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Dr. Sam 6/18/12

June 18, 2012 News 5 Comments

A Key Missing Element of EHRs

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

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

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

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

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

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

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June 18, 2012 News 5 Comments

News 6/13/12

June 12, 2012 News 8 Comments

Top News

6-12-2012 9-34-40 PM

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

Reader Comments

6-12-2012 7-33-56 PM

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

6-12-2012 8-12-05 PM

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

HIStalk Announcements and Requests

6-12-2012 9-40-51 PM

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

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

Acquisitions, Funding, Business, and Stock

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

6-12-2012 10-04-47 PM

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


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

6-12-2012 10-03-09 PM

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

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

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

6-12-2012 6-43-44 PM

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

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

6-12-2012 7-01-09 PM

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

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

6-12-2012 9-06-01 PM

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


6-12-2012 7-37-34 PM

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

Announcements and Implementations

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

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

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

6-12-2012 6-49-38 PM

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

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

6-12-2012 8-22-21 PM

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

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

Government and Politics

6-12-2012 7-11-23 PM

6-12-2012 7-12-26 PM

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

Innovation and Research

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

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


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

6-12-2012 6-32-52 PM

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

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

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

6-12-2012 10-11-08 PM

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

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

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Mobile.

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June 12, 2012 News 8 Comments

Readers Write 6/6/12

June 6, 2012 Readers Write 2 Comments

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

Moneyball and the Power of Data Analytics
By Gerard Livaudais

6-6-2012 7-49-34 PM

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

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

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

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

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

1. Focus on the Data that Matter

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

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

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

2. Leverage Internal and External Data

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

3. Influence Positive Patient Behavior

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

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

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

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

Gerard Livaudais is chief medical officer of Quantros.

Care in an Emerging Market
By Arvind B. Deshpande

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

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

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

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

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

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

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

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

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

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

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

Why We Do What We Do
By Dan Herman

6-6-2012 8-07-40 PM

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

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

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

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

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

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

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

Dan Herman is founder and managing principal of Aspen Advisors.

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June 6, 2012 Readers Write 2 Comments

Monday Morning Update 6/4/12

June 3, 2012 News 12 Comments

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

6-3-2012 4-22-51 PM

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

6-3-2012 4-24-33 PM

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

6-3-2012 3-39-45 PM

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

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

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

6-3-2012 5-18-20 PM

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

6-3-2012 4-18-12 PM

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

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

6-2-2012 5-58-49 AM

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

6-2-2012 6-13-26 AM

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

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

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

6-2-2012 7-37-32 AM

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

6-3-2012 5-21-32 PM

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

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

6-3-2012 5-22-50 PM

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

6-3-2012 5-26-50 PM

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

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

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

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

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

E-mail Mr. H.

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June 3, 2012 News 12 Comments

News 5/30/12

May 29, 2012 News 4 Comments
Top News

5-29-2012 6-49-41 PM

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

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

Reader Comments

5-29-2012 9-35-06 PM

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

5-29-2012 9-43-09 PM

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

HIStalk Announcements and Requests

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

5-29-2012 7-32-12 PM

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

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

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

Acquisitions, Funding, Business, and Stock

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


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

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

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

5-29-2012 9-39-50 PM

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

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


5-29-2012 6-25-56 PM

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

5-29-2012 9-04-28 PM

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

Announcements and Implementations

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

5-29-2012 9-47-44 PM

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

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

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

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

Government and Politics

5-29-2012 8-21-39 PM

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

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

Innovation and Research

5-29-2012 9-50-59 PM

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


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

5-29-2012 8-31-19 PM

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


5-29-2012 9-56-06 PM

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

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

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

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

Sponsor Updates

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


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

More news: HIStalk Practice, HIStalk Mobile.

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May 29, 2012 News 4 Comments

News 5/25/12

May 24, 2012 News 4 Comments

Top News

5-24-2012 10-09-40 PM

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

Reader Comments

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

5-24-2012 8-38-23 PM

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

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

HIStalk Announcements and Requests

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

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

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

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

5-24-2012 7-33-33 PM

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

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

Acquisitions, Funding, Business, and Stock

5-24-2012 10-23-35 PM

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

5-24-2012 10-24-12 PM

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

5-24-2012 10-25-05 PM

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

5-24-2012 10-25-40 PM

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

5-24-2012 10-26-54 PM

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

5-24-2012 9-41-22 PM

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

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


5-24-2012 10-28-21 PM

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

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

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

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

5-24-2012 10-29-37 PM

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


5-24-2012 5-43-53 PM

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

5-24-2012 9-15-32 PM

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

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

Announcements and Implementations

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

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

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

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

5-24-2012 10-01-00 PM

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

Government and Politics

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

5-24-2012 8-50-20 PM

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

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

Innovation and Research

5-24-2012 7-28-55 PM

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

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


5-24-2012 9-30-25 PM

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


5-24-2012 6-55-36 PM

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

5-24-2012 10-31-35 PM

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

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

5-24-2012 5-59-05 PM

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

5-24-2012 8-57-20 PM

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

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

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

5-24-2012 10-33-51 PM

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

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

Sponsor Updates

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

EPtalk by Dr. Jayne


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

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


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


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

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

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

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


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



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

More news: HIStalk Practice, HIStalk Mobile.

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May 24, 2012 News 4 Comments

Dr. Sam 5/23/12

May 23, 2012 News 5 Comments

On the Other Side of the Quality Chasm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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May 23, 2012 News 5 Comments

Curbside Consult with Dr. Jayne 5/21/12

May 21, 2012 Dr. Jayne 3 Comments


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

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

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

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

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

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

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

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

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

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

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


E-mail Dr. Jayne.

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May 21, 2012 Dr. Jayne 3 Comments

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

May 18, 2012 Time Capsule 2 Comments

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

I wrote this piece in May 2007.

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


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

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

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

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

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

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

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

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

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

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

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

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

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

What happens in between is up to us customers.

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May 18, 2012 Time Capsule 2 Comments

News 5/16/12

May 15, 2012 News 5 Comments

Top News

5-15-2012 7-53-49 PM

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

Reader Comments

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

5-15-2012 7-06-30 PM

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

HIStalk Announcements and Requests

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

Acquisitions, Funding, Business, and Stock

5-15-2012 8-48-22 PM

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

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

5-15-2012 8-20-04 PM

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


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

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

5-15-2012 7-28-46 PM

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

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

5-15-2012 7-29-39 PM

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

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

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

5-15-2012 7-32-13 PM

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

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

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

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

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


5-15-2012 6-05-47 PM

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

5-15-2012 6-07-26 PM

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

5-15-2012 6-08-50 PM

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

5-15-2012 6-09-38 PM

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

Announcements and Implementations

5-15-2012 8-38-16 PM

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


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

5-15-2012 8-39-34 PM

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

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

5-15-2012 8-15-40 PM

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


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

5-15-2012 7-35-18 PM

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

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

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

Sponsor Updates

5-15-2012 6-33-12 PM


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


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

More news: HIStalk Practice, HIStalk Mobile.

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May 15, 2012 News 5 Comments

Curbside Consult with Dr. Jayne 5/14/12

May 14, 2012 Dr. Jayne 3 Comments


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

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

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

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

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

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

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

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

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

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


E-mail Dr. Jayne.

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May 14, 2012 Dr. Jayne 3 Comments

News 5/4/12

May 3, 2012 News 7 Comments

Top News

5-3-2012 9-30-09 PM

The US Congress asks Accretive Health CEO Mary Tolan to provide the company’s hospital customer list, employee policies, and past complaints, citing its concerns about violations of HIPAA, EMTALA, and the Fair Debt Collection Practices Act. Above is a snip from the letter. AH shares dropped 3% Thursday and another 2% in extended trading, having given up 58% in the past four weeks.

Reader Comments

5-3-2012 10-40-37 PM

inga_small From Calorie Counter:  “Re: Cinnabon and nurses. Cinnabon is giving nurses free rolls (730 calories, 24 grams of fat) in honor National Nurses Week. Maybe hospitals should ban Cinnabon consumption.” Yeah, well, I wish hospitals good luck with enforcing that. Here’s another brilliant marketing idea: maybe CVS should consider honoring nurses by giving them a free pack of cigarettes.

5-3-2012 3-21-45 PM

inga_small From HIPAA Police: “Re: passwords. A nurse in IMCU was complaining to me about having to remember too many passwords. She then showed me the back of the badge to illustrate just how bad it is and let me take this photo.” In case you can’t make it out, her badge notes the passwords for several different systems, including Pyxis, pharmacy, and e-mail. I am sure that HIPAA Police does not work at the only hospital that can’t afford an SSO solution, so how do others manage multiple passwords? Bigger badges?

From Sweet Tea: “Re: size of the healthcare IT market. One commercial company’s estimate is $40 billion per year, close to your estimate of three times Vince’s $12 billion revenue number for the largest companies.”

5-3-2012 9-14-13 PM

From Stock Analyst: “Re: size of the healthcare IT market. Our company thinks it’s around $32 billion in size, of which $9 billion is hospitals.” Thanks for that information.

From J-Lo: “Re: Stage 2 comments. I seem to recall that with the Stage 1 NPRM, you could see the comments everybody else submitted. Is that not the case with Stage 2?”

From Nasty Parts: “Re: Allscripts. If things to continue to go bad for Glen Tullman, he can always focus on his other company. How many people know that Glenn is the CEO of another company?” At least 20,000+, assuming HIStalk’s readers paid attention when I mentioned it a couple of times in the past. People are always sending me stuff that I’ve already run, though, so maybe they’re trained by newspapers to assume that small stories aren’t important and are skimming HIStalk posts just a bit too fast. Here, I could describe World War III in one paragraph while using twice that space to rave about some weird band I like.

5-3-2012 10-45-36 PM

From Moe: “Re: Trinity Health. The group of hospitals in Columbus, OH (Mt. Carmel) brings 10,000 users live on Cerner big bang , including revenue cycle, clinicals, lab, and more.” Nice. If you have any pictures, send them over. Who doesn’t love command center pics?

HIStalk Announcements and Requests

inga_small This week’s highlights from HIStalk Practice: electronic medication reminders may improve adherence in the short term, but long term effectiveness remains unclear. More than 40% of all primary care providers are enrolled in RECs, including 50,000 in practices with fewer than 10 physicians. CareCloud CEO Albert Santalo wins Miami’s Technology Entrepenueur of the Year award. Dr. Gregg muses on odds and ends, inluding a shift in HIT discussions beyond Meaningful Use and the end of service for a few clinical informatics professionals. If you’re not a regular HIStalk Practice reader, what are you waiting for? And if you are one of the thousands of readers stopping by each month, many thanks!

A few folks always seem to be getting Inga and me confused, sending her information intended for me. Just to clarify: we don’t tag straight news items with who wrote them – we both do. If Inga adds her opinion, answers a question directly, or otherwise writes something in a way that might not be clear who’s talking, I put the little red icon in front of that item (as above). Otherwise, it’s me (Mr. H) you’re reading. I was tagging my items with a blue icon, but that was a bunch of unnecessary blue icons given that it’s just the two of us (other than Dr. Jayne, who has her own clearly marked section).

A pet peeve: confusing one-word adjectives with two-word nouns and adverbs. Example: Walmart may have everyday low prices, but you will see them in the story every day (not everyday.) You may have a backyard swimming pool, but it’s not in your backyard.

Acquisitions, Funding, Business, and Stock

5-3-2012 10-46-44 PM

MedAssets reports Q1 numbers: revenue up 15%, EPS $0.00 vs. -$0.28, with the company pointing to costs involved in its Broadlane acquisition in November 2010, but still beating estimates on both revenue and earnings. Non-GAAP earnings were $0.24 vs. $0.17.

5-3-2012 10-48-24 PM

The Advisory Board Company announces a 2-for-1 stock split following the release of its Q4 numbers: revenue up 33%, EPS $0.46 vs. $0.30.

5-3-2012 7-00-07 PM

Amcom Software acquires the IMCO-STAT CTRM product from IMCO Technologies that will allow traceable delivery of critical lab test results to the ordering physician by paging, PCs, tablets, and smart phones.

Facebook’s upcoming IPO will raise about $11 billion based on Thursday’s announced price range, valuing the former dorm room project at up to $100 billion.

Two law firms file class action lawsuits against Allscripts, charging the company and its officers with intentionally hiding failed integration efforts, missing its revenue and earnings guidance, and misrepresenting its post-merger prospects after it acquired Eclipsys. All routine and rarely meaningful, of course, guaranteed to happen when any company’s stock drops unexpectedly.


HHS contracts with Archimedes, Inc. to develop a modeling and simulation software platform for clinical scenarios, health interventions, and disease conditions.

5-3-2012 10-50-58 PM

Samaritan Regional Health System (OH) enters into a multi-year contract with CareTech Solutions for comprehensive IT services.

Radiology Associates of Fox Valley (WI) selects McKesson Revenue Management Solutions for its 33-physician practice.

Shands HealthCare will use the Rothman Index to monitor patient status and to conduct research at its Gainesville and Jacksonville campuses. I interviewed co-founder Michael Rothman 18 months ago for insight into how the software works.


5-3-2012 5-50-23 PM

Medecision names Katherine Schneider MD (AtlantiCare) as chief medical officer.

5-3-2012 8-32-58 PM

Former Eclipsys CFO Bob Colletti joins academic credentials exchange vendor Parchment as CFO.

5-3-2012 9-49-51 PM

MIT Sloan CIO Symposium chooses four finalists for its CIO innovation award based on four criteria: trusted advisor, business leader, strong communicator, and proven manager. Among the finalists is Catherine Bruno, VP/CIO of Eastern Maine Healthcare. Healthcare CIOs on the speaker list for the May 22 event include James Noga (Partners HealthCare), Chuck Podesta (Fletcher Allen Health Care), and Sue Schade (Brigham and Women’s Hospital.)

5-3-2012 9-56-07 PM

DuPage Medical Group (IL) names Krishna Ramachandran as chief information and transformation officer, where he will lead the 330-physician group’s Value Driven Health Care initiative. I note that he’s a member of the HIStalk Fan Club on LinkedIn, so special congratulations to him (it’s fun to read down the list of 2,408 members – since most folks have photos, it’s like an HIT yearbook.)

Announcements and Implementations

Mercy Health System (PA)  activates its Meditech EHR across its four hospitals and 44 physician offices.

Phoebe Putney Memorial Hospital (GA) goes live on McKesson CPOE on May 15.

5-3-2012 10-57-06 PM

Newark-Wayne Hospital (NY) goes live on Epic as part of Rochester General Health System’s $65 million EHR initiative.

JPS Healthcare (TX) will go live on its $110 million Epic system this Saturday, the seventh Metroplex-based health system to do so.

Practice Fusion launches an API that allows any laboratory to connect directly to its EMR and send lab results using standard HL7 data files.

Gartner names Kony Solutions a Visionary in its report on mobile application development platforms. The company also announces that it supports the BlackBerry 10 platform.

CE Broker announces the EverCheck paperless system for automatically verifying professional licenses for credentialing, including sending alerts about licensure status changes and maintaining an archive of all licensure changes for Joint Commission review. The price is $0.45 per employee per month.

Vassar Brothers Medical Center (NY) credits technology it had just installed with saving the life of a firefighter who had a heart attack during a fire. His EKG, taken immediately in the ambulance, was sent to cardiologists at the hospital, allowing them to hit a door-to-balloon time of 18 minutes, a third of the standard. The technology they use is AirStrip Cardiology (remote EKG viewing), GE Healthcare’s MUSE Cardiology (EKG storage), and Physio-Control’s LIFENET (EKG sharing between emergency medical services and hospitals).

5-3-2012 9-03-46 PM

The Johns Hopkins Hospital opens its new Sheikh Zayed Tower and The Charlotte R. Bloomberg Children’s Center using the Versus Advantages RTLS to support asset tracking, fleet management, nurse call automation, and food cart tracking. New York Mayor Mike Bloomberg donated $120 million of the $1.1 billion construction cost of the two towers.

MediServe announces a Web-based solution for private practice therapy providers. The Attigo system includes billing, documentation, scheduling, and practice management.

Government and Politics

During this week’s HIT Policy Committee meeting, members discussed whether licensed professionals and scribes should be allowed to enter data into EHRs on behalf of physicians under the Stage 2 MU program. The proposed rule would require physicians to use their own user IDs when accessing the system, also holding them responsible for approving information entered on their behalf by anyone else. Several committee members raised concerns that the doctor won’t benefit from clinical decision support otherwise since most systems provide their guidance during order entry.

Also from the HIT Policy Committee meeting: CMS reports that more than $5 billion in Medicare and Medicaid MU incentive payments have been made to 93,650 EPs and hospitals through the end of April.

5-3-2012 5-59-09 PM

Representative Renee Ellmers (R-NC), chair of a House subcommittee on health technology (also a nurse and the wife of a surgeon), asks CMS to exempt from MU requirements those physicians in small practices and those close to retirement.


The US again outspends other industrialized countries on healthcare with mixed results. At $8,000 per person, well above the next-highest Norway and Switzerland at $5,000, survival rates for breast and colorectal cancer were the highest, but death rates for asthma and diabetes-related amputations were also the highest. The report blames US costs on expensive drugs, medical services, and technology such as MRIs and CT scans, with a high obesity rate also adding to the total.

In Canada, the Hospital Employees’ Union publicly criticizes the outsourcing of 130 hospital medical transcriptionist jobs, saying the result will be less secure, of lower quality, and increasingly expensive. The hospital executive in charge of HIM says they’re already outsourcing half their transcription to the same group without problems, no information is stored on transcriptionist PCs, and per-minute rates are the same as they were in 2006 and will save $3 million of the $14 million annual transcription budget. Part of the appeal was the chance to move to a system that has better speech recognition capabilities.

Also in Canada, Nova Scotia’s Department of Health and Wellness and Canada Health Infoway announce an expansion of their peer support program for users of the Nightingale ambulatory EMR.

McKesson Automation’s building in Cranberry Township, PA was evacuated Tuesday evening after a female employee reported hearing a bomb. Police gave the OK to return when they concluded that the woman was hallucinating after experiencing an adverse reaction to an unnamed medication.

5-3-2012 9-45-04 PM

Bloomberg BusinessWeek profiles eClinical Works CEO Girish Kumar Navani and the company’s involvement with health projects in New York City. The company’s annual revenue was reported as $250 million.

5-3-2012 10-02-39 PM

Sunday night’s finale of The Amazing Race pits Epic employee Rachel Brown and her husband, Major Dave Brown, against three other couples. The winners will get $1 million.

5-3-2012 10-08-39 PM

In Ireland, three NUI Maynooth students win the Irish finals of the Microsoft’s Imagine cup for developing docTek, which allows patients with chronic illnesses to record symptoms for online review by their doctors. They will compete in the global finals this July in Sydney, Australia.

A UK doctor is investigated after sending an 18-day-old baby home with what was later determined to be myocarditis, which killed the baby the next day. The parents say that during the examination, the doctor looked up the baby’s meds on the computer and suggested giving him Tylenol, but he never left his chair to actually look at his patient.

Sponsor Updates

5-3-2012 8-25-07 PM

  • Benefis Health System (MT) signs an agreement with MedAssets to use its Spend and Clinical Resource Management Solutions and initiate use of MedAssets GPO and other cost containment services.
  • Angleton Danbury Medical Center (TX) creates a paperless registration system for its Meditech system using forms software from Access.
  • DrFirst announces that 6,000 pharmacies can now accept electronically transmitted prescriptions for controlled substances using EPCS Gold.
  • GetWellNetwork recognizes ten hospitals for Excellence in Interactive Patient Care during its GetConnected 2012 conference.
  • The Advisory Board honors Virginia Hospital Center (VA), Alegent Health (NE), and Monmouth Medical Center (NJ) with 2012 Crimson Physician Partnership Awards for improving the quality of care they provide while documenting more than $13.2 million in aggregate savings.
  • MEDecision introduces its new brand and highlights the evolving healthcare market during this week’s 2012 Client Forum.
  • A Detroit business publication profiles the growth and focus of JEMS Technology, which has seen one-year growth of 100% for its encrypted remote video solutions for healthcare.
  • Culbert Healthcare Solutions promotes Tina Sarantos to manager of consulting services for the company’s GE and Allscripts practices.

EPtalk by Dr. Jayne


CMS keeps sending me e-mails about ICD-10. For whatever reason, I thought this header was really funny given the recent delay. I’m personally worried that the 60-day comment period for the Stage 2 Meaningful Use NPRM is almost over and I haven’t gotten my personal comments finished yet. You can submit yours via the MU specific comments page. Although my organization has submitted its own official comments, I’m encouraging every physician, provider, and patient I know to comment as well.

CMS also issues a final rule on the use of the National Provider Identifier (NPI) on Medicaid and Medicare enrollment and claims documents. I can’t imagine that anyone out there practicing doesn’t have an NPI after all this time, but if you don’t, you have 60 days until the rule takes effect.

A Circulation article documents improvements in blood pressure control among US veterans. Over 10 years of data from the VA Health Data Repository was analyzed. Authors credit performance measurements in the EHR as contributing to the improvements.

Medical Economics advises providers how to respond to negative reviews on physician rating sites. Common complaints from a patient group profiled in the article include long wait times, lack of communication about delays, not being informed about test results, and failure to return phone calls promptly. Among the tips:

  • Don’t respond to negative reviews. Ask the site to remove unfair information.
  • As your patients to review you since most give positive reviews.
  • Conduct your own surveys to let patients feel heard.
  • Start a blog or practice website to help control your online presence

5-3-2012 6-34-21 PM

For women physicians tethered to their practices via smart phone, JoeyBra provides a solution that lets you avoid those pesky purses, totes, and satchels. Right now, it’s only available in leopard print. Personally I think an iPhone is a little bulky to be storing in my bra, but to each his (or her) own. Even with the leopard print, I don’t see Inga lining up to purchase one either.


Remembering an Industry Leader and Friend
By Daniel S. Herman

5-3-2012 6-39-56 PM

John Cornelius Wade, former CIO at Saint Luke’s in Kansas City, former chair of the HIMSS Board of Directors, colleague, and a close friend of mine, passed away on Saturday.

He was ill for the past several months. I spoke with his wife Cheri Thursday evening, and to John on his birthday a couple of weeks ago. He was in great spirits and was talking shop.

I first met John in Chicago in 1987 when we served on the First Illinois HFMA chapter IS Committee when I was with KPMG/Peat Marwick and he was CIO at Northwestern Memorial.  We were reacquainted by a colleague at FCG in the spring of 1993 shortly after he took the CIO position at Saint Luke’s.

John was a loyal person who was tenacious in everything he pursued. He would drive from Kansas City to Boston all night to see family. He did home repair himself, refusing to call a handyman despite his wife’s objections (until he fell off a ladder and dislocated his shoulder).

His loyalty was expressed in many ways across business and personal situations. He was an authoritarian leader when it came to running the IS shop, and was often opinionated when interacting with his customers throughout the health system.

In 1993, John took over a data processing (DP) shop from an interim management team from Andersen Consulting. He was swift to make leadership changes inside the IS organization, also changing how the department served its customers. He redefined the IT strategy; enhanced governance, project prioritization and executive ownership of technology-enabled IT initiatives; and established service level metrics by which he measured and demonstrated accountability. Saint Luke’s went on to become one of the first healthcare organizations to win the coveted Malcolm Baldrige Quality Award and the Missouri Quality Award almost 10 years ago.

When John retired from Saint Luke’s in 2008, the health system’s IT group was (and still is) considered one of the most effective and well-run healthcare provider IT functions in the country. It has been recognized for its outstanding IT governance structure.

John accomplished much in his 71 years and touched many people. I’ve learned a lot from him personally and professionally during our 25-year friendship. His memory will be in my heart for eternity.

Information about John, including photos and information about funeral and memorial services, is available here. Please take a moment to read the many memories and tributes from his friends and industry colleagues and add your own.

Daniel S. Herman is founder and managing principal of Aspen Advisors.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 3, 2012 News 7 Comments

News 5/2/12

May 1, 2012 News 11 Comments

Top News

Castlight Health raises $100 million in Series D funding, raising its total to $181 million. The San Francisco company offers online tools to help consumers choose providers, evaluate cost and quality, and understand their healthcare benefits. Above is a TV news report about the company.

Reader Comments

5-1-2012 7-40-54 PM

From Reckless Speculator CIO: “Re: Allscripts. Glen will appoint someone from HealthCor to the board to placate them and save his Teflon self. I think he said after the Misys merger, ‘Given the choice to control the boardroom or executive suite, always choose the executive suite.’” I tweeted Monday that big Allscripts shareholder HealthCor Management is urging the company’s board to replace Glen Tullman as CEO or put the company up for sale, saying his 13-year record of underperformance is not acceptable, particularly with the HITECH tailwind and high returns to shareholders of the company’s competitors (Cerner and athenahealth were named). They point out the company’s strengths, such as Sunrise and EPSi.

From Customer CIO: “Re: Allscripts. Stock prices don’t mean much to us as a customer, but I would like to know what the company disagreement was about. Perhaps over resources for its clinical products vs. a new inpatient revenue cycle product.”

From EMRwatcher: “Re: Allscripts. Glen wants to engineer a buyout of the company. He’ll probably get fired first, but that will make it easier for him to spend time getting the cash together.”

From MDRX Files: “Re: Allscripts. They should be well positioned for the shift of focus to the ambulatory world with clinical integration and accountable care. Epic is benefitting from their solid vision and impeccable execution, but the door is open for Allscripts to raise the bar as the only company designed to deliver on the future. Everybody else has inpatient baggage that will slow them down. I hope Allscripts takes advantage of the stock plunge to go for it. The software side of the industry needs fresh thinking. Some companies will become commoditized as data an information prevail as strategic and they’re so entrenched in their transaction processing history that they can’t fathom any other world. Epic has the advantage of not being publicly traded and not required to deliver quarterly numbers, but maybe an Allscripts shakeup was what was needed to invigorate them to take a bolder view of the future.”  

From Global Travelin Babe: “Re: Allscripts CEO debacle. I have no idea if it has any merit, but I heard they’re going after a few brand name, reputable CEOs to get their mojo back. Two names mentioned were Ivo Nelson from Healthlink and John Glaser of Siemens.” That sounded pretty off the wall, but I asked both Ivo and John since I like to get answers when I can. They say, not surprisingly, that they have not been approached and wouldn’t be interested.

5-1-2012 9-52-23 PM

From Kermit: “Re: healthcare IT from a doctor’s point of view. This is a monthly show for the Mass Medical Society, produced at a local cable access station where I volunteer. Given my links to health IT, I suggested this topic.”

5-1-2012 9-55-16 PM

From Vince Ciotti: “Re: Susan’s inquiry about the size of the healthcare IT market. The top 13 vendors had $12 billion in revenue in 2011, so I’d guess the total market is at least twice that with all the niche players and consulting firms.” Above are Vince’s numbers.

From Dragon Man: “Re: Mike Mardini. The founder and CEO of Commissure, the radiology speech recognition company acquired by Nuance in 2007, is leaving. He was also the founder and CEO of Talk Technology, acquired by Agfa in 2001.” Unverified. No change in his LinkedIn profile so far.

5-1-2012 9-38-18 PM

From HIPPA Hound: “Re: Raleigh newspaper’s series on hospital profits and low levels of charity care. Not new since it was reported last week, but it has struck a few nerves.” Politicians (including the ever-present Sen. Chuck Grassley, who will no doubt write a scathing letter of inquiry that yields nothing) get worked up about about the ongoing series, which I’m sure is exactly what the newspaper planned. Every newspaper follows the same formula when trying to goose dying circulation: (a) write a huge and endlessly publicized series on some hot button topic, with or without solid facts and objectivity; (b) refer to their own series in some high-and-mighty editorials; (c) prod everyday people enough times about the topic du jour until they get enough outraged quotes to yield let another article; and (d) pester people in power about their articles until somebody finally at least pretends to share their outrage and makes vague promises about coming down hard on the villains. That’s about as good as it’s going to get from the dead tree folks whose readers avoid making eye contact with the politics and world news sections as they make a beeline for the sports page and comics.

From Kaiser Roll: “Re: Kaiser Permanente’s innovation award winners. Here’s the list.” Some of the technology winners:

  • Knowledge Builder, which provides a way to import clinical algorithms into a rules engine to identify appropriate treatment conditions that are likely to occur, such as kidney stones
  • OpQ, an operational dashboard that extracts information from the data warehouse and Epic Chronicles database every 10 minutes to allow outpatient managers to oversee staff assignments and patient flow.
  • Specimen Transfer and Tracking (STAT), a chain of custody tracking system for specimens that would replace paper logs.
  • Ambulance on the Information Superhighway, an inter-facility transportation clinical documentation tool.
  • Nurse Advice Chat, an online chat function for the nurse advice center.
  • Matching Clinical-Facility Data, tools to integrate various information sources to determine whether the physical environment, such as patient room characteristics, affect patient outcomes.
  • Hospital Capacity Grid, a one-screen view of activity and capacity across a 21-hospital region.
  • BirdDog, which sends lab results to the mobile devices of ED clinicians.

HIStalk Announcements and Requests

5-1-2012 6-11-43 PM

Welcome to new HIStalk Gold Sponsor nVoq. The privately held Boulder, CO company offers the SayIt speech recognition solution, exclusively endorsed by the AHA with vocabulary support for over 35 medical specialties. The SaaS-based SayIt is being rolled out in both ambulatory and inpatient healthcare settings, where users gain productivity within minutes as they dictate SOAP notes and other text directly into their EMR with no integration required, even using voice commands to navigate through their templates and operate other applications. SayIt is delivered as a low-cost Internet subscription, so users can use it at work, at home, or on the road. The company is interested in expanding its service delivery network and welcomes inquiries to VP/GM Debbi Gillotti. Thanks to nVoq for supporting HIStalk.

Here’s a video I found of Microsoft’s Bill Crounse MD talking about nVoq.

Acquisitions, Funding, Business, and Stock

Allscripts expands its stock repurchase program to $400 million from the $200 million that was approved a year ago.

5-1-2012 7-05-04 PM

Kansas City, MO startup Cognovant raises $500K in a seed round to launch its first product, the PocketHealth personal health record. The basic version will be a free App Store download, with paid upgrades available for versions that handle more complex needs and allow use by multiple family members. The founders are Joe Ketcherside MD and Stan Pestotnik RPh,  who were executives at TheraDoc before it was acquired by Hospira.

5-1-2012 9-41-47 PM

McKesson announces Q4 results: revenue up 10%, EPS $2.09 vs. $1.62, beating expectations on both. Technology Solutions revenue was down 2% and profit was down 20%. John Hammergren said in the conference call that several Horizon Clinicals customers have committed to moving to Paragon and conversions have begun. He also said that while EMRs are important, customer success will be driven more by performance management, analytics, care coordination, and payor capabilities, and that RelayHealth is well positioned for the MU Stage 2 emphasis on connectivity.


Perry County General Hospital (MS) selects RazorInsights’ ONE-Electronic Health Record for its 22-bed critical access hospital.

Southwest Medical Center (KS) contracts for Summit Healthcare’s Provider Exchange for integration with physician offices.

West Tennessee Bone & Joint Clinic selects SRS EHR for its 11 providers.

Fletcher Allen Health Care (VT) will use the CapSite hospital purchasing database, which gives subscribers access to research studies and thousands of real-life contracts, proposals, and RFP responses covering healthcare IT, imaging equipment, professional services, and medical devices from 1,400 vendors.

5-1-2012 9-42-52 PM

Somerset Medical Center (NJ) signs a renewal agreement for secure e-mail services from Zix.

Perinatal Quality Collaborative of North Carolina will implement a wireless clinical support system from San Diego-based startup Cognitive Medical Systems.


5-1-2012 5-52-48 PM

The Allscripts board of directors elects Dennis Chookaszian as its chair. He was previously chairman and CEO of retirement advice site mPower and had retired in 1999 as chairman and CEO of insurance company CNA. He’s been on the board since September 2010.

5-1-2012 5-55-03 PM

New Jersey Hospital Association’s Healthcare Business Solutions affiliate appoints Michael Guerriero (MedAssets, Eclipsys) VP of business development.

5-1-2012 5-58-14 PM

Telemedicine provider Virtual Radiologic names former US Oncology COO George Morgan as CEO. He replaces Rob Kill.

5-1-2012 5-59-49 PM

Vocera Communications subsidiary ExperiaHealth names Elizabeth Boehm (Forrester Research – above) director of patient experience collaborative and Christine Henningsgaard (Accretive Health) national practice leader.

Elsevier promotes Hajo Oltmanns to president of its CPM Resource Center.


5-1-2012 6-04-11 PM

Joanne Wood, SVP of client services of Meditech and president and COO of LSS Data Systems, died Sunday, April 29. She was 58.

5-1-2012 6-08-44 PM

John Wade, former VP/CIO of Saint Luke’s Health System and former HIMSS board chair, passed away Saturday, April 28. He was 71.

5-1-2012 7-58-02 PM

Rick Brown, founder of the UCLA Center for Health Policy Research, died April 20 at 70.

Announcements and Implementations

5-1-2012 9-44-46 PM

Bon Secours Mary Immaculate Hospital (VA) goes live on Epic as part of Bon Secours Health System’s $200 million EHR initiative.

Lifepoint Informatics introduces CPOE Connect, a plug-in solution that allows vendors and commercial labs to offer seamless lab order entry using existing EHRs.

Preceptor Consulting, which offers go-live support and clinical training for EHR implementations, is supporting the implementation of the Cerner IView charting flowsheet at all campuses of Emory Healthcare.

5-1-2012 8-46-51 PM

In Canada, The Collingwood General & Marine Hospital goes live with PatientOrderSets.com.

Government and Politics

The American Hospital Association tells CMS that most hospitals will not be able to meet proposed Stage 2 Meaningful Use requirements, warning that, “many of the proposals put regulatory requirements ahead of actual experience with these technologies – an approach that will likely have unintended consequences."

Meanwhile, CHIME urges the government to give providers more time to prepare for Stage 2. Among its specific recommendations: a 90-day EHR report period for the first payment year in Stage 2.

The General Accountability Office (GAO) recommends that CMS verify provider requirements band collect more information before paying out EHR incentives.


MedAptus selects problem search technology from Intelligent Medical Objects for its Professional Charge Capture solution, which will allow clinicians quick access to diagnoses when completing charge documentation using ICD-10.

Wyse Technology integrates Imprivata OnSign into its thin and zero clients, offering No Click Access for Citrix and VMware View that supports roaming between locations with badge validation.

5-1-2012 9-46-29 PM

Valued Relationships Inc. signs with AT&T to provide remote patient monitoring services for VRI’s nurse-staffed telemonitoring center. The service will capture information from wireless health devices in the home, such as scales and blood pressure cuffs, and issues triage alerts to the monitoring center when appropriate.

More information on the technologies used by Max Healthcare, the first two hospitals in India to earn Stage 6 EMRAM recognition from HIMSS. They include WorldVistA EHR (a free offshoot of the VA’s VistA), the open source Mirth integration engine, and a homegrown hospital information system. Dell Services manages its IT operations, including the EHR implementation, running all IT infrastructure into a private multi-protocol label switching cloud hosted at a remote data center.

5-1-2012 9-47-59 PM

In the UK, Blackpool Teaching Hospitals NHS Foundation Trust rolls out 900 Samsung Galaxy Tab tablets to clinicians in a deal with Vodafone.

5-1-2012 9-27-47 PM

A Massachusetts psychologist creates  what she says is the first evidence-based treatment app for obsessive compulsive disorder. Live OCD Free costs $79.99.


KLAS reports that half of providers anticipate buying or replacing a business intelligence solution in the next three years. In alphabetical order, the top five most considered BI vendors are IBM, McKesson, Oracle, QlikTech, and SAP.

inga_small A Weird News Andy wannabe sends this story about man with a toothache who made a poor choice of dentists: the girlfriend he had just dumped. She sedated him and removed all 32 of his teeth, saying she had tried to remain professional, but couldn’t help thinking “What a b—–d” as he was unconscious before her. Most of us gals have had that feeling once or twice.

The real Weird News Andy wonders who will update EHR med lists if the FDA allows drugs for hypertension, diabetes, infections, migraines, asthma, and allergies to be sold without a prescription, possibly justifying that practice by requiring pharmacist counseling.

Here’s a fun SNL parody video that T-System created as an opening to its user group meeting. It has a lot of details that are worth a rewind, for instance at the 1:30 mark, where development VP Bill Hall is stereotypically sucking down what appears to be a Red Bull.

In the UK, North Bristol NHS Trust admits to a huge budget overrun in its second try at a successful Cerner rollout after problems with the first. Most of the extra money was spent on additional support people.

5-1-2012 7-31-48 PM

The Dr. Oz Show partners with Temple University Health System and Practice Fusion to run a May 19 “15-Minute Physical” event in Philadelphia, where 1,000 people will be screened and the resulting analytics report presented to the city by the end of the day.

Facebook urges its users to post their organ donor status. Self-proclaimed pundits crow that Facebook is naïve in thinking that sticking a “donate” label on your profile provides legal consent, but they’re missing the point: the idea is to use social networking to encourage people to sign up with state registries. Your Facebook profile will outlive you, so your organs might as well follow its lead.

Sponsor Updates

5-1-2012 7-56-19 PM

  • Cumberland Consulting Group promotes Saman Pourkermani to executive consultant.
  • Merge Healthcare releases its Merge Honeycomb Archive archiving application.
  • Beacon Partners is named by Boston Business Journal as one of the region’s fastest-growing companies.
  • Baptist Health System (AL), INOVA Health System (VA), and Park Nicollet Health Services (MN) select  LRS software for secure document delivery from their Epic footprints.
  • T-System outlines its pending response to the proposed MU Stage 2 rule to ensure it addresses the needs of EDs.
  • Olmsted Medical Center (MN) extends its partnership with MED3OOO through 2017.
  • Teletracking hosts a free networking lunch May 11 in Baltimore featuring Kevin Capatch, director of supply chain technology and process engineering for Geisinger Health System.
  • Intelligent InSites joins the Cisco Developer Network in the wireless / mobility category.


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

More news: HIStalk Practice, HIStalk Mobile.

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May 1, 2012 News 11 Comments

Curbside Consult with Dr. Jayne 4/30/12

April 30, 2012 Dr. Jayne No Comments

I wrote a couple of weeks ago about the pending EHR upgrade at one of the emergency departments I cover on a part-time basis. The witching hour for go-live has come and gone – or at least I think it has, or might have, but who really knows because I have received no communication whatsoever from the project leadership or from my department chair.

For those of you who may have missed my previous post, here’s the scenario. I moonlight in the emergency department at a hospital that is unaffiliated with my primary employer. They have been preparing to upgrade the ED information system for the better part of a year, with several previously scheduled upgrades being canceled at the last minute. I’ve been eagerly waiting upgrade of the system, which was less than optimal from a provider perspective. Since I’m just a contractor, I have no say in the design, implementation, or support of this product, so it’s a unique opportunity to see a system from the same perspective that my own physicians see the system I manage. I know I’m hyper-critical since I do this for a living, but some of the things that occurred were pretty unbelievable.

In the Pro column, the hospital provided plenty of notice on the training sessions. We were e-mailed approximately six weeks before and asked to schedule a slot. Opportunities were offered at two locations over a three-day period, with plenty of seats available to cover the number of providers in our department. The downside of that approach would be that if a physician was on vacation that week, he or she would not have a training opportunity. Advice for the future: split your sessions over two different calendar weeks to better accommodate vacations.

The first Con was readily apparent when I couldn’t find the training room and there was no signage – another easy fix for next time. After 15 minutes of wandering, I eventually made my way to an obscure IT office on the top floor of a physician office building. They had 20 computers set up. Since I was still early, I settled in and started checking e-mail. Apparently only some of them were actually usable for training, so when the instructor arrived (late), I was forced to move and go through the whole painful log-in cycle again.

Another Con (is this only two, or are we at three with having to move workstations?) was that the copy of the production database used to create the training database was so old that none of the users’ previous three passwords would work. Unfortunately, this led to the instructor having to use his personal log-in for all five of us, resulting in many fun adventures as we documented all over each other since we were on the same log-in.

A considerable Pro was that our instructor was clearly a grizzled vet of the IT wars. He handled all of the issues with a sense of humor, which although warped, was truly appreciated and made a difficult situation tolerable. He started his preamble with an apology; as we were the second training session of the day, he already knew that the deck was stacked against him. Our training sessions were scheduled to be four hours, and apparently the IT staff had asked our department secretary to send out a notice that the scope of the upgrade had changed dramatically and training would only be an hour long. Needless to say, none of the physicians received this message (Con) and apparently he got an earful from the 8 a.m. session. The preemptive apology definitely helped mitigate the ire of my group.

Upon making it through the log-in screen (now boldly decorated with the “Meaningful Use Certified!” enthusiasm of the vendor) the first change we noted was that our beloved grey inbox was now shaded a delightful salmon color. I’m not sure exactly why a vendor would want to do that, but salmon isn’t exactly a crowd pleaser, and I found it more distracting than the relatively vanilla grey tone we had previously.

In the Pro column, the IT staff had built test patients for each provider to train with. As a Con, however, none was built for me, “because you’re just part time – but don’t worry, since we’re only giving you part of what you need, I don’t mind if I only get part of your attention.” This instructor was really on his game – deflecting the negative vibes and making us laugh. He also gave us fair warning that the morning class identified some elements of the system that were less than stable. Maybe it was good that training only took one of the projected four hours, because that gave him time to call the mother ship to request that they stop tinkering with the system while training was in progress.

One of the major upgrades to the system was the addition of templated patient visits, a big Pro in my book because of the ease of documentation. No one wants a beautiful flowing narrative in the ED – they want what we call the bullet: “This is a 43-year-old Caucasian male with a gunshot wound.” We do not want to know that this is a 43-year-old male of Germano-Irish descent who was walking along Elm Street two blocks south of Chestnut, minding his own business on a bright and sunny day, when two guys game out of nowhere and he heard a “pop.” I found the templates extremely intuitive and the system very responsive. In hindsight, however, after writing my recent piece on ICD-10, maybe I will need to know what street he was on and what the atmospheric conditions were at the time of the injury, as well as whether he heard a “pop” or a “bang” etc. For now, however, I’ll leave those questions for the police report.

The other docs in my class didn’t like the templates much, but I think that’s largely due to the fact that they’re full-time docs who don’t have any other vendor experience for reference and who have been allowed to use voice recognition in lieu of the painful “visit builder” native to the application. (As part-timers, we are not allowed to use voice recognition due to licensing costs. Go figure.)

I was pleased to see that the patient education module had been completely overhauled (big Pro) and replaced with a third-party component that allowed creation of physician-specific macros as well as those available for sharing across the department.

Unfortunately, the biggest Con is that the much-hated prescribing system received no updates at all. When I mentioned this disappointment and how I loathe not being able to prescribe exactly what I want, one of the other docs in the class was happy to demonstrate some “undocumented functionality” in the system that allowed me to do exactly what I wanted despite the constraints. Although it’s not officially sanctioned (the instructor actually covered his ears and said “la-la-la” while we were doing this) I’m ecstatic and can’t wait to try it out.

One Pro/Con was the lack of training material given to us. Good because a lot of people don’t read it anyway (can you say Sanskrit?) and it kills fewer trees, but bad for those of us that might actually want to look at it. Apparently they didn’t print anything, because even the morning of class, they were debating the scope of the upgrade. Promising to e-mail it made sense (although I have yet to receive it.)

I mentioned a few weeks ago that I was concerned that the support staff wasn’t aware of the upgrade. Apparently this is because other than the salmon-colored inbox, all of the changes were on the provider side. Assuring us that the team would e-mail us with instructions on downtime and the final preparations for the upgrade, he sent us on our way. The instructions never arrived, but I’m putting that blame on the department secretary rather than holding it against the IT team.

Totaling the score, that’s six Pro and seven Con, a mixed bag by any standard. I hope the upgrade went well (if it went at all) but I really don’t know since there’s been no communication. I’m scheduled to work later this week, so I’ll find out then.

Have any outstanding upgrade tips to share with the HIStalk community? E-mail me.


E-mail Dr. Jayne.

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April 30, 2012 Dr. Jayne No Comments

Readers Write 4/25/12

April 25, 2012 Readers Write 5 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!

CDS by the Numbers: Three Useful Frameworks for Developing Clinical Decision Support Applications
By Lincoln Farnum

4-25-2012 6-11-29 PM

Clinical decision support, or CDS, is many things to many people. Ask any 10 healthcare providers what clinical decision support is and you’ll very likely get 10 (or maybe 20) different answers, all good ones. The answers are also likely to be tinged with some degree of frustration and mistrust.

CDS as a discipline stems from the original promise of computers developing artificial intelligence — actually practicing medicine, making diagnoses, and managing patient care. Obviously these early expectations have not yet been fully realized. Today, our understanding places computers in medicine into more supportive roles.

In practice today, one commonly seen CDS application is related to medication ordering — alerting for allergies; duplicate orders and therapeutic overlaps; and drug-drug and drug-food interactions. These applications have no doubt saved human lives and resources, but often do so at a high cost to prescribers in the form of confusing messages and alert fatigue from poorly designed or executed rules.

Also, ethical concerns can affect users’ experiences with CDS. Concerns that technology-driven decision making will affect the doctor-patient relationship or that it might fail to take into account the patient’s values, or produce a cumulative de-skilling effect on physician training have all been commonly cited. There are also frequent liability concerns relating to prescribers accepting erroneous advice from a computer. It’s the fallout from these common but very reasonable apprehensions that we as consultants must try to manage on a daily basis.

Designing effective CDS is as much art as science, and it’s a quite a bit of both. Detractors of clinical decision support enthusiastically point to the occasional bad examples, but are quite often not even aware of the good ones. They seldom see “good” CDS — in part because it’s so hard to do, but also because good CDS is often invisible. CDS applications are, at their best, an unseen hand gently guiding patient care and clinical decision making.

There exist today three common frameworks for designing effective CDS: the Three Pillars of Effective Clinical Decision Support, the Five Rights of CDS, and the Ten Commandments of CDS.

Let’s begin with discussing the Three Pillars.


The Three Pillars

Osherhoff, et al, in “A Roadmap for National Action on Clinical Decision Support,” uses an image of three pillars supporting effective CDS. They are represented in the image below:


4-25-2012 6-10-45 PM

Pillar 1: Best Knowledge Available When Needed

  • Represent clinical knowledge and CDS interventions in standardized formats (both human and machine-interpretable) so that a variety of knowledge developers can produce this information in a way that knowledge users can readily understand, assess, and apply it.
  • Collect, organize, and distribute clinical knowledge and CDS interventions in one or more services from which users can readily find the specific material they need and incorporate it into their own information systems and processes.

Pillar 2: High Adoption and Effective Use

  • Address policy / legal / financial barriers and create additional support and enablers for widespread CDS adoption and deployment.
  • Improve clinical adoption and usage of CDS interventions by helping clinical knowledge and information system producers and implementers design CDS systems that are easy to deploy and use, and by identifying and disseminating best practices for CDS deployment.

Pillar 3: Continuous Improvement of Knowledge and CDS Methods

  • Assess and refine the national experience with CDS by systematically capturing, organizing, and examining existing deployments. Share lessons learned and use them to continually enhance implementation best practices.
  • Advance care-guiding knowledge by fully leveraging the data available in interoperable EHRs to enhance clinical knowledge and improve health management.

The Five Rights

The Agency for Healthcare Research and Quality (AHRQ) has published a CDS Toolkit in which safe and effective medication management is supported by the use of CDS, though these concepts can easily be extrapolated to health care in general. The Five Rights of Effective CDS — not to be confused with the Five Rights of Medication Administration — proposes that we can achieve CDS-supported improvements in desired healthcare outcomes if we communicate:

  1. The right information. Evidence-based, suitable to guide action, pertinent to the circumstance.
  2. To the right person. Considering all members of the care team, including clinicians, patients, and their caretakers.
  3. In the right CDS intervention format. Such as an alert, order set, or reference information to answer a clinical question.
  4. Through the right channel. For example, a clinical information system (CIS) such as an electronic medical record (EMR), personal health record (PHR), or a more general channel such as the Internet or a mobile device.
  5. At the right time in workflow. For example, at time of decision, action, or need.

The Ten Commandments

Finally, David Bates, et al in JAMIA published “Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality,” in which he modestly proposes the following ten commandments for CDS:

  1. Speed is everything. Even if the decision support is wonderful, if it takes too long to appear, it will be useless.
  2. Anticipate information needs and deliver in real time. CDS must be presented at the moment the user needs it.
  3. Fit into the users’ workflow. Users won’t go looking for CDS — it needs to be in their workflow.
  4. Little things can make a big difference. Small changes in delivery can have an oversized effect in outcomes.
  5. Recognize that physicians will strongly resist stopping. Don’t bring clinicians to a dead end when making suggestions.
  6. Changing direction is easier than stopping. Propose alternatives when advising against something.
  7. Simple interventions work best. Complex and multi-paged guidelines will not be readily accepted.
  8. Ask for additional information only when you really need it. Try to obtain all necessary information passively. Ask for additional information only if it is absolutely required.
  9. Monitor impact, get feedback, and respond. Verify that interventions are producing the desired outcomes and communicate with your customer base.
  10. Manage and maintain your knowledge-based systems. Suggestions based on outdated information are dangerous and worse than no suggestions at all.

Obviously, this is a very high level overview of these frameworks. The below links will provide more information and context. The simple take-home lesson is that effective CDS isn’t easy and even good CDS isn’t always accepted or performs as its developers intend. The development and deployment of clinical decision support should be undertaken with an understanding of the challenges and recommendations for best practices, and with the strong cooperation of and input from the user community.

A Roadmap for National Action on Clinical Decision Support, Jerome A. Osheroff, MD, et al.

AHRQ, Approaching Clinical Decision Support in Medication Management

Ten Commandments for Effective Clinical Decision Support: Making the Practice of Evidence-based Medicine a Reality, David W. Bates, MD, MSc, et al.

Lincoln Farnum MMI, RRT-NPS, CPHIMS is a senior consultant with Vitalize Consulting Solutions, an SAIC Company and a graduate teaching assistant in the Master of Science in Medical Informatics program at Northwestern University.

I’m a Believer in Diagnostic Decision Support
By Scott W. Tongen, MD

4-25-2012 6-41-15 PM

When I read a vendor’s brochure about diagnostic decision support software that mirrors how medical students and physicians in training are taught to diagnose patients, I had an epiphany. My peers and I today are not diagnosing patients the way we were instructed in medical school and residency. As a result, we — and our patients — pay a heavy price.

As students and residents, we were asked to provide a list of all possible diagnoses based on patient’s symptoms, medical tests, accumulated medical knowledge, and other information. Next, we would use the data at our disposal to eliminate diagnoses that did not fit until we were left with one diagnosis.

However, advances in imaging software and electronic health records, revenue pressures, and crushing time demands had led us to stop using that “differential diagnosis” methodology on a daily basis, leading to misdiagnoses or missed diagnoses.

None of us likes to admit our mistakes and fallibilities when we’ve misdiagnosed or missed a diagnosis, but it happens: 40,000 to 80,000 patients die annually due to misdiagnosis, according to a 2009 study published in the Journal of the American Medical Association.

I believe a major reason for an inaccurate or incomplete misdiagnosis is due largely in part to the increased use of powerful EHR systems. Those systems are deemed so efficient now that they lull highly skilled and trained professionals into a false sense of security. Too many physicians rely on electronic alerts and images to help them solve the mystery of a patient’s illness, forgetting that technology can be a poor or terrific tool, depending on whether it is used correctly.

Also, doctors and hospitals do not realize that EHRs are not sold “out of the box” with diagnostic decision support that generate potential diagnoses and flag high-risk “Don’t Miss” diagnoses when patient’s symptoms and vital signs are entered into the application. When clinicians do not know what they do not know or are not thinking about a possible diagnosis, they certainly will miss it.

Another reason for misdiagnoses and missed diagnoses is physicians’ busy schedules, as continual reimbursement cuts are forcing them to squeeze in more patients. This, combined with other demands competing for their time, make it impossible for doctors to remember all pertinent details that could potentially explain a patient’s problem, much less keep up with the massive explosion of peer-reviewed studies and medical discoveries published in numerous medical journals.

All those thoughts flashed across my mind as I read the brochure, which ultimately led to my convincing administrators to fund and offer the tool to our physicians. Diagnostic decision support software can help doctors address those problems while minimizing misdiagnoses that harm or kill patients.

For that reason, every physician and hospital in the country should implement diagnostic decision support software that highlights and enables them to access relevant information about potential diagnoses. They will find the tool extremely valuable, particularly when diagnosing difficult as well as rare cases. A useful objective review of these tools was published recently, “Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs” by William Bond, MD, MS et al from the Lehigh Valley Health Network.

To be clear, I am not proclaiming diagnostic software needs to emulate a physician’s thinking. What I am advocating is that doctors should use it to bring up diagnoses they otherwise would not have considered or remembered. The tool will more than pay for itself if it prevents a single fatality or serious misdiagnosis. More importantly, it will enhance quality and safety of care.

At the time this article was written, Scott W. Tongen, MD was medical director of clinical documentation, compliance, and quality at United Hospital, part of Allina Hospitals & Clinics in Minneapolis. He has since joined Vitalize Consulting Solutions, an SAIC Company as medical director.

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April 25, 2012 Readers Write 5 Comments

News 4/25/12

April 24, 2012 News 10 Comments

Top News

4-24-2012 6-30-08 PM

Cerner breaks ground on its $160 million Kansas City, KS campus, which will eventually house 4,000 employees. The first tower is projected to open mid-year 2013 and will serve 1,000 employees, including about 800 new hires.

Reader Comments

From THB: “Re: Accretive Health. Wanted to hire me with this exact thing under the guise of implementing an ACO-type process (do you want us to put the kidney stones back in?)” The State of Minnesota goes after Accretive Health for its actions on behalf of its hospital customers, including placing its employees in the ED to demand payment before services are rendered and for using information in hospital charts to try to collect overdue bills. I’m uncomfortable with the tone of the entire article, which seems to suggest that (a) hospitals should be passive in their efforts to convince patients to pay for services rendered, asking them nicely and infrequently if they wouldn’t mind setting their debts at some point if it’s not too much trouble; (b) it’s unethical to ask ED patients to make payments for previous visits before seeing them again, when in fact many of those patients show up for non-emergent conditions anyway and treat it more like a physician office visit; and (c) hospitals are being shady when they allow Accretive employees to work in its departments, even though full hospital departments like dietary and housekeeping are outsourced all the time.

Why isn’t the state upset about a national healthcare system based on ridiculously inflated charges that are favorably discounted to big insurance companies but not to patients without insurance, or with patients who incur healthcare services with no intention to pay for them even when they are financially able to do so? Hospitals and Accretive are doing exactly what you would expect given the goofy rules of the game – hospitals are often huge and hugely profitable non-profits (intentional oxymoron) with multi-million dollar executives who are wired to maximize the bottom line. The system was changed years ago to eliminate the charity and tax-supported models and instead requires hospitals to be run like a business. The shades of gray about which services are mandatory, who can and can’t afford to pay, and how aggressive the bill collectors are allowed to be just detracts from the central issue – hospitals are doing nothing illegal, just selectively distasteful to those who think healthcare isn’t a business when it clearly and intentionally is, rightly or wrongly.

4-24-2012 7-50-39 PM

From Banishing Bob: “Re: North Carolina hospitals. Subject of a scathing investigative series by the Raleigh newspaper.” The five part-series, called “Prognosis: Profits — Hospitals Prosper at Patient’s Expense” is an extension of the argument above – behavior that’s unsavory, but legal and, according to the hospitals named, necessary. North Carolina’s non-profit hospitals – which pay no income, property, or sales taxes — are banking annual profits of up to $500 million, erecting massively expensive Taj Mahospitals, paying their executives handsomely (25 in the state make over $1 million), strong-arming patients who can’t or won’t pay their bills, and sitting on multi-billion dollar reserves in a couple of cases. All in the name of sustainability and giving the locals the care they deserve, the executives say. Most of the 25 non-profit hospital executives in the million dollar club work for Novant or Carolinas HealthCare. Carolinas HealthCare paid its CEO $4.2 million, the COO $2.5 million, the CFO $1.8 million, and has EVPs making nearly $2 million. Novant’s chief clinical, medical, and administrative officers each made over $1.5 million and its general counsel was paid $1.2 million. On the IT side, Novant paid its CMIO $801K and its CIO $770K. I don’t know about Carolinas HealthCare since their federal 990 form isn’t readily available for whatever reason (I assume because they’d rather it not be). Excessive? You decide.

From Oblate Spheroid: “Re: Bill O’Connor. Gone from Zynx. What’s going on there?” Unverified. Bill’s LinkedIn profile says he’s still there. He is (or was, depending) the SVP of marketing, joining the company nine months ago.

4-24-2012 8-19-08 PM

From Beeper King: “Re: beepers. Because there is no guarantee of message delivery with cellular communications, pagers will be with us for a long time to come. How often have you received a cellular text message a day late? The cellular community will need to be pressured to make this change. However, given the small portion of their market that healthcare segment makes up, this probably isn’t likely to happen soon.” The beeper discussion is fascinating. Somehow every other industry makes do without beepers for their critical, real-time communications. The only time I felt secure in knowing whether my message was received (and opened) was in the old days of the two-way RIM pager, precursor to the BlackBerry. Even now, there’s no perfect system – secure, cheap, usable in all geographic areas, and with verifiable delivery.

From Suggestion Box: “Re: interviews. You should interview health system CEOs about IT-related topics such as Meaningful Use and ACOs.” I really like that idea. If anyone can hook me up, I’m happy to do it. I’ve tried George Halvorson of Kaiser a couple of times with no luck, but just about any big-hospital CEO would be fun.

From The PACS Designer: “Re: cloud collaboration. An application that has been adopted for collaboration by over 120,000 businesses is Box. Box offers secure, scalable content-sharing that both users and IT love. The app pioneers a new level of content management security, with role-based access controls, 99.9% uptime guarantee, and data encryption using 256-bit SSL." A one-user, 5 GB personal account is free, although so is the long-delayed, just-announced Google Drive.

From Frank Poggio: “Re: Medicare payments. CMS proposes a payment update for acute-care hospitals that it projects will increase operating payments by about 0.9% in 2013. Well, let’s see — that would mean if you did not meet Stage 1 MU, that would be a penalty of 0.3%. In a 250-bed facility, that would be maybe a $100k loss. Is it worth slamming in an EMR? I doubt it. Oh, by the way the docs got 0%, so one-third of zero equals zero penalty.”

4-24-2012 6-50-38 PM

From Daniel Barchi: “Re: Yale New Haven Health System. Greenwich Hospital went live big bang on Epic for all financial and clinical applications this past Saturday. Greenwich is the first of the three hospitals to go-live and it joins 36 physician practices from Yale Medical Group, Northeast Medical Group, and private community physicians who have been live on Epic since October. I could not be more proud of our local Epic team and the staff and leadership of Greenwich Hospital. We have also been really well supported by a talented team from Epic. I have been through many go-lives and the preparation and hard work of all of these teams made this about as smooth as a hospital go-live can go. The attached picture shows Greenwich Hospital President and CEO Frank Corvino throwing the switch at a go-live ceremony the first day.” Thanks for the report. Daniel is CIO of the Yale health system and the medical school.

HIStalk Announcements and Requests

4-24-2012 6-55-05 PM

Welcome to new HIStalk and HIStalk Practice Platinum Sponsor simplifyMD. The Atlanta-based company offers The Digital Chart Room, which includes medical-grade document management, auto-indexing of scanned documents, a template generator, the Productivity Pilot task organizer, and a personal health record. It eliminates the limitations of paper-based charts (one-person access, lost files, high labor costs), avoids the risks of EMR implementation (physician workflow interruption, expense, lack of ROI), and allows practices to increase their volume to offset higher costs and reduced payment. The company’s talking points are fast and friendly customer support, affordability, easy implementation, and elimination of customer exposure to technical obsolescence. Customers choose between a fully hosted cloud-based solution or a local cloud (a local server that allows uninterrupted operation if Internet access is lost, but with access from anywhere). It’s one monthly price ($395) for everything and the customer can just stop using it with no additional charges if they find that it doesn’t pay for itself. Check out their ROI calculator here. Thanks to simplifyMD for supporting HIStalk and HIStalk Practice.

Acquisitions, Funding, Business, and Stock

4-24-2012 6-15-50 PM

Streamline Health reports Q4 results: revenue $4.5 million vs. $4.9 million, EPS $0.00 vs. -$0.19.

4-24-2012 6-16-33 PM

Standard Register announces Q1 revenue of $157.6 million, which includes $57 million from its iMedConsent (dba Dialog Medical) division and other HIT solutions. The company notes that sales of clinical documents and administrative forms fell 12% from the previous year due to customers implementing EMRs.

4-24-2012 6-17-21 PM

Healthways acquires Ascentia Health Care Solutions, a provider of population health management technology to support physician-directed population health initiatives.

4-24-2012 6-18-03 PM

HealthStream announces Q1 numbers: revenue up 28%, EPS $0.05 vs. $0.07, beating revenue estimates but missing consensus earnings estimates of $0.06. Shares made Nasdaq’s biggest percentage losers list for the day, down 10%.

4-24-2012 6-41-41 PM

Apple beats all Q2 expectations with revenue up 59% and EPS $12.30 vs. $6.40. The company sold 35 million iPhones that accounted for 58% of its revenue. It sold 11.8 million iPads, more than double the year-ago number even though the newest model was available for only the last month of the quarter. Mac sales were up 7% to four million, while iPod sold 15% less than the year-ago figure.


DR Systems announces seven new PACS contracts totaling more than $3.7 million.

The 90-physician Allied Pediatrics (NY) selects Isabel Healthcare’s diagnosis decision support technology, which will be integrated with Allied’s GE Centricity EMR.

The VA extends its contract with Authentidate for home telehealth devices and services for at least one more year with three one-year extension options. 

4-24-2012 6-43-09 PM

Indian River Medical Center (FL) selects RelayHealth to provide HIE and PRN technologies.

The Saskatchewan Surgical Initiative announces that it will expand the implementation of Surgical Information System technologies into new hospitals.

4-24-2012 6-44-35 PM

Duke University Health System will implement iSirona’s device connectivity solution.

Cuyuna Regional Medical Center (MN) chooses PatientKeeper’s clinical applications to create a virtual EMR from the hospital’s Meditech inpatient and Allscripts outpatient systems.


4-24-2012 6-27-11 PM

Poudre Valley Medical Group CEO Russell Branzell joins GetWellNetwork’s board of directors. He was formerly CIO of Poudre Valley Health Systems and the president and CEO of that organization’s for-profit IT company.

4-24-2012 6-27-54 PM

Communications consulting firm WCG hires Rob Cronin, the former head of corporate communications for SureScripts, as practice leader of healthcare technology and transformation.

4-24-2012 8-30-48 PM

AMIA President and CEO Kevin Fickenscher MD is named chairman of the newly created healthcare advisory board of Intelligent InSites.

4-24-2012 8-25-50 PM

Lt. Col. Danny J. Morton (on the right above) is named as the Army’s MC4 battlefield EMR product manager, replacing Lt. Col. William E. Geesey in a ceremony at Fort Detrick, MD.

Announcements and Implementations

Open source provider Medsphere Systems joins the Open Source Electronic Health Record Agent community, which focuses on establishing a code repository for the VA’s VistA EHR.

4-24-2012 9-37-52 PM

Mount Sinai Medical Center (NY) implements Perminova EP to manage the scheduling, workflow, documentation, and billing processes for cardiac electrophysiology procedures.

Phreesia adds an electronic version of the M-CHAT autism screening tool for toddlers to its patient check-in system.

The Health Information Trust Alliance (HITRUST) establishes the Cybersecurity Incident Response and Coordination Center to provide alerts and information-sharing related to healthcare cybersecurity threats.

EHR Doctors announces that its CCD Generator is being used by Ministry Health Care to create an ONC-ATCB certified Continuity of Care Document from its multiple EHR systems.

TigerText announces a new version of its secure text messaging application, with University of Louisville as its first higher education customer.

In Canada, doctors at Ottawa’s Queensway Carleton Hospital say they like what they’re seeing in the pilot project for a discharge information system developed by TELUS Health. PCPs automatically get electronic copies of the records of their patients who are seen in the hospital’s ED, replacing the paper records that took two weeks to deliver.


inga_small I don’t watch much TV (American Idol excluded) but I was glad to see that Epic employee Rachel Brown is still a contender in The Amazing Race. Rachel and her Army helicopter husband Dave are one of four remaining couples in the running to win a $1 million grand prize. If the Browns win, I am sure that Judy will be happy to offer investment advice.

A KLAS report says almost half of inpatient providers plan to purchase a computer-assisted coding solution within the next two years, according to KLAS, mostly because of ICD-10. The most recognized vendors are 3M, OptumInsight, and Dolbey.

4-24-2012 8-05-20 PM

Epic beats IBM in the StarCraft II Championship, earning $5,000 for its charity of choice, Doctors Without Borders. The motto of the 12-0 team, captained by JDUB, is “Need Medical Attention?”

A New Zealand doctor is reprimanded for failing to tell a patient about an abnormal blood test result. The doctor said he hit the wrong key on the keyboard, but a public health commission said he should have used other software to remind him about the result.

Sponsor Updates

4-24-2012 7-57-37 PM

  • GetWellNetwork customer Celebration Health and its CEO, Monica Reed MD, will host all 350+ attendees on its campus to kick off GetWellNetwork’s user group meeting in Orlando next week.
  • CynergisTek partners with the law firm of Davis Wright Tremaine to create the HIPAA Audit Readiness and Response Solution Portfolio for OCR audit compliance.
  • NextGate announces the release of MatchMetrix v8 and NextGate Registries for Healthcare for accurate identity matching and health information exchange.
  • Cuyuna Regional Medical Center (MN) selects PatientKeeper technology to aggregate data from the MEDITECH system used by the hospital and the  ambulatory care offices’ Allscripts system.
  • Meritas Health Corporation (MO) selects eClinicalWorks EMR for its 72 employed physicians.
  • Lakeside Orthopedics (NE) chooses the SRS EHR for its five physicians.
  • eClinicalWorks opens a Chicago office to provide a central US presence. The city will host eCW’s user group meeting April 28-29.


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

More news: HIStalk Practice, HIStalk Mobile.

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April 24, 2012 News 10 Comments

HIStalk Interviews Steve Liu, Founder, Ingenious Med

April 18, 2012 Interviews No Comments

Steven T. Liu MD, SFHM is founder, executive chairman, and chief medical officer of Ingenious Med of Atlanta, GA.

4-18-2012 5-11-53 PM

Give me some background about yourself and about the company.

I was an engineer first and earlier in life – electrical — and it’s just it wasn’t for me. I couldn’t see myself doing this for a long period of time. I decided at the last minute to do what I really wanted, which was become a physician.

When I got out, it was a really interesting time. In 1999, there was this new movement called hospitalist, which is what I became. I took a chance and jumped in to that. 

At the same time, I started building tools that I needed for myself to manage the hospitalist group — capture data, improve quality, and improve the practice’s performance. It was nice because that ultimately resulted in me building the company. There was an opportunity. I built some tools that were really helpful for myself and it turns out there was a market — a lot of other folks were having the same problems. That’s the inception of Ingenious Med.

At this point, we’re probably the largest inpatient revenue capture physician management solution out there, with about 14,000 users. We did the tally a couple of months ago. We did about 10 million individual encounters that we captured for the physicians and hospitals across the nation in 2011.

We’re a point-of-care solution. We’re in the physician’s hands every day on every patient. We’re able to engender correct actions in data capture and give feedback and align those physicians with the goals of their organizations, whatever those might be — cost, quality, revenue.


Describe the workflow of your users and how your application captures charges and documentation within that workflow.

Our bread and butter used to be hospitalists. They’re the minority of our users – it’s really inpatient physicians. The workflow is pretty similar across the board, whether you’re a cardiologist or a hospitalist or whatnot. 

Physicians round in the hospital. I measured it one day — I walk something like five to eight miles a day in a hospital when I’m rounding. They’re extremely mobile. As a result, it’s hard to always have access to a workstation. They see patients, but actual patient care time is only about 15 minutes. The rest of the time is spent thinking about patient, documenting information, and then capturing your revenue by making sure you document for compliance and quality and all those other things that your organization needs you to do.

We’re at the very front part of that revenue cycle process. There are only a few technology touch points with a physician where you can give them feedback and have them change behavior. Most of the time it’s through the EMR, but another opportunity is what we do, which is the mobile cloud space of revenue. When they finish doing everything they do with the patient, they need to capture the work that they performed. That’s what we do.

We do a whole bunch of stuff once they enter information for us. We give them a lot of feedback and education to hopefully enhance their behavior and performance. Then we take all that information and process it, give reports back to administration, to the physicians, score cards, etc. Then get it to the billing services or the back offices to be handled from their standpoint.

We’re highly adopted – we’re literally there at the point of care on every single patient of our users every day. It’s sort of an opportunity to do all this cool stuff.

Who are your competitors and what’s the alternative for physicians to improve if they aren’t using any system?

Back in ‘99, everyone was on paper. That was the best solution. Paper is probably one of the most ergonomic things out there. You can’t supplant it in many different areas, obviously, because we’re still 10 years out and we see practices still walking around with 3×5 cards and superbills. 

That’s the de novo basic situation. It has a lot benefits, but a lot of inefficiency. There’s been many studies and a lot of data on just how moving to electronic systems gets rid of all the inefficiencies of lost paper, illegible handwriting, and all that sort of stuff. 

There’s probably about two major competitors that focus on our space. They have wonderful products and we highly respect them, but it’s what you do with the charge capture. Everyone has charge capture, even 10 years ago. EMRs, HIS systems … people have it. But it’s such a critical part of a practice. If it’s not done correctly, your livelihood is very much at risk.

As a result, people started to migrate towards best-of-breed solutions rather than the de novo systems that were available, maybe even for free. That’s why people come to us.


It’s almost as though you’re the CPOE of physician financials. It’s easier for them to use paper, but you have to give them an incentive to go electronic.

I’ve never heard that spoken that way, but that actually is a really great way to describe what we do. That’s perfect. We’re the CPOE of financials and revenue for the physician — exactly. It’s not just capturing an E&M code and some diagnoses. It’s way more than that. That’s our core business, but there’s so much that goes on, so much that can be lost revenue-wise, and so much opportunity to do other things outside of just charge capture.

The whole industry is living towards managed care. Instead of charge capture, it’s work capture. With that information that you get right there at the point of care, you can do some really, really great stuff that impacts things that are non-financial or indirectly financial, like quality and core measures and all the things that are now becoming the new way to have a healthy revenue in your practice.


So your goal is not to be a documentation system, but to capture information that isn’t available in other systems as a by-product of capturing charges?

We think of ourselves as a complementary. One of our major missions in whatever we design in a roadmap is to always complement the EMR, not to go head to head with the big functionality that they do. 

One of the things we do is complement the documentation. We don’t really want to become the medical record. It’s really not our role. But existing systems may not do things as well as they could. You find that with all the requirements coming in healthcare in both financial as well as quality reform, the physician’s pen is the most powerful thing in the hospital. Everything comes out of that. As a result, you can shore up documentation. That’s how we think of our role in documentation — shoring it up.


Do you find it tough to fight for space on the portable devices or desktops, like what happened with the proliferation of devices and applications that demanded the attention of nurses a few years ago?

Not really. The reason why, I think, if something is pretty usable …  ergonomics and ease of use are absolutely paramount to have any sort of adaption. It’s like Hair Club for Men – I’m not only telling you to use the product, I’m a member. I use the product. That’s why I still practice. You have to be a clinician and use it in order to actually design really good stuff.

We have something that’s very embedded and keeps pace with the physicians from an electronic device – Web , PDA, or smart phones. It has to be usable, and then also useful. I think because we’ve got that combination, they do generate more revenue, capture more value, showcase more quality, or improve their care with our functionality. It doesn’t feel like a hindrance. It’s looked at more as a useful tool that you use every single time you see your patient.


How do lay out your turf beyond just charge capture?

Only 10-15% of our solution is charge capture these days. Over the past 10 years we’ve built that and we continue to build that up, but that’s a small part of what we do.

Our most powerful points — why people often choose our platform — is not necessarily for the revenue and the charge piece, but the other tools — the physician management functionality, the reporting and ability to scorecard your physician and let you know exactly what they’re doing to manage their performance and give them feedback and really engender change. That’s one of the most powerful things that has been very successful for us. I think it’s what we do very well, if not the best way in our particular market.
That’s an area for sure that we will continue to move down.

I think some of the other areas in terms of point of care, education and feedback … even a limited focus of decision support is probably another area that we would like to establish as huge experts in.


Most companies have figured out an angle to ride the wave of Meaningful use, accountable care organizations, analytics, or more than one of those. Are you finding that those are good springboards for your business or are they taking people’s attention away from what you’re offering?

Meaningful Use doesn’t impact us too much. It’s not a huge focus, simply because that’s what everyone else is focusing on. That doesn’t impact us as much. 

ACOs, however, do. If in a world of managed care and ACOs, you just change the word “charge capture” to “work capture.” You still have to measure the amount of productivity that physician actually does in order to see how contracts gets renegotiated, etc. ACO is an area that has been beneficial for us. We see that as an area of opportunity as we transform our offerings to fit the coming landscape.

The other areas that we see as being directly related through the functionality that we have are value-based purchasing and quality improvement and capturing all that data. PQRS is the physician component of VBP. That’s what we do. We were one of the nation’s first PQRS registries and we have 100% success with that. We would like to take our knowledge there and move it towards VBP.


You won a physician entrepreneur award in the fall and almost immediately brought some new folks into the company at the executive level. What’s the long-term strategy for the company?

You’ve probably heard this a million times .. an entrepreneur five years ago, eight years ago who said, “We’re at the hockey stick inflection point where we’re really about to grow.” You check in four years later they just haven’t done it for whatever reasons. I’ve been saying that for a long time. 

What happens is — especially with a growing company — if you’re smart, you reinvest and reinvest and reinvest in the company. That’s what we have been doing. We really have hit that inflection point. We’re on the other side. As a result, you have to go through big organizational change.

A couple of years ago, I put in a CEO to replace my role as CEO at the company, more for personal reasons, so I could start a family. That was one of the best decisions I ever made. We were able to really, really focus on strategy for the coming change. As a result, that was the first step in maturing the company — putting in the CFO and our CTO and really capable management. The new stage is large enterprise healthcare organizations — being able to support their needs. And not even just with those clients, but also to build the company out for what needs to be done 2-3 years out for the coming change.

Any final thoughts?

I’m humbled and thankful to be where we are right now in healthcare. It’s a pretty exciting time. It’s a time that forces folks to think about the future and innovate and grow. There’s a lot of opportunity. I think it’s a neat place to be. I’m pretty thankful about that. 

With everything that’s going on, it’s nice have sites like your own to have a touch point for what’s going on in the industry. Believe it or not, you really do educate myself and a lot of the healthcare folks out there about what’s going on in the industry and trends and all of that. 

I’m thankful just for having a role and being able to be successful in providing really, really neat, great functionality to the hospitals and providers out there that hopefully improves our lives. It’s part of our mission statement. It’s nice to be able to live on that.

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April 18, 2012 Interviews No Comments

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