Morning Headlines 4/2/13

Doctors firing back at patients’ online critiques

The Boston Globe covers the story of a Boston-based surgeon who is suing her deceased patient’s husband after he posted an unflattering review of her care.

Mixed results on computer-based support for diabetes

Researchers at University College London complete a systematic review of 16 control trials exploring the effect online and mobile diabetes management tools have on overall disease management. The study concludes that the tools had a positive but minor effect on glycemic control, with computer-based tools resulting in a net 0.2 percent drop in HbA1c levels, while the mobile tools yielded a 0.5 percent decrease. Four in ten tools showed a positive effect on lipid panels. The tools had no measured effect on weight, health-related quality of life, or depression.

H.R. 1331: Electronic Health Records Improvement Act

HR 1331, a bill that if enacted will create a Meaningful Use hardship exemption for providers approaching retirement age and small physician practices, is getting lots of media attention this week despite being given one percent odds of making it to vote and zero percent odds of being enacted. Its identical predecessor, HR 6598, was proposed on November 16 and died in committee, which is where HR 1331 now resides.

MMRGlobal Expands Licensing Initiative in Advance of Stage 2 Meaningful Use Patient Engagement Requirements

MMRGlobal announces that it will ramp up efforts to cash in on its patient portal patents, specifically declaring that it will expand its licensing efforts to include hospitals, ambulatory surgical centers, laboratory systems, pharmacies, mass merchandisers and other vendors and providers.

HIStalk Interviews Mitch Morris, MD, Principal, Deloitte Consulting LLP

Mitchell Morris, MD is a principal with Deloitte Consulting LLP.

Tell me about yourself and the company.

I am a partner at Deloitte. I lead our health information technology practice.

My background is a little unusual. l started as a physician and was in academic practice for nearly two decades at MD Anderson Cancer Center. I  got very interested around problems of quality and efficiency in healthcare, as so many of us do, and what technology tools can be brought to bear to solve those problems.

I complained a lot, got put on a committee, kept complaining, and I was chairing the committee. Eventually they said, “Well, if you think you’re so smart, here’s a budget, you do it.” Over a period of years, I ended up being the chief information officer at MD Anderson, a post I held for about six years. I left for consulting in 2001. I have been with Deloitte for going on seven years now.

Most of us in hospitals think about Deloitte working with providers, but you have responsibility over pharma and medical devices as well. Do you a lot of issues that overlap with what we traditionally think of as healthcare IT?

Yes. It’s a fascinating time. One of the things about being at Deloitte, the nature of our company gives us exposure to some of the areas of convergence that are happening.

Some great examples are large health plans acquiring medical practices and even hospitals with an eye towards payment reform and accountable care. We’re seeing tremendous convergence there. We’re seeing a great level of interest in life sciences companies – pharma, biotech, devices — in better understanding and integrating with what goes on in the provider world. Their business models are driving them towards closer integration and accountable care is even a part of that. 

An interesting phenomenon to watch is academic clients — academic health centers and universities, who in a sense can be viewed as small biotech companies on their own as they have a research agenda — are also linking up the combination of genomic and phenotypic information from electronic health records with what goes on in the laboratory. 

It’s a pretty exciting time when you look at all of the different pieces that are in the mix. The driver of health reform making everyone go into a frenzy has created a lot of activity. It’s fun to get creative and innovative around it, but then it’s all sometimes a little frightening as to where we’re all headed and how much control we have over it. But it’s been a good time from that point of view to be a healthcare consultant.

Every kind of company is positioning themselves for whatever they think the healthcare system will look like. The roles are becoming blurred about who’s the provider and who’s the payer. Do you think all this is going to benefit patients?

That’s a great question and I don’t think there’s an easy answer. Certainly the current healthcare system is too fragmented, broken, and too expensive, so we needed to change. What I wonder about is how much pain we’re going to go through during the change process and how quickly we will get to something that actually does help patients.

I think at the end it will help patients and consumers. Part of it also is your perspective. In the US, we tend to have a perspective of healthcare from the point of view of the individual. What’s going to happen to me or my loved one and what can I access for them? Most other countries have the perspective of the population. I’ve got a bucket of money. I have a population I need to serve. How can I do the most good with the bucket of money I have? 

As we transition as a country from a very individual view of healthcare — that we do everything for everyone — to a more population-based view of population health management, another common term along with accountable care, there’s definitely some pain that we will go through and some careful examination of our values as consumers and providers of healthcare as to what we think is most important. I’s a not easy decision ahead of us on that score, I don’t think.

Most of the science of public health was developed in this country, yet most of it gets exported to other countries whose citizens accept that concept better than ours. Is there a movement that suggests we will begin to behave more like a public health organization?

There are signs that Health and Human Services is directing funding to that end. I think the different iterations of value-based care, whether it’s accountable care organizations or other forms of value-based payment systems, are a step in that direction. The formation of the PCORI and their funding and pushing clinical effectiveness studies and the regulatory pieces that are coming out for pharma and for healthcare providers around clinical effectiveness are pushing us in the right direction. We make decisions and consumers make decisions not based on what they saw on the television commercial for that new drug, but rather let’s look at some data and see not just from a Phase III clinical trial but actually out in the market, what’s the most effective way to spend our healthcare dollar to be most helpful?

The pace sometimes seems fast to us, but I think it’s proceeding fairly slowly. I think an open question is this. We get to 2014 and as the health insurance exchanges kick in and more people have access to care, there will be further pressure on reimbursement. The whole sequestration issue in Washington right now is having a big impact on that as well with a 2 percent Medicare cut.

I think those things are going to be drivers in the marketplace to accelerate the adoption of some these other approaches to reimbursement and care in general. It has a potential to move faster than it is, but one thing I’ve been guilty of in the past is thinking things will happen faster than they will. I wouldn’t be surprised if change continues to be at a relatively slow pace and maybe that’s a good thing.

Are we putting too much faith in both the motivation and the ability of providers to use business intelligence and analytics to improve outcomes and reduce costs?

You probably went to HIMSS and a lot of your readers did. I think at least half the industrial exhibits there had the word “analytics” on the booth somewhere. There’s certainly a great deal of interest, but also a fair amount of hype.

The question will be when provider organizations in particular have to continue their march towards Meaningful Use, they have to deal with ICD-10, they have to deal with shrinking reimbursements and their cost-reduction initiatives –are they going to be willing to spend on things that are not required to do? If they do spend something, will it be a minimalist approach or a more comprehensive approach towards analytics?

Trying to run a healthcare organization today without good at analytics is like flying a plane blind. But I haven’t seen a huge change in organizations’ willingness to significantly invest in this.

The good news is with all the competition that’s out there creating solutions, that’s driving prices of solutions around analytics down. You don’t have to spend millions of dollars. There are out-of-the-box things that can help you, for example, analyze your revenue cycle or analyze readmissions or fill in the blank of what your current problem is. 

To  do a comprehensive approach to solve the analytics problem at an organizational level requires some investment, careful thought, and careful adjustments of governance and organizational structure to make it work. I think we’re ways away, but as measured by the interest at HIMSS, it seems like a lot of people are talking about it, that’s for sure.

Do you expect to see any new government involvement with healthcare IT issues, for example usability or FDA regulation?

As we take each federal agency, I think FDA has a strategy that they are enacting at a careful pace that will include a greater degree of regulation and oversight and a broadening of what they provide oversight for. I think in terms of what comes out of ONC and the rest of Health and Human Services, it’s hard to guess what kinds of things will come out from them. I think they pretty much have a full plate right now, but I wouldn’t want to speak for what their intentions are. Deloitte does a lot of work for those organizations, so I feel it will be improper for me to speculate.

What’s your overall thought on Meaningful Use as a program?

It certainly stimulated a lot of spending and a lot of progress. It’s far from being perfect, but I think overall it has driven a lot of benefit and organizations that had been taking a wait-and-see or very slow approach to the adoption of electronic health records –and certainly in the case of medical practices — it’s really accelerating things. 

The challenge that we have as an industry is not just getting in a system and checking the boxes on the Meaningful Use attestation document, but being able to really say as a group medical practice or as a hospital system, we’re driving benefits around quality and efficiency by using a system that we didn’t we have before.

While there are examples of electronic health records achieving benefits, there are also examples where it didn’t work out so well. It’s frustrating for me personally that as an industry, we haven’t done a better job of showing a broad and widespread benefit. We shouldn’t even be asking this question, and debating is kind of shameful in a way. 

The good news is most organizations I’m working with and our teams at Deloitte are working with are showing really great progress. It’s happening at a much faster pace because of the federal funding compared to prior to that. The maturity of the software also has a lot to do with it today, too.

Other than the minimal requirements for Meaningful Use, are providers showing an interest in technologies that engage and motivate consumers or patients directly?

I think that’s emerging. In terms of working directly with consumers, some of the healthcare organizations — and I’ll include health plans in this — that are a little more on innovator side are really looking at solutions that involve mobile technologies that go into the home or to the workplace and help with wellness and chronic disease management. There’s plenty of examples of where those things have been successfully implemented. 

As we get towards more mature versions of accountable care, linking together all the providers in a consumer’s ecosystem that they deal with and allowing things to happen at home or retail settings is a tremendous advance. A lot of that is technology enabled. You can’t do it without technology.

We’re still at the early stages of developing transactional systems that advance the agenda around population health management. We’ve got some pretty good back-end analytics stuff that we’re capable of doing today. We still have a way to go on on the transactional side. 

Part of it is that interoperability is still off in the future somewhere. Every community has a bunch of different systems that they have to put together, so that that makes it challenging. But there are some interesting emerging technologies from several software vendors that, as they mature, are going to bear some fruit.

What healthcare IT changes do you predict over a three- to five-year timeline?

It’s always difficult to predict disruptive things that might come along. Barring that, I look at what our clients are really challenged with. Managing and reducing cost is a huge issue, not just of IT, but overall. Being able to manage IT spend, looking and doing that through selective sourcing, making sure the organization is firing on all cylinders, being able to support analytics for your organization to reduce cost, making sure the revenue cycle systems are firing on all cylinders. Those things are going to be tremendously important.

We see the healthcare industry consolidating. At Deloitte, we have very large merger and acquisition practice. They’re tremendously busy, and we are doing a lot of post-merger integration. When all of the consolidation occurred in the 1990s, very often there wasn’t consolidation of IT and supply chain and HR, etc. Now because of the cost drivers, as we are seeing medical groups consolidate, hospitals consolidate, health plans consolidate, they are all trying to figure out, how do we get IT to be a key enabler of the efficiencies that we expect to gain from the merger or the acquisition? We’ll see a lot of that.

Preparing for value-based payments through accountable care and all the analytics need to support that we’ve already touched on. Convergence with the health plans and life sciences will be another significant driver. What’s going to wind down a little bit as this big round of primary implementations gets finished for Meaningful Use around clinical systems, that work will diminish, although there’s still a lot of optimization work that can be done out there. “I installed Epic, Cerner, fill-in-the-blank system, but to really get the benefit I expected, I need to spend more time looking at workflow and efficiency and quality and decision support. I think that’s work that I will spend time on.”

ICD-10 is going to wind down. I think mobility is going to crank up. The whole layer of coordinating care at the population level rather than at the facility level will create some opportunities for existing software companies, there will probably be some new entrants into the market who are able to beyond what an HIE does, really coordinate the care and the workflow beyond the walls of an organization. There’s multiple pieces of the provider supply chain taking care of people out there.That will be a really interesting one to watch.

At the Deloitte Center for Health Solutions, we recently released some work by Dr. Harry Greenspun that interviewed some CIOs of large systems and what they’re thinking. Some of the things I’m saying are reflected in that, and as well as some of challenge, which is juggling so many different priorities. I think one of the challenges our CIOs and healthcare today face, if you ask them what’s their number one priority, they’ll list 10 things because they’ve got so many things they have to do. That competing set of priorities that are all number one gets reflected in everything that we’re doing in the industry, and everybody who works in it is a reflection of all those things that are going on in healthcare. Those things are fun, but also a headache at the same time.

EHR Design Talk with Dr. Rick 4/1/13

The Text-Based Workaround

We have been considering two fundamentally different designs for presenting a patient’s past and present medical issues over time — the Snapshot-in-Time design and the Overview-by-Category design.

I have tried to make the case that the Snapshot-in-Time design, although rarely used as a high-level EHR paradigm, does a much better job than the widely adopted Overview-by-Category design for two reasons:

1) Clinicians think of the patient’s health as a story – a narrative of how things got to be the way they are. Each patient’s story is rich, complex, and unique. By presenting the patient’s story as a series of snapshots in time, this rich narrative gradually unfolds, a little like turning the pages of a picture book.

2) The Snapshot-in-Time design, when combined with assigning each category of data to a fixed location on the screen or page (see Why T-Sheets Work), allows us to take it in and process information using the fast visual processing part of our brain. In contrast, the Overview-by-Category design compels us to use slower cognitive processing.

In my last post, I wrote that perhaps due to the limitations inherent in the Overview-by-Category design, most EHRs that employ it also provide a workaround solution. This workaround is nothing other than a text-based chart note generated by the EHR.

For each patient encounter, the EHR can generate a single, relatively comprehensive text-based document assembled from the previously-entered structured data.

These text-based documents are typically in Microsoft Word or PDF format. They can be viewed on the monitor from within the EHR application, printed, or sent electronically as PDFs.

Although these text-based EHR chart notes are snapshots in time (unlike the Overview-by-Category EHR screens), they usually have significant problems, including:

• low data density
• non-interactive design
• poor spatial organization and layout

In this and the next several posts, I will address these issues by presenting mockups of text-based chart notes, based on the design of several well-known EHRs.

The mockups use the same patient database that I used for the Snapshot-in-Time and the Overview-by-Category mockups. While these examples are for an ambulatory patient, similar designs are common in hospital-based EHR systems.

In order to see the mockups and read the accompanying text, enlarge them to full screen size by clicking on the ‘full screen’ button in the lower right corner of the SlideShare frame below.

Rick Weinhaus MD practices clinical ophthalmology in the Boston area. He trained at Harvard Medical School, The Massachusetts Eye and Ear Infirmary, and the Neuroscience Unit of the Schepens Eye Research Institute. He writes on how to design simple, powerful, elegant user interfaces for electronic health records (EHRs) by applying our understanding of human perception and cognition. He welcomes your comments and thoughts on this post and on EHR usability issues. E-mail Dr. Rick.

Curbside Consult with Dr. Jayne 4/1/13

Every time I am invited to present at the hospital’s quarterly medical staff meeting, I feel like I should wear personal protective equipment. No one is hurling rotten tomatoes when we talk about EHR, but the verbal assault can be equally messy.

I was asked to present at the recent meeting with the goal of discussing our ICD-10 transition plan. Despite previous mistakes by our (now-disbanded) ICD-10 Task Force, our new team is confident that our vendor is ahead of the pack. I thought I would escape without too much drama. Thoughts of melting snow and approaching spring weather must have tricked me into forgetting the tendency of my colleagues to go completely off the agenda.

When we implemented EHR, we carefully audited the coding/billing functionality to make sure that not only did it adhere to CMS guidelines, but to the stringent standards of our auditors. We manually audited behind any computer-assisted coding for a period of time until we were comfortable that the algorithms were appropriate. At that point we discontinued full audits, but continued spot audits on high-dollar or high-risk episodes of care. We also continued our regular audit protocol where each physician had a set of charts audited each quarter with coding feedback delivered from our teams.

When the EHR was initially deployed, we saw a shift in the distribution of ambulatory Evaluation and Management codes, but this was expected. It also matched with published data that showed primary care physicians tend to under-document the care they deliver. We were happier with our increased documentation of the care we were appropriately providing.

Over time our EHR has matured and has had added to it a variety of individualized order sets, care plans, patient instructions, and documentation macros that allow our users to personalize their notes. Our coders have stayed on their toes, making sure visit documentation continues to be individualized despite these labor-saving features. We definitely don’t want to fall victim to the problems that can arise from cloned documentation or any other inappropriate use of the EHR.

Since we’ve been live so long and our medical staff has grown so much, many of our newer colleagues didn’t go through this initial auditing process and don’t understand the ongoing auditing that is in place. Without this comfort level with the EHR, they are extremely nervous about what will happen with ICD-10. Our EHR is moving to a new level of assisted coding to aid with the transition. 

People are, for lack of a better description, freaked out. The question and answer period following my ICD-10 presentation spiraled into paranoia and outright fear.

Providers have long been worried about audits that would demand large repayment sums based on a sampling of charts. Now they are worried about criminal prosecution on top of financial penalties and potential exclusion from federal health care programs. Several more vocal colleagues demanded that we go back to 100 percent chart review by certified coders, which is just not tenable given recent budget cuts. Others asked the medical staff to consider endowing a legal defense fund.

Fear of law suits has led to exorbitant health care costs through the practice of defensive medicine. Fear of audits will lead to more spending on non-patient-facing services such as chart reviews and coding audits. I for one would rather spend my healthcare dollar lowering the patient-to-nurse ratio and decreasing preventable harms. What do you think about the increase in audits related to the increase in EHR documentation? E-mail me.

E-mail Dr. Jayne.

Morning Headlines 4/1/13

Death of patient at Royal Derby Hospital leads to new system ‘to alert staff of medication needs’

In England, the Royal Derby Hospital implements an eMAR system after a patient’s DVT prophylaxis medication was skipped three times over nine days. During her stay the patient fell, broke her hip and then subsequently developed a fatal pulmonary embolism.  The coroner found that even though the appropriate fall precautions had been in place, the omission of DVT prophylactics "more than minimally contributed to the development of the DVT and was therefore a contributing factor in her death."

Hospitals Question Medicare Rules on Readmissions

An article in the New York Times questions the fairness of CMS’s new readmissions penalties, citing critics that say hospitals should be looking for ways to improve care for patients who are still in the hospital rather than managing the patients’ personal lives post-discharge. The article also questions the fairness of using readmission rates as a basis for penalizing hospitals. It does, however, acknowledge that since CMS’s October initiation of penalties, readmission rates have dropped from 19 percent to 17.8 percent.

Hospital implementing new electronic health record system

49-bed Keokua Area Hospital, of Keokua, IA, goes live with CPSI.

Tablet Computers Acceptable for Reading EEG Results, Mayo Clinic Study Says

Mayo Clinic physicians in Arizona have shown that tablet computers can be used to analyze EEG results. The objective of their study was to determine whether a tablet is an acceptable alternative to a laptop for remote EEG interpretation. The findings showed that the tablet cost significantly less and weighed less and had a comparable screen resolution as compared to the laptop.

Monday Morning Update 4/1/13

From DailyShowFan: “Re: Daily Show. Did anyone see the 3/27 segment where Jon Stewart, a steady advocate for veterans’ rights, takes on the interoperability challenge with AHLTA (DoD) and VistA (VA)? Sad reality, but it’s good to see him bringing this specific healthcare IT issue to wider attention.”

From KB: “Re: St. Mary’s Hospital, Waterbury, CT. Finally pulled the trigger to put down their awful, botched [vendor name omitted] LIS after being live only eight months. They just signed a $1million+ contract for Sunquest.” Unverified.

From The PACS Designer “Re: Qubole. A next-generation cloud service focusing on building a new cloud data platform is Qubole. Their solutions use Hadoop, Hive, and Pig software to solve Big Data issues for cloud services.”

Half of readers have contacted their primary care provider via e-mail or secure messaging. New poll to your right: do you expect to stop working for your current employer in the next 12 months?

Meditech specialist Park Place International leases space in Worcester, MA for what will apparently become the company’s US headquarters, logically positioned near Meditech.

ONC seeks public input as it updates the Federal Health IT Strategic Plan, allowing reading and adding comments for 10 topics related to consumer e-Health

In the UK, Royal Derby Hospital implements an electronic MAR after an inquest determines that a contributing factor to the fall-related death of an 89-year-old patient was three missed doses of enoxaparin.

A Mayo Clinic study finds that tablet computers can be used to analyze EEG results outside the hospital or clinic.

A New York Times article questions whether hospitals should be held financially responsible for managing readmissions by, as it says, “managing the personal lives of patients once they are released” instead of focusing on other ways to improve care. Experts drily note hospitals with high mortality rates would appear to be more successful in managing health since dead patients can’t be readmitted. A health policy expert says readmission metrics are convenient, but not accurate.

Keokuk Area Hospital (IA) goes live on CPSI.

Medseek’s Client Congress will be held in Austin, TX April 15-17.

A former Apple employee recounts in a story called “2 Letters from Steve” the touching story of e-mailing Steve Jobs in 2010 to ask if he could take an iPad, which had not yet been released and thus was highly secured, to show a terminally ill friend who was not expected to live out the week. He received the above response three minutes later.

Vince continues with the HIS-tory of Meditech this week.

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

More news: HIStalk Practice, HIStalk Connect.

Readers Write: Get Ahead with Mobile Job Hunting

Get Ahead with Mobile Job Hunting
By John Yurkschatt

According to a recent report from The World Bank, three quarters of the world now has access to a mobile phone. In addition, ownership of multiple mobile devices is becoming increasingly common, suggesting that their number will soon exceed that of the human population. Unbelievable, right?

Recently, at HIMSS, I encountered numerous people who were there to network about jobs in the industry. While speaking with many, I couldn’t help but notice that they were checking their smartphones often during our conversation. It became apparent that they were engaged in mobile networking at HIMSS as well. In fact, today’s job seekers are avidly using the following job related functions on their smartphones:

1. Search for jobs

2. Receive e-mail job alerts

3. Read about recruitment process and tips for interviewing

4. Apply for jobs

5. Share content on social networks such as Twitter

In the age of mobile technology, the job hunt is only a click away. The rise of mobile technology is changing the face of how job seekers conduct their search and how employers and recruiters are reaching out to top talent.

Savvy job seekers are using a number of mobile apps. I found three apps to be extraordinarily powerful for the job hunt and for meeting those people who have the jobs:

Hidden Jobs

This app provides you with job opportunities that are not posted on the company website. It tracks close to 2 million unadvertised jobs from companies that are growing and making headlines. In addition, if you are ever seeking a job at a particular organization, or within a geographic area, you must try Hidden Jobs.

LunchMeet

According to its site, LunchMeet is a great tool for talent hunters; job seekers; career development professionals; entrepreneurs; people who seek or offer free consultation over lunch or drinks; business school students; business development, sales, and marketing people; and anyone who is interested in strengthening and expanding their professional network.

Sonar

While this app is not necessarily a job search tool, it is the ultimate app to have while attending a conference. In fact, some job networkers at HIMSS found this app handy. Having Sonar enables like-minded individuals to easily connect while attending a conference, or within a certain geographic location. If I were in a networking frenzy, I would turn on my Sonar app and look for folks with similar interests. It is a great way to meet people you may have not known prior to arriving at the conference.

Let’s face it, mobile technology is changing the way people search for jobs and the way companies search for talent. It will only grow in popularity. Get a step ahead, or maybe, don’t get left behind. Take your job search mobile.

John Yurkschatt is project coordinator with Direct Consulting Associates.

Time Capsule: The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now

I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).

I wrote this piece in August 2008.

The Olympics as a Project Management Lesson: Those Chinese Would Have Had Your Clinical Systems Live By Now
By Mr. HIStalk

I don’t follow sports much. In fact, I might be the only American who didn’t watch any of the Olympics, other than a little of the women’s nude … uhh, beach … volleyball (I think the US beat some other teams, but I’m not really sure since they kept running back and forth under the net while I was distracted).

Actually, I did watch the closing ceremonies, having little choice because I had bartered away my evening TV rights to Mrs. HIStalk in return for being allowed to watch an Andy Griffith Show mini-marathon that preceded it (“The Pickle Story” episode was a key bargaining point in the protracted negotiations).

I’m glad I tuned in to watch the torch get snuffed. It held a valuable lesson (beyond the inevitability of aging, as evidenced by Jimmy Page’s frightful-looking gray hair).

The lesson is this: given resources and strictly followed project management principles, human achievement is nearly limitless.

Evidence was everywhere. China spent $40 billion on everything from infrastructure to costumes. The closing ceremony was so tightly scheduled and scripted that the elaborate equipment and cast of thousands could not be assembled until right before the show, with no time for on-site practice. Clips of memorable performances (all of victorious Americans, given the homer TV coverage) were a reminder of the incredible logistics of transportation, construction, lodging, computing, scheduling, media support, and preparation that rivaled and maybe even exceeded the obviously impressive human performance of the competitors.

If there was a project management Olympics, this Olympics would have brought home the gold. Everything was finished on time, it worked, and there was little evidence of what must have been hundreds of backstage arguments, compromises, and last-minute changes over several years. There were no excuses, extensions, or exclusions.

I bet you wish your last big project went that well. Me, too. In fact, I jotted down some thoughts about why China can orchestrate a picture-perfect Olympics while the average hospital can’t get its IT projects finished:

• Ruthless project management. Chinese leaders aren’t generally known as laid back cut-ups, so I’m assuming the pressure to deliver was excruciating.
• Unlimited budget. There’s no way costs could have been estimated accurately, so it must have boiled down to “whatever it takes.”
• Tons of dedicated employees and volunteers. China has over a billion people to choose from, none of whom have the “no, thanks” option.
• Individual and national pride was on the line.
• Would-be naysayers who were too scared to whine about the impossibility of it all, which left just shutting up and doing what they were told.
• A hard-stop, no-excuses, immovable deadline with the highly visible result beamed to the entire civilized world.

IT leaders probably shouldn’t rush out and declare themselves supreme ruler or demand billions of dollars just to get a project finished. Still, the Olympics would have failed if the goals were unclear, the money tight, or people stretched.

The lesson is that CIOs can do anything if given the right resources, requirements, and control. That is, if they bring highly polished expertise in planning, communication, and project management to the table. Anything less isn’t the Olympics; it’s more like professional wrestling.

My beach volleyball game would have suffered without these things. It might have been played on asphalt instead of sand because someone forgot to order it. It might have resulted in a tie because inexperienced scorers forgot to write down the points. And, it might have featured players wearing track suits because incompetent security guards allowed the team’s uniforms to be stolen from the coach’s wallet.

Morning Headlines 3/29/13

Lahey Health Invests in New Electronic Health Record System for Better Coordinated Care

Lahey Health announces that it will implement Epic across its health system beginning in June of 2013.

MEDHOST Names Barbara Bryan Vice President of Consulting

Barbara Bryan (Bryan Advisory Group) joins MEDHOST as VP of consulting. She will initially focus on integrating consulting services into the sales and delivery cycle of MEDHOST’s new patient throughput solution PatientFlow HD.

Empower Individuals through Health IT to Improve Health and Health Care

ONC launches the Planning Room, a website designed to collect public input on the federal health IT strategic plan.

Wolters Kluwer’s online move injects life into health business

Wolters Kluwer is seeing promising returns as it moves its health publishing content sales from paper to the web.

News 3/29/13

Top News

Caradigm will integrate Orion’s HIE solution with its Caradigm Intelligence Platform (CIP, formerly Amalga) and resell the Orion product. Orion will resell and provide services for CIP and Caradigm’s identity and access management solutions in New Zealand, Australia, and certain Asian countries. Orion will also develop decision support, population health, and quality improvement for CIP and promote CIP to its HIE prospects and customers. Caradigm has also decided not to commercialize the Qualibria knowledge solution product and will instead incorporate it into CIP, which will result in elimination and reassignment of an unspecified number of employee positions in product planning and engineering operations. The Salt Lake City newspaper says 70 percent of the company’s Utah employees, about 40 to 50 people, were laid off Wednesday.

Reader Comments

From Jasmine Gee: “Re: athenahealth’s attestation numbers. To answer readers’ doubts about how many of our Medicare Part B physicians using athenaClinicals are participating in MU, the answer is about 70 percent. That’s over 5,000 total Medicare Part B physicians. The remaining 30 percent are Medicare Part B physicians who bill so few Medicare claims that their incentive check would be tiny, so they’ve declined to pursue Medicare MU. Remember: the maximum Medicare MU incentive payment is 75 percent of billed Part B charges for the program year, with a cap based on when you start.” Jasmine is the product marketing director for athenaclinicals and was responding to recent comments from readers questioning the legitimacy of athenahealth’s claim that 96 percent of its participating providers have successfully attested for MU.

From ForEclipsii: “Re: delayed go-live at the new Royal Adelaide Hospital in Australia. I believe that the application in question is actually the brand-new Sunrise Financial Manager which rolled out a few months ago. People working on it were told to drop everything and work on a version for Australia.” Unverified, but that makes sense based on the newspaper article, the mention of billing issues, and the earlier Allscripts contract.

HIStalk Announcements and Requests

We opened a HIStalk Practice reader survey, which is different than the HIStalk survey we ran a couple of weeks ago. If you are a HIStalk Practice reader (and you should be!) please take 60 seconds to give us your input. Thanks.

Some of the HIStalk Practice goodies from the last week include: hospital-owned physician practices in Kentucky are losing as much as $100,000 per year per doctor. The Wall Street Journal examines patient-physician e-mail communications. The NCQA extends its PCMH recognition program to specialty physicians. The average turnover for physicians in 2012 was 6.8 percent, compared to 11.5 percent for PAs and NPs. Michael Brozino, CEO of simplifyMD, discusses his company, its technology, and the state of the EMR industry. DrFirst President G. Cameron Deemer shares insights on e-prescribing, EMR vendor consolidation, and the impact of government incentive programs. Take a moment and click on an ad or two – one of our sponsors may have a product or service that makes your life better. Thanks for reading.

On the Jobs Board: Senior Director Clinical Project Management, Product Manager, VP of Sales and Channel Development.

I’m looking for someone who can help produce Webinars and perhaps do some other paid part-time work. Industry experience would be nice but probably isn’t essential, although excellent writing, speaking, marketing, and organizational skills are. E-mail me.

Acquisitions, Funding, Business, and Stock

ReadyDock will receive $150,000 in pre-seed funding from Connecticut Innovations to continue development and marketing of its devices for disinfecting, charging,and storing computer tablets.

Bankrupt Raleigh, NC-based EMR vendor E-Cast, which had annual revenue of $4 million as late as 2006, is winding down after the business is sold to Global Record Systems LLC for $100,000.

Sales

Safeway will roll out the SoloHealth Station kiosk to 700 of its stores, giving customers access to free health screenings and personalized assessments.

Kettering Health Network extends its relationship with MedAssets for its revenue cycle management and workflow services.

Philips earns a fourth-year option worth $77 million to provide patient monitoring systems and training to the Department of Defense.

Lahey Health (NH) announces officially that it has signed with Epic, which will apparently replace Allscripts in both its hospitals and practices.

People

MEDHOST hires Barbara Bryan (Bryan Advisory Group/Eclipsys) as VP of consulting.

David Joyner (Blue Shield of California) joins Hill Physicians Group (CA) as COO, replacing the recently promoted CEO Darryl Cardoza.

Mobile Heartbeat names Jamie Brasseal (Dell Healthcare and Life Sciences) as VP of its western region.

Announcements and Implementations

Drchrono will incorporate digitized patient education material developed by Mayo Clinic into its EHR.

Five healthcare organizations will participate in the pilot phase of Tennessee’s Health eShare Direct Project, spearheaded by the Tennessee REC.

Children’s Hospital at London Health Sciences Centre in Ontario implements Upopolis, a social networking tool for children receiving care in hospitals that is powered by TELUS Health.

Vibra Healthcare completes the first phase of deployment of PatientKeeper NoteWriter electronic documentation software across four of its long term acute care hospitals.

Cerner will integrate print spooling software from Plus Technologies into Millennium to streamline print operations.

ACS MediHealth will work with Troy Group to develop prescription printing solutions for Meditech.

Government and Politics

ONC announces Planning Room, a Website launched in collaboration with Cornell University to allow public input on the federal HIT strategic plan.

Two North Carolina state senators introduce a bill that would require hospitals to post on the state’s HIE their pricing for common procedures and their typical reimbursements from health plans.

Other

An NPR article covers the massive increase in the number of Americans who are receiving government disability payments for often questionable reasons such as unverifiable back pain or mental illness, with 14 million citizens now being mailed a monthly federal check without even being counted among the unemployed. The article concludes that disability “has become a de facto welfare program for people without a lot of education or job skills,” with fewer than 1 percent of recipients from early 2011 having returned to the workforce.

CNN profiles St. Louis-based Advanced ICU Care, which offers tele-ICU services.

A Reuters article finds that Wolters Kluwer is able to make good profits in healthcare because its medical references are moving from printed to electronic form, with 100 medical journals offered as iPad apps. The company says demand is increasing because apps allow teaching procedures by video, which also allows the company to sell more targeted advertising.

Studies published in JAMA find that not only has a mandatory reduction in medical resident working hours failed to improve their depression rates or sleep patterns, it has also been associated with an increase of medical errors of up to 20 percent. One possible explanation is the unintended consequence of hospitals expecting their residents get the same work done in less time.

In Canada, an Alberta ED doctor is suspended for looking up the electronic medical records of patients she wasn’t treating. She was caught when a patient asked for a copy of his access log and found that nine doctors, none of whom were treating him, had looked at his files. The hospital determined that the ED doctor was using workstations that her colleagues had left logged on.

The New York Times says radiology residents are beginning to realize that the heyday of big money for minimal work is over due to Medicare cuts, technology-driven competition, teleradiology, and demands to move public money from specialties to primary care. Financially motivated medical students pursing the high-paying, procedure-based ROAD specialties (radiology, ophthalmology, anesthesiology, and dermatology) are all seeing average incomes dropping steeply with the exception of the less Medicare-dependent dermatology.

The NHS pays for a woman’s $7,260 breast implant operation after convincing doctors that her 32A chest size had put her in a state of emotional distress that could be alleviated only by an upgrade to 36DDs. The mother of two now intends to leave her children with her parents, move to London, and pursue a modeling career. She referred to TV star Katie Price in her statement: “I want the world to see the new me and want money and fame just like Katie. I can’t thank the NHS enough for giving them to me.” I can’t claim emotional distress, but perhaps I should consider moving to the UK so I could be a more successful anonymous blogger.

Weird News Andy says “some might call it murder.” A doctor in Brazil is charged with seven murders and is suspected of hundreds more as a hospital’s ICU team routinely freed up beds by administering muscle relaxants to patients and then turning off their oxygen supply. Prosecutors released the doctor’s wiretapped telephone conversations that included, “"I want to clear the intensive care unit. It’s making me itch. Unfortunately, our mission is to be go-betweens on the springboard to the next life.” WNA is also curious who approved a patient’s breast enlargement procedure when 1,200 people have starved to death in NHS hospitals “because nurses are to busy to feed patients.”

It’s like the postmortem version of fake Facebook friends: a UK company offers rent-a-mourners to families who want the funerals of their loved ones to be better attended or to “increase perceived popularity.” Actors, who are billed at $68 for a two-hour funeral or wake, are briefed about the deceased and trained to chat convincingly with real family and friends.

Sponsor Updates

• Minnesota Public Radio profiles Intelligent Insites and how its real-time operational intelligence software will be used in 152 VA hospitals.
• Regions Hospital (MN) reports that its use of Besler Consulting’s BVerified Transfer DRG and IME tools have resulted in significant revenue recoveries.
• The LDM Group discusses the rapid growth rate of e-prescribing across healthcare.
• API Healthcare’s President and CEO J.P. Fingado shares tips on increasing operational effectiveness with the healthcare workforce information exchange in an April 2 Webinar. 
• The Albuquerque Journal spotlights Seamless Medical Systems and its SNAP iPad app for capturing patient data.
• Eric Venn-Watson MD, AirStrip’s VP of clinical transformation, discusses how private healthcare could benefit from the US military’s cutting-edge health technologies.
• Gary Palgon, VP of healthcare solutions for Liaison Healthcare Informatics, discusses how data integration can help organizations reduce readmission rates.
• eClinicalWorks opens a website for its 2013 National Users Conference in San Antonio October 11-14.
• Frost & Sullivan publishes a white paper on the impact of ClinicalKey, Elsevier’s clinical insight engine.
• Impact Advisors Principal Laura Kreofsky discusses the privacy and security risks of social medicine and Senior Advisor Ryan Ulteg offers insight into the financial implications of ICD-10 implementations for physicians.
• ADP AdvancedMD launches a website that provides a timeline for practices as they prepare for the ICD-10 transition.
• Access chooses CoSentry as its cloud and data center services provider.

EPtalk  by Dr. Jayne

I didn’t have a lot of time to search for newsy tidbits this week because I was heads-down in CMS FAQs. As usual with government programs, now that money is flowing, audits have been introduced to try to recoup any inappropriate payments. My hospital is very concerned by the answers to the “Will there be audits” question, so I thought I’d share the highlights:

• Yes, there will be audits.
• You will need to have scads of documentation and it needs to be retained for six years.
• Contractors will be involved in auditing. If you already have post-traumatic stress disorder from heavy-handed RAC audits, I feel for you. They’re leaving the door wide open for abuse: “The level of the audit review may depend on a number of factors, and it is not possible to include an all-inclusive list of supporting documents.”
• Audit requests will come via e-mail from a CMS address. The e-mail used when registering for the EHR Incentive Program will be used for the initial request. If you put your physician’s e-mail address in the box, make sure she or he knows to be on the lookout for this and check your spam filters. Further communication will be through a secure communication process.
• You need to maintain documentation that supports the values you used for CQMs and payment calculations.
• Individual patient records may be requested for review.
• On-site reviews at the practice or hospital, including a demonstration of the EHR system, may be requested. For those of you gaming the system by turning on features just for your attestation period, this could come back at you unless you can re-create exactly the way you were configured at the time of attestation.
• Separate audit processes apply for Medicaid.

One of my CMIO colleagues received a hospital request in the fall. It was a spreadsheet that seemed pretty simple, but ended up requiring a ridiculous amount of data. She shared it with me confidentially. I loved the request that the reports include the EHR vendor’s logo to “prove” that it came from the EHR. If people are going to be fraudulent, I think they would be smart enough to dummy that up.

Despite clearly worded responses, the auditors didn’t understand the hospital’s answers or the math behind the calculations. They rejected spreadsheet data and insisted on screenshots from the application, or alternatively screenshots that showed a user exporting the data to spreadsheet. Again, do they not think screenshots are easy to fake? Maybe the hospital needs to film the user running the report and post it on YouTube for the auditor’s viewing pleasure.

From her recount, the auditors had all the power, and even having the vendor step in to provide supporting documentation didn’t help. MU is all or none – if there is a single discrepancy, you have to return all the money. It’s the equivalent taking a class and being expected to score 100 percent on every quiz, paper, and exam, including the final.

I hope CMS understands a simple principle about perfection that we learned in medical school — it doesn’t matter if all the lab numbers look great but the patient is dead.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 3/28/13

Caradigm Kills eHealth, Partners with Orion

Caradigm, the Microsoft and GE Healthcare collaboration, announces a partnership with Orion Health wherein Caradigm will go to market with Orion Health’s HIE solution rather than its own poorly performing eHealth HIE solution, which will be sunset.

‘Big Data’ for Cancer Care

The American Society of Clinical Oncologists announces that it is joining a Big Data movement by compiling data from hundreds of thousands of cancer patients to bring a new searchable resource to oncologists looking to review treatment strategies for their patients.

Healthcare Workarounds Expose EHR Flaws

A Journal of American Medical Informatics Association study explores workarounds frequently adopted by clinicians using EHR software and studies the various reasons that the workarounds were needed in the first place. Often, the study found, they were needed due to a lack of functionality within the the HER. Sometimes, however, it was just more efficient to employ the workaround than to follow the designed workflow. Other workarounds were built into the clinicians’ workflow to help them remember to complete tasks or to allow them to bring information into the examination room, where they would sometimes be without a computer.

CMS Focuses On Fraud Associated With Increased Use Of Electronic Health Records

Acting CMS Administrator Marilyn Tavenner reiterates that CMS will conduct audits of the billing practices of EHR-using providers. These "small, targeted audits" will take place in parallel with the Meaningful Use audit program that started in July 2012.

CIO Unplugged 3/27/13

The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Panel Pitfalls and How to Avoid Them

Have you ever attended a panel with anticipation but then ended up wanting to walk out? Well, I’ve participated on a panel and I have walked out.

Panels carry great potential, yet the benefits are seldom realized.

Not long ago, I was part of a panel for a prestigious graduate school career day. The moderator asked us to prepare a five-minute oral overview on our respective organizations and roles. He knew the students would have ample questions and preferred that the panel react to student interests.

We all stayed inside the time boundaries until the final participant. He approached the lectern and began a forced march, death-by-PowerPoint presentation. After 10 minutes, I started catching up on e-mail and Twitter. After 20 minutes, I left the panel and sat in the audience, incredulous. When I left the room at 30 minutes, the panelist was still pontificating and the students had long since checked out.

Shortly thereafter, I was on another panel testifying before the Texas Senate. My fellow panelist asked me beforehand to stay within my time limit because she wanted a fair shot to share her views. That was brash, but I admired her approach. We agreed to split the time, each taking 20 minutes. I also deferred to her, and she spoke first.

At the 25-minute mark, I became slightly annoyed and made subtle motions to get her attention. At the 30-minute mark, I was scrambling to rewrite my script. In the end, I had five minutes. I suppose her earlier brashness should have tipped me off.

I’m sure you have similar stories as an observer or a participant. When a panel hits the mark, I leave fulfilled. When they don’t, I feel as if I’ve squandered my most precious resource.

What’s worse than listening to a bad panel? Participating on a bad panel. Here’s a sprinkling of ideas to help avoid panel pitfalls:

• Moderator. Like an orchestra conductor, the moderator is the key to making the panel work. Ensure the moderator is qualified and skilled to keep the panel focused and effective.
• Practice. I noticed that professional moderators engage panelists, individually and as a group, long before the actual event. They query questions in advance and discuss them in warm-up meetings. Ground rules are established.
• Debate I. I want to pound my head on the table when a panelist says, “I agree with (insert name)” and then goes on to repeat the same point. The value of the panel is in its diversity and getting multiple opinions. If you have nothing new to add, don’t talk.
• Debate II. An alternative approach is to have the moderator present an opinion and and encourage contrarian viewpoints.
• Sound bytes. Strong responses need not take longer than two minutes. Short, to-the-point answers are always best and memorable.
• Size matters. The ideal panel size is three or four. Anything less becomes a speech; anything more becomes annoying.
• Move on. Not every question requires a response from each panelist. See “Debate.”
• PowerPoint. No.
• Furniture. A panel is about the panelists. Tables are a distraction. A row of chairs facing the audience is ideal.
• Clarity. Keep the panel objective in mind throughout the discussion. Some freedom of discussion is good, but it is very easy to then to head down a rabbit trail.
• Panel bios. Less is more. The audience can read about how great you are in supplemental materials.
• Diversity. Individuals should be knowledgeable and articulate, and the group needs to be at least somewhat diverse.
• Distribution. Ensure each panelist has equal opportunity to respond. Corral pontificators.
• Timekeepers. Timekeeping ensures focus and keeps panelists from rambling.
• Parking lot. An effective way of avoiding rabbit trails. “That is a great question; let’s put it on the parking lot.” And then never discuss it again.

While I see the value of a panel, I have to admit I cringe when I’m asked to participate on one. Just because I take personal measures to avoid pitfalls doesn’t guarantee everybody else will.

What ideas do you have on avoiding panel pitfalls and ensuring nobody walks out — including a fellow panelist?

Ed Marx is a CIO currently working for a large integrated health system. Ed encourages your interaction through this blog. Add a comment by clicking the link at the bottom of this post. You can also connect with him directly through his profile pages on social networking sites LinkedIn and Facebook and you can follow him via Twitter — user name marxists.