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June 14, 2012 News 11 Comments

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6-14-2012 9-53-12 PM

NIH and the National Cancer Institute announce grants to fund development of tools that empower consumers, patients, and/or their providers. The grants, worth up to $1.15 million each, encourage developers and entrepreneurs to partner with large health systems and health-related vendors. A long list of possible tool categories is provided.


Reader Comments

From Shhh: “Re: Epic. Speculation that it will have an SaaS offering.” A Forbes article written by a healthcare strategy consultant (who also has an article about Epic in The Atlantic that I’ll cover shortly) observes that Epic’s “fundamental but hardly delightful” system (KLAS scores suggest that Epic’s customers are pretty close to delighted, but let’s not quibble) that is client-server based and doesn’t communicate well with other systems. It says Epic is OK for healthcare innovation if you think repeatable processes will do that, but otherwise not. My opinion: I don’t really agree. I don’t get the cloud fixation – large hospitals that are accustomed to running data centers and hiring DBAs not only don’t demand a cloud-based system, they often don’t even want one. There’s nothing magical about “cloud” – somebody’s running a data center somewhere, so you’re just paying them to do it instead of doing it yourself, hoping the economy of scale they enjoy offsets the profit they demand. As far as the implication of clueless Epic customers, hospitals buy systems based on the benefits they expect, and it’s silly to think that an outside observer has the information to second guess their decisions (although I would agree that hospitals are awfully breezy with their ROI figures for Epic projects running into the hundreds of millions.) Epic is just Meditech for bigger and more egotistical hospitals – integrated, tightly controlled, as technically obsolete as their competitors, and sold by non-trendy and basically honest technologists who would rather walk away from a deal than herd you into a hard-sell Vision Center or make “partnership” promises they know won’t come true. Companies should stop fixating about mounting a full frontal attack on Epic that’s sure to fail and instead innovate on building products and services for Epic’s large client base just like the companies that coexist successfully with Meditech. As far as healthcare innovation goes, don’t put your hopes on the tools of the trade – the software market would spring to life tomorrow if healthcare incentives were changed. Today’s software market, right or wrong, reflects exactly what customers demand, which in turn reflects what the market pays them to do. HITECH created a false urgency that spurred providers to buy the same old systems they could have bought with their own money and hadn’t.

6-14-2012 6-56-39 PM


From Don Johnston: “Re: Bryan Sivak, chief innovation officer of the State of Maryland. He will be the new HHS CTO, taking over from Todd Park.” Verified. He was previously CTO of Washington, DC. Before that, he had founded customer service portal vendor InQuira, which was sold to Oracle last year for an unannounced price.

6-14-2012 9-55-06 PM

From Ron Mexico: “Re: Lahey Clinic. I’ve been told they are replacing Allscripts. Heard anything?” I e-mailed CIO Nelson Gagnon twice and he hasn’t responded. They have Allscripts for both inpatient and ambulatory, I believe. 


HIStalk Announcements and Requests

inga_small From HIStalk Practice this week: the AMA says Stage 2 MU requirements are too demanding for physicians. Practice Fusion CEO Ryan Howard invests in Ringadoc, a provider of virtual medical visits. A simple explanation of cloud computing from MGMA’s Rosemarie Nelson. The rise of cloud computing in healthcare and an Epic-directed dig. Aaron Berdofe weighs in on centralized repositories as a healthcare infrastructure data model. Pop over for a quick visit and don’t forget to sign up for e-mail updates. Thanks for reading.

Dr. Jayne warned me in advance that she was being “pissy” when she wrote her Curbside Consult this week, in which she laments that physicians are being pulled away from delivering care by the distraction of “pseudo-quality initiatives, MU, and demands by marketing teams that we have an online presence.” She also throws down a challenge that any new Meaningful Use or quality measures should be accompanied by evidence that they work to improve outcomes, the same standard that a drug or device would be held to. I saw lots of tweets referencing her post, and Evan Steele of SRSsoft cites Dr. Jayne in a blog post of his own that suggests that doctors are questioning the real value of chasing MU requirements.

Ed Marx updated his CIO Unplugged post this week, When the Worst is Best, with responses to your comments.


Acquisitions, Funding, Business, and Stock

6-14-2012 9-57-13 PM

Axial Exchange, which offers care transition software, acquires patient-facing mobile app vendor mRemedy from DoApp and Mayo Clinic.

Patient Safety Technologies files a patent infringement lawsuit against ClearCount Medical Solutions, claiming that company’s surgical sponge counting technology violates its intellectual property.

6-14-2012 10-23-34 PM

Microsoft will acquire Yammer, a Facebook-like application for enterprises, for around $1 billion, according to a rumor run by The Wall Street Journal.


Sales

6-14-2012 5-43-16 PM

Evangelical Community Hospital (PA) selects Allscripts Sunrise Clinical Manager for inpatient EHR. The 127-bed hospital already uses an Allscripts ambulatory EHR.

Global Healthcare Exchange selects Meddius to provide data exchange for its Implantable Device Supply Chain solution.


People

6-14-2012 5-09-36 PM 6-14-2012 5-16-14 PM

Practice Fusion hires Todd Martin (NewsRight) as SVP of business development and Sheila Ryan (CBS Interactive) as VP of people and culture.

6-14-2012 8-55-03 PM

Dan Michelson (Allscripts) is named CEO of Strata Decision Technology.


Announcements and Implementations

Home health software provider HealthWyse forms a strategic collaboration with Sutter Care and Home to enhance development of HealthWyse’s chronic care management solution.

6-14-2012 9-59-40 PM 

Florence Hospital at Anthem (AZ) goes live on Stockell Healthcare’s InsightCS RCM system.

AirStrip Technologies expands its platform to provide real-time delivery of data stored in disparate EHRs to clinicians using mobile devices. Travis covers it in detail on HIStalk Mobile.

6-14-2012 10-06-11 PM

MappyHealth releases the beta of  a web app that mines Twitter data for terms that could indicate a health-related development, such as a disease outbreak.

MedAssets opens the call for exhibitors for its Technology & Innovation Forum, to be held October 9 in Dallas, TX. Companies that aren’t already covered by a MedAssets purchasing agreement will present to its clients, with high-scoring vendors earning the chance to have their products added to the company’s contract portfolio.

6-14-2012 9-40-55 PM

Secure storage sharing vendor Box says it recently added four healthcare customers, including Greenway Medical, and that its healthcare cloud adoption is up 200%. It offers a free personal account with 5 GB storage if you want to play around with it.


Other

6-14-2012 8-53-26 PM

Here’s a new cartoon from Imprivata.

More than a third of physicians participating in an athenahealth/Sermo survey say their EHR was not designed with doctors in mind, while almost 3/4 report that using an EHR distracts them from face-to-face patient interaction.

An article in The Atlantic called Is One Company About to Lock Up the Electronic Medical Records Market? (co-authored by the same consultant who co-authored the Forbes piece above) says Silicon Valley types don’t understand how Epic can be successful when it breaks all their high-tech rules: it uses no open standards and it does not open up its information for other uses, but customers buy it anyway. It concludes that what Epic offers is the opposite of innovation – the quick implementation of its own rules that hospitals haven’t had the willpower to introduce on their own. In other words, hospitals buy Epic because they don’t really know how to improve their processes and use information to improve care, so they trust Epic to do it for them. While Epic’s paternalistic rules smack of industrialization, they let hospitals quickly gain efficiency and capture data they need to make both clinical and operational decisions. On the downside, Epic forces the practice of big-hospital medicine and locks customers into its outdated technology with high costs. I would generally agree – Epic’s success means we’ll see more organizations work like the big-name academic medical centers. Epic will drive some long-overdue evolutionary changes in healthcare delivery, but it’s not going to foster revolutionary gains on a broad scale. Given the country’s high healthcare costs and modest results, incremental improvements in health may not be enough, especially given the provider-centric view that improving healthcare services delivery is the same as improving health. 

A NEJM article, Escaping the EHR Trap – The Future of Health IT, argues that healthcare needs a dynamic information infrastructure instead of putting all the eggs in the EHR basket. The authors are Ken Mandl and Zak Kohane of Harvard and Children’s Boston, the guys behind the SMART project that advocates an iPhone-like apps ecosystem for healthcare IT (I haven’t heard much about that project lately.) Among the article’s talking points:

  • EHR vendors have dragged their feet in the nearly 50 years since MUMPS was invented, avoiding modular architectures that would support product extension, data sharing, and interoperability;
  • The business model of vendors is to control data, which prevents clinicians from having longitudinal and population-based views;
  • Google-type EHR data searches and population analytics are not easily accomplished without exporting information to neutral systems;
  • The hodgepodge of hundreds of non-interoperable EHR products hasn’t helped either doctors or patients;
  • Modern tools should be embraced – cloud data storage, secure communication via the Direct Project, collaboration applications to manage group tasks, and non-healthcare specific analytics tools;
  • Generic rules engines and user interface development tools could be used instead of each vendor using proprietary methods;
  • ONC grants are funding development of “post-EHR" products that will create innovation (like the project the authors are running, it should be noted in the interest of disclosure.)

Another article in the new NEJM is Unraveling the IT Productivity Paradox – Lessons for Health Care (don’t underestimate the significance of these two articles given that they’re running in the highly respected NEJM). It says that healthcare IT is following the path of other industries that embraced technology earlier: (a) trying to correlate IT use to productivity is iffy because metrics don’t capture true productivity and value; (b) healthcare is late to the IT party and hasn’t had time to redesign processes around it; and (c) poor software usability has historically undermined potential productivity gains. Conclusion: it’s too early in healthcare to say whether IT is worth it or not.

Here is Atul Gawande’s keynote from Health Datapalooza last week. He speaks as well as he writes – telling simple but compelling stories, speaking slowly and without obvious ego, and tying it all into a message that you didn’t necessarily see coming. He has an interesting perspective about how battlefield medical services have improved and how that might impact non-military healthcare delivery.

A reader from Catholic Health Initiatives obliged my request for more information about its $1.5 billion EHR project. The five-year project called OneCare will include electronic health records for both inpatient and outpatient, infrastructure, user access enhancements, and an HIE with portals. Its Hoover’s profile says it has 14,000 acute care beds, which would be just over $100K per bed. That’s a lot less than some hospitals pay per bed, but it’s hard to compare size and scope. They were implementing Allscripts on the outpatient side a couple of years ago, trying to get it to talk to Cerner and Meditech inpatient systems, but they seem to be posting Epic jobs lately.

A delay by University of Michigan in reporting suspected child pornography that led to the arrest of a pediatric ED resident could cost the school more than $500K. Its contract with a Chicago law firm calls for a minimum payment of $395K, with the lead attorney and a a partner billing $725 per hour, the associates at $540-595 per hour, and paralegals charging $180-280 per hour.

Weird News Andy can’t figure out why a woman would go into an empty stairwell with her abuser in this sad story. A surgeon who is also a former Special Forces weapons expert plants a tracking GPS in his former girlfriend’s car, stalks her house, and threatens to kill her more than once. He allegedly lures her into the stairwell of the hospital in which she worked, shooting her dead with a high-powered pistol. Police think he’s mentally unstable.

Strange: a nurse who stole a doctor’s iPad from the ICU lounge is caught when the device automatically connects to the hospital’s wireless network, allowing hospital security to catch him heading toward his car with the device.


Sponsor Updates

6-14-2012 5-26-08 PM

 

  • City Hospitals Sunderland NHS Foundation Trust implements BridgeHead Software’s Healthcare Data Management archiving solution.
  • CommVault is positioned in the Leaders quadrant of Gartner’s just-published report on enterprise backup and recovery software.
  • eClinicalWorks releases a case study highlighting the clinical and administrative improvements realized by Block & Nation Family Medicine (FL).
  • TeleTracking reports that over 80% of hospitals named in US News & World Report’s 2012 Best Hospitals use its applications.
  • OptumInsight is offering Webinars for clearinghouse customers, Epic users, and GE Centricity users.
  • Beacon Partners offers new white papers on HIE and organizational culture.
  • Gateway EDI highlights Mid-Illinois Medical Care Association and their claims processing success.
  • A MEDSEEK blog entry provides advice for overcoming physician resistance to patient portals.
  • Impact Advisors has been named to the 2012 Healthcare Informatics 100 list.
  • An Informatica-sponsored report reveals the vulnerability of sensitive data due to insufficient controls preventing unauthorized access.
  • Wipro Mobility Solutions collaborates with Kony Solutions to offer mobile application technology and services to enterprise customers in the US, UK, Australia, and the Middle East.
  • Puerto Rico Hospital Supply, Dell, and NextGen Healthcare will co-market and deliver medical technology and service to practices in Florida and the Caribbean.
  • Waterbury Orthopaedic Associates (CT) selects SRS EHR for its four providers.
  • Meditech collaborates with Intelligent Medical Objects to provide mapping of diagnosis and procedure terminology to billing and medical concepts.


EPtalk by Dr. Jayne

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I’m feeling really jaded right now, which usually means it’s time for a vacation. Unfortunately, there is a heap of implementations standing between today and vacation. I’m resorting to an old residency mantra: They can kill you, but they can’t stop the clock.

I’ve been in a practice since the wee hours of the morning and my eyes are crossing, so I haven’t been able to find witty news tidbits to share. With that in mind, we’re going to take a brief departure this week to open the reader mailbag.

Dolphins Fan writes:

I read your recent post on adoption, Meaningful Use, and provider incentives (they are paltry — they barely cover the cost of purchasing and installing an EMR, never mind maintenance) and it was right on target. I believe the EMR push is to reduce “provider” (I hate that word) productivity, because that will curb the growth in healthcare costs. I feel like I’m being sold a bill of goods. I am contemplating going back to paper – not that I love paper, I hate it – just because I resent being pushed in a direction that I have to make a business decision that explicitly harms my revenue. Docs aren’t businessmen, but I’m a good enough businessman to see the stupidity in that.

It will definitely be interesting to see if Meaningful Use actually improves the health of Americans. I’m not talking about making numbers look good – I’m talking about actually improving health. Those of us in the clinical trenches have all seen the patient in the ICU whose numbers (labs, vitals, etc.) look great, but they die anyway.

Mr. Lincoln writes:

I really enjoyed your really enjoyed your article on why doctors practice medicine and why the incentives of MU are not aligned with that mission. The big vendors have been selling the benefits of EMRs to the government for 15 years. Once they determined the government might fund systems, they created certifications that were meant to stifle innovation by creating obstacles they knew were difficult to build quickly. The two parts of functionality are prescription writing (saves money by formulary compliance) and order entry (saves duplicate tests). Both of these turn spatial-thinking doctors into frustrated, linear-thinking data clerks searching through pick lists.

Those barriers didn’t work so well, so they created a second set of obstacles called Meaningful Use that made it even more difficult for small vendors to innovate and compete, leaving physicians with the same old choices. In the end, doctors are receiving $8,800 per year so they can now be measured (see the Todd Parks interview speaking about rating and comparing doctors) and fairly or unfairly judged by this data. As all these MU-certified EMRs start to feed HIEs owned by insurance companies, it seems like the privacy of American citizens is being compromised.

That’s an interesting spin. At least if we’re going to wind up with de facto national healthcare, they could do us a favor and mandate a national patient identifier so we don’t have to keep arguing over the use of the Social Security number. My patients keep complaining that I am including their SSN on my lab requisitions, but it’s actually their insurance ID. Without it, the lab can’t bill the payer and the patient receives the bill. Catch 22.

I’ve had only a handful of replies to my call for vendors to describe how they use physicians in the development process. One of them made my day with this quote:

We eat our breakfast 300 yards from 4,000 medical staff who are trained to kill us, so don’t think for one second we can code with apathy, charge for upgrades, and not be nervous.

Several providers have contacted me directly, but most want to be anonymized so their employers won’t know it’s them. I’m shocked that I haven’t heard from more, so I’ll just run that teaser. I would think vendors would love the opportunity to brag on HIStalk, but maybe I’m wrong.

I am, however, secretly dreaming of a stream-of-consciousness e-mail from a certain CEO/former combat medic who hails from Watertown, MA, but maybe I shouldn’t hold my breath.

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Sometimes grammar mistakes make it through our extensive editing process (which actually consists of Mr. H eyeballing my work – probably in the wee hours of the night since I don’t usually write until late) and readers point them out. Please accept our apologies, and thank you for humoring us because, after all, we write after working often-grueling, full-time day jobs. As a student of the language, I did want to share this tidbit about the importance of the comma. I hope Rachael doesn’t decide to share those recipes.

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

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Currently there are "11 comments" on this Article:

  1. Great response to “Shhh” regarding Epic and how others should respond to them. Your insight never ceases to amaze me! I especially liked your comment about Epic as nothing more than Meditech for larger facilities (I’m paraphrasing from memory so hopefully I’m not putting words in your mouth). My belief is that a user’s satisfaction with a given system has much to do with which system they were indoctrinated with. There are many physicians using Meditech / LSS that feel as strongly about their system, as users of Allscripts, as users of Epic, as…(name your poison). They all have their strengths, and of course they all have their weaknesses. While Epic is likely no better or no worse than other systems, it is the “darling” of the industry right now.

    Regarding the cloud offerings – I agree with you to a point. I believe it true that if a facility is looking at straight hosting for a medium / large facility, it is a toss up as to whether or not a hosting or SAAS model is better. However, there are two things that might make a case for outsourced hosting (bring your own licensing) or SAAS:

    1) Failover Technology – It would be hard for anyone to deny that solid failover technology will be required to significantly reduce downtime (in comparison to today’s world). Failover technology equates to having insurance – something that most industries are adverse to carrying at today’s price point. Failover technology, both the physical technology and the staff expertise required to operate it, is a much easier of a sell when spreading it out over multiple facilities.

    2) Smaller / Rural Facilities – These facilities have a harder time investing in and then maintaining the proper types of staffing required (including ample backup staff) to operate systems on-site – let alone systems that include failover technology. In today’s world that typically doesn’t include failover technology, this is not as much of an issue and allows most facilities have their systems in a small data center or back office room. In the future, when adding failover technology into the mix, it may not be as easy to keep the systems on-site. My guess is that failover technology will push many of these facilities to treat computing like a utility such as electricity – let someone with the necessary expertise host the applications. In our neck of the woods, what we’ve found that differentiates a healthcare organization from their neighboring facilities is how well they implement and use the technology they have at their disposal (incidentally, without regard to software vendor).

    I don’t disagree with you – “cloud technology” is definitely a buzzword of the day. However, technology and the software applications from our vendor community have much growing up to do to build fault tolerant environments that are cost effective and easy to maintain. In the mean time, hosted environments may win out. Hopefully, ten years from now we’ll all be looking back and laughing at some of the technology we are using today.

  2. “As far as healthcare innovation goes, don’t put your hopes on the tools of the trade – the software market would spring to life tomorrow if healthcare incentives were changed. Today’s software market, right or wrong, reflects exactly what customers demand, which in turn reflects what the market pays them to do.”

    Truer words have never been spoken. People point out inane issues around EHRs (e.g., burdensome documentation requirements, lack of interoperability) but fail to realize these are just reactions to broken incentives (excessive insurance requirements / interference, paying for visits instead of care episodes and results). There are certainly areas where software can improve, but if we really want to change healthcare the incentive structures have to change. Technology can help with some of these changes, but it can’t erase broken incentives. Improve the system and the software will follow.

  3. Re: Shhh – I liked your answer as well. I wish I had the mind-reading capability of some of your readers regarding Epic. I could quit my job and make millions as a consultant.

    The fact of the matter is that Epic is successful not for their technological innovation, but because they put an increasingly good product on the table and they listen to their customers when it comes to product development. Those are very rare qualities in today’s marketplace. I can’t tell you the number of times I have been assaulted by a vendor who thinks they know my job and my business better than I do.

    Additionally, Epic’s success is not a new phenomenon. They have been doing just what they are doing now for a long, long time. I would be interested if anyone has statistics on percentages of customers who have replaced their Epic system in the last 15 years. I would bet Epic’s numbers would be head and shoulders above everybody else in the industry.

  4. Re: Lahey
    they do not use Allscripts for inpatient, and yes they are looking to replace them for outpatient.

  5. re Dr. Jayne :”She also throws down a challenge that any new Meaningful Use or quality measures should be accompanied by evidence that they work to improve outcomes, the same standard that a drug or device would be held to.”

    I could not agree more, especially if that standard includes the vetting of the CPOE and CDS devices that are running the medical care MU algorithms to be sure these devices improve outcomes.

    As for Shhh, and the software market, I think it to be a brilliant idea for the US Government should spend $50 billion more to incent medical care software development to fix the broken software market, which will, in turn, transform the health care system that has not been transformed yet as promised and theorized.

  6. “Technology can help with some of these changes, but it can’t erase broken incentives. Improve the system and the software will follow.”

    Absolutely – expecting health IT to solve the problems of our broken healthcare non-systems is the tail wagging the dog. Something that we risk, though, with the implementation of yesterday’s monolithic, inflexible, expensive health IT is that these systems will actually be one more barrier to care delivery reform.

    The ROI model on which billions of (taxpayer) dollars of EHRs have been bought is largely based on (sub) optimization of the current broken system. And those systems aren’t going to be ripped and replaced in favor of something else anytime soon.

    I also don’t have much faith that the current market will produce any better or more usable software (if and) when healthcare incentives do change, especially after a decade or two of dominance by a handful of entrenched vendors doing everything that they can to lock their customer base down.

    Anon

  7. Re: Epic and cloud…
    Could not agree with you more. Other reasons are:
    – Hospitals are very slooooow to change systems
    – preceived loss of ‘control’
    – every 7 yr TCO I have ever seen basically comes out even.

    But I do agree with SmallTown CIO – failover could change the tide. All we need to see is a handful of big outages and the Clouds could role in.

  8. Without Stimulus, or MU, where would all these EMR vendors be today?

    I’m seeing more and more small software vendors <50 employees but with broad customer base struggling to engineer these artificial MU measures.

    Can you say bubble?







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Reader Comments

  • Joanna Wyganowska: Dr. Jayne - I believe that the workflow and patient experience innovation already exists. As an industry, we just do a ...
  • Singularity: Having worked with Epic at various sites for years, I wish they'd recognize that where they're struggling most with inte...
  • Wearyof it: I love reading Dr. Jayne. Her writings are practical, helpful, provide usable concepts and practices to consider, and ju...
  • Laura K.: It's a sad commentary when we compare the US Healthcare to the typical DMV, but the parallels are undeniably present. ...
  • Orlando Portale: Jayne, many top tier Academic Medical Center's are island's of clinical excellence, surrounded by the Department of Moto...

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