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News 11/8/13

November 7, 2013 News 6 Comments

Top News

11-7-2013 6-41-31 PM

Allscripts reports Q3 results: revenue down 8 percent, adjusted EPS $0.05 vs. $0.23, missing estimates on both. By GAAP standards, the company lost $48.9 million in the quarter. The company also announced that it has fired Cliff Meltzer, EVP of solutions development since July 2011, and will pay him severance that includes his expected one-year salary and bonus totaling $900,000. A reader’s rumor suggests that former Jardogs CEO Jim Hewitt, named Allscripts SVP of development after the the company acquired Jardogs in March 2013, will replace Meltzer. I interviewed Hewitt in June 2012.

Reader Comments

11-7-2013 11-16-30 AM

inga_small From HerkyHawk: “Shoes. A Symantec representative was wearing these shoes at the Virginia HIMSS meeting. They serve a dual function: conversation starter and castrator for when she gets angry.” Readers often send me photos of fun shoes, for which I am thankful. This shoe earned a rare mention on HIStalk because its owner clearly understands that shoes offer so much more than foot protection.

HIStalk Announcements and Requests

inga_small A few goodies you may have missed from HIStalk Practice this week include: the implementation of HIT in practices reduces the demand for physicians. CMS says it’s not appropriate to charge patients a fee to access their records online. A reader worries about ZocDoc and HIPAA compliance. Lawmakers consider phasing out fee-for-service billing in favor of rewards-based models. The government shutdown delays the release of the 2014 Medicare physician fee schedule. Jaffer Traish of Culbert Healthcare Solutions discusses EHR clinician adoption and change management. Dr. Gregg shares a post-Halloween nightmare. Julie McGovern of Practice Wise offers advice for providers seeking a replacement EMR product. Micky Tripathi’s “Pretzel Logic” post is called Have Sympathy for Your Vendor. Thanks for reading.

11-7-2013 6-45-21 PM

HIStalkapalooza planning has begun for the February 24 event at the HIMSS conference in Orlando. It’s too early to announce the sponsor, venue, and other details (registration won’t start until right after New Year’s) but I always get requests from companies asking about co-sponsoring it along with the primary sponsor. The previous sponsors have always declined to share the limelight, but this one is OK with the idea and has a plan for providing exposure and recognition at the event because it’s going to be really big and impressive. Let me know if your company is interested.

Acquisitions, Funding, Business, and Stock

11-7-2013 6-47-10 PM

Verisk Analytics reports Q3 results: revenues up 10 percent, adjusted EPS of $0.62 vs. $0.54, missing analyst estimates on both measures. The company noted that its “healthcare business delivered growth that was below” plan, but it remains “enthusiastic” about the longer-term outlook.

11-7-2013 5-25-15 PM

Midwest grocery chain Schnucks follows its competitor Walgreens by opening its first 6,500 square foot IV infusion center, offering patients free Internet access, a TV, a snack bar, and evening and weekend appointments. The center’s pharmacist and two nurses can either infuse the medications on site or prepare them for home administration.


In England, BT selects Harris Corporation to supply clinical portal solutions for health and social care organizations across the NHS.

The California Office of Health Information Integrity awards contracts to Humetrix, UC San Diego Department of Emergency Medicine, and the Santa Cruz HIE to participate in a PHR demonstration project.

Huntsville Memorial Hospital (TX) selects StrataJazz from Strata Decision Technology for cost accounting, operating budgeting, long-range financial planning, and capital planning.

11-7-2013 6-50-27 PM

Mammoth Hospital (CA) chooses the MEDHOST emergency department information system.


11-7-2013 9-06-31 AM

Coker Group hires Jeffrey T. Gorke (Castle Gate Management) as SVP of practice management.

11-7-2013 9-20-24 AM

VA’s acting CIO Stephen Warren is named executive in charge of the office of information and technology and CIO.

11-7-2013 3-27-19 PM

Capsule names Didier Argenton (Siemens Healthcare) as VP of international sales.

11-7-2013 4-32-58 PM

Patricia Sengstack, DNP, RN, formerly deputy CIO of NIH and currently president of the American Nursing Informatics Association, is hired as chief nursing informatics officer of Bon Secours Health System (MD). 

Announcements and Implementations

Software Testing Solutions will provide automated testing services for Sysmex WAM decision support software for the clinical laboratory, validating the system’s rules, application settings, and workflow practices.

Surescripts adds 12 Epic health systems to its national clinical network, including Swedish, UCSD, UCSF, and Community Health Network.

11-7-2013 6-56-20 PM

pMD expands its charge capture secure messaging feature with real-time alerts and direct text messaging.

Government and Politics

11-7-2013 5-41-36 PM

CMS CIO Tony Trenkle will leave the agency, according to an internal email sent to CMS employees.Trenkle oversaw $2 billion in annual IT products and services, including the development of the healthcare.gov website. Dave Nelson, the current director of the office of enterprise management, will serve as acting CIO.

11-7-2013 1-49-39 PM

CMS paid $16.5 billion in EHR incentive payments to over 325,000 EPs and hospitals through the end of September. Customers of Meditech, Cerner, and Epic account for almost half of all hospitals that have attested for Stage 1 MU; customers of Epic, Allscripts, eClinicalWorks, and NextGen represent almost half of all EPs that have attested for Stage 1.

11-7-2013 5-45-29 PM

USO CEO Sloan Gibson, the President’s nominee for the VA’s deputy director position, says in his nomination hearing that he will focus on the agency’s disability claims backlog and the integrated EHR (i-EHR) project of the VA and Department of Defense.

The Military Retirement and Compensation Modernization Commission, reviewing the failure of the VA and Department of Defense to create a single EHR, floats the idea of combining the entire health systems of the VA and DoD into a single organization, with former Senator Bob Kerry stating, “If [VA and DoD] can’t work together, put one of them in charge. Pick your poison, I don’t care which one. Create a unified command with DoD or put VA in charge.” Former Indiana Congressman Stephen Buyer agreed by saying, “If you had one chief information officer in charge of budget and line items for both, this problem and many others would not be an issue.”

I signed up on Healthcare.gov this week just to see what all the fuss was about. I have to say it was a pleasant experience – the much-criticized identification system worked great and the entire process to get quotes took maybe five minutes. Once I saw the prices I’m glad I have hospital-subsidized medical insurance. I  wasn’t as pleased with the site when I logged back in later – it seemed to be confused that I had requested quotes without buying insurance, and I kept getting warnings about pending messages when there weren’t any. Trying again just now, all I got was a blank screen with no options, and clicking the “Get Insurance” tab just took me back to the default page.


Jackson Health System (FL), planning how it will spend the $830 million it will get from a just-passed property tax referendum, says it will upgrade rather than replace Cerner with the $130 million that is intended for EMR-related improvements.

An investigative report finds that financially struggling Lifespan (RI) paid its now-retired CEO $8 million in 2011, raising his 14-year total compensation with the organization to $39 million.

11-7-2013 6-33-54 PM

HIMSS, trying to ensure that FDA doesn’t regulate EHRs as medical devices, proposes to HHS a “risk-based oversight framework” that would consider the risk when used as intended and the cost vs. benefit of oversight. It makes sense – HIMSS points out that non-clinical IT that has no patient safety implications doesn’t oversight. They also don’t want vendors to be solely responsible, with surveillance and reporting responsibilities to be shared among vendors, providers, and government. They suggest that vendor responsibility ends once their control of their product ends, such as when users customize it.

Weird News Andy is at a loss for all but one word: unbelievable. A man claims that city police in Deming, NM pulled him over for rolling through a stop sign at Walmart, then decided from his posture and previous behavior that he was hiding drugs in his anal cavity. A judge issued a cavity search warrant but the local ED doc refused to do it, saying it was unethical. The man was then taken to Gila Regional Medical Center, which obliged by performing two sets of x-rays, two rectal probes, three enemas, and a colonoscopy, all without the man’s consent and with no drugs were found. The hospital is adding its own version of anal intrusion to the story by not only billing the man, but threatening to turn his debt over to collectors.

Sponsor Updates

  • Informatica achieves top marks for customer loyalty, overall quality of products, and product reliability in the 2013 Data Integration Customer Satisfaction survey.
  • Halim Cho, director of product marketing for Covisint, will discusses the importance of cloud identity and access management at the November 20 Gartner Identity and Access Management Summit in Los Angeles.
  • Intelligent InSites VP Marcus Ruark presents on the value of operational intelligence at this week’s Data Intelligence for Health Care Conference.
  • QuadraMed will add Health Language terminology management solutions to its QCPR platform.
  • Bottomline Technologies hosts its second annual Healthcare Customer Insights Exchange this week in Del Mar, CA.
  • Airwatch secures additional office space for its UK facility to accommodate recent growth.
  • Verisk Health publishes its schedule of events through the end of the year.
  • Vocera’s chief medical officer Bridget Duffy offers ideas for improving patient satisfaction scores.
  • eClinicalWorks CEO Girish Navani predicts that patient engagement and population health management will become essential components of EHRs.
  • Predixion Software publishes a white paper on embedding predictive analytics into software.
  • PGA Championship winner Jason Dufner gives Greenway employees a putting clinic.
  • Hayes Management Consulting provides details on its monthly webinar series.
  • HIStalk sponsors named to the Thomson Reuters 2013 Top 100 Global Innovator list include 3M, AT&T, Fujifilm, GE, NTT, and Xerox.
  • PeriGen hosts a November 13 webinar on labor progress as part of its inaugural webinar series on excellence in perinatal care.
  • ZirMed’s Betty Gomez discusses risk mitigation strategies for ICD-10 at next week’s WEDI 2013 Fall Conference in Maryland.

EPtalk by Dr. Jayne

News flash: CMS requests public comments on potential Clinical Quality Measures for Stage 3. The measure specifications are published on the CMS website for your review. If you don’t have any exciting social plans for the weekend, I’m sure it will be a good read. The comment period closes on November 25.


You know you’re a clinical informatics propeller head when you find a quote like this one funny. It’s gone somewhat viral in the health care IT universe since being shared on Twitter last week. I have a medical student working with me this month and he almost spit his coffee when I turned my laptop so he could read it. It’s true, though – lots of people are talking about doing it, but the realities of actually doing it are very different.

My own health system has a vision of big data. They’re spending loads of money building various analysis platforms since they never met a homegrown application they didn’t like. There is a herd of project managers and marketing types that has embarked on a road show to extol the virtues of big data. It’s exciting to hear them talk to groups of physicians about the vision for the future, when they will bring together data from our EHR with payer and community data and use it to change the world.

Call me cynical, but rather than pin all our hopes for the future on a project that is just getting started, perhaps it would be a good idea to go ahead and use what we already have to start changing how we practice. We’re fortunate to have selected an ambulatory EHR that has robust reporting capability. It also can automatically send patient-specific tasks to the care team when test results are overdue, when preventive services need to be scheduled, or when clinical values are out of range. A couple of years ago we bought additional hardware to be able to run over 250 clinical reports and tasks from them, but the servers are largely sitting idle.

Why is this happening? My theory is this. Unlike a certain baseball field in Iowa, if you build it, they may not come. Our physicians are deathly afraid of these reports and what they represent. They’re worried about liability – specifically, the liability of having these patient care tasks and not having the staff to work them. They’ve been told that having a report that they don’t take action on is riskier than having no report, so they have not allowed us to enable them for their practices. They feel trapped in a Catch-22 — if they can demonstrate higher clinical quality they hope to negotiate better reimbursement for their services, but they can’t demonstrate quality because they can’t afford the staff to drive it.

It’s easy to say that physicians should cut their take-home pay and hire more staff, but it’s not realistic. In our group, primary care physicians make less than half of what their subspecialty peers make and typically work longer hours in the office and hospital. The bulk of our primary care growth has been with younger physicians who are still paying off student loans debt that is higher than the mortgage on a McMansion. Our starting salary for most new primary care physicians is barely more than IT managers make.

This brings me to the point of why I have a medical student working with me. He’s in his fourth year and is a smart cookie, but is no longer sure he actually wants to be a physician. He sees the long hours that his faculty preceptors put in and the sacrifices their families have made and doesn’t feel it’s worth it any more. So, with over $180,000 in student loan debt, he’s looking for a way to leverage his clinical knowledge and critical thinking skills in the healthcare field. Unfortunately, learning about the complexities of the Meaningful Use program, the transition to ICD-10, billing requirements, documentation standards, the plethora of audits that we face, and the overall anarchy found in the healthcare system may be driving him out of medicine altogether.

One of the more challenging aspects of working with him has been trying to help him make sense of everything. Much of what we deal with defies logic and pushes the bounds of reason. When I delivered his mid-rotation evaluation, I asked what part of our time together he enjoyed most and he said it was the more IT-focused meetings we’ve had. We’ve been through some highly technical discussions the last few weeks about server virtualization, hardware and operating system upgrades, backups, redundancy, and off-site storage. I asked him what he found appealing about that and he said it was the fact that it was logical and made sense.

I’ve got another two weeks with him, so there’s hope, but it’s been interesting to see his reaction to the things that CMIOs deal with every day. At best I want to convince him to complete an internship so he can be fully licensed and will have more options than if he decides not to pursue additional clinical training. But in the mean time, I’m sure I can come up with plenty of sticky hardware and infrastructure issues to keep him occupied.

Do you work with medical students? What do they think about healthcare IT? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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November 7, 2013 News 6 Comments

Experian Acquires Passport Health Communications for $850 Million

November 6, 2013 News 1 Comment

11-6-2013 6-30-27 AM

Global information services company Experian announced this morning that it will acquire Franklin, TN-based Passport Health Communications for $850 million in cash.

Experian CEO Don Robert said of the acquisition, “Since entering the US healthcare payments market five years ago, we have steadily expanded our position through both organic investment and acquisition, and our business is growing strongly. We are now taking the next step and the acquisition of Passport Health will make us a clear leader in this high growth and attractive market. With our newly combined product range, we will offer our clients in the US healthcare industry a competitive one-stop-shop to manage risk and to satisfy their payments requirements. We are excited about the growth opportunities created by this combination and we greatly look forward to welcoming our new Passport Health colleagues to Experian once the transaction completes.”

Passport, founded in 1996, operates five divisions: Passport (orders, scheduling, verification, patient payments); HealthWorks (physician order screening for compliance); Nebo Systems (claims management); Stat Technologies (scheduling, surgery and bed management); and Data Systems Group (claims and payment processing). It summarizes its mission as “Patient access and payment certainty.” The company’s annual revenue was reported as $121 million.

Passport CEO Scott MacKenzie joined the company in April 2009 after serving as president of RelayHealth Pharmacy Solutions and holding several positions with Cerner. I interviewed him in November 2011.

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November 6, 2013 News 1 Comment

News 11/6/13

November 5, 2013 News 7 Comments

Top News

11-5-2013 9-31-24 PM

For-profit publicly traded hospital operator Health Management Associates will restate its financials going all the way back to 2010 after internal review finds that 11 of its hospitals inappropriately collected $31 million in HITECH money in 2011-2013 due to the corporation’s mistaken application of EHR certification criteria in failing to meet Meaningful Use requirements. HMA has repaid the money. I received a rumor report last Friday from FL IT Guy, which I didn’t run in its entirely because I couldn’t verify it and HMA is publicly traded, that said, “After releasing our CIO and multiple VPs from his organization at HMA, the office has been in a state of chaos. Auditors have been working around the clock including over the weekend capturing any and all documentation. It’s unknown to most of us what they are looking for however it appears serious and it’s easy to speculate that some inappropriate handling of funds was occurring with vendors.”

Reader Comments

From VAInsider: “Re: VA’s latest contracting fiasco. There is more to this story that is likely to be uncovered if an official investigation is launched. This is yet another example of the VA’s flawed IT procurement process and what happens when you let greedy contractors steer the ship.” The VA awards a $162.5 million contract to ASM Research to improve the user experience of VistA on September 30, choosing the vendor whose bid was more than triple that of two competing bids of less than $50 million. The bid was issued under a $12 billion IT contract with vague requirements that let departments use vendors without seeking competitive bids. One month after issuing the bid to ASM, one of the VA technical leads who worked on the contract quit to become chief strategy officer for ASM. The VA cancelled a 2012 $102.6 million contract with ASM due to a conflict of interest with ASM’s subcontractors, one of which is Agilex, which had hired former VA CIO Roger Baker as chief strategy officer in April. Accenture acquired ASM Research just over a month ago

HIStalk Announcements and Requests

11-5-2013 7-10-32 PM

Welcome to new HIStalk Platinum Sponsor BlueTree Network. The Madison, WI HIT consulting company’s network of 300 healthcare IT experts develop their professional equity via contributions to the company’s collaborative network, endorsements from colleagues, and ratings from previous clients. Once BlueTree objectively identifies the best people, they give them the chance to offer services that they’re really good at and enjoy, moving away from staff augmentation toward offering specialized solutions based on client needs. The best people get the best placements. One consultant used her extensive Epic and ICD-10 experience to develop an ICD-10 service package, while another created dynamic tools to help clients optimize their revenue cycle. Clients rate the experts publicly on every project, so there’s nowhere for mediocrity to hide. A happy consultant is a productive consultant and BlueTree’s Consultant Happiness Advocates offer feedback, goal alignment, and making sure work and lifestyle are balanced. If you think you’re up to the challenge of working with the best, create a profile on their site, find projects that interest you (part-time, full-time, remote, on-site, etc.) and see if you can make the cut to bid on and win a choice assignment. Thanks to BlueTree Network for supporting HIStalk.

Here’s an introductory video for BlueTree Network that I found by Googling.

Acquisitions, Funding, Business, and Stock

11-5-2013 6-39-11 AM

Vista Equity Partners, parent company of Vitera Healthcare Solutions, acquires the outstanding shares of Greenway Medical common stock for $644 million, completing the merger of the two companies. The new company will be privately held and operate under the Greenway brand, with Tee Green (Greenway) assuming the role of CEO and Matthew Hawkins (Vitera) as president. We interviewed Green and Hawkins when the merger was first announced in September.

11-5-2013 10-59-44 PM

The Advisory Board Company reports Q2 numbers: revenues up 16 percent, adjusted EPS $0.31 vs. $0.31, beating estimates on both. The company also announced the acquisition of Care Team Connect and the promotion of SVP Glenn Tobin to CEO of the Crimson unit. I asked Chairman and CEO Robert Musslewhite about former Crimson CEO Paul Roscoe, who has been in health IT for years at Microsoft HSG, Sentillion, Sybase, and NEON. According to Robert, “The Advisory Board Company leadership wants to recognize that Paul did a tremendous job of leading Crimson to explosive growth and impact to our member hospitals and health systems. Paul, in working from and living in New England, realized that there needed to be greater presence for the Crimson CEO role in Austin, Texas. We collaboratively initiated a decision with Paul to hand over management of the business to Glenn Tobin, PhD.” Tobin was previously SVP of accountable care solutions, and before that, held COO positions with CodeRyte and Cerner.

11-5-2013 11-00-22 PM

CPSI files Q3 numbers: revenues up 4 percent, EPS $0.66 vs. $0.63, missing expectations by $0.01. The board of directors also declared a regular quarterly cash dividend of $0.51 per share.

11-5-2013 11-01-13 PM

Francisco Partners completes its acquisition of McKesson’s hospital automation unit (the former Automated Healthcare) and renames it Aesynt.

11-5-2013 11-02-04 PM

Compliance information and HR training provider Business and Legal Resources acquires the HCPro and HealthLeaders Media brands.


Fletcher Allen Health Care (VT) selects healthcare enterprise management solutions from Avantas.

HealthCare Partners (CA) will deploy Allscripts EHR across its California medical group sites and will add the FollowMyHealth patient portal and the dbMotion population health management platform.

11-5-2013 9-51-52 AM

Indiana University Health selects Evariant’s Patient Solutions platform for business analytics and patient communications.


11-5-2013 6-35-24 PM 11-5-2013 6-45-40 PM

Kareo hires David Mitzenmacher (Volusion) as VP of customer success and Nitin Somalwar (Flurry) as VP of engineering.

11-5-2013 9-13-06 AM

Vikram “Vik” Natarajan (MDLIVE) rejoins Medfusion as CTO.

11-5-2013 8-05-52 PM

The Dallas Business Journal names T-System CFO Steve Armond private technology CFO of the year.

11-5-2013 8-10-34 PM

Cleveland Clinic Innovations names  acting Executive Director Gary Fingerhut to the permanent position. He was previously the group’s general manager for IT commercialization.

Announcements and Implementations

Ocean Beach Hospital and Medical Clinics (WA) rolls out Healthland for inpatient clinicals and NextGen for the clinics.

11-5-2013 10-01-30 AM

EXTENSION changes its name to Extension Healthcare and rebrands EXTENSION HealthAlert to Extension Engage.

One thousand healthcare professionals in Tennessee adopt Direct secure email technology through the state’s Health eShare Direct Project.

11-5-2013 6-31-26 PM

Bottomline Technologies announces Logical Ink for the iPad, which allows completion and signing of forms electronically and sending discrete data to downstream systems.

Government and Politics

11-5-2013 8-29-01 PM

This is either wickedly funny or a sad indication of just how far partisanship in government has gone. HHS Secretary Kathleen Sebelius, speaking at a healthcare event in Memphis, is presented with the book Websites for Dummies by Tennessee State Senator Brian Kelsey, who you may infer is a Republican. You may also infer from the Secretary’s expression that she was not amused.

And in the daily recap of new  Healthcare.gov problems, a South Carolina man demands that HHS remove the information he entered after another user accidentally pulls it up and e-mails him screen shots to prove it. CMS’s Marilyn Tavenner acknowledged the problem in a Senate hearing Tuesday, explaining, “We implemented a software fix yesterday to fix that.” The man who saw his records says he’s not buying insurance anyway – when he saw that the prices listed on Healthcare.gov were double what he expected, he figured he doesn’t need a doctor very often and decided to save money by going uninsured and paying the federal penalty instead.

Innovation and Research

A study of highly questionable design (and with quite a few product misspellings) from Riverside Methodist Hospital (OH) concludes that medical residents don’t think iPads are worth much for clinical use. It was performed as a satisfaction survey, which is already questionable since nothing was actually measured, but the reasons I suggest ignoring it completely (as well as any site that publishes its conclusions uncritically) are:

  • It asked a lot of questions about using the iPad on rounds and when doing documentation, but the hospital is still hand-writing orders with no CPOE.
  • It didn’t mention the clinical system they use, but the iPad access to it was running VMware View, which I assume means screens designed for seated users who are  typing on keyboards were just dumped onto an iPad.
  • It didn’t distinguish between resident satisfaction with the systems they were accessing vs. satisfaction with the iPad itself.
  • It questioned the residents on their use of the iPads outside the hospital, but the iPads were Wi-Fi only.
  • The app generating the highest number of complaints was ORB Mobile, OhioHealth’s homegrown results browser.
  • Many complaints related to connecting to Wi-Fi, but those complaints weren’t analyzed to determine if the problem was actually the network or authentication rather than the iPad.
  • User expertise wasn’t tested, so they don’t know how many of the residents had used iPads previously.


11-5-2013 10-21-28 PM

ECRI Institute releases its 2014 Top 10 Health Technology Hazards:

  1. Alarm Hazards
  2. Infusion Pump Medication Errors
  3. CT Radiation Exposure in Pediatric Patients
  4. Data Integrity Failures in EHRs and other Health IT Systems
  5. Occupational Radiation Hazards in Hybrid ORs
  6. Inadequate Reprocessing of Endoscopes and Surgical Instruments
  7. Neglecting Change Management for Networked Devices and Systems
  8. Risks to Pediatric Patients from “Adult” Technologies
  9. Robotic Surgery Complications due to Insufficient Training
  10. Retained Devices and Unretrieved Fragments


11-5-2013 12-58-33 PM

One-fourth of community hospitals say they would not buy the same HIS again, according to a KLAS report. No vendor demonstrates a combination of high customer satisfaction and strong sales momentum, though Epic comes closest. Epic is winning the most deals, mostly from larger health systems converting their community hospitals, while Siemens, McKesson, Meditech, and Cerner are losing the most legacy clients.

Epic reveals plans for its fourth campus, which will be called the Wizards Academy and is meant to resemble the traditional look of classroom buildings at older universities in the US and England. Plans call for exteriors with steeples and castle-like notched parapets, as well as 1,580 offices and underground parking for 1,500 cars. The two-story King’s Cross Dining Hall will have 64,000 square feet of space. Epic says the new campus will be filled to capacity the day it opens. The Verona City Council is scheduled to vote on a conditional-use permit next week. Who needs to go to Disney when you can go to Wisconsin to experience Harry Potter, a farm, outer space, and original art?

A Valence Health study finds that more than one-third of Americans will consider non-traditional healthcare plans.

11-5-2013 11-08-44 PM

In England, Rotherham NHS Foundation Trust, which was one of the first hospitals to bail out of the NPfIT program in 2009 to buy its own solution, will dump its $50 million Meditech 6.0 system that just went live last year. The primary reason appears to be that physicians don’t like it and weren’t involved in its selection and rollout. Perot Systems (now Dell Services) did the implementation. The Trust’s board called the project a “catalogue of failure.”

Jackson Health System (FL) had a $832 million bond referendum on the ballot Tuesday, of which $130 million is planned for electronic medical records. UPDATE: Miami-Dade voters approved the measure, which will raise their property taxes to fund facility and equipment upgrades as the hospital hopes to make itself more attractive to patients with insurance. Jackson will build a new rehabilitation hospital and open a dozen urgent care centers. The health system already gets $350 million per year from taxpayers from property taxes and a half-cent sales tax.

Northwestern Memorial Health Care (IL) paid an apparent record price for the Chicago area of around $349 million to buy 900-physician Northwestern Medical Faculty Foundation, or around $400K per doctor.

11-5-2013 11-13-25 PM

Strange: Desert Springs Hospital Medical Center (NV) rolls out a virtual plastic surgery imaging app, hoping that paying customers who like the looks of their photo after they’ve swiped away excess pounds will sign up for bariatric surgery.

11-3-2013 8-08-41 AM

inga_small I am happy to report I was finally able to complete my application on the healthcare.gov website last week. I also finally opened a letter from my current insurance provider (note to self: open mail more regularly) and realized that my existing plan would not be available next year. My choices were to move to a comparable plan that met ACA requirements (about five percent more than this year’s plan) or to a plan that did not include dental (about four percent less.) My 2013 rate, by the way, was about eight percent higher than 2012’s. Bottom line: I’ve secured a new plan that is four percent less than my current coverage and includes a lower co-pay and a significantly lower deductible and out-of-pocket maximum. Once I got through the initial problems logging into the system, I found the site easy to navigate and the amount of data required for the application was minimal, though I did have to provide my Social Security number. Over the weekend I encountered an issue that prevented me from reviewing my initial application and the live chat support advised me to call for assistance (I didn’t.) Without getting into any politics, I am glad the website finally worked for me and am pleased I’ll be saving a few hundred dollars a year.

Sponsor Updates

  • Aventura Founder and CTO Joe Jaudon presented at the International Conference on Awareness Computing and Technology on Monday on the topic of “Advancement in Clinician Efficiency Through Awareness Computing.”
  • First Databank will convene its annual customer seminar in Miami beginning Wednesday.
  • HIMSS Analytics reports that Imprivata is the most widely selected SSO solution in Canadian hospitals with a 34 percent market share.
  • Abraham Verghese, MD provides the keynote address at this week’s 2013 First Databank Customer Seminar in Miami.
  • Andy Smith, president and co-founder of Impact Advisors, discussed employee recognition systems at last week’s Workforce Live! event in Chicago.
  • CareWire discusses how effective communication increases patient safety in surgery centers.
  • Health Catalyst sponsors a November 6 webinar featuring Charles Marcias, MD reviewing cost and quality issues in light of changing payment models.
  • Consultant Micah Solomon recommends direct communication technologies, such as Vocera’s Communications Badge, to improve patient satisfaction.
  • Encore Health Resources selects Compuware’s Changepoint professional services automation solution to manage service engagements.
  • QlikTech and Deloitte co-host a November 6 webinar on the use of analytics to improve capital planning decisions.
  • Sagacious Consultants launches its Strategic Clinical service line to assist organizations with EMR implementations and optimization support.
  • Christine Kalish, national practice director of strategic advisory services for Beacon Partners, shares tips for simultaneously planning and implementing ICD-10. Beacon Partners also hosts a November 15 webinar outlining steps to reduce revenue cycle risks with ICD-10.
  • AirWatch CEO John Marshall discusses the industry’s move away from BlackBerry.
  • CliniComp celebrates its 30th anniversary with a record of near perfect reliability despite technological challenges and various disasters.
  • Hilo Medical Center’s (HI) use of E-forms on Demand from Access helps the organization move towards HIMSS Stage 7.
  • PointClickCare will connect its EHR platform for the long-term care industry to more than 120 labs and imaging departments using the Liaison EMR-Link hub.
  • iCIMS recognizes Intelligent InSites and NTT DATA with Excellence Awards for best company expansions of talent acquisition strategies.
  • Culbert Healthcare Solutions and Greenway co-host a November seminar on how ICD-10 will impact clinical workflow.


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

More news: HIStalk Practice, HIStalk Connect.


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November 5, 2013 News 7 Comments

HIStalk Interviews Pamela Arora, CIO, Children’s Medical Center

November 5, 2013 Interviews No Comments

Pamela Arora is VP/CIO of Children’s Medical Center of Dallas, TX.

11-5-2013 11-06-48 AM 

Tell me about yourself and the medical center.

At Children’s, we’ve reached our 100-year anniversary, which certainly shows that Children’s Medical Center here is here to stay. Relative to the organization, we’re a not-for-profit. We’re the fifth-largest pediatric healthcare provider in the country. We have campuses in Dallas, Plano, and Southlake, which is around this Dallas-Fort Worth area. We also have 15 My Children’s pediatric practices. By the end of the year, we’re expecting that to be 17.

From a Children’s standpoint, not only do we have the hospital and the ED and we’re a Level One trauma center, but we’re also affiliated with UT Southwestern Medical Center. We have been working the hospital, the ambulatory setting, with over 50 subspecialties, and we have these primary care offices around the area here.

Relative to my background, I’ve been here at Children’s as CIO for approaching seven years. When I joined Children’s, it was just embarking on its Epic deployment. Prior to that, I was CIO at UMass Memorial in central Massachusetts in Worcester and have over the years worked in information technology — including some of Ross Perot’s companies, Perot Systems and EDS — working in a number of industries, including healthcare.


How is it different working in a children’s hospital instead of a general one?

From an electronic medical records standpoint, we really do have to look at weight-based much more extensively and from the standpoint of how the alerts work. It does have unique aspects that really affect the quality and safety of the children that we serve. 

From a non-EMR standpoint, what I do say, which isn’t so professional, is that grumpy adults lead to grumpy adults, but kids, the pediatrics — they bring out the best in everybody. Really, I find that the folks here just love to adopt technology. It really is about making life better for kids. It helps people focus on, let’s say, the larger end game, just because with these children, they’re just amazing as far as how they’re working through their various conditions.


Someone from outside might say, gosh, you don’t have any Medicare to deal with. 

We have a huge Medicaid base. We do have Medicare as well, but Medicaid is administered at the state level. That’s about 60 percent of our population. Relative to Medicare, we have that as well.


How did you choose Epic it and how do you view that project?

With Children’s, they’ve been a Cerner shop as far as hospital-based. We still have a footprint of Cerner within our back yard. But we’re for the most part Epic in a single instance. That has ended up being a good solution for us and we have a very strong ROI for our deployment.

Why switch from one EMR vendor to another? As context, our ambulatory clinics and our primary care office — at the time there was one – were on paper. When the organization was going to deploy an enterprise solution, a single instance across the entire organization, we stepped back, looked at it strategically, also took a look at our campus partners with UT Southwestern because we’re a teaching hospital and we certainly collaborate very well with Parkland, who’s also on this campus. 

A strategic choice was made to go to Epic because our partners on the campus were also going to Epic. When you think of physicians that work in multiple environments, residents that may be working in Children’s as well as over at Parkland or one of the two hospitals with UT Southwestern, being able to be on the same EMR helps the care delivery.

In addition, our patients flow among the campuses. A baby might be born in Parkland and then end up being here at Children’s because they have broader needs. Sometimes from an ancillary standpoint we deliver services across the campus. Being on the same electronic medical record really helps.

We took it beyond that. We had cross-campus standards groups that clinicians engaged in to help us standardize how we deployed these three separate instances of Epic across our campus partner organization.


I’ve never heard of anybody collaborating with what could be considered your competitors. It’s interesting that for the benefit of physicians and patients, you’ve combined it into one big project.

We have, and I’ll give you more examples. We’ve even have a single program manager across all three campuses, select the same vendor product, kind of rework decisions along the way. We did that with our transplant solution. 

From that vantage point, we’re looking at some solutions today around radiology, because in many cases, we’re running these tests for patients across the various campuses. It’s something that we do, and we’re expanding. I will also offer that we meet on a monthly basis, and when I describe the kind of collaboration across our campuses, many organizations that are in the same corporate entity cannot get that level of cooperation.


Now that you’re on Epic and having seen Cerner recently, what would you say are the best and the worst aspects of being live on Epic?

We have no regrets about being on Epic at all. I’m going to give you just a quick sense of how we rolled out, because comparing Cerner to Epic in some ways is apples and oranges because we are using Epic differently.

I think Cerner has a good product suite as well, honestly. We think that they have a great lab system. Epic’s has improved dramatically, too. But as far as working through it, when we first embarked on the Epic journey, we had Epic in the hospital, but the doctors weren’t documenting on the system. There was no CPOE. Our ED was still on paper, Ambulatory was on paper, those 55 different subspecialties. That one primary care office we had — that was on paper, too. 

We went live with the first phase of Epic in October 2008. We took in scheduling, registration, and hospital billing. Phase 2, about a year later in November 2009, is when we got into the clinical documentation, bar code med administration, CPOE. Phase 3 was when we upgraded and we started to get into the subspecialties. But when you take a look at the doctors, it really became in Phase 2 that they got much more engaged. 

If you take a look at how we digitized, we have eliminated paper. We’re a HIMSS Level 7 organization. From the standpoint of that journey, the contract was in early 2007 and even now we’re doing different components of rolling out Epic. We’re very happy with the Epic solution. No regrets. 

As far as Cerner, we have been over the years a development partner with them, and bar code meds, we’ve been one of the first organizations. We’ve had, I think, four different solutions in here. Since I’ve been here, it was a Cerner solution and then we helped Epic as far as refining their solution. The nursing and the folks that had been using Cerner before – they came into using Epic with a point of view. 

There were some things that allow navigation that we needed to refine after we went live with Epic. At first the nurses in particular found it hard to follow the way the flow of documentation works within Epic. But truth be known, Epic is very flexible. They work with their customers. They’ve been very responsive.

Cerner, we’ve continued to be impressed with some of the innovations they’re doing around their lab solution. But because we’re trying to move to seamless, we keep working with our lab organization here, our lab department, to see at what point we can take them over to Beaker. Ultimately our aim is to deploy Epic enterprise-wide vanilla, and it has been deployed enterprise wide. But when you take a look at radiology, we still have iSite and we have Cerner for lab. There’s different boutique solutions we have out there.


What recent projects, excluding Epic, are you the proudest of?

Here in Texas, we’re just going onto prospective payment.That occurred in September of this year. As far as deploying that solution, as our organization is going through and seeing how that impacts our organization, there’s a lot of awareness that needs to be built with the clinical folks on how their documentation translates into how prospective payment informs reimbursement. From that vantage point, we’ve had a very helpful deployment. We’ve plugged in some 3M tools. The partnership between the HIM, the IT organization, and the clinicians as far as going through that transition … I’m incredibly proud of the accomplishments even at this early stage of the go-live of prospective payment in our state. 

In addition, we looked at it as a broader clinical documentation improvement program. I would say that a lot of the work that needs to be done for ICD-10, we’re at a state of readiness because we were working a lot of those components simultaneously, even though the date for ICD-10 was pushed out. I’m very proud of the accomplishments there.

We recently went live with a telemedicine solution for our NICU. Given that our organization handles the most of fragile of patients, and we have the highly specialized clinicians in our environment; we’re trying to figure out how to help the community broadly and allow children, especially when they’re in that fragile state, help them be able to stay in their community and only be flown in phone in or helicoptered in when they absolutely need to be. We have a partnership with Trinity Mother Frances. We’re deploying our talent with our NICU via telemedicine into that community hospital. In doing so, we’re finding opportunity to turn around the care of a patient within their environment.

When you talk about how pediatrics is different from adult care, the clinicians certainly see that there’s a difference between delivering care to a child versus an adult. In many cases, if you’re in a community hospital, you get concerned on whether you can deliver the right care for that child. Many cases, they’ll transport the child to us just because they’re not certain. By having telemedicine in the mix, we’re in a position to be able to give them that support that they need in their location, which ultimately leads to not only lower-cost care, but higher quality. When you talk about transporting a child when they’re in that fragile state, it impacts their health as well.

As far as that particular accomplishment, we’re getting such positive response on leveraging our capabilities around the NICU that we’re finding a number of locations across Dallas-Fort Worth that are interested in an organization that can help them in that manner. We are somewhat unique in that we’re the first pediatric hospital in Texas to achieve Level One trauma status and we’re the only pediatric facility that’s associated with UT Southwestern Medical Center.


What technologies have you planned or implemented that will empower the families of your patients?

We have several areas where we’re helping families. We have what we call the Children’s Online Experience. It’s a portal into our electronic medical record so that they can get information on tests and be able to see about appointments. In addition, we have very specialized portals based on the disease population. For example, if I’m an endocrine patient and let’s say I’m 10 years old, I might be wanting to converse with other patients that are like me in a support group way. We provide social networking capabilities in that regard as well as education on the portals.

I will also talk about one other initiative that we’ve worked with the OCR, and that’s our personal health record. While we leverage Lucy, which is part of Epic, some of this is consumer-based on whether they’re demanding or they’re interested or even asking or aware of what a personal health record is. We’ve been committed since I’ve arrived here at Children’s to support whatever platforms the patient families are interested in leveraging in that vein. But we haven’t seen it take off very rapidly.

The OCR felt similarly. They have a grant program called Ignite. They recently shot a video about some of the work that we’ve done with their Ignite program. It was a grant-funded program that we engaged in. We were the first in the nation to use the PHR where we take records from Epic and push them out to Microsoft HealthVault.  Verizon was good enough to donate handheld iPhones for our patient families that could help with sickle cell patients in Tyler, Texas. This is our initial case, and we have a number of instances across the organization, Children’s, that are interested in doing like-type solutions. 

In a nutshell, we push out the record directly into Microsoft HealthVault and then the patient family gets medication alerts for these sickle cell patients, because if they don’t take their medicine in a timely way, it’s very painful. That condition is such that if you don’t take it on a regular basis, it’s very painful. Through the mechanism of using the PHR, we’re using the medication alerts on these mobile phones. But on top of that, that patient and that family has their PHR information that’s theirs to leverage at all these different locations that they may get care delivered to them. In the case of Tyler, many of these patients, to travel to Dallas-Fort Worth. That’s a long distance. 

We’re finding that we’re doing a better job managing their conditions directly. It’s a slightly different model, but very similar to what we’re talking about with telemedicine. How do you get the care delivered to the location of where the patient family is, whether it happens to be in a community hospital, or happens to be on their handheld in a school?

There’s one other thing I’m going to mention relative to telemedicine. We’re also doing telemedicine with schools. It’s a much more sophisticated set of instruments for the NICU, but if you think of a little metal travel bag that someone might take on an airplane, about that size. It’s filled with medical equipment. A Children’s nurse goes into the school system and they’re able to deliver care to the patient in the school. At that point, not only is it helping the patient, it’s helping the families in some cases because it is a bit of a struggle when the child gets that earache in the middle of the day, and invariably when the parent comes home, they find it hard to find services.

In this case, we’re able to help the patients right in the school system and be able to leverage our primary care offices across the community to be able to deliver care without the child leaving the school and the physician can deliver care from one of our primary care offices. That’s another area where we’re reaching out into the community.

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November 5, 2013 Interviews No Comments

Advisory Board Acquires Care Team Connect

November 4, 2013 News 2 Comments

11-4-2013 4-03-51 PM

The Advisory Board Company announced this afternoon that it has acquired Care Team Connect. The Evanston, IL company offers an integrated, Web-based care management platform for population health management.

Care Team Connect will be positioned under the The Advisory Board Company’s Crimson organization and the name Crimson Care Management. Crimson offers hospital-physician alignment performance technology that include analytics and business intelligence.

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The Advisory Board Company also announced that SVP Glenn Tobin, PhD, has been promoted to CEO of the Crimson unit, replacing Paul Roscoe. Tobin joined the company in September 2012 and has previously served as COO of CodeRyte and Cerner.

Tobin was quoted as saying about the acquisition, “Care Team Connect (CTC) is a powerful complement to our Crimson physician analytics suite as it makes it easier for caregivers to implement our best-in-class analytics through lightweight and mobile workflows. As in other parts of our broad technology suite, ABC was led to CTC by our progressive members. The research arm of the Advisory Board profiled Care Team Connect as a best-in-class provider of care management technologies in our research for hospital and health system CEOs over the last two years. Additionally, our Crimson member MissionPoint asked the Advisory Board and Care Team Connect to coordinate much more closely to best serve the emerging MissionPoint’s needs for advanced population health capabilities. Through these channels we came to see the unique and valuable capabilities CTC had developed.”

HIStalk interviewed Care Team Connect Founder Ben Albert in May 2013. When asked how the company’s product fit in among analytics offerings such as those of the Crimson business, he said,

But as soon as a client really digs in and says, OK, how are we actually going to manage the population? Not how are we going stratify and identify the population, but how are we actually going to manage the population and all of these care coordinators we’re hiring now? How are we going to power their workflow in a way that we’re sure that they are going to follow the right patients and that we’re going to get the yield out of the initiative that we anticipated getting? It’s the next step. People recognize that as a major need. We sit on front of it to make it all happen. But until there is that understanding of what analytics is really built around — and it’s really built around crunching the data and what we do, which is built around workflow and coordinated care — I think the market does get confused until they understand the difference.

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November 4, 2013 News 2 Comments

News 11/1/13

October 31, 2013 News 7 Comments

Top News

Health and Human Services Secretary Kathleen Sebelius apologized Wednesday to Americans for the “miserably frustrating experience” caused by problems with the Obamacare website. Congressional leaders grilled Sebelius for 3-1/2 hours about the troubled website rollout and raised security concerns. The secretary said she felt confident the website would be updated and “optimally functional” by November 30.

Reader Comments

From C’mon Mane: “Re: Another Epic sale. Allegheny Health Network is ditching Allscripts Sunrise for Epic. The deal is worth many millions. They think there will be better connectivity as they put the private doctors out of business and hire hospitalists to run their programs.”

10-30-2013 6-36-08 PM

From Jessica: “Re: AHIMA buzz. Had to pass along this wicked shot of our GM, Don Graham, introducing Freddy Krueger to his fist at the Billian booth at the AHIMA conference (where our theme was something along the lines of ‘laying your health market data nightmares to waste’).” Thanks for the great Halloween imagery.

HIStalk Announcements and Requests

inga thumb Just a reminder that Mr. H is still out of pocket so today’s post is all me. Well, me and my BFF, Dr. Jayne.

A few treats from HIStalk Practice this week include: CareCloud will integrate ZocDoc’s appointment booking app into its platform. Physicians are still uncertain how the ACA will impact their workloads or wallets. I’m looking for a few vendor types to participate in a survey.General practice physicians were 1.5 times more likely than specialty practice physicians to have been awarded a MU incentive payment in 2012. In 2011, office-based physicians using EHRs were more likely than non-EHR users to exchange clinical data electronically. My idea of a perfect Halloween treat is having new readers sign up for HIStalk Practice email updates, so thanks in advance. Thanks for reading.

Acquisitions, Funding, Business, and Stock

Merge Healthcare reports Q3 results: sales down five percent, adjusted EPS $0.07 vs $0.13.

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MEDSEEK acquires the Madison, WI-based SymphonyCare, a provider of a population health and care management solution.

10-30-2013 12-09-43 PM

WebMD acquires Avado, a developer of patient relationship technologies, including a patient portal for messaging, reminders, and appointment scheduling tools.

CommVault files Q2 numbers: revenues up 20 percent, adjusted EPS $0.48 vs. $0.38, beating estimates.


10-31-2013 4-50-54 PM

TeraMedica names Nick Donofrio (Merge Healthcare) director of client services, taking over for Greg Strowig, who was promoted to COO.

Post-acute software provider Procura Group promotes Scott Overhill from VP of product management to president. Warren Brown, the former president, has assumed the role of chairman of the board and Bill Bassett (Deyta) joins the company as VP of product management.

10-31-2013 4-52-17 PM   10-31-2013 4-54-04 PM

Allscripts names Rich Berner (Caradigm) president of Allscripts International and promotes Stuart Miller to managing director of EMEA.

10-31-2013 2-53-31 PM

Deloitte names retired Air Force general and former Air Force surgeon general Charles Green, MD a director in Deloitte Consulting and CMO for Deloitte’s federal health practice.

CommonWell Health Alliance announces its board of directors, including Jeremy Delinsky (athenaHealth) as chairman, Rich Elmore (Allscripts) as vice chairman, Bob Robke (Cerner) as treasurer, Rod O’Reilly (McKesson) as secretary, Scott Schneider (CPSI), Justin T. Barnes (Greenway), and Keith Laughman (Sunquest).

Announcements and Implementations

San Diego Regional HIE changes its name to San Diego Health Connect and announces that Sharp Healthcare and Scripps Health have agreed to participate in directing the exchange.

Memorial Healthcare implements Hyland Software’s OnBase ECM solution integrated with its Meditech HIS.

10-31-2013 4-58-38 PM

Mille Lacs Health System (MN) goes live on GE Centricity at its physician clinics.

10-31-2013 5-00-27 PM

The eight-year-old nonprofit organization LCF Research, which is building New Mexico’s HIE, announces that it is now profitable and will be sustainable after its federal grant expires on January 1.

HCA deploys Ingenious Med’s impower platform to more than 4,000 hospital users nationwide.

10-31-2013 1-44-10 PM

Nuance Communications opens its mobile innovation center in Cambridge, MA to house its R&D employees dedicated to voice recognition, natural language, and user interface technologies.

Government and Politics

The Defense Health Agency plans to extend the life of AHLTA though 2018, signaling it will take that long to implement a new EHR.

The House passes a bill that would streamline the VA’s disability claims appeal process and would establish a 15-member commission to seek advice from veteran service organizations, technology companies, and the insurance industry.

Innovation and Research

A pilot demonstration for the ONC successfully demonstrates the use of patient privacy controls over shared medical records. The demonstration showed how externalized patient consent directives can be automatically fetched and applied during the exchange of EHRs.

About half of clinical decision alerts are overridden by providers and about half of overrides are classified as appropriate, according to a study published in JAMIA. The most common alerts to be overridden were formulary substitutions, age-based recommendations, renal recommendations, and patient allergies. While 53 percent of all overrides were classified as appropriate, the likelihood of overriding an alert varied widely by type. The authors recommend refining alerts in order to reduce alert fatigue.


10-31-2013 2-30-09 PM

Nuance introduces an intelligent virtual assistant that uses voice recognition technology to take directives for administrative tasks like ordering medications and labs. “Florence,” which will won’t be launched for another year, will understand the intent of a doctor’s request, actively listen, and respond with facts about how a particular medication or test may affect a patient. Think of the potential if Nuance could tweak this technology to work with spouses.


Healthcare providers outside of the US claim that functionality and support are the top reasons that Cerner Millennium PowerChart exceeds their expectations, according to a KLAS report. Respondents say that despite high costs and contracting concerns, PowerChart is part of their long-term plans.

The Michigan Health & Hospital Association Keystone Center reports that various patient safety and quality initiatives across the state’s 117 hospitals saved more than $116 million (less than one percent) in healthcare costs between 2011 and 2013.

The global market for cloud computing in healthcare is predicted to reach $3.9 billion in 2013, representing 21 percent growth over 2012.

A third (1,099) of Joint Commission-accredited hospitals achieve Top Performer status in the Commission’s annual report on quality and safety. That’s a 77 percent increase over the number of top performing facilities in 2012.

Sponsor Updates

  • The Advisory Board reports that YTD it has extended $1 million in skills-based volunteering to pro bono partners with participation from almost 100 percent of its employees.
  • Vonlay managing partner Aaron Carlock presents a session on portal strategies to improve patient care and business at next month’s HIMSS Midwest Fall Technology Conference in Milwaukee.
  • The Technology Services Industry Association recognizes TeleTracking Technologies  as a Certified Support Staff Excellence Center.
  • England’s Alder Hey Children’s and Liverpool Women’s NHS Trust share details of their implementation of Perceptive Software’s ECM integrated with Meditech.
  • Johnson Space Center will implement Fujifilm Medical Systems’ Synapse Radiology and Synapse Cardiovascular to support NASA’s in-flight and ground clinical care operations.
  • DIVURGENT employees raises $5,000 for Partnership for a Healthier American during its 2013 company retreat in Washington, DC.
  • Vitera announces the availability of Intergy Mobile 2.0 in the Apple Store.
  • Billian’s HealthDATA offers a Porter Research whitepaper on the evolution of consumer engagement in healthcare.
  • Emdeon releases an HTMS whitepaper on modernizing core administration systems and planning a system implementation.
  • CareTech Solutions website security expert James Hunter shares his expertise in a pre-conference education session at next week’s Greystone.Net Healthcare Internet Conference in New Orleans.
  • CTIA-The Wireless Association recognizes AirWatch with MobITS Awards for mobile device management, application development and platforms, and cloud storage and collaboration.
  • HealthMEDX implements INTERACT Tools into its Vision solution to improve early identification, assessment, documentation, and communication about changes in the health status of residents in skilled nursing facilities.
  • Intelligent InSites clients share how tracking software has improved healthcare delivery at their facilities.
  • Levi, Ray & Shoup hosts a secure printing webinar November 5 and 7.
  • Compuware is recognized as one of Michigan’s Healthiest Employers.
  • Vitera introduces Vitera Clinical Exchange, an electronic connection between Florida practices and the state’s online immunization registry, FloridaSHOTS.
  • Impact Advisors principal advisor Laura Kreofsky discusses the two most challenging areas for MU Stage 2.
  • ­­­RazorInsights announces its November conference schedule.
  • Meditech highlights the role of DrFirst in providing its customers e-prescribing functionality.
  • Wellcentive CMIO Paul D. Taylor, MD outlines three mission-critical pieces of network maturity to ensure value-based care.

EPtalk by Dr. Jayne

10-31-2013 5-08-12 PM

I got a chuckle earlier this week when Farzad Mostashari Tweeted about an article on using data to support accountable care efforts: “give MDs info on pts who need A1c, they look at you as though they’re drowning & you’ve just given them a baby.” The line comes from a piece about Memorial Hermann Physician Network (MHPN)and its work to use data to drive population health management.

The network has over 2,000 physicians and functions as an ACO under both Medicare and private-payer frameworks. MHPN is working to bridge the gap between claims-based data and EHR data and I don’t envy them. In working with those two data sources in my own organization, there are plenty of gaps. We continue to deal with practices and service providers that don’t bill in a timely fashion which can skew the claims data. I may have an ophthalmology report back from my colleague so I know I’ve satisfied the patient’s need for diabetic retinopathy evaluation, but the payer hasn’t seen a charge yet therefore the patient’s status is in limbo.

It continues to amaze me that practices can’t bill in a timely fashion even when they are using EHRs. I’m fortunate enough to have very good insurance not only from the patient perspective but from the provider perspective. It reimburses at the top of my fee schedule and also pays timely and accurate claims in a matter of days. As a patient I usually have a paper Explanation of Benefits in my mailbox within two days of when the payment check is cut to the provider, which typically happens within days of the claim. After my recent orthopedic surgery adventures, it took months to receive the first EOB. Based on some of the happenings in the office (such as being charged unnecessary copays during a global period and general disarray with scheduling) maybe I shouldn’t have been surprised. As lean as practices run though it surprised me they wouldn’t do everything possible to get their payments sooner.

In talking to some of my colleagues about the challenges of running an independent practice, it makes sense why so many have been purchased by hospitals and health systems during the last few years. Hospitals sell the vision that they are will deal with practice headaches including OSHA, CLIA, HIPAA, Human Resources, and a host of other issues. Although there are good organizations out there that get the job done, it feels more and more like physicians are being sold a bill of goods.

One of my residency colleagues is part of a small primary care group that was recently acquired. They had a successful EHR installation and were moving forward with Patient Centered Medical Home and other initiatives. Since the hospital medical group was on the same EHR as they were, they figured it would be a smooth transition once their data was migrated. Unfortunately the nightmare was just beginning. The employed physicians had done some significant customization to their version of the EHR, often damaging clinical workflow in the process. Required fields were added in a way that didn’t make sense with how physicians document.

Being a power user of the EHR previously, my friend questioned the way the group was using the system and who had been making the decisions to add the customizations. The group has a policy on change control and decisions are to be made by an IT Committee. Unfortunately its leader is a political appointee who is not actually a user of the system and his chief mode of management revolves around making sure there are no squeaky wheels. When the Compliance department asked for required fields to be added, he complied. When risk and legal made demands, he acquiesced. When specialists wanted fields hidden because they weren’t relevant to them, they vanished. Ultimately a system that could have been highly functional turned into a Frankenstein.

Her new colleagues inundate each other with strings of emails complaining about the system and demanding the administration rip it out and find a new vendor. The EHR has become the scapegoat for a number of problems in the offices, many of which are simply due to poor management. The leadership won’t hit the problem head-on because they are part of the problem. Revenues are down yet many practices have a substantial charge lag. It appears the group doesn’t have a policy on how quickly providers must document their patient visits or when charges are submitted. There are no metrics gathered to show how poorly practices are performing and no accountability to force anyone to change.

I suspect my orthopedic practice is probably managed in the same manner. This brings me back to the quote about giving a practice reports to manage when they’re already drowning. How can we expect a practice to perform population interventions when they can’t finish their documentation? Why can some primary care physicians on a given EHR see forty patients a day and others balk at seeing sixteen? Practices need active (and often aggressive) management to be able to achieve the high goals that are being set out for them. It’s not going to happen automagically and certainly not without a tremendous amount of work.

Medical group management teams need to make sure their physician offices know how to crawl before they push them to run a marathon. Otherwise they’re just setting them up for failure. There is a great quote in the piece that I think I’m going to use to illustrate this point as I discuss these issues with my colleagues: Big data is just making the haystack bigger and not making the needle better. It doesn’t make sense to hand a practice a sheaf of reports to work when they can’t even answer the phones or keep up with refill requests. Why send communications encouraging patients to schedule appointments when the providers have a three month scheduling backlog?

Technology can do wonderful things but it can’t do everything. It doesn’t remove the need for management, structure, and accountability. It won’t replace the basics and we’ve all seen how technology can make dysfunctional processes even more so. If you weren’t billing timely in the pre-EHR world there’s no magic wand that will make it happen just because you implemented a system. Hopefully by now you have some chills running down your spine. After all, it is Halloween. Do you find poor practice management as horrifying as I do? Email me.


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

More news: HIStalk Practice, HIStalk Connect.

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October 31, 2013 News 7 Comments

Morning Headlines 10/31/13

October 30, 2013 Headlines 1 Comment

Sebelius: ‘I apologize, I’m accountable’ for Obamacare website flaws

Amid growing demands for her resignation, HHS secretary Kathleen Sebelius testified before congress today where she took full responsibility for the healthcare.gov rollout and reported that to date the site has cost taxpayers $174 million, which includes $56 million for support. In an unfortunate timing of events, the site crashed again in the middle of her testimony.

HIPAA framework could be expanded, privacy expert says

Modern Healthcare reports that growing concern over the impact mobile health apps and patient portals are having on health information security could lead to another expansion of HIPAA.

NM’s massive electronic health record project finally in the black

After eight years in operation, the nonprofit that built New Mexico’s health information exchange is operating in the black. CEO Bob Mayer reports "Our federal grant runs out in January and we will be sustainable on Jan. 1.”

CommonWell Health Alliance Announces Board of Directors

CommonWell Health Alliance introduces its board of directors which includes: Jeremy Delinsky, Board chairman (AthenaHealth CTO); Rich Elmore, Board vice chairman (Allscripts VP); Bob Robke, Board treasurer (Cerner VP); Rod O’Reilly, Board secretary (McKesson VP); Scott Schneider (CPSI EVP); Justin T. Barnes (Greenway VP); and Keith Laughman (Sunquest EVP).

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October 30, 2013 Headlines 1 Comment

Time Capsule: The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting

October 25, 2013 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 November 2009.

The Latest Stimulus Package for Healthcare IT and a Wheezing Economy: H1N1 Reporting
By Mr. HIStalk


You are nobody as an HIT vendor unless you’re doing something fancy with H1N1 flu reporting, including spewing self-congratulatory press releases that brag about your civic contributions.

Cerner started it by sending customer ED data to Washington, supposedly giving Uncle Sam real-time H1N1 outbreak reports, even though H1N1-specific data elements are hard to come by, the vast majority of US hospitals don’t use Cerner, and the vast majority of flu sufferers don’t go to the ED. Not to mention that there’s nothing the government can do anyway except observe ("Man, Lockhart, Texas is really getting pounded.")

You would think H1N1 tracking is right up there with an actual H1N1 cure. Google has its own outbreak map generated from Web searches (they can also assess the prevalence of enlarged mammary glands and propofol overdoes, I’m guessing). Web sites loaded with AdSense ads are hoping for a quick buck from providing questionably useful maps and graphs.

Even Harvard Medical School and Children’s Boston have released their own competing iPhone H1N1 trackers ($2 and free, respectively). It’s not really clear what marginally coherent yet mobile consumers are supposed to do with their newfound information. Wear surgical masks? Do that point-and-wink thing instead of shaking hands? Head to their bomb shelters and fight off infected interlopers like the guy in “Night of the Living Dead?”

(Note to self: have my people contact Harvard to IPO a mash-up between their H1N1 tracker and traffic-enabled GPSs, allowing paranoid motorists to avoid entire swaths of geography where H1N1 is around).

H1N1 is a deadly, hand-wringing pandemic (according to TV people anxious for something somber to talk about between inane banter), even though only about 1,000 Americans have died of it so far compared to the 30,000 to 50,000 who die every single year from the plain old unsexy flu and its complications. Drug companies are licking their chops. Panicked citizens not typically known for following a healthy lifestyle or paying attention to seasonal flu vaccines are fighting each other to get the hyped H1N1 version, with the resulting shortages making them even more hysterical.

The government, meanwhile, is saying the one thing that’s guaranteed to send people into a full-fledged panic: "Don’t panic."

(This is actually Swine Flu II, of course. Gerald Ford got everybody excited about it as his presidential candidacy was flailing in 1976. The pandemic never happened, but 40 million people got the swine flu vaccine at a cost of $135 million, 30 died of its side effects, $3 billion in legal claims were filed, $50 million worth of vaccine was destroyed, Ford lost to Jimmy Carter, and Chevy Chase lost the subject of his only funny bit. It was the lowest point of the year, other than when "Convoy" went to #1 on the pop charts).

So what if you’re a small HIT player without the resources to accurately track (or even claim to track) H1N1? Here’s a plan: hire a bunch of unemployed telemarketers to just call up houses and ask whoever answers if they or anyone they know has H1N1. Put out press releases claiming it was your advanced technology, create a fancy Web page, and find yourself a politician to thank you publicly for your valuable services to a grateful nation.

Just be aware that people exaggerate their own illness for maximal sympathy or as justification for skipping work, so any kind of sniffles or tiredness will convince people to say they have H1N1 because they heard about it on Oprah ("headaches" become "migraines", "a cold" becomes "the flu", and "getting sick from too much Super Bowl beer, wings, and guacamole" becomes "food poisoning"). That’s actually a good thing, though — your H1N1 numbers will be higher than everybody else’s since most flu sufferers don’t need hospital treatment like Cerner is measuring, so you will be widely cited by people trying to prove that H1N1 is the next Black Death.

Those inflated H1N1 numbers are good. When it comes to healthcare IT and the economy in general, you just can’t have enough H1N1 stimulus. It’s what I call "viral marketing."

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October 25, 2013 Time Capsule No Comments

Morning Headlines 10/25/13

October 24, 2013 Headlines No Comments

Cerner shares drop on revenue miss, outlook

Cerner reports Q3 results: EPS of $0.35 vs $0.30, revenue increased 7.6 percent but missed expectations leading to a three percent drop in share price after hours. Cerner shares are up 43 percent year-to-date.

The Wellness Network Acquires LOGICARE Corporation

The Wellness Network, a media company that owns several in-hospital TV channels, acquires patient instruction and education vendor Logicare.

Representatives Blackburn, Green, Gingrey, DeGette, Walden and Butterfield Introduce SOFTWARE Act

A bipartisan group of legislators have introduced the Sensible Oversight for Technology which Advances Regulatory Efficiency (SOFTWARE) Act, a bill written to clarify the role the FDA will take in regulating medical software, including mobile health apps and EHRs.

Boston Children’s Hospital Researchers Launch Start-up to Offer Enterprise-grade Software Solutions and Services Across the Digital Healthcare Ecosystem

Boston Children’s Hospital announces the launch of Wired Informatics, a spinoff startup that will market an NLP product to hospitals and other healthcare organizations.

Fighting Healthcare Fraud Using Whistleblower Statute Returns $20 For Every $1 Invested

A report by the Taxpayers Against Fraud Education Fund finds that for every dollar spent investigating and prosecuting government fraud, more than 20 dollars are recovered. Health care economist Jack Meyer notes “If all costs and benefits are accounted for, the benefit to cost ratio of False Claims Act law enforcement now exceeds 20:1. Civil health care fraud is one area where federal and state governments are recovering far more than they are spending."

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October 24, 2013 Headlines No Comments

News 10/25/13

October 24, 2013 News 11 Comments

Top News

10-24-2013 7-17-26 PM

Cerner reports Q3 numbers: revenue up 8 percent, adjusted EPS $0.35 vs. $0.30, falling short on revenue expectations. From the conference call:

  • Domestic revenue was up 8 percent, while global revenue increased only 1 percent.
  • The company sold its sixth French client and its first one in Brazil.
  • Cerner says that by the end of the decade, the EMR will provide just one feed into a population health management system, and the company is already selling solutions and services to customers who don’t use a Cerner EMR.
  • Cerner and Epic are distancing themselves further from their competitors, and Cerner says it is gaining momentum against Epic.
  • Cerner says its clients have acquired hospitals at six times the rate of Epic’s, giving the company more potential users.
  • Cerner has been approved by Apple as the only non-carrier company allowed to sell the iPhone, and it will offer an unlocked, no-plan iPhone for CareAware Connect, which can replace pagers and other communications devices.
  • Cerner says its work with Intermountain Healthcare will disrupt the industry and accelerate clinical computing by a decade, reducing healthcare costs by up to 20 percent. Projects include using Intermountain’s Care Process Models as an EMR-agnostic “clinical navigation system” and blending content with the EMR to provide activity-based costing as a resource management system.
  • EVP Jeff Townsend compared Epic to Kodak for its suggestion that Meaningful Use be delayed for five years, suggesting that both Epic and Kodak spent too much time selling profitable old technology and trying to delay the inevitably changing future.
  • An analyst noted that “Intermountain has a history of chewing up and spitting out vendors” and asked how Cerner can keep them happy. Townsend said Cerner will do an accelerated Millennium implementation so they can get to the “fun stuff” more quickly.
  • Cerner says it was chosen over Epic at Intermountain because of population health and the ability to influence cost, saying, “This is not a project. This is a decade, if not a two-decade-type relationship.”

Reader Comments

From Digital Bean Counter: “Re: million dollar question. Why hasn’t the government asked any of us health informaticists about fixing the Healthcare.gov website?” It’s not an informatics problem, so that would be pointless. Nobody in healthcare (nor in government contracting, apparently) has the experience needed to plan for the kind of scale Healthcare.gov needs and there’s nothing there at all related to informatics. It requires people who have built monster-sized e-commerce sites, the kind who live in the Silicon Valley instead of the beltway. It’s a shame that the site has turned into a political football – nobody seemed to mind when the VA, DoD, and HHS were burning through millions to billions of dollars in poorly planned and poorly managed IT projects and the website is only marginally related to Obamacare. Nobody can say anything about any topic these days without someone screaming about a perceived political agenda, and politics isn’t the same as the government, which is comfortingly inefficient and wasteful no matter which party is involved. I think I remember a stat that 50 percent of US government software projects are utter failures and a complete waste of taxpayer money and almost all of the rest don’t deliver the expected value.

From Alexis Nexis: “Re: expense reports gone wild. There’s no understanding of what someone on the road experiences:  a hotel room and bed, no ability to cook some eggs in the morning, no ability to pack a sandwich for lunch, doing laundry just on the weekend, etc. Not to mention the additional six to 25 non-billable hours of travel (above the commute between hotel and office) typically incurred every week by road warriors. I can assure you that there’s no road warrior getting rich off his meal expenses. I am quite surprised that snacks and coffee are being included. IRS guidelines view meal expenses as breakfast, lunch, and dinner. Shame on the commentator for not having negotiated a contract accordingly. And shame upon those contract administrators who insist upon receipts for when IRS guidelines don’t require them. To have to save my receipt for the toll on the highway or for my $7 of breakfast in the morning is ludicrous. It burdens everyone with additional unnecessary overhead. I routinely put into my contracts the IRS per diem rate for the locale. Perhaps we should wonder about what it is that makes healthcare in the United States the most expensive in the world without our getting the best return what we spend. I would suggest that it’s not the relatively incidental amounts being referred to. By the way, where could I sign up for that $200 an hour rate?” This is one of those “don’t sweat the small stuff” issues. Line item living expenses are annoying because you get into that pointless mental debate over whether a consultant who buys a $4 coffee on the way to the hospital every morning must be screwing you in other ways as well, and yet sometimes that same employer doesn’t give the consultant a clear picture of what work needs to be done or doesn’t have the required internal people lined up. At $200 per hour, that $4 coffee represents just over one minute of billable time, and I’ve seen consultants trying to find things to do for hours each day because they were just shown a cubicle and abandoned because nobody had the time to manage them.

From Bignurse: “Re: Yann Beaullan-Thong of Vindicet. You interviewed him a few weeks ago. The 2013 McKnight Technology Award in the Transitions category was awarded to a Vindicet client for implementing its patient management system. The organization says the system cut admission time to its skilled nursing settings to less than 1 hour.” Yann’s HIStalk interview from December 2012 is here. The company offers referral management and discharge managing systems.

From Boy Oneder: “Re: Epic’s Healthy Planet. It’s population health management and is robust – wellness, chronic disease registries, population outreach, high risk care management, and risk stratification algorithms.” I heard the term “Healthy Planet” and asked Boy Oneder what it was all about. Boy Oneder also says that Epic had documented clinical workflows in the Netherlands years ago in preparation for sales like the two that just happened to two large Amsterdam hospitals. I don’t think Epic is joking when it talks about world domination.

From Player: “Re: Epic hospital. You should interview a CFO, anonymously or otherwise, about how they looked at the cost justification for implementing Epic.” That would be fun. Volunteers?

10-24-2013 10-57-39 PM

From Boy Lee: “Re: innovative companies. You profiled some of them years ago.” I ran a series I called Innovator’s Showcase in 2011, which took a ton of work. I invited startups to apply to be profiled on HIStalk, but they had to have an original product, real customers, real revenue (although not too much of it), an a short time in business. I had three folks review their brief applications and we chose seven for the Innovator’s Showcase. We thought these had the best chance of success. None have failed as far as I can tell. They were:

Aventura (clinician computing experience)
Health Care DataWorks (analytics)
OptimizeHIT (which was connected to ImplementHIT in some way that confuses me to this day, which offers EHR training)
Caristix (HL7 and interfacing software)
Logical Progression (acquired by Bottomline Technologies – offered mobile documentation)
Trans World Health Services (benchmarking and analytics)
Health Nuts Media (learning games and educational material)

From DrLyle: “Re: your comments about physician-focused startups with no clue how to make solutions for doctors. I loved your answer. I just wanted to make sure the key word is ‘most’ and not ‘all.’ Some of us are actually making some good stuff that truly uses HIT to automate and delegate care, saving time for docs and improving quality for patients.” I was amused at the number of folks whose brains blocked all but the words they get emotional about, firing them up to argue about what they perceived as an anti-innovation rant. I very specifically mentioned only companies that don’t care about patients or providers and that are clueless, arrogant, insulting, and badly planned. If I were CEO of one of those I’d keep quiet, and if I was one of the better startups, I’d be happy that my unworthy competitors had been called out publicly. I’ve been the hospital IT guy who heard these pitches and I’m fairly certain most of my peers think similarly – don’t come knocking until you’ve done your homework. Hospitals may seem like local businesses that need help, but they are massive enterprises. Getting your fledgling product in the door means someone internal is going to have to go to bat for you, meaning their job is on the line if you can’t deliver. Do you have documentation, an implementation plan, around-the-clock support, and sound technology that isn’t dependent on your one Romanian programmer not finding a better contract?

I should mention that part of my rant came about is because I resent any company (big or small) that barges into healthcare without showing respect for patients and the people who have been involved in taking care of those patients all along. Healthcare is a vendor’s Vietnam, as Misys or Sage or any number of other half-hearted former dabblers can explain. They saw themselves swooping in from other industries with massive firepower and a hearts-and-mind campaign that would ensure a quick and painless surrender by the peaceful, primitive locals. A handful of years later, their thoroughly defeated and demoralized salespeople and executives were climbing over each other’s backs desperate to squeeze onto that last available helicopter ride to safety.

10-24-2013 9-02-13 PM

From Lazlo Hollyfeld: “Re: Healthcare.gov. At least the CD version is slated for a ‘16 release.” The Onion is brilliant as usual in its satire about Healthcare.gov.

HIStalk Announcements and Requests

inga_small Some goodies you may have missed this week on HIStalk Practice include: Practice Fusion defends its practice of emailing patients to request physician reviews. Parents want to email their pediatricians and they want it to be free. The Rothman Institute will implement White Plume ePASS. Female doctors provide better quality care than their male counterparts. A physician is charged with breaking and entering after she broke into an office, set up a temporary practice, and began seeing patients. Hayes Management Consulting VP Rob Drewniak outlines a process to prevent breaches with HIPAA compliance. Dr. Gregg offers a Top 10 and a Bottom 10 List on HIT adoption. Linda Fischer, EMR manager for Boulder Community Hospital Physician Clinics, discusses her Greenway Medical EMR implementation, including details on the selection process, EHR data migration, obtaining physician buy-in, and quality care initiatives. In lieu of sending Halloween candy, please treat me to your email address to subscribe to the latest HIStalk Practice updates. Thanks for reading.

Here are a couple of on-the-spot interviews Bonny and Catherine of Aventura conducted at ACEP13 in Seattle last week. They just turned on the video recorder and let the folks say whatever they wanted about IT.

From an ED physician:

Technology is struggling to match what physicians and other clinicians actually want to have happen. When people say all the time, “Is this a great system?” then yes, it’s a great system, but not in this particular setting. There’s many, many, many times a mismatch between what the clinicians want to have done and what the technology can do. There’s innocence on both sides. That’s what my experience has been with this technology. This innocence of mismatch, where the technical people are extremely good at what they do, the hospital people and clinicians are very good at what they do, but this matching of the two is really not working nearly as well as everybody thinks it is. As an example of why there’s this disconnect between documentation and clinicians is my assessment of a patient begins way before anybody thinks it does. It begins when I hear that patient screaming out of the corner of my eye as he’s brought in. I’m not documenting then. I’m not even seeing the patient yet, but that’s when my assessment begins. When I walk into the room, the smells and everything, that’s all part of my assessment, but many times that does not get documented.

From a resident:

I’m a fourth-year EM resident. Our workflow is that we will typically sign up for patients at the doctor’s station and go and see the patient, which takes about five to 10 minutes. Then come back, put our orders in, see other patients, and then we’ll frequently come back and either document or dictate in between patients. Aventura seems like a good application. Friendly, very fast. Sounds like it would be helpful.

Acquisitions, Funding, Business, and Stock

10-24-2013 7-18-05 PM

Microsoft turns in Q1 numbers: revenue up 16 percent, EPS $0.62 vs. $0.53, beating expectations.

10-24-2013 11-01-16 PM

McKesson files Q2 numbers: revenue up 10.7 percent, adjusted EPS $2.08 vs. $1.79, beating expectations on both. Technology Solutions revenue was up 7.7 percent although software revenue was down 9 percent. The company also announced that it will acquire a majority stake in Germany-based drug wholesaler Celesio for $8.3 billion “to form a global leader in healthcare services.” John Hammergren, asked about whether the company will keep the technology business, waffled by saying results are good and there are no plans to change the mix, but MCK isn’t married to any particular strategy and has a responsibility to revisit that decision constantly.

10-24-2013 11-01-56 PM

Covisint reports its first quarterly results after its recent IPO: revenue up 19 percent, adjusted EPS –$0.08 vs. –$0.15.

10-24-2013 11-02-46 PM

Hospital health information management provider IOD Incorporated acquires ApeniMED, a Minneapolis-based company offering healthcare interoperability solutions.

10-24-2013 11-07-48 PM

Accelera Innovations secures a $200 million equity investment agreement from Lambert Private Equity. I’ve never mentioned Accelera even once on HIStalk and I admit I’ve never heard of them. Their website looks like something kid with FrontPage might have created in 2002, playing annoying music (unless you’re an “Arrested Development” fan, in which case you’ll enjoy Europe’s “The Final Countdown” because it will remind you of a G.O.B. magic trick ) following someone loudly and pedantically reciting a company pitch. Frankly, I’m struggling to believe the accuracy of the story that someone invested $200 million in this operation.

10-24-2013 7-18-58 PM

Quality Systems reports Q2 results: revenue down four percent to $118 million, EPS $0.22 vs. $0.31, missing analyst estimates on both. CEO and President Steven T. Plochocki says the results are indicative that the reorganization plan put in place during fiscal 2013 is beginning to gain traction. He also notes that revenue, bookings, and system sales were up from the first quarter.

10-24-2013 4-58-37 PM

The Wellness Network acquires hospital patient education software company Logicare.

10-24-2013 7-36-43 AM

Cureatr, which offers secure messaging solutions for providers, secures $5.7 million in Series A financing.

Miami Children’s Hospital signs a deal to allow HealthFusion to offer South Florida pediatricians an MCH-specific version of the company’s iPad-based MediTouch EHR that will connect to the hospital’s systems.


10-24-2013 10-36-56 AM

Trinitas Regional Medical Center (NJ) selects EDCO Health Information Solutions to implement Solarity technology and indexing services for medical records scanned at patient discharge.

Elmwood at the Springs Healthcare Center (OH) selects VersaSuite for EHR/PM for its long term acute care facilities.

Rush Health (IL) endorses athenahealth’s EHR and PM services for its 300 affiliated private physician members.

The State of California Office of Health Information Integrity selects iBlueButton from Humetrix for its HIE pilot.

The Berlin Visiting Nurse Association (CT) will replace McKesson Homecare with Brightree’s home health platform.

Children’s Hospital of Philadelphia signs a five-year contract with OnPoint Medical Diagnostics for its MRI Quality Assurance software.

VA Midwest Health Care Network chooses Visage 7 Enterprise Imaging Platform enterprise viewer for regional diagnostic interpretation and image access throughout its 11 hospitals. The organization also chooses Medicalis for enterprise workflow and Acuo for its vendor-neutral archive.


10-24-2013 10-24-23 PM

Athenahealth names Amy Abernethy, MD, PhD (Duke University Medical Center) to its board.

Vermont IT Leaders elects Paul Harrington (Vermont Medical Society) chair of its board.

Announcements and Implementations

Care at Home (CA) deploys AtHoc’s Home Care Alerts emergency mobile solutions.

Spectrum Health (MI) automates the exchange of patient information via CCD between its HealthMEDX post-acute care EMR and its Cerner and Epic platforms.

HIMSS names Texas Health Resources a winner of the 2013 Enterprise HIMSS Davies Award of Excellence for its use of HIT. CIO Ed Marx is a regular contributor to HIStalk.

10-24-2013 11-39-02 AM

Boston Children’s Hospital launches Wired Informatics to provide enterprise-grade NLP solutions for hospitals and other healthcare entities and introduces its flagship product Invenio, which extracts and leverages knowledge contained in clinical notes.

10-24-2013 4-57-34 PM

Partners Healthcare’s Center for Connected Health launches Wellocracy, a clinically-based source of self-help technologies for consumers, including health and fitness trackers and mobile apps.

Government and Politics

10-24-2013 12-49-20 PM

Finally some good news from the government: every dollar invested to investigate and prosecute healthcare fraud returns at least $20, based on data collected from 2008 to 2012.

A bipartisan group of House lawmakers introduces the Sensible Oversight for Technology  which Advances Regulatory Efficiency (SOFTWARE) Act  that would clarify regulations for mobile medical apps, EHRs, and other HIT technologies. The legislation builds on the FDA’s final guidance on mobile healthcare apps.

Healthcare.gov contactors tell a Congressional panel that it’s not entirely their fault the site doesn’t work as well as hoped – the government should have supervised them better and tested more thoroughly before setting the go-live date. An SVP of Canada-based CGI stuck with the story that user volume was greater than expected and said it was CMS’s job to do end-to-end testing, not the company’s. Andy Slavitt of Optum, which owns contractor QSSI, said the government decided late in the game to require users to create an account before viewing insurance plans and the company’s function for that didn’t work well in the site’s first few days. Rep. Anna Eschoo (D-CA), who represents the Silicon Valley, said blaming user volume is a “lame excuse” that “really sticks in my craw,” adding that Amazon doesn’t crash the week before Christmas.

10-24-2013 11-16-37 PM

John Halamka’s conclusion about Healthcare.gov: “… Nine women cannot create a baby in a month. There is a minimum gestation period for IT projects and our policymakers should learn from the lessons of the Health Insurance Exchange and re-calibrate the timelines shown in the graphic above [the CMS reform timeline] so that everyone is successful.” Or as one of my hospital programmers always told me years ago when pressed to make a delivery date, “You can take the cake out of the oven any time you want, but don’t blame me when you don’t like it.” 

10-24-2013 11-17-57 PM

The VA’s Office of the Inspector General finds that three ED patients died at the Memphis VA after receiving substandard care, one because the doctor violated policy by hand-writing an order for a drug to which the patient was allergic, a situation that CPOE would undoubtedly have warned about.

Innovation and Research

10-24-2013 11-19-02 PM

The Merck | Heritage Provider Network Innovation Challenge offers $240,000 in total prizes for creating tools that help people with heart disease or diabetes follow their care plans. Submissions are due November 10, 2013.

A peHUB article called “Disrupting healthcare – on whose terms?” says that companies with no healthcare background who jump into healthcare IT investments have a big performance disadvantage. It concludes, “These data clearly show a massive advantage for firms with healthcare expertise when making healthcare investments. And why shouldn’t they? Don’t we assume, for instance, that energy investors do better at energy investments vs. those firms without any energy focus or experience? Healthcare is at least as complex and regulated an ecosystem as energy and yet it repeatedly experiences cycles of outsiders driving up investor frenzy.”


Verizon Enterprise Solutions releases Converged Health Management, a remote patient-monitoring platform that allows patients to use biometric devices to capture vital signs and automatically transmit details to their providers.


10-24-2013 12-09-56 PM

Providers rely on telephone calls, letters, and face-to-face conversations more than any other method to communicate with patients, despite the increased use of newer technologies such as text messaging, social networking sites, portals, and emails.

10-24-2013 11-20-46 PM

HIMSS announces keynote speakers for the mHealth Summit in December: FDA Commissioner Margaret Hamburg, Qualcom CEO Paul Jacobs, Denmark’s Minister of Health, and Nobel Peace Prize Winner Muhammed Yunus. I’ll be reporting from the conference, as will Travis from HIStalk Connect. HIStalk will have a microscopic, sparsely furnished booth in the exhibit hall because they were nice enough to give us one, which will be capably manned (or womanned) by the fabulous Lorre.  She may have nobody to talk to since I’m not certain the mHealth Summit draws a lot HIStalk readers, but if you’re going, find our micro-booth (#1305, right beside a slightly larger booth and company called AT&T) and say hello. 

10-24-2013 8-33-51 PM

More on the summary of KLAS’s report on McKesson Paragon, which concluded that the product isn’t ready for big hospitals in important areas (like clinical functionality and an integrated ambulatory system) and has experienced a pretty big drop in KLAS scores since 2010, but customers seem satisfied to wait for the three-year roadmap to bring it up to their expectations. The graphic above shows that 32 large hospitals bought Horizon replacements in 2012, with 10 each choosing Cerner and Epic and 11 choosing Paragon, with cost being a big driver for the Paragon wins. Among smaller Horizon hospitals, Epic was the big winner, probably through acquisition if I had to guess since I doubt those hospitals could afford Epic otherwise except though an affiliate agreement. Allscripts, Meditech, and Siemens didn’t get a single Horizon replacement deal, with the most startling fact in that statement being the inability of Meditech to execute in what should be a receptive market.

10-24-2013 10-30-03 PM

Brian Stowe, the former Epic project manager charged with taking sexually explicit photos of passed out women (of whom six of the eight were his Epic co-workers,) pleads guilty to taking photos and video of a 17-year-old girl asleep in his bed and will be sentenced  in January to a minimum of 15 years in prison. He still faces 62 felony counts.

10-24-2013 8-59-19 PM

A thief breaks into the offices of AHMC Healthcare (CA), making off with two unencrypted laptops on which was stored the information of 729,000 patients. The hospital has expressed a sudden interest in encryption, which the near-certain $1.5 million fine might have covered. Apparently hospitals are unable to muster the technical expertise and financial motivation to encrypt computers until after they’ve been inevitably burned and fined, so it costs them even more. Police arrested a vagrant for the theft on Wednesday, but the laptops are still missing.

10-23-2013 10-28-08 AM

inga_small After reading Tweets and news stories about all the folks who have been able to find more affordable healthcare coverage options on the Healthcare.gov website, I decided to once again attempt the application process. Unfortunately I did not get farther than the second screen, which contained a lot of gibberish. I guess I’ll give Jeff Zients, Verizon, and all the newly recruited techies a bit more time to fix things.
Weird News Andy says he is singing “La Cucaracha” to himself as he enjoys this story: cockroach farming is booming in China as the country finds them both delectable as a culinary treat and miraculous as a a basis for drug development, with hospitals using them to treat burns and a pharmaceutical manufacturer claiming its cockroach syrup cures ulcers and TB.

Sponsor Updates

  • NVoq announces the general availability of its SayIt 8.2 release.
  • Strata Decision Technology hosts 400 attendees in Chicago this week at its annual summit.
  • Wolters Kluwer Health introduces Lippincott’s CoursePoint, a digital course solution for nursing education.
  • DocuTAP will integrate Wolters Kluwer Health’s Health Language applications into its EMR solutions for the urgent care environment.
  • Intelligent InSites will hold its InSites Build 2013 conference October 29-30 in Fargo, ND.
  • Greythorn will offer an October 29 webinar on Radiant implementation and optimization.

EPtalk by Dr. Jayne

Let’s face it, consultants are a fact of life in our industry. Most of us are trying to do more than we possibly can with the staff we have in place. We’re trying to cope with an ever-changing regulatory landscape. We’re feeling the squeeze between immovable deadlines and vendors who aren’t delivering required code as early as we want them to. Sometimes we can’t hire new FTEs quick enough or we may not have anyone with the skill sets needed to help us stay compliant. And so, we turn to consultants.

A reader mentioned last week that his or her company was not in favor of paying meal and incidental expenses for consultants and asserted that the consultant’s employer should pay those expenses since it is already charging a hefty per-hour fee. The comment sparked several replies, so I decided to reach out to some of my friends who are consultants to see what they think. I’ve been on both sides of the story as I’ve hired consultants and been one, but I’ll hold on my thoughts for now.

Most of the consultants I talked to this week feel that their clients have a skewed view of what consultants actually are paid. Even though a consulting firm or vendor may charge $200 or $300 an hour, it’s unlikely that the individual field consultants are taking home even a third of that. Although many senior consultants do quite well, many junior consultants spend up to 50 weeks a year away from home. Divide the pay by the hours away from home and family and the paycheck starts to look even less great.

Companies have to cover for the time that their consultants are engaged in non-billable activities such as training, staff development, continuing education, and maintaining competency with EHR vendor software. Increasingly clients are refusing to pay for consultant travel time (or imposing ridiculous travel caps that don’t even cover flying time) and that has to be covered as well. One consultant I’ve used repeatedly tells the story of going to a small town in a remote western state, where he had to take four flights (to stay under the client’s air fare cap) and then drive four hours to get there. The total travel day was close to 18 hours and then of course he had to get home. The client had a three-hour round trip travel cap. I’m pretty sure the client knows they’re a four-hour drive from the nearest airport.

One of my favorite niche firms works with a single EHR vendor and maintains a very small group of consultants. All of them are nurses and the CEO is a nurse as well. Most of them continue to maintain their licensure and attend CNE so they can stay current with clinical topics. It makes them extremely effective and I’m happy to pay a higher per-hour fee for them because I know I’m getting the quality input I need for projects that need both nursing or other clinical expertise and a high degree of vendor-specific knowledge. I’m also happy to pay more for a small firm that I know runs lean and has little administrative bloat because I know they pay their workers well.

Unfortunately, the health system I work for has what can only be described as Enron-style accounting and they are constantly late in paying the consulting invoices even when all supporting documentation is provided in a neat and timely package. I wish the accountants understood the value of these consultants – they are super busy and don’t need my business to stay afloat and I’m afraid eventually they’ll stop working for me because it is simply too much of a bother.

Due to the size and scope of some of our projects, I’ve had engagements with the 800-pound gorillas of the consulting world as well. Although there have been a handful of consultants that have tried to take advantage of expense policies, the majority have been fair in what they submit for reimbursement. For those who have been a little too cavalier with their spending, it’s been fairly easy to address it with management. I haven’t yet run across anyone operating like the George Clooney character in “Up in the Air” where he pushes his expense reports to maximize his airline mileage. If you’ve ever been a road warrior and haven’t seen the movie, I’d recommend it.

The best defense against ridiculous expense reports is negotiating a good contract with the consulting firm. Know what you are willing to pay for, but be fair. Know what typical hotel rates are in your area and make sure you are allowing your consultants to stay somewhere that you would consider staying yourself. I’ve heard horror stories (and seen pictures) of “client recommended” hotels that I can’t imagine a hospital administrator would expect his own family to accept. If you have a corporate discount, make sure consultants have the codes, and if there is a limit to the number of rooms that can be booked at the corporate rate, that they book well in advance.

As far as meal allowances, they seem fair for the companies I’ve worked with. I don’t begrudge my consultants the coffee and snacks they submit because they’re working their tails off for me. Some of them can deliver in a week what my IT department takes a month to deliver, so the expense is well worth it. One of our IT buildings is away from the main hospital campus and there aren’t any close restaurants. I always have lunch delivered for the consultants so they don’t have to waste time trying to find food and worry about their logistics. But when I negotiate engagements, that is taken into account and their maximum daily meal reimbursement is adjusted accordingly. If you don’t want to pay for alcohol because you’re a faith-based organization, write it into the contract or hire a consulting firm that doesn’t allow alcohol to be submitted.

As I’ve mentioned before, I did a fair amount of consulting while I was building my CMIO skills and still do a couple of jobs a year with the full permission of my hospital. Ethics and professionalism are what keep consultants from abusing the system. Having been in those shoes, if I find someone milking it, I’m going to send them packing. On the flip side, I’ve been abused by clients and it’s never pleasant. At one site where I was engaged for a couple of months, my “handler” would routinely book my schedule with 10-hour days containing back-to-back meetings that didn’t allow for restroom breaks, let alone lunch breaks. I would hit the local supermarket before going on site and stock up on granola bars, fruit, and drinks. The same client didn’t even have cups or utensils in the break room, so I had to travel with my own mess kit if I brought restaurant leftovers.

Another client scheduled a business dinner after a full work day. The agenda was for me to meet with providers and address their concerns regarding an upcoming implementation. It was at a fairly expensive celebrity chef restaurant and I was looking forward to it. However when the bill arrived, the client asked for separate checks and made me pay for my own. Needless to say that blew my expense account for the day (actually three days’ worth) and I had to cover it out of pocket. Had I been on my own that evening, I probably would have had a turkey sandwich and a handful of grapes. Maybe some chips if I was feeling wild and crazy. Most of would agree these examples are pretty extreme, but unfortunately I’m not the only one who has had those experiences.

If you’re looking to cut down on consulting expenses, look at whether you really need consultants on site. Those who work projects remotely don’t submit meal or travel expenses and often they are more productive when your staff isn’t interrupting them or trying to pick their brains on unrelated projects. One consultant friend keeps me laughing with stories of his prowess at slaying scope creep since his client’s analysts are hell-bent on involving him in work that has nothing to do with his engagement just because they know he has the skills. He could probably deliver his analytics build faster if he was working from his bachelor pad than sitting in your cube farm among squeaky chairs, gossipy employees, and those who bring colds and flu to the office.

That’s another thing – nice clients have a plan for when consultants get sick or have family emergencies. They are understanding. They don’t make you feel bad when your daughter breaks her arm and you have to accompany her to the operating room (true story from a former grad school roommate.) They may even offer to have a physician evaluate you and make sure you aren’t near death alone in your hotel room after you get food poisoning at a dinner they catered. I’ve written prescriptions (with appropriate examination and documentation, of course) to treat minor illnesses and helped consultants get care after sports injuries. Just because they’re consultants doesn’t mean they’re invincible.

If clients really have a problem with consultant expenses because they object to having to pass them on to patients, I recommend they look at their own policies as well as consulting policies. One hospital where I’m on staff provides a 64-ounce mug to each new employee, who can then fill it with free beverages throughout the work day. Although it was instituted as a staff perk, I can’t help but wonder what the patients think as they see staff slurping their way through the day from mugs that are less than clean. You can bet that’s being passed onto the patient bill, as are the employee health care expenses from obesity and diabetes since I rarely see people filling up with diet pop, that’s for sure. Then there’s the lost productivity for the trips to refill.

While we’re at it to cut costs and save healthcare, let’s cut out frivolous marketing, overkill signage, and anything having to do with “centers of excellence.” I bet we could lower some hospital bills right there. But let’s not take it out on consultants who are working hard on our behalf.

What do you think about consultants and their expenses? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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October 24, 2013 News 11 Comments

HIStalk Interviews Paul Brient, CEO, PatientKeeper

October 24, 2013 Interviews 1 Comment

Paul Brient is president and CEO of PatientKeeper of Waltham, MA.

10-24-2013 7-04-03 AM

Tell me about yourself and the company.

I’ve been in the healthcare IT business for my entire career, which is now about 25 years. PatientKeeper has been around for about 14 years. I joined 11 years ago. Our focus has always been to create technology that would help automate the day and the life of a physician, in a way that the physicians would see as a benefit to their workflow. We’ve been fighting the good fight for the past 14 years.


When you and I talked in 2010, CPOE adoption rates were tiny, especially in community-based hospitals. Is that still the case?

Certainly if you go about it in the traditional way, it’s still the case. There’s not a lot that’s changed in terms of the approach of classic CPOE vendors. There are many hospitals out there that are really struggling to get to 60 percent CPOE adoption. You hear stories of them having to badger and cajole and threaten physicians to make them use CPOE.

The essence and the core of the problem is that legacy CPOE applications reduce physician productivity. They spend more time taking care of the same number of patients than they did before. If you’re in private practice as a physician, that’s pretty devastating. For the healthcare system overall, automating the most expensive asset, or the expensive worker in the healthcare system, and making them less productive is not a win. 

In our view, we need to have a different approach to physician-facing technology. We have approaches that make physicians more productive, more efficient, save them time, and ultimately help them practice better medicine in a way that is consistent with the way they think they should be practicing medicine.


Hospitals were making their captive doctors use CPOE 100 percent while assuming that usage by the community-based docs would be nearly zero. Are hospitals paying more attention to the productivity and the satisfaction of their doctors?

I think they are, but they’re really torn. Many hospitals are torn between going after Meaningful Use and that’s what they’ve been told to do and it’s the right thing to do, and make the physicians happy. In many situations, those are somewhat exclusive.

One CIO showed me a graphic, saying, “As we’ve increased technology available to our physicians, we’ve decreased physician satisfaction pretty much in these relationships.” I think that puts a lot of CIOs between the proverbial rock and hard place. But I think most organizations right now are very focused on Meaningful Use and are having to sacrifice physician satisfaction in the short term. That’s probably not a long-term, sustainable strategy.


Everybody talks about the reduced productivity with CPOE. Do you think it’s mostly due to the poor application design for physician usability or the requirements by government or others that doesn’t benefit patients all that much?

As it pertains to CPOE and even documentation, there’s not a lot of government regulation that makes it difficult to use. It may make it difficult to write the software and get it out there and everything, but not difficult for the physicians to use per se.

I think the historical problem is that CPOE to date, from the classic way of getting it, is through an HIS vendor. Those systems evolved out of the back-end infrastructure. The physician has to learn how to put in orders in the way that the back-end system wants to consume them. That is not the way physicians are trained. Doctors have to go to two, three, four, five days’ of training just to be able to use these systems because they’re having to re-conform the way they think about ordering and the way they do stuff to the way the back-end systems in the hospitals process orders. That’s a way of doing things; it’s not a way to create great productivity.

An alternative way, which is the way we have approached the system, is to start with the way doctors think about ordering and build a computer system that translates it and gets it into the form that allows that order to be processed. If you think about the difference between like a Windows PC and an iPad in terms of user manuals and configurability and all this stuff, you pick up the iPad and it’s intuitive to use it. When we put a CPOE system in front of a physician, they mostly can just use it. Maybe it takes them 5, 10, maybe 15 minutes of training to be fully proficient. 

It’s not usability in the classic computer science sense. It’s about having a system that is designed from the beginning to work the way that doctors work. Then you get to do a whole lot of work in the back end to make it work the way the hospital does, because if they can put the order in but it doesn’t go anywhere, that doesn’t do anyone any good. It’s not an easy task. It’s a very different approach than anyone else has taken to date. I hope that as we move forward in this industry people take a different approach and focus more on the physician workflow and try to get systems that do mirror the way physicians have been trained and the way they practice.


Who would make that change? It’s almost all Cerner and Epic in hospitals at this point, and I assume that in your mind, both have usability problems.

You mentioned Epic. It takes two days to learn how to use. Obviously there’s a ways to go in terms of easy use and usability just from that fact alone. 

In terms of the “who,” this depends a little bit on whether we’re committed to an open, interoperable world. The government or anyone else didn’t make the edict that every single piece of IT used in a hospital should come from one of two vendors and you only get to pick one of them. That’s a pretty closed view of the world. There are other views of the world that would allow people to create best-of-breed solutions, whether it’s for specialty, or for different kinds of people within a hospital, whether it’s a physician or a nurse or phlebotomist, or whatever. And be able to have those systems automate those people in a fabulous manner and have the data flow back into those core systems. 

Frankly, the Cerners and Epics and even the Meditechs of the world, they run your hospital really well. You don’t hear problems of the laboratory folks or the pharmacists complaining about their Epic system or their Meditech system or their Cerner system. They actually do a really good job. They’re much more mature, especially with Epic. Cerner started out as a lab organization, a lab automation company. These systems are very mature and work really well for these folks. The challenge has been the doctor and some of the other caregivers that we don’t address. Certainly nurses have a fair amount of frustration. Some of that really is because the regulations and the requirements that are being placed on them. 

I think the solution to this is to have innovation. If we just have to get all our software from two vendors, that’s not necessarily going to create the most innovative part of the world. If you look at what’s happened elsewhere, like Salesforce.com and their ecosystem they created for our vendors. We run that as our core CRM system, but we run applications from three or four other vendors because it does it better than Salesforce.com. Salesforce.com opens their APIs and helps you buy them and all kinds of stuff. Hopefully we’ll be able to get to a place where the HIT world is like that.

We as PatientKeeper are trying to find ways that we might be able to leverage our technology and our 14 years of R&D to make these systems open for others as well. I’m not quite sure exactly when and how we’re going to do that, but we’re very committed to seeing innovation happen.


The challenge is that hospitals wanted one neck to wring, as they say, and chose single-vendor solutions even if they had to give up some things. What would be the driving force for that innovation if the customers don’t seem to want it and the two remaining dominant vendors that are out there don’t seem to have much incentive to change?

Just what we were talking about with physicians, we’re going through this Meaningful Use march. You see a lot of organizations that are really struggling to get to full physician adoption. Having two workflows, even if you can check the boxes on Meaningful Use and get to your 30 and 60 percent for your lab and pharmacy orders, that’s not a way to run a hospital. You want to get to 90 something plus percent. If you’ve slowed down your physicians and your physicians are complaining, you’re going to be in a big world of hurt. 

Certainly while any new sales of hospitals are going to mainly Cerner and Epic, more than half the hospitals out there don’t run Cerner or Epic right now. I’m not sure that they’re going to all magically convert over in any short period of time. I think we still have a world where there a bunch of hospitals out there really struggling with what to do with stuff that’s even more challenging to use than those two vendors. So yes, it’s going to be very interesting to see of best-of-breed versus one system thing. It waxes and wanes. 

In the rest of the world of technology, the notion of a single, closed, proprietary system that doesn’t allow support an ecosystem or support inoperability is pretty much passé. Technology is so good to be able to exchange data and integrate data. I hope that healthcare will ultimately succeed. It’s hard to put a crystal ball and see exactly how, but I think there’s been a lot of forces and they’re at work here and hopefully they will converge to create both the technological ecosystems but also the market demand for better systems for doctors.


Meaningful Use threw that equation off where it pushed people to buy the same old systems today, and hospitals spent whatever money they’re going to have for a long time. Is that an environment that will allow or encourage change? Do you think the Meaningful Use has degraded the market from where it would have been otherwise?

It’s certainly had an impact on it. It’s hard to say. It’s almost like you want to have a parallel universe, one with Meaningful Use and one without, to see exactly what would have happened.

The good news on Meaningful Use is that it got everyone focused on doing CPOE. The challenging news for some, as you point out, is that when we went out to look, if you’re a hospital looking for what the options are, there are only a few options. It is what it is. 

As people are now getting to the more mature phases of Meaningful Use and starting to look beyond it, that that’s where the opportunities are going to get created. When you’re trying to, “ I have to get to Stage 2. I’m going to check these boxes,” a lot of people went out and did the short putt, or in many cases, just took what they had and said, can we make it work? What we’re seeing is a lot of organizations that did that — and might even be at 50 percent or 60 percent utilization — but they are now saying, look, this is too painful. This is not sustainable. We need to do something different. 

They’re looking for options. PatientKeeper’s one option. There are other options out there. There a lot of creative solutions out there that people are starting to try. I think that as that pain becomes more acute, that will create receptivity to more and more creative options other than taking the HIS system I have now and try to deploy it more and more.


The world has changed a lot since PatientKeeper was formed. I think it originally ran on a Palm, if I remember right. Do you think that the way clinicians are using and expecting to use mobile devices has changed more than even on the consumer side?

Your memory’s good. It’s really interesting if you look at the mobile device world and you take a snapshot in time. Even when the Palm first came out, people said, well, gee, finally. If you recall what happened before the Palm, there were about 50 startup companies that tried to build a pen-based PC and failed. It was like for a while, Palm was it. Then you could take a snapshot in time and say, BlackBerry was absolutely it — that was a solution for all things mobile. 

There’s a point in time, and I think that point in time is actually starting to pass, where the iPhone looked like it was the only solution and the end-all, be-all. That’s starting to change, too. The Android devices are arguably much more innovative and more creative. The Android tablets are pretty darned compelling and half the price of an iPad. Who knows? It’s very hard to forecast what’s going to happen.

I’m certain, though, that mobility will continue to play a very big role in everyone’s lives, including physicians’ lives. I think physicians in general are probably a little behind the curve, in part because many HIS systems don’t have good mobile options. They can’t do core workflows in using mobile devices. But that’s changing. Companies like PatientKeeper and others are coming out with all kinds of cool, great devices to help physicians, and there are a million apps out there for them. Mobility is going to continue to be really, really important for physician. 

Let’s also not forget the PC. You know, PCs are still important, even for those of us who are entirely mobile. I remember when the iPad came out, a lot of my friends were trying to become just the iPad and not use any other device. Most of those experiments have failed and they’ve gone back to using multiple devices. It is about the right device for the right place. We just have a lot more options than we had when it was either the Palm Pilot or a big desktop PC. Now we got everything that ranges from little thing in your pocket to a bigger thing in your pocket to a thing in your coat pocket, different slim levels of laptops all the way up.

It’s great to see all these different form factors and these different approaches. We continue to leverage them, and certainly that is a net win for physicians, because if they can have the form factor that works for them in their practice at the right place, that that makes it that much easier for them to become productive.


There is an irony to physicians demanding the latest mobile device to run 25-year-old software. Are you finding that the KLAS report that showed PatientKeeper well ahead of the core HIS vendors in usability is convincing people that to just run the vendor’s application on a mobile device isn’t really getting very far other than to make it theoretically portable?

Certainly things like the KLAS report that looked at usability of the PatientKeeper approach versus others is very helpful for kind of providing a third-party assertion of it. I’d like to think that when people look at running like a Meditech screen through Citrix on an iPad that they understand the difference between that and actually having a real-life application in terms of usability. I mean, it’s possible, but as you point out, pretty ironic to be running software that was written in an environment when there weren’t even laptops, much less iPads, and running them on your iPad. 

As we focus on usability and focus on physical productivity, you’ve got to get the right applications and the right devices. Character-based screens on your iPad is not the right application on the right device.


The KLAS report was unusual in that it almost touted PatientKeeper directly over the vendors that trailed behind. What has the result been?

We certainly got a tremendous amount of interest and excitement. People have been looking for an alternative to the problem that we’ve been talking about. Doctors are not excited about not getting benefits from CPOE in particular, and they’re being forced to use it. 

One of the reasons that compelled KLAS to look at this was, here’s a new thing. It’s very different. There aren’t a lot of vendors out there right now that have CPOE that sits on top of other HIS systems. The HIS vendors don’t offer their CPOE for other HIS vendors. It’s a pretty unique concept that we’ve spent a lot of time and a lot of money making work. Certainly I think it’s got a lot of folk’s attention, because it’s a solution to a problem that’s here today. We’re really excited to see the usability reports from physicians about CPOE being so high.


You mentioned the creation of an ecosystem of independent apps like in the Salesforce model. Where do you see PatientKeeper fitting into that or how do you exploit that if it happens?

We spent $100 million plus of R&D effort essentially making these HIS systems open, to us at least, with integration technology and a platform. We run our CPOE system on whatever HIS system is out there. There’s a lot of work that I won’t call proprietary, in the sense of it’s specific to a given HIS system. 

We are contemplating ways that we might make that technology available to the industry. Imagine another vendor that wants to build a really great system for a care manager in a hospital. They are faced with the same task that we just spent all this money doing, of having to integrate with all these different systems that are out there. We could make that available to them so they could do a bidirectional integration to the system and be able to spend all their energy on what they’re good at, which is understand the care management workflow at discharge time, and create a great application for them without having to do the work and break their picks on all the rocks that we did as we built that. 

Certainly it’s a concept that we’ve been contemplating. We haven’t done anything in terms of actually releasing it into the world. But to your earliest question about how do you create innovation, we need something like that to happen. Even if all the HIS vendors open theirs up, they’d open theirs up in a different way and you’d have a difficult and challenging problem. There’s real opportunity there, and I think it’s opportunity not just for one company, but for the industry overall.


If those vendors were threatened by your existence and your performance on the KLAS report, could they  shut off the data nozzle so that PatientKeeper couldn’t run?

It depends a little bit on what they would tell their customers about that. Technologically, there’s no reason why we can’t run nicely against their systems. Certainly there are things that people could do to make those things not work well. It’s not an environment that they would be very well-received by their customer base. Ultimately, this comes down to the customers. If the customers demand this enough, vendors will have to supply it. 

I actually believe, totally honestly, that this isn’t about us versus the HIS vendors. It’s about all of us trying to figure out how to automate the healthcare system in the most thoughtful manner possible. We don’t replace an HIS system, and in fact, we can’t run our software without an HIS system in place, because we don’t run hospitals. All we do is help the doctors interact with the hospitals in a more effective manner. 

We don’t even see the HIS vendors as competitors. We see them as very much complementary to what we do. And God bless them, I totally respect all the work they do to run hospitals and they do it very, very, very well. Hopefully they will respond accordingly and say, hey, look, here’s a great opportunity to make a bunch of doctors happy and make them more efficient and it doesn’t cost them a dime of revenue.


Any final thoughts?

It’s just great to get to catch up. It’s been almost three years since we last chatted, so I really appreciate the opportunity. And I really thank you for continuing to help keep the industry informed of all the great news. HIStalk is always the place that I go first thing in the morning as I drink a little tea and get going for the day, so thanks so much.

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October 24, 2013 Interviews 1 Comment

News 10/18/13

October 17, 2013 News 2 Comments

Top News

10-17-2013 8-40-26 PM

HHS Secretary Kathleen Sebelius is reported to have no intention of quitting after Republican criticism of the Healthcare.gov online insurance exchange debacle. Sebelius has acknowledged the problems, but says fixes are being put in place and those who were unable to sign up should try again. Success rates for those attempting to enroll were less than 20 percent the week of its rollout on October 1 and under 13 percent the second week, although one researcher says fewer than 1 percent of those who tried to register were successful. Another report finds that the cost for the system ballooned from the original estimate of $94 million to $292 million, with those payments going to the US federal government division of Canada-based CGI. Other estimates peg the total cost of Healthcare.gov to be more than $500 million.

Reader Comments

10-17-2013 1-09-42 PM

inga_small From Dr. Travis: “Re: Color me pink. Breast cancer awareness month has jumped the shark this year.” Travis tells me he likes the innuendo of this poster’s message, which I believe was from the Twisted Taco restaurant in the Atlanta area. Thanks for the reminder to support breast cancer research, get screened regularly, and/or encourage your loved ones to be screened.

From Reader One: “Re: from a vendor-specific forum today. ‘We inadvertently assigned 5,000 accounts to a bad debt agency. Is there a way to mass cancel?’ Now that’s what I call exciting.”

HIStalk Announcements and Requests

10-17-2013 5-46-56 PM

Welcome to new HIStalk Platinum Sponsor Boston Software Systems. The company offers an error-free workflow automation platform that allows its healthcare customers and business partners to streamline their business processes and improve productivity. Boston WorkStation lets IT departments efficiently solve problems and eliminate performance gaps in existing IT systems – integrating third-party registrations, performing eligibility checks, integrating lab results, posting payments and collections notes, performing mass updates, creating backup databases, running and distributing reports, and managing dictionaries and tables. Existing systems can be enhanced by creating new business rules and workflows and providing real-time access to external applications. IT departments love Swiss Army knife-type solutions that be used to enhance systems without vendor involvement or ongoing labor requirements, such as the hospital that’s saving 125 hours per month using Boston WorkStation to automatically create a pre-registration account at the time of scheduling or another that saves $500K by automating their materials management system to load inventory purchases and manage price updates. The company also offers Cognauto, the next-generation automation platform. The company’s products are used by over 2,500 hospital customers running many IT systems. Thanks to Boston Software Systems for supporting HIStalk and for issuing a very cool press release announcing that fact.

10-17-2013 6-59-48 PM

10-17-2013 6-55-21 PM 
Thanks to Bonny and Catherine from Aventura, self-proclaimed “HIStalk minions” who volunteered to report from the American College of Emergency Physicians Scientific Assembly (ACEP13) in Seattle this week. They conducted some ED doc interviews about IT that I’ll have up later, but here are some of Bonny’s observations:

  • The topic of scribes performing EMR data entry split the group, with some ED physicians expressing satisfaction in offloading tasks to what is often a pre-med student, but others feel guilty about making scribes do what some would say is their work.
  • The best-of breed EDIS vendors were there (Picis, T-System, MEDHOST) as were the big enterprise vendors with EDIS, with Epic notably being MIA.
  • Education and discharge instructions vendors (Discharge 1-2-3, Elsevier ExitCare, Krames) were exhibiting.
  • Bonny says MEDHOST stole the show with a patient throughput solution that pushes preemptive communication about patients from the ED or OR, such as when a patient is likely to be admitted but whose emergency care is still underway. It also offers real-time and forecasted financial operational metrics for executives.
  • ACEP rented out the Space Needle, the Chihuly Museum, and the Experience Music Project for attendee events.
  • In the all-important vendor swag category, Bonny lauds Interactive Health Massage Chairs, whose booth was across from Aventura’s such that Bonny and Catherine could perform their own first-hand research as well as watch attendees shed their stress and exit happy. Check out the photo above – who wouldn’t want to have a chair massage while covered lightly with a blanket right on the show floor?

inga_small Highlights from HIStalk Practice this week include: a local paper profiles two physicians with opposing views on EMRs. CMS pushes a PQRS reporting deadline back three days. A vendor speaks out against shortened exhibit hours at MGMA. Most medical practices are concerned that ACA insurance exchanges will lead to increased collection burdens and lower reimbursements. Epocrates adds a provider directory to help members identify clinicians for consults and referrals. Emdeon will pay its departing CEO $2.4 million over the next two years. Thanks for reading.

Acquisitions, Funding, Business, and Stock

10-17-2013 6-14-23 PM

Athenahealth announces Q3 results: revenue up 43 percent, adjusted EPS $0.29 vs. $0.30, missing analyst estimates on both.

IVantage Health Analytics acquires Professional Data Services, a provider of managed care analytics and benchmarking solutions for hospitals.

10-17-2013 9-02-48 AM

StartUp Health admits 14 new companies to its three-year development program for health technology startups. Lt. Dan profiles the companies on HIStalk Connect.

10-17-2013 7-14-52 PM

Medical practice technology vendor Waiting Room Solutions changes its name to WRS Health.


Medical Services of America (SC) chooses Allscripts Homecare for its 70 home care service locations.

Elmcroft Senior Living (MO) will install Cerner CareTracker at its 85 assisted living facilities.

The 30-bed Aspire Hospital (TX) will implement clinical and financial applications from Healthcare Management Systems and physician documentation from Patient Logic.

The VA and DoD award Systems Made Simple a re-compete of the iEHR system contract for systems integration and engineering support.

10-17-2013 8-44-20 PM

Saint Luke’s Health System selects PeriGen’s PeriCALM fetal surveillance system for seven birthing hospitals in northwest Missouri and northeast Kansas.

The VA awards Harris Corporation a $60 million, four-year contract to design, install, and support the wireless infrastructure at 112 VA medical centers.

Riverside Medical Group (VA) selects athenaCollector for billing and practice management for its 300+ physicians.

The Texas Health Services Authority chooses EHNAC to develop a state accreditation program for private and public HIEs operating in Texas.

Texas Health Physicians Group selects StrataJazz from Strata Decision Technology as its integrated financial platform.

10-17-2013 8-45-28 PM

St. Luke’s Health System (ID) will implement Epic at a cost of $200 million and will offer Epic ambulatory to independent practices through an affiliate program.  St. Luke’s, defending itself against antitrust claims for its purchase of Salzer Medical Group, says Epic is a superior system that will allow providers to share information with patients and with each other more easily.


10-17-2013 4-29-12 PM

Northwest Community Healthcare (IL) names Glen Malan (Cadence Health) VP/CIO.

OpenTempo names Jim Crook (IDX) chairman of the board, Walt Marti (GE Healthcare) chief administrative officer, and John Jordan (dbMotion) VP of sales and marketing.

Announcements and Implementations

Quantros releases IRIS 2.4, a configurable dashboard to view overall hospital performance and display trends, distribution, and variations in performance.

Government and Politics

inga_small A California state appellate court rules that providers do not necessarily have liability to patients when medical records are stolen or misappropriated unless they are accessed by a third party. The ruling stems from a 2011 incident in which a UCLA Health physician’s laptop containing medical records on 16,000 patients was stolen from his home. The provider could have been liable for up to $16 million as part of the  class action lawsuit, even though there was never any indication the data had been accessed. The suit was dismissed. Rebecca Fayed, associate general counsel and privacy officer at The Advisory Board Company, tells me the ruling only applies to California, which has its own statute governing the disclosure of medical information and allows affected individuals to sue for damages for certain violations. She adds:

Although the ruling would not apply nationwide at the federal level, other states with similar state laws may look to this case for reasoning and may analogize to it even if it has no precedential value in any state other than California.

10-17-2013 1-51-48 PM

inga_small The ONC Tweeters seem happy to be back at the keyboard after a 16-day furlough.

Innovation and Research

10-17-2013 7-10-10 PM 

Children’s Hospital of Philadelphia (CHOP) offers Harvest, an NIH grant-funded open source software toolkit that allows biomedical researchers to explore large data sets, such as those from EHRs and genomic databases. Researchers from CHOP’s Center for Biomedical Informatics are testing Harvest against several data collections, including the Longitudinal Pediatric Data Resource that tracks data from children with conditions detected in newborn screenings.


Deloitte introduces PopulationMiner, a data analytics solution that draws clinical, financial, and operational data from Intermountain Healthcare’s warehouse to support patient-outcome analysis.

ArborMetrix integrates surgical video analysis capabilities into its reporting and analytics platform, enabling healthcare organizations to improve performance benchmarking of surgeons.

Ninety percent of surveyed nursing home physicians say their use of drug references on mobile devices prevented at least one adverse drug event the month before the survey.


Virtualization software and dictation with speech recognition applications are emerging as top areas for growth potential in hospitals, according to a HIMSS Analytics report on the US hospital IT market. The demand for ambulatory EMRs and ambulatory PACS also appears to be growing.

10-17-2013 7-47-45 PM

Joint Commission issues a sentinel alert warning for objects left inside surgery patients, which it says has caused 16 deaths in the past eight years. Most of the recommended actions involve processes and communication, but consideration of “assistive technology” such as RFID-tagged counting systems are also recommended.

10-17-2013 8-47-11 PM

In Canada, information on 2,000 patients of Parkwood Hospital is exposed when an unencrypted laptop is stolen from the car of a McKesson Automation employee.

10-17-2013 7-28-08 PM

Weird News Andy notes that California’s insurance exchange, Covered California, pulled down its online provider directory just eight days after go-live when the California Medical Association noted that obstetricians were labeled as ophthalmologists and doctors were incorrectly identified as speaking foreign languages. CMA also observed that some doctors were listed as exchange providers who didn’t actually sign up since insurance companies were permitted to add their in-network doctors to the list without their permission unless the doctor specifically opted out.

Staff and patients of Unit 5, the children’s cancer floor of the University of Minnesota Amplatz Children’s Hospital, create a video titled “Brave.”

Sponsor Updates

10-17-2013 12-27-57 PM

  • SRSsoft hosts about 300 customers at its User Summit this week in Greenwich, CT.
  • Sunquest and the Association for Pathology Informatics will offer an October 24 webinar on the topic of IT-driven virtual autopsies.
  • Clinovations celebrates its five-year anniversary and highlights a few of its awards and honors.
  • E-MDs integrates PatientPay’s online bill pay solutions within its PM software. The company will also integrate Phreesia’s point-of-care check-in solution into its EHR .
  • St. Elizabeth Hospital’s (WA) use of e-form solutions from Access and hosted services from Inland Northwest Health Services helped the hospital meet HIMSS Stage 7 paperless requirements while eliminating the need for dedicated on-site hardware.
  • Greythorn conducts a market survey for HIT professionals to analyze compensation, benefits, job satisfaction, hiring trends, and industry participation. Greythorn will donate $1 to the Boys and Girls Clubs of Bellevue and Chicago for every submission by November 20.
  • Ed Bayliss, executive director for ChartMaxx, participates in a panel discussion on data exchange across the continuum of care at the eHealth Initiative 2013 Data Exchange Summit October 30-31 in Washington, DC.
  • Humedica publishes a case study detailing how Mayo Clinic Health System prepared for value contracting using Humedica MinedShare.
  • ZeOmega will embed Health Language technology from Wolters Kluwer Health into its Jiva care management platform.
  • The Drummond Group certifies SRS EHR as a 2014 Complete EHR.

EPtalk by Dr. Jayne


You can tell that fall has arrived when every coffee vendor (including the one in the hospital lobby) is pushing pumpkin spice latte. Unfortunately, it is also the time I start sweating the fact that I need to come up with an extremely creative Halloween costume and come up with it stat. One of my favorite former bosses throws a massive party and the price of admission is a great costume. I enjoy Halloween immensely and have a closet full of costume options, but this party is peopled with brilliant individuals from academia, healthcare, and health IT so throwing on the Princess Leia braids simply will not do.

Maybe I’ll print a bunch of completely random attributes (some of which relate to me and some that do not) and go as my LinkedIn profile. I always laugh when people endorse me for knowledge of vendors I have never even heard of. I know several of the attendees are faithful HIStalk readers. Maybe I can convince my date to adopt a couples costume and we can go as Inga and Mr. H. Of course I could always go as Dr. Jayne, but that might be a little obvious. I guarantee at least one attendee will be wearing a bowtie and a Farzad-worthy grin.

The lobby of our medical school has a wall with pictures of our staff who have won various Nobel prizes. I could always dress as one of them and see if anyone picks up on it. Getting someone to identify that choice might be a little dependent on how far after the start of the cocktail hour I arrive, though, so not entirely a safe bet. I’m leaning towards possibly a World War I nurse just to have an excuse to purchase an awesome vintage cape. In medicine (and nursing) we used to dress more formally and I miss that. I understand that the current culture of scrubs is all about comfort and practicality, but I can’t help but think that if we dressed more seriously our patients (and administrators) might take us more seriously.

I took a course recently that covered communication and corporate culture. We did several exercises looking at how appearance plays a role in group dynamics. Watching several videos, we scored the characters based on believability, authority, seniority, and a host of other factors. Regardless of the scenario, those characters who dressed in traditional business attire scored higher than those who dressed casually. Besides dress, there are a lot of other factors at play with power dynamics, including the position of the participants (same height vs. seated/standing), tone, demeanor, etc.

I had the opportunity to rotate through a hospital in the UK during the late 1990s and was struck by the formality of the nursing staff. They still wore traditional dress whites (with caps) and nursing trainees wore blue. Physicians wore the long white coat and neckties. There were very few female physicians who I interacted with during my rotation, so I can’t particularly remember what they wore.

I trained at an academic medical center with an extremely traditional surgery department. Surgeons were never to wear scrubs outside the operating room. Trainees were not allowed to consume food or drink in the hallways – not even a sip of coffee – and white coats were to be fully buttoned at all times. Conversely, the OB/GYN house staff wore scrubs and sneakers 24×7, which created more than a few resentments. I wonder though if the patients or other hospital staff really perceived the departments differently? Was it a factor of dress code or of other factors that the dress code exemplified, such as discipline, order, and precision?

Scrubs and casual dress have become a way of life for most hospitals and medical offices. My hospital requires care teams to wear certain colors of scrubs depending on employee roles. Nurses wear navy, respiratory therapy wears light blue, patient care technicians wear khaki, etc. This seems to better help patients understand who is caring for them and what to expect. Unfortunately, physicians run the gamut between coat and tie and whatever scrubs they put on at the last hospital they rounded at. Some are so casual it’s hard to take them seriously. In response to a number of male physicians going sockless in loafers, one local facility created a rule requiring that “hosiery be worn at all times.” I’d like to have been a fly on the wall at the medical staff meeting where that was discussed: readmission rates, surgical site infections, ventilator-associated pneumonia, and bare ankles.

In the ambulatory care setting, the proliferation of scrub styles is mind boggling. We see a lot of “hip” medical assistants and patient care techs in low rider scrubs with flare bottoms that drag the ground to the point where they fray. I hope they never have to run to a code or crouch down to provide CPR, and if they do, that they have their waistband firmly in hand. One pediatrician I know has hand painted lab coats for every holiday and season. She’s the only physician on staff who wears a blue coat, so it really stands out. I smile every time I see her in the elevator, but I’m not sure what some of the patients and visitors think.

Generally I think the offices where staff dresses in a more uniform manner appear more organized and professional, but again maybe the dress code is a side product of management rather than a causative factor. Many of our offices provide staff with practice-logo polo shirts to be worn with khaki pants. This can be useful to reinforce an office brand as well as to help patients identify staff members, especially in busy offices with many ancillary services. That might be a great costume idea – maybe I’ll borrow a polo and masquerade as a staffer for a competitor practice.

I didn’t set out to write a fashion review, but perhaps Inga has been a greater influence on my writing than I previously thought. I could write an entire column on sassy patent leather hospital clogs, but we’ll save that for another night. I’m off to the internet for costume ideas. Got a great one? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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October 17, 2013 News 2 Comments

Morning Headlines 10/16/13

October 15, 2013 Headlines No Comments

Cerner Joins Wolters Kluwer, Hit 52-Week High

Cerner stock hits a 52-week high at $55.98 per share following an announcement that it will partner with Wolters Kluwer Health in a joint venture to develop a new physician documentation solution that will embed Wolters Kluwer’s clinical decision support tools.

Patient Engagement: How To Do It Right

InformationWeek profiles both the Cleveland Clinic and the Mayo Clinic and the work they are doing to draw patients into their patient portals.

IBM’s Watson wants to fix America’s doctor shortage

IBM’s Watson supercomputer will be implemented at Cleveland Clinic in an effort to create a digital assistant capable of scanning a patients record and pointing doctors to crucial data and likely diagnoses. The tool is still a prototype and will initially not be consulted until after a doctor has made a diagnosis. Neil Mehta, MD, the Cleveland Clinic project lead says "I’ve had a couple of patients where Watson found things that I had missed. It doesn’t work every time, but it’s getting better."

CareCloud CEO: We may go public next year

Ambulatory EHR vendor CareCloud hints at a 2014 IPO.

Novant Health honored for implementation of Epic

North Carolina-based Novant Health receives HIMSS Stage 7 designation after installing Epic across its 350 ambulatory offices this August.

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October 15, 2013 Headlines No Comments

News 10/16/13

October 15, 2013 News 3 Comments

Top News

10-15-2013 10-09-26 PM

Cerner shares hit a 52-week high Tuesday following announcement of a partnership with Wolters Kluwer Health to develop a physician documentation system using Provation Clinic Note content with Cerner Millennium. CERN shares are up 52 percent in the past year, with the company’s market cap now at $19 billion. 

Reader Comments

10-15-2013 9-13-05 AM

inga_small From Veteran: “Re: insurance marketplace. I take it all back. This really is a disaster. A New York Times article this weekend chronicled a whole series of issues going back months, not the least of which was HHS’s decision to project manage this themselves when they (and everyone else) knew they had neither the expertise nor the experience. Hope this doesn’t set health reform back years.” Veteran (and a few others) were critical of my comment that the opening day of the insurance marketplace was a “failure” because I was unable to access the system. According to the Times, insiders were aware of the system flaws long before the launch, but because of political concerns, continued with the original timeline. By one estimate the project is now about 70 percent of the way toward operating properly, but the time frame for completion could be anywhere from two weeks to a couple of months. Apparently I am just one of a few thousand people who have opted to wait a few weeks before making additional attempts to enroll.

From CA/DC Fellow: “Re: failed health insurance exchange site. Will US CTO Todd Park take the fall?” Healthcare.gov is a high-profile political embarrassment. In politics and government, someone has to be lynched publicly to appease the press. Todd was sent out to try unsuccessfully to talk around the situation, which I think puts him at risk. Sebelius would toss him overboard in a second to save her image. Nobody ever blames the contractors since it was someone’s job to manage them.

HIStalk Announcements and Requests

Listening: Nada Surf, a nearly perfectly listenable alternative rock band that’s been around for 20 years. I’m playing them constantly.

Acquisitions, Funding, Business, and Stock

10-15-2013 10-57-32 AM

A report predicts that HIT funding will double over last year thanks to the implementation of the ACA and HITECH. Venture capitalists invested $737 million in 51 deals during the third quarter, compared to $623 million in 168 deals a year ago.

CareCloud CEO Albert Santalo tells the Boston Business Journal that his company may launch an IPO next year.

10-15-2013 10-12-17 PM

A business publication says transcription vendor MModal, saddled with heavy debt and slow sales, may need to seek restructuring if its current turnaround efforts fail.


Australia’s NSW Heath will implement iMDsoft’s MetaVision throughout the state’s adult, pediatric, and neonatal ICU beds.

Adventist Health System selects the Explorys suite of analytic and population health management solutions.

TeamHealth (TN) chooses Shareable Ink’s Anesthesia Cloud and ShareMU solutions for selected sites nationally.

Virginia Hospital Center Physician Group selects eClinicalWorks EHR for its 100 employed physicians.


10-15-2013 3-12-46 PM

Henry Schein appoints Steve Klis (CareFusion) president of global practice solutions.

10-15-2013 9-27-43 AM

CareCloud names R. Scott Lentz (Aprima Medical, Picis) CFO.

10-15-2013 8-36-53 PM

AtHoc names John Tempesco (Informatics Corporation of America) as senior director of healthcare operations and marketing.

Vocera Communications hires Paul Johnson (Intuit) as EVP of sales and services.

Announcements and Implementations

10-15-2013 10-14-04 PM

Heritage Valley Health System (PA) activates Allscripts Sunrise for its Beaver and Sewickley campuses.

10-15-2013 1-40-27 PM

Medfusion rebrands its recently reacquired Inuit Health patient portal technology back to its original name and adds Vern Davenport (formerly of MModal) and Buck Goldstein (UNC Chapel Hill) to its board.

10-15-2013 10-15-26 PM

For-profit surgical hospital operator Victory Healthcare (TX) implements Omnicell’s G4 Unity medication management system.

Optum and Dignity Health introduce Optum360, a new company that will address the back office functions of healthcare systems.

Unified emergency notification systems Vendor AtHoc announces the launch of its healthcare vertical with the launch of AtHoc Home Care Alerts, which offer home care service organizations with mobile duress and emergency alerting, field reporting, and personnel tracking.

Jordan Shlain, MD and Todd Johnson of automated patient follow-up solution vendor HealthLoop will present at the UHC Conference Innovation State on Friday.

10-15-2013 10-17-02 PM

Lewistown Hospital (PA) implements Summit Downtime Reporting System for business continuity.

Lucca Consulting Group and ICD-10 Coach announce a partnership to help small hospitals and practices implement ICD-10.  

Government and Politics

The VA names Health eTime the winner of its medical appointment scheduling competition and a $1.8 million prize. The open source app allows veterans to schedule visits across VA locations and gives VA providers the ability to share appointments with the personal digital calendars of veterans.

A Pittsburgh Tribune-Review investigation finds that the VA is one of the largest violators of health privacy laws. From 2010 to May 31, 2013, VA workers or contractors committed 14,215 privacy violations at 167 facilities that victimized at least 101,018 veterans and 551 VA employees. Violations included postings of anatomy on social media sites and identities stolen to create fraudulent credit cards.

Innovation and Research

CEOs of hospitals with high levels of advanced technologic capabilities earn an average of $135,862 more than hospitals with low levels of technology, according to a study published in JAMA Internal Medicine. Hospitals with high performance on patient satisfaction also compensated their CEOs more, but no association was found between CEO pay and processes of care, patient outcomes, or community benefit. Based on the findings, researchers suggest that hospital boards place more emphasis on quality when setting compensation.

Two graduate students in Israel develop a computerized system for diagnosing Parkinson’s disease consistently. The patient performs specific movements in front of a 3-D depth camera, whose data is the analyzed by computer to determine a diagnosis with 94 percent accuracy.


10-15-2013 11-22-36 AM

Encore earns top scores in a KLAS report on go-live support vendors. Santa Rosa Consulting was recognized for having the most engagements overall, followed by Encore and ESD.

The Carolina eHealth Alliance (SC) reports that the four hospital systems participating in its electronic exchange network saved more than $1 million over a 12-month period by reducing unnecessary admissions and redundant procedures.

Clinithink posts an animated video depicting the role of clinical NLP in transforming healthcare.

An article in Medical Marketing & Media says that mobile devices are yesterday’s news for marketing drugs to physicians, concluding that “EHRs will become the dominant context for physicians” in promoting drugs at the time of e-prescribing. However, it warns that overly aggressive drug promotion could lead to regulation. A drug company spokesperson predicts  consolidation of the EHR industry, saying “a relative few will own the space and will own the access” for drug companies to promote their products as part of physician workflow. Drug companies are doing away with traditional field reps for product promotion.

10-15-2013 10-19-55 PM

The local newspaper writes up Novant Health (NC), which earned HIMSS Stage 7 EMRAM last week for its $600 million Epic implementation, which Novant says it finished three years ahead of schedule and under budget.

Sponsor Updates
  • Caradigm will add predictive clinical analytics capabilities from MEDai to its Care Management platform.
  • Sunquest announces a new partnership with the Boys & Girls Clubs of Tucson.
  • Cynthia Davis, RN, FACHE of CIC Advisory will speak Thursday at the 2013 Annual Healthcare IT Symposium in Las Vegas sponsored by the Shriners Hospital for Children. Her topic will be “Paddling Upstream: From Data Collection to Better Patient Care.”
  • Epic will allow direct use of the QlikView Business Directory platform within Hyperspace and will support content sharing between joint Epic and QlikView customers.
  • NTT DATA’s Optimum Suite achieves 2014 Edition Complete EHR Inpatient certification.
  • The SSI Group announces that both its clearinghouse services and RCM solutions are ICD-10 ready and that it is currently testing with provider and payer communities.
  • An Imprivata survey finds that the adoption of server-hosted virtual desktops in the EMEA healthcare industry could increase 74 percent within 24 months.
  • Trinity Health (MI) shares how it generated $3.1 million in profits and an eight to one ROI in five years using Medseek Predict for marketing campaigns.
  • VitalWare partners with DCBA to create CDiDocuMint, a clinical documentation improvement tool that uses a query and tracking methodology.
  • The Washington Business Journal recognizes Clinovations as the 10th fastest-growing company in the district.
  • Utah Business Magazine honors Health Catalyst Chairman David Burton, MD for his lifetime achievement as a healthcare hero.
  • Weill Cornell Medical College CIO Curtis L. Cole shares how he helped Intelligent Medical Objects develop its flagship product.
  • UltraLinq Healthcare Solutions partners with Mobisante to integrate UltraLinq’s image management platform with MobiUS point-of-care imaging devices, enabling providers to deliver remote diagnosis and second opinions.
  • LDM Group’s pharma messaging technology is featured in an article on engaging physicians through EHR messaging.


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

More news: HIStalk Practice, HIStalk Connect.


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October 15, 2013 News 3 Comments

Morning Headlines 10/11/13

October 10, 2013 Headlines 4 Comments

Physician job satisfaction driven by quality of patient care

A RAND study that interviewed 220 physicians across the US finds that a primary driver of their job satisfaction is being able to provide high-quality healthcare, and while some physicians acknowledge advantages of EHRs, the general consensus is that the systems in use today are cumbersome and are an important contributor to their dissatisfaction.

Kansas City Council approves $4.3 billion Cerner campus plan

The Kansas City Council voted 10-1 Thursday to approve a $1.63 billion tax incentive package to support development of Cerner’s new 4.5 million-square-foot campus. The new campus will house an estimated 15,000 new employees by the time it is complete in 2024.

KHC electronic records go live Sunday

25-bed Knoxville Hospital (IA) goes live with its new $2.8 million Cerner system on Sunday night, October 13. 

Union protests shutdown at VA Medical Center

Union employees at the Iowa City VA Medical Center are protesting in support of their IT staff who, because of the government shutdown, will begin working without pay this week. A spokesman for the union said that since there are no paper records in VA hospitals, the hospitals are entirely reliant on computer systems and the absence of funds to pay for the VA’s IT staff will cause problems for many VA hospitals across the country.

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October 10, 2013 Headlines 4 Comments

News 10/11/13

October 10, 2013 News 5 Comments

Top News

10-10-2013 7-03-28 PM

The DoD issues a solicitation to EHR vendors to demonstrate their products the week of October 21 for market research and planning purposes. The DoD says it is interested in “off the shelf” enterprise EHRs, including VistA solutions, to replace its legacy systems and notes that participation in the demonstration “is not mandatory, required, or a prerequisite for any future procurement activities.”

Reader Comments

From Curious: Re: PatientKeeper. Does anyone know if PatientKeeper is MU certified? Couldn’t find them by name on the CHPL website, but that’s not the world’s most reliable or usable site.” The folks at PatientKeeper shared this response:

PatientKeeper is certified for 2011 Edition as a Modular EHR, including CPOE and Medication Reconciliation, and we will be seeking 2014 Edition certification by the end of this year.

From HIS Junkie: “Re: HIPAA. Does HIPAA apply to the ACA Health Insurance sites? If there is a breach, will OCR slap HHS with a $1.5 million fine for each breach. No doubt we’ll soon find out. In a recent report, testers identified five major breach weaknesses in the Health Insurance web sites. They were: fake sites, all access requests for other sites, click jacking threats, cookie threats, and scam psychology threats. Firms like HPs web security group and Trend Micro did the testing. Clearly the slapped together sites would fail a HIPAA compliance audit. With people registering having to put in all their family member’s SSNs, the report concludes, ‘Expect Mischief.’”

From Wannabe Recovering Consultant: “Re: anonymous CIO interview. Incredibly fascinating. I would love it if you could do more of them. His or her insights into the thinking of a CFO made me think that an anonymous CFO interview would be equally insightful as relates to IT expenditures and activities.” That would be fun, too, if anyone wants to volunteer.

From MoreCowBells: “Re: California Medicaid. Any truth to the rumor that they won’t be ready to accept ICD-10 by next October. Are other states in the same situation?”

HIStalk Announcements and Requests

inga_small I spent most of the week in San Diego at the annual MGMA conference and posted several updates on HIStalk Practice. Take a read to get my impressions on some of the sessions, what was cool and not so cool in the exhibit hall, the scoop on after-hours parties, and what folks were talking about. If you prefer a more visual experience, you’ll find lots of pictures, including one or two of hot shoes. I also encourage you to check out Dr. Gregg’s latest post, which offers a few comebacks to the EHR nay-sayers. Thanks for reading.

10-10-2013 5-40-57 PM

Welcome to new HIStalk Platinum Sponsor Medi-Span, part of Wolters Kluwer Health. Medi-Span offers customized drug databases and medication decision support modules that enhance patient safety, support interoperability, and decrease alert fatigue. Medi-Span makes EHRs and other clinical systems smarter, supporting functions that include prescribing, dispensing, and claims processing for 1,600 hospitals, 49,000 retail pharmacies, and all 10 of the top pharmacy benefits managers. In addition to drug information, decision support, and pricing tools, MediSpan’s new offerings include Controlled Substances File that covers both federal and state requirements; Alert Control customization capability, Patient Safety Programs File that identifies drugs that have Black Box Warnings, Medication Guides, tallman names, or REMS; and ICD-10 Mapping Files. Thanks to Medi-Span and Wolters Kluwer Health for supporting HIStalk.


Health Catalyst will offer “Surviving Value-Based Purchasing: A Road Map to Success Under the New Reimbursement Model” on Tuesday, October 15 from 1:00 – 2:00 p.m. Eastern. Presenters will be Bobbi Brown, VP of financial engagement for Health Catalyst, and Jane Felmlee, healthcare consultant.

Acquisitions, Funding, Business, and Stock

10-10-2013 7-07-01 PM

Francisco Partners makes a strategic investment in EMR/PM vendor NexTech.

10-10-2013 7-07-53 PM

Three top executives of Bottomline Technologies take a pay cut from the previous fiscal year following the company’s 2012 net loss of $14.4 million. The combined compensation packages fell from $5 million to $4 million.

10-10-2013 7-08-29 PM

API Healthcare announces Q3 accomplishments that include a 23 percent increase in bookings and 35 new healthcare customers.


10-10-2013 7-10-50 PM

Augusta Health (VA) will implement community HIE technology from Sandlot Solutions.

Sentara Healthcare selects HealthMEDX to automate its clinical and financial operations for its skilling nursing, transitional care, and assisted living facilities.

San Luis Valley Health (CO) adds the iDoc document management software from CareTech Solutions.

Northern Colorado Anesthesia Professionals, LLC (CO) chooses Shareable Ink’s Anesthesia Cloud for data capture, billing, and scheduling and will use the company’s ShareMU program to help its providers earn EHR incentive payments.  

UNC Health Care (NC) extends its relationship with Practical Data Solutions, Inc. to deploy data models for Epic Resolute and Cadence, adding to its previous work with UNC on GE Centricity and Allscripts Enterprise.


10-10-2013 10-55-45 AM

Alere ACS hires Helen Figge (HIMSS) as VP of clinical integration.

10-10-2013 5-37-36 PM

St. Joseph’s Healthcare System (NJ) names Jane Tsui-Wu (Stony Brook University Hospital) as VP/CIO.

10-10-2013 6-37-20 PM

Streamline Health Solutions names Jack W. Kennedy, Jr. (PRGX Global, Inc.) as SVP/chief legal counsel.

Ian Gordon (Topaz Shared Services) joins McKesson Health Solutions as SVP/GM for decision management.

Liaison Technologies announces three new board members: William E. Kitgaard (Covance Global IT), David Parker (WebLogics), and Joseph B. Volpe III (Merck Global Health Innovation Group).

Announcements and Implementations

10-10-2013 7-12-12 PM

Knoxville Hospital and Clinics (IA) goes live on its $2.8 million Cerner implementation.

Bon Secours Health System (MD) integrates Wolters Kluwer Health’s UpToDate clinical decision resource within Epic.

10-10-2013 11-39-15 AM

Athenahealth will monitor and share population health information on flu outbreaks and other communicable diseases from its national database to fill the current gap in CDC reporting. Because of the government shutdown, the CDC has furloughed 8,754 employees (70 percent). Makes you wonder how much money the government could save if the private sector took over a few more tasks.

iMDsoft makes the MetaVision AIMS, MV-OR available via cloud-based hosting, with licenses offered on a subscription basis.

10-10-2013 5-38-56 PM

MEDHOST introduces AXON, a native iPad app that enables clinicians to interact with the MEDHOST EDIS.

Infor launches Health 3.0, the company’s vision for the future of HIT, which includes a suite of products that address the shift to value-based reimbursements.

Government and Politics

The VA Office of Information and Technology furloughs 2,754 employees, halting all software development on the VA’s benefits management system.

Union members of the Iowa City, IA VA medical center protest the effect of the government shutdown on the hospital’s IT workers. “Right now, the Information Technology section of our hospital that does all of our computer systems doesn’t have a budget, and those employees are currently working without pay. [Hospital employees] pretty much are at a loss for everything — charting, documentation, everything is at a loss.”

Innovation and Research

NIH awards Sutter Health, IBM Research, and Geisinger Health System a $2 million research grant to develop analytics methods to detect heart failure using EHR data.

Virtual assistant developer Next IT announces GA of Alme for Healthcare, which will respond to customer service questions and increase patient engagement.


Epocrates introduces Provider Directory to help members easily identify other clinicians for consultations and patient referrals.

A RAND study finds that the primary driver of job satisfaction for physicians is being able to provide high-quality healthcare. EHR use impacts doctor job satisfaction because of worries that EHR use interferes with face-to-face patient interaction increases clerical work by doctors. Physicians also have concerns that medical record accuracy may be negatively impact when templates are used.

American Well expands its $49 a visit telehealth consult services to 44 states and DC.

The Orlando business newspaper lists the salaries of executives of Adventist Health System. CIO Brent Snyder made the list with $1.14 million in salary in 2011.

Kansas City’s City Council Planning, Zoning & Economic Development Committee unanimously approves a plan to give Cerner $1.63 billion in tax incentives for its $4.3 billion expansion project. The full council is expected to extend approval Thursday for the 11-building, 4 million square foot development that would be built in 14 phases over the next 10 years.

A quality incentive program for salaried physicians at Massachusetts General Hospital improved EHR adoption and hand hygiene compliance, reduced ED use, and increased efficiency in radiology and cancer centers, according to a study published in Health Affairs. Physicians could earn incentives of up to two percent of their annual income, leading researchers to conclude that even small incentives can impact behaviors that improve the quality of care.

Sponsor Updates

10-10-2013 12-13-51 PM

  • eClinicalWorks hosts its national users conference October 11-14 in San Antonio.
  • Gartner positions Informatica as a leader in its 2013 Magic Quadrant for Data Quality Tools report.
  • Visage Imaging is exhibiting at this week’s ACR Annual Informatics Summit in Washington, DC, with GM Brad Levin participating in an October 11 vendor panel on mobile imaging solutions.
  • Aprima Medical offers customers an option to use TSPi’s MicroCloud Platform as a Service solution to host their Aprima EHR.
  • Billian’s HealthDATA and the Alliance for Home Health Quality & Innovation co-host an October 22 Twitter chat on mobile health and in-home technologies.
  • CCHIT extends ONC 2014 Edition Modular EHR Certification to PatientTouch System 3.2.2 and PatientTouch System 3.3 from PatientSafe Solutions.
  • Cerner will add Wolters Kluwer Health’s Provation Clinic Note content and decision support into Cerner Millennium.
  • TriZetto releases details of its 2013 Executive Vision Summit November 12-14 in Scottsdale.
  • The American Hospital Association extends its exclusive endorsement of data center hosting services from CareTech Solutions.
  • Michael Mutterer, VP of senior services at Riverside Medical Center (IL), shares his thoughts about “I couldn’t live without … HealthMEDX clinical EMR.”
  • pMD explains how its mobile charge capture solution can improve the PQRS reporting process.
  • Technology from Awarepoint and Versus are featured in a 24X7 article on the growing use of RTLS in healthcare.
  • EClinicalWorks adds Elsevier’s ExitCare technology for evidence-based patient education and discharge instructions into its EHR.
  • Quality Systems’ subsidiary Mirth releases Mirth Connect 3.0, an open source healthcare integration engine for HL7 message integration.
  • 3M Health Information Systems introduces the 3M Outpatient CDI Program, which offers consulting services for outpatient facilities and physician practices needing to improve the documentation and coding process.

EPtalk by Dr. Jayne


I’m completely disheartened by the behavior of our elected officials during this government shutdown and the months leading up to it. Regardless of your side of the aisle, it seems everyone is behaving badly at this point.

One of the things that surprised me is the shutting down of government websites. I was looking for information on a potential vacation site and discovered the National Park Service websites are down. I understand not paying people to create new content or update pages, but am not following the logic on how taking down the websites is saving a significant amount of money.

If they’re using commercial hosting at all, I doubt their vendors decided to quit charging them due to lack of appropriations. If they’re self-hosted, did they just turn out the lights at the data center and leave a few random servers up to share the message of gloom and doom? Are they hoping to cut their cooling bill as a way to balance the budget? I understand it’s all a political maneuver to make it as uncomfortable for everyone as possible, but it seems a little over the top. I decided to do some informal surfing to determine which websites were “essential” or not.

The National Park Service sites are down. Everything redirects to the Department of the Interior home page, which is up. Also live is the Deepwater Horizon oil spill page for those urgent updates from the 2010 spill. Not sure why that’s essential. The web pages of the USDA Forest Service are live with a disclaimer that they will remain available for public safety announcements and updates for wildfires, floods, and other natural disasters, which seems reasonable.

The Centers for Medical & Medicaid Services sites are up, with a disclaimer that information may not be up to date. That approach at least makes more sense than what the National Park Service has done. Is depriving fifth graders the ability to read about Old Faithful really the best way to serve the next generation of leaders? I think not.

One page that I found live with absolutely no disclaimer or mention of the shutdown is the HealthIT.gov page on How to Implement EHRs. Even the HHS HealthITBuzz blog is up without a disclaimer, although the last update was September 26. I wish the majority of physicians I worked with shared the same urgency for EHR adoption as the website does. Also, I was happy to see most of the Veteran’s Affairs websites still up (although there may not be people processing anything on the other side of the wires, which is shameful).

Those of us that work in healthcare IT are constantly preparing and refining our business continuity plans. We make sure we know how to deal with a business disruption and how to actually resume our processes when the systems come up. I wonder how many federal IT departments have the same level of thought or planning? I doubt they perform regular “government shutdown” drills and they probably don’t even have a downtime box because there would be no one there to use its contents. We can only assume that when the systems come back on line things will be messy.

Hopefully the parties involved will figure out a way to come together and start serving the American people again but, I think that’s probably asking a lot at this point. In the meantime the rest of us will continue doing our jobs, caring for patients, keeping the systems running, and paying our bills. And at least one of us will be dreaming of the Dry Tortugas. Got a seaplane? Want to sneak into a National Park? Email me.


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

More news: HIStalk Practice, HIStalk Connect.


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October 10, 2013 News 5 Comments

News 10/9/13

October 8, 2013 News 5 Comments

Top News

10-8-2013 7-28-00 PM

US CTO Todd Park tells USA Today that the Healthcare.gov insurance marketplace wouldn’t be failing if the site hadn’t drawn five times the expected number of simultaneous users. “Take away the volume and it works,” he said. Former National Coordinator and Republican appointee David Brailer wasn’t impressed with the Democratic appointee’s explanation: “Whoever thought it would draw 60,000 people wasn’t reading the administration’s press releases. The Medicare Part D site was supposed to have 20,000 simultaneous users and was (built for) 150,000, and that was back when computing was done on an abacus. It isn’t that hard.” A Wall Street Journal investigation finds that an Experian identity module is crashing frequently, the site contains orphan programming code that appears to do nothing, and caching was not employed for efficiency. It estimates that up to 99 percent of those people who try to register can’t complete the process. The previously chatty government contractors involved are now declining to return calls.

Reader Comments

From Patient Presents Without Comment: “Re: ICD 10. I wish I could see when, You’d be part of my past, and be gone; Your codeset is fine, but look: I prefer Nine. It’s opinion- how can it be wrong? There’s just under a year- it’s a while, but I fear, That there’s yet quite some Gantt chart to go; Could you install yourself? It’d be good for my health. So please MYOB, IMO.”

From Beer Reviewer: “Re: Monday morning news. The posts have been short. Is the news in short supply?” It is, actually. I go through the same steps every weekend to put together the Monday Morning Update, just like I’ve been doing since 2003. Lately news has been nearly non-existent. I could do like everybody else and pad it out with worthless, self-serving press releases masquerading as useful information, but I assume you would rather me not waste your time. Nobody has pointed out anything important that I’ve missed, a test I apply every single day to what I write.

From More Please: “Re: anonymous CIO interview. Fascinating! I would like to see more.” So would I. All I need are CIOs who are willing to be interviewed anonymously. If that’s you, let me know.

HIStalk Announcements and Requests

Everybody knows that most everything Yahoo is hopelessly antiquated crap, but I’ve stuck loyally with the paid version of Yahoo Mail for nearly 10 years because I like it better than the alternatives. No more. Yahoo is having a spam-related spat with Spamcop blacklisting that was causing my emails to fail and despite all the hoopla about improving the user experience, Yahoo has apparently removed every possible way of contacting support (even via an online form – thanks, Marissa Mayer). The best way to get me now is mr_histalk@histalk.com.

Acquisitions, Funding, Business, and Stock

10-8-2013 7-17-51 PM

Luminate Health, which offers a patient-friendly lab results portal, raises $1 million.

Nuance gives in to activist investor Carl Icahn by adding two of his nominees to its board in return for his support of the company’s slate.


Sacramento Family Medical Clinic (CA) is implementing Forward Health Group’s PopulationManager as it joins forces with The Guideline Advantage to improve quality outcomes and patient care.

Partners HealthCare (MA) selects InterSystems HealthShare to replace several integration engines as it consolidates to a single EHR.

The Valley Hospital (NJ) will implement Merge Healthcare’s CTMS for Investigators solution to organize and centralize its clinical research operations.

Aegis Sciences will implement Passport Health’s OrderSmart and PaymentSafe to automate transactions between its CBO and U.S. locations.

10-8-2013 7-33-50 PM

Washington Health System (PA) selects eClinicalWorks EHR for its 87 physicians and 21 residents in its family practice residency program.

In Brazil, Hospital Israelita Albert Einstein chooses Cerner Millennium.


10-8-2013 3-40-00 PM

St. Francis Medical Center (CA) names Judi Binderman, MD, MBA, MHSA (Encore Health Resources) as CMIO. 

10-8-2013 3-51-08 PM

Former ONC Principal Deputy Director David Muntz will join GetWellNetwork as CIO. We ran this as a reader rumor last week.

10-8-2013 3-57-23 PM

Encore Health Resources promotes Steve Eckert to partner of client services.

10-8-2013 5-40-50 PM

Alameda Health System (CA) names Dave Gravender (Kaweah Healthcare District) as CIO.

Clinovations hires Brian Morton (Halley Consulting) as VP of physician networks, Kim Tombragel (maxIT-Vitalize) as SVP of business development, and Robin Walters (Halley Consulting) as business development manager.

Announcements and Implementations 

10-11-2013 7-14-30 PM

A KLAS report finds that PatientKeeper is the most user-friendly standalone CPOE system on the market, with its 8.3 score on a nine-point scale beating Epic inpatient by almost a full point. All PatientKeeper customers interviewed by KLAS said they would buy it again, with an overall company performance score of 86.4 and reported physician user training time of as little as 10 minutes.

Nuance announces its Clinic 360 suite, an outsourced transcription service and application for physician practices and ambulatory clinics that manages dictation, review, editing, and sign-off for specialties such as oncology.

ADP AdvancedMD introduces its business intelligence solution AdvancedInsight during MGMA. The company also ADP releases its iPhone app.

Harris Healthcare achieves critical milestones while deploying its Service Oriented Architecture Suite across the US Department of Veterans Affairs and the DoD.

Vitera is previewing Intergy V9.00 at MGMA this week.

Capario introduces CaparioOne, its redesigned web portal application for revenue cycle management.

10-8-2013 4-49-11 PM

Next Wave Health launches Next Wave Connect, a problem-solving social network for healthcare organizations. Drex DeFord will serve as CEO and Mike Davis as EVP of research and analytics.

VHA Mid-Atlantic will offer its hospitals mobile patient satisfaction and experience tools from Marbella Technologies.

10-8-2013 5-32-04 PM

Peer60 offers HospitalTCO.com, which allows hospitals to determine total cost of ownership for IT systems over 10 years. It’s free.

Athenahealth announces its readiness for Meaningful Use Stage 2.

Mediware says it will expand the CPR+ platform it acquired in July 2013 to create a management tool covering home medical equipment, home infusion, specialty pharmacy, and home health.


10-8-2013 7-38-52 PM

Officials of Dane County (WI) Regional Airport are planning a $30 million parking deck expansion to handle the increasing number of Epic Systems travelers.

10-8-2013 6-11-43 PM

HIMSS releases a photo of its Innovation Center inside the just-opened Global Center for Health Innovation in Cleveland.

The local newspaper covers the $125 million Epic project of WellStar (GA).

10-8-2013 7-39-44 PM

UNC Health Care (NC) says it expects to post an operating loss for the fiscal year due to reduced volumes caused by its Epic go-live. 

Sponsor Updates

  • T-System launches two solutions to assist EDs overcome negative aspects of EHRs, including a paper-based note-taking tool (Doc Notes) and an ED physician documentation application (EV for physicians).
  • InstaMed says use of its Member Payments solution, launched earlier this year, will exceed $100 million in patient payments.
  • CareTech Solutions signs its first long-term care facility to its Clinical Service Desk support service.
  • PeriGen will offer an October 9 Webinar, “Uterine Tachysystole: How much is really too much?
  • The HCI Group is honored as the fastest growing private company in Florida by the Florida Business Journal.
  • Billian’s HealthDATA will host an October 16 webinar offering three perspectives on patient and provider engagement.
  • Predixion Software CEO Simon Arkell briefs the Boulder Business Intelligence Brain Trust on V3.1 of Predixion Enterprise Insight and its Machine Learning Semantic Model.
  • Genesis Health System (IA) discusses the performance efficiencies they’ve experienced since the integration of Vocera’s wireless communication system with their Cerner EHR.
  • Intermountain Healthcare and Craneware will present “Structuring Multidisciplinary Teams for Revenue Cycle Improvement” during the 2013 HFMA MAP Event October 28 in Ft. Lauderdale, FL.
  • Elsevier and Jefferson Medical College (PA) are co-sponsoring the “Art + Medicine: How Art Can Make Better Doctors” conference November 2-3 in Philadelphia.
  • Health Care Software participates in the AHCA/NCAL 64th Annual Conference and Expo in Phoenix this week.
  • Intelligent InSites will present “The Why’s and How’s of Reforming Healthcare Operations” on October 9.
  • NextGen Inpatient Clinicals V2.6 receives 2014 ONC HIT certification as a complete EHR.
  • Aspen Advisors Jody Cervenak is moderating a panel on the optimization of physician documentation during the CHIME13 Fall CIO Forum in Scottsdale this week.
  • ZirMed signs over 900 clients processing over 2.2 billion transactions while launching three additional products in the first nine months of 2013.
  • Greenway supports the national eHealth Exchange by joining Healtheway.
  • Dan Charney, managing partner of Direct Recruiters, Inc. / Direct Consulting Associates, is named a “Forty under 40” honoree by Crain’s Cleveland Business.
  • Orchestrate Healthcare is hosting an October 17 business intelligence Webinar.


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

More news: HIStalk Practice, HIStalk Connect.


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October 8, 2013 News 5 Comments

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