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April 12, 2012 News 6 Comments

Top News

4-12-2012 10-37-03 PM

The Defense Department’s inspector general finds that drug abuse among Marines in the Wounded Warrior Battalion at Camp Lejeune, NC is hard to detect because of shortcomings in its CHCS and AHLTA EMRs. Prescription information from the VA and civilian doctors are not visible in AHLTA. An Army doctor said AHLTA’s medication module is “a mess,” saying that it’s so bad that doctors just free-text in the patient’s medication list, especially after the most recent update that added interfaces to civilian pharmacies and the VA. The battalion also wanted to implement the EMMA medication dispensing system used by the Army at Fort Bragg, but the Navy nixed that idea over concerns that it might not be HIPAA compliant.

Reader Comments

4-12-2012 9-00-50 PM

From X-Ray Gun: “Re: Philips. In December, decided to discontinue their RIS product, XIRIS in NA. They have also decided to discontinue their Digital Dictation and VR solution.” Unverified. They live on at least as artifacts on the company’s webpage.

4-12-2012 8-59-11 PM

From WildcatWell: “Re: requirement to have health insurance like car insurance. Will it flood my TV with endless commercials such as we see now from Allstate, GEICO, et al? It’ll be worse than political season! But, imagine: ‘15 minutes on HIStalk could save you $15K or more on life insurance.’ Send me a royalty! Keep up the good work.” I would need to dress Inga up in all white with red lipstick like that loopy Flo chick from the Progressive commercials, which are indeed ubiquitous. I’m more of a fan of the Allstate ones since they feature Dennis Haysbert, best known for playing Pedro Cerrano, the Jobu-worshipping outfielder in Major League, one of the best movies ever.

From Recent Interviewee: “Re: interview. I’ve been answering very nice e-mails since the HIStalk interview ran. Congratulations on such a great service you provide to the industry. Everyone reads it.” Thanks. I do quite a few interviews and always let the interviewee know upfront that the result is usually quite a few reach-outs from folks who’ve lost touch over the years. I don’t think they generally believe it until it happens. Healthcare IT really is a small world and most of the players just move around in it without ever straying far.

4-12-2012 9-12-15 PM

From Gesundheit: “Re: Henry Ford Health System. The $100 million MIMS system was built in the 1980s, when there were no good vendor offerings. It lasted over 20 years – not bad in today’s environment. However, adding $300 million for Epic is insanity or some lack of governance process or client acceptance. I’d like to see the fact finding on this one.”

From Ixnay: “Re: Meditech. Heard they’re ditching LSS to create their own ambulatory product.” Unverified. That rumor has been going around for at least a year and they’ve bought the remainder of LSS in the mean time. I don’t know if it’s a competitive offering, but the rumors would suggest that at least some folks think it isn’t. Most inpatient vendors still have a weak ambulatory albatross hanging around their necks, not surprising for systems whose underpinnings go back decades when nobody in hospitals cared what physician practices did.

4-12-2012 9-02-38 PM

From Jonathan Grau: “Re: International Congress on Nursing Informatics. The meeting is one of the most important activities of the International Medical Informatics Association -Nursing Informatics Special Interest Group (IMIA/NI-SIG) and is held every third year to promote all aspects of nursing and health informatics globally. We expect over 800 in Montreal, June 23-27.” I don’t usually give free plugs since I don’t want to open the floodgates, but I’m feeling uncharacteristically generous. Jonathan is with AMIA. Attendees can hang around afterward and catch the Montreal jazz festival, with performers that include Norah Jones, BB King, Ben Harper, George Thorogood and the Destroyers, James Taylor, Liza Minelli, Seal, Stanley Clarke, old favorite Van der Graaf Generator, and an interesting group whose 1970s LPs populate part of my collection, Tangerine Dream. They put me to sleep every time with their all-instrumental space music that sounds like Pink Floyd taking an on-stage break, but I like the name and covers.

HIStalk Announcements and Requests

inga_small Catch up on your HIStalk Practice reading so you have the full scoop on these posts: PCMHs improve quality and reduce costs in New Jersey. CareCloud CEO Albert Santalo joins President Obama during the signing of the JOBS bill. AMA names HP its preferred provider for technology products. Dr. Gregg sends out an RFP for an EHR – and stirs some good discussion from readers. I am a firm believer that you can never be too rich, too thin, or have too many HIStalk Practice e-mail subscribers, so please either send money or diet tips or sign up for the e-mail notifications. Thanks for reading.

Listening: the brand new first album from Alabama Shakes, Joplin-esque (or is it Otis Redding?) Southern soul from Athens, AL, just in time for summer. Singer Brittany Howard, 23 years old, belts it out and leaves it all on the stage. Killer Led Zep cover here.

4-12-2012 10-43-28 PM

Travis is on fire over on HIStalk Mobile, with one excellent, meaty post after another. His latest: Pagers – There’s an App For That, which arrives at thought-provoking conclusions about the situations when hospitals can and can’t do like drug dealers did in the 1990s in dumping the typewriter of the communications world, alpha pagers, which surely have no market left other than in healthcare.

On the Jobs Board: HL7 Business Analyst, Director of Marketing, Director of Business Development. On Healthcare IT Jobs: PACS Application Coordinator II, McKesson Paragon Consultants, Cerner Go-Live Project Manager.

It’s a strange, strange world we live in, Master Jack. Reality TV that’s anything but real, rampant Facebook narcissism, crumbling economies, and celebrities whose IQs and morality levels compete like golfers shooting for the lowest score. One thing you can count on, though – like Big Ben or Old Faithful, I will be predictably spooning with my PC to bring you news, rumors, and Cerrano photos almost every day of the week just like I’ve been doing for nine (!!) years. How might one harvest this rich outpouring of prosaic potpourri, you might ask? Simple – just click the Subscribe to Updates link at the upper right of the page to get into the exclusive club of industry movers and shakers who read HIStalk but probably won’t admit it publicly, putting it right up there with pr0n in the guilty pleasure category. Should  you wish to take our relationship to a deeper level, may I suggest: (a) electronically bond with Inga, Dr. Jayne, and me on social not-working sites like Facebook and LinkedIn, where rejection is impossible because we accept connections from everyone; (b) send me rumors and secrets; (c) pay homage to the companies that pay the bills by perusing the Resource Center and the plethora of newly animation-free ads to your left, replacing heartfelt applause with mouse clicks to see what they all actually do; (d) if you are a provider seeking consulting help, broadcast your RFI to several companies in seconds via the RFI Blaster; (e) tell someone you know about HIStalk since they won’t hear about it otherwise; and (f) bow your head humbly as I strap on the Honorary Reflector Thingy in knighting you with gratitude as my tireless confidante and defender. Thanks for reading.

Acquisitions, Funding, Business, and Stock

4-12-2012 10-40-55 PM

Emdeon reports Q4 revenue of $284 million, up 3% from a year ago. Net loss for the quarter was $71 million compared to the previous year’s net income of $15 million. Emdeon, which went private last year, says the loss was “primarily due to costs and expenses, including increased interest expense.” The company also announces its intention to re-price its existing senior secured credit facilities to take advantage of current market rates and borrow $60 million of additional term loans for general corporate purposes, including potential acquisitions.

4-12-2012 10-41-33 PM

McKesson shares rose 4% to a 52-week high Thursday on news that its $4 billion per year drug supply contract with the VA will be extended for up to eight more years.

I recently interviewed Brian Phelps, the ED doc who co-founded iPad-based system vendor Montrue Technologies, whose Sparrow ED product won the Nuance’s Mobile Clinical Voice Challenge that I judged a couple of months ago. The company learned Wednesday that it had won the $160,000 Southern Oregon Angel Investment prize. It had already received $200,000 in angel investor money at a similar conference and some pretty nice prizes from Nuance.

4-12-2012 10-44-35 PM

CPSI will move some of its Mobile, AL operations to Fairhope, saying it has run out of room.


The State of Minnesota selects Hielix, Inc. to develop a statewide HIE.

4-12-2012 10-46-21 PM

Bayfront Health System (FL) signs an agreement with Unibased Systems Architecture to deploy its surgery management and physician order management solutions across more than 20 operating rooms.

Blue Mountain Hospital (UT) chooses clinical and financial solutions from Prognosis. 

Orion Health wins the HIE contract for North Texas Accountable Healthcare Partnership. Also announced: former T-System VP Joe Lastinger was named CEO of the HIE.

Franciscan Alliance selects iSirona’s enterprise device connectivity solution to integrate medical devices with Epic in its 14 hospitals.

Care Logistics sells something that sounds kind of software related to Catholic Healthcare East, but I can’t figure out what it is from this sly hint: “This comprehensive approach combines an organizational commitment to efficiency, systemwide process reengineering and enterprise logistics software to help hospitals achieve reliable and predictive operational performance in the areas of throughput, quality and patient experience.” Their site is similarly vague, but is clogged up with enormous blocks of dense text sure to send all but the most determined visitors fleeing.


4-12-2012 6-27-48 PM

Post acute care IT provider American HealthTech names David Houghton (Advocat) as COO.

4-12-2012 6-29-29 PM

Hospice and homecare IT provider CareAnyware names Ray DeArmitt (CellTrak Technologies, Allscripts Homecare) as sales VP.

4-12-2012 6-31-46 PM

Quest Diagnostics appoints former Philips Healthcare CEO Stephen H. Rusckowski president and CEO immediately after his resignation from Philips. He replaces Surya N. Mohapatra, who will join the company’s board.

4-12-2012 7-19-56 PM

Philips Healthcare promotes Deborah DiSanzo to CEO. She was previously CEO of Patient Care and Clinical Informatics for the company.

4-12-2012 6-45-32 PM

MediClick names Scott Pettingell (GHX) VP of the company’s new consulting services business.

The Healthcare Financial Management Association appoints Joseph J. Fifer its president and CEO, succeeding the retiring Richard L. Clarke. He most recently was VP of hospital finance at Spectrum Health.

Announcements and Implementations

The Hawaii REC names Curas its preferred eClinicalWorks vendor.

The Carolina eHealth Alliance (SC) announces that 11 Charleston area emergency departments are now connected to its HIE.

NexJ partners with Beth Israel Deaconess Medical Center (MA) to digitize the health system’s Passport to TRUST program and make it available through NexJ’s Connected Wellness Platform.

The New York Times profiles remote monitoring system vendor AirStrip Technologies in its list of companies it says are pushing healthcare transformation. Also on the list: Avado (Web-based forms and health status tracking); ClickCare (secure physician communication for consultations); ZocDoc (making physician appointments); and Telcare (cloud-based glucose meter data sharing).

Yuma Regional Medical Center (AZ) will go live May 1 on its $73 million Epic system.

Government and Politics

CMS Innovation Center picks seven states to pilot the Comprehensive Primary Care Initiative, which aims to strengthen coordination and collaboration between private and public healthcare payers to improve primary care.


The athenahealth folks sent over this video entitled It Sucks to Be Me, which highlights why it’s not easy being a physician, nurse, administrator, and patient. OK, so it’s mildly cheesy like an overwrought, applause-milking truck show Broadway musical on opening night in Omaha  (check out the drummer’s cowbell and wood block work – think Waiting for Guffman), but you’ve got to love athenahealth for its out-of-the-box marketing.

Several members of the Medicare Payment Advisory Commission (MedPAC) express concern that federal incentives may not cover the true cost of implementing an EHR. Some specific worries are that Stage 1 requirements are set too high and some required elements are too expensive to implement and offer questionable value.

Allscripts CEO Glen Tullman writes a Forbes piece on how consumer technology can be used in healthcare. He mentions FaceTime, Kinect, and FitBit. He included a video from Madonna Hospital showing some futuristic ideas that I was going to run here, but I noticed it’s a couple of years old and I would hope they’ve come up with new stuff since then.

This seems like a bad idea: an Indiana hospital implements a Web-based incident management system, intended for use during tornadoes and other natural disasters during which Internet connectivity is often lost.

4-12-2012 10-50-23 PM

A laid-off IT security administrator at Waterbury Hospital (CT) is arrested for hacking into the hospital’s computer system hours after he was marched out, using his boss’s own e-mail account to send him threatening messages.

A newspaper’s investigation finds that five electrophysiologists – cardiologists with the Ohio State University Wexner Medical Center were each paid a $1.3 million bonus in 2011, raising their one-year pay to $2 million each. The only employee at the state university to earn more was the basketball coach.

Sponsor Updates

  • EHRtv posts its HIMSS 2012 interview with T-System CEO Sunny Sanyal.
  • Macadamian assists in the design of Elsevier’s Mosby’s Certified Nurse Exam Prep smart phone app and its development for the iPhone, iPod Touch, and iPad. 
  • HealthMEDX provides an update on its HIPAA 5010 readiness preparations.
  • Allscripts President Lee Shapiro participated this week in a TechNexus panel discussion on the changing face of technology in healthcare.
  • A white paper from Care360 discusses the positive impact of technology on the quality of patient care.
  • NextGen will integrate Entrada’s clinical documentation technology with its PM/EHR.
  • GE Healthcare launches Centricity EDI Services 5.4,which includes support for HIPAA 5010 and stronger analytics.
  • Beacon Partners expands its ICD-10 Assessment Service with the addition of an ICD-10 translator and business intelligence application from McGladrey.

EPtalk by Dr. Jayne


The Colorado Regional Health Information Organization (CORHIO) releases a report on integrating behavioral health information through health information exchanges. Although agreeing that information on mental illness is a vital part of the overall data influencing the health of a patient, a role-based tiered consent structure was recommended. Surprisingly, the roles weren’t based on physician vs. nurse vs. checkout clerk but rather the specialty of physicians involved. For example, participants in community focus groups felt that specialists such as OB/GYN or dermatology had less need to know information than did hospital-based physicians. Being a primary care doc at heart, I think any time you start excluding classes of providers (especially when drugs to treat mental health have a number of potential interactions and contraindications) it’s a detriment to patient safety. Who will be liable when harm occurs because a physician was denied information that would have made a difference? Needless to say, I’m not a fan of pick-and-choose consent policies.

CMS has compiled individual quality and resource reports for physicians in Iowa, Kansas, Missouri, and Nebraska. Practices have been e-mailed a link to the reports, but only 3,300 of 23,730 reports have been accessed. I reached out to at least 10 physicians in these states and none of them knew anything about it. My guess is the e-mails either went to spam folders or are sitting in some administrator’s inbox.


I’m a reasonably diligent reader of the Federal Register but somehow I missed this item. The Drug Enforcement Administration is increasing physician fees for the privilege of prescribing controlled substances by nearly 33% – from $551 to $731. This allows us the privilege of having drug-seekers hassle us for meds and increases scrutiny of our practice patterns (not to mention an increase in medical liability insurance premiums.) It seems like what the feds provide in MU funding just slowly erodes to other areas.

I’m a little behind on my reading, so I laughed when I came across this article about the recent Utah Medicaid data breach reported to affect 24,000 patients. As of today, the number is closer to 900,000.

One of the folks I’ve found on Twitter has turned out to be one of my new favorite bloggers. Skeptical Scalpel is written by a surgeon with considerable (40+ years) experience in the field. Worth a view, especially if you have a clinical background. And if you aren’t clinical, it may provide some good conversation-starters to help you bond with physicians who are generally ticked off at the world when all you’re trying to do is fix their laptops.


I enjoy reader correspondence and always like to try to share information when I can. Recently a reader asked, “I am looking for a good hospital BYOD policy for physicians. We’re enabling physician use of iPads and similar devices to connect to our clinical systems and I am in need of a policy that covers their use. Have you come across a good one yet? If so, can you share it?” Being from a strictly “don’t touch my network” hospital, I don’t have personal experience with the thrill of being able to actually use my own device on the network. I do however have much experience hooking to the patient access network so I can use the forbidden Twitter and Facebook. I also have experience carrying both my own smart phone and a hospital-issue BlackBerry, which really makes me look goofy at times. Can anyone help a fellow reader? E-mail me.



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

More news: HIStalk Practice, HIStalk Mobile.

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April 12, 2012 News 6 Comments

3M Acquires CodeRyte

April 10, 2012 News 1 Comment

3M announced this morning that it has acquired CodeRyte, which offers natural language processing and computer-assisted coding tools. 3M has offered CodeRyte’s computer assisted coding products to its own customers since 2009.

CodeRyte offerings include Health System Coding (natural language processing and coding workflows); CodeAssist (automated coding using extracted text from physician documentation); CodeComplete (outsourced coding services); and DataScout (analytics using information extracted from both structured and unstructured records.)

3M Health Information Systems VP/GM Jon Lindekugel was quote as saying in the announcement, “This acquisition allows us to apply CodeRyte’s leading edge NLP technology to our new 3M 360 Encompass System. We believe CodeRyte’s powerful NLP engine combined with 3M’s deep expertise in coding, reimbursement and patient classification will foster further innovation in the application of NLP.”

CodeRyte’s 130 Bethesda, MD-based employees serve 250 customers, which the company says represents 85% of academic medical centers that use computer-assisted coding.

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April 10, 2012 News 1 Comment

News 4/4/12

April 3, 2012 News 1 Comment

Top News

4-3-2012 9-28-00 PM

A National eHealth Collaborative paper says that HIEs have great potential to improve care and reduce cost, but despite ONC emphasis and incentives, not a lot of value has been realized so far. Big issues remain funding, provider adoption, and difficulties connecting to the wide variety of available EMRs. They recommend focusing on patients above all else, build trust and a common vision among participants that often don’t particularly like or trust each other, ignore “one size fits all” proposals and listen to what the local community wants, and figure out how to make money once the grants run out.

Reader Comments

4-3-2012 6-37-27 PM

From Hardware Sue: “Re: Navin, Haffty & Associates. Heard that Park Place International is looking to buy them out.” Not true, NHA President John Haffty tells me. Park Place has expanded its technical offerings related to Meditech and NHA has collaborated with them on projects and will continue to do so since their work is complementary, but no acquisition-related discussions have been held or encouraged. Per John, “We have great respect for the old and new team over at Park Place, but we are committed to maintaining our independent status.” Norwell, MA-based NHA offers consulting services exclusively for Meditech customers.

From JayGlo: “Re: security testing firms. Know any that specialize in EHRs in general and Epic in particular? Who are the best white hat hackers?” I’ll defer to readers – leave a comment if you have suggestions.

From ForthePatients: “Re: Tampa Bay RHIO. Work has been dragging in the swamp for almost five years with a long list of special interests – academic medicine, lawyer, homegrown exchange vendor, and hospitals interested in connecting to their own practices. Who controls what is clearly a the crux of this one and not a focus on the patients or the community.”

Acquisitions, Funding, Business, and Stock

4-3-2012 9-30-56 PM

Santa Rosa Consulting announces that it has completed its acquisition of Nashville-based healthcare IT consulting firm InfoPartners.

4-3-2012 9-31-35 PM

Charge master vendor Craneware opens an office in Scottsdale, AZ.

4-3-2012 9-30-15 PM

Merge Healthcare shares dropped 16% on Tuesday after the company filed an SEC 8-K form indicating that a $2.75 million sale of kiosks was to higi LLC, a company founded and controlled by Merge Chairman Michael Ferro. Merge’s audit committee had cleared the sale. Merge topped the biggest percentage price decliner on Nasdaq list, shedding nearly $90 million of value for the day.


4-3-2012 9-32-50 PM

Cooper University Hospital (NJ) signs a three-year agreement with Newport Credentialing Solutions for its reporting and analytics software and back office credentialing solutions.

Southeast Michigan Beacon Community selects Covisint’s accountable care technology to aggregate regional health information.

DuPage Medical Group (IL) selects Humedica MinedShare to provide clinical benchmarking and analytics from its Epic EMR.

4-3-2012 9-36-07 PM

Einstein Healthcare Network (PA) licenses business analytics and patient financial services solutions from Streamline Health to monitor and drive revenue cycle performance in its 1,000- physician ambulatory care network.

Mount Sinai Medical Center signs with Siemens MobileMD for an HIE service agreement.


4-3-2012 6-21-38 PM

Cognosante names Eileen Cassidy Rivera (Vangent) as VP of marketing and communications.

4-3-2012 6-22-19 PM

Former Cigna VP of IT Marcus B. Shipley joins Trinity Health (MI) as SVP and CIO. He  replaces Paul Browne, who has been named Trinity’s SVP of integration services.

4-3-2012 8-15-25 PM

Nashville-based The Rehab Documentation Company, which sells therapy documentation systems, names Antoine Agassi as president and COO. He comes from Cogent Healthcare and was previously chair of Tennessee’s Governor’s eHealth Advisory Council and held executive roles at Spheris and WebMD Transaction Services.

Announcements and Implementations

Southeastern Med (OH) hosts a midnight ribbon cutting ceremony to officially launch its Meditech go-live.

West Calcasieu Cameron Hospital (LA) launches bedside bar code verification with McKesson’s Horizon Admin-RX.

4-3-2012 9-38-29 PM

Biggs-Gridley Memorial Hospital (CA) goes live on the Prognosis ChartAccess EHR.

Humana Cares completes installation of a 1,600 monitoring devices for a telehealth pilot project, where nurses will remotely check the vital signs daily of CHF patients in hopes of decreasing hospitalization. The project uses the Intel-GE Care Innovations Health Guide, a blood pressure monitor, and scales.

Government and Politics

A bipartisan group of House and Senate lawmakers introduces a bill proposing to link the prescription drug monitoring programs of individual states, allowing prescribers to look for patterns of prescription drug abuse across state lines.

VA CIO Roger Baker says the $4 billion joint VA/DoD EHR system could be available by 2014 and will be piloted at military installations in Hampton Roads, VA and San Antonio, TX.

4-3-2012 6-57-50 PM

The VA cancels its Software Assurance agreement with Microsoft covering its 300,000 users, giving the agency flexibility in seeking non-Microsoft alternative technologies, such as tablets and cloud-based systems.

The Coast Guard prepares to go live on its Epic-based EHR. It plans to provide mobile access via cellular network and to run cached copies of information from its vessels, which often do not have connectivity. The Coast Guard is looking for companies to provide service desk support.

Innovation and Research

A study performed in large UK teaching hospital finds that off-hours clinician response and satisfaction improved when pagers were replaced with wireless call handling and task management. Tasks were logged on a PC that sent messages to a coordinator’s tablet, who then routed the tasks via text message to on-call phones. Users liked the improvement in handoffs: task prioritization, the ability to monitor task assignment and completion, and elimination of handwritten notes.


4-3-2012 9-40-42 PM

Rochester, MN-based mobile healthcare apps vendor Preventice, partly owned by Mayo Clinic, expands into the medical device business with BodyGuardian, a diagnostic heart and respiratory monitor that patients can wear during normal activity. The company says the final product, when approved by the FDA, will be just 8×8 mm in size (about a third of an inch high and wide) and will attach like a Band-Aid for up to seven days, sending the physician a text message and EKG by Bluetooth when it detects cardiac events. The company plans to hire 15 employees and will move to new headquarters in Minneapolis.

4-3-2012 9-00-09 PM

Microsoft announces the 11 startups chosen from 500 applicants that will participate in its 2012 Kinect Accelerator. Among them are GestSure, which creates touchless interfaces for surgeons and interventional radiologists; and Jintronix, a virtual reality rehabilitation system for patients with motor control problems.


4-3-2012 7-06-22 PM

The University of Arizona Medical Center will replace Allscripts and iMed with Epic at its two hospitals and outpatient centers. The project will cost $100-135 million, will require 87 full-time employees over the next three years, and will involve providing 12 hours of training to each of 6,000 employees. Four miles away, Tucson Medical Center is already running Epic, having completed its rollout in June 2010.

Partners HealthCare researchers find that the number of lab tests ordered for outpatients who were seen at both at Brigham and Women’s Hospital and Massachusetts General Hospital dropped from seven to four after implementation of an HIE that allowed previous results to be viewed by either facility. The full text article isn’t available online to non-subscribers and the usual disclaimers apply: the study sample appears to be quite small, the study data was old (1999 to 2004), and whatever correlation was implied does not prove causation. 

Despite a fall in net income from $158 million in 2010 to just $1 million in 2011, Novant Health (NC) will spend $600 to $700 million over the next four years on its Epic project. Novant expects the first of its 13 hospitals to go live by the end of 2013.

4-3-2012 7-43-28 PM 4-3-2012 7-44-24 PM

Several readers found this non-HIT story interesting enough to send over. The $4 million-per-year CEO of Pittsburgh-based insurance company Highmark is fired after an ugly love triangle fight over his 28-year-old girlfriend, who worked for him at Highmark. Kenneth Melani, 58 and married, showed up at the girlfriend’s home and refused to leave when ordered by her 48-year-old husband, resulting in criminal charges. Melani has engaged an attorney to determine whether his dismissal was legal, while the DA agreed to postpone his preliminary hearing provided he undergoes anger management counseling.

Leila Denmark MD died this past weekend in Georgia at 114 years old. She she was the world’s oldest practicing physician when she retired at 103, having begun her pediatrics practice in Atlanta in 1931.

Sponsor Updates

  • Practice Fusion customers have received $22 million in EMR incentives through January, the company reports.
  • Emdeon offers a free weekly webinar on Emdeon Vision for Claim Management.
  • The HITR nursing technology blog is running a Bodacious Scrubs contest through April 25.
  • Iowa Health System contracts with Hayes Management Consulting and Coastal Healthcare Consulting to provide legacy support services.
  • MED3OOO’s IT and services divisions hosts a virtual job fair May 2. 
  • Encore Health Resources names attorney Tom Luce to its board.
  • ICA launches HIT Me Blog with commentary on current healthcare and HIT issues.
  • Lifepoint Informatics will participate in the 2012 Executive War College on Laboratory and Pathology as a corporate benefactor. The event will take place in New Orleans May 1-2.
  • Cognosante and 3M partner to provide 3M’s ICD-10 Code Translation Tool to state-sponsored health plans.
  • MedHOK announces that its 360Measures V 2.55 has achieved 2012 P4P certification.


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

More news: HIStalk Practice, HIStalk Mobile.

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April 3, 2012 News 1 Comment

Monday Morning Update 4/2/12

March 31, 2012 News 3 Comments

3-31-2012 8-15-36 PM

From HMSUser: “Re: HMS CEO departure. The company confirms.” HIS vendor Healthcare Management Systems (HMS) confirms the rumor I ran here Friday from HMSUser: President and CEO Tom Stephenson, a 25-year company veteran, has left “to pursue some long-time interests.” According to his LinkedIn profile, he is now assistant grass cutter at Stephenson Landscaping Services LLC. Pretty darned witty if you ask me.


3-31-2012 7-12-30 PM

Survey respondents say that companies in the hospital and physician practice market will lag those that are working in interoperability and post-acute care. New poll to your right: how will the Supreme Court rule on PPACA? (no fair answering after the decision is announced.)

My Time Capsule editorial this week from the 2007 vault: Brailer’s Santa Barbara RHIO Baby Goes Down the Tubes. The expensive flop that was the Santa Barbara RHIO launched David Brailer into the first ONC job and got everybody stoked about interoperability despite not having one iota of impact on patients or providers. Some of my parchment-scribed words from way back then: “SBCCDE was a ‘big hat, no cattle’ kind of project that left two sad legacies: (a) it blew millions in grant money,  and (b) it seduced politicians and reporters into thinking they’d seen the Second Coming of CHINs, only destined for success this time. They were half right.”

Readers keep asking me to do some kind of “top stories” summary each week. I used to do that with the Brev+IT newsletter I started, in which I rattled off stream-of-consciousness cynical musings about the week’s top news, usually after I was tired from writing HIStalk for the weekend and therefore likely to blurt out just about anything to get finished. I’ll revive that practice at the bottom of this post and give it a try for a few weeks. I’ll kill it if I get bored with it, if I don’t have the time, or if nobody seems to care much one way or another. I’m not looking to create more work for myself, but I’m pathologically eager to please.

3-31-2012 7-53-41 PM

Welcome to new HIStalk Platinum Sponsor TrustHCS. The Springfield, MO company’s consulting expertise covers coding, compliance, ICD-10, and cancer registry. Vacant coder positions threaten financial performance and TrustHCS can help out with staff augmentation or full outsourcing of coding services, with every one of the company’s employees holding AHIMA and/or AAPC credentials. They can work on-site or remote, with flexible pricing to meet budget requirements. The company can help provider organizations take advantage of the ICD-10 breather by performing the assessment, analysis, and education that they might have skipped back when the implementation deadline was looming. TrustHCS works with hospitals, practices, ambulatory surgery centers, and any other provider organization that does coding, offering whatever level of support is needed to optimize the revenue cycle. The company can provide the oversight and coding compliance training needed to avoid headlines that throw the whole “bad press is better than none” concept into serious doubt. Relationship matters and experience leads at TrustHCS, whose support I gratefully acknowledge.

3-31-2012 7-33-31 PM

3-31-2012 7-36-31 PM

Weill Cornell Medical College establishes the Center for Healthcare Informatics and Policy, which will conduct HIT-related research and offer a two-year fellowship in quality and informatics. Rainu Kaushal MD, MPH, a medical informatics professor and director of pediatric quality and patient safety at New York-Presbyterian Hospital, will serve as executive director.  

A nice HIStalk Practice post by Dr. Gregg poses the question: are EMRs to blame for terse physician documentation, or are lengthy patient “stories” less common due to (a) lack of physician time, (b) wordy residents who grew up to be more concise, or (c) lack of value when documenting the same old acute conditions over and over?

Vince continues his HIS-tory this week with Part 2 on MedTake. These pieces aren’t just overly fond looks back at long-dead companies – they always contain lessons that might prevent someone from repeating the same mistakes.

3-31-2012 8-39-21 PM

HIT Application Solutions raises $2.75 million in a Series A funding round. The Exton, PA company offers the Notifi communications platform for alerts, broadcast communications, and critical test results.

3-31-2012 8-41-37 PM

San Francisco-based healthcare IT incubator Rock Health will expand to Boston in June, adding a program on the campus of Harvard Medical School.

4-1-2012 7-31-47 AM

Epic did its always entertaining April Fool’s Day page, even dropping in an Inga mention with ”The Shoe’s on the Other Foot: HIStalk’s Inga Disputes Rumor She Wore Birks to Symphony.” I like it because I did a similar HIStalk spoof years ago and referred to Epic as the Birkenstock-wearing crowd.

E-mail Mr. H.

The Healthcare IT Week in Review

1. Vocera IPO Shares Jump 50%, Meaning the Company Paid Good Money for Bad Pricing Advice

Facts and Background

Shares in mobile healthcare communications Vocera jumped almost 50% in their first three days of trading after Wednesday’s initial public offering, opening at $16 and closing Friday at $23.40.


The company either priced its shares incorrectly or intentionally undervalued them to create positive press from the price run-up. Either way, investors and not the company pocketed the $41 million price difference in the 5.9 million shares offered. Still, the company was smart enough to up the originally planned $12-14 price. A $100 million IPO yield is impressive for a company that isn’t all that widely known and that lost money in FY2011.


  • Timing is everything when it comes to IPOs. Riding Facebook’s IPO coattails isn’t such a bad thing, at least unless Facebook stumbles.
  • The company, like most hardware vendors that are anxious to avoid commoditization and increase margins and professional services income by turning themselves into software vendors (think RTLS and bed management systems), markets benefits around its “Star Trek” badge communicators that include care transition, patient transfer optimization, and patient discharge communication.
  • Vocera made some key acquisitions in the past couple of years: Wallace Wireless in January 2011 (delivery of alerts to smart phones) and two White Stone Group spinoffs in November 2010 (handoff communications.)
  • More acquisitions are sure to come now that the company has $94 million of IPO money in the bank and needs to feed the earnings engine. A priority will almost certainly be value-added software for nurses that can run on the company’s existing communication platform since nurses are its primary users and therefore are most likely to advocate new purchases to otherwise indifferent hospital executives.
  • Chairman and CEO Bob Zollars, who joined the company in 2007, was best known as having run high-flying healthcare supply chain vendor Neoforma, and before that having executive roles at Cardinal Health and Baxter. He rode the irrational exuberance bubble hard in January of 2000, when Neoforma.com’s IPO, priced at $13 for 7 million shares, soared to $52.38 on their first day of trading. Not bad for a company with revenue of $464,000 in the previous nine months, in which the company lost $25 million but formed a complex ownership and incentive agreement with hospital buying groups VHA and UHC. Neoforma announced plans to buy Eclipsys for $2.1 billion of its stock in March 2000, but backed off two months later when its own shares dropped by 70%. He knows how Wall Street works and has a real company with strong revenue this time around.
  • It’s interesting that the Vocera IPO did so well while investor interest in the HITECH-goosed side of HIT seems to be waning. But everybody likes IPOs, at least for the first few weeks before the quarterly earnings grind sets in.
  • I don’t see Vocera getting into the mHealth market, but the successful IPO gives it a strong position in mobile apps for clinicians. It needs a doctor product, though, preferably one with direct impact on patient outcomes since that’s what hospitals will pay big bucks for.

2. Tampa Doctors, Hospitals Fight Over Which Group Will Lead Their Selfless Data Sharing Efforts

Facts and Background

A group of Tampa-area hospitals and the county medical association are pursuing independent efforts to share electronic patient information.


Florida has quite a few active HIE/RHIO projects that haven’t made much progress, probably because competition there, particularly among large health systems, is intense. This is one of few times where the previously unstated suspicion and distrust came right out on the table, as observed by a perceptive local reporter.


  • Neither group seems to be making much progress, which isn’t surprising when asking competitors to collaborate selectively with unknown benefits to each.
  • Florida’s AHCA issued a four-year, $19 million contract to Harris Corp. in late 2010 to develop a statewide HIE. Two months later, Harris announced that it had acquired Carefx, which offers the Fusionfx data sharing technology for competitors that need to exchange information. The only progress I’ve heard of is the availability of a secure e-mail program for providers and limited patient look-up services among the Big Bend RHIO and a couple of health systems, but it’s only been a year. I don’t know who’s getting ONC’s HIE grant money in Florida.
  • Hospitals bring most of the money and technical expertise to the table, while practices create much of the information that needs to be shared. Doctors also believe their motivations are purer than those of hospitals, which have a reputation for wanting to control anything they’re involved with for their own financial or strategic benefit. That plus the technical challenges may kill this initiative off early.
  • The main benefit of interoperability comes from hospitals exchanging information with their affiliated practices, which they often undertake without going to a third-party interoperability project. Unlike in some areas, Epic does not dominate the Tampa market. That would be an interesting follow-up article for the reporter – how well do the hospitals that want to control this project interoperate with their owned or affiliated practices?


3. Post-Op Patients Love iPads So Much They Don’t Mind that their Surgeons Don’t Visit Them

Facts and Background

Henry Ford Health System implements telerounding, where post-operative patients are given iPads to communicate by video with their surgeons, who may be miles away.


This is a really good idea since it seems cool and high tech, but basically frees surgeons of the requirement to actually make post-op rounds and makes them immediately available so that delayed actions don’t hinder the discharge pathway. But most of all because this is the first high-profile use of the iPad by patients since video projects usually involve Skype on PCs.


  • Post-op patients are usually coherent and can report their own medical situation, so this is more like ambulatory telemedicine than remote ICU monitoring.
  • Using iPads is a smart idea since they are portable and cheap. Installing telepresence hardware in individual patient rooms would be ridiculously expensive, and the enhanced video quality would offer no advantage when the intention is simply to chat with the patient. Observers often overlook the iPad’s price and maintenance advantage – it does a lot for $500.
  • Cynics might say that a phone call would work just as well as a video call, but physicians like seeing and not just hearing.
  • Once the iPads are in the hands of patients, their use could be extended to video-based patient education and self-documentation.
  • Once again Apple products prove their medical value not because of more in-depth technical capabilities over PCs, but because they are easy and fast to use, especially since a lot more people know how to use iOS products like the iPhone than have Windows expertise.
  • It’s easy to see how this project could be translated into home health or skilled nursing care, where it’s just not practical to have an ongoing physician presence. For that matter, a nurse could round with a single iPad as the physician participates by video.
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March 31, 2012 News 3 Comments

News 3/30/12

March 29, 2012 News 2 Comments

Top News

3-29-2012 9-40-00 PM

Vocera shares gain 40% over the $16 offering price in the company’s Wednesday IPO. Shares were up another 19% Thursday to $24.91, giving VCRA a 56% jump in the company’s first two days of being publicly traded.

Reader Comments

3-29-2012 9-45-10 PM

From Max: “Re: Microsoft/Sentillion. The bloodbath is in full effect. Employees received either a 60-day notice this week or an offer to move to Caradigm. I’ve heard losses on the Amalga side were significant.” Unverified. I asked my Microsoft contact, who says that like most companies, Microsoft doesn’t comment publicly on HR-related questions.

From HMSUser: “Re: HMS CEO. ‘Resigned’ last Friday, rumor that more high-level people will be shown the door.” Unverified, but Tom Stephenson’s bio has vanished from the executive team page. HMS’s parent company, HealthTech Holdings, has been owned since 2007 by private equity firm Primus, whose other healthcare IT-related investments include InSite One, Medhost, and Passport Health Communications.

From Epic-urious: “Re: Epic leading the market and gunning for the big guys. I’ve only read a few new customer updates. Where are all of these new customers?” Just to be clear, Epic is the big guy now, so there’s nobody left to gun for in terms of penetration of patients and providers (not necessarily in  number of hospitals since it’s a lot easier to dominate the market selling to one 1,000 bed hospital than ten 100-bed ones.) The company doesn’t announce sales, so new customers come to light only casually, like at conferences with mostly large-hospital attendees, where just about everybody finds out simultaneously that they’re all implementing Epic. Another way to look at it: the lack of significant sales announcements from Epic’s competitors, who do indeed happily announce new sales when they can get them.

HIStalk Announcements and Requests

3-29-2012 9-30-41 PM

inga_small This week on HIStalk Practice: a physician being sued by his former practice resigns over “technology troubles” and “billing errors” that he claims were the caused by computer problems. CMS offers help to providers not deemed “successful electronic prescribers” in 2011. Nancy Pelosi’s connection (or lack of one) between Practice Fusion’s rapid growth and the Affordable Care Act as she cuts the ribbon at the company’s new building (above.) Brad Boyd urges providers to continue moving forward on their ICD-10 transition. In our reader survey, 85% said reading HIStalk Practice helped them perform their job better last year, so if you’re in ambulatory HIT and need performance enhancement, you should be reading.

Listening: new from The Mars Volta, complex, perfectionist progressive rockers from El Paso, TX. An Amazon reviewer said it well: they’re what Led Zeppelin would have sounded like time warped into 2050. Dead ringers for Manfred Mann’s Earth Band at the 4:10 mark of the video, but very Zeppelin-like at 5:00. And I’m reflecting on the amazing musical contributions of Earl Scruggs, who almost single-handedly gave non-hayseed credibility to both the banjo as a musical instrument and to bluegrass as a uniquely American musical genre and who died Wednesday at 88. Foggy Mountain Breakdown was the speed metal of its day and it still sounds amazing as I listen to it right now.

Acquisitions, Funding, Business, and Stock

3-29-2012 9-47-54 PM

ClearDATA Networks, which provides healthcare cloud computing services, secures funding from Norwest Venture Partners and several angel investors.

3-29-2012 9-48-34 PM

Seven-month-old hospice management software vendor Hospicelink of Birmingham, AL says it expects $50 million in sales by the end of 2012. Color me skeptical.

3-29-2012 9-49-13 PM

Ann Arbor, MI-based HIE vendor CareEvolution is expanding its 22-employee workforce to 38, expecting to hire three software developers per quarter. I notice from the company’s site that they claim a trademark on the term One Patient, One Record, which I would associate more with Epic than CareEvolution, which I’ve heard of only once when a reader said they did an impressive demo but still lost the West Virginia Health Information Network bid. UPDATE: the company clarified the newspaper article – it has 38 employees now (22 of them in Ann Arbor) and will add another 15. WVHIN did choose Thomson Reuters’ HIE Advantage, but that product actually runs CareEvolution’s HIEBus under an expanded agreement between the companies signed in February 2011, so CareEvolution is in place (and scheduled for go-live next month) even though the announced winner was Thomson Reuters.

3-29-2012 9-52-02 PM

BlackBerry maker Research in Motion reports sagging sales, a quarterly loss, and an executive housecleaning. The CEO says he won’t rule out selling the company now that he’s seen from the inside just how dire the situation is, although he’s hoping for a turnaround. The steep downward slope above is the one-year share price, down 75%.


3-29-2012 9-56-45 PM

Asante Health System (OR) selects iSirona’s medical device connectivity solution to populate patient data in its Epic system.

Memorial Hospital of Union County (OH) selects Wolters Kluwer Health’s Provation MD for its gastroenterology and pulmonology departments. In addition, Duke University Health System (NC) licenses ProVation Order Sets.

3-29-2012 9-57-48 PM

Duke University Health System (NC) selects M*Modal Speech Understanding technology to support the Epic system it’s implementing.

Two practices within the University at Buffalo School of Medicine select PatientKeeper Charge Capture, which will be integrated with UBMD’s GE Centricity Group Management PM product.


3-29-2012 5-38-12 PM

EMR vendor CareCloud appoints PowerReviews CEO Ken Comée to its board.

3-29-2012 5-39-26 PM

Online physician networking site Sermo names former Revolution Health president Tim Davenport CEO. He replaces founder Daniel Palestrant, who left the company in January to run Par80, a startup focused on patient referrals.

3-29-2012 5-41-45 PM

Aventura hires Brian Stern (NewsGator Technologies) as SVP of sales and marketing and Brandi Narvaez (Sentillion, Vitalize – above) as chief customer officer.

3-29-2012 5-42-52 PM

eMerge Health Solutions, a provider of voice-powered documentation systems, hires Trent McCracken as president and CEO. He was previously owner of a telecommunications software company.

Announcements and Implementations

St. Francis Hospital & Health Services (MO) will go live on Epic Saturday morning.

3-29-2012 9-59-45 PM

The Verizon Foundation donates $100,000 to launch a telemedicine pilot project at Children’s Hospital of Philadelphia. CHOP will offer community hospitals consults with its pediatric specialists.

Government and Politics

The New York eHealth Collaborative and the New York State Department of Health form the Statewide Health Information Network of New York Policy Committee, tasked with updating and creating policy measures to protect PHI while expanding the state’s ability to electronically share clinical data.

The White House announced Thursday that various government agencies will invest $200 million of taxpayer money in so-called “Big Data” R&D. A NSF/NIH project will look at large-scale health and disease databases.

It’s not healthcare related, but it’s another hugely expensive government computing foul-up: the State of California pulls the plug on a $2 billion court system that still isn’t fully rolled out 11 years after the project started. The project was originally supposed to cost $260 million, with a state audit last year finding that the massive overruns were due to poor management of contractors. An IT project failure expert said, “I am dumbstruck over the incredible waste and obvious poor planning associated with this system. This failure only adds to California’s reputation as the land of IT boondoggles”


Henry Ford Hospital (MI) implements telerounding, in which minimally invasive surgery inpatients are given an iPad to post-operatively communicate with their remotely located surgeons using the FaceTime video chat app.


Weird News Andy likes this video story of a BYU nurse practitioner student whose professor, while observing her practice thyroid exams in her third week of class, happens to notice that she has a hard-to-spot tumor. The mass turned out to be highly aggressive, but she’s OK after fast-track surgery and radiation therapy. She will take a nurse practitioner job at the Thyroid Institute of Utah when she graduates this summer.

Hill-Rom joins Stryker and Zimmer in laying off hundreds of its employees to offset the cost of complying with a new medical device tax that takes effect next year. The 2.3% tax, enacted in the Affordable Care Act, is based on company revenue regardless of profitability. The industry estimates the tax will cost its members $30.5 billion and could result in the loss of up to 38,000 jobs.

3-29-2012 9-07-00 PM

Howard University Hospital (DC) notifies 34,000 patients that their health information was potentially exposed in January when a laptop was stolen from the car of a contractor who had downloaded the information in violation of hospital policy. The contractor had quit working for the hospital in December 2011, but reported the theft on January 25 of this year.

The government’s bet-the-farm idea of paying hospitals for quality didn’t move the needle on deaths or readmissions in its own demonstration project, a study published Wednesday in the New England Journal of Medicine found. The Harvard public health author says incentives are the right idea, but the metrics aren’t yet right. He also says it’s nice when processes are executed consistently, but the only thing that counts is that patients get healthier, and that didn’t seem to happen here.

It’s definitely not up to the high snark standards of The Onion, but this satirical article called Myanmar Embraces Facebook as Electronic Medical Record is kind of funny. “Whilst Facebook users can currently Add and Delete Friends, the updated site is going to allow users to Add Doctors, Nurses and other allied health professionals, who can be granted varying degrees of access to confidential medical data. ” You just know someone out there is working on this already.

3-29-2012 8-17-57 PM

I probably would find a new press release headline writer.

Here’s what HITECH has driven providers to. Physicians at Samaritan Healthcare (WA) gripe at a hospital board meeting about the hospital’s new Meditech system, which the hospital freely admits it implemented for only one reason: to get a $2.2 million HITECH check. According to one doctor, Meditech is “… time-consuming, it is frustrating, it is archaic, it’s hard to work with … It didn’t matter what we said, you were going to go ahead and implement this because there were the economic benefits being reaped by the hospital at our expense.” In response, the hospital CEO admitted that the system isn’t ideal, but says now that the money’s in the bank, Meditech is history, its replacement to be paid for by the HITECH money Meditech earned for the hospital.

3-29-2012 9-00-20 PM

Strange: two-thirds of respondents to an online poll run by the Chinese Communist Party’s newspaper choose a “smiley face” as their reaction to a story about a medical intern who was murdered by an enraged patient in a hospital, apparently because doctors are right up there with government workers in being hated for insisting on being paid bribes to do their jobs. The poll was quickly taken down. The government reported that over 5,000 medical personnel were injured by patients in 2006, the last year such statistics were published. Experts blame the anti-doctor mood to the lack of a medical malpractice system to provide compensation for errors, physician salaries that start at only $500 per month, and the fact that doctors are legally paid commissions for orders written. It was also reported that some doctors are taking kickbacks from funeral homes for promptly alerting them of the newly deceased.

Sponsor Updates

  • EHRtv runs an interview with David Caldwell, EVP of HIE vendor Certify Data Systems, filmed at the HIMSS conference. We interviewed CEO Mark Willard last month.
  • Salar and Transcend will participate in the Society Hospital Medicine 2012 Conference April 1-4, 2012, in San Diego, CA
  • MedAssets launches its Population Health solution suite to support the industry’s transition to fee for service and accountable care.
  • Greenway Medical Technologies announces the availability of PrimeMOBILE for Android and tablet devices.
  • TELUS Health Solutions will license Get Real Consulting’s InstantPHRO to resell into Canada under the TELUS Personal Health Record brand.
  • MEDSEEK announces that its eHealth ecoSystem V4.0 is 2011/2012 compliant and certified as an EHR Module.
  • Queensway Carleton Hospital (Canada) is delivering ED records to more than 120 family doctors using TELUS Health Solutions’ CareShare technology. 
  • GetWellNetwork announces its fifth annual users conference, to be held April 30 – May 2 in Orlando.

EPtalk by Dr. Jayne


All eyes are on the Supreme Court this week. Oral arguments for the cases challenging the Affordable Care Act concluded Wednesday. This has been a busy week at work so I haven’t been able to process the transcripts as quickly as I’d like. Stay tuned for my detailed reaction in Monday’s Curbside Consult. I find the whole process fascinating. It wakes up the non-medical part of my brain with the interplay of the Justices’ personalities and the complexities of legal theories of intent, severability, and judicial restraint.

The focus on PPACA overshadowed dialogue on last week’s ruling that state workers cannot sue their employer for violating a part of the Family and Medical Leave Act. A 2003 decision allows suits against state agencies for violations related to leave taken to care for family members, this decision involves leave take by employees to take care of their own health. There are already many loopholes in FMLA due to multiple court challenges over the past two decades. Additionally, states have made their own requirements and definitions, turning it into a patchwork. It’s a great example of what might happen to PPACA over the next few decades should it be allowed to stand.

My other exciting reading this week has been the recently-issued NIST protocol on EHR usability. The three-step process includes EHR application analysis, user interface expert review, and user interface validation testing. There are some interesting points in the document. Check out Appendix A, which discusses the use of human factors engineering by the Department of Defense, the Nuclear Regulatory Commission, and the Federal Aviation Administration.

It also provides questions used to evaluate an EHR’s “aesthetic and minimalist design” and “pleasurable and respectful interaction with the user,” including whether the EHR has artistic value. I never found that documenting as required by CMS (and now other payers) is particularly pleasurable, nor do I find artistic value relevant to patient care. I don’t care how ugly it is — I just want it to be easy to use and comprehensive.


AHIMA announces the Grace Award, which recognizes excellence in health information management. Nominations are open through June 30 and the award will be presented at the annual meeting in September. I give this new award a thumbs up for aesthetic and minimalist design (NIST would be proud.) It would look great on my credenza.


Wireless medical monitoring devices are highlighted in an article published yesterday. I like the idea of an edible sensor integrated into a medication that can document when it was taken, although I don’t want to receive patient information on my phone so that I can try to interpret it “all without a visit to the doctor.” Let’s take it one step further and integrate a monitoring sensor into every Girl Scout cookie produced, and if too many are consumed at a single sitting, it can send warning texts to purchasers. Having just found a stash of Thin Mints at the back of my freezer, I could definitely use the moral support.


More news: HIStalk Practice, HIStalk Mobile.

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March 29, 2012 News 2 Comments

Readers Write 3/26/12

March 26, 2012 Readers Write 2 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!

If You Did It, Enter It in the EHR
By Mitch McClellan

3-26-2012 4-25-12 PM

I was recently asked the following by a colleague:

We know that every organization has some physicians who just will not fully use the EHR. They will have nurses, MAs, and other clinical staff do all of the data entry. They may just hand the staff a piece of paper and have them enter the problem list. A specific example would be the MU requirement for weight counseling – do you think it is acceptable for an MA to indicate in the record that the physician did the weight counseling? Clearly it makes sense to have nurses and other clinical staff enter medications and even other orders and even start notes, but where do you draw the line?

This question certainly walks the line between facilitating accurate data entry vs.what is appropriate.

If an organization is truly going to embrace this much-needed change in healthcare, they need to enforce that their clinicians do the right thing. In this case, it would be physicians taking 100% ownership of entering the documentation specific to weight counseling. They are the ones actually provided the counseling.

I understand that is a black-and-white response, but I strongly believe that if an organization’s culture accommodates physicians who choose not to do their complete EHR responsibilities (e.g. not documenting the counseling that YOU provided), then it defeats the entire purpose of what we’re doing.

The EHR revolution is strongly driven by the fact that paper is not efficient and creates too many points of failure. Not only is the medium (paper) antiquated, so are many of the policies and processes that support those paper workflows (e.g. documenting a note that you then pass on to someone else to then "document a note" on your behalf).

Unfortunately, I believe most physicians are put into a "get it done now vs. a get it done right" scenario due to the payers’ stringent reimbursement policies. I completely understand the time demands on these physicians. But the rule I try to instill with all of my groups is that, "if you did it, then you must enter it in the HER." Otherwise, the effectiveness and efficiencies of an EHR are lost if the old way of doing things is still embraced.

The groups that I’ve worked with would require the physician enter that piece of documentation themselves instead of the MA. The only groups that I’ve worked with that would allow this scenario to happen would be if it was the physician’s nurse — not an MA –entering the documentation. To me, the issue is twofold. The first is workflow (reasons already stated), the second is the lack of credentials of an MA. I know I’d want a higher-credentialed healthcare provider entering that information if it’s not the physician themselves.

Mitch McClellan is manager of implementations at MBA HealthGroup of South Burlington, VT.

By Dave Vreeland

3-26-2012 7-26-43 PM

Cumberland brought together a select group of HIT executives from some of the nation’s leading health systems for a recent breakfast discussion The topic: optimization.

Now that many are on track for Stage 1 Meaningful Use and other compliance deadlines, the focus is beginning to shift beyond go-live toward getting the most out of HIT systems. The panel, made up of Cumberland’s Brian Junghans, HCA’s Dr. Divya Shroff, and Memorial Healthcare System’s Jeff Sturman, shared how non-profit Memorial and industry giant HCA are tackling optimization.

The takeaway: success largely hinges on solid communication and the collaboration of two very different worlds – IT and clinical. Clinicians are arguably the keystone in achieving effective system adoption and long-term optimization.

Junghans points out that IT folks tend to think in terms of projects, which have a defined beginning and end. When it comes to IT implementation projects, the end is go-live. In contrast, optimization is an ongoing effort.

Dr. Shroff points out that clinicians have more of an optimization mindset, with a continuous focus on improved quality of care, optimal patient outcomes, and best practices.

With techies and clinicians in different mindsets, speaking two different languages, communication issues are common. HCA has success placing physicians and other clinical professionals like Dr. Shroff in clinical transformation roles. Valuable insight and hands-on experience makes these clinicians effective ambassadors for both the IT and clinical teams. 

Sturman and the Memorial team have incorporated clinical aspects into their approach to optimization. The team makes regularly scheduled rounds to observe workflow, system usage patterns and identify opportunities for improvement throughout each of their six hospitals, clinics, and ambulatory practices.

The importance of a clear distinction between IT support and optimization teams was also stressed. HCA trains the IT support team to triage incoming calls, address specific break/fix issues, and refer optimization matters to the optimization team.

Both organizations have seen success with various efforts to improve clinical/IT relations and are on track with current and long-term efforts toward optimization.

In addition to a number of lessons learned and critical success factors to consider during and after the implementation process (summarized in our presentation Beyond Go-Live: Achieving HIT System Optimization), it was interesting to hear this room of executives from diverse organizations, representing both the clinical and IT fields, reinforce the significant impact collaboration between the two worlds has on the success of end-user adoption and achieving true optimization.  

Dave Vreeland is partner with Cumberland Consulting Group of Franklin, TN.

Stage 2: The Vendor View
By Frank Poggio

3-26-2012 7-47-00 PM

On March 7, 2012, a draft for comment on the new Stage 2 rules was published in the Federal Register. Actually there were two separate parts to the rules. They are:

  1. The CMS part that is aimed at provider requirements necessary to meet Meaningful Use, and
  2. The ONC piece that addressed proposed changes to the certification process for EHR vendors.

On the provider side, there are innumerable blogs and Web sites that are covering the provider issues, which deal mostly with a few added MU criteria such as electronic medication administration records, menu options in Stage 1 that are now mandatory in Stage 2, greater emphasis on exchanging patent care information across care levels, and greater patient access to care information.

This article will focus on the “second side” of the regulations — the elements that most impact the system suppliers, with emphasis on the impact to niche or best-of-breed (BoB) vendors.

The full text of the new ONC Certification proposed rules can be found at here.

Before we hit the high (and low) points of the rules keep in mind these are proposed rules. If there is anything you don’t like about them, have suggestions for improvements, etc. you have from now until June 7 to post comments on the federal Web site. Speak now or forever hold your price! (No that is not a typo … see the Ugly).

Here’s the Good, the Bad, and the Ugly of proposed certification changes for vendors.

The good news:

Privacy and Security — will it go away?

EHR Module certification gets a little easier for niche and best-of-breed vendors (BoB). The big change here is that Module certification no longer requires you to address any of the privacy and security criteria. In the past, there were eight P&S criteria (number nine was always optional), and in our working through many ATCB tests, if you said the right phrase, you could get a waiver on three others (Integrity, General Encryption, and HIE.) Proposed under the Stage 2 as a niche/BoB vendor, you can ignore all the P&S criteria. To get certified under Stage 2, it would seem all you will need to do is pass any one Inpatient, Ambulatory, or General criteria, just ignore the P&S criteria, and you’re home free.

ONC said they made this change because many of the smaller firms complained that the P&S criteria did not apply or were too burdensome. This may sound too good to be true. Maybe it is. Read what ONC says in other parts of the document:

Finally, we propose to require that test results used for the certification of EHR technology be available to the public in an effort to increase transparency around the certification process. We believe that there will be market pressures to have certified Complete EHRs and certified EHR Modules ready and available prior to when EPs, EHs, and CAHs must meet the proposed revised definition of CEHRT for FY/CY 2014. We assume this factor will cause a greater number of developers to prepare EHR technology for testing and certification towards the end of 2012 and throughout 2013, rather than in 2014.

This is classic ONC. They say you don’t have to get certified. There is no law that says any vendor MUST – even a full EMR vendor. They believe the market will tell you. And by the way, ONC will be publishing the details of your certification so the world can compare you against your peers.

As we tell our clients, the MU criteria you choose to test on is dictated more by your competition and clients, not by the ONC.

Gap certification for Stage 2

A question that we have heard frequently was if I was certified on 20 criteria for Stage 1, under Stage 2, would I have to be tested again for those same criteria? Under the proposed Stage 2 rules, you would not need to get re-certified on Stage 1 criteria. You will only have to be tested on new criteria you select, and tested on Stage1 criteria that has changed or been revised by ONC.

A good example is the encryption P&S test. The focus now will be on encryption for data at rest. They state:

EHR technology presented for certification must be able to encrypt the electronic health information that remains on end user devices. And, to comply with paragraph (d)(7)(i), this capability must be enabled (i.e., turned on) by default and only be permitted to be disabled (and re-enabled) by a limited set of identified users.

So if you tested out on encryption under Stage 1 and want to carry it forward into Stage 2, you’ll probably have to show how you default encryption for user devices.

Component EHR vs. Complete EHR

A typical misunderstanding we came across many times during past year taking our clients through the certification process was a CIO at a hospital would say to the vendor that he/she believed they had to install a full EMR from a single vendor to meet all the MU criteria. In the proposed regulations, ONC has clearly addressed this question. On page 104, they say:

Certified EHR technology means: 1. For any Federal fiscal year (FY) or calendar year (CY) up to and including 2013: i. A Complete EHR that meets the requirements included in the definition of a Qualified EHR and has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition EHR certification criteria or the equivalent 2014 Edition EHR certification criteria; or ii. A combination of EHR Modules in which each constituent EHR Module of the combination has been tested and certified in accordance with the certification program established by the National Coordinator as having met all applicable certification criteria adopted by the Secretary for the 2011 Edition HER certification criteria or the equivalent 2014 Edition EHR certification criteria, and the resultant combination also meets the requirements included in the definition of a Qualified EHR.

In effect, a provider could meet the MU criteria using as many suites of BoB systems as they believe necessary. They do not have to be from one or the same vendor.


Now some bad news:

Criteria components

Many BoBs struggled with the make up of the criteria for Vitals and Demographics and several other clinical criteria. On the surface, they seemed easy to pass. The problem was they contained some data elements that were not typically found in BoB systems. For vitals, the hurdle was growth charts. For demographics, the hurdle is date and time of death. To pass these criteria, some vendors would use user-defined fields or create new inputs that they knew their clients would never use. Repeatedly I was asked by niche and BoB clients, “Why would you ask a patient during a registration process, ‘When did you die?’” Now there’s a comforting dialog!

Keep in mind several or the participants in building the HITECH/MU program were academics and researchers who would find that piece of information critical to their retrospective medical data analyses. Also, vendors of full EMR systems would easily have that piece of data readily available in their medical record abstract system. But for an ancillary or niche vendor, not likely. As far as I know, there were no niche or BoB vendors represented on any of the HITECH Policy or Standard Committees.

You may wonder why any firm would go through the trouble of adding a useless data element. Again, keep in mind what ONC said above: market will require certification. It can be virtually impossible to sell an ancillary system such as surgery, ICU monitoring, therapy, anesthesia, etc. if you had to tell your prospect your product was not certified for vitals.

Unfortunately this issue is still there for BoBs. The big change is on the provider side. ONC has greatly liberalized the granting of exceptions to providers for MU attestation if the MU criteria (or element of the criteria) do not apply to their practice of facility. As an example, a psychiatrist does not have to do growth charts for his patients — an exemption will be readily available. But the vendor who sold him the system still must!

Continuing this topic, in a recent interview Dr. Mostashari chided EHR vendors who "aren’t making meaningful use of Meaningful Use." Instead of attempting to seamlessly incorporate MU standards into their interfaces, Mostashari said "vendors did what vendors do—they slammed in the criteria and got certified.”

I submit that ONC slammed these regulations into being as fast as they could due to Congressional and Executive pressure, so one good slam deserves another. Maybe if ONC took a moment to look at the impact of certification on niche and BoBs — which are mostly the smaller, more innovative developers — and adjusted the criteria, we all could stop slamming.


And now the ugly:

As I mentioned in an earlier HIStalk post, ONC wants comments on vendor product price transparency. Here’s the ONC statement:

During implementation of the temporary certification program, we have received feedback from stakeholders that some EHR technology developers do not provide clear price transparency related to the full cost of a certified Complete EHR or certified EHR Module. Instead, some EHR technology developers identify prices for multiple groupings of capabilities even though the groupings do not correlate to the capabilities of the entire certified Complete EHR or certified EHR Module. Thus, with the transparency already required by §170.523(k)(3) in mind, we believe that the EHR technology market could benefit from transparency related to the price associated with a certified Complete EHR or certified EHR Module. We believe price transparency could be achieved through a requirement that ONC ACBs ensure that EHR technology developers include clear pricing of the full cost of their certified Complete EHR and/or certified EHR Module on their websites and in all marketing materials, communications, statements, and other assertions related to a Complete EHR’s or EHR Module’s certification. Put simply, this provision would require EHR technology developers to disclose only the full cost of a certified Complete EHR or certified EHR Module.

As a former CFO, I know that the through definition of ‘full cost’ would take at least another 500 pages in the Federal Register. After the vendors in the audience come down off the ceiling, you’d probably like to share your reaction with ONC. Just click here.

Frank L. Poggio is president of The Kelzon Group.

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March 26, 2012 Readers Write 2 Comments

News 3/23/12

March 22, 2012 News 4 Comments

Top News

3-22-2012 9-10-24 PM

Thomson Reuters reportedly puts its healthcare data and analytics unit back on the market after shelving the process last year due to tough market conditions. Multiple bidders may be vying for the business, which is expected to fetch up to $1 billion.

Reader Comments

mrh_small From Willy Loman: “Re: Imprivata. Being sued for patent infringement for its OneSign SSO.” I Googled and came up with a new suit brought by CeeColor Industries LLC claiming that Imprivata is infringing on its 1999 patent for proximity-based security using electronic sensors. Imprivata’s OneSign uses a webcam with optional facial recognition software to validate a user and lock their session when they walk away. I can find nothing about CeeColor Industries, which suggests that their primary business, if they have one beyond just owning a patent, at least isn’t extortion by litigation. Companies get sued all the time for reasons both valid and not, so I wouldn’t get too excited about this lawsuit just yet. I interviewed Imprivata CEO Omar Hussain a year ago and asked him about Secure Walk-Away and how the webcam aspect works. Above is a video that explains it.


3-22-2012 6-52-20 PM

mrh_small From James: “Re: Roy the HIStalk King. We (Medicomp) had Roy’s HIStalkapalooza sash framed. He seems very happy about it ;)” Roy Soltoff from Medicomp was not only named HIStalk King, he also served as part of Inga’s security detail for her Quipstar competition. You can see Roy in action in the excellent HIStalkapalooza video that ESD put together (he wins at the 2:30 mark.) His beauty queen sash looks good up there on his wall and the color / black and white photo effect is cool (either that or Medicomp and its people are very drab.)  

mrh_small From Roller Boy: “Re: Allscripts. Downgrades from Jim Cramer and JP Morgan have created the perfect storm. Night and weekend meetings with board and execs with talk of impending changes.” Unverified and unwarranted, I’d say, given that shares are down only 6% in the past month, although the Nasdaq was up 4% in that same period. Other brokers have stood by their recommendations and neither Cramer or Morgan said anything new – they just recited the obvious challenges the company faces in integrating and selling Sunrise after its $1.3 billion acquisition of Eclipsys, if indeed that’s such an important driver of their business. My interview with Phil Pead and Glen Tullman about the acquisition is here and worth a revisit since I asked some tough questions, like how their performance should be graded two years down the road (that date is coming up soon.) I also said this about Eclipsys when the deal was announced in June 2010:

Despite the arguably superior CPOE and clinical documentation capabilities of Sunrise, it has competed poorly against Epic and Cerner … Nearly 40% of ECLP revenue supposedly comes from about 20 big customers … Eclipsys most likely paid big money for its recent acquisitions, buying the former Medinotes/Bond practice EMR products, EPSi financial management, and Premise throughput management as it desperately sought to diversify away from its at-risk Sunrise user base. Those acquisitions didn’t seem to do much for the company’s performance … It’s late in the HITECH land grab to try to integrate companies and products in the hopes that enough hospitals are left that haven’t locked into their vendor partners to prepare for Meaningful Use. This would have been a much better deal a year ago.

mrh_small From HITwatcher: “Re: system sales. A quiet year as everyone is hunkered down protecting their base while Epic continues to go after the huge brass rings. Will Partners really announce a choice of Epic by April 1? Dunno, but they will go that route, then on to HCA for the no pie-in-face lady.”

HIStalk Announcements and Requests

inga_small What you missed if you didn’t check out HIStalk Practice this week: Dr. Gregg’s recent cloud/hosted server debate. Joslin Diabetes Center (MA) offers national telehealth services. Practices adopting the PCMH model of care have higher staff morale but also higher physician burnout. EZ DERM incorporates Nuance’s medical speech capabilities into its iPad EHR. Practice Fusion offers free interfaces to 16 reference labs. While you are stopping by HIStalk Practice, take a moment to sign up for the e-mail updates because it will keep you smart and make make me feel loved.

inga_small My Internet (and cable TV) went out earlier this week, so I have resorted to tethering my laptop to my iPhone for Internet access. It’s not an ideal solution (the connection seems to drop at least once an hour) but it’s actually pretty handy. I’ve used the tethering option a bit in the past when I’ve bee in an area without free Wifi, but never before full time. I wouldn’t trade trade tethering for my high-speed cable, but it’s a surprisingly workable solution. Meanwhile, I keep wondering if no cable TV means no recordings of American Idol on the DVR.

mrh_small On the Jobs Board: Release Manager, Consultant, Application Developer. On Healthcare IT Jobs: Director of Federal Health Business Development, Technical Project Manager, Health Information Systems Programmer/Analysts.

mrh_small Inga, Dr. Jayne, and I are emotionally needy. We yearn for intimacy and fulfillment with our much-loved readers, but alas, our anonymity and geographic separation preclude such contact. Therefore, like a prisoner who proposes surreptitious visual stimulation from the other side of the telephone room glass or requests passionate mail in lieu of physical contact, may I suggest that you: (a) sign up for the e-mail updates; (b) engage in the mutually satisfying activity of liking, friending, and connecting via the appropriate online services in which we dwell; (c) send us news, rumors, or anything else that might serve as a fancy-tickler; (d) review and click some sponsor ads, marveling that otherwise button-down companies publicly support our unpolished journalistic style and sophomoric humor because their executives at times find as amusing and informative as a hyperactive, crude teen armed with neighborhood gossip; (e) check out the Resource Center for more sponsor information and the Consulting Engagement RFI Blaster to painlessly request consulting proposals; and (f) enjoy our fleeting moments together since one of these days when I’m no longer clacking the keyboard, you’ll be bereft of musical recommendations and HIMSS booth critiques. Thanks for reading, since without you all this typing would be pointless.

Acquisitions, Funding, Business, and Stock

3-22-2012 9-34-04 PM

On Assignment, a provider of temporary workers to IT and healthcare companies, will purchase IT staffing firm Apex Systems for $383 million in cash and $217 million in new stock.


Xerox’s IT division wins a 10-year, $1.6 billion contract to oversee claims processing for California’s Medicaid program.

WESTMED Medical Group (NY) chooses UnitedHealthcare and Optum to help it launch an ACO for its 220 physicians in Westchester County, NY.


3-22-2012 5-57-34 PM

The Huntzinger Management Group hires Nancy Chapman (ACS) as practice director of ICD-10 transition and RCM services. We also note that she is part of an exclusive group of 2,324 industry leaders who have joined the HIStalk Fan Club that long-time reader Dann started and maintains on LinkedIn.

3-22-2012 6-01-19 PM 3-22-2012 6-02-39 PM

LifePoint Hospitals (TN) appoints Karla Schnell (North Highland) as senior director of informatics and Paige Porter as senior director of pharmacy informatics.

3-22-2012 7-49-11 PM

National coordinator Farzad Mostashari will present the opening keynote address at the Summit on the Future of Health Privacy in Washington, DC on June 6-7, hosted by Patient Privacy Rights and Georgetown University. Security expert Ross Anderson PhD, FRS will also address the conference and Rep. Joe Barton (R-TX) will receive an award for his support of privacy and security protections in the HITECH act. Registration is free.

Announcements and Implementations

US Preventative Medicine announces an agreement to offer its wellness platform through Dossia’s Health Management System.

3-22-2012 6-04-50 PM

HIMSS names The Health Information Exchange Formation Guide, written by Laura Kolkman and Bob Brown, as its 2011 Book of the Year.

PerfectServe announces that its clinical communication applications are available for BlackBerry and Android smart phones.

iMDSoft’s MetaVision Suite for ICUs and ORs earns ONC-ATCB 2011/2012 certification.

Elsevier signs an agreement with ExitCare LLC to offer its patient education information via Elsevier’s Clinical Pharmacology electronic reference. Elsevier will also offer ExitCare licenses to its customers.

Air ambulance operator Mercy Jets implements iPad-based medical records, allowing its medical teams to monitor vital signs and to document care delivered during patient transport.

In England, Northumbria Healthcare NHS Foundation Trust goes live on NextGate’s Multi-Language EMPI for its clinical portal that links multiple systems.

Government and Politics

3-22-2012 10-01-06 PM

HHS launches a developers’ challenge to design Web-based applications that use Twitter to track health trends in real time, allowing officials to identify emerging health issues.

3-22-2012 10-02-16 PM

The FDA’s Janet Woodcock MD says the agency could do a better job of predicting the effectiveness and safety of new drugs if it were able to collect information from the field electronically rather than relying on voluntary drug company reporting.

3-22-2012 8-02-06 PM

mrh_small The State of Maryland, along with the CRISP RHIO and the Abell Foundation, launches a competition to identify innovative ways to improve public health using clinical information available from Maryland’s HIE, either alone or tied into publicly available data sets (motor vehicle records, birth and death, boards of education, etc. or Maryland subsets of federal databases) Submissions can address either general public health issues or ideas related to the Million Hearts initiative to prevent heart attacks and strokes. Prizes are offered and submissions are due by April 16. If you don’t want to submit, you can vote – the first round of vetting and discussion will involve the public, who can participate right on the site.


Memorial Sloan-Kettering Cancer Center and IBM collaborate to combine the computational power of IBM Watson with MSKCC’s clinical knowledge and data to create an outcome and evidence-based decision support system.


The Saginaw newspaper describes Covent HealthCare’s used of 14 locally trained scribes in the ED to interact with its Epic system while the physician focuses on the patient. Doctors say they save at least an hour for every 25 patients they see.

3-22-2012 7-11-42 PM

mrh_small HIMSS clarifies that hotel rooms for exhibitors at HIMSS13 haven’t been released yet, so they aren’t showing up on the housing site. They says a “blog site” (obviously this one) said they’re full, which isn’t exactly true – a reader (two, actually) told me that rooms weren’t showing up and I said I don’t know anything about exhibitor housing since I’m a provider grunt, but I did see at least 10 hotels showing non-exhibitor availability. Like most everything else at the conference, high rollers (Diamond members) get first crack. It’s like college football programs that require a big upfront donation to earn the privilege of buying expensive football season tickets.

Epic is awarded a patent for a search method that provides a list of possible appointments that match require provider and resource criteria.

Federal agents seize documents and computers from the town hall of West New York, NJ, reportedly investigating possible insurance fraud by Mayor Felix Roque, a physician who runs a pain clinic. Campaign staffers of the mayor’s defeated political opponent admit that they provided information to federal authorities hoping to discredit him.

mrh_small A highly regarded and long-established family clinic in Wisconsin becomes one of the first in the state to stop accepting Medicare, citing inadequate payments and increasing expenses that include $700K for a new EMR. Says the founder: “I love taking care of Medicare patients, but every time we treat them we have to dig into our wallets. What kind of business model is that?” The doctor’s wife says he says up until midnight at home some nights to finish up his EMR charts.

3-22-2012 8-55-15 PM

mrh_small A former patient sues a just-closed eight-bed Ohio hospital, claiming the struggling facility refused to transfer him to a more capable hospital because it didn’t want to lose the revenue. The lawsuit claims that lack of prompt treatment of the man’s infection by Physician’s Choice Hospital resulted in gangrene that required surgeons to perform emergency surgery, which included removing skin from his penis. He said it hurt, of which I have little doubt.

Sponsor Updates

3-22-2012 6-50-24 PM

  • T-System posts a new video showing its T SystemEV EDIS.
  • Lifepoint Informatics announces that its March user conference was attended by over 40 clients, with a keynote address by Bruce Friedman MD on “The Continuous Search for Greater Lab Functionality: Best of Breed LIS versus Enterprise-Wide Solutions.”
  • GE Healthcare will introduce Centricity Cardio Enterprise at next week’s 61st Meeting of the American College of Cardiology.
  • TELUS Health Solutions announces the integration of HIPAAT’s privacy consent management services into its Assure EHR Integration Platform.
  • API Healthcare sponsors the DAISY Foundation, which honors nurses through its DAISY Award for Extraordinary Nurses.
  • MedAssets offers a case study of the $65.4 million it helped Texas Purchasing Coalition save from its supply chain.
  • White Plume releases AccelaMOBILE, a free physician charge capture app for mobile devices.
  • The Advisory Board Company launches its Innovations in Impact grant program designed to reward best practice-driven initiatives that articulate measurable, quantitative outcomes goals. The application deadline for the $20,000 per year grants is April 13.
  • Houston Orthopedic & Spine Hospital achieves Stage 1 MU using the Healthcare Management Systems (HMS) EHR. 
  • Gateway EDI earns full EHNAC Healthcare Network accreditation. Gateway also shares results of ICD-10 preparedness survey, which includes the finding that 56% of practices report are moving forward with ICD-10 preparation despite the enforcement delay.
  • DrFirst congratulates 44 of its EHR partners who were awarded the Surescripts White Coat of Quality for 2011.
  • Nuesoft posts a full transcript of its billing webinar series on third-party insurance billing.
  • An article by Santa Rosa Consulting’s Matt Wimberley discusses the opportunity to improve a hospital’s financial outlook through participation in the MU program.
  • Informatica highlights BCBS Michigan’s ICD-10 transition and Ochsner’s standardization on Informatica technologies for its HIE.    
  • Recondo Technology partners with ZirMed to offer the ZPay credit card and check processing solution.

EPtalk by Dr. Jayne


Several readers were taken with my article on the caduceus vs. rod of Aesculapius debate. Several mentioned Nehushtan, the fiery serpent used by Moses to heal those who looked upon it.

CMS asks  providers who feel they have received an ePrescribing penalty in error to contact them. Impacted providers may have had their G codes stripped by billing clearinghouses or may have reported the wrong annual code. Problems with hardship exemptions may also be the culprit.

HHS’s Office of the Inspector General approves Ascension Health Alliance to form a group purchasing organization, allowing it to offer its contracting services to hospitals and health systems outside of Ascension. The 21-state Ascension, the largest Catholic healthcare organization in the US, says formation of the GPO “demonstrates our commitment to transform healthcare by 2020.”

A research letter in this week’s issue of JAMA discusses the prevalence of physicians using social media to post unprofessional content online. Surveying state medical boards, the authors found violations that included inappropriate patient communication, sexual misconduct, prescribing without a clinical relationship, and online misrepresentation of credentials.

IBM Research teams with an Italian cancer center on a new analytics platform that will personalize treatment based on pathology guidelines and past clinical outcomes as documented in hospital systems. The Clinical Genomics tool can also provide an aggregated view of patient care.

AMA Board of Trustees chair Robert M. Wah MD reflects on his recent trip to the HIMSS conference, calling it “a gathering of more than 40,000 of my closest friends and colleagues.” Dr. Wah has an interesting pedigree: Navy active duty, deputy national coordinator for health IT and founding staffer at ONC, chief medical officer at Computer Sciences Corp., and head of the Navy’s largest OB/GYN training program. He’s an interesting guy and I am glad someone with his experience is chairing the board. I hope the AMA will show real healthcare IT leadership to reverse the black eye it obtained by blocking ICD-10.

3-22-2012 6-28-25 PM

Speaking of ICD-10 codes, one of my Twitter followers keyed me in to this app available on iTunes. For $24.99 and it only one review, I think at this point I’ll take a pass.

Several readers responded to my mention of the allergist who closed his practice to join the Army as a lieutenant colonel. Rank is apparently based on experience and specialty. One reader told a great story about his own Army service, where he had to take away several service weapons from physicians who mishandled or misplaced them, including one major who left his Beretta in the PX while shopping. That’s a little different than losing your sunglasses or your keys.

A shout out to Children’s Hospital Los Angeles Medical Group, which is hosting its annual “Pediatrics in the Islands: Clinical Pearls” conference in Maui. It’s a great conference. but I think it’s time to include some health IT topics, hint hint. Perhaps a celebrity guest speaker?



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

More news: HIStalk Practice, HIStalk Mobile.

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March 22, 2012 News 4 Comments

News 3/21/12

March 20, 2012 News 7 Comments

Top News

3-20-2012 9-41-53 PM

Misys, whose only remaining healthcare-related product that I recall is Misys Open Source Solutions, agrees to be acquired for $2 billion by Vista Equity Partners. Competing offers are possible despite a simultaneously announced Misys profit warning after Q3 revenue slid 12%. If the deal goes through, Misys will join a family of Vista-owned companies that includes Sunquest and Vitera.

Reader Comments

3-20-2012 9-43-37 PM

From HIMSS Benefactor: “Re: HIMSS13. Almost all the decent hotels are already booked. What happened? The W French Quarter has a few rooms left at $909 per night! Too much hassle … will have to skip this one.” I just checked the HIMSS online booking site and they’re showing 13 hotels available to attendees, starting at $155. The four-star Marriott on Canal Street is $230 per night and appears available, as is the close-by Courtyard at $180. I tried several of the travel sites to see if maybe HIMSS hadn’t locked down the whole block, but all showed no rooms available. Major concerns about infrastructure readiness abounded when HIMSS last went to New Orleans in 2007 and the experience was uneven in many hotels and restaurants. Having too few or too expensive hotels would give HIMSS a black eye it doesn’t need after massive attendance in Las Vegas. Let’s hope they just haven’t released all the rooms yet since we’re nearly a full year away. Otherwise, I’m going rent a house or two for the week, bring in sleeping bags, and run a HIMSS Hostel at exorbitant nightly rates. I don’t know where I stayed last time – I only remember that it was forgettable.

3-20-2012 7-18-36 PM

From The PACS Designer: “Re: SMArt. With the release of the iPad, TPD thought it would be the right time to mention The SMArt Platform created by the Children’s Hospital Boston and Harvard Medical School. Travis Good alerted us a year ago about it and mentioned that there is $5,000 prize challenge for the winning design. The SMArt platform is envisioned to be an app store for health, with applications geared towards both patients and providers.”

From Doreen: “Re: HIMSS. You should rent one of the tiny booths for around $5,000, use the fact that you have the greatest advertising strength on earth for healthcare IT to tell people you’ll be there, have guest booth hosts like Ed Marx and Dr. Gregg, and offer giveaways.” I had to embellish the idea, of course, by suggesting that (a) I set it up like a welcome center and offer information on HIStalk’s sponsors, or (b) I find some other company in tiny booth Siberia and tell them I’ll be their next-door neighbor and bring lots of traffic their way if they’ll pay for my space. Then I recruit volunteers to serve as my proxy to host the booth in rotation. I was excited about putting out kegs of beer until I Googled the price at the Morial Convention Center: $450 for crappy domestic brands.

HIStalk Announcements and Requests

Medicomp commemorates Inga’s participation in its Quipstar game on the HIMSS exhibit hall floor with a video. Note the Shoe Cam pictures, security entourage, the IngaTini in her hand, her green M&M snack, and the carefully placed reflector thingy that I bought her as part of her disguise. She was scared to death, but determined to earn Mobile Loaves & Fishes the $5,000 charitable donation offered by Medicomp in return for her involvement.

3-20-2012 8-08-54 PM

Welcome to new HIStalk Platinum Sponsor Jardogs. The Springfield, IL company connects patients, providers, and communities with its Jardogs FollowMyHealth Universal Health Record, an ONC-ATCB-certified cloud-based solution that aggregates information from disconnected organizations (it was recently selected by Iowa Health System, I recall). Patients become gatekeepers of their own information from anywhere in the world using a single comprehensive view instead of running around to a bunch of individual, proprietary patient portals. They can electronically complete physician-requested forms that are pre-populated with the practice’s EMR information, check in for appointments, and get real-time updates. Providers improve their patient relationships and address ARRA incentives for patient access (send reminders, provide electronic copies of results and med lists, share information per patient authorization, and connect to public health registries). The company also offers a patient kiosk that streamlines registration and data collection. Next up: home and wellness applications, such as for home physical therapy and potentially for home monitoring. Thanks to Jardogs for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

RCM provider MD On-Line acquires MD Technologies, a provider of RCM products and the Medtopia Manager PM system.

Axial Exchange announces that its care transition solutions, Axial Provider and Axial Patient, are available for cloud deployment. The Raleigh, NC-based company offers care coordination and communications applications that connect first responders, hospitals, physicians, and health plans via a clinical dashboard.

3-20-2012 7-32-13 PM

In the UK, University of Lincoln and the local hospital trust develop a prototype of an orthopedic surgery training simulator that uses the Nintendo Wii to mimic the use of a surgical drill, allowing surgeons to improve their hand-eye coordination.


3-20-2012 7-46-17 PM

The non-profit United Health Organization (MI) will use video-to-handheld technology from JEMS Technology to connect patients requiring specialized medical attention with off-site physicians for consultation. Volunteer specialists who can’t leave their practices can visually examine the patient and provide treatment recommendations from their mobile devices.

3-20-2012 9-47-44 PM

DR Systems announces new contracts for its Unity CVIS with Twin Cities Community Hospital (CA), Good Shepherd Medical Center (TX), Healthcare Partners Medical Group (CA), and St. Luke’s Cornwall Hospital (NY).

The Maryland Department of Health and Mental Hygiene awards CSC a $297 million contract to replace the state’s Medicaid management information system and to provide fiscal agent services. The contract is for five years with three two-year options.

The Maricopa County (AZ) Board of Supervisors approves a $4.55 million contract to NaphCare for EMR licenses and installation services for its correctional healthcare system, which lost its accreditation in 2008 for issues that included poor recordkeeping.


3-20-2012 6-25-58 PM

Two weeks after agreeing to serve as CEO of Cal eConnect, Ted Kremer withdraws his acceptance and announces plans to stay on as executive director of the Rochester RHIO after learning that Cal eConnect’s funding is uncertain. Cal eConnect interim CEO Laura Landry will assume the CEO post.

3-20-2012 6-28-45 PM

Legacy Health System (OR) names John Kenagy PhD as interim SVP and CIO. He was previously with Providence Health & Services.

Healthcare analytics company Qforma appoints Valerio Aimale MD as chief of advanced products, William Howard PhD as SVP of new product development, and Delphina Perkins as director of client services.

3-20-2012 6-32-28 PM

Authentidate Holding Corp. names former Viterion Telehealthcare CEO Sunil Hazaray its chief commercial officer.

Announcements and Implementations

3-20-2012 6-33-20 PM

Cookeville Regional Medical Center (TN) implements MEDHOST’s EDIS.

Susquehanna Health Partners (PA) adopts Summit Healthcare’s Downtime Reporting System to address its business continuity and data protection needs.

3-20-2012 6-43-48 PM

Practice Fusion launches its research website to help public health agencies and physicians predict and manage outbreaks.

3-20-2012 6-58-48 PM

Objective Health, part of McKinsey & Company, announces the release of its Objective Scorecard performance dashboard and analytics solution for hospital executives.

UPenn Health System goes live on Brainware and Ascend solutions for accounts payable automation, helping it manage paper invoices and integrating with its Lawson ERP system.

The EZ DERM iPad EHR adds speech recognition using Nuance’s cloud-based technology. I accidentally strayed onto the cool new EZ DERM video above on YouTube. The company modestly calls its product “The Best EHR in the World.” I can’t vouch for that, but it might well make the best EHR videos in the world.

SAIC’s COO talks up the company’s Vitalize Consulting Solutions acquisition in Tuesday’s earnings call: “SAIC’s acquisition of Vitalize Consulting Solutions continues to support strong, double-digit growth in the commercial health IT arena.” In not-so-positive news, SAIC racked up a $161 million Q4 loss after setting aside $500 million to settle a criminal investigation involving cost overruns on a payroll system it developed for New York City.

Government and Politics

ONC releases a new version of its Connect software that incorporates updated technical standards and descriptions for the NwHIN Exchange. Connect version 3.3 supports such functions as patient discovery, document queries, and information retrieval.

Louisiana behavioral providers say that the state’s new Medicaid reimbursement software, which was supposed to make their claims submission easier, isn’t working. Providers say they can’t always enter new client information and some of what they’ve entered was lost, the progress notes function isn’t working, and nobody’s been able to bill for their services.


TeleTracking posts a fun video of The Capacity Blues, a Cajun-flavored piano tune written and performed by one of its employees in honor of its upcoming New Orleans patient flow symposium.

3-20-2012 7-11-58 PM

Divya Shroff MD, HCA’s chief clinical transformation officer, writes a company blog post called Can Access to an EKG on your Phone Save a Life? in discussing the company’s collaboration with and investment in AirStrip Technologies. Her example involves door-to-balloon time for cath patients, with the potential to send EKGs directly from the ambulance to the cardiologist as both are in transit to the hospital.

I’m watching interviews filmed at HIMSS in Las Vegas by EHRtv that our pal Eric Fishman MD has been posting. Here’s one with Matthew Hawkins, CEO of Vitera, and here’s another with Shareable Ink’s Stephen Hau.

In England, hospital officials admit that they ordered the IT department to clone and snoop around the computer hard drive of a whistleblowing doctor who complained about unqualified staff and and was later fired. His boss justified the action, saying she had heard from employees that he was on the Internet a lot and wasn’t seeing enough patients.

The local newspaper interviews eClinicalWorks CEO Girish Kumar Navani.

Dr. Wes says EMRs bury doctors in data without giving them useful information:

There’s so much data that we risk doctors becoming lost in it. It is entirely possible that we are in danger of not being able to find our most important clinical signals amongst the noise and clutter of all the data. Worse: time with patients is disappearing. Our health care information gold rush has acquired teams of programmers to feverishly implement a myriad of bureaucratic information system requirements in just a few short years. To this end, these programmers have been extremely effective. But almost as incredibly, these same programmers have little perspective of what physicians do or how we interact with patients and THEIR data. As a result, doctors are not only confronted by all of this this information placed before them, but waste precious time sifting amongst the data and continue to be the fall-guy for data entry. Codes, quality measures, documentation requirements and, oh, yeah, the progress and operative notes, are all being entered by doctors. In return, our screens have become crowded intersections of buttons, flags, options, icons, colors, warning alerts and (if we’re lucky) text. Oh yeah, and a new “upgrade’s” coming next week.

3-20-2012 9-08-52 PM

Note to companies: just in case you can’t spell HIPAA correctly, at least leave it out of the press release’s big-font headline.

University of Louisiana at Lafayette is looking for healthcare geeks to participate in its free Cajun Code Fest on April 27-28. Speakers include US CTO Todd Park, Intel’s Eric Dishman, and the guy who founded Priceline.com.

3-20-2012 9-52-31 PM

A Crain’s New York study finds that the 25 highest-paid New York City hospital executives earned a combined $60 million in 2010, with New York-Presbyterian’s Herbert Pardes topping them all again at $4.3 million.

Sponsor Updates

3-20-2012 6-46-28 PM

  • CapSite GM/SVP Gino Johnson will provide an overview of the HIE market at next week’s 4th Annual Health IT Insight Summit in Boston.
  • Liaison Technologies will offer Preventice’s wireless monitoring technology to collect and transmit patient data via its cloud services.
  • Bloomberg Businessweek profiles Digital Prospectors Corp.
  • CTG Health Solutions will participate in the Allscripts Central Region Users Group meeting in Des Moines, IA on April 19.
  • Trustwave completes its acquisition of M86 Security.
  • Health Care DataWorks selects Health Language’s Language Engine to map disparate data into its data warehouse.
  • BESLER Consulting will use the Inventu Flynet Viewer to give its hospital customers access to the Medicare Common Working File stored on 14 CMS mainframes, allowing faster and more efficient claims review.
  • DIVURGENT’s David Shiple discusses the proposed MU Stage 2 emphasis on personal health records vs. low consumer interest in using them in a blog posting.
  • The local paper discusses Premier Health Partners’ use of MEDSEEK’s predictive analytic tools for targeted consumer mailings.
  • Merge Healthcare and AG Mednet partner to integrate AG Mednet’s image collection platform with Merge’s Clinical Imaging Management System (CIMS) to enable higher quality images and data flow directly into Merge’s CIMS and EDC solutions. 
  • Capsule announces that it has surpassed the 1,000 mark for healthcare organizations using its medical device integration solution, including 200 new customers added in the last four months.


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

More news: HIStalk Practice, HIStalk Mobile.

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March 20, 2012 News 7 Comments

Readers Write 3/19/12

March 19, 2012 Readers Write No 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!

Sampling the Legislative Sausage
By Civics 101

Be careful reading the proposed Meaningful Use regulations. Note the “proposed” part. As a Notice of Proposed Rulemaking, it’s unwise to ignore any part of the document.

Every word in the document – even in the preamble — has survived numerous rounds of federal vetting. Every section is important, but especially so are those areas in which public comment is invited. Objectives may be added or removed, so don’t get hung up on those to the exclusion of the preamble or the overall intention.This is not a set of business requirements that is ready to be handed off to programmers to implement.

Read the NPRM as a big picture, keep an open mind, and try to understand the intention, not just the tentative objective list. And above all, don’t forget that while Stage 1 is locked in place, Stage 2 isn’t. My organization and yours need to study the NPRM carefully and comment on what we like or don’t like about what’s been placed before us. Remember all the changes that were incorporated between the Stage 1 NPRM and the final version? Every one of those came as a result of public feedback.

Using the iPad in Surgery
By Michael B. Peterson, MD

I use the iPad every day while rounding at work and connected to the encrypted hospital wireless network, finding web information for patients and showing educational videos. I use a Bluetooth keyboard and sometimes a stylus that fit into a netbook soft case when I need to do heavy typing.

We were doing a complicated vascular surgery, an axillary femoral femoral bypass. I had dissected out the blood vessels on the right groin, but the surgeon working on the left could not locate the critical arteries and branches. The patient did not have any pulses in the groins because of severe vascular disease.

I had the nurse drop the iPad into a sterile sleeve and seal it. I used it to pull up the CT scans on the table and paged to the proper level so we could compare the right to the left. Then we knew where to go. We could place the iPad right on top of the patient and visualize what we needed.

Then while my colleague and our PA completed the left side, I checked my Lotus Notes e-mail, went into the vascular econsult program and triaged some vascular consults to the appropriate clinics, and checked my inbasket in our Epic EMR to read labs and answer messages (the iPad runs Epic very well.) When I was done, we were ready for the rest of the surgery.  

The x-ray viewing is an innovative project on which we are partnering with with Thinking Systems.

We are using the latest Citrix Receiver to host our version of Epic on the iPad and other devices as well. Since the rollout of Epic Summer ’09 across the country in all Kaisers, the old web address we used for Spring ’06 access no longer works for the iPad. In addition, there are additional video requirements for Summer ’09 that our current web servers need that the Citrix receiver cannot handle. Attempting access to the Summer ’09 environment will result in a connection failure with a “USKIN” error message.

Fortunately our Kaiser web engineers were aware of this and understood the need for iPad functionality. They created special web addresses for Kaiser iPad users in Northern and Southern California, Hawaii, and Pacific Northwest. The official term is PNAgent Site. Setting it up is complicated, but the iPad works very well.  

Of course there are ergonomic challenges with a smaller screen, and accurate tapping is critical. But it is so fast and convenient — you don’t have to wander around looking for an unoccupied keyboard and computer. If I need to look up something, I just do it where I am. It has really spoiled me.

I don’t know if there is any way to demonstrate improved outcomes with the iPad. Kaiser is starting to roll it out to other medical centers with different specialties. My general feeling is that with the EMR, there is a 20% productivity hit with data entry and typing your note. It does take longer on the generic computer, but the the iPad is so much faster and it literally puts the medical record at your fingertips… or perhaps the patient’s.  

I plop the iPad down in front of the patient and point out pictures, diagrams, and a quick graphic plot of their rising creatinine. I run the lymphedema pump movie to show them how it works, or review the online video again to remind me or others how that endovascular closure device works again before I actually do it.  

I have invested the time it took to get comfortable with the iPad and arrange it the way I want. I could not do without it. I have very little specialized software on the iPad except for the VPN and the Citrix Receiver. And my medical apps, books, and games!

3-19-2012 8-05-25 PM

Michael B. Peterson MD is a surgeon with The Permanente Medical Group in Hayward, CA. His use of the iPad in the operating room was featured in the April 2012 edition of Macworld. Since Mike is an old friend of HIStalk, I asked him for more detailed information, which he provided above.

What Do You Do Regardless? Five ICD-10 Steps To Continue
By Torrey Barnhouse

3-19-2012 7-40-48 PM

The AMA lobby is strong. US government program delays are common. The two came together on February 16, 2012 when Health and Human Services Secretary Kathleen Sebelius announced a potential delay in the October 1, 2013 deadline for ICD-10 implementation.

The announcement, made just before the start of the HIMSS12 Annual Conference, left a lot of attendees scratching their heads and asking themselves, “Now what?” Most agreed a delay of one year or less gives everyone more time to prepare, train, and test. However, a delay of greater than one year spells chaos for healthcare providers and payers.

While at HIMSS, TrustHCS had the honor of sponsoring an executive roundtable on ICD-10. During the roundtable, speakers discussed five ICD-10 projects that should continue full steam ahead despite the delay. It’s a good list and worth sharing.

In general, the panel’s advice was to identify ICD-10 tasks that have collateral benefit for ICD-9 coding. These are the tasks that should be continued until such time as HHS makes another announcement regarding their plans, intentions, and deadlines.

Vendor and Payer Assessments

Continue checking with vendors and payers to see when systems will be ready for testing. Know what the ICD-10 upgrade will cost your organization, if anything. If your vendor simply can’t accommodate, start evaluating new systems to replace them. Conduct ICD-10 testing with your payers whenever and wherever possible to help reduce backlogs and denials upon go live.

Clinical Documentation Improvement

Any improvement in clinical documentation specificity and granularity will help support better, higher quality coding and reduce time wasted querying physicians. Coders can only code what is documented. This same core principle applies in ICD-10. CDI programs must be continued regardless of a delay.

Coder Biomedical Training

While educating coders in the finer nuances of ICD-10 coding can be postponed, strengthening their knowledge of the basics can’t. Many coders graduated from programs 10, 15, or 20 years ago. Medical science and our knowledge of anatomy, physiology, and disease processes has grown exponentially. Now’s the time to make sure your coders are brilliant at the basics. Anatomy and physiology training should continue to be conducted: online through a service provider or at a local community college.

Computer Assisted Coding (CAC) Technology

Coder productivity is predicted to drop by 50% during the implementation of ICD-10 and perhaps remain 10-20% below normal output for ICD-9 coding. CAC systems help offset this productivity loss by electronically “reading” the record and suggesting codes to the human coder. While CAC systems don’t replace coders, they do make them more productive and efficient. The delay provides more time for organizations to evaluate and implement this technology.

Assess and Refine Your Work Plan

Conduct a methodical step-by-step review of your initial plan. This process will identify which tasks can be pushed out and which cannot. The review will also uncover other tasks that have collateral benefit for ICD-9. For each task in your work plan, ask yourself, “Does the delay impact this task?”

Industry experts are already predicting the cost of an ICD-10 delay. Other experts are predicting lawsuits by providers to help recoup monies already spent. This expert simply suggests that you stay the course and keep working toward ICD-10 preparedness. We will all have to get there eventually. Better to be early than late on this one!

Torrey Barnhouse is CEO of TrustHCS of Springfield, MO.


Viva la CPOE!
By Daniela Mahoney

3-19-2012 7-08-23 PM

According to the HIMSS Analytics EMR Adoption Model , CPOE adoption remains steady at a rate of 13.2% for the past two quarters. And in recent months, many hospitals achieved the first stage of Meaningful Use. Congratulations to all!




However, looking at the story behind CPOE implementations reveals that adoption struggles continue —regardless of the vendor system. Many community hospitals expend great effort and many dollars meeting Meaningful Use criteria, but additional time and money is also spent avoiding a full-blown revolution within their provider community because of CPOE implementation.

Technology is really only 15-20% of a CPOE implementation. Process, acceptance, culture, and constant transformation are the parts that truly define the difference between CPOE failure and success.

At the end of the day, technology’s golden purpose is to support the infrastructure: devices, performance, remote access, integration/interoperability, streamlined single-sign-on, and ease of navigation. But even when working flawlessly, it’s still an uphill battle capturing provider adoption on that much-needed “voluntary basis.”

I can always hear the physician protests, even when left unsaid: “Why should I use it?” “What is in it for me?” “Show me the money, Jerry.”

The question remains: why? Why won’t providers embrace new CPOE technologies and take advantage of the wonderful features, such as clinical decision support or evidence-based order sets that streamline the admission process?

Truthfully, there is nothing wrong with the providers’ feelings here. They simply know what’s at stake. And the odds are not in favor of CPOE, despite the benefits we may see through our own rose-colored glasses:  “Oh, how it benefits the patient! Why don’t you providers just snap out of it and embrace CPOE for the people, or at least for the children?”

Kidding aside, what a new CPOE system takes away from providers is TIME.

… at least for a while.

Time is a provider’s most precious commodity. A new system changes the way they work and takes time away from office hours and family. Time is irreplaceable and invaluable.

But the Meaningful Use mandates say “so what” and to just do it and accept it. CPOE is a reality and must be part of every provider’s future in the hospital or in the office. With that, I sympathize. Providers may have cause to rebel.

I spent some time researching literature while preparing this article, looking at provider efficiency with CPOE. Many studies are relatively old, done in the ‘90s or early 2000s. Not to dismiss their importance, but many issues experienced then have been since resolved with today’s systems. In retrospect, they really aren’t relevant.

But one thing overlooked then and now, to me, is the most important question: what is the right value proposition to the provider?

The answer? One that fits a provider’s community and meets their conditions to accept CPOE into their domain.

With 22 years invested helping providers through CPOE adoption , I found only one simple and effective system pitch. Be truthful and realistic. That’s what works. That’s what opens door and also ears.

For example, we can’t deny that it typically takes significant time to adopt and adjust to a new system, and that efficiency improves only with consistent use. Additionally, never overpromise that CPOE is faster than handwriting an order or checking boxes on a pre-printed order set. I can tell you, that approach doesn’t work.

Once providers are engaged, gather the value proposition’s building blocks by talking and listening to them –  eliciting their concerns, needs, and requirements — and also identify opportunities for compromise.

Usually during interview sessions, similar things are voiced. And believe it or not, it’s less about Meaningful Use (understanding the “benefit” of hospital reimbursement is typically demonstrated by only a few) and more about the direction of technologies in healthcare and reporting requirements and how it affects the way they practice medicine.

For example, for some it is important to have remote access, and not just to CPOE, but to also do other tasks, such as signing their charts. And from others, I often hear how they would prefer using their own laptops or iPads, so they do not need to compete for devices.

Here are some very telling interview quotes from providers about CPOE adoption:

  • “Access from outside of the hospital, home access would be great.”
  • “CPOE should be a resource for us. It should not make us work harder to accommodate it.”
  • “Ease to use and quicker order entry is most important.”
  • “Online view of medications administered would be a great value.”
  • “Reduces errors and provides clarity of medical orders. There must be a safety net if errors are made, especially with residents. Incorrect orders need to be stopped.”
  • “A quick-pick list for providers would be nice.”

In the end, the right value proposition delivers the commitment of the hospital’s leadership to respond to what providers say and need. It engages all providers and can convince them to fully adopt CPOE as part of their workflow—especially with respect to efficiency in daily operations.

Providers become very reasonable and willing to compromise if engaged and their voices heard. Realistically, you cannot fulfill every need, but it is still important to listen and respond. The hospital’s leadership must be proactive and have a solid communication plan to manage expectations at different levels before, during, and after implementation. The direction of CPOE within the organization must be clearly defined, from the adoption and training to the deployment strategy. Lastly, completing a cultural evaluation the provider community provides tremendous insight into defining the value proposition which is the foundation of your CPOE success.

Let them eat cake, because we’re having crepes …

3-19-2012 7-15-24 PM

Here is a simple but delicious nutella-banana crepe recipe enjoyed by our family. Bon appetit!

Daniela Mahoney, RN BSN is vice president of Beacon Partners of Weymouth, MA.

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March 19, 2012 Readers Write No Comments

HIStalk Interviews Brian Phelps, CEO, Montrue Technologies

March 14, 2012 Interviews 1 Comment

Brian Phelps MD is co-founder and CEO of Montrue Technologies of Ashland, Oregon. The company’s Sparrow EDIS for the iPad was the grand prize winner in the 2012 Mobile Clinician Voice Challenge, presented by Nuance Healthcare.

3-14-2012 7-02-41 PM

You’re an ED doc. Why did you develop Sparrow EDIS?

I’ve been in practice for 10 years. I’ve had the good luck — or bad luck, depending on your point of view — of being involved in a few software implementations. One of them failed spectacularly. I felt like I learned quite a bit about the good and bad of software in the ED. I thought about the culture of the companies that are offering software and how to make the culture better suited coming into that environment.

When the iPad came out, it was pretty obvious that that was the future for us. I assembled the team and here we are.

Is the iPad application just for presentation using other systems or is it a completely separate application?

It’s a native iOS application that communicates with the Sparrow Server that then integrates with the underlying EMR. It’s an abstraction on top of the underlying EMR, but as far as the user experience is concerned, they’re in a purely Apple environment.

Describe the product and how they’re using it.

The Sparrow Emergency Department Information System includes patient tracking, order entry, physician and nurse documentation at the bedside, discharge planning, and prescribing. They’re doing all that on the iPad at the bedside. You don’t have to interact with the PC workstations any more with our system.

Does everybody use it? Is using it mandatory?

We’re the whole product, so we come in with the devices as with the software. We’re in pilot phase now so there’s some details to be worked out, but the idea is that that we provide the whole solution, including white coats that have pockets big enough to hold it and the stylus if you want it. Doctors and nurses and registration all are using the devices. 

At HIMSS, I learned a lot and met a lot of great people. One of the themes that kept coming back was getting doctors on mobile devices and the “bring your own device” mentality, which I think is a symptom of a disease and not a cure. The disease is that consumer technology has so rapidly outpaced enterprise technology that it’s making end users crazy. They’re coming in with these personal devices and they’re demanding to connect. They’re using Citrix and whatever else they can and it’s not providing a very good user experience. 

Nobody ever asked me to bring my Dell on wheels to the hospital. Ideally the hospitals will recognize that the users have spoken and these are the tools that they think are right for the job. That’s where we come in and deliver the right tools and the right software, all locked down in a secure environment.

How do you determine the success of the product if users can still use the underlying systems directly?

They can use the underlying systems to review records and place orders in the hospital information system, but we have order sets and a workload that is specific to emergency medicine. There are no longer paper charts when we come in. If they want to use the order sets that they have created, they would be using the iPad.

What tools did it require to create the iPad application?

It’s a lot. We have a server that runs SQLite. All of the devices run our application, which is in Objective-C for iOS. Our server and our iPads come in. There’s an interface that’s required to exchange data in HL7 with the inline EMR.

We have a strategic relationship with Nuance and they’ve really helped build out our product. Their SDK was very easy to use — it literally it took a few hours to get up and running. We have a relationship with LexiComp to do medication interaction checking and allergy checking on the devices and several other strategic business relationships that flesh out the product.

3-14-2012 7-14-59 PM

So it was easy to integrate speech recognition using the Nuance tools?

It was great how astonishingly easy that was. We had planned on speech integration from the very beginning. For all their wonderful qualities of iPads, the input mechanism for narrative is one of its minor weaknesses. We always knew speech was going to come into play. In fact, we built our application around it before we even knew that it was going to be technically possible. 

We had our eye on Nuance. When they released the mobile SDK, we snapped it up. The next day, we literally had a fully speech-enabled application.

Describe how the application uses speech recognition.

The thing about speech and documentation in medicine in general is that it allows you to capture the narrative. The patient’s story is really the heart of the patient-doctor relationship. There is no way that can ever accurately be captured by pointing and clicking. I can give you several examples of where template-driven documentation of the patient’s story led to harm. 

Building in speech recognition for the history of present illness and medical decision-making is really important. But we have to balance that with structured data to meet compliance and other measures, and also because there are some areas where structured data is perfectly appropriate. Medication reconciliation, for example, or even in our case we have templates for building physical exams and reviews of systems. 

Finding that balance between the unstructured narrative and the structured data input is what the iPad is ideal for, because as you’re sitting there with a patient, you basically can tap along and review their history and enter the important information. Then as you’re going to the next patient, you can speak in the parts of the encounter that are unique to that patient, namely their story.

What advantages does the user get from using an iPad application?

The biggest advantage is using the Apple navigation paradigm. We’ve been in a design relationship with Apple for about half a year. They’ve been advising us and getting it to be simpler and faster and more intuitive. The fact that it runs natively on the device means that it is incredibly fast and easy to use. Anyone who has used an iPhone or an iPad and used any of the native Apple applications knows immediately how to use our system.

It’s hard to overstate the importance of having something that sits in your lap while you’re engaging the patient. We’ve been speaking and poking at things for a million years as humans. We’ve only been pointing and clicking for 20. When patients are scared or in pain or feeling vulnerable, it’s almost cruel to turn away from them to click away on a QWERTY keyboard.

One of the themes that kept coming back at HIMSS was patient engagement. It means different things to different people, but in my line of work, I’m trying to engage the patient who’s sitting in front of me. I don’t think that you can engage patients with technology or with the latest application. You engage them by looking them in the eye and asking good questions and listening carefully and showing compassion.

Technology has only interfered with that process. The advantage of our system is that we get out of the way and allow doctors and nurses to interact with their patients in a way that they know how to do.

During your pilot phase, what are you measuring and what kind of response are you getting back?

We’re integrating the back end and we’re not live with patient data yet, so that’s coming up. When that happens, we’ll be measuring productivity, patient and physician and nursing satisfaction, and of course compliance with Meaningful Use.

Did you form the company just for this product or you have other products?

We formed the company with the goal of bringing mobile technology to emergency medicine. We had thought about strategy of having different sub-modules, but when it comes down to it, if you’re going to be successful in emergency medicine, you have to completely replace the three-ring binder. We spent two years building out every aspect of what had been a paper interface into our system. We are currently a one-product company and that’s our emergency department information system.

You said you designed the product around speech recognition even though it wasn’t available at the time. Do you think somebody could develop a comparable product without using it?

I think it could be done, but I think that the narrative input mechanism would be challenging. One possibility would be to have Bluetooth keyboards in each room and you pop the iPad in and type away your narrative, but I don’t see that it would be as effective. The combination of tappable templates plus speech for narrative on the iPad is really a match made in heaven.

At HIMSS there were companies at different stages of doing work on the iPad. What was your general feeling about where the industry is right now with the use of iPads? Did you expose your product to anyone to get a reaction?

We had an opportunity to present at the Venture Forum as well as on stage at the Nuance booth. We got lot of great feedback.

I think it’s very exciting what Epic is doing with their iPad interface. PatientKeeper has an excellent product. Nobody is doing exactly what we’re doing. We’re pretty thrilled that these other companies are demonstrating that there is a large, important market here. Beyond that, we take all that energy we might be thinking about competition and try to drive it back into our product and make it better.

Were you surprised that you were named the winner?

[laughs] I thought there was a pretty good chance we had a shot.

How will you use your prizes?

The best thing that came out of this was a deeper relationship with Nuance, who has been wonderful and supportive throughout. Just the recognition that that has brought to us has been phenomenal.

Assuming your pilot is successful, where do you go from there?

We’re making the product back end-agnostic, so any hospital that has an EMR that is struggling with workflow in their emergency department is a potential customer. There are at least 3,500 hospitals that meet that description. We’re pretty confident that as this wave of mobile devices washes into the mainstream, there will be a significant demand. The next step for us is to continue to make the product simpler and faster and more intuitive and then to connect with paying customers.

Typically that’s hard for a small company because it’s difficult to mount up a sales force. Do you see yourself selling directly into individual hospital emergency departments or partnering up with a specific vendor to make it an add-on?

We have been working on some channel partners. One strategy for us has been to look at the relationships we have with interface vendors to assuage the interoperability concern. We are pretty excited about the relationship that we built with Apple and we see a lot of ways that they — as part of their ambition to enter the enterprise space — could really be helpful for us getting in the mainstream market.

So far, our feedback from doctors and nurses has been fantastic. We’re pretty confident that we can leverage that groundswell of enthusiasm from end users to develop a relationship with their executives. To them, we will be focusing on our profound return on investment, which comes through improved charge capture.

I’m glad you mentioned that since I assumed the pitch would strictly be clinician satisfaction.

When software deployments fail, that’s the majority of the time due to physician rejection. Clinical informatics people really do have an incentive to make sure they’re finding a product their clinicians like to use. That’s one part of it.

The other part is that we capture charges just through the process of simple tap documentation. One of the commonly missed charges is IV start and stop times. Our system triggers the appropriate documentation, which we think will improve charges by about $40 per patient. There’s a thoroughly profound return on investment for executives as well.

The big challenge is that the gatekeepers tend to be the folks who have the least direct benefits from the application. Our goal now is to try as best as we can to understand what their needs are and meet those needs while still delivering a very usable product for these doctors and nurses.

Do you have any final thoughts?

This may resonate with you and what you’ve done with HIStalk, which has been phenomenal for me to learn about the industry over the last couple of years. When you really believe in something strongly as we do and you‘re willing to work at it, if you’re on the right track, doors start to open and more opportunities present themselves. That’s where we’re at with Montrue. We’re pretty happy that we’re on the right track and we’re excited about what’s to come.

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March 14, 2012 Interviews 1 Comment

Monday Morning Update 3/12/12

March 11, 2012 News 2 Comments

From N2InformaticsRN: “Re: Ed Marx and Jim Murry. Did a nice job discussing mobility in healthcare on CIO Talk Radio.” That’s pretty cool – the audio sounds like a real radio station.

3-11-2012 10-12-35 AM

From @Cedars: “Re: Cedars-Sinai CPOE go-live. As a consultant going from project to project, it’s easy to forget why I began to work in healthcare, but this weekend I was reminded of it. This means everything to our industry, as past failure is redefined forever. This project has been done right in every way. I was inspired by this note from CIO Darren Dworkin. Please, please interview him.” I think I’ve asked Darren before. The CPOE implementation and quick de-implementation at Cedars-Sinai years ago gives it an honored spot in the Healthcare IT Failure Hall of Fame, right up there with BIDMC’s massive network outage, Kaiser’s waste of $500 million hiring IBM to develop IT systems that were abandoned before completion to instead passionately mate with Epic, and El Camino’s near-shutdown after implementing a patient-endangering Eclipsys medication solution. Feel free to suggest new nominees since every one of these examples provided painful but valuable lessons for not just those involved, but also for the rest of us gawking at the smoking wreckage from the safe side of the “do not cross” yellow tape. All of those organizations learned from their mistakes and came back better than ever, although iterative learning isn’t necessarily a good thing for patients.

3-11-2012 2-23-14 PM

From Sinking Ship: “Re: GE Healthcare. Cancels the 2012 Healthcare Technology Symposium due to mounting budget pressures.” The reader provided a copy of what appears to be the announcement letter from VP/CTO Mike Harsh. UPDATE: I asked GEHC what this event is since I could find no reference to it. It’s an internal-only event, so it has no customer implications.

From Bed Manager: “Re: HIMSS13. They are pre-booking hotels and relatively few rooms are available in New Orleans. Did attendees wise up and book early, or are rooms being held back for exhibitors, or does New Orleans just not have enough rooms to handle the increased size of the HIMSS conference? Both hotels of my choice are sold out and they aren’t even in the HIMSS block.”

From Epic Employee: “Re: Farzad Mostashari. Will be speaking at Epic on April 24. Pretty cool.”

3-11-2012 5-36-55 PM

From John: “Re: HIMSS conference exhibit layouts. The problem was because it was at the Sands Expo Center instead of the Las Vegas Convention Center, which has high ceilings and a long hall. I heard that the conference was supposed to be in Chicago but fell through at the last minute, leaving the Sands as the only alternative. HIMSS missed revenue since it sold out the Sands space weeks before the show, although I liked the Sands because it involved less walking and easy access to the Strip.” I don’t know if HIMSS planned to return to Chicago after what I would consider a predictably terrible first and only trip there (snowstorms even after screwing up the schedule by moving the event back, surly union workers in the hall, wildly overpriced hotels), but I thought they originally announced a permanent rotation of only Orlando, New Orleans, and Las Vegas. I don’t think that plan lasted long since they’ve been to Atlanta since then. New Orleans was OK last time, but that was right after Katrina when hotels and restaurants really didn’t have enough employees to keep things running smoothly. I’ll still hold out for San Diego as my favorite HIMSS experience and I heard they were expanding the conference center to handle the huge annual comic book convention.

3-11-2012 3-54-12 PM 

From VA Doc: “Re: digital pens. The VA puts out an RFI for the technology, which has matured to the point where it makes sense to move beyond case studies.”

3-11-2012 3-59-11 PM

From MT Hammer: “Re: Clinical Documentation Industry Association. Ceasing operations, annual conference in Baltimore cancelled, financial pressures cited.” CDIA was a trade association for clinical documentation services, basically transcription. HIMSS could have possibly taken it over given a few familiar names among its dwindling list of members: Acusis, Arrendale, Diskriter, MD-IT, MedQuist, M*Modal, Nuance, and Verizon. The former Medical Transcription Industry Association (MTIA) rolled out its new name at the HIMSS conference in 2011, but a year later, both the organization and the conference are defunct.

From Sagacity: “Re: International Society for Disease Surveillance. Seeking comment on syndromic surveillance guidelines for the ambulatory and inpatient settings, targeting potential application for Meaningful Use Stage 3. The organization did the same thing for emergency and urgent care in the past, which led to MU Stage 1 specs.” Information here.

3-11-2012 4-51-26 PM

From Just a HIT Guy: “Re: WellStar. Moving off McKesson, NextGen, and GEMMS Cardiology, going to Epic. Internal memos released this week.” I’ll list this as unverified because I agreed to wait for a formal announcement as a courtesy to WellStar, but as usual, the organization’s long list of inpatient Epic job listings tell you everything you need to know anyway.

From EMR_Guru: “Re: WellStar. Announced to physicians they are scrapping NextGen and going with Epic. Wellstar has acquired a large number of physician practices over the last several years, Imagine getting bought and deploying NextGen only to be told a few months later that you have to scrap it and go with Epic.” That’s one of many risks involved in deciding to work for a hospital instead of for yourself.

From Prevailing Winds: “Re: Allscripts. You mentioned a vague acquisition rumor about Allscripts and IBM, but here’s something I’ve heard mentioned that I should say is completely unsubstantiated but potentially related. I’ve heard rumors of a potential buyout of Xerox/ACS by IBM. Allscripts remote hosting is outsourced to Xerox/ACS, so maybe the rumors refer just to that business instead of the whole company. Just rumor mill grist that may or may not mean anything.”

From Bony Moroni: “Re: HIMSS evaluation survey e-mail. It contained confusing instructions, misspellings, and a splash screen apologizing for errors in the e-mail. And we wonder why our industry is the butt of jokes by non-healthcare people. Here’s a crazy thought for an IT association in an industry known for sloppy work: test the damn e-mail merge program first. Not only was the merge done incorrectly, the ‘brief survey’ has a million questions on 11 pages, a status bar instead of an idea of what’s to come, and a pointless listing of the name and company of each recipient apparently just because they could. Obviously this is a contracted vendor, but does HIMSS really want this shoddy effort being the last thing people remember about the conference or the quality of work that HIMSS puts out?”

I’m back and rested after a week off out of the country, woefully behind, facing 500+ e-mails in my inbox, and regretting the loss of an hour due to springing forward since I’m already re-immersed into chaos even before I get back to my “real” job at the hospital. Actually I’m not that well rested since I got only four hours’ sleep Saturday night after downing my first-ever Red Bull to stay awake until  getting home at 3:00 a.m. Still, I’m happy to be back in my multiple saddles even though the horses tend to take off in different directions most of the time. Thanks to Inga for  keeping the HIStalk fires burning in my e-mail free absence. I’m sure I’ll repeat some items she’s already mentioned in trying to catch up, but that should be a one-time occurrence before things get back to normal with Tuesday’s news.

Thanks sincerely to everyone who completed my annual reader survey. It helps immensely and I’ve already made a to-do list for the next year based on the results. Obviously I almost cheated on my no-Internet vacation pledge to Mrs. HIStalk, but rationalized it to her by explaining that it took only seconds to download the results, even if I did spend several frowning and chin-stroking hours thinking about them and furiously taking notes. The preponderance of supportive comments was touching, although I probably won’t run them all here since that seems rather vain (as does re-reading them repeatedly, but at least I keep that particular vanity to myself.)

3-11-2012 8-55-10 AM

Readers grade ONC’s MU Stage 2 performance as maybe a D+. New poll to your right: does your PCP document your encounters in an electronic medical record? Mine does, even though the system he uses is about to get the boot in a hospital-mandated EHR replacement.

How did your Daylight Saving Time switchover go? Let me know if you had problems at your hospital. I’m always curious since vendors (some at my hospital, anyway) still haven’t worked out the bugs and punt by just suggesting shutting everything down for a couple of hours. Most of the problems are in the fall, when the “fall back” causes the 2:00 a.m. hour to be repeated, driving some badly designed systems crazy.

My Time Capsule editorial this week happens to be maybe my favorite one (at least until next time): Want to Anger a Nurse? Make Smug Comments about Grocery Store Barcoding. A desensitization dose: “They would buy Doritos by the bag, but would have to repackage and label individual chips and then track every chip – who bought it, who ate it, and whether they ate it in an appropriate quantity and with only complementary foods and according to dynamically calculated nutritional needs. ”

3-11-2012 8-51-51 AM

Fujifilm Medical Systems donates $25,000 to a laid-off radiology tech to save her foreclosed home, as seen on the Ellen show. 

3-11-2012 9-08-31 AM

Former HHS CTO and athenahealth co-founder Todd Park is named CTO of the United States, replacing Aneesh Chopra. Who would have put their money on the first HIT’er in the White House not being Allscripts CEO Glen Tullman?

3-11-2012 9-22-27 AM

Doug Stacy is named CIO at Labette Health (OK.) He was previously CIO at Coffeyville Regional Medical Center (KS.)

3-11-2012 3-50-22 PM

Dean Marketti, previously with BCBS, is named the first CIO of Morris Hospital & Healthcare Centers (IL.) I almost gave up trying to figure out what state the hospital is in given the common small-town newspaper website practice of not giving their location, apparently convinced that if you don’t already know, you couldn’t possibly care. Which I’ll concede is pretty much the case. 

Scott & White Healthcare names Matthew Chambers as CIO. I’m guessing he was interim while working for KPMG since his LinkedIn profile says he’s had the job since July 2011.

Holon Solutions (solutions for telepharmacy, order entry, results reporting, and the CollaborNet data sharing solution) names industry long-timer Mike McGuire as CEO. He was previously with MET-test.

3-11-2012 9-32-27 AM

Cincinnati Children’s Hospital (OH) and the local technology incubator launch QI Healthcare to commercialize the hospital’s quality improvement software that analyzes EMR data to identify improvement opportunities. I’m a bit skeptical about how easy it will be to commercialize any EMR data analysis application given the inconsistency in how each product and user stores and uses data, but hopefully they will figure out how to make that giant leap from Customer #1 to Customer #2. It took forever to find the startup’s Web page, which appears to be due to a combination of (a) lack of search engine optimization and Web content (just a leering stock art doctor on a GoDaddy parking page,) and (b) a poor choice of names that’s always going to give unrelated Google results. I continue to be amazed that new companies still choose names that won’t stand out in an Internet search.

It’s old news since I’m catching up, but First Databank mentions HIStalk (“the influential industry blog”) in the announcement of its rebranding, which I think is the first time a large, respectable organization has mentioned the name of this small, not all that respectable one in a significant announcement. I was impressed.

In the UK, Lord Carter of Coles, who heads up an NHS group to ensure fairness to its suppliers, is pressured to resign after the newspaper belatedly realizes that he’s also chairman of the UK division of McKesson (which he clearly disclosed when he took the job) and is part of an investment group that owns chunks of several healthcare companies. NHS pays him $90K per year for his two-days-per-week job, while McKesson pays him $1.25 million. Not surprisingly, nobody is suggesting that he quit the McKesson job.

Here’s Vince’s Part 2 of the CliniCom story.

The local paper covers the implementation of McKesson Paragon by McLaren-Bay Region (MI.) I think that’s actually McLaren Health Care, which makes a lot more sense.

A study at Minneapolis Heart Institute finds that surveillance software was able to retrospectively detect problems with implantable cardioverter-defibrillator devices long before the routine monitoring performed by the device manufacturers. The problem, of course, would be in collecting data in near real-time from the universe of patients in order to capitalize on the lead time.

3-11-2012 2-35-37 PM

The founder of SAP backs MolecularHealth, which offers software that matches the genomic data of individual patients to scientific evidence to suggest optimal cancer treatments. The application, which the company calls clinical decision support for oncologists, is being refined at MD Anderson.

Inga ran an anonymous reader’s rumor suggesting that GE Healthcare’s Centricity Perinatal could be on the sunset list. Not true, according to GEHC, and I’m sorry we ran that without asking the company for verification. GEHC is really fast and courteous about getting answers to my questions or rumor reports and I would have asked them for confirmation before running it. Inga doesn’t know the contact and probably figured she wouldn’t get a response.

3-11-2012 5-44-21 PM

Mrs. Dennis Quaid #3, the mother of the twins who were overdosed on heparin at Cedars-Sinai four years ago that were the subject of Dennis Quaid’s 2009 HIMSS conference keynote speech, files for divorce from the actor.

BCBS of North Carolina rolls out a mobile website that lets patients view claims, check their plan benefits, find a doctor, get a treatment estimate, and comparison shop drugs and insurance plans. The site, developed by Kony Solutions, supports Android and Apple platforms.

3-11-2012 3-38-57 PM

Philip White, historian and PR manager of electronic forms management vendor Access, appeared on Fox News last week after the release of his book about Winston Churchill’s Iron Curtain speech in Missouri in 1945. They asked him whether the lessons learned from the previous cold war still apply in situations related to Iran’s nuclear capabilities.

3-11-2012 3-51-39 PM

The local paper covers Oakwood Healthcare System’s (MI) $80 million Epic project, to be kicked off in August.

3-11-2012 4-26-51 PM

A fun Bloomberg BusinessWeek article discusses the joys of attending a conference in Las Vegas. It contains interesting mentions of the HIMSS conference, including four Craigslist “casual encounters” ads targeting HIMSS attendees like the one above.

A Kaiser Health News/Fortune article profiles Farzad Mostashari and HITECH. A quote:

Remarkably, in an era of partisan government, Mostashari’s program enjoys bipartisan support — or, at least, bipartisan tolerance. While only three Republicans voted for the stimulus bill in 2009, which provided the program’s funding, few have spoken out against it. The fact that the information technology industry is a big supporter — giants such as IBM, Microsoft, General Electric, Hewlett-Packard and a host of smaller health-care specialty technology companies — doesn’t hurt. The $27 billion will flow their way, and plenty of high-priced lobbyists are working hard to keep it flowing.

The New York Civil Liberties union criticizes the state’s privacy and security policies, saying HIEs should require patient consent to access their records and that the all-or-nothing approach to privacy means doctors see a lot of confidential information they don’t need to do their jobs.

3-11-2012 6-30-30 PM

Utah Business names Amy Rees Anderson, CEO of HIE technology vendor MediConnect Global, as its CEO of the Year.

3-11-2012 6-32-10 PM

State auditors discover that 269-bed Salinas Valley Memorial Healthcare System (CA), which earned scathing headlines last year when auditors found that its retiring CEO was paid over $5 million, did $21 million of business over a five-year-period with firms in which its executives held a financial interest.

A woman whose pending Supreme Court lawsuit argues that the federal government can’t force individuals to carry health insurance files bankruptcy after the family car repair business fails. Among the debts she’s petitioning the federal court to allow her not to pay: several thousand dollars owed to hospitals and physician practices. She had opted not to purchase health insurance.

E-mail Mr. H.

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March 11, 2012 News 2 Comments

News 3/9/12

March 8, 2012 News 4 Comments

Top News

National Coordinator for HIT Farzad Mostashari, MD takes issue with the recently published report that found doctors with online access to patients’ charts ordered more tests. Mostashari disputes the study, which raised questions as to whether or not EHRs cut costs. Mostashari’s contends that the study was based on 2008 data and before the start of the Meaningful Use program and thus does not address certified EHRs’ capabilities for data exchange and clinical data support.

Reader Comments

From EFMHead “Re: OB data management. Rumor has it that GE Centricity Perinatal is to be discontinued and that CPSI is auctioning off its OBIX product. Thoughts? If true, this signals an odd and sudden exodus of two major players from the OB data management market space.” Unverified. UPDATE: per GE Healthcare, the Centricity Perinatal rumor is not true.

3-8-2012 5-29-50 AM

From CW “Cake. Here’s a picture of the cakes that were prepared for Vada’s retirement. She was also presented with a quilt that reflected all the company names and colors over the last 24 years.” The cakes were prepared in honor of the retiring Vada Hayes, a longtime Allscripts/Misys/Medic support supervisor.

HIStalk Announcements and Requests

3-7-2012 2-10-35 PM

inga Highlights from HIStalk Practice this week include: a handy two-page summary of Stage 2 for EPs, prepared by two e-MD physician users. US physicians charge two to three times more than their French and German peers and achieve similar outcomes. MGMA urges Secretary Sebelius to consider adding due diligence to the ICD-10 timeline and limit required adoption to hospitals. A survey finds that 30% of physicians have implemented an EHR that meets MU criteria, 14% will in the next three years, and 17% have no plans to do so. Check out the rest of the goodies on HIStalk Practice and be sure to sign up for the email updates. Thanks for reading.

3-8-2012 6-42-37 PM

HIStalkapalooza’s  own singing Elvis is seeking  music video contributions for “Gimme My Damn Data,” as debuted at HIStalkapalooza last month. Dr. Ross D. Martin, MD encourages anyone wishing to promote access to their electronic health information to submit a video clip by March 26th. Check out the video clip – fun stuff.

Mr. H will be back in front of his computer this weekend, following his week-long get-away with Mrs. H. Of course I’m ready for him to be back at the helm, especially since he is the one most likely to feign amusement by my witty e-mails. He did a pretty good job staying off the Internet this vacation, meaning his inbox is likely overflowing; no doubt he’ll immediately be back to his workaholic ways.

Acquisitions, Funding, Business, and Stock

3-8-2012 7-10-24 PM

Medivo, a provider of decision support and analytics software, acquires WellApps, a developer of mobile disease management applications for chronically ill patients.


The 150 physician Holston Medical Group (TN) selects Humedica MinedShare as its clinical intelligence solution to be used in a joint venture with over non-Holston 1,300 physicians.

3-8-2012 10-14-26 AM

WellStar Health System (GA) selects PerfectServe’s clinical communication platform.

3-8-2012 7-12-04 PM

University Health System (TX) expands its Allscripts portfolio with the selection of Allscripts Community Record, powered by dbMotion, to share data across its 24 locations.

3-8-2012 7-13-05 PM

Watson Clinic (FL) selects MedAptus’ Professional Intelligent Charge Capture for its 294 multi-specialty providers.

Oakwood ACO (MI) contracts with Wellcentive to provide its the Wellcentive Advance healthcare intelligence solution suite for Oakwood ACO physicians.

3-8-2012 7-14-13 PM

Fairview Health Services (MN) chooses Amcom Software’s communication solutions, including smartphone-ready encrypted messaging and nurse call alerting on mobile devices.

3-8-2012 7-15-05 PM

Brattleboro Memorial Hospital (VT) selects Unibased’s ForSite2020 solution for enterprise scheduling.

CSC signs a nonbinding letter of intent with the NHS to move forward with additional implementations of the Lorenzo patient records system, beyond the 10 that have already been rolled out.


3-8-2012 7-16-08 PM

The Cal eConnect board of directors appoints Ted Kremer as president and CEO. Most recently Kremer served as executive director of the Rochester Health Information Organization.

3-8-2012 7-17-08 PM

Former Nuance Communications executive John Shagoury joins Eliza Corp. as president. Shagoury replaces company co-founder Alexandra Drane, who takes over as chairwoman and chief visionary officer of the patient engagement company. Shagoury is the former president of Nuance’s healthcare division.

3-8-2012 7-18-13 PM

Physicians Interactive, a provider of mobile and Web-based clinical resources, names Gautam Gulati, MD (Digitas Health) as CMO and SVP of product management and Joe Caso (King Pharmaceuticals, Pfizer) as EVP of new business development.

Announcements and Implementations

Datawatch Corporation partners with HIT consulting firm Jacobus Consulting, enabling Jacobus to incorporate Datawatch’s Monarch Report Analytics platform into its client offerings.

Bayscribe partners with Health Fidelity to integrate Fidelity’s NLP platform into BayScribe’s clinical documentation solutions.

Government and Politics

The Stage 2 proposed rules for Meaningful Use were officially published in the Federal Register Wednesday, marking the start the 60 day commentary period. CMS is accepting feedback through May 7th.


Solo and small practices are now outpacing larger practices in EHR adoption, with single-doctor office adoption growing from 31% to 37% for the second half of 2011. Overall EHR adoption rates remain higher as the number of physicians practicing at each site rises.

Moody’s Investor Service predicts even more consolidation among hospitals over the next few years as institutions look for ways to enhance efficiencies, improve competitiveness, and drive higher payments from insurers.

3-8-2012 6-26-39 PM

Forbes profiles Epic founder and CEO Judy Faulkner, whom it dubs “healthcare’s low-key billionaire.” The magazine estimates her net worth at more than $1.5 billion, making her the only woman to reach the rank of billionaire by founding her own technology company.

3-8-2012 6-58-17 PM

Weird News Andy checks in with a few goodies, including a story of a three-year-old who ingested 37 Buckyball magnets. The magnets snapped together in the child’s intestine, tearing holes in the intestine and stomach. WNA says, “No MRIs, please.”

WNA wonders how much the living received in overpayments, after an audit finds that Washington, DC paid nearly $700,000 in Medicaid payments for dead people, including one nearly nine years after the patient’s death.

And in an overachieving moment, WNA adds the story of a Texas dialysis nurse, accused of injecting bleach into the dialysis tubing of patients, killing five.

Sponsor Updates

  • API reports it added 38 contracts with new and existing clients between Q4 2011 and Q1 2012 to date.
  • BCBS North Carolina launches a mobile version of its member web portal that is based on Kony Solutions’ mobile technology
  • States and regional HIE’s drive demand for technology from Medicity, Axoloti, and Orion.
  • Gwinnett Medical Center (GA) launches MedGift, an online gift registry powered by RelayHealth.
  • Pathology Service Associates, a division of MED3OOO, prepares to move into a new, $5.5 million 32,000 square foot headquarters in Florence, SC.
  • Health 2.0’s Matthew Holt chats with Kareo CEO Dan Rodrigues about the current state of the one to four physician market.
  • iSirona releases DeviceConX 4.0, its latest version of connectivity software.
  • Hayes Management Consultant’s Anita Archer, CPC, provides recommendations for preparing for ICD-10.
  • Vitalize Consulting Solutions ranks third in the 2011 Best in KLAS Awards for software and services. Apparently KLAS inadvertently left VCS off the original report published in December.
  • The Advisory Board reports that nearly 50% of hospital CIOs will hire consultants to help achieve MU.

EPtalk by Dr. Jayne


Nuance announced plans to drop $300 million in cash to acquire Atlanta-based medical transcription and speech editing vendor Transcend Services. The move is aimed at expanding Nuance’s customer base in the small- to mid-size hospital market. We’ll have to see if employees still embrace the “It’s better here” motto after the dust settles.

In other acquisition news, CareFusion will PHACTS LLC. CareFusion hopes that by adding PHACTS to its existing Pyxis products, pharmacies can better manage inventory, manage drug shortages, and of course improve the bottom line.

IBM has named nine members of the Watson Advisory Board to “focus on medical industry trends, clinical imperatives, regulatory considerations, privacy concerns, and patient and clinician expectations around the Watson technology and how it can be incorporated into clinician workflows.” Seven of the nine are physicians, including family doc Douglas Henley MD who is CEO of the American Academy of Family Physicians. I learned at HIMSS that family docs can be a lot of fun so I’m excited to see him on the Board.


ONC is seeking public comment on how health care providers and health systems user mobile devices to access, store, and transmit health information. Laptops, PDAs, smartphones, and tablet computers were specifically called out but storage devices were excluded. Comments are being accepted through Friday, March 30th.

CMS will be releasing new online billing statements intended to help seniors find bogus charges. The “consumer-friendly format” goes live Saturday on Medicare’s secure web site. Features include larger type and explanations of medical services in plain language. Revised paper statements are coming next year. I cruised the site looking for samples but couldn’t find any, so I’ll use my next best research source: grandma. I definitely want to see one before patients bring them to me to discuss. Apparently the site also allows beneficiaries to check claims status and use an online appeals form. It also includes the Blue Button.


HIMSS released its online photo gallery in case you want to purchase photos of your favorite ONC, CMS, and HIT crushes. Although it’s not from the official HIMSS site, I’ve been told this pic depicts the response of a certain someone when informed that he missed the chance to dance with the ladies of HIStalk at HIStalkapalooza.


No, that’s not a sample of the tattoos that Inga and I had done while we were in Las Vegas – but one of my favorite readers did send an article about the growing phenomenon of medical tattoos. It’s low tech but does make a point for patients with health conditions or who want to make sure first responders understand an individual’s wishes for resuscitation. The tattoo chosen by the reader in question: “afraid of needles.”

Have a question about voice recognition, clinical decision support, or just want to share what you’d choose as your medical tattoo? Email me.



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

More news: HIStalk Practice, HIStalk Mobile.

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March 8, 2012 News 4 Comments

Nuance to Buy Transcend Services for $300 Million

March 7, 2012 News No Comments

3-7-2012 8-36-15 AM  3-7-2012 8-38-16 AM

Nuance announces Wednesday morning a definitive agreement to acquire Transcend Services, a provider of medical transcription and speech editing services, for $300 million, net, in cash. The acquisition accelerates Nuance’s expands the company’s presence in the small- to mid-size hospital market.

Janet Dillione, EVP and GM of Nuance’s Healthcare business said, “The acquisition of Transcend will expand the delivery of our innovative voice and Clinical Language Understanding solutions especially to small- and mid-size hospitals. With Transcend, we will drive change and improvement to the way these hospitals capture and leverage clinical information. The acquisition is a natural extension of Nuance’s existing healthcare business, and will strengthen our solution and services portfolio, as well as enhance our profitability.”

Transcend acquired electronic clinical documentation provider Salar in August of 2011.

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March 7, 2012 News No Comments

News 3/2/12

March 1, 2012 News 4 Comments

Top News

3-1-2012 7-03-49 PM

The Defense Department appoints former Harris Corp. VP Barclay Butler to serve as director of the Defense Department/VA Department Interagency Program Office to manage the development of an integrated EHR for both departments.

Reader Comments

inga_small From HairClub: “Re: Shafiq Rab. The CIO at Orange Regional Medical Center is taking the VP/CIO position at Hackensack University Medical Center.” Unverified.

inga_small From Free Lunch: “Jason DeSantis. Joining Zanett’s healthcare division as executive director of business development.” Unverified. He’s division CIO at University Hospitals in Cleveland.

mrh_small From Last Man Standing: “Re: GE Healthcare. Layoff today of 5% targeting services and support.” Unverified. Many of the GEHC rumors I get are somewhat true but exaggerated, so if the company provides an update (which companies usually don’t for HR-related issues) I’ll run it here.

3-1-2012 8-10-06 PM

mrh_small From Printgeek: “Re: Epocrates. Laid off their entire EMR staff on Tuesday and are shutting down their EMR project. The BOD lost patience, as crazy sales expectations were set by previous CEO and CFO. They expected to sell 1,500 docs in 2011 with an uncertified system that was release in July. This exec team did a good job hiring talent, but failed to listen to their feedback on what it takes to actually sell EMR and the subsequent expectations.” I think there’s a lesson to be learned here: if selling EMRs was easy, everybody would be doing it, and HITECH has accelerated the polarization of the successful and unsuccessful vendors. If Epocrates, which has an impeccable brand recognition in healthcare and was seemingly doing all the right things, struggled to meet sales numbers for its EMRs, clearly the age of the mom-and-pop EMR is over. Actually, there’s an even more applicable lesson here: publicly traded companies may say all the right things about being dedicated to healthcare, but quarterly numbers can send them fleeing for cover almost instantly. Whatever docs just bought their EMR are now finding out what it means to be on the wrong side of their vendor’s “core business.” The one-year share price chart doesn’t inspire much confidence that a steady hand on the tiller is what’s needed – shares are down almost 60% in the past year.

3-1-2012 9-01-37 PM

mrh_small From HIT Student: “Re: Connected Care Challenge. I thought some of your readers might be interested.” Janssen is offering $250K in awards for easily adopted, low cost technology solutions that can improve information sharing among hospitals, patients, caregivers, and community physicians, with the goal of improving post-hospital care and lowering the cost of unnecessary readmissions. Submissions are being accepted through March 25.

mrh_small From Non-Sequitur: “Re: SNOMED. Here are examples of the proposal to require SNOMED in Stage 2/2014 Edition. In the 45 CFR Part 170 Standards Companion, see Pages 45 (cancer registry), 52 (problem list MU objective), 58 (summary care record MU objective), and 90 (lab results to public health agencies MU objective.)” Thanks. I know several readers are interested in the potential requirement to use SNOMED.

3-1-2012 9-12-09 PM

mrh_small From I Was There: “Re: HIStalk sponsor lunch at HIMSS. Great location, great food, a nice mix of heavy hitters and rising stars, and great networking with lots of cards being passed and commitments for follow-up discussions. Art Glasgow’s talk was very well received, talking about how HIStalk plays a part in his daily activities as Duke University Hospital CIO, how vendors and providers should help spread the word about it, and the shifts he made going from the vendor world at Ingenix to Duke. The focus was on the three of you as people were trying to figure out who you are and checking out Inga’s shoes. I thought the event was great.” It was really cool that 100+ folks from our sponsoring companies took time away from a very busy first day of the HIMSS conference to let us say thanks to them for supporting what we do. Naturally Inga, Dr. Jayne, and I felt simultaneously ridiculous and vulnerable appearing in disguise, but we did our best. Most of our sponsors understand that we’re going to objective and fair to sponsors and non-sponsors alike and, to their credit, they support us even when what we say isn’t going to be popular back in their offices. If you were there, thank you very much.

mrh_small From Judy Judy Judy: “Re: Epic consulting firm. Last week Judy F. of Epic met with executives of [consulting firm name omitted] about their violation of Epic’s non-solicitation clause. An Epic client turned them in to Epic after the firm poached a handful of the client’s employees. Epic banned the firm for a year (which was ‘negotiated’ to a shorter term) from selling to or doing business with any new Epic customers. Seems like a slap on the wrist based on recent discussions with Epic Consulting relations personnel and their stringent expectations for consulting partners. Why not take away their preferred certification program as well?” Unverified, so I’ll leave out the company name for now.

mrh_small From MD Informaticist: “Re: digital pen technology – mightier than the mouse? Are they really making an impact on usability and clinical documentation? I would be interested in your opinion of the Verizon and other digital pens and clarify for us: can this technology re-energize a dormant innovative industry?” What I’ve seen of them seems pretty cool, but I’m interested in hearing from readers about who is actually using them and what results they are getting.

mrh_small From Mark Schmidt: “Re: HIMSS. It’s become such a large event that the Booth Crawl brought back feelings of those early days when it was possible to spend time with just about every vendor. I learned a lot and heard the latest from Sunquest, which has not been sitting still as the industry has progressed!” Mark, CIO of SISU Medical Systems of Duluth, MN, won a Sunquest-provided iPad last week. He and I have swapped occasional e-mails going back to early 2008.

mrh_small From Just a Fan: “Re: 5010. Anyone else having issues with a claims clearinghouse not being ready? Our cash on hand is taking a beating because our claims have been sitting at the clearinghouse and are only just now starting to trickle out to payers, which are requesting information required on 4010 but deleted in 5010. And the enforcement delay was good why?” We keep hearing anonymous rumblings with no specific examples. Give us details and we’ll see what we can find out.

HIStalk Announcements and Requests

inga_small This week on HIStalk Practice: Dr. Gregg pulls a double shift in an an attempt to diffuse last week’s “mournful silence” on HIStalk Practice while I was busy drinking IngaTinis and walking my high heels off at HIMSS. Dr. Gregg missed HIMSS this year, but still offers some fun HIMSS musings. A proposed rule would require physicians to return improper Medicare payments within 60 days of  notification and allow auditors to investigate 10 years of records. Most physicians believe EHR use is valuable for improving quality and managing patient care, but less convinced that EHR improves diagnosis accuracy or treatment planning. Black Book Rankings announces its ambulatory EHR vendor rankings. Athenahealth CEO Jonathan Bush likens his company to a “snippy kind of overconfident Chihuahua jumping up and trying to nip at the tails of the Dobermans.” By the way, we are conducting a reader survey on HIStalk Practice that is in addition to the HIStalk version; we’d love readers to take a moment to  have a  to provide input. Thanks for reading!

3-1-2012 7-24-23 PM

mrh_small I appreciate the support of Levi, Ray & Shoup (specifically LRS Output Management) for supporting HIStalk as a Platinum Sponsor. The company’s expertise is in document solutions for hospitals, so let’s use a typical Epic shop as an example. Maybe your big Epic print jobs fail; you need centralized capability to monitor and reprint jobs without re-running them on Epic; you are maxing out out your Windows print queues or the Windows print spooler; or you’d like to save print costs by allowing users to preview reports before printing and automatically route large reports to more economical printers. With the LRS solution, you gain centralized control, you can implement load balancing, you avoid installing multiple print drivers on each workstation, and you get rid of the unreliable science fair of printing solutions (UNIX to JetDirects, multiple printer types, a mix of Epic text and ERTF documents, etc.) and you can even require users to verify their identity before printing patient documents to an unattended printer. It doesn’t matter how cool Epic is if the tangible, patient-critical label or report it creates as an end product is hanging out there in the ozone because of a cobbled-together print solution that is far less enterprise grade than the system that drives it. One hospital with four FTEs handling printing issues cut back to just one after implementing LRS Output Management, which can handle anywhere from hundreds to thousands of printers. And while Epic is a good example, the solution works with any application (Lawson, SAP, etc.) Check out their case studies from Carilion, Hopkins, UVA, etc. Thanks to Levi, Ray & Shoup for supporting HIStalk.

3-1-2012 7-42-29 PM

mrh_small Liaison Healthcare Informatics is supporting HIStalk as a Platinum Sponsor. The Atlanta-based integration and data management company has over 9,000 customers all over the world, including more than 600 in healthcare. The company’s cloud-based data integration solutions provide a platform for the secure exchange of data among providers, payers, patients, and HIEs. Some of the pain points it addresses are HIPAA, HITECH, DEA Form 222, Safe Harbor qualification of encrypting PHI data at rest, electronic file transfers, and avoidance of data breaches. Its Liaison Protect solution makes sure you are securing your databases, integrating encryption, tokenization, key management, and logging. Its Liaison Exchange managed file transfer software suite allows cost-effective management of ever-increasing volumes of file transfer exchanges both inside and outside the organization. If you need to accelerate your HIE or ACO efforts, securely share patient information with other organizations, or gain control over risky and poorly monitored file transfers, give their offerings a look. Thanks to Liaison Healthcare Informatics for supporting HIStalk.

mrh_small Inga mentioned the reader survey — you have one last chance to provide input that we’ll use to plan the next year of HIStalk. Thanks. It really does help us given that we work largely in a vacuum and have to pick and choose our projects since we have limited time to get things done.

mrh_small For our numbers-obsessed reader(s), we had a record-breaking 125,867 visits in February, along with 196,565 page views. The e-mail blasts go out to 7,935 subscribers, while Dann’s HIStalk Fan Club has 2,268 members (OK, I admit that we’re not entirely comfortable with the idea of having fans, but it’s slightly satisfying to reflect on that fact during our frequent bouts of feelings of inadequacy and lack of accomplishment.) You can move our emotionally needy needles by (a) subscribing to the updates; (b) connecting with us on Facebook, LinkedIn, and Twitter; (c) supporting the sponsors who support us by poring over their ads, clicking those of interest, checking out their Resource Center pages, use the Consulting RFI Blaster to quickly solicit consulting help; (d) sending us news, rumors, guest articles, or anything else that would interest your fellow readers; and (e) feeling the positive thoughts Inga, Dr. Jayne, and I are beaming your way for supporting what we do in whatever form that support takes, which means a lot to the ladies and me.

mrh_small A reader asked about WellStar’s ambulatory EMR project. I have the information, but agreed to sit on it for a few days. Stay tuned.

3-1-2012 9-34-42 PM

mrh_small The overachievers at API Healthcare, not content to simply mail Gabe Davis (right) of Texas Health Partners his iPad prize from the recent Booth Crawl after he had to leave the HIMSS conference early, sent VP Kyle Allain (left) to his office to hand-deliver “the famous HIStalk iPad” personally. This was Gabe’s first trip to HIMSS and he had nice things to say about HIStalk and API’s support of it. His 16-year-old son will get the iPad and is apparently pretty stoked about it, and rightfully so because iPads are darned cool even if you aren’t an Apple fanboy.

On the Jobs Page: Financial Systems Consultants, Meditech CPOE Go-Live Support, Epic Certified Builders. On Healthcare IT Jobs: Senior Health Information Technology Specialist, Implementation Consultant, Project Manager CMIO Informatics, McKesson Paragon Consultants.

mrh_small I’m taking a little break to escort Mrs. HIStalk to somewhere warm and sunny where laptops are as rare as bathing suit tops (OK, I’m kidding on that one) so the eminently capable Inga and Dr. Jayne will be holding down the fort as I try to fight the urge to stay off e-mail (I’m rarely successful.) I don’t know about you, but I’m really tired after all the HIMSS-related activities over the past few weeks and I want to see what it feels like to sleep more than five hours in a single night.

Acquisitions, Funding, Business, and Stock

Teledermatology provider Iagnosis raises $1 million from 11 investors.

3-1-2012 10-33-58 PM

Accretive Health releases its Q4 numbers: profit of $13.2 million ($0.13/share) compared to last year’s $5.5 million ($0.06/share.) Net services revenue grew 53% to $260.1 million.

HP Enterprise Services notifies the State of Wisconsin that it will be eliminating 157 Medicaid program jobs in Madison and Milwaukee.


DR Systems announces six new contracts for its Unity platform totaling more than $2.07 million.

3-1-2012 10-34-51 PM

Cancer Treatment Centers of America signs an agreement to deploy Unibased Systems Architecture’s ForSite 2020 application suite across all its facilities.


3-1-2012 7-02-42 PM

Beacon Partners appoints Christina Bertsch (EMD Serono) VP of human resources.

3-1-2012 7-04-48 PM

The National Quality Forum board of directors announces that President and CEO Janet Corrigan will resign as of June 2012.

3-1-2012 7-05-52 PM

HHS Office for Civil Rights names attorney Juliet K. Choi (American Red Cross) as chief of staff and senior advisor.

Announcements and Implementations

3-1-2012 10-37-56 PM

Four Lakeland Healthcare (MI) hospitals go live on their $50 million Epic system.

T-System licenses its clinical terminology to Prognosis HIS, allowing Prognosis to incorporate into its ChartAccess EHR more than 200,000 clinical phrases.

MED3OOO chooses Macadamian to help develop a new product that it says will expand the usability and adoption of its ambulatory systems.

Shareable Ink incorporates Pentaho Business Analytics to create a data analytics platform for healthcare.

Michigan Health Connect wins second place in an IT innovator awards contest for its electronic referrals solution app, powered by Medicity’s iNexx, that was rolled out to nearly 1,000 physicians over 28 counties. 

Government and Politics

The Advisory Board Company does a nice high-level summary of the proposed Meaningful Use Stage 2, nice for CIOs prepping peer execs for what the IT agenda will look like.

In England, two NHS trusts seek a supplier to take over their IT help desk and infrastructure in what would be the first outsourcing contract of its kind. The deal is valued at  $50 million.

3-1-2012 10-39-00 PM

mrh_small I liked Doug Fridsma’s post on HHS’s blog about the Interoperability Showcase at HIMSS. He says Farzad Mostashari showed up there by surprise and challenged the participants to demonstrate impromptu interoperability with another participant with whom no relationship existed. He gave them one hour to make it happen technically, which involved overcoming challenges such as authentication certificates, vocabularies, and firewalls. The result: NextGen sent a C32 to Allscripts, EXCITA HIE and Medical Informatics Engineering exchanged a transfer of care document in ER discharge summary format, and Enable Healthcare sent a CCDA discharge summary to Verison to create a new patient chart. That’s pretty cool.


3-1-2012 10-42-49 PM

Ochsner Health System (LA) announces that its neurologists recently completed their 1,000th patient consult as part of Ochsner’s  telehealth stroke treatment program.

KLAS reports that some providers are concerned with a number product gaps and weaknesses in the McKesson Paragon product and wonder if Paragon can scale to larger hospitals, especially those with more than 400 beds.

Jackson Health System (FL) announces the layoff of more than 1,000 people in an effort to save the organization $69 million.

Trinity Health’s Michigan hospitals sign an agreement with University of Michigan to explore ways the organizations can work together to coordinate care, with one of the areas of discussion being information technology. 

3-1-2012 10-40-27 PM

A physician’s assistant who sued her former employer, Mercy General Hospital (CA), for sexual harassment is awarded $167 million.

3-1-2012 8-21-57 PM

mrh_small The folks at MED3OOO asked Inga and me to choose and announce a winner from the six finalists in their contest to create the best video testimonial. They offered to pay for our time, but we said it either had to be (a) free to them because they’re a sponsor, or (b) if they really wanted, they could donate whatever amount they wanted to a charity of our choice. Thanks to MED3OOO for their donation to Best Friends Animal Society, a highly rated charity whose mission is “to bring about a time when there are no more homeless pets.” And congratulations to the winner, Kyle Adkins, administrator of Golden Valley Medical Clinics of Clinton, MO (he’s in Interview 1 on the finalist page) which implemented the InteGreat browser-based EHR from MED3OOO. My favorite quote: “You don’t ever make this decision well the second time or a third time. You may make a better one if you’ve made the wrong decision, but there will be someone else making the decision.” Great job, Kyle, and for that you win an all-expense paid trip to MED3OOO’s 2012 National Healthcare Leadership and Users Conference in St. Thomas, US Virgin Islands in October.

Sponsor Updates

3-1-2012 9-06-36 PM

  • World Wide Technology is sponsoring Geek Day 12 in Washington DC, April 11-12, complete with showcase labs, breakouts, and birds of a feather session divided by industry focus. The event is free and so is lunch.
  • API Healthcare partners with Presagia Software to offer Presagia’s workforce absence management solutions to API clients.
  • ProHealth Care (WI) goes live with iSirona’s connectivity technology to deliver patient data from anesthesia monitors into Epic EMR.
  • A survey by BridgeHead Software finds that most hospitals want vendor neutrality with more control over their image data.
  • Black Book names Quest Diagnostic’s Care360 EHR the best EHR for single physician practices and for e-prescribing. It was also ranked eighth on Capterra’s most popular EMRs.
  • Alexander Orthopaedic Associates (FL) selects White Plume Technologies’ AccelaSMART resolution engine to bridge the gap between its Exscribe EHR and ADP’s AdvancedMD’s PM system.
  • MEDSEEK and BrightWhistle partner to offer a search and social media marketing solution.
  • Lawson Software enhances its Cloverleaf Secure Courier and Global Monitor for its Cloverleaf Integration Suite to increase speed and provide greater connectivity.
  • New York-Presbyterian Hospital goes live with Awarepoint’s RTLS at its Columbia University Medical Center campus.
  • Aventura will participate in the World Congress Inaugural eHealth Innovation Conference this month in Cambridge, MA.
  • Santa Rosa Consulting advisor Matt Wimberley  discusses confidentiality, integrity, and availability in the HIPAA security rule.
  • Bruce Friedman MD, emeritus professor of pathology at University of Michigan Medical School, keynotes at the Lifepoint Informatics User Conference 2012.
  • Evergreen Healthcare (WA) shares how API Healthcare’s Time and Attendance and Staffing and Scheduling technology helped the organization get its productivity and costs under control.
  • MedAptus launches a revenue cycle reporting and performance analytics module for its Professional solution.
  • Coastal Cardiovascular Consultants (NJ) will implement the SRS EHR at two locations for its six providers.

EPtalk by Dr. Jayne

The American Journal of Preventive Medicine recently published an article about cybercycling. It shows that riding a stationary bike which hooked up to interactive videogames could increase brain function in older adults compared with a standard exercise bike. Elderly study participants who took 3D tours and raced computer generated avatars showed better memory, attention, and problem-solving abilities. Not surprisingly, some reported knee and back pain as well as “frustration with interacting with a computer.” Now we just have to wait for a vendor to allow the cybercycling data to flow through the patient’s PHR into their EHR charts.

Shades of Eliot Ness: Even without federal approval, Illinois is getting tough on Medicaid fraud. The state will start matching Medicaid patient data with the state driver’s license database to make sure only Illinois residents are receiving benefits. Applicants would also have to show additional proof of income to maintain benefits. Even without federal blessing, this seems like a reasonable idea – recently 6% of Medicaid cards were returned as undeliverable or having an out-of-state forwarding address.

It looks like there might be another way for vendors to expand their offerings. The Department of Health and Human Services recently announced plans to look as far back as 10 years when auditing Medicare overpayments. I forsee a whole new subset of vendors offering data archiving and retrieval specifically for Medicare billing. As Medicare goes, so go the rest of the payers, so it’s only a matter of time before providers are forced to maintain massive amounts of data. And we thought seven years for the IRS was bad.

For those of you who work directly with providers, it will be interesting to see how upcoming changes to the Medical College Admission Test (MCAT) affect the physician pool. The test is being updated to gauge “knowledge of the psychological, social, and biological foundations of behavior” as well as critical thinking skills. The goal is to “better prepare students to be doctors in today’s changing health care system.” It will be interesting to see if this really makes a difference in patient care, but I do hope it will also make a difference in being able to intervene with colleagues who are ripping their hair out due to the continuous onslaught of ever-changing federal and payer regulations.

USA Today reports that Hawaiians rank at the top for residents having the best overall sense of well-being. Don’t attribute it all to the sunlight and tropical breezes though – North Dakota, Minnesota, and Alaska also made the top ten. West Virginia finished last. Gallup gathered the data by calling 1,000 people daily for all but 15 days of 2011.

I’m still poring over all the Stage 2 documentation that’s coming across my desk (and phone, and e-mail, and the water cooler) and for better or worse, it seems like I’ve become comfortably numb as far as finding something noteworthy to discuss. Have a thought about your interpretation of those 455 pages of bliss? E-mail me.



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

More news: HIStalk Practice, HIStalk Mobile.

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March 1, 2012 News 4 Comments

News 2/29/12

February 28, 2012 News 1 Comment

Top News

2-28-2012 8-12-15 PM

2-28-2012 6-12-17 PM

mrh_small Epocrates reports Q4 numbers: revenue up 9%, EPS –$0.18 vs. $0.01. The company reduced 2012 revenue estimates and says it will seek strategic alternatives for its EHR, which includes a native iPad version, since “the effort has hindered our ability to aggressively pursue such [physician network] opportunities.” Maybe that list of EHR mistakes is of theirs.

Reader Comments

2-28-2012 7-57-00 PM

mrh_small From BeenThere: “Re: WellStar. Shutting down its ambulatory rollout of [vendor name omitted].” I’m looking for confirmation and will provide more details if I get them.

mrh_small From Non-Sequitur: “Re: SNOMED. My manager attended Dr. Mostashari’s session and is able to substantiate what you wrote down about SNOMED and the problem list. He captured the talk on a Flip and we just listened to that segment talking how ‘we now have a standard for this or that’ ontology. Here’s specifically what he said regarding problem lists: ‘There is now a single standard for problem lists: SNOMED.’ I concur with the other people who have commented there is no mention of a requirement for SNOMED in the currently released document. We’ll see if what is published in the Federal Register provides additional detail.“ Thanks! I was hoping I hadn’t dreamed that part so early in his talk.

mrh_small From Jockey: “Re: Allscripts. Curious if you’ve heard rumors of an acquisition by some big non-healthcare guys.” Two anonymous readers have said that IBM (and possibly Oracle) might be making a move, but I have nothing substantial to back that up.

2-28-2012 8-03-03 PM

mrh_small From BrazosKid: “Re: KC area eClinicalWorks user group meeting. Surprise guest was CEO Girish. Said a few words and took some questions, made time for anyone who wanted to talk to him. A very personable and approachable CEO. You should interview him.” I have, actually: in 2006, 2008, and 2009. Girish Kumar Navani is one of my favorite people to talk to: honest, logical, and insightful, not to mention fun and an excellent businessman.

2-28-2012 7-58-48 PM

mrh_small From Phil: “Re: HIStalkapalooza. The flipbook with Elvis was the highlight of the memorabilia I brought back!” Those were cool. Check them out in the video if you haven’t already. I may need to make Elvis a fixture at future events since he was fun.

mrh_small From Kathy Wheatley: “Re: thanks for the Booth Crawl iPad from T-System. Coincidentally, some of our facilities use T-System and love it. Paper T’s in the past, but the electronic version is very easy, fast, and reliable. Thank you T-System for sponsoring HIStalk. I get my information from HIStalk, HIStalk Practice, and HIStalk Mobile, pull out applicable info, and copy it in another e-mail for our leadership team. My boss told me not to stop sending them – he was getting a lot of good market info from them. You have a great knack of pulling together applicable and trend information to hand it to your readers with a great synopsis and links to the full articles, which I have used often. I appreciate the writings of Inga, Dr. Jayne, and Dr. Gregg as well, and I enjoy reading Ed Marx – so spot on. Thanks for being the glue that holds this together.” Thanks for those nice comments from Kathy from HCA, for which I’m sure I’m speaking for T-System as well. I also got  nice e-mail from Jason Blunk, who won his iPad from MedPlus and said he enjoyed checking out booths he would have missed otherwise.

mrh_small From Sagacity: “Re: Meaningful Use Stage 2 references. Along with the bookmarked version of the NPRM, here is a bookmarked version of the ONC Standards, Implementation Specifications, and Certification Criteria. It comes with the added bonus of clickable MU Objective links, which take you back to the CMS MU objective being referenced in the CMS document. (Just be sure to save both in the same folder).” Thanks for sending the links.

mrh_small From The PACS Designer: “Re: iPad 3. When the iPad 3 is released next month, you’ll find that the majority of changes will be inside, since rumored details indicate that there will be no change in the size of the screen. One new upgrade coming is better High Definition, where the number of pixels will double by using a 4×4 matrix instead of 2×2 currently in the iPad 2.”

HIStalk Announcements and Requests

mrh_small If you’ve completed my once-a-year Reader Survey, thanks. If not, I’d appreciate your input.

Acquisitions, Funding, Business, and Stock

2-28-2012 5-01-15 PM

Halfpenny Technologies secures $2.25 million in VC funding co-led by Vital Financial and Emerald Stage2 Ventures. The company also announces that it has won approval as the first pilot by the Laboratory Results Interface Pilots Work Group.

2-28-2012 5-01-56 PM

T-System acquires Clinical Coding Solutions, a provider of technology for facility and professional charge capture and coding for EDs, observation, urgent care centers, and outpatient clinics.

2-28-2012 5-02-54 PM

Hello Health raises $10 million in a combination of common and preferred shares and issuance of convertible debentures through its parent company Myca Health.


2-28-2012 2-33-47 PM

CentraState Healthcare System (NJ) chooses Cognizant to develop its ICD-10 transition strategy.

2-28-2012 2-35-34 PM

Trinity Health (MI) selects Quest Diagnostics’ ChartMaxx Enterprise Content Management solution.

LifeCare Hospitals (TX) chooses Meta’s integrated HIM and CDI software suite for abstracting/coding and clinical documentation for its 27 long-term acute care facilities.

CMS awards SAIC a contract to provide enterprise remote identity proofing and multi-factor authentication credential services. The total contract value is $78 million, assuming all contract options are exercised.

HMO Simply Healthcare (FL) selects MedHOK’s care management, quality, and compliance software for quality improvement initiatives.

2-28-2012 2-39-10 PM

Sacred Heart Health Systems (FL), Piedmont Healthcare (GA), and Orlando Health (FL) sign contracts with QuadraMed for its identity management solutions.


2-28-2012 5-05-51 PM

KPMG appoints Richard Bakalar (Microsoft Health Solutions Group) to its Global Healthcare Center of Excellence.

2-28-2012 5-09-32 PM

CORHIO Executive Director Phyllis Albritton announces that she will step down at the end of March after four years of leading the organization.

2-28-2012 5-12-58 PM

Cape Cod Healthcare (MA) promotes Jeanne M. Fallon to VP/CIO.

2-28-2012 5-14-07 PM

CareCloud appoints John Hallock, formerly with athenahealth, as VP of corporate communications.

2-28-2012 5-15-29 PM

Siemens Healthcare names David Fisher, formerly with the Medical Imaging & Technology Alliance, as VP of healthcare policy and strategy.

Announcements and Implementations

2-28-2012 2-49-53 PM

Ochsner Health System (LA) standardizes on the Informatica platform for HIE, BI, and other IS initiatives.

2-28-2012 2-51-58 PM

Sentara Princess Anne Hospital (VA) implements EXTENSION’s clinical workflow solutions for nursing staff in its neonatal ICU.

2-28-2012 6-09-28 PM

Oakwood Healthcare Dearborn (MI) will go live with an $80 million Epic project in August.

Midwest Orthopaedis at Rush goes live with SA Ignite’s MU Assistant, which documents EHR usage in preparation for assessment.

Delaware Health Information Network announces that all of the state’s acute care hospitals and skilled nursing facilities are participating in its statewide community health record, making it the first state to have all hospitals involved.

2-28-2012 8-06-05 PM

New York eHealth Collaborative is accepting presentation proposals through March 23 for its 2012 Digital Health Conference to be held in October.

Shareable Ink announces partnerships with Greenway, NextEMR, and VoiceHIT for its handwriting recognition technology.

Government and Politics

In England, a hospital pilots an analytics service in which drug companies can use the hospital’s de-identified and aggregated data directly from its databases to perform queries and data analysis.

The VA orders worked stopped on its $103 million enterprise service bus that would connect external products to the EHR it’s developing with the Department of Defense. CIO Roger Baker also says the VA is looking for less-expensive alternatives to Microsoft Office, but has no immediate plans to switch.

CMS credits its fraud detection technology for the indictment of a Texas physician and six other people who it claims bilked the government for $375 million of unnecessary home health services. CMS says the physician certified more Medicare beneficiaries for home health service than any other US medical practice, claiming that he recruited them via door-to-door solicitations and visits to the local homeless shelter.


2-28-2012 2-53-34 PM

Novant Health (NC) is hiring 150 people with clinical and computer experience as it transitions to Epic.

Weird News Andy extends this story on cosmetic leg-lengthening surgery, which he captions, “Men, grow six inches.” WNA also likes this ink on medical tattoos, including “No CPR” emblazoned on a man’s chest, although the wording WNA suggests for breast implants is not family friendly.

Nuesoft is conducting a survey on attitudes about the transition to ICD-10 and ANSI-5010.

An article in the Minneapolis paper covers the local VA’s use of a virtual ICU to cover hospital ICUs in multiple cities from a single location, which an intensivist there likens to air traffic controllers watching from afar.

Sponsor Updates

2-28-2012 8-09-16 PM

  • DIVURGENT and Bon Secours Kentucky Health System publish a white paper on implementing an EMR.
  • Covisint partners with Anvita Health to add Anvita’s Smart Problem List to its HIE platform.
  • Comanche County Memorial Hospital (OK) will migrate from McKesson’s Horizon Clinicals to Paragon HIS.
  • ZirMed introduces VeraFund Manager, an end-to-end automated patient/payer solution for healthcare providers.
  • CommunityHealth IT (FL) partners with RelayHealth for its HIE.
  • Allscripts and MyCareTeam launch a diabetes management system that integrates the MyCareTeam application with Allscripts Enterprise EHR.
  • Beacon Partners launches Pillars Project Planner, a Web-based project management and implementation tool that provides organizations real-time access to their projects.
  • Nuance introduces two clinical language understanding solutions, Dragon Medical 360 | M.D.Assist and Dragon Medical 360 | QualityAnalytics.
  • eClinicalWorks announces Community Analytics, a data analytics solution for communities and ACOs that provides reporting, alerting, and messaging capabilities to manage population health.
  • UC Health (OH) expands its use of Streamline Health Solutions in three of its hospitals.
  • Central Alabama Health Image Exchange selects MEDecision to deliver its DICOM images and clinical information solution to seven of its hospitals.
  • Healthland partners with Imprivata to resell Imprivata’s single sign-on and access management technology.
  • Concentra (TX) selects Allscripts EHR to deploy in its 310 urgent care locations across the country. CVS Caremark’s MinuteClinic will transition from its proprietary EMR to AllscriptsMyWay EHR.
  • HFMA grants Surgical Information Systems the “Peer Reviewed by HFMA” designation.
  • LTC provider NuVista Living (FL) implements the Intelligent InSites RTLS solution as part of its Living Smart Room.
  • Trenton Health Team (NJ) selects Covisint as its HIE provider.
  • GetWellNetwork says it gained 25 new hospital customers and a 35% increase in live beds for its interactive patient care solution in 2011.
  • Healthcare Management Systems (HMS) and Certify Data Systems partner to make Certify’s HIE solution available to HMS customers.
  • Microsoft selects Health Language to map patient data within Microsoft Amalga platform.
  • Practice Fusion wins top honors for customer satisfaction in the primary care division of the Black Book Ratings
  • Imprivata introduces CorText, its secure texting application.
  • T-System introduces care coordination technology at the Emergency Nurses Association Leadership Conference.
  • PatientKeeper introduces the latest release of its medication reconciliation software.
  • Brown & Toland IPA (CA) selects Humedica MinedShare as its analytics platform to assist its 1,500 physicians with Pioneer ACO requirements.
  • CynergisTek partners with Iatric Systems to offer Iatric’s Security Audit Manager and Medical Records Release Manager solutions.
  • Quest Diagnostics announces a 30-day EHR implementation guarantee to enable bi-directional data exchange between hospitals and ambulatory physicians using the Care360 EHR.


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

More news: HIStalk Practice, HIStalk Mobile.

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February 28, 2012 News 1 Comment

Curbside Consult with Dr. Jayne 2/27/12

February 27, 2012 Dr. Jayne 2 Comments

Over the past several years (and especially with Meaningful Use) there has been a fairly significant shift in the attitudes of ambulatory physicians who are making the leap to electronic health records. The hospital-based physicians (and ambulatory physicians who see patients in the hospital) are a different story. They’re a captive audience who has always been subject to hospital control and who has a long-standing history of adapting to things imposed by various Big Brother entities: the Joint Commission, the hospital’s formulary team, insurance and hospital case managers, etc.

Those physicians have done pretty well adapting to electronic documentation, computerized order entry, and the like while in the hospital. Hospitals have also tended to phase their implementations over the scope of years – deploying in a modular fashion with lab, nursing documentation, CPOE, and provider documentation all done as separate initiatives. Ambulatory docs who dislike the hospital’s conversion have been able to escape back to the relative safety of private practice and cling to their paper charts.

As ambulatory physicians transition to EHR, though, they tend to deploy more rapidly – wanting to get rid of all the paper immediately, but also with a strong drive to keep the revenue stream steady. When I started deploying EHRs some time ago, we worked with early adopters who believed in the promise of electronic recordkeeping and were more willing to staff up, reduce patient load, or work longer hours to realize their goals. These physicians are now mature users who are leveraging their EHRs to achieve advanced Patient Centered Medical Home designations, increase fee schedules through demonstrable quality, and improve patient satisfaction.

On the other hand, there are now thousands of physicians who previously found the idea of the EHR distasteful and feel forced to make the transition. Whether by peer pressure, payer requirements, or the threat of government-related penalties, they’re now implementing and with a significantly different strategy than may be prudent.

More often, I hear of physicians that want to implement a system fast, cheap, and easy. The rest of us who have done this for a while know that it’s very difficult (if not impossible) to do all three. Often these late adopters refuse to follow vendor advice, consultant advice, or frankly anyone’s advice. Convincing them to cut schedules or hire staff is a challenge. Ultimately, it’s the patients who suffer.

As the healthcare market consolidates, hospitals and health systems are looking to “align” (one of my least-favorite buzzwords) with community physicians to ensure profitable referral, ancillary, surgical, and inpatient revenue streams. Many are offering subsidies and other incentives to bring these providers onto EHR systems.

Often these practices don’t actually want to align, but are feeling cornered and desperate. Some have previously turned down acquisition offers from the same hospital and see taking a subsidized EHR as a way to be somewhat protected from burdensome federal requirements while maintaining at least some degree of autonomy. Others simply can’t afford an EHR without the subsidy. A last group is providers who’d like to be acquired but for various reasons aren’t suitable candidates, but hope that alignment (and sending a steady volume of referrals which of course cannot be spoken about) will result in being ultimately asked to the dance.

These physicians often deploy on an existing system-wide EHR. Since they’re late to the game, though, they haven’t been stakeholders in any of the decision-making that’s already occurred and often have less buy-in to the idea of group goals than those users who are actually part of the group.

Another angle is that even though subsidized, these physicians are paying customers with different expectations than employed physicians and different ideas about governance. Of course, this would have been true even if these subsidized physicians were early adopters, but the differences are magnified by them being late in the EHR game and feeling pressured to demonstrate Meaningful Use as quickly as possible.

I still go out on implementations and perform physician training on a regular basis. Until recently, most of the physicians I have worked with have treated me as a respected colleague who could assist them through the difficult transition. Some have even looked at me as some kind of EHR shaman, able to smooth their journey to the other side with mystical wisdom. Of course, there have always been a few docs who were borderline (or overtly) hostile, but they were few and far between and usually we could leverage their partners or peers to moderate their behaviors.

Lately I’ve run into more and more angry physicians who are completely resistant to the idea of the EHR transition even though they’ve agreed to go paperless. Some are passive-aggressive, but others are openly abusive. This manifests in a variety of ways – disruptive behavior, inappropriate comments during training (think middle school students with a substitute teacher), or refusing to be trained at all. I find the latter group the most frustrating because then they can’t figure out why the system is so hard to use and scream the loudest about lack of support.

Looking at the data on how many physicians are actually using EHRs in practice (let alone being robust users) we’re just approaching the midpoint. If what I’m seeing in the field is any indication, it’s only going to get tougher as the last-ditch adopters come through with increasingly unrealistic expectations and correspondingly difficult implementations.

I feel bad for the vendors and for the teams who have to support these folks (mine included.) I feel bad for the physicians who don’t want to transition to EHR and the staff members that have to work with them every day. But most of all, I feel bad for the patients who entrust them with their care. Regardless of what they think about the EHR, the IT team, or the government, I hope the angry docs remember that after all, it IS all about the patient.


E-mail Dr. Jayne.

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February 27, 2012 Dr. Jayne 2 Comments

Readers Write 2/15/12

February 15, 2012 Readers Write 8 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!

iPad Fatigue: Choose Your Mobile Strategy Wisely
By Chris Joyce

2-15-2012 8-43-25 PM

I get the attraction of the iPad … your own personal device that’s sexy and lean, as opposed to the standard-issue, Windows XP desktop locked down by your hospital’s IT group or the clunky computer on wheels. The simple UI and the glossy new apps let you shed the pain of those legacy systems and, most important, you get mobility.

Given the glacial pace of innovation in healthcare, who can fault people for wanting to use these beautiful devices? We are all trying to create a sea change in healthcare IT, much like the iPhone did for telecommunications. But I’m going to say something that’s wildly unpopular: the iPad is not well suited for healthcare in its current state.

I’ve been working in tablet-based mobility for seven years (yes, there were tablets before the iPad). We’ve studied clinician data collection workflow in registration, the ED, home health, cardiology, radiology, orthopedics, and clinical trials. Trust that my opinions are carefully thought out from experience.

I will concede that the Windows-based tablet manufacturers deserved to be smacked around by Apple for their lack of vision and slow progress. Years ago, I, along with my customer (one of the largest health systems in California that had been using tablets in cardiology for years) sat down with the folks at Intel and Motion Computing to tell them that the C5 was too complicated and expensive. I shared what we needed in the ideal tablet: a bright, 12” screen with stylus support that’s ideal for documents, 8-10 hours of battery life, no external ports or other gadgets, and a sub-$1,000 price tag. Our request fell on deaf ears as they paraded out the next incremental chip set improvement in their roadmap.

When the iPad hit the market, we thought we’d finally gotten our ideal tablet. The price was right, the screen was bright, the battery life was unbelievable, it ran coolly and didn’t burn your arms, it booted in seconds, and the 1.5 pound. form factor (half the current tablets) was simple and elegant. Finally, we had the perfect complement to our mobile forms software. This wasn’t just a Windows laptop with the keyboard chopped off – it was an appliance, a tablet.

But it also has some major shortcomings that our customers are now discovering:

10” display
This is subtle because I like the more portable size, but those standard consents, ABNs and Medicare forms you’ve used for years don’t fit on a 10” display without disrupting the layout. Your app has to be “touch-aware” or you’ll interact with the screen when you rest your hand to sign or add a note. Our customers are counting clicks and don’t like the iPad because they have to scroll to use the forms that once fit on their 12” Windows tablets.

No stylus
This makes capturing signatures, annotations on diagrams, and unstructured notes impossible unless you buy a third-party stylus like Pogo. But that’s like writing with a crayon and there is no place to dock your pen. Are your patients going to be comfortable signing an informed consent with their fingers?

No handwriting recognition
The soft keyboard isn’t practical for a lot of data entry because you are still holding the tablet with one hand and pecking out everything with the other. And bouncing back and forth between numeric and alpha characters drives users absolutely mad. Handwriting recognition has its place in documentation, just like voice dictation, and it can be as fast as paper. There is nothing fast about the iPad’s soft keyboard when at the bedside.

Proprietary operating system and deployment isn’t enterprise-friendly
Obviously Apple wasn’t concerned with compatibility with “legacy” apps like Meditech or MS4, but in healthcare, that eliminates about 90% of current systems. Most hospitals have compromised for “runs on iPad” versus “optimized for iPad” using Citrix or a Web interface.

That leaves the end user with an underwhelming experience. Citrix apps don’t get the intimate integration with the display, touch, or the camera for image annotation. Not many vendors were prepared to rewrite their clinical systems in iOS or HTML5. The HTML5 standard hasn’t been published yet and isn’t consistently supported by all browsers (although it is the future). I know of several major healthcare systems that are still standardized on Internet Explorer 7, so I don’t anticipate adoption of HTML5 to be as high in healthcare as Apple would like you to believe. Again, we (healthcare) are not that nimble.

Lack of rugged form factor
Eventually your iPad will come into contact with fluids or the floor and you’ll realize it’s a consumer-grade device. These devices are often in a hostile environment, very unlike the environment in most iPad commercials.

The hype of hardware
One of our best mobile forms customers is a major health system in the Northeast. They gave each clinician an iPad, only to discover that they took them home to watch Netflix versus using them on their rounds. Hardware alone isn’t the answer. You also need software that’s mobile aware.

When you’re developing your mobile strategy, keep this in mind. The iPad is a beautiful device with multiple applications (just not healthcare data collection). It isn’t going to transform your hospital systems’ user experience. But don’t compromise – there are other options to consider. Look for vendors that can fill the gaps in your EMR with mobility solutions optimized for the right tablet for your environment (iPad, Android and/or Windows) and that upgrade your user experience/productivity.

Chris Joyce is director of healthcare solutions engineering for Bottomline Technologies of Portsmouth, NH.

Clinical Decision Support
By Dave Lareau

2-16-2012 1-09-18 PM

If you have achieved Stage 1 Meaningful Use requirements or are planning to attest in the future, you are likely aware of the required core measure for implementing and tracking at least one clinical decision support (CDS) rule. The goal of this measure — along with maintaining active problem and medication lists and recording vitals and smoking status — is to improve the quality, safety, and efficiency of patient care.

So what exactly is CDS and why is it important? 

In simple terms, CDS gives physicians the clinical information they need for decision-making tasks. For example, during a patient exam, CDS tools can provide prompting to help a doctor determine a diagnosis or select an appropriate treatment plan. Alternatively, a provider may use CDS technology to improve documentation or identify billing codes or determine the most relevant data to forward to a specialist.

CDS technologies are particularly powerful when the engine is mapped to a wide variety of medical concepts and diverse reference and billing terminologies, such as LOINC, RxNorm, SNOMET CT, ICD, and CPT. CDS tools are more robust the wider the engine’s mapping. Strong CDS engines have the ability to identify and interpret patient information from multiple sources, whether the data comes in the form of lab and test results, previous therapies, or patient histories.

It’s important to keep in mind that CDS tools don’t make the actual clinical decisions for a physician, but support a physician’s own decision-making by sifting through existing data and presenting the most relevant information. As more clinical information becomes available online from EHRs and health information exchanges (HIEs), providers will rely more heavily on CDS technologies to identify the most pertinent information for a given situation.

Many commercial EHRs and HIEs have embedded CDS tools to help providers wade through vast amounts of clinical data. CDS technologies work behind the scenes to identify the most clinically relevant information within a practice’s EMR or from a connected reference lab or from HIE records. Search engines consider additional relevant details amongst on thousands of clinical scenarios and then interpret the cumulative data. Physicians are then presented with pertinent information at the point of care and offered details to aid with diagnosis and treatment plans, as well as critical data needed for compliance and reimbursement.

Though Stage 2 Meaningful Use is not finalized, look for the ONC to add additional CDS objectives in the core measures.

Dave Lareau is chief operating officer of Medicomp Systems of Chantilly, VA.

Super-Sized Productivity Gains from Computer-Assisted Coding?
By Akhila Skiftenes

2-15-2012 8-56-48 PM

The required migration from the ICD-9 to ICD-10 has significantly increased the demand for computer-assisted coding (CAC), moving beyond its early beginnings in outpatient specialty areas. The potential benefits from using this technology to make the transition to ICD-10 can be very compelling –improved coding productivity, accuracy, consistency, transparency, and compliance.

Yet CAC products require a substantial investment, and implementing one does not a guarantee that these benefits will be realized. Therefore, it is essential for an organization to complete a thorough analysis before investing in a CAC product.

Exceptional productivity gains have been reported by vendors. However, these are based on a number of assumptions and the specific circumstances for the organizations using the system. The following are key considerations when estimating CAC benefits for your organization.

First, estimates are often based on outpatient implementation data. As more and more hospitals move toward using a CAC in their inpatient areas as well, these productivity estimates need to be adjusted accordingly. Inpatient stays are longer and have more variability, making accurate CAC translations much more complex. Vendor products have made great strides toward accurate inpatient coding, but it takes more computing power and more time, so productivity gains will be lower.

Second, CAC works best when the documentation inputs are standardized. There are four standard formats for documentation: consultation note, history and physical, operative note, and diagnostic imaging report. The more variability in documentation formats for your organization, the longer the CAC process will take and the lower the translation accuracy.

Standard medical terminology used by the electronic medical record system also impacts the effectiveness of CAC. Many EMR systems use ICD-9 verbiage rather than SNOMED-CT for physician documentation. In these situations, the CAC application will translate to a lower level of accuracy since SNOMED-CT has a more modern standard for medical terminology and greater levels of specificity.

Finally, there is a general belief built into benefits estimate that optimizing the CAC process is ongoing. Once CAC is implemented, it is vital for the Health Information Management (HIM) department to audit the output and identify any issues with the software’s documentation interpretation. A critical success factor is the working relationship between HIM and IT, with resources assigned on both sides for continued optimization.

When making a decision about CAC implementation and ongoing support, organizations need to incorporate all of these assumptions into the estimate of how much productivity can truly be realized.

Akhila Skiftenes is an associate consultant with Aspen Advisors of Denver, CO.

Virtual Patient Simulation: Strengthening Medical Decisions, Strengthening Outcomes
By James B. McGee, MD

2-15-2012 9-02-03 PM

Provide better patient care with fewer resources. Essentially, that is what healthcare reform is asking us all to do. Most providers agree that the only way to maintain the quality of patient care and decrease overall cost is to reduce errors, prevent duplicate or unnecessary tests, and discover more effective yet less expensive approaches to care.

As I see it, that is the simple reality we all have to work within. The real question is: what does it mean from a practical standpoint?

It means that the modern delivery of medical care is far more structured, more measured, and more reported on than I—or anyone—ever could have imagined. Even the most recently educated providers now have to learn new skills and processes in order to respond to federal and third-party payer demands. An entire generation of practicing physicians and physician extenders is being asked to change practice habits, yet still engage in complex decision making.

It is a tall order. However, virtual patients (VPs) offer a way to provide examples and feedback that can help train providers to work within the new constraints. Think about it: clinical decision making is a skill. Like any other skill, it needs to be practiced, refined, and updated regularly. Simulation in general offers a safe environment to assess specific skills and receive personalized, dynamic feedback. VPs can simulate a wide range of clinical decision-making scenarios without requiring dedicated space and time the way physical simulators do.

Simulators such as mannequins are a familiar way to practice clinical skills. VPs are a relatively new development best described as interactive web-based simulations used to develop, enhance and assess clinical decision-making for all types of learners (physicians, physician extenders, nurses, students, etc.). Branched narrative style VPs, in particular, do this by presenting a patient’s story and background information. They then challenge learners with multiple decision paths and show the impact of their decisions—without the risk of actually treating patients, of course.

Training with these realistic computer-based cases strikes a practical blend of simulation with the convenience of web-based delivery and centralized reporting. Think of them as “cognitive” task trainers.

Hospitals have long recognized that providers who pursue learning on a regular basis tend to have better patient outcomes at a lower cost of care. Educational programs like VPs provide a mechanism to make good clinicians better and—perhaps best of all—help novices improve the cognitive skills that lead to expertise.

One good example that I am aware of is Warwick Medical School in the UK, which created VPs to train new doctors to handle life-threatening acute medical emergencies. The doctors can practice over and over again. Through the VPs, they receive immediate, personalized feedback while responding to a rapidly evolving, life-threatening clinical challenge. This type of deliberate practice simply cannot be replicated in real life. In an actual emergency the doctors who practiced decision-making skills are more likely to perform successfully.

Given healthcare’s focus on accountability and other reform efforts, it is important to not lose sight of ways providers and nurses can improve the care and the safety of their patients. VPs provide a safe and objective way to identify variations in practice and decision-making; remediate using real-life examples; reassess until competency is demonstrated; and continually reinforce best practices.

In any given community hospital, providers with a wide range of prior knowledge, skills, and attitudes practice under one roof. Patients expect and deserve the highest level of expertise from all of their caregivers. Payers also expect a certain level of performance and have begun to reward superior performers.

Simulation provides an efficient way to assess clinician performance and provide feedback, whether in the form of clinical guidelines, performance metrics or formal educational programs. By strengthening medical decision making, virtual patients offer one way to reach everyone’s ultimate goal—better patient outcomes.

James B. McGee, MD is the scientific advisory board chairman and co-founder of Decision Simulation LLC, co-chair of the Virtual Patient Working Group at MedBiquitous, and assistant dean for medical education technology at the University of Pittsburgh School of Medicine. Additionally, he is an associate professor of medicine in the division of gastroenterology, hepatology, and nutrition and a practicing gastroenterologist.

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February 15, 2012 Readers Write 8 Comments

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