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Readers Write: Top Technologies in Private Practice for 2015 and Beyond

February 4, 2015 Readers Write No Comments

Top Technologies in Private Practice for 2015 and Beyond
By Arman Samani


As we enter into 2015, healthcare is entering an era where it must compete for the patient’s time and attention. Mobile and cloud computing are now pervasive enablers of other technologies that physicians can and should be leveraging. Mobile and cloud are attributes of other technologies rather than a technology or trend themselves.

As payment reform is progressing and we are switching from fee-for-service to fee for value models, it is critical that private practices take steps in 2015 to prepare for this new reimbursement model. This preparation will steer practices toward doing the right things for their patients as well their businesses. Practice management, EHR, patient relationship management, actionable analytics, and interoperability are broad categories that a private practice should evaluate carefully to be prepared for long-term growth.

Health watcher technologies are enablers of proactive patient engagement. According to the recent IDTechEx report on the wearables market for healthcare, the market is projected to grow from $14 billion in 2014 to more than $70 billion in 2024. This booming market is an opportunity for physicians to shift into the role of “health watcher” for their patients. The industry can no longer function in reactive ways to patients initiating visits. Both Apple and Samsung have introduced health tracking frameworks and data repositories in their mobile devices, and as a result, consumers will soon be wearing devices such as Apple Watch and Samsung wearables.

Not only can someone track how many steps or even floors they have walked, but health statistics like heart rate and blood pressure can be measured. Private practices should think about integrating this patient base data into their EHR in order to provide proactive and preventative actions to their patient population. Not only is this the right thing to do for the patients, it increases the practice revenue, enhances reputation, and decreases healthcare costs. While appointment reminder technology is now mainstream, health reminder communications such as email, text, and phone calls will be become mainstream in 2015 and beyond.

With the rise of mobile computing, convenience will be an important factor. A 2014 study from Manhattan Research found two in five physicians agreed that using digital technology to communicate with patients will improve patient outcomes. Starting January 2015, CMS will start paying for chronic care management, wellness visits, and psychotherapy services. The telemedicine cash business has been growing for a few years and now that CMS has expanded reimbursement for telemedicine, private practices need to start putting business processes and technologies together to take advantage of this growing market and offering a convenient way for their patients to save time and get readily accessible preventative care.

With industry regulations such as ICD-10 imminent, practice management software has to be ready to support the increased complexity in coding. However, the effects of an expanded code base aren’t all about technology. Patient visits and the associated workflows, from the moment a patient arrives through to receiving a claim payment, need to change in fundamental ways. The questions that are asked and data that is collected right at the point of care are also affected. Practices need to stop thinking of coding as data entry and make it a proactive process that happens in real time. Practices that don’t plan for this shift may see a rise in claim denials — the aftermath that creates may overwhelm staff and burden the business. Practices should do ICD-10 risk assessment now.

With cloud technologies, big data is no longer only for large health systems. From patient health monitoring to quality measures, accounts receivable and payer reimbursement, and more should be provided in easy and actionable analytics. In addition to actionable analytics for the different aspects of business, it is important to benchmark a practice against other practices or the industry as whole. Otherwise, a practice might never know how well it is doing and what new goals should be set. Benchmarking tells the practice manager where their business stands compared to other practices. It helps answer questions such as how much the practice is getting paid relative to other practices and if it needs to start collecting more for certain services. Analytics can measure these factors relative to the practice’s goals and in comparison to other practices. Benchmarking is complex and time consuming, but cloud providers of EHR and practice management technologies are especially well positioned to provide these benchmarking services.

Practices are overwhelmed with data and technology providers need to move beyond providing dashboards and monitoring trends. Big data must now be a driving force for actionable alerts that trigger automated staff or even patient actions. Physicians might be asking what treatment plan or medications other doctors are prescribing for the same diagnosis. Analytics data can help with matching up patients who share the same condition so they can compare notes and even create support groups.

All practices play a role in the healthcare ecosystem. Most practices receive patient referrals from or give patient referrals to other practices or care settings. It is important to have seamless transition of care among entities to save time and money and provide patients with excellent and convenient service. Interoperability will enable sending and receiving summary of care documents and other necessary information about the patient care continuum. Interoperable systems will be able to store patient information such as discrete data points within the EHR automatically. This will allow practices to not have to ask the same questions from patient multiple times and will expedite care, increase care quality, and decrease costs by avoiding unnecessary procedures and tests.

The pace of innovation in healthcare has immense potential to advance the quality of care in 2015 and beyond. Smart practices need to prepare and adopt for upcoming healthcare reforms and provide proactive preventative care for their patients. This is not only good business but also the right thing to do for the patients and communities.

Arman Samani is CTO of ADP AdvancedMD of South Jordan, UT. 

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February 4, 2015 Readers Write No Comments

Readers Write: EHR Ease of Use is Not Easy

February 4, 2015 Readers Write 3 Comments

EHR Ease of Use is Not Easy
By Lee Farabaugh


Usability shows no signs of losing its luster as a buzzword in health IT. Coverage of a usability collaborative involving the efforts of the Electronic Health Record Association, the American Medical Association (AMA), and the American College of Physicians to improve user-centered design of EHRs in the context of the Meaningful Use program has certainly escalated. I

It’s no secret that EHR usability is, generally-speaking, pretty abysmal. There are standouts in the realm of interface design excellence – think of the award-winning PracticeFusion and athenahealth. But the overwhelming response to EHRs from the physician community is a groundswell of complaints over poor design, longer patient encounters, time-consuming documentation, and slow information retrieval response time.

The AMA recently published an article entitled “Improving Care: Priorities to Improve Electronic Health Record Usability” that identifies eight EHR usability principles, including supporting team-based care, promoting care coordination, and reducing cognitive workload through a user-centered design (UCD) approach. But even the AMA admits that while “some vendors have implemented user-centered design … their results have been inconsistent and many other vendors have not [even] implemented UCD.”

Apparently it’s not as simple as just applying the UCD process of user research, iterative design, and usability testing to the field of EHR design. Mary Kate Foley, VP of user experience at athenahealth, perhaps says it best: “Our industry has been talking about EHRs for years now, and if it were simple to make EHRs easy to use, we’d be done by now.”

EHR interface design is still subject to the design choices of individual interaction, visual, and user experience designers. While we’ve become used to the new flat UI convention on our iPhones, the vast majority of EHRs still look like snapshots from the past. In short, we don’t typically look to EHRs to be on the cutting edge, whether in terms of visual design conventions or adherence to UI design best practices.

The AMA calls for “the development of a common style guide – designed through collaboration between physicians and vendors – so physicians who practice in different care settings can move from one EHR to another.” But it’s not just physicians who stand to benefit. This type of common design framework frees organizations to make changes to their toolset because they don’t have to fear a steep learning curve for providers on a new interface.

How can we as designers support these efforts?

  • Remember that EHR design affects not only physicians, but patients, too. Patient tools, while separate from the EHR itself, both push information to and pull information from the EHR, making patients de facto EHR users by default.
  • Acknowledge existing efforts to reach a common design language in EHR interface design. Juhan Sonin, Jeff Belden, and Catherine Plaisant, among others, have created a nice start towards an EHR style guide for the industry at Their work includes medication lists, allergy lists, and drug alerts.
  • Continue to push forward with additional design patterns. One area where common design vocabulary is needed is the patient banner. EHRs should employ common conventions for elements such as patient name, gender, date of birth, allergies, etc. that typically appear in this space, and balance information communication with respect for screen real estate.
  • Educate our colleagues in industry about the importance of understanding and designing for the way real humans think and work. In my course on user-centered design for healthcare at UAB’s Masters Program in Health Informatics, my students (nurses, business analysts, and EHR vendors) are learning about how humans process information, think irrationally, and act according to behavior patterns that point the way towards more intuitive design.

EHR usability isn’t easy. It involves a complex interplay of care teams, workflows, the legacy of paper charts, and the promise of a design language we can all speak. But the need is real, and as the focus on “checking the box” for MU fades away, we’ll get down to the real business of not just using EHRs in a meaningful way, but in a delightful way.

Lee Farabaugh is chief experience officer at PointClear Solutions of Atlanta, GA.

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February 4, 2015 Readers Write 3 Comments

Health IT from the CIO’s Chair 2/4/15

February 4, 2015 Darren Dworkin No Comments

Fine print: The views and opinions expressed in this article are mine personally and are not necessarily representative of current or former employers.

IT and the Big Rooms

Talking about change in IT is nothing new, but it feels like less has been written about the changing role of IT in the C-suite and at the board. Since I believe we are in the midst of a new shift, I wanted to raise the topic.

For the most part, the makeup and composition of C-suites and boards defies generalization. Company size, business sector, and stage — combined with the wide breadth of talent and backgrounds that compose these groups — makes them all unique.

But if I were to generalize, I would say that the trait that cuts across most C-suites (and certainly most boards) is the aversion to risk. IT has delivered many successes over the years and certainly in the last decade, but it is still often seen though this lens of risk.

If risk is the language, how can we leverage the opportunity?

Change, Change, Change

In the 1960s, the MIS manager (remember that title?) was a stranger to the big rooms like the C-suite and board. In fact, the common habitat of MIS was in an office in the basement near the IBM mainframe.

In the late 1970s with PCs, networking, and user interfaces that finally were not just green or amber, the groundwork was laid for a fresh look at the governance role of IT as the number of computer users started to grow.

By the mid to late 1980s, the IT executive began to emerge, MIS started giving way to IT, and our first CIOs were anointed. But the real shift in the C-suites, while not yet really inviting IT to the table, began the change to centralize IT budgets and gave large amounts of control to the IT head (MIS manager or CIO, depending on how trendy the company wanted to be back then).

In the 1990s, the big rooms still viewed the discussion of IT to be mainly approving the annual IT capital budget. For the most part, they did not really react much to the explosion onto the scene of little things like distributed computing, the World Wide Web, and the mobile phone.

Then came Y2K. The big rooms now had to deal with not just risk from IT, but material risk. In many companies, this was among the first active involvements of IT in the business conversation. While not thought of at the time, it also laid the groundwork for the IT executive to begin to not just solve operational issues, but to help lead the conversation about what could be next.

As we passed through public financial scandals (Enron, et al.) government regulation came pouring in. IT was seen as the builder of the key infrastructures to support the bevy of new mandates. Again, IT was back in the big room solving operational issues and laying the groundwork and credibility to help lead the business.

By the mid and late 2000s, IT became intensely preoccupied with the complex roles of shifting to the distributed computing era, solidifying IT’s role delivering function through ERPs and other key business applications, managing the still-steady stream of regulatory requirements, and coping with the rise of the Internet.

As the 2010s rolled around, IT risk conversations in the big rooms began to shift from asking “What will be the risk if something bad happens?” to “What is the risk if we don’t act?”

Today, the crazy mix of social, cloud, analytics, and mobile has everyone’s attention. IT firmly has shifted from the 1990s — when only 10 percent of the leading 4,000 companies in the US even had a CIO — to greater than 50 percent of CIOs today reporting to the CEO and having accountability to at least one board committee. IT is in the room.

So Now What?

I think IT has never been in a better place.

The big rooms will still want to manage risk and ask how IT will provide stable, resilient, and dependable systems and infrastructure. But the opportunity is to exceed expectations when answering these questions and use the credibility to pitch for new investments in digital innovations that can underpin growth and expansion. IT needs to present these ideas not in terms of technology, but frame them in terms of revenue (yes, revenue).

The Next Two Big Things

1) The digitization of EVERYTHING

2) The next cyberthreat

The C-suite and board will want to know how they are effectively managing the risk that new competitors and business models won’t wipe out overnight key lines of services delivered today. This creates an unprecedented opportunity for IT to not just be part of the next conversation, but to lead it. As our friends in Silicon Valley warn us that “Software will eat the world,” IT must help our companies not defend against the thread of digitization, but lead an impressive assault forward.

Finally, cybersecurity has marched into a new era. The big rooms — primary the board — will not just ask, but expect regular updates and leadership in this area. If they are not satisfied, it will be achieved through other sources – they will get answers. IT either has to lead or we will see 80 percent of the CISOs that report into the CIO today shift directly to chief compliance or risk officers. Cybersecurity is not a concern, it is a fear.

IT is fully positioned to leverage these great opportunities. The big room is looking right at us and asking us to innovate, deliver, and lead.

Let’s not screw it up!

1-29-2014 12-54-46 PM

Darren Dworkin is chief information officer at Cedars-Sinai Health System in Los Angeles, CA. You can reach Darren on LinkedIn or follow him on Twitter.

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February 4, 2015 Darren Dworkin No Comments

Morning Headlines 2/4/15

February 3, 2015 Headlines No Comments

athenahealth Collaborates with BIDMC on Inpatient Cloud-based EHR

Athenahealth acquires Beth Israel Deaconess Medical Center’s home grown inpatient EHR. Athena will scrap the code, but will use the system as a model to build its own inpatient EHR over the coming months.

Fiscal Year 2016 Budget of the US Government

ONC requests $92 million in the 2016 federal budget, of which $5 million will be used to establish a Health IT Safety Center.

HHS and ONC invest $28 Million in Health Information Exchange Grants

HHS announces $28 million in new grant money available to support the adoption of HIEs.

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February 3, 2015 Headlines No Comments

News 2/4/15

February 3, 2015 News 5 Comments

Top News



Cerner completes its $1.3 billion acquisition of Siemens Health Services as announced in August. Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet. Julie Wilson, Cerner’s chief people officer, says Monday was “the biggest single hiring day in Cerner history” as its employee count jumped from 16,000 to 22,000 with the acquisition. CERN shares rose 0.57 percent Monday on the news, giving them a slightly better performance (blue, up 20 percent) than the Nasdaq as a whole (red, up 17 percent) over the past year.

Reader Comments


From Lemmy: “Re: Athenahealth’s purchase of BIDMC’s WebOMR. Not sure why Athenahealth would be interested – WebOMR is a complete piece of crap being held together with gum.” I mentioned the acquisition in last weekend’s post as a rumor provided by reader InTheKnow, although I left out specific details since ATHN is publicly traded. More discussion follows below – I got details from John Halamka that go well beyond the announcement and invalidate some incorrect assumptions I had.

From Mr. Smith: “Re: national patient identifier. HHS and ONC are prohibited by law from even discussing anything related to an NPI even though they are acutely aware of the challenges posed by not having one. The legislative branch should address the issue, but HHS and ONC are trying to create a workable solution.”

HIStalk Announcements and Requests

Welcome to new HIStalk Gold Sponsor West Corporation and its healthcare practice. The Omaha, NE-based company processes billions of voice-related transactions each year. Its West Engagement Center drives patient engagement, care coordination, and provider collaboration using a variety of technologies (voice, text, email, mobile, contact center). Available solution sets include telehealth, patient access, prevention and wellness, and chronic disease management. It is used by providers, payers, and employers that are transitioning to value-based care, managing populations,  creating chronic disease care coordination programs, or adding patient engagement capability to existing population health management technologies. Sign up for an online tour here. Thanks to West Corporation for supporting HIStalk.

Here’s a YouTube video that shows how patients report their daily blood pressures using the West Engagement Center.


We’ve received just a handful of requests from real-life patients who want to take advantage of our HIMSS15 conference scholarship ($1,000 in travel cash plus registration). We’re accepting applications through February 9 and will choose the five based on their patient stories and their writing ability. See Regina’s description and send entries to Lorre.

Acquisitions, Funding, Business, and Stock

Athenahealth makes its second recent  push into the inpatient EHR market by acquiring the WebOMR system that was developed by Beth Israel Deaconess Medical Center (MA). Terms were not disclosed. The company will integrate WebOMR with its AthenaNet system. The internal announcement from BIDMC CEO Kevin Tabb says that BIDMC will do a “trial implementation” of “some of athena’s current products” in “select areas of our network.” BIDMC’s only obligation to Athenahealth is to help its engineers understand how WebOMR works “so they can try to expand its use beyond our walls” as “the days of self-built information systems will not last forever.” Athenahealth acquired small-hospital EHR vendor RazorInsights on January 14. Athena shares ended the day up just over 1 percent, the same daily gain as the Nasdaq composite.


I spoke to BIDMC CIO John Halamka, MD for clarification about the agreement:

  • BIDMC originally developed WebOMR as an ambulatory application, but it has been extended to include all BIDMC-developed automation – a certified inpatient EHR, OR management, oncology, laboratory, radiology, electronic medication administration record, and bedside barcoding. The only external dependency is First Databank for drug information. The only excluded module is the ED information system (which had been previously commercialized as Forerun) and the agreement doesn’t cover billing (which is performed by a McKesson application). BIDMC has done work with Google Glass and Apple Health and those components are included as well.
  • Athenahealth is buying BIDMC’s intellectual property, but it will not use BIDMC’s programming code, which was developed by a 25-member team using Cache’ and Cache’ server pages. Athenahealth will instead rewrite the entire product (or at least the parts they want to commercialize) using their own workflow, user interface, and business logic to create a new platform.
  • BIDMC will not act as Athenahealth’s development partner. What Athenahealth bought for an unstated cash investment is the intellectual property, one BIDMC FTE for two years to help them understand the applications, and access to an alpha site in BID-Needham, which has a 29-bed medical-surgical ward running Meditech (which will not be replaced there).
  • BIDMC gets a 20-year license to use the code that Athenahealth develops, but they do not have to move to Athenahealth’s version and are not precluded from replacing WebOMR with a commercial product, which Halamka says may happen at some point.
  • Halamka estimates that it will take Athenahealth 18 months to rewrite the product.
  • Athenahealth and BIDMC signed two agreements. The first covers the intellectual property as described above. The second is an agreement in which three practices within 38-site BIDMC Healthcare will begin phased implementation of Athenahealth’s ambulatory product, but BIDC has no further obligation to continue or extend the trial beyond those three practices that are participating in the trial.
  • Halamka says in a blog post that BIDMC won’t necessarily choose Athenahealth products when they consider replacing WebOMR since “we are a meritocracy and the best services at the lowest cost will win.” He adds, “Just as Mayo chose Epic to reduce the number of different IT systems, BIDMC will pursue a parsimony solution – the fewest moving parts possible. That might be one vendor, but hopefully it will not be more than two … While we want to continue to innovate, we know that commercial vendors will be able to leverage their knowledge and capabilities to build future platforms at larger scale.”



Cerner rang Nasdaq’s opening bell Tuesday.


Voalte lays off 25 percent of its staff, or around 40 employees, in a reorganization.


Canada-based consulting and services vendor Accreon is acquired in a leveraged buyout funded by its management team, its founders, and Mansa Capital. As part of the deal, the company gives up its 49 percent ownership in Velante, which ran a controversial e-heath project in New Brunswick, and turns it over to the other partner, the New Brunswick Medical Society.



Yale New Haven Health (CT) chooses Mobile Heartbeat’s clinical communications system.


Boulder Community Health (CO) chooses Voalte’s smartphone caregiver communication for its newly expanded facility.


Pocono Medical Center (PA) selects Authentidate’s telehealth solution.



Murray Reicher, MD is named CEO of DR Systems, which he co-founded in 1992. He replaces co-founder Rick Porritt, who has retired.

Announcements and Implementations


Vancouver, WA-based patient monitoring systems vendor OSTAR launches a cellular network-powered blood pressure monitoring system to reduce CHF readmissions.

Mediware announces CareTend, which combines its home care solutions into a single platform.

Government and Politics


HHS Secretary Sylvia Burwell announces a $28 million ONC-funded HIE grant program, described as, “Grantees will address interoperability workflow challenges, technical issues, and improve the meaningful use of clinical data from external sources. Providers will be engaged from across the entire care continuum, including those who are not eligible for the Medicare and Medicaid EHR Incentive Programs such as long term care facilities, to be able to send, receive, find, and use health information both within and outside their care delivery systems.”


ONC requests $92 million for its FY2016 budget, up from $60 million. ONC wants $5 million to establish a Health IT Safety Center that will go live in FY2016.


This is a great quote from former National Coordinator David Blumenthal, MD, tweeted by ONC annual meeting attendee @PharmDJD: “It is cognitive dissonance to want cutthroat competitive markets but to expect healthcare players to share valuable data.” It would be great if hospitals, retail stores, quick lube stations, and hair salons shared customer information freely for the benefit of their shared customers, but only healthcare providers are being (unsuccessfully) shamed into doing so.



Health IT equities researcher Jamie Stockton of Wells Fargo Securities provides a slice and dice of CMS’s Meaningful Use Stage 2 data. Hospital attesters included 97 percent of eligible Epic users, 63 percent of Allscripts, and 60 percent of CPSI, with everybody else falling under that number (Medhost and NextGen trailed the pack at under 40 percent). Physician Stage 2 rates were predictably abysmal, with Athenahealth out front at 58 percent and Epic at 26 percent, but vendors such as Allscripts, Greenway, Cerner, NextGen, and McKesson (the latter at 0 percent) having less than 5 percent of users attesting. Obviously it’s dangerous to read too much into the vendor vs. the customer, especially given the mass EP Stage 2 bailout.

Privacy and Security


Paper records from several New York City hospitals are lost when a Brooklyn document warehouse is destroyed in a seven-alarm fire that scattered charred patient charts over several blocks. Cleanup crews attempted to retrieve partially burned papers that contained patient clinical and financial information. New York City Health and Hospitals Corporation is among the organizations that stored documents in the warehouse, but says that as early EHR adopter, it expects no operational impact.

The creator of PGP encryption software (now owned by Symantec) says the Sony Pictures breach highlights the need for companies to redirect efforts from security to privacy by encrypting emails and documents and retaining less information online. “If you look at all the things that have been developed – firewalls, intrusion detection systems, all these things put in place to protect computers? They haven’t really hit a home run: they keep getting breached. But if you look at the Snowden material, the one thing that does seem to do well is strong encryption. Of all the things you see getting broken into, it’s conspicuously absent from that list … In the 90s, if you were using strong encryption, you’d have to defend yourself and justify what you were doing: ‘What, are you a terrorist or a drug dealer?’ Now, if you aren’t using strong encryption, you have to justify it. You’re a doctor? What do you mean you’re not encrypting your patient records? Or you left your company laptop in a taxi with 2,000 customer names on it? You better hope that data is encrypted or you’re in trouble.”


Researchers at Penn State College of Medicine suggest 10 situations where it would be acceptable for doctors to Google a patient, boiled down to (a) if they suspect the patient is lying to them about their history; (b) if the patient could be a doctor-shopping drug user; and (c) if the patient seems to have the capacity to harm themselves.


I received the email above from a well-known B2B spammer who apparently got an email list of HIMSS15 exhibitors and is offering to sell a database of full attendee details. The fraud clues are numerous: (a) the email purporting to be from “Tracy Nixon” was clearly not written by a native English speaker; (b) the company’s website is just a placeholder full of “lorem ipsum” text; (c) the domain owner’s name is blocked in its registration records; and (d) clearly a 7,500-record HIMSS conference attendee database is at best incomplete given the 40,000 or so attendees. The same company has scammed companies in other industries by selling them junk lists at high prices and then refusing to give refunds.


Weird News Andy titles this story “Heaven Scent” and adds that the device should be worth the cost of at least 1,000 Fitbits. A smartphone-powered cancer detection system called the SniffPhone detects the odor of lung cancer on the breath with 90 percent accuracy

Sponsor Updates

  • SyTrue CEO Kyle Silvestro posts “The Secret Life of your Healthcare Data.”
  • Verisk Health’s HEDIS measures are certified by NCQA for 2015.
  • Nordic publishes a blog post titled “Optimizing My Birkie and Your EHR.”
  • Four Medicity HIE customers are named in “Survivor: Edition HIE"–Can Statewide HIEs Achieve Sustainability?”
  • Dan Hamilton, COO of Nor-Lea Hospital District (NM), writes an article titled “Handling the Demands of a Population Boom: Using RTLS to Improve Patient Care and Workflows” about its use of Versus Advantages Clinic RTLS.
  • ADP AdvancedMD asks, “Has the ICD-10 Delay Hurt Provider Preparedness?” in its latest blog.
  • Bottomline Technologies will exhibit at the NAMIC Claims meeting February 10-12 in Phoenix, AZ.
  • Divurgent offers a new white paper entitled, “From the Trenches: Leadership Strategies from the US Navy SEALs Applied to Healthcare.”
  • Clinical Architecture’s Charlie Harp posts the second installment of the company’s blog series on “The Road to Precision Medicine.”
  • Caradigm will exhibit at the iHT2 Health IT Summit February 10-11 in Miami.
  • Matt Patterson, MD asks “What stage of Meaningful interoperability are you?” in the latest AirStrip blog.
  • CareTech Solutions will exhibit at the Health Forum Annual Rural Health Care Leadership Conference February 8-11 in Phoenix.
  • Amber Harner blogs about her trip to Costa Rica to help build houses with Habitat for Humanity, courtesy of the CoverMyMeds 2014 CoverMyQuest competition.
  • Michael Passanante writes about the physician’s role in lowering hospital readmission rates in the latest Besler Consulting blog.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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February 3, 2015 News 5 Comments

Morning Headlines 2/3/15

February 2, 2015 Headlines No Comments

Cerner Completes Acquisition of Siemens Health Services

Cerner announces the completion of its acquisition of Siemens Health Services. The new merged organization has a combined customer base of 21,000 facilities and an annual R&D budget of $650 million.

Community Health Systems Professional Services Corporation and Three Affiliated New Mexico Hospitals to Pay $75 Million to Settle False Claims Act Allegations

For-profit hospital chain Community Health Systems will pay $75 million to settle False Claims Act charges with the DOJ. Three New Mexico hospitals are accused of making illegal donations to county governments. The funds were used to pay the state’s share of Medicaid payments to the accused hospitals, in an effort to drive up local spending and take advantage of a federal program that reimbursed New Mexico $0.75 for ever dollar spent on rural Medicaid services.

ONC Annual Meeting, February 2 – 3

ONC’s Annual Meeting kicked off in Washington DC today. Tomorrow morning Karen DeSalvo, MD will join the former National Coordinators for an hour long round table on the state of the HIT nation.

Cost Comparison Between Home Telemonitoring and Usual Care of Older Adults: A Randomized Trial

Researcher compare the total cost of care for 205 patients over the age of 60 and find that, over the course of a 12-month period, traditional care costs the same as care supplemented with remote patient monitoring services.

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February 2, 2015 Headlines No Comments

Curbside Consult with Dr. Jayne 2/2/15

February 2, 2015 Dr. Jayne 1 Comment


Although I still haven’t answered the "should I stay or should I go" question regarding my day job, I did make a decision to leave the practice where I’m currently providing urgent care services. I haven’t resigned yet since there’s enough strangeness that I want to have my final paycheck in hand before I do.

I didn’t really pay attention to the calendar when I sent my available days for this month, so I’m spending Super Bowl Sunday seeing patients. So far, sinusitis is leading otitis media 13 to 2 going into halftime, where we expect a rousing performance by indie rock band Motor Vehicle Accident.

I’m certainly not a job hopper. Prior to this job, I had been with the same emergency and urgent care staffing company for nearly six years. They had a huge portfolio of customers, which allowed me to experience quite a few different care settings and a variety of different inpatient and outpatient EHR systems, health information exchanges, and more. 

Last year, they lost their contracts with most of the facilities in my area when another staffing company underbid them. I’m not sure the facilities were aware that all the part-time and as-needed physician providers were going to be replaced with non-physicians, but they should have seen it coming based on the pricing model. Along with more than a dozen other part-timers, I was let go.

I didn’t see patients for a couple of months while I evaluated my options. Eventually I received a call from a recruiter which led me to this opportunity — an independently-owned urgent care with two locations. The facilities are recently renovated, the drive was reasonable, and the pay was in my range, so I gave it a shot.

The only downside was their lack of EHR. For some, that might be a bonus — the learning curve for charting is certainly very small. But for someone who is used to the safety features of an EHR (allergy and interaction checking, pediatric dosage calculation, etc.) it was a little rough. I dabbled with a freestanding eRx system for a while, but the dual data entry was a bear.

My employer is certainly nice enough, but he’s suffering from the same things that are impacting most small practices. They don’t run themselves. Without a dedicated physician leader or a hands-on management style, it’s easy to start a death spiral with staff unhappiness, turnover, patient unhappiness, and ultimately physician unhappiness. All of these conditions contribute to a negative impact on the bottom line, as does his obsession with the salt water aquarium in the waiting room.

He tends to manage from afar, yet micromanages at times. Policies and procedures are lacking, but he shows up unpredictably and criticizes how work is being done. Poor performance is not addressed and high performers are not rewarded. The staff is relatively young, and without consistent leadership or supervision, they tend to fall into the behaviors that college-age people do. Smartphone use is rampant, which not only hampers productivity, but leads to some interesting conversations that patients overhear. Staff regularly shows up either at the exact time the office is supposed to open or even after and management doesn’t seem willing to address it for fear of losing people.

Although I can put up with a fair amount of chaos, I recently figured out that there were some significant irregularities in my onboarding. Apparently I’m not fully credentialed with most payers (not even Medicare / Medicaid), which is surprising for the length of time I’ve been here. That’s a red flag right there. The next red flag was when he emailed me to let me know there was an error on my 1099 tax form and I’d have to handle it on my own. Running a practice, or any small business for that matter, is not for the faint of heart or those without education, experience, or solid advisors.

Before making the decision to leave, I put myself in his shoes and considered whether there was anything he could offer to make me stay. He’s not going to run out and implement an EHR tomorrow, so the patient safety issue remains. It’s also an efficiency issue (although a bad EHR would certainly be worse than handwriting on pre-printed paper templates). Then there’s the clinical quality issue. I have no way of sending copies of our notes to primary care physicians unless I personally fax them since there is no system in place unless there is a specific request for release of information. The primary care practices in the area have yet to embrace the patient-centered medical home model. Few of them are open outside the hours of 9 a.m. and 4 p.m. and I can’t name any that have evening or weekend hours, so we’re essentially the safety net. We don’t have access to the local HIE or the state immunization registry, so we’re actively contributing to the fragmentation of care.

I don’t see him hiring a strong office lead or spending more time at the practice himself, so the staff will continue to be relatively undisciplined. The owner isn’t clinical and there’s not a named medical director, so I don’t see any expansion of policies or procedure that could help bring things into line. Strangely enough, he’s opening a third location in a fairly dangerous part of town without commitment by providers or staff that they’re willing to work there. I’m sure that will further dilute his ability to manage the practice effectively and might make staff turnover even more of an issue than it already is.

Although I don’t see him embracing new technology like the HIE or immunization registry web portals, I also don’t see him abandoning some of the problematic technology we already have. The computer-assisted coding system is a concern since it codes the visits after documentation is complete and providers don’t have a chance to confirm or correct the E&M codes before they’re released to the practice management system. Although most of my coding has been consistent with what I would have manually coded, it’s just another red flag.

On one hand I feel bad leaving because the patients are genuinely appreciative and certainly need physicians who understand their needs. But on the other hand, knowing what’s at stake from a regulatory standpoint and that I could wind up personally liable for any creative coding or billing that is occurring, I can’t afford to stay. 

I’ve got a new clinical endeavor lined up, one where they’ll ensure I’m fully credentialed before I see patients and where an EHR is already in place. They’re using a system I’ve never worked with, so I am looking forward to the new challenge. If nothing else, learning a brand new system will surely make for some good stories.

What makes a new employee run shrieking? Email me.

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February 2, 2015 Dr. Jayne 1 Comment

HIStalk Interviews Alan Weiss, MD, Director of Medical Informatics, Memorial Hermann Medical Group

February 2, 2015 Interviews 3 Comments

Alan Weiss, MD, MBA is director of medical informatics with Memorial Hermann Medical Group of Houston, TX.


Tell me about yourself and the organization.

I’m a general internist by training. I have a computer science background and an MBA. I’ve been involved in the development of EMRs for about 15 years. I practiced at the Cleveland Clinic for about 10 years doing EMR implementation and practicing.

I’ve been at Memorial Hermann for about a year and a half. It’s a 10-hospital system, about to become a 12-hospital system, with an outpatient medical group directly affiliated with about 170 providers. We’re a GE shop on the ambulatory side and a Cerner shop on the inpatient side. We also have an affiliated group of physicians, about 600 to 700, on a whole different group of EMRs, with our biggest one probably being eClinicalWorks. We are the largest healthcare provider here in Houston.


What is the state of EHRs and in what areas should they be better?

EHRs need to improve. When people talk about the current state, I always think about what the basics are of EMR — what does it have to do? It has to be able to allow providers to look at data, to enter orders, and to write notes in a clean and efficient manner. A lot of the EMRs don’t allow for this. Each EMR has its benefits and its drawbacks, but if you can do those three simply and easily, that’s when providers can use the tool as best as possible.


What is the place for the doctor’s true narrative and rather than text generated from click boxes?

I think we’re going to see a throwback away from the computer-generated text and back into true narrative. It’s gone too far. It doesn’t have a whole lot of meaning and notes are way too long. It doesn’t convey the clinical impression, which is what we need to provide the best care we can.


It wasn’t doctors who originally wanted to click boxes to create text. Do they have enough voice to turn the EHR back into a record that’s for them and not for someone else?

There are providers out there who love the being able to do all the clicking of text and checking the boxes to get things done. But it’s more to get things done, not to create the narrative. The problem is that the narrative that’s created through clicking boxes becomes a hard to read mess.

I think we’re going to see everything change back into a much better narrative. A better way of actually describing what providers want from the EHR, which is an easy way to document, but also a way that gives their notes meaning to them.


What parts of the note could give clinicians an immediate sense for what’s going on with that patient?

There’s a whole movement of trying to get the notes to be meaningful again. One of the best ones is to change your SOAP note — Subjective, Objective, Assessment, Plan — into an APSO note, where your assessment and plan are at the top. If you want additional information, you can go through and see the rest of the information. 

Many organizations have changed from SOAP to APSO as a way of making sure that the assessment and plan, which is what you really want, is right in your face with the supporting documentation later on. I think we’re going to see more of that as time goes on.


What do you think about the OpenNotes initiative and the new plan to allow patients to contribute to the notes?

It’s probably going to be the way of the future. I think we’re going to see open notes. I don’t see anything wrong with having patients see the notes the providers have written. It’s actually very good, and especially for patients who are very concerned about their own health, seeing what the providers write will help them. I think it will also help some providers write better notes in the process of providing care. That’s going to be great.

It’s interesting that in the whole notion of having the patients come in and add to the notes themselves; we have started looking at ways of taking some of the surveys that patients are filling out and incorporating those into the notes. It can have some very positive effects, especially when it comes to patient engagement.


Will the least technically savvy patients do that?

The technical savviness of patients versus physicians is interesting. I tend to think that patients right now are more technically savvy than a lot of physicians. They want more apps, they want more access to their data, and they want to be able to access their physicians all the time in as many ways that they possibly can. 

The technical savvy aspect is extremely important. The patients,though, who are least technically savvy also have some of the greatest health problems. For that population, we still need a better strategy.


What are some system-agnostic EHR changes you might recommend to improve care?

I’ve worked ambulatory and I’ve worked inpatient. You have to really distinguish between the two.

On the inpatient side, certainly order sets and standards are a lot easier to implement than on the ambulatory side. The ambulatory side is more of people doing whatever they want to do. It’s much easier to create rewards to get people to do either the right thing or to stop ordering the wrong thing. That’s much easier on the inpatient side.

On the ambulatory side, sometimes the right thing to do is actually not to change your EMR, but to give reports. For instance, we’ve got a very simple report that shows providers their top 20 medications, the ranking, and the amount. When we show it to the providers, they start to see patterns. We have one provider who saw their pattern with  very high antibiotic prescribing, lots of Zithromax, lots of Z-Paks prescribed. In fact, she was providing about one or two Z-Paks a day on average to her patients. When she realized that that was the most common medication and not the most appropriate medication for what she was seeing, she changed her behavior. She has reduced her prescribing of Z-Paks by two-thirds.

That’s the kind of thing you may do outside of the EMR itself. If you can provide those simple reports showing behaviors, they can often have a bigger effect than making huge changes in the EMR itself.


As more physicians who practice in ambulatory setting are acquired or are working more collaboratively on the patient as a whole via new payment models, will they see EHRs as the bad guy that enforces rules that they didn’t follow when they were on their own?

I don’t think it’s going to be EHRs. I think it’s going to be the medical practice itself. When you’re in large groups, you’re being held accountable for all of the costs. At the same time, you’re going to have a natural progression where everybody is going to be seeing that they have to be responsible for every single order they put in.


What is the medical group doing with managing populations and not just encounters?

We’re doing a huge amount of population health. We’re doing a lot of analytics, looking at gaps in care where we can better provide care for diabetics who are falling outside the ranges of desired HbA1C and other testing. We’re trying to make sure all the screens are being done.

We have a great population health program that is doing some wonderful things. We are part of ACO, and as part of that ACO and the analytics that it provides, we’ve become one of the highest savings ACOs in the country.


How are people reaching out to the patients who might need an intervention or education? They aren’t necessarily used to getting a call from a medical practice.

A lot of patients want it. They want people to be involved in their care, but certainly there are ways of making sure that the patients have access to the things they’re missing.

For instance, we have a patient portal that provides a way for our patients to check the things that are due for them. At the same time, the diabetics who haven’t been in for a while or who need testing done tend to like it that we’re reaching out. It makes them feel like we care about them, and in fact, we do care about them. It gives them a way of closing the loop in some of the testing that they need. Most patients are reacting very positively to it.


What opportunities and challenges do you see with being paid for value instead of volume?

Part of the problem is that what patients often want are more tests and more medications. The conflict that I see is that the advertising that’s out there, what’s on the Internet, seems to get patients to want to have all those tests done. It’s more testosterone testing, thyroid testing, checking this and checking that.

If anything, if you look at all of those news articles about the tests you should have, a lot of it is creating almost like a culture of fear. You have to get certain tests done in order to make sure you are healthy. Those are the kind of things that are coming out of the general advertising. Yet at the same time, all of the data shows we should be doing less testing.

For instance, there’s no reason to check for kidney problems in an otherwise healthy person without high blood pressure. There’s no reason to check for urine or chest X-rays or EKGs unless you have a reason for doing it. But the common practice often is that those things are checked and the patients demand them and want them.

It’s the same kind of thing with antibiotics. When patients come in for a URI, they want and they expect antibiotics because that’s what they think the medical practice should be giving them. They’ve taken time off from work or school and they feel like they need something to justify them being there. I’ve had friends who have said to me that if they don’t give them something, the patient has threatened to go see other doctors.

Certainly there are patient satisfaction scores that are part of this whole issue, the need to satisfy the patient and give them what they want. We have to divorce that. We have to start thinking about what we should be doing. What is good evidence and what do the patients really need. That’s going to be the big conflict that we are going to have in the next five to 10 years to try and rein in some of the healthcare costs.


Do you have any final thoughts?

EHRs are just one great tool to help us. If anything, it makes it easier to provide care in the EHR. I’ve been on EHR since I finished my residency almost 15 years ago and I would never go back to a paper system. There’s just absolutely no way. For me, it’s the way things should get done.

What I look forward to being able to do is to optimize EHRs to create a healthcare system that helps you to provide the best care possible. If we do it the right way, we can rein in costs. We can provide better care. We can take care of those gaps. It will work its way through, but the EHR has to be the backbone. It has to be the new tool for us.

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February 2, 2015 Interviews 3 Comments

Cerner Closes Siemens Acquisition

February 2, 2015 News 4 Comments



Cerner announced this morning that it has completed its $1.3 billion acquisition of Siemens Health Services as announced in August.

Cerner Chairman and CEO Neal Patterson said in a statement, “"By combining client bases, investments in R&D, and associates, we are in a great position to lead clients through one of the most dynamic eras in healthcare. Cerner remains focused on key development areas including population health, physician experience, open platforms, revenue cycle, and mobility. We see these as critical areas of investment to ensure providers can meet growing regulatory demands and control costs, while continuing to improve quality of care."

Cerner says its 2015 revenue will be around $5 billion, its employee count has increased to 21,000, and its annualized research and development expense will be $650 million.

Cerner reiterated in the announcement that it will continue to support Siemens core systems for an unspecified period, with Soarian maintenance guaranteed for 10 years. Former SHS CEO John Glaser has joined Cerner as SVP and a member of the company’s executive cabinet.

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February 2, 2015 News 4 Comments

Morning Headlines 2/2/15

February 1, 2015 Headlines No Comments

Interoperability Roadmap

ONC publishes a draft version of its 10-year interoperability roadmap. The 166-page document outlines a plan for deploying and maintaining an API-based interoperability framework over the next 10 years.

White House Details ‘Precision Medicine’ Initiative

President Obama’s recently announced Precision Medicine Initiative will send $5 million to ONC to develop an interoperability framework and data exchange standards.

CPSI Announces Fourth Quarter and Year-End 2014 Results and 2015 Guidance

CPSI announces Q4 and year-end results: revenue down 10 percent to $46.3 for the quarter and $204 million for the year, EPS $0.60 vs. $0.90. Share prices dropped 16 percent on the news.

Some Maine hospitals can predict your next trip to the ER: Here’s how

A local paper covers the population health analytics tool that Maine’s HIE HealthInfoNet is using to predict which patients are trending toward a stroke, heart attack, hospital admission, or ED visit.

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February 1, 2015 Headlines No Comments

Monday Morning Update 2/2/15

February 1, 2015 News 9 Comments

Top News


ONC publishes a draft version of its 10-year interoperability roadmap that includes a short-term goal of taking actions that “will enable a majority of individuals and providers across the care continuum to send, receive, find, and use a common set of electronic clinical information at the nationwide level by the end of 2017.” ONC wants to create a governance framework to address the rules of the road for interoperability, improve interoperability standards, use “policy and funding levers” to reward organizations that share data, and clarify that HIPAA requirements don’t stand in the way of interoperability.

A significant portion of the plan addresses patient empowerment, such as the ability to download  health information and contribute information to the EHR. It says providers should offer online scheduling, refill requests, telehealth visits, incorporation of wearables data and patient-defined goals of care into the EHR, and shared care planning. ONC also proposes to write policies for “identifying and addressing bad actors” that don’t comply with interoperability guidelines. Public comments are being accepted through April 3.

Reader Comments


From InTheKnow: “Re: [vendor name omitted]. Will announce Monday a strategic partnership with Beth Israel Deaconess Medical Center in Boston which involves their co-development of BIDMC’s homegrown WebOMR. In addition, BIDMC will implement the company’s products.” Unverified. I left out the vendor’s name for reasons that will become apparent should the rumor turn out to be true. WebOMR provides clinical results viewing, notes, problems, medications, order entry, patient lists, and integration with external references. Commercializing hospital-built systems of this scope usually fails, as McKesson can attest given its impending retirement of Horizon Expert Orders, a kludged, quick-to-market version of Vanderbilt’s WizOrder. Vendors usually discover that the product works well for the health system that wrote it, but contains odd technology dependencies and has hard-coded connections to other systems that have to be stripped out while not crippling the core product. BIDMC commercialized its ED software in 2006 under the company name Forerun, about which I’ve heard nothing for several years. Update: a second reliable source says the deal will indeed happen. There will be a lot to talk about once it’s announced.


From HIT Pundit: “Re: ONC’s interoperability roadmap. I predict that the 2017 provider implementation date will be pushed out because of one impossible hurdle it doesn’t address: creating a unique national patient identifier. ONC wants providers to accomplish what Congress refused to deal with through a Rube Goldberg process of virtual and probabilistic patient ID methods and then measure for each provider via the Meaningful Use program the percent accuracy rate for proper patient identification. If our government was willing to deal with this ID issue head on, we could have true interop in six months. My suggestion is this: if a person wants a true health record with coast-to-coast portability, they agree to subscribe to a unique ID. If they want to maintain privacy, they opt out.” I like the idea since Congress refuses to consider a mandatory national patient ID. The government could offer a voluntary, secure patient ID number and then let providers do the job of selling its benefit to their patients.

From Katy Petri: “Re: Sunquest. Laid off 40 people on Friday.” Unverified by the company, but I was given some of the specific names.

HIStalk Announcements and Requests


Twelve percent of poll respondents plan to buy a smart watch in the next year, with two-thirds of those expecting to own an Apple Watch. On the other hand, I recall my 2010 poll in which only 30 percent of respondents said the iPad would have healthcare impact, so I won’t underestimate Apple’s envy-creating marketing. New poll to your right or here: should the federal government issue a national patient identifier? Vote and then click the “comments” link on the poll to explain your position.

I’m getting a lot of inquiries about HIStalkapalooza. I haven’t opened up the “I want to come” page yet since I’m waiting to have a graphic designed. I decided to control the event myself this year, so I had to sign a contract with the House of Blues and the amazing Party on the Moon band way back in the spring before someone else booked the venue, meaning I was personally liable for $150,000 worth of expense (which covers only the HOB’s minimum buy-out charge and the band) without any guarantee that sponsors would step forward. I’m relieved that some great companies that I’ll highlight shortly are supporting the event, which means that, (a) I hopefully won’t go broke after all, and (b) I’ll be able to invite more people.

I don’t follow many people on Twitter, but I’m starting to unfollow those who: (a) post local weather and police updates; (b) share their couch-based hero worship of athletic teams and participants; and (c) live tweet events that didn’t interest me in the first place. Maybe Twitterers should have two accounts (one personal, one professional) or Twitter should add categories that could be suppressed by people looking for health IT insight rather than fervent sports victory prayers.

Last Week’s Most Interesting News

  • CMS announces plans to reduce the 2015 Meaningful Use reporting period from 365 days to 90 days.
  • ONC releases new Meaningful Use Stage 2 numbers that show only 15 percent of eligible EPs have attested as the deadline draws near.
  • Several large health systems collectively agree to move 75 percent of their business to value-based payment by 2020.
  • HHS announces that it expects to tie 30 percent of Medicare payments to alternative payment models by 2016.
  • The OpenNotes project announces pilot sites for its next phase, OurNotes, in which patients can add their own notes to the electronic chart.

Acquisitions, Funding, Business, and Stock


Surescripts will spin off its population health business into a separate company that will operate under the Kryptiq name. Surescripts acquired Kryptiq in 2012 and will keep its secure messaging, e-prescribing, and portal technologies. Surescripts will maintain a minority ownership position in Kryptiq, which will be run by the former Kryptiq management team.


CPSI announces Q4 results: revenue down 10 percent, EPS $0.60 vs. $0.90, sending shares down 16 percent as the Nasdaq’s fourth-largest percentage loser for Friday. Above is the one-year price chart of CPSI (blue, down 26 percent) vs. the Nasdaq (red, up 13 percent). The company said in the earnings call that hospital EHR penetration is close to 100 percent and sales will have to come from displacements, also showing some concern about increased competition from Epic in the small-hospital market and Athenahealth’s acquisition of RazorInsights. Chairman and CFO David Dye said when pressed by stock analysts to consider reducing headcount in response to lower sales, “We’ve never had any layoffs in the history of the company … we will continue to always think long-term … we’re a hell of a long way from thinking about anything like that.” 


Orion Health shares drop on lower than expected sales that the company blames on the “iPhone 6 effect” as its customers wait for new product announcements in April. Orion Health’s shares, which are listed on New Zealand’s NZX, are trading below their November IPO price.



Omer Awan (Memorial Hermann Health System) is named VP/senior regional CIO of Eastern Maine Healthcare.

Announcements and Implementations


Drug maker Roche will use Qualcomm Life’s medical device data capture network to connect chronic disease patients with their providers.

Government and Politics


New York legislators propose a one-year delay in implementing the I-STOP law that requires all prescriptions to be transmitted electronically by March 27, 2015, saying that the DEA moved too slowly in certifying vendors to transmit controlled substance prescriptions.

President Obama will propose a $215 million precision medicine initiative that includes $5 million for ONC to develop interoperability standards and privacy requirements for secure data exchange.


The FCC leaves no doubt that it is seriously angry at Marriott for trying to force its hotel guests to buy its Wi-Fi service by blocking their personal hotspots. Marriott had to pay $600,000 to settle with the FCC, but still brazenly pushed the agency to rule whether hotspot-blocking is illegal. The FCC’s response was abundantly clear.



Several hospitals are installing  Sky Factory photo or video technologies in walls or ceilings to provide a relaxing, nature-like view even in basement rooms. I almost rigged something similar years ago for my office in the hospital basement, where I was going to mount an LED monitor in a window-like frame and pipe in video from a outside webcam.


A Maine newspaper covers the use of predictive analytics to identify people likely to require an ED visit to support early intervention. The program is run by HealthInfoNet, which collects EHR data from 32 of the state’s 36 hospitals and 300 outpatient facilities. The software and algorithms provided by HBI Solutions, which was founded by former Eclipsys executives and clinicians from Stanford University, logged a 74 percent accuracy rate in predicting ED visits.


Weird News Andy asks, “Who you gonna call?” in referring to a decision by one of England’s NHS trusts to ration its overloaded ambulance service by downgrading 999 calls (their equivalent of 911) from patients known to be terminally ill or who had signed “do not resuscitate” requests. The since-rescinded policy was in effect for two months, during which time 57 patients died after their emergency calls were changed to low priority.

Sponsor Updates

  • TeraMedica’s Evercore VNA is named a KLAS category leader in “VNA/Image Archive.”
  • Victor Lee, MD writes about “Health IT and Care Coordination” in a Zynx Health blog post.
  • ZirMed will exhibit at the 2015 Combined Sections Meeting of the American Physician Therapy Association February 4-7 in Indianapolis.
  • Huron Consulting employees logged over 5,500 hours of service and participated in more than 100 philanthropic events in 2014.
  • Voalte Technical Writer Ashley Murphy asks “Is There a Voalte Solution for First-Time Parents?” in the latest company blog.
  • Verisk Health features “Three Questions for the CMS Star Ratings Expert” Melanie Richey in its latest blog.
  • Forbes interviews TransUnion Senior VP Julie Springer about the company’s new brand launch.
  • TeleTracking Technologies VP/GM Josh Poshywak writes about fighting infection with RTLS for Health Management Technology.
  • Stella Technology expands its corporate headquarters in a move to Sunnyvale, CA.
  • Sentry Data Systems will exhibit at the 340B Coalition Winter Conference February 4-6 in San Francisco.
  • Amy Krane recaps how Partners Healthcare eliminated prior authorization using Qpid Health technology.
  • Nordic wraps up its “I Heart Cupid” video series on Epic’s cardiovascular information system.
  • MEA/NEA’s Lindy Benton writes about the “Return of the RACs.”
  • The New York eHealth Collaborative will participate in the eHealth Initiative 2015 Annual Conference & Members Meeting February 3-5 in Washington, DC.
  • Patientco Marketing Specialist Patrick Creagh offers “7 Things You Need to Know About Your Patient Payments.”
  • Porter Research President Cynthia Porter offers insight into “Thought Leadership and Credibility Content in Healthcare B2B.”
  • PMD offers “PQRS Solutions for the New Year.”
  • Nvoq offers SayIt 9.3 with new features that simplify use and enhance organizational productivity.
  • Passport Health will exhibit at the Athenahealth Marketplace Fair February 3-4 in Boston.
  • Orion Health EVP of Healthier Populations David Bennett shares his thoughts on population health
  • Navicure’s Jeff Wood covers “How Answering Patient Questions can Boost Your Practice’s Revenue.”
  • The local business paper highlights the success Lexmark has had since acquiring Perceptive Software.
  • NTT Data opens an operations center in Bangalore, India.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

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February 1, 2015 News 9 Comments

Readers Write: EHR Go-Live Activation – Big-Bang or a Phased Approach?

January 30, 2015 Readers Write 8 Comments

EHR Go-Live Activation – Big-Bang or a Phased Approach?
By Zack Tisch


After completing the RFP process and determining which vendor and products will be part of the implementation, the real fun begins. Should the organization deploy this change in a single event — typically referred to as a big bang go-live –  or would a methodical, phased approach be a better fit?

At first glance, a big bang can feel aggressive, particularly in a healthcare environment where risk can mean significant consequences, not only to organizational financial health, but potentially to quality and patient safety. This surface analysis can be, misleading however, and more detailed consideration often reveals challenges to a phased approach that can be even more significant, particularly for multi-hospital organizations that may be on different core clinical or financial software platforms. The following considerations are a start to determining which approach may be best for a given organization.

Carefully categorizing likely risks and how to manage them is a major factor in determining a go-live activation approach. A successful go-live is one where known risks are decisively and quickly managed and unknown risks are quickly analyzed and attacked. Both activation approaches can be equally successful, but there are specific tasks and processes that should be put in place prior to go-live to help support the approach.

For example, with a big-bang go-live, technical considerations become primary due to the volume of users and equipment that will be interacting with the system at the same time. Is security configured correctly? Can all users log in? Have they verified this in the production environment prior to go-live? With a phased install consisting of a smaller initial pilot, security, login, printing, and hardware issues may not be as pressing.

On the other hand, with a large-scale big bang featuring potentially thousands of users and workstations, the first few days or week of go-live can easily be spent just resolving technical issues that could have been sorted out with a thorough pre-live plan. This is a known risk and I would strongly advocate as much testing in production with real hardware and actual end users as possible, regardless of the chosen go-live approach.

Outside of technical issues, another key risk for most EHR go-lives is operational change and how well clinicians, front desk, and back-office staff accept and adopt the new workflow changes and tools. With a phased install, there is the luxury of being able to portion this change over time, reducing end-user anxiety and the amount of information they need to process and retain from training. However, one major drawback is that with a phased go-live, there will often be interim workflows, requiring end users to learn a new process and then unlearn aspects of that process shortly thereafter.

One key area in the organization to evaluate for potential risks is physician coding, particularly on the outpatient side. Physician coding is a highly integrated process, beginning with appointment scheduling and patient registration through clinical support staff rooming, physician documentation and order entry, charge generation, coder review, and ultimately claims submission. When implementing a new system, it is important that there is clarity and consistency on who is performing what task, particularly for the charge generation and coding review steps.

Will physicians or clinician support staff be entering or reviewing charges? What about evaluation and management (E & M) codes for level of service? How do coders work with providers to get clarity or update documents? When considering a phased approach (as an example, bringing outpatient clinical modules live prior to a separate billing go-live), will these workflows change? Each change to this workflow introduces key elements of risk, primarily of missing or delayed documentation and charges. This is an area that can quickly spiral out of control, and if not well understood and managed prior to go-live, can lead to significant financial risk for an organization, which unfortunately seems to dominate headlines, rather than the many highly successful projects.

My suggestion would be to take the time to perform a detailed risk analysis or partner with industry experts to assist with this. Also, work closely with organizational senior leadership to evaluate the benefits of having a phased install versus a big bang. Going through this process in the past, I have seen highly risk-averse organizations that initially wanted to move forward with a very phased install transition to a big-bang approach because the interim workflows and frequent system changes of a phased approach posed a higher risk of failure.

Another key factor to consider is the current state of the legacy EHR data. If the health system has multiple ADT or EHR systems, with multiple patient MRNs, a phased go-live can be much more difficult. A detailed analysis and thorough testing of how this will impact your downstream systems must be performed. One of my clients who had two separate clinical and registration systems initially desired a phased approach. However, upon further analysis, there was significant crossover for orders and results between the two. As a result, it would have been extremely difficult to keep all systems in sync. While the new EHR could handle these multiple MRNs, a number of key integrated systems could not handle interfaced merge messages or multiple patient identifiers. We would have had to pursue a major parallel project to implement an additional patient identity management application or merge and update MRNs across the entire organization.

One other example that is often identified late or overlooked is the ability for a new system to run alongside the legacy system during a phased install. There are often significant compatibility issues between vendors related to the versions of Internet Explorer, Java, and other critical Windows / Web architecture components necessary for a system to function correctly. With a thin client deployment, it may be possible to get around this with separate setups on the individual servers, but this is not always possible.

Lastly, as someone who has experienced many implementations in a variety of roles — from analyst through project leadership — I would highly advocate considering the health, effectiveness, and well-being of the project team as it relates to the go-live approach. These implementations are challenging, requiring significant hours and brainpower, often well above and beyond a 40-hour work week. With a big bang go-live, the team has a single mission and a single event. Team members can see the light at the end of the tunnel and this is particularly critical as they work through the challenging build completion and testing phases of the project. Having an event to rally around can be significant for motivation and keeping everyone on the same page.

The downside is that one large go-live means only one chance to get it right. This can introduce significant anxiety, particularly for team members who have not previously worked on a similar project. It’s important for leadership to direct time and energy with the project team and end users to understand why a big-bang approach was selected and the significant steps and thousands of hours of hard work the team is putting in to ensure the go-live will be successful.

The benefit of a phased approach is each individual go-live is more approachable for the project team. The smaller scope and scale makes it easier for team members to wrap their heads around the effort and the amount of support required for the go-lives to be successful. However, by having multiple go-lives, the team now has to get up for more “showtime” events and more weekends and late nights performing pre-live cutover and go-live support. It can also make it more difficult to define when the project can be considered a success.

It is especially important to limit the number of phases and space them out appropriately. If they are too close together, it can feel like one very large and extended go-live, particularly if the initial phase is challenging and it is difficult to stabilize and move to support on time. I’ve also seen challenges where go-lives are spaced too far apart, and the project team and end users have become apathetic. If the amount of change at any one time is too little to be felt broadly across the organization, or too spread out, it can become difficult for staff to understand the benefits from the project and why the organization undertook this significant and expensive process. If choosing a phased approach, work carefully with the project team and vendor to make sure there is a realistic timeline with enough time between phases to appropriately stabilize and shift focus.

These considerations are just a small subset of the topics that are critical to discuss with the leadership team when deciding on a go-live approach. There are benefits and drawbacks to both approaches and one size certainly does not fit all. With appropriate foresight and planning, either approach can be highly successful. There are a multitude of expert resources and organizations that can share lessons learned to help follow in their footsteps.

Zack Tisch, PMP is director of strategic solutions with Nordic Consulting Partners.

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January 30, 2015 Readers Write 8 Comments

Readers Write: Information Blocking: Don’t Blame the EHR

January 30, 2015 Readers Write 3 Comments

Information Blocking: Don’t Blame the EHR
By Michael Burger


Healthcare IT seems to be getting some attention in Washington these days, and not necessarily in a positive way. As a case in point, a statement which affects healthcare IT was included in an explanatory statement by the chairman of the House Committee on Appropriations regarding the house amendment to the recently passed government spending bill.

Information Blocking. The Office of the National Coordinator for Health Information Technology (ONC) to use its authority to certify only those that … do not block health information exchange. The agreement requests a detailed report from ONC … regarding the extent of the information blocking problem, including an estimate of the number of vendors or eligible hospitals or providers who block information.

This is clear evidence that Congress is frustrated by the relative lack of data exchange despite an investment of $30 billion for healthcare IT. As the explanatory statement states, “ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in CEHRT, and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”

No question, information blocking is a significant factor in the lack of data exchange. It is appropriate for Congress to expect a return on taxpayers’ investment. What concerns me is the prevailing but erroneous perception that EHR vendors have conspired to block information.

In the nascent HIT business of 20 years ago, there was a notion of a “closed system,” where data was only accessible by those using that system. In those days, the closed system was certainly used to sell additional software by controlling the flow of data. That business model was ideal for a marketplace many years ago with few competitors and no real demand for interoperability.

However, such a strategy no longer exists in today’s HIT marketplace, if for no other reason than to meet the certification requirements for Meaningful Use (MU), EHRs must be capable of interoperability with other EHRs. A claim that a company’s EHR “doesn’t work well when you mix and match vendors” would not be a smart selling tactic, since it openly defies the very premise of MU and because there are many, many competitors.

There are fees from EHR vendors for interoperability, data extraction, and conversion from one system to another. These cover the vendor’s cost to do the work plus a profit margin. (Let us not forget that these are, in fact, for-profit businesses.) While the marginal cost of extracting the data may be small, it is not a provider’s inalienable right to have their vendor provide services for free.

One form of information blocking is called a “walled garden.” In Joel White’s recent blog post regarding Information Blocking, he says, “Information blocking [in a walled garden] occurs not because different technologies or standards prevent data transfer between EHRs, but because EHR vendors or health care providers engage in this activity as a business practice. This is not a technology problem, but a competition one.”

I disagree that EHR vendors in recent times conspire to strategically erect walled gardens, but I do see that healthcare providers routinely engage in this activity as a business practice. The following example illustrates my point.

Let’s say that there are two integrated delivery networks (IDNs) in a given market. Each IDN has acquired ambulatory practices and positioned itself to be able to offer a full spectrum of care, from pediatrics through geriatrics. Each advertises to their potential customers (patients) that they offer the highest quality, most convenient care in town. There is a competitive and profit incentive to keep patients within the network.

Now let’s say a patient is treated at IDN A and then receives treatment at IDN B. From a public health perspective, the patient’s records should flow from one to the other. But from a business perspective, there is no incentive in making it easier for a patient to go out of network and seek treatment at the other IDN. All IDNs use EHRs that are capable of exchanging clinical data in some capacity, but they do so grudgingly because of competitive concerns.

It’s appropriate for Congress to expect a return on our $30 billion healthcare IT investment. It’s refreshing to see that the authors of the spending bill understand the existence of information blocking. Let’s hope, however, that our new Congress doesn’t take the easy way out and blame EHR vendors for this phenomenon when it is really a result of competition of healthcare providers in the free market.

Michael Burger is a senior consultant with Point-of-Care Partners of Coral Springs, FL.

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January 30, 2015 Readers Write 3 Comments

HIStalk Interviews Rizwan Koita, CEO, CitiusTech

January 30, 2015 Interviews No Comments

Rizwan Koita is CEO of CitiusTech of Princeton, NJ.


Tell me about yourself and the company.

I have been involved with the company for nearly 10 years now, right from its inception. Prior to CitiusTech, in 1999 I founded TransWorks, a business process outsourcing company. The company was acquired in 2003 when it was about 1,800 strong.

We started CitiusTech in 2005 with a vision of being a provider of technology solutions to the healthcare space. We offer healthcare solutions and services to organizations worldwide including healthcare software vendors, hospitals, medical groups, health plans, and pharma companies. We focus on building deep healthcare domain expertise and technical knowledge. CitiusTech leverages its global workforce in a cost-effective manner to help accelerate innovation in healthcare.

CitiusTech assists its clients and partners build and implement enterprise healthcare technology solutions through its knowledge and experience in the healthcare IT landscape. We’ve grown from zero to 1,600 healthcare technology professionals over the last 10 years, making us one of the fastest-growing teams in the healthcare IT industry.


You offer an analytics product. Who’s getting traction in market and what customers are seeing real results?

Our healthcare BI and analytics solution, BI-Clinical, has been in the market for about five years, helping healthcare providers and services organizations with their analytics and reporting needs. BI-Clinical is deployed at thousands of provider locations across US and is certified against regulatory requirements like Meaningful Use, NCQA HEDIS, PQRS, etc. It offers more than 600 KPIs and quality measures out of the box, and is probably the only solution in the market to have such extensive coverage.

We are seeing significant traction in the market for BI-Clinical, primarily because of its ability to integrate clinical and financial data from different source systems and offer out-of-the box analytics capabilities for use cases like readmission management, population health, and risk-based contracts.


How are you using the $100 million investment by General Atlantic?

I believe that the healthcare space is still very nascent in terms of technology adoption and process evolution. Over the next 5-6 years, I expect this market to grow substantially, both in terms of size and complexity.

To address growing market needs, CitiusTech is making strong investments in four key areas. We are expanding our portfolio of service and solution offerings, especially in new areas like big data, mobility, and analytics. We have also established a strong data informatics group, where our in-house data scientists are helping clients mine clinical data. We are expanding geographically across the US, Europe, and Asia Pacific. In addition, CitiusTech is looking for strategic partnerships or investment opportunities in other healthcare organizations with complementary offerings


What new healthcare IT-related technologies do you think are most promising?

We are seeing tremendous innovation all across the technology landscape, in the areas of analytics, cloud computing, mobile health, and big data. The key challenge for healthcare organizations has been to effectively leverage these innovations in the context for healthcare. Say, using rapidly evolving mobile platforms while ensuring compliance to HIPAA, patient data privacy, safety, or disaster recovery.

So it’s not just the technology, but also the means by which the healthcare industry can use these new tools effectively that hold great promise for the future.


You’ve already created and sold a large company. What are the most important business lessons you’ve learned?

Focus is important. It’s easy to get involved in many initiatives, spread too thin, and lose patience. One needs to understand that any new initiative takes a lot of time to grow or show tangible results.

Secondly, it’s my belief that businesses should keep innovating to stay ahead of the curve. We live in a world where it may not be enough to just solve the customer’s problem, but we would also need to solve them at a much faster pace and at a more competitive cost than others.

More importantly, organizations should place their most valuable asset, employees, at the center of their philosophy. In a knowledge-driven economy, businesses need to place greater emphasis on capability development of their people. At CitiusTech, capability development is the biggest investment we make for growing our organization as a whole. CitiusTech has more than 600 of its engineers HL7 certified. Through our extensive internal knowledge portal called UniverCT, we help our employees constantly upgrade their healthcare domain knowledge.


You wrote two years ago that social media was a vital part of maintaining the company’s culture as hiring ramped up quickly. How do you see it being used by healthcare providers?

The power and influence of social media is gigantic. Social media today has really brought the entire world closer, and at the same time, has disrupted the traditional models of sharing information. I feel healthcare organizations need to hop on to this changing information ecosystem that is being driven less by the enterprise and more by consumers.

The new payer-provider engagement models like ACOs create significant financial upside for healthcare organizations to continue their engagement with consumers and patients outside the traditional care setting.


How would you characterize the healthcare IT market over the next five years?

The last five years have seen significant technology investments by healthcare companies, partly driven by technology innovation and also because of the healthcare reform initiatives announced by the Obama administration. In fact, for all the criticism it has received, Obamacare probably deserves more credit than it gets for accelerating healthcare technology adoption, changing payer-provider dynamics, and paving the way for better healthcare information access and efficiency.

Over the next five years, it will be interesting to see how the healthcare IT market leverages patient data to enhance clinical outcomes and optimize care delivery. I feel that with a wider use of analytics technology like big data and predictive algorithms, caregivers will be able to make significant improvements in population health, disease management, and care coordination programs.

Also, with the increasing adoption of powerful consumer devices like smartphones, tablets, and wearables, patients will start to have a greater say in the care delivery process. We are already witnessing leading mobile vendors like Apple, Google, and Samsung investing heavily in enhancing mobile devices to support tracking of patient vitals and other healthcare information.

Organizations that can effectively leverage these trends — using clinical data for analytics and engaging patients using mobile and social media — will be very successful.

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January 30, 2015 Interviews No Comments

Morning Headlines 1/30/15

January 29, 2015 Headlines 3 Comments

CMS intends to modify requirements for Meaningful Use

Following months of growing pressure from industry groups, CMS announces that it will reduce the 2015 Meaningful Use reporting period for from 365-days to 90-days.

Best in KLAS & Category Leaders 2014

KLAS publishes its annual “Best in KLAS” awards, with Epic winning top spot for: Acute Care EMR, Ambulatory care for practices over 10 providers, HIE, LIS, Billing, Surgery Management, and Patient Portal. MEDITECH 6.0 wins Best in KLAS for community hospital EHRs, and Wellsoft wins best stand-alone EDIS.

This Medical Supercomputer Isn’t a Pacemaker, IBM Tells Congress

IBM has been lobbying Congress to push the newly introduced 21st Century Cures bill through to ensure that its Watson supercomputer is protected from FDA oversight.

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January 29, 2015 Headlines 3 Comments

News 1/30/15

January 29, 2015 News 7 Comments

Top News


CMS announces plans to shorten the 2015 EHR reporting period to 90 days and to change hospital reporting to be calendar year in a new rule it expects to be approved in spring 2015.

Reader Comments

From Information Dirt Road: “Re: Practice Fusion. Earlier this month they interfered with all lab results traffic during peak business hours and now are having another outage. All who work with PF are cursed by the absurd spectacle of PF being the clueless center of their own special universe.” They have a scheduled weekly maintenance window of Thursdays from 9 p.m. to 1 a.m. Pacific, which seems sensible to me. I followed the link to their EHR status page, which appears to be rarely updated.


From HIS Junkie: “Re: HX360. I thought this was supposed to get people going on a new interoperability phase of HIT, but HIMSS has created a new meeting program for it right in the middle of its conference. It’s amazing how fast HIMSS jumped on this to make another buck.” I’m not a fan of co-located conferences, but you can watch a just-posted interview with HX360 CEO Roy Smythe, MD for more on what they’re doing. The HX360 exhibit hall is included with normal HIMSS15 registration, the full track is an extra $225, and the executive sessions are invitation-only.   


From Deli Meat: “Re: electronic signature pads. Thanks for an amazing website. We are trying to reach Topaz Systems about problems with their signature pads that we use in registration with Epic. Emails are bouncing, phone calls aren’t returned, and their website seems to be down. Please assist with any insider information you may have.” The website is up for me and I got a live salesperson when I called their number, so I passed along your email address and said you needed help as a live customer.

HIStalk Announcements and Requests

I forgot to include a link to the the now-separate Dr. Jayne post in the email update, but it’s right here.

If your company sponsors HIStalk and didn’t receive our email in which we’re taking RSVPs for our HIMSS sponsor networking event and collecting information for our HIMSS guide, contact Lorre. Sometimes the information we have for contacts is incorrect or even missing entirely.


We’re still accepting applications through February 9 from real patients who want to attend the HIMSS conference with a $1,000 scholarship and registration provided. These are for non-healthcare IT folks who have a compelling patient story to tell and who want to attend the HIMSS conference and write about their experiences on HIStalk afterward. Email Lorre with your story and why you want to attend – we’ll judge on both motivation and writing ability.

This week on HIStalk Practice: Telehealth takes over the headlines, with state licensing issues and vendor compliance making the news. GE Ventures looks to HIT to the potential tune of $40 million. Community Eye Center Optometry goes with VersaSuite. Doximity offers interactive physician salary data by state. Premedex launches new chronic care management solution for physician practices. Clinicient secures $7 million. Customer satisfaction with government services reaches a new low. Google Fiber heads southeast.

This week on HIStalk Connect: Google partners with Biogen Idec in a multi-year project focused on researching multiple sclerosis. The FDA approves the first smartphone-connected continuous glucose monitors, technology that diabetics have been demanding for years. Researchers from the University of Pennsylvania find that Twitter data analytics can be used to create highly accurate maps depicting the prevalence of heart failure at the county level. 

Welcome to new HIStalk Gold Sponsor CenterX. The Madison, WI company’s next-generation e-prescribing network improves medication adherence by closing the physician-pharmacist loop. It offers enterprise medication authorization, formulary management, pharmacy benefit eligibility, and medication profiles. Doctors are notified when the prescription is picked up and flat rate pricing eliminates the per-transaction penalty that discourages communication. Physicians benefit from electronic refill requests and automated prior authorization. Only about 40 percent of patients nationally pick up their prescriptions and use them correctly, but CenterX users have up to 90 percent adherence. The company just announced that it has fully integrated its Enterprise Medication Authorization solution with Epic. Thanks to CenterX for supporting HIStalk.

Acquisitions, Funding, Business, and Stock


Lexmark turns in anemic Q4 results, but its Perceptive Software business books a solid quarter.



Penebscot Community Health Care (ME) chooses Forward Health Group’s PopulationManager and The Guideline Advantage.


St. Joseph Health (CA) selects Clinical Architecture’s Symedical for terminology management, semantic normalization, and interoperability.



St. Tammany Parish Hospital (LA) promotes Craig Doyle to VP/CIO.


Impact Advisors promotes Jenny McCaskey to VP.


Richard Holada (IBM) joins Truven Health Analytics as chief data and technology officer.

Announcements and Implementations

First Databank announces GA of FDB Cloud Connector, an Amazon Web Services-powered web API solution that reduces development time and IT overheard required to deliver FDB’s drug knowledge. Meditech was an early adopter, and interestingly, the company mentions that future pharmacogenomics decision support may be impractical to deliver by traditional means.

Medsphere announces OpenVista Population Health, a Windows-based enhancement developed by the Indian Health Service for its RPMS ambulatory EHR version of the VA’s VistA. The company signed a $15 million contract in 2011 to support and enhance RPMS.

Epic wins Best in KLAS 2014 for overall software suite, acute care EMR, HIE, patient accounting, patient portal, surgery management. Epic Beaker beats the best-of-breed LISs as the #1 lab system (although one might argue that Epic Care Everywhere as the #1 HIE is equally surprising). Epic also wins best physician practice vendor and several EHR/PM categories. Athenahealth wins for practice management in the two larger practice size categories (11 docs and up), while Impact Advisors takes the top spot in overall IT services and clinical implementation principal.

Government and Politics


New ONC Meaningful Use Stage 2 numbers show that 88 percent of hospitals that are MUS2 eligible have attested so far with an April 2015 due date, with 25 percent of those using the Flexibility Rule. EP attestations are much less robust, with only 15 percent of MUS2 eligible providers attesting so far with a February 28 due date and nearly half of those using the Flexibility Rule.

Privacy and Security


The psychologist who pioneered the study of facial expressions in the 1970s fears that companies will use his work to infringe on privacy. Software can measure consumer reaction to ads, but is being extended to detect shoplifters and to interrogate suspects, leading him to worry that facial expression algorithms will be used in public spaces without consent. On a positive note, the technology is being testing for measuring post-operative pain and to detect stress levels.


A New York Times editorial by a Mayo Clinic anesthesiologist warns that despite President Obama’s call for heavily funded research for precision medicine, it won’t make most people healthier. He says that genes can’t predict the most common and expensive chronic diseases, but we can already do that with simple tests, while the treatment is decidedly non-technical: eat better, exercise more, and don’t smoke. He concludes that “moonshot medical research initiatives” such as the “war on cancer” usually fail and that efforts would be better directed to studying human behavior.

Bloomberg Business says IBM has lobbied Congress for two years to pass the 21st Century Cures bill that would keep Watson-powered medical capabilities free of FDA oversight. The bill, which also includes the Software Act and addresses several health IT issues, was drafted by the House Energy & Commerce Committee, whose Democrat members just pulled their support of the bill.


AliveCor’s smartphone-powered heart monitor earns FDA approval for new algorithms that assess an ECG as normal and that warn users that interference makes the ECG unreliable. The just-introduced third generation model costs $75, creates readings from a two-finger touch, and includes an algorithm to detect atrial fibrillation.



A group of health systems – including Advocate, Ascension, Atrius, Dartmouth-Hitchcock, Dignity, OSF, Partners, Providence, and SSM — and other healthcare players unite under the name Health Care Transformation Task Force in committing to put 75 percent of their business into value-based payments by 2020.

A NEJM study suggests that while the Affordable Care Act prohibits insurance companies from excluding coverage for pre-existing conditions, they may be using high drug co-pays to keep people with expensive diseases such as HIV from signing up in the first place.


The bonds of Einstein Healthcare (PA) are downgraded due to financial losses that are partly attributed to a drop in employee productivity caused by its Cerner EHR.

Massachusetts General Hospital (MA) used telemedicine virtual visits during the recent snowstorm when clinics closed.

A physician’s editorial in NEJM called “Death Takes a Weekend” ponders the age-old question of why — in this age of high-acuity admissions and fast discharges — hospital services shut down on weekends. “It seemed callous on the hospital’s part — expecting very sick patients and very worried family members to understand that the doctors’ convenience had to come first. They need the weekend off, so you’ll have to wait till Monday. Even in good hospitals, weekends had a decidedly makeshift feel, with a constant refrain of ‘I’m just cross-covering, we’re short-staffed, the person you need will be here Monday.’”


Weird News Andy researches scam online medical journals that charge authors to publish their work. A doctor tests their editorial review process by submitting an article composed of randomly generated phrases titled “Cuckoo for Cocoa Puffs?” with primary authors Pinkerton LeBrain and Orson Welles. Seventeen of 37 journals accepted it within the first two weeks and offered to publish it upon submission of a processing fee. One of the journals shares an address with a strip club. I checked out Global Science Research Journals, which publishes dozens of journals such as “Global Journal of Neurology and Neurosurgery” and “Global Journal of Pediatrics” and charges a $500 per article fee. The Nigeria-based publisher’s US office is in a Brooklyn apartment.


Another WNA find he calls “My Doctor the Car”: Mississippi’s medical board investigates an 88-year-old doctor whose practice consists only of house calls, saying they don’t like the idea that he writes prescriptions from his 2007 Camry. In the TV station video, a guy walks right up to the car window to explain his medical issues. WNA proposes a solution: he should upgrade to an RV.

Sponsor Updates

  • Named as KLAS Category Leaders for 2014 are Sentry (340B management inpatient), SIS (anesthesia), Merge (cardiology hemodynamics), Zynx Health (CDS care plans), Wolters Kluwer (CDS order sets), Premier (CDS surveillance), Optum (computer-assisted coding), Strata Decision (decision support business), Emdeon (eligibility enrollment), NextGate (EMPI), Allscripts (global acute EMR, Northern America), Encore (go-live support), GetWellNetwork (interactive patient systems), Capsule (medical device integration), Nuance (medical records coding, quality management), Ingenious Med (mobile data systems), Nordic (other implementation), TeleTracking (patient flow), Iatric Systems (patient privacy monitoring), Craneware (revenue cycle charge capture), SSI Group (revenue cycle claims management), and GE Healthcare (staff/nurse scheduling, time and attendance).
  • Named Best in KLAS 2014 are Merge (cardiology), ZirMed (claims and clearinghouse), Impact Advisors (overall IT services, clinical implementation principal), Wellsoft (emergency department), Streamline Health (enterprise scheduling), McKesson (ERP), Allscripts (global acute EMR), CareTech Solutions (IT outsourcing extensive), Orchestrate Healthcare (technical services).
  • Logicworks publishes the eighth installment in its DevOps Automation series, entitled, “Improving the End User Experience with Amazon Web Services.”
  • Orion Health earns accreditation as a HISP.
  • William Seay of Lifepoint Informatics writes a new blog entitled, “Get Your Laboratory & Anatomic Pathology Results in Real-Time, When You Want, How You Want & Where You Want.”
  • LifeImage’s Mike Murphy blogs about saving time, increasing referrals, and improving orthopedic patient care via medical image sharing.
  • PDR will exhibit at the NACDS Regional Chain meeting in Naples, Florida on February 2-4.
  • Ivenix Medical Advisor and anesthesiologist Matt Weinger, MD shares his views on infusion pump technology at the Association for the Advancement of Medical Instrumentation’s blog.
  • Kathleen Aller writes about looking for meaning in mounds of data in the latest InterSystems blog.
  • HealthMEDX offers insight into its full EHR implementation at Lexington Health System (KY).
  • Jim Blanchet, associate management consultant at Greencastle, blogs about “The Valley of Despair” and asking yourself the right questions.
  • The HCI Group offers five tips on meeting the ICD-10 implementation deadline.
  • Pepper McCormick writes about the four healthcare trends that will shape 2015 in the latest Healthwise blog.
  • Greythorn will exhibit at this weekend’s Geek Wire Startup Day in Seattle.
  • Health IT Outcomes profiles e-MDs and its work to exchange provider data directly with the new Kansas infectious disease registry.
  • DocuSign announces that over 50 million people in 188 countries now use its technology.
  • The Healthfinch team offers a new blog on healthcare IT assumptions versus reality.
  • Cynthia Ethier of Hayes Management Consulting offers advice on how to create an ACA front desk.
  • HDS takes a look at the growing phenomenon of walk-in clinics at local malls in its latest blog.
  • Ingenious Med Mobile Product Manager Brannon Gillis posts a new blog entitled, “Useful and Usable: Basic Mobile Development Philosophy in Action.”
  • ICSA Labs participates in the IHE North America Connectathon today in Cleveland.
  • Extension Healthcare will exhibit at the Association of California Nurse Leaders Conference in Anaheim from February 1-4.


Mr. H, Lorre, Jennifer, Dr. Jayne, Dr. Gregg, Lt. Dan.

More news: HIStalk Practice, HIStalk Connect.

Get HIStalk updates.
Contact us online.


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January 29, 2015 News 7 Comments

EPtalk by Dr. Jayne 1/29/15

January 29, 2015 Dr. Jayne No Comments

The physician lounge was buzzing this morning with discussion of HHS secretary Sylvia Burwell’s newly-announced goals for the Medicare program. The plan is to move 90 percent of Medicare fee-for-service (FFS) payments to a quality-based system by 2018 and to move 50 percent of FFS payments into “value-based alternative payment models” on the same timetable.

Although we’re pretty far along with the quality-based payments, we’re nowhere near that far with alternative models (such as ACOs). When you consider the number of providers who have failed to join (or dropped out of) ACO programs, that’s a pretty audacious goal. The general tone among my colleagues is this: they’re supportive of quality, but would like to see other institutions (especially the Medicare and Medicaid bureaucracies and held to the same standards.

I didn’t watch the State of the Union Address to hear about the President’s “Precision Medicine Initiative” but have been asked a couple of times what I think about it. Although it is very sexy, precision medicine is also very expensive. I surfed around for some quote from the Address and the Initiative purports “to give all of us access to the personalized information we need to keep ourselves and our families healthier.” It reminds me a little of end users who refuse to use the EHR because it doesn’t have one sexy feature or another. I have to talk them into using it to get the benefits it actually has rather than worry about what it doesn’t have. We need to figure out how to better encourage patients to take advantage of the general (but very effective as well as inexpensive) medicine advice we already have: eat less, move more, make healthy choices. Alas, daily exercise and delayed gratification aren’t as exciting as the idea that technology will fix all that ails us.


As a CMIO, I spend a fair amount of time listening to what physicians don’t like about our software. It’s always interesting when we perform an upgrade, and while some users like it, others consider it a “downgrade.” Sometimes the complaining is justified, but it always feels more acute when it’s a problem with the EHR rather than consumer software. I was interested to see a software firm other than Microsoft or Yahoo make a blunder recently. Intuit is under fire for realigning the features of its popular TurboTax product. Since I’ve already spent a couple of hours this week preparing all my documentation, I’m glad I saw this letter to customers that explained that the version many of us have used for years will no longer meet our needs. They’re trying to make it up to users with a $25 rebate. That’s about 50 percent of the purchase price of the version in question. Extrapolate it for what we pay for medical software and that could get interesting for a vendor who wanted to make good on a dodgy software release.


Speaking of vendors, I have a couple of physician friends who work in the vendor space. If you’ve ever wondered why they’re not spending all their time creating usable new features that physicians need and want, take a look at the test procedures they have to follow in order to get the product certified. If you’ve never seen them, let’s just say they make CMS billing regulations look like a pre-K reader.

Researchers at the University of Pennsylvania have harnessed Twitter to predict rates of coronary heart disease. Analyzing the content of tweets by county, “they found that expressions of negative emotions such as anger, stress, and fatigue in a county’s tweets were associated with higher heart disease risk.” Although there is no expectation of privacy when using Twitter, I couldn’t help but think about the documentation needed to do this kind of human studies research. Maybe Twitter should add something about it to their terms of service.

Another interesting twist on their work is the comment by one researcher that, “You’ll never get the psychological richness that comes with the infinite variables of what language people choose to use.” This is exactly what EHR-using physicians have been saying for years – that it’s impossible to get the “flavor” of the patient’s story through checkboxes and templates. I’m looking forward to the day when I can go back to dictating my notes and letting voice recognition and natural language processing do the heavy lifting of turning it into something appropriate for coding, billing, and interoperability.

The research team has experience with linguistic analysis, showing it can be as effective as questionnaires in assessing personality characteristics. I hope they’re not looking at my tweets, because given their recent infrequent nature, they would likely determine that I’ve become reclusive.

What does your Twitter history say about your personality? Email me.

Email Dr. Jayne.

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January 29, 2015 Dr. Jayne No Comments

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  • Grizzled Veteran: CareCloud CEO will remain as CEO, but will focus on large practices(i.e. like an Account Rep, hmm?) Beginning of the end...

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