Happy New Year!

Given the lame (and guardedly vague) healthcare IT predictions for 2012 that I’ve seen, written by reporters and other non-combatants, I’ll pass on giving my own. Some of the pearls of predictive wisdom: (a) companies may consolidate; (b) consumers will be engaged; (c) ACOs will be formed and will need analytics; and (d) social networks will be used to encourage good health.

My Time Capsule editorial from this same week of 2006: Can EMRs Sweeten their ROI by Moonlighting as Research Databases? A random sample: “Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.”

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

The HIT bubble is here to stay, most readers believe, which must mean it’s not really a bubble in their minds. New poll to your right: when a hospital says having its clinical systems offline for several hours resulted in no patient harm, do you believe them?

We’ll give the HISsies nominations just a few more days before moving on to the actual voting, so this is last call to get your candidates on the ballot. Some obvious choices haven’t been nominated, I should say.

Here’s Vince’s HIS-tory on outsourcing.

Geisinger Health System (PA) says it will not hire smokers starting in February, when job applicants will be required to take a nicotine test.

Reading Hospital (PA) retools its executive team to put clinicians in key roles. The new CEO and COO are nurses, while the new CMIO, chief medical officer, and VP of academic affairs are physicians. The CEO, COO, and CFO all came from the consulting company the hospital had engaged to review best practices. The hospital says it’s also implementing a management process that includes physicians in every decision. Also mentioned is the hospital’s $180 million decision to implement Epic, which the hospital’s board chair says “will explode the quality of care and increase patient satisfaction.”

Cleveland, OH health systems Cleveland Clinic and MetroHealth are sharing electronic patient records and Kaiser Permanente will join them shortly. They’re using Epic’s Care Everywhere rather than an HIE, meaning they can access the records of patients who have opted in from 300 hospitals and 4,000 clinics.

Stanford researchers develop an application that allows technicians to control MRI machines from HP’s TouchPad tablet, which was discontinued within two months of its launch and sold off for $99. The researchers liked it because HP helped them remove its metal parts, a requirement for operating near an MRI magnet.

A British physician advisory group proposes that NHS allow patients to review their own electronic medical records by 2015, including the ability to review physician notes and request prescription refills and appointments online. Expected roadblocks are patient confidentiality concerns, physicians who don’t want patients to see their documentation, and NHS’s potential inability to provide such a service.

A California hospital investigates one of its contracted employees who allegedly posted a photo of a patient’s medical record, including the patient’s name, on Facebook with the comment, “Funny, but this patient came in to cure her VD and get birth control.” Several people scolded the employee on Facebook for violating the patient’s privacy, to which he replied, “People, it’s just Facebook … Not reality. Hello? Again … It’s just a name out of millions and millions of names. If some people can’t appreciate my humor than tough. And if you don’t like it too bad because it’s my wall and I’ll post what I want to. Cheers!”

A man who rear-ended a parked fire truck and then sued the firefighter who saved his life gets nothing in the settlement of his lawsuit. The fire truck was parked in the opposite lane as firefighters were responding to an accident. The driver had a long record of traffic offenses, had been ordered by a court not to drive, was not carrying insurance, and was taking three judgment-altering drugs. He lost control while speeding on the rain-slicked road, crashed into the fire truck, and had to be flown out by medical helicopter. He wanted $300K to settle his suit that claimed the fire truck was parked in his lane, which the crash scene photo appears to show is not the case. The city paid $47,000, of which the man’s children will get $20,000 and lawyers $27,000, claiming it was cheaper to pay the money than the cost of a trial. Since the accident, the driver has been convicted of two additional crimes, one of them a felony that will likely send him to prison.

I’ll have full details on HIStalkapalooza mid-week, so watch for that if you’re interested. Readers always like to guess a company given a tiny section of their logo, so above is your challenge.

Also coming mid-week is information about an application development contest that we’re helping promote. Here’s the story.

One of our sponsors asked us if we had additional promotional opportunities available, i.e. they wanted to buy a featured post or access to the e-mail list. They were running a fun-sounding contest with some pretty cool prizes, right down the alley of HIStalk readers who have written medically related software (vendors or providers alike.) We said no, we don’t do that – all we offer is sponsorships, all sponsors get the same benefits, and we will never make the e-mail list available to anyone. We always turn down requests to provide more exposure for cash.

Inga and I were noodling around on how we might help in a non-commercial way that would benefit someone other than ourselves, so instead of just saying no, we told them, “Make a big donation to charity and we will help get the word out to our readers as long as we can do it our way.” They agreed. We suggested the charity and the dollar amount, to which the company also (surprisingly) agreed.

Receiving the company’s ample donation was Homes for our Troops, a top-rated charity (98.5% on Charity Navigator) that builds specially designed houses for severely injured and disabled veterans who receive them at no charge, with the assistance of donated labor and supplies. Our designated recipient is Marine Staff Sergeant Jack Pierce of Temple, TX, paralyzed from the chest down in his third deployment in Afghanistan when his vehicle drove over a 200-pound bomb, killing two other occupants and severely injuring six. The apartment in which he, his wife, and their young son live is not wheelchair accessible.

I’ll be sending the contest information out around Wednesday.

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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 December 2006.

Can EMRs Sweeten their ROI by Moonlighting as Research Databases?
By Mr. HIStalk

I’d never heard of the Clinical Data Interchange Standards Consortium (CDISC) until last week. That’s when that group announced the kickoff of a new interoperability project, this one involving linking EMR systems to the information systems of clinical investigators who are performing drug or disease research.

The audience is researchers, the Centers for Disease Control and Prevention, or registries for patients or disease. The IHE is involved in the testing and will demonstrate the results at the HIMSS conference.

I’m not usually interested in this sort of project. I’ve seen first-hand what an insurmountable effort it can be just to get hospital systems to swap clinical data across the hall, much less with national third parties. Still, this is an exciting indicator of how quickly the now-common idea of interoperability has taken hold. If nothing else, RHIOs have made hospitals think about the value of their patient information and how to exchange it in standard electronic formats.

Getting and keeping drugs and devices on the market is expensive and information-intensive. Several small, highly profitable companies have sprung up to help enlist patients in studies, to do the rigorous paperwork required, and to design research methodologies. Their key commodity is information.

Hospitals have patient information that’s available nowhere else, the kind that arouses researchers and manufacturers that have far deeper pockets. Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.

Let’s say your hospital implements a well-integrated, information-rich EMR system that can easily tie together everything about patients from medical history to demographics to procedure history. Suppose you add genomic data to the mix, storing information about family history, lifestyle, and a longitudinal history of disease, treatment, and outcomes. Your patients will benefit, but the information has an equally high value to those third parties trying to assemble or execute big research projects.

Drug companies and device manufacturers need the data that lives in your clinical systems. How else will they be available to target research to a very narrow range of patient types, maybe even those with a rare genomic profile? It could help them identify appropriate research subjects, design post-marketing surveillance, study population-based outcomes, and catalog adverse events. The information you provide could either be de-identified or made available only if individual patients opt in. The benefit to patients is access to a wider variety of treatments and protocols, most likely free to them if tied to a research project.

You wouldn’t just give that information away, of course. Hospital information is far deeper and more detailed than what’s available from any other source, with a wide scale to match. All you need is sophisticated EMR functionality and a relentless push to get every scrap of clinical information codified, categorized, and cross-referenced.

In the movie Wall Street, Gordon Gekko says, “The most valuable commodity I know of is information.” That’s true of clinical data, especially when those who value it can pay. Just don’t sign away too cheaply the rights to your treasure trove of data, even if the interested customer is a RHIO or third party data vendor.

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We asked several HIT vendor executives the following question: Where do you plan to invest your research and development dollars over the next 1-2 years?

Tim Elliott, Founder and CEO, Access

We are focusing on three technologies that every hospital needs: electronic signature, a data bridge between clinical devices and systems and EHRs, and paperless, online e-forms.

The next generation of e-signature not only enables patients to quickly and securely authorize e-form registration packets and bedside consents, but also offers administrators the convenience of a server-based model. A clinical data bridge can capture and standardize output from devices (such as EKG traces and surgery images) and systems (perinatal documentation, COLD feeds, etc), and interface these directly into EHRs – with no paper or manual indexing.

Finally, we’re giving hospitals a way to transform slow, inefficient paper-based processes – such as onboarding, capital requests and physician referrals – into fast, collaborative, paperless ones. Users will be able to access electronic forms from their browser, add attachments, apply digital signatures and send through the proper channels, and to track each stage of the process. Upon completion, a copy of the form is archived in the ECM system and data posted to business and/or clinical systems. With healthcare facilities shooting for full EMRs, we’re doing our part to create technologies that fill the gaps, and are focusing our R&D on removing paper from as many processes as possible.

Ray Dyer, CEO, Acusis

As a clinical documentation solution provider, we continue to look to our customers and healthcare IT market drivers. Given the many transformations underway, driven to a large degree by healthcare provider behavior, we are planning on investing our R&D funding in user intelligence tools including decision support and patient care analytics as well as mobile solutions development. We believe these areas will continue to be driven by customer need and demand, requiring data availability with strong privacy and security provisions. Acusis is poised and preparing to meet these challenges.

Dan Herman, Founder and Managing Principal, Aspen Advisors

Aspen Advisors’ investments will be focused on the expansion of our current services to address the needs of our clients:

• Adoption of EMR technologies and clinical informatics;
• Healthcare reform in support of “accountable care” delivery and financing models;
• Operational integration of Business Intelligence and Data Warehousing solutions to enhance care delivery, improve quality, reduce costs; and
• Improved reliability and cost effectiveness of technology infrastructure through the implementation of structured IT service management processes.

We will continue to invest in the development of structured, repeatable, yet flexible methodologies for planning and assessment, implementation management, and operational performance improvement.

We will also continue our investment in training programs for our consultants, so that our clients will continue to see the consistent application of expertise and delivery of service as our firm continues to grow.

Don Graham, General Manager, Billian’s HealthDATA

Our R&D investment will focus primarily on improving our data on outpatient care, and the better use of social media internally to communicate who we are and what we have.

With outpatient surgical visits now accounting for almost two-thirds of all surgical visits in the US, it is an area that our customers – healthcare vendors – are paying more and more attention to. We in turn must provide them with the data they need to best address this trend, which doesn’t show any sign of slowing down in my opinion.

As for social media, it’s proving to be the most effective way to distribute the news. That includes, of course, healthcare news. We realize that our customers and their provider customers are increasingly using social media as a means of communication and self-education, not to mention public relations and marketing. Patient referrals, good and bad, will have an ever-increasing influence on healthcare-related decisions made by the public, and the public’s migration to social media is obvious.

We, of course, want to be where our customers are, whether that be Twitter, LinkedIn, or blogs like HIStalk, so we’ll be ramping up our social media presence internally to make sure that staff are engaged and conversant in the healthcare discussions taking place online.

Stuart Long, President, Capsule

As the leaders in device integration, we’ve always been in the data business. Yet data needs are rapidly evolving. We are going well beyond the basic connectivity of data into information system(s). Basic connectivity is actually well understood as a necessity at this point; hospitals get that automating the vitals collection process is critical to recovering nursing hours, reducing charting hours and improving patient care. What they really need is better, more useful data to help improve decision making, to alert them to impending conditions faster and to improve the quality and safety of patient care overall.

We’ve reached a tipping point; hospitals are starting to scream “information overload.” Our customers are saying “we get so much data, from so many sources, that we need help sorting through it all; we need it presented in a meaningful way so we can act upon it faster.” We hear them loud and clear and will therefore be investing heavily on data; on how we increase the value of data so we can manage and disseminate the discrete data and communicate additional relevant context and meaning of that data to the right caregiver, at the right time, about the right patient. It’s a tall order and will take a lot of work with our EMR partners as well to make it a reality, but I think we are in the right place, at the right time to make it all happen.

Mac McMillan, CEO, CynergisTek

That’s easy — on the areas of privacy and security representing the greatest challenges for our customers.

We have always prided ourselves on staying out ahead and anticipating the needs of the industry and the needs of our customers in privacy and security. Five years ago, that meant attacking things like data leakage, encryption, and log management/auditing. Today it still involves finding better ways to monitor activity in the enterprise, but it also includes things like securing the cloud, defining managed security services for healthcare, managing the risk associated with the proliferation of mobile devices and medical devices that are not secure, and finding ways to better manage the security requirements with Business Associates.

Healthcare has enough complexity in its environment and more than enough on its plate with HIE, ACO, ICD-10, etc. It needs practical security strategies and solutions that work and are effective at stemming the tide of breaches like we have seen this year. We believe that in order for healthcare to win the battle with privacy and security, it’s going to take an investment in the right technologies and integration of Managed Security Services into compliance programs. We understand that technology alone is not the answer, and so the focus should be on implementation strategies and building the right processes around these technologies that enable them to be successful.

Michael O’Neil, CEO, GetWellNetwork

In recognition of the emerging reality that healthcare will be delivered anywhere and everywhere, no matter what the time, device or location, GetWellNetwork will sustain its investment in innovative Web-based, mobile phone and cable television technologies. When used properly, such technologies will support communication, education and even engagement throughout a patient’s care journey — from the home to the physician office, hospital, imaging center, or pharmacy and back to the home once again.

Platform-agnostic, technology-enabled patient engagement will be indispensable to providers, payers, and vendors as they work collaboratively to reduce hospital readmissions, promote self-care, boost patient and member satisfaction, and decrease cost per case. At GetWellNetwork, we are making significant investment in helping providers fulfill Stage 2 and 3 Meaningful Use requirements, and address the evolving challenges of medical home, accountable care and bundled payments.

Peter J. Butler, President and CEO, Hayes Management Consulting

At Hayes, we plan to invest R&D dollars in our hospital billing compliance software, MDaudit Hospital. It is designed to give auditors access to billing data to support revenue integrity, helping them to eliminate the errors for which CMS routinely recovers payments through its integrity programs such as RAC, MAC, and the efforts of the OIG.

However, we are finding that our clients are increasingly asking us about using this tool for other strategic projects such as ICD-10 documentation improvement, Meaningful Use, and data mining. Therefore, we are exploring related tools to use for these additional purposes. For example, via our recent integration with MediRegs clients can look up diagnosis and procedure codes and documentation requirements while in MDaudit. Additionally, some of our auditors are using MDaudit as a physician training tool on ICD-10 documentation.

Tiffany Crenshaw, President and CEO, Intellect Resources

Intellect Resources is investing in identifying and breeding new talent for the healthcare IT industry, with emphasis on training and go-lives.  In 2011 we debuted Big Break, a high-energy recruiting event designed to select an entire training and go-live teams in short period of time. Big Break is marketed towards individuals with no or minimal healthcare IT experience who have the right attitude, enthusiasm, and potential.  In an intensive one-day recruiting event, job applicants must complete a series of rigorous tests – one-on-one and panel interviews, extemporaneous public speaking, group work and classroom presentation skills – designed to identify only the best training and go-live talent.   

Once selected, Big Breakers complete an intensive course with classroom and hands-on learning, credentialing them in the appropriate EMR. As a result, a hospital system is able to select an entire training and go-live team in just a few days. Because Big Breakers do not typically have prior industry experience, they can often be secured at a fraction of the cost. As a result, hospital systems are able to breed and retain this new talent at a fraction of industry costs in a short amount of time.

Doug Burgum, President and CEO, Intelligent InSites

In our pursuit of improving care while lowering costs, we’ll be investing in three primary areas in the next 1-2 years.

First, one of Intelligent InSites’ most important objectives is to improve caregivers’ ability to spend more time at the patient bedside. To this end, we’ll be continuing our R&D investment in automating non-value-added manual tasks—including EHR data entry and finding available, clean equipment through easy-to-use applications—to give caregivers more time to spend with patients.

Second, as our solution utilizes RTLS and RFID technologies to know the location, status, condition, and interaction of all tracked equipment, patients, and staff throughout the hospital, we collect a massive quantity of operational data, every minute, every day, month after month, year after year. Through our Business Intelligence solution, we help our customers harness this “Big Data” to produce actionable insights critical to making sound and timely decisions, by utilizing flexible, high-impact, easy to create reports.

Third, because real-time data is generated from a wide variety of data sources, and because real-time intelligence can empower multiple healthcare IT systems, we’ll be continuing our investment in our partner ecosystem. We will continue to integrate with the expanding set of RTLS hardware vendors, and we’ll continue to expand our interfaces with EHR solutions, communications platforms, asset management applications, building management systems, and nurse call systems.

We are excited about investing in the future of RTLS, the “magic” of enterprise RTLS software, and helping our customers to truly improve the care they deliver, while simultaneously lowering their costs.

Tom Carson, CEO and President, MD-IT

MD-IT has traditionally developed and delivered software functions that provide or support practical use of technology for physicians and patients, and that will continue to be our focus. Like most vendors, we will keep an eye on Meaningful Use requirements and other market developments, but identifying specific features beyond the near term is tough, as the HIT market is quite volatile at this point.

We expect to see evolving demands as the industry moves from what we think of as effectively an EMR version 1.0 environment to a more mature EMR version 2.0 environment that is more sensitive to the needs of physicians and patients as the primary users of these systems. Certainly near-term efforts will be directed to expansion of our popular mobile functionality that streamlines physician workflows, as well as continued broadening of our interoperability functions that link providers, patients, and payors.

Patrick Hampson, Chairman and CEO, MED3OOO

We are focusing our investments and resources in numerous areas. MED3OOO has committed to focus our knowledge, products and services with a MED360 view of healthcare delivery. We are not like most vendors just supplying systems. Our investments will continue to expand our current operational and technical capabilities and offerings. We will continue to integrate our proprietary systems, and continue our investments in capturing and using data of populations. We will continue to invest in tools that providing information across the entire spectrum of care focused on: efficiencies wherever we can find them, the patient and provider experience, the cost and most importantly the quality of care delivery. We want to be the best partner to providers that is in the industry.

Our investments in point-of-care capabilities will also create a great differentiation for the providers using our proprietary systems. As part of this, we are investing in the area of clinical decision support. “CDS” in an Electronic Health Record can take many forms. It is certainly more than providing guidelines to a provider. We want to focus on the user experience and want to spend a lot of effort with physicians reviewing workflows to determine how CDS can truly add value to the provider and patient when care is being delivered. Our addition of Quippe is just one example of these efforts. Quippe is the state-of-the-art documentation tool in the industry and is the basis of enhanced CDS within our InteGreat EHR offering.

These efforts are also critical to the physicians and hospitals we have partnerships with, but who are on older technologies or legacy systems even though they come from today’s brand vendors. Physicians already have investments in these systems. They too, need these higher level capabilities and they too need knowledge-based solutions. While these systems may be older and not web- based, MED3OOO, as their operating partners we work to provide solutions to improve on the capabilities these older systems just do not have. A system agnostic approach allows us to not just throw them out and waste physician’s precious capital. We try to maintain those systems and it is somewhat like the BASF commercials, “We don’t make things, we make things better.”

Lastly we will continue to expand our significant M3IQ data warehousing capabilities, capturing data from disparate systems, continuing our focus on the promise of combining financial claims and clinical data, and turning that data into actionable, predictable intelligence.

Robert Connely, Senior Vice President, Medicity

We are going through a period of enormous change in healthcare, and it’s clear that healthcare IT will play a critical role in that change. Medicity is focused on a strategy that will enable rapid adaptation to changing requirements while realizing a more cost-effective model that we believe will lead the next generation of information technologies.

Today, we’re building out the underlying IT infrastructure required for tomorrow’s healthcare, including integrating EHRs, building data exchanges, and standing up repositories. We are expanding our analytics capabilities and are involved with developing standards like ONC Direct. 

Many of our R&D efforts are targeted at integrating and improving our family of products. The strategy levers common technology platforms, modular apps, and cloud services. We believe that by porting much of our current functionality into apps designed to run on a platform like iNexx (Medicity’s individual network exchange), we can reduce time to market for new features, control development costs, and provide a greater opportunity to adapt to new needs quickly. 

We believe that technology is evolving to the point that it can adapt to people as opposed to people adapting to the technology.  Towards this end, we continue to invest in emerging technologies and markets.  For example, our efforts range from pioneering pervasive analytics that employ software agents to better analyze information at the source, to enabling consumer platforms to drive better health.  We are also focused on building solutions that leverage payer, provider, and consumer interactions to create more effective care.

Peter Kuhn, CEO, MEDSEEK

MEDSEEK has always been ahead of the curve, developing strategic patient engagement and management solutions that help healthcare executives realize cost savings by improving care collaboration within existing workflows and find new revenue streams by finding and engaging patients. We were among the first to deploy our enterprise solutions to assist hospitals in finding, engaging, activating, and managing patient populations, and we’ll continue to invest in developing those solutions to allow hospitals to better prepare and position themselves in the rapidly changing world of healthcare reform.

Additionally, the strategic use of predictive analytics will ultimately become the market differentiator for hospitals, which is why we acquired Third Wave Research, Ltd, in 2011 and have been working on integrating their advanced predictive analytics expertise into our existing solutions. We will continue to invest in analytics technology that enables our clients to position for patient engagement, wellness and disease management. The rapid adoption of patient portals and the shift away from fee-for-service in favor of outcome- and quality-based reimbursement models will place more emphasis on finding new cost savings and revenue streams. To differentiate themselves from the competition, hospitals must find ways to personalize the patient experience and better manage the patient population. Effectively promoting profitable services to high-value patients and engaging them in wellness programs will influence healthy behaviors to positively impact outcomes.

Jay Mason, CEO, My Health DIRECT

It has been painfully obvious over the years that our solution was a bit ahead of it’s time. While very successful in directing patients to appropriate care settings in an ER, there wasn’t a pressing need to interact “outside of the walls” broadly or routinely. What we have seen in 2011 and see as our chief role moving forward is to serve as a health scheduling exchange. We will continue to invest our R&D in staying ahead of the curve. Today we can provide true Enterprise  Application Integration (EAI) with any willing trading partner via our own platform’s ability to leverage HL7, API, or CRM-based communication protocols.

So the next year will be more of the same for us — creating the integration tools, onboarding methodologies, and consumer engagement services that will allow our clients to redefine the way they interact and guide their patients and members.

Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

Going into 2012 the pressure is on for healthcare organizations to increase the quality of care delivered while reducing cost and complying with federal mandates. Nuance could not be better aligned to help healthcare organizations succeed in light of such pressures as Meaningful Use and ICD-10 and to ensure that clinical data is created in the most efficient way possible and is built from rich information that can be analyzed and intelligently used to drive broad healthcare enterprise change and improvement.

Over the next 1-2 years, we’ll continue to invest in areas that fundamentally improve the capture phase of clinical documentation, by which I mean empowering clinicians to document anytime, anywhere on any device in the most effective, natural way possible – via voice.  In 2011 we went to the cloud, offering SpeechAnywhere services to development teams across the industry.  Speech-powered clinical documentation is widely in demand and will continue to expand to encompass the complete healthcare enterprise and the mobile clinician workflow.

We’ll also continue to heavily invest and innovate in the area of language understanding and analytics technologies, which make it so clinical data can be extracted from unstructured documents and intelligently leveraged to drive better clinical and business decisions. Through work with 3M, IBM and UPMC, Nuance is making tremendous traction against its mission to transform patient stories into high-value information. Our speech-driven clinical understanding solutions will increase the quality of documentation, improve efficiency and drive better care – all while putting less burden on clinicians.

Todd Cozzens, CEO, Accountable Care Solutions, Optum

I heard someone say the other day that ACO = HMO 2.0 But With Data. It is indeed all about the data. I empathize with health system CEOs who, after spending anywhere from $100 million (average medium size IDN) up to the $3 billion Kaiser spent on installing EMRs in the last ten years that all they really achieved was computerizing paper records. Little has been achieved in actually doing something with the data. That’s what the next ten years is all about.

• Population Analytics: EMRs and the early data warehouses being developed on top of them are good at managing a census – sick people that visit hospitals and doctors. Population Analytics manage entire patient populations across all of their interactions with the health system. EMRs rely mostly on clinical data and some financial data. Population Analytics incorporate claims data, clinical data, financial data and actuarial data across ambulatory, in-patient, post acute and home care. We are in the top of the first inning of the biggest wave of change in our healthcare system any of us will see in our lifetime. These tools are also in their 1.0 versions and will evolve. Optum was almost purpose-built to bring all of these capabilities together into one cloud-based, integrated solution.
• End-to-End (E2E) Financial Efficiencies: Hospitals leak revenue more than any other business in any other industry – with the average health system collecting only 33% of what they actually bill under the current fee-for-service (FFS) system. And on top of this we’re now going to burden hospital finance departments by introducing new fee-for-value (FFV) payments starting with bundled payments and pay-for-performance measures right on up to full risk-bearing entities. In the forward-thinking health systems, we’re seeing the realization that they cannot do this all themselves. Many see FFV as the future so they want their current finance teams to be the experts in the new system. These same health systems are increasingly outsourcing their FFS financial systems to experts who know how to recover lost revenue, realize much higher collection rates and know how to drive cost takeout. We acquired Executive Health Resources to help hospitals drive revenue integrity for the big potential loss area of reimbursable admissions. The Lynx ED coding tool returns an average of $2.5 million lost revenue per medium size hospital. We combined those tools plus others around collections, billing, and Financial Health Record (FHR) to form our E2E solution set and we will invest more in these capabilities in 2012.
• ICD-10: Health systems are so encumbered with Meaningful Use compliance, RAC compliance, and facing the coming huge cuts in Medicare/Medicaid that they have largely been in denial about the impending ICD-10 deadline. With the introduction of up to 155,000 new reimbursement codes and less than 10% of healthcare providers halfway to ICD-10 readiness, ICD-10 could be an insurmountable challenge. We made a large investment in what we believe to be the best technology available to meet this new challenge. Because of the time caregivers will spend hunting for the right code, ICD-10 will actually make the health system much less efficient unless groundbreaking new technologies emerge. The natural language processing technology that we acquired from A-Life is exactly what’s needed to automate this laborious process. We’ve seen tremendous traction for this solution in the last six months and expect that to continue. Our R&D investment has increased so we believe we will keep and extend our technology lead here.
  

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  Paul Brient, President and CEO, PatientKeeper Inc.

  PatientKeeper’s number one priority is to deliver healthcare applications that improve the physician workflow. This means that we save physicians time, we help them provide higher quality care, and we help them get paid for more of the services they deliver.  

  We are still spending heavily in R&D to round out our suite of 13 fully integrated applications. Our near-term focus is to continue to add features to our CPOE product, complete our Medication Reconciliation product, release a next-generation charge capture application, and give our tablet/iPad applications feature parity with our desktop applications. The emergence of the tablet as a “first class” device has been eagerly anticipated by the healthcare IT community for nearly a decade and is finally here.  In fact, we have a small but growing number of our 40,000 users who use their tablet/iPad as their only computing device.

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  Todd Johnson, President, Salar

  While we have always been focused on "the physicians experience," the merger between Transcend Services and Salar has intensified this focus. In the months ahead, we are going to be able to address a physician’s workflow in ways never before thought possible. Understanding all of the external pressures applied to physicians, how remarkable it will be to offer solutions that offer either zero impact on their day-to-day, or better yet, offer drastic improvements to their workflow that they didn’t even realize were achievable? Not only will we be able to satisfy a physician’s interests for time, speed, and efficiency, but we will also be able to free the physicians from those same external pressures. By offering to our hospital customers clinical documentation solutions that meet the needs of coding, compliance, quality, billing, RAC audit mitigation, communication, and patient safety while doing so in a zero impact methodology to the delivery of care, we truly meet the needs of all parties at the table.

  To realize the benefits of this "enhanced physician experience," we will be investing heavily in our web-based platform to complement our existing thick client solutions, natural language processing tools, front end speech solutions, ICD-9 and ICD 10 GEMS mapping solutions, front end computer-assisted coding features, and even an improved workflow for traditional transcription services. We will continue to deliver all of the above through our "have it your way approach," thereby meeting the needs of both our physician users and our hospital customers.

  It’s been a long-time objective of Salar to become the de facto clinical documentation module within a host of HIS systems. We are closer to realizing that objective than ever before. Through some new and unique customer engagements, we will be integrating our platform into industry-standard information systems and, in turn, reaching out to an even broader customer base. The marriage of these solutions and the seamless nature of their delivery are incredibly important to us. Our customers count clicks–and so do we. We will continue to work over the next 1 to 2 years to streamline usability across systems and, ultimately, enhance a physician’s day-to-day experience.

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  Stephen Hau, CEO, Shareable Ink

  Everyone wants innovation, but no one wants to change.

  It is well understood that the healthcare industry must become more electronic and data-driven. However, we also know that change is hard. Market data reveal that, while most clinicians enjoy the accessibility of patient information that EHRs deliver, the majority does not prefer the Windows 95-style “point and click and drop down list” style of documenting that the standard EHR user interface requires.

  We believe that there must be a better way to extract information from a physician’s head without forcing them to become typists, tap a screen or mouse 30 times to create a “cookie cutter” note, or hire prohibitively expensive scribes out of desperation.

  As such, we have begun to invest aggressively in machine learning and natural language processing. Our system does not require user training. Instead, it has begun to learn from clinicians’ handwriting, gestures, and other natural inputs. The ambitious goal is to deliver innovation without requiring clinicians to alter time-tested workflows.

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  Ed Daihl, CEO, Surgical Information Systems

  Our R&D focus supports improving the management of perioperative services, the area of the hospital that continues to drive the financial success of the hospital. A recent survey by SIS shows an increased focus on reducing perioperative costs, with 78% working on cost reduction efforts – a 34% increase since 2010. Additionally,  the survey indicated another shift from 2010 with cost reduction efforts being prioritized over reimbursement concerns. In 2010, 25% of hospitals cited maximizing reimbursements as their top financial concern. In 2011, that number dropped by 56%. We believe that perioperative specific analytics is a powerful tool to help hospitals control costs — their top concern — and will continue to work to improve this management tool.

  Additionally, we see the adoption of anesthesia information management systems as a growth area in the industry. Electronic anesthesia documentation streamlines this process and provides accurate and legible anesthesia records. This equates to significant benefits, such as more accurate charge capture, quality improvement, and allows for the anesthesiologist to spend more time with the patient and less time documenting.  The addition of clinical intelligence with anesthesia analytics provides even more value to hospitals and anesthesia providers by unlocking powerful decision making data to help improve both care quality and financial return.

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  Evan Steele, CEO, SRS

  Over the next couple of years, SRSsoft will evolve to accommodate the acquisition and sharing of increasingly greater volumes of patient health information, as relevant to our specialist and primary care clients.

  We will remain focused on productivity (naturally!) as we evolve our data capture interfaces. This means that user interfaces will be implemented using techniques that are both ergonomic from a personal user perspective and accommodative of the actual workflow that takes place in the clinical office environment.

  We have put into place, and will continue to enhance, our own dedicated platform for data sharing and interoperability. Our Continuity of Care Exchange (CCX) platform manages connectivity and the physical transport of files, while our Discrete Data Exchange (DDX) components handle the import and export of discrete data to and from our system. We will continue to evolve CCX and DDX over the next couple of years to support increasingly higher levels of interoperability.

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  Rick Stockell, President, Stockell Healthcare Systems

  Over the next 1-2 years, Stockell Healthcare Systems will be devoting a significant amount of R&D to ongoing regulatory compliance.  In addition, we will continue our ongoing focus on client business process improvement through the development of advanced analytics and information management solutions.

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  Richard Atkin, President and CEO, Sunquest

  Sunquest is increasing its investment in product development across the board. We now have over 35% of our total resources dedicated to product development and product quality. We will have a particular focus over the next 24 months on developing new functionality in the converging areas of molecular pathology, anatomic pathology, and digital pathology. As a founding Gold Sponsor of the Digital Pathology Association (DPS) and through our partnership with Massachusetts General Hospital, we will be building the next generation of pathology workflow solutions.

  The incorporation of digital images of all sorts into the pathology workflow will drive significant growth, change, and efficiencies throughout our clients’ operations. Sunquest will work closely with our clients to enable them to take advantage of the coming changes in science, medicine, and technology. The ongoing evolution of molecular testing is driving a convergence between anatomic and clinical pathology. As healthcare delivery evolves to a more integrated, regional model and incorporates more personalized data, Sunquest will provide the solutions required to thrive in a new age.

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  Sunny Sanyal, CEO, T-System

  To meet clients’ current and evolving needs, T-System in the next 12-24 months will focus R&D investment on enhancing our emergency department information system, The T SystemEV. Our top three R&D priorities are as follows:

  • Support for regulatory mandates, including Meaningful Use and ICD-10. T-System will seek ONC-ATCB certification for Stage 2 Meaningful Use measures as soon as HHS finalizes the requirements. T SystemEV, already certified for 2011/2012 criteria for Stage 1 Meaningful Use requirements, will be compliant with ICD-10 in 2012, a year before the deadline. Our goal is to give clients maximum flexibility to address clinical, business and regulatory needs
  • Enhance interoperability. T-System will continue to invest and partner with other vendors to ensure that clients can seamlessly connect T SystemEV with disparate inpatient EHRs and other information systems outside the ED.
  • Continue to provide innovative and new functionality. As the care transition hub and starting point for a high volume of patient handoffs, the ED plays a critical role in ensuring the continuity of care. Supporting smooth patient transitions with efficient communication will become even more important as facilities and practices form accountable care organizations (ACOs). T-System will develop solutions and functionality that will help EDs lead the ACO model of healthcare delivery. Additional offerings will continue to improve clinical and financial outcomes that start in the ED and benefit the entire hospital and community.

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Top News

CSC says it will have to write off almost the entire $1.5 billion it spent trying to install iSoft’s Lorenzo in the defunct NPfIT project in England. The government has apparently declined to give CSC the new scope of work the company had requested. CSC has also withdrawn its financial forecast and stepped up plans to replace its CEO. It posted a loss of almost $3 billion in its Q2 report filed September 30, mostly due to a write-down of goodwill. The company’s market cap is $3.7 billion. Shares are at $23.68, off more than half since the beginning of the year.

Reader Comments

From Zafirex: “Re: hardship exemption for e-prescribing. Looks like so many providers are claiming it that CMS is having difficulties. Wonder how many are truly hardships? I doubt CMS could ever verify since it looks like they’re having trouble even producing a list.” Exemption categories include a practice area with no broadband coverage or that has too few participating pharmacies, practices that applied for Meaningful Use before requesting an exemption, practices that prescribe mostly narcotics that are not eligible for e-prescribing, practices that don’t prescribe regularly, or practices that e-prescribe but not for qualifying visits.

From Search Boy: “Re: searching HIStalk. Thanks for the explanation to King Salmon. Is there a way for retrieved searches to be indexed chronologically rather than as a percentage of keyword match?” I haven’t figured out how to do that. Since the pages are stored in a database, I don’t think the search function can determine the original publish date even though it’s in the title.

From Lilies: “Re: Epic. They’re #17 on the list of 25 oddball job interview questions, with ‘You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?’ There are two distinct valid answers.” Three is the obvious answer (one of each flower) that took me about two seconds to get. I assume the second answer depends on the question not stating explicitly that there are no other kinds of flowers in the bouquet (i.e., you could have two Venus fly traps only, making two a correct answer.)

From Stats Fan: “Re: readership stats. You haven’t given your readership stats lately for me to track.” Good timing since I realized a couple of weeks ago that I’ve been undercounting all along. I had forgotten to add the hit-counting Javascript to the mobile display that you see on iPhones and iPads. That hit me a couple of weeks ago, so I dug around the code and figured out how to fix it, also noticing that a surprising 30-50% of readers use Safari, most of them presumably on iPhones and iPads, which is a lot more mobile readers than I would have guessed. So far for December, it’s 96,250 visits, 148,218 page views, and 22,029 unique people reading (but that’s lower than the real number since I didn’t make the change until the middle of the month.) January and February will be good indicators since the HIMSS conference really pegs the needle on readership. Inga pays a lot more attention to the numbers than I do, so I will await her analysis. Above is where the visitors are from, just in case you are interested. Among cities, it’s Madison, Stone Mountain, Atlanta, New York, and Chicago making up the top five, but the major metro area is Boston with 8.41% of visitors. It’s a 62% male audience, so ladies, tell your friends.

From HIMSS Envy: “Re: HIMSS points. Got me wondering – it would be nice of HIMSS published an annual report for public review. It might not change a thing, but transparency is a powerful motivator. Come to think about it, Mr. H, how about you, too?” I thought HIMSS did a report, but I couldn’t find one. You can get their Form 990 from GuideStar, which always has interesting factoids (like that HIMSS FY 2009 revenue was $44 million and CEO Steve Lieber’s total compensation was $711K). I don’t know what I’d put in an annual report that isn’t already on the About page or contained in the list of sponsors … other than my hospital job, I don’t have any ownership in anything, I have no other income, and I don’t shill stuff like speaking or consulting under the delusion that I have value beyond what you’re reading right here.

From Peds Envy: “Re: tired of writing only good things about Epic. Private practice peds are the worst type of users for Epic. No surprise there. Someone who knows Brown & Toland told me the reaction is 100% unanimous – they hate it.”

From Anonymous Epic Fan: “Re: tired of writing only good things about Epic. Here are a few issues with their implementation methodology and support that even the Kool-Aid drinkers would have a hard time disputing.” Here’s the list from AEF:

• Epic’s implementation planning materials are weak. They have to be re-worked for each new application / scope mix, and after that is done, little to no effort is made by Epic to customize them based on organization specifics. If you want the project plan to be useful and to have sufficient detail, expect to spend a lot of time and effort re-working what gets initially delivered.
• Epic suggests you go live on Model workflows as quick as possible. As painful as it may be, it is definitely better from a cost perspective. Then, you plan to do the bulk of the ‘real’ implementation after getting live. This can/may work if the bulk of the existing documentation / orders workflows are paper based and you are implementing all of Epic’s applications, but this approach is suicide if the existing system being replaced has been customized for the end-users and they are happy with them or if you have to rely on the timelines of other vendors to build/test/implement interfaces and data conversions.
• The Epic Model does not work well for any hospital or outpatient units that are more complicated  then the most typical med/surg units and general practice specialties. Specifically, hospital outpatient departments that bridge the inpatient and outpatient void.
• The Epic Model completely breaks down if you are not implementing all of Epic’s applications and workflows rely on interfaces to/from legacy systems.
• With Epic’s implementation team constantly turning over, being spread across more and more customers, and the increasing pressure to implement faster, attention to detail is lacking. In my experience, they are over promising and under delivering more than they did years ago.
• Time estimates are always low. Everything takes much longer than anyone anticipates. Medication build, consolidating charge masters, cleaning up supply/pick lists, mapping lab components, consolidating multiple sources of payor/plans, cleaning up the provider / credentialing information, getting physicians to agree and sign-off on order set/documentation template content, and working down duplicate patients in your EMPI or mapping data elements for conversions etc.
• Epic implementation tools / deliverables are often shared just before an upcoming trip for when they are to be used. Though effort is made to customize them based on application mix/scope, they never really get updated to reflect the actual workflows discussed and validated early in the process – especially if they differ in any amount from the ‘model’ workflow. The delivered product if very inconsistent from application team to application team and integrated areas/workflows often get overlooked. So just like the implementation planning materials, expect to spend a lot of time re-working these deliverables to make them useful.
• All application teams involved in the implementation are siloed, and in addition, the Epic implementation teams, technical support teams, and development teams are also siloed. This causes issues for organizations live on one set of applications, rolling out another set, and implementing a third set.
• The silos mean that there are application experts, but very few Epic staff have cross-application experience / knowledge and if workflows are interface-dependent, very few have true integration experience.
• Epic’s training only scratches the surface. The true training is the implementation process and go-live. The shorter the implementation timeline, the more unprepared the customer IT staff is to support the applications when they go live – thus the demand for lots of consultants.
• The system documentation is very inconsistent and virtually impossible to search on the UserWeb. Unless you know where to find what you are looking for, you often have to e-mail Epic to ask if documentation exists. I is not uncommon to be sent an ‘unofficial’ document created by a frustrated Implementer not being able to rely on the system administration guides themselves. In fact, all of the implementation documentation / guides were historically written and maintained by implementers, but due to the inconsistency between applications and un-sustainability of keeping it up to date. no implementation documentation/guides exist today.
• Epic’s end-user training materials are great if you are implementing all of Epic’s applications and you are using all Epic model workflows. If anything changes, these are not so great – expect to have to overhaul them.
• Same goes for the testing scripts. An OK start, but definitely not something that can be used out of the box.

HIStalk Announcements and Requests

How Apple wins customers for life: I had a five-year-old, first-generation, 1 GB Nano that I only used for the gym. I heard Apple was recalling a few of them because of some explosion-prone batteries, so I put in the serial number on their Web page and darned if mine wasn’t on the list. They sent a postage-paid Fedex box to return it. Today I got back a brand new sixth-generation, 8 GB Nano, which now comes with a color display, gestures, FM radio with live pause, pedometer/accelerometer, and a bunch of other features, all in a package barely bigger than a watch face (in fact, you can buy a watchband that holds it, turning it into a watch.) It’s super cool, and so is Apple. You did good, Steve Jobs – RIP.

It’s time to wrap up the HISsies nominations soon, so contribute yours now to the blank slate that will be distilled into a handful of choices for the real voting that starts shortly. I’m particularly happy with one nomination for Smartest Vendor Action Taken: “HIStalk sponsors that replaced blinking ads before the deadline.” Well done, and a good observation. My sponsors really are the best – as much as I hated to spring the change on them since it requires work and expense on their end, they’ve been great about it. I’ve enjoyed the nominees for the Beer and Pie categories, as always, and there are some good nominees for the Lifetime Achievement Award.

Speaking of the HISsies, full details and signups will go up next week for HIStalkapalooza in Las Vegas. And also speaking of the HISsies, if you plan to vote (and I hope you do), sign up for the e-mail updates since I e-mail the voting link out to prevent ballot box stuffing that was as rampant as in a third-world dictatorship until I took that step. For that reason, if you aren’t on the list, you can’t vote.

Listening: new from The Roots, which even though I’ve only sampled it so far due to limited time, is just blowing me away. It’s extraordinarily music in the form of a concept album, making it impossible to label as rap, soul, or hip hop even though it includes strong elements of all of those. The accompanying short film is here. Their talent is mind-boggling. Down it goes to the new Nano, which contains only my latest favorites since I intentionally started from scratch: Genesis And Then There Were Three, two albums from Gooder, one from Metric, and Luminiferous Ether by the never-gets-old Zip Tang.

It’s just Dr. Jayne and me tonight as Inga is sojourning in the mythical Land Without Broadband. She will return soon. But in the mean time, Dr. Jayne is doing her usual fabulous job. I’m pretty darned lucky to have two smart, funny, hard-working, and undeniably cute ladies with whom to share the page, don’t you think? I will raise a glass in their honor for New Year’s (probably of Duvel beer since I got some for Christmas and I like it a lot.)

I’m not telling you Happy New Year yet because I’ll be posting a Monday Morning Update this weekend as usual, even if nobody’s around Monday to read it.

Acquisitions, Funding, Business, and Stock

Board members and executives of document management vendor Streamline Health Solutions will buy $400K worth of the company’s stock, news of which sent shares up 9% on Wednesday.

Healthcare alerting system vendor Extension, Inc. announces what it says is record quarterly growth, adding 17 new hospitals in the third quarter and quadrupling its headcount to 40 over the past two years. They might want to budget for a public relations or media person next since this is easily one of the worst-written press releases ever, starting off with a clumsy opening sentence that sounds as though someone whose native tongue was not English (or at least not good English) sweated over it until nothing interesting remained. It doesn’t get better as you read on.

Announcements and Implementations

Tampa General Hospital (FL) goes live on its $120 million Epic system, which works out to $118K per bed. The hospital says $40 million of that was for hardware and software, with the rest going for staffing and training.

Other

Weird News Andy sounds like a fortune cookie in summarizing this story as, “Foot in mouth results in mouth in foot.” A man shows up in the ED with a swollen, infected foot, claiming he stepped on a piece of glass on the beach a couple of weeks before. The beach and timeline part of his story were accurate, but not the glass part: doctors removed a tooth embedded between his toes, lodged there during a beach fight when he kicked his opponent in the jaw while wearing flip flops.

Several readers were interested in John Halamka’s post about his wife Kathy’s newly diagnosed breast cancer. The first of regular updates, posted Thursday, is here. Reading his thoughts and analysis of their situation makes you realize that HIT stuff aside, he’s probably a fine doctor as well, not to mention the kind of supportive partner we would all want if faced with a life-changing diagnosis and gearing up to fight it.

A big health-related software sale you probably didn’t hear about: General Cannabis, which operates the medical marijuana dispensary finder WeedMaps, acquires MMJMenu, whose software for marijuana growers and dispensaries tracks inventory “from seed to sale,” basically an ERP for pot growers. General Cannabis had revenue of $10.4 million in the first nine months of the year and paid $4.2 million last month to buy the Marijuana.com domain.

John Newman, MD PhD, a UCSF physician and legal scholar, worries that medical copyrights will threaten patient care, citing a recent case in which a company offering a licensed cognitive screening tool threatened legal action against a similar but free online tool. The implication is that tools based on published research, which could be anything from a pain scale to a hip fracture risk predictor, could be claimed as proprietary by a fast-moving company. The author speculates that without new forms of copyrights, “… as physicians walk down the hallway interviewing patients, they’re tallying up the licensing fees they need to pay for doing their day’s work, and hospitals are suing each other or making cross-licensing arrangements to manage each other’s intellectual property.”

A power surge caused by monthly back-up generator tests at Aspirus Wausau Hospital (WI) takes all communication and computer systems down for five hours, forcing the hospital to go on ambulance diversion. As is always the case, the hospital says patient safety was never at risk, which you might interpret as meaning that those systems contribute nothing to patient safety. They’re on Epic, I believe, not that the hospital’s Wisconsin location didn’t already make that fairly likely.

GE Healthcare agrees to pay $30 million to CMS to settle a False Claims Act charge that it encouraged hospital and cardiology laboratories to overbill Medicare for Myoview, its form of technetium 99 that shows areas of decreased blood flow in the heart.

Sponsor Updates

• Rockford Orthopedic (IL) announces that 21 providers have successfully attested for Meaningful Use using eClinicalWorks EHR suite.
• Baptist Health Line (KY) receives its third ICARE award from RelayHealth for work with Western Baptist Hospital’s transfer center.
• Paul Rooke, CEO of Lexmark, discusses how the company’s acquisition of Perceptive Software and Pallas Athena puts them in a unique position in his interview with All Things D.
• Health Choice Arizona, achieves a 44% improvement in its completion rate for preventive services pilot program using MyHealthDIRECT.
• AmkaiSolutions will offer revenue cycle solutions from ZirMed to its outpatient surgery provider software customers.

EPtalk by Dr. Jayne

Where have all the drug reps gone? With significant cuts in the budgets for Big Pharma, many reps have been “made available to the workforce,” as they say. It seems hospitals and health systems are hiring former drug and device reps to sell their facilities to physicians. A recent article discusses how they’re using infection data and patient satisfaction scores to drive business rather than the drug pricing and formulary data of yore. In my book, this is just another thing that sucks up valuable time that we need to care for patients, not to mention sucking up budget dollars that could be better spent on those patients.

I wonder how many physicians who refuse to see drug reps also refuse to see these new “physician liaisons?” And how many health systems place rules around having these reps in the office? At some large integrated health systems, policies ban providers from seeing reps or liaisons from any facility or service provider that competes with a system-operated service line. This includes home health agencies, remote cardiac testing providers, reference labs, and the like. Other health systems restrict the hospital privileges of their employees (prohibiting credentialing at competitor hospitals,) so I’m not sure how big of a target pool these new reps have.

Weird News from one of my favorite places: South Carolina sports a giant mound of tires that can be seen from space. At least it’s not burning like the one in my favorite fictional town. But kudos to Lee Tire Company, Inc. of Jacksonville, Florida for waiving the usual fees to shred and recycle the tires in an attempt to clear the 50-acre mess.

Inga and I are well into our pre-HIMSS preparations. As you’re thinking about traveling to fabulous Las Vegas, consider this recent article that discusses continued concerns about backscatter scanners at the airport. Until I read this piece, I didn’t know they had been banned in Europe. As someone who has to wear a badge to track my exposure to radiation in the hospital, I do worry about frequent flyers. Many of my friends who work for vendors fly two to four times a week. There’s enough radiation from just being in a plane, let alone adding to it with scanners. I’d love to see the cumulative dose numbers for some of those flyers. Maybe frequent flyer programs should start issuing radiation monitoring badges with their airlines’ logos as a promotional item.

Each time I sit to write for HIStalk, I’m still amazed to be part of this team. It’s particularly amusing when I’m just reading through my “normal” e-mail and find a mention of us – most recently a blurb from MED3000 regarding Mr. H’s recent piece asking vendor leadership about the biggest HIT-related news items of 2011. I hope I don’t have facial leakage when I see these blurbs (yes, I have a bad habit of multitasking during meetings) because I know I feel like smiling.

Speaking of multitasking, one of my Facebook friends shared another article on docs multitasking during critical procedures. Medical schools are apparently having to actually instruct students to focus on the patient instead of the smart phone. Looking at some of the examples given in the article, it sounds like some IT teams need to revisit the websites they allow users to access. I can’t think of too many medically legitimate reasons to be on Facebook, Amazon, or eBay in the operating room or in the ICU.

I mentioned earlier this month about my inability to keep up with Inga where shoes are concerned. I think I win this round though – I seriously doubt that Santa left a glass slipper filled with Cosmopolitans at her house.

Have a question about managing pesky sales reps, maintaining the perfect poker face, or the best way to garnish a Cosmopolitan? E-mail me.

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.

The Connecters

For six-year-old Herbert, a train ride was nothing new. But this train was different. Cold. Smelly. No seats. Conductors wore helmets, carried guns, and yelled. Shrouded in darkness and smushed between people’s legs, Herbert clung to his mother and aunt. Passengers wept and prayed. Days later, they disembarked at Gurs.

Horrid scarcely described the inhumane conditions in the “relocation” camp. Herb dug through the trash each day, foraging for crumbs. Six months into the torment, a soldier grabbed him and carried him outside the camp gates. The French Resistance, hiding in the night, whisked Herb into the woods.

Dodging armed patrols, they traversed the countryside and came to a convent near Lyon—Herb’s new home. During routine inspections, the nuns would hide him, the only Jew amongst gentiles. A year later, the Swiss underground led him on foot over the Alps into Switzerland, where he found solace in a group home for Jewish boys.

Herb never saw his family again. While he scaled mountains to freedom, they boarded trains for Auschwitz.

After the war, Red Cross officials connected Herb with relatives that had immigrated to the United States years prior. A young adolescent, fluent in French and German, Herb sailed across the Atlantic. Lady Liberty greeted him in the New York harbor. He learned English. Five years later, Herb returned to Germany as an American soldier.

He fell in love with a young fräulein. They had seven children. I am the youngest

At the end of each year, I reflect and give thanks for many things in my personal and professional life. I’m grateful for what I call The Connecters: the beautiful people who held my dad’s hand. From the German guard at Gurs who led him through freedom’s gate, to the hands of the men and women of the underground. For the nuns who loved a boy of a different faith. For the schoolmasters who hid my father in defiance of the law and for the hands of my immigrant uncle who welcomed him into his New Jersey home. They connected my father to his future. In my heart, I kiss those hands.

This year, my gratitude focuses on my personal Connecters — those who helped enabled my then-future career. While hiring me didn’t affect life or death, I am thankful to those who took a gamble on me. Here are my Connecters and what they taught me:

Pastor Rick Olmstead. In a small but growing church, Pastor Rick invited everyone from the congregation who had an interest in leadership to visit his home for a barbeque. He had hoped for gray heads of wisdom, but ended up with four young-in-their-faith sophomore college students. Trusting in a higher power, Rick pushed forward and invested in us. We eventually became part of the team that enabled multi-year, double-digit growth. His exceptional mentoring and leadership formed the foundation of who I am today.

Major Loomis. The Executive Officer of the 244th Army Reserve Engineer Battalion. This officer’s additional duties involved overseeing the Cadet program. As a nervous nineteen-year-old combat medic, I interviewed with him for one of the few coveted Cadet slots. I knew others had interviewed better than I did, but he took a chance and showed me unmerited favor. I went on to become a combat engineer officer. Upon earning the rank of Captain, I served as the battalion motor officer and battalion movement officer. I learned much about organization, leadership, and process.

Mary Hein. She agreed to interview me because she had misread one of my degrees. She thought I had a Masters in Computer Science when in fact it was a Masters in Consumer Science. When I brought this to her attention, she let it pass and continued the interview. I had very little experience to speak of, yet she offered me my first salaried professional position. I cried (not in front of her, of course.) Mary taught me poise, communication, and brand. She helped hone my leadership.

Mike Gogola. I was interviewing for a director of physician relations position when I realized it was actually an IT position. “You have the wrong person,” I told Mike. While I was good at physician relations and marketing, IT was not my forte. To this day, I’m not sure if he was desperate or sincere, but Mike assured me I had the right stuff for the position. He surrounded me with good technical people and I learned on the go. Mike took me with him to networking opportunities and conferences. He taught me project management and IT.

Kevin Roberts. Kevin believed in me before anyone else saw my executive potential. He took a major risk in supporting my bid to become a CIO at a young age and without requisite experience. He shielded me from naysayers as I learned to walk and then run. He pushed me to become increasingly independent, which grew my confidence. He believed in me.

I’m thankful for those men and women who saved my dad and made my life possible. And I’m thankful for the men and women who connected me, took a risk, and enabled my career.

Who are you thankful for? Take time this holiday to let them know your appreciation. But don’t stop there. Ask yourself who you can help connect. When is the last time you took a risk to help an eager wannabe advance?

Leaders are called to Connect.

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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