From Mintonw: “Re: NorthCrest Medical Center (TN). It’s the first hospital to receive a Medicaid EHR incentive payment by just using ED patients and an EDIS, in their case Allscripts ED 7.0, the only EDIS certified as a Complete EHR.” The hospital’s press release is here. SVP/CIO Randy Davis says the 109-bed hospital was already in the high 90s percentile and didn’t need to change much. The hospital says it will meet Medicare’s MU requirements later this year.

From Tommy Tune: “Re: Jim Fitzgerald. Definitely no longer at Dell. My source says it was his choice.” Unverified.

From Rigoletto: “Re: GE Healthcare. Says Centricity Practice and EMR can’t generate accurate Meaningful Use reports. See link here to its letter to customers.” It sounds like basic technical stuff, made interesting only because the company admits that there could be problems for clients who have already attested – the corrected reports may show that they didn’t hit the required thresholds after all . GE says they will provide “further instruction on how to work with CMS related to any changes related to attestation.” The recommend changes in practice are: (a) choose specific race/ethnicity codes instead of free text and don’t choose “multi-racial,” “Hispanic,” or “other;” (b) use specific options for describing smoking status; and (c) us prescribing to measure patient medication education since issuing handouts that the EMR did not suggest doesn’t count toward Meaningful use. I don’t see any of this as a slam on GEHC other than they are awfully late in identifying the problems, which seem pretty obvious. Let’s hope the triggering event wasn’t an eligible provider getting in trouble with CMS.

From Dr. Nurse: “Re: McKesson CEO John Hammergen’s $131 million one-year compensation. Their products are a patchwork of jury-rigged acquired code which has never been upgraded and they clearly have no idea what a usability standard is (the joke is, ‘just keep scrolling down and to the right and you’ll eventually find the right checkbox.’) They perform paper-based billing for specialty practices (Fedexing boxes of paper forms to Pittsburgh – really?) and use antiquated reporting systems that cannot be altered (you can’t add columns due to system limitations). His compensation package is obscene considering McKesson’s ongoing loss of market share, discernible lack of innovation, and adherence to outdated methodologies and business practices. He’s not alone – the CEO salaries of third-party payers are off the grid, too.” Above is the five-year performance of MCK (blue), the Dow (red), the Nasdaq (green), and the S&P 500 (yellow). A big chunk ($112 million) of that compensation was from stock options that he won’t get to exercise every year. At least shareholders (including employees) got to make money along with him. Not to mention that IT isn’t the company’s bread-and-butter business, although that product line is still profitable.

From Por Favor: “Re: WNA. I totally love Weird News Andy, but as a Canadian, I’m appalled by the actions of the clinicians at the hospital. There once was a time where it didn’t matter how you came to be in the ER. I was in the ER several years ago when a young man of about 17 was brought in with a terrible leg break. He was from England on a rugby tour with his school. I remember him crying and trying to tell the doc he had insurance and hoped the doc would take care of him even though he couldn’t produce the documents right there. I’ll never forget what the doc said: ‘Son, I don’t care if you have insurance or not. I’m going to take care of you. Rest easy, try to relax, and do not worry. You’re in Canada and under my care.’ That demonstrates why doctors became doctors in the first place – to heal the sick. It is so sad that somewhere along the way, we have lost this. Please tell Andy to keep the weird news coming – it’s always fun!” The example was from Canada, but I’m certain we have at least as many such cases on this side of the border.

From Neil Louwrens, MD FACP: “Re: physician’s malpractice award as a patient at Northwestern. I’m vehemently opposed to the current tort system, but passionately for justified litigation, including substantial earnings to injured patients. I’m equally and passionately against trivial pestering from the legal profession, claiming wrongdoing and pain-and-suffering that runs up ridiculous tabs at this nation’s expense. The physician in this case is a patient and the case must rest on that. When we fight for tort reform, we are asking for some sense of sanity to be infused back into the system. Nowadays, even the best doctors doing the right thing are still sued. It’s a lottery mentality and the nation picks up the tab. Most physicians who have wronged someone are remorseful and wish they could compensate the patient for their wrongdoing, but to watch the lawyers walk away with 50-60% of the winnings is a travesty. Give patients their money back! Wall Street’s wrongdoings pale in comparison with what the Association of Trial Lawyers of America has managed to carve out for themselves in the current system, backed and perpetuated by the preponderance of lawyers in Congress. Tort reform will reform this inequity, but will not touch the earnings to the injured for their costs, such as justified pain and suffering. We need tort reform – not ‘we’ as physicians, but ‘we’ as patients.”

Thanks to Jacob Reider, ONC’s new usability guy, for taking the time to interview. A reader had tipped me off that he’d taken the job, I e-mailed him, and he asked me to hold off for a couple of days (the details weren’t quite finalized, I surmise.) He not only gave me the first interview, but didn’t tell anyone about his new job until I could get back from vacation so we could do the interview and have the scoop here. Above is another interview he did on usability before he took the ONC job. ONC is interested in reaction to NIST’s usability paper, which I’ll be providing once I’ve had a chance to read it over. Hopefully those readers who constantly gripe about poor EMR usability will channel some of their energies into reviewing the NIST document since it’s the best hope so far (short of some super-secret vendor development project that nobody’s seen yet) to improve the healthcare IT usability landscape.

Listening: reader-recommended Elizabeth Cook, who sounds a good bit like Dolly Parton. The youngest of 11 children, moonshiner dad in prison, took dual degrees in accounting and computer information systems, and worked as an auditor for PWC.  She writes most of the songs, which have brilliant lyrics and range from the good old boy rowdy (“Say Yes to Booty”, “Sometimes It Takes Balls to Be a Woman”) to the starkly moving (“Heroin Addict Sister”).  Modern country is one of my least-favorite genres because it’s been taken over by industry-groomed, overproduced pretty faces faking credibility in the pain and loss department while fronting pop music that has the absolute barest minimum of mandolin or steel guitar, but this is the real deal.

My Time Capsule editorial this week, squinting its eyes upon seeing its first daylight since October 2006: GM and Intel are Right: Healthcare Is Too Expensive, but Technology Alone Can’t Fix It. A taste: “Most US job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching from China or India.”

Good stuff on HIStalk Mobile, where Dr. Travis Good covers How to Make Money on Consumer Health Tools and Enterprise Provider Apps. He started out covering straight news, but now that he’s comfortable, he’s putting together some really good analysis and opinion posts that I appreciate since I’m learning from them. Sign up for the e-mail update over there if you like what you see. Thanks to our sponsors there, too: founding sponsors AT&T and Vocera and platinum sponsors Voalte, 3M, Thomson Reuters, Patientkeeper, Kony, and Access.

I’ve said before how much I like using speech recognition for certain tasks (composing e-mails and sometimes writing HIStalk, for example). I was about to upgrade my Dragon Naturally Speaking when I found about Windows Speech Recognition. Like DNS, it’s great for dictation and controlling Windows by voice. Advantages: its system performance seems to be better, its accuracy is almost as good (96% vs. 99%), and it’s included free in Windows 7 (you’ll find it in Control Panel.) Well worth experimenting with since everybody can talk faster than they can type and sometimes your fingers just get tired.

Here’s the latest HIS-tory from Vince, this time with Part II of JS/Data, with lots of info about its eventual (many-named) acquirer.

Most respondents (some of them with considerable skin in the game) think HITECH should pay providers for starting their EHR use even before HITECH started. New poll to your right: should HHS require doctors to generate personalized, unique documentation (i.e., no boilerplate or macros) in order to be paid?

Dr. Jayne brought up an interesting point in her latest post: the government seems to want everybody to be fooled into thinking that Medicaid is insurance rather than a social program that takes money away from taxpayers and gives it to non-taxpayers (all warm-and-cuddly positives aside, that’s what it is.) We’ve already taken the shame out of being on the dole courtesy of the ever-fewer working Americans (Social Security and Medicare being the big drains among many), so unless you have a lot more faith than I do that either politicians or voters will start exercising responsibility instead of acting in their own self-interest, keep an eye on what’s happening in Greece because we’re getting close to that point of non-sustainability. Politicians won’t stop handing out financial lollipops and the taxpayer/non-taxpayer ratio keeps shrinking, so something has to give regardless of the indignation and injustices involved. Our lavishly funded healthcare system isn’t exactly helping as it sucks up an ever-increasing chunk of GDP.

ProHealth Care (WI) finishes its implementation of Epic.

GE announces Q3 numbers: revenue flat, EPS $0.31 vs. $0.28, meeting expectations.

Interesting revelations from the Steve Jobs biography, hitting stores Monday: (a) he apparently lied about the extent of his medical problems; (b) he initially resisted having surgery for his pancreatic tumor, so he tried diets, acupuncture, a psychic, and remedies he found online, to his apparent eventual regret; (c) he claimed Google stole iPhone features in creating its Android phone, saying he would “spend every penny of Apple’s $40 billion in the bank to right this wrong.”; (d) his last ambitions, possibly involving Apple products yet to be released, involved developing an integrated TV and taking on the textbook monopoly. He also told President Obama that he was destined to be a one-termer because he is business-unfriendly; described Microsoft as “mostly irrelevant” and struggling like most other companies that put salespeople in charge; and said HP is being “dismembered and destroyed” by poor leadership. Nobody quoted him all that much while he was alive and he stayed out of the limelight for the most part, but now every scrap of writing and video is being assembled into the Gospel According to the Recently Canonized Steve (and I admit being just as fascinated by it as everybody else.)

Speaking of Apple, here’s the first commercial for the iPhone 4S and its Siri voice command system.

Kaiser needs to dig into its Epic database to evaluate this study from Canada. Overweight people (BMI of 25 to 29.9) were found to have the same risk of health problems as normal-weight patients. The study found that the big health problems start with a BMI of 35 (defined as “obese.”) Hopefully the study looked longitudinally at patients rather than just current weight. You can calculate your BMI here.

Washington Hospital Center (DC) and AT&T develop CodeHeart, a mobile collaboration app that provides real-time audio and video contact in critical care situations, such as for ambulances in transit.

A lawsuit against Abbott Northwestern by a kidney stone patient alleges that a drug-addicted nurse stole his ordered narcotics for herself, leaving him to suffer excruciating pain through the procedure. The patient says the nurse told him she couldn’t give him very much medication and that he should just “man up.” During the procedure, he says the nurse was unsteady and slurring her words as she coached him for his pain, telling him, “Go to your happy place, Larry. Go to your beach.”

E-mail Mr. H.

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Jacob Reider MD is senior policy advisor of the Office of the National Coordinator for Health Information Technology of Washington, DC.

Tell me about yourself and your new job.

I’m a family doctor from upstate New York. I’ve been involved in health IT for a couple of decades. I started off as a medical educator in the Department of Family Medicine at Albany Medical College and moved on to leadership roles in health IT there and at Albany Medical Center, obviously in Albany, NY. Left there and joined a group called CapitalCare Medical Group, which is the large primary care group in Albany, doing EHR implementation.

There’s a sort of funny story to that one. Early in our EHR implementation, I posted this thing to this new communications platform called a blog. I started blogging in 1999. In about 2004, I put this post up about usability, which was a word people thought I made up, and how the usability of the EHR that I was using was missing the mark. About six months later, the president of the EHR vendor that I was complaining about contacted my boss and indirectly asked me to take down the post, because it was apparently costing them sales. That was Misys Healthcare, and the guy was Rob Kill, the former president of Misys Healthcare. I told my boss that last time I checked, this was a free country and I didn’t really have any intentions of taking the blog post down.

Then I actually started a dialogue with this guy, Rob Kill, and eventually he hired me to help them look at themselves in the mirror and try to improve the user experience of the EHR product. That may be answering your question about my background, because I eventually moved on from CapitalCare to Misys Healthcare, where I was medical director. Then we merged with Allscripts and I was CMIO of Allscripts for the last handful of years.

Then started interacting with folks from the government, and started to go back to my roots of idealism and thinking I could help solve really big problems. Got enticed to join Farzad’s team, because I was really inspired by the work that folks here are doing and the people who are here, who are just great folks who have the right vision and passion for getting things right. Sorry if I sound like a TV commercial.

What is your title and area of responsibility?

My title is senior policy advisor, which sounds very government. I tried on Luke Skywalker and Jedi Master, but so far we’ve got senior policy advisor on my business cards.

How much of the problem to get physicians and clinicians to use systems is because of usability issues?

Are you familiar with the NIST draft usability publication that was put out about a week ago?

I didn’t read it, but I heard it was out.

In that document, NIST calls out some fairly good evidence that user experience / usability is a barrier to broad EHR adoption. That’s not my opinion – that’s been stated by NIST in the publication. That was my callout in 2004, that these things were not optimal to use. I like to think of usability as kind of a milestone on the continuum of user experience. I’ll burden you with a little bit of my view of the world.

As a very basic component, if we think about any new technology, new tool, new anything, you’ve got at the basic end, functionality. Does the thing do what it was intended to do?  It’s something functional.

Beyond functional, you’ve got reliable. Does the thing do what it’s supposed to do every time? An example of functional is a Model-T car. It works, but Model-T cars came with toolkits because they broke, so they weren’t reliable. EHRs years ago – I can vividly remember that the system would go down at midnight every night for backups for four hours. They weren’t reliable. They were functional, perhaps – they did what they were intended to do – but they weren’t reliable.

I think we’ve nailed functionality, we’ve nailed reliability, so as the maturity of any new technology evolves, you evolve up the continuum, so you get functional, reliable, and usable. Usable implies that you can accomplish tasks efficiently; you can do things in an intuitive way. NIST’s document does a great job outlining how you can quantify usability. There’s an argument that it’s subjective, but I think they’ve documented that it’s quantifiable.

Beyond usability, you’ve got meaningful, so it does stuff that’s important. And then pleasurable, that it does stuff elegantly. Apple is a great example of a company that has reached the maturity pinnacle of pleasurability and not just usability, functionality, and reliability. Longer than I intended to blab about, but does it make sense?

People tend to react emotionally to the term usability, thinking it means somebody else designing their screens or taking away their competitive advantage, but in fact there is a usability science that has its own body of literature and its own professional groups. How do you take emotion out of what people think usability means and turn it into something that can move ahead constructively?

I think it’s about using terms carefully. Often I’ll talk to people about what I just described, because we can measure each of those components. I also talk about best practices, so as we think about the industry, we can think, “What are the best practices?”

I think the NIST document outlines best practices that are not just from our industry. If you want to design an airplane or an iPad or a coffee pot, there are methods that you use, and one of those methods is called user-centered design. As you mentioned, there’s a whole field that’s devoted to this. If we talk about using the right method and using the right processes, very frequently that disarms some of the emotional response and we can start to talk collaboratively.

That is what everyone wants to do. I don’t think anybody’s opposed to better usability. You’re not going to hear a user or a vendor or anybody from the government say, “We’re opposed to that.” It’s just The question of who should do what as we look to lever or accelerating that evolution of usability as it has evolved well, obviously, in the consumer electronics space.

How do you see your role specifically and ONC’s role in general affecting usability of software?

There are two areas that I’m really focused on as we move forward. One is clinical decision support and the other is usability. I actually think they are tightly linked. If you look at some of the great design literature from professionals like IDEO, who do a lot of innovation design, and Neilsen Norman Group, these are folks who were involved with the original Apple product and many other things that you’re familiar with.

You see how the design actually guides the actions of the user. A really well-designed door handle guides what I do. I think clinical decision support is not about alerts and reminders and hitting docs over the head with two by fours when they do things wrong. It ‘s about guiding care providers to more easily do what’s right and less easily do what’s wrong. Usability and CDS in that way – and that’s why I’m blabbing about this – fit together really nicely.

My role is to listen to the market, to end users, to eligible providers, to hospitals, and to vendors, and learning about all of these perspectives. Right now that’s the place that ONC is. We’re listening. We’re listening to the experts.

This report that NIST produced just a week ago is open for public comment. We’re very interested in the reaction to that document. It’s in the 30-day comment period and they’ve got a Webinar coming up. The more feedback they get — and by extension, we get –about that, the better, so we can learn more about what other folks think ONC’s role is in terms of facilitating the evolution of user experience in health IT.

Why hasn’t there been a market for usability, where somebody comes up with a more usable product that takes business away from less-usable products?

I think there are a couple of answers to that. We talked about Apple a little bit. In many cases, Apple Is a great example of great usability, great user experience, etc. Raise your hand if you owned or have a friend who owned the Newton. Did you have one?

I did not.

But you remember them, right?

I do.

Apple, of course, had some failures, too. If you look at that company, they’ve been through 30 years of fairly rapid evolution. They’ve succeeded in the long run because they’ve iterated over and over and over. Steve Jobs talked about how he just picked himself up and tried and tried again. Three decades of evolution from Apple that’s created that. And of course, the replacement cycle of a Mac or an iPhone is much more rapid than the replacement cycle of a $50 million electronic health record.

I think part of the answer to your question has to do with the maturity of the market. The market hasn’t matured as we know, with maybe 50% of this market is now penetrated, which means it’s still a young market. We’re not nearly as mature as the consumer electronics market. The other is the replacement cycle is slow, so you don’t have folks saying, “Oh, I can do that in three clicks in one system and 17 clicks in another, therefore I’m going to buy System A.” It’s just not as easy to rip and replace as it is your iPhone.

In your writings, you’ve said that usability guidance is what’s needed, not guidelines or set requirements. How do you see ONC positively affecting usability?

This summer, ONC, NIST, and FDA had a usability workshop. Along with the release of this document from NIST, the federal government will have have a wiki, where we’re going to invite participation from all communities and collaborate so that we can all openly discuss what the opportunities are.

If you’re asking me, “What’s ONC going to do next?” I can say honestly that I don’t know the answer, because what we’re trying to do is be intentional and/or deliberate about what we do next, why, and how, so that this isn’t something that anybody in the market perceives as reactive in any way. What ONC does will be product of dialogue and not something that we just pull out of the seat of our pants.

If we understand the concept that usability can be measured, do you see it either becoming a certification criterion or there being government-sponsored publishing of usability scores of software?

I can’t really answer that question. Sorry.

I did forget to ask you one important question. When did your job start?

I started here on October 3. I’ve been here, gosh, almost three weeks, and it’s flown by in a millisecond.

Any final thoughts?

The NIST document is a good thing to link to. 

The dialogue is important. Even if you solicited comments and you said something pithy and got your readers to throw in feedback, we would definitely pay attention to that – what people are saying on HIStalk about this topic. If you link to that and say, “Hey, what do people think about the NIST document and what’s the reaction to it?” That would be very interesting to us.

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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.

GM and Intel are Right: Healthcare Is Too Expensive, but Technology Alone Can’t Fix It
By Mr. HIStalk

Big-company CEOs have healthcare on their minds. I know that because they keep insulting us in the national media. We’re too expensive and we underutilize technology, they say. In fact, it’s our fault that jobs are moving offshore, not their own corporate greed or inefficiency.

My first reaction: who do they think they are? We’re getting lectures on innovation, productivity, and cost control from GM? If I wanted that kind of advice, I’d go to Toyota.

Quibbles aside, they’re right. Healthcare cost increases have to stop eventually. Most US job growth since 2001 was in healthcare, and that’s not something to be proud of. We’re leaving an expensive mess for our children to clean up just as Baby Boomers suck the system dry with healthcare demands. If GM doesn’t like it today, they’ll hate it tomorrow, unless they’re watching from China or India.

Businesses want to force computers on us, dragging us kicking and screaming out of the dark ages. Unfortunately, software doesn’t automatically bring increased productivity and lower cost. If it did, we’d be using it already. Think of all of those hospital dollars spent on Microsoft Office and Windows, which were supposed to have made us stunningly more effective, but instead gave employees something to screw around with instead of working.

I’d like to think that computerization can really reduce costs, but I haven’t seen that happen anywhere so far. Showcase sites keep buying the latest and greatest, but the correlation to bottom line and quality outcomes is murky at best. Where’s the average 100-300 bed hospital that has seen its overall costs drop 30% because of software? You’d know them, because every other hospital in their town would be out of business.

Hospitals can cut expenses in three ways, all of them at their local level. They can manage labor, which is by far their largest expense. They can go after the utilization and the cost of drugs and supplies. They can control physician practice variation. I’m glad I said “can” instead of “do” because, for various reasons, these things don’t happen. Software can only do so much.

I’m glad much of our recent IT investment relates to patient safety and outcomes. I hope electronic medical records really do become a standard, with all the information sharing that the RHIO people keep yapping about.

But when it comes to drastic cost reductions driven solely by buying and implementing software, I’d say that’s wishful thinking. There’s a lot of work to be done fixing the system and its underlying misaligned incentives before we try to automate it. No business became a world-beater just by installing SAP, even if they weren’t one of those that went bankrupt trying.

I do see a ray of hope in being called out by big-company CEOs. As hard as it is to have change forced on you, that’s the only way it will happen. I work in a hospital, but I’m also the occasional patient and medical and insurance bill-payer. When wearing those hats, I’m just as mad and frustrated with the system as those CEOs and I bet you are, too.

Healthcare is too expensive, too bureaucratic, and too unimpressive in benefits delivered compared to its horrendous cost. I’m pretty sure fixing it will require more talents than a software guy like me can offer, even if GM and Intel believe otherwise.

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Top News

HHS announces its Accountable Care Organization rules (Medicare Shared Savings and the Advance Payment Model.) Some differences between the preliminary and final versions:

• Quality measures reduced from 65 to 33
• Use of an EHR is not a requirement to participate
• Introduction of a savings-only track without financial risk during the initial contract period
• CHCs and rural health clinics now have an option to lead ACOs
• A longer phase-in for reporting and performance measures
• Multiple start dates established
• CMS will provide approved marketing guidelines and language (so ACOs don’t have to wait for CMS approval, as was stated in prelim)

Reader Comments

From EHR Geek: “Re: Joel Diamond. I love your posts so much that sometimes I feel like a stalker. With the current healthcare environment, it seems like you could make so much more money (just by dropping your malpractice alone) by doing standup comedy. Please?” Like EHR Geek, I love Dr. Diamond’s posts, which I find laugh-out-loud funny. This week, he discusses all that is good in healthcare. The topic only sounds benign.

From WhatTheDell: “Re: resignation. Jim Fitzgerald recently resigned from Dell’s Meditech Solutions Group. Big loss given his role of all things Meditech.” Unverified. There is no change in his LinkedIn profile or on Dell’s “About Us” page.

From Colorado Kid: “Re: University of Colorado Hospital. Went live on Epic in September, including physician documentation, CPOE, RN barcoding and charting, OR, anesthesia, inpatient pharmacy, labor and delivery, radiology, and ED. Outpatient clinics are 70% deployed, to be completed with Beacon oncology and Phoenix transplant by mid-2012.”

From Lady Pharmacist: “Re: National Pharmacy Week, October 16-22. It’s time for the annual shout-out for pharmacists and pharmacy technicians. Healthcare informatics plays a vital role with and for these clinical and medication distribution folks who make medication usage safe in our institutions!” As I usually say, a hospital is a very clean hotel that offers only three interventions: surgery, treatments, and drugs. Pharmacists and techs manage that last set of interventions with extraordinary skill given the complexity involved (not to mention that most of the country is taking a plethora of pills – a new study found that 11% of Americans over the age of 12 take antidepressants, which is in itself depressing.) Congratulations to those folks behind the counters, down in the basement, and (increasingly) out on the floors.

From MM: “Re: Dr. Jayne on cloned documentation. Did we really expect anything else? If you have been around medical reimbursement rules for any amount of time, you know that when the rules begin to be met by the majority of providers, the rules will change. It is really all about who gets to keep the money. We used to bill by diagnoses, then by time, now by documentation. All these rules were created by the insurers, and each time we achieve competence at following the billing rules, they change them.” I’ve said that for years. Payment is a shell game, where there isn’t enough money to stick under every shell. It is inevitable that when some individual or group starts winning too often, the dealer will move the shells around and change the rules, sometimes drastically altering the lifestyles of professionals along the way (nurse anesthetists and physical therapists come to mind if you look back 25 years or so). That’s really the problem with healthcare – providers flock to profitable services like bugs to a zapper, but patients don’t usually benefit. Expecting healthcare providers, even theoretically non-profit hospitals, to just keep doing the same work without regard to what they’ll get paid is just silly.

I am heading to MGMA in Las Vegas this weekend and will be posting updates on some of the action. If you are attending, be sure to take a look at HIStalk’s Must-See Vendors for MGMA 2011. The guide includes some tips on vendor giveaways (hint: you don’t want to miss a visit to Allscripts, MED3OOO, and Culbert Healthcare.) And if  you see one of these desktop signs in a vendor’s booth, please take a moment and thank them for supporting HIStalk, HIStalk Practice, and HIStalk Mobile.

Listening: reader-recommended The Heard, rootsy Southern rockers from Reading, PA. Sounds kinds of Allmans-meet-R.E.M. to me. Also reader-recommended: BluesMotel, some guys from the Netherlands that play Chicago blues. I can almost smell the smoke and beer.

This week on HIStalk Practice: in addition to our MGMA guide and a post from Dr. Joel Diamond, athenahealth reports that pediatricians are under-reimbursed for certain vaccines almost half the time. CalOptima REC names its preferred EHR vendors. The Department of Pathology at the Medical City Dallas Hospital (TX) goes with McKesson for billing and RCM. Emdeon expands the capabilities of its Office Suite solution. Radiology Medical Group (CA) announces plans to outsource its billing and lay off 24 employees.  If you are interested in the ambulatory HIT world,  highlights from MGMA, shoe fashion, and/or Inga’s mental health, please sign up for e-mail updates while visiting HIStalk Practice. Thanks for reading.

Thanks to NexJ Systems of Toronto, ON, now supporting HIStalk as a Platinum Sponsor. The company is all about eHealth, offering its Health Information Exchange solution that includes its Universal Health Connector (global messaging and controlled vocabularies and terminology) to facilitate interoperability among providers, ACOs, payors, and public health agencies. They also offer tools for chronic disease management, disease registry, electronic referrals, patient portal, provider credentialing, and a wellness platform. Other offerings include platforms for provider health, consumer health, and analytics. Click the image above to check out their October 28 Webinar on next-generation, open-architecture HIE technologies that are fast, flexible, and cost effective. Thanks to NexJ for supporting HIStalk and its readers. 

Pardon me while I communicate in techo-gibberish with my fellow geeks (non-nerds, hands over ears, please). You may have noticed that HIStalk loads faster now. Reason: I replaced Apache with the Litespeed WebServer. It’s hard to picture a Web server that’s running *NIX without Apache, but you’re soaking in it. I also had the PHP handler changed from DSO to SUPHP to improve security and to fix some CHMOD problems. (end of nerdspeak)

October is Breast Cancer Awareness Month, meaning it’s time to watch those cool Pink Glove Dance videos. My favorite so far is from Victoria Hospital – Prince Albert Parkland Health Region, Prince Albert, Saskatchewan (although they’ve disabled putting the video directly on HIStalk this time around, so you’ll have to click.) Check out all great videos and vote for your favorite here.

On the Jobs Board: Senior Business Analyst – Salesforce.com, HL7 Interface Developer, Account Manager. On Healthcare IT Jobs: Director – Epic and Clinical Systems, Security Engineer, Business Continuity Analyst, Clinical Nurse Analyst.

Don’t let Inga’s swaggering online demeanor fool you. Those of us who know her recognize that she’s sensitive (sniffles at movies), self-doubting (always convinced she doesn’t know enough to write authoritatively about topics she’s followed for many years), and fragile (I’ve quit telling her to stop double-spacing after a period because it devalues her). You can imagine the emotional harm wreaked by those who don’t sign up for e-mail updates; who fail to connect with us on LinkedIn and Facebook; who don’t support our sponsors and click their ads and Resource Center listings occasionally; and who hurtfully neglect to send her newsworthy scoops and fun information so she can at least temporarily feel confident about her knowledge base (cue emotion-tugging Sarah McLachlan warbling). In lieu of giving her a hug, consider checking off the items on the list above, ‘cause when Mama ain’t happy, ain’t nobody happy.

TransUnion acquires Financial Healthcare Services, a provider of a patient payment estimation solution.

Microsoft announces Q1 numbers: revenue up 7%, EPS $0.68 vs. $0.62, beating and meeting expectations, respectively.

Athenahealth announces Q3 numbers: revenue up 33%, EPS $0.15 vs. $0.11, beating expectations on both and raising fiscal year guidance.

San Diego’s West family, who made their $2 billion fortune from telemarketing and who established the West Wireless Health Institute in 2009, create a $100 million venture investment fund to invest in early-stage technology companies that can reduce healthcare costs. They pledge to invest any profits in medical research.

Alexian Brothers Health System (IL) expands its relationship with athenahealth by selecting athenaClinicals and athena Communicator for its network of 150 employed providers. In addition, athenaCollector client Harbin Clinic (GA) adds athenaClinicals for its 210 providers. Both are Allscripts replacements.

The Hay Group consulting firm promotes Bill Quirk from director of business development to national director of its US healthcare practice. He was previously with Sullivan, Cotter and Associates and Towers-Perrin.

The TriZetto Group names President and CEO Trace Devanny as the company’s chairman, succeeding TriZetto founder Jeff Margolis, who will serve as chairman emeritus. Devanny was president of Cerner until last year.

Streamline Health hires Tom Dean, formerly with CareCentric, as VP of product engineering.

Robert J. Bunker joins the board of directors of T-System. He is chairman and CEO of The Medical Staffing Network Inc. and started his work in healthcare as Humana’s COO in 1994 after serving 20 years in the US Air Force Medical Service, retiring with a rank of lieutenant colonel.

Joan Bishop, formerly with Lockeed Martin, joins Encore Health Resources as principal of its government client services business.

Announcements and Implementations

AtlantiCare (NJ) announces plans to to launch AtlantiCare Health Solutions, an accountable care organization.

Aprima Medical certifies GFI Software’s FaxMaker for use with Aprima’s EHR and PM solutions. Which reminds me of a recent need I had for a copy of certain medical records. My doctor’s office said I had to fax them a request form. Since I don’t have a fax machine, I asked if I could e-mail the form. They responded that they didn’t have e-mail. I had to double check the year to make sure I wasn’t in some sort of time warp.

ONC validates the South East Michigan Health Information Exchange (SEMHIE) for conformance and interoperability testing, allowing SEMHIE to go live on the Nationwide Health Information Network Exchange.

Intelerad Medical Systems launches InteleSuite, a RIS/PACS solution that combines Interad’s standalone PACS and RIS offerings.

University of Michigan Health System and Great Lakes Health Information Exchange sign an agreement to exchange information. Other members are Michigan State and Sparrow Health System.

A Detroit jury finds that Beaumont Hospital (MI) and an OB doctor let a woman deliver a 10-pound, 12-ounce baby vaginally instead of by C-section, causing brain injuries in the newborn girl. Despite the hospital’s claim that the disabilities of the child (now a teenager) were caused by the mother’s gestational diabetes, the jury awards the family $144 million.

I received an e-mail from Steve Pelton, VP of enterprise applications for Ministry Health Care (WI). They have completed their EHR certification tests through Drummond Group (“tough, but fair,” he says) and expect to demonstrate Meaningful Use and attest early next year after the 90-day demonstration period. He raises an interesting point:

From the CHPL web site, it appears that only 16 hospital and health systems have achieved either modular or complete EHR certification. While many or even most hospitals will wait for their vendors to provide updated, certified products for them to install, it does seem surprising that so few of the over 5,000 hospitals in the US have not gone through the self-certification process. Like Ministry Health Care, most of the 16 hospital and health systems achieved modular certification, which allows for the Meaningful Use of a collection of certified products. The most common modules that are self-certified seem to be homegrown data repositories. One would expect that many hospitals that have either homegrown systems or uncertified niche systems would attempt to certify them. One would also expect hospitals to self-certify their existing systems while they are working to replace or upgrade to a certified version. What is everyone waiting for?

Weird News Andy summarizes this story as, “Socialized medicine. Gotta love it.” An 82-year-old woman visiting her dying husband in a Canadian hospital falls in its lobby, breaking her hip. Two ED nurses and a security guard observe her lying face-down on a metal grate and bleeding, but refuse to help until an ambulance arrives. The  top executive can’t explain why a code wasn’t called. The same hospital made headlines last year when a woman who had stopped breathing was driven to the hospital by her boyfriend, but the ED staff refused to help since the couple were in their car in the parking lot and told the boyfriend to call 911 instead. The 39-year-old woman died a few days later of a heart event. The employees thought they wouldn’t be covered by malpractice insurance if they helped someone outside the four walls of the hospital.

ONC adds a principal deputy position to its organization, tasked with duties similar to that of a COO in the private sector. The yet-unnamed deputy will report to ONC coordinator Farzad Mostashari.

The VA gives Harris Corp. a two-year, $200 million blanket purchase agreement to develop VistA-connected outreach tools, including creating a point-of-service kiosk, redesigning the VA’s quality Web site, supporting the National Utilization Management Integration project, and developing a replacement bed management system.

The government’s Substance Abuse and Mental Health Services Administration (SAMHSA) awards 29 grants totalling $25 million over three years to increase access to behavioral health services with information technology.

Federal prosecutors file an $8.1 million fraud suit against Kernan Hospital (MD), part of the University of Maryland Medical System. The government says the hospital intentionally changed its billing system to create a diagnosis of severe malnutrition, looking for the words “protein malnutrition” and pressuring physicians to add that condition as a secondary disease.

Other

Nearly 300 GE Healthcare employees in Salt Lake city form a human pink ribbon in recognition of Breast Cancer Awareness Month. The company has scheduled similar displays across a couple of dozen cities.

The hospital EHR market is expected to peak in 2012, with revenues of $6.5 billion.

Twenty-six percent of CHIME CIOs say their organizations have qualified to receive Meaningful Use funding, with 13% actually having been paid. About 93% expect to achieve the Stage 1 MU during the first three years of the program.

An Internet outage in a small North Carolina town leaves a medical practice that uses a Web-based EMR out of luck. “We’re electronic medical records, and neither one of our softwares will come up because we’re Internet-based. If the Internet goes down, we have to just call patients back to get appointments re-scheduled.”

An Illinois physician claims his health system employer placed him on administrative leave because he has “no computer skills.” Steven Kottermann MD, who was a family physician with Memorial Health System, admits that he fell behind on his electronic charting after the health system’s implementation of Epic. The doctor believes that Memorial is at fault because “they bought a lousy system.”  The hospital’s chief medical officer says the issues go beyond the doctor’s EMR proficiency.

• GE Healthcare recognizes Frederik Memorial Hospital (MD) and Northeast Georgia Medical Center (GA) as winners of its 2011 Leaders of Change Awards at the Centricity Perinatal Users’ Group National Conference.
• Sentry Data Systems earns a spot on the South Florida Business Journal’s Top 25 Fast Tech Awards for significant revenue growth.
• Khalid Moidu, MD, PhD (Orlando Health) and Stephen Claypool, MD (Wolters Kluwer Health) will present Innovation Lab: Evidence Based Order Sets Tools from a Dynamic Hospital-Vendor Partnership at AMIA 2011.
• NVISION Laser Eye Centers (CA) selects NextGen for its 10 eye centers.
• NexJ Systems will host a free Webinar entitled The Next Generation of Health Information Exchange October 28th. NexJ Systems, by the way, was recently named the sixth fastest-growing company in North America on Deloitte’s  2011 Technology Fast 500.
• AdvancedMD receives the Healthcare Hero Award for Innovation from Utah Business Magazine.
• OptumInsight releases a guide for physicians to minimize security risks entitled Keep Patient Data Secure: Simple Actions for a Digital World.
• dbMotion and Allscripts will co-host a webinar on physician EHR connectivity on November 16th featuring dbMotion CMIO Joel Diamond MD and Ryan Winn, VP and CIO of MidMichigan Health.
• Perceptive Software will showcase its enterprise content management solutions at the Gartner Symposium/ITexpo in Spain.
• Newton-Wellesley Radiology Associates (MA) boosts its financial performance and prepares for ICD-10 using McKesson’s Revenue Management Solutions.

EPtalk by Dr. Jayne

Now that we’re in the last quarter of 2011, Physician Quality Reporting System (the artist formerly known as PQRI) data is available through the CMS quality portal. Groups can access data by taxpayer ID and individual providers can also request reports based on their NPI. Next year should be a little different, with CMS agreeing to provide interim feedback reports to those who use claims-based reporting. Too bad for those of us who are Meaningful Users of our EHR technology and are reporting through registries rather than claims.

Speaking of CMS, regulatory reforms are on the table, with two proposals being introduced and a third being finalized this week. Modifications to the Medicare Conditions of Participation would allow multi-hospital systems to have a single governing body for multiple hospitals rather than requiring each have its own governance structure. Hopefully combining governance structures will help those of us on staff at multiple hospitals within a health system to reduce the number of committees on which we are forced to serve.

Proposed modifications for non-hospital providers address durable medical equipment suppliers and dialysis providers. Also addressed are outdated e-prescribing technical requirements. Hiding towards the end of the document is language to end the use of the term “Medicaid recipient” and replace it with “Medicaid beneficiary.” Although this makes it parallel Medicare, I can’t help but think there are political games afoot, with this being one more move to make people think that Medicaid is insurance rather than an entitlement program.

We all know we live in a society that’s increasingly saturated by technology, specifically audiovisual media. The American Academy of Pediatrics Council on Communications and Media releases guidelines stating that children under age two should avoid television viewing. This also includes passive viewing while playing in a room where an adult or sibling may be watching.

There’s an app for that: Mobile MIM is one of a growing number of apps to receive FDA approval. It allows viewing of diagnostic images, including MRI and CT scans. Although the app (one version for physicians, one for patients) is free, physicians must pay $1 to upload each image to its cloud-based repository. Viewing the study costs $1 to $2 depending on the receiving device. Earning FDA approval took more than two years and included modification to the app to detect poor lighting conditions that are inappropriate for the interpretation of radiologic studies. Maybe the FDA should also include logic to detect whether it is being used in a bar, as my colleague was attempting.

Recent data from social media analytics firm Amplicate shows that over the last year, 69% of Facebook and Twitter users reported hating a particular insurance carrier. Data from over 2,500 posts is aggregated by payer. In contrast, the other industries the firm tracks were more positive, with 56% of users loving their grocery store chain and a 70% expressing a love connection for fast food chains. More negative than health insurers: banks.

The FDA approves Hologic’s Trident specimen radiography system. The system is designed for intraoperative specimen imaging during minimally-invasive, stereotactic, or ultrasound-guided breast biopsies and includes the ability to export to PACS.

October is Breast Cancer Awareness month. I first saw the Pink Glove Dance on HIStalk. It’s always good to see healthcare workers having fun and raising awareness about a disease that impacts so many people. More than 100 organizations are competing for thousands of dollars to donate to their favorite charities, so get out there and vote. Here’s a shout out to my co-workers who are fighting this disease and a special nod to all the women in my family who have beat it, including one 20+ year survivor. Love you, Mom!

Contacts

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

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The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

This is the fourth in a short series of posts on “The CIO’s Best Friends,” those BFFs who are critical in ensuring CIO effectiveness. This time we cover the CNO – CIO relationship.

Got Clinicians?

The CNO and I started our jobs about the same time. We knew we needed one another to be successful. With an electronic health record implementation looming, our partnership would be imperative.

As organizational rookies, we became kindred spirits. We commiserated, encouraged, and partnered. Through my CNO’s coaching, I learned we needed more clinicians inside of IT. “Got clinicians?” he prodded often. “If you don’t, you should.”

I wondered how many credentialed clinicians a healthy IT department should have. I now think 25% is a good target. Whatever your starting point, push to raise the percentage. Include a mix of MDs; RNs; radiology, medical, and pharmacy techs; pharmacists; therapists; and a smattering of other less common specialties. While many organizations have a CMIO, equally critical is a CNIO.

My CNO taught me that once you have clinicians on your team, you’ve got to ensure their successful transition into IT. Here are some things to think about in order to succeed.

Challenges for Clinicians Moving Into IT

Adapting to the office environment

• Cubes vs. nursing station reduces the sense of teamwork
• Use of meeting rooms is equated with loss of casual social interaction
• Taking work home
• Going out to lunch vs. grazing between patient care tasks

Difficulty recognizing accomplishments/results

• Need to understand the bigger picture (see beyond the patient)
• IT systems are configurable with gray areas; reduced workflow focus
• No more rapid results (average patient LOS is three days)
• Used to implementing changes quickly
• Giving up precision and timing on tasks

Loss of familiarity generates stress. The clinician must:

• Learn new tasks, find new resources, and create a new employee network
• Learn basic IT software (no more IVs)
• Fight pressure to already understand IT on the first day of work
• Assimilate IT language/acronyms

Facilitation skills are not in the typical nursing repertoire

• Scheduling appointments
• Creating agendas
• Taking minutes
• Using a meeting room to solve problems instead of on-the-spot interactions

Common Conflict Areas and Issues of Concern for Clinicians

• IT staff is generally unaware of clinician’s former environment and the required adjustments
• Lack of training for clinicians in IT subjects
• Clinicians are expected to already know what to do
• Downtime scheduling affects issues regarding patient care
• Clinicians have an inherent desire for more testing on software applications (like testing a drug before giving it to a patient)

Bridging the Gap and Investing in Clinicians

Preceptor program

• Increase depth of typical IT orientation
• Pair new clinical staff with experienced IT person; identify future clinician leaders
• Document and publish referable guidelines
• Create Web-based training on IT tools
• Ensure clinicians don’t get sucked into traditional IT mentality

Project management training

• Create project management processes that nurses can relate to
• Help clinician visualize the big picture and break it down into tasks

Professional development

• Develop a facilitation/leadership class
• Provide continuing education credits (CEU)
• Create internal training opportunities specific to clinical IT
• Develop clear development pathways, like a clinical ladder
• Clarify the position’s responsibilities

Spend time with your CNO. Actively partner. If you can’t afford a CNIO to bridge the nursing and IT gap, assign another clinician as a part-time liaison.

Over the years, we moved from 5% clinical staff to nearly 25%. I believe one reason we successfully implemented and adopted clinical applications was due to our staff mix.

Embrace the significance of melding clinicians with IT. Be intentional with it, maximize the value, and encourage further adoption. A healthy mix leads to a high-performing healthcare IT organization. I’m so glad I listened to my CNO.

Got Clinicians?

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.

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