Readers Write: Healthcare IT vs. Corporate IT

Healthcare IT vs. Corporate IT
By Anonymous

This is in response to an April 29 reader comment suggesting that healthcare IT leaders are unable or unwilling to make decisive decisions that would improve the bottom line.

I don’t think it’s always not making a “responsible” decision on the part of the HIT leadership. There are different priorities in healthcare organizations versus us in the corporate world. 

In the corporate world, we in IT are well aligned to the profit motive of our company. Period. In healthcare IT, leadership is often not worried about that profit motive. They say they are, but the other departments we serve — they say they are worried about finances, but they really aren’t. HIT leadership doesn’t want to have a crucial conversation with the department heads in the healthcare system about their wasteful applications. 

The infrastructure is normally fully under the control of HIT leadership. There is a ton of cost cutting that happens there. Way too much in my opinion, causing unnecessary downtime that would never happen in a corporate IT shop. That’s due to the cost cutting to not have that switch stack be fully redundant or we don’t need to buy ALL that storage area network growth space now … and then you run out. I’m looking at you HIT shops in the North Carolina Tobacco Road region. 

The real HIT waste is in the applications. Nearly every health system I’m familiar with have some pretty serious application redundancies. What I mean is an HR department that runs both Kronos and Lawson and the payroll department is not part of HR and not outsourced to ADP or the like. That’s two very expensive systems that can do the same job if someone can tell or convince HR to just pick one. 

Or better yet, just let someone else run that whole part of your operation. Many of the corporate IT guys handled the payroll / processing / HR system cost issue a long time ago via outsourcing. Then HR can focus on, oh I don’t know, recruiting people and working on benefit plans. That doesn’t seem to be all that common in healthcare IT.  

Also, your hospital maintenance departments run very expensive name-brand systems meant to run whole manufacturing operations. To do what? Inventory objects and print out repair orders. I’m not talking about your medical device department here, just good old facilities and services. 

The list of applications that cost serious dollars and do only  small jobs inside the healthcare operation as a whole goes on and on.  Corporate-based IT shops would have had a programmer build a little Web application or SharePoint portal to eliminate a few hundred little apps inside a typical healthcare IT shop. 

There’s not a lot of movement in HIT shops to simplify. Simplicity equals cost savings in both break/fix and maintenance/purchase dollars. 

Why not focus on those applications particularly that need simplification and save costs? 

I believe it’s political costs mainly in the healthcare IT field. Those department heads often hold much power in an organization. Healthcare IT is not the sole owner or, at minimum, the first owner of the application. That department or unit is. They can claim patient benefit or employee benefit, or most often, that the redundant systems allow them to have their own inflated head counts. 

Will a healthcare IT leader have time to quantify those patient benefits into a dollar measurement to then justify the maintenance cost and support/time cost for that application? No. Who has that kind of time? 

There are often redundant departments in a healthcare operation. Health systems have DBAs/report writers creating reports for clinicians, but there is a whole other Decision Support Services department with their own specialized application. Nine times out of 10, it’s the same data being reported in almost the same way, and let’s not talk about that DSS app and how it gets the data every day or night and the integration and support work there. In some shops, those DSS people with limited SQL writing skills will even tug some of that DBA’s time to help with their work. 

In corporate IT, there is one measure — efficiency measured in real dollars. There are no patients, so the hard math is easier to quantify. How much does that application cost to have support, maintenance, and upgrades purchased? OK, that’s $100. What does it save us in time running the business vs. another application/process? We are in the positive side in $1,000s — it is justified. There isn’t a lot of worry about the business unit’s politics other than making sure their process is as lean and efficient as possible and that usability of the application is good so that the process time is as efficient as possible.

That’s not to say that a corporate business unit doesn’t have its own political pull, but often you can show the C-level the numbers and those numbers win the argument. Proof in the corporate world means something. I’ve been in many healthcare IT ROI discussions showing the cost savings that could happen. They are normally hundreds of thousands to millions when you take into account the database licenses at the infrastructure layer also. Healthcare IT leadership still passes. It’s not their priority to go against the department heads. 

Internal politics are everywhere. In healthcare, political might can win an argument when the proof in dollars are staggeringly in support of the other point.

I’d say this is changing in healthcare IT as many organizations are having their bottom line get worse and now some of those golden goose political situations are getting weaker.

The dollars of cost argument is winning the day here and there. It’s just the wins are only on small projects and applications to show the cost saving committee that we saved $50K. That’s for show. The real cost saving opportunities that exist are hundreds of thousands in savings.

Time Capsule: Every Time I Say It’s About Patient Care, You Tell Me It’s a Business: Healthcare IT Lessons Learned from “North Dallas Forty”

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

I wrote this piece in October 2008.

Every Time I Say It’s About Patient Care, You Tell Me It’s a Business: Healthcare IT Lessons Learned from “North Dallas Forty”
By Mr. HIStalk

One of my favorite and most insightful lines from any movie comes from “North Dallas Forty,” a cynical and dark football film from 1979. In a key scene, fictional football player O.W. Shaddock, masterfully played by former Oakland Raider John Matuszak, explodes his rage and frustration onto the team’s coaches, who constantly resort to using fear and ridicule to get tired and injured players to keep performing even when they shouldn’t. "Every time I say it’s a game, you tell me it’s a business. Every time I say it’s a business, you tell me it’s a game."

The quote may have been about sports, but it’s relevant to healthcare as well.

I’ve worked for both vendors and hospitals. There were plenty of times on both sides where I wanted to scream at management, “Every time I say it’s about patient care, you tell me it’s a business. Every time I say it’s a business, you tell me it’s about patient care.”

Our unusually capitalist approach to healthcare delivery is schizophrenic. Everybody understands giving massages or tummy tucks for the biggest fee the market will bear, but there’s something inherently distasteful in performing life-saving surgery or seeing patients through their final days of cancer while a business guy taps his calculator every now and then to remind everybody — including the patient — to keep the cost down.

IT is usually smack in the middle of that rift between clinicians and executives, the bearer of bad news about something one group wants that the other is loathe to deliver. Clinicians resent being told how to deliver care by $1 million hospital CEOs and their business-savvy underlings. The people in the mahogany offices can’t talk slowly enough about cost control to get the message across the financially naïve white coats who would bankrupt the place if someone wasn’t watching the till. Somebody wants a CPOE system or a tool to run a balanced scorecard and the IT person knows exactly which part of the organization will be calling for his or her head.

Clinical people working for vendors have the same struggle. They’re supervised by executives who not only have never delivered care, but who most often drifted into healthcare by accident and will probably drift right back out again someday. Every undelivered system enhancement or overstated capability make the clinicians want to scream like O.W. Shaddock, physically threatening an overconfident MBA vendor suit whose last service to others was whispering the Black-Scholes equation to a B-school classmate during a tough finance test.

We’re in a confounding business whose mission is frustratingly mixed. Deliver the best care or the best clinical software possible – as long as it’s profitable. If it’s not, the MBAs are ready to rush in and whip the widgets into shape. That’s a threat and a promise.

Maybe it would help to see how the other half lives. Clinicians should sit through the meetings in which life-or-death decisions are made that concern the health of the entire organization, not that of individual patients. Executives should have to face real patients and caregivers regularly just to remind themselves of a mission more important than fancy new buildings and slick marketing.

And IT folks working for both providers and vendors … well, there’s really nothing you can do except wait for the dust to settle and support and enable whatever strategic plan results. Those other folks are playing tug-of-war and you’re the rope.

Morning Headlines 5/3/13

Financial woes at Maine Medical Center

Maine Medical Center suffers a $13.4 million operating loss in the first half of the fiscal year, a situation CEO Richard Petersen calls a first in recent history. Petersen pointed to declining inpatient and outpatient volumes and an Epic install which is causing issues with billing. The remaining rollout of Epic is on hold until the situation is resolved. The system has also initiated a hiring freeze, cancelled unnecessary travel, and reduced overtime in an overall effort to save $15 million during the second half of the fiscal year.

March 2013 EHR Incentive Program Update

Almost half of all eligible providers have now received EHR incentive payments according to the most recent CMS update.

Post–Acute Care Riddled With Challenges and High Expectations

KLAS evaluates health IT vendors working in the post-acute care market following an ACO-driven surge in interest. HealthMEDX was the top rated vendor.

Hospital Execs Forecast Higher IT Spending

A survey of hospital executives finds that 43 percent say their largest anticipated investment for the coming year will be in health IT.

News 5/3/13

Top News

A selectman and software developer from Edgecomb, ME blames MaineHealth’s decision to close a local ER on the health system’s $150 million Epic implementation. The selectman’s letter to the editor to the local newspaper notes that MaineHealth has charged “millions of dollars” to member hospitals, but has had “a real failure in its implementation,” resulting in unplanned operational costs with minimal benefit to the state. Meanwhile, in a memo to employees last week, Maine Medical Center’s CEO listed several causes for its $13.4 million loss in the first half of the fiscal year, including “unintended financial consequences” of its Epic rollout as well as incorrect charging. The organization has placed further Epic implementations on hold as teams from Epic and the hospital try to fix problems.

HIStalk Announcements and Requests

A few HIStalk Practice highlights from the last week: patients say the most bothersome aspect of doctor visits is unclear or incomplete explanations of problems. Health Texas Provider Network partners with MediMobile for its mobile charge capture solution. The number of physician office jobs for billers and medical record clerks has declined sharply over the last two years. Epocrates is the most popular mobile app among US physician app users. Athenahealth names St. Boniface Haiti Foundation the winner of its 2013 Vision Award. Physicians are generally making more money this year than last, but are also spending more time on paperwork. Most news items on HIStalk Practice are not mentioned HIStalk, so peruse HIStalk Practice regularly to stay current on the ambulatory HIT world. Thanks for reading.

On the sponsor-only Jobs Page: Regional Sales Director, Senior Director of Business Development, Senior Manager Engineering Development, Open Positions in Development.

Acquisitions, Funding, Business, and Stock

Merge Healthcare reports Q1 results: revenue up 4.3 percent, EPS –$0.07 vs. –$0.02, missing earnings estimates.

API Healthcare announces the signing of over 25 contracts in Q1 and bookings that were 25 percent higher than the same period in  2012.

MedAssets announces Q1 numbers: revenue up 15.3 percent, adjusted EPS $0.41 vs. $0.24, beating expectations on both.

Athenahealth announces Q1 results: revenue up 30 percent, adjusted EPS $0.38 vs. $0.17, beating on both but adjusting fiscal year EPS guidance to below consensus.

Sales

University of Nevada School of Medicine chooses GE Healthcare’s Centricity Business, Centricity Practice Solution, and Centricity PACS-IW.

Filmore County Hospital (NE) selects NextGen Healthcare’s Inpatient Clinicals and Inpatient Financials.

Baylor Quality Alliance (TX) chooses Humedica MinedShare from Optum to analyze administrative and clinical data from payers, various EHRs, and the Baylor Health Care System HIE.

Louisiana Specialty Hospital will implement ONE-Electronic Health Record from RazorInsights. 

MD Anderson Cancer Center (TX) chooses Epic as its vendor of choice, according to an internal memo forwarded by a reader. Other readers had reported that same rumor late last week, saying that Epic had beaten Cerner as VOC.

People

UNC Health Care (NC) interim CIO Tracy Parham, RN is named permanent CIO, where she will lead its Epic project.

Parallon Business Solutions names John Guevara (Allscripts ) as CIO.

Patient Privacy Rights names Adrian Gropper, MD (HealthURL Consulting) as CTO.

Stephen Collins (Allscripts) is named president of Austin-based behavioral charting system vendor ChartAssist.

The Advisory Board Company CEO Robert Musslewhite is named by Washingtonian as one of its 100 Tech Titans and is also profiled in a feature in The New York Times.

Galen Healthcare Solutions appoints Joel Splan (Northwestern Memorial Healthcare) as CEO.

Announcements and Implementations

Rockdale Medical Center (GA) implements Nuance’s PowerScribe 360 voice recognition software for the dictation of imaging reports.

PointClear will move its corporate headquarters from Huntsville, AL to Dunwoody, GA.

McKesson recognizes Peninsula Regional Medical Center (MD) as the 2013 winner of its Distinguished Achievement Award for Clinical Excellence for effectively using McKesson technology along with Modified Early Warning Scores to proactively identify patients at risk for a code blue.

Aprima Medical Software will interface its EHR/PM system with the Homecare Homebase platform.

LHP Hospital Group implements McKesson’s Paragon HIS at Portneuf Medical Center (ID), Seton Medical Center Harker Heights (TX), and Texas Health Presbyterian Hospital WNJ (TX).

Elsevier launches its third annual “Superheroes of Nursing” contest and is accepting nominations for applicants in the categories of Achiever, Protector, Educator, Validator, and Connector.

SCI Solutions adds text appointment reminders to its Schedule Maximizer scheduling solution.

Modern Healthcare has corrected its article about the State of West Virginia’s payments to Medsphere for implementing OpenVista. The originally reported figure was $8.4 million per year, but that was actually the total amount spent since the contract was signed in 2005. Current payments are just under $1 million per year.

Mount Sinai Medical Center (NY) announces that it has enrolled 25,000 patients in its BioMe program, which links DNA samples to its Epic EMR information to support targeted medical care and to provide de-identified data for research. 

First Databank announces ICD-10 for Saudi Arabia at the HIMSS Middle East conference.

Government and Politics

HHS names Lyfechannel the winner of its healthfinder.gov Mobile App Challenge for its myfamily app, which helps individuals manage their family’s health through customized prevention information for each family member.

Healthcare modeling and analytics company Archimedes collaborates with CMS to give users easier access to public payer claims data.

CMS announces that hospitals and EPs have been paid $13.7 billion through the end of March, with $8.5 billion going to 8,558 hospitals and $5.2 billion to 255,722 EPs.

FDA launches the redesigned FDA Patient Network, which will educate patients and their advocates about FDA and will invite them to attend and present at FDA meetings.

Farzad Mostashari was a panelist in a discussion of technology in healthcare put on by Politico last week. The 77-minute video is of very high quality and it’s an interesting mix of people and topics.

CMS gets criticism for removing information on hospital-acquired conditions from its Hospital Compare site. CMS says the information is flawed and is redundant, but patient groups say CMS is buckling to the complaints of low-performing, high-profile hospitals.

Innovation and Research

Vanderbilt University launches the Health App Challenge to transform clinical summaries into a more patient-friendly form. Entries are due August 1, with the winner receiving $10,000 and up to five finalists being awarded $2,000 or more each.

Technology

Former Google Health product manager Missy Krasner, now involved in startups and an advisor to Box, says Google Health was a good idea in theory, but “It was a very bumpy user experience for even the most super-charged, IT savvy consumer.” She says Box will take over where Google Health left off for storing personal health records that it supports HIPAA requirements. She concludes, “So here is my hope for the future. If most EHRs can currently export a Continuity of Care Document (CCD) via the Clinical Document Architecture (CDA), why couldn’t Box grab that clinical care summary format and stylize it in a way that made sense to other doctors or patients via its documenting previewing technology? This would help the interoperability and file transfer juggernaut get a whole lot easier.”

FastCompany profiles companies started by founders who were frustrated with existing products, among them Amazing Charts.

Other

KLAS reports on the post-acute care market, which is critical for managing outcomes and costs. HealthMEDX was named the top performer among long-term care vendors with 100 percent of its customers saying the company keeps its promises and that they would buy HealthMEDX Vision again.

Weird News Andy summarizes this article as “coming clean.” Piedmont Healthcare (GA) admits that for two years it improperly cleaned colonoscopy requirement at one of its ambulatory surgery centers, requiring it to notify 456 patients that they should be tested for hepatitis and HIV. Employees cleaned the equipment with soap, but missed the disinfectant step.

Sponsor Updates

• T-System posts a photo gallery from its linkED 2013 Emergency Care Conference held in Dallas April 22-25.
• Emdat posts a case study from Illinois Bone and Joint Institute, which reduced documentation costs by 50 percent by implementing Emdat’s transcription software and the company’s mobile documentation tool.
• The Nashville Business Journal names Passport CEO Scott MacKenzie one of the most influential business executives in Middle Tennessee.
• First Databank hosts a May 14 Webinar on the use of RxNorm within information exchange and clinical quality measures.
• Kareo offers a May 16 Webinar that considers five activities to prevent a government audit.
• Executives from Yale-New Haven Health System, Hartford HealthCare, and North Shore-LIJ Health System will share strategies to reduce readmissions at the iHT2 Summit in New York City on September 17-18.
• Porter Research posts a presentation that provides insight into the trends, challenges, and benefits of engaging consumers in every stage of healthcare.
• Capsule Tech will exhibit at the annual MUSE conference May 28-31 in Washington, DC.
• Truven Health Analytics receives a five-year accreditation from the National Institute for Health and Care Excellence for its Micromedex Medication Management solution.
• The National Committee for Quality Assurance certifies Verisk Health’s Quality Intelligence solution to support quality reporting for commercial and Medicare Advantage populations in the California P4P program.
• As part of this week’s Medical Library Association Annual Meeting and Exhibition in Boston, Elsevier pledges to donate $1 to One Laptop Per Child for every ClinicalKey search made at Elsevier’s booth.
• Allscripts releases details on its annual ACE client conference in Chicago August 21-23.
• Liaison Healthcare launches its EHR Partner Program, which give participants access to orders and results connectivity to over 100 major lab and radiology service providers.

HIMSS opens the call for proposals for the 2014 conference in Orlando with 24 topic categories. If you’re like many of us in the non-profit trenches, being selected as a presenter may be the only way to go to a meeting, so good luck!

The hot topic in the physician lounge this week was HR 1701, the “Cutting Costly Codes Act of 2013.” Introduced by Representative Poe of Texas last week, it aims to block ICD-10 implementation. What surprises me most was the number of physicians who think the mere introduction of a bill will support their lack of preparation for ICD-10. News flash – if you haven’t started preparing, you’re already behind, and I certainly wouldn’t wait around to see if this becomes law before I get started.

It’s not health IT, but it’s my favorite story this week: “untethered microgrippers.” Engineers at Johns Hopkins are working on miniature devices to retrieve biopsy specimens. Although they’re not quite ready for human testing, they look cool and are promising as a mechanism to take multiple biopsies in hard-to-reach areas.

I almost missed this little tidbit in the Federal Register that would allow use of eight CMS record systems for emergency preparedness. The change would allow CMS to disclose individually identifiable records to “public health authorities and entities acting under a delegation of authority of a public health authority” for the purpose of providing health assistance in an emergency or disaster.

CMS issues a Call for Measures for potential Quality Reporting System items to be used in future rule-making years. CMS is focusing on measures that cover clinical outcomes, patient-reported outcomes, care coordination, safety, appropriateness, efficiency, patient experience, and patient engagement. Submissions must have strong scientific evidence, so I guess my “number of patients seen on time because they weren’t yakking on their phone when I entered the room” measure won’t make the cut.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 5/2/13

Trinity Health, Catholic Health East complete merger deal 

Trinity Health Systems and Catholic Health East have completed a merger that will make the new 79-hospital organization the second largest not-for-profit system in the country. Interim CEO Judith Persichilli recently said that the new organization will choose which EHR can best support their needs. Trinity uses Cerner, while Catholic Health East runs Meditech.

Project seeking ways to detect diabetes

New York University, NYU Langone Medical Center, and Blue Cross will collaborate on a project to develop machine-learning algorithms to identify cases of undiagnosed diabetes and to predict pre-diabetes.

The Defense-VA-Vendor Conference Nobody Wants You To Know About

The VA and DoD are holding a joint conference with EHR vendors to discuss the stalled iEHR project. The meeting will feature high-ranking speakers from both departments as well as representation from any vendor that expresses an interest in attending. The press has been explicitly prohibited from attending.

Finalists Announced!

The New York eHealth Collaborative’s Patient Portal For New Yorkers project announces nine finalists in its search for a statewide integrated patient portal. The finalists were selected by public voting and will pitch their products to a live audience and a panel of judges.

Readers Write: Never Had a Breach?

Never Had a Breach?
By Kev Larson

Never had a breach? I find it remarkable that so many on the HIStalk Advisory Panel can answer so swiftly, so confidently, and so authoritatively, “No, we have never had a breach.” 

I want to know how they know that. I want to know what they are doing — day in and day out — to monitor, audit, and confirm their operational performance that allows them to make that bold statement – the one that they report to HIStalk and its readers, their boards, and their patients.

I am sure you know the old saying, “The absence of evidence is not the evidence of absence.” For those that are reporting no breaches, just how hard are they looking? Would their staff even know what to report or how to report a potential breach? 

I am not saying that a perfect record is not in the realm of possibility. It is just so incredibly improbable that it defies common sense. I would really love to know the secret formula that has gotten those CIOs that report no breaches to the place where they have that level of confidence and certainty. I am sure others would, too.

Along these lines, I finally got a chance to read ISMG’s Healthcare Information Security Today Annual Survey in which 35 percent of the 200 respondents reported that their organizations had not suffered a breach of any size in the past 12 months. I realize that this is a dangerously low sample size, but let’s just take it at face value for the sake of illustration. The trend is not too terribly off from the responses from the HIStalk Advisory Panel. 

The question and response that really got me chuckling was this one, though. “What type of breach (of any size) has a BA with access to your organization’s patient information had in the past 12 months?” Can you believe that 59 percent of the respondents answered that their BAs had no breach of any size in the past 12 months? That is downright laughable and borderline reckless.   

CEs are doing precious little to evaluate, interrogate, or assess BA risk or compliance performance. Again, the absence of evidence is not the evidence of absence. If a CE responded to this question based on the BA’s self-report to them alone, that should not be enough information to give that BA a clean bill of health. We have to hold them to more rigorous criteria than that. 

The certain truth is the universe of BAs is exponentially larger than that of CEs, and BAs have only recently received the formal mandate to fully comply with HIPAA.  We have a long way to go in the BA community and CEs should be guarded, probative, and assertive in the management of their BAs. We cannot wait 10 years for our BAs to catch up.

What really matters in this discussion is what has changed under Omnibus. One of the most significant changes is that the Omnibus Rule replaces the “risk of harm” test that was so contentious in the interim final rule with a default presumption that any acquisition, access, use, or disclosure of PHI in a manner not permitted by the HIPAA Privacy Rule is a breach unless the CE or BA “demonstrates that there is a low probability that the [PHI] has been compromised based on a risk assessment.” [78 Fed. Reg. at 5,695] 

Kudos to the organizations that have employed a breach risk assessment process and have implemented it consistently. Interestingly, they seem to be the ones reporting their breaches in real time, even the small ones that they could have reported later. They have a real process and are actively demonstrating a posture of continuous compliance, which is the desired state according to OCR. 

However, there are a whole bunch of organizations that are just winging it. They have no process, no criteria, no tools, and no commitment. We see it all too often and it is just not enough.

Take the five-month window before you must comply with Omnibus to shore up this part of your program –  all things related to breach risk. Consider working with an expert consulting firm to help you. This is probably an area where a little investment can go a long way. 

Readers Write: Are Hospital EHR Vendors Primarily Software or Services Companies?

Are Hospital EHR Vendors Primarily Software or Services Companies?
By Kyle Samani

Hospital EHR vendors are not primarily software companies with professional services divisions. They are primarily professional service companies with software divisions.

Although the core value of hospital EHR companies is the software they develop, the bulk of the value they provide is in training, data conversion, setup, logistics, and support. These services are built on top of the software that they support, but are collectively more valuable than the software itself.

I’ve seen the challenge of deploying an EHR in a hospital first hand. Most of the challenges are with the people, not the software. Hospital EHR vendors derive most of their value for their professional services.

Hospital EHR vendors employ more services staff than software staff. At least 60 percent of the employees at the major hospital EHR vendors are in deployment and support services, not software design, development, testing, or administrative functions. Employees, especially road warriors, are expensive. The more employees involved in a given division, the more expensive and valuable that division is.

But perhaps even more important than sheer costs, healthcare IT staff need to receive sophisticated training in hospital workflows and software systems. Before the HITECH Act, there weren’t enough people with healthcare IT skills to deploy the entire country in five or six years. Many argue that there still aren’t enough people. The EHR vendors had to develop large-scale internal training programs to teach all of these people how to set up, train, deploy, and support hospitals. This is one of the greatest sources of value that the big EHR vendors have generated: an educated healthcare IT workforce. The scale and scope at which they’ve done that has been remarkable.

Epic employs 6,400 people and Cerner 11,900. I would estimate that at least 60 percent of those – or 11,000 people in just these two companies – work in training, deployment, and support roles. These companies and many others have developed phenomenally large internal training programs for their employees, who are usually fresh college graduates.

To provide a sense of scale, the University of Texas at Austin — one of the largest universities in the country by enrollment (60,000+ students) and located in a major US technology center — boasts that it has graduated a grand total of 333 people in its 9-10-week-long healthcare IT program since its inception a few years ago. Vendors are educating the workforce, not the educational system.

Training and conversion costs usually prevent hospitals from switching EHRs. These costs are multi-dimensional, spanning financial cost, employee personal costs, and opportunity cost of working through other initiatives such as Meaningful Use 2 and ICD-10.

As an employee at a smaller hospital EHR vendor, I’ve experienced this phenomenon. We are trying to spearhead the replacement market for hospitals that are dissatisfied with their legacy EHRs. Most of them love our product and are even willing to pay, but aren’t willing to change systems because the non-financial costs of change are too great for the organization.

Because the costs of switching are high, the cost of choosing the wrong EHR the first time is even higher. Most large software projects that fail do so because of the people, processes, and cultures, not because the software isn’t capable. In that sense, the services surrounding the software implementation are even more important than the software itself. The majority of the value that the vendors provide is in services, not software.

Looking at hospital EHR vendors as service companies can help understand management decisions that may not have made sense when looking at them as software companies. Decisions are made based on training and deployment realities, not software limitations. This analytical framework can also help explain vendor practices and methodologies (especially hiring), release cycles, growth rates, stability, and many other operating metrics.

Kyle Samani is inpatient deployment manager at VersaSuite of Austin, TX.

CIO Unplugged 5/1/13

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

It’s Not About the Rock: The Remote Village that Turned our Lives Upside Down
(Part 2 of 2)

While the majority of us climbed Kili, five of our team — including my wife and daughter — went to the village and succeeded in making introductions, finalizing plans, and educating. The village elders opened the schools, and the advance team covered critical subjects on the basics: nutrition, health, and universal precautions.

By the time the rest of us arrived, clinic construction was still a few days behind. We would open without water or electricity.

June 22, opening day. Seventeen of 20 senators plus the former Tanzanian Prime Minister attended the incredible ribbon-cutting celebration. Doug and Martha represented our team, and with the Prime Minister, blessed the clinic. Villagers dressed in a vast array of colors, surrounded their new clinic, singing in Maa. This put most of our team in tears; I hid mine behind a camera lens. We were all humbled and a little shocked by the fanfare and how much this meant to the Maasai and their country. Media from all over Tanzania rolled cameras and a major party wrapped up opening day.

Talitha Marx

The following morning, we opened for business. Winjie and Liz had us well organized. We had a doc and medical assistant for each of the four treatment rooms plus another working in the lobby. The triage unit included two assistants and two translators. They started the medical records, took vitals, and prioritized patients. Two women manning the supply room / pharmacy / break room dispensed meds and supplies. The rest of us rotated between crowd control and entertaining all the kids. We played lots of soccer and taught them football and Frisbee.

Our first patient was a young mother who had not felt her baby move in 36 hours. “Oh great,” I heard myself saying. “What if our first two patients die?” What would be the risk to the clinic longevity? Would the villagers turn hostile? Had we lured all these people here to die? Even if the village accepted the deaths, it would cast a dour vibe over our clinic. What an ominous beginning. I prayed, but, as much as I hate to admit it, I was more negative than positive.

While I was getting uptight, the team swung into action. One of our docs happened to be an OB/GYN. Liz also went into our “birthing suite.” She held the mother’s hand and assisted her OB/GYN husband with the delivery.

Outside, it seemed the entire village had gathered as news spread quickly (without FaceBook). Crowds pressed in and my thoughts grew darker as we held the line. I could hear the rest of the team behind me going in and out of the room, but no baby. Someone shouted for one of the other docs, who by coincidence happened to be a neonatologist. When he entered the room, I figured the baby had been born. Unbeknownst to me, our CEO, his wife, and some of our ladies met inside the pharmacy room, held hands, and prayed.

Silence fueled my anxiety. The eager crowd grew antsy. Some had traveled many miles to receive treatment and this incident held things up.

Resuscitation attempts were underway. Lacking requisite equipment, improvisation came into play. A plastic baggie turned into an ambu bag; a shoelace became a clamp. Ten minutes passed. The baby took a breath on her own. The precious infant pinked up, and then … the cry that loosed hope. Those in the birthing room heaved deep sighs and shed tears. That one cry carried a message to all the villagers and (as we found out later) reached the Serengeti, a four-hour drive away.

Open Arms Clinic is a good place!

Baby Elizabeth at birth, with neonatologist Darryl Miao, MD

Isina suffered a second-degree tear. The only suture available was a 5-0 chromic suture, and no needle driver. The OB/GYN found makeshift suture scissors and sewed up the tear. All this time, Liz had been consoling Isina, acting as her birthing coach. She had built a bond with this first-time mother. Toward the end, Isina asked her name, and she replied, “Elizabeth Ransom.” While the physicians are working, Isina announced, “I am naming my baby Elizabeth.” 

Everyone in the room broke out in tears. Nine months prior, Elizabeth Ransom had been the doctor who originally suggested we set up a clinic. Coincidence?

Talitha Marx at TEDxKids

We learned many things in June 2011. A few universal leadership gems include:

THR CEO Doug Hawthorne and UNTHSC  CEO Scott Ransom, MD

• Leaders serve. We saw this over and over again, but perhaps nowhere as poignantly as when we caught the Texas Health CEO and UNTHSC CEO kneeling and wiping up urine from an exam room floor. This was not posed.
• Want what you have because you may not have what you want. We had sparse equipment and facilities. But compared to the locals, we were blessed. Had we focused on what we did not have, our time would have been miserable and full of complaint. Rather we learned to accept the circumstances and did what we could. That is where joy came.
• Influence knows no boundaries. My then 17-year-old daughter Talitha was the bridge between the villagers and our team. From the mouth of babes. Don’t ever tell me title or experience matters. This video above tells the story from her perspective via TEDxKids.
• Innovation. Our clinical improvisation saved lives and healed wounds. Always think outside of the box. When the right tools don’t exist, make them.
• Rewards beyond the vision. We came prepared for any opportunity. While Open Arms Clinic was our mission focus, the team was ready for anything. When the elders realized we could teach the village about universal precautions and nutrition, school was called back in session.

Baby Elizabeth at age 20 months, two months ago

The Open Arms Clinic continues to serve the village today. An African physician and nurse run the operation. Residents from UTSW will begin rotations there in 2014. The government continues to honor its commitment of service. Several from our team continue to offer in-kind support.

We took care of 350-plus patients and witnessed various other miracles that week. We went to climb a mountain, but found our trip wasn’t about Kilimanjaro. While we impacted a village of 10,000 in a remote part of the world, that village turned our own world upside down. We came back changed, transformed, as the villagers were. We grew as leaders. As friends. As individuals. We found ourselves. We deepened our faith. Our lives will never be the same. It’s not about the rock.

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

Morning Headlines 5/1/13

Texas lawmaker introduces bill to ban ICD-10 implementation

Rep. Ted Poe (R-Texas) introduces H.R.1701, "Cutting Costly Codes Act of 2013," which would prohibit HHS from replacing ICD-9 with ICD-10. The bill has no co-sponsors and has been referred to the Committee on Energy and Commerce and the Committee on Ways and Means for further consideration.

Nuance shares sink on profit drop

In Q1, Nuance’s net income drops to $110.4 million, down from $138.8 million last year. EPS $0.34 vs $0.43. Shares dropped 19 percent by the close of trading Tuesday. The company also announced a $500 million share buyback plan today as hostile corporate takeover specialist Carl Icahn continues to build his stake in the company, which now stands at 10.7 percent.

Case study: Breach increases risk of fraud

A case study examining the 2012 Utah Department of Health data breach that compromised 780,000 individuals found that in 2010, one in 10 individuals who received a data breach notification became a victim of fraud, but that in 2012, that number jumped to one in four.

Senators urge Obama to help resolve veterans claims backlog

A bipartisan group of 67 senators sent a letter to President Obama asking that he take direct action in resolving the VA’s backlog of veteran disability claims.

News 5/1/13

Top News

Greenway Medical announces that it will swing to a loss for the current fiscal year because of declining sales and deferred revenue. The company’s fiscal year earnings estimate of $0.10 to $0.17 on $145-$150 million in revenue was revised to a loss of $0.11 to $0.13 on revenue of $132-$134 million. The fiscal year ends June 30. Shares dropped from Friday’s $16.05 close to just above $12 by Tuesday morning, but had rebounded to $13.47 by Tuesday’s close. Above is the one-year GWAY share price (blue) vs. the S&P 500 (red).

Reader Comments

From Big Tex: “Re: Epic deals. St. David’s Healthcare in Austin and Methodist in Houston are both heading to Epic, though I don’t think either has officially announced yet.” Unverified.

From John: “Re: interesting comment from an FBR analyst covering Nuance’s poor earnings announcement. ‘While several industry/external (smart phone consolidation, transcription transition, EMEA weakness) factors have put pressure on mobile and healthcare growth, we believe the blame lies squarely around Nuance’s execution in the field, coupled with management’s feverish acquisition strategy over the last year, which has put onerous integration risks back into the Nuance story. While we believe potential activism could put a floor on Nuance shares and ultimately enhance shareholder value over time (e.g., management changes, split-up of the company, M&A path), we find it hard to remain positive on the Nuance story as the company goes through a challenging transition process in its business over the next six to nine months.’” Carl Icahn just announced that he’s loaded up on more shares, so the surprisingly poor results for both revenue and earnings help make his eventual argument that the company should be broken up or sold outright.

From Mr. Eko: “Re: HIMSS Middle East. Started Monday. Some American-based companies there are Cerner, GE, and Medicity. Judy Faulkner, CEO of Epic, was spotted yesterday morning eating breakfast in the Four Seasons hotel. Rumor has it they are pitching to the Ministry of Health for Saudi Arabia.”

From Giles: “Re: healthcare IT decision making. Interesting reader comments. What’s your opinion?” I agree with some of the comments that healthcare organizations are quicker to promote and retain executives who wouldn’t qualify for comparable jobs in most other industries based on their education and experience. However, healthcare is a different world, trying to balance the demands of an increasingly interventionist government, regulators, special interests, politicians, clinicians, community leaders, and giant insurance companies with the patients and families who are hardly typical customers. I’ve seen cases where hotshot IT people from allegedly more progressive sectors were brought in with near disastrous results, even though the IT shop looked like a showcase on paper. Some healthcare CIOs are not very good at strategic planning, management, and customer engagement, but they have a small domain with minimal clout and high operating and capital expenses due to decisions almost always made by someone else with more influence. Healthcare CIOs also aren’t given a lot of unilateral decision-making over anything other than infrastructure – everybody likes to suggest and approve massive change management projects that get incorrectly tagged as IT initiatives, but those folks disappear when their own lack of leadership ability starts sending the project down the drain due to poor user acceptance, lack of resources, and poor project decisions. My opinion, therefore, is that healthcare IT leaders aren’t empowered to make a lot of decisions on their own, are struggling to deal with the mess foisted upon them by their fellow executives and third parties, and are trying to deal with the squeeze of ever-increasing demand with an ever-decreasing budget. I’m fairly certain that swapping them out with fat-resume private sector CIOs wouldn’t make much difference on the plus side of the ledger, but would cause all kinds of unintended consequences to patient care. It’s easy to shoot the messenger, and with regard to many high-profile projects, that’s all the CIO is allowed to be. If nothing else, consider the high degree of CIO turnover – if all it took was new people in the chair, you’d be seeing wide swings in success from that alone and that’s not the case.

HIStalk Announcements and Requests

The global reach of @histalk here at #himssME at the Faisalea Tower in Riyadh #HealthIT twitter.com/drnic1/status/…

— Nick van Terheyden (@drnic1) April 30, 2013

Nick van Terheyden, MBBS, CMIO of Nuance, posted the cool photo above on Twitter. If you’re traveling anywhere interesting, send a fun local photo with something that identifies HIStalk and I’ll run it here.

Welcome to new HIStalk Gold Sponsor Porter Research, A Billian Company. The company provides its clients with customized market intelligence and research insight that includes go-to-market strategy, focus groups, win-loss analysis, prospect profiling and lead generation, competitive analysis, customer and market analysis, and M&A research. Don Graham (GM of both Porter Research and Billian’s HealthDATA) and Cynthia Porter (president) have many years of industry experience with major healthcare IT firms. The company offers a brochure, case studies, a newsletter, and white papers that illustrate its expertise. Thanks to Porter Research for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Emdeon completes re-pricing of its existing senior secured credit facilities, securing lower interest rates on its term and revolving loans.

Nuance reports Q2 results: revenue up 15.9 percent, EPS $0.34 vs. $0.43, missing estimates on both and sending shares down 18 percent and increasing speculation that activist investor Carl Icahn will use his recently acquired 10.7 percent of the company’s shares to force a breakup.

USARAD.com launches SecondOpinions.com, which offers same-day medical second opinions. Radiology-related reports range from $29 for an X-ray to $99 for an MRI. The company also offers second opinions for primary care, surgery, dermatology, and other services.

Forms automation vendor FormFast opens a UK-based subsidiary.

Sales

Trinity Health (MI) signs a multi-year agreement with Explorys for data analytics solutions.

Saint Mary’s Regional Medical Center (NV), Renown Health (NV), and Chandler Regional Medical Center (AZ) select MRO Corp.’s ROI Online platform to manage release of information.

West Florida ACO will deploy Sandlot Connect, Dimensions, and Metrix from Sandlot Solutions for patient health information management.

Methodist Health System (NE) selects Wolters Kluwer ProVation Medical software for its gastroenterology procedure documentation and coding.

Amerinet contracts with Cornerstone Advisors Group to provide HIT advisory and implementation services to its group purchasing members.

Tri-State Orthopaedics (IN) selects SRS EHR for its 24 providers.

Saudi Arabia’s King Fahd University Hospital will implement Nuance Healthcare Dragon Medical 360 | Network Edition hospital-wide.

The Cleveland Clinic’s MyPractice Healthcare Solutions will provide project management and implementation assistance to Glens Falls Hospital (NY) as it deploys Epic at its physician and specialty practices.

People

MedMatica Consulting Associates appoints Jerry Howell (KPMG) CEO and a member of the company’s board of directors.

Thomas H. Lee, MD (Partners HealthCare) joins Press Ganey as chief medical officer.

CSI Healthcare IT hires Martin O’Neil (Charts In Time) as health information management practice director.

Meditab Software appoints Adele Nasr (WebMetro) VP of marketing.

A. John Blair III, MD, CEO of EMR consulting firm MedAllies, is elected chair of independent Direct community DirectTrust.org.

Christopher Mansueti, former VP of client services for RelWare, died Friday, April 26 of amyotrophic lateral sclerosis. He was 53.

Announcements and Implementations

VHA, Inc. adds physician dashboards to enhance its VHA IMPERATIV Advantage performance improvement solution, which leverages transactional-level data through Truven Health Analytics and UHC.

MDI Achieve, provider of the MatrixCare EHR for long-term acute care, will integrate with Homecare Homebase, a provider of homecare and hospice technology solutions.

Heywood Hospital (MA) streamlines clinician workflow following its implementation of Accent On Integration’s Accelero Connect integration platform.

Samaritan Albany General Hospital (OR) moves from Meditech to Epic this week.

Transylvania Regional Hospital (NC) goes live on Cerner.

Children’s Hospitals and Clinics of Minnesota implements wireless data transmission between Cerner’s EMR and CareFusion’s infusion pumps.

PeriGen recognizes its client Banner Health (AZ) for reducing unnecessary early-term deliveries by 22 percent, earning the health system a Showcase in Excellence Award from the Arizona Quality Alliance.

Florida Hospital Tampa implements the EarlySense bedside patient monitoring system.

A Modern Healthcare article covers the State of West Virginia’s VistA implementation. It’s paying Medsphere $8.4 million per year for support and an unspecified amount to InterSystems for Cache’ licenses. The state also added financial systems from NTT DATA to replace VistA’s minimal capabilities. Update: Modern Healthcare issued a correction to this article – Medsphere has been paid $8.4 million over the life of the contract (since 2005), around $940,000 per year.

The Pittsburgh paper profiles Omnyx, a five-year-old digital pathology systems vendor formed as a joint venture between UPMC and GE Healthcare.

Government and Politics

Arizona lawmakers pass legislation that will require health insurers to pay for telemedicine treatment for certain specific conditions for patients living in 13 rural counties.

Rep. Ted Poe (R-TX) introduces a bill that would prohibit HHS from mandating providers to switch to ICD-10 code sets, which Poe contends would cost about $80,000 for individual doctors and $250,000 for practices with five to 10 physicians.

A bipartisan group of 67 senators sends President Obama a letter calling for him to be more directly involved in the VA’s disability claims backlog situation. The senators note that the average wait time for first-time disability claims is around 316 days, with a delay of up to 681 days in certain parts of the country. Of 900,000 pending claims, more than 600,000 are over 125 days old.

Innovation and Research

A peer-reviewed article published by the CDC finds that the interface technology of Intelligent Medical Objects is superior to population classification techniques as a disease surveillance tool. The findings are based on a study that showed IMO terminology service was 32 to 42 percent more accurate in identifying coronary heart disease compared to algorithms using reimbursement coding and classification techniques in identifying coronary heart disease.

Technology

AirStrip Technologies settles its patent dispute with MVisum, Inc., a competitor it accused of infringing on its patent for real-time viewing of patient data on mobile devices. MVisum agreed not to offer infringing products that include “streaming or displaying real time or near real-time patient physiological data.”

NextGen Healthcare launches Comparison Utility, a proprietary ICD-9/ICD-10 comparison tool that is available a no charge to its customers.

Healthcare Holdings Group acquires the exclusive rights to 3D-Practice’s patient education graphics technology, which it will embed in its ChartZoneMD EHR.

Other

Athenahealth and MIT’s H@cking Medicine host a May 4-5 Hack-a-Thon aimed at at bringing about disruptive and meaningful solutions to healthcare challenges.

Anthony Weiner, the former Congressman who resigned after admitting to sending sexually suggestive text messages and photos to several women, is making big money as a corporate consultant. One of his clients is EMR vendor CureMD.

Here’s Imprivata’s latest HIT cartoon.

• DrFirst publishes a white paper highlighting the 428 percent growth in e-prescribing for controlled substances.
• Medseek holds the inaugural meeting of its Clinical Advisory Council , formed to enhance patient engagement.
• MedAptus highlights three customers and their seamless integrations between the MedAptus charge capture solution and their EHRs.
• GetWellNetwork recognizes 12 hospitals and individuals for improving clinical care and outcomes through the use of IPC technology.
• Inland Northwest Health Services releases its 2012 Community Report.
• Martin’s Point Health Care (ME) discusses how its use of PopulationManager by ForwardHealth Group has improved its ability to respond to patient needs, identify gaps in care, and make systemic changes based on performance.
• Imprivata hosts May 9 Webinar introducing the benefits of OneSign for healthcare.
• Nuesoft hosts a May 8 Webinar on  using technology to improve revenue cycle.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

Morning Headlines 4/30/13

Greenway Revises Fiscal 2013 Outlook

Greenway revises its full-year 2013 outlook, lowering total revenue from $145-$150 million to $132-$134 million and revising its EPS forecast from a profit of $0.10 to a loss of $0.13. The stock dropped 22 percent by the closing bell.

Hospital to adopt new record system 

Samaritan Albany General Hospital on Thursday will become the second facility of five-hospital Samaritan Health Services to go live on Epic. The entire health system is scheduled to be implemented by the end of the summer.

athenahealth Hosts Health Care Hack-a-Thon

Athenahealth and MIT partner to host a hackathon at the company’s Watertown, MA headquarters on May 4-5. The event brings together innovators from science, medicine, and health IT to pitch disruptive solutions to the problems faced in healthcare. Judges from Harvard University, Blueprint Health, and others will select the winners.

Patient satisfaction with health care hits two-decade high

A recent American Customer Satisfaction Index report finds that heath care satisfaction has reached 80 on a scale of 100, up 1.9 percent from the previous year, the highest satisfaction scores have climbed in 20 years.

Readers Write: Achieving Value, A Different Kind of Medical Miracle

Achieving Value, A Different Kind of Medical Miracle
By David Bond

Practice management system (PMS) vendors have long sought to provide their physician customers with more capabilities than just traditional practice management and EHR capabilities. Specifically, providing outsourced patient statements and RCM services are some of the most important opportunities that have been identified to bring greater value to their customers and increased revenue to their firm.

However what I’ve seen is quite frankly an assortment of “half-measure” solutions that don’t efficiently utilize today’s interconnected world: portals that aren’t truly integrated, systems that don’t enhance a practices workflow or focus on usability for both the practice and patient alike. More importantly, that seek to find a solution that yields untapped profit opportunities for those PMS vendors that are able to satisfy these requirements.

In fact, many PMS vendors are mired in paper-based billing methods or a clunky billing portal instead of looking to implement an integrated solution that truly drives value for both the practice and the patient. I also find it interesting that most of these current billing mechanisms do little to significantly boost the profit margins of the PMS vendors offering these services in addition to their core offerings.

My aim is not to criticize these companies, as many have been very successful and offer fantastic products that are of use to their customers, but instead offer insight into new opportunities they can adopt to increase their efficiency and profitability. While the PMS providers might feel their current outsourced paper billing solutions put them in a more favorable light with their physicians, they do little to put more profits in their own pockets, streamline the billing process, help practices with their workflow, create clarity for patients, speed time to payment, or reduce errors on the back end.

Instead of going with a traditional solution that only marginally helps PMS vendors, how about something that can be easily integrated with most solutions and be welcomed with open arms by medical practices and patients alike?

Online billing, patient balance management, and reconciliation services that can be easily integrated with most PMS vendor offerings is in fact a reality today. It drastically reduces the need for paper bills and the cost and delays they create and makes obsolete billing portals that are not truly integrated. Presenting patient statements that are easily understood and allocate the remittance precisely to the services that were received creates clarity for everyone and is highly profitable for any PMS vendor looking to bolster their bottom line through a recurring revenue stream.

Want proof? A major PMS vendor ran the numbers and realized an additional $3 million in pure profit by integrating this capability with its core practice management offering used by 3,500 medical practices. I don’t care who you are, this is real money.

If you’re a PMS vendor and want to achieve real value, both in profitability and long-term customer retention, providing a simple and integrated online bill pay solution will get you there.

David Bond is EVP of PatientPay of Durham, NC.