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News 10/26/12

October 25, 2012 News 2 Comments

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Cerner reports an 18 percent increase in Q3 revenues from a year ago, with EPS of $0.56 versus 2011’s $0.45. Net earnings grew 25 percent and the company’s $769.9 million in third quarter bookings represent an 18 percent jump over last year.

Reader Comments

10-24-2012 3-43-36 PM

 inga_small From Weird News Andy: “Re: MGMA write-ups. This is too good a post not to have a comment.” WNA is referring to one of the four updates posted to HIStalk Practice this week covering the MGMA meeting in San Antonio. If you are interested getting the scoop on the conference, check out the writeups from  Monday, Tuesday morning, Tuesday evening, and Wednesday. I covered an assortment of topics including educational sessions, exhibit hall happenings, and parties. Other publications may offer a more in-depth look at some of the specific sessions, but I bet none published a photo of mariachis with Ronald McDonald.

10-25-2012 3-53-17 PM

From Junior Birdman: “Re: MGMA. The athena rep told me that two-thirds of the demos they were doing were for current Allscripts and GE customers.” Unverified.

From Empire Statesman: “Re: Allscripts. A totally unverified rumor is that they filed the HHC protest just in case a New York-based private equity company turns out to be their buyer and can then exert local influence on HHC to change its mind. The slim hope they will prevail may also delay the market’s reaction long enough to get them sold before the decision is announced.” Unverified. Another reader’s unverified rumor is that Allscripts had a big meeting with a PE firm on Thursday.

From CIO Reader: “Re: CIOs reading HIStalk. You’ve taken a good first step in running the excellent work of Ed Marx and Bill Rieger. Perhaps include other writing from insightful and innovate CIOs and/or CMIOs?” I’m happy to do that. If you’re both interested and interesting, there’s a place for you here.


From King Biscuit: “Re: RazorInsights. I’m telling you, these guys are going to leapfrog everyone … so cool!  Best engineered software, by far.  Blows Epic and Cerner away.” Unverified, but KB is a non-anonymous expert whose name you’d instantly recognize and who has no horse in this particular race, so I respect that opinion. Some company communication I intercepted says they are #2 in KLAS (behind Epic) and #1 in the community hospitals category, with 64 hospitals in the pipeline.


From HITesq: “Re: Allscripts. You can confirm the unhappy Allscripts issue. Allscripts sued Aprima in the Northern District of Illinois.  Complaint attached. Alleges trademark infringement and unfair competition.” Allscripts demands that Aprima stop using the MyWay name in its advertising and stop insinuating that Allscripts is sunsetting the product. I’ll side with Allscripts. I’m not a lawyer like HITesq, but I assume Aprima can continue to target its advertising to MyWay customers as long as it doesn’t imply that Allscripts is forcing those customers to change and perhaps adds the common disclaimer that MyWay is an Allscripts trademark and product. Kudos, by the way, to HITesq for always finding these interesting legal nuggets from sources the rest us don’t have access to.

From AnotherOneBitesTheDust: “Re: GE. Will be sunsetting it Oracle-based Centricity product – the old Logician – after upgrading it for MU 2 next year.” Unverified. 

HIStalk Announcements and Requests

I get several e-mails each week imploring me to take advantage of the many ways I could make more money from HIStalk (recent ones: drastically raise the admittedly low sponsorship costs, rent the mailing list, make it a pay site, sell consulting services to vendors). I’ll be honest in saying that I have no plans for any of those since I do it for fun, not money, and the more it would become a real business, the less I’d like it. All I need is the satisfaction, and that’s where you come in: (a) sign up for the e-mail updates since Inga loves seeing that number increase; (b) connect with us on Facebook, Twitter, LinkedIn, and Dann’s 2,821-member HIStalk Fan Club; (c) cruise the ads of our loyal sponsors, check out their listings in the Resource Center, and shoot out your consulting RFIs to several companies at once via the RFI Blaster; (d) send us news, rumors, guest posts, or ideas of how we can help the industry and patients; and (e) tell your colleagues you read here since the only way we get new readers is via word of mouth and Google. Thank you for spending time with us.

Acquisitions, Funding, Business, and Stock

McKesson will acquire PSS World Medicine Inc. for about $2.1 billion. PSS is primarily a medical products distributor, but is also an athenahealth reseller. Analysts estimate that PSS’s athenahealth sales represent less than five percent of athena’s new customers per year.

AdvantEdge Healthcare Solutions, a provider of billing, practice management, and coding services for specialty physicians and hospitals, acquires Medrium, a Delaware-based billing and PM company.

10-25-2012 2-05-22 PM

HIT raised $194 million in VC funds from 37 deals during the third quarter, according to Mercom Capital Group.

Compuware reports fiscal year 2013 Q2 financials: revenues down 15.4 percent, net income down 53.3 percent, and EPS of $0.05 versus $0.10. Analysts were expecting $0.06/share. Compuware’s Covisint division reported a 17 percent increase in revenues from a year ago.


In Australia, Queensland Health expands its use of iMDsoft’s MetaVision ICU system by purchasing a statewide enterprise license.

10-25-2012 3-57-31 PM

University Physicians Group (NY) will implement the PatientPoint Care Coordination platform and its electronic Check-In/Check out process.

Johns Hopkins Medicine expands its relationship with MModal by rolling out its Natural Language Understanding to all facilities.

10-25-2012 4-01-27 PM

Hi-Desert Medical Center (CA) selects iDoc from CareTech Solutions for document imaging and management with Meditech’s EHR and health information management systems.

Partners Healthcare (MA) renews its contract with Omnicell for pharmacy automation.

10-25-2012 4-02-52 PM

MedVirginia signs a multi-year contract extension with Alere Wellogic, the creator of the HIE’s technology infrastructure.

The Defense Health Services Systems awards an $11 million prime contract to SAIC for support of the TRICARE Online system and expansion of Blue Button capability.

Holston Medical Group (TN/VA) selects Performance Clinical Systems and the Symphony platform for care coordination.

10-25-2012 4-04-57 PM

Queens Long Island Medical Group (NY) chooses MU Assistant from SA Ignite to automate MU reporting and enable one-click electronic attestation to CMS.

Rochester General Health System (NY) purchases Carestream Vue for Cardiology PACS.

Prime Healthcare Services (CA) selects FairWarning Patient Privacy Monitoring for privacy auditing with its Meditech system.


10-25-2012 4-11-43 PM

Phreesia appoints Ralph Gonzales, MD (UC San Francisco) as chief medical advisor.

10-25-2012 4-13-06 PM

Convergent Revenue Cycle Management names Mark Schanck (HBCS) SVP of sales and marketing.

10-25-2012 4-14-06 PM

David Bates, MD, the SVP for quality and safety at Brigham and Women’s Hospital, joins the EarlySense medical advisory board.

Announcements and Implementations

Family Healthcare (ND/MN) goes live with RTLS from Intelligent InSites to track patients, staff, and equipment.

10-25-2012 2-55-53 PM

Van Buren County Hospital, an affiliate of Iowa Hospital and Clinics,  goes live on Epic.

Government and Politics

OIG says in the video above that among its planned 2013 work is to “identify fraud and abuse vulnerabilities in electronic health records (EHR) systems.” I assume the HHS/OIG survey I ran earlier this week was the first step in that effort.

The VA announces plans to get its VistA system Meaningful Use certified, but says that probably won’t be completed until 2014.

CMS publishes a document containing minor corrections to the Stage 2 MU Final Rule.

Innovation and Research

10-25-2012 4-32-53 PM

KLAS finds that 70 percent of providers are using mobile devices to access clinical applications. Physicians using McKesson and Epic applications are more likely to view data on a mobile device than providers running other EMRs. Providers and healthcare organizations say their biggest concerns with mobile devices are preserving the security of patient data and managing and tracking devices.


Most healthcare data breaches occur in facilities with less than 100 employees, according to a Verizon study. The majority of attacks on healthcare systems are financially motivated and target personal and payment data.

The Australian federal government terminates a $23 million contract with IBM to build the National Authentication Service for Health, citing missed deadlines and delays.

Sponsor Updates

  • Informatica introduces PowerCenter Big Data Edition, which allows organizations to leverage data for advanced analytics.
  • Eugene Gastroenterology Consultants (OR) selects ProVation MD for GI from Wolters Kluwer Health.
  • Surgical Information Systems renews its HFMA Peer Reviewed designation for its rules-based charging product.
  • Tigermed Consulting Co selects Merge eClinical’s CTMS solution to streamline clinical trial management.
  • ROI is not the primary measurement used by organizations to gauge the success of their EMR systems, according to a Beacon Partners survey. The report also finds that quality management and IT departments are the ones most often responsible for EMR performance measures. Beacon also hosts a Webinar featuring a discussion of navigating unknown risk in a practice.

EPtalk by Dr. Jayne


Inga and I are back from MGMA. She is drowning in e-mails I am drowning in the sea of humanity that is a double shift in the ER. I recently started watching Doc Martin on Netflix and sometimes wish I could channel his bedside manner to those folks that think that every ER visit comes with a meal tray and a complimentary can of Sierra Mist.

Like Inga, I was underwhelmed by the lack of buzz both in the meetings and in the exhibit hall. I’m chalking it up to the fact that practices are simply beaten down. Those that have already gone to EHR have spent their available cash and are focused on optimizing what they have. It might have been a good sales opportunity for consulting groups to peddle their skills.

I only saw a handful with booths, but I did run into several consultant colleagues who were there as attendees. There were a lot of complaints about sessions being too full and one Central Business Office Director told me she was skimping on the exhibit hall to make sure she had a seat in sessions.


As you can see, Inga and I were not the only celebrities in town.


San Antonio Banderas responded to my comment about the bottles and trash I saw on the Riverwalk during my morning jog. “I have attended many conventions in San Antonio in my last career, and always referred to the Riverwalk as the Sewerwalk. And Inga said she was walking barefoot back to the hotel? Ick! Have you experienced having a snack or drink at one of the nasty riverside restaurants or bars and have the pigeons land on your table, only to shed feathers and dander all over you when you shooed them away? Ick, ick!” Luckily I haven’t had the pigeon experience, and I’m happy to relay that most of Inga’s shoeless wandering was in hotel lobbies and the occasional restaurant. As her personal physician, I do try to look after her health and welfare, offering the above cowboy-style galoshes as a potential solution.


I wanted to get a better photo of these guys and their sassy purple paisley pants, but I could never find their booth. I assume they were exhibitors rather than two friends who share a stylist. The “Cushiest Carpet” award goes to Pulse. Although they wouldn’t give Inga a pair of green sneakers, they did try to buy our love with coffee at a time when we sorely needed a pick-me-up.

We spent some time cruising the hall together. I admit that I still have to stifle a giggle every time I see my signature on the HIStalk placards. I had the chance to get to know some of our sponsors better and to hear more about the plans for the upcoming HIStalkapalooza. Let me just say it’s going to be something to remember, and based on the theme, I have the perfect wardrobe for the event.


I’m looking forward to next year’s MGMA in San Diego and hope to be joined by Bianca Biller for even better perspective. I seriously doubt, however, that I will find any pastry in the shape of California in 2013. God Bless Texas!


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

More news: HIStalk Practice, HIStalk Mobile.

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October 25, 2012 News 2 Comments

Monday Morning Update 10/22/12

October 21, 2012 News 13 Comments

10-20-2012 9-30-04 PM 10-20-2012 9-30-49 PM

From MyWay or the HyWay: “Re: Aprima. I hear that Allscripts is upset that Aprima is offering MyWay customers a free conversion to Aprima. I don’t understand the situation there.” Unverified, but that’s surely the case. Here’s some history for the industry newcomers. Misys was a train wreck in 2007, a clueless British company stuck with a bunch of badly aging practice EMRs that could not compete with newer, better, and cheaper competitors that were flooding the small practice market. Instead of developing a new product, Misys took the questionable step of paying iMedica for the source code to its EMR product in a non-exclusive agreement that allowed each company to do its own development going forward, with Misys relabeling its copy as MyWay and selling it through resellers instead of the traditional sales channel. The relationship got ugly, with all kinds of legal actions and maneuvering.

Misys then merged with Allscripts in 2008, its old HealthMatics EMR product was renamed Allscripts Professional, and iMedica changed its name to Aprima in 2009 (for a first-person historical snapshot, see my 2008 interview with Aprima CEO Michael Nissenbaum and my 2010 interview with Glen Tullman and the since-departed Phil Pead from Allscripts.)

Fast-forward to 2012: Allscripts tells customers it won’t enhance MyWay to meet ICD-10 or Meaningful Use Stage 2 requirements, but will support their continued use of their product as-is or convert them to Allscripts Professional for free. Aprima, sensing opportunity, offers those customers a similar deal to move to its product, which is a lot more like MyWay than Allscripts Professional (Aprima’s product isn’t ICD-10 or MU Stage 2 ready either, but the company has said those enhancements are on its roadmap.)

MyWay customers have four options:

  1. Keep using MyWay, realizing that while Allscripts support will continue to be available, the product is moving into maintenance mode with no planned ICD-10 or Meaningful Use Stage 2 capabilities. Practices that don’t need those enhancements don’t need to make any change at all right away. Historically, however, vendors usually don’t continue to indefinitely support maintenance mode products, so this option is realistically more of a decision deferral than a long-term strategy.
  2. Accept the rather generous Allscripts offer of a free conversion and no-change maintenance cost in moving to the arguably more comprehensive but also more complex Allscripts Professional. That’s a great deal on the surface, but with a caveat: even free EMR conversions to an entirely different product are painful and productivity-sapping, not to mention that the Allscripts conversion schedule is ambitious and they’ve previously struggled with even same-product upgrades (TouchWorks).
  3. Convert from MyWay to Aprima at no charge. The Aprima product should look and feel more like MyWay than Allscripts Pro. The switch involves signing up with a different company, which could be good or bad depending on how you feel about Allscripts as a vendor. I don’t know if Aprima has ever done a conversion of that type, but I would suspect they haven’t.
  4. Buy a competitor’s product instead of accepting a unwelcome migration to either Allscripts Pro or Aprima. That option makes sense only for a limited subset of customers given the effort and expense required for an on-your-own switch. However, kicking tires doesn’t cost anything, so some customers will probably at least explore competitive products, driving their sales reps crazy since “free” is a tough selling point to beat.

In comparing products, KLAS customer respondents score them about the same:

Aprima EHR 72.39
Aprima PM 71.58
Allscripts MyWay EHR 70.54
Allscripts Professional EHR 69.81

Aprima beats Allscripts significantly in the all-important “would you buy it again” number from real-life customers, which I consider to be the most important KLAS measure since it summarizes both the product and the company:

Aprima EHR 80 percent
Aprima PM 71 percent
Allscripts MyWay EHR 60 percent
Allscripts Professional EHR 60 percent

I’d want assurances from either vendor:

  1. How much productivity will you lose during the switch?
  2. Can you talk to reference sites that converted before yours? You don’t want to be the first one.
  3. What information will be converted automatically? “Conversion” is not necessarily a generic term.
  4. What’s the cost of any required third-party product licenses, hardware upgrades, optional maintenance costs, after-hours support availability, on site training if you think you’ll need it, etc.? Both companies suggest minimal changes, but I’d want that in writing.
  5. Will they guaranteed maintenance costs with limited escalation?
  6. Will they send you a sample project plan for the conversion?
  7. What if something goes wrong? Every factor that’s important to your practice should be covered by a contractual promise from the vendor and a contractual penalty if they fail to meet it.

I’m a cheap-seater on this issue, so comments from Allscripts and Aprima users are welcome.

10-20-2012 9-28-13 PM

From Now Seriously: “Re: Paul Levy’s Stockholm syndrome comments about Epic. For some reason in his mind, it’s a bad thing that Epic skated to where the puck was going and got there first with string of solid installs that are successful models for the industry. His poor judgment and lack of clear thinking must have helped him achieve the title of ‘former CEO’ and his blog’s title change to ‘Not Running a Hospital.’” Paul is certainly entitled to his opinion even when it’s uncharacteristically negative, but he (and the pedantic EHR-haters that posts like this one always attract) would carry more credibility with actual experience using Epic or any other commercially available product. It’s the height of arrogance to dismiss the first-hand opinions and experiences of hundreds of hospitals and thousands of actual users of Epic or any other clinical system by writing them off as collectively deluded, like a know-it-all nosebleed-section sports fan shouting out naïve advice to a professional athlete. Paul finishes on a wild tangent in predicting that any Epic error (of which the documented incidence is apparently zero) will cause “a bunch of Congressional committees to come down on the firm like a ton of bricks.” That didn’t happen with Cerner at UPMC Children’s Hospital, the homegrown CPOE system at Cedars-Sinai, or Eclipsys at El Camino Hospital, where IT problems definitely threatened patients. Or for that matter, at Paul’s former employer BIDMC, where a multi-day network outage in 2001 that included its homegrown EMR surely exposed its patients to harm. The crux of his message seems to be that someone should stop Epic’s domination of the hospital systems market (like their competitors, maybe?) and the FDA should regulate clinical software, which always elicits passionate, conflicting opinions about whether government intervention generally improves a given situation.  

10-20-2012 2-10-12 PM

From HIPAA Girl: “Re: Blount Memorial Hospital. The Tennessee hospital’s stolen laptop contained information on 27,000 patients.” The laptop stolen from an employee’s home contained only basic demographic information. The hospital says the laptop was password protected, which usually means not encrypted.

From Virtual Virtuosity: “Re: copying and pasting of patient information in EHRs. Is Dr. Mostashari aware that this is how most EHRs work? Does HHS and ONC really expect providers to individually enter every piece of data from a clinic visit? We had a doctor join our practice from the same Kaiser office I used to work at. She had been using Epic for eight years and I asked her how she did it. She said it was initially hard, but she and most of her colleagues finally just made 20 templates and copied them for the vast majority of patients. EHRs from Epic and everybody else were designed to improve efficiency by copying and pasting. If HHS and ONC really expect providers to manually enter every piece of data from every patient visit, we’ll need double or triple the number of primary care providers to keep up with demand. That also brings up another point: as we read the rah-rah press reports about how Kaiser is a shining beacon on a hill for gathering and collecting data to improve healthcare, aren’t they just analyzing the same data constantly if their doctors are just using those 20 templates over and over? How does that reduce costs or improve efficiency?” My opinion is that providers have met every expectation as long as each patient’s EHR information is accurate. If HHS wants providers to craft innovative and individualized prose just for the sake of making every patient record pointlessly different, then they need to set a payment rate for creative writing. First they wanted discrete data, then they decided that what they really want is lots of plain text to assure them that they aren’t being defrauded since they are apparently powerless to determine otherwise. I’ve said it before: the reason that EHRs haven’t improved patient outcomes is because HHS and other payors have forced vendors to focus their development efforts on administrivia enhancements to meet needlessly complex payment requirements that have nothing to do with patients. You could develop a kick-butt EHR if you weren’t required to get bogged down in the Vietnam-like quagmire of billing documentation requirements that allows payors (Uncle Sam included) to avoid writing checks. Unfortunately, that situation is getting worse instead of better as the government insinuates itself even deeper into the practice of medicine. I bet you could design a really cool EMR for cash-only practices, except you’d have few prospects to sell it to.

From Minor Key: “Re: Michigan HIEs. Talk to providers and practices in the state and you’ll hear a different story. They’re realizing benefits now, with little jeopardy or delay in the HIE’s work toward the longer-term goal of interconnection.”

From Jock Ewing: “Re: FDA and biomedical system OS, antivirus, and software patches. This 2005 article says it’s a common ploy for vendors to tell customers that applying software patches would require re-approval by FDA. FDA has clearly said that this is not the case. The bottom line is that manufacturers are supposed to be validating patches and the only issue with getting that done is their willingness to dedicate resources to the task. It’s up to their customers to demand that they validate patches in a timely manner.”

10-21-2012 10-23-15 AM

From The PACS Designer: “Re: busy week ahead. Both Apple and Microsoft plan to introduce new hardware and software next week. First, we hear from Apple on the 23rd with the expected offering of new smaller versions of their product line, and on the 26th we will hear from Microsoft on the introduction of Windows 8. Windows 8 is the big deal of the week because it is projected to be the key operating system that will replace Windows XP, and will be used in many upgrade efforts across all of industry, academics, healthcare, and home computing. One of the first apps in healthcare space will be Pariscribe’s Windows EMR Surface (above), which should draw some interest from practitioners.”

From LaRusso: “Re: Fast Company. Several pages on healthcare IT are in the current issue.” It’s mostly the usual oversimplified geek piece on how tiny software startups you’ve never heard of are going to not only disrupt healthcare IT, but healthcare itself because they have brash founders, a few thousand dollars of VC or incubator money, and cool Web pages. I don’t recall many industries that have been disrupted by apps or websites, other than retailers outflanked by competitors who started selling first via the Web, so I’m skeptical that most of these companies will even survive, much less single-handedly transform the highly profitable, political, and parochial healthcare system into a consumer-driven and transparent industry where good defeats evil. Companies get my attention once they hit $5 million in revenue since that’s the point where the concept has been validated, initial development and scaling has been completed, the organizational culture has been defined, and skilled management has been brought in to protect the VC’s investment from the managerial whim of the inexperienced founders. That’s when companies become worth writing about, if for no other reason than the strong possibility that some old-school company will just buy them outright, making the founders as rich as they’d hoped while usually ruining what they created.

Now that I’ve been predictably curmudgeonly in dismissing wide-eyed startups and their naïve faithful who really believe that every David will inevitably rise to defeat his personal Goliath, I’ll take my own counterpoint in reminding myself that I ran a successful series of profiles awhile back called Innovator’s Showcase that introduced several companies to the more traditional side of the industry that most of us work in. I want those small companies to innovate and succeed and that was my way of trying to give them a boost, choosing those that seemed to have predictors of success. Some of them have done quite well since then from all appearances. If your healthcare IT-related company is less than five years old, has sold your offering to real customers, and brings in revenue of less than $2.5 million from selling a truly innovative product or service, e-mail me and tell me why my readers should be interested — I might include it in future posts. Those companies I’ve showcased previously include Aventura, Caristix, Health Care DataWorks, Health Nuts Media, Logical Progression, OptimizeHIT, and Trans World Health Services. There’s work for both of us to do if you’re chosen, so don’t take it lightly.

10-20-2012 7-51-23 AM

Widespread interoperability is limited because (a) technology or standards are limited, and (b) because providers have no incentive to share the data they keep. New poll to your right: does your PCP use Twitter for medically related tweets? I don’t really care so I wasn’t sure if mine did, but I’m guessing no since he doesn’t turn up in a Twitter search.

10-20-2012 10-10-42 PM

Welcome to new HIStalk Gold Sponsor HealthTronics, which offers a wide portfolio of urology-specific services (mobile lithotripsy, laser prostate treatments, cryotherapy, equipment services) that includes IT solutions such as its market-leading, urology-specific EHR used by over 2,100 providers seeing 18,000 patients daily and who have received more than $12 million in HITECH incentive payments. Its UroChartEHR and MeridianEMR were among the first EHR products to earn certification. Features include hundreds of templates and treatment plans specific to urology, pre-programmed urology terms, an easily understood user interface that requires minimal training and offers a one-screen patient encounter, PQRI, eRX, a sketch pad, device integration, built-in practice analytics and economics analysis, and remote access via iOS and the Web. HealthTronics joined Endo Health Solutions in 2010. Thanks to HealthTronics for supporting HIStalk.

10-20-2012 3-39-17 PM

Mrs. HIStalk dragged me to my once-a-year trip to the mall this weekend since I needed some new cooler weather clothes. I noticed that a Microsoft Surface kiosk is scheduled to open there shortly (in the mean time, it was serving as a place to deposit partially consumed cups of coffee and food court trash). The tablet is scheduled to ship on October 26, but pre-orders have sold out. Microsoft is getting killed as iPads have eroded sales of Windows-using PCs (Apple is the #1 PC maker in the world if you consider an iPad a PC as many consumers apparently do) and they need Surface to stop the bleeding. It comes in two versions: one that’s priced similar to the iPad running Windows RT (which has a micro-percentage of the number of apps as the iPad and a questionable apps ecosystem to compete with iTunes) and an expensive Surface Pro running Windows 8. I don’t see it making a dent in consumer iPad sales or even those of Android devices, but Microsoft’s one advantage over Apple is enterprise credibility. I would say their best chance for Surface success is that companies push off employees demanding to use iPads by offering Surface as an less-desirable but acceptable enterprise alternative. Otherwise, I expect few consumers to pony up $499 for a Surface RT tablet (not including the $100 keyboard) with they can get an iPad for the same money. If you can’t beat Apple on price, you’re screwed, because they own the customer experience.

10-20-2012 2-02-12 PM

T-System is on a roll with its funny HIT-related e-cards.

10-20-2012 2-05-38 PM

John Glaser of Siemens Healthcare wins CHIME’s lifetime achievement award. Above is a photo of the occasion taken by Ed Marx.

10-20-2012 2-08-03 PM

Also at CHIME, Ed Martinez, SVP/CIO of Miami Children’s Hospital, is awarded CHIME’s Innovator of the Year award.

A newspaper covering the highly publicized opening of the Massachusetts HIE provides a good reminder of where healthcare stands compared to other industries: “To those in fully automated industries, like banking, the state’s rollout of a new health information network last week must seem sadly behind the times … the experience can leave anyone who has ever used an Internet driven technology like Facebook or even simple email wondering just how exciting it can be to send one file electronically from one organization to another? Very exciting, say those in the health care profession.”

Athenahealth shares took a dive Friday as investors reacted to earnings that were improved, but increased less than expected following its Proxsys acquisition. ATHN closed at $73.31, down more than 8 percent to levels last seen in June. In the earnings call, Jonathan Bush blames Epic for extending the company’s sales cycles and a lowering its close rate:

They go out and sort of do some Bush Doctrine, saying, “In three years, we’re going to be live with this thing, and it’s going to slice and dice and bring world peace. You’re either going to be on it or not allowed in our hospital … you’ll be cut out of our ACO. You’re going to not be clinically integrated with us if you’re not on this thing.” … I believe that all of the banks in America may not be on one instance of one software, and yet all of us can stumble up to any cash machine we want and exchange information. It’s a ludicrous, pre-Internet idea.

El Camino Hospital (CA) provides most of the funding for a group that’s trying to defeat a November 6 ballot measure called Measure M, which would cap ECH’s executive compensation as a tax district-supported hospital. ECH’s CEO makes $700K and can earn a 30 percent bonus. The measure was proposed by the SEIU labor union, which says it’s less interested in that topic now since another bill has earned its undivided attention – one that would limit the ability of unions to raise money for political candidates.

Quite a few readers are fans of snarkmeisters The Onion and feel-good TED talks that tend to be long on inspiration but short on applicability, so here’s what happen when they meet. “I’ll be your visionary, and you do the things I come up with.”

The parents of an 8-year-old boy sue a Chicago hospital for pronouncing their son dead and taking him off life support for five hours until the patients insisted on a cardiac ultrasound that showed he was actually alive. Family members said doctors told them that the boy wasn’t actually opening and closing his eyes – it was just the medications he’d been given that made it look that way. The hospital says he really was dead, but they’re happy that his heart function returned spontaneously.

Sponsor Updates

10-20-2012 3-05-39 PM

  • Medicomp hosted the two-day MEDCIN U for 32 EHR developers and vendors last week in Reston, VA, teaching attendees about integrating the company’s MEDCIN engine and Quippe into their applications. That’s Medicomp CEO Dave Lareau and Clinical Architecture CEO Charlie Harp above.
  • EHR vendor Prowess will use the OrdersAnywhere CPOE product from Ignis Systems for lab orders, results, and lab integration. OrdersAnywhere has been integrated with 120 lab and radiology systems and is being used to satisfy Meaningful Use Stage 2 orders requirements.
  • Quest Diagnostics announces that it has certified the first 20 EHRs under its Health IT Quality Solutions program that recognizes EHRs that share data with Quest’s clinical laboratory system. The full list is here.


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

More news: HIStalk Practice, HIStalk Mobile.

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October 21, 2012 News 13 Comments

News 10/19/12

October 18, 2012 News 3 Comments

Top News

10-18-2012 6-22-53 PM

AirStrip Technologies wastes no time in filing a lawsuit claiming that clinical mobility vendor mVisum is violating its remote monitoring patent, awarded September 11, 2012. Travis wrote about the patent on HIStalk Mobile at that time, musing about its potential effect on innovation against the backdrop of Apple’s $1 billion patent victory over Samsung. Travis said:

There isn’t an answer yet as to exactly how this patent will protect AirStrip or how it will affect other mobile health vendors developing solutions to enable remote, mobile viewing of physiologic data by providers. As a methodology patent, can AirStrip use it to protect the experience of viewing a EKG, zooming into specific leads, accessing relevant additional data at the at point in time? … It’s interesting to consider the potential of a company’s defining and protecting the experience of mobile patient data viewing. As we start to see more intuitive user experience design for providers, will a standard emerge and can it be protected, enabling a patent holder to require licensing of the its patents to mirror the user experience?

Reader Comments

10-18-2012 3-14-00 PM

From Iguana: “Re: MED3OOO leadership conference. I was pleased to hear McKesson exec Pat Leonard suggest that InteGreat may be the go-forward ambulatory EHR product for hospitals implementing Paragon. Another highlight was former Highmark CEO Kenneth Melani, who provided a terrific synopsis of healthcare reform and where it’s heading.” The MED3OOO folks say several hundred clients participated in last week’s National Healthcare Leadership Conference and Users Meeting in St Thomas, USVI.

10-17-2012 4-09-12 PM

From Ms. Kravitz “Re: HIStalk’s Must See Vendors for MGMA 12. How do vendors get on this list?” The“Must See Vendors” lists for MGMA and HIMSS includes those HIStalk, HIStalk Practice, and HIStalk Mobile sponsors who chose to be included (there’s no charge) and provided exhibit information. The MGMA list includes over 50 vendors. Most of them will have a booth on the exhibit floor, while a few others aren’t exhibiting but will have people available for one-on-one meetings.

From F. Jackie: “Re: LogiXML fake 1960s TV commercial. Totally cheesy, but I needed a good laugh and it delivered.” I like it.

From Awkward Debates: “Re: degrees. I’m considering a post-grad education and wonder how the industry, particularly the vendor side, views degrees. MBA? Health informatics? Finance?” Vendor side, I’d go with an MBA unless you’re interested in sales or the executive ranks, in which case degrees (advanced or otherwise) matter little and many folks in the job don’t have them. Health informatics is a good advanced degree or certificate program, but less useful if you don’t already have a clinical degree to pair it up with. My experience is that if you have good qualities (ambition, smarts, relevant experience) and make early connections then a degree doesn’t matter all that much, especially the higher you go up the ladder, and there aren’t many cases where the degree itself is going to get you a job that you couldn’t get otherwise except in technical areas. Personally, I’d say an MBA was my best investment, but the one I admire the most in healthcare specifically is an MPH plus a professional degree (physician, nurse, pharmacist, PT, etc.) We’re going to need public health expertise since you can’t fix healthcare while ignoring health.

From Academic CIO: “Re: Allscripts protest of NYHHC’s Epic selection. We had a similar experience with Cerner. After losing on all counts, including price (Cerner’s five-year cost of ownership was twice Epic’s), Cerner had the audacity to aggressively pursue a Freedom of Information Act request for all of our e-mails, notes, meeting minutes, and Epic-supplied documents in an obvious attempt to get competitive information on Epic. At the end of day, we didn’t have to give it them, but it cost us a great of taxpayer-supplied resources to comply with their request. This was one of many attempts they made to circumvent the selection process. I would never do business again with them under any circumstances.” As I wrote previously, it’s a high-reward, high-risk strategy for a vendor to try to force itself on a customer who prefers a competitor’s product. Maybe you get a desperately needed new client and keep Wall Street off your back for one quarter, but who’s going to invite you to bid in the future knowing your history of being a sore loser?

10-18-2012 7-08-59 PM

From In the Know: “Re: Arcadia Solutions and the Azara Healthcare spinoff. The Pohlad family will sell them to a private equity firm, with the deal expected to close November 1.” Unverified. Arcadia is a consulting firm, while Azara offers analytics. The Minneapolis-based Pohlad Family Companies, which made its founder one of the richest people in America, bought Arcadia in 2007, adding it to holdings that include the Minnesota Twins, real estate, car dealerships, and banks.

10-18-2012 8-25-14 PM

From Oh MyWay – Dust in the Wind: “Re: MyWay. Here’s the Allscripts letter sent to each MyWay client with the grim confirmation. Interesting that the letter wasn’t from Glen, but rather Laurie McGraw. I guess he has bigger issues trying to find a buyer for his company.” It’s a good deal (free) for those MyWay customers who want Pro, but it’s anybody’s guess as to the percentage of MyWay customers in that camp, not to mention that changing systems is always tough. Allscripts says everybody will be upgraded from January to September 2013, which seems ambitious given the tendency of practices to delay until the last minute. I’m curious: if you attended ACE in August, what was said about MyWay then? I assume MyWay clients weren’t forewarned even though Allscripts surely had already planned its strategy. Given that Allscripts says MyWay isn’t ready for Meaningful Use Stage 2 or ICD-10, what were customers led to expect? Still, it’s probably a good decision – Inga asked Glen Tullman an insightful question when she interviewed him on HIStalk Practice in April 2010:

It seems almost as if Allscripts really has two businesses, one that’s focused on the selling the inexpensive MyWay option to small practices through resellers and the other focused on selling to the large, integrated delivery networks and hospitals that subsidize the small practices and offering them the Allscripts EHR products. Explain the strategy and tell me how you avoid channel conflicts.

From Lady Pharmacist: “Re: National Health-System Pharmacy Week next week. It’s time for the annual shout-out to pharmacists and pharmacy technicians, who from an IT perspective are helping their organizations attest for Meaningful Use, closing practicing gaps, and helping with medication-related safety initiatives related to CPOE, medication reconciliation, barcode medication administration, and e-prescribing.” Consider it shouted out.

From Patty Melt: “Re: HIEs. This article from Crain’s Detroit reminds me of the Rodney King line – can’t we all just get along? Do you ever wonder what the cost to society is for lack of consensus and cooperation?” The article says that the state’s two biggest HIEs (Great Lakes HIE and Michigan Health Connect) are competing to become the statewide exchange and aren’t sharing patient information with each other. The CEO of Oakwood Healthcare says they’re happy with Epic and not interested in joining an HIE until there’s just one because they could connect with one that won’t survive. Beaumont, also on Epic, said the state needs to get more involved but healthcare reform will force information exchange in any case.



HIStalk Announcements and Requests

inga_small Highlights from HIStalk Practice this week include: Mount Sinai Queens (NY) implements Epic at its ambulatory care locations. MED3OOO and SRS provide updates on their user conferences. Patients who are comfortable accessing and understanding their health information online will use PHRs more willingly. A REC advocacy organization defends the Meaningful Use program. CBS Morning News profiles a pediatrician’s use of social media. Dr. Gregg ponders whether HIT is becoming passé. And as mentioned above, our HIStalk Must See Vendor Guide for MGMA12 is a must-read for anyone heading to MGMA in San Antonio this weekend. Nothing says I love you like a gift of Lucchese cowboy boots (since I am Texas-bound) or your e-mail address for our HIStalk Practice updates. Thanks for reading.

inga_small Speaking of MGMA, I will be posting conference updates starting Sunday night or Monday morning (depending, of course, on the quality of the Sunday evening parties.) Our exhibiting HIStalk sponsors will have signs indicating their support of HIStalk, so please take a moment to tell them thanks on our behalf. If you have any suggestions for sessions or exhibits I should peruse, let me know. Please also take a moment to share any conference comments you might have, as well as your photos. See you in San Antonio! E-mail me.

10-18-2012 7-23-57 PM

I was initially startled and then pleased to receive this HIStalk sponsorship announcement at my hospital e-mail address. I finally realized that it went out a broad audience, not just me. Inga got one too, and we agreed that it’s nice when a sponsor is publicly proud of supporting our work (as most seem to be). It made our day.

10-18-2012 7-55-12 PM

Welcome to Aprima, sponsoring both HIStalk and HIStalk Practice at the Platinum level. The company offers a certified, fully integrated, single application, single database EHR/PM solution along with RCM services. The template-free design is chief complaint-driven with adaptive learning capability. The company, which has a 14-year track record, is offering a timely deal (free license and data migration with a signed support agreement) to users of Allscripts MyWay, for which it provided the original code in 2008. A partial list of the nearly 1,000 enhancements Aprima has made to the product since then is here. MyWay customers and resellers can connect with the Aprima folks at MGMA next week or AAFP this week. Thanks to Aprima for supporting HIStalk and HIStalk Practice.

10-18-2012 9-15-50 PM

Welcome to new HIStalk Platinum Sponsor SuccessEHS. The Birmingham, AL-based company offers a Certified Complete EHR and PM that it says can prepare practices for Meaningful Use within 60 days, not to mention that its clients experience an average 11 percent in visit increases and a 19 percent increase in collections in the first six months. The company has been in business for 15 years and is profitable and debt free, with 425 clients and 4,200 providers. Calling support gets you an in-house employee sitting in Birmingham. They’ll be at MGMA next week, also presenting the results of their new practice survey on maximizing revenue. They’re also offering a white paper on healthcare reform (e-Prescribing incentive, Meaningful Use, ICD-10, PQRS). Thanks to SuccessEHS for supporting HIStalk.

I always hit YouTube to see what a new sponsor has out there, so here’s an introductory video from SuccessEHS.

Listening: new from Brooklyn-based Woods, sometimes labeled as folk, but to my ear is more 1970s-influenced trippy, jangly guitar rock with lots of hooks and thoughtful lyrics. I liked it even from the first listen. Best song to me: “Find Them Empty,” featuring wailing psychedelic guitars and keyboard work that could pass for paisley ‘70s bands like Strawberry Alarm Clock or Vanilla Fudge.

On the Jobs Page: Product Manager, Regional Sales Executive.

Acquisitions, Funding, Business, and Stock

10-18-2012 9-47-41 PM

Athenahealth reports Q3 numbers: revenue up 26 percent, EPS $0.30 vs. $0.24, falling short on revenue expectations. Shares are down 3 percent in after hours trading.

Microsoft’s Q1 numbers: revenue down 7.9 percent, EPS $0.53 vs. $0.68, missing earnings estimates on continued weakening in PC demand and a corresponding drop in Windows sales.

Shares in Google dropped precipitously Thursday when the company’s financial printer filed its 8K report in the middle of the trading day instead of after hours as intended. Trading in GOOG was temporarily halted, but shares still ended up down 8 percent at the market’s close because of slowing revenue growth.

Trinity Health and Catholic Health East announce plans to merge, forming a new system with annual operating revenues of about $13.3 billion and 87,000 employees. Trinity’s president and CEO Joseph R. Swedish would head the new organization and Catholic Health East’s president CEO Judith M. Persichilli would be EVP. The organizations anticipate reaching a definitive consolidation agreement in the spring of 2013.


Australia’s UnitingCare Health will implement Cerner at the recently-opened St. Stephen’s Hospital, which claims it will be the country’s first digital hospital.

The 60-provider Mid Dakota Clinic (ND) selects athenahealth’s EHR, practice management, and care coordination solutions.

10-18-2012 10-10-02 PM

Wenatchee Valley Medical Center (WA) chooses Merge’s iConnect Enterprise Archive.

The University of California, Irvine Medical Center, will deploy MModal Fluency Direct and MModal Catalyst integrated with Allscripts Sunrise Clinical Manager.


10-18-2012 5-42-37 PM

RCM and consulting services provider Cymetrix names Jeffrey Nieman (Accelion) SVP of remote operations.

10-18-2012 5-44-12 PM

Alan Fowles, managing director of Cerner Europe and overseer of the first Cerner NHS installations, resigns after 11 years with the company.

10-18-2012 5-45-26 PM

RCM provider Office Ally names Daniel Wojta (United Healthcare) director of eSolutions and business development.

10-18-2012 5-46-34 PM

Health First (FL) appoints Lori DeLone (PatientKeeper) SVP/CIO.

10-18-2012 11-08-33 AM

Mobile PHR provider Cognovant hires Andrew Lambert (Press Ganey) as EVP of business development.

10-18-2012 11-13-41 AM

Lynn Danko (Lawson Software) joins Amcom Software as CFO.

Ambulatory surgical center and rehabilitation clinic software vendor SourceMedical announces the resignation of CEO Larry McTavish and the promotion of Ralph Riccardi from EVP/COO to president and CEO. The company announced last month that PE firm ABRY Partners had made a significant investment.

Standard Register promotes John King from VP of sales to president of Standard Register Healthcare. He replaces Brad Cates, who is leaving the company to serve as CEO at another company.

Announcements and Implementations

Omnicell and Cerner will develop interoperability between their products using CareAware iBus,  Cerner’s medical device connectivity solution .

HIMSS names the 91-provider Coastal Medical (RI) the winner of its 2012 Ambulatory HIMSS Davies Award of Excellence.

10-18-2012 5-53-25 PM

Kennewick General Hospital (WA) launches McKesson Paragon CPOE.

10-18-2012 5-54-42 PM

Baptist Memorial Health Care (TN) deploys EMC VNX and Citrix virtualization technologies in advance of its Epic implementation.

University of Kentucky Healthcare implements Harris Corporation’s Business Intelligence Documentation and Coding dashboard.

MedAptus announces the availability of its ICD-10 software suite.

Government and Politics

National Coordinator Farzad Mostashari, MD says the HIT Policy committee will review whether EHRs are leading doctors to overbill Medicare. He says repeated copying and pasting of patient information is “not good medicine” and wants to determine if EHR functions that prompt doctors to inflate their bills should be made “off limits.”

An Institute of Medicine report finds that the DoD and VA’s failure to create a sequential prescription number system has hindered joint EHR development at the co-managed Captain James A. Lovell Federal Health Center (IL). Because the DoD and VA have both agreed not to charge their respective EHRs, the departments are spending $700,000 a year for pharmacists to manually input prescription data. The IOM recommends that the DoD and VA avoid establishing other combined facilities until an integrated EHR is available.

The VA launches a contest to encourage the development of an appointment scheduling system to work with VistA EHR open source applications.

10-18-2012 12-20-22 PM

ONC announces availability of Cypress, an open source certification tool for testing the availability of complete or modular EHR systems to meet Stage 2 MU requirements for clinical quality measures.

As of September, almost 50 percent of all EPs and nearly 81 percent of hospitals have registered for the MU program. CMS also reports total program-to-date payments of $7.7 billion, including $4.8 billion to hospitals and $2.6 billion to eligible providers and healthcare professionals.

10-18-2012 5-59-29 PM

Two weeks after House Republicans call for a freeze on all MU payments, four Republican senators request a meeting with HHS Secretary Sebelius to discuss the incentive program. The senators would like CMS and ONC to address four questions, including whether EHRs are increasing the volume of diagnostic tests and Medicare billings. One of those questions (above) indicates a lack of familiarity with the HITECH program, which did not require providers to buy anything at all to qualify for taxpayer-funded incentives.


10-18-2012 6-02-21 PM

eMDs launches its nMotion EHR iPad application.

Medsphere Systems contributes its MSC FileMan database management system to the OSEHRA open source community, which chose it for collaborative development work on VistA.

An article in MIT’s Technology Review says that medical devices in hospitals are regularly infected with viruses because vendors are so scared of the FDA’s requirements that they won’t allow hospitals to keep their operating system patches and antivirus software current. I’ve seen this personally: my former hospital had a nasty worm that was flinging itself with impunity from one networked system to another because our vendors wouldn’t allow us to apply any changes to their FDA-approved configuration (even including applying the latest antivirus update that was known to fix the problem). We had to take the entire imaging network and several systems offline to the extreme displeasure of our physicians, while the vendor said they might get us an answer in a few weeks. I told the network team to ignore everything they had heard and simply do what they knew needed to be done. We were worm-free within a few hours and I have no doubt patients would have suffered had we not ignored our vendor’s advice, albeit at our own risk.


Former Beth Israel Deaconess Medical Center CEO Paul Levy, writing in his Not Running a Hospital blog, equates buying Epic to the Stockholm syndrome, where hostages develop affection for their captors. He concludes that Epic’s market share, driven by HITECH money, makes the company a target for Congressional retribution if a system malfunction harms patients. He also complains, “How did this firm get such a big share of such a critical market with no government review?”

The local paper covers Michigan-based HipaaCat, an image sharing and messaging app developed by a plastic surgeon.

10-18-2012 7-45-55 PM

Dan and Colin from Divurgent said Olympic bling-bearers Kerri Walsh Jennings and Misty May-Treanor were “great fun and great sports” in posing with attendees like themselves at CHIME 2012 this week. They (Kerri and Misty, that is) look a lot different with sunglasses off and clothes on.

In England, a healthcare trust that’s in such serious financial straits that it may be dissolved takes heat from the local paper for sending five managers to the Cerner Health Conference. The paper couldn’t find a source to back up its predetermined editorial outrage, so it quoted some guy who whose partner “does not wish to be named who worked as a nurse at Princess Royal Hospital.” It also seems to find a sinister connotation to KC’s power and light district, which it repeatedly places inside quotation marks as though it’s a code word for a hooker-staffed crack house. Must have been a slow news day.

Weird News Andy thinks maybe someone misspelled “birth” as “berth” in this story: a woman delivers her one-month premature baby in a Philadelphia subway car in which she is the only occupant. She calmly walks off the car and finds a police officer, who says the newborn girl “took on her personality” in exhibiting the same calm demeanor as her mother as they were taken to the hospital.

Tweets from CHIME

Sponsor Updates

10-18-2012 9-57-20 PM

  • PatientKeeper employees donate services, goods, and cash to help a Boston-area homeless family move into a furnished apartment.
  • GetWellNetwork launches its Transformative Health blog with an introductory post by CEO Michael O’Neill, Jr.
  • Intelligent InSites shares best practices for deploying an enterprise-wide RTLS during an October 25 Webinar.
  • Infor opens its new headquarters in NYC and unveils updated branding. Also, the Institute for Transfusion Medicine (PA) upgrades its Infor Healthcare Revenue Management solution to integrate with its outpatient records and receivables solution.
  • Oregon Medical Association will offer Dr. First’s RcopiaMU e-prescribing services to its members.
  • Emdeon releases a white paper on payment collection best practices for small physician offices.
  • Teradata will integrate QlikView in-memory data with Teradata’s Integrated Data Warehouse via the QlikView Direct Discovery  utility.
  • Physicians in Costa Rica’s public health system use DynaMed’s clinical reference tools to create national breast cancer guidelines.
  • Quality IT Partners sponsored last month’s 2012 Hillman Cancer Center Gala in Pittsburgh.
  • Imprivata announces 10 additional sponsors of its Imprivata HealthCon 2012 User Conference next month in Boston.
  • Cancer Treatment Centers of America and CareTech Solutions present a case study on the need for clinical help desks at this week’s CHIME CIO Forum.
  • American Well CEO Roy Schoenberg and Allscripts CMO Douglas A. Gentile discuss the benefits of integrating American Well’s telehealth offer with EHRs offered by Allscripts.
    McKesson integrates RelayHealth’s procedure and test results functionality into its Practice Choice EMR and financial management software.
  • T-System announces six winners of its T-System Client Excellence Awards.

EPtalk by Dr. Jayne

Researchers at Duke University create a 3D training application for transesophageal echocardiography for anesthesiology residents. It runs only on the iPad, leading one researcher to state that it would have greater effect if it worked on multiple platforms.

Speaking at the American Academy of Family Physicians annual meeting in Philadelphia, Farzad Mostashari encourages physicians to “turn the tables” on vendors that aren’t addressing interoperability issues. He reportedly advised users to report vendors to certification bodies. Considering the rank-and-file primary care physicians I work with every day, I’m not sure many of them are savvy enough to understand the certification requirements, let alone to become whistle-blowers. I’d rather see physicians spending their time learning to use their EHRs efficiently to deliver quality care. I invite my family physician readers who may have heard the speech in its entirety to weigh in – don’t worry, I’ll keep you anonymous.

The Breast Tissue Screening Bra from First Warning Systems has been designed to detect minute temperature changes in breast tissue that may indicate cancer via sensing the growth of new blood vessels. Temperature data is uploaded to the Internet and algorithms provide a reading to the patient. FDA approval is pending, but release in Europe is anticipated next year.

An impending change in the ranks of Medicare administrative contractors prompts concerns from providers that payments could be delayed. CMS is in the process of re-bidding contracts for claims processing, program enrollment, and other administrative functions in several regions. During a 2008 change, some payments were delayed for six to 12 months. Given the rigor with which CMS audits providers and the narrow tolerances in which we must perform to get paid, it would sure be nice if they held their contractors to the same standards. If we don’t file promptly, we don’t get paid – maybe if they don’t pay promptly, they should be fined.


I have to admit that I’ve been jealous reading about Inga’s plans to attend the MGMA meeting in San Antonio next week. I’m trying to find a way to sneak away for a day so the two of us can make a pilgrimage to the source of some of the hottest boots known to (wo)man. I had a chance to buy these beauties last year and flinched. Cross your fingers!


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

More news: HIStalk Practice, HIStalk Mobile.

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October 18, 2012 News 3 Comments

Readers Write 10/17/12

October 17, 2012 Readers Write No Comments

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

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

ONC Moves on Data at Rest
By Frank Poggio

ONC recently published the draft of the new Stage 2 certification criteria for data at rest — or as they call it, End User Device Encryption Test Procedure 170.314(d)(7). With the almost weekly stories about stolen notebooks, lost thumb drives, and missing data CDs while the new HIPAA audits get underway, this new criteria are no surprise. But as understandable as the ONC goals are, the implementation of 170.314(d)(7) may give system vendors fits.

Per the published ONC test script, there are two ways for a vendor to meet this criteria:

  1. If, while your Complete EHR or EHR Module is active you allow data to be moved to external devices, then your system must do it using a FIPS 140-2 (AES 256) encryption algorithm. The data on the device must stay encrypted and only be allowed to be de-encrypted by authorized personnel. Encryption must be the default setting.
  2. Or, your system must prohibit any movement of PHI data to external devices.

To pass the new Device Encryption test procedure, you must have either one of the above capabilities embedded in your system.

Here are just a few possible problems you might encounter from a vendor’s perspective under Scenario 1.

If you are currently using a full system encryption tool such as BitLocker under Windows, this will not work for external devices, so you’ll have to move to other third party products such as TruCrypt or 7Zip.

If within your application you support user-generated SQL searches and tools like Crystal Reports, then the reports that the user generates will only be allowed to be copied to external devices (thumb drives, note books, tablets, etc.) if the reports are properly encrypted. The same is true for images, care notes, instructions, etc.

It can get more complicated if you have a patient portal and allow me to download my personal info to my personnel tablet. Will you encrypt the download? And then give me the key to allow me to view my information after I have signed off from your portal? Will my tablet support your encryption tool? If on the other hand you (the vendor) do not support downloads, yet I undertake that step on my own (e.g. use screen print), then per ONC the vendor is not responsible.

If all that seems too complicated to deal with, as noted earlier, you could go for Option 2 and prohibit any movement of PHI to external devices. You allow clients to see reports on screen but not move /copy them. No transfers to Excel or Crystal and no screen dumps. Already I can hear the roar of client complaints.

On a positive note, ONC does say that the vendor must supply the provider with this capability, but it is up to the provider to use it. This new criteria also state if a provider manages to accesses your application data outside your application, you are not responsible.

Finally, included in the last set of Stage 2 test criteria there was a another new one called ‘Safety Enhanced Design’ (170.314(g)(3). I’ll cover that one next time. You can see all the new Stage 2 test criteria here.

Frank L. Poggio is president of The Kelzon Group.

RTLS Offers Value Beyond Asset Tracking to Healthcare Facilities of All Sizes
By Barry Cobbley

HIMSS Analytics Vice President John Hoyt was recently interviewed regarding Real-time Locating Systems (RTLS) for an article that appeared at mhimss.org and healthcareitnews.com. The premise of the article is true enough—that RTLS offers significant ROI as well as improvements to patient safety, yet adoption among hospitals is lower than it should be.

However, other assertions simply miss the mark.

First and foremost, RTLS is discussed primarily in terms of asset tracking. It’s a common use, but forward-thinking healthcare organizations use it for so much more. Mr. Hoyt does mention “patient tracking,” but only as a way to relay completed stages of a patient’s visit to family. The article even goes so far to state that “RFID/RTLS has a lot to offer—but primarily only to hospitals—big ones, at that.”

This couldn’t be further from the truth. Large facilities like The Johns Hopkins Hospital will reap huge value from RTLS, but there’s plenty of evidence that small- and medium-size facilities benefit as well, and the value goes far beyond simple asset tracking.

What Mr. Hoyt seems to miss is that RTLS is not just about tracking. It’s about making healthcare more efficient through workflow automation. In this way, RTLS addresses a fundamental challenge that all healthcare organizations are facing: how to do more with less.

Large and small emergency departments, hospital operating rooms, outpatient clinics, ambulatory surgery centers (ASCs), long-term care facilities, and others successfully use RTLS to improve processes, giving providers more time with patients while increasing volume. They’ve reduced patient wait times and increased patient satisfaction. They’ve nearly eliminated phone calls and search times for patients, assets, and other staff members, allowing more time to focus on the patient. And in one of the most impressive use cases, they’ve automated EMRs, relieving skilled clinicians of tedious data entry.

I agree with Mr. Hoyt that the rate of RTLS adoption would certainly be higher in a healthcare landscape not focused on regulatory compliance. But the fact of the matter is that nearly one in five hospitals have already adopted this technology without a mandate. In other words, based strictly on merit. Those organizations that are truly internalizing the need to operate more efficiently are at the head of the adoption curve.

Take for example Memorial Hospital Miramar, a 178-bed facility in Florida, the first to automate Epic EMR with RTLS. Thanks to their work, RTLS was highlighted as a hot technology recently at Epic UGM. The integration automates the entry of important patient data normally typed manually into Epic (patient arrival, nurse/doc assignment, room/bed assignment, nurse/doc assessment complete, discharge time, etc.)

EMR automation is just one of several ways Memorial Miramar leverages RTLS. This community hospital is one of many who see the big picture of healthcare IT, where technology like RTLS improves efficiency and enhances patient care—far beyond finding assets.

10-17-2012 5-23-38 PM

Barry Cobbley is director of location solutions of Versus Technology of Traverse City, MI.

Strategies for Healthcare’s Successful Transition into the BYOD Era
By Brent Lang

Bring Your Own Device (BYOD) is a hot topic as companies across all industries are increasingly faced with allowing employees to use their own smartphones, tablets, and other mobile devices for work purposes. Within the healthcare industry, there continues to be a rise in the number of busy physicians, nurses, and other healthcare professionals who have consolidated their mobile devices to streamline the use for both work and personal into one. In fact, a recent survey of mobile device usage indicates that 84 percent of individuals across all industries use the same smartphone for personal and work issues.[i]

Despite this demand, security concerns have led hospitals and health systems to embrace BYOD in varying degrees. Some organizations permit employees within designated departments to use personal devices, while requiring other employees to use company devices designed specifically for unique healthcare settings. For instance, purpose-built devices or in-building wireless phones are relatively easy to manage, secure, and clean. Conversely, there can be great variation in employee personal devices and operating systems. This lack of uniformity will place an increased burden on IT departments as they seek to configure, manage, and implement both security and network changes on a plethora of devices.

Fortunately, various strategies exist to mitigate the risk caused by this rich diversity of mobile devices entering the healthcare work environment. For example, the use of Mobile Device Management (MDM) software, which can include password protection, software control, version management, remote wiping, inventory, and other security controls. MDM tools can also be used to create “enterprise partitions” in personal devices. This allows for an individual’s work-related applications and data to reside on a secured partition within the device, easily managed by the hospital or health system. Organizations may also consider storing patient information on a centralized enterprise server rather than on the individual device, or creating wireless local area networks (WLANs) specifically for personal devices to help limit network access.

Additionally, executives tasked with health IT purchasing decisions should only partner with healthcare communications vendors that make their applications “BYOD ready.” In certain circumstances, this will include encrypting all data while “at rest” and “in motion” and providing remote wipe capabilities. Vendors should also have the ability to monitor the security of their corporate data.

By and large, BYOD is having an impact on companies across all industries. Its evolution has unique meaning in healthcare, where a generation of internet savvy physicians, nurses, and other clinicians are bringing the promise of mobile technology to the bedside. To ensure the successful transition of the healthcare industry into the BYOD era, hospitals and health systems must carefully consider and adopt policy, software and infrastructure controls, and educational initiatives.

[i]Weber, M. (2012, August 14). BYOD Survey Results: Employees are not playing it safe with company data

10-17-2012 5-32-53 PM

Brent Lang is president and COO of Vocera Communications of San Jose, CA.

 ICD-10: Time to Act
By John Pitsikoulis

Now that the ICD-10 implementation deadline has been extended to October 1, 2014, time is ticking away as we move closer to the date. The extension was a reaction to intense pressure from the American Medical Association (AMA), hospitals, and others who reported that they need more time to implement the extensive changes. As the deadline loomed, many hospital leaders admitted that their organizations weren’t prepared for the ICD-10 transition.

Now that we have an extension, how can providers use the time wisely, especially as they are contending with other competing and conflicting priorities such as electronic health records projects, Meaningful Use deadlines, and IT system replacements that impact the abilities of organizations to stay on task with their ICD-10 activities? Now is the time for hospitals to go into overdrive and concentrate on their planning, strategic decisions and implementation activities.

Developing the ICD-10 project plan for complying with the deadline is the first step many organizations have accomplished. While there are some great resources for organizations to utilize for managing the assessment and implementation key remediation components, many organizations are relying on a “check the box” methodology for readiness and mitigating the risks associated with the conversion to ICD-10. While this is a good framework for project managing the global tasks associated with ICD-10 initiatives, this approach will not provide the organization with alternative strategic considerations or the content expertise that will complement the organization’s portfolio of strategic initiatives. The average organization’s resources are stretched so thin, they just do not have the bandwidth of personnel to manage all of the activities required to mitigate the risks.

Managing a multi-year enterprise-wide initiative is a monumental initiative that requires planning, preparation, collaboration, progress evaluations, and alternative decisions throughout the project’s life cycle. With any multi-year enterprise project, periodic evaluations of the plan, progress, and timelines are critical success factors for achieving the desired end goals. But how are you measuring the end goals?

For example; there is an industry shortage of medical record coders. The simple answer to meet the demands of the industry would be to train more coders. This might be a solution for the productivity issues associated with ICD-10, but how many CFOs would be comfortable with entry-level coders determining the organization’s reimbursement? Coding is more complex than simply assigning a code from a coding book – it takes years of education, training, and mentoring to be a seasoned coding resource. You may have met the goal of providing education and training, but do you have the confidence that after the coders, physicians, and other contributors are educated they will achieve the same level of proficiency they obtained with the ICD-9 system? Managing the clinical documentation specificity and coding quality requirements will be a continuous process that will require dedicated resources focused on clinical documentation improvement, operational process improvement, and financial analysis to ensure the organization is receiving the appropriate reimbursement under ICD-10.

How will your organization test for ICD-10? We know the testing focus for ICD-10 will be fundamentally different than 5010 testing. Even with the 5010 experience, the industry learned that validating the end result was not sufficient and a significant amount of content modification was required. ICD-10 will require changes to the IT infrastructure, which is the foundation for the organization’s business processes. More importantly, the content of the business transactions that are the core of the healthcare delivery, reimbursement, and data outcome models is being replaced with a new set of coding standards.

Standard testing for compliance with format and content will not be enough for a seamless transition. End-to-end testing with payors and trading partners will require a detailed inspection of the claims submission and adjudication transaction process, both from an internal and external methodology, to ensure that business intent and reimbursement requirements meet the anticipated results.

Testing functionality and content with payors will be a challenge that will be costly from a dollars and resources perspective. Close enough is not good enough when talking about revenue neutrality and compliance with billing guidelines. ICD-10 testing will certainly need to include end-to-end, cross-functional, bi-directional, internal and external testing activities. Additionally, ICD-10 will require coupling testing analytics with ICD-10 coding expertise to validate the results of the test transactions and expected revenue outcomes.

Hospitals must also take a hard look at their strategic approach when it comes to the ICD-10 transformation of the organization’s processes and technology. Emphasis must be placed on the tactical approach for education, clinical documentation improvement, testing, and data outcomes, etc. Organizations that focus on content and desired outcomes and not merely the steps to complete a task will achieve the benefit s of a highly trained workforce and a strategic and comprehensive ICD-10 business transition that covers every major impact area.

10-17-2012 5-28-01 PM

John Pitsikoulis is ICD-10 practice leader for CTG Health Solutions of Buffalo, NY.

Seven Things Most Important to Top Performers
By Frank Myeroff

Can you relate?

Recently, a leading HR organization conducted a survey of top performing professionals at a wide variety of organizations in order to understand what they find most important to them on their jobs. Overall top performers ranked the following seven as the most important things to them (industry or practice area did not matter):

  1. Challenging and meaningful work. Top performers want to be engaged and energized by their work and organization. In addition, people generally want to feel a sense of achievement, responsibility, and to know that what they’re doing on a daily basis has some purpose behind it.
  2. Compensation. Top performers want to make top dollar, and salaries that include bonuses and benefits ranked as very important. Also, regular performance reviews and salary reviews were included as part of compensation.
  3. Job security. While job security is hard to come by these days, it is important for workers to avoid layoffs and declining salaries. Therefore, top performers found it important to have up-to-date skills, follow industry trends, and keep pace with their industry in order to bolster their job security.
  4. Work-life balance. Top performers are looking for synergy between their personal and professional lives. The 8 a.m. to 5 p.m. schedule isn’t for everyone. They appreciate having a say over when they work and sometimes even where they work, including from home.
  5. Career development. Technology innovations and fast-changing trends in any field are hard to keep up with. That’s why top performers value ongoing career development and training. It enhances their capabilities and sharpens their skills.
  6. Leadership style. A manager’s leadership style is critical to a satisfactory work environment and production levels. To keep the best and brightest engaged in their jobs and performing at high levels, managers need to provide support, resources, and opportunities.
  7. Advancement. A promotion is viewed as important and desirable because of the impact it has on pay, authority, responsibility, and the ability to influence broader organizational decision making. In addition, a promotion raises the status of an employee because it is a visible sign of esteem from the employer.

10-17-2012 5-17-20 PM

Frank Myeroff is managing partner and VP of business development and operations of Direct Consulting Associates of Solon, OH.

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October 17, 2012 Readers Write No Comments

Curbside Consult with Dr. Jayne 10/15/12

October 15, 2012 Dr. Jayne 2 Comments

It’s been a rough couple of weeks around the hospital with several ambulatory practice go-lives. It’s also the last time this year that Eligible Providers can start their Meaningful Use attestation periods.

We had a couple of affiliated physicians decide at the last minute that they wanted to give it a try. Since my hospital never says no, the team had to scramble to get everything in place for them to be ready to report. Everyone is so afraid of the audits that the level of documentation being produced to support attestations is simply staggering.

Whenever there’s an increased work load in my day job, I find myself spending more and more time on Twitter and other social media sites just surfing around and trying to get my brain to shut off for the night. I also end up sifting through little notes I make throughout the week reminding myself of potential content for HIStalk. Many of us should be glad that we work in IT because it somewhat insulates us from being on the front lines. Here’s tonight’s highlight reel:

  • Healthcare “feel bad” story of the week: A Detroit paramedic lands in hot water after giving a blanket to an elderly fire survivor who escaped his home wearing only his underwear. This is a great parable for preventive medicine. It sounds like the powers that be would have preferred to have to treat the man for hypothermia and transport him to the hospital instead of keeping him warm in the first place.
  • The supersonic skydive: I’m eager to see the data they gathered regarding human physiology in extreme conditions. I have a soft spot for space exploration and am also excited about potential new technologies to help astronauts in the event of a catastrophe.
  • Healthcare “gross out” story of the week: The New England Compounding Center fiasco, which has led to hundreds of sick patients and at least 15 deaths. While I’m being audited to make sure my recommendations meet strict guidelines and that I check meaningless boxes to meet federal requirements, these guys are completely unregulated at the federal level.
  • Black market silicone injections: I spend a good part of my day telling patients that their backsides are too big and they need to lose weight. Another chunk of time is spent with patients who are trying to fight me about the costs of preventive care and screening tests. And yet, there’s a subset of the population out there who is willing to give thousands of dollars in cash to charlatans selling illegal cosmetic treatments to plump up their posteriors. Some of the substances injected by perpetrators: hardware-grade silicone, mineral oil, Fix-A-Flat tire sealant, and furniture polish additives.
  • Proofreading is dead: The editor of CMIO Magazine (now Clinical Innovation + Technology) pens an article about their recent CMIO Leadership Forum. Unfortunately, her headline copywriter doesn’t know the difference between a marquee and a marquis. Farzad is definitely a headliner, but now I’m excited to learn he’s also a nobleman.
  • Too much standardization is just too much: I received my flu shot recently at an occupational health clinic where I received it last year. I was handed a patient demographic form (clearly printed from their billing system, because they hadn’t replaced the vendor’s logo with their own) and asked to verify the contents. My employer information was completely incorrect, so I made sure to mention it to the receptionist rather than just handing back the clipboard after I marked it up. I work for a large health system with hundreds of locations, but know for sure that we don’t have a building at the address that was listed. The explanation: they wanted to standardize their master files, so they only allow one location for any given employer name. I can buy that, but if you’re going to do so why not choose the address of the corporate headquarters at least? I hope they never have to call me at work, because I didn’t recognize the phone number either. I’m also not sure why they wanted me to waste my time updating it if they have no ability to correct it.
  • D’oh, I can’t believe I missed this: I ignore a lot of e-mails I get from certain organizations, simply because my mailbox is so full it’s barely functional. As the days get shorter I can’t believe I missed that the AMA 2012 Interim Meeting is in Hawaii in a few weeks. It would have been a great opportunity for some sunshine and a tax-deductible trip to stock up on material.

Let’s hope this week is better than the last few. Thank goodness I have a vacation coming soon!


E-mail Dr. Jayne.

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October 15, 2012 Dr. Jayne 2 Comments

News 10/10/12

October 10, 2012 News 7 Comments

Top News

10-9-2012 3-18-02 PM

Bloomberg reports that Allscripts has received first-round bids for a leveraged buyout from PE firms Blackstone Group LP and Carlyle Group LP and expects additional offers within three to four weeks. Allscripts closed Tuesday at $13.57 per share.

Reader Comments

10-9-2012 8-35-23 AM

From Master Yoda: “Re: Cerner Health Conference. I doubt you will be able to make it to the conference, but if any of your readers are going, I’ll be the one in the guayabera with the hair that says ‘he really isn’t trying to impress anyone.’ I hope to see Farzad speak and I wonder how long it will take before I hear someone say ‘Epic’?” Cerner provides its own Day One Recap here.

From Innovator: “Re: Cerner conference. The vibe here is cautiously optimistic. Cerner has put a significant emphasis on mobility. PowerChart Touch (Cerner iPad app) and Cerner Careaware Connect (nurse iPhone app). Both are very impressive and the immediate reaction from the customer base seems very positive. However, you can sense a bit of hesitation, as if customers are cautious about getting too excited about new technology because they have been burned in the past.”

From Motown Nurse: “Re: HCA and Beaumont. A couple of my CRNA colleagues who work for Beaumont state that they were informed that HCA has purchased their health system. I had not read this as confirmed anywhere yet though I may have missed it.” The local Detroit business news mentioned a rumored sale last month but I could not find confirmation. Meanwhile Beaumont’s Physician Organization and United Physicians announce plans to combine operations by the end of the year.

From Future Perfect: “Re: Cerner. Have you heard about Cerner trying to sell a single patient accounting system for both hospitals and physician offices? Usually Cerner sells ProFit for hospital billing and Powerchart for physician billing but now they are trying to sell ProFit for both and compete head-to-head with Epic’s combined billing solution. Does it really work and is it tested?” Do any readers have an answer?

From Retired Barkeep:Inspiration by drink. I have a great single-serving margarita recipe for you.” Thanks for the recipe, which I am happy to share with interested readers. I am pretty sure I will need at least a double by the time Mr. H return at week’s end. Retired Barkeep was unable to offer cabana boy services to accompany the beverage(s) so I will continue to accept applications.

From Amarba: “Stan Opstad. Stan was the product SVP at Healthland but is no longer there.” Healthland confirmed that the company’s product management and development operations were consolidated under SVP Michael Karaman in 2011 and that Opstad left the company in August.

HIStalk Announcements and Requests

inga thumbMr. H has yet to check in with me, other than to report a typo, so I suspect he is in total relaxation mode. Feel free to send me your burning HIT news until he returns this weekend.

Acquisitions, Funding, Business, and Stock

Orion Health’s managing director and majority owner says the company is “strongly considering” going public.

10-9-2012 7-03-35 AM

Health Tech Hatch, a crowd-funding site, launches to provide early funding and mentoring to HIT innovators that are developing new companies and products.

Volate secures $6 million in new funding from an unnamed HIT leader and a major healthcare system. The company plans to triple its staff to almost 150 over the next 18 months.


Massachusetts Eye and Ear Infirmary selects MedeAnalytics’ Clinical Performance Intelligence and Revenue Cycle Intelligence solutions to analyze physician utilization and quality metrics. MedeAnalytics also secures a five-year contract extension with West Tennessee Healthcare for its Compliance and Revenue Integrity and Revenue Cycle Intelligence solutions.


10-9-2012 8-16-36 AM

MediRevv appoints Patrick Tierney (above – University of Iowa Hospital and Clinics) managing director of consulting services and Matthew Reat and Diana Moore (CSC) senior consultants.

10-9-2012 6-31-18 AM

Medecision names Jerry Baker (Halfpenny Technologies) SVP and GM of its value-based healthcare solutions business for care delivery systems.

10-9-2012 8-12-10 AM

Consulting services firm SISU Medical Solutions names Scott Lee (Lee Advisory Services, KPMG) CEO.

10-9-2012 9-56-03 AM

RegisterPatient, which just raised $4.1 million in series A funding, hires Jana Skewes (Shared Health) as CEO.

10-9-2012 11-45-56 AM  10-9-2012 11-23-54 AM  10-9-2012 11-26-44 AM

CHIME elects Pamela Arora (Children’s Medical Center Dallas), Charles Christian (Good Samaritan Hospital), and George McCullock (Vanderbilt University Medical Center) to its board of trustees.

Announcements and Implementations

10-9-2012 4-24-47 PM

Awarepoint announces 226% deployment growth, including new activations at Kaiser Permanente, Yale New Haven Health System (CT), Monongahela Valley Hospital (PA) and Vidant Medical Center (NC).

The town of New Canaan, CT pilots a teleheath program that provides 10 seniors iwith Pad or Acer tablets to communicate with nurses two to three times per week. The participants, who range in age from 70 to 85, will also be provided medical equipment to monitor and report vital signs.

10-9-2012 4-26-32 PM

Hillcrest Medical Center (OK) goes live on Forerun’s FlexChart physician documentation in its ED.

AT&T and IBM will begin selling private cloud computing services next year over a mutually owned network.

10-9-2012 4-28-28 PM

Southern Tier HealthLink (NY) joins the New York eHealth Collaborative’s Health Information Network.

Allscripts announces its Open App Challenge, which offers $750,000 in rewards for developers that create and integrate applications that build upon Allscripts Open EHR platform.

10-8-2012 12-46-07 PM

Aprima reminds MyWay customers that the software is based on Aprima’s PRM 2008 version and offers a no-charge license migration, as long as practices sign up for maintenance and support. Aprima also says that MyWay resellers can join Aprima’s reseller network and offer their customers an upgrade option.

Innovation and Research

Physicians using EHR scored significantly higher on quality of care for four screening measures for diabetes, breast cancer, chlamydia, and colorectal cancer, according to a study published in the Journal of General Internal Medicine.


10-9-2012 12-11-33 PM

Imprivata releases Cortext, a free HIPAA-compliant text messaging solution for iPhones and Android devices and Web-based chat solution for nurses without smartphone access.

Anesthesia Business Consultants and iMDsoft launch cloud-based myAnesthesia for the iPad.


10-9-2012 1-15-25 PM

Providers need to work together to accelerate interoperability and electronic information sharing across care settings, according to a report from the Bipartisan Policy Center. The Center also recommends a national strategy to improve accuracy of patient matching; an extension of Stark Law exceptions and Anti-Kickback Statute for safe harbors for HIT donations; and improved clarity of federal privacy and security laws.

Doctors are generally healthier than other US workers according Gallup-Healthways report. A physical health index that considers such factors as obesity, colds, the flu, headaches, and sick days gives doctors a score of 86, nurses 80, and other employed adults 81.

The New York Times takes a look at the use of telemedicine on Nantucket Island, MA as a means to increase access to specialists and decrease costs. Nantucket Cottage Hospital’s CEO estimates that the island’s use of tele-dermatology is saving $29,000 per year and provides patients’ access to dermatologists six times a month instead of just four times a year.

Sponsor Updates

10-9-2012 7-46-23 AM

  • Three hundred Encore Health Resources’ employees build and deliver fifty wheelchairs to Houston-area veterans and the disabled during the company’s annual retreat.
  • Aspen Advisors’ Fran Turisco and Dan Coate deliver a presentation on patient monitoring technologies and accountable care at next week’s NY eHealth Collaborative Digital Health Conference.
  • NTT DATA will integrate Dart Chart Systems’ proactive analytics tools into its NetSolutions POC software.
  • A local Eden Prairie (MN) publication profiles Virtelligence, which was recently named as one of the country’s fastest-growing companies.
  • Wellcentive’s VP of product strategy Mason Beard discusses six pillars of population health management.
  • Mike Reppart, (Hendrick Medical Center TX), and Kelley Blair (Craneware) will speak at the 2012 AAHAM ANI Conference on RCM strategies and performance improvements.
  • IDC Health Insights recognizes Harris Corporation as a leader in the packaged HIE segment.
  • Beacon Partners offers two Webinars in October on risk management.
  • Infor releases its Workforce Management 6.0 solution and announces a private beta availability of its iPaaS stack on the IBM SmartCloud platform.
  • EBSCO Publishing and Elsevier will provide access to Elsevier’s Scopus database from within EBSCO’s Discovery Service.
  • Imprivata customer Dr Harald Eder joins a panel discussion on improving patient care with cloud-based desktops during VMworld 2012. Imprivata also announces the finalists for its inaugural Healthcare Innovation Awards.
  • Visage Imaging will participate at the second annual Imaging Informatics Summit this week in Washington, DC.
  • McKesson announces general availability of its Reimbursement Manager to assist with bundled payments and fee-for-service reimbursement models.
  • Surgical Information Systems offers integration with abeo’s MedSuite billing software.

Clarification from Allscripts

We asked Allscripts to answer a few additional questions about their MyWay to Professional Suite upgrade option. We appreciate their providing us with these responses.

Could you clarify “free upgrade?” Is that a free license, a free conversion, or both?

This upgrade includes software, implementation and training. It will start in January 2013 and end in September 2013. The implementation will be facilitated by enhanced tools that make data conversion and interface activation seamless. This, coupled with tailored simulation learning and a hands-on weekend learning event, will prepare clients to take advantage of their newly upgraded software.

Does the maintenance fee change for MyWay clients once they’re on Pro?

The maintenance fees will remain the same as what is defined in a MyWay client’s current agreement.

And when you say “converged platform,” how is it different than the current Pro product?

We are launching a converged platform and the first step is to move our MyWay clients to this platform. They will experience many enhancements including mobility with Wand, our native iPad mobility solution, additional content including more specialties, and real time point of care/clinical decision support. In addition, the converged platform will be able to process ICD-10 codes and is planned to be certified for Meaningful Use Stage 2.

More news: HIStalk Practice, HIStalk Mobile.

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October 10, 2012 News 7 Comments

Curbside Consult with Dr. Jayne 10/9/12

October 8, 2012 Dr. Jayne 2 Comments


Despite recent calls by some members of Congress to halt Meaningful Use incentive payments, providers are still gearing up to attest. The last 90-day reporting period for 2012 just began and it’s interesting to see people who haven’t yet been able to meet the requirements try to gear up and get it done.

I ran across an article that’s really timely. Basically it poses the question: Who gets the money? Whether providers are employed by large integrated delivery systems or whether they are partners in small practices, it’s often not clear how incentive payments should (let alone will) be allocated.

This doesn’t apply to just MU payments, but nearly any kind of pay for performance bonus, quality bonus, or capitation payment. Often physicians seem to be too busy actually caring for patients to spend the kind of up-front thought needed to solve these questions before they become practice-shattering issues.

The article presents a cautionary tale about a solo physician who employed a nurse practitioner in her office. After spending more than $50,000 to implement an EHR, the employee received the MU check and walked away with the cash, leaving the practice holding the bag. There’s probably more to the story, but it raises important questions about the intent of MU incentives and how they are paid.

The employed physicians working for our large health system have language in their contracts that basically state any incentives received for work done as an employee belong to the health system. In the event that they are paid to the physician personally, they are to be signed over to the health system who also has the right to pursue legal remedies to obtain the funds. The language is clear that it only applies to work done within the course of employment. It also requires providers to complete any assignment paperwork within 30 days of receipt or penalties apply (the same language applies to credentialing paperwork, conflict of interest documentation, employee code of conduct updates, etc.) It’s very “take it or leave it” and that’s part of what being in an employed situation is about.

The key here is that these stipulations are made clear during the hiring process – no surprises. Should the health system decide to be benevolent and actually share quality bonuses with physicians, it’s completely up to the leadership. Although it’s maddening as a provider because we’re doing the work, it’s understandable because none of us personally put up the $45,000 it cost to deploy our EHR system. The one time they did pass funding through to the physicians, I ended up with a whopping $40 bonus. I think at the time it covered about a week’s worth of interest on my student loan payment.

Even in small practices with physician partners, I’ve seen resentment between those who embrace EHR and enter the majority of the data and those who coast on the coat tails of their colleagues. There need to be minimum standards for data entry if payments are to be divided equally. This is not a lot different than the decisions that need to be made when partners who have capitation agreements cross-cover patients or when one partner takes more call or works less than another.

Bottom line: regardless of which side of the table you may be on, this needs to be addressed contractually before it becomes an issue. If you’re an employer and your providers haven’t brought it up yet, don’t assume they won’t be bitter when they figure out in the future that they should have. Be the bigger person and start the dialogue now. And if you’re an employee, be ready to discuss what kind of a split you think is fair and why you feel that way. Interesting discussions will certainly ensue and it may not be easy to avoid hurt feelings or bitterness on either side. Personally, after living through my last contract negotiation, I might just be inclined to arm wrestle for it.

How does your organization allocate incentive payments?


E-mail Dr. Jayne.

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October 8, 2012 Dr. Jayne 2 Comments

News 10/5/12

October 4, 2012 News 4 Comments

Top News

10-4-2012 6-05-54 PM

10-4-2012 6-11-18 PM

10-4-2012 5-56-15 PM

From DrLyle: “Re: House committee call to suspend HITECH payments. I’m at this meeting. Farzad is keeping his cool. He says it’s just pre-election rumblings and nothing can change without major legislative work.” Several House Republicans call on HHS Secretary Kathleen Sebelius (copying CMS Administrator Marilyn Tavenner and National Coordinator Farzad Mostashari) in an October 4 letter to immediately suspend HITECH payments because the Meaningful Use bar is set too low, resulting in a program that “squanders taxpayer dollars and does little, if anything, to improve outcomes for Medicare.” It claims that $10 billion has been wasted. It also references increasing payments due to higher levels of provider coding, as well as Stage 2 rules that don’t emphasize interoperability enough, leading to “our health care system trapped in information silos, much like it was before the incentive payments.” The letter also directly challenges the HHS/ONC count of HITECH provider participants, saying that HHS is “trying to pad participation rates.”

Signers of the House letter were Rep. Dave Camp (R-MI, Chairman, Committee on Ways and Means), Rep. Fred Upton (R-MI, Chairman, Committee on Energy and Commerce), Rep. Wally Herger (R-CA, Chairman, Committee on Ways and Means, Subcommittee on Health), and Rep. Joe Pitts (R-PA, Chairman, Committee on Energy and Commerce, Subcommittee on Health). One might presume given the timing and the fact that all four signatories are Republican that there’s a political motive, although that doesn’t change the fact that you either do or don’t agree with their assessment of HITECH. If their arguments are sincere, perhaps they should have made them earlier. Also, note that their objections aren’t to the value of EHRs but rather to the value of taxpayers in subsidizing them, so reciting a list of why EMRs are inherently good is not an appropriate rebuttal, nor would a list of accomplished users like Kaiser who got free money for using something they’d already bought without taxpayer bribes.

10-4-2012 6-54-59 PM

From BadgerMom: “Re: Valley Medical Center, Renton, WA. Goes live with Epic inpatient.” Congratulations to them. Thanks for the picture.

From Horshack’s Laugh: “Re: Caradigm. The company was simply a consolidation of two non-performing assets so that GE and MSFT could get them off their respective books and write off their significant losses ($1 billion over seven years for Qualibria alone) and allow Immelt and Ballmer to save face.” Unverified. I asked that question in my interview with CEO Michael Simpson.

From THB: “Re: Epic’s succession plan. What about HIStalk’s succession plan? You have built a great open source forum, but at some point you will be the old curmudgeon (and I mean that in the nicest sense!) Believe me, Judy reads this site, as does Glen T. and the rest of them. You share what you can and keep close to the vest what you cannot (that is a fine display of TRUST).” HIStalk is to me a hobby rather than a business, and given that I do it part time (as do my far-flung co-conspirators Inga, Dr. Jayne, Dr. Travis, etc.) I don’t have a specific plan for it to continue without me, nor am I vain enough to think that the healthcare IT world will stop spinning on its axis when I stop typing. Sometimes I feel guilty that Mrs. HIStalk would get no financial benefit from my years of labor if I flamed out tomorrow, but I don’t have a solution. It’s an inherently and intentionally amateurish operation.

10-4-2012 7-34-11 PM

10-4-2012 7-45-34 PM

From Jeeves: “Re: Patrick Soon-Shiong. His announcement was a big deal. I want to point out that at the end of last year when all the pundits were doing their predictions, Travis of HIStalk Mobile was the only one that I’m aware of that said this would be the year that Patrick’s stuff becomes real.” Travis is looking good with his predictions for the year so far: (a) smart phones everywhere; (b) more research and pilots on mHealth; (c) AirStrip as the biggest mover in mHealth; (d) price transparency gets a foothold; and several others. Travis has a lot of experience (MD, startup, NGO, etc.) and you’re missing out on his insight if you haven’t signed up for e-mail alerts when he posts something new. Soon-Shiong’s announcement this week that his NantWorks group of companies has developed a package of supercomputing, high-speed networking, and mobile access that will let doctors instantly individualize cancer treatment based on the patient’s genome. I listened to the live webcast for a few minutes while I was at work and heard him taking the usual shots against outdated, MUMPS-based systems that don’t talk to each other, although I’m not sure what that has to do with his project, which in itself sounds fascinating depending on who’s paying for it and who’s making money from it. BPC has posted the full video of the all-day event, although I haven’t had time to watch it. There’s bonus footage of an extremely cool Farzad bow tie in his segment at around the 180-minute mark.

Reader Comments

10-4-2012 6-20-21 PM

From Pick Six: “Re: Allscripts. Replacing MyWay with Pro.” An internal Allscripts e-mail says that it will standardize its small physician market offering on Allscripts Professional Product Suite, with free migration of MyWay users starting in January. The company also announced that its VAR network will be reduced from 40 to four resellers and that Pro Suite pricing will be standardized (it’s not clear from the wording whether MyWay users will get a free license or just a free migration once they’ve paid for Pro). Also not mentioned is what happens to MyWay, although the most common rumor we’ve heard is that it will be sold rather than mothballed (which makes more sense than Allscripts taking a write-off of some of its Misys acquisition costs). Allscripts is trying to consolidate platforms because of the development effort required for ICD-10, Meaningful Use Stage 2, and accountable care. The risks are that users of MyWay, rumored to be the most popular product Allscripts sells, could look elsewhere given the decision the company has forced on them. One potential winner is Aprima, which under its former name iMedica built the original version of MyWay that Misys licensed in 2007, followed by ugly disputes between the companies (see my July 2008 interview with Michael Nissenbaum). Since then, Aprima has rewritten the PM app and upgraded their version of both EHR and PM, so the gloves will come off if Aprima decides to offer an easy conversion from MyWay to their similar product, potentially also signing on some of the former Allscripts VARs who will be left scrambling. Also affected will be Etransmedia, an Allscripts partner that sells MyWay for $499 per month through Costco.

HIStalk Announcements and Requests

10-4-2012 3-38-32 PM

inga_small I noticed that one of my new Twitter followers is a “healthcare visionary,” leading me to ponder how one earns that designation. Self-assigned? Or is it an advanced accreditation available through HIMSS for those over-achieving members who feel the need for additional titles? I’m going with self-assigned, so from here on out I will refer to myself as Inga HIStalk, HV. Maybe I will get Mr. H to make some ribbons for HIMSS so fellow healthcare visionaries can promote themselves. By the way, feel free to follow me and my HIStalk buddies on Twitter, connect with us on LinkedIn, and be our virtual BFFs on Facebook.

inga_small This week’s highlights from HIStalk Practice: a rumor and a response from e-MDs. CareCloud gives Florida International University informatics students access to its EHR. Practice owners struggle over how to allocate incentive payments for employed providers.The Ohio AFP pilots a project to transform practices to the PCMH model, train medical students, and recruit physicians to practice in the state. Julie McGovern of Practice Wise offers tips for physicians to train for their EHR training – and don’t miss the comment from MarathonMan. You know what makes me happy: that two-second signup for HIStalk Practice e-mail updates. Thanks for reading. 

10-4-2012 8-05-40 PM

inga_small  Am I the luckiest gal in HIT or what? That’s Dr. Mostashari and Dr. Lyle Berkowitz holding up an IimageInga sign at today’s CMIO Leadership Forum. (Eat your heart out, BFF Dr. Jayne.)

10-4-2012 5-24-43 PM

Welcome to new HIStalk Platinum Sponsor VMware, which offers dependable, always-on frontline clinical systems access. Connect to your mobile clinical desktop from anywhere, view medical images, use any digital device securely with no clumsy security steps, and save time with a clinical desktop that follows you everywhere with fast logins to patient care systems. VMware offers cost-saving, secure, and IT-friendly solutions for virtualization, non-stop point-of-care desktops, trusted cloud security and compliance, and zero-downtime continuity and recovery. Thanks to VMware for supporting HIStalk.

From my obligatory YouTube cruise, I found the above VMware video wrap-up of HIMSS12. I like that they pictured and thanked their employees who staffed the booth.

10-4-2012 5-38-52 PM

Thanks to Philips Healthcare, supporting HIStalk as a Platinum Sponsor. The company’s solutions address interoperability (IntelliBridge Enterprise and Bedside to connect Philips products with others); clinical decision support (sepsis monitoring, vital signs and alert trending, EKG analysis, cardiac decision support); mobility (OB TraceVue for iPad-powered fetal information, HeartStartMRx ECG to smartphone, and IntelliSpace Event Management); and telehealth (eICU, IntelliSpace PACS, and Home Telehealth Solutions). I interviewed CMIO Joe Frassica, MD in August, who not only explained the company’s offerings well, but also got promoted to CMIO/CTO/VP right after the interview ran, according to his LinkedIn profile. Thanks to Philips Healthcare for supporting my work.

Here’s a brand new Philips Healthcare video that seems appropriate for Breast Cancer Awareness Month.

As a change of pace, I’ll refrain this week from urging you to sign up for e-mail updates and Like us and all that. Instead, I will suggest just one course of action: tell your colleagues you get news and opinions from HIStalk. I’ve received many e-mails from new readers and new sponsors who admitted that they hadn’t heard of HIStalk until people whose opinion they valued kept telling them they should read it. I appreciate that a lot.

I’ll be taking a little break next week, although I’m sure I won’t be able to resist the laptop’s siren song. My hiatus is minuscule compared to that of Vince Ciotti, who’s enviably taking his bride of 40 years to Europe for the whole month of October to re-live their honeymoon (and unlike me, he’s vowing to stay off the laptop). That means HIS-tory will return in November, and I can honestly say I will miss it since I enjoy every one of them.

Acquisitions, Funding, Business, and Stock

Homecare Homebase closes $75 million in senior securing financing from CIT Group.

Peak Health Solutions acquires the assets of consulting firm Health Data Essentials.


Managed care health plan Kern Health Systems selects McKesson’s VITAL Care Management programs to provide members with care management and educational materials.

10-4-2012 8-52-41 PM

Scottsdale Healthcare and Scottsdale Physician Organization will implement Harris Corporation’s Clinical Integration Solution to connect its hospitals, physicians, labs, and other providers.

Booz Allen Hamilton Holding announces 35 new federal and private healthcare contracts totaling more than $112 million in August and September.


10-4-2012 10-42-14 AM

Patient flow software provider Central Logic names Steve Erickson (SageCreek Partners) CFO.

10-4-2012 3-07-24 PM

Stephen Lawrence (Southern Illinois Healthcare Foundation) joins the Lincoln Land HIE as executive director.

10-4-2012 3-18-49 PM

Kaiser Permanente Chairman and CEO George Halvorson announces his retirement effective December 2013.

Announcements and Implementations

Inova (VA) becomes the first organization to participate in the ConnectVirginia HIE.

The New England Healthcare Exchange Network (NEHEN) selects the Massachusetts eHealth Collaborative to take over its executive management, business development, and operations management.

Mediware Information Systems earns updated 510(k) clearance from the FDA for its core blood management software products.

10-4-2012 8-54-09 PM

Penn State Milton S. Hershey Medical Center implements an interconnected CareFusion and Cerner solution that centralizes clinical information between the Pyxis MedStation 4000 system and Cerner Millennium EHR using Cerner’s CareAware iBus integrated device connectivity architecture.

Horm Memorial Hospital (IA) and Faulkton County Memorial Hospital (SC) beta-test Healthland’s Centriq Clinic, an ambulatory care solution for rural physicians.

Iowa Specialty Hospitals, The Gabrielson Clinic, and Orthopedic Specialists go live on EMR Oct. 8. The hospitals and clinics are all part of University of Iowa Healthcare, so that’s probably Epic.

CliniComp commits to meeting ONC Stage 2 MU certification with its Essentris EMR.

AHIMA calls for improved EHR patient documentation standards and principles at its conference this week.

Government and Politics

10-4-2012 6-50-43 PM

The Medicare Fraud Strike Force charges 91 individuals — including doctors, nurses, and other medical professionals — for falsely billing the government $492 million, including more than $230 million in home health fraud, $100 million in mental health fraud, and $49 million in ambulance transport fraud. Half the people, not surprisingly, operated out of Miami.


Qualcomm Foundation awards Scripps Health a three-year, $3.75 million grant to develop wireless medical devices, including biosensors that are inserted into the blood stream for disease detection; a mobile app that captures medical data from biosensors and transmits it to patients’ smart phones; and a handheld device to detect genetic variations that may prevent particular medications from working correctly.


St. Francis Health Center’s (KS) will lay off eight patient accounting employees as a result of the hospital’s November 1 transition to Epic.

10-4-2012 7-15-33 PM

A Wall Street Journal article called “Hospital Horrors” covers a newly published book on hospital transparency written by a Hopkins surgeon. He says state medical boards do a poor job of policing doctors, hospitals are pushed by lower reimbursement to increase volumes to unsafe levels, and bad treatments pay better than good ones in many cases. He quotes a recent Hopkins survey of employees of 60 high-quality hospitals, where more than half of the respondents said they would not feel comfortable receiving care in the unit in which they work. I’ve said that many times: those of us working in the healthcare system are a lot more scared of it than laypeople when we become patients.

Friday is the premiere of “Escape Fire: The Fight to Rescue American Healthcare.” Variety gave it a pretty good review from its Sundance screening in January, but said it should have included more about how lobbying keeps the healthcare industry safe from political action.

Weird News Andy says he might believe the woman who blames lupus-triggered delusions for causing her to strip naked and chant religious phrases outside a high school, but that doesn’t explain why she was joined by her two adult daughters and teenage son. The adults got probation after pleading guilty to indecent exposure.

inga_small A Utah man is convicted of disorderly conduct and charged a $140 fine after paying a disputed $25 doctor bill in pennies. Apparently the practice did not appreciate having 2,500 pennies dumped onto the receptionist’s desk. Personally, I think his approach was creative, and I bet quite liberating.

inga_small Just in time for Breast Cancer Awareness month: a “smart” bra that uses sensors and predictive analytics for early breast cancer detection. Don’t look for it at Victoria’s Secret or anywhere else any time soon: the company does not expect to launch the product in the US until 2014.


inga_small Men with shaved heads are perceived to be more masculine, dominant, and in some case have greater leadership potential than those with longer or thinning hair. Thank you, University of Pennsylvania’s Wharton School for confirming what I have known for quite some time.

Bizarre: a man sues a stripper who was performing at his bachelor party, claiming she slid down the stripper pole and landed so hard on his abdomen that she ruptured his bladder.

Sponsor Updates

  • CMS names SuccessEHS a 2013 EHR Direct Qualified Vendor.
  • CareTech Solutions offers discounted pricing for its BoardNet portal to members of the AHA Center for Healthcare Governance.
  • The CliniSync REC (OH) profiles Premier Physician Center and its use of e-MDs.
  • API Healthcare celebrates customer service week by honoring its client-facing support staff.
  • The Journal of the Medical Library Association ranks DynaMed in the top ten among online clinical resources.
  • NextGate joins the partner network of HIT consulting firm Exsede.
  • Shareable Ink introduces its Meaningful Use program for anesthesiologists.
  • QlikView hosts an October 11 webinar featuring Nationwide Children’s Hospital (OH) and its use of QlikView for data discovery.
  • MedHOK announces that its technology platform positions participants in the Comprehensive Primary Care initiative to share in savings and improve patient care.
  • T-System showcases its RevCycle+ physician coding and billing solution at next week’s ACEP Scientific Assembly in Denver.
  • iSirona sponsors a Code-A-Thon programming challenge at Florida State University’s department of computer science.
  • Datapharm Australia Pty selects Merge Healthcare’s eClinical OS solution for enterprise-wide electronic data capture.

EPtalk by Dr. Jayne

I’m mourning the loss of a colleague today – one of my favorite partners is leaving our group. Patients adore him and I’d trust him to care for my loved ones. The reason: he’s fed up with insurance, bureaucracy, and paperwork and is launching a cash-only practice.

He will be sorely missed, but he’s not the only one. Increasing numbers of physicians are dropping participation in insurance plans. It doesn’t do much good to have patients insured when few will accept low-paying insurance plans (see: Medicaid). A New York Times piece this week shares some additional stories. More interesting than the feature itself are the reader comments.


Sponsored by ONC, the Blue Button Video Challenge runs through November 13. This is your chance to create an “engaging and entertaining” two-minute video to advocate use of the Blue Button to access health information online. Judging criteria include submissions being “fun, edgy, and memorable.” First prize is $3,000 to help motivate you creative types.

In the medical staff lounge this week, there has been a fair amount of discussion around the Annals of Internal Medicine article covering patient access to physician notes. The authors concluded that patients felt the practice was beneficial and that providers experienced “no more than a modest effect on their work lives.”

So many of my colleagues think the sky will fall if their patients have access to visit documentation. Not a week goes by that one of my peers doesn’t corner me about making parts of the patient plan documentation “hidden” or “non-patient-facing.” Although they profess concern that patients can’t handle the truth or that phone calls to explain the notes will be a burden, I really think they’re afraid that patients will discover their poor written communication skills.

Reading the notes of some of my peers is exhausting even when they’re dictated, so one can’t always blame the EHR. I wonder if some of them know how pompous they sound or that they simply ramble with no concept of sentence structure? In order to make sure our patients (and sometimes our colleagues) understand us, we need to be communicating clearly and often at an elementary-school reading level.

Even if your organization doesn’t have an open notes policy, I strongly encourage providers to start documenting as if patients will read the notes. Chances are they’ll be reading them in a few years whether you like it or not. Better to prepare now.

For those that are worried that patients can’t handle the truth (aka, “She’s not going to like it if I say she’s obese”) it’s time to be direct with patients. Tiptoeing around the edge of major national health problems like obesity, diabetes, hypertension, and coronary artery disease because we’re worried about hurting a patient’s feelings isn’t good for the patient or for society. I’m not saying we need to be unfeeling or unkind, but sometimes we need to just call it what it is and work to help patients address their health needs.

Being able to communicate well is a learned skill and needs to be taught in medical school and reinforced in residency and continuing professional activities. Last time I checked, online translator software doesn’t offer “Doctor” as a language choice (although I did find a pirate translator), so it’s time for healthcare providers to get with the program.

What do you think about patient-facing documentation? Do you use it in your practice? E-mail me.



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

More news: HIStalk Practice, HIStalk Mobile.

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October 4, 2012 News 4 Comments

News 10/3/12

October 2, 2012 News 8 Comments

Top News

10-2-2012 6-33-03 PM

Patients say they are better equipped to help manage their own medical conditions when physicians give them access to their visit notes, according to the year-long OpenNotes study published in Annals of Internal Medicine. Ninety-nine percent of patients at the three participating hospitals who responded to the survey said they wanted the project to continue. None of the participating physicians elected to end their participation at the study’s conclusion — they were less enthusiastic about the patient benefits, but found that allowing patients to review their notes didn’t require any additional time or effort on their part. Responses to the potential benefits in the graphic above are indicated by circles (patients) and squares (physicians).

Reader Comments

From Jedi Knight: “Re: EHR adoption numbers. Has anyone pointed out that ONC and CDC are tracking very different numbers? They are showing 58 and 39 percent, respectively.”

From Start and Stop Again: “Re: Nuance. How do you think 3M feels with Nuance acquiring QuadraMed’s Quantim and JATA, who clearly compete with 3M? This has to signal the end of Nuance’s Computer-Assisted Physician Documentation announced last February in a partnership with 3M. Does Nuance think it can stitch the pieces of two dusty companies into Frankenstein?” Unverified.

10-2-2012 7-28-23 PM

From Familiar with the Transaction: “Re: McKesson acquiring MED3OOO. It’s a good fit. MCK gets the InteGreat EHR, which has a lot of functionality including a data warehouse and integration with Medicomp’s Quippe. They get instant market share in specialty revenue cycle management such as lab, emergency, and ambulance billing. They get a new market in full management of multispecialty groups, and ACO market opportunity from someone further down the path than they were. Not to mention that they take out a competitor and pick up a decent client base.”

10-2-2012 9-49-49 PM

From What, Me Worry?: “Re: West Penn Allegheny downtime. Patient care was not affected – we rely on meaningfully used paper.” West Penn’s servers went down Tuesday morning after a power surge, forcing the hospital to use paper backups. Some systems were up eight hours later and others were expected to come online overnight. It’s not much of an EHR pitch when a hospital claims that being without the computer didn’t really make any difference in patient care. That’s probably more of a PR observation rather than a medical one, though.

From THB: “Re: Allscripts. Are the reports that the company is putting itself up for sale accurate? After your hard day at work, here I am asking you to validate more information, i.e. do more work.” Bloomberg News claimed Friday that Allscripts talked to several private equity firms before engaging Citigroup to explore its options, but neither company would confirm. Shares have risen 11 percent since then, which might be meaningless since (a) the original rumor may have been planted by someone anxious to sell their shares, which is always possible; (b) the rumor may be incorrect; or (c) the rumor may be correct, but may not result in any decisive action. Reasons that going private makes sense: (a) the company’s shares tanked and haven’t recovered after an ugly day in April in which the company fired its board chair, saw three other board members quit in protest, announced the departure of its CFO, and reported lower earnings and guidance; (b) the company conceded to demands by a large shareholder to add its three candidates to the Allscripts board, and those new directors may be influencing the discussion of strategic alternatives; (c) the critical Q3 earnings numbers will be announced in November, and if they aren’t looking so good, this would be the time to plan an escape route from the bloodbath that’s likely to follow; and (d) the stock has fared so poorly in a generally good market that any major strategic changes might be better conducted outside of Wall Street’s baleful glare. My answer, then, is that I have no idea if the rumor is true, but I suspect that it is, and even that wouldn’t mean much until Allscripts decides what it wants to do.

HIStalk Announcements and Requests

10-2-2012 4-49-59 PM

inga_small My new iPhone 5 arrived last Friday and I am happy to report I have successfully made the migration. It’s definitely faster, the camera is better, it’s lighter, and I like the bigger screen. The battery life, however, does not seem any better than the iPhone 4 and actually seems worse, if that is possible. Maybe the battery life is longer in standby mode, but not when you are using all the cool new features. I also checked out the new maps utility and was amused that my “hospitals” search presented me with an option for “The Shoe Hospital” and for an animal hospital, but no traditional hospitals. It did find more choices when I searched “hospital” (singular), however. An “emergency room”  search found a few urgent care centers, but missed the three closest me and didn’t find any ERs attached to a hospital. Good luck with that issue, Mr. Cook.

Acquisitions, Funding, Business, and Stock

10-2-2012 9-50-58 PM

Tenet Healthcare subsidiary Conifer Health Solutions will acquire InforMed Health Care Solutions, an information management and services company.

Ontario-based Kallo, Inc. enters into a $2 million stock purchase agreement with Kodiak Capital Group. The company offers EMR, PACS, and medical device connectivity solutions.

10-2-2012 9-51-50 PM

Nuance acquires JA Thomas and Associates, which offers clinical documentation improvement programs. Obviously Nuance is interested in clinical documentation and the ICD-10 transition given the September 27 announcement that it had acquired QuadraMed’s HIM solutions (coding, compliance, computer-assisted coding, abstracting, record and document management, workflow, and clinical documentation integrity) and its acquisition earlier this year of Transcend, which offered transcription and clinical documentation (including the documentation and charge capture solutions of Salar, which Transcend acquired last summer).

HIMSS acquires CapSite, which offers a vendor database that includes actual pricing and contract information as well as research services that HIMSS will fold into HIMSS Analytics. It will be interesting to see how HIMSS balances the confidentiality desires of its vendor members against CapSite’s detailed and vendor-specific pricing and contracting information. My speculation is that it will go away, replaced by aggregated non-identifiable vendor information. And as I tweeted when the news was announced, that means that HIMSS is now an inadvertent HIStalk sponsor, which Inga pounced on with great glee.

In one of the oddest healthcare transactions in recent memory, The Washington Post Co. buys a majority stake in a hospice and home health service, obviously desperate for further non-media diversification as its Kaplan education cash cow dries up after the government reins in for-profit colleges.

10-2-2012 9-14-38 PM

10-2-2012 9-13-00 PM

Healthcare billionaire Patrick Soon-Shiong announces a deal between his NantHealth company and Blue Shield of California, which will work with St. John’s Health Center in Santa Monica, CA to roll out healthcare breakthroughs and personalized medicine. He will present the news to a Bipartisan Policy Center conference in Washington, DC on Wednesday, starting with an invitation-only 8:00 a.m. small-group breakfast session and then a larger session later in the morning. He’ll be joined in the session covering the use of supercomputer-powered genomic medicine by Senator Bill Frist; J. Michael McGinnis of the IOM; the president of Blue Shield of California; the top medical executives from AT&T, Verizon, and Caremark; and several academics.


10-2-2012 8-38-44 PM

The board of New York City Health and Hospitals Corporation approves execution of a ten-year, $303 million contract to implement Epic throughout the entire corporation. I believe the incumbent was QuadraMed Affinity, although it’s been a long time since I’ve thought about HHC. Cerner and Allscripts were the losing bidders and Allscripts has formally protested the award to Epic, which I would assume means HHC passed on the lower bid by Allscripts, which isn’t at all unusual when prospects get Epic fever. I assume the only difference from the usual hospital decision is that HHC is a government entity, so there’s someone to complain to. UPDATE: readers tell me the product HHC is running is QuadraMed CPR, the former HDS Ulticare / Per Se Patient1 / Misys CPR that they bought from HDS in the early 1990s and used in all inpatient, outpatient, and ancillary areas. It won them a Davies Award in 2006.

Baton Rouge General Medical Center (LA) chooses RelayHealth for its enterprise HIE.

The 77-physician Optimal Radiology selects McKesson Revenue Management Solutions for billing, reporting, and collections.

10-2-2012 9-52-58 PM

Faxton St. Luke’s Healthcare (NY) adds the Surgical Information System anesthesia information management system to its Allscripts Sunrise Surgery perioperative system.

The US Coast Guard awards Lockheed Martin a $2.3 million contract to develop a mobile interface to its Epic-powered EHR.


10-2-2012 6-16-38 PM 10-2-2012 6-17-19 PM 10-2-2012 6-18-00 PM

Device integration provider Nuvon appoints Christopher Gatti (Living Strategies) CEO and Stephen Spencer (Advantis Medical) VP of sales and marketing. Cathleen Asch will transition from CEO to EVP of strategic initiatives and remain on Nuvon’s board.

10-2-2012 6-19-41 PM

Jo Ann Rooney (DoD – above) and Robert Mills (ACS/Xerox) join Huron Consulting Group’s healthcare practice as managing directors.

10-2-2012 6-23-30 PM

The Military Health System names David Bowen (FAA) CIO.

10-2-2012 6-38-06 PM

University of Buffalo School of Medicine names Peter Winkelstein, MD as executive director of the school’s Institute for Healthcare Informatics. He is also CMIO of UB/MD.

10-2-2012 7-10-15 PM

Impact Advisors hires C. Lydon Neumann (Accenture) as VP.

10-2-2012 7-13-19 PM

Health Care DataWorks names founder Jyoti Kamal, PhD as president. She was previously deputy CIO and director for the information warehouse at The Ohio State University Wexner Medical Center.

10-2-2012 7-40-03 PM

Aspirus names Todd Richardson (Deaconess Health System) as CIO.

10-2-2012 8-14-32 PM

Jonathan Grau (AMIA) joins National Quality Forum as senior director of stakeholder collaboration.

10-2-2012 8-54-28 PM

Florence Chang is promoted to EVP of MultiCare Health System (WA). She was previously SVP of clinical support services and CIO.

Announcements and Implementations

WakeMed Health & Hospitals (NC) implements the Philips eICU remote critical care monitoring technology.

10-2-2012 9-53-55 PM

AHIMA awards the University of Wisconsin Hospital and Clinics the Grace Award for demonstrating effective and innovative approaches in using health information to deliver high quality healthcare.

Healthland will integrate Health Language’s terminology platform to support ICD-10 readiness and terminology standardization.

UnitedHealthcare commits $20 million to help 11 critical access hospitals in California improve their technology, including the addition of EHRs.

Partners HealthCare pledges to award Massachusetts community health centers $90 million over the next 15 years to upgrade technology and make other infrastructure improvements.

CORHIO announces that all six northern Colorado hospitals are connected to the HIE.

UPMC, Oracle, IBM, Informatica, and dbMotion will create a $100 million data warehouse that combines clinical, financial, administrative, and genomic information for analytics and predictive modeling applications.

Orion Health awards Cognosante a contract to provide integration and identity management for the first stage of the Massachusetts Statewide HIE program.

MModal makes available its Catalyst for Quality solution for clinical documentation.

North Carolina Healthcare Information & Communications Alliance offers a Vendor Management Policy Template that addresses HITECH requirements for business associate agreements. It’s free to NCHICA members, $50 otherwise.

A study published in the Journal of Clinical Epidemiology finds that DynaMed is ranked highest of 10 online clinical resources based on timeliness, breadth of coverage, and quality of supporting evidence.

CTG signs an Epic implementation contract with an unnamed five-hospital IDN.

The city of Billings, MT goes live with an ONC-funded and Dossia-powered pilot project to give its employees the ability to view and manage their electronic health information.

10-2-2012 7-50-16 PM

Dolbey announces the VoiceBox recording system that tags physician dictation so that the completed transcription can be inserted into the correct location of the EMR.

Verizon announces a cloud and data center infrastructure for storing and sharing PHI. Unlike non-healthcare cloud providers, Verizon will sign a business associate agreement that meets HIPAA requirements.

VersaSuite announces that its 8.0 product has earned pre-market CCHIT ED certification. VersaSuite is certified for both inpatient and ambulatory use, a distinction it says only two companies have achieved.

Government and Politics

Medicare initiates two ACA-legislated programs that target quality of care and readmission rates in hospitals. The Hospital Value-Based Purchasing Program allows the government to pay hospitals bonuses if they meet high performance standards on certain quality measures, while the Hospital Readmissions Reduction Program enables Medicare to reduce reimbursements up to one percent for hospitals with high readmission rates.

ONC announces a goal of helping 1,000 critical access hospitals achieve Meaningful Use by the end of 2014.

ONC releases a consumer-focused video on the benefits of electronic medical records, with cameos by Todd Park, Don Berwick, Farzad Mostashari, David Blumenthal, and others.

Innovation and Research

Kaiser Permanente researchers find that the use of an EHR improved drug therapy and follow-up monitoring of Type 2 diabetics, as well as improved the patients’ glycemic and lipid control.

10-2-2012 8-13-07 PM

Health Nuts Media launches a crowdfunding campaign, hoping to raise $90,000 to develop an asthma education app for children. Rewards are offered for various donation levels, with a $50 contribution earning a copy of the app, a “Wall of Fame” credit, coloring pages, a poster, recognition in the app, and a tote bag.


10-2-2012 4-43-10 PM

CalHealth prepares to launch MD Mouse, a device that measures pressure information when a finger is slid inside a cuff that folds out from the middle section of the mouse.


The Census Bureau says adults under age 65 made an average of 3.9 visits to physicians in 2010, down from 4.8 visits in 2001. Possible explanations: more uninsured, fewer physicians, higher patient costs, innovation that allows providers to accomplish more in a single visits, and more meds available without a prescription.

Cerner expects over 10,000 attendees from 21 countries at its 27th annual Cerner Health Conference next week in Kansas City.

An Irish pediatric surgeon is found guilty of poor professional performance after a 2010 error in which the wrong mouth surgery was performed on a baby. The doctor correctly ordered an upper lingual frenulectomy in his patient notes, but an administrator entering the procedure into the hospital’s computer system said the only option it gave him was “tongue-tie.” He chose that option, it printed on the OR list, and the surgeons performed that operation. They chairman of the inquiry committee said he was satisfied with the decision even though the committee had concerns about the OR scheduling and coding systems.

10-2-2012 7-01-33 PM

Weird News Andy is amused that a study finds that tickling rats after inducing a stroke appears to prevent paralysis and sensory deficits, possibly by forcing a rerouting of blood through unblocked veins. Playing music seems to work equally well, leading to the “it may not help, but it can’t hurt” recommendation that when someone is suspected of having a stroke, squeeze their hand and talk to them. WNA is also amused at the prospect of giving the rats warfarin as a stroke treatment, which usually is dosed in much larger quantities in the form of rat poison.

WNA cheers this story with a hearty “Hear, hear.” Doctors at Johns Hopkins successfully create a new ear for a woman who lost the original to cancer. They grew the new ear under the skin of her arm until it was ready to be attached.

Strange: a veteran sues the VA for $10 million, claiming that a nurse packed his groin with ice for 19 hours following his genital surgery, causing frostbite that required reconstructive surgery.

Sponsor Updates

10-2-2012 9-57-30 PM

  • Elsevier launches its nationwide ClinicalKey Experience Tour, an all-day outdoor event at hospitals and academic centers to promote its ClinicalKey clinical reference tool.
  • Iatric Systems offers an October 11 webcast on Meaningful Use Stage 2 featuring Beth Israel Deaconess Medical Center CIO John Halamka, MD.
  • Michigan Orthopaedic Institute (MI) selects the SRS EHR for its 17 providers.
  • Intelligent InSites announces members of its Healthcare Advisory Board.
  • Collom and Carney Clinic Association (TX) selects MModal Fluency Direct to voice-enable its EHR.
  • Cynergis Tek CEO Mac McMillan achieves the Fellow of HIMSS designation in recognition of his advancement of privacy and security within healthcare.
  • Balsam Healthcare Corporation (Saudi Arabia) licenses First Databank’s Middle East Drug Knowledge solution for integration with the OASIS HMIS system. FDB also releases new customizable alert categories within its FCB AlertSpace alert management system.
  • Delta Health Technologies selects ZirMed as a preferred business partner to provide RCM solutions to homecare providers.
  • McKesson hosts its 25th Health Solutions Conference next week in Orlando.
  • Gregg Mohrmann and Mark Van Kooy, MD of Aspen Advisors will lead sessions at this week’s New Jersey HIMSS/Delaware Valley HIMSS joint annual conference.

A Report from athenahealth’s “More Disruption Please: The CEO Retreat”
By Jonathan Baran, Co-Founder and CEO, Healthfinch

10-2-2012 7-37-48 PM

Athenahealth’s recent "More Disruption Please" event brought together 50 CEOs of health IT companies and their investors to the Point Lookout Resort in Maine (a resort that athenahealth bought for $7.7M… a steal!). Each CEO was given their own private log cabin to stay in (or to sleep off late nights with Jonathan Bush). The purpose of the meeting was for athenahealth and these newer, innovative HIT companies to get to know and learn from each other.

Any time you get to spend time with Jonathan Bush, you never know what to expect. He did not disappoint, as he began at eight in the morning by impersonating Ali G, telling everyone how athenahealth gets "ka-ching and da bling for doing the right thing!" A couple of more presentations followed, including one by Marty Anderson, who asked how innovation can come from the top-down when "the healthcare industry is a giant cartel."

Then the fun began as 30 CEOs gave two-minute pitches, with five finalists promised a ten-minute presentation to 2,500 of athenahealth’s users. We (Healthfinch) were selected as one of the five finalists, along with iTriage, Entrada, Epion, and Wellframe. In a smart market research move, athenahealth then asked their customers to vote on which company’s product they would most like to see integrated with athenahealth. Ultimately, our scrappy startup from Madison, Wisconsin took second place to Aetna’s iTriage.

Jonathan Bush’s final display of how to "keep it real even when you’re CEO of a publicly traded company" began when he gave us a lesson on how to build a successful business model. Jonathan, like every other EMR CEO, drew inspiration from the “Saturday Night Live” skit, "D— in a Box." He gave us all the following instructions:

  1. Get a box (find a pile of work that users hate and suck at).
  2. Cut a hole in the box (figure out how to break into the market).
  3. Put your junk in the box (bring your secret sauce to the market).

I couldn’t say it any better myself.

Athenahealth also discussed more of their plans for their entire "More Disruption Please" program, the smartest move being their recognition that the biggest challenge in bringing innovation to market (and thus allowing small companies to flourish) is in the distribution channel. That’s why athenahealth is promising to bring the top innovations to their customers by rapidly scaling interesting products and innovations to their entire user base.

Time will tell if athenahealth can live up to its grand plans to become the information backbone of the health system, but their program (and their conference) seem to indicate they are on the right track.


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

More news: HIStalk Practice, HIStalk Mobile.

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October 2, 2012 News 8 Comments

Time Capsule: If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?

September 30, 2012 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 2007.

If Nurse Shortages Require a 50 Percent Labor Reduction, What Technology Will You Install (or De-Install)?
By Mr. HIStalk


The recent CDW Healthcare nurse survey about IT is both fascinating and sobering. Nurses are too busy with patient care to get application training or participate in IT projects. They continue to believe that IT can improve their jobs, even though current systems involve frustrating duplication. They also think that applications bought on their behalf are ineffective and unreliable.

“Nursing systems” really aren’t that at all. They are really “systems to get nursing to do stuff that someone else wants.” Electronic charting, medication administration, order entry, bedside barcoding, and patient assessment: none of these save nurse time. They may have an impact on quality (slight or otherwise) and they may create an impressive-looking electronic record for other people to read. What they don’t do is make it easier for nurses to finish their work by shift’s end.

Here’s an exercise to ponder. The hospital CEO comes to you and says, “Mr. or Ms. CIO, our RN shortage is serious this time. There’s no solution in sight. We have no choice but to use just half the nursing hours we have available today. You heard me right — I said half. Quality cannot suffer. You have an unlimited budget to implement whatever technology you can find that will deliver that result. Do that and you’ll get a nice bonus — I’ll let you keep your job.”

Let’s say you receive that ultimatum. Would you recommend clinical documentation systems or bedside barcoding as a way to survive on 50 percent fewer nursing hours? I’m pretty sure you wouldn’t. So what would you recommend?

You’d first need to find out how nurses spend their time. That’s a simple observation study, easily done by data-driven IT types, engineers, or quality experts.

Then, you’d push tasks that add minimal value down the food chain to cheaper and more readily available employees. That assumes you have those, of course. Many hospitals inexplicably got rid of LPNs and nurse aides years ago, using expensive and hard-to-find RNs to pass meal trays and give baths. Didn’t all those hospital suits learn anything about labor management in their MBA programs?

Then, you’d automate where you could to improve efficiency. Buy more PCs and Pyxis machines so nurses don’t wait in line. Provide portable communications devices. Have all drugs and supplies delivered to an in-room cabinet for each patient. Let someone else reconcile narcotics counts and give report. Integrate nurse call systems with other communications.

Maybe you’d even de-install some of those applications that quietly eat up nurse time because of poor design. Watch the kid at McDonald’s ring up your hamburger. Now imagine what the screen would look like if your current clinical systems vendor designed it. Real estate sales would skyrocket because every McDonald’s would need another mile of drive-through lane to hold the angrily waiting customers.

Maybe the RN shortage isn’t that severe at your place (so far, anyway). Still, you should make sure that IT systems aren’t contributing to it. When installing new systems, practice “first do no harm”: will they require more nurse time? Any answer other than “no” is unacceptable. And if you’re convinced that technology saves time, this is a great opportunity to prove it.

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September 30, 2012 Time Capsule No Comments

HIStalk Interviews Alan Portela, CEO, AirStrip Technologies

September 30, 2012 Interviews No Comments

Alan Portela is CEO of AirStrip Technologies of San Antonio, TX.

9-22-2012 3-31-03 PM

Tell me about yourself and the company.

I’m the CEO at AirStrip Technologies. I have about 20 years of experience in healthcare information technology. I came from the EMR side in the past. I have been on the board of AirStrip for about two years and have been the CEO for a little short of two years, since January 2011.

When I came to AirStrip, the core business was mobilizing medical devices — specifically in obstetrics — on the inpatient side. We were accessing fetal surveillance on mobile devices with 510(k) class II FDA clearance. We were the only company doing this with FDA clearance. We remain today the only company doing this with FDA clearance.

Since then, the company moved into mobilizing other medical devices in the inpatient care setting and adding applications for ambulatory care as well. We introduced a cardiology product, which is now deployed in about 60 medical centers. We also introduced a patient monitoring component for mobile devices. All of our medical device connectivity products are cleared with the same classification by the FDA.

Next, we’re moving into the home health space with a partnership we formed with Qualcomm Life to be able to take management of chronic diseases outside of the hospital walls into a patient / population-centric approach.

I interviewed Cameron Powell – the president, co-founder, and chief medical officer — in early 2010. He said that contrary to what people might think, AirStrip is not just a vendor of mobile waveform display applications, but instead is a mobile solution that can expose any data. How will that influence the direction of the company?

I’d like to talk a little bit about the industry trends, how we fit in, and how we evolved as a company to where we are today.

When I started at AirStrip, the comment I received from the members of the team is that AirStrip was viewed at that time — two years ago — as a nice-to-have tool. Mobility overall was viewed as the first technology that healthcare organizations were going to deploy as soon as they were finished with the implementation of their electronic medical records and electronic health records systems to comply with Meaningful Use requirements, at the time Stage 2 and moving to other stages in the future.

My comment coming from the EMR world to my team was, “Well, good luck, because it’s going to take a long time until the process of EMR and EHR deployment is ready. There’s always a new tool that is coming up and a new product that is coming out.” That was the market trend.

I stated to the team that there are a number of initiatives and challenges that we need to look at in the industry. One is the shortage of caregivers. We have known since the Leapfrog Report that there is a shortage of caregivers. Now as we’re going into an outcomes-based reimbursement model and a patient-centric care approach, everything is centered more around the specialists and the top chronic diseases – a cardiologist for heart disease, endocrinologist for diabetes, neurologist for stroke.

What we need to do is leverage mobile technology to bring the data to the specialists and the primary care physicians wherever they are, rather than bringing them to the data. Mobile technology has to become a mission-critical tool to be able to bring the clinically relevant data to those caregivers at the right time, so that they can make the right decisions.

We started looking at mobility throughout the continuum around chronic diseases. When we shifted our messaging to a patient-centric approach, we started experiencing significant growth. In 2011, we grew about 300% over 2010. We started signing contracts, developing partnerships with large healthcare organizations like HCA, Dignity, Vanguard, et cetera that clearly saw the importance of using mobile technology not only to attract patients to their facilities, but also to attract physicians to their systems by offering the right tools and improving their quality of life.

As we looked at this whole thing, we said if we are mobilizing one of the most important clinical data sources — medical devices — throughout the continuum, we need to make sure that we look at the other clinical data sources that are going to make the physician’s life much better. Immediately we looked at EMRs and EHRs. About three months ago, we acquired the intellectual property of a product that was developed at a healthcare organization by physicians on a very similar platform with a very similar approach as what we have done with medical devices. We acquired the IP for a mobile EMR extender.

This is where the other trend comes in. As you see more organizations creating ACOs to manage population health, you’re starting to see that a number of providers are expanding outside themselves by buying more hospitals or acquiring surgery centers, urgent care centers, imaging centers and the like. They’re adding to their systems. Mostly likely they are going to have multiple EMR vendors, even though primarily they were using one particular EMR or EHR vendor.

The moment you do that, it’s the same thing that we experienced on the medical device side. You’re going to have multiple vendors in different units. You need to have a seamless way of mobilizing all those devices into one view.

What we realized was that by buying the IP for this mobile EMR extender, we now needed to do the same thing we did with mobilizing medical devices — mobilize all EMRs and EHRs into one single view, being able to move data across the continuum and having physicians look at one view of their world, improving their workflow.

Of course, there are other things that we have to include. Later on, we’re going to look at imaging and at third-party components that we can apply on top of our platform. Then we will look into videoconferencing to be able to offer the complete solution.

I always talk about that announcement from Steve Jobs when he introduced the iPhone. He said, “It’s not a Web browser. It’s not a phone. It’s not an iPod. It’s everything in one.” That became a revolutionary announcement. What we are basically telling the industry now is, it’s not a medical device, it’s not an EMR/EHR, it’s not an imaging system. It’s all in one, fully integrated on a mobile device, bringing the data to the physicians in one view wherever they are. We create that whole concept of the virtual physician in a way we have all been trying to do for a long time.

The key is to be able to now support data standardization throughout the care continuum, looking at things like CCD — continuity of care documentation — as a standard, and also looking at how we can move HL7 data to create a true healthcare information exchange and take advantage of things that the government has made available to us. This includes NHIN Direct or NHIN Connect for routing, data warehousing and also for an enterprise master person index.

Today the company has evolved beyond medical device mobility. Now we’re mobilizing EMRs/EHRs in a seamless way for physicians. We are now working with the existing standards the same way we’ve been working with the FDA requirements. We’re looking at the standards for data standardization, nomenclature and healthcare information exchange to be able to support the care continuum.

I think that AirStrip now offers is equivalent to what Steve Jobs announced for the iPhone. I think that AirStrip is the next generation of healthcare transformation — being able to put everything into one view for caregivers.


The company is fairly new to have gotten this far with remote monitoring solutions and FDA approval. Are you concerned about what it will take to go after those goals you mentioned?

We all have to recognize that the transformation is necessary and we need to stick to the things that we know, that will be able to make a difference. Transformation will take place thanks to our mobile platform.

I always make the comparison of operating systems on your devices. On your PC, you have Microsoft, or on any Apple device, you have the O/S, the operating system. The true value that you bring to improve workflow in any industry comes from the ability to apply technologies or applications on top of those operating systems. For us, we have the same situation, but we not only have good applications in the mobile space, but we have a very solid platform that we view as becoming that platform or operating system in healthcare that is going to allow for us to bring not only our modules, but other third-party components on top of our platform to be able to solve the problems that we are discussing.

From a development standpoint, what we’re going to do is stick to our core. Today, our core is mobilizing medical devices, EMRs and EHRs. When it comes to imaging and videoconferencing, all we’re going to do is look at third-party packages, plug them into our platform, and then use standards to be able to support single sign-on, content management, and as I spoke about earlier, healthcare information exchange to move the data around.

The key for us, and we’re doing, is to pick those healthcare organizations that are the visionaries and partner with them to be able to move in baby steps toward implementing this huge transformation — but do it in a way that we start region by region — medical devices, EMRs, EHRs and then bring the tools to those regions to be able to replicate that model in other geographies. What we’re doing is carefully picking those healthcare organizations that have the right vision and have the right clinical level of expertise and the right intentions to improve outcomes while reducing cost. Then, working with them, we take things to the next level.

When I’m talking about the vision, I’m really explaining a vision that we’re planning to achieve in the next 12 months. Although the technology is ready today, the bigger challenge is continuity of care. It’s allowing all those systems that the hospitals have to be able to comply with the standards that already exist.


How big is the company today in terms of revenue and headcount and how large it will need to get in the near term?

As a privately held company, we don’t share our revenue figures, but I can tell you that when I came in about two years ago, we were probably about 20 people. We have over 100 already. We have offices in San Diego, Nashville, Chicago, and our headquarters is in San Antonio — that’s where the company started.

As I mentioned to you when I talked about the growth of last year, we added a lot of presence with some key customers. We introduced our cardiology solution officially about 10 months ago and we already have anywhere between 57 to 60 hospitals installed. We already have contracts with another 200 to go live over the next 12 months.

We definitely see a significant growth in the company, but where we are putting most of the emphasis is on what we call clinical / business transformation. We clearly identified that technology is just an enabler of transformation. Transformation happens as a result of aligning people and process as drivers, with technology as an enabler. We created a whole new team where we brought physicians from the top consulting firms to work with us to be able to partner with our customers –you’re going to see some announcements in this area coming out in the next few weeks – to partner with customers to deliver the value proposition.

I believe that technology moving forward is not going to be acquired unless the technology pays for itself, clearly proves out the value proposition on a daily basis and is aligned with the requirements for ACO and Meaningful Use. That’s also why one of the acquisitions we made about two weeks ago was a Meaningful Use tracker to be bundled with our EMR enhancer. We believe that the EMR enhancer on mobile devices is going to increase decision, adoption and utilization and that automatically creates the compliance with Meaningful Use, being able to go to Level 1 and Level 2 much faster.


You have an extensive background in selling systems to the federal government. Do you see that in AirStrip’s future?

Yes. As you know, I was part of the team that installed 60 medical centers at the Department of Defense and 30 at the VA. That is close to my heart. My biggest passion before coming to AirStrip was to help those wounded warriors. Today’s environments are more dramatic. You look today at shortening stent time, event-to-balloon time, for a patient that has a full blockage of the arteries. You look at the wounded warriors, you have to immediately react to patients that are injured in the battlefield and take them through several layers of care until you bring the right outcomes to those kids.

My goal is take this to the federal government and be able to learn from what they have done in areas like security. The federal government is doing security at a level that no one else is doing yet in the private sector. We’re going through that process as we speak because we want to bring that lesson to the private sector – security from the federal government. We also want to bring the experience that we have in the private sector to all the things that we’re doing in the military space. So, yes, it’s definitely an area that we’re planning for.


Do you anticipate further acquisitions or going public at some point?

At this point we are backed by Sequoia. We just closed our third funding round with the Wellcome Trust group, who are very close partners with Sequoia. Now we have a strong 18 to 24 month plan to be that game-changer in healthcare.

That’s our immediate goal. How can we make the transformation to the point that everybody will look back two years from now and say, “AirStrip recognized the importance of virtualizing the caregivers and supporting the patient / population-centric model.” Everybody will remember the types of discussions that we’re having, how we were able to do that by collaborating with large progressive health systems as partners but also large EMR/EHR vendors and medical device companies. We are talking to all of them. We are looking at all of those as partners in full collaboration.

The idea of IPO is not something that we are concentrating on right now. We are enjoying this incredible growth. Acquisitions of other products that will be synergistic to our vision … we are always open to that.


Any final thoughts?

The key moving forward is coming up with the right technological approach and partnering with the right people and the right processes to be able to transform healthcare. But when we talk about people, we have to recognize that that we are talking about the provider, the payers, the vendor community, the systems integrators, all working together and collaborating to be able to sustain the transformation.

We know that transformation is coming. The sense of urgency has been established. This is where you’re going to see more collaboration between all the sectors, more than you have ever seen before. The ones that do not collaborate are the ones that are going to be left out.

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September 30, 2012 Interviews No Comments

News 9/28/12

September 27, 2012 News 2 Comments

Top News

9-27-2012 7-39-56 AM

The American Hospital association agrees in a letter to HHS Secretary Kathleen Sebelius and the Attorney General Eric Holder that EMR-assisted cloning and upcoding should not be tolerated, but retorts that CMS has ignored its repeated recommendations to expand E/M (evaluation and management) codes to create a national standard for hospital ED and clinic services. My opinion: the election-sensitive, administration-friendly HHS’ers got blindsided by a Center for Public Integrity article that insinuated but didn’t prove that a shift to higher complexity codes means that EDs and physician practices are gaming the system to the tune of $11 billion, so given too little time between now and the November 6 election to actually do something useful (like identify and prosecute someone who’s actually guilty), HHS just went public with meaningless finger-wagging to make it appear that they’re on top of the situation. HHS keeps bragging on how great their fraud detection systems are (which they should be, given the hundreds of millions paid to fat cat contractors to develop them), yet they apparently trust journalists more than their own armies of bureaucrats to tell them they have a problem. The reimbursement system is even worse than the tax laws in being a confusing hodgepodge of rules that nobody, even CMS, really understands or can interpret consistently. Some providers are undoubtedly committing fraud and the 99% honest ones would love to see them shut down and punished. However, as with tax loopholes, there’s nothing illegal or immoral about taking the maximum benefit that the law allows. There’s a reason that crime syndicates are moving from drug dealing to Medicare fraud: payment is quick and rarely questioned, the money is great, and the risk of actually going to jail is almost zero.

Reader Comments

From High Roller: “Re: QuadraMed. Quantum is just the first QuadraMed domino to fall. Franciscan Partners isn’t interested in holding on to the rest of the company forever, so it won’t be long before the other pieces are sold off. QuadraMed has a large enough client base, so they could milk their revenue stream for awhile. More likely, Franciscan will look to sell what’s left to someone like Allscripts who’d be interested in having a larger client base to sell into.”

HIStalk Announcements and Requests

inga Highlights from the last week on HIStalk Practice: patients want more online access to their health records but most doctors don’t offer the option. Lack of staff impacts EHR adoption, especially in smaller practices. Tips for using an EHR as a marketing tool and to increase patient satisfaction. Parents are more likely to fill children’s e-prescribed prescriptions than paper ones. Physicians are working fewer hours and seeing fewer patients than they were four years ago. I am looking for some MGMA picks. Thanks for reading.

9-27-2012 5-59-09 AM

Welcome to new HIStalk Platinum Sponsor Emdat, which offers hybrid clinical documentation and transcription solutions that improve the productivity and satisfaction of EHR-using physicians. Instead of pointing and clicking, physicians continue to use the most efficient method of documenting patient encounters – dictation. Emdat’s DaRT system automatically tags sections of transcription content (chief complaint, medical history, etc.) and then seamlessly auto-populates discrete information directly into the EHR just as though the physician entered it directly using structured documentation. Its Emdat Mobile solution not only allows physicians to document encounters on the go, but provides a more patient-friendly way to document during an encounter. Loyola University Health System uses it with Epic and says the setup was simple, reducing transcription turnaround time by 50% and allowed doctors to continue dictation, which they say is faster and better for patient care. Thanks to Emdat for supporting HIStalk.

inga Mr. H took off a little early to treat Mrs. H to some fun, so today’s post is a bit shorter than usual.  He’ll be back to serve up a full course of the Monday Morning Update over the weekend.

Acquisitions, Funding, Business, and Stock

 9-27-2012 7-40-04 AM

9-27-2012 7-35-34 AM

As reported earlier today, Nuance will acquire QuadraMed’s Quantim product line. You have to wonder if Nuance didn’t rush the announcement a bit following our Wednesday mention of the deal on Twitter and HIStalk: early Thursday morning Nuance posted these (now corrected) announcements referring to “QuadaMed” and “Quantrim.”

The Kentucky Economic Development Finance Authority approves a $150,000 grant for Health Catalyst, a business accelerator for companies creating health-related software, including life-sciences and HIT companies. Health Catalyst will nurture five startups a year by providing work space, mentoring, and seed funding.


9-27-2012 3-48-26 PM

Evergreen Health (WA) selects MEDSEEK’s ecoSmart Patient Precisioning solution for predictive analytics.

Adventist Health selects MedeAnalytics’ Patient Access Intelligence solution for point-of-service cash collection across its 16 hospitals.


9-27-2012 6-42-20 AM

Mark Burgess (Cerner) joins Allscripts as director of solutions management.

Fletcher Allen Health Care (VT) hires Adam P. Buckley, MD (Beth Israel Medical Center) to be the organization’s first CMIO.

Announcements and Implementations

9-27-2012 3-31-19 PM

Wake Forest Baptist Health (NC) goes live on Epic.

Wellcentive announces Advance Risk Manager, a predictive risk modeling system for population health management that allows providers to focus on patients with specific risk profiles.

The three largest health systems in St. Louis join the Missouri Health Connection HIE.

Government and Politics

9-27-2012 4-41-20 PM

Rep. Mike Honda (D-CA) will introduce a bill to set up an Office of Mobile Health at the FDA to provide recommendations on mobile health issues. The legislation also calls for the creation of a support program at the HHS to advise app developers on privacy regulations and for a low-interest loan program for physician offices to purchase new technology.


9-27-2012 3-14-20 PM

The West Health Institute is developing Sense4Baby, a wireless and portable fetal monitor for high-risk pregnancies in remote clinics. The system, which is being piloted in Mexico, sends the captured data over a cellular network to the patient’s physician.


The Seattle Times covers Caradigm, the Microsoft-GE joint venture whose headquarters opened this week in Bellevue,WA. Positive comments from Providence about Amalga are included, along with less enthusiastic ones from Swedish CMIO Tom Wood, who says he’s not sure how they can add a layer on top of EMRs without a lot of cooperation.

UMass Memorial Health Care (MA) will eliminate 140 positions, some of them in IT, in seeking $80 million in cost reductions.

John Reynolds, the former CEO of Hospital for Special Surgery (NY), is arrested for racketeering, charged with soliciting kickbacks from prospective vendors and extorting $300,000 from a hospital employee in return for arranging an annual bonus.

9-27-2012 6-59-04 AM

Weird News Andy wonders how this is possible. A women who is “internally decapitated” when her skull is torn from her spine in a car accident not only survives, but is basically back to normal.

Here’s a new video from St. Jude Children’s Research Hospital, featuring patients, employees, and celebrities singing “Hey, Jude” to highlight National Childhood Cancer Awareness Month. Some of those featured are Jennifer Aniston, Betty White, Robin Williams, and Michael Jordan.

Two-thirds of CHIME members report staff shortages and are in most need of more specialists to implement and support clinical applications.

A study published in the Journal of the American Medical Informatics Association concludes that CPOE was the main challenge among hospitals failing to achieve MU in the program’s first year.

Sponsor Updates

9-27-2012 6-50-09 AM

  • TELUS Health brings its TELUSHealth.com portal live to showcase its solutions that link Canadian patients to their providers.
  • Elsevier unveils its EduCode Clinical Documentation Improvement eLearning curriculum for ICD-10 at next week’s AHIMA meeting.
  • New York eHealth Collaborative spotlights five health IT champions at the NYeC gala October 15.
  • Muhannad Samaan, MD of Aultman Inpatient Medicine discusses how Ingenious Med’s charge capture software improved patient hand-off and communications.
  • Software Magazine ranks Macadamian #435 on its Software 500 list, which is based on revenues of the world’s largest software and services suppliers.
  • Sandlot Solutions releases a report on using data and analytics to improve healthcare delivery.
  • Skylight Healthcare Systems integrates its Service Recovery process with Vocera’s communication devices.
  • Optum launches its Optum ICD-10 Core Education program.
  • TI combines its DM8148 system on-a-chip with Imprivata OneSign to provide out-of-the-box strong user authentication into any software application.
  • McKesson expands its Intelligent Coding portfolio to include observation services.
  • First Databank executives Keith Fisher, MS and Patrick Lupinetti, JD  will present educational sessions at next month’s AMCP 2012 Educational Conference.
  • Vitera Healthcare Solutions reports record attendance at this month’s VIBE conference in Orlando.
  • 3M Health Information Systems adds 18 physician education modules to its Web-based curriculum to address ICD-10 readiness.

EPtalk by Dr. Jayne

Don’t forget — October 3 is the last day for Eligible Professionals to begin their 90-day reporting period for the Medicare EHR Incentive Program, aka Meaningful Use. One of my buddies in the consulting business has been sharing e-mails he is receiving from providers. Today’s special: “I would like to be Meaningful Use but do not know to begin. I need the money. Please send tips for me to start?” I guess that’s someone’s idea of a consulting RFP.

An American Medical News article lists common EHR blunders. I’ve seen all of these in various forms across practices from small to large. Topping the list: lack of infrastructure, lack of workflow assessment, lack of training, lack of buy-in, failure to communicate with patients about delays during the transition, and failure to appropriately integrate the computer into the patient-physician relationship.

News flash: Nearly one-third of US medical school students who initially planned to enter primary care ended up switching to a more lucrative specialty. Surveys of students in New York show that “medical students who anticipated high levels of debt upon graduation and placed a premium on high income were more likely to enter a high-paying medical specialty.” Really.

In similar news, the US medical schools that still don’t have Family Medicine departments are starting to get with the program. Some of these schools are big name and I know all too well what it’s like to attend one. Now we just need to get all medical schools to incorporate informatics into their programs. Let’s teach budding doctors (and nurses, and everyone else) how to leverage technology to better care for patients rather than fighting it or trying to undermine it. Although the new generation seems tech savvy, I see too many students trying to short-cut their documentation.


Mashable lists “10 Office Technologies on Their Way Out.” The list of items they predict will vanish in the next five years includes obvious items like fax machines, tape recorders, and the Rolodex. I’m not sure about desktop computers, cubicles, and standard working hours. There are a lot of entrenched management types out there who will resist. Although I won’t miss formal business attire, which includes pantyhose (#7), I’d like to lobby to keep fashionable shoes part of the equation. If I see one more pair of flip-flops in the office, I just might scream.

The Greater Atlanta area is a hotbed of health IT vendors, so I hope that none of you were recipients of the free kittens given away in the parking lot of the McDonough Walmart. Apparently they were rabid.

As Mr. H mentioned earlier this week, HIMSS registration is open and the room supplies are dwindling. I’m glad he gave me a reminder. I booked tonight, yet wasn’t able to get my preferred hotel or even my preferred dates. I’m leaving a day early, but that’s probably OK since I have to take vacation to attend this year. My hospital no longer has a conference budget or paid professional development days, so I’m not complaining about spending one less night in an overpriced hotel. Plus, I was able to snag a super-cheap plane ticket so I can afford some hot new shoes for Histalkapalooza.



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

More news: HIStalk Practice, HIStalk Mobile.

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September 27, 2012 News 2 Comments

Nuance To Acquire QuadraMed’s Quantim HIM Line

September 27, 2012 News 3 Comments

9-27-2012 8-26-30 AM

Nuance Communications announced this morning that it will acquire QuadraMed’s Quantim product line for health information management. Quantim includes applications for coding, compliance, computer-assisted coding, abstracting, clinical documentation integrity, record and document management, and workflow.

HIStalk reported Nuance as the buyer Wednesday on Twitter and on HIStalk following the filing of Federal Trade Commission documents. The announcement was reportedly originally scheduled for October 1, the first day of the AHIMA conference.

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September 27, 2012 News 3 Comments

Readers Write 9/26/12

September 26, 2012 Readers Write No Comments

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

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

Weaknesses Revealed:  Secrets Exposed by Data Integrity Summary Reports
By Beth Haenke Just

9-26-2012 7-37-49 PM

The data integrity summary report is one of the most powerful – yet underutilized – tools hospitals have at their disposal for maintaining the integrity of the data within their MPI. Digging deeper into the statistics provided in these reports reveals far more than the volume of overlaid or duplicate records within the system. It can also reveal areas of weaknesses that, left unchecked, could threaten the long-term integrity of the MPI, limit its usefulness in achieving quality and safety goals and Meaningful Use, and hamper participation in ACOs and HIEs.

In addition to pinpointing the root cause of data integrity issues, summary reports can identify specific areas upon which hospitals should focus corrective efforts. These may include improved education and training, policy clarification, enhanced communication, and other steps that result in fewer duplicates and overlays for a more accurate MPI and improved data integrity.

Regular reviews of summary reports can also reveal patterns of errors. For example, too many null or empty fields in certain records can signal problems with registration processes. Drilling down deeper, data integrity statistics can be used to track errors with greater specificity, such as identification of incorrect patients, transposed Social Security numbers, or non-compliance with naming conventions. Data integrity reports can even provide detailed insight into the specific types of errors that are happening most frequently within individual departments or facilities and even enterprise-wide.

Once patterns are identified, individual cases can be closely examined to pinpoint where additional training or policy refreshers might be required. Coupling the data integrity summary report with advanced analytics tools allows hospitals to determine precisely where errors are entering the system and the specific types of mistakes being made. This, in turn, allows education programs to be customized to strengthen specific areas of weakness.

For example, if the summary report reveals an unusually large number of registration errors being made within a short period of time, a hospital can drill down into the data to determine the department where the mistakes are originating, as well as who is making them, why, and how. Often the culprit is an individual who is unfamiliar with the registration process and who is attempting to save time by creating new records for every patient versus first searching the MPI for existing ones. Additional training and education will significantly reduce, and in some cases eliminate, these types of registration errors.

The integrity of patient identity data is critical to achieving care quality and safety goals and plays an integral role in the success of HIEs and ACOs. By taking advantage of the wealth of information found within summary reports, hospitals and health systems can ensure the long-term integrity of their data.

Beth Haenke Just, MBA, RHIA, FAHIMA is CEO and president of Just Associates of Centennial, CO.

Round Peg in a Square Hole: Behavioral Health and EMRs
By Kathy Krypel

9-26-2012 7-43-34 PM

Implementing an EMR for behavioral health is like putting a round peg in a square hole. Yes, you read that right: a round peg in a square hole (the opposite of the traditional analogy). The EMR (round peg) can fit, but unless certain steps are taken, it won’t fill the behavioral health (square hole) need entirely. Those steps that need to be taken include:collecting the appropriate data and offering the behavioral specific tools and care plans for optimal diagnosis and care delivery.

Why does it matter? Since many large hospital systems offer behavioral health services as part of their continuum of care, it is important to fill in the gaps and variances around the EMR. The following are just a few examples of why it is important to offer behavioral care services that are supported by a robust EMR:

  • One in eight (or nearly 12 million) ER visits in the US are due to mental health and/or substance use problems in adults.1 This is the most costly venue for care delivery.
  • Major depression is considered equivalent, in terms of its burden on society, to blindness or paraplegia. Schizophrenia is equivalent to quadriplegia.2

What are these behavioral healthcare EMR gaps and variances?

  1. Providers. Most behavioral health providers are not MDs. In fact, primary care physicians spend limited time with patients and are often hesitant to diagnose and treat behavioral concerns. Most behavioral health providers are clinicians with Masters or Doctorate degrees who have been licensed by their state(s) to diagnose and treat behavioral health disorders.
  2. The diagnostic process and tools. Behavioral health disorders are the only serious, chronic illnesses that are diagnosed based solely on self report. The tools used to assess the behavioral health patient’s mental status and substance abuse patterns are very different than the traditional medical diagnostic tools of imaging and lab work. Behavioral health diagnostic tools are most often elaborate question and answer tools that are can be both clinician-administered and self-administered. Behavioral health clinicians use tools such as the Beck Depression Inventory (BDI), Generalized Anxiety Disorder scale (GAD 7), and the Diagnostic and Statistical Manual (DSM IV). These tools need to be incorporated into the data capture and workflow built into an EMR. Additionally, behavioral health providers are required to develop elaborate treatment plans with the patient’s participation. Non-behaviorally focused EMRs typically don’t have tools built in for this and must be built (or ignored). If ignored, the EMR becomes nothing more than a word processor.
  3. Customization will always be required. While there are multiple behavioral health specific EMR vendors in the marketplace and enterprise-wide EMRs that can be configured to cover behavioral health, customization will be required to meet multiple state-specific mandates, practitioner specialty requirements, and federal privacy rules that apply to behavioral health.

Although there are challenges, successes are growing. The following recommendations help to ensure a positive implementation outcome:

  • Create a small but specific implementation team that aligns with your behavioral health leadership during the build and test period, so all build and testing work is completed in a collaborative manner.
  • Build using the most commonly used diagnoses and their DSM IV criteria into the EMR to make it easy for providers and therapists to use drop-down lists to create the diagnostic picture of the patient.
  • Build using ASAM criteria, so chemical dependency staffs can more easily complete treatment planning.
  • Design within the “tighter than HIPAA” federal constraints that govern confidentiality of patient information for patients receiving chemical dependency treatment (i.e., CFR 42).
  • Involve trainers and testers in the workflow discussions.

In order to avoid putting a round peg in a square hole, it’s essential to understand the variances in the behavioral health setting and address them in workflow, data capture, information exchange, provider engagement, and administrative requirements and incorporate them into the EMR project plan, design, and implementation.


1. Mental Disorders and/or Substance Abuse Related to One of Every Eight Emergency Department Cases. AHRQ News and Numbers, July 8, 2010. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/nn/nn070810.htm

2. Disability Adjusted Life Year, DALY, Daly 2004

Kathy Krypel is master advisor at Aspen Advisors of Pittsburgh, PA.

Data Virtualization Best Practices Accelerate Time to Value
By Richard Cramer

9-26-2012 7-46-55 PM

Data virtualization offers a value proposition that quickly excites business leaders and technologists alike. Business executives are enthusiastic because data virtualization enables IT departments to more quickly respond to new requirements – often in days or weeks rather than months or quarters. Information technologists are similarly excited about being able to get more done, more quickly, and deliver higher value to their business customers.

However, unless we’re careful, this same enthusiasm can lead to organizations trying to use data visualization where it’s not appropriate and results in a classic “square peg in a round hole” situation. It is important to keep in mind that while data virtualization is an important part of the data management tool kit, it is not the right tool for every purpose, and doesn’t eliminate the need for a traditional data warehouse.

Successful deployments of data virtualization share some common characteristics. First is that data virtualization is most successful when it complements a mature data management infrastructure, development standards, and implementation processes. Best practice in these organizations is to use data virtualization as a part of an overall data management life-cycle where data mapping logic that had been built in the virtual solution is seamlessly reused in the physicalized data integration solution.

Second, there are specific use cases where data virtualization is most appropriate. Best practice is to vet candidate uses of data virtualization against these use cases. Just because data virtualization can be used does not mean it should be used.

This is particularly true in the early stages of adopting data virtualization technology, since missteps in using data virtualization for inappropriate use cases in the first project or two can give the technology a black eye that is hard to overcome later.

Good use cases for data virtualization share the following characteristics: (a) data needs are of a short duration; (b) business requirements are unclear or evolving; and (c) situations where quickly prototyping a view of integrated data is required.

Situations where data virtualization is not a good fit include: (a) complex join logic is required; (b) high performance query response is a driving requirement; or (c) source system availability is unreliable or unpredictable.

In this context of best practices, it is exciting to see the healthcare industry providing many opportunities where data virtualization can be a key enabler of organizations looking to maximize their return on data. There are a large number of healthcare organizations with traditional enterprise data warehouse solutions in place, and that can most benefit from the addition of data virtualization to their architecture.

There are also many examples of use cases that are appropriate for data virtualization and can quickly deliver high value. For example, data virtualization can be used to accelerate drug research by providing scientists with integrated views of internal and external information to aid in the drug discovery process. The unpredictable nature of discovery can be enabled by virtualized data integration solutions—quickly combining lesser-known external data with well-known internal data speeds up the decision-making process and ultimately reduces the time to bring new drugs to market.

For healthcare providers, the ability to respond to ambiguous and frequently changing data requirements in a rapidly changing regulatory and business environment is a must. The rapid prototyping enabled by data virtualization can be invaluable in meeting fleeting reporting and data needs today that may be gone or completely different tomorrow. 

Richard Cramer is chief healthcare strategist of Informatica Corporation of Redwood City, CA.

Coordinating Physician and Nursing Care
By David Lareau

9-26-2012 7-52-29 PM

Historically, physician and nursing systems and workflow have often been parallel, but independent of each other. Physicians and nurses must be able to share information to provide coordination of care.

For example, physicians must comply with standards such as ICD-10, ICD-9, SNOMED CT, RxNorm, LOINC, DSM-IV, and CPT, while nurses employ terminology like NANDA, NIC, NOC, ICNP, PNDS, and CCC. With so many different standards in place, creating an integrated picture of patient care can be difficult at best.

Fortunately, all of these standards have already been mapped to link physician and nursing information. The capability now exists to integrate physician and nursing documentation and care capabilities as well as provide links between a patient’s clinical diagnoses and nursing care.

To create this functionality, all existing nursing standards were evaluated to identify the best candidate for use at the point of care in computerized systems. The Clinical Care Classification (CCC) system was selected and 182 CCC Nursing Diagnoses were linked to the more than 55,000 clinical diagnoses. Linking the CCC and clinical diagnoses makes it possible for all members of the care team to generate a list of nursing diagnoses based on the physician’s clinical diagnoses for that patient.

In addition, CCC Nursing Diagnoses are linked to CCC Nursing Interventions and to more than 1,760 specific nursing actions. Also, a starter set of customizable documentation protocols has been developed for each of the nursing actions.

One of the most significant aspects of this work is that the same concepts in the nursing protocols are linked to the physician content where appropriate. Coordination of care has arrived.

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

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September 26, 2012 Readers Write No Comments

News 9/26/12

September 25, 2012 News 4 Comments

Top News

9-25-2012 5-32-10 PM

HHS Secretary Kathleen Sebelius and US Attorney General Eric Holder warn AHA and other hospital organizations that the government will take appropriate steps to pursue healthcare providers who misuse EHRs to defraud Medicare, specifically calling out upcoding and cloning of medical records.

Reader Comments

9-25-2012 8-30-24 PM

inga_small From Wicked Fun: “Re: HIStalkapalooza planning. I just moved from the vendor side to a provider organization. As much as I am loving my brand new job, I miss the ‘fray’ of the world of HIT. The first comment from one of my MD friends  was, ‘What if you don’t go to HIMSS? We always go to the HIStalk party together!’’” The lesson here for the HIStalkapalooza faithful is to add our annual event as a mandatory condition of employment in your contract negotiations. If you like planning ahead, the 2013 version of HIStalkapalooza is scheduled for Monday, March 4, with registration opening sometime in January.

9-25-2012 7-25-33 PM

From Plinker: “Re: Northwestern in Chicago. Going Epic.” I don’t recall if I’ve mentioned that previously.

9-25-2012 6-50-30 PM

From Squint Eastwood: “Re: Vermont. Not a rumor, but interesting.” Fletcher Allen Health Care and Dartmouth-Hitchcock Medical Center submit an ACO plan that would create the for-profit OneCare Vermont LLC, which would include 13 of the state’s 14 hospitals (Porter Medical Center passed), 58 medical practices, two FQHCs, and other organizations. If approved in October, OneCare would be up and running by January 1, serving most of the state’s 105,000 Medicare beneficiaries. Fletcher Allen SVP Todd Moore, who will be CEO of OneCare if it’s approved, says access to data was a driver. “This is really an access to information revolution as much as it is anything else for us. This gives us access to the full claims set for the first time to Medicare beneficiaries that we treat … to understand how they seek care, how often they go to (the doctor) — whether it be at Fletcher Allen or at Northwestern Medical Center or in Florida.”

9-25-2012 7-24-04 PM

From Adam: “Re: Tampa General Hospital. Saw they’re going with RelayHealth for HIE. Aren’t they an Epic shop?” They are indeed.

From HereWeGo: “Re: MCK acquisition of MedVentive. The fat, spoiled kitty found a new toy to bat around and destroy until the next shiny object captures its attention.” Usually the fat cat in a given deal is the seller, so at least some of MCK’s cash trickled down to the MedVentive owners. I should clarify that the rumored MCK acquisition that I mentioned last week isn’t MedVentive, so another announcement could be coming if the rumor turns out to be accurate.

From Bobby D: “Re: MCK acquisition of MedVentive. This is the second company that Nancy Brown has been involved with that McKesson bought, the first being Abaton.com. She has two to go to catch Mike Myers of CliniCom history, who has sold them four companies.” Mike’s at QuadraMed now, I’m told, so he could bag “one for the thumb” if MCK happens to buy QuadraMed’s Quantim line, if indeed the rumor is true that it’s about to be sold (and even if it is, MCK hasn’t been mentioned as a player.) UPDATE: per Federal Trade Commission filings, Nuance will be the acquirer of Quantim.

From Moak: “Re: upcoding. How did you miss this one?” I get at least one e-mail per day (including this one) with a link to a big news story that I’ve already covered, so skimmers are missing out. Still, I appreciate the notice just in case I really did miss something, and Moak brings up an interesting point: the feds gave Faxton St. Luke’s Healthcare (NY) as an example of an ED whose higher levels of treatment jumped 43 percent in 2009, the same year it implemented EHRs. He says the hospital only has 22 days’ cash on hand and therefore is not stealing from anyone. I wouldn’t necessary make that assumption since poverty usually encourages rather than discourages criminality, but I think his point is that the hospital was struggling financially and may have simply cracked down on sloppy billing practices. One might assume that the feds would do some audits before slamming the entire healthcare provider universe with unproven fraud innuendo, but given its poor track record in uncovering even widespread fraud (see: South Florida), maybe the only arrow in its quiver is to bluff. If they have found even one case of EHR-abetted fraud and wanted to deliver an effective message, they should have had a photo op with someone in handcuffs.

HIStalk Announcements and Requests

9-25-2012 8-33-06 PM

inga_small A big thanks to all the readers who sent me notes bragging that they had already gotten their iPhone 5s after little or no wait at their local Apple store. My phone will arrive from China on Thursday. I loved the lightweight feel of a friend’s iPhone and had fun taking a few panoramic photos. My friend claims it is much faster than the iPhone 4, but she is not yet convinced the battery life is dramatically improved.

9-25-2012 6-07-15 PM

Welcome to new HIStalk Platinum Sponsor VersaSuite. The Austin, TX company offers an integrated system for medical enterprises (hospitals, clinics, surgery centers) that includes a hospital information system (including CPOE and eMAR), inventory management, RIS/PACS, laboratory information system, pharmacy management system, accounting, and HR. It’s all built on a single Windows-based stack running on a single database, standardizing the user experience across inpatient, outpatient, and ED. The company says it holds the largest number of CCHIT certifications of any single product, including CCHIT’s enterprise certification, giving healthcare systems one product that is MU certified for both EPs and hospitals. VersaSuite’s EHR includes specialty-specific templates for 24 disciplines, keyboard-free data entry, dashboards, tablet support, and a four-click assessment/plan for outpatients that takes only 5-10 seconds vs. up to two minutes in competing EHRs. The company is a member of IHE and its products support interoperability standards such as HL7 and DICOM and are compliant with HIPAA 5010 and ICD-10. Thanks to VersaSuite for supporting HIStalk.  

I booked my HIMSS room this week and suggest you don’t wait too long. I got my first choice, but the supply for close-in rooms is dwindling. HIMSS usually opens up more hotels later, but they’re usually a long shuttle bus ride to BFE.

Acquisitions, Funding, Business, and Stock

9-25-2012 7-28-59 PM

Cancer support site Navigating Cancer raises $2.3 million to hire developers and integrate its patient portal into EMR applications.

McKesson announces that it will acquire MedVentive, which offers population and risk management tools.


9-25-2012 8-34-56 PM

Wentworth-Douglass Hospital (NH) selects the Siemens perioperative management system by SIS.

The Upper Peninsula HIE (MI) will implement ICA’s CareAlign CareExchange platform.

Tampa General Hospital (FL) selects RelayHealth Enterprise HIE for CCD data exchange.

9-25-2012 8-36-06 PM

Johns Hopkins Hospital and Health System (MD) selects 3M’s 360 Encompass System for automated coding and clinical documentation.

Health plan service provider Magnacare (NY) will offer online appointment scheduling services from DocASAP, a startup competitor to ZocDoc.

Methodist Dallas Medical Center (TX) selects ProVation Order Sets from Wolters Kluwer Health.

9-25-2012 6-04-21 PM

Amcon’s Australian division announces the launch of its Messenger clinical alerting middleware at the 848-bed St. Vincent’s Hospital Melbourne.


9-25-2012 9-17-18 AM

M*Modal hires Mike Etue (OptumInsight, Allscripts) as EVP of sales, replacing Michael Clark.

9-25-2012 10-54-01 AM

Former PatientKeeper VP Michael Bertrand joins home health software provider HealthWyse as VP of development.

9-25-2012 5-28-50 PM

RemitDATA appoints John Stanton (Beacon Partners, above) as VP of consulting and Phillip McClure (MedeAnalytics) as VP of sales.

9-25-2012 1-40-21 PM

Beacon Partners promotes Christopher Kondrat from principal to VP of professional services.

9-25-2012 7-17-08 PM

Phillip Madden (Cerner) is named director of client sales at Orion Health.

Yuma Regional Medical Center names Robert Budman, MD (Catholic Healthcare East) as CMIO.

Besler Consulting appoints Edward J. Niewiadomski, MD (Southern Ocean Medical Center) as senior medical advisor.

Quality Systems, Inc. appoints Daniel J. Morefield (LEADS360) as EVP/COO.

Announcements and Implementations

Munson Healthcare (MI) implements VPLEX Metro virtual storage from EMC and private cloud technology from EMC and VMware.

9-25-2012 3-10-10 PM

SCIOinspire Corp. changes its name to SCIO Health Analytics.

Prognosis adds a configurable template engine and a physician rounding tool to its ChartNotes EHR.

In the UK, CSC admits that it will sunset the former iSOFT physician systems, including Synergy, Premiere, and Ganymede, that are used by about six percent of England’s practices. It denied the rumor of the impending retirement until Monday’s announcement.

9-25-2012 6-00-41 PM

PerfectServe adds a patient-centered rounding feature to its communications system, allowing clinicians to contact the appropriate physician for each patient.

Cleveland Clinic is implementing software from its new spinoff iVHR, which will present information from its Epic system to doctors in a visual form. The software will create maps patient locations with indicators of patient condition that link to all the background data from Epic, displaying it visually to help doctors see the big picture.

Government and Politics

The FCC’s mHealth Task Force recommends that wireless health and e-Care technologies be incorporated as best practices for medical care by 2017. Example technologies are remote monitoring devices, apps, body sensors, implanted microstimulation devices, medical device data systems, provider apps for remote image viewing, patient portals, clinical decision support tools, and a broadband-enabled HIT infrastructure. Some of its specific recommendations to the FCC include: (a) fill the open position for an FCC healthcare director; (b) provide education and outreach; (c) work more closely with ONC and CMS, specifically helping ONC with secure health messaging and communications standards; and (d) open up more of the communications spectrum for mobile broadband.

9-25-2012 8-37-47 PM

UC Davis Health System signs a 16-month, $17.5 million agreement to take over the state’s struggling HIE, formerly run by Cal eConnect. The project has been renamed the California Health eQuality Program (CHeQ) and will be led by Ken Kizer, MD MPH of UC Davis, who was previously CEO of the VA healthcare system, Medsphere, and the National Quality Forum. The project is halfway through its four-year, $39 million grant. They claim they are confident they’ll seamlessly move to a post-grant revenue model when the federal breast runs dry in 2014, which will make them one of almost none if they actually pull it off.

9-25-2012 8-38-30 PM

NPR posts the audio and transcript from Tuesday’s “The Diane Rehm Show,” featuring Farzad Mostashari and others on “The Pluses and Minuses of Electronic Medical Records” (but not Diane Rehm, who was on vacation, and not Farzad for the second half because he had to leave). The substitute host led an inordinate amount of the discussion toward upcoding, which made it a lot less interesting. What Farzad said: (a) maybe the EHR just captured the charges correctly; (b) the current system pays doctors more for recording what they actually do, so why wouldn’t they?; (c) EHR or not, fraud is illegal, and in fact the audit trails of EHRs can make it easier to detect. A former healthcare CIO and practice manager named Jim called in to say that his docs always intentionally downcoded with paper records because they were afraid insurance companies would challenge their recordkeeping, but were more confident that electronic records made it safe to bill accurately.


OIG finds that Essentia Health (MN) overbilled Medicare by $865,000, or $3.18 for every $1.00 it was owed. Essentia blames its billing system, which it says it has replaced.

Avado CEO Dave Chase opines in a Forbes article that New York is “the epicenter of healthcare’s reinvention.” He cites as examples health accelerators, Medicaid HMOs, WebMD, the New York eHealth Collaborative, the state HIE, IBM, and Farzad Mostashari.

9-25-2012 8-40-14 PM

Weird News Andy finds an article from the physician author of Bad Pharma stating what everybody knows: drug companies selectively publish studies that make their drugs look good, using tricks such as small-numbers studies and statistical tricks that exaggerate questionable benefits. Less-flattering studies get shelved. Industry-funded drug trials were positive 85 percent of the time, while only 50 percent of government-funded studies were. Industry-sponsored studies of statin drugs were 20 times more likely to favor the test drugs. From the book’s description, “We like to imagine that doctors are familiar with the research literature surrounding a drug, when in reality much of the research is hidden from them by drug companies. We like to imagine that doctors are impartially educated, when in reality much of their education is funded by industry. We like to imagine that regulators let only effective drugs onto the market, when in reality they approve hopeless drugs, with data on side effects casually withheld from doctors and patients.”

Another WNA find, which he labels “workaholic”: the New York Post digs through public records to find city-employed psychiatrists who make multiples of their base salaries by claiming extensive overtime for ED coverage. One psychiatrist boosted his $173K base pay to $481K by claiming he worked 80 hours per week. The same doctor made $689K in 2009 by turning in 3,820 hours of overtime, including one non-stop stretch of 96 hours. The physicians are also allowed to operate private practices.

9-25-2012 6-40-48 PM

Here’s the latest cartoon from Imprivata.

Sponsor Updates

  • eClinicalWorks releases the agenda for its October 25-28 National Users Conference.
  • DrFirst creates an infographic called “Key Dates You Need to Know to Maximize Meaningful Use Incentive Payments.”
  • Lifepoint Informatics announces its Gold Level sponsorship of the G2 Lab Institute Conference in Alexandria, VA October 10-12.
  • MED3OOO VP Steven Stout discusses the risk and rewards of contracting for global risk in an October 3 Webinar.
  • McKesson hosts a September 27 Webinar on strategies for driving reimbursement.
  • A survey by commissioned by simplifyMD finds that EMR vendors often convince practices to replace their practice management system when implementing their EMR, but practices often experienced problems with cash flow and employee productivity as a result.
  • MedVentive offers demos of its Population Manager and Risk Manager products during next week’s AMGA Institute for Quality Leadership Annual Meeting.
  • Benefis Health System (MT) realizes a $4.9 million increase in appropriate hospital charges, a $3.5 million increase in reimbursement, and a $2.3 million reduction in uncompensated care within four months of implementing the first phase of its RCM initiative with MedAssets.
  • MedAptus releases its Mobile Schedule application for Apple iOS.
  • An Imprivata-sponsored survey finds that 72 percent of hospital IT decision makers believe pagers will be replaced by secure text messaging within three years.
  • iSirona releases a white paper on device integration.
  • Wellsoft will participate in the 2012 ACEP Scientific Assembly next month in Denver.


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

More news: HIStalk Practice, HIStalk Mobile.

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September 25, 2012 News 4 Comments

HIStalk Advisory Panel: Increasing Physician Involvement

September 24, 2012 Advisory Panel 1 Comment

The HIStalk Advisory Panel is a group of hospital CIOs, hospital CMIOs, practicing physicians, and a few vendor executives who have volunteered to provide their thoughts on topical industry issues. I’ll seek their input every month or so on an important news developments and also ask the non-vendor members about their recent experience with vendors. E-mail me to suggest an issue for their consideration.

If you work for a hospital or practice, you are welcome to join the panel. I am grateful to the HIStalk Advisory Panel members for their help in making HIStalk better.

This month’s question: What successful actions have you taken to improve the involvement and satisfaction of physicians with IT projects and services?

  • We ask physicians what kind of IT solutions they believe would be beneficial to our service, quality, and affordability objectives. Physicians help us evaluate proposed solutions. Project teams are partly staffed by physicians, and in some roles, we pay them for their subject matter expertise. CIO meets directly with CMIO to ensure alignment on priorities and clarity regarding improvement opportunities.
  • We strive to find ways to use HIT to make it easy for our physicians to do the right thing. We obsess over how many clicks each action takes, and whether someone else on the team should be doing it instead of the doctor. We are not perfect, but we’ve stumbled into a few things based on these principles which are unique ways to use our EMR, but which result in improved efficiency and quality.
  • We formed a physician group called the PIT (Physician Information Technology) group that meets every other week. We do this so frequently because we are in the middle of a large EMR project. We run all decisions impacting docs through this group, from order sets to clinical notes design. Another thing we have done is launched a physician portal that has a blog manned by our CMIO and CIO, but I will have to tell you it does not get much traffic.
  • The single most important tool for physician engagement has been shoe leather (OK, shoe rubber?) Getting out and making face-to-face contact with them in the hospital and in the clinics. Asking what works and what we can do better. Optimizing the EMR is an ongoing task and the first step is to convince them that we’re committed to it. Also, recognizing that one size does not fit all, whether it is the interface or the device or the software tools, has been critically important. Be flexible wherever possible about the tools we provide.
  • I think this follows the classical thought process today: First, have a physician in a key leadership area seen as the owner of the project. I like to have a VPMA or Medical Director leading the charge depending on the scope of the project. (IMO, depending on this roles relationships with physicians and the physician model of the organization, this may or may not have any impact on the project.) Another key is having the right type of person in a Physician/IT role (CMIO, Med Dir of Informatics, etc.) Someone that can earn the trust and respect of the other Docs, translate clinical needs between IT and business workflow, and "prep the battlefield" for major decisions by meeting with groups or individuals off-line. Having key physician champions attend discussions with other clinical areas is a must. This is where workflows overlapping various areas (physicians and nursing, for example) come to a head. For ongoing support, maintenance, and optimization, having IT topics on MEC, division meetings, physician steering/champion groups, etc is a key strategy. And as a last resort, free meals are always appreciated. 
  • We’ve taken a new approach to engaging physicians with our EMR via an online collaboration / community. Our "MyEMR" secure intranet site is unique and now has almost 500 physician members. Physician IT champions moderate discussion forums, answer questions for their peers. Education ‘tips and tricks’ videos. Design drafts are posted for review on new content and development items. New information (e.g., Stage 2 Meaningful Use information) also posted for review and education. Project status documents posted so that all can see progress on important efforts. This site was conceived by our physicians and now co-managed with them.
  • Defining specific roles for physicians and using physicians to recruit other physicians has been a successful approach that I have used. Whether it is software implementation work or ICD-10 implementation or anything in between, physicians need to have clarify on the expectations and time commitments that they will be signing up for.
  • We created a steering committee for them that reports to the medical staff executive committee. The only person from the hospital who is there routinely is the IT director (no CIO here). It is their chance to blow off steam about issues, and they do. If they gripe to the hospital administration about IT, they’re told that they have a channel for those complaints, and they are asked to use it. Once they recognized that we do listen and that within the strictures of the software and legalities, we’ll accommodate them if we know there are problems, they started using the committee. Now, it is more about moving forward than about fighting the battles of the last 20 years.
  • With any change, you need executive leadership support (administration and physician), evidence-based metrics, peer-to-peer pressure, and a system’s level continuous process improvement culture that is combined with a comprehensive, multi-pronged communication plan that reaches all levels of your organization. You have to include physicians (champions and high-volume user representatives) at the table from the very beginning and recognize that they are key stakeholders, and not just barriers to IT implementation. Physicians, like us all, are slow to adopt new, disruptive technologies. Active involvement and an active communication plan are critical to getting them involved.  If they feel like they are part of the solution, then it will work. The solutions themselves also have to be designed for the user (the physician). They need to here "what is in it for them." Perhaps it is a reduction in time, errors, callbacks, etc. The more specific the better.
  • We created a CITAC (Clinical Informatics Technology Advisory Council) made up of physicians representing most of the sections of the hospital(s) and we take them all of the new things we look at, get their input, get advice as to how to communicate with the entire medical staff, or to introduce new systems or technologies, etc. They also bring us suggestions from their respective sections on order sets, CPOE screens, prompts, core measure attributes to build in, etc. It’s really been helpful. In addition to the docs, we also include some nursing staff, my IT clinical informatics staff, and our vendor representative. We air some dirty laundry, and deal with some turf issues, some of which can be awkward but the end result is pretty positive. In addition to this, we have made trips to each of the major provider clinics to meet with those physicians to discuss issues and desires related to CPOE screens, prompts, processes, etc. But, one of the biggest things that I feel contributes to better adoption of new technologies, is that we use a lot of hospitalists in our organization, and once we get them to use technology and make some changes based on their feedback, we’re finding the other physicians are more prone to try it (since they see the hospitalists using it).
  • We’ve worked very hard to partner with and develop Physician Champions. Physicians in this role are more in tune with current projects and services, and enjoy being involved in the decision making process. For many of our physician champions, we have regularly scheduled meetings with them and their Practice Administrators to prioritize projects and discuss options, which is beneficial for all of us. We are expecting to roll out a full Physician Governance program this next year.
  • Physician IT committee, physician champion for certain projects, specific physician IT ‘helpline’ to facilitate quick resolution of their issues.
  • The key to physician satisfaction and engagement in health IT efforts is definitely having them involved. It is not enough for them to just be invited to receive information about the project. They need a seat at the decision making table and a voice that is heard and listened to. The level of their involvement in decision making and governance can vary depending on the project/program at hand, but having as many thought and action leaders from the medical staff in active roles in the project/program as feasible pays dividends with the entire medical staff. The opposite situation (zero physician involvement) yields highly negative results in terms of medical staff satisfaction, engagement, and adoption. However, it is also absolutely vital to choose wisely those physicians that are selected for involvement. We naturally want to involve those who have "connectedness" with their peers and thus high influence, but we also must select for traits such as "collaborativeness", ability to understand and explain the "vision" and rationale of what we are doing to peers, and flexibility (as plans necessarily change while in progress more often than not).
  • Most success has been to not just involve the docs, but have them lead initiatives. For example, we have three MDs that have had tasks and expanding roles in our Epic project. In addition, when you can have the docs be decision makers in projects, and those docs have the respect of most of the medical staff, per se, then things seem to go better. Having docs sit on a committee and updating them or asking for opinion is clearly not enough. They have to be like the pig at a breakfast of bacon, sausage, and eggs. Not like the chicken. 
  • When we went through the process of choosing an EMR we intentionally set up a steering committee made up largely of our physicians. We had representatives from all of our clinic types and almost one from each clinic. These docs were an integral part of the process. Once our selection process was down to three, we did demonstrations of several days with each vendor and asked all of our clinicians docs and staff to sit in. We required a survey upon exiting even if it was just a check mark on a few basic questions. After demos, site visits, and analysis was completed, the only folks who voted were the physicians. We have tweaked the system we purchased to make it as useful to the docs as we can. When we have a live date planned, we make sure the physician has someone within hearing distance to answer all questions and concerns. It is all about the support.
  • This is a long story, but something for which we are proud.  Many years ago (1993, in fact) we created a Clinical Systems Advisory Committee. It came to be because there was significant dissatisfaction among members of the user agreement. It started as a very small group of physicians who would meet with us weekly, then ultimately bi-weekly, to discuss our work. We provided dinner and (cheap) wine. We would always meeting in the evening; we would always make it a comfortable, and somewhat informal meeting. Over the years, it grew, and grew, and grew. And now, we meet monthly. The room is full with doctors, nurses and IT professionals. There are often more than 50 people in the room. Sometimes there are 75 or 80 people in the room. It is open to anyone who wishes to attend, although there is a membership list. Lots of great folks participate, and we all genuinely look forward to the meeting. It’s a social event as well as a work event. Lots of time to network and catch up. The meeting typically lasts for about two hours, but many folks stick around late into the evening. We serve great dessert. We have learned so much, made important decisions, and used the output as a way to advise our executive team. It has been a real joy. Additionally, now that we have embraced Epic as our enterprise-wide solution, we have added a Physician Council and a Nursing Council. In this case, we have ensured that we have a representative from every department or division. It is equally effective, equally active, much more focused and a bit more formal.
  • Use of "Tech Rounds" at one of our hospitals, conducted by the local CMIO; done monthly and showing latest technology applications, use of system, etc.
  • We have a mature CPOE implementation and a lot of community docs and contracted hospitalists (in many disciplines). It has been challenging to maintain physician involvement and enthusiasm for continuous improvement of order sets, decision support, etc. On the satisfaction front, hiring a CMIO (me) has been very helpful, and having a crew of dedicated physician educators / support specialists has been essential. Most of our physicians don’t bother with the IT Help Desk any more.
  • Lots of one on one discussion; open conversations with physicians in various meeting formats, informal lunches, working  to provide prebuilt documentation screens by specialty, demonstrating the improvements in outcomes using computer associated protocols agreed to by provider groups.
  • As part of our Epic implementation, we formed a Physician Advisory Group chaired by our CMIO consisting of physicians representing every discipline across our health system. This group has been key to driving significantly increased engagement by physicians in the requirements, design, implementation, testing, training, go-live, and ongoing improvement of our new EMR. The core advisory group has been meeting weekly for a year and has been very successful. We also invite other physicians, outside the core group, to participate in requirements and design sessions when needed, which extends our reach further into the community. These, and other supporting, actions have been effective in improving involvement and satisfaction of our physicians with IT projects and services. 
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News 9/21/12

September 20, 2012 News 8 Comments

Top News

9-20-2012 9-03-43 PM 9-20-2012 9-04-29 PM

The Forbes 400 list of richest Americans includes Epic’s Judy Faulkner (#285 with a net worth of $1.7 billion) and Cerner’s Neal Patterson (#391 at $1.12 billion).

Reader Comments

9-20-2012 5-28-10 PM

From HIStalk Fan: “Re: EHR experience reporting. The IOM recommendations could improve outcomes and safety. It remains puzzling that ONC is against robust vetting for safety and efficacy.” ONC asked the IOM to suggest ways to collect and report EHR user experiences, particularly those involving problems with patient safety. IOM’s just-published paper lays out ways that could be done. Possibilities include (a) testing vendor products against use cases; (b) placing a “report a problem here” button on EHR screens to allow users to quickly report problems; (c) have EHRs collect information such as number of clicks or the number of screen views and mine that data to look for problems; (d) conduct user surveys; and (e) develop a formal reporting program. The article recommends posting the collected information on a website that would rate individual functions vendor by vendor using a star-type rating system.

From Misys_Ex: “Re: QuadraMed. Not all to be sold, only the HIM/Quantim line. Sale to close in a week. Spending and hiring freeze in effect. MModal is the rumored buyer.” Unverified. An all-company call has been scheduled for October 1, rumor has it, which would logically place the announcement on the first day of the AHIMA conference.

9-20-2012 7-01-07 PM

From Dale Sanders: "Re: odd iPad requirement. The Colorado Department of Health Care Policy and Financing is re-competing its Medicare and Medicaid Information System contract. The draft RFP requires each vendor to submit their response on seven iPads, one for each member of the selection committee.” The rationale is that the iPad saves printing and shipping cost, although you could do a lot of printing for the $3,500 or so. The state says vendors like the idea and the iPads are more secure than paper, ensuring that documents don’t fall into the hands of competitors and thereby force an expensive re-bid and/or legal challenge for the $100 million project. None of that would seem to preclude returning the iPads given that the state plans to erase and reuse them anyway.

9-20-2012 7-13-32 PM

From Laura: “Re: Practice Fusion. Another cloud downtime.” Only for a few minutes, apparently, but judging from the comments, I bet that Like button didn’t get much action while the users killed time waiting to get back on.

9-20-2012 9-15-18 PM

From Writing My Resume: “Re: McKesson’s Better Health 2020. Will go down as the largest mistake in the history of HIT. Customers like Providence, Southwest Washington, Ohiohealth, John Muir, Valley Health, WellStar, HealthEast, and Resurrection are moving from Horizon to Epic. The new Paragon customers are small community hospitals and it will take 10-15 of them to replace one Horizon customer. Rumors of another layoff coming.” Unverified. I interviewed MPT President Dave Souerwine when the program was announced in December 2011. Better Health 2020 was a series of commitments to (a) invest $1 billion in R&D over the following two years, a good bit of that in enhancing Paragon over a 30-month development cycle; (b) sunset no products, but shift resources away from Horizon clinical applications to Paragon; (c) stop the development of Horizon Enterprise Revenue Management and lay off 174 employees immediately; and (d) continue to support Horizon customers through Meaningful Use and ICD-10.

HIStalk Announcements and Requests

inga_small Are you current on all the latest ambulatory HIT news? Here are some highlights from HIStalk Practice over the last week: RAC auditing of physicians begins in 15 states, focusing on higher-level E/M codes. The state of Colorado reports that Medicaid medical homes are reducing hospital inpatient stays and ER visits. EHR adoption at community health center grows to 74 percent, thanks to HITECH funding. eClinicalWorks predicts a 23 percent increase in revenues for 2012. Implementation costs and low patient adoption are big barriers for practices wanting to add patient portals. A physician weighs in on the impact of the ACA, incentives, and EHR. Nuesoft Technologies’ Blake LeGate offers tips for preparing for ICD-10. Dr. Gregg thinks (a lot) about going back to paper. Some days, especially those when Mr. H is especially busy at his day job, the only way I know I am appreciated is to see that someone new has subscribed to HIStalk Practice. When you check out these stories, show me the love and sign up for the e-mail updates. Thanks for reading.

Working anonymously is good in some ways, bad in others. On the “bad” side, Inga, Dr. Jayne, and I labor in our otherwise empty rooms with no human contact, meaning our little HIStalk world will evaporate the moment we quit or get hit by that proverbial bus. It’s up to you to write our electronic epitaph in advance, as follows: (a) connect with us and Like us (note to Mark Z — a Love button would be better) on the usual ego-feeding social not-working sites; (b) sign up for our spam-free electronic updates; (c) show your appreciation for the companies that keep our caustic keyboards clacking by reviewing the gallery-quality ads to your left and impulsively clicking those that pique your interest; (d) inspect the more detailed sponsor information housed in the Resource Center and consider using the Consulting RFI Blaster to effortlessly contact several consulting firms at once about your needs; (e) send us news, rumors, photos, ideas, or anything else that interests you and therefore would probably interest the rest of the HIStalk universe; and (f) look into the nearest reflective surface and give yourself a jaunty thumbs-up on our behalf for being discerning enough to recognize that despite its amateurish presentation, occasionally inappropriate content, and intentionally ironic pipe-smoking logo character, HIStalk does a mostly OK job in keeping you informed as well as a guy with a full-time hospital job can do.

My inbox is bulging and I have a lot of catching up to do this weekend. That’s the best I can do, unfortunately. Re-sending your e-mail doesn’t really help solve my problem of needing to sleep five hours or so, which is about all the time I have left at the end of the day. I promise I have not forgotten you.

9-20-2012 7-30-12 PM

Welcome to new HIStalk Platinum Sponsor TeraRecon of Foster City, CA. The company is a global leader in enterprise image management solutions, especially with regard to advanced imaging procedures. Its zero-footprint iNtuition EMV (Enterprise Medical Viewer) can deliver interactive images to any Web browser for even the largest and most complex CT exam, even interactive 3D. Instead of a peering at static JPGs in the EMR or a generic 2D viewer short on useful tools, physicians get a rich viewer with contextual tools and viewing configurations that are automatically set based on image type. Specialists in particular get real value from 3D images. The flagship iNtuition solution integrates with any vendor-neutral archive, so it works with a wide variety of systems including PACS from any vendor. TeraRecon created the concept of advanced visualization and iNtuition is the leader in enterprise-wide, thin-client server-based visualization with over 4,500 installations all over the world. Thanks to TeraRecon for supporting HIStalk.

I admit that imaging solutions aren’t my strong suit, so hopefully this TeraRecon overview video that I found on YouTube will make up for any deficiencies that I shamelessly exposed in my introduction above.

Acquisitions, Funding, Business, and Stock

Skylight Healthcare Systems, a provider of interactive patient systems, raises $5 million in Series D financing.


The New York eHealth Collaborative selects MedAllies to operate its Direct Solution on the Statewide HIN of NY.

CMS awards HP a $43 million task order to continue providing IT services for the EHR incentive program and for maintaining the CMS Integrated Data Repository database.

9-20-2012 9-17-21 PM

Loma Linda University Medical Center (CA) selects Nuvon to provide medical device connectivity and interoperability as it migrates its OR, ICU, and dialysis center to Epic.

The VA awards Systems Made Simple (SMS) a $27 million renewal contract to support the Veterans Service Network program and Benefits Gateway System development project.


9-20-2012 4-54-04 PM

Bill Conroy joins Kareo’s board, a position he also holds for Prognosis Health Information Systems and Phreesia.

9-20-2012 9-32-24 PM

Ben-Tzion Karsh, a University of Wisconsin-Madison professor of engineering and one of the authors of the IOM article on EHR experience reporting that I mentioned above, died last month at 40.

Announcements and Implementations

INTEGRIS Health (OK) implements PatientSecure by HT Systems for biometric palm scanning.

Intelligent Medical Objects announces a search engine appliance to deliver just-in-time secure terminology services at the point of care.

Elsevier releases a version of its ClinicalKey reference system aimed at individual clinicians, which features information from 900 textbooks and 500 medical journals covering 41 specialties.

In Canada, three-employee Clinisys launches its first product, a cloud-based EMR.

9-20-2012 9-35-55 PM

New in the AMA’s CPT 2013 data file: consumer-friendly descriptors of each CPT code for patients and caregivers.

9-20-2012 8-29-52 PM

Santa Fe-based Seamless Medical Systems launches an iPad app for physician waiting rooms that allows patients to complete their forms online, review educational material, take notes during the visit and e-mail them to themselves, and play games.

Government and Politics

Sen. John Kerry (D-MA) introduces MITECH, a bill that expands the MU program to include safety net clinics that don’t necessarily qualify under the Medicaid incentive program. Kerry’s legislation would allow providers to qualify for incentives if at least 30 percent of their patient volume comes from lower-income patients.

ONC posts the vendors who signed up for the Blue Button Pledge (Alere Wellogic, Allscripts, athenahealth, AZZLY, Cerner, eClinicalWorks, Greenway, Intellicure, NextGen, and SOAPware) and invites other vendors to tweet their #VDTnow pledge to be added. Above is Farzad Mostashari’s welcome to the Consumer Health IT Summit where the companies were announced.

9-20-2012 8-34-49 PM

The US Army tests real-time medical communication software that uses mobile devices and 4G networks to support battlefield medics treating severely wounded solders. Portable physiologic monitors are used to to send streaming video, voice, and photos, along with treatment records, to surgeons that in real-life situations would be located in remote hospitals.

Innovation and Research

Mobile health apps that help manage medications and blood glucose are linked to improved diabetes management in socially disadvantaged populations.


The board of directors of the Kansas HIE votes to transfer its duties to the Kansas Department of Health and Environment by October, 2013, which will save $350,000 a year.

The Joint Commission designates 620 hospitals as top performers on 45 evidence-based care processes closely linked to positive outcomes.

Joe Goedert of Health Data Management wrote a rebuttal to the Soumerai and Koppel editorial that ran in The Wall Street Journal this week called A Major Glitch for Digitized Health-Care Records. Joe mentioned some of the same points I did in my criticism of the editorial and the studies it selectively cited, but added quite a few more in Bad Research Shouldn’t Affect Good Policy. I respect the opinions of the authors and I’m as cynical as the next guy, but the editorial had just enough citations to possibly fool someone into thinking that it was new research (or that the old research mentioned was actually well done, which it wasn’t.) My criteria for assessing the objectivity of articles on almost any contentious topic (religion, politics, sports, or healthcare IT) is this: if the authors never give credibility to anything that doesn’t match their own beliefs, then I simply don’t bother reading because I already know what they’re going to say. I should note, though, that Ross Koppel was one of the authors of the IOM report on EHR problem reporting that I mentioned above and that’s a nice credit.

Job postings for healthcare professionals with EHR skills have jumped 31 percent over the last year.

Georgia Tech is offering a free, online Health Informatics in the Cloud class taught by Mark Braunstein MD, who has more relevant experience than anyone I can think of. Students don’t need a technical background – just five to seven hours per week for 10 weeks. The class is offered via Coursera, an online education startup that has already enrolled 1.5 million students in its “massive open online courses.” Its partners include Brown, Columbia, Stanford, Penn, and other topnotch schools that aren’t ordinarily interested in giving away their courses for free. This looks really good, especially for folks who don’t have a lot of formal healthcare IT education on their resume.

The family of a man who died in the ED of Beebe Medical Center (DE) files suit against the hospital and the ED staffing company it uses. The patient was discharged from the ED after being seen for chest pain, but he made it no further than a chair in the lobby before dying of a heart attack while waiting for a ride. Nobody noticed until hours later.

People who have eaten in Epic’s cafeteria will enjoy this profile of Executive Chef Eric Rupert (not celebrity French chef Eric Ripert, although I’m sure Epic could afford him if they wanted). The chef says Judy is a serious foodie — the only non-chef he’ll talk to about food — and she insists that Epic’s employees and visitors be fed well. He leads a staff of 78 Epic employees and describes the company environment: “There really is very little hierarchy here. You’re either a team member or a team leader, and the team leaders do everything that team members do, and then they also manage people. It’s not considered a promotion to go from a team member to a team leader; it’s just additional responsibilities.” He says Epic is different from its Silicon Valley counterparts in that employees pay the cost of ingredients for their meals instead of getting them for free, and everything is made in-house, even the baked goods. But like Google and other high-tech companies, Epic uses their food as a recruiting tool and has a diverse group of employees to feed, representing 55 countries.

Inga masquerades as Weird News Andy in finding this story. A Colorado man sues several food companies for “popcorn lung,” claiming that he ate microwave popcorn for years and the artificial butter fumes damaged his lungs. The jury, who apparently didn’t find his years of exposure to carpet-cleaning chemicals to be contributory, awards him $7 million. Inga adds that she hopes he gets his money in a Jiffy.

Epic UGM Report
By David Miller

Dave Miller, vice chancellor and CIO of University of Arkansas for Medical Sciences, e-mailed me privately about Epic’s UGM. I asked him if I could run his comments on HIStalk since non-Epic customers are always mystified by the company’s cult-like following. If you were one of the 8,000 UGM customer attendees and would care to share your thoughts about why it’s different than other user group meetings you’ve attended, I’d like to hear from you.

I have been to a number of UGMs at Epic, though it has been about three years since my last one. I am always amazed at the creativity of the Epic staff and the almost flawless way in which they execute the logistics to handle almost 8,000 users.

It continues to be primarily a user-driven event, from the advisory councils to the UGM sessions and even to the entertainment. The sessions themselves demonstrate the excitement that their users feel with what they have been able to do with one of the top healthcare IT products.

At the end of the day, it really comes down to Epic’s ability to instill their culture in each and every employee. Their simple focus on customer service was demonstrated by every employee I encountered. They had people stationed everywhere on campus to give directions, to drive golf carts to your destination, or just about anything else you needed.

I actually did not see a lot of Judy, but when she was present, she cheerfully took pictures with about anyone who would ask. Pretty amazing for a CEO of that stature. In my experience, most individuals in her position are self-absorbed and would never mingle like she does. I’ve also known Carl Dvorak for about 15 years, and he is about the most down-to-earth individual you would ever want to meet.

Judy creates an atmosphere for her employees that encourages and enables them to be at their creative best. The end result is a really good set of tools to manage the complexity of issues that healthcare organizations deal with every single day. Yes, there are imperfections, but they are so outweighed by the positives that they become irrelevant.

They used to say that no CFO ever got fired for hiring a Big 8 firm. Short of having someone completely inept in that role, I think I would say the same thing about a CIO.

Sponsor Updates

9-20-2012 9-24-10 PM

  • ChartWise Medical Systems profiles Jennie Stuart Medical Center (KY) and its use of ChartWise:CDI to improve documentation an reporting.
  • SuccessEHS reports that more than 10 percent of its EHR and PM client are now using its RCM services.
  • Health Care DataWorks offers a September 25 webinar on CMS’s Value-Based Purchasing program.
  • DrFirst offers Meaningful Use webinars over the next three weeks covering avoiding penalties, data exchange, the EHR as a clinical tool, and clinical quality measures.
  • Orion Health’s portal solution for Alberta Netcare reaches 100 million views since its 2006 implementation.
  • Versus features Northwest Michigan Surgery Center in its October 17 Webinar on maximizing patient flow with RTLS.
  • TELUS Health Solutions and Sun Life Financial launch an eClaims solution for extended care providers across Canada.
  • The Web Marketing Association recognizes CareTech Solutions as Outstanding Website Developer for winning nine WebAwards in 2012.
  • CommVault joins The Association of Certified E-Discovery Specialists as an affiliate member.
  • Awarepoint integrates its awareED module with Rauland Responder’s nurse call system.
  • CDN Channel Elite recognizes NexJ Systems with gold awards for best cloud computing and best mobile solutions.
  • MEDSEEK hosts roundtable discussions on marketing’s role in MU at this week’s Society for Healthcare Strategy and Market Development conference.
  • Greenway hosts a Webinar series addressing the trends of electronification, consumerism, and improving population health.  
  • Lifepoint Informatics will sponsor the Pathology Informatics 2012 conference in Chicago October 9-12.

EPtalk by Dr. Jayne

I read a variety of newsletters in an attempt to keep up. I got a chuckle out of a pair of articles in a single e-mail. The first article suggests evening and weekend appointments as a way to reduce annual medical expenses. It calls for physicians to “rearrange schedules to offer greater availability when patients are off work.” Just a few blurbs down, another piece by the same author discusses recent survey findings that new physicians find a four-day work week highly desirable.

I’m guessing that many of those that want a four-day week don’t intend for it to be made up of weekends or evenings. Most of my colleagues who run 10-hour days see patients 7:00 a.m. to 5:00 p.m. Even though running extended hours with more providers increases utilize of office space and changes the overhead profile, I don’t see it luring providers without a change in the compensation model.

I used to have evening hours in my practice. I didn’t mind it, but it was extremely hard on my staff, who struggled to find child care after 6:00 p.m. Just another illustration of why fixing the access issue isn’t as simple as it initially seems.


It’s not health IT, but it’s a great story. A British teenager floats his own science platform 20 miles into the atmosphere, capturing amazing photos with a camera he bought on eBay. The camera and other instruments survived a 150 mph descent and were recovered about 30 miles from the launch site.

Midmark @MidmarkNews tweeted yesterday about vitals workflows based on research findings. I’m all about evidence-based medicine, so it got my attention. Their brochure documents some interesting findings from a study they did on efficiency and accuracy of vital signs capture. Covering both manual and EHR-integrated automated devices, their data parallels what I’ve seen in practice. Even though it’s a sales piece, I liked their use of workflow diagrams. They point out some of the problems with the design of the average physician office: lack of space to place belongings when standing on the scale, facilities that aren’t conducive to accompanying family members, and workflow bottlenecks. I unfortunately work with a healthcare architect that is still designing exam rooms from the 1950s. I think I’ll leave a copy on his desk anonymously.

I seem to be getting farther and farther behind on e-mail. I’m not sure how Mr. H does it, but I must get him to teach me his secrets. Reader Dr. Nurse responded to my piece on why IT alone will not fix health care:

I have mild Crohn’s disease, so I get the wonderful privilege of having every-other-year colonoscopies. Being the dutiful patient I am, when my PCP reminds me it is “time,” I schedule my appointment. I called our local hospital to schedule the appointment. Despite their Epic implementation, which allows them to view my history, insurance coverage, PCP info, etc. the scheduler informed me that I could not self-refer for a colonoscopy and would need to have a doctor’s order faxed from my PCP’s office. I told her my insurance (BCBS) did indeed allow me to schedule such tests, but she refused.

She goes on to share a tale of woe spanning two weeks, ending with a procedure at an independent outpatient clinic and a letter of complaint to the hospital that resulted in a “horrified” apology from the hospital’s VP of client services. She asks, “If I have excellent insurance and they insist on placing such silly barriers to care in front of me, what do less-privileged people do?”

That is exactly the kind of problem solving we need to be working on in tandem with IT. Let’s leverage real-time eligibility, medical necessity determination, and clinical histories to knock down the barriers.

Do you have a story about integrated care that works well? E-mail me.



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

More news: HIStalk Practice, HIStalk Mobile.

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September 20, 2012 News 8 Comments

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