room designed to hold 20 women. The men’s locker room had 40 empty lockers. Go figure.

Duplicate Drug Checking
A Reader’s Response

I’m one of those readers who works for a vendor of a clinical drug database, though not the one referenced in the article. For the sake of transparency, I’m in product management at First Databank (FDB).

I agree that duplicate therapy is one of the more challenging domains of medication decision support. In the article under discussion, there was a scenario in which two different physicians wrote aspirin orders five minutes apart for a patient who had undergone a cardiac stent procedure. The authors agreed with the duplicate therapy alert that was fired (though they brought to light that the doctor missed it because it was buried amongst nuisance alerts, which I’ll touch on below).

However, in another context, two orders for the same drug will not warrant a duplicate alert (for instance, when a patient gets a one-time dose in the ED and then the order is continued on the floor). Venue matters. And that’s just one context among a number of different contexts that need to be considered, such as change in level of care, timing of the order, same or multiple clinicians placing the order, etc. Most of these factors are outside the purview of the drug knowledge base.

But I am not passing the buck. It is critical for the drug knowledge base to keep evolving to providing decision support that considers additional context.

One approach is to have the duplicate therapy knowledge driven off of pre-configured orders rather than the drug products. This requires that structured orders be employed by the vendor system, but can more easily identify orders that are intentionally given together, such as a bolus with a continuous infusion, or an order for which the nurse decides on the route (also referenced in the article). One of your sponsors, an MD, uses our structured orders, along with their own logic, and asserts that duplicate therapy does not have to overwhelm. 

Of course, as many have pointed out, dialing back the sensitivity in the content is another obvious component. We have done a lot of work on this over the last year. When I entered some of the key examples in the article into our test system, I found that we matched the authors’ recommendations.

We hit on the previously mentioned example of two aspirin orders, but not on the other alerts which the authors felt were spurious and caused the doc not to notice the true duplicate. Similarly, we satisfied the recommendation to generate a hit for an order for metoprolol IV on top of metoprolol PO.

Mr. H.’s insight that attributing severity for duplicates so that a site can turn off the less severe ones “en masse,” as is done with drug-drug interactions, also needs to be tackled. We do support our users with a solution that enables them to easily customize—turn off, or selectively turn on—alerts even without that attribute. 

We recognize that the volume of alerts is still too high for duplicate therapy as well as other domains and are investing heavily in addressing alert fatigue.

Contacts

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