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News 12/16/11

December 15, 2011 News 10 Comments

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12-15-2011 10-19-15 PM

12-15-2011 9-47-52 AM

12-15-2011 9-49-22 AM

KLAS publishes its 2011 Best in KLAS Awards for software and professional services. A few highlights:

  • Epic is named the top overall software vendor and takes the #1 spot in seven categories, including acute care EMR and ambulatory EMR over 75 providers. Epic’s winning margins in these categories were significant. In acute care, Epic earned 90.3% satisfaction score compared to second place Cerner PowerChart at 78.5%. In the ambulatory EMR75+ provider segment, Epic scored 89.8% compared to eClinicalWorks’ 76.1%.
  • If you compete against Epic on inpatient core clinicals and ancillaries, you’ve got your work cut out for you. Epic tops every application category except lab, including EMR (orders, results, documentation), pharmacy, radiology, and surgery, not to mention that Epic also is #1 in patient accounting and patient management. And, all of those products run on a single database and are fully integrated. It’s not shocking, then, that vendors are trying to beat Epic on price since that’s about the only competitive point that’s up for grabs.
  • McKesson Paragon beat Cerner PowerChart by 10 percentage points in the community acute care EMR segment. Interestingly, Paragon was not ranked in the acute care segment because that’s not Paragon’s primary market (according to KLAS.) Paragon’s scores in the acute care segment would have been good enough for a fourth-place ranking, beating out Horizon and others.
  • It’s pretty impressive to have 100% of your users (those participating in the survey, anyway) say they would buy your product again. Among those achieving that distinction: Epic (multiple categories), SCI Solutions (enterprise scheduling), Sunquest (community laboratory), Allscripts (patient accounting/patient management), Nuance (speech recognition), iMDsoft (anesthesia), GetWellNetwork (interactive patient systems), athenahealth and SRSsoft (ambulatory EMR), athenahealth and OptumInsight (practice management), and ZirMed (clearinghouse services.) Interestingly (to us, anyway), all but two of these companies are HIStalk sponsors.
  • maxIT was ranked the top overall services firm, edging Hayes Management Consulting by 0.2 points.

Reader Comments

mrh_small From DtwlnLax: “Re: iPhone users. Check this out – 25 GB of free cloud storage for iPhone users.” Sign up for Microsoft SkyDrive and its yours.

mrh_small From Non Sequitur: “Re: holiday greetings! HIStalk provides a great service and somehow ties us all together into one common community in some way that I don’t entirely understand, but it works. You should enjoy knowing how common an occurrence it is around this setting (and in my former life as a vendor) to walk in on a conversation where someone is saying, ‘Did you read such and such in HIStalk this morning?’ or counters an argument in a meeting with, “There was an article on HIStalk recently where they addressed this, and the gist of it was…’ I really appreciate the news, the good articles, the inside story, and of course the delicious pithy comments! An e-mail from HIStalk or HIStalk Practice is like getting a little gift from my Secret Santa. Your industry insight amazes me and those of us in the trenches really, truly appreciate the effort and commitment! Happy Holidays to Mr. HIStalk, the long-suffering Mrs. H, and to the Intrepid Inga! My hero!” That was maybe the best e-mail anybody has ever sent us. Inga wanted me to run it unedited, but I argued that it was indeed great, but it seemed distastefully self-promoting to run it publicly instead of just basking in it privately. We compromised: I edited it to the version above to reduce the volume of the shameless tooting of our own horn (from 11 to 10, at least). Non Sequitur, who works for the hospital of one of the finest public universities in the country, made our day, needless to say. She’s sweet.

mrh_small From All Hat No Cattle!: “Re: Partners Healthcare. Sent an internal memo stating they have decided to buy a new EHR for their facilities. Wanna bet whether it will be Epic or Siemens?” Glaser connection or not, Siemens wouldn’t seem to be a great choice given Soarian’s limited (non-existent?) track record with facilities their size and complexity, although they’ll surely get lots of promises of extra-special hand-holding that might sway their opinion from the obvious choice.

12-15-2011 9-23-44 PM

mrh_small From Patti: “Re: ACO training in four hours. Check out this Craigslist ad for the Prognosis ACO. The ACO sales rep would get four hours of education on ACOs and ‘the sales pitch’ and would then be ready to recruit physicians to sign up, pushing their EHR as well. Reps get the equivalent of $30K per year plus $500 per enrolled doc, but their contract ends in March.” The big spiff for reps is that the company provides business cards. The Craigslist ad is here. There’s not much listed about who is behind the hard-selling ACO, but domain registrations seem to point to an Illinois oncologist.

mrh_small From Larry: “Re: McKesson. They wanted to get rid of Paragon years ago, but worried about the viability of old products like Series and HealthQuest with ICD-10 coming and let Jim Pesce talk them into Paragon as a clinical solution. About the same time, Michael Simpson, now running the GE-Microsoft thing, swore he could get HERM done if they let him take it offshore like he had with his previous employers (check out Unisys and Novell to see how well that worked out.) Paragon was to be the hedge bet, to be killed off if Simpson was successful. Obviously he wasn’t.”

12-15-2011 10-10-34 PM

12-15-2011 10-09-39 PM

mrh_small From Wet Willy: “Re: the new company of former Allscripts CTO John Gomez. I hear they are working on a search and analytics platform for healthcare, a hybrid of Google and Amalga done right with a huge emphasis on usability for outcomes-focused analytics. I also heard they are introducing an Allscripts-to-Epic migration tool and service that will allow a hospital to migrate Sunrise facilities, printer locations, patient records, medical history, formulary and other data and map it to Epic’s schema with 80% accuracy.” I asked John. His answer for #1: “It is true, we are working on that.” For #2: “We really can’t comment.” Above are his company’s guiding principles.

HIStalk Announcements and Requests

12-15-2011 4-26-06 PM

inga_small This week on HIStalk Practice: athenahealth’s Jonathan Bush calls for greater transparency and accountability in the Meaningful Use program. The White House says the government has recovered more than $2.9 billion in healthcare fraud this year. HHS issues an advisory opinion that concludes a vendor would not be violating anti-kickback statutes if it facilitated payments between providers for the exchange of EHR data in a patient referral situation. The Chicago and Maine RECs say they’ve met their enrollment targets. If you can’t send me a pair of Christian Louboutins for Christmas (size 8), then the next best thing would be to faithfully read HIStalk Practice and sign up for e-mail updates.

mrh_small A reader from a large hospital system in Shanghai, China is looking for a vendor to provide an outpatient PM/EMR/dental system that can then be expanded to the inpatient hospital. I don’t know of any US-based vendors that offer these capabilities with support for customers in China, but if yours can, I can forward your contact information. I was just happy to brag to Inga that one of our readers needed our help, and oh by the way, she’s in China.

12-15-2011 8-34-00 PM

mrh_small Say hello to new HIStalk Platinum Sponsor Ingenious Med of Atlanta, GA, whose company name is one of my favorites. The physician-founded company has been around for more than 10 years, offering workflow-intelligent physician solutions for charge and data capture, coding and documentation, quality, reporting, and inter-staff communication. “Physician-friendly” means “mobile” these days, and Ingenious Med just this week won its third consecutive Mobile Star Award. The company has 9,000 users in 800 facilities that include Emory Healthcare, WakeMed, Kaiser Permanente, Texas Health Resources, Sentara, Geisinger, BJC, and a bunch of other high-profile providers. So why would a hospital be interested in solutions like these? Simple: hospitals spend tons of money subsidizing the P&L of their docs, eating the loss with the hopes of offsetting it via increased hospital business, while the company’s tools soften the blow by increasing collections by $30-40K per doc per year just by capturing information accurately (they’ll put it in writing, and show you their 97% customer renewal rate). Hospitals also like reduced exposure to RAC audits and insight into whether individual physicians seem to be over- or under-coding based on industry standards. Thanks to Ingenious Med for supporting HIStalk.

mrh_small On Healthcare IT Jobs: McKesson STAR Analyst/Consultant, Cerner PathNet Consultant, EMR Application Specialist.

Acquisitions, Funding, Business, and Stock

athenahealth reaffirms its existing guidance for fiscal 2011, predicting earnings of $0.78 to 0.85 per share and revenue of $320-$325 million. Analysts had predicted $0.86 per share. The company also projected 2012 revenue of $410-430 million, in line with expectations, but non-GAAP net income of $0.85 to $0.97 per share vs. the Street’s anticipated $1.16 per share. The share price slipped over 15% Thursday to $49.04.

12-15-2011 4-31-33 PM

Spectrum Equity Investors and Trident Capital  take a majority position in HealthMEDX, LLC, a provider of long term and post-acute care technology. Former McKesson Technology Solutions President Pam Pure joins the company as CEO. Former Visicu SVP/CFO Vince Estrada was also named EVP of business development and CFO.


12-15-2011 4-32-29 PM

Orion Health appoints Andrew Ferrier, former CEO of Fonterra, to its board of directors.

12-15-2011 6-12-30 PM 12-15-2011 6-13-53 PM

CHIME elects Melinda Costin (VP, Baylor Health Care) and Randy McCleese (VP/CIO, St. Claire Regional Medical Center) as board trustees.

12-15-2011 4-37-33 PM

Diversinet Corp. names Hon Pak, MD as interim CEO, succeeding the retiring Albert Wahbe. Pak recently retired as CIO of the US Army Medical Department and had served as president of the American Telemedicine Association.

12-14-2011 3-39-43 PM

The New England chapter of HIMSS names Daniel J. Nigrin MD, MS as Clinician of the Year. He’s SVP/CIO and a pediatric endocrinologist at Children’s Hospital in Boston, not to mention a faithful HIStalk reader.

National eHealth Collaborative announces new officers: Kevin Hutchinson (My-Villages), Holt Anderson (NCHICA), Tom Fritz (Inland Northwest Health Services), Paul Uhrig (Surescripts), and Janet Corrigan (National Quality Forum).

Announcements and Implementations

Catholic Healthcare West’s north state division will deploy MobileMD to connect its hospitals to physician offices, clinics, and other hospitals.

12-15-2011 4-40-18 PM

St. Rita’s Medical Center (OH) goes live on Ohio’s statewide HIE with the transmission of clinical data to Greenway EHR customer Health Partners for Western Ohio.

Emerus Emergency Hospital (TX) goes live on the InsightCS revenue cycle solution of Stockell Healthcare Systems at six Texas locations.

Birmingham VA Medical Center (AL) implements GetWellNetwork’s interactive patient care solution in its tertiary care facility.

Government and Politics

mrh_small A healthcare blog post in The Hill observes that Republican presidential front-runner Newt Gingrich isn’t talking about electronic medical records like he used to, possibly because conservative voters weren’t thrilled with his support for spending taxpayer money on technology for private businesses (some of which were his consulting firm’s customers.)

mrh_small CMS will announce the first Medicare accountable care organizations on Monday, rumor has it.

mrh_small North Carolina legislators criticize the state’s Department of Health and Human Services for allowing cost overruns for building a new Medicaid claims system. The final tally for the state’s $265 million contract with CSC is now pegged at $495 million. It will also take 22 months longer to complete the system and will cost $91 million more to keep the old system running in the mean time. One state representative called the project a “money pit” and added that if it were a private sector project, heads would have rolled, but when the agency’s IT head was asked to give herself a grade, she said she deserves an A. CSC originally got the bid when a 2004 contract with ACS was cancelled, costing the state $10 million to settle the resulting ACS lawsuit. When the CSC contract was signed in 2009, the current DHHS secretary was a lobbyist for CSC.

mrh_small In the UK, vocal NPfIT critic MP Richard Bacon says BT and CSC are charging NHS trusts triple the market price for Cerner Millennium and iSoft Lorenzo.

Innovation and Research

Mount Sinai Medical Center (NY) will start a pilot project in January that will link the genomic sequence of patients to their electronic medical records, allowing physicians to incorporate the patient’s genetic characteristics when choosing drugs and dosages.

12-15-2011 10-14-40 PM

The safety institute of Johns Hopkins Medicine, led by Peter Pronovost MD, PhD, will collaborate with Lockheed Martin to create a new generation of hospital ICU. An example given of its potential work is a patient alarm prioritization system. According to Pronovost, “A hospital ICU contains 50 to 100 pieces of electronic equipment that may not communicate to one another nor work together effectively. When an airline needs a new plane, they don’t individually select the controls systems, seats and other components, and then try to build it themselves.”


Fujifilm Medical Systems announces the availability of Synapse Financials, a billing solution that integrates with Fujifilm’s Synapse RIS platform.

Axial’s Care Transition Suite wins first place in the "Ensuring Safe Transitions from Hospital to Home" initiative, sponsored by Health 2.0 and HHS’s Partnership for Patients Initiative.


12-15-2011 6-20-53 PM

Wes Wright, CTO of Seattle Children’s Hospital (WA) says its deployment of 2,600 Wyse zero client devices for Citrix will save $400,000 per year in power consumption.

mrh_small MoneyWatch reports the top-compensated US CEOs for 2010, with McKesson’s John Hammergren in the #1 spot with $145 million (5,370 times the median US income.) Two other healthcare CEOs made the Top 10: Joel Gemunder of Omnicare ($98 million) and Ronald Williams of Aetna ($58 million.) Another site says Hammergren’s payday will get a lot bigger if McKesson changes ownership at some point — his contract calls for him to be paid $469 million.

mrh_small Making sure to place this item for maximal ironic effect, soon-to-be-displaced McKesson employees can check the comments left on my earlier post, where some vendors who are looking for Horizon or other talent have posted their contact information (I entered a few myself from information e-mailed to me).

mrh_small An interesting article in The New York Times ponders whether clinicians are becoming distracted by their growing arsenal of smart phones, tablets, and other gadgetry. It cites a research article that asked technicians who monitor heart bypass machines during surgery whether they used their electronic devices right in the OR, with 55% saying they had talked on their cell phone and 50% admitting they had texted. Funny: a Stanford doctor and author calls the attention-demanding screens “the iPatient,” and says the iPatient is getting wonderful care. In a sobering example, a patient was left partly paralyzed after surgery, with evidence presented in the ensuing malpractice lawsuit documenting that the neurosurgeon had made at least 10 personal calls from a wireless headset during the surgery.

mrh_small A Boston Globe article covering a visit by the head of HHS’s HIPAA enforcement organization, Office for Civil Rights (which it mislabels as Office of Civil Rights), cites Micky Tripathi’s breach article on HIStalk Practice. It’s also being reprinted in a Canadian information security journal after they requested his permission and he graciously deferred to us.

Sponsor Updates

  • Jeffrey DiLisi MD, associate VP of medical affairs at Virginia Hospital Center (VA), will discuss motivating physicians to improve documentation during The Advisory Board Company’s December 16 web conference.
  • MD-IT releases a case study on the ability of neurologist Gordon M. White, MD (TX) to maintain productivity while qualifying for the EMR incentive program.
  • Nuance joins 11 other organizations as a strategic partner with the Center for Connected Medicine.
  • Billian’s HealthDATA announces an alliance with  HealthLink Dimensions to add hospital-affiliated physician data to Billian’s existing offerings.
  • Nuance releases findings of a managing paper records in a medical practice.
  • Ignis Systems releases its EMR-Link Maintenance Training webinar schedule.
  • Greater Glasgow and Clyde Health Board (EU) announces that over 15,500 active patients have adopted its Orion Health clinical portal.
  • Practice Fusion shares its top seven healthcare IT predictions for 2012.
  • The Micromedex mobile drug information app from Thomson Reuters earns a spot on the WIRED App Guide to 400 Essential Apps.
  • Covisint works with Intermountain Healthcare (UT) to earn nearly $1 million in PQRS incentives.

EPtalk by Dr. Jayne

Medicare announces that starting in January, recovery audit contractors (the dreaded RAC auditors) will offer a new service to amuse and delight physicians: prepayment reviews. The audits will be piloted in states with a relatively high percentage of fraudulent and inaccurate submissions, as well as states with a high percentage of short hospital stays. Another demonstration project will require prepayment review for motorized wheelchairs and scooters, with a goal of requiring prior authorization within the next year.

It is unclear why Medicare chose to use the RACs to do this instead of the Medicare Administrative Contractors that actually process the claims. I do like the idea of looking at the process for payments covering powered mobility devices. A couple of vendors are entirely too pushy and work very hard to convince patients that every Medicare beneficiary deserves a scooter “at absolutely no out of pocket cost” because they’re not cheap and all of us are paying for them.

CMS plans to offer up to $1 billion in grants for healthcare innovations. The Health Care Innovation Challenge program targets public-private partnerships, multi-payer groups, and groups caring for patients with complex health care needs. Administered by the Center for Medicare and Medicaid Innovation (CMMI – ooh, a new acronym!), the grants stem from $10 billion in funding from recent health reform legislation. Proposed projects have to be rapidly deployable (less than six months) and able to be replicated, expanded, and sustained. I’m interested to hear from anyone who is considering an application. Letters of intent are due Monday and applications are due January 27, so if you want to wait until after the deadline so no one steals your ideas, I understand. The minimum award is $1 million, so get those keyboards moving.

Based on the content so far, I might as well make this the “all CMS, all the time” column this week. The House of Representatives passes a bill this week to postpone the scheduled 27% pay cut for Medicare physicians that is only a few days away. However, it is not expected that the Senate will follow, and even if they do, President Obama is expected to veto it.


HIMSS will open the process to solicit volunteers for its 2013-14 committees on January 2. Individual members and corporate members who are not already in HIMSS leadership positions are eligible as long as they have maintained membership for the past 12 consecutive months. Watch the Committees home page for more information.

We talked about flu vaccines recently, but right now there’s an outbreak of pertussis (whooping cough) in Chicago and surrounding counties. Vaccines are effective and are now recommended for adults as well as for children.


I mentioned last week that I had something big planned. Since our last get-together was at HIMSS11, I thought it was time that I paid my BFF Inga a visit. Although I frantically searched the racks at Nordstrom looking for something appropriate to wear, I suspected my efforts would be fruitless because I could never keep up with Inga. Seeing her walk through the door having paired these with jeans for a casual dinner, I knew I was right.

So what do the sassy ladies of HIStalk discuss over drinks? The enigma that is Mr. H, recent events at McKesson, who has the best date for HIStalkapalooza, and potential beauty queen sashes. We also discussed our no-longer-secret project. As Inga mentioned, you’ll want to make sure you include a pair of new or gently used shoes for our charity event when you make your packing list. (Sorry, no stiletto dash for those of you who suspected that’s what we were up to. I don’t want to be called upon to treat any orthopedic injuries while I’m enjoying the evening.)

It was nice to actually get together since we typically connect via e-mail and the occasional text message. I usually have at least one good physician war story for Inga, and this time she topped me with the writeup of a new book: Stuck Up! You’ll have to read for yourself what it’s about. Let me just say that it’s wackier than anything even Weird News Andy would send.



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

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December 15, 2011 News 10 Comments

News 12/9/11

December 8, 2011 News 6 Comments

Top News

Microsoft and GE announce the formation of a joint venture company that will take over most of the people and assets of the Microsoft Health Solutions Group along with specific GE Healthcare products. See the HIStalk story from early Thursday, which includes insights from interviews with the key executives involved.

Reader Comments

12-8-2011 6-45-08 PM

inga_small From Curious Reader: “Re: Black Book Rankings. I am confused about Black Book’s results. Do they break out their ratings by hospital size? CPSI usually sells to community hospitals, not the same ones Epic sells to. I don’t know how those are comparable. How is Black Book even defining and EMR? Picis is a surgery and anesthesia vendor — they don’t really have an EMR system.” This report includes multiple categories including under 100-bed hospitals, community hospitals, large hospitals, health systems, and EDs. Per Black Book’s website, the rankings are based on survey results that cover 18 performance areas. To make the Top 20 list, vendors must have at least 10 unique clients participate. Results for these ratings were based on 12,075 validated responses. There is no mention on how an EMR is defined, though it may be included in the full report. In you need to further satisfy your curiosity, you can purchase a report for $3,250, but note it will only include details on a single category and not all the inpatient EHR categories.

12-8-2011 9-07-25 PM

mrh_small From EMR Wannabe: “Re: GE and Microsoft. From trying to work with it, I know that Amalga UIS is an overly complicated hairball. I wasn’t sure about Qualibria, although last year when I asked a GE team how the knowledge project with Intermountain Health was going, they just broke into laughter and said, ‘depends who you ask.’ I said, ‘Well, I’m asking you,’ to which they took the Fifth (amendment, not bottle). Now with this announcement, we can see that Microsoft and GE decided to combine, and then bury, their respective dead or dying.” Amalga seems cool, but I don’t hear much from its customers once they’ve signed contracts, so NewCo should work to get the word out. I hope the companies really are planning to do something innovative like the announcement says. However, those with long memories will find it hard to forget (or forgive) historical examples of big, unfocused vendors who brashly stormed the HIT gates and then slunk off quietly shortly thereafter, unceremoniously dumping the charred remains of once-proud companies they had burned through and hoping the smell of utter failure would wash out of their Teflon-coated corporate suits. Recall when Baxter and IBM formed IBAX and quickly sold it off to HBOC, relieved to put distance between themselves and the albatross they had spawned from their passionate but short-lived union by creating a new company and not really caring whether it succeeded or failed.

For those scoring the Microsoft-GE JV at home, I’d watch for: (a) an indication of how much money the partners are investing vs. just letting the new organization sink or swim on whatever revenue it can muster; (b) the announcement of a real, delivered, buzzword-free product; (c) press releases listing newly signed contracts from paying customers that aren’t cherry-picked partner sites getting something else in return; (d) a lengthening roster of third-party developers that buy the “ecosystem” story and build useful apps on top of it; and (e) the assignment of experienced, high-ranking executives to the new company (so far new CEO Michael Simpson is the only person named and he’s been with GEHC only since 2010.) Some would say Peter Neupert’s retirement was the most negative aspect of the news (and it wasn’t even included in the announcement,) but to me it’s the fact that the announcement was made in such a hurry that they hadn’t even chosen a company name yet. We will report their progress here, good or bad. I’m as guilty as anyone about moaning that nobody innovates, then laying on the scorn when someone tries, so I’ll try to be cautiously optimistic, even though in talking to Neupert and Simpson Wednesday before the announcement, I couldn’t figure out exactly what they are planning to build, who the customer will be,and how the odd lot of products will contribute to the end result. I’m neutral on most of the products named since I’ve heard little about them, but I hope the former Sentillion people and applications don’t suffer in the chaos since they deserve better, having created a strong base of hospital customers that rely on their technologies.

mrh_small From SmallMe: “RE: Microsoft HSG. Major RIF and re-org in advance of the HSG/GE joint venture announcement.” According to our Microsoft contact that I asked to confirm, “Like all companies, Microsoft evaluates our business priorities regularly. As we evolve HSG’s strategy, we’re concentrating more on building a compelling platform and have eliminated a small number of positions to align with current priorities.”  

12-8-2011 8-59-18 PM

mrh_small From EthicsInHealthcareBusiness: “Re: RSNA. I’m surprised there isn’t more stringent hiring vetting by big vendors. Take the example of [vendor VP name omitted], who while at [vendor name omitted] was named in a federal lawsuit (CIVIL NO. 2004-116) accusing him of fraudulent pricing in dealings with government purchasing agents. The lawsuit was dismissed on a technicality, but it drove a parallel criminal investigation by the Defense Department and the US attorney’s office in Philadelphia. Why would a company risk this potential liability?” I omitted the specifics since, as you said, the lawsuit was dismissed and his innocence must be presumed. If he’s found guilty by the Feds, I’ll name names. His previous employer was known both globally and historically for shameful bribery. I blurred their name only a little above, but enough to say I didn’t unfairly name the company specifically.

mrh_small From Erik: “Re: McKesson. Halting all development of Horizon Clinicals 10.3 and deployment of Horizon Enterprise Revenue Manager.” Unverified. I got several e-mails from MCK employees Thursday morning that a company call was in progress (our readers are so loyal I’m surprised they didn’t conference us in.) Inga asked what was up and I told her if I had to guess, I would say MCK is either killing off Horizon or moving its revenue cycle efforts from HERM to Paragon since both had been rumored previously. I’ll be crowing to her endlessly if both guesses are correct, although I must credit readers who reported those possibilities to me in the first place starting many months ago. I’ll know more Friday, as McKesson Provider Technologies President Dave Souerwine asked to brief me. Unfortunately it will be late in the afternoon since I have to get home after work from the hospital to do it (darned day job!), but I’ll recap in the Monday Morning Update if not before.

mrh_small From MCKWorker: “Re: McKesson. All HERM staff essentially laid off. New direction for development, to combine with Paragon. HERM employees will have 60 days to interview for positions with that new strategy.” Unverified. It’s funny that Inga pinged a couple of her MCK sources and they told her company bigwigs had warned them that HIStalk would be probing for information. They were correct. Inga and I were flattered, even though the compliment was almost certainly unintentional. Apparently they weren’t too worried about anyone but us being on top of the breaking news and caring enough to dig beyond any official announcement.

mrh_small From Must Remain Anonymous: “Re: McKesson. It has finally happened! The call came today that McKesson will cease development of its Horizon product. All support will stop in seven years. Product development will now focus on the Paragon application instead. To be announced to their physician advisory council tomorrow morning. It is about time that McKesson drops the dead weight.” Unverified, until Friday anyway. If true, that would be truly remarkable given that Paragon has been close to being killed off several times, as Vince has explained in his HIS-tory lessons. Horizon has ample problems, but to think of Paragon as MPT’s flagship product is a mind-bender. If true, kudos to that little engine that could for hanging in there, excelling over and over, and giving the company an overachieving understudy for when its star couldn’t make curtain call.

And lest we forget among the corporate announcements from the several companies mentioned here, there are people behind these decisions, grunts like you and me who leave their families every day to do the best job they can, competently even though their expertise is related to products no longer in favor, who are torn with worry about their future livelihoods that are being manipulated invisibly by factors entirely beyond their control as corporate drones judge them unfairly on what they do today rather than their ability to contribute in a different way tomorrow (I hate that about corporate BS more than anything). Right now, they’re putting on a game face to try to make a nice Christmas or Hanukkah for their kids and families without seeming too preoccupied by work stuff that shouldn’t be intruding on their celebrations and religious observations, but at night when the lights go out, they are sleepless in contemplating what could change for them and those who depend on them. Join me in beaming some positive thoughts their way because I’m guessing they could use them right about now. I’ve been there and it sucks, but it eventually gets better.

mrh_small From Kurt: “Re: McKesson. I’m hearing they announced that they are spending $1 billion in healthcare IT. Is this correct? If so, this is more than most other vendors combined.” I’ll let you know soon. That sounds like an awfully large number even for a company of McKesson’s size, but I’m not ruling anything out. If they asked me for advice (not likely), I’d say they should show some leadership (meaning spend money) in building innovative solutions that will make their HIT presence respectable (i.e., high KLAS scores and a growing customer base), unlike their fellow conglomerate vendors that seem to be happy milking the wrinkled, desiccated udders of their thinning herds of malnourished and badly aging cash cows. In McKesson’s defense, they did make a huge investment (and later write-down, unfortunately) in developing HERM, so give them some credit for taking action, even if the result wasn’t what they had hoped. Corporate management has changed since then (and probably for that reason), so perhaps the environment is more conducive to nimble innovation now. I’d have to see that to believe it since it’s a rarity in a huge, publicly traded company.

12-8-2011 9-13-22 PM

mrh_small From Leotardo: “Re: Epic in the UK. Old news?” Two big-name English hospital trusts name their short list of potential post-NPfIT EMR vendors: Cerner, Epic, and Allscripts. The report says that “Epic is known to have invested heavily in the Cambridge procurement.” The Brits had better price out flights from London to Madison before finalizing a budget since they would be creating a massive carbon footprint for the endless mandatory training visits. Britain was one of few places where Cerner could pursue business knowing that Epic wouldn’t be sitting across the table, so news of an Epic win would not be celebrated in KCMO. And if Epic loses, that would be even bigger news since they usually don’t.

mrh_small From Wildcat Well: “Re: Costco selling Allscripts MyWay. Isn’t that an insult to every EHR sales rep out there? What exactly will Allscripts sales reps do now? The EMR adoption bubble is developing a very short shelf life.”

12-8-2011 8-31-36 PM

mrh_small From JB: “Re: Epic. I think this job would be humorous to highlight.” Epic hires only fresh-from-college greenhorns, so if you are experienced in healthcare IT, informatics, consulting, or process re-engineering, this is your one chance to get your foot in the Star Trek-themed door. I wonder how many Epic dishwashers have passed the company’s notorious MUMPS programming test?

mrh_small From Poutine: “Re: Quebec’s medical error registry. Finally done after being promised in 2002, but not getting provider data.” Provider error reporting is mandatory, but a third of them submitted incomplete information, while nine hospitals claimed “technical difficulties” that prevented them from filing even one report.

mrh_small From Skeptic: “Re: Micky Tripathi’s breach article. Part of me says. ‘Well done for a conscientious job.’ It’s not as if the folks involved had much of a choice in how to respond if they wanted to be law-abiding and careful stewards of the cards handed them by our system. The rest of me says. ‘This is insane.’ A street thief  steals a laptop and there is ‘an infinitesimally small chance’ the information would be accessed and/or abused. We spend $300K direct dollars and another large chunk of internal time — not to mention hours spent on the government regulatory side — addressing it, after which the thug still has the laptop and the exposure is still infinitesimally small. How much will we spend when the risk is real? And the lesson learned is that we all need to behave even more carefully and institute even more policies. This is great news for security companies, government agencies, and regulators. It’s horrible news for patients. Every dollar we spend on this kind of craziness is a dollar not available for patient care. At present, we’ve managed to construct a ridiculously expensive system relative to actual care delivered. This is an index case of how we’ve done it. (a) lesson one: no amount of anything is going to prevent this sort of thing. That’s not an excuse to be careless, but we need to use some common sense when applying blame. This blame falls on the thief. Period. (b) lesson two: the most sensitive data the healthcare system owns is financial. Identity theft is worth cash; PHI is close to worthless despite the paranoia surrounding it. We need to find ways to universally encrypt ADT/financial information and to not bind it so tightly to PHI. (c) lesson three: if we want to deliver better healthcare, there are better places to spend our patients’ money.”

HIStalk Announcements and Requests

inga_small Thanks to Micky Tripathi’s outstanding contribution on his organization’s patient data security breach, traffic on HIStalk Practice has been especially heavy this week. We’ve posted a number of other great items over the last week including Brad Boyd’s discussion on the need for clinically integrated organizations. Other news bits of note: CMS releases a well done MU toolkit for providers. Physicians are fairly unaware of ACOs and don’t know if they should join one. Only 4% of all eligible providers have been paid incentives for meaningful EMR use. Physician wait times are shortest in Wisconsin and longest in Mississippi. Requests: (a) read HIStalk Practice regularly because it thrills me to know that my father is not the only one tuning in; (b) next time you need to purchase something HIT-related, consider the offerings of our sponsors; and (c) sign up for HIStalk Practice e-mail updates because I love knowing that I am not the only one with an overflowing inbox. Thanks for reading.

mrh_small On the Jobs Board: Manager of Professional Services, Senior Trainer, Senior Software Engineer. On Healthcare IT Jobs: NextGen Workflow Process Consultants, EMR Application Specialist, Technical Services Manager.

mrh_small Inga, Dr. Jayne, and I take risks writing HIStalk. We could get fired from our real jobs if unhappy companies figure out who we are and complain to our bosses about something we’ve said about them. We could lose sponsors for reporting news objectively and stating our opinions honestly (GE, Microsoft, and McKesson are all HIStalk sponsors, for a current example, but we still have to say what we think or else we’d be just another rag that uncritically spews vendor-friendly non-news). We could lose long- or short-term significant others because we sit in front of computers way too much, or risk letting life pass us by as we fixate on the relatively tiny topic of healthcare IT after spending already-long days at work (tonight’s HIStalk took me 5.5 hours, so my total non-work time in the past 24 hours, including sleep, was about six hours.) If you want to provide some reward to offset that risk, (a) sign up for e-mail updates for HIStalk, HIStalk Practice, and HIStalk Mobile; (b) connect with us on Facebook and LinkedIn; (c) support our sponsors, especially those we have to occasionally say negative things about, by clicking their ads, checking them out in the searchable, indexed Resource Center, and sending them consulting RFIs; (d) send us rumors, news we might have missed, and updates on what’s going on where you work; and (e) help us find the good news of IT helping patients, IT people doing commendable work, and IT companies innovating and making a difference. Thanks for being part of what we do, which means you’re actually part of who we are.

Acquisitions, Funding, Business, and Stock

12-8-2011 7-55-08 PM

inga_small A day after we (and thus you) were tipped off by HIStalk reader Elroy, Streamline Health Solutions announces that it has signed a definitive asset purchase agreement to acquire Interpoint Partners for $5 million. We like to think they had to fast-track the announcement because of Elroy’s rumor report.

12-8-2011 4-05-38 PM

Humana acquires healthcare analytics company Anvita Health.


12-8-2011 4-09-31 PM

The federal government awards McKesson Provider Technologies its DIN PACS III contract, allowing it to sell PACS and related sub-systems to all branches of the US armed forces and civilian defense department agency facilities. The two-year contract has a potential value of $30 million.

12-8-2011 4-10-43 PM

Morehead Memorial Hospital (NC) selects Unidesk for desktop provisioning and application delivery for its VMware-based Virtual Desktop Infrastructure.

Meridian Health (NJ) upgrades to ICA’s CareAlign 3.0 for its 95 locations.

Group Health Cooperative of South Central Wisconsin and Group Health Cooperative of Eau Claire (WI) select McKesson Analytics Advisor.

Tidewell Hospice (FL) chooses Allscripts Homecare and EPSi financial management.

China-based diagnostic testing vendor Kindstar Globagene Technology chooses PathCentral’s anatomic pathology system for its 2,000 hospital customers in China.

Personal health record vendor MMRGlobal, which runs the MyMedicalRecords.com site, says Surgery Center Management has offered $30 million to license its patents for the PHR, patient video site, and document management system for providers.

12-8-2011 9-52-39 PM

CSC says it expects its NPfIT contract will be extended by an extra year through 2017, despite the company’s past problems delivering implementations on schedule that contributed to the cancellation of the $19 billion project. CSC expects to earn up to $3 billion for the 12-month extension. The former CIO said CSC would probably sue if its contract was cancelled, concluding that it might be cheaper just to pay them.


Medical documentation software provider Emdat hires Michael Grayson (Eclipsys, Sentillion, IDX) as VP of strategic partnerships.

12-8-2011 6-06-38 PM 12-8-2011 6-07-34 PM 12-8-2011 6-08-34 PM 12-8-2011 6-09-17 PM

HIMSS adds four members to its board of directors: Dana Alexander, RN, MSN, MBA, FHIMSS (GE Healthcare); Brian R. Jacobs, MD, MS, FHIMSS (Children’s National Medical Center, DC); Kenneth R. Ong, MD, MPH, FACP, FIDSA, FHIMSS (New York Hospital Queens); and Fred D. Rachman, MD, FHIMSS (Alliance of Chicago Community Health Services.)

Encore Health Resources expands its client services leadership team with the hiring of Greg Bluth, Ken Frantz, Jason Griffin, and Jim Kearns.

12-8-2011 6-30-09 PM

MED3OOO’s board of directors promotes Carl Smollinger from executive VP of ACO and employer services to COO.

Announcements and Implementations

12-8-2011 4-20-47 PM

NYU Langone Medical Center implements IOD’s release of information solution.

Wolters Kluwer Health releases its expanded IPhone app, UpToDate MobileComplete.

University Behavioral HealthCare (NJ) goes live on Stockell Healthcare Systems’ InsightCS Revenue Cycle Information Management platform.

DrFirst partners with Atlas Medical to offer physicians the ability to place lab/rad orders and review results via DrFirst’s Rcopia e-prescribing solution.

Government and Politics

12-8-2011 2-35-30 PM

Medicare and Medicaid have paid 2,868 hospitals and 21,425 EPs approximately $1.8 million for the Meaningful Use of EHRs through the end of November.

12-8-2011 8-29-49 PM

Dr. Jayne mentions below, but here’s a list of all Medicare EPs who have received HITECH money through September 30.

The State Department and the US Coast Guard sign an interagency agreement to share Epic’s EHR and access to VLER, the EHR used by the US Armed Forces EHR for its current and retired members.


VA employee unions raise concerns that a plan to add RTLS technology will lead to staff monitoring. The VA is issuing a $550 million draft request for proposals for RTLS to interface with cleaning and sterilization equipment. The department claims it has no official plans to tag and track employees. One union representative views any plans to use RTLS to track employees as “the beginning of Big Brother” and “and invasion of privacy.”

12-8-2011 4-22-12 PM

Meditech announces it will return to the HIMSS conference this year as an exhibitor. In looking at the HIMSS conference site, it does not appear that Cerner will be following Meditech’s lead in coming back.

Programmers world-wide celebrated last weekend with Random Hacks of Kindness, where self-proclaimed hackers developed programs for humanitarian purposes. Among them were an emergency response system for the Samoan Islands, a real-time disease tracking system, and an app that can scan a photo of water-borne bacteria to determine if it’s safe to drink.

The FBI subpoenas several businesses in its investigation into the financial dealings of Wayne County, MI. Among the companies whose contracts are being reviewed is Strategic Business Partners, a Detroit IT company that has billed the county for $22 million over several years, some of that for developing EMR software for the county jail.

A hospital in Canada being sued for malpractice by a patient who suffered a stroke during surgery tries to convince a judge to give it access to the patient’s Facebook and Twitter accounts, her computer, and her iPhone. The hospital’s argument was that since the patient claims her health and enjoyment of life had been harmed, they should be able to look for evidence to the contrary. The judge said no, calling it “ a classic fishing expedition without the appropriate bait.”

Sponsor Updates

12-8-2011 8-51-19 PM

  • The Advisory Board Company’s Crimson business unit wins the Best Booth award at the IHI forum in Orlando, with recognition of its employees for their knowledge and demonstration skills.
  • GE Healthcare releases a white paper that highlights the use of Centricity Practice Solution to achieve Meaningful Use requirements.
  • Healthwise launches Healthwise Spanish Knowledgebase, which includes evidence-based health information.
  • Symantec Health and DrFirst will present at April’s EPCS Leadership Symposium.
  • Blanton Godfrey, co-founder of the Institute for Healthcare Improvement, keynotes at TeleTracking Technologies’ 2011 Client Conference and predicts that better workflow choices will determine winners and losers after health reform.
  • DIVURGENT releases a white paper on the selection of the right IT infrastructure for ACOs.
  • The Irish Health Service Executive announces that four of its 35 hospitals are live on McKesson’s Horizon Medical Imaging PACS, with the remainder coming up within 20 months.
  • T-System’s CMIO Robert Hitchcock MD and CFO Steve Armond CFO discuss how to use IT to make an emergency department profitable.
  • Lawson Software introduces Infor10 Lawson S3, which includes integration between Lawson technology and products and applications from its newly acquired company Infor.
  • e-MDs customer James F. Holsinger, MD, PC wins the 2011 HIMSS Ambulatory Davies Award of Excellence for the quality of patient care through practice’s Meaningful Use of EHR.
  • MedVentive was selected to participate in last month’s Mid-West BluePrint Health IT Innovation Exchange Summit.
  • Intelligent InSites posts congratulations to President and CEO Doug Burgum, who is also chairman of the board of the SuccessFactors, just acquired by SAP for $3.4 billion. He was also an early investor and leader of Great Plains Software, which Microsoft acquired for $1.1 billion in 2001.

EPtalk by Dr. Jayne

HIPAA 5010 report: just a tad more than three weeks left until the January 1, 2012 deadline. Although CMS has announced that it won’t enforce compliance until March 31, don’t let the extension fool you. Many in the industry are predicting transaction rejections and cash flow interruptions to those who are not ready. CMS will be looking for non-compliant physicians who are expected to provide proof that they are preparing to be fully compliant.


It’s National Influenza Vaccination Week through Saturday. I’ve been impressed by the Centers for Disease Control and its use of social media (they had me at the Zombie Apocalypse.) Hospitals and health systems are steadily moving towards making vaccination a condition of employment whether you’re in direct patient contact or not. Several of the “IT guys” I work with always complain about it since they don’t work in the hospital proper and I usually have to remind them it’s not just about patients, but also about lost workforce productivity and increased healthcare costs. People do still die from the flu and it’s recommended this year for everyone age six months and older. Please get your flu shot, especially if you’re in a high-risk group.

The American Medical Association publishes a “How To” guide for Accountable Care Organizations and Co-Ops. Chapter Six includes advice on EHR incentive programs. It’s not a bad read for those who either have been living under a rock the last several years or just need a refresher on the basics. I like the chapter’s closing paragraph:

As is clear from this chapter, the adoption of a certified EHR system and the achievement of Meaningful Use is a very arduous task. Eligible professionals should remember that the incentives or penalties that are the consequences of this task are not insignificant.

Speaking of Meaningful Use, if you’re a Safety Net provider, I thought this upcoming webinar from the Health Resources and Services Administration (HRSA) looked interesting: Tips for Overcoming the Gray Areas of Meaningful Use for Safety Net Providers. At least someone is admitting there are some gray areas. Presenters from Regional Extension Centers and CMS will review “problem areas” that include vendor relations, attestation, and troubleshooting quality measures. It’s December 13 at 2 p.m. EST. You can send questions in advance to healthit@hrsa.gov


CMS has a new web page that shows MU incentive payment and registration data through October 2011. Maps show payment and registration breakdowns by state as well as individual state reports of registrants and payments. For those of you who want to know if your colleague in the doctor’s lounge was just blowing smoke, here’s the list of those who have already received payments.

There was an announcement earlier this week that Medicare will allow mining of its claims database for the purpose of creating report cards on providers. Employers, insurers, and consumer groups will have access to the data and physicians will be individually identifiable. People have been after this data for a long time, but I’m not sure how useful it will really be. There are so many other factors that go into determining quality other than sheer volume and claims data. One prominent hospital I worked at appeared on some payer reports as having poor numbers for morbidity and mortality for certain high-risk procedures. Once the case mix was analyzed, it was apparent that this tertiary referral center really did have patients that were sicker than average and also that they were willing to attempt procedures on patients so sick that other facilities wouldn’t even consider it. We’ll just have to see what comes out of the data.

I’m back from the rodeo and settling back into the daily routine of crunching quality reports of my own, as well as doing never-ending upgrade planning and dealing with ever-cranky colleagues. I do have something big planned for next week, but you’ll have to keep reading to find out what it is. Let’s just hope it doesn’t end up involving law enforcement or a bail bondsman.

Have a question about Meaningful Use, CMS, or whether the wearing of red Rocky Mountain jeans really says something about a girl? E-mail me.



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

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December 8, 2011 News 6 Comments

Bottomline Technologies Acquires Logical Progression

December 5, 2011 News No Comments


Financial software vendor Bottomline Technologies announced today that it has acquired the assets of Logical Progression of Cary, NC, which sells the Logical Ink mobile provider documentation solution for hospitals and large clinics. Terms were not disclosed.

Logical Ink is an interactive paperless forms platform that the company markets as an intuitive, workflow-based alternative to traditional computer documentation. Bottomline Technologies will offer that product as part of its healthcare product portfolio.

Logical Progression was featured in the HIStalk Innovator Showcase in June 2011.

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December 5, 2011 News No Comments

Monday Morning Update 12/5/11

December 3, 2011 News 12 Comments

 12-3-2011 4-30-02 PM

From It’s All Good: “Re: [vendor name omitted]. In post-acquisition happenings, staffers have been required to sign a highly restrictive non-compete agreement or face termination, with a number of 10+ year veterans opting not to sign and accepting termination instead. Next up, aptitude tests for those who remain. Pushing out seasoned veterans without having ready replacements is not a best practice.” At least it’s a free country, where the employment commitment works both ways. I admire those who took their walking papers instead of sticking around if they were really that unhappy. Complaining about your job while staying in it is like telling everybody how your spouse mistreats you – if you truly feel demeaned or endangered, stop talking and get out of the situation immediately. The bad thing about company belt-tightening is that you first lose the people with marketable skills and experience, leaving you stuck with those who don’t have anywhere else to go. Update: I concur with a reader’s comment that my “spouse” comment sounded insensitive, so I reworded to be clearer what I meant.

From Farina: “Re: being anonymous. It’s a shame you’re anonymous as you know more than pretty much all of the people that I talk to at vendors, VCs, or healthcare orgs. You’d also make a great advisor for a lot of companies.” I’m happy keeping a low profile, which also keeps me as focused and honest as a monk in a locked-down monastery. Not to mention that “knowing” is different from “doing,” obvious since I still toil in the salt mines of a non-profit hospital. Sometimes I’m envious of those with greater ambition and different skills who create and run large organizations and make names for themselves, but this is still the best “job” I’ve ever had (and the longest held at 8.5 years and counting.) I’m not motivated by money, power, or fame, so I’m fine. I firmly believe that if you do something you really enjoy for reasons other than making money, the money will find you anyway.

12-3-2011 3-19-32 PM

It surely cannot be possible that Christmas is just three weeks away and the HIMSS conference is just eight weeks after that. I get slammed every year in January and February doing the HISsies, gearing up for HIStalkapalooza, setting up our little HIMSS sponsor appreciation lunch, handling a big surge of e-mails of all kinds, and running around the conference anonymously and telling you about what I’m seeing (and trying to keep up with my real job at the hospital, of course.) If you need anything from me, this is a great time to let me know since I’ll be heads-down from New Year’s until March.

12-3-2011 3-07-27 PM

Nearly half of respondents say they have a problem buying into healthcare-related ideas that are presented by someone who’s overweight. New poll to your right: did you go to HIMSS last time and will you be going in February? I registered and made travel arrangements last week. This past year on February 20, Las Vegas was sunny with a high of 46 degrees compared to the normal high of 64. Exhibitors are going to hate the location since they’ll be competing for attendee attention with casinos and showgirls.

12-3-2011 3-50-28 PM

Our own Travis Good MD of HIStalk Mobile will be reporting from the mHealth Summit in the DC area starting Monday. Here’s his preview and links for following along with him this week (sign up for updates and you won’t miss anything). HIStalk Mobile is a media partner, meaning Dr. Travis gets to play intrepid reporter and prowl around areas that are off limits to regular attendees (OK, I’m not sure there really are any of those, but that makes it sound more exclusive than just taking notes along with everybody else.) Big-name keynoters include the Surgeon General, the chairman of the FCC, Kathleen Sebelius of HHS, and some notables from Qualcomm, Apollo Hospitals Group, Verizon, and West Wireless Health Institute.

12-3-2011 9-22-42 PM

I’ve just posted on HIStalk Practice Micky Tripathi’s gripping, highly educational account of having his organization’s patient data breached. It’s long, detailed, full of documentation and like nothing you’ve ever read since nobody has ever talked so openly about their own organizational mistakes. We all know data breaches are potentially embarrassing, but you’ll be surprised (unless you’ve lived through a breach yourself) at the gray regulatory areas, the “who’s really responsible” question (shocker: legally, it wasn’t Micky’s organization, Massachusetts eHealth Collaborative), and just how much money and effort is required to go through the required steps. I’ve preached for years about encrypting mobile devices, so if budget is your barrier, send a copy of the article to your CEO and I bet the project will be quickly funded. I always enjoy Micky’s regular HIStalk Practice columns since he’s not only an expert, he’s also one of the most engaging writers I know. In this case, has served the entire industry, for which we should all be grateful. I consider this piece to be mandatory reading for just about everybody.

Listening: Odessey and Oracle from The Zombies (and yes, I spelled it correctly). This is the innocence, psychedelia, and British Invasion fascination of the 1960s captured permanently on vinyl like a prehistoric bug in amber. By the time this album came out in 1968 the band was broke and disbanded (they could barely afford studio time and had to record it in mono.) Time of the Season climbed the charts and the group still declined to tour, so fake groups gave concerts using their name, with one even grabbing the band name’s trademark that had expired. For my money, I’d take this album over Sgt. Pepper’s and Pet Sounds as the best of the decade (right up their with Love’s Forever Changes and either The Doors or Strange Days from The Doors).

I had some major upgrade work done on the site over the weekend. Most of it is behind the scenes, but if you read HIStalk, HIStalk Practice, or HIStalk Mobile on a smart phone or iPad, you may see some improvements. I noticed that the iPad display was sometimes fuzzy for reasons I could never figure out and that seems to be fixed, plus there’s new support for Apple’s Retina display.

My Time Capsule editorial this week from five years ago: HBOC 1, Everybody Else 0, in which I opine, “Among those involved were certainly some crooks and some fools, but let’s not forget those who suffered most, those McKesson lifers who had stashed away years’ worth of shares of their unexciting company’s stock instead of risking their future on flaky fads like Microsoft and Dell. When lonely old conservative widower Dad McKesson brought home a sexy young step-mom named HBOC, she stole the kids’ piggybank.”

12-3-2011 6-36-13 AM

Welcome to new HIStalk Platinum Sponsor Etransmedia Technology. You may recall that the Troy, NY company facilitated the offering of Allscripts MyWay nationally through Costco, but they’ve created quite a few products of their own related to PM/EHR, patient connectivity, physician mobile, revenue cycle, and clinical documentation. The SaaS-delivered EtransConnect ACO product suite has tools for connectivity, patient identity management, a clinical data repository, and an orders report portal for providers, rounding those solutions out with a community patient portal and back-end analytics tools. The company’s ambulatory EHR toolkit provides a full-function patient portal (appointments, health histories, messaging, refills, consents, online statements, and structured data exchange such as by CCD). Also offered is custom reporting modules and a mobile charge capture app that lets physicians document their hospital rounding activities to send charges back to their own EHRs for billing. The company just announced that it’s  #155 on Deloitte’s Technology Fast 500 with a 647% revenue growth over the past five years. Thanks to Etransmedia Technology for supporting HIStalk and its readers.

12-3-2011 6-56-08 AM

Thanks to Intelligent InSites for supporting HIStalk as a Platinum Sponsor. The Fargo, ND company’s tagline is Enabling the Real-Time Enterprise, which it does with an extensive list of RTLS-powered solutions (asset management, patient flow, bed management, infection control, patient and staff safety, environmental monitoring, and mobile information access.) The company just announced its enterprise Big Data analytics solution that uses the wealth of information it captures to identify trends, track key performance indicators, and call out process improvement opportunities. Also just announced is a consulting service that helps hospitals identify specific areas (and hard-dollar impact) in which RTLS-powered solutions can improve outcomes, patient satisfaction, and cost. I was intrigued that the company’s largest investor and interim CEO is Doug Burgum, who bootstrapped and ran fellow Fargo company Great Plains Software until Microsoft bought it for $1.1 billion in 2001. Thanks to Intelligent InSites for helping me do what I do.

I like to get the big-picture view of a company by checking out an introductory video (I’m lazy and have a short attention span), so I found the one above for Intelligent  InSites on YouTube.

The new Plano, TX office of MedAssets will consolidate over 1,000 employees in a building covering 225,000 square feet. The company’s corporate headquarters is in Alpharetta, GA, which I note has a population around 60,000 and about the same number of HIT-related company offices (slight exaggeration.)

12-3-2011 8-32-45 AM

The IT team behind the US Army’s MC4 battlefield EMR wins the top IT team award from the Association of Military Surgeons of the United States. Receiving the award above is Lt. Col. William Geesey, project manager (on the right.)

Vince Ciotti takes a slight detour from his ongoing HIS-tory of HIT software vendors, this time leading off a series on consulting firms. Vince is looking for your first-hand stories, so if ampersanded names like Coopers & Lybrand and Ernst & Whinney cause one of those TV dream bubbles to appear over your upraised head as you dreamily recall the glory days of dark-suited Big Six accountants descending on your hospital with their weapons of choice (legal pads, expense accounts, and blank RFPs for selling add-on work), then feel free to reminisce with him for future installments.

An ED doctor in Canada admits that he looked up medical information on his girlfriend’s former husband during a child custody dispute. The hospital’s computers have a 10-minute logout period, so the doctor would go behind users who left their PCs logged on to look up records under their user ID. The hospital’s SVP of medicine says it hopes to implement a card-based computer system that automatically logs users off, so there’s a sales opportunity if your company offers those.

12-3-2011 4-08-15 PM

Ed Marx has a big go-live at Texas Health Resources and found this signage amusing.

A fascinating Forbes article called The Bomb Buried In Obamacare Explodes Today – Hallelujah! says the only truly important part of the Affordable Care Act took effect on Friday. That’s when the medical loss ratio part of the law kicks in, requiring insurance companies to spend 80% of the premium dollars they collect on medical care (if they underspend, they have to write customers a check.) The author says this marks the slow but sure death of for-profit insurance companies because they know they can’t do that and still make a profit, so they are already moving to more profitable businesses (but read the comments at the end for some interesting counterpoints, with a notable one being that insurance companies make most of their profit from investing the money until it’s spent anyway and that’s not changing.) A snip from the article:

So, can private health insurance companies manage to make a profit when they actually have to spend premium receipts taking care of their customers’ health needs as promised? Not a chance – and they know it. Indeed, we are already seeing the parent companies who own these insurance operations fleeing into other types of investments. They know what we should all know – we are now on an inescapable path to a single-payer system for most Americans and thank goodness for it. Whether you are a believer in the benefits of single-payer health coverage or an opponent, mark this day down on your calendar because this is the day seismic shifts in our health care system finally get under way. If you thought that the Obama Administration chickened out on pushing the nation in the direction of universal health care for everyone, today is the day you begin to understand that the reality is quite the contrary.

12-3-2011 9-30-03 AM

Raul Recarey, president and CEO of the Missouri Health Connection HIE, quits after eight months on the job.

12-3-2011 9-46-00 AM

HCI’s USA-built Android-powered RoomMate Healthcare TV for hospitals includes a patient and visitor whiteboard, a web browser, video and music options, a pillow speaker, an an optional hard drive for video streaming. It comes in screen sizes from 22 to 42 inches and includes just about every kind of connectivity available. It integrates with the company’s MediaCare2 product, which allows hospitals to send “information prescriptions” to specific patient TVs, such as educational videos, images, and announcements. It also allows hospital staff to control patient TVs from a central location.

Stupid lawsuit: a prisoner sues his former hostages, a newlywed couple whose home he broke into while evading police on suspicion of murder. The couple agreed at knifepoint to hide him, but called police when he fell asleep. He brandished the knife again and was shot by a SWAT team officer. He’s suing the couple for $235,000 worth of medical costs and emotional distress, saying they breach breached  an oral contract by turning him in.

E-mail Mr. H.

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December 3, 2011 News 12 Comments

An HIT Moment with … Ramsey Evans, CEO Prognosis Health Information Systems

December 2, 2011 Interviews No Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Ramsey Evans MBA, is president and CEO of Prognosis Health Information Systems of Houston, TX.

12-2-2011 6-31-12 PM

What’s on the minds of small hospitals these days with regard to operational challenges, healthcare IT, and Meaningful Use?

Executives at small hospitals are thinking about the same issues that their counterparts at larger hospitals are struggling with: financial challenges associated with shrinking reimbursements; the relentless need to improve quality; and, of course, the rush to achieve Meaningful Use in order to qualify for government incentive funds.

However, the obstacles faced by healthcare providers and patients in rural areas are vastly different than those in urban areas. Rural hospitals are smaller in size, have limited assets and financial reserves, and a higher percentage of Medicare patients due to their populations being older than urban populations.

The desire to achieve Meaningful Use is exacerbating a frustration that hospitals have been struggling with for years — the time and money that it takes to implement EHRs. It’s the No. 1 headache out there, but it is especially vexing for rural hospitals as they simply don’t have the same financial and human resources that larger providers have. Our Web-native technology enables rural and community hospitals to move from signing to implementation to the realization of Meaningful Use in less than 120 days, which translates into a significant time to value as well as the lowest total cost of ownership.

The big-hospital market has shaken out to just two or three vendors that regularly sign new customers. What’s the competitive landscape in the smaller hospital market?

A similar shakeout is underway in the smaller hospital market. Vendors are realizing that it takes special product offerings and service to meet the needs of the rural and smaller community hospitals. Some of the large vendors are trying to bring their systems into the smaller hospitals, but they are finding that the solutions and the service model just don’t mesh with the way critical access and smaller rural community hospitals operate. Simply repackaging their monolith systems into a smaller box with a slightly faster implementation is not what’s required for this unique market.

Realizing that smaller hospitals simply cannot afford the multi-million dollar, client-server based systems that take years to implement, we focus on disruptive innovation. In his seminal book The Innovator’s Dilemma, Clay Christenson explains that a disruptive innovations improve a product or service in ways that the market does not expect, typically first by designing for a different set of customers in the new market and later by lowering prices in the existing market. His follow-up book explains how the disruptive innovation concept could play out in healthcare by delivering capabilities formerly only available to large providers with huge budgets to smaller providers that can then leverage such solutions to improve care delivery. That’s what we are trying to do.

How advanced are your client hospitals in their use of your clinical documentation, ordering, and clinical ancillary applications?

Our clients don’t have the same level of complexity as large tertiary hospitals with a range of specialties such as cardiology, oncology, and pediatric departments or Level Four trauma centers. So IT system utilization is in line with their charter. But they still have to provide quality care  and document it.

They should be able to leverage an EHR that will enable them to do that as well as larger hospitals. That’s really the issue we are addressing. Take a look at the inequities. According to the National Rural Health Association, Medicare patients with acute myocardial infarction who were treated in rural hospitals were less likely than those treated in urban hospitals to receive recommended treatments and had significantly higher adjusted 30-day post AMI death rates from all causes than those in urban hospitals.

Our system can help to close this digital divide. Our “clinical visual pathway” makes it easy for nurses and physicians to deliver the best care by simply following a visual map that walks them through standard best practice scenarios while treating a patient.

How are your customers and you as a vendor affected by the push toward alignment with physician practices and the developing ACO market?

With our target market of rural, critical access and smaller community hospitals, we haven’t seen much focus today on ACOs. These smaller providers traditionally focus on defined requirements, instead of those that are in a constant state of motion such as the ACO requirements were in the past several months.

With defined ARRA regulations for Stage 1 and defined incentives, leaders at these hospitals have been keenly focused on identifying a way to meet the requirements. With the final ACO rules recently published, though, these hospitals are likely to begin to add ACOs to their list of challenges and it will start to become a concern.

What’s the future of interoperability among hospitals and practices?

There is an ever-increasing interest in evaluating both hospital and physician EMR systems at the same time. Providers in rural communities understand that there is real value in sharing records, as patients frequently receive care from various providers across a region. And providers really want all of this sharing to be seamless. They want to make it possible for patients to go from facility to facility and simply have their medical information follow them.

To make good on this notion, we are working with a number of our hospital clients to help support the West Texas RHIO, where eight hospitals across a region are accessing records via a shared EHR. The RHIO enables clinicians to access patient records at any of the hospitals, such as when a patient shows up in an emergency room or is transferred. As such, doctors and other clinicians can provide care with access to complete information, which, in turn, enables them to make the best care decisions and save lives in the process. 

This arrangement makes it easy to create a virtual health information exchange. That’s because authorized physicians can retrieve patient records from any of the hospital databases once they are verified with user name and password. In contrast, most emerging health information exchanges across the country involve competing organizations, usually with different records systems, creating a network from scratch to share certain patient information. It’s just an example of how innovation can make it possible for healthcare organizations to go beyond what was possible with the formerly dominant technologies.

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December 2, 2011 Interviews No Comments

News 11/30/11

November 29, 2011 News 17 Comments

Top News

mrh_small HIMSS EHR Association responds to NIST’s EHR usability draft. Its concerns:

  • There’s no proof that usability issues are a barrier to EHR adoption
  • The document does not take into account how EHRs are used in practice
  • The document’s references are old and the checklist-based review method has limitations
  • The stated expert review requirements are “unwieldy and unproven”
  • The summative testing requirements are impractical and don’t reflect practice customization and limitations imposed by vendors of the underlying operating system
  • Users prefer a system that’s efficient to one that’s easy to learn and the main beneficiary of usability improvements would be novice users
  • Usability reviews are subjective and even expert evaluators often don’t reach the same conclusions
  • Prescriptive standards for functionality and aesthetics will hinder innovation

Reader Comments

11-29-2011 7-55-04 PM

mrh_small From Blue Horseshoe: “Re: ViaTrack acquisition by NextGen. Verified.” According to the e-mail, QSI’s acquisition of its NextGen EDI partner closed on November 14, with the goal of expanding the company’s inpatient EDI market (with no impact to its ambulatory clearinghouse partners, the e-mail emphasizes).  

11-29-2011 9-23-51 PM

mrh_small From Red Flag Raised: “Re: Epic. Why are they talking to the New York Stock Exchange?” Epic’s CFO speaks at the Wisconsin School of Business in a presentation stated to be “a practice run through the material that the Epic group is planning on giving to the NYSE.” The topic was on the Dodd-Frank Act that addressed Wall Street reform. A bit of sleuthing turns up Anita Pramoda’s November 29-30 NYSE audience – a CFO forum for institutional investors at NYSE Euronext. She’s moderating the session, which doesn’t appear to have anything to do with an Epic plan to go public. Unrelated: she’s apparently also the CFO of OnTech, which makes self-heating drink containers for coffee. Above is what rather surprisingly displayed when I pulled up her LinkedIn profile.

mrh_small From ShakingMyHead: “Re: UMCSN in Las Vegas. Finally signed an agreement to buy Horizon Clinicals. Now that is weird news.” The hospital chose McKesson as vendor of choice in August 2010, but ran into money problems until McKesson apparently came way down on price.

11-29-2011 6-53-52 PM

mrh_small From The PACS Designer: “Re: Nimbula. TPD has blogged about cloud applications in the past, and now that the concept is becoming widespread, thought HIStalkers would like to try out this concept themselves. Now they can with a free trial called Nimbula Director 1.5.” The company says the product provides “a one-stop virtual data center management solution.”

Acquisitions, Funding, Business, and Stock

11-29-2011 3-22-15 PM

Optometry HIT company RevolutionEHR is raising $600,000, according to an SEC filing.

11-29-2011 9-26-39 PM

Xerox subsidiary ACS acquires The Breakaway Group, developers of the PromisePoint cloud-based service that allows providers to practice using their EMR technology in a simulated environment.


11-29-2011 3-29-00 PM

Beth Israel Medical Center (NY) signs a five-year contract with CriticalKey for its KeyEngine software, which enables the electronic transmission of patients results from Beth Israel’s RIS system to the individual EMRs of participating physicians.

The Johns Hopkins Hospital selects Versus Advantages RTLS for staff locating, asset tracking, and automated nurse call cancellation.

Abbeville Area Medical Center (SC) selects Virtual Radiologic’s Enterprise Connect, a PACS alternative solution.

11-29-2011 3-26-20 PM

Wake Forest Baptist Medical Center (NC) chooses Huron Consulting’s Click Portal software to automate clinical trials business processes.

Vitera Healthcare Solutions announces that Medical Group of North County (CA), Bloomingdale Medical Associates PA (FL), Doctor’s Medical Center (FL), Rheumatology Associates PC (MA), Women’s Care Group, PC (TN) and Robert C Byrd Clinics (WV) have selected Vitera Intergy Meaningful Use Edition EHR solution.

Northern California Surgery Center selects the ProVation EHR solution for ambulatory surgery centers from Wolters Kluwer Health.

St. Jude Heritage Medical Group (CA) chooses MediRevv for insurance resolution A/R management services.

Acuo Technologies announces contracts for its vendor neutral archiving solution with University of Rochester Medical Center (NY), Kettering Health Network (OH),  and CHRISTUS Health (TX).


11-29-2011 5-11-46 PM

Good Shepherd Medical Center (TX) appoints Ralph Holcomb as CIO. He was previously with Baylor Jack and Jane Hamilton Heart and Vascular Hospital (TX).

11-29-2011 5-13-44 PM

MedQuist Holdings hires Matt Jenkins as SVP of corporate business development. He was previously with Allscripts.

11-29-2011 5-15-19 PM

Elsevier/MEDai names Thomas H. Zajac as president. He was previously with CareScience and TSI.

11-29-2011 7-04-06 PM

Cardiology center software vendor Perminova announces Craig Collins as its president and CEO. He was previously with PetriTech.

Medicalis names Jim Boyle (Stentor, Perot) as COO and Guy Anthony (Solaicx) as CFO.

Announcements and Implementations

Children’s Mercy Hospital & Clinics (MO) completes its 30th installation of SeeMyRadiology.com for the communication of radiology images between hospitals, imaging centers, and physician practices.

11-29-2011 3-30-05 PM

Willis-Knighton Health System (LA) deploys EMC Symmetrix VMAX storage systems to accommodate its Meditech, Siemens Soarian, and Sectra PACS applications.

University Behavioral Healthcare, a division of the University of Medicine and Dentistry of New Jersey, goes live on vxVistA and vxMental Health Suite from DSS, Inc.

11-29-2011 9-32-06 PM

Martin Memorial Health Systems (FL) gets a mention in the local paper for going live on the first phase of its $80 million Epic EMR this week. VP/CIO Ed Collins checked in with an update last week.

Kony Solutions announces Member Mobile, which allows health plan members to browse and purchase plans, locate care services, request appointments, check benefit status, and refill prescriptions.

RTLS vendor Intelligent InSites will introduce its “big data” business intelligence solution at IHI’s quality improvement forum in Orlando next week. The company also announces a consulting service to help hospitals place a value on their RFID and RTLS technologies.

Walgreens subsidiary Take Care Health Systems, which operates employer health and wellness centers, will run Cisco’s San Jose health center and provide telemedicine services from there to the company’s Durham, NC campus using Cisco’s HealthPresence technology.  

11-29-2011 7-07-45 PM

Healthcare imaging vendor Barco announces MediCal QAWeb Mobile, calibration software for tablets used for viewing medical images. A free version is available on iTunes.

Select Data introduces an iPad application for use in the home health market.

Candelis announces that its cloud-hosted medical image services will be integrated with Microsoft HealthVault, allowing patients to import and share images.

11-29-2011 9-34-13 PM

Montage Health Solutions says that its enterprise search and analytics technology for EHRs and radiology information systems is live at Keck Medical Center of USC (CA), Children’s National Medical Center (DC), and University Health Network (Ontario).

Government and Politics

11-29-2011 8-42-59 PM

Rep. Tom Marino (R-PA) is taking heat from critics of his bill that would allow providers to report suspected EMR-related errors without legally admitting wrongdoing. Attorney Cliff Reiders, who sues providers for a living, says giving providers immunity would “encourage the wrong thing” and wouldn’t provide encouragement to improve EMRs.

The National Library of Medicine updates its RXNorm clinical drug vocabulary, adding standardized drug names linked to NDC numbers and also including the full NDC set from the Red Book by Thomson Reuters.

The VA says 89% of its project milestones were met on time in FY2011, exceed the goal of 80% that was set in 2009 when fewer than 30% of its projects were finished on schedule.

Innovation and Research

ONC announces four finalists for its developer challenge for apps related to using public data for cancer prevention and control. They are Ask Dory! (locates nearby clinical trials), My Cancer Genome (provides treatment options based on clinical trials involving specific genetic mutations), Health Owl (provides cancer recommendations from family history and demographics), and Cancer App by mHealth Solutions (offers suggestions for reducing cancer risk).

Technology developed by a hospital in Israel allows the family members of patients undergoing cardiac catheterization procedures to watch in real time on their iPads. The original version of the story said the app was co-developed by McKesson, but that reference has been removed.


Sanford Health (ND) is hiring 100 part-time and full-time employees to help with its $8 million transition to the Sanford One Chart EHR (aka Epic).

Oxford University Hospitals Trust pushes back this week’s Cerner go-live at three of its hospitals, saying it needs more time to prepare.

inga_small I couldn’t help but reminisce about  Mrs. Fletcher reading this story. An 81-year-old woman activates her medical alert system when her 55-year old daughter attacks her in bed after an argument over money. Paramedics saved the day.

inga_small One day I will check out RSNA, mostly because I am intrigued by the size and scope of the event. OK, I also like the idea of holiday shopping on Michigan Avenue. RSNA was expecting about 700 exhibitors and over 58,000 attendees from over 100 nations. If you are there, send us an update and your best photos.

UCSF, Brigham and Women’s Hospital, Weill Cornell Medical College, and Inland Imaging partner with Medicalis to form a radiology workflow consortium to enable direct scheduling of radiology orders from the point of care.

Karen Pletz, the former president of the Kansas City University of Medicine and Biosciences, is found dead in her Florida home. Under her leadership, the school expanded its campus and fund-raising efforts, but she was abruptly fired in 2009 amidst charges of embezzling $1.5 million.

11-29-2011 9-37-02 PM

MedicalRecords.com, which offers a free online database of EMR applications to generate leads that it sells to vendors for $150-300 each, says the 400 EMR vendors clamoring for business is “like a gold rush” with 7% of them buying its leads.

The New York Post runs just-released compensation information for executives of New York’s hospitals, naming four hospital CEOs whose one-year bonuses exceeded $1 million. Herbert Pardes, retiring CEO of New York-Presbyterian Hospital, made $4.3 million, while the CEO of a struggling 326-bed hospital came in #2 with $4.2 million in total compensation in a single year.

mrh_small Weird News Andy, observing that “people are smarter than governments” since healthcare insurance doesn’t carry a two-year contract like cell phones, likes this story: a study finds that “jumpers and dumpers” are taking advantage of a Massachusetts law that forces insurers to accept patients with pre-existing conditions. They are buying insurance, having expensive elective surgery, and then dropping coverage. That practice costs the state $37 million per year. WNA also likes this story about electronic surveillance of hospital handwashing practices, which he entitles, “Big Brother is Washing You.”

Sponsor Updates

11-29-2011 6-19-36 PM

  • Quality IT Partners sponsored the 12th Annual Scott Hamilton & Friends Ice Show and Gala, held in Cleveland on November 5. The company’s guest was a patient undergoing cancer treatment at Cleveland Clinic. 
  • Medical Transcription eXpress joins MD-IT as a Medical Transcription Service Organization associate, allowing it to resell the MD-IT platform and EMR.
  • Nuance Healthcare and Bayer HealthCare’s MEDRAD launch an interoperable solution that connects the MEDRAD Certegra informatics platform and Nuance PowerScribe 360 reporting technology .
  • Sarah Corley MD, CMO of NextGen Healthcare, and Gregory Sheffo MD, CMO of Clearfield Hospital (PA) will discuss the impact of healthcare reform to the ambulatory care sector during a December 15 Webcast.
  • Dell says its acquisition of InSite One a year ago has increased its managed object count by 25%, with the company managing over 65 million clinical studies and 4.5 billion diagnostic imaging objects.
  • Robert Hitchcock, MD FACEP, T-System VP and CMIO, discusses five key reasons a CDS should be used in the ED.
  • Worcestershire Acute NHS Trust goes live with Orion Health Clinical Portal.
  • At RSNA, Merge Healthcare unveils its cloud-based platform Honeycomb along with its first application, free image sharing.
  • T-System expands its partnership with Iatric Systems to include interfacing technology for hospitals connecting T-SystemEV EDI with enterprise EHRs.


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

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November 29, 2011 News 17 Comments

News 11/23/11

November 22, 2011 News 3 Comments

Top News

11-22-2011 9-05-52 PM

mrh_small A USA Today article examines the effect of stimulus money on publicly traded companies, with those in healthcare IT being “the clearest connection between the stimulus and the economy.” I don’t get this statement: it says Cerner clients have earned $100 million in stimulus money and Cerner has 20% market share, so it concludes that industry sales must have been boosted by $500 million per year, when (a) stimulus payments to providers have nothing to do with vendor sales; (b) even if they did, it wouldn’t be an annual increase; and (c) the number is probably much larger than $500 million a year, given that Epic alone has probably exceeded that number even just on the software and services part of its contracts. The article mentions sales increases for Allscripts and athenahealth, although Jonathan Bush of athenahealth opined that his company is “… a beneficiary of stimulus spending, but we’d be doing even better without it. What you really needed was hundreds of cloud-based companies innovating.”

Reader Comments

inga_small From A Muse: “Re: weighty issue. Does anyone else feel a bit uncomfortable when we have industry thought leaders, spokespeople, and senior management of do-good healthcare companies or organizations who are overweight? When I see obese people in organizations advancing remote patient monitoring or other disease management, it makes me think, ‘Yep, it’s working for you, partner.”

11-22-2011 3-42-41 PM

inga_small  From Teena Martini: “Re: picture perfect. I saw the shoe when I was in Las Vegas and crawled into it. And I am a Martini!’” All Inga BFFs beware: there is some stiff new competition from Teena Martini (that’s her real name!) Teena, who is director of clinical applications at Gwinnett Medical Center in Georgia, sent me her photo after I mentioned a desire to crawl in this exact shoe with an Inga-Tini in hand. During HIMSS, I am dragging Dr. Jayne with me to the Cosmo for a serious photo shoot.

inga_small  From EMRsehole: “Re: [vendor name omitted.] The acting head of HR whacked numerous sales reps and others have had to sign an airtight non-compete.” Unverified.

11-22-2011 9-11-42 PM

mrh_small From Mack Chiavelli: “Re: Newt Gingrich. All true. My former healthcare IT company, now dead and therefore nameless, ‘donated’ much, much money for Newt’s influence to drive interoperability and open systems in government circles. We even sponsored a number of his speeches to pre-HIMSS CHIME annual Fall Forums and later to CHIME members when the organization capitulated to HIMSS. I don’t know how successful we were, but Newt certainly made out well.”

mrh_small From Insider: “Re: Epic moving into Meditech territory at Poudre Valley. It’s true that PVHS is getting rid of Meditech 6.0 and putting in Epic. Meditech’s 6.0 performance was just too painful and their response was not enough to keep the business.”

11-22-2011 7-19-10 PM

mrh_small From PigEarstoPurses: “Re: 3M. I received this e-mail today about a 3M interface policy change. Wondering if others got it? It true, I would hope customers tell them to take a hike since it’s none of 3M’s business where and how customer data is utilized.” A letter from OptumInsight to its own customers says that a new 3M policy requires customers to submit an inventory of anything that interfaces with 3M’s applications. It also requires vendors of those systems to license their interface with 3M because its intellectual property is at risk. The letter claims 3M says it will disable any interfaces that aren’t covered by licenses by July 2012. Readers have sent rumors about 3M supposedly not allowing their encoder product to interface with non-3M speech recognition applications, so that may or may not be related. 3M is welcome to provide a response since this is just one side of the story.

11-22-2011 7-40-47 PM

11-22-2011 7-39-40 PM

mrh_small From Ed Collins: “Re: Martin Memorial Health Systems, Florida. I’m an avid reader and find HIStalk to be a valuable tool in my CIO arsenal. Here is a bit of news that your readers might enjoy. MMHS will be going live with Epic inpatient and ambulatory apps at our two hospitals, our freestanding emergency department, and nearly half of our medical group (45 PCPs) on December 1. The specialists who represent the remaining half of our medical group go live in March. The local ad campaign started over the weekend. Nine days and counting to go-live!” I asked Ed (he’s the VP/CIO of MMHS) if he got tired of shuttling people to Verona for the never-ending Epic training, but he observes that the product just works, so the training focuses on user and analyst knowledge of the system. I swapped e-mails with another CIO earlier this week and we reached that same conclusion: you begrudge the huge time and money investment for Epic’s upfront training that seems like overkill, but only until the day you go live and everybody’s ready (extensive training, documentation, and proficiency testing is part of Epic’s secret sauce that competitors rarely emulate.) Above is MMHS’s ad in the local paper explaining the transition. I know from a long-ago site visit I took there that MMHS’s outgoing system is Meditech, so this is yet another instance of a previously unthinkable but now increasingly common phenomenon. Thanks to Ed for the report – I always enjoy hearing from the front lines.

11-22-2011 7-50-10 PM

mrh_small From THB: “Re: Franciscan Health System (WA). Going Epic.” According to its project page, Franciscan brought in Deloitte for planning (seems like Deloitte gets a ton of that business) and will name a consulting firm to help with the implementation any day now.

mrh_small From The Fixxer: “Re: UPMC’s altered EMR lawsuit. I am amazed that electronic medical records are being used to tamper with evidence. Why would an old geezer retired surgeon want to learn how to enter a finding in an EMR? The hospital has training facilities and Cerner experts to teach him. The bigger story is who advised him to do this. Might there just be a Penn State like scandal involving the attempted cover up of deaths of adults?” A judge orders UPMC to allow its head of quality assurance to be deposed to explain why he changed the electronic medical record of a patient who had died three days earlier in the hospital. UPMC’s lawyer in the malpractice lawsuit against it argued that the QA director was doing routine peer review work, but the plaintiff’s attorney says he not only changed the record after the fact, but also asked another doctor to add documentation about how the patient died.

11-22-2011 8-03-56 PM

mrh_small From Nikita: “Re: Alegent in Omaha. They have also begun the popular to journey to Epic, starting from Siemens in their case. The board is planning a final act on the subject in March 2012, with a stated 4-5 year migration period. Part of the support argument references Epic’s being ‘a single system.’” Unverified. Alegent and Siemens have been ultra-chummy for years. If the rumor is true, Soarian gets the boot.

HIStalk Announcements and Requests

11-22-2011 3-26-18 PM

inga_small  Looking for some interesting HIT companies to follow on Twitter? I created an “Inga’s Fav” list on Twitter, so if you follow me, you should be able to access the list.

mrh_small I don’t know about you, but I’m particularly thankful for the Thanksgiving break because I’m tired. I will most likely not post again until the Monday Morning Update (unless I can’t resist), so we will reconvene here then. If you are traveling, spending time with friends and family, or just slouching in front of football on the TV while dribbling gelatinous globs of cylindrical canned cranberry sauce down your front, I hope you have a wonderful holiday reflecting on those things for which you are thankful.

Acquisitions, Funding, Business, and Stock

Telemedicine provider Foundation Radiology Group raises $1 million to expand its network of community hospitals.


11-22-2011 3-54-31 PM

In advance of its migration to the Meditech 6.0 platform, Parkview Medical Center (CO) expands its agreement with Summit Healthcare to include Summit Express Connect.

11-22-2011 7-02-19 PM

Children’s Mercy Hospital & Clinics (MO) chooses Accelarad’s SeeMyRadiology for image sharing. The company says its growth in the past 12 months makes its platform “effectively a Health Information Exchange for imaging in the region.”


11-22-2011 4-05-07 PM

Cal eConnect appoints Robert M. (“Rim”) Cothren, PhD as its CTO, tasked with overseeing the organization’s HIT and exchange projects. He previously served as CTO for Cognosante.

Announcements and Implementations

SCI Solutions convenes its charter Executive Advisory Board to advise the company on solution development and the acceleration of the company’s growth. Some of the familiar names on it: Dave Garets (The Advisory Board Company), Ivo Nelson (Encore Health Resources), Jay Toole (Dearborn Advisors), and Allana Cummings (Northeast Georgia Health System.)

11-22-2011 3-56-20 PM

Nuance Communications signs a reseller agreement with Montage Healthcare Solutions, allowing it sell Montage’s healthcare data mining and performance measurement technology to its radiology customers.

11-22-2011 4-00-11 PM

St. Vincent Healthcare (MT) replaces its GE Centricity EHR with a $4 million system from Epic. It’s part of Sisters of Charity of Leavenworth, which is moving all facilities to Epic.

Innovation and Research

11-22-2011 8-51-51 PM 11-22-2011 8-53-24 PM

Aetna and the Center for Biomedical Informatics at Harvard Medical School will partner to apply bioinformatics data analysis techniques to aggregated clinical databases, hoping to evaluate treatment alternatives for outcomes and cost, study patient compliance in chronic disease, and evaluate the potential of combined EHR and claims data to predict disease. The project will be co-directed by Zak Kohane MD, PhD of Harvard and Brian Kelly MD of Aetna (above.)


11-22-2011 3-35-53 PM

inga_small  A 46-year-old former physician is arrested for practicing medicine without a license out of her home and for committing a series of burglaries that include the theft of landscaping lights, decorative patio chairs, and bicycles. She has also been charged with selling phony lottery tickets. Lisa Marie Cannon was a licensed pulmonologist until she failed to renew her license in June. The local police chief calls the case “very bizarre.”

The Joint Commission issues a statement saying it is “not acceptable for physicians or licensed independent practitioners to text orders for patients to the hospital or other healthcare setting.” It notes that texting does not provide the ability to verify the sender and  it can’t store the original message for validation.

HIMSS is launching mHIMSS, a new organization focused on mobile health technologies. The new website indicates a late November launch.

EHR adoption for midsize and large ambulatory practices will exceed 80% by 2016, according to IDC Health Insights. IDC provides an assessment of 10 EHR products from eight vendors, based on their current successes and predicted performance over the next three years. eClinicalWorks earns the top score, followed by Cerner, Sage, and NextGen. 

mrh_small Weird News Andy calls this article “Abs of steel, butts of steal.” Florida police officers arrest a transgender woman for practicing medicine without a license after complaints that her derriere-enhancing procedures involved injecting patients with toxic substances such as Super Glue and Fix-a-Flat. WNA also tracks international news as evidenced by this story, in which a German gynecologist is arrested for taking photos of his patients during their exams without their permission, with the evidence search yielding 35,000 nude pictures. And WNA likes the development of a talking plate in England that commands diners to stop bolting their food down, although he’s hoping that the 1,500 pound plate refers to British currency rather than weight.

11-22-2011 8-17-00 PM

mrh_small A couple of items sent over by Roger Maduro of Open Health News from the just-ended VISTAExpo & Symposium in Redmond, WA. Oroville Hospital (CA) goes live on VistA without using outside consultants after spending $500K of its own money to enhance the VA’s product to meet its needs, tapping into the developer community to create its own modules and interfaces. The total project cost was $10 million, which includes all hardware, replacement lab and medical equipment that could interface to VistA, and iPads. Roger also notes that VA CIO Roger Baker made a surprising announcement in embracing newly named VistA custodial agent OSEHRA (Open Source Electronic Health Record Agent), saying the VA will use the OSEHRA product as its own and will contribute development to it.

mrh_small I got Vince’s HIS-tory (HIS Inc., Part 2) a bit late for Saturday, so here it is, including naming “the most pathetic name in the HIS industry.” I really like this week’s instructional guide on “How to Sell Vision-Ware,” which I found to be deadly accurate. Another excellent installment from HIT’s de facto historian.

Sponsor Updates

  • Covisint will participate in Michigan’s Council of Women in Technology Signature Event on December 3.
  • Passport Health Communications announces its educational and online demonstration webinars through December.
  • Gateway EDI will participate in next week’s PriMed Midwest meeting in Rosemont, IL.
  • Software Testing Solutions offers its free eBook, The Who, What, When and Why of Validation.
  • Trustwave announces three December webinars on security trends.
  • Amit Hajra of Hayes Management Consulting blogs on ways to optimize EHR to improve efficiency and increase ROI.
  • Practice Fusion wins Top Ten ratings in ten categories from AmericanEHR Partners, a program of the American College of Physicians.
  • RelayHealth co-sponsors a free on-demand webcast on medical home leadership.
  • CapSite’s SVP and GM Gino Johnson will present findings from CapSite’s recently published HIE study at next week’s 23rd Annual Piper Jaffray Health Care Conference. The Advisory Board, Allscripts, GetWellNetwork, Imprivata, MedAssets and PatientKeeper are also conference presenters.
  • Transcription Unlimited (MO) signs a partnership agreement with MD-IT to offer the MD-IT platform and EMR to its physician clients.
  • Culbert Healthcare Solutions becomes an Executive Corporate Partner of AMGA.
  • Sixty-three of Texas Health Care’s 140 physicians have demonstrated Meaningful Use compliance with NextGen EHR.
  • Oracle awards Orion Health the Oracle PartnerNetwork APAC ISV Partner of the Year for 2011, reflecting Orion’s performance using Oracle products and technology to create value for its customers.


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

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November 22, 2011 News 3 Comments

Readers Write 11/21/11

November 21, 2011 Readers Write 13 Comments

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

ICD-10 Déjà Vu
By M. Christine Kalish, MBA, CMPE

11-21-2011 6-29-17 PM

The American Medical Association (AMA) passed a resolution at its 2011 Interim Meeting mandating the group to "vigorously work to stop the implementation of ICD-10 and to reduce its unnecessary and significant burdens on the practice of medicine.” The resolution that the AMA will "do everything possible to let the physicians of America know that the AMA is fighting to repeal the onerous ICD-10 requirements on their behalf" continues.

Strong language, AMA, but the ICD-10 train has already left the station. And we have seen this sort of talk before —there is a sense of déjà vu here.

Remember the successful efforts of the AMA and other organizations to delay the original ICD- 10 implementation date of October 2011? That’s the day CMS originally targeted for mandatory ICD-10 adoption for physicians, hospitals, and payers.

The AMA’s point of contention about the October 2011 date was that physicians were not given sufficient time to upgrade all systems and then provide training and education. They also cited the cost would be significant and the expense of the implementation should be spread out over a longer timeline. The Bush administration allowed a delay until October 1, 2013 — two additional years.

After the announcement of the initial delay, a seemingly satisfied AMA led the way in providing resources for physician practices to transition to ICD-10 within the agreed-upon timeline.

So why the change of heart now?

Organizations have already invested significant resources in ICD-10 adoption. No one is arguing that the implementation is challenging and costly, especially on the heels of Meaningful Use and other healthcare reform measures. But the AMA seems to have forgotten that they helped architect (and then eventually approved) the October 2013 delay.

Also, the AMA or, more importantly, the physicians within the association, needs to realize that the benefits of ICD-10 far outweigh the costs of implementation.

ICD-9 is outdated and no longer effective. The numbering system cannot support the addition of the new codes. With time, attempts to find codes are increasingly difficult since some are being placed wherever there is a free space in the sequencing.

The rest of the world uses ICD-10. In fact, the rest of the world is getting ready to move to ICD-11. The US needs to not only catch up, we need to realize that sharing and comparing data with other countries yields better quality of care with increased clinical efficiency and improved outcomes.

The additional codes provided by ICD-10 afford another degree of specificity that will reduce claims processing costs by reducing recurrent requests for information during the billing process. Of course, there is the flip side: documentation will continue to be a challenge. For example, a physician may know specific information about a patient but not write it down, even though the additional documentation will help with outcome assessments and quality of care indicators. It’s up to the provider, but wouldn’t they want to show how their care provides exceptional patient outcomes?

Let’s proceed with some caution. Do not let this latest AMA decision stop or even slow the implementation of ICD- 10 within your organization. It seems that a better solution would be for the AMA to get back on the train and determine how to they can improve the transition process rather than try to derail it.

Change is never easy, but let’s not be in the same position another two years down the road and have déjà vu “all over again.”

M. Christine Kalish, MBA, CMPE is an executive consultant with Beacon Partners.

A Response to Vince’s Epic Article
By QuietOne

This is a counterpoint to Vince Ciotti’s Readers Write article, The Other Side of Epic.

I usually don’t comment, but I definitely had to say something here. Epic — like everything else — has its problems. However, Vince’s claim that Siemens Soarian or Cerner Millenium has "equal or better" functionality is totally laughable. I’ve worked with both and neither comes close.

Vince states that Epic is not an integrated solution because it lacks general ledger and payroll functionality. Cerner and Siemens (in Soarian) don’t, either. Siemens had GL/AP/payroll in their older SMS products, but they aren’t offering it any more and are selling SAP instead.

Furthermore, GL and payroll are probably the least of your worries. If you get Siemens, you’ll have to interface disparate clinical, patient financial, and pharmacy systems as well as a bunch of departmental systems, each of which have different platform, database, and hardware requirements. You’ll also have to deal with all the third-party components required to make the system work, some of which have to be purchased separately. Epic, on the other hand, truly is an integrated system with a single database used by all modules (as is Cerner Millennium.)

Speaking of databases, why does Vince call InterSystems Cache’ a "proprietary" database? It is proprietary, but so is Oracle (used by Cerner Millenium) and MS SQL (used by Siemens Soarian Clinical, Financial, and Scheduling). Incidentally, Siemens Pharmacy, which you "have to" get if you want a fully functional Soarian Clinical system, also uses the InterSystems Cache’ that Vince seems to dislike.

Some of Epic’s departmental modules are arguably weak, but the same can be said of Siemens and Cerner as well as most other vendors. That is the price you pay for an integrated solution.

There is talk that Epic doesn’t play well with other systems. I do not believe that to be true, either. In addition to your everyday HL7 interfaces, Epic has a module for real-time query/retrieve relationships with non-Epic EMRs. Cerner has equivalent functionality, but Siemens does not (although I assume they must be working on something or buying another bolt-on product). 

Epic, which has the best documentation I’ve ever seen, provides extensive documentation of their architecture, database, and APIs. As a last resort, you could dive into that. Obviously, the server-side MUMPS code is visible to customers since it’s interpreted, but I was stunned to find out that they also provide the client-side source code to customers as well, obviously with legal restrictions on how it can be used.  

I am not sure where Vince got the idea that Epic is less customizable than Siemens. Siemens Invision is very customizable, but Siemens Soarian definitely is not. 

For the record, I have no ties to any vendor.  I can honestly say that I have never seen a product or company that impresses me like Epic and I am definitely not prone to brainwashing. I also want to say that I really enjoy (most of) Vince’s articles. This last article bewilders me, though, because it would seem to suggest that he is either biased or misinformed. I am disappointed.

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November 21, 2011 Readers Write 13 Comments

News 11/16/11

November 15, 2011 News 16 Comments

Top News

11-15-2011 9-24-11 PM

The AMA’s House of Delegates votes to “work vigorously to stop implementation” of ICD-10, which it says will create “significant burdens” on the practice of medicine with no direct benefit to the care of individual patients. AMA President Peter W. Camel, MD also notes that physicians are concentrating on EMR implementation and the switch to ICD-10 would “add administrative expense and create unnecessary workflow disruptions.”

Reader Comments

11-15-2011 12-10-34 PM

inga_small From Big Scout: “Re: NextGen User meeting. Kicked off today with a multimedia presentation including keynote speaker John Foley, former lead solo pilot for the Blue Angels. Some of the key themes so far: Meaningful Use preparation, ICD-10, and high performance teams. Farzad Mostashari is also in attendance.” We love the “from the field” reporting, so thanks for sharing. Big Scout is one of over 4,200 participants at this week’s NextGen user meeting in Las Vegas.

inga_small From Unibroue: “Re: HITECH mess. One of my clients just got rejected for her ARRA money because Kaiser claimed her payment earlier in the year. She had supposedly signed a contract with them while still in medical school, though she never actually went to work for them. She has no idea how it happened, but expects a nightmare to undo it. The feds don’t even provide any kind of contact information and have just advised her to ‘get in touch with Kaiser Foundation.’ A billion-dollar conglomerate has her $22K and she’s not happy.” Maybe readers have suggestions on how to resolve. Good luck.

inga_small From Not in Kansas: “Re: NHS. The National Health System is a thing to be seen. Of course on the way to seeing it, you have to deal with impossible parking, non-working lifts, a large bucket catching the drips from the ceiling, and hazardous waste parked in the corridor.” Not in Kansas reports that she is across the pond assisting a relative who is having surgery. While some American patients might envy the cost of NHS care (it’s free), the US model does, for the most part, afford us an abundance of well-maintained facilities and other niceties.

mrh_small From Non-Sequitur: “Re: HIStalk quoted. I just loved the sweet irony of seeing you quoted in the pages of one of those magazines you described, which ran an article on the Colorado HIE cost challenges saying the story was ‘plucked from the HIStalk web site.’” I thought that was darned nice of Health Data Management (or perhaps more accurately, reporter Joe Goedert,) for hat-tipping HIStalk instead of just following my link and pretending they found that story on their own. Joe’s one of the good writers who learned the players and the lingo, sticks to reporting the news objectively and skillfully, and doesn’t confuse being an sideline observer with being a participant who’s qualified to render advice or provide expert editorial opinion (“I’m not a doctor, but I play one on TV.”) The first thing I do when I read an editorial or self-assured comment telling providers or vendors what they should or think is check LinkedIn for the author’s education and experience. I’m usually not impressed.

mrh_small From Olly Oxen: “Re: Cleveland Clinic. A healthcare market research report says Cleveland Clinic has exceeded Epic’s capabilities for data analysis and revenue cycle tools that will be needed to manage populations in an ACO-type model. Executives there are apparently disappointed that Epic isn’t interested in helping them in those areas, forcing the clinic to bring in other vendors after paying all that money for Epic.” Unverified, but OO provided an excerpt from the report.

mrh_small From Janga: “Re: NIST’s draft on EHR usability testing. HIMSS provides their commentary.” The HIMSS response expresses concern at having actual usability experts doing the testing, favoring instead “inclusion of individuals with practical clinical experience.” I don’t agree – the document clearly identified steps in which subject matter experts would be involved to provide subjective analysis and comments, but real usability testing is product-agnostic (are menus labeled clearly, how many clicks to complete a task, etc.) HIMSS also thinks testing conditions should reflect real-life interruptions and competing workflow, which sounds nice on paper but isn’t really how usability testing is done (remembering again that usability is a profession with its own literature and standards, not just a bunch of nerds deciding arbitrarily how products should be tested.) Having said that, though, I think HIMSS was admirably restrained in not nitpicking the draft to death and trying to insert itself into the process (like it did for EHR certification.) So I’ll moderate my comments: HIMSS brings up some industry-specific points worth considering, although usability experts and NIST have way more expertise and thus should have the final say.

HIStalk Announcements and Requests

11-15-2011 6-43-54 PM

mrh_small Welcome to new HIStalk Platinum Sponsor NextGate, whose MatchMetrix master index solution manages over 50 million unique entities (patients, providers, terminology) worldwide. The Pasadena, CA-based company was founded by the technical brains behind one of my favorite products of all time, the STC Datagate integration engine (we’re talking mid-1990s here that I was involved in buying it for my health system), arguably the first generation of what eventually became vendor-independent interoperability solutions. The NextGate folks are serious technologists with expertise in EMPI, enterprise registry, enterprise application integration, and service oriented architecture, all vital for presenting consolidated data views and exchanging information. MatchMetrix gets high KLAS scores; is used by both providers (HIEs and health organizations) as well as vendor partners; and offers low TCO, fast implementation, and straightforward management. For those of us who appreciate high-achieving geeks, note that every single member of NextGate’s leadership team has earned their technical stripes. Thanks to NextGate for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

11-15-2011 2-56-25 PM

simplifyMD secures $4.5 million in new capital and names Michael Brozino as president and board member. He was previously with McKesson and the McKesson-acquired A.L.I.

PHR vendor MMRGlobal reports a Q3 net loss of $2.1 million, compared to last year’s loss of $1.7 million. Revenues were $352K compared to last year’s $270K.

11-15-2011 6-15-43 PM

Nashville-based critical access hospital software vendor Custom Software Systems, Inc. changes its name to CSS Health Technologies. It sells the ChartSmart EMR.

Healthcare learning and research solutions vendor HealthStream opens the public offering of 3,250,000 shares of its common stock, with the sole book-running manager being William Blair & Company, LLC. Proceeds could reach more than $50 million.


11-15-2011 2-58-58 PM

Avalon Health Care Management selects HealthMEDX Vision as its enterprise-wide solution for its 39 long-term care facilities.

Alabama Medicaid and the state of Alabama partner with Thomson Reuters to build the infrastructure for a statewide HIE known as One Health Record.

11-15-2011 6-38-29 PM

Barnabas Health (NJ) selects the MedAptus Professional Intelligent Charge Capture solution for its 4,500 physicians.

11-15-2011 7-09-23 PM

Healthcare Access San Antonio (TX) chooses Medicity’s HIE technology to connect its providers and area hospitals, initially using the iNexx platform to create a 22-county referral network. HASA is one of only two regional grant recipients to qualify for state funding to start implementing an HIE.

11-15-2011 8-43-01 PM

Florida Medical Clinic selects Humedica MinedShare for managing its patient population and improving clinical outcomes.

11-15-2011 8-44-26 PM

Catholic Healthcare West signs a three-year, $4.3 million deal to implement AirStrip OB remote fetal monitoring on mobile devices.

University Medical Center (NV) gets county approval to buy an unnamed $31 million clinical system (presumably McKesson.) The hospital said in July that it couldn’t come up with the $60 million needed and had only $25 million to spend with McKesson, its vendor of choice.

11-15-2011 6-34-29 PM

mrh_small The board of Edward Hospital (IL) voted Monday evening to approve the purchase of Epic as its core system along with Lawson for ERP, VP/CIO Bobbie Byrne MD, MBA tells me. She says, “I have a great deal of respect for many of the vendors in our industry and I was impressed with several of the proposals we received. Epic was the right choice for Edward because of the robust integrated products for clinical and revenue cycle across both hospital and physician office settings. One patient, one record, one bill …” You may remember Bobbie from her four years with Eclipsys as SVP of clinical solutions.

11-15-2011 8-48-16 PM

The Portland VA chooses Magpie Healthcare’s CareConnect to connect clinicians with on-call staff and to activate care teams. Magpie was one of six organizations to receive funding under the VA’s Innovation Initiative.


Mediware CFO Michael Martens will step down effective February 15, 2012 to rejoin a former employer. He joined the company two years ago. The company will conduct a national search for his replacement.

11-15-2011 6-17-09 PM

Sean P. Kelly, MD joins Imprivata as chief medical officer. He will continue his practice as an emergency physician at Beth Israel Deaconess Medical Center.

11-15-2011 6-25-31 PM

ZirMed names former Culbert Healthcare and GE VP Kent Rowe as VP of sales.

11-15-2011 6-20-14 PM

Jack Walsh, formerly with IMS Health, Inc., joins SRSsoft as CFO.

11-15-2011 6-21-50 PM

Intelligent InSites names Mary Jagim chief nursing officer.

11-15-2011 6-36-27 PM

Carol Simon, PhD is named director of the just-announced Optum Institute for Sustainable Health.

Announcements and Implementations

11-15-2011 3-03-07 PM

inga_small Henry Ford Health System (MI) launches its $100 million EMR this month (the article says it’s a homegrown product, but I believe it’s actually RelWare’s EXR.) That’s a temporary solution since the health system is negotiating with Epic in a deal valued at $350 million, which based on HFHS’s most recent financial report, will cost the health system six years’ worth of net income.

MRO Corp announces that it is among the first health information handlers to successfully pass all critical integration tests for CMS’s CONNECT Gateway Pilot Program, which facilitates the electronic submission of medical documentation to RAC auditors.

Cincinnati-based HIE HealthBridge selects IBM Initiate Patient software for its infrastructure.

Greenway Medical launches PrimeDATACLOUD, a care delivery platform that recognizes and aggregates data from various EHR and HIS platforms and facilitates health information exchange.

Government and Politics

HHS’s own Indian Health Service is struggling with the transition to ICD-10 for its RPMS, IHS’s version of the VA’s VistA. CIO Howard Hays says ICD-10 is his highest short-term priority.

Florida Governor Rick Scott, appearing on a public radio talk show, seemed to be referring to the Florida Health Information Exchange when saying, “There haven’t been a lot of studies to date that suggest electronic medical records have saved a lot of cost. They’ve increased cost because of the way you have to keep all the records. I’m the one who should be taking care of my information and not relying on the government to do it because I believe it will raise the cost of healthcare without a result.”

Innovation and Research

inga_small Researchers in Belgium are developing technology to embed “electronic noses” in mobile phones to verify the freshness of food, test air quality, and measure blood alcohol levels. It’s all part of a human “Body Area Network” (BAN) system that also incorporates wireless sensors for monitoring heart rates and blood glucose levels.

11-15-2011 2-37-44 PM

inga_small And in other nose news, Grand Challenges Canada and the Bill & Melinda Gates Foundation award The Electronic Nose a $950,000 grant to support further development and testing of its technology for detecting TB immediately and non-invasively from a patient’s breath.

11-15-2011 8-56-05 PM

In England, a former Royal Army Medical Corps captain working on his PhD in computer science develops Mersey Burns, an iPhone and iPad app that calculates the IV fluid needs of severely burned patients such as soldiers on the battlefront. His research, conducted with two plastic surgeons, won an NHS innovation award this month.


Michigan Health Connect (MHC) announces that Olympia Medical Services is extending MHC’s HIE solutions to its 500 physician members.

mrh_small Massachusetts doctors who take patient photos for their EMRs and in reaction to the Red Flags identity theft rule are losing patients who claim the practice is an invasion of their privacy. The practices highlighted say they’ll scan the patient’s own photo or driver license instead of taking their picture if the patient prefers, but the patient interviewed by the local paper says “people are being tracked.” The executive director of the World Privacy Foundation says medical identify theft is usually an inside job that the photos won’t prevent, not to mention that “we don’t want our healthcare providers to become the new airport TSAs.”

mrh_small In South Korea, the medical doctor who founded the country’s leading anti-virus software company donates $133 million (USD) to educate the children of low-income families. He’s also a top candidate for next year’s presidential election.

11-15-2011 8-39-30 PM

mrh_small ECRI Institute announces its Top 10 Health Technology Hazards for 2012, all related to recent incidents that made headlines:

  1. Alarm fatigue / lack of alarm response
  2. Exposure hazards from radiation therapy
  3. Infusion pump-related medication errors
  4. Cross-contamination from flexible endoscopes
  5. Change management with regard to medical device connectivity
  6. Mixing up enteral feeding lines with IV lines
  7. Surgical fires
  8. Sharps injuries
  9. Anesthesia equipment problems not discovered during surgery
  10. Poor usability and design of home medical devices, leading to misuse

Sponsor Updates

  • Optum launches The Optum Institute for Sustainable Health to provide analysis and insight on the landscape of healthcare.
  • Miami Children’s Hospital’s nursing manager Deborah Hill-Rodriguez, MSN, ARNP, PCNS-BC, will discuss best practices during GetWellNetwork’s November 17 Webinar entitled Leveraging Technology to Support Pediatric Fall Prevention.
  • NextGen Healthcare recognizes five client hospitals for successful Stage 1 Meaningful Use attestation.
  • David Finn of Symantec Health shares his thoughts on the need to take action on security and privacy in healthcare in the company’s Healthcare Online blog.
  • The Detroit Free Press names CareTech Solutions a Top Workplace in the large company category for the third year in a row.
  • Apixio announces that its Community Search product has been integrated with Allscripts Sunrise EHR and is available on the Allscripts Application Store and Exchange.
  • AdvancedMD announces the availability of its 2011 Fall release, which enables practices to send ANSI 5010-formatted claims.
  • Awarepoint is awarded four additional patents for its real-time location systems for hospitals.
  • Imprivata wins the Security Projects of the Year award at the 2011 Computing Security Awards.
  • MEDSEEK announces that 18 of its healthcare clients received a total of 25 honors at the Strategic Communications eHealthcare Leadership Awards competition.
  • The Technology Services Industry Association and Impact Learning Systems designate TeleTracking Technologies as a Certified Support Staff Excellence Center.


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

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November 15, 2011 News 16 Comments

Curbside Consult with Dr. Jayne 11/14/11

November 14, 2011 Dr. Jayne 4 Comments


Dear Dr. Jayne,

Is our current EHR paradigm dated? Docs practiced for years with paper. Pencil evolved to ink, both inscribed on compressed wood. Housed in manila folders, stickers provided the index and retrieval involved sight-based interpretation based on patient names. Then, we introduced computers. Initially similar to the paper paradigm, full summaries in ANSII or images are stored in a paradigm that still resembles folder-based paper storage.  From the images and full ANSII summaries came discrete data points. Ink on paper had now evolved to data capture as unique field based database storage. Over time, these discrete data points will become much more comprehensive.   

With all the technical advances where is the industry going? Will the paradigm shift from practicing medicine on discrete data points to something else, and when? Will medicine be able to shift? Is multimedia the next frontier? Just like the initial paper to electronic chart paradigm shift, when will computer science convert images and video to discrete data points? We all know the value of discrete data.

Fan of Dr. Jayne from the Deep South

Dear Southern Fan,

You pose some interesting questions. Given the fact that physician recordkeeping didn’t change much for hundreds of years, the relative pace of records evolution at present is staggering. We’re already becoming fairly adept at converting spoken language into discrete data, allowing physicians to document patients’ stories not only with codified data points, but with the rich narrative that frames individual patient circumstances and situations.

In my opinion, the biggest barrier to the kind of documentation that can be envisioned is unfortunately the proverbial hand that feeds us. The regulations, policies, and requirements of CMS are still stuck in the paper paradigm. And as we all know, as CMS goes, so go the rest of the payers. Despite federal mandates to take the technology forward — such as HIPAA and HITECH — healthcare providers are still being scored based on documentation standards that have not evolved in more than a decade.

Physicians can’t get “bullet point” credit for documenting a cancerous skin lesion with a photograph. They say a picture is worth a thousand words, but in an audit, a picture is worth nothing.

I remember sitting in medical school watching a video of a child with whooping cough. No written description could ever take the place of that. When you see and hear that kind of pathology, it’s etched in your brain forever. Nevertheless, embedding a video clip of a patient isn’t worth anything, either. I can look at a photograph of a diabetic foot and tell you a lot more about a patient’s illness and status than I can glean from a multi-page nonsense note generated from a poorly-implemented EHR.

I once heard someone say that our thinking is constrained by the technology of today. I don’t think that’s the entire problem; our vision is also constrained. And it’s not the technology that locks us in, but also the auditing and payment paradigm that hobbles us.

I was initially hopeful that the rise of Accountable Care Organizations with their risk-sharing and outcomes orientation would help us move to a more modern way of thinking and documenting. It doesn’t look like the fact that providers and payers are sharing risk is going to move us away from the incessant and costly paradigm of documentation for documentation’s sake.

The promise of telemedicine and other technology ventures such as real-time electronic patient communication was exciting. However, lack of payment and increased regulatory burden continue to keep it from realizing its potential. I’d like to think the future’s so bright we’ll have to wear shades, but I’m not sure CMS agrees.

Dr. Jayne


E-mail Dr. Jayne.

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November 14, 2011 Dr. Jayne 4 Comments

Monday Morning Update 11/14/11

November 12, 2011 News 9 Comments

11-12-2011 6-11-16 AM

From THB: “Re: Cheyenne Regional Medical Center. Going Epic.” The 218-bed hospital gets board approval to replace McKesson Horizon with Epic in a $19 million deal, saying it will cost about $5 million over five years to implement Epic. It says Meaningful Use money will offset that amount, and after that, Epic will actually be cheaper that McKesson. Epic doesn’t usually sell to hospitals that small, so either CRMC is affiliated with a larger Epic customer or Epic is started to push down into Meditech territory.

From WSDiner: “Re: HCA. At a Credit Suisse Healthcare conference investor dinner Thursday night, HCA’s management said they piloted Meditech 6.0 this year and will pilot Epic next year. They said that no other vendors (i.e., Cerner) were under consideration.” The reader provided a Credit Suisse contact to confirm, but he didn’t respond to my e-mail. This will be interesting if it’s true – my read has always been that HCA just wants to scare Meditech into better pricing by bringing in competitors, but Epic doesn’t walk away without a contract in most cases. HCA is Meditech’s largest customer, contributing 8% of the company’s revenue in 2010.

From Commodore: “Re: Cerner running poorly on the iPad. Do other inpatient vendors have native apps?” The only one I know of is Epic, which has Canto (above.) There may well be others. I tried using a couple of my hospital’s clinical apps the iPad using the Citrix portal and that’s definitely not something that’s workable for clinicians. The shrunken screen is impossible to comfortably read, you have to constantly zoom to hit tiny drop-downs with your finger, and the clicking doesn’t feel sure-footed at all. I think it’s safe to say that for most vendors, there’s not much to brag on if your iPad capability consists of running an emulated desktop screen. Only your marketing people will be impressed.

11-12-2011 7-36-12 AM

From The PACS Designer: “iPad viewer. The FDA has now approved an iPad viewer from Carestream called Vue Motion. The application permits the viewing of image files from many different PACS platforms, including cloud-based offerings, and can be integrated into EHR solutions to permit viewing of image files and patient records through a single sign-on.”

Here’s my summary of business lessons learned from the Steve Jobs biography. 

My Time Capsule editorial from October 2006:  Economics 101 and the Healthcare IT Market (that’s a pretty lofty premise to cover in 500 words). A Sam’s Club tiny paper cup-sized sample: “Hospitals can be convinced by questionable claims of product superiority or patient risk, and even more so by seeking vendors just as prestigious as they fancy themselves (no Walmart shopping for big academic medical centers, even though patients are the ones paying.)”

Note the reduced number of animated ads to your left thanks to those overachieving sponsors who have already traded out their animated ads in advance of the January 1 target date. I always feel bad when requiring changes like that, but it will benefit sponsors as well since readers will pay more attention to more subtle ads. I’ll digress by saying that while few things surprise me these days, one that does is the non-financial support I get from sponsors. Not all of them, since a few are purely ad placements without much personal connection, but the majority have executives and regular employees who keep in touch, send me music recommendations, e-mail me a well-timed attaboy right when I’m feeling overwhelmed or under-accomplished, or send off-the-record snarky comments about one thing or another. HIStalk is an after-work hobby for me rather than business and I like that the connections aren’t always business related.

Venture capital superstar and billionaire Peter Thiel, speaking at Practice Fusion’s conference (he’s an investor), says highly paid salespeople can land big businesses as customers and relentless marketing can get consumer sales, but companies that can sell to small businesses (like most medical practices) are rare since those small businesess are reluctant to change. He gave as examples QuickBooks and PayPal (implying Practice Fusion as well, naturally.) Also at the conference: Practice Fusion rolls out its iPad app, although I’m not clear if that’s a new native app or just the LogMeIn remote control version that was announced at HIMSS.

11-12-2011 5-03-52 PM

Doctors and hospitals in Boulder, Colorado are questioning whether joining Colorado’s statewide RHIO (CORHIO) is worth the subsidized cost. Small practices say the upfront training costs and $85 per doctor monthly fee are steep, and doctors at Boulder Medical Center says there’s not much value to them since they’re already connected via their NextGen systems. CORHIO’s five-year business plan called for taking in $26 million in federal grants and $19 million in subscriber fees.

11-12-2011 6-30-01 AM

Polls that list companies always bring out ballot box stuffers, but they’re fun nonetheless. Epic wins this one handily, with a fairly even spread among the losers. New poll to your right: how will ONC respond to the IOM’s report that criticized patient safety efforts related to electronic medical records?

We already know what HIMSS thinks of the IOM recommendations since Steve Lieber quickly released a statement. He zoomed right past all the patient safety concerns, preferring to focus on one sentence that says paper records are also risky, thereby summarizing the entire work as “a strong endorsement for the path healthcare is on.” Well, OK. He also is somewhat dismissive in saying IOM looked at only at the patient safety aspect of HIT and it’s already fussed about that before (which is exactly what you’d want IOM doing given that there are plenty of loud voices, especially that of HIMSS, extolling the virtues of technology for purely commercial reasons and ignoring IOM’s previous recommendations). A critic might say, “Who’s this association executive  with no credentials in medicine, research, or technology speaking on behalf of his unpolled membership to critique the work of a large group of unbiased and extremely well-credentialed IOM medical experts whose thoughtful opinions were commissioned by ONC?” but to question the authority (audacity) of HIMSS to weigh in on complex national matters is just not done. If you say anything even slightly negative about commercially sold healthcare IT, HIMSS is going to hit the PR airwaves, often cherry-picking a few HIMSS-friendly members to chime in for credibility support. Choose your side: an unbiased group of scientists vs. an exhibit hall-funded trade group. I like some (maybe even most) of what HIMSS does, but its predictable knee-jerk defense of the industry and federal grants just annoys the heck out of me as a dues-paying member, especially given that so many of us members pride ourselves in spotting and debunking shoddy research methods, investigator bias, and inconclusive evidence, all in the interest of improving patient outcomes and reducing healthcare costs just like IOM is trying to do.

Here’s Vince’s latest HIS-tory, highlighting Healthcare Information Systems. I’m cringing a little because he attacks someone at the end, to be named in the next installment. I don’t know who it is, but I’m hoping that person is (a) not a reader; (b) dead; or (c) one of Vince’s pals he’s just joking around with.

Thanks to the following sponsors (new and renewing) that supported HIStalk, HIStalk Practice, and HIStalk Mobile in April. Click a logo for more information.

11-12-2011 6-50-36 PM
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11-12-2011 6-57-10 PM

Epic hosted a college team programming competition in its offices this past Saturday. You wonder how many of the geeky combatants left with job offers, and also how the reporter kept a straight face in writing up details: “Winners and awards will be announced after the 4:30 p.m. conclusion of the competition, which will be held in the Nebula room in the Heaven building. Parking is available in the Yoda underground garage.”

Jackson Memorial Hospital takes part in a quickly assembled telemedicine project that will connect Miami specialists with hospitals in Iraq, part of a $1 billion contractor’s project as the State Department takes over field hospitals and medical care when US troops pull out December 31.

Weird News Andy wonders how many EMRs have edits that would prevent documenting this. In Mexico, a 10-year-old girl gives birth. You have to either admire or detest the creativity of the UK-based newspaper’s accompanying photo of a girl packing a toddler along in some kind of serape, clearly desperate for a visual, yet struggling with the lack of an Enquirer-like picture of a 10-year-old: the photo has nothing to do with the actual story and was “posed by models.” Its readers are apparently so stupid that reading text without even an irrelevant picture is unthinkable.

WNA also notes that health conditions are leaning toward the Third World in the Occupy Wall Street encampment. The unfocused unemployed there are coming down with a variety of respiratory infections as they sleep among their trash, pee in bottles without washing their hands, pass cigarettes and alcohol mouth to mouth, and refuse free flu shots because they’ve concluded that vaccines are a government conspiracy. They have a volunteer-staffed medical tent, but it only stocks herbal remedies.

ONC’s blog (which is actually written by its contracted PR company – it’s not like Farzad’s going to bare his innermost thoughts or music recommendations there) highlights the VA’s Blue Button initiative in honor of Veterans Day.

11-12-2011 7-30-48 AM

As Dr. Jayne mentioned, Walmart is denying that it plans to develop some kind of national primary care program, but they might want to check with their RFI people they’re clearly looking for partners to “rapidly create a comprehensive healthcare solution to deliver low-cost, high-quality primary healthcare services nationally.” The RFI lists specifically that partners should be able to offer chronic care services (diabetes, hypertension, etc.), lab tests, vaccinations, physical exams, health screenings, and durable medical equipment support. They say they will consider vendors who offer only “enabling technologies” as well, and the RFI requires prospective vendors to describe their proposed information system and “data sharing model.”

Ed Marx updated his most recent post to respond to reader comments. He’s always gracious, even to his anonymous attackers. And here’s the secret I shared with Ed: I don’t usually delete negative comments because I’d rather let readers provide the majority opinion via their own responses.

Speaking of Ed’s pieces, a few folks howl if I dare run anything that’s not directly related to their jobs, but many (most, maybe, especially at the senior levels) enjoy a mental break with personal stories about patients, working in HIT, or life’s lessons learned. Yours are welcome.

11-12-2011 9-25-20 AM

An Investor’s Business Daily article notes that its medical software sector dropped from #2 a month ago to #67, mostly due to the huge drop in CPSI’s share price after it missed expectations. The article says Cerner beat estimates but profit margins slipped in the most recent quarter, while Quality Systems shot itself in the foot in its earnings conference call by implying (but later clarifying) that most of its new sales were coming from replacements, suggesting that the market was past its peak. Athenahealth is mentioned for beating expectations but not by enough (double expectations?) and took a 7% share price drop as a result. On the positive side, shares in MedAssets jumped 14% and later 17% after beating estimates and Allscripts share price took a slight turn north after reporting results. Above is a one-year price chart of the shares of all those companies: Allscripts (blue), Cerner (red), Quality Systems (dark green), athenahealth (yellow), MedAssets (brown), and CPSI (light green). Leading the pack are Cerner and athenahealth. Looking at just the past three months, the clear winner is Allscripts, with MedAssets and Cerner basically tied for #2 but pretty far off the pace. Looking back five years, your best return would have been Cerner and Quality Systems. Always amusing is that ever-vigilant stock analysts flip-flop their recommendations a day or two after unusually good or bad news is announced, providing no benefit whatsoever for the clients paying them for non-retrospective advice.

I’m beginning to be annoyed by research companies selling expensive reports under the headline, “XX Market to Reach $X.XX Billion by XX.” One of these days I’m going to check the accuracy of their past predictions, which I suspect is minimal. Inga loves to run those press releases like they’re real news, along with the splashy results of questionably conducted surveys that are favorable to the companies paying to have them done. She’s usually good natured about my edict that she’s allowed only one survey mention per post.

Inga notes that Sage’s new name, Vitera, is also a band’s name. She and I don’t usually like the same music, but they’re good for an unsigned band, a Latin-style pop with a harder guitar edge, like a Spanglish Guns N’ Roses. Check out this live video and the flying V fiddle, which sounds to me like prog rock meets Texas swing. 

11-12-2011 10-25-16 AM

A Jacksonville, FL woman starts a booming business that provides scribes to do patient care documentation for ED physicians. The scribes, often pre-med or nursing students, are contractors billed out at $20-25 an hour, a bargain according to the company’s medical director. “For every hour we spend, we get about 15 minutes at the bedside of patients and 45 minutes of every hour documenting everything … part of it’s insurance. Part of it’s medical-legal. Part of it is a federal mandate to have everything documented electronically.”

Startup accelerator Rock Health signs on UnitedHealth Group as a sponsor. It joins Microsoft, Nike, Qualcomm, and Quest.

Outsourcer and iSoft acquirer CSC reports Q2 numbers: revenue up 1%, EPS –$18.56 vs. $1.19, cutting guidance. The ugliness was caused by a massive $2.69 billion write-down of goodwill and a settlement of a contract dispute with the US government. Shares predictably tanked.

Two nurses file a class action lawsuit against Aurora Medical Center (CO) after being written up for trying to clock in before putting on their hospital-provided scrubs. They say they should be paid for the time it takes to go to the scrubs room, find some that fit, put them on, then go clock in.

History Mingles with Innovation in Atlanta
By Erin Sweeney, Director of Marketing
The Friedman Marketing Group

The “who’s who” on the Atlanta healthcare scene met at the historic Fox Theatre this week to discuss innovation and opportunity—along with military weaponry. The HealthIT Leadership Summit, founded by the Technology Association of Georgia, Metro Atlanta Chamber, and Georgia Department of Economic Development drew nearly 200 attendees and such notables as Drs. Robert Kolodner, Mark Dente from GE, and Kenneth Wilson, a U.S. Army Major who served three tours in the Middle East.

Key takeaways from the eyes of this healthcare marketing guru include:

  • There is a whole new generation of healthcare IT experts ready to lead the charge.
  • Analytics are a key capability for all healthcare IT systems.
  • There are some really cool virtual reality glasses being tested in Afghanistan to help military medics and other first responders save lives—may come stateside soon.
  • Vendors that enable ACOs through harmonization of multiple systems will be winners.
  • Vendors that are behind can easily get ahead using new technology.
  • Cloud computing is here to stay, on-premise is antiquated.
  • Patients will spur providers to innovate.
  • Boards will be more involved in quality improvement.
  • Interoperability must happen between states.
  • Average venture capitalist investment in healthcare IT is $3 – $5M.
  • VCs are more interested in companies where technology is driving a service; and the two are not treated separately.

Amidst all the innovation, attendees did hear one reality check offered up by a panelist and based on research from Cigna Health: the average patient has 200 documents located in 19 different places.

And finally, Justin Barnes from Greenway Medical painted a gloomy picture for physician reimbursement and suggested groups ask themselves, “Do we interoperate or join an ACO?” Another panelist encouraged groups to look around and decide who they’ll affiliate with instead of waiting until the best dance partners are taken.

Overall, the Summit was interesting and a bit eye-opening. The TAG speakers and panelists added some fun and humor to the discussions. Dr. Dente pointed out that women are caregivers for not only their own elderly parents, but also their in-laws. Doctors’ appointments, prescriptions, transportation to and from check-ups — the women do it all. Looks like the upcoming holiday gatherings will be a walk in the park compared to what’s in store for this gal.

E-mail Mr. H.

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November 12, 2011 News 9 Comments

An HIT Moment with … Stuart Long, President, Capsule Tech, Inc.

November 11, 2011 Interviews 2 Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Stuart Long is president of Capsule Tech, Inc. of Andover, MA.


What’s new in the world of medical device connectivity?

I think the biggest change is that more and more hospitals understand the need for device integration and have moved on to the realization that clinical workflow improvement is a significant factor. This means that when hospitals are evaluating connectivity, that they are not only looking at the technical components, but are really investigating whether the solution fits the way the nurse works. They realize that doing so not only ensures successful adoption, but ensures that the benefits of device integration are
truly realized. 

We’re seeing actual data from our customers indicating their clinical staff gains as much as one-fourth of their time back to bedside caring of their patients. This is significant. I also think this is why you see the role of CMIOs and CNIOs increasing in the industry — understanding the importance that IT plays in the evolution of improved clinical care. They are leading the way at bridging the gap between IT and clinical and ensuring that the technology not only fits technically, but clinically as well.

Why is vendor-neutral device connectivity important?

There are hundreds of devices throughout a hospital. There are dozens of receiving systems that want data from those devices. Without a vendor-neutral solution, hospitals end up with vendor-dependent solutions that only solve connectivity for one device or one system and can significantly drive up the cost of deployment, management, and upkeep. The result of this type of connectivity is multiple points of integration that are nearly impossible for the hospital to manage and that offer no flexibility to add,
change, or upgrade their devices or IT systems. As connectivity evolves, there will be even more points of integration to manage.

Vendor-neutral connectivity is the optimal way for a hospital to ensure that their architecture is as clean as possible, that it minimizes points of integration for easier management, that it helps manage costs, and that it offers the flexibility and scalability to allow hospitals to add and change devices or IT systems as needed.

However, we consider this basic vendor neutral connectivity. Customers want to connect more devices, but they also want a visual status display at the bedside. They want a solution that allows them to validate and send vitals from the bedside in lower acuity areas such as med-surg. They want to expand their solution to do more advanced connectivity, such as reporting and analytics, that could result from the collection and comparison of all collected data. 

Many of our customers understand the burden of managing many third-party applications on a PC not originally intended for this type of use. They tell us with FDA being a priority, “We want you to own it cradle to grave.” This way there’s no ambiguity as to who owns what. The point of demarcation between what is our responsibility and what is the customers is crystal clear.

Our product is a medical grade platform that delivers basic connectivity and enables connectivity across the hospital, fits into workflows, is dedicated to connectivity management, and is field-upgradeable. Customers can realize the benefits of improved patient care, workflow efficiency, and patient safety today and grow without having to overhaul their solution to add features and applications later.

Are we at a point where our ability to collect medical device data exceeds our ability to do anything useful with it?

There is always a need to automate the basic charting process. Manual vital sign collection and charting is simply a waste of nursing time. Even if the only goal for a hospital is to implement the basic connection of devices to systems to automate this charting process and improve patient care at the bedside, this in and of itself justifies the implementation.

However, I think the industry is in the early stages of the next big growth cycle for device connectivity. Clearly the connection to the EMR is still the biggest driver for connectivity today, but there are many applications that have been emerging over the past few years that require not only the discrete device parameters, but also the alarms and waveforms from devices. Some of the emerging drivers are decision support, remote surveillance and monitoring, mobile devices, alarm management, and device-to-device

There are definitely many current and future uses for all this device data. The challenges are in being able to process, format, and ultimately serve up the data to these applications. We are experts at doing this. Providers also need and want to get more useful data to help improve decision making. In fact, there is already much progress on the BI and analytics aspect of healthcare.

Do you have examples of providers that have demonstrably improved patient outcomes by using medical device data integration?

Yes. The key benefits of medical device connectivity are improved workflow efficiency and patient safety. Our customers have documented amazing progress in this area and reported improvements in the amount of time vital signs are now available in the patient’s record.

One customer nearly eliminated the delay of vital signs to the patient record, going from six hours to just seconds. Another customer recognized an annual savings of $265k in reduced waste previously caused by vital sign delays. Another reported a 23% reduction in documentation time post medical device connectivity. Ultimately, this translates to more time in direct care activities and supports improved patient care and satisfaction. This leads us to the results of one customer that reported a 61% Gallup improvement in their nursing satisfaction pertaining to their job.

Patient safety is positively impacted by medical device connectivity as well. Charting errors are reduced and patient data errors are avoided. Accurate vital signs are available in the EMR and accessible to physicians and clinicians, which improves patient care coordination. One of our customers is linking near real-time vital signs with their early warning system and using it as patient surveillance to track deterioration of the patient status and the need for rapid response intervention. They are also using the benefits of device connectivity to monitor the potential for sepsis in lower acuity environments.

Exact metrics on errors and omissions are hard to come by since hospitals are sensitive to report this information. However, we are seeing our high reliability customers more willing to study this metric so they can continuously improve and initiate actions to create a safer environment for all their patients.

What changes do you predict over the next few years that will affect your products?

The largest changes will be related to improvements in clinical workflow and the use of data. This includes the collection and management of alarms and waveforms and the ability to integrate smart pumps. Closely related to all of this is the industry shift from collecting data based on the patient’s location to a workflow, whereby the data is directly linked to a confirmed patient ID.  All of these areas are huge challenges for hospitals. 

We have been working with our customers and our device and information system partners to solve these needs. There are a lot of technical details to sort through to make it happen and a lot of testing that needs to be done end to end. But that work has
started and connectivity will, in my opinion, be rapidly changing in the years to come.

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November 11, 2011 Interviews 2 Comments

News 11/9/11

November 8, 2011 News 15 Comments

Top News

mrh_small A remarkably frank Institute of Medicine report commissioned by ONC, Health IT and Patient Safety: Building Safer Systems for Better Care, urges significant government intervention with regard to the safety of healthcare IT systems. It takes shots at both HIT vendors and HITECH incentives, saying in the preface,

Stories of patient injuries and deaths associated with health information technologies (health IT) frequently appear in the news, juxtaposed with stories of how health professionals are being provided monetary incentives to adopt the very products that may be causing harm.

On the committee were researchers, academics, and practicing physicians. Vendors were not represented, although John Glaser of Siemens was a reviewer. These are the most interesting points from my quick read of the report.

  • The report recommends that ONC require all health IT vendors to publicly register their products with ONC, starting with certified EHRs.
  • It urges HHS to eliminate non-disclosure and limited liability clauses in vendor contracts that discourage users from sharing patient safety-related software concerns.
  • It suggests that reviews of software applications be published publicly.
  • It recommends that HHS form a council to develop criteria for the safe use of information technology.
  • It urges HHS to require software vendors to report IT-related patient safety harm or concerns to a central organization and also encourage users to voluntarily report to that organization as well.
  • Software-related problem reports would be reviewed by a new group that would be the HIT equivalent of the National Transportation Safety Board. The report says FDA is not up the task since it’s an oversight body, AHRQ is too research-focused, CMS is mostly good at threatening the income streams of providers, ONC doesn’t have the expertise, and Joint Commission and related organizations are so dependent on income from special interests that they can’t be objective.
  • It observes that “poor user interface design, poor workflow, and complex data interfaces are threats to patient safety” and “lack of system interoperability is a barrier to improving clinical decisions and patient safety” once you get beyond lab-related terminologies such as LOINC. Overall, it is quite critical of system usability and observes that vendors don’t have much incentive to make their products interoperable with those of their competitors.
  • The report says that the industry has done a poor job of regulating itself with regard to patient safety and suggests turning the whole thing over to the FDA to regulate if the foot-dragging continues: “These and other recommendations would comprise the first stage for action, greatly advancing current understanding of the threats to patient safety. However, because the private sector has not taken substantive action on its own, the committee further recommends that HHS monitor and publicly report on the progress of health IT safety annually, beginning in 2012. If progress is not sufficient, HHS should direct the Food and Drug Administration (FDA) to exercise its authority to regulate health IT.”

Reader Comments

mrh_small From Pachelbel: “Re: Vince’s article on Epic. Cache’ is not proprietary to Epic as it is owned by InterSystems. It can be an extremely fast database if implemented properly. Ask QuadraMed or any of the hundreds of other HIS vendors that use it. I suspect your gripe is with the way Cache’ was implemented. No database works well if the data structure or queries are malformed. Full disclosure: I’m a Cache programmer who has seen the good, bad, and plenty of ugly implementations of Cache’.” Cache’ is one of few technologies developed for healthcare that was adopted by the financial industry for mission-critical applications, with organizations such as Credit Suisse, Ameritrade, and a couple of stock exchanges using it.

mrh_small From SouperDooper: “Re: Vince’s article on Epic. I agree with the points made about the Epic way, rookie staff, and high costs. But to say that GE and McKesson have equal functionality is beyond ridiculous.”

mrh_small From Astrid: “Re: Vince’s article on Epic. This feels like ‘nobody ever got fired for buying IBM.’ I know a hospital where the VP had Epic where he came from and wanted Epic there, so it was a total rip-and-replace without a business analysis or needs analysis. I understand that a strict implementation keeps clients from shooting themselves in the foot, but that usually speaks to their lack of business sense, discipline, and management ability. Having an implementation guided by people without healthcare experience and knowledge seems to guarantee rework later.”

mrh_small From Lorenzo’s Oil: “Re: Catholic Healthcare West. Hear they’ve scrapped their dual Cerner/Meditech strategy and are moving forward with Cerner system-wide after Meditech problems, with Cerner picking up about 20 sites once they’re done. I also heard Epic tried to jump into the fray, but CHW didn’t like the exorbitant price tag.” Unverified.

mrh_small From Unbiased Consulting Firm: “Re: Epic. They clearly have a huge lead in implementations over the last 24 months, but the talent pool is not available to support those implementations, nor does the application support this market advance. Meditech, Cerner, and Allscripts … there is much to do with marketing and creating awareness. If you purchase Epic, you need to be able to support and implement it successfully. Each of these applications are market leaders – do not be taken by the media. Make your choice, but consider all the factors.”

Acquisitions, Funding, Business, and Stock

11-8-2011 3-20-04 PM

Grant Thornton, LLP acquires Computer Technology Health Associates’ Health Solutions division, including five military healthcare contracts and the staff supporting them.

11-8-2011 3-21-10 PM

HMS Holdings Corp. announces plans to buy RAC contractor HealthDataInsights for about $400 million. HMS expects HDI to contribute $85 million in revenue next year.

Days after the SEC releases new guidance on the matter, HCA revises its accounting for the recognition of income from HITECH incentive payments. Last week the SEC indicated that the “gain contingency” accounting model was the appropriate income recognition model for payments. Under this model, HCA will “recognize HITECH income when its hospitals have demonstrated MU and the cost report information for the full cost report year that will determine the final calculation of the HITECH payment that is available.” HCA expects to recognize HITECH income of $100 million to $130 million in Q4 and $190 million to $220 million for the full year.

San Diego-based Perminova, which offers SaaS-based applications for managing cardiac electrophysiologic labs and cardiovascular surgery, gets $7 million in venture funding. Its software is used by UC Sand Diego and Mount Sinai in New York.


11-8-2011 3-22-46 PM

UC Health (OH) selects Ciena Corporation’s 4200 Advanced Services Platform to provide network connectivity across four hospital buildings and its data center facilities.

11-8-2011 3-26-17 PM

Iowa Health System chooses Jardogs’ FollowMy Health Universal Health Record to provide online access to its patients.

11-8-2011 3-27-49 PM

Conway Medical Center (SC) purchases PatientKeeper’s clinical suite of applications to automate physician workflow and drive physician adoption of HIT.

Kindred Healthcare signs for practice management and revenue cycle tools and services from MED3OOO.


11-8-2011 6-13-17 PM

IT service provider Systems Made Simple hires Viet Nguyen, MD as CMIO to advance technology initiatives to improve continuity of care and enhance patient safety. He was previously with KForce eGovernment Solutions and the VA Office of Information.

11-8-2011 6-14-46 PM

Optum’s Accountable Care Solutions team, led by Todd Cozzens, now includes over 700 cross-functional team members focused on aligning hospitals, physicians, and health plans for integrated care models.

11-8-2011 8-35-09 PM

Fast Company profiles Zynx Health Chief Nursing Officer Pat Button EdD, RN.

Announcements and Implementations

11-8-2011 9-33-01 PM

Cedars-Sinai Medical Center (CA) launches Voalte’s point-of-care communication solution following a year of research and testing.

11-8-2011 9-46-31 PM

Platte Valley Medical Center (CO) goes live on eCareNet, powered by Soarian Clinicals.

11-8-2011 9-48-20 PM

Rochester General Hospital (NY) and seven affiliated practices go live on Epic. They will spend $65 million over the next two years to convert the entire health system, which includes two hospitals and 40 practices.

11-8-2011 8-25-55 PM

Kronos announces its InTouch time clock that features a color touch screen, gives employees access to their accrual balances and schedules, and supports off-peak use of apps such as employee surveys or streaming of informational videos.


Panasonic expands its Toughbook line of ruggedized laptops, popular in hospitals, to the Android-powered Toughpad, initially available in 2012 in a 10-inch form factor ($1,299) with a 7-inch version to follow.


CCHIT announces that AOD Software’s Answers EHR and HealthMEDX Vision are the first EHRs to earn its Long Term and Post Acute Care certification.

Home health agencies, by the way, will see a 2.3% decline in Medicare payments next year under a newly released regulation. Opponents claim the cuts will leave half of Medicare home-health agencies operating in the red in 2012.

Community hospitals are progressing with their EMR implementations, with 69% saying they have acquired the technology and 39% of those reporting that their EHR project will cost over $8 million. The same report finds that almost all community hospitals have begun the conversion to ICD-10, though only a quarter are currently undergoing remediation. Forty-three percent of the hospitals say they are participating in HIEs.

11-8-2011 3-28-54 PM

The local paper provides an update on Cape Code Healthcare’s (MA) $20 million HIT investment, which includes a replacement of Meditech Magic with Siemens Soarian. Mr. H. interviewed Cape Cod VP/CIO Sheryl Crowley last year.

11-8-2011 9-34-34 PM

The HIMSS EHR Association announces its support of iHealth Alliance’s EHRevent, an online system for reporting adverse events. It’s part of the PDR Network, whose CEO Edward Fotsch MD was interviewed on HIStalk a year ago.

Eighty-three percent of clinical informaticists participating in a Billian’s HealthDATA survey report an improvement in quality outcomes from using EMRs.

CMIOs, CNOs, and senior nursing executives believe their roles and responsibilities will continue to evolve as new technologies are developed, according to a research report by Capsule. CMIOs indicate their most basic job function is to bridge the gap between clinical needs and IT, while CNOs and senior nursing execs see their roles evolving to be more inclusive of departments outside of nursing.

11-8-2011 2-45-44 PM

The EHR/HIE Interoperability Workgroup issues technical specifications to standardize connections between providers, HIEs, and other data-sharing partners.

Rival health systems HealthPartners and Allina Hospitals and Clinics (MN) claim their collaboration allowed them to shave $6 million in medical costs for patients across two counties. The organizations are participating in a seven-year “learning lab” that involves the pooling of resources, sharing of EMRs, and mining of insurance claims data for about 26,700 people with private insurance.

11-8-2011 6-32-02 PM

Kevin Lasser, CEO of JEMS Technology, compares Ford’s smart phone app for owners of the Focus Electric to his company’s own telemedicine app in My Ford Magazine, distributed to 4.7 million recipients.

mrh_small I featured Aventura in one of my Innovation Showcases and at least two readers have told me they’ve gone to work for the company. CEO Howard Diamond writes a post for Boulder Startups urging entrepreneurs to jump into healthcare IT: “The software and other tools that are supposed to be building efficiencies, reducing errors, and building collaboration and trust across caregivers are actually having the opposite effect; they are creating barriers to efficient quality care.” I like the list of information sources he provides for those interested in the healthcare revolution: Clayton Christensen (the Harvard professor who wrote The Innovator’s Dilemma), Regina Herzlinger (the Harvard professor who wrote Who Killed Health Care?), HIMSS (which needs no introduction), and HIStalk (the non-Harvard, non-professor known mostly for goofy music recommendations and HIT rumor-mongering.) Howard’s just being nice since I profiled his company.

mrh_small I bet the Harvard people have more time after their day jobs to pursue their side ventures than I do, though. Mrs. HIStalk keenly observed this weekend that “whatever it is you do upstairs all the time won’t get done when you kick the bucket.” That’s the extent of her knowledge about HIStalk.

New York’s state controller nixes a proposed $22 million deal with Allscripts that would have created a call center for SUNY Downstate Medical Center. Allscripts had reserved the right to send work offshore, raising confidentiality concerns.

Practice Fusion is named top EMR for ePrescribing and helping practices achieve Meaningful Use by Brown-Wilson’s Black Book Rankings.

mrh_small I’m not an attorney, but this ruling by Colorado’s Supreme Court seems to uphold a previous verdict that a man suing Kaiser for malpractice can’t claim physician-patient privilege in denying Kaiser’s lawyers access to his electronic medical records. He had a heart attack while taking a treadmill stress test and is suing Kaiser and one of its doctors, but didn’t want the defense to be able to study his medical records. A footnote in the ruling sounds like a HealthConnect (Epic) commercial: “Kaiser’s integrated electronic medical record is instantaneously accessible by any and all Kaiser healthcare providers and is a hallmark of the services Kaiser provides.”

11-8-2011 8-43-01 PM

mrh_small Next month’s mHealth Summit has added as keynote speakers Surgeon General Regina Benjamin MD and HHS Secretary Kathleen Sebelius. HIStalk (in the form of HIStalk Mobile) is a media partner, so our own Travis Good, MD will be providing daily reports. He’s outstanding at understanding and explaining the business of mHealth, so he’ll provide both health and business perspectives. It’s December 5-7 at the Gaylord National Resort and Convention Center in the DC area. Full registration is $525, or $195 for federal government employees. I had a pretty good time there last year and the venue looks much better than last time, although I’d miss the proximity to the National Mall and all the fun sites and restaurants nearby.

Sponsor Updates

  • Mike Marvin of CareTech Solutions and Kara Wingerter of Blessing Health Systems (IL)  will present a case study on increasing revenue with online pre-orders and sales at this week’s Greystone.net Healthcare Internet Conference.
  • OptumInsight launches additional capabilities for its Netwerkes EDI service, including integration with Epic PM Systems claim administration and clinical information workflows.
  • GetWellNetwork appoints Wellford Dillard as CFO.
  • Facilities of Vitalité Health Network (Canada) will go live next week with a pharmacy medication order management system connected to its Meditech system and powered by Perceptive Software’s ImageNow enterprise content management system.
  • ICA releases a white paper entitled All Health Information Exchanges Are Not Created Equal.
  • Mac McMillan, CEO of CynergisTek and chair of the HIMSS Privacy and Security Policy Task Force, will serve a panelist for Clearwater Compliance’s HIPAA-HITECH Blue Ribbon Panel webinar How to Prepare for HIPAA Audits.
  • Tee Green, president and CEO of Greenway Medical, will host a November 15 webinar on future trends in healthcare.
  • Beacon Partners receives Epic’s “Community Connect” certification.
  • McKesson launches RelayHealth in Canada at the HealthAchieve 2011 Conference.
  • University Medical Center of Princeton at Plainsboro (NJ) selects ProVation MD for its GI department’s documentation and coding.
  • DST Health Solutions LLC announces an agreement with 3M Health Information Systems to integrate 3M’s ICD-10 Code Translation Tool with DST solutions.


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

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November 8, 2011 News 15 Comments

Monday Morning Update 11/7/11

November 5, 2011 News 5 Comments

From The PACS Designer: “Re: iPad. A new, free iPad application called Line2 HD turns your iPad into a phone. This extended feature could increase the penetration of iPads into healthcare environments.” It’s very cool, but it should be noted that while the app is free and so is the service for a seven-day trial, the ongoing cost is $10-15 per month depending on the options chosen. That gets you a new or transferred number, voice mail, and conference calling, all over Wi-Fi or cell. A cool feature: if you’re not connected, it will forward incoming calls to up to six other numbers. This CNET review is positive.

11-5-2011 10-43-48 AM

From Lobstah: “Re: Meditech. New executives.” Meditech promotes Chris Anschuetz to SVP of technology and Scott Radner to VP of advanced technology. They’ve been with the company for 36 and 21 years, respectively. 

From Ralph Hinckley: “Re: NextGen. Drops MEDSEEK as a white-label enterprise portal, developing its own.” Unverified. Ralph sent over an e-mail saying that NextGen will release its own enterprise patient portal in 2012, integrated with its HIE platform and physician portal. The companies signed their agreement just three months ago.

Speaking of Meditech, the company releases its Q3 report. Revenue was up 19% to $141 million, EPS was unchanged with profit of $32 million for the quarter.

My Time Capsule editorial this week, gasping for air after being entombed journalistically for five years: Leapfrog’s Leap into Irrelevance. I looked back to Leapfrog Group’s founding: “Predictions were dire back then in the post dot-bomb nuclear winter. Hospitals would be wildly overbedded. Savvy baby boomers, emboldened by buying books and dog food online, would be calling the shots, making shrewd healthcare decisions and choosing providers based on stringent quality measures that would be plastered all over the Web. Unfocused, change-resistant hospitals, which included all the ones I’d ever worked for or heard of, would be road kill. ”

Listening: Frosting on the Beater, a 1993 album by The Posies, alt power pop from Washington with a big, radio-friendly guitar sound. You either found it a guilty pleasure on VH1 or missed it entirely.

11-5-2011 7-39-30 AM

Welcome to new HIStalk Platinum Sponsor Henry Elliott & Company of Wellesley, MA. The company operates in a fascinating, high-demand niche: providing certified experts in InterSystems Cache’, M/MUMPS, and Ensemble for almost 20 years. The company offers experts in those technologies (contract, temporary, remote, and direct placement.) Or, if you are skilled in those areas and are feeling under-appreciated, review the plethora of opportunities in case you’re in the job-changing frame of mind and want to connect with a company that understands and values your highly specialized talents. If you need or have Cache’ or MUMPS expertise, Henry Elliott & Company would love to hear from you. Thanks to those folks for supporting HIStalk.

11-5-2011 9-59-52 AM

Also supporting HIStalk is Acusis, a new Gold Sponsor. Pittsburgh-based Acusis offers clinical documentation solutions in the form of outsourced medical transcription. Customers choose whether they would prefer US or global CMT-certified transcriptionists. Their Six Sigma-driven processes include a separate Quality Control editing step, and medical language specialists are paired with the customer’s dictating clinicians to give consistently high quality and fast turnaround time. The company’s team of 50 software engineers created dictation options that include telephone, VoIP, digital recorders, and smart phones, also supporting rules-based report distribution (network printing, fax, e-mail), multiple electronic signatures, and integration with just about every HIT system. Back-end speech recognition is offered, providing customers with a lower-cost solution for their more consistent clinicians. An iPhone-based, Dragon-integrated front end speech dictation option was announced a few weeks ago.Customer testimonials are here. Thanks to Acusis for supporting HIStalk.

11-5-2011 9-42-44 AM

It’s a 60-40 split that today’s healthcare software cannot or can, respectively, support needed improvements in cost and quality. New poll to your right: a quick read on which vendor is “doing things right” more than the others, which you can define however you like (quality, vision, business, etc.)

11-5-2011 10-22-45 AM

Financial performance solutions vendor MedAssets reports Q3 numbers: revenue up 50%, EPS –$0.02 vs. $0.14. Excluding integration costs from its Broadlane Group acquisition, earnings of $0.26 handily beat expectations of $0.16, sending shares flying on Friday to close up 16.7% as Nasdaq’s seventh biggest percentage gainer. I’m not much of a stock-picker and I own no shares in MDAS, but after a year of not-so-good performance (MDAS in blue, Nasdaq in green, and the Dow in red), it looks as though MDAS is moving up out of its trading range on increased volume, which is usually a good thing (duh). Market cap is $712 million.

Weird News Andy can’t decide whether this is a trick or a treat. A man walks into a hospital complaining of leg pain. Astute clinicians postulate that a potential etiology is the bullet lodged there from a Halloween shooting three days earlier. The patient said yes, he did recall that unfortunate eposide, but didn’t think it was a big deal.

11-5-2011 5-07-05 PM

New York-based Netsmart Technologies, run by former Cerner COO Mike Valentine, will relocate to Kansas City, creating 130 jobs with plans to hire up to 520 total employees. CEO Valentine never moved from Kansas City since he left Cerner in April 2011 and joined Netsmart in May 2011, so he gets to make all the employees move so he doesn’t have to (those handful willing to leave New York to go to Missouri, anyway, although the company will keep a New York office.) Netsmart sells solutions that include behavioral, public health, substance abuse, and social services.

Here’s Vince’s Part 2 HIS-tory of Computer Synergy.

Medicare’s pilot projects for commercially run disease management programs actually cost taxpayers more money and didn’t improve quality, a study finds. Five of the eight participating companies were losing so much money they paid an exit fee to drop out early. The conclusion is that just calling or visiting elderly patients occasionally doesn’t really accomplish much, and health coaches in such a program need to be given access to hospitals and practices and their patient information to coordinate care.

News I missed: Meditech co-founder and original president Mort Ruderman died October 12 at 75. A tribute video is here.

11-5-2011 2-31-36 PM

The DC RHIO is shut down when the city declines to continue funding it. The mayor apparently wants to take the federal grant money and start a new HIE.

11-5-2011 5-09-34 PM

The Louisiana Health Information Exchange launches after conducting pilots with Lafayette General Medical Center and Opelousas General Health System. They’re trying to recruit Ochsner, LSU, and Franciscan Ministries to sign up.  Orion Health is providing the technology. The HIE received $10.6 million in federal taxpayer dollars in March 2010.

11-5-2011 2-36-37 PM

UCLA Health System notifies 16,000 patients that their personal information was stored on a hard drive that was stolen in a burglary of the home of one of its doctors. The drive was encrypted, but the doctor had written the password on a slip of paper near the drive and that appears to have been taken as well.

Lawrence Memorial Hospital (KS) warns that patient billing and credit card information was exposed on the Internet for more than a month due to “failed security measures” by the Web host of the hospital’s online bill-pay vendor.

Blue Cross Blue Shield of Delaware offers to spend $30 million in charitable projects, including donating $1 million a year for the next five years to support the Delaware Health Information Network, in an attempt to convince regulators to allow it to merge with Pittsburgh-based insurer Highmark. The state’s attorney general says Delaware citizens have subsidized BCBS to the tune of $181 million and he wants at least $45 million set aside to benefit Delaware. 

Massachusetts plans to allow casinos to operate in the state, earmarking 23% of the hefty license fees involved, or around $50 million, toward encouraging the use of electronic medical records in hopes they will help control the state’s rising health costs.

E-mail Mr. H.

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November 5, 2011 News 5 Comments

HIStalk Innovator Showcase–Caristix

November 4, 2011 News No Comments

11-4-2011 6-17-05 PM

Company Name: Caristix
Address: 1400 St-Jean-Baptiste Avenue, Suite 204, Quebec City, QC G2E 5B7
Web Address: www.caristix.com
Telephone: 877.872.0027
Year Founded: 2009
FTEs: 5

Elevator Pitch

The Caristix HL7 software suite helps healthcare IT vendors and hospitals reduce interface deployment from months of work to a few days.

Business and Product Summary

Caristix develops software for healthcare IT analysts and developers. With a focus on HL7 and data mining, Caristix streamlines the delivery of interfaces that support the flow of data in healthcare. If we look at innovation in this space, we took a leap forward about 15-20 years ago with the introduction of interface engines. The next leap forward is going to come from automating the manual scoping and configuration work involved in interfacing, leaving integration analysts free to add value on other more complex data integration topics.

With our software offering, we help vendors and providers scope HL7 interface requirements more quickly before coding, test more thoroughly before go-live, and troubleshoot over the interface lifecycle. Benefits to vendors and providers include lower interfacing costs, faster time to value, and reduced process waste and risk. We provide annual licenses that include support and maintenance releases. We also offer services, such as creating interface specifications for our customers, and getting them started on documentation and interfacing best practices.

Target Customer

HIT software and service providers, hospitals and IDNs, and HIEs.

Customer Problem Solved

The biggest bottleneck in HL7 interfacing isn’t coding or setting up the interface. With modern interface engines, that’s easy. What’s hard is figuring out what to code. In other words, which data should you handle and what does each piece look like in the real world (not on paper in the spec)? Our software figures out what to code automatically.

The way the industry solves this problem today isn’t going to work for much longer, especially with volume of data enabled through Meaningful Use. Right now, folks are essentially using trial and error. In other words, you set up an interface based on a site survey form and a broad product spec, connect up to a test system to get some data coming in, see what’s broken, then fix it. Rinse and repeat. If you’re lucky, you’ll make your schedule. If you’re not, you might be six months out. If you decide to go live anyway, the vendor and/or the hospital’s IT team will be facing one heck of a support backlog, which in turn, can tank adoption rates.

Trial and error is increasingly problematic with today’s interfacing volumes. It’s certainly going to get tougher to sustain once Meaningful Use forces real data integration, with multiple sources of clinical data coming into and going out of the EHR and other information systems. We’re seeing early-adopter vendors and hospitals moving away from trial and error. We think we’ve hit a sweet spot with our software. We’ve come up with a way to not only get proactive on scoping, but also keep scoping documentation up to date for future integration projects.

11-4-2011 8-15-02 PM


Our competitors are niche tool vendors and a few of the interface engine vendors. However, that second category includes a little overlap: we also complement interface / integration engines and are working with two vendors in this space. But our biggest competitor is the status quo, folks just going along with business as usual.

Advantages Over Competitors

We integrate data mining so analysts can easily grasp their data and what it means. This can drive up interface quality while driving down project risk. The functionality we provide around HL7 data helps interface analysts to grasp sending and receiving system specifications easily. This enables analysts to identify gaps to be bridged by interfacing and integration early during a project. With complex interfacing and integration projects, project leaders can increase interface quality and confidence without jeopardizing timelines.

Fast Facts

  • KISS (Keep It Simple…) If our spouses let us, the founders would tattoo “KISS” on our respective foreheads. At Caristix, we really want to keep things simple for our customers.
  • We’re concentrating on HL7 for now. But keep an eye on us for other data standards over the next year.
  • We’re an experienced healthcare IT team and we have a shared work history. Some of us even go back 12 years, and our team brings over 50 years of combined experience, in both technical and business areas in healthcare IT.
  • The company has a product management focus. In other words, our products reflect market and user needs and where we think the market is going. As a startup, the last thing we’re interested in is the tech fantasy of “build it and they will come.”
  • Here is a customer quote: “This is the only tool that provides me with the filter functionality needed to successfully dissect thousands of transactions and find all of the deltas, without jeopardizing timelines.”

Pitch Video Created Specifically for this Showcase

Customer Interview (a system analyst for a large healthcare IT software vendor)

What problems have you solved using Caristix products and what impact has that had on your organization?

We are seeking ways to continuously improve our customer enablement process for our product. An activity in that process is understanding the customer environment. The Caristix Conformance product assist the SME knowledge of their environment and not to rely on outdated documentation and assumptions. Conformance gives us (and the customers) a great visual of their environment.

With this improved visibility, we reduced the rationalization logistic interactions – a lengthy Q/A process (i.e. what systems are involved in the project?  what data comes from that system? <<…implementation period…>> Are you sure? Well, we’re seeing this type of data and it does not agree with the initial statements. Are there any more surprises? etc.). This form of interaction occurs over weeks or months and creates much re-work as information becomes known. Knowing upfront the true reality not only mitigates loss time (and financial expenditures), but also improves customer satisfaction and overall product experience.

Caristix also has other products which we review:

  • Cloak, which de-identifies data – another great product in the making. One colleague commented, “… this is the simplest interface I’ve ever used…”
  • Pinpoint, which enables what I call “finding a needle in a haystack” simple. Pinpoint cut so much time out finding what’s occurring within the data flow, it’s amazing! One colleague said, “…I wish I had this product when dealing with customer ABC — it would have saved me days of work.”
  • Although we have not looked at their other products, based on the ones we did, I’m confident they pointedly address the intended concerns.

What alternatives or competing products did you consider and why did you choose Caristix?

We searched for products that address our specific concerns, but didn’t find any. Also, as we began to use the product, the company was open to our product improvement suggestions. And the most amazing thing occurred — they not only implemented the suggestions, but also saw the general benefits to other users as well. Their turnaround time to implement was truly Agile. We saw results in weeks, not months or worst, year(s). As Conformance continues to mature with new features, plus the incorporation of the suggestions, I foresee retiring some of our legacy tools.

How would you complete this sentence if speaking to a peer? "I would recommend that you take a look at Caristix under these circumstances:"

If you are looking for a company who really wants to work with you to solve the problems that their product set addresses, then certainly call Caristix. They truly try to understand the customer use cases, see how (and which product(s)) can meet those needs. And on the rare occasion when their isn’t a “match,” they are upfront to let you know, but still try to see if it’s possible within their reach.

Their response is impeccable, from showing you mock-up to real running code. They are willing to see how your suggestion can make their product better. The proof is when you see the implemented result! Now that’s amazing! Their Say:Do ratio is on par.

They have a good idea where the market is progressing and are making plans to be there as you review their product roadmap. I believe they are flexible enough to make the necessary course corrections as they occur.

An Interview with Stéphane Vigot, President, Caristix

11-4-2011 6-35-22 PM

HL7 interfacing sounds simple, at least on paper. Why do organizations need your products?

HL7 is called a standard, but it’s more of a framework. It’s extremely flexible. You’ve got some guidance regarding the way you could organize the data, but each and every hospital adapts the organization of the data to its clinical workflows.

For example, if you consider the admit status sex of a patient, you can have up to six different possibilities. There are very, very few systems that would use those six possibilities. Most of them will use three or four, and even when they pick only three or four, let’s say for a male and a female, one could say, “OK, a male is designated as an M and a female as an F,” or another will say, “In my organization, we’d rather use an 1 and a 2.” That’s a real example.

For any kind of field, you’ve got a type of flexibility. Even though two hospitals are using the very same ADT system, let’s say –  admission, discharge and transfer — and they use the very same vendor, the very same version of the system, the data will most likely be organized in a different way.

Thanks to our technology, instead of having an interface analyst looking and reading, literally, HL7 messages, we get the feed from the system that you have to connect. In a matter of a few minutes, we do some reverse engineering on the metadata and then we issue a document that will very precisely tell you how the data is organized within a system.

11-4-2011 8-13-17 PM

With interfaces, you often just play back a bunch of messages and try to figure out all the exceptions and rules, with an application expert on one side an an interface expert on the other. How would a hospital use your product to create their own interoperability?

They would get the software platform that we have. They would get HL7 logs, so basically several HL7 messages, and they can deal with tens of thousands of different messages. They would put that file into our platform, and then automatically the platform will do a reverse engineering process. It will read the data and issue a Word document that will tell you precisely how the data is organized.

Then the technician, either from their vendor side or from the hospital side, will know exactly how to configure the interface engine. They will know exactly what data is what and how it is organized — the length of the field and everything. That’s basically it. It’s a very straightforward application that saves hours and sometimes days or weeks of work for an interface analyst. We’ve got a customer testimonial where a task that usually took up to eight hours is done in three minutes, thanks to our platform.

Does the typical customer buy your product just for a specific interface problem they’re trying to solve, or is it in their tool chest of things that they end up using a lot?

They end up using it a lot, because an average hospital in the US will usually deal with more than 100 interfaces. Every single time there is an update to any of the systems they’re using, then the interface will need to be adapted to the update. We know hospitals that have up to five persons dedicated to managing the interfaces. That’s what they do all day long. That’s why our platform can be used on a daily basis.

11-4-2011 8-14-17 PM

How would a customer use your product to validate the integrity of an interface, either a new one or an existing one to make sure nothing has changed?

They will just get the logs, do  a reverse engineering on the new or existing system, and perform gap analysis between the current interface, or on the old interface if you will, and then the new interface that they want to build. There’s a built-in functionality within our platform that allows you to perform in a matter of a few minutes a gap analysis between two specifications.

You’re based in Canada. Do you see any particular challenges that you’ll face when working with the US?

It’s our target market. In fact, 80% of our customers are in the US. Historically, the team of Caristix worked for a major US vendor for a number of years. The genesis of Caristix was because of a reduction of forces — we had to let go several software developers that were working for that US vendor, so our expertise was really in the US.

Who is it you market to and how do you reach those people?

We market to two segments: hospital vendors and hospitals. We are currently working on a free application for hospitals that will allow the hospital’s IT teams to document the specification of the different systems, again, in a matter of a few minutes. 

We use a lot of white papers, we use a lot of reference, if you will. Since we’ve been working with US companies for years, we know a lot of them, so that’s how we reach out to them. We’re now getting more visibility and we’ve got some consultants — or I’d say gurus — in healthcare IT that are also talking a lot about us.

The nice thing about our platform is that once you see how it works, you automatically understand the benefits and you automatically understand the savings that as a vendor or even as a hospital you’re going to be able to make. I’d say it’s an easy sell. As soon as you talk to people who know and understand the complexity of HL7 Interfacing, it’s almost – and I hate to use this term – but it’s almost a walk in the park from a sales standpoint.

What do you hope to gain from the exposure on my site?

Any hospital is dealing with HL7. You’re extremely visible in the HIT world. I was at HIMSS this year – I’ve been attending for the past seven years – and a lot of people know Mr. HIStalk. You’ve got quite some followers there. I think that’s going to provide us a lot of visibility.

Most of the people who are dealing with HL7 interfacing will definitely take a look at our website. When they take a look, we’ve got a great response and they automatically understand what we do. The savings are very positive. That’s where we see a lot of potential, and thanks to your help, we see a lot of lead generation, thanks to the HIStalk blog. 

The feedback we’re getting from existing customers is that within their first interface project, the return on investment is immediate. You don’t have to be using our platform for months to get to see the benefits. It almost pays for itself with the first project.

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November 4, 2011 News No Comments

News 11/4/11

November 3, 2011 News 8 Comments

Top News

11-3-2011 9-40-44 PM

Citing the need for more time, ONC announces it will delay the launch of the permanent program for EHR certification until mid-2012. The timeframe coincides with the anticipated final rule of Stage 2 of Meaningful Use and standards and certification criteria. ONC says it can’t make the original January 1 deadline to approve testing labs and authorize certifying bodies.

Reader Comments

mrh_small From Viking: “Re: doctors, texting, and HIPAA. This video on how to make a ‘pager scanner’ shows how easy it is for anyone to listen in and breach via texting.” Though I was distracted by the painful-looking lip piercing on the geek chick, I need to get someone to build me one of those. Go to about the 2:45 mark to see her computer screen filling up with pager messages. It’s definitely a target-rich environment at my hospital, although I expect the messages are amazingly dull.

mrh_small From Megan: “Re: HIStalk page loading improvement. Thank you! I’m new to the industry and like to stay on top of news, but that one little fix made this site so much more reader-friendly.” I’m embarrassed that it was a relatively simple change once Dave Dillehunt suggested it. I wish I’d done it sooner. I find myself pulling up the page several times a day just because I like watching it snap to attention on my command. The beauty of it is that everything still displays, sponsor ads and all, but just in a slightly different order. 

mrh_small From AnotherDave: “Re: HIStalk page loading improvement. I second, third, and fourth the shout-out to Dave Dillehunt. Instant access to HIStalk: priceless.” This may well be Dave’s finest hour. I mean, sure, he’s a CIO and everything, but how many times do strangers publicly sing his praises?

11-3-2011 5-17-41 PM

mrh_small From NoSleepTillEpic: “Re: Kadlec Regional Medical Center. Live with Epic inpatient, ambulatory went in August, One of Epic’s smallest customers, a PlaneTree hospital with a reputation for doing technology right. JCAHO showed up the week before go-live!” Nice.

mrh_small From Anon: “Re: ONC budget. Is this something to be concerned about?” I don’t know the source of the attached material and I don’t understand all of it, but it says ONC’s 2011 budget was $61 million and the President requested $78 million for 2012. The Senate Budget Committee recommended holding the budget to $61 million, but supposedly (and this would be the big news, if true) that figure would also include ONC’s HITECH allocation, which was $57 million in 2010 and was scheduled to increase to $499 million and $874 million in 2011 and 2012, respectively. A House subcommittee has proposed only $28 million. If you know more about this, please share since it sounds important if it’s true.

mrh_small Unrelated, but while Googling the subject, I came up with ONC’s 2012 budget justification, which has key indicators that include the percentage of practices and hospitals using EMRs and receiving Meaningful Use payments. ONC requested 189 FTEs for 2012 with an average cost per FTE of $148,000.

HIStalk Announcements and Requests

11-3-2011 1-56-09 PM

inga_small This week on HIStalk Practice: Dr. Gregg enlightens readers on the behind-the-scenes coordination for AAP’s Pediatric Office of the Future. A reader comments on providers who seem overwhelmed by Meaningful Use-fueled EHR purchases and rushed implementations. MGMA calls on CMS to establish a 5010 contingency plan in case practices and their trading partners can’t meet the looming deadline. Physicians believe EHRs are safer than paper, but patients disagree. CMS advises providers to report on all clinical measures in their EHR, even if the data is incomplete – and thus meaningless. Shuffle on over to HIStalk Practice, get your ambulatory HIT fix, and sign-up for e-mail updates. Thanks for reading.

11-3-2011 5-35-00 PM

mrh_small Welcome to new HIStalk Gold Sponsor New York eHealth Collaborative. The not-for-profit, formed in 2006, strives to improve healthcare for New Yorkers through the use of healthcare IT. It helps develop policies and standards to help providers move to electronic health records and coordinates connecting providers statewide. It runs a Regional Extension Center and the Statewide Health Information Network (SHIN-NY). They’re presenting the NYeC Digital Health Conference 2011 December 1-2 at Pier Sixty on the Chelsea Waterfront in NYC, with keynotes by HHS CTO Todd Park and journalist T. R. Reid. Registration is $395 general and only $195 for practicing physicians and government employees. I’m running a text ad for them over to your right just in case you want to check it out later. I would loved to have gone, but it was just too hard to get time off from the hospital, which left Mrs. H deprived of the opportunity to enjoy New York near Christmastime. Thanks to New York eHealth Collaborative for supporting HIStalk.

mrh_small On the Jobs Board: Java Developer, Senior Interactive Graphic Designer, Cerner and Epic Resources. On Healthcare IT Jobs: Research Informatics Analyst II, III, IV, Lab Information Systems Analyst, Regional Sales Executive, Senior Pharmacy Analyst.

mrh_small Suggestions on how to spend your extra minutes of free time each day now that HIStalk loads faster: (a) seek Inga, Dr. Jayne, and me on Facebook and LinkedIn and consummate our electronic union by Liking, Friending, and Connecting; (b) sign up for spam-free e-mail updates on HIStalk, HIStalk Practice, and HIStalk Mobile; (c) send me scandalous rumors, squelched news, and anything that would interest readers like yourself by clicking the atrocious-looking green Rumor Report box to your right that sends your secure message and an optional attachment right to my inbox; (d) peruse the friendlier-loading sponsor ads to your left and click those that seem fun, or check out the Resource Center to browser and search, pausing to marvel that polished and powerful executives command their underlings to mail a check to a PO box to support an anonymous hospital guy’s amateurish blog; and (e) look yourself in the mirror while giving yourself a little nod and a Bill Clinton finger-pointing recognition gesture to acknowledge your role in reading and doing all of the above, which keeps the vivacious and erudite Inga and Dr. Jayne smiling.

Acquisitions, Funding, Business, and Stock

11-3-2011 10-08-34 PM

HealthGrades signs a definitive agreement to merge with CPM Marketing Group, a provider of customer relationship-management services for hospitals.

11-3-2011 10-10-53 PM

Mediware announces Q1 numbers: revenue up 24% to $15.5 million and profits up 42% to $1.49 million or $0.18/share.

11-3-2011 8-48-38 PM

Medical practice documentation management software vendor Updox gets a $500K loan from the state of Ohio to develop a mobile version of its product, to integrate with more EHR products, and to promote its free secure messaging service.

11-3-2011 10-11-43 PM

Advisory Board Co. reports Q2 net income of $5.2 million ($0.30/share) compared to $4.9 million ($0.30/share) last year. Revenues grew 30.7% to $92.9 million.

mrh_small Allscripts reports Q3 numbers: revenue up 13%, EPS $0.11 vs. $0.01, beating expectations. The company raised guidance on both revenue and earnings. The earnings call transcript is here. Interesting snips from it: (a) CEO Glen Tullman says the new January 1 readmission rule in which hospitals eat the cost of patients readmitted for the same condition within 30 days is driving interest in care management and discharge management applications; (b) he says Allscripts beat Cerner and Epic at Flagler Hospital (FL) because the hospital wanted to connect to a variety of EMRs used by community-based physicians (c) several new hospitals signed up for the EPSi performance management system, among them UC-Davis and Stanford; (d) Glen sees big opportunity from ICD-10 (“you’re going to have to replace every practice management and revenue cycle management system out there”) and analytics; (e) he says Sunrise Clinical Manager is used by “all the best names out there,” saying it’s “open” and “not outdated” and “what the market wants, what physicians want, is one comprehensive patient view, not one database, because they realize you can’t do that”; (f) their most frequent ambulatory competitors are Greenway and eClinicalWorks.

11-3-2011 6-14-43 PM

UPMC Health Plan and The Advisory Board Company form Evolent Health, which will offer the Identifi population and health management software developed by the health plan and used by UPMC to manage the health of its 54,000 employees. Each organization capitalized the venture with $10 million. Its first customer will be MedStar Health. Former Advisory Board CEO Frank Williams will serve as CEO of Evolent Health.

11-3-2011 10-12-25 PM

Merge Healthcare reports Q3 results: revenue up 33%, EPS –$.01 vs. –$0.06, missing consensus estimates by a penny.


Health Care Authority for Baptist Health selects MEDSEEK for clinician and patient engagement tools.

11-3-2011 10-13-41 PM

Lompoc Valley Medical Center (CA) will deploy Allscripts’ Sunrise Clinical Manager EHR and offer the Sunrise Clinician Portal to it physicians. Also, DMC Children’s Hospital of Michigan selects Allscripts EHR for its employed and affiliated physicians.

Houston Healthcare (GA) selects Wolters Kluwer Health’s ProVation Order Sets for Houston Medical Center and Perry Hospital.

11-3-2011 10-16-53 PM

Wake Forest Baptist Medical Center chooses RelayHealth’s RelayCare for readmission management.

Intermountain Healthcare signs a five-year agreement with Accretive Health to manage its revenue cycle. The organizations say they will create a Salt Lake City-based revenue cycle Center of Excellence that will provide best practices, technology, and education.

Harris Corporation wins a $4.5 million VA contract to develop Web-based mental health self-documentation tools for the MyHealtheVet personal health record.


11-3-2011 4-04-36 PM

Apixio names Darren Schulte MD as chief medical officer. He was previously with Anvita Health.

11-3-2011 4-07-05 PM

Availity promotes Russ Thomas from COO to CEO, succeeding Julie Klapstein, who will remain on the board of managers.

11-3-2011 2-17-58 PM

Recombinant Data Corp. hires Jason D. Oliveira as managing director of health system consulting.  He previously led the healthcare BI practice at Kurt Salmon Associates.

11-3-2011 5-10-36 PM

AMIA President and CEO Ted Shortliffe MD, PhD announces that he’ll be leaving the job he’s held since mid-2009 to pursue other interests. The board will initiate a search for his replacement, expected to be in place by early 2012.

11-3-2011 6-28-45 PM

Main Line Health (PA) promotes Karen Thomas to SVP/CIO. She was previously VP/CIO.

Announcements and Implementations

11-3-2011 4-08-31 PM

Physician practice marketing and communications company Medley Health partners with athenahealth to integrate its physician-patient communications platform with athenahealth’s suite of offerings.

Guam launches the first phase of its HIE with the deployment of secure messaging and clinical document exchange using the ApeniMED HIE platform.

The Wichita HIE signs up its first two physician practices.

11-3-2011 2-52-02 PM

New Hanover Medical Group (NC) goes live on Epic, the first step in a system-wide, $53 million upgrade. The local TV station covers its rollout of MyChart.

Inland Northwest Health Services (INHS) announces that 12 client hospitals have successfully attested for Meaningful Use.

Trustwave introduces its Web application security offerings, including an enhanced version of Trustwave WebDefend.

Three rural Adventist Health hospitals in California will share a $1 million Blue Shield of California grant to implement electronic medical records.

11-3-2011 9-23-16 PM

Healthcare IT services provider Anthelio will add 200 jobs in Detroit and Flint, MI to support its area customers, which include Detroit Medical Center and McLaren Health Care Group.

Innovation and Research

11-3-2011 5-28-22 PM

mrh_small Stanford’s Lucile Packard Children’s Hospital publishes a NEJM article describing its use of patient information from its electronic medical records system to choose drug therapy for a patient’s rare disease. The 13-year-old patient had lupus complications and was a candidate for anticoagulants, but cases are so rare that a literature search came up with nothing on the risk-benefit profile. Jennifer Frankovich MD (above) used a research tool to query de-identified EMR data and found the records of 98 patients over a five-year period who had similar conditions and determined that the risk of clots was high enough to justify starting anticoagulants right away. Their conclusion is that a physician probably couldn’t have figured it out otherwise since there were so few patients, recall is sometimes biased, and EMRs have so much information that it’s hard to pick out the important data elements. They also expect that aggregated patient information will be used during rounds to make treatment decisions in the not-too-distant future. I assume the EMR in question was Cerner, which Packard is supposedly having to give up despite publishing extensively about its patient safety benefits (parent Stanford Hospital uses Epic.)


11-3-2011 8-53-07 PM

Toyota announces that it will start selling mobility robots in 2013, one of them being Independent Walk Assist, a computer-controlled mechanical exoskeleton. It was developed at the University of California at Berkeley, where one of its students who is paralyzed was able to walk across the stage to receive his diploma with the help of the technology. Toyota is working on another version that will lift and move patients.

11-3-2011 9-00-53 PM

Mobile healthcare apps tools vendor Diversinet is awarded a patent for encryption technology that prevents data from being transferred from one mobile device to another.


inga_small From KLAS: over the next five years, almost half of providers will replace their RCM system; 87% of those will make the switch in the next three years. Most providers are looking at a new RCM in terms of how it fits in with a single-source enterprise strategy, often driven by the clinical vendor. Epic and Siemens top the list of considerations for over-200 bed providers, while McKesson and Meditech were the most considered by community hospitals.

mrh_small A Richmond TV piece covers the use of AirStrip Cardiology at Bon Secours St. Francis Medical Center, in which one of the doctors sheepishly admits that the previous standard of practice for ED doctors to get cardiology consults was to send them an iPhone picture of the EKG.

mrh_small A Virginia psychiatrist avoids becoming the first physician to be prosecuted for HIPAA violations when the judge dismisses charges against him. Prosecutors claimed the doctor retaliated against a patient who had complained about him by telling her supervisors that she had been involuntarily committed. The doctor says “it could have collapsed the entire system” had he been convicted since doctors would become reluctant to provide such warnings.

11-3-2011 6-22-53 PM

mrh_small The Rhode Island Department of Health investigates four Lifespan hospitals after getting reports they gave 2,000 discharged inpatients prescriptions for immediate-release drugs instead of the timed-release versions ordered by the physician. Lifespan blames “software used to generate medication instructions provided to discharged patients.” State Senator Jamie Doyle says he is “shocked” and wants a review of all Lifespan hospitals and the Rhode Island Department of Health.

mrh_small Weird News Andy is positively lyrical over this story, which he titles “Crystal Gayle, where are you?” A California doctor (and former entertainment lawyer) develops a laser procedure that can permanently turn brown eyes blue in 20 seconds. WNA provides the soundtrack: “Colored contacts, with you I’m through; That laser beam oh, it’s so brand new; Doctor Gregg now, let your aim be true; And don’t it make my brown eyes blue.”

Sponsor Updates

11-3-2011 1-22-18 PM

  • Medicomp Systems announces that Quippe, powered by the MEDCIN Engine, is now embedded into MED3OOO’s InteGreat EHR. Medicomp, by the way, exhibited at MGMA and trained seven people every hour on Quippe.
  • The latest newsletter from TELUS Health Solutions includes several articles on using data to drive transformational change in heath systems.
  • Virtelligence is participating in this month’s VA and Midwest HIMSS conferences.
  • Orion Health CEO Ian McCrae calls out his company’s continued success, calling Orion Health the leading healthcare IT software vendor in health information exchange.
  • MedAptus President Larry Hagerty discusses the company’s use of Internap’s cloud solution.
  • Carefx will participate in the Midwest HIMSS 2011 Fall Technology Conference in Indiana.
  • CareTech Solutions is recruiting 60+ people for installation and support of hospital IT systems.
  • Concerro opens registration for its November 29 Webinar entitled, “Achieving Compliance with the Joint Commission’s Staffing Effectiveness Requirements.”
  • CynergisTek CEO Mac McMillian is presenting “Data Security – Eliminating Imaging Informatics Risks” at the virtual AuntMinnie.com RAD Expo 2011 November 2-3. He will also  present a Health IT Capstone Course at the American College of Physician Executives Fall Institute 2011 November 8-9.
  • MyHealthDIRECT CEO and Founder Jay Mason will discuss the changing landscape for Medicaid health plans at the upcoming Medicaid Health Plans of America Annual Meeting in Washington, DC.

EPtalk by Dr. Jayne

This time of year as it starts to get a little chilly, I think fondly of places where sassy CMIOs can go for some fun in the sun. News from the sun belt: Cigna purchases HealthSpring, which runs the Medicare insurance plan for Miami-based Leon Medical Centers. The $3.8 billion dollar deal brings the plan’s 37,000 Medicare beneficiaries to Cigna and is seen as a major move into the Medicare Advantage market.

The AMA claims a win for helping to extend the deadline for providers to file for hardship exemptions to prevent penalties for not ePrescribing. Not a huge win in my book — the previous deadline was November 1 and it was very well publicized.

Mr. H usually reports on health IT vendor earnings calls and I rely on his summaries because I’m usually looking at pharmaceutical and other industry outlooks. Pfizer admits to its plan to work towards marketing an over the counter version of Lipitor. As the company’s best-selling drug goes off patent, they’re obviously trying to resuscitate their cash cow. The concept of bringing this class of drugs OTC comes up periodically – Merck asked the FDA three times over a seven-year period to allow them to take Mevacor OTC and was rejected every time.


When most people think of healthcare IT, they think of hospital and ambulatory documentation software, revenue cycle, laboratory information systems, and the like. In my opinion, one of the more fascinating breakthroughs is the computing power that helps scientists sequence the genome of various organisms. The journal Nature reports success in sequencing the DNA of Yersinia pestis, the agent that caused Black Death in the mid-1300s. Researchers extracted the DNA from teeth of victims buried in 1348.

I hope the HIPAA compliance zombies don’t hear about this one. The Defense Advanced Research Projects Agency (DARPA) challenges techies to reconstruct handwritten documents that have been shredded. Screenshots of shredded documents are on the Shredder Challenge website. Get your decoder rings ready – winners will be announced on December 5. Should emerging technology make it easy to piece together these puzzles, I’m sure we’re all in for compensatory advances in document destruction technology.

In the weirdest research study of the week, Israeli researchers conclude that drinking cold water increases the resting energy expenditure of overweight children, helping them burn calories. The patients drank water cooled to 4 degrees Celsius while watching a movie lying down. Not exactly my idea of a good time, but just illustrates how desperately people are looking at the obesity problem. I’ve got an idea: how about asking the kids to do stretching exercises or even calisthenics while watching? Bet that would work too.

Bad news for social habits favored by the ladies of HIStalk: a study published in this week’s Journal of the American Medical Association documented a statistically significant increase in breast cancer risk among women who drank small to moderate amounts of alcohol – the equivalent of three to six drinks per week. The data comes from the Nurses’ Health Study, a prospective observational study of over 100,000 women which has produced a multitude of findings.



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

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November 3, 2011 News 8 Comments

HIStalk Interviews Patrick Hampson, Chairman and CEO, MED3OOO

November 2, 2011 Interviews 2 Comments

Pat Hampson is chairman and CEO of MED3OOO of Pittsburgh, PA.

11-2-2011 7-38-46 PM

Tell me about yourself and the company.

I was a business major in management. My mother was a hospital administrator and my brother was a lawyer who litigated against physicians, so I chose the middle ground of working with physicians. I started a practice management franchise back in 1987 and expanded that into revenue cycle management.

In 1995 when we got our first capital raise, I started MED3OOO. I’m the chairman and founder of the company. Historically during that period of time, I was lucky enough to be befriended by John McConnell, who was the CEO and founder of Medic, and was able to invest and be on the Medic board. Then the same thing with A4 Health Systems. Conversely, John McConnell’s on my board. I think you could say it’s incestuous to some extent.

A lot of people, including the ONC folks, are talking about the usability of physician software. How are MED3OOO and the industry in general doing in that area?

I don’t know anybody that’s like MED3OOO, for two reasons. One, we’re in the physician practice management business, so basically we were born and raised as operators. Whether it’s an Allscripts system or a Sage system or our own systems, we know what we want these systems to do to better manage a practice.

Conversely, we’re also system-agnostic, so if the physician group or the hospital who has employed physicians already has a system, we’re able to use their systems. It’s like BASF — we don’t make things, we make things better. We use their systems to improve how they run their physician practices, or if it’s an independent group, how we run the practice. 

Separately, we have InteGreat, which is our proprietary, Web-based PM system. If we’re talking to physicians for the first time about EHRs, it reduces the barrier to the sale. We let them look at all the EHRs and then hopefully they’ll pick InteGreat, but if they don’t, we’re fine with them picking one of the other vendors and we’ll install it and service it and manage it for them.

How do you separate those lines of business within the organization?

MED3OOO has three lines of business. The first business is physician services. That has three components. One component is where we manage a physician’s group, whether it’s hospital-owned or they’re independent-owned, on a turn-key basis. We do the accounting, the finance, the administration, the billing, the collections. We do the managed care contracting. Usually those are long-term contracts, but it’s turn-key.

Separately, we actually own physician practices in some states where you’re allowed to own them. We have large physician groups that are actually owned and operated by MED3OOO.

Third, we have the revenue cycle management. I think we’re one of the largest private RCM companies in the US. That all falls under physician services.

Separately, we have an ACO division, which is accountable care, and that houses our IPA business. In California, Illinois and Florida, we’re a TPA and we manage large IPAs. Some of our IPAs are taking global risk and some of the IPAs are taking professional risk, so now that the word ACO has come about, we’ve been taking reimbursement risk on patients and quality for quite a few years. We have our own systems for that.

The third division is the technology division. It can either be agnostic and utilize the non-proprietary systems like Allscripts, Sage, or GE, or we’ll sell our own proprietary system, which is InteGreat PM, EHR, and data warehousing. It’s really the physician’s choice. As you know, physicians like different bells and whistles, depending on their specialty. But we try to stay agnostic as much as we can, even though we believe the product that we built with InteGreat has much more capabilities than some of the older legacy systems.

I’m glad I asked you that question because I didn’t realize the scope of what you do. Are you the only company offering physician systems that actually owns physician practices and performs TPA duties?

I think we’re the only company out there that has all three of those divisions, which is  kind of interesting because the market’s now come to us. Again, there’s a lot of hospital groups, there are a lot of hospitals, there are a lot of physician groups that now want to … you know, they’re worried about getting into the ACO business. If you think about it, we can walk in and we already have the risked-base experience because we’ve been doing global risk for 10 years for our clients. We have the technology, because we’re a TPA. Then we have the electronic health records, whether it’s the system that they’re using or developing a community model, and we have data warehousing. So we’re pretty much a plug-and-play for folks that want to go to the next step and partner with someone to become an ACO.

How big is the company?

In 2012, our run rate will be about $200 million in revenues. We have 14 operating centers across the U.S. and about 2,500 employees.

Wow, it’s huge. I’m sure there’s going to be a lot of folks other than me who are going to do a little double-take when they read that. There are potential acquirers out there looking at revenue cycle, different kinds of companies, and you’ve got several sweet spots. Are you getting a lot of interest from folks who see your very large footprint and are interested in participating with you in some way?

Where we get a lot of interest is from companies that want to invest in MED3OOO and then for it to go public. We’ve been in business since 1995.  I have been on public boards, Medic being one of them. Historically, because we are privately held, we’ve been able to pretty much put all the capital back in the company, so we’ve been able to build internally. We already have population health management. We have predictive modeling. All the tools that we need to manage our physician practices or our own risk-based IPAs — we built these things internally, so it’s not vaporware. It’s things that really work in the field of fire, not selling a product and then running off to the next client.

Recently, it’s kind of exciting for us, but we signed the state of Florida to do their children’s Medicaid services. That’s not only a nice contract for us because it’s across the whole state of Florida and it’s a state contract, but they’ve also signed us to build a continuous quality of care modules, which no one else in the industry is trying to do because they might have the software expertise, but they don’t have the operating expertise to actually build it so that once it’s up and ready to go, then it works at the point of care.

I know that you’re a big user of Quippe and jumped on that pretty quickly. How important is that and its acceptance to the strategy on the EHR side?

Quippe’s pretty important because the thing it does that others – I think we’re one of the first to use it – but it’s template-free documentation. The way it’s set up, you don’t have to build templates. It really thinks like a physician. You can really fly.

I think why that’s important is it feels like the market is now down to where it’s the one doctor to the 25-doctor practices. Most of the larger groups have already been saturated with technology. We think there’s a big difference between putting systems in onesy-twosy practices than there are for these large clinics that have tons of infrastructure, they might have their own CTOs, they might have a training group.

The smaller practices don’t have that. You really need to have something that’s low-cost, that’s easy to use, and at the same time, moves the way the doctor moves, not have the doctor move the way the vendor built the system. Last but not least, it’s also cloud-based with our technology, so we don’t need a VPN or network, so it also keeps the pricing down for folks.

You mentioned the small to mid-sized practices. How much of the practice market are you seeing that’s being driven by hospitals that are choosing single-vendor offerings, like from Allscripts or from Epic or whoever, and then subsidizing those offerings to their affiliated physicians?

I’d say the majority of cases, from I can see. The hospitals are choosing their select vendor. We’ve got a lot cases where we have hospitals and we’re not the main vendor for their employed physicians. I’d also say that if you’re a large group, an independent physician group, the problem that you have is that you’re in a marketplace where you want to connect to all the other physicians that affiliate with your hospital or your practice group. In most cases, we might go into a market and there’s 600-700 physicians on staff and they have all the different systems you’d every want to know.

We’re a little different as, again, we’re agnostic. We can work with that hospital system, that group system, or we can help them connect with the marketplace where you’ve got 16-20 different vendors out there that have already sold systems. I think the Web-based technology for us is important, too, because the majority of systems out there are legacies. You’ve got a few Web-based systems, but there’s going to be over time a large capital cost for the folks to get off the legacy systems because they’re just not going to be able to do what they need to do easily. We believe that InteGreat is pretty well positioned for that second phase in the market.

There are people that predict that the small practice is an endangered species, and especially with all the emphasis on technology and affiliations, that it’s going to be tough to survive. Do you see that happening, and how do you see the technology needs either helping them go away or helping them not go away?

I think that the industry is cyclical. In 1995, back when we were first named MED3OOO, you had companies like PhyCor and MedPartners and you had hospitals and everybody employing physicians. From 1995 to 2007, they lost a lot of money on their employed physicians. The physicians weren’t happy, the hospitals looked at the P&Ls of physicians and weren’t happy. 

I think you’ll still see employment models strategically in certain areas like Pittsburgh, for example. Highmark and UPMC are battling, so there’s more competition there. What we see more of is hospitals and/or large physician groups and/or IPAs trying to figure out different methods to align with physicians versus just employ them.

In some states like California, you can’t have a non-compete. Even if you pay the physician a lot of money for his practice, they can go six doors away and reopen a practice or go to someone else. We think the smartest move that people are making is just figuring out different ways to keep the physicians to align with them, not necessarily just use the employment model.

You mentioned the ACO market in general. How do you think hospitals and practices will address that need to collaborate and integrate their delivery, especially with IT?

Right now today, ACO to me means “awesome consulting opportunity.” Everybody is running around, everybody wants one, but very few really know the details. The government just came out with their new set of regulations and I’m not aware of any of the pilots in the ACO realm that have made any money. I think the jury is still out.

Do I think there’s any need for a different reimbursement model that’s based on quality and based on access to care? Sure. But is it the ACO model? I’m not sure but – this is a sales pitch for MED3OOO – if somebody wants to become an ACO, now again, what do you need? You need heavy technology on the reimbursement side, the payer side. You need ways to align physicians and hospitals. You need expertise, somebody that’s actually handled global payments. We believe we’re the best partner, whereas the hospital or physician group to make him successful in whatever the new ACO world is.  It’s just not having it, and so it’s not being a vendor. You have to be a partner to make this really work for a hospital or a physician group.

As a developer of systems, what are the challenges that you see with managing population health?

Right now we have about 2% of the U.S. population in our data warehouse. Getting data is easy. Sorting data and making sure that it’s viable data is much more difficult. then doing it on a real-time basis so that people have that data at the point of care.

But in our world, population, health management, predictive modeling — these aren’t new terms. We’ve been doing it for five years and doing it successfully with our groups. It’s more of an issue of access to the data. Will the states continue to fund HIEs and deploy them so that everybody can share data? With the economy, will that funding continue? And if it doesn’t, what’s the solution were everybody can share data?

The government did a great thing by saying everybody had to be interoperable, but that’s a technology term. It still doesn’t mean that you have to share data. I think this will shake out in the next three or four years, but it’s those that have the data and then those that know that it has to be processed before it’s usable are the ones that will have a leg up.

You mentioned interoperability and HIEs. What customer demand are you seeing for that and what are your strategies in those areas?

InteGreat is certified for Meaningful Use, and interoperability is one the components of Meaningful Use. We’ve got two things. We’ve got the EHR that has Meaningful Use and interoperability, but separately, the data warehouse will let you extract data from disparate systems. Then we can turn that data into actionable information for the physicians.

You need to have a strategy that has different parts, because if you’re a vendor, all you care about is selling your system. If you’re in management, you care about what systems you’re using, but you also care about what system the other 60% of the market is using and how you get access to that data. That’s where we made an investment 10 years ago into the data warehousing piece. I  you think about it, because we are a large user of Allscripts and NextGen and Misys and Sage and InteGreat, we got the data warehousing so we could manage our own disparate systems. Now it’s a plus, because in these communities, we can manage the disparate systems that are in that community and an HIE can’t do that. An HIE can connect them, but it’s really not a place to house data and then turn it into information.

Every executive makes bets about what’s going to happen in the future, making company decisions today that won’t realize fruition for years. What are some of the bets you’re making about what the industry is going to look like down the road?

I’ll be really different. I don’t think we’re making a bet. I think what we decided years ago is that the industry is cyclical, so we wanted to have expertise in technology. We wanted to have the expertise in management and operations. We wanted to have the expertise in data. 

When these markets shift, for example, you might assume that if everybody’s employing physicians, the revenue cycle management business would be less. But if hospitals are employing physicians, that practice management piece accelerates, because they usually don’t know how to manage physicians. What we’ve decided to do is have the components, and then as the industry shifts, two of our components, two of our divisions might be on fire right now. I think just four years ago the IPA market was kind of flat — there wasn’t anybody developing new IPAs. Now the IPA market has become the ACO market and everybody wants one, but very few have the tools and the knowledge on how to really do it. While physician employment might be saturated or systems might be saturated, the knowledge base in our ACO division … it’s tough to keep up right now.

Any final thoughts?

You’re going to have to get to scale, whatever you do as a company. I truly believe that if you want to make a difference — where it’s quantifiable, you’re making a cost improvement and a quality improvement on the clinical side — you really need more. You can’t just be a vendor. You’ve got to provide people with a stepping stone and a map to get to disease management and population health management. There are a lot of people today that are just starting and are not sure where they should start. I think we would be good partners for them, because we’ve been doing it. That’s the core of the company and we’ve got all the tools and services, but more importantly, we actually do it for a living. We’re not a vendor to most of our physician clients or hospitals.

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November 2, 2011 Interviews 2 Comments

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