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Readers Write 9/21/11

September 21, 2011 Readers Write 11 Comments

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

EMR Usability and the Struggle to Improve Physician Adoption
By Todd Johnson

9-21-2011 4-22-51 PM

Now that Meaningful Use money is up for grabs, almost every US hospital is somewhere down the pathway to deploying at least a Stage 1-certified EMR. Once installed, the tab on many of these systems can run as high as nine figures. For that kind of coin, every user in every department should see their daily workflow improve dramatically. Yet industry-wide physician adoption of hospital EMR systems continues to fall short of expectations.

For many users, the source of frustration is the clinical documentation system they’re asked to use. In theory, these tools are designed to make physicians’ lives easier. But too many documentation systems compromise the usability of the EMR for its most important users.

Not surprisingly, physicians resist changing the way they work to use tools that don’t solve their daily challenges. They stick with familiar workflows – even cumbersome tools such as pen and paper – to capture the details of patient encounters. And they leave it to the hospital to figure out how to extract the data they need.

The net result: physicians end up engaging with the EMR as minimally as possible. Without timely and comprehensive involvement from a significant percentage of physicians, an EMR system cannot help hospitals achieve their clinical, financial and operational improvement goals.

Determining the “usability” of an EMR is less subjective than it sounds. Here’s how usability is defined in the HIMSS Guide to EHR Usability:

  • Usability is the effectiveness, efficiency, and satisfaction with which specific users can achieve a specific set of tasks in a particular environment.
  • Efficiency is generally the speed with which users can complete their tasks. Which tasks and clinic processes must be most efficient for success? Can you establish targets for acceptable completion times of these tasks?
  • Effectiveness is the accuracy and completeness with which users can complete tasks. This includes how easy it is for the system to cause users to make errors. User errors can lead to inaccurate or incomplete patient records, can alter clinical decision-making, and can compromise patient safety.
  • User satisfaction is usually the first concept people think of in relation to “usability.” Satisfaction in the context of usability refers to the subjective satisfaction a user may have with a process or outcome.

Each of these components is measurable. Even user satisfaction, while highly subjective, can be measured through user queries. Yet even with an objective framework of EMR usability, physicians continue to suffer through documentation tools that often fail to meet any of these criteria.

Clinical documentation has become a victim of its own exploding popularity. Thanks to Meaningful Use and other technology-driven initiatives, the value of the data found in clinical notes has skyrocketed. Hospitals now have more incentive than ever to deploy systems that capture, aggregate and transfer data as efficiently as possible.

As the point of entry for a majority of patient information found in the EMR, electronic physician documentation has the added burden of converting notes into usable data. But too often, HIS solutions attempt to solve this problem by delivering electronic documentation that migrates all users to a single, inflexible workflow. Rather than accommodate multiple data entry methods and adapt to user preferences, physicians must instead learn to navigate drop-down menus, check boxes, and other pre-defined selections to complete their documentation.

A one-size-fits-all approach to documentation is shortsighted for two reasons. First, “narrative” shouldn’t be a dirty word in the electronic documentation workflow. A comprehensive patient record is much easier to achieve through a blend of structured and unstructured data input. Certain types of notes, such as H&Ps, benefit from the physician’s ability to capture all details of the patient encounter in his or her own words. Elements with repetitive values, such as lab results and vitals, benefit from structured input – even better if these values automatically carry forward daily.

Second and more important, we can’t lose sight of the fact that we’re asking physicians to alter a very important – and very personal – part of their jobs by asking them to use new clinical documentation solutions. Workflow flexibility is crucial to achieving user satisfaction. Narrative-based capture methods such as dictation remain popular because they’re easy to use. Forcing users to modify their behavior and abandon familiar workflows – to “document to the system” – is a recipe for continued lackluster physician engagement with the EMR.

Ultimately, a truly user-friendly advanced electronic clinical documentation system should empower users to document however they’re comfortable without compromising speed, accuracy, data availability, and overall productivity. The specialized technology solutions are in place to make that possible.

Modern speech recognition and transcription systems can convert dictated narrative to structured data. Universal interoperability standards such as HL7 Clinical Document Architecture (CDA) enable that data to integrate seamlessly into the EMR, regardless of which best-of-breed physician documentation solution you’re using.

The only way to know we’re achieving the right balance of structure and narrative is to let the end users guide the design of the finished product. By achieving high rates of physician adoption, hospital CIOs and other stakeholders can finally focus attention on other priorities.

Todd Johnson is president and co-founder of Salar of Baltimore, MD.

Is ONCHIT About to Chase the Clouds Away?
By Frank Poggio

9-21-2011 4-30-42 PM

My sincere apologies to Chuck Mangione. For our younger readers, Chuck is a great French horn jazz musician from the 70s. His signature song was Chase the Clouds Away. Now back to ONCHIT.

Cloud computing is the latest systems deployment panacea. In the recent past, it was referred to as SaaS (Software as a Service), and before that, remote hosting. The word ‘cloud’ clearly has a better visual impact. Cloud computing runs all your data and applications at a remote facility, giving the user many advantages such as built-in redundancy, reduced capital investment, effortless backups, better integration with many other Web services, and faster and simpler delivery of updates and fixes.

One of the core elements of the ONCHIT certification process and the Meaningful Use attestation requirements is that a provider must run certified software. The certification must tie back to a vendor’s specific version and build. Directives from two of the current ATCBs state:

CCHIT: If you modify or update your CCHIT Certified product in a manner that carries a significant risk of affecting compliance, you must follow this procedure. Before marketing the modified or updated product as CCHIT Certified, you must apply for re-testing of the product to verify continued compliance with all published criteria and Test Scripts.

Drummond: If changes are made to the Drummond Certified EHR product, you must submit to Drummond Group an attestation indicating the changes that were made, the reasons for those changes, and a statement from your development team as to whether these changes do or do not affect your previous certification and other such information and supporting documentation that would be necessary to properly assess the potential effects the new version would have on previously certified capabilities.

If you sell and install a certified full EHR or EHR module, you must at minimum notify the ATCB with each new version or build so that your previous certification gets inherited to your new update or release, preferably before you send it out to your client base.

Turnkey system vendors (do they really fly above the Cloud?) would send out two or three updates during the year, with perhaps one being a major release. If there was an emergency fix needed for a specific client, they might send that out separately. Clearly the update notice to the ATCB should happen before you would send the fix out, but in an emergency situation if the impact was to only one or a few clients, you could send it out just to them and notify and re-certify later.

The same would be true for any special enhancements. Say a new customer requires a specific enhancement as part of a new install contract. For the period your client is running the enhanced software, that version or build would not be deemed certified. This means they could not use your package to attest to MU. But it’s only one client, and if you are a best-of-breed or niche vendor, it may not matter to that client since they might be able to cover the MU criteria with other vendor-certified products. A good example is with the ONCHIT demographic criteria. This requirement could be covered by several EHR modules.

Lastly and most importantly, the assumption is that your updates or fixes do not impact any certification criteria. At this time, how ‘no significant impact’ is defined and determined is left to our imagination, but starting next year it will be a question that must be tackled by the ONCHIT AA surveillance auditors.

Meanwhile, back in the Cloud, it gets little more complicated. As noted before, one of the real advantages of the SaaS approach is that the user never has to load updates. They are handled centrally. One load and all clients are running the new code. Back to our example where a new client contracts for a special enhancement or a fix is needed — you code them, load them, and go. Everybody has access to the new enhancement and everybody is now running a non-certified system. Ouch!

The simple solution, of course, is to make your new customer wait for a full version release, or in the case of a fix, require a workaround until you get re-certified. Either way, ONCHIT has succeeded in turning the clock back to those Neanderthal days of legacy and turnkey system releases.

Cloud vendors who are ONCHIT certified will really need to rethink that load-and-go approach.

Frank L. Poggio is president of The Kelzon Group.

Interoperability? But of Course!
By Cheryl Whitaker, MD

9-21-2011 4-42-19 PM

An HIStalk reader, Rusty Weiss, recently wrote about interoperability (Is Healthcare Interoperability Possible With a Conflicted Federal Committee?, 9/14/11.)

I am not writing to comment on the appointment of Epic’s Judy Faulkner to the Health Information Technology Policy Committee. I am writing to endorse the concept of interoperability. 

In his article, Weiss states, “Democrats, Republicans, and industry experts alike recognize the importance of interoperability.”

Amen. It’s logical that we move to a model in which health information systems talk with each other. I concur that by “tapping into ‘big data,’ there will be opportunity to learn more from existing information – and to make healthcare more effective and less expensive.”

Weiss also states, “By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of ‘software that improves interoperability and connectivity among health information systems.”

Weiss goes on to quote Otech president Herman Oosterwijk,  who says, “The entire industry is 15 years behind in interoperability compared with PACS systems.”

PACS solutions were early in the landscape of healthcare’s adoption of electronic information exchange. However, let’s be clear. Diagnostic imaging is far from superior in the context of interoperability. Visit a doctor’s office and you’re likely to see a patient carrying his or her own images burned onto a CD. Ride in a ambulance with a trauma transfer and you’re likely to see a CD strapped to the patient or the stretcher. 

When it comes to exchange of diagnostic images, the inefficiencies are horrific. The room for error is frightening.

Weiss quotes Andrew Needleman, president of Claricode Inc., who says, “Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems. For healthcare data, even the demographic data to determine if you are talking about the same patient is complex.” 

Consider the realities of diagnostic imaging: 

  • Healthcare organizations generate nearly 600 million diagnostic imaging procedures annually.
  • Based on a study of data from 1995 to 2007, the number of visits in which a CT scan was performed increased six-fold, from 2.7 million to 16.2 million, representing an annual growth rate of 16%.
  • One CT scan exposes a patient to the same amount of radiation as 100 chest x-rays.
  • $100 billion of annual healthcare costs are related to diagnostic imaging tests – but an estimated 35% ($35 billion) represents unnecessary costs for US patients and insurance providers.

PACS solutions facilitate electronic image management. But these are proprietary, closed systems that do not allow providers to easily share information between departments and entities, and also across "ologies." Exchanging images outside of a "system" is difficult if the two facilities have different PACS vendors.

To solve this challenge, some entities have added solutions to morph imaging studies so they can be viewed on a receiving system. Until recently, this has required the implementation of specialized hardware and software and costs that were not sustainable.

We continue to see patients carrying their images around on CDs. Yet according to a January 2011 article in the Journal of the American College of Radiology, Johns Hopkins researchers found that approximately 60% of respondents said most images provided by patients on digital media were unreadable or not importable.

With today’s movement toward ACOs and medical homes, new approaches are needed. An enterprise imaging strategy must focus on providing access to any type of image, anywhere, any time, by anyone – provider, referring physician, radiologist, patient, etc. – across the continuum of care. This vision goes beyond PACS to make image sharing truly interoperable and accessible in real time on any device, without having to load and support additional software and without complicated and unnecessary movement of data. Image-enabling the EHR is also critical.

Three components are required for the move to a truly interoperable imaging environment: a standardized vendor-neutral archive (VNA), an intelligent digital image communication in medicine (DICOM) gateway, and a universal viewer that can be accessed via an embedded link or a standalone portal that enables viewing of images on any browser-based electronic device.

This technology exists. An organization can readily start with just one of the components, then build toward a more robust enterprise solution. There is no wrong door for entry.

Today’s most progressive organizations are embracing enterprise imaging, saving time and money, reducing unnecessary radiation exposure, and improving quality of care.

Healthcare data is voluminous and complex. Regulatory demands seem daunting.  Other industries, however, have adapted to a multitude of “data pressures.” Banking, for example, has been successful with leveraging federated data models to enable cross-organizational transactions via ATMs. 

The time is now for healthcare to create exchanges that allow EMRs, HIEs, and PHRs to access content and results from any location without moving data. We should empower patients, providers, and payers to manage the total healthcare experience from computers, mobile devices, and new types of access points, including kiosks.

Cheryl Whitaker, MD is chief medical officer of Merge Healthcare of Chicago, IL.

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September 21, 2011 Readers Write 11 Comments

News 9/21/11

September 20, 2011 News 4 Comments

Top News

9-20-2011 12-42-12 PM

Aetna, Humana, Kaiser Permanente, and UnitedHealthcare will pool five billion medical claims records in a data mining initiative to identify trends in cost, utilization, and intensity of care. Beginning in 2012, the not-for-profit Health Care Cost Institute will combine 11 years’ worth of records from the carriers, publish scorecards, and support analysis of aggregate trends to qualified researchers.


Reader Comments

mrh_small From Wilbur: “Re: Aventura. Did you already get this? You interviewed Howard Diamond for the HIStalk Innovator Showcase. Really neat company, people, and technology.” Denver-based Aventura HQ, which offers a clinician front end for EMRs and other systems, raises $13 million in its first round of institutional vendor funding. I profiled the company in late July. Wilbur isn’t a shill, by the way – he sent this non-anonymously and he has no vested interest in the company (nor do I.)

9-20-2011 10-27-25 PM

mrh_small From Elane Twofer: “Re: UPMC electronic medical records alteration. I’m puzzled why that is central to peer review. Mr. HIStalk, please provide some advice and your wonderful wisdom.” The trial begins in Pittsburgh of a lawsuit brought by a deceased patient’s family against UPMC Presbyterian (PA). The family claims that doctors caring for a 62-year-old inpatient failed to note in his electronic medical record that he would be difficult to intubate. He experienced respiratory distress, exacerbated by a nurse who inappropriately gave him a tranquilizer to calm him down, and doctors could not establish an airway. He died. The family’s attorney says UPMC’s EMR transaction records show that its head of quality assurance tried to add a red-letter “Dif Intub” warning to his EMR three days after he died. The hospital says the entry was for peer review purposes rather than to favorably falsify the records. I know this reader and I believe the hope is that I’ll expound against EMRs from this example, but I’ll take the opposite approach. I’ve been on various hospital committees (death, tissue and transfusion, etc.) and I’ve seen first hand paper charts that were falsified after the fact by doctors and nurses to cover their butts after making mistakes that harmed patients. It wasn’t hard to suspect they did it (the handwriting was clearly different, the change was present only on the original order and not the copy, etc.) but hard to prove. If the family is correct, UPMC’s own electronic records will provide the inarguable evidence. Score: EMR 1, paper 0. I’d like it even better if standards were in place that would physically protect all electronic documentation transactions from database-level changes, journaling every entry, change, and deletion as a permanent record that even IT uber geeks could not destroy.

mrh_small From Ludmila: “Re: NJ chapter of the American Academy of Pediatrics. Apparently there’s about to be a blowup over its PCORE (Pediatric Council on Research and Education) section accepting money related to referring practices for HITECH, which it isn’t allowed to do as a 501(c)(3) corporation.” Unverified. I e-mailed the organization and received no response.

mrh_small From Sepulchre: “Re: Meaningful Use. Frequent reader, first time I’m posting a question. No one has been able to answer this. In getting your ‘certified’ system and achieving MU, what happens if the user decides to change vendors? During that kind of transition, you would expect your reporting on objectives could be impacted and you might not meet them for the year. Do you incur penalties from Medicare during that time? Seems like a great setup for vendors. Once you use them and achieve MU, you must keep using them to avoid penalties.” Hopefully my really expert readers will weigh in.

9-20-2011 9-02-32 PM

mrh_small From Reluctant Epic User: “Re: McKesson ad. Do you think they’re struggling in the large hospital market because their marketing department thinks people are still running Pocket PCs?” I like the irony of the “Better Technology” headline right beside some old and not-so-good technology, but their problems are more related to Horizon than what it runs on.

9-20-2011 9-08-37 PM

mrh_small From Space Ghost: “Re: newsletter. Writing headlines must be a tough job.” The mistake is especially notable since it came from Government Health IT, whose parent company has HIMSS (or HIMMS, if you prefer) as a majority owner. The correct spelling is obviously the first word of the article, so someone went out of their way to screw it up.


Acquisitions, Funding, Business, and Stock

Practice Fusion announces that it has received over $6 million in additional funding from several new investors, including Western Technology Investment (an early Facebook investor) and Scott Banister (Idealab, IronPort.)

9-20-2011 8-55-52 PM

EMR vendor SuccessEHS acquires the MediaDent practice management, electronic dental record, and dental imaging solution from MMD Systems. SuccessEHS will offer the integrated solution to Community Health Centers, including the 190 that are already its customers. 

Transcription vendor MedQuist raises guidance and announces a $25 million stock repurchase program following its recent acquisitions of M*Modal, All Type Medical Transcription Services, and JLG Medical Transcription Services.

9-20-2011 9-58-01 PM

India-based technology vendor Wipro says it’s looking to acquire US-based health and life sciences companies, especially those with analytics and mobility products and companies involved in revenue cycle management. Wipro also says it will benefit from ICD-10 conversions as US work is offshored to India and the Philippines.

9-20-2011 10-50-55 PM

mrh_small The Advisory Board Company launches its new logo and Web site, which emphasize its research work plus newer offerings that focus on technology applications and healthcare support. An interesting history of its logo over the years says it started as a drawing of the townhouse owned by the founder’s mother (the company’s first headquarters, in 1979), followed by the Jefferson Memorial-related logo that was used for 20+years, then finally the new version that’s based on a revolving bookstand designed by Thomas Jefferson to allow him to check multiple references at once, a prototype of the database (which also happens to look like the letter A.)

9-20-2011 10-38-49 PM

mrh_small I keep forgetting that The Advisory Board Company is publicly traded, so here’s how shares have done over the past couple of years compared to the S&P 500 (green) and Nasdaq (red). An ABCO share bought for around $25 two years ago would be worth over $60 today.


People

Meditech announces that family physician Steven Jones, MD will join the company to act as lead its EHR development efforts. He has served on the company’s Physician Advisory Committee.

9-20-2011 7-05-16 PM

MedAssets reports in an SEC filing that Neil Hunn, president of revenue cycle technology, is leaving the company to pursue “other career opportunities.” He joined the company in 2001, was promoted to RCT president in January 2011, and leaves with $570,000 in separation pay. Meanwhile, Greg Strobel (above) moves from president of the revenue cycle services business to president of the MedAssets RCM segment.

9-20-2011 7-23-50 PM

Bayhealth Medical Center (DE) names Lynn Gold as senior director of information services and telecommunications. She was previously with GE Healthcare.


Announcements and Implementations

9-20-2011 11-49-35 AM

OSF St. Francis Hospital (IL) goes live on Epic, replacing its eight-year-old GE/IDX system.

mrh_small University of Iowa Hospitals and Clinics spent $6 million on a failed laboratory information system implementation, hospital officials reported to the state Tuesday. The hospital terminated the contract over performance issues with the unnamed vendor. I know its pathology department was replacing Cerner with SCC Soft Computer and was supposed to go live a few months ago, but I don’t know if that’s the system being de-installed.

Voalté will offer a mobile device management solution called Connect, which is based on the AirWatch enterprise-grade smartphone and mobile device security
and management platform.

mrh_small The local TV station covers the use of the PatientSecure palm vein scanning system for positive patient identification at Duke University Hospital (NC). The hospital enrolled 2,000 patients in the first six weeks and says patients who were antsy about having their fingerprints scanned (one can only imagine why) don’t mind the palm vein scan.

Ottawa Hospital, fresh off the deployment of 2,000 mobile devices including iPads, says the next step is to use business process modeling to understand the natural workflows of clinicians and to give them convenient information when and where they need it. A quote from SVP/CIO Dale Potter:

Mobility is here to stay. It’s tactical in a sense because it is a device that allows people to do their work differently. Physicians and other clinicians are falling back into workflows that are natural to the work they are doing. They were forced out of that workflow with the advent of technology 25 years ago when they would have to go somewhere to log on to a PC. They had almost forgotten that they used to do rounds at the bedside. Now it’s conceivable and practical for them to be able to do that. The patients feel a higher level of engagement because of the tools.

9-20-2011 9-25-42 PM

Ophthalmologists at a UK hospital work on OpenEyes, an open source ophthalmology EMR.


Government and Politics

HHS’s Text4Health Task Force issues recommendations to HHS regarding text messaging and mHealth apps: a) develop and host evidence-based health text message libraries and make them available to the general public; 2) develop further evidence on the effectiveness of health text messaging programs; and, 3) explore partnerships to create, implement, and disseminate health text messaging and mHealth programs. 

In Australia, Queensland Health is negotiating with Cerner for a $249 million (US) hospital clinical systems contract, with the opposing political party claiming that health officials changed an independent report to give Cerner an edge and that the technical information Cerner provided was inaccurate.

Senior executives and physicians from Ireland are visiting the VA this week to learn more about its VistA system.

mrh_small A newspaper article says patients are somewhere between surprised and offended at being asked for their ethnicity and race during physician visits, newly required by the Affordable Care Act. An ophthalmologist says many patients cross out the “race” question and one patient answered “the Boston Marathon.”


Innovation and Research

9-20-2011 9-40-50 PM

Researchers in Spain are working on a “garment-based patient biomonitoring platform,” or smart shirt, that will monitor vital signs and patient location.

9-20-2011 9-48-16 PM

mrh_small AHRQ offers guidelines for future and current EHR users on avoiding unintended consequences. Credit to Joe Conn of Modern Healthcare, whose article about this came up in an unrelated Google search I was doing.

9-20-2011 10-19-08 PM

Texas Heart Institute releases a free iPhone and Android app to train medical students in auscultation (listening to the heart). It was developed by James Wilson MD, director of cardiology education.


Technology

9-20-2011 8-42-23 PM

mrh_small I ran across this interesting (and free) tool. Chatter is like a private, secure, and hosted Facebook, a social network for businesses that allows co-workers to push out updates, share files, and solve problems. Signup for the hosted app requires only a company e-mail address, and the network is private to users within that domain. Clients are available for iPhone, iPad, BlackBerry, Android, and the desktop. It’s owned by Salesforce.com.

An article on MIT’s Technology Review profiles speech recognition software in healthcare, specifically Nuance’s Clinical Language Understanding.


Other

9-20-2011 9-35-54 AM

inga_small Posted on Twitter:  a picture of the opening session at Epic’s user group meeting. The poster notes, “This is a big auditorium!” Epic is expecting 11,500 attendees, including 6,500 customers, for the four-day event in Verona. Another tweet from a Stanford University physician: “35-45% US pop covered by Epic EMR, 2% of world pop covered, $92 billion in claims in 2010!”

9-20-2011 8-48-14 PM

9-20-2011 8-47-20 PM

9-20-2011 8-45-28 PM

mrh_small Here are more Epic UGM photos from a reader. Thanks for sending them over. Above is the lunch tent built for the conference. They’re offering horse carriage rides and bikes for exploring the back trails. The theme is “Once Upon a Time” and attendees were invited to attend Tuesday’s opening session in musical costume as Judy was to do (I’m thinking Ziggy Stardust drag or Insane Clown Posse makeup). Your updates and photos are encouraged.

9-20-2011 10-00-54 PM

The American Nurses Association signs on as partner in Care About Your Care, a healthcare wellness awareness initiative supported by the Robert Wood Johnson Foundation, AHRQ, and ONC.

9-20-2011 7-17-12 PM

inga_small In what are believed to be the harshest prison sentences ever for Medicare fraud, a federal judge orders 50-year and 35-year sentences to American Therapeutic co-owners Lawrence Duran and Marianella Valera. The company billed Medicare for over $205 million in claims over eight years for mental health services that were either not required or never provided to patients. They were ordered to pay $87.5 million in restitution.

mrh_small The Honolulu Police Department tries to figure out how to bring criminal charges against one of its officers for posting a hospital bed photo of a suspect on Facebook. The patient had been badly burned while trying to steal copper wire, giving the officer creative inspiration for the Facebook caption, “See when you like steal copper.”


Sponsor Updates

9-20-2011 8-29-39 PM

  • A 12-member GetWellNetwork triathlon team led by CEO and Founder Michael O’Neil raised $36,000 for The Leukemia & Lymphoma Society in The Nation’s Triathlon in Washington, DC on September 11, 2011. The team’s donations led all national participants as it honored the memory of Justin Thorton, who died of leukemia at 19 earlier this year.
  • 3M partners with Clinical Architecture to offer 3M Healthcare Data Architecture, a terminology-mapping interoperability and data standardization solution.
  • Iatric Systems adds a clinical quality measure component to its Meaningful Use Manager product and earns expanded ONC-ATCB certification.
  • CynergisTek and Diebold will partner to showcase their “Smart Hospital” security model at The Healthcare Facilities Symposium and Expo September 20-22.
  • Alan W. Portela, CEO of AirStrip Technologies Inc. will participate as a panelist at the AdvaMed 2011 MedTech Conference September 26-28.
  • API Healthcare partners with Role-Based Practice Solutions to track, manage, and develop professional role competencies.
  • Colette Weston of ADP AdvancedMD provides a 5010 transactions update based on progress by AdvancedMD and partner RelayHealth.
  • CaroMont Health (NC) selects RelayHealth to facilitate HIE among the hospital, employed physicians, and affiliated physicians.
  • Healthwise SVP Molly Mettler will moderate a panel discussing shared decision-making at the World Congress Leadership Summit September 22-23.
  • Highline Medical Center (WA) selects Wolters Kluwer Health’s ProVation Order Sets for its healthcare campuses and 20 clinics.
  • Prognosis HIS clients Parkview Hospital (TX), Stonewall Memorial Hospital (TX), and Throckmorton County Memorial Hospital (TX) qualify for MU incentive funds using the ChartAcess EHR.
  • Monongahela Valley Hospital signs a multi-year agreement to use Thomson Reuters Micromedex solutions for evidence-based clinical reference information.
  • EHR Scope reports that its free online service EMRConsultant.com has made over 5,000 referrals so far in 2011.
  • NYU Langone Medical Center establishes the Joan H. Tisch Center for Women’s Health, which will incorporate Epic’s EMR technology and palm scanning identification from PatientSecure.
  • Allscripts is named a finalist for the Chicago Innovation awards.

Contacts

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

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September 20, 2011 News 4 Comments

HIStalk Interviews John Gomez, CEO, JGo Labs

September 19, 2011 Interviews 9 Comments

John Gomez is CEO of JGo Labs.

9-19-2011 6-42-58 PM

We haven’t talked for some time. Let’s start out with the obvious question. Why did you leave Allscripts?

There isn’t really a deep dark reason I left. There really isn’t a juicy back story. After almost eight years, I didn’t feel I could make the impact I wanted to continue to make and my career was pretty much at a standstill. I realized that I was becoming stagnant and I am not the type of person who likes to be stagnant. As much as it pained me, I decided that it was time for me to leave and pursue other opportunities.

During my time at Allscripts and Eclipsys, I had a tremendous opportunity to learn and stretch my abilities. I built an international business that started as four people and was break-even from Day One. Today, that business unit is tracking to be valued at over $100 million. I got to oversee and run our business development groups, product marketing, product support, and services organizations. I was able to work with some really bright and passionate product development people who I am truly proud of. I also got a chance to introduce some awesome concepts and innovations to healthcare information technology.

I do miss the people, the clients, and the products, but I am ready to try something different from an intellectual standpoint.

Name some of the innovations.

We released the first App Store in HIT, allowing third parties to access to our products through APIs. We provided copies of database schema to clients, thereby allowing them to access their data without having to confront industry standard obstacles. We also pushed hard to have a well-understood object level API. We centralized security and auditing. We did a lot of work on mobility. We redrafted our UI to be far easier to use and more powerful. Lastly, we introduced personalized workbenches and physician mobility products.

This was a lot of work, but we added substantial value to the companies’ respective product lines and enhanced capabilities for our respective customers.

Do you think the merger of Allscripts and Eclipsys was a good idea?

Yes. Both companies had offsetting strengths and weaknesses. Allscripts was strong in ambulatory and weak in acute. Eclipsys was the opposite. From a philosophical perspective, it did and does make total sense. The companies’ products gaps overlapped well and I know that there is tremendous work being done to continue fusing their respective offerings.

Any lessons learned from the merger or your time at Allscripts/Eclipsys?

So many I have actually thought about writing a book about it, kind of like a guide for executive leaders.

The biggest lesson is be product led. It is all about the product at the end of the day. If you build great products without compromise, client satisfaction, employee morale, and loyalty as well as the profits will follow. If you just focus on the financials and making the numbers, you’re not going to really deliver over the long term.

Steve Jobs, Jack Welch, Lee Iacocca, and Steve Denning all preached and proved that lesson, yet today way too many companies sell out to Wall Street and try to make a quarter happen rather than really standing strong and leading with their products and all the supporting infrastructure required to make that happen.

Think of it this way. If two companies met on the field of battle, all they would have is their products and their service and support teams. The victor would be the one with the strongest products, services, and support. All the other trappings are just that – trappings. Great products are the backbone of a great company.

What you would tell your replacement?

I don’t know the man, but from what I hear he is a good guy and has strong experience. My advice would be rather generic to anyone taking a role for an enterprise software company, not just my replacement at Allscripts.

First and foremost, learn the industry and lead. For him or anyone who wants to build great products in this industry — or any industry for that matter — I would tell them to learn the industry and challenges of the clients. Get on the ground and actively design your products. Don’t just delegate — lead the design and be part of the birthing experience.

Product managers are a good source of information, but ultimately the leaders of a company should be deciding on exactly how the product will function, wow, and thrill the clients. If you can’t log in, use, or install your products, move on to a new company and line of work. So my humble piece of advice: learn the industry and truly learn the products inside out.

Any other advice for Allscripts?

OK, I will add this, given my continued love of the entire Allscripts team. Stop telling people about your past and your car collection. No one cares and it just alienates you. Take the time to create a new chapter of shared experiences. You’re better off just asking others what they think and save the personal stories for a year from now when you have earned their trust and respect.

That said, I think my replacement, from what I know, is a great choice. He has overall been really well received and embraced. At the end of the day, people need to accept him as he is and for who he and give him a chance.

Allscripts filings indicated that you would be consulting for the company. What are you working on with them?

I think there is some confusion out there in regards to my relationship with Allscripts. The truth is that since my departure on May 31, I haven’t had any input into Allscripts products, strategy, or direction. There was some thought of me doing consulting for them, but we couldn’t come to terms.

Last time we talked, I quoted a reader who had called you "the Steve Jobs of HIT.” Now you and Steve have both resigned from the companies that defined much of your career to date.

I am truly no Steve Jobs and I doubt I could ever fill his shoes, or sandals as the case might be. I appreciate the compliment and understand the analogy, but honestly, I just love building great products. I truly believe that if you do great things, great things follow you. Love your teams, love your clients, and love your products. The rest will follow. The moment you realize you can’t love those around you and what you’re doing, it’s time to figure out a new path.

I would suspect that Steve has done most of what he has done out of love. That love translated to great products that changed lives and created fanatical followings and ultimately tons of margin and revenue. If there is any similarity between Jobs and me, it is that we are truly passionate about building great products people love to use and buy.

What are you up to now? A reader says he hears you and Jay Deady are returning to Allscripts.

I am not in talks of any kind with Allscripts to return. As far as Jay goes, he isn’t either, to the best of my knowledge. Jay and I do talk, and from what I can tell, he is loving life and leading an awesome company doing some rather great things for healthcare related to patient and resource tracking, called Awarepoint.

I started a small company called JGo Labs. Our mission is to build great leading edge products for HIT as well as in other industries. Our products focus on home healthcare. Specifically, gaming to start, predictive informatics and diagnostic decision support, and robotic aides. We also are taking all we know about building great products and working with some terrific companies in security and HIPAA compliance, mobility for healthcare, and some really interesting growth areas.

Given my passion for Apple, we are also working with a couple of hospitals on how to help them become more like Apple in terms of how they design their facilities, patient experiences, and workflows.

Any hints who you’re working with?

Sure, but I have to be a little cloak and dagger as we are bound by non-disclosure. Basically we have a series of companies reaching out to JGo Labs and asking us to help them build some really compelling products for HIT. By “build,” I mean design, strategize, evolve, and drive their ideas forward. We are very much like an IDEO or Dyson in regard to this, acting as a research lab and product design group for these companies.

At the moment, we are working on a very sleek and innovate HIPAA Compliance Appliance for one company, two very cool mobility platforms, a voice product, an AI-based documentation system, as well as some products related to workflow and process engineering. We are also in talks with the US Army regarding some advanced research that goes well beyond the current state of HIT offerings.

What about your own products? You’re a development guy.

JGo Labs is divided into two divisions. The Confab Group is doing consulting to other technology companies, their boards, and hospitals. The other division is The Manufactory, which we view as an old-world artisan studio where we craft our own products.

We are working on a very cool Xbox game for home healthcare using the Kinect technology from Microsoft. We are also working on developing technologies which bring concepts from outside healthcare to healthcare. Much of what we do is ask “what if.” For instance, “What if you could apply cross-sell and up-sell algorithms to helping clinicians?” or, “What if you could predict outcomes of a decision based on similar biological attributes and observations?”

It is very far-reaching and speculative in terms of our own products. But without risk, there is no reward.

I have no interest in continuing to work on EMR/EHR technologies as that is a crowded space with little growth. I really love the idea of working on those technologies that change the game on how we deliver healthcare. The stuff we are working on has huge potential returns and we are looking at it holistically in terms of assuring any product we release is a great experience for our clients.

We are actively working on these items today, but also trying to secure funding to accelerate their market entry. We won’t disclose our release dates, but we are trying to be as aggressive as possible. We would be happy to give you a sneak peek in the coming weeks.

What does Apple have to do with hospitals?

We started asking, “What would a hospital be if Apple designed the hospital and everything in it?” We are working with a couple of hospitals who are trying to improve their operations, margins, and patient/clinician experiences and trying to apply an Apple-esque approach.

For instance, collaboration is something that just doesn’t happen enough in hospitals. Not that it doesn’t take place, but it is cumbersome and disruptive. We are looking at a technology from a company called Blurts to see how micro-voice tags can be used to help drive better collaboration.

We are also looking at how people flow and interact with the healthcare experience and taking a lot of ideas from how Apple design’s their retail stores to route patient traffic, greet people, and interact with them and move them through the institution faster, thereby providing better returns for the hospital and overall higher quality outcomes across multiple metrics.

Your name came up with some kind of hacker convention. What was that about?

Defcon is one of the largest, if not largest, gathering of hackers in the world. I was asked to present on how to hack healthcare systems. I ended up presenting on how to hack not only your basic networks, but how you could change a diagnosis in an MRI or CT scanner or how you could literally kill a patient by hacking a medical device or rules engine. It isn’t that hard to do, and in this world of cyber-terrorism, I think that this is a serious exposure for hospitals.

Privacy regulations are not enough when you can literally alter data used by clinicians to make life or death decisions. If you compromise healthcare and shake people’s confidence in a doctor’s ability to safely treat patients, then follow that with a biological attack, even a small one, a terrorist would have one seriously successful attack.

What’s the value in telling hackers how to hack?

We aren’t showing anyone the specifics or teaching people how to do what we outline, just alerting people that it is possible. My hope and goal is to work with the Department of Homeland Security to help get ahead of this problem and help healthcare organizations address this issue. It is one of the reasons we are working with people like Corey Tobin, head of the Healthcare Solutions Group at Trustwave, on a really compelling compliance and security offering specific to healthcare that is ground breaking.

You implied that the EMR/EHR market is stagnant. Is everybody who assumes it’s the hottest thing going wrong?

It is a hot market, but that doesn’t make it a growth space. Growth is about developing products that create 20%-30% growth for a company year over year. Fundamentally, the EMR or EHR market isn’t going to yield that return or won’t long term. Eventually will be rather flat, or companies will need to expand to overseas markets, which most are not positioned to attack.

Let’s face it, we aren’t building a ton of new hospitals every year where you can go schlep your products or suddenly seeing tens of thousands of doctors every year looking for a new system. Given those factors, at least here in the US, and the fact that you have a hugely dominant vendor like Epic, well it isn’t really the place where you are going to see a lot of growth. There will be some growth and companies in these sectors will probably post some good numbers, but it isn’t going to be dramatic. You will see a bunch of services money from maintenance agreements, but I doubt anyone is announcing they are going after 1,000 new hospitals that just came into play.

What are your predictions for the healthcare IT market?

Analytics is going to be huge, but I don’t see any vendor today who really gets it. By “get it,” I mean that they are making it easy to integrate, don’t require millions of services hours, and that the system is intuitive and built on a platform that has the ability to meet future demands while providing just-in-time information.

Mobility is obviously hot. Regardless of what the old-timers think, it is going to be the future. Mobility apps will be hot, but are people willing to pay for them or are they part of the core offering from a vendor? I would heed vendors to figure that out. I see tremendous upside for niche vendors and would also see great opportunity for acquisitions of mobility vendors.

I think infrastructure will be hot. I mentioned security already, but also things like mobile device management and provisioning, medical device integration, disaster recovery, long-term storage and smart retrieval, and home healthcare and robotics.

Why home healthcare and robotics?

First, every human is a potential customer, so my bet is if you want to see awesome returns, you target home healthcare. Very few people are today, and those that are rarely get it. Secondly, it is a cool market that has a lot of need. I don’t think the PHR is the ticket to this market. I would focus on gaming and robotics. One is a mid-term deliverable and the other long-term. Both offer huge upsides to patients and clinicians, especially if integrated with mobility.

Somebody e-mailed me this week that you’re working on healthcare gaming, which surprised me.

I’ll explain briefly, because I am a little worried about having my idea stolen, especially by innovation-starved companies.

Overall, the concept is that you provide a means for people to have fun while getting treated. Take the negativity out of the experience. Make it convenient and clinically relevant.

I really want to talk more about this because it is so exciting and we are doing some great things, but I really can’t give more details.

At the mHealth Summit last year, Bill Gates said home health robotics was his prediction of the biggest growth area.

I really think that there is a tremendous upside for robotics in healthcare and we have not even scratched the surface. We are in talks with a company out of France that has designed a three-foot-tall, really cute robot. Cute is critical here, as we see the robot helping elders and special needs children at first, so the social attachment is really important.

The model is really compelling and the challenge is reducing manufacturing costs while expanding battery life. But I have no doubt that robotic aides and adjuncts will be commonplace in the long term, as there is no real daunting technology hurdle.

If you don’t like EHR as a hot sector, you probably hate revenue cycle.

People are going to upgrade their financial systems and evolve them, but I don’t think you are going to see a mass exodus to a bunch of new offerings. I think Athena is the Epic of financial systems and they will continue to see growth and grab market share. I think others will eventually level out, but I don’t think that suddenly someone will come out of the blue and own the market.

The reality is that people are trying to minimize churn and and not add to it with a huge rip-and-replace of their financial systems, putting the lifeblood of their organizations at stake without a seriously compelling reason.

Google bet wrong on PHRs.

The PHR is critical and offers tremendous benefits, but I think that the PHR as we know it is sad. A Web page that requires you to go somewhere and do something is silly in this day and age. Google’s idea wasn’t bad, it was just the wrong approach.

In today’s world, a PHR should be part of a mobile experience. You should be gather just-in-time information when the event occurs. If you feel dizzy, rate the dizziness now. You’re in pain, rate the pain now.

My point is that until there is a compelling PHR that is part of the patient’s experience at the time the experience occurs, the PHR as we know it has had its day and really isn’t the right model.

Maybe you should build one, not that the pioneers have had much encouraging success.

I would, actually. It could be fun. I see it as a space that needs to be totally rethought. Like I said, Google’s idea wasn’t bad, they just didn’t know what they were doing and were probably constrained by the need to tie it into the mother ship.

There is huge potential here, but you need to get off the Web and into the patients’ pocket. You also need to give the patient real value. Not having to repeat your meds to a doctor isn’t real value. If people think it is, they don’t understand value from a patient’s perspective.

What’s silly about the industry?

Complexity and lack of eating the low-hanging fruit.

We make things too damn complex. We spend too much time trying to please the clients and thereby make everything for everyone. As an industry, vendors need to learn what clients need, guide them to what is going to give the best return, and stop promising the world just to make the numbers. Be honest, deliver a great end-to-end experience, and loyalty and happiness will follow.

By lack of eating the low-hanging fruit, I mean that we as industry just don’t do the little and simple things that could provide huge upside. Look, I can send an appointment request from my iCal calendar app on my phone to someone across the world using Outlook. They get it and bam, it’s on their schedule. They accept, decline, or modify it, and I am updated seconds later. I know of no vendor who provides this out of the box. It is like 20-30 lines of code and it would be huge if, when you schedule your doctor’s appointment, it appears in your calendar.

Here is another one that is easy. Why can’t I integrate Facebook with my PHR? Why can’t a doctor send updates to his patient on Facebook via an EHR? Not PHI related, but general tips to his patient base, like, “Check your immunizations as we head into cold and flu season” or “I will be on vacation through end of month, for an emergency, contact…”

Why don’t most financial systems support PayPal for deductibles or online payment? There are just so many things that are commonplace across the world, yet in healthcare they just don’t exist.

Everybody says that, but nothing ever changes. Why?

Most executive leadership are sales guys who don’t understand products or product design or the state of technology. Same goes for product managers and designers. Most people I meet just don’t connect the dots, and it really isn’t that hard to do or that expensive.

Hell, to integrate Facebook, you need like 30 lines of code. I am sure people will freak at all this and say, “It’s much harder.” My advice is if you need to call someone in engineering to figure out if what I am saying is right, you shouldn’t be running a company. If your engineering is telling you it is massively hard, you’ve got big issues. It’s time healthcare started asking “what if?”

The inverse of that is “the shiny object” problem, where someone in a company sees a cool technical something or other and decides “man, that would be cool.” That is a big issue. Cool for the sake of cool is never a good idea. For instance, integration of instant messaging with a product seems like a good idea, but it’s not a great idea. The focus should be on integrating voice and video for collaboration anytime, anywhere, but somewhere along the line, someone in a company who sits at their desk all day thinks, “Why wouldn’t a doctor want instant messaging in their app? This would be so cool!” That is just stupid. It shows that the company doesn’t really understand the world of the clinician. IM might work for a billing clerk or office worker tied to their desk in a hospital, but not a clinician.

The point is, someone sees this shiny object, which is a cool technology for the most part, but has no real application to healthcare. Again, if an executive in a company — the CEO, COO, CFO — can’t distinguish between low-hanging fruit and shiny objects, they shouldn’t be running those companies. Investors should be very cautious, as should clients and prospects.

How should prospects or investors evaluate a vendor?

Everyone is an investor. I don’t care if you are a client, prospect, employee, or Wall Street investor. You are all investing. Start by really asking, “How is my money going to be used and how it is being applied by this company to get me a maximum return over the long term?” That means asking some not-so-obvious questions. How do you really decide on what goes into a product or not? Listening to our clients is not the right answer, and probably just a sales guy trying to make a sale.

How much training does your services team and support teams get per year on new products? If it isn’t 20-25% of their time, you are not dealing with a world-class company, just a company trying to make numbers. No way anyone is going to be really well skilled at implementing complicated HIT systems and not get a ton of training every year. I suggest you run for the hills or buckle in for a bumpy ride.

Show me the easy button. Take me through all the things that are going to make my life easy as a user of your products, a champion of your products, and investor in your products. Show me your roadmap and how you have made your deliverables in the past. Past does reflect the future, and you should ask how they deal with quality, make their dates, and keep their promises.

Ask to tour and speak to the development teams and support centers. Are they cool, excited, and work in really awesome environments? If not, well, sad people build sad products. Who is my dedicated account management team? If you are spending a ton of money with someone, you should be getting personal service. Heck, you get a cool concierge when you stay at a hotel for a weekend — you should get the same thing when your tossing several hundred thousand or millions to an HIT vendor and signing a multi-year contract at the very least, without paying a premium.

If you ever want to know how good a company is doing, check out the people working in accounts receivable. If they are totally stressed, working long hours, and ready to snap, it is a clear sign of unhappy clients. When you have to fight to get your money, there is always a reason.

Tell the vendor you want to be treated as an investor, not a damn partner. You really aren’t partners in all this — you as the client are an investor. You want the same accountability, diligence, openness, and hand-holding that public companies afford their investors. A company should never ever lose sight of the fact that their clients and prospects are not their partners — they are the lifeblood of their company and therefore should be treated like royalty.

I could go on and on, providing an insider’s view of selecting a HIT vendor. If people want, they can reach out to me and I would be happy to send them a list of questions and answers to look for and what that potentially could mean to them. No, I am not looking to charge them for it.

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September 19, 2011 Interviews 9 Comments

Readers Write 9/14/11

September 14, 2011 Readers Write 39 Comments

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

Is Healthcare Interoperability Possible With a Conflicted Federal Committee?
By Rusty Weiss

9-14-2011 7-22-21 PM

Interoperability – the ability of health information systems in different organizations to “talk” with each other – is crucial to the future of healthcare. By tapping into “big data” to learn more from existing information, we will make healthcare more effective and less expensive. By allowing patients to carry their health information across provider lines as easily as we want them to carry their health insurance across state lines, we will empower patients. In fact, one of the stated goals written into the Recovery Act was the development of “software that improves interoperability and connectivity among health information systems.”

But one politically connected left-wing company, Epic Systems, could destroy this healthcare progress.

With over $19 billion in stimulus money being dedicated to health IT, the selection of members to occupy the Health Information Technology Policy Committee was a crucial one for the Obama administration. And a platform of interoperability isn’t exclusive to the Obama camp. Democrats, Republicans, and industry experts alike recognize the importance of interoperability.

So why, despite their public support for interoperability, did the administration appoint to the HHS board Epic Systems CEO Judy Faulkner, who opposes the broad consensus position on interoperability?

As Lachlan Markey pointed out in the Washington Examiner, “Epic employees are massive Democratic donors.”

Unfortunately, those political donations may have caused the administration to overlook things like Faulkner’s 2009 comments to Bloomberg News claiming that sharing electronic health records (EHR) “doesn’t work when you mix and match vendors.” She added, “It has to be one system, or it can be dangerous for patients.”

Tariq Chaudhry, a consultant for American Soft Solutions Corp. says, “Judith Faulkner’s version of interoperability reveals a clear effort to establish (a) monopoly for Epic.”

He also believes that after working with Epic for a couple of years, there is little to indicate that their software is unique in the industry.

“I have not seen anything specific to Epic, not found elsewhere that could set (them) apart from other competing EHR/EMR systems,” Chaudhry explains.

In fairness, the entire industry is, according to Otech President Herman Oosterwijk, “15 years behind in interoperability compared with PACS systems”. PACS (Picture Archiving and Communication System) is a technology that allows medical images and reports to be stored and transferred electronically.

Oosterwijk, who has worked with the US Department of Veterans Affairs and the US Department of Defense, believes that “none of the EHR systems are truly open.” He adds, “I can connect a PACS workstation to pretty much any PACS system and query and retrieve images. Compare this with an EMR where we, at best, can get a HL7 feed and/or CDA summary documents out.”

Andrew Needleman, president of Claricode Inc., acknowledges difficulty with the implementation of interoperable EHR systems.

“Due to the amount and complexity of data being transmitted between systems, even systems that attempt to be interoperable run into issues when they send data to other systems.”

Expanding on the complexity problem, Needleman says:

“For healthcare data, even the demographic data to determine if you are talking about the same patient is complex. Then, you add things like medications with dosages, different forms, such as capsules, liquid suspensions for injections, tablets, inhalers, etc. And then you need to include observations, doctor’s orders, lab requests and results, admissions and discharges, billing information, vital signs, etc.”

“Despite the existing standards,” he says, “It’s not an easy task.”

Rob Quinn, a partner at APP Design, a software development company, says the office of Health and Human Services “is trying hard to get vendors to communicate via standards,” though he doubts many health IT companies like Epic will comply.

“There’s simply too much money to be made in locking in their clients,” Quinn admits.

In the end, Needleman isn’t sure if the appointment of Faulkner crosses ethics boundaries, but says a conflict of interest may be unavoidable.

“I think that it would be extremely difficult to appoint someone who was knowledgeable enough about the industry, was willing to serve, and didn’t have an interest in the outcome of the regulations.”

Needleman has a point about the difficulty of finding somebody without any conflict of interest. But it seems like the administration, at a minimum, should have appointed somebody whose business was not antithetical to an interoperable future. Unfortunately, as an iWatchNews investigation pointed out in Politico, the administration has appointed hundreds of big donors to “plum government jobs and advisory posts …”

The appointment of Faulkner poses a significant challenge for the Obama administration. Her opposition to interoperability creates difficulty for the advancement of the health IT industry. The market should decide whether the Epic Systems approach to health IT should be rewarded or deprecated, but – in the interests of interoperability and political integrity – HHS should immediately ask Judy Faulkner to step down from her role on the HHS Health IT Policy Committee.

Rusty Weiss is a freelance journalist focusing on the conservative movement and its political agenda.

Is Meaningful Use Enough When Disaster Strikes?
By Eric Mueller

9-14-2011 7-10-54 PM

Within the last 12 months, natural disasters have taught the health IT community the necessity of preparation. We’ve seen tsunamis threaten nuclear disaster; tornados wipe out entire communities and hospitals; earthquakes damage national monuments; and hurricanes effect remote coastal towns. In the wake of Hurricane Irene’s flooding and billions in damage, I truly wonder what we can learn from this experience in an effort to make the next disaster … less of a disaster.

When I think of disasters, I think of recovery. In health IT, how do we clean up and recover from the unexpected? How do we recoup data, tests, records, history, systems, schedules, hardware, software, and all the technical things that make our facilities run? Katrina occurred six years ago, yet some areas of New Orleans are still cleaning up. Virginians can tell you all about the unexpected now that they’ve experienced an earthquake in their back yard.

And who can forget the tragic images of Joplin, Missouri, where St. John’s Regional Medical Center stood directly in the path of the monster EF-5 tornado? Thankfully, St. John’s had just switched to an electronic medical record system, though it reportedly sustained some permanent paper record loss. We’ve already heard reports of IT-related problems stemming from Irene with offsite centers and backup generators failing along with general logistical and access issues. Unfortunately, after the dust settles, we’ll likely hear of communication outages, lost patient records, and failed technology – a story that is become a bit too familiar.

Having learned from past disasters, many large facilities have business continuity plans in place to restore their operations quickly. They have online data storage backups and cloud-based hosting facilities to mitigate minimal interruption and risk. But what about those that don’t? Many physicians and hospitals across the country continue to lack capital and access to advance to technology typically afforded to large hospitals. Many find it challenging to meet the noble intentions of Meaningful Use, which is designed to do just that. Reach the communities that don’t have the funds or access.

Long-timers in health IT know that implementation and adoption of new technology can be S-L-O-W. So when exactly is the appropriate time to hold ourselves and our vendors to a higher standard of safety, data recovery, and connectivity over finances? What measures do we enact to safeguard our IT investment before a catastrophic event strikes? Moreover and most importantly, how do we help those caregivers in need RIGHT NOW of information technology?

For example, cloud technologies are words that scare us. We think liability and compliance obstacles instead of opportunity and solutions. Flexibility is paramount. Many organizations are in critical risk positions because archaic and poorly funded IT processes and architecture are wrapped around one very inflexible platform. In allowing the unknown to stop us from proactively seeking out sustainable solutions, will we allow history to repeat itself the next time a natural disaster crosses our path?

Creating flexible and efficient solutions provides the foundation for innovation and problem solving. Remember, if your vendor doesn’t play well with others, Mother Nature will force you to figure this out. Patients rely on the entire continuum of healthcare to do one thing – deliver great care. Doctors, nurses, and administrators can’t deliver great care without depending on their arsenal of tools and technology in their greatest time of need. Let’s challenge ourselves to be innovative and redefine Meaningful Use in ways to help all providers regardless of size and limits, both at work and in our communities. I believe it’s worth the effort.

Eric Mueller is president of WPC Services of Seattle, WA.

Is It Only CPOE, or Is There More?
By Daniela Mahoney, RN

9-14-2011 7-08-20 PM

We’ve got to think about what is ahead of us more holistically. CPOE is no longer a standalone project. If there is one common denominator amongst any size hospital that is embarking on this journey, it is the fact that the effort is considerably underestimated. Unless you have directly experienced projects of such magnitude, it is natural to treat and plan for this project as you would for any other.

What makes CPOE so different? It is often a multi-year process, especially for larger organizations. It has clear beginning, but not an end. It impacts every operational aspect of a hospital’s business. Above all, it leads to significant clinical transformation efforts that are not welcomed by providers and clinical staff.

Adding to the complexity of delivering CPOE within the Meaningful Use timeline is that all of the clinical components targeted for Stage 1 interrelate. We have two significant integration points: (a) the integration of the CPOE application with the appropriate modules and technologies (lab, radiology, pharmacy, documentation, ED, medication reconciliation, discharge instructions, etc.) and, (b) integration of clinical workflows. The latter is more challenging.

The easier question that organizations should ask is not what CPOE impacts in a hospital, but what it does not impact. That answer is by far shorter. To drive successful CPOE implementation, we know that the leaders have to be involved to “pave” the road and set direction.

To achieve Meaningful Use Stage 1, a cadre of leaders — including the CEO — need a working knowledge of the requirements and organizational changes necessary to succeed. An IT strategic plan aligned with the vision of the organization should be in place at the time Meaningful Use projects are executed. For successful organizations, their strategic plan is centered on the patient and how to maximize clinical performance, the need for increased transparency, pay for performance, provider engagement, and building and expanding business intelligence capabilities, to name a few. This calls for resources, innovative technologies, and infrastructure, as well as a strong leadership team that is able to drive such a vision.

The CIO’s role in the execution of the vision is essential. To successfully attain these goals, the infrastructure must support all these clinical and revenue-generating applications and the new tools that optimize the care delivery process. Someone made the analogy that the infrastructure is like a garden — cultivate it and it will produce expected results, but ignore it and the weeds will take over. As we plan the budgets for these initiatives, although we lead with saying that these are clinical applications and we need to focus on clinicians, we cannot minimize the importance of reliable infrastructure.

In the big scheme of things, what does CPOE impact? Putting it simply, it will impact everything that a provider order does today. Moreover, if what happens today is not functioning at the most optimum levels, then CPOE will accentuate all inefficiencies, resulting in potential barriers towards its adoption. Even processes such as the timely assignment of the appropriate provider to a case will impact CPOE, as any delays or inaccurate information will cause disruptions in communication, delays in care, inaccurate physician performance reporting, billing, etc.

Another critical factor is the fluency of clinical processes related to patient flow, especially at the points of entry through ED or PAT/surgery. As an example, take the efforts of trying to integrate CPOE with a disparate ED system while fine-tuning the medication reconciliation processes. In most cases, the result is a mixture of new processes that could still place patients at risks, unhappy providers if they have to use multiple systems, and budget overruns. Time is a precious commodity – neither the patients nor providers want to waste it.

How do we plan for CPOE? It is by beginning with the end in mind and creating a patient-centric implementation. CPOE has to be safe, should optimize our clinical performance, and improve organizational efficiency. It is complex, but we can simplify it by always asking the question: will the patient and provider/clinicians benefit from it? If the answer is yes, then we are on the right track.

9-14-2011 7-04-37 PM

I mapped a visual diagram on how to think about the Meaningful Use components in parallel with what is happening to a patient when admitted to the hospital. This will provide a reference of thinking about what we do in a different way.

9-14-2011 7-06-04 PM

And of course, I did not forget about another delicious recipe you could try as we are approaching the end of the summer. I know this has nothing to do with CPOE other than finding a way to relax after a long day at work. And next time, we will talk more about provider adoption, organizational culture, and how to look for that value proposition.

Daniela Mahoney RN is vice president of Healthcare Innovative Solutions of Seville, OH, A Beacon Partners Company.

PHR: the Unicorn of HIT
By Ryan Parker

The Personal Health Record (PHR), in theory, is one of the best ideas in healthcare. Not only in terms of value (think of Facebook and Twitter’s skyrocketing valuations), but also in terms of patient care. As a depository of information, medical records would be easily accessible by patient and provider alike, with medications, procedures, and diagnoses always being accurate and up to date.

Unfortunately, the PHR is the unicorn of healthcare IT.

There have been some valiant efforts, but everyone seems to miss the key reasons why this fantastical PHR will remain just that, a fantasy.

  1. PHR interoperability would be an issue. For a viable PHR, it would need to link with every practice and hospital, not only to ensure that providers can view information, but to also make sure that patient data is recorded properly. However, a direct EMR/PHR link would be costly and resource heavy. It would essentially be more effective to create a national HIE (which I won’t get started on why that will never happen). Since we all know that is not an option for the near future, the best option would be to give patients the responsibility of filling out the information themselves. This brings me to my next point …
  2. People don’t want to take the time to fill out a PHR. Unless they are made to, most people won’t take the time to find a PHR online and then take the necessary time to fill out all of the information accurately to really make it a worthwhile source of information. In order for this to work, you would need almost a social networking/PHR option that draws people in and then allows them to fill out their medical information, essentially a “Facebook for your health.” However …
  3. There will never be a “Facebook for your health.” I’ve heard this idea thrown around quite a bit, and again, it would only work in theory. Most people only use one social networking site. Although Google+ has seen some initial success, I think it will soon bow down to the Facebook beast. The only way we can guarantee a majority of the population has access and comes into daily contact with a PHR would be for Facebook to add a PHR section, which leads to my final point …
  4. Facebook will never step into the healthcare arena. Sorry, folks, it is just not going to happen. Facebook is fun, exciting, and laid back. Unless you feel reviewing friends’ home medication list and procedure history is really something that most people would enjoy doing (and if you do, I think you might be in the minority on that one) venturing into healthcare IT would be an extreme departure from Facebook’s prior success strategy.

I, for one, am interested in seeing what the next few years bring in terms of PHR strategy. I think there is an option out there that will work, but it definitely has not been created yet.

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

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September 14, 2011 Readers Write 39 Comments

News 9/13/11

September 13, 2011 News 4 Comments

Top News

9-13-2011 7-33-49 PM

mrh_small President Obama declares this week to be National Health Information Technology Week.


Reader Comments

mrh_small From MT Hammer: “Re: All Type acquisition. As you reported earlier, MedQuist makes it official.” Sort of, anyway – the financial advisor  to All Type Medical Transcription Services issues a press release about its role in the transaction. Reported here on August 25 by Hammer, who didn’t hurt ‘em.

9-13-2011 9-32-20 PM

inga_small From Proud athenista: “Re: athenahealth’s MU dashboards. The other day I was surprised to learn my very own company was going public with our MU transparency and just read the great interview with Jonathan Bush. Whodda thunk it would ever happen? I suggest that all vendors share their numbers.” PA is referring to last week’s HIStalk Practice  interview with athenahealth CEO Jonathan Bush, who discussed the company’s decision to publish the performance of its athenaclinical clients against Meaningful Use metrics. We are happy to share similar information from other vendors, though I can only think of a couple of others that are offering those details.

9-13-2011 9-46-30 PM

mrh_small From Funky Bunch: “Re: Medicare attestation numbers. Here is some information from CMS that you may have seen.” CMS says $149 million has been paid as of July 31, but it doesn’t give a provider count or breakout of hospitals vs. eligible professionals. Medicaid incentive payments total $248 million and registrants for both programs total 77,549. Hospitals would get pretty big checks for their Medicare attestation, so that number might represent a fairly low number of EPs. On a related page, CMS answers the question of whether audits will be performed: maybe, so keep your documentation for at least six years, it says, else the payment “will be recouped.”

mrh_small From Just Askin’: “Re: Innovator Showcase. Is that paid promotion?” I’m kind of insulted that you would ask that, but no. Interested companies applied and my volunteer review team (investment guys and a hospital person) choose a handful from the several dozen that they felt were truly innovative based on some rather probing application questions. One of those companies happened to be a current HIStalk sponsor by coincidence and all of them earned their spot strictly on merit.

mrh_small From Farmer Joe: “Re: Meaningful Use incentives. You seem to make a lot of implied negative statements about spending taxpayer dollars on these. Farm belt clinics are faced with closing due to low patient volume and MDs looking to retire, but with no residents who want to join them due to low pay and practices still on paper. These rural communities provide 80% of the food in this country. Every American who eats anything they don’t grow or hunt themselves should be glad to pay money to keep these practices in business to keep young farmers from quitting and moving to cities.” Sounds like a bit of a stretch that farmers will stop farming if the rest of us don’t buy EMRs for their doctors. If we have to subsidize money-losing medical practices, then I’d rather do it directly instead of paying them to adopt a particular technology that isn’t guaranteed to improve either their medical capabilities or their profitability. And I’m nearly always going to be against new government spending like HITECH, stimulus, TARP, artificial jobs creation, or whatever other cause du jour has aroused our debt-happy and votes-desperate Congress. As someone once said, “The American Republic will endure until the day Congress discovers that it can bribe the public with the public’s money.”


Acquisitions, Funding, Business, and Stock

Streamline Health reports Q2 results: a net loss of $7,000 vs. a loss of $76,000 last year; revenue $4.1 million vs. $4.7 million.

9-13-2011 2-44-44 PM

Telehealth provider Teladoc secures $18.6 million in funding
.

9-13-2011 3-10-45 PM

9-13-2011 3-11-29 PM

EDI provider MD On-Line acquires healthcare communications company Strategic EDGE Communications.


Sales

9-13-2011 3-31-05 PM

Via Christi Health (KS) purchases QuadraMed’s Identity Management solutions.

9-13-2011 3-52-57 PM

Newberry County Memorial Hospital (SC) selects Summit Healthcare to provide interface engine technology for its Meditech system.

9-13-2011 7-54-51 PM

Wilmington Health (NC) chooses Humedica MinedShare as its clinical data warehouse.


People

HHS Secretary Kathleen Sebelius announces the appointment of Leon Rodriguez as director of the Office for Civil Rights, replacing Georgina Verdugo. He was chief of staff and deputy assistant attorney general in the Justice Department’s Civil Rights Division. He was nominated by the President last December to be Administrator of the Department of Labor’s Wage and Hour Division, but that nomination was withdrawn last week.

9-13-2011 3-33-45 PM

vRad names Sandy Schmitt SVP of Strategy and Development. She was previously with Allina and VHA.

 9-13-2011 6-01-17 PM
AT&T names its first CMIO, rheumatologist Geeta Nayyar MD, MBA. She was previously with Vangent.

9-13-2011 3-20-08 PM

MediClick promotes President Mike Merwarth (above) to CEO, taking over for Ron Kupferman, who remains chairman of the board.

9-13-2011 8-21-13 PM

Hon S. Pak, MD joins AirStrip Technologies as a senior advisor. He was previously CMIO for the Army Surgeon General and is an innovator in telemedicine, particularly teledermatology, and is a graduate of the United States Military Academy and a former combat medic.


Announcements and Implementations

HIMSS names four additional winners of its 2011 Davies Awards of Excellence: Kaiser Permanente (Organizational / Epic); Fallon Clinic (Ambulatory / Epic); James F. Holsinger, MD (Ambulatory / e-MDs); and Hudson River Healthcare (Community Health Organization / eClinicalWorks).

McKesson introduces McKesson Practice Choice, a Meaningful Use certified, Web-based integrated EHR/PM solution for small, independent primary care practices.  The company also announces McKesson Practice Care, a service line that offers patient-centered medical home consulting in conjunction with AAFP’s TransforMed and available exclusively for practices running Practice Partner, Medisoft Clinical, Lytec MD, and Practice Choice.

Zynx Health will hire 40 new employees, including those with technical and sales experience.

Anvita Health is awarded a patent for a decision support system that can apply a variable medication patient co-pay, which it calls “dynamic, context-specific pricing.” Its intended use is to encourage optimal prescribing by charging the patient extra if he or she insists on getting prescriptions for drugs known to lack efficacy or safety. Co-pays can be reduced if a patient accepts a less-expensive cancer drug that matches responsiveness markers, or if patients are compliant with their prescribed meds.

9-13-2011 8-04-49 PM

A group of University of Alabama in Huntsville professors launches Decision Innovations, whose first product is a nurse staffing dashboard started as a 2008 pilot project with Catholic Health Initiatives. The company won the $100,000 Alabama Launchpad 2011 Business Plan competition and is setting up shop now.

Health benefits provider WellPoint signs a deal to develop commercial healthcare applications using IBM Watson technology. Few specifics were given, but the press release suggests that the applications could help physicians choose treatment options and direct patients to providers who have the best track record in treating their condition. WellPoint says it will start pilot projects early in 2012.


Government and Politics

HHS awards $8.5 million to 85 community health centers in Beacon Communities for the adoption of HIT.

HHS Secretary Kathleen Sebelius reports that 80,000 providers have applied to received Meaningful Use incentive payments and 70% of primary care physicians in rural communities have signed agreements with RECs.

A proposed HHS rule would give patients direct access to their own lab test results.


Technology

mrh_small Microsoft previews Windows 8 (that’s the working name, anyway). This SlashGear hands-on review shows it running on a tablet (assuming someone other than Apple is making them by the time Win 8 hits the streets). The big question for me: how well does a design that looks like it was borrowed from the iPad work on a desktop using a keyboard and mouse? Microsoft is betting the cash cow that consumers and businesses want their desktop and laptop PCs to have a radically different user interface.  

mrh_small Software that creates natural-sounding news articles from a set of facts could write medical journal articles, the company that developed it says. They claim it can compose a unique, smooth-reading article in about one minute that even experts can’t tell wasn’t written by a human.


Other

The Canadian hospital that refused to name the nurse who breached the electronic records of 5,800 patients, citing her right to privacy, changes its mind after the province’s privacy officer declares there is no such law in a newspaper’s letter to the editor. The hospital now says it will give the nurse’s name, but only to patients who state by letter that she accessed their files.

9-13-2011 9-38-59 PM

An interesting article in the Charleston, WV newspaper covers Charleston Area Medical Center’s patient transfer center, an air traffic control-like room with a huge electronic status board showing bed status in its three hospitals.

inga_small I awoke this morning realizing I had been dreaming that a network technician was working to maximize the speed of my home network. I gloated when he told me how impressed he was with the labeling of all the devices, and I was school girl giddy when he complimented me on the strength of my passwords. We then discussed the merits of various printers. I am clearly overdue for a vacation.

mrh_small A former pediatric nurse at NYU Langone Medical Center says hospital employees snooped in her medical records and, from her history and diagnosis of endometriosis, assumed she was a virgin. Her co-workers then kept trying to convince the 41-year-old woman to have sex, she says, with a neurosurgeon making references to “The 40-Year-Old Virgin” movie. She’s suing the hospital for $45 million, claiming it didn’t protect her medical records.

mrh_small Wake Forest Baptist Medical Center (NC) fires and sues a former administrative director for “unjustified, vindictive, malicious, and gratuitous actions.” His transgression: he alerted the state that it was overpaying his employer under the terms of its health plan. The state auditor agrees, saying sloppy state contracting and oversight allowed the hospital to overbill by $1.34 million. The hospital says it was none of the former employee’s business and its contract allows it to raise prices without notifying the state.

inga_small The Wall Street Journal highlights the industry’s transition from ICD-9 to ICD-10 and mentions several of the wackier codes. One of my personal favorites: V91.07XA (burn due to water skis on fire.) athenahealth’s CTO Jeremy Delinsky correctly notes that, “You have millions of transactions flowing in the healthcare system and this is an opportunity to mess them all up.”

mrh_small  Even Weird News Andy finds this cringe-worthy news item from China “too weird for words.” A man bathing with live eels as part of a spa’s exfoliation treatment is startled when he looks down at his private area and sees a six-inch-long eel disappearing by the obvious method of ingress. The eel found its way to his bladder on its own, but removing it required a three-hour surgical procedure.


Sponsor Updates

  • Sandhills Pediatrics (SC) receives $184,000 in ARRA incentives from its use of SRS.
  • MEDSEEK announces the availability of ecoSmart Patient Precision predictive analytics technology.
  • Practice Fusion forecasts that 5,000 of its eligible provider clients will receive $18,000 in Meaningful Use incentives in 2011.
  • Two T-System employees, CMIO Robert Hitchcock, MD and Center for Performance Excellence Manager Janie Schumaker, RN, are elected to the board of the Emergency Department Practice Management Association.
  • Aspen Advisors releases a case study on the Epic implementation of St. Anthony’s Medical Center’s (MO). 
  • BridgeHead Software announces the successful integration of its MediStore archive technology with  three leading PACS products.
  • Ben Michelson of Hayes Management Consulting discusses lessons learned from ICD-9 implementations in a guest article.
  • Wolters Kluwer Health releases a ProVation MD module to support participation in the ACC National Cardiovascular Data Registry CathPCI Registry.
  • Thomson Reuters introduces MarketScan Treatment Pathways to analyze medical care, outcomes, and costs.
  • TeleTracking Technologies announces the availability of its RTLS to the UK healthcare market.
  • Cumberland Consulting Group provides a checklist of 10 things hospitals should consider as they undergo EHR implementation.
  • MidMichigan Health uses Concerro’s ShiftSelect in its retiree return-to-work program.
  • The AHA Center for Healthcare Governance selects CareTech Solutions and its customer San Luis Valley Regional Medical Center as presenters for its Fall Symposium.
  • The Massachusetts Department of Public Health replaces its e-Forms system with Access’s electronic forms on demand solution.
  • AT&T contributes $100,000 to support a mobile health initiative to use smartphones in diabetes education.
  • Elsevier / CPM Resource Center will integrate its evidence-based clinical practice guidelines and documentation solution into the McKesson EMR of Medcenter One(ND).
  • Iatric Systems adds the federal government’s Blue Button capability to its PtAccess patient portal, which allows patients to download their health information as a text or PDF file.

Contacts

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

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September 13, 2011 News 4 Comments

News 9/9/11

September 8, 2011 News 5 Comments

Top News

9-8-2011 8-32-01 PM

mrh_small I reported weeks ago that Beth Israel Deaconess Medical Center was prepared to offer its CEO job to Stanford Chief Medical Officer Kevin Tabb MD, who has spent nearly all of his medical career in informatics roles on both the vendor and provider sides of the house as an IT geek. BIDMC announced Tuesday that he has accepted the position. My assessment then was that “he would be a geeky kindred spirit for CIO John Halamka,” which both FierceHealthIT and DotMedNews quoted and nicely credited to HIStalk.


Reader Comments

9-8-2011 9-27-51 PM

mrh_small From Inquiring Mines: “Re: Medicare stimulus check. A local group got their federal check and its check number was less than 200, an ungodly low number to have been issued. A provider in the group was told only 6,000 providers had filed to date. Am I missing something? The Medicare spigot doesn’t seem to be flowing as expected.” IM sent a scan of the provider’s check and it does appear that, unless CMS has multiple accounts (this one is called “EHR Incentive Payment Account”) they haven’t issued many checks to date.

mrh_small From Pacman: “Re: Mayo – Elkin lawsuit. A $1.9 million attorney’s fee award for Mayo against Dr. Elkin.” Unverified. This is the suit in which a Mayo doctor (Elkin) sued Mayo over software he developed while employed by them, but then took the source code with him when he left. The jury found in favor of Mayo in April, but also ruled that the doctor is due royalties under Mayo’s royalty sharing policy. As is nearly always the case with lawsuits, the big winners are the lawyers.

9-8-2011 7-42-04 PM

From Harvey: “Re: Mediware. Reported a very solid quarter, but indicated that their labor costs have gone up. It would seem that, despite overall job market woes, there’s a bit of a bidding war on for HIT staff.” Mediware’s Q4 numbers, announced Wednesday: revenue up 20%, EPS $0.25 vs. $0.12, with a big DoD blood bank software contract pushing the numbers up. The one-year share price is above, with MEDW (blue) compared to the Nasdaq (red) and the S&P 500 (green). Market cap is $91 million.


HIStalk Announcements and Requests

mrh_small Listening: Black and White America, the new album from Lenny Kravitz. Retro 60s funky with big horns in places, modern soul elsewhere, and melodic rocking on some tracks. A great sound throughout and lyrics that aren’t the usual dance track drivel. I get quite a few e-mails from readers wondering how to get back in the habit of listening to new music and I would recommend this as easy to enjoy – it’s got a nice beat, it’s not explicit (he’s religious), and it’s original. And Watching: Mercy (a pretty good hospital yarn) and The Good Guys (a funny cop buddy series). Netflix is predictably in full meltdown mode since any fool could see that its content providers like Starz would be holding it hostage once their old contracts ran out, so I’m watching now before the lack of programming (or increase in price) pushes me to cancel.

Jobs on Healthcare IT Jobs: eGate Integration Analyst, Senior Systems Analyst – Physician Systems, Implementation and Account Manager, Pegasus Health IT Director. There’s quite few interesting jobs there.

HIT is a contact sport, so get off the couch and interact with us: (a) subscribe to the e-mail updates so you can be a like Paul Revere galloping down the cubicle rows shouting out the latest shocking news that I’ll deposit in your inbox if only you’ll allow me; (b) do all that friend / like / connect stuff on your choice of social media sites, seeking out HIStalk, Dr. Jayne, Inga, and me so that we might consummate our union electronically; (c) send me news, rumors, or whatever interests you about the industry; (d) behold with wonderment (and perhaps some strategic mouse-clicking) the graphical proof to your left signifying the unlikely fact that impressively powerful healthcare technology firms are willing to support an anonymous muckraker who struggles to keep a hospital job given the extensive time required to keep up with all the HIT windmill-jousting that needs done; and (e) appreciate that our world revolves around patients, no matter how much electronic insulation separates them from us. Thanks for reading.


Acquisitions, Funding, Business, and Stock

Mediware’s Q4 numbers: $16 million in revenue, up 20% from last year; net income $6.3 million vs. $3.2 million.

9-8-2011 3-43-48 PM

Private equity firm The Riverside Company acquires Avatar International, which administers patient satisfaction surveys.

9-8-2011 3-46-35 PM

Teleradiology firm Virtual Radiologic acquires the 60-radiologist practice Diagnostic Imaging, Inc. (PA/NJ).

9-8-2011 7-51-44 PM

Hospital revenue cycle predictive analytics vendor Apollo Data Technologies Health, Inc. changes its name to MethodCare, Inc.


Sales

9-8-2011 3-48-37 PM

CHRISTUS Health (TX) selects HiSoftware’s Compliance Sheriff for SharePoint solution for HIPAA compliance with Sharepoint data.

9-8-2011 3-54-15 PM

inga_small Royal Caribbean Cruises selects eSeaCare EHR for its Azamara Club, Celebrity, and Royal Caribbean International cruise lines. Dang, I sure need to do a site visit.

CMS contracts for ICD-10 code translation technology from 3M Health Systems to assist with the conversion of the agency’s systems, applications, and reports from ICD-9.


People

9-8-2011 3-57-40 PM 9-8-2011 3-58-10 PM

Zynx Health appoints Bill O’Connor, MD (Allscripts) as SVP of global product management and marketing and David Cerino (Microsoft Health Solutions) as EVP and COO.

CSC promotes David Levitt from account director to VP of HIT solutions for its North American Public Sector Health Services division. 

Healthcare investment bank Leerink Swann names Bill Suddath managing director of the firm’s Healthcare IT and Technology Enabled Services franchise. He was previously with Robert W. Baird & Co.

9-8-2011 5-37-35 PM

AHIMA appoints Lynne Thomas Gordon, MBA, RHIA, FACHE as CEO. She was previously with the Children’s Hospital at Rush University Medical Center.

CentraCare Health System (MN) names Amy Porwoll CIO, replacing the retired Charles Dooley.


Announcements and Implementations

9-8-2011 4-01-09 PM

Humility of Mary Health Partners (OH), which includes three hospitals owned by Catholic Health Partners, goes live on its $56 million Epic system.

Accenture completes an assessment and plan to support implementation and interoperability standards for a statewide HIE for the Texas Health Services Authority.

The VA will expand its Virtual Lifetime Electronic Record pilot in which the health records of veterans are electronically shared with the Department of Defense aid private healthcare facilities. It says the HIE capabilities will be live this fall.

9-8-2011 10-24-37 AM

inga_small The ONC launches HealthIT.gov, a new website which includes HIT information for both healthcare professionals and consumers. It’s definitely prettier and easier to navigate that older ONC site, but contains much of the same information.

9-8-2011 5-45-33 PM

MetroWest Medical Center (MA) debuts its use of the EarlySense system, which uses motion sensors placed underneath beds to track patients’ vital signs. Massachusetts Governor Deval Patrick was on hand.

TeraMedica introduces a medical archiving solution capable of managing from 25,000 to 10 million medical image procedures.

9-8-2011 4-13-28 PM

Free EHR vendor Mitochon Systems announces built-in connectivity from its EHR to Hoag Hospital’s Medicity-powered HIE.

9-8-2011 4-16-13 PM

Isabel Healthcare and VersaSuite partner to integrate Isabel’s diagnosis decision support tool into the VersaSuite EHR.

9-8-2011 7-30-42 PM

Nuance announces that MedMaster Mobility has added voice-powered navigation and documentation capabilities using Nuance Healthcare’s cloud-based speech recognition. The app is a customizable mobile front end that works with any EHR system.

9-8-2011 7-57-18 PM

Athenahealth releases a dashboard showing the progress of its network of physicians toward meeting Medicare Meaningful Use requirements. Inga interviewed Jonathan Bush, athenahealth CEO, president, and board chair right after the announcement was made. A snippet:

Show me how you are going to audit this. I want our clients to prepare for audits now. I want to make sure you audit more your fair share of our clients and I want you to do the audits so you don’t just distress our clients. I want you to audit everyone else so nobody attests without really doing it. Furthermore, let’s get away from this attestation thing if you are not really going to do thousands of audits. Then I want you to stop attestation as part of this larger trend of making unreasonably and obscene rules with massive penalties for non-compliance, and then not auditing, or auditing in such a random way that it really, really, really hampers innovation and creativity and excitement in the healthcare space. If you want information: ask for it, be ready to receive it, and then pay for it as it comes out. Don’t say, “I will pay you if you promise me I will receive, it even if I don’t receive it.” It’s like “don’t ask, don’t tell” — it is the most absurd and embarrassing way because you create distance between what a doctor attests to and what is true.

9-8-2011 8-10-51 PM

Clay County Hospital (IL) goes live on Healthcare Management Systems (HMS), announced in a local newspaper story that surprisingly gives the full names of the last “paper patient” and first “electronic patient,” hopefully with their permission.

Qualcomm and Life Care Networks launch a Wireless Heart Health 3G mobile health project in China. Components include smartphones with ECG sensors, Web-based EMR software, and clinic-based 3G wireless workstations that give 30 physicians access to the electronic records and ECG data.


Government and Politics

mrh_small Federal agents arrest 42 people in South Florida for suspected Medicare fraud. Assisted living facilities and related businesses convinced out-of-state elderly and disabled people to come to Florida for a fresh start (and to bring their Medicare cards along). They’re accused of submitting $160 million in phony claims, of which Medicare dutifully paid $90 million without question. The lead FBI agent chastised HHS for not preventing fraud upfront, saying that it takes extensive resources to catch the crooks, who by the time they’re arrested, have usually spent all the money.


Innovation and Research

9-8-2011 9-44-40 PM

Albert Einstein College of Medicine of Yeshiva University will use an NIH-funded grant to study advanced retroviral drug therapy in HIV/AIDS patients in Central Africa. Clinics will implement the OpenMRS open source medical record to collect data, also giving governments the option to make its use a national initiative.


Technology

Inova Health System (VA) partners with a genomics company to sequence the genomes of 500 pre-term NICU babies and their parents to identify OB-related diagnoses and treatments. Information from Inova’s EMR will be used to study outcomes.


Other

mrh_small A physician’s guest editorial in The New York Times makes the common observation that electronic medical records are good as long as the caregiver doesn’t let the computer interfere with their relationship with their patients.

In the old days, when a patient arrived in my office, I laid the paper chart on the desk between us. I looked directly at the patient. As we spoke, I would briefly drop my eyes to jot a note on the page, and then look right up to continue our conversation. My gaze and my body language remained oriented toward the patient nearly all the time. In the current computerized medical world this is impossible. I have to be tuned toward the computer screen to check labs, review X-rays, read prior notes, document the patient’s current concerns. Like most internists, I know that the interview is the most important part of a patient visit. It always yields far more information than the physical exam, which, in many ways, is an afterthought. But now that the computer is impeding the intimacy normally achieved during the talking part of the visit, I find that I rely on the physical exam more. Once the patient and I have broken free from confines of the desk, with its dictatorial PC, we have a more comfortable realm, that of touch. As soon as there is skin-to-skin connection, conversation flows more easily. In the absence of a machine lodged between us, the traditional doctor-patient relationship is restored.

9-8-2011 9-46-41 PM

mrh_small An Ontario hospital notifies patients that an employed nurse inappropriately accessed the records of 5,800 patients. The mother of one of them was upset by the hospital’s  response to her request for details:  they won’t release the nurse’s name because doing so would violate the breacher’s privacy.

mrh_small Weird News Andy likes this ink: an 81-year-old grandmother gets a chest tattoo that says, “Do Not Resuscitate,” fearing that doctors won’t see the DNR entry in her medical record. “I do not want to be half dead, I want to be fully dead … I don’t want to lie for hours, months or even years before dying. I don’t want my family to remember me as a lump. My mother-in-law lived to be 106 and in the last six years of her life she’d have been much better dead. She was miserable.”

mrh_small Also from WNA is this story in which England’s Primary Care Trusts are demanding that family physicians reduce their use of ultrasound, MRI, and CT scans. WNA has a cost-saving solution: send them through TSA’s body scanners.

mrh_small Police in China are investigating the death of a patient during a fire in a hospital OR. Employees evacuated themselves and all patients except one, a man whose leg was being amputated under general anesthesia. When they returned, they found him on the OR table, dead of smoke inhalation.


Sponsor Updates

9-8-2011 8-14-43 PM

  • The Disposable Film Festival and Practice Fusion launch Disposable Film Festival Health to encourage original short films about health, medicine, patients, or doctors. Participants will compete for a $5,000 prize.
  • Orion Health is adding more than 100 new positions, with about two-thirds in New Zealand and the rest in North American and the Asia-Pacific region. Most of the openings are in R&D.
  • Ten unaffiliated physician practices connect to the Coastal Connect HIE (NC) and begin the electronic transmission of patient referral data using Medicity’s iNexx technology.
  • Radiology Associates LLC (LA) selects McKesson Revenue Management Solutions for practice management and medical billing services.
  • Robert Freedman of Hayes Management Consulting will moderate an ICD-10 panel discussion at HCCA’s New England Regional Annual Conference on September 9 in Boston.
  • Stockell Healthcare Systems and ZirMed announce a partnership in which ZirMed’s claims management will be integrated with Stockell’s Insight Revenue Cycle Information System.
  • Decatur Medical Center (IL) will deploy Wolters Kluwer Health’s ProVation Order Sets. Wolters Kluwer also signs a multi-year contract with Health Shared Services British Columbia for its Lexicomp solution.
  • TeleTracking Technologies announces the formation of its RTLS Workflow Consulting Group. The company is also hosting a free webinar, RTLS Asset Management and How to Make the Most of Your Owned Equipment Resources.
  • MediServe clarifies the PAI Discharge Window. 
  • Cumberland Consulting Group promotes Tom Howard to principal.

EPtalk by Dr. Jayne

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JAMA is e-mailing physicians to take part in a survey regarding mobile electronic devices. Questions included: what devices are owned; plans for new device purchases; how much time is spent each day using a mobile device for medical information; when during the day devices are used; how important the device is for various pursuits; and desirability of a medical journal app for full text articles.

Mailbox alert: The Centers for Medicare & Medicaid Services will be mailing revalidation requests to over a million health care providers, more than half of which are physicians. Providers who enrolled prior to the institution of new screening criteria on March 25, 2011 will have 60 days to recertify their enrollment or be blocked from billing Medicare. Providers worry that the already cumbersome Medicare enrollment process will negatively impact honest providers rather than catch the crooks for which it was intended.

This week’s New England Journal of Medicine includes Electronic Health Records and Quality of Diabetes Care. The authors looked at diabetes care data from 569 providers at 46 practices from 2007 to 2010, concluding that the “findings support the premise that federal policies encouraging the meaningful use of EHRs may improve the quality of care across insurance types.” The practices included safety-net providers and publicly reported performance data. On composite standards for diabetes care, EHR locations scored higher than paper-based locations for outcomes and also showed a higher annual improvement (after adjusting for insurance, age, sex, race, ethnicity, language, income, and education.)

The authors note that this is in contrast to other recent studies showing no improvement in quality for practices using EHR. They attribute their favorable results to looking at systems with clinical decision support that is specifically designed to improve care and which include mechanisms for care coordination and provider communication. Additionally, patients had to visit the practice two or more times during the study period for inclusion. The authors propose that this demonstrates a “mutual commitment to longitudinal care” which may have been lacking in other studies.

Medical Economics recommends some LinkedIn groups for social media savvy physicians to join. I was disappointed to not see the reader-created HIStalk Fan Club on the list. With over 1,800 members, it beats all but two of the groups listed.

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Several of my friends who are consultants in the health IT realm spend most of their weeks traveling from practice to practice. Since food is no longer served in most parts of the not-so-friendly skies, road warriors are often subjected to the carry-on fare of their neighbors. One former colleague was so offended by his neighbor’s snack he e-mailed me from 30,000 feet looking for sympathy. Normally I’d tell him to “suck it up,” but he snapped a photo of the fare: Ahi tuna jerky. The aroma was bad enough that someone asked a flight attendant to speak with the passenger about putting it away. I’m not sure about the rationale behind dehydrating a perfectly good piece of fish, but to all the road warriors out there, may your flights be fish-free.

Have a health IT road warrior horror story? E-mail me.

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Contacts

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

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September 8, 2011 News 5 Comments

Curbside Consult with Dr. Jayne 9/5/11

September 5, 2011 Dr. Jayne 2 Comments

Today is Labor Day, which according to the United States Department of Labor, is dedicated to the social and economic achievements of American workers. I decided to spend a bit of time crunching numbers from the Bureau of Labor Statistics. The BLS predicted that healthcare would generate 3.2 million new wage and salary jobs between 2008 and 2018.

The Bureau also predicted that computer systems design and related services would be one of the fastest growing industries in the economy. Management, scientific, and technical consulting services were forecast to be the fastest growing, with an 83% increase.

Of course, a recession has a way of throwing a wrench into things, but I’d be interested to see how far off the mark these numbers are when it’s all said and done. ARRA and HITECH legislation have had and will continue to have a significant impact on employment in the healthcare IT segment.

The industry continues to move at high speed, not only on the development side, but in implementation as well. For the latter, I worry that too many organizations are moving at a pace that is foolhardy. Every day I hear another horror story from a colleague.

There was the one about the hospital that didn’t have their support structure figured out just four six weeks before their scheduled go-live on clinical documentation. Numerous project members tried to call a “time out” to arrange appropriate resources, but leadership forged ahead anyway in order to be able to go-live before a competitor. Physicians had no super users or trainers on the floors to help them, just a call center number.

Then there was a facility that didn’t have all the end-user hardware in place for a CPOE go-live, but went live anyway. Physicians were frustrated and actively developed ways to circumvent workflow, including hiding from nurses and phoning verbal orders from the doctor’s lounge. Juvenile, but understandable.

My personal favorite is from a small primary care practice. A few weeks prior to go-live, a competing practice hired away several key staffers. The practice used a temp agency to quickly fill the positions and stayed with their original go-live data. The temporary staffers had only a few hours of training and the practice didn’t block patient schedules to allow time for documentation. Tempers flared and staff refused to return to the assignment, making matters worse. Rather than pausing to regroup, the providers elected to continue to try to implement.

I don’t understand why anyone thinks that continuing to steamroll ahead when these situations come up is a good idea. Sure, some people continue to drive their cars with the “check engine” light on, but this is the equivalent of driving not only with a dashboard light illuminated, but also with a flat tire and smoke coming from under the hood. I can’t imagine that these same physicians would start a surgery with missing instruments or with a scrub tech who has never done the scheduled procedure.

It is folly to try to implement with an untrained staff, a recognized lack of hardware, or without an appropriately scaled support structure. It doesn’t matter how much time, money, or effort has been invested in the planning – it’s simply a recipe for disaster. If you are on one of these runaway freight trains, you know what I’m talking about.

October is approaching and many eligible providers and hospitals are going to try to achieve Meaningful Use attestation in the last 90 days of the year. I imagine I’ll continue to hear lots of stories from the field, as organizations that are simply not ready move forward, no matter the cost or chaos.

Have a war story to share? E-mail me.

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E-mail Dr. Jayne.

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September 5, 2011 Dr. Jayne 2 Comments

Monday Morning Update 9/5/11

September 4, 2011 News 6 Comments

From It’s All Good: “Re: Sage Healthcare. Tom Chmielewski, VP of product management, leaves to ‘pursue other interests,’ following the recent departures of project management execs Mike Burger (PM/EHR), Rob Price (practice analytics), and Mark Martin (EDI). It’s an interesting time to be cleaning the product management house. Who’s minding the store for Stage 2 and beyond?” A source verifies that Tom Chmielewksi has left the company.

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

9-2-2011 4-10-20 PM
9-2-2011 4-06-57 PM
9-2-2011 4-09-13 PM
9-2-2011 4-08-15 PM

Listening: reader-recommended Metric, female-led Canadian indie rock with only a little bit of guitar (reminds me a little of Muse, but more subdued). I was surprised that I missed a band this good, but it turns out I didn’t: I recommended them back in April 2009. Really good stuff, fresh and tight. I’m happy for the reminder to listen to them all over again.

My Time Capsule editorial this week, archeologically excavated from the ash heap of history circa 2006: “Hospitals Want Software to Do The Dirty Work of Changing Physician Behavior.” A free sample of the equally free product: “No software contains a switch that turns resistant physicians into docile, rule-following sheep who make better decisions under the watchful eye of Big Brother’s can’t-miss medical guidelines.”

InterSystems acquires Siemens Health Services France from Siemens, whose Clinicom system is used by 60 French hospitals. InterSystems will pair Clinicom with its TrakCare HIS, which offers electronic patient records, documentation, order entry, flowsheets, patient management, ED, OR, rad, lab, pharm, and billing. InterSystems acquired TrakCare and its Australian developer, InterSystems application partner TrakHealth, in 2007.

The joint VA-DoD EHR will yield an open source results, at least according to VA CIO Roger Baker. That statement didn’t come from DoD, which has a rich history as an intractable, contractor-enriching bureaucracy not interested in giving up control or collaborating outside its walls.

9-2-2011 7-20-32 PM

Indiana Secretary of Commerce Mitch Roob will resign to become president and CEO of WoundVision, an Indianapolis company that sells software that performs risk assessment and predicts pressure ulcers. He replaces founder James Spahn MD, who will remain board chair.

9-2-2011 7-25-07 PM

Microsoft will work with Social Interest Solutions, a non-profit that connects low-income individuals and families to health resources. Microsoft wants to use the organization’s knowledge to get involved with government health insurance exchanges.

This article says US News & World Report used HIMSS Analytics data to choose their top hospitals, which I thought was bizarre since HIMSS Analytics looks only at IT metrics and US News evaluates death rates, reputation, and several non-IT factors. Turns out the story is not really correct: USN&WR used the HIMSS Analytics information only to create a Most Connected Hospitals list by cross-referencing its own top hospitals with those that are EMRAM Stages 6 or 7.

9-2-2011 4-13-26 PM

We are collectively torn on the issue of whether Congress should rescind HITECH money. New poll to your right, for hospital employees: to what degree does your board review and analyze big IT requests before approving or rejecting them? I got the idea from Joel French’s interview, in which he marveled that boards of struggling hospitals approve $70 million system purchases (I assume he meant Epic) without any guarantee the investment will help the bottom line. My experience with hospital boards is that members (community movers and shakers, hefty donors, and a token smattering of social advocates) are mostly interested in the community relations aspect rather than deep diving into operational decision-making. Rightly so, hospital executives would argue. It’s like Congress: the outcome of  big decisions is a foregone conclusion since the execs have persuasively lined up the support they need long before the issue is brought up for a board vote.

9-2-2011 7-05-33 PM

9-2-2011 7-08-22 PM

This article says hospitals are using doctors with questionable objectivity or even “doctor bots” (example 1, example 2, both using the same doctor name but pictures of different people) to spit out medical advice via Twitter, which gain a following and reap AdSense revenue for the commercial sites they link to. The bots take existing articles of questionable value that have no references or detailed information, swap words using an electronic dictionary to make it look like something new, and then tweet links to it. My first thought was that laws would surely prohibit either falsely claiming to be an MD or dispensing questionable advice as one, but then I realized that (a) someone would have to file a complaint, and (b) those laws are mostly at a state level, so it may not be clear whose domain something like this falls under.

9-2-2011 4-31-17 PM

Cayman Islands Health Services Authority CIO Dale Sanders tells me the national healthcare conference will be held November 17-19 at the Ritz Carlton in Grand Cayman. I think I need to be there.

Meditech cancels plans to build an office building in Freetown, MA after the state historical commission overrides an archaeological firm’s recommendations and insists that the company dig, sieve, and log the contents of a two-foot layer of dirt covering 21 acres, which Meditech says would have taken at least a year. Town officials fear the company will look out of state for a substitute location. The mayor of Fall River, where the company already has offices, says his town will beat any Freetown offer.

Healthcare RTLS vendor Versus Technology announces Q3 results: revenue down 15.4%, net income –$15,000 vs. $38,000.

9-3-2011 8-45-27 AM

Oroville Hospital (CA) is profiled in a local publication for its impending implementation of the WorldVistA’s EHR, the first US hospital to go live on that particular variant of the VA’s VistA. From the Bob Wentz, the 153-bed hospital’s CEO: “Why do most healthcare organizations and doctors’ offices have software owned by a company? … What if they wanted to change to a different provider? What would it cost them to get out? And they would get no help transferring their data.” On the other hand, he’s not exactly objective – according to the article, he’s associated with Tenzig Corp., which it says offers hospital implementation services for VistA. I don’t know what happened to the hospital’s original plan to implement Medsphere’s OpenVista, announced in 2007, that caused them to switch to WorldVistA. It was announced a few days ago that WorldVistA EHR 2.0 earned ATCB certification as a complete inpatient and ambulatory EHR, with Oroville proving money, enhancements, and coordination.

More from Vince Ciotti on Gerber Alley. Care to share some vendor reminiscing from back in the day? (that being defined as pre-1990, let’s say, involving visionaries or now-defunct companies). E-mail Vince.

Continua Health Alliance releases its 2011 Design Guidelines for personal health devices, with new coverage of Bluetooth Low Energy temperature sensors, ZigBee networks in which a single sensor communications with multiple hosting devices, and user identification over a Wide Area Network interface.

A survey in Ireland finds that almost 50% of people diagnose themselves using the Internet instead of seeing a physician. Nearly half of those surveyed said they would use SMS or IM to communicate with their physician if available.

9-2-2011 7-42-59 PM

A hospital in England ditches the “do not disturb” vests that nurses were wearing to prevent distractions during medication administration. Patients hadn’t complained, but newspapers had run quotes from other areas in which visitors claimed to be miffed at being told to leave the nurses alone until they had given all their meds, even though studies have shown significant error reduction when nurses are allowed to focus on the task at hand. One might logically conclude that if it weren’t for the social aspect of being hospitalized, hospital units should be closed off to outsiders just like the psych ward or an auto garage. You’ve got dangerous equipment and drugs being hauled around, bodily fluids flowing, people trying to focus on life-and-death tasks, and patients having life-threatening events, all while visitors are getting in the way, asking questions, and spreading germs. It’s like trying to run a busy restaurant kitchen where patrons are allowed to wander in and out and maybe reach around the chef for a sample.

A futurist’s view of sleep technology and the “hotel room of the future” predicts that within 20 years, sleepers will be able to choose their dreams and share them with others; wear active contact lenses that will deliver 3D TV images directly to their retinas; and participate in virtual lovemaking where feelings and emotions are shared via skin sensors.

9-2-2011 7-54-46 PM

Government contractor CSC acquires Baltimore-based Maricom Systems, which provides informatics and data management systems used by HHS. 

9-2-2011 8-49-28 PM 9-2-2011 8-49-46 PM

Allscripts files suit against Virginia-based consulting company Visus, alleging trademark infringement. Allscripts claims the company used its company and product names without approval to promote EHRs. Visus has removed references to both Allscripts and NuWave from its site (before and after image above) after both companies insist they have no relationship with Visus.

A nursing professor in Canada conducts a telenursing pilot project in which nurses monitor home-based diabetic patients using smart phones and the Internet. Part of the project involved creating an interactive telehealth platform that is being commercialized by McGill University with Magellan Global Health, of which the professor appears to be president and COO after the company was merged with her medical tourism company. Being a professor has to be the best job in the world. You get a substantial paycheck for teaching a few classes a week at a pretty campus that offers lots of entertainment opportunities, you get grant money and eager beaver student research assistants, and there’s plenty of time to run consulting or product businesses on the side.

9-2-2011 8-19-02 PM

Jeffrey Kriseman, an Arizona State University PhD student, is profiled for developing an open source messaging system used to exchange public health information for disease surveillance. It’s being used by Nevada providers to submit reportable lab results to public health agencies, qualifying them for HITECH money. Kriseman is finishing his PhD in biomedical informatics.

Strange: the FBI investigates a prosthetic manager at University of Minnesota Medical Center, accusing him of convincing patients to replace their perfectly useful artificial limbs with new ones, after which he would sell their old ones on eBay.

9-4-2011 10-05-49 AM

Stranger: a 17-year-old part-time doctor’s billing clerk is arrested in Florida after posing as a physician’s assistant, convincing the hospital’s HR department to give him a PA badge so he could work in the ED where he examined patients, dressed wounds, and performed CPR on a patient in cardiac arrest. He was caught after he pestered HR to upgrade his badge so he could hang out in the doctors’ lounge, but gave the excuse that he was working undercover for the police. He had previously been dismissed from a Sheriff’s Explorer teen police program for wearing a deputy’s badge and bulletproof vest in public.

E-mail Mr. H.

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September 4, 2011 News 6 Comments

News 8/31/11

August 30, 2011 News 15 Comments

Top News

8-30-2011 11-20-38 AM

8-30-2011 11-22-35 AM

Prognosis Health Information Systems, Inc. signs a definitive agreement to acquire Creative Healthcare Systems, developers of the financial management and patient accounting system MedGenix. Prognosis will integrate MedGenix with its ChartAccess EHR. Creative Health CEO Steve Everest will stay on board to lead revenue management operations.


Reader Comments

mrh_small From A Vendor: “Re: Billians Health Data and HIMSS Analytics. Do vendor readers have an opinion of the superiority of one over the other as a source of hospital data? We’re interested both in the database and the networking potential of the organization.” Comments are welcome.

mrh_small From Antoine: “Re: duplicate med alerts. I’m not sure I agree with your comments. A duplicate check is just a med-med check where the two meds are the same. Whatever deficiencies exist in duplicate checks should exist in med-med checks. The abstract of the article said the number of exact duplicates was high, which I assume is an error, unlike conditions where other factors are different.” The biggest different between duplicates and drug-drug interactions is that the latter are graded by severity at the database level, so they can be turned off en masse and unselectively to suppress noise. Those allowed to display are then almost always clinically significant. The former are triggered by partially or wholly identical drug codes in two or more active orders, but further refinement requires looking at order-specific information such as route of administration, overlapping times, and frequency, and if that isn’t done well, those warnings are rarely clinically useful. In the article, some of the duplicate warnings were appropriate, caused by issues in CPOE such as multiple providers not looking at each other’s orders and entering an exact duplicate. Even exact duplicates may or may not be significant: if one order ends tomorrow and the other starts the next day, the system needs to decide whether that deserves a warning. I have readers who work for vendors of the clinical databases that make these “alert or not” decisions, so I welcome their review of the article. But I’ll stand by my conclusion: duplicate warnings are fairly close to useless, at least as measured by the ultimate yardstick – how many times does the clinician ignore the warning and enter the order anyway?

mrh_small From ADALMA: “Re: Allscripts. I’m an employee and had two flights cancelled because of the weather. My manager called to say family comes first and not to do anything to jeopardize my family or my safety.” Another reader sent over a company e-mail that, while mentioning safety a couple of times, didn’t explicitly say to take care of family first. I attribute that to the fact that it came from a marketing person, so naturally her focus is on the conference rather than general managerial advice. I’m sure interpretations of what’s between the lines of any e-mail vary based on the reader’s disposition, but it seemed fine to me and I wouldn’t be insulted if I worked there – the company seemed appropriately concerned for the well-being of its employees. I was more interested that the reader told me that company attendees share hotel rooms at the conference, so naturally I had to ask how that works – do you get to choose a bunkmate, and what if one of you snores, is hygienically challenged, or is unusually modest? Answer: you either choose a roomie or have one assigned, or you buy out their half of the room with your own money. Forced room-sharing to save the company money always seems a little bit creepy to me, but I can see why it’s financially attractive when you’re sending hundreds of people to one event (but I still wouldn’t like it). Feel free to send me your first-person stories about that arrangement since I’m sure lots of companies do the same.

mrh_small From Big Fight Brewing: “Re: 3M. ICD-10 is pushing hospitals to computer-assisted coding. 3M is telling clients that their encoder (used by 4,000 hospitals) will not interface with any NLP or CAC solution other than their own. Big clients are not happy.” Unverified.

8-30-2011 7-47-55 PM

mrh_small From Gilbert O’Sullivan: “Re: UNC Health. Announced to its IT employees Friday that Rose Ann Laureto will be the new CIO. Seems to be a good hire.” She is (or was, if the rumor is true) CIO at University of Illinois Medical Center at Chicago. JP Kichak was UNC CIO until recently and still is on his LinkedIn profile, so that’s all I know.

mrh_small From TRL: “Re: Cedars-Sinai. Live on Stork and a new fetal monitoring system. I’m a consultant and leadership at Cedars-Sinai might be the best in the country. They demand near perfection, but those of us with high demand skills respect being asked to perform at our best. Far too many places are just happy to follow with some strange comfort that just buying Epic is enough. Make no mistake, Epic is good software, but implementation leadership is EVERYTHING when it comes to success.” Unverified.


Acquisitions, Funding, Business, and Stock

8-30-2011 9-22-30 PM

Scotland-based charge master vendor Craneware announces financial results for its 2011 fiscal year: pre-tax profit grew from 2010’s $7.26 million to $8.65 million; revenues increased 34% from $28.4 million to $38.1 million.

Blackstone Group seeks a $1.2 billion loan to fund its $3 billion buyout of Emdeon.

8-30-2011 8-09-51 PM

India-based business process outsourcer Ajuba Solutions says US healthcare reform has boosted its business, encouraging the company to spend $5 million on technology and $5 million on a new building. It will hire 700 new employees.


Sales

8-30-2011 9-24-45 PM

West Virginia Health Information Network selects Thomson Reuters HIE Advantage for its technology backbone.

Ardent Health Services (TN) expands its use of Surgical Information Systems solutions to include anesthesia documentation.

Reston Radiology Consultants (VA), Washington Radiology Associates (VA), Shady Grove Radiological Consultants (MD), and Advanced Diagnostic Radiology (MD) select Merge Healthcare’s RIS.

PriMed (CT) expands its relationship with MED3OOO by selecting InteGreat EHR for its 28 locations and 75 providers.


People

8-30-2011 7-30-27 PM

Brad Levin is named North American GM for Visage Imaging. He was previously with GE Healthcare.

8-30-2011 8-05-34 PM

Impact Advisors hires Michael Nutter as its director of firm culture and associate satisfaction, a position it also calls “happyologist.” He was previously with Florida Hospital.

8-30-2011 8-35-09 PM 8-30-2011 8-36-31 PM

Huron Consulting Group names Michael Cadwell and Andrew Schramm as managing directors in its healthcare practice. They’re from Ingenix Consulting and Tefen Management Consulting, respectively.

8-30-2011 9-12-44 PM

Lisa Crymes joins Bottomline Technology as director of healthcare products and strategy. She was previously with Emdeon.


Announcements and Implementations

8-30-2011 12-47-37 PM

eHealth Global Technologies deploys Axolotl Image Exchange to provide diagnostic image exchange services for hospitals participating in HealtheConnections RHIO of Central New York.

The American National Standards Institute (ANSI) launches the  Permanent Certification Program for HIT that will accredit organizations that certify EHRs. The permanent program will replace the current temporary certification program in 2012. ANSI is accepting applications through October 7.

8-30-2011 12-51-04 PM

Allscripts reports that over 4,700 attendees are taking part in this week’s ACE meeting in Nashville.

Florida providers can now use secure email though the Florida HIE Direct Secure Messaging (DSM) service. The secure messaging service is the first milestone in the HIE’s $19 million initiative, which uses technology from Harris Corporation.

8-30-2011 9-29-01 PM

Addington Hospital says it will be the first in South Africa to implement Meditech 6.0.

mrh_small Travis recently mention on HIStalk Mobile something that I hadn’t heard – Facebook allows drug companies (and only drug companies) to disable or edit comments left on their wall. Facebook announced on August 15 that it will no longer give drug companies that option except on pages created for specific drugs. Several drug companies have deleted their pages, while others allow comments if they adhere to stated policy. The reason for Facebook’s original special handling of drug company pages makes sense – if someone’s public comment suggests they’ve experienced an adverse drug event, the company might have to file a report with the FDA, at least in the absence of FDA policy that says otherwise.


Government and Politics

US CTO Aneesh Chopra will deliver a keynote speech at the Consumer Electronics Association’s Industry Forum in San Diego next month. The press releases mentions the announcement of “a major, new digital health and fitness program.”

Innovation and Research

8-30-2011 9-05-39 PM

Researchers at Tel Aviv University create a Facebook game that will help them understand how infections spread. PiggyDemic allows Facebook users to infect their friends, which the researchers say is how viruses really spread rather than being distributed equally across populations.


Technology

mrh_small Yale’s medical school will no longer provide printed course materials, instead giving students iPads and putting all the study materials on them. They expect to save up to $100K in annual printing cost plus the labor involved. “It really makes the curriculum imminently updateable,” the assistant dean was quoted as saying, although hopefully in his mind — unlike that of the reporter — he spelled it “eminently.” Students get an iPad, apps to manage the reading material and recorded lectures, and a gift card to buy a keyboard. Harvard Medical School isn’t quite there yet, letting students buy whatever mobile device they want and giving them the choice of paper or electronic course content.

Physical therapists at Banner Good Samaritan Hospital (AZ) are using video games to put rehab patients through painful exercises. Patients like Wii Bowling, but the hospital is experimenting with Microsoft’s Xbox Kinect since it covers the whole body.

8-30-2011 9-15-34 PM

SeeMyRadiology.com releases a free iPhone/iPad remote viewing tool for its medical image exchange.


Other

mrh_small Vince keeps digging deeper with his company HIStories, aided by readers who send him memory-jogging historical tidbits, so Gerber Alley turned into a two-parter, with Part I above. If you have Gerber Alley info to share (especially any photos of Urban Gerber, who died in 1984) it’s not too late to contribute to next week’s Part II. I love reading these, especially when I recognize someone’s name or picture. I’m thinking about starting an Healthcare IT Hall of Fame with a panel of voters to choose from the nominees. Wouldn’t it be cool to see them inducted at HIMSS or something? Everybody’s suddenly nostalgic about the history of Apple and Steve Jobs (justifiably), so why not our own industry, which goes back even further? Not to mention the “doomed to repeat history” thing.

8-30-2011 10-50-55 AM

inga_small In Taiwan, HIV-infected organs are mistakenly transplanted into five patients after a hospital staffer misunderstands “non-reactive” instead of “reactive” when the donor’s HIV test results are called in and not double checked.

8-30-2011 11-15-11 AM

inga_small Indianapolis Colts quarterback Peyton Manning delivers this great line to reporters after being peppered with a few too many questions about his May neck surgery and ongoing recovery:

“I don’t know what HIPAA stands for, but I believe in it and I practice it.”

mrh_small Apple gives new CEO Tim Cook over $380 million worth of shares, awarded if he remains an employee for ten years.

mrh_small El Camino Hospital (CA) hires celebrity nurse practitioner Nurse Barb, who seems to already be a hospital employee although it’s not exactly clear, to develop a televised health series and to increase its social media presence.

8-30-2011 7-26-51 PM

mrh_small Weird News Andy was so moved by this story that he titles it, “Sheer brilliance of doctors” with only a tiny trace of his usual dry humor. An 86-year-old Arizona man drops his pruning shears while gardening. The sharp end sticks in the ground and the man slips and falls while picking them up, jamming the protruding handle through his eye socket and into his neck, pressing directly against his carotid artery. Surgeons at University Medical Center remove the shears and repair the damage with wire mesh, saving his eye and leaving him fully recovered other than some minor double vision. There’s plenty to dislike about the US healthcare system, but if you’ve got a lawn tool jammed into your skull, be glad you’re here.


Hurricane Irene Updates

Forty-three patients from Johnson Memorial Medical Center in Stafford Springs, CT were transferred to other facilities when the hospital lost power from two separate power feeds Sunday morning. The hospital had switched to a backup generator, but it failed.

Staten Island University Hospital was one of several hospitals evacuated in advance of Irene. CIO Kathy Kania reports that the hospital sustained only minor damage, including water in “peripheral” portions of the IT department. All IT systems were restored to full operations between 1:30 p.m. and 9:30 p.m. Sunday.

In the mid-Hudson Valley region of New York, flooding and damaged roads are creating the biggest problems for hospitals. Bridges approaching St. Anthony Community Hospital are washed out, leaving the hospital on an island. Several parking lots at Bon Secours Community Hospital are under water and flooding on local roads is making it difficult for employees to get to work. Meanwhile, St. Luke’s Cornwall Hospital is fully functional, though relying on a backup generator.

Dorchester General Hospital (MD) was evacuated Sunday morning and 30 patients were transferred after wind and rain damaged the roof. By 2:00 a.m. Sunday, the floor was covered in four inches of water and water was pouring from the ceiling. The laboratory sustained the most damage, though the ED, operating rooms, central supply, some patient rooms, and the chemo unit were affected.

SCI Solutions offered its customers free appointment voice reminder calls before the storm hit, working with partner TeleVox. Patients with scheduled appointments got a telephone message of the hospital’s choosing, with one hospital’s chosen message being “Hurricane Irene may disrupt power at the facility your appointment is scheduled. Please contact the facility before you leave home to ensure your appointment is still possible and/or call Central Scheduling for information. Please continue listening for your appointment details.”


Sponsor Updates

8-30-2011 1-19-33 PM

  • maxIT Healthcare presents the Beads of Courage Beads in Space tour, which is traveling to 10 US cities in honor of September’s Childhood Cancer Awareness Month.
  • Consulting Magazine includes Impact Advisors and North Highland on its list of 2011 Best Firms to Work For.
  • Billian’s HealthDATA introduces HITR.com, a social networking tool for benchmarking hospital IT satisfaction, at an August 31 webinar.
  • ESD rolls out its new branding and Web site at Allscripts ACE. Also at ACE: Awarepoint showcases its Patient Tracking Board solution and Allscripts unveils its Mobile EHR apps for iPad .
  • GE Healthcare hosts a September 7 webinar entitled EMR & Quality Management.
  • Central Maine Medical Center (CMMC) ranks among the nation’s 25 Most Wired and Most Improved following its partnership with The Huntzinger Management Group.
  • Faith Community Hospital (TX) gets its Meaningful Use check using Prognosis ChartAccess. The 41-bed hospital signed a contract in October, started implementation in January, went live in March, and attested on June 5.
  • PatientKeeper announces that its user group conference will be held in Denver September 18-20.
  • Frost and Sullivan awards Merge Healthcare its 2011 Customer Value Enhancement of the Year Award for Medical Analytics.
  • Imprivata announces that several organizations are have adopted its No Click Access solution for VMware.
  • TeleTracking Technologies releases a white paper that lists the top 10 reasons that RTLS location accuracy in healthcare matters.

Contacts

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

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August 30, 2011 News 15 Comments

Readers Write 8/24/11

August 24, 2011 Readers Write 7 Comments

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

“Installing IT” Understates the Organizational Change that IT Can Bring
By Mike Quinto

8-24-2011 6-57-48 PM

Our organization recently underwent an $18 million turnaround in 24 months. We are very proud of this accomplishment and have no intention of stopping there. 

In a recent financial periodical, our CFO was quoted as saying, “Considerable attention has also been given to IT. In the past, top-of-the-line software products purchased for the radiology, pharmacy, lab and other areas were highly functional in their own spheres, but didn’t integrate well. Now, new integrated software is being deployed to improve communication among departments.”

Well, he said it was IT. In reality, we in IT focus on getting cross-functional teams working together to solve business challenges. IT has been the facilitator of organizational change through process redesign, not new fancy software that adds, subtracts, multiplies, or divides better. 

Software, for the most part, does not “…improve communication among departments.” Governance, change management, and cross-functional teams do. 

We implemented Lawson’s ERP suite, but the largest benefit was not gained from the new splash screen or the logo in the corner of the screen. Vendors tend to think that they have solved the same old problem with new fancy software. It is rare that there is disruptive technology that actually changes the way we do things. For the most part, software is a commodity. The real benefit is the implementation and process redesign that takes place during a system rollout.

The opportunity was the chance to focus on charge capture and develop a policy, process, and strategy around it. We could have used a spreadsheet — the technology was not a magic bullet. The focus on business strategy was.

Don’t get me wrong, we like Lawson as a vendor. However, the software had little to do with our transformation. It was the implementation process that allowed open dialogue about the way we do things, and the way we should do things. That opportunity allowed us to evaluate broken process, identify areas that there was poor or no communication, and establish governance around important operational metrics. Just getting HR and Finance in a room monthly has done wonders to find financial opportunity and redefine policies and process. 

In one case, we had two vendors blaming each other for an outrageous claims denial rate. QuadraMed and McKesson couldn’t get on the same page, and that was creating a claim that had fields transposed. This created a denial rate that was almost 100%. I don’t blame the vendors. At the end of the day, we had a department that was not communicating and working with a broken process. 

Once we “re-implemented” the software, we were able to have open, honest conversations about who needed what and how the billing office should be run. Yes, there was an interface issue; however, IT and the business office were not talking. That was the larger issue.

We put in place weekly change management meetings, assigned application owners for each operational department that has an IT counterpart, and implemented basic project management. These changes had more to do with the performance improvement than any single piece of software, hardware, or vaporware we could install.

To say we purchased IT and installed it is underestimating the organizational change that “IT” can bring.

As a CIO, I spend most of my time helping business units redefine their goals, processes, and governance. Very little of my time is spent with bits and bytes.

Mike Quinto is VP/CIO of Appalachian Regional Healthcare System, Boone, NC.

PDF Healthcare: Why PDF is the "Currency" of Health Information 
by Tom Lang, MD

Health information technology faces challenges from many different quarters and for many different reasons. It’s time for a major dose of simplicity. PDF Healthcare (in both static and dynamic modes) is this major dose of simplicity.

Here are two compelling reasons that PDF Healthcare lives up to its billing as a "secure container for the exchange of healthcare information."

PDF is easily viewed/printed from virtually any computer. With the ubiquity of PDF readers, this is a reality. This fact can be thought of as another approach to interoperability. That is, if we can simply turn healthcare information into PDF, that information is available in a human readable form. Last time I checked, humans were still taking care of patients.

Image and other unstructured data files are easily converted to PDF. Clinical medicine is a world of image files and unstructured data, and that will never change. For example, our universe is filled with EKGs, X-ray images, video clips, audio files, and text-based reports  Equally important are those medication and allergy lists that are scrawled on scraps of paper (yes, paper!) that are so important at the point of care. The fact that PDF supports image files and almost any type of file format is very important in this environment.  ​

PDF (Portable Document Format) was originally developed by Adobe Systems Incorporated, but released as an open ISO standard in 2008. This has been an important step to stimulate innovation and competition, making PDF more capable, affordable, and available for our use in health IT as well as other industries.

As an ER physician, let me give you one example of how PDF can jump over the top of interoperability problems.  

I do quite a bit of locums ER work in many settings and frequently find myself in small rural hospitals trying to communicate with specialists that I need to refer patients to over a distance. Probably the biggest slam dunk for HIT has been PACS, which even in the smallest hospitals is almost universally present.  

One weekend, working in very small rural hospital, I faced the same problem twice: I saw patients with complex fractures, and the question was, "Does this patient need surgery immediately, or is this something that can be splinted and taken care of in a day or two?” Orthopedics is not available at this small hospital, and these patients requested orthopedic care in different directions.  

I was easily able to contact the orthopods by phone, but they needed to view the films to make a decision about what needed to be done and how urgently it needed to be done. This hospital has PACS, but despite this, neither of these orthopods could view the images. In this case, which is the most common arrangement I see, the only person who had remote access to view the images was the radiologist who was contracted to officially interpret the study ("Dr X not credentialed, hospital not on this image sharing network … blah … blah … blah").  

Because the radiology tech for the day was a hacker of sorts, he had some screen capture and turn-to-PDF programs on one of the radiology monitors. In both cases, we brought the images we needed on the screen, took a screen shot, turned the file to PDF, and e-mailed to the orthopedist. Also in both cases, not only were the orthopedists delighted we could provide this to them, but we determined that both patients could be splinted and dealt with in 1-2 days rather than immediately, saving many parties much trouble.

In order to raise the level of awareness of PDF Healthcare, colleagues from the PDF Healthcare working group have arranged, for a limited time, to give away a simple little app that will help HIE in the trenches. We are doing this for the solo / small doctor office. As a special for HIStalk readers, we will give away 50 copies.

Here is a short video that outlines the functionality of this app.

For your free copy, be one of the first 50 to go to the PDF Healthcare site and scroll down to Health Information Aggregator (under the heading of Resources.)

Tom Lang is an ER physician and a member of the PDF Healthcare working group.  

This Way to a Better Patient Experience
By Jeff Kao

8-24-2011 6-49-12 PM

Everyone’s been lost at one time or another. Whether you’re far from home or just around the corner, the experience is universally the same, with plenty of stress, aggravation, and wasted time.

Thankfully, the advent of navigation systems and smart phones means most of us get lost much less frequently these days, and that’s a good thing. But what about when you’re off the grid, say trying to find a family member’s hospital room or a lab for a blood draw?

Few places are as massive and confusing as a medical campus. With countless floors, departments, and even buildings to navigate, locating the desired destination can be a daunting task. On top of these logistical challenges, patients often arrive at a medical office or hospital feeling rushed, unwell, or anxious about their visit, only compounding the situation and causing them to be late or to miss appointments altogether.

Wayfinding systems offer a viable solution and pick up where navigation systems leave off. From the moment a patient or visitor walks in the door, these self-service kiosks virtually map paths to and from multiple points in a facility, resulting in a more pleasant and personalized experience. Leading healthcare organizations like Chicago-based Northwestern Memorial Hospital have placed wayfinding kiosks near entrances and other common areas, making it easy for patients and visitors to quickly locate a specific room or department and print a customized map with step-by-step directions.

At a time when consumerism is on the rise and patients have greater flexibility in their choice of healthcare provider, such systems are fast becoming a valuable strategic asset. According to a survey conducted by The Beryl Institute, hospital executives list the patient experience as one of the top three priorities they will focus on over the next three years. Wayfinding systems directly impact the experience patients and visitors have by enhancing the level of service that’s provided and eliminating the hassle of being late or lost.

Beyond guiding patients to the correct destination, wayfinding systems can also reduce demands on staff time, both in terms of time spent giving directions and updating software. While some wayfinding systems once required users to manually re-create maps on each kiosk every time an office or department was moved, today’s dynamic, data-driven applications are extremely scalable and allow technical and non-technical staff alike to quickly recalculate routes on the fly.

When not in use for wayfinding, these systems provide an effective venue for displaying video or text-based messages and marketing medically-related services and events. Patients can also use kiosks to register for promotions or request additional information. And, once in place, wayfinding systems establish a platform for future expansion and growth, eventually allowing healthcare providers to add new self-service capabilities from the same screen.

So, what is the path to a better patient experience? The answer may be inside your own front door.

Jeff Kao is vice president and general manager of NCR Healthcare.

Specificity to the Extreme: As ICD-10 deadlines Draw Closer, Is Your Organization Ready for the Good, the Bad … and the Offbeat?
By Sean Benson

8-24-2011 7-25-06 PM

Chances are that most healthcare organizations will be able to raise the bar on current documentation practices high enough to support coding for suture of an artery under ICD-10—even though the possible codes expand from just one under ICD-9 to more than 180 under the new code set. But what if a patient walked into a lamp post (W22.02xA) or was bitten by a sea lion (W56.11xA)? What if the patient was burned by a flaming jet ski (V91.07 xA) or suffers from inadequate sleep hygiene (Z72.821)?

If your organization’s clinical documentation and coding processes can’t support that level of specificity, you need to act fast to get it up to speed. Because rest assured, no matter how weird the diagnosis, ICD-10 includes a code that accurately defines the patient’s status to a T.

The authors behind ICD-10 covered all the bases in an effort to capture the full patient picture—sometimes to the extreme and offbeat. With approximately 68,000 diagnosis codes compared to just 13,000 under ICD-9, it’s clear that documentation approaches that work fine today simply won’t cut it under ICD-10.

It will be complex enough to ensure coding staffs are adequately trained on ICD-10. Finding the resources necessary to advance clinical documentation improvement programs to meet the ICD-10 challenge is simply out of the question for many organizations. Nor are most clinicians interested in spending the amount of time required to become fully proficient on the new system, especially when it takes them away from patient care.

That is why many hospitals and healthcare facilities are looking to software vendors to help them make the transition. Software that automates the documentation and coding process can ease the transition to the expanded code set and shorten the learning curve for physicians, especially if they are faced with the ever-so-common encounter of a patient who has been struck by a bird (W61.92).

Not all coding and documentation software is created equal. The best ones will drive comprehensive documentation to capture the high level of detail required under ICD-10. The software should guide physicians through the process of documenting with enough specificity and granularity to ensure appropriate coding. Otherwise, the code that would accurately identify an embarrassing fall on the local airport’s escalator (W10.0xxA) might be missed.

Healthcare organizations will want to focus on the software’s ability to provide prompts relevant to the documentation needs of ICD-10. That is why it’s important that the evaluation be done by someone who is well-versed in ICD-10 to ensure the right questions are asked.

There are multiple initiatives competing for the attention and resources of healthcare organizations, including 5010 and Meaningful Use, in addition to ICD-10. Because it will affect every aspect of operations, the transition to ICD-10 needs to be placed at the forefront.

For many organizations, leveraging the efficiencies inherent in technological solutions to drive documentation improvement is the best strategy for meeting the ICD-10 challenge head-on.

Sean Benson is co-founder and vice president of consulting with ProVation Medical, part of Wolters Kluwer Health.

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August 24, 2011 Readers Write 7 Comments

News 8/19/11

August 18, 2011 News 9 Comments

Top News

8-18-2011 7-36-19 PM

image General Dynamics will acquire federal healthcare software vendor Vangent for $960 million, the company announced this week. Says the General Dynamics chairman and CEO, “Vangent is a well-regarded, fast-growing company that will add significant depth and breadth to General Dynamics’ healthcare IT organization, creating a Tier 1-level healthcare IT business unit with the scope and scale to compete in markets that are receiving high priority in current funding and entitlement-reform initiatives” The Arlington, VA-based Vangent, which has 7,500 employees, does work for HHS and the military. It developed the Army’s MC4 battlefield EMR. Kerry Weems, SVP and GM of Vangent’s Health Solutions business, joined the company in 2009 when he left his government position as head of CMS. He was also vice chairman of the American Health Information Community.


Reader Comments

8-18-2011 6-34-36 PM 8-18-2011 6-35-25 PM

image From Watchdog: “Re: HIMSS. Pictures of its new headquarters in the financial district of Chicago. They also hired Steve Rosenfield as executive vice president / managing director of HIMSS Media, a new position and department, and seek an associate manager of social media to improve the society’s ‘positive visibility.’ All that was required is an Associate’s Degree.” Steve doesn’t appear to have a degree, but did write co-write this book documenting the late 70s history of an influential Long Island club that includes photos and an audio CD of the folks who performed there (Springsteen, Aerosmith, Rick Derringer, Stanley Clarke, etc.)

8-18-2011 7-21-45 PM

image From One Of Their Hospitals: “Re: MDG Medical. The support numbers are no longer in service.” I ran this reader’s rumor last week, in which he said his hospital’s pharmacy got word from the pharmacy dispensing automation vendor that they would close their doors last Friday. I said I wouldn’t name them until I checked to see if the phones were disconnected. Sure enough, the support number and PBX option now give a fast busy. The Israel-based company opened an office in Beachwood, OH in 2001 and moved its corporate headquarters to Aurora, OH in 2010. It claims to have 150 hospital customers and was announcing expansion plans as recently as October. I can’t verify anything other than that their support numbers aren’t working and they didn’t respond to my earlier e-mail asking about the rumor.

image From Wildcat Well: “Re: RECs. There have been claims that healthcare IT will be the primary sector for job creation. Does it count when a REC receives funds from ONC, the REC coordinator contracts for systems integration work with ‘local’ vendors, and the jobs are filled through the overseas facilities of those vendors? We may just be stupid enough to deserve the mess we are in.”

image From Hate Manual Entry: “Re: Sage Healthcare. Rumor is they bought a SaaS-based HER from a recently bankrupted company. Any others hearing the same?” We asked Sage, which said that for competitive reasons, they don’t comment on acquisitions or technologies that may or may not be under consideration.

8-18-2011 7-46-56 PM

image From Laura: “Re: Joplin. I’m sure you’ve seen that Mercy has announced plans to rebuild in Joplin. They have kept employees on the payroll since the May tornado and raised $500 million in a co-worker fund to help with expenses.” The 28-hospital Mercy (formerly called Sisters of Mercy) will spend $950 million to build a new 327-bed hospital in Joplin. They’re an Epic shop, I believe.


HIStalk Announcements and Requests

image Check out the good stuff on HIStalk Practice: Don Michaels of Hayes Management Consulting and the Harvard School of Public Health weighs in on ACOs and the results of CMS’s demonstration project. Julie McGovern of Practice Wise offers recommendations for providers upgrading their software. Rob Culbert of Culbert Healthcare Solutions suggests key performance indicators to assess a practice’s financial health. CMS provides a breakdown of EMR Meaningful Use payments by specialty and provider type. The GAO advises CMS on how to improve physician quality reporting. I’m a simple gal with simple needs and I’ll be simply thrilled if you sign up for e-mail updates while visiting HIStalk Practice.

On the Job Board: Project Manager I, Epic and Cerner Consultants, Senior Enterprise Sales Executive.


Acquisitions, Funding, Business, and Stock

8-18-2011 9-58-10 AM

drchrono closes an additional $650K in seed funding and announces the release of OnPatient, a free patient check-in app for the iPad.

Deloitte acquires the assets of Intrasphere Technologies, a New Jersey drug safety and regulatory consulting company that also offers R&D informatics software for registering clinical trials.

image HP announces a restructuring that includes ceasing production of tablet computers and smart phones, trying to sell its PC business, and spending $10 billion to acquire British search technology vendor Autonomy at a 64% premium to its share price. The HP Touchpad has barely been on the market for a month. The announcement probably signals the inglorious end of Palm, which HP bought last year for $1.8 billion before phasing out the brand.


Sales

8-18-2011 12-25-35 PM

The University of Chicago Medical Center will implement Omnicell’s Inventory Management Carousels with WorkflowRx software for inventory management and Omincell’s automated dispending system.

Imprivata announces that 12 Siemens customers have chosen its OneSign single sign-on.

8-18-2011 6-22-37 PM

Stamford Hospital (CT) will implement SmartRoom technology in all of its patient rooms, which provides real-time patient and RTLS information on an in-room monitor and provides touch-screen documentation capability. SmartRoom was developed by UPMC, which owns the company.  

8-18-2011 9-03-07 PM

Evergreen Healthcare (WA) chooses Cerner clinical systems.


People

8-18-2011 8-02-38 PM 8-18-2011 8-03-49 PM

Healthcare software vendor Net.Orange names Rob Beardall MD, MPH as EVP/Chief Medical Officer and Troy Roth as SVP of solutions strategy. They come from Health Synectics LTD and MedAssets, respectively.

8-18-2011 8-10-23 PM

Paula Guy, CEO of Georgia Partnership for TeleHealth, joins the board of the Georgia Health Information Exchange.


Announcements and Implementations

Arkansas critical care hospitals Piggot Community Hospital, DeWitt Hospital, Delta Memorial Hospital, and Chicot Memorial Medical Center select Healthland.

Nine hospital systems in Western Pennsylvania partner to create the ClincalConnect HIE. dbMotion will supply the infrastructure for the $4 million project.

8-18-2011 6-26-32 PM

The radiology department of University of Utah Health Care reports that its use of artificial intelligence resource management software from Allocade reduced overtime cost by 90% and overall FTE expenses by 10-15%.

8-18-2011 8-35-57 PM

Miami-based EMR vendor CareCloud says it has tripled headcount in the past year to 80 and will bring on another 30 employees by the end of the year.


Government and Politics

The VA issues an RFI for cloud-based collaboration tools for its entire workforce. They plan to pilot document sharing and calendar applications with 5,000 physicians, potentially replacing Outlook and Exchange, SharePoint, and Jive Software for all of their employees if the pilot is successful.

Other

image I got an earful from my doctor and his office manager today about their “horrible” EMR. Since purchasing it a year and a half ago, they’ve suffered through performance issues, upgrades problems, inadequate templates, and many unexpected expenses. The Meaningful Use money, which they’ll receive this month, covers the EMR’s cost but not the $10K per year for maintenance. The doctor blames the vendor, which has been around for less than five years, for releasing an immature product. I checked their Web site and it looks like the latest and greatest. I wonder how often providers opt for bleeding edge, only to later regret not buying the tried and true option?

Here’s a video showing the Texas Health Resources group that climbed Mount Kilimanjaro (including Ed Marx) opening a medical clinic in a Tanzanian village a few weeks ago.

image A drug company’s laid-off IT tech pleads guilty to extracting his revenge by wiping out most of the company’s electronic systems while he still had access as a contractor. The drug company lost e-mail, inventory systems, and payroll capabilities, crippling it for several days at an estimated cost of $800K. The tech faces 10 years in prison.

image The FBI subpoenas Parkland Memorial Hospital (TX) and its IT department, seeking records related to a former Dallas County commissioner and a telecommunications system business owned by a close friend. According to the Department of Justice, the investigation involves “allegations of public corruption, tax evasion, and money laundering.” The telecommunications company got $3 million worth of consulting work from Parkland and UT Southwestern Medical Center. Another of its customers, the local toll authority, paid $47,500 for a no-bid consulting report that basically said “your equipment needs to be replaced” and included graphics lifted directly from another company’s 12-year-old product manual.

8-18-2011 8-23-09 PM

image In Ireland, an interim examiner is appointed to review three hospital software vendors that have claimed insolvency, putting the electronic records of 10 million patients at risk. The companies operate under the name IMS Maxims.

image French software vendor Atos Healthcare, whose software is used in England to evaluate disability claimants, investigates two employees (one of them a nurse) for their Facebook comments about those claimants, which they characterized as “down and outs” and “parasitic wankers.”


Sponsor Updates

  • Intelligent Medical Objects and dbMotion will participate in the Allscripts Client Experience next week.
  • MEDSEEK’s eConnect HIE technology successfully connects the WNC Data Link (NC) HIE to the VA’s VistA.
  • UCare selects RelayHealth’s Payer Connectivity Services (PCS) for its 230,000+ members.
  • API Healthcare will exhibit at the ASHHRA annual conference in Phoenix next month.
  • Healthcare Innovative Solutions VP Daniela Mahoney, RN, will present Best Practices in CPOE Deployment Strategies, and Physician Resistance, Adoption and Value Proposition at the Kansas Hospital Association: Meaningful Use Summit, and Executing Key Plays: How Team Members Must Adapt to Succeed at SC Hospital Association the TAP Conference.
  • TeleTracking Technologies is offering a free Patient Flow symposium in Raleigh, NC next month.
  • Nuance Communications unveils Dragon Medical Practice Edition, which targets the needs of physicians in practices smaller than 25 providers.
  • OptumInsight’s Axolotl EMR Lite, version 9.2 receives ONC-ATCB certification as a complete ambulatory EHR.
  • A healthcare claims review company implements Symantec’s PGP Whole Disk Encryption to meet HIPAA requirements, claiming a one-month payback period after switching from free encryption software that was killing employee productivity.


EPtalk by Dr. Jayne

I returned home from my most recent sojourn to find the only thing I hate worse than filing my taxes or a root canal — a re-credentialing packet for my hospital privileges. Despite our health system’s large IT department and our belief that we are high tech, the credentialing process is decidedly low tech.

When I was a practicing physician, my practice manager took care of the application and applied sticky flags to areas that needed review or my signature. But now that I’ve crossed to the dark side of information technology, there’s no one in my organizational tree who has any idea how to do these, so I have the pleasure. I think next year I might just ask my former staffer if she’d be willing to do it for cash (as an independent contractor, of course — I’m not about to run afoul of the IRS.)

Under the 26-page “standard” credentialing form was an additional 22 pages of forms to be completed. They had been photocopied so many times they were practically illegible. Lurking at the bottom of the stack were several nearly identical sets of privilege forms for the different hospitals at which I am on staff, one for each facility (heaven forbid they share information from a central repository or from the master application itself.)

I find it slightly humorous that I still hold privileges for OB labor and delivery as well as operative circumcision despite having not performed either procedure in quite some time. Oh yes, and I can also pierce the earlobes of inpatients if I so choose.

In addition, they want a copy of my Curriculum Vitae and documentation of my Continuing Medical Education hours, which along with everything else has to be returned on paper and by mail. Seriously. Everything else we do in the hospital is electronic – CPOE, patient recordkeeping, even patient meal selections done on a touch-screen at the bedside. Except this.

When it comes to the concept of ensuring that physicians have accurate and up-to-date data before approving them to start or continue seeing patients at a facility, we’ve gone back to 1956. (Actually, 1956 was probably easier – you could most likely have just hung your diploma on the wall and started seeing people.)

If this would have been an online process, I’d have knocked it out right away while lounging on the sofa with some quality Netflix and recuperating from my travels. But instead, it goes on the dreaded ‘pile’ somewhere between the bill from the local lawn care guy and the student loan payment coupon, both paper-based businesses.

clip_image001

Turning to health IT news, legislators on the House Energy and Commerce Committee have asked the Government Accountability Office to review Federal Communications Commission efforts to ensure the safety of wireless medical devices. Their request featured discussion of the recent demo where an insulin pump was hacked and hijacked. As I was reading this piece, I envisioned a flashing “As Seen On HIStalk” seal of approval.

Finally, a reader question. It’s been a long time since we have had one and I do enjoy them (hint, hint).


Dear Dr. Jayne,

Is the new Chest-Compression-Only method of CPR taking hold, or is there some resistance to it? I still see classes offered in the older method and have to wonder… why? What do you think?

Breathless but Hearty

Dear Hearty Reader,

I think overall, more data is needed. When I completed my certifications for CPR and advanced life support (both cardiac and trauma) as well as pediatric life support a few months ago, traditional CPR was required. The American Red Cross issued a statement last year about compression-only CPR, stating:

“…Compression-Only CPR until an AED [Automated Extermal Defibrillator] is available is an acceptable alternative for those who are unwilling, unable, or not trained to perform CPR.”

I tend to agree with them. The idea of CPR is that you want to prevent brain death, and unless you’re oxygenating the blood by getting air into the lungs then circulating it with compressions, you’re not going to be as successful if oxygen levels remain low.

On the other hand, if it’s the difference between CPR not being done because a bystander isn’t sure how to do it correctly or is worried about communicable diseases or some of the more unpleasant side effects of bystander CPR, then I think compressions alone are better than nothing.

The American Heart Association offers a trademarked “Hands-Only CPR” method that’s demonstrated on their website. I like their bullet point: “Don’t be afraid. Your actions can only help.” Regardless, knowing the legal world, I offer this advice — if you’re trained in traditional CPR and have no other reason not to do it, traditional CPR should be your first choice. I’d hate to get into a “standard of care” discussion on this one.

Jayne

Have a question about LOINC codes, the Russell Viper Venom time assay, or whether snakebite extraction kits really work? E-mail me.




Contacts

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

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August 18, 2011 News 9 Comments

News 8/17/11

August 16, 2011 News 14 Comments

Top News

image The VA has been on-again, off-again on whether it will build or buy a replacement for its VistA system, but former deputy CIO Ed Meagher says the VA and DoD may pay companies billions to write a new open source system. He now works for CSC, one of the contractors hoping to get the VA’s business. I knew the VA recently issued a $5 million contract to create an open source community for the VistA replacement and had previously announced plans to go that route, but I haven’t heard a definitive final word, especially when a group of Epic-friendly politicians is pushing the VA to look at commercial systems. The article’s choice of experts to quote about vendor products is questionable: Allscripts has done a great job creating an open architecture platform (according to an investment firm analyst who just put a Buy rating on MDRX shares) and GE Healthcare could work well in the VA’s environment (according to a government sales guy from GE Healthcare).


Reader Comments

8-16-2011 9-25-26 PM

image From Too Big for my Breaches: “Re: yet another data breach. I’m getting tired of hearing about these.” St. Francis Hospital (DE) apologizes for a doctor’s loss of a thumb drive containing information on 474 maternity patients. He lost it in the spring, but someone mailed it back to him on June and he didn’t report it until then, pushing the hospital’s 60-day deadline to report the loss. The doctor was authorized to copy the information but violated hospital policy by not encrypting the drive. He must have been researching old cases — the hospital says the in utero babies whose records he copied are now nine or 10 years old.

image From Victory at Sea: “Re: UAB. I believe that most people in healthcare are honest and want to help people, but there’s a lot of money rolling around inside these organizations (vendors too) and temptation is always to be found for those who are open to it.” The FBI launches an investigation into Alabama’s only organ donation center, UAB-run Alabama Organ Center, after discovering that its director and associated director had an “improper financial relationship with a vendor.” UAB has fired the employees and parted ways with the unnamed vendor.

8-16-2011 7-30-42 PM

image From TxPathDr: “Re: Jason Dufner. Anyboy else notice that he had a Greenway Medical logo on his chest for the PGA tournament in Atlanta this week? I can’t remember ever seeing an EMR company logo on a golfer before.” Greenway struck a deal a few weeks back to have him wear their logo and be available for marketing and company-sponsored events. The green logo really pops on his pink shirt.

image From A CEO: “Re: our interview. Questions I get from healthcare trade rags and the financial press are vanilla – my sense is the editors / journalists are just trying to get their stories written vs. trying to arrive at insights relevant to their readership. I found your questions intellectually stimulating. Keep doing what you are doing – we appreciate it.” Thanks, both for doing the interview and for the nice words. I don’t like asking stupid questions, at least when I can help it, so I treat my interviews as a conversation. As in most conversations, not everybody is fascinated by every interview of the hundreds I’ve done – it depends on their area of interest. As for me, everybody I’ve interviewed has taught me something.

image From Bruce Werner: “Re: interview with our CEO, Mark Debnam. The HIStalk interview was a big success. Our Facebook ‘likes’ jumped significantly. We are proud to be part of the HIStalk family.” Mark of Quality IT Partners and I are both progressive music nerds, so we were nearly breathless in discussing the latest tours and albums from Yes and Asia, which I omitted from the interview transcript since, puzzlingly, not everybody is a fanboy for semi-obscure bands whose heyday was a couple of generations ago.

8-16-2011 9-26-43 PM

image From Chillicothe: “Re: Epic. Wondering if you saw this?” Several readers sent over a link to that story in The Examiner, a free, conservative DC-area newspaper. It’s all rehash: Judy Faulkner of Epic was appointed to the HIT Policy Committee and Epic employees have given $300K to Democrats since 2006 (doesn’t sound like much for a company of that size). Surely nobody’s shocked that donors get some reciprocal back-scratching, like being appointed, but her spot was set aside as a vendor rep, so why not her? The article takes a somewhat slanted position that Epic isn’t open to interoperability (the article’s one quoted source to back that statement – CEO Glen Tullman of Epic competitor Allscripts, who is himself a lot better connected politically than Judy will ever be). The rag finds a hidden Obama agenda — the examples he’s given of well-run hospitals (Geisinger, Kaiser, Cleveland Clinic, and Mayo) are all Epic customers. One thing I might agree with: it would indeed be a bit suspicious if Epic got the VA’s bid (which doesn’t seem to be happening, at least at this moment) but otherwise, they’re getting plenty of business without government help. And yes, the Obama administration was mighty generous with our money in bribing providers to use EMRs they weren’t spending their own money on. 

8-16-2011 8-07-14 PM

image From The PACS Designer: “Re: Toodledo. Will Weider of Candid CIO blog fame recently posted about a to-do listing app called Toodledo. You can get Toodledo versions for your mobile phone, as well as an app to add it to your e-mail, on your calendar, and integrate it directly into your web browser.” I’d be interested if it does recurring events and reminders. I don’t use Outlook at home and I’m finding Google Calendar to be pretty sucky when it comes to reminders. In fact, I’m becoming slowly annoyed at most things about Gmail and Google Docs – the spare design was cute at first, but everything feels clunky and I still don’t like the “conversation” design of Gmail since I’m always deleting entire message threads by mistake.


Acquisitions, Funding, Business, and Stock

8-16-2011 3-36-48 PM

8-16-2011 3-35-27 PM

Intermedix, a provider of RCM services for emergency healthcare services, buys the assets of RCM-provider Comprehensive Medical Billing Solutions of Oklahoma City.

8-16-2011 3-37-39 PM 
8-16-2011 3-39-01 PM

Axiom Systems acquires Ivertexo Internet Solutions, a provider of administrative software solutions for healthcare providers.

8-16-2011 8-49-09 PM

MedQuist Holdings announced Q2 numbers Tuesday morning: revenue flat, EPS $0.11 vs. -$0.06. Its acquisition of M*Modal gets clearance to be completed in August. MedQuist shares made the list of biggest Nasdaq losers Tuesday, down 18%. The company says it’s pushing more work offshore, but is being negatively impacted by customers sending work offshore themselves, by customers using speech recognition instead of transcription (which I’m sure is why they are buying speech recognition provider M*Modal for $130 million) , and by providers focusing on EHRs.

8-16-2011 9-08-48 PM

Vocera files SEC paperwork for its $80 million IPO.


Sales

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Cooper County Memorial Hospital (MO) will spend $2.5 million for Meditech, which it selected over Cerner and Healthland. Hospital CEO Allen Waldo says, “Meditech won the contract because the hospital’s clinicians thought it was more user-friendly and had a better data recovery system.”

The VA awards ICS Nett and Beacon Enterprise Solutions Group a $3.4 million contract to provide the management and installation of an RTLS solution for tracking equipment, supplies, implants, and surgical instruments.

8-16-2011 3-48-05 PM

St. Joseph’s Medical Center (CA) selects PerfectServe’s voice, mobile, and Web-based clinical communications system.

8-16-2011 3-51-31 PM

The Australian government chooses a consortium of eight firms to participate in the infrastructure build of its $466.7 million personally controlled electronic health record (PCEHR). Winners include Accenture ($47.8 million), Oracle ($17.8 million), and Orion Health ($11 million) along with sub-contractors Telstra, Cerner, ThinkPlace, Extensia, and Ocean Informatics.


People

8-16-2011 11-23-48 AM

Lehigh Valley Health Network promotes Donald L. Levick, MD, MBA to CMIO.

8-16-2011 12-46-38 PM

Former McKesson Health Solutions CFO and VP Peter P. Csapo will join VHA as CFO.

8-16-2011 6-45-47 PM

Beebe Medical Center (DE) names Jeffrey Hawtof, MD VP of medical operations and informatics.

8-16-2011 8-15-00 PM

Kevin Groskreutz is promoted to CIO of Hospital Sisters Health System Western Wisconsin.

Bassett Healthcare (NY) names Scott Groom VP/CIO. He was previously with Cabell Huntington Hospital (WV).


Announcements and Implementations

8-16-2011 3-55-38 PM

Resurrection Health Care (IL) goes live on its system-wide Epic implementation with the activation of billing and scheduling at 20 ambulatory care clinics. The practices will add EMR over the next six to eight months;  the first of six hospitals will begin go-lives in the fall.

Zynx Health announces two enhancements to its clinical decision support technology: Workflow Management to streamline content development and Export Validation to allow Cerner CPOE users to validate order sets before exporting them.

Vital Images / Toshiba gets 510(k) clearance for its VitreaView browser-based universal patient imaging viewer, which allows EMR and HIE users to view all patient images. It was announced in June.


Government and Politics

8-16-2011 3-57-45 PM

image President Obama announces new economic initiatives to spur growth and create jobs in rural areas, including loan programs to enable hospitals to purchase HIT. The administration also announces a loan repayment program for more than 1,300 small, rural hospitals to recruit new physicians. The White House estimates that the addition of one new primary care physician in a rural community generates $1.5 million in annual revenue and creates 23 jobs annually.

FDA will hold a public workshop seeking input on what types of mobile medical applications it should regulate on September 12-13 in Silver Spring, MD. This follows FDA’s July draft guidance on that topic.


Other

8-16-2011 8-09-01 AM

image A proposed compost facility in Freetown, MA is stinking up Meditech’s plan to develop a new office building that could bring 800 jobs to the area. The city is looking into the issue.

8-16-2011 3-58-48 PM

image CEO compensation at Boston’s nonprofit teaching hospitals is leveling off, with 2009 pay equal to or less than the previous year’s. Elaine S. Ullian, the former CEO of Boston Medical Center experienced one of the biggest declines: $1.8 million in 2009 compared to $4.8 million in 2009.

About 40% of EDs in urban areas e-prescribe compared to just 6% in rural areas.

8-16-2011 7-19-01 PM

image I’m loving the site (sites, actually: this one and this one) of Atlanta anesthesiologist Michelle Au MD, author of This Won’t Hurt a Bit (And Other White Lies): My Education in Medicine and Motherhood. She’s darned funny, describing her book as: “It contains ‘pages’ and ‘words.’ I done wrote it.’” But if you’re on the fence as to whether she’s wickedly humorous, click the graphic above to enlarge. Brilliant. I think I’ll buy the book.

8-16-2011 7-38-18 PM

image Vince Ciotti (and I) would approve: McKesson joins The IT History Society as a corporate member.  

image Another highly paid non-profit hospital CEO: the head of a 326-bed Brooklyn hospital made $4 million in 2009 while laying off employees and closing clinics that served its predominantly Medicaid patient population. The board gave the usual “market rate” excuse.


Sponsor Updates

  • Memorial Sloan-Kettering Cancer Center (TX) signs an enterprise license agreement for iSirona’s device connectivity solution.
  • Canterbury District Health Board (NZ) partners with Orion Health to provide secure access to patient information.
  • Capsule is exhibiting at this month’s Allscripts Client Experience 2011.
  • Capario launches a new Web site, blog, and social media presence on Twitter, Facebook, and LinkedIn.
  • Scott Besler of Besler Consulting will discuss New Cost Report Changes at next month’s HFMA NJ’s quarterly meeting.
  • NextGen announces a webinar and live demo for its digital pen solution, NextPen.
  • MedPlus will exhibit at Epic’s 2011 Users’ Group Meeting in September.
  • Practice Fusion’s Research Division releases a list of most-prescribed drugs, derived from its EMR database.
  • The 25-bed critical access hospital Lakewood Health System (MN) selects McKesson’s Paragon HIS.
  • Billian’s HealthDATA publishes a white paper called Providers’ Perceptions: Mobility in Healthcare.
  • Eisenhower Medical Center (CA) contracts with Wolters Kluwer Health for its ProVation gastroenterology procedure documentation and coding software.
  • The healthcare business of Thomson Reuters introduces Payment Reform Solutions to help hospitals adopt new payment methodologies.
  • Kyle Swarts joins Culbert Healthcare Solutions as a regional sales executive.
  • The District of Columbia Primary Care Association subscribes to CapSite’s online service, giving its network of providers the ability to identify technology pricing and packaging options.
  • Kareo hires James Mathews its first VP of business development. He has worked for Sage Healthcare, Carefx, and WebMD.
  • GE Healthcare will launch Centricity Business 5.0 at next week’s Centricity Business National Users’ Conference in Boston.

Contacts

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

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August 16, 2011 News 14 Comments

Curbside Consult with Dr. Jayne 8/15/11

August 15, 2011 Dr. Jayne 1 Comment

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In the realm of medical devices, this is one of the coolest things I’ve seen in a long time. University of Illinois engineering professor John A. Rogers and team have designed a sensor that’s about as obtrusive as a temporary tattoo. Not only can it pick up biometric data, but when placed on the throat, it can sense differences in spoken words such as “stop” and “go,” as well as directional commands. Hot news for patients with muscular or neurological conditions, it appears in last week’s Science.

Pardon me while I embrace my inner physics geek, but the sensor adheres using the van der Waals force, which is what geckos use to climb glass. Sounds funny, but it’s a big deal for patients who are allergic to medical adhesives. Tuck that away for your next Trivia Night.

I came across too many juicy tidbits this week to hold them for EP Talk, so this week’s Curbside Consult is more newsy than usual. Some recent all-nighters and an insane volume of Meaningful-Use related work also may have caused my attention span to be so short I’m not sure I’m capable of crafting an entirely cohesive page-long feature at the moment.

And did I mention the not-so-subtle influence of Las Vegas, home of total sensory overload? (BTW, it’s chock full of Siemens people. I thought about crashing, but maybe some readers can send me reviews and commentary from the Innovations ’11 Customer Education Symposium.)

Now that some vendors have finally tweaked their systems to allow appropriate documentation, the World Health Organization declares the H1N1 “swine flu” pandemic over. It doesn’t mean that the virus has gone away, just that it no longer meets pandemic standards. As an IT person, this was a great litmus test for the ability of vendors to be nimble. Quite a few were able to load systems with the ability to document, treat, and track quickly; several were less fortunate. This isn’t the first time we’ve seen emerging diseases (remember SARS?) and certainly won’t be the last, but hopefully next time it will be easier for the end users.

The Patient Right to Know Act will bring back a controversial Illinois database housing information on physicians, including malpractice settlements and judgment information. The database and its associated Web-based tool went offline following an Illinois Supreme Court decision regarding a medical malpractice reform law. The database will contain information on over 46,000 physicians and should be online in a few months.

Speaking of state news, Kentucky and Ohio are banding together to share prescription data. KASPER, the Kentucky All Schedule Prescription Electronic Reporting system, will connect with the Ohio Automated Rx Reporting System, also known as OARRS. (Not to be confused with the band O.A.R., which if Mr. H hasn’t listened to them yet, he should check them out — their new album was released last week.) Focusing back on the topic, it sounds like a great idea, but I’m very interested in how it actually works for the doc who’s trying to figure out whether the patient is drug seeking. If anyone has details or first-hand knowledge, please share.

Athens Regional Medical Center in Georgia has seen a 15% rise in online scheduling since implementing a scannable Quick Response code in advertising materials. The code is different depending on where it is placed, allowing tracking for the most effective referral sources.

Speaking of smart phones, I’m liking Mobiledia right now. Sometimes I need a break from healthcare, and their recent piece on Chinese plans for an app to update People’s Liberation Army troops on the latest happenings was just what I needed. Watch out though – the site is fascinating but will take you Wonderland-style right down the rabbit hole. I quickly bypassed the blurb about the recent bust of counterfeit Apple stores straight to the one about the Chinese teenager who sold his kidney for an iPad 2. (I don’t think I’ve ever put three hyperlinks in the same paragraph, so you can tell how addicting it is.)

I just discovered this is the tail end (no pun intended) of the World Mermaid Convention, so I’m going to check that out. If it’s a bust, there’s the Official Star Trek convention as well. Viva Las Vegas!

E-mail Dr. Jayne.

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August 15, 2011 Dr. Jayne 1 Comment

News 8/12/11

August 11, 2011 News 7 Comments

Top News

8-11-2011 6-30-53 PM

image Rep. Renee Ellmers (R-NC) asks HHS Secretary Kathleen Sebelius to study the adoption, benefits, and cost effectiveness of healthcare IT, including its impact on medical errors. She’s a nurse and her husband is a physician; she ran for Congress as a critic of government-run healthcare. She chairs the Subcommittee on Health Care and Technology. She was quoted in a March press released as saying this about PPACA waivers:

As a nurse of twenty years, wife of a surgeon and owner of a wound clinic, I am not only aware of the problems that currently exist in the American health care system, I have seen them up close as a caregiver, a patient and a small business owner in the health care industry. Unlike the remedy we were promised, ObamaCare has done nothing to improve the quality of health care in our country, and has already done significant damage to the economy. I join Chairman Graves in asking for a full explanation of the waiver process, to ensure that individuals and small businesses are treated fairly.


Reader Comments

image From Data Dump: “Re: [vendor name omitted]. Loses years of patient data at an Epic facility, is technically unable to recover data from the backup.” Unverified, so I’ve omitted the name of the enterprise content management vendor. I’d be interested in hearing from the client, though.

8-11-2011 7-44-32 PM

image From CagneyInMillerton: “Re: Yale. You are missing a big story on their not rolling out Epic. Big negative money angle and someone going after Harvard CIO position.” I asked CIO Daniel Barchi, who reports that (a) they are two months away from their first practice go-live; (b) they are under budget; and (c) the three hospital go-lives have been moved up, with the first going up in April 2012 and the last in June 2013. They are implementing Epic in three hospitals, the School of Medicine, the 800-physician Yale Medical Group, and several independent community physician practices. Daniel says if the Harvard rumor was about him, it’s not true.

image From One of Their Hospitals: “Re: [vendor name omitted]. Based on a phone call our pharmacy received, they are closing their doors Friday.” Unverified. I asked for confirmation from the company, but got no response. This Ohio-based vendor offers medication and supply management systems, mobile carts, and software. I think the source is solid, but I’ll give the vendor a little extra time to respond (or call this weekend to see if the telephone has been disconnected).

8-11-2011 7-30-40 PM

image From Ronnie James Dio: “Re: Computerworld article on HIT job growth. The author says SimplyHired has 7,200 HIT jobs posted out of 4.9 million. That sounded way too low, so I contacted SimplyHired to find out how they arrived at this number. Their answer: they just searched for the specific term ‘healthcare IT,’ which does not even remotely identify all healthcare IT positions. Downright goofy.”


HIStalk Announcements and Requests

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image This week on HIStalk Practice: legislation is proposed to allow PAs and NPs to qualify for Meaningful Use funds. Aprima Medical acquires an RCM company. AAFP posts its EHR survey results online. Meaningful Use incentives drive physicians to adopt EHRs. Sage Health employees volunteer at CHCs in honor of National Health Center Week. Integritas President Mary Stroupe explains why even “ineligible” providers should adopt certified EHRs. When you are catching up on your ambulatory HIT news, show some love to our loyal HIStalk Practice sponsors by clicking on their banners and learning what they are all about, Heck, they could be offering some good stuff you didn’t even realize you needed. Thanks for reading.

On the Jobs Page: Director of Public Relations, Project Manager – Healthcare Implementation, Developer I. Healthcare IT Jobs is temporarily offline while some administrative and technical work is completed to move it to a new hosting service, but it will be back soon. 

8-11-2011 9-11-14 PM

You know who’s cool? You, for reading – thanks. To take cool to the next level, consider: (a) signing up for e-mail updates; (b) socially attaching yourself to Inga, Dr. Jayne, and me on Facebook and LinkedIn (Dann’s HIStalk Fan Club has 1,751 members, so you might as well join that while you’re at it); and (c) checking out the sponsor offerings by clicking the lovely (and soon to be non-animated) ads to your left or delving deeper in the searchable, categorized Resource Center. We can’t promise to always be the most informative and entertaining site in HIT, but it’s not for lack of trying. 


Acquisitions, Funding, Business, and Stock

An Emdeon shareholder sues Emdeon and Blackstone Group, charging that Blackstone’s $3 billion buyout offer for Emdeon undervalues the company.

8-11-2011 6-26-02 PM

Nuance announces Q3 numbers: revenue up 20%, EPS $0.13 vs. –$0.01, or $0.35 vs. $0.30 excluding one-time expenses, beating analyst expectations of $0.34. Healthcare revenue was up 22%.

8-11-2011 8-49-10 PM

CSC’s Q1 numbers: revenue up 3.1%, EPS $1.17 vs. $0.91, but the earnings jump was partially due to a one-time tax benefit. The company restated guidance, but both analysts and shareholders reacted negatively. Revenue is projected to be flat even with the contribution of newly acquired iSOFT. In the earnings call, the CEO declined to speculate on the potential future of NHS’s NPfIT, a big customer of CSC and its former subcontractor, iSOFT.


Sales

The VHA awards Apelon a multi-year blanket purchase agreement for its terminology and data interoperability solutions.

The Wisconsin HIN selects ABILITY network to provide electronic messaging services for its connected stakeholders.

Flagler Hospital (FL) chooses Allscripts Sunrise Enterprise, also endorsing the Allscripts PM/EHR for its 130 affiliated physicians.


People

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Genomind hires former MEDecision CEO Scott Storrer as COO.

Decision Resources Group names John Ho, MD president of its Decision Resources Consulting.

8-11-2011 7-33-20 PM

Health Language Inc (HLI) promotes April Yoder to VP of professional services.

Navigant adds eight senior consulting professionals to its healthcare practice.


Announcements and Implementations

UPMC and Nuance sign a 10-year agreement to develop EMR information capture technologies related to speech and clinical language understanding, as well as natural language-powered data repository searches. UPMC will also standardize on Nuance to provide speech and natural language processing tools for its 20 hospitals, 30 imaging centers, and 400 outpatient sites. Nuance says the co-developed solutions will be generally available by the end of the year.  


Government and Politics

image Two years after to agreeing to merge their EMRs, officials from the DoD and VA admit it could take up to six more years to complete the project. VA insiders acknowledge that the process has been complicated by bureaucratic infighting, as each agency is unwilling to give up its legacy health system. The departments have now agreed to slowly upgrade both networks into a new shared system over the coming years.

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image Kansas Governor Sam Brownback returns a $31.5 million HHS grant, saying he had doubts the federal government would be able to maintain its promised future payments. Kansas was one of six states awarded grants to establish HIEs that other local governments could use as a model; Oklahoma also rejected funds for the project. Critics say the move was politically motivated.


Other

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Hospitals tell KLAS they need more comprehensive and integrated systems for pharmacy inventory management. Providers report that the biggest functionality gaps for these systems involve formulary database integration, expiration date tracking, and reporting.

8-11-2011 6-57-37 PM

image A British physician risks being “struck off the medical register” for bad behavior that includes self-prescribing medications, asking an employee to shred hospital correspondence related to an ongoing investigation, and biting a police officer.

In Australia, a software error causes the deletion of prescription records for more than 140 patients, with the conditions of 14 of them found to have worsened during that time.

8-11-2011 8-03-18 PM

Canadian researchers blame poor IV pump design for the 4.5% of medication errors that involve children receiving 10 times the intended drug dosage, often in PICU/NICU. They point out that IV pump keypads have the decimal point, zero, and confirm buttons side by side.

8-11-2011 8-09-13 PM|

image Mayo Clinic opens a high-tech consumer wellness information storefront in the Mall of America, intending it to be a gateway to its services. Features include wellness evaluations, symptom checkers, “trained health experience navigators,” and unnamed products for sale. Mayo says they have no plans to replicate the project in other malls, but wants to “learn about adapting its services to other settings.”

8-11-2011 8-12-27 PM

image Another part of Mayo’s mall experiment: an iPhone-powered scavenger hunt.

8-11-2011 6-50-41 PM 

image The team of GAUCHOS, an Open Software electronic charting application developed for volunteer clinicians (homeless shelters, the Operation Smile cleft palate repair organization, etc.) launches a Kickstarter project. They hope to raise $83,800 in crowdsourcing funds to complete the Operation Smile rollout and to develop a tablet version that does not require Internet connectivity. Like all Kickstarter projects (including a couple that I’ve donated money to), swell prizes are offered — $1,000 gets you a launch party invite and Web recognition, but just $15 earns a logo coffee mug.

image A Sage Healthcare survey finds that non-EHR using physicians have different expectations than those actually using EHRs. Physicians already using an EHR say they’re happy if it tracks outcomes and reduces errors, while the holdouts say they expect the EHR to increase their revenue.

A computer-on-wheels catches fire at Uniontown Hospital (PA), requiring firefighters to air out the third floor.


Sponsor Updates

  • Team GetWellNetwork and CEO Michael O’Neil will compete in the September 11 Nation’s Triathlon in Washington, DC to support the Leukemia and Lymphoma Society. The team’s fundraising page is here. They are participating in memory of Justin Thornton, who died of leukemia this year at 19. He was the son of Lt. Cmdr. Tony Thornton, CIO of National Naval Medical Center.
  • Hamilton General Hospital (TX) achieves Stage 1 Meaningful Use using the EHR of Healthcare Management Systems (HMS).
  • Elsevier releases a new white paper, “Two Years and Counting,” and updates its eBook, A Guide to Education and Training for ICD-10 Implementation.
  • Healthcare Innovative Solutions will exhibit at Siemens Innovations 2011 on August 14-17.
  • Orlando Health selects MEDSEEK ‘s 360-Degree Patient Experience to create a single patient interface to multiple EHRs.
  • Louisiana Health Information Exchange (LaHIE) chooses Orion Health as its primary technology provider.
  • e-MDs announces that physicians of its client, Silver Sage Center for Family Medicine, are the first priority primary care physicians in Nevada to receive Meaningful Use funds.
  • Anita Archer, director of regulatory and compliance services at Hayes Management Consulting, provides some thought leadership on how ICD-10 can improve patient care and the importance of EMR documentation. Hayes also published a white paper on vendor selection.
  • Staffing and consulting provider H/P Technologies will exhibit at the Epic UGM in September.

EPtalk by Dr. Jayne

As of last month, the American Academy of Family Physicians is no longer offering a paper mail-back card for its Continuing Medical Education quizzes. Participants will need to complete the quiz online. Definitely a step in the right direction as far as encouraging computer literacy at a basic level. Despite what those of us in the IT space might think, there are still quite a few docs out there who haven’t used a computer. Usually when those folks are integrated into our health system, I have the privilege of training them one-on-one. You’d think it would be exasperating, but it’s often very rewarding as you see one of these physicians start to realize the power of computers.

A 26-year old South Carolina man was denied participation in a federal assistance program for breast cancer patients because he’s a man. Approximately 1% of all new breast cancer cases each year involve men. This gentleman doesn’t have health insurance and didn’t qualify for Medicaid. The Breast and Cervical Cancer Prevention and Treatment Act is a federal law designed to help patients in this category;  unfortunately, you have to be female to qualify. South Carolina has tried to cover male patients under this provision in the past but has been denied. The Centers for Medicare and Medicaid Services state they’re working to find a solution.

Speaking of CMS, it recently launched the Hospital Compare website to go along with the Physician Compare website that we’re all so fond of. There is much more information available to look at for hospitals: process of care measures, outcomes measures, etc. Of course, hospitals have been more transparent about this information than individual physicians, so it’s not surprising.

In other South Carolina news, Greenville Hospital System is offering “speed-dating” events to try to match young adults with physicians. Realizing that health reform legislation will increase the number of young adults with insurance coverage (by allowing them to stay on parents’ policies, purchase through exchanges, or enroll in Medicaid) they’re using Facebook and more social events to draw these patients in.

Sometimes I receive e-mails I just can’t believe. Here’s what came from the American Medical Association the other day:

Find out how you can achieve meaningful use without an EHR. Learn about a unique approach to meeting federal meaningful use guidelines at less cost than an electronic health records (EHR)-based approach by viewing a webinar at noon Eastern time Wednesday from Amagine, Inc., a subsidiary of the AMA, and WellCentive. The program will feature a demonstration of WellCentive EHR-M.

Really? The marketing folks behind this blurb should be fired. The product demonstrated has EHR in its name. How does that make it not an EHR? Is it really any cheaper than the cheapest certified system out there?

A quick visit to the WellCentive website looks like it’s just another modular product. And I bet once you get done buying WellCentive EHR, WellCentive PQRS, WellCentive e-Rx, WellCentive Patient Outreach, WellCentive Registry, and WellCentive Connect (you get my point) you might as well have bought a top-shelf complete EHR.

The Department of Veterans Affairs is sponsoring a contest (complete with a $50,000 prize) to use its Blue Button download tool to develop a personal health record and place the technology on 25,000 physician websites. Over 300,000 veterans have used the Blue Button on MyHealth.va.gov to download data in the last year. The goal is to expand this functionality to the 17 million vets receiving care from non-VA providers. The contest runs through October 18 unless someone wins it sooner.

A shout-out to all of you at Community Health Centers since this is National Health Center Week. You are vital to the healthcare of so many people. I’m continually amazed by the ability of some CHCs to deliver high-quality care to a challenging population on a shoestring budget. Keep up the good work, and thank you!


Contacts

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

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August 11, 2011 News 7 Comments

HIStalk Interviews Ken Willett, CEO, Ignis Systems

August 5, 2011 Interviews No Comments

Ken Willett is president, CEO, and chief technical officer of Ignis Systems of Portland, OR.

8-5-2011 6-40-13 PM

Tell me about yourself and and the company.

I’ve been in software development ever since I got out of college in 1974. I’ve worked in a number of high-tech startups, mostly in the electronic design industry. I got into healthcare IT as I started a consulting business in about 1994. Ignis Systems was incorporated in 1999. 

One of my first major clients was MedicaLogic, now the Centricity products from GE since they bought MedicaLogic. That then led to EMR-Link, which is the current product that we have. Ignis is no longer a consulting company — it’s a product and services company. A number of people have joined — quite a few of them with GE Centricity background — but we’re now spreading out, bringing in people with expertise in other EMRs. 

The system deals with CPOE from the ambulatory side – orders and results – and in the diagnostic area: lab orders, lab results, radiology orders and results, and so forth.

Describe briefly how the orders flow within an ambulatory EMR.

The EMR is the main cockpit of the provider these days. People who are really using EMRs well want everything to be driven out of the EMR — the decisions that they’re making, documentation they’re providing, and in particular, creating orders for outside services.

In the past, what’s typically happened is labs have provided either Web-based or application-based ordering systems to providers. Providers don’t want to switch to a different application to place a lab order, a medication order, or any other kind of order. They want that out of the EMR.

We provide the ability for them to do the ordering within the EMR. The provider generally provides some minimal information. What they’re interested in is, “What tests do I want run? What’s the justifying diagnosis for this test? When does it need to happen? Is it an urgent or a regular order?” But that’s not really sufficient information for the lab. The lab needs to know a lot more status information about the patient. They need to know about insurance. They need to know what account to bill things to. 

Our application collects the information from the provider, the basics of the order. It then allows a staff person to augment that information to get it to the point where it meets all the order requirements for the lab.  That helps to guarantee that when the results come back through us, they are going to meet the needs of the provider in terms of being a high-quality diagnostic report.

Many people would have assumed this problem was solved many years ago, especially since e-prescribing has settled down to universal standards. Do you think a long-term solution is coming for orders other than what you are offering, or is this as good as it will get in linking an ambulatory practice to the outside world?

I hope it will get better. When I was first involved with MedicaLogic, e-prescribing was just as much of a black hole as lab orders and lab results are now. What happened in the intervening years was there were a few large players on the prescribing side that were the pharmacy benefit managers. Once those large players got their act together and Surescripts was involved and that technology. That made it easy to essentially move that whole industry toward one set of standards and one method for communicating these orders.

The same thing hasn’t happened on the lab side. The lab industry is much more fragmented. There are two or three big players in the US, but they only account for about 20% of the total lab volume. We’re talking about hundreds or thousands of hospital labs, and now, even more in-office labs in large physician practices. It’s very, very difficult to drive a consensus there through just market activity.

What we end up having to do is have lots of different kinds of connections to different labs. They have slightly different flavors of HL7 data for orders and results and have different communications methods. We have to make sure that our hub adapts to those differences.

I think over time, particularly with a push from the federal government for information exchange, there will be some focus on standards. There’s some standards activity going on right now both at the federal level and within the HL7 community that hopefully will get adopted more widely. I think that will reduce the number of variations we have to deal with, but I don’t think it’s going to drive it down to one common standard that everybody’s going to be using.

Who is your target audience?

We sell services to the major labs and also to hospital labs as a way for them to connect the providers and their community, or the providers that they market their lab services to. The same thing with radiology. But the main user of our system is the provider. We have to make sure that what we are doing is a great solution for the doctor as they’re providing care for the patient, even though they typically pay for a small portion of our service. Most of our service is actually paid for by the lab. So it’s not simple from a marketing and sales point of view, because we have one customer who’s making the purchase decision, but we’re going to have a different customer that we have to satisfy from the usability point of view.

Let’s say LabCorp sponsors the implementation for a particular practice. Is the connection only then to LabCorp, or once it’s in place, can it be used for other lab companies?

One of the things that we think is important is to have a single ordering solution that can connect with all labs that a particular provider is going to use. The typical case is probably two to three. Because of insurance contracts, most of the people who send orders to LabCorp also send them to Quest because some insurance carriers require that. Then they may have a hospital lab that they send things to just because it’s in their community.

We have is a single application that allows ordering from any of those. From a business point of view, we have to break that apart so that LabCorp is paying for their piece of that system, Quest is paying for their piece of that system, and then there’s a subscription piece that the provider pays that’s a recurring annual usage fee.

By definition, your practices all have a large entity as a sponsor, correct? Its not really a universal system from the physician side, but rather whatever parts the sponsor wants to subsidize?

That’s true for the larger labs, but we actually have a range of different scales that we operate at. We have a lot of customers that are relatively small practices, maybe a dozen or so providers, but they have in-house lab. They want electronic ordering and electronic results. The smaller-scale LIS systems that they may be using for their in-office lab maybe don’t have that capability. 

We can allow them to do electronic orders and results. Even though the lab system is in the same building that they’re in, they connect through us because it just works better and smooths out the workflow.

Then we have a lot of labs that are in the middle. They may be a single hospital or a multi-hospital organization that may have a single consolidated lab, or they might have a lab at every hospital. We provide the ability for them to connect to practices either within their organization or affiliated practices within their community.

And then of course there are the large reference labs where labs are their only business. We also have a number of hospitals who provide labs and radiology, and we can provide a single ordering and resulting solution that handles both types of orders.

What kind of user or transaction volume are you seeing?

We have about 5,000 providers using our solution at between 250 and 300 different sites. We’re handling between a half million and a million transactions a month through our system. We have unsolicited results in some cases, but they may quite often have an order with a matching result coming through.

What’s the selling point for Meaningful Use?

This goes back to the Meaningful Use criterion around structured lab results. Lab results traditionally, in a lot of cases, have been faxed to providers or they’ve been sent through a remote print engine. They print it on paper, and then maybe they’re rescanned. But the established EMRs that have been around for a number of years can handle HL7 lab results. They can do things like display the patient trend graphs or they can filter the population based on lab values.

We’re seeing a flood of new EMRs hitting the market and a lot of them don’t have that capability. A lot of them believe that lab results just means that you can present a lab report to the provider so that they read it. If a provider or an organization chooses structured lab results as one of the menu items in Meaningful Use, then they need to have a system that can present that structured data to them. In some cases, their EMR may not be able to do that.

One of the things that we provide on the result side is that we can maintain the structured data in our system. We can provide it a readable, high-quality printed report or viewable report to the provider, but we can also provide the trending and the structured data that they need. It’s also sometimes the case that we can provide viewable lab results to a provider who doesn’t have an EMR yet, or isn’t set up to handle structured lab result data yet. We can populate that EMR with the structured lab data once that provider’s ready.

It seems reasonable for EMR vendors to let a specialty company develop the integration piece while they focus on the inherent functionality needed for their own workflows.

We think that’s the right model. In most cases, with a few exceptions, the EMR vendors don’t really do a very good job of interoperability with outside systems. It tends to be an afterthought. It’s a whole different business. EMR vendors usually are as software development and database experts. They’re used to building essentially closed systems that are delivered and installed at the customer’s site.

Interoperability is a much broader game. You have to be an expert in data communications and security, error recovery, and all kinds of things which may be or not that applicable in the EMR that’s installed at a particular customer site. I think it makes sense for people to leave that to us. 

We’re finding that, both with the EMR vendors and also with labs, when they start to add up they’re paying to implement lab interfaces and get them working, maintain them over time, and recertify them every two years, a lot of those companies that just don’t want to be in that business.

You mentioned use of your tools by practices with no EMR. Tell me about Orders Anywhere, which you market as a starter step.

That’s great for people that aren’t on an EMR yet. There are also many EMRs which don’t have electronic ordering at all. They don’t have the ability to generate an outbound electronic order message. A lot of them are designed just to document the orders in the chart. Some of them have an ordering capability but it’s just not very good — they don’t have the ability to configure ordering preferences to what the provider needs and they can’t split orders when they need to be split into multiple requisitions. 

Orders Anywhere is a way for people to have electronic ordering, even when their EMR doesn’t provide it. It’s both for people that don’t have an EMR and people whose EMR doesn’t have good ordering capability.

Are you seeing providers who have decided that HITECH money just isn’t worth the trouble and picking and choosing just those technologies that make benefit them directly, like perhaps your electronic ordering product?

You don’t necessarily find out what the provider is intending as far as the Meaningful Use stuff. I’ve heard stories of doctors who have said, “This isn’t worth it to me right now.”

But I think what we’re seeing is that a lot of the volume growth in EMRs really is being driven by the Meaningful Use rules, so the people who’ve decided that it’s not worth it probably aren’t talking to us anyway. For somebody who has an EMR and they think EMRs are good tools to use, they’re probably going to figure out how to get their use of the EMR up to the point where they can get some Meaningful Use reimbursement.

The other thing that we’re seeing that’s sort of odd and a little scary is vendors who build their systems to the Meaningful Use requirements. They may have some technology pieces and they’re asking, “What’s the minimum we can do so that a doctor can get paid by the government?” Not what’s a good EMR or what makes sense for taking care of patients, but more, “How do we meet the letter of the Meaningful Use regulations so that if they buy our product they can get paid?“

That’s not a very far-sighted view. Those regulations are going to change over time, but that set of things that have been identified by the ONC by the Meaningful Use, they’re really pretty arbitrary. There’s a lot of other things that you really should be doing if you’re going to be a good EMR user.

You’re in a fairly niche-type technical product area. Do you see your expertise translating into other products or services beyond orders integration?

Yes. We have a couple of things in the works that I can’t really talk about them in detail, but there are a number of problems now that are of the form of having multiple back-end organizations with different standards like the labs are in our world, maybe having to have some connection on the front end to every provider, or maybe all providers in a state, or all providers in a certain geographic area.

Understanding how to put together a hub-and-spoke architecture that does the right kind of translations in moving data from one side to the other  — we’ve learned a lot about doing that with labs and radiology. We believe there are similar problems that can benefit from that.

CCHIT chose your tools to test orders integration for certification. Did that raise the company’s profile?

Well, we hope it did. We have lots of experience with lab results and what works in the real world. That was a project of mine to work together with the CCHIT technical team to put together the test suite for Meaningful Use certification for lab results.

Where does the company and the industry need to go?

One of the things that we work very hard at is being really responsive as things change. One characteristic of where we are in the market is we’re hooking up new practices and new labs all the time. We have a hosted solution, a Software as a Service model, and we need to be able to turn things on very quickly, generally within the space of a few days. We can do that pretty readily as a small company. I think it might get more difficult as our organization gets bigger.

But there’s a lot of room for small companies like ours to fill in some of the gaps between these large systems, which often take 12-18 months to incorporate new capabilities. Things are moving too fast – people can’t afford to wait that long.

Any final thoughts?

I think there will be a separation between transport companies and transport technologies and content companies and technologies, sort of like what’s happened in the television industry. Communications companies deliver data from one place to another, then you have other organizations, like Facebook or  HBO, that provide the content.

We’re very much in the content business. We want the information provided by the provider to be useful for the lab, and we want the results from the lab useful to the provider. We don’t necessarily want to be involved in the plumbing that makes all that happen. In the HIE world, some of the work that’s going on with Direct standards, the transport pieces are becoming more of a commodity. Those things will separate themselves out from those of us who focus more on the content.  

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News 8/5/11

August 4, 2011 News 12 Comments

Top News

8-4-2011 9-16-25 PM

image A diabetic computer security researcher proves that hackers could theoretically remotely control medical devices such as insulin pumps and glucose monitors, which don’t have enough battery power to encrypt their wireless signals. The same threat had already been demonstrated for defibrillators, but no real-world examples have surfaced.


Reader Comments

8-4-2011 9-05-00 PM

image From Gary: “Re: drchrono free EMR. I can’t find anything on their site about their revenue source other than VC funding. Is it advertiser supported?” The company says they’ll get back to me on that. Their free product is limited in storage and support and doesn’t include some functions (e-prescribing and electronic billing), so I assume they hope users will move up to a paid version. I don’t know much about the product, but their website is one of the slickest ones around.


HIStalk Announcements and Requests

image Listening: a new lost album from The Screaming Trees, a 1990s Seattle band with a fresh roots rock sound (even now) that mixes light grunge with dark twang and psychedelia, like minor chords REM meets Alice in Chains. They never made it big, but should have. I’m kind of loving it as I contribute my air drumming to the mix.

image I made a decision last week after careful deliberation: I’m phasing out animated sponsor ads on HIStalk on January 1. Sponsors are responding positively to Inga’s e-mail describing the change, which I appreciate – I think they know intuitively that everybody will benefit from less distraction and faster page loads, which will result (ironically) in more ad views and clicks. That’s the theory, anyway.

image Inga will be back to full HIStalk duties shortly. If you want to make her return even more joyful, consider: (a) signing up for e-mail updates on HIStalk and HIStalk Practice; (b) give us the electronic version of the insincere Hollywood air kiss by friending us on Facebook and connecting with us on LinkedIn; (c) send us cool stuff like rumors and secret information; (d) click some sponsor ads to check out their offerings since I turfed off the “no more animated ads” sponsor e-mail to her to send and she probably needs to regain her stature in their eyes for being the messenger; and (e) use subtle peer pressure to send new readers our way since she loves poring over the readership stats.


Acquisitions, Funding, Business, and Stock

8-4-2011 4-18-08 AM

ZocDoc, a provider of an online physician locating service, raises $50 million in Series C funding from DST Global. Other ZocDoc investors include Marc Benioff (Salesforce.com) and Jeff Bezos (Amazon).


Sales

8-4-2011 11-24-04 AM

St. Vincent’s Medical Center (CT) signs a seven-year agreement with GE Healthcare to upgrade to the SaaS version of several Streamline Health products for HIM.

Centegra Health System (IL) will implement iMDsoft’s MetaVision critical care system for all 113 of its monitored and ICU beds, integrating it with ADT, labs, CPOE, billing, scheduling, PACS, LDAP, and its GE EMR.


People

8-4-2011 6-27-47 PM

Paul Ruflin, former CEO of Eclipsys and Noteworthy Medical Systems, joins software tools vendor PreEmptive Solutions as president and COO.

8-4-2011 6-25-13 PM

Integrated Healthcare Strategies announces that William F. Jessee, MD will join the consulting firm as a SVP and senior advisor following his October 2011 retirement as MGMA’s president and CEO.

8-4-2011 7-44-52 PM

Surgical Information Systems (SIS) appoints Gary S. Long (above) to VP of North American sales and Jonathan C. Lujan to VP for Business Development & Strategic Planning.

8-4-2011 7-16-06 PM

David Kissinger, regional VP of maxIT Healthcare, is appointed to the board of directors of Southern Ohio HIMSS, also serving as its public relations committee chair.

ZirMed names former IDX/GE executive Thomas W. Butts president and CEO. He replaces Jerry Merritt, who stepped down “for personal reasons.”


Announcements and Implementations

8-4-2011 9-10-24 PM

North Colorado Medical Center goes live with CPOE as part of Banner Health’s $250 million Cerner EMR initiative.

Swedish Health Services (WA) expects the former Stevens Hospital to be live on Epic’s EMR by the fall of 2012. Swedish took over management of Stevens last year and is making $150 million in infrastructure upgrades.

Royal United Hospital Bath NHS Trust goes live on Cerner Millennium three years later than planned, caused by Fujistu’s termination as the local service provider.

RCM software provider Avisena partners with Intuit Health to make the Intuit Health portal available to Avisena practices.

image NextGen confirms the earlier rumor I ran – the company is working with MEDSEEK to create a new NextGen Enterprise Patient Portal for hospitals, allowing patients to access staff, review test results, make appointments, and request prescription refills in a single view. It’s business as usual for the existing NextGen Patient Portal – this is an alternative for a different audience.

Ouachita County Medical Center (AR) chooses Healthcare Management Systems for its financial and clinical applications, including EDIS. Meanwhile, CMH Regional Health System/Clinton Memorial Hospital begins its implementation of HMS.

8-4-2011 8-03-33 PM

Oroville Hospital (CA), which uses a version of the WorldVistA EHR 2.0 that it customized, helps WorldVistA get it certified for outpatient Meaningful Use by contributing its self-developed e-prescribing module. They say it’s the first version of VistA to be certified for outpatient use. Oroville says it has spent $4 million hospital-wide on implementing the open source product, but did it all with internal IT resources.

Midland Memorial Hospital (TX) connects to the Nationwide Health Information Network and the Social Security Administration MEGAHIT project using the Medibridge.net HIE platform from EHR Doctors. It generates Continuity of Care Documents from VistA/CPRS like the Medsphere version that Midland uses.


Government and Politics

CMS reports that about 77,000 providers have registered for the Medicare and Medicaid EHR incentive program as of July. A total of 2,383 EPs have verified they met MU requirements; 137 attested unsuccessfully (though it’s unclear why.) CMS has issued almost $400 million in incentive payments.


Other

image US physician practices spend nearly four times as much per physicians Ontario in dealing with health insurers and payers. Though much of the difference stems from Canada’s single payer system versus the US’s multiple payer model, the authors of the Health Affairs-published study suggest there are ways that US health insurers could reduce costs and increase efficiencies.Other

An article in an Indian business publication says that companies there will get a lot of business from ARRA and ICD-10, quoting Bronx-Lebanon CIO Ivan Durbak. The hospital says it is saving at least 50% of the cost of its EHR project by issuing its $30 million contract to a Chennai-based outsourcer.

8-4-2011 8-32-00 PM

In Canada, Ontario Telemedicine Network is expanding by adding an Internet-based videoconferencing solution that participants can access on any PC.

8-4-2011 8-41-05 PM

image Emergency personnel in western North Carolina paid their respects Tuesday to Asheville Fire Department Captain Jeff Bowen, who died in a medical building fire last week after helping save an oncology clinic’s computers and electronic records.

8-4-2011 8-50-23 PM

image Max Harry Weil MD, PhD, who in the 1950s developed the “shock ward” concept of today’s ICU, including crash carts, stat labs, and computer-monitored vital signs, died last week at 84.

image Odd lawsuit: the family of a man killed by his chemist wife, who poisoned him with the diagnostic agent thallium, sues her drug company employer, the hospital where he died, and six doctors. The suit claims he would still be alive “if only one of the world’s biggest drug makers and an accredited medical center had just done their jobs.”


Sponsor Updates

  • Regal Medical Group, a California-based IPA, announces a partnership with MyHealthDIRECT to assist its members in the care transition process.
  • MEDSEEK earns a #5 ranking in the State of Alabama’s Best Companies to Work For program in the 50-249 employee category.
  • Pamela Bradshaw RN, CCRN, NE-BC, CNO and VP of Nursing and Clinical Services at United Regional Health Care System (TX) credits Clairvia’s CVM Patient Acuity for higher levels of job satisfaction among staff nurses and better patient care.
  • CareTech Solutions announces a partnership with Cardinal Path, a Google Analytics Certified Partner, as a value-add service for its CareWorks content management system.
  • FormFast will host a free August 18 webinar entitled EMRs Need More to Support Meaningful Use.
  • TeleTracking Technology is nominated for Tech Titan of the Year for 2011 by the Pittsburgh Technology Council.
  • Perceptive Software expands its global OEM program.
  • Nuesoft releases a video on reducing medical practice risk through strong HR policies.
  • Merge Healthcare announces sales of $57M in the second quarter. The company also posts a podcast on radiologists and Meaningful Use.
  • Lorie Richardson of Hayes Management Consulting discusses eight ways IT can improve training and adoption rates.
  • Concerro offers a webcast entitled CXO, WOW & WOM: A Powerful Approach to Patient Experience Management Tied to the Bottom Line.



EPtalk by Dr. Jayne

Nominations are now open for the 2011 HIMSS Award and Recognition Program. Too bad Mr. H is anonymous, because he certainly meets some of the criteria for service to the industry. Nominations are open through October 14.

clip_image001

Weird drug news: the first FDA-approved treatment for scorpion stings has arrived. That’s good news for those of you in Arizona, which plays home to most of the poisonous scorpions in the US. I’ve spent enough time in the southwest to be freaked out by these little buggers. Although most adults don’t need treatment if stung, this is good news for children who might have a too-close encounter of the Centuroides sculpturatus kind.

Like many of you, I’m pretty tired of US politics and healthcare reform being flogged during the debt ceiling discussions. One bright spot in government though is the “Restoring Access to Medication Act” introduced as H.R. 2529 and S. 1368. This would allow patients to use their flexible spending accounts and health savings accounts to purchase over-the-counter (OTC) medications without a physician order, as they could prior to 2011.

I can attest that this issue has caused quite a bit of patient angst and increased healthcare spending as patients come in for office visits to obtain prescriptions for OTC drugs, not to mention healthcare IT spending as many practices created custom order sets and forms to be able to rapidly order a broad spectrum of OTC drugs for patients in a single click. I shuddered the first time I had one of these visits as I wrote scripts for Tums, hydrocortisone cream, and a pregnancy test. (Even worse is the fact that a pregnancy test is not an OTC drug and that a script isn’t required – but my patient had a letter from her benefit administrator demanding a script and stating that they wouldn’t honor the examples given in the FAQ section of the Internal Revenue Service website.) It’s about doing what’s right for the patient, regardless. Let’s hope Congress gets this one right.

I’ve mentioned my thoughts on sunscreen and tanning before, as well as my appreciation for a good glass of wine. A recent study from the Journal of Agricultural and Food Chemistry notes that “A compound found in grapes and grape derivatives may protect skin cells from skin-damaging ultraviolet (UV) radiation.” Maybe Inga and I can sign up for the follow-up study.

There are days when I joke about needing to wear body armor to work, but I’m usually referring to the need for protection from the slings and arrows of my colleagues. The LA Times reports on this, noting that 10% of emergency department nurses had been assaulted in the week prior to being surveyed. Most violence is from patients and family members.

I was recently at a training techniques class with a group of professional Health Informatics trainers. There were a few newbies in the group, and the topic of physicians “getting physical” during EHR training came up. Nearly all trainers reported having something thrown at or near them – from pens and paper to coffee cups, all the way up to laptops. One even reported a physician tipping over a computer-on-wheels in frustration. Seriously, people. It embarrasses me that physicians behave like this. Discipline for these kinds of infractions should be the same as that for surgeons that throw instruments in the operating suite. The fact that EHR or CPOE training is involved is no excuse.

Last, our nominee for quote of the week: This gem is from CMIO magazine and William F. Bria MD, President of the Association of Medical Directors of information Systems (AMDIS). “Another usability problem is the expectation of some physicians that the whole point of these systems is to make them more efficient and happy.” If you’re a project manager out there selling technology as a way to increase physician satisfaction, please think of another marketing bullet point. How about patient safety? That’s something we should all be able to get behind.


Contacts

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

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August 4, 2011 News 12 Comments

Readers Write 8/3/11

August 3, 2011 Readers Write 2 Comments

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

The Pressures of EHR Adoption and a Market Trend of Converged Services and Technology
By Janet Dillione

8-3-2011 7-26-22 PM

Recent mergers and acquisitions in the healthcare information technology (HIT) industry bring to light many facets of electronic health record (EHR) implementation that often go overlooked. As many in the medical industry know, implementing an EHR system so it works seamlessly with clinical workflow is more complicated than downloading and installing software with the click of a mouse. There is not an EHR switch that can simply be turned on.

Healthcare organizations that have successfully implemented EHR systems, along with those currently navigating the process, can attest to the need for a scalable system wide approach. To achieve improvements in the quality, safety and efficiency of patient care special attention should be paid to services and technologies that foster EHR adoption across the clinician population.

Recent strategic alliances in the healthcare IT space signify a movement toward a promising future of EHRs, a future with a genesis in advanced clinical documentation. A successful, long-term EHR strategy, one that will position healthcare organizations to overcome the many pressures of the healthcare industry in the years to come – Meaningful Use, ICD-10, Accountable Healthcare – begins with effective data capture. The reality is that an EHR is only as good as the information captured within it, and as the saying goes, it takes a village …

I have no doubt that the industry will continue to see more strategic partnerships. These alliances establish greater resources for the healthcare industry, leading to more streamlined workflows, greater cost savings, satisfied physicians, and improved quality of patient care. However, none of this happens overnight and healthcare organizations should see this as an evolutionary process, not one of instantaneous change. By this I mean, every provider setting has a clinical documentation workflow in place, and pursuing an approach that is diametrically opposed to the status quo can prove counterproductive to the effort.

Despite the enthusiasm for employing state of the art technologies, healthcare organizations should not feel pressured to immediately make all data capture mobile, to put all applications in the cloud tomorrow, or to force doctors to use an EHR without a safety net out of the gate. In time, the increased amount of service and technology convergence across the industry will help healthcare organizations to better address the pressure of EHR adoption, and more importantly, will help them better manage their robust collections of clinical data.

It is becoming increasingly clear that in healthcare, data is knowledge. It drives care decisions, billing and reimbursement, compliance with federal regulations, and is key to overall health system improvement. Today, there is no one solution, no one vendor, and no magic potion that can address all of these issues and capitalize on all opportunities. However, by strategically bringing together the best in technology with the best in services, healthcare organizations will be better positioned to make the transition from traditional workflows to the EHR in a thoughtful, natural way.

An impressive amount of progress has been made over the last several years, particularly in light of EHR adoption pressures. Innovation and automation is transforming the processes and outputs of clinical documentation. What once was scribbled on a notepad, created on a typewriter, or passed from caregiver to caregiver in the hallway, is captured and transferred more efficiently and effectively than ever before. Such effective clinical documentation establishes an important foundation for EHRs.

By leveraging and contributing to technology collaborations, healthcare organizations can access the best in services and technology. This means a transition from handwritten records stored in manila folders to digital information stored within EHRs captured through natural clinical workflows. Moving forward, there will be multiple ways to capture the patient story including keyboard input and speech-to-text technologies.

Once clinical information is captured, we’ll see the application of highly intelligence clinical language understanding (CLU) technologies, often referred to as natural language processing or NLP in other industries. These highly sophisticated technologies will turn our vast amounts of clinical data into knowledge to be leveraged across the healthcare ecosystem.

The convergence going on across the healthcare industry amongst healthcare IT vendors, academic centers, service-oriented businesses, and other organizations is promising, but should be scrutinized by healthcare organizations.  There are many promises amongst the recent M&As and partnership activity, but only few proven results and long-term plans.  As you work to tackle EHRs as a strategic initiative, enlist supportive guidance and build a nimble infrastructure where the EHR can become a launching pad for better use of data.

Janet Dillione is EVP/GM of the healthcare division of Nuance of Burlington, MA.

Meaningful Use and Innovation
By Ryan Parker

All human development, no matter what form it takes, must be outside the rules; otherwise we would never have anything new. – Charles Kettering.

I have recently finished up some consulting work for a startup HIT company (which for non-solicitation reasons I will refer to as Company X.) I was working with them to help develop their EMR. 

When Company X first showed me their product, I was amazed. In just over a year, they had developed an almost fully functioning EMR. Using more advanced coding language than what you would find in most legacy systems (i.e. C#, Silverlight) they came as close to mimicking the clinical workflow as I have seen with an information system.

Everything was looking up. Their product was becoming more and more complete and becoming more and more advanced. But then they ran into an issue. If anyone has worked with or been a part of a start-up, momentum is key to success, and in this company’s case, the Innovation truck slammed head first into the Meaningful Use wall.

To be completely honest, forcing Company X to get their product Meaningful Use certified did have some benefits. There were some system needs they hadn’t thought of previously. In terms of HIE and interoperability, the requirements will have a positive impact as a whole as we move to a more ‘data-sharing’ driven information system structure. However, the innovation, creating a system different from anything else, which, to keep the truck metaphor rolling, was sitting in the driver’s seat of the company, dissipated as executives and engineers dived deeper and deeper into the ONC requirements.

Weeks turned into months of working on the Meaningful Use requirements. Although Company X was making progress, the focus slowly turned from creativity and ingenuity to one of conclusion, as in, “How soon can we meet these requirements and be done with this product?”

Soon, the executives starting turning their attention to other products, focusing on solutions that fall outside of the ONC/Meaningful Use umbrella.

I have no doubts that after they complete their Meaningful Use certification in the near future, and hospitals and health systems get a good view of their product, Company X will receive accolades on their HIT advancements from the healthcare community. Personally, I will be wondering what progress could have been made without standardization. What advancements could Company X have made without the rigors and requirements forced upon EMR vendors?

Ryan Parker is implementation practice director of Preceptor Consulting Corporation of Fort Myers, FL.

HIEs: High Performers Will Be Around for the Long Term
By John Haughton

8-3-2011 7-13-51 PM

Improved patient care outcomes, lower administrative costs, fewer medication errors, improved ability to manage chronic conditions, reduced unpaid re-admissions, greater efficiency, fewer ER visits …

There is no question about the benefits that a highly effective health information exchange (HIE) brings. By highly effective, I mean a healthcare ecosystem grounded in evidence-based medicine, clinical guidelines, and performance reporting.

For providers hoping to achieve Meaningful Use (MU) or to become Accountable Care Organizations (ACOs), performance-based HIEs hold the promise of pulling together data from myriad sources — medical staff and community physicians, insurers, labs, imaging centers, behavioral health and home health providers, employers, consumers, retail pharmacies — to finally deliver truly coordinated care.

But there is also no question about the challenges facing fledgling HIEs, the primary one being a sustainable business model. It turns out that, if you build it, they won’t necessarily come. And once the grant money runs out, the organization rapidly runs out of steam.

The only way to build an HIE with enduring power to transform the health of a community is to have providers pay for it. And the only way to do that is to provide high value — quickly. This means demonstrating value from Day One by raising the bar on clinical quality for their customers, namely, patients.

In response to the MU requirement for value-based purchasing and market realities pushing margins into negative territory for about half of all hospitals, HIEs must help hospitals survive and thrive in the new patient-centric business model to garner lasting provider support.

The HIEs that have done this successfully have something in common: they pretty much all have their heads in the cloud, which is to say, they use platform-as-a-service (PaaS) cloud computing technology that offers authorized users easy, but extremely secure access to centrally stored, actionable information for an affordable price.

Here are the seven technology elements needed to play in the high-performance league:

  1. Maximum functionality and flexibility. Since around three-quarters of healthcare in this country remains paper-based, technology is needed that supports hospitals and physicians regardless of their technology sophistication. This favors best-of-breed EHR modules that can meet a wide variety of needs, budgets and timetables, rather than a comprehensive, enterprise-wide approach.
  2. A full range of value-added tools and services. Think of the app store on an iPhone. That type of flexibility and customization are what is wanted from HIEs, only instead of YouTube, GPS, and Fandango, apps that provide clinical decision support, performance management, quality reporting and analytics, clinician messaging, shared guideline dictionaries, and disease registries are valued.
  3. On-the-fly translation. As long as stakeholders continue to speak different electronic languages — all of which are upgraded and updated almost constantly — mapping and translation services are needed for interoperability.
  4. Scalability. An HIE is a dynamic entity; it needs a platform that continually accommodates more of everything: providers, users, technologies, regulations… Collaborating across town is great. Collaborating anywhere is the ultimate goal, however.
  5. Ease of use. An identity federation service means providers need just one user name and password to interact with each other, health plans, regulators and patients — and just one point of access for all clinical and administrative data held by the HIE.
  6. A 360-degree, real-time view. A single, comprehensive view of a patient’s status, including all information submitted by all authorized sources from five decades ago to five minutes ago, will help eliminate redundant tests and procedures.
  7. Sharing of best practices. The best HIEs aren’t merely repositories. They must be able to analyze input, generate point-of-care solutions, and disseminate data that draws on documented successes.

So the future is bright for those high-performance HIEs that “bring it” — clinically speaking. HIEs and other data exchange organizations that figure just having the data will have hospitals and physicians beating a path to their door are being naïve and are putting their long-term survival at risk.

Like it or not, healthcare is a business as well as a service, and organizations need to deliver ongoing value to ensure their long-term relevance and sustainability.

John Haughton MD, MS is CMIO of Covisint of Detroit, MI.

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August 3, 2011 Readers Write 2 Comments

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Reader Comments

  • confused: Not at all - I don't actually have a position on it. From my post, "... I am not very close to this space ..." Jus...
  • Switch: Have you read "Switch" by Chip and Dan Heath? Consider a visceral driver (as opposed to rational) to motivate the move a...
  • Brian Too: Re: confused Do you not like the brussel sprouts story because it's not applicable, or because it does not validate y...
  • Scars to Prove It: The comments about working in good faith on the most vocal resistors describe what is in my view the right way to approa...
  • Anonymous - Any patient: We can argue over the evidence and the validity and limitations of the referenced studies, but, there is a direct infere...

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