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Dr. Sam 7/13/12

July 13, 2012 News No Comments

MEMS and the Patient – Computer Real-Time Interface

We are an industry of fads and trends. As a close consultant friend of mine often says, our industry spends hundreds of millions of dollars annually trying to differentiate between the two. "Futurists" tell us what is happening next – or sometimes what is happening after what is happening next – a relatively safe place from which to operate since by the time whatever happens after what happened next happens, it is too late to get your money back.

I’d like to discuss an essential technology with unlimited application to healthcare technology and quality care that has been quietly happening while everything else that is happening next has been happening – almost completely under the healthcare IT industry radar.

Have you ever wondered how your cell phone or iPad display knows how to orient itself depending on the position in which you are holding your phone? How your digital camera remains stable enough to take a perfect picture even though you know you moved a little bit when you pressed the shutter button or icon? How the compass application on your cell phone knows the direction you are pointing the phone? Or how your Wii game reproduces the tennis stroke, golf stroke, or punch that you deliver with the handset swinging in midair with just the right direction and intensity?

Just a few decades ago, we marveled that entire computer circuits could be on a single chip the size of the head of a pin. Today, micro-machines are created and produced on silicon chips that fit easily on chips of the same size. Almost any machine that you can imagine – with actual moving parts – can now be embedded in microchips. That includes (but is no means limited to) gyroscopes, radios, sensors (pressure, radiation, stress), transmitters, levers, hinges, gears, chain assemblies, micron-sized motors, tweezers, pumps, separators, injectors, needles, scalpels, propellers, turbines, mirrors, …. and on and on. The Industrial Age is being reborn on a microscale and even a nanoscale level. The science of MEMS – Micro-Electrical-Mechanical Systems – is well underway and has been for more than a decade.

That positional sensor that rotates your cell phone display is a microscopic acceleration detector. Micro gyroscopes keep your camera steady. MEMS sensors keep choice lists and drop-down menus scrolling on device screens when you speed up your touch movements. Combinations of such devices tell your Wii machine if you just threw a jab or an uppercut and how hard you punched. Within a few months of the tsunami disaster in Japan, micro-radiation detectors were available within cell phone circuitry to serve as alerts to radiation exposure.

On the nano scale, sensors based on silicon chips use electron spin instead of charge to store information using nanoscale layers of magnetic film with thickness measured in atomic levels.

The implications for medicine and healthcare are both endless and mind-boggling. Embedded microchips are currently capable of measuring and transmitting real-time blood pressure and glucose levels in a linear timeline. Hearing aids are likely to be replaced by self-adjusting artificial cochleas. There is active development of artificial implantable retinas. Cardiovascular stunts are being designed to measure and transmit blood flow and therefore the integrity, patency, and efficiency of the stent (cheaper and more accurate than CT scanning). Embeddable microchips can perform and transmit lab analysis studies and even do DNA analysis. Micro pressure sensors can transmit intra-arterial pressure in abdominal aortic aneurysms. Pressure sensors in contact lenses and even embedded in the iris can transmit intraocular pressure measurements for real-time monitoring of glaucoma treatment.

As we struggle to implement electronic health records to maximize real-time documentation, order entry, lab reporting, and data sharing, an entire science is developing that is capable of delivering direct exchange of digital information. Not between external devices, but directly from within the bodies of our patients.

Imagine how this capability might eventually impact health information exchanges, data collection, outcomes monitoring and adherence to protocols, developing personal health records, and the concept of the Medical Home.

The trends of today may well fade to fads that have been eclipsed by science that has outpaced them.

The MEMS industry itself is no fad. In 2001 it was a $215 million industry. According to IHS iSuppli‘s market intelligence, MEMS revenue will grow at an enviable 9.7% CAGR (compound annual growth rate), from $7.9 billion in 2011 to $12.5 billion in 2016. This compares to only 4.5% for the overall semiconductor industry. In term of units, shipments of MEMS sensors and actuators will more than double, from 5.4 billion in 2011 to 13.7 billion devices in 2016—a 20.7% CAGR.

An entire renovation and revolution in how we diagnose, treat, measure, and monitor is soon to envelop us.

Gentlemen, start your nano-engines.

Sam Bierstock MD, BSEE is the founder of Champions in Healthcare, a widely published author and popular featured speaker on issues at the forefront of the healthcare industry, and the founder of Medical MEMS, a healthcare MEMS technology consulting group.

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July 13, 2012 News No Comments

News 7/11/12

July 10, 2012 News 3 Comments

Inga and I are on a short break for another couple of days, so I’ll keep my posts brief (and rather Spartan) so that Mrs. HIStalk doesn’t feel neglected on vacation. If I’ve missed anything important, let me know.

From UK Lurker: “Re: Epic. As Epic projects get going in the UK, is there any indication of how UK customers will be handling their project team staffing? Are they using US-based consultants who have experience with Epic? UK firms that know the NHS?"

The CEO of Baptist Memorial Health Care (TN) says he is “thrilled” to announce that the organization has signed with Epic. We reported the rumor from Jog that Epic would replace McKesson Horizon there on July 6.

Kevin Shimamato is named interim CEO of Tulare Regional Medical Center (CA). He was previously CIO at Sierra View District Hospital and says it’s a trend that hospitals are hiring CEOs with a technology background. He applied for the job through his consulting company. 

MyHealthDIRECT names board member Tom Cox (Healthways) as CEO. He replaces founder Jay Mason, who will remain with the company and continue serving on its board.

University of Virginia and GE Healthcare head off to court this week over what UVA says is the failure of the former IDX to meet hospital information system implementation milestones going back to 1999. GE Healthcare bought IDX in 2006, the hospital says GEHC didn’t resolve the issues, and it’s suing for $30 million after already moving to replace IDX with Epic. GEHC says UVA didn’t make an effort to fix its own project and still owes it money. 

7-10-2012 8-20-14 PM

Weird News Andy is glad to see that these nurse assistants have been banned from healthcare. While working on contract for the Virginia Veterans Care Center, they took four wedding rings from elderly veterans suffering from dementia and other chronic conditions, pawning them immediately for a total of $405 (their appraised value was over $4,000.) The first was found guilty, but says she took only two of the rings and claims she didn’t remove them forcibly, although at least one of the victims had bruised fingers. She could be sentenced to up to 120 years in prison. Her partner in crime (check out her photo above – would you voluntarily choose her as your caregiver?) will be tried later this month.

Sponsor Updates
  • University Physicians (CO) will deploy GE’s Centricity Business solution across its hospitals and physician practices.
  • Legacy Health (OR) selects ProVation Medical software by Wolters Kluwer Health for its GI lab documentation and coding at five hospitals.
  • Hartford Healthcare Corporation realizes $15.3 million in financial improvements within a year of selecting MedAsets revenue cycle solutions.
  • DrFirst launches an e-prescribing task force to assist New York physicians in meeting the requirements of i-STOP.
  • Southwest Community Health Center (CT), an FQHC, will deploy NextGen EHR, PM and Electronic Dental Record across its 12 locations.
  • InMedica, a division of IMS Research, names Merge Healthcare as the #1 vendor neutral archive provider in its recent market study.
  • OrthoKC (KS) selects SRS EHR for its 10 providers.
  • e-MDs congratulates its client, Princeton Healthcare Affiliated Physicians, for the successful MU attestation of all 21 eligible providers.
  • Optum launches coding technology to facilitate and accelerate hospitals transitioning to ICD-10.
  • NextGate highlights two wins by its partners, Orion Health and Covisint, using its EMPI and provider registry.
  • New York City Health & Hospitals Corporation attests to Stage 1 MU in all 11 hospitals and met interoperability requirements by exchanging data with New York’s RHIOs using QuadraMed solutions.
  • James Backstrom MD of Foundation Radiology Group and Robin Brand of The Advisory Board Company will present strategies to increase imaging referrals during a free webinar July 19.
  • Memphis Obstetrics & Gynecological Association (TN) selects MED3OOO’s InteGreat EHR for its 24 providers.
  • MEDSEEK partners with BrightWhistle to resell its social patient acquisition solutions.

E-mail Mr. H

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July 10, 2012 News 3 Comments

Monday Morning Update 7/9/12

July 6, 2012 News 7 Comments

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From Gob Bluth II: “Re: Health Information Partnership for Tennessee (HIP TN). HIP RIP. Another HIE bites the dust.” Verified. Gob forwarded the e-mail that went out to stakeholders on Friday, along with a copy of the official announcement that will be released Monday. The three-year-old state network says officials decided to pursue a simpler strategy of using the DIRECT system as a HIP replacement. HIP TN chose Optum’s Elysium Exchange (the former Axolotl) in October 2010 and now it’s going to the Greek mythology version of Elysium, the afterlife of the chosen.

From Data Birth: “Re: Consumer Reports hospital safety rankings. I’ll wager the reason the data were inconsistent or missing is because hospitals don’t want this particular information to reach the eye of regulators or the public. You would think this would be available through Joint Commission inspections.” In my experience, the Joint is good for two things: (a) reacting to headlines by setting big-picture goals and ever-moving standards that never result in hospitals getting punished, and (b) clearing the hallways of carts and getting storage boxes away from the fire sprinklers, which happens only when their inspectors are on site. Hospitals in the past have been given a clean bill of health by Joint Commission, only to be threatened with shutdown immediately afterwards by inspectors from the state or CMS over egregious patient safety problems. I’m not casting implications on the Joint’s motivations since I’d much rather have them than not, but they’re making nice coin by not only selling inspections but also the tools and services that help hospitals pass them, and sometimes I think they struggle with the balance of being both a regulator and a vendor (like other similar organizations.) I think they see their role as more consultative than punitive, while sometimes the latter seems more appropriate.

From Max Payne UK: “Re: NHS and Epic. Epic doesn’t have a UK localised product and Cerner is installed in several Trusts. Reportedly, Cerner was cheaper than Epic. So how did Epic wind up being the winner? What consulting company or consultant advised the Trust on this decision?” Hospitals often choose Epic for non-financial reasons: perceived honesty, a near-perfect track record of going live on time, general polish on issues like training and documentation, and lack of Wall Street pressure that could shift their focus quarter by quarter. Not to mention that the big price tags mentioned for Epic projects are all-inclusive of even internal labor, which other vendors don’t include to the later discomfort of their customer. If you’ve seen the actual contracts (and I have), Epic isn’t always more expensive than arguably inferior alternatives. With regard to localization, they have over 5,000 employees and have learned from the mistakes made by others, so the have a leg up on the pioneers before them who crawled back with arrows in their backs. You bring up a good point – do organizations buy Epic because consultants recommend it, or do consultants even get involved with Epic decisions? And as one last thought, Epic (and Meditech) are big enough to command UK attention, but emerged unsullied by the NPfIT meltdown since they weren’t players, so that’s a plus for them. I would hope that those who made the Epic decision talked to the Cerner-using trusts first.

From Konrad: “Re: job stress. I often wonder if part of the fear of EMR and Obamacare is tracking of stressful of employers, like cancer centers. One place I worked actually did that for employees.” The former CEO of France Telecom is released on bail after being questioned by government officials about the suicide of more than 30 company employees in the two years just before he quit. He says the suicide rate was similar to that of non-employees and blames pressure brought on by the economy and the company’s minority shareholder (the French government), but did say he wishes he had paid attention to the warnings of doctors that the company’s massive layoffs and unreasonable performance targets were causing employee health issues.

From BitesTheDust: “Re: John Muir. Epic must have gotten another major McKesson account – this time John Muir in California. Looks like the CIO (Eric Saff) is already gone too as an executive firm looks for his replacement and prefers Epic experience.” They chose Epic awhile back, I think. I had run a rumor here (without naming the hospital) that Epic had originally declined to work with John Muir over some perceived conflict with its IT department and told the hospital’s board as such. I think this may happen more often that we know – the Epic train rolls right over the CIO during selection or implementation when Epic’s way isn’t warmly embraced by IT.

From HR Guy: “Re: stack ranking of employees. Epic does stack ranking as well, with about the same results, combined with the slow hire/quick fire mentality it’s been pretty deadly.” An article about Microsoft’s lack of agility and its fall from swaggering innovator to bean-counting market follower blames stack ranking, the practice that requires a fixed percentage of employees to be identified as great, adequate, or poor, with the great getting promotions and the poor getting shown the door. It concludes, based on Microsoft employee interviews, that everybody spent more time stabbing each others’ backs and sucking up to those who might review them instead of worrying about how Apple was beating them like a drum. Steve Ballmer gets a lot of the blame (honestly, what does Microsoft see in that guy that nobody else does?) but the damage was well underway when Bill Gates was still running the show. A former marketing manager concludes, “I see Microsoft as technology’s answer to Sears. In the 40s, 50s, and 60s, Sears had it nailed. It was top-notch, but now it’s just a barren wasteland. And that’s Microsoft. The company just isn’t cool any more.” Epic does apparently follow the same practice of quickly categorizing employees based on feedback from managers and co-workers who may barely even know them. I like the practice in theory, but as in most aspects of life and business, execution is everything.  

7-6-2012 7-42-46 PM

Welcome to new HIStalk Platinum sponsor Visage Imaging. The San Diego company is a global provider of enterprise and advanced visualization solutions that make slow, trickily deployed client-server and Web-based PACS approaches obsolete. No more reconstructions at the modality console while the radiologist twiddles his or her thumbs waiting on digital mammography or PET/CT — Visage 7 makes even the largest multi-slice datasets completely navigable in seconds via an intelligent thin-client viewer displaying server-rendered 2D, 3D, 4D, and advanced visualization imagery on a single desktop (in plain language, huge images don’t need to be pushed painfully and slowly from the hospital data center to the radiologist’s workstation – the server does the work and interpretation gets underway faster no matter where the radiologist is sitting.) Its platform enables enterprise viewing and interpretation and image enablement of EMRs, VNAs, HIEs, and RIS/PACS. You can use it on smart phones and even on Macs. Thanks to Visage Imaging for supporting HIStalk.

I headed over to YouTube to see if Visage Imaging had anything there, and lo and behold, here’s a brand new video on Visage 7 that includes some cool product video (though being a non-radiologist, anything with lots of movement and color seems cool to me).

Clearing out my “Listening” box for now: Phideaux, interesting “psychedelic progressive gothic rock” led by TV soap opera director Phideaux Xavier. Think Jethro Tull, Kansas, and Renaissance rolled into a more modern package with bigger production. It’s really good, especially coming from a guy who directs General Hospital as his day job. I’m playing it loud enough for Mrs. HIStalk to ask me what I’m listening to, though her tone suggests an interest that doesn’t necessarily involve my loading it to her Nano.

Inga and I are coincidentally both traveling this week (not together, just to be clear) so we may be occasionally tardy in our responses and terse in our writing as we take rare simultaneous vacations. Let me know if anything really important comes up this week that I might otherwise miss since I’m hoping to spend a few more hours than usual not working.

Thanks to the following sponsors, new and renewing, that supported HIStalk, HIStalk Mobile, and HIStalk Practice in June. Click a logo for more information as you ponder with me the illogicality of respected, successful companies backing a shoot-from-the-lip journalistic ne’er-do-well who nonetheless appreciates their support in forms that often extend beyond financial to personal. There hasn’t been a day in the nine years I’ve been writing HIStalk that I didn’t marvel at how cool it is to live my Mr. H alter ego even though it’s purely imaginary.

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7-6-2012 5-04-01 PM

PPACA pretty much splits us as taxpayers, but we apparently like it fine as healthcare IT people. New poll to your right: which group would you target first to reduce healthcare costs? Obviously it’s a simplistic question with limited answer choices, so the poll accepts comments for your further elucidation.

7-6-2012 6-21-45 PM

A Physician’s First Watch poll on the Affordable Care Act drew similar results, with 65% of respondents (presumably mostly doctors) saying they like the Supreme Court’s decision (which presumably means they like PPACA).

7-6-2012 6-27-42 PM

CapSite releases its 2012 Laboratory Information Systems study. By the numbers, the dominant vendors are Meditech, Cerner, and Sunquest, and 81% of respondents say they won’t be replacing their system within two years. I like reading CapSite’s reports because they’re formatted as PowerPoints saved as PDFs and they get right to the point with charts. I had forgotten until I read the graphic above that Allscripts offers a LIS, which I assume is the former Sysware that it acquired in 2006. I also noticed that Epic’s Beaker is moving up the LIS ladder even though it’s not quite there yet, but probably will be by the time its newly implementing customers are ready to take another look at lab systems.

For the stats-obsessed among us (not me, but maybe Inga, and surely that one person who always e-mails me to ask), June’s readership numbers were really good given the annual summer slowdown: 102,849 visits and 191,515 page views, up a bunch from last year.

Weird News Andy finds the comments left on the Physicians’ Declaration of Independence interesting.

7-8-2012 6-38-12 AM

Here’s why e-MDs CEO Michael Stearns is  no longer with the company, as explained to its customers via e-mail. Grizzled Veteran provided that rumor last week. Founder and board chair David Winn has replaced Stearns as CEO.

7-8-2012 7-01-33 AM

This might be the first time that a hospital is acquired primarily for the value of its expected Meaningful Use payout. Cookeville Regional Medical Center (TN) will hold back $700K of its $6.7 million acquisition price for Cumberland River Hospital until that hospital gets its $4 million in Meaningful Use money. CRMC’s CEO said, “Part of the viability of this acquisition is the fact the Meaningful Use dollars are tied to it. That’s why it’s vital to have those dollars. That’s why we were adamant to have a hold-back of $700,000 so that we wouldn’t close the deal and they would stop working if they have a chunk of money held out there to comply with the purchase."

Vince continues his HIS-tory this week with HMS, having connected with co-founder Tom Givens to get a first-hand account of those heady days. I suspect many of you who are enjoying Vince’s series lived the experience first-hand in some of the 1970s-80s companies he has mentioned (and those he’ll be mentioning down the road). If so, Vince could use your old pictures and papers for future installments, but most of all, your anecdotes of what it was like back in the day.

E-mail Mr. H.

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July 6, 2012 News 7 Comments

Readers Write 7/2/12

July 2, 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!

Note: the views and opinions expressed are those of the authors personally and are not necessarily representative of their current or former employers.

ICD-10: The ED Effect
By Robert Hitchcock, MD, FACEP

7-2-2012 7-20-38 PM

As I visit current and prospective hospital clients, they openly express uneasiness about their organizations’ finances. Market forces are squeezing margins and expectations are high that Medicare and private payers will continue cutting reimbursement rates. These challenges are only intensified by ICD-10 and Meaningful Use mandates.

In the 20-plus years I’ve worked in healthcare, I’ve seen no other initiative with the potential to impact hospitals more greatly than ICD-10. With one-half of all inpatient admissions and 45% of a hospital’s overall revenue, the emergency department in particular can help define whether or not this impact will be positive or negative. As the population ages, patient volumes will continue to multiply, and the ED will need to keep up in order to keep the hospital financially afloat.

Most hospitals are anticipating – and depending upon – their departmental or enterprise EHR vendors to provide the necessary changes that will facilitate the capture of the appropriate information needed for ICD-10 coding. Unfortunately, however, some key hospital executives fail to recognize that very different approaches can be taken when implementing ICD-10 in clinical applications.

It is imperative that these executives evaluate how a solution will achieve compliance. How will content be built and maintained? How will ICD-10 codes be generated? How will the system work to maintain productivity? The method for compliance can represent success on one end of the spectrum and failure on the other end – each with tremendous financial implications.

If the vendor does not provide and maintain standardized encoded clinical content for documentation but instead offers “fully customizable content,” the client will be required to update and maintain an extensive data set with the corresponding ICD-10 terminology and/or codes. While a money-saving approach for the vendor, it will mean significant costs to the client.

If the vendor chooses to simply use an ICD-10 clinical terminology look-up function that is not integrated with other clinical content in the application, it could limit the ability of the application to re-use previously recorded information, requiring duplicate documentation. This presents another productivity burden to the clinician.

In terms of ICD-10 code generation, some software designs will offload to the physician the burden of navigating long lists of possible code-able terms to search for the most appropriate clinical diagnoses. ICD-10 represents a vast increase in the number and specificity of codes from ICD-9. As a result, physicians may fail to complete this part of the documentation or choose less definitive diagnoses when and where it saves time. This can negatively impact reimbursement as well as reporting for regulatory compliance, risk management, conformance to clinical polices, etc. Instead, having codes that are generated automatically based on providers’ documentation will not impede clinician workflow, productivity and, ultimately, documentation quality.

To obtain accurate, discrete data for analysis and reporting, physicians must embrace the user interface design of the application. Good data analysis requires a foundation of good data collection. Like CPOE, if the clinical workflow and user interface is well designed, potential benefits are quickly realized. If designed poorly, the results can be agonizing.

The increased specificity of ICD-10 will drive more than just reimbursement, magnifying the impact of the ICD-10 implementation for better or worse. Additional granularity, if accurate, can facilitate many other processes that also have financial implications to the ED and hospital, such as risk management, regulatory reporting, quality initiatives, clinical decision support, and metrics for productivity, patient throughput, ordering of tests, and resource utilization.

As well, ICD-10 has the potential to offer easier and tighter system interoperability. A standardized coding system requires that all systems speak the same language, freeing hospitals to choose the best possible technology for the ED. Indeed, having disparate but interoperable systems in the ED and inpatient environments no longer has to present the same challenges it has in the past.

My advice to those solving for ICD-10: Look beyond the basic issue of compliance and choose technology that will truly optimize the ED. It is the front door to your hospital, the start of the patient record, and the key to your organization’s prosperity. I would hate for any hospital to have to experience the frustrations and wasted expenses associated with having to rip out a system and replace it. 

Robert Hitchcock MD, FACEP is vice president and chief medical informatics officer of T-System of Dallas, TX.

Standardized Data Just the Start in Making Data Usable at the Point of Care
By Jay Anders, MD

7-2-2012 7-30-44 PM

3M Health Systems recently announced it will open access to its Healthcare Data Dictionary, which translates standard terminologies and enables semantic interoperability between disparate systems. 3M made this move to meet contract conditions with the VA and Department of Defense, which are using the Data Dictionary to facilitate interoperability for their joint EHR.

The news is significant for several reasons. By making its Healthcare Data Dictionary free, providers and vendors have access to tools that translate a collection of clinical terms in a variety of standard terminologies such as RxNorm, ICD-9, ICD-10, LOINC, and SNOMED. A common language for clinical terms facilitates data standardization, analysis, and exchange.

When data is available in a standardized format, health information exchange is easier. The interoperability of clinical data is essential for Meaningful Use and the cornerstone for new reimbursement models that emphasize outcomes and accountability for patient health over traditional patient encounter volume.

The need for tools that decipher disparate but related clinical concepts will continue to grow exponentially in coming years. The healthcare industry relies on standard terminologies to move information between providers, and many stakeholders are calling for even more standards for files, codes, and other data.

The proliferation of standards aids data exchange, but the data is of limited value without means to disseminate the information and then to make it usable by clinicians. Clinical data mapping addresses part of this problem.

Payers and clinical researchers, for example, rely on clinical data to analyze financial and health trends. Data mining on a large scale is nearly impossible without technology that identifies common concepts, regardless of the terminology.

Similarly, Accountable Care Organizations and HIEs require tools to make sense of vast amounts of data from physicians, health systems, and other providers. Clinical data mapping enables the efficient identification and accurate interpretation of the information required for ACO and HIE analysis and reporting.

Given the amount of clinical data which is about to flood the industry, organizations must have methods in place to both exchange and store clinical data in standardized formats, and to make the clinical data usable at the point of care.

These are not the same.

In addition to 3M’s Health Data Dictionary, there are clinical data technologies and tools available from Clinical Architecture, Health Language, Inc., Intelligent Medical Objects, Medicomp Systems, and others. Regardless of which one of these is chosen to exchange and store clinical data, it is also necessary to organize and present clinical information to the clinician during the patient encounter.

For example, for a patient with five existing clinical conditions, the provider needs to be able to instantly see the clinical data relevant to renal failure, as opposed to their diabetes, hypertension, arthritis, or migraine headaches. Once the HIEs are up and running, there may be thousands of clinical data points for a single patient.

What is needed is an engine to organize and present clinical information at the point of care. This requires millions of links between data points to filter, analyze, and present data relevant for that specific patient encounter.

This is critical in enabling physicians to follow their own thought process and make sense of the flood of clinical data. Widespread standardization and sharing of clinical data between systems has the potential to enhance the quality of healthcare. The power and potential of clinical data is truly realized when data is delivered and made usable at the point of care.

Jay Anders, MD is chief medical information officer of MED3OOO of Pittsburgh, PA.

Healthcare Cure?
By Vince Ciotti

The idea is simple: keep people healthy. We do a great job of treating those who are already sick, but it is costing us far too much, whether through taxes, premiums, or deductibles and co-pays. How to keep people healthy? Discourage them from getting sick. How to do that? Make the cost of things that make them sick prohibitive. How do we do that? Pass the cost of curing sick people on to those products that cause specific, preventable illness.

One of the leading cancer killers today is lung cancer, pretty directly attributable to smoking. Best way to break the smoking cycle? Turn our capitalist free-market system loose by passing the cost of treating lung cancer directly on to those who smoke, until the price is so prohibitive they cease to buy tobacco. Thanks to PPS and DRGS, we know what treating most specific diseases cost. Let’s say last year the ≈300,000 people who died from lung cancer cost us taxpayers about $100,000 each to treat. That’s roughly $300B in taxes and premiums we all paid for their care. Now allocate that $300B across the tobacco companies based on their revenue. That’s a pretty stiff hit on any company’s bottom line, so they’d have to triple or quadruple the price of cigarettes to $20 or even $30 a pack to maintain a decent profit margin.

By letting the free market accurately reflect the healthcare cost of a given product, we consumers would be a lot wiser in buying unhealthy products, and their manufacturers would have to develop healthy alternatives or see their revenue gradually dry up. Farmers would have to plant other crops, and the many attorneys who file tobacco lawsuits would have to find other segments of society to represent.

Let’s shift to another easy target: obesity. Pass the cost of treating diabetes on to sugar manufacturers. Not a tax, but an invoice for what they are costing us in health care to treat diabetes. Like tobacco manufacturers, they would have to raise the price of their product to cover the resulting health care cost. Now, Wheat Checks and Al Bran would only cost a fraction of what sugar-laden cereals cost and more people would buy them, catching manufacturers’ attention. So on and on, with every disease that is directly attributable to a specific product or ingredient: mesothelioma and asbestos, cirrhosis and alcohol, heart attacks and cholesterol, melanoma and tanning booths. 

It would be a bitch to set up. Many politicians, their PACS, and lobbyists would fight hard every step of the way for each disease being targeted. Maybe we should pass the cost of treating heart attacks and ulcers on to them. Jobs would be created for medical experts, economists, and statisticians. Jobs would be lost for lawyers, doctors, and marketers.

In the long run, consumers would follow their wallets to those products that cost the least, once they included healthcare costs, and avoid those products that cost the most, because of high healthcare costs. That’s the beauty of capitalism’s free-market way. This is an economic problem for which we need an economic solution.

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

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July 2, 2012 Readers Write 8 Comments

Monday Morning Update 7/2/12

June 30, 2012 News 6 Comments

From Hellcare: “Re: ACA. Interesting reader responses. You have collected many devoted readers and contributors with varied backgrounds, experience levels, and opinions over the past few years. What about an open forum week, in addition to your regular articles, where we discuss, ‘What is wrong with the healthcare system and how do we repair it?’ Who knows, maybe we’ll do better than Congress! I don’t think that it even needs to be a dissection of the ACA, but maybe opinions from more than just C-level management that have to give the answers they have to give to save their jobs. If Ell Jeffe is right, then there is much to discuss and even better, more to learn.” I’m game. To keep it positive instead of everybody just complaining, tell me what you’d change and why. Also, operate under the assumption that we aren’t going to simply throw out today’s healthcare system, so your changes should be realistic. Anyone want to start us off?

From Pliny: “Re: mobile apps. The FDA says they are subject to its oversight if they process user input with a formula or algorithm, output a treatment recommendation, or perform a calculation that results in an index or score. That would cover any mobile app that connects to an ARRA-certified product, would it not?” Good question. I interpret it as meaning the logic is running from the mobile device itself, which wouldn’t be the case with most clinical system front ends that are just displaying data and capturing input, no different than a Citrix session. Anybody else want to chime in?

6-30-2012 4-58-00 PM

From The PACS Designer:”Re: Apple’s 7-inch iPad? With the launch of Google’s $199, 7-inch tablet called Nexus, can Apple be next with a 7-inch iPad? Earlier this year, such rumors were swirling about a mini iPad that would make a better fit in lab jacket pockets, so we may see it in 2013 at a price of around $300.”

6-30-2012 4-54-59 PM

From DrLyle: “Re: AMDIS meeting. About 300 attendees, mainly CMIOs and similar, about 50% more than last year. Some great discussions from both academics and applied informaticians, with topics such as problem list management, ACOs and population health, EMR usability, analytics, and role of the CMIO.” Presentations from the AMDIS 21st PCC Symposium are here. Above is a DrLyle photo from the meeting last week in California.

6-30-2012 2-20-47 PM

A surprising 91% of readers say hospitals and practices aren’t using sound financial principles when they decide to buy their clinical systems. New poll to your right: what’s your professional and personal reaction to the Supreme Court’s decision that Obamacare (as both parties now call it) will stand as law?

From the above poll results, here’s my challenge to CIOs of hospital that are spending $100 million or more on an inpatient clinical system. Readers are skeptical that your employer did its due diligence on return on investment. Explain to them why they are right or wrong (e-mail me a paragraph or two – I will leave you anonymous unless you indicate otherwise.) How did your organization justify the expense and what’s being measured to prove that the decision was a good one? Or if you made your investment and went live more than a year or two ago, how do the benefits you’re seeing (both financial and non-financial) compare to what you expected?

I haven’t followed the PPACA drama all that closely, but here are the healthcare IT ramifications I would expect judging from what I’ve heard here and there.

  • The majority of people and companies who paid little attention to PPACA under the assumption that some or all of it would be found unconstitutional will have to scramble to catch up. Few expected it to survive unscathed, so they wasted the first couple of years after it became law in March 2010 when they could have been figuring out what it means to them.
  • More people will have access to insurance, so hospitals theoretically won’t see as much self-pay and bad debt. However, they will need even more people and systems to handle all of those insurance transactions.
  • A fly in the ointment, however, is that employers may decide that the penalty for not providing insurance is cheaper than actually buying it with their significant employee subsidies, so they may just drop coverage entirely and force employees into the open market via health insurance exchanges. Employees may make the same choice, especially in PPACA’s early years, when penalties for not carrying medical insurance are minimal (just a few hundred dollars per year). Real-time eligibility checking and a plan to collect patient responsibility upfront will be required for provider survival.
  • States have made poor progress in developing health insurance exchanges, so they probably won’t be ready any time soon.
  • Medicaid rolls will swell massively under the plan, so providers will need to watch their reimbursement rates and payor mix carefully, especially since states are already teetering financially and now have another headache to deal with.
  • With 30 million newly insured citizens and a shortage of primary care providers, the pressure will be on to improve PCP efficiency (even if just to restore the time EMR usage has stolen).
  • Platforms that provide the ability to schedule PCP visits against their open schedules will be in demand to even out supply and demand based on provider and location.
  • Given the likelihood that PCPs will still be overloaded, I would expect more care to be delivered by extenders and telemedicine, which will change the expectation of the systems in use.
  • The demand for provider information will be insatiable. The same federal government and insurance companies that require endless petabytes of questionably useful information will now want even more of it once the promise of cost reductions isn’t realized. They are even more in charge of providers now than they were previously.
  • Medical device vendors can’t be happy since PPACA requires them to start paying an annual 2.3% tax on gross revenues starting in January.
  • PPACA’s impact on cost will probably be to increase it. In that regard, the biggest problem has still not been addressed since the special interests would have killed the bill otherwise – the healthcare system, regardless of who’s paying, is bloated, inefficient, and run by those special interests (including the biggest special interest of all, politicians.) 

6-30-2012 5-07-43 PM

Investor reaction to the Supreme Court’s decision: shares of hospital chains and healthcare IT vendors are mostly up, insurance company shares are down. Allscripts was up 8% on the week, while Quality Systems, McKesson, and Cerner jumped around 4%, a little better than the S&P 500. Athenahealth was up, but only by 1%. Cerner’s market cap is up to $14 billion, with Neal Patterson holding $462 million worth.

Not getting your HIStalk e-mail updates? Here are two solutions: (a) sign up for them if you haven’t already (duh), and (b) add mlsend.com to your so-called whitelist of e-mails allowed to get through your spam filter (your e-mail administrator will probably need to do this). I changed the e-mail service a few weeks back, so if you aren’t getting the e-mails all of a sudden, go with option B and tell your e-mail person that mlsend.com e-mails aren’t spam.

6-30-2012 3-44-24 PM

CapSite releases its Revenue Cycle Management study, which finds that 21% of hospitals plan to replace their RCM solution in the next to years and 53% say they will upgrade what they have. Interestingly, the larger the hospital, the more likely they are to replace or upgrade their RCM. The most-desired bolt-on solution is patient insurance eligibility verification, although 400+ bed hospitals are more interested in kiosks and the most-planned purchase of all is coding solutions. I was also interested in a relatively minor stat from the extensive report – in 400+ bed hospitals that responded, the #1 registration/ADT vendor (as a proxy to overall system penetration in my mind) was Epic, followed by Siemens, Cerner, and GE. I also liked the strategic priority question above.

The non-profit Patient-Centered Outcomes Research Institute (PCORI) is hosting the National Workshop to Advance the Use of Electronic Data in Patient-Centered Outcomes Research this week in Palo Alto, CA. Assuming it’s a bit late to plan attendance in person since they just sent me the announcement, they’ll have a live webcast (July 2-3). Speakers include folks from PCORI, Stanford, UCSD, NIH, FDA, and other big organizations. I hadn’t heard of most of the speakers, but those whose names I recognize are Doug Fridsma (ONC) and Paul Tang (PAMF).

Medical image management vendor UltraLinq offers Cardiac Accreditation Accuracy, software that allows users to track their QA documentation and statistics through integration with its exam data.

The PACS Designer is updating his list of iPhone apps, so if you’ve run across any that are interesting, post a comment to tell him about them.

CTG announces four new contracts for outsourcing, business process re-engineering, IT medical management, and HIE implementation support.

6-30-2012 6-00-33 PM

A jury returns a $15 million verdict against Springhill Memorial Hospital (AL) for a 2008 incident in which a 45-year-old non-ventilated patient died after bypass surgery due to an overdose of the anesthesia drug propofol that was administered by a nurse working her first shift in the cardiac recovery unit. The nurse was found to have no documentation of training appropriate to her assignment, had no experience in working with cardiac recovery patients or propofol, and failed to call for help when the patient lapsed into an immediate coma. Afterward, the nurse changed her documentation of the patient’s vital signs and ventilator settings, then erased the IV pump’s memory and destroyed the propofol container.

Vince’s HIS-tory this week covers HMS, tracking down co-founder John Doss for a first-person account.

Wall-mounted entertainment consoles are being removed from South Australia hospital patient rooms after at least four patients are harmed by units falling off the wall. Plans to install 3,500 of the units were cancelled.

Strange: a journal article chronicles the case of a 24-year-old software engineer from India who experienced an intense headache every time he tried to watch pornography, forcing him to change his plans. The authors didn’t figure out what caused the headaches, but they successfully treated the patient by advising him to pre-medicate himself with ibuprofen and acetaminophen.

E-mail Mr. H.

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June 30, 2012 News 6 Comments

News 6/22/12

June 21, 2012 News 2 Comments

Top News

The VA establishes a goal of conducting more than 200,000 clinic-based telemental health consultations in fiscal year 2012, offered to veterans without requiring a co-payment per VA policy that covers all videoconferencing-based encounters.

Reader Comments

inga_small From Overheard: “Re: HIT sales training. A friend tells me he just completed a sales training class led by one of the professional training and coaching organizations. His impression was that the course was developed by a ‘bunch of bitter nerds who are haters getting their kicks off telling the nice-looking popular kids that they are stupid.’” Ouch. Before begging Mr. H to hire me, I considered taking a position as a sales coach. At least in this gig I don’t think too many people call me a nerd and I can get away with telling just about anyone that they are stupid.

inga_small From Eros: “Re: Cerner and autocorrect. Have you ever tried typing ‘Cerner’ in a message on your iPhone?” It seems that Apple insists the correct word should be Cerberus, a mythological three-headed watchdog that guards the gates of Hades to prevent anyone from escaping. Perhaps Neal should invest in one for the employee parking deck.

From Printgeek: “Re: [free EMR vendor’s name omitted.] I heard its board and executive team has seen four departures. They are making good headway with physician enrollments, but actual usage is poor and eyeballs on the screen are not meeting expectations. Additionally, the model to generate revenue from data and ad sales isn’t coming close to investor expectations.” Unverified, so I’ve omitted the company’s name, not that most readers aren’t astute enough to know it instantly anyway.

HIStalk Announcements and Requests

6-22-2012 9-02-25 AM

The latest from HIStalk Practice: Medford Medical Clinic (OR – above) signs up with athenahealth. The AMA votes to evaluate ICD-11 as a possible alternative to ICD-10 for replacing ICD-9. The ONC plans to help small providers increase security on mobile devices. Offices with great EHR implementation had only slightly higher patient safety culture scores. Dr. Gregg reveals his interoperability nightmare. Give HIStalk Practice a test drive if you aren’t a regular. Thanks for reading.

Acquisitions, Funding, Business, and Stock

6-22-2012 9-05-44 AM

eMerge Health Solutions, a developer of a hands-free documentation and workflow solution for gastroenterologists, closes on $850,000 in seed funding from CincyTech and private investors.

GE Healthcare sells the assets of its Nurse Call business to Switzerland-based Ascom, which markets its own nurse call system outside of the US.

PatientKeeper raises $6.25 million from existing investors to expand professional services and support operations.

Etransmedia Technology acquires Associated Billing Services, a provider of RCM services.

T-System acquires Marina Medical Billing Service, which provides ED medical coding and billing services to 110 facilities.


6-22-2012 9-10-44 AM

Iowa Health System selects Explorys’s Enterprise Performance Management  applications to support its ACO initiatives.

6-22-2012 9-09-09 AM

O’Bleness Memorial Hospital (OH) chooses ProVation Order Sets as its electronic order set solution.


6-22-2012 9-11-43 AM

Former RelayHealth exec Matt Llewellyn joins BillingTree as its VP of sales for the healthcare market.

OTTR Chronic Care Solutions names Sandy DeRoberts (Carefusion) regional VP of sales.

Announcements and Implementations

Pacific Medical Centers (WA) installs Versus Advantages RTLS to track patient flow at its Totem Lake clinic.

6-22-2012 9-12-55 AM

St. Rita’s Medical Center (OH) goes live on Epic.

KLAS names Encore Health Resources the top-rated consulting firm serving Epic clients in the category of Team Implementation Leadership & Advisory.

CareFusion signs an agreement to support bi-directional connectivity between its Alaris smart IV pumps and Epic.

Kony Solutions releases a new version of its Mobile Health Plan.

6-22-2012 9-15-10 AM

In the UK, Rotherham NHS Foundation Trust begins implementation of Meditech.

The US Air Force will use SAS tools to support research and to deploy a global dashboard to improve operational and clinical decision support. An example given involves SAS Scoring Accelerator for Teradata, in which researchers can run query of 1.2 million patients to determine which 10% of those with diabetes are most likely to have an ED encounter in the next two months.

Three competing hospital systems in the Charleston, WV area (Thomas Memorial, CAMC, and St. Mary’s in Huntington) meet to discuss their use of Siemens Soarian. The article cites two examples of its use by Thomas Memorial’s CMIO Matthew Upton, one in which he entered patient orders from home before leaving for the conference and another where he followed his patient from a café in Italy using an iPad.

Government and Politics

ONC launches a pilot project to measure the effects of giving providers and pharmacies better access to drug monitoring programs in order to reduce prescription drug abuse.

CMS awards a $20.75 million Health Care Innovation Challenge grant to VHA, Inc, TransforMED, and Phytel for a three-year national project to expand the PCMH concept and test the viability of a patient-center medical neighborhood model.


6-22-2012 9-21-26 AM

inga_small The Association of Regional Centers for Health Information Technology, or ARCH-IT, is formed as a national association for the country’s 62 Regional Extension Centers. I noticed, by the way, that of the 143,000 providers signed up with RECs, only 12,000 have received incentive payments. Maybe a bit more mindshare wouldn’t be a bad thing.

The Long-Term and Post-Acute HIT Collaborative issue a roadmap for HIT in nursing homes and rehab centers, focusing on care coordination with other providers, implementing quality measurement activities, and promoting technology education among LTC workers.

In New York City, merger talks between NYU Langone Medical Center and Continuum Health Partners break down after Continuum entertains a similar offer Mount Sinai Medical Center.

More Accretive Health news, all of it bad. Minnesota’s attorney general expands the suit against the collections company; Maple Grove Hospital (MN) fires the company at the request of its 25% owner, Fairview Health; and two US congressmen investigating the company’s practices say it has not replied adequately to their inquiries, failing to produce requested internal documents and ignoring their requests for a meeting.

A DrLyle blog post talks about EMR extender tools, postulating that EMRs have become somewhat stagnant infrastructure tools and that the innovation ecosystem will instead involve tools other companies build on top of their platforms.

Oracle CEO Larry Ellison buys himself a Lanai, but instead of being a tiny porch like that word would imply for most of us, it’s a 141-square-mile Hawaiian island of that name. The world’s sixth richest man will pay around $500 million cash for the purchase, which you might take a moment to enjoy vicariously the next time your hospital pays an Oracle invoice.

Weird News Andy muses about who the patient (especially for the all-important hospital billing) is in this story and others like it, in which an oral tumor was removed from an unborn child during the mother’s 17th week of pregnancy.

Sponsor Updates

  • Pittsburgh Bone & Joint Surgeons (PA) selects SRS EHR and PM for its seven physicians.
  • Emdeon launches Emdeon Payment Network, which combines electronic and print payment services for payers.
  • TeleTracking announces a series of webinars on improving hospital operations and ROI using real-time capacity management. 
  • The Minnie Pearl Cancer Foundation names Emdeon EVP/CIO Damien Creavin and Cumberland Consulting Group partner David Vreeland to its board.
  • NextGen Healthcare’s Electronic Dental Record receives ONC-ATCB certification from CCHIT.
  • Acusis introduces AcuMobile for the capture of patient encounters on the iPhone.
  • T-System will showcase its RevCycle+ solution at next week’s HFMA’s Healthcare Finance Conference in Las Vegas.
  • St. Joseph Health (CA, NM, TX) pilots AT&T Telepresence Clinic service.
  • Kliniken Maria Hilf (Germany), SALK (Austria), Bakiroy Dr. Sadi Konuk Egitim va Arastima Hastanesa (Turkey), and Boston Children’s Hospital (MA) go live on iMDsoft’s MetaVision solution.
  • Greenway Medical exhibits its PrimeRESEARCH solutions at next week DIA 2012 Annual Meeting in Philadelphia.

EPtalk by Dr. Jayne


I am humbled by the response to this week’s Curbside Consult. My e-mail has been overflowing with readers who know what it means to come from a farming background. Most of the themes revolve around hard work, perseverance, and living with the consequences of your decisions. There was even great story from one reader whose family ran moonshine to earn money after a tragic accident.

One reader stated she was going to post the 4-H pledge at her desk to remind her every day about striving to be better person. From the responses, it looks like there are some regional variations, but for those of you who haven’t Googled it yet, here is the 4-H Pledge:

I pledge my head to clearer thinking,
My heart to greater loyalty,
My hands to larger service,
and my health to better living,
for my club, my community, my country, and my world.

It’s kind of like the Everything I Needed to Know, I Learned in Kindergarten list, but maybe it’s something that healthcare should embrace as we slow the pace down and stick to the basics.

Another reader shared her love of trail riding and said that being on a farm is “the one place where I know I can keep all those untamed healthcare acronyms at bay for a while in favor of what my father would call honest work.”

Slightly surprising (but not really) was that nearly all of the responses were from women, several of whom cite their backgrounds as helping them make it in IT:

Being raised around country people, I was fully supported when I ventured into traditionally male roles like running a bush hog, planting, or working on engines. No one thought a thing about it – you did whatever you had aptitude for. I grew up “liberated” and was mystified by all the fuss in the 70s. How fortunate to grow up with the belief that you were only limited by the barriers you set for yourself.

Thank you again to all of you who wrote about the article. You’ve helped recharge my somewhat depleted batteries as I slog through a series of intense go-lives. And now, back to our regularly scheduled healthcare IT message.

John Halamka blogged this week about “meaningful consent” for health information exchanges. His institution is using an opt-in model where patients can choose to share or not share data originating from various institutions. There will be no clinical override or “break the glass” functionality. Although I agree generally with this patient-centric model, I’ve practiced under a similar one and found it to be less than optimal for monitoring basic patient data. When patients can choose to share some data but not all, it fragments the patient record making it very difficult to identify duplicate therapies, drug interactions, and redundant tests. Since this is the prime reason for having an HIE, it somewhat defeats the purpose.

A reader shared this write-up of the new website ChickRx whose tagline is Expert Advice to get Happy, Healthy, & Hot. The review describes it as “what would happen if WebMD met Cosmo.” Presented at a recent Rock Health Demo Day, it has some serious potential as an entertaining alternative to existing consumer-focused sites.

Both Inga and I picked up on this piece about the situation where the chief medical officer at Northwest Community Hospital was found to be lacking a medical license. A hospital administrator described needing a medical license as “irrelevant” for administrators. Although I don’t think physicians working in the tech space always need licensure, I feel it’s essential for hospital administrators. If nothing else, it shows solidarity with the physician community and gives the ability to emphasize with burdensome administrative requirements with which the rest of us have to comply. Working at a hospital yet allowing your license to lapse makes an administrator seem detached from the rest of the physicians who have to live under his or her policy decisions.

I found an interesting blog posting that discusses “cloned” EHR documentation. It’s a quick read and illustrates something providers should watch out for. In trying to avoid cloned notes, the author used different wording at each visit for the same physical findings. This resulted in an attorney trying to twist a stable disease into a progressively worsening condition. We’re damned if we do and damned if we don’t.



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

More news: HIStalk Practice, HIStalk Mobile.

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June 21, 2012 News 2 Comments

Dr. Sam 6/18/12

June 18, 2012 News 5 Comments

A Key Missing Element of EHRs

Nurses play a key — if not crucial — role in successful hospital EHR implementations.

  • They are the first people that frustrated physicians complain to and often have to deal with borderline or actual abusive commentary or language emanating from an angry physician.
  • They are often the initial super-users who can show physicians how to navigate through specified workflows that they may not have absorbed during EHR training (if they attended training sessions at all).
  • They often have to enter orders or deal with verbal orders given by a physician who cannot (or does not want to) enter orders by Computerized Provider Order Entry processes (CPOE – please note use of the term “Provider” and not “Physician,” which is the true appropriate use of the acronym CPOE.)
  • They are often the first users in the go-live schedules for clinical documentation.

In spite of their key role in patient care, by tradition (in both paper and electronic worlds), their clinical notes are almost universally unread by physicians. In spite of being the caregivers who spend far more time at the bedside than any other clinicians, their notes are either ignored, or at best casually reviewed by physicians.

As a result, both the paper and electronic environments are often replete with documentation contradictions with inaccurate information entered by either the physician or the nurse, or with information that conflicts with patient status. After cataract surgery, a nurse might enter “Pupils Equally Round and Reactive to Light and Accommodation (PERRLA) when one pupil is pharmacologically dilated or constricted, or a physician might document “Patient fully ambulatory and stable” when the patient is in fact unable to get out of bed or has had fluctuating vital signs. The number of possible conflicting entries is both unlimited and endemic.

This is where standard vocabulary becomes as important as accurate clinical observations. An EHR functionality that has been lacking since the early years of clinical information system design has been the ability to cross reference nursing and physician clinical documentation notes and to generate alerts when contradictions are present. This is not only of essential importance to patient care, but to reducing vulnerability to medical liability.

Sam Bierstock, MD, BSEE is the founder of Champions in Healthcare, a widely-published author, and a popular featured speaker on issues at the forefront of the healthcare industry.

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June 18, 2012 News 5 Comments

News 6/13/12

June 12, 2012 News 8 Comments

Top News

6-12-2012 9-34-40 PM

Private equity firm TPG Growth acquires critical care systems vendor iMDsoft. We reported that rumor here on June 8, along with the rumored sales price of $80 million that was not confirmed in the announcement.

Reader Comments

6-12-2012 7-33-56 PM

From SmallBiz: “Re: Accolade. Your post about Accretive Health’s chairman Michael Cline and reference to Accolade made me curious. A quick Google search shows the company on the SBA 100 list of companies that have received small business assistance. Call me crazy, but I thought SBA assistance was meant for budding entrepreneurs or bootstrappers trying to change the world, not for multi-millionaire private equity guys who want to add one more high flyer to their portfolio. The more one researches Accretive, the more one scratches their head.” Ditto the more one tries to understand how the federal government can be so free with taxpayer money while drowning us all in red ink.

6-12-2012 8-12-05 PM

From The PACS Designer: “Re: Apple’s iOS6 Preview. This fall we’ll see the arrival of Apple’s iOS 6 platform. For now, we have the iOS 6 Preview announced by Tim Cook this week. TPD particularly likes the Apple Maps, which shows cities and their skylines through Apple’s detailed  air mapping process.“ I’m not really an Apple fanboy even though I use the iPad for routine stuff (checking the weather, looking up something I’m watching on IMDB) but I admit that I intently follow live blogs of their World Wide Developer’s Conference every June. There’s just something compelling about the excitement of the unveiling and the hipness of Apple that makes me want to feel like I’m there among the geeks and crusties. The big announcements (other than Apple dumping its Google relationship for maps) involved a refresh of the laptop line (including a rare price drop on the Mac Pro) and some iOS enhancements. Boring if you were expecting a new Apple TV or the iPhone 6. It was cool, though, that everything being announced other than the new Mountain Lion OS was available for online purchase the same day (once they brought the Apple store back online later Monday.) Other than Google, the companies taking it in the shorts from Apple were Intel and its partner companies trying to sell Windows-powered Macbook Air lookalikes (aka ultrabooks) that aren’t nearly as cool for about the same price ($999), the same Apple manufacturing pricing advantage that makes it suicide to roll out an iPad competitor. Even the low-end Air now comes with all-flash storage, Thunderbolt and USB 3 connectors, and a FaceTime HD camera. For Maps, it looks like Apple has struck a deal with TomTom to turn the iPhone into a free, voice-powered GPS with real-time traffic updates driven by automatic data from individual iPhones and integration with services such as Yelp and OpenTable.

HIStalk Announcements and Requests

6-12-2012 9-40-51 PM

Maybe it’s just me, but has Facebook been dog slow lately? Are they punishing users for their unimpressive IPO by throttling back the Web server horsepower? Ditto the hourglass city for Twitter. How many billions does it take to keep the Web page coming up?

I’m speaking to the men here, but the ladies are welcome to read. I was reading a list of suggested ways to make the woman in your life happy. A common answer was to hug her from behind, kiss her cheek, and tell her she’s beautiful whether she is or not (assuming she is to you, anyway, which I hope is the case.) You and I probably have in common the fact that we haven’t done this with either Inga or Dr. Jayne even though they are clearly loved and beautiful, so here’s a list of alternatives: (a) sign up for spam-proof e-mail updates; (b) give them a virtual hug by friending, liking, and connecting via all the hipster social not-working sites; (c) send us news, rumors, photos, or anything else that is informative or entertaining; (d) intently study our sponsors via the categorized and searchable Resource Center or the gloriously non-animated ads to your left, and if you’re provider seeking consulting help, fill out a quick online form and get a bunch of responses via the Consulting RFI Blaster; (e) have patience with our sometimes terse and/or delayed responses or occasional crankiness since we work full time elsewhere, and doing all things HIStalk is an intensely enjoyable but time-sucking hobby that requires constant reallocation of hours. Do these things and the smart and sassy HIStalk ladies will virtually lean their heads on your shoulder and sigh contentedly, squeeze your bicep and insist that your workouts are buffing you up, and pretend to find your timely Caddyshack quips to be funny. Heck, I might do that myself since we appreciate all of our readers and sponsors.

Acquisitions, Funding, Business, and Stock

The Chicago business paper reports that Fidelity Investments, the largest outside investor in Merge Healthcare, has sold most of its shares, dropping its ownership from 6.7% of the company to around 1%. Shares were up 1.34% on the day, although they’re still down by more than 60% since late March.

6-12-2012 10-04-47 PM

Compuware hires an underwriter to prepare for the IPO of its Covisint business. The company hopes to raise $200 million.


Bacon County Hospital (GA) selects Summit Healthcare’s Express Connect and Provider Exchange interoperability technology for its Meditech 6.0 system.

6-12-2012 10-03-09 PM

Huntington Memorial Hospital (CA) announces a strategic collaboration with Cerner to implement its clinical and financial solutions and connect with the hospital’s information exchange.

The Orange County Partnership RHIO (CA) selects Mirth’s data exchange solutions.

Catholic Health Initiatives selects Orion Health as its HIE technology partner for its $1.5 billion EHR initiative. I’m interested to know the scope of the overall project given its cost, so help me out if you know.

6-12-2012 6-43-44 PM

Thailand-based medical tourism hospital Bumrungrad International Hospital chooses business intelligence tools from Agilum Healthcare Intelligence of Nashville, TN (known as Anthem Healthcare until a name change a few weeks ago.)

Wireless infrastructure vendor Firetide wins a contract for 4,000 centrally managed access points for a 180-hospital WLAN rollout in Korea.

6-12-2012 7-01-09 PM

Dallas County Medical Center (AR) chooses the Prognosis HIS EHR after reviewing a dozen vendors. The hospital’s CEO says a key factor was a guaranteed 120-day go-live and the 100% of customers who have received Meaningful Use money.

Federal contractor CACI International is awarded a $20 billion contract to provide IT services to the National Institutes of Health and other government agencies. The company says healthcare IT is an important growth area and that its services will provide “innovative solutions to enhance taxpayer services.”  

6-12-2012 9-06-01 PM

The Navy rejects the EMMA computerized medication dispensing system from INRange Systems because of concerns about the security of its wireless communication. They planned to pilot it, but changed their minds when it failed to earn certification and word of bad experiences from Army pilot sites got out. They also said its potential to control drug abuse among service members was overstated.


6-12-2012 7-37-34 PM

Steve Sarros (Spectrum Health) is named VP/CIO of Baptist Health Care (FL).

Announcements and Implementations

Agfa Healthcare selects Dell to host its medical imaging archiving services.

Precyse signs a software interface license agreement with 3M Health Information Systems to interface Precyse’s computer-assisted coding product with 3M’s Coding and Reimbursement system.

T-System introduces RevCycle+, an RCM solution for the emergency department that encompasses facility coding, physician coding and billing, and consulting.

6-12-2012 6-49-38 PM

M*Modal announces its Catalyst suite of cloud-based applications that allows extraction of data from unstructured clinical documentation (such as dictated encounter notes) that can be merged with structured EHR information. A key benefit is the ability to search all medical documents regardless of source and system while preserving context beyond simple keyword searches.

Hospira announces enhancements to its TheraDoc clinical surveillance system to support hospital antimicrobial stewardship programs, including an eMAR interface, dashboards, and alerts.

6-12-2012 8-22-21 PM

Business analytics software vendor SAS partners with the non-profit Health Care Incentives Improvement Institute to develop analytics-powered provider reimbursement models to support bundled payments and ACO shared savings models. I’m impressed with the most recent (and fun) blog post by HCI3’s executive director Francois de Brantes (formerly of GE) or his ghostwriter — Too Many KITAS can be a PITA, which applies behavioral theory to ACO-type reimbursement:

The carrot and stick approach, what Herzberg refers very cynically in his paper as the KITA method (for kick in the ass), doesn’t work very well. Instead, he suggests an exercise in minimization of toxic environmental factors. We’ve grown accustomed to thinking that incentives can be optimized, that behaviors can be finely tuned to respond to the incremental adjustment in fee schedules or bonuses. They can’t. What we must do is actively minimize misalignment of incentives – factors that lead to job dissatisfaction. If I encourage employees to seek care while penalizing physicians for delivering too much care, then I’m creating a toxic environment leading to dissatisfaction. If I put physician income at risk but only tell them after the fact what their budget was and that they blew it, then I’m creating a toxic environment leading to dissatisfaction. If we want physicians to develop and maintain an internal motivating generator (as Herzberg refers to it), we have to minimize the factors that are stopping them from achieving their potential.

Government and Politics

6-12-2012 7-11-23 PM

6-12-2012 7-12-26 PM

AHRQ produces an e-prescribing toolset for physician practices that includes a readiness assessment, sample workflows, a task table, an e-prescribing vendor assessment tool, sample project timelines, a computer skills assessment, and a flyer for patients.

Innovation and Research

A JDRF-funded study demonstrates the feasibility of an artificial pancreas for ambulatory use. Two patients were connected to an insulin pump that was controlled by a smart phone that constantly monitored their blood glucose levels and adjusted their insulin doses accordingly, allowing them to eat meals and sleep outside the hospital while maintaining near-normal blood glucose levels without medical intervention. 

An Arizona teen wins an innovation award for his enhancements to existing free software that allows people with Lou Gehrig’s disease to control a browser using their eye movements. Commercial equivalents cost $20,000, but his version costs less than $2,000 including hardware. He’s talking to some VCs about marketing it.


HIMSS Analytics introduces the Ambulatory EMR Adoption Model, which will track IT adoption in more than 28,000 ambulatory facilities that are part of hospitals or hospital systems. None of the 9,247 ambulatory facilities that are providing information to HIMSS Analytics are at Stage 7 and nearly half are Stage 0 (purely paper-based.)

6-12-2012 6-32-52 PM

The Advisory Board Company’s daily briefing newsletter highlights this story, in which a researcher digging through boxes of old paper at the National Archives finds 21 pages of notes taken by the first doctor to attend to Abraham Lincoln after his shooting at Ford’s Theater. The doctor, who was also attending the play “Our American Cousin,” had earned his medical degree just six weeks before. I couldn’t help but think how uninformative the rich historical narrative would be had it been reduced to today’s codes and checkboxes.

A UK hospital admits that it believes one of its employees leaked information to a tabloid about the cystic fibrosis diagnosis of the four-month-old son of former Prime Minister Gordon Brown in 2006. The tabloid is owned by Rupert Murdoch.

In Canada, a Grey Bruce Health Services computer problem takes down the phone and computer systems of six hospitals.

6-12-2012 10-11-08 PM

Patient advocates complain that University of Iowa Foundation sent patient information to the questionable fundraising groups it hired, allowing them to enhance their mass mailings seeking donations to its hospitals by adding the signature of each patient’s doctor. The hospital says the practice is legal and everybody else does it. One of the fundraising companies raised $1.1 million for the university, but charged $1 million for doing so. The newspaper article only casually mentions an item that I consider the most troubling:

The head of the hospital’s ophthalmology department says the flow of information works both ways in that the foundation tells him which of his upcoming patients have agreed to donate money. The foundation and hospital have also agreed in writing to collaborate on “wealth screenings of patients” in order to maximize donations.

An American Medical News editorial calls Meaningful Use Stage 2 “a recipe for failure,” saying its increased number of performance measures and higher thresholds raise the chances that a practice will miss out on their HITECH check, possibly through no fault of their own (like practicing in an area where labs can’t accept electronic EHR data and patients who aren’t interested in using technology).

Inga says she hopes she has a leg up on Weird News Andy in finding this story. A Gulf of Mexico shrimper drags up a $30,000 custom-painted artificial leg from the water, saying, “I was hoping I wasn’t going to find a body with it as well.” The leg’s University of Kentucky motif allowed him to track down the owner, who says he lost it while swimming over Memorial Day. The diehard Wildcats fan wasn’t reduced to hopping on one leg in the interim: he has two more like it.

Sponsor Updates

  • AirStrip Technologies and Palomar Health launch a vendor-neutral mobile platform to provide access to clinical data.
  • Kony Solutions hosts a June 14 Webinar on developing an enterprise mobile strategy.
  • EBSCO Publishing releases three medical e-book collections of top-rated content on its EBSCOhost electronic library collection of 300,000 e-books and audiobooks.
  • The Ohio Orthopedic Center of Excellence selects eClinicalWorks EHR for its 59 providers.
  • Covisint announces that DocSite is open for 2012 PQRS submission, which costs a flat $299 per provider. It also offers free webcasts and a 2102 CMS Incentives FAQ document.


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

More news: HIStalk Practice, HIStalk Mobile.

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June 12, 2012 News 8 Comments

Readers Write 6/6/12

June 6, 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!

Moneyball and the Power of Data Analytics
By Gerard Livaudais

6-6-2012 7-49-34 PM

I’m not much of a baseball fan, but I really enjoyed the movie Moneyball. If you haven’t seen it (or read the equally excellent book by Michael Lewis), here’s a ten-second synopsis. Billy Beane, general manager of the Oakland As baseball team, bucks traditional scouting methods by using data analytics to find undervalued players. He is pilloried by baseball purists for his stats-obsessed methods, but he builds a winning team on the league’s lowest payroll.

Moneyball may be a baseball movie, but the real story is about the transformative value of data. And as the final credits roll, what’s clear (at least to this viewer) is that even the most under-funded team in baseball uses data more effectively than most healthcare providers.

The use of data as a business intelligence tool is hardly new. In almost every industry on the planet, companies are leveraging data-driven decision-making to realize productivity gains, achieve competitive advantages and improve overall performance. Even the smallest of SMBs (small and medium-size businesses) are getting in on the act, thanks to the simultaneous rise in computing power and drop in hardware and storage costs.

Businesses like the Oakland As are using data to win baseball games. In a hospital, access to the right data at the right time saves lives. Yet healthcare organizations as a whole are failing to use current, accurate data to support their clinical, financial, and operational decisions.

Healthcare should be setting the standard for data-driven business intelligence. Here are three strategies we can use to get there.

1. Focus on the Data that Matter

Healthcare organizations certainly don’t lack for data. Thanks in part to a constellation of regulatory mandates, we already capture, store, and report phenomenal amounts of data. On the other hand, financial incentives – never the top priority but always a factor — for effective use of data are rising. Meaningful Use Stage 2 includes numerous value-based purchasing elements and aggressive penalties for hospitals and physicians who fail to demonstrate the quality of care they deliver.

One way we can leverage data more effectively is by breaking down the data silos that prevent the right information from getting into the right hands. As an industry, we spend billions of dollars building and maintaining the data warehouses that power analytics across healthcare environments. These internally-hosted systems may be great at assembling data and powering analytics for specific departments or functions. But they also isolate that data, inhibiting its value as a decision support tool.

The right business intelligence technology can break down these data silos much more easily and cost effectively, enabling all decision-makers within an organization to access the most relevant metrics and performance indicators. The implementation and support cost factors for Software-as-a-Service (SaaS) solutions are several orders of magnitude less than internal systems.

2. Leverage Internal and External Data

Once internal data silos are torn down, healthcare organizations have the ability to seamlessly share information across departments and business units. Integrating data from outside your organization is essential to enabling true comparative analysis. Inconsistent data formats are a nightmare to normalize and aggregate manually. But industry data standards such as HL7 are helping enable true interoperability among best-of-breed technology solutions.

3. Influence Positive Patient Behavior

Health outcomes are ultimately dictated by patient behavior. One of the most promising frontiers of clinical business intelligence is the ability to blend data that reflect not just clinical activity, but social factors that can help predict how well certain patients will comply with a treatment plan, particularly for chronic illness.

These factors can range from patient-generated measures – such as how patients prefer to interact with their physicians – to the presence of psycho-social indicators such as depression and exercise level. Their economic impact can be profound. The cost to treat diabetes in patients with depression is more than twice that of diabetes patients without depression. By blending clinical and social indicators, providers are able to “personalize” treatment plans that simultaneously raise the probability of successful health outcomes and reduce the overall cost of treatment.

However, some of these measures of efficiency are not universally appreciated just yet. As Billy Beane discovered, prioritizing on-base percentage over batting average may be a more efficient path to building a successful team. But his Oakland As had to win games first – a lot of them – before his industry appreciated his logic.

The good news for healthcare is that everyone – from physicians and providers to device manufacturers, pharmaceutical companies, insurers and other payers, and even academic and research institutes – benefits from more efficient and successful patient outcomes. All parties also benefit from instant access to accurate healthcare data. The right tools can open up a world of opportunity to improve outcomes and save lives.

Gerard Livaudais is chief medical officer of Quantros.

Care in an Emerging Market
By Arvind B. Deshpande

Recently my father, who is 84, was hospitalized for profuse sweating based on telephonic advice of our family doctor.  I live in a city about 150 km from Bangalore (or Bengaluru). I am describing the care at the hospital.

We arrived on a Saturday around midnight without calling the hospital. As soon as we reached the hospital, staff at the entrance wheeled him to ED. The duty doctor took an ECG and advised moving him to ICCU. By the time I finished the paperwork at billing (where they located his nine-year-old ECG record in less than a minute,) he was in the ICCU on the first floor of the four-floor hospital.

The doc in ICCU immediately connected a vital signs monitor. Noting the low heart rate of 40, he mentioned that an external temporary pacemaker might become necessary. I signed the consent, giving my contact details.

Around 2:30 a.m., I got a call saying they had connected the external pacemaker after his heart rate became irregular and he had been defibrillated. My father stayed in the ICCU until Monday morning, when the interventional cardiologist took a look and advised an angiogram. He mentioned that if there was a heart block, they might have to introduce a stent.

I again signed the consent papers. The whole procedure, including angioplasty, was completed in an hour. My father was moved back to ICCU. Care in ICCU was good, timely, and home-like, to say the least.

The doctor mentioned that he would stay in ICCU for two days, then be shifted to the ward for another 2-3 days. The external pacemaker would still connected as a safety standby. He was moved to the ward after two days and the external pacemaker was disconnected on Day 4. He continued in the ward until Day 6 as a precautionary measure, then was discharged from the hospital.

I had the opportunity to interact with the doctor every morning. The findings were recorded on paper and explained to me daily.  On the last day, all the records were signed off, billing was completed, and we came home,  which is about a 10-minute drive from the hospital.

This 30-bed hospital dedicated to cardiac specialty has its own IT hardware setup and software locally developed to support them. Meaningful Use and EMRAM standards do not exist and are not mandatory. This hospital is ISO 9001 certified ,and one can say they comply with the standard in letter and spirit.

I work for a medical device manufacturer here. I am an avid reader of your blog, from where I have gained some insight into how providers and vendors work towards patient care in the US.

I am not suggesting that the recent measures announced in the US are not necessary. The above incident is only to spread awareness as to how good care is primary and systems are required to support care.

Arvind B. Deshpande is head of quality assurance and regulatory affairs for Larsen & Toubro of Mumbai, India.

Why We Do What We Do
By Dan Herman

6-6-2012 8-07-40 PM

I have received a birds-eye view of our healthcare delivery system while tending to my mom over the past couple of months. She had major open heart surgery at a hospital outside of Chicago in late April. She was discharged to rehab and is doing pretty well for a woman who will turn 82 next week.

The hospital that cared for her is part of a large IDN, highly integrated on a single EMR platform for their inpatient and multi-specialty physician group practice.

They are a HIMSS Analytics EMRAM Stage 6 organization. Not only was the care and patient service impressive, but the collaboration and coordination among the care team was practically seamless. Her internist, cardiologist, thoracic surgeon, and anesthesiologist; nursing teams in the med-surg, ICU and SICU units; physical and speech therapists; dietitian; and social worker for discharge planning were all working in synch across her episode of care and had access to her clinical information across the care continuum (including her previous problem list and meds and allergies from her internist that practices at the medical group). Mom also accesses her regular lab results from home (and now the rehab facility) through the health system’s patient portal.

My key observation was the impact of what we do as healthcare IT and operations improvement professionals. The hospital that cared for my mom has long been recognized as a leader in the use of information technology to support care delivery, operational, and financial management processes. They had a paperless business office in the early 80s; standardized the nursing documentation process across their four acute care sites in the 90s; and obtained 90%+ CPOE adoption almost 10 years ago.

During the inpatient stay, I didn’t see any paper. Everything was documented in the system – nursing notes, MD notes, anesthesia and OR record, legal documents, ICU monitoring device results, etc. But more than the IT aspects, I noticed a very streamlined and coordinated care process that was centered on the patient. Patient safety and service was the driver behind the outstanding use of the top-of-the-line technology. Always confirming the patient’s name, medication bar coding that ensured the right meds, doses were delivered to mom at the right time (she really hated being woken up at night or at 7 a.m.)

Mom was transferred there from the hospital down the street (it’s where the ambulance took her). She never felt comfortable and safe at the first hospital. Her doctor didn’t practice there. They didn’t explain what was going on. They didn’t have access to her past clinical history. The caregivers weren’t coordinated. Patient safety was in question (a nurse came in with meds for another patient). The facility wasn’t as nice, and the food was not nearly as good. However, they used the same EMR.

It’s not about systems. It’s about leadership, accountability, and the care delivery process. The contrast between the two hospitals was a case study. This overall experience drove home the significance of what we do. Whatever your specialty is or your role within your organization, it’s essential to never forget our true mission – improving healthcare.

Dan Herman is founder and managing principal of Aspen Advisors.

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June 6, 2012 Readers Write 2 Comments

Monday Morning Update 6/4/12

June 3, 2012 News 12 Comments

From Roger Collins: “Re: JAMIA article on dictating into the EMR. The authors measured ‘quality of care’ by looking at discrete quality measures in the EMR. By definition, clinicians who dictate their documentation aren’t using templates and would not have double-documented by checking off boxes. The study didn’t look at the transcribed dictation notes, so they had no way to know whether those clinicians even met the quality metrics, much less that they provided lower-quality care.” It appeared to me that the study looked only at whether the documentation was complete (tobacco use recorded, blood pressure taken, etc.) rather than patient outcomes, so I was suspicious about its conclusion that “physicians who dictated their notes appeared to have a worse quality of care than physicians who used structured EHR documentation.” But it does raise an interesting question: if we agree that transcribed dictation provides a richer narrative, then in our fanaticism to distill every encounter into a set of predefined checkboxes that will be used to measure quality, determine payment, and drive Meaningful Use payments, how are those checkboxes going to be populated without losing their original context? We’re reaching an electronic decision point: as a clinician, would you rather assess a patient based on the verbatim thoughts of your peers or a bunch of lists and graphs? And if the answer is that we need both, how do we make that happen? Your comments are welcome.

6-3-2012 4-22-51 PM

From CT Scan Moneyball: “Re: healthcare price disparities. One way to fix this is a fixed fee schedule like they have in Japan as described in this article, but it probably can’t happen here in our poisonous political climate. A bonus is controlling cost – Japan’s spending on health went from 7.7% to 8.5% of the gross domestic product over eight years, compared to an increase from 13.7% to 16.4% in the US.” 

6-3-2012 4-24-33 PM

From SmallTown CIO: “Re: MUSE 2012. The crew from MUSE have done a great job again with a well-organized conference. As a long-time attendee, it is a little strange seeing a younger crowd – some of the usual suspects I haven’t run into. However, at the same time it is great to see the up-and-comers that will keep MUSE and Meditech strong. The vendor exhibits have been good with some new faces. Forward Advantage, Iatric, and Dimensional Insight are among a few that have a bigger presence. Forward Advantage held a great party at House of Blues – definitely an extracurricular event highlight. The thing I appreciate more than anything at MUSE is the vendor exhibits aren’t ostentatious, which fits very well with the customer base of Meditech (we are all driven by cost effectiveness). It is great to see Meditech have a presence at the conference in terms of presentations. My hope is that next year they have a presence in the vendor exhibit area as well, where we can catch up on the latest software changes. All in all, it has been a good conference and I tip my hat to Alan Sherbinin and crew – nice job!" Thanks for the report.

6-3-2012 3-39-45 PM

From THB: “Re: Epic. Going down the path toward NHS implementation – they’ve posted a job to help prepare their product for the UK. Anyone know where I can find workflow documents for NHS hospitals?” I found the listing above. People thought Epic was kidding when they talked about world domination. They weren’t.

From Cyber Spy: “Re: hacking. Medical IT is highly vulnerable.” This article covers the development of Zero Day exploits. A former NSA hacker shows how randomly changing file data at the byte level will eventually cause a system to crash, and once that happens, he can often figure out why to discover a previously undocumented exploit. It mentions the secret Stuxnet cyberattack on an Iran (the White House financially admitted last week that it was a US-Israel creation and it got out of control) and that the Pentagon now considers cyberspace to be a theater of war. I seem to remember that at least one UK hospital was hit by a Stuxnet-caused outage, so if so, that means the US government may have caused patient harm in England.

From No Bull: “Re: sex in the road. Doctors could not get to their patients. Thank heavens for mobile medical devices.” A busy highway in Pennsylvania is closed for hours due to a bull-and-cow hookup, or as one state trooper described the scene, “They’re having relations in the road.”

6-3-2012 5-18-20 PM

From Wheeler and Dealer: “Re: deals between Congress and pharma. There other others between Congress, HIMSS, and IT vendors.” The House Energy and Commerce Oversight and Investigations Subcommittee (made up of 14 Republicans and nine Democrats by my count) reports on what it calls Closed-Door Obamacare Negotiations. It says the White House struck a PPACA deal with the Pharmaceutical Research and Manufacturers of America, committing to protect the drug companies from price controls, government-run prescription insurance, and new drug importation policies in return for $80 billion in payment cuts. The deal came together quickly when the Obama administration was getting beat up over PPACA the week of June 18, 2009, and was desperate to announce something positive before the Sunday political talk shows. I actually read this as pro-Obama: he told the drug companies that if they didn’t play, he was going to call them out as foot-dragging and hit their profits via mandatory rebates and the elimination of tax-deductible direct-to-consumer advertising. The gist of the findings is that Obama conducted closed-door meetings with drug companies after being critical of such practices as a candidate.

6-3-2012 4-18-12 PM

From The PACS Designer: “Re: World IPv6 Day. This coming Wednesday, we’ll see the launch of the next Internet upgrade to IPv6, promoted as World IPv6 Day. The upgrade has become necessary since the supply of available IPv4 addresses has been exhausted. The challenge for IT departments will be testing IPv6 on all browsers and servers for compatibility with existing applications and security issues.” You can follow along on Twitter.

Listening: Fitz and the Tantrums, LA indie kids who sound eerily like a really good 1965 Detroit soul band, right down to the growling organ. They are amazing in this live video, especially the female lead singer, and were the subject of an episode of the excellent Live from Daryl’s House, where they did a better-than-the-original cover of “Sara Smiles.” On tour now, appearing in Houston, Birmingham, Greenville, Manchester, Charleston, and Raleigh this week.

6-2-2012 5-58-49 AM

Being blessed as I am with heightened perception of the obvious, I believe I see some agreement (95%) that hospitals should be able to provide a bill that the average patient can understand. New poll to your right: does the average hospital CIO encourage innovation or stifle it?

6-2-2012 6-13-26 AM

HMS customers meeting last week at its Nashville office: Millie Schinn (Hamilton General), Diane Sherrill (Medical Arts), Rob Malone (Houston Orthopedic), HMS Chief Medical Officer Frank Newlands, Cindy Jandreau (Northern Maine), and Angie Waller (McDonough).

The weekly employee e-mail from Kaiser Permanente CEO George Halvorson says KP has once again mined its HealthConnect database to discover a new treatment, as reported in the journal Neurology. In reviewing the records of nearly 13,000 ischemic stroke patients spanning seven years, it found that starting cholesterol-reducing statin drugs as soon as possible cuts the death rate by nearly half and raises the chances of the patient going home instead of to a nursing home by 20%. And if the patient was already taking statins at the time of their stroke, simply continuing the drug during their hospitalization dropped the death rate to 5% (if the drug was stopped, deaths jumped to 23%). As George concludes, “We are the only people in healthcare who have done that analysis. Our stroke researchers have done truly great work. This finding has the potential to save many lives. Every stroke treatment program on the planet Earth can and should either start to give or continue to give cholesterol-lowering statins to their stroke patients.” KP has already changed its stroke order sets to start statins on Day 1 as the default.

In less-cheery Kaiser news, its Oakland hospital gets hit with a $75K Department of Health fine for a 2010 incident in which nurses ignored a telemetry patient’s tachycardia alarms, including warnings that the alarm itself was about to shut down due to a low battery. The patient was found unresponsive and was resuscitated, but died afterward. The nurse says he didn’t call the doctor as instructed for the tachycardia because the patient seemed OK, and ignored the low battery warnings because he was too busy.

6-2-2012 7-37-32 AM

I curse the name McAfee regularly when Scan32 and MCShield suck the life out of my hospital laptop, especially during the once-weekly antivirus scan that assures a solid several hours of hourglass when I’m trying to work. Now I can humanize that annoyance with this story of founder John McAfee, who at 66 is living on the run in the jungle. Forty-plus police officers in Belize (specifically the Gang Suppression Unit) raid his guarded estate, kill his dog, and rouse him from the bed he is sharing with his 17-year-old girlfriend, charging him with running an illegal antibiotics factory and possessing unregistered weapons. He claims he declined to bribe a local official and the drug companies don’t want competition from the topical antiseptic and female Viagra that he’s developing, so they hired the police as muscle to claim he was operating a meth lab. A fascinating 2010 profile is here – the man’s clearly both a genius and a total wack job. I think we can agree that he looks great for 66, although perving around with a 17-year-old might be a bit much even in a country where it’s legal at 16. 

6-3-2012 5-21-32 PM

In the UK, Brighton and Sussex University Hospitals NHS Trust is fined $500,000 when hard drives containing the medical information of patients were sold on eBay. The hospital is upset about the size of the fine, says it can’t afford to pay it, and is appealing. It hired a subcontractor to erase 1,000 hard drives, but he listed 250 of them on eBay without the hospital’s knowledge.

This could be a hint of things to come (or a 1990s flashback). Three fired HCA doctors in Florida publicly criticize the chain for hiring huge waves of physicians to prepare for an ACO environment, then dumping those whose practices were not profitable. They also say the company doesn’t have the infrastructure to support the practices it’s buying. One doctor who left said that HCA was sloppy in controlling costs, paying multiples of what he paid in private practice for everything from business cards to transcription services. My experience is similar: hospitals in general are inefficient, bureaucratic, loaded with VPs of inconsistent talent and motivation, and the worst possible partner for a small business. I’ve sat in those meetings when docs complained and once they were gone, we mostly talked about how to marginalize them. Some physicians are fine with working for a huge corporation under their rules (like academic medical center docs), but the free spirit types hate every minute of it. Like any other business, entrepreneurs enjoy selling their businesses to big companies for a big one-time payday, but don’t usually last long with them as employees afterward.

6-3-2012 5-22-50 PM

New Hanover Regional Medical Center (NC) was set to go live Saturday with Epic. Their cost was given as $56 million.

6-3-2012 5-26-50 PM

The University of Missouri School of Medicine fires two radiologists and announces that its dean will retire following the announcement that the health system is the subject of a federal Medicare fraud investigation. The school says it believes that the radiologists, one of whom was the chair of the department of radiology at the time, billed for work performed by medical residents without reviewing their work. The MU radiology department says it will modify its software to prevent future occurrences and says it will pay for having the images of any concerned patients re-read, either by the health system or by an outside radiologist of the patient’s choosing.

I’d like to see Vince’s HIS-tory series continue. I know the best way to make that happen: send him fun anecdotes, old articles, or “where are they now” updates that will get him enthused to keep it going. He’s specifically looking for anyone who can facilitate connections to the folks who started companies back in the 1970s and 1980s so he can get their first-person stories, which would be very cool.

A Texas urologist and his practice manager wife are charged with healthcare fraud, with federal prosecutors saying the doctor submitted at least $1.5 million in fraudulent benefit claims since 2003. His claims indicated that he treated as many as 117 patients in a single day, sometimes billed for more hours than exist in a day, and billed for services provided by office personnel while he was traveling in Iran. The couple was indicted in 2010 for funneling $1.8 million to Iran for investments claimed to be charitable contributions, using a charity run by their daughter.

The Lexington, KY newspaper covers a non-profit mental health board whose for-profit subsidiary, run by the board’s retired CEO, sells scheduling, billing, and payroll software to other state-funded regional boards. It also notes that the retired CEO is married to the current CEO and continues to be paid as a consultant, while their son-in-law is the organization’s IT director.

Weird News Andy says the bomb squad and ED “cheated Darwin” again by removing unexploded fireworks from a man’s chest. He was apparently setting off illegal fireworks from a hand-held mortar to celebrate Memorial Day when “a firework intended for the sky penetrated his chest.” The hospital had to call the bomb squad to remove the pyrotechnic before they could operate. The last reports I saw said the patient is in critical condition with massive chest trauma.

E-mail Mr. H.

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June 3, 2012 News 12 Comments

News 5/30/12

May 29, 2012 News 4 Comments
Top News

5-29-2012 6-49-41 PM

In the UK, NHS says it will shut down its HealthSpace personal health record by March 2013. The Department of Health director says the system attracted few users, which he says is because, “It is too difficult to make an account. It is too difficult to log on. It is just too difficult.” A 2010 report commissioned by the government said it was failing for the reasons that government-run software projects usually fail: poor project oversight, lack of ability to define standard datasets, poorly defined consent practices, and contractors looking out for their own interests. I found this comment fascinating and relevant to other clinical IT system deployments:

The fortunes of the SCR and HealthSpace programmes appeared to turn partly on the philosophical question “Where is the wisdom we have lost in knowledge?”. Many though not all senior stakeholders in CFH, the professions and the IT industry viewed knowledge as stable and discrete data items which could be extracted from their context, placed on the SCR and transmitted to new people and contexts while retaining meaning. An alternative perspective holds that much knowledge is tied to particular people, organisations, experiences and practices and is difficult if not impossible to extract from its context or the people who know it.

Reader Comments

5-29-2012 9-35-06 PM

From Period Piece: “Re: hospital pricing article. Cash is king.” The LA Times covers the seldom-discussed topic of hospitals offering lower prices to cash-paying patients. Its lead example is a hairdresser who pays $700 per month for medical insurance and who was charged $6,707 for a CT scan, of which her share after insurance was $2,336, but had she just written the hospital a check, she would have paid only $1,054. Another hospital lists the same test at $4,423, the Blue Cross Blue Shield negotiated price is $2,400, and the cash price is $250. Says the patient, “I was really upset that I got charged so much and Blue Shield allowed that. You expect them to work harder for you and negotiate a better deal … it kills me that I’m paying that much in premiums and it’s better to pay cash out of my own pocket.” In yet another example, a doctor ordering blood work for his patient found that the hospital charges $782, the insurance company billed the patient for $415, but the patient’s cash price would have been $95. Like everything related to hospital charges, there’s even a catch to paying cash: you have to lie upfront in saying that you don’t have insurance since hospitals won’t give the cash discount otherwise since they don’t allow price cherry-picking, although they may offer a cash discount on the insurance company’s negotiated price. The hospital’s Robin Hood-like explanation: insured patients have to pay more to cover the underpayment of Medicare and charity care. The hairdresser is suing Blue Shield and seeking class action status, but the insurance company says it doesn’t guarantee that providers won’t undercut its negotiated prices for cash-paying patients (in other words, they’re making a fortune on administrative skim and premium-raising and thus have no incentive to worry about what their customers are paying providers.) Here’s the thing about medical insurance: both patients and providers would be better off without it other than for its coverage of catastrophic events, which of course is what it was supposed to be in the first place until it morphed into the borderline socialist “health insurance” that used to pay for everything, but now pays less and less even as medical costs increase and patient rebel at the idea of being responsible for their own healthcare expenses.

5-29-2012 9-43-09 PM

From Pico D’Gallo: “Re: Duke. Their cost for implementing Epic was announced at $700 million over seven  years, surely a record.” Verified, at least the $700 million part — I found a link here.

HIStalk Announcements and Requests

inga_small Based on the success of the HIStalk Advisory Panel, we want to add a separate HIStalk Practice Advisory Panel for practicing physicians and others working in the ambulatory space. Every month or so we’ll e-mail 3-4 questions pertaining to product issues or needs, cool technology that you might be using in your practice, and other issues affecting physician offices. If you have a few minutes every so often to participate, please drop me an e-mail. Many thanks!

5-29-2012 7-32-12 PM

Thanks to HealthCare Anytime, joining HIStalk as a Platinum Sponsor. The San Diego-based company offers a cloud-based patient self-service portal (online bill pay, recurring payments, once-time payments by telephone, appointments, pre-registration, secure messaging, refills, and PHR) that gets providers paid faster and makes their operation more efficient. Of course, patients like it too – who wouldn’t, compared to playing time-wasting telephone tag and jotting down indecipherable notes about balances and appointments? The portal helps providers meet two key Meaningful Use Stage 2 requirements: allowing patients to view/download their information and actually exchanging secure messages with at least 10% of them. The company has been around since 2000 and is run by Steve Click (founder and former CEO of Dairyland, now Healthland) and Brady Click (CEO of Intelligent Health Systems and founder of HealthCare Anytime.) The company is at MUSE in Orlando this week if you’d care to drop by Booth 207 to say hello. Tell them you saw them mentioned on HIStalk – sponsors love that tangible manifestation of their support. Thanks to HealthCare Anytime for supporting HIStalk.

I trolled YouTube to see if there were any videos about HealthCare Anytime and, what do you know, here’s a just-posted two-minute overview of their patient portal. I’m usually not that lucky, mostly because not all companies have caught on to the marketing value of posting videos on YouTube or Vimeo.

I can’t believe I’m saying this, but I’m getting kind of excited about Windows 8. I’m hoping it’s an easy and cheap upgrade, but the “cheap” part is negotiable with me – I don’t mind paying for an OS that’s more stable and functional (but I wouldn’t use Internet Explorer even if you paid me.) History has shown a predictable “every other Windows release sucks” pattern going back to Windows for Workgroups, so I’ll believe Microsoft has regained its long-lost relevancy and reputation for innovation if they can break that pattern. If not, Steve Ballmer needs to be fired immediately and I may go with a Mac since the Win 8 team appears to have stolen liberally from the Mac OS anyway. I’m interested in the announcements from WWDC (Apple’s developer conference, probably the most-watched conference in the world) in a couple of weeks, the first without Steve Jobs.

Acquisitions, Funding, Business, and Stock

In the UK, McKesson hires a lobbying company to help it earn IT business following the demise of the government’s NPfIT project. McKesson, which wasn’t a successful bidder in that project, can now sell directly to individual hospital trusts.


The National Institutes of Health awards Evolvent Technologies a 10-year contract to provide IT services and solutions for the NIH IT Acquisition and Assessment Center. The contract’s ceiling value is $20 billion.

Australia’s Austin Health and the Center for Ambulatory Surgery (NY) select ProVation by Wolters Kluwer Health for GI coding and documentation.

In the UK, Surrey and Sussex Healthcare NHS Trust votes to not only stick with the NPfIT-provider Cerner Millennium, but to extend its contract and add on the RadNet radiology information system. The trust is also seeking a PACS.

5-29-2012 9-39-50 PM

David Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, tells me that the organization has approved an $87 million Epic implementation. They expect to save $10 million per year in clinical improvements and $2 million in reduced software maintenance costs. Upgrading existing systems to meet Meaningful Use requirements would have cost $24-30 million.

LongView International Technology solutions wins a $300 million Military Health System contract to develop proof-of-concept applications that may have something to do with the joint DoD-VA EMR (the announcement doesn’t really say). The company also recently won part of another $20 billion contract. The five-year-old company was started by a retired Navy officer with an MS in hospital administration who had been assigned to the Secretary of Defense to manage a $20 billion appropriation (hopefully not the same one his company won.)


5-29-2012 6-25-56 PM

Imprivata names Mark Clark (Hitachi Data Systems) as VP of international sales, based in London.

5-29-2012 9-04-28 PM

Andrew Terry is named VP of software engineering at electrophysiology lab software vendor Perminova. He was previously with Sotera Wireless.

Announcements and Implementations

Krames StayWell makes its library of discharge instructions available to Meditech customers.

5-29-2012 9-47-44 PM

The HealthBridge HIE (OH) announces the go-live of its ED Admit Alert System, which lets physicians know when their patient visits the ED or is admitted.

MediServe announces that its MediLink for Outpatients solution will support recent changes to therapy caps for hospital-based outpatient therapy services.

The White House invites Iatric Systems to participate in the June 4 Patient Access Summit, where it will be one of 25 invited participants. Facilitating the event will be US CTO Todd Park, National Coordinator Farzad Mostashari, and VA CTO Peter Levin.

Image sharing network vendor lifeIMAGE anounces release of programming APIs that will allow software developers to enable image sharing directly from their applications. The announcement cites an unnamed academic medical center’s use of the API to send images from access management systems to Epic and to allow its employees to populate WebMD’s PHR with their images. I interviewed President and CEO Hamid Tabatabaie awhile back and learned a lot about the state of image sharing.

Government and Politics

5-29-2012 8-21-39 PM

Former US CIO Vivek Kundra, now with Salesforce.com, takes a shot at the IT establishment, which he says is stifling innovation. “There are these evil CIOs that everyone hates because they’re the ones that tell you ‘you can’t bring technology to your workplace.’ They represent the greatest threat not just to innovation, but also to citizens getting the services they want.”

Under fire: the Affordable Care Act’s 2.3% excise tax on the gross sales of medical devices, set to kick in next year but facing increasing Congressional resistance. At least if you believe the WSJ article, which seems to be partisan in the Republican direction (read the article comments for fun).

Innovation and Research

5-29-2012 9-50-59 PM

The CareFusion Foundation awards a $329K grant to the Healthcare Technology Safety Institute to study smart IV pump errors. Brigham and Women’s will coordinate the efforts of 10 hospitals in observing smart pump use to find problems, then identify possible solutions. The institute is part of the biomed-intensive, non-profit Association for the Advancement of Medical Instrumentation, which has worked with FDA on issues related to IV pump safety.


inga_small Epic authorizes implementations of its EHR on Intel x86 servers running open-source Linux, virtualized to VMware. Previously Epic ran exclusively on AIX and UNIX servers. This should make Epic a bit less expensive and perhaps more attractive to smaller facilities, though hardware is a minor part of the Epic implementation budget. Awhile back we ran a rumor that Epic was looking at the open source equivalent to Cache, so this might be a signal that they are looking for less proprietary and less expensive ways to run their systems.

5-29-2012 8-31-19 PM

Cisco kills off its Cius tablet for businesses less than two years after it was launched, born back when the original iPad wasn’t all that robust and businesses were expected to buy enterprise-grade tablets instead of succumbing to pressure from their employees to be allowed to  bring in their own far cooler tablets. It’s bad enough to be trying to move non-Apple tablets, but you are toast if yours is more expensive besides (the Cius was $700).


5-29-2012 9-56-06 PM

South Shore Hospital (MA) will pay $750,000 to settle charges related to a 2010 data breach that compromised the personal data of 800,000 people. The hospital contracted with Archive Data Solutions to erase and resell 473 data tapes, but failed to encrypt the data and didn’t tell the vendor that the tapes contained PHI. The vendor shipped the tapes to a subcontractor to do the work and two of the three boxes were lost.

A UK doctor accused of killing two elderly patients by ordering tenfold overdoses of morphine is acquitted of manslaughter. He admitted that he made a mistake in prescribing the drugs while he was reading e-mail and checking online cricket scores.

Also in the UK, a hospital launches an urgent investigation after a patient complains that an exam light wasn’t working when the doctor was trying to stop her post-delivery bleeding, leading him to order the nurse to hold up his iPhone so he could work from its light. Says the patient, “Then the doctor and nurse had a bit of an altercation when the light went off, as she didn’t know how to do the finger swish thing to keep turning it on, and he… felt she wasn’t listening to his instructions.”

Weird News Andy says this took guts, but he urges police to add practicing surgery without a license to the charges. Police responding to the home of a New Jersey man who was threatening to harm himself with a 12-inch kitchen knife find him barricaded in his room, and when they kick the door down, the man stabs himself repeatedly in the abdomen and throws skin and parts of his intestines at the officers. The man, who has a history of psychiatric problems, is hospitalized in critical condition.

Sponsor Updates

  • AT&T Health sponsors a June 5 Webinar discussing the creation of an enterprise image management strategy in the cloud. 
  • Bloomberg Businessweek profiles Digital Prospectors Corp.
  • Capsule will showcase its device integration solution a this week’s International MUSE 2012 Conference.
  • Newfoundland and Labrador Centre for Health Information selects Orion Health to provide framework for its providence-wide interoperable EHR.
  • SCI opens registration for its Client Innovation Summit 2012, to be held October 21-24 at Chateau Élan in Braselton, GA.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 29, 2012 News 4 Comments

News 5/25/12

May 24, 2012 News 4 Comments

Top News

5-24-2012 10-09-40 PM

The FCC votes 5-0 to approve allow wireless patient monitoring systems such as those being developed by GE Healthcare and Philips to share a frequency spectrum that was previously used exclusively for aircraft testing. Hospitals using the new systems will be able to monitor patients anywhere in their buildings without connecting them to hard-wired instruments and limiting them to specific areas such as ICUs. In-home patient monitoring via Medical Body Area Network devices will also be supported, so that body-worn sensors can communicate wirelessly with an in-home station that will send data to a hospital or other provider.

Reader Comments

From Raydonia: “Re: downtime of Transcend Systems/Nuance on 5/21. They are paying full-time transcriptionists the princely sum of $60 for the day of downtime. As of this writing Tuesday, we are down again. It’s a big deal. At-home workers don’t have the rights that on-site workers have. Any questions and you’re told, ‘Be glad you have a job.’” Unverified. I’m probably the last person you’d want to have soothing you since I’m not usually too sympathetic to career-related gripes. If you don’t like the job and have better prospects, you should take the better job. If you don’t have better prospects, then I agree with the company – the market is telling you something and you should be glad you’re working since lots of people aren’t. In this economy, knowledge workers and those with skills that are in high demand but limited supply are going to be treated very well, but the rest will be have to reset their expectations since the threat of automation or offshoring is always there (hello, HP layoffs). I don’t mean to be a downer, but our parents and schools are feeding us the “dream big and do whatever makes you happy and you’ll be rich and famous” story that doesn’t usually match reality unless you’re freakishly smart, cunning, connected, hard working, or lucky. I think that’s one reason the unemployment rate isn’t going down much – people are holding out for yesterday’s comfortable, high-paying jobs that are gone for good for many of them. In your case, I concur that being paid a “salary” based on piecework seems odd, but if that’s the work arrangement you signed up for, then I guess being paid just the base amount for days you can’t work is consistent, even though it sucks when it’s not your fault that there’s no work to do (kind of like minimum wage restaurant servers who would starve without tips). Hopefully they’ve got their systems back to normal since I’m sure your hospital customers are as anxious as you are to reconnect. 

5-24-2012 8-38-23 PM

From Pop Top: “Re: HL7. They are encouraging vendors to put the ‘Care Connected by HL7’ logo on their splash screens. Do you think any vendors will do this?” I don’t know why they would. Users are the ones who see the splash screen and they don’t care about HL7. Other than giving HL7 free advertising, I don’t see the benefit. And not to be overly critical since I’m probably the worst at aesthetic design (as readers who are always complaining about the HIStalk format can attest), but the logo looks kind of cheesy to me – harsh and badly proportioned wth an unpleasant 3D chiseled effect. Not to mention that the HL7 part of it, even though it’s their regular logo, is hard on the eyes. White on black looks like a DOS screen.

From Annie: “Re: Cerner. Consulting SVP David Sides resigned last week.” Unverified. His bio is still up and his LinkedIn profile says he’s still there.

HIStalk Announcements and Requests

inga_small Some nuggets you might have missed this week from HIStalk Practice: former Medic and A4 CEO John McConnell shares insights on HIT startups, Meaningful Use, Allscripts, and more. Dr. Gregg discusses the data-drenched world of HIT and the need for tools to keep things simple. A glitch leads to the rejection of 450,000 Humana claims sent through the Availity clearinghouse. Is the direct primary care model just a new name for concierge medicine? My take on banning smart phone pics in doctors’ offices (hint: good luck with enforcement.) A physician seeks opinions on drchrono. ONC promotes device integration for ophthalmologists. What do these news bits, interview, and opinion pieces have in common? None can be found on HIStalk, meaning you best pop over to HIStalk Practice to ensure you remain in the know. While there, click on a sponsor ad or three and educate yourself on some cool offerings. And don’t forget to sign up for the e-mail updates. As always, thanks for reading.  

Listening: brand new from Slash, excellent guitar-heavy rip-it-up rock that’s loaded with licks reminiscent of the best of the 1970s and early 1980s: Deep Purple, AC/DC, Whitesnake, and of course Guns N’ Roses. Nobody’s making straight-ahead hard rock these days, especially the kind that sounds like a real band instead of one guy and a laptop. It doesn’t exactly break new ground, but it’s going to be killer at summer gigs like Rocklahoma this weekend. And I can’t help cheering for Black Sabbath, together on stage again (minus drummer Bill Ward over money issues) after a seven-year hiatus and Tony Iommi’s lymphoma, opening their Birmingham, UK show last week with 1971’s amazing Into the Void.

Dr. Rick is back from the NIST-ONC EMR usability meeting. I asked if anybody recognized him since I work in an anonymous vacuum and always wonder what that’s like. He said a few folks did, including Farzad Mostashari. Rick will be providing a meeting recap after he gets caught up on his ophthalmology work.

On Healthcare IT Jobs: Application Analyst II, Assistant Director IT-Medicine, Hospital Software Analyst II, System Architect, Cerner Testing Project Manager.

5-24-2012 7-33-33 PM

Welcome to new HIStalk Platinum Sponsor Clinithink. Healthcare solution vendors use the company’s cloud-based CLiX natural language processing engine to turn free text medical notes into fully coded structured data (ICD-9, ICD-10, SNOMED CT) that payers, providers, and analytics companies can use to improve quality, increase revenue, and meet reporting and regulatory requirements. Structured data entry via check boxes and drop-downs makes like easier for the computer, but the richness of the patient encounter is often locked away in the detailed narrative of those providing the care. CLiX converts that data to information for everything from capturing Meaningful Use measurements to providing doctors with smart search capability for research that understands “bronchial hyperreactivity” as being related to “asthma.” Thanks to Clinithink for supporting HIStalk.

Here’s an overview I found of Clinithink’s CLiX on YouTube. It shows the user’s narrative popping up SNOMED CT codes.

Acquisitions, Funding, Business, and Stock

5-24-2012 10-23-35 PM

Kony Solutions closes on a $15 million third round of funding, led by Insight Venture Partners.

5-24-2012 10-24-12 PM

Healthcare payment network InstaMed secures $14 million in new capital.

5-24-2012 10-25-05 PM

Shares of Scotland-based charge master systems vendor Craneware drop by 15% after analysts speculate that its US customers might be chasing Meaningful Use money rather than buying its financial software, at least until next year. The company indicated in January that the situation was exactly that, but predicted a quick reversal of the trend. Other analysts agree with that earlier assessment, saying demand is already recovering.

5-24-2012 10-25-40 PM

Compuware reports Q4 numbers: revenue up 21%, EPS $0.12 vs. $0.16. Its Covisint subsidiary, which offers HIE and cloud-based services for healthcare, had annual revenue of $74 million, up 34%.

5-24-2012 10-26-54 PM

Nashville Medical Trade Center signs its biggest tenant so far, the RFID in Healthcare Consortium trade group. It will use part of its 80,000 square feet for The Intelligent Hospital, the hospital replica you saw in the downstairs exhibit hall at HIMSS in Las Vegas earlier this year (it was doing big business each time I checked). HIMSS will have 25,000 square feet in the building, which has 1.5 million square feet.

5-24-2012 9-41-22 PM

University of Maryland spins off Analytical Informatics, Inc., which will offer radiology dashboards and eventually expand into BI and quality tools that cross systems. 

Philips shares drop after its CEO warns that the European debt crisis may hurt imaging sales there.


5-24-2012 10-28-21 PM

Kosair Children’s Hospital (KY) selects Amcom Software’s clinical alerting middleware and smart phone communication solutions, planning to integrate it with their GE Healthcare Telligence nurse call system, GetWellNetwork interactive patient care system, and Cisco wireless IP phones and smart phones.

Omnicell closes on its previously announced acquisition of MTS Medication Technologies, a provider of medication adherence packaging systems.

Tri-State Gastroenterology Associates (KY) selects eMerge | ENDOTM for procedure documentation and workflow for its endoscopy center.

Lakeland Healthcare Group (IL) selects Merge Healthcare’s complete radiology cloud solution.

5-24-2012 10-29-37 PM

Indiana Orthopaedic Hospital selects the anesthesia information management system from Surgical Information Systems.


5-24-2012 5-43-53 PM

Former WellPoint VP Ryan Miller joins Availity as SVP of strategy and corporate development.

5-24-2012 9-15-32 PM

Todd Helmink (Allscripts) has joined The LDM Group as VP of strategic partnerships.

Greater Houston Healthconnect, a regional health information network, names Philip Beckett PhD (Baylor College of Medicine, RosettaMed) as CTO.

Announcements and Implementations

The US Olympic Committee announces that GE’s continued sponsorship will include the use of Centricity to manage the care of the 700 athletes participating in the London 2012 Olympic Games.

Iatric Systems and Order Optimizer announce the availability of an evidenced-based order set platform for Meditech Magic using Iatric Systems’ OrderEase solution.

MED3OOO announces the general availability of InteGreat EHR V6.5, which includes Quippe technology from Medicomp Systems.

RelayHealth and Greenway Medical complete a development agreement to exchange data between hospitals and ambulatory clinics.

5-24-2012 10-01-00 PM

Healthwise wins a Center for Plain Language award for its course on coronary artery disease. The non-profit company’s course combines easily understood content that is personalized by user type (recent coronary event, someone whose symptoms have subsided, etc.) Healthwise has previously won similar awards for its arthritis and low back pain materials.

Government and Politics

Representatives Michael Burgess MD (R-TX) and Gene Green (D-TX) introduce legislation that would require states to require hospitals to disclose information on charges for certain inpatient and outpatient services and to require insurance companies to provide enrollees a statement of estimated out-of-pocket costs for healthcare services.

5-24-2012 8-50-20 PM

US CTO Todd Park, writing on The White House Blog, announces the Presidential Innovation Fellows program. He’s looking for 15 innovators to spend 6-12 months in DC starting in July to work on one of five projects:

  • Open Data Initiatives (entrepreneurial use of government data for societal benefit, including but not limited to healthcare)
  • Blue Button for America (consumer downloading of their own health information)
  • MyGov (access to government information)
  • RFP-EZ (development of a platform to make it easier for the government to buy technology from startups)
  • The 20% Campaign (move US aid payments from cash to electronic payments)

Innovation and Research

5-24-2012 7-28-55 PM

Three students at a Ugandan university win a prize for their smart phone-powered fetal monitoring system, which analyzes fetal sounds and produces a plain-English description that midwives and birth attendants can understand. The device costs at least 80% less than an ultrasound machine.

A study finds that OptumRX’s text message prescription reminder program improved medication adherence, with 85% of patients taking their at-home oral meds correctly vs. 77% without the reminders.


5-24-2012 9-30-25 PM

Cerner is looking pretty smart for buying up 65,000 IP addresses from bankrupt Borders for $12 each. The IPv6 kickoff is in a couple of weeks, but the transition is expected to take up to 10 years, meaning Cerner hedged its bets in being able to run in dual stack mode with the additional old addresses.


5-24-2012 6-55-36 PM

The main Delaware newspaper covers the Delaware Health Information Network, which it says has enrolled 92% of the state’s providers. The front page story’s key figure is Christiana Care Health System CIO and DHIN Chair Randy Gaboriault, who had a recent positive experience with the value of shared medical information during a heart attack scare. He says his mother was not as fortunate – she died a couple of months ago after being treated by an unconnected hospital that did not have her history available, which he is convinced led to her unfortunate outcome.

5-24-2012 10-31-35 PM

Fairview Health Services (MN) fires CEO Mark Eustis, presumably after being embarrassed by never-ending press caused by the heavy-handed patient debt collection tactics allegedly employed by Accretive Health, which he brought in. Of course he also could have been fired had Fairview lost a ton of money by not collecting aggressively enough, so there’s that fine line thing.

As already reported here thanks to a tip from reader Gran Cru, Partners HealthCare (MA) takes a $110 million write-down on its soon-to-be dumped Siemens financial system, dropping its Q2 net income to $5 million vs. last year’s $71 million. As also reported here, bringing in Epic will cost another $600-700 million.

5-24-2012 5-59-05 PM

A scrub nurse at a Washington urology practice sues Robert Weissman MD, claiming that he threw an intra-operative tantrum that included cursing at her, throwing instruments, and finally intentionally stabbing her in the finger with a needle that he had just withdrawn from a patient’s scrotum.

5-24-2012 8-57-20 PM

Weird News Andy finds this story to be weird and wonderful. A Baltimore area high school freshman develops a 3-cent paper sensor that can detect cancer by indicating high levels of a particular protein, making it cheap enough to use in routine screening. Over 200 researchers he asked to help him test his invention turned him down, but now he’s working with a Johns Hopkins researcher, he has won $75,000 in the Intel International Science Fair (above), he has patented his device, and a San Diego biotech firm has offered to help him perform the FDA-required clinical trials.

WNA also likes this spooky security camera video from the ED of St. John’s Mercy Hospital in Joplin, MO as it was being hit by a tornado a year ago.

Dr. Jayne wants to play Weird News Andy in finding this obituary of a “crazy woman” characterized by her family as “De Facto empress of the hell she lived in.” I almost ran out of fingers trying to tally her former / present, living/dead husbands, not to mention her “friends at the Lakeside Trailer Park.” The family also noted that among the folks who will miss her most are Anheuser-Busch, Philip Morris, and the Ohio State Lottery. Her loved ones concluded with some sound advice: “Everyone dies, but not everyone lives. Mom lived. She lived hard, but she lived full. So, ‘Don’t cry because it’s over….. Smile because it happened!’ Light your smoke and raise your glass and remember the last thing she said to you that made you laugh so hard you thought you were going to wet yourself; but this time don’t hold back. Because she never did. “

5-24-2012 10-33-51 PM

I was startled to see this pop up on my LinkedIn page.

The executor of the estate of a 102-year-old heiress says everybody robbed her blind before she died, convincing her to give them extravagant gifts. Her daytime nurse got $31 million, the night nurse was given $1.1 million, her two doctors got $3.1 million, and Beth Israel Medical Center got a $6 million Manet painting for allowing her to live in the hospital for years even though she was healthy. Her attorney says she gave the gifts because she was generous (and he got only $60,000).

Sponsor Updates

  • Practice Fusion announces the availability of customizable endocrinology templates.
  • Cooper Green Mercy Hospital (AL) goes live on Stockell’s InsightCS Revenue Cycle Inofrmation Management system, including patient access and patient accounting.
  • TELUS Health Solutions and Orange partner to develop remote monitoring solutions for chronic disease patients.
  • Allscripts releases a white paper by CMOs Doug Gentile MD and Toby Samos MD that explores insights from ACO pioneers.
  • Lifepoint Informatics is sponsoring G2 Intelligence’s Laboratory Outreach Conference June 6-8 in Las Vegas.
  • The Advisory Board Company’s Crimson team will lead two breakout sessions at the 3rd Annual Health Datapalooza June 5-6 in Washington, DC.
  • CareTech Solutions announces that its clients Barnes-Jewish Hospital (MO), Touro Infirmary (LA), and Wheaton Franciscan Healthcare (WI) have won 2012 Aster Awards for their websites.

EPtalk by Dr. Jayne


Is it easier to focus when viewing content on an iPad vs. a television? Maybe. Pediatric neuroscience researchers note that while children will look away from a TV screen 150 times per hour, they are less likely to look away from an iPad. This is felt largely to be because of the touch interface being directly aligned with the action on the screen. This could help children learn more effectively, although scientific studies of how devices affect child development can take three to five years. The iPad’s relatively short time on the market in effect makes all of us (not only children) guinea pigs.

Seasoned IT staffers sometimes comment to me that new physicians seem like they’re getting younger. Recent actions to shorten medical school may make this more of a reality. Citing the nationwide shortage of primary physicians as well as increasing student debt, schools are compressing primary care training. Those who have already decided to pursue careers in primary care will experience fewer vacations and elective courses. Schools are also offering accelerated programs for certified physician assistants who want to pursue medical degrees.


With smart phones being everywhere, practices are considering asking patients to refrain from taking pictures while receiving care. Although providers are mandated to maintain privacy, patients are not. I was reminded of this a couple of years ago while riding on my hospital’s float in a community parade. A patient stepped out from the crowd and called up to a surgeon riding next to me, “Hey doc – my husband’s hemorrhoids are much better!” (And yes, those are cow-print balloons.)


One of the challenges of being a medical informaticist is doing the right thing with data. The recent USPSTF recommendation against routine PSA-based prostate screening is an interesting case study in data-driven clinical decision making. Numerous consumer groups are coming out against it, much like they did with revised mammogram recommendations in 2009.

Several readers responded to Monday’s Curbside Consult that discussed whether patients presenting to the emergency department should pay before being treated for their non-emergent condition. One reader notes,

One strategy implemented in a southwest US health system was to assess but not treat such patients. A triage nurse did the full assessment and scheduled them with a new PCP in the a.m. This reduced ED use by the patients over later months. They even had virtual staff to interview and set up the follow-up for smaller EDs. I think this was presented at the last CHIME meeting.

Isabel Healthcare releases a mobile version that offers Apple-using clinicians additional clinical decision support at the point of care. Subscriptions are available in weekly, monthly, and annual varieties, making it ideal for rotating medical students and occasional users. I’ve used Isabel (via EHR integration) for some time and it’s extremely valuable.


Florida State University researchers have created the Pacifier Activated Lullaby device, which musically reinforces premature newborns who must develop the ability to coordinate a suck / swallow / breathe response for feeding. The specially wired pacifier and speaker system plays a lullaby each time a baby completes a successful sucking motion and has resulted in shorter hospital stays and reduced costs. The FDA-approved device reduced neonatal ICU stays by an average of five days. It’s a cool an innovative device that I almost missed reading about – the sending address on the press release had University misspelled, making me think it was spam.



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

More news: HIStalk Practice, HIStalk Mobile.

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May 24, 2012 News 4 Comments

Dr. Sam 5/23/12

May 23, 2012 News 5 Comments

On the Other Side of the Quality Chasm

The acceleration of the movement toward electronic health record (EHR) implementation and adoption begun by the Institute of Medicine reports of the late 1990s and fueled by the American Reinvestment and Recovery Act of 2009 has propelled us away from the paper environment at a rate that would undoubtedly not have been present in their absence. It is now possible to conceive of a time when the majority of our healthcare institutions and professionals function entirely in an electronic environment.

Now that the other side of the quality chasm is in sight, it is worthwhile to consider what it may be like when we land there, and prepare for a vastly different environment.

A significant body of evidence has been building over the last decade reflecting medical errors that may occur because of electronic medical records. Examples include default acceptance of all orders in an order set when some may not be applicable to a specific patient, or an inaccurate weight entered manually for a newborn but used to automatically calculate medication doses. Any implementation should include attention to proactively averting such errors by responsible quality control processes.

The practice of medicine in real time and enhanced capabilities for granular auditing bring the considerable exposure to medical liability to the forefront. Standards of expectation should be established for reasonable response times to alerts, e-mails and data generated and delivered in real time. Clear policies, consistent with state law, should be established to define exactly what compromises a legal electronic medical record, what information must be produced in the event of litigation, and consideration of consistency in patient care considerations in implementing new features and functions. (Is a different level of care being delivered to a subsection of patients within a hospital if a new feature or function goes live on one service and not another?)

It will be very long time before most hospitals and practices cease to work in a part paper, part electronic environment, but the common goal is to eliminate as much paper as possible. It is therefore highly probable, if not certain, that a generation of clinicians will eventually evolve who have never worked on paper.

It is also certain that hospitals and practices will experience both planned and unplanned system down time. Downtime policies specify circumstances where documentation and order entry must revert to paper, but do not generally address the possibility that clinicians may not know how to work on paper. As part of disaster planning and down time policy determination, policies should be in place for clinicians to be trained at regular intervals in the use of order forms, progress notes, history and physical notes, medical administration forms, etc. that may be called to use in a disaster environment or system down time. After a few years using fully implemented EHRs, they may simply not know how to use paper.

Similarly, ward clerks, pharmacists, lab technicians, and other support personnel must know how to carry out their responsibilities on paper, and must periodically be retrained.

Paradoxically, we may have to be certifying people to work on paper in the future.

Several years ago, I began to consider the vulnerability of our massively growing medical databases. Even though security measures, redundancy, and backup processes are in place, much of the firewall technology is "off the shelf," which simply means to me that someone sitting in a distant country can find a way through it. Most hospital security and background checks on IT personnel consist of credit reports and other forms of superficial investigation, but are rarely in-depth security evaluations.

In spite of painful mass casualty attacks and natural disasters that we have experienced (the Oklahoma bombing, September 11, Hurricane Katrina), our emergency rooms remain woefully unprepared to handle a massive number of injured people or able to sustain care for a large population of injured individuals for anything other than a very short time. If one considers the potential chaos that could ensue from a combined mass casualty episode combined with an intentional attack on the same regions’ medical databases, the importance of this consideration becomes obvious. Organizations such as HITRUST are bringing the importance of protecting our databases to light. As we move further toward the universal use of EHRs, hospitals and database specialists will need to devote more time, energy and money to protecting our healthcare databases.

I have recently been an active participant in the debate over physician-patient communication by e-mail. The greater issue goes far beyond this particular debate. While the mechanics of physician-patient interactions may be brought into the 21st century by reduction to the 1s and 0s of the binary world, the art of medicine cannot be.

If one has ever engaged in online dating, cyber political debate, or an e-mail argument, they will appreciate that much is lost in the absence of face-to-face interaction. Things are said that would never be said when an immediate reaction can be anticipated with someone who is physically present in real time and not in an untouchable, invisible virtual space. In an electronic environment, as much attention needs to be paid to taking care of the emotions and reactions of patients as is paid to the convenience of the communication vehicle in use. This lesson must not be lost for the upcoming generation of texting / Facebooking / Twittering clinicians. Those of us with grey hair have a teaching responsibility in this arena

Let’s not cross a quality chasm and create an empathy chasm.

Samuel R. Bierstock, MD, BSEE is the founder and president of Champions in Healthcare, LLC, a strategic consulting firm specializing in clinical information system implementation and healthcare IT business strategies.

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May 23, 2012 News 5 Comments

Curbside Consult with Dr. Jayne 5/21/12

May 21, 2012 Dr. Jayne 3 Comments


Mr. H posted the results of a recent poll asking whether it’s OK to ask emergency department patients to pay before treating them for non-emergent problems. The vast majority of HIStalk readers responding thought it would be OK.

Since I’ve spent the better part of the last week working the ED, I have to say I agree. Normally I don’t work this many shifts, but the combined stresses of recent changes in our nursing ratios that resulted in some “blue flu” among the nursing staff seems to have inspired an unusual number of call-ins among the medical staff as well. (Either that, or my partners just want to get a jump on their summer vacations.)

Most of my shifts were on the lower acuity side of the ED, which suits me just fine. The full-time docs can handle all the gunshots, “fit for confinement” exams, strokes, heart attacks, and major trauma, thank you very much. I’m perfectly happy to handle fractures, asthma exacerbations, lacerations, and minor trauma. This week, however, we had a boom in patients who simply should not have been in the ED.

This was a bit of a bummer from an electronic documentation standpoint. Our recent upgrade brought us the ability to have condition-specific defaults, and I had spent a fair amount of time building out my personal templates for the conditions I typically see. I did not, however, spend any time building templates for problems that might be best handled at home with a wet paper towel and a nap. The highlight reel:

  • A teenager with an insect bite. His mother wrote a note giving permission for a neighbor to bring him in. He noticed the bite in the morning before school when it wasn’t bothering him at all, but mom decided at 10 p.m. that she wanted to know what kind of insect it was that bit him. Unfortunately, I am not an entomologist.
  • A high school senior with mild sunburn who wanted to know what she could put on it to make it go away before graduation (which was the next day.)
  • An adult male with a 0.5 cm lump on his arm that had been there for six months. That prompted him to arrive at 1 a.m. “just to get checked out,” although he couldn’t say why he was coming in NOW.

I’m pretty sure that if someone in the waiting room would have told them it would be a minimum of a two and a half hour wait and a $200 charge, these three musketeers (and the dozens like them) would probably have chosen to go home. I wish we could have a seasoned registered nurse stationed in the waiting room, administering simple first aid and counseling patients to follow up with a primary physician or a walk-in clinic in a day or two rather than using scarce ED resources. While I was dealing with them, we had an elderly woman with a complex fracture of her upper arm, several patients with lacerations, and a chap with a knee the size of a grapefruit that needed my attention.

Unfortunately, fallout from the Emergency Medical Treatment and Active Labor Act (EMTALA) makes it difficult for us to employ creative strategies to reserve the ED for appropriate use. Becoming law in 1986 as part of the COBRA legislation, EMTALA seemed like a good idea at the time. Although EMTALA was intended to ensure that patients presenting with emergent conditions were not turned away for inability to pay or other discriminatory reasons, the unintended consequence is a generalized fear of saying “no” to anyone who walks in the door.

The Code specifically defines an “emergency medical condition.” More than half of my patients this week failed to meet that standard, yet they had full visits anyway. We had to document each visit in detail, including a full review of systems, counseling on advance directives, nutritional screening, and more. (We also had to arrange transportation home for the mom who brought her daughter by ambulance for a splinter, but that’s another story entirely.)

I wasn’t in practice prior to 1986 so I can’t say what it was like, but I can’t imagine it was as chaotic and soul-sucking as it is now. I was, however, in the trenches when E&M Coding appeared on the scene, and I experienced first-hand the ridiculous make-work that ensued.

Looking at the track record for federal meddling in health care, it’s hard for me to think that the changes occurring as a result of Meaningful Use will turn out well in the long run. I may have Certified EHR Technology and full command of the Meaningful Use program. I can cite all the measures verbatim even after a couple of glasses of wine. I have more timely access to old charts (which are now actually legible) and better drug interaction checking, but other than that, the benefits still seem elusive.

How do you think we’ll feel in 25 years when we look back at Meaningful Use? E-mail me.


E-mail Dr. Jayne.

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May 21, 2012 Dr. Jayne 3 Comments

Time Capsule: Incompetence by Committee: How Customers Dumb Down Vendor Software

May 18, 2012 Time Capsule 2 Comments

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

I wrote this piece in May 2007.

Incompetence by Committee: How Customers Dumb Down Vendor Software
By Mr. HIStalk


We software customers often complain that our vendors lack vision. Maybe so, but what goes unsaid is that we ourselves are largely responsible.

Many or most vendors do their best work before their second customer comes on board. Their bright and dedicated employees, along with perhaps a development site’s subject matter experts, work from a blank slate and do some really innovative work.

Once customers sign up, however, the once-fresh product is dumbed down. Every new customer has their list of must-have enhancements, almost entirely (a) a smorgasbord of unrelated bells and whistles they saw in some other vendor’s demo; or (b) a feature of questionable necessity that exists only in the product they’re replacing. Consider the irony in either case.

That’s why software turns into a crazy quilt of unrelated and immature ideas. Too many customers come up with lame ideas that vendors are scared to ignore.

Customers, you see, are terrible visionaries. They always have a punch list of minor productivity tweaks and site-specific changes that move the product sideways at best. Vendors who ignore these suggestions, often with good reason, are considered unresponsive.

No wonder quality assurance, product documentation, and integration are so bad in healthcare software. Applications aren’t an integrated software platform with a clear focus – they’re a collection of unrelated product features and emergency tweaks held loosely together with the unreliable glue of a common user interface, customization switches, and a single database, all voted on by committees of self-interest.

Too many cooks in the kitchen indeed. We blame customers or poor training when only 20% of software capabilities are used. Maybe it’s because only 20% of a scattershot of functionality applies to a given site.

The enhancement process encourages this. A bunch of customers – heavily overweighted by those from big hospitals with travel money – sit in a room and vote on enhancement ideas. What’s wrong with that democratic approach?

  • The larger the committee, the less likely anything bold or innovative will result.
  • The voting process ensures that only safe, universally acceptable enhancements will be chosen. Products that were created through risk-taking and creativity get watered down by dull, uninspired changes that neither enrage nor delight anyone.
  • Small, obviously beneficial changes never get done. Why waste your user vote on something less than a sweeping change that no one else wants?
  • Customers have no idea what they want or need. They’re also unwilling to expend any more effort than to toss out off-the-wall suggestions.
  • Customers will provide crudely drawn screen mockups (users think only in terms of screens). They don’t employee critical thinking skills until the enhancement arrives on their doorsteps, at which time they suddenly get engaged and loudly proclaim its imperfection and refuse to use it.

Ample evidence exists that hospitals have few original thoughts and little ability to think strategically. Putting hospital staff in charge of product design and strategic direction is a bad idea.

Once a product has evolved into a Frankenstein-like set of unrelated product appendages, testing and integration get geometrically more difficult. A great niche product with a fanatically loyal customer base becomes an unwieldy fibrillation of disjointed ideas with an indifferent audience and mediocre KLAS scores (sound like anybody you know?)

Vendors don’t help. Is the intended product audience a 50-bed rural hospital, a 1000-bed academic medical center, or an IDN with a big ambulatory business? "Yes!! We want a product that is universally cherished and appreciated." Fat chance.

I see nothing to challenge the basic premise that innovation will come only from small, cheeky vendors willing to break the rules and provide leadership, not contract programming to customer specs. At the other end of the product life cycle is the elephant graveyard, those publicly traded vendors and multi-industry conglomerates where once-interesting products go to die slowly and painfully.

What happens in between is up to us customers.

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May 18, 2012 Time Capsule 2 Comments

News 5/16/12

May 15, 2012 News 5 Comments

Top News

5-15-2012 7-53-49 PM

Accretive Health sends a detailed response to Senator Al Franken, who is investigating the company’s hospital collection practices. The company says its primary purpose is to help patients by making sure they use the benefits to which they are entitled, also adding that the company follows HFMA guidelines, including making it clear that services won’t be withheld for financial reasons. Accretive says it complies with all federal laws, including HIPAA, and that all but one of its missing laptops was encrypted and that one was because a now-fired employee messed up. The company also hires a boatload of influential guns-for-hire former politicians to polish its tarnished reputation: former HHS Secretaries Mike Leavitt and Donna Shalala, former Senate majority leaders Tom Daschle and Bill Frist, and former CMS administrator Mark McClellan. Newt Gingrich on Line 1?

Reader Comments

From MT Hammer: “Re: Transcend Services (now Nuance). Medical transcriptionists file a class action lawsuit against the company for labor law violations.” The 13 named transcriptionists claim that Transcend violated federal labor laws by paying them per line of text transcribed or edited but not for related activities such as looking up information, thereby dropping their compensation below the $7.25 federal minimum wage. I’m surprised that Transcend hired them as work-from-home employees instead of independent contractors, but maybe the company provides more direction than would be expected for a contractor.

5-15-2012 7-06-30 PM

From David Stock-Man: “Re: Quality Systems/NextGen. Anyone have thoughts on the company missing its numbers and shares getting crushed?” QSII announced preliminary Q4 results last Thursday, with expected revenue for the quarter of $107-111 million and EPS $0.24-0.27, blaming revenue recognition delays for missing expectations and issuing guidance down for the fiscal year. FY2013 guidance calls for revenue and earnings growth of up to 25%. Some folks on the stock message boards are crying foul, saying that pro traders were taking huge put positions in the shares right before the announcement, suggesting the possibility that word leaked out (without having any proof, of course.) Shares that were trading in the $45 range just a handful of weeks ago are down to $30. Above is a one-year graph of QSII (blue) and the Nasdaq (red). Shares have a long track record of steady growth, are now priced relatively cheaply, and the company’s margins are good, so if you’re feeling confident that this is just a bump in the road, you get to buy shares at a discount (and if you’re wrong, you get to lose even more money). All I know is that quite a few of the old-school EMR vendors seem to be failing to meet lofty expectations lately despite billions of taxpayer dollars being spent to help them sell product, so if not now, when?

HIStalk Announcements and Requests

Thanks very much to the 68 readers who donated to support the four young daughters of Epic analyst and long-time HIStalk reader Tim Dodson of Children’s Medical Center (TX), who passed away recently at 34. Including the three of us who matched $250 in contributions dollar for dollar, our total contribution was $5,495, which I’ve deposited to the fund set up by Tim’s wife Wendy for the girls, flagging it with a note saying it came from Tim’s fellow HIStalk readers. I covered the credit card fees, so every dollar you donated went directly to support the children. Those of us who chipped in know that it could have been us who died young and unexpectedly, leaving a family deprived of not only their loved one, but of their primary breadwinner as well. You did good.

Acquisitions, Funding, Business, and Stock

5-15-2012 8-48-22 PM

The Trizetto Group announces that its subsidiary Gateway EDI has acquired NHXS, a provider of contract compliance and point-of-service adjudication workflow automation. Gateway will incorporate NHXS’s capabilities into its EDI and RCM offerings.

Wolters Kluwer sells its prescription data business to PE firm Symphony Technology Group.

5-15-2012 8-20-04 PM

Simplee, which offers free online medical expense management tools for consumers, raises $6 million in a Series A funding round.


Unity Health System (NY) selects Phytel’s Atmosphere platform as part of its infrastructure for population health management.

Cape Cod Healthcare (MA) chooses Courion Suite for user access management for its Siemens Soarian system, scheduled for a December go-live.

5-15-2012 7-28-46 PM

Stewart Webster Hospital (GA), a 25-bed critical access hospital, selects the ONE EHR from RazorInsights.

The State of Arizona contracts with Mosaica Partners for consulting help in updating strategic and operations plans for the state’s HIE.

5-15-2012 7-29-39 PM

Orange Coast Memorial Medical Center (CA) selects PerfectServe’s clinical communication platform.

Hartford Hospital (CT) will deploy OTTR’s transplant system, including the recently announced OTTRvad module for ventricular assist device patients.

Norton Sound Health Corporation (AK) will deploy ambulatory and inpatient solutions from NextGen.

5-15-2012 7-32-13 PM

Chesapeake Regional Medical Center (VA) contracts with ICA Informatics to develop an HIE for its integrated delivery network.

Boston Medical Center (MA) signs a five-year license agreement with Streamline Health for use of its business intelligence and analytics solutions in 19 physician group practices, while Bronx-Lebanon Hospital Center (NY) extends its licensing agreement with Streamline Health for five years.

North Texas Accountable Healthcare Partnership (TX) selects Orion Health’s HIE solution to connect its 12,000 physicians.

Advocate Health Care (IL) selects Merge Healthcare’s cardiac imaging and informatics solution. Merge also announces that 12 radiology and orthopaedic practices have selected its EHR products.

Aetna selects Kony Solutions’ KonyOne Platform for its mobile health app.


5-15-2012 6-05-47 PM

The Massachusetts eHealth Institute names Laurance Stuntz (NaviNet, CSC Healthcare) as director.

5-15-2012 6-07-26 PM

e-MDs hires former CO-REC director Robyn Leone as director of public policy and government initiatives.

5-15-2012 6-08-50 PM

M*Modal brings on Kathryn Twiddy (Quintiles, Misys) as chief legal officer.

5-15-2012 6-09-38 PM

Blair Butterfield (GE Healthcare IT) joins VitalHealth Software as president of its North American division.

Announcements and Implementations

5-15-2012 8-38-16 PM

Rockford Memorial Hospital (IL) goes live next spring on the health system’s $40 million Epic system. Rockford’s physician group has been live since last year.


SoutheastHEALTH and Missouri Delta Medical Center join forces to build and manage a $3.5 million networking and data storage center for their organizations and other medical providers. Both hospitals will also install a $12 million Siemens Soarian system over the next year.

5-15-2012 8-39-34 PM

Austin Diagnostic Clinic (TX) goes lives on PatientKeeper Charge Capture for its 120 physicians.

Aetna Pharmacy Management offers its members new services based on their prescription claims data: (a) switching to once-per-day meds when appropriate; (b) recommending trying a less expensive single component of a combination drug; (c) flagging prescription that have been taken longer than recommended; (d) sending prescribers a letter for daily doses that exceed that listed in product labeling; and (e) identifying cases where a new prescription may indicate that a previous one caused side effects.

5-15-2012 8-15-40 PM

Medical billing and financial management vendor Fi-Med Management says it will expand its services and add 145 new jobs in the Milwaukee area. It says its new software can help hospitals identify over- and under-charging and avoid audits.


Allscripts will train and hire 40 City College of Chicago graduates, whose salaries will be paid by the City of Chicago for their first six months.

5-15-2012 7-35-18 PM

Cerner customer The Hospital de Denia achieves HIMSS Analytics Europe Stage 7, the first Spanish hospital and the second in Europe to do so.

A Northwestern Memorial Hospital (IL) employee is charged with identity theft after a police search of her home, triggered by her use of several credit cards to pay her water bill, uncovers the credit card numbers, birth dates, and Social Security numbers of more than 50 patients.

inga_small Last weekend I had the chance to snuggle with a relative’s new baby, which reminded me of this recent article. Laptop magazine compiled a list of 15 current technologies that newborns will never see, including wired home Internet, Windowed operating systems, hard drives, the mouse, desktop computers, and fax machines. If I had written the article, I would have put an asterisk by a few of them (desktops, fax machines) and added, “Not applicable to healthcare because providers are resistant to change.”

Sponsor Updates

5-15-2012 6-33-12 PM


  • Surgical Information Systems recognizes five hospital systems with 2012 SIS Perioperative Leadership Awards, among them Holy Spirit Hospital (PA – above.)
  • Certify Data Systems ranks as a tier one enterprise HIE vendor in the Chilmark 2012 HIE Market Report.
  • CynergisTek expands its portfolio of offerings to include the HIPAA Surveyor Solution Series and the HIPAA Audit Readiness Solution Portfolio.
  • AHA Solutions and GetWellNetwork host a Webinar featuring Texas Children’s Hospital and its interactive patient care RFP process.
  • PatientKeeper awards Ashe Memorial Hospital (NC) its customer innovation award.
  • EHRConsultant’s AIMSConsultant division provides advice on choosing the right anesthesia information management system.
  • Informatica releases its Informatica 9.5 platform, designed to maximize customers’ return on big data.
  • BridgeHead Software will sponsor The Big Event social gathering at the 2012 MUSE International Conference May 29-June 1.
  • Computerworld honors Lehigh Valley Network (PA) with its 2012 Laureate award and NASCAR Teamwork award for its innovative use of DigitalShare, T-System’s ED patient documentation system that’s based on Shareable Ink technology.
  • Barrington Orthopedic Specialists (IL) selects NextGen’s EHR, PM, portal, and other solutions for its 15-physician practice.
  • College Park Family Care Center (KS) selects eClinicalWorks EHR for its 91 providers.
  • Emerson Hospital (MA) integrates Access Intelligent Forms Suite with its Meditech Magic system.
  • Kareo upgrades its billing system clients to a new release, which includes enhanced claim scrubbing capabilities.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 15, 2012 News 5 Comments

Curbside Consult with Dr. Jayne 5/14/12

May 14, 2012 Dr. Jayne 3 Comments


Over the last several months, there have been quite a few articles and studies about the growing phenomenon of mobile device distraction. Smart phones, tablets, and other devices have become ubiquitous. It’s almost unusual to see a group dining in a restaurant without devices littering the table. I don’t need to mention the danger of distraction while driving or otherwise being on the street and using a mobile device.

I wasn’t surprised then to see four Tweets in the last 24 hours that addressed the issue. There’s quite a buzz around psychologist Larry Rosen’s book iDisorder: Understanding Our Obsession with Technology and Overcoming Its Hold On Us. Some of his ideas are pretty common sense, such as the recommendation that families should have dinners where technology is not allowed at the table. I do agree with his point that technology might be making us dumber – the “Google effect” may make us less able to remember facts when we know that they are at our fingertips through search engines. His acronym for wireless mobile device (WMD) is accurate when you consider its other meaning: weapon of mass destruction.

Maybe having been required to be accessible 24×7 during my medical school and residency years jaded me, but until the last year or two, I had never been one of those people to compulsively carry my cell phone. Even now I don’t always answer it. Definitely not during a meal or a social event unless I’m on call or waiting for a specific return call.

The advent of the smart phone has made it easier to be in touch, though. I find texting or e-mailing to be less disruptive than taking a phone call as long as it’s self limited. However, when you open your e-mail to send a quick note to your staff or a colleague, it’s awfully tempting to troll through your account(s) to see what else is in there, and down the rabbit hole you go.

Like any other dependency, some have an easier time returning to real-time socialization than others. Some also have a hard time switching from texting-based communication to the traditional written word. This becomes apparent when I work with young people who can barely write grammatically correct sentences, but can text like crazy. In addition, despite having vast social networks, many are isolated when it comes to the skill of face-to-face communication.

An opinion piece in The Wall Street Journal proposes that, “We ought to group these machines with alcohol and adult movies.” I’m not sure I disagree. I’ve had to conduct interventions with parents who can’t seem to understand that their 11-year-old children shouldn’t be playing with an iPhone while I’m trying to take the child’s history and perform a physical exam.

Often, the phone belongs to the child, not the parents. That still baffles me given the cost of a data plan. I’ve had to explain more than once that when parents complain that children are spending too much time on the phone or with video games, it’s the parents’ job to put limits on those items.

What do you do, though, when the offenders are adults? It doesn’t seem like we have collectively developed the skills to police ourselves. I can’t imagine using a Bluetooth phone to make personal calls while performing surgery or surfing the Internet while administering anesthesia. We know it happens, however. I’ve had physicians complain that the EHR makes it to difficult to complete their documentation, one of them as she sat doing holiday shopping on her phone.

Do we need to put device behavior clauses in our medical staff bylaws along with rules about documentation deadlines and appropriate interpersonal behavior? Should facilities create WMD-Free Zones to allow us to decompress? Or do we just throw up our hands in defeat?

Have a suggestion on the wide-open field of WMD etiquette? E-mail me. I’ll try to read it in between surfing the net for animal-print crystal phone cases and signing charts.


E-mail Dr. Jayne.

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May 14, 2012 Dr. Jayne 3 Comments

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