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News 1/24/14

January 23, 2014 News 3 Comments

Top News 

1-23-2014 8-33-43 PM

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


Reader Comments

1-23-2014 5-33-01 PM

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

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

1-23-2014 6-37-04 PM

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



HIStalk Announcements and Requests

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

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

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


Upcoming Webinars

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

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


Acquisitions, Funding, Business, and Stock

 

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

1-23-2014 3-40-06 PM

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

1-23-2014 10-04-45 PM

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

1-23-2014 3-40-43 PM

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

1-23-2014 3-42-05 PM

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


Sales

1-23-2014 1-01-15 PM

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

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

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


People

1-23-2014 1-33-33 PM

EDCO Health Information Solutions promotes Lynne Jones to president.

1-23-2014 6-53-23 AM

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

1-23-2014 1-35-08 PM

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


Announcements and Implementations

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

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

1-23-2014 9-52-01 PM

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


Government and Politics

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

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

1-23-2014 8-25-41 PM

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


Technology

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

1-23-2014 6-56-34 PM

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

1-23-2014 9-58-33 PM

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

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

1-23-2014 8-08-28 PM

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



Other

1-23-2014 1-43-56 PM

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

1-23-2014 5-44-54 PM

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

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

1-23-2014 7-22-39 PM

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

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

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

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

1-23-2014 8-53-42 PM

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


Sponsor Updates

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


EPtalk by Dr. Jayne

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

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

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

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

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

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

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 23, 2014 News 3 Comments

GE To Acquire API Healthcare

January 21, 2014 News No Comments

1-21-2014 10-38-01 AM

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

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

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

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

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

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January 21, 2014 News No Comments

HIStalk Interviews Lyman Garniss, Pathology Project Director, Partners HealthCare

January 21, 2014 Interviews 2 Comments

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

1-21-2014 9-05-59 AM

Tell me about yourself and the organization.

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

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

 

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

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

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

 

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

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

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

 

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

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

 

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

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

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

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

 

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

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

 

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

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

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

 

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

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

 

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

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

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

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

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

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

 

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

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

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

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

 

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

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

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

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

 

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

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

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

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January 21, 2014 Interviews 2 Comments

Morning Headlines 1/20/14

January 19, 2014 Headlines No Comments

GE Healthcare revenue flat, earnings up 4%

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

Netherlands hospital staff visits St. Rita’s Medical Center

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

Girish Navani, on Why Titles Don’t Matter

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

Royal Berkshire Hospital booking system ‘still flawed’

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

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January 19, 2014 Headlines No Comments

Monday Morning Update 1/20/14

January 19, 2014 News 6 Comments

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

1-18-2014 2-14-01 PM

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

1-18-2014 2-26-46 PM

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

1-18-2014 3-33-19 PM

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

1-19-2014 8-45-35 AM

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

1-19-2014 10-37-06 AM

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

1-19-2014 10-38-13 AM

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

1-19-2014 10-39-16 AM

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

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

1-18-2014 4-06-55 PM

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

1-19-2014 9-09-14 AM

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

1-19-2014 10-00-22 AM

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

1-19-2014 9-26-13 AM

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

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

1-19-2014 10-41-17 AM

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

1-19-2014 10-24-32 AM

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

1-19-2014 10-43-10 AM

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

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

1-18-2014 4-12-44 PM

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

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


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 19, 2014 News 6 Comments

News 1/17/14

January 16, 2014 News 7 Comments

Top News

1-16-2014 7-51-54 PM

Streamline Health will acquire St. Louis-based patient scheduling and surgery systems vendor Unibased Systems Architecture.


Reader Comments

From Salient Point: “Re: vendor layoffs. I’ve never had so many colleagues (most of them older), including high-performing salespeople, being let go. Seems like more than the usual Q4 pruning. Are you seeing this?” I will defer to readers. It does seems as though companies are cutting back, maybe because the HITECH boom is pretty much over unless you are Epic, Cerner, or a consulting company.  The EMR dance partners have largely been chosen, other than the likely ambulatory rip-and-replace caused by unmet expectations and acquisitions.

From Eclipsys Gal: “Re: Chad Eckes, chief strategy officer at Cancer Treatment Centers of America. Replacing Sheila Sanders as CIO at Wake Forest Baptist University Medial Center (NC).” Unverified. Sanders resigned after four years at WFBUMC in May 2013 following a disastrous Epic rollout, although the hospital said her departure was unrelated.


HIStalk Announcements and Requests

A few highlights from HIStalk Practice over the last week include: CareCloud reports the addition of 520 new clients in 2013, including the 20-provider Urology Austin (TX). The PCMH model leads to lower cost, better access to care, higher patient satisfaction, and fewer avoidable or unnecessary services. Practice Fusion achieves 2014 Complete EHR certification in time to beat its December 31 “guarantee” deadline. More than half of providers say they have not yet estimated the impact of ICD-10 on their cash flow. Doximity claims it has more physician members (250,000) than the AMA. SureScripts adds almost two dozen vendors to its clinical network for secure HIE. A dozen HIT vendors share opinions on the biggest challenges facing physicians and physicians practices in 2014 in part one of a three-part series. Thanks for reading.

1-16-2014 4-26-31 PM

Welcome to new HIStalk Platinum Sponsor MBA HealthGroup of South Burlington, VT. The company’s consulting services include Epic, Allscripts, ICD-10, EHR optimization, Meaningful Use, and RCM. They’ve trained and supported more than 5,000 physicians on Allscripts EHR, trained 3,000 users on Epic 2012, and provided RCM services to 400 physicians in 38 states. Fletcher Allen CIO Chuck Podesta mentioned using the company’s Epic 2012 upgrade services when I interviewed him earlier this week (the case study is here.) I noticed a new company blog post on the benefits and pitfalls of personalizing Epic that contains good nuts-and-bolts advice. Thanks to MBA HealthGroup for supporting HIStalk.

Listening: The Neighbourhood, a new California-based five-piece that skillfully blends alternative music with R&B. The singer is 22, which must be the coolest thing ever.


HIStalkapalooza and HIMSS

1-16-2014 3-16-49 PM

HIStalkapalooza registration will continue for several days. Everybody who wants an invitation has to register individually (that includes Inga and me, so don’t expect sympathy after the fact if you didn’t bother). We would love to invite everyone, but that’s not possible given that we had more than 750 requests in the first few hours, so watch your inbox for invitations on February 4 or so and follow #HIStalkapalooza14 on Twitter. Imprivata is doing an amazing job to make it the best event possible, as you’ll see if you score an invitation. It’s hard to comprehend that this will be the seventh version, going all the way back to Orlando in 2008 when it was 200 or so people in a Peabody Hotel conference room. I was thrilled because I was secretly hoping for 100 but expecting 25.

HIStalk sponsors: let Lorre know if you’ll be attending our sponsor-only networking reception on Sunday evening, February 23 at the HIMSS conference. It’s going to be pretty cool and a nice way to finish to the pre-conference weekend. Contact Inga if you haven’t sent your information for our HIMSS guide.


Acquisitions, Funding, Business, and Stock

1-16-2014 3-38-29 PM

The price of Allscripts shares climbed nine percent Wednesday following the company’s prediction of five to eight percent adjusted revenue growth per year from 2014 to 2016. Analysts were expecting five percent growth in 2014. Above is the one-year chart with MDRX in blue and the Nasdaq in red, with shares rising 60 percent.

1-16-2014 3-40-14 PM

Valence Health reports revenue growth of 35 percent for 2013 and a 65 percent increase in bookings.

1-16-2014 3-41-01 PM

Craneware says its first half earnings are expected to be up five percent over last year.

1-16-2014 6-11-24 PM

Mercom Capital Group issues its healthcare mergers and acquisitions report for 2013, reporting $2.2 billion and 571 deals in 2013 vs. $1.2 billion and 163 deals in 2012. The top five VC-funded companies for the year were Evolent Health ($100 million), Practice Fusion ($85 million), Fitbit ($73 million), MedSynergies ($65 million), and Proteus Digital Health ($45 million). Above are the largest M&A transactions of the year. The full report costs $599.


Sales

Center for Diagnostic Imaging (MN) extends its use of Merge Healthcare solutions to include the iConnect Network interoperability platform.

Long-term care provider Grace Healthcare (TN) selects the Daylight IQ disease management system from COMS Interactive.

1-16-2014 3-55-06 PM

NorthBay Healthcare (CA) selects Health Catalyst’s Late-Binding Data Warehouse and Analytics platform.

1-16-2014 3-56-44 PM

WakeMed Health & Hospitals (NC) will implement population health and final risk management solutions from Evolent Health.

Kaiser Permanente (CA) renews a multi-year agreement with MedAssets for strategic sourcing and spend analytics solutions and to serve as Kaiser’s exclusive GPO for its nationwide facilities.


People

1-16-2014 4-21-50 PM

ISalus Healthcare hires Jason McDonald (Kareo) as chief sales officer.

1-16-2014 4-22-51 PM

HIMSS names its former board chair Willa Fields (San Diego State University) the winner of the 2013 HIMSS Nursing Informatics Leadership Award.

1-16-2014 4-23-41 PM

Rick Roycroft (MedAssets) joins Huron Consulting Group as managing director of the company’s healthcare practice.

Cureatr names Vik Shah (Medidata Solutions) as EVP of client services and operations.


Announcements and Implementations

Johns Hopkins HealthCare (MD) and BlueRush Media Group will co-develop an online portal that provides information for employers and their employees who are undergoing or have gone through cancer treatment.

1-16-2014 8-30-37 PM

The City of New Orleans EMS integrates its EMS Service Bridge electronic patient care reporting system from ImageTrend with the Greater New Orleans HIE.

In Canada, Cerner completes deployments of its ambulatory EMR  at three Ontario ambulatory clinics, supported by Canada Health Infoway.

1-16-2014 4-55-49 PM

Compass Oncology (OR) pilots My Care Plus, a patient portal designed specifically for cancer patients by McKesson Specialty Health.

1-16-2014 8-33-42 PM

The VA deploys Health Level’s critical case management platform for all its VA National Teleradiology Program medical centers.

The Ministry of Health of the Kingdom of Saudi Arabia launches nationwide open access to Wolters Kluwer Health’s UpToDate for the country’s 80,000 physicians and nurses.

1-16-2014 4-53-06 PM

Lincoln Hospital (WA) and Community Wellness (WA) use the INHS TeleHealth system to offer diabetes and pre-diabetes education to rural communities in northern Idaho and eastern Washington.


Government and Politics

1-16-2014 5-00-05 PM

1-16-2014 5-03-31 PM 1-16-2014 5-04-40 PM 1-16-2014 5-06-52 PM

ONC releases the Safety Assurance Factors for EHR Resilience (SAFER) Guides, which include checklists and recommended practices to help providers assess and optimize the safety and safe use of EHRs. The set of nine guides are High Priority Practice, Organizational Responsibilities, Contingency Planning, System Configuration, System Interfaces, Patient Identification, CPOE with Decision Support, Test Results Report and Follow-Up, and Clinician Communication. Each starts with a checklist of recommended practices for optimizing EHR safety. The guides were developed by Joan Ash, PhD (OHSU), Hardeep Singh, MD (Houston VA, Baylor), and Dean Sitting, PhD (UT Health Science Center). This is some really good work.

ONC announces the beginning of a 30-day period for organizations to submit requests for ONC-Approved Accreditor status, which is valid for up to three years. This the organization that accredits EHR certification organizations, with ANSI as the incumbent since the role was first defined in 2011.

CMS and ONC select McKesson and Meditech as its first designated “Test EHRs.” In order to meet the transition of care objective in Stage 2, EPs, EHs, and CAHs must successfully exchange an electronic summary of care document with a CMS-designated test EHR or with an EHR technology different that the provider’s EHR technology.

1-16-2014 8-39-31 PM

Several North Carolina doctors file a class action lawsuit against the state for delayed Medicaid payments, claiming that the the state’s Department of Health and Human Services and its contractors — CSC, Maximus Consulting, and SLI Gobal Solutions — were negligent in their rollout of the state’s $484 million NCTracks payment system.

Brian Ahier provided this audio of Karen DeSalvo’s introduction of herself to the HIT Policy Committee earlier this week. She sounds kind of fun, but for some reason her voice goes up in tone at the end of some sentences like she’s asking a question when she isn’t.


Other

1-16-2014 3-43-21 PM

A HIMSS Analytics report predicts accelerated growth for patient portals, clinical data warehousing and data mining, and radiology barcoding applications. The number of patient portal vendors rose from 28 in 2009 to 62 today.

CTG will add 300 jobs in its home city of Buffalo, NY in a medical informatics partnership with University of Buffalo’s Center for Computational Research in a genomics and big data initiative. The company helped create UB’s Institute for Healthcare Informatics in 2010 and contributed funds for Roswell Park Cancer Institute’s Center for Personalized Medicine.

1-16-2014 3-12-00 PM

A California highway patrol officer stops a California software developer for speeding, also citing her for wearing Google Glass. He considered the device to be covered under the same laws that prohibit playing video in the driver’s field of vision.

Texas and the city of Austin offer athenahealth $5.7 million in incentives to open an R&D center that would create 607 jobs with a capital investment of $13 million. The company is also considering locations in California, Massachusetts, and Georgia, the latter two of which have previously provided athenahealth with similar incentives.  

1-16-2014 9-21-33 PM

BIDMC CIO John Halamka says he has written two books, one a reflection on his blog writings and other a fictional thriller. He’ll be signing the former at HIMSS. He really is a Renaissance man now that he’s turned into a gentleman farmer (I’m hooked on his “Building Unity Farm” series.) I just can’t understand how he finds the time to get so involved in so much, maybe because I’m lazy.

The governor of Guam signs a bill approving a $25 million loan to Guam Memorial Hospital to help it repay its previous bailout loan and to pay the support fees of NTT Data, which threatened to cut the hospital off from software support.

1-16-2014 7-35-53 PM

Michael Gilbert, MD, a family medicine physician with St. Joseph Health (CA), writes a good ONC post for practices called “How to Use a Patient Portal.” As an Allscripts Enterprise user, he says the company pushed him to use Jardogs FollowMyHealth after they bought that company, resulting in a 40 percent drop in registrants from their previous portal (presumably Intuit Health). Current problems include the large number of pending registrations that never become active (which throws off the MU Stage 2 denominator), the requirement for users to install the Microsoft Silverlight graphics browser plugin (which hangs up my browser regularly, so I can understand that), and  the need for providers to motivate patients to participate. Interestingly, the practice bought a software development company and will build its own portal and HIE (!!!), but in the meantime seems fairly happy with the Allscripts product:

[providers] participate in secure online clinical communication, schedule appointments, refill medications, and answer routine questions with and for patients. The new portal automatically uploads all results within minutes of being verified by the provider and patients can directly schedule into providers schedules, ask for medication renewals and pay bills. The portal also offers a computer, iPad and iPhone application with all of the above functionality to patients. We have over 30,000 patients registered, and have achieved 10 percent penetration of all registered patients across both medical groups. Some providers have almost half of their patients registered. Our physicians encourage their patients to message them via the portal.

Weird News Andy appropriately finds this story sad. An ambulance takes 18 minutes to arrive at the scene of a shooting in a mall parking deck, unable to enter the facility because of the low ceilings. The crew had to roll the gurney up the ramp to get to the male victim, who had refused to hand over his keys to four carjacking assailants, who then shot him as his wife sat beside him in the car. He died.

An Iowa state prison psychiatric hospital employee is fired for downloading patient photos from the hospital’s computer, Photoshopping them, and emailing them to co-workers, who often responded with additional requests (some of those folks were also fired, apparently.) One of his works involved patient faces superimposed on a “Star Wars” poster whose title he changed to “Tard Wars.” He was also found to have used work PCs to visit adult site including “Heavy Hotties.” The man said his job mostly involved playing cards or Wii with patients, which enabled him to “Photoshop at the same time I am changing lives. It’s called multi-tasking.”


Sponsor Updates

  • The coreANALYTICS health system performance improvement system from Encore Health Resources earn ONC 2014 certification as an EHR module. Catholic Health Initiatives is using it.
  • Allscripts announces that its KLAS scores are on the rise, with Allscripts Enterprise EHR up 11 percent for the 12-month period ending December 2013 and Sunrise Clinical Manager up four percent.
  • Coastal Healthcare Consulting introduces Convergence, a patient identity management solution that uses NextGate’s Enterprise MPI.
  • NextGen will map its EHR directly to the IRIS eye disease registry.
  • Josh Byrd, Patientco’s director of marketing, shares his perspective on why the patient experience matters.
  • Joseph Petro, SVP of healthcare R&D for Nuance, explains how clinical language understanding is critical for helping providers drive productivity while remaining focused on patient care. 
  • TriZetto’s Provider Solutions Business unit introduces the Top Codes Report, which allows providers to chart their most frequently billed procedure and diagnosis code pairs in preparation for ICD-10.

EPtalk by Dr. Jayne

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ONC releases SAFER Guides to aid providers in safe use of health information technology. The Safety Assurance Factors for EHR Resilience Guides contain best practices for EHR use and include checklists for practice assessment. ONC Chief Medical Officer Jacob Reider discusses the nine guides on his “Health IT Buzz” blog.

There was a lot of discussion in the physicians’ lounge this morning regarding the suggestion that medical school could be reduced to three years. Certainly the idea of saving a year’s worth of tuition and living expenses might be attractive to those who already know what residency they want to pursue. Several of the programs currently in place reduce electives and require summer classes in order to meet required educational standards.

My medical school’s fourth year curriculum was all elective, and in hindsight, I’m glad I had it. Being at an urban academic medical center allowed me to see things I wouldn’t have been exposed to in residency and also allowed me to practice my clinical skills with less focus on competing against my peers. Coupling reduced medical school experiences with resident work hour limits could create a rocky start for some physicians entering practice.

The other hot topic in the lounge has been the recent New York Times article on scribes. After reading the article, several of my colleagues now think scribes are the be-all, end-all answer to their EHR problems. I enjoy moonlighting at a local emergency department that uses scribes, but physicians need to understand the limitations of the scribe model. Although they’re very popular for episodic care (emergency, urgent care) there are challenges in office-based medicine. One of the major issues is that using a scribe doesn’t relieve the physician of the need to learn the EHR. He or she will need to be able to access the system to view data and to handle after-hours patient contacts such as hospital admissions, phone calls, cross-coverage, etc.

Scribes hired from third-party agencies are expensive – up to $28 per hour in my market. It’s hard for physicians to cover that expense in primary care. The alternative chosen by many physicians is to train a medical assistant to scribe. That approach can be effective as long as the medical assistant is relieved of their other daily responsibilities. It is extremely difficult to try to play both roles in a busy primary care practice. The article says physicians using scribes can see up to four extra patients per day. That’s not been the experience of physicians in our community, who are lucky to see one or two extra patients per day. Scribes may not be as helpful with telephone messages, provider-to-provider communication, and other administrative burdens that impact physicians.

Physicians also need to spend time reviewing the scribe’s notes for accuracy. At my site, there is a pool of scribes and we may work with three or four during a single shift. Although the overall quality of their work is acceptable, the work of some is much stronger than others. Their work requires careful review, especially when they are new. Scribe training programs may be only a few weeks long. If you get lucky and have one who is a pre-med student or a nursing student, it can be a lot of fun since you can do some teaching along the way and they are generally very motivated to do a good job in the hopes they will be able to ask for a recommendation. If you get unlucky and have a scribe who has been up late the night before cramming for exams, it can be a challenge.

Speaking of challenges, today HIMSS invited me to attend a focus group. How could I resist their opening line: “Are you a CIO with a bed size of 150-400 or an IT Director/Manager with a bed size above 300 and not a practicing physician?” Why do they keep demographic files on members if they aren’t going to use them? Between that and the overall lack of HIMSS social invites, I’m starting to wonder whether this meeting is going to be more work than play. I’m confident, however, that with Inga’s vast social network, things will turn around. What are your HIMSS social plans? Email me.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 16, 2014 News 7 Comments

Advisory Panel: Top 2014 Priorities and Concerns

January 16, 2014 Advisory Panel 2 Comments

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This question this time: What are your organization’s top three IT priorities for 2014 and the concerns you have about executing them?


(1) ICD-10.
(2) Data center relocation to a CoLo.
(3) Complete enterprise EHR rollout.

The only one I’m really concerned about is ICD-10. There are just so many uncertainties around how the providers and the payers will make the transition.


Our top three IT priorities for 2014 all revolve around our Epic platform.

(1) We need to finish our enterprise-wide Epic implementation.
(2) Once we survive our go-live, we will enter into an extended period of optimization of the system, which I anticipate will take at least three to four months.
(3) Subsequent to that, we will begin to develop the capabilities within IT to begin to extend our Epic platform to other entities across our state.

My biggest concern for all of these is the ability to maintain my current resource levels as well as adding new resources in order to address the organizational strategic outreach initiatives.


(1) We are determining whether to stay on our current EMR platform or to switch.
(2) ICD-10 is looming.
(3) We are also focused on getting our remaining hospitals to Stage 7.


(1) ICD-10. Significant work needs to be completed on all facets of this mandate. Vendor testing and validation, staff education (HIM, physicians, and billing), reporting requirements, and many more. Payors are not ready, IS vendors are not ready, and our staffs are stretched thin, so it remains my greatest concern in 2014.
(2) MU Stage 2. So much is still not known. How will we meet the patient engagement goals (absurd for a community hospital with independent medical staff that also must meet the portal goal)? What will the CQMs require for new data collection? How will the medical staff deal with electronic medication reconciliation and the requirements of the Transitions in Care electronic documentation at the hospital while also dealing with a different system and set of requirements in their office? These questions remain and the vendors will not be ready until the last quarter leaving no room for error.
(3) Pending affiliation. During all of this, we are entering into an affiliation that will dramatically change our organization and will, at some point in the near future, require a conversion to a new ERP system and EHR.


After the massive expense of our EHR and in the face of ongoing financial financial struggles (real or perceived), there will be great pressure to hold down costs, perhaps even to find a revenue-generating activity for IT. The concern is that needed education and training will be shortchanged and clinician workflows that should be corrected promptly will be allowed to calcify, requiring even more resources in the future. Many of these workarounds reflect inadequate technical support (I never knew it could do that!) or training (I never knew it could do that!)


(1) Ensuring readiness for regulatory items like ICD-10 and Stage 2 Meaningful Use).
(2) Continuing to optimize our EMR investment via new high-value clinical decision support projects. 
(3) Implementing new enterprise-wide revenue cycle solution.


(1) ICD-10. 
(2) Operational cost reductions (both IT and non-IT).
(3) Growth through acquisition.


(1) ICD-10.
(2) MU Stage 2.
(3) Financial resource management (conservation).

The three are not compatible. I’ll need resources for both of the first two while being asked to use less at the same time. 


(1) Our top IT priority is moving from Cerner to Epic, with the obvious concerns about data migration and workflow changes slowing us down initially.
(2) Appropriately using analytics (from identifying high-risk patients for outreach, to looking for otherwise hard to find adverse events), with the dual concerns of (a) not having enough report writers, and (b) not having enough people to execute on what we find. 
(3) Figuring out telehealth at our organization, with the concerns of (a) finding a technical model that works efficiently, and (2) finding a business model that makes sense (who will pay for it!)


(1) Epic optimization. Hiring and retaining qualified Epic analysts is becoming very challenging in our region. Standard now is  work from home and significant yearly salary increases due to the local competition from institutions out of build phase so analysts are free to jump ship.
(2) Windows XP support (lack thereof). The March 2014 move to Windows 7 has us very nervous – Epic and scores of integrated applications cannot be tested enough to quell the unease.
(3) ICD-10. Ouch… how am I going to get providers that don’t document well to do an even better job next October? We discovered quite quickly that Epic support is still just nudging up their own learning curve.


(1) MU Stage 2. 
(2) ICD-10. 
(3) Integrated financial and clinical systems.


(1) ICD-10. Since ICD-10 success is based on physician documentation, it’s a wildcard as to how well you will do regardless of the education effort. 
(2) MU Stage 2. MU Stage 2 criteria related to transitions of care will be particularly difficult since there are three components (i.e. 50 percent of discharges, 10 percent using CDA format, and a transaction to a different EHR.) Items 1 and 3 are easily achievable but 10 percent using CDA format could be difficult depending on where your patients transition (both inpatients and ambulatory). Many post-acute settings, for example, do not have an EHR capable of receiving this format.
(3) Privacy and security. Privacy and security is just a matter of keeping up with the regulations. Competing for resources is difficult since this area doesn’t  get enough attention until you have a problem. With the final Omnibus rule in place, fines have increased, as will audits. Business associates will be particularly vulnerable, as well they should be. There are a considerable amount of other priorities for 2014 (e.g. ACO IT, EHR optimization) but these may have to wait.


(1) Government regulations compliance.
(2) M&A integration.
(3) Growth initiatives.

My main concern is having too many top priorities competing for finite resources, both in IT and operations.


I’d be very surprised if anybody answers anything but:

(1) MU2.
(2) ICD-10.
(3) Keeping the place running.


(1) MU Stage 2. Vendor delays, expectation of patient engagement.
(2) ICD-10. Inability of vendors to deliver on time; excessive fees (CAC).
(3) Volume to value mandates (reporting, data exchange, etc.), a market mess.


(1) Meaningful Use Stage 2 and 3. Concern about areas where we don’t have full control.
(2) Expanding use of mobile and connected care connecting our enterprise and our community through mobile devices.
(3) Maintaining security in a rapidly changing environment. Expecting more and more security breaches.


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January 16, 2014 Advisory Panel 2 Comments

HIStalk Interviews Laurie McGraw, CEO, Shareable Ink

January 15, 2014 Interviews 2 Comments

Laurie McGraw is president and CEO of Shareable Ink of Nashville, TN.

1-14-2014 12-27-26 PM

Tell me about yourself and the company.

I’ve been in healthcare for 20 years. I started way back when at IDX in Burlington, Vermont. In the late ‘90s, they broke off a subsidiary called Channel Health. I was running development at the time. That got bought by Allscripts. I was part of the Allscripts team from 2000 up until the time that I left in January of last year. 

When I started at Allscripts, we had five customers doing the EMR. It was called EMR back then. When I left, it was a $1.5 billion company that was pretty large. Those 12 years were a blast, just an absolute blast for me. 

This past summer, I joined Shareable Ink. I am the CEO of Shareable Ink today. It is a young and vibrant company that was founded by a brilliant innovator named Steve Hau who took a common sense approach to doing clinical documentation.

Shareable Ink does clinical documentation and we do it really, really fast. We take existing paper forms, tag them, digitize them, and preserve workflows for physicians to document, Again, very efficiently, very fast. We have these analytic tools where people can get great insights from the data that they’ve put in and drive financial outcomes and quality improvements.

 

Part of the appeal of the digital ink option for data input was that CPOE adoption was pathetic and electronic physician documentation wasn’t common two or three years ago. Usage of those has improved. Is there still a need for an alternative form of input?

I think so. I’ve worked with physicians all these 20-plus years. I’ve been in front of hundreds of physicians, physician audiences from physician groups to hospitals to whatever. What I know is, physicians don’t hate technology. They don’t. They love technology.

But what they hate is they hate being slow. Everyone appreciates getting quality data at the point of care. They want all that information. They just hate being slow. 

With Shareable Ink, we can extend the investment that’s already been made in electronic health records, or we can just simply replace paper that still exists in lots of different places in the healthcare system. Just making that physician fast, it’s very valuable. People have already made significant investments in clinical technology, but when physicians are slow, there are a lot of things that need to be done to improve that for them.

 

Part of your value proposition is the concept of clinically rich documentation. Does the typical electronic medical record product support that?

Fundamentally, the answer is yes. Electronic health records — and I’ve worked on them for all 20 years — are good products. Whether it was ones that I had worked on previously or other companies who are putting out electronic health records, they’re fundamentally good products.

Where the electronic health record falls short for physicians, in terms of what I’ve seen, is where they start to slow the physician down. It doesn’t mirror workflows that previously worked, either in the paper world or in the newly adopted electronic world. That’s where I see the need to either augment or go back to workflows that were previously really fast.

I know I keep saying fast, fast, fast as a theme here. I say that because all of the benefits of electronic health records, everybody still wants them. Many, many organizations are achieving them. But they’re still falling short. Everything in healthcare is driving towards more need for data at the point of care. That’s where we’re focused.

 

Is it common for hospitals that have successfully implemented CPOE and clinical documentation for physicians to add a product like Shareable Ink or do they usually use it before they are ready to adopt those EMR tools?

It’s pretty rare that an organization is completely on paper. Usually Shareable Ink is in a place that is supplementing some already automated clinical workflows. We’re either extending an EHR investment that’s already been made by some specific workflows in a particular specialty or we’re replacing some existing paper forms that are still being used because those particular paper forms capture all the data in a really efficient manner for the clinician. 

For example, we do a lot of work in the area of anesthesia, where a lot of paper still exists. We’re replacing the paper. But in many other places, we are replacing paper where clinical technology already exists.

 

I made the observation when I interviewed Steve Hau four years ago that the higher you go up the specialization chain of physicians, the more reliant they are on very specific forms rather than the general documentation that an internist might us. What areas of the hospital are most reliant on those specialized forms that don’t translate well to an EMR?

A couple of years ago, I would have said specifically areas like cardiology or orthopedics or something of that nature. The discussions that I’m having today, it’s back to areas — surprisingly to me — like primary care, where, quite frankly, there’s a lot of documentation needs, but organizations are still needing to supplement what their primary care physicians are doing because the speed at which they need to document in the electronic health record isn’t fast enough because of the tools that they’re using. They’re going back to things like paper to supplement it and scanning it in, or they’re looking at hiring scribes to help those physicians meet their productivity objectives. 

The premise of “the more specialized you are, the more likely that there are paper forms to supplement that” … it’s not that that is not true, it’s just that there are more general areas like primary care where there still is a lot of paper because of the productivity needs of those clinicians.

 

Hospitals put in systems, find them to be a burden to productivity, and then come to you for an alternative?

Absolutely. There’s opportunity to extend that electronic health record. The investment has been made and everybody is driving their quality programs based on what they can get out of their electronic health records, but they have to also meet certain productivity objectives within their organization because the volumes for these physicians and clinicians are increasing. 

Shareable Ink can help expand an electronic health record in those areas where you hear of physician dissatisfaction with their electronic health records. That’s a pretty common complaint. The reason is rarely because they don’t believe in the electronic health record. It’s always because of the speed issues and the productivity issues or how they’re encumbered because of using the technology. They just feel it slows them down. I’ve heard this directly for such a long period of time.

 

Most of the new hospital EMR sales are by either Cerner or Epic. What are some examples of integrating the Shareable Ink offering into those products?

We can integrate through interfaces so we can provide data into those systems, whether they’re Cerner or Epic, in the hospital. We have partnerships with vendors like Allscripts, like Greenway, where we use their open APIs to send discrete data into the electronic health record. 

Those are ways that we can extend the electronic health record investments organizations have made with those vendors. We’ll be looking to do more extensions like that in the coming year.

 

For a company like Epic that hasn’t offered too many hooks into their application, what would be a functional view of an Epic hospital implementing Shareable Ink?

We’re exploring those workflows now. Shareable Ink is a young company, but where we’ve implemented today is in specific areas where we’re replacing paper forms that already exist. They go into a McKesson system, a Cerner system, through a document viewer within that other system. Shareable Ink preserves the view of the form that has been filled out as well as all of the discrete data that is under the covers of that paper form.

 

There’s a lot of richness involved with what you can write on a piece of paper, even including the way you write it, where you write it, or what you draw as a picture. Are people realizing that that sterility of a set of fields that are extracted into an electronic medical record may lose some of the patient context?

I think that is a problem. I think that is an issue. I believe Shareable Ink can help solve some of that by bringing some of that richness back.

I’ve seen the discussions and been in the discussions with physicians who feel like they’re looking at a SOAP note or a clinician note that may be complete, but it’s so sterile they’ve blocked all the nuances of the care that was provided to the patient. Can Shareable Ink help in that regard? Sure, it can help — but not necessarily in the same ways as speech – through different pictures or notations or things of that nature. But I don’t want to pretend for a second that getting to that specific discrete data is still incredibly important for all of the quality metrics and everything else that an organization’s trying to drive toward.

 

Can you hand forms that have been turned into Shareable Ink to someone with no training and turn them loose?

You can. It is a stretch to say no training. There is some training required, but it is simple training. 

With Shareable Ink, when clinicians adopt it, they are not clearing their schedules. They’re not reducing their patient volumes to then adopt this additional clinical technology. What they’re doing is taking some additional time. The paper metaphor or what they’re used to with a form — that’s the workflow that’s preserved. 

It’s already a workflow that they’re familiar with. Now they’re just doing it on an iPad, or that same form on an iPad, or they’re doing it with a digital pen.

 

How is Meaningful Use affecting your business?

I’m hoping that it will increase the need for tools from Shareable Ink because Meaningful Use means a whole lot of additional data is required at the point of care. Just simply voice recognition into blobs of text is not going to be enough in terms of all the data that’s required for Meaningful Use. 

Shareable Ink can provide that additional rich data at the point of care while still keeping that clinician very, very fast. I’m expecting Shareable Ink to again be a great addition in complement to the EHRs that are out there.

 

Do you have any final thoughts?

I’ve spent 20 years in healthcare. While it has been awesome in terms of paving the clinical information highway, today what I see is that we spend a lot of time on all of the challenges that are out there: adoption, physicians being slow, needing better data, the challenges of Meaningful Use and ICD 10. What all that points to is really the need for better data at the point of care. 

I am optimistic that what we’re doing at Shareable Ink in terms of providing that rich data at the point of care and by doing clinical documentation in a way that is fast and efficient for the physician that we’ll be able to deliver on the promise of data-driven healthcare.

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January 15, 2014 Interviews 2 Comments

News 1/15/14

January 14, 2014 News 11 Comments

Top News

1-14-2014 7-43-05 PM

Healthcare billionaire Patrick Soon-Shiong launches health IT company NantHealth at the JPMorgan Healthcare Conference, which will offer the “intelligent Clinical Operating System” (iCOS) that will integrate information from molecular science, computer science, and big data to deliver solutions for population health management, cancer care coordination, transition management, and wellness. The company also announced a partnership with the Clinton Foundation to implement iCOS in two areas of the country. The company says iCOS is running in the country’s largest oncology group that covers 150 practices, 22 EMRs, and real-time data feeds moving 50GB per day; its Cancer Decision Support Engine is used by over 50 percent of oncology practices; and its EMR is running in 12,700 facilities in 13 countries. It talks about DeviceConX device connectivity, which is the iSirona’s product it gained when it acquired the company effective January 1, 2014.  Most of the other offerings are also previous NantHealth acqusitions, including the GlowCaps medication reminder system, home monitoring devices from Boston Life Labs, and Ziosoft medical imaging. Soon-Shiong spent $800 million on 60 companies and research projects that make up iCOS, which he says can be purchased right now. I’m never quite sure whether to take Soon-Shiong seriously, but having $7 billion gives him at least some instant credibility.


Reader Comments

1-14-2014 5-00-38 PM

From Holly S: “Re: Jonathan Bush’s leave. He’s going on an extended vacation from February to April. He’ll be spending time with friends and family, both travelling and hunkering down. His agenda is to play and experience some things he’s always wanted to do. He has never been so energized about the business, its ability to effect change in health care, the marketplace’s receptivity to change. He’s all-in on what’s ahead.” Thanks to athena for providing this update in respond to a reader’s inquiry. JB told me he hates to miss “the boat show” (the HIMSS conference) and especially his MC duties at HIStalkapalooza, but as he also confided, “I am honored to have been your MC these past few years and hope dearly that whoever replaces me in 2014 will be a bomb so that you will have me back in 2015.”


HIStalk Announcements and Requests

1-14-2014 4-59-23 PM

Thanks to Greenway Medical for sending this note in response to recent rumors of employee layoffs:

We’d prefer to not comment on rumors. We have, in fact, been working through a very thorough review of our organization since completing the merger of Greenway Medical Technologies and Vitera Healthcare Solutions, which includes Vitera’s SuccessEHS. That process includes aligning our resources to most effectively serve our customers, which we’re accomplishing by delivering our innovative7 industry-leading solutions, delivering data liquidity through our powerful interoperability engine, and leading our customers through what will be an awesome change from production medicine to outcomes-based medicine through our clinically driven revenue cycle management solutions. Our mission at Greenway remains the same.  We believe healthcare will continue to electronify, the consumer will become more engaged and demand change, and we will improve population health by delivering smarter solutions.  We’re privileged to serve such a large provider base, clinical professionals who provide care to millions and millions of patients. 

Voting for the HISsies awards is underway, as follows:

  • I pleaded for nominations on HIStalk over several days and, as happens every year, didn’t get many nominations even though anyone can nominate. If you don’t like the choices on the ballot, blame those few hardy readers who actually submitted nomination since everyone who has complained so far didn’t.
  • The most-nominated entries made it onto the final ballot, which was emailed directly to the addresses in the HIStalk update list (which prevents ballot box stuffing since the voting is tied to the email address.)
  • So far, 765 of the 10,000 email recipients have voted.
  • The results will be revealed at HIStalkapalooza and on HIStalk.

On the Jobs Page: NextGen Activation Consultant, Epic Activation Consultant, Epic Certified Builder.

Listening: new (released today, in fact) from Sharon Jones & the Dap-Kings, brilliant and amazing 1960s-style revivalist pop soul with lots of horns recorded on good old analog. Treatments for Sharon’s pancreatic cancer (diagnosed June 2013) left her bald but unbowed in the video.

1-14-2014 5-42-48 PM

Welcome to new HIStalk Gold Sponsor Accreon. The company is a leader in system optimization, information integration, and software solution development. They worked on Canada’s clinical information highway and have built tools for US-based vendors for population health management, remote patient monitoring, and workflow optimization. Services for providers include strategic planning, project management, implementation, integration, analytics strategy and optimization, and HIE architecture and sustainability. They can also help vendors with near-shore solutions, software development, integration, and analytics projects and they also do work for payors, pharma, and government. Eric Demers is the Boston-based president of Accuron USA and not only is an industry long-timer who you may know, he even has a MHSA degree, which always clearly signifies that “I’m a healthcare person” since just about everybody else gets a general MBA instead. Thanks to Accreon for supporting HIStalk.


Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.



HIStalkapalooza

1-14-2014 4-37-23 PM

I’ll post a separate HIStalk article Wednesday afternoon with the link to the registration page, so watch for the email update. There’s no need to rush – we’ll leave the registration page up for several days and then invitations will go out February 4. Above is a bit of a hint about the sponsor and location. Meanwhile, I’ll say just once more that I think the primary sponsor has one co-sponsor slot open, so email me if you want more information.


Acquisitions, Funding, Business, and Stock

1-14-2014 6-04-48 PM

WellDoc, provider of a Type 2 diabetes mobile device management program, raises $20 million from Merck Global Health Innovation Fund and Windham Venture Partners.

1-14-2014 6-24-15 PM

Surgical Information Systems acquires ambulatory surgery EMR and management software vendor AmkaiSolutions.

1-14-2014 6-10-53 PM

Online employee health shopping systems vendor HealthSparq acquires ClarusHealth Solutions, which offers a provider search function for consumers. HealthSparq’s president is Scott Decker, formerly of NextGen and Healthvision.

1-14-2014 7-00-46 PM

Transcription and speech recognition vendor MModal, acquired by a JPMorgan private equity arm in a leveraged buyout worth $1.1 billion in August 2012, hires a restructuring firm, according to sources cited by The Wall Street Journal. Sales are dropping and  the company is paying high interest charges on its debt of $750 million, which has tripled since the acquisition.

Post-acute care software provider Brightree acquires Strategic AR, a provider of private-pay billing and collection services.


Sales

1-14-2014 6-29-53 PM

Rush Health (IL) contracts with Caradigm for healthcare analytics and population health software to support its private HIE. Rush Health’s CEO says the HIE is the largest investment the organization has ever made, adding, “We want to use this infrastructure to connect and exchange real-time information so we can do a better job coordinating care.” Rush Health will also offer to cover the first-year of EHR expenses the 10 percent of its doctors who are still using paper, moving them to Epic, eClinicalWorks, or athenahealth.

1-14-2014 8-41-02 PM

Contra Costa County Health Services (CA) engages Vonlay to support its Epic 2012 upgrade.

The 22-hospital St. Vincent Health (IN) will pilot Acupera’s population health analytics and clinical workflow management platform in one of its physician offices.

1-14-2014 6-32-14 PM

Catholic Health Partners (OH) will implement Epic’s MyChart Bedside at all of its hospitals following a successful pilot at its St. Rita’s Medical Center (OH) location. Patients and family members access their health information, labs, caregiver team member information, and educational materials on a hospital-issued tablet.

Geisinger Health System (PA) selects Besler Consulting to identify Transfer DRG underpayments.

CMS awards Optum/QSSI a contract to serve as a senior advisor on the HealthCare.gov website following its interim engagement as general contractor after the site’s October 1 meltdown. The company’s press release, oddly enough, includes testimonials from HHS Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner.


People

1-14-2014 5-17-16 PM

CHIME names HIStalk’s own “CIO Unplugged” Ed Marx (Texas Health Resources) as its 2013 John E. Gall Jr. CIO of the year.

1-14-2014 5-18-47 PM 1-14-2014 5-19-39 PM

Arcadia Healthcare Solutions names Sam Adams (Accretive Health – above left) SVP of sales,  Jonathan Rider (Jetstream Consulting) SVP of technology and engineering, and Sandi Molettieri (UTC Aerospace Systems – above right) director of HR.

1-14-2014 5-23-05 PM

NavigatorMD appoints Alexander Poston, Jr. (Entrada) CIO.

1-14-2014 5-25-27 PM

Artemis Health Group names John Doulis, MD (MedCare) president and CEO, replacing Phillip Suiter, who resigned.

1-14-2014 5-36-28 PM

Andrew Baker (Intuit Health) joins Culbert Healthcare Solutions as VP of business development.

1-14-2014 5-38-38 PM

Mike “The PACSMan” Cannavo (McKesson) returns to his PACS consulting business.

Kim Bahrami joins government contractor Acentia as VP of business development over the company’s expansion into DoD and VA healthcare.

CMS appoints Acting CIO Dave Nelson as the agency’s permanent CIO.


Announcements and Implementations

CECity and athenahealth will offer a health data exchange integration and reporting service to automate information flow from athenaClinicals to national clinical registries using CECity’s clinical quality data gateway.

1-14-2014 12-10-33 PM

Dubai’s Mediclinic City Hospital and Mediclinic Welcare Hospital will install Oneview Healthcare’s patient engagement software.

Varian Medical Systems will expand its existing Salt Lake City facilities in anticipation of creating 1,000 full-time jobs over the next 15 years.

1-14-2014 9-41-47 PM

Heart Imaging Technologies provides Merge Healthcare access to its portfolio of healthcare information patents, including zero footprint technologies to provide access to diagnostic-quality images in a standard web browser. The agreement also settles litigation initiated by Heart IT against Merge for patent infringement related to internet-based image viewing.

MedHOK, which just closed $77.5 million in funding, will increase its 100-person staff by about 35 percent over the next year. 


Government and Politics

1-14-2014 1-55-54 PM

CMS announces it will consider on a case-by-case basis requests made under the Freedom of Information Act for information to find out much Medicare pays individual physicians.

VA CIO Stephen Warren says that for 2014 his agency will be focusing on improving its system baseline practices and procedures, configuration management, patch management, and elevated privilege review.

1-14-2014 1-46-25 PM

A GAO report criticizes CMS, the VA, and six other agencies for their inconsistent implementation, policies, and procedures for responding to data breaches involving personally identifiable information.


Innovation and Research

A report finds that ACOs are competent in offering e-prescribing, a single database containing medical and prescribing information, and formulary options that encourage the use of generic drugs, but lack tools that notify physicians when prescriptions are filled, prevent duplicate drug therapy, measure quality, and demonstrate the value of appropriate medication use.


Technology

1-14-2014 8-20-28 AM

Alere Connect receives FDA 510(k) market clearance for its Alere HomeLink platform, which also earned CE Mark certification which will allow it to be marketed in Europe.


Other

Cerner Middle East expands its office in Riyadh (Saudi Arabia) in support the company’s growth plans.

1-14-2014 1-23-01 PM

Products from EBSCO, Elsevier, Wolters Kluwer, Truven Health Analytics, Isabel, and Logical Images earn the highest rankings in a KLAS report on clinical decision support resources, including tools for disease reference, drug reference, nursing reference, and diagnostic decision support.

An ICD-10 readiness survey by Navicure and Porter Research reveals that 74 percent of physician practices have not yet started implementing their ICD-10 transition plan, though most don’t anticipate any disruptions from their EHR, PM, or clearinghouse vendors. A couple of alarming stats: 27 percent of survey practices are unsure how or where to start preparing for the transition, while 22 percent claim they don’t have the staff or resources to begin preparing.

The former CEO of two-hospital, 350-bed Cape Cod Healthcare (MA) who resigned abruptly in 2010 remained the organization’s highest-paid employee for the next two years, earning over $1 million in each year, and was still being paid in 2013. The hospital’s board chair said, “A lot of executives have post-employment benefits,” while a business ethics expert says it’s no wonder that US healthcare is so expensive. The CEO is also a physician and was disciplined by the state medical board after he left the hospital for inappropriately writing prescriptions for family members.

Weird News Andy notes, “Hipsters, beware” about this story in which a man in China stretches and yawns so hard that he collapses his own lung. WNA provides his targeted warning because the at-risk group is “tall, slim young men.”

WNA also likes a story that he titles “Clean Booze,” in which a man steals 12 bottles of hand sanitizer from a hospital by hiding it in his arm sling and then goes back twice more for additional bottles. He told the police who finally nabbed him that he makes a cocktail by mixing the alcohol-containing cleaner with orange juice.


Sponsor Updates

  • HealthMEDX announces that it will be the first long-term and post-acute care EMR vendor to participate in the Interoperability Showcase at HIMSS14.
  • McKesson’s MED3OOO division expands its Dayton, OH office space from 10,000 to 12,000 square feet and will increase its local employee head count from 110 to 122.
  • Allscripts will incorporate the Adheris DirectStart medication adherence communication program into its EHR.
  • Gartner positions InterSystems as a Challenger in its Magic Quadrant for Operational Database Management Systems.
  • Clinovations consultant Matt Lambert, MD publishes a book that includes his reflections on healthcare and the push for change in the midst of healthcare reform.
  • Wolters Kluwer Health expands use of Lippincott’s Nursing Procedures and Skills to include hospital-based clinicians and renames the product Lippincott Procedures.
  • Doctors Community Hospital (MD) shares how its use of GetWellNetwork improved patient education and entertainment while generating revenue.
  • The Rochester Business Journal names eHealth Technologies to its Rochester Top 100 list based on dollar and percentage revenue increases over the past three years.
  • Loran Cook, product evangelist for Billian’s HealthDATA, considers the future of partnerships, payers, and a loophole in the ACA.
  • Rock Health names Health Catalyst CEO Dan Burton to its list of Top 50 Digital Health Entrepreneurs.
  • RelayHealth releases the second generation of RelayAnalytics Pulse for comparative analytics.
  • Emdeon achieves CAQH CORE Phase III Certification, which certifies the company accurately and efficiently exchanges healthcare electronic funds transfer and electronic remittance advise information.
  • ICSA Labs certifies InteHealth’s patient and physician portals with 2014 Edition Modular EHR Inpatient and Ambulatory ONC HIT Certification.
  • Cornerstone Advisors founder and president Keith Ryan advises Bartlett Regional Hospital’s (AK) planning committee on its EHR options. 

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 14, 2014 News 11 Comments

HIStalk Interviews Chuck Podesta, SVP/CIO, Fletcher Allen Health Care

January 13, 2014 Interviews No Comments

Chuck Podesta is SVP/CIO of Fletcher Allen Health Care of Burlington, VT.

1-13-2014 12-11-55 PM

What lessons did you learn as your single hospital expanded into a health system?

I’ve worked with systems in the past, so I was prepared from a due diligence standpoint to understand what we were getting into. The interesting thing has been is being at the beginning of a system being born as opposed to going to work at an organization that already had created the system. That part has been really, really exciting.

From a learning standpoint — and I’ll just speak from an IT perspective right now — it’s how you merge the cultures of the different organizations, both from a leadership perspective and staff perspective. We haven’t merged all four hospitals’ IT under IS from a cost center perspective, but I am the system CIO over those organizations. 

I work very hard to get our leadership within IS to work with their leadership in their organizations and staff-to-staff communication as well. We’re geographically disparate from each other, so it makes it a little bit more difficult. That part has gone really well. That’s been the biggest thing that we’ve done.

We created an IT council that’s a high-level group of the high-level IT folks. Then we did a sub-group that’s made up of low-level managers but also some staff that are working together across the system and looking at things like linking email and some of the nuts and bolts things that need to be done behind the scenes. 

That’s brought these teams together, working on the same projects. What we’re finding is that the more and more that you do that, it’s going to make it easier as we get to the more difficult projects of implementing different types of technologies in these organizations.

Every hospital has the challenge of trying to look at new tools to support risk-sharing arrangements and population health management, but you’re also faced with trying to combined the financials to give a view that makes sense and to understand the physician relationships.

Absolutely. If you look at the last time we talked in July 2009, we were Fletcher Allen Health Care academic medical center, Burlington, Vermont. Now we’re a four-hospital system. We also are 50 percent owner of OneCare, which is a Medicare Shared Savings Program with Dartmouth-Hitchcock. There’s 14 hospitals involved in basically the entire state of Vermont, about 50,000 covered lives that are under that right now. A very large Medicare Shared Savings.

We’ve got the issues around exactly what you mentioned — the data analytics, advanced population analytics that we’re implementing. We’ve got some unique stuff going on there, along with working with two health information exchanges, because we are not only in Vermont, we’re also in northern New York. We work closely with VITL in Vermont and Hixny in northern New York. They’re working together to link their two HIEs together to benefit us as well.

On the advanced population analytics side, we’ve joined a group called Northern New England Accountable Care Collaborative. That’s made of Eastern Maine, Maine, Dartmouth-Hitchcock, and now ourselves. It’s a unique opportunity. They take our CMS claims data in and using VITL, we move our EHR data into that data warehouse. We can also have access to the de-identified data of the other organizations. Instead of just looking at populations of 300,000 or 600,000, now we can look at populations that are in the millions. The bigger the denominator, the better off you’re going to be.

 

People claim that healthcare is behind technologically, but we have business models that seem to change every five years, government involvement and reporting, and insurance company requirements. Everybody wants something different on the back end and yet you’re trying to keep the front end running. Is that sustainable? I can’t think of any other industry where there’s so much change that isn’t to support the business, but to meet new minimum external requirements.

I think over the next year we’re going to find out whether this is sustainable or not. If you look at the priorities that we have right now, we have ICD-10 coming. We’ve got Meaningful Use Stage 2, then Stage 3. Privacy and security is huge with the passage of the final Omnibus Rule and we’ve got to spend a lot of time there. We’ve got our system IT priorities that we need to put in place, and then also our OneCare ACO IT priorities that need to be put in place.

You add all those up and just look at the care and feeding of an Epic EHR and the priorities that go into that, it’s daunting. I joke a little with my senior leader that in the past, we were able to do a business planning session, have the IT strategy follow the business plan, and do a three- to five-year IT strategic plan. That’s no longer the case. I can’t even do a six-month strategic plan. 

What I’m trying to get my organization to do is to talk a lot about how do you survive, how do you manage, how do you lead in an organization that every single priority is a high priority? In the past, you could make a list and start at one and go to 10. You might have four or five projects that are twos. But in this particular case, they’re all ones. The federal government deadlines on a lot of these things are all coming to a head. 

How do you get your organization to work in that type of environment? That’s been amazing from a cultural standpoint. What you’re going to see across the country is some organizations will be nimble enough to do that and then others won’t.

 

Given the low likelihood of success and the fact that CIOs aren’t typically given extra resources, will it be harder for CIOs to keep their jobs?

Absolutely. If they don’t set the expectations with their senior leader colleagues …  even though I mentioned earlier that I make a joke about not being able to do a six-month strategic plan, I’m actually pretty serious about that. If my senior leader colleagues — my boss, my CEO, the board – are expecting a three-year plan and I’m not clear on what our priorities are, even over the next couple of months, and to get them to understand, then I’m setting myself up for failure. I know that has happened to other CIOs across the country. 

This coming year, year and a half, I think there’s a lot of CEOs out there that expect all this stuff to get done. If the CIO is not clear with the individual that they report to, that based on the resources that they have, these are the things that we can get done and these are the things that we can’t get done. We’re also in a situation where you can’t add any more resources. I can’t go to my boss and say, give me 10 more FTEs and I can do 10 more things. It’s just unsustainable from that standpoint. 

It will be interesting. I think there will be a lot of turnover in the next year to 18 months or so as the Medicare penalties kick in as well in 2015. There will be a lot of CIO turnover, I believe.

 

In the past, that type of environment is where health systems start thinking about outsourcing their IT departments because consulting firms claim they can do more with the same resources and still make a profit. Do you think the environment is going to swing back what seemed to be a diminishing trend of health systems looking outside to have their IT run by someone else?

Yes. What you’re going to see first, though, is just from the healthcare industry in general, the mergers and acquisitions that are happening. I firmly believe that within the next five years, there’s probably going to be 100 to 200 health systems in the United States. They will be regionally focused. Bigger is going to be better in this new world of population health management. That’s happening all over the United States. 

What you’ll see first is merging the IT shops. How that all shakes out will take a little bit of time and outsourcing may play a role in that. But I see those IS organizations working hard to come together first. They may look at outsourcing, but I just don’t think that’s going to be as high a priority as merging these various organizations.

 

What types of health IT-related businesses do you think will benefit from that consolidation scenario and which ones do you think will suffer from it?

The call center can be outsourced and consolidated probably fairly easily. We’re doing that now across our system. That’s probably one of the easier ones. If you look at field service, network, server management, and data centers, for example, there’s a lot of savings there. Looking at how you merge your data centers and cut some costs there. That’s the easy part.

The harder part is on the application side. If you’ve got more than one Epic organization coming together … you’ve seen one Epic organization, you’ve seen one Epic organization. They all have their different nuances. But most of the systems are coming together. You have an Epic organization and the other one might be a Cerner, and you’ve got to go through a process of, are you going to keep them that way, or are you going to put Cerner in the other organization, or are you going to choose Epic? 

That is going to be much more difficult to do. The application people that support those applications, the retraining associated with that, is just going to be really, really difficult to do and very costly. For these large organizations coming together, you’re talking hundreds of millions of dollars. You’re seeing it now — some of the bigger organizations are doing implementations and mergers and acquisitions at the same time.

 

There was a lot of buzz recently about your health system announcing plans that it expected to lose a lot of money but also that it would be doing a lot of hiring to support Epic. Internally, is Epic providing the expected benefits and return on investment, or are executives privately questioning whether the cost was worth it?

 

If you had asked that question a year ago … to be honest with you, I was questioning it. A lot of that was self-inflicted. It didn’t have to do with Epic. We had implemented Epic. We had gone live. We spent a lot of time on the ambulatory side and really got that humming. 

Then we didn’t take care of the inpatient side of things. The inpatient side got very stale. It got very customized. I think we had 70 different flowsheets across the organization. Data wasn’t landing in the database where it should be to get reports out. We ran into that with Meaningful Use. It was very difficult for us.

About a year and a half ago, I hired a CMIO. He came in and one of the ideas he had was that we needed to go to 2012 upgrade. He said, why don’t we just take all 7,000 enhancements and go back to model as close as we can? Originally when we thought about that, we were like, what are you, crazy? Typically when you do an Epic upgrade, you look at 50, maybe 100 enhancements. You never get to all the enhancements from an Epic upgrade typically. 

This was a radical change from that. When we approached Epic, they were really noncommittal on whether we should do that. But the more we talked about it, they gave us the green light. Last spring, we started that process. We went live in October. It completely changed. It was a non-event over a weekend. The training wasn’t too difficult. It became a better system.

Now we’re relying on Epic to do the R&D instead of us building things that Epic’s already building in future releases. We found ourselves doing that when we looked at 2012. We were building things in 2010 that already existed in 2012. It just didn’t make any sense at all.

We got creative on the how we used consultants during that period. We needed some help and we used some firms come in and help us from a resource perspective, because you imagine a whole change going from an 80-20 customized system to more of an 80-20 in the opposite direction model versus a custom system. The changes that we needed to make were huge. 

We worked with a national company, but their local headquarters are here in Vermont. It’s a perfect marriage. They were Allscripts at the time. Their name is MBA HealthGroup. They were nervous based on where Allscripts was going and we needed help, so they came forward. We started talking about us sponsoring them with Epic so that they could create an Epic practice. In return, they would send people, get them certified, and bring them on site at a very reduced rate, about a 50 percent reduction in what you normally would pay. 

After a six-month period, we would have the right to hire, which we thought was great. We view that as a creative win-win situation with them. They’re offering it across the country now to certain organizations. We used them for our training in the Epic space. We hired two of the individuals at the end of the project. We were able to pick the best and brightest out of the group and hire them. That was a win all the way around.

We’re also reaching out to the local colleges and universities here and getting lists of engineering, math, and science majors with 3.5 and above and encouraging them to apply for open positions. We’ve hired a couple of kids right out of college. They have been amazing. The productivity is just … they learn so fast. What we’ve found is you can’t give them a deadline, because if you do, they’ll wait up until the last minute and then get it done. They can do it a lot faster than the deadline that you give them. Just give them the work and don’t give them a deadline and you’ll get much more out of them. That’s been fantastic and we’re continuing that type of program as well.

 

What are your biggest challenges and opportunities over the next one to two years?

Looking at the next year,we’ve got ICD-10. We’ve got Meaningful Use Stage 2. Privacy and security, which is constant vigilance on that.

Every time you turn around, you see another breach. Everybody’s going to have a breach at some point. At some point, somebody’s going to do something stupid and it won’t be malicious and you’re going to have a breach. But the ones that I see that could be avoided, those are the ones that really get me going. The non-encryption of a mobile device. It makes no sense to me as to why people haven’t done that.

The breaches that are happening, those are the only ones we know about. There’s so many out there that we don’t know about. It’s going to be more and more difficult because OCR is certainly going to ramp up the audits and the fines are going to start coming out. That’s a big one. 

Then the accountable care IT infrastructure that we’re building with the health information exchange and population analytics. Then trying to look at synergies across our system from an IT perspective and where we can save some money and increase services across the four hospitals. My expectation is that the next time we talk, we’ll be larger than a four-hospital system. 

All that stuff has to get done in the next 12 months. Otherwise we’ll be behind the curve on what we need to get done. A lot of other organizations are in the same situation whether they realize it or not. They have these same priorities, especially if they have an ACO or are part of an ACO. Whether they realize it or not, all that stuff is coming to a head over the next 12 months.

 

Do you have any final thoughts?

I can’t say enough about the privacy and security side of it. A lot of the technology that we use today enables physicians and nurses and clinicians to take care of patients. These systems are helping to give us higher quality, eliminate errors, and impact patient safety. That’s been great and it’s been worthwhile.

But we have a mission — we should have a mission — to protect the privacy of the information within these electronic health records. I can’t go to a bedside and take care of a patient directly, but I can certainly involve myself directly in the privacy and security programs of this organization. I think more and more CIOs that do that and get directly involved in the privacy and security, understand it, make sure you have a chief information security officer, get the tools that you need, figure out a way to justify those, and get those in. For our patients, that’s the one thing that a CIO can directly impact.

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January 13, 2014 Interviews No Comments

Monday Morning Update 1/13/14

January 11, 2014 News 1 Comment

1-11-2014 2-49-45 PM

From Yogic Flyer: “Re: Merge. How could a sales rep hide being paid for non-existent contracts unless there are absolutely zero controls in place in that company?” Merge announced last week that a former sales rep created phony contracts worth $15 million to meet his or her sales quota, earning the rep more than $250,000 in sales commissions. The rep worked in the eClinical OS business, which sells clinical trials software to drug companies. It’s hard to believe that some level of collusion (individual or corporate) wasn’t required for a sales rep to just make up contracts that were used not only to pay commissions, but also to be rolled into the corporate orders backlog of a publicly traded company. It’s also interesting that customers weren’t billed for the amounts specified in the contracts, so Merge’s internal processes must be majorly disjointed. MRGE shares dropped more than 10 percent on the news, decreasing the company’s market capitalization to just over $200 million. The share price is down nearly 70 percent from February 2013. Chicago-based vendors Merge and Allscripts seemed likely at one time to cause a worldwide shortage of feet to shoot themselves in.

From It’s a Sledgehammer: “Re: Allscripts. [sales exec name omitted], another former IBMer hired by Glen Tullman, has been terminated. Paul Black’s master plan of putting the Cerner band together takes one more step.” Unverified.

1-11-2014 2-47-59 PM

From Willing Participant: “Re: HIStalkapalooza. I enjoyed last year’s event and read that invitations will be sent next Wednesday. Do I need to do anything to be eligible?” The registration page will go live Wednesday, January 15 (CGI isn’t building it, so hopefully we won’t have problems.) Sign up  then if you want to come. We will email invitations on around February 1 to those we can accommodate since we always have a lot more demand than supply. The most important thing to remember is that you have to register if you want to attend. Every year I get emails from people ranging from pleading to angry who didn’t register and who apparently expected the Official HIStalk Psychic to divine their attendance intentions and send them an unsolicited invitation. It doesn’t matter if you are a swaggering CEO, a sponsor executive, or a self-identified industry celebrity – you have to register (just like I do) to be considered for an invitation. Please don’t embarrass both of us by claiming I didn’t mention it on HIStalk since I clearly do multiple times, and once the spots are assigned, it’s too late. I can say this so far having had several conversations with the sponsor: HIStalkapalooza (#HIStalkapalooza14 on Twitter) is going to be amazing.


Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.

Webinar questions? Contact Lorre.


1-11-2014 8-15-37 AM

Respondents think ICD-10 will challenge hospital CIOs more than other high-profile issues in 2014. New poll to your right: how much impact will IBM’s Watson computer have on healthcare?

1-11-2014 3-48-30 PM

1-11-2014 4-27-21 PM

Speaking of Watson, IBM announces plans to spend $1 billion to improve Watson’s slow sales progress, with most of the money earmarked to bring in more salespeople and consultants and to create an app store program. The smothering hype after Watson’s “Jeopardy” performance obviously set unreasonable expectations, so there’s a little bit of desperation as it slides in the Trough of Disillusionment. At least it’s being used: Elsevier will employ the technology to enhance the online search capabilities of its medical journals and textbooks, allowing users to search by natural language questions rather than a list of keywords.

1-11-2014 9-21-29 AM

Welcome to new HIStalk and HIStalk Connect Platinum sponsor Voalte (that’s pronounced “volt,” in case you were wondering.) The Sarasota, FL-based company provides caregiver-connecting mobile technology that includes Voalte One (all-in-one smartphone communication including VoIP calling, alarm notification, and text messaging), Voalte Me (secure texting that can be used securely on personal smartphones), and Voalte Connect (mobile device management, powered by AirWatch). Available case studies include Cedars-Sinai, Texas Children’s, and Sarasota Memorial. I interviewed Trey Lauderdale, president of the company, in September and we talked a lot about pagers, medical device alarms, and BYOD. Thanks to Voalte for supporting HIStalk.

Here’s a demo of Voalte One that I found on YouTube.

Stuff you can do to support HIStalk: (a) sign up for email updates, thereby entering an exclusive club of 11,194 well-informed and slightly offbeat healthcare IT experts; (b) connect with us on Facebook, Twitter, and LinkedIn so that Inga, Dr. Jayne, Lorre, and I can pretend we are socially active despite the reality of spending most of our time alone in front of a computer; (c) join the HIStalk Fan Club that reader Dann started in 2008, which now has 3,349 members who are all above average and cute besides; (d) send me news and rumors so I don’t miss something important; and (e) peruse a few ads of sponsors and their listings in the Resource Center, confident that despite your differences with their role as vendors and yours as a prospect, you all show your innate coolness by reading HIStalk for sophomoric humor and scandalous rumors.

Listening: Ozma, serving up Pasadena-based power pop since 1995 and best known as being Weezer’s tour mates (not to mention sounding a good deal like them). They are better than you might expect.

1-11-2014 2-43-08 PM

Quality Systems announces that it will review certain assets in its NextGen Hospital Solutions division and record a charge against those assets in Q3. The announcement mentions the division’s poor performance and implementation backlog. The company also announces that its Q3 results will fall short of expectations due to poor Hospital Solutions Division results, a reduction in capitalized software development expense, and higher expense amortization related to new versions of NextGen Ambulatory. The hospital division is made up of the acquired Opus Healthcare Solutions and The Poseidon Group.

1-11-2014 8-50-37 AM

The White House fires Canada-based CGI Federal from the Healthcare.gov project, handing Accenture a one-year, $90 million, no-bid contract. The outcome of that should be interesting.

I’m getting a little bit annoyed by carefully cloaked Twitter bragging disguised as humility, i.e. “Thanks to all my great co-presenters at XXX conference” or “I’m honored that XXX Magazine has chosen to run my article.” We get it, you are wonderful and way better than the rest of us. 

1-11-2014 4-07-12 PM

Andrew Ury, MD, who founded Practice Partner and sold it to McKesson in 2007, raises $1.9 million in funding for his new venture, ActX. The Seattle startup is working on technology to incorporate patient genomic information into medical practice.

1-11-2014 10-04-46 AM

Five University of California medical centers test the use of game-based clinician education sent to their smartphones in small sections over a three-month period. It’s delivered by Harvard-based Qstream, whose primary offering supports sales rep coaching. 

Harvard Business Review finds that the impact of potentially disruptive retail clinics has been disappointing, with slow growth, little expansion to underserved areas, and an unclear impact on healthcare spending. Reasons: (a) poor people would rather go to the ED for free than pay even low retail clinic prices; (b) the clinics are usually staffed by nurse practitioners , whose reimbursement is less than that of physicians; and (c) Medicaid doesn’t want to pay for services delivered by retail clinics. In other words, hospitals are so unwilling or unable to make ED abusers pay that the market can introduce no acceptable alternative. It’s tough to compete with “free.”

1-11-2014 10-28-16 AM

ONC is looking for someone to lead its EHR certification team.

In Australia, an anesthesiologist says he’s being harassed by his hospital employer after complaining that a study of blood transfusion patients failed to de-identify them properly, allowing him to easily determine their names via an Internet search.

Bill Gurley, a partner in Benchmark Capital (Uber, Zillow, OpenTable, and Yelp) is looking for  “orthogonal/disruptive” approaches that don’t “partner closely with current players.”

Phoebe Putney Memorial Hospital (GA) fires two employees over two PHI-containing laptops that were stolen from one of its clinics in November, hinting that the terminated employees violated the hospital’s policies.

1-11-2014 10-48-13 AM

@Farzad_MD tweeted this table from an Annals of Internal Medicine “study of studies” article showing good historical outcomes for healthcare IT, leading me to accept his broadly issued challenge of, “I bet the next negative study of some bad health IT implementation gets more ink.” I pondered this and concluded that negative articles are more popular because:

  • With the money and effort involved with implementing systems, it shouldn’t be newsworthy that they work and provide ROI and patient value. It should instead be newsworthy when they don’t.
  • It’s still hard to convincingly prove that healthcare IT saves money or improves outcomes, and experience is still inconsistent because of not only lack of standardization, but even the lack of consensus that standardization is a good thing.
  • Successful implementations often don’t have any conveniently easy lessons to learn since they often involved big organizational commitment and slow, steady progress. The closest thing to a magic bullet is not what to do, but what to avoid doing, and the negative articles call out those potential potholes.
  • Technology is incorrectly viewed by technologists as the solution rather than a way to enhance the effectiveness or ineffectiveness of a given organization. Amazon doesn’t make you smarter – it just makes it easier to buy the kind of books you already read.
  • The industry is small and there’s always animosity toward a given vendor or provider organization based on personal or organizational history.
  • People feel superior when someone else fails in ways they are convinced they themselves would never be guilty of doing.
  • Organizational HIT success often is accompanied by selective user discontent, so it’s common for a physician to write emotional editorials against the intrusion of technology (as well as government, health systems, and insurers) into the practice of medicine while their employer can demonstrate positive improvements from that very same technology. The “organizational good” story gets buried if it’s written at all, while the “public good” story gets even less exposure.
  • Most of the people writing don’t have any direct experience with healthcare IT or reading peer-reviewed journals and find it easier to make names for themselves with sensationalistic or negative headlines pulled from questionably newsworthy source stories. 
  • Organizations with successful HIT outcomes don’t get any benefit from telling the world about their experiences, while those that fail are usually mad at someone they blame instead of themselves and are happy to talk about it.

HIMSS exhibitors, take note of “Confessions of a Former Booth Babe,” written by a “brand representative” assigned to the huge CES in Las Vegas. Her summary: (a) at $25-$50 per hour, it pays better and was at least less demeaning than being a shot girl or go-go-dancer; (b) it’s the hiring company and not the attendees that sets the level of lewdness; and (c) you know what you’re being hired to do if the application requires full-body photos rather than sales experience. Another expresses discomfort with photo-seeking male attendees who are far right on the horndog-pervert continuum: “You kind of wonder where your picture’s going to end up. I had someone ask to take a picture just of my feet. One guy asked to take a picture of me while I was wearing nude fishnets. Then, after he took the photo, he wanted to talk to me about his pantyhose fetish.”

Weird News Andy titles this story “Right Bullet, Wrong Gun.” A couple finds via DNA testing that their daughter, born by artificial insemination in 1992, was fathered by a fertility clinic employee rather than the husband who provided sperm. Testing suggests that the part-time employee may have swapped out his own sperm sample for that of hundreds of prospective fathers. The couple is urging former clinic patients to have the DNA of their children tested.

1-11-2014 3-54-51 PM

WNA says he can’t put his finger on what’s wrong with this story, which he names “Proctally Perfect in Every Way.” Researchers develop an artificial robotic butt for teaching medical students to perform prostate exams. It warns them not only if they press too hard, but also if they don’t make enough eye contact beforehand. I can think of far more lucrative consumer applications.

Vince is wrapping up his HIS-tory series after a several year run on HIStalk, which leaves me disappointed since I enjoy the heck out of them. His next-to-last one tries to untangle the remaining hairball of McKesson’s acquisitions that turned into 200 products.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 11, 2014 News 1 Comment

News 1/10/14

January 9, 2014 News 3 Comments

Top News

1-9-2014 10-34-30 PM

inga thumb Merge Healthcare discovers in an internal review that a former sales employee falsified the existence or amount of certain customer contracts. Merge had not invoiced any of the customers or recognized revenues, meaning previously reported results are not affected. However, the company reduced its non-GAAP subscription backlog totals over 25 percent from prior statements. The sales rep, who had been paid about $250,000 in commissions on the invalid contracts, has admitted to falsifying the orders and has offered to pay restitution. Merge has referred the matter to the US Attorney’s Office. While the rep’s actions are reprehensible, I am sure that plenty of sales veterans (me included) in HIT and other industries are aware of other instances of  “creative accounting” in order to hit quotas.


Reader Comments

1-9-2014 10-35-38 PM

From Politico: “Re: Greenway. Major layoffs this week.” Unverified, but reported by several readers, one of whom gave a number of 80 affected employees.

From Nasty Parts: “Re: Carrollton is cratered. Rumor is 150 people downsized at Greenway’s former HQ, including the VP of HR. This comes on top of an exodus of sales executives, including two VP. Approximately 10 of the top reps have left, many because they did not want to sign the feared Vista non-compete. Also, word is that the HQ of SuccessEHS, another Vista acquisition, was also cleaned out today.” Unverified, but Nasty Parts has been right several times in the past. We didn’t receive a response to our inquiry.

From Xflo-Bee: “Re: Cerner. I’m hearing a lot of buzz on the wire about Cerner being the focus of a big lawsuit over a state reporting SNAFU. Can anyone verify?”

From Bob A. Booey: “Re: MU attestation. We’re having an awful time trying to attest for 2013 MU on the CMS website. Here is the response from CMS. ‘We have been notified that the Registration and Attestation Application is experiencing technical difficulties. This is currently being investigated. At this time, we do not have an estimated time for resolution. Please try again later. We apologize for any inconvenience this may cause.’”

1-9-2014 10-15-33 PM

From MT Hammer: “Emdat. A new banner on Emdat’s website points to another Nuance acquisition.”


HIStalk Announcements and Requests

inga thumb Here’s some HIStalk Practice highlights from the first week of 2014: doctors who Google patients. CMS wants to ban abusive prescribers from government programs. Free app Figure1 allows physicians to share de-identified photos of medical conditions. Patients from practices affiliated with University Hospital (GA) embrace the health system’s Epic portal. Montana requires insurers to reimburse telehealth visits at the same rate as in-person visits. Brightree and athenahealth will share patient referral data. Dr. Gregg provides insight on why some physicians choose to remain independent. While you are stopping by, sign up for the email updates so you don’t miss a post. Thanks for reading.

inga thumb We sent our sponsors an email earlier this week about our activities at the HIMSS conference, so if you should have seen this and didn’t, email me

1-9-2014 12-56-29 PM

inga thumb Speaking of HIMSS, I ran across this infographic depicting the importance of social media during HIMSS14. Mr. H, Dr. Jayne, and I will be providing occasional updates on Twitter, but you’ll also want to make sure you are following Lorre (@Lorre_HIStalk). She’ll be manning our HIStalk booth (#1995) and passing along our impressions of the exhibit hall’s best and worst booths, as well as tips for finding the coolest swag, free cocktails, and good coffee.

Last chance: HISsies nominations will close shortly, so nominate your choice for Best Vendor, Best CIO, etc. ASAP.

HIStalkapalooza details and registration will be available next Wednesday, January 15. We’re getting a bunch of emails every day asking about it, so please save us some time by hanging in there until next week. Our primary sponsor still has spots for two more co-sponsors who will be recognized in a variety of ways, so email me if your company is interested.

1-9-2014 9-34-01 PM

Welcome to new HIStalk Gold Sponsor Wide River Consulting. The Lincoln, NE-based company offers healthcare IT consulting services with an emphasis on serving hospitals in rural and underserved communities. Wide River has helped 50 Critical Access and Rural Hospitals that were struggling to keep up under the weight of ICD-10, MU, EHR upgrades, and PQRS reporting, often with vendors that find it challenging to send people to their locations. The company offers a wide range of technical and engineering services through a partnership with Sterling. Executive Director Todd Searls tells me that with the REC grants ending, PPCPs and CAHs need a low-cost way to keep forging ahead with Meaningful Use and Wide River can help. The company’s ICD-10 services are a big hit as well. CAHs can get a one-year subscription to Wide River’s Meaningful Use Help Desk for $175 per month and providers can sign up for $60 per month, gaining access to experts who can help with MU-related questions ranging from patient portals to exclusions. The company’s goal is to help teach small and rural hospitals to succeed with the resources they have, even helping them form mini-HIT co-ops. Thanks to Wide River Consulting for supporting HIStalk.


Upcoming Webinars

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.


Acquisitions, Funding, Business, and Stock

Shareholders of Health Management Associates approve the previously announced $3.9 billion sale of the hospital chain to Community Health Associates.

Endo Health Solutions will sell its HealthTronics business to Altaris Capital Partners for total consideration of up to $130 million, including $85 million in cash upfront. HealthTronics is a provider of urological products and services, including the UroChart EHR and meridianEMR systems.

1-9-2014 10-42-01 PM

Lumiata, formerly known as MEDgle and the developer of a predictive analytics platform for healthcare, closes a $4 million Series A round led by Khosla Ventures.


Sales

1-9-2014 10-47-00 AM

Dameron Hospital Association (CA) selects Allscripts Sunrise clinical products suite.

1-9-2014 12-22-08 PM

Presbyterian Senior Living (PA) will implement AOD Software’s long-term care EHR across its 23 locations.



People

1-9-2014 11-23-59 AM

VMware promotes Ben Fathi from SVP to CTO.

1-9-2014 11-23-15 AM

Telehealth solution provider AMC Health names John Larus (Clinipace) SVP of solutions development for the clinical trials division.

1-9-2014 11-21-57 AM

RCM provider Encoda names Michael Kallish (RemitDATA) CEO, replacing co-founder William Cox, who will assume the role of president and CTO.

1-9-2014 11-53-23 AM

Impact Advisors appoints Steven Schlossberg, MD (Yale School of Medicine) VP/CMO.

1-9-2014 12-15-42 PM

Surescripts announces that CEO Harry Totonis will step down effective March 2014 and that it has hired an executive search firm to find his successor.

AHIMA members elect Angela Kennedy (Louisiana Tech University) as president/chair of the board of directors, a role she has held since June following the death of Kathleen A. Frawley. Members also elected Cassi Birnbaum (Peak Health Solutions) president/chair elect; Jennifer McManis (Crowley Fleck Attorneys) speaker of the house; and Zenethia Clemmons (HHS OCR), Virginia Evans (Emory Healthcare), and Colleen Goethals (Midwest Medical Records Association) directors.

Southcoast Health System (MA) hires Greg Robinson (AltaMed Health Services) as executive director of enterprise informatics.



Announcements and Implementations

ICUcare and IEEE will collaborate to develop a universal industry standard/specification and a free web-based middleware API to help healthcare providers map data from medical devices to EHRs and other health information systems.

1-9-2014 12-04-06 PM

Advocate Eureka Hospital (IL) implements electronic patient and e-forms technology from Access.


Other

1-9-2014 11-05-23 AM

The Institute of Medicine proposes a standard framework to help providers identify and quantify the costs and benefits of EHR implementations.

Non-profit hospitals paid their CEOs a mean compensation of $594,781 in 2009, according to a JAMA Internal Medicine-published report. Hospitals with high levels of advanced technologic capabilities compensated their CEOs $135,862 more than hospitals with low levels of technology.

A Reuters article says that drug companies, with newly limited access to doctors per PPACA requirements, are moving their sales efforts to EHRs. It mentions Practice Fusion, which sells EHR pop-up ads, and EHRs that email refill and vaccine reminders that don’t clearly state if the message is sponsored by a drug company.

Weird News Andy says the appropriate ICD-10 code is “X59.9 or X12 or combination thereof.” At least 50 people are scalded from emulating TV weather people who tossed boiling water into cold Midwestern air to watch it freeze.


Sponsor Updates

  • AirWatch wins three 2014 Compass Intelligence Awards in the enterprise mobility category, while AT&T was named the best service provider in the health and wellness category, as well as a winner in multiple non-healthcare related categories.
  • Lexmark’s Perceptive Software launches Perceptive Media Connector, which enables the cloud-based capture, management, and access of video content with the Perceptive Content client interface.
  • Ping Identity opens registration for Cloud Identity Summit 2014, scheduled for July 19-22 in Monterey, CA.
  • KLAS extends a high early-performance score to Health Catalyst for its healthcare-specific analytics platform.
  • ChartWise Medical Systems and TrustHCS partner to offer ChartWise’s CDI software with TrustHCS’s coding services and ICD-10 education.
  • Ellis Medicine (NY) cut overtime costs by $721,000 during the first six months after deploying API Healthcare’s workforce management technology.

EPtalk by Dr. Jayne

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After several extremely slow news weeks, I’m glad to see things are starting to heat up. I’ve heard a lot of buzz about the Consumer Electronics Show, which is taking place this week in Las Vegas. Several readers have sent me blurbs about wearable tech. I’m not nearly as much of a fashionista as Inga, but I do like to keep an eye on the trends, especially when they’re related to health IT.

The first product I looked at was the wearable ambulatory blood pressure monitor from iHealth. It’s both USB- and Bluetooth-enabled and allows for blood pressure readings at intervals of 15-120 minutes. Most home blood pressure monitoring units are bulky and patients are not as compliant as they might be. It is compatible with both iOS and Android and can store up to 200 measurements. It reminds me a bit of a futuristic version of the shoulder holsters worn by 1980s television cops, but with a touch of neoprene.

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The company also has a wireless ambulatory ECG device that looks pretty cool. Instead of having multiple sticky leads attached to the patient, it has a single unit that is worn under clothing. In keeping with the throwback 80s vibe, it reminds me of the handset of a vintage rotary phone, although it doesn’t appear to come in avocado green or harvest gold. Bluetooth connectivity to iOS allows for real-time transmission of readings. Both it and the blood pressure monitor are still awaiting FDA clearance and pricing isn’t yet available, so put your credit cards away.

Another reader sent me an article about the need to design tech wearables for women. I was excited to read about Ringly, which is creating jewelry and accessories that receive notifications from the wearer’s mobile phone. Being alerted by jewelry would be much nicer than the incessant phone checking I see. After recently working in an office where the front desk staff notified the back office of patient readiness using an extremely loud intercom (“patient for Dr. Jayne!”) I wonder if we could tie it to the EHR patient tracker. Ringly’s goal is to create jewelry that looks like jewelry rather than gadgets and also to allow users to leverage its app to prioritize the alerts they receive.

Don’t get me wrong, gadgets can be cool. I wear a Garmin when I run that screams, “Hey, I’m a GPS! No way you’re mistaking me for a watch!” I’m not crazy about how it looks, but its function makes it tolerable. On the flip side, there’s Everpurse, which can charge a cell phone on the go and looks nice as well. Although they’re sold out of virtually everything except the persimmon leather clutch, I might have to keep an eye on the site for new offerings.

Looking back at some of the promotions from the Consumer Electronics Show, Intel has launched its Make it Wearable contest to help identify the next generation of accessories. Maybe someone will develop a white lab coat with a sensor to track the level of dirt on the cuffs or the time since it was last laundered. I can think of a couple of physicians who would benefit from that functionality.

How about a patient hospital gown that alerts you when your backside is flapping in the breeze or one that self-adjusts to prevent unintended exposure? The video clip on the Intel website showed a dress that appeared to be zipping itself, so it might just be in the realm of possibility. Maybe next year Inga and I should include the Consumer Electronics Show in our meeting and convention plans. Have a connection that can help us register? Email me.



Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 9, 2014 News 3 Comments

News 1/8/14

January 7, 2014 News 1 Comment

Top News

1-8-2014 6-34-26 AM

Two healthcare-focused private equity firms will invest $77.5 million to take minority positions in MedHOK, which offers care, quality, and compliance software.


HIStalk Announcements and Requests

1-8-2014 5-29-05 AM

Welcome to new HIStalk Gold Sponsor Coastal Healthcare Consulting. The Mountlake Terrace, WA-based company has completed 850 engagements and won numerous KLAS clinical implementation awards since its founding in 1995. Most of its consultants have been with the company for at least 10 years. Offerings include Catalyst (SWAT team project crisis response), Convergence (reducing denied claims), Fusion (linking technology to clinical processes), and Wave (application support, workflow analysis, system build, and activation). Product expertise includes Allscripts, Cerner, Epic, GE Healthcare, and Meditech. Industry long-timer Amy Noel, RN is CEO of the company. Thanks to Coastal Healthcare Consulting for supporting HIStalk.


Upcoming Webinars

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years.

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify, and extract waste from their systems.



Acquisitions, Funding, Business, and Stock

1-7-2014 11-51-07 AM

Press Ganey acquires On The Spot Systems, developer of a real-time data capture system for patient feedback, and launches Point of Care, a solution that allows providers to capture patient feedback via tablets and mobile devices.


Sales

Mount Sinai Health System (NY) selects MU Assistant from SA Ignite to automate its MU attestation process.

The Guam Regional Medical City hospital will deploy Allscripts Sunrise EHR and Financial Manager platforms when it opens in late 2014.

The Department of Defense awards Carestream Health a  one-year, $70.2 million contract for medical imaging technology.


People

1-7-2014 7-32-21 PM

McKesson Specialty Health and the US Oncology Network appoint Jeffrey Kao (Coventry Health Care) CIO/SVP of information and technology services.

1-7-2014 7-33-36 PM 1-7-2014 7-34-26 PM

T-System promotes Mark Horner from VP of client services to SVP/GM of RevCycle+ and  expands CFO Steve Armond’s duties to include leading the company’s documentation solutions.

1-7-2014 8-07-10 AM

Jacob Nguyen (Craneware) joins VitalWare as EVP of business development and operations.

1-7-2014 7-35-30 PM 1-7-2014 7-36-55 PM

Vocera names Rhonda Collins (Fresenius Kabi, USA) chief nursing officer and promotes Steve Jackson from COO of its ExperiaHealth division to chief strategy officer.

1-8-2014 7-34-58 AM

David Cerino (Zynx Health) is named CEO of WiserCare.


Announcements and Implementations

1-8-2014 7-02-06 AM

Fairfield Medical Center (OH) goes live this month with a fingerprint ID system from CrossChx.

Harrison Medical Center (WA), which affiliated with Franciscan Health System last year, will switch to Epic this summer.

Riverside Medical Center (IL) implements the DebMed electronic hand hygiene compliance monitoring system.

Wesley Medical Center (KS), Cypress Surgery Center (KS), and Surgery Center of Kansas go live on Anesthesia Touch from Plexus Information Systems.

inga thumb McKesson announces the general availability of its Paragon Ambulatory Care Practice Management solution, which is an extension of its single database HIS for inpatient facilities and designed for hospital-owned practices. I understand the PM module was developed internally, as opposed to a bolt-on of one of McKesson’s acquired products, and that an EHR module is also in the works. Sounds like McKesson is positioning itself to compete with Epic and Cerner in the IDN market.


Government and Politics

The Office for Civil Rights proposes an amendment to the HIPAA privacy rule to allow certain entities to disclose the identities of individuals with mental health “prohibitor” status to the gun background check system. The change would apply to individuals who have been involuntarily committed to a mental institution; found incompetent to stand trial or not guilty by reason of insanity; or otherwise deemed by a lawful authority to be in danger of themselves.

CMS reports that more than 30,000 hospitals, physicians, and medical equipment providers are using its online esMD documentation system instead of mail or faxes for auditor medical record requests and prior authorizations requests for power mobility devices.

1-8-2014 6-01-46 AM

A new OIG report says CMS and its contractors haven’t done enough to address Medicare fraud related to EHRs. It recommends that CMS provide guidance to its contractors on detecting fraud and suggests they review provider EHR audit logs. The report identifies inappropriate EHR copy-pasting and creating of false documentation to support higher charges as key fraud issues. CMS responded by saying it will develop copy-paste guidance and identify best practices for its contractors to detect fraud associated with EHRs.


Innovation and Research

South Dakota philanthropist T. Denny Sanford donates $125 million to Sanford Health (SD) to support the incorporation of genomics into the health system’s primary care programs, including added genetic testing information to the EHR to allow clinicians to personalize drug therapies. Sanford has donated $1 billion to the health system that bears his name.


Other

1-7-2014 9-42-35 AM

QlikTech’s QlikView earns the top spot among business intelligence products in a KLAS report on the healthcare analytics market.

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inga thumb According to a JAMA-published study, not too many physicians are joining Mr. H’s smoking doc for smoke breaks. Only about two percent of physicians admit to smoking, compared to 16 percent of the general population and 25 percent of licensed practical nurses.

1-7-2014 8-31-06 PM

A local paper profiles Whidbey General Hospital (WA), which experienced critical cash flow issues during its transition to Meditech. The hospital claims its billing process was abnormally slow after the system went live in May and caused A/R levels to climb and cash on hand to decline. The hospital, which expects to spend $7.5 million on its Meditech installation, is recovering. The paper incorrectly blames the ACA rather than than HITECH for requiring the use of EMR to avoid financial penalties.

A federal judge dismisses a patient’s lawsuit that charged a healthcare provider violated HIPAA laws when an employee’s laptop was stolen. The judge ruled that only HHS can enforce HIPAA and individuals do not have the right to bring lawsuits for its enforcement.

1-7-2014 8-50-30 PM

The Pittsburgh paper profiles hospital pharmacy automation vendor Aesynt, the former McKesson Automation / Automated Healthcare that was sold to Francisco Partners in November. It says the company has developed new hospital drug management software being tested by UPMC and Intermountain. President and CEO Kraig McEwen says the company has introduced more products in the past 12 months than in the past five years. He also says the company is looking for acquisitions  that will help it expand its offerings for reducing hospital drug costs.  

IBM’s “Jeopardy”-winning Watson computer is falling far short on the company’s revenue targets. Healthcare is its most promising market, but a $15 million M.D Anderson cancer genomics project is “in a ditch” according to the IBM executive in charge. A Watson oncology regimen project at Memorial-Sloan Kettering could go live later this year. IBM’s business plan calls for Watson to contribute $1 billion in annual revenue by 2018, but it has only generated $100 million in its three-year existence. The main problem is the effort required for engineers to program Watson for each business case so that it can learn from available information.

1-8-2014 6-53-33 AM

Massachusetts will launch the second phase of the Mass HIway HIE Wednesday at Beth Israel Deaconess Medical Center. The HIE  has received $55 million in federal funding.

E-Health Ontario, the provincial agency tasked with creating EHRs for all Ontarians, will share $2.3 million in performance bonuses across its 704 staff members. The payout follows a court settlement that restored payouts that were cancelled in 2011 as part of a controversial wage freeze.

John Lynn of EMR and HIPAA is producing an April 7-8 Las Vegas conference covering healthcare IT marketing and PR.

James Parks, former COO/CIO of Box Butte General Hospital (NE), is indicted on seven counts of child pornography after the hospital reports finding explicit content on his computer.

The governor of Minnesota blames IBM for problems with its state-run health insurance exchange that launched October 1. Minnesota Governor Mark Dayton sent a highly critical letter to CEO Ginny Rometty last month that blamed the company for a laundry list of items:

Your product has not delivered promised functionality and has seriously hindered Minnesotans’ abilities to purchase health insurance or apply for public health care programs through MNsure…. your product has significant defects, which have seriously harmed Minnesota consumers.


Sponsor Updates

  • CCHIT certifies that the Arcadia Analytics Meaningful Use Calculation Engine v1.0 is compliant with the ONC 2014 Edition criteria as an EHR module.
  • PeriGen recognizes Barbara LaBranche, senior director of clinical informatics design and usability, for being named an EHR Game Changer.
  • Muhammad Chebli, interoperability product manager for NextGen Healthcare, discusses the importance of interoperability in achieving MU2 objectives, particularly summary of care.
  • Liaison Technologies reveals its top predictions for 2014, including the dramatic growth of data integration complexity and the normalization of mass customization.
  • Nuance Communications demonstrates wearable devices with Dragon Mobile Assistant and Swype keyboard for smartwatches at this week’s CES 2014 in Las Vegas.
  • Prominence Advisors is named one of the 50 top Chicago employers of Generation Y employees (those aged under 33).
  • Visage Imaging releases a demo video shot at RSNA of its Visage 7 Enterprise Imaging Platform.

Contacts

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

More news: HIStalk Practice, HIStalk Connect.

 

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January 7, 2014 News 1 Comment

Morning Headlines 1/3/14

January 2, 2014 Headlines 1 Comment

President Obama Announces More Key Administration Posts

Leon Rodriguez, director of the Office for Civil Rights of HHS, will be nominated to take over as the Department of Homeland Security’s director of the United States Citizenship and Immigration Services.

Other new NC laws taking effect with the new year

In North Carolina, a law that took effect on January 1 requires that all hospitals connect with the North Carolina HIE and submit data on any services paid for by Medicaid.

Pentagon Kicks Off Procurement To Maintain Current Health Record Until 2018

The DoD initiates a procurement process that will allow it to stick with its existing EHR until 2018.

Cerner ‘seals the deal’ on $4.3 billion office plan at Bannister site

Cerner completes its purchase of a 237-acre property outside Kansas City where it will build a $4.3 billion campus over the next 10 years, eventually providing office space for 15,000 employees.

Digital Health Funding: A Year In Review

Health IT startups raised $1.9 billion in VC funding during 2013, a record breaking year and 39 percent increase over last year. Most money went to EHR vendors, big data startups, population health tools, wearable biosensors, and patient engagement platforms.

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January 2, 2014 Headlines 1 Comment

News 1/3/14

January 2, 2014 News 3 Comments

Top News

1-2-2014 7-58-42 PM

President Obama announces that he will nominate Leon Rodriguez, director of the Office for Civil Rights of HHS that enforces HIPAA, for Director of Citizenship and Immigration Services in the Department of Homeland Security.


Reader Comments

1-2-2014 7-45-24 PM
Photo: Brian Snyder/Reuters

From DZA MD: “Re: Baystate Medical Center. Cerner PowerChart crippled with record inpatient census and Nor’easter in full effect. Unable to process timely discharges before brunt of storm arrives.” Unverified. As I write this Thursday evening, Massachusetts is about to get nailed by a winter storm that will bring up to 30 inches of snow in places with wind chill as low as 20 degrees below zero and even colder Friday night.

From Dirk Benedict: “Re NextGen lawsuit. Mountainview Medical Center in Montana sues NextGen, saying it didn’t install its $441,000 EHR system as promised.” The six-bed hospital contends that NextGen was to install a system “which would permit MVMC to demonstrate ‘meaningful use’ of such electronic health records through all stages of applicable federal regulations” and was to complete implementation by October 1, 2013. According to NextGen’s website, NextGen Inpatient Clinicals EHR 2.6 is 2014 Edition certified as a modular EHR, so it’s difficult to determine what the exact issue(s) might be. NextGen provided us with this statement:

We cannot comment on the pending litigation, other than to say that we firmly believe the allegations made by Mountainview Medical Center are without merit and we will defend against them vigorously. We confidently stand behind the quality and performance of our products and offerings.

1-2-2014 6-06-14 PM

From Intractable Vermonting: “Re: Vermont health insurance exchange. The cost overruns have been tremendous and the politicians responsible pass it off as ‘changing project scope costs money.’ 99 percent of all IT leaders in the US would be fired if they managed a project in this fashion. Also, security is the last thing that is built into the technology before it goes live and I am sure there were shortcuts taken with all these exchanges. The hackers know that most sites require Social Security number to register.” The Vermont Health Connect insurance exchange website is the most expensive IT project ever undertaken in the state, running up a tab of $172 million, of which the federal government contributed $48.7 million. One big contractor was the ever-present CGI, which managed to turn its $42 million contract into $84 million worth of billables while missing key deadlines that kept the site from being ready on October 1. CGI was smart: the state says the delays cost $26 million, but CGI’s contract says it can be penalized a maximum of $5 million.


HIStalk Announcements and Requests

1-2-2014 5-48-35 PM

It’s time for the HISsies nominations. What’s your choice for “Stupidest Vendor Action Taken,” “Most Overused Buzzword,” “Industry Figure With Whom You’d Most Like to Have a Few Beers,” and “HIStalk Healthcare IT Industry Figure of the Year?” Enter your nominations, from which the most-nominated choices will go on the final ballot in a week or so. That means no complaining if your choice isn’t on the ballot and you didn’t nominate them.

1-2-2014 6-15-48 PM

HIStalkapalooza registration will open up the week of January 13. Read HIStalk religiously for the link to the signup notice in the next couple of weeks. We fill up really fast every year. Above is a photographic hint of the venue for those wondering. The primary sponsor has a couple of co-sponsors whose support will allow the event to be even bigger and better. If your company is interested in getting exposure as a HIStalkapalooza co-sponsor, let me know and I’ll connect you since they are willing to take on two more.

1-2-2014 6-39-01 PM 1-2-2014 6-48-11 PM

Welcome to new HIStalk Platinum Sponsor healthfinch (they tell me it’s supposed to be all lower case). The company offers RefillWizard, which improves doctor efficiency as a “Team-Based Decision Support System” that improves patient safety while reducing refill turnaround time by up to 95 percent. They begin by preparing a customized savings document like the one above and making recommendations to optimize the refill process. They have found that 62 percent of refills can be selectively and safely delegated to clinical staff, reducing the staff time to 34 seconds (some PCPs spend 1-2 hours per day just managing refills.) RefillWizard, which just won the Allscripts Open App Challenge, works either with paper protocols or integrated with the EMR. HIStalk readers probably know DrLyle (Lyle Berkowitz, MD), the company’s chairman and chief medical officer. Thanks to healthfinch for supporting HIStalk.

I found this healthfinch RefillWizard overview on Vimeo.


Upcoming Webinars (Times are Eastern) 

January 7 (Tuesday), 1:00 p.m. Clinical Analytics for Population Health Management. Sponsored by HIStalk. Presenter: Core Sharma, principal analyst, Chilmark Research. As providers move from fee-for-service to value-based payment models, they must not only comply with ever-proliferating quality metrics, but also transition from a cost-plus business model to one of cost containment. 

January 9 (Thursday), 2:00 p.m. Beyond the Summits. Sponsored by HIStalk. Presenters: Ed Marx, SVP/CIO, Texas Health Resources, and Elizabeth Ransom, MD, FACS, EVP/clinical leader North Zone, Texas Health Resources. Everyday healthcare executives share leadership and teamwork principles they learned from climbing some of the world’s highest peaks over the last four years. 

January 16 (Thursday), 1:00 p.m. Advanced Efforts to Identify and Eliminate Waste from Healthcare. Sponsored by Health Catalyst. Presenter: David Burton, MD, executive chairman, Health Catalyst. Based on a breakthrough analyses using several large healthcare data sets as representative samples, Dr. Burton and team will present insights designed to help executives struggling to identify, quantify and extract waste from their systems


Acquisitions, Funding, Business, and Stock

Healthcare Data Solutions acquires StratCenter, a provider of healthcare provider data.

1-2-2014 9-09-48 PM

Stryker Corporation will acquire surgical sponge counting technology vendor Patient Safety Technologies, Inc. for $2.20 per share. The company’s market cap is $85 million.


Sales

1-2-2014 11-52-35 AM

In the UK, King’s Mill Hospital signs a five-year, $5.9 million EHR contract with Specialist Computer Centres and McKesson.

Medical billing company Medorizon Partners selects InstaMed’s patient payment plan technology.

The Defense Logistics Agency awards TeraRecon a maximum $30 million fixed-price contract for the procurement of radiology systems and services.

Central Georgia Health System will implement Infor’s healthcare business automation applications.


People

1-2-2014 11-54-08 AM

CareTech Solutions hires Daniel Lincoln (Palace Sports & Entertainment) as corporate controller.

1-2-2014 11-55-09 AM

CMS announces the retirement of COO Michelle Snyder, who supervised development of HealthCare.gov. The agency says Snyder had originally planned to retire in 2012 but stayed on at the request of CMS chief Marilyn Tavenner.

1-2-2014 3-47-05 PM 1-2-2014 3-49-03 PM

CareView Communications, which offers patient flow and safety solutions, promotes Steven G. Johnson from president to CEO, taking over for Samuel A. Greco, who is retiring for health reasons. Careview also names Sandra K. McRee (McRree Consulting) COO and appoints Jason T. Thompson to the board, replacing his father, Tommy G. Thompson.    

1-2-2014 7-26-42 PM

Direct Consulting Associates promotes Frank Myeroff to president.


Announcements and Implementations

Baptist Memorial Health Care (TN) goes live on Epic this week at four minor medical centers and at its Baptist Medical Group clinics. Four Memphis-area hospitals are scheduled for a March 11 go-live.


Government and Politics

1-2-2014 8-13-46 PM

A new North Carolina law requires hospitals with EHRs to connect to the state’s HIE and submit data on services paid for with Medicaid funds.

The Department of Defense issues an RFP to keep AHLTA and CHCS running through the end of 2018 after plans for a joint DoD-VA EMR were scrapped last year when costs were estimated at $28 billion. The value of the new contract is estimated at $250 million to $1 billion. DoD is looking at a commercial replacement for contractor-developed AHLTA, whose estimated cost to taxpayers was up to $5 billion.


Innovation and Research

1-2-2014 8-06-17 PM

A study of 295 smartphone apps that claim to prevent, detect, or manage cancer finds no published studies that prove their usefulness, effectiveness, or safety.


Technology

The FDA extends the Kinsa Smart Thermometer the first-ever 510(k) clearance for a smartphone-connected thermometer.

The US Patent and Trademark Office issues CommVault Systems a patent for efficient data management improvements, such as docking limited-feature data management modules to a full-featured data management system.


Other

Riverside Health System (VA) announces that a now-terminated LPN inappropriately accessed the records of 919 patients over a four-year period.

Cerner completes the purchase of the 237-acre tract for its planned $4.3 billion office development in south Kansas City.

1-2-2014 12-09-10 PM

Ward County (TX) officials will give Ward Memorial Hospital an additional $200,000 to cover a budget shortfall that is partially blamed on their recent EHR implementation (Healthland Centriq, I believe.) 

A new study contradicts the Affordable Care Act assumption that putting uninsured Americans on Medicaid will reduce ED visits, instead finding that ED visits in Oregon increased by 40 percent as the newly insured sought ED for issues that could have been handled in physician offices. The primary author, an MIT economist, concludes that, “As I tell my economics students, when something is free, people use more of it.”

The Department of Justice joins the whistleblower lawsuit of two Charlotte, NC contract ED physicians who claim for-profit hospital chain Health Management Associates offered them kickbacks to order unnecessary tests and increase admissions. The doctors say HMA’s Pro-Med software was programmed to automatically order batteries of tests on ED patients based on their complaints before they were seen by a physician. They say HMA required EDs to admit 50 percent of Medicare patients whether they needed it or not, quoting a 2009 email from an HMA executive to ED managers that said, “Big declines in over 65 admissions – you know what to do!”

A Huffington Post reprinted piece by writer and medical resident Brian Secemsky, MD doesn’t have much good to say about the EMR used by the underserved clinic where he works:

After several months of receiving emails full of buzzwords such as improved care coordination and effective closed-loop med administration from the powers that be, I couldn’t help but drink the Kool-Aid and join the anticipated excitement of integrating an innovative source of technology into an over-booked and often overwhelming practice. Where my mind was brimming with images of easy-to-use tabs, high-yield keywords and a system where clinic documentation could effectively reflect patient encounters using minimal time and effort, I was instead bombarded with yet another early ’90s-style template full of odd-sized buttons and novel concepts that were the far from intuitive. The spiked punch quickly wore off the minute I first fumbled through this bulky piece of technology, and I was back to spending hours each night typing away, well after seeing the last of my patients.

1-2-2014 6-34-23 PM

Weird News Andy likes this unlikely innovation and even suggests the above graphic for advertising. A car mechanic in Argentina falls asleep after watching a YouTube video about a machine that extracts corks from wine bottles, then wakes up inspired to invent a device that uses an inflated plastic bag rather than forceps to extract babies stuck in the birth canal. Against all odds, WHO has endorsed his invention and a US device maker has licensed it.

1-2-2014 8-51-31 PM

A bizarre article concludes that the government is planning to execute US citizens. It concludes that ICD-9 code E978 (legal execution) is part of a secret plan to create an “International One World Government,” claiming that, “Even more disturbing, is finding out American citizens have been subject to the ICP Medial code for many years. Thus, giving the United Nations our private information through coding.” The article proposes a solution even more dramatic than ICD-10 foot-dragging: the US should pull out of the United Nations.


Sponsor Updates

  • Sunquest releases new versions of Sunquest Laboratory and Sunquest Molecular.
  • The Boston Globe profiles Sumit Nagpa, CEO of Alere Accountable Care Solutions.
  • Jason Fortin, senior advisor for Impact Advisors, discusses the impact of Meaningful Use in 2013.
  • EDCO Health Information Solutions posts a Point of Care Scanning Process video.

EPtalk by Dr. Jayne

I received a lot of feedback about this week’s Curbside Consult. I’ll be posting more responses to the original reader email in the next Curbside Consult, but wanted to share some quick responses in the interim.

One reader asked for more detail about how we’ve tied the physician bonuses to EHR use. I can’t claim credit for the approach since we copied it from another organization, but it has worked well. It only applies to employed physicians using the group’s EHR platform. We have a couple of practices that we have acquired that are on other systems and are not yet converted, so they are exempt for now.

Physician bonus amounts are determined by three factors: patient satisfaction, clinical quality scorecard results, and productivity. A sliding scale is used for each element. For example you might receive 100 percent of your patient satisfaction and productivity bonuses but only 80 percent of your quality bonus.

The EHR plays into that in two ways. Since we’ve been fully adopted on EHR for many years, all of our quality reporting is now derived from EHR data (no more manual chart reviews). If providers are not documenting in the EHR, their scores will be low. We initially did a hybrid approach with both manual chart review and EHR reporting while physicians were adopting, but that has been phased out. Our staffing for compliance reviews has dropped significantly. They used to take three full work days per physician and now they take two to three hours per physician.

The major way that EHR applies to the bonus, however, is simple. All visits must be documented in the EHR and must meet our minimum data standards. These aren’t a lot different than the paper chart. The visit has to be complete within 24 hours of the patient visit and has to include certain critical data elements that essentially align with CMS coding requirements. For example, documentation has to have a chief complaint, history of present illness, review of systems, review of pertinent patient history, physical exam, and an assessment and plan.

We expected this to be present in the paper world and now it’s actually easier since the data is shared across the multispecialty group rather than living in separate paper charts by location. Providers can review histories with one click rather than having to dig for histories that may have been mentioned in various progress notes. Our physicians were not particularly good at keeping the paper problem list and past / family / social history face sheets up to date on paper.

For some practices that were challenging implementations, we actually had to physically visit the practice and make sure they didn’t have shadow charts. One site didn’t have charts, but had “jackets” for each patient. We didn’t just fail them outright but gave them three months to remediate, then audited them again. Over the last few years that the EHR requirements have been attached to the bonus structure, we’ve been fair about doing pre-audits so people know where they stand, then allowing enough time for them to remediate before their final audit.

The reader also asked about the “standards” that I mentioned our physicians have to meet to stay employed. Some are pretty simple – no OSHA or CLIA violations, favorable scores on coding and compliance audits, and getting along with their partners and staff. Some are more rigorous. We have high standards for clinical quality, and physicians are graded on blood pressure control, appropriate use of drugs for coronary artery disease, cholesterol control, influenza vaccination, cancer screening (colorectal, breast, prostate), diabetes management, and a couple of others. Physicians who can’t keep their scores in the desired range are remediated (as are their office staff – many of the metrics can be improved by leveraging staff and using standing orders including vaccination and screenings).

Finally, physicians are expected to be productive – specifically, to be above the 75th percentile based on MGMA data. That’s a lot to ask, but the group makes it clear when physicians join and it’s actually spelled out in the contract. Our compensation parallels this – our physicians consistently earn salaries in the top 20 percent based on MGMA data. If they choose to work less than full time, the productivity expectations are scaled accordingly. Our retention rate has been very good. Most of the providers who leave within five years of joining have a family reason. For example, they may only work with us for a year or two while they wait for their spouse to receive a residency or fellowship appointment that requires relocation.

In addition to their bonuses, our providers also received a hefty chunk of their Meaningful Use payments as a cash bonus. This differs from most organizations I’ve talked to that tend to keep the MU payments at the corporate level. I think the way we shared them is especially surprising given the fact that our providers don’t pay anything for EHR software, training, or maintenance. The only EHR-related charge that the practices incur is for hardware, which averages $8,000 – $10,000 per provider every three to four years.

Another reader asked how we handle the EHR records with a physician who chooses to leave the organization (or is let go) yet wants to keep his or her patients and office location. It’s actually pretty easy. We have a subsidized EHR offering (under the Stark exception) so we already have local private physicians on our EHR database with independent practice data. We simply copy the charts of active patients (those seen by the provider within the last three years) into a new practice in the EHR. Only clinical data is copied, no financial data and no accounts receivable.

If the provider is on staff at one of our hospitals, he or she may be eligible for a subsidy. Otherwise they pay fair market rate and we host it similar to a SaaS model offering. Although the providers can still share data with the employed practice, they have to do it through our private HIE rather than sharing a direct chart within the multispecialty practice. Providers are charged $0.50 per chart for the copy. That’s a holdover from our old contract when we had paper charts and they paid that much for the paper charts. I have no idea where that number came from — it’s been in place for at least 15 years.

If they choose not to stay on our platform, we have a third-party consultant perform an extract based on the new vendor’s specifications. It’s the same very skilled consultant we use when we acquire practices and bring the data into our system. Once the drive goes into the Pelican case and enters the physical transport protocol, though, it’s out of our hands.

I’ve seen two physicians treated poorly by their new vendors. One took several months to move the extracted data onto the new EHR. Another simply turned the data into PDFs and parked it in the new EHR’s scanning system, which is pretty sad considering the level of discrete data we can provide. Providers can also buy a system directly from our vendor and we’ll do the extract in that situation as well.

I’ve shared a lot of fairly specific information this week, so I hope it doesn’t come back at me. Stay tuned for the next Curbside Consult. I’ll be sharing my thoughts on infrastructure and interoperability as well as what happens when you try to drive a Ferrari in a corn field.


Contacts

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

More news: HIStalk Practice, HIStalk Connect.

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January 2, 2014 News 3 Comments

Morning Headlines 1/2/14

January 1, 2014 Headlines 1 Comment

White Sulphur Springs hospital says company never installed health records system

Mountainview Medical Center (MT) is suing NextGen Healthcare Information Systems for failing to install a certified EHR by a contractually agreed upon install date of June 1, 2013. When the date passed, the NextGen and Mountainview agreed to a new delivery date of October 1 but, according to the lawsuit, the extra time did not resolve the underlying issues and no system was ever installed.

3 hospitals start new year at Stage 7

Hilo Medical Center (HI), Round Rock Hospital (TX), and White Health System (TX) are all named to the HIMSS stage 7 list. Round Rock and White Health’s ambulatory clinics received stage 7 ambulatory designation as well. Both run Epic across their networks, while Hilo is a Meditech 6 site.

Stocks of KC firms large, small did well in 2013

Cerner is profiled by the Kansas City Star newspaper in a year-end review of the city’s top performing businesses. Cerner shares grew 43 percent in 2013.

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January 1, 2014 Headlines 1 Comment

Readers Write: 2014 Resolutions

January 1, 2014 Readers Write No Comments

2014 Resolutions
By Vince Ciotti

I’m getting ready to wrap up the HIS-tory series with the final episodes on McKesson, so it’s apropos to take a break and look at the future a bit with these 2014 New Year’s resolutions for today’s leading HIS vendors (in order of their 2012 annual revenue).

McKesson

They’re doing so well with Paragon that they made a resolution to rename their other legacy systems:

  • Horizon = Parazon
  • Series = Seriegon
  • Star = Staragon
  • Practice Partner = Practice Partagon
  • RelayHealth = ParlayHealth
  • Homecare = Homecaragon
  • InterQual Online = InterQual Paragonline
  • Capacity Planner = Capacity Paranagon
  • Performance Analytics = Performagonalytics
  • Patient Folder = Patient-Paper-Folder-Gone
  • (you get the idea…)

On another front, McKesson announced plans to open Paragon’s first international office in either Aragon or Patagonia, depending on negotiations with their governments about minor changes to the spelling of their names.

Cerner

Will make an epic move of their HQ from Kansas City to Salt Lake City and re-name Millennium HNA as Millennium IHCNA.

Siemens

After cutting 15,000 jobs worldwide over the past two years, Siemens will announce several openings in its HR recruiting department for 2014.

Allscripts

Will join Cerner, McKesson, athenahealth, Greenway, and RelayHealth in the CommonWell Health Alliance to promote EHR interoperability in 2014 in 49 states (excluding Wisconsin).

Epic

Will be recognized as the KLAS act in 2014 by becoming the only HIMSS Stage 8 vendor in Gartner’s Magic Quadrant.

GE

Will announce a program in 2014 whereby any hospital buying Centricity will receive a free refrigerator for every nurse station.

Meditech

Will announce the 2014 version of Release 6.0, which will be called Focus, er, MAT, I mean, 6.0.1, that is 6.1, or maybe 6.0.A…

NextGen

Will announce the 2014 re-packaging of Opus, Sphere, and IntraNexus as “ThisGen.”

CPSI

Will sets the goal of having 500 of their clients attest for MU by the end of 2014, a total of over 1,000 beds.

Harris

A subsidiary of Constellation Software Inc. (from Canada) announces a project for 2014 of using the other Harris (from Melbourne, FL) CareFX interoperability workflow solutions to differentiate their company names.

NTT Data

ヴィンスがこれらの不快な言語の策略を用いるのを止めてください。

HMS

After being re-named Medhost, company executives will announce a joint effort with the AHA to launch a campaign in 2014 that re-defines all US hospitals as ancillary departments of their emergency rooms. 

Healthland

Will resolve to combine its two corporate offices in Minnesota (Glenwood and Minneapolis) once the roads are plowed in August 2014.

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

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January 1, 2014 Readers Write No Comments

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