Today is Halloween, which is without a doubt my favorite day of the year. It’s one of those days where even adults can act like kids and playing dress-up is OK. People love to mark the occasion by visiting haunted houses, watching scary movies, and telling ghost stories.

So everyone grab a popcorn ball and some of those little peanut-buttery candies in the orange and black wrappers and turn the lights down low, because it’s time for Dr. Jayne’s Top Ten List of Horrifying and Frightening Things.

10. HIPAA compliance zombies. You know the type — those that cite HIPAA as the reason for everything, regardless of relevancy. I had a run-in with one of these who told me (as the referring physician) that she couldn’t fax me a copy of a consultation note (which was addressed to me, but had only arrived with one of three pages present) unless I sent a release signed by the patient. Reason: HIPAA. (I bet in her head it was spelled HIPPA.)

9. Physicians who demand that allergy checking and other EHR decision support be completely disabled because they “know all that stuff already.” I understand (and loathe) alert fatigue as much as the next gal, but seriously, I can’t imagine that there’s a physician who has never accidentally prescribed a medication to someone who was allergic to said medication. I know I’ve done it and you know you’ve done it at least once in your career, too. If that doesn’t scare you into leaving the allergy checking active, it should.

8. Shortages of common medications, including vaccines and chemotherapy drugs. Often these are low-profit margin generics and are made by only a handful of manufacturers. If one of them experiences production issues, the entire supply is threatened. Something to think about the next time you read about all drug makers being branded as greedy.

7. Celebrities and politicians dabbling in the public health sphere by adding to vaccine hysteria. Want to see something really scary? Pictures of vaccine-preventable diseases. I wish they’d spend their time advocating anti-drug and anti-obesity propaganda instead.

6. Patient-facing software vendors who do not have licensed physicians on staff (or at least as consultants.) I’m not sure how they evaluate usability, let alone suitability for patient care. The only thing scarier is the hospitals and health systems that actually purchase this software.

5. Hospitals and ambulatory organizations that implement patient-facing software without physician leadership or oversight. I recently moonlighted at a JCAHO-accredited facility that had an allegedly certified system. However, for some reason, the prescriptions printed without a medication route. The system also had “never use” abbreviations on the prescribing screen. I’m not sure why they were printing on paper in the first place, but with obvious patient safety and regulatory issues to address, I didn’t pick the eRx battle that day.

4. Congressional rule-making that increases health care costs in the name of balancing the budget. I’m talking about the ridiculous change that made patients obtain prescriptions in order to use flexible spending accounts to reimburse over-the-counter drugs. Let’s see, the reason they’re over-the-counter is because they don’t require a prescription. But now, to save money, I have to get a prescription for my OTC med (after paying a co-pay), take it to the pharmacy, waste their time submitting it to my insurance to get the denial because it’s OTC, then pay cash for it and submit it to my FSA overseer. If they thought this process was going to deter patients, they were wrong (I’m not sure they thought it that far through the process, though) because patients are coming in droves for these scripts and some offices are charging fees for preparing these extra prescriptions. There’s a whole lot of spending going on here and it’s your fault, Congress. Next time you’re going to do this kind of thing, can you please ask a primary care doc his or her opinion first? I’d rather be counseling the obese, hyperlipidemic, hypertensive diabetic about his cardiac risk than writing another prescription for little Johnny’s diaper cream.

3. The fact that the item above is only a teeny, tiny, microscopic piece of what Congress has done or is trying to do with healthcare. I’ve got an idea: Let’s form a Congressional HMO, enroll all the legislators and their families in it, and use it as a pilot site for health care reform proposals. Once they prove efficacy on a captive population, only then should it be allowed to see the light of day. Muahahaha!

2. The emergency department at almost any urban hospital and quite a few suburban and rural ones, too. Overcrowding is often the norm, and due to fright-inducing Acts of Congress such as EMTALA, everyone is treated regardless of the ridiculousness of their chief complaint or its appropriateness for the emergency department. I know some hospitals were (and still are) guilty of patient dumping, and that is indeed a crime, but having to perform a medical screening examination on a patient who presents with “wants to know if I’m dyslexic” at 11 a.m. on a Saturday is a waste of resources. And yes, I really did see this patient, but only after the nurse had to spend his time assessing the patient’s pain score and asking him if he had an advance directive. This was in an ED that sees about the same patient volume as that of Massachusetts General Hospital, so it’s not like we were just sitting around shoe shopping on the Internet.

1. Watching providers adapt to ICD-10. I’m hearing lots about ICD-10 readiness and how software and billing systems will handle it, but am hearing very little about how organizations are actually going to train their providers to identify the appropriate new codes for old diseases. Word in the Doctor’s Lounge is that providers think EHR vendors will just automagically map the codes for them. They apparently missed the fact that it’s not a 1:1 conversion. If your vendor is telling you they’ll do this, you should be as frightened as if you just ran into Jason Voorhees and Freddy Krueger chatting at the coffee machine.

I hope after all this you’re not too scared to open the door to trick-or-treaters tonight or to do some candy hunting of your own. Maybe you’ll stop by Casa Jayne and not even know it. I’m one of the “good candy” houses and my office at work is also well provisioned. I stocked up on Sweet Tarts and Sprees should a certain sassy sales exec decide to stop by. I’ll be in costume (of course!) but I’ll give you a clue — you’ll be able to figure me out by my shoes. I’ll bet Inga doesn’t have a pair of these!

E-mail Dr. Jayne.

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Farzad Mostashari MD, SCM is National Coordinator for Health Information Technology of the US Department of Health & Human Services.

Has HITECH spurred EHR adoption to the level anticipated?

I think so. I think the EHR marketplace had been kind of growing, but slowly. After 20 years, we were at 20% EHR adoption. Then, with the passage of HITECH, I think it is undeniable.

You talk to practically any provider out there and they have either acquired, they are shopping for, or planning to get an EHR. The ice has broken run a very real way. The survey results from last year found that among primary care providers, it went from 20% to 30% in one year for having a basic EHR. I expect this year to be 40%. Next year, 50%.

That is pretty remarkable. As the Secretary put it, HITECH has been successful at “lighting the spark” that is now ignited in terms of getting this modernization of healthcare to happen. I think it had its intended effect.

Now for the long term, this is not a one-year or six-month or 18-month story. The longer test of HITECH will be: are we able to serve as a foundation for healthcare that costs less, that has higher quality, that is more patient centered and safer? We are going to have a little bit longer time before we can answer that definitely. But so far we, are hitting the milestones.

What do you think? Do you think HITECH has had its intended effect on EHR adoption?

Yes, it has had an effect, but what has been the benchmark? Was there a specific goal on the onset as to where we would be in Year One, Year Two, Year Three? There is still is obviously a lot of resistance out there for one reason or another.

Healthcare doesn’t change very quickly. It can take four years to get one hospital to go through an implementation. People who have done actual implementations of EHR know how hard it is to get one hospital to move. We did not say,” If we hit this number, we are successful. If we do less than that, we are unsuccessful.” But, I think by any metric, the early indicators are extremely positive.

Usability is one excuse that providers use for not adopting EHR. Is ONC doing anything to try to do to improve usability in the marketplace?

I think it is more than an excuse. I think that there really is a frustration on the part of many providers with usability of the systems they purchased. I was recently at my reunion for my residency class in internal medicine. Someone came up to me and said, “Thank you for what you are doing, but the EHR that we have is really lousy.” And I said, “I am really glad I didn’t choose it for you!” [laughs.]

That is one difference between the approach we took in the States versus what the UK did. They said, “We are going to do the procurement. We are going to choose the systems and that is what you are going to use.” We said no, providers are going to choose what system is right for them. I love that market-based approach.

The only problem is that providers consistently say, “I didn’t know what I bought until three months after I bought it. I didn’t know what the usability of the system was really going to be, because all I saw was these demos I had from people who knew their way around the system and knew spots to avoid.”

I do think usability is a serious issue for us — vendors, doctors, academics, and the government — to tackle together. The right question that you asked was, “What do you think you can do about it?” I think it starts with having some baseline expectations around user-centered designs, around user-based testing.

I hope we’ll have some common sense, consensus-derived standards for what are some aspects of usability that you actually can measure. I think if we can bring that to the industry and to providers, we will have done a great service.

Would that involve making usability a requirement in certification?

No. I think the first step is simply just to say, “This is how you would measure usability,” and vendors are free to test their products against this. There will be more transparency. People, when they are purchasing systems, they can say, “What is your usability on this or that metric?” and incorporate that into their decision-making. This is something we will have to monitor and adapt as we go along.

We are very aware of the policy balance between the protection of the safety of the patient, certainly, and responding to what we are hearing from providers that usability being a major sore point for them, but not stifling innovation and not saying, “You shall do design this way,” which is a sure way to not get the innovation that we want.

As the bar continues to be raised in Stage 2 and Stage 3, what happens if providers aren’t able to meet those requirements? Does the money not get spent? Does the stick not get used?

What we heard from the Policy Committee and the vendors and providers was that people are going to need more time in Stage 1 before they do step up. We have heard that. We agree with the logic of the Policy’s Committee recommendations on that. Under that scenario, people would have 2011, 2012, and 2013 at Stage 1 before they would have to move up to the Stage 2 requirements.

One of the things that we are going to be doing in rule-making is around what Stage 2 is going to look like. If you look at what the Policy Committee recommended, it is going to strike the same sort of balance we struck in Stage 1. Where Stage 2 requirements are ambitious, they do they move the ball forward, but they maintain connection and continuity with what went before. So, it is not a dramatic departure from what Stage 1 is. It is more evolutionary than revolutionary in terms of what Stage 2 is compared to Stage 1.

Our goal is for it to be achievable, but ambitious. I am sure will hear plenty of feedback as to whether we hit the target.

When is the last time you used an EHR?

Wow. I have had the great fortune of seeing a lot of different EHRs, but the last one was when I was in New York City, when we were not just using them, but actually helping create more usable public health than prevention-oriented functionality in the systems that we worked with there.

Was that with a variety of systems, or was that when you were implementing eClinicalWorks?

We were implementing eClinical, but also Epic at the Institution for Family Health and NextGen, so working with a number of different products to particularly implement decision support quality measurements.

Much of the country is critical of the Obama Administration and many feel that perhaps there’s been failure there. What is your opinion?

I am very proud of the work that we have done on HITECH and in this administration. I think a lot of what we have done sets the foundation for doctors and hospitals to provide care that is safer and more effective, and that is more affordable and more patient-centered. I have no second thoughts about the rightness of the approach this administration has taken on this issue that I am working on.

I also want to make clear that I think the Affordable Care Act is greatly underappreciated, in terms of how beyond what it does for prevention and beyond what it does for coverage. There are really, really fantastic aspects of the Affordable Care Act that people don’t know about and just don’t understand — around care delivery, around giving options for providers who want to deliver care differently and have different payment models.

There is a lot of attention focused on the ACO regulations that just came out. I think there is widespread opinion that they are greatly improved, and I absolutely agree. There are a whole host of different payment models that are enabled. Also, the Innovation Center, that can test different models and roll the out to the rest of Medicare.

I just think people think the Affordable Care Act is just about insurance, but it is about so much more than that. There’s a lot of good stuff there.

When you met with the HIT standards committee, you urged them to move forward on the HIE piece of it. Are you encouraged that we are moving forward?

I think we are, absolutely. I think the message was heard and they made recommendations for moving ahead on standards that are not going to be perfect, but will be good enough, and we will continually improve them. I felt that unless we move on moving data — not just structuring it within systems, but actually having standards for how that information gets transported — we are going to be me missing a big opportunity.

This is the most important question of all. In the last couple of years, Dr. Blumenthal earned HISsie awards for Industry Figure of the Year. If you should win it for 2011, are you going to accept your award in person at HIStalkapalooza?

I would be happy to.

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From What About Bob?: “Re: HIT Stack Exchange. Took a year to get enough people to commit, now we need the masses to ask and answer questions so the site can survive. Give us nerds some love.” HIT nerds or nerd-wannabes should take a look.

From Orlando Cepeda: “Re: Dr. HITECH’s Rainbow Button Initiative Rap. Lyrics are here.” Ross did great with these. Here’s a section where he lyrically explains the VA’s Blue Button medical record download:

I been to far-off lands, tryin’ to do what’s right, I had dreams and plans, when I got caught in a firefight.
Now back in the states, I’m a wounded warrior, all my doctors are great, but sometimes I ain’t sure,
Exactly how to keep it straight, or know just how to navigate, all my meds and lab results, and how they relate,
But now I push the Blue Button, and it’s all there to see, just a click of the mouse, and it all comes to me. 
And it’s not just for this vet, heck that ain’t nuttin’, just see what stuff *you* get, when you hit the Blue Button.

From Arcturus: “Re: exposure. You recently mentioned our company on HIStalk. We got several inquiries from companies wanting to be a VAR for us, several VCs inquired, and it caused some buzz. Very much appreciate your doing this.” My pleasure. If I’ve heard about something and it interests me, I’ll almost always mention it. It does get a bit tough when companies try to press me to write about them and (a) I don’t find their product or service all that interesting, or (b) I’m too busy. People sometimes forget that HIStalk is an after-work thing for me, meaning I can’t chat on the telephone during hospital working hours and I’m not usually willing to give up some of my handful of free hours each week to watch a demo or comment on a white paper, especially if it’s a company or person I’ve never heard of.

Three-quarters of respondents say it’s silly for docs to be required to crank out engaging, unique narrative for every repetitive patient encounter, but a fourth don’t want HHS paying for encounters described in boilerplate. New poll to your right: can healthcare reform’s needed improvements in cost and quality be realized with today’s IT systems?

My Time Capsule editorial from 2006: Misys Lesson: Mama, Don’t Let Your Vendors Grow Up to Be Conglomerates. I don’t like to show paternal favoritism toward my editorial offspring, but I admit this is one of my favorites, with hyper-caffeinated ramblings like, “Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their Web site, ‘The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.’ That’s about as unemotional as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential passion-filled payout.” 

Unrelated (mostly, anyway – it does involve exercise and personal motivation) but for a guaranteed Monday morning smile, check out this brilliant commercial for Contrex mineral water, which I can’t get out of my head. I know Inga will like it.

The merry pranksters at Epic put up a Halloween-inspired Web page that includes interactive spider-smashing. I’m sure it will be gone after Monday, so last call.

Encore Health Resources announces that Joe Boyd has replaced co-founder Ivo Nelson as board chair. Boyd has been advising the company for the past 18 months and has worked with Ivo and CEO Dana Sellers before at Healthlink, where Joe was board chair, Dana was president and COO, and Ivo was CEO until they sold the company to IBM in 2005. Encore has been quickly ramping up revenue and headcount and was named the #2 best HIT advisory firm by KLAS. Ivo will remain on the board.

Coincidentally, I’d been thinking for several days about something Ivo told me in my 2009 interview, reminded of it while reading the Steve Jobs biography:

This is nothing more than me doing what I love to do. If it leaves a legacy, I think that’s OK, but I’m not sure what you really get out of that. When I’m hopefully up in my 80s or 90s and I pass away, the people that are going to come to my funeral are going to be my family. It’s not going to be clients. It’s going to be people that are close to me personally in my personal life, my kids and my sisters and a handful of friends probably that I have. That’s a legacy. You say, "What kind of legacy would I want to leave?" and it would be a legacy that’s more related to being a good father to my children and being a good husband to my wife. That kind of stuff. Not anything I do professionally.

Inga encroaches on Weird News Andy air space in summarizing this story as, “I guess the guy wanted the doctor to give him a hand.” A homeless man with a history of mental problems rushes into a urologist’s office gushing blood, saying he had just accidentally chopped off his arm on a homemade guillotine. Nurses call 911 (probably the best course of action for a urology practice dealing with an amputation,) and when police check out his wooded camp, they find a huge guillotine built from scavenged timber, along with his recently severed arm. One world-weary police officer observed, “My goodness, a lot of thought went into this.” One can only imagine the intended purpose of his handiwork given that his self-amputation was accidental.

Vince’s HIS-tory covers a company I’m not familiar with: Computer Synergy. He says its product was so progressive that its still running in dozens of hospitals and its successor firm was just acquired a few months ago, with details coming next time.

Shareable Ink CEO Stephen Hau is named Innovator of the Year by the Nashville Technology Council. They haven’t posted pictures of the winners yet, so I’ll go with a company team lunch pic that I found on Facebook, with Stephen on the right.

CHIME Foundation gives Allscripts CEO Glen Tullman its 2011 Lifetime Achievement Award.

Omaha-based transplant systems vendor HKS Medical Information Systems is acquired by an investment group led by Argenta Partners LLP. Louis Halperin is named CEO and Paul Markham COO.

AventuraHQ names neurosurgeon and venture partner Teo Dagi MD as CMO. How about these educational credentials: Columbia undergrad, Hopkins MD/MPH, Harvard MTS, Wharton MBA, Queens University DMedSc. I profiled Aventura, which offers a virtual desktop for efficient clinician access, in July.

Small hospital systems vendor CPSI announces Q3 numbers: revenue up 2.8%, EPS $0.54 vs. $0.45, missing expectations by quite a bit and falling short of previous guidance. System sales were down, which is not exactly cheery news knowing that the HITECH effect is close to peaking. Shares were hammered, taking a 28.5% haircut at Friday’s close as the Nasdaq’s biggest percentage loser by far. Above is the one-year chart of CPSI (blue, straight vertical line on the right) compared to the Nasdaq (red) and S&P 500 (green). The stock had been climbing nicely, but tanked enough in a single day to barely put it above the indices for the year. Market cap is $564 million.

Speaking of stock, shares in MedAssets jumped 14% Friday, with an analyst attributing “weakness across the rest of the health IT group” that includes Cerner, Quality Systems, and CPSI. Michael Cherny of Deutsche Bank Securities says MedAssets “has no exposure to electronic health records” like those previously mentioned EHR vendors whose earnings reports this week were “disappointing” or “confusing.” That may just be a reaction, however, since after-hours trading shows MedAssets, which reports earnings Thursday, giving back the full amount of its Friday gains. And while MDAS shares had a nice Friday, the past 12 months haven’t been nearly as kind, with shares down 40%. The one-year share price graph shows compares MedAssets (blue), Cerner (green), and Quality Systems (red).

The Rockford, IL paper covers the HITECH status of local hospitals. OSF Saint Anthony uses Epic and has been paid $2.5 million in MU money. SwedishAmerican, with Meditech and Epic, has earned $7.5 million for the hospital and $4.5 million for physician practices. Rockford Health is installing Epic in its practices and hospital and will attest in 2012 and 2013, respectively.

For my techie brothers and sisters: Tom Munnecke (software architect, VistA) has an after-dinner chat with Ward Cunningham (inventor of the wiki) and Ralph Johnson (computer science professor and author) on the subject of “refactoring",” specifically with regard to VistA. Tom’s iPhone made a darned nice video with good audio. It’s kind of like Live from Daryl’s House for geeks. I got myself thinking about my techie sisters reference – nothing’s more attractive than a smart, cynical female programmer, of which there are sadly too few.

Meaningful Use and Beyond, a book by Fred Trotter (healthcare open source expert) and David Uhlman (CEO of open source EMR vendor ClearHealth), is published by O’Reilly.

The Federal Trade Commission will require the parent company of prescription data vendor IMS Health to sell two product lines of its acquisition target SDI Health to receive FTC’s approval for the sale to occur. SDI’s tools for promotional audits (estimates drug marketing costs) and medical audits (analyzes physician prescribing by condition) would give IMS Health a monopoly, according to the complaint by FTC, which must approve the buyer of the two product lines.

I feel like a Facebook stalker for posting this, but I will anyway. I noticed a “Like” for a recent post from Mark Work, IT director at ProMedica Health System in Toledo. Checked out his info, it linked to a site for Madison Avenue Band, a ten-piece cover band with horn section and no computers (thank goodness.) Check the video above – these guys (including Mark, I assume – looks like him on keyboard, but I’m not sure) are real-deal rockers. Check out this smokin’ version of “Vehicle” and here of “Wild Nights.” Not only do I love the music, Mark’s Facebook pics are a trove of cool 70s music history – Foghat, Uriah Heep, ELP, Queen, Foreigner, Heart, Styx, and Yes. Well worth my half hour to watch the videos and check out the pics. My arms are tired from air-drumming.

Cisco CEO John Chambers and the King of Jordan launch the Jordan ICT Task Force, which will promote Jordan’s HIT vendors.

GetWellNetwork is named Emerging Business of the Year by the Montgomery County (MD) Chamber of Commerce, which featured the company in a three-minute overview video.

A state-mandated Web site that allows Ohio consumers to compare hospital performance is apparently going down the tubes. The Ohio Hospital Association is supporting a bill that would eliminate the requirement that hospitals provide their data for the Ohio Hospital Compare site, saying they already send the same data to CMS’s Hospital Compare site that anyone can use.

Texas Health Resources runs an ad campaign around its use of AirStrip Cardiology that includes billboards (“Now Your EKG Gets Here Before You Do”) and TV commercials (above).

Merge Healthcare says 11 radiology practices have bought its RIS v7.0 to achieve Meaningful Use. One of its customers brings up the Complete vs. Modular HER issue, saying, “If you utilize a modular system, you as the provider, the onus is on you to find another product or combination of products that meet the remaining criteria before you can claim to be using a certified EHR and qualify for MU funds.”

Chiropractors are getting their HITECH payments, too.

Medtronic hires Symantec to assess the security of its insulin pumps after a McAfee team demonstrates how a hacker could control them from up to 300 feet away. 

In England, a terminally ill, mostly blind 14-year-old boy has his iPad stolen from his hospital bedside, which had been donated my Make-A-Wish Foundation so that he could enjoy it for the short time until he goes fully blind. All is well, however – a local supermarket was touched and bought him a replacement, with his reaction to it pictured above.

A new poll finds that only 34% of Americans like the Affordable Care Act, while 51% view it unfavorably, the worst numbers since it was introduced last spring.

A Massachusetts court dismisses a lawsuit against Tufts Medical Center, sued by a patient who claimed their faxing of her hysterectomy surgery records to her employer’s fax machine violated her privacy because co-workers read them. The patient had given the doctor instructions to send the records there, but still feels her lawsuit was justified.

E-mail Mr. H.

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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 October 2006.

Misys Lesson: Mama, Don’t Let Your Vendors Grow Up to Be Conglomerates
By Mr. HIStalk

I doubt most Misys Healthcare customers are following the company’s corporate drama as it plays out in England. They want to go private. Wait – no, they just want to sell it to someone! The CEO will lead a takeover group. Hold on, he just resigned! Their board chair is optimistic about their prospects. Shhh … did I just hear him say the company’s software was old and non-competitive? What’s that smell? Shareholder torches burning outside the castle door!

Healthcare makes up about a third of the Misys portfolio. Within that, the lineup is a salad bar of old, mixed-heritage applications from Per-Se, Medic, Amicore, Payerpath, and Sunquest. Sometimes the blended family gets along, but often they don’t (and I’m speaking both technically and culturally.) If you know of any healthcare IT conglomerates in which any of the above isn’t true, that makes one of us.

Why did a British financial software company get into the US healthcare IT market in the first place? Well, let’s just say it wasn’t a noble desire to better humankind. From their Web site, “The main objectives were to reduce the Group’s exposure to a single market (insurance) and to increase its size in an already consolidating software sector.” That’s about as unemotional as an accountant’s nimble calculator fingers determining the net present value of three dinners with Myra the secretary vs. the potential passion-filled payout. At least they were honest.

With just two software sectors, Misys is focused, at least compared to bigger conglomerates that dip 1% of their corporate body (a toe) into the healthcare waters. Since Misys is the only company actively considering deconstructing healthcare IT out of the soup, what are we learning from their troubles?

• The best way to make money as a conglomerate is to break it up into parts that are usually worth more than the whole and are more affordable to more prospective bidders.
• Conglomerates often reduce corporate value unless they can harness some elusive benefit in supply chain management, reproducible management excellence, or marketing, which few can.
• Conglomerates are fine until you want to sell to someone else who doesn’t share your unconditional love for some of the uglier corporate children.
• Product investment matters more than that impressive brand name. You may be getting free milk every day, but at some point, you better start saving up for a new cow.
• In most cases, button-down corporate management saps out the innovation that made formerly independent companies interesting and successful in the first place.
• Healthcare IT divisions of big companies live and die by the quarterly (or twice-yearly) numbers. Ambitious division executives will sell their souls to avoid being called out as company laggards among their peers. Long-term planning goes out the corporate window.
• Healthcare IT customers carry little weight with toe-dippers. Are GE brass more worried about the flatlining former CareCast or sagging toaster sales at Wal-Mart? Does patient safety come up in Siemens corporate meetings as often as power generators?

Just about every outcome suggests that Misys Healthcare will be carved off and sold. If you’re a foot soldier, hang in there at least long enough to see if the change benefits you. If you’re a suit, Misys publicly labeled its healthcare unit as underperforming, which isn’t a highly valued resume bullet for the new owners, so you might want to beat the traffic out. If you’re a customer, anything or nothing could happen, but you’re stuck either way. If you’re a prospect, there’s a lot of uncertainty ahead, so act accordingly.

And if you’re a vendor focused only on healthcare IT, especially if you’ve resisted the urge to cash out by going public, I say thank you.

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Company Name: ImplementHIT
Address: 4001 S. Decatur Blvd., Las Vegas, NV 89103
Wen Address: www.optimizehit.com
Telephone: 888.457.3332
Year Founded: 2009
FTEs: 20

OptimizeHIT provides an innovative training platform that enables both pre- and post-implementation training to significantly drive clinical adoption via a more comprehensive, yet easy way for physicians to access the training curriculum.

Business and Product Summary

OptimizeHIT offers a sophisticated, physician-friendly, dynamic EHR training portal. OptimizeHIT’s staff, comprised of MD EHR experts and PhDs in education, have developed innovative, patent-pending learning technologies that integrate seamlessly with any practice setting or specialty. With proper EHR training significantly impacting the success or failure of any implementation, OptimizeHIT’s training suite delivers powerful and relevant training that is easy for physicians to access, significantly reducing the time they spend out of clinic to learn how to use the EHR.

With this technology, organizations are realizing higher rates of clinical adoption beyond Meaningful Use, with a bonus of significant cost savings via a reduction in trainer hours consumed during live training time and time physicians spend out of clinic for training. Management can view learner progress on training as well as their productivity in graphical form, using real-time implementation statistics, and objectively understand the status of each site’s implementation. The solution can also allow on-site support to customize each physician’s learning curriculum to their specific knowledge gaps, keeping their learning time focused on what is most needed for them to learn.

Our cost model is based on per month/per user charge, which can accommodate a small physician’s practice or clinic as well as large, multi-location hospitals. Furthermore, we recently introduced a new no-risk pricing model, where there is no cost per user till a user actually completes their basic EHR training. Once a user becomes an intermediate or advanced user, the EHR benefits to patient safety and ROI quickly climb in to the $1000s per provider.

Target Customer

Large academic hospitals all the way through two-physician practices use this solution successfully.

Customer Problem Solved

Clinical adoption. It is when physicians achieve intermediate- and advanced-level use of an EHR that the greatest patient safety benefits and cost savings are realized. Our portal is built specifically for health IT training, recognizing the unique challenges of training physicians and other healthcare professionals with very little spare time. We are not only getting physicians ready for Meaningful Use Stage 1, but later phases and beyond. Customers live with the portal can easily distribute system upgrade training, new best practices, and even ICD-10 training when the time is right.

Competitors

Other groups that provide standard EHR training with go-live being the end point, like most EHR vendors and a few specialized service consultant groups. However, no one else offers a solution that targets post-implementation training, and that is where you achieve the most efficient leaps in EHR use.

Advantages Over Competitors

We don’t recommend moving all pre-implementation training online, but through a hybrid approach that was featured at HIMSS this February in a presentation by one of our customers. We want to minimize the amount of time physicians must spend out of clinic to learn. Furthermore, we know that physicians learn more advanced features of the EHR a lot faster once they have had an opportunity to use an EHR, which is why our portal integrates the more comprehensive post-implementation training. By providing one integrated solution for pre- and post-implementation training, along with enabling implementation management to see learning and productivity progress in real time, we are much better than any competitor.

The system is also task-based, which means it is more relevant to the learner instead of talking about EHR modules that are abstract for beginner users. Furthermore, because it is task-based and since we deliver standard EHR tasks from beginner to advanced — including Meaningful Use for 10 specialties — the effort to customize the learning content down to the physician specialty is greatly reduced, which makes the content far more relevant and meaningful to the learner.

Pitch Video Created Specifically for this Showcase

Customer Interview (an applications trainer for a large orthopedic practice)

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

The first problem solved by using OptimizeHIT’s computer-based training (CBT) modules was improving our training model as we began to prepare our EHR rollout. We were looking at hours of preparation and actual classroom training time with users who were all over the map in terms of PC skills. It was a daunting project and would have required users to be out of clinic and coming in for Saturday training classes as well, which would have meant overtime for some employees. While we still had a few Saturday classes, it was held to a minimum. Our providers never had to take time out of clinic and the overtime was also kept to a minimum.

Anyway, then I was introduced to Andres by a friend, and as soon as I started talking with him, I knew we would work together. His company created customized CBT modules for us using our workflow and screens so that our users were learning how to use the EHR on screens that were our screens – it wasn’t a generic or canned version of training. They worked closely with us to make sure the training modules included great detail. We were able to put much of the responsibility for basic training on the users and they rose to the challenge. We did have to manage the process, checking to see that they were completing the CBTs and where they were weak so we could do focus training with them. But for the most part, our employees did a great job. For those who needed a bit of encouragement, they got “the e-mail” reminding them their CBTs were mandatory.

As far as the impact on the practice, I would say that our users, especially our medical assistants, were well prepared on their first day of live. By the end of the first week, they were fairly confident users. We intentionally designed the training process so that the medical assistants could act as a resource for their providers and they do just that.

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

To be honest, I’d say don’t even try to train your users without really well designed CBTs, and that you can’t go wrong with OptimizeHIT. They are professional, efficient, epitomize customer service, and even more, they are kind and are comfortable with humor. It was just fun to work with this company and we ended up with an excellent product. I have said exactly that to other organizations.

For those of us who have been in this field for a few years, we have recognized for years that end user training/education is the great hole in the process of implementing healthcare software. Vendors have not, historically, educated the clients (there’s a difference between training and education) and in turn, the clients do not understand the importance of educating their users. With healthcare records, you want confident, accurate users and that means educating them to use the system, but to also think about their use of it critically. Andres and OptimizeHIT focus on exactly that – they are combining adult educational concepts with technology and offer it to sites. 

We call it the gift that keeps on giving. Besides training users for our rollouts, we now use the CBTs for new hire training, upgrade training, user review etc. We are also looking forward to using their new tool to create a post-implementation educational process as a continuing education requirement for our clinical staff and providers.

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

If you are a mid- to large-size organization and have a small EHR build/training team, you will simply not be able to meet the demand of build, workflow design, workflow validation, and training. And if you don’t have anyone on staff that has a background in adult education, then you need to consider using this company.

If you’re planning on taking your users through a set of screens and allowing them to do hands-on once or twice – you cannot really consider them educated, and it will show when you take the system live. They will have no confidence and won’t even know when they are making a mistake, so they won’t be able to report it. It could be months or longer until you see that your users are failing to use the system accurately or efficiently.

An interview with Andres Jimenez MD, CEO, ImplementHIT

What’s wrong with the way organizations train physicians to use technology?

There are several issues. Implementation is typically the endpoint of most training curriculums designed for health IT implementations. The challenge is that without the user ever using a system, it’s impossible to teach them everything they will need to know to become an advanced user. Maybe not impossible, but extremely difficult and inefficient.

The challenge with trying to move your training over time to extend it beyond implementation is having a vehicle or a platform like ours to deliver just-in-time training that’s convenient, relevant, and very powerful for end users and extends beyond implementation and builds upon the experiential knowledge that users gain after the first week or two of using an EHR, where learning more advanced features is far more efficient.

Tell me about the technology that you use. I know you have or are seeking a patent.

It runs on Google Web Toolkit, Google Apps Engine. It’s kind of like Gmail for training. It essentially is real-time, Web-based technology. We’ve structured it in a way where it provides real-time statistics to management. It allows us to plug into practice management systems so we can deliver to learners who may be physicians. We can deliver to them real-time productivity metrics, like how many patients are they seeing per day, how is their increase in learning affecting the number of patients they’ve seen per day, how they’re billing, their level of coding. We’re able to pull that data real time. That’s one of the ways that’s very, very unique.

Very often, training and on-site support are two different processes going on in an implementation. We try to combine them, because we feel on-site support is a great opportunity to further the user’s knowledge on the system. We’ve provided input so that the on-site support personnel can continue to assist learners and then they can fine-tune or focus their training curriculum. If the doctor has 10 minutes or an hour to log in to the training programs late at night, they can focus in just on their specific knowledge gaps instead of starting from scratch. That’s another thing that I think is very innovative about the program.

We really feel that it’s going to become the future of health IT training, where it’s task-based, it’s not necessarily module-based. We can assign specific task-based skills that are usually on the two- to three-minute timeframe or are using bite-size training clips. We can assign specific ones to learners based on their role, based on their specialty, and even within two specialties that are different sites. We can customize training at that level. That makes it very relevant, and that’s very important for adult learners.

I’m sure one of the things that you’ve experienced both as a physician and an entrepreneur is that physicians typically don’t like to sit in a classroom with other physicians. Either they get frustrated with the pace or they just don’t feel like they’re being treated individually enough. Is what you’re offering an alternative to that, or is classroom training still a part of their experience? How do you feel about how classroom training works with doctors?

You’re absolutely right. That is one of the challenges that we hear from other physicians. I think on-site training still has an important role. One of our customers at HIMSS this past February presented some results where they were able to reduce the amount of training time, to cut training time in half because they had a Web-based component and a live training component.

Another one of our customers was able to train their physicians without any time out of clinic before the implementation. Now that doesn’t mean that they didn’t do any on-site live training, but what it means is that they were able to move a significant component of the pre-implementation curriculum to a Web-based component through our platform. Then they were able to focus in the on-site session just what the learner needed to go live and do well those first two weeks. Then, since they have the platform, they can allow the users to progress in their use and start learning more advanced functions at their own pace.

So I agree, the traditional on-site training approach has its weaknesses. A curriculum that only relies on that is part of the reason that you see so many implementations failing, because you can’t get that customization. But even on other types of computer-based training, we’re not the only ones that deliver a training online, but our platform allows to do it in a way where it’s very easy to customize it.

One of the other challenges that we see is that many vendors offer e-learning that is just a number of clips by modules in the EHR that are geared towards one specialty. If you’re a cardiologist, the last thing you want is sit down and watch training – especially when you’re having a busy day – with the clinical context of a kid with an ear infection and how to take care of him with the EHR. We make it easy to inject that relevance in training with our platform, which is extremely important for adult learning to get their interest piqued and  their attention level is high. They really learn, and when you want them to perform, they’re able to recall that information.

How do you convince a prospective client who plans to do their own training or pay the vendor to do it to that they need you instead?

We partner with many vendors, so we never want to go necessarily head-to-head with the vendors. They certainly have their place in providing training, but the challenge for most vendors is that they’re scrambling right now just to acquire market share. They haven’t necessarily been able to provide the focus needed on a very specialized approach on training. Not just training that gets them to use the basics, but that drives to Meaningful Use and beyond, where you get the advanced features and the greatest safety benefits for your patients and the greatest return on investment.

We typically tell our customers that we’re providing a platform that is very innovative. It will help your users get to advanced clinical adoption faster with less of an impact on overall productivity. One of our customers was able to get their physicians to full productivity about a week after implementation. That had a huge impact for them. They’re an orthopedic group and some of their physicians see 60 patients per day. We combine our training with the phased rollout approach to make sure that they can return to full productivity. Those are the things that are very important to a lot of customers.

Obviously cost is a factor. We’ve been able to show, for instance at HIMSS this past February, a return on investment of $6 for every $1 invested in our training. 

It’s important for our customers that this platform stays around for awhile. While they may have a cost incurred on just the implementation training, they’re working with the vendors, etc. our platform can stay around. They can start with Meaningful Use functionality and the platform, but right around the corner, there are updates from the vendor, ICD-10, and many other initiatives. They can build into the platform additional training. That’s been very important to our customers. They can do that on their own.

What do you hope to gain from this exposure?

We really feel that our platform is going to be future of health IT training. The fact that not all computer-based training is created equal, that our training specifically drives adoption, gets folks to full productivity faster, and we have a number of customers that have really appreciated and seen the benefits of that. 

What I’m hoping to get from the exposure is actually people getting the chance to hear about us. We’re a small organization, so we don’t have the advertising budgets or the large-scale sales team that existing companies have. Because we’re a smaller group and very innovative, we’ve been able to produce a platform that’s very cutting edge. We’re hoping with this exposure that we can get the word out and more people come on to our site and learn. We’re happy to provide more demonstrations and happy to connect prospects with existing customers, because they’ve been our greatest sales force to date.

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