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News 5/7/14

May 6, 2014 News 12 Comments

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Comments from hedge fund manager David Einhorn send shares of athenahealth down nearly 14 percent Tuesday after he tells investment conference attendees that ATHN is one of a few “bubble stocks” trading at high valuations for no good reason. He added that athenahealth really isn’t a cloud vendor deserving of high share price multiples since its main role is as a business process outsourcer of mundane back-office physician practice tasks. He also said that athenahealth’s promotional videos are full of buzz words and that “Epic’s dominance will only grow” as “the undisputed winner from the fragmented IT market.” He predicted the company’s shares will drop 80 percent. Above is the one-year chart of ATHN (blue) vs. the Nasdaq (red), with shares closing Tuesday as Nasdaq’s fifth-largest percentage decliner.

Reader Comments

From Bratman: “Re: Vonlay acquisition by Huron Consulting. The acquisition price was $35 million, all cash, and was a 1.2 times multiplier on revenue. There were several interested acquirers. The price may have ended up lower since Epic forced the Vonlay owners to modify the terms of the Vonlay-Epic agreement to extend the non-compete for former Epic employees from one year to two years. Epic required this change before it would agree to transfer the Vonlay agreement to Huron. The legality of forcing Epic employees into non-compete agreements they never knew about or agreed to is definitely up for debate and the length of the new non-competes likely makes them unenforceable. Epic seems to be using its power to try to minimize employee attrition and limit the supply of certified third-party consultants.” Unverified.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock


QPID Health raises $12.3 million in a Series B funding round and adds a board member from New Leaf Venture Partners.


Radiology outsourcer Alliance HealthCare Services acquires the assets of OnPoint Medical Diagnostics, which offers a cloud-based scanner quality control system used by 81 hospitals, for $1 million in cash and two years’ of royalties.


Huron Consulting Group closes its acquisition of Epic consulting firm Vonlay of Madison, WI.


Pittsburgh-based teledermatology technology vendor Iagnosis raises $2.8 million from angel investors.


Xerox will acquire ISG Holdings, which offers workers’ compensation software systems under the StrataCare and Bunch CareSolutions brands, for $225 million.



Valley General Hospital (WA) chooses Medsphere’s OpenVista EHR for its 68 beds.

Alere Accountable Care Solutions will build a community-wide HIE for Whittier Independent Practice Association (MA).

Emerald Physicians ACO (MA) selects the eClinicalWorks Care Coordination Medical Record.



Oneview Healthcare names Jeff Fallon (Fallon Strategy) as president, North America.

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ESD hires Cinthia Tenorio, LPN (Lake Health System) as CDI practice director and John Ortego (CTG) as Meditech practice director.


Tracy Gregory (Linguamatics) joins SyTrue as chief scientist.


Patrick Clark (Vonage Business Solutions) joins Wellcentive as CFO.


Accenture CEO Jorge Benitez will retire from the company at the end of August.

Announcements and Implementations


MModal announces enhancements to its Fluency Flex mobile dictation application for iOS devices.


In Australia, Sydney Children’s Hospital Network announces plans to use commodity software for its telemedicine program, including Lync videoconferencing and Skype video calling, both from Microsoft.

RadNet goes live on Nuance PowerScribe 360 at the first of its 250 imaging centers and 27 practices.

Advocate Medical Group of Chicago (IL) implements Forward Health Group’s PopulationManager and The Guideline Advantage.


Propeller Health earns FDA approval for the new generation of its inhaler-measuring asthma monitoring system.


St. Joseph’s Hospital Health Center (NY) goes live with Epic.


Zoeticx makes available an API that it says will allow developers access to “any EMR system.”

Government and Politics


Massachusetts announces that it will abandon its $57 million CGI-built health insurance exchange website and hire hCentive, which developed three other state marketplaces, to build a new one. The state also says that just in case that doesn’t work, it will just join the federal exchange in November. Massachusetts isn’t sure if it will need to ask the federal government for more money than the $174 million it already received since it is disputing its CGI contract, but the “dual track” option it chose (the sequel to its disaster movie) will cost another $100 million.


CMS reports that only 50 doctors and four hospitals have successfully attested for Meaningful Use Stage 2 through (or “thru,” as the slide says) May 1. CMS also reports that it has approved 66 of 72 applications for hardship exceptions.


Michelle Consolazio of HHS tweeted this photo of the HIT Policy Committee thanking outgoing member and Epic CEO Judy Faulkner, who has been replaced as its vendor representative after four years by Cerner CEO Neal Patterson.


The talking heads in this hysterically partisan and sensationalist Fox News program seem exceptionally clueless yet smugly superior about nearly everything, but Jesse Watters (I don’t watch TV, so I don’t know who he is) outdoes himself at the 12:40 mark when talking about the VA wait list controversy by declaring, “They’re still using paper records at the VA. They’re not even computerized yet.” That’s embarrassing no matter what your political persuasion, but of course he only plays a journalist on TV and can’t be expected to differentiate between disability claims forms and medical records.

National Coordinator Karen DeSalvo, MD says her husband, also a doctor, uses a “clunky” EHR. A bit of Googling suggests that her husband is (or at least was) an ED doc at Lakeview Regional Medical Center in Covington, LA, so perhaps his clunky EHR could be identified. I assume it’s Meditech since it’s an HCA hospital.

Innovation and Research


MedStar Health (DC) will co-locate some of its employees in the offices of DC-based incubator 1776, connecting the health system with technology startups to arrange pilot projects. MedStar will also provide education for the 20 percent of 1776’s companies that deal with healthcare.


IBM names 25 finalists in its Watson Mobile Developer Challenge. Those that are healthcare-related include GoGoHealth (telemedicine), Ultramatics (personalized health answers), Ringful Health (patient-physician communication), GenieMD (health management), Biovideo (information for expectant mothers), and (medical information).



Community Hospital (IN), which is treating the first US patient to be infected with Middle East Respiratory Syndrome (MERS), used its Versus RTLS system (along with video surveillance recordings) to identify employees that had come in contact with the patient, earning a mention on the local TV news report. Hospital CMIO Alan Kumar, MD says, “We can tell down to the second how long they were in contact with the patient, and how long they were in the room, and provide data to CDC.” According to the state’s health commissioner, “MERS picked the wrong hospital, the wrong state, and the wrong country to try to get a foothold.”


Durham County, NC commissioners vote to give Lincoln Community Health Center $500,000 to install Epic, half the amount it requested. The $2 million implementation would allow the clinic to connect with Duke University Health System’s Epic system. Commissioners suggested hitting up Duke for more than the $1 million it offered toward the cost, with one saying, “In the big scheme of what’s been invested at Duke, between $500 million and $700 million, this additional half a million, I would hope they would be able to absorb that and do what needs to be done.”

Investor Lisa Suennen (“Venture Valkyrie”) writes a blog post about the recent Health Evolution Partners Annual Summit that is brilliant in both insight and wit.

And this group of people, who know everything there is to know about how we got into such a healthcare system mess (because they helped create it) and what has got to be tackled to fix it (even if not how to do that exactly) is dealing with quite a conundrum. They are caught in a vortex where they have to straddle the old world and new world—the land where healthcare decisions are mostly still driven by volume and not quite ready to chuck it all for a world based on “value.” … it is impossible to train the entire hospital to act in two completely different ways based on the patient who shows up. You simply can’t run two different workflows and two different case management programs and two different follow-up programs efficiently. Most of the time the actual caregivers in a hospital—physicians, nurses, etc.—don’t even have a clue in what insurance program or risk-pool the patient is enrolled; certainly no one is yet handing out bar-coded wrist bands that tell the caregiver whether to minimize or maximize services, based on the financial motivation (I hope).


Points from the 2014 HIMSS Regional Extension Center Survey, with 37 of 60+ RECs (which have received $677 million in taxpayer support) responding:

  • Nine out of 10 say their #1 business issue is staying alive, with several respondents saying financial sustainability isn’t possible or isn’t something they’ve planned adequately.
  • One-fourth of the RECS say they won’t be viable by the end of the year, and half of those that say they’ll survive expect state grants to keep them solvent.
  • Three-fourths of them want more ONC grants to keep afloat.
  • One-fourth of the respondents say they will partner with other RECs to ensure their viability.
  • Staffing ranged from two to 80, with an average of 23 FTEs.
  • The #1 services priority is providing information services related to business intelligence and data warehouses, while optimizing EHRs and providing Meaningful Use services came in right behind.


Fitch downgrades the bonds of Centegra Health System (IL), blaming its acquisition of physician practices and its EHR rollout (McKesson Paragon, I believe) for “light operating profitability.”


Blue Cross Blue Shield of North Dakota fires its CEO right after the company reports an $80 million loss largely due to problems in its Noridian Healthcare Solutions subsidiary, which developed Maryland’s failed health insurance exchange website. Paul von Ebers had vowed Thursday to improve the organization’s financial position by reducing administrative overhead, which its board took to heart in unanimously voting Monday to fire him effective immediately.


Guess which vendor is looking for a marketing director? Wrong … it’s HIMSS, trying to find someone to help push its many publications.

@deansittig tweeted out a link to an Epic promo-type video by Lucile Packard Children’s Hospital Stanford (CA) that is well done, but I liked the one above better.  

Some hospitalists at the annual conference of the Society of Hospital Medicine focus on IT issues, urging their peers to “establish ourselves for the informatics role we have taken” by earning informatics subspecialty board certification.

Weird News Andy intones that “exercise can kill you.” In Portland, OR, a naked man doing pushups in the middle of the street at 4 a.m. is run over and killed by a car, with predictable toxicology results pending. WNA can’t keep his hands off his Oregon as he files another story that he calls, “is there a governor in the house?” as ED doc and Oregon Governor John Kitzhaber jumps out of his limo to perform CPR on a collapsed woman (WNA wonders he couldn’t spare some compressions for Cover Oregon.)


The family of a Miami doctor sues the driver of the Lamborghini in which he died when it crashed into a car stopped at a light at over 100 miles per hour two weeks ago. The driver, the founder of a vodka company, was drunk when he and the doctor left the Versace Mansion after discussing investments. The non-practicing doctor had a vodka company, too, going by the nickname Dr. Vodka.

Sponsor Updates

  • Deloitee’s Harry Greenspun, MD is interviewed about mobile health devices on Federal News Radio.
  • Strata Decision Technology, MedAssets, and Prominence Advisors are named to Becker’s “150 Great Places to Work in Healthcare.”
  • Helen Figge with Alere Accountable Care Solutions discusses how to still meet requirements for MU Stage 2.
  • Capsule’s Michelle Grate explores healthcare as a complex adaptive system and explains why it matters.
  • Beacon Partners recommends five steps for developing a CDI program as part of preparation for ICD-10.
  • Voalte releases a white paper offering three key elements to secure physician texting.
  • Advanced Data Systems will integrate Merge Healthcare’s iConnect Network with its MedicsRIS.
  • Truven Health reports that premature or low-birth weight infants funded by Medicaid cost nine times more than uncomplicated newborns.
  • T-System’s Elizabeth Morgenroth offers three reasons to start documenting for ICD-10.
  • Aventura CEO John Gobron discusses awareness computing bringing intelligence to the clinician workflow at the Healthcare IT Institute in Sarasota, FL.
  • Cottage Hospital (NH) reports that it has saved over $100,000 in interface fees since going live on Summit Healthcare’s interface engine.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.


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May 6, 2014 News 12 Comments

Morning Headlines 5/6/14

May 5, 2014 Headlines No Comments

Epic, Cerner are top EHRs for docs meeting meaningful-use requirement

Epic remains the top vendor for Meaningful Use attestations by eligible providers with a complete EHR, while Cerner is the top vendor for EPs attesting with a modular EHR.

Health Information Exchange among U.S. Hospitals Continues to Grow, but Significant Work Remains

ONC says in a recent report that 93 percent of US hospitals now possess a certified EHR. In a separate report, it says that 62 percent of the same hospitals are using HIEs to exchange laboratory results, radiology reports, clinical care summaries, or medication lists with outside providers.

Fitch Rates Centegra Health System & Affiliates, IL Ser 2014A Revs ‘BBB’; Downgrades Rev Bonds

Fitch Ratings has lowered its outlook for Centegra Health System (IL) from stable to negative, and issues a rating of BBB on its revenue bonds. Fitch expected improved performance in 2013, but one-time EHR implementation costs, combined with an increase in practice acquisitions, dampened financial results. Centegra then added $200 million in debt to pay for construction of a 128-bed hospital.

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May 5, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 5/5/14

May 5, 2014 Dr. Jayne 2 Comments


It’s time for another update in my ongoing saga about the physician group that our health system purchased. We’re in the process of preparing them to upgrade to the 2014-certified version of their EHR software. Initially, they balked at any suggestion of retiring their custom content. Our team has been diligently working on them and has convinced them to agree to approximately half of our recommendations.

At this point and given their resistance, I can get on board with half. It’s certainly more than none. Through discussion of their actual needs and observing their workflow, we’ve even identified a handful of customizations that we’re going to advocate that our vendor incorporate into the product out of the box. Ultimately, what allowed us to get the agreement we achieved was the idea they will be piloting the changes for a couple of months after the upgrade and then we’ll revisit them.

We added the pilot approach when we sensed they were stuck in analysis paralysis. The reluctance of the identified physician champions to make decisions was palpable. They feared backlash from their colleagues and claimed to be unable to reach consensus.

I’ve been through this enough times to know what kinds of darts their colleagues might start throwing, so I was happy to offer myself as a virtual human shield. If using the larger health system as the scapegoat for required change is what it takes to move them ahead, so be it.

Now that the decisions are made, it’s time to get their build underway and start preparations for testing and training sessions. I’m grateful the build will be fairly easy. Although large in number, most of the customizations are very easy. If we get in a bind on the timeline, we can always bring in contractors to knock it out quickly. As for the testing requirements, though, I think we’re going to be in for another fight.

Typically we bring in key end users to help us with testing. That way we can ensure that any unusual workflows they’ve come up with get put through their paces using the new software. Over time, we’ve aggregated many of these scenarios for our physicians into test scripts that our analysts can use to replicate their workflows.

The new group is a little bit of a mystery. though. I’m sure there are plenty of aberrant workflows we’ve yet to discover, so having access to their actual staff will be essential.

As we suspected, they didn’t want to let us pull anyone out of the offices or create a situation where overtime might be needed, so we had to get a little creative. I was able to pull together data from our previous go-lives and upgrades and convince them that if they let us leverage the users now, they will need less training right before the upgrade.

It still seems somewhat contrived that we have to produce data to convince them of a proven solution. I just have to keep reminding myself that they’ve come under our umbrella under circumstances that were less than willing.

I know there will be culture shock when they experience our training program as well. We require not only attendance, but participation in our sessions. Users are expected to demonstrate competency before they are signed off.

We use both written and practical evaluations for non-provider users. Providers are expected to demonstrate mastery by replicating 15-20 past patient encounters in the new system. Ideally I’d like to get them to do more, but we’ve found that’s about all we can get them to agree to.

We find that when users have completed a certain number of scenarios, they are able to get back up to speed more quickly in the days following the upgrade. It’s not rocket science – it’s a simple matter of practice.

Nevertheless, we often have physicians who fight us about the need to practice. It’s difficult to help them understand that documenting quickly and accurately in EHR while preserving the integrity of the patient visit is a skill, just like anything else they do. They wouldn’t try a new procedure on a patient without supervised practice.

Some of them try to tell us that they didn’t need any special training to document on paper. Although I’d agree that they didn’t need “special” training, they did need training. As medical students, we wrote hundreds if not thousands of patient notes, notes that were critiqued by our interns, residents, and attendings. Those of us in employed practice models had our notes further critiqued by coding and compliance auditors as well.

We plan to have our first testing and training event in a few weeks. We’re bringing in the non-physician staff first and will do our best to make the sessions not only educational, but fun and interactive. By winning their hearts and minds, it should make for an easier battle when it’s time to address the physicians.

I always like to bring homemade goodies to user events and this won’t be any exception. Right now this quick bread (made with an insane amount of butter, sugar, and sour cream) is a leading contender. Despite the calorie count, I can at least pretend it’s a health food. After all, it’s got bananas — how can it not be?

Email Dr. Jayne.

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May 5, 2014 Dr. Jayne 2 Comments

HIStalk Interviews Keith Neilson, CEO, Craneware

May 5, 2014 Interviews No Comments

Keith Neilson is CEO and co-founder of Craneware of Edinburgh, Scotland.


Tell me about yourself and the company.

I was born in Edinburgh, Scotland and live there to this day. My background was in physics. I was very poor at physics, so I migrated into computers and computer science and around those areas from sales and marketing positions, but also technical and development positions. 

In 1999, along with my co-founder Gordon Craig, we decided to form a software company. We met a healthcare consultant based in New Jersey called Nora McNeil, whose company did charge master management for a large proportion of the New Jersey and New York hospitals. We partnered with her to write some software to produce the first automated charge master solution in the marketplace.


It must have been tough to get those first customers to sign on with a company located outside of the United States. What was your story that led them to have that confidence?

In the early days, we were selling through the consultancy company. It was an extension to the services that the consulting company was providing. 

We started to develop our own direct sales force and direct sales after probably about the first year or so and started to move through from there. In the first year, it was all through Nora McNeil’s consulting company. We were writing software that her consultants were then using out in the field.


How many employees does the company have and how many of those are in the United States?

We’re about 220 in total, of which I think about 130 or 140 are in the US.


What are the key revenue cycle issues that hospitals are struggling with?

We started in charge master. I still believe that’s an untapped asset in many hospitals. The charge master is a valuable control point within their hospital operations.

We’ve widened towards a more transactional basis. We have transactional software that deals with claims generation, claims processing, and denials management. We have some RAC audit software in there as well and third-party payer audit software. At the front end, we’re starting to move more into patient access and into the consumerization of healthcare.

There’s probably three, maybe four areas that hospitals should be looking at. One is around, are they billing correctly and getting everything that they’re entitled to? Because they should be. Future revenues will be based upon their success in doing that currently, and equally we know that revenues are going to get tighter in the future. It’s going to be proportioned in different ways with the Affordable Care Act and different areas from there.

Hospitals should also be considering their cost base and looking at their supply side and their supply chain and whether they’re getting value out of that. 

The data that’s flowing through the revenue cycle, whether they’re capturing that and whether they’re utilizing that to the best value.

Lastly, it’s the consolidation trend. How do you manage? If you’re a consolidator, how do you get value out of the hospitals that you’re buying or the facilities that you’re buying to be able to achieve the economies of scale that people are looking for? Equally on the other side, if you are being acquired, how do you manage to continue to provide quality of care within your community and provide your mission and your needs from there?  

To me, those are the four things that are going to be the biggest challenges going forward.


How do you see the supply chain systems market shaking out given that many hospitals bought ERP systems but don’t seem to be getting the value from them they expected?

I think hospitals are probably getting exactly what they need from some of these systems — or certainly have the ability to get exactly what they need from them — which is very, very good quality stock management systems. In the healthcare environment, though, more uniquely than many other environments, supplies and pharmacy have to be tracked in a different way. Equally, they are billed in a different way because they are typically billed independently — or at least recorded independently — and in high volumes. It’s very different from many other industries. 

If  we take the car manufacturing industry, the car is the sum of many different parts. It is recorded within the ERP system as being the sum of many parts. But they don’t bill that way. They don’t claim that money back. They don’t get reimbursed on the individual parts. They get reimbursed on the car in its entirety.

In healthcare, that’s not the case, and I believe certainly for the foreseeable future that will not be the case. You’ll still need to have detailed out what drugs, what supplies are actually going in, for both a health and safety perspective of knowing where supplies and drugs have been administered, implantable devices, those kind of things. But also just from an accountability perspective, were they actually supplied to the patient? Did the patient actually consume them? Were they medically necessary?

Also record details of them from a perspective of trying to drive future cost savings in healthcare by understanding the use of implantable devices, new med tech as it’s coming through, general supplies, but also both the current wave of pharmaceuticals and the new wave of smarter pharmaceuticals that are coming through as well so that people can learn from that. 

Supply chain is quite a critical area for hospitals. I think the latest statistics I saw from American Hospital Association was that up to about a third of costs come from supplies and pharmaceuticals for hospitals. That drives directly to reimbursement as well because many of these things are on very thin margins and many hospitals are running very thin margins. That’s a significant amount of spend that I don’t think gets enough attention both from a financial and from a data perspective at this stage.


You mentioned getting paid for the components of a car rather than the whole car, but new payment models push more toward getting paid for the car. How do you think that will change your business?

On the surface, we’ll look at individual payments there. I would be very surprised if people don’t still want the detail and the data underneath.

If we are moving to electronic health records with a purpose of better understanding the patient interaction so that we can better anticipate cost and the need for investment in healthcare going forward, why would we go to the stage where we would then take that data and destroy that data? We’ll still need that data at a later stage.

I also think that there’s a potential that bundling ACO models were not necessarily indicating that need for data will be relatively short-lived. We already have a case just now where if we think about it, we have our DRGs, and within the DRGs, we have ambulatory payment classifications, which take over a higher level than the individual procedural codes below that. But although the individual procedural codes are not necessarily billed individually. You still have to record that you’ve carried out those individual procedures and you’ve proved the individual pharmaceuticals supplied down to the patient so that people know that they’re getting value and they’re getting the full treatment.

I think we’ll have a similar thing with bundled payments and in the ACO model. I don’t think that level of detail will disappear from underneath. It actually will become more critical as we go forward. The genie’s out of the bottle.

If we go to Volkswagen, although they sell one car, they don’t record all the data and all the component parts of that car and just say, well, that’s a Volkswagen Beetle. They look at all the individual components and have them all listed and have a full understanding of what the cost implication of supplying part A or supplying part B is to make up a brake caliper. 

From there, I think that level of detail is only going to increase underneath. And of course, with ICD-10, potentially ICD-11 — whenever that rolls out to bring coding in line with the rest of the world — you’re increasing that level of detail again.


The company has talked about acquisitions for some time. You’re publicly traded. You have a big footprint, with a fourth of US hospitals as customers. What are you looking for in terms of potential acquisitions, especially with regard to analytics?

Certainly from a data perspective, we believe that we should be continuing to invest in our internal data platforms to be able to take the information that we gather and build that into better products. That’s been a longstanding commitment from us to do that. In fact, we’ve had tools in that marketplace since I want to say 2005, but what we’ve tended to do is roll them into our other products rather than have them as standalone.

Part of the reason for that is that analytics themselves, I believe, are becoming more and more of a commoditized marketplace. You can buy off the shelf a whole series of Microsoft tools that even four years ago, we couldn’t have dreamt we would have had that kind of analysis ability at our fingertips. I think the actual analysis itself will become more and more commoditized.

Where I think we need to focus more of our efforts as an organization – and where I believe our customers are focusing and starting to look — is more of the content that goes alongside that to make those analytics intelligent. A combination of both predictive analytics, truly looking at how we can model the future to try and get an understanding of today and current short-term performance as well as long-term performance. How do we do that with predictive analytics?

But also looking at content and value add of, what do those analytics actually tell you? If you’ve got this traffic light, what does it really mean? How do you improve the performance of your operations with the ultimate aim of then improving patient care? What’s the thing or the 10 things that make the difference to improve that patient care and do that in an environment where you can afford to be able to do that?

That’s the bit that we’re trying to concentrate on more of. That’s what you see as quite a common theme throughout our products. It’s about applying that intelligence and doing more than just providing the tools, but providing some of the structure and some of the workflow in that as well. If you do highlight a problem, how you can correct that and manage it through?


How do you see the future playing out in terms of acquisitions?

We’ve made it quite clear and been quite public that we continue to look for acquisition opportunities that extend the range of our product set or augment the range of our product set. Particularly in our supply chain side of things, particularly in patient access. We’ve got some very good products in there, but we don’t have what we would call a gateway product in there, a product that’s strong enough as a standalone elite product that we can take in to a brand new customer.

From there, find revenue from that, then generate more sales and provide benefit to the customer as well and incremental extra benefit to the customer. We’re looking to add into patient access, and equally, we’re looking in around revenue cycle and revenue integrity with a slant towards supplies and pharmacy. That’s where we’re looking.

We are a publicly traded company, as you said, on the London Stock Exchange. We have been successful, but we believe we can be far more successful. We believe we can do far more to help our customers and provide value to them, and therefore through that, grow our business. We’ve only just scratched the surface of that.

In the future, I certainly would see us getting that scale and building that scale through a combination of both organic growth and through acquisition. Then to be able to look at potentially becoming a public company in the US as well.


I wouldn’t say you fell by accident into becoming an entrepreneur, but it sounds like it took some turns that wouldn’t have been expected. What are the most surprising things that you’ve learned in becoming an entrepreneur and now running a publically traded company?

I think it’s fair to say I fell by accident into healthcare, definitely. [laughs] That’s something that I’ve really enjoyed and certainly haven’t regretted at all. I  feel that we’re making a difference there.

From the entrepreneurial side of things, from a very early age, I’ve been writing software and selling software and doing things from there. I think what that can bring to healthcare is a very fresh approach. I think that both the combination of what we did both in 1999 and hopefully we have consistently done through today is try to tip some of those sacred cows over. Trying to look at healthcare as an organization and trying to understand where the differences are between healthcare and other industries and how we can bridge those gaps, predominantly how we can bridge those gaps with technology. 

We’ve been very much about trying to produce solutions which are easy to implement and easy to roll out for our clients and give them maximum benefit as quickly as possible.

I’m not sure if I answered your question. The lessons are being able to be dynamic in terms of your approach, being able to be flexible to the circumstances and the changing legislative landscape. But also being able to put those changes into context and look at them over the long term rather than just over short term. By short term, even cycles of two or three years, and trying to look at cycles of five and 10 years and see how we can have long-term sustainability.

Those are some of the things learned through the course of this journey and my previous work, but particularly are relative for healthcare just now.


Do you have any final thoughts?

I know that many of your readers will be potentially very frustrated with some of the changes that are coming through with the Affordable Care Act and some of the uncertainties that come with whether ICD-10 is coming in this year or next year and all the various different vagaries of that.

But underlying, healthcare in the US has the potential to be absolutely phenomenal. There is wastage there. There are areas that can be improved. But there are areas that can be measurably improved within the resource bands that are there just now. That sometimes gets lost in the noise. 

We talk about ACOs and we think, OK, everyone’s going to be an ACO. Actually, that’s probably not going to be the case. We talk about, everyone’s going to be driven by these quality measures and it’s going to be quality or everyone’s going to be affected by just having bundled payments. Actually, that’s probably not going to be the case.

What’s most likely going to happen is most facilities are going to claim and be reimbursed through a variety of different models. What they need to do is very calmly and rationally think through what the data implications of that are going to be. What data can they influence? What data do they need? What tools to be able to help understand and analyze and correct? 

There are tools being generated just now. We’ve seen a huge change in even just the last two or three years with the software that’s available and the adoption of software within facilities. I think the next two or three years and beyond that will have equally aggressive change coming forward. A lot of that will be for the better. 

There tends to be a big despondency and malaise out there, but actually things are turning out not quite as bad as people were expecting. I think a little bit of optimism should be there.

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May 5, 2014 Interviews No Comments

Morning Headlines 5/5/14

May 4, 2014 Headlines No Comments

Blue Cross Blue Shield of ND reports $72.9 million loss

Blue Cross Blue Shield of North Dakota releases its 2013 year-end report. Within the report, BCBS-ND discloses that its bottom line dropped $72 million, compared to 2012. Its subsidiary Noridian Healthcare Solutions took a $51 million loss after being fired as the lead contractor on Maryland’s health insurance exchange. BCBS-ND took an additional $25 million loss when the newly implemented EHRs being rolled out by local providers caused billing delays and a claims backlog that BCBS significantly underestimated the value of, and did not budget for.

CPSI Announces First Quarter 2014 Results

CPSI announces Q1 results: revenue up five percent to $52.1 million, driving net income up 11 percent to $7.7 million. EPS $0.69 vs $0.63 last year, missing analysts forecasts by a wide margin. Stock prices ended down 4.6 percent at the end of the trading day Friday.

How scribes made Allina an extra $205,000

After Cardiologists with Allina Health started using scribes to handle EHR related data entry, the health system noticed a significant jump in patient volumes. Cardiologists using scribes were generating $205,740 in additional revenue per 65 clinic hours. Scribes also helped reduce doctor burnout.

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May 4, 2014 Headlines No Comments

Monday Morning Update 5/5/14

May 4, 2014 News No Comments

Top News


Blue Cross Blue Shield of North Dakota partially blames its poor 2013 performance on newly implemented EHRs of providers that delayed their insurance claims submissions, which it says caused it to underestimate the value of those claims. I didn’t realize until reading the CEO’s discussion that Noridian Healthcare Solutions is a subsidiary of BCBS of North Dakota. Noridian built the failed Maryland health insurance exchange and was fired from its $193 million contract in February. Maryland has hinted that it may sue Noridian in hopes of getting back some of the $55 million it has already paid toward Noridian’s five-year contract. North Dakota’s insurance commissioner says the agency is watching BCBSND to make sure it doesn’t try to increase insurance premiums in the state to cover Noridian’s projected $17.8 million loss. Every time I hear that name I think of Veridan Dynamics from “Better Off Ted.”

Reader Comments


From Guillermo del Grande: “Re: CIOs. Here’s a list of “A Few Things CIOs Should Know (Or Think About).”

  • If you want the FDA to regulate EMRs but have a service level agreement of two days for major fixes, you may want to learn about software development models. If you have to ask what a software development model is, how did you get to be a CIO?
  • FDA requires waterfall development. This is not Niagara Falls.
  • How many of the good EMRs use waterfall any more? Here’s a hint: not many. Most are agile. EMRs are more complicated than a medical device. How many different medical devices connect to your EMR? Do you even know? Do you feel like testing every scenario per medical device that connects to your EMR? Do you think your vendor does that?
  • Are you afraid to let developers and your IT people watch healthcare and the software in action? You’re not agile. You’re going over the waterfall in a barrel.
  • If your SLA is two days, but you require a change control meeting that only happens every two days, and then a software testing process that takes two days, and then another change control meeting, and then only migrate changes once a week, you may have a problem.
  • How long does it take your vendor to fix a minor issue? You should be asking this question before you buy.
  • What makes you think your IT staff can fix a problem in a SLA period when you don’t know if it’s something your IT folks can do or it’s something the vendor has to do?
  • Do not try to manipulate an IT staff or a vendor into repairing your highest priority by only reporting that item. IT staff have lots of end users. Vendors have lots of customers and sometimes will fix issues only if lots of different customers are seeing them.
  • If you think a problem made it to the field because the software testers at the vendor didn’t find the issue, you don’t know much about how software companies. Remember that story about the guy who had his heart burned out of his chest a few years ago because of a bug? If not, look it up on HIStalk — it was a known issue for 10 years. Ask your vendor how many known issues they have in their tracking system. Hint: they’re not all reportables.
  • The Supreme Court is reluctant to take new cases and software developers are reluctant to fix bugs for many of the same reasons and use some of the same processes.
  • “Not a customer workflow” is heard at many a vendor to defend not fixing a bug, often before there are any customers.

Thoughts on FSMB’s “Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine”


The Federation of State Medical Boards is a Euless, TX-based non-profit trade association that represents all US medical boards that license physicians. It does not make regulations directly, but state boards usually adopt its recommendations.

Key points from its report include:

  • Telemedicine is defined as requiring videoconferencing. Encounters conducted via telephone or email are not telemedicine.
  • Physicians must be licensed in the state “where the patient is located” because physicians are licensed by individual states.
  • A physician-patient relationship must exist, but it can be established using telemedicine technologies.
  • The physician must document the patient’s history. Having the patient complete an online questionnaire doesn’t count.
  • The physician should obtain the patient’s informed consent, including a description of the security features of the telemedicine technologies being used.
  • The physician must make themselves available following the encounter.
  • The physician may not promote services for which they are receiving payment or benefits.

The intention of the group is clear. It wanted to prevent providers from selling prescriptions online. Nearly all of the wording restates requirements that are already in effect for traditional physician-patient encounters, clarifying that those requirements hold true for telemedicine-based encounters. The policy attempts to prevent online-only practices by prohibiting misleading websites, undisclosed financial relationships, and running an online consultation service simply to sell drugs online.

The only significant (but unsurprising) recommendation is that physicians must hold a license in the state where the patient is physically located during the encounter. That also is no different for traditional medical practice – an ED doctor in Florida can see vacationing patients from anywhere in the world from a Florida-based hospital, but he or she can’t travel to those other states to treat the same patients at their homes unless licensed there.

The most positive development for telemedicine supporters is that the model policy allows patients to be managed entirely by telemedicine without an in-person component.

The negative aspects of the model policy are:

  • FSMB isn’t a particularly transparent organization and didn’t disclose the members of the work group or who it consulted to develop its proposed policies. It also did not provide a way to incorporate industry or patient feedback.
  • Doctors already diagnose and treat patients by telephone and email, but those options are not considered telemedicine in the model policy, although it doesn’t limit or prohibit them. That would suggest that nothing changes for those visits, although future questions may come up involving payment for services.
  • Doctors must be licensed in the state where their patients are located, which isn’t even accurate in some cases (military physicians.)
  • It doesn’t address the desirability (nor should it have, most likely) of national rather than state-by-state licensure of physicians or an expanded reciprocity program that would make it easier to practice across state lines. That’s the biggest clash between telemedicine proponents and state regulatory boards, whose revenue and power come from overseeing in-state professionals and (arguably) protecting them from competition.
  • It calls for requirements that exceed those of non-telemedicine encounters, such as prohibiting randomly assigning patients to physicians (which EDs, walk-in clinics, and other services do routinely) and requiring that the medical records of patients be reviewed before treating them (which urgent care providers can’t do by definition.)

The conclusion is that telemedicine proponents wanted a policy that opened up state borders and encouraged innovative care, while FSMB’s goal was to prevent unethical doctors from running pill mills and online medical scams.

HIStalk Announcements and Requests


A commendable 37 percent of poll respondents use an activity tracker at least five days per week. New poll to your right: should doctors be licensed nationally instead of state by state? It’s an important question if you think telemedicine can improve the efficiency and geographic reach of physicians.

Thanks to the following sponsors, new and renewing, that recently supported HIStalk, HIStalk Practice, and HIStalk Connect. Click a logo for more information.


Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock


Vocera announces Q1 results: revenue up 10 percent, adjusted EPS –$0.14 vs. –$0.07, beating expectations for both. VCRA shares were the second-largest NYSE percentage losers on the news, shedding 14.7 percent. From the conference call:

  • The company released the Vocera Collaboration Suite and an expanded Vocera Care Experience in the quarter.
  • It opened a development shop in India.
  • President and CEO Brent Lang called hospital spending “challenging” as hospitals wait to see where changes in patient population and healthcare reform go.
  • He quoted a report that says 97 percent of hospitals don’t believe their nurses have the right tools to determine the availability of caregivers and that consumer-grade smartphones aren’t working well for hospitals.
  • Lang mentioned a tentative US Army study in which use of Vocera’s system provided a 12-month payback.
  • The alarm management system it gained with its mVisum acquisition in January 2014 will be launched this summer.
  • Lang said the company will pursue more acquisitions.


Evariant, which offers a patient marketing platform, raises $18.3 million in a Series B funding round.

image says it will create 175 jobs in central Indiana over the next five years, having just received $3 million in state tax credits. I can’t really tell what the company is selling since the site is a mess of buzzwords and vaguely feel-good statements behind one of the worst company names I can imagine (shades of 1999), but it seems to be a customer relationship management system for outreach labs and radiology practices.

General Dynamics will lay off at least 645 Utah-based call center employees it had hired under a CMS contract to take related inquiries about insurance.


CPSI announces Q1 results: revenue up 5 percent, EPS $0.69 vs. $0.63. From the conference call:

  • The company installed financial systems in nine hospitals and clinical systems in 12.
  • Add-on sales made up 26 percent of total revenue
  • The company expects to gain ground with MU Stage 2 as “a number of our competitors continue to struggle with obtaining certification for their software, as well as struggling with the installation and usability of their software in the small hospital market.”
  • Its new ED module will GA in Q3.
  • CEO Boyd Douglas says that while Epic and Cerner talk about moving into smaller hospitals, CPSI isn’t seeing much of that, mostly just their usual small-hospital system competitors (Meditech, McKesson Paragon, and Medhost, I assume.)
  • The Leerink Swann analyst managed to say “sort of” four times in one question, also using that annoying verbal crutch twice in a follow-up question.



The Defense Health Agency awards Leidos a $70.7 million, sole-source contract to support its EHR systems for the next 11 months.

Nashville-based MindCare Solutions signs the first customer for its tele-behavioral platform and provider network, Genesis HealthCare, which will offer remote psychiatric services to its 400 skilled nursing facilities.

Announcements and Implementations

New York State Immunization Information System will use Blue Button to make records available to the parents of patients.

AMIA calls for nominations for its 2014 awards for informatics leadership, nursing informatics, informatics health policy contributions, and informatics innovation. Winners won’t necessarily be the best, just the best who pay AMIA dues: a key selection attribute is “demonstrated commitment to AMIA through membership.”

The Boston Business Journal profiles Alere Accountable Care Solutions, mentioning that it will offer its care management, connectivity, and analytics systems in Europe. I interviewed CEO Sumit Nagpal in October 2013.

Government and Politics


President Obama makes fun of at the White House Correspondents Dinner on Saturday, saying that he has replaced his campaign slogan “Yes We Can” with “Control-Alt-Delete.” Near the end of his presentation, he pretended to have problems with a video and former HHS Secretary Kathleen Sebelius got a cameo as she rushed to the podium to fix it. The President’s last words of the evening, after thanking the press and uttering the obligatory “God Bless America,” were “Thank you, Kathleen Sebelius.” Other than following the party line, I question whether the fired Sebelius did anything worthy of that level of adulation.



A Minneapolis cardiologist, intrigued by the use of scribes in the ED, tries them in his cardiology clinic. The four doctors he studied were spending all but two minutes of their average 13-minute patient visit working on the computer. Turning that work over to scribes shortened the visits to nine minutes, but beyond that efficiency gain, patients got seven minutes of that as face-to-face time, nearly four times as much compared to non-scribe visits. The doctors saw 60 percent more patients using scribes, boosting revenue by $206,000 in 65 clinic hours. Patient satisfaction was unchanged, which is nice for making a case for scribes but not so nice for the doctors — all that extra face time apparently didn’t impress patients.


Dr. Andy’s HIStalk Practice rant on the problem list is drawing interesting comments from his physician peers. Example: why can’t the problem list attribute cause and effect, or allow attaching meds to specific problems (or more than one problem?)


The dean of the new Dell Medical School at the University of Texas (I wonder who paid for that?) says that while Austin is behind in a competitive biotech industry market, “Areas like digital health and informatics, no one owns that right now. That is an area that’s rapidly growing and ultimately it will win and be a huge area … Companies who handle personal data see that health is a huge frontier and represents a huge economic engine, but no one has been able to innovate the platform that scales to a huge field … There are companies waiting to do that, but no one is inviting them in. We can do that.”


Mineral Community Hospital (MT) reports to its board that its NextGen implementation resulted in unplanned upgrade-related downtime and a 45-day delay in sending bills out for the 25-bed hospital.

A man Googling for CPAP machines for his sleep apnea notices that unrelated Google searches start displaying ads for those devices, leading him to complain to the Office of the Privacy Commission of Canada that targeting ads based on a health-related search constitutes a privacy violation. The office agrees after an investigation, determining that the practice not only violated its advertising guidelines, it also violated Google’s own policies that state the company won’t use health-related browser cookies to target ads. Google blames some of its advertisers and says it will improve its training and monitoring programs.

New York State Insurance Fund blames a software upgrade after the medical records of 20 worker’s compensation patients are to the wrong attorneys.


Bizarre: a mother is awakened by the sound of a man’s voice in her sleeping 10-month-old daughter’s room screaming, “Wake up, baby.” She runs into the room and sees the camera of the video baby monitor turn toward her as the hacker who is controlling the camera starts screaming obscenities at her. The woman’s Foscam IP camera had been updated to fix a security flaw, but she didn’t know about it. The conclusion is that the Internet of Things will give hackers a lot of household (and hopefully not hospital) gadgets to play around with.

Sponsor Updates

  • The Health IT Quality Solutions Program of Quest Diagnostics certifies iPatientCare’s EHR as a Silver Quality Solution.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.


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May 4, 2014 News No Comments

Morning Headlines 5/2/14

May 1, 2014 Headlines No Comments

ManTech Announces Acquisition of 7Delta, Inc.

ManTech International Corporation acquires 7Delta after the Maryland-based IT services firm won a 5-year contract with the VA through its Transformation Twenty-One Total Technology procurement program. Through the acquisition, ManTech will be in position to support the VA’s transition to newer IT systems.

Medicare Program: Hospital Prospective Payment Systems

CMS confirms, buried within a 1700-page document, that the new ICD-10 transition date will be October 1, 2015.

Sovereign Wealth Fund KIA Invests $100 Million in NantHealth, a NantWorks Company

The Kuwait Investment Authority invests $100 million in  healthcare billionaire Patrick Soon-Shiong’s newest venture NantHealth.

athenahealth Names Karl Stubelis Acting Chief Financial Officer

athenaHealth announces that CFO Tim Adams has stepped down to pursue other opportunities, and that current vice president and corporate controller Karl Stubelis will take his place.

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May 1, 2014 Headlines No Comments

News 5/2/14

May 1, 2014 News 4 Comments

Top News


Defense contractor ManTech International will acquire 7Delta, which provides healthcare IT contracting to the VA, DoD, and HHS. ManTech wants a piece of the VA’s Transformation Twenty-One Total Technology program, for which 7Delta has won more task orders than any other vendor.

Reader Comments


From Matthew Holt: “Re: HIMSS Analytics interview. Can the HIMSS PR people just stop with the BS? How many times do they have to say that they are a ‘cause-based, mission-based organization?’ This guy is selling market research to IT vendors and HIMSS non-vendor ‘members’ are all providers feeding at the federal teat. None of them are helping the starving in Africa. HIMSS has been on an acquisition tear in the conference and media business, including doing some extremely uncharitable activities towards its competitors there (not to mention the way they treat their vendor clients.) And Steve Lieber got paid $900K in 2011 and presumably over $1m by now. I’m a capitalist, I have no problem with anyone making money in healthcare while trying to change the world for the better, and I support the idea of more IT being a good thing. But seriously, who are they trying to fool with this rhetoric?” I seem to remember that HIMSS Analytics was originally set up as a for-profit subsidiary of HIMSS when it was first acquired many years, but something (presumably the IRS) forced a change. HIMSS is like hospitals: somehow it keeps minting more and more money and using it to buy for-profit companies (conference organizers and publishers, mostly) and then suddenly declaring them to be non-profit. The annual conference generates a ton of cash that can only go so many places: big salaries (check) and acquisitions (check). Or the less-obvious choice: HIMSS could scale its income to its expenses rather than vice-versa.


From Boy Wonder: “Re: Allscripts. The company sent an email to its portal users saying Medfusion caught the the company off guard with its announcement.” Medfusion announced this week that an unspecified payment dispute will force it to shut down access to its portal by Allscripts customers as of May 31, 2014 unless they sign a new contract directly with Medfusion. The Allscripts email reassures those users that they can be live on the Allscripts FollowMyHealth portal (the former Jardogs product it acquired in March 2013) by October 1 if they commit by May 31. The bottom line is that those 30,000 users have to make a commitment to one of the companies within four weeks, and if they choose Allscripts, they’ll have to try to strike their own deal with Medfusion to keep their portal running until they can make the switch. The Tullman-era Allscripts made a colossally bad decision to redistribute Medfusion’s portal instead of developing or acquiring its own, making both the company and its customers vulnerable to the actions of an external vendor. Allscripts predecessor Misys made a similarly bad decision in licensing a customer version of iMedica (now Aprima) that Allscripts resold as MyWay before retiring it and leaving those users in an equally unpalatable position through no fault of their own. In both cases, Allscripts gets a black eye for putting its customers in a jam and then trying to migrate them to another Allscripts product to fix it.

Dim-Sum provides the usual cryptic and amusing update of the Department of Defense’s commercial EHR system selection process, or as he or she describes, “Status and latest rumors in the halls of bedlam, located right K Street.” This is a huge many-billion dollar deal and the only insider reports I’ve seen are coming right here from Dim-Sum, so thanks for the update.

May 2014

  1. DHMSM competitive teams are almost in place.
  2. Themes are being discussed, ideas are being circulated and people are starting to wonder, “Why did I pick this team?”
  3. CACI, where are you, and has anyone seen where Harris, SRA, and yes even CGI went?
  4. HP is getting press and nobody knows why. I bet you wish you thought of the Newseum “experience” (outstanding job by IBM/Epic, or should it be Epic/IBM?)
  5. Whatever you do, IBM, do not mix Epi-BM for your team moniker. That is a bad connotation in healthcare.
  6. GDIT is sitting on the sideline with Northrop Grumman watching in awe as their fellow poobah Lockheed has found functional and willing partners in Siemens and Athena. Good luck, best of breeders! Lockheed please note: Boston is an academic mecca, you will be comfortable there. Now the firm in the Philly suburb, whatever you do, do not wear a Redskins tee shirt — Eagles fans will hurt you.
  7. CSC is trying to figure out how they can make a cloud in the shape of an EHR – fun!
  8. Accenture is still confident, proof positive that their strategy was focused on any large EHR vendor in the Central time zone. Personally, I like the combination – well done, Jim and Ken – airline tickets are cheaper to Kansas City anyway. Kansas City, sadly, is located 70 miles south of the airport.
  9. Teams are congealing. However, smalls are scrambling and the ones invited to the table are excited. They tend to pontificate upon their vast knowledge of the current environment and then wonder if that is something to brag about.
  10. IBM, can you please bring back the Blue Man Group for an epic focused percussion’ fest? That would be very cool, and yes, the pun was intentional.
  11. There will be an online course for all participating COTS vendors explaining  cutting edge Kyrgyzstan interoperability standards like FTP, as well as expressing how each and every hospital across the Military Health System has one single positive attribute — they serve heroes. Outside of that, the technology is fair to awful.
  12. Had some initial thoughts about themes for each team:

    IBM / EPIC: “Judy and Watson, sitting in a tree, K-I-S-S-I-N-G!”
    Lockheed / Athena, Siemens: “We build planes, ships, and missiles. How tough a nut can healthcare be?”
    Accenture / Cerner: “DHMSM is like an onion — lots of layers and lots of tears.” Sorry, Accenture, my kids are watching Shrek.

More in June…

HIStalk Announcements and Requests

I hear through murky sources that a huge acquisition will be announced Friday morning (by “huge” I mean “you won’t believe it.”) I’m skeptical, but also receptive to being tipped off early if you are knowledgeable of the supposed deal. The fact that I’ve heard it only once suggests that my caution is well placed.


The latest “CMIO Rant” from Andy Spooner, MD is on HIStalk Practice where he addresses “The Problem List: Foe or Enemy?” complete with screen mockups. His first rant was “The Great Prescription Pad Race.”

Highlights from HIStalk Practice this week include: Medfusion parts ways with Allscripts over payment disputes. The EHRA opposes ONC’s proposed 2015 voluntary EHR certification criteria. A National Quality Forum panel finds pay-for-performance programs unintentionally worsen disparities between rich and poor. Forty percent of physician practices are looking to replace their EHRs, while those struggling to improve collections are taking on more aggressive billing strategies. Researchers find that almost one-third of patients fail to fill first-time prescriptions. 2014 MU incentive payments indicate a potential slow-down in EP participation. Thanks for reading. This week on HIStalk Connect: NIH announces a series of grants aimed at spurring mHealth research focused on chronic disease management, remote patient monitoring, and telemedicine. Doximity, often described as LinkedIn for doctors, announces a $54 million Series C round. Israeli startup Consumer Physics launches a Kickstarter campaign to fund a handheld digital spectrometer that it claims can scan food and calculate calorie and nutritional content. Dr. Travis discusses the 10-year horizon of connected health devices and the implications that they could one day have on healthcare overall.

Upcoming Webinars

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock


The Kuwait Investment Authority takes a $100 million position in Patrick Soon-Shiong’s NantHealth. I wasn’t paying attention to the company’s logo placement on the page above and thought that the female on the left was sporting a Hiawatha-like Native American headdress.


Merge Healthcare reports Q1 results: revenue down 20 percent, adjusted EPS $0.04 vs. –$0.01. From the earnings call:

  • The ICD-10 delay moves up window during which hospitals may consider upgrading their imaging systems.
  • The company’s MU2 certifications give it opportunities with ambulatory radiology and orthopedic customers.
  • Merge improved its Epic integration and avoided an issue involving provisional patents.
  • Merge’s eClinical OS clinical trials system has 18,000 users.
  • The company will introduce a retinal screening product for diabetes and glaucoma patients, with the target customer being hospitals that are bearing risk.


Streamline Health announces that its Q4 and FY2013 results will be delayed until the end of May as the company’s new auditors review its internal controls. The company says three unnamed go-lives will contribute recurring revenue beginning in Q2 and it booked a new sale for one of the products it obtained in its $6.5 million acquisition of Unibased Systems Architecture in February 2014.


Etransmedia Technology acquires Medical Billing Solutions, expanding its geographic presence placing it in the top 10 large scale RCM services business.


Athenahealth announces that CFO Tim Adams will leave the company to take the same role with electronic commerce vendor Demandware, naming VP/Controller Karl Stubelis as acting CFO.


New York City Health & Hospitals chooses UpToDate from Wolters Kluwer Health for mobile clinical decision support.


Citizens Medical Center (TX) chooses electronics forms management from Access.



IBM names Keith Salzman, MD (CACI International) as CMIO for IBM Federal, which hopes to sell Watson and other technologies to the federal government for healthcare use.


Health Data Specialists promotes Bill Chandler to national accounts manager.


TriZetto announces John McAuley (PatientPoint) as president of its provider solutions business.


John Thornbury, a highly awarded hospital IT leader in England, died on April 28.

Announcements and Implementations

St. Vincent’s Medical Center (CT) goes live with Cerner, according to a tweet from the hospital’s CEO.

Government and Politics


CMS proposes increasing Medicare payments by 1.3 percent overall for FY2015 for the 3,400 acute care hospitals that participate in the Hospital Inpatient Quality Reporting Program and that have met Meaningful Use EHR requirements. Hospitals that haven’t met Meaningful Use would lose 0.675 percent of the proposed increase.  

ONC releases a 30-second promotional video about Blue Button.


The VA says it will develop the next generation of its VistA EHR with the help of contests and challenges. Former VA guru Tom Munnecke is unimpressed: “It is not clear how the government owning all submissions in a contest will attract the best in the field. It is unlikely that many people would be interested in spending time and money to enter a contest where they give away their intellectual property.”

The Health IT Policy Committee will hold a May 7 public hearing in Washington, DC to review ONC’s certification process. It seeks input on allowing anyone to submit test cases so that certification measures real-world scenarios.


HHS didn’t want the Congress-mandated ICD-10 delay in the first place so it’s hardly shocking, but a proposed 1,700-page rule changing Medicare payments seems to confirm that ICD-10 will be implemented at the earliest date allowed by law – October 1, 2015. It could be that someone just updated the pre-delay document and forgot that Congress mandated only the earliest date, not the actual date – it’s only a proposed rule. The same document also spells “HIPAA” as “HIPPA,” so even the federal government gets confused.


Most physicians order unnecessary tests and procedures if their patients insist, but they also agree that ordering such tests and procedures is a big problem. They think doctors are better equipped to solve the problem (58 percent) than the government (15 percent), according to the telephone survey funded by the Robert Wood Johnson Foundation.


Athenahealth VP Kyle Armbrester explains the company’s More Disruption Please program:

Our unique spin is that, because we take a percentage of net collection, we don’t actually partner with technology companies. We partner with outcomes companies like ourselves. So to be a part of the More Disruption Please program, we give our partner the scorecard, and that scorecard shows how they’re either driving more revenue to the doctors for doing the right things, or decreasing operational inefficiencies inside the providers’ workflow, or helping to improve patient and provider outcomes.

I’m always fascinated when family members riot and destroy hospital infrastructure after an unfortunate patient outcome (which doesn’t usually happen in the US, thankfully.) In Pakistan, a mob riots at a hospital, trashes the place, vandalizes cars in the parking lot, and beats up doctors and other employees after an appendectomy goes wrong and the patient ends up on a ventilator. Five days later, doctors haven’t declared the patient dead, and I wouldn’t either given the situation.


Microsoft gives in on its “no more updates for Windows XP” policy after the Department Homeland Security warns people to stop using Internet Explorer until the company fixes a security hole present in versions 6 through 11 that “could lead to complete compromise of the affected system.” The company says it will issue a one-time-only Windows XP auto-update to fix the vulnerability.


CHIME tweet out this photo of its 1994 Board of Trustees. Who can name them all?

Weird News Andy calls this story “Well Shut My Mouth.” Pediatrics nurses in a Saudi Arabian hospital are caught taping the mouths of babies shut to stop them from crying.

Sponsor Updates

  • First Databank will present new safety guidelines for pediatric dosing at the 2014 Pediatric Pharmacy Conference April 30-May 4 in Nashville, TN.
  • NC HIE upgrades its Orion Health Direct Secure Messaging.
  • Ingenious Med will integrate Entrada’s dictation and content fulfillment technology into its charge capture platform.
  • A report names Allscripts, Health Catalyst, McKesson and Verisk as key players in the population health management market.
  • HCS will lead a discussion on LTCH CARE data set changes at the NALTH meeting in Washington, DC this week.
  • Gartner names Validic in its 2014 Cool Vendors for Healthcare Payers report.
  • Health Catalyst announces speakers and topics for the Healthcare Analytics Summit 2014, to be held September 24-25 in Salt Lake City, UT.
  • DrFirst expands its Rcopia e-prescribing with electronic prior authorization functionality from CoverMyMeds.

EPtalk by Dr. Jayne


Mr. H already scooped me on this one, but the Federation of State Medical Boards (FSMB) recently adopted “Policy Guidelines for Safe Practice of Telemedicine.” My gut reaction is that this is just another way for licensing boards to extract more money from physicians by requiring additional licensure. My second response in actually reading the document (numbered line by line such that it reminded me of a deposition) is that there seems to be a whole lot of self-importance going on here. The seven-and-a-half page document has a Preamble, for goodness sake.

Physicians have been practicing by telephone and using secure messages for years, but apparently now we need to codify new standards just because there is technology involved. News flash: all the old standards (HIPAA, standard of care, ethics, etc.) already apply.

Some of the policy’s contents are very much common sense:

  • The need for a “credible physician-patient relationship.” I suppose they’re trying to prevent physicians from turning into so-called pill mills, but then again they haven’t done a great job of preventing those in traditional face-to-face medicine. A quick look at the number of dishonest physicians selling work excuses and gratuitous prescriptions for controlled substances proves that.
  • Adherence to privacy, security, consent, and safety principles. Again, already in force simply because we’re physicians.
  • Proper supervision of non-physician clinicians.

On a subsequent read, however, several other provisions caught my eye.

  • “Where appropriate, a patient must be able to select an identified physician for telemedicine services and not be assigned to a physician at random.” Isn’t this exactly what happens when a patient presents to the emergency department, an urgent care, or many public health clinics? They are seen by the next available physician. They don’t get to pick and choose. Same thing with the assignment of patients to managed Medicaid panels, at least in my state. Again, not a lot of choice there and often a random assignment. Why should telemedicine be treated any differently?
  • “A physician must be licensed by, or under the jurisdiction of, the medical board of the state where the patient is located.” Again, this feels like a money-grab. I practice in a border town. The idea that I should have to get a different state license to practice telemedicine on a patient when I can see them in person with the license I already have if they’re willing to hop in the car, bus, or train is preposterous. What is magical about telemedicine that I should have to prove my competence to another state board?
  • “The practice of medicine occurs where the patient is located.” I tend to think the practice of medicine occurs where my brain and ears are located – where I can hear, understand, and process the patient’s story. In medical school, we learned that 80 percent of the diagnosis comes from the history. The exam just confirms it and provides additional information when it is unclear. I guess the FSMB is now going to turn that old adage on its head. What if my patient sends me a camera phone picture of her rash (via a secure patient portal message using Certified EHR Technology) while on her beach vacation? Do I need a Florida license now because that’s where the patient is? The policy seems to say so, per Page 4, Lines 3-5 and 13-14. Maybe those line numbers were handy after all.
  • “The maintenance of preferred relationships with any pharmacy is prohibited.” Excuse me? I have had preferred pharmacies my entire career. I prefer Mom and Pop shops rather than chains, especially when they know their stuff and don’t try to sell my patients aisles of junk food, questionable candy, and outdated cosmetics. I really prefer a pharmacy that doesn’t tell the patient, “The physician never sent your script” when they’re too busy to check the secondary screen on their prescribing software. I agree with the follow-up sentence that physicians shouldn’t send scripts to a specific pharmacy in exchange for benefits if we’re talking about SIGNIFICANT benefits (oh yeah, there’s a typo on Page 7, Line 23) but really, no preferred pharmacy? Does the fact that the Mom and Pop down the street brings a physician homemade cookies during the holidays make her unduly coerced? After all, that’s a benefit. What if the physician also takes them cookies because she’s grateful they are so meticulous with her patients’ scripts? Does that negate the benefit?

In this day and age with the mobility of our society, mobility of physicians, and the technology at hand, it seems more and more preposterous that individual states should continue to license physicians individually and/or without a greater degree of reciprocity. There are all kinds of problems with physicians being disciplined in one state and just going for a license in another state. Why not have a national licensure process? I suppose a counter argument would be that Medicare has a single provider identifier but still can’t correctly identify fraud, but that’s another story.

I really like their closing paragraph. Here’s a winner: “…physician remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral)…” Why should this be unique to telemedicine? Isn’t this something we grapple with on a daily basis, patients who come in wanting a script or referral they don’t need? What about those that want a test “because Medicare pays for it” whether they need it or not? Often our remuneration is ultimately based on whether we comply, either through patient satisfaction scores or the simple fact that they will vote with their feet. On the flip side, what about aesthetic medical services? Aren’t those ultimately driven by patient-desired outcomes? Especially ones like this recent find for aesthetic foot surgery.

On its face, this policy regulates us too much in regards to telemedicine, but perhaps I’ll go a little Jonathan Swift and suggest that maybe we’re not regulated enough in regards to everything else. It’s like saying we’re going to regulate wine in a box but not in a bottle. At this point, the policy is “advisory” so states can take it, leave it, or modify it.

What do you think about the FSMB’s plans for telemedicine and telemedicine technologies? Email me.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.


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May 1, 2014 News 4 Comments

Morning Headlines 5/1/14

April 30, 2014 Headlines No Comments

Merge Reports First Quarter Financial Results

Merge reports Q1 results: revenue dropped to $50.9 million from $63.6 million during the same period last year, but lowered costs drove a net income increase of 47 percent. EPS of $0.00 vs -$0.07, stock prices ended trading five percent down on the day.

Boston Medical Center fires vendor after data breach

Boston Medical Center fires its transcription service vendor after it was discovered that 15,000 patient records were posted on the vendor’s website without password protection.

VA Eyes Cash Prizes To Generate Ideas For New Health Record

According to a notice posted on a federal contracting website, the VA will launch a series of design challenges to help generate innovative solutions for its next-generation VistA platform.

March 2014: EHR Incentive Program

CMS has now paid out $22.9 billion since the start of the EHR Incentive Program.

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April 30, 2014 Headlines No Comments

Health IT from the CIO’s Chair 4/30/14

April 30, 2014 Darren Dworkin 4 Comments

The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers. Objects in the mirror may be closer than they appear. MSRP excludes tax. Starting at price refers to the base model; a more expensive model may be shown.

The Budget Paradox

Hospital IT budgets come in two forms: capital budgets (one-time project expenses) and operating budgets (staff and ongoing expenses.)

I probably don’t need to write much by way of background to make the case of why hospitals are under pressure to reduce expenses. It would be fair to add that the pressures are more intense these days. The larger problem involves how we deliver care, but that does not mean that hospital systems aren’t equally focused on cutting expenses.

To be more precise, most budget reduction efforts are macro projects to either hit a specific target or to “bend the curve” such that operating expenses don’t rise or rise at a slower pace. This can be particularly vexing for IT for a number of reasons.

The first big one relates to how organizations view information technology. Often, to the chagrin of IT leaders, IT is seen (or willed) to be a magic bullet. As such, solutions are ordered in increasing numbers, creating scenarios of increasing IT demand. Often these systems are justified around the capital budgets alone, with the operational budget implication not fully understood until a year or two later.

If IT shops were standalone businesses, this increased demand would be a good thing (more customers! ) But IT shops aren’t standalone business, so they often have loose ROIs to carry. The resulting consequence is more weight added to the operating budget.

This in itself does not really create a paradox, but it does add to the pressure of trying to meet a budget target. The budget paradox is tied to a changing philosophy and approach around IT pricing.

Before I tie the pieces together, let me talk about Meaningful Use. Forget for a moment stages and government regulations. At its core, MU was a great idea to reward or incent organizations not for just installing IT, but for using IT. Some ideals and subjective concepts were added to aim beyond “use” and to strive for something higher (Meaningful Use), but that aside, of the things MU did was legitimize the pricing strategy that IT software could (and maybe should) be measured by use, not by installation.

Prior to this thinking, most hospitals bought large IT purchases around capital budgets and booked the expense based upon install. Reflecting the early days of IT, we took credit for simply getting a system in.

I support and like the idea that we should get credit for success upon use. While it’s hard to measure and define what might be “meaningful use” versus “use,” I think as long as we are generally focused on having IT measured beyond the install, we are aiming in the right direction.

Back to the budget paradox. Traditional thinking around operating budgets is that as you continue to operate, you should be able to control or reduce costs. Experience, efficiency, and maturity of operations should all lead to cost reductions. This manifests itself in common year after year quests to either keep operating budgets flat or reduce them. 

But as IT pricing models have shifted to use-based or volume-based, and with the magic venture capital words of “recurring revenue,” the idea of year-over-year reductions and rising costs from growing use begin to conflict.

Take the following example. A hospital deploys an EMR. Over the course of the year, it builds upon its success and increases its user base. Let’s imagine more orders entered, more concurrent users, and maybe even new modules and functions turned on. Juxtapose this against an expectation to achieve operating maturity and flat or reduced budgets. You are aligned for a paradox as you pay new fees for new use.

Of course, like every good CIO, I keep great records for my “guilty but with an explanation” budget list. I use sophisticated spreadsheets to demonstrate that on a “same-store basis,” my budget is trending down. But none of this matters if the organization’s macro demands are for budget control.

How do we solve our paradox? How can we continue to grow and contain costs? 

No doubt the answers are different for everyone and deeply tied to specific situations, but I think we need to work on a few themes.

  1. We need to get as good at turning off older systems as we are at turning new ones on. Incremental gains don’t much help here. A discipline of measuring off or on must be applied.
  2. We need to look at ways to leverage infrastructure at scale beyond our own individual sizes.
  3. We need to find ways to use more of what we have to gain richer functionality from the systems (and costs) that we already own.
  4. We need to be close to our labor costs and understand how best to balance all the levers.

The challenges ahead are complicated and will require us to think about things in new ways. The hospital IT budget is only going to be faced with new demands. It’s time to get innovative.

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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April 30, 2014 Darren Dworkin 4 Comments

HIStalk Interviews Blain Newton, SVP/COO, HIMSS Analytics

April 30, 2014 Interviews No Comments

Blain Newton is SVP/COO of HIMSS Analytics of Chicago, IL.


Tell me about yourself and HIMSS Analytics.

I started in IT, with a focus on healthcare IT, probably 15 years ago as an accountant in finance. I moved into operations and strategy at some large EMR vendors, both here and in the UK. I was CEO of CapSite, acquired by HIMSS. I joined the HIMSS Analytics business unit from there.

HIMSS Analytics is the sister company to HIMSS North America, which is what most people think of when they think of HIMSS. We’re a market research firm with a number of market intelligence solutions, databases, and a suite of customized consulting services. We’re the data and the information behind the HIMSS EMR Adoption Model that you’ll see a number of hospitals and vendors post on your site about on occasion as they reach Stage 7.


Describe how HIMSS Anayltics operates as part of HIMSS.

We’re part of HIMSS Worldwide. We’re a strategic business unit of HIMSS Worldwide, as is HIMSS North America, HIMSS International, and HIMSS Media Group. We’re not-for-profit. We are part of the cause-based, mission-based organization that HIMSS is.

We operate independently. We help vendors make more strategic, informed decisions about going to market and how they’re competing in the landscape. We help providers make more informed IT investment and deployment decisions. 

We are separate entirely from the HIMSS North America that you’d be familiar with the trade show or with membership or with advocacy operations. We’re run as a cause-based not-for-profit, but separately run from the broader HIMSS.


CapSite had interesting offerings like market research and the contracts database. What elements of CapSite have been rolled into HIMSS Analytics?

The really good thing is there was really very little overlap in the HIMSS Analytics offerings and the CapSite offerings. They’ve been integrated in a very complementary fashion.

We still offer the CapSite database of contracts and proposals. There’s over 6,000 of them covering 150 categories. Actual Ts and Cs, actual pricing information, to help vendors understand how their competitors are going to market, to help providers understand where they can mitigate risk and potentially negotiate better deals. That still exists and is being integrated more fully with the HIMSS Analytics database, which was an existing asset.

The market research and reports that you’re talking about also still exist, although we’re now leveraging the information that we get in the HIMSS Analytics database to add even more flavor and information to these reports. 

In the next 12 months or so, you’re going to see a different spin on those. It’s still the same level of information coming from the market research, the same kind of color to the palette, let’s say. Who’s doing what in the market and why and why decisions are being made, along with a historical view of what has happened in the market over the last few years and where the market stands today as far as market share, mind share, etc. Those offerings still exist and are being built out to leverage the strength of the HIMSS Analytics tools in a more robust way.


How do you collect the information for the database?

For the HIMSS Analytics database, we do a census survey of every hospital in the country, as well as Canada and several other countries across Europe and Asia. It’s not census-based in Europe and Asia, but in the US we reach out to well over 5,400 hospitals that have another 40-plus thousand affiliated ambulatory practices and a number of ACOs. We talk to their CIOs or others to gather information about what IT they’re using, how they’re using it, etc. What their replacement plans are for those technologies.

On the CapSite database, we also work with the provider organizations directly and gather this information under the Freedom of Information Act. As part of a cause-based organization, we bring that information in and we redact it so there’s nothing proprietary going out. We’re not in the business of sharing vendors’ family secrets and we’re not in the business of exposing any healthcare organization. Our role with the CapSite database is providing a level of transparency in the IT procurement cycle. But again, it’s all gathered under the Freedom of Information Act.


What products do you sell and who buys them?

We sell the HIMSS Analytics Database to vendors. They use the tool to understand where they fit in the competitive landscape. Helping them understand market share, where there’s market opportunity, where they can better present their offerings to the market.

From the providers’ standpoint, they also utilize the HIMSS Analytics database — it’s free of charge to them — to help them benchmark themselves against their peers, help them understand where they fit on the maturity models that we have out — the EMR Adoption Model, the Ambulatory Adoption Model, the DELTA Powered Analytics Assessment — we have a number of maturity models.

On the CapSite side, vendors also purchase the CapSite database to understand how they’re presenting themselves and proposing themselves against their competition. Providers use it, as you can imagine, to understand when they’re sitting at a data negotiating table, how are they mitigating their risk, how are they making sure they’re getting a good deal for their organization.

To complement those market intelligence solutions, which is what we call those databases, we offer a variety of customized research capabilities, whether it be helping providers do gap analysis and roadmap assessments for where should they spend that next dollar of IT budget or for vendors helping make strategic decisions about product direction and where they should take their portfolio as well as how they can maximize the products that they have in market today through understanding their client base better through voice of client engagements, win/loss engagements. Win/loss engagement is tailored to and tied to the market intelligence tools that we have to do more than just win/loss — it’s focused on organizational improvements to help capitalize on the market better. 

Then of course we offer the research reports that you talked about. We have a tool called the Essentials Report that we put out as well as the CapSite syndicated reports. As I said, we’re going to be merging those two together into a new and improved Essentials for the next 12 to 18 months.


Is it typical for a member organization to conduct market research of members who are prospects and sell that information to members who are vendors?

We view it a little bit differently than that. We look at it as the way that we’re helping with the cause of better healthcare IT. We’re trying to bring transparency to the entire procurement cycle. 

To the extent that we can help a provider understand what they should be looking for in terms of next steps in technology, how they should deploy it — that’s a positive. To the extent that we can help a vendor position their product in a way that will more effectively meet the needs of the provider — that’s a benefit. 

We don’t look at it in terms of, we’re going to help you sell your product. We look at it and say, the more transparency that we can bring into this cycle, the less cost will be present in it, the more openness and transparency will be in it, and the better off everybody is for doing it. We’re really just trying to bring information to the market and let the parties on either side of the table make decisions based on that information.


Do you contact every hospital in the country? What kind of logistics are required to do that?

We do. Much of it’s self-reported. We have tools in place to allow the provider organization to self-report much of the data. So much of what we do is validation and gap fill. In exchange for getting peer benchmarking reports, in exchange for understanding whether organizations fit on the EMR Adoption Model and other maturity models, many of the participating organizations — which is virtually all — self-report much of the data.


What trends are you seeing that most people wouldn’t have expected?

I don’t know if there’s anything terribly surprising based on what’s out there and what folks read on your blog. But as you can imagine, folks are now moving beyond Meaningful Use Stage 1 and understanding what’s going next. A lot of it is optimization of what’s already been bought. There’s still much to do in doing that.

But the biggest trend we’re seeing is this push towards patient engagement and care outside of the walls of an organization. How do you care for that patient and what is the value proposition to do so? There’s a lot of interest right now in understanding that and moving towards that. As we’ve gathered all this data as part of setting up our EMRs, now what do we do with it and what is the value proposition behind it? 

I don’t think it’s anything terribly surprising. Different organizations are at different stages of it. Some of that depends on whether or not they have patient lives at risk under a healthcare plan, for example. They may be more inclined to understand care beyond the walls than somebody that doesn’t have those patient lives at risk as part of a healthcare plan. But again, it’s just really understanding now we have all this data, what do we do with it? 

We launched at the last annual conference in Orlando a couple of additional maturity models to help organizations make sense of that, the Continuity of Care Model and the Total Revenue Management Model.


Part of the transparency that’s most needed is the products someone bought that didn’t work out as they expected or the lessons they learned the hard way in implementing new ideas or strategies. Do you report any of that?

We don’t report it, per se, as part of data. We do look at adoption of technology. We can look through and say, this particular solution has not been adopted to the level that others have. That’s hard to say whether or not it was product implementation or organizational. We don’t get into that level of detail. 

As you know, you’ve been in this game a long time, a perfectly good solution could not be as successful as folks wanted it to be for any variety of reasons. It’s rarely just because of the solutions, so we don’t report them that directly. We do help vendors who are trying to improve their retention rate, improve their win rates. We do go in through qualitative and quantitative research, help them understand why their solutions are being adopted successfully or not, and help them make those organizational improvements to do so.

We think that’s in the best interest of the industry as a whole. If we can get all the vendors better understanding how they can be successful, then that’s a good thing for everybody.


Are vendor user groups the best place for that to happen? People seem to just want to know what their fellow customers did, what problems they had, and how they solved them.

I think vendor user groups can be very successful. In a previous life, I was very active as a moderator in a vendor user group and I saw tremendous value come out of it, as long as there was that willingness to be open and honest about strengths and weaknesses on both the provider and the vendor side. I think that’s just one avenue to start to get this information out there.

We try to do it through a variety of mechanisms — through focus groups, webinars, and vendor user groups. We work closely with the HIMSS regional chapters to try to share this information with members and vendors. I think it’s a powerful forum, the vendor user groups, but it’s one of many.


What changes do you expect with HIMSS Analytics and in the industry in the next three to five years?

As I think about where HIMSS Analytics is going to be, we’re experiencing strong growth right now. We can expect to continue that. We expect a lot of our growth to happen on the customized consulting side. 

Everyone had a blueprint for what they needed to do previously. They needed to go out and buy an EMR. Now their question is, what’s next? We see a lot of folks coming to us and asking, where’s this market going and how do we succeed in it and make our clients happy?

We see providers saying, all right, we have all this data, what technology should we go after next to achieve the most benefit from that data and this information that we have? We see huge growth coming from our consulting organization as we help both sides make better, more informed strategic decisions.

From the industry side, we launched the Total Revenue Management Model. We launched the Continuity of Care Model. That is an indication of where we see the industry going. As we start to shift towards a more accountable care world, what technologies are going to be needed to care for that patient beyond the walls of your facility, beyond the walls of your organization, in the patient’s home, in a non-affiliated practice? What are the value propositions and the revenue implications, the bottom line implications, of doing that? 

We structured these two models — along with the DELTA-Powered Analytics Assessment, which is a way to understand an organization’s capabilities in terms of using data as information — to help guide the industry in those next three to five years because it’s a bit of an unknown. We’ve seen some very successful organizations achieving significantly improved outcomes and cost realizations from using analytics and capturing information outside of the organization, but those are rare. Those are not the norm right now. That’s the trend we see happening.

Some of your readers have had thoughts about it. Dr. Wellbeing brought up a point that the technology’s great, but it’s ahead of the payment paradigm right now. That’s certainly true in some instances, but we see that trend beginning to shift and organizations beginning to understand the value of leveraging as much information as they can to improve patient care and achieve cost-benefit realizations.


Any final thoughts?

I’ve been in this game for 15 years or so. We’re at a really exciting time. I think both of us remember the time when very few people had EMRs and no one quite knew what to do with them. We’ve moved into this place where virtually all have and a significant portion are using them in a very capable way. 

Now that we have them in place, we can truly use the information that’s coming out of them to improve care, reduce cost, and start to achieve the vision that everyone had when we laid out the notion of healthcare IT.

We have a long way to go, but it’s a pretty exciting time. I’m thrilled to be part of an organization that can help bring some clarity to a market that may be a little bit cloudy at the moment.

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April 30, 2014 Interviews No Comments

Morning Headlines 4/30/14

April 29, 2014 Headlines No Comments

M*Modal Files Chapter 11 Plan Backed By Creditors

MModal files its disclosure statement and reorganization plan, detailing the company’s strategy to exit Chapter 11 bankruptcy by August 15.

UPMC Selling Analytics to Curb Health Care Costs

UPMC will begin licensing its homegrown clinical analytics system to other healthcare organizations. The platform identifies the lowest cost treatment plans that consistently lead to the highest quality outcomes and then benchmarks individual physician performance against this data. In the ED, the system is used to predict which patients were more likely to be readmitted, helping UPMC staff reduce readmission rates by 37 percent.

Medfusion’s Relationship with Allscripts Comes to an End

Medfusion will no longer offer its patient portal through Allscripts "due to unresolved payment disputes," according to a statement released Monday.

Nuance CEO Paul Ricci tops in pay among Massachusetts executives

The Boston Globe calls Nuance CEO Paul Ricci the most overpaid executive in Massachusetts. Ricci earned $87 million over the past three years, during which time his company’s stock fell 16 percent.

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April 29, 2014 Headlines No Comments

News 4/30/14

April 29, 2014 News 6 Comments

Top News


MModal files its plan to exit Chapter 11 bankruptcy by August 15. The company provided a statement: “MModal is pleased to have reached this important milestone in our financial restructuring process. The proposed Plan of Reorganization reflects the previously announced agreement the company reached with the controlling majority of its lenders and bondholders that will dramatically reduce the company’s debt, strengthen its balance sheet, and provide it with significant financial flexibility.”

HIStalk Announcements and Requests


Bonny from Aventura provides an Charles Schulz-powered illustration of the ICD-10 situation that will resonate with many people.

image image

I noticed these signs in a doctor’s office today. It seems that all forms of customer-insulting emphasis are represented: capitalization, bolding, underlining, and massive deployment of exclamation points (always five except for the laptop message, which ends with an unprecedented six exclamation points for those undeterred by inferior numbers.)

Upcoming Webinars

May 1 (Thursday) 1:00 p.m. ET. Think Beyond EDW: Using Your Data to Transform, Part 2 – Build-Measure-Learn to Get Value from Healthcare Data. Sponsored by Premier. Presenters: Alejandro Reti, MD, senior director of population health, Premier; and Alex Easton, senior director of enterprise solutions, Premier. Once you deploy an enterprise data warehouse, you need to arrive at value as quickly as possible. Learn ways to be operationally and technically agile with integrated data, including strategies for improving population health.

May 7 (Wednesday) 1:00 p.m. ET. Demystifying Healthcare Data Governance. Sponsored by Health Catalyst. Presenter: Dale Sanders, SVP, Health Catalyst. Challenged with governing data? This vendor-neutral discussion will cover the need to develop a data governance strategy, including general concepts, layers and roles, and the Triple Aim of data governance (quality, literacy, and exploitation.)

Acquisitions, Funding, Business, and Stock

4-29-2014 7-29-41 AM

Physician networking site Doximity closes a $54 million Series C fundraising round, planning to expand into Canada and to add other healthcare professionals, such as nurses.

4-29-2014 1-47-30 PM 

Truven Health Analytics acquires Fortel Analytics’ predictive healthcare fraud technology, which will be integrated into Truven’s payment integrity solutions.

4-29-2014 11-29-53 AM

General Atlantic commits $125 million to Alignment Healthcare, which offers a care coordination solution.

4-29-2014 1-49-40 PM

Alere reports Q1 results: revenue down three percent, adjusted EPS $0.55 vs. $0.53, missing revenue expectations. The company also reported that its Health Information Solutions segment experienced a decline in net product and services revenue from $134.2 million a year ago to $123.7 million.


Press Ganey acquires Dynamic Clinical Systems, a patient-reported outcomes services and solutions provider.


Infor completes its acquisition of substantially all the assets of GRASP Systems International, a provider of automated patient acuity, workload management, patient assignment, and consulting services.


Consumer engagement provider Accolade acquires konciergeMD, which offers a platform for care plan adherence.


For-profit hospital operator HCA discloses in its earnings call that it took in $30 million in EHR incentive money in Q1 vs. $39 million in 2013, incurring EHR-related expenses of $43 million and $26 million, respectively, meaning it spent exactly the same as it made in the two years. Seems like quite a coincidence.


Roper Industries says in its earnings call that its Sunquest operation experienced “double-digit revenue growth” due to improvements in its implementation process and expects to have a “quite an exceptional year in 2014.”


A German business magazine predicts that Siemens will announce on May 7  the elimination of 5,000 to 10,000 jobs and the merging of its four main divisions (industry, energy, healthcare, and infrastructure/cities) to create a flatter hierarchy.


Craneware wins a seven-year, $3.8 million contract with an unnamed US hospital group for its Chargemaster Corporate Toolkit.

Southern Illinois Healthcare, MBB Radiology (FL), Radiology Imaging Associates (CO), Southwest Diagnostic Imaging Center (TX), St. Paul Radiology (MN), and Washington Radiology Associates (VA) and 13 other organizations select Merge Healthcare’s iConnect Network interoperability platform for clinical data exchange.

CHE Trinity Health will implement Verisk Health’s Provider Intelligence solution and DxCG platform to manage its national population health management initiatives.

4-29-2014 9-48-17 AM

The board of trustees of Cumberland River Hospital (TN) approves $156,644 in upgrade costs to allow the hospital to update its CPSI software to meet Stage 2 MU requirements.


The University of Arizona Medical Center will use services from Besler Consulting to identify Medicare Transfer DRG underpayments.

Kettering Health Network (OH) selects Wolters Kluwer Health’s ProVation Order Sets.

University of New Mexico Medical Group chooses StrataJazz from Strata Decision Technology for budgeting and planning.


4-29-2014 1-53-45 PM

Castlight Health appoints Ed Park (athenahealth), brother of co-founder and US CTO Todd Park, to its board.

4-29-2014 1-55-41 PM

Symphony Technology Group promotes Al Vega to president/CEO of Symphony Performance Health.

image image

Jonathan Perlin, MD, CMO will step down as chair of ONC’s HIT Standards Committee. He will be replaced by Jacob Reider, MD of ONC.

MEA|NEA appoints Scott Hefner (Jopari Solutions) VP of sales.

Announcements and Implementations

4-28-2014 3-24-39 PM

Practice Fusion launches a population health management offering in collaboration with drug manufacturer Merck, giving practices a real-time dashboard that compares a provider’s patient vaccination rate with the rates of other Practice Fusion providers.


Regional Medical Center Orangeburg (SC) goes live on Cerner’s patient portal.

Central Illinois Health Information Exchange, Lincoln Land Health Information Exchange, Illinois Health Exchange Partners, and MetroChicago Health Information Exchange connect their health information exchanges, which collectively serve 63 hospitals.

Government and Politics

4-29-2014 1-17-28 PM

CMS releases an interactive search tool to streamline access to Medicare provider payment data.

The GAO appoints three members to the Health Information Technology Policy Committee: Christop U. Lehmann, MD, American Academy of Pediatrics (representing vulnerable populations); Neal Patterson, Cerner (representing vendors); and Kim Schofield, Lupus Foundation of America’s Georgia chapter (representing consumers and patients.) Paul Tang, MD of Palo Alto Medical Foundation was reappointed as physician representative.

Innovation and Research

Physicians reviewing EHRs carefully read the impression and plan section, but only quickly scan details on medications, vitals, and lab results, according to a study published in Applied Clinical Informatics. Researchers recommend optimizing the design of electronic notes to include “rethinking the amount and format of imported patient data as this data appears to largely be ignored.”

Brigham and Women’s Hospital chooses four companies in its “shark tank” competition for pilot projects: Twine Health (collaborative chronic disease management), MySafeCare (patient and family reporting of safety concerns), Healo (remote monitoring of wound healing), and Tenacity Health (peer health coaching.) 


The Federation of State Medical Boards approves telemedicine guidelines that include a policy to apply the same standards of care for remote medical encounters as for in-person encounters. The guidelines also call for physicians to care for only those patients located in their licensure coverage areas, establish a credible patient-physician relationship; and adhere to safety and privacy principles.

A Boston Globe columnist names Nuance Communications CEO Paul Ricci as the most overpaid executive in Massachusetts based on his compensation of $87 million over the past three years, during which time the company’s share price dropped 16 percent.

4-28-2014 9-44-15 AM

Medfusion ends its relationship with Allscripts “due to unresolved payment disputes” and gives the 30,000 Allscripts users of its patient portal until May 31, 2014 to sign a contract directly with Medfusion. The termination is hardly a surprise given Allscripts acquisition of the competing Jardogs product last year.

Boston Medical Center (MA) terminates its transcription contract with MDF Transcription Services after discovering that the records of 15,000 of its patients are visible on the company’s Internet server.


St. Joseph’s Hospital Health Center (NY) discloses in a prospectus offering to sell $68 million worth of junk-quality bonds to pay for a new power plant and EHR system that it will probably be sued over claims that a disruptive surgeon slapped and verbally abused anesthetized patients going back to early 2012.

Rural hospitals are considering EHR implementation assistance as one reason to affiliate with a larger organization, hoping to earn financial incentives or avoid penalties.

University of Mississippi Medical Center (MS) CIO David Chou recounts what it’s like when a hospital loses Internet connectivity and access to cloud-based applications. The article mentions that low adoption rates prevented using Twitter and Facebook for communication during the outage, which I assume means by smartphone cellular since nobody could get to those sites otherwise (although they could use self-hosted Yammer instead if Microsoft still offers that.)

A San Francisco Examiner opinion piece by an orthopedic surgeon complains about his hospital’s use of the “all-pervasive Epic” system, which he says has caused doctors to focus on the computer instead of the patient and has sterilized the medical record to the point of uselessness. He seems to blame the system for the behavior of its users, saying it only improves care “from the point of view who want to watch data from across the room” while he prefers to “talk to the patient” and be a “hands-on doctor,” neither of which as far as I know is prohibited among Epic users.

UPMC (PA) will partner with one of three unnamed companies to sell analytics software it developed to benchmark costs per individual physician. UPMC says it spent $5-12 million to develop the system, which it claims has reduced its readmissions by 37 percent.

4-29-2014 1-06-39 PM

A state audit reveals that a former IT consultant with the University of Iowa Hospitals and Clinics illegally sold $57,000 worth of hospital computers to staffers and friends between 2005 and 2013. A woman tipped off the IT department after trying to get technical support from Dell for a laptop the consultant gave her, only to be told that it was registered to the hospital.

Weird News Andy (“Weird News You Can Use”) finds this ironic: hundreds of attendees of the national Food Safety Summit in Baltimore get food poisoning. WNA is also transported by this story, in which doctors trigger vivid memories of a patient’s childhood as they stimulate areas of his brain with electrodes in trying to determine the cause of his epilepsy.

Sponsor Updates

  • McKesson launches Managed Mobile Services to simplify mobile device management.
  • iHS2 releases a research report entitled “Healthcare Security: 10 Steps to Maintaining Data Privacy in a Changing Mobile World.”
  • Craneware and its customer Southeastern Ohio Regional Medical Center will discuss the future of patient access at the National Association of Healthcare Access Management 40th Annual Education Conference May 16 in Hollywood, FL.
  • Independent auditor LBMC confirms that PerfectServe has achieved Service Organization Controls (SOC) 2 Type II of its security and privacy controls.
  • Allscripts recognizes its customer Carson Tahoe Health (NV) for attesting for MU Stage 2 using Allscripts Sunrise.
  • Medhost adds high-availability disaster recovery and remote monitoring and management to its managed IT service offerings.
  • Shake IT Baby is the theme for Impact Advisors’ annual Impact Palooza April 30-May 2 in Scottsdale, AZ.
  • William J. Leander, SVP for Santa Rosa Consulting, will discuss value-based healthcare at next month’s MUSE 2014 International Conference in Dallas.
  • Allscripts profiles Unity Health System (NY) in a blog post and discusses how dbMotion’s HIE technology helped Unity achieve better outcomes.
  • Liaison Healthcare partners with AOD Software to connect its long-term provider customers with lab and imaging vendors on the Liaison EMR-Link hub.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis, Lorre.

More news: HIStalk Practice, HIStalk Connect.


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April 29, 2014 News 6 Comments

Morning Headlines 4/29/14

April 28, 2014 Headlines No Comments

Merck Teams With Electronic Health Record Provider Practice Fusion To Improve Patient Health

Merck partners with Practice Fusion to bring EHR-based immunization reminder tools into physician practices. The partnership will provide physicians with the added ability to track immunization rates at the population level, and automatically send immunization reminders to patients.

What Do Physicians Read (and Ignore) in Electronic Progress Notes?

Researchers at the University of Massachusetts Amherst studying the eye movements of physicians as they read electronic notes find that the clinical narrative within the impression and plan section of the note was nearly always carefully read, but that the remainder of the note was only quickly scanned.

Reading Pain in a Human Face

Researchers with the Institute for Neural Computation have created software tool that can outperform humans at differentiating real pain from faked pain by analyzing facial expressions. In the study, participants were asked to watch a video showing subjects expressing either real pain or  faked pain. The participants were only able to correctly identify real pain 55 percent of the time, but the computer program could accurately identify real pain 85 percent of the time.

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April 28, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 4/28/14

April 28, 2014 Dr. Jayne 4 Comments


Death of a Practice

I wanted to be a physician from a very young age. Most people find that interesting because no one in my family is a physician or even in the healthcare field.

Going into junior high school, my best friend (who eventually became a nurse) and I became candy stripers, starting our healthcare careers. My first memory of a physician who didn’t make me cry was the kindly general practitioner my parents took me to after our pediatrician retired. He was the kind of doctor who kept his patient records on index cards (they were 4×6 inches) and wore a reflector on his head – old school.

Flash forward to second year of residency, when most primary care trainees start looking for a job. I had a potential offer from the medical group affiliated with the hospital where I was training. I had seen too much from the inside, though, to really want to work for them, so I decided to investigate whether that hospital where I first started was hiring any physicians.

In a stroke of luck, they were looking for someone interested in solo practice. I was offered a start-up in the small town where I grew up.

Their deal looked pretty good. Although technically employed during the first couple of years, the group allowed their sites to run like private practices and the physicians were on a largely eat-what-you-kill model. They were allowed autonomy over their practice except for certain office processes, which were paid for through a management fee taken off the top. Compared to hiring separate billing, compliance, OSHA, legal, HR, and other services, the management fee was extremely competitive.

I had rotated in one of their practices as a student and had seen first-hand how things ran. Two trainees ahead of me had taken jobs with them and everything was on the up-and-up. The non-compete was such that physicians could actually buy their practices and go private, staying in the same location, once they got off the ground. Coupled with the fact that they were willing to install an EHR at no cost to me and the fact that as a solo doc I wouldn’t have to deal with anyone else’s baggage, it was a done deal.

I had a lot of input on the office itself since construction had just started in a local strip mall. It was built for electronic health records from the beginning and was large enough to eventually house three physicians. The sponsoring hospital had done its homework and knew there was primary care demand in the community. We had people trying to make appointments more than a month before we were set to open.

I completed residency at the end of June, sat for the Board exam two weeks later, and opened the practice the following Monday. I saw nine patients that first day and never looked back.

I was proud to be part of the community. I had my own branding, Most people didn’t realize we were affiliated with the hospital. That was a big draw for some and gave us a certain pride of ownership I don’t think we would have had if we were visibly under the hospital umbrella.

Patients loved us being in the strip mall near a high-traffic intersection, glad they could park 20 feet from the door rather than having to use a parking garage or large lot at one of the hospital-based practices. I threw candy from a float in the Founders’ Day parade. It many ways, it was a dream come true.

My little office grew by leaps and bounds (“local girl comes home” is a powerful marketing statement.) Before long, I was ready to add another physician and eventually a nurse practitioner. The hospital sponsored several other start-up primary care practices, hiring a couple of my residency colleagues to help them build a troop of primary care docs to stay ahead of the community’s needs.

As for my site, since we were piloting the EHR system that the hospital’s parent health system planned to implement for all owned practices, I became pretty visible as an EHR champion. Eventually I was hired as part-time medical director for ambulatory EHR. One half-day a week at the IT office became two, then four, to the point where several years later I was only in the practice one day a week.

Eventually, patients’ lack of access to me became the topic of every office visit. Realizing it wasn’t good for the practice or my morale, one of our IT directors figured out a way for the hospital and IT to buy me out. It was a bittersweet decision to leave my little start-up, which wasn’t so little any more. We never turned an enormous profit, but we did break even and I had the opportunity to recruit my own replacement. It seemed like things were in good hands, so off I went to the land of IT.

The practice thrived until the recession started, the auto industry failed, and other heavy industry went to states with cheaper costs of labor. I had moved on career-wise, but still had enough connections to hear the updates on “my” practice. The staff was a little less busy, the bad debt write-offs grew, and the finances moved into the red.

The hospital president believed in primary care, though, and continued to subsidize the practice, knowing there was a need in the community (I’m not naïve — he also knew how many million dollars in ancillaries the average primary care doc drives to his or her preferred hospital.) And so the office stayed open.

Fast forward, and the hospital (now a major part of the regional safety-net rather than a community resource that drew patients through innovation and excellence) posted several major losses, sending its president to greener pastures elsewhere. Then one of the providers left for a higher salary, followed by another who took a maternity leave and never came back.

The hospital had a hard time finding a physician who wanted to care for patients with difficult socioeconomic challenges, especially when affluent practices with richer payer mixes beckoned. They weren’t willing to guarantee a salary that would have convinced someone to stay. I had last heard the practice was running with a single nurse practitioner who was supervised by a physician 20 miles away.

I found out today that the office is closing. Once I stood on the sidewalk with the mayor of our small town, cutting the “Grand Opening” ribbon with his giant gold-painted scissors. Now that sidewalk will lead people to yet another vacant quasi-retail space.

The provider who remains is being “consolidated” into a shared office on the hospital grounds, where physicians seem to land when they can’t get along with their partners or their practice loses too much money. Any trace of the office we worked so hard to build will soon be gone.

The economic reality is that no one wants to own small primary care practices any more. The work is hard, the hours are long, and the pay is less than other specialties. Hospitals stepped in hoping to lure primary care docs to their communities and solidify their slices of the revenue pie. Once they stop making money, though (which is often the reality of primary care in our current model,) it’s the beginning of the end.

Perhaps new payment models could have saved my little practice, but we will never know. Rather than having a family physician down the street or around the corner, patients will drive half an hour and navigate the maze of the hospital campus. They’ll probably be subject to a facility fee now, as I’m sure the remaining provider will be set up as a hospital outpatient department to try to eke out as much revenue as possible.

Even though I haven’t practiced there in years, I feel bad about it. I’m sorry that primary care doesn’t get the respect or compensation it deserves. I’m sorry that the hospital is no longer willing or able to subsidize valuable community services.

But most of all, I’m sorry for the patients. I’m grateful, though, for the time we had together, for the times I was able to help, and most of all, for the memories.

Email Dr. Jayne.

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April 28, 2014 Dr. Jayne 4 Comments

HIStalk Interviews Cynthia Petrone-Hudock, Chief Strategy Officer, The HCI Group

April 28, 2014 Interviews 1 Comment

Cynthia Petrone-Hudock is chief strategy officer of The HCI Group of Jacksonville, FL.


Tell me about yourself and the company.

I have a background in financial institutions, about 17 years. I’ve spent about the last eight years in healthcare.

As our mission states at The HCI Group, I focus on collaborating somewhat from a management consultant perspective. I work with clients to identify what their needs are and then develop creative solutions that reduce the cost of healthcare and at the same time improve their ability to increase the quality of healthcare.

We were established to meet the system implementation needs of healthcare organizations, but we promote cost-effective solutions. In the electronic health record arena, that seems to be very important these days.


People always compare healthcare to the early days of banking before ATMs and online services. How do you compare the two?

It’s quite fascinating because I do see a lot of analogies. We are at the stage now in healthcare where we’re selecting systems and implementing them, but then truly sustaining them in a cost-effective way and getting to interoperability.

You think about interoperability in the banking world. They’ve mastered it. I think we’ll push a little further in healthcare when it comes to data analytics and making sure that we’re using the data that we capture in a proactive and focused way. We saw some of that in banking, too, but I think it will mean more in the protocols of care in the healthcare arena.


Treating patients as a customers means hospital systems should include some aspects of a customer relationship management system. Is there a demand for those capabilities?

Yes. A lot of our focus is on business intelligence. We launched a sustaining support service line at HCI. Our goal is to support users of the electronic health record, but when you really think about it, it’s business intelligence of how they’re using that system to meet the needs of their clinicians who are taking care of their patients is what it’s all about. 

Maybe the future, when we’re talking about patient engagement, it’s really the analytics around that and the touch points of how the patients are interacting with the healthcare system which will be key. Forward thinking, where are we three to five years from now? It’s full-service care and you can interoperate on the health record. You’re certainly putting that full-service care capability in the hands of a clinician.


Back to the bank analogy, hospitals are putting in systems that run what happens inside the bank or at the ATM, but not how banks market to customers and prospective customers in between and keep them engaged. Could the same transition happen in healthcare?

Yes.  I think healthcare is starting to realize that they can get their arms around that capability. We’re seeing it now. We’re seeing it with marketing departments and healthcare systems who are now focused on engaging the consumer. Even with the new consumer technology, whether it’s handing out free Fitbits and having folks proactively start to monitor their health and having reasons for them to be reaching out to the doctor in a proactive way.

It’s exciting. I think we will see that. It gets back to the ability for the patient to be in control of their care. I’m hoping that’s what the enabling technology brings to bear.


For large hospitals, the market has pretty much boiled down to Epic versus Cerner. From the selections you’ve been involved with, why do hospitals choose one versus the other?

They start with their thoughts around the business case and their total cost of ownership, including their incumbent situation. But they do focus on functionality and where they want to get down the road. 

Quite often the cultural difference between the two organizations plays in some of the demonstrations and the ability to understand how their patient will be engaging with their organization going forward and whether that’s an integrated touch point or not. Most of my background is in Epic, but The HCI Group is vendor neutral.


How do you characterize the cultural factor differences between the vendors and which one prospects respond to?

I haven’t been around the block enough to weigh in on that from a client’s perspective. I’m guessing different clients would tell you they have different reasons why they are more comfortable in one camp versus the other.

Both systems, of course, are very exciting for us to be working with, and just knowing that we have organizations worldwide that are getting on EHRs for the first time, which is also exciting. We do a lot of work in that space, so I get to see organizations who are literally on paper, and just knowing that they’re going to get on electronic medical records is changing the protocols of care at the moment they go live. 

It’s more a fit and feel between the two organizations and whether that organization feels confident that they’ll have interoperability opportunities down the road. I think even the paper-oriented firms abroad are very focused on someday it should all interoperate.


Have hospitals done a good job in understanding and budgeting the post-live requirements for personnel and maintenance costs? 

I think there’s a lot of realization going on after they get past the capital period and they’re in their expense mode. They’re realizing that they need to focus on the lowest common denominator. 

For instance, our sustaining support line is a good example where when we go into an organization, we help look at the total process of supporting that application. At every point along the cycle, if there’s a way to do that service at a higher quality and a lower cost, of course we assist in improving the process. It’s the ability of having capacity that can ebb and flow, whether you’re looking at an upgrade or you’re looking at bringing in the new module that you didn’t go live with out of the gate. 

I do believe the CIOs are finding themselves in the situation where they’re explaining to the CFO why their piece of the total cost of ownership pie has gotten bigger. In some cases, it’s going to stay that way because you can no longer give care without the enabling technology. This is where The HCI Group is going to be able to go in and collaborate. Every organization’s slightly different. Some will say, I need a little support with the Epic application, for instance. Others will say, it’s the whole support model — I just can’t keep the staff on board at the right caliber to be servicing my clinicians. The unique approach by organizations in terms of what is best for their future is where we focus. A lot are going down the path of shared services, which I’m sure you’ve heard about.


Do you think hospitals looked at the cost of these systems as requiring a return on investment or did they just assume they are a cost of doing business?

If you had asked me eight years ago, I would have said they’re a cost of doing business. Now I believe organizations are more focused, even on the international front, with making sure they at least can realize the benefits that go along with spending the money. The return quite often is focused on the quality of care, which is nice to hear.

But there’s a new eye on this total cost of ownership that I didn’t see when I entered eight years ago. It’s exciting for me because some of our international clients are public healthcare systems, and whether you’re spending the public’s money or you’re spending an individual’s or a payer’s money, you still want to be doing it an efficient, effective way. I’m happy to see that.


How are the needs of those international customers different from domestic ones?

We are focused on being recognized as a global leader in delivering innovative IT solutions. What we’re finding is there’s a lot of opportunity on the global front to learn lessons that we’ve experienced here in the States.

I think you do have to take into consideration where they are in the journey. Some are where you may think healthcare in the US would have been 20 years ago. It looks to someone from the States like a pretty simple, low-hanging fruit opportunity, but what it brings is a tremendous transition. I think it’s greater change management for them than we have experienced here as we’ve come along. 

In most cases, whether we’re in the UK, the Middle East, or Australia, when I turn the system on, we’ll be changing protocols of care in our country, which is very exciting, to making sure that we’re being fiscally responsible. It’s been wonderful to work in that international marketplace and bring to them lessons learned so they don’t have to maybe climb over the same hurdles that we have done here in the States.


Have you worked on projects where hospitals wanted to involve patients more in their care?

A few organizations, we’ve worked with around patient engagement. The ones that are most exciting, they’re not being really led by the IT department — they’re being led by the business development arm of the organizations. 

Of course, in the Epic world, there’s Connect, but then there’s also these opportunities to engage the community in care, some of the new devices that are out for the consumers. What’s exciting about is it there’s a focus to think through new strategies to engage patients. It’s more than just the patient portal. It’s the medical devices that you may be able to use in your home and bringing more home health, which as the baby boomers age, we definitely need to be focused on as an industry. It’s been exciting to be working with the business development arms of the healthcare systems.


Give me some unusual, bold predictions for the next 3-5 years.

It’s really analytics and how we’re going to end up using all of this massive data. I think there will be a blip in inefficiencies since we have the challenge of big data, how we govern, what’s being asked of the IT department to pull out information around that data and use it in a positive way to change care, evidence-based care and research. That’s the exciting part.

We’re all  heads down pushing through the new technology today, but the exciting part will be five years from now. There are organizations, of course, that are ahead of the curve and doing it already. But to bring the rest of the country and the world to where we have as close to real-time information to be making great decisions.


Any final thoughts?

In terms of looking at where The HCI Group operates, we’ve just recently brought in a new CMIO, Dr. Bria. He has a fabulous background as one of the founders of the concept of the CMIO. He’s going to be working on some clinical service lines for us which start to leverage the ability of what the electronic health record has brought to the industry. So I guess in closing, wait and see what we’re able to do with it. We’re all excited at The HCI Group to have him on board and to refocus ourselves on the CMIO’s needs and not just the CIOs that we support so well today.

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April 28, 2014 Interviews 1 Comment

Morning Headlines 4/28/14

April 27, 2014 Headlines 1 Comment

Cover Oregon: $248 million state exchange to be jettisoned in favor of federal system

Oregon’s health insurance exchange program will be dissolved and replaced by the now functional site. Oregon spent $248 million trying to bring its exchange live, but failed to enroll a single person.

It’s Insanely Easy to Hack Hospital Equipment

Fargo, ND-based health system Essentia Health asks its head if IT security to thoroughly evaluate its network for security vulnerabilities. Two years later, the team reports that they were able to hack into the hospital’s EHR system and its imaging system. In addition, they were able to hack into and change the settings on drug infusion pumps, wireless defibrillators, and refrigerators that store blood products. 

2015 Edition EHR Standards and Certification Criteria Proposed Rule

The HIMSS EHR association publishes its comments to ONC’s proposed 2015 EHR certification criteria. EHRA’s primary concern is that there is not enough time left after final rules are published for vendors to properly code and test enhancements. The association is requesting an 18-month window be built into the timeline for coding and testing to take place before customers are expected to be live with the new features.

Hacker group Anonymous targets Children’s Hospital

Hacker group Anonymous is suspected of recent hacking attempts on Boston Children’s Hospital’s networks. Anonymous threatened to initiate attacks after a doctor from the hospital brought medical child-abuse charges against the parents of a patient, leading to the child being removed from the parent’s custody.

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April 27, 2014 Headlines 1 Comment

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