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News 5/22/13

May 21, 2013 News 4 Comments

Top News

5-21-2013 7-35-19 PM

Healthland acquires post-acute care software vendor American HealthTech of Jackson, MS.

Reader Comments

5-21-2013 7-49-08 PM

From Dortlund: “Re: GE Healthcare. Charging a premium on top of annual maintenance for MU Stage 2 and ICD-10.” Not to mention spelling “after hours” as “afterhours” for some reason.

5-21-2013 7-56-24 PM

From CMIO: “Re: clinical informatics exam. I applied, paid, and took a board prep course and plan to take the practice test this summer. I did not do a fellowship, but I want to be on the inaugural class of the new board based on three years as CMIO. It is worth it for me, as this is my career and this is my credential.”

5-21-2013 10-12-35 PM

From NoLongerPhamis: “I LOVED the last Slideshare about GEHC/IDX. Almost fell out of my chair laughing. The part about seamless integration of marketing materials was spot on. I was there.” This was in a recent episode of Vince Ciotti’s HIS-tory.

Acquisitions, Funding, Business, and Stock

Healthcare consulting firm Information Resources Associates, Inc. merges with ESD.

5-21-2013 9-03-24 PM

Virtual visit technology vendor ConsultingMD raises $10 million in funding from Venrock.

5-21-2013 9-35-25 PM

Pittsburgh-based wound care EHR vendor Net Health acquires Integritas, which offers EMR/PM solutions for urgent care, occupational health, and hospital employee health. 

Quality Systems, Inc. investor and board member Ahmed Hussein, mostly known for criticizing his fellow board members and launching proxy fights in an attempt to take control of the company, resigns. He owns more than $100 million in QSII shares.


Orange Accountable Care, a subsidiary of Orange Health Solutions, will deploy Sandlot Care Manager, Sandlot Dimensions, and Sandlot Metrix.

5-21-2013 12-47-20 PM

Wellmont Health System (TN) expands its relationship with MModal to include MModal Fluency Direct and Fluency for Imaging as its clinical documentation platforms.

St. Joseph’s Imaging (NY) selects Merge Healthcare’s Outpatient Radiology Suite.

The ERx Group, a staffing provider for rural acute care and critical access facilities, will use T-System’s clinical, financial, and operational technology and services.

Southeast Alabama Medical Center selects Besler Consulting to assist in the identification of Medicare Transfer DRG underpayments.

5-21-2013 10-17-52 PM

Western Maryland Health System (MD) will use Dimensional Insight’s business intelligence solution, The Diver Solution.


5-21-2013 3-43-25 PM

Long-term care EHR provider MatrixCare names Denise Wassenaar (Alliance Pharmacy Services) chief clinical officer.

5-21-2013 3-47-11 PM  5-21-2013 3-45-12 PM

Imprivata, expecting to go public within two years according to its CEO, names John Halamka, MD (Beth Israel Deaconess Medical Center) and former Phase Forward CFO Rodger Weismann to its board.

5-21-2013 3-50-02 PM

Stoltenberg Consulting appoints Douglas Herr (maxIT Healthcare) VP of Epic practice and client relations.

Announcements and Implementations

Peak Health Solutions partners with ChartWise to offer a solution that includes Peak’s clinical document improvement consulting and education program and ChartWise’s CDI software.

5-21-2013 11-17-00 AM

Stillwater Medical Center (OK) integrates its Philips IntelliVue patient monitors and Meditech ED management solution using the Accelero Connect healthcare integration platform from Accent on Integration.

North Shore-LIJ Health System adds cameras in operating rooms at its Forest Hills Hospital (NY) to remotely audit surgical teams for performing timeouts prior to procedures and to alert hospital cleaning crews when a surgery is nearing completion.

5-21-2013 7-44-22 PM

Fox Business News is running a week-long series called “How Private are Your Medical Records?” on “The Willis Report.” Monday’s episode featured Deborah Peel, MD of Patient Privacy Rights and Mark Rotenberg of the Electronic Privacy Information Center.

Covenant Health (TX) and MemorialCare Health System (CA) are named winners of the 2013 Crimson Physician Partnership Awards presented by The Advisory Board Company, saving a combined $20 million by presenting comparative performance information to their physicians.

5-21-2013 9-11-45 PM

CampDoc.com releases an electronic medication administration record module for its summer camp EHR.

Government and Politics

5-21-2013 11-45-17 AM

The Consumer Partnership for eHealth and the Campaign for Better Care submit a letter to the six Republican senators who last month questioned whether the implementation of the HITECH Act was money well spent. The consumer groups argue that MU is working and that delaying Stage 2 implementation and Stage 3 rulemaking will be detrimental to patients, will stifle innovation, and will delay progress towards interoperability.

CMS posts the 2014 ICD-10-PCS files, including code tables, index, and coding guidelines. CMS notes that the FY 2014 ICD-9-CM diagnosis codes will not be updated.

ONC posts positions (1, 2) for medical officer reporting to the Office of the Chief Medical Officer.

5-21-2013 9-28-21 PM

Twila Brase, RN, president and co-founder of Citizen’s Council for Health Freedom, says EHRs are burdensome and inaccurate, adding that they are turning doctors into data clerks. She adds, “Documenting a full clinical encounter in an EHR from scratch can be pure torment. The full chart doesn’t fit on the computer screen. Each element is selected by a series of clicks, double-clicks, or even triple-clicks of a mouse button. Hunting, clicking, and scrolling just to complete a simple history and physical exam is a tedious and time-wasting experience."

A Health Innovation Council commentary article says HITECH is causing, “A massive disruption of providers’ patient care focus as they chase Meaningful Use dollars; increased burdens on physicians, nurses and clinicians since EHRs as currently designed require more, not less, of their time and effort; and an unprecedentedly huge expenditure by providers on EHR hardware and software at a time when providers are under severe financial pressures.” The group recommends that the HITECH program either be redesigned to emphasize patient care, safety, and efficiency or be shut down completely and spend what’s left of the money on rewarding provider care improvement by whatever means they choose.  What is minimally noted in the press release is that the Health Innovation Council was formed and is run by Anthelio Healthcare, the former PHNS, a healthcare IT consulting services vendor.

In the UK, Health Secretary Jeremy Hunt announces creation of a $400 million fund to help hospitals with the cost of replacing paper-based clinical documentation and prescribing with electronic systems.


MyMedicalRecords.com files another patent lawsuit, this time against the recent Allscripts acquisition Jardogs. The complaint states that the FollowMyHealth Universal Health Record infringes on MMR’s personal health record patents.

5-21-2013 12-09-06 PM

LSU Health Shreveport (LA) and Siemens Healthcare inform 8,330 patients of an unintentional disclosure of PHI  stemming from an error in a computer data entry field. LSU and Siemens, which prints and mails bills on behalf of LSU Health physicians, have now identified and corrected the error that caused the names and treatment information for one patient to incorrectly align with another patient’s mailing address.

Palomar Pomerado Health CMIO Ben Kanter, MD presented A Darwinian View of the Electronic Medical Record at a HIMSS SoCal meeting.

UPMC will outsource its transcription services to its development partner Nuance at the end of June, laying off 100 transcriptionists who have been offered jobs by Nuance.

Moore Medical Center (OK) is destroyed by a 200 mph tornado, but the 30 patients housed in the 46-bed hospital all survived, as did all of the hospital’s employees.

5-21-2013 10-19-35 PM

A Silicon Valley newspaper editorial lauds the $220 million Epic implementation at Santa Clara Valley Medical Center (CA), saying it will improve billing efficiency and quality of care, also avoiding the 1 percent Medicare penalty and instead reaping $11 million in HITECH funds.  

Weird News Andy says he’ll take one today if it can help find his car keys. A New York Times article says helper robots will be used to help care for the elderly.

Sponsor Updates

5-21-2013 12-42-24 PM

  • ISirona employees participate in the Emerald Coast Mud Run benefiting Heart of the Bride, which supports orphans around the world.
  • Valence Health offers a May 29 Webinar in its monthly series called Care Coordination and Patient Outcomes: Utilize Innovative Automated Population Health Solutions.
  • DocuTrac, a provider of EMR technology for behavioral health, will add DrFirst’s e-prescribing technology into its QuicDoc EMR Professional and Enterprise edition software.
  • An Imprivata-commissioned survey of Canadian HIT executives reveals key barriers for clinicians when accessing patient data, including a lack of systems integration, privacy and security concerns, and slow access.
  • McKesson’s Horizon Lab 13.5 becomes for the first LIS to receive EHR Module certification for MU Stage 2.
  • Ingenious Med updates its impowermobile charge capture software to include the ability to create a virtual superbill at the point of care.
  • Greenway Medical adds ClientTell’s ReminderManager patient communications solution to its Online Marketplace as a certified API solution for the PrimeSUITE platform.
  • DirectTrust.org and EHNAC extend accreditation to ICA under its Direct Trusted Agent Accreditation Program.
  • IHT2 hosts Health IT Summit Denver July 24-25.
  • In a GetWellNetwork-sponsored Webinar May 29, administrators from Hasbro Children’s Hospital (RI) share details of how it improved patient satisfaction and workflow by joining patient-centered care technology with a meal ordering system at the bedside.
  • Kareo posts a Webinar that answers the top six Stage 2 MU questions and offers three reasons to check out CMS eHealth.
  • Several HIStalk sponsors earn a spot on the Informatics 2013 Top HCI 100 list, including 3M, ADP AdvancedMD, Allscripts, API Healthcare, Beacon Partners, Capario, CareTech Solutions, Covisint, Craneware, CTG, Cumberland Consulting Group, eClinicalWorks, Elsevier, Emdeon, ESD, GE Healthcare, Greenway, Iatric Systems, Impact Advisors, Infor, Intellect Resources, MModal, McKesson, MedAssets, Medseek, Merge, NextGen, NTT DATA, Nuance, Optum, Orion, Passport Health, Philips Healthcare, Siemens Healthcare, Sunquest Information Systems, Surgical Information Systems, T-System, TeleTracking Technologies, TELUS Health Solutions, The Advisory Board Company, The SSI Group, Vitera Healthcare Solutions, Vocera Communications, Wolters Kluwer Health, and ZirMed. Porter Research submitted, compiled, and reviewed sales figures to create the list.
  • The Philadelphia Alliance for Capital and Technologies recognizes InstaMed  as its Technology Growth Company winner and Halfpenny Technologies a Life Science Growth Company finalist at the Alliance’s 2013 Enterprise Awards.
  • Imprivata launches a migration program that enables customers using the Citrix SSO feature to migrate to Imprivata OneSign SSO. Also, Imprivata participates in a breakout session on desktop virtualization and SSO at this week’s Citrix Synergy conference in California.
  • Emdat profiles Illinois Bone and Joint Institute, which realized a 50 percent year-over-year cost savings in documentation and correspondence costs using Emdat alongside its EMR.
  • Beacon Partners hosts a May 31 Webinar integrating business intelligence and analytics through the healthcare enterprise and offers a white paper on why risk assessments help reduce an organization’s risk of a data breach.
  • Awarepoint’s RTLS platform will be featured in an industry-wide interoperability demonstration at the Association for the Advancement of Medical Instrumentation 2013 Conference and Expo June 1-3 in Long Beach, CA.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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May 21, 2013 News 4 Comments

News 5/17/13

May 16, 2013 News 12 Comments

Top News

The House Appropriations Committee approves $344 million in development funds for an integrated EHR for the VA and DoD, but mandates that no funds be expended on any EHR unless it is an open architecture system that serves both agencies.

Reader Comments

5-16-2013 8-31-28 PM

From Stifler’s Mom: “Re: Marin General Hospital. Nurses warn that the new computer system is causing errors.” A dozen unionized Marin General nurses attend the healthcare district’s board meeting to ask hospital administration to put the McKesson Paragon implementation on hold, claiming orders are being entered on the wrong patients, patients have been given meds to which they are allergic, and discharges and surgical prep are taking two hours.

From Carolyn: “Re: first HIStalk Webinar with HTTS. Will the recording be made available for those of us who could not attend the live session?” The recorded Webinar, “Vendor Software Training: What Providers Should Demand” is available for anyone to view here and a PDF of the slides is here. Everyone who registered will get an e-mail with these links, along with those to the HTTS-developed forms mentioned in the presentation (the Software Vendor Training Checklist and Sample Evaluation Form.)

5-16-2013 7-50-36 PM

From Horizon Consultant: “Re: Bayhealth – Milford Memorial Hospital. Went live on Horizon Expert Orders full house with physicians this week, with few problems.”

From Acorn: “Re: Maine Medical problems. Their Epic project is over budget by some unidentified amount, but will be high 8-9 digits, more than member hospital boards signed up for. Rollouts that were expected to conclude in 2013 are on hold until Maine Medical Center is stabilized – 2015 maybe? MaineHealth’s mouthpiece said training was not an issue, but I respectfully disagree. Insufficient engagement at all levels and all phases has been at the root of problems.”

HIStalk Announcements and Requests

inga_small This week’s highlights from HIStalk Practice include: the AMA looks at how patient-physician communication is affected by the use of computers in the exam room. INTEGRIS Health (OK) contracts with athenahealth for athenacollector and other products. Doctor office visits fell in 2012 while patients’ out-of-pocket costs jumped 30 percent. Primary care providers beat specialists in generating money for hospitals. The AMA does not recommend jumping directly from ICD-9 to ICD-11.  Make the world a happier place (at least my world) and sign up for e-mail updates when you check out the HIStalk Practice news. Thanks for reading.

5-16-2013 7-24-53 PM

Nuance CMIO Nick Terheyden tweets out another fun photo as he carries the HIStalk logo on his travels, this time with HIMSS President and CEO Steve Lieber from the stage of the Arkansas HIMSS Chapter meeting. Take along a printed logo or your iPad and snap and e-mail a photo from somewhere fun and I’ll run it here. We’ve seen photos from London and Dubai previously, so it’s your turn.

I’m behind on almost everything, so be patient if you are expecting something from me. I was so exhausted Wednesday night after work that I literally fell asleep in the middle of typing HIStalk, so I’m struggling to keep up.

On the Jobs Board: Clinical Analyst, Marketing Communication Specialist. Sponsors post their jobs for free.

5-16-2013 8-04-07 PM

Welcome to new HIStalk Platinum Sponsor, HCS (Health Care Software, Inc.) of Wall, NJ. Everybody likes stable vendors who aren’t just dabbling temporarily in healthcare, and HCS has been doing provider-only healthcare IT since 1969 (!!) The company’s INTERACTANT platform, an integrated suite of clinical and financial applications (revenue cycle, financials, EMR, mobile, and analysis) is meeting and exceeding the needs of all kinds of provider organizations (inpatient, outpatient, long term acute care, behavioral, and rehab). Check out their white papers (the best title: “Meaningful Use: Why Should Ineligible Providers Still Care?”) and case studies.  Thanks to HCS for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

The AMA reports a four percent decline in 2012 revenues from 2011, largely due to an 86 percent drop in advertising revenues and lower sales for printed coding books.  Membership was up over three percent, but net  operating profit fell 33 percent.


Port Huron Hospital (MI) signs a three-year contract with CareTech Solutions to use the iDoc Archive solution for storage of patient data as the hospital transitions to a new EHR.

Wilson Memorial Hospital (OH) chooses Access to integrate electronic patient signatures into Meditech and register patients electronically during downtime.

5-16-2013 10-13-57 PM

Trinitas Regional Medical Center (NJ) selects Dell’s Unified Clinical Archive solution to manage its clinical image archive.

The VA extends its contract with Authentidate for its Electronic House Call vital signs monitoring device and service and for the Interactive Voice Response System for remote patient monitoring.


5-16-2013 12-40-55 PM

MedeAnalytics names Andrew Hurd (Epocrates/Carefx) CEO, taking over for Mike Gallagher who will serve as executive chairman.

5-16-2013 6-17-47 PM

Jerry Baker (Halfpenny Technologies) joins HIT Application Solutions as president and CEO.

5-16-2013 6-18-54 PM

URAC appoints Kylanne Green (Inova Health System) president and CEO.

Streamline Health Solutions promotes Nicholas Meeks from VP of financial planning to SVP/CFO, taking over for the resigning Steve Murdock. Carolyn Zelnio (Aderant) also joins the company as VP/chief accounting officer.

Announcements and Implementations

5-16-2013 7-17-41 PM

HealthTech, parent company of HMS, MEDHOST, and Patient Logic, held a ribbon-cutting ceremony this past Wednesday to celebrate the opening of its new, larger headquarters in Franklin, TN. Participating were Allen Borden (assistant commissioner, Tennessee Department of Economic and Community Development); Rogers Anderson (Williamson County mayor); Ken Moore, MD (City of Franklin mayor); Matt Largen (president and CEO, Williamson County Chamber of Commerce); Bill Anderson (president and CEO, HealthTech); Steve Starkey (president, HMS); and Craig Herrod (president, MEDHOST).

Encore Health Resources launches its health analytics consulting practice, which follows the company’s preference of "Smart Skinny Data” (using information from specific sources to focus on specific analysis needed) over “Big Data.” The practice will offer analytics strategy, tools selection, implementation, performance improvement, and data governance help.

5-16-2013 10-16-04 PM

New York eHealth Collaborative issues an RFP to develop a statewide health portal, just after declaring Mana Health’s design to be the winner earlier this week.

5-16-2013 8-52-13 PM

Patient Updater releases a new version of its HIPAA-compliant messaging platform that allows hospitals to keep the families of surgery patients informed.

Government and Politics

The Senate confirms Marilyn Tavenner as CMS administrator, making her the first CMS leader to be confirmed in over nine years.

CMS will spend up to $1 billion for the second round of the Health Care Innovation Awards to promote projects that test new payment models in support of better care and lower costs.

5-16-2013 8-21-37 PM

Eleven top government officials will speak at the 2013 Health Privacy Summit, June 5-6 in Washington, DC, including Todd Park (White House), Joy Pritts (ONC), Leon Rodriguez (OCR/HHS), and David Muntz (ONC).

Innovation and Research

5-16-2013 9-07-42 PM

Massachusetts Governor Deval Patrick visits a digital health summit in Ireland to discuss collaboration between startup companies in their respective areas.

5-16-2013 9-11-20 PM

The wireless pill reminder bottle from AdhereTech wins the Healthcare Innovation World Cup.


5-16-2013 11-23-15 AM

CareTech Solutions takes the top spot in a KLAS survey on IT outsourcing. Though many providers are pulling back on extensive IT outsourcing (EITO) in favor of partial IT outsourcing (PITO), EITO remains the most popular option for smaller hospitals.

5-16-2013 8-42-58 PM

The city government of Juneau, AK, which owns 57-bed Bartlett Regional Hospital, votes down an $8.5 million appropriation for a Cerner implementation the hospital has already signed for. The hospital CEO says the contract was signed before Quorum Health Resources left as facility managers and he’s not comfortable with the $1.155 million in annual maintenance costs on the $7.37 million capital purchase (15.7 percent per year). The hospital is hoping its contract has enough out clauses to convince Cerner to allow it to walk away as it seeks a less expensive system.

5-16-2013 12-09-29 PM

The deadline to submit proposals for educational content for HIMSS14 is June 3, or about 7 1/2 months before the actual conference. Interestingly, HIMSS suggests that proposed topics be “timely.” Interested speakers should consult their crystal balls before applying.

The federal government charges 89 people — including about 22 doctors, nurses, and other medical professionals in eight cities — with Medicare fraud schemes that totaled $223 million in false billings.

5-16-2013 9-30-15 PM

A New York medical practice exposes the personal information of thousands of its patients when a clerk mistakenly attaches an Excel worksheet to an e-mail being sent to 200 patients.

Weird News Andy offers a pithy headline for this story, “Time to eat cookies whilst on the rack,” but you’ll have to think to get it. British researchers find that body mass index (BMI) is a poorer predictor of life expectancy than the ratio of waist size to height. People with a ratio of 0.8, which would be 56-inch waist for a 5’10” man or woman, lived 17 years less on average, while keeping the ratio at 0.5 or less (a 35-inch waist in this example) was associated with reduced incidence of stroke, heart disease, and diabetes. The ratio works on children as young as five, the researchers say.

Sponsor Updates


  • OB leaders at MedStar Franklin Square Medical Center (MD) describe PeriGen’s EHR, surveillance, and decision support system that supports healthier babies and mothers on “Today in America.”
  • T-System posts a video explaining how its system benefits ED patients and clinicians.
  • e-MDs will offer analytics and dashboards to its customers via an agreement with dashboardMD.
  • ReadyDock adds Complete Tablet Solutions as a reseller of its tablet management products.
  • This week’s 2013 Truven Health Advantage Conference in Scottsdale, AZ featured keynote addresses by Gov. Howard Dean, MD; Sen. Bill Frist, MD; and David Newman, MD.
  • Prognosis Health Information Systems discusses key considerations when changing EHRs. 
  • SuccessEHS hosts a CEU-approved Webinar May 29 on ICD-10 changeover planning.
  • The Boise Metro Chamber of Commerce recognizes Heathwise with its Healthcare Industry Excellence Award.
  • Kareo posts a Webinar on the ins and outs of Stage 2 MU.
  • Verisk Health hosts a May 29 Webinar featuring Bob Kay, senior data analyst with New Hampshire’s Granite Healthcare Network, who will discuss analytics for ACOs.
  • Craneware offers Webinars May 22 and May 30 on best practices for improving financial performance.
  • ChartWise Medical Systems CEO Jon Elion, MD discusses ethical practices in clinical documentation improvement on May 21 during the ACDIS Conference in Nashville.
  • MedAssets customer Oconee Medical Center will share how it used the company’s technology and services to improve point-of-service collections at this week’s NAHAM conference in Atlanta.
  • Finalists for Impact awards from the Technology Association of Georgia Southeastern Software Association include Billian’s HealthDATA (emerging mega trend and technology solutions provider) , McKesson (technology solutions provider), and NextGen (independent software vendor).

EPtalk by Dr. Jayne

From Big G: “Re: sick or not sick. I have a story to mirror yours. There I was, a medical student rotating at a large, urban children’s hospital’s ER. I was getting my duties from the charge nurse (‘Don’t touch anything.’) Without breaking stride, looking out at the vast, screaming waiting room, surely my vision of Hell, she pointed to one kid, and said, ‘He’s next.’ 30 years on, that display of sick/not sick sticks with me. Meningitis. Thanks for sharing. We’ve all had those semi-scary moments where we’re amazed by someone’s psychic abilities. Thank goodness for seasoned warriors in the trenches.”

During a recent “listening session” with CMS officials, the AMA offered testimony on the issue of cloned documentation. Comments on usability and reconsideration of Stage 2 MU were also hot topics in the discussion.


What is it with endorsements on LinkedIn lately? In recent weeks I’ve been “endorsed” for skill sets that I don’t remotely possess. If nothing else, it’s good for some entertainment, and some of it makes me sound just the slightest bit cool.


The National Committee for Quality Assurance (NCQA) publishes the names of 112 people newly certified as Patient Centered Medical Home experts. Those certification is aimed to help providers assess the quality of those offering to assist practices through the PCMH process. I hope they were all aware that their e-mail and snail mail addresses were going to be published to the world.

Speaking of certifications, I’m interested to hear who plans to sit for the American Board of Preventive Medicine subspecialty board exam in clinical informatics. The online application for initial certification is live and late fees apply to any application submitted after June 1. The exam is already fairly pricey and the Board will offer a non-fellowship pathway for the first few years. It will be interesting to see how presence or absence of certification impacts the job market for physician informaticists. Have you registered? What did you think? E-mail me.



Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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May 16, 2013 News 12 Comments

Readers Write: Hospital Pricing Data: Another Step Down the Rabbit Hole

May 15, 2013 Readers Write 6 Comments

Another Step Down the Rabbit Hole
By Data Nerd

On Tuesday, May 7 at 9:53 p.m., the Center for Medicare and Medicaid Services released a new open dataset to shed light on hospital pricing variations. The Times and The Washington Post (among others) published lengthy online articles (presumably overnight), complete with data visualizations to assist consumers in understanding the vast differences between what hospitals charge Medicare for their services. CMS released state and national averages a week later after The Washington Post published an article aggregating the data for comparison on the state level.

On the first day of its release, the dataset was downloaded over 100,000 times, displaying the large appetite that the public has for open healthcare pricing data. What is unfortunate is that this data set is fundamentally flawed for the purpose for which it was made public.

In the age of high(er)-tech journalism, I was disappointed to read article after article that overlooked the data documentation and went straight to the numbers and visualizations that could be concocted. Even HHS’s own chief technology officer got it wrong when he referred to the data as, “The actual prices that hospitals charge Medicare for the top 100 procedures across the country.”

The data given are not the top 100 procedures. They are the top 100 DRGs, which means that in any given claim, there could have been anywhere between one and 25 procedures performed (and they do vary, wildly.)

If the goal is to compare hospital’s charge rates, you need a normalized cohort. Or in layman’s terms, you need to compare apples to apples instead of kumquats to grapefruits. People with the same DRG suffer from the same diagnosis and often share similar courses of treatment, but wouldn’t a better analysis look at patients that all had the same procedures?

A DRG is a diagnostic related group, a very broad categorization of the primary diagnosis that the hospital is treating. A claim only has one DRG, but can have anywhere between one and 25 procedure codes. The data as it is currently presented is inherently incapable of pointing to charging discrepancies because a claim could be charging for one procedure or 25.

Personally, I think the move was more of an administrative muscle flex going into the healthcare exchanges set to open in October — fueled by the threat of public perception rather than an attempt to shed (non-refracted) light on the subject. A more accurate approach would have been to isolate claims where only one procedure was performed and provide the average charge or reimbursement data for those. Unfortunately, CMS charges nearly $4,000 for the data in a format that would allow this type of analysis.

This open dataset is another unfortunate example about our exuberance for “big data” giving way to our human propensity to under-analyze and take misinformed baby steps toward a greater goal, however noble it may be. As more and more data is presented for public digestion, its dissemination must be properly documented and cited if it is to be used to drive analytical outcomes.

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May 15, 2013 Readers Write 6 Comments

HIStalk Interviews Benjamin Albert, CEO, Care Team Connect

May 15, 2013 Interviews 2 Comments

Ben Albert is founder and CEO of Care Team Connect of Evanston, IL.

5-15-2013 7-00-56 PM

Tell me about yourself and the company.

The company started officially in late 2008, but I took it on full time in early 2009. Prior to starting Care Team Connect, I worked in healthcare technology for my whole career, most recently in a services company, PatientKeeper, for the acute care setting, where we were pulling together data for hospitalists and the providers within the hospital to better coordinate and manage care within the hospital.

As a result of that and parallel to that, my grandfather had his second stroke. Seeing all the effort that was going into the inpatient setting and very little effort going into the community setting compelled me to start the company to better coordinate care in the community for high-risk patients.


Describe how care coordination should work ideally.

There’s a number of perspectives on that. In my opinion, the way care coordination should work is that patients should get a patient specific plan of care that encompasses all people who touch that patient so they’re singing off the same sheet of music. Making sure it considers psychosocial factors, patient history and patient risk, and the whole patient as the plan is assembled, so that everybody knows who is going to do what when for each patient. That will enable efficiency, lower costs, and higher quality.


What needs to happen to make the patient-specific plan of care ubiquitous, like medication reconciliation?

You need to have the right team in place in order to manage and coordinate a population’s care. While our technology will streamline it and allow you to do a tremendous amount more with the resources that you have than if you don’t have a platform like ours to power workflow and coordinate care, if you don’t have the people who are focused on it — and I mean truly focused on it, not tangentially focused on it — as soon as you determine that you need to establish a team that’s responsible for coordination, then you need to power that workflow and allow it to scale.

Where we see most of the initiatives fail is that people will make that decision, but then they won’t be able to get lift or scale around the population, because they end up managing just the highest of high-risk patients with a few part-time or full-time resources. That in itself isn’t a way to enable full, broad-scale care coordination.

You need a more systemic process around how you are going to manage the high-risk, moderate-risk, and low-risk patients. What things are you going to do specifically for each patient as they impact quality and cost? Then allow yourself to scale that through automated processes like our technology. But before you even get to technology, you need to talk about your program development and how you can scale,  which we also help our clients with.


How does your platform support that process?

The platform listens for data that would trigger action on a patient that’s being managed in a population. Truly managed, not any patient in the population. We’ll identify which patients need to be managed. We’ll reconcile actionable data, which could be a real-time admission alert from an ADT, it could be a new medication, it could be a change in a patient’s psychosocial status like a change in home setting.

Any number of these things can be a triggerable event in our system that would drive action. The system listens for that, weights it against the patient-specific information and the risk to the patient and the care program that that person sits in, i.e. what we need to do in the event this piece of data comes in for this particular patient at this risk?

It drives the specific tasks to the right people across the continuum. When I say that, I mean those right people can be a family member, a clinician, a nurse, and anybody who has a relationship to that patient. The system’s rule will tell you, OK, based on this patient, here’s where you fire this task to.


What integration is required?

The most common integrations we do are to either claims or attribution models from payers or a shared savings program or ACOs or however they have their attribution models in their claims from the payers. We’ll pull that in as the foundation for the population being managed. Then we’ll marry real-time data to that on the fly, which includes ADT, medication feeds, and visits to the physician office. Those types of pieces of data are real time, married to the attribution and patient-specific data.

It can be labs. It can be any number of data elements that will trigger action. Based on the population being managed, we build these programs and actionable events around the data that’s more pertinent to the population being cared for.


How would a typical customer connect to that data and what are they doing with the results?

I’ll walk you through a couple of customer scenarios. We work with medical homes, ACOs, health systems, and we’re starting to get into some more of the employee health types of things. In the ACO medical home scenario, we’ll take a client who is currently managing 120,000 lives across an entire state with 77 physician practices. They need to manage that care across all those lives, across all those demographics.

They take their attribution, and then they take some real-time ADT information from various places across the state, and the plan of care that’s been established for each of the patients based on their criteria. They marry that specific data, i.e. an admission for anyone in their 120,000-patient population will trigger a workflow for the care managers or care navigators supporting that population. That’s a very basic core workflow that prevents readmission, increases coordinated care, and truly establishes a workflow around it, a transitions of care workflow in particular. That’s one example.

Another example might be a pure preventable readmissions initiative with a specific client, who upon discharge, we receive just ADT information along with some other data to identify which patients are at risk of readmission. From there, we’ll drive a particular plan of care based on what type of patient it is, what type of follow-up needs to occur, and drive the tasks and the actionable plan around that in an automated fashion.

If I go back to that first scenario for a second, I failed to talk about one core piece of data that is a differentiator. The population health analytics companies who today are doing a great job of identifying gaps in care and managing the data around the population that also in case of truly managing the health of a population, that data is valuable in addition to the real-time data, in addition to the attribution to trigger the right plans of care based on the patient’s attribution, risk, gaps, and beyond.


Many companies are involved in analytics and population health management. How do you see your offering fitting and who do you consider to be your competitors?

In the population health analytics space, we look at their data as great triggerable events married to all the other things we’re doing with the population. We like to work closely with them, especially if our clients decide to go in that direction and feel the need is strong enough for their population to identify gaps and do that analytics.

We really don’t feel like we’re competitors to the analytics companies. It’s more as a partner, where we can leverage their data to truly drive workflow and action, which seems to be a pretty big gap in the market right now that we’re filling.


Is it difficult for people to understand what you’re offering and how it fits in?

It can be, until the market understands the difference between care coordination and care management and population analytics, which we’re charged with helping the market understand. There’s a huge difference. It can get gray in terms of the client’s perception of what we do versus what those solutions provide.

But as soon as a client really digs in and says, OK, how are we actually going to manage the population? Not how are we going stratify and identify the population, but how are we actually going to manage the population and all of these care coordinators we’re hiring now? How are we going to power their workflow in a way that we’re sure that they are going to follow the right patients and that we’re going to get the yield out of the initiative that we anticipated getting?

It’s the next step. People recognize that as a major need. We sit on front of it to make it all happen. But until there is that understanding of what analytics is really built around — and it’s really built around crunching the data and what we do, which is built around workflow and coordinated care — I think the market does get confused until they understand the difference.


It sounds so obvious that there should be a patient-specific plan of care. Describe how it gets created and maintained and what the end result looks like.

It is somewhat of a new concept in the way in which we approach it, but I think there had been a lot of folks after the longitudinal plan of care for a patient. They are often templated and disease based, much as disease management companies or groups like that have approached the market in the past.

What we do is much different. There are elements of disease-based plans of care, but it’s really about the patient themselves, the psychosocial data, meaning what is their mental health, what is their home status? A number of those other elements which can help dictate how to follow up and manage that patient. Essentially, how much do I need to do to support this patient as opposed to how much can they do on their own without my involvement?

Our approach takes that data, which changes over time, and marries it to the real-time data. The plan is always changing. It’s a living, breathing plan of tasks and documentation to support that patient. As data changes from a real-time perspective and there is a profile change for a patient, the plan morphs along with the patient to make sure that it’s always providing the right level of support and efficiency around that patient’s care as required.

That’s really a big difference for us. It’s by no mean a single-threaded plan of care. This is a living, breathing plan of care based on the data coming in to the system and the patient’s needs, which really hadn’t been done before, not in this way, anyways.

It seems to be getting a lot of traction in the marketplace as a result, because our clients don’t have all the resources in the world and that’s not going to change. How are you going to truly manage this population of patients and help our community members who are collaborating with you in this ACO or in this shared risk initiative to support the population in real time? That’s how we help it happen.


A typical example would be where there is a primary care provider and a hospital relationship that integrates specialists and therapies. They’re potentially with an admission or an ED visit and there might be a specialist involved and there might be therapies of some sort. The resulting plan integrates all that into a single single source of truth that everybody agrees and understands that is taking care of that patient.

Absolutely. You’ve got it. That plan is driven by the individual or group that is responsible for the population. The ACO group may create that source of truth through our platform, or the hospital. It really depends on where is the risk is. They’ll drive that plan based on the automated routines.


The new brave new world of ACOs has put together some bedfellows that may not be comfortable with each other, as in hospitals and practices. 

You can add the health plans into that mix as well, in terms of all the groups who are participating in these initiatives and how well they work together in a way that makes sense for everybody.

I suppose the answer to you is that’s initiative by initiative, community by community. In some cases, like in Battle Creek where we are working, everybody is collaborating really well. It’s actually the practices who are leading the initiative, supported by the health systems and other folks in the community organizations and the community.

In the hospital-driven initiatives, it can be very effective. For example, we’re working with a health system in the Northeast. They are powering all their skilled nursing facilities through our platform. Upon discharge, one of the skilled nursing partners will get all their detailed plans for a heart failure patient that’s being discharged to them. Not in the placement type of variety, which I know is probably the next question, but more on, what’s the plan of care for this patient?

Those people are engaging and wanting that type of information because they aren’t armed with that data in a way that makes them successful. They want that type of collaboration. They know in the future it’s all going to be shared, and if they are not lining up to collaborate well with the health system today, it’s going to be a big problem for them in the future.


Everybody thinks about physicians and hospitals when they think about care coordination or ACOs, but in this model that you’re describing, it sounds like there is an important role for a nurse.

A huge role for a nurse and family and community partner. If you fall in to the trap of this is only a physician-led or hospital-led initiative, you’re not going to change things the way that they need to be changed in order to really coordinate care.

You need to infiltrate that with a care navigator-type nurse function that supports the population and also understands what it means to truly work with community members, Meals on Wheels, various partners in the community, family members, adult caregivers. All these people who can play a role for you. 

I’ve got all this work to do for this population. I know I need to do to support the population well. I have a handful of resources to make it happen. There are community resources out there willing to do this and they just need to be armed and ready to go. If you put that process in right, you are actually solving a much bigger problem by truly supporting the community and the population as a whole.


Where do you see that company being in five years?

That’s a great question. I get it often. The way I answer that is, I’m not sure where the company will be in five years. We just keep delivering value week to week, month to month, year to year basis, and keep listening to what our clients are telling us. Making sure we understand where the market is going and keep driving and building a successful organization that has value and purpose.

We try very hard not to focus on our five-year plan, but to focus on execution, action, value, and purpose as an organization. The rest will take care of itself.


Any final thoughts?

The company is doing tremendously well. I’m sure this is consistent with what everybody says, but the company is truly doing great. We recently signed our largest client to date. I think Care Team Connect is very, very well positioned for the foreseeable future. We’re just excited to continue to read your blog and hopefully show up there more and more with good news.

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May 15, 2013 Interviews 2 Comments

Morning Headlines 5/13/13

May 12, 2013 Headlines No Comments

Cash-strapped hospital bosses employ American IT expert on a salary of £25,000 A MONTH…and even picked up his bar tab and his laundry bill

In England, Rotherham NHS Hospital is being criticized for spending $40,000 a month on consultants in hopes of salvaging a struggling $60 million Meditech implementation.

District Medical Group Partners with Medical Scribe Program to Optimize Electronic Medical Record

Phoenix, AZ-based District Medical Group hires scribes to support physician documentation in its transition to an EMR. The scribes has improved physician workflow and eliminated transcription costs.

UPMC Q3 operating income down by half

University of Pittsburgh Medical Center reports a nearly 50 percent drop in Q3 revenue compared to the same time last year. The drop-off would have been closer to two-thirds lost had UPMC not picked up a $53 million return on its 2006 investment in dbMotion, which sold to Allscripts this March for $235 million.

Tampa Stakes its Claim to Lead Healthcare into the Future

In an effort to attract jobs, Tampa is developing a city-wide program to embrace technology and best practices to reduce overall healthcare costs, generally the second highest cost for businesses after payroll. The program is being offered in lieu of the traditional tax breaks offered as an incentive by most cities.

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May 12, 2013 Headlines No Comments

Readers Write: Managing Total Medical Expense While Improving Health Outcomes

May 10, 2013 Readers Write No Comments

Managing Total Medical Expense While Improving Health Outcomes
By Michael Gleeson

5-10-2013 8-53-34 PM

As our healthcare system evolves and payment reform expands, providers are forced to deliver higher quality care at a lower cost to curb explosive growth in national expenditures seen in past decades. As a result of this paradigm shift, the industry is responding.

In order to accommodate the incentives and priorities set forth by the Affordable Care Act (ACA), health systems must elevate the importance of primary care. This care model is shifting, with many adopting a patient-centric “Medical Home” approach to patient management. This new model emphasizes cross-provider care coordination, risk-stratified patient management, and proactive, preventative care.

Organizations are also using data more effectively. Increased adoption of electronic health records (EHRs), has led to valuable clinical data that can be mined and analyzed to inform health plans and providers on both their patient population as well as clinician behavior. However, the problem is that it isn’t being mined correctly. By integrating claims and clinical data, building trust and acceptance by care delivery professionals, and reorganizing care teams around actionable information, health systems will start demonstrating reductions in medical costs while improving patient outcomes.

So where should you start?

The four key pillars for success outlined below focus on improving health outcomes and managing total medical expense as critical elements in achieving lasting change within the practice.

Building Trust and Sharing Data

Despite significant investment in technology and data sharing by health systems, health plans and most primary care providers still have no visibility into their patients’ activity outside the four walls. And some health systems are hesitant to share data and/or performance with their counterparts, so as a result, it’s important to do the following when integrating with the network:

  • Create data governance policies. It is important to have a policy that dictates the use and exchange of shared data.
  • Establish role-based security and blinded data policies. This is a good rule for those who are apprehensive to share information. Not everything needs to be shared in order to drive change.
  • Data validation. Assessments to ensure that the data presented to the practice accurately reflects the activities at the point of care is critical to building trust.

Patient Attribution and Outreach

Quality improvement programs are often hindered by the challenge of accurate patient designation. If you can’t accurately identify who is responsible for a patient, you can’t improve the care rendered to them. Health plans often provide member rosters, but these can be large, burdensome to work with, and are often wrong.

It’s important to implement a system that will absorb the membership files from multiple plans, sync this data with the EHR and Practice Management data, and generate a list of members who are inaccurately attributed. The upkeep on this process, once it’s started, can be done monthly and will only take a couple of hours. With the attribution problem solved, the practice can reach out to the non-engaging patients it was responsible for and re-immerse them in primary care.

Fast, Accurate, and Actionable Data

In the whirlwind of external data feeds and complex EHR data structures, finding meaning can be a long process. Utilizing a flexible, transparent and vendor-agnostic data warehouse system allows information from multiple EHR feeds and claims files to aggregate on a nightly basis. This data is merged into a simple, patient-centered data model for reporting and analytics use. A focus on the EHR’s clinical data ensures near real-time analysis and greater relevance to the providers and care teams, resulting in more accurate and efficient patient results that can be monitored accordingly.

Transforming Clinical Care Teams

Even with access to timely and accurate data, practices can still struggle to improve outcomes because of inadequately aligned care teams. Providers are burdened with excessive documentation requirements in poorly optimized clinical systems. When a PCP is spending 10+ hours a day documenting in their EHR, they do not have the time and energy to consume the relevant information to drive proactive care management and move the needle on patient performance measures.

Arranging these roles appropriately within the care team maximizes resources and is critical to successful patient care. Medical Assistants should become the primary consumer of reports and act as a quarterback for the team, beyond their role of taking vitals. Using pre-visit planning reports, they should identify care gaps and coordinate with the RN and care manager to ensure the right actions are taken before the patient arrives. This will enhance the interaction and allows all current and potential problems to have the time to be addressed.

The inevitability of healthcare reform is forcing practices nationwide to shift how they view, plan and deliver care. While there is a renewed focus on managing quality and cost containment, this requires health systems of all sizes to master their data assets and align care team roles around the right tools and mandates.

As noted earlier, this charge is not easy. However, many organizations are currently rising to and conquering this challenge by utilizing these four pillars of success. By meticulously positioning themselves in line with this industry transformation, and keeping their goals and attention keenly on improving patient care and dissolving excessive costs, real improvements are being identified in the current health environment.

Michael Gleeson is senior vice president of product strategy for Arcadia Solutions.

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May 10, 2013 Readers Write No Comments

News 5/10/13

May 9, 2013 News 7 Comments

Top News

5-9-2013 7-31-07 PM

Allscripts reports Q1 results: revenue down 4.8 percent, EPS –$0.07 vs. $0.03, missing estimates on both.

Reader Comments

From IT Exec: “Re: HIStalk. Thanks for everything you do. My day wouldn’t be complete without spending a few hours on there.” Thanks. Mine either.

From PCP Doc: “Re: athenahealth. Just got back from their user conference. Jonathan Bush did not mince words on stage, just like in their earnings call, when talking about ‘companies of Epic proportions.’ Athena going to Haiti to install an EMR in a rural clinic that treats spinal injury patients was a noble touch.”

From Green Lantern: “Re: CMIO searches. I am aware of a couple of hospital systems that restarted their search rather than make an offer to an existing applicant. Does that happen often with CMIO searches vs. other C-level corporate officers? Are there enough applicants, or are hospitals being unreasonable?” Your thoughts are welcome.

HIStalk Announcements and Requests

inga_small Highlights from HIStalk Practice this week: the AMA’s board of trustees chair criticizes the federal government for mandating the use of EHRs under threat of monetary penalty while simultaneously accusing providers of cloning documentation. Frederica Krueger responds to the AMA’s complaints in a “Nightmare on EHR Street” Readers Write post. DigiChart changes its name to Artemis. American Medical News reviews the status of various lawsuits against Allscripts since the company announced plans to stop regulatory development of its MyWay product. CMS creates a timeline for aligning quality measurement and reporting for multiple initiatives. Dr. Gregg considers patient engagement and patient empowerment from both the provider and consumer points of view. Get your fix of ambulatory HIT news and sign up for the email updates while you are there. Thanks for reading.

On the Jobs Page: Open Positions in Development, Senior Manager Engineering Development, Clinical Analyst.

Acquisitions, Funding, Business, and Stock

5-9-2013 7-31-44 PM

HealthTap raises $24 million in series B funding led by Khosla Ventures.

5-9-2013 7-32-33 PM

Alere reports Q1 results: revenue up 10 percent, EPS $0.09 vs. –$0.05, beating expectations on both. The company also acknowledged that an investment firm that is a major shareholder will launch a proxy fight.

5-9-2013 10-04-47 PM

The Advisory Board Company reports Q4 results: revenue up 19.1 percent, adjusted EPS $0.33 vs. $0.31, beating analyst expectations for both.

5-9-2013 7-29-59 PM

Canada-based vertical software vendor Constellation Software acquires Quantitative Medical Systems of Emeryville, CA, which offers dialysis-specific revenue cycle and EMR software.


5-9-2013 6-16-19 PM

The Mount Sinai Medical Center signs a multi-year agreement for Cureatr, a mobile app designed by one of its residents that offers HIPAA-secure group text messaging for care coordination.

Chicago Health System ACO (Vanguard Health Systems) selects Care Team Connect’s integrated care management platform.

SSM Health Care – St. Louis (MO) selects the EDCO Health Information Solutions day forward medical record scanning services for use at its seven area facilities.

Quality Health Solutions, formed to support the virtual network of seven healthcare systems and Medical College of Wisconsin, chooses population health management and clinical integration solutions from Valence Health.


5-9-2013 9-14-13 AM  5-9-2013 9-17-38 AM    5-9-2013 1-21-59 PM
Culbert Healthcare Solutions adds Jason Faaborg (Dell), Tom Gurdak (CSC), and David Howe (Public Consulting Group) as VPs of sales.

5-9-2013 6-25-26 PM

Forbes profiles Imprivata CEO Omar Hussain in an article on leadership.

5-9-2013 7-22-43 PM

Adventist Midwest Health names Thomas Schoenig (Wyoming Medical Center) as regional CIO.

5-9-2013 8-40-57 PM

Care collaboration platform vendor CareInSync names Steve Curd president and CEO. The company also announced a follow-on investment from California HealthCare Foundation’s Health Innovation Fund.

NCPDP names First Databank’s VP of Health Policy and Industry Relations Tom Bizzaro to its board of trustees.

Mike Vandiver (SecureWorks) joins Ingenious Med as CFO.

Charlie Ditkoff (Bank of America Merrill Lynch) joins Cumberland Consulting Group’s board.

Announcements and Implementations

5-9-2013 9-37-23 AM

Royal Philips and Al Faisaliah Medical Systems open Philips Healthcare Saudi Arabia, a 50-50 joint venture to market and sell Philips solutions and services in the Kingdom of Saudi Arabia.

5-9-2013 10-04-50 AM

Geisinger Health System (PA) will give patients access to their doctors’ notes in its RWJF-funded OpenNotes program, in which 82 percent of participating patients opened up at least one EMR note.

5-9-2013 7-39-33 PM

Martin’s Point Health Care will present at the AQA meeting in Washington, DC on May 13. They use Forward Health Group’s PopulationManager at all nine sites and 70 provider panels for micro and macro reporting.

API Healthcare and TeleTracking Technologies enter into a strategic partnership to offer API’s workforce optimization solutions and TeleTracking’s workflow automation offerings.

Project MIST takes first place in an athenahealth and MIT H@cking Medicine-sponsored hack-a-thon for its glaucoma eyedrop spray canister.

Lake Tahoe Regional Hospitalists (NV) and Shasta County Hospitalists (CA) deploy MedAptus for inpatient charge capture.

5-9-2013 10-09-07 PM

Rochester General Hospital (NY) implements EDCO Health Information Solutions’ point of care batch medical record scanning solution.

Government and Politics

HHS releases data on inpatient charges that shows significant variations in pricing, such as joint replacement that ranges from $5,300 to $223,000.

Innovation and Research

5-9-2013 9-49-26 PM

Healthfundr launches its equity-based crowdfunding platform for health startups, open to accredited investors only and working with more established companies.



Epic gives VMware Horizon View “Target Platform” status for EMR delivery through a virtual clinical desktop, quoting Metro Health CIO William Lewkowski as saying the move is saving his organization $1.6 million per year.




5-9-2013 10-12-15 PM

Fletcher Allen Health Care (VT) will lay off 40 staff members and outsource its transcription services to Nuance Communications, which will offer jobs to 35 affected transcriptionists.

5-9-2013 6-32-04 PM

The Leapfrog Group finds in its spring update that hospitals have made only incremental progress in addressing errors, accidents, injuries, and infections that kill or hurt patients. Sixteen hospitals received an “F” grade.

Gila Regional Medical Center (NM), struggling with uninsured patient volumes, downgrades employees, halts an expansion project, and postpones implementation of a new hospital information system.

Keynote speakers at the MUSE conference May 28-31 in Washington, DC will be Farzad Mostashari and George Will.

5-8-2013 3-03-08 PM

A Surescripts report finds that 69 percent of office-based physicians actively e-prescribed last year and nearly half of patient visits generated an electronically-delivered medication history, 31 percent more than in 2011.

Allscripts will add 350 new jobs over the next five years in Raleigh, NC as it consolidates its US engineering centers. State officials will extend up to $5.35 million in incentives if Allscripts meets investment and hiring goals and maintains its 1,266 jobs in Raleigh.

5-9-2013 3-52-39 PM

An eight-country survey of physicians finds that 93 percent of US physicians report using an EMR. E-prescribing rates were highest (65 percent) among US providers, as were rates for entering patient notes into EMRs (78 percent.) While the majority of doctors in all countries report EMR and HIE have had a positive impact on their practice, US doctors were the least likely to report that their use reduced organizational costs.

Ken Roberts, MD and Jim Granfortuna, MD sing about EHRs in “Our Song of Epic Proportions.”

5-9-2013 8-06-59 PM

Weird News Andy wonders, “What is it with Brazilians and harpoons lately?” A couple of weeks ago a Brazilian guy accidentally shot a harpoon into his own head. Now a Brazilian man cleaning his spear gun in the living room accidentally shoots off a spear that goes through the mouth of his wife, who was in the kitchen at the time. She’ll recover fully. And in another incident, a Brazilian teen fishing in the Amazon River mistakes his brother for a fish, shooting a harpoon into his face and then paddling 195 miles in a canoe to take him to the hospital.

WNA also ponders this story, in which a South Florida plastic surgeon is arrested for using waterboarding-type torture on his girlfriend for 16 hours after being angered by her Facebook post.


Sponsor Updates

5-9-2013 7-02-12 PM

  • Consulting firm Virtelligence and its client Cone Health (NC) donated 400 tree seedlings via the Arbor Day Foundation to the Guilford County School System, whose students planted the trees around the Triad. The company tracked the number of pages printed during the Epic implementation and used an online program to estimate the number of trees required (361) to manufacture it.
  • NTT Data moves its North American corporate headquarters to Plano, TX.
  • EClinicalWorks releases agenda details for its 2013 National Users Conference October 11-14 in San Antonio.
  • Holon Solutions hosts a May 15 Webinar introducing the value of building an HIE.
  • Sandlot Solutions Director Rosalind Bell discusses how recent emergencies highlight the need for HIEs.
  • Billian’s HealthDATA releases its Provider Portal benchmarking database, which gives hospitals and health systems data for competitive analysis.
  • In a company blog post, Patientco addresses the growing patient payment problem.
  • Red Herring names Awarepoint, InstaMed, and Kony Solutions finalists for its 2013 Top 100 North American Award, which honors private technology ventures.
  • Aspen Advisors consultants will co-present at two sessions during next week’s Texas HIMSS Conference in San Antonio. Aspen’s Director of Clinical Informatics Mark Van Kooy, MD will participate in a panel discussion during an executive summit in San Francisco May 15-17.
  • Kathy LePar, VP of strategic services for Beacon Partners, offers recommendations for healthcare organizations for creating an integrated, holistic approach to strategic enterprise initiatives.

EPtalk  by Dr. Jayne

Georgia Governor Nathan Deal signs the State Physician Shield Act, which is aimed at preventing use of Affordable Care Act provisions to establish standard of care in liability cases. Supporters want to ensure that payment guidelines aren’t used to define care standards to the exclusion of individual patient factors or other clinical standards.

CMS releases Medicare provider charge data for the top 100 most frequently billed discharges across 3,000 hospitals. The variation across some procedures is as much as tenfold.

CNBC recently ran a piece on bad habits demonstrated by younger job-seekers. There are certainly a lot of relatively young workers in IT departments, but I’ve found that regardless of age, behavior is becoming more boorish. I may not be Emily Post, but I’d like to offer some etiquette tips for the age of social media:

  • Learn how to put your phone on silent. Practice this skill often.
  • Texting or checking e-mail on your phone while in face-to-face meetings is just rude.
  • Choosing “Darth Vader’s Theme” as your supervisor’s ringtone is not a career-advancing move, especially if you haven’t learned to put your phone on silent.
  • If you’re hosting a Web-based meeting and sharing your desktop, turn your instant messenger and e-mail notifiers off. I’m tired of seeing embarrassing, unprofessional, and distracting messages come across while I’m trying to work with you.
  • If you’re attending a meeting by conference call, don’t multitask unless you have the skills to pull it off. Asking, “Can you repeat that? I was on mute.” makes no sense and brands you as inattentive and illogical.
  • If you join a meeting late, don’t waste the group’s time with excuses. Say “I’m sorry” then sit down and get to work.
  • Lock your Facebook page down like Fort Knox unless you can keep your mouth shut. Do you really think it’s smart to advertise to your co-workers that you accepted prime hockey tickets from a vendor and thereby violated corporate policy?
  • Learn how to use Scheduling Assistant, Busy Search, or whatever tools your company uses when inviting people to meetings. If an attendee is already booked and you make them “required,” have the courtesy to discuss it and obtain approval first.


Speaking of meeting etiquette, it’s been a rough week, so I was happy to see a tweet for The Ridiculous Business Jargon Dictionary. I think I’m going to try “acluistic” in a meeting I have scheduled for tomorrow and see if anyone figures it out.



Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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May 9, 2013 News 7 Comments

News 5/8/13

May 7, 2013 News 8 Comments

Top News

5-7-2013 10-43-55 PM

McKesson reports Q4 results: revenue down 3.4 percent, adjusted EPS $1.45 vs. $2.09, missing expectations on both. In the earnings call, John Hammergren mentions that the company will exit its international technology and hospital automation business. I don’t know which product lines hospital automation includes, for instance whether that means the medication packaging and distribution systems business (ROBOT-Rx, AcuDose-RX, etc.) Technology solutions revenues were up 3 percent, but profit was down 16 percent, “well below our expectations.”

Reader Comments

From The PACS Designer: “Re: Windows 8. The unfriendly start menu for Windows 8 has Microsoft scrambling to fix the problem.” The company admits that its flagship product has a steep learning curve as it forced users to use its touchscreen-friendly tile-based graphical system instead of giving them the familiar Start button.

From Kaye: “Re: HIStalk sponsorship. This remains the best value we get for the money in advertising!” Thanks – that’s a nice comment and we appreciate it, especially coming from a company that has sponsored multiple HIStalk sites since 2009.

5-7-2013 10-45-46 PM

From Anesthesiologist: “Re: Google Glass. How can I partner with companies to develop applications that might be useful in the perioperative setting?” If you’re interested in working with this doc, e-mail me and I’ll forward to him.

From Arcane: “Re: Epic implementation. Do you know of a source for rollout and post-live support staffing numbers?” I have many readers and consulting firms that have implemented Epic, so please add a comment with your thoughts.

Acquisitions, Funding, Business, and Stock

5-7-2013 10-46-35 PM

Greenway reports Q3 results: revenue up 3 percent, adjusted EPS $0.01 vs. $0.08, beating earnings estimates of –$0.02  but falling well short of revenue expectations. The company blames a faster-than-expected shift to subscription-based pricing. Shares are near their 52-week low. President and CEO Tee Green also said in the earnings call that with HITECH in the rear-view mirror, buyer fatigue has set in over the past several quarters. Training revenue was also impacted, he said, by customers choosing train-the-trainer and pushing training back to after the quarter’s close.  He also said that Greenway’s participation in CommonWell hasn’t resulted in any sales (without expressing puzzlement at the analyst who apparently thought it might) but said more companies are signing on.

5-7-2013 10-47-20 PM

InstaMed raises $3.5 million in an internal round of funding.

5-7-2013 10-48-05 PM

Healthcare transaction processing firm MediSwipe signs a term sheet with a Chicago-based PE fund to receive up to $600,000 over the next nine months.

5-7-2013 10-48-35 PM

Vocera Communications reports Q1 numbers: revenue down 3.1 percent, EPS –$0.14 vs. -$0.08. CEO and Chairman Bob Zollars says the company saw an increase in new customer signings but did not complete several significant hospital deals.

Siemens Healthcare posts a 4.9 percent increase in Q1 profits, although revenues fell 2 percent.

5-7-2013 10-50-27 PM

Qualcomm Life acquires HealthyCircles, a startup that supports the secure sharing of patient data.

WebMD CEO Cavan Redmond, who has been on the job less than a year, will leave the company, along with CFO Anthony Vuolo.

Perceptive Software blames recent acquisitions for its decision to lay off about 40 employees, or three percent of its workforce.


5-7-2013 10-51-42 PM

Massachusetts General Hospital selects eHealth Connect Referral Portal from eHealth Technologies to support two-way communication between the hospital and its referring doctors.

East Kent Hospitals University NHS Foundation Trust chooses Harris Corporation’s Clinical Integration Platform to integrate data from six clinical systems across five sites. East Kent will also use Imprivata’s OneSign single sign- on technology.

Upper Peninsula Home Health, Hospice and Private Duty (MI) will implement the Procura for Hospice solution.

SCL Health System (CO) selects Leap-10 from Wolters Kluwer Health to streamline its conversion to ICD-10.

Amarillo Legacy Medical ACO (TX) selects eClinicalWorks Care Coordination Medical Record to advance its ACO objectives and coordinate care among its 100+ provider members.

Physical Rehabilitation Network will deploy NextGen Healthcare’s EHR, PM, PatientPortal, and NextPen products across its 100+ locations and use NextGenRCM Services for revenue cycle management.

Virtual Radiologic signs a five-year deal with Visage Imaging to implement Visage 7 Enterprise Imaging Platform for its 400 radiologists in a read-anywhere environment.


5-7-2013 10-38-08 AM

Ernst & Young names Intellect Resources President and CEO Tiffany Crenshaw a finalist for Entrepreneur of the Year 2013 in the Southeast region.

5-7-2013 11-09-04 AM

Former Cerner VP Ian Chuang, MD joins Netsmart Technology as CMO/VP of healthcare informatics.

5-7-2013 11-14-09 AM

Former National Coordinator Robert M. Kolodner, MD joins telehealth provider ViTel Net as VP/CMO.

5-7-2013 2-26-52 PM

Care Team Connect names Richard Popiel, MD (Regence BCBS) to its board.

5-7-2013 3-32-46 PM

Healthcare software solution provider MedicaSoft, LLC appoints Mike O’Neill (VA Center for Innovation) CEO.

5-7-2013 7-29-50 PM

Beebe Medical Center (DE) names Michael J. Maksymow, Jr. (Continuum Health Alliance) VP/CIO.

5-7-2013 10-27-30 PM 5-7-2013 10-28-38 PM

QPID hires Gary Zakon (ModelLogic) as VP of engineering and Caroline Smyth (Smyth Consulting) as VP of sales.

5-7-2013 8-31-06 PM 5-7-2013 8-31-57 PM

Eric J. Topol, MD is named editor-in-chief of Medscape. What’s most interesting to me is that his ongoing full-time employer Scripps Clinic apparently Photoshopped his black suit jacket to look like a white lab coat in the pictures above from their site.

Announcements and Implementations

Access is named as a Meditech Collaborative Solutions vendor, offering Meditech customers an integrated solution to capture and upload electronic signatures and data collected from clinical systems and medical devices.

5-7-2013 10-53-44 PM

Johns Hopkins Medicine integrates Epic with Hyland Software’s OnBase enterprise content management solution in its ambulatory and inpatient departments.

Philips launches Healthcare Transformation Services, a global business unit to provide consulting services to hospitals and health systems.

Trustwave introduces a mobile security practice to help enterprises with their BYOD strategies.

HCA MidAmerica Division equips seven hospitals and multiple physician offices in its Midwest region with Accelarad’s medical imaging solution.

Lifespan (RI) completes its rollout of the the TeamNotes electronic documentation system from Salar.

5-7-2013 8-07-30 PM

PerfectServe launches DocLink, a secure communications network for physician-to-physician communication.

Government and Politics

5-7-2013 10-21-35 AM

ONC publishes a governance framework for trusted health information exchange to help HIEs and other healthcare organizations understand ONC’s priorities and how to align with “national priorities.”

5-7-2013 10-54-20 AM

CHIME recommends in a letter to six Republican senators a one-year extension for Stage 2 MU before progressing to Stage 3. CHIME contends the extra year will give providers the opportunity to maximize their EHR technology to achieve the benefits of Stage 1 and 2 and give vendors time to “prepare, develop and deliver needed technology to correspond with Stage 3.”

5-7-2013 9-10-19 PM

Deputy National Coordinator Judy Murphy, RN kicks off National Nurses Week with a blog post on the role of nurses in healthcare IT and an invitation for nurses to share their stories.

Innovation and Research

5-7-2013 8-55-50 PM

UCSF creates the Center for Digital Health Information. It will be led by UCSF Medical Center CMIO Michael Blum, MD, who will assume the newly created position of associate vice chancellor for informatics and who will continue to lead its Epic implementation (physician leaders of the project are pictured above, with Blum on the left). Current projects include a team-based communications platform, an open source diabetes management system, a Web-based collaboration tool for virtual tumor boards, and a social media-based cardiovascular study.

Kaiser Permanente Center for Total Health will hold a Google Glass event in Washington, DC the evening of June 18.

5-7-2013 10-17-39 PM

South Carolina-based Iron Yard launches the Digital Health Program accelerator and incubator in the Spartanburg area.


Bloomberg TV covers the technology used by Palomar Medical Center (CA) and the "hospital of the future.” Palomar Health Chief Innovation Officer Orlando Portale is featured.


An Imprivata-sponsored study finds that clinicians waste 45 minutes per day in using inefficient communication systems such as pagers.

Hospital IT leaders are focused on accommodating greater mobile and wireless connectivity to their networks and with ensuring the security of patient data in BYOD environments, according to a HIMSS Analytics study.

5-7-2013 8-13-09 PM

A Raleigh, NC clinic warns patients that it was scammed by a company that claimed it would digitize the practice’s old X-rays, but instead harvested their silver content and then destroyed the films.

5-7-2013 10-56-14 PM

University of Rochester Medical Center warns 537 patients that their PHI may have been compromised when a resident lost a USB drive containing quality improvement information. The hospital thinks it went to the laundry and was destroyed.

John Halamka reports on new Meditech 6.1 development after mixed response to Version 6: a cloud-hosted system based on standards, Web-centric and mobile-enabled, with both inpatient and outpatient capabilities, complete with analytics, a PHR, and care management tools. He says it will ship in 2014.

5-7-2013 9-01-55 PM

Drug chain CVS shuts down its drug company-sponsored refill reminder program because of limitations imposed by the new HIPAA Omnibus Rule on using patient information for marketing.

Weird News Andy refers to this story as “brain drain.” A man who thought his year-round runny nose was caused by allergies finds that it’s actually brain fluid leaking from a tiny hole. It’s been fixed and he’s fine. WNA also likes this story, in which researchers claim to have found the cause of graying hair (hydrogen peroxide buildup in the hair follicle) and a cure for both gray hair and vitiligo (a proprietary treatment involving a UV-activated enzyme).

Sponsor Updates

5-7-2013 10-36-38 PM


  • API Healthcare and The DAISY Foundation offer The Nurses Week Story Contest, with submissions from nurses due May 12.
  • McKesson releases version 13.0 of its Homecare solution.
  • Orion posts a video featuring Orion clients that have solved interoperability challenges.
  • More than 200 hospitals using CareWorks content management system from CareTech Solutions have received 32 Website awards in the past year.
  • Truven Health Analytics finds that healthcare spending is 20 percent higher for public sector employees than for the private employee population.
  • Passport Health Communications names Texas Health Resources, Trinity Medical Center (AL), and Kadlec Regional Medical Center (VA) winners of its Leaders at the Forefront of the Healthcare Experience contest for best healthcare access management practices.
  • Gwinnett Medical Center (GA) discusses how using RelayHealth services helped the hospital remove patient billing obstacles.
  • iHT2 hosts a May 29 Webinar on security, privacy, and compliance risks in a post-reform era.
  • Greenway Medical President and CEO Tee Green discusses the compatibility of innovation and other topics with PGA tour partner Jason Dufner.
  • Red Herring names Kony Solutions a finalist for its Top 100 North America award, which honors the year’s most promising private technology ventures.
  • EBSCO announces its intent to collaborate with the American College of Physicians to give ACP access to its DynaMed evidence-based clinical summary resources and literature surveillance.
  • Gartner names Health Catalyst to its list of Cool Vendors in Healthcare Providers 2013 and profiles Shareable Ink in its update on 2011 winners.
  • Greenway Medical releases agenda details for its PrimeLEADER 2013 user conference in Washington, DC August 22-25.
  • CommVault launches a customer education services program that includes customized user training and access to online training courses for its Simpana software.
  • ADP launches a Website to help clients and other employers plan for and comply with the Affordable Care Act.
  • Nuance names seven healthcare organizations winners of its Voice of the Customer award for improving quality of care, reducing costs, and accelerating EMR adoption using speech recognition and clinical language technology.
  • CCHIT extends EHR Module certification to the latest version of the Medseek Empower patient portal.
  • TELUS Health and McGill University enter a three-year joint venture to conduct research on how best to use technology to improve health and healthcare delivery for Canadians.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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May 7, 2013 News 8 Comments

Morning Headlines 5/6/13

May 5, 2013 Headlines 1 Comment

Two Cerner live sites go to tender

In England, two NHS hospitals release an RFP seeking a replacement for their Cerner systems.

AMA says EHRs create ‘appalling Catch-22’ for docs

Steven Stack, MD, chair of the AMA board of trustees. spoke at a CMS listening session on billing and coding within an EHR system. He questioned the government’s mandating the use of EHRs while simultaneously orchestrating a witch hunt over cut-and-paste fraud accusations associated with physician documentation. Sack points to the generic, nearly uniform output of EHR documentation systems for causing a false perception fraud.

TriZetto Corporation Announces Reorganization of Leadership Team

TriZetto announces an executive reorganization as CEO Trace Devanny departs immediately leaving an empty seat that will be temporarily filled by TriZetto board member Vicky Gregg. An executive search is underway for a permanent replacement for Devanny. Jude Dieterman, formerly EVP and COO, has been promoted to the newly created role of president.

Govt moves to roll out ambitious e-health plan

The health department in India has issued an RFP for its recently announced e-health plan, which calls for each citizen to have a health card to hold demographic data and an integrated EHR that will automate hospital processes and bring all information into a centralized state health information system.

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May 5, 2013 Headlines 1 Comment

News 5/3/13

May 2, 2013 News 2 Comments

Top News

5-2-2013 10-44-47 PM

A selectman and software developer from Edgecomb, ME blames MaineHealth’s decision to close a local ER on the health system’s $150 million Epic implementation. The selectman’s letter to the editor to the local newspaper notes that MaineHealth has charged “millions of dollars” to member hospitals, but has had “a real failure in its implementation,” resulting in unplanned operational costs with minimal benefit to the state. Meanwhile, in a memo to employees last week, Maine Medical Center’s CEO listed several causes for its $13.4 million loss in the first half of the fiscal year, including “unintended financial consequences” of its Epic rollout as well as incorrect charging. The organization has placed further Epic implementations on hold as teams from Epic and the hospital try to fix problems.

HIStalk Announcements and Requests

inga_small A few HIStalk Practice highlights from the last week: patients say the most bothersome aspect of doctor visits is unclear or incomplete explanations of problems. Health Texas Provider Network partners with MediMobile for its mobile charge capture solution. The number of physician office jobs for billers and medical record clerks has declined sharply over the last two years. Epocrates is the most popular mobile app among US physician app users. Athenahealth names St. Boniface Haiti Foundation the winner of its 2013 Vision Award. Physicians are generally making more money this year than last, but are also spending more time on paperwork. Most news items on HIStalk Practice are not mentioned HIStalk, so peruse HIStalk Practice regularly to stay current on the ambulatory HIT world. Thanks for reading.

On the sponsor-only Jobs Page: Regional Sales Director, Senior Director of Business Development, Senior Manager Engineering Development, Open Positions in Development.

Acquisitions, Funding, Business, and Stock

5-2-2013 10-45-35 PM

Merge Healthcare reports Q1 results: revenue up 4.3 percent, EPS –$0.07 vs. –$0.02, missing earnings estimates.

5-2-2013 10-46-12 PM

API Healthcare announces the signing of over 25 contracts in Q1 and bookings that were 25 percent higher than the same period in  2012.

5-2-2013 10-48-26 PM

MedAssets announces Q1 numbers: revenue up 15.3 percent, adjusted EPS $0.41 vs. $0.24, beating expectations on both.

5-2-2013 10-49-46 PM

Athenahealth announces Q1 results: revenue up 30 percent, adjusted EPS $0.38 vs. $0.17, beating on both but adjusting fiscal year EPS guidance to below consensus.


5-2-2013 10-51-29 PM

University of Nevada School of Medicine chooses GE Healthcare’s Centricity Business, Centricity Practice Solution, and Centricity PACS-IW.

Filmore County Hospital (NE) selects NextGen Healthcare’s Inpatient Clinicals and Inpatient Financials.

Baylor Quality Alliance (TX) chooses Humedica MinedShare from Optum to analyze administrative and clinical data from payers, various EHRs, and the Baylor Health Care System HIE.

Louisiana Specialty Hospital will implement ONE-Electronic Health Record from RazorInsights. 

5-3-2013 7-08-25 AM

MD Anderson Cancer Center (TX) chooses Epic as its vendor of choice, according to an internal memo forwarded by a reader. Other readers had reported that same rumor late last week, saying that Epic had beaten Cerner as VOC.


5-2-2013 6-25-04 PM

UNC Health Care (NC) interim CIO Tracy Parham, RN is named permanent CIO, where she will lead its Epic project.

5-2-2013 6-47-56 PM

Parallon Business Solutions names John Guevara (Allscripts ) as CIO.

5-2-2013 7-14-00 PM

Patient Privacy Rights names Adrian Gropper, MD (HealthURL Consulting) as CTO.

5-2-2013 7-48-03 PM

Stephen Collins (Allscripts) is named president of Austin-based behavioral charting system vendor ChartAssist.

5-2-2013 8-07-48 PM

The Advisory Board Company CEO Robert Musslewhite is named by Washingtonian as one of its 100 Tech Titans and is also profiled in a feature in The New York Times.

Galen Healthcare Solutions appoints Joel Splan (Northwestern Memorial Healthcare) as CEO.

Announcements and Implementations

Rockdale Medical Center (GA) implements Nuance’s PowerScribe 360 voice recognition software for the dictation of imaging reports.

5-2-2013 8-53-10 AM

PointClear will move its corporate headquarters from Huntsville, AL to Dunwoody, GA.

5-2-2013 11-02-55 AM

McKesson recognizes Peninsula Regional Medical Center (MD) as the 2013 winner of its Distinguished Achievement Award for Clinical Excellence for effectively using McKesson technology along with Modified Early Warning Scores to proactively identify patients at risk for a code blue.

Aprima Medical Software will interface its EHR/PM system with the Homecare Homebase platform.

LHP Hospital Group implements McKesson’s Paragon HIS at Portneuf Medical Center (ID), Seton Medical Center Harker Heights (TX), and Texas Health Presbyterian Hospital WNJ (TX).

Elsevier launches its third annual “Superheroes of Nursing” contest and is accepting nominations for applicants in the categories of Achiever, Protector, Educator, Validator, and Connector.

SCI Solutions adds text appointment reminders to its Schedule Maximizer scheduling solution.

Modern Healthcare has corrected its article about the State of West Virginia’s payments to Medsphere for implementing OpenVista. The originally reported figure was $8.4 million per year, but that was actually the total amount spent since the contract was signed in 2005. Current payments are just under $1 million per year.

5-2-2013 10-54-20 PM

Mount Sinai Medical Center (NY) announces that it has enrolled 25,000 patients in its BioMe program, which links DNA samples to its Epic EMR information to support targeted medical care and to provide de-identified data for research. 

First Databank announces ICD-10 for Saudi Arabia at the HIMSS Middle East conference.

Government and Politics

5-2-2013 6-30-10 PM

HHS names Lyfechannel the winner of its healthfinder.gov Mobile App Challenge for its myfamily app, which helps individuals manage their family’s health through customized prevention information for each family member.

Healthcare modeling and analytics company Archimedes collaborates with CMS to give users easier access to public payer claims data.

5-2-2013 3-29-16 PM

CMS announces that hospitals and EPs have been paid $13.7 billion through the end of March, with $8.5 billion going to 8,558 hospitals and $5.2 billion to 255,722 EPs.

FDA launches the redesigned FDA Patient Network, which will educate patients and their advocates about FDA and will invite them to attend and present at FDA meetings.

Farzad Mostashari was a panelist in a discussion of technology in healthcare put on by Politico last week. The 77-minute video is of very high quality and it’s an interesting mix of people and topics.

5-2-2013 11-08-05 PM

CMS gets criticism for removing information on hospital-acquired conditions from its Hospital Compare site. CMS says the information is flawed and is redundant, but patient groups say CMS is buckling to the complaints of low-performing, high-profile hospitals.

Innovation and Research

Vanderbilt University launches the Health App Challenge to transform clinical summaries into a more patient-friendly form. Entries are due August 1, with the winner receiving $10,000 and up to five finalists being awarded $2,000 or more each.


5-2-2013 9-43-07 PM

Former Google Health product manager Missy Krasner, now involved in startups and an advisor to Box, says Google Health was a good idea in theory, but “It was a very bumpy user experience for even the most super-charged, IT savvy consumer.” She says Box will take over where Google Health left off for storing personal health records that it supports HIPAA requirements. She concludes, “So here is my hope for the future. If most EHRs can currently export a Continuity of Care Document (CCD) via the Clinical Document Architecture (CDA), why couldn’t Box grab that clinical care summary format and stylize it in a way that made sense to other doctors or patients via its documenting previewing technology? This would help the interoperability and file transfer juggernaut get a whole lot easier.”

FastCompany profiles companies started by founders who were frustrated with existing products, among them Amazing Charts.


5-2-2013 9-48-14 AM

KLAS reports on the post-acute care market, which is critical for managing outcomes and costs. HealthMEDX was named the top performer among long-term care vendors with 100 percent of its customers saying the company keeps its promises and that they would buy HealthMEDX Vision again.

Weird News Andy summarizes this article as “coming clean.” Piedmont Healthcare (GA) admits that for two years it improperly cleaned colonoscopy requirement at one of its ambulatory surgery centers, requiring it to notify 456 patients that they should be tested for hepatitis and HIV. Employees cleaned the equipment with soap, but missed the disinfectant step.

Sponsor Updates

  • T-System posts a photo gallery from its linkED 2013 Emergency Care Conference held in Dallas April 22-25.
  • Emdat posts a case study from Illinois Bone and Joint Institute, which reduced documentation costs by 50 percent by implementing Emdat’s transcription software and the company’s mobile documentation tool.
  • The Nashville Business Journal names Passport CEO Scott MacKenzie one of the most influential business executives in Middle Tennessee.
  • First Databank hosts a May 14 Webinar on the use of RxNorm within information exchange and clinical quality measures.
  • Kareo offers a May 16 Webinar that considers five activities to prevent a government audit.
  • Executives from Yale-New Haven Health System, Hartford HealthCare, and North Shore-LIJ Health System will share strategies to reduce readmissions at the iHT2 Summit in New York City on September 17-18.
  • Porter Research posts a presentation that provides insight into the trends, challenges, and benefits of engaging consumers in every stage of healthcare.
  • Capsule Tech will exhibit at the annual MUSE conference May 28-31 in Washington, DC.
  • Truven Health Analytics receives a five-year accreditation from the National Institute for Health and Care Excellence for its Micromedex Medication Management solution.
  • The National Committee for Quality Assurance certifies Verisk Health’s Quality Intelligence solution to support quality reporting for commercial and Medicare Advantage populations in the California P4P program.
  • As part of this week’s Medical Library Association Annual Meeting and Exhibition in Boston, Elsevier pledges to donate $1 to One Laptop Per Child for every ClinicalKey search made at Elsevier’s booth.
  • Allscripts releases details on its annual ACE client conference in Chicago August 21-23.
  • Liaison Healthcare launches its EHR Partner Program, which give participants access to orders and results connectivity to over 100 major lab and radiology service providers.

EPtalk by Dr. Jayne

HIMSS opens the call for proposals for the 2014 conference in Orlando with 24 topic categories. If you’re like many of us in the non-profit trenches, being selected as a presenter may be the only way to go to a meeting, so good luck!


The hot topic in the physician lounge this week was HR 1701, the “Cutting Costly Codes Act of 2013.” Introduced by Representative Poe of Texas last week, it aims to block ICD-10 implementation. What surprises me most was the number of physicians who think the mere introduction of a bill will support their lack of preparation for ICD-10. News flash – if you haven’t started preparing, you’re already behind, and I certainly wouldn’t wait around to see if this becomes law before I get started.

It’s not health IT, but it’s my favorite story this week: “untethered microgrippers.” Engineers at Johns Hopkins are working on miniature devices to retrieve biopsy specimens. Although they’re not quite ready for human testing, they look cool and are promising as a mechanism to take multiple biopsies in hard-to-reach areas.

I almost missed this little tidbit in the Federal Register that would allow use of eight CMS record systems for emergency preparedness. The change would allow CMS to disclose individually identifiable records to “public health authorities and entities acting under a delegation of authority of a public health authority” for the purpose of providing health assistance in an emergency or disaster.

CMS issues a Call for Measures for potential Quality Reporting System items to be used in future rule-making years. CMS is focusing on measures that cover clinical outcomes, patient-reported outcomes, care coordination, safety, appropriateness, efficiency, patient experience, and patient engagement. Submissions must have strong scientific evidence, so I guess my “number of patients seen on time because they weren’t yakking on their phone when I entered the room” measure won’t make the cut.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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May 2, 2013 News 2 Comments

News 5/1/13

April 30, 2013 News 4 Comments

Top News

4-30-2013 7-09-06 PM

Greenway Medical announces that it will swing to a loss for the current fiscal year because of declining sales and deferred revenue. The company’s fiscal year earnings estimate of $0.10 to $0.17 on $145-$150 million in revenue was revised to a loss of $0.11 to $0.13 on revenue of $132-$134 million. The fiscal year ends June 30. Shares dropped from Friday’s $16.05 close to just above $12 by Tuesday morning, but had rebounded to $13.47 by Tuesday’s close. Above is the one-year GWAY share price (blue) vs. the S&P 500 (red).

Reader Comments

4-30-2013 10-18-31 PM

From Big Tex: “Re: Epic deals. St. David’s Healthcare in Austin and Methodist in Houston are both heading to Epic, though I don’t think either has officially announced yet.” Unverified.

From John: “Re: interesting comment from an FBR analyst covering Nuance’s poor earnings announcement. ‘While several industry/external (smart phone consolidation, transcription transition, EMEA weakness) factors have put pressure on mobile and healthcare growth, we believe the blame lies squarely around Nuance’s execution in the field, coupled with management’s feverish acquisition strategy over the last year, which has put onerous integration risks back into the Nuance story. While we believe potential activism could put a floor on Nuance shares and ultimately enhance shareholder value over time (e.g., management changes, split-up of the company, M&A path), we find it hard to remain positive on the Nuance story as the company goes through a challenging transition process in its business over the next six to nine months.’” Carl Icahn just announced that he’s loaded up on more shares, so the surprisingly poor results for both revenue and earnings help make his eventual argument that the company should be broken up or sold outright.

4-30-2013 8-17-49 PM

From Mr. Eko: “Re: HIMSS Middle East. Started Monday. Some American-based companies there are Cerner, GE, and Medicity. Judy Faulkner, CEO of Epic, was spotted yesterday morning eating breakfast in the Four Seasons hotel. Rumor has it they are pitching to the Ministry of Health for Saudi Arabia.”

From Giles: “Re: healthcare IT decision making. Interesting reader comments. What’s your opinion?” I agree with some of the comments that healthcare organizations are quicker to promote and retain executives who wouldn’t qualify for comparable jobs in most other industries based on their education and experience. However, healthcare is a different world, trying to balance the demands of an increasingly interventionist government, regulators, special interests, politicians, clinicians, community leaders, and giant insurance companies with the patients and families who are hardly typical customers. I’ve seen cases where hotshot IT people from allegedly more progressive sectors were brought in with near disastrous results, even though the IT shop looked like a showcase on paper. Some healthcare CIOs are not very good at strategic planning, management, and customer engagement, but they have a small domain with minimal clout and high operating and capital expenses due to decisions almost always made by someone else with more influence. Healthcare CIOs also aren’t given a lot of unilateral decision-making over anything other than infrastructure – everybody likes to suggest and approve massive change management projects that get incorrectly tagged as IT initiatives, but those folks disappear when their own lack of leadership ability starts sending the project down the drain due to poor user acceptance, lack of resources, and poor project decisions. My opinion, therefore, is that healthcare IT leaders aren’t empowered to make a lot of decisions on their own, are struggling to deal with the mess foisted upon them by their fellow executives and third parties, and are trying to deal with the squeeze of ever-increasing demand with an ever-decreasing budget. I’m fairly certain that swapping them out with fat-resume private sector CIOs wouldn’t make much difference on the plus side of the ledger, but would cause all kinds of unintended consequences to patient care. It’s easy to shoot the messenger, and with regard to many high-profile projects, that’s all the CIO is allowed to be. If nothing else, consider the high degree of CIO turnover – if all it took was new people in the chair, you’d be seeing wide swings in success from that alone and that’s not the case.

HIStalk Announcements and Requests

Nick van Terheyden, MBBS, CMIO of Nuance, posted the cool photo above on Twitter. If you’re traveling anywhere interesting, send a fun local photo with something that identifies HIStalk and I’ll run it here.

4-30-2013 8-00-00 PM

Welcome to new HIStalk Gold Sponsor Porter Research, A Billian Company. The company provides its clients with customized market intelligence and research insight that includes go-to-market strategy, focus groups, win-loss analysis, prospect profiling and lead generation, competitive analysis, customer and market analysis, and M&A research. Don Graham (GM of both Porter Research and Billian’s HealthDATA) and Cynthia Porter (president) have many years of industry experience with major healthcare IT firms. The company offers a brochure, case studies, a newsletter, and white papers that illustrate its expertise. Thanks to Porter Research for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

4-30-2013 7-39-52 PM

Emdeon completes re-pricing of its existing senior secured credit facilities, securing lower interest rates on its term and revolving loans.

4-30-2013 7-38-31 PM

Nuance reports Q2 results: revenue up 15.9 percent, EPS $0.34 vs. $0.43, missing estimates on both and sending shares down 18 percent and increasing speculation that activist investor Carl Icahn will use his recently acquired 10.7 percent of the company’s shares to force a breakup.

4-30-2013 7-47-17 PM

USARAD.com launches SecondOpinions.com, which offers same-day medical second opinions. Radiology-related reports range from $29 for an X-ray to $99 for an MRI. The company also offers second opinions for primary care, surgery, dermatology, and other services.

4-30-2013 9-10-16 PM

Forms automation vendor FormFast opens a UK-based subsidiary.


Trinity Health (MI) signs a multi-year agreement with Explorys for data analytics solutions.

Saint Mary’s Regional Medical Center (NV), Renown Health (NV), and Chandler Regional Medical Center (AZ) select MRO Corp.’s ROI Online platform to manage release of information.

West Florida ACO will deploy Sandlot Connect, Dimensions, and Metrix from Sandlot Solutions for patient health information management.

Methodist Health System (NE) selects Wolters Kluwer ProVation Medical software for its gastroenterology procedure documentation and coding.

Amerinet contracts with Cornerstone Advisors Group to provide HIT advisory and implementation services to its group purchasing members.

Tri-State Orthopaedics (IN) selects SRS EHR for its 24 providers.

4-30-2013 10-35-53 PM

Saudi Arabia’s King Fahd University Hospital will implement Nuance Healthcare Dragon Medical 360 | Network Edition hospital-wide.

The Cleveland Clinic’s MyPractice Healthcare Solutions will provide project management and implementation assistance to Glens Falls Hospital (NY) as it deploys Epic at its physician and specialty practices.


4-30-2013 12-25-15 PM

MedMatica Consulting Associates appoints Jerry Howell (KPMG) CEO and a member of the company’s board of directors.

4-30-2013 12-33-30 PM

Thomas H. Lee, MD (Partners HealthCare) joins Press Ganey as chief medical officer.

4-30-2013 12-54-50 PM

CSI Healthcare IT hires Martin O’Neil (Charts In Time) as health information management practice director.

4-30-2013 1-23-24 PM

Meditab Software appoints Adele Nasr (WebMetro) VP of marketing.

4-30-2013 7-55-42 PM

A. John Blair III, MD, CEO of EMR consulting firm MedAllies, is elected chair of independent Direct community DirectTrust.org.

4-30-2013 8-19-02 PM

Christopher Mansueti, former VP of client services for RelWare, died Friday, April 26 of amyotrophic lateral sclerosis. He was 53.

Announcements and Implementations

VHA, Inc. adds physician dashboards to enhance its VHA IMPERATIV Advantage performance improvement solution, which leverages transactional-level data through Truven Health Analytics and UHC.

MDI Achieve, provider of the MatrixCare EHR for long-term acute care, will integrate with Homecare Homebase, a provider of homecare and hospice technology solutions.

Heywood Hospital (MA) streamlines clinician workflow following its implementation of Accent On Integration’s Accelero Connect integration platform.

4-30-2013 3-38-00 PM

Samaritan Albany General Hospital (OR) moves from Meditech to Epic this week.

Transylvania Regional Hospital (NC) goes live on Cerner.

Children’s Hospitals and Clinics of Minnesota implements wireless data transmission between Cerner’s EMR and CareFusion’s infusion pumps.

PeriGen recognizes its client Banner Health (AZ) for reducing unnecessary early-term deliveries by 22 percent, earning the health system a Showcase in Excellence Award from the Arizona Quality Alliance.

Florida Hospital Tampa implements the EarlySense bedside patient monitoring system.

A Modern Healthcare article covers the State of West Virginia’s VistA implementation. It’s paying Medsphere $8.4 million per year for support and an unspecified amount to InterSystems for Cache’ licenses. The state also added financial systems from NTT DATA to replace VistA’s minimal capabilities. Update: Modern Healthcare issued a correction to this article – Medsphere has been paid $8.4 million over the life of the contract (since 2005), around $940,000 per year.

4-30-2013 9-37-04 PM

The Pittsburgh paper profiles Omnyx, a five-year-old digital pathology systems vendor formed as a joint venture between UPMC and GE Healthcare.

Government and Politics

Arizona lawmakers pass legislation that will require health insurers to pay for telemedicine treatment for certain specific conditions for patients living in 13 rural counties.

Rep. Ted Poe (R-TX) introduces a bill that would prohibit HHS from mandating providers to switch to ICD-10 code sets, which Poe contends would cost about $80,000 for individual doctors and $250,000 for practices with five to 10 physicians.

4-30-2013 3-33-08 PM

A bipartisan group of 67 senators sends President Obama a letter calling for him to be more directly involved in the VA’s disability claims backlog situation. The senators note that the average wait time for first-time disability claims is around 316 days, with a delay of up to 681 days in certain parts of the country. Of 900,000 pending claims, more than 600,000 are over 125 days old.

Innovation and Research

4-29-2013 2-10-36 PM

A peer-reviewed article published by the CDC finds that the interface technology of Intelligent Medical Objects is superior to population classification techniques as a disease surveillance tool. The findings are based on a study that showed IMO terminology service was 32 to 42 percent more accurate in identifying coronary heart disease compared to algorithms using reimbursement coding and classification techniques in identifying coronary heart disease.


AirStrip Technologies settles its patent dispute with MVisum, Inc., a competitor it accused of infringing on its patent for real-time viewing of patient data on mobile devices. MVisum agreed not to offer infringing products that include “streaming or displaying real time or near real-time patient physiological data.”

NextGen Healthcare launches Comparison Utility, a proprietary ICD-9/ICD-10 comparison tool that is available a no charge to its customers.

4-30-2013 9-04-40 PM

Healthcare Holdings Group acquires the exclusive rights to 3D-Practice’s patient education graphics technology, which it will embed in its ChartZoneMD EHR.


Athenahealth and MIT’s H@cking Medicine host a May 4-5 Hack-a-Thon aimed at at bringing about disruptive and meaningful solutions to healthcare challenges.

4-30-2013 7-24-51 PM

Anthony Weiner, the former Congressman who resigned after admitting to sending sexually suggestive text messages and photos to several women, is making big money as a corporate consultant. One of his clients is EMR vendor CureMD.

4-30-2013 8-15-35 PM

Here’s Imprivata’s latest HIT cartoon.

Sponsor Updates
  • DrFirst publishes a white paper highlighting the 428 percent growth in e-prescribing for controlled substances.
  • Medseek holds the inaugural meeting of its Clinical Advisory Council , formed to enhance patient engagement.
  • MedAptus highlights three customers and their seamless integrations between the MedAptus charge capture solution and their EHRs.
  • GetWellNetwork recognizes 12 hospitals and individuals for improving clinical care and outcomes through the use of IPC technology.
  • Inland Northwest Health Services releases its 2012 Community Report.
  • Martin’s Point Health Care (ME) discusses how its use of PopulationManager by ForwardHealth Group has improved its ability to respond to patient needs, identify gaps in care, and make systemic changes based on performance.
  • Imprivata hosts May 9 Webinar introducing the benefits of OneSign for healthcare.
  • Nuesoft hosts a May 8 Webinar on  using technology to improve revenue cycle.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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April 30, 2013 News 4 Comments

Advisory Panel: Surprise Projects for 2013

April 29, 2013 Advisory Panel No Comments

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 question this time:  What "surprise" IT or informatics projects have come up recently that you didn’t expect to have to deal with in 2013?

We’re about four months away from a pretty big EHR rip-and-replace go-live. The surprise for me has been the steady drumbeat of “business as usual” requests: a new POC lab system, new offices, clinics and moves, interfaces to the legacy system that will be replaced 30 days after go-live, etc. I guess I shouldn’t be surprised — just a little freaked out.

When we began the fiscal year in October, we had not planned on applying for a CMS Shared Savings ACO. The learning curve was steep on this, and now that we were awarded one in January, we are being cautious to make the right decision on an IT platform to support the ACO.

Not sure that it’s a surprise, but the increased focus on meeting regulatory demands have shifted the focus of IS. Even though the organization focuses well on our EHR and Meaningful Use progress, it is difficult to find the funds to refresh our infrastructure and deliver the smaller application needs of the organization (food management and employee health are recent examples that come to mind). Our average age of infrastructure continues to creep upwards while our MU efforts monopolize most of the IS capital. On top of that, there is renewed focus on patient access and experience that have impact to the IS "pot o’ gold" (and for my organization it’s not really much of a pot to begin with – maybe a cup is more accurate). I have had to redirect money away from the non-regulatory projects and leave organizational needs unmet. Old equipment and unhappy customers create uncomfortable CIOs. Not a complaint really, just a reality of the job. These demands on capital make it more critical for IS to be able to tell the story on how we are
going to decrease costs, increase revenues, avoid penalties, etc.

The surprise projects are currently getting planned for 2014 in our organization. Many of them are focused on Meaningful Use – both for 2014 Stage 1 and Stage 2. From our organization’s perspective, it will probably late 2014 or 2015 before we can focus on any significant IT project that isn’t driven by a regulation or a dependency for a project that is.

Multiple instances in my organization where a doctor or department had spent time and money to build out an application for their use and want to now commercialize it. Who knew there would be so much entrepreneurial spirit going on under our hood? Begs the question – should we better create an atmosphere and infrastructure to support these projects, and what is the best way to support them moving forward (e.g. do we help to spin them off into new companies to help create a way to sustain them?) And of course we
have to work through the IP issues as well.

A couple of large HR system and outpatient business analytics projects competing for resources with ICD-10 and Meaningful Use Stage 2 prep projects.

Replace our software for calculating month end reserves. Replacing software for electronic claims submission.

I’m not sure I would call these a complete surprise, but what has surprised me is the volume of good, value-added ideas that are coming up related to using our EMR to further improve quality, safety, efficiency. Multiple IT-enabled optimizations using our EMR and analytic tools to help further reduce readmissions, provide an early warning on septic patients, reduce catheter -associated urinary track infections, and the like. In addition to ensuring readiness for Stage 2 Meaningful Use, we are spending much effort and energy on optimizing our EMR.

No real surprise projects. What is creating unrest is BI, ACO support, and keeping up after we cut our staff by 20 percent.

Interestingly, most surprises here are due to our operational need to jettison existing partners, in my case, in rad onc and imaging. This was primarily due to the relationships going south fairly quickly. Standing up linear accelerators et al, as well as a new PACS, was definitely not even on the radar. Both are significant projects.

HIMSS Healthcare Transformation Project.

Major modifications to our revenue cycle system and the interfaces to our insurance companies, based upon changes to reimbursement policies, particularly capitated payments. Still reeling.

We have a solid strategic plan that’s updated each year. We also have an engaged IT Governance group. I can’t think of any surprises, but we are only halfway through the fiscal year. My mindset is that IS should expect them and not overreact. This is where you can see what your team is made of. Also, surprises provide teaching and growth opportunities.

We have to go through three major code upgrades before February 2014, rather than just two. And we have to implement our EHR vendor’s HIM module upgrade, to our surprise, because none of the vendor’s new functionality works with our current HIM module. That turns out to be a major project, and a prerequisite that has set several other projects (such as physician documentation) back by nearly a year. Lastly, our pharmacy had been trying to "skate by" the MU Stage 2 regs by only implementing bar-coding for IV meds, but we realized after some calculations and CMS FAQs that still wouldn’t hit our required 10 percent. We’re going to have to do a full medication barcode implementation under very tight time frames.

Most surprises have been in the realm of infrastructure upgrades (additional storage and additional wireless capability). Under the heading of wireless capability, the organization chose many years ago to implement a guest wireless network. Our administration wanted to bring their own devices — they balked at having to give permission to sign on to the guest network even with something as simple as an acknowledgement. Because of this, our guest network is regularly exceeding its connection limit. We are working to create a third network for employees and their devices.

New hospital process reengineering projects that will have IT implications.

There is possibility of squeezing in (at least the beginnings of) more inpatient EHR implementations during the latter part of the year than anticipated as we get ever closer to Stage 2 requirements kicking in.

Not a total surprise, but our physicians and our key ambulatory vendor are very rapidly moving toward multiple mobile solutions as well as patient centric solutions. More quickly than we had anticipated, we are learning to support the iPad EMR version, iPhone  apps, and patient portal.  The vendor is providing new cloud computing solutions and we’re learning how to implement and support these very rapidly.

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April 29, 2013 Advisory Panel No Comments

News 4/26/13

April 25, 2013 News 8 Comments

Top News

4-25-2013 7-33-10 PM

Cerner posts Q1 results: revenue up 6.1 percent, EPS $0.62 vs. $0.51, beating adjusted earnings estimates but falling short on revenue. A 12 percent decline in system sales was balanced by a 16 percent increase in support, maintenance, and service revenues. From the conference call, the company announced one win over Epic in the quarter, talked up its international business, and touted its population health management efforts. Neal Patterson participated, finishing up with, “You can see from the CommonWell Alliance that we use our leadership position in the industry for the greater good, but also to basically highlight where basically we have bad actors around subjects such as interoperability.”

Reader Comments

From Med Student: “Re: Meaningful Use Stage 3. If you could change anything in Stage 3, what would you include or cut out?” I’m curious about that myself, so please leave a comment with your thoughts.

From Herky: “Re: warm-blooded. Spotted at TEDMED last week, riding the bus together from the Kennedy Center to GWU for Great Challenges Day: Allscripts CEO Paul Black and former CEO Glen Tullman. I guess all those rumors about bad blood between the two were ill founded.”

HIStalk Announcements and Requests

inga_small Some hot news you may have missed this week on HIStalk Practice: compensation for medical directors is increasingly tied to quality metrics, as are job responsibilities. Advice for physicians engaging in Web-based messaging services. Details on athenahealth’s emergency response process, which was activated during last week’s manhunt for the Boston Marathon bombing suspects. EMR adoption by primary care physicians in Canada has doubled from 23 percent in 2006 to 56 percent in 2012. Rather than sell out to hospitals, practice management consultants offer alternate alignment models for consideration. Dr. Gregg puts his spin on the phrase that pays and playing in the healthcare sandbox. Take or moment or three to catch up on the latest ambulatory HIT news and sign up for e-mail updates while you are there. Thanks for reading.

Acquisitions, Funding, Business, and Stock

4-25-2013 7-30-54 PM

Hill-Rom Holdings reports Q2 results: revenue up three percent,  EPS $0.37 vs. $0.43.

4-25-2013 7-31-34 PM

Streamline Health’s Q4 numbers: revenue up 49 percent, EPS –$0.63 vs. $0.00.

4-25-2013 7-32-28 PM

Lexmark subsidiary Perceptive grew Q1 revenue 47 percent to $44 million.

4-25-2013 9-05-02 PM

Informatica reports Q1 results: revenue up 9 percent, EPS $0.16 vs. $0.24.

4-25-2013 9-08-55 PM

Qlik Technologies announces Q1 results: revenue up 22 percent, adjusted EPS –$0.09 vs. –$0.03, beating expectations on both.

Nuance seeks the advice of Goldman Sachs following the acquisition by activist investor Carl Ican of 9.3 percent of the company’s shares.


The Michigan Health Information Network partners with Surescripts to allow users of Surescripts’ Clinical Interoperability network to send electronic health information to the State of Michigan’s public health reporting system through the HIN and the Michigan Department of Community Health.

Presence Health (IL) awards Harris Corp. a three-year contract to create a private HIE.

4-25-2013 7-35-58 PM

The University of New Mexico Health Sciences Center purchases MDaudit Professional billing compliance software from Hayes Management Consulting.

Syracuse Community Health Center (NY) selects NextGen Healthcare’s Ambulatory EHR, PM, and Electronic Dental Record solutions for its 16-location FQHC.

MModal signs seven new hospitals and imaging centers for its Fluency for Imaging radiology workflow technology.

4-25-2013 7-35-00 PM

Fisher-Titus Medical Center (OH) selects Wolters Kluwer’s ProVation Order Sets.

UC Davis Medical Center (CA) selects TriZetto’s ClaimLogic as its claims processing solution, where it will integrate with Epic.


4-25-2013 6-17-53 PM

The Patient-Centered Outcomes Research Institute hires Bryan Luce (United BioSource Corporation) as chief science officer.

4-25-2013 6-18-33 PM

Interactive patient care system provider Skylight Healthcare Systems names Lisa Romano (TeleTracking Technologies) chief clinical officer.

Cleveland Clinic Innovations names its current GM of IT Commercialization Gary Fingerhut as the organization’s interim director, taking over for founding executive director Chris Coburn, who is heading to Partners HealthCare to lead innovation efforts.

Announcements and Implementations

Atlantic General Hospital (MD) implements Allscripts Sunrise.

Physicians’ Alliance of America launches iMedicor SocialHIE, giving its 34,000 physician members the ability to electronically exchange clinical information.

4-25-2013 9-57-08 PM

Athenahealth announces its marketplace for third-party solutions.

4-25-2013 8-24-52 PM

HCS, which offers the Interactant suite, launches a new logo and website.

UMass Memorial Health Care deploys MedAptus Technical Charge Capture.

4-25-2013 8-11-18 PM

Patient Logic launches its physician documentation system at three small hospitals. Its sister HealthTech companies are HMS and Medhost.

Children’s Specialized Hospital (NJ) launches GetWellNetwork’s GetWell Town interactive patient system, funded by a grant from L‘Oreal USA.

The physician informaticist who heads up MedAppLab in Germany says diagnostic or prescriptive smartphone apps present too many possible sources of error to be recommended for use, including the quality of peripherals such as headphones.

4-25-2013 8-54-16 PM

Online storage vendor Box says its product is now HIPAA compliant, also announcing 10 partner applications that include the drchrono EHR, in which Box has taken an undisclosed equity position.

Lott QA Group and HRS announce an ICD-10 testbed for coding and clinical documentation.

4-25-2013 7-37-03 PM

John Halamka says in his blog that Beth Israel Deaconess Medical Center will go live on its homegrown electronic medication administration record in June. He says it’s Web-based, mobile-friendly, and integrated into existing systems. It will support the use of iPhones for viewing, iPads to verify orders at the Omnicell cabinets, and wall-mounted computers with bar code readers for verification.

Government and Politics

CMS proposes raising the maximum reward for reporting Medicare fraud from $1,000 to $9.9 million; denying Medicare enrollment to providers affiliated with an entity that has unpaid Medicare debt; and denying or revoking billing privileges to individuals with felony convictions.

ONC revokes EHR certification on EHRMagic-Ambulatory and EHRMagic-Inpatient following notification that the products did not meet the required functionality and should not have passed certification. InfoGard Laboratories, which certified the products originally, retested them after reviewing additional information and gave them a failing score. Above is the reaction of Candid CIO Will Weider.

AHA tells CMS not to add additional HIE requirements for providers, but instead focus more on implementing current HIT initiatives.

4-25-2013 3-49-10 PM

Meanwhile, the founding members of the CommonWell Health Alliance tell CMS they are committed to collaboration with HIT suppliers, adding that they will use existing standards and supplement them only when needed. Members also emphasized the importance of creating an open forum for secure patient data exchange and removing data access barriers.

4-25-2013 8-04-04 PM

A North Carolina Senate panel approves a bill that would require hospitals to create easily understood bills that include definitions for any medical terminology. State Senator Jeff Tarte, a former hospital CIO via a stint with Ernst & Young, says transparency is tough to solve and just creating nicer bills isn’t going to fix the problem.

A federal grand jury convicts the former medical records director of a Florida-based partial hospitalization program for leading a scheme that submitted $63 million in fraudulent Medicare and Medicaid claims. The therapy provided to the severely mentally ill patients involved watching Disney movies and playing bingo.


4-25-2013 7-24-03 PM

A new KLAS report says that patient accounting systems are the next hot thing in 200+ bed hospitals because of accountable care needs, the tapering off of Meaningful Use system selections, and the impending transition to ICD-10. Integration is a priority, leaving Epic and Cerner as the only inpatient billing systems that also cover ambulatory billing, with Cerner still scoring low but trending up. Update: KLAS says my summary is misleading, so here is their exact wording: “Epic and Cerner are the only vendors whose inpatient billing systems are integrated with both their inpatient EMR and ambulatory billing systems.”

4-25-2013 7-52-13 PM

A solo family physician in rural Colorado says he “gave up on healthcare in America,” sold his practice to a hospital, and moved to Australia because of the 2 percent Medicare penalty he would have been charged in 2015 for not adopting an EHR that he couldn’t afford anyway. He says in Australia people love his American accent, he gets a lot of time off, and he makes $250,000 a year for a light schedule vs. the $100,000 he was making for being overworked in Colorado. “Primary care is highly respected here. That’s not the case any more in America. In the United States, health care has become more about the business of making money. The personal side of medicine is going away.”

CommonWell, challenged directly on Twitter by Terry Bequette, state HIT coordinator for the State of Vermont, says “all HIT developers” are welcome to join.  

WakeMed (NC) creates a video celebrating its 52 years and touting its new $100 million Epic system, which it is implementing along with nearby Triangle-area academic medical centers Duke University Hospital and UNC Health Care.

Truven Health Analytics reports that 71 percent of ER visits made by patients with employer-sponsored insurance coverage are for conditions that did not require immediate attention or could have been prevented with outpatient care.

Medhost files a lawsuit against Health Management Associates, claiming the hospital operator continues to use its ED software despite not having paid the third installment of $4.5 million last year.

4-25-2013 10-13-15 PM

Henry Ford Health System (MI) reports a 15 percent decrease in net income, primarily due to an increase in uncompensated care and the $36 million it spent to implement Epic. According to the CEO, “We knew that 2012 and 2013 would not be easy years for the system because of the Epic costs.”

A court orders UPMC to allow employees to use its computers and e-mail system for union-organizing activities.

Weird News Andy says this is like a reality show for doctors. Utah pediatricians trying to relate better to their teen patients hire acting students to simulate clinic visits and act out medical scenarios. The students are enjoying it so much that they have volunteered to continue after school is out.

WNA also likes this story, in which Seattle police are investigating reports that a nurse imposter entered patient rooms at Swedish Medical Center and cut the IV lines of patients to steal what sounds like narcotic-containing PCA cartridges.

4-25-2013 11-13-38 AM

inga_small In patient fashion news, Henry Ford Health System introduces a new double-breasted hospital gown that closes in the back, uses snaps instead of ties, and is made of thicker fabric than traditional gowns. One of the gown designers notes that, “By creating a hospital gown that is safe, stylish, and comfortable, we’ve made the patient feel more at home, like they’re wearing their own garments." Kind of makes me want to schedule some elective surgery just to try one out.

Sponsor Updates
  • Aprima Medical Software, Greenway Medical Technologies, and Allscripts forego interface fees as preferred partners for Greater Houston Healthconnect’s regional HIE.
  • Elsevier issues a brief that identifies the need for and potential impact of evidence-based medicine.
  • Wellsoft will participate in next month’s 2013 Emergency Medicine Update conference in Toronto and the e-Health 2013 conference in Ottawa.
  • Barb White, director of healthcare solutions for AT&T, discusses cyber attacks and security breaches in healthcare. 
  • MedAssets’ Sandy Hoffman co-hosts the Fifth Annual Mouse Races for MS in Cape Girardeau, MO on April 27.
  • Laura Kreofsky, principal advisor with Impact Advisors, discusses how EPs are spending their Meaningful Use incentives.
  • Prognosis suggests topics to discuss with current or potential vendors to avoid EHR dissatisfaction.
  • Penn State makes the DynaMed clinical reference database available to all students and staff. 
  • Boston Children’s Hospital Chief Innovation Office Naomi Fried and Carnegie Mellon University professor Alan Russell will provide the keynote addresses at the iHT2’s Health IT Summit in Boston May 7-8.
  • ADP AdvancedMD hosts a May 8 Webinar on engaging patients in their healthcare. 
  • NextGen Healthcare hosts a May 1 Webinar on effective claims processing.
  • Stuart Long, Capsule’s chief marketing and sales officer, discusses the benefits of medical device integration and how it works in a hospital.

EPtalk by Dr. Jayne

ONC issues the Apps4TotsHealth Challenge to encourage integration of the TXT4Tots message library into new or existing platforms. The library includes evidence-based messages focusing on nutrition and physical activity and is targeted to parents and caregivers of children 1-5 years old.

The National Institutes of Health is using IT to boost energy savings. Maneuvers that would benefit healthcare entities include forcing computers to go on standby at the end of the day and software to aggressively manage environmental systems.

Children’s National Medical Center is using video games as a way to measure and manage chronic pain. Applications are used for physical therapy as well.


Overheard in the physician lounge: two of my colleagues were discussing slick new carts that have appeared on the floors. I’m happy to note that they are from HIStalk sponsor Enovate.


I received a HIMSS e-mail regarding the annual conference experience and asking me to take a brand survey on my “emotional connection” to HIMSS. I was asked to select images that fit attributes for the HIMSS brand on “touch, taste, scent, sight, and sound.” Maybe I’m too much of a literal person, but I found the concept odd. It also didn’t fit my screen without scrolling, making it a non-starter.



Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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April 25, 2013 News 8 Comments

Morning Headlines 4/25/13

April 24, 2013 Headlines 1 Comment

FDA Device Surveillance to Tap Phone App

The FDA Adverse Event Reporting System will be revamped in part by launching a smartphone app for streamlined adverse event reporting by physicians.

Electronic health records key to patient care quality improvement

In England, a survey of physicians reveals that 94 percent believe that patients should have at least some access to their electronic medical records, but only 34 percent like the idea of full access. Physicians also overwhelmingly support allowing patients to update standard sections of their own electronic records, including demographics, family history, allergies, and home medications.

Patient-Centered Outcomes Research Institute to Invest Up to $68 Million to Develop a National Patient-Centered Clinical Research Network

PCORI has committed $68 million in funding to support the development of a national infrastructure to advance patient-centered clinical research that enables efficient participation from broad patient populations.

athenahealth Marketplace Brings Shopping to Health Care IT

athenahealth launches a marketplace of bolt-on pfferings for its cloud-based practice solution from a variety of vendors, including Experian Healthcare, InHealth Clinical Documentation Solutions (ICDS), NHXS, iTriage, and Entrada.

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April 24, 2013 Headlines 1 Comment

HIStalk Interviews Elizabeth Holland, Director HIT Initiatives Group, CMS

April 24, 2013 Interviews 8 Comments

Elizabeth Holland is director, HIT Initiatives Group, Office of e-Health Standards and Services for CMS.

4-24-2013 1-33-51 PM

Describe the scope and process for the Meaningful Use audits for hospitals and EPs.

It’s really two pronged now, because we started last year. We started a post-payment audit program and now we are also doing pre-payment audits as well. 

When I say audits, it’s mainly the audits that are being done on the Medicare side. Medicare is actually handling the audits for all the Medicare eligible professionals and then all the Medicare hospitals as well as the Medicare dual hospitals, the hospitals that can get Medicare and Medicaid. But the Medicaid audits of the eligible professionals are being done by the individual states. 

Our audit are looking at Meaningful Use. We’re looking at providers to validate that they are using certified EHR technology. Secondly, we’re looking at them to see if they have the documentation and can justify that they are in fact Meaningful Users.


Will all attesting providers be audited in some fashion or will it be a random selection?

It’s actually a little of both. Certainly not all will be audited, but we are looking and refining our ability to make selections. Some selections are totally random and others are more targeted. We’re using a combination of both.

Some of the targeting is really crude and basic, like we had people who wrote a numerator and denominator to get 100 percent on every single measure. That flagged them for audit.


Like IRS audits, where you have a chance of being randomly audited, but there are certain red flags that you may or may not publicize?



Will the audits be strictly desk audits or will there be field audits?

There may be some field audits, but so far they’ve all been desk audits.


The question I’m asked most often if it will be like IRS forms that tell you how long it will take you to provide the information. Do you have an idea of how much time providers will need to set aside?

I don’t have a feel for that. The audit process becomes very individualized. We’re using the same contractor for pre-payment and post-payment. They send an initial request letter asking for certain things.

What I’m told is that it varies by practice how quickly they can pull that stuff together. Some providers have it all together because they pulled it together  when they did their attestation, so it’s very easy for them to pull it together. Others, it takes more time.

I believe the initial request gives them two weeks to pull everything together. However, if they need more time, we’re very flexible. All they need to do is contact the contact names on the letter they received. We’ve been giving everybody who’s requested it additional time.


What criteria were used to select the audit contractor?

That I honestly don’t know. The selection wasn’t done in my office, so I don’t know how.


Will the auditors, either the individual auditors or the auditing firm, be financially rewarded for identifying fraudulent attestations so that they’re encouraged to find problems?

I don’t believe so. I think they’re paid by the audit. We’re not looking for fraud so much. We’re wanting for people to tell the truth, but so far the only thing happens if you’re found not to be a Meaningful User is that you return your incentive payment. That goes right into the Treasury. It’s not like the whole practice and all your Medicare claims billings are being looked at. That’s not the way these audits are working.


I  assume that a lot of what you may find wrong, like on tax forms, are honest mistakes rather than intentional fraud.



How will you determine intention if you’re only doing desk audits? It would seem like you would need to have a direct conversation.

It has varied. We have sent audit letters and people have returned checks without sending in any documentation. What does that mean? I don’t know. I’m just telling you that’s a fact.

This is not really meant to be a gotcha. If you attested to a particular measure and the standard for that measure was 50 percent and what you told us is you had 90 percent … if we go back in and see you only had 80 percent, that’s fine. You’re still a Meaningful User. We’re not going to say gotcha.

We’re really looking to validate Meaningful Use. if it’s like a percentage off on one measure, we’re not going to die on our sword for that. It’s just if you have repeated measures where what you told us is massively different than the documentation that you’ve shared with us, that’s when you may have more of an issue.


How many audits have been done so far?

All we’re saying right now is that we’re aiming for 5 to 10 percent of the people who received incentive payments.


Based on experience and what you’ve learned so far, do you have any feeling for what the percentage might be that you will find not in compliance that will have to return their check?

I don’t have the feeling for that yet. Part of it is when they first started doing the audits, there were a lot of things that the auditors weren’t totally clear on. My policy staff has worked with them very closely to try to clarify things. That’s part of why we put out some of the guidelines that we put out, so that everybody can be more clear about what documentation they need to save, what they need to be attached to, all sorts of things like that, so that everybody’s nearly well aware of what the requirements are.

I think in the beginning there was just a lot of cloudiness and now we’re trying to make everything much clearer for the auditors and for the providers as well.


Will it be a phased approach where they’re looking at a random sample over a fixed time period, or will it be a big swoop of people …

It will be ongoing throughout the program. What will probably happen — and I don’t know this for sure — but my sense is that if you are audited and you pass, the likelihood of you being selected in the next year will be lower than if you did not pass and you participate in a subsequent year.


Going back to the model of financial audits or IRS audits, there’s usually a thoroughly documented step-by-step process that has every procedure down pat so that the audit person doesn’t have to use a lot of judgmental analysis. Does that exist for Meaningful Use audits, and if so, is it publicly available?

Very close. Any time there is any call for judgment, it comes to my staff. If there’s anything that’s not clear, we make the decision.


Since providers are being held to those audit standards, would they have access to see what those standards are other than the obvious about how the process will work?

I’m thinking we’re going to be putting out a lot more information on that. But yes, they should know what the standards are, and part of that is what the definition of Meaningful Use is.

The goal of the program from my perspective is to get people to switch from paper to electronic, and then once you’re using the EHR, to use it in a meaningful way. We’re not trying to scare people. We’re not trying to get people to return to paper. But then again, we’re also paying out an incredible amount of money. We want to make sure that taxpayers are getting what they expected — that people are really switching to electronic health records.

We have a really strong fiduciary responsibility, so we’re trying to balance that to make sure people know that we’re serious. You should have documentation that backs up your attestation, but it’s not going to be like a “surprise, gotcha” thing. It will be things that you know about.


If the provider is judged to have not been in compliance, is there an appeals process?

At this point, we are still deciding that.


But from what you said, the auditors won’t hold the sole authority on any decision …

That’s the thing. The appeal process is run by my office. If we’ve already weighed in back and forth on the audit, then there’s no need for us to weigh in again.


Let’s say a provider fails the audit and blames their certified vendor. Will there be any push to then evaluate the vendor as well as the user?

We’re talking to the Office of the National Coordinator a lot about that. Honestly, a lot of providers are concerned about their products. But what we’ve said is if the product produces a report and you rely on that report for your attestation, that gives you documentation, and if the tool itself is not calculating accurately but you have reports that document what you attested to, then you’re fine.

There have been lots of instances that the EHR is not calculating things correctly and patches going out and providers being really scared.


If that occurs and it turns out the vendor software has made a mistake of some sort, will there be repercussions to that vendor?

I don’t know if there will be, but we’ve certainly known of several instances with different vendors about patches they’ve put out. We made the auditors well aware of those things so that they don’t penalize the providers.


Much of the documentation involves EMR-generated reports with the vendor’s name on them. It seems like it would be pretty easy for someone to just Photoshop those.

That’s one of the things we’re working on.


Doctors are telling me that there is definitely fraud occurring under the Medicaid program Adapt, Implement, and Upgrade where providers claim to be customers of a vendor and the vendor has never heard of them. Is there ability or an interest in checking to see that if a customer claims that they’re using a particular vendor software that by simply contacting the vendor to find out if they really are or not?

Each state is handling that differently, but before they pay, they’re supposed to have in various standard of validation comes before they pay. In a way it’s like a pre-payment audit where you have to give a bill of sale and things like that to justify your payment.


I don’t want to suggest even though I used that Medicaid example that the possibility is limited to Medicaid. Under the Medicare audit, it could be the same issue, where someone has attested and says, “I use NextGen,” but NextGen says, “No, they’re not a legal user of our software.”

Some of the things that we ask for in the audit are screen shots and things like that. We’re talking about trying to get some sort of automatic … like you have to send an e-mail from the EHR to us so we can validate that they’re actually using the tool. But I think for Medicaid, it’s because you don’t have any measures to do. You are just adapting, implementing, or upgrading. You don’t have to be using. You can just get these tools. I think it’s harder to validate. At this point, the number or people we have participating is so large that I don’t know how we would call all the vendors to find out.


Will the results of the audits be made publicly available in any form?

Yes, but I don’t know when that will be. We have a lot of people who are wanting that.


That wouldn’t name providers, I assume.

I don’t believe so, no. It could certainly go after like provider type, like  large or small eligible professional or hospital. I think from my understanding right now we’re doing a lot more audits on EPs just because there’s more of them. The hospitals are doing really well. The EPs have more issues, but that’s mainly based on sheer numbers.


Audit notices are going out by e-mail. In the experience so far, have there been providers who just didn’t get the e-mail or just ignored it hoping it would go away?

I don’t know that if they ignored it to would go away, but I think if they don’t respond then we send them a letter, like a mail letter. That’s just the first. Just because they don’t respond doesn’t mean they’re off the hook. Good try.


There’s been a lot of attention paid to the group of Republican senators who are challenging the Meaningful Use program. Do you see that the nature or the scope of the audits will be adjusted in any way to appease the folks who want to see it made tougher?

Quite honestly, I think that was an interesting letter. And I think we’re actually, despite what the letter says … a lot of what they want us to do is already included in Stage 2 of Meaningful Use. I believe we’re on the path that they want us to be, but also in the letter they told us to slow down to Stage 3. Stage 3 would be an additional push to do more, but they asked us to … they were happy that we were delaying the rulemaking. 

We’re definitely going to have more conversations with them to clarify how we’re moving forward. We believe we’re really in alignment. We just have to make a better case for ourselves, I think.


One of the most misunderstood aspects from the beginning is that you didn’t have to buy anything to qualify for the incentive. Do you think that people understood that you didn’t necessarily have to invest? Do you have a feel for how many people did invest to earn the payment versus those who are already pretty much in compliance already?

My understanding is that every EHR system out there had to be tweaked. Some were major tweaks and some were minor tweaks, so depending on what kind of system you had, they had to be certified, but in that most cases like the vendors would take care of that. Then you had to make sure you got whatever upgrade or whatever and made sure that it was certified. 

What we don’t have good intelligence on are how many people, especially with the early adopters, were already electronic and just had to do Meaningful Use to get a payment and how many people were nowhere. They just decided, oh, here’s an opportunity to go electronic — you can get some compensation for it. We’re trying to look more into that data.

There’s misinformation out there thinking that there’s a mandate that they must go to electronic health records. That’s not true, although it is true if they’re not Meaningful Users for Medicare, they will get a payment reduction starting in 2015. It’s sort of like the carrot or the stick, any way you can get people to switch to going electronic, because one of the big goals is having interoperability but if you have half the EPs still on paper, reaching true interoperability is going to be really hard.


I don’t mean to harp on this question, but I have a lot of vendor readers. Do you see any reaction to the results of the audits that would impact vendors, such as some changing of the certification criteria?

The certification criteria are already changing for 2014. That was all in rulemaking, so there’s nothing else we can do for Stage 2 at this point. We had to do the rulemaking so early without, in my opinion, enough data to really know what the main issues were with Stage 1.

What we heard anecdotally from vendors is a lot of them have many different tools and that there’s going to be some sort of consolidation as they move to Stage 2. Not necessarily a merging of vendors, but a vendor may have 10 tools that he may only get six or something like that certified for Stage 2 or the 2014 certification. Hopefully that means that vendors are concentrating on certain products and trying to make those products as good as they can possibly be.


Any final thoughts?

From my perspective, we’re trying really hard to educate providers, but we’re also trying really hard to educate the vendors. We have a new vendor work group that we have called with the vendors, working through issues that they’re having. My staff are the people who wrote the Meaningful Use rules, so that we go into in depth explanations about what we mean about each of the Meaningful Use objectives and measures. 

We’ve had a much more collaborative process as we’re moving through Stage 2, mainly because there were a lot of misinterpretations of Meaningful Use measures at the beginning of Stage 1. This time we’re trying to be more proactive as we move forward. The providers have been appreciating that and the vendors have been very appreciative.

We have a really large group of vendors that is participating with us. Hopefully that will lead to a more unified determination for programming of the Stage2 EHRs so that the EHRs will just do better work. They’ll work for providers better.

The main thing that I keep saying to people that I talk to is you shouldn’t be worried about the audits as long as you have told the truth. I know there’s some panic out there, but if you’re honest and you’re telling the truth, you have really nothing to worry about.

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April 24, 2013 Interviews 8 Comments

News 4/24/13

April 23, 2013 News 4 Comments

Top News

4-23-2013 8-43-50 PM

Nextgov uncovers a scathing internal Pentagon memo that says DoD’s plans to acquired commercial off-the-shelf software fly directly in the face of the President’s call for a joint DoD-VA EHR based on open standards.

Reader Comments

4-23-2013 9-46-12 PM

From Wesley: “Re: Encore Health Resources. They have laid off multiple people in recent weeks.” I asked Encore CEO Dana Sellers, who provided this reply:

Encore continues to experience strong, healthy growth thanks to wonderful clients and the best consultants in the industry. As a result, we’ve done some realignment of our Client Services organization over the past few weeks to better position Encore to execute our strategy: the delivery of a full life cycle of consulting solutions with a focus on business intelligence and performance improvement. In fact, to meet our increasing business demands, we are actively recruiting for Client Services Executives in Nashville, Florida, Colorado, and California. Send some great folks our way, would you?

From John Porta: “Re: Advisory Panel CIOs not finding value in the HIMSS conference. Who does find value, the marketing VPs? Sales employees think it’s the biggest waste of their time in the pipeline, which is why they spent their days on their phones while ignoring the giveaway seekers and non-buyer IT staff. Why do vendors spend an average of probably $250K to be there preaching to the choir? Maybe just  companies trying to justify their marketing existence. I believe the HIMSS conference is an ongoing, self-perpetuating, ad-selling, marketing come-on. Few companies have the balls to pull out.”

4-23-2013 9-46-55 PM

From Iggy: “Re: MModal. Debtwire said that on April 3, executives told their debt holders that they fell out of compliance in the period ending March 31 and One Equity will ‘cure’ this. Is this routine?” I asked Ben Rooks, who writes HIStalk’s “Healthcare IT from the Investor’s Chair,” who with help from his friends at investment bank Houlihan Lokey provides this explanation:

Loans such as the one that allowed One Equity to borrow money to purchase MModal (the Leverage in the term LBO, or Leveraged Buy Out) have certain ongoing requirements with which the company must comply (known as “covenants”). In this case, there was actually only one such covenant, but it allowed for a maximum amount of net leverage (how much debt each dollar of EBITDA — earnings before interest, taxes, depreciation, and amortization — must support). This metric rose since the deal closed, reaching 6.43x at the end of last year in contrast to the 5.35 that was projected. Interestingly, it was set at 6.5 in Q1, then drops sequentially by .25 until it reaches 5.75 in Q1 2014 (presumably as the company both pays down its debt and grows its revenues and EBITDA). According to Standard & Poor (the debt rater in this case), “MModal has seen its revenue weaken as a result of a slower-than-expected transition to its new products strategy and competitive pricing pressures” and it downgraded the debt a notch. Realizing that these things can happen, however, the loan agreement allows the sponsor (One Equity) to cure the problem, typically by adding more equity dollars or else guarantying part of the loan. Incidentally, M*Modal might not be public, but its debt is, so this was, in fact, disclosed publicly, just not as loudly as in the case of public companies.

Acquisitions, Funding, Business, and Stock

4-23-2013 9-47-45 PM

LifeIMAGE closes a $15 million Series C round of financing.

Henry Schein, Inc. secures $300 million of committed financing with The Bank of Tokyo-Mitsubishi UFJ, Ltd. based on the securitization of its A/R.

4-23-2013 9-48-31 PM

CTG reports Q1 results: revenue up five percent, EPS $0.24 vs. $0.20. CTG attributes its growth on increased demand for EMR and other health information technologies.

4-23-2013 9-49-11 PM

Healthcare learning platform vendor HealthStream announces Q1 results: revenue up 25 percent, EPS $0.07 vs. $0.05, beating earnings expectations and sending shares up 16 percent Tuesday.

Israel-based medical social data mining vendor Treato raises $14.5 million in funding. The company’s platform extracts patient comments from blogs and discussion forums, applies natural language processing and other analytics, and provides an overview of patient comments about drugs and conditions. According to the company’s CEO, “Until now, everyone wanted to hear the doctor’s voice. Now, because of social changes and even legislation, everyone wants to hear the patient’s opinion. Regulation no longer pays for the doctor to treat, but for the patient to heal.”


Nightingale Preventive Care, a provider of healthcare services in Kmart stores, selects HealthFusion’s MediTouch EHR.

4-23-2013 9-50-47 PM

Riverside Health System (VA) chooses HealthMEDX Vision for EMR and billing for its Lifelong Health and Aging Related Services division.

Orange Accountable Care (FL) selects Halfpenny Technologies to provide a lab data interface for referring physicians using risk management services from Orange Health Solutions.

Scott & White Healthcare (TX) contracts with KPMG LLP to assist with its Oracle PeopleSoft v0.2 Human Capital Management reimplementation project.

Ardent Healthcare will expand its use of Infor’s human resources and financial management suites.


4-23-2013 9-40-49 AM  4-23-2013 9-42-41 AM

Huron Consulting Group hires Todd Christiansen (IBM Global Business Services) and Joseph Gaetano (Siemens Medical) as managing directors in its healthcare practice.

4-23-2013 7-15-38 PM

Anthony Caponi (Maxim Healthcare Services) joins Direct Consulting Associates as VP of sales.

4-23-2013 7-19-35 PM

MediRevv hires Randy Blue (Resource Corporation of America) as director of sales.

4-23-2013 9-02-49 PM

VC firm Polaris Partners names Tim Kilgallon as CEO in residence, focusing on consumer-directed digital health opportunities. His healthcare IT experience includes stints with Pointshare Corporation and Medaphis.

4-23-2013 9-07-37 PM

Health program and population health management software vendor Aegis Health Group promotes Bill Walker to CTO.

4-23-2013 9-33-06 PM

Mobile applications platform developer Kony Solutions, announcing 90 percent year-over-year growth, names Abhay Parasnis (Oracle) as president and COO.

Gary Peat (Council Capital) joins eDoc4u as SVP of corporate and business development.

Announcements and Implementations

The Patient-Centered Outcomes Research Institute will fund up to $68 million to support organizations focused on the advancement of comparative clinical effectiveness research.

Hamad Medical Corporation in Qatar will implement Cerner Millennium across its primary care centers and eight hospitals.

Allscripts releases Allscripts Care Director to enable care coordination across all care settings.

4-23-2013 7-25-45 PM

Emmi Solutions wins a communication award from The Center for Plain Language for its Heart Failure Transition multimedia series.

4-23-2013 9-55-07 PM

Gwinnett Hospital System (GA) adopts the ChartWise:CDI clinical documentation system.

Government and Politics

HHS considers amending the HIPAA Privacy Rule to allow states to report information on potentially dangerous mental health patients to the National Criminal Background Check System, the database that houses information on individuals prohibited by law from possessing firearms.

4-23-2013 11-42-37 AM

CHIME calls on HHS to extend certification requirements to include the HIE market.

CMS and ONC will convene a May 3 meeting on appropriate coding using EHRs from 9:00 a.m. until 2:00 p.m. in Baltimore. The session will also be streamed online.

A bipartisan group of senators unveils a discussion draft of a bill to create a nationwide electronic system for tracking the distribution of prescription drugs. The proposed measure would require every entity in the prescription drug supply chain to provide electronic transaction information when there is a change of ownership, plus shift the country from a lot-level drug tracing system to a unit-level tracing system.

4-23-2013 2-40-32 PM

CMS and ONC post a joint fact sheet that breaks down the progress made since the passage of the HITECH Act that also includes the latest numbers on EHR adoption, e-prescribing rates, and the increased emphasis on interoperability and exchange.


Medical device company Smiths Medical will develop connectivity between its infusion systems and Epic using IHE standard profiles to establish communication between the systems.


A small-scale Johns Hopkins study finds that first-year residents in academic medical centers spend just 12 percent of their time interacting with patients, while computer duties take up 40 percent of their hours. Patient time has been significantly reduced since a similar 2003 study, suggesting that mandatory reduced hours may have caused an undesirable balance of work duties. The researchers say better EMR systems would reduce some of the computer time required. The study’s senior author, a hospitalist, concludes, “All of us think that interns spend too much time behind the computer. Maybe that’s time well spent because of all of the important information found there, but I think we can do better.”

4-23-2013 9-56-36 PM

The Kansas Department of Health and Environment will officially take over the Kansas HIE effective July 1. The HIE board acknowledged in September that it financially unsustainable and voted to relinquish its functions to the state.

John Halamka reflects on hospital lessons learned from last week’s Boston Marathon bombings in his “Life as a Healthcare CIO” blog. Among them: making sure systems can support working from home, limiting data center access, increasing on-screen warnings to staff about looking up patient information, and improving HIE capabilities.

A review of CEO salaries of non-profit Chicago hospitals finds 20 who made at least $1 million in total compensation in 2011, with the CEO of Northwestern Memorial HealthCare leading the pack at $4.6 million.

Two former patients of Glens Falls Hospital (NY) file a class action lawsuit against the hospital and its contractor Portal Healthcare Solutions after the medical records of 2,300 patients are left on an unprotected computer network for four months.

Microsoft will sponsor an April 25 panel discussion on Unintended Consequences: Patient Perspectives on the HIPAA Omnibus Rule at the Microsoft Innovation & Policy Center in Washington, DC. Panels will include Iliana Peters (OCR), Corinne Cary (New York Civil Liberties Union), Deborah C. Peel, MD (Patient Privacy Rights), and Hemant Pathak (Microsoft).

4-23-2013 8-49-10 PM

Baltimore-based Healthify, a new startup led by Johns Hopkins University graduates and students, develops a free electronic waiting room questionnaire that can screen for health determinants such as psychosocial risks, nutritional status, housing, education, and substance abuse, all of which significantly increase the odds of an individual requiring hospitalization.

No-frills clinics in India say they can offer heart surgery for $800 by operating in prefabricated buildings that have air conditioning only in the OR suites and that require family members of patients to help care for them. The company’s founder, a noted heart surgeon, says that while Stanford Hospital is spending $600 million to build a 200-300 bed hospital and a new London hospital will cost $1.5 billion, the clinic can build and equip a hospital for $6 million and have it up and running within six months.

Weird News Andy says this might make sense. In England, NHS is considering sending recovering elderly patients to “hospital hotels” run by private hotel chains. It’s modeled after a similar program in Scandinavia and would relieve “bed blocking,” where local councils have cut funding for home health and residential services, leaving patients stuck in expensive hospital beds they don’t really need.

4-23-2013 7-37-54 PM

WNA also likes a story that he titles “A different kind of Brazilian close shave.” A Brazilian fisherman accidentally fires a foot-long harpoon into his skull, then decides to go home to sleep it off. His aunt calls the fire department 10 hours later. He’s in ICU and has permanently lost sight in one eye.

Sponsor Updates

4-23-2013 7-29-06 PM

  • Infor will donate $5 to charity for each attendee of Monday night’s Infor Healthcare party, held in conjunction with Inforum in 2013 in Orlando.
  • Greenway Medical will add RemitDATA’s comparative analytics solution into its PrimeDATACLOUD Remittance Intelligence service, giving practices reimbursement and productivity insights and performance benchmarking.
  • Jill Farnsworth and Mike Grisaffee from Encore Health Resources  will participate in educational sessions at the HIMSS Texas Regional Conference May 14-15 in San Antonio.
  • Healthcare Anytime offers a June 4 Webinar on surviving the avalanche of patient data.
  • Bottomline Technologies donates $2,500 to a memorial fund for Joshua Krantz, a recently deceased employee.
  • The Denver Post names Ping Identity Top Workplace for the second consecutive year.
  • InstaMed launches the InstaMed Healthcare Payments Account, which helps providers get paid faster and through more channels.
  • Visage Imaging releases version 7.1.3 of the Visage 7 Enterprise Imaging Platform, which incorporates over 1,000 enhancements and product fixes.
  • T-System will deploy the NextGen PM solution for its RevCycle+ solution clients.
  • Craneware showcases enhancements to its Bill Analyzer and InSight Audit solution during this week’s HCCA 17th Annual Compliance Institute in National Harbor, MD.
  • eClinicalWorks offers a series of Webinars in April and May on its upcoming eBO Version 6 release.
  • Henry Johnson, MD, VP and medical director for Midas+, a Xerox company, discusses value-driven analytics and the best big data trends for healthcare.


Mr. H, Inga, Dr. Jayne, Dr. Gregg, Lt. Dan, Dr. Travis.

More news: HIStalk Practice, HIStalk Connect.


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April 23, 2013 News 4 Comments

HIStalk Interviews Keith Figlioli, SVP Healthcare Informatics, Premier

April 19, 2013 Interviews No Comments

Keith Figlioli is senior vice president of healthcare informatics of Premier of Charlotte, NC.

4-15-2013 7-07-13 PM

Give me some background about yourself and your job.

I’m the senior vice president of healthcare informatics at Premier. Premier, as you probably know, is the largest healthcare performance improvement alliance in the country. We’re this interesting company in that we’re owned by both for-profit and non-profit providers. We’re an extension of their organization to help them with supply chain things, consulting and performance improvement things, and also data things, informatics things.

I’ve been in the technology space for about 20-plus years. I spent the last 10 exclusively in the healthcare IT space and am a veteran of the EMR space as well as the performance improvement space.


You’re now on the HIT Standards Committee. Give some background on what that group does, what its composition is, and what agenda items it takes on.

ONC has two different committees. You have the Policy Committee and then you have the Standards Committee.  They are two sets of committee which both report into Farzad. I have yet to join the first committee meeting, but they meet every single month.

The idea and intent is to get a broad-based set of industry stakeholders to provide input into ONC in terms not only policy changes, but also HIT standards changes. The last committee meeting, which you reported on, was talking about the CommonWell Alliance. What does that mean because to some of the work those groups are doing now when you have the private sector playing in going in with what the government is trying to do as well. it’s those types of issues, along with obviously the guidelines and the focus of Meaningful Use.


You said in a guest article that EHRs are too siloed and that thinking that HIT starts and stops with EHRs is a great delusion. How do you think that status should change and what role should ONC have in changing it?

That’s actually how I got started in this journey with them. I used to be with Eclipsys, now Allscripts, as you probably know. It’s interesting when you are in that environment you have this view that everything is about EMR. Then you come over to a place like Premier and you broaden your lens and you’re interacting with the C-suite at all these different large IDNs across the country. You obviously get a much broader lens.

I’ve been saying for a while now that we’ve been conditioned that EMR is the panacea. It’s an important transactional system, but it’s one of many in the provider footprint.

What we’re going to see –and you saw a little bit of this noise coming out at HIMSS — is this notion of the post-EHR era. I think you’ve mentioned it and it’s out there as well because when you start thinking about clinical groupware and other groupware and you think about the advent of mHealth and all that stuff, you are starting to see this different burgeoning of set of technologies and toolsets the various stakeholders are going to grab onto here as the industry evolves.

A lot of these core systems and really all the EMRs were architected in the late ‘70s or early ‘80s. A lot has changed. The demands — you look at usability, you look at all the different things that are coming up and bubbling up through Meaningful Use and the adoption of all these systems — maybe they are not set for the demands of the providers’ needs of the future.


The irony being that you came from a vendor that sold EHRs and now you serve on a committee for ONC, which basically pays providers to use only EMRs and nothing else. Clearly it’s not just vendors who are pushing EHRs. How do you reconcile all these groups that somehow end up recommending EHRs to the exclusion of everything else?

I think it’s tough. I think to your last question for me — why I wanted to get involved in this — is I could easily be a critic on the sidelines and throw bombs. When Meaningful Use started, one colleague and myself actually owned all the capacity planning for that EMR vendor. Literally we’d come into work and sit with our development group and go, “Oh my gosh, what are we going to do with Meaningful Use, and what do I do with all the other stuff that our customers wanted?”

I’ve had a bird’s eye view on that in terms of really thinking through, “My gosh, look what’s actually going to happen to our development capacity, and is this the right thing that our customers are asking us for?” Then you come over to the Premier side and I get that every day. The interesting thing about my job running the informatics group here is I literally am in a different C-suite discussion every single week, sometimes many. I was in three last week. You start to hear full-time, not only from the CIO’s point of view but the CEO’s point of view, CMIO’s point of view, the CFO’s point of view. You start getting all these different point of view of how technology is really interacting with where they are trying to go and take these systems in the future. It changes your perspective dramatically, at least it has for me.


People criticize that EHRs are not innovative and are monolithic, but customers will almost always, when given the choice, buy from their incumbent vendor. How will that market ever take hold if the customers would prefer to buy from the same vendors who are accused of not being innovative?

I use this analogy a lot and I’ve been criticized for using this analogy, but I will use it anyway in this discussion. Come out of healthcare. I had the luxury of doing some work in the travel industry about 15 years ago. You think about the travel industry and you think about the transactional systems in travel. They’re still in use. SABRE is one of them. The advent of the Web came along and we layered SABRE, because if you go and watch that person actually doing that travel booking for you at the gate, you look at that DOS prompt and the F: prompt that the person is doing you’re going, “I don’t even know what she’s doing or he’s doing.”

Then we created the Web. We created the Web front end and put a level of abstraction on top of that transactional system,. That was just a website, so that was USair.com if you will, but we don’t book travel that way.

So we created another level of abstraction. We created Orbitz.com and Expedia. So we aggregated the websites and then … I live in Boston and here in Cambridge they created Kayak, and so they aggregated the aggregators. Now you’re like three levels abstraction up off the transactional system, but you did that because everybody wanted a different view of the information.

I really believe — and I’ve said this many, many times — that the same analogy, because it plays out in any industry, is going to happen in healthcare. We just happen to be in that transactional mode right now. If we get to what ONC says we’re going to get to, 85 percent penetration by the end of the year, that would be great in terms of that core base level. But how do you get to that next point? You’ve got to get people to start thinking about what’s that next level of abstraction tool sets that help them take it to a different place because they have different views of information.

If you have an ADT system that’s driving to a patient list for the day or a rounding list for the day, is that the right thing to do? Or do you need to round up a set of specialists that round up a set of diabetics? That’s not really a registry. It’s really much more of a workflow-based component of how you pull that information together and try to get the outset and the outcomes that you actually want.


The travel industry had somewhat of a luxury in that SABRE was a monopoly for the most part, and all they had to do was layer on top of SABRE. You’ve got thousands of EMRs out there. What are you going to layer on top of?

Everyone is different and that’s the complexity here. The next 10 years are going to be the most interesting years in this space, because how this plays out I think is still anybody’s guess. You have all these payers coming in and spending all this money on HIT assets. They run the gamut. You got United that has high acuity solutions — they bought the Picis assets all the way to HIE assets. You’ve got providers standing up population health companies. You’ve got EMR guys trying to build up data warehouse businesses. I think it’s anybody’s guess still how it really plays out.

To your point, because there was no standardization, you have what we have. Another thing I say often is I think we have capitalism running amok in a system that really needs a little bit more standardization. Whether the government can do and pull us out of that is still, I think, TBD.


It worked without the government’s involvement for Visa, when they convinced banks it was in their self-interest to connect to a neutral network and exchange information. Is there any potential that that’s the platform that you build on top of?

Yes. I think it’s a great point. Whether it’s something like the Policy or the Standards Committee or ONC or Farzad going, “Hey, this is what we’re going to do. We are going to round everybody up to connect that.” Or it’s something like CommonWell, assuming that everybody belongs and everybody is invited to belong. That’s the thing.

There’s got to be some sort of polarizing collaboration event or set of events that starts that next level. That’s what we’re talking about. That’s really where the next step of innovation is. We’ve done some innovative things in this space, but I don’t think we really have done what we could do potentially.

When you start looking at what’s happening in the portable app area, that’s where interesting things are going on. I’m a runner, so I use one of those applications all the time. I have a Basis watch which tracks my heart rate every single second. That’s real data. I always joke with a lot of our folks “Here is my real EMR — it’s sitting on my wrist.”


When you look at groups that had good ideas, like the SMART group, I don’t know that they’ve done a whole lot except to announce that everything should look like an app. Do the EHR vendors need to yield to allow those app vendors to connect, or can those apps be built without EHR vendor cooperation?

That was a big part of our push at Eclipsys right before I left. If you go out into your customer base and you really look at it, if you look at all those great academics that Eclipsys had and still have some but they have lost a few, where was all the innovation coming from? The innovation was coming from people stitching on to that rich documentation and CPOE system all sorts of interesting little things. You can call them apps, you can call then whatever, but that’s where the real innovation was taking place. It wasn’t taking place in the four walls of the development shop at Eclipsys. That was running the core infrastructure. 

That’s why we moved to that Objects Plus open layer that we decided to go do at the time. Then finally as they got into Allscripts, they realized wow, that’s the platform that really we need to think about, and more importantly, compete against folks like Epic and Cerner.

That’s still TBD to play out, but I’m a big believer, as you can tell, in openness. I think whatever you call it, this space to move to the next level has to be open. Even my point about the wristwatch. It’s really interesting and I can analyze it, but unless I pull up the website in my physician’s office, we’re not going to go much farther than because no one is letting these folks in.


The only pressure a vendor feels is from customers or shareholders, neither of which has a lot of vested interest. The customers don’t seem to be demanding and maybe can’t even define what openness means. Has there been enough education of customers about what should they be demanding from their vendors to push from inside instead of outside?

I don’t think so. That’s part of the reason I came to Premier, which I would say was like a sideways move outside of the vendor community. When I go talk to my board at Premier, I’m talking to all my members, all my customers. We’re trying to educate them into that path, which is, “This is what you really could do with all this information because we’re such a big data company and we have so much data.” There are different things that we can do there.

As more and more people start pushing on this, the idea that this group and this industry actually start understanding what it could become is going to be very viral and very fast. I think they are going to get to such a tipping point in the next five to seven years that this thing will flip on its head and everybody would be like, “Wow! I can’t believe we got here.” All the people who thought these certain encumbered vendors were locked in for good — I think we’ll see how that plays out.


What things excite you in the non-EHR world that could be a vital component?

When you look at KLAS data, it that says that 60 percent of providers are either going to replace an existing data warehouse or build a new one. They might not be building your father’s Oldsmobile data warehouses. They might be building a next generation for that abstraction layer point I was making. That starts giving you an infrastructure if they do it in a certain way, to be able to have openness and to be able to use the data. It’s all about the data. 

The Eclipsys data was funny when some of the burgeoning stuff like Amalga and that stuff was coming out. It was funny to watch that all take hold, because people didn’t know how to react to that. They wanted to have everybody locked into those transactional systems. But the fact is, when you pull back on the transactional systems, you’ve got a GL, you got an MMIS system, you’ve got an EMR, you’ve got 40 other different transactional systems in a provider footprint.

How do you get the information out of that? How do you open it up? Then how do you expose it to a bunch of people to do a lot of things with? If we are going to move to population health, even the big payers don’t have enough money to keep up with the use case demand.


How will the EHR vendors react to being forced into a transactional system role? Are they getting blindsided by this, innovating because they have to, or just planning to buy up the competition to make sure nothing is shaken up?

A little bit of all of what you said. You already seeing the movements. You saw Cerner do the wellness move. You’ve seen Cerner start to move on the cloud-based analytics. You’ve seen Epic doing Cogito. They are all seeing this coming — it’s just how do they let it play out? They got to preserve the run rate revenue.

I think the math changes, too. The days of investing $250 million on an EMR are not that long left. There’s going to be a whole different equation for value. 

What I find fascinating about this is that some of the stuff that you’re seeing in population health right now – it’s very nascent and everybody is being dashboarded to death. But the math is so fundamentally different in terms of the dollar signs with that work compared to what the EMR transactions were.

That’s what you saw on ERP, too. If you think back to the SAP and Oracle and PeopleSoft days you had these huge dollar amounts. Then all of a sudden you got a disruptor like Workday come in, and Workday is at a difference price point. It’s an op-ex rather than a capital cost, subscription based, a cloud variant. It’s just different. I think the same thing is going to take hold here.


Offering the subscription model didn’t seem to help Eclipsys much. It doesn’t seem that the market cares as much about that as you would think. People are happily writing those hundreds of millions of dollars checks and can’t be dissuaded that that’s a bad idea.

[Laughs] That was a  different set of issues for another time over a drink.


What do you think the biggest difficulties are going to be, both for healthcare in general and healthcare IT specifically, in getting people to think in terms of public health rather than episodic care?

These CommonWell folks are onto something. This is not the first time – it just happens to have a lot of press. There were a lot of other variants. There was Intermountain, Geisinger, and a few others trying to do this underneath the covers of something else a while ago. But this idea of privacy and this idea of a national identifier … if you think about the amount of work we’re going to have to do in population health — I know it because we’re doing it right now — to just connect John Smith.

If I take pre-adjudicated claims, I take EMR data, and I take post-adjudicated claims and I want to attach all that to John Smith, we need enormous amount of fuzzy logic work. That is enormous amounts of expense. Where you look at Facebook, you look at a credit card transaction log … if you give me those two feeds, I can probably tell you your health status. But now we’re going to spend all these time arguing about health and healthcare data in a different light, when in actuality, all the other ways that people work in an online medium, they are actually exposing that same information — they just don’t know it.

This is what’s going to be the biggest issue for us to get over that hump, and it may actually delay us by five to seven years longer than what I even originally suggested. Until you get to a generational gap, which is the other side of this privacy debate… if you take a 25-year-old, take somebody from the bridge gap, and then take somebody who’s 50 or 55 — different views on privacy. This idea of data liquidity — the stuff that Todd Park talks about, the stuff that others have talked about in the past — if you want to get to that state, you got to change the public persona of healthcare data. That may be a national identifier. That may be a lot of different things that are sort of being noodled around.


There are thousands of times more resources being devoted to trying to comply with screwy government payment policies that are so arcane and illogical that no one can even understand what they mean. If the government is so interested in having everything be transparent and interoperable and easy to understand, shouldn’t they first trash the payment system?

Yes, absolutely, and that’s what they’re doing. If you think about all the government is doing, they’re kind of are, even though we’re all being cynical. They are pushing and pulling right now. They’re pushing you because they’re going to cut you to death. They are going to cut you with all these illogical payment approaches, which are what’s going on, all the way from SGR changes to PQRI.


Then they’re pulling you through CMMI in different programs. Whether that’s a test cycle of MSSP, whether that’s a test cycle of a pioneer program, whether that’s a commercial thing that’s doing on the private side, we are actually in this fight right now. The question is, is the government going to have the perseverance to continue to pull people into that mode?

I live in Massachusetts. It’s a nice place to be from a test stage standpoint because we adopted a global budget plus a CPI cap. I think the governor signed it two or three months ago. We’re already playing it out over the cap.

At Premier, we’re a big believer — and I think the members are in this position — that we’re going to be a global payment. It’s just a matter of when. It’s going to be a tough battle in that push and pull sequence until we get there.


What is Premier’s position on how healthcare IT is going to evolve?

We’re doubling down heavily. We’ve been in this space for 15 plus years doing informatics all the way back to the days of running tape and taking data out of transactional systems and turning it into information for providers.

Our view is that it’s a critical component of this transition. Having said that, I think the other side for us is just the pure social system changes. The social system change, what we see loud and clear — we run a pretty extensive ACO network and what we see pretty loud and clear — is just what it’s going to take for these members in these organization to transition from the business they’re in today to the business they need to be in tomorrow.

And just a stupid subtle point – it’s not that stupid, but it is subtle — how do you even think about asset allocation? How do you think about building a new cancer tower comparatively to maybe investing in nursing homes or building out your SNFs or your behavioral health footprint?

It’s a really interesting discussion going on right now at the administrative layer of providers. How do you think about this asset allocation? Then, how do you think about the differences of the people you have within that to make this transition?

The ones that we see are the typical ones. The ones that have a health plan understand how to think like a payer as much as like a provider. Kaiser is the blue chip here because they first think like a payer and then they adapt into the provider care footprint. I think a lot of what we see –we’ve got Geisinger as a big member, we’ve got SummaCare and Summa in Ohio is a big member — those folks have big health plan footprints. It’s interesting to watch them as they go into this change.


Do you have any concluding thoughts?

It’s interesting to finally talk to you. I think I’ve been following you since you started. I can’t believe it’s been 10 years.

It’s just going to be an interesting time for all of us. Some of the best days are ahead of us. Our ability to attach to a much more open framework and getting people still be able to make a dollar — because I don’t want to push the vendors out of the space – we’ve got to get to a place where people can  interact together and we all can do what we’re here to do, which is fundamentally transform the health of communities. That’s the game here. It’s not maximizing your shareholder.

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April 19, 2013 Interviews No Comments

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