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Monday Morning Update 1/30/12

January 28, 2012 News 13 Comments

1-27-2012 7-57-44 PM

From You Know Who: “Re: RelayHealth. Jim Bodenbender out, announced abruptly on phone call. Jeff Felton, who ran the RelayHealth Pharmacy group and was a transplant from McKesson San Francisco, is taking over the entire division.” That appears to be true from the company’s management team page, on which Jeff Felton (above) is now listed as president.

1-28-2012 8-36-46 AM

From RAC Frustration: “Re: electronic RAC responses. I see that Medical Electronic Attachment (MEA) has become the latest company to be certified by CMS. I am curious how many HIStalk readers will use the esMD (electronic submission of medical documentation) for RAC and MAC responses?” MEA’s progam uses an NHIN gateway to send electronic responses to CMS’s post-payment audit requests of several flavors (RAC, MAC, CERT, PERM, and ZPIC.) I’m interested in how much transaction volume the average hospital will experience to keep CMS happy once esMD Phase 2 goes live in October and all documentation requests will be sent electronically. Comments welcome.

Surely the calendar is playing a cruel joke: it can’t be just three weeks until the HIMSS conference, can it?

My Time Capsule editorial this week from five years ago: Want Physicians to Use Systems? Standardize Screens Like You Do Back-End Databases. A free sample: “Hospitals never seem to get how illogical it is to physicians that every hospital buys a different system, but expects community-based doctors who cruise in for an hour a day to master all of them without burning up more hours of their self-employed day. They seem puzzled when doctors jeer at their zealous requests to bone up on Cerner when he or she is fuming at Eclipsys across town and McKesson at the university hospital.”

Listening: reader-recommend James, which I would characterize as jangly Britpop with strong vocals. They (it’s a band,  not a guy) remind me of the Smiths. They aren’t totally obscure, having sold 25 million albums in their 30 years. They probably would sell more if they had a more search engine friendly name, although come to think of it, that’s another similarity between them and the Smiths. 

1-27-2012 4-50-23 PM

A lot of money and effort is spent putting on the exhibit and educational tracks of HIMSS, but that’s just to provide the backdrop for the real reason people attend: to connect with folks for business and pleasure, two-thirds of respondents said. New poll to your right, as suggested by a reader: what reaction do you have when you hear that a vendor uses offshore programming resources?

1-27-2012 7-23-04 PM

Thanks to CSI Healthcare IT, supporting HIStalk as a Platinum Sponsor. The company is a leading national provider of IT and training professionals, both contract and permanent. The company’s team of 75 recruiters can often find local qualified resources, minimizing billable travel expenses to the client. Its pricing model has saved health system customers such as Sutter, Baylor, Texas Health, Clarian, and Sentara up to 60%. The company is vendor neutral, providing resources for projects involving McKesson, GE Healthcare, Allscripts, Epic, Cerner, Meditech, NextGen, and others. It can handle work ranging from providing a single resource to managing the projects of large health systems, also offering a specific package called Epic Community Connect that helps health systems provide Epic’s ambulatory systems to community practices (marketing, contracting, readiness assessments, implementation, and support.) Thanks to CSI Healthcare IT for supporting HIStalk.

Federal CTO Aneesh Chopra resigns and is expected to run for lieutenant governor of Virginia. You aren’t surprised if you read HIStalk on January 13, when my non-anonymous, well-placed informant chose the fantastic phony name of DeepThrowIT to tell us that Chopra was heading out. I think that might have been my first non-healthcare IT big scoop rumor.

1-27-2012 6-12-04 PM

I recently quoted some Epic facts provided by Chief Administration Officer Steve Dickmann in a recent talk he gave to a Madison group. The full video is here, from which I pulled a few more:

  • The company started in a basement in 1979 doing UW psych department work.
  • Epic went from 2.5 employees in 1979 to 30-40 employees in 1994, but then changed direction to focus on the electronic medical record.
  • The product was changed from text-based to a graphical GUI in 1994, the same year when the database was scaled up for large enterprises.
  • Epic Web came out in 1997; MyChart in 2000.
  • The company gained competitive advantage from Y2K because it had minimal remediation to accomplish while its competitors had to redirect resources to work on that problem.
  • Epic also gained competitive advantage from being in Wisconsin, which was an early adopter of large integrated delivery systems.
  • Epic does not subcontract or acquire software; everything was developed in Wisconsin.
  • The original motto was “Do good, have fun.” The “make money” part was added later.
  • Epic focuses on large hospitals and clinics, children’s hospitals, and academic hospitals and turns away other prospects. The only exception they will make is for hospitals located in Wisconsin.
  • Epic doesn’t do acquisitions because they would have to rewrite the code anyway to keep a truly integrated product.
  • Competitors have 20-30% of their employees doing sales and marketing, while Epic has 1%.
  • Epic’s culinary team has 70 employees and it also staffs its own horticultural team. It does not contract those functions out.
  • All of Epic’s implementers fly out Monday afternoon, which ties up a good bit of the Madison airport’s capacity with 600-700 people all leaving at about the same time.
  • Each customer has an assigned tech support team that knows the customer’s people and systems. The team is available 24×7.
  • 91% of the HIMSS EMRAM Stage 7 hospitals use Epic.

1-27-2012 8-19-04 PM

Supporting HIStalk as a Platinum Sponsor is Versus, which offers real-time location systems for patients, staff, and equipment. Hospitals use that information to automate workflow, improve efficiency, increase patient safety, boost patient satisfaction, and increase revenue. The company provides interesting examples: (a) advancing patients to the next level of care based on events, such as completed labs or EKGs; (b) locating telemetry patients in distress wherever they are; (c) alerting the physician when patients are ready to be seen; (d) reminding staff to wash hands; and (e) alerting housekeeping to clean the room when the patient’s badge is dropped into the discharge bin. The Traverse City, MI company has been around for over 20 years, with its combined infrared/radio frequency system being endorsed by the American Hospital Association. Hospital customers have documented improvements such as cutting equipment losses from $1.5 million to $40,000 year, eliminating the need for clinic waiting rooms, reducing telephone calls by 75%, and increasing bed capacity by 25% with no construction. Interesting stats: the company has over 600 facilities using 500,000 of its components to track more than 1 million patients per year. The big announcement a few weeks back was that The Johns Hopkins Hospital chose Versus to manage staff and assets in real time for some locations after a three-year pilot of several RTLS systems, with additional deployments scheduled. Thanks to Versus for supporting HIStalk.

The Peace Corps has an RFI out for an EMR product, just in case you’d like to sell them one. They’re actually looking to have OpenEMR customized, along with Microsoft Dynamics 2011 and BizTalk for reporting.

In England, Homerton University Hospital allows its original NPfIT contract for Cerner and BT expire and signs its own seven-year extension directly with Cerner, declining to open the opportunity to other vendors because of its working relationship with the company.

1-27-2012 9-04-08 PM

The Bipartisan Policy Center releases its recommendations for using healthcare IT to improve care and reduce costs. Quite a few industry names served on the task force and provided their input. Some of its observations and recommendations:

  • Even with new delivery models, the healthcare system continues to financially reward procedure and patient volume rather than better care. Recommendations: purchasers and plans should reward care that is higher quality and lower cost, incorporate those models into Medicare physician payments, expand pilots of new care models, and share lessons learned with private sector pilot projects.
  • Despite a lot of HIE activity, not much patient information is actually being exchanged. Recommendations: improve the HIE business case by adding more stringent information exchange requirements to Stage 2/3 of Meaningful Use, develop long-term standards that make sense for healthcare delivery, assess the level of information exchange that is occurring, do more work related to two-way data exchange, and clarify the role of health information exchange in the several programs funded by HITECH.
  • Consumer engagement with electronic tools is minimal. Recommendations: raise public awareness, help providers engage their patients to use technology, improve the usability of consumer tools and provide easy data import/export for consumer-facing applications, launch an awards program for consumer tools outcomes, share lessons learned, ramp up Meaningful Use requirements to include more consumer tools, and offer incentives to chronic disease patients to use electronic tools to manage their health.
  • EHR and Meaningful use adoption is still low. Recommendations: raise awareness of incentive programs and expand RECs and similar programs, clarify Meaningful Use requirements, roll out lessons learned form federal programs to the whole industry and not just government contractors, encourage sharing of best practices, and improve EHR usability.
  • Consumers are worried about privacy and security. Recommendations: require all entities that use PHI to comply with policies at least as stringent as HIPAA, clarify government guidance across agencies, development a national strategy for patient identification (a national ID was not specifically mentioned), and issue common sense security practices to providers.

1-28-2012 8-34-29 AM

I’ve previously mentioned the MIAA EHR mobile viewer app developed by a three-person Palomar Pomerado Health development team for its own use with its Cerner systems. A preview at a Toronto mobile healthcare conference generates interest, with the app going to pilot in March. The hospital hopes to commercialize it. Said a Canadian hospital IT director at the conference, “We need to look seriously at how a publicly-funded hospital in the States has been able to advance their technology like this when we seem to stumble on things like policy and rules.”

The Pennsylvania Health Department finds that nurses at St. Luke’s Hospital overdosed three patients in the past two years by incorrectly programming their PCA pumps. Hospital employees said the hospital did not require training on the devices.

An article covering successful businesses that did not use outside financing provides an example in eClinicalWorks CEO and co-founder Girish Kumar Navani, quoting him:

I don’t foresee leaving the company for at least 10 years. I would like to leave it a private company with no external investors and absolutely no thoughts whatsoever about Wall Street. I am having fun and take great pride in my freedom. There is no reason I would give that up. We are a cash flow positive company. We have recurring revenues and no debt. We have a large customer base that is growing exponentially.

1-28-2012 8-15-21 AM

Compuware says it will take its Covisint subsidiary public in its next fiscal year, which starts in April. Covisint, which has $74 million in annual revenue, offers an exchange platform that connects hospitals and practices, including services for identity management, collaboration, master patient index, and record location.

Vince’s latest HIS-tory: Part 2 of Health Micro Data Systems.

A column in The Atlantic revisits a 1995 article it published about Newt Gingrich, saying that some of his goofy, overly dramatic “we are at a crossroads” ideas (like colonizing the moon) prove that he can’t separate something that sounds cool if given little thought from pushing the government into spending huge amounts of money just to find out how cool it is or isn’t, even though the free market is better equipped to make that call. Healthcare technology was mentioned in that 1995 article:

Gingrich also thinks health care technology is cool. Serious students of this subject worry that insurance insulates patients from the cost of technology, thus yielding lots of high-cost, low-benefit use and in turn steering too much of society’s resources to the further development of such machinery. But Gingrich wants more. In 1984 he wanted more cat-scan machines, and he wanted the government to provide a $100 million incentive for the development of user-friendly dialysis machines–even though "there are already companies and researchers interested in this problem." The point here isn’t that Gingrich will now waste tons on technology. The current political climate will restrain this tendency. The point is that–in case you hadn’t noticed–there is little careful thought underpinning his enthusiasms, nothing solid beneath his unshakable self-assurance and his intense disdain for disagreement.

E-mail Mr. H.

More news: HIStalk Practice, HIStalk Mobile.

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January 28, 2012 News 13 Comments

Monday Morning Update 1/23/12

January 21, 2012 News 8 Comments

1-21-2012 9-08-49 AM 

1-21-2012 10-21-53 AM

From KC HIT BootsOnGround: “Re: Missouri’s statewide health information network. A rumor no more … Cerner will not serve as the technical service provider. Statement attached.” Above are last April’s announcement that negotiations had commenced and Thursday’s announcement that they have ended.

1-21-2012 10-23-01 AM

From Al Faretta: “Re: Baptist Montgomery. Just wanted to let you know that our clinical system is not McKesson – it’s Cerner. Thanks for all you do – I start my morning with you!” Thanks. That eliminates McKesson’s sole entry in the Thomson Reuters Top 15 Hospitals list and boost’s Cerner’s presence there.

1-21-2012 9-04-41 AM

From Karen Thomas: “Re: Main Line Health. I wanted to clarify the systems used at Jefferson Health System, JHS. JHS is comprised of Main Line Health and Thomas Jefferson University Hospital. TJUH uses GE as their EMR. The Main Line Health System uses Siemens Soarian in four of our hospitals and Cerner in one of our hospitals. I understand that this does not change the point of the author, George, but I thought I should point out that GE is not the EMR for JHS. Also, all the Main Line Health hospitals have recently achieved HIMSS analytics Stage 6 designation.” Thanks for the clarification. Karen is VP/CIO of Main Line Health.

From PharmGuy: “Re: Prognosis Health Information Systems. The CTO, who was the brains behind the company and a co-founder, is gone.” I asked Prognosis President and CEO Ramsey Evans about Isaac Shi. He responded as follows:

Isaac is a co-founder of Prognosis and remains a significant shareholder. He has the gift to see the “big picture” and introduce innovative solutions to the marketplace. His leadership of our ChartAccess EHR has been the foundation of our rapidly growing company. As you realize, our marketplace demands a fully integrated clinical and financial solution. As a result, we’ve broadened our focus and Isaac’s responsibilities changed as our strategy has evolved. With the 2006 vision now becoming a reality and confidence in our path forward, Isaac made a decision to look at some other opportunities to expand on his vision. He remains in good standing with Prognosis and is very supportive of our company’s direction.

1-21-2012 8-42-07 PM

From Alzado: “Re: separated at birth? Being an HIT guy and a music connoisseur, I figured you would recognize the resemblance.” I do, but I’ll leave it up to readers to figure out how those categories fit this photo. Hint: two first names, both starting with J.

From Pippy: “Re: HIStalkapalooza. Have the invitations gone out yet?” Everybody who signed up will get a response by the end of the week, hopefully – either an invitation or an apology that we couldn’t invite everyone (it’s about 50-50 since we had over 1,000 requests). As much as I like hearing from readers, I respectfully request (based on experience from previous years) that folks don’t e-mail Inga or me to ask (a) what happened to their e-mail, since we can’t control your spam filters, or (b) if we can slip them an invitation even though they didn’t get one or didn’t register in the first place. I’m already overwhelmed. But here’s some good news – next year’s HIStalkapalooza in New Orleans is already somewhat underway, with a sponsor and venue secured. I’m really lucky that companies volunteer to underwrite not only the cost of putting on the event, but to manage the surprisingly complex logistics required to do it right for readers.

From The PACS Designer: “Re: Blue Button initiative. TPD was first introduced to healthcare blogging by Shahid Shah, a fellow blogger, who started HITSphere to power this whole healthcare phenomenon by highlighting HIStalk and other websites. Now, he has blogged about the VA’s Blue Button Initiative and what he sees as its key benefits. Since it is on the NHIN Watch website, you’ll have to create an account there to read his seven key positives of the project. ”

1-21-2012 6-58-36 AM

The level of HITECH payouts is about what most readers expected, although a significant minority thought it would be more. New poll to your right: what do you like best about the HIMSS conference?

My Time Capsule editorial from 2007: Crossing the Cliché Chasm: Banished HIT Words for 2007. It obviously wasn’t effective since most of 2007’s overused words are still being repeated endlessly. A snip: “Thought leaders – people smarter than you and me, at least in their own minds. Companies often present their high-ranking employees as thought leaders when they want to sell you something. Thought leaders don’t have real jobs –they just think and cling to HIMSS podia. Picture that Rodin statue wearing a suit or black turtleneck and bringing Dilbert-laced PowerPoints.”

I just noticed that with increasing readership, we’ll be close to hitting the 5 millionth HIStalk visit right around when the HIMSS conference starts. That’s since I started it, way back in June 2003. I sometimes question whether it’s worth the effort, but I still have a blast doing it every single day, as much or more than I did 8.5 years ago.

Listening: I got several outstanding recommendations from reader Cody, including one I posted here way back in 2007 that deserves a revisit: The Hives, a hard-working Swedish garage rock band that doesn’t take itself too seriously (they wear matching but ever-changing black and white costumes and use old-school corded instruments) playing real, raw rock music with a stage presence and energy that makes them probably the best live band in the world. Proof: the live versions of Tick Tick Boom or Hate to Say I Told You So, which is like a 40-years-ago Mick Jagger without the scowling. They’re playing Coachella in April and my MP3 player starting today. When it comes to music, it’s not about their look, their audience demographic, or their age – it’s about how their music makes you feel. If you can sit immobile while The Hives are playing, then we differ.

Vince’s HIS-tory this week pays tribute to Bill Corum, who passed away earlier this month. Vince will have some fun stuff upcoming – I got an e-mail from Elaine Heusing, whose enjoyed seeing a cover of the magazine her father produced, Healthcare Computing and Communications, on one of Vince’s slides. I suggested to Vince that he cover some of those publications of yesteryear and the people who put them out. Back in the day, you waited anxiously for your mail copy of the magazines (even thought most of them were 70% ads, with mostly harmless and vendor-friendly prose intended to not threaten that ratio) and even faxed copies of newsletters like H.I.S. Insider. The folks who published those magazines and newsletters were highly respected, many of them with healthcare IT experience that went above just writing about it.

1-21-2012 7-26-50 AM

Welcome to new HIStalk Platinum Sponsor First Databank. The company requires minimal introduction since its electronic drug databases power a great number of the clinical IT systems out there, but here’s a recap. The San Francisco-based FDB’s team of pharmacists, physicians, and technologists, working with its system developer customers, turn drug information into tools that reduce medication errors by empowering clinicians as they make medication-related decisions: drug information, drug selection, clinical decision support, clinical alerts, and patient education. FDB has developed the first physician-friendly CPOE drug database, the OrderView Med Knowledge Base, that gets clinicians quickly (two clicks, in many cases) to the desired medication without bogging them down with needless details related to dispensing or billing (making prescribers choose a warfarin 5 mg and a warfarin 2 mg to get the desired dose of 7 mg is lame – that’s a dispensing decision that prescribers shouldn’t have to worry about.) The company offers case studies of how developer customers have used its products: Design Clinicals (medication reconciliation), athenahealth (meet Meaningful Use requirements), DMD America (drug pricing analysis), and Personal Caregiver (consumer drug information for mobile devices). FDB, whose vision is “A World Free of Medication Errors,” has been delivering drug knowledge solutions for over 30 years and it was recently ranked #1 among drug database vendors in nearly all key indicators in the just-published KLAS report on clinical decision support. Thanks to First Databank for supporting HIStalk.

The Virgin Islands Health Department conducts an EMR and HIE town meeting with mixed results. An interventional cardiologist talks up how much he likes the EMR, but loses his computer connection while demoing it, leading another doctor in the audience to comment that lost connections are typical in her practice and that the infrastructure may not be up to the challenge. Another doc said computerization slowed them down so much that patients were waiting 2-3 hours to see a doctor and she was thinking about finding a different career purely because of the EMR.

Robert Schwab MD, chief quality officer at a couple of Texas Health hospitals, warbles The Ballad of Go-Live in recounting their Epic go-live week by week.

In England, reliably anti-NPfIT MP Richard Bacon calls for the Cerner Millennium patient scheduling system to be shut down after problems are reported by two NHS trusts. Surgeons complained that their surgery schedules listed incorrect procedures and cases that were not within their specialties. Another trust had so many problems with long call wait times and delayed appointments that they had to stop charging patients for parking.

The VA, fulfilling its data center consolidation plan, will move VistA hosting to Defense Information Systems Agency facilities operated by Verizon subsidiary Terremark Worldwide. In a related story that I missed while taking a break last weekend, the military’s AHLTA system goes down for 10 hours after an upgrade-related problem with its commercial data storage software. An unidentified source says the outage highlights the lack of Military Health System contingency plans for AHLTA, such as a failover data center.

Kronos acquires the OptiLink acuity-based staffing solution from The Advisory Board Company. Kronos will use the system to enhance its healthcare workforce management solutions, saying it will support collaborative cost management efforts between hospital finance and nursing departments.

I like this week’s e-mail from Kaiser’s George Halvorson. He’s throwing down the gauntlet on HIV treatment next week and the CMS Health Care Innovation Summit, challenging organizations to meet KP’s HIV death rate that’s less than half the national average and even 20% better than the VA. KP will also share its tools and strategies. Most interestingly, KP has eliminated HIV treatment disparities, with no outcome differences by race, with a goal of eliminating race-related differences in 16 NCQA HEDIS categories. Well done.

A belated holiday-related charity update: HEI Consulting offered a matching donation challenge to benefit Community Services League, raising $15,000 for the Jackson County, Missouri self-sufficiency organization.

Paul Beckwith, former assistant controller of clinical intelligence vendor TheraDoc (acquired by Hospira in December 2009 for $63 million,) is sentenced to 18 months in federal prison for moving $1.3 million of the company’s money to his stock trading accounts. He initially profited from trading and moved the money back monthly, but like many gamblers and speculators, started losing and got desperate to recoup his losses by betting even more. The company got almost all of its money back.

The Secretary of State of Massachusetts goes public with his spat with Meditech over a proposed construction site, saying of Founder and CEO Neil Pappalardo, “Mr. Pappalardo wants the right to do whatever he wants and not be responsible for anything — including the rights to dispose of skeletal remains if they find them.” A public hearing is scheduled for Tuesday on the construction project, which pits jobs against archaeology.

GE reports Q4 numbers: revenue down 8%, EPS $0.35 vs. $0.42. GE Healthcare reported a revenue increase of 1% to $5.16 billion, but operating income dropped by 5% to $953 million.

GE Healthcare lays off an undisclosed number of employees (“less than 50”) at its South Burlington, VT office, citing “changing market demand and technology needs” in healthcare IT.

Police in Russia investigate whether frequent power outages were responsible for the deaths of eight newborns in 10 days, all of whom were on respirators that apparently had no back-up power source.

1-21-2012 10-01-59 AM

Clinical documentation vendor MD-IT names Bard Betz as CEO, replacing former President and CEO Tom Carson. Kevin Shaughnessy is promoted to president.

A baby born 16 weeks prematurely at 9.5 ounces (considerably less than a can of soda) is discharged after a five-month stay at LA County-USC Medical Center. The hospital declined to state who is paying the estimated $500-700K cost.They’re still not sure if the baby, now at 4 pounds 11 ounces, has permanent neurological damage.

1-21-2012 8-50-07 PM

Reader James thought maybe Weird News Andy preempted him on this story, but he nailed it. A man building a shed thinks he cut himself with his nail gun, at least until he has X-rays, when doctors told him he had actually shot a nail into his brain. His response: “Did you get that out of the doctor’s joke file?” The response: “No, man, that’s in your head.” While being transported by ambulance to another hospital for surgery, he cheerfully posts his X-ray on Facebook. After surgeons successfully removed the nail and replaced a chunk of the man’s skull with titanium mesh, he said, “We need to get the Discovery Channel up here to tape this. I’m one of those medical miracles.”

E-mail Mr. H.

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January 21, 2012 News 8 Comments

HIStalk Interviews Dan Paoletti, CEO, Ohio Health Information Partnership

January 20, 2012 Interviews 1 Comment

Dan Paoletti is CEO of Ohio Health Information Partnership of Hilliard, OH.

1-20-2012 4-07-20 PM

Tell me about yourself and about OHIP.

I’ll start with the Partnership since that’s really what it’s about. The Partnership is a non-profit created about 2 1/2 half years ago by the Ohio Hospital Association, the Ohio Medical Association, the Osteopathic Association, the State of Ohio, as well as another non-profits. It was designed to apply for the federal ARRA grant dollars that had just been issued. We were awarded the state-designated entity for health information exchange in Ohio by the governor at that time and were awarded those federal dollars as well as we were awarded about $28.5 million of Regional Extension Center monies to help providers adopt electronic medical records.

My background is very simple. I was vice president with the Ohio Hospital Association. Previous to that, I worked for Johnson & Johnson. I’m kind of a data geek. I am really here just to facilitate the grassroots effort of the Partnership.

Ohio is progressive when it comes to healthcare technology, even down to Board of Pharmacy regulations that are both admired and feared. Compared to how other states or organizations have set up their HIEs and RECs, how is your structure different or better?

It’s hard to compare if we’re actually better, but I think we are different. We decided very early on that we were going to use the resources and the expertise that existed already in the communities throughout Ohio. There was no reason to layer on another complex organization on top of all that. We are really a facilitating body to gather together the resources that exist in the state, like connecting the dots and get everybody working in the same direction.

Most of the work is being done at the community level, the grassroots level. It took us a while to get started. We started off pretty slow, but right now I believe we have more doctors than anybody signed up in the country. We just passed 6,000 primary care providers that are using our Regional Extension Center services. That grassroots effort is really the key. That’s what makes the difference.

Early on, groups thought their problems were going to be technical, so they were quick to go through a rigorous process of selecting technology vendors and looking at infrastructure. What blew up in their faces was issues related to bringing competitors together at the table or privacy issues that were a lot different than they expected. When you look at your long term strategy, the question always is, “Well, what’s your business model once the grant money runs out?”

Great question. You did hit the nail on the head with that. It’s really not a technology issue, it’s a trust issue. 

It goes back to our roots. Our board consists of stakeholders from throughout Ohio that have a lot vested in this and building the trust among each community. We’re targeting not Ohio necessarily as a state, but community by community, and using the community leadership to really get people to the table. That’s the key. It’s not about the partnership. It’s not about the health information exchange, it’s about assisting and solving problems in those local communities. That’s really what’s generated the success model to date.

Privacy is a huge issue. We’ve decided with CliniSync , which is what our health information exchange is called, it’s an opt-in model. We have developed a policy that users of the program will assist and educate the patients that are going into the exchange, what that means. It’s not a law, it’s not a state-level policy, but it’s users of the CliniSync program. We’ve tried to address those very carefully. It’s taken us a long time, but we’ve gotten buy-in from most of the major players and small providers in the state. We’re ready to move forward, and we are.

You must have a good message to get that number of providers on board since they typically understand that there’s patient benefit, but it requires extra work and potentially money from them, plus having to work with competitors that they’re not especially fond of. What selling points make them want to hook up to the HIE?

The core message is it’s about the patient. This is about what’s best for the patients in Ohio and the folks that are receiving care in Ohio. The providers in the state understand that. That’s really what’s most important.

We’re not competing about data. It’s not about competing on that. It’s about competing on service and quality. All of this can have a great effect on that as well as bring efficiencies to the table. Once you sit down and look at specific issues around what the electronic medical records and what the exchange can do for that community-based model and really take it down to that level, people understand. It’s keeping the focus on the patient. That really has had a tremendous affect.

Like all statewide organizations, you’ve got some high-profile, big-ego organizations involved. You also have some that are using systems like Epic, which touts its own private HIE capabilities among Epic users. Has that been a problem when you’re working with groups like Cleveland Clinic?

It’s not a problem. It’s one of those issues that you have to really get down to the patient level and figure out what’s best for the community. I’m not sure about this statement, but I think by the end of this coming year in 2012, we’ll probably have more Epic installs than state in the country. 

It’s a unique challenge, but when you look at specific community models, not everybody in every community is using the same systems. You have to be able to communicate with home health agency. You have to be able to communicate with the skilled nursing facility and the competitor down the street. If that patient is moving in and out of all of those, there’s no way that one system solves all that problem.

What we’ve tried to do is position this product as very community-focused, a neutral third party that is a gateway. We’re not storing data. We’re not a data repository. It just allows people to communicate with each other. The focus on the patient has been the key to getting people to work together.

In your experience connecting these different clinical systems that are out there both in the practices and the hospitals, have you found that you had to blaze new ground with vendors who weren’t comfortable with either the technology or the concept of sharing information?

That’s an interesting question. I don’t think technology is quite at the point where we thought it was to allow for the free flow of information. But we’ve worked very closely with most of the vendors, especially the ones that have the bulk of the market, and for the most part they have really been great to work with. They are looking for some standardized process to make all this happen. They really do want this to happen now that this is real, because it is happening and this transformation of healthcare is real. 

It has been a challenge. We’re finding a few that are ahead of the others, but we’re using them to blaze that new ground in sharing that information with the others. Even among the vendor community, what we’ve found is they really do work well together as long as you’re not taking sides. That neutrality is key. But it is blazing new ground, without a doubt.

You had an announcement within the last couple of weeks about using the Direct system to communicate with another state, which sounded good on paper, but somebody might say, “Well, it’s not really that relevant. Most care is local.” Why was that event important?

It really did not affect any patient care. This was really a test of whether we could accomplish it.

If you look at what ONC has tried to do – and I would like to just say that this is all happening, this transformation in healthcare around electronic medical records and exchange, is really a result of this stimulus act, and it’s a result of a lot of the great work that ONC has done — Direct is something that they thought was a way to quickly allow people to exchange information. We want to help them be successful. It was really a communication between two clinics. We really didn’t have a whole lot to do with it except to help them facilitate that process. They wanted to see if it could happen, so it was really instigated by the providers themselves.

The important piece was that you had providers that were trying to exchange information across state boundaries. It wasn’t the fact that we could do it, it was their interest, and we were help in enabling that. But what is important about that is there is information that without sophisticated health information exchange in using this Direct Project, these Direct protocols, it can really help the patients.

Let me give you an example. You have a mental health patient that shows up in the ER. That sensitive type of information is very difficult to exchange in a health information exchange, especially with the laws in Ohio. We see the Direct protocols as a way to exchange some information, with the patient’s permission, explicitly to another provider that they might be going to for a follow-up care. We think there are some definite use cases that that can help. It’s an easy way for doctors to do that. Was it going to change the world? No. But it’s a start.  The exciting part is that it was between the providers. That’s what we want to emphasize.

According to the announcement, that was the first time Direct had exchanged data across state lines. I would have thought it was further along than that. Is there a technical reason that it hasn’t been done or was it just that nobody felt the need to do it?

I think it has a lot to do with everybody ramping up. The Direct protocols are fairly new. People are ramping up trying to create those protocols and create the secure e-mail systems. There’s nothing new about secure e-mail, but getting the providers provisioned with an address and making sure that everything adheres to HIPAA compliance and all of that — it’s complicated for a lot of folks to get that up on a large scale; especially with a lot of folks that received these state-designated entities. We’re getting close. We just happen to be a little bit out in front, but I think you will see a huge charge of other states and other entities doing this now. We just happen to be a little in front.

What does the big picture look like when there are HIEs springing up from two places that are a mile apart to crossing multiple states, you’ve got the Direct protocol out there for folks to use, and maybe private HIEs that vendors have set up. How will the average medical practice be interoperating?

I’d like to speak for Ohio if I could. The picture here is really community based. The reason that’s important is that the majority of care occurs inside a community. That community could be a single town, it could be a county, it could be multiple counties. But there is some geography where the bulk of care occurs. Ensuring that that information can be exchanged, whether there’s two regional health information exchanges that exist within that community or whether it’s a community without any ability to exchange. The vision that the partnership board and the grassroots stakeholders in the state that are part of OHIP see is that the partnership can be that gateway to facilitate that.

Again, it’s not about us. It’s not about our ability to store and retrieve data. It’s about our ability to allow others to communicate with each other. And for a while – I don’t know whether it will be five years, 10 years, 20 years — there’s still going to be some middleware required to allow that type of exchange to occur. I think that was the vision of ONC — to facilitate this.

In Ohio, our model is just a little bit different, but we’re pleased because we have a lot of folks that have already expressed interest and commitment to make that happen regardless of where they stand technology-wise. That’s our vision, it will be interesting to see what happens though in the next five or 10 years.

The jury seems to somewhat be out on whether Regional Extension Centers are really increasing EHR adoption and whether they’re helping technology improve outcomes and reduce costs. Do you get the sense that they’re accomplishing what they were supposed to?

Our process is a little bit different. It all starts with electronic medical record adoption. It’s hard to accomplish all that without widespread adoption, so that’s where we spent the last two years, really working with our community leaders to adopt the electronic medical records. The next stage is working with the community stakeholders to begin to exchange that information and get a solid base of exchange going so we can start to work as a community on the outcomes and improving quality.

It’s connecting the dots. It’s been a phased approach. I think it will be difficult to accomplish the vision that many people have set without that kind of phased approach. We think we can, because we are accelerating things here in this state. Adoption is the key.

There was huge interest in HITECH money early on, but it’s starting to look like some folks gave up or decided it wasn’t worth doing. Are you seeing people who thought they might be going with electronic health records who saw the wall in front of them and decided to stick to where they are?

In the beginning, there was a lot of doubt and a lot of concern. I do think we did have some people drop off. But what we did here in the state is develop that grassroots support mechanism, so the physician and the practices and the small hospitals weren’t out there by themselves. They had a support structure in place. Because of that support structure, I think you will see an incredible acceleration of Meaningful Use attestation in 2012.

Ohio, I believe, ranks third as far as Medicaid payments for Meaningful Use and we also are at the top as far as Medicare attestation. Our goal for next year is to help 10,000 providers attest to Meaningful Use, not just primary care providers, but all providers. It’s pretty lofty, but because of that support structure, we’re trying to accelerate and keep things moving forward, because without that, we’re not going to see the benefit. That’s our number one priority. The key is that support structure — they have to have somebody to fall back on.

Is there resistance to the check-off for Meaningful Use that it isn’t really directly related to patient care?

That’s a very difficult thing to answer, especially where we are right now. Is the Meaningful Use criteria going to directly affect patient care? I think it will, in the sense that as providers have to work towards meeting that, it’s going to naturally bring along more and more of the practices as far as how it’s going to affect that patient outcomes. It was a great starting point, but what people have to realize is there’s only so much at the federal level that they can make happen. It really comes down back to that community level in putting the support structure in place to help people meet Meaningful Use. 

Then make the next step to help them exchange that information, then get these projects together that will help providers learn from each other and really make the impact on patient care in the outcomes and the efficiencies — because we have to have the efficiencies as well. It will happen. It’s just coordinating all that together, which is a monumental task. 

Every transformation is hard. It’s about having that support structure in place at the grassroots level to help facilitate that. It will happen. We spent a lot of time looking at the return on investment of electronic medical records, return on the outcomes of care of electronic medical records. I think there’s enough documentation out there now to prove that yes, it does have an affect. We want to be able to prove it has a significant effect. We think in a couple of years that we’ll be able to do that.

If you look down the road, let’s say five years, how will you know that you’ve done the job you hoped to do?

I can tell you the goals we have in place. Our board and our stakeholders make sure that we’re very goal-oriented.

To document success is the number of providers that have adopted; the number of providers that have attested to Meaningful Use; the number of providers and institutions that are sharing information; and then ultimately getting the entire community — the payer community, the employer community, the patient-consumer community, as well as the provider community — to get enough data to document that we have had an impact on the outcomes and the cost of care. And getting everybody involved in that process.

Can I give the exact metrics that we’ll need to prove that? No. But we have enough momentum now that I believe in five years, at least in Ohio, we’ll be able to prove what kind of success that this whole thing has caused. We’re pretty excited about that.

Any concluding thoughts?

This is really an exciting time for Ohio. ONC has enabled us to jump on board with this and provided the funds we’ve needed to help create transformation here in the state. It’s not about our organization. It’s really about the folks out in the community doing the work. We’re here to help them, and we hope to be one of those models of success that people can point to and say, “Look, if you can do it like this, you’ll be successful.”

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January 20, 2012 Interviews 1 Comment

News 1/13/12

January 12, 2012 News 12 Comments

Top News

1-12-2012 2-56-44 PM

Adventist Health expands its affiliation with Cerner, announcing plans to implement Cerner Ambulatory EHR across its 130 clinics.

Reader Comments

1-12-2012 8-54-21 AM

inga_small From Booth Babe: “Re: HIMSS and HIStalkapalooza. Have mercy on the aching feet of worn out tradeshow floor ‘workers’ who have only minutes to spare getting from work to FUN. Do you know how often during aching feet moments we think of the upcoming party and how it drives us through each additional hour until we can cut loose and have some fun?! I would never have time to deck out as some of those fashionistas did last year, though they looked fabulous and were fun to see. Maybe you should add a category for best ‘survivor’ shoes for tradeshow performance. ” Gee, the term “survivor” shoes is right up there with the “straight from the exhibit hall” style company logo shirts. That being said, I have a couple pair of great shoes similar to the ones above that are comfy enough for the trade shoe floor, yet stylish enough for a quick transition to Vegas nightlife. E-mail me if you want details on the brand.

1-12-2012 7-21-44 PM

From ThickAndThin: “Re: McKesson. To acquire European firm MACH4 Pharma Systems?” Unverified. The England-based company sells drug packaging and preparation automation for hospital pharmacies.

1-12-2012 9-06-17 PM

mrh_small From DeepThrowIT: “Re: White House CTO Aneesh Chopra. Word on the street is that he will announce in the next few weeks that he will be leaving his job. No word on where he’s going next.” He’s a young guy (39) with a lot of enthusiasm and charisma, so if the rumor is true, we’ll see whether he pursues money (running a private company) or power followed by money (running for office.)

mrh_small From LeftCoaster: “Re: EDI 5010. Oregon and Washington hospitals are experiencing significant issues with transmission and receipt after mandated January 1 use, but deferred enforcement until April 1. Clearinghouse vendor [vendor name omitted] is a huge problem – they are not responding to support calls and hospitals are considering switching. Both Cigna and Providence Health Plan claim they are unable to transmit payments and organizations are having major cash flow problems, particularly community hospitals. Anyone else having problems?” Unverified, so I removed the vendor’s name. Further reports are welcome.

mrh_small From Nasty Parts: “Re: [vendor name omitted]. Is moving away from their legacy EHR product and all efforts will be put behind a SaaS product they bought last year. 400+ people will be RIF’d as a result in the near future.” I removed the vendor name while we try to get confirmation (which I don’t expect to be successful), but Nasty Parts has been accurate about this company in the past.

HIStalk Announcements and Requests

1-13-2012 1-52-10 PM

inga_small Highlights from HIStalk Practice this week include: Dr. Gregg explains why he is skipping the HIMSS soup line this year. Hospitals now employ 20% of physicians. CareCloud grows rapidly. A breakdown of EP attestations by EMR product. Age affects physicians’ perceptions of HIT. A little bit of ambulatory HIT news is like a ray of sunshine of a cloudy day. In other words, by signing up for e-mail updates on HIStalk Practice, you can keep the winter doldrums at bay. Thanks for reading.

1-12-2012 6-24-41 PM

mrh_small Welcome to Humedica, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The Boston informatics company offers SaaS-based clinical business intelligence solutions that create a real-time longitudinal patient care view, giving providers insight into their patient populations, the outcomes of the treatments and procedures, and how those factors impact quality, outcomes, and cost. For physician practices, the company’s MinedShare Ambulatory product supports clinical, operational, and financial benchmarking. Humedica partners with Anceta, the informatics subsidiary of AMGA, to allow its members to collaborate on quality improvement and to share best practices. I interviewed President and CEO Michael Weintraub last month, where he talked about the company’s top-rated performance in KLAS, its partnership with Allscripts, the $50 million in capital investment the company has received, and what’s next for the industry after EMRs. Thanks to Humedica for their support of HIStalk and HIStalk Practice.

mrh_small Speaking of Humedica, the company announces a predictive analytics tool that analyzes EMR data (not claims information) to identify high-risk CHF patients and intervene before they require hospitalization. Preventable heart failure admissions cost up to $35 billion per year, with 40% of Medicare CHF patients readmitted within 90 days. MinedShare client Community Physician Network (IN) says the tool will help it perform in an Accountable Care Organization model by avoiding unnecessary admissions and providing better patient outcomes.

1-12-2012 7-37-05 PM

mrh_small Reminder: you app and Web developers still have plenty of time to enter Nuance’s 2012 Mobile Clinician Voice Challenge, considering that it takes only a couple of lines of application code to speech-enable your mobile or Web app for clinicians and the deadline isn’t until February 3. Prizes and fame could be yours. Even non-programmers can get a shot at the prize kitty by tweeting about the contest.

Acquisitions, Funding, Business, and Stock

1-12-2012 9-10-22 PM

T-System acquires Practice Management Associates, a provider of coding and billing services for EDs.

TriZetto Group, which last week acquired Medical Data Express, acquires Kocsis Consulting Group.

Practice Fusion raises an additional $2 million in funding, raising its total to $38 million from Band of Angels, Felicis Ventures, and other investors.

1-12-2012 9-08-50 PM

Columbia University signs an exclusive agreement with Health Fidelity to commercialize its MedLEE text-based natural language processing technology. Fidelity offers its own NLP solution called Fidelity Platform, which uses MedLEE to extract medical data from unstructured text and generate SNOMED codes from it.

1-12-2012 9-11-13 PM

In Europe, CompuGroup Medical acquires Netherlands-based ambulatory and pharmacy systems vendor Microbais Werkmaatschappij BV. The transaction also gives CompuGroup a 51% stake in healthcare connectivity startup MediPharma Online.


1-12-2012 2-49-30 PM

Barnabas Health (NJ) adds MedeAnalytics’ Revenue Cycle Intelligence solution to compliment its existing Patient Access Intelligence solution.

1-12-2012 3-05-03 PM

El Paso Children’s Hospital (TX), which opens next month, selects RCM provider Cymetrix for business office technology and services.

The DoD awards GE Healthcare a three-year, $43 million extension of its contract for patient monitoring systems.

Illinois Neurological Institute selects JEMS Technology to provide tele-stroke evaluation.

Massachusetts Eye and Ear selects PatientKeeper Charge Capture and PatientKeeper P4P for its 250 clinicians.

1-12-2012 9-12-42 PM

Catholic Health East signs a five-year, $40 million contract to implement AUXILIO’s managed print services in its 19 hospitals.


1-12-2012 5-51-40 PM

Former Google Health exec Missy Krasner joins Morgenthaler Ventures as executive in residence. She was also previously senior communications director at ONC under David Brailer.

1-12-2012 12-15-24 PM 1-12-2012 12-16-26 PM

Medical appointment booking site ZocDoc adds former Senators Tom Daschle and Bill Frist to its advisory board.

1-12-2012 8-09-15 PM

Encore Health Resources promotes Thomas J. Niehaus from EVP of client services to president and COO. Dana Sellers remains as CEO. In case you missed it, Mr. H recently interviewed Joe Boyd, Encore’s chairman of the board.

1-12-2012 5-54-01 PM


Lisa Conley, formerly with McKesson, joins Sunquest Information Systems as VP of North American sales and global marketing.

1-12-2012 8-00-32 PM

Industry long-timer Kerry de Vallette joins OPTIMA Credentialing as EVP of sales and marketing.

1-12-2012 8-53-47 PM

Interactive patient care systems vendor Skylight Healthcare Systems names Scott Johnson as VP of sales. He was previously with A-Life Medical and Philips.

Announcements and Implementations

1-12-2012 2-58-53 PM

North Hawaii Community Hospital begins implementation of its HIE, which uses Wellogic’s technical platform

Intelligent Medical Objects announces the successful integration of 2012 ICD-10-CM within its newly released IMO Problem IT 2012 Regulatory 1.3 software.

Nuance Communications expands the availability of Dragon Medical to French-speaking Canadian providers with the delivery of Dragon Medical 11 French.

mrh_small Yale New Haven Hospital SVP/CIO Daniel Barchi provides an update on its Epic project. Six practices of 27 physicians are live, with e-prescribing at 91% and 80% of encounters closed the same day. Physician productivity for those docs is nearly back to pre-Epic levels. Greenwich Hospital will be the first hospital to go live in April. Daniel is one of few CIOs who has implemented Epic in two large health systems (he came from Carilion) so I asked him how it was the second time. He says Epic’s greatest strength is that they fully believe and trust their own process — developing their own software, rarely partnering with other companies, and creating finely detailed training plans. The benefit for customers, he says, is that if you just follow their plan, you will have a successful go-live.

Innovation and Research

Researchers at the University of Washington develop medical robots that support the open source Robot Operating System, saying it’s time to get away from proprietary, one-off medical robots and allow universities to collaborate in sharing their applications.



inga_small Ford partners with Microsoft, Healthrageous, and BlueMetal Architects to develop “the car that cares,” which would monitor the health and wellness of drivers. Data would be collected biometrically and through voice capture, then uploaded into HealthVault.  And I thought texting while driving was distracting.

1-12-2012 8-05-40 PM

A doctor in Canada gets her smart phone PHR app certified by Canada Health Infoway, only the second app to earn that distinction. She named it Mihealth, with the “Mi” referring to her feeling that adopting digital data in Canada was Mission: Impossible.

1-12-2012 8-35-45 PM

The Qualcomm Tricorder X Prize offers $10 million to anyone who can create a Star Trek-like tricorder that can diagnose medical conditions non-invasively. The X Prize Foundation chairman helpfully adds, “We don’t have a requirement that it makes the same noise.”


An AHRQ study finds that 5% of Americans account for 50% of the country’s $1.26 trillion in healthcare costs. The top 1% of spenders account for 22% of the costs.

1-12-2012 12-30-11 PM

inga_small Could there be a connection? Life expectancy is up two years since 2000 and Hostess, maker of Twinkies, DingDongs (my personal fav), and HoHos, files for bankruptcy protection. Experts blame a shift toward healthy foods.

mrh_small Here’s a point/counterpoint issue to mull over. Inga and I disagree on the value of CMS’s attestation statistics. Inga thinks the percentage of each vendor’s customers that have attested is a good benchmark, so she did lots of spreadsheet work to compare vendors and to assume that varying percentages among them must be reflective of product capabilities and ease of use in meeting Meaningful Use requirements. I said the information is useless for that purpose since it’s more reflective of unmeasured customer demographics and buying criteria than anything else and that it would be wrong (not to mention statistically indefensible) to use the CMS figures to infer that vendors with a higher percentage of successfully attested users have a better product for earning Meaningful Use money. Feel free to take sides. One thing’s for sure: vendors who massage the data into slick marketing collateral won’t be footnoting their handouts with statistical disclaimers.

Weird News Andy says “the eyes have it” in referring to this story, in which researchers are working on a smart contact lens that can continuously and non-invasively monitor glucose levels, electrolytes, and cholesterol, sending the results electronically.

1-12-2012 8-31-07 PM

Former Steve Jobs mentor turned nemesis John Sculley, who served as Apple CEO for 10 years, is interviewed at the Consumer Electronics Show, where he was promoting a company he advises and invests in, Audax Health. He describes his interest:

The area I am particularly excited about now is healthcare. Healthcare has been the last major industry that hasn’t been touched by technology in terms of productivity and consumer adoption in the way so many other industries have. While I’m not bringing any technology experience to the healthcare industry, I do see some similarities between what I was asked to do when I came to Apple, which was to bring big brand consumer marketing to Apple and carry it over to the whole Silicon Valley industry – because everybody does that today – well that same opportunity exists today in healthcare. Health innnovation enabled by digital technologies to build big consumer service brands, is an incredibly interesting complex problem to work on. Audax is really the first social health company and it’s focused on consumer engagement in the healthcare space bringing in a lot of the social media technologies and experiences that have been learned from companies like Facebook and Zynga and others.

The federal government adds insurance fraud to the list of charges faced by a Louisiana doctor that also includes possession of child pornography. The doctor was medical director for a company that monitored neurophysiologic surgeries over the Internet, billing insurance companies for their time. He and the company are accused of billing for surgeries in which no Internet connection was established, padding their billed hours, and instructing non-physician employees to log on to the monitoring system and pose as physicians for billing purposes.

An Indiana health insurance plan alerts 2,700 members that their records may have been exposed on the Internet in February 2011, when a server was inadvertently opened up to the Web during an upgrade.

Sponsor Updates

1-12-2012 2-09-49 PM

  • SRS helps its customer Midwest Ortho (IL) celebrate its successful MU attestation with a tasty-looking cake.
  • Pete Rivera of Hayes Management Consulting  discusses building leaders and improving team effectiveness.
  • Picis will participate in this month’s 2012 Military Health System Conference in Maryland.
  • OnX and MEDSEEK enter into a strategic partnership that allows OnX to distribute all of MEDSEEK’s enterprise patient engagement solutions.
  • MED3OOO shares details of InteGreat EHR’s improved KLAS scores.
  • Minnesota’s REC recognizes e-MDs customer Christopher Wenner, MD for being one of the state’s first providers to achieve Meaningful Use.
  • Gateway EDI and AAPC align to offer ICD-10 training for practices, starting with a January 24 Webinar.
  • Orion Health opens its 14th international office in Paris.

EPtalk by Dr. Jayne

It may only be Thursday as I write this, but I’m really wishing it was Friday. This has been a hectic week full of clinical snafus and customer services annoyances.

The first guilty party is HIMSS, whose registration system apparently malfunctioned last month. HIMSS12 registrants were charged a zero dollar amount for their HIMSS renewals. I received an e-mail notice about the registration problem and was told that someone would call me to discuss whether or not I really wanted to renew. They did, while I was seeing patients. I didn’t want to ignore it and risk a snafu in Las Vegas.

I called the customer service number left on my voice mail and the answering staffer had no idea what I was talking about. After more than 15 minutes on the phone and two call transfers, they finally got their act together. I hope the conference itself runs much more smoothly. And to HIMSS, let me introduce you to the concept of service recovery. If you accidentally undercharge people, let it go and use it as a lesson learned. Did that many people really register on those two days that you are going to suffer without the extra $160 per person? Goodwill is invaluable.

The second guilty party was the staff at Well-Known University Medical Center whose performance at the check-in desk gave new meaning to the phrase “epic fail.” Not only did they insist that my insurance information wasn’t in the system (doubtful since it just paid a claim last week on another appointment) but they were also rude about it. As I sat in the waiting room, I was also annoyed by their ham-handed questioning of patients on race and ethnicity. I wanted to jump up and intervene with some better scripting.

If organizations can’t even handle those customer service basics, I have no idea how they’re going to achieve Meaningful Use, let alone be a meaningful participant in an ACO. Not to mention that they didn’t ask everyone about race and ethnicity. I’m not sure if they just “assumed” for the rest of us or if they decided to judge by appearance.

The final straw was a resident physician who actually was using his BlackBerry to e-mail or text during my visit. Really. Talk about smartphone distractions. He set it on the table between us and typed as he was doing the exam. I know for sure he wasn’t documenting in the EHR because the scribe was tapping away at the PC in the corner.

The resident didn’t think it was funny when I asked him if I was keeping him from something important. He did sheepishly put it in his pocket. Maybe he should have noticed the “faculty” label on my encounter bill. Oops!

Lest you think I’ve just become Angry Jayne, some good things did happen this week. Inga and I strategized on the coveted HIStalkapalooza beauty queen sashes and I have narrowed down the list of candidates who are vying for the chance to escort me to the event.

HIMSS released their list of its 2011 Best Hospital IT Departments. Texas Health Resources, whose IT shop is led by contributor Ed Marx, is listed for large hospitals.


I’m curious about Nemours/Alfred I. DuPont Hospital for Children, which is described on the “medium hospitals” list as having 237 IT staff for its 180 licensed beds. I could certainly do a lot more with 1.3 staffers per patient. I wonder what their nursing ratio is?

Life Technologies Corp. announces that its new Ion Torrent genome sequencer will be able to map an individual human genome in a single day for less than $1,000. Although technically this is HOT, sequencing of a person’s genome brings up lots of controversial ethical and legal issues, not to mention the cost of the human expertise needed to transform the genetic data into something meaningful and to then counsel patients.

The absolute highlight of my week, though, is this delightful video about computers in medicine circa 1964. Thanks to Rockstar HIStalkapalooza correspondent Evan “Velvet Jacket” Frankel for making my day. See you at HIMSS.



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

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January 12, 2012 News 12 Comments

2012 Mobile Clinician Voice Challenge 1/4/12

January 4, 2012 News No Comments

1-4-2012 4-12-17 PM

Nuance, an HIStalk Founding Sponsor since July 2005, has made a significant contribution to Homes for our Troops in honor of HIStalk’s readers and in appreciation of HIStalk’s sharing of this information with them.

12-31-2011 10-12-22 AM

The Problem

Clinicians and their mobile devices are everywhere. Doctors, nurses, and other licensed professionals are interpreting clinical information and making clinical decisions right now using smart phones and tablets, often from locations outside the four walls of the hospital, clinic, or medical practice. They need better ways to interact with these systems beyond tiny keyboards.

The Solution

Give mobile clinicians a voice by speech-enabling your applications, both Web-based and mobile, with as few as two lines of code and in as little as a couple of hours. Free them from the limitations of poking at keyboards that are too small for normal fingertips –let them document on the go using their voice.


The Challenge

The 2012 Mobile Clinician Voice Challenge offers over $25,000 in prizes for most innovative, speech-enabled healthcare application (Web-based or mobile) developed using the HIPAA-secure, cloud-based Nuance Healthcare Development Platform. The contest runs through February 3, 2012, with winners to be announced at the HIMSS conference.

1-4-2012 4-08-58 PM

The Prizes

1-4-2012 4-10-25 PM

Full Details

Information is available on the contest page. See the text ad in the right column of HIStalk as well, which will run throughout the contest.

Not a Developer?

Tweet about the contest using @NUAN_Healthcare and #2012mobilechallenge and you’ll be entered in a daily giveaway for contest tee shirts and an iPad 2.

Contest Video


An interview with Jon Dreyer, senior manager of mobile solutions marketing, Nuance Communications, Healthcare Division

Describe Nuance’s philosophy about the mobile clinician.

The “mobile clinician” is quickly becoming synonymous with the modern clinician. In fact, physician smart phone adoption, which is currently at 72%, outpaces the general U.S. adult population by more than 50%.  And by the end of 2012, mobile device adoption among healthcare professionals is expected to reach 85%.

Whether racing from exam room to exam room or working remotely, mobile access to clinical information and mobile collaboration tools are essential for caregivers. This new breed of healthcare professional is in need of better experience-enhancing technologies, such as speech recognition that is available on any device at any time, in order to be completely untethered, yet still be fully plugged in to interact with and contribute to the care delivery process.

With voice-powered applications becoming common, especially on smart phones, do you see that as becoming a standard for systems designed for clinician use?

Absolutely. Voice will continue to grow as a primary form of input into mobile devices for consumer markets as well as within healthcare. Touchscreen devices with small onscreen or physical keyboards will never catch up to the speed of data entry on a desktop environment. Speech recognition overcomes the challenges associated with touch typing and bridges the gap to provide a ubiquitous experience for all users on all devices and platforms.

Keep in mind that speech recognition software designed specifically for healthcare professionals has been in use for more than a decade. On a daily basis, hundreds of thousands of clinical users across all healthcare specialties rely on the technology to reduce turnaround times, cut costs, and improve the overall delivery of patient care.

Given the dramatic rise in mobile device adoption over the past few years, and its projected growth, it’s only natural that the speech recognition experience clinicians have come to appreciate on their desktop is something that they will expect from their mobile and web-based apps as well.

Give me some cool ideas or apps you’ve seen that would be a good choice to speech enable just in case developers out there need some inspiration.

We have more than 100 partners in our evaluation program today. Healthcare app developers are rapidly embedding secure, cloud-based, medical speech recognition in point-of-care documentation/mobile EMRs, reference and content databases, disease management, clinical trial, pharma, and specialty-specific reporting tools. The applications run on a variety of devices and operating systems that are supported by the development platform, including iOS, Android, Web Browser (Internet Explorer, Safari, Firefox, Chrome), and native desktop applications.

Examples of clinical scenarios and apps that use speech recognition powered by Nuance Healthcare include:

  • Mobile EMR access. With speech recognition as part of the workflow, physicians can easily voice document findings and clinical notes without having to return to a workstation or office.
  • Interactive patient-side care. Specialists using mobile applications can now visit patients post-surgery and retrieve, as well as document using their voice, all relevant information on their mobile devices.
  • Trauma communication and coordination. With specialized, speech-enabled mobile apps, clinicians can capture in their own words the patient story without delay. In a trauma scenario where every minute matters, this streamlined mobile approach helps to speed communication across care teams while expediting prep time for surgery.
  • Diagnostic image view and reporting. Radiologists can now access patients’ diagnostic images via their mobile device and dictate reports from anywhere and at any time. The time in which patients receive feedback and care can be significantly shortened.

Do you have any words of encouragement for those who are thinking about entering the challenge?

Healthcare app developers should join the challenge because there’s really no reason not to participate.  Not only is it free to evaluate the Nuance Healthcare cloud-based medical speech recognition technology, but it’s also easy to integrate, deploy, and maintain. It requires minimal development effort (most evaluation partners have their integrations up and running within a few hours of registering) and clinical end users will benefit greatly from having access to medical speech recognition from their mobile and web-based apps.

Contest Notes

  • The contest is open to any developer who is a legal resident of the US.
  • You can submit multiple entries.
  • Apps do not need to be live and/or commercially available.
  • Apps do not need to be written specifically for the contest – it’s OK to integrate the speech service into an existing app.


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January 4, 2012 News No Comments

Curbside Consult with Dr. Jayne 1/2/12

January 2, 2012 Dr. Jayne 7 Comments

What Gets Measured Gets Managed

During the last five years, we have seen significant shifts in how healthcare is delivered and in the way in which different healthcare services are valued. Most of us have realized for quite some time that fee-for-service medicine is clinging to life. Pay-for-outcomes is going to be the order of things from here on out.

Hospitals are no longer going to be paid to ameliorate hospital-acquired conditions or to deliver care to patients who were impacted by preventable harms. Physicians are going to be judged on their patients’ lab data and biometric information rather than the number of visits they bill.

Care will be transformed regardless of how we feel about it, whether it’s by the name Accountable Care, Shared Savings, or Pay-for-Performance. It’s something we all need to get used to.

My colleagues were ringing in the New Year this morning in the time-honored tradition of complaining around the coffee pot. (Most of us were rounding a bit later than usual and I did see a couple of bloodshot eyes.) It seems that many independent physicians, particularly those in small practices, don’t know where to start. (Employed docs are generally confused too, although to a slightly lesser degree.)

I decided to introduce them to Peter Drucker, whose famous statement, “What gets measured gets managed,” should be well understood by now. But let’s just say I was more than surprised by the blank looks in front of me.

Several of the docs didn’t understand that Meaningful Use is going to get trickier as time goes on. Although there are some metrics for Stage 1, many of them are easily achievable with a minimum of work. (Apparently though not as easy as people might think – I’m still stumped by the phenomenon of people unsuccessfully attesting. If you don’t have the numbers, why would you attest? Still waiting for someone to shed light on this.)

Although we don’t have final metrics for Stage 2 and beyond, it’s virtually guaranteed that the bar will be higher and the hoops smaller. In talking with the docs in the lounge, though, many of them don’t have a clue how to approach care metrics – even those with sophisticated software. I’m seeing far too many physicians who are barely using their certified EHRs, who are confused by some of the terminology, or who are hung up on wanting flash and sizzle.

I felt like I was giving a Grand Rounds presentation because our friendly chatter turned into a lecture that I probably could have given CME credit for. Docs don’t seem to understand that you have to know what you’re looking at in order to drive change. It’s not going to drive itself. You have to figure out what you want to work on, then measure it, then work on it, then measure it and work on it some more. Lather, rinse, repeat.

It seems pretty straightforward, but maybe it’s not, so allow me to share some other “secrets” that your docs may not know.

First, don’t get hung up on the fact that your EHR vendor may or may not have a registry or dashboards. Maybe they do and it’s just called something else, or maybe they don’t. One doc I was chatting with was caught up in the fact that he didn’t have his vendor’s dashboard product live yet. He was either under the impression (or in denial – it’s debatable) that he couldn’t start managing care until he had the pretty charts to back up the data. He didn’t like it too much when I called baloney on that one.

Most certified EHRs have at least some minimally decent ability to do reporting. That’s really all you need to start. If you have discrete data, you can report on a wealth of conditions. Prostate cancer screening? Check. Blood pressures? Check. Documentation of advance directives? Check.

You don’t need pie charts to tell you how to care for patients. When your report has blanks on it because you haven’t documented an item for a particular patient – that, my friends, is an opportunity for care.

Second, don’t get baffled by the metrics. Looking at some of the NCQA or NQF or MU measures and how they’re calculated makes my head spin as much as yours does. If you’ve never tried to do quality improvement before, start with something basic.

If it’s important to you to make sure every patient over 50 has a documented cholesterol test, start there. Don’t get hung up in the numbers and managing everyone down to an LDL of 70 or figuring out complicated exclusions. Start with something manageable, such as actually testing everyone. Run reports, do outreach, give it a month or two, then run those reports again and see if you’re making a change.

Third (and this is one of those points where I’m glad I’m anonymous – my CIO is probably spitting his coffee as he reads this) you don’t even have to have an EHR to make a difference. (I think I heard a few vendor gasps out there, perhaps the hissing of the word “heresy,” but it’s true.) You can make tangible gains in patient care without even a single chart pull. If you have a practice management system (that’s a “billing system” to some of you docs) with even rudimentary reporting capabilities, you can find opportunities to deliver care.

How so, you ask? Take an all-too-common diagnosis like diabetes (250.xx in ICD-9 terms.) Run some claims reports. Run a report of patients seen in the last three years with that group of diagnoses codes on a claim (or pick a single one like 250.00 if you’re scared at what you might find) and the date of their last billable visit. Presto! Anyone who hasn’t been seen in the last six months is an opportunity for care. This, of course, assumes that you actually bill the codes you’re addressing at the visit and not just cloning the last visit’s codes, which may or may not have included the diabetes. Primary care physicians are notorious for under-documenting the work they do.

Calculate the percentage of diabetics who haven’t been seen in the last six months and you just created your first metric. (If you passed epidemiology and biostatistics, which you must have to have graduated, you can calculate this. Trust me.) Send some postcards and make some calls (HIPAA-appropriate of course) and get those patients to come to your office for an actual billable visit. Report again in two to three months and see how you did. If you need a graph to show you the results, allow me to introduce you to my friend, Microsoft Excel. But I’m betting the numbers will speak for themselves.

Finally, it’s not just enough to have the data. You have to make it visible to make it actionable. Post your goals and action plans in a visible place in the office. Post monthly outcomes numbers. Celebrate those victories. When the numbers aren’t in your favor, take some time to figure out why and how you can do things differently. Involve everyone in the office. Even if you’re only focusing on a single metric each month, you WILL make a difference in the lives of your patients.

If you don’t believe that what gets measured gets managed (especially if you’re posting it publicly for everyone and their cousins to see) think again. I used to think I was pretty decent with my exercise habits (although it truly is difficult to hit the treadmill with a martini, so I wouldn’t recommend it.) In 2010, I did about 870 miles, which wasn’t totally shabby.

However, a double-dog-dare by some of my staff led to the public posting of our activities, with technical validation courtesy of our friends Garmin and Nike+ to prohibit cheating. (I suppose I could have paid the neighbor kid to jog around with my Garmin on, but that wouldn’t have been very sporting.) We have some serious running junkies on our team, and although I wasn’t delusional about keeping up with them, I felt pretty strongly about being able to beat most of the 20-somethings that populate the cube farm we call home. (Yes, they’re young. Yes, many of them are liberal arts grads. No, we’re not an Epic shop.)

Everyone had to share his or her numbers Saturday night. I almost forgot, so I was frantically uploading with a glass of Bailey’s in hand. I finished respectably with over 1,200 miles, but there’s always 2012:

Just Measure It. Just Manage It. Just Do It.


E-mail Dr. Jayne.

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January 2, 2012 Dr. Jayne 7 Comments

Monday Morning Update 1/2/12

December 31, 2011 News 2 Comments

Happy New Year!

Given the lame (and guardedly vague) healthcare IT predictions for 2012 that I’ve seen, written by reporters and other non-combatants, I’ll pass on giving my own. Some of the pearls of predictive wisdom: (a) companies may consolidate; (b) consumers will be engaged; (c) ACOs will be formed and will need analytics; and (d) social networks will be used to encourage good health.

My Time Capsule editorial from this same week of 2006: Can EMRs Sweeten their ROI by Moonlighting as Research Databases? A random sample: “Repurposing that existing information by making it available to those willing third-party customers, even when motivated purely by mission-supporting cash, is at least more beneficial to society than running a McDonald’s or building medical office buildings.”

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

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The HIT bubble is here to stay, most readers believe, which must mean it’s not really a bubble in their minds. New poll to your right: when a hospital says having its clinical systems offline for several hours resulted in no patient harm, do you believe them?

We’ll give the HISsies nominations just a few more days before moving on to the actual voting, so this is last call to get your candidates on the ballot. Some obvious choices haven’t been nominated, I should say.

Here’s Vince’s HIS-tory on outsourcing.

Geisinger Health System (PA) says it will not hire smokers starting in February, when job applicants will be required to take a nicotine test.

12-31-2011 8-00-19 AM

Reading Hospital (PA) retools its executive team to put clinicians in key roles. The new CEO and COO are nurses, while the new CMIO, chief medical officer, and VP of academic affairs are physicians. The CEO, COO, and CFO all came from the consulting company the hospital had engaged to review best practices. The hospital says it’s also implementing a management process that includes physicians in every decision. Also mentioned is the hospital’s $180 million decision to implement Epic, which the hospital’s board chair says “will explode the quality of care and increase patient satisfaction.”

Cleveland, OH health systems Cleveland Clinic and MetroHealth are sharing electronic patient records and Kaiser Permanente will join them shortly. They’re using Epic’s Care Everywhere rather than an HIE, meaning they can access the records of patients who have opted in from 300 hospitals and 4,000 clinics.

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Stanford researchers develop an application that allows technicians to control MRI machines from HP’s TouchPad tablet, which was discontinued within two months of its launch and sold off for $99. The researchers liked it because HP helped them remove its metal parts, a requirement for operating near an MRI magnet.

A British physician advisory group proposes that NHS allow patients to review their own electronic medical records by 2015, including the ability to review physician notes and request prescription refills and appointments online. Expected roadblocks are patient confidentiality concerns, physicians who don’t want patients to see their documentation, and NHS’s potential inability to provide such a service.

A California hospital investigates one of its contracted employees who allegedly posted a photo of a patient’s medical record, including the patient’s name, on Facebook with the comment, “Funny, but this patient came in to cure her VD and get birth control.” Several people scolded the employee on Facebook for violating the patient’s privacy, to which he replied, “People, it’s just Facebook … Not reality. Hello? Again … It’s just a name out of millions and millions of names. If some people can’t appreciate my humor than tough. And if you don’t like it too bad because it’s my wall and I’ll post what I want to. Cheers!”

A man who rear-ended a parked fire truck and then sued the firefighter who saved his life gets nothing in the settlement of his lawsuit. The fire truck was parked in the opposite lane as firefighters were responding to an accident. The driver had a long record of traffic offenses, had been ordered by a court not to drive, was not carrying insurance, and was taking three judgment-altering drugs. He lost control while speeding on the rain-slicked road, crashed into the fire truck, and had to be flown out by medical helicopter. He wanted $300K to settle his suit that claimed the fire truck was parked in his lane, which the crash scene photo appears to show is not the case. The city paid $47,000, of which the man’s children will get $20,000 and lawyers $27,000, claiming it was cheaper to pay the money than the cost of a trial. Since the accident, the driver has been convicted of two additional crimes, one of them a felony that will likely send him to prison.

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I’ll have full details on HIStalkapalooza mid-week, so watch for that if you’re interested. Readers always like to guess a company given a tiny section of their logo, so above is your challenge.

Also coming mid-week is information about an application development contest that we’re helping promote. Here’s the story.

One of our sponsors asked us if we had additional promotional opportunities available, i.e. they wanted to buy a featured post or access to the e-mail list. They were running a fun-sounding contest with some pretty cool prizes, right down the alley of HIStalk readers who have written medically related software (vendors or providers alike.) We said no, we don’t do that – all we offer is sponsorships, all sponsors get the same benefits, and we will never make the e-mail list available to anyone. We always turn down requests to provide more exposure for cash.

Inga and I were noodling around on how we might help in a non-commercial way that would benefit someone other than ourselves, so instead of just saying no, we told them, “Make a big donation to charity and we will help get the word out to our readers as long as we can do it our way.” They agreed. We suggested the charity and the dollar amount, to which the company also (surprisingly) agreed.

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Receiving the company’s ample donation was Homes for our Troops, a top-rated charity (98.5% on Charity Navigator) that builds specially designed houses for severely injured and disabled veterans who receive them at no charge, with the assistance of donated labor and supplies. Our designated recipient is Marine Staff Sergeant Jack Pierce of Temple, TX, paralyzed from the chest down in his third deployment in Afghanistan when his vehicle drove over a 200-pound bomb, killing two other occupants and severely injuring six. The apartment in which he, his wife, and their young son live is not wheelchair accessible.

I’ll be sending the contest information out around Wednesday.

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December 31, 2011 News 2 Comments

HIT Vendor Executives – Part Two of Two 12/30/11

December 30, 2011 News No Comments

We asked several HIT vendor executives the following question: Where do you plan to invest your research and development dollars over the next 1-2 years?

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Tim Elliott, Founder and CEO, Access

We are focusing on three technologies that every hospital needs: electronic signature, a data bridge between clinical devices and systems and EHRs, and paperless, online e-forms.

The next generation of e-signature not only enables patients to quickly and securely authorize e-form registration packets and bedside consents, but also offers administrators the convenience of a server-based model. A clinical data bridge can capture and standardize output from devices (such as EKG traces and surgery images) and systems (perinatal documentation, COLD feeds, etc), and interface these directly into EHRs – with no paper or manual indexing.

Finally, we’re giving hospitals a way to transform slow, inefficient paper-based processes – such as onboarding, capital requests and physician referrals – into fast, collaborative, paperless ones. Users will be able to access electronic forms from their browser, add attachments, apply digital signatures and send through the proper channels, and to track each stage of the process. Upon completion, a copy of the form is archived in the ECM system and data posted to business and/or clinical systems. With healthcare facilities shooting for full EMRs, we’re doing our part to create technologies that fill the gaps, and are focusing our R&D on removing paper from as many processes as possible.

Ray dyer

Ray Dyer, CEO, Acusis

As a clinical documentation solution provider, we continue to look to our customers and healthcare IT market drivers. Given the many transformations underway, driven to a large degree by healthcare provider behavior, we are planning on investing our R&D funding in user intelligence tools including decision support and patient care analytics as well as mobile solutions development. We believe these areas will continue to be driven by customer need and demand, requiring data availability with strong privacy and security provisions. Acusis is poised and preparing to meet these challenges.

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Dan Herman, Founder and Managing Principal, Aspen Advisors

Aspen Advisors’ investments will be focused on the expansion of our current services to address the needs of our clients:

  • Adoption of EMR technologies and clinical informatics;
  • Healthcare reform in support of “accountable care” delivery and financing models;
  • Operational integration of Business Intelligence and Data Warehousing solutions to enhance care delivery, improve quality, reduce costs; and
  • Improved reliability and cost effectiveness of technology infrastructure through the implementation of structured IT service management processes.

We will continue to invest in the development of structured, repeatable, yet flexible methodologies for planning and assessment, implementation management, and operational performance improvement.

We will also continue our investment in training programs for our consultants, so that our clients will continue to see the consistent application of expertise and delivery of service as our firm continues to grow.

Don Graham

Don Graham, General Manager, Billian’s HealthDATA

Our R&D investment will focus primarily on improving our data on outpatient care, and the better use of social media internally to communicate who we are and what we have.

With outpatient surgical visits now accounting for almost two-thirds of all surgical visits in the US, it is an area that our customers – healthcare vendors – are paying more and more attention to. We in turn must provide them with the data they need to best address this trend, which doesn’t show any sign of slowing down in my opinion.

As for social media, it’s proving to be the most effective way to distribute the news. That includes, of course, healthcare news. We realize that our customers and their provider customers are increasingly using social media as a means of communication and self-education, not to mention public relations and marketing. Patient referrals, good and bad, will have an ever-increasing influence on healthcare-related decisions made by the public, and the public’s migration to social media is obvious.

We, of course, want to be where our customers are, whether that be Twitter, LinkedIn, or blogs like HIStalk, so we’ll be ramping up our social media presence internally to make sure that staff are engaged and conversant in the healthcare discussions taking place online.

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Stuart Long, President, Capsule

As the leaders in device integration, we’ve always been in the data business. Yet data needs are rapidly evolving. We are going well beyond the basic connectivity of data into information system(s). Basic connectivity is actually well understood as a necessity at this point; hospitals get that automating the vitals collection process is critical to recovering nursing hours, reducing charting hours and improving patient care. What they really need is better, more useful data to help improve decision making, to alert them to impending conditions faster and to improve the quality and safety of patient care overall.

We’ve reached a tipping point; hospitals are starting to scream “information overload.” Our customers are saying “we get so much data, from so many sources, that we need help sorting through it all; we need it presented in a meaningful way so we can act upon it faster.” We hear them loud and clear and will therefore be investing heavily on data; on how we increase the value of data so we can manage and disseminate the discrete data and communicate additional relevant context and meaning of that data to the right caregiver, at the right time, about the right patient. It’s a tall order and will take a lot of work with our EMR partners as well to make it a reality, but I think we are in the right place, at the right time to make it all happen.

Mac Mcmillan

Mac McMillan, CEO, CynergisTek

That’s easy — on the areas of privacy and security representing the greatest challenges for our customers.

We have always prided ourselves on staying out ahead and anticipating the needs of the industry and the needs of our customers in privacy and security. Five years ago, that meant attacking things like data leakage, encryption, and log management/auditing. Today it still involves finding better ways to monitor activity in the enterprise, but it also includes things like securing the cloud, defining managed security services for healthcare, managing the risk associated with the proliferation of mobile devices and medical devices that are not secure, and finding ways to better manage the security requirements with Business Associates.

Healthcare has enough complexity in its environment and more than enough on its plate with HIE, ACO, ICD-10, etc. It needs practical security strategies and solutions that work and are effective at stemming the tide of breaches like we have seen this year. We believe that in order for healthcare to win the battle with privacy and security, it’s going to take an investment in the right technologies and integration of Managed Security Services into compliance programs. We understand that technology alone is not the answer, and so the focus should be on implementation strategies and building the right processes around these technologies that enable them to be successful.

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Michael O’Neil, CEO, GetWellNetwork

In recognition of the emerging reality that healthcare will be delivered anywhere and everywhere, no matter what the time, device or location, GetWellNetwork will sustain its investment in innovative Web-based, mobile phone and cable television technologies. When used properly, such technologies will support communication, education and even engagement throughout a patient’s care journey — from the home to the physician office, hospital, imaging center, or pharmacy and back to the home once again.

Platform-agnostic, technology-enabled patient engagement will be indispensable to providers, payers, and vendors as they work collaboratively to reduce hospital readmissions, promote self-care, boost patient and member satisfaction, and decrease cost per case. At GetWellNetwork, we are making significant investment in helping providers fulfill Stage 2 and 3 Meaningful Use requirements, and address the evolving challenges of medical home, accountable care and bundled payments.

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Peter J. Butler, President and CEO, Hayes Management Consulting

At Hayes, we plan to invest R&D dollars in our hospital billing compliance software, MDaudit Hospital. It is designed to give auditors access to billing data to support revenue integrity, helping them to eliminate the errors for which CMS routinely recovers payments through its integrity programs such as RAC, MAC, and the efforts of the OIG.

However, we are finding that our clients are increasingly asking us about using this tool for other strategic projects such as ICD-10 documentation improvement, Meaningful Use, and data mining. Therefore, we are exploring related tools to use for these additional purposes. For example, via our recent integration with MediRegs clients can look up diagnosis and procedure codes and documentation requirements while in MDaudit. Additionally, some of our auditors are using MDaudit as a physician training tool on ICD-10 documentation.

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Tiffany Crenshaw, President and CEO, Intellect Resources

Intellect Resources is investing in identifying and breeding new talent for the healthcare IT industry, with emphasis on training and go-lives.  In 2011 we debuted Big Break, a high-energy recruiting event designed to select an entire training and go-live teams in short period of time. Big Break is marketed towards individuals with no or minimal healthcare IT experience who have the right attitude, enthusiasm, and potential.  In an intensive one-day recruiting event, job applicants must complete a series of rigorous tests – one-on-one and panel interviews, extemporaneous public speaking, group work and classroom presentation skills – designed to identify only the best training and go-live talent.   

Once selected, Big Breakers complete an intensive course with classroom and hands-on learning, credentialing them in the appropriate EMR. As a result, a hospital system is able to select an entire training and go-live team in just a few days. Because Big Breakers do not typically have prior industry experience, they can often be secured at a fraction of the cost. As a result, hospital systems are able to breed and retain this new talent at a fraction of industry costs in a short amount of time.

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Doug Burgum, President and CEO, Intelligent InSites

In our pursuit of improving care while lowering costs, we’ll be investing in three primary areas in the next 1-2 years.

First, one of Intelligent InSites’ most important objectives is to improve caregivers’ ability to spend more time at the patient bedside. To this end, we’ll be continuing our R&D investment in automating non-value-added manual tasks—including EHR data entry and finding available, clean equipment through easy-to-use applications—to give caregivers more time to spend with patients.

Second, as our solution utilizes RTLS and RFID technologies to know the location, status, condition, and interaction of all tracked equipment, patients, and staff throughout the hospital, we collect a massive quantity of operational data, every minute, every day, month after month, year after year. Through our Business Intelligence solution, we help our customers harness this “Big Data” to produce actionable insights critical to making sound and timely decisions, by utilizing flexible, high-impact, easy to create reports.

Third, because real-time data is generated from a wide variety of data sources, and because real-time intelligence can empower multiple healthcare IT systems, we’ll be continuing our investment in our partner ecosystem. We will continue to integrate with the expanding set of RTLS hardware vendors, and we’ll continue to expand our interfaces with EHR solutions, communications platforms, asset management applications, building management systems, and nurse call systems.

We are excited about investing in the future of RTLS, the “magic” of enterprise RTLS software, and helping our customers to truly improve the care they deliver, while simultaneously lowering their costs.

Tom Carson

Tom Carson, CEO and President, MD-IT

MD-IT has traditionally developed and delivered software functions that provide or support practical use of technology for physicians and patients, and that will continue to be our focus. Like most vendors, we will keep an eye on Meaningful Use requirements and other market developments, but identifying specific features beyond the near term is tough, as the HIT market is quite volatile at this point.

We expect to see evolving demands as the industry moves from what we think of as effectively an EMR version 1.0 environment to a more mature EMR version 2.0 environment that is more sensitive to the needs of physicians and patients as the primary users of these systems. Certainly near-term efforts will be directed to expansion of our popular mobile functionality that streamlines physician workflows, as well as continued broadening of our interoperability functions that link providers, patients, and payors.

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Patrick Hampson, Chairman and CEO, MED3OOO

We are focusing our investments and resources in numerous areas. MED3OOO has committed to focus our knowledge, products and services with a MED360 view of healthcare delivery. We are not like most vendors just supplying systems. Our investments will continue to expand our current operational and technical capabilities and offerings. We will continue to integrate our proprietary systems, and continue our investments in capturing and using data of populations. We will continue to invest in tools that providing information across the entire spectrum of care focused on: efficiencies wherever we can find them, the patient and provider experience, the cost and most importantly the quality of care delivery. We want to be the best partner to providers that is in the industry.

Our investments in point-of-care capabilities will also create a great differentiation for the providers using our proprietary systems. As part of this, we are investing in the area of clinical decision support. “CDS” in an Electronic Health Record can take many forms. It is certainly more than providing guidelines to a provider. We want to focus on the user experience and want to spend a lot of effort with physicians reviewing workflows to determine how CDS can truly add value to the provider and patient when care is being delivered. Our addition of Quippe is just one example of these efforts. Quippe is the state-of-the-art documentation tool in the industry and is the basis of enhanced CDS within our InteGreat EHR offering.

These efforts are also critical to the physicians and hospitals we have partnerships with, but who are on older technologies or legacy systems even though they come from today’s brand vendors. Physicians already have investments in these systems. They too, need these higher level capabilities and they too need knowledge-based solutions. While these systems may be older and not web- based, MED3OOO, as their operating partners we work to provide solutions to improve on the capabilities these older systems just do not have. A system agnostic approach allows us to not just throw them out and waste physician’s precious capital. We try to maintain those systems and it is somewhat like the BASF commercials, “We don’t make things, we make things better.”

Lastly we will continue to expand our significant M3IQ data warehousing capabilities, capturing data from disparate systems, continuing our focus on the promise of combining financial claims and clinical data, and turning that data into actionable, predictable intelligence.

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Robert Connely, Senior Vice President, Medicity

We are going through a period of enormous change in healthcare, and it’s clear that healthcare IT will play a critical role in that change. Medicity is focused on a strategy that will enable rapid adaptation to changing requirements while realizing a more cost-effective model that we believe will lead the next generation of information technologies.

Today, we’re building out the underlying IT infrastructure required for tomorrow’s healthcare, including integrating EHRs, building data exchanges, and standing up repositories. We are expanding our analytics capabilities and are involved with developing standards like ONC Direct. 

Many of our R&D efforts are targeted at integrating and improving our family of products. The strategy levers common technology platforms, modular apps, and cloud services. We believe that by porting much of our current functionality into apps designed to run on a platform like iNexx (Medicity’s individual network exchange), we can reduce time to market for new features, control development costs, and provide a greater opportunity to adapt to new needs quickly. 

We believe that technology is evolving to the point that it can adapt to people as opposed to people adapting to the technology.  Towards this end, we continue to invest in emerging technologies and markets.  For example, our efforts range from pioneering pervasive analytics that employ software agents to better analyze information at the source, to enabling consumer platforms to drive better health.  We are also focused on building solutions that leverage payer, provider, and consumer interactions to create more effective care.

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Peter Kuhn, CEO, MEDSEEK

MEDSEEK has always been ahead of the curve, developing strategic patient engagement and management solutions that help healthcare executives realize cost savings by improving care collaboration within existing workflows and find new revenue streams by finding and engaging patients. We were among the first to deploy our enterprise solutions to assist hospitals in finding, engaging, activating, and managing patient populations, and we’ll continue to invest in developing those solutions to allow hospitals to better prepare and position themselves in the rapidly changing world of healthcare reform.

Additionally, the strategic use of predictive analytics will ultimately become the market differentiator for hospitals, which is why we acquired Third Wave Research, Ltd, in 2011 and have been working on integrating their advanced predictive analytics expertise into our existing solutions. We will continue to invest in analytics technology that enables our clients to position for patient engagement, wellness and disease management. The rapid adoption of patient portals and the shift away from fee-for-service in favor of outcome- and quality-based reimbursement models will place more emphasis on finding new cost savings and revenue streams. To differentiate themselves from the competition, hospitals must find ways to personalize the patient experience and better manage the patient population. Effectively promoting profitable services to high-value patients and engaging them in wellness programs will influence healthy behaviors to positively impact outcomes.

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Jay Mason, CEO, My Health DIRECT

It has been painfully obvious over the years that our solution was a bit ahead of it’s time. While very successful in directing patients to appropriate care settings in an ER, there wasn’t a pressing need to interact “outside of the walls” broadly or routinely. What we have seen in 2011 and see as our chief role moving forward is to serve as a health scheduling exchange. We will continue to invest our R&D in staying ahead of the curve. Today we can provide true Enterprise  Application Integration (EAI) with any willing trading partner via our own platform’s ability to leverage HL7, API, or CRM-based communication protocols.

So the next year will be more of the same for us — creating the integration tools, onboarding methodologies, and consumer engagement services that will allow our clients to redefine the way they interact and guide their patients and members.

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Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

Going into 2012 the pressure is on for healthcare organizations to increase the quality of care delivered while reducing cost and complying with federal mandates. Nuance could not be better aligned to help healthcare organizations succeed in light of such pressures as Meaningful Use and ICD-10 and to ensure that clinical data is created in the most efficient way possible and is built from rich information that can be analyzed and intelligently used to drive broad healthcare enterprise change and improvement.

Over the next 1-2 years, we’ll continue to invest in areas that fundamentally improve the capture phase of clinical documentation, by which I mean empowering clinicians to document anytime, anywhere on any device in the most effective, natural way possible – via voice.  In 2011 we went to the cloud, offering SpeechAnywhere services to development teams across the industry.  Speech-powered clinical documentation is widely in demand and will continue to expand to encompass the complete healthcare enterprise and the mobile clinician workflow.

We’ll also continue to heavily invest and innovate in the area of language understanding and analytics technologies, which make it so clinical data can be extracted from unstructured documents and intelligently leveraged to drive better clinical and business decisions. Through work with 3M, IBM and UPMC, Nuance is making tremendous traction against its mission to transform patient stories into high-value information. Our speech-driven clinical understanding solutions will increase the quality of documentation, improve efficiency and drive better care – all while putting less burden on clinicians.

12-19-2011 5-07-28 PM

Todd Cozzens, CEO, Accountable Care Solutions, Optum

I heard someone say the other day that ACO = HMO 2.0 But With Data. It is indeed all about the data. I empathize with health system CEOs who, after spending anywhere from $100 million (average medium size IDN) up to the $3 billion Kaiser spent on installing EMRs in the last ten years that all they really achieved was computerizing paper records. Little has been achieved in actually doing something with the data. That’s what the next ten years is all about.

  • Population Analytics: EMRs and the early data warehouses being developed on top of them are good at managing a census – sick people that visit hospitals and doctors. Population Analytics manage entire patient populations across all of their interactions with the health system. EMRs rely mostly on clinical data and some financial data. Population Analytics incorporate claims data, clinical data, financial data and actuarial data across ambulatory, in-patient, post acute and home care. We are in the top of the first inning of the biggest wave of change in our healthcare system any of us will see in our lifetime. These tools are also in their 1.0 versions and will evolve. Optum was almost purpose-built to bring all of these capabilities together into one cloud-based, integrated solution.
  • End-to-End (E2E) Financial Efficiencies: Hospitals leak revenue more than any other business in any other industry – with the average health system collecting only 33% of what they actually bill under the current fee-for-service (FFS) system. And on top of this we’re now going to burden hospital finance departments by introducing new fee-for-value (FFV) payments starting with bundled payments and pay-for-performance measures right on up to full risk-bearing entities. In the forward-thinking health systems, we’re seeing the realization that they cannot do this all themselves. Many see FFV as the future so they want their current finance teams to be the experts in the new system. These same health systems are increasingly outsourcing their FFS financial systems to experts who know how to recover lost revenue, realize much higher collection rates and know how to drive cost takeout. We acquired Executive Health Resources to help hospitals drive revenue integrity for the big potential loss area of reimbursable admissions. The Lynx ED coding tool returns an average of $2.5 million lost revenue per medium size hospital. We combined those tools plus others around collections, billing, and Financial Health Record (FHR) to form our E2E solution set and we will invest more in these capabilities in 2012.
  • ICD-10: Health systems are so encumbered with Meaningful Use compliance, RAC compliance, and facing the coming huge cuts in Medicare/Medicaid that they have largely been in denial about the impending ICD-10 deadline. With the introduction of up to 155,000 new reimbursement codes and less than 10% of healthcare providers halfway to ICD-10 readiness, ICD-10 could be an insurmountable challenge. We made a large investment in what we believe to be the best technology available to meet this new challenge. Because of the time caregivers will spend hunting for the right code, ICD-10 will actually make the health system much less efficient unless groundbreaking new technologies emerge. The natural language processing technology that we acquired from A-Life is exactly what’s needed to automate this laborious process. We’ve seen tremendous traction for this solution in the last six months and expect that to continue. Our R&D investment has increased so we believe we will keep and extend our technology lead here.

    paul brient1

    Paul Brient, President and CEO, PatientKeeper Inc.

    PatientKeeper’s number one priority is to deliver healthcare applications that improve the physician workflow. This means that we save physicians time, we help them provide higher quality care, and we help them get paid for more of the services they deliver.  

    We are still spending heavily in R&D to round out our suite of 13 fully integrated applications. Our near-term focus is to continue to add features to our CPOE product, complete our Medication Reconciliation product, release a next-generation charge capture application, and give our tablet/iPad applications feature parity with our desktop applications. The emergence of the tablet as a “first class” device has been eagerly anticipated by the healthcare IT community for nearly a decade and is finally here.  In fact, we have a small but growing number of our 40,000 users who use their tablet/iPad as their only computing device.

    12-16-2011 1-30-45 PM

    Todd Johnson, President, Salar

    While we have always been focused on "the physicians experience," the merger between Transcend Services and Salar has intensified this focus. In the months ahead, we are going to be able to address a physician’s workflow in ways never before thought possible. Understanding all of the external pressures applied to physicians, how remarkable it will be to offer solutions that offer either zero impact on their day-to-day, or better yet, offer drastic improvements to their workflow that they didn’t even realize were achievable? Not only will we be able to satisfy a physician’s interests for time, speed, and efficiency, but we will also be able to free the physicians from those same external pressures. By offering to our hospital customers clinical documentation solutions that meet the needs of coding, compliance, quality, billing, RAC audit mitigation, communication, and patient safety while doing so in a zero impact methodology to the delivery of care, we truly meet the needs of all parties at the table.

    To realize the benefits of this "enhanced physician experience," we will be investing heavily in our web-based platform to complement our existing thick client solutions, natural language processing tools, front end speech solutions, ICD-9 and ICD 10 GEMS mapping solutions, front end computer-assisted coding features, and even an improved workflow for traditional transcription services. We will continue to deliver all of the above through our "have it your way approach," thereby meeting the needs of both our physician users and our hospital customers.

    It’s been a long-time objective of Salar to become the de facto clinical documentation module within a host of HIS systems. We are closer to realizing that objective than ever before. Through some new and unique customer engagements, we will be integrating our platform into industry-standard information systems and, in turn, reaching out to an even broader customer base. The marriage of these solutions and the seamless nature of their delivery are incredibly important to us. Our customers count clicks–and so do we. We will continue to work over the next 1 to 2 years to streamline usability across systems and, ultimately, enhance a physician’s day-to-day experience.

    12-23-2011 12-43-08 PM

    Stephen Hau, CEO, Shareable Ink

    Everyone wants innovation, but no one wants to change.

    It is well understood that the healthcare industry must become more electronic and data-driven. However, we also know that change is hard. Market data reveal that, while most clinicians enjoy the accessibility of patient information that EHRs deliver, the majority does not prefer the Windows 95-style “point and click and drop down list” style of documenting that the standard EHR user interface requires.

    We believe that there must be a better way to extract information from a physician’s head without forcing them to become typists, tap a screen or mouse 30 times to create a “cookie cutter” note, or hire prohibitively expensive scribes out of desperation.

    As such, we have begun to invest aggressively in machine learning and natural language processing. Our system does not require user training. Instead, it has begun to learn from clinicians’ handwriting, gestures, and other natural inputs. The ambitious goal is to deliver innovation without requiring clinicians to alter time-tested workflows.

    12-18-2011 3-23-08 PM

    Ed Daihl, CEO, Surgical Information Systems

    Our R&D focus supports improving the management of perioperative services, the area of the hospital that continues to drive the financial success of the hospital. A recent survey by SIS shows an increased focus on reducing perioperative costs, with 78% working on cost reduction efforts – a 34% increase since 2010. Additionally,  the survey indicated another shift from 2010 with cost reduction efforts being prioritized over reimbursement concerns. In 2010, 25% of hospitals cited maximizing reimbursements as their top financial concern. In 2011, that number dropped by 56%. We believe that perioperative specific analytics is a powerful tool to help hospitals control costs — their top concern — and will continue to work to improve this management tool.

    Additionally, we see the adoption of anesthesia information management systems as a growth area in the industry. Electronic anesthesia documentation streamlines this process and provides accurate and legible anesthesia records. This equates to significant benefits, such as more accurate charge capture, quality improvement, and allows for the anesthesiologist to spend more time with the patient and less time documenting.  The addition of clinical intelligence with anesthesia analytics provides even more value to hospitals and anesthesia providers by unlocking powerful decision making data to help improve both care quality and financial return.

    evan steele

    Evan Steele, CEO, SRS

    Over the next couple of years, SRSsoft will evolve to accommodate the acquisition and sharing of increasingly greater volumes of patient health information, as relevant to our specialist and primary care clients.

    We will remain focused on productivity (naturally!) as we evolve our data capture interfaces. This means that user interfaces will be implemented using techniques that are both ergonomic from a personal user perspective and accommodative of the actual workflow that takes place in the clinical office environment.

    We have put into place, and will continue to enhance, our own dedicated platform for data sharing and interoperability. Our Continuity of Care Exchange (CCX) platform manages connectivity and the physical transport of files, while our Discrete Data Exchange (DDX) components handle the import and export of discrete data to and from our system. We will continue to evolve CCX and DDX over the next couple of years to support increasingly higher levels of interoperability.

    12-18-2011 4-17-10 PM

    Rick Stockell, President, Stockell Healthcare Systems

    Over the next 1-2 years, Stockell Healthcare Systems will be devoting a significant amount of R&D to ongoing regulatory compliance.  In addition, we will continue our ongoing focus on client business process improvement through the development of advanced analytics and information management solutions.

    Richard atkin

    Richard Atkin, President and CEO, Sunquest

    Sunquest is increasing its investment in product development across the board. We now have over 35% of our total resources dedicated to product development and product quality. We will have a particular focus over the next 24 months on developing new functionality in the converging areas of molecular pathology, anatomic pathology, and digital pathology. As a founding Gold Sponsor of the Digital Pathology Association (DPS) and through our partnership with Massachusetts General Hospital, we will be building the next generation of pathology workflow solutions.

    The incorporation of digital images of all sorts into the pathology workflow will drive significant growth, change, and efficiencies throughout our clients’ operations. Sunquest will work closely with our clients to enable them to take advantage of the coming changes in science, medicine, and technology. The ongoing evolution of molecular testing is driving a convergence between anatomic and clinical pathology. As healthcare delivery evolves to a more integrated, regional model and incorporates more personalized data, Sunquest will provide the solutions required to thrive in a new age.

    sunny sayal

    Sunny Sanyal, CEO, T-System

    To meet clients’ current and evolving needs, T-System in the next 12-24 months will focus R&D investment on enhancing our emergency department information system, The T SystemEV. Our top three R&D priorities are as follows:

    • Support for regulatory mandates, including Meaningful Use and ICD-10. T-System will seek ONC-ATCB certification for Stage 2 Meaningful Use measures as soon as HHS finalizes the requirements. T SystemEV, already certified for 2011/2012 criteria for Stage 1 Meaningful Use requirements, will be compliant with ICD-10 in 2012, a year before the deadline. Our goal is to give clients maximum flexibility to address clinical, business and regulatory needs
    • Enhance interoperability. T-System will continue to invest and partner with other vendors to ensure that clients can seamlessly connect T SystemEV with disparate inpatient EHRs and other information systems outside the ED.
    • Continue to provide innovative and new functionality. As the care transition hub and starting point for a high volume of patient handoffs, the ED plays a critical role in ensuring the continuity of care. Supporting smooth patient transitions with efficient communication will become even more important as facilities and practices form accountable care organizations (ACOs). T-System will develop solutions and functionality that will help EDs lead the ACO model of healthcare delivery. Additional offerings will continue to improve clinical and financial outcomes that start in the ED and benefit the entire hospital and community.
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December 30, 2011 News No Comments

News 12/30/11

December 29, 2011 News 12 Comments

Top News

12-29-2011 10-03-00 PM

CSC says it will have to write off almost the entire $1.5 billion it spent trying to install iSoft’s Lorenzo in the defunct NPfIT project in England. The government has apparently declined to give CSC the new scope of work the company had requested. CSC has also withdrawn its financial forecast and stepped up plans to replace its CEO. It posted a loss of almost $3 billion in its Q2 report filed September 30, mostly due to a write-down of goodwill. The company’s market cap is $3.7 billion. Shares are at $23.68, off more than half since the beginning of the year.

Reader Comments

12-29-2011 8-27-57 PM

From Zafirex: “Re: hardship exemption for e-prescribing. Looks like so many providers are claiming it that CMS is having difficulties. Wonder how many are truly hardships? I doubt CMS could ever verify since it looks like they’re having trouble even producing a list.” Exemption categories include a practice area with no broadband coverage or that has too few participating pharmacies, practices that applied for Meaningful Use before requesting an exemption, practices that prescribe mostly narcotics that are not eligible for e-prescribing, practices that don’t prescribe regularly, or practices that e-prescribe but not for qualifying visits.

From Search Boy: “Re: searching HIStalk. Thanks for the explanation to King Salmon. Is there a way for retrieved searches to be indexed chronologically rather than as a percentage of keyword match?” I haven’t figured out how to do that. Since the pages are stored in a database, I don’t think the search function can determine the original publish date even though it’s in the title.

From Lilies: “Re: Epic. They’re #17 on the list of 25 oddball job interview questions, with ‘You have a bouquet of flowers. All but two are roses, all but two are daisies, and all but two are tulips. How many flowers do you have?’ There are two distinct valid answers.” Three is the obvious answer (one of each flower) that took me about two seconds to get. I assume the second answer depends on the question not stating explicitly that there are no other kinds of flowers in the bouquet (i.e., you could have two Venus fly traps only, making two a correct answer.)

12-29-2011 10-05-51 PM

From Stats Fan: “Re: readership stats. You haven’t given your readership stats lately for me to track.” Good timing since I realized a couple of weeks ago that I’ve been undercounting all along. I had forgotten to add the hit-counting Javascript to the mobile display that you see on iPhones and iPads. That hit me a couple of weeks ago, so I dug around the code and figured out how to fix it, also noticing that a surprising 30-50% of readers use Safari, most of them presumably on iPhones and iPads, which is a lot more mobile readers than I would have guessed. So far for December, it’s 96,250 visits, 148,218 page views, and 22,029 unique people reading (but that’s lower than the real number since I didn’t make the change until the middle of the month.) January and February will be good indicators since the HIMSS conference really pegs the needle on readership. Inga pays a lot more attention to the numbers than I do, so I will await her analysis. Above is where the visitors are from, just in case you are interested. Among cities, it’s Madison, Stone Mountain, Atlanta, New York, and Chicago making up the top five, but the major metro area is Boston with 8.41% of visitors. It’s a 62% male audience, so ladies, tell your friends.

From HIMSS Envy: “Re: HIMSS points. Got me wondering – it would be nice of HIMSS published an annual report for public review. It might not change a thing, but transparency is a powerful motivator. Come to think about it, Mr. H, how about you, too?” I thought HIMSS did a report, but I couldn’t find one. You can get their Form 990 from GuideStar, which always has interesting factoids (like that HIMSS FY 2009 revenue was $44 million and CEO Steve Lieber’s total compensation was $711K). I don’t know what I’d put in an annual report that isn’t already on the About page or contained in the list of sponsors … other than my hospital job, I don’t have any ownership in anything, I have no other income, and I don’t shill stuff like speaking or consulting under the delusion that I have value beyond what you’re reading right here.

From Peds Envy: “Re: tired of writing only good things about Epic. Private practice peds are the worst type of users for Epic. No surprise there. Someone who knows Brown & Toland told me the reaction is 100% unanimous – they hate it.”

From Anonymous Epic Fan: “Re: tired of writing only good things about Epic. Here are a few issues with their implementation methodology and support that even the Kool-Aid drinkers would have a hard time disputing.” Here’s the list from AEF:

  • Epic’s implementation planning materials are weak. They have to be re-worked for each new application / scope mix, and after that is done, little to no effort is made by Epic to customize them based on organization specifics. If you want the project plan to be useful and to have sufficient detail, expect to spend a lot of time and effort re-working what gets initially delivered.
  • Epic suggests you go live on Model workflows as quick as possible. As painful as it may be, it is definitely better from a cost perspective. Then, you plan to do the bulk of the ‘real’ implementation after getting live. This can/may work if the bulk of the existing documentation / orders workflows are paper based and you are implementing all of Epic’s applications, but this approach is suicide if the existing system being replaced has been customized for the end-users and they are happy with them or if you have to rely on the timelines of other vendors to build/test/implement interfaces and data conversions.
  • The Epic Model does not work well for any hospital or outpatient units that are more complicated  then the most typical med/surg units and general practice specialties. Specifically, hospital outpatient departments that bridge the inpatient and outpatient void.
  • The Epic Model completely breaks down if you are not implementing all of Epic’s applications and workflows rely on interfaces to/from legacy systems.
  • With Epic’s implementation team constantly turning over, being spread across more and more customers, and the increasing pressure to implement faster, attention to detail is lacking. In my experience, they are over promising and under delivering more than they did years ago.
  • Time estimates are always low. Everything takes much longer than anyone anticipates. Medication build, consolidating charge masters, cleaning up supply/pick lists, mapping lab components, consolidating multiple sources of payor/plans, cleaning up the provider / credentialing information, getting physicians to agree and sign-off on order set/documentation template content, and working down duplicate patients in your EMPI or mapping data elements for conversions etc.
  • Epic implementation tools / deliverables are often shared just before an upcoming trip for when they are to be used. Though effort is made to customize them based on application mix/scope, they never really get updated to reflect the actual workflows discussed and validated early in the process – especially if they differ in any amount from the ‘model’ workflow. The delivered product if very inconsistent from application team to application team and integrated areas/workflows often get overlooked. So just like the implementation planning materials, expect to spend a lot of time re-working these deliverables to make them useful.
  • All application teams involved in the implementation are siloed, and in addition, the Epic implementation teams, technical support teams, and development teams are also siloed. This causes issues for organizations live on one set of applications, rolling out another set, and implementing a third set.
  • The silos mean that there are application experts, but very few Epic staff have cross-application experience / knowledge and if workflows are interface-dependent, very few have true integration experience.
  • Epic’s training only scratches the surface. The true training is the implementation process and go-live. The shorter the implementation timeline, the more unprepared the customer IT staff is to support the applications when they go live – thus the demand for lots of consultants.
  • The system documentation is very inconsistent and virtually impossible to search on the UserWeb. Unless you know where to find what you are looking for, you often have to e-mail Epic to ask if documentation exists. I is not uncommon to be sent an ‘unofficial’ document created by a frustrated Implementer not being able to rely on the system administration guides themselves. In fact, all of the implementation documentation / guides were historically written and maintained by implementers, but due to the inconsistency between applications and un-sustainability of keeping it up to date. no implementation documentation/guides exist today.
  • Epic’s end-user training materials are great if you are implementing all of Epic’s applications and you are using all Epic model workflows. If anything changes, these are not so great – expect to have to overhaul them.
  • Same goes for the testing scripts. An OK start, but definitely not something that can be used out of the box.

HIStalk Announcements and Requests

12-29-2011 6-44-44 PM

How Apple wins customers for life: I had a five-year-old, first-generation, 1 GB Nano that I only used for the gym. I heard Apple was recalling a few of them because of some explosion-prone batteries, so I put in the serial number on their Web page and darned if mine wasn’t on the list. They sent a postage-paid Fedex box to return it. Today I got back a brand new sixth-generation, 8 GB Nano, which now comes with a color display, gestures, FM radio with live pause, pedometer/accelerometer, and a bunch of other features, all in a package barely bigger than a watch face (in fact, you can buy a watchband that holds it, turning it into a watch.) It’s super cool, and so is Apple. You did good, Steve Jobs – RIP.

12-29-2011 10-21-30 PM

It’s time to wrap up the HISsies nominations soon, so contribute yours now to the blank slate that will be distilled into a handful of choices for the real voting that starts shortly. I’m particularly happy with one nomination for Smartest Vendor Action Taken: “HIStalk sponsors that replaced blinking ads before the deadline.” Well done, and a good observation. My sponsors really are the best – as much as I hated to spring the change on them since it requires work and expense on their end, they’ve been great about it. I’ve enjoyed the nominees for the Beer and Pie categories, as always, and there are some good nominees for the Lifetime Achievement Award.

Speaking of the HISsies, full details and signups will go up next week for HIStalkapalooza in Las Vegas. And also speaking of the HISsies, if you plan to vote (and I hope you do), sign up for the e-mail updates since I e-mail the voting link out to prevent ballot box stuffing that was as rampant as in a third-world dictatorship until I took that step. For that reason, if you aren’t on the list, you can’t vote.

Listening: new from The Roots, which even though I’ve only sampled it so far due to limited time, is just blowing me away. It’s extraordinarily music in the form of a concept album, making it impossible to label as rap, soul, or hip hop even though it includes strong elements of all of those. The accompanying short film is here. Their talent is mind-boggling. Down it goes to the new Nano, which contains only my latest favorites since I intentionally started from scratch: Genesis And Then There Were Three, two albums from Gooder, one from Metric, and Luminiferous Ether by the never-gets-old Zip Tang.

It’s just Dr. Jayne and me tonight as Inga is sojourning in the mythical Land Without Broadband. She will return soon. But in the mean time, Dr. Jayne is doing her usual fabulous job. I’m pretty darned lucky to have two smart, funny, hard-working, and undeniably cute ladies with whom to share the page, don’t you think? I will raise a glass in their honor for New Year’s (probably of Duvel beer since I got some for Christmas and I like it a lot.)

I’m not telling you Happy New Year yet because I’ll be posting a Monday Morning Update this weekend as usual, even if nobody’s around Monday to read it.

Acquisitions, Funding, Business, and Stock

Board members and executives of document management vendor Streamline Health Solutions will buy $400K worth of the company’s stock, news of which sent shares up 9% on Wednesday.

12-29-2011 10-23-11 PM

Healthcare alerting system vendor Extension, Inc. announces what it says is record quarterly growth, adding 17 new hospitals in the third quarter and quadrupling its headcount to 40 over the past two years. They might want to budget for a public relations or media person next since this is easily one of the worst-written press releases ever, starting off with a clumsy opening sentence that sounds as though someone whose native tongue was not English (or at least not good English) sweated over it until nothing interesting remained. It doesn’t get better as you read on.

Announcements and Implementations

12-29-2011 8-34-58 PM

Tampa General Hospital (FL) goes live on its $120 million Epic system, which works out to $118K per bed. The hospital says $40 million of that was for hardware and software, with the rest going for staffing and training.


Weird News Andy sounds like a fortune cookie in summarizing this story as, “Foot in mouth results in mouth in foot.” A man shows up in the ED with a swollen, infected foot, claiming he stepped on a piece of glass on the beach a couple of weeks before. The beach and timeline part of his story were accurate, but not the glass part: doctors removed a tooth embedded between his toes, lodged there during a beach fight when he kicked his opponent in the jaw while wearing flip flops.

Several readers were interested in John Halamka’s post about his wife Kathy’s newly diagnosed breast cancer. The first of regular updates, posted Thursday, is here. Reading his thoughts and analysis of their situation makes you realize that HIT stuff aside, he’s probably a fine doctor as well, not to mention the kind of supportive partner we would all want if faced with a life-changing diagnosis and gearing up to fight it.

12-29-2011 9-26-38 PM

A big health-related software sale you probably didn’t hear about: General Cannabis, which operates the medical marijuana dispensary finder WeedMaps, acquires MMJMenu, whose software for marijuana growers and dispensaries tracks inventory “from seed to sale,” basically an ERP for pot growers. General Cannabis had revenue of $10.4 million in the first nine months of the year and paid $4.2 million last month to buy the Marijuana.com domain.

12-29-2011 9-34-07 PM

John Newman, MD PhD, a UCSF physician and legal scholar, worries that medical copyrights will threaten patient care, citing a recent case in which a company offering a licensed cognitive screening tool threatened legal action against a similar but free online tool. The implication is that tools based on published research, which could be anything from a pain scale to a hip fracture risk predictor, could be claimed as proprietary by a fast-moving company. The author speculates that without new forms of copyrights, “… as physicians walk down the hallway interviewing patients, they’re tallying up the licensing fees they need to pay for doing their day’s work, and hospitals are suing each other or making cross-licensing arrangements to manage each other’s intellectual property.”

12-29-2011 9-41-55 PM

A power surge caused by monthly back-up generator tests at Aspirus Wausau Hospital (WI) takes all communication and computer systems down for five hours, forcing the hospital to go on ambulance diversion. As is always the case, the hospital says patient safety was never at risk, which you might interpret as meaning that those systems contribute nothing to patient safety. They’re on Epic, I believe, not that the hospital’s Wisconsin location didn’t already make that fairly likely.

GE Healthcare agrees to pay $30 million to CMS to settle a False Claims Act charge that it encouraged hospital and cardiology laboratories to overbill Medicare for Myoview, its form of technetium 99 that shows areas of decreased blood flow in the heart.

Sponsor Updates

  • Rockford Orthopedic (IL) announces that 21 providers have successfully attested for Meaningful Use using eClinicalWorks EHR suite.
  • Baptist Health Line (KY) receives its third ICARE award from RelayHealth for work with Western Baptist Hospital’s transfer center.
  • Paul Rooke, CEO of Lexmark, discusses how the company’s acquisition of Perceptive Software and Pallas Athena puts them in a unique position in his interview with All Things D.
  • Health Choice Arizona, achieves a 44% improvement in its completion rate for preventive services pilot program using MyHealthDIRECT.
  • AmkaiSolutions will offer revenue cycle solutions from ZirMed to its outpatient surgery provider software customers.

EPtalk by Dr. Jayne

Where have all the drug reps gone? With significant cuts in the budgets for Big Pharma, many reps have been “made available to the workforce,” as they say. It seems hospitals and health systems are hiring former drug and device reps to sell their facilities to physicians. A recent article discusses how they’re using infection data and patient satisfaction scores to drive business rather than the drug pricing and formulary data of yore. In my book, this is just another thing that sucks up valuable time that we need to care for patients, not to mention sucking up budget dollars that could be better spent on those patients.

I wonder how many physicians who refuse to see drug reps also refuse to see these new “physician liaisons?” And how many health systems place rules around having these reps in the office? At some large integrated health systems, policies ban providers from seeing reps or liaisons from any facility or service provider that competes with a system-operated service line. This includes home health agencies, remote cardiac testing providers, reference labs, and the like. Other health systems restrict the hospital privileges of their employees (prohibiting credentialing at competitor hospitals,) so I’m not sure how big of a target pool these new reps have.


Weird News from one of my favorite places: South Carolina sports a giant mound of tires that can be seen from space. At least it’s not burning like the one in my favorite fictional town. But kudos to Lee Tire Company, Inc. of Jacksonville, Florida for waiving the usual fees to shred and recycle the tires in an attempt to clear the 50-acre mess.

Inga and I are well into our pre-HIMSS preparations. As you’re thinking about traveling to fabulous Las Vegas, consider this recent article that discusses continued concerns about backscatter scanners at the airport. Until I read this piece, I didn’t know they had been banned in Europe. As someone who has to wear a badge to track my exposure to radiation in the hospital, I do worry about frequent flyers. Many of my friends who work for vendors fly two to four times a week. There’s enough radiation from just being in a plane, let alone adding to it with scanners. I’d love to see the cumulative dose numbers for some of those flyers. Maybe frequent flyer programs should start issuing radiation monitoring badges with their airlines’ logos as a promotional item.

Each time I sit to write for HIStalk, I’m still amazed to be part of this team. It’s particularly amusing when I’m just reading through my “normal” e-mail and find a mention of us – most recently a blurb from MED3000 regarding Mr. H’s recent piece asking vendor leadership about the biggest HIT-related news items of 2011. I hope I don’t have facial leakage when I see these blurbs (yes, I have a bad habit of multitasking during meetings) because I know I feel like smiling.

Speaking of multitasking, one of my Facebook friends shared another article on docs multitasking during critical procedures. Medical schools are apparently having to actually instruct students to focus on the patient instead of the smart phone. Looking at some of the examples given in the article, it sounds like some IT teams need to revisit the websites they allow users to access. I can’t think of too many medically legitimate reasons to be on Facebook, Amazon, or eBay in the operating room or in the ICU.


I mentioned earlier this month about my inability to keep up with Inga where shoes are concerned. I think I win this round though – I seriously doubt that Santa left a glass slipper filled with Cosmopolitans at her house.

Have a question about managing pesky sales reps, maintaining the perfect poker face, or the best way to garnish a Cosmopolitan? E-mail me.



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

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December 29, 2011 News 12 Comments

News 12/28/11

December 27, 2011 News 17 Comments

Top News

12-27-2011 8-39-42 PM

UPMC’s Cerner systems go down for 14 hours at most campuses last Thursday and Friday, forcing them to go back to paper. The PR person blamed “a database bug,” which makes the above Oracle press release from this past summer a particularly fun read. Cerner and UPMC have an atypical vendor-customer relationship since they’ve invested big money together in innovation projects and UPMC runs a Cerner implementation business overseas.

Reader Comments

12-27-2011 7-59-30 PM

From King Salmon: “Re: search. Is here a way to search HIStalk by keyword?” You can use the search box that’s in the right column. It’s not visible on mobile devices, though, in which case you can do a Google search by keyword, then click the gears icon at the upper right of the results screen (that’s where Google has moved the advanced search options, which used to come up on the main search screen.) Then, qualify your search down to the specific HIStalk site as shown above.

12-27-2011 8-27-04 PM

From Booth Boy: “Re: MEDITECH and Cerner. As I predicted, see the attached Las Vegas floor plan. Since they lost their HIMSS points by sitting out a few years, they are way back in the corner by the freight doors. If it’s cold on setup day, they’re going to freeze their butts off because the doors never close.” Just about every year I run the link to the rules of how HIMSS awards its much-coveted Exhibitor Priority Points, which rewards vendors who spend a lot with HIMSS by allowing them to buy bigger and better located booth space. Points can also be earned by buying sponsorships, booking hotel space through their housing company, signing up for corporate membership and paying your dues early, and buying services from HIMSS Analytics. Because they didn’t exhibit, MEDITECH is way down the list in the #727 spot (behind mostly companies you’ve never heard of and even some universities) and Cerner is at #429 (two notches below University of Alabama at Birmingham.) Needless to say, prime exhibit real estate isn’t happening for them this year, so you’ll need to seek them out.  

HIStalk Announcements and Requests

Inga’s taking a short break, so it’s just me (Mr. H) this time around.


12-27-2011 9-56-43 PM

The board of 125-bed Powell Valley Healthcare (WY) approves the purchase of NextGen EHR to replace its “dysfunctional” and old Healthland system, saying the hospital is getting a bargain because the company offered to drop $400K from the $2.65 million cost if the hospital signed by December 31. The hospital plans to collect $1.5 million in Meaningful Use incentives, which it says it could not have done with Healthland because, according to the IT manager, “The system we have now is not good. It’s terrible. It crashes. I can’t imagine being a nurse or a physician and working with it every day.” The money-losing hospital says buying a new clinical system probably means that other projects, such as needed renovations in surgery and the ED, may not get done, but a board member says the new system is even more important. “This is a have-to. We have to do this. I remember going into the lab a few years ago, and the lab girls were crying, and it was over Healthland (the current system). It needs to be replaced,”


12-27-2011 8-10-04 PM

Saint Francis Care (CT) names Linda Shanley as VP/CIO. She was previously with Stony Brook University Hospital.

Announcements and Implementations

12-27-2011 10-12-43 PM

Pikeville Medical Center (KY) goes live on Wellsoft’s EDIS, which is integrated with its McKesson applications.

Innovation and Research

An Ohio ED doctor develops NARx Check, which calculates a drug abuse “credit score” using Ohio’s prescription monitoring program data and alerts ED staff of patients likely to be abusing drugs. The application has generated positive comments from the state pharmacy board and local hospital association.

West Wireless Health Institute says that less than 1% of hospitals have deployed fully functional tablets, mostly because clinical systems vendors haven’t developed iPad-native apps, but also because wireless connectivity is spotty, iPads don’t fit into the pockets of standard-issue lab coats, and typing on an iPad is a pain when PCs are always close by anyway.


The western regional chapters of HIMSS are putting on the one-day Women in Healthcare Information Technology Conference in San Francisco on Friday, January 20.

An insurance company sues the former COO of Christus St. Vincent Regional Medical Center (NM), trying to recoup the $3 million it reimbursed the hospital for fraud losses. The COO allegedly funneled hospital IT payments through corporations that were run by a woman with whom he was having a relationship. He supposedly even paid a part-time student to impersonate an engineer with the phony company when the hospital got suspicious. The hospital fired the COO for cause in early 2008 and says it’s still waiting for authorities to charge him with a crime.

12-27-2011 10-06-44 PM

Jacob Goldman, the former chief scientist of Xerox who created the famous Palo Alto Research Center (PARC) in 1970, died last week at 90. Xerox was happy making money from copy machines and didn’t commercialize PARC’s research, but those discoveries, such as the graphical user interface and ethernet, created the personal computer industry when further developed by Apple, Microsoft, Cisco, Adobe, Sun, and other fledgling Silicon Valley companies.

A new KLAS report says that while only 10-15% of hospitals use real-time location systems, 95% of those that do say they increased operational efficiency.

Several readers sent over a link to this article, in which another conservative publication takes some unfocused political shots at Epic’s Judy Faulkner using healthcare IT as its weapon of choice (actually, they aren’t new shots, just the same old ones recycled yet again for a new audience.) Her oft-recited transgressions:

  • She donates to Democratic political candidates.
  • She represents vendors on the Health IT Policy Committee.
  • She’s anti-competition and anti-innovation, at least according to the unbiased opinion of Allscripts CEO Glen Tullman, an Epic competitor, quoted from an interview we did with him on HIStalk Practice (being a conservative publication, they had to be grasping to quote a long-time supporter and friend of President Obama who had a lot more influence than Judy Faulkner in getting billions in HITECH money included in the stimulus package.)
  • She could have benefitted from politician meddling in which a group urged the VA to buy instead of build systems, mentioning as their argument successful clients that happen to be all Epic users. That’s true, but perhaps a fact worthy of inclusion is that the VA ignored the unsolicited advice and is sticking with its original plan to develop an open source replacement for VistA, so the net benefit to Epic was zero.
  • Epic clients (Geisinger and Cleveland Clinic) were named by President Obama as being good technology users.
  • Epic clients, like those of all vendors, have had some unrelated IT incidents that were listed.

The article concludes, predictably and with no facts whatsoever to back it up, that Epic is preventing patients from getting good care because of “partisan politics” (meaning beliefs that differ from the ones held by the authors.) You would think instead of just Googling up some old articles they could have turned up an actual expert in a hospital somewhere instead of just quoting a competitor’s CEO and a reporter. I’m a conservative more or less (fiscally, anyway) but this is just lazy political editorializing pretending to be reporting, indiscriminately throwing out loads of unrelated mud in the hopes it will stick to someone of a different political persuasion.

Surely someone could build a better case against Epic, although it’s probably hard to write around the inconvenient facts (its customers are among the best hospitals, they are voluntarily buying Epic given the other available options, and Epic tops every industry statistic by a mile, such as big-hospital sales, KLAS rankings, and hospital customers that have been awarded HIMSS EMRAM Stage 7.) Or maybe they can’t. The anonymous anti-Epic comments I get are almost always long on emotion and opinions and short on facts and first-hand knowledge (and they often come from the same handful of posters using different names, which makes me suspect that they are unhappy former Epic employees, spurned job-seekers, or employees of struggling competitors.) I don’t know that I’ve ever seen a negative comment about Epic from someone who actually uses it in a provider role, and I don’t recall hearing remorse from any of those users about losing the systems that Epic replaced. I get tired of writing positive things about Epic and keep hoping someone who’s actually in the game and not on the sidelines will provide an intelligent and convincing counterpoint to why they aren’t as great as the Kool-Aid drinkers say. I’m still waiting.

Sponsor Updates

  • Weed Army Community Hospital (CA) chooses T-System for paper-based ED documentation.
  • Salar suggests three New Year’s resolution in a blog posting.
  • Nuance releases a case study on Emerson Hospital’s (MA) use of Nuance Transcription Services powered by eScription.
  • Digital Prospectors Corp., which offers embedded systems engineering and healthcare information systems consulting services, is featured in Bloomberg Businessweek.
  • Jeff Wasserman, VP of Culbert Healthcare Solutions, discusses physician employment opportunities, job culture, and interview skills in an American Medical News article.


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

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December 27, 2011 News 17 Comments

Curbside Consult with Dr. Jayne 12/26/11

December 26, 2011 Dr. Jayne 2 Comments

Technology: The New Scapegoat?

I’ve always been a bit of a tech junkie. If I wasn’t afraid of revealing my age, I could tell some pretty good stories. To me, technology is exciting and invigorating, but also something to be respected. Technology at any level can run amok – think about Lucy in the chocolate factory as a basic example of what can go wrong. And who wants the artificial intelligence to run amok like HAL 9000

In conversations with providers, hospital administrators, and end users, the problem is always “the EHR” or “the system” or “the computer.”

Having lived in an electronic practice for nearly a decade and having used computers in the hospital for almost a decade before that, I can say with a good level of confidence that it’s not always the technology that’s at issue. Systems are only as good as the users who operate them, in conjunction with the training they receive and the proficiency they demonstrate. A recent situation at UC Irvine Medical Center illustrates this.

12-26-2011 7-43-33 PM

Although the headline screams “drug pump issue,” a close reading of the Statement of Deficiencies document (it begins on Page Five) yields some interesting factoids:

  • The hospital deployed new infusion pumps without hospital-wide training.
  • No policy and procedure document was developed (let alone approved) for the safe use of the new pumps.
  • A physician overrode a “soft stop” alert on the pump, leading to a patient receiving a high dose of medication. (I agree that the fact that there wasn’t a “hard stop” alert programmed in, but let’s remember a physician did override the alert.)
  • The hospital was “unable to ensure that MD… was competent in accurately programming the medication infusion pump.” The pump didn’t have a drug library and was programmed with a dose over 30 times that of the prescribed dose.

After two patient-related incidents, the hospital took corrective action, including:

  • Only allowing trained RNs who have documented competency to program the pumps.
  • Ensuring that dose, concentration, and flow rates are chosen from a current drug library appropriate to the care area.
  • Restricting the ability for users to enter dose/rate for non-library medications unless a second user verifies the programming.
  • Requiring re-verification of orders and programming when soft limits are overridden.
  • Instituting hard stops which cannot be overridden for certain medication doses.
  • Instituting independent double check for programming of pumps that deliver certain high-risk medications

These seem like no-brainer fixes to me. I’m glad the hospital put policies in place that should have been there all along (regardless of the newness of the brand of pump, model, etc., these are just good patient safety procedures).

The document goes on to list several other fairly horrifying behaviors, including a director of pharmacy who admitted knowing that no policies were in place and that no one was overseeing pump safety. “We will in the future, but the pharmacy department needs to be trained first.” He/she also stated that the vendor provided inadequate training for monitoring of pump-related events. Blaming the vendor is always easy – it takes a steadfast leader to halt a go-live when adequate training has not yet taken place.

Other scenarios mentioned in the document:

  • A resident physician involved in a pump-related incident that involved infusing a medication over one hour instead of the recommended six hours was “unaware or unwilling to accept the hospital pharmacy directive to infuse the medication over six hours.” The resident’s anesthesia record stated that he was aware that he dosed the medication to infuse over one hour. The resident also violated Department of Anesthesia rules by not paging his attending physician to be present for the end of anesthesia as was required. Oh yeah – he also “overlooked” the patient’s low oxygen level and didn’t take corrective action. When the attending arrived after the resident finally paged, the attending called a Code Blue because the patient “had poor color and was not breathing.”
  • Residents examining patients but not writing progress notes (even after a nursing supervisor notified the attending physician) on several occasions.
  • An oncology staff nurse (whose job duties included validating chemotherapy doses) who was unable to calculate the dose when given a patient’s weight in pounds and a dose in milligrams per kilogram.
  • Contract nurses allowed to operate infusion pumps without training (one with an ungraded proficiency exam in the personnel file — if you made him take it, why not grade it?)

I had to quit reading after a while because I’m extremely compulsive about patient safety and it was just making me increasingly agitated.

Despite the potential harm involved in the pump-related incidents, I’m actually glad they happened. Why? Because the incidents acted as a trigger to expose some significant issues and deficits in patient safety. Patient safety is a culture that requires education and support. It doesn’t happen in a vacuum.

I wouldn’t let an adolescent operate a lawn mower independently without appropriate training, safety gear, and close supervision. We don’t allow teenagers to drive cars (aka operate deadly weapons) without proving a minimum level of proficiency. Yet in this situation, users were allowed to operate equally dangerous machinery without training. The documentation doesn’t mention whether the nurses were forced to operate the pumps over their objections, but the point is they shouldn’t have been asked to use potentially lethal equipment they weren’t qualified (by training and demonstrated competency) to use.

I hope this case serves as a wake-up call for some institutions. I hope end users continue to speak up when they’re asked to do things that are unsafe and that someone listens. Lives depend on it.


E-mail Dr. Jayne.

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December 26, 2011 Dr. Jayne 2 Comments

Time Capsule: 2006 Product Rankings – Pay Some Attention, But Not Too Much

December 23, 2011 Time Capsule No 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 December 2006.

2006 Product Rankings – Pay Some Attention, But Not Too Much
By Mr. HIStalk


The 2006 Best in KLAS Awards were just announced. I know a lot of folks wait anxiously for those, especially vendors.

KLAS has its critics, of which I’m occasionally one. I like the idea of surveying customers, but having taken KLAS surveys myself, I’ve seen first-hand how poorly designed some of their questions are. A respondent can’t complete the survey without in-depth knowledge of product functionality, support, documentation, executive relationships, hardware, and so on.

In other words, either the person cares so much that they carefully enlist the assistance of 3-10 colleagues, or they just wing the damn thing so they can get back to work instead of wasting time on yet another hard-to-finish survey. You guess which. At least KLAS sometimes follows up by phone.

All of that data collection and interpretation imprecision is masked by a numbing array of graphs, charts, and tables in the final product. No one pays attention to those, recognizing them as a way of padding out the sometimes-skimpy data to make it more impressive and convincing.

The scores tend to wander a lot from one report to the next, which KLAS attributes to swings in vendor or product performance. It’s much more likely to have been caused by the imprecision of the survey methodology. Do you really believe that Meditech’s client-server EMR was improved so much that it earned itself a move from sixth in an eight-horse race all the way up to second place in just one year? Me neither. KLAS marks it as having a low confidence level, so how do you interpret its score?

Still, I’d definitely pay attention to the top-ranked product and be careful with the last-place finishers. I wouldn’t try to overanalyze products in between, especially when the scores are close. Read the customer comments instead, the best part of the KLAS reports if you ask me (although you don’t know what kind of organizations and employees are being represented.)

The most discouraging point is that no vendor does everything well, if you believe the scores. If you look at KLAS’s 15 main general solutions categories, you’d find 13 top-ranked vendors. If you’re a best-of-breed shop, you’ll end up with a lot of interfaced systems if you chase the winners. If you’re a single-vendor organization, some of your departments are going to be stuck with systems far short of being the best. And of course, in the next survey, they may all shuffle around anyway.

My takeaway is this: somebody has to be last, and if the scores are tight, it may not mean much. On the other hand, why can’t a #1 ranked vendor in one product area use that knowledge to excel in the others? Or, do vendors selectively invest in some strategic lines and allow the others to languish? What does the #1 vendor know or do that everyone else doesn’t?

You don’t have to be a KLAS subscriber to see who’s #1. Just check out the HIMSS booth walls and vendor marketing material. You will need to pony up, though, to see who earned worst in KLAS and which vendors did well in important categories like “would you buy it gain.” That’s where the subscription is worth it. Use it like Consumer Reports for car-shopping – at the beginning and end of your selection process. The work in between is on your own.

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December 23, 2011 Time Capsule No Comments

HIT Vendor Executives – Part One of Two

December 21, 2011 News 4 Comments

We asked several HIT vendor executives the following question: What was the biggest HIT-related news or event in 2011 and why?

Ray dyer

Ray Dyer, CEO, Acusis

The industry has experienced continued mergers in 2011 (Allscripts/Eclipsys and Medquist/M*Modal, to mention a couple), the federal government has come to a ruling on how ACOs should work, MU payments were issued, and we have seen a rise in the use of and demand for mobile devices in healthcare, including new medical students being issued iPads.

I don’t think a singular event could be identified as the biggest moment in HIT in 2011. However if mapped across a timeline, we could certainly mark these as significant highlights during this past year.

12-16-2011 8-36-03 AM

Dan Herman, Founder and Managing Principal, Aspen Advisors

McKesson Provider Technology (MPT) division’s Better Health 2020 strategy announced on 12/9/11. MPT has publicly announced what has been rumored for some time – that it will curtail further development of its Horizon software product line and invest heavily in its Paragon product. This decision affects hundreds of hospitals throughout the country. Some long-term McKesson customers have already seen the writing on the wall and have made strategic and financially significant decisions to move away from McKesson’s non-integrated Horizon clinical platform. However, many other customers (medium-sized community hospitals and multi-entity integrated delivery networks) are faced with a critical decision: do we stay the course with McKesson or rethink our EMR strategy and pursue an alternative course?

Reading between the lines, this change in direction will have a huge financial impact on current McKesson Horizon customers, and it brings McKesson’s credibility in the EMR market into question. Although the market for EMR technologies has grown, the Horizon product line has experienced decline in market share, system development delays, poor product integration, and significant customer dissatisfaction.

On one hand, I laud MPT for coming clean on the challenges it has had with the development and support of the Horizon product. However, it appears that MPT’s go forward strategy is “déjà vu” – a poorly thought out approach to integrate disparate platforms, enhance a product that has experienced success in a focused market place (Paragon), and promise customers that MPT is committed to delivering “a fully integrated core clinical and revenue cycle IT system.”

Regardless of McKesson’s direction, healthcare providers need to evaluate their needs against the software available to support them and make decisions that are in their best interests.

1-3-2012 6-13-51 AM

Jay Deady, CEO, Awarepoint Corporation

The biggest HIT-related news of 2011 is that 1,211 eligible hospitals and 21,425 eligible professionals (EPs) have successfully attested and collected $1.84 billion from Medicare and Medicaid through the end of November for meeting Stage 1 meaningful use of electronic health records (EHRs).

The news, disclosed at the December 7, 2011 meeting of the Health IT Policy Committee, is significant for several reasons. First, it indicates the transformation of the health system and national commitment to improve access, quality, coordination, and efficiency of care through information technology have begun in earnest.

Second, it ensures providers adhere to baseline quality standards that can be measured and compared, including: using CPOE for medication orders, implementing decision support rules, exchanging key clinical information, and protecting electronic health information.

Third, attesting hospitals and EPs had to meet reporting requirements that some providers have characterized as challenging, onerous and time-consuming. Those that haven’t attested or plan to attest to Stage 1 in 2012 will benefit from lessons learned by early attesters.

Fourth, the payments demonstrate the meaningful use program is real, which will motivate providers to automate sooner rather than later in order to subsidize or recoup the cost of an EHR. As they automate, however, providers must remember that EHRs alone won’t address every problem afflicting healthcare. To accomplish that and aid throughput, they must complement EHRs with other technologies such as real-time location systems.


Don Graham

Don Graham, General Manager, Billian’s HealthDATA

I would have to say it’s been the extreme focus providers seem to be putting now on enterprise healthcare analytics and business intelligence, especially when coupled with the recent release of final ACO regulations. They realize that healthcare transformation requires more than the implementation of an EMR. As providers move more towards the coordinated care model (PCMH, ACOs and beyond), the challenge will be to meet the analytical needs to support this model. It will be critical to deliver an integrated view of clinical, financial and operational data not only across the enterprise, but across the community as well. Access to this data will enable providers to move into new areas of care.

In acknowledgement of the importance of analytics and its role in healthcare transformation, Billian’s HealthDATA and affiliate Porter Research have decided to focus one of our Provider Perception studies on Enterprise Analytics early next year. It’s something that our healthcare vendor customers are in turn paying more and more attention to, and appreciate the insight into.

Stuart long

Stuart Long, President, Capsule

I think the biggest HIT-related news this year is ARRA. It seems that all hospitals are just looking at how they are going to meet the criteria and qualify for the stimulus dollars. They are looking for any and all news on the topic. They are looking for help in sorting through and interpreting the legislation and what they specifically need to do to qualify. They are setting up cross-functional teams within the hospital to sort through it all. And they are looking to their vendor partners to prove how their technology and solutions fit within ARRA and therefore whether or not they will make it to the hospitals short list or not.

In fact, it’s one of the biggest areas we’ve been working on at Capsule and with our EMR partners — to help define where device integration fits within meaningful use and CPOE. I believe that ARRA and CPOE have hit all areas of the HIT space, from hospitals, to vendors, to system integrators, and to the publishing community at large – whether that be new publications, journals, trade shows, blogs, and even social media.

I just believe that the entire healthcare IT world has been turned upside down with ARRA. And of course it’s not over. We will all continue to be focused on it as Phases 2 and 3 roll out in the years to come. It might be a bumpy ride, but all we can do is hold on tight and keep on moving forward.

Mac Mcmillan

Mac McMillan, CEO, CynergisTek

I’m sure from an overall HIT perspective the answers will be quite different, but from a privacy and security perspective, it had to be one of two announcements from the federal government.

The first is OCR announcing it will finally initiate its regular audit program to conduct routine, random compliance audits of organizations accountable to HIPAA. The initiation of the audit program completed OCR’s menu of compliance and enforcement-related activities by adding to its existing practices: investigation of breaches and response to complaints. The OCR will likely disclose more information about these audits and their outcomes next year.

The second candidate for the biggest HIT-related event is the ONC announcing a delay in Meaningful Use Stage 2 in order to give organizations more time to meet Stage 1 requirements and to further support adoption of EHR technologies.

Both of these have a direct impact on the industry and its move to privacy and security readiness. We at CynergisTek are working with a lot of healthcare organizations to achieve compliance goals and improve their overall security posture. We’ve seen Meaningful Use increase attention to security and work to provide the support covered entities need to accomplish their risk analysis and implement the security features of their EHR/EMR effectively. This approach is consistent with OCR’s guidance on risk analysis and produces a step-by-step action plan that guides remediation efforts. In addition to that, we understand the partnership model desired in healthcare and we provide ongoing advice and assistance throughout the remediation process and beyond.

Michael o'neill

Michael O’Neil, CEO, GetWellNetwork

2011 was the year that the healthcare industry fully recognized patient engagement as a business imperative. Driven generally by the reality of a shift to a value-based US health system — and specifically by the requirements for patient engagement in Stage 2 Meaningful Use and the push by ONC to support consumer health IT adoption — leading providers moved aggressively to develop strategies, find partners, and adopt solutions to help.

Due to the confluence of regulatory, business, and technology transformation underway, patient engagement emerged as a core strategy for performance improvement for providers. Leveraging HIT, patient engagement solutions can take the form of Web-based portals and interactive patient care (IPC) education and communication solutions, or as simple as an online patient guide or patient bill of rights. It’s education. It’s entertainment. It’s empowerment. In fact, it’s all aspects of being involved in care.

One thing is sure: providers must work to ensure that the principle of patient engagement permeates clinical and business workflow and every aspect of care delivery. In 2012, there is no doubt that a focus on patient engagement will take greater hold throughout the continuum of care.

12-18-2011 4-04-38 PM

Peter J. Butler, President and CEO, Hayes Management Consulting

Attempting to identify the biggest HIT-related news item is difficult. However, based on research from the Ponemon Institute, which  conducted detailed interviews with executives at 72 healthcare organizations, the economic impact of information breaches can be far reaching and should be considered one of the top news items. Consider the following breach survey results:

  • On average, organizations surveyed have had four data breach incidents in the past two years, up from three in last year’s study.
  • The average number of lost or stolen records per breach is 2,575, up from 1,769 in the previous study.
  • The top three causes for a data breach are lost or stolen computing devices, third-party mistakes, and unintentional employee action.
  • Insufficient budgets and inadequate risk assessments are cited as the two greatest breach prevention weaknesses.
  • Some 81% of those surveyed use mobile devices to collect, store, or transmit patient information, but 49% say they’re doing nothing to protect these devices.

There hasn’t been a slow news day in healthcare this year, but the topic of breaches is the alarm bell for the industry. With the onslaught of new technology, the most important data – patient health information – is not safely secured. It reflects the cracks in the frantic attempt to catch up with all the unintended byproducts of the industry changes.

For example, just when the industry secured all its laptops, mobile technology took off. Now, smart phones, mobile carts, tablets, and thumb drives need to be monitored and secured. Not a day goes by where a laptop has been lost or stolen. HIPAA’s reporting policy means that the clock is ticking when the breach happens, organizations are responsible for business associates’ breaches, and the fines pale in comparison to the impact on reputation.

Healthcare organizations must put privacy and security at the top of their 2012 priority list. They must develop policies and procedures for reporting in a timely manner on breaches. Further assessments need to be conducted on a timely basis – annually at least.  This protocol must be understood by every employee and monitored to ensure compliance across the enterprise. Training and communication of HIPAA regulations need to incorporated within each healthcare organization and monitored. Micky Tripathi’s blog post on this topic gives a stunning insider view to what it’s like to have a breach happen in your organization. No one is immune – and it takes a village to rectify it.

tiffany crenshaw

Tiffany Crenshaw, President and CEO, Intellect Resources

Meaningful Use and ICD-10 are what everyone is talking about, but surprisingly, no one is talking about what Meaningful Use and ICD-10 mean from a human resources standpoint.  Incentive deadlines have created an industry-wide shortage of experienced healthcare IT professionals, specifically those with Epic experience. Think about it — everyone in the industry is working towards the exact same deadline!

Countless planning hours are put forth to ensure a successful go-live and meet incentive deadlines. Technology, equipment, infrastructure, training and other task related functions are all meticulously planned in advance with the intention of those tasks being carried out by future experienced healthcare IT hires. But what if you can’t find those future hires? What happens to your plan then?

Meaningful Use and ICD-10 have created a huge demand for experienced healthcare IT professionals and there simply aren’t enough experienced individuals to fill these much-needed positions. Now is the time to think creatively about hiring solutions and start planning.

doug burnman

Doug Burgum, President and CEO, Intelligent InSites

The biggest healthcare IT event in 2011 was the Department of Veterans Affairs’ decision to improve healthcare efficiency with a national investment in Real-Time Location Systems (RTLS.)

The VA has the nation’s largest integrated healthcare system: over 150 medical centers, almost 1,400 community outpatient clinics, and 53,000 independent licensed healthcare practitioners, serving more than 8.3 million Veterans every year. Eric K. Shinseki, Secretary of the VA, has identified 16 transformational initiatives for the VA. One of these initiatives, Health Care Efficiency, directly includes RTLS to improve care while lowering costs.

The Government Executive reports that the VA views a planned $550 million National RTLS implementation as a way to improve efficiency, track equipment, and properly sterilize medical instruments.

We are thrilled that our industry has the opportunity to contribute to this groundbreaking effort. Intelligent InSites’ customers have improved patient satisfaction and patient safety, while decreasing hard-dollar expenses, through their use of RTLS solutions for asset management and patient flow. They do this by automatically collecting real-time data from throughout the hospital, processing that data, then using actionable intelligence to make fundamental improvements to how they run their hospitals. By using RTLS, they can process the location and status of every critical piece of medical equipment, patient, and staff in a healthcare facility, then use this data and intelligent workflow automation to improve their healthcare processes.

The next few years are going to be amazing—not just the RTLS industry, but also for the transformational benefits to the delivery of care.

Mike Sweeney, President and CEO, maxIT Healthcare


This was such a busy year in the HIT industry, it would be difficult to name just one event, so I will limit myself to three.

First, Epic’s continued dominance in new account sales along with the recent trend of their customers’ rolling the Epic applications out to their affiliate networks (acute and ambulatory) has had a major impact this year. Second, McKesson’s announcement of their product direction with Horizon and Paragon will have a significant ripple effect in the market as we get into 2012. Finally, the government mandates and programs surrounding Meaningful Use, ICD-10 and ACOs are driving so much demand and activity in the market, those can’t be left out of top events for 2011.

It’s definitely an exciting time to be in our industry, and I can’t wait to see what’s in store next year.

Tom Carson

Tom Carson, CEO and President, MD-IT

The clear emergence of physician preferences for mobile applications to interface with their HIT systems has huge implications for systems criteria and future workflow demands. Most legacy HIT systems were developed with the idea that physicians would sit in front of desktop computers for their documentation and care-planning tasks. After years of physician reluctance to adapt to these defined work processes, the relatively rapid increase in popularity of applications for smart phones and tablets suggest that doctors are beginning to participate on their terms in EMR adoption and use, and that HIT vendors are due for a re-think in their approach to product solution design and delivery.

This is significant because it marks a maturing of the EMR industry in that products will have to be more customer-driven going forward, as opposed to regulatory-driven to succeed.

12-18-2011 3-31-56 PM

Patrick Hampson, Chairman and CEO, MED3OOO

The biggest news related event was just recently announced by the Kathleen Sebelius, the HHS secretary. By relaxing the time frame for meeting Meaningful Use Stage 2 requirements, physicians, EHR vendors, HIE projects, and most all operators of healthcare will all get more time to adapt to the rapid expansion of electronic health care delivery.

Changing healthcare to a more seamless, interconnected health system in the US is absolutely critical. Doing it right and not just doing it fast is even more critical. Why have providers go from a paper mess to an electronic mess? Why just add technologies without the strategy, knowledge, and planning needed and the provider level knowledge necessary to actually get a return on your investment? How about a return in care for your patient?

Physicians and hospitals were forced to scramble to adopt new work flows, new processes of care delivery, and at the same time, implement new technologies (EHR systems) and install patient portals to meet the requirements for Stage 1. If these same providers want to stay viable, they have to maintain productivity, fight competitive forces in their markets and pre-pay, for most of this while the government gives them an IOU. Throw in the current economic conditions of our depressed economy and it is all too much for providers. Great for vendors, not so great for providers.

Relaxation of the Stage 2 requirements deadline is less about not wanting to get somewhere, but it is more about getting there efficiently. A pet peeve of mine is why have financial penalties should you not do it fast? Why not financial incentives for doing it right?

Hopefully we will all take this delay as a continued opportunity to improve the designs of technology, not just to process a bill or serve as expensive transcription, but provide technology that can really support providers and the coordination of care across the populations they serve. While Accountable Care is touted as the next big step for many, MED3OOO as a healthcare management and technology company has provided technologies and operations for physicians and hospitals and communities are already accountable for care and for managing risk and been doing it successfully for more than 15 years.

For those that haven’t, the learning curve and the costs are steep. These organizations will require more than just production systems like accounting systems, practice management systems, and electronic health records. Organizations will require and we will provide strategies, systems, and operations economically. Organizations will need to have capabilities that include integration of disparate systems and disparate centers of data. Organizations will need the ability and systems to disseminate population data and then distribute that same data efficiently back to the point of care for its best use.

MED3OOO is uniquely position to partner with providers and provide our existing packages of system, software, and knowledge infrastructure to make this next journey a successful one for new Accountable Care providers. In doing this, we will continue our mission and make absolutely sure that the patient has a better outcome. We do believe that outcomes matter!

peter kuhn

Peter Kuhn, CEO, MEDSEEK

With Microsoft partnering with GE, Google exiting the PHR market, and more payers entering the provider market, the events of 2011 have significantly changed the healthcare industry. How patients respond to payers acquiring providers depends on whether they perceive an improvement in care coordination or feel that quality of care is mitigated by payers influencing physicians. With access to both risk models and clinical information, how well these acquisitions work also depends upon the ability to analyze that data to create effective business strategies.

Analytics, particularly predictive analytics, has been in the healthcare news this year. At MEDSEEK, we understand that analyzing data and creating actionable strategic plans will help our clients set themselves apart. That’s why we made the decision to acquire Third Wave Research, Ltd. We’ve subsequently integrated what we believe to be the most advanced predictive analytics technology into our strategic patient engagement and management solutions.  With the commoditization of patient portals and patient outcomes and wellness driving revenues, the major market differentiator will be how well hospitals engage new and existing patients, manage costs, and coordinate care.

Hospitals’ success will increasingly hinge on using predictive analytics to match high-value patients with appropriate, profitable services when and where they need them and make informed investment decisions based on population health propensities. Combined with factors such as demographic, financial, and insurance data, predictive analytics will play a larger role in executing cost-effective, personalized marketing campaigns that influence patient behavior and improve population health.

jeff sturges1

Jeff Surges, CEO, Merge Healthcare

With new federal policies to reduce reimbursement and foster information sharing, the question is not if, but when a healthcare system should implement an enterprise imaging strategy that focuses on providing electronic access to medical images. Hospital CEOs, CIOs and physicians can no longer ignore:

  • Patient safety issues around radiation exposure
  • Competition to attract and retain the best physicians
  • Compliance with Meaningful Use guidelines
  • Support for an ACO strategy
  • The push for interoperability in EHRs across healthcare systems and HIEs

These issues are driving the need for a new paradigm of image sharing and enterprise-wide imaging strategies.

An enterprise imaging strategy must focus on image storage, the ability to ingest images from outside of the enterprise, and provide accessibility to any type of medical image, anywhere across the continuum of care, anytime, by anyone. It should include three components:

  • Storage. A vendor-neutral archive (VNA) to create a patient-centric record of images across all sites and modalities.
  • Gateway. An intelligent DICOM gateway, capable of receiving and morphing studies from outside the enterprise.
  • Viewer. A universal viewer that can be used in any environment on any device and is accessed via the browser, thus requiring no software to be downloaded.

There really is no wrong way to proceed with an enterprise imaging strategy as long as decision-makers fully understand the capabilities of each technology component, relate the capabilities to meeting their top business challenges, and look at the enterprise imaging strategy as a solution that can grow and evolve over time.

Jay mason

Jay Mason, CEO, My Health DIRECT

I see the roll-out and clarification for Accountable Care Organizations this year as being a significant event or turning point. While there is yet to be much to determined in how they will play a role in reimbursement and delivery, it has forced organizations — both payers and providers — to rethink how they function and how they look at themselves. Infrastructure, resources, and relationships will be reshaped.

This means they must commit to new ways to work together as providers, as well as how they are engaging, informing, managing, and directing patients. The silos that have been built up over the past decades will soon come crashing down.

Janet Dillione, Executive Vice President and General Manager, Nuance Healthcare

Janet dillione1

ICD-10 came onto the scene in 2011 in a big way. It received enormous attention throughout the year and has even been compared to Y2K. In short, it’s a monumental shift from what is documented, coded, and billed against today in healthcare and what level of specificity will be expected to be documented, coded, and billed against come 2013.

As a result of this major transition in medical coding, the reimbursement process will get more complicated and will expand. At Nuance, we believe that ICD-10 success begins with the physician at the point of documentation. In turn, over the past year we’ve allocated resources to develop, in partnership with 3M, next generation ICD-10-ready clinical documentation and coding solutions. In 2012, we’ll bring to market Computer-Assisted Physician Documentation, a new category of solutions that will interact with physicians at the point of documentation to review and prompt for the level of specificity required to achieve reimbursement in correlation with ICD-10 standards. Simply put, it turns clinical language (doctor’s spoken words) into codable language.

By combining Nuance’s speech recognition and Clinical Language Understanding (CLU) capabilities with 3M’s experience in developing and implementing coding products and services around the world, we’re well positioned to deliver solutions that will substantially improve physician workflow and will facilitate more precise, complete coding, and more accurate claims.

12-19-2011 5-07-28 PM

Todd Cozzens, CEO, Accountable Care Solutions, Optum

This past year has been filled with game-changers – from Meaningful Use to ICD-10 – but the biggest milestone in healthcare IT had to be the CMS final rule on the Medicare Shared Savings Program, which I believe will be looked back at one day as the event that spawned a whole new generation of health information technology.

Notice that I’ve not include the “care” ending to health. This next generation of IT solutions will focus not just on patients currently seeing doctors and being admitted to hospitals. It will cover a much broader spectrum of wellness and prevention products to comprehensive management of patient populations. The final regs set the tone for the industry and made a statement: accountable care is here to stay.

When I talk about accountable care these days, I am quick to point out I’m talking about the general idea of healthcare providers taking on some form of risk – i.e. being responsible for the outcome AND the cost of that outcome. McKinsey thinks there will be around 750 MSSP ACOs within five years. That sounds about right. But when we at Optum talk about the broader concept of sustainable health communities, we believe that every health system in the country will adopt some form of risk taking – whether it be bundled payments or new risk-sharing health plans with payors, all the way up to fully capitated networks.

Healthcare reform was the catalyst that started the dialogue. The budget deficit, with its inevitable cuts in entitlements, created the sense of urgency. The Medicare MSSP program signaled that CMS is 100% behind the effort. We all know that when CMS coughs, the US healthcare industry has a cold, and that’s why this final rule is such a game changer.

paul brient1

Paul Brient, President and CEO, PatientKeeper Inc.

One of the biggest HIT-related news stories in 2011 was the extension in the effective date of Stage 2 Meaningful Use. At some levels, this was a non-event. ONC’s decision to push back the Stage 2 start date for Stage 1 “early attesters” by a year (to Oct. 1, 2013) corrected a flaw in the original plan that effectively penalized hospitals for being on the ball and attesting for Stage 1 early. Yet the move created a fair amount of confusion in the market and headlines in industry media, and paused some Meaningful Use activity.

That is largely behind us now. The Stage 2 proposed rule will be published in the next month or so, and many hospitals are beginning to focus on the challenge of getting widespread physician adoption of CPOE and documentation software that will be required by Stage 2 and 3 objectives.

12-16-2011 1-30-45 PM

Todd Johnson, President, Salar

In a conference this past summer with chief medical information officers and physician informaticists, a physician’s panel was convened to consider the next big challenge for their hospitals. Without question, the conversion to ICD-10 topped the list. As discussed in that conference in Ojai, California, and paraphrased here: “ICD-10 is entirely a physician documentation issue.” While this statement does not to suggest a minimized importance for consultative services, back-end billing systems, or payer reform, it does call to light the critical nature of a physician’s clinical note. All coding starts from the note. Indeed, the note itself justifies all other pieces in this puzzle.

Going into 2011, we believed (as did many others) that Meaningful Use would continue to dominate all discussions. In retrospect, we’ve been surprised to see how quickly ICD-10 has become a front-burner issue though so poorly addressed by the healthcare market. Both hospitals and the vendor community alike seem woefully ill-prepared to address this issue which simply fuels the anxiety and paranoia of this “great unknown.” Just as Meaningful Use taglines blanketed the banners at HIMSS this year and MS-DRG coding dominated the banners in years before, you won’t be able to walk 10 paces without seeing ICD-10 lingo at HIMSS 2012.

Stephen Hau, CEO, Shareable Ink

12-23-2011 4-23-27 PM

The growing acceptance of enterprise cloud computing in healthcare has been a persistent and recurring theme of 2011. We are excited by this development because it will help accelerate much needed innovation in healthcare IT.

Hugely successful IT projects in our industry are relatively rare. Some may feel that this reputation is unfair and not deserved. However, who can deny that the industry has a track record of protracted implementation projects, lengthy development / release cycles, and expensive hardware investments that can quickly become obsolete?

Enterprise cloud computing represents an approach that is compelling for small physician practices (with no in-house IT support), large health systems (that require scalability, minimal administrative burden, and stringent uptime commitments), and organizations in between. We have observed shorter deployments, transparent and non-disruptive updates, and removal of hardware obligations from the customer. A cloud-based distribution model allows software providers to respond to market demands more nimbly – and healthcare organizations to take advantage of rapid innovation.

Taken together, enterprise cloud computing has the power to provide a very positive IT experience, allowing healthcare organizations to focus on the benefits of technology and creating a better environment for innovation.

Ed Daihl, CEO, Surgical Information Systems

12-18-2011 3-23-08 PM

Hospitals and anesthesia providers are facing reimbursement changes, shifting payment models, increased regulatory reporting, and Meaningful Use. We believe that hospitals will continue to focus on achieving ARRA funding to help combat these challenges.

It is important to us at SIS to ensure that we help our clients respond and prepare for these changes. We were the first perioperative healthcare software provider to achieve ONC Meaningful Use certification in 2010, and more recently, our Anesthesia Information Management System (AIMS) achieved Meaningful Use certification as well.

evan steele

Evan Steele, CEO, SRS

One of the biggest HIT-related events was the recent announcement by HHS that it was postponing the implementation of Meaningful Use Stage 2. It was important, not because it will directly and significantly impact very many providers, but rather because of what it acknowledges and the positive message it sends.

All that the delay does is to reward early adopters by giving them access to three years’ of incentives under the easier rules of Stage 1 and to remove one of the reasons that might have discouraged some of them from attesting in 2011. Contrary to Secretary Sebelius’s contention, it can do nothing to speed adoption since the announcement came too late to impact any providers who have not already implemented—and been successfully using—a certified EHR.

What the delay does accomplish, however, is to send a heretofore unheard message—one of flexibility and of an acknowledgment of the significant challenges that Stage 1 is posing for many providers and vendors. By delaying the schedule for Stage 2, the government has let them know that the rules are not set in stone, that some things are negotiable, and that it is willing to work with providers and vendors in the interest of accelerating EHR adoption. If this same message is conveyed in the release of the actual rules for Stage 2, the likelihood of the program’s ultimate success will be greatly enhanced.

Rick Stockell, President, Stockell Healthcare Systems

12-18-2011 4-17-10 PM

As we have seen and experienced with our customers, the impact of prepping for and addressing Meaningful Use and ICD-10/5010 compliance on the healthcare industry was certainly significant in 2011, and it will continue to be a major factor into 2012 and beyond.

Richard atkin

Richard Atkin, President and CEO, Sunquest

Over the past several years, structured reporting of laboratory results has been promoted as a public health priority. Its inclusion as a Meaningful Use objective is helping to drive the accelerated adoption of EMRs.

This past January, Sunquest Information Systems became the first and only dedicated laboratory information system vendor to achieve 2011/2012 Meaningful Use compliance and certification as an EHR Module by the Certification Commission for Health Information Technology (CCHIT.)

Sunquest continues to lead the industry with regard to the HITECH Act and Meaningful Use regulations. Meeting with government officials and continuously monitoring client preparedness are just two of the ways that Sunquest helps its clients complete the three steps for earning incentives: adopt certified electronic health record (EHR) technologies, achieve Meaningful Use objectives, and apply for incentive payments.

In addition to meeting many of the Meaningful Use modules, Sunquest solutions provide the capability to improve the overall safety, quality, and efficiency of healthcare. Our comprehensive Meaningful Use plan includes expanding the use and management of LOINC and SNOMED-CT codes. This initiative is a critical priority for our clients as they plan their LOINC strategy.

Sunny Sanyal, CEO, T-System

sunny sayal

The recent decision by the US Department of Health and Human Services (HHS) to delay by one year the start date of Stage 2 Meaningful Use of certified electronic health records (EHRs) is by far the biggest HIT-related development of 2011.

By pushing the compliance deadline from Oct. 1, 2013 to Oct. 1, 2014, HHS recognized that the original timetable was too aggressive. Many hospitals planning to be ready for Stage 1 in 2011 or 2012 would have faced little lead time to prepare for Stage 2 requirements, which will not be finalized until July 2012. This deadline would have made it extremely difficult for both facilities and vendors to upgrade and install Stage 2-compliant EHRs by October 2013.

Prior to the delay announcement, we were beginning to hear rumblings from hospitals about potentially abandoning efforts to qualify for Meaningful Use incentives, instead waiting to attest until 2015 to avoid Medicare reimbursement cuts. The one-year grace period will enable providers who attest to Stage 1 Meaningful Use in 2011 to qualify for three payment years and those attesting in 2012 two payment years. It will give them and their EHR vendor partners additional time to develop a plan for Stage 2 compliance and design and implement optimal software. More importantly, it buys hospitals time to drive adoption of EHRs intended to improve the quality, safety and cost-effectiveness of care.

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December 21, 2011 News 4 Comments

News 12/21/11

December 20, 2011 News 14 Comments

Top News

12-20-2011 8-55-21 PM

HHS names the 32 healthcare organizations selected to participate in the Pioneer Accountable Care Organization model. The Pioneer ACOs will test the effectiveness of several payment models to support better care and outcomes at a lower cost.

Reader Comments

inga_small From Unicorn Hunter: “Re: IT resources. I need people or a company who can extract, transform, and load data from popular ambulatory EMRs to EpicCare, with skill in Oracle programming and Epic Bridges.” We don’t usually get involved with recruiting, but leave a comment if you have suggestions.

inga_small From Curious Reader: “Re: Medicomp. Interesting interview with Dave Lareau. Which vendors are using Medicomp?” I checked with Dave, who unfortunately can’t help. “Because of the proliferation of patent trolls in the marketplace and their ‘bulk litigation’ approach, Medicomp does not publish its customer list.” But if you go to HIMSS, I bet he will tell you, and if it’s like last year, several vendors will be bragging on their use of MEDCIN and Quippe.

mrh_small From Music Man: “Re: your frenetic schedule. Know that your efforts are appreciated by me, my team, and many others. You’ve liberated us from the pay-for-play, outdated, and hopelessly out of touch hegemony of the publications put out by HIMSS and others.” Not only was that a nice comment from a sponsor, it uses a word not often heard. I had to check the pronunciation and definition: hee JEM uh nee, meaning dominance. I’m pretty sure the old guard is still dominant, but we’re happy heel-nippers.

mrh_small From Harold the Barrel: “Re: [vendor name omitted]. The head of its demo team resigned today. Also, rumor has it that [name omitted], a well-liked executive from before the acquisition, has resigned. Also, [name omitted], who was responsible for driving new acute care sales, has parted ways.” I’m leaving out specifics since I know from experience that the company doesn’t confirm personnel issues and I’m uncomfortable running the names of people without verification.

mrh_small From Big Sigh: “Re: Cleveland Clinic. Despite its health technology savviness, it still orders tests without regard to best evidence.” The top five tests ordered there are of questionable value, says this article.

12-20-2011 7-38-56 PM

mrh_small From The PACS Designer: “Re: Withings. Since it’s the holiday season, TPD thought it would be nice to highlight a potential gift for someone you know. If that recipient has health issues, the gift of Withings may help start the improvement process. Withings is Wi-Fi enabled, can monitor blood pressures and other body parameters, and also has a baby monitor application.”

HIStalk Announcements and Requests

12-20-2011 6-45-02 PM

mrh_small I keep mentioning the Resource Center and Consulting RFI functions, so I finally got around to having banners made that link to them (to your left, below the Founding Sponsor ads). I decided to make it confusing by calling the Resource Center “Vendor Catalog” (actually, even though it’s inconsistent, I thought that label was more immediately understandable.) The Resource Center lets you find HIStalk sponsors by category, which is pretty cool, or you can look them up by name or do a full-text search. The Consulting RFI Blaster lets you fill out a really simple form and send it with a click to one, some, or all HIStalk sponsors who offer consulting services. CIO readers came up with the idea for both of these functions, asking for a way to make it easy for them to give sponsors a chance to earn their business.

12-20-2011 7-42-29 PM

mrh_small It’s that time again: HISsies nominations are open. Name the best and worst vendors, choose the Industry Figure of the Year, and of course give thoughtful consideration of your nominee for Industry Figure in Whose Face You’d Most Like to Throw a Pie. The most-nominated winners advance to the final ballot in a couple of weeks, so don’t assume someone else will nominate your candidate. The winners (who, paradoxically, are losers in some categories) will be announced grandly at HIStalkapalooza in Lost Wages on Tuesday, February 21, amidst an embarrassment of jollity, eating, drinking, and edgy entertainment (by healthcare IT standards, anyway, where the 30-year-old third cousin of a former roadie for The Temptations with questionably legal rights to their name can cause near-pandemonium by covering their modest hits that charted decades before he was born). Even if you’re a button-down stiff who doesn’t find The Pie award funny, give some thought to the Lifetime Achievement and Industry Figure of the Year awards, which are serious. That’s athenahealth CEO Jonathan Bush above doing his one-man HISSies awards show at HIMSS 2011 in Orlando, decked out in the beauty queen sash we provided that read, “I’m In the Cloud.”

Acquisitions, Funding, Business, and Stock

12-20-2011 2-08-27 PM

VeriTeQ Acquisition Corp. signs a non-binding letter of intent to buy the non-core assets of PositiveID Corporation, including the company’s VeriChip and Health Link businesses that PositiveID has not marketed  for over two years.

12-20-2011 7-54-14 PM

Intel’s investment arm makes an investment in Pixeon, a Brazil-based PACS vendor.

12-20-2011 9-11-36 PM

Chicago healthcare technology accelerator Healthbox names its inaugural class of 10 startups that will receive seed capital, work space, and mentoring:


12-20-2011 2-09-33 PM

Silverton Health (OR) contracts with Summit Healthcare for interface and connection tools to facilitate its migration to the Meditech 6.0 platform.

12-20-2011 2-11-33 PM

Adena Health Systems (OH) awards a five year contract to Precyse for transcription services and various aspects of HIM administration.

Crescent City Beacon Community (LA) selects Mirth Corporation’s interoperability products.

The Delaware HIN chooses ABILITY Network’s DIRECT Messaging tool for the secure exchange of health information between providers.

12-20-2011 2-13-48 PM

Baystate Health (MA) selects ATLAS to provide outreach and connectivity services to manage Baystate’s lab, radiology, and other ancillary orders and results requirements.

East Tennessee Health Information Network will use the Axolotl HIE platform from OptumInsight to connect regional providers, hospitals, labs, and pharmacies.

12-20-2011 9-01-58 PM

St. Vincent’s HealthCare (FL) selects Orion Health HIE and Clinical Portal.

Shannon Health (TX) chooses the Rothman Index for patient surveillance.


12-20-2011 6-19-15 PM

Harrington HealthCare System (MA) names Harry Lemieux as CIO. He was previously with Morton Hospital and Medical Center.

12-20-2011 7-26-59 PM

Craig Joseph MD, is named CMIO of Agnesian HealthCare (WI). He was previously with Epic.

12-20-2011 7-30-14 PM

Jim Milligan, previously with Antek Healthware, has joined Baltimore-based PM/EMR vendor Software Unlimited, Inc. as CEO.  Readers voted him as “Best Non-CEO Executive” in the 2006 HISsies when he was with QuadraMed.  

12-20-2011 8-51-35 PM

New Zealand businessman Andrew Ferrier, formerly CEO of the country’s dairy co-operative, invests in Orion Health and takes a seat on the company’s board.

Announcements and Implementations

Hoboken University Medical Center (NJ) gets a Meaningful Use check for its use of Medsphere’s OpenVista.

12-20-2011 8-16-22 PM

Ohio-based HealthSpot will market its Care4 Station primary care telemedicine kiosk to military facilities. It includes software for scheduling appointments and managing health records.

Government and Politics

MGMA calls for HHS to immediately issue an expanded six-month contingency plan for the Version 5010 transaction standards. MGMA reports that less than a third of its members have completed all the upgrades and testing required for the 5010 transition and is encouraging HHS to allow physician practices to continue submitting Version 4010 transactions


Cedars-Sinai Samuel Oschin Comprehensive Cancer Institute will provide clinical expertise to WellPoint as the insurance company develops a commercial application using IBM’s Watson technology.


12-20-2011 5-58-41 PM

The Apple App Store names AirStrip CARDIOLOGY the best US medical application for the iPhone.

mrh_small A just-published article in Annals of Internal Medicine finds that users of the VA’s My HealthVet are overwhelmingly interested in sharing their PHR information with family members or other providers. Another article finds that primary care providers are mixed about sharing electronic progress notes, with a significant number expressing concern that increased patient worry might outweigh the benefit of improved communication and education. An editorial discusses the two articles, but mostly just asks a lot of cautious questions about what patients might do with the information in their records. 

mrh_small Rumors say The Chicago Sun-Times will be sold to an investment group led by Michael Ferro, CEO of Merrick Ventures and chairman of Merge Healthcare.

mrh_small A hospital CEO alerts colleagues that his Facebook friend requests are actually coming from an imposter who set up a Facebook page using his name and photos. The scammer has friended several hospital employees, with at least one of the requests saying, “I love you.” The CEO e-mailed Facebook for help and got the usual prompt, personal service: they changed something so that he can’t see the fake profile, even though everybody else still can.

mrh_small The laptop of a terminally ill woman in Canada is stolen from her apartment, and along with it the only copies of the farewell message videos she had recorded for her five children under 18 to remember her by.

12-20-2011 6-59-49 PM

mrh_small The New York Times runs an article taken from Micky Tripathi’s HIStalk Practice post describing the experience of his Massachusetts eHealth Collaborative in dealing with a lost laptop. In his own blog, he mentions his annoyance that the paper didn’t credit HIStalk Practice (since corrected, and notice that he still had preemptively slipped it into the photo they asked him for), the article implied that an increasing number of breach reports must mean that more breaches are occurring, and it suggests that electronic records are more susceptible to inappropriate exposure. Most importantly:

Finally, I found it a little ironic, that while the NYT article itself is an important step toward educating the public about the real issues surrounding the loss of electronic patient information, it glossed over the steps we’ve taken to educate the industry – like writing the post that lead the Times to the story in the first place. I think it was a bit of a missed opportunity to encourage organizations that have similar experiences to follow the path of full disclosure that we did.

mrh_small Weird News Andy is doing his own end-of-year retrospective, targeting this “high-caliber story” from Italy. A man hit in the head by a bullet fired by a New Year’s reveler is lucky when it lodges in his nasal passage without causing serious damage. His luck got even better as he waited to see a doctor in the hospital: he sneezed the bullet out of his nostril, requiring only eye surgery before being discharged.

Sponsor Updates

12-20-2011 9-16-57 PM

  • Providence Holy Family Hospital (WA) uses the Access e-Forms Repository to standardize surgery documentation.
  • CBSMedTech joins MD-IT as a Medical Transcription Service Organization associate.
  • Practice Fusion releases an infographic to share its record growth and accomplishments for 2011.
  • API Healthcare offers a case study on MemorialCare Medical Centers’ (CA) successful integration of staffing, time and attendance, and payroll software.
  • Concerro hosts a free January 24 Webcast  on how to avoid burnout in the healthcare management workplace.
  • Vermont Information Technology Leaders partners with CapSite to assist its physician practices in adopting EHRs.
  • Joel French, CEO of SCI Solutions, discusses four proven methods to improve hospital revenue in 2012.
  • Gateway EDI releases a free webinar on how to effectively build a revenue management strategy.
  • T-System publishes a white paper on the advantages and disadvantages of ICD-10 and the effects on EDs and hospitals.
  • The American Hospital Association exclusively endorses Imprivata OneSign single sign-on.
  • Orthopaedic Center of Southern Illinois selects SRS EHR for its nine providers.
  • TeleTracking Technologies announces that its Capacity Management Suite is now iPad compatible.


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

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December 20, 2011 News 14 Comments

Readers Write 12/19/11

December 19, 2011 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!

View from the Healthcare Recruiter’s Chair
By Don Calhoun

Happy Holidays! As this year comes to an end, I thought I’d share some insight into the job market, hiring trends, tips for candidates, and tips for clients. Not to mention some observations that may or may not have anything to do with any of the above. The following are educated opinions with some fact sprinkled in.

The Job Market

We continue to see strong demand for implementation consultants, project managers, and practice directors. Shocking, right?

Instead of just trying to find one of the 1,000 Epic Certified “X” consultants to fill one of the 4,000 Epic Certified “X” consultant openings, we have employed a new strategy. Starting in 2012, we will be working with George Lucas on a controversial project. I can’t say a lot more at this time, but DNA will be involved.

Tips for Candidates

You may be looking for a better position, going through RIFs, or just putting EMR on your resume in the hopes that will create a bidding war for your services.

Tip #1. Recruiters see hundreds of resumes per week. They can become lazy. If you have experience with a vendor product, a particular system, or an integration tool, make sure it is on your resume. This is a world of keyword searches. If you don’t list these, you could be missing out.

Tip #2. If you have been at the same firm for sometime and have a feeling that they are underpaying you, talk to a recruiting firm. Some companies pay below-market value, and if you get comfortable in that role, you may be shortchanging yourself.

Tip #3. If you don’t mind travel, put that on your resume. If we stick with the theory that recruiters see hundreds of resumes per week and need to prioritize who to call first, the biggest slam-dunks will get that call. The slam-dunk has all of the pertinent information available – skills, software, general idea of rate/salary, and ability to travel.

Tips for Those Laid Off

Tip #1. Get on LinkedIn and make it known that you are looking for a new position. Put all of your skills, training, etc. on your profile.

Tip #2. Network like crazy.

Tip #3. If you have the drive and ability, think about starting your own firm. It doesn’t cost much to get incorporated in most states. You may be surprised about local work you can pick up.

Editorial Comment Section

When are large companies who think they can buy their way into healthcare going to learn that they are five years late to the dance? And that IT NEVER WORKS?? I wouldn’t be surprised if General Motors is a “healthcare” firm next year. Sorry – had to be done.


(Not ours — they already know this.)

Tip #1. Being thorough and expedient is a difficult trick to pull off when hiring, but it is a must in this market. Whoever dies with the best healthcare consultants wins. You must make this a priority in order to grow, create a great reputation, and have a happy work force. A couple of phone interviews are great, but at some point it is time to lock all decision-makers in a room with the candidate and make a decision. Some companies are hiring people two weeks after starting the process. Are you able to compete with that? If not, talk to HR/Recruiting and figure out a way to streamline your process. You will save yourself lots of recruiting dollars, disappointment with candidates you missed out on, and will ultimately have a stronger workforce.

Tip #2. Before deciding on a hiring initiative, reach out to some people in the recruitment business to see what the market is commanding in terms of salary, bonus, travel, time off, etc. Salary surveys run by third parties don’t seem to be in line with the real healthcare market (just my opinion). Ensure that you are making strong offers. I view the current healthcare market like NFL free agency. The best players want the top teams, the most dollars, and the best situation. Everybody wants the top free agents. Playing the lowball and hope they accept game isn’t going to get you anywhere.

Tip #3. If you decided to engage a search firm, make sure you know who is actually conducting the search and talking to candidates. You need experienced healthcare people talking to these candidates. I may get threats for saying this, but some firms put the big gun on the phone with you to sell you their services and then turn the search over to a “just out of college, took a recruiting job to pay the bills until my band makes it” recruiter. Make sure you talk to the people that are going to talk to your future employee.

I hope some of this provided some value. We’re off to an undisclosed location to meet with Mr. G. Lucas. An update should be coming soon.

Don Calhoun is founder and managing director of Executive Search Recruiting, LLC of Cornelius, NC.

Breakfast of Physician Champions!
By Daniela Mahoney

12-19-2011 6-51-53 PM

Culture eats strategy any day.

I think we have all heard this saying. More than ever, it proves to be true when I think of any initiative that involves providers, changes to their workflow, perceived loss of autonomy, and the sacrifice of something very, very precious — TIME.

Yet when introducing a new initiative, hospital and project leaders must somehow get everyone on board in a relatively short time frame and also convince them to embrace the new way of doing business.

So, you ask, where are the challenges?

Unwritten Rules

The relationship between organizations and their providers varies based on structure, history, leadership culture, and vision of the future. Therefore, for any organization, every new initiative is challenged by implicit unwritten rules that define and govern certain expectations, organizational design and behavior.

And moreover, initiatives that involve the introduction of advanced clinical systems to providers — particularly CPOE — are subject to the greatest scrutiny. These projects subsequently pose serious challenges to the unwritten rules because they raise a very fundamental question from providers: “If our present rules will no longer support what we know and feel comfortable with, what will it take to change these rules so we can create an environment that better aligns with the new vision of the organization?”

These days, most hospital leaders encounter this challenge when implementing a new system. Regardless of motive —whether implementing CPOE because the organization is on the fast track to meeting Meaningful Use or, more nobly, because “it is the right thing to do” to improve patient care and outcomes— the reality is that the unwritten rules must be rewritten upfront and early to successfully transform the staff culture and ensure quality and predictable patient outcomes with the new system in place.

Great Expectations

It’s about inclusion from the get-go. The staff culture has to be given serious consideration and be honestly and fully included in implementation plans from the time you begin talking about these new initiatives to the time they are executed and realized. I have witnessed noticeable and successful changes in culture only when the majority of the providers are aligned with the vision of the organization (I say “majority” because in most cases, non-academic organizations have difficulty achieving 100% buy-in from all providers.)

How do we go about learning what is important to your providers? What are their expectations and what are their fears? The answers to these questions are the elements that eventually create the adoption strategy map. And the pursuit for these answers is a concerted effort executed in the early phases of the implementation (although sometimes we get pulled in at the tail end of an implementation when things do not go as planned. This makes the recovery efforts more difficult and at times delays the initiatives!)

If done well, this initial Q & A or interview exercise yields a fairly clear plan, yielding one strategic decision to make about it:

  • Should things be mandated and, if so, when and how?


  • How will the support and training strategies need to be structured to make things manageable?

Constant Compromise

To me, the decision is a basic balance of give and take, a constant compromise where the art of negotiation reaches amazing peaks. This is when it is important for the CEO to have a close relationship with the medical staff and be actively involved and visible with these new initiatives. The CIO needs to think outside the box and not lead with the technology as the value proposition. A strong CMIO or physician champion should truly understand his/her peers and their workflows and master the art of negotiating.

The unwritten rules have to be explored. These are the rules that might imply that “nothing can be mandated to physicians”, that “physicians must always have individual choice and prerogative”, that if “I am not involved in a decision, I will not support it”, or that “variability is desired.” It reflects the true art of medicine and the uniqueness of every individual patient, that the art of medicine always trumps the science of medicine.

Understanding the unwritten rules from the beginning helps establish the appropriate path to implementation. For example, in one of our cultural assessments this year, we learned that the initial plans included a very aggressive deployment of CPOE, house-wide at once, with rapid expectations toward universal adoption (“mandate” is an ugly word.) As much as this approach is desired, it is more important to know if it could be executed successfully. In this particular case, the expectations of the medical staff were not integrated into the original plan. During the cultural assessment process, these expectations surfaced and were far from being consistent with the original plan.

Now, one can push and try to keep the plan as defined initially but, in the long run, this would alienate many (or probably most) of the providers. Why not take another look at the plan? And by employing a much more collaborative approach, see how it can be adjusted and eventually executed —successfully — while still attaining the same goals. Also, by doing this, the unwritten message from the CMO and other organizational leadership would be clear: “We do care about what you [providers] are telling us. We know it will not be easy to implement CPOE. But we are committed to working with you for all of us to succeed.”

Personal to Us, but System Agnostic

Culture is something personal to all of us —to any organization. CPOE touches clinicians at many different levels and inarguably creates significant disruptions in everyone’s routine. I truly believe that CPOE is the best thing we can do for our patients, but as I say this, I know that not all CPOE outcomes are the best. With a failure rate somewhere in the neighborhood of 30%, along with a long list of unintended consequences, it makes us realize that technology is only 15-20% of the challenge. The rest is all the change and optimization that needs to be done for this to work as intended.

We should also recognize and accept that provider culture is system agnostic. We can hope that the more advanced systems become easier to design solutions that support clinical processes. But it is naïve to believe that CPOE will be an easy project simply because you install the Cadillac version of a system. We have seen many successes with more modest versions of clinical systems and failures with very sophisticated ones and vice versa.

A system alone does not guarantee a successful outcome. It needs much more than that. As part of the team planning clinical initiatives for your hospital, please listen to your providers and understand your organizational history and its culture. Many of the answers to what it takes to succeed are right in front of you— you just have to look to see them.

12-19-2011 7-00-17 PM

Time for Breakfast!

I just returned from a visit oversees and came across this wonderful blini (Russian pancakes) recipe. I guarantee the entire family will love them, especially on cold winter mornings. I serve mine with 1 cup ricotta cheese, 1 tablespoon sugar, 1 teaspoon vanilla extract, and a scant ½ cup golden raisins added at the end once all other ingredients are mixed well.

Till next time, when we will talk more about the CPOE value proposition to providers. Safe and happy holidays to all!

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

By Vince Ciotti

An interesting week of news for our EMR world.

On Tuesday, the National Transportation Safety Board (NTSB) called for the first-ever nationwide ban on driver use of personal electronic devices while operating a motor vehicle. According to NHTSA, more than 3,000 people lost their lives last year in distraction-related accidents. NTSB Chairman Deborah A.P. Hersman stated, "It is time for all of us to stand up for safety by turning off electronic devices when driving. No call, no text, no update, is worth a human life."

The heart of their argument can be found in a few statistics:

  • Globally, there are 5.3 billion mobile phone subscribers, or 77% of the world population. In the United States, that percentage is even higher – it exceeds 100%.
  • A Virginia Tech Transportation Institute study of commercial drivers found that a safety-critical event is 163 times more likely if a driver is texting, e-mailing, or accessing the Internet.

Hersman concluded, "The data is clear; the time to act is now. How many more lives will be lost before we, as a society, change our attitudes about the deadliness of distractions?"

On Thursday, an article on the front page of The New York Times caught my eye while driving my RV down I-4, As Doctors Use More Devices, Potential for Distraction Grows. Wow, doctors? That’s our business! Reading on (while occasionally checking my mirrors before changing lanes), I read these amazing factoids:

  • A peer-reviewed survey of 439 medical technicians published this year in Perfusion, a journal about cardio-pulmonary bypass surgery, found that 55% of technicians who monitor bypass machines acknowledged to researchers that they had talked on cellphones during heart surgery. Half said they had texted while in surgery.
  • Scott J. Eldredge, a medical malpractice lawyer in Denver, recently represented a patient who was left partly paralyzed after surgery. The neurosurgeon was distracted during the operation, using a wireless headset to talk on his cell phone. “I’ve seen texting among people I’m supervising in the OR,” said Stephen Luczycki MD, an anesthesiologist and medical director in one of the surgical intensive care units at Yale-New Haven Hospital. “Amazon, Gmail, I’ve seen all sorts of shopping, I’ve seen eBay,” he said. “You name it, I’ve seen it.”

So who am I to pontificate on this seeming bit of common sense? Some of you may know I am also an avid vintage motorcycle buff (not loud Harleys, but quiet Hondas) and have published a few articles in bike magazines. My most recent was last year in Motorcyclist entitled Driven To Distraction. In it, I admonish my fellow bikers to wear bright clothing, flash headlights, etc. — anything so their 500-pound motorcycle gets the attention of the driver of a 5,000-pound SUV.

So after all our Herculean efforts the past few years to get our RNs to use BMV and eMARs and to coerce our MDs to use CPOE and EHRs, now some of them are over-using the technology! I guess it had to happen in this world of cell-phonies.

What’s a CIO to do? My suggestion: send the Times article to your CMO and CNO. They’ll do the rest. Clinicians are such consummate professionals, all they need are a few facts like the above and they will caution their staffs in a hurry. Will it be a total cure? No more than I’m likely to stop keying on my GPS while dodging semis. But it will make them aware of the problem, which is always the first step to addressing one.

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

My Christmas Wish
By Chip Perkins

12-19-2011 6-47-04 PM

I’ve been reading quite a bit lately about how important sharing data is to improving healthcare quality and outcomes, and reducing costs. The ability to share health data between patients, providers, specialist, and health plans is a key building block for patient centered medical home (PCMH) or accountable care organization (ACO) initiatives. 

But there is one more thing about data to consider. The data needs to be discrete. The data needs to be actionable. The data needs to be standardized. The data needs to be semantic. 

As healthcare systems ramp up their efforts to transition to ICD-10-CM/PCS, launch clinical documentation improvement projects, report Meaningful Use quality indicators, implement electronic lab reporting (ELR) to public health, and build analytic tools to monitor improvements in health outcomes, organizations will recognize the importance of leveraging controlled clinical vocabularies and terminologies such as SNOMED CT, LOINC and RxNorm. 

The standards exist. The standards turn raw data into semantic data. Now we have to build the use of standard terminologies into our health information technology infrastructure. 

I’m hoping Santa will put a little semantic interoperability into everyone’s stocking for Christmas.

Chip Perkins is managing director, CAP STS of College of American Pathologists of Deerfield, IL.

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December 19, 2011 Readers Write 2 Comments

Monday Morning Update 12/19/11

December 17, 2011 News 10 Comments

From EpicNews: “Re: HCA. Any rumors about HCA signing with Epic?” I’ve mentioned here several times that HCA is putting up an Epic pilot as they choose between that option and upgrading Meditech. I haven’t heard anything more than that, although a couple of less well-placed rumors seem to think Epic is the likely choice (I’m guessing that’s due to Epic’s track record rather than any real insider knowledge.)

From CIO Lookin’: “Re: company that has a contracts database. One of your sponsors offers a database of vendor contracts with full details about pricing and terms. I don’t remember the company’s name. Can you help?” It’s CapSite. Very useful. It’s cool looking at the actual scan of the contracts but also having all the numbers broken out into a worksheet for easier review.

12-17-2011 6-18-20 PM

Aetna reveals at an investor conference Thursday that it acquired mobile app developer Healthagen “about a month and a half ago.” Aetna says it will add cost estimation functions for patients to its iTriage app. Aetna’s chairman, president, and CEO also told investors that the company will make the software development kit for the Medicity iNexx platform available free so that anyone can write apps for it.

Micky Tripathi’s breach article on HIStalk Practice has raised the interest of The New York Times, which will apparently be running a story about his experience in Monday’s business section.

My Time Capsule editorial from 2006 for this week: Embrace FDA Oversight If You Want Clinical — not Clerical — Systems.  A snippet:

It’s like Lucy working on that candy assembly line – reams of often irrelevant information are unceremoniously dumped faster and faster into the laps of physicians and nurses, who are expected to manually figure out what’s useful and then “process” it, often by entering even more on-screen information. Eventually, the administrivia buries someone who ought to be making patient care decisions instead of romancing a keyboard.

TPD has updated his list of iPhone apps.

A reminder for McKesson folks whose jobs will be eliminated in February: check the comments left on the past few posts since I invited companies who might have jobs for you to leave their contact information.

12-17-2011 3-25-59 PM

Another newspaper picks up on Newt Gingrich’s dichotomy on stimulus money, which he called a “pork-laden bill” that should be stopped even as he cheered the $19 billion it contained to pay providers to use EHRs sold by clients of his consulting firm, Center for Health Transformation. It mentions his participation in 2009’s EHR Stimulus Tour, where his company helped its clients Microsoft and Allscripts encourage providers to use federal incentives to buy their products. Gingrich also pressed his former House colleagues to block efforts to dismantle Stage Children’s Health Insurance Program while being paid by drug companies and insurers that would have lost profits, as well as urging them to support the expansion of Medicare’s prescription drug benefit, which benefited his center’s $200K per year founding member, drug maker Novo Nordisk. Novo listed their payment as a lobbying expense, although Gingrich says that’s not the case.

12-17-2011 6-30-23 PM 

In related news, the former CEO and VP of the Center for Health Transformation and Gingrich Group join Leavitt Partners to create Health Intelligence Partners, a membership organization that will offer advice to healthcare executives. The founder and chairman of Leavitt Partners is Mike Leavitt, former HHS secretary and Utah governor. The president and CEO is his former HHS chief of staff and the managing director is Leavitt’s former HHS senior executive advisor.

Some readers are getting their HIStalk e-mail blasts long after I’ve sent them out. It’s a worsening problem, primarily affecting users of free e-mail services (Hotmail, Google, Yahoo) since those are apparently ramping up their inspection of incoming e-mails for spam. Those services are also slowing down my sending speed since my server has to wait on theirs and they have throttled back their connection rates. My web host has taken a couple of steps to hopefully reduce the scrutiny and therefore increase the delivery speed, but it’s somewhat out of my hands.

Here’s my latest pet peeve (I know you were anxiously awaiting it): publications that refer to doctorate holders as “Dr. John Smith.” It’s perfectly legitimate (but damned obnoxious) to introduce yourself socially as Dr. John Smith, but that form should not be used in a publication of any kind since it provides no clue to exactly what kind of doctorate is held (MD, non-research based EdD, mail order fake PhD, etc.) Honorary doctorate holders should never be addressed either as (a) Doctor, or (b) listing their unearned PhD. If you see a professional advertising their white-coated services as Dr. John Smith instead of stating their actual degree (it’s usually chiropractors who do that) or using bookended vanity titles on both ends of their names (such as Dr. John Smith, MD) run fast and far since at least in my experience, these folks are often seriously incompetent, insecure, ill-informed, or all of the above.

12-17-2011 3-48-14 PM

Welcome to new HIStalk Gold Sponsor Macadamian, a global firm headquartered in Quebec that provides user interface design and software innovation services for clients that include HP, Cisco, and Adobe. They help product management executives turn ideas into market-ready products, including working with mobile apps. The company offers design services, usability consulting and testing, and user services (focus groups, task analysis, and field research). Healthcare IT vendors they’ve worked with include Sage (updated Intergy’s encounter note function), Cardinal Health (designed a touch-screen interface for a bedside patient information system), and Elsevier (developed a fresh user interface for the online Mosby’s Nursing Consult). The company offers a one-day EHR Usability Workshop to help vendors understand the implications of NIST’s usability draft and to develop a usability plan. Thanks to Macadamian for supporting HIStalk.

I’m getting an increasing number of requests from companies and organizations that want to get me involved in their projects in some way (conferences, education, contests, etc.) I almost always turn those down, and just to save future time all around, here are my standards, which I don’t think I’ve explicitly stated until now:

  1. I have almost no time between work and HIStalk and I have no employees, so I will always turn down anything that would require much of my time.
  2. I won’t do anything to compromise my ethics (endorse products, further a hidden agenda, or write anything that I don’t believe.)
  3. The only item I offer is sponsorships. I don’t rent my e-mail list, run paid article placements, or shill my services for speaking or consulting (easy since I don’t do those things anyway).
  4. I don’t entrust HIStalk’s reputation to anyone else, so I don’t get involved with activities unless I’m offered control over them (HIStalkpalooza being a good example.)
  5. I’m not very motivated by money, so it’s easier to raise my interest for projects that will benefit HIStalk’s readers or that involve undeniably good deeds, education, industry enlightenment, or something offbeat and fun.

12-16-2011 9-09-32 PM

Only 22% of respondents reacted positively to Mckesson’s Better Health 2020 product realignment plan. New poll to your right: it’s the same as this one, only regarding Microsoft and GE forming a new HIT company.

Here are some products from HIStalk sponsors that topped out their respective category in the Best in KLAS report that just came out:

Ignis Systems releases EMR-Link ResultsAnywhere, which works with the company’s lab outreach solution to create patient-friendly lab results. It meets the new guidelines under which patients can access their own lab reports. Video here.

12-18-2011 1-34-31 PM

Weird News Andy says he has a nose for news with this article: Louisiana’s state health department warns consumers about the use of neti pots, a pitcher-like container (aka “nose bidet”) used to flush the sinuses with salty water to relieve nasal congestion. Two people have died from amoeba infection of the brain after apparently using tap water instead of the manufacturer-recommended distilled water. WNA also finds this Grinch-like story: a UK hospital cancels more than 80 surgeries, some of them involving cancer patients who had waited for months to get on the schedule, after the broad daylight theft of the copper cabling from the hospital’s backup electrical generator.

12-17-2011 6-34-59 PM

An interesting item came up at athenahealth’s stock analyst day this past Thursday. The company is trying to turn its athenaCoordinator product (from its acquisition of Proxsys in July 2011)  into a private HIE so that practices in a given geographic area can manage referrals through it, something that was hinted at in this request from an unnamed (but easily identified) vendor for an HHS ruling that was rendered on December 7. Athena would charge fees for use of its network, with a somewhat complex set of rules deciding which practice (referring or receiving) gets the bill. Athenahealth would reduce the monthly subscription cost of athenaClinicals, using the new referral transaction fees to offset its reduced revenue.

12-17-2011 6-05-00 PM

Meanwhile, it was a wild ride for ATHN shares this week, with guidance below expectations sending shares down 15%, but conflicting investment opinion pushing it partly back up (Leerink Swann and Oppenheimer upgraded, Piper Jaffray cut its price target, Morgan Stanley stuck with its Underweight rating.)  

12-16-2011 10-57-52 PM

Rep. Tom Price (R-GA), an orthopedic surgeon, says paper medical records are insane and practices should be using technology to communicate and to give patients access to their own records. He’s not a fan of HITECH, though:

Instead, what does the federal government do and think it’s getting high tech? It is defining every little thing, every box that the physician or nurse has to check every time you see a patient, in order to get an extra 1.5% of reimbursement from the government. Or, not getting dinged for an extra 1.5 or 2%. These are the Meaningful Use things.  Washington always has these great lines, right, these wonderful Meaningful Use standards. They’re neither meaningful nor useful and they’re so ridiculous that they actually incentivize pathologists to have to ask on every single patient that they care for how old they are, how many allergies they have, what medications they’re on, when was the last time they saw their primary care physician, on and on and on, including of a slide of a patient … the pathologist never actually sees that patient … or a corpse for an autopsy. This is no lie. The federal government wants the pathologist to determine whether or not a corpse has any allergies. How you feeling today, right? This is nonsense.

So what do you do with technology to make it so it actually works for healthcare? I think the proper role of government in the area of technology in healthcare is to say, OK, this is the platform we will use. This is the highway upon which we will ride. Everybody needs to have a system that allows it to speak to another system within these parameters. And not dictate what the docs are doing on a day-to-day basis for a given patient, because it doesn’t make any sense. It’s a waste of time. They can never, ever put in place the right standards for a bureaucrat to determine whether or not the doctor’s doing the right thing.

An MSNBC article says aides of former Massachusetts Governor Mitt Romney arranged to buy the hard drives of their office computers for $65 as his term ended, thus eliminating the only record of official e-mails and details about his health insurance mandate since they had also had the servers replaced. Romney says the hard drives might have contained personal information, such as medical records and job applications, but reporters noted that government officials could use that excuse to keep every paper record from the public eye by just writing their Social Security number on the bottom of every page.

Here’s the latest HIS-tory from Vince, which contains the answer to this trivia question: what hospital programmer started a one-person consulting practice that eventually grew into a company of over 1,400 employees?

Zach Mortensen of CareFusion picks up on Barry’s comment on HIStalk about a possible change in Epic’s sales strategy, speculating that Epic may be willing to sign ambulatory-only contracts because they’ve hit capacity, run out of new customers, or fear low-cost ambulatory competitors. I’m not convinced Epic is changing strategy at all just because a couple of unnamed consultants speculated as such (Epic has always sold ambulatory-only deals), but if they are, I’d infer the opposite. Epic has not hit the predicted wall on scalability, customers keep giving its products industry-leading KLAS scores, nobody is de-installing or grumbling about value, and prospects keep signing up in droves despite high project costs. Each time Epic sells an ambulatory-only deal, it (a) deprives a competitor of a new sale, and (b) plants a flag that has a decent percentage chance of yielding an easy inpatient sale down the road. If anything, I suspect Epic is gaining confidence given the near absence of significant competition and is willing to ramp up sales, which by definition means they will be selling to smaller hospitals and practices. The company’s favorite statistics involve not the number of hospital customers it has, but rather the percentage of physicians and patients using its systems. I think they want that number to keep rising for reasons beyond financial, and any change in strategy can be attributed to unchallenged dominance rather than newfound desperation.

Analysts speculate that Research in Motion (BlackBerry) may be on its last legs, with bad earnings, grim forecasts, delayed new products, and a continue share price slide (down 77% year to date).

12-17-2011 5-55-47 PM

Allina Hospitals & Clinics is involved in an unusual but minor patient privacy breach. It sends an e-mail blast to 250,000 patients promoting Epic’s MyChart, but eight of those e-mails bounce back as undeliverable. Its mail software then tries to re-send the message to those eight recipients, but mistakenly blasts it back out to the 250,000 original recipients, only this time including the name, employer, and e-mail address of the eight patients (whited out above).

A California patient opens up her medical records to an investigative reporting agency to show how medical upcoding happened at Shasta Regional Medical Center (CA), which claimed that almost 20% of its patients suffered from the mostly third-world nutritional disease kwashiorkor. A DRG coding firm analyzed the records, which mentioned nothing about nutritional issues, and found that the correct payment was $4,708. Adding the kwashiorkor diagnosis raised the payment for the same stay to $11,463. Irrelevant but interesting: the patient’s daughter reviewed her mother’s bill and noticed charges that included $273 for a cloth sling and $22 for a 4×4 gauze.

Texas Health Resources is holding a Nursing Informatics Boot Camp April 28-29 in Arlington, TX to prepare nurses to take the ANCC certification exam.

The Alaska State Medical Association is providing DocBookMD to all physicians in the state to allow them to share information, including referrals, using mobile devices.

A jazz singer unhappy with her new nose job creates a Web site criticizing the work and credentials of her plastic surgeon, files complaints with the state medical board, and posts negative reviews on several Web sites. The doctor says his practice went from $4.5 million to two patients a week. He files a defamation lawsuit against the patient and is awarded $12 million. That’s a lot of jazz.

Every year about this time (when we remember it, anyway) we like to get in the Christmas spirit by asking our sponsors what holiday and charitable activities they’re involved with, preferably with photos since the usual half-hearted hospital door decorating contest just doesn’t stir up much Christmas spirit.  Here are a few.

12-17-2011 3-40-28 PM

DIVURGENT sponsored a Winter Wonderland event at Children’s Medical Center at Legacy (TX) last week for children hospitalized there. Every child got a teddy bear, shown being delivered above.

12-17-2011 4-02-16 PM

Hayes Management Consulting donated $1,000 worth of toys to Toys for Tots and sent an equal amount of money to the Susan G. Komen Foundation.

12-17-2011 4-08-53 PM

Surgical Information Systems held its Coins for Kids fundraiser contest, where each of its departments decorated a piggy bank to collect money (the above entry from sales and marketing was branded as Miss Barbie-Q). It has raised $6,000 so far for The Giving Tree, EduNations, and the Westlake Estate Home for Girls. Employees also donated time and supplies to stuff 50 stockings for the troops and collecting DVDs for Children’s Hospital of Atlanta. Employees also held coat and winter weather drives and continued their support for Cool Girls, Inc.

12-17-2011 4-15-25 PM

12-17-2011 4-16-13 PM

maxIT sponsored the Beads of Courage Beads in Space Tour to honor Childhood Cancer Awareness Month. It’s a non-profit that works with children experiencing serious illnesses to use beads to tell the story of challenges they have overcome during their treatment, such as spending a night in the hospital or undergoing chemotherapy treatments. The organization took its program on the road, stopping at 10 hospitals to show a display of beads that few on the space shuttle, with one design from each being incorporated into a real bead and the top ten to be featured in a book.

12-17-2011 4-20-50 PM

Software Testing Solutions donated $10,000 to Heifer International, a non-profit that focuses on long-term sustainability and self-reliance by purchasing llamas, sheep, goats, chickens, and honeybees and providing agricultural education for poverty-stricken communities around the world.

12-17-2011 4-23-30 PM

12-17-2011 4-24-28 PM

The business development team of World Wide Technology volunteered at Kingdom House, a neighborhood community center in downtown St. Louis, where they repaired tables and chairs, cleaned the food pantry, and reorganized the thrift store.

12-17-2011 4-26-35 PM

Aspen Advisors held a fun walk/run at its annual all-associate retreat in Fort Lauderdale, FL and raised $1,500 for Broward Health.

12-17-2011 4-35-13 PM

12-17-2011 4-37-28 PM

Quality IT Partners supported Habitat for Humanity, the American Heart Association, Special Olympics, the Scott Hamilton CARES Initiative, the American Cancer Society, the American Association for the Study of Liver Diseases, and local schools and food banks.

12-17-2011 4-53-39 PM

Sunquest held its annual fundraising barbeque this month, this time supporting Tucson-based Aviva Children’s Services, which provides support services to children under the care of Child Protective Services after experiencing abuse, neglect, or poverty. Employees received lunch in return for their donations of toys, gift cards, and money, raising $3,500 for Aviva’s Christmas giving program.

12-17-2011 4-31-50 PM

Cynergis Tek supported OPERATION Hug-A-Hero and its Holiday Hugs program. It provides children with dolls that contain an image of their deployed service member parent or other relative, providing a tangible, comforting connection with their loved one.

E-mail Mr. H.

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December 17, 2011 News 10 Comments

HIStalk Interviews Dave Lareau, COO, Medicomp Systems

December 16, 2011 Interviews 2 Comments

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

Tell me about yourself and the company.

I was in Baltimore in the late 1980s and had my own practice management reselling company. One of my customers in 1990 came to me and said, “Dave, we’re real happy with your services, your billing system — we want to start looking at EMRs.” I said, “What’s that?” He said, “We think they’re going to be the thing of the future. Would you help us look at them?” 

We set up a process where once a month they would come into my office and I’d bring in a vendor. After a few months, they said, “Nope. All this makes us data entry clerks. It’s all template-based. We hate it, can’t use it. Thanks. Here’s what we need you to find.”

A couple of years later, maybe ’92, I happened to see Peter Goltra and his team at Medicomp and I was intrigued. I thought, “This sounds like what those guys were talking about. Let’s bring them in.” They looked at it and said, “That’s exactly the way this stuff needs to work, but it’s just ugly as hell.” It was a Unix-based system, the old green screens and stuff dropping down. They said, “If you put a decent user interface on that and integrate it with a billing system, that would really be something.”

I talked Peter into letting my little company do that. I eventually came home to my wife one day and said, “Honey, I just found what I want to do with the rest of life. Can we move to Virginia? I really want to work with this company. I love what they’re doing. I think it’s the thing of the future.” I figured at that point, yeah, 10 years from now everybody will have an EMR. You know how it was in 1992. 

I joined Medicomp. I found that they provide clinical content for documentation and patient care that thinks and works the way a physician does. It’s just simply that. We’ve been doing that ever since, with changes along the way in response to the markets, technology, etc.

You said you had to find Medicomp. I always got the feeling that both the company and Peter Goltra aren’t as widely recognized as they ought to be. Is that low-key approach intentional?

The low-key approach is somewhat intentional. We provide a really critical component to about 10 to 12 different vendors in the space. That’s growing all the time.

We leave it them to do a couple of things. Differentiate themselves from each other. And, we want to make it clear to the marketplace that if you want an EMR that uses our content, you need to go to our customers, not to us. 

We’re very low-key at industry events. We really only concentrate on going to industry events like HIMSS and MGMA, where we’re there primarily to support our customers, who are EMR vendors, and educate their potential customers about the benefits of an EMR that uses MEDCIN.

The other way we stay in the background is when a new vendor decides to license our technology and put it into their product, we leave it to them to time the announcement to let their installed base know. As you know, once somebody announces a change in direction, even if it’s a good thing – which we think implementing our MEDCIN engine and Quippe is — it still tends to freeze what is then perceived as a legacy product, and these people need to maintain that revenue stream.

For readers who don’t know, describe the MEDCIN engine and how it’s used.

MEDCIN at its core is a clinical knowledge base that has about 280,000 clinical concepts in it. For the most part, they are pre-coordinated. The purpose of the engine is to present the relevant information to the physician at the point of care given a specific clinical scenario. 

For example, there are 293 concepts in MEDCIN whose relevance is scored for a patient with asthma. In that case, adding more concepts to MEDCIN doesn’t do anybody good. We can focus on the relevant items given almost any clinical situation, which is what makes it valuable for a providers treating a specific patient for a specific problem or a set of problems at a specific point in time.

What’s nice is is that it thinks and works like a clinician, and then all those concepts are mapped to ICD-9, ICD-10, SNOMED, CPT, LOINC, RxNorm, and all the 44 Meaningful Use criteria. All the nonsense — from the doc’s point of view — is taken care of in the background. The engine presents to the physician the things that they would care about for a patient with that condition.

We came up with that in 33 years of working with physicians saying, “OK, here’s the presentation. What would you want to be in your note? What will you want to look at? What kind of lab results would you want? What are potential orders? What would you do for the review of systems? What history? What physical?” It presents the things that real docs who are treating patients every day tell us they would want. We’re not trying to tell them what to do – we’re presenting to them what they said they would do.

Describe where your content comes from.

We have at any point about 20 to 30 active clinical consultants. We tried in the mid-80s having medical MDs on staff and nurses on staff to do that, but we found that when we brought guest experts in — consultants to help us build the data engine — all they did was argue with each other over, “You were trained here, you were trained there. I wouldn’t do it that way, I wouldn’t do it that way.”

We ended up saying, OK, we’re going to be clinical knowledge management engineers. Let’s engineer an editing system, where we can bring these people in and we have editing facilities. Now with the Web, you don’t have to do it locally, but when we did, we had an editing facility in Martha’s Vineyard, we had one in New York, whatever’s convenient. We’d typically bring somebody in for two or three days at a time. Some of these guys come in regularly, some come in every six months, some once a year for a week or so.

We sit with them and say, you’re seeing a patient with asthma. What would you normally expect to have to think about or address? They’ll say wheezing, difficulty breathing, is the wheezing episodic. What do I see in the lungs? Auscultation. Family history. Do they have exposure to dust mites? What’s the spirometry? What’s the O2 sat? Do they have any other conditions, maybe nasal polyps?

We say, is they’re anything else that might help you differentiate asthma from something else that we should put in the asthma – we call them indices – in the asthma index that you’d need for rule-out? So there’s things in there that have both a positive and a negative correlation. 

We put those in, and then we’ll go back and say, now for each one of those things, wheezing … somebody comes in wheezing, it doesn’t mean they have asthma. Means they might, but what else might it be? Let’s built out the index for those things.

You do this in an iterative process over years. We’ve ended up with about 293 items in the asthma index, one of which is wheezing, which has 260-some links of its own to diagnoses other than asthma. You can attack it from either point. This is iterative. Then we’ll have pulmonologist come in and say, we just did this recent work with somebody who was a specialist in asthma. How does this intersect with other things that you see? Does it raise the risk factors for pneumonias? 

It’s iterative. It’s one of the reasons why it’s so hard to replicate this with a template system, because we’ve been at it so long. Everybody says you can’t take nine women and have a baby in a month. That’s sort of what we’re dealing with here.

Does the MEDCIN engine have competition other than templates and text-based literature look-ups?

In terms of what we do and the way we do it, no. But in terms of competition, there’s tremendous competition all throughout the marketplace for our approach and any other approach. We define competition as anything that causes somebody to say, “Hey, your stuff looks great, but I don’t really need it.”

You can fake some of this activity for a single-problem patient with loads of templates, but eventually it doesn’t scale up when you start to have multi-problem patients whose conditions progress over time with clinical sequelae, complications, comorbidities, etc. Nobody really does or is close to doing what we do, but as long as people think that there are reasonable alternatives … sure, we have competition, and now you’re hearing about Watson’s going to do this and Zynx has protocols and Wolters Kluwer is getting into the market. 

One of the things that we do that those folks don’t do is we actually have the concepts for documentation linked to E&M, linked to all the other stuff designed for use at the point of care. It’s not a knowledge resource — it’s a documentation and patient care resource. In that regard, there’s really nobody else that I know of that does what we do.

Explain the advantages of Quippe and why physicians like using it.

When we first started designing this stuff, we were a little bit limited by the current technology at that time, by the state-of-the-art of user interfaces, and that kind of stuff. We made the decision in 1997 to make the knowledge engine its own component without a UI. When some of the browser-based technologies and some of the performance stuff for cloud type services came along in 2002 to 2005, that enabled us to think about a completely new way to deliver two things to the user at the point of care: deliver the content and give them control over the presentation of it.

What we’ve managed to do with Quippe is take 25 years — from 1978 to about 2003 — of clinical content development and what would now be looked on as rather primitive user interface options, and bring a bunch of docs in here and say, “We can deliver any of this content anywhere you want in millisecond time. What is it you really want, and what control over it do you want at the point of care in a user interface?

We had docs come in here over a period of about two years, probably 10 different sessions, and just say “Give me what I want to know when I need to know it. Give it to me in a format that I can control, that can learn from me as I go along, adapt to my needs, and not fix me into a template, but actually push the information to me that I want to see for any condition I treat without me having to go and find it or ask for it.”

Quippe is a note-like user interface that has all this data behind it ready to serve whatever action the clinician takes and give it to them on almost any device. Right now tablets are the hot new thing, but it doesn’t have to be that way.

How is it different selling to vendors rather than end-users? You had a significant presence at HIMSS, including sponsoring HIStalkapalooza. You have to develop interest by the user, but through their vendors.

There’s two ways to do it, and we have to do a little bit of both. Going with MEDCIN and Quippe as your platform is a major strategic and management decision. You have to get the interest of probably the busiest people at HIMSS, who are the CIOs, the CEOs, the clinical people of the vendors who are there to do business with their potential customers. They’re not there to talk to me. We have to get their attention and we have to prove to them that we can provide value. 

One of the reasons we do the iPad giveaways at HIMSS that we just did at MGMA is to show these vendors that we can provide to them something that I can train their customers to use in 20 minutes on a busy show floor. They look at that and say, “Wow. That means I can scale up. I can get implementations up. The docs seem to love it. Tell me more about Medicomp and MEDCIN.”

It’s a two-pronged strategy. We’ve got to appeal to the end user, but we’ve got to also get the attention of the busiest people at HIMSS and MGMA.

I knew nothing about documenting an encounter or using an iPad, but it really was just that easy to use Quippe. What response did you get and are getting at conventions where you just sit people down cold in front of it and say, “Here you go?”

They can’t believe it. It looks so easy they think we’re faking it, which is why we have to put it in their hands. 

I don’t know anybody else that puts software with the complexity underneath it and power in a user’s hand on the show floor at HIMSS and just says, “Have at it.” That’s a very powerful message and one we’ll continue to use over the next couple of years. 

That all comes from those docs coming in here. Every time I had an idea for the user interface or somebody here did, the docs said, “No, no, no. Just give me what I want and get out of my way because I already know how to treat patients. I already know what a note looks like. I know how to document. Just give me the information I want and a format I’m used to looking at it.”

That’s really all that we do. There’s a tremendous layer of technology underneath that, but MEDCIN is like the wizard behind the curtain of Quippe, except there’s really something there, not just some guy pulling strings. The only way to prove that is to put it in somebody’s hands and let them do it.

Like the iPad it runs on, that’s an Apple-like strategy to replace complexity with elegance, but let the user do what they need to do efficiently.

Exactly. One of those light bulb moments for me was I went out to visit the end user of one of our customers about five or six years ago. She was not happy with how much the user interface that we had in the old VB6 days slowed her down. She was vocal about it, but she made some really good points. She gave me a lab coat and said, “You’re an intern for the day. You’re following me around. Let’s go see two patients.”

We went into see one. Lights were on, computer, etc. She did what she did using the software of one of our vendors, who will go unnamed. She went to document and do all this and do all that. At the end of that and said, “Did you see how excruciating that was? Let’s go in to the next patient.”

She pulled up the shades so that light came in. She unplugged the computer and pulled out a pad. Saw the patient, did what she did, gave the patient a prescription, walked out, and she said, “I already knew how to do everything. Without your technology, it took me 11 minutes. With your technology, it took 15. Don’t slow me down. Get out of my way.”

I came back to the guys and I said, “We’ve got to kill the idea of fixed templates. We got to kill the idea of checkboxes on forms. We got to come up with a different model for this. What do physicians know? They know medicine, they know what they’re thinking, and they know they have to produce a note. Let’s marry all that together.”

As it turns out, our engine was almost perfect to serve up that sort of solution. We brought the docs in here and said, “Help us do this.” They just kept saying simplify, simplify, simplify. That’s how we did it. That’s what makes it possible for us to teach people to document on an iPad on the show floor in 20 minutes.

That gets into the area of EHR usability, which is, along with ICD-10 and Meaningful Use, is a hot topic. What is Medicomp doing to address those?

A couple of things. Back in 1997, when the National Committee on Vital and Health Statistics decided to set up a standards committee, we were very involved in that. One of the big decisions they made in maybe 1999 or 2000 was ,”We’re going to set reference terminology standards for the exchange of information between systems. We’re not going to dictate user interface terminologies. We think those have to adapt to users and it’s not going to be the same for everybody ,so let’s establish standards.”

In July of 2003, they said that LOINC, RxNorm, and SNOMED were going to be some of the voluntary standards for this. We immediately said everything we do from now on is geared at making sure we maintain that layer of usability and map to all these standards in the background. We probably added 30% to our staff, we added consultants, and we just started cranking out those mappings, just doing them reiteratively over and over again.

When we saw that ICD-10 was going to happen eventually, we prepared for it. We’re now implementing that. We did the same thing for E&M, which is another kind set of coding mappings back in 1999, 2000. We continue to do all that mapping in the background.

We adopted Virginia Saba’s clinical care classification system for nursing and built a nursing engine and documentation index that integrates with the physician index that we’ve been talking about, so that nurses and allied health can both treat the patient based on the same information in the note, but their documentation overlaps in some cases, but is very different in other cases. That’s what’s getting us now into the enterprise market more deeply.

So you think you’ll have an inpatient clinical documentation system for nurses?

We do have it. I expect that we will make … as I said, we let other vendors make the announcements. I’m virtually certain we’ll make an announcement of a major vendor in the next six months and possibly two by the end of next year. They don’t announce until they’re almost ready to deploy. I think it’s going to stun people.

These are vendors that are committing to retool their product to have your version of the MEDCIN engine as the front end?

Yes. We found an interesting thing. We did a project in Asia about three years ago. I went to Asia and I demo of Quippe in English and they said, “Forget about that. Let’s see it in Mandarin, in simplified Chinese. When will you have that done?” We hadn’t even started and that wasn’t my intention. What would be acceptable? They said, “If you can document 95% of what you do in Chinese, that’ll be fine.”

We pulled the MEDCIN index out for the top 500 diagnoses, all the index records for those, plus 200 other areas of our clinical hierarchy that weren’t represented in the 500. We merged them all together and it came 10,104 of our 285,000 items. We got translations for those done in less than three months for positive and negative. I went back and did a demo — 98% of everything came out in Chinese.

That was pretty cool, but when we started dealing with the enterprise vendors and they said, “You know Dave, we’ve got existing content that covers most of what anybody does” – this is two different vendors independently – and I said. “How many others do you have?” They said just over 10,000.

How weird is that? It pretty much told us that even in a large population, 10,000 to 15,000 of our elements constitute 97 to 98% of total data occurrences, but the struggle that the continue to have to add items, they continue having to map them. The more items you add without some intelligent way of presenting them, the more templates you have to build and maintain over time. 

The big vendors, for the most part, are coming to the conclusion that they do not want to be in the clinical content business. There’s a couple of big exceptions, one located in the Midwestern state south of Chicago.

You’ve been good at predicting the future and being ready for it. Where do you go from here looking down the road a few years?

We have to be ready for a couple of things. Whether anybody likes it or not, if you’re a clinical provider and you’re treating a patient, you have to be prepared to deal with what we think of internally as the coming data tsunami. Once these HIEs are in place and once these standards are in place and people are required to send this as LOINC or RxNorm or SNOMED or ICD-10, and I’m treating a patient and they’re under my supervision now – maybe I’m their caretaker under an ACO model — I’m responsible for that data coming in. I’ve got to be able to make some sense of it.

I might have a patient with the classic big three in America — hypertension, obesity, and diabetes — plus two other things. Maybe today I just want to deal with this.  I’ve got to find the relevant information in there, because I’m probably going to be held responsible for it, and I’m probably going to be held responsible for whatever I do and making sure that patient, once I treat them, if I admit them to a hospital or I discharge them from ambulatory care; if we got to outcomes-based reimbursement, I’ve got to take that data in, treat them, and keep them from coming back.

All of our tools are built to enable that. That’s one of the reasons we got into integrating the nursing care. If somebody gets discharged or somebody comes in even to an ambulatory practice with an open wound, I’m going to be responsible if they show up with an infection coming back. I’ve got to teach them hand hygiene, I’ve got to teach them wound care, I’ve got to teach them signs of infection. I’ve got to do all that. That’s why we built that stuff and then integrated it, because whether it happens or not – and I think it will, I think it’ll take longer than people think – we’ve got to be ready for that data tsunami that’s coming.

We also have to be ready to make it possible to scale up – and I’m including implementation and training and updates of software – quickly as medical knowledge changes and get it deployed out to the places where care happens, which is why we started building our cloud-based model about six years ago. Whether or not ACOs push integrated care, information is going to increasingly be … you’re going to need to be able to integrate it quickly, absorb it, find what you want, treat the patient successfully, and manage them on an ongoing basis.

We’re building all of our tools as if we have to do that. We also know from our experience, now with about 100,000 people using MEDCIN everyday, that training consists of, “You’re new here. Let me show you how I use this.” They get about 20 minutes of training, it’s done, and they’re on they’re own. That thing had better push the information they need to them. It better be intuitive. It better be easy to use, maintain, train, deploy.

That’s what we’re focused on. It’s a lot, but it’s really one problem. Giving them the information they want when they want it so they can do what they need to do and not require massive support to do that.

Any concluding thoughts?

We think there are going two be major challenges. How do enterprises handle data and account for their outcomes? How do you get the tools to do the individual clinicians on the front lines to do their job, which is patient care, and take care of all of that other stuff in the background? That’s what we’re trying to do.

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December 16, 2011 Interviews 2 Comments

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