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August 23, 2012 News 11 Comments

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Meaningful Use Stage 2 regulations are approved.

National eHealth Collaborative will present a free Webinar Friday afternoon, August 24, from 1:00 to 2:30 p.m. Eastern time called How to Play by the (Final) Rules: An Overview of Meaningful Use State 2 and the Standards and Certification Criteria Final Rules. CMS and ONC presenters will go over the rule and answer questions.


Reader Comments

8-23-2012 6-39-41 PM

From Limber Lob: “Re: Massachusetts healthcare law. Note the quote by Governor Dev Patrick.” In summarizing the bill that he says will save the state $200 billion over 15 years, Patrick said, “We are ushering in the end of the fee-for-service care system in Massachusetts in favor of better care at lower cost.”

From Concerned in Texas: “Re: Epic. I work for a Epic hospital and haven’t signed any kind of agreement. I’ve heard from two sources that if my hospital wants to block another hospital from hiring me, my hospital can call Epic and they’ll tell the other hospital not to hire me. Is that true?” Recent discussion on that topic here brought out lots of folks with firsthand experience, so I’ll defer to them.

From Kara: “Re: managing population health and overall analytics. I would love to know who is having tangible, positive ROI-type success in this area. Not a vendor white paper, but real-world experience measuring financial impact done by someone who would be willing to talk about it.” I told Kara that the payment model isn’t very far along to have allowed anybody to demonstrate ROI on managing population health, but that’s probably a hospital-centric answer that doesn’t include other kinds of programs. She would really appreciate your comment if you can help.


HIStalk Announcements and Requests

inga_small Do the dog days of summer leave you wishing for cool reading material? If so, here are a few HIStalk Practice highlights from the last week: physicians are more likely to suffer job burnout than other professionals. Happtique introduces prescribe-able apps. Epocrates offers its Essentials reference product free to medical students. The number of retail clinic visits increased fourfold between 2007 and 2009. Student loan repayment is the top source of stress for physicians. Attorney Jessica Shenfield offers advice for physicians to stay HIPAA compliant in the age of mobile devices. Dr. Gregg shares the “gray lining” of the cloud. While you’re catching up on your HIStalk Practice news, click on a few sponsor ads and see if there are any ambulatory HIT goods or services that might make your life more complete. Thanks for reading.

I don’t like being scooped, so I was pleased to put a reader’s rumor that Inga forwarded to me on Twitter early Thursday morning saying that Meaningful Use Stage 2 would hit the Federal Register Thursday afternoon (which it obviously did). I tweet only stuff I think is important, so you won’t get bombarded following @histalk, but you might share my scoopage on occasion.  While you’re in that interoperating mood, you might as well follow Inga too, and follow that with a LinkedIn and Facebook chaser of connecting with any or all of our various personas since we are free with our Internet love. We don’t really solicit sponsors or hold their hands if they’re considering it, so marvel at how many of them have exhibited the resourcefulness to become one anyway and perhaps click on their ads to your left in a primitive form of the Like button. You can dig around in more detail in the Resource Center, and if you want to summon offers of consulting help while sitting regally on your throne and beaming benevolently at your hushed minions, simply fill out the Consulting RFI in maybe 60 seconds and dispatch it to several willing providers with one click of your royal scepter and wait for your e-mail to light up. You have surely noted that HIStalk is a contact sport – we minimize the usual pontificating and self-indulgent journalism and give readers the floor whenever they’ll take it – so feel free if not morally obligated to send us your news, rumors, and anything we would find interesting. It’s delightful having you as a reader.

On the Jobs Board: Services Implementation Project Manager, Account Executive Northeast, Services Implementation Consultant.

8-23-2012 5-44-52 PM

Welcome to new HIStalk Gold Sponsor Velocity Data Centers. The Chelsea, MI company offers economical, quick-to-build modularly constructed data centers installed on site. They’re bulletproof, hurricane tested, suitable for any climate, and less expensive than building from scratch or using valuable hospital square footage for data center space. If you’re worried about cloud security or service levels, you can build your own private cloud instead of renting someone else’s. if you’re struggling with technology expansion, obsolete disaster recovery capabilities, or need space for big data storage or research computing, you can get the data center capability you need for less money and time. Thanks to Velocity Data Centers for supporting HIStalk.

I found this really cool time-lapse YouTube video of a Velocity Data Center being built in 90 days.


Acquisitions, Funding, Business, and Stock

8-23-2012 5-08-05 PM

Two of the Quality Systems directors who were nominated by dissident board member Ahmed Hussein in a proxy fight have been elected, along with seven of the company’s eight nominees. Names have not yet been released pending certification of the results. The company also announced that Scott Decker, president of its NextGen subsidiary, has resigned effective September 7 to take another job with an unnamed healthcare IT vendor that the company says is not a Quality Systems competitor. QSII shares dropped another 4.5% Thursday to $17.39, above their 52-week low of $15.04, but down 66% from their 52-week high of $50.70.

8-23-2012 5-08-47 PM

Data analysis tools vendor Apixio raises $5.8 million of its $7.8 million goal from at least 10 private investors.

Michael Kluger, an Allscripts board member since 1994, resigns because of what the 8-K form says is, “His desire to spend time on his professional responsibilities.”

8-23-2012 9-07-28 PM

Roper Industries completes its previously announced $1.4 billion acquisition of Sunquest.

8-23-2012 7-13-44 PM

HP reports the biggest loss in its 73-year history, writing down a mind-boggling $8 billion of its $13 billion acquisition of Electronic Data Systems from GM in 2008 (GM had bought it from Ross Perot for $2.5 billion in 1984). Excluding one-time charges, the company’s revenue dropped 5% and earnings declined by 13% as its PC, printer, and notebook sales all dropped by double-digit figures. CEO Meg Whitman says she’s confident of a turnaround, but analysts are looking warily at the company’s $30 billion debt load. Above is the five-year HP share price (blue) compared to Microsoft (green) and the S&P 500 (red). Shares are at $17.64 after dropping more than 8% Thursday on the news, 41% off their 52-week high of $30.00.


Sales

8-23-2012 9-10-00 PM

Union General Hospital (LA) selects the Healthcare Management Systems EHR and EDIS.

Walgreens will deploy its WellHealth EHR, built on Greenway’s PrimeSuite, to 8,000 locations, allowing pharmacy employees to view the immunization and health testing history of patients.

EHealth Saskatchewan awards SAIC Canada a three-year, $16 million contract to provide implementation and maintenance technology services in support of the province’s EHR.

8-23-2012 9-12-09 PM

West Virginia Health Information Network launches its statewide HIE, with Truven Health Analytics (the former healthcare business of Thomson Reuters) as its technology provider.

Mountain States Health Alliance selects the Siemens perioperative management solution by Surgical Information Systems for its 13 hospitals in Tennessee and Virginia.

Franciscan Alliance (IN, IL) selects Merge Healthcare’s iConnect imaging solution. Children’s Hospital & Research Center (CA) also contracts with Merge for its iConnect Access and Share solutions.

8-23-2012 9-11-25 PM

Rochester General Health System (NY) selects Wolters Kluwer’s ProVation Order Sets powered by UpToDate Decision Support for its eight affiliate hospitals.


People

8-23-2012 5-10-25 PM

The University of Michigan Health System names long-time Brigham and Women’s Hospital CIO Sue Schade as its new CIO, effective November 1.

8-23-2012 5-11-46 PM

Physician networking site QuantiaMD appoints Mike Coyne (Verisk Health) as president.

8-23-2012 5-27-43 PM

Hayes Management Consulting names Shawn DeWane (Emdat) as EVP of business development.

8-23-2012 5-36-05 PM

Cumberland Consulting Group names Jeffrey Sturman (Memorial Healthcare System) as partner.


Announcements and Implementations

Hospitalist management company Cogent HMG will extend its use of athenahealth’s athenaCollector.

8-23-2012 9-13-40 PM

The University of South Carolina School of Medicine completes its implementation of Cerner Ambulatory EHR for 143 providers and 1,200 users. Affiliate Palmetto Health will bring another 153 providers live over the next 13 weeks.

The local paper mentions that Providence Medford Medical Center (OR) has implemented a Modified Early Warning System that scores vital signs entered into the EMR and pages the charge nurse if the score indicates possible problems. The article doesn’t give specifics, but it may be Caradigm Amalga that they’re using.


Government and Politics

CMS selects 500 primary care practices across seven regions to participate in the Comprehensive Primary Care initiative, which will pay primary care practices a care management fee of $20 per month per beneficiary to support enhanced coordinated services on behalf of Medicare FFS beneficiaries.

Open health and VistA advocate Matt McCall was honored Thursday by the White House as a Presidential Innovation Fellow. He’s working on the Blue Button initiative, the HealthME PHR, and formerly the VA’s OSEHRA VistA community.

In England, the Department of Health is reportedly pursuing the replacement of Cerner Millennium for its Choose and Book scheduling system, hoping to eliminate its dependency on commercial software products to reduce costs. It hopes to own the intellectual property outright.

8-23-2012 7-57-44 PM

The US Army creates an open encounters report for its MC4 battlefield EMR in Afghanistan using a Business Objects query that finds open encounters that are more than three days old. The weekly reports, along with toughened policies, reduced open encounters by 72% in the first month, which it says will allow better care because encounters not closed per policy by the original physician were being cleaned up afterward by someone else.


Other

8-23-2012 6-47-59 PM

Greenway has put out a summary of the Meaningful Use Stage 2 rules for EPs.

8-23-2012 6-59-12 PM
8-23-2012 6-57-47 PM

Microsoft unveils a new company logo, its first in 25 years. According to the company, the font is Segoe, while the symbol conveys the company’s diverse product portfolio. The video is running 3,530 likes to 670 dislikes so far. Personally, I like it.

Epic is awarded a patent for, “A system for facilitating patient ownership of his or her medical data through the use of third-party health repositories that preserves the maximum information content of the medical records by displaying information relevant to the authority of the medical data as reflected by its source and types of modification as it has moved between institutions, as well as the data itself. In this way, improved use of this data is made possible.”

8-23-2012 9-15-05 PM

United Memorial Medical Center (NY) eliminates five transcriptionist jobs, blaming its financial losses and electronic medical record as good reasons to outsource the function. Two of them complained to the local paper, saying it “added insult to injury” that Intivia, the company chosen to take over the function, offshores some work to India.

8-23-2012 9-17-30 PM

In Malaysia, the University of Malaya Specialist Centre is developing clinical and imaging systems for its new campus that will scale up from the current 100 concurrent users to 4,000. The CIO estimates that 80% of Malaysian hospitals are still paper-based and the remainder keep their electronic information in silos. He’s using VMware products to virtualize servers and desktops, including thin-client touchscreens for the OR that have washable mice and keyboards. He says desktop PCs are “irrelevant” with triple the three-year cost of a terminal, plus they support the “bring your own device” movement. The hospital is spending 4% of its annual revenue on IT.

Dan Mandy from Winthrop Resources tells me that CMS has changed its rules that previously required critical access hospitals to purchase hardware to be eligible for the Meaningful Use incentive. CMS apparently announced in July that a capital lease will meet the “purchase” requirement.

8-23-2012 8-27-10 PM

An Arkansas nursing home installs a telemedicine station that allows residents to be evaluated by a physician quickly instead of in several weeks. They’re using a digital stethoscope and cameras, while the vendor (IntegrateMD) will also offer wireless stethoscopes and iPad access.

The city of Alpharetta, Georgia forms a commission to attract and retain technology companies, hoping to brand itself as the “Technology City of the South.” The commission’s members include executives representing several companies that sell healthcare technology.

Grady Hospital in Atlanta suspects that a a married couple holding senior financial positions (payroll director and budget director) stole $500,000 from the hospital. They had been laid off and then sued the hospital for discrimination.

A fired account representative of a Chicago-area psychiatric hospital admits that she stole copies of patient files and used the information to send harassing letters to the hospital’s patients, which the police said included “vulgar comments, references to confidential medical information and psychiatric treatment received by these patients.” She also threatened to expose the information to the friends and families of the patients.

The State of Missouri will provide $4.6 million in incentives to Sporting Innovations, which will hire 120 people and spend $20 million renovating a Kansas City, MO building for building smartphone sports apps. The company is an offshoot of Kansas City’s professional soccer team, which has as two of its five owners Neal Patterson and Cliff Illig of Cerner. The soccer team famously chose Kansas City, KS for its stadium and a new Cerner complex after Kansas outbid Missouri with $230 million in “border wars” incentives. Illig says Sporting Innovations will deliver the same technology improvements to sports as Cerner has done for hospitals, allowing fans to view multiple video feeds of sports events and to scan QR codes on stadium seats to order team apparel. According to Illig, “What we see in sports is similar to health care. You have stadiums with 30 different technologies that don’t talk to each other. This will enhance the fan experience and be a platform for innovation.”

Strange: a male porn star named Mr. Marcus admits that he convinced a medical testing service to omit the positive result of his syphilis test, which he calls “the Scarlet Letter,” so he could continue working. The company denies his claim, saying their software does not allow employees to omit specific test results. Nine cases of syphilis have been documented in investigating an outbreak, with one trade group urging a temporary national moratorium on the production of adult films until all performers have been tested. I was highly entertained by the performer testimonials (especially their hilarious phony names) on the testing company’s site, including one enthusiastic Ms. Bailey Brooks, who said, “I have such a hectic life between kids, college, and travelling to shoot that I LOVE TTS!!!”

8-23-2012 9-26-16 PM

Hospital district officials checking up on complaints about taxpayer-funded 269-bed Salinas Valley Memorial Hospital (CA), best known for the $5 million retirement package it gave to its CEO last year followed by extensive layoffs and losses, say they have no problem with the hospital’s interim CEO turning in $4,000 in receipts from “Airport Town Car” since his contract guarantees him a car service. The driver providing the service: his daughter. They’re also happy to pay his commuting expenses from Seattle, his rounds of golf, and the candy bars he buys at the airport.


Sponsor Updates

8-23-2012 7-47-41 PM

  • Attendees at the all-employee annual meeting of Ignis Systems on August 9-10 pitched in at the Oregon Food Bank, repackaging two tons of bulk pasta for distribution to families in need.
  • Santa Rosa Consulting reviews the 2012 impact of the CMS hospital readmission reduction program in a blog post.
  • The State of Florida awards iSirona $530,000 in grant and tax incentives to create jobs in the Bay County, FL area.
  • Greenway Medical VP Justin Barnes reflects on the eight-year journey to accountable care in a blog post.
  • Wolters Kluwer Health’s Sentri7 Patient Surveillance software earns high marks in two recent KLAS reports.
  • Intelligent InSites offers a free August 29 webinar titled How to Better Manage Consumable Medical Assets with RTLS/RFID Solutions.
  • Medicomp Systems CEO Dave Lareau discusses the need to make clinical data usable in order to enhance patient outcomes in a guest article.
  • Nearly 200 volunteers from GE Healthcare helped prepare Milwaukee-area school buildings for the new school year on Wednesday.
  • eClinicalWorks expands its Westborough, MA headquarters with the purchase of a 61,000-square-foot building in the same complex.
  • Medical billing technology vendor Healthpac will offer products and services from simplifyMD to its customers.

Inga’s Quick Skim of Meaningful Use State 2

 

Inga came up with this after a quick skim of the rule as published. She and many others will be poring over the rule in more detail, so please leave a comment (as will Inga) with anything interesting you find.

  • A special three-month reporting period rather than one year of reporting for providers attesting to either Stage 1 or 2 in 2014.
  • A delay in the Stage 2 timeline probably is the most important to EPs. In the Stage 1 final rule, CMS established that any provider who first attested to Stage 1 criteria in 2011 would begin using Stage 2 criteria in 2013. This final rule delays the onset of those Stage 2 criteria until 2014, “Which we believe provides the needed time for vendors to develop certified EHR technology [CEHRT].”
  • For 2014 only, providers that are beyond the first year of demonstrating MU will have a three-month quarter reporting period to allow up to nine additional months to upgrade certified EHR technology to the 2014 edition.
  • Nearly all of the Stage 1 core and menu objectives included in the proposed rule are being finalized for Stage 2.
  • Adds “outpatient lab reporting” to the menu for hospitals and “recording clinical notes” as a menu objective for both EP and hospitals.
  • There will be 20 measures for EPs (17 core and 3 of 6 menu) and 19 measures for eligible hospitals and CAHs (16 core and 3 of 6 menu).
  • New core measure for EPs: use of secure electronic messaging to communicate with patients on relevant health information.
  • New core measure for EH/CAH: automatic tracking of medications from order to administration using assistive technologies in conjunction with an eMAR.
  • Ability to use a batch reporting process for MU, which will allow groups to submit attestation information for all of their individual EPs in one file.
  • CMS is requiring providers to send a summary of care record for 50% of its patients rather than more than 65%.
  • Providers electronically transmit a summary of care for more than 10% of transitions of care and referrals, but eliminated the requirement that the summary of care be electronically sent to a provider with no organizational or vendor affiliation.
  • Lab reporting for hospitals as a menu objective.
  • EPs who can demonstrate that they fund the acquisitions, implementation, and maintenance of CEHRT, including supporting hardware and interfaces needed for MU, without reimbursement from an eligible hospital or CAH —and use such CEHRT at a hospital, in lieu of using the hospital’s CEHRT—can be determined non-hospital based and receive an incentive payment. Determination will be made through an application process.
  • EPs must report on nine out of 64 total clinical quality measures (CQMs).
  • Eligible hospitals and CAHs must report on 16 out of 29 total CQMs.
  • All providers must select CQMs from at least three of the six key health care policy domains from the HHS’ National Quality Strategy: Patient and Family Engagement, Patient Safety, Care Coordination, Population and Public Health, Efficient Use of Healthcare Resources, Clinical Processes and Effectiveness.
  • Beginning in 2014, all Medicare providers that are beyond the first year of demonstrating MU must electronically report their CQM data to CMS.
  • Added four categories of exceptions for EPs to avoid Medicare pay adjustments: in a geographic area without sufficient Internet access; new EPs; unforeseen circumstances, such as a natural disaster; and, specialist/provider type, such as those that lack direct patient contact of follow-up needs with patients.
  • Made 12 additional children’s hospitals eligible to participate in Medicaid incentive program, despite not having a CMS certification number since they don’t bill Medicare.

EPtalk by Dr. Jayne

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The Food and Drug Administration approves the Ingestion Event Marker, or so called “smart pill,” for marketing as a medical device. The sensor is embedded in a pill and is activated by contact with fluid in the stomach. A signal is sent to a wearable water-resistant patch that wirelessly transmits the data to a smart phone or computer. Manufacturer Proteus Digital Health Inc. will begin direct-to-consumer marketing in the United Kingdom with the sensor embedded in a placebo taken at the same time as the patient’s regular medication. The company hopes to gain FDA approval to embed it in therapeutic medications by 2014.

The Archives of Internal Medicine publishes a study that not surprisingly shows that burnout is more common among physicians than other types of workers in the US. Frontline specialties such as internal medicine, family medicine, and emergency medicine are at greatest risk. I’d be interested to see how healthcare IT workers fared on the same screening instrument.

HIStalk reader Evan Steele blogs about the “arduous task” of having hundreds of EHR vendors each programming more than 100 clinical quality measures. Software companies are spending their time jumping through hoops rather than advancing usability and innovation.

Hi tech, low tech: Dallas County declares an emergency with the recent outbreak of West Nile virus. Aerial spraying crews are deploying synthetic pyrethroids (chrysanthemum extract) to combat mosquitoes. If you’re going to be outside at dusk, it’s not a bad idea to break out the insect repellent.

Weird but true: Molecular geneticists translate an entire book into 55,000 strands of DNA, then convert it back to text. Researchers propose that “a device the size of your thumb could store as much information as the whole Internet.” The text used in the project was a book on genomic engineering. There are several other fun facts in the article, including discussion of sequencing Disney’s most annoying song, “It’s a Small World,” into a micro-organism.

Weird News Andy wannabe: This wasn’t from him, but it’s worthy of his name. The FDA recalls surgical bone putty that can ignite during surgery.

Medicare announces the completion of updates to its website. The list of accomplishments includes better design, increased compatibility with smart phones, and improved access to key parts of the site.

I had the privilege of hanging out with one of my favorite CMIOs as he was passing through town this week, and I’m especially pleased that he noticed my shoes. That’s the mark of a true Renaissance man, if you ask me.

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

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Currently there are "11 comments" on this Article:

  1. Population risk mgmt has been done for yrs by payers using claims data. The big push now is to do the same, but more real-time with clinical data. Lots of issues with using clinical data for population risk and I’m not aware of any demonstrable ROI from use of clinical data in such scenarios.

  2. Per a presentation at a conference today Providence uses Epic, Amalga and an Enterprise Data Warehouse for reporting. Amalga drives their MEWS scoring and distribution to users.

  3. University of Alabama Medical Center built and then presented an early warning system based on patient parameters at HIMSS this year. They built it with Allscripts Sunrise Clinical Manager and custom MLMs and reported some excellent outcomes.
    I think one of their key points was that the technology isn’t all that difficult, it’s the people and infrastructure that are challenging.

  4. Regarding Mass Deval Patrick, what they are putting into place will amount to rationing. Like the healthcare mandates for Mass before it, the state will not see any savings unless they control the cost of care, and what they put into place is an idea that has not been tested on a broad scale, controls are not in place, and there is little buy in from physicians. They got the buy in from the major health systems, but that was political pressure. (Partners paid $40m into a insurance pool due to state pressure.) Of course they say it will work, because their pilot sites providers controlled care with employed physicians.

    The Mass mandate gave everyone health insurance with no plan to improve access, increase the number of providers and a way to pay for it. ED’s are still over utilized. Our company health insurance cost continue to rise every year, and now we will be told what care we can be given and someone else ie a 3rd party will decide how much the provider can get paid.

  5. Kara, for real-world descriptions of ROI and improved population health analytics, read the reports of the Davies Award winners on the HIMSS website. These are written by provider organizations, not by vendors, and the evidence is clear.

  6. Re: MU State 2.

    No wonder doctors are dropping Medicare patients or retiring.

    There’s gonna be a big problem soon Lucy!

  7. RE: Kara

    If you understand the value of predictive modeling and clinical analytics, one of the most progressive and successful vendors for population health stratification with credible ROI analytics for present COSTS and future COSTS based on population data sets, look into the science and software of Elsevier MEDai.

  8. For “Concerned In Texas”. As a HCIT Recruiter, we experience difficulties placing Epic Consultants due to Epic Non-Compete clauses. Specifically (in most cases) an new Certified Epic Consultant cannot leave a hospital system with 90 days (pre or post) of a go-live. There are some loop-holes. Do plenty of research before you chose to leave and remember that jumping ship shortly after receiving certification might not be a breach of contract or non-compete but it still looks bad.

  9. (Corrected) For “Concerned in Texas” As an HCIT Recruiter, we experience difficulties placing Epic Consultants due to Epic Non-Compete clauses. Specifically (in many cases) a newly certified Epic Consultant cannot leave a hospital system within 90 days (pre or post) of a go-live. There are some loop-holes. Do plenty of research before you chose to leave and remember that jumping shipt shortly after receiving certification might not be a breach of contract or non-compete, but it still looks bad.

  10. Concerned in Texas – As part of a simple one-page user agreement that you signed to get log-on access to your employer’s system, it probably said something to the effect of “comply by all obligations and policies” of the hospital. That means that their obligations apply to you. You need to hope that your CIO or CEO who signed the Epic contract negotiated some reasonableness in terms of noncompetes for their employees who had to be trained on Epic.







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