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Monday Morning Update 2/11/13

February 9, 2013 News 15 Comments

2-8-2013 9-24-20 PM 2-8-2013 9-25-14 PM

2-8-2013 9-22-56 PM

From Potsie: “Re: McKesson reorg. The customer announcement is attached. They’ve said they won’t force Horizon customers to convert to Paragon, but now with Pesce over both Paragon and Horizon, the writing is on the wall. I’ve also heard they’re encouraging Horizon employees to take jobs at Relay, which would seem to be scaling back by attrition rather than by layoff.” The customer e-mail from McKesson Technology Solutions EVP/Group President Pat Blake says RelayHealth will expand to over 1,000 employees, but more germane to Potsie’s comment, Paragon, Horizon Clinicals, Revenue Cycle, and Managed Services will be combined in a new organization called Enterprise Information Services, with Jim Pesce from the Paragon business (above left) serving as president. Rod O’Reilly (above right) will become SVP of strategy for MTS.  

From Ellingham: “Re: HIStalkapalooza. How can readers have missed the announcements? Presbyopia?” Beats me, but Inga and I get e-mails every day from people who swear they’ve study HIStalk intently each day without seeing the large HIStalkapalooza announcements I’ve run three times now. Maybe they’re not really HIStalk readers and just want an invitation, but I think they’re conditioned by the rags and other sites that trumpet non-newsworthy stories with a come-on headline and 10 paragraphs of padded prose that I would have summarized in one sentence without missing anything important. Skim HIStalk and you’ll miss stuff for sure. It takes me a lot of time to write in a way that wastes a lot less of yours. That’s why I guarantee that if you’ll give me 5-10 minutes of attentive reading each day, you’ll know more than almost everybody in the industry. 

An HIStalkapalooza menu update for readers who asked: Chef Brad confirms that he will have vegetarian and gluten-free items available.

2-9-2013 7-55-47 AM

The HIMSS conference will enjoy a net attendee gain this year compared to last if you believe that my poll is statistically reliable. Doing the math suggests an attendance of 33,450 based on last year’s count, but of course New Orleans can’t match Las Vegas as a draw. New poll to your right, from CHIME’s comments about ONC’s patient safety plan: should the federal government issue a national patient identifier?

2-9-2013 3-56-52 PM

Nuggets from the athenahealth earnings call Friday:

  • Jonathan Bush says the company reduced physician documentation per encounter to less than five minutes.
  • He acknowledges that athenahealth has low physician visibility and the Epocrates acquisition will be a way of promoting the company’s other businesses given its 90 percent awareness.
  • He said “athenaCoordinator had a rough year,” referring to the care coordination platform developed from the July 2011 Proxsys acquisition. He did not specifically reference the announced March 6 layoff of 36 employees from that group, but said the Proxsys system had to be rewritten from scratch, which hurt sales, and getting pre-certifications from payers is hard because each has different rules.
  • The company has integrated six products into athenaNet through its “More Disruption Please” program and plans to add another 25 in 2013, but is collecting no fees from those vendors.
  • They will launch athenaResearch next month to use the company’s database to provide insight back to clients.
  • While the company has developed turnkey rip-and-replace programs, they don’t push them because the data in the EMRs of clients isn’t reusable, or as Jonathan Bush said, “We’re going to get better at delivering it and develop the confidence to make promises that we’re good at delivering it more convincingly where we’re just going to have to get better at explaining to people why their Flock of Seagulls EMR is going to go to the same place that their Flock of Seagulls vinyl albums went.”
  • The company says they may dabble in the inpatient EMR business after reviewing a vendor’s implementation manuals and concluding, “That’s it? That’s what all the fuss is about?” and raised the possibility that athenahealth could replace the EpicCare ambulatory part of an Epic implementation and interface to Epic’s inpatient systems.

2-9-2013 2-09-27 PM

Medical facilities are necessarily extensive at Kumbh Mela, a Hindu pilgrimage held every 12 years in India that is drawing 30 million people as the largest human gathering in history. The military-like clinics were set up in two months and will be gone by the end of March. Medical records are basic and scrawled on paper. A team from Harvard School of Public Health created an iPad-based system for documenting the chief complaints and medications of the thousands of emergency patients seen each day. It also transfers data to a server to help detect public health outbreaks such as diarrhea. As stated by Logan Plaster, managing editor of Emergency Physicians Monthly:

So far the Harvard team has gathered more than 15,000 patient records, an impressive number by any research standards, and arguably the largest public health dataset ever gathered on a transient population. Their findings have been stable and predictable; most complaints are of cough and cold, and most prescriptions are for anti-inflammatory drugs, like ibuprofen. That’s good news to everyone’s ears as millions of new pilgrims enter Allahabad in preparation for February 10, the holiest bathing day on the calendar.

In China, a doctor’s social network warnings about a particular medication used in children causes shares of the drug’s manufacturer to drop 10 percent in a week, losing $160 million in value. It turned out that the doctor was wrong, having incorrectly recalled government literature. He has only 2,000 followers, but his message was reposted by a Chinese celebrity to his 26 million followers. The doctor apologized and clarified several times, but his original message continued to spread. Public relations analysis determined that a company’s response to publicly disseminated incorrect information must be issued within eight hours to be effective and must be distributed online rather than via traditional media.

The State of California fires SAP Public Services from its state employee payroll and medical benefits computer project after the new system was found to be making errors at 100 times the rate of the 1970s-era system it was supposed to replace. The project is years behind schedule and costs have piled up at triple the original estimate, with $371 million spent so far. SAP Public Services has been paid more than $50 million after the state fired BearingPoint three years ago.

An employee of Xerox/Affiliated Computer Services and an accomplice are indicted in Kentucky for using patient information collected in managing CVS’s Medicare Part D prescription plan to file fraudulent tax returns.

2-9-2013 4-17-39 PM

In England, the CEO of Royal Berkshire Hospital reports to the hospital’s board that implementation of its $47 million Cerner Millennium system need an extra $6 million to cover staff time required to navigate through patient scheduling screens that take up to 15 minutes per appointment. He warns that Millennium-related expenses will cause the hospital to move from a financial surplus to a loss for the year. According to the executive, Millennium crashes regularly, including this past Tuesday when it was down all day and the hospital had to revert to paper. The hospital’s 2013 implementation costs are projected at $10 million vs. its budget of $4 million due to unplanned manual data correction and extra staff time. The CEO said in a prepared statement to the Council of Governors, “The level of issues the trust faces having implemented Cerner Millennium is a significant drain on management capacity, despite robust risk mitigation plans. This has a significant impact on the trust’s financial performance and cash position, being the key driver between a surplus and forecasted deficit.”

Tennessee health department officials trying to manage a September meningitis outbreak were forced to develop an electronic workaround to their usual manual hospital data collection process due to the urgency of the situation. The agency had to convince hospitals to give it electronic access to their systems given restrictive federal privacy laws. Vanderbilt University Medical Center was identified as “becoming a substantial hindrance to our investigation” because its permission lagged that of all other area hospitals. The health department is considering proposing legislation to give it easier access in an emergency.

2-9-2013 3-07-00 PM

ORNGE, the air ambulance service of Ontario, is under fire for paying its physician CEO $4.6 million over two years. Taxpayers also paid questionable expenses that included European travel with $2,400 per night hotel rooms, a $1,200 dinner, limousines, minibar champagne, in-room movies, and trips with his girlfriend, who he had promoted to VP of the organization.

The CEO of the public healthcare system in Maricopa County, AZ defends her $125,000 salary increase, saying her $500,000 salary is “always the lowest of any hospital CEO in the entire state, even the little-bitty hospitals.” The board chair voted against the increase, saying the CEO has done a great job, but, “A $125,000 raise in a year when we give our janitors maybe a 1 percent raise or lay off people? It just doesn’t make sense.”

Beth Israel Deaconess Medical Center (MA) pays its former chief of anesthesia $7 million and will name its pain clinic after her to settle her charges of gender discrimination. Carol Warfield, MD says the former surgery chief, along with former hospital CEO Paul Levy, forced her out when she complained about being ignored in meetings. The Boston Globe says the hospital probably wanted to avoid reopening anything related to Levy since the woman’s attorneys had already claimed that the inappropriate relationship Levy had with a hospital employee was evidence that he ignored workplace rules.

A Truthout article says EMR adoption poses new challenges to lesbian, gay, bisexual, and transgender (LGBT) populations who will have to decide whether to share their status without knowing how that information will be handled digitally. One advocate says she doesn’t want to have to bring up her status in every medical encounter, saying, “I’m out to everyone, but I don’t want to have to come out to doctors over and over again.” Ares of EMR concern: (a) questions ask status like “gay” or “bisexual” instead of specifically identifying a patient’s relationships, since “sexual orientation is not useful medical information”; (b) EMRs should be able to identify same-sex partnerships instead of just checking “married”; (c) a label of “transgender” is not sufficient without more details; and (d) equal protection is not guaranteed in all states and an EMR-related outing can create problems. In an interesting twist on the tired HIE argument of “unconscious patient in the ED while on vacation” example, LGBTs say that their shared information could be a disaster in LGBT-hostile areas or facilities. An IOM study was mentioned whose conclusion was that the best course of action is to allow LGBTs to self-identify and opt out of answering related questions.

2-9-2013 2-15-19 PM

A hospital in Australia will discipline five employees, one of them a nurse, for posting in information to Facebook that it says violated patient confidentiality. The nurse posted the nursing home photo above, which she labeled as, “Randomly stripping for the oldies at work.” She also posted a patient’s pelvic x-ray showing an embedded object with the caption, “Take a guess what this is kids!”

2-9-2013 4-48-44 PM

Weird News Andy summarizes this story thusly: “I’ve heard of butt-dialing, but not answering.” A Sri Lankan prisoner who is startled by guards demanding to search his cell shoves a cell phone and two hands-free accessories into his rectum. The guards are surprised to hear a cell phone ring during the search, followed by the prisoner’s complaints of back pain. They take him to the prison hospital, where he tells doctors that his pain was caused by guards beating him. When the doctors reviewed x-rays and announced plans for surgery, he produced the contraband voluntarily.


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

More news: HIStalk Practice, HIStalk Connect.

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February 9, 2013 News 15 Comments

HIStalk Interviews Reed Liggin, CEO, RazorInsights

February 8, 2013 Interviews 2 Comments

Reed Liggin is president and CEO of RazorInsights of Kennesaw, GA. 

2-8-2013 6-53-15 PM

Tell me about yourself and the company.

RazorInsights was formed in December of 2010. We are an enterprise hospital information system company.

We named our company from the principle of Occam’s Razor, which says the best explanation is usually the simplest one. Our tag line is “Simplified Healthcare Technology.” Our goal was to build an electronic health record initially that was easy to use, simple to learn, and something that you would purchase from the company that would be easy to do business with and simple to do business with.

We offer the solution on cloud technology. It’s software as a service. It’s a single integrated database on a multi-tenant cloud. We call our solution One simply because it’s on a single database.

As for my background, I’m a pharmacist by trade and have been in health IT since around 1997. I formed the company with two colleagues that I worked with in the past, Edward Nall and Michael McKenzie.


I don’t even remember the last time somebody wrote a new full-hospital system from scratch. Why haven’t they done that, and why is RazorInsights doing that now?

[laughs] Well, I think we’re just crazy enough to give it a try. It’s really a big challenge and a daunting task.

Our initial roadmap was the EHR Meaningful use criteria that were released in 2010 along with the pharmacy system. We felt that medication management was the core of a good clinical system. We started there, and we’ve evolved into a full enterprise HIS as a response to market conditions and the opportunity that’s been presented to us.


Do you think your product is competitive with systems like Meditech and CPSI that have been around for decades?

We do. I think I would be disingenuous to say that we have every single bell and whistle and the breadth of functionality that companies have been the space for a really long time do. But I think we do a really good job of focusing on the really critical 30 or 40 percent of things that hospitals need the most and make sure we do those really well.

Then we are on a long-term mission to, every day, expand our functionality to cover all the pieces of functionality that hospitals need out of an enterprise hospital information system. But I will say that I think we are very competitive across the board as far as feature functionality goes. The depth of our functionality in quite a few areas like CPOE and pharmacy is very strong, but obviously we still are a work in progress.


Is it difficult to convince a customer that it’s in their best interest to have a limited but deep set of features?

We have to find the right customer that shares our vision. As we started the company two years ago, we have taken a deliberate pace to not try to sell every single deal we could possibly sell. We had to be sure that our product was ready to go to the market on a large scale. 

We try to be fairly selective in choosing the right hospitals who share our vision and understand that there’s an evolution here and the end result will occur in a very short amount of time. The end result will also be that they’ll have a solution that can be achieved from going with a different company.


I assume that your primary customers are going to be smaller hospitals. Is that a limiting factor because that’s as big as an enterprise you can serve or just because they’re easiest to sell to at this point?

It’s a little of both. Certainly you want to start where there’s an opportunity. We saw an opportunity in the smaller hospitals — under 100 beds — because those hospitals typically had older technology for the most part. As we started to serve those hospitals, we have had opportunities to sell to larger hospitals, but most of the time they’re not ready to go into a situation where they’re going to have to do without certain functionality for a period of time.

You start with the opportunity that’s the biggest where you can serve the needs. We expect to evolve to be able to serve larger hospitals, but one of the things we wanted to do as a company was not try to do too much too fast. We want to be careful, because the worst thing you can do is try to outsell your capabilities, whether that’s to too many hospitals too fast or whether that’s to larger hospitals that you can’t accommodate. We want to be sure we got this right as we go along.


A lot of folks would say that part of Epic’s success is because they qualified their customers as much as their customers qualified them. Is it difficult as a small company to not pursue sales that you probably could make?

I don’t know if we’ve been as selective as Epic. We had an opportunity that was presented to us with the stimulus to get in the game, so to speak. We didn’t really get that selective, but we targeted hospitals that we knew would be a good fit for what we’re trying to do and found hospitals that had management teams or executives who shared the vision we were creating. 

The challenge for us has been, if you grow at a more deliberate pace, obviously there’s market pressures based on the window of opportunity you see that there’s always pressure to move faster, to get bigger faster, to move to bigger hospitals faster, to sign more hospitals faster. We always have that pressure to move faster because the window of opportunity won’t be there forever. We want to be sure that we capitalize on the opportunity that’s before us, but at the same time not put ourselves in a position where we can’t deliver.


My sense is the market wants competition instead of just Epic, Cerner, or Meditech and some of your competitors in the smaller hospital market. Do you feel the pressure to be something that you’d rather not be in serving those larger hospitals that don’t have a lot of choices?

I think there’s a tremendous amount of pressure from larger hospitals and medium-sized hospitals that are looking for another choice. They want us to get there faster than is probably possible. We just try to get up and get better every day. That’s our motto — every day we just try to improve upon what we’re doing and grow as fast as we can. 

That being said, we built our ONC-certified Complete Inpatient EHR from the day we started coding it to the day we were certified in about 100 days. We built a full, enterprise HIS within two years. We have some breadth of functionality still to cover in that product, but for the most part, we can service a small hospital very well. We’ve done it faster than most other companies have done it. I think that works in our favor.


What’s the secret? Nobody else has been able to figure out how to do that.

What we know needs to be done, a lot of people know. I’m a little surprised sometimes not more people have tried it. I think probably because it’s a capital-intensive effort that’s held a lot of people back.

We were just a group of people who had worked in the trenches at various health IT companies, at hospitals as healthcare workers, and really had a clear vision of exactly what we wanted the product to do and what we wanted it to be. We wanted it to be something that was easy to use, easy to learn, a modern look and feel.

We use a rich Internet application called Adobe Flex for our graphic user interface. We were looking for that new modern user experience in a system that would be easy to adapt.

On the services side, we also wanted to focus on being transparent with our customers, keeping our pricing simple. We have a bundled pricing model that’s all inclusive. You don’t get a contract with two pages of line items of different third-party software that’s included in the product. We try to be very straightforward. 

Also, we actually do the build for our clients. When we go into a hospital to do an implementation, we’re gathering information from the hospital, and then we do the build process and then bring the product back and train the client on it. 

It’s a different approach, and I think there’s other companies that have done different elements of that. I don’t know if there’s a lot of secrets there. There are a few. One is the way we develop. We have a pretty unique development process which takes a lot of industry subject matter expertise combined with some very fast coding talent to develop the product almost around the clock. We’re able to produce new code pretty quickly.


Are those technical resources employees or are they  contracted?

Some of both.


It seems like it would have taken a lot of cash for some guys who used to work for vendors to put together.

[laughs] We bootstrapped it pretty much to date. We are in the final stages of completing a private equity deal. We’ll be announcing that within the next couple of weeks. That will give us the capital to take the company to a whole other level and put our foot on the accelerator when it comes to building out this enterprise vision.


What can you share in terms of company size?

We’re still pretty small. We have 55 team members. That’s the team that services, develops the product, and everything. We have clients mostly in the Southeast, but we’ve expanded to some states west of the Mississippi and in the Midwest also.


What’s your pitch when you get in front of these small hospitals and maybe they’ve never heard of you? How do you sell them on the idea of doing business with you?

First and foremost, we’re all about being a single database, integrated product. Today we bring a single database integrated financial and clinical system to the market. By spring, we’ll be releasing our ambulatory product, which will include an electronic health record and practice management system for physician practices on that same single database.

The other thing that we’ve done, as we started to develop the system, we looked at hospital systems and how they evolved. They evolved departmentally, where there were pharmacy systems and lab systems and nursing systems and CPOE systems, etc. What we looked at was, how can we really make this a more efficient, improved approach? 

We decided to knock the walls down between the departments in the hospital. We’ve created what we call a non-modular solution. Each user has access to the system based on the privileges they have according to their role, but every user has the same access into the system and a similar look and feel and view.

We call that view of the patient record our holistic patient record. If I’m a pharmacist, in a lot of systems, I can only see what’s going on with the patient’s medications and maybe some lab results. I can’t necessarily see the surgical procedures or radiology tests they’ve had unless I go to a different module in the system. In our system, in the holistic patient record, I’m able to see all of that information and have a complete picture of what’s going on with the patient right there in one view no matter what role I have, as long as I’m supposed to have access to that information.


Are your revenue components fully developed even though your emphasis seems to be on clinicals?

We started out as an inpatient electronic health record vendor. We began building out the entire clinical suite. As we got into the market, hospitals were rapidly adopting EHRs for the stimulus opportunity.

About a year into it, hospitals started to pretty much demand that they would select a new vendor based upon them having an entire HIS. The market really changed a lot more quickly than we expected. We did expect a system replacement market to occur, where old technology would be replaced by newer cloud technology in the next few years, but the shift happened a lot more quickly than we expected. 

We either had to acquire or partner within a revenue cycle system or we had to build it. We opted to build it. There’s still work to do and we’ve got most of the pieces built. We can operate a hospital. There’s a few things we still will build out, but in a couple of instances we used partners to help supplement what we don’t have at this point.


Since you and your colleagues  worked for a variety of vendors, what mistakes do you think you’ll be able to avoid having that experience?

I think staying true to the vision as a single integrated database is important. While you may not necessarily want to build every piece of software that a hospital would ever use, you need to have a clear vision as to what’s a core component of that single integrated database solution and stay true to that.

Additionally, I think reliability is a big factor – becoming a company that is known for reliable installs, reliable support, somebody that is a partner the hospital can count on. Obviously our friends at the big ship in Wisconsin have done a great job of that.


You mentioned your VC investment that’s upcoming. A lot of companies stumble at that point because the VC wants to take it in a different direction, at a faster speed, or with different people running the show. Do you see that vision holding true with the influence of the outside money you’re going to take in?

Yes, we do. It’s an interesting process and the first time I‘ve been through this process to seek capital for a company. I spent about a year looking for the right partner. I went from Silicon Valley to New York and everywhere in between meeting with venture capital and private equity firms. Usually within the first 10 minutes, you could tell in the conversation if they understood what you were trying to do and understood your vision.

We were just absolutely committed to the fact that we were going to find a partner who understood what we were trying to do and understood our vision. We turned a few offers down and finally found what we think is the ideal partner. They share the vision, they understand exactly what we’re trying to do, they have a really in-depth knowledge of the space. We think we’ve pretty much found our dream partner.


How do you see the next five years playing out for the company and for the industry?

Wow, that’s a big question. The next five years for the company, we’ll continue to grow our market share in the small hospital space. I think we’ll evaluate whether we want to move upstream to bigger hospitals and how quickly. At some point, we’ll start to execute on moving into that space, where we think there’s potentially a lot of opportunity in addition to the small hospitals.

Additionally, we may look at some international opportunities. We’ve been investigating a few recently. If they make sense and are not outside of our core focus, we may pursue some of those. I think we’re in the beginning of a real shift for a lot of HIS system replacements to take place over the next few years. We just want to make sure that we capitalize on being a part of that opportunity.

For the industry in general, I think you’ll see obviously a lot of smaller hospitals moving to cloud or hosted solutions as that becomes a more practical way for them to manage a system without a lot of IT resources on staff.

You’ll see IDNs continue to consolidate smaller hospitals into their organizations. We’ll continue to see the trend of physician practices becoming part of hospitals and IDNs and becoming employees. It will be interesting to see what happens in our space with some of the larger ambulatory EHR vendors as hospitals acquire those physician practices. They may start to encroach on their market share by pushing hospital systems out to those physicians, so I think there’s an interesting dynamic that will come along with the consolidation. And then, finally, I think it’s still to be determined what impact ACOs will have in our industry, but there will be some impact. It’s going to be interesting to see how that plays with what’s going on in HIT.

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February 8, 2013 Interviews 2 Comments

Morning Headlines 2/6/13

February 6, 2013 News 2 Comments

Cerner Reports Fourth Quarter 2012 Results

Cerner beats estimates with earnings per share of $0.67 vs. $0.55 a year ago, with revenues up 15 percent.

DOD, VA to Speed Integration of Health Records

The Integrated Electronic Health Record, originally scheduled for a 2018 rollout, is on track for go-live by the end of 2014.

Can computers predict medical problems? VA thinks maybe.

The VA solicits bids for a pilot program that will analyze information in its VistA electronic medical record using natural language processing and machine learning to uncover patterns that can be used to improve outcomes and efficiency.

Health care venture in Leawood plans to generate 200 jobs

Startup eLuminate Health, which offers a consumer site for pricing elective surgeries and choosing providers, says its planned Kansas headquarters will create 200 jobs over the next five

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February 6, 2013 News 2 Comments

News 2/6/13

February 5, 2013 News 7 Comments

Top News

2-5-2013 6-26-04 PM

Cerner announces Q4 results: revenue up 15 percent, EPS $0.67 vs. $0.55, beating estimates of $0.64. Shares rose five percent in after-hours trading Tuesday. The company’s market cap is $14.3 billion. From the earnings call:

  • Q4 bookings were just over $1 billion, a record
  • System sales were $252 million of the $710 million in revenue
  • Thirty percent of the bookings came from non-Millennium clients
  • The company says it had nearly double the number of new HIMSS EMRAM Stage 6/7 users as its closest competitor, presumably Epic
  • It claims that Epic is pushing back on Meaningful Use Stages 2 and beyond because it will be challenged to meet them
  • EVP Jeff Townsend said the industry needs to step up to the challenges of interoperability, including use of a patient identifier
  • The company says it thinks even Epic clients that have paid a lot of money can be convinced to change systems if their reimbursement is threatened due to quality problems
  • The company signed four deals worth $40 million or more, with the showcase being LA County
  • Neal Patterson said the market is really a choice between two companies, presumably Cerner and Epic
  • The company says 85 percent of its customer base has completed Stage 1 attestation

Reader Comments

2-5-2013 6-14-35 PM

From Mike Tomlin: “Re: Rich Goldberg. He is leaving McKesson/MED3OOO to run marketing for GE reseller Virtual OfficeWare.” Unconfirmed, but the source is good and his departure would not be surprising given McKesson’s recent acquisition of MED3OOO.

From Bean Enumerator: “Re: Brigham and Women’s CIO position. Not filled yet.” A reader reported on January 30 that Joe Schmitt was taking the job, but that was not verified. The opening remains posted.

2-5-2013 7-46-15 PM

From MedWreck: “Re: Innovation Institute. Color me skeptical.” St. Joseph Health (CA) launches for-profit The Innovation Institute that will include includes an incubator, shared services, and an investment portfolio. The primary motivator seems to be to commercialize the intellectual property of large academic medical centers. The only hospital member named is St. Joseph Health, which provided almost all the institute’s executives, including former St. Joseph Health SVP/CIO Larry Stofko, who will run the Innovation Lab. Larry let me know about the Institute’s formation last summer, at which time I mentioned it and his new job there.

2-5-2013 7-18-05 PM

From Incredulator: “Re: HIMSS e-mail blast. A customer forwarded this e-mail they received from a company pitching their HIMSS booth. Check out the last line.” It’s easy to doctor a forwarded e-mail, so I’ll assume that’s the case since surely the company whose identifiers I’ve blurred wouldn’t be stupid enough to end an otherwise button-down e-mail blast with a puzzling grand finale. Although if they did, I’ll be interested to see if they own up to it as either a horrific faux pas or an overly bold attention-getter.

HIStalk Announcements and Requests

We did a good interview with Vocera Chairman and CEO Bob Zollars on HIStalk Connect.

2-5-2013 10-02-06 PM

Welcome to new HIStalk Platinum Sponsor Cornerstone Advisors Group. The five-year-old Georgetown, CT-based professional services firm, in its own words, “provides high-value consulting, advisory, implementation, and staffing services to the healthcare delivery middle and lower market segments at a fair and reasonable price” around its core principles of partnership, integrity, commitment, and value (remember “value” because it’s coming up again). The company took the #1 spot in “Planning and Assessment” and #2 in “Vendor Selection” in the 2012 Best in KLAS awards, with its customers scoring it with a sweet 98.4 and 96.1, respectively, also giving Cornerstone stellar marks for value with a 9.0 in the all-important “Money’s Worth” score in both categories. Cornerstone’s leaders and associates are former Big Six consultants, CIOs, and physicians, and I notice that President and Founder Keith Ryan has a distinguished industry history on the front lines as VP/CIO of Stamford Health (CT) and Elmhurst Memorial Healthcare (IL) as well as having held executive positions with top consulting firms, not to mention that I notice he is an HIStalk Fan Club member, which carries a lot of weight (with me, anyway). I’ve seen the company’s revenue and FTE numbers by year and it’s a steep curve up, earning it a spot on the Inc. 5000 with 431 percent three-year growth. Some of its clients include HCA, William Backus, Chilton Memorial, and Finger Lakes. If you need help with advisory, implementation, or staffing services, consider giving Cornerstone Advisors Group a chance to earn your business. I appreciate their support.

Acquisitions, Funding, Business, and Stock

Oak Investment Partners invests $40 million in xG Health Solutions, an independently operated venture that will market intellectual property and expertise developed by Geisinger Health System, including healthcare IT optimization, consulting services, population health data analytics, and care management. We announced the news on January 11 when phony-named reader Jerry Aldini forwarded a copy of the internal announcement.

2-5-2013 6-25-23 PM

CTG acquires etrinity, a provider of IT services to the healthcare market in Belgium and the Netherlands.

2-5-2013 6-29-43 PM

Michael Dell will regain control of the fading company he founded as Dell announces plans to be taken private in a $24 billion leveraged buyout that also includes taking a loan from Microsoft. The company plans to move its focus from low-margin and low-demand PCs to enterprise services, which worked for IBM years ago as it moved away from hardware. That same strategy hasn’t done much for HP, which is now discussing breaking the company up in hopes of finding shareholder value hidden somewhere in its diverse offerings. The Dell change could be good for its healthcare consulting folks, most of whom were brought on board with its 2009 Perot acquisition that included the former JJ Wild.

Startup eLuminate Health announces plans to open its headquarters in Leawood, KS and create 200 jobs over the next five years. The company offers a network for imaging and surgical providers to provide transparent pricing, clinical quality, and customer satisfaction ratings for consumers (sounds pretty much like an Angie’s List for elective surgery). CEO Tami Hutchison came from Cerner, which you probably guessed given the company’s location and line of business.

Speech technology vendor Vestec raises $1.5 million in capital from V. Raman Kumar, founder and former CEO of MModal. The company offers a speech recognition engine and a Natural Language Understanding system, with a text-to-speech engine planned. The products seem to be small-vocabulary systems for specific voice commands for use in devices such as TVs, GPSs, and PBX-type setups, although Kumar says he’ll help the company move into healthcare.


CHRISTUS Continuing Care (TX) selects HEALTHCAREfirst’s homecare, hospice, and CPO solutions.

MDH Radiology chooses Sectra’s Breast Imaging PACS, Merge Healthcare’s CADstream, and other tools to create a national telemammography solution.

2-5-2013 3-17-22 PM

MD Anderson (TX) chooses Oracle Health Sciences applications  and Oracle technology for an organization-wide analytics initiative to develop personalized cancer treatments.

CMS awards Emdeon a contract to define the process for testing new HIPAA and ACA transaction standards.

Kentucky Medical Services Foundation and UK Healthcare sign a five-year agreement for Opportunity AnyWare, the business analytics platform from Streamline Health Solutions.

2-5-2013 3-19-19 PM

Kalispell Regional Medical Center (MT) selects EDCO Health Information Solutions for its day-forward scanning technology and services.

Middletown Community Health Center (NY) chooses EHR, PM, and EDR (dental) solutions from SuccessEHS for nine service locations and two mobile health units, announcing plans to go live within 90 days. 

2-5-2013 10-25-25 PM

Parkview Health (IN) selects ProVation Medical from Wolters Kluwer Health for gastroenterology procedure documentation and coding.


2-5-2013 7-04-20 PM

Kasey Fahey joins Direct Recruiters as project coordinator in its healthcare IT practice.

Announcements and Implementations

Covisint launches Covisint Healthcare, an integrated solution for analytics across multiple systems and stakeholders that includes enhanced data capture and reporting, real-time admission and discharge notifications, and patient outreach and scheduling.

2-5-2013 6-41-23 PM

Reading Hospital (PA) goes live on its $150 million Epic implementation.

Four hospitals of Bassett Healthcare Network (NY) go live with Epic.

LHP Hospital Group (TX) implements McKesson Paragon at five hospitals.

Cox Medical Center Branson (MO) completes activation of T-System’s PerformNext Care Continuity solution to facilitate patient transitions and improve communication and access to clinical data.

2-5-2013 6-50-48 PM

ZirMed launches Clinical Link, a nationwide provider-to-provider information exchange platform.

2-5-2013 6-53-53 PM

Awarepoint Corporation launches Bed and Bay Sensor for precise tracking of mobile equipment and patient and caregiver interactions in locations with tight bed spacing such as the ED and PACU.

Government and Politics

2-5-2013 6-46-11 PM

The VA solicits bids for a pilot program to test how advanced clinical reasoning and prediction systems can use its VistA patient data to improve care, efficiency, and outcomes.

Brian Ahier reports that a new federal law will be published this Friday that will require drug, device, and medical supply managers to publicly disclose gifts given to physicians or teaching hospitals. The Physician Payment Sunshine Act, part of the Affordable Care Act, charges HHS with collecting information about consulting fees, gifts, honoraria, food, entertainment, and travel from companies that are covered by any federal health program.

Innovation and Research

2-5-2013 2-53-03 PM

The Washington Post looks at the burgeoning field of geomedicine, which uses geographic information system technology to correlate environmental conditions with health risks. One example is an inhaler device from Asthmapolis that is equipped with Bluetooth to track when and where patients use their inhalers.

2-5-2013 7-28-35 PM

A Germany-based company develops an intelligent armchair that contains health-monitoring technology that constantly measures the health of its occupant, also displaying the user’s historical health measurements via a tablet PC to the TV using Bluetooth. A virtual health assistant uses the information to develop and monitor a personalizes health plan, for which the chair transforms into a rowing machine. The company plans to add mental games to encourage participation and increase alertness.

2-5-2013 8-39-58 PM

Fast Company covers the just-concluded MIT Health and Wellness Hackathon, which focuses on commercially viable products. Some of the entrants: an app that encourages HIV/AIDS patients to take their meds, a sensor-based home monitor for congestive heart failure, an endometriosis surgery app for patients, home Parkinson’s monitoring tools built into gloves and a coffee cup, a blood pressure pill bottle reminder, and a diet tracker for epileptics.


I don’t see the point of “pass a test, earn some paper” certifications like the ones offered by HIMSS and some for-profit companies, but this one really puzzles me. HIMSS introduces CAHIMS, designed for “emerging professionals” with less than five years’ experience in healthcare IT. I would be doing all I could to try to hide my newbie status on my resume rather than proudly waving around a paid-for certificate that boasts of my relative inexperience.

2-5-2013 8-26-50 PM

Baltimore-based startup Parallax Enterprises, founded by a physician who is also a military pilot and an Air Force major, raises $1 million to develop a heads-up display of surgical checklists. I’m intrigued that Jeff Woolford, MD has booked 1,000 hours in the single-seat, low-level combat A-10 Thunderbolt II tank killer, which is ugly, slow, low-tech, cheap, and scary as heck for the pilot but the most reassuring sight imaginable for ground troops, at least those on the same side. I’ve seen live exhibition flights of just about every modern-era US warplane and the A-10 was the most memorable. Hats off to Dr. Woolford for his service as a Wart Hog driver over Afghanistan.

Former HealthStream executive Luther Cale offers 33 Ways to Reboot Your Life, free on Amazon through midnight Wednesday. Judging from the “Look Inside” feature, you won’t get much out of it if you don’t believe in non-traditional medical techniques like spiritual psychotherapy and healing tonics.

Unverified rumors claim that Cerner and McKesson will open up interoperability between their systems to try to compete with the Epic juggernaut, with a potential announcement planned for the HIMSS conference. I’m skeptical that two large, publicly traded competing companies would agree to such cooperation, so if you have details, please share.

2-5-2013 9-12-13 PM

Seattle-based Carena launches its CareSimple program, offering Webcam-based virtual visits with one of its 15 physicians and nurse practitioners for limited conditions for a cost of $85 or for $5 with a family membership of $35 per month.

Texas Medicaid tries to revise its “pay and chase” policies after a TV station’s investigation finds that taxpayers were charged for $705 million over three years for orthodontics. The state is holding the payments of 91 dentists suspected of fraud.

Sponsor Updates

  • MedAssets pledges support to employees who serve in the National Guard and Army Reserve.
  • Chris Tackaberry, co-founder and CEO of Clinithink, shares details of how Clinithink came about and the challenges along the way in an interview. 
  • SimplifyMD reports that 100 percent of its customers choosing to file for MU attestation have completed the process.
  • The Advisory Board Company hosts senior policy makers on Capitol Hill to discuss efforts to improve care under new Medicare value payment programs.
  • Cerner will integrate Gateway EDI’s claims and remit systems with its PM solutions.


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

More news: HIStalk Practice, HIStalk Connect.

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February 5, 2013 News 7 Comments

Monday Morning Update 2/4/13

February 3, 2013 News 10 Comments

2-3-2013 8-45-21 AM

From HIStalk Fan: “Re: HITPC/HITSC testimony of Karen Van Wagner, executive director of North Texas Specialty Physicians. The Pioneer ACO shares results of its community HIE.” She talks about successful efforts to increase EMR usage (eCW, Allscripts, NextGen) and the results of the exchange (Sandlot Solutions), which was launched in 2006. She says traditional healthcare IT isn’t providing cost and quality improvements because it focuses on retrospective data, often from claims databases, and the optimal solution involves both retrospective and current clinical information. They did a discharge transitions project study that exceeded targets for PCP follow-up, having discharge summaries available for the follow-up PCP visit, and readmissions. Her specific recommendations to the government: (a) simplify consent and disclosure rules; (b) expedite adoption of IHE standards; (c) require laboratory diagnoses to delivered by LOINC standards; (d) require hospital EMRs to send a “just admitted” notice to community providers via their own EMRs; and (e) require pharmacy systems to communicate with HIEs and provide their information at no charge.

Hospitalist DZA MD left an insightful comment on my Time Capsule article about doctors getting lost in the barrage of generally useless information cluttering up EMRs. Excerpting:

Anything that is templated has exactly zero clinical information value to me. I don’t care if Osler himself dropped in “dyspnea improved,” “no diarrhea” … If I want to know the validity of that kind of thing, I will look at the narrative part of the nursing note … The only data I look at that actually represents signal is the vital signs and lab data. The rest of the discrete data is noise … The narrative and visual graphics (including graphic displays of lab and vital signs data) are for us (clinicians). The templated stuff is for the suits and insurance grifters. QED.

2-3-2013 9-27-06 AM

From The PACS Designer: “Re: Microsoft Office 365. Microsoft is making a dramatic switch by selling its enhanced Office products in the cloud. They are calling it Office + Office 365, and will be offering a monthly subscription service with pricing based on business size and features selected by the customer. It’s a big gamble on users satisfaction with cloud services which as we know can experience interruptions in service at inappropriate times of the business cycle.” The good thing about Office is that the once-touted Office killers, especially Google Apps, are vastly inferior flops. The bad thing is that home Office users aren’t likely to lock themselves into a $100 ongoing subscription for something they formerly bought or stole once, although it’s a pretty good deal if you have a bunch of PCs since the home license covers up to five (less likely now that everybody’s using iPads and phones instead of extra PCs). And, you can temporarily load and run it to a non-licensed PC. I think it can work – antivirus software moved subscription software for home users to the mainstream, not to mention that Microsoft can just jack up the price of the box version to move people toward the cloud-based offering,  which would also kill the bootleg business (possibly their primary motivation). It won’t help that Office 365 had an outage almost immediately after its launch, allowing the boxed software users to work merrily along while the leasers couldn’t even get to Outlook.

From Godzilla: “Re: [hospital name removed]. Filing suit against [vendor name removed]. Unhappy with the products, implementation, and project management.” A hospital media spokesperson replied on the record to my inquiry, “Nothing could be further from the truth. Inaccurate on all counts.”

From Unbeatable: “Re: [vendor name removed]. Laid off 31 developers and outsourced all work to India and the Ukraine. The Chicago office lost the largest number of staff.” I’ll see what I can find out.

From IndustryBnkr: “Re: OptumHealth. Rick Jelinek is leaving as CEO to pursue another opportunity outside the company, with Larry Renfro taking over.” Unverified, but his former “About Us” page has been deleted. He took the CEO job a year ago.

2-3-2013 9-52-42 AM

From HITEsq: “Re: MMR. Made good on its threats to sue someone for patent infringement in January, going after Walgreens. MMR’s theory is that displaying a list of your prescriptions infringes on its patents. I seem to remember having access on Walgreens before 2005 when the MMR patent was filed.” Patent trolls love the US system because (a) the Patent Office is overwhelmed, they don’t have the knowledge required to understand highly technical patent requests, and will approve just about anything and let the courts sort it out later; and (b) lawyers are so expensive that mounting a legal defense can bankrupt a defendant even when they are clearly right since our legal system requires the winner to pay their own legal costs. Unfortunately lawyers often morph into politicians and are predictably loathe to bite the hands (as inserted into the pockets of others) that once fed them and may again, so we are required to be collectively complacent about the status quo.

Speaking of despicable patent trolls, let us hear from our new hero, Lee Cheng, Newegg chief legal officer and extortionist squasher. 

2-3-2013 12-07-09 PM

In related patent troll news, billionaire bad boy Mark Cuban endows “The Mark Cuban Chair to Eliminate Stupid Patents” at the Electronic Frontier Foundation, which he funded because, “Dumbass patents are crushing small businesses. I have had multiple small companies I am an investor in have to fight or pay trolls for patents that were patently ridiculous.” Mentioned in the article is Acacia Research, which I’ve railed about here many times, which claims to own the process of sending medical images over the Internet.

2-3-2013 8-54-45 AM

Yale-New Haven Hospital (CT) went live with Epic on January 31. Above: Sue Fitzsimons, RN, PhD (SVP, patient services); James Staten (EVP, finance); Marna Borgstrom (CEO); Daniel Barchi (CIO, health system and medical school); Lisa Stump (VP, Epic project); Peter Herbert, MD (chief medical officer); and Richard D’Aquila (president and COO).

2-3-2013 8-59-17 AM

The stock-pickers among us like Cerner and athenahealth just about equally. New poll to your right: did you go to the HIMSS conference last year, and are you going this year?

Speaking of those stocks I listed, I decided to see how they’ve done in the past year: athenahealth (up 40 percent), Allscripts (down 45 percent), Quality Systems (down 57 percent), Cerner (up 34 percent), and Merge (down 49 percent).

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

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2-3-2013 10-18-18 AM

Psychology scientists from Brigham and Women’s Hospital perform an interesting study in their research into “inattentional blindness.” Radiologists were asked to examine the CT scans of five patients and click on whichever of the 10 known nodules they could find. The final case included a gorilla image that was 50 times the size of the nodule, which 20 of the 24 radiologists did not notice even though eye-tracking instruments showed they had looked right at it. I don’t see this as necessarily bad – a lot of the work in medicine is tuning out the noise to focus on what you’re looking for. However, it does reinforce the idea that in general it’s good to get a second opinion from someone less focused on the problem at hand, and if you’re a patient or lesser expert, you still might detect the forest that the tree-obsessed people have missed. It may also touch on confirmational bias, where people tend to place higher value on information that matches what they already believe (like brains not containing gorillas).

A New York Times op-ed piece observes a “casual lack of transparency” in that drug and device companies make sure that only positive studies are published, with the trigger being Johnson & Johnson’s recalled artificial hip that was marketed despite known problems that the public wasn’t told about. It observes two attempted fixes that have failed: (a) the FDA requires new clinical trials to have summaries posted on a federal site, but an audit found that 80 percent of the trials ignored the requirement and no fines have been levied; and (b) the medical journal industry promised to publish only pre-registered studies, but an audit found that more than half of published articles involved trials that weren’t registered correctly and one-fourth covered studies that weren’t registered at all.

2-3-2013 12-10-37 PM

Good luck explaining healthcare pricing to the public. A graduate student’s gallbladder removal was billed at $60,000 by an out-of-network provider. His insurance paid what it defined as a reasonable rate: $2,000. The average commercial price is $12,292, while Medicare would have paid $958. An advocacy group stepped in and the surgeon accepted $340. The article says the Affordable Care Act does nothing to limit out-of-network fees, which are almost always a surprise to patients since buildings and white coats don’t come with “I’m in your network” labels. I’ve known people burned by in-network EDs that used out-of-network doctors or lab companies, and of course nobody volunteered that information, not that you really have a choice in the ED anyway. The comments left on the New York Times article are fascinating and often insightful. The graphic above is from a new AHIP report.

A foundation employee of Fairbanks Memorial Hospital (AK) is charged with diverting $12,000 in donations that had been collected online via PayPal.

GE Healthcare is working with the VA to develop surgical robots that can locate, sterilize, and deliver instruments.  

2-3-2013 12-03-36 PM

Meditech files its annual report. For the year, revenue was up 9.7 percent, EPS $3.55 vs. $3.41. Neil Pappalardo owns nearly 39 percent of the company, holding shares worth around $650 million. CEO Howard Messing’s shares are valued at around $18 million. Share values are probably low given that the company is not publicly traded – I just used the most recent per-share acquisition price, but if the company were to be sold or IPO’d, the value would probably be a lot higher.

Nuggets from the McKesson earnings conference call late last week:

  • Technology Solutions revenue was flat
  • Margins of the Technology Solutions numbers was hurt by a required revenue recognition change for the System C UK business McKesson acquired in 2012
  • RelayHealth and the payor software business contributed more than half of the profits of Technology Solutions
  • More legacy customers than expected have either already moved to Paragon or have committed to do so instead of moving to competitor systems
  • The Paragon ED solution is close to being generally available
  • Both Horizon and Paragon will support Meaningful Use Stages 2 and 3


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

More news: HIStalk Practice, HIStalk Connect.

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February 3, 2013 News 10 Comments

News 2/1/13

January 31, 2013 News 9 Comments

Top News

1-31-2013 5-38-58 PM

McKesson announces Q3 results: revenue up one percent, non-GAAP EPS $1.41 vs. $1.40, missing earnings expectations of $1.63 and guiding earnings slightly down for FY2013. Operating costs rose 10 percent, while technology solutions revenues were flat.

Reader Comments

1-31-2013 7-52-02 PM

From AphexTwin: “Re: Allscripts. Laid off five percent of its workforce (350 people) in testing and development roles. All remote development staff are being forced to relocate or be terminated.” An Allscripts spokesperson provided this response:

We internally announced the creation of R&D Centers of Excellence to enable us to better serve our clients, reduce complexity, and save costs. By making this move, we’re aligning with industry best practice and will be more agile in delivering results for our clients. Many team members will have the opportunity to relocate and some to work remotely. Unfortunately, there will be some team members whose positions will be adversely impacted, and they will be offered a severance package. In addition, we anticipate there will be Development jobs created in the North American locations with the majority of those in our Raleigh and Boston locations.

1-31-2013 7-59-22 PM

From The PACS Designer: “Re: iPad with Retina display. Apple keeps making the iPad more brilliant and powerful with the announcement of the iPad with Retina display. This new version also has 128GB of storage and a selling price of $799. The communications options now include both Wi-Fi and iPad with Wi-Fi+ Cellular as added features.”

HIStalk Announcements and Requests

1-31-2013 1-31-00 PM

Highlights from HIStalk Practice this week include: Epic, Allscripts, and eClinicalWorks accounted for 42 percent of all EP MU attestations through October, 2012. iPractice Group confirms that it has ceased operations. AMGA says it now represents 430 group practices and 130,000 FTE physicians. The HIStalk Practice Advisory Panel shares details of their practices’ social media policies and privacy and security measures. As always, thanks for reading.

On the Jobs Board: Director of Marketing, Epic Experienced Providers, Product Marketing Manager.

January, which isn’t quite over yet as I write this, will set an HIStalk record for the most monthly visits ever at 140,000, up 25 percent over January 2012.

1-31-2013 5-58-58 PM

Welcome to new HIStalk Platinum Sponsor VitalWare, a market leader in healthcare intelligence and regulatory compliance. The Yakima, WA company’s offerings include VitalView (ICD-10 planning and status between hospitals and vendors), VitalSigns (supports real-time retrospective coding to ICD-10 for starting efforts now to estimate impact on reimbursement and cash flow), VitalCoder (next-generation coding and revenue cycle resource), the just-announced CDM Navigator (charge master maintenance), and ICD-10 consulting and implementation. The company also offers VitalVendors, a vendor ICD-10 readiness rating system that’s part of the HIMSS ICD-10 Playbook. A guest post by Founder and CEO Kerry Martin provides a sobering update on the stage of vendor readiness for the October 1, 2014 ICD-10 compliance date. Thanks to VitalWare for supporting HIStalk, which thanks to its support will be fully ICD-10 ready.

Acquisitions, Funding, Business, and Stock

CommVault announces Q3 numbers: revenue up 24 percent, non-GAAP EPS $0.39 vs. 0.27.

Aetna announces Q4 numbers: revenue up 16 percent, EPS $0.56 vs. $1.02.

1-31-2013 7-53-01 PM

CPSI announces Q4 results: revenue up 14 percent, EPS $0.83 vs. $0.59, falling short of consensus estimates of $0.88. Shares are down nearly nine percent in after-hours trading.


1-31-2013 5-09-37 PM

Wenatchee Valley Medical Center (WA) and Central Washington Hospital select NextGate’s EMPI and provider registry systems.

Huron Valley Physicians Association (MI) chooses eClinicalWorks EHR for its 600 providers.


1-31-2013 5-11-06 PM

AHRQ Director Carolyn Clancy, MD announces plans to step down.

1-31-2013 5-20-26 PM

API Healthcare expands General Counsel Hayden Creque’s role to include vice president of human resources.

Announcements and Implementations

The VA completes integration and testing between VistA and Authentidate’s Electronic House Call and Interactive Voice Response telehealth systems.

1-31-2013 5-12-14 PM

The 24-bed Melissa Memorial Hospital (CO) completes implementation of its EMR.

1-31-2013 5-14-12 PM

Piedmont Newnan Hospital (GA) goes live this week on Epic.

Welch Allyn will distribute the EarlySense proactive patient care solutions to US hospitals.

1-31-2013 3-28-53 PM

Good Samaritan Hospital (NY) goes live on Epic March 9.

1-31-2013 3-30-19 PM

The University of California at Irvine uses the dbMotion interoperability platform to connect with  the Orange County Partnership RHIO.

Quantum Health integrates the Healthwise Care Management Solution into its Patient Information Virtual Integration Tool to provide real-time healthcare education to its members.

Stellaris Health Network (NY) goes live on PatientKeeper Charge Capture at five of its clinical practices group.


Government and Politics

The VA enhances Blue Button to give patients access to their Continuity of Care Document and the VA’s OpenNotes provider documentation.

Innovation and Research

1-31-2013 7-31-36 PM

A University of Washington graduate student develops FoneAstra, an Android phone app that monitors the pasteurization of donated breast milk. It’s being tested in South Africa. Other versions are used to ensure that vaccines remain refrigerated in developing countries.


1-31-2013 7-54-51 PM

Lt. Dan summarizes what the BlackBerry10 announcement means for mHealth and healthcare on HIStalk Connect.

University of Missouri-Kansas City’s Innovation Center will launch the partially federally funded Digital Sandbox KC IT accelerator on Friday, with officials from Cerner and other businesses on hand.


Fifty-seven percent of Canada’s primary care physicians are using EMRs, which is almost double 2006’s adoption rate. Almost half routinely e-prescribe compared to 11 percent six years ago.

KLAS and EHI, a UK-based HIT research firm, partner to improve transparency and performance measures for the UK health technology market and to cross-market their research products.

Michael Dell’s family foundation donates $50 million to build Dell Medical School in Austin, TX.

The Minnesota Supreme Court rules that calling a doctor “a real tool” on a doctor rating site is protected speech.

1-31-2013 6-54-01 PM

Here’s an example of how technologically backward healthcare is. A body shop in Canada has been receiving faxed medical information for three years because its fax number is one digit different from that of the local health center. Says the body show owner, “In this day and age, why are they still using fax machines? It seems odd to me.”

I’m fascinated that this happens regularly in India. Twelve angry relatives of a teen who died after a bicycle accident trash the ICU and beat doctors and security guards. Medical residents then go on strike to demand better security and the arrest of the family members, which requires patients to be diverted and surgeries to be cancelled when only 20 doctors remain to care for 300 inpatients.

WNA thinks a hospital parody video makes him wonder whether ACO stands for Abridged Care Organization. Fox Business News says the video “mocks how health reform can make more money for doctors and hospitals” by showing staff blocking the admissions department door, handing out stacks of cash, and giving free laptops to employees. I didn’t see it that way – it looked like fun way to get the ACO idea across to otherwise learning-indifferent employees. The hospital says the video was a contest winner. Fox claims the video was “leaked,” which apparently means “posted to YouTube under the hospital’s name and still there but copied to Fox’s servers and covered with self-promoting graphics to make it look like the result of crack investigative reporting.”

Sponsor Updates

  • ESD joins ANIA as a Gold Level member.
  • dbMotion hosts a February 7 seminar in Dallas on connecting communities through clinical integration.
  • Laura DeBusk from White Plume Technologies will co-present an ICD-10 session at the Becker’s Hospital Review Fourth Annual Meeting in Chicago in May.
  • 2012 highlights for Aspen Advisors include the addition of 26 clients and the development and deployment of a population HIT planning methodology, a data governance maturity model, and an EHR value realization maturity model.
  • DynaMed showcases how Memorial Hermann Healthcare System (TX) utilizes technology to allow physicians to practice evidence-based medicine in a journal article.
  • Emdat Mobile usage has quadrupled from January 2012 with the rapid adoption of smartphones.
  • Lucca Consulting Group posts new client, consultant, and trainer testimonials on it website.
  • Macadamian CEO Frederic Boulanger says he is impressed with the new BlackBerry 10 and the company has developed 10 apps for it.
  • Truven Health Analytics announces that staff members Eboney White and Jillian Thomas have been presented with the unique credential of Accredited Health Care Fraud Investigator.
  • CareTech Solutions added five Service Desk clients in 2012 and experienced a 75 percent uptick in the use of its help desk services overall.

EPtalk by Dr. Jayne

Earlier this month, Virginia Senator Stephen J. Martin introduced SB 1275, “Medical data in an electronic or digital format; limitations on use, storage, sharing, & processing.” As a medical informaticist, all I can ask is what was he thinking? It would prohibit anyone who stores medical data in an electronic or digital format from participating in the Nationwide Health Information Network; performing analysis or statistical processing on medical records for purposes of diagnosis or treatment, including population health management; processing medical data within Virginia where a majority of the patients do not live in Virginia; and storing data on more than 10,000 patients in a single database, It also prevents providers who refuse to implement EHRs from being penalized and prohibits Virginia from authorizing or operating a health information exchange. I’d be interested to hear from anyone in Virginia who can tell us more about what’s really behind this besides anti-ARRA posturing. It’s been sent to committee where it will likely die, but still makes for good cocktail party conversation (at least among HIT folks).

It’s about time: Medicare will look at the facility fees charged by ambulatory medical practices. Many feel that these hospital-owned practices are driving up the cost of health are with this billing practice. Many of the groups in my area are now doing this. It’s not only annoying, but also feels dishonest.

Lots of buzz this week about the HIPAA update and the impending September compliance date. Looking forward to reading hundreds of pages of fun during my free time, whenever that is.

Although I thankfully don’t have any direct reports, before our recent hiring freeze I was often asked to interview potential employees for other managers. I’m going to keep this list of bizarre interview questions tucked away for when administration figures out we’re dangerously short-handed on some of our teams.


Bad news for Inga: an increasing number of young women are having issues with their feet that require surgery. Some blame is being placed on genetics, but the phenomenon is at least partially attributed to high heels and pointy-toed shoes. She’s always telling me I’m too conservative in the shoe department, so maybe for HIStalkapalooza I’ll be more inspired this year.



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

More news: HIStalk Practice, HIStalk Connect.

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January 31, 2013 News 9 Comments

News 1/30/13

January 29, 2013 News 10 Comments

Top News

1-29-2013 6-31-49 PM

Medecision, which just announced plans to lay off 83 employees, acquires Cerecons, a provider of care coordination, population management, and quality outcomes and reporting applications for ACOs.

Reader Comments

1-29-2013 7-10-48 PM

From Greenway Rep: “Re: iPractice Group. During the last few days, we did learn that iPractice Group, one of Greenway’s resellers, ceased operations effective last Friday, January 25. This reseller represents a very small percentage of our provider base. We look forward to continue working with these sites, which will have the option to either transition to another Greenway partner or choose to work directly with us for implementation and/or support services.” Greenway confirmed that iPractice Group has ceased operations, as reported by reader Nasty Parts this past weekend. The company claimed to have almost 1,000 provider clients, so the impact to Greenway remains to be seen. The CEO of the three-year-old iPractice blamed its closure on poor Q4 sales. The company moved into a new headquarters building in October 2012 that was more than triple the size of its former location, increased headcount by 800 percent to 70 employees since 2011, and acquired a competitor in 2011. Greg Bolan, who runs the healthcare equity research arm of brokerage firm Stern Agee, credited HIStalk with the initial rumor in an investor flash note, also expressing concern about the impact on Greenway’s sales. Greenway was among the ten biggest percentage decliners on the NYSE Tuesday, with shares dropping 7.7 percent.

From Tom: “Re: [inpatient vendor name omitted]. Is laying off 75 percent of its staff. All IT staff gone, most implementation and some development staff gone.” Unverified, so I’ve left the vendor’s name off for now. Usually someone leaves a comment saying, “Yep, that’s my company and it’s true,” so we’ll see.

1-29-2013 9-52-49 PM

From Mrs. Te’o: “Re:  Joe Schmitt, previous CIO of Steward Health Care. Will be named new CIO of Brigham and Women’s.” Unverified, but the forwarded second-hand e-mail insists that’s the case.

1-29-2013 8-11-15 PM

From CIO Tracker: “Re: Barry Blumenfeld, MD, MS. Leaving as SVP/CIO of MaineHealth less than 60 days after bringing Epic live at the main hospital. The planned rollout to seven member hospitals is being pushed back while the main hospital consumes all resources. The CIO is a casualty of exceptionally wide scope without commensurate resources.” CIO Tracker provided a genuine-looking memo purporting to be Barry’s notice to staff that he’s leaving as of January 30, but I’ve heard that he actually left early. They’re looking for an interim CIO, rumors say.

From The Amish Avenger: “Re: GE/IDX. I want to pare back its use for scheduling and registration and use the EMR instead. I keep hearing that GE/IDX isn’t selling well and has had job cutbacks. What can I expect to see? Fewer code updates? Less support?” I’ll step aside and let readers chime in.

1-29-2013 7-29-58 PM

From Danbury Whaler: “Re: Norwalk Hospital. Getting swallowed up by Western Connecticut Health System. Rumored layoffs of 200+.” Norwalk signed the affiliation agreement last week. Layoffs weren’t mentioned, but are certainly likely.

HIStalk Announcements and Requests

1-29-2013 7-02-37 PM

The window for expressing interest in attending HIStalkapalooza is closing. Sign up now if you’re interested in a March 4 evening of food, drink, HISsies, bowling, and Zydeco music.

1-29-2013 7-53-01 PM

Welcome to new HIStalk Platinum Sponsor Dearborn Advisors, LLC. The Chicago-area professional services firm, founded in 2001, is a trusted advisor to clients who need help with clinical systems strategy, adoption, and deployment. Its services fall into three groups: strategy and value, clinical, and engagement and project management. All of those help clients maximize the return on investment of their clinical systems. The company’s consultants are experts in Allscripts, Cerner, Epic, GE, McKesson, Meditech, and NextGen, while the company maintains a close working relationship with Epic and Meditech. I’m impressed by the quality of their blog posts, such as this one on medication management. You surely know some of their executive team members if you’ve been around the industry for a while: Rick Mager, Jay Toole, Sally Akers, Bruce Bowers, John Brill, and quite a few more highly experienced people, with a significant number of them clinicians. Thanks to Dearborn Advisors for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

1-29-2013 6-32-50 PM

Intuitive Health, which offers a platform that connects providers with at-home patients and their personal health devices, raises $3.8 million.

Informatica’s Q4 results: revenues up three percent; non-GAAP EPS of $0.41, down from $0.47 last year. The consensus EPS estimate was $0.37.

Roper Industries announces Q4 results: revenue up 10 percent, EPS $1.44 vs. $1.23, beating expectations on earnings while falling short on revenue. Chairman, President, and CEO Brian Jellison said the integration of Sunquest, which the company acquired this past summer, is on track, with Sunquest being a strong performer with high single-digit growth. The company’s CFO did note in explaining a tax rate adjustment, “Sunquest as a US-based company generates most of their earnings in the United States, which is the highest tax rate in the world.”

1-29-2013 10-06-41 PM

Lexmark announces Q4 results: revenue down nine percent, EPS $0.10 vs. $0.94. Its Perceptive Software unit was the bright spot, reporting revenue that increased by 40 percent over 2011.

1-29-2013 9-40-18 PM

Startup Ringadoc, which offers after-hours triaging of physician calls for $50 per month with no contract, raises $1.2 million in seed funding. I believe that’s a reflector thingy in its logo.

Philips announces that it will exit the consumer audio and video business to focus on home appliances and healthcare.

1-29-2013 10-08-03 PM

Margo Hendrickson, athenahealth VP of human resources, responded to our query about the company’s announced plans to lay off 36 employees of its Birmingham, AL office on March 6. That office is the site of the former care coordination platform vendor Proxsys that athenahealth acquired in July 2011:

“As a high growth company, we are always looking to apply efficiencies to the way we work. While it is incredibly difficult to let people go from what otherwise is a growing employee base, our intent and commitment to shareholders is to align investment with business growth opportunities. This focused set of employee restructuring will allow us to achieve several critical business scaling and financial objectives that otherwise we would struggle to meet. At athenahealth, we are committed to ongoing team growth; in the past year alone the Company has grown its US employee base 28 percent, adding a total of 473 new employees to its US total of 2,140.”


1-29-2013 2-55-23 PM

Sidra Medical and Research Center in Qatar selects Amcom’s emergency notification and call center solution and Omnicell’s G4 automated medication management system.

1-29-2013 6-34-33 PM

Scripps Health (CA) will implement Wolters Kluwer Health’s ProVation Order Sets software as its electronic order set solution.

Pioneer Medical Group (CA) signs an agreement with McKesson’s MED3OOO division to jointly own and operate an advanced management services joint venture.

1-29-2013 3-03-12 PM

Holyoke Medical Center (MA) expands its relationship with eClinicalWorks to include the eCW Care Coordination Medical Record for advancing ACO and PCMH objectives.

1-29-2013 3-04-18 PM

University of Virginia Health System will deploy MModal Fluency Direct and MModal Catalyst for Quality to speech enable its EHR systems.


1-29-2013 3-06-17 PM

HealthTech Holdings hires Tom Mitchell (MModal) as VP of marketing for its HMS, MEDHOST, and PatientLogic companies.

1-29-2013 3-15-34 PM  1-29-2013 10-26-32 AM

HIMSS recognizes James L. Holly, MD (UT Health Science Center) with its 2012 Physician IT Leadership Award and Robin S. Raiford (The Advisory Board Company) with its 2012 Nursing Informatics Leadership Award.

1-29-2013 6-39-08 PM

MedAssets appoints Keith L. Thurgood (US Army Reserve) president of its Spend and Clinical Resource management segment.

1-29-2013 3-22-52 PM  1-29-2013 3-24-36 PM

Streamline Health adds  Richard D. Nelli (OptumInsight) as SVP/CTO and Herb Larsen (Edifecs) as SVP of client services. Streamline also announces the resignation of SVP/COO Gary Winzenread.

1-29-2013 3-26-59 PM    1-29-2013 3-31-53 PM

HL7 appoints Joyce Sensmeier (HIMSS) and Walter Suarez, MD (Kaiser Permanente) to its advisory council.

1-29-2013 8-35-45 PM

Randy Gaboriault, VP/CIO of Christiana Care Health System (DE), is named by Computerworld as a 2013 Premier 100 IT Leader.

Former Barnabas Health (NJ) SVP/CIO Joseph Sullivan is named “client in residence” by management print services vendor Auxilio.

Announcements and Implementations

1-29-2013 3-33-16 PM

CPSI announces the formation of TruBridge, LLC, a wholly-owned subsidiary that will provide business services, consulting services, and managed IT services to rural and community healthcare organizations.

Intelligence InSites announces integration of its real-time intelligence platform with ScheduleAnywhere, an online employee scheduling software from Atlas Business Solutions.

1-29-2013 10-00-13 PM

Gottlieb Memorial Hospital (IL), part of Loyola University Health System, goes live with Epic.

TriZetto announces that BCBS of Tennessee is using its benefits solution to offer value-based insurance benefits to members.

Government and Politics

ONC publishes research to help providers putting HIEs in place, including findings on query-based exchange, HIE-driven notifications and subscription services, provider directory solutions, master data management, and consumer engagement and consumer-mediated exchange.

The operator of the leading cord blood bank settles FTC charges that it lacked policies and procedures to protect patient information in a 2010 breach involving unencrypted computer equipment stolen from an employee’s car containing the information of 298,000 patients. The company avoided a financial penalties by agreeing to improve IT security and to conduct a security audit every other year.


1-29-2013 10-09-18 PM

State auditors cite University of Iowa Hospitals and Clinics for not encrypting laptops. The hospital responded by saying it encrypts “where technically possible,” but the state official refused to back down, saying, “If it’s not technically possible, then they need to tweak the system a bit so that it is technically possible.”


1-29-2013 7-41-27 PM

This patent troll story doesn’t involve healthcare, but it provides a good lesson. A fake company set up by a lawyer who bought some old patents and created a business based entirely on suing big companies for infringing on its claimed patent on online shopping carts finally gets its butt kicked, courtesy of online retailer Newegg. The company had shaken down big online retailers, demanding a percentage of annual revenues. Victoria’s Secret and Avon had already been ordered to pay $18 million and one percent of their annual online revenue, while Amazon had paid the patent troll an amazing $40 million. Newegg, which has vowed that it will never settle with a patent troll, successfully had the company’s patents invalidated on appeal. You have to admire Lee Cheng, Newegg’s chief legal officer (above):

”We basically took a look at this situation and said, ‘This is bullshit.’ We saw that if we paid off this patent holder, we’d have to pay off every patent holder this same amount. This is the first case we took all the way to trial. And now, nobody has to pay Soverain jack squat for these patents … Just think about the dynamic if you’re a juror … Everyone wants to go home. It’s not their money. Defense oriented jurors are more likely to compromise and say, ‘Maybe we’ll just split the baby. Maybe we’ll just give them $2.5 million and call it a day.’ … We’re competing with other economies that are not burdened with this type of litigation. China doesn’t have this, South Korea doesn’t have this, Europe doesn’t have this. Just in our experience, we’ve been hit by companies that claim to own the drop-down menu, or a search box, or Web navigation. In fact, I think there’s at least four that claim to ‘own’ some part of a search box … Then they pop up and say, ‘Hello, surprise! Give us your money or we will shut you down!’ Screw them. Seriously, screw them. You can quote me on that.”

1-29-2013 10-02-19 PM

Guam Memorial Hospital says a software bug introduced by its vendor NTT Data caused it to underbill drugs by $1.9 million since May 2012. It found the problem as part of a financial improvement initiative and says NTT Data has confirmed and fixed the bug.

Zoll Medical says it’s the first defibrillator vendor to promise that it will share patient data from its devices, providing tools that allow other vendors to share the information it collects for patient care, such as in emergency medicine.

A small town in Australia loses its Internet connectivity for the third or fourth time in a month, with some of the previous outages having lasted days. Merchants can’t charge credit cards, but the medical clinic brings up more pressing problems: “We receive all our pathology results, specialist letters and discharge summaries through the Internet. If a patient comes to us needing treatment after they have just been discharged from hospital and we don’t know what they need or what they’ve had done, that’s a real problem.”

HIT incubator Rock Health rolls out a single online employment and internship form for applying to work at any of its 49 portfolio companies.

Weird News Andy finds this story amazing: researchers at Texas Heart Institute are building replacement human hearts from pig hearts, saying animal organs “reanimated” with human stem cells can be used in emergencies. The lead scientist also predicts being able to reverse aging at some point, storing stem cells from patients while they’re healthy as replacements for when they aren’t. She says she’s regularly called Dr. Frankenstein.

Sponsor Updates

  • Intellect Resources offers tips for job seekers hoping to get the attention of online recruiters.
  • Infor Healthcare and NTT DATA host a February 13 webinar to discuss Lawson Financials and the effective interaction between legacy and new technology systems.
  • CommVault announces details of its fifth annual WTG Customer Seminar March 13 in Boston.
  • Truven Health Analytics hosts a January 31 Webinar highlighting coverage challenges under the ACA.
  • First Databank releases the FDB State and Federal Controlled Substances Module, which facilitates the e-prescribing, dispensing, tracking, reporting, and claims processing of controlled substances.
  • Vitera Healthcare Solutions will give practices using its Vitera Stat PM/EHR product access to DiagnosisOne’s CDS content and patient education materials at the point of care.


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

More news: HIStalk Practice, HIStalk Connect.

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January 29, 2013 News 10 Comments

An HIT Moment with … Chuck Demaree, Access

January 25, 2013 Interviews No Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Chuck Demaree is CTO of Access of Sulphur Springs, TX.

1-25-2013 6-26-17 PM

What’s the continuing role of electronic forms as hospitals move to EHRs and other systems?

First, we have to establish a basic understanding about forms. A form is merely a structured tool to collect and organize data. Whether it is paper or electronic, its purpose remains the same.

Electronic forms can be placed in two categories. Online forms are primarily used for data acquisition. Managed output forms re-structure and automate the distribution of data in either a printed or electronic format. 

Hospitals need both types of forms going forward. The online, outward-facing forms collect data from sources that may not be connected to their hospital network, such as patient homes, clinics, and physician offices. Managed output forms organize data from the many disparate systems used in a hospital into a normalized format prior to routing forms into a document repository, or ECM/EDM system, as part of the EHR. This also becomes important if a Legal Health Record (LHR) ever needs to be produced for litigation purposes. 


What are some examples of workflow, productivity, and information needs that for most hospitals can be met only via the use of electronic forms?

Most health information and EHR systems — including those from Siemens, Meditech, Epic, McKesson, and Cerner – utilize some sort of workflow, but there is almost always another process or workflow that takes places even before the HIS or EHR is used. Today, that workflow is still a manual process that is either verbal or written. It is difficult to build a system that can address all the varied processes that exist. Electronic forms allow a hospital to address each process uniquely by designing a form or set of forms and custom workflow to address that process. 

Some examples are patient scheduling or pre-registration from home, feeding a registration or scheduling system. Automating acquisition of data from systems such as endoscopy, EKG, and perinatal and normalizing the structure of the data and routing and indexing the documents into the document repository. Adding electronic signatures and barcodes to existing forms and systems that do not currently provide that capability, such as discharge instructions or patient teaching documents. Business and back office functions, such as human capital management, purchasing processes, and accounting output such as checks or direct deposit notices.


If a hospital has already purchased an EHR, what would they do with your systems that would benefit patients?

Some EHRs have very nice patient portals to access the patient’s medical information, but not all patients are technically inclined or have access to the Internet. Some patients still prefer a physical document, and sometimes that is the only method for transferring data from one hospital’s EHR to another.

Our systems can provide outward-facing secure data acquisition across the Internet for patients and practitioners who are not on the hospital’s network. They can also easily control the format of data before it is printed or aggregated into an EHR. Controlling and normalizing the format of data makes it easier to read and find the information needed. This helps expedite care and reduce mistakes.


What is the role of electronic forms during system downtime and disaster recovery?

This goes back to the purpose of the form as a tool. During a downtime or business continuity episode, well-designed forms make it easier to continue to move patients through the clinical process and still capture data in a structured and familiar format. If these forms are barcoded with the form ID and the patient ID, then automatic indexing of this data into the document repository becomes much more efficient and less prone to error or misfiling.


Do hospitals intentionally use electronic forms as an alternative to entering data manually into a cumbersome online system?

I think there are a limited number of choices for hospitals to fine tune a system to make it easier for their staff and patients. We have many customers that use our output management products to automatically capture disparate medical device and clinical system data and redistribute it into an EHR or document repository. We have others who have chosen to not purchase employee or patient self-service systems and instead use our online forms solutions to create their own user-friendly front end for data acquisition.

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January 25, 2013 Interviews No Comments

News 1/25/13

January 24, 2013 News 9 Comments

Top News

1-24-2013 9-15-30 PM

Quality Systems (NextGen) reports Q3 results: revenue up two percent, EPS $0.26 vs. $0.36, missing analyst estimates on both. The company reported a 29 percent drop in system sales revenue as operating expenses rose six percent. The earnings call transcript is here. The results were announced before Thursday’s market open, with shares closing down only 0.16 percent by the market’s close.

Reader Comments

1-24-2013 5-53-24 PM

From Kojak: “Re: Intuit Health changes. Medfusion founder Steve Malik is retiring in June and Sanjiv Waghmare is taking over as Intuit Health’s new GM.” The e-mail announcement was attached. Malik (above) was named president of the Intuit Health Group when Intuit purchased Cary, NC-based portal vendor Medfusion for $91 million in 2010. Waghmare is a VP of product marketing.

From WHIMSSical: “Re: booth demo stations. PowerPoint or video? Should vendors use PPT since nobody can hear the video?” I say video and/or a live demo backed by a credible and engaging demonstrator, but perhaps also a fast-paced and highly graphical looping PowerPoint on a big projection screen as a billboard to grab attention as attendees streak by. Readers, what would get your attention?

From Doc Tari: “Re: Allina. Did know if you heard Allina having a bit of restructure. CMIO Shrift left to Cleveland and now CIO over all the IS areas.” 

1-24-2013 6-34-08 PM 1-24-2013 7-18-27 PM

inga_small From Carrie Prejean: “Re: HIStalkapalooza. What exactly does one wear to HIStalkapalooza this year? Bowling shoes? I want to come prepared because I am determined to win the ‘Inga Loves My Shoes’ contest!” When I first heard that this year’s bash was going to be in a (very cool) bowling alley, I was also perplexed on the proper attire. We are fine-tuning things, but suffice it to say that just about anything will go. We will once again have a red carpet, so arriving in stiletto heels and sequins will be totally acceptable. Alternatively, if you own a vintage bowling shirt, this could be the time to pull it out of the back of the closet. The shoe contest will include categories for those partial to high fashion as well as those who choose to adorn more functional bowling shoes. We will also be crowning a HIStalk King and Queen based on their total fashion package. Winners will be awarded amazing prizes, so don’t show up in your “straight off the exhibit floor” attire, especially if the look includes a company logo’d tee shirt.

1-24-2013 6-43-11 PM

From RFP: “Re: MD Anderson. Posts an EHR RFP.” The RFP strongly suggests that prospective bidders attend the pre-proposal conference on Wednesday, January 30 just in case you want to thrown your electronic hat into the ring.

From Slim: “Re: Optum. I read your update confirming that Humedica was bought by Optum. Wouldn’t it have to be announced since Optum is part of UnitedHealth Group, which is publicly traded?” I’m not an expert, but I believe SEC disclosure requirements cover only “material events,” meaning companies must file an 8-K form only if a merger, loss of a key customer, or policy change could reasonably be expected to impact share price in the company’s subjective judgment. UnitedHealth Group’s market cap of $58 billion and annual revenue of $111 billion would make all but a huge acquisition non-material.

1-24-2013 7-41-12 PM

From Bill O’Plenty: “Re: SB 1275. Crazy law introduced in Virginia.” Virginia State Senate Bill 1275, introduced January 14, would prohibit any organization that stores electronic medical information from (a) participating in the Nationwide Health Information Network; (b) performing analytics on multiple patient records for diagnosis, treatment, or population health management; and (c) processing medical data within Virginia if most of the patients represented live out of state. It also mandates that providers cannot be penalized for refusing to implement EHRs, that patient consent for electronically storing their information is valid only for healthcare coverage purposes, and that the state is prohibited from starting or operating an HIE. I e-mailed the office of the bill’s sponsor, Republican Senator Stephen H. Martin, to ask what he’s trying to accomplish with the bill, but I haven’t heard back. Senator Martin is running for lieutenant governor, which could ironically pit him against Democrat Aneesh Chopra, former White House CTO and advocate for all the items that the bill would prohibit, so perhaps he’s just trying to pick a fight.

From Wearing Dad’s Suit: “Re: Epic’s non-compete. Does it cover this?” Applicants for the head football coaching job posted on the University of Wisconsin’s HR website include a Walgreens pharmacist whose only relevant experience was as a season ticket holder, a Fedex driver who said he’d take $60K to lead the Badgers, and a financial analyst with Epic whose college athletics experience consists of having been a practice player for Tulane’s basketball team. I give our young Epic friend credit for trying even though he lost the $2 million job to a more experienced candidate who responded to the online posting, Utah State Coach Gary Andersen.

HIStalk Announcements and Requests

The latest highlights from HIStalk Practice include: Epocrates says its app has helped clinicians avoid more than 27 million adverse drug events. Farzad Mostashari, MD highlights some of the ONC’s 2012 achievements. Pharmaceutical companies and other businesses embrace advertising opportunities within cloud-based EMRs. E-visits may be as effective as in-person office visits for uncomplicated ailments. Dr. Gregg describes a day in the office in the Year 2063 (quite fun.) You know the drill: catch up on all the latest ambulatory HIT news, click on a few sponsor ads to find a goodie or two that might improve your life, and sign up for the e-mail updates. Thanks for reading.

On the Jobs Board: Cerner Experienced Providers, Product Marketing Manager, Healthcare Strategy Communications Specialist, Project Specialist.

Acquisitions, Funding, Business, and Stock

1-24-2013 5-56-29 PM

Healthcare social networking site iMedicor acquires iPenMD, which offers a digital pen solution to capture clinical data. iPenMD apparently bought the intellectual property of nextEMR this past July per a reader’s rumor report.

1-24-2013 6-03-35 PM

Merck Global Health provides $6 million in growth capital to eHealth Technologies, a provider of continuity of care solutions.

1-24-2013 6-04-22 PM

Praesidian Capital invests second lien debt capital in eTransmedia Technology to replace debt and fund growth.

1-24-2013 8-34-24 PM

Revenue cycle systems vendor Recondo Technology receives a $20 million growth investment from private equity firm Bregal Sagemount.

1-24-2013 6-25-07 PM

Healthcare Growth Partners releases its 2012 HIT Market and M&A review that summarizes capital markets, M&A, and capital raising activity for the healthcare IT and services sector.


1-24-2013 4-02-46 PM

Tampa General Hospital (FL) selects Merge’s CTMS for Investigators solution for enterprise management of clinical trials.


1-24-2013 3-50-34 PM  1-24-2013 3-51-42 PM

Huron Consulting Group adds Jim Agnew (Navigant Consulting) and Jeffrey McLaren (VHA, Inc.) as managing directors in its Huron Healthcare practice.

1-24-2013 3-53-51 PM

HIMSS promotes Thomas M. Leary to VP of government relations, taking the place of Dave Roberts, who was elected to the San Diego Board of Supervisors.

1-24-2013 1-39-04 PM

Iatric Systems promotes Frank Fortner from SVP of software solutions to  president.

1-24-2013 6-09-34 PM

The Northeast Business Group on Health honors Truven Health Analytics president and CEO Mike Boswood at its 18th Annual Tribute to Leadership.

1-24-2013 3-56-46 PM

Clinical data integration provider Apixio hires Jonathan Murray (Aetna) as chief business development officer.

1-24-2013 6-12-51 PM   1-24-2013 6-14-16 PM

Intellect Resources announces triple-digit growth in 2012 and announces several promotions and hires, including the promotion of Eileen Dick to VP of technology and Cindy Orr to VP of go-live services.

1-24-2013 9-11-26 PM

Robert Rowley, MD (Practice Fusion) is named medical advisor for personal health care vendor LifeNexus.

Announcements and Implementations

CareCloud and HealthTronics partner to combine CareCloud’s PM product with HealthTronics’ UroChart EHR and meridianEMR urology-specific EHR platforms.

1-24-2013 9-22-42 PM

Fletcher Allen and Dartmouth Hitchcock Medical Center (above) announce the creation of OneCareVermont, the nation’s first statewide ACO that includes 13 hospitals and hundreds of primary care physicians. We announced their plans in September.

Three Ontario hospitals go live on PatientKeeper Physician Portal, Mobile Clinical Results, and NoteWriter, including Alexandra Marine & General Hospital and two hospitals in the Huron Perth Alliance.

The RFID in Healthcare Consortium and Intelligent Hospital.org recognize six organizations for their advanced use of healthcare technology solutions.

GE Healthcare introduces Centricity Practice Solution 11.


Winthrop Resources is conducting a survey on cloud solutions and bring-your-own-device practices. If you’d like to take about 10 minutes to help them out, the survey is here.

HIMSS finds yet another way to offer preferential treatment for its higher-ranking provider members whose purchasing influence makes its vendor members salivate. Healthcare Transformation Project offers “exclusive access” to services, meaning of course that someone has to be excluded (like the rest of us dues-paying members). For example, invitation-only HTPers get “up-front VIP seating at the HIMSS13 Keynote Address by President Bill Clinton” (I was going to insert a cigar joke, but decorum prevailed). The Transformers who are willing to spend $295 of their employer’s money to attend its annual forum at the HIMSS conference get to hear a bizarrely HIT-unrelated group of political speakers – former Florida Governor Jeb Bush, Democratic political strategist Donna Brazile, and former Nixon speechwriter Pat Buchanan. HIMSS says that “participants will make commitments that will translate goals into meaningful and measurable results in their own organization or community,” so we can all look forward to seeing how those work out for patients. Meanwhile, HIMSS offers vendors a bunch of expensive ways to get in or near those decision-making faces, with $50K buying you a podium speaking slot and free tickets for prospects who would be impressed by Pat Buchanan.

Cerner and Sporting KC take heat for failing to keep their promise to build a $35 million youth soccer complex in return for the $200 million in taxpayer-funded incentives they received to build their professional soccer stadium and Cerner office buildings. The youth fields were supposed to in use by now, but work hasn’t started.

1-24-2013 8-41-55 PM

Spain’s leading newspaper says it was duped when it ran a fake photo of Venezuelan President Hugo Chavez in his hospital bed, which the paper was told had been taken illicitly by a hospital nurse. The image, widely panned as unconvincing, turned out to be a screen shot of a YouTube surgery video from 2008 featuring an acromegaly patient being intubated.  

The local TV station covers the use by Georgetown University Hospital (DC) of the iPad-based patient data collection system from Tonic Health that replaces paper forms in the doctor’s office. The story says other Tonic users include Mayo, UCLA, the VA, and Kaiser. The company says the product integrates with EHRs via HL7 or can send a CCD record. It offers a free version with limited functionality. Founder and investment information is here.

1-24-2013 9-28-26 PM

As tweeted by @Cascadia: a Virginia medical practice charges patients for using its patient portal, billing $125 per year for Gold access to make appointments and refill requests, while the $250 per year Platinum plan adds three electronic visits. That’s the opposite of every other industry, where free online services encourage customers to do it themselves without tying up an expensive employee. This is like banks offering free teller service but charging for ATM access, or maybe McDonalds adding a drive-through surcharge.

A Texas judge orders the deposition of two partners of a CPA firm accused by a medical practice of failing to secure the accounting system it installed in the practice, which the practice says allowed an employee of the practice to embezzle $1 million over five years.

Weird News Andy says this man wears his nose on his sleeve, also wondering if he will pick his nose in public. British scientists are using a man’s own cells to grow a new nose to replace the one he lost to cancer. They have two noses underway (“just in case someone drops one,” the researcher said) and the patient will chose one of them to be implanted under the skin of his arm until it’s ready to transplant.

I had a feeling where WNA’s story was going when I saw his best-ever headline, “Nothing like having a cold one after work,” but I still nearly choked on my soda when I saw the story, in which a male hospital nurse is arrested on suspicion of having sex with the body of a deceased patient.

Sponsor Updates

  • Nuesoft Technologies CEO Massoud Alibakhsh discusses data security and Nuesoft’s technology platform in the video above.
  • Awarepoint celebrates its tenth anniversary and recaps key successes.
  • GetWellNetwork Founder and CEO Michael O’Neil delivered Thursday’s keynote address on interactive patient care technologies at the IPC Symposium at Hasbro Children’s Hospital (RI).

EPtalk by Dr. Jayne

Your tax dollars at work. On Tuesday, the US Supreme Court rejected an attempt to reopen Medicare claims that are more than two decades old. The hospitals assert that CMS miscalculated payments between 1987 and 1994 that were intended to compensate their treating large numbers of low-income patients. Based on the fact that it took my local academic medical center over a year to settle the bill for a routine eye care visit, it doesn’t surprise me that it takes years for hospitals to figure out they’re missing money.

Attention vendors: Mayo Clinic releases a new list of the top reasons for visiting US health care providers. Maybe you should use this as a starting point for your primary care office visit templates rather than some of the bizarre things I sometimes see on your screens. Granted the data is from Olmsted County, MN, but it looks surprisingly similar to my clinic roster this week except for the absence of “flu” and “freaking out that spouse has the flu.”

I received my first HIMSS-related mailing today. It was so underwhelming I can’t even remember who it was from. When I went to dig it out of my recycling bin, I couldn’t find it – which means it was nondescript as well. Great job, marketing team!

A wise man once told me to always spend a small amount of time “looking for your next gig” because things are constantly shifting in the world of medicine. For those of you who think the same way, ONC is looking for a policy advisor “who knows meaningful use policy backwards and forwards.” I was curious, so I checked out the link and got the best laugh of the day. The low end of the salary range is $123,758. Leave it to the federal government to specify it down to a bizarre dollar amount.

I had lunch with four of the smartest women in the world today. Three have been my boss in the past while the fourth who taught me everything I know about billing. Here’s a shout out for leaders who not only know their fields but “get it” as far as motivating employees to excellence. Thanks for keeping me grounded and reminding me that although I currently work in chaos, I can always count on your listening ears. And your unbiased opinions when I text you pictures of shoes I’m thinking of buying. And your assistance with crafting the “Typhoon Jayne” cocktail for HIStalkapalooza. Salud!



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

More news: HIStalk Practice, HIStalk Connect.

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January 24, 2013 News 9 Comments

Morning Headlines 1/23/13

January 22, 2013 Headlines No Comments

Missouri, Kansas and Nebraska Connect via Direct Secured Messaging

The Nebraska Health Information Initiative, Kansas Health Information Network, and Missouri Health Connection announce that they are now connected and able to exchange Direct secure messages across state lines.

Naperville’s Edward Hospital to merge with Elmhurst Memorial

Edward Hospital & Health Services of Naperville, IL and Elmhurst Memorial Healthcare announce plans to merge, forming a three-hospital health system with revenues of more than $1 billion.

Providers Get Help From Clinical Decision Support Evidence Vendors but Still Face Obstacles

KLAS evaluates clinical decision support strategies and roadblocks for providers and concludes that third-party order sets, care plans, and drug dictionaries lead the pack in CDS plans but notes that a lack of integration with EHRs is hindering the utilization of these tools.

King Saud University Signs a Strategic Agreement With Cerner for Two Major Hospitals in Saudi Arabia

King Saud University signs with Cerner to implement EHRs for two academic facilities in Saudi Arabia.

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January 22, 2013 Headlines No Comments

News 1/23/13

January 22, 2013 News 5 Comments

Top News

The Nebraska Health Information Initiative, Kansas HIN, and Missouri Health Connection connect their exchanges to share Direct secure messages across state lines.

Reader Comments

1-22-2013 10-01-20 PM

From Embers: “Re: Humedica. Being bought by Optum, I’ve heard. I wonder what will become of the Allscripts deal that frankly brought Humedica some business, but also had them running in circles (true for anyone dealing with Allscripts in the past few years)? Also, the new Optum research center in Cambridge is gathering steam and they are putting together a nice team to be a healthcare think tank. Hope you had a nice few days off – my imagination puts you on the podium with Obama and not sipping drinks by the pool.” A couple of readers told me they’ve heard that clinical data vendor Humedica has been acquired, one of them specifically saying it happened last week with no public announcement planned. Wednesday morning update: I’ve confirmed via a reader that the company has been sold to Optum. I’m happy to say that my mini-vacation consisted of the latter and not the former, as I took Mrs. HIStalk out of the country for some magnificent and rare downtime sprawling under 80-degree blue skies, swaying palms, and very small paper umbrellas that didn’t protect our white-to-red skin but did make our tropical drinks look even more fetching. I’m paying for the break today after getting home in the early morning, heading off to work just five hours later, and now sitting here with no break or bedtime in sight after 17 hours of non-stop catching up.

1-22-2013 6-57-28 PM

1-22-2013 6-55-10 PM

From EHR Watchdog: “Re: MedLink. See attached. Unfortunately customers can’t reach the company as its top two executives are being investigated by the SEC. The company’s EHR is certified and customers are no doubt trying to figure out what to do. One physician has a contractual requirement that records for his 6,000 patients will be available digitally, but he’s having to go through them one by one to either print or save to an external device as he shops for another EHR after spending thousands of dollars on MedLink.” The reader attached the SEC’s October 2012 complaint against Medlink and its two executives, Ray Vuono and Jameson Rose. It claims the company filed a Form 10-K audit report bearing the name of an auditing firm that had in fact not audited the company’s books, with that same SEC form bearing the electronic signature of one of the company’s directors who had not reviewed the form or authorized that his signature be attached. Lastly, the SEC claims an investor asked to have his check returned, but the company deposited it instead. In the SEC’s words, MedLink “purports to be a healthcare information technology company” and Vuono is “a recidivist securities law violator.” I know what that word means because Raising Arizona is one of my all-time favorite movies.

1-22-2013 7-23-52 PM

From Iconic Reader: “Re: Allscripts. The smoking doc, at least the reflector part of his attire, is apparently the model for the isolation icon in an Allscripts product!” I give them the nod for going old school, with a doc sporting a reflector thingy and a nurse wearing a starched white cap with a red cross on it.

From Pinky Toe: “Re: vendor shakeup. The vendor is Allscripts. Major reorg in the development group, which includes product management and testing, in which 200+ remote employees are being required to move to Raleigh, Chicago, or Burlington VT or face termination. This move not initiated by Paul Black, but he has sanctioned. This is a RIF, but instead of calling it a RIF, management is calling it a consolidation of resources to ‘centers of excellence.’” More convincing (but also unverified) were reader declarations that the vendor referenced in a reader’s earlier comment about employee layoffs is in fact NextGen, but I don’t have confirmation on anything since companies rarely announce or confirm personnel actions.

From Ben Dover: “Re: NextGen. Cutting personal days for employees, sent out the week of January 16 but backdated to January 1, which means employees who took personal days for the holiday will be back-charged for vacation.” Unverified, but the source is non-anonymous and has a copy of the internal communication. The backdating, which adds a bit of sting to the slap in the collective employee face, seems indicative of either an impulsive management decision or inability to get the corporate act together.

1-22-2013 10-03-32 PM

From THB: “Re: Edward Hospital & Health Services. Merging with Elmhurst Memorial Healthcare to create a $1 billion system that would be among the largest in the Chicago area. Edward is going through an Epic implementation.” Verified in a Tuesday announcement. I interviewed Edward VP/CIO Bobbie Byrne a year ago. Edward seems to be the dominant would-be partner, so I expect the Epic implementation will continue and Elmhurst will drop Meditech.  

From Idol Observer: “Re: Greenway’s announcement of meeting ONC 2014 criteria as an EHR Module. According to the announcement, they only met two criteria, a safety-enhanced system and a quality management system. The first requires the vendor to simply name their testing methodology for the features already required by the 2011 feature – no programming is required. The second is to just identify the quality management system being used, with no programming required there either. In other words, it’s just meaningless PR that will get physicians even more confused.” I get lost in all the certification minutiae, so I’ll defer to Frank Poggio.

From Rand Reader: “Re: the recent Rand report. It said EMRs remain costly without good outcomes because doctors haven’t re-engineered their workflows to accommodate electronic systems. Why would they want to do that when the change could be averse to safe care? Just an idea for your next poll.” My opinion is that many doctors will never accept EMRs because to do so would implicitly accept the idea of process standardization and repeatable processes everywhere, and doctors are trained to be confident in their individual abilities and wary of any process that doesn’t involve their own brains and hands. Patients are usually on the side of doctors since everybody likes to think they’re getting extra-special treatment and not being managed by a corporate algorithm. I don’t know that either side has proved its point convincingly.

From Just Wonderin: “Re: ONC’s HIT Safety and Surveillance Plan of December 21. The ‘public comments’ solicited by HHS are not so public after all since they are not being presented for the public to see. Is it because HHS and ONC don’t want the public to see the comments offered by the Cerner and Epic ilk?” It appears that comments can be submitted only via e-mail.

HIStalkapalooza 2013, Sponsored by Medicomp

1-22-2013 8-02-29 PM

1-22-2013 7-56-06 PM

1-22-2013 7-55-27 PM

1-22-2013 8-59-24 PM

HIStalkpalooza will be Monday, March 4, 2013 at Rock ‘n’ Bowl, New Orleans, LA. Medicomp CEO Dave Lareau, one of the coolest guys I know, wanted to bring you some real New Orleans flavor for Medicomp’s return as HIStalkapalooza sponsor. He’s ably assisted by the ultra-professional crew who engineered the 2011 event: Patrice at bzzz productions, Shannon and Cindy from Thomas Wright Partners, Anthony from Istrico Productions, and of course the Medicomp stars like Roy and James that you saw on the stage and at the Quipstar event on the HIMSS show floor.

Medicomp sponsored the 2011 event at BB King’s in Orlando (video is here, although I doubt anyone has forgotten that bash). They said then they wanted to return this year, so naturally I’m super happy to have them back and expecting them to rise to the challenge of a superb 2012 HIStalkapalooza in Las Vegas courtesy of ESD (I still play their video every now and then because it’s so cool).

Rock ‘n Bowl is equal parts bowling alley, dance hall, live music venue, and old-school Cajun-Zydeco shrine, which sounds kind of low-brow until you notice that it has earned a 4.5 average review on both Yelp and Tripadvisor. Beats the heck out of a cookie cutter hotel ballroom or a Disney-like fake Cajun place. It’s a big place even though the layout makes it hard to tell in pictures. Some details:

  • Buses will take HIStalkapaloozans from the convention center to Rock ‘n’ Bowl and back to the key hotels.
  • You’ll be offered the chance to once again execute your perfect red-carpet strut while having an Ingatini thrust into your parched palm and being surrounded by industry glitterati.
  • You will have the option to sip (or guzzle) the aforementioned Ingatinis and Typhoon Janes, not to mention just a lot of drinks in general. The ladies are providing guidance on how they want their namesake potions prepared (I’ll bet there’s a lot of alcohol involved), so details on those will come later.
  • You’ll be entertained by Brian Jack and the Zydeco Gamblers, with instructors leading you in Zydeco dance lessons if you so choose.
  • You’ll be fed you authentically and well with red beans and rice, jambalaya, crawfish etouffee, and retro bowling alley food like pizza, wings, and fried seafood. No tray-passed mini-quiches or two-per-person drink tickets here, folks.
  • Inga will be overseeing our usual shoe and attire contests, best bowling shirt judging, and some other categories I’m not privy to but that I expect will result me spending excessive money on beauty queen sashes and prizes. She can chime in later on the particulars.
  • The inestimable Jonathan Bush will once again preside over the not-to-be-missed HISsies awards at 7:30, the role he created at the first HIStalkapalooza in 2008 and has held since. I have it on good authority that the people you chose for all of the important and serious awards (Industry Figure of the Year, Lifetime Achievement Award, etc.) will be there, which would be quite an assemblage of industry talent.
  • There will be a fun bowling tournament, but since I haven’t bowled since college (translation: I’ve never bowled sober nor seen any reason to) I’ll let Medicomp explain how that will work later. I know some of Medicomp’s partner companies will be hosting individual lanes, so I’m sure we’ll have some fun folks there.
  • You will have networking opportunities like crazy given the remarkable number of CEOs, VPs, investment bankers, press, and lower-ranking but generally amiable grunts like me who’ll be hanging around and lowering their guard to conduct frank and possibly slightly slurred conversations. Deals will be made, jobs will be offered, and a variety of propositions will be extended and considered. A good time will be had by all.

The registration page is now open. Since demand always exceeds supply, registration puts your name on the “I want to come” list. If we have enough capacity, everybody on the list will get an invitation in mid-February. If not, then I’ll have to channel my velvet rope bouncer technique in choosing who gets an invitation (providers and long-time HIStalk supporters get picked first, then I just try to make it interesting by employer and role). Every HIStalk reader is important to me, so I sure hope we can squeeze everybody in since it’s your night.

Acquisitions, Funding, Business, and Stock

1-22-2013 10-10-31 PM

Kareo raises $20.5 million in series F funding led by Stripes Group.

1-22-2013 10-09-55 PM

Shares in Scotland-based revenue software vendor Craneware jump after the company said it expects half-year revenue to increase by seven percent.

1-22-2013 10-11-09 PM

Compuware reports Q3 results: revenue up two percent, EPS $0.12 vs. $0.10. The company says its Covisint HIE business grew 30 percent. The board says it will make a decision shortly about an unsolicited takeover offer of $11 per share, equal to the current share price.


1-22-2013 6-23-52 AM

King Saud University in Saudi Arabia contracts with Cerner to provide Millennium to two of its hospitals.

Lowell General Physician Hospital Organization (MA) selects HDS, athenahealth’s healthcare data management service for population-based cost and quality data analysis and reporting.

The New Mexico Health Information Collaborative will implement Orion Health’s HIE platform for its statewide exchange.

1-22-2013 3-09-01 PM

Henry Mayo Newhall Memorial Hospital (CA) selects Accent on Integration’s Accelero Connect platform to integrate its Philips IntelliVue patient monitors with its Meditech HIS and EDM solution.

Hong Kong and Tsuen Wan Adventist Hospitals select First Databank’s International Drug Knowledge.

El Camino Hospital (CA) chooses data warehouse and analytics solutions from Health Care DataWorks.


1-22-2013 3-24-15 PM  1-22-2013 3-25-26 PM

Mobile health provider Glooko hires Rick Altinger (Intuit Health) as CEO and Dean Lucas (Epocrates) as VP of product development. Glooko, which Dr. Travis included in a recent review of tools for diabetics, just received FDA 510(k) clearance for its mobile logbook device.

1-22-2013 3-27-40 PM

Amplion Clinical Communications names Tom Stephenson (Health Management Systems) president and COO.

1-22-2013 5-40-06 PM

Wendy Penfield (RealMed) joins Intellect Resources as VP of consulting services.

1-22-2013 3-31-25 PM

The Carroll County Chamber of Commerce (GA) names Greenway Medical founder W. Thomas Green as its 2012 Entrepreneur of the Year.

1-22-2013 9-23-59 PM

Rich Boehler, MD (MedeAnalytics) is named president and CEO of St. Joseph Healthcare (NH).

Announcements and Implementations

HIMSS awards 10 scholarships to students enrolled in HIT and management system degree programs.

1-22-2013 9-15-06 PM

Kansas City area hospitals form the Cerner-hosted Lewis and Clark Information Exchange (LACIE), originally created by Heartland Health.

Wheeling Hospital (WV) deploys PeriGen’s PeriCALM Plus in its obstetrical department.

1-22-2013 3-38-03 PM

UNC Health Care’s Rex Hospital (NC) implements Merge Hemo to automate cath lab processes into its EHR.

1-22-2013 3-39-57 PM

UPMC Beacon Hospital (Ireland) implements BridgeHead Software’s integrated backup solution for Meditech.

Neighborhood Health Plan and Partners HealthCare (MA) will provide $4.25 million in grants to 49 community health centers to expand HIT systems, train on Meaningful Use and medical coding, and train and build capacity for performance improvement.

HealthSparq launches its consumer health shopping platform (patient reviews, cost estimator, provider search, and social media forum) to health insurers.

1-22-2013 9-28-57 PM

The Government of Cantabria, Spain will deploy the initial phase of a European-wide e-health service from Texas-based Prodea Systems.


Brian Ahier and a couple of privacy experts will discuss the new HIPAA rules in a Google Hangout streaming video session on Wedneday, January 23 (which is “today” for most readers) at 2:00 p.m. Eastern.

1-22-2013 5-46-13 PM

KLAS looks at clinical decision support tools and finds that more providers are turning to third-party order set and care plan vendors. Key findings:

  • Almost half of providers using third-party products previously tried to build a solution from scratch.
  • Among providers using third-party order sets, half use for reference content only because of an inability to move built pieces into the EMR.
  • Most providers would like more ability to customize medication alerts.

Sponsor Updates

  • SRS reports a 94 percent increase in revenues from 2011 to 2012 and the addition of 56 new employees.  
  • AT&T Healthcare’s Christine Furjanic will speak at the Western Physicians’ Alliance (NV) January 29 seminar on accountable care.
  • Orchestrate Healthcare expands and relocates its corporate headquarters to Carbondale, CO.
  • Greenway Medical Technologies, Inc., announces that Greenway PrimeSUITE 2014 (17.0) is compliant with the ONC 2014 Edition criteria and has earned certification as an EHR Module.
  • Shareable Ink reports 300 percent year-over-year growth and a twofold increase in employees since January 2012.
  • PatientPay CEO Thomas Furr offers advice on managing practice A/Rs and cash flow in a guest articl.
  • API Healthcare announces a 60 percent increase in year-over-year sales bookings and record bookings in the fourth quarter of 2012.
  • T-System will offer the PayRight Health Solutions patient collection system with its RevCycle+ solution.
  • CynergisTek and managed security service provider Solutionary partner to offer outsourced security monitoring.


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

More news: HIStalk Practice, HIStalk Connect.

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January 22, 2013 News 5 Comments

News 1/18/13

January 17, 2013 News 4 Comments

Top News

1-17-2013 8-57-34 PM

HHS Secretary Kathleen Sebelius announces the final omnibus rule that substantially changes HIPAA regulations for the first time in 15 years. It (a) expands HIPAA’s reach to business associates such as contractors who will now be directly liable; (b) increases penalties to a maximum of $1.5 million per violation; and (c) clarifies the HITECH breach notification requirements. Patient provisions include (a) the right to request their own information in electronic form; (b) allowing cash-paying patients to instruct providers to not share their treatment information with their insurance company; and (c) limiting the use and sale of a patient’s information without their permission. The 563-page document has considerable detail including a discussion of feedback received, so feel free to leave a comment with nuggets you run across.

Reader Comments

From Digital Probe: “Re: headline. One of the rags ran a headline all day saying Health Information Exchange over a story about health insurance exchanges.” Indeed they did, and they’ve since quietly corrected their mistake, I see. I’m slightly mystified by their confusion, but even more so at their running a lengthy article on health insurance exchanges in an IT publication intended for a provider audience who I can’t image cares one iota about them.

From Android Powered: “Re: TPD’s list of iPhone apps. Anybody want to share their list for Android?”

1-17-2013 5-51-39 PM

From Boy Gary: “Re: Anthem CA Blue Cross. Their electronic eligibility system is down, so they e-mailed providers telling them to e-mail subscriber and patient information to check eligibility. They’re asking for the subscriber’s Social Security number to be sent by unsecured e-mail.” That’s such a bad idea that I’ll overlook their less-egregious omission of the apostrophes in the possessive occurrences of “subscriber’s.” They get credit for at least putting a manual step in place to help providers get paid.

From The PACS Designer: “MakerBot at CES. An addition to MakerBot’s product line that TPD posted about was introduced at the Consumer Electronics Show in the form of a 3D plastic design system. The MakerBot Replicator 2X 3D printer uses melted plastic to form objects based on available 3D pattern software. So, for example you want a new coffee mug, you use your pattern design software to create the desired result. Maybe one of our adventurous readers will buy the Replicator to design a new shoe for Inga!” Pretty fascinating – the $1,749 device can replicate household hardware parts, antiques, and who knows what else.

From Lumpy Rutherford: “Re: former NextGen President Pat Cline. He has resigned from the QSI board effective immediately and on his LinkedIn page lists himself as CEO of newly incorporated Delaware corporation Lightbeam Health Information Systems. I don’t know the connection, but I suppose you could draw conclusions.” Indeed you could. I was interested in the corporation’s other officers, but couldn’t turn them up on Delaware’s corporations page (at least not without paying).

HIStalk Announcements and Requests

1-17-2013 2-58-51 PM

inga_small My inbox has been filling up with inquiries about HIStalkapalooza. Here’s what I can share for now. We will post a link to the invite sometime in the next couple of weeks, so keep reading HIStalk. We will again have the Inga Loves My Shoe contest as well as a crowning of the HIStalk King and Queen for best attire. Translation: if you needed a legitimate excuse for splurging on a new outfit, you now have one. However, you might want to wait for more details on the event because it may influence your final selection. The date again is Monday, March 4 at 6:30 p.m.

inga_small The latest goodies from HIStalk Practice include: the HIStalk Practice Advisory Panel discusses the various resources they use when purchasing HIT system to compare vendors and products. Bruce Henderson of Aetna Accountable Care Solutions suggests some factors that practices should consider before committing to an ACO model. Rob Drewniak of Hayes Consulting Management overviews and defines data governance. SRS CEO Evan Steele expresses concern about the future of the EHR incentive program. Proposed legislation would provide SBA loan guarantees for the purchase of clinical IT systems. A study suggests that projected primary care physician shortages could be eliminated if practices used EHRs and shifted more care to non-physician providers. EHR adoption by family physicians is expected to exceed 80 percent by the end of 2013. Most physicians don’t find online physician ratings helpful, though the vast majority believe their own ratings are at least partially accurate. Thanks for reading.

I’m taking a short beach break, leaving Miss Inga in charge of the Monday Morning Update. You can occupy your time by (a) connecting with us via our non-Catfished social not-working profiles; (b) porting intently and clicking methodically over the ads to your right from the folks who underwrite your HIStalk habit, if such a thing exists for anyone but me; (c) signing up for spam-free e-mail updates; (d) reviewing more in-depth sponsor information and filling out a two-minute form to solicit consulting help; and (e) evangelizing to your colleagues who won’t see our slick marketing campaigns and ads since we don’t have any. Seriously, you are the best.

On the Jobs Board: Product Marketing Specialist, Expert Solution Consultant – Revenue Cycle Specialist, Healthcare Vertical Solutions Director, Sr. Applications Engineer – EMR.

Acquisitions, Funding, Business, and Stock

1-17-2013 9-07-11 PM

PE firm Primus Capital Funds invests in Emmi Solutions, a provider of patient engagement solutions.

MIT Media Lab spinout Atelion Health will commercialize one of the lab’s project, a care coordination system that’s being tested at Boston Medical Center, Joslin Diabetes center, and Mayo Clinic.

1-17-2013 8-16-40 PM

Cleveland-area data archiving vendor MediQuant, which says its revenue is growing at 45 percent per year, moves into a larger space for its 40 employees and the 10 additional it plans to hire this year.

A hedge fund shareholder of Compuware criticizes the company for “intentionally dragging your feet” by not yet responding to a $2.3 billion December 18 takeover offer from Elliott Management Corp. Just after it received that offer, Compuware announced plans to conduct an $200 million IPO of its Covisint HIE business unit by the end of March.


Centra Health (VA) selects Wolters Kluwer Health’s ProVation software for cardiology procedure documentation and coding.

HP Enterprise Services announces that it has been chosen by the VA for a $543 million, five-year, 152-hospital RTLS contract, being issued the bid again after competitor protests of last year’s award. Subcontractors are CenTrak, Intelligent InSites, and WaveMark.


1-17-2013 5-19-49 PM

The Society of Health Systems and HIMSS award Dean Athanassiades, senior director of software customer services for Philips Healthcare, the 2012 SHS/HIMSS Excellence in Healthcare Management / Process Improvement Award for leadership in implementing synergies between the process improvement and IT professions.

1-17-2013 5-22-01 PM

Symphony Health Solutions names Frank Lavelle (Siemens Medical Solutions, Medquist) CEO.

1-17-2013 5-22-53 PM

Doug Cusick (HP, IBM) joins Clinovations as a partner, tasked with leading the expansion of the company’s payer, life sciences, and technology service lines.

1-17-2013 6-23-14 PM

Dann Lemerand is promoted to EVP of strategic alliances for The HCI Group.

Announcements and Implementations

Greenway Medical Technologies unveils its interactive Developer Portal and API to facilitate creation of apps that interoperate with Greenway’s EHR and PM platform.

Siemens Healthcare offers consulting services for value-based purchasing, preventable readmissions, and healthcare-acquired conditions.

1-17-2013 9-13-14 PM

A Dell-sponsored study finds that the family medicine residency program of Tallahassee Memorial HealthCare (FL) saved $600,000 and enhanced productivity by implementing the company’s Mobile Clinical Computing solution, which includes desktop virtualization, single sign-on, and strong authentication.

Government and Politics

1-17-2013 5-28-23 PM

ONC selects four winners of its Health Design Challenge to develop patient-friendly designs for printed health records to help patients better understand and use their EHRs. The winners shared $31,000 in prize money.

ONC publishes several reports on HIEs.

1-17-2013 8-44-01 PM

In the UK, Secretary of State for Health Jeremy Hunt calls on NHS to become paperless by 2018, making it “the most modern digital health service in the world.” The physician’s union replied, “The biggest challenges to making the NHS paperless by 2018 are down to funding, resources, prioritization, and the choice of systems in secondary care. Although there may potentially be some efficiency savings, technology will not necessarily create huge cost savings. As well as ongoing hardware and software funding, sufficient resources will be required to support evolving training, IT support and admin support.” Other goals the Secretary set: (a) every patient will have online access to their own records by March 2015; (b) referrals will be paperless; (c) patient records held in different locations will be linked; and (d) records will follow patients throughout NHS and social care.


1-17-2013 8-11-40 PM

A NIH-funded University of Pittsburgh study of four skin lesion apps finds that three of them weren’t very good at diagnosing a test set containing 53 images of lesions known to be cancerous. The apps incorrectly concluded that 30 percent of the lesions weren’t cancerous. The fourth app, which sends the image to a dermatologist for review, missed only one of the samples. The conclusion is to not trust unregulated apps with important medical decisions.


The Leapfrog Group retracts the “F” grade it gave to Texas County Memorial Hospital (MO) after the hospital complains that its score was based on incorrect data. The 25-bed hospital opted not to participate in Leapfrog’s survey because it did not have the resources required to complete the 80-page questionnaire. It says Leapfrog applied “questionable methodology” and used information that was not confirmed by NQF or independently assessed for reliability and validity. The hospitals has retained legal counsel. 

Siemens Health Services CEO John Glaser, who served as an ONC senior advisor helping craft Meaningful Use in 2009 while still VP/CIO at Partners HealthCare, agrees with several member organizations in calling for a slowdown of its rollout. He says, “The pace is too damned high. People are just cramming this stuff in.” Johns Hopkins Vice Provost for IT/CIO Stephanie Reel says the “one size fits all” approach is causing headaches for specialists and the Meaningful Use program needs to be evaluated for effectiveness, saying, “To keep moving ahead with such an aggressive strategy strikes me as foolish. We don’t know what’s working and what’s not working.” Obviously pushback is escalating.

1-17-2013 7-20-08 PM

Sporting Kansas City, partly owned by Neal and Cliff of Cerner, parts ways with its charity partner, Lance Armstrong’s Livestrong. ESPN says Livestrong cancelled the stadium-naming deal because the soccer team owed it money, while Sporting KC takes advantage of the Dope Pedaler headlines by loudly announcing the breakup with perfect timing. Livestrong’s name gets yanked down from the Livestrong Sporting Park sign and it loses its percentage of the gate, worth $8-10 million over six years.

An article in a security magazine says Australian security researcher have found “dangerous, unpatched flaws” in the Philips Xper cardiovascular imaging system that allow them free access to patient information. The researchers said they weren’t able to connect with someone at Philips, so they got in touch with the Department of Homeland Security and the FDA instead. They claim Homeland Security told them the agency was taking over all aspects of software vulnerabilities related to medical devices and software. Philips says the flaw is present only in old versions of its software. The researchers also played around with an iPad-based patient monitoring and found problems.

Lurie Children’s Hospital of Chicago sues a web design firm, seeking the return of the $859,000 it paid the company to design a site to promote its new $915 million hospital.

1-17-2013 7-42-26 PM

The Dallas paper profiles Robert Abbate, DO, who started One Touch EMR, an iPad-based EMR.   

A reader once swore she would never read HIStalk again if I mentioned the term “fecal transplant” again, so here’s a sad but necessary wave goodbye to her from Weird News Andy, who subtitles the story “May I borrow some Grey Poopon?” A study finds that the unsavory procedure works better than antibiotics for treating diarrhea due to C. Diff. WNA adds, “When they figure out how to put them in a pill, maybe,” which I might argue is even more disturbing.

Sponsor Updates

1-17-2013 9-18-44 PM

  • Columbia Valley Community Health (WA) chooses Access Evolution for creating and managing paperless forms and workflow.
  • Craneware offers VP-and-above healthcare finance executives a chance to win a $250 Amazon gift card if they answer a 10-question Executive Industry Survey by February 5.
  • HMS will participate in the HFMA Region 11 conference in Las Vegas January 27-30 and the THA 2013 Annual Conference February 13-14 in Austin.
  • dbMotion shares the agenda for its February 7 seminar in Dallas on connected healthcare.
  • Emdat adds Carmichael Business Systems, Northland Business Systems, and Integrated Data Technology as resellers of its digital dictation software.
  • The Advisory Board Company offers an infographic  that addresses accountability gaps and best practices for improving teamwork among frontline staff.
  • The City of Springfield (OH) renews its contract with MED3OOO for EMS billing services through January 31, 2014.
  • The US Army Network Enterprise Technology Command issues CommVault a Certificate of Networthiness for its Simpana 9 data and information management software.
  • Santa Rosa Consulting’s Carl Jaekel discusses issues practices will need to consider to accommodate PCMHs in a blog post.
  • T-System offers its T Sheets flu documentation template free to hospitals to help EDs manage the national flu epidemic.

EPtalk by Dr. Jayne

Every day is a good day to be anonymous, especially for the HIStalk team. Sometimes I marvel that I haven’t been outed at the office. I and am grateful that apparently I have enough of a filter so that my superhero identity isn’t revealed. I do have to be especially vigilant to ensure I’m logged into the correct Facebook and Twitter accounts so I don’t inadvertently post as the “wrong” me.

I’m just one of thousands of physicians using social media and was excited to see this article in the Annals of Internal Medicine. The authors sent hypothetical social media situations to various state medical boards to evaluate whether there was consensus on which situations might lead to a disciplinary evaluation. Not surprisingly, the riskiest posts included misleading clinical or credentialing information, using patient images without permission, and inappropriate contact with patients such as contacting them on dating sites. There was low consensus for sharing clinical anecdotes (as long as confidentiality was maintained) and for “showing alcohol use without intoxication.”


I do have some latent Victorian sensibilities, so I’m not sure photos of anyone drinking belong on Facebook. I have been friended by some of my colleagues and I think that either they have forgotten that their posts are visible to the workplace or perhaps they simply don’t care. Working for a conservative non-profit, I’d be a little concerned that those posts could someday be an issue (if not for the current workplace then for a potential or future employer.)

Many organizations have social media policies or codes of conduct, but it’s not a bad idea to find out if there are “informal” policies in play as well. Is it frowned upon for subordinates to “friend” their supervisors? Is there a difference between connecting on Facebook and connecting on LinkedIn? What about posting to social medial during typical business hours? Depending on an employee’s role and career goals, some of these are less than appropriate.

Having TMI (Too Much Information) seems to have become the norm. I’m not advocating for a return to the days of inkwells and quill pens, but I do miss having a little mystery in the world. I don’t need a photo of your lunch every day, unless of course if includes an awesome martini. If you have pictures of those, feel free to e-mail me.



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

More news: HIStalk Practice, HIStalk Connect.

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January 17, 2013 News 4 Comments

News 1/16/13

January 15, 2013 News 9 Comments

Top News

1-15-2013 8-26-57 PM

AMA submits comments to ONC urging that Meaningful Use Stages 1 and 2 be evaluated before committing to a Stage 3. It says its members most often express five concerns: (a) passing requires a 100 percent score; (b) the core measures are inflexible with regard to practice patterns and specialties; (c) the program needs to be independently evaluated; (d) EHR certification should place more emphasis on software usability; and (e) healthcare IT infrastructure barriers prevent data sharing. AMA wants three years between stages to give EHR vendors time to prepare – one year for making the rules, one for product development, and one for implementation.

Reader Comments

From EHR You Experienced?: “Re: Johns Hopkins Epic motivation for clinicians. Funny.” It is, but I can’t for the life of me figure out why people keep writing Epic in all capital letters. It’s just plain wrong.

HIStalk Announcements and Requests

Need a new Spotify playlist? Here you go. Beach House, Christian Mistress, Young the Giant, The Maldives, and others ranging from popular to obscure (mostly the latter since I strenuously resist musical monotony).


Just for you Smokin’ Doc fans, I’ve had the old logo turned into smaller ones of various sizes and shapes featuring just the doc himself, which I’ll be using regularly here and there. I may even place him permanently at the top of the page since people keep lamenting his apparent demise, which is simultaneously endearing and disturbing. However, just to be clear: (a) I don’t smoke a pipe or anything else and never have; (b) he doesn’t look like me; and (c) you won’t find many doctors wearing reflector thingies on their heads unless you time travel back to the 1960s – they’ve gone electronic.

Acquisitions, Funding, Business, and Stock

1-15-2013 7-09-32 PM

Twelve-employee Flatiron Health raises $8 million in a Series A funding round led by Google Ventures. The company, which is running a private beta of its oncology analytics platform, was started by the two founders of media buying platform vendor Invite Media. They sold that company to Google for $81 million in 2010.


Primary Partners (FL) contracts with telemonitoring provider AMC Health for remote monitoring of discharged patients using biometric devices.

1-15-2013 5-05-06 PM

Springhill Medical Center (AL) selects Omnicell for automated medication solutions and business analytics.

Holland PHO (MI) chooses Wellcentive Advance for aggregating and analyzing patient information from multiple EMRs and systems into a central repository to meet BCBS Michigan’s OSC program guidelines.

HealthEast (MN) chooses RelayHealth to power an enterprise HIE that will help coordinate care across its four hospitals and 14 clinics.

Health Services for Children with Special Needs (DC) selects care and claims systems from TriZetto.

1-15-2013 8-29-03 PM

Norwegian American Hospital (IL) chooses revenue cycle solutions from HealthWare Systems.

Aetna and Centene Corporation choose readmission predictive analytics software from Predixion Software.


1-15-2013 5-06-41 PM  1-15-2013 5-07-30 PM  1-15-2013 5-08-35 PM

KLAS appoints John Halamka (Beth Israel Deaconess Medical Center), Wright Lassiter (Alameda Medical Center), and Denni McColm (Citizens Memorial Hospital) to its advisory board.

1-15-2013 5-09-22 PM

Kareo hires Rob Pickell (Strategy for HireRight) as its first chief marketing officer.

1-15-2013 5-10-33 PM

HIMSS and the American College of Clinical Engineering recognize Paul H. Frisch (Memorial Sloan Kettering Cancer Center) with the ACCE-HIMSS Excellence in Clinical Engineering and Information Synergies Award for demonstrating leadership in promoting synergies between IT and clinical engineering.

1-15-2013 5-12-09 PM

Merge Healthcare Chief Medical Officer Cheryl Whitaker, MD leaves the company to pursue new ventures.

1-15-2013 5-57-07 PM

Mike Quinto (Quantros) joins PatientSafe Solutions as regional sales VP.

1-15-2013 7-26-29 PM

Former consultant and National Quality Forum SVP/COO Laura Miller joins HP as client principal in the public health sector.

Announcements and Implementations

1-15-2013 2-41-49 PM

Optum and Mayo Clinic launch Optum Labs, an open, collaborative research and development facility focused on improving patient care. Participants in the project will have access to Optum and Mayo’s information assets and technologies, including de-identified clinical and claims data.

White Plume Technologies adds AccelaPQRS, powered by Wellcentive, to its solutions suite. Its smart workflows and customized rules capture eligible encounters that allow users to transmit their denominators and numerators to Wellcentive’s registry.

An independent study finds that PeriGen’s PeriCALM Patterns can accurately screen fetal monitoring strips in real time, with its findings matching that of three experts from National Institutes of Health 97 percent of the time. Clinicians can also use the software retrospectively to test new hypotheses on stored fetal heart rate information. I interviewed CEO Matt Sappern in September.

1-15-2013 6-13-54 PM

Here’s a new cartoon from Imprivata.

1-15-2013 7-19-28 PM

US Rep. Tom Price (R-GA) visits Roswell-based revenue cycle vendor MediStreams.

MModal announces a partner certification program for vendors using its Fluency Direct speech recognition and natural language processing technologies.

Henry Schein MicroMD enhances its PM/EMR automated solutions line with tools for dashboards, patient marketing, data backup, electronic payments, statements, websites, PDR information, and third-party collections.

Government and Politics


CMS expands the MU program to include physicians who assign their reimbursement and billing to critical access hospitals.

1-15-2013 6-28-05 PM

William Zurhellen MD, a solo practice pediatrician in the New York City area, petitions the White House to move EHR strategy away from facilitating payment to a national approach for improving outcome and costs. His petition has 123 signatures so far of the 25,000 needed to put it in front of the President. We interviewed him on HIStalk Practice three years ago, where he explained why he wrote his own Unix-based EMR and why he’s not a HITECH fan. “The entire ARRA is a trade for information. We’ll give you money to put in records, but in return, we want you to supply us with performance data. Performance does not equal quality.” A reader reports that a recent CCHIT meeting, he received applause from at least half the audience when he announced, “Certification should focus on improving care. Anything else is a waste of time.”

Innovation and Research

Joe Kiani, founder and CEO of patient monitoring systems vendor Masimo, launches a patient safety conference and calls for fellow vendors to share their monitor information. He envisions a “superhighway of patient data” that can be analyzed by algorithms to provide an early warning of patient problems that will reduce 200,000 preventable deaths that occur under a provider’s care. Promising to share were Circuit Board, GE, Cerner, Smith Medical, SonoSite Fuji, Surgicount Medical, and Zoll Medical. Other solutions discussed were patient checklists, medical mistakes, and hospital overuse of blood from blood banks. Bill Clinton delivered the conference keynote and patient safety expert Peter Pronovost, MD, PhD also presented.

1-15-2013 7-56-57 PM

Conor Delaney, MD, a surgeon at University Hospitals Case Medical Center (OH) is profiled in an article about Socrates Analytics, which he founded to develop a system for University Hospitals that analyzes hospital information to support quality improvement efforts.


1-15-2013 5-52-30 PM

The Raleigh-area business paper covers the departure of Diane Adams, VP of culture and talent of Allscripts. We detailed her severance package here when it was first filed, but the paper recaps: a year’s salary in cash, her annual target bonus in cash, a year of health benefits, partial accelerated vesting, and other potential bonuses. She gets an extra year’s salary if the company sells out within the next year. She made $1.9 million in 2011 for her job, described as “building a values-based, high-performance environment where people, learning, and fun are the priorities.” It would be interesting to hear from those people whether they enjoyed $1.9 million worth of learning and fun.

1-15-2013 3-10-04 PM

HIMSS Analytics reports that in the last five quarters, the number of US acute care hospitals achieving EMRAM Stage 5 or Stage 6 has increased more than 80 percent and the number reaching Stage 7 has grown 63 percent, suggesting that HITECH has spurred the increased implementation and meaningful use of EHRs.

A routine compliance audit by Samaritan Medical Center (NY) uncovers what it says is illegal activity by a sheriff’s department RN who was authorized to review the electronic medical records of inmates, but who was found to be checking out the records of other patients as well.

Pennsylvania’s Department of Vital Statistics warns parents to check the birth certificates of their newborns after a vendor’s newly implemented records software was found to be pulling in incorrect names for the father.

1-15-2013 8-09-18 PM

Northwestern University (IL) will spend $1 billion to replace its women’s hospital, planning to tear down an existing structure that preservationists are trying to have designated as a protected landmark.

1-15-2013 8-35-21 PM

Weird News Andy finds this story odd: the VA hospital in Buffalo notifies hundreds of patients from 2010 to 2012 that they may have been exposed to HIV or hepatitis because nurses misused insulin pens by correctly discarding the used needles, but re-using the same pen on multiple patients.

Strange: a Washington psychiatric hospital loses its accreditation because of an unsecured karaoke machine. State inspectors said the cord presented a patient safety hazard, no doubt remembering an event from a month before in which one patient at the hospital strangled another in karaoke-unrelated incident.

Sponsor Updates

  • HealthMEDX customer Asbury Methodist Village (MD), which recently won an award for its use of technology to improve care transition from long-term care to other settings, is featured in a video from Leading Age and the Center for Aging Services Technologies.
  • John McCullough, associate VP of clinical applications for Wake Forest Baptist Medical Center (NC), reviews his organization’s partnership with Intellect Resources, which provided Wake Forest with strategic planning services prior to its go-live.
  • Steve Besch, senior systems analyst for Ingenious Med, discusses PQRS and the need for program participation in 2013 to avoid penalties in 2015 in a blog post.
  • TrainingWheel introduces its mobile solution for automating help desk issues and support tracking.
  • TrustHCS offers advice for the C-suite on preparing for ICD-10 and Meaningful Use in a blog post.
  • Velocity Data Centers breaks down how it builds data centers in 90 days and publishes a time-lapse video documenting the start-to-finish process.
  • VersaSuite will participate in the Rural Health Care Leadership Conference in Phoenix February 10-13.
  • Arian Bichsel, director of client support for Allscripts, shares strategies to reduce hospital readmissions.
  • API Healthcare discusses the use of payroll and HR software to drive down the cost of care, boost efficiencies, and improve clinical outcomes.
  • Infor recognizes NTT DATA as its 2012 Infor Lawson Service Partner of the Year based on its 250+ successful implementations of Lawson’s ERP software.
  • Informatica sponsors GovernYourData.com, a vendor-neutral online community and resource center for data governance.
  • ICSA Labs and IHE USA partner to provide industry-accepted certification to complement existing testing of IHE integration profiles.
  • The Colorado Health Insurance Cooperative selects Emdeon subsidiary HTMS to provide strategic planning and operational roadmap for the development of a consumer-owned health insurance plan.


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

More news: HIStalk Practice, HIStalk Connect.

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January 15, 2013 News 9 Comments

News 1/11/13

January 10, 2013 News 2 Comments

Top News

1-10-2013 8-39-19 PM

The VA launches a Medical Appointment Scheduling System challenge to replace its VistA scheduling module. Up to three entrants will win up to $3 million each.

Reader Comments

1-10-2013 7-17-31 PM

From TV’s Frank: “Re: Intermountain Healthcare. Finally dumping GE Healthcare.” An e-mail from Intermountain CIO Marc Probst to IT employees says the still-incomplete system it’s been building with GE is deficient in clinical documentation, CPOE, and integration with coding and billing. As a result, Intermountain has evaluated GE’s future EMR strategies and decided not to renew their contract, instead considering three options: (a) keep building their homegrown EMR without GE’s involvement; (b) buy Epic, Cerner, or Siemens; or (c) buy best-of-breed and try to integrate. I’ve panned the GE-Intermountain deal since it was announced in 2005, skeptical that dumping a few hundred million dollars and GE’s questionable expertise was going to ever yield anything tangible, which apparently is exactly the case seven-plus years into the 10-year deal. Or as I described it in 2011, “GE-Intermountain screwing around that never seems to provide any real, marketable products (are those Intermountain-led Carecast enhancements just about done?)”
1-10-2013 6-46-44 PM

From Jerry Aldini: “Re: Geisinger Health System (PA). I contacted you a while back with the rumor that they were developing a commercial solution for accountable care enablement. It was announced at JPMorgan last week. Announcement attached.” I haven’t seen announcement hit the wires, but it says that Geisinger is launching xG Health Solutions, a for-profit spinoff that will commercialize its intellectual property. On the list: consulting services, population health analytics, care management, healthcare IT optimization, and third-party administration services. Geisinger EVP Earl Steinberg, MD, MPP (above) is named CEO and former Alere Chief Innovation Officer Gordon Norman, MD will be chief medical officer.

From PolishingMyResume: “Re: Allscripts. Preparing for relocations and layoffs in the software development organization for development people who work remotely or outside the seven core offices of Boston, Bangalore, Burlington, Chicago, Raleigh, Pune, and Vancouver.” Unverified. Seems like a smart strategy to me. The problem with indiscriminate acquisitions is that you have people strung out all over the place who understandably don’t want to move, limiting your opportunity for the synergy or culture management that Allscripts could use quite a bit of right about now (not to mention expense reduction, ditto). One of quite a few bad decisions by Eclipsys before Allscripts overpaid to buy the company was hiring CEOs who refused to relocate and instead occasionally jetted a few time zones over when the troops needed demoralizing, so I assume that lesson was learned and Paul Black will work out of the Chicago office. 

1-10-2013 8-07-46 PM

From Joan Hovhanesian: “Re: Howard University Hospital. Went live on Soarian clinical documentation on January 7.” Congratulations to the folks there. That’s a gutsy move going live immediately after the holidays. I still think of Joan as being with FCG and later VP/CIO of Shands Healthcare, so I’m out of touch – she’s with Program Advisors now.

HIStalk Announcements and Requests

inga_small HIStalk Practice highlights from the last week include: only 16 percent of providers met PQRS requirements in 2010. Primary care physicians are more likely to demonstrate improvement on measures of care when they have had sustained and extensive technical assistance. A billing service and four pathology groups agree to pay $140,000 to settle allegations that they improperly disposed of thousands of medical records found in a public dump. Job opportunities for physicians will continue to rise in 2013. The AMA and other professional medical organizations urge CMS to stop the implementation of the ICD-10 code set for outpatient diagnosis coding. Galen Healthcare releases a plug-in for Allscripts Enterprise EHR that sends providers EHR task updates to their PC or smartphone. It’s a new year and I hope your 2013 resolutions include not only a commitment to good health, but also a vow to expand your HIT ambulatory knowledge by faithfully perusing HIStalk Practice. Thanks for reading.

On the Job Board: Marketing Manager, Senior Applications Engineer – EMR.

1-10-2013 6-10-34 PM

Welcome to new HIStalk Gold Sponsor HTTS (Health Technology Training Solutions). For you vendors out there, this is my theory: customers often slam your product on KLAS surveys when their problem is really inadequate user training, not your software. The last thing you want customers to experience before go-live is a hastily thrown together set of PowerPoints and talking head demos put together by someone who knows the application but has no knowledge of instructional design and adult learning theory. You’ll hear an earful afterward, but not just on your training evaluation forms – users will under-use your systems, overload your help desk, and badmouth your product on reference calls. The HTTS team of healthcare IT and instructional design experts can help eliminate those problems by reviewing your training strategy, conducting a training needs analysis for new products or releases, and developing your training content using state-of-the-art learning techniques. Check out the testimonials of vendors who have engaged HTTS to optimize their training experience. If you’ve experienced professionally designed software training (both online and instructor-led), it’s easy to distinguish it from the more typical variety assembled by well-meaning amateurs. Now’s a good time to arrange a HIMSS conference connection to learn more. Thanks to HTTS for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

7 Medical Systems closes on its acquisition of HealthLink Minnesota Management Group, a provider of administrative and IT services to clinics.

1-10-2013 5-12-29 PM

ManTech International completes its acquisition of CMS contractor ALTA Systems.

1-10-2013 5-11-29 PM

EBSCO Publishing expands its evidence-based pediatric content with the acquisition of PEMSoft, a pediatric point-of-care clinical information library and multimedia decision support system.


1-10-2013 2-25-22 PM

Saint Luke’s Health System (MO/KS) expands its use of Perceptive Software solutions to include integration with Epic.

CalHIPSO contracts with ClearDATA Network to offer cloud hosting, offsite backup, and disaster recovery services to CalHIPSO provider members.

Emergency Medicine Physicians selects athenaCollector and athenaCommunicator for its 800-physician group. athenahealth also announces that Prospira PainCare with deploy athenaClinicals, athenaCollector, and athenaCommunicator.

1-10-2013 2-27-24 PM

Children’s Mercy Hospitals & Clinics (MO) selects GE Healthcare’s Centricity Business as its enterprise-wide RCM solution.

1-10-2013 5-15-44 PM

Straith Hospital for Special Surgery (MI) chooses the ONE EHR from RazorInsights.

1-10-2013 2-30-01 PM

Flagler Hospital (FL) contracts with Surgical Information Systems for Sunrise Surgery.

1-10-2013 5-17-46 PM

Doylestown Hospital (PA/NJ) subscribes to the CapSite Database to assist with the capital planning and purchasing processes.

Lincoln Orthopaedic Center (NE) selects SRS EHR for its 14 providers.

1-10-2013 8-42-32 PM

Vanderbilt University Medical Center will use event-driven software from Tibco to support its clinical decision support capabilities.

1-10-2013 3-12-54 PM

Rainbow Babies & Children’s Hospital (OH) will encourage non-emergent ED patients to instead use HealthSpot telemedicine kiosks staffed by medical assistants and equipped with monitoring instruments. Also announced: telehealth provider Teladoc will offer HealthSpot’s kiosks.


1-10-2013 5-18-39 PM 1-10-2013 5-19-37 PM

MedSys Group names Steven Heck (First Consulting Group) president and Luther Nussbaum (First Consulting Group) chairman of the board.

1-10-2013 5-21-44 PM

URAC President and CEO Alan P. Spielman announces his resignation.

Announcements and Implementations

1-10-2013 3-09-43 PM

Sentara Healthcare (VA) begins implementation of Morrisey Associate’s Concurrent Care Manager software across its 10 hospitals and 100 medical facilities.

The dbMotion-powered ClinicalConnect HIE (PA) expands its reach to 1.3 million patients.

1-10-2013 5-26-19 PM

South West Medical (KS) and Rems Murr Kliniken in Germany go live on iMDsoft’s MetaVision platform.

1-10-2013 8-30-21 PM

Hospital messaging services vendor Critical Alert Systems partners with Mobile Heartbeat, which provides hand-held messaging and alarms, to create an enhanced nurse call solution.

3M Health Information Systems opens an innovation center in Silver Spring, MD that will showcase its offerings.

Meta Healthcare IT Solutions announces customized versions of its clinical documentation, CPOE, pharmacy, and medication administration software that meet the requirements of Canada-based customers.

Government and Politics

The FCC announces it will make available up to $400 million in annual funding to healthcare providers to spur development of broadband networks for telemedicine.

HHS Secretary Kathleen Sebelius announces the formation of 106 new Medicare ACOs.

Former CMS administrator Don Berwick, MD says he is strongly considering running for Massachusetts governor in 2014. He says healthcare experience gives him sensitivity to issues, adding, “I get more and more excited about the idea of Massachusetts as a model.”


1-10-2013 6-57-49 PM

Panasonic announces an expanded line of Toughpad enterprise-grade tablets that include a 10-inch model running Windows 8 Pro ($2,899) and 7-inch ($1,199) and 10-inch ($1,299) Android versions.

HL7 releases a CCD to Blue Button Transform Tool that allows organizations using the CCD format to allow patients to download information as ASCII text.


1-10-2013 8-00-53 PM

A heavily recruited professor couple at University of Minnesota’s School of Public Health, one of them director of the ONC-funded University Partnership for Health Informatics (UP-HI), quit amidst charges they were double-dipping by simultaneously being paid by another university employer. The State of Georgia handed down felony indictments against Julie Jacko in 2011 after finding that she and Francois Sainfort were collecting full-time paychecks from both UM and Georgia Tech, but dropped charges in return for a plea agreement, restitution payments, and probation by Sainfort. Jacko ran the UP-HI project, funded by a $5.1 million ONC grant.

A California judge refuses to grant Kaiser Permanente access to the PCs and e-mail accounts of a couple whose small document storage business it hired to manage paper patient records. The state health department found last month that Kaiser put medical records at risk by turning them over to the small company without a signed contract. Kaiser claims it picked up the paper records, but the couple didn’t return everything.

Vermont’s Department of Financial Regulation scolds Porter Hospital for overrunning the $4.3 million budget of its Meditech-MedHost EMR project by 63 percent. The hospital undertook the project to earn HITECH money and to participate in Vermont Blueprint for Health. The hospital’s VP of public relations said, “The Meditech folks would hand you a box and say, ‘Good luck, do you have any questions?’” The hospital admits that during the physician practice rollout, all of its practices stopped accepting new patients for an unstated period, with the article ironically concluding, “Porter found that the productivity of doctors took a big hit each time the software was rolled out at a new practice … Officials said it has not been unusual for a doctor who normally saw 20 patients an hour to be able to see only 10 or 12 once the productivity-enhancing software was introduced.”

Weird News Andy finds this story a HIPAA stretch. Police confiscate the cell phone of a man filming an arrest on a public street, with a deputy telling him, “If I end up on YouTube, I’m gonna be upset.” The man was charged with obstruction and disorderly conduct, with the deputy claiming it was a HIPAA violation. A Stanford law expert opines the obvious: “There’s nothing in HIPAA that prevents someone who’s not subject to HIPAA from taking photographs on the public streets. HIPAA has absolutely nothing to say about that.”

1-10-2013 9-14-16 PM

It’s not an April 1 gag: the iPad-ready children’s iPotty debuts at CES. My only surprise is that the adult model wasn’t rolled out first.

Sponsor Updates

  • Jim Stilley, director of clinical workflow consulting for Versus, will discuss the use of RTLS to improve patient flow and efficiency at the 2013 Patient Flow Management Congress January 28-29 in Las Vegas.
  • The Advisory Board Company offers a February 14 Web conference on the inpatient value-based purchasing program.
  • MedHOK earns full 2013 NCQA HEDIS software certification for its 360Measures v2.56.
  • Bill Bithoney, MD of Truven Health Solutions discusses innovative and targeted approaches for reducing costs by improving care quality for better patient outcomes in a blog posting.
  • Medicity publishes a white paper discussing how to build patient centeredness into the ACO model. 
  • iMDsoft highlights some of its 2012 milestones, including successful implementations in Canada and the Czech Republic, 60 critical care and anesthesia projects, and go-lives of MetaVision in 17 countries.
  • Prognosis HIS doubles its client base for the second consecutive year and announces that all of its eligible clients exceeded baseline requirements to complete Stage 1 MU attestation using ChartAccess EHR.
  • Beacon Partners defines population health management and its relation to ACOs in a January 18 Webinar.

EPtalk with Dr. Jayne

CMS is seeking comments from hospitals, EHR vendors, and “other interested parties” on its electronic quality reporting. Starting in 2014, the Hospital Inpatient Quality Reporting (IQR) program requires use of the Quality Reporting Document Architecture (QRDA) standard. According to the e-mail, “CMS wants to increase efficiency and reduce the burden for providers…” If that’s true, I have some other suggestions for them as well. The comment period closes January 22, so sharpen those pencils and fire up those keyboards.

Speaking of CMS, don’t forget that if you completed your 2012 reporting period on time, you only have until February 28 to attest for Medicare. Those attesting with Medicaid should check for their specific state deadlines.

One more CMS deadline-related item and then I’ll quit, I promise. The comment period for ONC’s Health IT Patient Safety Action & Surveillance Plan is open until February 4. Goals of the plan include making it easier for clinicians to report patient safety events, engaging vendors to “embrace their shared responsibility for patient safety,” and incorporating health IT safety in post-market surveillance of certified EHRs. It’s only 40 pages, considerably shorter than most ONC reads.

From Follow Up Fred: “Re: sticky workplace problems. Good topics for discussion! One solution I’ve successfully employed for years is this. If I need a prompt response to a question or request communicated by voicemail or e-mail, I always end the message by asking for a response by a certain date and time. Typically, “Hey Jane, I’d appreciate it if you’d get back to me by close of business Thursday, January 10.” I then flag the e-mail or voicemail follow-up date on phone in the event the requested deadline is missed. I’ve found it very effective for myself but also the recipient, who in turn can prioritize the return response.” An excellent point, especially in a workplace where people won’t do anything until they’re absolutely up against a deadline.

The AMA continues to play Chicken Little with their ongoing pleas for CMS to halt implementation of ICD-10. Citing the cost and administrative burden, they ask that it not simply be delayed again, but to call on “appropriate stakeholders to assess an appropriate replacement for ICD-9.” There has already been significant expense to prepare for implementation and I know many people will be aggravated at the lost time, money, and effort if they’re successful. Do I sense an HIStalk poll in the making?


Inga and I are hard at work designing the beauty queen sashes for HIStalkapalooza. Thanks to some virtual BFF shoe shopping (via camera phone and text message), I’m ready for HIMSS. Do you have your shoes picked out and your accessories coordinated? E-mail me.



Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Connect.

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January 10, 2013 News 2 Comments

Readers Write 1/9/13

January 9, 2013 Readers Write 3 Comments

Submit your article of up to 500 words in length, subject to editing for clarity and brevity (please note: I run only original articles that have not appeared on any Web site or in any publication and I can’t use anything that looks like a commercial pitch). I’ll use a phony name for you unless you tell me otherwise. Thanks for sharing!

The views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

Why Medical Practices Must Manage A/R Better … Now
By Tom Furr

1-9-2013 6-46-10 PM

“I didn’t go to med school to be an accountant.” How many times have we heard those words being muttered from a physician’s mouth?

Until now, that’s been an acceptable sentiment for any doctor. Today such thinking is financially dangerous if not downright disastrous. Even doctors in practice for as little as 10 years kept their focus on the insurance company, the source of 85 to 95 percent of their income. That almost predictable cash flow made reviewing accounts receivable reports — universally known as A/R — barely necessary.

Today, looking at A/R is an absolute requirement because of four letters that are having a huge impact on medical practices of all sizes and types – HDHP, which stands for High Deductible Health Plans.

These insurance plans have sent a loud and clear message to doctors across the United States: the game has changed. Simply stated, those practices that adjust quickly and wisely will be better able to survive. Those that don’t will be at risk of needing to sell out to hospitals or suffer serious issues with cash flow that could threaten the survival of their practices.

According to the annual report of America’s Health Plans, the number of U.S. residents using HDHPs rose nearly 20 percent in the past year. In 2013, 70 percent of larger employers will offer HDHPs, noted a Tower and the National Business Group of Health study. While the growth rate of this type of plan varies from region to region, no practice can think it won’t affect them soon.

The new reality is deductibles as a percent of contracted rates are about 50 percent. The days of the $25 co-pay are gone. Now practices are tasked with securing half the service bill’s balance from the patient. Unfortunately, physicians today don’t know the amount due until weeks after service, making it a priority to get the patient bill out as soon as the claim is adjudicated by the insurance company. That’s especially the case at the start of a calendar or plan year.

No one is suggesting doctors turn in their white coats and stethoscopes for green eye shades and a handful of sharpened pencils. However, they must become more attuned to the state of their practices’ financial condition. If a system is not embedded in their practice management software to manage patient bills and balances as well as produce insightful A/R reports, the doctor and his/her office manager should identify one and put it into place. Even if a new practice management system has just been deployed, that doesn’t mean you don’t need to ask the questions immediately of how to capture patient balances and post them automatically.

In the HDHP environment, everyone in the practice has a role to play, from front desk personnel to physicians. Each member of a practice should be educated on the new reality of HDHPs and how patients understand this new reality. However, it is also the responsibility of the practice to provide patients a simpler way to meet their financial obligations to the practice and continue to keep their healthcare relationships sound. If patients understand and have easy ways to remit payments, the physician keeps a sharp focus on the practice of medicine, secure in the fact that the A/R is being managed.

However, make no mistake, there is a limit on how much delegation a doctor or his/her office manager can allow. The tough calls need to be made by those individuals leading the practice. Decisions of the sort that most medical professionals could never have conceived of during their internships, like “firing” a patient.

Think about it:  with HDHPs, the shift from patient to deadbeat can occur in a matter of weeks if close attention is not paid to A/R.

Tom Furr  is CEO of PatientPay of Durham, NC.

NLP and Physician Workflow: An End to Physician Resistance?
By Chris Tackaberry, MB, ChB

“I hate all the EMRs out there, including the one our practice just bought. Notes that come from an EMR have so much extra stuffing in them that it takes me forever to figure out what you guys really had to say about the patient I referred to you. I have to wade through lines and lines of empty verbiage to finally find a meaningful sentence or two that tells me what I need to know.”

While the promise of the EHR/EMR remains as great as ever for healthcare providers, so too does the issue of physician resistance, as evidenced by this doctor’s comment, part of a conversation highlighted in a MedPageToday online article. Since EHRs came on the scene decades ago, physicians have remained slow to adopt the technology, even with the promise of improved workflow automation, enhanced care quality, rapid data exchange, and increased efficiencies. While the issue of physician resistance is certainly not new, it becomes an ever-more important concern as many hospitals continue to struggle to achieve Meaningful Use requirements.

There may be several reasons why physicians remain slow to come on board, but the most obvious is simply that doctors want to spend their time caring for patients, not struggling to use technology that introduces foreign, cumbersome tasks into their workflow. The truth is, even with today’s best systems, EHR data remains, on the whole, insufficiently descriptive or lacking in clinical context. Complete patient details often reside within historical notes embedded deep inside the EHR, and manually reviewing them for each and every patient, if a physician can access them, is incredibly time consuming and cumbersome.

Even with the technological advancements EHRs have seen over the years, physicians still have to spend tremendous amounts of time describing patient problems, medications, allergies, etc., in cumbersome forms or templates. As my colleague Tielman Van Vleck, PhD, Clinithink’s director of language processing, recently stated: “There is an intrinsic inefficiency in this process because so much of this information must be documented in the clinical notes repeatedly. As a result, there has been significant physician pushback against EHRs, despite their potential to improve both the quality and efficiency of physician-delivered care.”

NLP effectively embedded into an EHR has shown remarkable promise when it comes to minimizing the negative impact EHRs have on physician workflow. Rather than burdening physicians, NLP delivers more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

This is an important concern for providers dealing with Meaningful Use requirements, particularly Stage 2 and ICD-10, where capturing patient problem lists with unfamiliar coding terminology is another big deterrent to physicians. The good news is that NLP within an EHR can automatically tag all the problems referenced in a patient note, which in addition to facilitating analytics and clinical decision support not previously possible, can also support the capture of medications and allergies, saving physicians time associated with filling and maintaining these lists.

Physician resistance to EHRs won’t end tomorrow. But with the advent of Natural Language Processing and the manner in which this technology compliments physician workflow and will ultimately improve care quality, the light at the end of the tunnel may be considerably closer. Dr. Van Vleck recently noted, “NLP isn’t just a bigger hammer to build better widgets. If we do this right, we can improve medicine, helping people lead healthier, longer lives; we can simplify healthcare delivery and involve patients more; we can even help researchers make medical discoveries or respond to new diseases. There are a million ways that NLP can be leveraged in healthcare.”

It would seem tough to find a physician who could resist that scenario.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Vendor Resolutions for 2013
By Vince Ciotti

I tried to go to the gym today, but couldn’t get in. Too many people making New Year’s resolutions to exercise! So I went back to the office early and wrote this piece on New Year’s resolutions for our top 13 vendors, listed in order of their annual revenue.

  1. McKesson. So big (over $3B in annual revenue) that they made two: (a) find jobs for the 200+ well-paid Horizon veterans they laid off last year, all with 15+ years experience in healthcare, programming, etc., and (b) hire 200+ new employees for the expanded Paragon line, following the Epic model of young, inexperienced, and cheap.
  2. Cerner. Kick Paul Black’s butt.
  3. Siemens. Use the excellent marketing materials and RFP responses for Soarian financials to start the design and programming soon.
  4. Allscripts. Make Neal Patterson sorry he ever let Paul get away.
  5. Epic. Find a NYC bank with a high interest rate on CDs.
  6. GE. Sell something to somebody, somewhere, sometime, somehow …
  7. Meditech. Start the design work on Release 7.
  8. NextGen. Integrate the brochures, proposals, and PowerPoints for Opus, Sphere, and IntraNexus.
  9. CPSI. Sell a large hospital (over 25 beds).
  10. QuadraMed. Take a Quantim leap backwards.
  11. NTT/Keane. Optimize their disparate product lines.
  12. HMS. Get ready for Primus time.
  13. Healthland. Rearrange their various products in Concentriq circles.

Vince Ciotti is a principal with H.I.S. Professionals LLC.

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January 9, 2013 Readers Write 3 Comments

News 1/9/13

January 8, 2013 News 10 Comments

Top News

1-8-2013 8-59-11 PM

A RAND study finds that the cost-saving promise of healthcare IT it predicted in a vendor-subsidized 2005 study has not been reached because deployed systems are not connected and not easy to use. The study’s authors blame shortcomings in the design of IT systems and recommend improving interoperability between systems, providing better access to records for patients, and designing more intuitive systems. The original RAND study published in Health Affairs (above), partly paid for by Cerner, claimed that electronic medical records would save at least $81 billion per year, which the Congressional Budget Office said at the time was a ridiculously inflated number. Still, the study was cited repeatedly to justify government spending on EHR-related programs. Another RAND study predicted that HIEs would generate hundreds of billions of dollars per year in healthcare savings.

Reader Comments

1-8-2013 7-17-38 PM

From Homecare: “Re: interesting misstep. From a VC-backed home care tech vendor.” Family Care Medical Services (WI) files suit against medical equipment and home health billing service vendor Brightree, claiming that the billing company Brightree acquired made inadequate efforts to collect money owed to the business. Brightree, an investment of Battery Ventures, acquired home health and hospice software vendor CareAnywhere late last week.

1-8-2013 9-12-24 PM

From Big O: “Re: HL7. Announced in September they were going to open up their standards for free in Q1. Anyone know the specific data?” I inquired via HL7’s contact page. They didn’t respond. I found a bunch of free downloads on their site, but I don’t know what else they’ll be releasing.

1-8-2013 7-45-37 PM

From Mickie: “Re: CenTrak RTLS lawsuit. Attached.” AeroScout, owned by Stanley Black & Decker, claims Centrak violated its patent for a WLAN-based RFID asset tag and locating system.

1-8-2013 7-01-33 PM

From Brandywine: “Re: Octo Barnett, MD at Massachusetts General Hospital. He’s officially retired and is not giving interviews any more.” I’m sorry to hear that since I really wanted to interview him. He should write his biography since he’s one of the pioneers of healthcare IT, along with the recently deceased Homer Warner and a few other key players. Octo developed the MUMPS programming language in the 1960s with Meditech Chairman Neil Pappalardo, which more than 40 years later still runs the systems used to care for probably 90 percent of hospitalized patients in the US.

HIStalk Announcements and Requests

inga_small Mr. H and I have been talking HIStalkapalooza the last few days. I’m not sure he is quite ready to leak all the details, but here’s what I can share. The party, which will likely be the most fun event of HIMSS 2013, will be bigger than ever and include exotic shoes, excellent food and drink, entertaining music, a few contests, and even a bit of dancing. And of course the annual HISsies awards. You will want to keep your calendar open for the evening of Monday, March 4.

Acquisitions, Funding, Business, and Stock

1-8-2013 8-05-50 PM

Health Catalyst, known until recently as Healthcare Quality Catalyst, raises $33 million in Series B funding from Norwest Venture Partners, Sequoia Capital, and Sorenson Capital Partners. I interviewed co-founder Steve Barlow in 2011 and SVP Dale Sanders this past October.

1-8-2013 8-04-17 PM

Point-of-care technology vendor PatientSafe Solutions closes a $20 million Series C round led by the Merck Global Health Innovation Fund.

Private equity firm Riverside Partners invests in Stinger Medical, a provider of mobile clinical workstations and medical technologies.

1-8-2013 3-26-34 PM

Care Thread, a provider of secure mobile messaging and a recently named “App of the Month” by Nuance Healthcare, secures $250,000 in seed funding from Slater Technology Fund.

1-8-2013 8-16-55 PM

Lightbank, the venture fund launched by Groupon’s founders, leads a $1.4 million investment in fertility app vendor Ovuline. The startup’s next product is a pregnancy monitoring app.

Data analytics company Blue Health Intelligence acquires Intelimedix, a healthcare analytics firm specializing in employer group and payer reporting solutions.

Passport Health Communications acquires California-based Data Systems Group, a provider of revenue cycle software solutions.

Travis analyzes possible reasons that athenahealth acquired Epocrates on HIStalk Connect.


ICON selects Cerner’s Discovere Late Phase platform to support its pharma and device studies.

The Health Information Trust Alliance designates Booz Allen Hamilton a Common Security Framework Assessor, tasked with conducting information security audits of healthcare organizations.

1-8-2013 3-33-54 PM

The Liverpool Heart and Chest Hospital NHS Foundation Trust augments its Allscripts electronic patient record with Hyland Software’s OnBase solution for enterprise content management.

1-8-2013 3-35-42 PM

St. Anthony’s Medical Center (MO) selects Capsule Tech’s device connectivity technology for use in multiple areas to automate the flow of patient data into Epic.

1-8-2013 3-37-15 PM

Stellaris Health Network (NY) signs a multi-year agreement with MedAssets for strategic sourcing, BI, and process improvement consulting.

Delaware Health Information Network approves the AlliedHIE Company as a Direct messaging provider for the HIE’s enrolled practices, with messaging and interoperability technology provided by ICA’s CareAlign Direct Messaging and Exchange solutions.


1-8-2013 12-06-51 PM

CHIME and HIMSS name University of Utah Health Care CIO James Turnbull its John E. Gall, Jr. CIO of the Year.

1-8-2013 7-22-18 PM

LifeBridge Health names Tressa Springmann (Greater Baltimore Medical Center) as CIO.

1-8-2013 7-25-10 PM

Blackford Middleton, MD, MPh, MSc (Partners HealthCare) will join Vanderbilt University as assistant vice chancellor, chief informatics officer, and professor of biomedical informatics.

1-8-2013 6-54-39 PM

O’Neil Britton, MD is appointed chief health information officer of Partners HealthCare, replacing David Blumenthal MD, who left earlier this year to head The Commonwealth Fund.

1-8-2013 12-48-27 PM

The South Florida REC promotes Amy Rosa from assistant director to interim director.

1-8-2013 2-32-19 PM

Vocera Communications names M. Bridget Duffy, MD (ExperiaHealth) CMO.

1-8-2013 3-04-55 PM 1-8-2013 3-06-27 PM 1-8-2013 3-07-57 PM

QuantiaMD names Daniel Malloy (IMS Health) SVP, promotes President Mike Coyne to CEO, and appoints CEO Eric Schultz to executive chairman.

1-8-2013 8-42-19 PM

Home monitoring systems vendor Healthsense names A.R. Weiler (Emdeon) as CEO.

Announcements and Implementations

1-8-2013 3-38-27 PM

North Arkansas Regional Medical Center becomes the first facility to implement the State Health Alliance for Records Exchange (SHARE), the statewide HIE for Arkansas.

CareCloud and the online physician platform QuantiaMD partner to survey QuantiaMD members on key practice trends.

1-8-2013 6-39-51 PM

Philips Healthcare introduces Lifeline GoSafe, a mobile personal emergency response system that includes fall detection capabilities, locating services, and two-way cellular voice communications.

Coding software vendor Trucode announces a cloud-based product that allows vendors to incorporate coder functionality into their systems. Customers include ChartWise, BayScribe, Dolbey, MModal, Precyse, and PlatoCode.

1-8-2013 9-17-46 PM

Florida Hospital Wesley Chapel (FL) completes the first phase of its nurse response system, which includes a Rauland-Borg nurse call system, Cisco wireless handsets, and Extension middleware.

Innovation and Research

1-8-2013 8-22-34 PM

The X PRIZE Foundation announces ambitious competition guidelines for the $10 million Qualcomm Tricorder X PRIZE, for which 255 teams have already registered. Along with monitoring vital signs and specific conditions, devices will need to address a core set of 12 conditions that include diabetes, atrial fibrillation, stroke, TB, and COPD.


1-8-2013 8-30-50 PM

Hunting and fishing supplies retailer Cabela’s apologizes for a New Year’s Day computer glitch that added the Affordable Care Act’s 2.3 percent medical device tax to every purchase. The company says it has no idea how that happened.

In the UK, an NHS surgery practice blames human error on its creation of over 4,000 summary patient records without giving patients the chance to opt out.

Xerox files a protest with the West Virginia Department of Health and Human Services after the state awards a $248 million Medicaid claims processing system contract to Molina Medicaid Solutions. Xerox claims the state’s 2011 contract with Incumbent vendor Molina to upgrade the state’s existing system gave that company an unfair advantage.

An article on patent trolling identifies a maze of closely held companies that are sending out threatening letters to businesses, demanding license payments of $900 to $1,200 per employee for their patent that covers e-mailing scanned documents. The article says a study of startups found that 22 percent of them ignore patent trolling letters, 35 percent fight back at average court cost of $870,000, and 18 percent go out of business.

1-8-2013 7-57-55 PM 1-8-2013 7-56-12 PM

VistA guru Tom Munnecke observes that Secretary of Defense nominee Chuck Hagel was intimately involved with the MUMPS-based VistA system in its skunkworks early days as a VA deputy director, praising him for supporting the “Underground Railroad” despite the objections of VA brass who wanted to run a huge, centralized hospital information system instead.

Weird News Andy is stuffed with good news: the guy who invented the Segway is working on a gadget that will let people gorge themselves on food, then pump their own stomachs through a surgically installed abdominal valve. WNA says Dean Kamen obviously “has his finger on America’s thready pulse” since his inventions discourage walking and encourage gluttony.

Sponsor Updates

1-8-2013 9-20-40 PM

  • The PriMed (CT) provider group and MED3OOO distributed coats, sleeping bags, and gift bags to the needy through the Bridgeport Rescue Mission’s Sleeping Bag Give-Away event right before Christmas.
  • The local paper profiles Don Catino,who co-founded New Hampshire-based Digital Prospectors in 1999.
  • McKesson Paragon is named Best in KLAS Community Hospital Information System for the seventh straight year.
  • API Healthcare participates in the ACNL 2013 Annual Conference in San Diego February 10-13.
  • AdvancedMD hosts a January 23 Webinar  that provides a crash course on qualifying for Meaningful Use.
  • T-System offers complimentary benchmark information that considers the timeliness and quality of ED care.
  • Nuance Healthcare’s Jonathon Dreyer, director of mobile solutions, predicts that 2013 will be the “year of the mHealth user” with more widespread availability and adoption of mobile health technology.
  • CSI Healthcare IT earns satisfaction scores 2.2 times higher than the industry average for staffing firms in an independent satisfaction survey, also earning a74 percent “would recommend’ score.
  • Vocera releases updates to its software platform that enhance nurse workflow and provide improved analytics and reporting. 
  • Medseek looks at patient engagement, MU, and meeting patient expectations with technology in a January 16 Webinar. 
  • Billian’s HealthDATA releases a white paper that focuses on the top innovations in HIT.
  • Imprivata names Johns Hopkins Medicine the winner of its 2012 Healthcare Innovator of the Year Award for an exceptional implementation of OneSign.


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Connect.

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January 8, 2013 News 10 Comments

Monday Morning Update 1/7/13

January 5, 2013 News 10 Comments

From Willy Mays Hayes: “Re: Cerner. Our remote-hosted Cerner system just experienced a six-hour downtime that they are attributing to hardware failure in Kansas City. We’re wondering how many other clients were effected.” Unverified, but speak up if your system went down.

From Zorba P: “Re: non-compete agreements. A Wired essay says enlightened companies realize that non-competes hurt the economy.” The article didn’t convince me that companies shouldn’t require employees to sign non-competes, only that allowing employees to freely take their proprietary knowledge to a competitor might increase competition and thus economic output. Maybe it all works out where companies poach each other’s people like a Cold War spy exchange, but the odds of that intellectual property flow being equally balanced among all competitors seem slim and some companies are going to lose. The article tries unconvincingly to make the point that Boston’s Route 128 startup environment lost out to Silicon Valley because California law essentially voids all non-compete agreements, leaving the Massachusetts companies with no-choice lifer employees who stagnated their employers. I might agree with the conclusion that employees should be free to immediately leave and start their own companies since the economy would benefit from having more entrepreneurs and fewer unmotivated corporate clock-punchers, but I’m just not comfortable with the idea that any company with big pockets should be able to steal competitive secrets by simply hiring away insiders.

From The PACS Designer: “Re: Pebble e-paper Smart Watch. Our Travis Good posted in The Year of the Health Gadget about Pebble e-paper Smart Watch, so TPD thought it would be a good addition to the upcoming update of TPD’s List of iPhone Apps. Also found a YouTube preview explaining its use in transferring apps from mobile devices to the wrist watch.” I inadvertently burst out laughing at 0:20 when the company’s “Dream Team” (i.e., stereotypical startup nerds) make a reluctant and un-photogenic appearance, displaying palpable discomfort at being exposed to actual sunlight and fresh air. If your life won’t be complete without a rather ugly but smartphone-connected watch whose least-interesting capability is telling time, you’ll pay around $150 if it ever reaches the market (pre-orders started in May and the company isn’t providing updates), you’ll be buying from a company that failed previously before renaming itself and raising $10 million on Kickstarter, and you’ll be waiting until they find Asian companies willing to build their product cheaply. Not to mention that depending on hard-to-predict fashion acceptance, you’ll either look like the coolest kid around or a clueless idiot flashing a geeky Dick Tracy calculator watch.

1-5-2013 7-27-03 AM

As healthcare IT professionals, we’re even more skeptical than laypeople that providers can keep our medical information secure, with 84 percent of poll respondents saying they lack that confidence. New poll to your right: have you used a patient portal offered by your PCP? I have, and I like it — it’s convenient for making appointments, checking lab results, and pre-paying for a visit and printing a barcoded page that lets me check in at a kiosk instead of waiting in line.

1-5-2013 7-41-43 AM

Welcome to HealthITJobs, sponsoring both HIStalk and HIStalk Connect at the Platinum level. I like the clean look of their site, which has some pretty cool jobs listed. Employers typically need to fill positions in a hurry, and with HealthITJobs.com, positions you post go online immediately. Job hunters can manage the process from their smartphones: checking for openings, receiving real-time alerts when new jobs go up, and even applying for jobs from anywhere. As an employer, I’ve posted hospital IT jobs on some of the big job boards and it’s usually been a disaster, with 95 percent of the applicants having no healthcare experience, no US work credentials, or clearly insufficient capabilities. HealthITJobs focuses on health IT professionals, so you won’t be have Bolivian bricklayers bugging you about your CMIO position. The biggest regret I have about the crappy jobs I’ve held as an employee (thankfully not recently) was that I let inertia keep me from getting serious about moving on. It would have been so easy then and even easier now to find a new gig: register, download the iPhone app, and see what’s out there (hint: it’s a booming industry, so there’s a lot). For employers and recruiters, unfilled positions cost a lot of energy and money, so HealthITJobs is a painless way to post your listings and find that one right person who’s apparently not perusing your listings posted elsewhere. Thanks to HealthITJobs for supporting HIStalk and HIStalk Connect.

1-5-2013 7-43-31 PM

Hackers hit the servers of UNC Lineberger Comprehensive Cancer Center (NC), exposing the information of 3,500 employees and contractors. No patient information was involved. The breach occurred in May, but those affected weren’t notified until after Christmas. University IT employees say their servers are hit with attempted hacks thousands of times every hour.

CMS announces a 90-day extension for meeting Affordable Care Act transaction standards for eligibility and claim status. The reason given: nobody was going to be ready.

1-5-2013 7-44-27 PM

Wolters Kluwer Health completes its acquisition of Health Language, Inc., announced in October.

The fired former president of University of North Texas Health Science Center says he was let go for a variety of not-so-good reasons. One of them was his analysis of an all-campus shared services business center, which he says upset the university’s chancellor because it found that the health science center was paying twice as much as before with reduced quality, including a two-day EMR downtime that affected patients.

1-5-2013 7-33-02 PM

Home medical billing software vendor Brightree LLC acquires CareAnyware of Raleigh, NC, which sells home health and hospice software.

1-5-2013 8-43-06 AM

Reuters covers the recent Critical Care Medicine article in which researchers used plagiarism detection software to determine that most physician progress notes contained at least 20 percent material copied and pasted from elsewhere in the electronic record. I pulled up the original article (thanks to my academic medical center employer for providing remote access to our online journal library) and offer these observations:

  • It was a one-hospital study (MetroHealth Medical Center, Cleveland) of 135 patients admitted to a 14-bed ICU for at least three consecutive days.
  • The EMR system was Epic, which offers built-in functions for copy-paste and copy into a new note.
  • Residents copied more often, but attendings copied more actual text.
  • The threshold for identifying copying was phrases of at least four words and 20 or more total characters that contained at least a 20 percent match.
  • The authors did not interview any of the physicians found to have copied material, did not postulate why they did so, did not ask those involved in care of the identified patients whether the copied material negatively impacted patient care, and drew no conclusions about the potential or actual impact of copying progress note text on patient outcomes.

My conclusion: like many studies that raise a red flag and then run, this one seems to have been thrown together and executed quickly, resulting in a slightly interesting article that has no meaningful conclusion other than that someone with more resources should do a better study. Doctors may well copy progress note material, but that’s not necessarily a bad thing given that EMRs don’t typically offer easy ways to tag highly relevant material from the routine junk that hospital administrators, regulators, and malpractice lawyers require. It should be assumed that bringing material forward has an at least an equal likelihood of being positive for the patient since it might be missed otherwise. And intentional copying is a lot less bothersome than template-generated babble that looks good but says nothing useful.

Everybody wants to armchair quarterback how doctors document. How would you like having a roomful of stern third parties examining every e-mail you write for relevance, insightfulness, originality, and style, looking for opportunities to reduce your pay or sue you? If doctors aren’t complaining about the body of progress notes they work with in caring for their patients (including attendings reviewing the work of residents), then the armchair quarterbacks aren’t likely to find a smoking gun of vast conspiracy or widespread negligence.

If you’re a hospital, set standards on how documentation should be done. Demand that your EMR vendor develop ways to separate the useful from the worthless, and to add logic that considers the age of a documentation element and its graded value from individual providers in predicting its relevance. If you want elegant and thoughtfully composed prose, expect to pay for it in reduced physician productivity. And if you can prove that particular methods or styles of progress notes directly impact patient care, let’s see your data.

I think we can agree that electronic documentation works better in theory than in practice due to poor design and unguided use and therefore could be improved. To that end, I’ll close with a pithy quote from contributor Robert Lafsky, MD: “I’d sure like to see that visiting expert professor try to unravel a difficult case using nothing but the printed output from a typical EMR.”


Mr. H, Inga, Dr. Jayne, Dr. Gregg.

More news: HIStalk Practice, HIStalk Connect.

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January 5, 2013 News 10 Comments

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