From FunFacts: “Re: Newt Gingrich. The 2010 Cerner Health Conference had a speaker from Newt’s Center for Health Transformation, Melissa Ferguson. Any idea what she talked about?” Newt’s business is getting scrutiny from everywhere now that the dearth of decent Republican candidates puts him in front of the pack by default. The Washington Post says his think tank pocketed $37 million from healthcare companies. Not to mention that HIMSS gave him its Advocacy Award in 2005, admiring his “consistent support and insight for the adoption of interoperable health records” as a “key collaborator and advisor with HIMSS and others on healthcare information technology topics.” CHT has locked down its online membership list, but I mentioned some of Newt’s clients back in 2007: GE Healthcare, Siemens, Allscripts, CHIME, and more.

From From the ONC Annual Meeting: “Re: Epic. In the usability session, Janet Campbell from Epic said the government would need to pay Epic to perform usability safety validation. An audience member asked how much more than $27 billion would be needed. Silence from young Ms. Campbell. Is this an indication of the way the EHR industry (or maybe just Epic) is going to react to the IOM report on HIT safety?” Unverified. The shame is that customers aren’t pressing vendors for improvements. That being the case, I can see the vendors’ point of view: why should they (and thus their customers) be forced to pay for an unfunded mandate for changes that customers aren’t demanding? (much like EHR certification.) 

From Quixotic: “Re: Epic moving into Meditech territory. The board of Poudre Valley Health System has approved the decision to move from Meditech to Epic. This comes right on the heels of the Edwards decision you published last week. Both were Meditech 6.0 sites.” Unverified. Poudre Valley is a Baldrige winner and CIO Russ Branzell (above) is a pretty high profile, quoted on Meditech’s site from 2009 as saying, “being committed to excellence also meant being committed to our Meditech system.” It was just this past January that Russ said PVHS’s Meditech implementation would be complete right about now after spending $30-40 million.

Regardless of whether this item is true, what can we learn from recent decisions that have gone Epic’s way?

• It used to only be Cerner who needed to worry about Epic and even then only with its bigger customers. Now it’s every vendor of inpatient clinical systems and hospitals of every size.
• Epic used to be selective about which customers it would take on. Either it has relaxed the requirements or the demand must be overwhelming given the huge ramp-up of customer count, most of it in last two years.
• As hospitals and practices consolidate, Epic’s footprint grows by default since its large customers are usually the acquirer rather than the acquired.
• Everybody said Epic couldn’t scale up to handle a lot of business. They were wrong, at least so far.
• Epic’s revenue is up to around a billion dollars a year. The “small company risk” argument used by big competitors isn’t working.
• Hospitals are so anxious to move to Epic that they don’t care about the money and organizational energy they’ve spent on recent implementations. Hospitals with freshly implemented systems costing dozens to hundreds of millions of dollars are happy to dump them and move to Epic, so incumbents can’t even count on switching costs to protect their customer base.
• If even seemingly happy customers of Epic’s competitors are willing to replace their current systems with Epic, imagine how easily Epic could steal the unhappy ones if it wanted.

Since both Epic and its competitors just keeping doing what they’ve always done, you might suspect the leading team will keep piling on points in this embarrassingly lopsided victory. Time and customer money is running out to mount significant competition, so the only Plan B is to hunker down, try to keep existing customers happy since new ones will be hard to come by, and hope Epic’s dominance causes it to stumble to the point that customers will walk away from their huge investment and go shopping yet again for systems they didn’t want the first time around. That or just cede the core inpatient systems market to Epic and find less-competitive territory, which some pretty cool small companies are already doing.

From Clearing House: “Re: Netwerks. They are our clearinghouse and changed to 5010 on November 7, 2011. The vast majority of our claims have not been processed by payors. We have physicians having to go to their line of credit to make ends meet. Almost two weeks and counting.”

Listening: a rare “highest recommendation” for reader-recommended Zip Tang, the most stunning, heart-racing progressive rock I’ve heard since early Genesis or Kansas. For my fellow prog heads, think Flower Kings or Spock’s Beard without the wimp factor and with regular wisps of Gentle Giant, ELP, and maybe a little Styx thrown in, but stripped of the 70s excesses and with a harder edge, more soul, and catch-your-breath harmonies. They are just stupendously good, to the point that I can’t sit still while listening and I almost got a lump in my throat a couple of times from the sheer brilliance of it. Their version of Tarkus is better than ELP’s. Here’s the kicker: these are day-jobbers, with Passport Health SVP Marcus Padgett on horns and keyboard and Richard Wolfe MD of Resurrection Health Care on bass (but I’m not giving them a mulligan for that – their excellence requires no asterisk.) These guys make me remember why I love prog so much. I’ll be playing Zip Tang’s three albums all weekend and buying them from iTunes for the Nano. Truly awe-inspiring, and I’m not prone to hyperbole.

My Time Capsule editorial this week from November 2006: The Bandwagon Effect and Healthcare IT Purchases. A test dose: “After all, everyone whose organization is as good and well-known as yours is buying Vendor A’s products, they say. Those customers are not only deliriously happy, they’ve formed a high school-like clique that makes fun of Vendor B losers and dates cheerleaders after football practice instead of attending chess club meetings. ”

Thanks to one of my CIO readers for this great idea. He gives HIStalk sponsors first crack when seeking consulting help and suggested I create a single form that allows prospects to contact any or all of them in a single step. The result: the Consulting Engagement Request for Information page. Fill in the very basic information about your needs, add a supporting attachment if you like, check off the companies you want to send it to (one, many, or all) and click Submit. Your work is done – the companies you chose get your information immediately by e-mail. I’ll be adding a linked graphic later, so if you can think of a more memorable name for it (I thought of RFI Blaster, but couldn’t warm up to it) let me know.

OhioHealth selects the athenaCommunicator patient communication service from athenahealth. It’s an odd-looking press release since both organizations surgically excised the logical space between their two names, with one choosing to capitalize both names of their artificially conjoined twins while the other chose to capitalize neither. I blame marketing people run amok.

Want to see Farzad Mostashari and Aneesh Chopra bust a move? I’m not exactly sure who shot this video at ONC’s annual meeting (the screen capture above is the best I could get), but I have to say that the bow-tied National Coordinator Dr. FM is looking good out there on the makeshift dance floor with some nice improvisational and rhythmic movement, while the US’s CTO appears somewhere between bemused and mortified. I like to think that they were pulled to the dance floor by the excellent music, the legendary Meaningful Yoose Rap from Dr. HITECH (Ross Martin, MD.) I like that they loosened up and aren’t afraid to have fun. Inga and I tried to connect with Farzad’s predecessors (Brailer, Kolodner, and Blumenthal) and all of them stiffed us repeatedly like we were unworthy interlopers on sacred ground, but the new boss seems a little more tolerant to riffraff of our ilk.

Speaking of Farzad Mostashari, is it just me, or does he strongly resemble the outstanding actor Enrico Colantoni (Veronica Mars)?

And speaking of ONC, 60% of readers say it will do little in response to the IOM’s healthcare IT safety recommendations. New poll to your right: are HIT Regional Extension Centers worth the $650 million in federal grants designated to fund them?

Two tiny Washington hospitals consider affiliating with Swedish Medical Center, with one carrot being that they’ll get Epic cheap. Jefferson Healthcare, with 25 beds, says they could never afford Epic on their own, while 45-bed Forks Community Hospital says it’s facing a $1 million Meditech upgrade anyway and would welcome Epic at a lower price even though it “may be overkill” for a small hospital.

A Maryland woman says she may sue the hospital where her baby was born after nurses restricted the time she was allowed to spend with her newborn son. The baby had tested positive for drugs, but as an addictions nurse herself, the woman demanded to be tested and was found to be drug-free. The hospital later apologized, saying scheduled computer downtime resulted in erroneous lab results.

Weird News Andy makes a rare weekend appearance, calling out this story in which a woman suddenly goes completely deaf after delivering her third child (and not from the crying, WNA helpfully adds.) The happy outcome: a University of Utah surgeon diagnoses her condition as otosclerosis, a genetic condition in which the hearing bones are fused together. He fixed her problem and she says she’s hearing better than she has in decades.

Another WNA find: a three-year investigation by a group of 21 scientists concludes that there’s not enough evidence to prove that drinking water prevents dehydration, so bottled water companies will be prohibited by law from claiming otherwise. Said a Member of European Parliament, “This is stupidity writ large. The euro is burning, the EU is falling apart, and yet here they are: highly-paid, highly-pensioned officials worrying about the obvious qualities of water and trying to deny us the right to say what is patently true. If ever there were an episode which demonstrates the folly of the great European project then this is it.” 

E-mail me.

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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 November 2006.

The Bandwagon Effect and Healthcare IT Purchases
By Mr. HIStalk

TV networks don’t announce election winners until the polls close. Why? Because those people who haven’t yet voted will be more likely to vote for the projected winner instead of whomever they really want to see in office.

It’s the same phenomenon that makes the Super Bowl or World Series winner everyone’s sudden favorite team. Everyone likes to be associated with a winner. Or, more precisely, no one wants to be associated with a loser.

Big healthcare IT vendors and consultants use that tendency to their advantage. Big Vendor A pretends to be genuinely puzzled as to why you’d risk your reputation and your career on smaller Vendor B. After all, everyone whose organization is as good and well-known as yours is buying Vendor A’s products, they say. Those customers are not only deliriously happy, they’ve formed a high school-like clique that makes fun of Vendor B losers and dates cheerleaders after football practice instead of attending chess club meetings. So you’re told, anyway.

Hospital IT people ought to know better. Unhappy Vendor A customers aren’t hard to find, although in some cases you must evade their marketing people and their cease-and-desisting attorneys threatening unhappy users to keep their gripes to themselves.

Healthcare IT also tends to follow polls run by HIMSS and vendors. What technologies are hot? What are other CIOs planning to implement? What IT projects do hospital CEOs see as strategic? Never mind the methodology of the survey or its applicability to an individual hospital. If everyone else is buying CPOE, single sign-on, or business intelligence applications, then who wants to be a contrarian loser?

Those in charge of technology decisions could make a brave stand for a product or vendor that their gut tells them is right. Or, more importantly, to provide the voice of reason for a purchase that makes little sense. They usually don’t. The fear of being fired if it doesn’t work out usually wins. Even if you’re right, you won’t get much reward for it, so why take the risk? Surely the popular product is at least “good enough.”

It’s ironic, though, that by making the “safe” decision, executives are often rewarding the behaviors opposite those they supposedly admire: innovation, entrepreneurship, customer support, and honest sales and marketing. If the market votes one way with its mouth but another with its dollars, those unrewarded traits everyone admires will become extinct.

CIOs gripe endlessly about Microsoft, but Linux on the desktop or even using open source office suites is too much trouble. They fuss about consulting fees, but don’t bother to make the case for bringing expertise in-house instead of contracting for it. They want the best PACS system, but not if it involves a low-profile company unwilling to fund travel junkets or make donations to the hospital’s foundation.

Bigger is not necessarily better. Best marketed, most widely sold, most written about, highest stock market capitalization, most money spent sponsoring industry events and organizations: none are necessarily better.

When all the lemmings are heading in one direction, the path of least resistance is to follow them. On the other hand, once you’ve seen where they’re going, that extra effort to break rank seems worth it.

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Top News

CMS announces a 90-day period of “enforcement discretion for compliance” for the HIPAA 5010 transaction set, meaning CMS will not enforce compliance until March 31, 2012. The announcement follows mounting pressure to delay enforcement since many payers, providers, and vendors are reporting they are behind in their internal and external testing. And the rejoicing commences among procrastinators and those dependent on procrastinators.

From Kaiser-ite: “Re: fixing MU payment mishap. After doing some digging, I have a contact for someone that should be able to correct the issue with the doctor who was not paid her Meaningful Use incentive because it was incorrectly paid to Kaiser. From what I could tell, Kaiser’s  Meaningful Use payments are sought through a combination of different entities, but there is an overall PMO for getting it done. Being a Kaiser-ite, I hate to see the opacity of the org frustrate people.” I have connected Kaiser-ite with Unibroue, who originally sent us the note on behalf of his frustrated client. I’m thankful we have so many great readers that are eager to lend a hand when possible. We hope to hear a happy ending to this mess.

From Beantower: “Re: giant shoe sculpture at Cosmo. This made me think of you. Possible venue for the HISsies.” OMG that is beautiful! If our sponsors hadn’t already secured another Vegas venue, I would be lobbying hard for the Cosmo. Actually, I might be too easily outed if HIStalkapalooza were somewhere close to this shoe as I would be the one trying to crawl into the sculpture with my Inga-tini in hand.

From Little Honey Bee: “Re: Connexin Software. Connexin receives a multi-million dollar investment from Bluff Point Associates. Note the plan for ‘broader clientele’, which is code for ‘no longer focusing on pediatricians’ because there’s no VC company in the world who’d focus on the lowest paid of the specialties.” Connexin offers Office Practicum EHR/PM, which has traditionally been marketed exclusively to pediatricians. The press release makes numerous references to pediatrics, so at a minimum Connexin trying to ease potential concerns from customers that the company’s commitment to pediatrics will be lost in the “next stage of growth.”

From TH: “Re: 5010 enforcement delay. The questions have started pouring in to vendors, payers, and providers on implications.” It seems the government never sticks to a firm date when HIT is involved, which given some of what the government requires is like a death row inmate hearing that the electric chair is broken, but the repair person has been called. I don’t know that a three-month option enforcement period really changes anything, other than to give laggards hope that 5010 will just go away if they ignore it long enough.

From TheBus: “Re: Epic’s reputation. I attended a Minneapolis Collaborative meeting this morning, which focuses on innovation and startups. This one was focused on healthcare innovation, with a great lineup of startup and CEO panelists. Epic was cited specifically by two separate panels as a barrier to progress. Startups and legitimately funded innovators are chomping at the bit to share healthcare data and make it more actionable and Epic’s unwillingness to share and cooperate is a major issue. This group of driven CEOs will move on without Epic if they need to. Epic needs to decide if it’s an innovator or a cash cow. It’s beginning to act like the latter, which is good for its owners, but bad for everyone else.” Just to play devil’s advocate, few companies go out of their way to help their competitors. It’s kind of their job to earn the business on their own. But if we’re talking “healthcare is different than other businesses” even though it really isn’t no matter how often we keep saying it, then it would be nice if Epic played well with others, although as Steve Jobs urged, “Control the user experience.”

From CDSMavin: “Re: UpToDate. A study found that use of UpToDate’s clinical decision support shows shorter length of stays, lower risk-adjusted mortality rates, and better quality performance.”  I don’t find the Journal of Hospital Medicine article impressive. The quality differences were almost imperceptible (LOS 5.6 days vs. 5.7 days, for example) and it was another of those public health-type studies that just matched up a bunch of readily available databases (the UpToDate customer list being one) and looked for differences between customers and non-customers without any attempt to distinguish between cause vs. effect. Were those tiny differences in the cherry-picked numbers due to using UpToDate, or rather due to the differences in characteristics of which hospitals buy UpToDate and which ones don’t? (like if your hospital is hemorrhaging cash and can’t afford to buy medical databases, you’re probably falling short in clinical areas as well.) They didn’t even ask how  hospitals were using UpToDate, so if you believe the authors’ conclusions, all you need to do is buy the product and put it on the shelf. The authors had the data right in front of them that would have provided a more conclusive answer to their vague assertion that UpToDate improves outcomes: show us the mortality rates of individual hospitals before and after they signed up. UpToDate is an excellent product (full disclosure – Wolters Kluwer Health is a sponsor, but I was using UpToDate way before then), but as a vendor of critically evaluated, soundly researched medical evidence, I wouldn’t promote this article too hard if I were them.

HIStalk Announcements and Requests

This week on HIStalk Practice: the Wichita City Council entices Pulse Systems to stay local. Medley Health secures $20 million in Series A financing. gloStream expands it partners program. AAFP’s president encourages members to achieve PCMH recognition. Practice Wise’s Julie McGovern reflects on the similarities between HIT and medicine. In you are curious about the above photo, details here. Stay in the ambulatory HIT loop by signing up for email updates and checking out our sponsors’ offerings. And thanks reading.

Listening: reader-recommended Kevin Salem, a reclusive, commercially indifferent but very talented roots rocker (Tom Petty meets The Replacements) whose modest peak of reluctant fame came in the mid-‘90s. He’s a smart writer on his site, with this fun snip: “In this way, becoming a parent is a lot, I imagine, like being Newt Gingrich: you wake up one day fat and changing your position on virtually everything, blaming your transgressions on the overflow of devotion (in his case, to country, in ours, to our progeny).”

  Go ahead, make Inga’s day: (a) sign up for e-mail updates; (b) electronically canoodle with us via Facebook and LinkedIn; c) send news and rumors by clicking the puzzlingly green Rumor Report box to your right; (d) thank a sponsor since CEOs just gush when a reader tells them their sponsorship is appreciated; and (e) behold in the mirror the face of a rebel, a thinker, a self-directed universe-denter who isn’t afraid to get news from a thoroughly unprofessional site of uncertain provenance, for which I am eternally grateful since it would be lonely here otherwise.

My latest pet peeve: desperate pseudo-news sites that insist on running dumb slide shows or photo galleries, forcing you to click endlessly through unrelated pictures one at a time just to see the crappy list they’ve hastily assembled with dumbed-down headlines that would have easily fit onto a single page, like”12 Great Places to Raise Kids” or “25 Gourmet Ramen Noodle Ideas.” You know, of course, why they do that: every one of your time-wasting clicks counts as a page view, eliciting gooseflesh on the part of Internet-savvy but marketing-stupid advertisers who don’t catch the fact that such mindless clicking, no matter how many impressive statistics it generates, provides them with no benefit whatsoever.

On the Jobs Board: Clinical Applications Analysts, Director Client Programs – HIE Architect, Senior Implementation Project Manager. On Healthcare IT Jobs: SQL/EHR Programmer, Manager IS Enterprise Systems, Epic Revenue Cycle.

Acquisitions, Funding, Business, and Stock

Safeguard Scientifics leads a $7 million Series A financing for Medivo, an HIT company providing data analytics and lab testing services. Safeguard also recently added billing system software provider AdvantEdge Healthcare Solutions to its portfolio.

The stocks of nursing home operators and their landlords have fallen sharply since July, when the government announced a 11.1% cut in Medicare reimbursements. Landlords are concerned that some nursing homes won’t have enough money to pay their rent. Industry analysts believe investors may be over-reacting since many nursing homes have ample cash to manage operations for at least another 12-18 months, and most landlords set rents low enough so that operators have cash available in the event of earnings shortfalls. 

Perceptive Software releases its ModusOne document output management solution for GA.

AirStrip presented at the mHealth Conference in Paris this week as the company prepares for an international launch, with GE Healthcare as its global distribution partner.

  GE announces that it will open a global software center in San Ramon, CA, hoping to speed innovation and commercialization of software technologies in its many business lines and to lead its 5,000 software professionals. The announcement mentions intelligent systems that operate on the “industrial Internet.” Healthcare gets the only customer quote, with Mount Sinai Hospital President and COO Wayne Keathley talking up GE’s tools to manage patient flow and costs. The gratuitous photo accompanying the press release didn’t do the company any favors other than to boost CT scanner usage as readers suddenly come down with unexplained headaches.

New Mexico Software changes its name to Net Medical Xpress Solutions. It offers PACS, a radiology reading service, and a newly announced telemedicine service.

Sales

HANYS Solutions, a subsidiary of the Healthcare Association of New York State, expands its agreement with QuadraMed to include identity management solutions.

Northern Ireland Health and Social Care selects Mediware’s JAC Computer Services Limited technology for enterprise medication management.

San Diego Beacon Community (CA) selects OptumInsight to build its health information exchange.

Huntington Hospital (CA) engages MedAssets for revenue cycle solutions that include tools for charge master management, charge capture auditing, and cost management of drugs and supplies.

People

The  Patient-Centered Primary Care Collaborative announces that Marcia Nielsen, PhD, MPH, will take over as executive director as of January 2, 2012. She is associate dean for health policy at the University of Kansas Medical Center. 

Revenue cycle and PM vendor MedSynergies names Vicki Laurie as CIO. She was previously with Anthelio.

Healthcare Quality Catalyst brings on HIT long-timers Dale Sanders (above) as SVP and Larry Grandia as a board member. Dale was CIO of the Cayman Islands health system and at Northwestern University Medical Center before that. Larry was CTO of Premier, but those who’ve been around awhile remember him from DAOU Systems and Intermountain Healthcare (Vince mentioned him in his HIS-tory recently, in fact.) HQC sells clinical improvement data warehouse solutions; I interviewed co-founder Steve Barlow in August.

Frank Maddux is named chief medical officer of renal therapy provider Fresenius Medical Care North America. Health IT Services Group, the EMR company he founded, was acquired by Fresenius in 2009. It sells the Acumen nEHR nephrology EMR.

  Mary Alice Annecharico, formerly SVP/CIO at University Hospitals (OH), is named SVP/CIO of Henry Ford Health System (MI) in an HFHS internal e-mail forwarded by a reader. The announcement mentions HFHS’s “clinical transformation with Epic,” the impending $350 million project to replace its just-implemented $100 million system.

Announcements and Implementations

The 25-bed Grande Ronde Hospital (OR) enters its initial stages of EHR implementation. The hospital’s IT manager tells the local press that “the electronic health record system doesn’t necessarily save time because physicians will have a lot more data to type into the system, but it’s more efficient and the government is requiring more information on costs and quality.” The article also notes that the EHR could provide other benefits “if the system works.”

CureMD Healthcare launches its HIE connectivity with HCA.

Northern Michigan Regional Hospital goes live on CPOE with Cerner PowerChart.

Massachusetts General Hospital goes live on the Sunquest CoPathPlus 5.0 anatomic pathology solution.

SCI Solutions announces that it signed 53 new clients in FY11, raising its total to more than 450 hospitals.

Sectra’s newly announced RIS v 7.0 includes enhancements to allow radiologists to meet Meaningful Use objectives, including a referring physician portal, a patient portal, and lab test tracking.

Government and Politics

CMS releases the 2012 application for its Medicare Shared Savings Program. ACOs have the option of starting April 1 (applications accepted December 1-January 20) or July 1 (applications March 1-30.)

Technology

Home care software provider Procura launches Procura Mobile for Android, adding that option to its existing BlackBerry client.

Business analytics company Pentaho announces native HL7 support with Pentaho Business Analytics.

Other

HIMSS releases its full agenda for the HIMSS12 educational program, which includes over 300 sessions.

CHIME and eHealth Initiative release an HIE guide for CIOs.

AHIMA expresses disappointment with the AMA’s opposition to the ICD-10 implementation schedule, noting that ICD-10 offers “countless benefits.” AHIMA says it has demonstrated that administrative systems can be easily implemented for most primary care practices and that specialty practices will only be using a small number of codes.

Despite widespread success recruiting  and enrolling providers, RECs have helped relatively few providers attest for Meaningful Use. Of the 90,000 providers enrolled nationwide, only 1,000 have attained Meaningful Use; the goal for RECs is for at least 20% success. Some RECs have faced challenges with staff recruiting and retention, while others complain of difficulties getting software upgrades from vendors on behalf of their clients.

A blogger visiting the Epic campus posts a great collection of photos from her tour of Intergalactic Headquarters. She captures everything from obscure works of art, architecture, and the assorted whatnots.

GetWellNetwork PatientLife System earns the top spot in KLAS’s just-released review of interactive patient systems, beating four competitors. The category covers hospital in-room systems that can provide patient education, on-demand video, patient surveys, entertainment, Internet access, patient requests, and nurse communication.

A laptop stolen last month from Sutter Medical Foundation contained personal information for 3.3 million Sutter Health patients, although that information was benign (patient names, contact information, medical record number, and insurance information.) The laptop wasn’t encrypted, although Sutter says its encryption project was underway and it will now accelerate that effort.

Health Outcomes Sciences posts a free trial of its ePRISM clinical risk modeling software, which provides patient-specific automated consents and outcomes forecasts for angioplasty.

Verizon makes its Fraud Management for Healthcare software available to government and private health insurers. “Makes available” was not qualified with “for free,” so this is apparently a product announcement.

This is a rare two-Newt mention edition: USA Today calls out Newt Gingrich for shilling healthcare vendors who pay fees to his big-money Center for Health Transformation without disclosing his vested interest. Example: he and Sen. John Kerry lauded his Center’s clients Allscripts and Misys in promoting electronic prescribing legislation that would benefit them back in 2008. I’ve ripped Newt’s center here for years because he passes it off as a noble think tank working for the betterment of society, when in fact its primary purpose is to line Newt’s pockets and keep him publicly visible. In fact, here’s what I said in 2008 when I was annoyed at another example of Newt’s shameless pitching:

Newt Gingrich pops up at Silver Cross Hospital (IL) to brag on Misys technology, of all things. Well, mostly about himself and his business, Center for Health Transformation, which the newspaper calls a "collaboration of public and private sector leaders." He’s our Jesse Jackson, sticking his head anywhere there’s a camera, somehow becoming wealthy without ever having had a real job, and working the system for personal benefit. I still kind of like him, but it’s trending down.

 This is one of the most egregious medication errors I’ve heard of: a hospital nurse intending to give Pepcid IV to a patient who is suffering from heartburn instead grabs pancuronium, the muscle blocker most often used for intubation (with respiratory support) and to kill prisoners (without respiratory support, basically smothering them). He dies; the family is suing. An investigation found that the nurse pulled the pancuronium from the secure area in which it was stored, didn’t read the label, skipped the bar code checking step, and then left the patient alone for 30 minutes afterward. She was fined $2,800, received a warning, and still works at the hospital.

A man trying to commit suicide in a hospital’s ED parking lot by mixing deadly chemicals in his VW convertible changes his mind, strolling into the ED at 3 in the morning. The ED had to shut down for over four hours as the hazmat team cleaned up. The man is fine and may face charges.

Sponsor Updates

• Shepherd Center (GA) implements RelayHealth’s MedGift patient gift registry and social media network.
• Buchanan County Health Center (TX) says its implementation of  the Access Intelligent Forms Suite has streamlined the organization’s paper process and facilitated integration with its Meditech 6.0 system.
  Billian’s HEALTHDATA releases its list of the 25 Best & Worst Rated US Hospitals, based on patient experiences at 3,002 hospitals.
• Concerro revamps its website and asks for feedback. Those sharing their opinion on Facebook, LinkedIn, or Twitter will be entered into a drawing for a $100 Amazon gift card.
• Practice Fusion reveals its iPad prototype and roadmap at last week’s Connect 2011 meeting.
• MED3OOO congratulates its client PED-I-CARE (FL) for winning the MGMA/ACMPE Fred Graham Award for Innovation in Improving Community Health.
• Healthcare Management Systems (HMS) announces that 17 additional client hospitals have successfully attested Stage 1 MU.
• Cynergisk Tek CEO Mac McMillan will discuss healthcare privacy and security issues at seven regional HIMSS conferences in Q4 2011.
• David Nace MD and Arien Malec of RelayHealth participated in ONC’s annual meeting this week in sessions related to IT requirements of Patient-Center Medical Homes and interoperability, respectively.
• Elsevier Clinical Decision Support collaborates with ExitCare to integrate ExitCare content into the Elsevier/Gold Standard and MDConsult products.
• NextGen names Port Gabmle S’Klallam Tribe (WA), Drs. Goodman & Partridge OB/Gyn (AZ), and Nautilus Healthcare Management Group (CA) as winners of its sixth annual Best Practice Awards for exemplary use of NextGen solutions.

The Centers for Disease control recently released its final review of the Healthy People 2010 program. The results of its 10-year health goals aimed at improving the health of Americans are mixed. Although targets were met for 23% of the 733 objectives and progress was made in half of the remainder, there was no change for 5% of the objectives and 24% of them actually became worse. Obesity and health disparities targets were among those missed. Now that we have a baseline, I’ll be interested to see if Meaningful Use makes a difference on any of these metrics.

Surprise, surprise: a new study published in the Journal of the American Medical Association finds that physicians who own and bill for nuclear stress and stress echo testing are more than twice as likely to order those tests than physicians who don’t bill for those services.

News of the Weird: enterprising parents who want their children to be naturally infected with chickenpox are apparently using Facebook to arrange shipment of items contaminated by sick children. Pre-licked lollipops, blankets, and other disgusting items were reportedly being exchanged. In addition to being gross and disgusting, it’s also illegal.

Disco isn’t dead: researchers looking at effective technique for cardiopulmonary resuscitation (CPR) compared the chest compression technique of providers listening to either silence or the songs “Achy Breaky Heart” or “Disco Science.” Although the disco beat helped providers give compressions at a more ideal rate, it didn’t improve the depth of compressions.

The AMA announces a series of workshops to assist with the ICD-10 transition. Exciting locations include Baltimore, New Jersey, Dallas, Atlanta, and Las Vegas, all during the first part of December.

To Wear, or Not To Wear: hot on the heels of a UK ban on wearing white coats or long-sleeved uniforms in health care, a pair of articles show that maybe traditional garb isn’t as bad as was thought. A study performed in Jerusalem showed that upwards of 60% of physician and nurse uniforms harbored bacteria, some of the multidrug-resistant variety. Authors note, however, that “it remains to be determined whether these bacteria can be transferred to patients and cause clinically relevant infection.”

A separate study published earlier this year showed no significant difference in bacterial colonization rates between infrequently washed white coats and short-sleeved uniforms which were donned fresh each day. After eight hours of wear, the newly laundered uniforms were as contaminated as the white coats.

Frankly, I think some of the grossest places in the hospital are the computer workstations. I see very few keyboard covers that can be wiped down, and what’s even worse is the food crumbs in the keyboards, meaning someone is actually eating while using a dirty keyboard. Eww. That’s one more reason I carry my own personal tablet on rounds – I know when it’s been sanitized and I know for sure I don’t ever document without washing my hands first.

While researching this topic, I came across a related study which showed that “non-conventional” nurses’ attire (i.e. brightly colored clothing) helped lower children’s distrust of healthcare providers and reduce fear. Maybe Patch Adams was onto something after all. Interestingly, coloured uniforms (honouring the British spelling) also improved parental perception about the reliability of the nurse.

No surprise here: empathy can’t be taught. A study in the Archives of Surgery shows that surgical residents who attended communication training increased their communication scores, but not how much empathy they are perceived to have.

People notes: HIStalk Medicine Cabinet member Micky Tripathi was featured in a Medical Economics piece on Regional Extension Centers.

Have a question on billing practices, keyboard sanitizing, or choosing sassy scrubs? E-mail me.

Contacts

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

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Top News

The AMA’s House of Delegates votes to “work vigorously to stop implementation” of ICD-10, which it says will create “significant burdens” on the practice of medicine with no direct benefit to the care of individual patients. AMA President Peter W. Camel, MD also notes that physicians are concentrating on EMR implementation and the switch to ICD-10 would “add administrative expense and create unnecessary workflow disruptions.”

From Big Scout: “Re: NextGen User meeting. Kicked off today with a multimedia presentation including keynote speaker John Foley, former lead solo pilot for the Blue Angels. Some of the key themes so far: Meaningful Use preparation, ICD-10, and high performance teams. Farzad Mostashari is also in attendance.” We love the “from the field” reporting, so thanks for sharing. Big Scout is one of over 4,200 participants at this week’s NextGen user meeting in Las Vegas.

From Unibroue: “Re: HITECH mess. One of my clients just got rejected for her ARRA money because Kaiser claimed her payment earlier in the year. She had supposedly signed a contract with them while still in medical school, though she never actually went to work for them. She has no idea how it happened, but expects a nightmare to undo it. The feds don’t even provide any kind of contact information and have just advised her to ‘get in touch with Kaiser Foundation.’ A billion-dollar conglomerate has her $22K and she’s not happy.” Maybe readers have suggestions on how to resolve. Good luck.

From Not in Kansas: “Re: NHS. The National Health System is a thing to be seen. Of course on the way to seeing it, you have to deal with impossible parking, non-working lifts, a large bucket catching the drips from the ceiling, and hazardous waste parked in the corridor.” Not in Kansas reports that she is across the pond assisting a relative who is having surgery. While some American patients might envy the cost of NHS care (it’s free), the US model does, for the most part, afford us an abundance of well-maintained facilities and other niceties.

From Non-Sequitur: “Re: HIStalk quoted. I just loved the sweet irony of seeing you quoted in the pages of one of those magazines you described, which ran an article on the Colorado HIE cost challenges saying the story was ‘plucked from the HIStalk web site.’” I thought that was darned nice of Health Data Management (or perhaps more accurately, reporter Joe Goedert,) for hat-tipping HIStalk instead of just following my link and pretending they found that story on their own. Joe’s one of the good writers who learned the players and the lingo, sticks to reporting the news objectively and skillfully, and doesn’t confuse being an sideline observer with being a participant who’s qualified to render advice or provide expert editorial opinion (“I’m not a doctor, but I play one on TV.”) The first thing I do when I read an editorial or self-assured comment telling providers or vendors what they should or think is check LinkedIn for the author’s education and experience. I’m usually not impressed.

From Olly Oxen: “Re: Cleveland Clinic. A healthcare market research report says Cleveland Clinic has exceeded Epic’s capabilities for data analysis and revenue cycle tools that will be needed to manage populations in an ACO-type model. Executives there are apparently disappointed that Epic isn’t interested in helping them in those areas, forcing the clinic to bring in other vendors after paying all that money for Epic.” Unverified, but OO provided an excerpt from the report.

From Janga: “Re: NIST’s draft on EHR usability testing. HIMSS provides their commentary.” The HIMSS response expresses concern at having actual usability experts doing the testing, favoring instead “inclusion of individuals with practical clinical experience.” I don’t agree – the document clearly identified steps in which subject matter experts would be involved to provide subjective analysis and comments, but real usability testing is product-agnostic (are menus labeled clearly, how many clicks to complete a task, etc.) HIMSS also thinks testing conditions should reflect real-life interruptions and competing workflow, which sounds nice on paper but isn’t really how usability testing is done (remembering again that usability is a profession with its own literature and standards, not just a bunch of nerds deciding arbitrarily how products should be tested.) Having said that, though, I think HIMSS was admirably restrained in not nitpicking the draft to death and trying to insert itself into the process (like it did for EHR certification.) So I’ll moderate my comments: HIMSS brings up some industry-specific points worth considering, although usability experts and NIST have way more expertise and thus should have the final say.

HIStalk Announcements and Requests

Welcome to new HIStalk Platinum Sponsor NextGate, whose MatchMetrix master index solution manages over 50 million unique entities (patients, providers, terminology) worldwide. The Pasadena, CA-based company was founded by the technical brains behind one of my favorite products of all time, the STC Datagate integration engine (we’re talking mid-1990s here that I was involved in buying it for my health system), arguably the first generation of what eventually became vendor-independent interoperability solutions. The NextGate folks are serious technologists with expertise in EMPI, enterprise registry, enterprise application integration, and service oriented architecture, all vital for presenting consolidated data views and exchanging information. MatchMetrix gets high KLAS scores; is used by both providers (HIEs and health organizations) as well as vendor partners; and offers low TCO, fast implementation, and straightforward management. For those of us who appreciate high-achieving geeks, note that every single member of NextGate’s leadership team has earned their technical stripes. Thanks to NextGate for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

simplifyMD secures $4.5 million in new capital and names Michael Brozino as president and board member. He was previously with McKesson and the McKesson-acquired A.L.I.

PHR vendor MMRGlobal reports a Q3 net loss of $2.1 million, compared to last year’s loss of $1.7 million. Revenues were $352K compared to last year’s $270K.

Nashville-based critical access hospital software vendor Custom Software Systems, Inc. changes its name to CSS Health Technologies. It sells the ChartSmart EMR.

Healthcare learning and research solutions vendor HealthStream opens the public offering of 3,250,000 shares of its common stock, with the sole book-running manager being William Blair & Company, LLC. Proceeds could reach more than $50 million.

Sales

Avalon Health Care Management selects HealthMEDX Vision as its enterprise-wide solution for its 39 long-term care facilities.

Alabama Medicaid and the state of Alabama partner with Thomson Reuters to build the infrastructure for a statewide HIE known as One Health Record.

Barnabas Health (NJ) selects the MedAptus Professional Intelligent Charge Capture solution for its 4,500 physicians.

Healthcare Access San Antonio (TX) chooses Medicity’s HIE technology to connect its providers and area hospitals, initially using the iNexx platform to create a 22-county referral network. HASA is one of only two regional grant recipients to qualify for state funding to start implementing an HIE.

Florida Medical Clinic selects Humedica MinedShare for managing its patient population and improving clinical outcomes.

Catholic Healthcare West signs a three-year, $4.3 million deal to implement AirStrip OB remote fetal monitoring on mobile devices.

University Medical Center (NV) gets county approval to buy an unnamed $31 million clinical system (presumably McKesson.) The hospital said in July that it couldn’t come up with the $60 million needed and had only $25 million to spend with McKesson, its vendor of choice.

The board of Edward Hospital (IL) voted Monday evening to approve the purchase of Epic as its core system along with Lawson for ERP, VP/CIO Bobbie Byrne MD, MBA tells me. She says, “I have a great deal of respect for many of the vendors in our industry and I was impressed with several of the proposals we received. Epic was the right choice for Edward because of the robust integrated products for clinical and revenue cycle across both hospital and physician office settings. One patient, one record, one bill …” You may remember Bobbie from her four years with Eclipsys as SVP of clinical solutions.

The Portland VA chooses Magpie Healthcare’s CareConnect to connect clinicians with on-call staff and to activate care teams. Magpie was one of six organizations to receive funding under the VA’s Innovation Initiative.

Mediware CFO Michael Martens will step down effective February 15, 2012 to rejoin a former employer. He joined the company two years ago. The company will conduct a national search for his replacement.

Sean P. Kelly, MD joins Imprivata as chief medical officer. He will continue his practice as an emergency physician at Beth Israel Deaconess Medical Center.

ZirMed names former Culbert Healthcare and GE VP Kent Rowe as VP of sales.

Jack Walsh, formerly with IMS Health, Inc., joins SRSsoft as CFO.

Intelligent InSites names Mary Jagim chief nursing officer.

Carol Simon, PhD is named director of the just-announced Optum Institute for Sustainable Health.

Announcements and Implementations

Henry Ford Health System (MI) launches its $100 million EMR this month (the article says it’s a homegrown product, but I believe it’s actually RelWare’s EXR.) That’s a temporary solution since the health system is negotiating with Epic in a deal valued at $350 million, which based on HFHS’s most recent financial report, will cost the health system six years’ worth of net income.

MRO Corp announces that it is among the first health information handlers to successfully pass all critical integration tests for CMS’s CONNECT Gateway Pilot Program, which facilitates the electronic submission of medical documentation to RAC auditors.

Cincinnati-based HIE HealthBridge selects IBM Initiate Patient software for its infrastructure.

Greenway Medical launches PrimeDATACLOUD, a care delivery platform that recognizes and aggregates data from various EHR and HIS platforms and facilitates health information exchange.

Government and Politics

HHS’s own Indian Health Service is struggling with the transition to ICD-10 for its RPMS, IHS’s version of the VA’s VistA. CIO Howard Hays says ICD-10 is his highest short-term priority.

Florida Governor Rick Scott, appearing on a public radio talk show, seemed to be referring to the Florida Health Information Exchange when saying, “There haven’t been a lot of studies to date that suggest electronic medical records have saved a lot of cost. They’ve increased cost because of the way you have to keep all the records. I’m the one who should be taking care of my information and not relying on the government to do it because I believe it will raise the cost of healthcare without a result.”

Researchers in Belgium are developing technology to embed “electronic noses” in mobile phones to verify the freshness of food, test air quality, and measure blood alcohol levels. It’s all part of a human “Body Area Network” (BAN) system that also incorporates wireless sensors for monitoring heart rates and blood glucose levels.

And in other nose news, Grand Challenges Canada and the Bill & Melinda Gates Foundation award The Electronic Nose a $950,000 grant to support further development and testing of its technology for detecting TB immediately and non-invasively from a patient’s breath.

In England, a former Royal Army Medical Corps captain working on his PhD in computer science develops Mersey Burns, an iPhone and iPad app that calculates the IV fluid needs of severely burned patients such as soldiers on the battlefront. His research, conducted with two plastic surgeons, won an NHS innovation award this month.

Other

Michigan Health Connect (MHC) announces that Olympia Medical Services is extending MHC’s HIE solutions to its 500 physician members.

Massachusetts doctors who take patient photos for their EMRs and in reaction to the Red Flags identity theft rule are losing patients who claim the practice is an invasion of their privacy. The practices highlighted say they’ll scan the patient’s own photo or driver license instead of taking their picture if the patient prefers, but the patient interviewed by the local paper says “people are being tracked.” The executive director of the World Privacy Foundation says medical identify theft is usually an inside job that the photos won’t prevent, not to mention that “we don’t want our healthcare providers to become the new airport TSAs.”

In South Korea, the medical doctor who founded the country’s leading anti-virus software company donates $133 million (USD) to educate the children of low-income families. He’s also a top candidate for next year’s presidential election.

ECRI Institute announces its Top 10 Health Technology Hazards for 2012, all related to recent incidents that made headlines:

1. Alarm fatigue / lack of alarm response
2. Exposure hazards from radiation therapy
3. Infusion pump-related medication errors
4. Cross-contamination from flexible endoscopes
5. Change management with regard to medical device connectivity
6. Mixing up enteral feeding lines with IV lines
7. Surgical fires
8. Sharps injuries
9. Anesthesia equipment problems not discovered during surgery
10. Poor usability and design of home medical devices, leading to misuse

Sponsor Updates

• Optum launches The Optum Institute for Sustainable Health to provide analysis and insight on the landscape of healthcare.
• Miami Children’s Hospital’s nursing manager Deborah Hill-Rodriguez, MSN, ARNP, PCNS-BC, will discuss best practices during GetWellNetwork’s November 17 Webinar entitled Leveraging Technology to Support Pediatric Fall Prevention.
• NextGen Healthcare recognizes five client hospitals for successful Stage 1 Meaningful Use attestation.
• David Finn of Symantec Health shares his thoughts on the need to take action on security and privacy in healthcare in the company’s Healthcare Online blog.
• The Detroit Free Press names CareTech Solutions a Top Workplace in the large company category for the third year in a row.
• Apixio announces that its Community Search product has been integrated with Allscripts Sunrise EHR and is available on the Allscripts Application Store and Exchange.
• AdvancedMD announces the availability of its 2011 Fall release, which enables practices to send ANSI 5010-formatted claims.
• Awarepoint is awarded four additional patents for its real-time location systems for hospitals.
• Imprivata wins the Security Projects of the Year award at the 2011 Computing Security Awards.
• MEDSEEK announces that 18 of its healthcare clients received a total of 25 honors at the Strategic Communications eHealthcare Leadership Awards competition.
• The Technology Services Industry Association and Impact Learning Systems designate TeleTracking Technologies as a Certified Support Staff Excellence Center.

Contacts

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

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Dear Dr. Jayne,

Is our current EHR paradigm dated? Docs practiced for years with paper. Pencil evolved to ink, both inscribed on compressed wood. Housed in manila folders, stickers provided the index and retrieval involved sight-based interpretation based on patient names. Then, we introduced computers. Initially similar to the paper paradigm, full summaries in ANSII or images are stored in a paradigm that still resembles folder-based paper storage.  From the images and full ANSII summaries came discrete data points. Ink on paper had now evolved to data capture as unique field based database storage. Over time, these discrete data points will become much more comprehensive.   

With all the technical advances where is the industry going? Will the paradigm shift from practicing medicine on discrete data points to something else, and when? Will medicine be able to shift? Is multimedia the next frontier? Just like the initial paper to electronic chart paradigm shift, when will computer science convert images and video to discrete data points? We all know the value of discrete data.

Fan of Dr. Jayne from the Deep South

Dear Southern Fan,

You pose some interesting questions. Given the fact that physician recordkeeping didn’t change much for hundreds of years, the relative pace of records evolution at present is staggering. We’re already becoming fairly adept at converting spoken language into discrete data, allowing physicians to document patients’ stories not only with codified data points, but with the rich narrative that frames individual patient circumstances and situations.

In my opinion, the biggest barrier to the kind of documentation that can be envisioned is unfortunately the proverbial hand that feeds us. The regulations, policies, and requirements of CMS are still stuck in the paper paradigm. And as we all know, as CMS goes, so go the rest of the payers. Despite federal mandates to take the technology forward — such as HIPAA and HITECH — healthcare providers are still being scored based on documentation standards that have not evolved in more than a decade.

Physicians can’t get “bullet point” credit for documenting a cancerous skin lesion with a photograph. They say a picture is worth a thousand words, but in an audit, a picture is worth nothing.

I remember sitting in medical school watching a video of a child with whooping cough. No written description could ever take the place of that. When you see and hear that kind of pathology, it’s etched in your brain forever. Nevertheless, embedding a video clip of a patient isn’t worth anything, either. I can look at a photograph of a diabetic foot and tell you a lot more about a patient’s illness and status than I can glean from a multi-page nonsense note generated from a poorly-implemented EHR.

I once heard someone say that our thinking is constrained by the technology of today. I don’t think that’s the entire problem; our vision is also constrained. And it’s not the technology that locks us in, but also the auditing and payment paradigm that hobbles us.

I was initially hopeful that the rise of Accountable Care Organizations with their risk-sharing and outcomes orientation would help us move to a more modern way of thinking and documenting. It doesn’t look like the fact that providers and payers are sharing risk is going to move us away from the incessant and costly paradigm of documentation for documentation’s sake.

The promise of telemedicine and other technology ventures such as real-time electronic patient communication was exciting. However, lack of payment and increased regulatory burden continue to keep it from realizing its potential. I’d like to think the future’s so bright we’ll have to wear shades, but I’m not sure CMS agrees.

Dr. Jayne

E-mail Dr. Jayne.

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