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News 8/23/13

August 22, 2013 News 12 Comments

Top News

8-22-2013 7-46-29 PM

Steve Malik, the Cary, NC entrepreneur who sold his Medfusion patient portal startup to Intuit in 2010 for $91 million, acknowledges that he has bought the business back from Intuit, which had announced its intention to divest Intuit Health Group to focus on its core tax and financial software business. Intuit wrote down $46 million earlier this year when partner Allscripts decided to look elsewhere for a portal solution. Revenue was down to $16 million in 2013. Malik says he looked at healthcare IT startups before realizing that his former company held the highest potential. Malik, the sole owner of the company, says he hasn’t decided whether he will revive the Medfusion name (my vote and expectation would be yes even thought the name isn’t descriptive.)

Reader Comments

From Boy Wonder: “Cerner and Epic. Are you aware of any health systems that have switched or are in the process of switching from Cerner to Epic? Just wondering.” I was thinking that Aurora had done so. I assume the specific interest would be those that switched voluntarily rather than being forced by acquisition. Readers?

From Vendor Venting: “Re: McKesson Horizon. As a customer, we have noticed that support and services have steadily declined since the ‘Better Health 2020’ announcement in December 2012. The average tenure of support employees supporting us has dropped severely with resignations. We have to run a gauntlet of triage and bottom-tier support before most of our issues are escalated to a rare senior resource. They are exerting pressure for us to migrate to Paragon while failing in their commitment to support us on Horizon. In the BH 2020 announcement, we were assured that there would continue to be a commitment to Horizon customers, but the executives who made those commitments have moved on. Actions speak louder than words and customers have been left to deal with the fallout.” Unverified. I would be interested in speaking to a customer that has moved from Horizon to Paragon since those mentioned by the company seem to be happy.

8-22-2013 7-05-11 PM

From CDiff: “Re: ICD-10 codes for High Life in the ER. Wondering if Weird News Andy has reported the need for five ICD-10 codes for beer?” A Johns Hopkins Hospital study of the one-third of ED visits that are alcohol-related finds that the beer brands most often involved are those most appropriately consumed from a paper bag koozie rather than a tulip glass: Budweiser, Steel Reserve, Colt 45, Bud Ice, and Bud Light. They’re planning to extend the study to see if it’s just a Bal’more thing.

From Pacific Girl: “Re: CIO Unplugged 8/12/13. Mr. HIStalk, that is by far the most moving post I’ve read from your site, and it couldn’t have come at a better time. Thank you, thank you, thank you.” I think people sometimes underestimate how hard it must be for Ed Marx to write soul-baring articles like “Falling from Grace” and post them publicly for his peers with his name on them, opening himself up to criticism from folks who enjoy the benefit of anonymity. Ed doesn’t seem to mind as long as he makes them think.

From Boston Beans: “Re: John Halamka. Why do people feel the need to run him down? He’s doing his job at BIDMC or they wouldn’t keep him.” Long-time readers may recall that I was unflaggingly cynical about him years ago given his ubiquity, but that changed when I met people who know him and then met him myself (as me, not Mr. H) He’s the real deal and I detected no self-serving agenda at all. He won’t take money for doing work external to BIDMC because he considers his time paid for by them, he is patient in explaining what he knows when I’m sure I wouldn’t be, and I think he really cares about patients more than anything else. I interviewed him in 2010 and was impressed at his lack of pretension or ego. I may or may not agree with every IT decision he’s made and he’s got some biases unique to Harvard and Boston, but he’s a good guy. Folks who say he isn’t usually haven’t actually met him. If you’re looking for egotistical douchebag CIOs or executives, you have many more deserving choices.

HIStalk Announcements and Requests

inga_small Some HIStalk Practice highlights from the last week include: MGMA urges HHS to not penalize physicians who have met Stage 1 MU requirements but may miss the Stage 2 deadline. The Air Force’s 62nd Air Division highlights its use of RelayHealth’s secure messaging platform. An AHRQ report concludes that the use of HIT in ambulatory care settings has a positive impact on care delivery and provider satisfaction. Physicians can expect an average salary increase of 2.4 percent in 2014. Thanks for reading.

8-22-2013 7-21-49 PM

Inga needed a new laptop and asked me if this one from Office Depot was OK (Toshiba Satellite C55-A5286). I was shocked that an Intel-powered 8GB memory Windows 8 laptop with a memory card reader, USB 3.0, a decent screen, and a DVD drive could be bought for $380 after rebate, to the point that I joined Inga in buying one and so did our newest HIStalk colleague. I’m extremely happy with it after doing the usual setup tasks: opening Internet Explorer long enough to download Firefox and Chrome, de-installing all of the bloatware that the manufacturer gets paid to include, and installing a utility that bypasses the new (and confusing) Metro interface in favor of the old Win 7 start menu.

Listening: the entire catalog of Portland-based indie band The Thermals. Also, new Superchunk.

Ed has updated his CIO Unplugged “Falling from Grace” post with a response to the comments left by readers.

Acquisitions, Funding, Business, and Stock

8-22-2013 6-22-10 AM

Bottomline Technologies reports Q4 earnings: revenue up 5.86 percent, adjusted EPS $0.32 vs. $0.26, beating analyst estimates of $0.29.

8-22-2013 8-50-54 PM

Nuance adopts a poison pill defense, hoping to prevent investor Carl Icahn from taking control of the company and selling it off in pieces.

Orange Health acquires the software assets of ExtendMD, which offers patient-physician communications technology.

8-22-2013 4-07-55 PM

Connecticut Innovations, which provides funding for Connecticut technology startups, extends a $200,000 follow-on funding commitment to tablet computer sterilizer manufacturer ReadyDock.


8-22-2013 9-04-42 PM

The Lott AQ Group, a healthcare IT quality assurance and consulting firm, will use VitalWare’s VitalSigns auditing and financial risk assessment tool for ICD-10 testing.


8-22-2013 4-09-51 PM

Jim Jirjis, MD (Vanderbilt University Medical Center ) is named chief health information officer for HCA.

8-22-2013 10-51-54 AM

St. John’s Riverside Hospital (NY) appoints Daniel Morreale (Kingsbrook Health System) VP/CIO.

8-22-2013 8-20-20 PM

Denis Connaghan (etrials) joins clinical trials network provider Clinverse as CEO.

The San Francisco Department of Public Health names Bill Kim (Dignity Health) to the newly created position of CIO.

Announcements and Implementations

EHNAC releases updated and final 2013 criteria for the electronic exchange of clinical data.

8-22-2013 1-11-44 PM

The Southeast Michigan Beacon Community names Quest Diagnostics its first provider of diagnostic information services for its HIE, BeaconLink2Health.

8-22-2013 4-12-57 PM

Allscripts names healthfinch the grand prize winner of its Open Apps Challenge for its automated prescription renewal request app. We interviewed healthfinch CEO and Co-Founder Jonathan Baran on HIStalk Connect last year.

8-22-2013 8-34-10 PM

AirStrip and Vivify Health will develop a remote care platform for the AT&T mHealth Platform.

Innovation and Research

8-22-2013 8-54-28 PM

Robert Wood Johnson Foundation offers $100,000 in prizes for entrants who combine healthcare with public health data to improve community health.


8-22-2013 4-25-49 PM

The CVS drugstore chain notifies 36 prescribers that it will no longer fill their controlled substances prescriptions after an analysis of its million-prescriber database indicates a high likelihood of improper prescribing.

8-22-2013 8-46-32 PM

In England, the final tab for the failed NPfIT project is tallied at nearly $16 billion, having delivered an estimated $4 billion in benefits.

8-22-2013 5-54-23 PM

Meditech announced to employees this week that it has acquired a six-story, 108,500-square-foot office building from Adobe Systems in Waltham, MA on Route 128. The company will fully occupy the 400-seat, three-year-old LEED Certified Platinum building when existing tenant leases expire in late 2015.

8-22-2013 5-18-53 PM|8-22-2013 5-20-11 PM

Peer60, which offers customer intelligence tools, has put together a pretty funny downloadable e-book called “Executives Are Idiots,” which pokes fun at getting executive feedback.

8-22-2013 6-27-11 PM

A major national health system work group studying copy-and-paste issues in EMRs recommends monitoring the practice within existing documentation audits, according to an internal PowerPoint presentation forwarded by a reader.

8-22-2013 7-36-14 PM

Dubai Health Authority orders 3,000 Android tablets, vowing to provide one for every patient bed toward its plan to use “the latest IT technology to enhance customer service experience.” The hospitals will roll out their EMR in the next 2-3 years.

UMass Memorial Medical Center (MA) pays $66,000 to settle fraud charges in which it was accused by a whistleblower of intentionally mailing bills to a homeless shelter so it could then bill the state for the unpaid amounts.

8-22-2013 6-33-29 PM

Weird News Andy says of the story headlined German Doctors Remove Tumours From Liver Using an iPad that he would have used a scalpel instead since it’s sharper.

WNA also likes this story, which he titles “Herniating Money.” A man is told by a hospital that his hernia surgery will cost $20,000 upfront with his insurance company covering the rest. Instead, he heads over to another hospital and has the surgery done the next day for a total price of $3,000 without using his insurance at all. The surgeon who penned the article concludes, “It was clear to both of us that the only way to make health care more affordable is to diminish the role of third-party payers. Let consumers and providers interact through market forces to drive down prices and drive up quality, like we do when we buy groceries, clothing, cars, computers, etc. Drop the focus on prepaid health plans and return to the days of real health insurance—that covers major, unforeseen events, leaving the everyday expenses to the consumer—just like auto and homeowners’ insurance.”

8-22-2013 8-56-15 PM

In England, a patient dies after employees omit the an apostrophe in her last name while looking up her electronic records, causing them to miss her history of depression. She was discharged and killed herself with a sleeping pill overdose shortly after.

Sponsor Updates

8-22-2013 5-50-15 PM

  • Sunquest held its annual Executive Summit last week in Scottsdale, AZ at the beginning of its SUG annual user group conference.
  • Emdat releases a video highlighting the advantages of using its medical documentation system within an EHR.
  • LG Electronics will integrate Imprivata’s OneSign authentication solution into its V-Series zero client systems.
  • Zirmed partners with Catch Data Systems to provide GE Centricity customers integration with ZirMed’s RCM, clinical communications, and analytics solutions.
  • The Washington State Hospital Association endorses Besler’s Transfer DRG and IME revenue recovery services.
  • Vitera Healthcare Solutions announces details of its VIBE 2013 user conference, to be held September 10-13 in Orlando.
  • Forbes features Xerox in an article about 3-D printing in healthcare.
  • Two KishHealth System hospitals advance their EHR initiatives with the implementation of Access’s e-form on demand solution.
  • Care Team Connect hosts an October 8 Webinar highlighting the implications of Medicaid expansion on care management.
  • Greenway Medical adds Krames Staywell’s Integrated Patient Education solution to its online Marketplace as a certified API.
  • T-System CMIO Robert Hitchcock, MD discusses an all-in enterprise model for data needs.
  • Sunrise Women’s Medical Group (CA) shares how its use of ADP AdvancedMD PM/EHR improved workflow and coding and billing.
  • Cornerstone Advisors is named to Inc. 500’s 2103 Fastest Growing Companies in America. Also on the list is Intellect Resources.
  • Direct Recruiters made the Inc. 5000 list announced this week.

EPtalk by Dr. Jayne


I’ve heard a lot of complaining recently about the Medicare Physician Compare website. The AMA and other physician advocacy organizations have complained about the redesigned site and its errors, which include problems identifying physician location, hospital affiliations, board certification, and other practice information. I searched for myself and even broadened the criteria to a 100-mile radius around my hospital but still can’t get myself to display, so yes, I would agree it’s inaccurate.

I seem to be running into more and more physicians who are integrating scribes into their practices. Some cite EHR as the reason, feeling like it has turned them into data entry clerks. Others see the scribe as a key partner in team care, freeing up the physician to perform cognitive work rather than data gathering and results tracking. I found this nice document from the American Academy of Family Physicians that outlines the potential duties of a scribe (which they expand on using the concept of a clinical assistant) during a routine office visit.

Having implemented EHR with several hundred physicians, I know the importance of helping physicians realize that the support staff is a great asset in prepping both the chart and the patient for the office visit. The document points out the staff role in collecting any recent lab/diagnostic test results and updating preventive care information before the physician ever sees the patient. Whether you use scribes or not, seeing patients in the age of Accountable Care, Pay for Performance, and Meaningful Use definitely takes a village.

AAFP also offers its Family Practice Management Toolbox, which was one of my favorite sites when I was in traditional primary care. Check out their section on practice improvement tools for some interesting practice assessment and improvement worksheets.


The American College of Emergency Physicians will be hosting its annual Scientific Assembly this October in Seattle. I had hoped to attend, but I have an unavoidable conflict that week. I don’t see a huge number of ED physicians in the informatics realm, but I am interested in what products ED docs think are hot and which are not. Ever thought of seeking fame and fortune as a roving reporter? If you’re a HIStalk reader and planning to attend, I’d love to hear from you.


Speaking of the emergency department, quite a few of you reached out to offer your condolences after I wrote about the closing of the quick care unit at one of the facilities where I was seeing patients. I’m happy to report that another facility has offered me a part-time position, although I’m not sure how much inspiration it will provide for writing since its physicians document on paper. Going electronic isn’t an impossible dream, however, as our paper system is provided by HIStalk sponsor T-System. I was happy to see the smoking doc logo on their website.

My email inbox is always deluged with invitations to various webinars, symposia, and conference calls. Some are from vendors and others are from professional organizations, but nearly all suffer from lack of lead time. Some arrive less than two days before the event being promoted. Word to the wise, marketing people — if you’re really trying to reach CMIOs or other C-levels, you should allow at least two weeks notice. Happily Mr. H advertises our HIStalk webinars well in advance – I’ll be listening in on the ICD-10 webinar on September 12. Hope to see you there!


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

More news: HIStalk Practice, HIStalk Connect.


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August 22, 2013 News 12 Comments

HIStalk Interviews Bob Watson, President and CEO, Streamline Health

August 19, 2013 Interviews 2 Comments

Robert E. Watson is president and CEO of Streamline Health of Atlanta, GA.

8-19-2013 5-59-49 PM

Tell me about yourself and the company.

Streamline was founded in 1989 and went public in 1996. The fundamentals of the business are really about capturing the unstructured data around the patient care experience, integrating that information with the record, providing a series of workflow solutions around coding, clinical documentation improvement, and analytics to improve financial outcomes. 

I’ve been in healthcare for 30 years, originally as an investment banker, unfortunately. It seems like I have to apologize for that. I’d been the founder and CFO of a company in the ambulatory surgical center business that we took public in the 1980s and sold that business to HCA. I’ve spent the last 13 years in the healthcare technology space.


Speaking about unstructured data in general, what’s new in that area, and how is the co-existence with EMRs going?

What people find when they deploy a record — and we hear this all the time — is that there’s an abundance of information that’s outside of the core record. Most of it’s unstructured. Historically, it had been paper.

Today, if we look at our own business, the percentage of that unstructured data that’s paper is dropping into the mid-80s. You’re seeing things like images that don’t for some reason interface with the RIS or PACS, .WAV transcription files, and other pieces of information that are important for the quality of patient care. Also important, frankly, to the financial outcomes. You have to get that information in order.


Are hospitals, even those that claim to be paperless, still getting a lot of external information from places that aren’t?

Yes. There is tremendous amounts of information that comes in externally. We have a client in metropolitan New York that 95 percent of the inbound physician order referrals for surgical events come in via fax. I don’t foresee that changing in the near term.


There was some enthusiasm for the hybrid EMR, which made the best use of paper records moved to an electronic form such as scanned images. What can people do with information in your system that they can’t do with paper?

It depends on the construct on how you get that information and unstructured data into the EMR. At the very basic, you can view that information inside the EMR. For example, if you’re in an Epic facility and there are prior visits, those prior visits may have been outside of the electronic version of Epic that’s in place. You can click on a tab and look at the PDF of those versions.

Where we’re seeing the market got today is a much broader use of OCR technologies and other ways to make that unstructured data actually actionable inside the record. We see it as taking unstructured data and turning it into knowledge to help not only clinicians, also but the financial side of the provider to make better decisions.


The criticism of scanned text documents is that nobody’s ever going to look through a bunch of PDF files. Is the OCR technology and your ability to build that into the workflow changing the usefulness of that data that previously nobody would have even looked at?

We’d like to think so. It has to. There are pieces of information that exist outside that core record that are important to the quality of the care of that patient. 

I realized clinicians are pressed for time, but there’s information that’s critical. You want to make sure they have it in a form that’s actionable. If you can search it and deliver that information to them at the point of care, you’ve made a big advancement over simply viewing a PDF where you’ve got to read it and look for the pieces of information.


Much of the agenda of both providers and vendors has involved chasing after the Meaningful Use requirements. Are those having an effect on your business?

It has. Less so in Stage 1 than as we start looking in Stage 2. There are parts of the Stage 2 process that the things that we happen to do at Streamline would give them proof points to get their payments along those lines. For example, release of information, a very critical part. Historically, as you and most of your readers probably know, a lot of the release of information processes have been outsourced. Some of the vendors like ourselves have built that release of information process into the technology that we sell.


The acquisition you did in 2011 of Interpoint Partners to create the OpportunityAnyWare product changed the company’s footprint drastically, along with the Meta Health acquisition. How do you think the analytics market looks and who do you compete with most often?

That acquisition of Interpoint was transformational for Streamline. We would not be where we are today had we not been fortunate enough to be able to complete that transaction, and for a variety of reasons.

But fundamentally, if we think about the analytics space today, if you were at HFMA a few weeks ago at the ANI meeting in Orlando, every other booth had big data or analytics, probably every booth actually. It’s a realization in the marketplace that there is an abundance of information that’s generally available — in EMR systems, in the claims systems, in the billing systems, in the coding systems — that has not historically been used to the best advantage of the payers, the providers, or frankly even the patients. I think that gets lost in this, by the way.

We see analytics as the cornerstone of everything we’re going to do at Streamline. But more importantly, the market itself in general has realized that there is great information that sits in these systems. We need to get it out and we need to get it in form that is actionable. It’s one thing to present a KPI dashboard. It’s another thing to give someone actionable information. We think that’s a key part of what we’re trying to do.

Competitively, it’s the usual cast of characters you’d expect us to be competing against – The Advisory Board, MedAssets, MedeAnalytics.


I think I heard you say that the benefit to patients is often lost and the marketing is aimed at hospitals trying to get control of their physicians. Is there enough emphasis on what the individual patient can immediately get out from all that data?

Do I think there’s enough emphasis on the patient side of it? No, absolutely not. I think it’s going to take a long time to get there. 

The financial challenges and operational challenges that providers face today are staggering and they’re only going to get worse. The first step in the lifecycle of analytics is to address the financial and operational components of the enterprises. Along the way, what comes out of that is an understanding that there is an enormous amount of rich clinical data that can have an impact on the patient either at the point of care or post-care. If you’re able to provide a patient with positive information that’s going to help them once they’re discharged — that prevents readmissions, for example — that’s a piece of information that we should get in the patient’s hand. Or just helping the hospitals understand their patients better.

For example, if you have 70-year-old patient taking 12 different medications, lives in a third-floor walk-up in the Bronx, and has mobility issues, do you think that patient is going to actually get those scripts filled? Pulling that kind of patient information out and being able to present that in format that the care management team can say, this patient is likely to be readmitted because they’re not going to fill their medications — what do we do as part of the care management plan to make sure that he or she gets those medications? That’s the patient part I’m talking about.


It sounds like what you’re saying in terms of who is looking at analytics is that there may be some desperation involved. Hospitals are trying to save the ship financially and desperately trying to find tools that can help do that. Do you sense that hospitals need a solution that they can’t necessarily define because they are facing the uncertainty and aren’t really sure how to react to it?

Yes. They can’t define what it is that they want when it comes to analytics. That’s why you see so many vendors saying, “We’re the next generation in analytics vendors. We can help solve all your financial problems.”

The reality is I don’t think anybody has cracked the crystal ball of what’s the right amount of information and how to deliver and how to make it actionable for our clients. None of the vendors have. But I think we all have the right intention in mind, which is to ensure that our clients are getting meaningful, positive return on investment that’s ultimately going to translate into that provider IDN’s ability to provide quality care in the community. We have to keep the hospitals alive.


I was looking at the STRM stock chart today and noticed that the share price has gone from in the $1.50 range in early 2012 around to $7 today. Do you think that the industry, in all its excitement about the bigger and better-known companies, has missed a pretty big success story?

Streamline flew under the radar for a long time. Over the last couple of years — really starting last May – the investor marketplace started to pay attention to what we were trying to assemble here, I think. A lot of investment dollars chased the big EMR vendors. Look at Cerner’s stock charts or anybody else – they’ve all done fairly well in this period, for the most part.

At $1.50 per share, our market cap was about $16 million. It’s hard to find institutional investors, but lot of retail people want to own that kind of stock where we trade by appointment. I think in 2010 we were trading 5,000 or 6,000 shares a day.

We’ve invested a considerable amount of effort in telling our story to the marketplace and it has responded favorably. Frankly, our team here has performed very well. Our sales organization delivered, our operational teams delivered, the technology folks delivered. We’re getting a little better recognition in the marketplace at the moment.


My first reaction to the market cap was the value of being publicly traded is marginal compared to the expense and headaches involved, but it was a lot worse when the market cap was smaller. Will you be able to grow better at this point because you’re publicly traded? 

I don’t think there’s a person on the face of the earth that wakes up one day and says, you know, I want to be CEO of a microcap public company, so I can assure you I did not.

That being said, our current position being public offers us some advantages. The obvious one, you have better access to capital and the capital markets, but beyond that, the cost of being public is still quite burdensome. It was clearly excessively burdensome when we were a $50 million market cap company.


You used the term a couple of minutes ago that investors were responding to what you are trying to assemble. The two acquisitions made the company a lot more attractive in different ways. Do you see that the company’s growth will be based on further diversification or acquisition?

We gave our guidance to the analysts earlier this year. Our growth guidance in terms of revenue and Adjusted EBIDTA were entirely based upon organic growth. We think we’ve assembled a set of assets today where there’s inherent meaningful organic growth in an orderly fashion and have really focused our teams on that.

That said, when I get asked the acquisition question in every earnings call, I try to give the same answer. One of the things we’ve tried to create culturally here is building deep, meaningful relationships with our clients. Those relationships give us ideas and point us in directions of where our clients think there are either weaknesses in other vendors or challenges they don’t see being met by their current set of vendors, where they come to us and said, hey, can you do anything along these lines? Have you thought about being in this business? So when we think about the potential to do additional inorganic growth opportunities, that thought process is really frankly driven by our relationships with our clients.


What’s your plan for the company over the next five years?

When we came here in early 2011, we had a vastly different plan than the plan we have today. Plans are iterative, as you’d expect. The original plan was, let’s try to stop the cash losses and grow the business modestly. 

In early to mid-2011, we went back to the board of directors and said, we think there’s an opportunity for a mercurial growth here. We want to set out a plan where we put forth a five-year strategic plan, which we redesigned again this year to take another look at the next rolling five years now that we’ve been here but little over two years. We think we have meaningful runway in front of us, an opportunity to build something that’s exciting. We’ve been able to culturally create an environment where our clients understand our commitments.

One of the things we use internally culturally is something called the three Rs, which is respect, responsibility, and results. The cornerstone of those three R’s is building those relationships with those clients. We think those client relationships put us in a position to grow a meaningful business over the next four to five years.

Our current five-year plan starts every morning when I get up. It’s the first day of that five-year plan.


Do you have any concluding thoughts?

First, thank you very much for thinking of Streamline. We’ve flown under the radar for 20-plus years, so I appreciate the opportunity to tell a little bit of our story.

Secondly — and I think this is an important generic comment about this space — as we all know, we’re entering another series of challenges for the whole healthcare ecosystem. The one question that we all need to ask ourselves is, what can we do to ensure that we have a healthy healthcare system for the generations that follow us?

I think that’s really an important question. Every day we challenge our associates to think about what can we do to make sure that the health system survives all the challenges that are in front. 

Thanks again for thinking of us and our team here at Streamline.

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August 19, 2013 Interviews 2 Comments

News 8/16/13

August 15, 2013 News 3 Comments

Top News

8-15-2013 9-19-55 PM

CareCloud secures an additional $9 million from Adams Street Partners as part of its Series B financing round, bringing the company’s total funding to $55 million.

Reader Comments

From Frank Poggio: “Re: certification scoreboard. Here we are just six weeks away from the termination of Stage 1 vendor Certifications on 9/30/13 and there are only six Inpatient EHR vendors with 2014 Edition Certified systems (aka Stage 2). They are: Epic, McKesson (Paragon only), Allscripts, Meditech, HMS, and CPSI. No-shows for full EHRs are Cerner, GE, Siemens, Healthland, QuadraMed, and NTT-Data (Keane). If you are running a Stage 1 Certified system on 10/1/13, it will be considered a non-certified product even though you’ve not changed a line of code. As I have said on this blog before, the process and details under 2014 are far more difficult than ONC would admit, and even today the test scripts are still changing. In fact, while working through some test data with several of my clients this week, we came across three situations where the test data is in error. When we brought this to the attention of the test labs they simply said, ‘We’ll notify ONC, but for now just ignore it.’”   

From Dodging a Bullet: “With all the praise and glory for the soon-to-be former ONC head, you have to wonder about the timing of his departure. Does this really mean that MU2 will be pushed back and he doesn’t want to be at the helm when that takes place?” I can’t imagine the timing of Stage 2 would be enough to make Farzad leave. He’s been through Congressional grillings, has taken every kind of criticism there could be, and works for an agency that rarely sticks to dates it sets.

8-15-2013 6-49-59 PM

From Potha Cary: “Re: Allscripts tip of the week. Tells you how to look up a zip code on the United States Postal Service website. Asinine.” It would be nice if the app could do the lookup itself, but at least if not, they gave users good instructions that they may or may not need. I don’t see a problem with that.

HIStalk Announcements and Requests

8-14-2013 1-14-06 PM

inga_small Hot news from HIStalk Practice this week includes: the AAFP urges CMS to add a 12-month extension to the timeframe for Stage 2 MU compliance. MGMA-ACMPE adds almost 600 new members as HCA Physician Services joins the association. The majority of physicians believe EMRs have at least some positive impact on patient care according to an athenahealth / Epocrates survey, though 17 percent believe they worsen care. Thanks for reading.

inga_small Facebook reports that 128 million Americans and 24 million UK users access Facebook every day. A mere 278 of those are my friends, which happens to be a few more than Mr. H and Dr. Jayne but far less than the 2,271 who like our HIStalk page. We are collectively of the belief that you can never have too many friends, so send us a request and we’ll be happy to join your inner circle. If you prefer to keep it professional, you can connect with Mr. H and me through LinkedIn.

8-15-2013 5-52-17 PM

Welcome to new HIStalk Platinum Sponsor Symantec, which secures the IT systems and health information of medical practices, hospitals, and payers. Symantec Backup Exec simplifies backup and disaster recovery for practices. The company’s healthcare software solutions provide security, data loss prevention, HIPAA compliance automation, business continuity, and storage and infrastructure management (the list of specific products is surprisingly long, and Mobile Management is probably worth a look, as is Endpoint Virtualization for managing applications and standardizing single sign-on). Many of these tools are available as free trial downloads. Thanks to Symantec for supporting HIStalk.

Surescripts Mini-Interview

8-15-2013 4-42-52 PM

Surescripts announced Tuesday that it has added 19 state HIEs and health information providers to its clinical interoperability network, allowing them to exchange referrals, discharges lab results, CCD, prior authorization, and notes via the Surescripts network. I spoke to Jeff Miller, SVP/GM of clinical interoperability for Surescripts, who says the company “decided to move out of just electronic prescribing and support a wider set of clinical information on the Surescripts network.”

Surescripts network members have always been able to communicate with each other through the network directory, but Miller says that “communities of networks have significant populations we need to reach.” Now that Greater Rochester RHIO is on the network as one of the 19 new participants, for example, any of its members can communicate with any member of the Surescripts network and vice versa. Surescripts is paid by hospitals and EHR vendors, who may or may not pass along charges to their own users, but there’s no extra charge to use the gateway. 

Miller says the connectivity marketplace consists of HIE applications that poll EHRs to get information and send messages and EHRs that can exchange information within their own vendor-specific network or through partners such as Surescripts. The EHR-based solutions allow that communication to be integrated into user workflow, so that an Epic user discharging a patient can look up a provider in the directory and send a message out without launching another mailbox-type application. Miller says over 600 EHR vendors are connected to its network.

I asked how this type of messaging could support population health management. He says networks need to support three models: (a) a push or message-based model; (b) a pull or query-based model; and (c) a publish model, such as moving data to a repository to support managing populations. The benefit to patients, he says, “is to get rid of that clipboard you get at the practice. Let the doctors become more proactive. Take cost out and improve quality.”

Acquisitions, Funding, Business, and Stock

8-15-2013 9-22-27 PM

Imprivata announces that Q2 bookings grew 30 percent and headcount was increased to 250 with the addition of 48 new employees.

8-15-2013 9-23-26 PM

A stock analysis firm starting its coverage Quality Systems with lukewarm enthusiasm claims that the company’s customers, and presumably those of other EHR vendors, are being lost to enterprise vendors such as Cerner and Epic as hospitals acquire practices.


8-15-2013 9-24-18 PM

The NY eHealth Collaborative awards Mana Health a contract to build the “Patient Portal for New Yorkers.” 

8-15-2013 1-43-15 PM

Orthopaedic Associates of Augusta (GA) selects SRS EHR for its 14 providers.

8-15-2013 12-25-34 PM

Charleston Area Medical Center (WV) contracts with Besler Consulting to assist with the identification of Transfer DRG underpayments.

8-15-2013 12-23-24 PM

The NFL’s Buffalo Bills will implement medical imaging technology from Carestream at the Bills’ Ralph Wilson Stadium to provide early detection and monitoring of brain injuries.


8-15-2013 12-49-24 PM

James McDevitt (GE Healthcare) joins API Healthcare as VP of human resources.

8-15-2013 12-51-26 PM

The Integrating the Healthcare Enterprise Patient Care Device Domain Technical Committee names Iatric VP Jeff McGeath co-chair.

8-15-2013 7-58-25 PM

Jeff Finkelstein, MD, former chief of emergency medicine and CMIO of The Hospital of Central Connecticut (CT), joins Hartford Hospital (CT) as chief of emergency medicine.

8-15-2013 9-02-28 PM

Standard Register Healthcare names Kevin Lilly (McKesson) as VP of marketing and product management.

8-15-2013 9-10-21 PM

John Halamka,MD is named to the board of Imprivata.

Announcements and Implementations

8-15-2013 12-54-23 PM

Hawaii Health System concurrently implements Perioperative Management by SIS and Siemens Soarian.

8-15-2013 12-55-52 PM

The Central Illinois HIE launches Direct communication between its members and other HIEs using ICA CareAlign Connect technology.

8-15-2013 12-56-53 PM

Prime HealthCare Services will connect its 23 hospitals to the Inland Empire HIE, which is based on the Orion Health HIE platform.

Appalachian Regional Healthcare System (NC) goes live on Allscripts Sunrise Clinical Manager.

Diagnotes launches a mobile clinical communications system for patient information, caregiver communication, and documentation.

Innovation and Research

ShiftyBits, LLC releases ID My Pill, a $4.99 iPhone app that identifies prescription tablets using the phone’s camera.


Weird News Andy concludes about a story he titles “En Fuego” that, “Well, they are part of the fire department.” Two Washington, DC ambulances catch fire in separate incidents on the same day, fortunately with no injuries. WNA also likes this story, in which a surgeon intentionally lied to a patient for reasons unknown in claiming that he had removed her brain tumor, when in fact he had not.

8-15-2013 7-06-21 PM

An OIG audit finds that Medicare paid $449 million too much in 2011 to hospitals that shouldn’t be considered critical access hospitals because they aren’t in rural areas and aren’t far from other hospitals. States were allowed to override the location criteria until 2006; OIG says it’s time to take their exemptions away and CMS seems to agree.

Sponsor Updates

  • Greenway Medical approves Master Mobility iPad and iPad mini applications as certified API solutions for its PrimeSUITE platform.
  • An article by Brad Levin of Visage Imaging covers radiology’s “imaging IT disorders.”
  • Intelligent InSites celebrates its 10th anniversary.
  • Aprima reports having over 600 participants at annual user group conference earlier this month in Dallas.
  • A Santa Rosa Consulting article offers a test to determine whether an organization needs to conduct an IT cost optimization review.
  • GetWellNetwork publishes an e-book on transformative health trailblazers.
  • Ohio State University’s Wexner Medical Center and GE Healthcare collaborate to find ways to make healthcare more enjoyable for patients.
  • HIStalk sponsors earning a spot on “Best Places to Work 2013” are Aspen Advisors, CTG Health Solutions, Cumberland Consulting Group, Divurgent, Encore Health Resources, ESD, Hayes Management Consulting, Health Catalyst, Iatric Systems, Impact Advisors, Imprivata, iSirona, Sagacious Consultants, Santa Rosa Consulting, and The Advisory Board Company.
  • ORA Orthopedics (IA/IL) reports that its implementation of Emdat’s clinical documentation technology has yielded operational and administrative advantages.
  • Direct Consulting Associates and Direct Recruiters expand their offices, staff, and services. 
  • HIMSS Analytics’ James Gaston, senior director of clinical and business intelligence, will participate in a panel discussion on leveraging analytics in clinical operations at next month’s Midwest Hospital Cloud Forum. 
  • Wolters Kluwer Health introduces iPad and iPhone apps of Lippincott’s Nursing Drug Handbook.

EPtalk by Dr. Jayne

Now here’s an app I’d use. A group of New York University researchers has developed a mathematical model to help identify which preventive measures would most improve a patient’s life expectancy. Responding to the challenges physicians face when trying to address the mass of preventive recommendations that exist, they hope to integrate the model into EHRs to prioritize guidelines on an individual basis. It’s not ready for prime time, but I’m seriously intrigued.

An app that is actually on the market, “Health through Breath – Pranayama” includes controlled breathing exercises intended to relieve tension and promote relaxation. I wish I could have beamed it to the attendees of a meeting I was in the other day because everyone was keyed up and irritable. Its topic: the cost of ICD-10 readiness.

Speaking of apps, Medical Economics releases its list of the top 10 apps physicians recommend to their patients. Four of the 10 are diabetes related, which parallels the percentage of patients I seem to be seeing.

The National Uniform Claim Committee publishes its transition timeline for the new CMS 1500 claim form. The timeline meshes with Medicare’s and proposes that payers begin accepting the new form in January 2014 with a dual-use period through April 1, 2014 when the new form is required. I may have mentioned this before but it’s worth mentioning again – I don’t know how a lot of providers keep up with this and I’ve gotten quite a few questions on it in the last few weeks.


The American Academy of Family Physicians proposes a revised Stage 2 compliance timeline for Meaningful Use. The proposal actually includes three different revisions depending on whether 2014 is your first, second, or third/fourth payment year.

It’s not just a photocopier any more. Affinity Health Plan settles with the US Department of Health and Human Services over HIPAA violations. A returned leased copies rwas later sold to the CBS television network and investigators checking the hard drive found protected health information belong to over 300,000 patients. According to the documents, Affinity didn’t include photocopier hard drives in its HIPAA risk analysis as required. Show of hands: who is pulling out their risk analysis right now to double check? The FTC’s guidance on copier hard drives is here for your reading pleasure.


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

More news: HIStalk Practice, HIStalk Connect.


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August 15, 2013 News 3 Comments

News 8/7/13

August 6, 2013 News 2 Comments

Top News

Farzad Mostashari, MD, MSc announces via Twitter that he has resigned his position as National Coordinator for Health Information Technology, a post he has held for two years and will vacate in the fall. The internal announcements are here.  Who would you choose to replace him, either the individual or the ideal background? Leave a comment with your thoughts – you never know who might be listening.

Reader Comments

8-6-2013 8-18-41 PM

From BowTie No More: “Re: ONC. Big announcement coming out tomorrow …” I received this anonymous rumor report Monday. I asked the official ONC press contact as well as an insider if Farzad was resigning and received no response from either, which I told Inga seemed suspicious. The tiebreaker was that Inga’s contact didn’t know anything about it, so I decided to wait and see. I should have direct messaged Farzad, although he probably would not have confirmed.

From Piker: “Re: Farzad. Where’s he going?” He claims he doesn’t know. I would do what he’s doing: announce my availability well before my last day at ONC and see what offers roll in during the interim. He’s not making a mint working for Uncle Sam and therefore probably can’t undertake a lengthy job hunt after his federal checks stop, but he certainly can cash in big time afterward if that’s his ambition. A reader sent a rumor that he described as “weak” that perhaps Farzad is going to Siemens, playing off an earlier rumor that the company was about to hire an unnamed notable. Other than Farzad’s relationship with Siemens Medical Solutions CEO John Glaser, I don’t know why he would go there, so I would put those odds as low.

From Lazlo Hollyfeld: “Re: Farzad. Vendor – no way.  He’ll join a policy / consulting shop (maybe a K Street firm or not), get a few director positions on various boards (10-20k/year for each director position that is almost free), and reevaluate what he wants to do. It’s time for him to go make some easy cash, stop getting grilled on the Hill, and kick back.” That’s more along the lines of what I would expect him to do. His conscience would be clear that he didn’t sell out completely since he would still involved with healthcare IT at a high level, he wouldn’t have to deal with ugly vendor issues like profitability and product lines, and his value would be highest in offering his cache to the highest bidders. 

inga_small From InfoDoc: “Re: HIMSS board. I am considering running for a position. Will it be worth my time? Will HIMSS be gaining or losing power in the next four years?” The general consensus is that HIMSS has become increasing vendor-focused in recent years, as opposed to provider-focused. With that shift, I am sure there are plenty of providers and provider organizations who believe HIMSS is not the unbiased advocate it may have been 10 or 15 years ago. On the other hand, you don’t have to look further than the increasingly crowded exhibition floor at the annual conference to recognize the importance that vendors place on HIMSS. As to whether a board position is worth your time, I’d say it in part depends on whether you are hoping to be a voice of providers or of vendors. Readers?

8-6-2013 6-07-02 PM

From Boy Lee: “Re: recruiter. This recruiter needs 20 analysts per Cerner module. Is a large nation-state converting to Cerner?” That’s a lot of analysts, suggesting a fast rollout by a big organization. I thought first of HCA, which at one time was looking at Cerner and Epic as an alternative to Meditech 6.0. If you know who it is, tell me. I started to call the recruiter, but dreaded getting locked into a lengthy conversation that probably wouldn’t have resulted in my getting the employer’s name anyway.

8-6-2013 6-43-03 PM

From Larry: “Re: Practice Fusion HL7 ORU laboratory specs. The tech writer forgot to take the spec doc out of Word’s Track Changes mode before saving it as a PDF. Perhaps you can drop a hint to accept all changes, turn off the balloon display option, and convert it to a clean PDF with working hyperlinks? Just trying to help on the long slog to interoperability.” Hopefully this will provide the hint.

HIStalk Announcements and Requests


inga_small Forget MU and all of Farzad’s accomplishments at the ONC. The real bummer is that Dr. Jayne and I will have to seek a new HIT crush. This is my favorite picture of Dr. Jayne, by the way, who photo-bombed an intense conversation between Farzad and Jonathan Bush at this year’s HIStalkapalooza.

Lt. Dan not only writes  the daily HIStalk news headlines and articles on HIStalk Connect, he’s also a veteran and healthcare IT guy. I ran his comments about how he would approach the never-ending (and always expensive) VA-DoD EHR issues. He got a response from an Army Medicine physician who’s working on project similar to what Lt. Dan proposed. We may have updates, depending on what can be said publicly at this point since it’s more of a concept than a finished project.

8-6-2013 6-17-58 PM

Welcome to new HIStalk Gold Sponsor Talksoft, which offers HIPAA-compliant patient reminder systems (phone, email, mobile, and SMS) for appointments, recall reminders, broadcast messages such as last-minute practice closings, payment reminders, notification of new lab results, and outreach calls to help meet Meaningful Use requirements. Practices can estimate their ROI with the on-screen calculator. Orthopedic Associates of Rochester felt pretty good about its 9.4 percent no-show rate vs. the national average of 16 percent, but using Talksoft dropped it to 5.6 percent. Setup took a week (some customers are up and running within a day), one hour of office time, and no phone line or computer hardware, plus Talksoft charges only for usage with no subscription commitment required. I enjoyed playing around with the sample messages and looking at the audit report, and thought it was cool that the practice’s brand is protected because caller ID shows the practice’s number, all aspects are customizable, and the practice records its own messages so the patient hears a familiar voice. Thanks to Talksoft for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

8-6-2013 8-21-42 PM

The SSI Group acquires the Dallas-based Claimsnet.com, a provider of claims processing solutions and payer connections.

8-6-2013 8-23-01 PM

Hospital billing provider HealthTech Solutions acquires RCM provider Gaffey.

8-6-2013 8-23-35 PM

Vocera reports Q2 results: revenue up 12.9 percent, adjusted EPS $0.01 vs. $0.09, beating earnings expectations of –$0.03. Shares are up 18 percent in after-hours trading.

8-6-2013 8-24-33 PM

Nuance announces Q3 results: revenue up 9.5 percent, adjusted EPS $0.34 vs. $0.45. CEO Paul Ricci warned that a shift to a subscription-based revenue model will hurt revenue and margins of its mobile offerings in the short term. The company’s healthcare unit was the star, with sales up 29 percent.


Providence Health & Services contracts with Quantros to provide safety performance improvement advising services across 16 of its facilities.

8-6-2013 8-34-33 PM

BCBS of Tennessee will implement Care Team Connect’s population health management platform.

The VA awards CACI International a $14 million contract in to build a data exchange platform that consolidates EHR data and benefits information across the VA, DoD, and other agencies as part of its VLER program.

Rideout Health (CA) chooses the Pavisse incident management solution from RGP Healthcare.

American Medical Software selects Health Language applications from Wolters Kluwer Health to enhance clinical documentation and regulatory compliance in its ambulatory EHR solutions.

The Indian Health Service awards SAIC a $17 million task order to help replace the agency’s electronic dental record system.

8-6-2013 7-54-41 PM

HealthSouth signs a five-year deal worth up to $20 million to implement a nurse communications system from Australia-based Austco Marketing and Services.


8-6-2013 4-01-37 PM

David Furnas, CIO of Gila Regional Medical Center (NM), resigns in the wake of the hospital’s financial crisis that has resulted in the departure of most of the senior leadership team.

8-6-2013 11-57-45 AM

TeraRecon names Jeff Sorenson (Hyland Software) SVP of global sales, marketing, and business development.

8-6-2013 4-03-12 PM

UltraLinq Healthcare Solutions hires Bao Ho (Canon Healthcare Solutions) as VP of sales.

Announcements and Implementations

The Indiana HIE and Predixion Software will jointly develop predictive health analytics solutions to be offered by IHIE to ACOs and hospitals across Indiana.

8-6-2013 8-36-25 PM

Taylor Regional Hospital (GA) integrates its CPSI EHR with PeriGen’s PeriCALM perinatal system.

The Mount Sinai Medical Center launches RateMyHospital, a real-time patient feedback survey tool for patients seen in its cancer treatment center.

Modern Healthcare announces what it calls “Healthcare’s Hottest,” its list of the 40 fastest-growing companies (companies nominate themselves and their own financial information is used to choose the winners). I don’t recognize all the names, but sponsors that were included are Allscripts, Beacon Partners, CTG Health Solutions, Cumberland Consulting Group, ESD, Impact Advisors, Imprivata, Intellect Resources, and The Advisory Board Company.

Government and Politics

ONC’s Consumer Health IT Summit will be held in Washington, DC on September 16, 2013. Admission is free and the morning’s general session will be streamed live. Registration opens next week.


According to a Health Affairs-published study co-authored by the ONC’s Farzad Mostashari, MD, almost six in 10 hospitals actively exchanged electronic health data in 2012., an increase of 41 percent since 2008.

8-6-2013 5-08-00 PM

An organization-wide e-mail sent by Kaiser Foundation Hospitals and Health Plan CEO Bernard J. Tyson says the organization needs to focus on affordability and intends to hold per-member, per-month costs flat, reducing the current 3 percent trend to zero, because of “competitors who are enjoying unprecedented success in managing costs.” He wants to see membership growth, care transformation, and standardization of care and service at all locations. HealthConnect wasn’t mentioned, which never would have happened under George Halvorson.

8-6-2013 8-30-56 PM

The CEO of Fletcher Allen Health Care (VT) says that despite an expected $200 million in losses over the next 10 years due to Medicare cuts, the health system will add 280 jobs. Many of them will apparently result from its implementation of Epic. According to the CEO, “You do create new jobs. If you’re going to interface new technology, you need people who are savvy about health care and that are savvy at getting into relatively complex software and systems.”

An investigative report finds that six of UCLA’s 17 academic deans claim that their medical conditions require them to fly first class despite a University of California ban prohibiting it. One of them is triathlon competitor and self-professed “cardio junkie.”

Weird News Andy is moved by this story. A man who has been hospitalized and ventilated for 45 years after a bout of polio-caused infantile paralysis teaches himself computer animation and is creating a TV series about his life.  

Trustwave warns that a luxury toilet’s Android app could allow hackers to “cause the unit to unexpectedly open/close the lid, activate bidet or air-dry functions, causing discomfort or distress to user.”

Report from the AHDI Conference
By Jay Vance, CMT, CHP

8-6-2013 6-57-50 PM

The Association for Healthcare Documentation Integrity (AHDI) has wrapped up its Annual Conference & Expo held this year at the Buena Vista Palace Resort in Orlando. This is the annual meeting of the professional association for Healthcare Documentation Specialists (formerly referred to as medical transcriptionists).

Unabashed rebranding is underway to portray HDS as true HIM professionals who are important contributors to accurate clinical documentation, quality patient care, and by extension, to improved reimbursement. As part of this rebranding, future annual meetings, beginning next year in Las Vegas, will be known as Healthcare Documentation Integrity Conferences. Additionally, AHDI is working closely with AHIMA, the American Health Information Management Association, to bring greater understanding of the important role of HDS to a wider audience.

Admittedly late out of the starting gate, our association is nevertheless pushing back hard against the perception of HDS as glorified typists who cost money and are easily replaced by technology such as speech recognition technology and, of course, electronic medical records systems. The reality is that SRT still requires thorough review by human editors, while many EMRs are so user-unfriendly that an entire medical scribing industry is springing up to relieve caregivers from the burden of having to use those expensive EMRs which were supposed to reduce costs by eliminating the need for transcription.

Furthermore, it seems more than coincidental to many HDS that costly clinical documentation improvement programs have grown in inverse proportion to our devaluation and outright elimination. Declining physician productivity and satisfaction? Those have also gotten worse as dictation has been eliminated and transcription budgets have been slashed.

Of course we understand that correlation doesn’t necessarily equate to causation, and certainly there are other forces in play. But just because we’re paranoid doesn’t mean they aren’t out to get us. All facetiousness aside, there are a number of research initiatives underway within our industry to quantify in real terms to what degree, if any, removing skilled HDS from the clinical documentation process has adversely affected the quality of documentation, and concomitantly, negatively impacted patient care and provider revenues.

Sponsor Updates

  • Stern Cardiovascular Foundation (TN) reports that its use of Emdat for dictation and transcription services has resulted in significant process improvements, reduced costs, and improved provider productivity.
  • Orion Health introduces a converged cloud service based on HP’s CloudSystem Matrix, which will support cloud services tailored to individual customers.
  • Siemens Healthcare will offer mobile alert, notification, and secure messaging services from EXTENSION to users of Siemens Soarian and legacy Siemens EHR products.
  • CCHIT designates eClinicalWorks V10 compliant with the ONC 2014 Edition criteria and certifies it as a complete EHR.
  • CIC Advisory releases a report on the challenges and opportunities facing the country’s top healthcare organizations.
  • Aprima PRM 2014 EHR/PM v. 14.0 earns Meaningful Use Stage 2 certification as a Complete EHR.
  • The FDA grants 510(k) market clearance for Alere MobileLink, a self-testing at home device that connects to Alere’s Connected Health platform.
  • Allscripts, McKesson, Medicity, and Sandlot Solutions sponsor a webinar discussing how leading healthcare organizations are using data and analytics.
  • Outside Magazine names iSirona to its list of best places to work.
  • The Association of Affiliated Plans names CTG Health Solutions a preferred vendor.
  • Clinical Architecture CEO Charlie Harp reviews data normalization in a blog post.


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

More news: HIStalk Practice, HIStalk Connect.


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August 6, 2013 News 2 Comments

Morning Headlines 8/6/13

August 5, 2013 Headlines No Comments

Can plagiarism detection tools catch EHR upcoding?

A Government Health IT article explores the idea of combating copy-and-paste documentation in healthcare by adopting anti-plagiarism software popular in many academic settings.

CACI wins VLER contract

The Department of Veterans Affairs has awarded CACI International a $14 million contract to build a data exchange platform that will consolidate EHR data and benefits information across the VA, the Defense Department, and other agencies in support of the Virtual Lifetime Electronic Record program.

EMR Impact: How Patients Are Connecting To The Future Of Healthcare

A study of 1,000 insured US health consumers finds that 52 percent are interested in using a patient portal, but are not currently doing so. Patients indicating that they are using a portal reported higher than average patient satisfaction scores and stronger network loyalty.

St. Elizabeth Hospital Recognized as Leader in Electronic Medical Records

Thirty-eight bed Saint Elizabeth Hospital in Enumclaw, WA achieves HIMSS Stage 7 recognition.

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August 5, 2013 Headlines No Comments

Readers Write: Seven Strategies for Optimizing the EHR

July 31, 2013 Readers Write No Comments

Seven Strategies for Optimizing the EHR
By Marcy Stoots MS, RN-BC

7-31-2013 4-11-56 PM

Healthcare organizations are making a mistake if they subscribe to the notion that once an EHR is successfully implemented, it no longer requires attention. Even the most carefully designed EHR will not work as intended in all situations, causing users to create workarounds that are counterproductive and inefficient. It’s important to develop and implement an ongoing strategy for fine-tuning the EHR so that users can input and access the data they need with fewer clicks and better outcomes, which will improve clinician satisfaction.

Besides moving toward usability and adoption, optimization will help with plans to achieve Meaningful Use Stage 2, which raises the bar significantly. Under the Stage 2 final rule, for example, hospitals must report on 16 of 29 clinical quality measures (CQMs) and Eligible Professionals must report on nine of 64 CQMs. Optimizing the EHR to properly capture this data and generate compliance reporting is crucial.

Finally, optimization is a key step to realizing the financial ROI of the EHR, in which a substantial investment has been made. In today’s landscape of cost containment and healthcare reform, an organization can ill afford to sacrifice financial ROI or be bogged down by inefficiencies.

Below are seven strategies for optimizing the EHR to increase efficiency, improve the ROI, drive adoption, and improve usability, with the ultimate goal of providing better outcomes.

1. Create a Governance Structure

Just as an organization needed a governance structure during planning and implementation of the EHR, it will need one for ongoing optimization. This will provide an avenue for making decisions and keeping the optimization plan moving forward. Problems will continue to arise and solid governance will ensure that they are dealt with effectively. A process should be in place to manage variances when clinicians do not want to adhere to a standardized documentation or workflows. When these crop up, the governance group will need to decide upon appropriate action.

2. Create a Solid Informatics Structure

Many healthcare organizations struggle with the size and organization of the informatics team. From an optimization standpoint, it’s important to get this right. There is no standard answer here; every organization is different. Detailed descriptions of job roles and responsibilities should be created and appropriate resources budgeted.

3. Assign Responsibility

An individual at the leadership level should be designated as the responsible party for optimization. This function should be incorporated into that person’s job description. This is typically an informatics director, but could also be a CMIO or IT director, depending on the organizational structure. Assigning this responsibility will help ensure that optimization is an ongoing process, since it requires continual evaluation and modification. Ideally, for larger health systems, there should also be an optimization team in place that could include clinical leadership, operational leadership, informatics analysts, and super users. For smaller health systems, the team would be much smaller, but informaticists should have optimization as a core job function.

4. Measure

The pain points of clinicians should be determined by interviewing stakeholders, examining service desk tickets, listening to input from IT and informatics staff, analyzing reports and metrics, and observing end-to-end workflows. The most important issues should be focused on with data collected at baseline and after 30, 60 and 90 days. Measuring is an ongoing process. It should be used to monitor progress and gauge success.

5. Create Scorecards

Scorecards are a powerful tool for demonstrating what has been achieved. They display the collected data and communicate improvements to the team and stakeholders. Managing workarounds starts with accountability; Scorecards lets users know where they stand and create a healthily competitive environment that encourages success. They can be used to compare units within a hospital or hospitals within a health system.

6. Provide a Quick Win

Clinicians can be easily frustrated by glitches in the EHR, so areas should be pinpointed that will quickly increase their satisfaction. These are issues that are important to them, yet easy to address, the low-hanging fruit that delivers the highest impact. Success breeds enthusiasm, setting the stage for better adoption.

7. Continue Refining

Optimization is never complete. It is an ongoing endeavor without an endpoint.

Workarounds are a reality. The organization should have an optimization plan to monitor and manage them, as well as establishing ownership of that plan. With proper planning and a roadmap in place, addressing problems and overcoming challenges will go smoothly. The end result will be satisfied users and healthier patients (and lower costs).

Marcy Stoots MS, RN-BC is a principal with CIC Advisory of Clearwater, FL.

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July 31, 2013 Readers Write No Comments

HIStalk Interviews Sunny Sanyal, CEO, T-System

July 29, 2013 Interviews 1 Comment

Sunny Sanyal is CEO at T-System of Dallas, TX.

7-29-2013 12-48-08 PM

Tell me about yourself and about T-System.

T-System was formed in the early 1990s by a couple of ED physicians who essentially wanted to get through the day. They would work all day and then stay back for hours after work trying to figure out what they did all day so they could document all that and get paid correctly.

These  two ED docs said, “Can we just take all the stuff that we do in the ED and organize that with some taxonomy in a way that all all this clinical content can be streamlined? So that we can document while we’re with the patient and very quickly get it all done in not more than two to three minutes and be able to support optimal coding and billing, be able to stand up to scrutiny in case of a lawsuit, be clinically accurate, and support all of our performance and quality and regulatory needs? 

That’s how it started. One sheet of paper, front and back. By the way, Dr. Rick Weinhaus did a really good job on this article about why T-Sheets work. I owe him some thanks. We couldn’t have said it better. 

The company all along has had a combination of both clinical and financial orientation. We’ve kept that alive in our products and services throughout.

I joined the company three years ago when the company was going through a transition and was acquired by a private equity firm. It was an opportunity for me to be a CEO. I had an appreciation for T-System, having seen it as a competitor in my past life. I jumped in because I saw a tremendous opportunity to do some great things in this space.


What are the most pressing issues that EDs are facing?

We call this the unscheduled care space. That’s a combination of emergency care, freestanding ED, hospital-based EDs, freestanding EDs, and urgent care centers. The macro demographic systemic issues are hitting all of these in the same way, but perhaps they’re feeling them differently.

I will clarify that. Largely speaking, they are all seeing an increase in volumes, rising volumes in the ED. At the same time, while volumes are growing, they are also seeing an increase in self-pay. Historically, we associated self-pay as people that didn’t have insurance. You’d have a hard time collecting from them. But more and more self-pays are coming from people on high-deductible plans and HSAs that we call insured self-pay. That’s making collections very, very difficult.

Add to that that reimbursement levels aren’t going up. They are just getting tougher. Productivity demands from people staffing the ED are going on. 

This space is under a tremendous amount of pressure. Doctors are struggling, frankly, to keep up with being able to provide the right services, the right quality of the clinical services, while they’re getting paid less to do more and having to deal with more and more regulatory pressures. The whole system is under a lot of pressure.

At the same time, what we’re finding is in order to get away from some of these pressures, some physicians are leaving the ED as a practice and going to urgent care centers, where they don’t have some of those regulatory challenges. That further exacerbates the pressures in the EDs because now all of a sudden you’ve got staffing shortages. It’s difficult to find doctors, particularly in rural areas.

ED as an environment in general is under siege and we don’t see it getting better. We see it getting worse in that regard because all of the regulatory changes that are in the horizon make it tougher for the ED. If health reform adds more patients, those patients are unlikely to have access to primary care. It’s more likely that they will show up in the ED than not. If there are further reimbursed changes and modifications in the reimbursement programs and reimbursement gets cut then it will hit the ED even harder. 

There is a tipping point here that the volume of beds is not increasing while the patient volumes are increasing. All of the changes in the horizon appear to be negative from an overall impact of the ED perspective.


I like that term “unscheduled care.” Is there any hope at all of reducing utilization of ED as a non-urgent care provider?

Absolutely. If there is a significant shift in the reimbursement models, then you will see hospitals taking steps to reduce ED utilization. Those patients fall into few different categories. Patients that are habitual ED users that don’t need to be at the ED can be redirected somewhere else or they can be educated to not seek care. That’s one option. Patients that do need urgent care but they don’t necessarily need to be at the ED can be redirected to urgent care facilities. I think there’s an opportunity to redirect the patients away from the ED.

However, the real problem is that while there may be habitual abusers, the vast majority of them will need access to care. That is why we coined the term unscheduled care. We’re seeing entire segment growing dramatically. Five years ago, you might have seen a few urgent care centers across any town or city, but today you see a lot of urgent care centers, The volume of urgent care visits today is estimated about 150 million a year. That volume is coming at the cost of other settings of care, maybe ambulatory.

That’s why this unscheduled care segment, which in some ways was nonexistent many years ago, has become this in-between segment. You have scheduled care, which is hospital and physician offices, and then this massive unscheduled care segment. Not all of it is bad. What we want is for patients not to over-utilize the ED services or something where there’s a better, cheaper setting of care. 

I do think that there will be redirection and education and other care coordination — patient navigation services that will redirect the patients to lower-cost settings — but it’s going to be more likely to be the freestanding EDs or the urgent care centers.


Everybody expected a huge influx of newly insured patients with the Affordable Care Act. With the ACA having somewhat of an uncertain future, what do you predict the ED business is going to do?

The patients that need care that don’t have access to care, if they are uninsured, they are showing up in the ED today. I think they will continue to show up. I think the difference perhaps is that with the Affordable Care Act, they were going to get some level of insurance, and that was good for hospitals because rather than receiving nothing and having all these uncollectible or very low levels of collections, they at least get some low level of insurance guarantee that they’ll get some money for it. 

I think the situation is not going to get worse than it is today. That’s my take. I think hospitals would miss an opportunity to collect from these patients. I’m not anticipating that ED volumes would change one way or another, go up or go down, if the Affordable Care Act doesn’t pass.


Hospitals complain about their ED volumes and the burden of servicing these volumes, yet they advertise their ED wait times. Are they trying to market selectively or are just confused about whether they do or don’t want the business?

That’s a great point. They don’t see the ED as a problem. They see the ED as a front door to their hospital, and more and more hospitals are using the ED to change their patient mix. 

I had a hospital CEO tell me that, look, 80 years ago when my hospital was built in this downtown location, it seemed like a good idea. Today, it’s not such a great idea. I can’t help that I’ve got this huge bricks and mortar here, but but what I can do is two things: put my urgent care clinics in the residential areas where I have a better payer mix, and I can do my advertisements on billboards in those areas. Over time, I’ll gradually shift my patient mix and attract a larger percentage of the targeted patient mix into the hospital.

That we see them doing. The person that knows how to use the iPhone to go find the right ED and get to the right wait times or the person that has a car is driving on the highway … chances are they belong to probably a better payer mix. We think this is a conscious effort at shifting the mix. I know they have a volume problem, but by getting better payer mix and with care managers and other triage mechanisms ED, I think their hope is that they can manage that volume better as long as they can get favorable payer mix.


T-System has expanded the product line beyond the core business of ED documentation. Explain why you did that and how.

Even though T-System started out as a clinical documentation company, the founders of the company had reimbursement in mind all along. They wanted to get paid for the work that they did. They wanted to spend as little time as possible to get through the documentation. Even though as a company we have been a clinical company all along, revenue cycle was in our DNA. 

We looked at the market landscape. We looked at what was wrong with the space or what the opportunities were. We were telling our customers if you use T-Sheets or T-System electronic EDIS, you will get reimbursed optimally. But we found that it’s easy to say but harder for hospitals to implement and sustain because over time, even though they’re using a system, chances are they’re not keeping up with training. Chances are they are not keeping up with upgrades and performance. There’s also the chance that performance would degrade and they’re not getting the outcomes that we thought they should get or they could get.

We said a better approach might be to tell our customers that if you use T-System solutions, we will get you paid better, rather than giving them the promise of that they might get reimbursed better. We say, “Use our software and services and we will get you paid better.” Talking about the outcome versus the potential for an outcome as they do it was the difference in changing our strategy. We decided to become a technology-enabled services company. Going forward, we’re applying that philosophy pretty much for every solution line we introduce.

For example, we have a care coordination offering. Rather than just offering software, we want to say, here’s our software that allows you to plan your care transition at the point of discharge well. But then, here’s a set of services where we can help you with that or we can do that for you as well. That’s the approach we’re going to take pretty much in every solution that we roll out. It will be a combination of both the technology and services.


Are you feeling any pressure as a best-of-breed vendor among the Epics and the Cerners out there to cast your net a little wider within your own specialty to make sure that you stay competitive even as their offerings become attractive because they’re fully integrated?

A couple of enterprise vendors have viable ED solutions. Several of them are very far behind. You can see in the recent KLAS study there’s a pretty big gap between the enterprise block in general and the best-of-breed block in general. There’s some natural selection that happens upfront when institutions decide whether they’re going to best-of-breed or enterprise. What we are seeing is that when someone makes a decision now to go best-of-breed, that’s a long-term decision. They’ve decided for certain reasons that that’s the path they’re going to take. It is a fairly stable decision.

We’ve seen this in other departments, where over time when all the systems have been shaken out and interoperability-related issues have been resolved,. Which by the way, each year as Meaningful Uses raises the bar on interoperability, what we find is that it’s becoming easier to have the conversation around how data will flow from the ED into the enterprise.

Given that, you look at other environments like radiology. It used to be that you needed an integrated RIS-PACS system in order to be able to run a radiology department effectively. Over time, that settled into the RIS in some ways being replaced by enterprise order entry, enterprise results supporting, and enterprise scheduling. PACS drives the physician workflow in the department. There has been a settling down where the co-existence of best-of-breed and enterprise has already occurred. You’ve seen that in several other places – cardiology, potentially oncology.

We think similar model is evolving in the ED as well. A good example for us would be Memorial Hermann. They’re a Cerner site. The ED uses Cerner for the enterprise workflow. For the physician documentation or physician workflow, they use T-System as the best-of-breed and the two co-exist in that environment. That’s how we see the space evolving between the enterprise and the best-of-breed.


How do you see the impact of Meaningful Use, especially the future stages, impacting your business?

The more there is an emphasis on interoperability, the better. That’s good for the industry, good for everyone, good for us as well. We hope that ONC will continue to drive that dimension harder. Secondly, Meaningful Use in general has accelerated the adoption of systems, which has been good.

Now what we’d like to see is that at some point, more emphasis be based placed on optimization of these systems. For example, in the ED there’s measures around documentation. Physicians don’t have to document in an electronic system. If the intent was to capture discrete data, if the intent was to get physicians to use the system, just stopping at physician order entry is not adequate.

We’d like to see the data capture portion also be included in some of the future Meaningful Use standards. That would be good for the industry to accomplish what it started out to achieve, which is to gather discrete data and have data codified to electronic format. That would be good for vendors such as for ourselves, because that’s what we do really well.


What are your priorities for the company for the next five years?

If I break that down into short-term and long-term, T-System made this transition to becoming a technology-enabled services company. We started that with revenue cycle. We acquired a few companies last year and we’re in the midst of integrating those companies and we’ve made pretty good progress there. 

Short-term priorities are to continue on with the integration work. Our vision was that technology in the front office and service in the back office … if you combine the two together, you can move the back office component to the front office and become more efficient that way.

Our vision is that a locked ED chart ought to be a coded chart. Our investments are going in that direction. We’re making investments in products and technologies to move our products and services towards that vision. 

Secondly,making investments in the businesses that we’ve acquired to add in new platforms. You might have seen the announcement that T-System is putting in NextGen system as our enterprise practice management system across our entire company. We’re introducing new technologies for point-of-service collections. That’s a real big problem in the ED. Patients leave without paying anything and there’s really no good approaches. We’re going to deploy some POS technologies to improve collections. We’re continuing to make technology investments in automating as much of the coding and billing process, as well as then integrating the coding platforms into the core EDIS.

I’d say in the next two-year, three-year timeframe longer term, we will continue to evolve the company into other service areas. For example today, patients are discharged from the ED. It’s a handshake at curbside. We think that’s wrong. It ought to be a warm handoff to that next caregiver and the transition should be coordinated. We have solutions to do to care transition. 

We believe that where the industry is headed, care coordination, care transition, and helping patients navigate through the system is going to be important. As a company, we will make products and services available in that area. There are other areas within the ED where T-System, with the software systems that we used in the ED and the access to data that we have, we think we can make an impact in areas such as utilization management. We will continue to evolve our capabilities in that direction.

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July 29, 2013 Interviews 1 Comment

HIStalk Interviews Bobbie Byrne, MD, VP/CIO, Edward Hospital

July 26, 2013 Interviews 7 Comments

Bobbie Byrne, MD, MBA is VP/CIO of Edward Hospital of Naperville, IL.

Tell me how your Epic project is going.

It’s going really well. I’m really very happy to be on this end of the project 10 weeks after go-live. That period of time is little nerve-wracking. It’s like being very, very pregnant and just wanting to give birth.

But even though it’s going really well, it’s really hard. Expectations of what a good go-live means … it’s important to keep resetting that within the organization, that even though we’re having challenges, even though we’re not quite sure how this workflow is supposed to work, and even though we are making a lot of system changes, that’s expected from a good go-live.

I liken it to the patient who wants to know why they can’t run a marathon 10 weeks after having open heart surgery. Well, you just had open heart surgery. We’re not up to marathon speed yet. I think that’s probably typical.


Has anything been a disappointment so far?

I don’t think there’s anything I’m disappointed in. There’s a lot of things I wish I had done differently. If I get the chance to do this again, I will definitely do certain things differently. There are some things that I thought would work out well that worked out beyond my expectations, and then other things that I thought were going to be really great that have faltered a little bit, but nothing that’s been disappointing.


How much of the Epic decision and the Epic satisfaction going forward is based on the personality of the company rather than the product?

I knew from the beginning and in that period before we went live that I felt 100 percent confident that Epic was going to be there with whatever resources or whoever resources were required in order to get us live safely and effectively. I felt this huge confidence of having the company behind us. I knew they would circle the wagons if we needed it.

In certain areas, we did ask for that. “Hey, you know, we really need some help in this area. We didn’t expect that it was going to be this complicated.” Even after we went live we said, “Please come down and help us with this” and they absolutely did. That was no problem.

But you know, I’m kind of an old development junkie. I really believe that the product is super important. Where we have elegant workflows based on sophisticated and intelligent design, things go really well. Where we have workarounds because the product doesn’t quite reflect the nature of the care that we’re giving here, we have a lot more issues.

So it’s the product and it’s the company. I’m going to say it’s half and half.


What is the biggest differentiator that Epic offers that the competitors don’t?

It’s that 100 percent confidence that they’re going to get us to a successful implementation and they will do whatever it takes to get us there. But they also have all the breadth of products that we needed in order to do a complete rip-and-replace of a hospital. They really do have a very robust surgery system and a very robust medical record system as well as clinical systems and revenue cycle.

Nobody in my organization, no department feels like they got the shaft, like they had to take the immature product or they had to take the worst part in order to give up for the rest of the organization. The product suite is mature across the board. Those two things really made me happy that we chose Epic.


One of the discussions that always seems to come up is that CIOs get fired over Epic for whatever reason. Do you think that …

[laughs] It seems seems to be happening even more lately.


Do you think it’s a problem with Epic? What would it take from your viewpoint as a CIO to get you fired in the middle of an Epic implementation or shortly after?

I don’t want to give anybody any ideas [laughs] Two things that I think were really, really key to our implementation — and not being close to those other situations, I have no idea whether these were impacts those other situations, but for us these were really important — is that number one, our revenue cycle implementation was outstanding. We very quickly got our daily charges out the door, got payment back for care that we were giving one and two and three days after go-live. We did not have a big dip in the finances due to Epic. 

If you think about the way that healthcare is going today, where there’s just declining reimbursement all over the place for a whole host of reasons that have absolutely nothing to do with HIT. You take hospitals that maybe had some financial stress and then you add Epic and a negative impact for Epic on the finances and I can see why the CIO would be blamed, because now we have some real pain for the organization. That did not happen for us. We had an excellent revenue cycle implementation for a whole host of reasons that I won’t get into.

The second piece is setting the expectations. When you first purchase Epic, there’s a great excitement and everybody is very, very excited about, “We’re going to get Epic and we’re going to do all these new things.” There was a period of time when people thought that Epic was going to solve every problem that has ever happened from a workflow perspective in the hospital. 

I started months and months and months ago talking about how hard this was going to be and trying to set the expectations very reasonably. I don’t know if I did it 100 percent and I don’t know if it got through to everybody, but people were saying that all I did for the last three months is walk around saying, “You know, this is really, really going to suck.” So that when there was pain, it was like, “Remember when I told you about how hard this was going to be? This is what I was talking about. This is painful.”

Now we have completely new interactions between nurses and pharmacists, so our nurses and pharmacists get along really well. But now we have these things where the pharmacist says, “I think nurses should do that.” Nurses think, “I think the pharmacist should do that.” These are the kinds of hard choices that we knew we were going to need to make and it’s going to make somebody unhappy. 

I think the expectations for the high of buying Epic and the long implementation and then the high around going live and then you head into that we call the valley of despair, where you realize it’s just really, really hard and it takes really lot of work. When we hit that valley of despair, people were expecting it. They said, ”Oh, yes, you told us so. You told us that this was going to come.”


One of my responses to the idea that Epic seemed to be coincident with the CIOs losing their job was that if you were going to fail, there was a strong likelihood that Epic’s executive status report told you you were going to fail. Did you find that to be true?

It’s probably a matter of degree. We did not expect some of our issues around the high turnover procedural areas and that was a little bit of surprise. We had some challenges with that workflow. But for the most part, Epic was warning us, saying, “You know, your staff is a little bit low on this team. That’s worrisome.” 

When it came down,  those probably were the areas that we should have shored up and maybe would have avoided some of it. But you know, part of this is just a complexity. You think this is thousands of people, thousands of different processes. Epic is really good, but I don’t think even they’re going to be able to totally predict which way your implementation is going to go. And you know, at 36 or 72 or one week or three weeks later, who are going to be the portions of your hospitals that are going to be doing really, really well and who are the portions that are going to be having some challenges. They just don’t have that much of a crystal ball.


One of the other arguments made about why CIOs seem to lose their job after Epic is the huge post-live expense burden. Suddenly the CIO has to try to make things work within the budget that’s allowed when that expense was larger than expected. Do you think there will be surprises in what’s going to cost you to keep running Epic?

No. We talked very extensively at the time that we were doing the purchase and discussing with our board which resources we’re going to stay on. We set the expectations from the very beginning that we were absolutely not going to be able to run Epic on our previous Meditech-level staffing.

The pieces that potentially are coming up as a little bit of a surprise to the organization are the costs of implementing additional modules. The only two things we didn’t implement are the lab product and anesthesia intraoperative documentation. Almost everything else turned over.

When we started to look at what it cost to implement the lab product, there was some surprise. We said, “Wait a minute. I thought we already bought this. It’s part of the enterprise license.” We did have the license fee, but then the additional implementation resources and additional maintenance fee … they thought they were getting a free lab product. We have a joke around here that with Epic, nothing is free, but a lot of things are included.

You have to think about the frame of reference. If you’re trying to do the cheapest IT system you can, Epic is clearly not your vendor, but if you’re trying to think about value for a price and how much we get for how much we pay, I think it seems a little more palatable.


What work is keeping your busiest?

Certainly where we are with Epic is still keeping me busy. We also just closed on a merger with another hospital, Elmhurst Memorial, which is about 17 miles from our core Naperville campus. There’s a lot of work that’s going on in just trying to figure out how these two organizations are going to come together.

We have started to to implement Lawson, which is our ERP system at Edward. We have started that implementation at Elmhurst.

For me, it’s related to stabilizing Epic and getting the Epic mother ship in good shape. Then, how do we extend it out to our new sister hospital?


They are also a Meditech site, right?



Is anything going on with the HIPAA changes coming up?

I saw that in some of your talks online. This is something that we have discussed quite a bit internally and felt pretty prepared for. I don’t know whether our compliance and legal team is just maybe a little bit more HIPAA happy than others. It seems like some of your other readers were kind of surprised by this, but these are things that were really were already in play, for us so that’s not something that I am really too worried about.

We continue to have all the worries around how we’re going to grow our data warehouse and how are we going to continue to provide all of the quality data that are required for patients that are medical home. We’ve applied to be in ACO. We have certainly a number of pay-per-performance initiatives going on with different payers. 

Maybe a year ago I would have said that’s really what’s keeping me up at night. Now it is is how do I find and recruit enough report experts and people who can work on our data warehouse to keep feeding this beast of requests for more and more and more information? Which by the way, they all seem to want to be formatted it in a slightly different way and have slightly different requirements and definitions. That has become an operational challenge for that team.


Are you using Epic’s Cogito or do you have some other product that will be your data warehouse?

We have a SQL longstanding homegrown data warehouse that we use for many different purposes and have many feeds that go into them, including all of our historical information. We also feed Epic into there. We would want to keep up with as Epic becomes more sophisticated in their capabilities. We certainly want to make sure that we take advantage of what they’ve developed instead of continuing to develop our own, but right now, I feel like we’re in transition.


Are you planning to buy anything for the possibility of your ACO-type arrangement?

I don’t think the contract is signed, so don’t want to speak about it, but yes, we do have a few add-on analytical products that we need to get implemented in order to feed data in, get comparisons, render it back to our physicians in a way that is helpful, that drives behavior, and allows us to bend this cost curve and try and deliver better care at a  lower price and then hopefully drive back the gain-sharing that all these systems are intended to drive back to the hospital.


It seems like that’s everybody’s first purchase when they contemplate a risk arrangement is to be able to go to their physicians with data in hand and have the peer pressure do the work for them. How are you planning to take that information out?

We have the beginnings of the team. They haven’t fully hired all of the bodies that will do that. We already have a physician liaison program in place. I think a lot of hospitals do, where they are going out to the private offices and so know the individuals in their private offices and have developed those relationships. What we’ll do is expand that model, arming these physician liaisons with the analytics and the dashboards and the … not just the ‘Hey doc, do a better job,” but, “Here’s the key parts of this. Here is how other practices have improved their quality scores.”

I think the first part is to get the data out there to the physicians. Makes a lot of sense. We’ve been working on that for quite a while on inpatient data, saying, “Hey doc, your length of stay in the ICU is much longer than all of your counterparts. What’s going on there? Your medication costs per patient are much higher than all of your counterparts. What’s going on there?”

We’ve been doing that for a while on the inpatient side. Now it’s more of just getting the individuals out of the hospital into the offices to work on the ambulatory data, which is of course where most of the care is delivered and most of the care that we will be at risk for is delivered.


Most of your physicians are mostly community based, right?

We have a relatively large employed physician group, about 135, so a medium-sized employed physician group. We also have a partner medical group, which I believe now almost 400 physicians, that we work very closely with. We share an instance of Epic with them. That means that for our own employed medical group and for DuPage Medical Group, it’s seamless experience for them. That maybe makes up about 55 to 60 percent of our physicians and then the other 40 percent are independent. The DuPage Medical Group is certainly independent, but we have a tight IT relationship with them.


When you look at the problems you’re being asked to solve in general, do you see a need for technology that you don’t either have or doesn’t exist?

I see a need to utilize the technology that we already have invested in to a much greater degree more than I see the need that I don’t have a product that solves this problem. Here actually I have the opposite. Somebody says, I have a particular quality initiative that I want to work on, and oh by the way, I found a niche product and some vendor and salesperson called on me and here, I want to buy this product. 

When you dig in, you say, OK, but wait a minute. Can’t we already do this with the systems that we have today? That’s where it is a constant going back to, say, instead of buying another product, another product, another product, how can we leverage the investment that we’ve made?

I don’t see that there is a lack of products available for what I want to do. I think sometimes that’s not through the organization, because clearly my organization is still looking for these niche products. I think the piece that we really struggle with — and people say they can do it but I kind of I’m a little skeptical — is getting the ambulatory data out of the private physician offices. People go in and say, yes, I can go into 10 different offices running 10 different EMRs and I have a secret sauce that lets me mine each of those 10 different EMRs and feed quality data back so that we can do things like clinical integration or ACO contracting. I just haven’t seen it, so I’d like to see that actually work.


Does having Epic shut the doors for the need for a lot of other systems?

We come back to our core vendor. We’re focused on that core vendor strategy, so for us, it’s Epic, Lawson, DR PACS, and Merge. We really are starting to say, of these systems that we already own, can one of them already do what this niche vendor might do? So it is very often Epic.

Epic also is very good about telling you they don’t have something. They don’t have case management yet, so they’ll say, “Don’t try and take our system and pervert it and put it into some strange configuration in order to make it into a case management system. It isn’t a case management system. When we have it, we will tell you, and then you can implement it.” I don’t feel like we’re trying to do a square peg around hole a lot. I think it’s just a matter of knowing what the full system’s capabilities are.


When you look down the road five years, what do you see is the biggest challenges and opportunities that your department has or your hospital has?

I think the biggest challenges are going to be the new world order of healthcare. How do we take more risk as hospitals, which many of us have never been insurance companies and don’t have that kind of background, so we don’t really understand what that’s going to be? How do we have the higher quality for everyone, not just for certain subsections of the population? How do we do it at a lower cost? 

And then probably most importantly, how do we not go bankrupt between now and that future state? Right now, we still get paid more for doing more. In the future, we will not. But you have to adjust your rate of change with the changes and reimbursement or we won’t even be around in five years in order to continue to serve our community. It’s a very interesting time in healthcare.

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July 26, 2013 Interviews 7 Comments

News 7/26/13

July 25, 2013 News 2 Comments

Top News

7-25-2013 11-14-10 AM

CIOs and CMIOs tell the HIT Standards Committee that Stage 2 MU needs to be delayed a year. They argue that EHR vendors will not deliver 2014 certified software updates in time for hospitals to implement, validate, and train on the changes and meet the July 1, 2014 deadline for starting the 90-day Stage 2 reporting period. The AHA and AMA also submitted recommendations to extend the MU timelines and make them more flexible.

HIStalk Announcements and Requests

inga_small Hot stuff this week from HIStalk Practice includes: comments on why EMR selection should not be based on features. MGMA urges HHS to conduct ICD-10 testing with external trading partners, including physician offices. Social media experts offer tips for physicians. Commentary on EHR vendor consolidation and provider dissatisfaction. EPs share their reasons for dropping out of the MU program. Legislation moves forward to to repeal the Medicare SGR payment formula and develop a payment program based on quality and efficiency. Nothing is more refreshing on a hot summer day than an ice cold beverage and a quick perusal of HIStalk Practice. Thanks for reading.

On the Jobs Board: Developer, Full Stack Android (Google Glass), Sales Director.

HIStalk Webinars

7-25-2013 5-48-30 PM

Encore Health Resources will present Full Speed Ahead: Creating Go-Live Success on Thursday, August 15 at 2:00 Eastern, presented by Judi Binderman, MD, chief medical officer.

In implementing a new EHR, organizations typically focus on getting the software ready … building workflows, creating interfaces, and performing data conversions. Just as critical as having the software reflect the organization’s needs is having the go-live activities mirror the organization’s culture, goals, and end user support needs. This webinar will give an in-depth discussion of those items frequently overlooked and under resourced in bringing an EHR live. Encore Health Resources will share our experiences and lessons learned in supporting 28 go-lives for 22 facilities and over 10,000 physicians.

C-level HIStalk readers have provided presenter feedback and the session will be moderated by HIStalk. Register here.

Acquisitions, Funding, Business, and Stock

Kareo acquires ECCO Health, a Las Vegas-based medical billing provider.

7-25-2013 6-06-21 PM

Compuware’s Q1 results: revenue up 0.6 percent, adjusted EPS $0.10 vs. $0.09. Revenue of its Covisint division was up 17 percent.

7-25-2013 6-07-38 PM

VMware’s Q2 numbers: revenue up 11 percent, EPS $0.57 vs. $0.44.

7-25-2013 6-08-26 PM

Cerner’s Q2 report: revenue up 11 percent, adjusted EPS $0.34 vs. $0.29, meeting earnings estimates but falling short on revenue.

7-25-2013 6-29-33 PM

McKesson’s Q1 results: revenue up 5 percent, EPS $1.83 vs. $1.58,  beating earnings expectations but falling short on revenue. Technology Solutions revenue was up 9 percent, with the company reporting growth in RelayHealth, McKesson Health Solutions, enterprise, medical imaging, and Paragon, which is tracking ahead of projections on getting Horizon customers to switch. Hospital Automation and International Technology have been moved to discontinued operations.

7-25-2013 10-30-07 PM

Vitera Healthcare completes its acquisition of SuccessEHS, which was announced June 17.

7-25-2013 10-30-48 PM

From the Quality Systems earnings call: the Hospital Systems business unit saw a 52 percent drop in revenue as it sustained a $2.6 million loss. The company said it caved in to the threatened proxy fight by dissident shareholder Clinton Group to avoid being “faced with what would be a two-month period of yet another proxy fight like we had last year.” The company says the proxy issue and rumors of a potential sale of the company hasn’t affected the sales pipeline.


7-25-2013 10-31-34 PM

Sunnybrook Health Sciences Centre in Toronto will implement iMDsoft’s MetaVision clinical information system in its ICUs.

Boston Medical Center selects MModal’s transcription services for its healthcare provider network.

The Denver Endoscopy Center selects ProVation Medical from Wolters Kluwer Health.

7-25-2013 10-33-56 PM

Santa Clara Valley Health & Hospital System (CA) will deploy Capsule Tech’s DataCaptor medical device integration software.

Congress Medical Associates (CA) selects SRS EHR for its 21 orthopedic providers and two locations.

The Physician Alliance (MI) expands its use of Wellcentive to include Wellcentive Advance for creating a quality improvement registry.


7-25-2013 6-12-07 PM

Caremerge hires Greg Silvey (PSS World Medical) as VP of business development.

7-25-2013 7-41-24 PM

Direct Consulting Associates names Andrew Tipton (Direct Recruiters, Inc.) project manager.

Announcements and Implementations

7-25-2013 10-34-38 PM

CPSI and Sunquest Information Systems join CommonWell Health Alliance.

7-25-2013 12-32-34 PM

The Regenstrief Institute and the International Health Terminology Standards Development Organisation will link their global healthcare terminologies LOINC and SNOMED.

Siemens Healthcare releases a series of nine videos recorded at the HIMSS conference in which experts address critical health IT issues using only three slides and three minutes. Above is our own CIO Unplugged and Texas Health Resources CIO Ed Marx talking about social media and the hospital CIO.

SCI Solutions announces the the integration of its Order Facilitator product with the Surescripts Clinical Interoperability network.

7-25-2013 7-17-17 PM

Healthcare Growth Partners releases its mid-year 2013 HIT Market and M&A review. It says that healthcare IT buyers will outnumber sellers this year, with competition keen for companies with strong recurring revenue, products that are beyond proof of concept, revenue of at least $5 million, software with strong ROI delivered as a service, and ideally with offerings that fit in risk-based models.

Users of pMD’s mobile charge capture solution increased their Medicare reimbursement by automatically scheduling follow-up visits for discharged patients that are reimbursed under two new CPT codes (99495 and 99496) that pay for transitional or follow-up care if the patient is contacted within two days, the company says. The company says its almost impossible to meet the requirements using a paper-based system because of the tight timelines. If your goal is amusement rather than reimbursement, check out the company’s FAQ page, which in answering a question about the types of reports provided, the answer is “completely, totally amazing ones.”

Innovation and Research

7-25-2013 7-36-00 PM

Qualcomm and Palomar Health (CA) launch Glassomics, the first medically-focused Google Glass incubator.

Above is the just-released TEDMED presentation by Harvard’s Isaac Kohane of the SMART Platform, which advocates the use of extensible, open source apps that sit on top of vendor EHR systems.

7-25-2013 9-19-23 PM

The commercialization arm of Wake Forest Baptist Medical Center (NC) signs a deal with Charlotte-based app vendor Novarus Healthcare to develop disease management apps.

Philips Healthcare announces plans to start an incubator in Israel, where it has a large development center and has made previous acquisitions.


7-25-2013 10-21-28 AM

inga_small St. Luke’s Medical Center in the Philippines introduces an online service that allows patients to book their preferred rooms in advance based on price and room amenities. I kind of like the $1,155 per night Presidential Suite, which includes a receiving room, guest room, PC and printer, eight-seat dining area, and three plasma TVs.

inga_small The mail processing company for  Clark Memorial Hospital (IN) blames a “processing error” for sending 1,093 billing statements to the wrong address.

7-25-2013 3-02-41 PM

inga_small Ezekiel Emanuel, MD, occasional White House advisor and chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, calls the U.S. News & World Report “Best Hospitals” rankings and similar rankings “flawed to the point of being nearly useless.” In an opinion piece published in the Wall Street Journal, Emmanuel says the criteria used for rankings are “unrelated to quality, easily manipulated, and incentivize the wrong choices and behaviors.” Emanuel contends that if hospitals showed more transparency about quality, patients wouldn’t need rankings to select the best healthcare.

A Harvard Business Review article suggests that organizations are asking too much of their CIOs, saying the next generation of CIOs will need to balance four personas: infrastructure management, integrating systems, business intelligence, and innovation, possessing an integrative mind, focus and vision, and a trusting and trustworthy nature.

7-25-2013 6-40-31 PM

A Forbes analysis from last month of John Hammergren’s compensation titled “The World’s Most Outrageous Pension Deal?” says the McKesson CEO’s numbers are “utterly absurd”: a $159 million pension if he were to quit today, $131 million in one-year compensation,  a rumored $469 million if he’s fired by any new owners of the company, and $260 million due to his heirs if he dies or becomes disabled. The article says most companies other than McKesson cut back on very high CEO pension plans after SEC rules changed in 2007 requiring them to disclose those deals publicly. It also says the company gave Hammergren credit for years he didn’t work and pay he didn’t receive to come up with the big number, also waiving its early retirement penalty that applies to its other employees.

7-25-2013 7-54-29 PM

New analysis of CMS EHR attestation data for May by from Jamie Stockton of Wells Fargo Securities finds that Meditech, Cerner, and Epic hospitals lead the way in total numbers with over 400 attesting hospitals each, while Cerner, Epic, and HMS are the frontrunners in client percentages with 65 percent of their hospital customers successfully attesting. Trailing in customer percentages with 50 percent or less are McKesson (50 percent), Siemens (45 percent), and QuadraMed (25 percent.)

China’s public hospitals would collapse without the rampant bribery involving underpaid doctors and administrators, according to a Reuters review. New doctors earn $490 per month, the same as cab drivers, and without bribes would simply walk away from medicine. Patients are often expected to pay doctors extra in cash to ensure successful outcomes and to skip the line of waiting patients.

Sponsor Updates

  • e-MDs recognizes six of its clients selected by ONC as either as an Healthcare IT Champion or Meaningful Use Vanguard.
  • Black Book Rankings ranks Vitera the top ambulatory EHR in its user satisfaction survey. Other HIStalk sponsors earning high marks include Care360 Quest, Greenway, GE Healthcare, Kareo, Allscripts, McKesson, and eClinicalWorks.
  • First Databank releases the FDB High Risk Medication Module to help users identify medications designated as high risk by the FDA and with a Risk Evaluation and Mitigation Strategy (REMS) requirement.
  • Aspen Advisors Principal Dawn Mitchell discusses how to build a technology roadmap for emerging value-based care modules in a CHIME College live Webinar.
  • Jessica Clifton, product marketing manager for Billian’s HealthDATA, offers predictions of which healthcare skills will be in demand over the next decade.

EPtalk by Dr. Jayne


My “meeting of the week” award goes to our internal discussion on upcoming changes to the NCQA Patient-Centered Medical Home program, due to launch next spring. New proposed standards call for better integration between behavioral health and primary care. It seems like most of our time in primary care is spent in some flavor of behavioral health anyway – even when dealing with chronic conditions such as hypertension, diabetes, and hyperlipidemia, many of the best solutions are behaviorally driven rather than pharmaceutically derived.

This fifth version of the PCMH recognition program also aims to reduce duplicative testing, focus resources based on patient need, and emphasize outcomes. It sounds a lot like old-time family doctoring, when we aimed to treat what could be fixed as efficiently as possible and not waste resources when they wouldn’t change things.

Somehow I don’t think it’s going to be that easy, though. NCQA accepted comments (limited to 1,800 characters each) until a few days ago. The funniest comment was by my colleague who didn’t find out about the comment period until today, saying he was sorry he missed the opportunity to demonstrate the heightened abbreviation skills he’s mastered after a decade of using EHRs with character limits.

CMS will host a July 30 Webinar on one my favorite topics: Administrative Simplification. All medical students and residents should have to sit through a session like this so that they can see what they are really getting themselves into. If I had any idea how much I would have to learn about medical billing and other non-clinical arenas just to get by, I might have taken my sibling’s offer to pay for the LSAT exam a little more seriously.

Speaking of things that make physicians go “hmm…” the Washington Post runs a piece on doctors’ pet peeves. Items at the top of the list include patients talking on cell phones, late arrivals, no-shows, failure to share all information, lying, asking physicians to commit fraud, and “by-the-way” questions at the end of visits. I recently started moonlighting at a new emergency facility that is very busy and I’m trying to put a positive spin on the exhaustion. Maybe patients talking on the phone when you’re trying to interview them is a good thing – it’s a quick and easy indicator that you have time to run to the bathroom before you see them.

CMS releases the 2015 PQRS Payment Adjustment Fact Sheet, which my billing colleague dubbed “the penalty page.” Read and enjoy!


The MGMA Annual Conference is coming up in San Diego. Inga texted me the other day to see if I was ready to try to beat last year’s record for most parties attended by two bloggers in a single evening. Unfortunately, I’ll be sitting for the new Clinical Informatics board exam that week so I had to let her down gently. Hopefully I made up for it, though, by sharing the happiest bow tie I’ve seen this summer.



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

More news: HIStalk Practice, HIStalk Connect.


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July 25, 2013 News 2 Comments

Curbside Consult with Dr. Jayne 7/1/13

July 1, 2013 Dr. Jayne 6 Comments

It’s been a busy couple of days for me with a lot going on outside of work. Unfortunately, it was all healthcare related and not in a good way. As I was leaving the office Friday, I received a call from an elderly relative. I wasn’t surprised to hear from her since her daughter had e-mailed me earlier in the week for advice.

It started out last Monday as as a classic tale of the things that can go wrong in a medical office – phone messages not making it to the physician in a timely manner, test results being misplaced, and more. Surprisingly, this was happening in the flagship office of a hospital’s employed medical group that had been on EHR for years. There was no excuse for lost messages, missing results, or delayed callbacks, especially with a frail patient. It was bad enough that she was considering a change of physicians after nearly 20 years at the same practice.

Unfortunately the best advice I could offer based on the information available (and it being Friday after 5 p.m.) was a recommendation to go to the emergency department since the likelihood that she would get a call from the physician was low. I offered to pick her up rather than wait for her daughter to drive over. After all, when you can take a spare physician to the ED with you to make sure you stay safe, you might as well.

The facility wasn’t very busy, but the registration experience left something to be desired. She was in a wheelchair and couldn’t see the “Guest Relations Specialist” over the tall counter. I put that title in quotes because I’m not sure what she was really there to do. She wasn’t performing registration (and in fact refused the insurance cards that were offered) or doing triage. Basically she just found the name in the computer and went back to chatting with her co-worker, which she did for most of the time we were in front of her.

After some time, we met with a triage nurse, who clearly had already reviewed the patient’s records in the EHR was able to ask targeted questions in addition to the required screenings and assessments. We moved quickly to an exam room, where the actual registrar came in and took care of the insurance paperwork. She also corrected a phone number that was at least six or seven years out of date despite several recent visits to the health system.

As sometimes happens in the ED, we saw the physician before the nurse came in. I was pleased to see that the nurse had already reviewed the chart when he arrived. He specifically mentioned that he had looked at her information and would try not to ask the same things as the doctor, which was much appreciated. Although a long-time employee of the health system, he was new to the facility. We sympathized about the EHR and getting used to it. He apologized for being slow on the system and we appreciated his honesty.

I can’t say we appreciated the nurse that was mentoring him, though. She would come into the exam room from time to time and tell him he needed to do things differently in the computer. She never introduced herself or acknowledged the fact that there was a patient or a family member in the room. She barked instructions at him and then left. I could tell he was embarrassed by her behavior. I appreciated his attempts to make up for it.

We finally received the radiology results more than three hours after the tests were performed. After five hours in the ED, she was admitted, which took another 90 minutes. There was little communication about what was going on and why it was taking so long. I know it was frustrating for her as a patient and it was even more frustrating for me as a support person and especially as an ED physician who knows we can do better.

The fantastic nurse wrapped our sweet nonagenarian in heated blankets for the trip to the med/surg unit. He was rolling her out the door when his mentor stopped us to complain about his data entry skills and to make him fix the entries before he left the ED. She had absolutely no compassion for the patient and didn’t even apologize for leaving the gurney half hanging out in the hallway while she complained about the documentation.

We finally made it to the floor, only to experience another bit of silliness. Although the patient was asked at triage whether she was suicidal, whether she felt safe in her home, and the level of her pain, she was never asked her preferred name even though I know there’s a field for that in the system. She goes by her middle name rather than her first, so asking might have been courteous. The nurses immediately called her by her first name and that’s what they had on the white board in her room as her preferred name. Regardless of whether she uses her first or middle, as a healthcare professional, I would never dream of calling a non-pediatric patient (especially one in her 90s!) by anything other than Mrs. or Ms. and her last name.

By now it was nearly 2 a.m. and I helped the nurse get her settled. I’m not sure why we had to go through the instructions for the touchscreen meal ordering system or how to operate the television at that hour, but we did, along with a stack of paperwork that I’m fairly sure she would not have understood without my help. She was finally allowed to rest. Since then her hospitalization has been uneventful, but she has savvy family members that are keeping up with her treatments and medications and making sure to minimize the risk of medical misadventures.

In thinking back about all of it though, it makes me sad. I think we’ve lost the care in healthcare. We’re so busy meeting the letter of the law and checking the boxes that we can’t deliver what we hoped to when we were called to the healing professions. Those making the rules forget that patients are seeing and hearing everything we do and are recognizing that our focus is not on them.

As colleagues in healthcare IT, let’s promise to do our best to turn it around. How do you think we can make a difference? E-mail me.


E-mail Dr. Jayne.

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July 1, 2013 Dr. Jayne 6 Comments

News 6/28/13

June 27, 2013 News 2 Comments

Top News

6-27-2013 7-27-32 PM

ONC releases its report to Congress on healthcare IT and HIE adoption through April 30, 2013, basically a predictably uncritical annual report of its activities. I chose this graphic randomly, then immediately noticed the common mistake of saying “Advanced Directives” instead of “Advance Directives” (you specify them in advance, but they aren’t necessarily advanced.)

Reader Comments

inga_small From Chris ToeBall: “Tenet-Vanguard deal. The merger could be good news for a lot of vendors, starting with Tenet’s Conifer Health Solutions.” Tenet President and CEO Trevor Fetter says in a conference call that Conifer will provide RCM services to Vanguard’s 21 hospitals, which could provide a 28 percent boost to revenues. Less clear is the impact on athenahealth, which provides services for Vanguard’s ambulatory clinics, and McKesson, which serves Tenet’s clinics.

HIStalk Announcements and Requests

inga_small HIStalk Practice highlights from the last week include: Humana takes the top spot in athenahealth’s 2013 PayerView Report, while Medicaid continues to underperform. Financial management issues are the most challenging difficulties currently facing group practice executives. Consumer Reports publishes an excellent overview of the PCMH model. The AMA votes to lobby CMS for a two-year grace period to avoid complying with the ICD-10 transition – which seems like wasted energy to me, given the ONC’s promise to hold firm on the current October 2014 deadline. CMS concludes that the adoption of EHRs in community practices doesn’t necessarily impact costs. Dr. Gregg amuses with a fairy tale in the kingdom of happy healthcare. Maybe HIStalk Practice isn’t exactly summer beach reading, but there is still lots of good stuff to check out. Thanks for reading.

On the Jobs Board: Data Analyst Meaningful Use, Healthcare Software Project Manager, Resolute PB Team Lead.

Acquisitions, Funding, Business, and Stock

Craneware warns that its revenues and earnings will be below market forecasts, saying it will likely not close one of its large sales opportunities despite increased levels of sales activity.

6-27-2013 9-43-02 PM

PokitDok, a startup that offers a platform for healthcare providers to advertise directly to consumers, raises $4 million in funding.


Erlanger Health System expands its relationship with MModal to include MModal Fluency Flex for creating reports and documenting patient records.

6-27-2013 9-52-15 PM

Slidell Memorial Hospital (LA) will implement Medhost’s EDIS and ED PASS for self-service patient check-in.

Piedmont Orthopaedic Associates (SC) selects SRS EHR.

6-27-2013 9-53-00 PM

South Georgia Medical Center will implement RelayHealth’s HIE platform.

ProMedica’s Lenawee Physician Hospital Organization (MI) selects Wellcentive’s population health management and data analytics solutions.

6-27-2013 9-54-52 PM

North Shore-LIJ Health System chooses InterSystems HealthShare for connectivity of all its systems in a $25 million deal. Competitor Allscripts dbMotion, now owned by NS-LIJ’s incumbent EHR vendor, wasn’t mentioned.

6-27-2013 9-34-49 PM

The Miami VA chooses GetWellNetwork for in-room entertainment, Internet access, and patient education under a $2.4 million contract.


6-27-2013 6-29-10 PM

CareTech Solutions appoints Brian Connolly (Oakwood Healthcare) chairman of the board, replacing Peter Karmanos.

6-27-2013 6-31-36 PM

Chris Bauleke (RelayHealth) joins Healthland as CEO. Former CEO Angie Franks (above) continues as president.

6-27-2013 6-33-01 PM 6-27-2013 6-34-34 PM

PatientPoint hires John McAuley (Allscripts) as COO and Eldon Richards (UnitedHealth Group) as VP of engineering and technology services.

6-27-2013 6-35-36 PM

Nordic Consulting promotes Vivek Swaminathan to chief consulting officer.

6-27-2013 6-37-08 PM

Jacobus Consulting names Noel Allender (Beacon Partners) managing director of its Epic practice.

6-27-2013 6-38-25 PM

RemitDATA names Michael Kallish (MPV – above) SVP of business development and Jim Harter (e-Rewards) CTO.

6-27-2013 9-38-06 PM

Imprivata President and CEO Omar Hussain is named as an Ernst & Young Entrepreneur of the Year in New England.

Huron Consulting hires Tracey Mayberry (CSC) and Kevin Smith (MedeAnalytics) as managing directors in its Huron Healthcare practice.

Announcements and Implementations

Cerner achieves HDI Support Center Certification.

Quest Diagnostics makes its Care360 Solution Suite available through AT&T Healthcare Community Online.

6-27-2013 8-21-06 PM

The local TV station profiles Cedar Rapids, IA-based healthcare website developer Geonetric, pointing out that none of its 70 employees have managers, food is available and free, and flex time and sabbaticals are standard. According to the HR director, “We want you to enjoy life and experience life, and do great work for us. And it’s awesome.” It says the company will hire another 130 people and move into a new building. Its website declares it to be the “coolest healthcare Web company. In the history of ever.” According to its site, employees get free ice cream when a new client is signed,  dress is casual, Grillin’ Friday is BYOM (bring your own meat), and there’s a knitting circle.

6-27-2013 8-06-11 PM

AMIA’s review course for the clinical informatics subspecialty certification that starts in October is scheduled for July 15 availability. Live courses started in April.

Caristix introduces Caristix 2.0, the latest version of its HL7 interface lifecycle management platform.

Allscripts announces that Sunrise Acute Care 6.1 and Sunrise Ambulatory Care 6.1 have been certified as Complete EHRs under ONC 2014 Edition criteria.

Penn State Hershey Children’s Hospital uses Amcom Messenger for calling Code Blue.

Cerner announces its support for Blue Button +.

6-27-2013 7-54-43 PM

Sprint announces the availability of the TigerText HIPAA-compliant secure messaging solution and a less-expensive offering powered by TeleMessage branded as Sprint Enterprise Messenger – Secure.

Government and Politics

Industry officials testifying before the Senate Committee on Finance offer opinions on how to improve healthcare quality. Concerns raised include:

  • CMS should consider reducing the 1,000+ quality measures currently used for reporting and payment programs and develop measures that are more outcome- and patient-oriented.
  • Many traditional EHRs, especially those used by small physician practices, are not well designed, which limits a provider’s ability to produce meaningful data for quality reporting.
  • Provider payments need to be better aligned with outcomes and quality reporting.
  • The government should go beyond the EHR incentive program and work towards the development of a framework for care coordination and long-term care outcome measurements.

CMS redesigns its Physician Compare Website to include details on physician or practice specialties, EHR use, board certification, and hospital affiliation.

Practice Fusion launches a medical imaging API that will allow its practice users to connect to imaging centers, allowing physicians to receive results electronically for Meaningful Use and giving imaging centers potential new business. Use is free for the practice, but not for the imaging center.


6-27-2013 9-01-45 PM

Arizona-based surgeon Gil Ortega, MD performs the world’s first orthopedic trauma surgery while wearing Google Glass, which he says will be useful for teaching students who will have a clear view of the sterile field, recording the surgery, and requesting information via the device.

6-27-2013 9-18-59 PM

A study finds that the survival rate for non-hospital heart attack patients doubled when paramedics performing CPR were coached using Real CPR Help software that is standard on  ZOLL Medical’s defibrillators.


A study published in JAMA finds that treating the costliest Medicare patients in doctors’ offices instead of ERs may not save as much money as previously hoped, only about 10 percent.

Porter Research looks at ICD-10 readiness among physician practices and finds that most are concerned with disruptions in cash flows when the new code set goes into effect. Of practices that have not yet started preparing for the transition, more than a third believe they have adequate time to prepare. The rest either don’t know where to begin or lack time, staff, or training resources.

Healthcare attorney David Harlow, who writes HealthBlawg, launches a crowdfunding project called Hacking HIPAA. It will a create a new Common Notice of Privacy Practices that will give patients an explanation of potentially beneficial electronic transfer of their data (e-mail, cloud, video, text messaging) and obtain their consent for its use before the new Omnibus HIPAA Rule “will make cloud hosting of healthcare projects untenable very soon.” He’s hoping to raise $10,000. That’s Fred Trotter in the video.

6-27-2013 8-52-49 PM

Who proofed this announcement? It’s apparently how they role.

6-27-2013 8-57-23 PM

Kaiser Health News test drives the health insurance exchange enrollment software that will be rolled out in Minnesota, Maryland, and DC for the scheduled October 1 launch.

Weird News Andy hopes the patient remembers his native language. A 69-year-old man being treated for stroke at Robert Wood Johnson University Hospital is sent unconscious on a charter flight back to his native Poland when he’s found to be uninsured and living in the US illegally.

Sponsor Updates

6-27-2013 7-35-20 PM

  • Visage Imaging releases a case study about the use of the Visage 7 Enterprise Imaging Platform by teleradiology provider Rays.
  • UltraLinq Healthcare will incorporate cardiology decision support tools from DiACardio into its cloud-based image management and reporting system.
  • Karen Marhefka, MHA, RHIA of Encore Health Resources will present a primer on value-driven healthcare at the Texas AHIMA convention today (Friday, June 27) at 1:30 p.m. Central time.
  • Quantros announces the patent pending status of its Smart Classification technology for classifying incident reports in real-time.
  • The Center for Economic Growth recognizes etransmedia Technology with a technology innovation award.
  • Cornerstone Advisors announces its #1 KLAS mid-term ranking in the Planning and Assessment category and its projected 100 percent growth this year.
  • Nuance Communications names 11 hospitals as 2013 winners of the Million Dollar Club, having saved at least $1 million by using Dragon for medical transcription and clinical documentation.
  • Xerox VP Ed Gala asks JetBlue co-founder Ann Rhoades and hospital IT executives what airlines and hospitals have in common.
  • Greenway Medical will integrate the inpatient EHR of Health Management Systems its PrimeSUITE solution.
  • Nuesoft Technologies celebrates its 20th anniversary.
  • Kareo integrates its PM application with Demandforce, an Intuit company, to help practices build their online reputations and proactively engage with patients for preventive or recurring care.
  • Sandlot Solutions CEO Joe Casper discusses improving care with HIE and data analytics.
  • Verisk Health recaps its recent Webinar featuring Granite Healthcare Network’s (NH) use of data analytics to provide cost-effective care.
  • Versus offers a replay of the AHA-hosted Webinar on improving safety measures with RTLS featuring Western Maryland Health Systems. Versus also offers a case study that details how the organization reduced elopements and improved response times with RTLS technology.
  • AT&T partners with Project HOPE to improve women and children’s healthcare in Asia and Africa.
  • Northern Ireland’s health minister writes about the transformation of the country’s healthcare system using technology from Orion Health.

EPtalk by Dr. Jayne

The National Uniform Claim Committee announces that CMS has finally approved the new 1500 claim form. It allows identification of whether ICD-9 or ICD-10 is being used and expands the number of diagnosis codes which can be reported. The deadline for transition to the new form seems to be fluid. Providers should contact their clearinghouses to determine when they will begin accepting the form and should work with their vendors to ensure practice management systems can generate the new form.

HIMSS calls for proposals for pre-conference symposia. New this year, they’re looking for abstracts for full-day preconference programs. The deadline is July 22 and those selected will be notified in August.


Medical Economics identifies “10 regulatory irritants fueling physician dissatisfaction” according to a Physicians Foundation study. The list includes:

  1. Meaningless work
  2. Box checking
  3. Data is replacing information
  4. Quality
  5. Site of Service
  6. Fraud
  7. Sustainable growth rate (SGR)
  8. PCORI and IPAB
  9. Costs
  10. The government is coming between me and my patients

Bloomberg discusses the top US states where physicians have gone digital. I was surprised to see Washington, DC at the bottom along with Louisiana, New Jersey, and Connecticut. Wisconsin is at the top, followed by Minnesota, North Dakota, and Massachusetts.

Note to marketing folks: always test your mail merge skills before sending out blast e-mails (and especially snail mail). This week I’ve been on the receiving end of two charity letters asking me to send my pledge (which wasn’t a pledge but an outright donation) and now an e-mail addressed to “Dennis.” First impressions are everything, folks.


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

More news: HIStalk Practice, HIStalk Connect.


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June 27, 2013 News 2 Comments

Readers Write: The Case for One Source of Truth

June 26, 2013 Readers Write 4 Comments

The Case for One Source of Truth
By Deborah Kohn

The notion of managing and being accountable for the health status of defined populations requires much more sophisticated clinical data collection methods and skills than most healthcare organizations have today. However, for decades, numerous coded systems have been used to successfully capture clinical data for reporting purposes, such as quality initiatives and outcome measurements, as well as for reimbursement and other myriad purposes.

Such coded systems, which health information professionals categorize as either clinical classification systems[1] or clinical terminology systems[2], can continue to be used to assist in determining prospective, pre-emptive care management on covered populations. However, no single classification system meets all use cases. ICD-9 CM does not contain medications. ICD-10 CM does not address functional status. In addition, no single terminology system meets all use cases. LOINC is used to encode laboratory data. SNOMED CT is used to encode clinical care data. RxNorm is used to encode medications.

Consequently, using the existing or newer coded systems to meet any of the fast-growing clinical data collection and analysis initiatives presents a significant challenge: too many systems from which to choose, hindering any efforts to change the collection of the data into actionable information for interoperability and health information exchange. To resolve this challenge, one “one source of truth" or one central authority platform (CAP) for all clinical data capture systems, existing and new, allows all coded systems to be used to capture and exchange information.


© Deborah Kohn 2013

With one CAP, healthcare organizations need not be concerned about when to use which data collection system for which purpose. Organizations are able to capture required clinical, financial, and administrative data once and use it many times, such as for adjudication and information governance purposes. In addition, organizations are able to compare the data for data integrity purposes. More importantly, organizations are assured that electronic healthcare data input by different users is semantically interoperable, i.e. the data are understood and used while the original meaning of the data is maintained.

For example, for typical diabetic patients, Reference Lab #1 might denote glycohemoglobin within the chemistry panel, Physician Office Lab #2 might denote glycohemoglobin as an independent test: HgbA1c, and Hospital Lab #3 might use the embedded LOINC code: 4548-4. The central authority platform recognizes each of the three laboratory information system inputs representing the same value — glucose level. Subsequently, the healthcare organization’s electronic health record (EHR) or business intelligence system makes use of the common meaning, and for example, generates a trend analysis of the patient’s glucose readings over time.

Developing a CAP requires considerable effort. The platform must be able to store all coded values, metadata, and all the content / terms. It must be able to normalize and catalog all the content / terms. It must be able track all changes in content identifiers, watches for differences in terms, cross-maps the content, route the content while preserving the data and context, and regenerate the data and content as it was stored. Finally, it must be able to manage all the content updates / releases. Today both the public and private domains have been moderately successful in developing the platform.

The Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) collaborated with the National Library of Medicine (NLM) to provide the Value Set Authority Center (VSAC). VSAC is to become the public domain, central authority platform for the official versions of the value sets that support Meaningful Use’s 2014 Clinical Quality Measures (CQMs). However, currently VSAC does not go far enough to cover all use cases.

In the private domain, several health information technology vendors provide most of the required capabilities of the CAP. Interestingly, these vendors collaborated with clinical professionals to create different categories of coded systems to describe their products than those categories created decades ago by health information professionals. For example, the vendors refer to any coded system used for capturing and exchanging data as a “terminology” system, even though some of these systems are categorized by health information professionals as classification systems. In addition, the vendors categorize all “terminologies” as either standard[3] or local terminologies[4]. Some of these vendors go even farther in categorizing all “terminologies” as either retrospective or point-of-care terminologies[5]. Consequently, today not only are there too many coded systems for data capture and exchange from which to choose, but too many categories of coded systems to make sense of it all.

Assuming that both public and private domain CAP options will prevail, healthcare organizations can expect widespread use of the platforms, allowing EHRs and other electronic records, such as financial records, to incorporate multiple coded systems for specified needs. In addition, workforce demands for the clinical informatics skills needed to manage all the coded data will continue to remain strong.

[1] Clinical classification systems, such as ICD-9-CM, ICD-10-CM, and ICD-10-PCS derive from epidemiology and health information management. These systems group similar diseases and procedures based on predetermined categories for body systems, etiology or life phases. As such, they organize related entities for easy retrieval. They are considered “output” rather than “input” systems and were never intended or designed for the primary documentation (or input) of clinical care.

[2] Clinical terminology systems (a.k.a., nomenclature or vocabulary systems), such as SNOMED CT and RxNorm derive from health informatics. These systems are expressed in “natural” language, and, typically, codify the clinical information captured in an electronic health record (EHR) during the course of patient care (because the number of items and level of detail cannot be effectively managed without automation). As such, they are considered “input” systems.

[3] Standard terminologies consist of “administrative” terminologies, such as ICD and CPT, and “reference” terminologies, such as SNOMED, LOINC, RxNorm, and UMLS.

[4] Local terminologies are those that healthcare providers, such as laboratories or physicians, use on a daily basis in their records, on the telephone, etc., to describe specific diagnoses and procedures.

[5] Retrospective terminologies consist of all standard terminologies (administrative and reference) and local terminologies, while point-of-care terminologies are those that are healthcare provider-friendly and used for specific documents.

Deborah Kohn, MPH, RHIA, FACHE, CPHIMS, CIP is a principal with
Dak Systems Consulting.

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June 26, 2013 Readers Write 4 Comments

Curbside Consult with Dr. Jayne 6/24/13

June 24, 2013 Dr. Jayne 7 Comments

There are some days where I just have to shake my head. Today is one of them. I received some news from one of the hospitals where I moonlight. It was the kind of news that defies all logic, and especially in the era of healthcare cost cutting, makes you wonder what in the world people are thinking. In trying to process through it, I’ve decided that there must be some kind of extraterrestrial accounting system (not to mention logic) that only applies to hospital administration.

It reminded me a little of the starship Bistromath in Life, the Universe, and Everything by Douglas Adams. For those of you who aren’t sci-fi aficionados, the Bistromathic Drive is a propulsion system that “works by exploiting the irrational mathematics that apply to number on a waiter’s bill pad and groups of people in restaurants.” Read the full description — it’s good for a laugh. I always think of it when I’m with a group trying to figure out who owes what part of a check.

I’m not against hospital administrators. This is not an “us vs. them” rant. I understand they have to make the same types of difficult choices that all of us do in trying to deliver high-quality, cost-effective care to the right people at the right time. Some of my best friends are administrators. They seem to be between the proverbial rock and the hard place a good percentage of the time, especially those at non-profit and safety net facilities. How they juggle the competing requests for resources and determine how one priority takes precedence over another is often beyond me.

What did they do this week however that was so logically convoluted I had to take my jaw off the floor? The administration of a semi-urban safety net hospital decided to close the “quick care” part of the emergency department. I’ve written about my work here before, joking that we could provide more cost-effective care by stationing a well-trained Boy Scout with a first aid kit at the front door.

People come to this hospital for everything under the sun. I’ve worked on the express care unit for half a decade because the “real” emergency physicians don’t want to go there. Those of us that are board certified in other specialties enjoy the work because it looks a lot like a primary care practice although without a stable patient population.

Quick care has been doing its part to keep the overall ED wait times low. We handle all patients door-to-door in close to 60 minutes or less, which is amazing when you consider the population, their lack of follow-up, and the volume. The hospital is one of the busiest facilities in the region, which is why I was completely floored when I received notice today that the quick care unit was closing. Since this isn’t my full-time hospital, I had no idea it was coming. Worse yet, neither did the staff with whom I just worked last week.

The hospital has decided to take the unit and roll it into the rest of the ED. As another part of the cost-saving measure, they’ve decided to terminate the services of all the part-time physicians. Quick care patients will be handed by nurse practitioners and physician assistants embedded in the “regular” emergency department.

Why doesn’t this make sense? Several things jump out at me.

The physical quick care unit will be repurposed and the patients will be physically seen in the existing ED. This is a net loss of nine beds. The existing ED physicians will be expected to supervise the midlevel providers in addition to their normal shift duties. Nursing staff ratios will be kept the same and the quick care nurses were laid off as well. I almost cried when I realized that. These men and women are the rock stars of the ED, handling nine patients at a time and keeping the flow moving while doing the same level of documentation as the rest of the ED, often having to clean rooms themselves because of the lack of other support staff and sometimes taking care of really sick overflow patients still at a 9:1 ratio. They are hard workers who know just how to juggle patients to keep the visits under 60 minutes. Most of them have been in quick care for more than a decade.

It was this realization that led me to believe they must be using some kind of Bistromathic accounting. In this healthcare climate, who lays off nurses? Especially nurses who can juggle patients and flip rooms as fast as this crew? Who thinks they can just take an additional 50 to 60 patients per shift and funnel them into the ED workflow without drastically sabotaging the ED wait time statistics? And with nine fewer beds? I also wonder who thought the ED physicians would be game to supervise additional midlevels without compensation, which is part of the package.

I think there may have been a bit of sorcery involved as well because none of the line staff seemed to know this was coming. I’m sure the department chair and the nursing directors were in cahoots with the administrators and accountants, but the rest of the team sure wasn’t. Keeping a secret like that is pretty impressive. They managed to keep it quiet a good long time too, only showing their hand the week before the closing. I guess I won’t be bringing my famous chili dip to the July 4 shift party after all.

For those of us that don’t have regular shifts, it was like a death in the family – realizing that you may never again see people you’ve (literally) shared blood, sweat, and tears with. For the handful of staff that are losing their full-time jobs, it’s stunning. Maybe it will go better than I expect, although I can’t wait to see the next quarter’s numbers for wait time, patient satisfaction, and provider productivity.

I’m mourning for my colleagues and missing them already. I suppose it’s a good thing since I’ll have unexpected free time. But if you happen to need a skilled adrenaline junkie to pick up some shifts, give me a call.


E-mail Dr. Jayne.

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June 24, 2013 Dr. Jayne 7 Comments

Readers Write: What’s in YOUR Medical Record?

June 21, 2013 Readers Write 4 Comments

What’s in YOUR Medical Record?
By Ken Schafer

6-21-2013 8-07-36 PM

If my wife were admitted to the hospital with diabetic ketoacidosis (DKA), I’m pretty sure I wouldn’t want her electronic record to erroneously record a leg amputation (BKA). I’m equally confident that if this documentation mistake were made, I wouldn’t care too much how it happened. I would just want it fixed.

And if incorrect documentation on my diabetic wife resulted in an incorrect treatment course, which resulted in her death? You might end up with a $140 million verdict like this one.

Inga’s post on The Atlantic’s “The Drawbacks of Data-Driven Medicine” (from Big Datty,on 6/12/13) illustrates something that we all know to be true. Our medical records often contain mistakes, and electronic errors perpetuate themselves embarrassingly quickly. But her comments – and the source article – miss two very important points.

Doctors are responsible for the content of the records they create. This is true regardless of the method used to document patient encounters. Blaming the speech recognition system for hearing “DKA” instead of “BKA” makes no more sense than blaming a keyboard for a typographical error. If the physician picked the wrong checkbox on an EHR interface, would that be the fault of the EHR? Of course not.

Speech recognition, keyboarding, and dropdown menus are all methods for data capture. For that matter, so is a more traditional transcription process. But all of these methods have one element in common: the final content should be reviewed and validated by the documenting clinician. Physicians who fail to do this put their patients at risk.

Doctors make mistakes. I know a radiologist who dictated “liver” when he meant “heart.” The transcriptionist dutifully returned the report with the word “liver,” and it was signed by the physician. When the mistake was discovered, the audio was retrieved. The doctor listened to himself dictate the wrong organ, and blamed the transcriptionist. The point? Doctors are people, and people make mistakes, whether they own up to them or not.

That same physician was convinced speech recognition would eliminate transcription errors, and he was right – sort of. What speech recognition systems really do is eliminate transcriptionists, not errors. If radiologists are involved, there will still be errors. There’s no speech recognition system that will hear the word “liver” and change it to “heart.”

In fact, in our DKA:BKA example, the doctor may have had a bad day and actually said BKA to the speech recognition system. No matter what, though, the doctor made a mistake – either in what he said, or in what he saw on the screen and failed to correct.

Those with experience greater than mine often post to HIStalk about the shortcomings of EHRs in terms of the data they contain, with usability and completeness being favorite topics. My concern for our records is more specific. Especially when speech recognition is involved, what metrics do we have in place to make sure that narrative data is recorded accurately? If doctors are responsible for the content of their documents, and we know they make mistakes, how do we monitor and improve the quality of the narrative components of our EHRs?

As the government, physicians, patients, and the free market determine what systems we are to use and how they should work, we should never lose sight of this one truth: no matter what’s in the record, it should be right.

Ken Schafer is executive vice president, industry relations for

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June 21, 2013 Readers Write 4 Comments

News 6/21/13

June 20, 2013 News 4 Comments

Top News

6-20-2013 11-41-31 AM

Healtheway announces its nine founding organizations. The public-private partnership will provide operational support for the eHealth Exchange, formerly known as the Nationwide Health Information Network Exchange.

Reader Comments

6-20-2013 7-27-05 PM

From Site Watcher: “Re: HIStalk. Happy 10th anniversary!” Thanks! It has gone by quickly.

From Doug: “Re: Meaningful Use security risk analysis. I would be interested in which of your sponsors offers consulting engagements, especially those appropriate for a 100-bed community hospital.” Thanks for showing preference to HIStalk’s sponsors, any of which that can help Doug can contact me and I’ll forward your information.

From Vascular Surgeon: “Re: health data. A Wired graphic from April finds that Kaiser Permanente’s data set is 31 petabytes, six times the size of the digital collection of the Library of Congress.”

HIStalk Announcements and Requests

inga_small Highlights from HIStalk Practice this week include: the top ambulatory EHR, PM, and clearinghouse products according to the KLAS Mid-Term Report (and don’t miss the readers’ comments about the rankings.) A computer outage in the Canadian province of Alberta causes 202 practices to lose access to patients’ charts for over five hours. Almost half of practicing physicians are dissatisfied with their jobs. CMS publishes updated 2014 clinical quality measures for EPs. Technology could improve treatment outcomes for children with chronic illnesses. I whine and wonder about waiting at my doctor’s office. I love new readers almost as much as I love ambulatory HIT news, so sign up for the e-mail updates when you are perusing the news. Thanks for reading.

Some of the interesting recent posts on HIStalk Connect are (International) White Collar Healthcare, Mobile Health App Platform Choices, Apple Markets Its Role in Global mHealth, and Start Me Up HIT Event. Get e-mail notification of new HIStalk Connect posts by signing up.

I’ll be surveying the HIStalk Advisory Panel of primarily CIOs again this week. Let me know if you have a question you’d like me to ask them.

6-20-2013 7-40-56 PM

Welcome to new HIStalk Platinum Sponsor Logicare. The Eau Claire, WI company offers patient instructions for hospitals, clinics, and EDs that integrate with all major EHRs including the VA’s VistA. Clinicians enjoy the ability to create a patient-specific teaching document in just a few clicks, while patients can actually understand that document since the content is written at a sixth-grade reading level. Patient instructions are offered for 6,300 topics and the system has earned numerous ONC certifications, making it easy to meet the Meaningful Use requirement to provide electronic discharge instructions (flash drive, secure e-mail) at the time of discharge for patients who request them. Thanks to Logicare for supporting HIStalk.

Acquisitions, Funding, Business, and Stock

6-20-2013 8-46-41 PM

Clinical Outcomes Management Systems, a provider of disease management technology for the long-term care industry, secures a minority investment of $21 million from Summit Partners.

6-20-2013 8-48-21 PM

Agilum Healthcare Intelligence raises $1.82 million of a $2.32 million equity offering.


Polyclinic Surgery Group (WA) selects ProVation medical software from Wolters Kluwer Health.

The Georgia Department of Community Health selects Truven Health Analytics to build and implement the Georgia Health Information Network.

6-20-2013 8-50-36 PM

Chinese Hospital (CA) will deploy NextGen Inpatient Clinicals.

6-20-2013 8-53-41 PM

KishHealth System (IL) selects PerfectServe clinician-to-clinician communications platform for two of its hospitals.

WellStar Health System (GA) will deploy Capsule’s DataCaptor software across its five hospitals.


6-20-2013 5-59-28 PM

Eastern Maine Healthcare Systems announces that VP/CIO Catherine J. Bruno will retire in December.

6-20-2013 6-02-28 PM

Ernst & Young names Encore Health Resources CEO Dana Sellers its 2013 Entrepreneur of the Year for Healthcare in the Gulf Coast Area.

Jerry Dennany (Allscripts) joins RazorInsights as CTO.

UltraLinq Healthcare Solutions appoints Ross Hoffman, MD (MedSolutions) CMO.

Announcements and Implementations

Caradigm announces the availability of Provisioning v4.0, which manages clinician access to applications while supporting data privacy regulations.

6-20-2013 1-14-17 PM

EHealth Technologies breaks ground on its new company headquarters in Rochester, NY.

Cerner launches a pilot of the Primary Health Network, a health model that uses retail locations as access points for wellness screenings.


Government and Politics

6-20-2013 11-19-59 AM

The HHS Office of Inspector General audits four Texas RECs and concludes that each has met the scope of services in their cooperative agreements with the ONC. The audits are the first of their kind by the OIG and focused on outreach activities, vendor selection and implementation assistance, and workflow analysis.

The VA announces the availability of eBenefits, an online portal that will allow veterans to file disability compensation claims electronically.

Today’s best use of a “This Is Spinal Tap” reference in a tweet comes from, interestingly enough, the federal government.


6-20-2013 8-55-12 PM

Unionized nurses with Affinity Medical Center (OH) call on hospital officials to delay this weekend’s implementation of Cerner EMR, saying patients will be at risk because the nurses have not received sufficient training and will be short staffed during the first days of the live. The nurses detailed their concerns in a letter to hospital officials, but claim that hospitals officials refused to meet with them and would not accept the letter.

Here’s athenahealth’s Jonathan Bush speaking at TEDMED 2013 on healthcare profits, pointing out that non-profit hospitals often make bigger margins than Exxon. “In the mid-1990s, healthcare was annoyingly affordable – annoying if you’re one of the hospitals.” He names names.

6-20-2013 8-56-53 PM

Cone Health (NC), facing a $30 million annual budget shortfall, will lay off 150 employees. Both Cone and nearby Wake Forest University Baptist Medical Center say their Epic implementation costs hurt their bottom line at least temporarily.

Sponsor Updates

  • HealthEdge, a provider of IT solutions for healthcare payors, partners with NTT DATA to transition Independent Health and Riverside Health to the HealthRules product suite.
  • Divurgent posts a video of its DIVOLYMPICS employee spring games event.
  • Two members of Wellcentive’s implementation team earn NCQA certification as content experts for patient-centered medical homes.
  • Access partners with The Last Well to bring clean water to all of Liberia.
  • A Deloitte Center for Health Solutions report explores how CIOs are navigating  day-to-day management challenges.
  • Visage Imaging publishes “Three topics you may have missed from #SIIM13” as a follow-up to the recent Society for Imaging Informatics in Medicine 2013 meeting.
  • ISirona President Peter Witonsky lists key criteria for evaluating a medical device data system.
  • GetWellNetwork announces the Transformative Health Series, a series of short films that recount the personal journeys of patients, families, caregivers, and healthcare professionals who are shaping the patient engagement movement.
  • API Healthcare opens its annual conference with a keynote address featuring Paul Spiegelman, author of Patients Come Second: Leading Change by Changing the Way you Lead.
  • Verisk Health announces the agenda and speakers for its 2013 national conference September 18-20 in Orlando.
  • The Association for Healthcare Documentation selects Emdat as a nominee for the Innovation Through Technology Award.
  • A local publication features Canton-Potsdam Hospital (NY) and its online bill-pay service operated by Instamed.
  • Strata Rx announces the schedule for its O’Reilly Strata Rx Conference September 25-27 in Boston.
  • Aspen Advisor consultant Claudia Blackburn will discuss how to empower population health during a June 25 Webinar.
  • Wellsoft’s EDIS earns the top rating for EDIS and Imprivata takes the top spot for Single Sign-On in the KLAS 2013 Mid-Year Performance Software & Services report.
  • Former CMS Administrator Donald Berwick, MD discussed the future of healthcare at this month’s 22nd Annual Midas User Symposium.

EPtalk by Dr. Jayne


The American Medical Association’s House of Delegates met in Chicago this week. One of their resolutions addresses sitting in the workplace. Employers are encouraged to make alternatives available including standing desks, treadmill desks, and isometric balls. I’d love to have a treadmill desk, although I spend half my day on conference calls which would render it almost useless. Several schools in my area are experimenting with standing desks in the classroom, citing famous users Thomas Jefferson, Winston Churchill, Charles Dickens, and Ernest Hemingway.

I loved this piece on batch workflow for the medical office that turned up on KevinMD this week. It should be required reading for EHR users. Author Dike Drummond, MD compares physicians that respond to popups and messages in the EHR to a dog with a tennis ball that can’t choose to not chase it once thrown. Watching my colleagues become totally distracted with Instant Messenger, Twitter, Facebook, and e-mail all day long, I can’t help but agree.

Dr. Gregg tweeted earlier in the week about the fundraising effort for Scanadu Scout, being billed as the first real medical tricorder. I e-mailed myself to look at it later and am happy to see that they have raised over a million dollars. I also learned that the Scout is built on the same platform as the Curiosity Rover, which is pretty cool if you’re a science geek like me. Scanadu hopes to use backers to gather data to help refine its algorithms as well as to prepare for FDA approval as a medical device.

Speaking of Twitter, Bill Gates @BillGates noted this week that he is “Excited to join the 200M+ strong @LinkedIn community.” I wonder if his connections will start endorsing him for skill sets that he doesn’t actually have, which is what my connections recently started doing? It’s definitely been amusing.

I’m excited about the new HIStalk webinar series, but unfortunately my day job keeps interfering with my potential attendance. Next week’s webinar addresses “Using Clinical Language Understanding & Infrastructure Planning as Key Strategies to Ensure Clinical Revenue Integrity with ICD-10” and you can register here. I’ll likely register anyway with the hopes that my conflicting meeting will cancel – hope to see you there!


We’ve all heard horror stories about organizations dumping medical records rather than shredding them or unintentionally misplacing paper charts. Now that patients are receiving copies of their visit summaries and other documents at every visit, there’s an increased chance that we’re going to see more than grocery receipts and shopping lists blowing in the wind. Kudos to my friends at DISC Corporation who made sure the full-color copies of a patient’s colonoscopy report made it to the shredder. Not every patient-facing document has a patient or practice address, so that was probably the most ethical course of action.


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

More news: HIStalk Practice, HIStalk Connect.


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June 20, 2013 News 4 Comments

News 6/19/13

June 18, 2013 News 4 Comments

Top News

6-18-2013 7-20-54 PM

Robert M. Wah, MD, a reproductive endocrinologist, chief medical officer for Computer Sciences Corporation, Navy veteran, and ONC’s first deputy national coordinator, is elected president of the AMA. He’ll take office in June 2014.

Reader Comments

6-18-2013 8-22-09 PM

inga_small From Alectrona: “KLAS Mid-Term report. Epic was the only acute care EMR to earn a green stoplight.” In KLAS-speak, a green stoplight indicates a customer satisfaction that’s at least six points above the average for that product segment. EpicCare Inpatient scored 90.4 compared to the 12-month segment average of 73.2. Cerner Millennium PowerChart came in a distant second at 77.5. The average score for community hospital EMRs was 70.6, indicating a good deal of discontent across both segments. Ambulatory EMRs fared better, led by PCC EHR (94.5), EpicCare Ambulatory (88.3), and SRSsoft EHR (86.7).

From Stephanie: “Re: EMR. Can you recommend a system that would be ideal for a small, new epidemiology practice?“ I’ll open the floor to suggestions, particularly for EMRs known to work well for a practice of that type.

From Re-Org: “Re: Springfield Clinic. Dual-headed CIO initiates re-org and dismantles the clinical informatics department, which merges with IT. Top talent jumps ship along with dual-headed CIO. HR will no longer meet with confused, misled, and frustrated employees.” Unverified.

HIStalk Announcements and Requests

6-18-2013 6-32-28 PM
Welcome to new HIStalk Platinum Sponsor SpeechCheck. The Yorkville, IL company can help prevent errors that occur when physicians (especially radiologists) fail to correct mistakes created by speech recognition systems, which is often a problem with their rapid rollout. Those mistakes can cause embarrassment, loss of reputation, patient care problems, and lawsuits. The company analyzes a facility’s reports, trains their physicians, and develops measurable quality standards that include a goal of 98 percent accuracy and zero critical errors. The result is improved care, risk management, and increased reimbursement. Choose from four service packages that offer choices for type and frequency of auditing, creating or reviewing templates, one-on-one physician training and conversion to self-edit , and compliance updates. See where you stand by finding your documentation quality metric. As the company says, we’ve all seen radiology reports where the technology failed to wreck a nice beach recognize speech. President and CEO Lee Tkachuk is a friend of HIStalk going way back; she also leads ChartNet Technologies and Keystrokes Transcription Service. Thanks to Lee and SpeechCheck for supporting my work.  

Maybe I should have taken a picture with my iPhone. I noticed a guy standing at the urinal in the restroom at work doing his business while frantically keying into his iPad mini with both hands. I dawdled at the sink to see if he washed his hands afterwards since I wondered if he could stand the separation from his beloved gadget. He did, not that it mattered at that point.

Acquisitions, Funding, Business, and Stock

6-18-2013 8-25-02 PM

CareCloud secures $20 million in Series B financing led by Tenaya Capital, bringing its total funding to $44 million.

6-18-2013 8-24-24 PM

Mobile health monitoring provider Medivo raises a $15 million Series B round.

PaySpan, a provider of automated healthcare payments and reimbursements, acquires the assets of mPay Gateway, a point-of-service patient payment solution for healthcare providers.


6-18-2013 8-28-29 PM

St. Mary’s Health Care System (GA) selects Merge’s iConnect Access and iConnect Enterprise Archive for enterprise imaging.

OnePartner HIE will add the Allscripts dbMotion platform to enhance reporting and connectivity.

Nature Coast ACO (FL) expands its relationship with eClinicalWorks to include eCW’s Care Coordination Medical Record.

Community Health Network (IN) will deploy OpportunityAnyWare business analytic solutions from Streamline Health Solutions.

WellStar Health System (GA) selects Avantas to provide consulting services and its Smart Square labor management software to improve labor performance in its nursing units.

Lehigh Valley Health Network (PA) will implement Salar’s TeamNotes solution to capture clinical documentation and comply with ICD-10.


6-18-2013 5-56-57 PM

HIMSS Analytics promotes Bryan Fiekers (above) to director of consulting solutions sales and Matt Schuchardt to director of market intelligence solution sales.

6-18-2013 5-59-41 PM

CareCloud hires Tom Cady (athenahealth) as VP of professional services.

6-18-2013 6-02-18 PM

Former CMS Administrator Donald Berwick announces that he will run for governor of Massachusetts.

6-18-2013 6-03-18 PM

John Frenzel (Conifer Health Solutions) joins Convergent Revenue Cycle Management as CFO.

Announcements and Implementations

Cedars-Sinai Medical Center reports it has recovered more than $300 million by reducing net A/R with the help of Hyland Software’s OnBase ECM platform.

6-18-2013 8-31-48 PM

Mary Greeley Medical Center (IA) implements PeriGen’s PeriCALM fetal surveillance solution, interfacing it to Epic Stork.

Glenn Medical Center (CA) goes live on CPSI.

Laurel Regional Hospital and Prince George’s Hospital Center, affiliates of Dimensions Healthcare System (MD), activate Cerner.

6-18-2013 8-33-15 PM

EvergreenHealth (WA) goes live with PatientKeeper Charge Capture.

Bumrungrad International Hospital (Thailand) deploys the Intelligent InSites RTLS solution.

ARC Community Services (WI) implements Forward Health Group’s PopulationManager to monitor addiction treatment programs.

Cerner will embed the MedAssets Claims Management solution within its patient accounting solution.

6-18-2013 8-34-41 PM

University of Ottawa Heart Institute (Canada) goes live on the Med Access EMR.

Adventist Health finishes its implementation of Strata Decision Technology’s StrataJazz for operating budgets and management reporting and will begin rolling out additional StrataJazz modules for capital planning and strategic planning.

Government and Politics

inga_small National Coordinator Farzad Mostashari, MD has supposedly confirmed that the ICD-10 transition date will not be extended beyond October 1, 2014. If CMS weren’t notorious for soft deadlines, would this even be news?

White House Senior Advisor Ryan Panchadsaram, a former executive of Ginger.io and former Rock Health fellow, talks about patients accessing their electronic records at TEDMED 2013.


6-18-2013 1-05-28 PM

The first of 4,000 Cerner employees begin moving into the first of two high-rise towers at the company’s new Cerner Continuous Campus in Kansas City, KS.

6-18-2013 8-36-18 PM

The Meditech system of Memorial Hospital (IL) has been down since June 11 after upgrade-related problems and won’t return to normal operation until June 24, forcing the hospital to go back to paper charts for almost two weeks.

6-18-2013 7-54-38 PM

The UK government fines North Staffordshire Combined Healthcare NHS Trust $86,000 for exposing the medical information of three patients by manually entering the fax number of a psychiatric facility incorrectly and sending it instead to someone’s house.

Sponsor Updates

6-18-2013 1-50-56 PM

  • Optum donates $10,000 to Arnold Palmer Hospital for Children (FL) in connection with its successful “Make Every Step Count” campaign during this week’s HFMA-ANI conference.
  • PeriGen pledges support for the first published draft of nursing care quality measures developed by the Association of Women’s Health, Obstetric  and Neonatal Nurses.
  • e-MDs expands its headquarters to three locations in the Austin, TX area.
  • An eClinicalWorks survey finds that the primary motivator for becoming an ACO or PCMH is to improve patient outcomes, with respondents also stating that an integrated EHR would be the most valuable IT feature.
  • 3M Health Information Systems introduces the 3M CAC System, a computer-assisted coding solution for small hospitals.
  • Bay Area News Group includes First DataBank on its list of Top Workplaces based on employee feedback.
  • David M. Walker, former US comptroller general, provides the keynote address at the SCI Solutions Client Innovation Summit October 15 in Braselton, GA.
  • Advocate Health Care (IL) says its use of the Healthcare Workforce Information Exchange from API Healthcare has given the organization the ability to link patient satisfaction with employee satisfaction.
  • Craneware introduces enhancements to its Chargemaster Toolkit software.
  • Hayes Management Consulting discusses common areas to consider for increased EHR efficiency.
  • GetWellNetwork integrates its Interactive Patient Care solution with Rauland Responder nurse call system to improve nursing workflow and communication.
  • Capsule posts a white paper that discusses medical device connectivity that is vendor-neutral, open architecture, and device-specific.
  • SRSsoft completes the first phase of certification for the 2014 Edition of the SRS EHR.
  • HIStalk sponsors AT&T and Ping Identity are included on Computerworld’s “100 Best Places to Work in IT 2013.”
  • MedAssets introduces its Procure-to-Pay Solutions suite, which is designed to enhance the management and oversight of contract compliance, standardization, and pricing accuracy.
  • Beacon Partners hosts a four-part Webinar on getting the maximum value from HIT systems beginning with a June 21 discussion on optimizing systems to improve workflow around patient access.
  • T-System posts a video highlighting its RevCycle+ solutions for physician.


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

More news: HIStalk Practice, HIStalk Connect.


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June 18, 2013 News 4 Comments

Morning Headlines 6/18/13

June 17, 2013 Headlines 1 Comment

Vitera Healthcare Solutions Announces Acquisition of SuccessEHS

Vitera announces the acquisition of Birmingham, AL-based SuccessEHS. Both vendors operate in the ambulatory EHR space. The acquisition expand Vitera’s user base to 10,500 organizations, 415,000 medical professionals, and 85,000 physicians. Financial details were not disclosed.

Mostashari asserts no more ICD-10 delays

Farzad Mostashari, MD gave the keynote address at the HIMSS Media ICD-10 Forum this week, during which he reiterated that there would be no additional deadline extensions for the ICD-10 switchover on October 1, 2014.

Apollo to scale up IT’s role in services 

Apollo Hospital is the first in India to be named a HIMSS (Asia Pacific) Stage 6 hospital, going live with CPOE and physician documentation on its Med-Mantra EHR.

Smooth move to electronic records in PT

Jefferson Healthcare, a Port Townsend, WA-based 25-bed critical access hospital and nine supporting clinics, goes live with Epic on Saturday morning at 2 a.m. The project was reportedly on time and on budget. Jefferson Healthcare is part of the Swedish Health Network.

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June 17, 2013 Headlines 1 Comment

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