Top News

McKesson reports Q3 numbers: revenue up 9% to $31 billion, EPS $1.20 vs. $0.60, beating estimates. The company announced that it will buy back an additional $650 million worth of its stock. Shares rose 4% on Tuesday, making MCK the third-best performing S&P 500 stock of the day. Technology Solutions revenue was up 4% with an operating profit of $69 million, although the company took a $42 million pre-tax charge against the termination of development on Horizon Enterprise Revenue Management and the move to Paragon as its go-forward platform. From the conference call:

• The company reiterated that it has no plans to sunset Horizon Clinicals, but also made it clear that customers will probably either choose to move to Paragon at some point or switch vendors.
• McKesson paid $6 million in severance related to the shutdown of HERM.
• The company talked up its payer and transaction businesses (like RelayHealth) in a manner that suggests it likes the steady, predictable revenue they generate compared to the sales-driven revenue swings of the software business.
• The company admitted that “as you know, we’ve had some challenges with the Horizon Clinical implementations.”
• My overall impression is that the company is being fairly open in describing its challenges with HERM and Horizon Clinicals, although in the last couple of quarterly calls they were quite upbeat about both. Publicly traded companies aren’t very good about warning investors of potential bumps in the road.

Reader Comments

From Baystatehockey: “Re: Mark Gorrell, VP/CIO of Baystate Health. Gone and replaced by Heather Nelson as interim CIO.” I think I can safely call this rumor verified based on Mark’s exuberant and obviously recently updated LinkedIn job title, which is darned cool. Here’s his blog with sailing photos and some really interesting thoughts about pursuing something he and his family always wanted to do, even though he says he’s risk-averse and prone to motion sickness.

From Duxelles: “Re: IBM. To acquire [publicly traded vendor name omitted] – any truth to this?” I haven’t heard anything and it doesn’t seem likely. Then again, neither did the rumor at HIMSS time awhile back about this company that turned out to be true, which made me glad that I at least mentioned so I didn’t look clueless. It is likely that quite a few big announcements of various flavors are being embargoed by several companies until the HIMSS conference, so I’m sure we’ll have lots to talk about in three weeks.

From Amish Boy: “Re: Epic’s support teams. At my previous hospital, I got to know our application’s assigned support person very well. I’ve worked with Cerner for years and they don’t have the same personal attachment. We used to joke that Cerner’s Immediate Response Center number was busy because the middle school bus hadn’t dropped the IRC employees off at Cerner HQ yet.”

From Bill Rieger: “Re: Flagler Hospital, St. Augustine, FL. Kicked off its Meditech to Allscripts SCM transition at a well-attended campus event. The IS department broke out in flash mob just before the CIO spoke about how hard it would be to tear down the walls of poor processes that have been built up over the years. We are engaged and involved and want to be dancing when we go live in June 2013.” Bill  is CIO at Flagler Hospital. Nice video.

From The PACS Designer: “Re: FuelBand. A new mobile application from Nike that is worn on the wrist and can track your daily activity with an accelerometer. It tracks calories expended, steps taken, and the time of day, as well as your NikeFuel score viewable on an LED display. Your score is based on an algorithm that assigns points to various movements.”

From BuffaloWings: “Re: Sandlot and Santa Rosa Consulting. To merge?” Santa Rosa already was a partial owner of the HIE technology vendor Sandlot (the other owner is a Texas physician group). I haven’t heard if they are taking that relationship further.

Mr. H and I were commiserating last night about our pre-HIMSS overwhelmed-ness. The last few days I have been working on the HIStalk Guide to HIMSS12, which includes an overview of what our sponsors will be featuring this year. We are also including contact information for at least a dozen sponsors who are not exhibiting, but that are available for one-on-one meetings with attendees. Look for the Guide to be published the week before HIMSS. Sponsors, make sure to send your information.

If you are attending HIMSS, you only have about 20 more days to prep. It’s not too soon to go through your old shoes (including your kids’ old shoes) to bring for our Soles4Souls shoe drive. We will have drop-off boxes on the exhibit floor at the DrFirst booth (5456) and possibly one other location. We’ll also accept donations at HIStalkapalooza for those who received invitations (with a free IngaTini for every pair you donate.)

We like highlighting cool vendor events at HIMSS since readers are always looking for fun stuff to do there. Here’s one: CSI Healthcare IT is offering cocktails and dinner at the Canaletto Ristorante at the Venetian on Wednesday evening (February 22) from 6:30 until 9:30. It’s invitation-only and you can RSVP by e-mail.

Speaking of HIMSS events, ours is full. We have a lot of friends and loyal readers, and if we had endless space and money, we would happily invite every one of them to the ESD-powered HIStalkpalooza. Since we don’t, we have no choice but to turn down requests, even for invitees who want to bring a guest (I’d estimate that we have close to 1,000 people who want to come that we don’t have room for.) Maybe next time I should also run a secondary event that’s cheaper to produce so that lots and lots of folks could come as a backup event, like renting some big New Orleans field, hiring a band, setting out pallets full of beer and wine, and passing out hot dogs and marshmallows to roast over a bonfire. That’s my kind of networking event.

Your honey-do list from Inga: (a) search our sponsors in the Resource Center; (b) take five minutes to get your consulting RFI request in front of several companies at once with the RFI Blaster; (c) click on some sponsor ads just to see where you end up; and (d) send us rumors and cool stuff. And while Inga, Dr. Jayne, and I don’t want you to feel like a number, you are, in a good way that we appreciate: one of almost 5 million HIStalk visitors since 2003 and over 110,000 this month; one of 7,861 subscribers to our e-mail updates; one of the 2,165 members of the HIStalk Fan Club that Dann started; or one of our LinkedIn connections or Facebook friends. Unlike HIStalkapalooza, those numbers can scale infinitely, so feel free to increase them. Sometimes we screw up in running an erroneous rumor or being slow in responding to e-mails, but one thing we never do is take readers and sponsors for granted, so thank you for being part of what we do.

On the sponsor-only Job Board: NextGen Training Coordinator, Epic Go-Live Support, Cerner Go-Live Support. On Healthcare IT Jobs: Senior Technical Advisory Consultant, Epic Certified Clinical Analysts, Epic Hospital Billing.

Welcome to new HIStalk Platinum Sponsor Lifepoint Informatics, which offers vendor-neutral data integration solutions, with an emphasis on lab outreach. Its EMRHub  provides fast, easy LIS-to-EMR connectivity (Web-based middleware with only one LIS interface required) for hospitals and any type of labs interested in strengthening physician relationships, developing new revenue streams, and earning Meaningful Use incentives. Its LPI CPOE ensures clean, valid CPOE lab/rad orders that meet medical necessity and ABN requirements. Its LPI Web Provider Portal is a cost-effective way to deliver a complete patient picture to providers, providing a unified clinical inbox, flowcharts, and reports using information from systems such as clinical labs, pathology, micro, AP, cyto, and cardiology via any Web browser, helping hospitals, labs, and groups meet the IT needs of their clients. The company just landed a big deal in providing Sparrow Laboratories, one of the country’s top outreach labs with 15 labs in Michigan, with solutions to extend its reach to current and potential customers. Other customers include Indiana University Health, Continuum Health Partners, Memorial Hermann, and New York-Presbyterian. Drop by Booth 153 at HIMSS for two reasons: (a) to see their tools in action, and (b) to get one step closer to bringing home an iPad 2 in the soon-to-be-announced HIStalk Booth Crawl, of which the company is a sponsor. Thanks to Lifepoint Informatics for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

IT professional services firm NTT DATA Americas announces that its Keane, Intelligroup, MISI Company, The Revere Group, Vertex, and Agile Net organizations will start doing business under the NTT DATA brand.

ADP acquires small-practice revenue cycle management company PhyLogic Healthcare of Springfield, MA and will offer its outsourced billing services to its ADP AdvancedMD customers.

Greenway Medical goes public Thursday, with its $80 million IPO providing a market cap of $330 million.

Sales

BCBS of Kansas City selects InterComponentWare to implement a master patient index to address demands for aggregated patient data in the HIE environment.

Shriners Hospitals for Children selects the MedeAnalytics Clinical Performance Manager solution.

Oswego Hospital (NY) contracts for Wolters Kluwer Health’s ProVation Order Sets.

Acadia Healthcare (TN) selects Healthcare Management Systems Inc.’s (HMS) financial applications for its 25+ facilities.

Banner Health contracts with MEDSEEK solution to deploy its patient, physician, consumer, and employee engagement platform.

Riverside Medical Group (VA) licenses Streamline Health’s physician workflow management solution to manage A/R and denials.

People

PwC US hires Andrew Kemmeling, formerly with Phoenix Health Systems, as a partner in its enterprise resource planning and business transformation practice.

Providence Health & Services, Southern California promotes Elizabeth Petrich-Kennedy to chief nursing informatics officer.

Former CSC and First Consulting CMO David Classen joins patient safety solutions vendor Pascal Metrics as CMIO. Former TheraDoc CEO Stanley Pestotnik also joins the company as a senior advisor.

PerfectServe hires former Krames Healthcare sales executive Michelle Piel as a VP of sales.

iSirona promotes Mary Carr, RN, BSN, CPN to Chief Nursing Officer.

Quantros promotes Gerard Livaudais MD, MPH to chief medical officer and SVP of content and product management.

Alerting vendor Extension hires Tom Berger RN as chief nursing officer. He was previously with Vocera.

Announcements and Implementations

Resource Anesthesia deploys the Shareable Ink Anesthesia Suite across multiple states and facilities.

KishHealth System (IL) implements the Pharmacy Xpert clinical surveillance and intervention solution from Thomson Reuters.

CynergisTek releases Surveyor for Business Associates, a risk management solution for demonstrating HIPAA/HITECH compliance.

The US Patent and Trademark office awards Medicity a patent for locating, indexing, matching, and sharing patient records among healthcare organizations. It’s the company’s third patent issued in two years.

Macadamian will launch its Usability Maturity self-assessment checklist at the HIMSS conference, building on previous work that found that easier-to-use EHRs increase productivity, decrease errors, and provide cognitive support to users.

DrFirst launches its EHR Advisor online tool to help physicians find a solution from those offered by the company’s partners.

HealthStream and Laerdal Medical, through their SimVentures collaboration, offer SimManager, a SaaS-based system for managing simulation-based healthcare training.

Government and Politics

In a Congressional subcommittee hearing, a VA official says its new paperless claims processing system will help reduce the department’s claims backlog and take out months of processing. The current number of pending VA claims is over 854,000, which is 100,000 more than a year ago and 500,000 more than three years ago.

A Congressional Budget Office report predicts that the cost of government healthcare programs will more than double over the next 10 years to $1.8 trillion, or about 7% of the nation’s economy. It predicts that Medicare spending will increase by 90%.

The COO of the West Virginia Health Network is named by a legislative auditor as being one of several retired public employees who are exploiting a loophole that allows them to collect both a pension and  paycheck at the same time.

Conservative group Judicial Watch calls on Newt Gingrich to release the full client list of his Center for Health Transformation.

Innovation and Research

Oracle Health Sciences Institute announces its first group of research projects, including a Brigham and Women’s/Harvard study that will use EMR and claims data to analyze treatment alternatives and a University of Maryland project to visualize longitudinal EMR and claims data to detect adverse events.

Other

The Robert H. Smith School of Business at the University of Maryland announces the “Innovate 4 Healthcare Challenge,” a nationwide contest for college students to develop HIT tools to improve patient engagement with healthcare providers. The challenge is supported by ONC and includes $30,000 in prize money.

I was amused to read that people  lie more when texting than when communicating by other methods, including video chat. I wonder if that carries over to clinical interactions, since I’ve only had one text conversation with a physician and I think we were both pretty honest. However, I’m now wondering  about the text from an old boyfriend who said he couldn’t meet for dinner because he was moving to South America.

Someday there will be a Steve Jobs of the EMR world who will come along and produce a system that listens in on my office visit with the patient, uses voice recognition and AI to produce an extremely accurate summary of the discussion, and schedules all necessary tests and medications based on what I explain to the patient—all without me having to even interact with a computer keyboard.  The note will be instantly dispersed to the patient and all other caregivers.  The program will suggest any useful therapies that I may have missed and provide educational resources to the patient based on the subjects discussed.  And, of course, it’ll hit all the high points needed by the coders and Medicare overlords. When this happens it’ll put every other EMR out of business; because, finally, we’ll have a system that actually helps us rather than hampers us.

A California hospital is fined $100K after a nurse in its long-term care unit replaces a comatose woman’s breathing tube, but forgets to remove the cap, suffocating the 81-year-old woman.

Six employees of the Food and Drug Administration who tipped off Congress about what they claim was the agency’s corrupt push to approve unsafe medical devices file a complaint against their employer, saying that FDA violated whistleblower protections by intercepting their personal e-mails and installing spyware on their PCs.

Sponsor Updates

• Kareo announces the opening of its Indianapolis office and its plans to add 50 new sales and customer service positions.
• Practice Fusion hires Jonathan Malek as SVP of technology and John Hluboky as VP of technical operations.
• OptumInsight announces that its HIE and computer-assisted coding solutions achieved the highest industry standards for interoperability at the IHE North American Connectathon.
• T-System launches Care Continuity, a Web-based patient referrals tool.
• The 37-provider Mendelson/Kornblum Orthopedic and Spine Surgeons (MI) selects the SRS EHR.
• Concerro hosts a webinar on disaster preparedness and emergency management.
• Hayes Management Consulting offers an EMR optimization webinar.
• A PatientKeeper survey finds that preparation for the ICD-10 transition is the highest priority of finance professionals in healthcare provider organizations.
• Allscripts facilitates a meeting with Surgeon General Regina Benjamin MD and 20 North Carolina business leaders.
• Altoona Regional Health System (PA) selects Access Intelligent Forms Suite for its three locations.
• Merge Healthcare adds six practices to its Merge OrthoEMR client base. 

Contacts

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

More news: HIStalk Practice, HIStalk Mobile.

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Don’t Take Me Out of Context

Depending on the size of the communities they live in, CMIOs can sometimes feel isolated. Some may work in cities with multiple hospitals and health systems and have easy access to peers (and getting together over drinks is certainly fun!) but many work in towns with only one hospital. For the latter, finding and collaborating with peers can be a challenge.

I belong to a virtual community of CMIOs that contains a mix of big-city and small-town CMIOs. There are a couple of former CMIOs and a couple of young pups just starting out in informatics thrown into the mix as well. It’s been a great resource for idea sharing over the last several years and has helped me preserve my sanity on numerous occasions.

We recently got into a discussion about single sign-on options. Even those hospitals with single-database systems often have legacy systems with which clinicians need to interact. They also need to access a variety of homegrown and interfaced applications in order to care for patients and manage clinical data. Many hospitals have tackled this with single sign-on, proximity badges, or other strategies to reduce the need for clinicians to manage multiple passwords.

I’ve used several of these solutions and they are undoubtedly cool. However, they lack the ability for clinicians to rapidly access a single patient across multiple systems. Providers end up searching for the patient in multiple applications while they try to mentally create a unified view of the patient. This is less than ideal. One of the young pups in the group mentioned that he was looking at context-sharing solutions in an effort to remediate this problem. Luckily we have a few CCOW aficionados in our group. For best-of-breed shops, this can be essential to efficient access by clinicians.

For those of you who don’t know where I’m going with this, let me introduce you to CCOW. CCOW stands for Clinical Context Object Workgroup, which is an HL7 standard that allows clinical applications to share information. Through this standard, applications can participate in both user context sharing and patient context sharing.

From a practical standpoint, this means that when the clinician accesses a patient chart, all other applications that the provider is accessing synchronize to that patient. When user context is also included, it may also facilitate reduced sign-on into applications which are subsequently accessed. CCOW can go deeper than just user and patient context – encounter context can also be included.

CCOW (thanks to Health Level Seven, Inc. for the graphic) is often misunderstood by clinical and IT people alike. Although many vendors create their applications to be CCOW compliant, this does not mean that just installing two of them will “automagically” link them together. Context management is required. When the systems lack a shared master patient index or a common patient identifier, an intermediary mapping agent may also be necessary. Dedicated context management software may also need to be installed locally or on servers to help synchronize client-server and Web-based applications.

CCOW also doesn’t magically move data from one application to another. It simply allows users to access information on a single patient across disparate applications with a minimum of fuss and bother. Depending on the setup of the environment, CCOW may not work the same for users accessing from home or from non-network devices.

The use of CCOW also creates additional testing requirements during application upgrades in order to ensure that functionality remains unchanged. I know of at least one major vendor whose CCOW functionality has been negatively impacted by an upgrade, causing much consternation to the numerous hospitals live on its product.

There are multiple context managers out there, including Microsoft’s Vergence product (formerly of Sentillion) and Carefx Fusionfx. The fate of the Vergence solution is one reason that the recent Microsoft / GE Healthcare joint venture (first reported by Mr. HIStalk back in December) makes a lot of people nervous. Customers were already twitchy after Microsoft acquired Vergence from Sentillion in 2009, with reports of a decline in customer service and support.

Quite a few significant players in the hospital industry are customers, so hopefully that will be incentive enough for the as-yet-unnamed entity to resist making a mess of it. (Any idea on that name? I’ve been keeping my eye out, but haven’t seen anything, and there’s nothing on the Microsoft Health Web page yet, either.)

Most of the big vendors are CCOW compliant, but there are still some who don’t understand the value proposition to clients. Far from a gimmick or a “nice to have” feature, for organizations such as Mayo Clinic, Johns Hopkins, and many more, it’s essential. Once again, I was grateful to my CMIO coffee klatsch for a good discussion and plenty of humorous anecdotes. I’m looking forward to catching up with y’all at HIMSS12 in just a few short weeks!

Have a question about virtual networking, best-of-breed systems, or what the new Microsoft/GE entity should be called? E-mail me.

E-mail Dr. Jayne.

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Joe DeLuca is knowledge architect with Fulcrum Methods of Oakland, CA.

Give me some brief background about yourself and about the company.

I have been in the healthcare informatics and information technology industry for about 30 years. I started back in Wisconsin, primarily doing research work on effectiveness, the use of information technology to achieve what we would call the early ‘80s critical effectiveness, and better efficiency and efficacy. That started my career in wanting to help improve the healthcare through both consulting and the development of measurement tools. That culminated in the development of Fulcrum Methods.

At Fulcrum Methods, we provide methodologies, templates, and standard tools that help organizations go through the information technology planning, vendor selection, design, implementation, PMO processes – all focused on outcomes. The theme in my career has been aligning the specifics of a clinical improvement process or business improvement process with the use of technology. I feel very fortunate and privileged to have been part of this evolution over the last 30 years as it continues on.

You co-wrote the book, The CEO’s Guide to Healthcare Information Systems. What mistakes do you see hospital CEOs making with regard to IT strategy and their relationship with their CIO?

I think I would break that into a couple of components, if you’ll allow me to.

I think there’s been a tremendous shift in the awareness of the role of information technology and responsibilities of the CIO over the decades that I’ve been doing this. I think today the CEO-CIO relationship, whether it’s a direct report or not, is much more respectful than it was in the past. Progressive, if you will.

The mistakes that are made today have to do with incomplete involvement of the CIO in the strategic visioning process for the organization, and in the assessment of how information systems can progress, accelerate, and differentiate the organization. I think it’s better than it used to be, but it still requires some improvement.

For example, we have many technologies … I’ll pick on one because it was just recently noted in part of HIStalk … NCR’s healthcare kiosk was sold to QuadraMed. There was a time when the whole kiosk self-serve technology was foreign to the healthcare industry, and many regards it still is, depending on the adoption rates.  But there were some leading CIOs who came forward and said, “You know, we really need to look at this. This improves our patient convenience. It improves our satisfaction scores. It gives us better access to information, increases productivity, and so forth.”

That kind of thinking — bringing that forward — is something CIOs need to do more. That’s just a small example of that versus waiting for the CEO or the executive team to dictate more of what should be done based off of someone else’s doing it.

Because of Meaningful Use, people are making huge investments in clinical systems. Some of those decisions are being made fairly quickly and without a lot of publicly obvious analysis. Do you think those decisions are adequately involving the CIO?

I’m going to say yes to that. I think they are, because I think that the investment dollars and the potential for the stimulus dollars in inventive payments and then eventually, the Medicare disincentive payments and penalties are ironically forcing the CIO, because of that financial perspective, into a larger role with more credibility and more involvement on these decisions.

I think the patient safety initiatives that started to launch 5-7 years ago had a similar effect, though I think that bubbled off a little bit with the implementation of the systems and the increasing roles of the CMOs and CMIOs in the organization. So I would say there is adequate involvement, or an increased perspective.

I’d also say that today, with the emphasis on what’s going on at Meaningful Use, the CEOs have a better conviction, are more aware of and are focusing on the quality of the implementations that are occurring. At least in my consulting work, I see CEOs and CFOs actively sit back and go, “This is not just about getting the money. This is about doing it correctly. This is about doing it so that we permanently change our processes. In order to do that, we have to have a team of medical management, CMIOs, CIO, and other elements of the organization to achieve that.”

I’m sure some places consider the HITECH money they’re going to get as the initial return on investment. The CIO gets a pat on the back for achieving that. What pushes the next set of steps?

For the first point, in some organizations, I’ve seen the CIO and the team involved share some incentive bonuses relative to achieving Meaningful Use. Not large ones, but it’s certainly happening.

When the program was put in place and the set of Stage 1-2-3 distinctions were put onto the timeline, it was really quite an intelligent process out of Washington, DC. The emphasis on Stage 2 … some of it is just increasing the numerators on number of medication orders that are processed through the system electronically, but many of them, especially the physician requirements, the eligible professional requirements, really do focus on increasing the patient involvement, the patient interaction with care, transferring some data along the continuum of care in a consistent way that can be used and interpreted by the providers along the continuum. That clearly is the movement towards whether we want to call it accountable care or value-based compensation or pay for performance or population management – good things to do for healthcare, things that have been needed for a long time.

I think the impetus to continue will be the business value that’s now achieved from certified electronic health records as it moves towards managing a population, both for quality and for economic gain. At the end of the day, the health systems and eligible professionals are still going to look at what’s the financial benefit associated with Stage 2 and clearly Stage 3, with an emphasis on population health improvement, are the incentives to continue to move along to the end road further.

If a CIO realizes that most of their responsibilities and the expectations placed on them involve keeping systems up and running, having the help desk be responsive, and keeping cost under control, what are some strategies they can use with this opportunity that HITECH and the potential of Accountable Care Organizations have put in front of them to earn a more strategic role?

I think the first realization that CIOs have to come to grips with is that they can no longer think information technology, infrastructure, and application systems. Many have progressed beyond that. The CIO today, in order to advance and survive two, three, or five years from now, has to be thinking informatics. I use that term very precisely.

They have to be thinking about how the information that is managed through the information technology assets are actually used to achieve that business benefit for the organization, that clinical benefit for the organization. It’s really quite beyond just efficiency. Efficiency is certainly one element of it. Could I move my transactions along faster? But it’s really the informatics component. How do all of these different aggregations of data get transformed to clinical information that then improves both our care position with our population and our financial position?

The key survival element is to get very deep into this learning curve, if they’re not already there. Get in front of the questions that are being asked.  If someone today says, “I’m going to build an Accountable Care Organization. I’m going to need to have some quality improvement metrics.” Great. That’s certainly a starting point. The CIO needs to be saying, “How are we going to actually improve care? What’s the next step in those quality metrics? How does that integrate in with a patient-centered medical home? How much do I understand that, so that instead of waiting to be informed by the physician community, by payer community about this, I can actually inform my executive team about those needs two or three years from now?”

What structure and expertise does a CIO in a medium to large hospital or hospital network need that they didn’t need two or three years ago? What do they need to operationalize that change in philosophy about what IT is all about?

There are many demands on the CIO, operational as well as strategic. They need to have a strategic thinking department that may not actually reside within the IT department per se. That could be aligned very, very tightly with the strategic planning group ,with the CMO of the organization, and also since most medium or larger organizations today will have some form of a medical foundation or medical group affiliation, really aligning closely and understanding their needs and their vision going forward.

They also need to have a very strong data modeling capability within the organization. That’s not necessarily to build a custom clinical data warehouse or clinical performance reporting system, but to really be able to understand as all of a sudden, “Gee we have to plug into a patient-centered medical home that’s using remote management technology for congestive heart failure patients.” The minute we say something like that, we have a superficial vision of the clinical flow of information that moves along in order to achieve that. You need someone in the organization who can sit back and model that at a meta level, and inform all of the other elements, both within the IT department of the data characteristics, the patient transactions that need to occur along the way. It’s not really from a technical perspective, but it’s understanding of what’s behind the data and understanding what’s needed to make that data harmonious across all the different ownership patterns of the data.

I will also say that with the explosion of mobile technologies, the CIO really needs to have a good handle on mobile technologies and what that means.

Are IT departments going to be funded to do that? Are CEOs aware of these multiple priorities, everything from customer service to Meaningful Use to analytics to integrating with physicians and other partners, and giving CIOs being given the budget and the responsibility to carry those things out?

I think it’s a split vote right now. One of the concerns I have about Meaningful Use is that it’s forcing this huge investment up front in electronic health records. There may be a hangover effect similar to what happened with Y2K, where all of a sudden, “OK, you had your share. Now we will only fund and continue this progression in very select areas or in a marginal way.”

I’m actually seeing in the consulting practice about half of the organizations constraining IT growth rather than expanding IT growth. That’s resulting in extending the Meaningful Use deployment schedule. We won’t try to get all the money up front that we could, or we won’t try to get any this fiscal year, but we’ll string the investment out or two or three years and slide in right under the wire relative to the reporting attestation guidelines. I’m also seeing pulling back dollars that might otherwise be used for – I’ll call them experimental programs, but that’s not the right term – but for exploratory efforts that might be going on, like piloting that kiosk.

I think it’s going to get worse. I think as the cost pressures come in, we will see further emphasis on containing IT costs to some industry standard metrics that may be underfunding the environment.

I think we’ll also see – talking out of the other side of my mouth on this – a greater emphasis on system impact. If we can prove that it will speed things up, make things better, quicker, faster, improve patient safety, or support some form of a new reimbursement model … those will get funded differentially.

New systems always cost more than the ones they replace, and once the Meaningful Use money has been spent and forgotten, hospitals will be locked into high-cost maintenance. The hospital has a low margin and no real potential for it to get higher, but the IT budget has to grow because all of the systems that were optimistically brought. How will hospitals reconcile their original appetite for IT versus the ongoing cost to keep it?

I agree with those trends. Just as a footnote. I recently completed a total cost and ownership budget for an EHR purchase, working on a graph with percentage hardware, software, and implementation costs, and maintenance and support over time. I went back to a similar study that I did 10-15 years ago just to see what’s actually somewhat happening. As you would expect, hardware cost has gone down pretty significantly as a proportion. Software dollars were about the same as the total proportion, a little bit higher. Implementation costs and ongoing software support were almost twice what they were as the percentage of budget.  

I see that as a problem. The reaction from any organization will be, “These are fixed costs. We know we have to have the software vendor invoices paid, so we will cut end user support. We will trim down our help desk functions. Instead of using an N minus 1 release program,  we’ll go to N minus 2 or N minus 3.” I think that it’s a very real issue. There will be a constant tension in that environment.

I think the other thing that happens is the competition for resources between things like information technology and clinical services, when you have a revenue cycle and top-line revenue is flat or margin is under further pressure. Those contentions, those issues between those buckets of money, become even greater.

Give me some predictions or some unconventional thinking about what you see as the future of healthcare IT.

I think we will see, unfortunately, a major security breach that will damage the view of what we can do in information technology that will potentially hurt the long-term evolution of sharing of data amongst providers. We’re all somewhat very concerned about this. We have information in our silos. We know how to exchange it selectively. We’re now opening this up further with health information exchanges and so forth. I think that’s all very good, but I think we will have a breach that will somewhat shock us.

I think the role of the medical home will rapidly change to not only its physician-supported view, but we will have a new class of care attendants in the home environment. This could be, for example, myself taking care of a chronic asthmatic child or an insulin-dependent parent, where the technology that we will use will be much broader than what we perceive now as the PHR — Personal Health Record, and some monitoring that might be attached to it – that will really be into assisted diagnoses, some replacement of what we would consider to be normally a physician- or clinician-supported process. I see that coming fairly quickly within three to five years, especially as the health insurance exchanges come into play and we move a huge population of uninsured people into the insured population without an adequate supply of provider resources under the current physician labor model.

Last but not least, I think that the aggregation of some of the clinical information into our data warehouses and into our clinical performance reporting systems will support and provide breakthrough benefits for new disease management models. Once we really get some of this information consistently applied, we’ll be able to  overlay pattern analysis and other considerations that we don’t use today, which will help us improve population care.

Any concluding thoughts?

I would make a couple of observations. First, I appreciate the opportunity to do this. 

I have one other concern in the industry. Where’s our next generation of informatics leadership coming from? I am concerned about the CIO for now, concerned about incentives for CMIOs and CIOs to come into the industry and stay in the industry and to fight through the challenges and barriers that are out there. 

One of my closing comments would be, keep this dialogue going, keep people reading things such as HIStalk. Hopefully, that will provide the community that will support the evolution of us in the industry very different than 30 years ago.

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From You Know Who: “Re: RelayHealth. Jim Bodenbender out, announced abruptly on phone call. Jeff Felton, who ran the RelayHealth Pharmacy group and was a transplant from McKesson San Francisco, is taking over the entire division.” That appears to be true from the company’s management team page, on which Jeff Felton (above) is now listed as president.

From RAC Frustration: “Re: electronic RAC responses. I see that Medical Electronic Attachment (MEA) has become the latest company to be certified by CMS. I am curious how many HIStalk readers will use the esMD (electronic submission of medical documentation) for RAC and MAC responses?” MEA’s progam uses an NHIN gateway to send electronic responses to CMS’s post-payment audit requests of several flavors (RAC, MAC, CERT, PERM, and ZPIC.) I’m interested in how much transaction volume the average hospital will experience to keep CMS happy once esMD Phase 2 goes live in October and all documentation requests will be sent electronically. Comments welcome.

Surely the calendar is playing a cruel joke: it can’t be just three weeks until the HIMSS conference, can it?

My Time Capsule editorial this week from five years ago: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Databases. A free sample: “Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital.”

Listening: reader-recommend James, which I would characterize as jangly Britpop with strong vocals. They (it’s a band,  not a guy) remind me of the Smiths. They aren’t totally obscure, having sold 25 million albums in their 30 years. They probably would sell more if they had a more search engine friendly name, although come to think of it, that’s another similarity between them and the Smiths. 

A lot of money and effort is spent putting on the exhibit and educational tracks of HIMSS, but that’s just to provide the backdrop for the real reason people attend: to connect with folks for business and pleasure, two-thirds of respondents said. New poll to your right, as suggested by a reader: what reaction do you have when you hear that a vendor uses offshore programming resources?

Thanks to CSI Healthcare IT, supporting HIStalk as a Platinum Sponsor. The company is a leading national provider of IT and training professionals, both contract and permanent. The company’s team of 75 recruiters can often find local qualified resources, minimizing billable travel expenses to the client. Its pricing model has saved health system customers such as Sutter, Baylor, Texas Health, Clarian, and Sentara up to 60%. The company is vendor neutral, providing resources for projects involving McKesson, GE Healthcare, Allscripts, Epic, Cerner, Meditech, NextGen, and others. It can handle work ranging from providing a single resource to managing the projects of large health systems, also offering a specific package called Epic Community Connect that helps health systems provide Epic’s ambulatory systems to community practices (marketing, contracting, readiness assessments, implementation, and support.) Thanks to CSI Healthcare IT for supporting HIStalk.

Federal CTO Aneesh Chopra resigns and is expected to run for lieutenant governor of Virginia. You aren’t surprised if you read HIStalk on January 13, when my non-anonymous, well-placed informant chose the fantastic phony name of DeepThrowIT to tell us that Chopra was heading out. I think that might have been my first non-healthcare IT big scoop rumor.

I recently quoted some Epic facts provided by Chief Administration Officer Steve Dickmann in a recent talk he gave to a Madison group. The full video is here, from which I pulled a few more:

• The company started in a basement in 1979 doing UW psych department work.
• Epic went from 2.5 employees in 1979 to 30-40 employees in 1994, but then changed direction to focus on the electronic medical record.
• The product was changed from text-based to a graphical GUI in 1994, the same year when the database was scaled up for large enterprises.
• Epic Web came out in 1997; MyChart in 2000.
• The company gained competitive advantage from Y2K because it had minimal remediation to accomplish while its competitors had to redirect resources to work on that problem.
• Epic also gained competitive advantage from being in Wisconsin, which was an early adopter of large integrated delivery systems.
• Epic does not subcontract or acquire software; everything was developed in Wisconsin.
• The original motto was “Do good, have fun.” The “make money” part was added later.
• Epic focuses on large hospitals and clinics, children’s hospitals, and academic hospitals and turns away other prospects. The only exception they will make is for hospitals located in Wisconsin.
• Epic doesn’t do acquisitions because they would have to rewrite the code anyway to keep a truly integrated product.
• Competitors have 20-30% of their employees doing sales and marketing, while Epic has 1%.
• Epic’s culinary team has 70 employees and it also staffs its own horticultural team. It does not contract those functions out.
• All of Epic’s implementers fly out Monday afternoon, which ties up a good bit of the Madison airport’s capacity with 600-700 people all leaving at about the same time.
• Each customer has an assigned tech support team that knows the customer’s people and systems. The team is available 24×7.
• 91% of the HIMSS EMRAM Stage 7 hospitals use Epic.

Supporting HIStalk as a Platinum Sponsor is Versus, which offers real-time location systems for patients, staff, and equipment. Hospitals use that information to automate workflow, improve efficiency, increase patient safety, boost patient satisfaction, and increase revenue. The company provides interesting examples: (a) advancing patients to the next level of care based on events, such as completed labs or EKGs; (b) locating telemetry patients in distress wherever they are; (c) alerting the physician when patients are ready to be seen; (d) reminding staff to wash hands; and (e) alerting housekeeping to clean the room when the patient’s badge is dropped into the discharge bin. The Traverse City, MI company has been around for over 20 years, with its combined infrared/radio frequency system being endorsed by the American Hospital Association. Hospital customers have documented improvements such as cutting equipment losses from $1.5 million to $40,000 year, eliminating the need for clinic waiting rooms, reducing telephone calls by 75%, and increasing bed capacity by 25% with no construction. Interesting stats: the company has over 600 facilities using 500,000 of its components to track more than 1 million patients per year. The big announcement a few weeks back was that The Johns Hopkins Hospital chose Versus to manage staff and assets in real time for some locations after a three-year pilot of several RTLS systems, with additional deployments scheduled. Thanks to Versus for supporting HIStalk.

The Peace Corps has an RFI out for an EMR product, just in case you’d like to sell them one. They’re actually looking to have OpenEMR customized, along with Microsoft Dynamics 2011 and BizTalk for reporting.

In England, Homerton University Hospital allows its original NPfIT contract for Cerner and BT expire and signs its own seven-year extension directly with Cerner, declining to open the opportunity to other vendors because of its working relationship with the company.

The Bipartisan Policy Center releases its recommendations for using healthcare IT to improve care and reduce costs. Quite a few industry names served on the task force and provided their input. Some of its observations and recommendations:

• Even with new delivery models, the healthcare system continues to financially reward procedure and patient volume rather than better care. Recommendations: purchasers and plans should reward care that is higher quality and lower cost, incorporate those models into Medicare physician payments, expand pilots of new care models, and share lessons learned with private sector pilot projects.
• Despite a lot of HIE activity, not much patient information is actually being exchanged. Recommendations: improve the HIE business case by adding more stringent information exchange requirements to Stage 2/3 of Meaningful Use, develop long-term standards that make sense for healthcare delivery, assess the level of information exchange that is occurring, do more work related to two-way data exchange, and clarify the role of health information exchange in the several programs funded by HITECH.
• Consumer engagement with electronic tools is minimal. Recommendations: raise public awareness, help providers engage their patients to use technology, improve the usability of consumer tools and provide easy data import/export for consumer-facing applications, launch an awards program for consumer tools outcomes, share lessons learned, ramp up Meaningful Use requirements to include more consumer tools, and offer incentives to chronic disease patients to use electronic tools to manage their health.
• EHR and Meaningful use adoption is still low. Recommendations: raise awareness of incentive programs and expand RECs and similar programs, clarify Meaningful Use requirements, roll out lessons learned form federal programs to the whole industry and not just government contractors, encourage sharing of best practices, and improve EHR usability.
• Consumers are worried about privacy and security. Recommendations: require all entities that use PHI to comply with policies at least as stringent as HIPAA, clarify government guidance across agencies, development a national strategy for patient identification (a national ID was not specifically mentioned), and issue common sense security practices to providers.

I’ve previously mentioned the MIAA EHR mobile viewer app developed by a three-person Palomar Pomerado Health development team for its own use with its Cerner systems. A preview at a Toronto mobile healthcare conference generates interest, with the app going to pilot in March. The hospital hopes to commercialize it. Said a Canadian hospital IT director at the conference, “We need to look seriously at how a publicly-funded hospital in the States has been able to advance their technology like this when we seem to stumble on things like policy and rules.”

The Pennsylvania Health Department finds that nurses at St. Luke’s Hospital overdosed three patients in the past two years by incorrectly programming their PCA pumps. Hospital employees said the hospital did not require training on the devices.

An article covering successful businesses that did not use outside financing provides an example in eClinicalWorks CEO and co-founder Girish Kumar Navani, quoting him:

I don’t foresee leaving the company for at least 10 years. I would like to leave it a private company with no external investors and absolutely no thoughts whatsoever about Wall Street. I am having fun and take great pride in my freedom. There is no reason I would give that up. We are a cash flow positive company. We have recurring revenues and no debt. We have a large customer base that is growing exponentially.

Compuware says it will take its Covisint subsidiary public in its next fiscal year, which starts in April. Covisint, which has $74 million in annual revenue, offers an exchange platform that connects hospitals and practices, including services for identity management, collaboration, master patient index, and record location.

Vince’s latest HIS-tory: Part 2 of Health Micro Data Systems.

A column in The Atlantic revisits a 1995 article it published about Newt Gingrich, saying that some of his goofy, overly dramatic “we are at a crossroads” ideas (like colonizing the moon) prove that he can’t separate something that sounds cool if given little thought from pushing the government into spending huge amounts of money just to find out how cool it is or isn’t, even though the free market is better equipped to make that call. Healthcare technology was mentioned in that 1995 article:

Gingrich also thinks health care technology is cool. Serious students of this subject worry that insurance insulates patients from the cost of technology, thus yielding lots of high-cost, low-benefit use and in turn steering too much of society’s resources to the further development of such machinery. But Gingrich wants more. In 1984 he wanted more cat-scan machines, and he wanted the government to provide a $100 million incentive for the development of user-friendly dialysis machines–even though "there are already companies and researchers interested in this problem." The point here isn’t that Gingrich will now waste tons on technology. The current political climate will restrain this tendency. The point is that–in case you hadn’t noticed–there is little careful thought underpinning his enthusiasms, nothing solid beneath his unshakable self-assurance and his intense disdain for disagreement.

E-mail Mr. H.

More news: HIStalk Practice, HIStalk Mobile.

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Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The Top 10 Mistakes Salespeople Make at the HIMSS Conference
By Beth Friedman

A vendor’s sales staff is one of the company’s most important assets. While marketing, PR, and events management put it all together, the sales staff determines whether or not the HIMSS conference is a success.

Is your sales team engaged, interacting with prospects, and busy with pre-scheduled appointments? Or are they sitting around the booth, eating dinner together, and looking like Las Vegas wallflowers?

Here’s a Top 10 list of sales staff mistakes at HIMSS derived from our 30+ years of combined experience. Avoid them and you’re golden. Make them and you’re history. It’s that simple!

Mistake #1: Sitting Around the Booth

Your booth is crowded with salespeople, but no prospects. This is the most common mistake at any trade show.

Prospects must be enticed to enter your booth. They won’t come into it willingly. It is the job of your sales team to get them in. Yes, that means standing at the edge of the carpet and greeting attendees. A simple “hello” and smile works wonders. Multiply your smiles and see how many you get back. Hey, these guys and gals are competitive – have a contest!

Secondly, ask attendees easy, friendly, open-ended questions as they pass by. Get them engaged in a friendly conversation to start. Before you know it, you’ll be giving a demo! For example:

• How are you enjoying the show so far?
• What did you think of the keynote this morning?
• How are you finding the educational sessions this year?
• Did you go to HIStalkapalooza?

Mistake #2: Smart Phone Syndrome

All year you’ve made cold calls, left messages, and begged for appointments. Guess what? The same folks you’ve been trying to reach for six months via phone are here at HIMSS, live and in person. Dump the cell phone and talk to everyone in real time.

Avoid e-mail or any other electronic-based interpersonal avoidance. This includes time spent in the booth, between exhibit hall and hotel, in the elevators, during lunch breaks, and at the roulette table. Attendees are everywhere. Be “on” and smile at all times.

Mistake #3: Selling Too Much

Keep the sales pitch in the booth. If you meet attendees at events, poolside, or at the casino, keep conversation fun, personable, and low pressure. People are people. Everyone likes to meet someone personally first, professionally second. Overselling is one sure way to drive people away.

Mistake #4: Having Dinner Alone

Even if your company is small, make the most of having all your customers and prospects in one place. Arrange a dinner. Invite customers for cocktails. Host a small reception, focus group, or breakfast.

Breaking bread with fellow employees only is an opportunity lost. Make sure every meal includes a customer or prospect. You’ll be glad you did!

Mistake #5: Assuming One Size Fits All

Sales staff often uses a “one size fits all” approach to HIMSS attendees. Take a moment to ask questions and better understand your audience. See what problems they are trying to solve. If your company can solve it, great! If you company can’t solve it, don’t waste their time. Refer them to a company that can, and remember that smile!

Mistake #6: Avoiding Sessions

HIMSS offers a huge educational opportunity. Hundreds of sessions are offered and your prospects are sitting in each one!

Take the time to attend sessions. Sit next to someone interesting. Introduce yourself. Attending educational sessions is the best investment sales teams can make at HIMSS. Plus, it might make you smarter.

Mistake #7: Negative Selling

Talk your company up, not others down. Negative selling never works. And it especially doesn’t work at HIMSS. Enough said.

Mistake #8: Keeping Your Company’s Presence a Secret

You’ve invested time, money, and effort into HIMSS. Why not shell out a few more bucks to let everyone know? Direct mail is back. E-mail campaigns and promotions help. Unless attendees know you’re there, you’ll get lost in the noise.

And remember to attach promotion to your HIMSS efforts, and some emotion to your promotion. Give attendees a reason to visit your booth. And have some fun!

Mistake #9: Confusing Signage

OK, this mistake is usually made by the marketing folks and not sales. But confusing signage is a nuisance to everyone. Your company has less than three seconds to tell HIMSS attendees what you do. Make those three seconds count! Keep signage brief and communicate in familiar industry terms.

Mistake #10: Not Making Appointments

Failing to make one-on-one appointments with customers and prospects at HIMSS is inexcusable. Even if your company doesn’t have access to the pre-show attendee list, just call them! See if they are going. If your direct contact is not going, chances are that someone from their organization is. Call and introduce yourself. Schedule a cup of coffee or have a drink.

Reach out and touch someone before the conference. Because once everyone is in Vegas, it is too late.

Good luck. Have fun. Make the most of HIMSS. It only happens once a year!

Beth Friedman, RHIT is president of The Friedman Marketing Group of Atlanta, GA.

EHR Systems Can Be “Genius” to Use
By Seth Henry

In proper accordance to government regulations, approximately 50% of doctors’ offices nationwide have implemented some form of electronic health record (EHR) system. However, of these, only 25% have adopted the technology to serve in a meaningful and useful way. Most managers understand the mandatory changes that are underway, and in many cases, have begun the critical transition to these systems. Even if users have implemented the proper technology, they may be unsure of how to effectively incorporate it into their daily protocol or how to operate them with maximum benefits.

Compounding the financial investments required to implement an EHR system, there is an average of 1,000 hours of data entry required within the first year of adoption. Doctors and their staff are already pressed for time and money and do not have the proper resources to accomplish this tedious but crucial task. Moreover, they need to be focused on their real job – providing quality healthcare to patients.

The good news is that EHR systems can become user-friendly with the addition of proper infrastructure. Comparable to personal technologies, EHRs originate as a generic platform, with the responsibility of the owner to engage with the product to create a usable, tailored system.

Compare your iPod to that of your friends. No two are exactly alike after you each have the opportunity to personalize and import desired features and applications. Electronic health record systems are similar. They start with standard capabilities and can be uniquely personalized and adapted to meet individual facility requirements. The EHR technology requires applications to make them accommodate the needs for users to engage with the system on a daily basis to further benefit patients.

The most formidable part of any technical change is the actual use of the product and gaining consensus amongst the staff to implement it accurately and consistently. EHR professionals are constantly looking for better ways to educate, counsel, and instruct their client facilities on the technology as together they identify the most meaningful way to apply the tailored applications.

Taking a bite out of Apple’s famously coined “Genius Bar,” functional, hands-on training and support is the cornerstone to the successful use and implementation of any new product integration. The “Genius Bar” adapts the concept found at global Apple retail stores: in-person assistance for product-related education. Technology providers are retaining onsite, dedicated experts equipped with the skills, solutions, and passion for information sharing to guide facility staff through the program until they are 100%autonomous.

A single-style teaching approach is not an acceptable resolution to ensuring total integration of these technical upgrades. Thoroughly educating users in a personalized method, void of time constraints, will enable them to be properly trained to engage with the systems. Not everyone responsible for use will learn in the same manner or adapt as quickly as others. Therefore, the “Genius Bar” solution allows hands-on training and a continuous resource for resolving practical issues encountered as they implement the systems.

When the facility staff and doctors are comfortable with using the products, they are more inclined to incorporate the processes into their daily routines. In-person, ongoing support from their “Genius Bar” representative will help facilitate a smooth transition and implementation process.

The real benefit of an EHR system lies in generating, analyzing, and, ultimately using patient information to directly improve overall patient care. Tailored applications that enhance the EHR technology allow facilities and users to employ the appropriate features and accommodate their needs without the high cost of in-house IT infrastructure and staffing.

With the value of applying customizable, intuitive features, internal office support, and the help of the “Genius Bar” staff, facilities can succeed in long-term implementation and meaningful use of electronic health records.

Seth Henry is founder and president of Arcadia Solutions of Burlington, MA.

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