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Advisory Panel: Web Hackers

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: Have web hackers ever impacted your operation?

Hackers did once penetrate our organization. They never got close to any HIPAA-related data. What they did do is get into our phone systems so that they could make international calls for free for a short time until we shut things down.

We have not seen any specific attacks or hacks. We have had several security audits, so I believe we are well documented and not just whistling past the graveyard. I know that larger providers in our area have had these types of attacks but I think we remain below the radar.

Aside from a virus outbreak many years ago, we have not had any known breaches or attacks that have affected our operations.

Our organization has not documented DDOS attacks, unauthorized network access, or server compromises. 

Not yet. We do penetration testing / white hat hacking to help reduce our risks. I am not sure if any organization can ever reduce their risks to zero.

No. The bigger issue has been phishing.

So far, no. We use some network appliances that monitor and protect the perimeter. I’m sure it will happen some day!

Fortunately we haven’t had any major attacks or unauthorized network access. Roughly five years ago we did experience a compromised windows 2003 server hosting DNS externally for our organization. It was a known OS vulnerability and we didn’t have it patched on time. At the end of the experience we ended up removing and rebuilding the server vs. attempting to correct the unauthorized access.

We have not had any impact to date, though there have most certainly been attempts. I have a very talented IT security team that does an amazing job every day to keep us safe. I do have concerns, however, about the increasing attempts to hack us through biomedical devices. This is not an area where these vendors are very robust, so we are building capabilities to better monitor and support security in this area.

No. However, we are concerned about our ability to monitor and discover these types of activities. We continue to focus our security efforts to create a multi-layered infrastructure and provide better discovery tools for our staff members. We also feel it is important to implement as many “self-healing” security services as possible (example: the system can “see” a phishing message and automatically create a rule that protects our users, even if they click on the link).

Not hackers, but a virus. Lesson learned. Remove the exclusions from all application servers on a regular basis and run virus scan. Applications that will not run with AV scanning certain directories are places for a virus to take hold. Implementing an IPS and proper network design can help minimize the impact when something does take place.

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May 16, 2014 Advisory Panel No Comments

Morning Headlines 5/16/14

May 15, 2014 Headlines No Comments

Medfusion sues Allscripts for breach of contract

Medfusion files a breach of contract lawsuit against Allscripts because the company acquired and then began marketing a competing patient portal system while it still had an active contract to resell the Medfusion patient portal. Allscripts announced the acquisition at the start of HIMSS 2013, giving "virtually no advance notice to Medfusion, whose representatives were attending and prepared to jointly market the portal with Allscripts at the show.”

Medicare Fraud Strike Force Charges 90 Individuals for Approximately $260 Million in False Billing

The Medicare Fraud Strike Force announces that a nationwide investigation running across six cities has resulted in 90 individuals, including 27 clinicians, being charged with Medicare fraud. Collectively, the defendants received $260 million in fraudulent reimbursements from Medicare.

Seeking Your Meaningful Use Experiences

The Health IT Policy Committee’s Meaningful Use Workgroup is soliciting the feedback of providers, hospitals, payers, and vendors. HITPC is interested in hearing about experiences in developing, adopting, and meaningfully using electronic health records. Webinars will be held on May 20 and May 27.

Group urges Congress to make telehealth mandatory

The Information Technology & Innovation Foundation issues a report calling on Congress to pass the Telehealth Modernization Act of 2013, a bill that was introduced by Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) on December 12, 2013 and immediately referred to the Subcommittee on Health, where it remains.

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May 15, 2014 Headlines No Comments

News 5/16/14

May 15, 2014 News 2 Comments

Top News



Medfusion files suit against Allscripts, claiming the company didn’t live up to its agreement to resell Medfusion’s patient portal to EHR customers of Allscripts. Medfusion says Allscripts owes it $5 million, with damages potentially tripling the lawsuit’s value. The lawsuit claims:

  • The companies signed a five-year agreement valid through July 17, 2014.
  • Allscripts delayed implementation and billing of the Medfusion portal for more than a year for some customers, creating an unpaid backlog for Medfusion and causing the companies to amend the agreement to require Allscripts to start billing new customers within 30 days. Medfusion says that backlog cost it more than $10 million.
  • Because Meaningful Use requirements were expected to boost demand for patient portals, Allscripts agreed to include the Medfusion portal in every new Enterprise and Pro deal it signed and market the product as its only portal solution.
  • Allscripts refused to integrate Medfusion’s online forms capability.
  • The companies amended their agreement to give Allscripts 55 percent of net revenue and recurring charges while Medfusion would get 45 percent.
  • Allscripts acquired Jardogs early in 2013 and announced it without warning at HIMSS13, where Medfusion was co-marketing its portal with Allscripts.
  • Allscripts started marketing the Jardogs product as its preferred solution (FollowMyHealth) before its contract with Medfusion ran out and also started converting customers waiting to have Medfusion’s portal implemented to the FollowMyHealth product.
  • Allscripts created marketing material that compared the FollowMyHealth product to Medfusion’s with the conclusion that its own product was better.
  • Allscripts stopped developing its end of any portal enhancements and blamed Medfusion when clients reported issues.
  • Medfusion accused Allscripts of breach on April 14, 2014, saying it had not paid $5.5 million worth of outstanding invoices. Allscripts, it says, sent payment of just under $1 million in response and disputed the remainder.
  • Medfusion says customers told it that Allscripts made misleading statements in trying to get them to sign three-year contracts with Allscripts, including that: (a) Allscripts had terminated the agreement due to Medfusion problems; (b) Medfusion was going out of business; (c) Medfusion wasn’t providing portal updates and the customer would have to implement the Allscripts product to qualify for Meaningful Use; and (g) customers would be invoiced for May even though Medfusion wasn’t invoicing Allscripts that month because of their dispute.

Reader Comments


From Hobie Cat: “Re: Google Glass. Being handed out to all medical students at UC Irvine. The link made the rounds this morning with the subject, ‘Does this have HIPAA violation written all over it?’ Perhaps someone from UC Irvine can chime in with thoughts on how they’re approaching HIPAA. I’ll also be curious about how patients respond to this technology during rounds and the perception of a student talking to themselves and head nodding toward the ceiling to wake up Glass while in the room with the patient… ‘Just turning on the Glass, yo!’” The medical school says students in their first two years will use Glass during anatomy and clinical skills courses, while those in their third and fourth years will wear it during their hospital rotations, especially in the ED and OR. Google stores the information saved by off-the-shelf Glass, so in the absence of a business associate agreement with Google (which they probably won’t sign since it’s a consumer device) and because Glass doesn’t encrypt, I would say its use in patient care settings is a HIPAA problem. However, the UCI announcement says they are using proprietary software that is HIPAA compliant, probably the Pristine system they were piloting earlier this year, so they are trusting their vendor.

From TooMuchCoffee: “Re: UK’s Royal Devon. Going to Epic, although ‘affordability is a huge issue.’ At least they’ll get something that works – NHS spent billions on a failed decade-long project involving GE Healthcare and other vendors that produced nothing.” Royal Devon and Exeter NHS Trust chooses Epic as vendor of choice. It will now undertake a 12-week study to see if it can afford it.


From Fighting Accountants: “Re: Northwestern telestroke team. Congratulations for winning the Innovation Award at their annual nursing fair. They save lives and improve outcomes where it wouldn’t otherwise be possible. Not all health IT is as painful as an EMR.”

From Joey Junior: “Re: Mayo. Heard any rumors about the Cerner-Epic faceoff?” I haven’t. I will defer to readers.

From Concerned: “Re: voice mail messages. I need HIStalk reader insight. A large academic hospital organization would like to store their voice mail messages on Exchange Server. I don’t feel that this is ideal, but does it actually violate HIPAA?” I’m sure an expert will weigh in, but my interpretation is that voice mails left by patients (which I assume is the content you are referring to) are not covered by HIPAA since they didn’t start out in electronic form, the provider didn’t listen to them initially, and nobody suggested the patient leave PHI-containing voice mails. Providers leaving messages for each other might be problematic, though, but the server is still inside the firewall and the messages can’t be forwarded outside or accessed without security credentials. I haven’t convinced myself, so let’s hear some other viewpoints.

HIStalk Announcements and Requests


Several of the reader-submitted items you see here came from the all-purpose contact form, which accepts comments and attachments and whisks them straight to my inbox, where they may age gracefully until I get to them.

Highlights from HIStalk Practice this week include: Xerox fares poorly when it comes to state Medicaid management systems. GA-HITREC’s Dominic Mack, MD weighs in on the HIMSS 2014 Regional Extension Survey results. Physicians have differing opinions about the business model of CrowdMed, which is looking to turn a profit via crowdsourced medical advice. ONC approves ANSI for a second term as an approved creditor for its HIT certification program. Athenahealth finds itself in the same quagmire as Facebook and Tesla. "Anonymous" sends letters to 30 patients alerting them to the ease of stealing their medical information. A solo-practice physician becomes the first in New Jersey to attest for MU Stage 2, thanks to help from NJ-HITEC. Thanks for reading.

This week on HIStalk Connect: Dr. Travis discusses the state of patient engagement and questions whether the Patient Engagement Framework, developed by the National eHealth Collaborative and HIMSS, is an ideal tool for benchmarking progress. Researchers at Johns Hopkins develop a smartphone-based carbon monoxide breathalyzer that they hope will provide smoking cessation programs the tools to objectively measure smoking abstinence more easily. Cedars-Sinai Health System announces that it has formed a partnership with MemorialCare Health System to create a shared health technology VC fund called Summation Health Ventures


Ms. Barnes sent this photo from her Mississippi kindergarten classroom, for which we as HIStalk readers provided write-and-wipe boards and markers (you can see them in front of the students) in response to her DonorsChoose grant request. She reports that the class is using them for practicing their writing and they wouldn’t have them otherwise because of district budget cuts.

Acquisitions, Funding, Business, and Stock 


Oscar, a technology-powered startup that sells medical insurance only to New York residents so far, raises another $80 million in funding, bringing its valuation to nearly $1 billion.



The VA chooses Agilex and Calgary Scientific for enterprise viewing of radiology images on a variety of devices.



Applied Health Analytics hires Craig Smith (The Advisory Board Company) as president of its Coalesce consulting division.


Lee Fowinkle (McKesson) joins InformedDNA as CTO.

Announcements and Implementations

image image

Mercy Hospital (MO) breaks ground on its four-story, 120,000 square foot, $50 million virtual care center that will house its 300 telemedicine program employees for remote management of ICU, stroke, cardiology, sepsis, radiology, pathology, nurse on call, and home monitoring.


Health Care Cost Institute, a non-profit funded by UnitedHealth Group, will in Q1 2015 make available to the public medical claims data from private insurers, the first non-government healthcare pricing data to be released. Aetna, Humana, and Kaiser Permanente have signed on.

Government and Politics

HHS’s Medicare Fraud Strike Force charges 90 people, including 27 clinicians, for fraudulently billing Medicare for $260 million. The defendants were charged with a variety of activities that include paying pharmacy kickbacks, billing for undelivered products and services, charging the government for 1,000 unneeded power wheelchairs, and laundering money using Medicare beneficiary information. HHS also announced that it has indicted the Brooklyn surgeon who billed Medicare for $85 million worth of surgeries that he didn’t actually perform.

ONC chooses ANSI for a second three-year term as the accreditor of its certification bodies.

Innovation and Research

A study of primarily Iowa VA hospital ICUs finds that telemedicine didn’t reduce 30-day mortality rates or length of stay.


A free, eight-week online course, “Exploration of SNOMED CT Basics,” runs through June 13 if you have time to double up on the video lectures to finish in time.

The Chicago-area nurses union National Nurses United launches a heavy-handed campaign against “experimental, unproven medical technology” (specifically, EHRs.) Much of it rings true, unfortunately, even the dot matrix printer.



Roshni Nadar Malhotra, the only child of a technology billionaire from India, will spend $168 million to build a network of Johns Hopkins-affiliated health clinics starting in New Delhi. She says IT will be a key component.


The Pittsburgh business paper reviews the federal tax forms of West Penn Allegheny Health System, noting that Allscripts was its second-highest paid contractor at $7.3 million.

Employees of a company that won a $1.2 billion HHS contract to process paper insurance applications from health insurance exchanges are staring at computer screens with nothing to do, a whistleblower claims. The whistleblower says the employees have been told to refresh their screens every 10 minutes to give the appearance that they are accomplishing something. Serco, the British contractor that won the big contract, is under investigation in England for overbilling the government. I wrote about the company in October 2013, including the patient harm it caused when it took over the largest pathology labs in England’s NHS in 2009.


An editorial by Newt Gingrich on the VA’s problems says the VA and DoD need to integrate their IT systems (which is much more of a DoD problem than a VA problem):

Every effort to integrate Department of Defense and VA medical record systems has failed. The result has been an absurd process of transitioning from active duty health services to VA health services. At a time when you can instantly make airline and hotel reservations or get money from an ATM worldwide in seconds, it takes 175 days to transition a veteran’s care from the Defense Department to the Department of Veterans Affairs. The DoD and VA spent $1.3 billion to build a joint electronic medical record system for their health care services before the two secretaries announced in February that they were abandoning the effort. This is on top of the over $2 billion the Defense Department has spent on a failed upgrade to its own electronic medical system.


The mHealth Summit opens its call for presentations for the 2014 meeting, due June 27. The meeting will be December 7-11 in National Harbor, MD.


Interesting: a suspicious fire in the medical records department of a psychiatric hospital in Trinidad and Tobago erupts one month after the health authority requested copies of the hospital’s medical equipment purchasing records. The hospital, which is looking at EHRs, says it will have to create records by asking patients about their history. It hopes to make a second set of paper records for patients to take home.

Weird News Andy says when it comes to cancer vs. measles, it’s no contest for this patient. Mayo Clinic doctors try a desperate cancer treatment in injecting enough genetically modified measles virus into a female patient to inoculate 10 million people. The doctors say the use of viruses to fight cancer, known as oncolytic virotherapy, has been tried since the 1950s and in this patient’s case, seems to have worked.

Sponsor Updates

  • Extension Healthcare sponsors the National Coalition for Alarm Management Safety.
  • Capario shares five facts about eligibility verification.
  • Capsule’s Halley Cooksey relates the NFL draft to selecting a committee to evaluate technology.
  • PatientKeeper posts its summer conference event schedule.
  • Orchestrate Healthcare posts an article called “What is Healthcare IT Integration?”
  • HDS will attend MUSE on May 27-30 in Dallas.
  • Park Place International offers seven tips for project managers to get and stay organized.
  • Jennifer Crowley from MedAptus discusses the importance of time in the daily life of a provider.
  • The Outsourcing Center names Springhill Medical Center (AL) and Allscripts winners of its 2014 Outsourcing Excellence Award in the Best Healthcare category.
  • TriZetto will offer  grouping, edit, compliance and pay-for-outcomes logic from 3M in its NetworX Pricer and NetworX Modeler solutions.
  • Iatric Systems launches Business Associate Manager as a tool for compliance with the HIPAA Omnibus Final Rule.
  • Sentry Data Systems completes a Service Organization Control 3 examination.
  • Summit Healthcare joins the federal initiative for standards-based healthcare communication DirectTrust.
  • Black Book names ADP AdvancedMD, Allscripts, Aprima, Care360 Quest, eClinicalWorks, eMDs, Greenway, Kareo, McKesson, and Optum to its list of top EHR, PM, and billing vendors.

EPtalk by Dr. Jayne

I was excited to hear about HR 4077 , which would exempt physicians and other healthcare professionals from antitrust laws when they take part in contract negotiations with health plans. Although it doesn’t apply to Medicare, Medicaid, or other governmental payers, it seems like it could help independent physicians as they fight the big payers. Having been part of such a physician network in the past (although it was determined that we violated antitrust laws and our contracts were voided) it could be a help for many providers.


My informaticist friend @techydoc tweeted a link to this healthcare data map last week. It’s amazing all the places our data goes, sometimes whether we want it to or not. Apparently one place data doesn’t go, however, is to my mom’s doctor appointment. Her physician recently moved from one practice location to another within the same physician group. Despite the fact that they’re on a common EHR platform and also have an HIE in place, she was told they had to key in all her information again. It’s a shame they didn’t catch her last name and give a better answer, because I implemented the EHR and HIE in question. Sounds like someone needs an in-service.

HIStalk Practice picked this up first, but I wanted to throw in my two cents on this study that concluded that costs rise when hospitals own physician practices. The data used for the analysis was for the period 2001-2007. It doesn’t take into account the shared savings plans that have come into play during the last six or seven years. There are also just too many confounding factors present. To get an accurate analysis, I think you’d have to have to control many more of the variables. Maybe in a couple of years we can get some robust data from Accountable Care Organizations that have both employed and independent provider participants.

From The Major: “Re: site visits. As usual, thanks for sharing. I have been through a site visit (as a consultant, and my client was the jerk) like that. We had an hour ride back from the site to his hospital, where I naively told him he wouldn’t learn anything if he didn’t listen and ask good questions.” Several readers wrote to commiserate about my recent site visit experience. I’m happy to report that I received a note of apology and a cookie basket for my staff. Either the CMIO understands his behavior wasn’t appreciated or one of his accompanying colleagues is trying to smooth things over for him.

From Oceans Eleven: “Re: site visits. A long time ago we were an early adopter of a particular vendor. Based on our success, we eventually did about 100 site visits over the first few years. What became apparent after the first few minutes with a couple of them was that they had no intention of signing with any vendor. Much to the chagrin of the sales guys, we immediately scaled back our planned agenda and sent them on their way to the beach, which was probably the covert reason for the visit.” I’ve looked at dozens of products over the years and that approach hadn’t occurred to me. I’m thinking the next site visit we do might have to consider geography as well as how similar the facility is to ours. Besides, it’s been a long winter and I’m feeling a little pale. I’m sure an increase in my Vitamin D would be beneficial.


Anyone who has ever engaged in a friendly game of Office Bingo should appreciate this card, courtesy of a reader at Authentic Medicine. I used it during a recent pep talk from our chief medical officer. She was trying to explain why it was a good idea that all the experienced emergency physicians are being let go so we can replace them with cheaper independent contractors who don’t know our hospital or our patient population. Did I mention the emergency department is barely a third of the way through with a massive construction project that has required everyone involved to bend over backwards to preserve quality patient care? The hospital is transitioning in a little over a month – it will be interesting if nothing else since we’ll have new residents and new attending at the same time. I reached BINGO after barely a handful of sentences.


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

More news: HIStalk Practice, HIStalk Connect

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May 15, 2014 News 2 Comments

Readers Write: FDASIA and Healthcare’s Moon Shot Goal of ICU Safety

May 15, 2014 Readers Write 7 Comments

FDASIA and Healthcare’s Moon Shot Goal of ICU Safety
By Stephanie Reel


Preparing for the FDASIA panel was an energizing opportunity. It allowed me to spend a little time thoughtfully considering the role of government and the role of private industry in the future of health IT integration and interoperability. It gave me an opportunity to think a great deal about the important role ONC has played over the past few years and it made me question why we haven’t achieved some of the goals we had hoped to achieve.

As I was preparing my remarks, I reflected on the great work being done by my colleagues at Johns Hopkins and our vendor partners. We have the distinct privilege of having the Armstrong Institute at Hopkins focused on patient safety and quality, which is generously funded by Mr. Mike Armstrong, former chairman of our the Board of Trustees for Johns Hopkins Medicine. It is unequaled and a part of our fabric and our foundation. The Armstrong Institute is inspirationally led by Dr. Peter Pronovost, who is an incredibly well-respected leader in the field of patient safety, and also a trusted colleague and a good friend.  

We in IT at Hopkins receive exceptional support from our leadership – truly. We also have amazingly strong partnerships with our school of medicine faculty, our nurses, and our enterprise-wide staff. I suspect we are the envy of most academic health systems. The degree of collaboration at Hopkins is stunning – in our community hospitals, physician offices, and across our academic medical centers. Our systems’ initiatives derive direct qualitative and quantitative benefit from these relationships. Our CMIO, Dr. Peter Greene, and our CNIO, Dr. Stephanie Poe, are the best of the best in their roles. The medical director of our Epic deployment, Dr. John Flynn, is a gift.  

We are luckier than most. We could not do what we do without them. But despite this impressive and innovative environment, we still have significant challenges that are not unique to Hopkins. 

Despite huge investments and strong commitments to Meaningful Use, we have challenges across all  health IT initiatives. They aren’t new ones and they aren’t being adequately addressed by our current commitment to Meaningful Use criteria. We are still not operating in a culture adequately committed to safety and patient- and family-centered care. We are still not sufficiently focused on technologies, processes, and environments that consistently focused on doing everything in the context of what’s best for the patient. 

We decided to try harder. All across Johns Hopkins Medicine, we published a set of guiding principles that guide our approach to the deployment of information technology solutions. These guiding principles reduce ambiguity and  provide constancy of purpose. They drive the way we make decisions, prioritize our work, and choose among alternatives – investment alternatives, deployment alternatives, vendor alternatives, integration tactics, and deployment strategies. They provide a “true north” that promotes the culture we are hoping to create.

Our first guiding principle expects us to always do what is best for the patient. No question, no doubt, no ambiguity. We will always do what is best for the patient and for the patient’s family and care partners. We are committed to patient safety and it is palpable. This is our true north.

Our  second guiding principle allows us to extend our commitment even further. We commit to also always doing what is best for the people who take care of patients. So far, we have never found this to be in conflict with our first guiding principle. We view the patient and the patient’s family as our partners. Together, we are the team. Our environment, our work flow, our processes, and our technologies need to do what is best for all members of the team and all of the partners in the process of disease prevention, prediction, and treatment.

Our remaining guiding principles deal with our commitment to integration, standardization, and best practices. We know that unmanaged complexity is dangerous. We know that there are opportunities to improve our processes and our systems if we are always focused on being a learning healthcare system. We know we can achieve efficiencies and more effective solutions if we also achieve some degree of standardization and data and system integration. This is essential, critically important, and huge. It is something FDASIA (the FDA,FCC, and ONC) and the proposed Safety Center may be able to help us address. 

Is this the best role for government?

Government has an important role and government has the power to convene, which is often critical. But I also feel strongly that market forces are compelling and must be tapped to help us better serve our patients and the people who care for our patients. Health systems and hospitals have tremendous purchasing power. We should ensure we define our criteria for device and system selection based upon the vendor’s commitment to integration, standardization, and collaboration around best practices. We must find a way to promote continuous learning if we are to achieve the triple aim. 

We need to step up. We need to say we will not purchase devices, systems, and applications if the vendors are not fully and visibly committed to interoperability and continuous learning. This must be true for software, hardware, and medical devices. It must be true for our patients and for the people who care for our patients.

Moon shot goal

This relates my plea that we define a moon shot goal for our nation. We must commit to having the safest healthcare delivery system in the world. We should start with our intensive care units. We must ensure that our medical devices, smart pumps, ventilators, and glucometers are appropriately and safety interoperable. We must  make a commitment to settle for nothing less. We must agree that we will not purchase devices or systems that do not integrate, providing a safe, well-integrated solution for our patients and for the people taking care of our patients.

Let’s decide as a nation that we will place as much emphasis on safety as we have on Meaningful Use. Or perhaps we can redefine Meaningful Use to define the criteria, goals, and objectives to be achieved to ensure that we meet our moon shot goals. We will ensure that we have the safest hospitals in the world and we will start with our ICUs, where we care for the most vulnerable patients. We might even want to start with our pediatric ICUs, where we treat the truly most vulnerable patients.

More than 10 years ago, I was given an amazing opportunity to “adopt a unit” at The Johns Hopkins Hospital as a part of a safety program invented at Hopkins by Dr. Peter Pronovost. Each member of our leadership team was provided with an opportunity to adopt an ICU. We were encouraged to work with our ICU colleagues to focus on patient safety. We were educated and trained to be “preoccupied with failure” and focused on any defects that might contribute to patient harm. We didn’t realize it at the time, but we were learning how to become a High Reliability Organization.  

I learned quickly that our ICUs are noisy, chaotic, extremely busy, and not comforting places for our patients or their families. I learned that our PICU was especially noisy. Some of our patients had many devices at their bedside, nearly none of which were interoperable. They beeped, whirred, buzzed, and sent alarms – many of which were false alarms — all contributing to the noise, complexity, and feeling of chaos. They distracted our clinicians, disturbed our patients, and worried our family partners. 

Most importantly, they didn’t talk to one another. So much sophisticated technology, in the busiest places in our hospitals, all capable of providing valuable data, yet not integrated – not interoperable – and sometimes not even helpful.

I realized then, and many times since I adopted the PICU, that we all deserve better. Our patients and the people who care for our patients deserve better. We must build quiet ICUs where our care team can listen and learn and where our patients can receive the care they need from clinicians who can collaborate, leveraging well-integrated solutions and fully integrated information to provide the safest possible care. Many of these principles influenced the construction of our new clinical towers that opened two years ago. Again, we are fortunate, but huge challenges remain.

What about Quality Management Systems? Are we testing and measuring quality appropriately?

In many ways, I think we may focus too much on the back end. Perhaps we focus too much on testing and not enough time leading affirmatively. A commitment to excellence – to high reliability – might lessen the complexity of our testing techniques. I am very much committed to sophisticated quality assurance testing, but it seems far better to create and promote a culture that is committed to doing it right the first time. It will also be important that we affirmatively lead our design and deployment of systems that rely only on testing our solutions. 

With that in mind, I would prefer to see an additional focus or strategy that embraces High Reliability at the front end in addition to using quality management techniques. We undoubtedly need both. 

As I have recently learned, most High Reliability Organizations have much in common related to this dilemma. We all operate in unforgiving environments. Mistakes will happen, defects will occur, and we need to be  attentive. But we must also have aspirational goals that cause us to relentlessly focus on safety at the front end. We must remain passionate about our preoccupation with failure. We must recognize that our interventions are risky. We must have a sense of our own vulnerabilities and ensure we recognize we are ultimately responsible and accountable despite our distributed and decentralized models. We must continue to ask ourselves, “How will the next patient be harmed?” and then do everything possible to prevent harm at the front end as well as during testing.  We must create a culture that causes us to think about risk at the beginning.  And of course, we must be resilient, reacting appropriately when we do recognize errors, defects, or problems.

I should note that many of these ideas related to High Reliability are very well documented in Karl Weick and Kathleen Sutcliffe’s book, Managing the Unexpected. They encourage “collective mindfulness” and shared understanding of the situation they face. Their processes are centered around the five principles: a preoccupation with failure, reluctance to simplify interpretations, sensitivity to operations, commitment to resilience, and deference to expertise.

Why the moon shot goal?

As Dr. Pronovost at Johns Hopkins Armstrong Institute often says, “Change travels at the speed of trust.” We need to learn from one another. We need to be transparent, focused, and committed to doing what is best for our patients and for the people who care for our patients. We must commit to reducing patient harm. We must improve the productivity and effectiveness of our healthcare providers. We must have faith in our future and trust our partners. We need to make a commitment to no longer expect or accept mediocrity. 

From a recent study performed at the Armstrong Institute under Dr. Pronovost’s leadership, we know that patients around our country continue to die needlessly from preventable harm. Healthcare has little tangible improvement to show for its $800 billion investment in health information technology. Productivity is flat. Preventable patient harm remains the third leading cause of death in the US.

In addition, costs of care continue to consume increasingly larger and unsustainable fractions of the economy in all developed countries. While cutting payments may slightly decrease the cost per unit of service, improving productivity could more significantly deflate costs. Other industries have significantly improved productivity, largely through investments in technology and in systems engineering to obtain the maximal value from technology. Yet healthcare productivity has not improved. Our nurses respond to alarms — many of them false alarms – on average, every 94 seconds. This would be unthinkable in many other environments.

Despite my view that we must encourage market forces, we know that we have a long way to go to have an ICU that has been designed to prevent all patient harm while also reducing waste. Clinicians are often given technologies that were designed by manufacturers with limited usability testing by clinicians. These technologies often do not support the goals clinicians are trying to achieve, often hurt rather than help productivity, and have a neutral or negative impact on patient safety.

Moreover, the market has not yet integrated technologies to reduce harm. Neither regulators nor the market has applied sufficient pressure on electronic health record vendors or device manufacturers to integrate technologies to reduce harm. The market has not helped integrate systems or designed a unit that prevents all patient harm, optimizes patient outcomes and experience, and reduces waste. Hospitals continue to buy technologies that do not communicate.

It is as if Bloomberg News would have been successful if there were no standards for sharing of financial and market data. It would be unthinkable that Boeing would continue to partner with a landing gear manufacturer that refused to incorporate a signal to the cockpit informing the pilot whether the landing gear was up or down. We need the same engineering, medical, clinical trans-disciplinary collaboration expectations to ensure the same is true for healthcare.

Back to the moon shot….

An ideal ICU is possible if we decide it matters enough. If we agree to combine trans-disciplinary collaboration with broad stakeholder participation and demand authentic collaborations, we can get there in less than five years. But it won’t be trivial. It will require a public/private partnership.

The cultural and economic barriers to such collaborations are profound. Engineers and physicians use different language, apply different theories and methods, and employ different performance measures. We must take a holistic approach to create the ideal ICU and the ideal patient and family experience.

A safe, productive system is possible today. Technology is not the barrier. Let’s make it happen. Let’s have a goal for 2020 that we will have the safest ICUs (and the safest hospitals) on the planet – focused on patient- and family-centered care, disease prevention, and personalized and individualized healthcare.

Stephanie L. Reel is CIO and vice-provost for information technology at Johns Hopkins University and vice-president for information services for Johns Hopkins Medicine of Baltimore, MD.

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May 15, 2014 Readers Write 7 Comments

Morning Headlines 5/15/14

May 14, 2014 Headlines No Comments

Royal Devon edges towards Epic

In England, Epic is named vendor of choice at Royal Devon and Exeter NHS Foundation Trust. Financial details were not disclosed, but an insider familiar with the process explained,  “Epic presents incredibly well to clinicians, when they’ve seen it they just don’t want anything else, but affordability is a huge issue.” Epic’s total project costs at Cambridge University, its first and only UK site, came in at $335 million over 10-years.

Health IT Summit: Halamka predicts only 20% will achieve MU Stage 2

During a speech at the iHT2 Health IT Summit, BIDMC CIO John Halamka, MD predicts that only 20 percent of hospitals will attest for Stage 2 Meaningful Use this year.

Big Data Treasure Trove From Routine Medical Checkups

The Wall Street Journal reports on several recent clinical research projects that use retrospective EHR data analysis rather than clinical trials. In some instances, the findings resulted in new medical discoveries, and the development of new clinical tools.

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May 14, 2014 Headlines No Comments

Health IT from the CIO’s Chair 5/14/14

May 14, 2014 Darren Dworkin 7 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.

Hockey and Health IT Innovation

I grew up in Montreal, Canada, so hockey is in my blood. With the playoffs in full swing, I thought I would write my post themed to my hometown sport.


(There was no reason to include this photo, it just seemed like a fun thing to do.)

Innovation is on everyone’s mind in healthcare today. Much of that focus is either directly or indirectly tied to IT. As healthcare models continue to evolve, many believe that given the rapid pace expected, IT innovations will be needed to fuel the change.

As health systems prepared in the past to meet the demand for EMRs, what will they need to do differently to meet this growing expectation of delivering innovation?

Using hockey as a backdrop, here are eight themes.

  1. Learn to skate. Learning the fundamentals is clichéd advice for a reason. In health IT, this means implementing an electronic medical record. EMRs can be big, complicated projects and can lead to great things, but having an EMR only means you can skate. It is the starting point to becoming a hockey player. Innovation starts after the go-live.
  2. You have to lose a lot to win. The teams with the best regular season records won just 56 of 82 games this season, which means they lost 34 percent of the time. To innovate, you have to be prepared to fail. Hospital cultures are not set up up for this mindset. On the other hand, new entrepreneurial companies are often forced to pivot to new models to stay alive — it is in their DNA by design.
  3. Icing is a delay-of-game penalty. Delays or failing to make a decision will not work in today’s rapidly changing healthcare environment. Yesterday’s news was the need for change. Today’s news is improving our velocity of change. Health IT innovation needs to be supported around a model adoption. This is what a health system team can do best. Others who are better equipped to iterate might need to create the innovations themselves.
  4. Three referees are on the ice during the whole game. Like hockey, healthcare has rules, regulations, and operating procedures. They are in place to help protect everyone. But that does not mean you can’t play aggressively, increase your tempo, and skate hard. Playing hard also does not mean the rules don’t matter. Health systems are experts at operating procedures. Find a way to be part of the process without feeling the need to own it.
  5. The team is more that just a star player. Healthcare is no doubt a team sport, but sometimes the team needs to viewed as being beyond the four walls of the hospital. The innovation team should not be viewed as just employees, but also all of your great partners. If you don’t have great partners, it is time to make that a priority.
  6. If you can’t make the shot, pass. Making the great shot is often about being in position. If you are not in the right position, then pass to someone who is. Some of the best hospital IT departments I have seen are amazing at implementing and understanding the complex workflows of healthcare. That does not mean they are best positioned to develop new software.
  7. Skate to where the puck is going to be, not where it has been. What has worked in the past for healthcare and health IT will not necessarily work in the future. The puck has moved.
  8. You miss 100 percent of the shots you don’t take. Innovation in health IT is all about taking the shot (and the risk.)

Game on!

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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May 14, 2014 Darren Dworkin 7 Comments

HIStalk Interviews Sai Raya, PhD, CEO, ScImage

May 14, 2014 Interviews 2 Comments

Sai Raya, PhD is founder and CEO of ScImage of Los Altos, CA.


Tell me about yourself and the company.

I’ve been in medical imaging for a long time. For 30 years, from my university days at Hospital of the University of Pennsylvania. I started a little company for 3D imaging workstations and that kind of stuff. 

After that company, I started this company with a different mindset, with zero investment from any external people. I wanted to take one customer at a time and build a good ecosystem with customers. That’s what we have done.


What effect have publicly traded conglomerates and startups had on the healthcare IT market?

The fundamental problem with quarter-to-quarter financial reporting is that middle managers are forced to sell whatever they can, say whatever they can, and show the numbers. In the process, they have to go out and acquire new companies and change the solutions and whatnot.

Over time, they are working with one hospital. Maybe in about 10 years, there may be a couple of forklift updates. They acquire Company A and they have a solution for that. Then they acquire a new company, so they take the Company A solution out and put the second company’s solution in. In the process, hospitals are paying more. They don’t have the continuity in terms of what the hospital would like to do with data mining and all that stuff. 

Small companies, on the other hand, can’t survive without proper financial backing. It is a competitive world. 

From the lessons that I learned in my first venture, it’s very clear to me that the only way to build a solid company with a good financial foundation and bring that equilibrium is to have customer loyalty, and then continue the same solution over and over again. That’s why we have customers still with us since 1996. We never did the forklift update. The programs that we rolled in 2000 still work fine. That’s why there’s a kind of loyalty and a relationship between vendor and the hospitals and the physicians. That’s what we’re trying to enjoy.


It’s tough being an early adopter, like those pioneers who wanted to get rid of film and paper and move to PACS and EMRs before those systems were ready. Did hospitals jump on board too early?

Absolutely. Some people jumped on board without much thought. Somebody came and said, if you go to digital, you will save 50 cents per film or something like that. But first generation is first generation. They chose certain solutions. 

Now we may be in the third generation. But in the grand scheme of things, digitization of the enterprise is just the first phase of what is going to happen to this healthcare IT in general. Whatever digitization that we’re trying to do these days, it is not dead yet. We’re maybe 70 percent of the way there. 

This becomes kind of a building block for the future healthcare IT, where information and imaging have to co-exist. There cannot be any boundaries between these two things. A patient record is a patient record. It has to have everything that patient has ever done.


How do you see the market shaking out as imaging systems and EMRs try to figure out that co-existence?

If you went to something like RSNA in 2007, everybody was a PACS vendor. Everybody was changing film. But if you went to the latest RSNA, some companies went away and some got merged. A lot of consolidation is going on. In the process, certain hospitals learned something and some did not. 

Images are growing. The image pointer that’s in the EMR seems to be the buzzword right now. That will go on for some time.


What are the most important workflows that an imaging system needs to address?

When we started this product we call PICOM, the fundamental point that I was trying to make was, if you go to any department — doesn’t matter, radiology or other — you see images and information. You have images and then lots of requisition sheets and observations and tech notes and physician notes and all kinds of things.

We wanted to create a platform that combines images and information together. Of course, we’re talking data in terms of components in the departments. We’re not talking EMR kind of systems.

For some of them, we had standards like DICOM and document exchange kind of things. Others we did not. We started acquiring them in their native format and put that solution together.

These days, if you go to any kind of imaging system, you have people talking about not just images, but information. Once this total data package is available, it needs to be seamlessly available to the front-end portal that the physician is going to interact with. There’s a lot of work to be done there. In my opinion, that is going to be the key for people that are involved with imaging.


How often do physicians who aren’t radiologists want to see the original image versus the interpretation from the radiologist?

We are coming from a multi-departmental type of company. We treat both radiology and cardiology together. In fact, we deal with radiology, cardiology, OB-GYN, and orthopedics all together. That’s one product for us.

Any patient that goes to the hospital many times, you get the ECG done more than you get chest film done. Images and waveforms are all together. In the case of ECG-type studies, as soon as the physician gets some kind of test result for the patient and before the physician wants to consult with the patient, they do want to take a look at these waveforms to tell them exactly what’s going on. 

Modalities like ECG where the waveforms and interpretation are together – they are bound to open those kinds of things. Similarly these days, mainly for the orthopedic things, they generally use the images, but if it is a big CT study, I don’t think they’ll be using it.


What’s the status and challenges of sharing images across organizations?

The basic problem is there’s no universal patient identifier. We have our own way of doing it, but fundamentally it’s exchanging information from one PACS system to another system or one ordering system.

We created what is known as a universal MPI translator. That’s what we do. Right now, 20 percent of our business is interoperability, where we have to pull and push information from disparate systems and consolidate the reading and that kind of stuff. 

That seems to be the name of the game for the next two years before somebody has to come up with a standard. If that somebody is the government, it’s not going to happen any time soon. [laughs]


What are the most pressing issues you are seeing from providers?

On one side, it’s the image life cycle management. It’s well defined and many companies have good solutions, including us.

But in the whole process, the diagnostic physician contributes the most complex and important content. The diagnostic physician’s impressions need to be distributed everywhere, wherever it’s needed. In fact, even for Meaningful Use, we have to take certain key measurements or key statements that need to be delivered to the EMR in a separate channel. 

These are all the challenges. We have doubled up a good set of tools to do those things. Of course other people have also done that. But in the process, we’re still learning. 

I see the importance of  driving the subset of information from the diagnostic report and making that information co-exist with the image pointers or images and making them travel across the enterprise or make them travel outside the enterprise. That is the challenge.


Is there anything that’s being discussed that would allow images to be searched on qualities that weren’t noted by the interpretation, like the content of the image itself that might interest a researcher?

We have a lot of metadata in these images. If you want to search by image type or study type, it is possible. But the quality of the image, still it’s a visual perception, and a trained eye is the only one that seems to be doing a good job in terms of image quality audit.

But in terms of searchable images using, for example, something like “mitral valve prolapse,” that is easy to search and get information. It depends on the system. Some systems can do it. 

In our system, we maintain an outcomes database and analytics and other things that we take very seriously. Every data object that comes into our system has the metadata latched on. It’s embedded right there in the image itself. It becomes easy to share that information or maybe make it available as an API for other systems to search.


With the rise of the vendor-neutral archive, what data types are people wanting to store that you wouldn’t have expected five years ago?

That’s funny. In 2000, we started an online “PACS in the cloud” type of environment called PICOM Online. Those days it was not cloud — it was an America Online-type of company name, so we called ourselves PICOM Online. [laughs] 

My fundamental thing there was exactly this. It’s not just images. You’ve got to get all your documents, your spreadsheets, your PowerPoint presentations, and your business documents or billing statements — whatever is needed. They all get packed up into one object. It’s called study object. That study gets archived. The intelligence on the back end of the archiving system should handle based on how the client is interacting with it.

That’s exactly what we have done. After 14 years, more than 100 hospitals are using our online cloud solution. It’s a complete PACS, including reporting, voice recognition, and all kinds of crazy things. Some of the big companies these days are now finally opening their eyes and looking at the importance of delivering the documents with the images.

But 80 percent of the industry is still DICOM in, DICOM out, DICOM in, DICOM out. That’s all they talk about.


What’s the future of the industry or the company or both over the next few years?

Interoperability and making the image pointers universal. That’s one thing. 

Security seems to be the biggest factor now, in terms of how securely we can encrypt this data and make it available to the right people at the right place at the right time and have the complete audit trails going with it? That is the key technology that we as an imaging provider needs to provide to the EMR companies.

No matter what, the biggest companies like Epic, when it comes to imaging intensified activity, it’s going to be with PACS vendors and image workflow vendors. We collect the data and then we have to make this data properly available to these people. That is a growing opportunity for us and I think it’s going to be there for a long time to come.

There’s going to be major consolidation and all that stuff, but still lots of hospitals don’t like this cookie cutter type of an approach. They would like to have customizable solutions that works for their hospital. That’s the opportunity smaller companies like us have.


Do you have any final thoughts?

We like what we are doing and we’re having fun. Being a private company with a good balance is a nice thing to do. We’re enjoying our little company.

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May 14, 2014 Interviews 2 Comments

Morning Headlines 5/14/14

May 13, 2014 Headlines 1 Comment

McKesson Reports Fiscal 2014 Fourth-Quarter and Full-Year Results

McKesson reports Q4 and full-year results: revenue for the quarter ended up 25 percent, at $30.5 billion, and dusted EPS climbed to $2.55 vs. $1.48, beat analyst forecasts on both.

How Massachusetts screwed up Obamacare

Massachusett’s poor performing health insurance exchange was the result of a systemic failure to communicate between three state bureaucracies that were all issuing change orders to CGI, the lead contractor responsible for the site. MIT health economist Jon Gruber, who is a member of the state health exchange’s board of directors, says "There wasn’t a single point of management," Gruber says. "It was poorly set up and it was this horrible combination where the contractor would get different orders, and would do none of them."

The Advisory Board’s CEO Robert Musslewhite on Q4 2014 Results – Earnings Call Transcript

During The Advisory Board’s Q4 earnings call, CEO Robert Musselwhite reports that the company acquired HealthPost, a physician search and schedule tool similar to ZocDoc, for $25 million.

Medtronic exec: Google looms large as next great rival

Medtronic’s resident technology scout Dr. Stephen Oesterle predicts that 20 years from now Google will be a dominant player in the medical device industry, competing with the likes of Boston Scientific and Covidien.

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May 13, 2014 Headlines 1 Comment

News 5/14/14

May 13, 2014 News 7 Comments

Top News



The Phoenix VA hospital that is charged with creating a secret waitlist to hid months-long treatment delays waited until the last minute to implement the electronic waitlist system whose VA rollout started in 2001. According to a former VA official, “Phoenix was one of the very last to deploy. Transition from a paper-based system to the electronic one was not handled well. From what I hear, there was a great deal of resistance from staff as well.” The electronic system was introduced to increase transparency and reduce paper-based mistakes.

Reader Comments

From KD: “Re: Epic. I heard a rumor they will buying InterSystems. Any chance you can get the lowdown?” I haven’t heard anything and my one possible source hasn’t responded. I’m highly skeptical. Arguments for: Epic customers pay a lot for InterSystems Cache’ licenses and Epic and its customers are heavily dependent on that company as a result. Arguments against: almost everything else. The companies have been working collaboratively together for decades, their founders are billionaires and don’t need the money, Epic has never done an acquisition and that would be a huge one, and both companies generally stick to their knitting (the exception being a couple of InterSystems application acquisitions years ago.) I can’t imagine this is true.

From Lee Brother: “Re: MU Stage 2. At a conference, John Halamka says most hospitals will either apply for an exemption or quit the program completely.” That’s likely given that only four hospitals have attested so far. Running your business is more important than running after government money that comes with strings attached.

Acquisitions, Funding, Business, and Stock


Pharma commercialization services vendor Quintiles will acquire consulting firm Encore Health Resources, hoping to use real-time EHR information to give drug companies outcomes data. Houston-based Encore has 250 consultants.


McKesson announces Q4 results: revenue up 25 percent, adjusted EPS $2.55 vs. $1.48, beating consensus estimates of both. From the conference call:

  • Technology Solutions revenue was down 1 percent on the quarter, up 5 percent on the year.
  • The company expects Technology Solutions revenue to “decrease modestly” in FY2015 because of declining Horizon business and “the impact of eliminating a low-margin product line.”


The Advisory Board Company says in its earnings call that it paid $25 million to acquire HealthPost, a physician finder and appointment scheduling site that will be rolled into the company’s Crimson analytics offerings that are used by 1,400 hospitals. HealthPost has seven employees, seven customers, $1 million in annual revenue, and is break-even on the P&L side. According to Advisory Board Chairman and CEO Robert Musslewhite,

“HealthPost is a cloud-based ambulatory scheduling solution that enables health systems to reduce referral leakage and track new patients by using it. It does it with what we felt like was a market leading SaaS technology that enables physicians and consumers to identify the right provider of care, based on certain criteria, especially in terms of geography and it makes it a very easy one-click appointment booking experience for either the provider or the patient. So we’re excited about it. In terms of how we’re going to roll it out, it’s still TBD. I imagine we will have a program launch coming from it, then more news on that down the line. But your question — as your question indicate, its certainly very complimentary to a lot of the works that we do in Crimson Market Advantage and with our MRS acquisition from last summer.”


WestView Capital Partners makes a minority growth investment in Meditech technology solutions provider Park Place International.


Three Lawson Software founders will pay $5.8 million to settle insider trading charges related to the company’s 2011 acquisition by Infor.


Partners HealthCare (MA) will consolidate several laboratory, pathology, and blood banking systems in moving to systems from Sunquest.


Saint Francis Health System (OK) will deploy Perceptive Acuo VNA. 


University of Louisville Physicians (KY) selects Shareable Ink’s Anesthesia Cloud and ShareMU for 45 of its providers across 20 operating rooms.


Vanderbilt University Medical Center (TN) chooses CitiusTech’s BI-Clinical health content and analytics.


UW Medicine (WA) hires Versio (formerly known as ScribeRight Transcription Agency) to bring legacy ambulatory data into its new Epic system.



Medfusion names Michael Raymer (MModal) as VP of solutions management.

image image

Predixion Software names Costa Harbilas (HP Software) as SVP of global sales and Terri Avnaim (Quest Software) as VP of marketing.


Abington Health (PA) hires Jonathan Sternlieb, MD (Holy Redeemer Health System) as CMIO.

Greg Shorten (Allscripts) joins Shareable Ink as chief growth officer.

Announcements and Implementations

Nominations are open through Thursday for Mosby’s Superheroes of Nursing contest.

EClinicalWorks says that more than half (580 of 1,147) of Federally Qualified Health Centers use its products, four of them being Davies winners.


Cerner’s community health work in Nevada, MO is profiled in the Kansas City paper, which points out that the healthcare IT market is maturing and the project can help generate consulting revenue for Cerner and enhancement of its Healthe Intent population health management software. According to Cerner’s population health VP, “It’s in the DNA of our company to have the vision and passion to fix what’s broken in health care. We’ve solved the data problem. Now, it’s not about what the doctor does. It’s about what the individual does.” According to an analyst of the all-important stock market, “Other than goodwill with the client, I’m not sure how they get paid for thinking about real-world population management.” The Healthe Intent system is running at two hospitals, one in Chicago and another in Vancouver, with a third to be announced.

Government and Politics


The Massachusetts Health Connector health insurance exchange failed because the three state agencies involved didn’t communicate with each other, according to a board member of the $57 million site, which the state will be replacing. "There wasn’t a single point of management. It was poorly set up and it was this horrible combination where the contractor [CGI] would get different orders and would do none of them."


North Carolina’s HHS signs a data use agreement with the NCHIE as part of a House bill that requires hospitals to submit the demographic and clinical data of Medicaid patients to the HIE, allowing DHHS to monitor services and patient safety.

Innovation and Research

Researchers develop a smartphone app that analyzes the voice tone of callers with bipolar disorder to provide an early warning of mood changes.

The SVP/MD of medicine and technology of medical device maker Medtronic says the company’s biggest competitor won’t be current players, but rather “will be Google. I am certain of it.” He cites Google’s $8 billion annual R&D budget and its recent work on a smart contact lens that can measure glucose levels. He adds about healthcare, "It’s where the money is. We’re spending 18 percent of the GDP on healthcare. Why wouldn’t they think that’s where they want to be? We spend more on healthcare than we do on manufacturing in the US, so everybody thinks it’s their destiny.”


Venture capitalist Beth Seidenberg, MD of Kleiner Perkins Caufield & Byers offers advice for entrepreneurs trying to get a foothold in the tricky world of digital health:

  • Build interfaces to open up intentionally built data silos
  • Help customers make their own decisions.
  • Figure out a revenue model upfront.
  • Make healthcare apps social so users don’t get bored.
  • Include healthcare experts on the management team.



Confused about “correlation” vs. “causation” when a shoddily created study claims that Event A must have caused Event B because they happened together? See the chart above from a website devoted to ridiculous examples of “Spurious Correlations.”


It seems there’s a national healthcare IT conference every week, and despite claims that everybody in healthcare is struggling financially, somehow those conference rooms (and $300 hotel rooms) keep filling up with attendees. I suspect many of those attendees just keep popping up at one conference or another since I don’t know many working people who have the travel budget and time off to support endless conference attendance. One conference I hadn’t heard of is running now: the National Healthcare Innovation Summit in Boston. It’s put together by HIMSS, apparently, since membership gets you a $700 discount on the $1,095 registration fee and the browser’s tab title is “HIMSS Innovation Summit.”

Above is a tweet from Microsoft HealthVault GM Sean Nolan, who says Meaningful Use complainers are “whiny.”

Financially struggling Cochise Regional Hospital (AZ) is fined for violating its license by not providing surgical services for two years, last cleaning its operating rooms in July 2012. The 25-bed hospital says part of its correction plan is to spend $2 million on an EHR. Its website touts its advanced technology from Empower Systems, which I’ve only mentioned once in HIStalk, in 2011 when the company’s CEO quit.

A report finds that at least 15 hospital executives in Connecticut were paid more than $1 million last year, including six from Yale New Haven Hospital alone. The VP of psychiatry at Hartford Hospital made $3.24 million.

The UPMC employee who sued her employer for a data breach drops payroll processor Ultimate Software Group from her suit, saying she was mistaken in thinking that UPMC used its services.


University of Mississippi Medical Center CIO David Chou lists 10 technologies that are revolutionizing health IT:

  1. Smartphones
  2. WiFi
  3. BYOD
  4. Government mandates
  5. VoIP
  6. Social media
  7. Virtualization
  8. IP-based medical devices
  9. Mobile health
  10. Big data


Johns Hopkins School of Nursing offers a free, five-week course (known as a MOOC, or massive, online course) on “The Science of Safety in Healthcare” starting June 2. Pay $39 and you get a certificate; add another $60 for CNE hours. Peter Pronovost is one of the instructors.


Two tear-down analyses of Google Glass find that the $1,500 gadget contains either $80 or $152 worth of parts.

Weird News Andy questions, “Dim bulbs or bright lights?” Two British doctors refuse to use energy-saving light bulbs in their homes and instead stocked up on the obsolete incandescent types. One claims the bulbs cause sunburn-type damage over time, while the other worries about the possibility of cataracts and macular degeneration.

Sponsor Updates

  • Portland (OR) IPA certifies a pilot group of clinics for NCQA’s Patient-Centered Specialty Practice Recognition using the IRIS referral management system of Proximare Health.
  • Allscripts announces GA of Sunrise Surgical Care 14.2.
  • GetWellNetwork CIO David Muntz will deliver the keynote address at the DoD/VA Healthcare Summit in San Antonio, TX next week.
  • TriZetto will offer Enkata’s claims processing system to its consulting clients.
  • EDCO Health Information Solutions publishes a blog post, “True or False: Decentralized Records Scanning Reduces Chart Quality.”
  • A Beacon Partners blog post urges providers to use the ICD-10 delay to gain a competitive advantage.
  • Visage Imaging will demonstrate its enterprising imaging platform at the SIIM annual meeting in Long Beach, CA this week.
  • Holon discusses the use of HIE for for identifying and reducing ED frequent fliers in a recent blog posting.
  • Wolters Kluwer will sell POC clinical decision support solutions to nursing schools for use in their curriculum.
  • CliniComp will participate in the Association of Women’s Health, Obstetric and Neonatal Nurses 2014 Convention June 14-18 in Orlando.
  • Health Catalyst shares its history, goals, and direction.
  • AirWatch expresses its intention to continue working with BlackBerry.
  • Shareable Ink announces the members for its newly-formed Anesthesia Leadership Board.
  • ADP AdvancedMD offers a guide on how financial reporting is changing the way private practices operate.
  • Terry Edwards, CEO of PerfectServe, will speak at the WLSA Convergence Summit in San Diego May 14.
  • Arcadia Healthcare Solutions, Certify Data Systems, and CTG Health Solutions executives weigh in on the challenges of forming and operating an ACO.
  • Truven Health Analytics will provide technical support for CMS during the Testing Experience and Functional Tools demonstrations in Community-Based Long Term Services and Supports program.
  • CommVault extends its relationship with Microsoft to provide data management and protection.
  • Navicure achieves faster product development times by using of VMware vCloud Suite for provisional testing and development environments.
  • MModal opens a healthcare technology center in Bangalore, India.
  • Lexmark’s Perceptive Software passes all integration tests at the 2014 IHE North American and European Connectathons.
  • NextGen Healthcare earns its third Surescripts White Coat of Quality award.


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

More news: HIStalk Practice, HIStalk Connect

Get HIStalk updates.


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May 13, 2014 News 7 Comments

Morning Headlines 5/13/14

May 13, 2014 Headlines 1 Comment

Quintiles Announces Agreement to Acquire Encore Health Resources

Health IT consulting firm Encore Health Resources is acquired by Quintiles, a consulting firm focused on optimizing research, development, and manufacturing in the pharmaceutical industry.

HITPC workgroup supports narrowed focus of EHR certification program

After a hearing on the EHR certification process last week, the Health IT Policy Committee formally endorses narrowing certification EHR requirements to interoperability, clinical quality measures, and privacy and security standards.

It Took the VA Hospital In Phoenix 10 Years To Install an Electronic Waitlist System

The Phoenix VA hospital was one of the last in the nation to implement the VA’s electronic appointment waitlist system. The system was generally available after 2002, but the Phoenix did not implement it until 2012. The hospital was recently accused of maintaining a secret appointment waitlist that kept veterans waiting more than a year for appointments, and resulted in an estimated 40 preventable veteran deaths.

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May 13, 2014 Headlines 1 Comment

Encore Health Resources, HealthPost Acquired

May 12, 2014 News No Comments


Drug research and services vendor Quintiles announced this morning that it will acquire health IT consulting firm Encore Health Resources. Terms were not disclosed.

According to Quintiles CEO Tom Pike:

Today’s announcement signifies the increasing importance of leveraging EHR and real-world information to inform our customers and improve their probability of success. Encore has significant EHR expertise, strong relationships with many large U.S. provider networks and academic medical centers as well as experienced consultants, proven tools, and methodologies. It will be a key strategic addition for our business that will extend our services suite and allow us to work with Encore to strengthen its provider-focused solutions.”

Encore Health Resources was founded in 2009 by Ivo Nelson and Dana Sellers.


Another Nelson-related company, online provider search and booking site HealthPost, has been acquired by The Advisory Board Company, according to an announcement this morning. No details were announced.

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May 12, 2014 News No Comments

Curbside Consult with Dr. Jayne 5/12/14

May 12, 2014 Dr. Jayne No Comments


Mr. H recently asked the HIStalk Advisory Panel to weigh in on how the ICD-10 delay will impact their organizations. My organization had asked me to put together an impact statement, but I was waiting a few weeks to see if CMS issued a final date. Now that we know it will be October 1, 2015, we can start quantifying the costs. Some of them are fairly straightforward, but others are a bit more nebulous.

Like many of the Advisory Panel respondents, we will have a fairly significant cost for retraining physicians. We had already started many of our employees through a training program. Although initially it was informational and high level, we were set to accelerate rapidly into the summer. At this point, we have placed all training on hold and will plan to start from scratch again next January.

One of our training strategies included interactive Web sessions which are invoiced monthly based on our number of licensed providers. I was pleased to find out that our legal department had inserted a clause that addresses any delay of ICD-10, so we won’t be losing much on that contract. We’ll see if the vendor tries to renegotiate, however.

We had planned to have additional last-minute training sessions provided by contractors in September. We won’t lose much on those, either. The vendor involved doesn’t charge for cancellations that occur with at least 60 days’ notice. Given the fact that we’re going to have a longer training window, I doubt we’ll need those resources for the next go-round.

One of our major costs, however, will be the training that we’ve already put into our existing coding staff. Although the majority of our ambulatory physicians are expected to do their own coding, there are some subspecialties (particularly surgical) where coding staff are deeply involved. Additionally, we have our internal compliance and audit teams. We had already sent those teams through specialized training and they may need a refresher. Due to their specialized training and knowledge of our organization, we had provided retention bonuses for several of them to stay at least through November. Given the fact that many organizations will be retraining, I suspect their value will continue to increase and we’ll likely be extending those retention payments.

We will also have increased upgrade and testing costs. Our upgrade plan was pretty straightforward since our ambulatory vendor’s ICD-10 version is also their Meaningful Use 2014 version — we were planning to kill two proverbial birds with one stone. We had already done the majority of the testing and the code is already in production, so we thought we were home free. Now we’re going to have to take at least one if not two updates prior to ICD-10, which means more testing. Worst-case scenario, there could be more updates, because it seems like every time CMS issues a new FAQ or refines an existing answer, our vendor has to create a hotfix.

I feel bad for our vendor. As a high-visibility client, I have come to know many of the senior development team members personally. I know they have agonized over the hours they put into meeting certification and regulatory requirements and the fact that those projects have cut into clinical and usability issues. Even though they’re a vendor, I know they don’t have an endless pot of money or endless resources. Hard choices had to be made. There were a few times in the past few years where I sat on focus groups with other clients to discuss various development initiatives and rank potential work, so I know directly how much consideration went into those decisions.

That opportunity cost will play forward to our providers as lost functionality. I know our vendor has plans to use this honeymoon period to shift back to usability enhancements and adding functionality. Although this is a good thing, I would bet that due to the increased regulatory and certification complexity, they will take more time to deliver new features. We’ll be playing a game of chicken to decide which updates to take based on existing vs. future features and the testing timeline as we approach October 2015.

In my mind, though, one of the more significant issues isn’t really quantifiable. I’m not sure how much of an impact it will be. Many of our providers now assume we are on a slippery slope towards skipping ICD-10 altogether. I had forgotten everything I learned in middle school about voice votes vs. roll call votes, but the nuances of how the actual legislative timeline unfolded on this one have been an interesting read. I’m not sure if Congress used this as a deliberate jab to undermine the very clear statements by CMS on there being no delay or if they were just oblivious to the nuances of the ICD-10 portion of the bill. Who is to say that some crafty legislators won’t sneak something in later?

The only good news I’ve heard out of Washington recently is the reopening of the Washington Monument after being damaged by the 2011 earthquake. I’m a big fan of our National Parks and had visited shortly before it was closed. I hadn’t been aware that half of the $15 million restoration was funded by a private contribution and was pleased to learn it was completed on time and on budget. Maybe something inside the beltway can be done right, after all.

Email Dr. Jayne.

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May 12, 2014 Dr. Jayne No Comments

HIStalk Interviews Alexis Gilroy, JD, Partner, Jones Day

May 12, 2014 Interviews No Comments

Alexis Gilroy, JD is a partner with the Jones Day law firm of Washington, DC. She served as a subject matter expert for the Federation of State Medical Boards, which recently issued its model policy for telemedicine.


My interpretation of FSMB’s model policy is that it focuses on trying to prevent online pill mills rather than expanding telemedicine, emphasizing that requirements are the same for both traditional visits and telemedicine encounters.

I think that’s right. Certainly to draw parallels between traditional in-person medicine and practicing medicine using telemedicine technologies. But really, there’s no difference. It’s still the practice of medicine with the same standard of care.

But the only caveat to that is that there are different standards that currently exist in some states for telemedicine services versus in-person services. The new policy would provide for more expansive use of telemedicine in contrast to states like Texas and Alabama and a new proposed rule in Tennessee, which limits the utilization of telemedicine without some prior in-person exam or visit or things like that.


Are FSMB’s model policies usually adopted by state medical boards without changes?

If we look back at a couple of different examples from other activities of the Federation, like their licensure and statement on where medical practice occurs, being where the patient is actually physically located … I went back to a paper letter they wrote in the 1980s that now we find most states have some form of either law or regulation that ties the location of where the practicing medicine occurs to the location of the patient. Which is a really important factor from analyzing licensure requirements.

If you think about it from that perspective, as history tells anything, it does tell us that Federation policies tend to inform and educate and hopefully advance various regulations and statutes of medical boards and regulators. But certainly regulators can pick and choose or choose to go a different direction as it relates to telemedicine from this model policy.


I’ve heard two interpretations of the model policy. One says that says telemedicine can be used to both establish and maintain a physician-patient relationship in the same way as an in-person visit. The other interpretation is that the initial encounter has to be conducted in person. Which is the case?

It’s my read that even in your initial encounter with a patient, the policy indicates that you can initially establish a doctor-patient relationship using telemedicine technologies. Which is a new and different view from some states, like the Texas and Alabama model and the proposed rule in Tennessee, which currently would require for establishment of a doctor-patient relationship through some prior in-person visit first before you can then have telemedicine encounters with a patient. 

The model policy takes a much more expansive view of telemedicine. Assuming that you meet the standard of care, you can establish a doctor-patient relationship for the very first time using telemedicine technology.


Some groups like the model policy, while some don’t. Was input solicited from groups or public comment or was it a closed door discussion?

In full disclosure, I participated and sat on what the federation referred to as the SMART work group. I acted in the capacity of an advisor on what’s the state of various regulations and legal issues out there when it comes to this topic and would answer questions from time to time from the medical board members that  over a period of a year met about this issue, discussed it at length, had done a pretty full survey of various laws and regulations. 

There were a number of other participants from the industry on the insurer side, the technology side, and the provider side that participated in those discussions, all in the realm of advisors to the board. It’s the medical board members and delegates that made the determination, the decisions, for what is going to be ultimately in the policy. But they did ask for industry participants and I believe also the policy was circulated among all the medical boards several months prior to the vote in April. There was clearly at least an attempt to consider input from a number of different resources.


Some people may have expected that the model policy would address the issue of state-specific licensure and oversight vs. national licensure. Are changes being considered that would make it easier for physicians to obtain licensure in multiple states?

Absolutely. There was a statement to indicate that this policy really doesn’t change licensure. It is what it is currently on the books in various different states. But there is a separate effort from the Federation of State Medical Boards to move forward an interstate compact of sorts that would address facilitating easier access to licensure. Not just for telemedicine providers, but for doctors who are conducting in-person services.

There’s also a number of different efforts in federal legislation that would push forward different licensure agendas, some related to specific Medicare-enrolled participants or Department of Defense individuals seeking care from healthcare providers. There are a number of different efforts going on.

This issue, although it does make a statement about licensure, really isn’t intended to speak toward or change or advance the case of licensure at all.


Secure messaging seems to fall under the model policy’s definition of telemedicine technology, while a telephone call clearly doesn’t. If I’m a patient from Ohio on vacation in Florida, I can call my Ohio doctor and they can diagnose and treat me without being licensed in Florida. The model policy would seem to prohibit that same conversation if was conducted via secure messaging. Is that your interpretation?

That’s not my interpretation. The intent here is rather than to focus on one type of technology, to indicate, number one, that you can establish doctor-patient relationship using telecommunications if you meet the standard of care and that that standard of care is going to be aligned with general principles of traditional medicine. 

Where this hits a rub when it comes to different technologies is every individual practitioner really needs to consider are the facts and circumstances such with using store and forward technology, using secure messaging, using telephone, using videoconferencing, that given the facts and circumstances, do I have enough information to make a diagnostic decision in compliance with traditional standards of care? 

There are certainly circumstances, I’m sure, where especially if you have a pre-existing relationship between the doctor and patient, that some practitioners would feel they would have enough information and history that when a patient contacts them by secure messaging or by phone, that they would be able to adequately determine what’s going on with a patient and assist them merely through those technologies.

There was some language in the policy that went along the lines of generally telephone-only doesn’t provide enough information to meet the standard of care. From sitting in the room and listening to medical boards discuss that concept and their thinking behind adding that language, it was rather than to limit the use of one type of technology or to box it out of telemedicine, that was by no means the case. Rather it was to indicate that without some pre-existing relationship or without the capability to get other data, whether it’s visual through video or whether it’s text data or pictures through store and forward or whether it’s claims data or other biometric data from a patient, they felt that in most cases — not all cases, but in most cases — if you only are able to talk on a telephone and it’s your first encounter with that patient, it may not be enough to meet the standard of care. 

They were trying to indicate that in that circumstance, they would feel like if you were in a case where you’re testing the standard of care,that’s probably not enough, rather than pinpointing or saying a particular type of technology is outside the bounds of telemedicine. It is a hard concept and it has been confused and probably will continue to be confused and debated. But that’s where we are on that issue, and that is how I interpret it and heard folks discuss it and talk about it.


Does the policy create a new standard of care that you can’t do an encounter by telephone for an ongoing patient who is not presently in the provider’s state of licensure because it’s not considered telemedicine? Or that the provider can’t conduct that encounter by secure messaging because it is considered telemedicine?

It doesn’t create a different standard of care because the standard of care depends on the facts and circumstances in each case. But what it should do is remind practitioners to consider — whether it’s telephone, whether it’s videoconferencing, whether it’s any form of technology, and this is the only means by which they have to engage with the patient, and in particular with only telephone being used — am I able to get enough information through that to diagnose the patient? 

I think that’s what the medical boards were attempting to do here, to highlight something for practitioners that they should be careful that in scenarios where they’re only able to just talk by telephone and nothing else with a patient that they may only be meeting for the first time. Are they able to get enough information? 

There certainly may be some facts and circumstances where they are. Perhaps with mental health scenarios, other sorts of scenarios, that may be perfectly capable and meet traditional norms of research and other standards to meet the standard of care to get them the relevant information. But I think it should cause practitioners to take some pause and to consider whether any type of technology, used alone or in a particular circumstance, gives them enough information. In most cases, they’ll find and consider that absolutely it does. They’re able to gather the history that they need, determine whether given the facts and circumstances that this is an appropriate diagnosis, and that they can move forward and treat the patient. 

That’s the good news of what this policy does. It says that we’ve got these amazing tools now available to us today that we call telemedicine. We can change the models and delivery paths with which we can provide medicine and the medical boards aren’t going to get in the way of that. We just need to use our discretion appropriately and consistent with traditional standards of care.


How would the policy have addressed the recent Idaho case where the physician has been threatened with loss of board certification for taking a telephone call from a patient in which she was licensed and issuing a prescription for an antibiotic?

It’s a really good example. This is a scenario, if I’m a telemedicine practitioner in Idaho, now it informs me about, well, wait a minute, how are the Idaho regulators actually looking at this topic? Should I go in and educate them further about how I can use telecommunications to gather information and help me as a practitioner appropriately diagnose and treat a patient? And maybe that should be happening? 

Should I, though, look at this and say, now I have a better idea about what Idaho might be thinking and adjust my practices and procedures appropriately. Maybe I should also seek claims data or seek some other verification rather than just a telephone information.

I think things would perhaps have been different in that case had the practitioner had a pre-existing relationship. Most medical boards do view that very, very differently than no prior relationship. I think it does inform you. That’s sort of the point.

These are all very individual fact-specific circumstances and that was telling to see how a board would react to it. You have to take that into account when you’re building your business model around telemedicine and when you are, as a practitioner, using telemedicine technologies to engage with patients. And hopefully educate the regulators.

It will be an evolving process with regulators. I always encourage telemedicine companies and practitioners to engage with the boards. That education is very, very important.


Where do you see the discussion going from here?

Where we need to see more discussion is around things like the mobile devices, like you mentioned earlier. The secure messaging, the non-traditional telemedicine.

Telemedicine is a fairly new technology, but in some cases, it’s been around for a long time, especially the doctor-to-doctor telemedicine. How we’re using smartphones and apps in different ways, and does that allow us to engage with the patients and providers in many different ways? Not just physicians, but ancillary healthcare providers. 

The other issue in addition to the very first question you mentioned around –is this just really restating the obvious, there’s nothing new here — many states are actually silent on much of this. Which, to some, you might feel, well, that’s great – let’s go ahead and do it if there’s no prohibitions on it.

The problem is many of the traditional healthcare laws are written in the context of traditional bricks-and-mortar and in-person practice, things like how you supervise various different healthcare providers or how you engage with them in an in-person environment. The laws are just written with that in mind, so it’s very difficult to analyze them in the context of many of these new technologies. 

I think engaging with health regulators around those topics is really the next stage of this, in helping them understand. I’ve yet to find medical boards and members and regulators who aren’t anxious to hear about new, good use cases that advance the quality of care. They may be hesitant to modify regulations, but if you have very thoughtful and positive engagement with them, it usually leads to a good end result.

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May 12, 2014 Interviews No Comments

Morning Headlines 5/12/14

May 11, 2014 Headlines No Comments

Catholic hospitals suffer second data breach this year

Catholic Health Initiatives sues an unknown Pakistan-based hacker that compromised its network in hopes that it can then convince Microsoft to release the true name behind the outlook email account that was used in the attacks.

Insurance CEO: Shut down Hawaii health exchange

The CEO of Hawaii’s health insurance exchange is calling for it to be shut down after a disastrous $100 million rollout that netted only 9,000 enrollments.

Greenway’s Barnes talks next steps

Greenway Health VP of industry and government affairs will leave the company at the end of the month. He will reportedly launch his own health IT focused startup, in addition to providing health IT consulting services.

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May 11, 2014 Headlines No Comments

Monday Morning Update 5/12/14

May 10, 2014 News 3 Comments

Top News


Catholic Health Initiatives files a lawsuit against an unknown hacker, hoping to convince Microsoft to turn over the identities behind several of its email accounts that were used to breach CHI’s systems from Pakistan. The John Doe hacker redirected internal emails to his or her own account and  took control of some of the organization’s domain registrations. The systems of CHI affiliate Franciscan Health System were compromised in March when employees were fooled by a phishing scam into providing their login credentials to a hacker site.

Reader Comments

From Iron City: “Re: reduced readmissions. These stories get a lot of attention, but it’s easy to overstate the gains on readmissions from situations where the same patients were simply kept in the ER or observation instead. That is cheaper and still a partial success, but not the same as avoiding the readmission cost completely.” That’s a good point. You would have to take a guess at which patients would have been readmitted, then examine claims data to see if they were treated in other hospital settings instead. Just looking at the overall readmission percentage wouldn’t provide the full picture. I also question the historical inability of hospitals to understand their true marginal cost of an admission vs. their average cost of an admission – putting one more patient in a bed for the night doesn’t necessarily trigger the same high expense as having a post-up cardiac surgery patient occupying a similar bed during that same night.


From Blockade Runner: “Re: SuccessEHS. We are a FQHC with a grant to implement the product, which was bought by Greenway. The CEO failed to mention a long-term plan for it in a recent webinar even after saying it has 8,000 providers using it. We’re thinking about starting a search. We have specific needs for our UDS reporting and our sliding scale fees based on the Federal Poverty Line. Are any FQHCs using something that works?” My caution there would be to give Greenway a chance to address your concerns directly rather than reading too much into lack of encouraging news in a webinar. If you like their product, put your concerns in contractual T&Cs and see if they approve them – if not, your worst fears are probably justified.

HIStalk Announcements and Requests


Three-quarters of poll respondents say doctors should be licensed nationally rather than by individual states. New poll to your right or here: athenahealth got a lot of stock market attention last week. What was your reaction, if any?

Listening: new from Atlanta indie-soul singer Curtis Harding, sweet 1970s-style horns over a hip-hop beat. One track even goes disco while managing to sound great. I’m also still playing a lot of Georgia grunge rockers Dead Confederate.

Acquisitions, Funding, Business, and Stock


Friday’s market close share performance after Thursday’s earnings announcements: Castlight Health up 10 percent, Allscripts unchanged, Nuance down 3 percent, The Advisory Board Company down 2 percent.


From the Allscripts conference call:

  • Quarterly bookings grew 26 percent, with recurring revenue making up 78 percent of the total.
  • The $3 million drop in revenue came from an unnamed outsourcing client that took its $20 million per year effort in-house.
  • Allscripts says constrained provider capital and a lack of enthusiasm for rip and replace projects will help it sell portal and interoperability products.
  • The company says the 10-year, $500 million agreement it signed with Xerox’s ACS subsidiary in 2011 has “challenging economics” and may require changes.
  • Paul Black says that hosting systems without owning any of the underlying infrastructure has “created a more virtual environment than we’re comfortable with” and that the company will be “much more active managers of our destiny.”
  • Black says he feels “pretty good” about the company’s functionality for inpatient, outpatient, revenue cycle, population health management, and patient portal.


RadNet says in the earnings call that all of its 260 diagnostic imaging centers will be running eRAD RIS/PACS within a year. RadNet acquired the Greenville, SC-based eRad in September 2010 for $11 million.


A site promoting Utah tech business profiles Health Catalyst, which it says will generate up to $100 million in revenue this year and will IPO in 18-24 months.



Justin Barnes, VP of industry and government affairs at Greenway Medical, announced this week that  he’s leaving the company at the end of May. He tells our Jennifer Dennard that he’ll be stay busy over the summer with plans to start two companies (one of them in healthcare IT, with a nod toward consumerism, interoperability, and patient engagement), join a tech incubator, and continue his involvement with government issues in an unstated capacity. He says his Greenway departure is friendly and unrelated to its November 2013 acquisition by Vista Equity Partners or the April 2014 departure of Greenway President Matt Hawkins.


Speaking of Matt Hawkins, who was CEO of Vitera when it was acquired by Greenway in November 2013 — he’ll be replacing Richard Atkin as president of Sunquest, according to internal sources.

Government and Politics


The CEO of HMSA, Hawaii’s biggest medical insurance company, says the state should either shut down the Hawaii Health Connector insurance exchange site or let the federal government take it over. The exchange received $200 million in federal taxpayer money, spent $100 million developing the site, signed up just over 9,000 customers, and raised only $40,000 in user fees that were supposed to fund its ongoing operation. Hawaii didn’t really need the exchange at all since a state act requires employers to provide subsidized insurance to their employees.  In an interesting story twist, the state’s legislature passed a bill last week ordering HHC to kick out the insurance company members of its board, among them HMSA, which in that role oversaw the site’s creation and is now calling for its shutdown.


Hospital music videos have probably reached the Peak of Inflated Expectations on Gartner’s hype cycle now that the marketing people are cranking them out for commercial benefit, but you might still be cheered up this Monday morning by HHC Elmhurst Hospital Center’s cover of “Happy.” Or not, since it probably drives cynics and pessimists crazy (although I’m both and I like it.) 

You also might be inspired (or not) by “Steve Jobs’ 13 Most Inspiring Quotes.” My favorites:

  • "Remembering that you are going to die is the best way I know to avoid the trap of thinking you have something to lose. You are already naked. There is no reason not to follow your heart."
  • "I’m as proud of many of the things we haven’t done as the things we have done. Innovation is saying no to a thousand things."
  • "Being the richest man in the cemetery doesn’t matter to me … Going to bed at night saying we’ve done something wonderful … that’s what matters to me."

The Massachusetts House passes votes to eliminate a law that would have required physicians to demonstrate EHR competency or Meaningful Use certification as a condition of earning or renewing their medical licenses after January 1, 2015. The House voted to delay from 2017 to 2022 a requirement that all providers use EHRs that are connected to the state HIE.

An interesting patient-centered technology example on ReelDX: the mother of a patient records her toddler’s respiratory symptoms on her smartphone. The question: why can’t the video (or other media) be included in the EHR?


Weird News Andy submits a spinning heart story from NEJM: a motorcyclist survives an accident in which his heart rotates 90 degrees due to air pressure in his chest. Doctors removed the air and the heart shifted back. And in a WNA-like story that he didn’t actually submit (yet), an English hospital admits that a man scheduled for an unspecified “minor urological procedure” was instead given a vasectomy.


A UPMC employee sues the health system and a payroll processing firm after a data breach in which hackers filed fraudulent tax returns using the identities of UPMC employees. What’s unusual about the lawsuit: (a) the employee is only asking for identity theft protection, which is usually offered anyway, although she wants 25 years of it instead of the usual one year; and (b) UPMC isn’t a client of the payroll processing firm she sued, according to that company.


Strange: Kosair Charities sues Kosair Children’s Hospital (KY), claiming the hospital is mismanaging its donations, while the hospital responds publicly that the charity isn’t giving it enough money. According to the IRS documents I found, the charity brings in $15 million per year, holds $163 million in assets, and gave the hospital $4 million in the most recent year. Hospitals are last on the list of charities I would support given the waste, mismanagement, and self-serving agendas I’ve seen firsthand in having worked for a few of them. Supporting hospitals isn’t the best way to support patients.


Here’s a brilliant flow chart whose author I can’t credit because it is has been tweeted / retweeted / incorrectly retweeted so many times I can’t figure out its source. Someone shares my intense annoyance at pedantic blowhards who hijack the microphone after a conference speaker has opened the floor to questions that turn out to be eloquent expressions of self love. Use the microphone kill switch, moderators, or take responsibility for the trampling injuries that will result from the mad dash for the exits.


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

More news: HIStalk Practice, HIStalk Connect

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May 10, 2014 News 3 Comments

Advisory Panel: How Will the ICD-10 Delay Affect Your Organization?

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: How will the ICD-10 delay impact your organization?

The ICD-10 delay will cost us more for the implementation. It could be up to $1 million in implementation resources. Our project team will extend for another year, upgrades will stay on track, and we will dual code for longer than planned. We have hired coders who only know ICD-10 and we have to retrain them for ICD-9 so that they can be productive. Unless our vendors come out with yet another ICD-10 version, we should be finished with upgrades by this summer and have a year or longer to test.

[from a vendor member] The delay won’t impact our organization at all  We were ready a while back and so honestly the bad part of this is that all our hard work as compared to other vendors will somewhat go unrecognized. That said, it’s really not that bad since it just means our solution will be even better given the year delay.  Our clients who were already on the track for ICD-10 readiness are all staying focused on ICD-10 preparations regardless of the delay.

Overall I am neutral on the delay. We have done a great deal of preparation, but most of that is helpful with ICD-9 or 10. It would have been a much bigger relief and benefit if MU Stage 2 were delayed. We had already begun an aggressive Clinical Document Improvement (CDI) program aligned with our ICD-10 project. We will continue that program and will also complete our Computed Assisted Coding (CAC) project as it is well underway and has the added impact of allowing us to outsource much of our coding function. Most of the software upgrades came with the MU S2 changes so that testing was needed. The places we will cut back on is training, testing, and outsourced project manager costs. The CDI related training will continue and coder training will be slowed. All other ancillary training and provider ICD-10 specific training will be put on hold. Testing with payers will be delayed for as long as it takes. Unfortunately, this does not really make any resources available to do all the other projects on the list!

This hospital was in the midst of individual system testing and had worked with a few payers to do some combined testing when the delay was announced. Most systems had been upgraded and others were close. We had implemented computer-assisted coding in 2013 to ease the transition into dual coding and had that project live. We had purchased ICD-10 training content, had our coders trained, and had started scheduling provider training. I’d like to say the ICD-10 delay was good because of everything else we have going on in IS (MU Stage 2, an anesthesia go-live, new clinics opening, etc.) as well as all of the other pressures placed on our providers. The reality is that this organization is going to absorb even more expenses than planned due to the delay. The opportunity costs alone concern me. We could have done more productive things this past year that could have had positive impact to our bottom line or patient care. We will have some repeat work to be done in testing and training for the next run at things (unless it’s delayed again – ICD-11 anyone?) I’d like to see us push through and get the rest of the systems upgraded and get our providers trained. The rest of the organization wants to put everything off until we have to do it.

The good news is that we have more time to modify application systems that fell behind schedule for ICD-10 updates. We will be adding more acceptance testing of system changes, especially for our physicians. On the coding side, we will expand our dual coding efforts to identify where improved clinical documentation is needed. Physician training will be delayed. The longer the work spans the higher the cost. So far we’ve estimated an impact of $500,000 to $1 million extra expense due to our need to extend resources.

We are one of the few sites that are rejoicing over the delay. We were woefully late (I have not been here long) and were trying to do too much before the deadline. We will maximize the delay to our benefit.

We were all ready, but stopped cold and now have some smart team members who can do other things. It also meant the government has lost all credibility in this area and we will not try and be too ahead of the curve next time. 

The ICD-10 delay shouldn’t impact us terribly, so I don’t see it as good or bad. Our primary systems have been set up for dual coding for several months now. The majority of our coders are through a vendor, so our primary target is the physician population. The focus with the physicians to date has been better documentation rather than ICD-10 so we will continue this strategy. We are also implementing computer-assisted coding with a live date of June so that will continue as well.

Time was tight for us but we were on track to be ready by 10/1. Although we had begun training, it was organizational / high level therefore we don’t see the time wasted. We are going to use the time to focus on more of the plumbing prior to launching additional training before the next requirement date kicks in. Overall we see the delay as good organizationally.

It is good for us. Generally speaking, it is hard to see how the good of ICD-10 outweighs the bad. With everything else going on in healthcare and healthcare IT, having another year to prepare is a good thing. I have been somewhat surprised to see our professional organizations (CHIME, HIMSS, AHIMA) come out so strongly in favor of keeping it in 2014 when almost half of the provider organizations feel positive about the delay.

We would have been ready for ICD-10 this fall. While the delay does give more time to test, etc. we see it as a negative. We will continue with our testing (integration underway) and will move forward with the majority of our plans this year regardless of the delay. Main impact is around the timing of training – this will be delayed and we have to now reassess our plans to keep ICD-10 “fresh” for those coders that were in process. Also, it causes us to have to extend our resource commitments – whether internal or consulting – which will cause additional expense. We also now have to reassess several large go-lives whose schedules were made based on ICD-10 happening this year.

We have already implemented tools to support ICD-10 in our EHR and will use the delay time to get our users used  to more specific documentation to support ICD-10. Will shift our planned education push to meet new schedule.

As an organization, we are not happy with the delay. We believed we were well positioned for October 1, but we were unsure how our payers, especially CMS, would be ready. The delay will cause us to slow down our physician education, but we are continuing our work on infrastructure like reports and having them ready to go. Concerned they may decide to skip ICD-10 and go to ICD-11 and have another delay.

It gives us time to complete the required upgrades without the intense pressure and also focus on a clinical replacement. Being a McKesson Horizon customer, we have to select a new system.

[from a vendor member] The delay is unfortunate and bums me out.  If folks weren’t ready, we need vendors who step up to take care of the transitions, not more delays. We were ready and spent a tremendous amount of effort to get ready so the biggest negative impact to us is all the things we could have done instead. What could we have done for caregivers instead of using our resources on ICD-10? High opportunity cost.

Kill me now. This is the most ridiculous thing I have ever encountered in my health IT career. We make plans for big projects at least a year ahead of time. Much of our project planning for converting hospitals to Epic was designed around avoiding the immediate post ICD-10 period. Since CMS has been silent—are we to assume the next date is October 1, 2015? We need to make plans and are in a holding period once again. Does anyone have any credibility on this topic?

We’re not stopping, but we are slowing down. We’re in the middle of a bunch of other projects (MU, physician documentation, revenue cycle revisions, massive system upgrades to non-clinical systems, etc.) that need attention. Most of our vendors will have compliant systems long before the deadline, so that all we really will have to do is flip switches. I consider this a neutral to positive. We’ve got limited staff resources to address everything and this gives us one space where we have a little breathing room.

The ICD-10 delay gives us a chance to spend more time implementing and more thoroughly testing our solutions end to end. I for one was thankful for the delay as we just had too much going on at one time. The only question I have is whether or not the Feds will start leaning toward ICD-11 instead.

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May 9, 2014 Advisory Panel No Comments

Morning Headlines 5/9/14

May 8, 2014 Headlines 8 Comments

Flatiron Health Raises $130 Million Series B Round Led by Google Ventures and Agrees to Acquire Leading Cloud-Based EMR Company Altos Solutions

Oncology analytics startup Flatiron Health raises a $130 million Series B round led by Google Ventures. The startup, which was founded by two 20-something ex-Googlers with no medical or health IT experience, is also announcing that it will immediately invest some of that new capital by acquiring Altos Solutions, another cloud-based Oncology analytics firm.

Castlight Health Announces First Quarter 2014 Results

Castlight Health reports its first quarter results since going public: total revenue was $8.4 million, up significantly over 2013 results, but EPS was -$0.72 vs. –$1.19, missing analyst expectations. Their stock price is down seventy percent since their March IPO.

New HHS data show quality improvements saved 15,000 lives and $4 billion in health spending

HHS reports that, since implementing the Affordable Care Act, reductions in falls, adverse drug events, and infections “have prevented nearly 15,000 deaths in hospitals, avoided 560,000 patient injuries, and approximately $4 billion in health spending over the same period." HHS also says readmission rates have dropped 1.5 percent.

19th Annual Sohn Investment Conference: David Einhorn

Hedge fund manager David Einhorn’s slides from the critical presentation he gave on athenaHealth are released. Athena’s stock prices have dropped 15 percent since his statements.

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May 8, 2014 Headlines 8 Comments

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