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December 4, 2012 News 19 Comments

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12-4-2012 9-55-58 PM

The Atlanta newspaper covers the case of an internist whose stolen identity was used to apply for a National Provider Identification number, then used to incorporate a fictitious Buckhead medical clinic using a UPS Store mail box as an address with “Olga Teplukhina” named as the clinic’s CEO. The paper then did its own investigation, finding 131 CMS-registered medical providers that used an Atlanta UPS Store as their practice location, resulting in OIG looking into at least two dozen of them. One UPS Store-based company was found to have billed Medicare for $1.2 million in fraudulent injections, but is still in business because companies that are barred from billing Medicare can still bill private insurance. Despite the fact that the newspaper created the list of 131 practices using minimal effort and desktop software, CMS says it doesn’t have the technology to recognize private mailboxes since they carry a regular street address. The article says CMS pays claims that it really should deny under existing regulations because it worries that legitimate provider mistakes would unduly delay payments. One doctor complained to CMS that his name was being used to bill Medicare fraudulently, but two years later, the phony provider still has an active NPI that uses the doctor’s name.

Reader Comments

From Diminutive Avian: “Re: Epic. Most people don’t know that Epic has one final implementation check. Judy has to personally give the go-ahead. If she doesn’t like what she sees, she tells the customer she’s pulling out and gives them their money back. That’s another reason why the company has only successful implementations. Unlike publicly traded vendors, Epic is more than willing to walk away if the client is botching the install and ignoring Epic’s recommendations.” I’ve been told that at least two big academic medical centers are in precisely this predicament as we speak. From what I’ve heard, Judy gives the client two choices: (a) agree to let Epic send in a SWAT team to take over the project, or (b) find themselves another vendor.

From BubbaLove: “Re: Duke University. Heard they’re being sued by Deloitte for breach of contract due to mismanagement of the Epic implementation.” Unverified. Perhaps HITEsq or another attorney reader can scour the legal databases and report back. UPDATE: two well-placed sources and one even better second-hand source contacted me to say there’s no truth to this rumor. I’ve also had no volunteers tell me they’ve turned up any legal documents. I’m concluding that the reader’s report report, which they admitted was second hand, is inaccurate –the Duke and Deloitte working relationship hasn’t changed as the project continues.

12-4-2012 7-18-57 PM

From Current Epic Employee: “Re: Epic’s employee ages. In the November staff meeting it was announced that Epic’s #2 Carl Dvorak has worked for Epic for 25 years. He showed a slide saying that 42 percent of the current employees weren’t born then — i.e. are under 25 — and 78 percent are under 31.” People get nervous at the idea of fresh graduates telling major medical centers how to run their business, but it seems to work and it’s brilliant on Epic’s part. You take new graduates whose career prospects are negligible, plant them in Wisconsin where there aren’t many other jobs, and pay them more than they would make otherwise but less than everybody else pays their more senior HIT people. You train them in skills with minimal value elsewhere, like MUMPS programming, and give them job perks that make them feel like they’re working for Google. The young folks don’t complain much, they don’t bring in all the bad habits they learned working for less successful vendors, and by following the formula they almost always get the job done. That makes Epic almost infinitely scalable unless Midwestern universities stop graduating liberal arts majors with high GPAs. Nobody seems to mind except the experienced people who Epic won’t hire.

From UKnowMe: “Re: IBM. Seems like several high-ranking healthcare people are getting very connected on LinkedIn lately. A sign of change to come?” I don’t know, but I think your observation has business merit for LinkedIn. They could sell the names of companies that have a large percentage of current employees updating their profiles (preparing to bail) or companies newly added to a lot of profiles (on a hiring binge).

From HC IT Advisor: “Re: AeroScout, recently acquired by Stanley Black and Decker. Has issued a cease and desist order to Centrak and will be filing a patent infringement suit. Apparently Centrak is using the patented CCA capability in their new WiFi tags.” Unverified. Calling HITEsq again, either that or I need to sign up for one of the lawsuit databases like PACER so I can look these up myself.

Acquisitions, Funding, Business, and Stock

Health analytics and research company Decision Resources Group acquires the UK-based Abacus, a health economics consulting firm.

12-4-2012 10-02-32 PM

Talent management software provider HealthcareSource acquires NetLearning, which makes learning management software for the healthcare industry.

12-4-2012 9-37-29 PM

Nuance acquires Accentus, an Ontario-based transcription, documenting imaging, and remote coding technology vendor.

An article in the San Antonio newspaper questions whether Gene Powell, chairman of the University of Texas Board of Regents and co-founder of AirStrip Technologies, should have disclosed that Vanguard Health Systems, which the board chose to launch a new $350 million children’s hospital in San Antonio, had a pending business deal with AirStrip at the time. Powell did not vote on the issue, did not recommend Vanguard, and was not legally required to make any disclosure since he owns no Vanguard stock and is not a Vanguard employee, so perhaps it was a slow news day.

The former Big Five accounting firm Arthur Andersen, driven out of business in 2002 for its role as Enron’s auditor, is ordered to pay an additional and final $9.5 million for its similar auditing involvement in the 1999 merger of McKesson and HBOC. Andersen agreed to pay $73 million to settle McKesson HBOC-related class action claims in 2006, with the possibility of contingent payment claims.


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Children’s Hospital of Central California will implement athenaClinicals, athenaCollector, and athenaCommunicator across its 127-provider system.

Marietta Memorial Hospital (OH) extends its IT services contract with CareTech Solutions for an additional three years.

Twenty-one VA medical centers will implement GetWellNetwork’s interactive patient care solution, including the new Interactive Patient Whiteboard.

12-4-2012 12-26-37 PM

Memorial Health System (IL) purchases the Omni-Patient enterprise master data application and the WebFOCUS BI platform from Information Builders.

MemorialCare Health System (CA) renews and expands its relationship with MedAssets to include GPO services for supplies and purchased services and MedAssets Capital and Construction solutions.

12-4-2012 10-08-07 PM

Huntsman Cancer Institute at the University of Utah selects Wolters Kluwer Health’s ProVation MultiCaregiver EHR.

Contract resource organization NCGS selects Merge’s eClinical OS and clinical trial management solution.

Consulting firm AmpliPHY will provide Wellcentive’s data analytics platform to primary care practices.

Managed care company Amerigroup Corporation chooses McKesson Clear Coverage for point-of-care utilization management, coverage determination, and network compliance.

Michigan Health Information Network Shared Services signs with HIPAAT International for technology that allows patients to control the sharing of their PHI and allow them to view an audit log of who has viewed it.


12-4-2012 7-09-38 AM

Qualis Health hires David Chamberlain (Cardiac Science and Criticare Systems) as CIO.

12-4-2012 11-56-27 AM

Saint Francis Hospital and Medical Center (CT) names Sudeep Bansal, MD as the organization’s first CMIO. 

12-4-2012 7-49-18 PM

Todd Johnson, former president and CEO of Salar and SVP of Transcend Services/Nuance after Salar’s acquisition, is named CEO of HealthLoop.

12-4-2012 8-41-37 PM

Michael Waldrum, whose roles at the UAB Health System included a five-year stint as CIO through 2004, is named CEO of University of Arizona Health Network.

12-4-2012 9-43-44 PM

Charlie Baxter, AVP of Iatric Systems and former Army captain, died Friday at 48. The guest book is here.

Announcements and Implementations

Allscripts EHR customer Primary Physician Partners (CO) becomes the first practice to connects to the CORHIO.

The Indiana HIE says that more than 750 physicians and 174 practice sites have agreed to publicly post their clinical quality measure scores on the Quality Health First Program’s public reporting website.

12-4-2012 10-09-35 PM

Imprivata announces that more than 250 healthcare organizations enrolled in its Cortext HIPAA-compliant, pager-replacing text messaging solution its first 60 days of release. Pricing ranges from free (unlimited users, unlimited messaging, unlimited photo messages, standard support, 30 days’ archiving) to $5 per user per month (upgraded support and archiving).

Elsevier integrates its ExitCare library of discharge instructions and patient education with Meditech’s EHR.

ICSA Labs and IHE USA unveil a certification program to test and certify the security and interoperability of HIT, with three tiers of certification: conformance to IHE profiles, demonstrated interoperability among disparate systems, and validated implementations of deployed certified technologies. Participants in January’s 2013 NA Connectathon in Chicago can register for testing at the event.

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Montrue Technologies releases a free version of its Sparrow EDIS iPad-based emergency department information system. I interviewed Co-Founder and CEO Brian Phelps, MD earlier this year.

Government and Politics

12-4-2012 11-34-27 AM

Recovery auditors collected $2.2 billion in overpayments in fiscal year 2012 and gave providers $109 million in underpayments. Net 2012 corrections were $2.4 billion, compared to 2011’s $939 million.

Congressman Mike Honda (D-CA) introduces the Healthcare Innovation and Marketplace Technologies Act to foster more healthcare innovation through the development of marketplace incentives, challenge grants, and increased workforce retraining. The bill would also establish an Office of Wireless Health at the FDA.

Innovation and Research

A Microsoft Research documentary shows the organization’s work in using technology to fight tuberculosis in India, including development of a biometric monitoring system to make sure patients keep their healthcare appointments and systems that trigger an SMS message to a manager when a patient misses scheduled medication doses. Treatment is effective and straightforward, but requires more than 40 clinic visits in six months. Non-compliance causes TB spread, drug resistance, and nearly 1,000 deaths per day in India.

12-4-2012 8-49-58 PM

UCLA engineering school researchers create BigFoot, a software package that allows people with chronic foot problems to track their conditions using a PC and flatbed scanner.


Streamline Health, which acquired Atlanta-based Interpoint Partners a year ago, will move its corporate headquarters from Cincinnati to Atlanta. The company will continue to operate the Cincinnati and New York City offices.

12-4-2012 8-28-41 PM

Cerner analyst Staci Klinginsmith is crowned Miss Kansas USA.

University of Virginia Medical Center warns patients that a mobile device used by on-call IV pharmacists in its home health agency is missing and contains patient information, including diagnoses, medications, and Social Security numbers used as health insurance ID numbers.

HIMSS, responding to OIG’s recommendation that the bar for Meaningful Use payments should be raised via pre-payment reviews, improved EHR MU reporting, and improved EHR reporting certification, supports CMS developing guidelines that will help providers prepare and retain audit-related documentation. In other words, like CMS, HIMSS isn’t a fan of pre-payment reviews.

I’ve spent a considerable amount of money and energy on programming workarounds required to make HIStalk work on the incredibly buggy and standards-breaking Internet Explorer, but I’ve noticed its gradual improvement. I’m encouraged that Microsoft gets the lack of browser love it receives and can even poke fun at itself with a fun “it sucks less” video (above) and a new site, www.browseryoulovetohate.com. I’m checking it out in Firefox, of course, since I’m not that forgiving of IE’s past transgressions, but I may download the IE10 beta just to see what all the fuss is about.

A new JAMA article finds that the average dentist now out-earns the average physician, with pharmacists not too far behind.

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Lyle Berkowitz, MD (Northwestern University) and Chris McCarthy, MPH, MBA (Kaiser Permanente Innovation Consultancy) are editors of the newly published Innovation with Information Technologies in Healthcare. DrLyle says it tells the stories of 20 organizations who are HIT innovators in improving care quality and value, with details that he describes as “a big cookbook of recipes on how to innovate with HIT” divided into sections covering electronic medical records, telehealth, and advanced technology. I took a quick skim over a couple of the sample chapters he sent over and it’s meaty, without the usual fluff that makes some HIT books seem like a handful of good ideas and thoughts that were shamelessly padded to justify an author credit and a higher selling price. The book is $74.14 on Amazon and you can use the Look Inside! option to try before you buy.

A Colorado Public Radio article covers EMR adoption, showcasing a five-physician practice that expected its new EMR to increase patient capacity by 25% and get its bills out more quickly. That turned out to be wishful thinking on the salesperson’s part. They never got back up to more than 80 percent of their pre-EMR workload, they found that their Medicare patient volume was too low to qualify for incentive payments, one doctor quit over frustration with the EMR, and the remaining four partners were on the hook for the $200,000 they had borrowed to buy it. The end result: they had to sell their practice.

Use of mobile technology to view patient information and to access non-protected health information is on the rise, according to a HIMSS mobile technology survey. Key uses include collection of data at the bedside, bar code reading, monitoring data from medical devices, and capturing visual representation of patient data. Funding and security concerns are the top barriers to mobile technology adoption.

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Athenahealth’s Jonathan Bush channels Dr. Mostashari on Fox Business wearing a holiday-red bowtie and pitching healthcare technology.

12-4-2012 2-33-03 PM

A local paper shares the story of a clerical supervisor in a British Columbia hospital who was conducting training on the Vocera communication system when the device issued a Code Orange, warning of an impending flood. Clinical staff moved patients to safety just before a wall collapsed in a flood of water, while the supervisor scrambled to save paper charts and the hospital’s stockpile of 75 Vocera badges.

Weird News Andy is really fired up about use of the Liverpool Care Pathway for palliative care in the UK. An audit of records from 178 NHS hospitals finds that nearly half of the dying patients who had life-saving treatment (drugs, fluids, food) withdrawn via the protocol weren’t told that fact, 22 percent had no documented evidence that their care and comfort was maintained, and a third of the families didn’t receive literature explaining the process. A proposal is on the table to require consulting with the patient or family before initiating the pathway, which leads to patient death in an average of 29 hours.

WNA could contribute only a “sheesh” to this article, which finds that Dallas mothers and daughters are bonding over cosmetic surgery procedures, often motivated by reality TV shows that make that practice seem normal.

A former Microsoft manager takes advantage of newly legalized marijuana in Washington by opening a “premium marijuana” retail business, expressing his desire to position his brand of weed like fine brandy or cigars to high-income baby boomers. He says, “Think of us as the Neiman Marcus of marijuana … the buzz is in the air.” He says he came up with the plan while high and will name the business after his marijuana-farming great-grandfather.

12-4-2012 9-23-41 PM

In Brazil, an apparently computer-savvy thief robs an ATM by replacing its USB security camera with a Plug and Play keyboard and a USB stick, then restarts the machine and keys commands to withdraw all its cash. He was caught. The article mentions the recent discovery of several ATMs at Inova Fairfax Hospital (VA) that were rigged with “ATM skimmers” that fit over the card slot, capturing the card’s number and in some cases using video recording to capture the user’s PIN.

Sponsor Updates

12-4-2012 12-10-39 PM

  • Aspen Advisors hosted 62 associates at its annual retreat in Fort Lauderdale, which included a run fun that raised $1,000 for the University of Miami Health System.
  • Besler Consulting representatives will present at upcoming New Jersey and Metropolitan Philadelphia HFMA seminars.
  • Santa Rosa Consulting announces E2E Activation Support, a service line that will provide elbow-to-elbow EMR go-live support.
  • The Black Book Rankings names DrFirst the top vendor for e-prescribing and recognizes Emdeon for outstanding developments in clinical exchange solutions. Other HIStalk sponsors earning honors include Allscripts, e-MDs, Vitera, Aprima, SRS, Quest MedPlus Care 360, and McKesson.
  • A local paper profiles eClinicalWorks CEO Girish Kumar Navani and the success of his company.
  • AT&T names its top five healthcare trends for 2013, which emphasize growth in mobile apps and telehealth.
  • Sacred Heart Health Systems (FL/AL) shares how Iatric Systems’ Security Audit Manager has aided privacy compliance by capturing audit log data from its Siemens, McKesson, and Picis systems. 
  • Three Informatica customers win Ventana Research Leadership Awards, including HMS Holdings (IT Leadership Award for Analytics and Overall IT Leader); Moffitt Cancer Center (Business Technology Award for Big Data); and  Ochsner Health System (IT Leadership Award for Information Management.) Informatica’s PowerCenter Big Data Edition also won the Ventana Research Technology Innovation Award.
  • Mark Van Kooy, Myra Aubuchon, and Dawn Mitchell of Aspen Advisors present a December 5 Webinar on addressing EMR value with a hospital board.
  • 3M Health Information Systems offers a Webcast featuring 3M CMIO Sandeep Wadhwa’s presentation on improving ACO efficiency and outcomes.
  • Cumberland Consulting promotes Charles Taylor to principal and Jose Gonzalez to executive consultant.
  • The Advisory Board Company’s Southwind program recognizes Dignity Health (CA), Adirondack Region Medical Home Pilot (NY), and Lancaster General Health (PA) for successful physician partnerships.
  • Covisint releases a white paper that outlines the evolution, growth, and future of HIEs.
  • Beacon Partners employees assemble 108 care packages for troops during the company’s annual meeting.
  • Wellcentive’s VP of Product Strategy Mason Beard discusses interface strategies for population health management in a blog post. 


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

More news: HIStalk Practice, HIStalk Connect.

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December 4, 2012 News 19 Comments

Monday Morning Update 12/3/12

December 1, 2012 News 12 Comments

11-30-2012 6-26-29 PM 

From NoNamesPls: “Re: MD Anderson. They will replace not only their in-house developed EMR, but also commercial systems for pharmacy, lab, RIS/PACS, and ADT/Scheduling. Epic and Cerner are the frontrunners.” Another reader forwarded me the internal e-mail from the deputy CIO and the CMIO, which says MDACC spends $20-$30 million per year on its homegrown ClinicStation but still can’t keep up with federal regulations. The RFP goes out in January. It’s interesting that the e-mail suggests that they’re happy with the patient benefits of their existing system, but will spend hundreds of millions of dollars to replace it for non-patient reasons. Somehow you have to wonder if that’s really a good thing.

12-1-2012 7-59-39 AM

From Upon Further Review: “Re: three hospitals of Dignity Health (formerly CHW). Scrapping their Meditech 6.0 and Medhost implementation that was supposed to start going live last week and moving to Cerner. Go-live required by January 1, 2014.” Above is part of Friday’s letter sent to employees by Chuck Cova, president and CEO of Marian Regional Medical Center, which says, “We are not confident in the Medhost and Meditech system’s meaningful use and ability to perform at a high level for optimal use.” It went down to the wire: Medhost was to supposed to be brought live starting November 26, but the project was delayed on November 13 and then killed on November 30.

DZA MD replied to my Time Capsule editorial from 2008 in which I suggested that patient encounters be recorded on video now that multimedia storage is cheap (security cameras are running everywhere, after all, and your encounters with Las Vegas card dealers are recorded in multi-angle splendor). Here’s what DZA MD had to say:

Imagine how well behaved everyone would suddenly be! Patients and caregivers. Both are in need of civility IMHO.

Though certainly not the first, I proposed this solution to patient care documentation to interested academics at my institution  round the millennium. It was not taken seriously and was viscerally scary in a dot.gov sort of way, but the time has arrived. Some consequences (positive):

  • Documentation. Real-time video and audio. Obvious. Supplement with dictated or keyed notes into the EMR, capturing decision-making and care coordination / consults. Even online research pertinent to the visit (can sarcoidosis cause GI symptoms?) could be incorporated into the record (browser history), supporting decision making and due diligence. These AVI files are completely portable without need for interface language.
  • Billing. How about simply paying an hourly rate for time spent, like lawyers? Time stamps on audio and video, post-visit data entry and online patient care research would serve as indisputable evidence of billable time.
  • Legal. ‘Nuff said. Patients who opt in to AV documentation assent to legal arbitration. And benefit from reduced insurance costs associated with this documentation product. Patients who opt out must use the traditional tort pathway, but are exposed to the added expense of that course of action.
  • Patient education and self care. An electronic copy (edited or not) of the visit can be provided to the patient. Presumably the interaction involves patient education elements from the clinician.
  • QA. NLP can sort through audio files for key words related to quality metrics. AV files can be used for clinician feedback for both physical exam skills as well as interpersonal behavioral skills.
  • Cost.  Memory is cheap. AVI files are portable, searchable, and easily indexed and archived. Insurers could develop pilot programs using this technology to study cost impacts in preparation for wide release if promising.

I hand-picked this week’s Spotify playlist with music sharing only one attribute: I like everything I included. On it: Pond, RPWL, The Killers, Band of Horses, Marina and the Diamonds, Turtle Giant, and a searing live version of “Little Wing” from Clapton/Winwood. Here’s a trivia throw-down: what movie (one of my favorites) opens with Tune #13 as buses drive by in the night? If you want to play along at home, I also created this empty playlist to which you can add your song du jour — I’ll listen to them and choose some for next week’s playlist (it’s like a clinical inbox for music referrals).

 11-30-2012 6-45-18 PM

Welcome to new HIStalk Platinum Sponsor Fujifilm, which offers the Synapse product line (RIS, PACS, 3D suite, virtualization, managed services, and teleradiology RIS). The Web-based Synapse radiology management solution provides hospitals and outpatient imaging facilities such capabilities as integrated dictation, a referring physician portal, electronic dashboards, mammography reporting, peer review that meets ACR guidelines, and critical result notification, all included at no extra cost. Users can craft their own workflows via built-in tools for instant messaging, automated e-mail notification, and digital forms creation. They can also use drawable consent forms, inventory tracking, and real-time eligibility checking. The RIS integrates with every PACS on the market, including of course Synapse PACS. It even includes teleradiology capabilities. You can choose Synapse RIS as a turnkey system that includes software, hardware, hosting, system management, upgrades, and optional disaster recovery services and off-site archiving. Customers pay by exam volume rather than per user or per site, which makes it affordable for facilities ranging from small imaging centers to multi-facility enterprises. Thanks to Fujifilm for supporting HIStalk.

Here’s an overview of Fujifilm’s Synapse RIS that I found on YouTube.

Thanks to the following sponsors, new and renewing, that have recently supported HIStalk, HIStalk Connect, and HIStalk Practice. Click a logo for more information. 

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 11-30-2012 6-00-37 PM

The vast majority of survey respondents believe that transcription is a commodity service differentiated primarily on price. New poll to your right: should the government require more upfront proof of attaining Meaningful Use before before sending payments?

Few people buy traditional software (i.e. PC programs in a box instead of apps in a Web store) these days, and those who do are rarely delighted. I’m happy to report an exception. I bought the just-released Dragon Naturally Speaking 12 and it’s amazing. The accuracy approaches 100 percent and it’s quite fast. I bought the premium version from Amazon for $126, which also includes the ability to transcribe pre-recorded dictation, sort of like Nuance’s eScription server-based speech recognition (the Home Version is only $50). You can speak at least three times faster than you can type, not to mention saving your wrists. I’ve used previous versions as well as the Windows 7 speech recognition and Siri and there’s no comparison. (Disclosure: Nuance is a sponsor and has offered me free copies several times, but I paid out of my own pocket so I wouldn’t feel bad about saying I hated DNS if that was the case). DNS 12 is one of the most amazing things I’ve ever seen run on a PC, although as critics always point out, you can’t use it with an EMR since that requires the more expensive medical version. But if you want to feel like Bill Shatner sprawling back in a chair on the Enterprise bridge and barking out orders for the computer to obey, you need it. It must be a miracle for people with handicaps who can’t use computers in traditional ways.

Scanadu, the 20-employee company whose tagline is “Sending your Smartphone to Med School,” announces that it will release three consumer tools by the end of 2013. The $150 Scanadu Scout is held to the temple and in less than 10 seconds, checks pulse, heart activity, temperature, and pulse oximetry and sends the results via Bluetooth to its smartphone app. Project ScanaFlo is a disposable cartridge that turns a smartphone into a urine analysis reader (pregnancy complications, gestational diabetes, kidney failure, or UTI). Project ScanaFlu is a saliva tester that detects cold symptoms by checking for strep, influenza, adenovirus,and RSV. Scanadu is best known for working on a tricorder-like health assessment device and these modules are the first components of it. Above is a Friday interview with the co-founder and CEO, who seems to be at a loss of how to explain medical principles to the sing-songy twenty-something interviewer who nods intently while saying “sort of “ and “you know” a lot while clearly not understanding most of what he’s saying.

It appears that Blackstone Group has become the frontrunner to acquire Allscripts, although the company is rumored to be holding out for more money than Blackstone thinks it’s worth. Shares dropped 11 percent Friday, having lost most of the gains that occurred after rumors of the company’s sale slipped out in late September. The other bidders were claimed to be Carlyle Group LP and TPG Capital Management LP. I don’t understand SEC rules, but this business of running newspaper stories quoting insiders about who’s making offers and at what price sure seems to open the door for cheating, like intentionally leaking out news that will move the share price up or down in a way that will benefit the leaker.

CareFusion announces that Children’s Hospitals and Clinics of Minnesota has gone live on wireless connectivity between its Alaris smart IV pumps and Cerner Millennium.

Health Management Associates warns investors that a “60 Minutes” report is expected to claim that the for-profit hospital operator’s contracted ED doctors were pressured to admit patients who didn’t need to be hospitalized. Both HMA and Community Health Systems have disclosed in SEC filings that several government agencies are following up on whistle-blower allegations by requesting admissions information. HMA says it thinks authorities want to know how more about its vendor-provided ED software and whether it was programmed to admit patients unnecessarily. Tenet Healthcare had accused competitor CHS in early 2011 of using ProMed Clinical Systems software to boost its admissions in a lawsuit, but a judge dismissed the claim. HMA is also a user of ProMed’s Web-based vEDIS software, which is ONC-ATCB certified. I seriously doubt that ProMed makes admission decisions that the ED docs can’t override, so if there’s a smoking gun, I’d expect to find it in internal e-mails, meeting minutes, or in interviews conducted with the actual ED docs.

12-1-2012 7-52-49 AM

Kansas Health Information Network becomes the first HIE to connect directly to the CDC’s BioSense outbreak tracker, allowing hospitals to quickly share information about threats and report them to CDC to investigate possible outbreaks.

Advanced Data Processing announces that it has fired an employee who admitted stealing data from an ambulance billing system it runs and selling it to a criminal group suspected of using the information to file fraudulent tax returns to collect refunds. The information came from Cape Fear Valley Hospital Health System (NC). The same scam has led to the arrest of three people in Florida, at least one of them an employee of Florida Hospital Tampa, who used hospital patient billing information to collect $1.5 million in IRS tax refunds.

Why can’t American healthcare strikers be this much fun? Public health workers in Spain protest government spending cuts and healthcare privatization by performing a flash mob dance outside La Paz Hospital in Madrid.

GE CEO Jeff Immelt says, “The next holy grail is about decision support and analytics.”

A rare Weird News Andy weekend update: in France, a man is awarded $250,000 in his lawsuit against GSK, maker of the Parkinson’s drug that he claims caused him to become addicted to gay sex and gambling. The suggestion that gay sex is a shameful addiction that requires compensation is kind of insulting, but apparently the jury bought it.

Bizarre: a pharmacist pleads guilty to planting mercury in areas of Albany Medical Center Hospital (NY) in the hopes that the ensuing panic would drive patients away. Police searching the home of the man, who was upset that the had hospital billed him for treatment, found child pornography, Nazi memorabilia, and a stockpile of guns and ammunition.

Also bizarre: a Washington veterinarian and aspiring EMT is charged with animal abuse after former employees claim he punched and choked animals under his care. He had already admitted to stealing and using drugs from his practice. The owner of one animal that was allegedly mistreated summarized, “Well, I wouldn’t want him to be my first responder. Golly.” The doctor’s Facebook blames disgruntled former employees and lawyers trying to change the state’s veterinary malpractice laws, which limit plaintiffs to recovering the “market value” of their animal with no pain and suffering award available for the lawyers to skim their 33 percent of.

Vince covers the fascinating HIS-tory of CPSI this time around, getting some help from Troy Rosser, SVP of sales there.


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

More news: HIStalk Practice, HIStalk Connect.

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December 1, 2012 News 12 Comments

News 11/30/12

November 29, 2012 News 7 Comments

Top News

11-29-2012 8-05-24 PM

The Office of the Inspector General finds that CMS has not implemented adequate safeguards to verify the accuracy self-reported EP and hospital data for the MU program. It also says that the audits CMS plans to conduct after the fact may not work, either. OIG recommends that CMS randomly select providers to provide supporting documentation for pre-payment; issue guidance detailing the types of documentation that providers should maintain to support compliance; and require certified EHRs to produce reports verifying the achievement of MU measures. Medicare hasn’t audited any of the $3.6 billion it’s paid out so far. Acting CMS administrator Marilyn Tavenner doesn’t like the idea of pre-payment review, saying it could “significantly delay payments to providers” and “impose an increased upfront burden on providers.”

Reader Comments

inga_small From Uncorked: “Re: MyWay switch. I’ve learned the upgrade that Allscripts is offering  its customers from MyWay to Pro does not include a detailed conversion of financial data, meaning users have to work the old balances in MyWay. Sounds painful.” The details on the MyWay to Pro upgrade are on the client-only section of the Allscripts Web site, so I can’t verify. However, since detailed conversion of financial data between disparate systems can be quite complicated and time consuming, maybe the balance forward option is actually the lesser of two pains.

11-29-2012 7-45-21 PM

From NoNamesPls: “Re: MD Anderson. To release an EMR RFP in January.” Unverified.

From Lucille Carmichael: “Re: Nuance. Planning to spin off Salar, which it acquired with its Transcend acquisition, possibly as early as Friday.” Unverified.

HIStalk Announcements and Requests

inga_small If your week has been anything like mine, you are still recovering from all your thankfulness last week. In case you missed any HIStalk Practice news, here are some highlights. ONC says the percentage of physicians e-prescribing on the Surescripts network through an EHR has jumped from seven percent in 2008 to 48 percent as of June 2012. Almost 10 percent of US residents now receive their healthcare through an ACO. The highest-rated EMRs in an AAFP-member survey are Praxis, Medent, Healthconnect, Amazing Charts, and SOAPware. Pediatricians lag other specialties in EHR adoption. Practice Wise’s Julie McGovern offers key points for selecting an EMR vendor. Dr. Gregg muses about corporate chaos and HIT. Thanks for reading.

On the Jobs Board: Marketing Programs Manager, Meditech Clinical Trainer, National Sales Director, Ambulatory Implementation and Deployment Managers — athenaclinicals.

Acquisitions, Funding, Business, and Stock

The mobile interactive health advice platform HealthTap acquires the health business of Avvo, including its directory and network of providers.

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Ginger.io, which analyzes sensor and patient-entered smartphone data to for the equivalent of a “check engine light” for patient populations, raises $6.5 million. The investor is Khosla Ventures, whose founding partner Vinod Khosla famously predicted several weeks ago that machines will replace 80 percent of doctors (some of his other investments include iPhone attachments for heart monitoring and diagnosing ear infections). Ginger.io is based on research conducted at the MIT Media Lab. The company acquired another startup, Pipette, earlier this year for its technology that claims to reduce hospital readmissions by reviewing patient-reported outcomes. Travis reported the acquisition on HIStalk Connect back in March, where he concluded,

Ginger is a company we are going to hear a lot more about in the coming years. They have a clear focus on learning about patient behavior and proactively trying to address potentially costly events. The main question will be how much money can Ginger make quickly from pharma research or how much money can it raise to sustain itself until the healthcare industry is ready to pay for services like this. Either way, this acquisition is good for mobile health startups and Rock Health.


Stormont-Vale Healthcare (KS) selects Hyland Software’s OnBase enterprise content management solution for integration with its Epic ambulatory EMR.

Yale-New Haven Hospital contracts with Mediware for its Transtem software for tracking the use of stem cell products in providing patient care.

OnFocus Healthcare adds 75 hospital clients of its OnFocus | epm software during the company’s fourth quarter.

11-29-2012 7-47-52 PM

Pomona Valley Hospital Medical Center (CA) selects Dell and Siemens Healthcare to provide diagnostic image archiving and sharing services.

BJC Healthcare (MO) expands its use of the Surgical Information Systems perioperative information system to Saint Louise Children’s Hospital and Barnes-Jewish West County Hospital.

11-29-2012 7-50-45 PM

Santa Clara Valley Health and Hospital (CA) awards CSI Healthcare a contract to support its Epic initiatives.

Beaufort Memorial Hospital selects the Medseek Empowered solution to expand its patient engagement initiatives.

St. Joseph Health System (TX) chooses GroupOne Health Source for EHR medical billing services.

Ophthalmic Consultants of Boston (MA) deploys MedAptus for professional charge capture in its office and ambulatory surgical center locations.


11-29-2012 1-30-21 PM

SPI Healthcare appoints Ken Christensen (Health PCP) SVP of operations.

11-29-2012 2-34-35 PM

CareTech Solutions names Robert M. Johnson (Palace Sports & Entertainment) CFO.

11-29-2012 6-29-52 PM

Joseph Kvedar, MD, director of the Center for Connected Health of Partners HealthCare,  signs on as a principal with Wellocracy, but will continue in his role at CCH. The new company will focus on personal activity trackers and motivation tools that integrate healthy activities into busy lifestyles, initially producing books. He’ll be joined by a self-help author, a personal trainer turned physician, and a media relations expert.

11-29-2012 6-45-31 PM

Bill Bria, MD (Shriners Hospital for Children) is named chief medical officer of business intelligence software vendor Dataskill.

11-29-2012 9-47-40 PM

Peter Henderson (PatientKeeper) joins social networking-based employee wellness vendor ShapeUp as COO.

Announcements and Implementations

Washington DC Mayor Vincent Gray announces the go-live of Direct Secure Messaging in the district using Orion Health’s technology platform.

RelayHealth announces that it will provide an open, vendor- and payer-neutral platform for patient identity management, patient consent management, and other technology services to enable a longitudinal patient record. The technology will allow providers to embed a cross-entity MPI into their native systems and enable patient identification across multiple systems.

11-29-2012 7-51-45 PM

Jennie Stuart Medical Center (KY) goes live on Ingenious Med’s Impower charge capture solution.

The Kansas HIN and ICA share patient data with the CDC’s Biosense public health tracking system.

Government and Politics

An opinion piece in The Wall Street Journal written by former US Senator George LeMiuex (R-FL) says the government is doing little to stop the estimated $100 billion per year that Medicare loses to waste, fraud, and abuse. He had proposed a credit card-like fraud prevention system that would stop questionable claims before they’re paid, but that’s the $77 million system developed by Northrop Grumman and Verizon that had stopped less than $8,000 in questionable payments in its first eight months. He concludes that the problem is “bureaucrats hiding in their own ineptitude.”

11-29-2012 3-09-34 PM 

CMS has paid more than 150,000 EPs and 3,238 hospitals $8.4 billion in MU incentives through the end of October.

CMS extends the Medicare MU attestation deadline for New York and New Jersey hospitals affected by Hurricane Sandy. Eligible hospitals must submit to CMS and extension application to extend the attestation deadline from November 30, 2012 to the spring of 2013.

11-29-2012 6-48-13 PM

HHS issues a guide for de-identifying patient data to meet HIPAA privacy rule requirements.


11-29-2012 8-44-55 PM

British troops in Afghanistan are using a portable 3D camera to assess battlefield injuries and send images around the world for second opinions.

Surgical Theater LLC sells its first 3D imaging surgical rehearsal platform. It generates statistical models from an individual patient’s scanned images, providing life-like feedback using flight simulator technology that allows the surgeon to practice the procedure hands on. The first customer is University Hospitals Case Medical Center (OH), which isn’t surprising since its co-originator is the chair of the hospital’s neurosurgery department and the product bears his name. FDA approval is pending. The co-founders are former members of the Israeli Air Force, with my reason for calling out that fact becoming more clear as you read further down the page.


The California Department of Public Health fines Prime Healthcare Services $95,000 after determining that Shasta Medical Center violated patient confidentiality when it shared a woman’s medical information with journalists and sent an e-mail about her treatment to several hundred hospital employees. The disclosures were made when the hospital was seeking to respond to a news story featuring the woman and the hospital’s alleged overbilling of Medicare.

11-29-2012 1-56-22 PM

Philips moves from last place to first place in KLAS’s review of the MRI market.

11-29-2012 2-58-34 PM

A survey finds that promoting EHRs and mobile health are a low priority for voters compared to other healthcare issues. When asked where federal healthcare spending should be cut, 50 percent of voters said payments to providers should be reduced, while 42 percent said the government should spend less on healthcare IT.

11-29-2012 8-18-21 PM

Leapfrog Group’s second round of hospital safety ratings show significant swings in the months since the original report after it changes its methodology and uses newer data, with 103 hospitals moving from a C to and A, two changing from A to D, and an overall 8 percent moving at least two grades. Ronald Reagan UCLA Medical Center earned an F grade along with 24 other hospitals, while Cleveland Clinic took home a D. Predictably, the high-profile hospitals with the bad grades denounced the methodology when stung by local press coverage of their embarrassing results, claiming they’ve improved vastly in the 1-3 years since the information was collected.

The Bureau of Labor Statistics predicts that IT positions in healthcare and social assistance will account for about 28 percent of all new jobs by 2020.

A New Zealand sleep expert blames mobile devices for a 50 percent jump in sleeping pill consumption by young people, saying, “People go to bed with their iPhones and iPads and expect to be able to then go straight to sleep, but realistically, you can’t do that. You really need to put these devices down about an hour before you go to bed.”

11-29-2012 7-52-48 PM

I was interested in the answer Kobi Margolin gave to my interview question about why Israel produces so many healthcare IT companies that sell products to the US. He suggested reading Start-Up Nation, which describes the business climate there. I plan to do so, but from the Amazon reader comments, some of the reasons that the country is so successful despite being constantly at war, surrounded by enemies, and devoid of natural resources are: (a) mandatory military service that encourages innovation and forges early social networks; (b) Jewish tradition; (c) open immigration that encourages brilliant innovators to come there; (d) a tradition of young people traveling all over the world due to the small size of the country; (e) government policies and culture that supports entrepreneurism and the questioning of authority; (f) a flat hierarchical society; (g) acceptance of failure in the quest for success; (h) early maturity and lack of belief that people shouldn’t start businesses without a lot of experience, emphasizing instead agile, problem-solving generalists; (i) mashing up technology with other disciplines in fresh ways; and (j) great universities. In other words, pretty much exactly opposite what we have in the US except for the great universities part. If you’ve read the book, feel free to chime in.

An article in The Wall Street Journal raises the question of the ownership of data created by implanted medical devices like defibrillators. It’s your body, but only the device manufacturer (and possibly your doctor, if you see one regularly) can see what it’s emitting. A Medtronic spokesperson says, “Our customers are physicians and hospitals” and says demand is low and patients couldn’t make sense of their data anyway, but then admits that the company is thinking about selling its patient data to health systems and insurance companies. Another senior Medtronic executive calls the information it collects “the currency of the future.” The company has created a data unit specifically charged with creating a business around selling patient data, working the loophole that only providers are covered by the 17-year-old HIPAA regulations, not device manufacturers. One patient paid $2,000 to take a technician’s class for reading the reports, but still has to pay his cardiologist for a visit to get the data.

Remedy Health Media launches a service that will send electronic newsletters to patients with specific conditions under the name of their doctor, who pays the company for use of its patient data management system. The company says health reform gave them the opportunity, while advertising drug companies give them their profit. It’s a double-opt in service due to comply with spam laws, meaning patients need to sign up and then click a link on a welcome e-mail indicating their interest to receive further e-mails. Some of the company’s brands include HealthCentral, The Body, RemedyMD, and My Refill.

Attendees of an auction at a bankrupt and closed Pennsylvania hospital claim to have seen unattended medical and employee records and computers up for bid that were displaying patient information. The bankruptcy trustee claims the medical records were in roped-off areas and the computers had been wiped clean, but a bidder says that’s not the case.

An excellent article in the Toronto newspaper questions whether e-health will ever deliver a return on investment in Canada. It calls out the massive spending on eHealth infrastructure, implying that it’s a desperate shot at addressing the question, “Could the elderly bankrupt Canada?” but points out that for all the investment, Canada is still well behind most of the industrial world, with 80 percent of its physicians still using “a fax machine running full blast against a ceiling-high backdrop of manila files.” It says that Canada’s efforts are looking a lot like those of the UK, where ambitious and expensive programs tanked with little to show for it other than billions of taxpayer pounds transferred to consultants and contractors. A former deputy health minister had an interesting thought: instead of buying EHRs for everybody, which he says will cost more than the healthcare services they consume, he suggests providing them only for seniors and people with chronic disease since 1 percent of Ontario patients have been found to consume 50 percent of hospital and nursing home costs.

Weird News Andy wonders if this is where we’re headed. In England, sick babies are being put on “death pathways,” with the rather lurid newspaper article quoting one doctor who admitted that he took part in “starving and dehydrating ten babies to death in the neonatal unit of one hospital alone.” A hospital nurse calls it “euthanasia by the back door.” An investigation will determine whether hospitals earned bonuses for hitting death pathway targets.

Sponsor Updates

11-29-2012 9-57-58 PM

  • Nuance gives the $73 (at Walmart) Philips Digital Voice Tracer dictation recorder its highest rating for recording and voice recognition accuracy with Dragon Naturally Speaking.
  • 3M announces details of its 2013 Client Experience Summit, set for April 2-4 in Tysons Corner, VA.
  • Liaison Healthcare announces that four out of five global pharmaceutical companies use its integration and data management services.
  • The Orlando paper spotlights Kony Solutions and its “cutting edge” app development.
  • Levi, Ray & Shoup publishes a case study highlighting the benefits that Memorial Hermann Healthcare (TX) realized simplifying output management.
  • SuccessEHS integrates the Midmark IQvitals device with its EHR.
  • BridgeHead Software releases a white paper highlighting the crucial concerns of image availability.
  • Besler Consulting offers a free comprehensive summary of the Hospital Outpatient Prospective Payment System final rule.
  • API Healthcare offers five tips for payroll success in hospital mergers and acquisitions.
  • Informatica introduces a global messaging routing capability for the Informatica Ultra Messaging environment.
  • The Tampa Bay Technology Forum honors MedHOK with the 2012 Emerging Technology Company of the Year Award.
  • Ingenious Med releases software upgrades for its Web and mobile solutions that include a Virtual Superbill to improve charge capture.
  • Health Language Inc. releases new terminology mapping to support providers and EHR vendors meeting Stage 2 MU requirements for SNOMED-encoded problem lists.
  • iSirona releases Software Makes Sense, a five-part video series detailing the specific configurations and their advantages used by iSirona’s hospital customers to sync medical devices and EHRs

EPtalk by Dr. Jayne

Friday is the last day for HIMSS 2013 Interoperability Showcase submissions. Demonstrations must include health information exchange between at least three healthcare organizations.

Friday is also the last day for Eligible Hospitals and Critical Access Hospitals to register and attest for incentive payments in fiscal year 2012. CMS has a tutorial on YouTube which, strangely, enough seems to have been filmed in front of a green screen that wasn’t replaced by graphics, rendering it nauseatingly distracting.

Finally, a data breach that doesn’t involve a lost laptop or stolen hard drive. A resident physician terminated from the University of Arkansas for Medical Sciences kept patient lists and notes after being terminated in 2010. The resident began to produce the records during a lawsuit against the residency program, leading to a court order to prevent further release.

Discussions at RSNA reveal mixed opinions about releasing radiology results directly to patients. I think many providers would prefer to release only annotated results to patients – those results to which the ordering physician has added comments that explain the clinical significance of the radiologist’s interpretation. There are a lot of vague terms used by some radiologists (clinical correlation recommended, questionable presence of something, etc.) and that leads to fear of patients misunderstanding, which leads to fear of being transparent with results. If health systems are going to release without annotation, maybe they should require radiologists to document results at the 5th grade reading level: “Your chest x-ray looks like the chest x-ray of every other person who lives in your part of the country. I don’t see anything that doesn’t belong there.”


For those whose providers have embraced transparency and are offering patient portals and other engagement platforms, the Family Caregivers Video Challenge offers a chance to tell how health information technology or eHealth tools have helped manage a loved one’s care. Video submissions are due by December 10 and prizes worth $8,350 are at stake.

My hospital has been lucky that this hasn’t happened to us (yet). A NYU staffer inadvertently sends an e-mail that allows a student to accidentally “Reply All” to nearly 40,000 of his classmates. Thousands of students jump on the bandwagon, creating what some termed the “replyallcalpyse.” It’s only a matter of time before it happens here.



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

More news: HIStalk Practice, HIStalk Mobile.

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November 29, 2012 News 7 Comments

HIStalk Interviews Kobi Margolin, Founder and CEO, Clinigence

November 28, 2012 Interviews No Comments

Jacob “Kobi” Margolin is founder and CEO of Clinigence of Atlanta, GA.

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Tell me about yourself and about the company.

I’m the CEO and founder Clinigence, my third venture in healthcare IT. I am semi-Americanized, an Israeli originally. In the mid-1990s after seven years in an intelligence branch of the Israeli Defense Forces with a group of colleagues that I met in the military, we started Algotec, a medical imaging company. With Algotec, I came to Atlanta in 1999 to start US operations. 

We sold the company to Kodak in 2004. I then joined a startup at Georgia Tech that focused on the Software-as-a-Service (SaaS) model in medical imaging.

At my first company, Algotec, we were pioneers of bridging web technologies into the PACS market. These were days when medical imaging went through the electronic revolution. Our technology was all about distributing clinical images across the enterprise and beyond. My second company, Nurostar Solutions, capitalized on this electronic revolution and the SaaS model to facilitate new business models for imaging services. In those days, teleradiology was exploding and we became the leading technology platform for these services.

In 2008, I started on a path that led me to Clinigence today. 2008 was an election year. In the days leading to that election, I looked at what was going on in the market and thought that there might be new opportunities opening up around electronic medical records. I had followed the EMR market since my first HIMSS in 1997 in San Diego. The market was advancing, as one of the analysts put it, at glacial speed. Then in 2008 or 2009, suddenly an explosion of funds was allocated for this market. I started thinking about what was coming next. Let’s assume that the market is already on electronic medical records. What impact is that going to have?

That led me to the concept of clinical business intelligence, which in essence is, how do we make sense of the data in electronic medical records from both the clinical and business or financial standpoint for the benefit of healthcare providers, for the benefit of medical practices and their patients? This is when we started Clinigence.

Officially started in 2010, we had our first beta in February 2011 and our first commercial installation in October 2011. Today we are in over 70 medical practices with about 400,000 patients on the platform, with two EMR companies as channel partners. We just signed our second partner a few weeks ago and our first ACO customer just a few days ago.


How do you position yourself in the market and who do you compete most closely with?

In the clinical analytics industry, we are unique in that we are entirely provider centric. We jumped into clinical analytics with the vision that everything is going to be inside clinical operations and everything is going to be electronic. We have created a technology foundation that uses electronic medical record data as its primary source.

If you look at clinical analytics, that is a multi-billion dollar industry. Pretty much all of that industry has focused on healthcare payers or health plans. The technologies are based on administrative or claims data. There are specific benefits ,we believe, in the use of EMR data as your primary source. The number one differentiator for us is in the use of EMR data, which allows us to do three things.

Number one, our reports are real time. We create a real-time feedback loop that takes the data from the provider system and goes back to the providers and helps them change the way they deliver care to their patients in more proactive ways.

Number two, our reports are very rich in outcomes. We all know that the ultimate goal of everything we’re doing in health reform today and healthcare transformation is patient outcomes. Yet a lot of the reports you look at today in the market don’t give you any outcomes in them, because the data that’s used to generate them is data for billing purposes that doesn’t include clinical outcomes.

Number three, because we focus on the system that comes from the healthcare provider organization itself, we give providers the ability to break the report all the way down to individual patients and individual clinical data elements. The reports are not anonymous for them. The reports are something that they can trust, something they can work with. With that, we have the power to change the behavior of providers and affect behavior change in their patients, which improves outcomes.


If a physician is receiving reports from your system, what kind of improvements might they suggest?

The reports from our system drive a process, the process of improvement. It’s like peeling layers of an onion. We focus today almost exclusively on primary care. When we go to a primary care practice, we first have the physicians look at how they document clinical encounters today. 

Oftentimes the outer layer of the onion is helping the practice or the individual physicians with their documentation practices — making sure that they’re documenting everything that needs to be documented. We often find that physicians say, “Oh, we do these things,” but when you look down at their report, it doesn’t show it. It turns out that they’re doing things, but they’re not always documenting them or not documenting them correctly.

Then the second layer is we help the practices compare their performance, the compliance of their staff, with medical guidelines, recommended care, and sometimes their own protocols within the organization or the practice. You go into a practice and you ask the doctors, “Do you follow these protocols?”

For example, in family medicine, diabetes is chronic disease number one. The recommended guidelines, recommended care protocols for diabetes are pretty well established. We know the things we need to do. You go in and ask the physicians and they always say, “Of course we follow medical guidelines. Of course we do all the things that we’re supposed to.”

Then you start breaking the data down to reports across the organization, across the staff within the practice. Almost inevitably you find that there are variations in care, differences among providers and their compliance with these protocols which lead to gaps in individual patient care. We help them find these variations in process compliance, close these gaps, and improve their compliance with those medical guidelines and protocols.

The deepest layer of the onion, which only a few of the practices we’re working with are at that level — certainly in the ACO market we think that there’s going to be more of that — is about going into the effectiveness of your protocols within the practice in driving outcomes and that goes both to patient outcomes and eventually to business or financial outcomes for the practice. In this context, we give the customer the power, essentially, to do things like comparative effectiveness, look at various protocols that they use and see which ones are driving the outcomes or the results that they want.


The ACO concept is new enough that I’m not sure anybody really understands how they’re going to operate. Does anybody know how to use the data that you’re providing to manage risk, specifically within an ACO model? Or is it just overall quality and that’s what ACO should encourage?

I think that the ACO market is indeed still a baby. OK, it’s a newborn. Everybody is at the beginning of a journey. Even some of the organizations that have been doing this for the longest, like the pioneer ACOs, are still in very early stages.

We are focusing in the ACO market on finding organizations that we think have the best shot of going through this journey and being successful in going through this journey. We come to them and offer them a partnership in the journey, where we become somewhat of a navigation system for them with the kind of reports I mentioned earlier. Then really all that our technology can do — empower them with those navigation tools to find the roads that lead to the holy grail of accountable care, to find the roads to the triple aim of health reform.

As I’ve said, we’ve just closed our first ACO customer, so it’s going to be presumptuous of me to say, “Yes, the answers are already there.” But with the three things that I mentioned earlier, specifically, primary care driven and physician-led ACOs have unique potential of identifying, figuring out the ways to get to that holy grail. We think that our technology is a critical piece that can help them and then accelerate them in their path towards that holy grail.


Describe the patient-centered medical home model and the data capabilities physicians need to operate under that.

In primary care, we are doing much more work on medical homes than ACOs because ACOs are still few and far between. There is great interest in the patient-centered medical home model.

The patient-centered medical home model in itself is only a care delivery model. It does not come with a payment model attached to it, but there are certain markets where payers actually offer incentives to those practices that go to the patient-centered medical home model.

To become a patient-centered medical home, there are specific areas that the practice needs to address. NCQA offers a certification process that has become the de facto standard in certification as a medical home. They don’t necessarily force you to have an electronic medical record, so you can potentially become a patient centered medical home even without one. But what we would say is, as you look at your goals in the patient-centered medical home — specifically goals around continuous quality improvement, goals around population health management — using electronic medical records becomes necessary, a prerequisite to your ability to engage seriously in those kinds of efforts. 

We typically come in with our technology after the practice implements or adopts electronic medical record technology and help them take the data in their electronic medical record and translate that into a clear path towards quality improvement.


Is it hard to get physicians to follow your recommendations?

Most physicians are independent. They don’t like to be told what to do. Before I started Clinigence, I looked at clinical decision support and decided not to jump into it, basically because I didn’t want to be in a position to tell physicians what to do. Instead, I selected clinical business intelligence. It was more around telling physicians how well they’re doing and how well their patients are doing. 

One of the unique aspects of what we’ve built is that we created a “declarative classification engine,” which in essence means that the physicians can ask the system whatever question they want about their operations, about their patients, about their quality. We give them flexibility to go around the medical guidelines that come from the outside sources, build their own protocols, and then look at compliance and look at their performance relative to the protocols that they have set up for themselves.

You have to be somewhat careful when you do that. If you’re looking for success under a specific pay-for-performance program, then you have to abide by whatever the payer or some outside authority has set for you, and it is not uncommon for us to have variations or flavors of the same guideline. One that measures performance for the outside reporting purpose, and then a second one or even a number of them that give the practice the ability to create their own flavor of protocols. 

Then it’s no longer somebody telling you – Big Brother telling you — what to do. You have the power to determine what to do. I think the ACO model — and to some degree, also the patient-centered medical home as a step towards the ACO model – puts the physicians within those ACOs in the driver’s seat. Nobody is telling them where to go or what road to try in order to drive the success of the ACO.

There are 33 quality metrics for an ACO that are defined by Medicare. We say, “Is this sufficient?” Clearly these metrics are necessary; you have to report on those to Medicare. But are these sufficient? Will these guarantee your success? 

It is clear to everybody in the ACO market that the answer is no. These may provide a starting point, but nothing more than that. You have to carve your own way to achieve the outcomes. We know what outcomes are desired, but as far as how to get there, much is still unknown. There’s great need for innovation in fact in the market to figure it out.


A number of Israel-based medical technology companies have come in to the U.S. market, a disproportionate number based on what you might expect. Why are companies from Israel so successful in succeeding here?

My personal story may be a bit of a reflection of the success story of Israeli medical technology. Israel has become a Silicon Valley, an incubator of technology. Israel has more technology companies on Nasdaq, I think, than all of Europe combined. A lot of it is around the medical field.

Why has Israel has become that? I can speak from my own personal experience. There’s a book called Start-up Nation that was written by Dan Senor that looked more generally at this same question. His thesis in the book is that the military in Israel is the real incubator, the real catalyst for innovation.

I can say from my experience it really was like that. In my first company, Algotec, we started fresh out of the military. We were a group of engineers in the military. We knew very little about healthcare, certainly not healthcare in the US.

What we knew — and what the military instilled in us — was the desire to do something, to innovate, to create something. Beyond the desire, also the confidence to think that at the early age and early in our careers as we were back then, that we could do something like that. We could go and make a difference like that. 

There’s a lot of that going on in the medical field. I joke around that every Jewish mother wants her kid to be a doctor. Certainly there’s a lot of that here in the States. When I was growing up, somehow I was never really attracted to that. I was more on the exact scientific side. For my undergrad, I chose math and physics. In grad school, medical physics for me was a way to bridge the gap, to fulfill at least a portion of the wishes of my mother.


Any concluding thoughts?

You asked me about the process that we go with practices and I said it’s like peeling layers of an onion. Today, mostly with our clients we focus with them on some of the outer layers. We help them comply with pay-for-performance or create a patient-centered medical home. 

But where I think all of this gets really exciting and interesting is when you start getting to the deeper layers. We took great efforts to build a platform that’s very flexible. The unique piece I mentioned earlier in this context was the declarative classification engine. We also built what we believe is the first commercial clinical data repository that’s based on semantic technologies. Now this may sound to some folks like technology mumbo jumbo, but what’s important here is the ability to get data — any type of data — and make sense of it, so the system can understand the data even if it has never seen data like that before.

We think that over time, as our healthcare system goes through this journey of figuring out how to deliver more effective and efficient care, we can with technologies like that drive or create a bridge in between medical practice and medical science or medical research. Imagine that all of medical research — pharmaceuticals that go to the market or new devices that go through clinical trials — where they test the devices on hundreds or thousands of patients. We are building a system that can collect data from many millions of patients. Already today we are collecting data on hundreds of thousands of patients every day in medical practices.

Imagine what kind of insights we can get out of the data that we’re collecting, and then how this can then accelerate medical knowledge. Not just in the context of the holy grail of accountable care – helping deliver care that’s more efficient and effective – but really advancing medical science, identifying new things, new treatment protocols that otherwise we would never know about or would take us generations potentially to find.

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November 28, 2012 Interviews No Comments

News 11/28/12

November 27, 2012 News 16 Comments

Top News

11-27-2012 1-34-54 PM

OIG includes “integrity and security of health information systems and data” as one of the top management challenges faced by HHS for 2013.

Reader Comments

11-27-2012 9-01-37 PM
From Image Is Everything: “Re: RSNA. As a vendor, some of us had to go to Chicago the Monday before Thanksgiving and work through the weekend. The trick was to take your spouse, since the Magnificent Mile had beautiful displays, shopping, tourists from around the world, and lots of nice people. The problem was Thanksgiving dinner – think the Chinese restaurant in ‘A Christmas Story.’” I accompanied Mrs. HIStalk to a Chicago conference a few weeks ago, the first time I’d been there since the wintry HIMSS conference of 2009. We had a pretty good time this trip – stayed at the Hyatt on the river, ate at semi-touristy places (XOCO, the Walnut Room, South Water Kitchen, and the Metropolitan Club in Willis Tower), bought Frango Mints, and tried to stay warm since the temperature dropped from the mid-70s the first day to the 40s the rest of the week, ruling out the architecture boat tour. I wouldn’t say Chicago is my favorite city (I think Seattle and San Diego probably top my list), but I at least liked it better than when snow and fellow HIMSS attendees were swirling around me.

11-27-2012 7-00-21 PM

From The PACS Designer: “Re: 3D printing. TPD has posted about 3D software solutions in the past, and now you’ll become aware of a retail 3D printer called MakerBot. This company reminds TPD of when Xerox was first to introduce a new way of high quality printing decades ago. MakerBot just opened the first 3D Photo Booth in NYC, its home base, and I’m sure when the photos are viewed, word will spread across the country quickly. Healthcare could benefit by employing this 3D solution to view images of the anatomy, especially the heart, by practitioners and patients undergoing treatment.” 

From Keystone: “Re: EMR. I’m involved with five practices being implemented and all are complaining that their efficiency is going backwards because of extra keyboarding. Do you think this is due to added documentation that they should have been doing all along, poor system design, or both? These are mostly primary care physicians and they are definitely seeing fewer patients per session. Also, do you know of bolt-on products to support dictation or other simpler input tools?” Readers, I’m sure Keystone would welcome your comments, which you can add at the end of this post.

From Cloud Dancer: “Re: PACS. Your blog is incredible! Was wondering about your coverage of cloud imaging solutions like Merge as well as other trends in PACS going cloud.” One thing I excel at is recognizing my innumerable limitations, among them being paucity of in-depth knowledge about imaging and lack of time to learn since I’m a full-time hospital employee. I could use an expert contributor if anyone is interested in taking HIStalk a bit deeper into that area. The other areas that people seem to want more coverage about include HIT-impacting federal policy activity, patient-centered technologies, and startups and other innovation. You might think it would be easy to find and engage experts to contribute to HIStalk, but it’s not – they’re either too busy or not all that interested in writing regularly since it’s harder than it looks.

HIStalk Announcements and Requests

11-27-2012 8-50-43 AM

inga_small I am back from my Thanksgiving break, which included a bit of holiday shopping. I was remarkably restrained in my purchasing, though I did note quite a few items for my letter to Santa. Topping the list: Christmas tree ornaments for the shoe lover.

11-27-2012 9-04-09 PM

Thanks for the nice comments folks have sent about the redesign of HIStalk Connect (the artist formerly known as HIStalk Mobile). Next up: a revamp of HIStalk Practice and HIStalk, which will have a different look that’s more appropriate to longer posts. I haven’t changed the appearance of the sites since 2007, so hopefully nobody will be too jarred by the change (me included).

Just in case you have any doubts about the financial literacy of the average American, check out the lines of people waiting to buy tickets for the $500 million Powerball lottery. These are the folks who couldn’t be bothered to play when the prize was only a couple of hundred million. Does that make sense? Do you suppose a lot of statisticians are plunking down their cash given the impossible odds of getting it back? Maybe the feds should run a lottery to help pay down the smothering national debt – it’s like a tax that nobody complains about.

11-27-2012 5-55-07 PM image

Welcome to new HIStalk Platinum Sponsor Innovative Healthcare Solutions. The 12-year-old Punta Gorda, FL-based company offers clinical and revenue cycle implementation services, with a focus on Epic and McKesson (ambulatory and inpatient EMR, STAR, Pathways, and Horizon, including upgrades and optimization.) They’ve been a Best in KLAS winner for the past two years in the Clinical Implementation – Supportive Work category. They also do assessment, optimization, testing, and strategic planning. Their approach is proven and cost effective, with the recognition that healthcare organizations are required to focus on both financial and clinical excellence for success. The principals have lot of industry experience – Robin Bayne was at McKesson for many years and Pat Stewart has been in healthcare for more than 30 years. Thanks to Innovative Healthcare Solutions for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

Healthrageous announces that Partners HealthCare participated in its recent $6.5 million round of Series B financing.

11-27-2012 9-08-13 PM

Hello Health, which offers an EHR platform that’s paid for by patients ($5 per month, according to its site) instead of doctors, secures $11.5 million in financing.

11-27-2012 6-25-21 PM

VisionMine launches a service and Web portal that will match small startups with big companies trying to solve specific technology problems. The company will grade startups for the review of the large companies and will coordinate introductions when there’s mutual interest.

Merge Healthcare files a lawsuit against orthopedics PACS vendor Medstrat, claiming the company’s false claims and unfair business practice have cost Merge tens of millions of dollars in revenue. The suit claims that Medstrat sent e-mails and advertisements to Merge customers implying that the company’s announced plan to seek strategic alternatives was an indication of instability, tagging one e-mail with the phrase, “Why go through more pain? Converting is simple.” MRGE shares closed Tuesday at $3.31, down more than 50 percent since February.


11-27-2012 9-02-58 AM

Valley Medical Group (MA) contracts with eRAD for its PACS and speech recognition solution.

Intermountain Healthcare (UT) signs an $11.7 million, multi-year contract for Siemens Image Sharing and Archiving.

Adventist Health System will expand its use of Cerner’s P2Sentinel solution for auditing clinician access to patient data.

11-27-2012 9-11-52 PM

Virtua (NJ) implements the Vergence and proVision identity and access management solutions from Caradigm.


11-27-2012 9-50-11 AM

Cadence Health (IL) names Dan Kinsella (Optum Insight) CIO and EVP, replacing the recently retired Dave Printz.

11-27-2012 1-24-59 PM  11-27-2012 1-23-57 PM  11-27-2012 1-23-05 PM

Orion Health names Tracey Sharma (Baxter) sales director, Sergei Maxunov (Bell Canada) senior solutions consultant, and Health Linkletter (EMIS) project manager of its Canadian eHealth team.

Announcements and Implementations

HIMSS honors the family practice of Jeremy Bradley, MD (KY) as a winner of the 2012 Ambulatory HIMSS Davis Award of Excellence.

Cerner and telecommunications information company Global Capacity partner to deploy Cerner Skybox Connect, a high availability private network for the healthcare industry.

11-27-2012 9-59-23 AM

Children’s of Alabama implements Accelarad’s medical image sharing network to enhance care coordination with referring facilities.

11-27-2012 10-04-07 AM

Jefferson Radiology (CT) deploys Repair, a remote MPI management service from Just Associates.

NextGen Healthcare and Microsoft launch NextGen MedicineCabinet, a free app for the Windows 8 platform for the management of personal medication records.

Nuance Healthcare announces Assure for Powerscribe 360 | Reporting, which uses clinical language understanding to QA radiology reports before they’re signed.

Medsphere marks its tenth anniversary by noting that more than 70 percent of its OpenVista customers have achieved Meaningful Use Stage 1 so far.

Wellcentive announces that its Advance Outcomes Manager population health management and analytics solution has earned NCQA certification.

11-27-2012 6-35-21 PM

GetWellNetwork and Sharp HealthCare (CA) develop and launch what they say is the first in-room collaborative patient whiteboard. It identifies care team members, tracks visits and family questions, provides a daily schedule and plan, and allows patients to communicate with their family members.

11-27-2012 6-54-44 PM

University of West Georgia in Carrollton, GA, whose graduates make up a third of Greenway’s employees, names its new sports stadium building “Athletic Operations Building, sponsored by Greenway, Inc.” and adds the company’s logo to the building.

Cerner lists all of its customers that have successfully attested for Meaningful Use Stage 1.

11-27-2012 7-55-29 PM

Chicago-based Valence Health, which offers population management and reimbursement risk management tools and services to providers, announces that its 2012 revenue will increase by 75 percent to over $30 million compared to 2011. The announcement mentions new hires Eric Mollman (Staywell Health Management) as CFO, Kevin Weinstein (ZirMed) as chief marketing officer, and Prasanna Dhungel as VP of product development.

The Panama City, FL paper writes up the expansion of local business iSirona,which also announces that Mercy Medical Center (IA) has contracted for its medical device integration in the OR.

Government and Politics

CMS awards a 10-year, $15 billion contract to eight vendors to compete to build various aspects of a virtual data center for the agency’s IT infrastructure, including claims processing and hosting services for a national data warehouse application.

CMS picks the Kansas City Improvement Consortium, the Health Improvement Collaborative of Greater Cincinnati, and the Oregon Health Care Quality Corporation to be the first organizations to participate in a Medicare claims sharing initiative to assess provider performance.

November 30 is the last day for eligible hospitals and critical access hospitals to register and attest for an EHR incentive payment in fiscal year 2012.

Tennessee’s Medicaid program requests $9 million to replace its obsolete IT system with the VA’s VistA.


The Madison, WI paper looks at the growth of Epic and its impact on the region. Epic left Madison several years ago for Verona, which has seen huge jumps in property values, but Madison has also benefited by increased demand for rental property and more employment opportunities. Madison city officials say Epic visitors are driving revenue to the hospitality industry, resulting in a 30 percent increase in city room tax receipts from 2010 to 2012.

11-27-2012 4-15-16 PM

A new KLAS report concludes that the top global radiology PACS vendors vendors are those offering meaningful and timely upgrades with expanded usability. Infinitt and Intelerad rated highly as innovators, along with DR Systems, McKesson, Novarad, and Sectra.

A Weird News Andy literature review notes that two new studies conclude that “flu vaccine is a heart vaccine” since people in the study who got a flu shot experienced 50 percent fewer cardiac events and 40 percent lower heart-related mortality. I’d need to review the original research to feel good about that conclusion, about which I’m skeptical otherwise.  

Also from WNA: in the UK, ministers are warned that a plan to implement “virtual clinics” powered by Skype will save billions of pounds immediately, but could leave less technology-savvy patients behind. The Health Minister expects video visits to reduce unnecessary hospital stays, saying that a third of patients can be managed without a face-to-face appointment, leaving more capacity for those who need to be seen in person.

WNA also notes this nugget: the Cincinnati-based TriHealth health system fires the 150 of its 10,800 employees who did not get a mandatory and free flu shot.

I’ve mentioned Italian brain cancer patient (and artist, engineer, and TED fellow, as it turns out) Salvatore Iaconesi several times for his “My Open Source Cure” appeal for treating his condition, much of which involves the struggle to share his records electronically with experts around the world who volunteered to help. CNN ran his story on its main page Tuesday morning. You should watch his newly published TEDx talk above on the challenges created by the medical establishment and his views on wellness and cures (the human being, not the “patient”). I don’t agree with everything he says, but he will definitely make you think, especially if you’ve been a patient with a serious condition. He is exchanging information with 15,000 people and 60 doctors and reviewing 50,000 strategies sent to him with the help of 200 volunteers.

MMRGlobal is awarded a fifth EMR-related patent, proudly proclaiming that despite having supposedly harassed companies into signing $30 million worth of license agreements for its newly-issued patents, the company is not a patent troll since the patented technology is part of products it sells itself. Or tries to, anyway – according to this month’s quarterly filings, the company’s total quarterly revenue was $346,000 with a net loss of $1.5 million, with current liabilities exceeding current assets by $8 million and only $42,000 cash in the bank as it seeks additional financing from its founder and anybody else willing to loan it money. OTC-listed shares are at $0.0147, valuing the whole enterprise at $7 million and obviously reflecting serious market doubt about the company’s banking the $30 million it claims to be owed for its newly created intellectual property portfolio.

11-27-2012 8-16-43 PM

Cleveland Medical Mart announces that it has signed Cleveland Clinic and GE Healthcare as tenants. HIMSS, which had signed on with a similar project in Nashville that went bust, has toured the facility, which is three-quarters complete and scheduled for a September 2013 opening.

The local paper in Edmonton, Alberta gets its hands on the expense records of the former CIO of the Capital Health region, whose boss there was found to have been reimbursed $350,000 for questionable expenses that included opera tickets and a butler. Donna Strating, who like her boss was billing $2,700 per day as a consultant, was reimbursed for large restaurant tabs, movie tickets, and snacks.

Sponsor Updates

11-27-2012 12-55-37 PM

  • Employees of Digital Prospectors supply 30 Thanksgiving meals to the New Hampshire non-profit Families in Transition.
  • MModal releases software updates to its Fluency for Imaging Reporting technology platform to support report creation and clinical documentation workflow.
  • Merge Healthcare makes its iConnect Enterprise Clinical platform available through EMC Select.
  • The GPO Yankee Alliance offers its healthcare members connectivity solutions from Lifepoint Informatics.
  • Frost & Sullivan honors Acuo Technologies with its 2012 Market Share Leadership Award in Imaging Informatics.
  • Visage Imaging announces a new video about its enterprise imaging platform, Visage 7 – Speed is Everything, at RSNA.
  • Frost & Sullivan awards TeraRecon its 2012 New Product Innovation Award in Medical Imaging Informatics.
  • Telus Health executives Francois Cote and Brendan Bryne are quoted in a newspaper article on the digital transformation in healthcare.
  • The Web Marketing Association awards Imprivata its 2012 WebAward for Outstanding Achievement in Web Development in the Best B2B Website category.
  • The Detroit Free Press recognizes CareTech Solutions with its fourth consecutive Top Workplace award in the large company category.
  • Frost & Sullivan awards Humedica the 2012 North American Health Data Analytics Customer Value Enhancement award.
  • BridgeHead Software releases a white paper outlining strategies for addressing concerns about image availability.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 27, 2012 News 16 Comments

News 11/21/12

November 20, 2012 News 9 Comments

Top News

11-20-2012 8-06-30 PM

Nuance reports Q4 results: revenue up 28 percent, adjusted EPS $0.51 vs. $0.42, beating expectations of $0.48. In the earnings call, Chairman and CEO Paul Ricci said the company’s healthcare business will generate more than $1 billion in 2013, making the company one of the largest HIT vendors. He also said that the recent Quantim and JATA acquisitions will contribute $90-100 million in annual revenue.

Reader Comments

inga_small From Samantha Taggart: “Re: giving thanks. I am very grateful and thankful to all of you for doing what you’ve done for this (our/my/your) industry. Healthcare is a precious thing and I can’t imagine what HIT would be like today if you all hadn’t somehow provided the transparency and insight into what’s really going on in this industry. We ALL thank you so very much. Enjoy your holidays and feel very good about what you do.” On behalf of Mr. H, Dr. Jayne, Dr. Travis, Dr. Gregg, Donna, and Lt. Dan, a big thank you for the kind words. I will save this note for those days I find myself thinking I can’t possibly read one more thing about healthcare and technology. I am thankful that I lucked into the greatest job ever in HIT, that I work with such fun and smart people, and that people continue to read and support HIStalk week after week. Best wishes to all for a great holiday. I’m off for the rest of the week off to spend time with family and friends, eat too much food, watch some football, and perhaps buy a couple of pairs of new shoes.

From MDRX Scrooged: “Re: Allscripts. Everyone is expecting huge cost cutting if Allscripts is sold to a private equity firm, but what may not be expected is that the cost cutting will start in the next couple of weeks. Between 70 and 130 employees will be let go, mostly from services and engineering. Happy holidays to us!” Unverified. I’ve received a few rumors on where the possible acquisition stands, pretty much split between: (a) talks are at an impasse because the PE people won’t pay above $15 per share and the board won’t accept that offer with shares trading at $12.35, and (b) a deal has already been finalized but not yet announced. In other words, I don’t know any more than you do.

11-20-2012 6-47-24 PM

From Force Majeure: “Re: Allscripts. A practice that requested termination of its MyWay agreement was turned down even though its contract says Allscripts will comply with any CMS requirements to meet MU and any other standards, with the explanation that the practice was offered a free upgrade to Professional. What about costs for infrastructure, equipment, and possible lost productivity? The contract didn’t say they company will meet the requirements by making the customer switch products. They’re going to be flooded with these requests.” Unverified, but FM provided a copy of the purported e-mail above, where the company takes the position that moving a customer to a completely different product than the one they bought is contractually acceptable since it’s a free switch to a more expensive product. I think I’d probably side with the company legally, although as a customer I’d still be ticked that I have to spend money and energy because of the company’s business decision. Obviously your options as a customer are limited if you recently signed up for the five-year lease – you’re going Professional unless you’re willing to lose a lot of money (either by not collecting Meaningful Use money or in paying off your lease while buying a competitor’s product). I assume the leases work like they do for a consumer transaction – a third-party financing company buys the contract at a discount and handles the payment collection, meaning it’s not up to Allscripts to let customers out of their lease agreements. Leasing terms might make an interesting topic for Bill O’Toole in a future HITlaw column given this example.

From Nasty Parts: “Re: [company name omitted]. They were apparently shocked to see former employees working for competitors at MGMA and offered a bounty to current employees to identify them so they can be send cease and desist letters.” Unverified. I’m sure someone must have proof if this claim is accurate, so I’ll fill in the blank if someone will provide that proof.

HIStalk Announcements and Requests

I will most likely not do news this Friday unless I get bored since I doubt anyone would read anyway. Enjoy your holiday. I’ll be back at the keyboard Saturday as usual putting together the Monday Morning Update.

Acquisitions, Funding, Business, and Stock

11-20-2012 5-33-03 PM

Medical education firm Pri-Med, a division of Diversified Business Communications, acquires EHR provider Amazing Charts.

11-20-2012 6-12-45 PM

Shades of McKesson-HBOC: shares of the perpetually bumbling HP drop 12 percent Tuesday after the company announces that it will take an $8.8 billion write-down on its 2011 acquisition of British software vendor Autonomy. HP says Autonomy had cooked its pre-acquisition books by counting low-margin hardware sales as software income and claiming that resellers were customers. Details have been shared with US and British regulators to pursue criminal and civil charges. If HP is right, nice work by Deloitte, to whom it paid big money for pre-acquisition due diligence. The previously fired CEO of Autonomy denies everything, defers to Deloitte’s audits, and says HP destroyed the company’s value by raising prices and lowering sales commissions, adding that, “The difficulty was that the company [HP] needed a strategy, and I still couldn’t tell you what that is.” HP’s now-irrelevant Q4 numbers: revenue down 5 percent, adjusted EPS $1.16 vs. $1.17 but more dramatically –$3.49 vs. $0.12 including the write-down. The ugly five-year chart above plots HP shares (blue) against the Nasdaq index, indicating that you’d probably have been better off burning dollar bills to keep warm. Oracle was smarter: they passed when Autonomy made a “please buy us” pitch – see the hilarious Another Whopper from Autonomy CEO Mike Lynch post from September 2011 on Oracle’s site, placed there after Lynch denied trying to convince Oracle to buy his company. The always-feisty Oracle, in response to his denials, posted the PowerPoint slides Lynch used in the meeting, which seemed to jog his memory of the conversation.


The National Football League signs a 10-year contract worth $7-$10 million with eClinicalWorks to implement an EHR that can help the league research and treat player head injuries.

DoD awards Acuo Technologies a nine-year, $40 million contract for its vendor neutral archive solution.

11-20-2012 11-13-02 AM

Huntington Memorial Hospital (CA) selects the Merge PACS iConnect Enterprise Clinical Platform for its hospital inpatient EHR and its Huntington Health eConnect HIE.

Sharp HealthCare selects 3M’s 360 Encompass System for medical records coding, clinical documentation improvement, and performance monitoring across its four hospitals and affiliated medical groups.

Aurora Health Care (IL, WI) will deploy Humedica’s MinedShare analytics platform to support its ACO initiatives, improve coding accuracy, and develop ambulatory physician scorecards.


11-19-2012 7-23-45 AM

CareCloud hires Ralph Catalano (athenahealth) as VP of operations.

11-20-2012 8-56-21 AM

Health monitoring company Medivo appoints David B. Nash, MD (Jefferson School of Population Health) to its medical advisory board.

Announcements and Implementations

11-20-2012 11-14-34 AM

White Plume Technologies releases its AccelaMOBILEmobile charge capture product app.

11-20-2012 11-15-40 AM

McKesson will give $1 million in free Practice Choice EMR licenses to 100 small-practice physicians who practice in primary care, internal medicine, gynecology, or pediatrics and who have a history of providing unreimbursed care to low-income patients.

11-20-2012 5-43-37 PM

MedCentral Health System (OH) expands its system-wide use of the Surgical Information Systems solution to include anesthesia automation, perioperative analytics, patient tracking, and integrated tissue tracking.

11-20-2012 5-52-53 PM

NextGen Healthcare releases its 8 Series EHR content, which includes a new user interface, standardized framework for templates, and streamlined navigation.

Children’s Hospital Association goes live a contract with Baltimore-based mdlogix to provide an informatics platform that will support its Hospital Survey of Patient Safety tool.

Government and Politics

The GAO finds that CMS is behind schedule on the implementation of its Fraud Prevention System for analyzing Medicare claims data for fraudulent behavior.

11-20-2012 6-44-34 PM

CMS releases Meaningful Use Stage 2 spec sheets for EPs and hospitals.

The Tampa paper covers the power struggle between dueling startup HIEs, the state-run one and a local, for-profit HIE that has the Hillsborough Medical Association as a member. The article suggests that the organizations are fighting for the potential profits involved with selling HIE-collected de-identified patient data. The local HIE says the state HIE is not seeking physician input, noting that the average hospital doesn’t see most of the patient population and also generates only 10 percent of patient health records.

Innovation and Research

The Consulate General of Canada in Philadelphia will launch a healthcare IT accelerator in early 2013, hoping to increase growth opportunities for Canada-based companies as similar efforts have done for companies in Israel. The 4th Annual Canada-US eHealth Innovation Summit will be held November 28 in Philadelphia, featuring presentations from Canadian companies Caristix, EDO Mobile Health, Evinance, Input Health, HandyMetrics Corporation, Mensante Corporation, Memotext, NexJ Systems, Nightingale Informatix Corporation, Orpyx Medical Technologies, TelASK Technologies, and VitalSignals Enterprises.

11-20-2012 8-11-44 PM

A JAMA-published study finds that patients using a patient portal had a higher number of office visits and telephone encounters than non-users. The study, which reviewed the use of MyHealthManager by patients of Kaiser Permanente Colorado, concludes that just putting up a portal doesn’t reduce demand for clinical services, and in fact may have the opposite effect.


11-20-2012 5-45-23 PM

ADP-AdvancedMD introduces a charge capture app for EHR for use on the iPad and iPad mini.

Nurses at Phoenix Children’s Hospital create the Journey Board discharge teaching app, funded by a $5,000 donation from former hospital patients. It’s available free for Android and iOS.

11-20-2012 7-54-25 PM

Massachusetts General Hospital Emergency Medicine Network launches EDMaps.org, a national ED locator for travelers, and a new version of its EMNet findER app.


11-20-2012 11-52-23 AM

Key findings from the eHealth Initiative’s 2012 Report on HIE:

  • Support for ACOs and PCMHs is on the rise
  • Federal funding still supports many HIEs, raising concerns about their long-term viability
  • HIEs worry about competition from other HIEs and from HIT vendors offering exchange capabilities
  • Other challenges for HIEs include privacy, technical barriers, and addressing government policy and mandates
  • Support for Direct is growing, particularly to facilitate transitions of care and the exchange of lab results.

11-20-2012 5-49-42 PM

The National eHealth Collaborative publishes a five-tier framework of strengthening patient engagement strategies that includes steps entitled Inform Me, Engage Me, Empower Me, Partner With Me, and  Support My Community.


An Imprivata roundtable on the healthcare impact of technology and mobility featured Boston-area healthcare IT executives, with their discussion summarized in the eight-minute video excerpt above.

Weird News Andy says “This doc was da bomb.” A 60-year-old doctor and Occupy Wall Street protester who was fired by his hospital employer in 2007 for suspected stalking of a nurse is arrested when police find assault rifles and large quantities of bomb-making chemicals in his basement.

Sponsor Updates

  • MedAssets CEO John Bardis wins a Community Leadership Award for driving and supporting the volunteer activities of his employees.
  • Greer Contreras, T-System’s VP of revenue cycle coding, discusses revenue integrity and the need for organizations to have a holistic view of their revenue cycle processes in a guest article.
  • Compressus integrates MModal’s speech understanding solution into its MEDxConnect suite.
  • Vitera Healthcare introduces Hands-On Lab for virtual product training.
  • Shareable Ink is spotlighted for assisting The Center for Orthopedics (OH) capture MU data.
  • Zirmed releases a white paper on the use of technology to manage rising levels of patient responsibility.
  • PeriGen posts its November and December Webinar schedule.
  • David Caldwell, EVP of Certify Data Systems, discusses opportunities offered by HIEs that can enhance revenue and improve patient care in a guest article.
  • Besler Consulting’s CTO Joe Hoffman reviews challenges in complying with the CMS exclusion list during a November 28 Webinar.
  • Dell ships its PowerVault DL2300 appliance with CommVault Simpana 9 software for enterprise-wide data protection.
  • SCI Solutions recognizes Mountain States Health Alliance (TN) with its Most Innovative Use award for best adoption and implementation of its self-scheduling tool.
  • Levi, Ray & Shoup releases an enhanced version of its Enterprise Output Management software that includes mobile access and support for Windows 8.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 20, 2012 News 9 Comments

Readers Write 11/19/12

November 19, 2012 Readers Write 1 Comment

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.

Paying Attention to How NLP Can Impact Healthcare
By Chris Tackaberry, MB, ChB

11-19-2012 3-48-25 PM

Unstructured clinical narrative is increasingly being seen as the primary source of sharable, reusable, and continually accessible knowledge, essential in helping providers make informed decisions, reduce costs, and ultimately improve patient care. While form-driven EHRs readily leverage and share captured structured data, the richest patient information remains locked inside EHR databases as unstructured notes.

Natural Language Processing (NLP) technology is becoming increasingly recognized in healthcare as a powerful tool to unlock this vital clinical data and turn it into analyzable, actionable information. While many have heard of NLP, there is significant confusion about what it actually means for healthcare.

In short, NLP means recovering computable data from free text. Even though most of the world’s knowledge is documented in some form of written narrative, we increasingly rely heavily on computers to analyze the world around us, and computers work better with well-defined, structured data rather than unstructured text.

Google has clearly proven that simple text search allows us access to vast amounts of information, but it still requires humans to determine meaning in the results. NLP is the science and art of teaching computers to understand the meaning in written text in order to extract data from narrative for reporting, analysis, etc.

NLP, typically embedded within other solutions, can help deliver significant benefit to providers and their patients by:

  • Improved reporting and monitoring. Many administrative tasks in healthcare depend on structured data, including the submission of billing codes that describe diagnoses and procedures to insurance companies. The identification of billable concepts in clinical narrative is probably the most common application of clinical NLP because it is the most direct path to delivering financial benefits.
  • Improving utilization of clinician time, resulting in more efficient care delivery. Doctors and nurses are accustomed to carefully documenting the condition and care of each patient in clinical notes. Without computable data, however, hospital operations, physician reimbursement, and patient care are all compromised. By pulling data directly from notes with NLP, even in real time at the point of care, we can save clinician time and frustration while identifying more data and detail to support clinical decision making, efficient care delivery, better public monitoring, and more.
  • Improved physician understanding of patients. NLP provides the level of clinical detail necessary to provide quicker access and review of patient histories. Revealing key information in existing notes that would be invaluable for more timely, better-informed clinical decisions.
  • Better research and monitoring. Existing studies have looked for correlations between patient genes or proteins and characteristics identified in the patient’s medical record. Conducting similar studies with the greater volumes of so-called phenotypic data, which can be pulled from patient records using NLP, will reveal far more about what makes our species tick – or sick.
  • More efficient clinical workflow. There is an intrinsic inefficiency in EHRs because so much of the information must be documented repeatedly. As a result, there has been significant physician pushback against EHRs, despite their acknowledged advantages.
  • Embedded NLP tools can facilitate EHR redesign for more efficient and intuitive documentation of patient information in a manner already natural to the traditional physician workflow.

Done well, there are countless ways NLP can be leveraged in healthcare to deliver benefit by improving efficiency, driving outcome-based performance, promoting access, facilitating research, and supporting population-based healthcare delivery models.

The application of NLP technology to healthcare will transform what we know about disease, wellness, and healthcare performance, enabling major improvement in efficiency and outcome. At the heart of this data-driven transformation is clinical narrative, a powerful and valuable asset. We need to recognize that.

Chris Tackaberry, MB, ChB is CEO of Clinithink of London, England.

Defining a Complete Patient Engagement Solution
By Jordan Dolin

11-19-2012 3-54-04 PM

A few years ago it was somewhat rare for a technology vendor to pitch the benefits of patient engagement. Today it seems that everyone is claiming to be a “leader in patient engagement technology.” This has led to a good deal of confusion in the marketplace. 

Patient engagement can deliver significant financial and clinical results, but to actually achieve these benefits, organizations need to select a "complete" solution.  A complete solution is one that addresses the needs of all constituents. It engages patients on their terms and also contains the content, technology, and regulatory considerations sought by providers to support care in every setting across the continuum. 

Simply stated, a solution that satisfies these eight critical elements has the ability to improve clinical and financial outcomes.

  1. Understands how to synthesize and deliver actionable information to patients. An effective solution must impart information to a patient in a manner that will actually change behaviors and improve outcomes. Addressing a spectrum of learning styles, literacy levels, and cultural relevance requires a tremendous amount of expertise across multiple communication methodologies.
  2. Facilitates engagement along settings across the continuum of care. A complete solution must support the needs of the patient and the provider in care settings across the continuum as well as the transitions between them. This includes addressing clinical, operational, and regulatory needs of providers in addition to supporting new models of care such as ACOs and PCMH.
  3. Engages patients at their convenience. Historically, healthcare technology solutions have always targeted the convenience for the provider, not the patient. Patients must have the ability to receive information when they want, where they want, and on the devices they already own.
  4. Seamlessly integrates into IT systems and workflow. Organizations are no longer willing to accept disruptions to their infrastructure or existing processes. To be successful, solutions must be complementary and additive, not disruptive or distracting.
  5. Results measured down to the individual patient. The single unifying goal that now pervades healthcare is accountability. A solution must contain tools that allow providers to measure their impact from multiple perspectives. The ability to confirm that a patient received and reviewed information prescribed by their clinician is a fundamental measure needed to quantify impact.
  6. Measures and delivers an economic return. Healthcare organizations are accountable for outcomes and their partners should be as well. Clients should expect hard dollar ROI studies and vendors should impartially fund and conduct them.
  7. Backed by an organization with the requisite knowledge and experience. Investing in an engagement solution to support key business objectives is a critical decision. The vendor selected should have the appropriate experience and staff to support the success of their clients and their clients’ employees and patients.
  8. Effectively supports the near-term and long-term objectives of the organization. The partner selected must understand the challenges of health systems and have a track record of delivering solutions that effectively address them. In addition, it should be clear that investments are being made in new solutions and innovations that will continue to address the needs of an ever-changing market.

Jordan Dolin is co-founder and vice chairman of Emmi Solutions of Chicago, IL. This article contains an abbreviated list due to space limitations; the complete list is available by download. 

Physician Compensation: The Accountable Care Challenge
By John C. Roy

11-19-2012 3-32-35 PM

As healthcare systems and physician groups across the country grapple with definitions and implications of “accountable health care” and “value-driven contracting,” physician compensation based on a fee-for-service model is irrational. Pioneering institutions have already incorporated quality and outcomes into their compensation plans. Similarly, payment for health care services is shifting into fee-for-value models.

As these models evolve, compensation plans must reward physicians for meaningful quality improvement and patient outcomes. Key questions emerge. How can clinical and other data help providers enhance value in the most strategic ways? What measurement strategies, and which data, can be used to reward provider teams that contribute the highest value?

In a fee-for-value world, physicians and hospitals will have to focus on quality, outcomes, and cost (or efficiency) requiring a true culture of quality improvement. Physician engagement is critical in shaping that culture. Physicians will have to assess and agree upon outcome measures and practice standards and change practice based upon valid, practice-specific data.

Today, many health systems struggle with the absence of such data. Essential data supporting such a transformation is often stored in disparate clinical and financial databases, including multiple electronic medical record systems and homegrown software solutions.

One universally challenging example is accurately attributing patients to individual physicians. Accurate attribution is central to reporting outcomes, but all too often proves extremely difficult. If physicians don’t trust that the data accurately reflect their practice, they cannot invest adequate time and energy in improving quality of care.

On the other hand, when physicians trust data that truly does reflect their practice, the data spur meaningful conversations around quality and outcomes. They see improvements in real time. The ability to correctly assimilate, align, and attribute patient data to individual physicians is a fundamental issue today and a cornerstone of reimbursement and compensation tomorrow.

As payment for health care shifts from “caring for sick” to “maintaining health,” providers will need extremely effective, efficient care management strategies for chronic disease patients. They will rely on patient data that is strategically aggregated to identify interventions around priority patient populations. They will direct sophisticated, well-coordinated management plans to help insure appropriate patient management, appropriate testing, control complications, and improve direct attention to that patient. They will have the ability to report improvements in quality, demonstrating the value of their work over time. All of these efforts deliver significant value that needs to be monitored and rewarded when achieved.

In a fee-for-value world, the provider groups who use population-level data to create and implement successful strategies for effectively managing their chronic disease patients will command higher compensation, regardless of their RVUs. Successful systems and groups will design physician compensation models around elements that matter most in a new, risk-based health care environment. To do this, patient data needs to be more physician-centric, with improving population health as the primary goal.

John Roy is vice president of Forward Health Group of Madison, WI.

Six Facts You Should Know About Stage 2 Meaningful Use and Data Interoperability

11-19-2012 4-04-51 PM

In the world of care delivery, having access to the right information at the right time can be a matter of life or death. Anyone who has been a patient or cared for one understands that the transfer of medical information – whether current or historical – among providers is not readily happening today.

The Stage 2 Meaningful Use requirements, which begin as early as fiscal year 2014, call on eligible providers and hospitals to increase the interoperability of clinical data and adopt standardized data formats to ensure disparate EHR systems are capable of information sharing.

The following are six high-level areas of the Stage 2 rules to consider during your preparations. These areas underscore how clinical data interoperability will change and impact IT infrastructure:

  1. Interoperability of clinical data is no longer optional. Hospitals are required to connect with disparate EHR systems and send clinical information electronically for at least 10 percent of its discharges.
  2. Vendor software certified for 2014 clinical data interoperability criteria will produce and consume a consolidated CDA (C-CDA) document (one specification). The C-CDA document must contain medications, allergies, and problem list elements as well as many other clinical data elements. The majority of the clinical data elements in the C-CDA have single, well-defined coding system requirements. For example, the SNOMED CT July 2012 release for a problem list. Thus, all vendors will speak the same language.
  3. Transmission specifications to other systems for Stage 2 include only “e-mail” (SMTP) and cross-domain sharing format (XDS). These do not require costly and complex HL7 interfaces and instead just configuration to make connections for data flow.
  4. Vendor software certified for 2014 clinical data reconciliation criteria will be able to import and reconcile home medications, allergies, and problem list elements as discrete, codified data. The ability to reconcile discrete, codified data in conjunction with the C-CDA and transmission standards nearly eliminates vendor and technical obstacles to clinical data sharing. The coding standards also eliminate some of the complexities. Vendors will likely have to map the data into their systems to support drug-to-drug and drug-to-allergy checking.
  5. Hospitals must have ongoing submission of reportable labs, syndromic surveillance, and immunization information unless there is no entity present that can accept and exchange this data. This bi-directional information sharing is largely at the local level, meaning the abilities on hand to perform this function in a production state will vary. The requirement of these three submission measures is a significant change from Stage1, which only required one data sharing test and failure of that was an acceptable option.
  6. Patients must have electronic access to their records within 36 hours of discharge. Eligible entities must provide a patient portal that enables the patient to view, download, and transmit information. This Stage 2 criteria now mandate providers to encourage patients to make behavioral changes accessing their own data. The information that feeds these patient portals must be available within 36 hours of discharge. Therefore, key workflow modifications ensuring appropriate timing are a top priority.

Ali Rana, MBA, MCITP, CISSP is manager of implementation and integration services and client services for T-System, Inc. of Dallas, TX.

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November 19, 2012 Readers Write 1 Comment

Time Capsule: Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station

November 16, 2012 Time Capsule 1 Comment

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 February 2008.

Fiction Writers, Get Ready: The “Most Wired” Bandwagon is Leaving the Station
By Mr. HIStalk


It’s “Most Wired” time again and I’m excited! Just like those folks who find themselves overdue for a teeth cleaning or an annual prostate exam.

Actually, it’s worse. Hygienists and rubber gloved doctors work quickly. Those magazines, companies, and consultants with a vested interest in the Most Wired nonsense yammer incessantly about it for months, wasting free magazine space on how insightful it is, how much the results correlate directly to everything that’s good in the world, and how inferior you should feel if your hospital isn’t participating (and winning, preferably, since this is America and everything is competitive).

I once worked in a fairly sophisticated IDN’s IT shop. Lo and behold, right there on the newly announced Most Wired list was one of our tiny hospitals, a 100-bed rural facility with zero IT staff, remotely hosted green screen apps, and no IT budget.

We never found out who completed the application, but it was an impressive work of fiction. For example, it claimed a really high CPOE utilization, which was especially amazing because they didn’t even have a CPOE application (maybe they thought it stood for Clipboard Physician Order Entry). Same with nursing documentation – they were purely paper-based, but claimed to be electronic. Those reading the hallowed roster of winners probably thought that our little hospital was an enviably progressive IT hotbed.

People often make interpretational errors on the Most Wired survey form (often to their advantage, I know you’ll be shocked to hear) and sometimes lie outright. I’ve read down the list of winners some years and laughed out loud at their audacity. All it takes is some competitive pressure and a CIO or CEO who’s looking for bragging rights and suddenly the submitted numbers are as opportunistically flexible as a vendor completing a prospect’s RFP. If in doubt, just say you’re doing it and feign misunderstanding if caught.

Most Wired wouldn’t be so bad if only CIOs read it, bragging about their big W like a pimply teenaged boy excitedly describing his prowess in a purely fictitious romantic liaison. What’s the harm? It’s this: non-IT executives may actually think it’s a useful yardstick. The magazine loads up with impressive graphs and makes enormous logical leaps to connect IT spending with quality, cost, and the salvation of mankind. The gloss increases the danger that someone might take it seriously and leap vigorously onto the ill-advised bandwagon as a result.

I asked one of my employees to complete our Most Wired application one year. He was struggling with its ambiguity and the knowledge that many applicants were most likely fictionalizing to some unknown degree. Finally, he summarized: “How I answer depends on how badly you want to win.” We had won in the past and he knew the pressure was on for a repeat.

Just about everyone pushing Most Wired makes money on IT sales, implementations, or advertising. They have a vested interested in shaming people into buying and implementing, even when it’s a bad idea. The message is clear: winners buy IT while Luddite losers cower in the corner.

You can’t stop your peers from entering and maybe even winning Most Wired. You should, however, let your executives know what categories it measures, what you’re doing in those areas, and how your IT efforts support organizational goals in ways that go far beyond a simple survey.

If enough people do what they should be doing instead of what the survey pushes, maybe the foolishness will stop. It would be nice if organizations focused on their own strategic IT needs instead of worrying about how they rank on a vendor-sponsored survey that encourages one-size-fits-all conspicuous consumption.

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November 16, 2012 Time Capsule 1 Comment

Readers Write 11/14/12

November 14, 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!

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

Formal HIT Education
By Deborah Kohn

11-14-2012 6-59-16 PM

I read with interest HIStalk’s news regarding Georgia Tech’s free online health informatics class in the cloud and Mr.HIStalk’s comment, "This looks really good, especially for folks who don’t have a lot of formal healthcare IT education on their resume."

This led me to research four-year baccalaureate degree programs in health information technology (HIT), where I expected students in such programs to earn a BS degree, a Health Information Technologist title, and, perhaps be ready to sit for a rigorous certification exam.

No such programs exist in US colleges and universities – online, on-campus, or combination – as far as I know, except perhaps one at Miami (Ohio) University’s regional campuses. (note: I am not referring to four-year baccalaureate degree programs in health information management or HIM, which are complementary to but different from four-year baccalaureate degree programs in HIT.)

Largely due to 2009 ARRA/HITECH dollars (workforce training), many two-year, community college-based HIT programs exist (before the dollars run out), where students earn an AA degree (or similar), a Health Information Technician title, and are ready to sit for the Department of Health and Human Resources’ HITPro exam. (A certification is not conferred upon successfully passing the HITPro exam.) Unfortunately, contrary to expectations and because of lack of experience, most of these students cannot find jobs.

Many excellent one-to-two-year, post-baccalaureate degree programs exist in health informatics (e.g., Georgia Tech), whereby graduate students (typically clinical) earn either a MS degree or similar or a certificate, allowing the student to officially wear the Health Informaticist title (Nurse Informaticist, MD Informaticist, etc.).

As a college undergrad, I earned a BS degree in medical record science (today, health information management). My program in medical record administration was part of the university’s Allied Health Professionals Division. General Arts and Sciences Division requirements (English composition, sociology, chemistry, biology, etc.) plus anatomy and physiology consumed our freshman and sophomore years. Many of our junior and senior year courses were shared with the Allied Health Professionals Division’s undergrad nurses, pharmacists, lab technologists, dieticians, etc. The remaining courses were specific to HIM (ICD coding, records management, etc.). All Allied Health Professionals Division students experienced a minimum of four months practice in a hospital in the nursing, lab, pharmacy, dietary, and medical records departments.  

I graduated the university with a Medical Record Administrator title and was prepared to sit for a rigorous exam that, upon passing, allowed me to be certified as a Registered Record Administrator (today, Registered Health Information Administrator – RHIA). Similarly, my fellow student nurses, pharmacists, lab technologists, dieticians,etc., became RNs, RPhs, RDs, etc.  In general, we went directly into good-paying jobs as entry-level — but at least semi-experienced — healthcare professionals.

As a graduate student, I had few options except to pursue a masters degree in Health Services and Hospital Administration (or similar), which I do not regret. However, today, those with BS degrees in the healthcare professions can pursue advanced degrees in health informatics, highlighting advanced skills, knowledge, and experience in healthcare and in IT. 

Consequently, I am proposing that four-year colleges and universities, working with or without existing two-year college HIT programs promoting Health Information Technicians, consider offering sorely-needed, workforce HIT programs promoting Health Information Technologists (like lab technologists). Subsequently, graduating students could sit for certification exams and become registered. (This is a subject for another article that would address those associations that would be able and willing to manage the testing.)  

These healthcare information technologist programs would allow the BS-degreed, graduating Health Information Technologist (registered or not) to gain required experience in the HIT industry and, if interested, to choose an HIT advancement and graduate path in health informatics.

In addition, I propose that these four-year, baccalaureate degree programs be incorporated into universities’ existing four-year, Allied Health Professional Divisions. Unfortunately, I learned from one public university with such a division that it is difficult to get the right parties to agree to offer new degree programs at the undergraduate level. I learned from one private university with such a division that undergraduate programs do not generate enough revenue to justify adding new programs, and only post-graduate programs do. Perhaps an accredited online university that is willing to keep the cost reasonable and can quickly establish a program also should be proposed, although program quality might be a concern.

Who or what entity is willing to take me up on my proposal? 

Deborah Kohn is the principal of Dak Systems Consulting of San Mateo, CA.

Value of Meaningful Use Funds Debated at IHT2 Conference
By James Harris

11-14-2012 6-53-38 PM

“History will not look positively on how the meaningful use funds were spent,” said Dale Sanders, senior vice president, Healthcare Quality Catalyst, at a November 7 IHT2 Conference in Los Angeles.

The panel was discussing the current status of healthcare analytics. Several panelists, including Sanders, said the $30 billion federal program had erred by not including more incentives for providers to use analytics.

Sanders said a “substantial” proportion of the EHR Meaningful Use fund had gone to large hospitals which had already purchased or planned to purchase an EHR system. “The program has served to further entrench Epic and Cerner” as the dominant systems in the hospital industry, Sanders said. This is unfortunate because neither company has shown a willingness to “opening their API” to outside vendors with analytic programs.

All of the panelists agreed that analytic programs held significant potential to reduce both clinical and administrative costs in hospitals.

According to Steve Margolis, MD, MBA, chief medical informatics officer of Adventist Health Systems, the newest types of analytic programs will offer “visual discovery tools,” which he described as being like Amazon’s system of suggesting additional purchase items based upon the consumer’s buying habits.

Margolis said in the future analytic programs will give “each individual provider, whether she’s in the ER, kitchen, or NICU, will get her own individual ‘dashboard.’” This dashboard would contain specific KPIs for the individual position to help in decision making.

Sanders noted that the most significant barrier to widespread adoption of analytics was the current economic model in healthcare. “Until we move to paying for quality, not quantity,” there is little incentive for hospitals to use analytics.

He added that the “I” in CIO should stand for “analytics.” Margolis countered that many CIOs felt the “I” stood for “insecure.”

In the conference’s opening keynote speech, Brent James MD, chief quality officer and executive director of  Institute for Health Care Delivery Research of Intermountain Healthcare, noted the vast amount of waste in the US healthcare system.

James said $2.83 trillion was spent on healthcare in one recent year and about 50 percent, or some $1.5 trillion, was “wasted.”

He said studies showed that 32 percent of all clinical care was “inappropriate,” meaning unnecessary or without proven clinical benefit.

James said “nobody in healthcare believes we will not be seeing major payments cuts” in the future. He urged healthcare executives to study the principles of W. Edward Deming, the famed engineer and management theoretician.

James said the old advice to American manufacturers, “Do Deming or Die,” takes on new meaning in US healthcare. He said the retail and auto industries have shown that “quality drives down costs.”

James Harris is president of Westside Public Relations.

It Takes One Bad Apple…
By Fernando Martinez, PhD, FHIMSS

11-14-2012 6-40-38 PM

I recently hosted an information assurance webinar that focused on security and audit and control functions that are frequently overlooked by healthcare organizations. In order to establish the appropriate context for the discussion, I began by reviewing notable trends and statistics regarding experiences around data security in the industry.

For example, in recent years, almost 21 million patient records have been implicated in reported breaches of electronic protected health information (ePHI). The statistics included a brief review of civil and criminal penalties for HIPAA-related violations which apply to covered entities and business associates alike.

Although the primary industry and regulatory focus has been on covered entities such as providers and healthcare organizations, compliance expectations have also matured and expanded to now include business associates. While business associate agreements are by design typically an affirmation that the business associate agrees to comply with some degree of security and related controls, not until recently have audits been directed specifically to business associates. The expectation is that the business associate has the same level of accountability as the covered entity when it comes to safeguarding ePHI.

Although it seems that some of the impetus for the heightened focus on business associates is related to consumer complaints about HIPAA violations or perceived violations, it is safe to conclude that regulators recognize the need to audit business associates simply because a relationship exists with one or more covered entities. Business associates are expected to conform to the same level of HIPAA compliance as covered entities where applicable, which in turn suggests that a properly designed, executed, and monitored management program must be in place by the business associate.

At the annual NIST/OCR conference held in June 2012, several presentations reinforced the point that a dedicated focus is going to be directed toward business associates. Evidence of this heightened focus is demonstrated in a Wall Street Journal article which appeared late July 2012. A complaint was initiated by the Attorney General of Minnesota directed at a service provider that was implicated in a security breach associated with patients from two local hospitals. The article reported that without admitting to any of the allegations, the service provider agreed to settle out of court. The terms of the settlement speak to the significant risk of not adequately managing compliance with security and privacy standards.

The settlement included the following terms:

  1. The provider will pay $2.5 million to the state of Minnesota as part of a restitution fund to compensate patients
  2. The provider must cease operations within Minnesota for a two-year period (the company voluntarily decided to cease operations in the state)
  3. If the provider wants to do business within Minnesota after the two-year exclusion period, it must first obtain the consent of the state’s Attorney General

The fallout from the incident also resulted in the resignations of several of the provider’s executives, the loss of an estimated $20-$25 million in projected annual revenue, and a 56 percent drop in the stock price of the company.

Fernando Martinez, PhD, FHIMSS is national practice director, enterprise information assurance at Beacon Partners of Weymouth, MA.

The Seven Most Important Soft Skills for Healthcare IT Consultants
By Frank Myeroff

11-14-2012 6-47-34 PM

Google “soft skills” and you’ll find that they are defined as the cluster of personality traits, social graces, communication, language, personal habits, friendliness, and optimism that characterize relationships with other people.

While soft skills are a fairly new emphasis in healthcare IT, today’s job candidates and project consultants are either landing or losing positions based on them. Healthcare IT hiring managers regularly ask me about our consultants’ soft skills and consider them as important as their occupational and technological skills.

Therefore, in the event you are interviewing people or even currently seeking a new healthcare IT position yourself, you will need to understand or even demonstrate that there are a number of the soft skills required to be successful on the job. So my best advice to you — get in touch with your soft side and hone these skills quickly!

With that in mind, here are seven top soft skills considered vital for healthcare IT consultants:

  1. Excellent communication skills. Emphasis is being placed on IT professionals who are not only articulate, but who are also active listeners and can communicate with any audience. Good communicators are able to build bridges with colleagues, customers, and vendors.
  2. Strong work ethic. Organizations benefit greatly when their people are reliable, have initiative, work hard, and are diligent. Workers exhibiting a good work ethic are usually selected for more responsibility and promotions.
  3. Positive work attitude. Wanting to do a good job and willing to work extra hours is highly valued. In general, a person having a positive work attitude is more productive and is always thinking how to make things easier and more enjoyable. Plus a positive attitude is catchy.
  4. Problem-solving skills. Today’s businesses want IT professionals who can adapt to new situations and demonstrate that they can creatively solve problems when they arise. To be considered for a management or leadership role, problem-solving skills are a must.
  5. Acting as a team player. Clearly a worker who knows how to cooperate with others is an asset. They understand the importance of everyone being on the same page in order to achieve organizational goals.
  6. Dealing with difficult personalities. Businesses want people who are capable of handling all types of difficult people and situations. Healthcare IT workers who succeed in this area are in great demand.
  7. Flexibility and adaptability. The business and IT climates change quickly. Job descriptions are becoming more fluid. Therefore, professionals who are able to adapt to changing environments and take on new duties are becoming more valued in the workplace. Those who rely on technical skills alone limit how much they can contribute.

The importance of soft skills in a healthcare IT environment cannot be stressed enough. Healthcare organizations link them to job performance and career success. Having the right soft skills mean the difference between people who can do the job and those who can actually get the job done.

Frank Myeroff is managing partner of Direct Consulting Associates of Solon, OH.

My View from the Other Side
By Vendor Nurse

I have worked in and around the vendor world for about 13 years now. But last month was my first experience as a patient in a practice just going live on an EMR (Greenway). In one day, I experienced two doctor visits. Both had recently adopted an EHR.

The first was a dermatologist using Greenway. My appointment was at 1:00 p.m. I arrived a bit early, was asked to fill out several pages of forms, including patient registration forms, PMH, ROS, etc. I was called back to the front desk window four times to answer questions about race and ethnicity, insurance, and I forget what else.

My nurse (MA, really) finally took me back to the exam room at 1:35 p.m. and started to ask me all the questions I had just filled out. When I said, "It’s all on the forms," she said, "I know, but I have to ask you anyway." As she typed into the laptop, she sat at a diagonal but did not face me or make much eye contact and seemed more interested in entering the documentation than me. Of course, I get that, but geez it didn’t feel good.

The second appointment was with my PCP for URI symptoms. They are a major academic healthcare center and are going live on Epic (who isn’t?)…their third EMR! This doc was a little more fluent with an EMR, but sat with her back to me the whole time. She handed me a patient care summary and e-prescribed my medications, but forgot to print the referral for a mammogram.

Somewhere during that visit I was given information about the patient portal, which I had been waiting for a long time. As it happened, I had a couple of questions come up within the week and absolutely loved being able to send a message and get a response within an hour or two. This rocks! No more automated phone messages that go on so long I can’t even remember why or who I called.

Anyway, just thought I’d share my personal experience with EHRs. I have to say it will help me as I work with other physicians going live on their EHR.

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November 14, 2012 Readers Write 2 Comments

News 11/14/12

November 13, 2012 News 7 Comments

Top News

11-13-2012 5-20-42 PM

ONC releases the draft of the proposed Stage 3 Meaningful Use rule.

Reader Comments

11-13-2012 12-52-14 PM

From Minnie Mouse: “Re: NextGen User Group meeting. Over 4,400 attendees have descended on five Disney resorts in Orlando.” The NextGen folks sent over a few pics and we are running a Twitter feed box with meeting updates. The company honored the winners of its innovation awards Monday evening, which included the Flemington, NJ-based Hunterdon Healthcare Partners (above) as Grand Champion. Attendees tweeted positive comments about the food, the presenters, and the enhancements being previewed.

From SideWays: “MyWay contract. Will Allscripts let MyWay users out of their contract if they choose not to migrate to Allscripts Professional?" We’ve asked Allscripts for clarification.

From Peter Potamus: “Re: Allscripts. John Gomez has been consulted by some PE companies asking for guidance and insight into MDRX, and possibly the idea of his returning as CEO. He is getting tremendous pressure to step up, take the helm, and reinvent the company as he did during his early tenure at Eclipsys. I wish he would take it on, but so far he has been resistant. In the Sunrise XA days, he galvanized the client base, rallied the employees, and delivered all he said he would, inventing the App Store, Helios, Objects Plus, and much more.” I’m going to keep my response guarded since Allscripts is publicly traded. I have reason to believe that one or more of the PE companies with an interest in bidding for Allscripts may have approached John for advice that may or may not have included discussion of a possible role if the acquisition moves forward. That’s hardly surprising – if I were a PE guy, l would be calling up departed executives such as John, Jay Deady, Phil Pead, Bill Davis, and maybe even John McConnell for an arm’s length opinion about what they think needs to change to make the company successful. They could also read the advice of the HIStalk Advisory Panel. Or yours, if you’d care to leave a comment – I have a lot of readers who are VCs, equities analysts, etc. so make me proud by showing them how insightful you are.

11-13-2012 6-13-43 PM

From Stock Doctor: “Re: cartoon. Thought this was amusing.” I like it.

11-13-2012 7-51-34 PM

From Country Lane: “Re: Geisinger. I’ve heard rumors that they will release a commercial product aimed at the ACO market.” Geisinger Consulting Group offers software-related services, but I don’t know if the health system is selling software directly. It doesn’t seem like their core competency, but that doesn’t mean they aren’t doing it.

From G.E. Smith and the SNL Band: “Re: GE Healthcare IT. Layoffs coming, the third large one this year. The Centricity Business line is rumored to be heavily impacted again. Software development for various imaging product lines will likely also be cut. Tragic for employees, unfortunate for customers. In any competitive industry, failure to innovate=death. In this case, GE Healthcare has chosen assisted suicide at the hands of Epic and other more agile competitors.” Unverified.

From Fly on a Wall: “Re: GE Healthcare IT. Rumor has it they’re dumping people (layoffs Wednesday) and capital to prepare for a potential acquisition of a large healthcare IT company that McKesson was rumored to be acquiring last week.” Unverified. The subjects of the McKesson rumor that appeared here were athenahealth and Greenway. Monday’s stock market action gave no hints that ATHN is in play (shares were down in a down market), but GWAY shares rose 2 percent on no news other than a management overview. That’s interesting, but probably means nothing.

11-13-2012 6-12-31 PM

From HITEsq: “Re: American Hospital Association. They’re very litigious, with dueling complaints filed in federal court with SSI Group. SSI Group seeks declaratory judgment that the UB-04 codes are not valid copyrights or that any protection ‘is extremely thin.’ AHA filed suit against SSI Group for copyright infringement.”

From Karl Marx Brothers: “Re: ONC. It would seem like a good time to look at the return on investment of ONC. In 2009, this office had a budget of $67 million. I am told that in FY 2012 the budget was over $2 billion. While I understand some increase was needed, this seems excessive in a time where a balanced budget is becoming increasingly important. Do we really need masses of beltway bandit consultants working on HIE interoperability issues, such as communicating lab results, that were solved 10 or more years ago?” According to FY2013 budget documents from February 2012 (the only documents I found), ONC requested 191 FTEs and $66.3 million for 2013, up $5 million from 2012.

From EpicBuzz: “Re: HCA. One HCA hospital went live on Epic earlier this year and now Epic is quietly assembling an implementation team to begin rolling out more facilities. Can they be successful with this huge win? As a former Epic employee, they already seemed stretched to meet customer needs – I was working 70+ hour weeks when I left. This large of a commitment will be a test of their strength for sure.” HCA hasn’t confirmed plans for further Epic rollouts beyond the pilot, or at least the several HCA people I asked said they didn’t know anything about it. Epic is the only vendor that has demonstrated an ability to rapidly ramp up without apparently loss of quality, but HCA has a couple of hundred hospitals and that would indeed provide the ultimate test of turning thousands of brand new liberal arts grads into healthcare IT experts via a short company training program. I don’t think the already-stretched Epic-certified talent bank can even begin to handle a multi-year HCA rollout if it happens, so that probably means a salary war to lure people over. That might throw some disarray into Epic’s carefully managed centralized contractual control over people seeking new opportunities without a waiting period. I don’t have enough fingers to count the percentage of US patient volume that Epic will have if indeed it does land the HCA whale. 

11-13-2012 7-54-51 PM
Photo: Michael Henninger/Post-Gazette

From Grizzled Veteran: “Re: UPMC. How is this possible?” UPMC reports Q1 revenue of $2.5 billion, up $39 million, but the real eye-opener is its $300 million net revenue swing from –$120 million a year ago to $180 million. Kaiser Permanente also turned in good quarterly numbers, with $12.7 billion in revenue vs. $11.9 billion and operating income of $561 million vs. $320 million. KP’s net non-operating income got a huge pop from investments, swinging from a $365 million loss last year to a positive $242 million in Q3.

From MadisonHIT: “Re: Dean in Madison. I’ve heard indirectly that they are laying people off and blaming Obamacare because 100 doctors are leaving because ACA doesn’t let them place patients first. Supposedly this is a nationwide occurrence since the election. Anyone hearing anything similar?” I haven’t heard that, but I’m all ears.

HIStalk Announcements and Requests

I’m running “Morning Headlines” early each weekday on HIStalk, a quick summary of the handful of most important news items you should know about. You won’t get an e-mail blast – just go right to the site. If you’re in a hurry or need a quick smartphone HIT news check while eating breakfast at your hotel, this is the place.

Acquisitions, Funding, Business, and Stock

11-13-2012 7-47-56 PM

A Reuters report quotes unnamed sources who say that three private equity companies placed bids last Friday to acquire Allscripts: Carlyle Group, Blackstone Group, and TPG Capital. The sources said that Allscripts is asking for a premium to the current share price and a deal isn’t guaranteed for that reason. It also said that Bain Capital declined to bid because of unreasonable price expectations and company management turmoil. Shares closed Tuesday at $12.32.

11-13-2012 3-55-50 PM

EarlySense Ltd., a maker of patient monitoring sensors, completes a $15 million Series E financing round.

11-13-2012 5-06-35 PM

Emdeon reports Q3 loss of $15.2 million, which represents a 341 percent decline over a year ago. Revenue was up 5.3 percent to $297 million. Emdeon attributes the loss to increased interest expenses and costs associated with the company’s acquisition by Blackstone a year ago.

InterSystems opens an office in Riyadh, Saudi Arabia to support its TrakCare EMR system.

QualComm Life announces availability of its cloud-based health device connectivity solution in Europe.


11-13-2012 3-57-14 PM

Lake Health (OH) selects Accelarad’s SeeMyRadiology.com imaging management and storage solution.

11-13-2012 3-58-22 PM

Orlando Health contracts with Phytel for its Atmosphere population management suite, including the Outreach, Insight, Coordinate, and Transition products.

11-13-2012 3-59-31 PM

Erie County Medical Center (NY) selects Merge Healthcare’s iConnect Enterprise Archive and iConnect Access for real-time access to images and information from Meditech.

Medina Regional Hospital (TX), Red River Regional Hospital (TX), Ward Memorial Hospital (TX), and First Street Hospital (TX) choose Healthland Centriq, adding to the company’s total of more than 70 rural Texas hospital customers.

Central Washington Hospital (WA) selects patient privacy monitoring tools from FairWarning.


11-13-2012 1-14-58 PM  11-13-2012 1-13-39 PM

Zynx Health announces that President and CEO Scott Weingarten, MD (left) has resigned to return to Cedars-Sinai Health System. He will be replaced by First Databank President Greg Dorn, MD (right), who will run both of the Hearst organizations.

11-13-2012 5-08-45 PM

Awarepoint names Vanguard Health Systems Vice Chairman Keith B. Pitts to its board of directors.

11-13-2012 3-50-41 PM

Apprio names H. Allen Dobbs, MD (HHS) CMIO.

Announcements and Implementations

McKesson renames Horizon Surgical Manager to McKesson Surgical Manager to convey that the product is not specifically tied to the Horizon product line.

FDA issues Cerner 510(k) pre-market clearance for its Cerner FetaLink+ mobile fetal monitoring solution for the iPad and iPhone.

Piedmont Healthcare and WellStar Health System (GA) create the Georgia Health Collaborative, a partnership which includes 10 hospitals and over 700 physicians. The organizations will remain independent, but will partner to share best practices and create innovations and cost reductions through economies of scale.

Intelerad will offer Nuance’s PowerScribe 360 voice-enabled reporting radiology system to customers of its imaging solutions.

Galaxy Health Network will offer its 400,000-member physician network iMedicor’s SocialHIE, a NHIN Direct-powered secure messaging service that the company calls “the social network for healthcare professionals.”

Steward Health Care System (MA) expands its use of Craneware’s Chargemaster Corporate Toolkit and InSight Audit across 10 hospitals.

Over 1,000 physicians across 422 practices have joined Michigan Health Connect and are using Medicity’s iNexx Referrals app.

The Upper Peninsula HIE goes live on ICA’s CareAlign CareExchange interoperability platform.

An article in the Sarasota newspaper profiles Voalte, including its $6 million in recent funding, the planned tripling of its headcount and physical space, and hints of major new sales in 2013. It says the smartphone hospital communications system vendor is doing $10 million in business annually. Sarasota Memorial Hospital nurses are sending 600,000 text messages and 6,000 telephone calls through the system each month.

11-13-2012 6-21-49 PM

Visage Imaging’s mobile viewing app has been enhanced to support the iPhone 5/iOS 6. It’s available in the Apple App Store.

Government and Politics

HHS announces the first class of the HHS External Innovation Fellows, who will spend the next six to 12 months building systems and infrastructure to solve such issues as the acceleration of clinical quality measures for the Affordable Care Act, building technology to withstand natural disasters, and devising electronic tracking and transport systems for the national transplant system. 

Innovation and Research

11-13-2012 8-20-34 PM

A Detroit TV station covers research commercialization at University of Michigan, including a profile of real-time patient monitoring software vendor AlertWatch. AlertWatch, used by UM Hospitals and awaiting FDA marketing approval, was developed by a UM doctor who also invented the pulse oximeter.


The president of New York’s public hospital system says it will cost more than $300 million to repair damages from Hurricane Sandy. Full restoration of the hard-hit Coney Island and Bellevue Hospitals will take two to three months.

Here’s a time lapse video of the audience filing in for Monday’s opening session at NextGen UGM 2012 in Orlando.

11-13-2012 9-04-34 PM

London-based Future Lab Group launches the FlipPad, a medical grade, ruggedized case for the iPad that’s being piloted in several NHS hospitals.

11-13-2012 8-15-46 PM

Bart Harmon MD, chief medical officer for Harris Healthcare Solutions and former Military Health System CMIO, writes a Forbes Veterans Day editorial on the use of healthcare IT to deliver care “both in the field and when they return home.”

In Greece, several hospitals lose their connection to the outside world when protesting students break into the data center and disable servers.

Employees and patients of Cincinnati Children’s Hospital create a video dubbed to Flo Rida’s “Good Feeling.”

Steve Sinofsky, the president of Microsoft’s Windows division and one-time CEO heir apparent, is leaving the company just a few weeks after the launch of Windows 8.

11-13-2012 8-44-49 PM

Guaranteed doctor blood pressure raiser: Lawsuit Settlement Funding Company hires a marketing company to help it find medical malpractice victims. The company offers malpractice plaintiffs quick-approve loans of up to $250,000 as an advance against their potential court winnings.

The son of a woman who died after knee surgery at a Massachusetts hospital files a HIPAA complaint, saying that rounding students visited her room without the family’s permission. He also tries to file homicide charges against the hospital and doctors, but police said it’s a civil matter. The son’s song tribute to Fenway Park is played before Red Sox home games, while his mother starred in the song’s video along with William Shatner just before she died.

11-13-2012 8-49-34 PM

One Medical expands to Boston, offering concierge medicine for $199 per year whose consumer-friendly experience includes online appointments and e-mail contact with physicians. Unlike most organizations of that type, they accept insurance.

11-13-2012 3-17-10 PM

inga_small A Chinese man sues his former wife after she gives birth to an “incredibly ugly baby.” He initially accused the mother of having an affair since the baby did not resemble either of them, but later found that his wife’s beauty was due to the $100,000 in plastic surgery she had prior to their marriage. The judge ordered the woman to pay her ex $120,000 for tricking him into marrying her. I hope she hits up the plastic surgeon for a loan in exchange for all the free publicity.

Sponsor Updates

11-13-2012 6-06-25 PM

  • Transplant solutions vendor OTTR Chronic Care Solutions exhibited at last week’s National Marrow Donor Program conference in Minneapolis. That’s Joy Nock above.
  • Five care management solutions providers featured in a recent market report use consumer health education tools from Healthwise.
  • Versus offers a Webinar  that highlights the use of Versus RTLS by Northwest Michigan Surgery Center.
  • MedHOK enhances its care management, quality, and compliance system by incorporating HTML5.
  • Informatica introduces Cloud Winter 2013, which includes enhancements in master data management and end-user integration.
  • Prognosis Health Information Systems will integrate Health Language’s provider-friendly terminology and Language Engine into its EHR suite.
  • Frost & Sullivan recognizes Humedica for its innovative approach to clinical data analytics and the value it provides to clients.
  • Emdeon exhibits its Edge payment solution suite and offers educational sessions during this week’s National Health Care Anti-Fraud Association conference in Anaheim, CA.
  • T-System’s VP of Revenue Cycle Management Compliance Greer Contreras discusses the value of relevant clinical documentation to ensure proper reimbursement in a guest article. 
  • UK HealthCare (KY) licenses Vendor Selection, Systems Implementation, and Program Management Methodologies from Fulcrum Methods.
  • Merge Healthcare updates its Merge Eye Care PACS to support video and the DICOM OPT standard.
  • The Nashville Chamber of Commerce and Entrepreneur Center recognizes Cumberland Consulting and Emdeon with 2012 NEXT awards for their significant growth in revenue and employees.
  • BridgeHead Software’s file archiving data and storage management systems for PACS is successfully tested by Fujifilm.
  • The Huntzinger Management Group streamlines its services offering to include RCM offerings from both its Advisory Services and Managed Services segments.
  • CareTech Solutions introduces CareWorks, an out-of-the-box content management system for smaller hospitals.
  • Brad Levin and Malte Westerhoff, PhD of Visage Imaging were featured in an Imaging Biz article called “The High-performance, High Speed Enterprise Viewer.”
  • Worcester Business Journal awards eClinicalWorks top honors for its employee rewards and recognition.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 13, 2012 News 7 Comments

Curbside Consult with Dr. Jayne 11/12/12

November 12, 2012 Dr. Jayne No Comments


Bianca Biller and I recently traveled to a continuing education seminar out of town. Although the trip started out as a lot of fun (the flight attendant actually asked me for ID before allowing me to have an adult beverage), it quickly turned dark as we began discussing the challenges faced by ambulatory physicians.

Once again, there is a looming Medicare pay cut. Although Congress has overruled this annually since 2003, it’s nerve wracking to face the medical practice equivalent of the Fiscal Cliff. Based on our recent election cycle, I don’t have a lot of hope for a permanent fix any time in the near future.

Providers who haven’t yet gotten with the program are starting to see their e-prescribing penalties become reality. Although this shouldn’t be a surprise, physicians are still grumbling and generally behaving badly.

Bianca is seeing an increase in prepay audits for high level visit codes – claims are processed and denied (who doesn’t love a zero payment?) with a reason code that requests records. For physicians who don’t have savvy billing staff paying close attention to the reason codes, this could be a problem. Payers have different time limits for receiving the supporting documentation – the clock is ticking, so it’s key to be aware of the different requirements.

This is almost certainly fallout from the transition to HER. At least in our organization, providers are actually billing for the work they do and document instead of under-coding as they have been for more than a decade. It’s sad that this is perceived as potential fraud instead of a move to capture more accurate billing.

Although we’ve started to see some recovery in office visit numbers (which have been nationwide the last several years) the holiday season is upon us, which usually results in a downturn in productivity. Although patients have met their deductibles they’re busier and have less time to be seen for non-emergent issues. This is also the time when physicians and staff tend to take vacation, which can lead to increased charge lag. It’s important to make sure documentation is done and charges are billed to keep cash flowing into the New Year.

The “usual suspects” of ACO, PCMH, and ICD-10 continue to be wolves at the door. Hopefully your house is made of bricks rather than straw and you have your plans shored up to be compliant with the different nuances of each program.

There is one ray of sunshine on the horizon. Medicaid rule CMS-2370-F increases Medicaid reimbursement rates to equal Medicare for key specialties: primary care, general internal medicine, family medicine, and pediatrics. Although positive, it’s both a slap and a kiss in some markets where Medicare payments lag far below commercial.

Ultimately the trip was good, the weather was sunny, and we actually learned quite a bit at the conference. We also had time to discuss our projects and goals for the next year, which we never get to do at the office despite being in countless meetings together. Here’s to good friends, strong teams, and another year in healthcare.


E-mail Dr. Jayne.

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November 12, 2012 Dr. Jayne No Comments

HIStalk Interviews Janet Dillione, EVP/GM, Nuance

November 12, 2012 Interviews No Comments

Janet Dillione is executive vice president and general manager of the healthcare division of Nuance Communications.


How do Nuance’s recent acquisitions of Quantim and J.A. Thomas and Associates tie in with the company’s long-term plans?

For long-term plans specific to the Healthcare Division, we are quite interested in having a positive impact on clinical documentation, especially bridging the world between the clinicians and what you could call the administrative processes of healthcare. That crosswalk, if you will, from clinical documentation to CDI to reimbursement.

I think we are fortunate we have quite distinctive technology to help here. Along with speech, we have our clinical language understanding technologies. We think we are in a unique position to help. As I always like to say, we are morally compelled to leave it better than we found it, so let’s get in here and take a look at these processes and the software and the support and then let’s try to have a positive impact here and help the customers.


Earlier this year, Nuance partnered with 3M for computer-assisted coding. How is the J.A. Thomas acquisition going to impact the relationship with 3M?

3M and Nuance will remain partners. This is not unusual for Nuance. We’ve done this across other lines with businesses like radiology, where we’re both probably called a full-stack workflow provider as well as a technology provider. We are quite comfortable doing that. We’ve done it before and we’ll continue to do that. Right now, there will be no changes.


In addition of Quantim and J.A. Thomas, earlier this year Nuance acquired Transcend, which had purchased Salar. What overlaps, if any, do you see with these products?

Transcend for us is very much about an expansion and an extension into the mid-market. We have a channel strategy that’s really a customer-based expansion, a mid-market expansion with our traditional transcription line of business, great KLAS scores, great customer reputation, great customer relationships. It is really about that. 

The Quantim and the J.A. Thomas acquisitions are about filling out that clinical documentation support, which we can then take into that broader Nuance customer base. Transcend was absolutely about getting a great brand and a great customer base and that has had success. These latest two were really about clinical documentation expansion with the CDI.


I understand that there is quite a bit of development work that is still being done on the Quantim CAC offering. What is the timetable for completing that product?

A good amount of work has already been done. There is development and different types of work and some building up of content and knowledge. The other part is really doing some of the underlying plumbing, sort to speak.

The Quantim team had done quite a bit on the knowledge and the content side of it, so we have a very aggressive plan to be in market. We have product in the market now with Quantim and we’ll continue that and will have further releases the end of the year and early next year. We adapted some of the changes with what we believe is an uplift in technology. The developers are working together on this and have been working on this already for quite a bit. We have a very good idea of exactly what has to happen. We’re very positive about what we need with this one.


Do you anticipate that any of the other Quantim products will be retired or changed substantially now that they’re under your wing?

With Quantim, we’re looking at what they have available for coding and CAC and compliance and reporting modules. We think all of those are well suited. There is some integration work we’ll do, especially in some of the reporting, but we actually feel that in most areas there’s no overlap. It’s not part of the integration plan and it wasn’t part of the due diligence.

We don’t see overlap. We see net new. We actually said this throughout the acquisition plan. This is all about going forward and there’s not a lot of the reverse energy, so to speak.


We understand that MModal may have had some type of relationship with Quantim for CAC. Any plans to maintain that agreement?

I would hate to speak for MModal for any prior agreements, but the CAC solution in the market will be with Nuance technology.


Nuance has been continually diversifying its offerings. Do you see any plans to move into the HIS or RCM world?

[Laughs] Right now we are very focused on providing a unique value-added solution into this very complex world of CDI and clinical documentation and CAC. We’ve made quite an investment here and throughout the market. We’re going to be very focused for quite a while making sure we get these solutions out to the customers.


Any additional comments?

I have been here two years. It’s been great. We are blessed. We have fantastic customers, a phenomenal customer list. Great loyalty with our customers, great trust, which is fantastic. We take it very seriously.  

We didn’t make these extensions, these decisions, lightly. We have a brand that we are very conscious of. We think that this is a space where we can add value. We are excited about it.

I was at AHIMA for three days. I was quite frankly really pleased with the market reaction. Customers coming up and saying, “Great, I get it.” It’s so great when we do something that’s significant and have customers say, “I get it. Wow! I get it. That makes perfect sense.”

That was very validating. These are smart people who have been in this space for years, so it’s helpful when you get that kind of a market reaction. That validates the long hours working into the night.

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November 12, 2012 Interviews No Comments

HIStalk Interviews Richard Atkin, President and CEO, Sunquest

November 9, 2012 Interviews 1 Comment

Richard Atkin is president of Sunquest Information Systems of Tucson, AZ.

11-9-2012 7-00-28 PM

Tell me about yourself and the company.

Sunquest is the largest laboratory software company in the world. We provide solutions that enable the full automation of the hospital laboratory and also solutions that extend across the continuum of care to all areas of healthcare where lab tests are ordered, samples are collected, or results are needed to make effective clinical decisions.

They are mission critical because the decisions are made 24/7, so the solutions have to operate 24/7. Around 70% of all clinical decisions are based on lab data.

I’m the president of Sunquest. I’ve held that position for nearly seven years now. Together with the leadership team, we’ve taken Sunquest through a series of transformations and changes of ownership, but always with a focus on creating solutions that add value and result in client delight.


Tell me how the acquisition by Roper took place and what changes have been made as a result.

Roper had been looking at Sunquest and the progress that we’d been making in the marketplace for quite a little bit of time. They had approached the shareholders and entered into a conversation with the shareholders about acquiring the business. I think they’d been looking at software companies in general.

They’ve got a very large software presence across a number of industry verticals. They really liked what they saw in Sunquest with our customer base, market share, and transformation we made in the product portfolio. It was a conversation through the investors and the match that Sunquest in its profile had with Roper’s view of where they wanted to invest and how they could grow their business. It became a win-win for both the existing shareholders and for Roper that the acquisition closed.


What is most different about being owned by a private equity firm versus being a publicly traded company?

We’re only about two months into the Roper ownership, but I’ve enjoyed each of those phases of the business. When I first joined Sunquest, it was part of the Misys organization, which from the healthcare perspective, became Allscripts. It was part of Misys and then it was a private equity and now it’s with Roper.

Each owner has really helped us in the business focus on how you add value and what you need to grow the business. The questions are essentially the same. How do the shareholders help add value and how do you grow the business?

There’s a view that private equity is short-term focused. That was not my experience. They really focused on growing value in the business. That requires a strategic perspective, not just a short-term one. You don’t grow value because of your short-term focus.

It’s the same so far with Roper. They are publicly traded and there’s a view that publicly traded companies only think quarter to quarter, but all the conversations I’ve had with Roper are about how we are going to grow the business further and how we add value in the marketplace. They are really taking a longer-term view.

I think one of the main differences is, though, that Roper has a track record of owning businesses forever. Their message to employees was that this a permanent home for Sunquest. That’s really how they thought about it. When they did their due diligence, it was on the basis that they were going to own Sunquest forever. That thought about what’s the next step or who’s going to be the next owner for Sunquest has been removed — it is Roper. They’re a permanent home and we’re focused long-term on growth.


Will they be a hands-off owner who is happy with the operation as it stands or do you see them wanting change the strategic direction?

They’re what’s traditionally been called a holding company. Their businesses are all autonomous. They have around 33 businesses and Sunquest will operate autonomously within the Roper family. I continue to be responsible and the leadership team continues to be responsible for direction and running the business.

They clearly as owners — and they have invested a lot of money here — have a view as to how they have helped their existing businesses grow, their track records for growth. A lot of that is being focused on globally — international growth — and also focused in on ensuring that the channels to market are effective, not just the products. A lot of technology companies are focused on product, but that the channel to market — the sales channel and the delivery channel — are also effective. 

The questions that we’re getting are, “What else do we need to do to drive international growth? Are there any more things that we need to do to be effective in the marketplace with the sales channel and delivery channel?” But otherwise, the leadership team’s all in place, the messages are that everybody is being retained — there were no synergies from the acquisition that were planned. Everybody has a role and everybody’s being kept in place.


Do you think people were surprised that the transaction was for $1.4 billion? That’s a pretty big deal in healthcare IT.

There may been some surprise externally. Internally within the company and with the shareholders, less so. We knew how much value was being created and how much the business is growing. 

I think one of the things that perhaps we’ve failed to do is get our message out as clearly as we could have about how much success we have generated within Sunquest. Order intake is growing consistently in the mid to high teens year over year. That has driven obviously revenue growth. It’s driven the profitability of the business. Sunquest today is a very different organization than it was five years ago when it was acquired by private equity.

We’ve also transformed product development. We’re writing three times the lines of code per year and releasing four times the number of product releases per year that we were five years ago. The products have changed, the organization has changed, and we’ve been growing consistently every year. That represents value.

But I don’t know that we got that message out well enough for all of your readers to say, “That’s understandable, because Sunquest is on the move.” When you  look at the performance of the business, it’s been on move for five years.


The company has stayed focused on lab systems even though you have offerings in radiology and in other areas. Would you still characterize Sunquest as a laboratory information systems vendor and do you see that changing?

Yes, that’s how I’d characterize it at our core. We have other products, but largely what we’ve done is looked at the workflows in and around the laboratory. We think about the lab business as being inside the four walls of the lab and having a comprehensive set of solutions that operate within the four walls. But then looking at the workflows outside of the lab but within the hospital, we’ve got a comprehensive set of solutions that extend those workflows — to the point of care, to surgery, emergency department, etc. — and then take those workflows outside to the doctor’s office.

When we looked at that, we saw a huge opportunity for growth. We went about developing those solutions and acquiring some to enable us to fully automate all those workflows associated with the laboratory and laboratory testing, but right across the continuum of care.

Then when you think about anatomic pathology and the opportunities to fully automate anatomic pathology and then move toward digital pathology and the image aspects of digital pathology, we still see this huge amount of opportunity for future growth without having to step outside of this core, very deep focus that we have in and around the lab.


What do you think is on the radar for genetic testing being used by hospitals and practices, and how might Sunquest fit?

We’re spending a lot of our time and focus and investment in and around not just genetic testing, but the things that can enable the opportunity to move from healthcare being focused on the treatment of acute illness and diagnosis to move towards prognosis and then potential for prevention. Diagnosis, prognosis, to prevention. 

Our view is that genomics and genetic testing is going to be one of the enablers to be able to move in that continuum. That to my mind is going to enable the fundamental transformation of healthcare. I know there’s different views as to either when that could occur or the impact it will have, but I do think that that transition will occur and that in the future, we’ll have a very different view of what healthcare really means — that it’s not just about the treatment of illness.


I’m hearing that Epic’s Beaker LIS product is coming along fairly strongly, especially in the anatomic pathology areas, and of course Cerner and Meditech and other vendors offer a full line of products that include a laboratory information system. What do you think is the future for best-of-breed LIS products?

I think it’s very strong, as evidenced by the growth that we’ve already exhibited in the last five years. During the time when there was a lot of focus on the enterprise and Meaningful Use, etc. we’ve been growing very substantially.

The way I view this is there is so much complexity in and around the lab and there’s so much opportunity still to fully automate that area. That really does require a deep understanding of the workflows and a deep understanding of the needs in that area. I do not personally see the compromise that comes from an enterprise or a “one size fits all” approach in and around the lab.

One thing that’s very high on my agenda is the focus on quality in healthcare and quality in terms also of software solutions. Whether software solutions such as the ones Sunquest and our competitors provide are already medical devices. There seems to be a lot of discussion about that.

I am firm believer and an advocate of the fact that the types of solutions that we provide and the software solutions that are used in the enterprise are medical devices. If they’re not, I don’t know what other definition you could apply. These are clearly products that are used to help improve the effectiveness of healthcare, to help provide information that enables physicians and others to make clinical decisions. 

I’m a strong believer that these are medical devices. I really don’t understand the position that others seem to take that they’re not medical devices, and therefore they should not be subject to things like FDA review. I take a contrary view to most of my colleagues on that.


Supposedly the vendors convinced the FDA years ago that it would police itself without FDA involvement. FDA seems to be signaling at least some level of interest, which might be a positive development for companies like Sunquest that already have experience in working under FDA’s guidelines. Do you see FDA’s view changing?

I don’t whether the view will change. I agree with you — there seems to be some dialogue occurring, but perhaps going a little softly on that is to whether they would really get into this area. I know there’s a lot of discussion, but I don’t know whether they will change their view.

I do think it would good for Sunquest. We have blood bank products that are classified as medical devices. We’ve chosen to register virtually every product we’ve got as a medical device. We are subject to FDA audits, and we see that as a positive as opposed to a negative. 

On our last FDA audit, we had zero observations. That’s a pretty high standard that we set. We also had zero observations from our ISO audit. We see a robust quality system, repeatable and demonstrable process documentation, and adherence as a core of delivering high-quality solutions that operate as advertised. We see the benefit to the business. We would see it as a benefit, of course, if others were asked to perform to the same high standard.


A lot of healthcare IT software companies operate more like they’re selling general business software. They don’t have the ISO certification and they don’t want any part of FDA oversight. In your mind, would patients be safer if both of those were standards for companies that sell software that impacts patient care?

Well, I don’t know if I would go there because I’m not sure. I can’t really talk to any other companies in how they validate that their products are high quality. I just know that in our case, we use the quality system and the compliance to the ISO standards and validation requirements — we’ve got a number of ISO certifications — and the FDA audit.

We use those as a guide post to having a quality system, which is a core business system within the company. I feel a lot more comfortable and I can sleep a lot more soundly knowing that we have a very, very robust quality system — that third parties audit and concur that its is a very solid system — and that we are operating very effectively to that system. Then we can demonstrate that the quality of the solution is to a very high standard as well.


You mentioned Meaningful Use. What parts of it do you think are most relevant to laboratory information systems?

There are several areas. In Stage 1, they were in the optional list. Stage 2 is moving them into core. If and when Stage 3 gets finalized, they’ll all be core. 

There’s a number of different things like reportable results, which sounds pretty straightforward, but we’ve been interfacing out to the CDC and others to provide reportable results for years. Even some of our competitors with lab solutions find that difficult. To do that out of an enterprise solution is extremely difficult. The lab has the very granular information that we can utilize to move the right results to the right place. 

There are a number of different things, but I think reportable results is one of them. With Stage 2, it’s going to get increasingly important.

Then we have LOINC, which is to enable information to be shared. Again, there’s a lot of detail around LOINC and lab-to-lab and enterprise-to-enterprise communications. I believe the best-of-breed lab solutions provider is best positioned to meet that need and to be able to provide those solutions.


I’m curious – do you have any idea what percentage of hospitals are using best-of-breed laboratory information systems?

I can only guess. My guess is over 50 percent.


Where did your past growth come from and where do you see it coming from in the future?

It’s probably several areas. As we’ve invested and expanded our portfolio, there’s growth around what the laboratory calls outreach. It is really connectivity to the physician office and enabling physicians in the community to have meaningful interactions with the lab — easy ordering, rapid results, effective management of the samples into the lab. We have an outreach suite, which enables the lab to manage those relationships on an effective business professional level. That’s been an area of growth.

Within the hospital, automating the workflows back from the point of care — when lab tests are ordered, samples collected, and results come back. We’ve got solutions that have been demonstrated by our customers to eliminate error in those processes. That’s been a significant area of growth.

The other is we have a large footprint. As networks standardize, they standardize on Sunquest for their lab within the footprint. We have a lot of additional hospitals that convert to Sunquest within our base, but it’s the new hospitals that have converted to Sunquest that’s been part of our growth.

Then these applications in anatomic pathology — automation of anatomic pathology, sample management in anatomic pathology. 

There’s a fairly broad swath of solutions that have represented that growth.


A fair amount of the interest in the interoperability side is either preventing ordering of duplicate tests or doing alerting on abnormal results. Do you see a lot going on, or do you hand off to other systems for that?

No, we have those solutions. We do that. We’re constantly enhancing the solutions with new releases and new versions. Those things you mentioned we’ve considered as core capabilities for a best-of-breed lab solution for many years.


Are you expecting or experiencing international growth?

Yes. We’re expecting and experiencing international growth — both of the above.

We’ve made an acquisition in the UK. We’ve got a great solution over there which does a lot of what you’ve just asked about – alerting about orders and resulting. It’s in use by 65 percent of the national health hospitals in the UK and nearly 50 percent of the doctors’ offices use that particular solution. 

We have around 300,000 users in the UK, but we’re also expanding internationally, putting more resources in. We recently added new customers in Australia and we’re looking for further expansion in the international marketplace.


Any concluding thoughts?

We’ve been very successful. We’re growing and we’ve also created a lot of value, but I think that value is really reflected in the solutions and in the quality of the solutions that we provide. I feel very fortunate to be in the position I’m in and to have had the opportunity to take some steps forward in this way.

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November 9, 2012 Interviews 1 Comment

News 11/9/12

November 8, 2012 News 4 Comments

Top News

11-8-2012 5-13-39 PM

Allscripts reports Q3 results: revenue down 1 percent, EPS $0.23 vs. $0.24 excluding special items, missing consensus revenue estimates by 4 percent but beating adjusted EPS estimates by a penny. Earnings were down by more than 50 percent on asset write-downs and slipping margins. CEO Glen Tullman confirms earlier reports that the company is evaluating strategic alternatives, adding that the company will not comment further on the issue and will not issue financial guidance for the next quarter.

Reader Comments

From Curious in Cleveland: “Re: Lyman Sornberger, executive director of revenue cycle management at Cleveland Clinic. Two confidential informants confirm that he’s out – any idea why? I’m a loyal reader and ex-Epic. Judy had me scared stiff to report anything to any blog, so this is a real thrill for me even if you don’t publish it.” Unverified. We’ll see if anyone confirms. I get basically no reports from anyone at Epic, so you’re not alone there.

From Coyote: “Re: McKesson. Half verified – they will acquire Greenway and athenahealth.” Unverified and unlikely given that those are two publicly traded vendors of competing systems with market caps totaling more than $2.5 billion. However, experience has taught me to at least mention even bizarre rumors just in case they happen to come true. If this rumor is accurate, it would easily be the most bizarre. Color me even more skeptical than usual.

HIStalk Announcements and Requests

11-5-2012 12-43-17 PM

This week’s HIStalk Practice highlights include: CMS adds a couple of new hardship exemptions for the e-prescribing rule. As more hospitals buy physician practices, facility fees for routine office visits are expected to increase Medicare spending $2 billion a year by 2020. The number of physicians in independent practices is predicted to drop to 36 percent by 2013. Occasional HIStalk  contributor Lyle Berkowitz, MD earns a spot on the list of Top 25 Clinical Informaticists. The most commonly deferred Stage 1 menu objectives by EPs include providing patients with a summary of care at transitions, using EHRs for reminders, and reporting data to public health agencies. NYeHC Executive Director David Whitlinger provides an overview of his organization and its initiatives. Stop by HIStalk Practice to get the latest ambulatory HIT updates, and while you are there, check out a few of our sponsor offerings and sign up for e-mail notifications. Thanks for reading.

On HIStalk Mobile, the talented and knowledgeable Lt. Dan is putting up several news items each day, while Dr. Travis has written an immediately popular post called Where I Would Invest. We don’t want to overload your inbox with the news posts, so you’ll get notification only of Travis’s longer posts if you sign up for updates. Thanks to HIStalk Mobile’s sponsors: 3M, Access, AT&T, Imprivata, Kony Solutions, Truven Health Analytics, Vocera, and White Plume.

11-8-2012 6-47-17 PM

Welcome to new HIStalk Platinum Sponsor Clinovations. The advisory practice of the DC-based company targets ambulatory and inpatient provider organizations, non-profits, and federal and state government. Their expertise includes patient safety, quality, and all phases of electronic medical records implementation. I mentioned Pitt County Memorial as one of the North Carolina academic medical centers running Epic and I’ve learned two things about that since yesterday: (a) Clinovations provided go-live support, EMR optimization, and physician engagement services for their implementation; and (b) the hospital changed its name earlier this year to Vidant Medical Center, with the 10-hospital system now going by the name of Vidant Health. I first connected with Clinovations a few weeks ago when I interviewed CEO Trenor Williams, MD, recommended to me by Travis from HIStalk Mobile, who knows him. More than half of the company’s 100 employees are clinicians, Trenor told me. In fact, read the interview to get a feel for how the company works (hint: they’re big on upfront optimization planning, wringing value from EMR implementation, and using data to improve care delivery). Thanks to Clinovations for supporting my work.

On the Jobs Board: Systems Engineer, Epic and Cerner Resources, Senior Certified Epic Analyst, Senior Quality Engineer. HIStalk Platinum Sponsors post their jobs for free, while everybody else watches enviously because they aren’t allowed to post jobs there at all.

11-8-2012 7-41-58 PM

It’s unfortunately unfashionable to divert one’s attention from self-absorbed activities to take a moment to think about members of our military, living and dead, whose sacrifices (ranging from modest to ultimate) provide us with the illusion that the world is full of caring people who wish us no harm. Sunday is Veterans Day, the eleventh day of the eleventh month that is set aside to honor every man and woman who has served this country in uniform. It’s a real shame that most cities don’t bother to have Veterans Day parades any more, but chances are you know a veteran or will see someone in uniform this weekend who would be grateful for nothing more than a nod and a “thanks for your service” instead. If you served, thank you. If not, thank them.

Acquisitions, Funding, Business, and Stock

11-8-2012 5-12-54 PM

Cerner will acquire Anasazi Software, Inc., a provider of behavioral health technology.

11-8-2012 9-04-55 PM

Accretive Health’s Q3 numbers: revenue up 2 percent, EPS $0.03 vs. $0.07. They signed some new revenue cycle management deals despite being run out of Minnesota for harassing ED patients to pay up. Amusing: their AR days jumped from 48 to 56 due to “delayed payments from a few customers.” They must not have strong-armed their own customers like they did those of their hospital clients, although they did take “action relative to the resources that were local in the market and focused on the clients in those areas,” i.e. fired their Minnesota employees once the company got the boot from there.

11-8-2012 9-06-55 PM

A Reuters article says that Merge Healthcare has attracted the interest of at least five private equity firms as it contemplates taking itself private. Named as suitors Thoma Bravo LLC, GTCR LLC, Welsh Carson Anderson & Stowe, Francisco Partners, and Avista Capital partners. Sources say the company hopes to have offers by today (Friday).

For-profit hospital operator Vanguard Health Systems announces that it will consolidate its IT operations in San Antonio. They will move to the Inner City Reinvestment/Infill Policy zone, which sounds great for corporate tax credits but lousy for night shift computer operators.


11-8-2012 11-13-52 AM

SAIC subsidiaries maxIT Healthcare and VCS close a combined $102 million in contracts from several North American hospital and clinics.

Summit Radiology Associates (NJ) selects Merge Healthcare’s radiology suite.

The DoD awards Evolvent Technologies a $20.5 million contract to build additional coding, database uses, and mobile applications into AHLTA-Theater.


11-8-2012 7-53-38 AM

Lakeland Regional Health System (FL) names J. Scott Swygert, MD chief quality officer and CMIO.

11-8-2012 2-55-02 PM

Vermont Information Technology Leaders appoints John K. Evans (Strategic Alliance Advisors dba s2a) president and CEO of its statewide HIE.

Announcements and Implementations

Wellmont Health System (TN) will begin file building for its Epic implementation in January and will phase its go-live throughout 2014.

11-8-2012 8-21-12 AM

The 17-provider Reedsburg Physicians Group (WI) goes live next week on GE Centricity EMR.

11-8-2012 9-07-52 PM

Park Nicollet Health Services (MN) goes live with Levi, Ray & Shoup’s VPSX software solution for document and printer management.

RamSoft will integrate MModal’s Speech Understanding technology into its PowerServer RIS/PACS, PACS, and Tele Plus Systems.

Government and Politics

11-8-2012 10-27-38 AM

CMS releases updated reference grids for Stage 1 and 2 MU requirements, including details on how MU objectives align with EHR certification criteria.

HRSA (Health Resources and Service Administration) offers a November 16 Webinar called Patient Charting and Documentation in an Electronic Health Record for Nurses and Allied Health Professionals, with presenters that include practicing nurses.

11-8-2012 9-09-52 PM

El Camino Hospital (CA) considers a legal challenge after voters narrowly pass Measure M, which will limit the pay of its executives to twice the governor’s annual salary, or around $350K. CEO Tomi Ryba, CFO Michael King, and CMO Eric Pifer, MD would all see major pay cuts if the legality of the measure is upheld. Meanwhile, an SEIU-UHW union steward admits that the union proposed the measure only because hospital officials declined to meet with its leadership in last year’s labor negotiation in which the union was unhappy that its members were no longer being offered free healthcare (that perk has since been reinstated).

Innovation and Research

A study published in the Journal of General Internal Medicine finds that clinical decision support tools in EHRs can help reduce the inappropriate use of antibiotics for acute respiratory infections.

Chicago startup MetisMD offers radiology second opinions for $75 (report review) to $250 (MRI, CT, PET, mammography, nuclear medicine, echocardiograms). Patients get a copy of their study, upload it to the company, and get a written report and a conversation with the radiologist within 1-2 days.


11-8-2012 6-27-29 PM

Healthcare venture capitalist Lisa Suennen says healthcare reform will create business opportunities for companies offering tools that can help manage chronic care and that keep people out of hospitals. She mentions one of her investments, SeeChange, which pays patients if they get annual blood work and agree to follow customized prevention guidelines that are generated from a mash-up of the lab results, personal health record information, and claims data. She says hospitals and insurance companies are vulnerable to marginalization if they are slow to react to the changes:

We are going from fee-for-service to not-quite-fee-for-service, in a pretty broad way, where you are paying fixed amounts for cases. Hospitals don’t know how to deal with that. The profit now will come from being efficient instead of being prolific. So they will need tools and programs and analytics to help them make that transition. The other area is the whole “retailization” of insurance. There is a huge, fundamental shift in the business, as individuals are driven more and more to buy their insurance from exchanges. Insurance companies don’t sell that way. They don’t have good brands from a consumer-satisfaction standpoint; in fact they have some of the worst brands in the world. So organizations that work on consumer brands are coming into the marketplace.

11-8-2012 8-40-18 PM

Motorola Solutions rolls out the HC1 Headset Computer, a self-contained wearable computer with a boom-mounted viewer that simulates a full-sized monitor, a two-way headset, and the ability to respond to voice or head-movement commands. It came out too late for making a fashion statement at AMIA.


Aprima announces that it has settled the lawsuit brought against it by Allscripts, which had claimed that the wording of Aprima’s advertised “MyWay Rescue Upgrade Program” violated state and federal laws. Aprima agreed to changed its advertising, but will continue to market its product to users of the Allscripts MyWay EHR. Allscripts previously announced that MyWay will not be upgraded to handle ICD-10 or Meaningful Use Stage 2, but customers will be offered a free conversion to its Professional product.

11-8-2012 6-39-47 PM

Athenahealth Chairman, CEO, and President Jonathan Bush appeared  on CNBC Thursday morning in a discussion about healthcare reform.

You’re going to get more rules and innovation anyway when the healthcare costs are going up faster than GDP. Everyone is going to force some innovation. In this next stretch, it will come from the government … Medicare first and the commercial health plans are falling nervously behind the tank that is Medicare … If you’re a buyer of healthcare, an employer or consumer, you’re going to see two things. You’re going to see some markets where hospitals rally around and buy up doctors. We’ve seen half the doctors in the country become employed in the last three years in preparation for this. And then jack up commercial rates and say, “I got this huge group of Medicaid rates coming in, I’m going to jack up” … we saw this in Massachusetts, the first state that did this. Commercial rates went up 50 percent for the same coverage over a five-year period just for the commercial side … The hospitals bought all the doctors and said, “You can’t have any of us unless you go up.” There will be others who figure out how to get cheaper. They’ll get more efficient. They won’t need to raise rates. And then the third group will be the ones who go bust … they’re supposed to go bust. Please, no bailouts for the hospitals that go bust.

Here’s a new video on the Texas approach to a statewide HIE that involves 12 local HIEs.

11-8-2012 9-12-22 PM

Heisman winner runner-up and Indianapolis Colts rookie quarterback Andrew Luck signs his first big endorsement deal … with Riley Hospital for Children.

A new study finds that doctors, like most people, are subconsciously biased against the two-thirds of Americans who are overweight. If you’re obese, your best bet for compassion is to find a fat female doctor, the study results suggest.

FDA urges that providers writing prescriptions write neatly, minimize the use of abbreviations, and consider using e-prescribing instead. The practitioners being addressed are veterinarians.

inga_small This is nuts: genital injuries send 16,000 men and women to the ER each year.

Bizarre: a California couple lose a real estate fraud lawsuit when the husband, the director of pathology and clinical laboratories of Community Regional Medical Centers, admits that he faked the death of his wife, a former National Raisin Queen. The purchaser of their horse ranch, an anesthesiologist, says the couple faked her death to increase the value of their property to $2.3 million. The wife, a former waitress, changed her name from Genevieve Sanders to Genevieve Marie de Montremare and claimed to be a physician and French-born royalty. Their transgressions will cost them $1.55 million.

Sponsor Updates

  • API Healthcare CEO J.P. Fingado offers insight on how the results of the presidential election will affect the healthcare workforce.
  • Prognosis maintains its 100 percent success rate among its eligible clients achieving and attesting for MU.
  • GetWellNetwork launches Transformative Health, an online publication covering the intersection of patient engagement and technology.
  • 3M hosts a Webinar on the critical need to start ICD-10 education now.
  • White Plume offers advice on creating interoperability in preparation for the ICD-10 deadline in a blog post.
  • The IT director and a senior systems analyst from Henry Mayo Newhall Hospital will lead a November 14 Webinar on their use of solutions from Access to create a paperless admissions and bedside consent system, send completed forms automatically to their Meditech system, and maintain electronic registration and clinical activities when the hospital system is down.
  • Shareable Ink hosts a Webinar on preparing anesthesiologists to qualify for MU.
  • An article by T-System VP Greer Contreras highlights the need for physicians to describe their thought process when documenting to help prevent denial of payment.
    Bottomline Technologies publishes a case study that highlights Alamance Regional Medical Center (NC) and the efficiencies it has gained since implementing the Logical Ink e-form solution.
  • The Canadian Health Informatics Society honors Orion Health and eHealth Saskatchewan as Project Implementation Team of the Year for the successful integration of Orion Health’s Clinical Portal with four eHealth Saskatchewan applications.
  • Liaison Healthcare’s Gary Palgon, VP of healthcare solutions, discusses cloud-based solutions for big data during this week’s 12th Annual BMS IT Symposium in Princeton, NJ.
  • Robin Mitchell, MD (WA) shares how her practice has improved patient care by leveraging EMR support services from INHS in a company profile.
  • Ingenious Med becomes one of the most downloaded apps for Android.
  • SAIC subsidiaries maxIT Healthcare and Vitalize Consulting Solutions will exhibit at the NextGen User Group Meeting next week.
  • Fulcrum Methods recognizes new Meaningful Use-EP Tracker users, including Duke  Private Diagnostic Clinics (NC), Greenville Hospital System (SC), Lucile Packard Children’s Hospital at Stanford (CA), Physicians Medical Group of Santa Cruz County (CA), and University Hospitals-Cleveland (OH).
  • IT staffing company Digital Prospectors Corp ranks #9 on “Top 100 Private Companies for 2012” by Business NH Magazine.
  • Besler Consulting will participate in the HFMA Region 9 conference in New Orleans November 11-13.
  • Carl C. Jaekel of Santa Rosa Consulting offers five ingredients for successful ICD-10 activation in the company’s team blog.
  • Jason Fortin, a senior advisor with Impact Advisors, weighs in on meeting Stage 2 menu objectives.
  • MModal’s chief scientist Juergen Fritsch discusses ways for healthcare organizations to obtain a holistic view of patients’ health in an article published in the Allscripts Newsletter.
  • The latest version of Imprivata’s OneSign technology includes Fade to Look walk-away security for shared workstations, No Click Access for Citrix XenApp, and support for Epic 2012.
  • Florida State University student Bill Blough takes first place and a $1,500 prize in iSirona’s e Code-A-Thon competition.
  • Bottomline Technologies hostted a November 8 Healthcare Customer Insights Exchange to foster collaboration between healthcare organizations using its technology.
  • Wellcentive highlights Borgess Health (MI) and its use of Wellcentive’s Advanced Outcomes Manager solution for population health management and clinical analytics. 

EPtalk  by Dr. Jayne

I worked double shifts in the emergency department this week as a result of another physician defection. In case there’s any question, I can attest to the fact that the front-line physician shortage is very real, especially if patients are on Medicaid or are uninsured. Out of an entire day’s work, only two patients actually belonged in the ED – a child with a laceration and an adult with a fully dislocated finger. There were multiple patients there for medication refills, work notes, and plenty of malingering.

I think stationing a Boy Scout with a first aid kit outside the door of the hospital would have not only have provided great cost savings, but also also would have helped patients learn that many of their conditions could be treated at home with basic first aid training and a little common sense. Until we figure out how to educate patients on these things, we will continue to have unnecessary ED visits.

Other countries seem to do a better job with this. A friend who lives in Germany keeps telling me about the baby nurse that comes to her home to do basic parenting and health education (how to handle fever, why babies are fussy, what to do when your child falls and hits his/her head, etc.) Having something like that here would be fabulous. However, that would require what many interpret as government intrusion and it would certainly require government funding, so I don’t see it happening here anytime soon.

Here are some pearls of wisdom from last night’s adventure:

  • Influenza season is here. If your child has a fever, doping them up on Tylenol and sending them to daycare to infect everyone else is a bad idea.
  • When your child shoves something in her ear, do not try to get it out with a cotton swab. You will jam it in further. What I could have removed quickly and painlessly has now become a procedure that requires us to sedate your child and quadruple your hospital bill. And BTW, please do not call an ambulance for this.
  • Pain in a wrist you broke 10 years ago is not an emergency condition. I will screen you and send you home.
  • Asking me to diagnose a rash that is no longer present is just silly.
  • When you’re a homeless guy who just wants a warm place to hang out and a sandwich, it’s best not to strip naked and sexually harass the nurses and physician. We will call security. But if you keep your clothes on, we’ll board you for a little while.

I did have some downtime in the wee hours of the morning and tried to keep up on the massive stream of social media and correspondence that was flowing my way. One of my Tweeps mentioned that BlackBerry 10 looks “promising.” Unfortunately, the hospital firewall blocked my attempts to read the article. but I did find a blurb on YouTube. Anyone seen it and have good intel? It sounds like it has a slick camera feature that lets you go back in time to modify faces when someone blinks.


Inga’s not-so-secret admirer Dr. Lyle Berkowitz makes Modern Healthcare’s list of Top 25 Clinical Informaticists. Of all the honorees, he’s got one of the best-looking head shots. Being an anonymous blogger, I know I will never make the list, but it’s fun to see lots of HIStalk friends on it.

I ran across another first-hand account of the evacuation of NYU Medical Center, this time from a medical student. It depicts situations which would make great scenarios for your next disaster preparedness drill.

There have been lots of good tweets coming from attendees of the AMIA 2012 Annual Symposium. Lots of thoughtful ponderings on “real” interoperability and what data elements really need to be tracked across disparate care settings. Not a lot of photos, though. If you were there and have some good ones to share or general thoughts about the meeting, feel free to send them along.


Speaking of meetings, the NextGen Annual Users Group Meeting starts Sunday in Orlando. Hope to see some good pics and tweets from readers who are enjoying the warm weather and getting in some quality time with The Mouse.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 8, 2012 News 4 Comments

An HIT Moment with … John Vaughan, MD, Sharp HealthCare

November 6, 2012 Interviews No Comments

An HIT Moment with ... is a quick interview with someone we find interesting. John Vaughan, MD is director of medical informatics at Sharp HealthCare of San Diego, CA.

11-6-2012 8-25-07 PM

What are Sharp’s most important projects and biggest challenges?

We are engaged in implementation of dbMotion with our associated multi-specialty group, Sharp Rees-Stealy, and will also be engaged in implementing our HIE with our independent physician group at Sharp Community Medical Group. In addition, we have been in discussions with Family Health Centers of San Diego, a private nonprofit community clinic, for collaboration on patient discharge data. 

Also, we are working with the Beacon project of San Diego, facilitated by UCSD. We are in the process of connecting our EDs with the county Emergency Medical Services for near real-time receipt of electrocardiograms in our emergency departments. We are also resolving single sign-on issues for implementation of the Beacon interface.

What technologies are you using to connect with your affiliated practices and to prepare for an accountable care model?

Most of these technologies are involved with the projects I mentioned. In addition, we are also looking at ways in which we can simplify our analytic data analysis across the continuum of care.

What are your thoughts about recent concerns that EHRs encourage copy-and-paste physician documentation?

We have been actively involved in discussions with our health information management supervisors regarding this issue. We will continue to monitor this concern as further regulatory oversight rules are published.

What are some innovative projects you’ve been involved with at Sharp?

We are actively involved in a clinical documentation improvement project. In addition, we will be adding front end speech for improvement of our documentation process over the next several months.

What technologies have made the most positive difference in how your physicians practice?

We are continuing to see improved efficiencies for inpatient care as medical records become more unified. By making the right information available in the right place at the right time, we hope to enhance the overall physician experience.

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November 6, 2012 Interviews No Comments

News 11/7/12

November 6, 2012 News 1 Comment

Top News

11-6-2012 6-13-42 PM

ECRI Institute’s “2013 Top 10 Health Technology Hazards” report includes several patient issues that are IT-related or potentially IT-solvable: alarm hazards (#1); IV infusion pump errors (#2); data mismatches in clinical IT systems (#4); interoperability failures between IT systems and medical devices (#5); and caregiver distractions due to mobile devices (#9). The nonprofit organization’s report, which contains good assessment tools and recommendations, is available as an immediate and free download with registration.

Reader Comments

11-6-2012 6-20-18 PM

From Ron Strachan: “Re: Community Health Network in Indianapolis. I’m happy to report that we’re live on the final wave of Epic sites. Community is an Enterprise customer and now has four hospitals and over 200 sites of care live on EpicCare. The install started in April 2011.” Congratulations to the team there and to the CIO, which happens to be Ron. Epic “waves” of ambulatory go-lives within an organization are like an army’s push into enemy territory – cause for concern beforehand, but worth celebrating after the careful planning pays off.

From Karl: “Re: for Inga and Dr. Jayne. Beware … you are about to lose substantial time and money too.” The Pinterest page is shoe porn for the ladies, or possibly for cash-eager healthcare providers who specialize in treating the foot and leg damage that some of the more bizarre models surely cause. But as they say, it’s better to look good than to feel good.

From Tarheel Ingenue: “Re: UNC Health Care. Named Epic vendor of choice on Friday.” Unverified, but hardly surprising given that not only is Epic getting just about every big-hospital deal, they have several of UNC’s academic hospital neighbors as customers (Duke, Wake Forest Baptist, Pitt County in Greenville, and probably others I’m forgetting.)

11-6-2012 8-08-49 PM

From JB: “Re: soft drinks. Mayor Bloomberg isn’t the only one banning the sale of sugary drinks.” Children’s Mercy of Kansas City, MO will stop the sale of all sugar-containing drinks on January 1, including sugar-loaded faux healthy fruit juices. The hospital cafeteria emphasizes healthier food choices, encourages purchase of fruits and vegetables, and plans to trash their deep fryers by 2015. They will also switch all IVs from dextrose to normal saline starting in 2015 (OK, I made that part up). This is an admirable step in trying to lead by example. Outsourced food service departments of hospitals are big-time nutritional offenders in serving whatever is easy and cheap, although in their defense they’re selling what people unfortunately want. It would be interesting to see how many overweight people suck down sugary drinks regularly, which are surely the least-satisfying calories you can take in. Put your finger a third of the way up the side of a soda can – that’s how far the 140 calories’ worth of sugar would pile up if you removed the colored water.

HIStalk Announcements and Requests

inga_small I plan to get comfy on the couch tonight in front of the TV to watch the election returns. Hopefully by the week’s end I can unhide a few of my more politically passionate Facebook friends whose various posts have raised my blood pressure in recent weeks. I’ll then be happy to ignore all politics for awhile – at least until Bill Clinton keynotes at HIMSS.

We like reading tweets from conferences, so we’re offering sponsors a free tweet box from their annual user meetings. The one from Imprivata’s HealthCon is running to your right.

Speaking of meetings, AMIA’s seems to be going well judging from the tweets. Your report is welcome since we aren’t there.

Acquisitions, Funding, Business, and Stock

11-6-2012 11-32-56 AM

NexJ pays $5.5 million to acquire Broadstreet Data Solutions, a provider of data management, analytics, and mobile solutions.

11-6-2012 8-12-00 PM

Shareholders of Streamline Health Solutions vote to convert $5.7 million in convertible notes to preferred stock in order to reduce company debt and reduce interest expense.

11-6-2012 5-27-44 PM

Hearst Corporation, whose holdings include Zynx Health and First Databank, will acquire Milliman Care Guidelines LLC, a provider of evidence-based clinical healthcare databases.

11-6-2012 11-34-08 AM

Tenet Healthcare subsidiary Conifer Health Solutions, which provides business process management services to 500 hospitals, acquires Dell’s revenue cycle management business for hospitals and healthcare systems.

11-6-2012 8-12-33 PM

Vocera reports Q3 results: revenue up 27 percent, EPS $0.07 vs. -$0.25, beating estimates on both and raising earnings guidance.

As we reported earlier, McKesson announces that it will acquire Emendo Ltd., the New Zealand-based vendor of the CapPlan hospital capacity planning solution. Its customers are in New Zealand, Australia, the UK, and Canada, with some US hospitals signed since it began marketing here through partners in 2010.


11-6-2012 5-35-28 PM

Legacy Health (OR) contracts with Explorys for its platform and enterprise performance management applications to power Legacy’s PCMH and ACO initiatives.

11-6-2012 5-33-56 PM

Altru Health System (ND) selects Perceptive Software’s content and process management solutions to complement its Epic patient registration, HIM, and patient finance processes.

Baptist Health (AR) chooses the Patient Access Intelligence and Revenue Cycle Intelligence solutions from MedeAnalytics.

First Choice Health Centers (CT) signs with eClinicalWorks for its six-location community health center organization.

11-6-2012 8-15-02 PM

Coosa Valley Medical Center (AL) selects Merge Healthcare’s iConnect Enterprise Clinical platform, including Merge PACS, iConnect Access, and iConnect Enterprise Archive.

HomeTown Health buys McKesson’s CareEnhance-Review Manager Enterprise technology to increase the accuracy and efficiency of medical necessity review and documentation among its network of rural hospitals and providers.


11-6-2012 8-53-53 AM

Kaiser Permanente promotes President and COO Bernard Tyson to chairman and CEO, replacing the retiring George Halvorson.

11-6-2012 5-38-25 PM

Stuart Nelson, MD (US National Library of Medicine) joins Apelon as chief innovation officer.

11-6-2012 5-39-32 PM

The TriZetto Group hires Jeffrey Rose, MD (Ascension Health) as CMIO.

11-6-2012 11-19-30 AM

The Georgia CIO Leadership Association names Emory Healthcare CIO Dee Cantrell its CIO of the Year.

11-6-2012 7-08-21 PM

Tony Fonze, CIO of Carondelet Health Network (AZ), is named president and CEO of Carondelet’s St. Joseph’s Hospital of Tucson.

Announcements and Implementations

11-6-2012 5-41-04 PM

NYU College of Nursing and Rubbermaid Medical Solutions combine resources to develop and enhance clinical technology solutions for nursing education that will  include scholarship programs, telemedicine projects, and educational initiatives.

11-6-2012 12-01-28 PM

The executive director of HealtheConnections reports that about 1.2 million people in central and northern New York are now connected to its HIE.

First Databank releases the ICD-10 code set within its FDB MedKnowledge clinical decision support drug knowledge.

nVoq and Mi-Corporation will collaborate to deliver voice-enabled versions of commonly used templates for the home health and long-term care industries and will develop additional voice-enabled e-Forms for other healthcare settings.

11-6-2012 6-37-35 PM

One of my Advisory Panel members mentioned using Vendormate to review the financials and sanction record of prospective vendors. The healthcare-specific company recently announced Medzo, an online service that matches the needs of buyers with seller offerings, potentially eliminating the RFI process. Vendormate’s network covers 70,000 companies, 660,000 provider-vendor relationships, and 48,000 users. Hospitals get free access and vendors get a free basic listing in Medzo.

Government and Politics

A Masachusetts law went into effect this week that prohibits employers from requiring nurses to work overtime.

Innovation and Research

A Rand Corporation study finds that physicians with fewer than 10 years of experience account for 13.2 percent higher overall costs than physicians with 40 or more years of experience.


11-6-2012 12-41-13 PM

GE Healthcare issues a field safety notice to physicians warning of a potential defect in its Centricity PACS imaging systems that could result in the loss of images when sending exams from one Centricity PACS to another.

11-6-2012 5-56-24 PM

Eleven vendors own 80 percent of the HIE market, according to a new KLAS report. Epic, ICA, and Siemens MobileMD earned the top scores for overall connectivity and satisfaction, though scores for all HIE vendors except Cerner have declined over the past year.

Social workers in British Columbia are startled when their computers display the home page of the US Department of Homeland Security and an entry form labeled “Co-Conspirator.” Their new, problem-plagued software was modified from Homeland Security’s system by a contractor at a cost of $194 million and counting. The government shut down an $89 million student information system last year after giving up that its problems could be fixed.

Strange: a doctor tells a British couple who aren’t having any luck conceiving that the problem might be the husband’s laptop, which he props in his lap for several hours each evening to use Facebook. Three months after the husband starts using a table instead of his lap, his wife becomes pregnant.

Sponsor Updates

11-6-2012 6-00-26 PM

  • The Sandy Relief Drive of SRS generated almost $5,000 in employee donations, which the company then matched in purchasing supplies for affected employees. The balance of the money will be donated to the Red Cross and Governor Christie’s Relief Fund.
  • GetWellNetwork completes its 350th interface in US hospitals.
  • CHMB (CA) partners with Ingenious Med to expand its RCM service offerings to hospitalists.
  • Intelligent InSites announces that its software platform integrates with the ultra wide band RTLS from PLUS Location Systems.
  • iSirona offers a $1,500 prize to the winners of a Code-A-Thon programming challenge at Florida State University.
  • ICSA Labs calls for qualified EHR technology developers of both complete EHRs and EHR modules to participate in a pilot program for the 2014 Edition certification criteria.
  • Orion Health CEO Ian McCrae discusses the growth of his company and its approach to software integration in a video interview.
  • Imprivata is ranked 26th in the medium company category of 2012 Top Places to Work in Massachusetts.
  • eClinicalWorks receives full NCQA certification as a CAHPS PCMH survey vendor to conduct NCQA HEDIS surveys.
  • Philips SpeechMike Premium earns a perfect score of six dragons on Nuance Communication’s recording accuracy test for assessing compatibility with the latest version of Dragon Naturally Speaking.
  • Dawn Mitchell and Kathy Krypel of Aspen Advisors will co-present break-out sessions at next week’s HIMSS Midwest Fall Technology Conference in Des Moines, IA.
  • Eye Health Services (MA) selects SRS EHR for its 21 providers and 11 locations.
  • Quality IT Partners sponsored the 13th Annual Scott Hamilton CARES Initiative Gala and hosted a patient from the Cleveland Clinic Taussig Cancer Institute last week.


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

More news: HIStalk Practice, HIStalk Mobile.

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November 6, 2012 News 1 Comment

Readers Write 10/29/12

October 29, 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!

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


It’s Only One Extra Click
By Jonathan A. Handler, MD

10-29-2012 7-02-39 PM

Clinicians swear an oath to put patients first, so why is it so difficult to get them to adopt new processes and technologies designed to improve care? Perhaps my experience during the SARS outbreak can provide some insights.

In the middle of the SARS outbreak, I was the director of emergency medicine informatics at a large hospital in the heart of a major city. A tourist with SARS would likely come to our ED. SARS disproportionately affects caregivers, and our ED nurses serve as our first line of defense when working in triage. Since I had written our ED’s tracking system, they begged me to add a SARS screening tool. I refused, saying it would add work and they wouldn’t use it.

Persistent, they mounted a campaign to convince me. The screening required only a few questions. Only the first question needed to be answered if the patient had no fever. I could build it right into their existing workflow. It might save patient and caregiver lives. A compelling argument.

So I did it. We added just a single click to the workflow in the vast majority of cases.

Of the thousands of patients triaged the next week, on what percentage did the nurses do the single click needed to answer that first question on fever? One percent. What was the click rate for patients with a chief complaint of fever? Zero.

In a world of increasing patient volumes and decreasing staffing, time spent on health information technology (HIT) is largely an “unfunded mandate.” Many caregivers are overwhelmed, with literally not a second left to spare. Each second spent on an additional click must be stolen from something else. Faced with the choice of clicking a button to note that the current patient does not have a rare disease versus triaging the next acutely ill patient, the extra click loses almost every time. And rightly so.

Early HIT efforts (e.g. digital labs and EKGs, PACS) dramatically improved care and saved time for caregivers. More recent HIT (e.g. electronic documentation) has largely stolen time from caregivers without improving outcomes. Our hubris has been our belief that all HIT offers enough value to justify encroaching on direct care activities such as talking to patients, administering medications, and performing life-saving procedures.

Despite clearly proven benefit, for 150 years we’ve been unable to get clinicians to consistently wash their hands. Now we take away fast and easy paper and dictation, replace them with electronic health records (EHRs) driven by slow and clunky keyboard and mouse, ask clinicians to document more than ever, and we expect rapid adoption?

Not going to happen. When asked, clinicians will agree to anything that might improve care. When time is short, they will prioritize tasks in order of perceived importance. Care will supersede documentation and quality initiatives that are not relevant to the immediate need.

One therapeutic prescription: things that save time for clinicians – such as badge and biometric login, single sign-on, context management, transcription services, speech recognition with natural language understanding, analytics, mobile access, and seamless integration with the local health information exchange – must be considered “mandatory pre-requisites.”

Right now, most consider these “nice to have some day.” The issue is much more than clinician resistance: patients are suffering from delays in care due to EHRs, and too often the promise of HIT is not being realized. When we recognize that one extra click is nearly always one too many, we (and our patients!) will have taken the first step on the road to recovery.

Jonathan Handler, MD is chief medical information officer at MModal.

Prepare Now for More Patient Requests for Medicare’s Annual Wellness Visit
By Averel B. Snyder, MD

10-29-2012 6-52-27 PM

Medicare records show that less than seven percent of people aged 65 and older have taken advantage of the Medicare Annual Wellness Visit (AWV). While it’s surprising that so few patients are receiving this important benefit, what’s even more alarming is that many seniors don’t know the AWV is even available. In fact, another study conducted by the John A. Hartford Foundation found only 32 percent of seniors are even aware of the benefit.

As more seniors become aware of the AWV and its benefits, these statistics will undoubtedly rise—and quickly. There’s no better time to prepare than now, as Medicare’s Open Enrollment period is now underway, and more than 49 million Medicare beneficiaries are being inundated with literature about all Medicare benefits, including the AWV. Physicians must be prepared not only to answer patient questions about the AWV, but also to provide the service efficiently and effectively.

The AWV includes specific components that address all aspects of a senior’s health status—physical and mental. A comprehensive AWV involves not only a review of a patient’s medical history and medications, but also a conversation about his or her functional ability and lifestyle issues that impact health. A list of risk factors, conditions, and treatment options must be established. Cognitive function must be assessed, and a 5-10 year preventive screening schedule created.

Until now, many physicians have been hesitant to offer the time-intensive AWV. That’s certainly understandable, given the challenge the hour-long visit poses to physicians who have limited time to visit with patients, especially when ongoing acute care visits are a priority. Fortunately, there are steps that can be taken now to get ready to accommodate a growing number of patient requests for this benefit.

  • Step 1: Use a non-physician practitioner (NPP) to conduct the AWV. The Affordable Care Act allows NPPs to deliver the service—which in turn enables physicians to focus on problem-oriented visits.
  • Step 2: Automate the process as much as possible with an electronic solution that identifies age- and gender-appropriate health screenings based on the patient’s health risk assessment (HRA). This solution can also dynamically generate a personalized prevention plan, order screenings or tests indicated during the AWV and make necessary referrals. If you have an electronic medical record (EHR) system, the solution should be integrated. This reduces documentation time, ensures an accurate patient health record, and prompts physicians to ask questions at follow-up visits based on the wellness visit recommendations.

Because a key component of the AWV is a personalized preventive health plan that’s updated each year, it’s also important to use a solution that provides recommendations for areas such as nutrition and exercise that are based on accepted guidelines and protocols. That way, you don’t have to have a number of staff members on hand who are trained to address those specialty areas.

Every year, the government spends $500 billion to treat Medicare patients impacted by chronic conditions. Many of the most costly chronic conditions — including heart failure, coronary heart disease, and diabetes — can be easily prevented with routine screening, which is what the AWV is designed to ensure. NPPs and technology can help physician practices offer this valuable benefit to patients in an efficient and cost-effective manner, and as a result, improve the quality of patient care and the level of patient satisfaction.

Averel B. Snyder, MD is co-founder and chief medical officer of Senior Wellness Solutions

Throw MU Out the Window!
By Darius LaGrippe

I don’t watch the presidential debates because they are irrelevant. I already know who I am voting for, and I’m certain the adorable concerns of swing voters are of no interest to me.

On the other hand, I sure do like to start a debate from time to time. Like right now.

It could be argued that the introduction of MU has destroyed more jobs than it has created. MU might be the cause of incredible amounts of lost patient information. MU might even be taking technology backwards.

Let’s face it. Smaller vendors with tighter budgets don’t have the free cash flow like that of larger corporations for development and marketing expenses, which denies startups and small vendors competitive resources for meeting the newest regulatory mandates, not to mention the Meaningless Use requirements that reimburse physicians for adopting electronic health records.

Unfortunately, those small, down-to-earth, client-focused private vendors ultimately dissolve or are absorbed. In my opinion, the products being acquired often are better than the larger companies’ product offerings, but when you answer to the stockholders, the
clients are there for your benefit. So who cares about the product?

Adopting electronic health records is very costly. Especially when the chief benefactors are ultimately the larger EHR vendors sucking up the stimulus milk shake through the government straw. With all these EHR products on the outs, who is responsible for maintaining that software and database you paid eleventy-thousand dollars for three years ago?

Not the vendor, because they are off the hook when your maintenance agreement expires, and they are not offering a renewal for your product. What kind of crappy loophole is this? During this realization, you might scream out loud like me, exclaiming, “This should be unlawful!”

The vendors are bound by the same HIPAA requirements as doctors and can be held accountable for HIPAA breaches. Last I knew, HIPAA had a six-year retention requirement, which follows federal statute for limitations for civil penalties(42 CFR Part 1003). If the physicians are required to maintain those records, shouldn’t the vendors be held to the same standard? Of course they should. Vendors should be required to either support and maintain those records for six years from when the product is shelved during “end of life cycle” or provide a comprehensive migration path for those clients at very little cost.

However, being a victim of an acquisition shouldn’t automatically force the physicians into a product they don’t want. The physicians shouldn’t be pigeonholed into a downgrade, upgrade, or migration. They should have the option to refuse the new product and seek a new one. Physicians should be able to demand their patients’ data from the vendor in a reasonable amount of time. Vendors should relinquish ownership of the patient data to the clients so they can at least explore their own migration path.

We’re talking about people’s health. Their lives. The records shouldn’t suffer the same attrition as the employees of the acquisitions, and the demise of the EHR shouldn’t be an albatross around physicians’ necks.

If the intentions of the HIT stimulus were to engage patients in their healthcare, provide physicians means to better electronic systems, and possibly even boost the economy, they are doing it wrong. That $19 billion should have been invested into the smaller companies to help produce better, cheaper technology at a faster pace and to keep the industry competitive. Instead we see attrition, poorly integrated products with no better standards than we had four years ago, and innumerable amounts of lost patient records.

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October 29, 2012 Readers Write 2 Comments

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Reader Comments

  • GeekyNurse: Isn't that why so many are focused on practices? Whether large PHOs/IPAs or the zebra-like solo practitioner? While a...
  • Deborah Kohn: I like that --- the patient's (electronic) "care management medical record." Goodbye EHR or EMR or any of those moniker...
  • Pilsner: Great interview. Hearing John's highly informed but also practical, in the trenches, perspective at this time in the pol...
  • Bill Spooner: Great interview - tremendous insights. Thanks for sharing....
  • Tom Ihlenfeldt: We are thankful for your blog, Dr. Jayne! Have a wonderful Thanksgiving!...

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