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Time Capsule: HIMSS10: Party Like It’s 1999

January 24, 2014 Time Capsule No Comments

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

I wrote this piece in March 2010.

HIMSS10: Party Like It’s 1999
By Mr. HIStalk

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Healthcare is different, everybody says, Well, it sure is when it comes to throwing the excessive bacchanal that is the HIMSS annual conference.

Most citizens are shell-shocked from economic devastation. Most industries are reeling. But at HIMSS, it was 1999 all over again.

Sprawling exhibitor booths are burning electricity like a third-world country! Bring on the big-name entertainment! (OK, I admit that I hadn’t heard of Colbie Caillat and singing in a building full of fish tanks is new to me, but her Grammy Award seemed to get people’s attention). Cocktail hour in the exhibit hall are just what stressed hospital executives need to make informed, responsible IT decisions!

The most common phrase I heard in the exhibit hall other than Meaningful Use was Ruth’s Chris.

It was a Las Vegas time warp in Atlanta. Everybody slept in expensive hotel rooms and wore pricy clothes and screwed around with party schedules on expensive smart phones and fretted over dinner reservations and wine lists at expensive restaurants. The neon and booth babes were out in force, everybody loaded up on overpriced Starbuck’s coffee, and hired cars and limos lined up to transport captains of the HIT industry and their minions to and from the convention center.

In the back of my mind, though, was my hospital’s ED. I was thinking of the people patiently waiting there, those using it as their primary care provider because they can’t afford insurance. If I randomly chose one of those patients and took them to HIMSS, what would they think of the free-wheeling technology funfest?

I worry that hospital executives have decided that they are far superior in every way to the average patient they supposedly serve. They have more education, make more money, and enjoy life benefits that the randomly chosen ED patient cannot comprehend. When they travel, they travel in style, and thus supposedly struggling community hospitals will reimburse executives for $250 hotel rooms. And when they go to HIMSS, self-sacrifice is hard to find. In fact, so is any mention of real, live patients, many of whom would probably cause the suit-wearing crowd to physically recoil because they don’t look or act like them.

The other irony is that the key element of discussion, the topic that packed the conference rooms, was getting hands on taxpayer money. All those highly paid and highly expense accounted people were getting together to talk about hitting those economically shell-shocked people and companies a little harder in the pocketbook, making the choice on their behalf that their personal income would be better used to fund EMRs through higher taxes.

Maybe the local TV stations should send video reporters to conferences like HIMSS, just to show the folks back home who make it all possible how their healthcare and tax dollars are being spent.

I could be naïve. Maybe the HIMSS spectacle is so over the top that everybody gets the irony. In fact, I bet they were discussing it at Ruth’s Chris.

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January 24, 2014 Time Capsule No Comments

HIStalk Interviews John Kass, VP of Healthcare Strategy, Bottomline Technologies

January 24, 2014 Interviews No Comments

John Kass is vice president of healthcare strategy and business development for Bottomline Technologies of Portsmouth, NH.

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Tell me about yourself and the company.

Our go-to-market strategy is twofold, both on the direct front and as well working through Tier 1 ECM vendors. As healthcare changes and there’s a lot of consolidation in the market, we’re seeing a movement toward procurement being something that they want to simplify in that supply chain. 

I spent four and a half years at Hyland Software prior to coming to Bottomline. We were taking many people from paper to electronic and linking that information into the electronic medical record. But one of the things that really stood out is that paper has been holding back the power of ECM for quite some time. 

Logical Ink was an e-capture, mobile capture, e-data solution. There was a lot more you could get out of paper and changing the process was key. We signed a private label partnership with Hyland Software. Really being able to go back to customers that I’ve worked with for quite some time and improve the value in technology they’ve already purchased.

 

Describe what Logical Ink does and how you incorporated that acquisition into the product line.

We acquired that technology several years back. It was called Logical Progression. Chris Joyce, who is our director of product development here today, is the developer of the solution.

When Chris invented Logical Progression, the market looked very different. The biggest change is that we’re seeing much more connected healthcare brought on by Meaningful Use. We’re seeing EMR adoption growing. The goal is, how do we create a longitudinal view into the patient?

What’s really changed is, when I came on board, taking the focus around the strategy of… this is something that ECM became a very natural marriage. The product is a much more connected solution today. It’s an enterprise, what we call a standardized one capture platform, any downstream system. In addition to moving and capturing the form, we have the ability to capture discrete data elements in the form and map that downstream. You can have one encounter, capture that information, send it to a Hyland Software OnBase, link that to an electronic medical record, and simultaneously send discrete elements of data down to a population health system or another system discretely. 

The other change is that four years ago, solutions like the iPad did not exist. They’ve revolutionized the way we interact with technology in a way that I can hand my 70-year-old mother an iPad and she immediately gets it. We’ve got a native iPad application. We’re also on Windows. The ability to have devices that are much affordable and usability being much higher has changed the game in the last several years.

 

Can you explain what Hyland OnBase does and how you tie into it?

It stands for “one database.” OnBase is an enterprise content management system. In the patient-related world, there are things inside of that electronic medical record that you’re capturing as discrete data elements, but there are all kinds of things that generate from paper or other people’s systems that have no meaning to it. It’s called unstructured content.

Hyland can quickly bring that content in, capture it, and then put meta-data or key words around that content. Once they add meaning to that content, they have some very slick opportunities to link that contextually into an electronic medical record, or even on the ERP side in the non-healthcare world.

One of the things that we saw was having the ability to not have to scan physical paper into a physical device. There are too many documents going down to HIM to batch scan, so the burden on HIM is still very, very heavy. The goal is, how do we decentralize the capture in a seamless way and how do we optimize the ability to ultimately know what that form type is, because we’re starting electronic in a way that’s very meaningful with the patient?  

We can simplify all of that, the scan queues and hiring people to work and help index that content. We can immediately send that to OnBase through an API and they can immediately place those hyperlinks contextually within the electronic medical record. When you look at it from a workflow and a patient engagement perspective, it’s a game-changer in how you interact with that content.

 

HIM does batch scanning, indexing, and QA to link the scanning of paper. Is electronic mobile capture a better way, and will that process eventually go away?

You’re seeing quite a few trends in the industry. I’ll categorize it in a couple of ways.

There’s always going to be that external content. A patient walks in with pieces of paper that originated in another facility. I call that third-party content. We’re seeing that as an area that you still typically have to scan. If you’re a large IDN, you’re seeing a lot of the banks starting to offer the ability to scan that for you and create an index file as a value-added service. That’s number one.

We’re seeing more things captured discretely as a result of Meaningful Use, tying EMR adoption to reimbursement. But more importantly, certain stages of Meaningful Use are required. In other words, the government said these EMRs need to be certified and they have to do certain things. That’s certainly gotten rid of some of the paper.

There’s that remaining paper. There’s that remaining interaction. Those are things that start inside your own facility. It’s the consents. It’s the patient history. It’s the ABNs. It’s sometimes taking a photo and being able to embed that photo and have the patient or clinicians fill out information about that photo. Prior to Logical Ink, you would have to literally plug a camera into a USB, go out and find that photo, and attach it and attach meaning. With Logical Ink on an iPad, a clinician can take a photo with the embedded camera, embed that photo instantaneously in a form, and fill out information or have the patient fill out information. When we hit submit, it can automatically be linked into the downstream system.

 

Do you think that the increased use of electronic medical records has expanded rather than contracted the content management market?

Certainly it has. There is absolutely no doubt about it that. There was a mandate, there was reimbursement tied to it, and there was a timeline. These were all very compelling events to moving people forward. It’s an impetus to a range of people adopting technology at different times. We’ve seen an industry movement across the board through this mandate that’s been very big. 

Certainly with the enterprise content management piece being a component … I always tell people, your goal isn’t to buy an enterprise content management system and an EMR. Your goal is a longitudinal record of the patient where you can see every action and encounter through one viewer. So Epic becomes that viewer, for example, or Cerner. But what’s great about ECM with the embedded nature of it, when you’re viewing some of that content through the core EMR, many times folks don’t even realize that the ECM portion of that is not just an extension of the actual core system.

 

Thinking about gaps in functionality or gaps in usage that electronic medical record systems have, what can automated or online forms add?

HIMSS came out recently and talked about with so many EMR vendors moving so quickly to try and fill the mandates of the different stages of Meaningful Use, while they focused on the functionality, usability’s probably something that has not taken a front seat given the time.

The other thing we’re hearing is that early productivity reports are showing that with clinicians having to do so much charting in front of the patient, productivity is going down. As you can imagine, part of diagnosing a patient is observing that patient. One of the things that we have been focusing on is the ability to have the patients fill out on an iPad, for example, all of these required forms. That’s unvalidated data at that point.

Now imagine as you walk into your doctor, having the doctor on an iPad asking you questions and updating and editing that information to validate that. Then capturing in that one encounter, moving the form into an ECM solution, but moving the data elements and mapping them discretely into the electronic medical record. We see that that is absolutely key.

The other thing is that while the EMR encompasses probably 80 percent of the overall enterprise technology around clinical and financial applications, there’s all kinds of “ologies” and patient disease management systems. People talk about data silos in healthcare. I would argue that what we really have is vendor silos. We’ve become that unified front end despite where the information is going with a simplified front end that they’re used to, applications like a Windows tablet or an iPad. We’ve focused on those areas to help augment and improve the usability and the optimized workflow.

 

What are some ways that customers are using your technology to improve their core hospital systems?

We’ve got a facility in California that is capturing various forms, but also simultaneously feeding discrete data from Logical Ink right into their disease management system, their population health system. They saw an application that we believe is a differentiator. We’re not just capturing signatures on forms — we’re having a very interactive process with that data. We came up with a concept of you have one encounter, so you capture once with the ability to push to any downstream system.

This is a paradigm shift for them. Before, they were scanning that piece of paper and somebody was entering the discrete information manually into a system. The ability to automate that process in a way that happens very natural with the interaction was a real game-changer from both a workflow time to get information in and certainly from a cost perspective, removing the manual process of having to hire people to manually do that.

 

Do you have some ideas about best practices for improving the satisfaction of patients with the intake process?

There are areas that you’ll go into, a very static patient access area, where there are stations of people working. You literally are going to go in there, check in, and sign all your forms. The fact that our solution can be a desktop solution, can be a web solution or can be a tablet solution means that we offer a very, very compelling licensing model where we don’t differentiate. A device is a device. It gives you the opportunity to use many different platforms for many different uses. 

Where things become very compelling is healthcare – unlike, for example, an accounting job, where you log in and you may not move all day long — many healthcare workers are roaming throughout the facility for different encounters and what have you. The ability to take what used to be maybe a computer on wheels with a scanner on a cart, wheeling that around, physically having to take a packet of 10 forms and physically putting 10 forms through a physical device called a scanner, is a lot of work. Sometimes that gets in between you and the patient. 

If you’re out there wheeling that cart around and your role is to wheel that around all day, changing that from walking with an iPad, scanning a patient’s wrist band, having the ability to pull that patient, pack it up because we’ve got all the integration on the back end with the ECM and all of the different document types and the levels of those document types already being pre-set to the EMR, your ability to walk in very pervasively and have that ability to capture things in a pervasive or untethered way is something that again is a paradigm shift. It allows people to be much more natural and upright and  a tablet doesn’t get in the way between you and the patient.

Most people didn’t see the potential for enterprise use of tablets when the iPad came out, but now everybody wants to use them. WiFi connections are decent and tablets are cheap. Will more opportunities come up?

I think so. Like you said, we’ve got bandwidth today. We’ve got devices. I look at an iPad as a productivity tool, more an appliance than a computer. That’s where you can draw a line in the sand. It really does simplify the way in which you interact with technology, for example. 

Four years ago, you look at where bandwidth was. We had no Meaningful Use. You were talking about a tablet that might cost $1,500 and it really wasn’t enabled for the touch experience. The market wasn’t there to take advantage of the applications.

Fast forward to today, looking at being linked to those Tier 1 vendors, looking at really tying and anchoring into investments that have been made there, and putting the engine behind the ECM in a way that paper has held ECM down for years. If you look at all of those factors, we’re at a time where the market’s there.

People are using these tablets in their personal lives. There’s a very consistent, constant look and feel. People don’t want to use a device at work that’s more of a barrier than the one they use at home to look up an article on the Web. We believe that we’ve bridged that gap in a way that the same simple tools they use in their personal life, they can absolutely start to use in their professional life.

 

What are the company’s plans for healthcare over the next few years?

The timing is right. The market is right. We’ve got the right platform. We think we’ve got the right strategy. We want to be heads-down focused. The company is always looking for potential acquisitions, so that’s something that I would say is ongoing. But we’re looking to do the right thing for the right time and the right reasons. I’ve been on board a year. 

I’ve gotten very, very comfortable in my role and I’m at a point where I feel like we’re optimizing some of the things that we’ve done over the last year. For the time being, we want to keep focused on the opportunity we have right in front of us.

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January 24, 2014 Interviews No Comments

Morning Headlines 1/24/14

January 24, 2014 Headlines No Comments

Quality Systems, Inc. Reports Fiscal 2014 Third Quarter Results

Quality Systems Inc., parent company of NextGen, release their Q3 results: total revenue decreased five percent compared to the same period last year. Adjusted EPS was $0.11 vs $0.26, a 62 percent decline. Still, shares rose eight percent on the results by the end of trading.

Best-of-breed oncology vendors hold their own

KLAS finds that McKesson is leading the medical oncology market, while Cerner and Epic continue to improve. Best of breed vendors are still leading the radiation oncology market.

US and UK working to strengthen use of health IT for better patient care

HHS Secretary Kathleen Sebelius and U.K. Secretary of State for Health Jeremy Hunt sign a bi-lateral agreement between the nations committing to: share medical data, share and co-develop quality indicators, promote the adoption of EHRs, and foster innovation in health IT.

Healthcare Information Technology and Healthcare Information Services: 2013 Year-End Review

Healthcare Growth Partners publishes its annual review of the healthcare IT market, and its current and predicted future financial drivers.

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January 24, 2014 Headlines No Comments

News 1/24/14

January 23, 2014 News 3 Comments

Top News 

1-23-2014 8-33-43 PM

At ONC’s annual meeting on Thursday, HHS Secretary Kathleen Sebelius UK Secretary for Health Jeremy Hunt sign a collaboration agreement between the US and UK that calls for sharing quality indicators, exchanging data and interoperability ideas, maximizing healthcare IT usage, and encouraging health IT innovation.


Reader Comments

1-23-2014 5-33-01 PM

From Freedom Rock: “Re: Martin Health System, Stuart, FL. A friend who is there says their $80 million Epic system is down throughout three hospitals and many other facilities and physician offices. They’re calling in off-duty nurses and clerks to go back to paper.” I asked CIO Ed Collins, feeling guilty as I did so knowing as an IT person how annoying it is to field questions about downtime when you could be fixing it instead, but he was gracious to provide a response Thursday afternoon:

“Martin Health System had a hardware failure that has resulted in our network being down. The failure occurred the evening of Jan. 22 and we are continuing to work on rectifying the situation. Epic is among the systems being impacted by this hardware failure, however, it was not the genesis of the problem. We are continuing operations as scheduled, while strictly monitoring any potential patient safety concerns or issues that would require appropriate care determinations to be made. Our patient care teams are following downtime procedures and protocols to ensure patient safety and proper documentation is provided.”

1-23-2014 6-37-04 PM

From Macke: “Re: Dave Henriksen. The former SVP/GM at McKesson who left to become president of healthcare information solutions at Carestream Health in July 2013 has left Carestream.” Verified. A Carestream spokesperson says Henriksen has left the company for an unspecified opportunity.



HIStalk Announcements and Requests

inga_small Some of this week’s highlights from HIStalk Practice include: EMRs helped improve the identification and follow-up of infants born infected with hepatitis C. Connecticut IPA Medical Professional Services selects athenahealth’s Population Health Management platform. Provider engagement and administrative issues present the biggest challenges to practices adopting and implementing EHRs. The biggest complaint patients have about their physician: waiting in their office. CMS seeks EP participation in the 2013 PQRS-Medicare EHR Incentive Pilot. Twelve HIT vendors discuss emerging technologies expected to have the biggest impact on physician practices over the next 12-18 months in the second of a three-part series. Dr. Gregg ponders if HIT has jumped the shark. Thanks for reading.

I like it when companies issues press releases announcing their HIStalk sponsorship, so thanks to Coastal Healthcare Consulting for doing just that.

On the Jobs Board: Principle Clinical Healthcare Consultant, Marketing Manager, Sales Engineer – Boston or Raleigh.


Upcoming Webinars

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.


Acquisitions, Funding, Business, and Stock

 

VMware will buy mobile technology management vendor AirWatch for $1.54 billion. VMware gains secure mobile device credibility to its story for enterprises, including hospitals, that are shifting from fat client desktops to virtualized and mobile devices.

1-23-2014 3-40-06 PM

Quality Systems reports Q3 results: revenues down five percent; adjusted EPS of $0.11 vs. $0.29, missing estimates on both due to previously announced problems with its hospital software division. Shares rose 8.4 percent Thursday after the announcement before the market opened.

1-23-2014 10-04-45 PM

Microsoft announces Q2 results: revenue up 14 percent, EPS $0.78 vs. $0.76, beating estimates of both.

1-23-2014 3-40-43 PM

Proteus Digital Health, a developer of patient-care and self-health management technologies, closes $31.6 million in debt financing expansion. The company had previously raised around $160 million in funding. Proteus sells miniature medication tracking sensors (smart pills) that are activated by gastric contents, sending the information to skin patches that then forward the information via mobile device to a central service and allowing clinicians and family members to track oral medication intake.

1-23-2014 3-42-05 PM

Telehealth services and software provider MDLive raises $23.6 million.  It offers around-the-clock consumer access to doctors. An individual plan costs $15 per month and includes one-day physician response to emails; phone or video visits cost $20. The company’s previously announced partnerships include Cigna and Sentara Healthcare (VA). One of its financial backers is former Apple CEO John Sculley, best known for firing Steve Jobs from Apple.


Sales

1-23-2014 1-01-15 PM

Parkview Health (IN/OH) will implement business analytics and denials management solutions from Streamline Health.

The District of Columbia Primary Care Association joins The Guideline Advantage quality improvement program, which uses population health management tools from Forward Health Group.

OSF Healthcare (IL) chooses Strata Decision Technology’s StrataJazz for budget and management reporting.


People

1-23-2014 1-33-33 PM

EDCO Health Information Solutions promotes Lynne Jones to president.

1-23-2014 6-53-23 AM

The Pennsylvania eHealth Partnership Authority HIE names the state’s HIT coordinator Alexandra Goss executive director.

1-23-2014 1-35-08 PM

HIMSS names Emanuel Furst (Improvement Technologies) the recipient of the 2013 ACCE-HIMSS Excellence in Clinical Engineering and Information Technology Synergies Award.


Announcements and Implementations

Philips Healthcare launches a Healthcare Informatics Solutions and Services business group to be led by Jeroen Tas, who previously served as CIO for Philips. It will offer hospitals clinical programs, analytics, and cloud-based platforms. The company also reorganized its North America Healthcare sales organization.

Mississippi Gov. Phil Bryant announces the launch of the Mississippi Diabetes Telehealth Initiative to improve disease management and health outcomes for diabetic patients. The program, which is a joint effort between the University of Mississippi Medical Center, GE Health, North Sunflower Medical Center, and C Spire, will use telehealth technology to connect UMC providers with diabetic patients in the Mississippi Delta.

1-23-2014 9-52-01 PM

Santa Clara Valley Medical Center (CA) goes live with RTLS asset management from Intelligent InSites.


Government and Politics

In his annual budget address, New York Gov. Andre Cuomo proposes a $95 million plan to digitize patient records using $65 million in state funds and $30 million from the federal government’s Medicaid program.

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New National Coordinator Karen DeSalvo kicked off ONC’s annual meeting Thursday morning, mostly providing some background about herself and talking yet again about Hurricane Katrina like it was yesterday instead of eight years ago. HIMSS marketed the heck out of that disaster as a call to arm for electronic medical records (as sold by the vendors who provide most of its income, and when that didn’t help sales much, along came HITECH) and now KD has ridden it into the National Coordinator chair as her primary credential even though I haven’t seen any proven Louisiana outcomes that resulted. Her EHR experience isn’t clear, but she has a great public health background. I liked that she characterizes HITECH money as the involuntary taxpayer gift that it was, referring to it as “major investments by the American people.” She seems nice enough and her speech was friendly if not particularly powerful, although her uptalking made her sound less authoritative and is sure to drive mellifluous members of Congress who are used to polished oratory crazy. Nitpicking aside, I like her so far.

1-23-2014 8-25-41 PM

In England, Secretary of State for Health Jeremy Hunt urges hospitals to treat patients like people and for clinicians to work together as teams, suggesting that British doctors to behave like US hospitalists in taking responsibility for the patient’s entire stay from plan to handoff, including putting their names up on the wall of the patient’s room as being responsible. He also urges adoption of information-sharing technology, studying whether medical specialties are too specialized, and reducing patient transfers. I don’t know much about him or his politics, but I like him.


Technology

A Microsoft research project uses Kinect to help stroke victims recover.

1-23-2014 6-56-34 PM

An irrationally exuberant and painfully breezy INC Magazine article declares mHealth to be “the trillion dollar cure” and “the miracle cure for the rising cost of health care in America” in which “smart startups are already cashing in” and that mHealth is “up for grabs, providing an extraordinary opportunity for medically minded entrepreneurs.” It quotes HIStalk Connect’s Travis Good (“a physician and influential blogger on health care technology”) and Palomar Health Chief Innovation Officer Orlando Portale, both of whom contributed just about the only thoughtful content amidst the hype. Like mHealth itself, the article is all over the place with a hodgepodge of apps ranging from weight loss to vital signs monitoring. It isn’t convincing in the slightest that most of them are either effective or destined for financial success, much less the cure for healthcare’s quality and cost problems, but business magazines like to make everything sound like a sure thing.  

1-23-2014 9-58-33 PM

Speaking of mHealth, you know it has jumped the shark when former basketball player Shaquille O’Neal gets involved. Shaq says he’s working with Qualcomm on wireless and health technologies (I hope that won’t interfere with the making of Kazaam 2 or the next “Shaq Fu” album). Cynicism  aside, Shaq actually has meaningful comments, not surprising since he’s a smart guy (he earned an Ed.D doctoral degree in 2012):

I have been using a FitBit, a connected activity monitor, to manage my fitness levels and am finding motivation in the real-time data I can collect on my movement—or lack thereof! Not only can mobile health technologies be engaging, social and easy-to incorporate into your everyday lifestyle, but using them for health monitoring will actually save between $1.96 billion and $5.83 billion in health-care costs worldwide by 2014. The latest technologies can’t solve all of our problems, though. Throughout my career I have found that when individuals come together for a common goal, whether it’s to win an NBA championship or reduce the number of people with chronic disease globally, greater results are achieved. We are on the verge of a new wave of breakthroughs in medical and wireless technologies, legislation and more, but unless we all come together to collaborate across public and private sectors and across educational systems and research institutions we will not see significant change and improvement.That’s why I am joining forces with the World Economic Forum, who are encouraging a global shift towards healthy living and supporting healthy, active lifestyles at individual, community and societal levels.

1-23-2014 8-08-28 PM

A Wall Street Journal report says IBM’s Curam eligibility software is responsible for problems with health insurance exchanges in Maryland and Minnesota.



Other

1-23-2014 1-43-56 PM

Cerner and Epic are making inroads in the medical oncology market, but product immaturity is leaving providers with a lack of functionality, according to a KLAS report. Radiation oncology is still a best-of-breed market with Elekta and Varian as the main competitors.

1-23-2014 5-44-54 PM

A HIMSS heads up: I didn’t realize that the Peabody Hotel in Orlando, across from the street from the convention center and the favored gathering place for well-heeled HIMSS attendees (meaning I’ve never stayed there, although we did hold the first HIStalkapalooza there in 2008), was sold in October for $717 million. It’s now the Hyatt Regency Orlando and is being marketed to mouse ears-wearing tourists. The famous ducks are gone, and given the prohibitive expense of shipping them back to the only surviving Peabody in Memphis, they may well have ended up as a l’orange.

A study finds that the use of EHRs improves the follow-up in identifying and treating babies born to mothers with hepatitis C. Identification of at-risk patients increased from 53 percent to 71 percent, while appropriate follow-up jumped from 8 percent to 50 percent.

1-23-2014 7-22-39 PM

Healthcare Growth Partners releases its 2013 Year-End Review report, which is as insightful, rich in detail, and downright eloquent about healthcare in general as it is healthcare IT investments. I would say it’s a must-read for anyone interested in the business side of healthcare delivery. An excerpt:

HGP remains very bullish on the health IT sector. Creating an environment of connected networks and transparency is core to addressing the structural flaws of the U.S. healthcare system, and IT is critical to enable the reform initiatives underway and any reform initiatives that may follow. The need is high, the runway is long, and the consequences are significant – as long as we get out of the way of ourselves, health IT stands to completely redefine not only the delivery of healthcare but also the management and sustainability of health.

inga_small The dearth of HIT fashion-related news is finally over, thanks to B-Shoe, a start-up company that is testing a walking shoe that helps prevent falls. Designed for seniors or the physically challenged, the shoe incorporates pressure sensors and an algorithm that detects imbalance, plus a motion device that rolls the shoe slightly until the wearer regains his balance. Perhaps there will be a stiletto version by the time I’m in need.

Weird News Andy makes a Roman numeral pun in calling this story “The 4th Doctor.” A company called IV Doctor makes house calls in New York to deliver a $200 hangover-curing IV solution, even providing a sales video. Those who attended the HIMSS conference in Las Vegas will recall my mentioning a similar service in that city.

1-23-2014 8-53-42 PM

WNA also turned up this story. A Nashville opera singer says a nurse-midwife’s episiotomy incision ended her mezzo-soprano career when it caused her to experience incontinence and excessive flatulence. She’s suing the federal government for $2.5 million since the treatment was provided by the Army, in which her husband was serving at the time.


Sponsor Updates

  • Solstices Medical will use Infor Cloverleaf to integrate its DOCK-to-DOC platform with clinical, financial, and supply chain systems, including Infor Lawson Enterprise Financial Management and Chain Management for Healthcare.
  • Vonlay adds 4,000 square feet in office space to its existing Madison, WI headquarters.
  • CCHIT awards Iatric Systems Meaningful Use Manager ONC HIT 2014 certification for all 29 clinical quality measures.
  • Kareo integrates its PM application with the Nexus EHR.
  • Connance CEO and Co-Founder Steve Levin and Gwinnet Hospital System (GA) VP Cathy Dougherty author an HFM Magazine article, “A New Imperative for Patient Relationship Management.”


EPtalk by Dr. Jayne

A recent post on the Harvard Business Review blog discusses research indicating that smartphone use after 9 p.m. can make workers less productive the following day. Their work concludes that phone use causes sleep disturbances that impact work performance. Their two studies will be published later this year and I’m looking forward to seeing the details.

In the first study, they used a survey approach where each participant’s survey response data was analyzed individually over a two-week period. It had a relatively low number of participants (fewer than 100) but showed that increased phone use impacted sleep, creating work issues the next day. The second study had twice the number of participants with more diverse occupations. In addition to daily surveys, they measured use of phones, laptops, tablets, and televisions. The data indicated that smartphones had a greater impact than other devices.

As a physician, I enjoy being able to remotely access my patients’ charts, handle refill requests, process lab results, and take phone messages without being tethered to the office or to a PC. For me, however, using my phone to handle these tasks is a choice. Since my physician income is based on an “eat what you kill” model, I understand the value of my time and can make an informed decision to work outside the office or not.

Our ambulatory EHR has a great mobile product. Logging in and accessing a patient chart takes just a couple of seconds. This has made cross-covering after-hours call for colleagues much easier. I provide better care because I know more about the patients. I don’t have study data, but it would seem to be safer (not to mention more convenient) for the patient if I can address the issue based on the information in the chart rather than sending patients to urgent care. It also makes documenting those phone calls a snap.

Putting on my CMIO hat, however, I worry about the prevalence of working outside the office. Despite various office policies and customs encouraging staff to stay off email after hours, we’re having increasing challenges with staffers who continue to work long after the work day is over. Many of our employees are able to use flex time to accommodate family issues and expect to see some after-hours access in that circumstance. We’ve had some significant weather events with multiple school cancellations this winter, so quite a few parents have been working at home.

Barring flex time arrangements, however, I don’t expect to see people online at 8 or 9 at night unless it’s a scheduled maintenance event, and in that case, it would be happening after 11 p.m. Why is this behavior growing, then? Our health system has been through a couple of rounds of downsizing in the last couple of years and I wonder what impact that has had on people working after hours. Are employees trying to work longer and harder to distinguish themselves from their teammates in the event of another reduction in force? Are they young motivated analysts trying to get ahead? Are they just workaholics? I’d be interested to hear if readers in the trenches are seeing the same trends and what they’re doing to address them.

I beat Weird News Andy to the punch on this one. A Wisconsin medical examiner agrees to a plea deal after being accused of stealing body parts. According to the Wausau Daily Herald, she is accused of taking a piece of cadaver spine and human tissue “to train her dog.” Next time I’d suggest a Milk Bone or possibly a package of Snausages.

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Earlier this week in Curbside Consult, I mentioned that I’m going to need roller skates to maneuver through everything we need to accomplish in 2014. Thanks to @SmyrnaGirl who found me the perfect pair. I bet Inga will be jealous.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 23, 2014 News 3 Comments

Morning Headlines 1/23/14

January 23, 2014 Headlines No Comments

Results of Health IT Research Review Positive Overall, but Some Topics Need More Focus

An ONC EHR literature review finds that the number of EHR-related studies is increasing about 25 percent each year, most of them focused on clinical decision support and CPOE. Other important EHR functions, such as e-prescribing and interoperability, were the subject of fewer studies.

VMware to buy mobile security firm AirWatch for $1.54 billion

VMware announces plans to acquire mobile security company AirWatch for $1.54 billion, allowing VMware to offer PC-level security solutions for smartphones and tablets used by employees.

Government health data sharing may break EU law

In England, a plan to collect health information on all citizens, store it in a centralized database, and share it with care providers across the nation may hit a roadblock as the European Union drafts a data protection law that requires citizens to opt in for data sharing.

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January 23, 2014 Headlines No Comments

CIO Unplugged 1/22/14

January 22, 2014 Ed Marx 13 Comments
The views and opinions expressed in this blog are mine personally and are not necessarily representative of current or former employers.

Leadership and Identity—Look at Me! Look at Me! Look at Me! (Part 4 of 4)

We may not admit it, but most of us crave recognition and awards like a drug. Receiving honors gets us high. We love the buzz that says, “I’m better than you.”

Accolades, though fine on their own, can create an identity on which we base our self-esteem and worth. But it’s only a short-term fix, and the satisfaction quickly fades. The buzz wears off. Worldly recognition is a pursuit that never quenches the real need for significance and worth. The new gold plaque merely masks our insecurities.

So we seek after more, something bigger. Perhaps a more prestigious award. Another graduate degree. Another Fellow.

Don’t believe it? Bing the thousands of companies out there that make a living off our need for recognition. Peruse the corporate office walls. Facebook screams, LOOK AT ME!

You want to score a quick hookup? Talk up your target and pour on verbal affirmation and validation. Want to watch a coward become a hero? Entice him with a ribbon for his chest. Humans are complex for sure, but when it comes to our ego’s need for glory, we are single focused, simple minded, and easily led astray.

Hey, I’m stuck there in the “Look at me!” frenzy. I have sacrificed those most important to me just to win that coveted award. I worked longer hours than reasonable just to be ranked number one. I had to add cabinets to store my prizes. Heck, I spent three hours per day in the gym purely so I could outperform those half my age and get a medal around my neck to brag about it.

I know I’m not alone. I’ve watched marriages destroyed because some guy needed to upgrade his trophy wife. It’s madness! And I am determined to stop it in my own life.

Whoa, now, hold on a minute! There is nothing wrong with winning awards and being recognized for great service or whatever. True. But it becomes a problem when we make it the foundation for our identity. How do you know you have an identity issue? Ask yourself some key questions.

  • Are you defensive reading this post so far?
  • Do you perform so you can get your name engraved on a plaque?
  • Do you covet the other guy’s award?
  • At parties, do you brag about your trophies, medals, certificates?
  • When in conversation, can you draw out the success of others without speaking a word about your last honor?
  • Do you set performance targets because they are the right thing to do or because they will gather positive self-attention?
  • Who do your pursuits make more famous, your employer or you?
  • When you receive recognition, do you take all the glory or share it?
  • When you receive recognition, do you display false modesty?
  • Do you live for yourself or for others?
  • Do you always need to be in control?
  • Are you constantly bewitched by the legacy you will leave?
  • When you don’t win what you want, are you ticked off?

If your identity is based on the need for external validation, what can you do?

First, get rid of people who feed you bullshit. You know who they are — the ones who make you feel good because they inflate your ego. Replace them with people who will be brutally honest and have no fear of repercussion. How do you know who they are? They’re the ones who make you mad.

A couple of my direct reports are good at this. I have staffers who are unafraid of me and get in my face. I love ’em! If there is nobody close to you who challenges you to the point of making you mad, you might need an identity reboot. Conflict, not flattery, is what helps build our character.

As I draw closer to the half-century mark, I find myself on a new learning curve. Man, the growth is painful. I’m OK with recognition and awards now as long as they are purely an external validation of an internal (team) reality. I won’t personally pursue them nor take actions for the sole purpose of personal fame.

Recently, I made the biggest mistakes of my life when I forgot who I was and chased false sources of identity. If it weren’t for mercy, I might not be writing this post. I’m committed to discovering who I really am so I never do that again. Finding my true self is painful and ugly, but at the same time, gloriously beautiful. And freeing.

I’ll leave you with this from one of my heroes, Saint Paul:

The very credentials these people are waving around as something special, I’m tearing up and throwing out with the trash—along with everything else I used to take credit for. And why? Because of Christ. Yes, all the things I once thought were so important are gone from my life. Compared to the high privilege of knowing Christ Jesus as my Master, firsthand, everything I once thought I had going for me is insignificant—dog dung. I’ve dumped it all in the trash so that I could embrace Christ and be embraced by him.

During this series, I pointed out that an identity based on what you do, how you look, or your titles and awards will not lead to fulfillment. What I’m learning is truth for me and it’s rooted in faith. I know I am Edward Marx. A follower of Christ. Here to serve and point others towards the pursuit of truth. I might fail, but I will get back up and move forward.

Who are you? Where is your identity rooted?

This concludes a four-part series on Leadership and Identity. The previous posts are Identity and the Leader, I Look Better than You Do, and It’s All About the Title.

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

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January 22, 2014 Ed Marx 13 Comments

Morning Headlines 1/22/14

January 21, 2014 Headlines No Comments

GE to Acquire API Healthcare

GE announces that it will acquire workforce management software vendor API Healthcare for an undisclosed sum. API Healthcare’s administrative solutions are used by more than 1,600 hospitals and staffing agencies in the U.S. The company’s time and attendance solution has been rated by Best in KLAS for the last 10 years.

Three EMRs lead the pack in the midsize-practice space

Epic continues to lead performance scores in the midsize physician practice market, with athenahealth and Greenway rounding out the top three.

Use and Characteristics of Electronic Health Record Systems Among Office-based Physician Practices: United States, 2001–2013

In 2013, 78 percent of office-based physicians used some form of EHR, but only 13 percent reported using systems that comply with Stage 2 Meaningful Use. In total, only 69 percent of respondents report that they intend to participate in MU.

‘Defect’ on VA benefits site shares vets’ personal details online

The VA’s online eBenefits program is suspected of exposing thousands of veterans personal information after an upgrade-related defect causes other veteran’s data to be erroneously presented to users when they logged into the system. Exposed data reportedly including past and current medical conditions, bank routing numbers, and social security numbers. The VA has shut the eBenefits system down pending an investigation, and will provide credit monitoring for affected users.

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January 21, 2014 Headlines No Comments

News 1/22/14

January 21, 2014 News 6 Comments

Top News

1-21-2014 4-15-52 PM

GE will acquire API Healthcare, a provider of healthcare workforce management software and analytics solutions.


Reader Comments

From Brian: “Re: Advisory Panel ‘2014 will be the year of …’ patient relationship management. Spanning not only the clinical realm, but the financial realm as well. Every touch, clinical and financial, influences the patient’s attitude towards the health system, impacting satisfaction and their willingness to return for elective services or recommend to friends and family.”

1-21-2014 5-31-25 PM

From Keith: “Re: HHS. This issue needs Meaningful Use guidelines.” OIG finds that HHS paid $172 million in claims for 474,000 vacuum erection systems (penis pumps) from 2006 through 2011, spending twice as much per unit as the VA paid or what online retailers charge.

1-21-2014 5-38-21 PM

From Across the Pond: “Re: interesting article from Isala Hospital, Netherlands. It’s in Dutch, but explains the positive outcomes (reduced hospital mortality and others) realized from introducing an extra pre-procedure safety check beyond the usual time-outs before open heart surgery. Results are remarkable: 95 percent vs. 55 percent of professionals now feel the treatment is a team effort and the post-surgical hospital mortality rate was reduced from 15 percent to 1.7 percent. Doctors plan to share the results with US colleagues.”

1-21-2014 8-30-06 PM

From MDCIO: “Re: Windows XP computers after its retirement on April 8. Can you be HIPAA compliant and qualify for Meaningful Use if your system is not receiving security updates?” At minimum, you could interpret that running an obsolete OS for which no security updates are available means you aren’t protecting PHI to the best of your ability. I’m interested to hear from readers, especially CIOs whose hospitals are still running some XP PCs. Hard and fast rules aside, I wouldn’t want to be deposed to provide post-breach “why were you still using XP” justification to OIG or a plaintiff’s attorney. According to HHS:

The Security Rule was written to allow flexibility for covered entities to implement security measures that best fit their organizational needs. The Security Rule does not specify minimum requirements for personal computer operating systems, but it does mandate requirements for information systems that contain electronic protected health information (e-PHI). Therefore, as part of the information system, the security capabilities of the operating system may be used to comply with technical safeguards standards and implementation specifications such as audit controls, unique user identification, integrity, person or entity authentication, or transmission security. Additionally, any known security vulnerabilities of an operating system should be considered in the covered entity’s risk analysis (e.g., does an operating system include known vulnerabilities for which a security patch is unavailable, e.g., because the operating system is no longer supported by its manufacturer).

1-21-2014 6-53-26 PM

From NurseJane: “Re: Prognosis HIS. Did you know it was acquired? We are concerned as we are going through a MU audit and we are on their system. They laid off over half the company last year and replaced the CEO. I would appreciate you finding out more and reporting on it.” CEO Jim Holtzman provided a quick response to our inquiry:

In 2013, Prognosis completed a transaction in which it was acquired by two of its original founders who have since rejoined the company, with the common goal of enhancing its ability to provide the best software and services to our customers in their dedication to provide excellent healthcare services to their patient base.

As a bit of history, In 2012 I joined Prognosis as CFO. At that time, I rapidly joined with our team in a process of improving Prognosis’s financial position, while also taking on a venture/PE fundraising effort that had started shortly before I joined the company. Through 2012 and into May of 2013, our management team worked to enhance our financial position, part of which included a restructuring and initial reduction in force. On May 15, 2013, I took the role of CEO and continued our mission of managing through our challenges. At that time, we implemented one more, final reduction and began the process of completely revising how we approach our business processes to better and more efficiently serve our customers. Over the remainder of the year, we radically improved our support processes, closed new business and continued to guide our company through some difficult waters.

Then, three weeks ago on December 30, 2013, Prognosis closed an investment transaction with AO Capital Partners, LLC, a private equity firm and financial investor. As part of their investment, AO Capital Partners acquired Prognosis through an asset acquisition and made an initial cash investment in the company in the form of working capital.

It is important to note that AO Capital is led by two of Prognosis original founders, Dirk Cameron and Isaac Shi.  Previously, Mr. Shi was the Chief Architect of our software when it was originally designed and built back in 2006. We are extremely excited to have both Mr. Cameron and Mr. Shi back in the Prognosis fold and as members of our leadership team. We are already actively exploring new pathways of product development that include innovative new features and functionality, as well as innovative methods of delivery. We also continue to focus on enhanced customer support and professional service models to better support our customers. We look forward to sharing the fruits of this new partnership with our customers and prospects in the very near future. The simple fact of this transaction is that our customers will feel essentially no difference aside from our efforts, with new development and support resources to further enhance our processes that we have worked on so hard this last year.

We continue to work toward completion of our MU2, 2014 software certification which will be completed in multiple waves. The first of those waves was completed in December and we crushed the certification process, completing our certification, in one day of testing, of more modules than we had originally scheduled. I am confident that we will perform as flawlessly in the remaining waves as we did in wave one. We are now modularly 2014 certified following wave one and continue along the pathway of full EHR certification by end of the first quarter of 2014.  Our customers are going to feel nothing more than continued improvements. 

The only minor change that we will be making beyond the comments above is a tweak to our name, which will now be Prognosis Innovation Healthcare, reflecting our commitment to innovative software that serves the healthcare community.

As always, I welcome calls and questions and will be happy to answer any questions about our company and our products and services.


HIStalk Announcements and Requests

inga_small I was looking over the HIMSS conference schedule today and was intrigued by the new Startup Showcase, which features 40 startup and early stage HIT companies. It looks like the showcase will be in the exhibit hall and participating vendors will have a chance to demo their offerings. Could be fun.

1-21-2014 8-33-47 PM

inga_small Another fun option might be the HIMSS14 Wellness Challenge. Participants wearing a Misfit Shine activity tracker can compete in different daily challenges such as steps taken, calories burned, and distance walked. I always feel like I walk 10 miles a day, so maybe I should sign up.

Reminder: sign up by January 29 if you want to be considered for a HIStalkapalooza invitation. Not everyone who signs up will be invited, but on the other hand, everyone who is invited will have signed up (this sounds like one of those logic problems from the SAT, but it’s really not hard.) We will email invitations to the folks we can accept on February 4 or thereabouts. We have hundreds more requests than we have spots, so not everybody will get an invitation, unfortunately.

1-21-2014 5-58-03 PM

Welcome to new HIStalk Platinum Sponsor MEDHOST. The company offers solutions for ED (MEDHOST EDIS); patient flow (MEDHOST PatientFLow HD); perioperative (MEDHOST Advanced Perioperative Information Management System); patient portal (MEDHOST YourCareCommunity); public health reporting (MEDHOST YourCareLink); clinicals, patient access, revenue cycle, and financials (Enterprise Solutions); BI (MEDHOST Business Intelligence); hosting and managed services (MEDHOST Direct); and services for outsourcing, consulting, and optimization. The 30-year-old Franklin, TN-based company, formerly known as HealthTech and serving more than 1,000 hospital customers of all sizes, unified its corporate identify and product line under the MEDHOST name last month. It pledges to deliver unparalleled value and easy-to-use technology for managing care and the business of healthcare. Customer case studies are here. Thanks to MEDHOST for supporting HIStalk.

I found a YouTube video describing MEDHOST Direct hosting at Valley Regional Hospital (NH).


Upcoming Webinars 

February 5 (Wednesday) 1:00 p.m. ET. Healthcare Transformation: What’s Good About US Healthcare? Sponsored by Health Catalyst. Presenter: John Haughom, MD, senior advisor, Health Catalyst. Dr. Haughom will provide a deeper look at the forces that have defined and shaped the current state of U.S. healthcare. Paradoxically, some of these same forces are also driving the inevitable need for change.

February 12 (Wednesday) 1:00 p.m. ET. Healthcare CO-OPs and Their Potential to Reduce Costs. Sponsored by Health Catalyst. Presenters: David Napoli, director of performance improvement and strategic analytics, Colorado HealthOP and Richard Schultz, VP of clinical care integration, Kentucky Health Cooperative. Consumer Operated and Oriented Plans (CO-OPs) were established by the Affordable Care Act as nonprofit health insurance companies designed to compete in the individual and small group markets. Their intended impact was to provide more insurance options for consumers to pay for healthcare.


Acquisitions, Funding, Business, and Stock


1-21-2014 4-16-32 PM

Kareo secures $29.5 million in growth capital.

1-21-2014 4-17-35 PM

UnitedHealth Group’s Optum health services business grew revenue 35 percent in the fourth quarter.

1-21-2014 4-18-26 PM

Etransmedia Technology acquires Medigistics, a Columbus-OH based provider of RCM and AR management services for the healthcare industry.


Sales

1-21-2014 10-41-02 AM

RegionalCare Hospital Partners (TN) will deploy AirStrip ONE OB and AirStrip ONE Cardiology across its eight-hospital system.

Medical Professional Services selects athenahealth’s population health Management platform for its 450-provider IPA.

1-21-2014 10-42-26 AM

Healthstat will implement eClinicalWorks EHR across more than 350 sites.

1-21-2014 10-44-51 AM

Nexus Health Systems (TX) selects Summit Healthcare Express Connect interface technology.

1-21-2014 10-45-52 AM

Scotland County Hospital (MO) chooses Access electronic patient signature and e-forms solutions to complement its Meditech 6.x EHR implementation.

Summit Healthcare selects Secure Exchange Solutions as its Health Information Service Provider for secure healthcare information exchange.


People

1-21-2014 10-47-04 AM

VisionWare names Paul Roscoe (The Advisory Board) CEO and board member.

1-21-2014 4-25-27 PM

Medhost names Lionel Tehini (Acuitec) president of the company’s professional services division.

1-21-2014 8-09-03 PM

Telemedicine software vendor REACH Health names Steve McGraw (SAI Global) as president and CEO, replacing the retiring Richard Otto.

AtHoc appoints Karen Garavatti (Ericsson) head of human resources.

Salar appoints new members to its clinical documentation advisory board, including Neri Cohen, MD (Greater Baltimore Medical Center), Brian Houston, MD (Johns Hopkins Medicine), Don Levick, MD (Lehigh Valley Health Network), Eric Radler, MD (Lifespan), and Jenson Wong, MD (San Francisco General Hospital.)


Announcements and Implementations

1-21-2014 8-36-01 PM 1-21-2014 8-36-49 PM

Michigan Health Connect and Great Lakes HIE will merge their operations later this year to create one of the country’s largest HIEs.

AirWatch opens a Miami office.

1-21-2014 4-28-28 PM

University Hospital Southampton NHS Foundation Trust in the UK expands the rollout of its personal health record, which is based on Get Real Health’s InstantPHR patient engagement platform.

1-21-2014 5-19-16 PM

France-based IT services vendor Atos launches an enterprise content management system for healthcare based on EMC Documentum.

1-21-2014 8-37-43 PM

Aventura will integrate its instant-on awareness computing technology for clinicians with virtualization offerings from Varrow.


Government and Politics

1-21-2014 10-24-31 AM

About 69 percent of physicians intend to participate in the MU program, according to CDC survey conducted in mid-2013. At that time, 13 percent of them were using an EHR capable of supporting 14 of the 17 Stage 2 Core Set objectives. Half of office-based physicians were using at least a basic EHR, up from 11 percent in 2006.

An IT security expert says that Healthcare.gov is not secure, claiming that he can extract thousands of database records directly from the site without even hacking it. He listed 20 security issues weeks ago and says  they haven’t been fixed. HHS says it doesn’t believe him and the site is fine.

1-21-2014 8-17-54 PM

The VA says that the medical and financial information of more than 5,000 users of the VA/DoD eBenefits military benefits site may have been exposed to other users last week due to a programming error.


Other

1-21-2014 11-34-04 AM

“123456” tops Splashtop’s list of the of most commonly stolen passwords for 2013, beating out longtime favorite, “password.”

1-21-2014 7-31-44 PM

A new KLAS report says Epic, athenahealth, and Greenway lead the 11-75 physician practice segment. Allscripts, McKesson, and Vitera have the highest percentage of unhappy customers who will stick to the EMR they bought even though they wouldn’t buy it again.

A study finds that the leading online source of medical information for both providers and patients is Wikipedia.

Tim Moseley and Ron Hedges of the IT department of Memorial Hospital of Gulfport (MS) are presented a certificate of appreciation and Seven Seals Award for setting up a Skype session that allowed Air National Guard Staff Sergeant Drew Bynum, deployed overseas, to see his newborn daughter. Major Jeff Wyatt of the 255th Air Control Squadron told the men, both of whom are veterans themselves, “It’s hard enough being over there and doing your job in trying circumstances, but you’re never totally over there. There’s always a part of you that is back here with your family and friends. It takes people like you, supporting us, to enable us to do our job overseas.”

Weird News Andy provides a quote for this story: “There is not one blade of grass, there is no color in this world that is not intended to make us rejoice.” A 70-year-old man who was born color blind can suddenly see colors after experiencing a fall. Doctors can’t explain it since color blindness is a retinal cone defect, but postulate that it’s the man’s perception of colors that has changed.


Sponsor Updates

1-21-2014 5-55-46 PM

  • More than 150 Surgical Information Systems employees participated in the company’s first community service day in metro Atlanta.
  • NextGen Healthcare reports that its Ambulatory EHR version 5.8 meets the latest ICD-10 standards, adding that it will offer customers ICD-10 educational and testing tools.
  • Harry Greenspun, MD, senior advisor for healthcare transformation and technology for the Deloitte Center for Health Solutions, discusses the four dimensions for effective mobile health in a blog posting.
  • Quest Diagnostics certifies CompuGroup Medical’s LabDAQ LIS as a Gold Quality Solution under Quest’s Health IT Quality Solutions program.
  • Wolters Kluwer Health collaborates with the Academy of Medical-Surgical Nurses to review the core procedures in the Lippincott Procedures software application.
  • RelayHealth’s RelayClearance, RelayAssurance, RelayAnalytics, and RelayPayer Connectivity Services achieve a Level 2 appraisal rating under CMMI Institutes’ Capability Maturity Model Integration.
  • Beacon Partners hosted an analytics roundtable on establishing an analytics-driven healthcare culture.
  • EDCO Health Information Solutions sponsored a presentation by HIMSS VP John H. Daniels on the HIMSS Analytics EMR Adoption model at a New Jersey Hospital Association meeting last week.
  • Surgical Information Systems and QlikTech renew their agreement to expand the use of QlikView with SIS Analytics.
  • Adventist Health (CA) shares how it reduced its revenue cycle by two days after implementing The SSI Group’s RCM solution.
  • A Nuance Communications study finds that 71 percent of physicians would be more responsive to clinical documentation improvement clarifications if they were delivered in real time within their EHR workflow.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 21, 2014 News 6 Comments

GE To Acquire API Healthcare

January 21, 2014 News No Comments

1-21-2014 10-38-01 AM

GE announced this afternoon that it will acquire workforce management and analytics software vendor API Healthcare. Terms were not disclosed.

GE will incorporate API Healthcare’s offerings into its Hospital Operations Management product line that includes asset management and patient flow optimization solutions.

GE Healthcare Services President and CEO Michael Swinford was quoted in the announcement as saying, “Labor costs represent over 50 percent of hospital operating budgets. With this acquisition, GE Healthcare will be able to address a significant portion of hospital operations costs – assets, patients and labor – with a mix of software, real-time data, powerful analytics and professional services.”

The Hartford,WI-based API Healthcare offers solutions for staffing and scheduling, patient classification, human resources, talent management, payroll, time and attendance, business analytics, and staffing agency. The company’s solutions lead the KLAS rankings in the time and attendance and staffing and scheduling solutions categories. 

Private equity firm Francisco Partners acquired API Software in November 2008, naming former Cerner executive J.P. Fingado as president and CEO. The company’s name was changed to API Healthcare in February 2009. Workforce management systems competitor Kronos announced plans to acquire the company in February 2011, but that agreement was scrapped in April 2011 after the Department of Justice expressed antitrust concerns. The company acquired hospital staffing and scheduling systems vendor Concerro in February 2012.

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January 21, 2014 News No Comments

HIStalk Interviews Lyman Garniss, Pathology Project Director, Partners HealthCare

January 21, 2014 Interviews 2 Comments

Lyman Garniss is project director for Partners Enterprise Pathology at Partners HealthCare of Boston, MA. He was interviewed by Lorre Wisham of HIStalk

1-21-2014 9-05-59 AM

Tell me about yourself and the organization.

I’ve been here at MGH and Partners for 25 years this month, primarily working with the clinical laboratories and anatomic pathology folks at the MGH. However, in the past year, I’ve been working with Partners HealthCare, the larger system, to roll out Sunquest lab and some of the blood bank systems and other products across all of Partners and also integrating that with Epic. 

Epic is going in across all of Partners, and everyone’s getting a standardized HIS. We’re also at the same time moving everyone to a standardized LIS.

 

What are your thoughts about the future of genetics and genomics in terms of data and whether it comes from the HIS or the LIS?

The LIS really needs to own that space. It’s where the data is generated today. At least 70 percent of the data in a patient’s medical record in the HIS is coming from pathology, from the labs, from anatomic pathology, and blood bank. There’s some 10 billion lab tests that are performed in the US each year. We produce a ton of that data. 

It’s going to get much larger with the genetic information, proteomics, and all the variant information that goes along with those data points. There’s no easy way to manage that today. The lab owns the specimens and some of the reporting of that, but they really need to own the data itself, the mining of that data, and the curation of the information related to the genetic variance and the proteomic data.

 

You’re saying lab needs to own it, which suggests they don’t now. What has to happen?

It’s a collaboration of the LIS vendors, companies like InterSystems or IBM that manage large data sets well, as well folks from the academic and medical area. A three-way collaboration that has to happen.

The lab information vendor knows the lab space really well and the lab processing and the specimen processing, but their niche really isn’t large data sets and mining large data sets. That’s where they’ll need some help from some of the large database companies, as well as some input and advice and boots on the ground from some of the folks that are actually performing these tests.

 

You mentioned Epic. What do commercial electronic medical record systems have to do long term to keep up with medicine on the lab side?

The breadth and scope of HIS vendors are so large that it’s very difficult, if not impossible, for them to be experts or to be best of-breed in every single area or every single domain that they touch. They may have some expertise in specific areas, but they would have to invest a lot of money in the lab space and really be focused on that. It’s difficult for large vendors like Cerner and Siemens and Epic to be experts at the lab and also manage that large breadth and scope. Their domain is huge.

 

Why are you not choosing to implement Epic’s Beaker LIS instead of Sunquest?

There’s a number of reasons for that. The first one is the Beaker product just doesn’t seem mature enough for our needs. That’s one data point. The second data point is we have a rich history of collaboration with Sunquest. We’re working on integration between the laboratory system and the anatomic pathology system. 

The walls between AP and CP are breaking down. The type of work that is happening in the lab information system is starting to look, in some instances, more like anatomic pathology — large, rich textual reports that the CP system doesn’t do well but AP does well. The reverse is true. We’re doing more instrumentation and instrument testing on the anatomic pathology side. The AP systems really don’t manage instrumentation and stuff well, where the lab system does.

Sunquest is moving forward with us on breaking those walls down so that the integration between AP and LIS, the APLS, and the LIS is much more robust and streamlined, much more integrated.

 

What do you think a hospital CIO should know about lab or pathology informatics?

I was invited to speak to several different groups of my peers here at Partners.The message that I was trying to get across to folks in IS and to other areas is that, again, we’re providing 70 to 75 percent of the data that’s in that HIS. The lab information system is large, it’s complex, and we’re producing a lot of data, a lot of rich data. We’re going to continue to produce even more of it in the future.

 

How are you using your EMR for clinical decision support to guide physicians in ordering labs?

Poorly. [laughs] We have a current provider order entry system. It’s a homegrown system. We are able, with that homegrown system, to customize it to some degree to help steer clinician ordering away from expensive send-out tests.

I’ll give you an example. We show dollar signs next to the test. We don’t actually say how much it costs, but we provide alternative tests that would be cheaper to keep the costs down, especially as we move towards that ACO market. We’re starting to look on the lab side how to steer clinicians towards tests that may be just as effective, but may be less expensive. Epic doesn’t really do that today.

 

Clinical analytics for population health management is a hot topic. What is Partners doing to standardized data and enable better reporting?

The first step is moving to Epic. I believe that the folks at Partners are working with Epic to work more on some of those outcome models and patient care models moving forward.

 

How do you see personalized medicine based on patient genomics moving into everyday practice?

It has to start with the discrete data that’s in the laboratory. We can’t possibly send all the genetic information to the HIS. It would be overwhelming for the clinicians. It would be overwhelming for the HIS system itself. 

The role of the LIS vendor is going to be looking at all these rich data sets and mining, looking for patterns for outcomes to figure out both on the CP side for predicting potential disease states based on genetic variance, but also on the anatomic pathology side, looking at outcomes and survivability for specific types of cancer to figure out.

It’s probably best if I use an example. Something like pancreatic cancer, where the survival rates of that are horrific. Once you’re diagnosed with pancreatic cancer, usually you have weeks or months to live. But there’s probably people that survive longer than others, and we have their specimens. We have a rich biorepository of anatomic pathology specimens, where we can look at what’s the genetic variance in a particular type of that outcome versus somebody that didn’t survive as long. Then we can start targeting therapies based on that. 

The example that everyone’s using today is the HER2. There were one or two treatments for breast cancer in women. Depending upon the treatment, sometimes it killed the patient quicker, but sometimes it cured them. But there was no rhyme or reason until folks figured out that we could base the therapy on specific genetic markers in the tumors.

HER2 is a perfect example and more and more of those examples are going to come forward. But the only way to find those models or find those differences is to be able to mine the data. The laboratory owns that data. It doesn’t reside in the HIS. Mining of that data has to happen in the LIS space.

 

How can the average hospital involve the lab people in their EMR decisions and setup?

I have attended the Sunquest User Group for many years. There’s now Epic roundtables at SUG, the Sunquest User Group. Those have been very enlightening. 

What we’ve seen at those meetings are basically two camps of folks. There’s folks that Epic was installed at their site and the laboratory was not involved. In speaking with those lab folks now, Epic has become a nightmare for them because they were not involved with a lot of the decision-making process. They don’t have access to a lot of the way that the system was designed or built. Supporting the lab information system and integration with Epic has been extremely problematic for those sites where lab was not involved up front and early with the HIS vendor with that integration and testing process.

Then there’s the other camp, where the LIS folks — both IT and the actual people that are doing the science in the laboratories — were involved early on with the HIS implementation. Those folks are happy with Epic. They’re happy with their HIS and things are going extremely well. We learned from that at Partners early on. My team and others on the lab side are working really closely with the Epic folks in installing the systems here and doing the integration work. It’s been absolutely fabulous. A lot of decisions are being made that make sense for both sides of the equation. Again, we’re providing 70 to 75 percent of the data that’s in the HIS. The lab has to be involved early on with the design, setup, and decision-making process that goes on with the HIS build.

 

How is Partners exchanging information with other facilities outside of your group?

We’re part of the Mass HIway. That interchange is still being rolled out. I wouldn’t say it’s in its infancy, but it’s in its adolescence. 

We send quite a bit of information to the Mass HIway. We do all of our state and city reporting to the Mass HIway. Data that has to go to the state for state-required reporting, like some of the blood management things and the microbe reporting.

Partners HealthCare provided the seed money for an exchange years ago called NEHI. It was for medical centers in the New England area to exchange information with the insurance companies. We’ve been doing that for years. Instead of just having the Partners facilities manage that, we invited other institutions as well because we thought it would be in everyone’s best interest to share the cost of that insurance exchange with them.

 

What are your biggest challenges and opportunities at Partners over the next year?

There’s a few things that we’re working on. Expanding the LIS into areas that they typically haven’t worked in. One is research and managing the research specimen flow; the second is biorepositories. There’s a lot of rich specimens flowing through our systems, but we’re not able to track cohorts or manage consented patients in the LIS, so we don’t know when their specimens are flowing through the system to be able to move those specimens elsewhere or inform a researcher that specific, unique specimens are available. We’re throwing tons of these specimens away and they’re actually quite valuable in some instances. The biorepository area is something that we’re working with the LIS vendors on and we’ll expand in the future.

And then of course the genetics, genomics, and proteomics, and the rich data set … curating the data that goes along with those. The variant information. It’s a huge challenge for all of the institutions that are doing genetic testing to be able to track and update the most recent information about specific genes or gene variants. It’s a huge challenge for folks. There’s no straightforward tool sets that manage that rich data set today. It’s one of those things that the lab, the LIS needs to own and need to expand their role in.

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January 21, 2014 Interviews 2 Comments

Morning Headlines 1/21/13

January 21, 2014 Headlines No Comments

EDs with HIE more likely to avoid repeat imaging

One of the first large-scale studies on the links between HIE participation and imaging in hospital emergency departments finds that redundant CT scans, x-rays, and ultrasounds decreased significantly, with savings in the millions of dollars, at hospitals connected to an HIE.

How Data Analytics Helped Spark a $36.5M Turnaround at Boston Medical Center

Boston Medical Center President and CEO Kathleen Walsh attributes a data analytics project to the hospital’s financial turnaround in which it went from a $32 million loss to a $4 million surplus in two years.

Survey says: EHR incentive program is on track

National Coordinator Karen DeSalvo, MD outlines the progress made thus far under the EHR incentive program.

St. John embraces digital records

A local paper covers St. Johns Medical Center’s (WA) Epic go-live. St John’s is Part of PeaceHealth’s system-wide Epic install.

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January 21, 2014 Headlines No Comments

Curbside Consult with Dr. Jayne 1/20/14

January 20, 2014 Dr. Jayne 2 Comments

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Last week, Mr. H polled his HIStalk Advisory Panel regarding their top priorities and concerns for 2014. I laughed out loud at the response above. Not only is it extremely direct, but in the case of my hospital, it’s entirely true.

Like many facilities, we spend a lot of time going through various exercises to define the various projects we need to work on during the year. We also expend a great deal of effort reviewing our personnel and their capabilities while we determine the overall capacity for work.

I looked back at our timekeeping system, and during 2013, I spent nearly 100 hours in various project evaluation and prioritization efforts. That doesn’t include the time spent looking at team members and whether or not they can take on additional projects. At most of those meetings, there were between six and 12 attendees, so that means we spent close to half a person-year trying to figure out what we need to work on and in what order.

We have over 100 prioritized projects on our ‘to do’ list. Being “prioritized” means that a project fits certain business criteria. For example, it might be in support of our Accountable Care or patient outreach efforts. It might be a process improvement project which requires modification of existing systems or addition of a new system. It might even be something that enhances the user experience or the overall usability of an application. Bring prioritized, however, does not mean that a project is funded.

There are a lot of things on the list that the requestors believe we need to do, but are not willing to commit funds to actually accomplishing. They want us to find funding out of some nebulous IT pot of gold which simply doesn’t exist. Because these projects aren’t funded it means they languish on the prioritization list, which adds to everyone’s frustration. The IT department feels like it can’t ever move things off the list and our departmental customers feel like the IT department doesn’t do anything.

When a project is actually funded, we can knock them out pretty quickly. For example, one of our outreach clinics recently applied for and received grant money for a very specific clinical reporting project. The requested a suite of reports and a dashboard for monitoring. We created a proposal and they approved it. The IT chargeback item was opened and the scope document created and finalized. We had their dashboard live in beta in under 30 days and in production a week or two after that. We probably could have done it faster, but there were some delays with accounting and paperwork and we’ve learned the hard way not to start anything until all the paperwork is in place.

Looking at the actual IT discretionary budget that we have to work with, it’s going to be nearly impossible for us to do anything that isn’t MU-2 or ICD-10 related. If it’s not regulatory, it’s not going to happen unless D.B. Cooper drops a mysterious bag of cash from the sky. We have enough in the budget to handle various hardware and infrastructure upgrades so we can stay ahead of the vendor requirements game.

Like many other hospitals, we’re struggling with the fact that our vendors aren’t delivering the MU-2 and ICD-10 software as quickly as we want it. I hope what we ultimately receive is high quality because we can’t afford endless rounds of testing or delays when what we receive requires patch upon patch. We need to get the MU software in so we can free up the environments for ICD-10 testing. If there are delays, we can’t afford to stand up extra testing environments to handle what the vendors should have taken care of during beta testing.

At least our ambulatory vendor has delivered its software package, which includes both MU-2 and ICD-10. We’ve got it in testing and it looks pretty solid, but there are a couple of fixes we’re waiting for that are fairly specific to our environment. We should have them in the next week and then the real fun will begin. Our physicians are very nervous about the ICD-10 transition and we’re using a third-party vendor to augment the mapping provided by our vendor, but that’s one more thing we’ll have to test.

We’re only a couple of weeks into the year, but I already need a vacation. We plan to attest for MU-2 in the third quarter so we can coast towards ICD-10, but I doubt it will be a smooth ride. In the mean time, we’ll be on-boarding new practices and adding several dozen physicians to existing practices. I think I’m going to need roller skates. If you’re a CMIO what are your priorities for the year? Email me.

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January 20, 2014 Dr. Jayne 2 Comments

HIStalk Interviews Adam Cheriff, MD, CMIO, Weill Cornell Physicians

January 20, 2014 Interviews 2 Comments

Adam Cheriff, MD, is chief medical information officer of Weill Cornell Physicians of New York, NY.

1-20-2014 8-28-26 AM

Tell me about yourself and the organization.

I am the chief medical information officer for Weill Cornell Physicians. I’m a part-time internist, the rest of the time responsible for the clinical health information technology and clinical operations for our physician organization. Weill Cornell Physicians is 950 multi-specialty faculty physicians associated with New York-Presbyterian Hospital.

 

You recently went live with Epic. How’s that going and what are the most important lessons that you’ve learned so far?

We have been an Epic ambulatory customer for many, many years, since 2001. We have a great deal of experience with ambulatory clinicals. What we did most recently was convert our legacy practice management system, which had been GE-IDX, to Epic. We’re very happy with how that’s gone.

We gave it a lot of careful consideration as to what the motivations were for doing it. For us, it was really about trying to consolidate onto a single platform for our administrative and clinical systems; the patient experience and improving it via self service; and lowering the training burden for our staff and faculty. We had an eye towards the future, where we knew we were going to have to do more advanced analytics, and being able to seamlessly move between the clinical and the administrative was a big deal. We had a hope that in doing this that we would lower some of our long-term operating costs.

We went into it with what we thought was good justification. I thought we were thoughtful in terms of how we restructured organizationally from an administrative business unit standpoint in order to support the implementation. That really was a lot of matrixing of the IT and clinical staff that knew the Epic clinicals and knew how to manage that relationship, the business office that were the core revenue cycle domain experts, and our finance office. I think that matrixing really helped a great deal.

 

Some organizations, particularly on the hospital side, have struggled with the conversion to Epic from a revenue cycle standpoint. What’s been your impact?

We feel very fortunate, obviously. I think the press seems to have a little bit of a selection bias in terms of seizing on, unfortunately, the missteps. I can completely see how these things would happen. They’re extremely complicated projects.

We have felt very, very fortunate about how things have gone. I should say that our implementation methodology may have predicted some of our success. Despite the fact that Epic would like to see organizations do this big bang — and I think that there are reasons for that in terms of not necessarily bleeding this out and being trapped in two worlds — we did this in a series of pilots leading up into a big bang. That gave us just enough experience with the new tools, so that with each phase of it, we got stronger.

The high-level summary of our financials is that for one cohort, we’re about six months into this. For the two-thirds of our business, we’re about three months, or one quarter, into this. We are 10 percent year to date increased in our receipts. Now it’s unfair to attribute that all to Epic, because obviously we have a lot of other growth initiatives. But if you look at it from the standpoint of what we budgeted in terms of anticipating that growth, we’re still three percent up, which you can fairly attribute to the Epic effect.

The main efficiencies that we’ve gained is that Epic is great in terms of transparency and accountability, for working charge edits and claim edits, and really has a great task management system to do that. Our pre-AR, we’re working much more aggressively than we were pre-Epic.

 

When you converged onto the single Epic platform, what goals and metrics did you hope for as an outcome?

We looked at the classic revenue cycle metrics. Those are all important. Days in AR , and this might be somewhat Epic-speak, but days in pre-AR as well, claim edits, denials.

Epic does a fairly good job of being prescribed and doing a fair bit of hand-holding with tools to be able to look at those metrics as you’re making the transition, even including some of the legacy practice management statistics as you make that implementation. We are also very interested not exclusively in the revenue cycle side, but also on the access and front-end side — registration quality, patient duplicates, the number of patients that make online appointments, our access metrics in terms of how long people have to wait to get appointments, and so forth.

 

When you mentioned patient self-service, were you primarily referring to self-scheduling?

Yes. Self-scheduling and online bill payment were the two features of MyChart that we were able to unlock with the conversion to practice management.

 

What kind of feedback do you get from patients?

It’s a little early for us to have amassed a lot of formal feedback. Anecdotally, we think that patients love it and that it is definitely helping our brand. Although I will say that given our marketplace in New York City, we have to keep up in that. Many of the other big academic centers are using similar if not identical platforms. Patients really like the convenience that is afforded in sectors other than healthcare. 

Culturally, from a physician organization standpoint, we still have a ways to go. While the consumer is definitely demanding it and the patients want it, the physicians are a little bit slow and guarded about the degree to which they’ll give open access to scheduling. But I think we will evolve.

 

You mentioned that Epic is part of your brand just as it was for Kaiser Permanente, who named their implementation HealthConnect. Do you see that as a competitive advantage and a way to enhance your brand with patients?

Yes. We did something similar right down to the name in that we branded MyChart as Weill Cornell Connect. The patient engagement strategy is so important. From a regulatory standpoint, it’s become increasingly important in terms of all the Meaningful Use objectives around engagement and how you need to communicate with the patient.

From a branding standpoint, the patients really do feel connected. Part of it is the transparency and the visibility of the record, which, of course is something else that the physicians slowly have to wrap their heads around.

But it’s really the interactivity. It’s the ability to, in an asynchronous way, reach out to the practice for all the things that people need to reach the office for. Not being on these endless phone queues is a real patient satisfier.

 

You mentioned that having both sides of the house on Epic gives you some new opportunities. What are you doing or what will you be doing in terms of analytics and population health management?

We are pretty energized about this. Clearly we’re moving from the phase where it’s less about the adoption of the technology, even to some extent less about optimization, although that is going to occur forever. It’s more about now that we have had critical massive adoption, what do we do with all this great data that we have been collecting? We, like most Epic clients, rely heavily on the relational model of Epic’s data, which is Clarity. We have pretty sophisticated report writers and business intelligence tools, including both Business Objects and Cognos, that sit on top of that. 

We are very eager to see where Epic continues to develop in this arena. They have done a good job of recognizing that in order for us to effectively manage populations, we’re going to need more than just the data that’s within Epic. The Epic data warehouse that they’re building towards that will allow us to take in outside claims data and patient satisfaction data is very intriguing to us.

 

Have you gained insights from having all that data available?

We engage in the same kinds of clinical outcomes and chronic disease management metrics that most large institutions engage in. We understand how our diabetics are being managed and our CHF patients and COPD and the chronic disease markers. 

We have struggled, like many organizations, to drill into that from a utilization and cost containment standpoint. That’s why it will be critical for us to start to marry those clinical data, which have become ubiquitous in our system, with the claims data that will be generating now that we have the practice management system.

 

How do you see practices changing both in terms of the changes prescribed by the healthcare environment and the availability of the technology like you’ve implemented?

Oh, boy, that’s a good one. The technology absolutely changes our culture and our practice patterns. I can give concrete examples over our life cycle. 

The first thing that the electronic health record did is it made us function more as a group model. We are a group. We’re a federated group of clinical departments. But sharing the single patient record with the focus changing from the provider’s record to the patient’s record was a real paradigm shift in the way that you can’t help but promote communication. That has promoted better outcomes. 

The next major paradigm shift was the rise of the patient portal, that level of transparency and really getting providers to understand that in many ways the patient owns the data and being as transparent with the results. The self-service model and the online scheduling. Even the rumblings of the OpenNotes project, where people will expose their clinical documentation. 

These are all things that are going to be profound drivers of the way we practice and probably will predict better outcomes because you’ll have a class of patients that’s much more engaged in their care.

 

Are you implementing more evidence-based medicine and standardized care protocols along the way?

We have. We have made use of fairly standard decision support tools that are available in Epic, particularly around Health Maintenance Rules. For certain populations of patients or certain chronic diseases, making sure that we have the data-driven schedule of what should be done for those patients. We use decision support alerts to support that. I think it’s been very effective, actually. We probably have, at this point, dozens of rules that are keeping track of that information.

 

Is there more interest, or could there be more interest, in patients taking a more active role in their healthcare and their health than they have previously?

Yes, because it’s more accessible. If you go back even just a few years pre-portal, it’s pretty difficult for patients to really access their information. What they’re left with is what they can absorb in a hurried clinical interaction, which is often exceedingly difficult for patients. As the word says, a portal is a window into what’s going on with them. 

The fact that we’ve been able to embed patient-friendly education that directs people to do further learning about their conditions, I really do. Where Epic is developing some of the tools that we’ve implemented is that for chronic diseases, that there are tools for patients to engage. Whether that’s blood glucose monitoring for the diabetic or blood pressure monitoring for the hypertensive, that’s a way for them to engage in their health and to promote that communication back with the provider.

 

If you look ahead two or three years, where do you see the most important IT-related priorities that will impact your organization?

It may have become a cliché at this point, but the past couple of years have really been about keeping up with regulation. Unfortunately I don’t see that necessarily dying down. Meaningful Use, ICD-10, and all these things that we really have to do. A lot of good that has come out of it, but in many ways, it has stifled innovation. 

The next couple of years are going to be about usability and trying to refine these user interfaces. Clearly interoperability is where we’re headed. The goals of some of this regulation is consistent with promoting the this interoperability, but many of us at the ground level have not seen that realized. T think that’s going to be incredibly important.

Locally, and this is true of many organizations like us, growth is going to be a big driver. The fact that we’re probably going to extend into a larger provider network to take care of larger populations, we’re going to have to find ways to spread our technology and to be reasonably agile about that.

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January 20, 2014 Interviews 2 Comments

Morning Headlines 1/20/14

January 19, 2014 Headlines No Comments

GE Healthcare revenue flat, earnings up 4%

GE Healthcare reports Q4 earnings, revenue declined one percent to $5.12 billion, but profits were up four percent.

Netherlands hospital staff visits St. Rita’s Medical Center

Epic appears to be expanding its presence in Europe as nine members of St Jansdal Hospital, located 40 miles from Amsterdam in the Netherlands, go on a site visit to St. Rita’s Medical Center in Lima, OH.

Girish Navani, on Why Titles Don’t Matter

Girish Navanti, CEO of eClinicalWorks, is interviewed by the New York Times on his leadership style. Navanti hires directly from college, and does not believe in firing people. He enjoys an 80 percent approval rating on employee review website Glassdoor.com, higher than the CEO’s of Greenway, Allscripts, or Epic.

Royal Berkshire Hospital booking system ‘still flawed’

In England, the new CEO of Royal Berkshire Hospital addresses employee concerns over the hospital’s $47 million Cerner Millennium system which went live in 2012.

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January 19, 2014 Headlines No Comments

Monday Morning Update 1/20/14

January 19, 2014 News 6 Comments

From Big Kahuna: “Re: Advisory Panel question about ‘2014 will be the year of …’ Patient Access! Of the 10 hospital CEOs we heard speak at last week’s J.P. Morgan conference in San Francisco, eight mentioned patient access as a chief concern or initiative.”

1-18-2014 2-14-01 PM

“Jeopardy” winner or not, readers aren’t impressed with the healthcare potential of IBM’s Watson. New poll to your right, as requested by a reader: are HIT vendors laying off more people than 1-2 years ago? You can click the poll’s Comments link after voting to explain.

1-18-2014 2-26-46 PM

Lorre is finishing up work on HIStalkU, a new site that will showcase our completed, recorded HIStalk webinars to give them more long-tail visibility. We included the capability to include outside webinars, white papers, and videos as well, so if you are interested, contact Lorre. We have plans for adding more purely educational content such as lectures and slide sets (thus the name.)

1-18-2014 3-33-19 PM

Welcome to new HIStalk Platinum Sponsor Arcadia Healthcare Solutions of Burlington, MA. The 12-year-old, 200-employee company has worked with 7,500 providers, 150 PCMH practices, and five pioneer ACOs to improve healthcare quality and reduce cost via EHR outsourcing and consulting, vendor-agnostic data integration and population analytics, provider retention, and practice transformation and coaching. The company can improve key ambulatory network measures 15-30 percent in six months by bringing together EHR and claims data and helping providers use it. Some of its EHR optimization accomplishments include reducing log-in time by 50 percent, improving system performance by 27 percent, and increasing physician satisfaction by 20 percent. Arcadia provides expert advisors rather than, as it says, “high-priced management consultants who leave nothing behind but PowerPoint.” You probably know some of Arcadia’s industry long-timer leaders: Sean Carroll (Nuance); Sam Adams (Lawson, Picis); and Chris Couch (Health Dialog). Thanks to Arcadia Healthcare Solutions for supporting HIStalk.

1-19-2014 8-45-35 AM

Cerner launches what will be the largest corporate campus in Missouri at an eventual 4.1 million square feet. Cerner says its $4.3 billion complex will house up to 1,500 new employees within three years.

1-19-2014 10-37-06 AM

Meanwhile in England, the interim CEO of Royal Berkshire Hospital says its $47 million Cerner Millennium system is still not working right, adding, “It was particularly bad the year before, but it’s still not good enough. We’re in the process of moving with a new strategy with what the information system should be in future.”

1-19-2014 10-38-13 AM

The local newspaper covers a site visit to St. Rita’s Medical Center (OH) by a nine-member delegation from an Epic prospect hospital in the Netherlands.

1-19-2014 10-39-16 AM

DreamIt Health Baltimore launches and adds Kaiser Permanente to its list of strategic partners that includes Johns Hopkins and Northrop Grumman. Startups chosen for the four-month boot camp, many of which don’t even have websites that I could find, are:

  • Aegle. Wearable biometrics.
  • Avhana. EHR clinical decision support.
  • Cognuse. Game-based stroke rehab.
  • EMOCHA. Medication data capture.
  • Protenus. Patient consent management.
  • Respi. Smartphone-based spirometry.
  • Patient Feed. Inpatient collaboration.
  • Phobious. Augmented reality treatment of behavioral health issues.
  • The Smartphone Physical. Smartphone diagnostic tools.

1-18-2014 4-06-55 PM

Beverly Bell (Health Care DataWorks) is named VP of consulting at Siemens Healthcare. 

1-19-2014 9-09-14 AM

Connie McGee (AirSrip) joins Pershing Yoakley & Associates as a principal.

1-19-2014 10-00-22 AM

Actor Dennis Quaid is back on the patient safety bandwagon again years after after his high-profile legal crusade against medication errors went on hiatus. Quaid, whose newborn twins were given 10,000 unit/ml of the blood-thinning drug heparin as an IV flush rather than 10 units/ml at Cedars-Sinai in 2008 without permanent harm, is urging Californians to support the Pack Patient Safety Act that would require doctors to look up their patients in the state’s CURES prescription dispensing database before prescribing narcotics. The proposed act, which will appear on the November ballot if it gets enough signatures, would also adjust California’s $250,000 medical malpractice cap for inflation to $1.1 million, require physicians to be randomly tested for drugs and alcohol, and would require doctors to report their peers if they witness substance abuse or medical negligence. Bob Pack’s two children were killed in 2003 when a doctor-shopping drug addict ran over them, after which he found that multiple Kaiser Permanente doctors were prescribing narcotics for the woman without realizing it. Pack, the founder of NetZero, developed the CURES system that few doctors use ( including those of Kaiser) and that doctors say is user-unfriendly. Quaid sued everybody in sight after the medication error involving his twins (including the drug’s manufacturer and distributor, who had nothing to do with the nurse’s mistake) and shamed Cedars into spending $100 million for medication barcoding. HIMSS put him on as a conference keynoter in 2009. He merged his patient safety foundation with another group the next year and hasn’t had much to say about patient safety since.

1-19-2014 9-26-13 AM

NextGen, like Greenway and Allscripts before it, will integrate analytics from Inovalon (which changed its name from MedAssurant last year.)

A Wall Street Journal blog entry mentions an Amazon patent for “anticipatory shipping,” where the company it will use its customer information to reduce the delays between ordering and shipping that “may dissuade customers from buying items from online merchants.” Nobody seems to interpret the possibilities as I do in reading between the lines: the company could ship items “on approval” for opt-in customers with return postage paid, allowing the company to put appealing merchandize into the hands of qualified customers with the confidence that many will keep it. Amazon would be putting a lot of trust in the information it owns, but imagine the possibilities of customers voluntarily buying items they didn’t order, just like making impulse purchases in a store’s checkout lane. Amazon has blurred the line between bricks-and-mortar stores and online purchases with its Prime program, fast shipping, digital downloads, superb product recommendations and reviews, and the possibility of drone-delivered packages. I can see this as its next step in world domination. Imagine the mess if hospitals and practices used their patient data to automatically schedule tests or issue prescriptions and you’ll see why Amazon is a lot smarter.

1-19-2014 10-41-17 AM

GE Healthcare announces 2013 financial results, with sales down slightly but profits up 4.4 percent.

1-19-2014 10-24-32 AM

The local paper says the formerly high-flying transplant program at University of Arizona Medical Center has been temporarily shut down after a dispute with the program’s chief surgeon, who was fired in September 2013 when the hospital accused him of falsifying the electronic records of unsuccessful surgeries. The surgeon claims he was let go after criticizing the dean of the university’s medical school.  

1-19-2014 10-43-10 AM

Girish Navani, CEO of eClinicalWorks, is interviewed by the New York Times on his management style. Some highlights: (a) he doesn’t believe in titles because they create “title warfare”; (b) he doesn’t fire people, he just tells them to take three months to find something else they want to do or be prepared to change how they work; (c) the company hires straight out of college, saying, “We don’t hire free agents, we draft players.” I like this idea:

There’s a big, oval table outside my office, with eight chairs around it, and I spend a lot of time working there. It gives an opportunity to anybody to come up to me, ask questions, discuss an idea and brainstorm on a big whiteboard. Some people will join a conversation just because they want to learn. You never ask the question, “Why are you sitting at this table?”

1-18-2014 4-12-44 PM

Weird News Andy says she’s on pins and needles. New England Journal of Medicine reports the case of a woman with resistant knee pain who was found by doctors performing X-rays to have knees filled with hundreds of acupuncture needles, apparently left there intentionally for ongoing benefit by her acupuncturist.

Vince’s HIS-tory of McKesson Paragon is bittersweet because it’s the last episode in his series that has been running on HIStalk for years. Industry long-timers have enjoyed some fond (and not-so-fond) memories of companies, products, and people in the past, while newer folks have developed new appreciation for the origins of the industry in which they work.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 19, 2014 News 6 Comments

Time Capsule: Dark Side on Line One: If Cash Really is King, Now’s the Time to Leave That Hospital Job

January 17, 2014 Time Capsule No Comments

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

I wrote this piece in February 2010.

Dark Side on Line One: If Cash Really is King, Now’s the Time to Leave That Hospital Job
By Mr. HIStalk

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These days, more and more industry people are using Willie Sutton’s famous answer to why he robbed banks. “Because that’s where the money is,” they say. The current form of the question is this: “Why are you leaving your hospital job to work for a vendor or consulting company?”

I’ll be honest … I thought self-serving university people were full of it when they predicted big shortages of healthcare IT people. The sky is falling, they cried, but it sounded like a lame pitch to boost enrollment in their informatics degree programs. ARRA or not, it just didn’t seem likely that implementers and project people would suddenly be in big demand.

The anecdotal evidence I used to support that belief was this: many of the best people who work for the vendors my hospital uses have been laid off. Experience = higher salary = first to go, at least in the minds of dimwitted vendor VPs whose own ill-informed revenue projections fail to pan out, meaning he or she gets the elevator while the worker bees get the shaft.

I figured there must be lots of talent available, considering vendors are still cutting people loose. Plus, I didn’t (and still don’t) think federal handouts are going to provide enough lipstick for the pig that most doctors visualize EMRs as being (it’s not EMRs they are resisting – it’s USING the EMRs. Sounds the same, but isn’t.)

I guess my lesson learned is to never bet against the money. Cash will presumably get doctors to use EMRs they don’t really want. It’s also working to pull several hospital CIOs and other IT people to (or back to) the vendor dark side.

One non-profit CEO asked me if I thought he should continue working in his current role, which is good for society but not necessarily so great for his wallet. As altruistic as I can sometimes be, I gave him the classic answer from MBA economics: take the better-paying job and donate more to charity. Buy carbon credits for selling out. The window is wide open and this opportunity may never repeat.

Vendors and consulting companies are loading up. The talent they can most easily afford comes from hospitals. From there come the fresh troops, getting their call like a minor league baseball player being offered the chance to move up to The Show.

For those with short memories, though, vendors are just as quick (quicker, actually) to unload FTEs when conditions slip. If you have a loving, loyal hospital spouse who makes you happy and puts up with your idiosyncrasies, then think carefully before running off with the tarted up, drug-seeking vendor stripper who is whispering in your ear to throw it all away to run off to Las Vegas with her to gamble. It’s not nearly as fun as it looks.

The hospital IT people I know are in two camps. Some have worked for a vendor and wouldn’t go back at gunpoint, or have enough roots and loyalty to resist the siren song. You’ll see the second group at HIMSS – former colleagues who suddenly show up in a vendor both wearing shiny new Koolaid-stained suits, so flush with newfound enthusiasm that you would be jealous if you didn’t know the odds of eventual disappointment.

It’s like when low-paid civil service employees quit public service to work for fat cat contractors. It’s a shame, but nobody can really blame you for taking advantage of the cards you were dealt. There’s no unattractive scar even if you did just sell your soul.

I’m not even slightly tempted. I don’t like suits, travel, lumbering bureaucracy, and strategies developed by bean counters who don’t understand healthcare. The second happiest day of my work life was when I was hired by a vendor; the happiest was the day I quit. The years in between are a vaguely unpleasant blur.

But if your hospital job isn’t so great, if the economy has killed the hope retirement, or if you just want a change of scenery, the time is now to do something strictly for the money. The great thing about hospitals is that they won’t hold a grudge if you have to come crawling back in a couple of years.

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January 17, 2014 Time Capsule No Comments

Advisory Panel: Recent Vendor Experiences

January 17, 2014 Advisory Panel No Comments

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: Can you describe a particularly good or bad experience you’ve with an IT-related vendor lately?


Explorys has been great to work with as we focus on connecting our community physicians


I have been very pleased with the responsiveness of our consultants and vendors to lower their fees in order to help us meet our budgetary needs around our $100 million plus implementation. It has become clear to me which vendors can be relied upon to become true partners in which are only in it for themselves.


We’ve had a very tough time with Voalte. Call quality has been pretty awful and Voalte hasn’t been able to delve an app that addresses the problem. They keep telling us that the iOS7 version of their app will correct the problems, but they do not recommend that we deploy that version. Hmmm. 


I’ve actually mentioned this vendor before, but they continue to provide major benefit to me. Virtual Procurement Services.  (VPS). They have saved our organization millions of dollars in capital and operating expenditures. It’s an interesting model, actually, probably worth one of your interviews.


I continue to me amazed at the poor state our vendors are in as we prepare for MU Stage 2. They blame CMS and ONC and say the certification process is broken and that the regulations come out too late and are not fully baked, but the fact is they are sending us code that doesn’t work and isn’t ready for testing. Many of us are in jeopardy of not meeting MU S2 since we will have to wait until Q4 leaving no room for error. The vendors must do a better job getting us a product we can use as we face the challenges of implementing the processes and workflow changes that are required once the software works.


A CDS vendor with a good presentation of a great product, concentrating on our EHR and our issues. They are Dutch, so they already know about ICD-10. I guess that identifies the company.


Predixion Software, good experience related to analytics, supporting our clinical staff in better management of readmission rates.


None of late. Still ramping up in the new gig and the only net new I have hired is the Advisory Board for ICD-10 help. We just started (I know, I know – this is way late but clearly one of the reasons I got hired!)


On the good side, a vendor sent me a holiday gift card that could only be used for donation to a provided list of charities. You could donate on behalf of yourself, your organization, or anyone else. On the bad side, any and all vendors that send you half of something expecting that you will meet with them to get the other half of something that as a whole you couldn’t and wouldn’t accept in the first place.


I was just discussing a system upgrade with a manager. The upgrade turns out to be a reimplementation. The ballpark cost provided by the sales guy/gal, that we budgeted, has now tripled. While I’m obviously not opposed to a vendor improving their product, I think they should be assuming some of the additional expense. While they are changing the system’s infrastructure to something “better” there is no acknowledgement that their previous infrastructure may have been somewhat lacking.


Unfortunately all seemingly middle of the road/mediocre.


I work for a vendor now, but when I worked in a hospital, I found Iatric to be the most responsive vendor we dealt with. They were professional and very quick in all responses. If we had a problem they would have their people work through the night to fix it. Literally every dealing I have ever had with anyone in that company has been positive.


A general experience growing with vendors who really do not take time to know or understand customer needs. Let’s stop cold calling and cold emailing in health IT.


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January 17, 2014 Advisory Panel No Comments

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Reader Comments

  • Looking Deeper: Re: both your 2009 thoughts about EHR data (in which you mentioned "collection clerks known as doctors and nurses") and ...
  • Jan Roberts: Beautiful, Ed. Life is about creating special moments - thank you for sharing. Jan...
  • Tasha Mayfield: I had this exact convo regarding physicians and the quality of their documentation that is the data. Just as there are t...
  • Julie Sykora: Ed--belated congrats to you! Was really liking your philosophy, you approach to work and play UNTIL I read Julie's post ...
  • U2fan: Great story and very applicable to work life, but I'm wondering if the princesses thought that the Edge was waiting in ...

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